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When the Six Qi (Six Climatic Factors: Wind, Cold, Summer-heat, Dampness, Dryness, Fire) cause disease, they can all lead to fever. However, Cold and Heat are interrelated, and Summer-heat follows Dampness; only Dryness is contrary to Dampness. Wind, Cold, Warmth, and Summer-heat are mostly caused by Heavenly Qi (external climatic factors), whereas Dampness diseases are mostly caused by Earthly Qi (environmental dampness), and Dryness diseases are mostly caused by internal factors (deficiency of body fluids). This constitutes the difference and similarity in etiology. In the Nineteen Pathogenesis Formulas of *Nei Jing* (Inner Canon), among those attributed to the Six Qi, Fire accounts for eight, while Wind, Cold, and Dampness each account for one; there is no specific mention of Dryness symptoms. Regarding "various spasms and neck stiffness belong to Dampness," I have often suspected that this should be attributed to Dryness. Now, *Shanghan Lun* (Treatise on Cold Damage) distinguishes between Spasm (Jing) and Dampness, and states: "In Taiyang disease, excessive sweating leads to Spasm." Thus, it is beyond doubt that Spasm belongs to Dryness. Spasm is named after its manifestation, which arises from blood deficiency causing tendon tension. The affliction of the Six Qi is sufficient to cause spasm; however, without Heat there is no Dryness, and without Dryness, Spasm cannot form. Spasm disease exists in all six meridians; one must examine the location to differentiate them. Those affecting the posterior aspect of the body belong to the Taiyang Meridian; thus, any case involving stiff neck and back, rigidity of the nape and back (*gang jiang*), spinal rigidity with opisthotonos, waist feeling like it is broken, thighs unable to bend, and popliteal fossa feeling bound or knotted, are its symptoms. Those affecting the anterior aspect belong to the Yangming Meridian; thus, trembling of the head and face, trismus (locked jaw), pain in the supraclavicular fossa, and cramping of the feet are its symptoms. Those affecting the lateral aspect belong to the Shaoyang Meridian; thus, facial paralysis (deviation of mouth and eye), traction of hands and feet, hypochondriac tension, and hemiplegia are its symptoms. If there is abdominal tension, accompanied by limb tension due to vomiting and diarrhea, this is Taiyin Spasm. Aversion to cold, curling up to sleep, sitting on the buttocks with heels raised as if walking, spine bent forward with head lowered as if looking down, able to flex but not extend, is Shaoyin Spasm. Elevation of the testicles, downward flow of the Zongjin (major tendons), urgency and tension in the lower abdomen, cramping in the genital area, and tension in the knees and shins constitute Jueyin Spasm. If Spasm is complicated by Wind and Cold, the symptoms include fever, anhidrosis, and aversion to cold; qi rushing upward to the chest and scanty urination; the pulse must be firm and tight, and the posture rigid with trismus. This results from Heavenly Qi (external invasion), corresponding to what *Nei Jing* calls "sudden rigidity belongs to Wind." Its momentum is fierce, hence it is called Gang Spasm (Yang Spasm). Since the pathogen is external, one should dispel the evil and release the exterior. For Spasm complicated by its original pathogen (Dampness), the evil emerges from within; thus, there is fever and sweating without aversion to cold, the pulse is deep and slow, and the manifestation is rigidity of the nape and back. This results from Earthly Qi (internal/environmental factor), corresponding to *Nei Jing*'s statement "spasms and neck stiffness belong to Dampness." Its momentum is weak, hence it is called Rou Spasm (Yin Spasm). Since the cause is internal, one should nourish Yin to harmonize the interior. It must be understood that Spasm attributed to Wind is not caused by Wind per se, but by Heat; Spasm attributed to Dampness is not caused by Dampness per se, but by Dryness. Using Puerariae Radix (Gegen) as the sovereign herb for treating Wind-related Spasm, and Trichosanthis Radix (Gualou Gen) for Dampness-related Spasm, is not primarily to treat Wind or Dampness, but truly to generate fluids and moisten Dryness. At the onset, Spasm is not a primary disease but is always mixed with other diseases. Physicians of the world usually attribute it to Wind, failing to understand the underlying principle. Skillful physicians must examine and prevent it amidst other symptoms. For instance, stiff neck and headache are precursors of Spasm, indicating Taiyang blood deficiency leading to tendon tension. Nowadays, people only recognize Wind and Cold, disregarding body fluids; thus, excessive sweating frequently leads to Spasm. The signs of Spasm have their origins; once mismanaged, bizarre manifestations appear. Rigidity of the nape and back is a sign of impending Spasm, so Puerariae Radix is used; general body rigidity indicates established Spasm, so Trichosanthis Radix is used; inability to lie flat on the bed, foot cramps, and trismus indicate extreme Spasm, so Rhizoma Rhei (Dahuang) and Natrii Sulfas (Mangxiao) are used. These are all herbs rich in fluids to nourish Yin and Blood; they cannot be treated similarly to cases where sweating should have been induced but was not. Consider a Shanghan case with floating pulse, spontaneous sweating, vexation, aversion to cold, and foot cramps: the trend of Spasm has already formed. One must nourish Yin and preserve fluids, rather than treating it solely as Shanghan. Therefore, using Guizhi Tang (Cinnamon Twig Decoction) would lead to cold limbs, whereas using Shaoyao-Gancao Tang (Peony and Licorice Decoction) allows the feet to straighten, which is clear evidence. However, since exterior symptoms remain, Chengqi Decoctions cannot be used directly. If delirium occurs, a small amount of Tiaowei Chengqi Tang (Harmonizing the Stomach and Regulating the Bowels Decoction) may be given. This shares the same mechanism as giving Dachengqi Tang (Major Order the Yellow Decoction) to patients whose condition is severe enough that they cannot touch the bed with their backs. Generally, Spasm is rarely caused by external pathogens damaging the tendons, but mostly by blood deficiency causing tendon tension. If mistakenly treated as Wind, using acrid-dispersing herbs to boost Yang will further deplete True Yin; using drying agents to expel Wind will further desiccate the Blood. Thus, sudden onset of Spasm is rare, while that caused by mismanagement is common. In deficiency without tonification, death is inevitable. Without using Ginseng Radix (Renshen), Astragali Radix (Huangqi), Angelicae Sinensis Radix (Danggui), and Rehmanniae Radix (Shu Dihuang) to regulate Ying and Wei Qi, it is difficult to resolve Spasm and achieve quick results.

*Nei Jing* states: "All dampness-induced swelling and fullness belong to the Spleen." It also says: "Excessive Dampness leads to loose stools." This refers to Dampness injuring the interior. It further states: "Earthly Dampness, when contracted, harms the skin, flesh, sinews, and bones." And: "Due to Dampness, the head feels wrapped." This refers to Dampness injuring the exterior. If Dampness combines with Heat, the large sinews shorten causing constraint, and the small sinews elongate causing flaccidity; this is a variant manifestation of Rou Spasm. The Yangming chapter mentions yellowing due to Damp-Heat. Wang Shuhe did not discuss these separately, focusing only on Wind-Damp interaction in Taiyang, leaving several clauses uncollected, which is an oversight in compilation. *Nei Jing* states: "The upper half of the body is attacked by Wind; the lower half by Dampness. Attacking Yang channels causes flow into the meridians; attacking Yin channels causes flow into the fu organs." It also says: "Yang meridians receive Wind Qi, Yin meridians receive Damp Qi. Therefore, Wind attacks the upper part first; Dampness attacks the lower part first." These statements contrast Wind and Dampness, whereas *Shanghan Lun* discusses them together. When Wind and Damp combine, Yin and Yang clash, and both upper/lower and interior/exterior are affected. Thus, there is bodily restlessness and pain, inability to turn over, joint pulling pain, inability to flex or extend, dysuria, and conversely, rapid bowel movements. *Nei Jing* states: "When Wind-Damp attacks, Qi and Blood merge with the pathogen in the fenli (interstices); the pulse is firm and large, hence termed Excess. When Cold-Damp attacks, the skin relaxes, muscles are firm, Ying Blood is stagnant, and Wei Qi departs, hence termed Deficiency." Here, the excess and deficiency of Dampness patients are differentiated by Cold and Wind. In *Shanghan Lun*, after sweating for Shanghan, if Cold-Damp remains unresolved internally, causing jaundice of the body and eyes, combined with Yangming Heat that cannot vent, leading to stagnant Heat inside and yellowing, the decision to purge or not purges differentiates Excess and Deficiency based on Cold-Damp versus Damp-Heat. *Nei Jing* holds that Bi Syndrome is formed by the combination of Wind, Cold, and Damp; *Shanghan Lun* adds Heat to name it Damp-Bi. One must know that both Bi and Spasm arise from transformations of Dampness. The same Dampness, when dried out to an extreme, becomes Spasm; when lingering and attaching for a long time, it becomes Bi. Bi is Excess, Spasm is Deficiency; their forms differ, and their nature (Excess/Deficiency) differs. One must not rashly attribute Spasm to Wind, nor, because it originates from Dampness, view Spasm entirely as Dampness.