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Spasm refers to the inability of limbs to extend for a prolonged period. If the condition persists and becomes entrenched, it is difficult to treat, unlike twitching and cramping which are temporary ailments. The pathogenesis lies in two aspects: "cold causes contraction and drawing-in," and "heat causes dryness and shrinking." Among these, cold patterns are easier to treat, while heat patterns are difficult. Why? Although cold causes contraction and traction of the tendons and vessels, the tendons do not wither. By using warm and hot agents to dispel the cold, yang qi returns, the frozen state resolves, and the contracted tendons relax, making treatment not difficult. (However, there are cases where long-standing cold qi gathers into foam and condenses into phlegm, wrapping around and hardening the tissues so that medicinal decoctions cannot penetrate; in such cases, external therapies such as moxibustion warming, washing, cauterization, and moxibustion can be applied.) Only when heat causes dryness and shrinking, after a long duration, the tendons have become withered and fixed; even with vigorous efforts to moisten and nourish, recovery of original vitality is ultimately difficult. Heat patterns are often deficient, caused by the depletion of blood. There are also excess patterns, where either wind-cold blocks the exterior or phlegm-fluids stagnate, preventing the smooth flow of blood vessels. The nature of fire, being suppressed and stagnant,激ates and erupts suddenly, causing abrupt spasms and curling (like the movement of a snake coiling and twisting, which illustrates this image); this can be observed in the twitching and shrinking of calf muscles. Cold patterns are often excess, caused by the stagnation of blood, phlegm, and dampness due to cold. There are also deficient patterns, caused by insufficient yang qi. Danxi treated a village laborer who suffered from a hunched back and contracted feet, rendering him disabled. His pulse was deep, wiry, and choppy. He used Zhang Zihe's Wei Shen San (Roasted Kidney Powder) to treat him. After more than two months of induced vomiting and diarrhea, the patient recovered.

The *Zhunsheng* states that spasm is equivalent to *yu zong*. *Yu* refers to tendon constraint and urgency, while *zong* refers to flaccidity and relaxation. Twitching belongs to the category of *yu zong*, but there are slight differences. Constraint refers to tendons and vessels being tight and urgent, unable to extend and relax, as seen when toes become rigid due to cold. Twitching refers to frequent extension and flexion.

Twitching refers to the frequent extension and flexion of hands and feet. Some refer to it as *chu nuo*. *Nuo* means the ten fingers frequently opening and closing, and the fists tightly clenched. This syndrome belongs to wind-fire. Wind and fire are yang pathogens, characterized by activity and restlessness. The reason it manifests as twitching rather than restlessness is due to blood depletion and tendon urgency. If one recklessly applies moxibustion burning or induces sweating to release the exterior, death will follow immediately. Pediatric acute convulsive disease (Ji Jing Feng) often presents this syndrome. It is appropriate to drain liver wood and heart fire, primarily using Liang Jing Wan (Cool Convulsion Pill). If due to blood deficiency, use Xuduan Wan (Dried Stem Centaury Pill). If liver evil is excessive, it is advisable to save the spleen, using Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) with modifications. If heat damages yuan qi, use Renshen Yiqi Tang (Ginseng Qi-Boosting Decoction). If qi and blood are weak, internal fire is abundant, and there is an invasion of both internal and external wind, with wind and fire fanning each other, dispersing agents must be added; use Mingming Zhusan (Success Decoction). If accompanied by mental confusion and cloudiness, use Duhuo Tang (Angelica Pubescens Decoction). For postpartum blood deficiency with fever, where excessive heat generates wind leading to this condition, use Bazhen Tang (Eight Treasures Decoction) plus Mu Dan Pi (Moutan Cortex) and Gouteng (Uncaria Rhynchophylla) to generate yin blood. If ineffective, additionally tonify the spleen and stomach to generate blood. After pediatric vomiting and diarrhea, if the yin qi of the spleen and stomach is damaged, leading to slow convulsive disease (Man Jing Feng), this is also commonly seen, representing deficient wind and deficient heat. If yang qi is further deficient and sinking, the wind-fire becomes an even more rootless false flame. For deficiency, use Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) plus Rougui (Cinnamon Bark) and Fuzi (Aconite Lateral Root); for sinking, use Buzhong Yiqi Tang (Tonify the Middle and Boost Qi Decoction) plus Rougui and Fuzi. In these yang-deficient syndromes, aversion to cold in the limbs and a faint, fine pulse indicate true signs. If the pulse is floating and large, accompanied by fever, irritability, and thirst, these are false signs. One must not stick to the phrase "syndrome belongs to wind-fire" and assume it is an excess pathogen. If the eyes roll back (Dai Yan), the body arches backward (Fan Zhe), and sweat beads like pearls appear, it is untreatable. (Note: The assertion that blood depletion and tendon urgency is the sole cause may be incomplete. Observing those enduring pain often clench their teeth and fists, similar to the shape of pediatric convulsions involving teeth grinding and fist clenching, indicates that this condition must be due to internal attack by wind-fire, presenting a difficult-to-resist state, hence these defensive manifestations. Since wind-fire moves intermittently, twitching occurs and stops. If it were truly caused by blood depletion and tendon urgency, there should be more flexion than extension, fists constantly clenched, and no teeth-grinding would occur. Twitching represents the curving and straightening imagery of wind-wood; clenching, grasping, and teeth-grinding represent the patient's distress and resistance.)