bubble_chart Concept

Opisthotonos refers to the symptom of stiffness in the neck and back, with the back bending backward in an arch-like shape. Lingshu. Jingmai: "Jingmai diseases, when cold, cause the tendons to contract and bend backward." Lingshu. Rebing states: "Heat-induced convulsions can be fatal... with symptoms such as back arching, spasm and convulsion, and clenched teeth." These all refer to opisthotonos. Sui Dynasty. Chao Yuan-fang Zhubing Yuanhou Lun first introduced the term "opisthotonos," listing it under "opisthotonos syndrome," stating: "Wind evil injures a person, causing the back to bend backward, making it impossible to bend forward or backward, resembling a bow. This is due to the evil entering the yang meridians."

Opisthotonos can be seen in various acute Rebing, acute and chronic infantile convulsions, tetanus, and other diseases.

bubble_chart Pattern Analysis

1. Cold-dampness Obstructing Collaterals︰Opisthotonos, lockjaw with mutism, limb convulsions, fever and chills, headache, body pain, thin white tongue coating, and floating-tight pulse. This syndrome arises from external contraction of cold-dampness pathogens obstructing the meridians and collaterals. Dampness has a congealing and stagnating nature, while cold governs contraction, thus manifesting symptoms such as opisthotonos, lockjaw with mutism, and tendon-vessel spasm. As stated in Suwen.Zhizhenyao Da Lun: "All spasms and neck rigidity are ascribed to dampness." Lingshu.Jingmai says: "Jingmai diseases, when cold, cause reversed bending and tendon tension." Since cold-dampness pathogens are in the exterior, symptoms such as fever and chills, headache, body pain, white tongue coating, and floating pulse manifest as an exterior pattern. In cases of this syndrome categorized as exterior excess without sweating and floating-tight pulse, it was anciently termed "exogenous convulsive disease." Treatment should focus on releasing the flesh to induce sweating, with modifications of Pueraria Decoction. If it presents as exterior deficiency with deep-thin pulse, it was anciently called "exogenous convulsive disease," and treatment should harmonize nutrition and nourish fluids, using modified Cinnamon Twig Decoction with Trichosanthis Fruit.
2. Exuberant Heat in Yangming︰Opisthotonos, lockjaw grinding of teeth, spasm of hands and feet, flushed face, red eyes, high fever without aversion to cold but with aversion to heat, profuse sweating, thirst with desire to drink, and even delirium, abdominal distension and fullness with constipation, red tongue with yellow and dry coating, wiry and rapid pulse with strong force. This is caused by external pathogens transforming into heat in the interior, pathogenic heat steaming in the Yangming qi aspect, intense heat damaging fluids, and malnutrition of the sinews and vessels. Therefore, alongside opisthotonos, lockjaw grinding of teeth, and spasm of hands and feet, symptoms such as flushed face, red eyes, fever without aversion to cold but with aversion to heat, profuse sweating, thirst with desire to drink, red tongue with yellow coating, and rapid pulse with strong force manifest as signs of exuberant Yangming heat. Treatment should focus on clearing heat and rescuing fluids, and the formula selection is White Tiger Decoction Plus Ginseng with modifications. If accompanied by abdominal distension and fullness with constipation, indicating a fu-excess pattern, the treatment should aim to discharge heat to preserve yin, and the formula selection is Liquid-Increasing Purgative Decoction with modifications. This applies to cases accompanied by signs of exuberant Yangming heat, such as intense fever, extreme thirst, profuse sweating, and rapid pulse with strong force.
3. Heat Disturbing the Nutritive-Blood︰Opisthotonos, lockjaw convulsion, fever aggravated at night, dry mouth without significant thirst, vexation and insomnia, or even unconsciousness and delirium, or the appearance of macula and papule, a crimson-red tongue texture, and a thready rapid pulse, among other symptoms. These are caused by externally contracted warm-heat pathogens that have internally transmitted to the nutrient-blood level, leading to exuberant internal heat and stirring liver wind. Therefore, alongside opisthotonos and lockjaw convulsion, symptoms such as fever aggravated at night, vexation and insomnia, occasional delirious speech, or even unconsciousness and delirium, macula and papule, a crimson-red tongue texture, and a wiry, thready, rapid pulse manifest as signs of the nutrient and blood aspects. Treatment should focus on clearing heat and cooling blood, extinguishing wind, and pacifying the liver. The recommended formula is Rhinoceros Horn and Rehmannia Decoction combined with Uncaria Decoction with modifications. If the condition persists for a prolonged period, depleting yin fluids and leaving residual heat unresolved, symptoms such as low-grade fever, night sweats, flushed cheeks and emaciation, vexing heat in the chest, palms, and soles, dry mouth and tongue, a glossy red tongue with scant coating, and a thready, rapid, and weak pulse may appear, indicating yin deficiency with internal heat. Treatment should focus on nourishing yin and extinguishing wind, using Major Wind-Stabilizing Pearl with modifications. Apart from opisthotonos, the key differences between the two conditions lie in the presence of fever aggravated at night, unconsciousness with delirious speech, and macula and papule on the skin, which are signs of heat harassing the nutrient-blood level.
4. Internal Stirring of Deficient Wind︰Opisthotonos, limb convulsions, dizziness, blurred vision, palpitation, shortness of breath, mental fatigue, lack of strength, spontaneous sweating, night sweats, pale and lusterless complexion, pale tongue texture, and wiry-thin pulse. This syndrome arises from prolonged illness leading to deficiency of vital energy, or due to sweating, purging, or loss of blood causing dual impairment of qi and blood, resulting in malnutrition of the tendons and vessels and subsequent spasm. Therefore, alongside opisthotonos and limb convulsions, symptoms such as dizziness, blurred vision, palpitation, shortness of breath, mental fatigue, lack of strength, spontaneous sweating, night sweats, lusterless complexion, pale tongue texture, and thin pulse indicate severe deficiency of qi and blood. As stated in Jingui Yaolue Xindian · "Treatment of Convulsive, Dampness, and Summerheat Syndromes with Abnormal Pulses": "There are also cases where loss of Dragon's Blood Resin, injury to yin-yang, leads to the development of convulsions." This syndrome lacks exterior patterns and major heat patterns, distinguishing it from opisthotonos caused by cold-dampness obstructing the collaterals, excessive yangming heat, or heat disturbing nutrient-blood. For opisthotonos due to internal stirring of deficient wind, treatment should focus on greatly tonifying qi and blood, with the formula selection being modified Eight Precious Ingredients Decoction.
5. Golden Wound Wind Toxin︰Opisthotonos, aversion to cold with fever, headache, facial muscular rigidity and spasm presenting as a sardonic grin, trismus, stiff tongue with lockjaw, red tongue with yellow coating, and wiry-rapid pulse. This syndrome is caused by unclean wounds due to metal injuries or general trauma, allowing wind-toxins to invade the Jingmai, also known as "tetanus." Although this syndrome shares manifestations such as opisthotonos, trismus, and stiff tongue with lockjaw similar to the aforementioned syndromes, it is uniquely characterized by a history of trauma and facial muscular rigidity with a sardonic grin. Treatment should focus on dispelling wind and stopping spasms, using modified Jade-like Vitality Powder.

Opisthotonos can be seen in various diseases and syndromes, and it is essential to differentiate between exterior and interior deficiency in clinical practice. Opisthotonos caused by cold-dampness obstructing the collaterals is an exterior pattern, while opisthotonos in other pattern belongs to the interior pattern. The interior pattern should be further distinguished between deficiency and excess. Opisthotonos due to intense heat in the Yangming, heat disturbing the nutrient-blood, and wind-toxin from metal injury are all excess pattern; opisthotonos caused by internal stirring of deficient wind is a deficiency pattern. Wind stirring and fluid injury are two critical aspects in the mechanism of disease for opisthotonos. Therefore, in pattern differentiation and treatment, it is crucial to adhere to the therapeutic principles of dispelling wind and enriching yin to produce fluids.

bubble_chart Documentation

1. Suwen-Gukong Lun: "The disease of the Governor Vessel, the spine is stiff and bends backward."
2. Jingyue Quanshu-Convulsive Disease: "All those who belong to the category of yin deficiency and blood deficiency, unable to nourish the sinews and vessels, leading to convulsions and rigidity, are all of this syndrome. For example, in apoplexy with this condition, it must be due to the decline of vitality and the failure of yin; in postpartum women with this condition, it must be due to excessive blood loss and exhaustion of the Chong and Ren vessels; in those with sores with this condition, it must be due to blood following pus out, Yingqi exhaustion; in children with this condition, it may be due to wind-heat damaging yin leading to acute convulsions, or due to sweating and diarrhea leading to yin exhaustion and slow convulsions. All these types are generally syndromes of yin deficiency."
3. Dampness-heat disease chapter: "pattern of dampness and heat, within three to four days lockjaw occurs, the limbs are pulled and cramped, and in severe cases, opisthotonos occurs, this is dampness-heat invading the meridians and collaterals. It is appropriate to use fresh Earthworm, Gentian, Chinese Clematis Root, Talc, Cocklebur Fruit, towel gourd stem, kadsura pepper stem, wine stir-fried to yellow Coptis, and other flavors."