Head and nape stiffness · tou xiang qiang tong

Also rendered: Head and neck rigidity (Literal) · Nuchal stiffness with headache (Clinical)

Reviewed · 2026-10-28

At a glance

Pinyin: tóu xiàng qiáng tòng
Simplified: 头项强痛
Literal: 頭 tóu, the head; 項 xiàng, the back of the neck; 強 qiáng, drawn stiff; 痛 tòng, pain. Four characters and no verb: the book names the place and the two things wrong with it at once. The pain is not in the head alone and the stiffness is not in the neck alone; they are one complaint running down the back of the head into the nape.
Shuowen: **《說文》：「項，頭後也。」「強，弓有力也。」「痛，病也。」****底本二見**（5-01、5-33），皆在太陽篇上。**此四字為太陽提綱之主證**：5-01 以「脉浮，頭項強痛而惡寒」九字定太陽之為病，後文千百條皆從此出。**「強」讀 qiáng，不讀 jiàng**：強直之強，謂筋脉牽急，非倔強之強。**頭項與頭痛別**：頭痛言痛之所在，頭項強痛兼言筋脉之拘急，故太陽中風、傷寒皆有之，而陽明頭痛不必然。

In brief

The signature complaint of taiyang: pain running from the head into the nape, with the muscles there drawn stiff. The book puts it in the nine-character definition of taiyang disease, beside a floating pulse and aversion to cold, and every later pattern in the chapter is a variation on that sentence. It persists after mistreatment, which is how the book uses it a second time: the exterior has not been cleared.

Senses in the classical corpus

The taiyang definition 頭項強痛而惡寒

脉浮、頭項強痛、惡寒三者並見，即太陽之為病；頭項強痛言筋脉拘急，非徒頭痛

A floating pulse, stiffness and pain of head and nape, and aversion to cold: these three together are what taiyang disease is.

太陽之爲病，脉浮，頭項強痛而惡寒 — 傷寒論·辨太陽病脉證并治上第五

Still there after mistreatment 仍頭項強痛

服桂枝湯或下之後而此證仍在，知表未解；故雖有汗出，仍當解外

After cinnamon twig decoction, or after purging, the stiffness and pain are still there: the exterior has not been resolved, and however much sweat there has been, the outside must still be cleared.

服桂枝湯，或下之，仍頭項強痛，翕翕發熱，無汗，心下滿微痛，小便不利者 — 傷寒論·辨太陽病脉證并治上第五

Occurrences in the classics

Passages where the term does real work, with the original, pinyin and English on the same line.

Display

2 passages

傷寒論·辨太陽病脉證并治上第五 Read in context →

太陽之爲病，脉浮，頭項強痛而惡寒。太阳之为病，脉浮，头项强痛而恶寒。

tài yáng zhī wéi bìng mài fú tóu xiàng qiáng tòng ér wù hán

When the taiyang falls ill, the pulse is floating, the head and nape are stiff and painful, and there is aversion to cold.

**「頭項強痛」五篇共2見**（經文，不含成注），本文引第5篇第01段、第5篇第33段。

傷寒論·辨太陽病脉證并治上第五 Read in context →

服桂枝湯，或下之，仍頭項強痛，翕翕發熱，無汗，心下滿微痛，小便不利者，桂枝湯去桂，加茯苓白朮湯主之。服桂枝汤，或下之，仍头项强痛，翕翕发热，无汗，心下满微痛，小便不利者，桂枝汤去桂，加茯苓白术汤主之。

fú guì zhī tāng huò xià zhī réng tóu xiàng qiáng tòng xī xī fā rè wú hàn xīn xià mǎn wēi tòng xiǎo biàn bù lì zhě guì zhī tāng qù guì jiā fú líng bái zhú tāng zhǔ zhī

After Cinnamon Twig Decoction, or after purging, if the head and nape are still stiff and painful, there is a smothering heat, no sweat, fullness and slight pain below the heart, and urine is blocked, Cinnamon Twig Decoction with cinnamon removed and Poria and Atractylodes added governs.

此證與惡寒、脉浮並見則為太陽；若單見而脉不浮，則當别求其經。

Compounds built on this term

頭項強痛

tóu xiàng qiáng tòng

stiffness and pain of head and nape

辨太陽病脉證并治上第五

項背強

xiàng bèi qiáng

stiffness of nape and back

辨太陽病脉證并治上第五

頸項強急

jǐng xiàng qiáng jí

neck and nape rigid

辨痓濕暍脉證第四

How it has been translated

Every rendering below is a decision about which reader is being addressed. There is no neutral option.

This site	head and nape stiffness	keeps the pain and the place together
Literal	head-nape stiff-pain	exact, and awkward as English
Clinical	nuchal rigidity with headache	clear, and narrower than the Chinese

Entry status

Review pending — who reviews this?

2026-10-28

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