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Yu Chang said: For spasm (Jing syndrome, a condition characterized by muscle stiffness and convulsions) with obvious manifestations, later generations have even lost its name, let alone the subtle changes of the pulse in spasm. However, it can still be discussed. Spasm differs from ordinary diseases, and the pulse in spasm must differ from ordinary pulses; therefore, when the body is stiff, the pulse is also strong. It is impossible to find a soft and moderate pulse. Moreover, a strong pulse often mixes with Yin pulses, manifesting as deep-choppy (Chen Xian) or deep-tight (Chen Jin), indicating that the pathogenic factor is deep and the pulse qi is constrained, making it difficult to rapidly eliminate. Zhang Zhongjing stated, "When both Yin and Yang aspects of the pulse are tight, this indicates the loss of Yang." This belongs to Shaoyin disease, and the tightness seen here is not comparable to the tightness of Taiyang disease. He also said, "In Shaoyin disease, if the pulse is tight, and after seven or eight days, the pulse suddenly becomes faint, the hands and feet become warm, and the tightness disappears, this indicates that the condition is about to resolve." From this, we can see that for spasm to resolve, the originally tight and solid pulse must transform into a faint one, revealing the true nature of the severe illness, before it can gradually return to a normal pulse; it will not resolve immediately. Among ancient and modern discussions on spasm and its pulse, none are more detailed than those in *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet). However, these are merely fragmentary statements at key points. Without a profound understanding of the methods of comparing and inferring among Taishang (Cold Damage) diseases, one would be ignorant of the author's intent. Therefore, while discussing spasm disease, I also discuss the pulse of spasm.

*Jin Gui Yao Lue* states: "Taiyang disease with fever, deep and fine pulse is named spasm, which is difficult to treat." Because fever is a symptom of Taiyang disease, and deep-fine is the pulse of Shaoyin disease; a Yang disease presenting with a Yin pulse is therefore difficult to treat. Difficult to treat does not mean untreatable. Zhang Zhongjing had methods for treating fever with a deep pulse, such as Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction), which should be applied by analogy. If one were to still use Guizhi Tang (Cinnamon Twig Decoction) or Gegen Tang (Kudzu Decoction) for Taiyang disease, it would instantly destroy the root of isolated Yang, rendering it truly untreatable. The organ of Shaoyin stores Jing (Essence), and its residence is Shen (Spirit). Jing belongs to Yin, and Shen belongs to Yang. Whenever a faint pulse appears, it indicates weak Yang; whenever a fine pulse appears, it indicates depleted Yin. Weakness makes one prone to loss of Yang, and fineness makes one prone to loss of Yin; this is why it is difficult to treat. Thus, if the disease transmits to Jueyin, but the Jing and Shen of Shaoyin are not depleted, there will be no death. Those who present with cold limbs, diarrhea, irritability, and a faint pulse leading to death ultimately do so because Jueyin disease has exhausted Shaoyin. This is the true subtlety of the pulse, applicable to all diseases, not just a golden key for spasm pulses.

It further states: "Taiyang disease with complete symptoms, stiff body, rigidity of the neck and back (Xiang Bei Qiang Jin), and a pulse that is surprisingly slow (Chi), is called spasm." This also belongs to a Yang disease with a Yin pulse, but a slow pulse is vastly different from a faint or fine one. A slow pulse indicates that the Ying (Nutrient) blood of the Taiyang channel has been affected by Yin pathogens. Thus, when the pulse arrives at the Cunkou (radial artery position), its arrival is slow, meaning Ying blood cannot nourish the sinews, resulting in spasm. One should only employ methods to tonify Yin and generate fluids to harmonize the sinews, without using the same methods as for Shaoyin disease. This is how to distinguish between these two conditions involving Yin pulses.

The text cites *Mai Jing* (Pulse Classic): "Patients with spasm have a Fu (Hidden) pulse, firm and straight up and down, and upon pressing, it feels tight like a string, running straight up and down, mutually explaining their meanings." This clarifies that "Fu" does not mean hidden away; it can be felt upon pressing, which is what is meant by "Chen" (Deep). "Firm" does not mean unfocused; it means tight like a string, unyielding to the finger, indicating solid pathogenic factors. "Running straight up and down" occurs because the Du Mai (Governing Vessel) and the Foot-Taiyang Bladder Channel run together within the spine. When Taiyang pathogenic factors are abundant, the Du Mai also manifests abundance. Since the Du Mai runs along the back of the body and the Ren Mai (Conception Vessel) along the front, like the Zi-Wu positions of heaven and earth, situated in the center of North and South, the pulse appears to go straight up and straight down. *Mai Jing* states that "running straight up and down" refers to the Du Mai. Seeing this pulse in adults leads to Dian (epilepsy/madness), and in children to Kong (startle/fright). Because it is mixed within the Deep pulse and requires heavy pressure to detect, diseases like epilepsy and spasm cannot be compared to ordinary Yang diseases. If the pulse goes straight up and down and is visible with light touch, it indicates Yang Kuang (mania). The symptoms include climbing over walls and fences, with strength double that of usual; how could it be as contracted as in spasm? This is how to distinguish the apparent Yang nature of Yin pulses in spasm.

However, in Cold Damage, if one mistakenly induces sweating in Shaoyin disease, it will surely disturb the blood, causing lower cold and upper exhaustion, leading to loss of Yin and difficulty in treatment. In contrast, if one mistakenly induces sweating in spasm disease, it will surely disturb Dampness. Although Dampness is a Yin category, it is an externally acquired Yin pathogen, distinct from internal Yin blood. The Yang Qi that is disturbed rushes into the Dampness and is submerged by it, creating a catastrophic disaster, which is a transformation of loss of Yang. Zhang Zhongjing said, "Its pulse is like a snake." Although he did not describe the symptoms, before inducing sweat, one already sees aversion to cold, head shaking, locked jaw, stiff back, and leg cramps, indicating that Yang is about to perish. After inducing sweat, symptoms such as muscle twitching, tongue retraction, scrotal retraction, curved back, drooping shoulders, neck feeling like being pulled, waist feeling like being broken, coarse neck tendons, and cold extremities are all fully present in spasm disease,无需 saying. Because inducing sweat disturbs Lower Jiao Dampness and forces True Yang to escape into the Dampness, besides the loss of Yang from excessive sweating, another manifestation of Yang loss is added. Hence, the pulse is described as "like a snake." This means that the escaped Yang, originally eager to rise and agile like a dragon, is hindered by the sluggishness of Dampness, resembling the movement of a snake. Despite struggling to break free, it cannot fly. This is the ultimate variation of the pulse and the utmost precision of the principle, never before explained.

Furthermore, sudden abdominal distension is said to indicate resolution, while the pulse remains unchanged and repeatedly shows a String-like (Xian) quality. The *Classic* text does not narrate the origin and details of the disease. Suddenly mentioning "resolution" is like a half-gatha in Zen Buddhism, leaving one wondering where to meditate. Try to meditate on it, and the wonder is beyond words. Generally, when Cold Damage transmits to Jueyin, there are cases of impending resolution and cases of non-resolution after passing through the meridian stages. Here, the presentation of resolving symptoms alongside unresolved pulses suggests that when spasm transmits to Jueyin, the meridian pathology is exhausted. Whether it resolves or not can be known by distinguishing the pulse and symptoms. In resolving cases, Jueyin pathogens must transmit to Spleen Earth, overcoming what it controls, causing sudden abdominal distension. This aligns with the *Nei Jing* principle that "when Jueyin governs the lower, people suffer from abdominal distension." It also shows that Jueyin does not transmit further to Taiyang but turns to Taiyin, indicating the pathogen is about to resolve. Upon resolution, the pulse must show slight floating. How do we know this? From the statement in Cold Damage Jueyin Wind Strike: "A slightly floating pulse indicates impending recovery; a non-floating pulse indicates no recovery." If the pulse remains Yin-like, showing Deep-Choppy qualities, it will damage its own sinews, leading to contraction and spasm, similar to non-resolution after passing the meridian stage, and the date of resolution cannot be determined.

Regarding treatment, each of the Six Meridians has established methods. *Jin Gui Yao Lue* only takes two formulas from Taiyang and one from Yangming as examples. However, Jueyin sinus disease itself is caused by Shaoyin Yang deficiency failing to soften and nourish the sinews, hence the pulse is surprisingly Deep-Choppy. In such cases, one should use Warmth to rescue Yang. Cold Damage Jueyin loss of Yang must manifest internal tension. Internal tension is the profound meaning of *Ling Shu*: "Diseases inside belong to Yin and cannot extend upwards." Thus, knowing that Shaoyin governs the interior, the use of Warmth in Jueyin still follows warming Shaoyin. Additionally, for Jueyin diarrhea and abdominal fullness, Zhang Zhongjing first warms the interior. Although the Pathogenesis states "All abdominal distensions and swellings belong to Heat," sudden abdominal distension is due to Shaoyin Yang deficiency combined with Yin excess, causing the abdomen to swell suddenly rather than gradually. Since Yin is sudden, Yang is not sudden; thus, Jueyin also follows the warming method of Shaoyin. Without warming, there is not only no hope of resolution but also a risk of death. I specifically trace back to Zhang Zhongjing to guide future students, hoping for some success. Respectfully discussed.

*Nei Jing* says: "Those injured by Dampness receive it first in the lower part." This means earthly Dampness attacks humans, first striking the feet that touch the ground, then gradually affecting the upper parts. "Dampness flows into the joints" means earthly Dampness enters the four limbs and hundred joints, having not yet entered the Zang-Fu organs. "Yin receives Damp Qi" means earthly Dampness has entered Taiyin Spleen Earth but not Yangming Stomach Earth. "Excessive Dampness above transforms into Heat" refers to Dampness received below invading the Three Yang, transforming into Damp-Heat in the chest, back, head, and face via the Upper Jiao Yang. Damp-Heat transforming at the Upper Jiao is most common in summer. Summer earthly Dampness combines with heavenly Heat and solar暑 (Summer Heat) to form steaming heat. The human body responds with red and swollen head and face, numerous boils and sores, and epidemic pathogens taking hold, a process not occurring overnight.

Various schools discuss Dampness only saying "Dampness flows into the joints." They never mention the principle of "Excessive Dampness above transforms into Heat." Now I discuss it fully. "Excessive Dampness above transforms into Heat," *Nei Jing* adds one point: "Sweating as usual brings relief," a subtlety beyond words. "Excessive Dampness above transforms into Heat" is what is meant by "Earthly Qi rises to form clouds." "Sweating as usual" is what is meant by "Heavenly Qi descends to form rain." When Heavenly Qi descends as rain, the rising Earthly Qi is dispersed and ceases to exist. Is not the mechanism of treating disease deeply understandable?

"Excessive Dampness above transforms into Heat," the patient's urination will definitely be obstructed. Because the Qi transformation of the Bladder is first blocked by Damp-Heat and fails to function, the Dampness that has risen finds it difficult to descend. *Nei Jing* again says: "Treating Dampness without promoting urination is not the correct treatment." Thus, treating excessive Damp-Heat above by promoting urination is the second principle. However, there are two patterns: Yang Excess and Yang Deficiency. In Yang Excess, urine is red and painful; promoting urination allows the obstructed Yang Qi of the Upper Jiao to flow freely, and the Damp-Heat naturally drains downward through the Bladder. In Yang Deficiency, urine is white, with frequent dribbling and excessive sweating; all drugs that promote urination cannot be used. Misusing them violates the prohibition against weakening the deficient, which must be distinguished.

*Jin Gui Yao Lue* treats Upper Jiao Dampness based on the *Nei Jing* principle of "Excessive Dampness above transforms into Heat," dividing it into mild and severe cases. Mild cases present only with fever, red face, wheezing, headache, nasal congestion, and irritability. With pathogen in the Upper Jiao and no other internal disease, one simply inserts medicine into the nose to extract the yellow fluid brewed by Damp-Heat. Since the nasal orifice is the gateway to the brain, applying dispersing and draining methods through the nose is the most miraculous and rapid method. Severe cases present with body heat, cold feet, frequent head heat, red face, and red eyes, all clear signs of excessive Damp-Heat above. Damp-Heat excessive above causes head heat, red face, and red eyes. Damp-Heat excessive above causes Yang Qi to congest upward, failing to descend to the Yin, resulting in cold feet. Since Cheng Wuji claimed this was Damp injuring below and Wind injuring above, Zhang Zhongjing elucidated the profound meaning of *Nei Jing*, rendering Cheng Wuji's interpretation worthless. Did he not read *Nei Jing*? Does Wind generate Heat but Dampness not? Winter Cold Damage is already a Heat disease. Why would Summer Damp injury not be a Heat disease? Examining Zhang Zhongjing's severe case of "excessive above transforms into Heat," listed under the most severe spasm条款, without stating treatment... I attempt to reveal a thread here, but it is merely a step up the bamboo pole; will observers turn away in disappointment? *Nei Jing* originally had the method "Treat those above by lowering them." Pathogens moving from below to above must be driven out from below; this is a fixed principle. In mild cases with no other internal disease, extracting yellow fluid from the clear Yang nasal orifice suffices. In severe cases with many critical internal symptoms, one must drive out the yellow fluid from the anterior and posterior orifices; this can be inferred. *Jin Gui Yao Lue* adds twenty-four characters below the text: "If sweating is induced..." warning beginners not to use sweating as a cure, which can also be inferred. However, the difficulty of purgation lies in not deducing why sweating is contraindicated, one cannot grasp the rationale for using purgation. Zhang Zhongjing notes head shaking, locked jaw, stiff back, and leg cramps, indicating Yang is about to perish. If sweating is induced again, it severely damages the defensive Yang, and aversion to cold will worsen. If sweating is induced and the pulse becomes like a snake, True Yang escapes, and death occurs instantly. From this, we infer that severe cases of excessive Damp-Heat above cannot survive without purgation. Purgation must use Warm herbs to ensure Dampness leaves without Yang departing with it; this is not baseless talk. Zhang Zhongjing supplements in this chapter: "After purgation, if sweat appears on the forehead, slight wheezing, and free urination occur, death results." Is this not a major taboo against purging and simultaneously depriving Yang? Alas! This is likely equivalent to the principles of Human Nature and the Way of Heaven.

Discussing *Jin Gui Yao Lue*'s use of Mahuang Baizhu Tang for Dampness. The text says: "For damp patients with bodily restlessness and pain, Mahuang Tang may be given to induce sweating; fire therapy must be strictly avoided." This is a formula for treating simultaneous Heat and Dampness, addressing both exterior and interior. Restlessness indicates Heat; pain indicates Dampness. Using Mahuang to induce slight sweating dissipates exterior Heat; using Baizhu to strengthen the Spleen moves interior Dampness. When Mahuang meets Baizhu, although it induces sweating, it does not cause excessive sweating. When Baizhu meets Mahuang, it can move both exterior and interior Dampness downward through the water passages, maintaining a balance. For Cold Damage failing to sweat leading to jaundice, Mahuang Lianqiao Chixiaodou Tang is used to separate Heat and Dampness, following the same logic. However, Cold Damage treatment does not typically use Baizhu; *Jin Gui Yao Lue* introduces this method, showing that for miscellaneous diseases with internal Spleen Dampness invasion, Baizhu must be the primary treatment.

Comprehensively discussing *Jin Gui Yao Lue*'s use of Guizhi Fuzi Tang, Baizhu Fuzi Tang, and Gancao Fuzi Tang for Dampness. All Summer Dampness is Damp-Heat, unlike Winter Dampness which is Cold-Damp. Why does *Jin Gui Yao Lue* use formulas containing Fuzi (Aconite) in various forms? Those analyzing formulas to deduce symptoms invariably mistake Damp-Heat for Cold-Damp. They fail to consider that individuals with inherent Yang deficiency become even more deficient in Summer. Due to deficiency, Yang Qi does not fill the body, allowing Yin Dampness to occupy it. Using standard Dampness treatments in such cases will cause deficient Yang to depart with the Dampness, leading only to death. Therefore, in cases of Yang deficiency with Dampness excess, aside from assisting Yang, there is no other way to expel Dampness; it is a necessary method.

Guizhi Fuzi Tang and Baizhu Fuzi Tang. The text says: "After eight or nine days of Cold Damage, Wind and Dampness intertwine, causing bodily pain and restlessness, inability to turn oneself, no vomiting or thirst, and a floating, deficient, and choppy pulse; Guizhi Fuzi Tang governs. If stool is hard and urination is free, remove Guizhi and add Baizhu; Baizhu Tang governs." Using Guizhi and Fuzi warms the channels and assists Yang, securing the exterior and interior to expel Dampness. Since there is no vomiting or thirst, body fluids are not damaged, so these are used. If stool is hard, body fluids are insufficient. If urination is free, body fluids are not retained. Thus, Guizhi, which depletes fluids, is removed, and Baizhu is added to moisten dry stool. This, along with the next line Gancao Fuzi Tang, comes from the Taiyin Chapter of *Shang Han Lun*. It is not recorded in the *Shang Han Lun* Spasm-Dampness-Sunstroke chapter, but is recorded in the *Jin Gui Yao Lue* Spasm-Dampness-Sunstroke chapter, showing that for Yang deficiency in treating Wind-Damp versus Damp-Heat, the use of this original formula should not differ. *Shang Han Lun* only says: "If stool is hard and urination is free, remove Guizhi and add Baizhu; Baizhu Tang governs." *Jin Gui Yao Lue* re-establishes the formula and adds under it: "After one dose, feel body numbness; after half a day, take another dose; after three doses are finished, the person may feel like they are in a trance; do not be alarmed. This is because Baizhu and Fuzi are moving together in the skin, driving out water qi, which has not yet been eliminated." Cheng Wuji annotates this line in *Shang Han Lun*: "Guizhi disperses exterior Wind, Fuzi drives out channel Dampness," never mentioning Yang deficiency. I repeatedly emphasize: obtaining this passage provides evidence. Feeling body numbness after one dose means the drug power has moved the Dampness, but Yang Qi is not yet sufficient to circulate. After three doses, Yang Qi can move. The whole body feeling like needle pricks, with a state of dispersion and difficulty in gathering, is described well by *Jin Gui Yao Lue*. Furthermore, humans rely on Yang Qi to hold hands and walk feet, moving lightly and fearlessly; how could they be unable to turn themselves? How can this be blamed on Dampness? Even if Dampness is dominant, where has the Yang Qi gone? Moreover, with no vomiting or thirst, and a floating, deficient, choppy pulse, Yang deficiency is undeniable. Cheng Wuji teaching the treatment of external Wind-Damp pathogens would surely mislead future generations!

Gancao Fuzi Tang. The text says: "Wind and Dampness intertwine, causing bone and joint pain and restlessness, pulling pain, inability to bend or stretch, extreme pain upon touch, sweating, shortness of breath, difficult urination, aversion to wind with reluctance to remove clothes, or slight body swelling; Gancao Fuzi Tang governs." This is also a Yang deficiency pattern, roughly similar to the previous line. Wind injures Wei (Defensive) Qi, and Yang does not secure the exterior. Dampness flows into joints, and Yang does not fill the channels. This formula secures Wei, warms channels, and dispels Dampness.

Discussing *Jin Gui Yao Lue*'s Fangji Huangqi Tang. The text says: "Wind-Damp with floating pulse, heavy body, sweating, and aversion to wind; Fangji Huangqi Tang governs." This treats cases where exterior Defensive Yang is too deficient, but interior True Yang is intact; Fuzi cannot be used. Instead, Huangqi (Astragalus) strengthens Wei, Baizhu strengthens Spleen, utilizing the meaning of sweet-warm supporting Yang to achieve gradual healing. The formula instructions say: "After taking, one should feel insects crawling in the skin; from the waist down, it feels like ice. Sit warmly on a blanket, wrap another blanket around the waist and below, warming until slight sweating occurs for recovery." This shows that sweating is spontaneous sweating due to Yang deficiency, while the area below the waist, belonging to Yin, has no sweat. Taking this formula moves the Dampness, but exterior Defensive Yang is still insufficient to overcome it. Hence, insects crawling in the skin is less severe than the previous whole-body trance-like state. Gently warming the lower body with blankets induces slight sweating for gradual recovery. This is also a method of treating lower-received pathogens by expelling them from below.

Spleen dislikes Dampness. In Summer, Heat and Dampness steam each other, often leading to jaundice. However, this differs slightly from Yangming Stasis-Heat Jaundice in Cold Damage. The latter belongs to more Heat, with bright color. This belongs to more Dampness, with dark and dull color.

*Nei Jing* says: "Excessive Dampness leads to Bi (Obstruction) Syndrome." *Jin Gui Yao Lue* uniquely attributes it to the Kidney, naming it Kidney Bi. It says: "In Kidney Bi disease, the person has a heavy body and cold waist, as if sitting in water, appearing watery, yet not thirsty, with free urination and normal diet. The disease is in the Lower Jiao, caused by labor and sweating, with cold and wet inner clothes over time, leading to cold pain below the waist and heaviness in the abdomen as if carrying five thousand coins; Gan Jiang Ling Zhu Tang governs." This condition involves Damp-Yin attaching to the outer layer of the Kidney, unrelated to the inner storage of the Kidney. Earthly Dampness pathogen attaches to the cold outer layer of the storage, causing Yin Qi to condense, hence cold waist as if sitting in water; it is truly not cold essence of the Kidney storage. If the essence were cold, the Bladder would draw it, reversing from the paraspinal region to the Middle and Upper Jiao, resulting in countless disorders of Ying and Wei circulation. Now the pathogen only attaches to the Lower Jiao, diet is normal, not thirsty, urination is free, and it is unrelated to the Fu organs of the intestines and stomach, let alone the Kidney storage. This is merely caused by labor, sweating, and cold/wet clothes over time. Using Gan Cao (Licorice), Gan Jiang (Dried Ginger), Fu Ling (Poria), and Bai Zhu (Atractylodes), sweet-warm to support Yang and bland-draining to move Dampness is sufficient. Why seek to warm the Stomach and strengthen Yang? Gan Jiang Ling Zhu Tang.

The Nineteen Pathogenesis Mechanisms in *Nei Jing* describe Heat diseases predominantly. It states: "All diseases involving wheezing, vomiting, acid regurgitation, sudden diarrhea with tenesmus, muscle cramps, turbid urination, abdominal distension and swelling, drum-like sound upon percussion, carbuncles, ulcers, rashes, tumors, lymph node swelling, vomiting and diarrhea cholera, dizziness and depression, swelling, nasal congestion, rhinorrhea, epistaxis, hematemesis, hematochezia, dysuria and distress, body heat with aversion to cold, shivering,惊惑 (fright and confusion), crying and laughing delirium, nasal bleeding, bloody污 (filth)" all belong to Heat. Liu Hejian annotated each disease clearly, so later generations followed him; thus, *Yuan Bing Shi* (Original Treatise on Disease Causes) must be read.

In miscellaneous diseases, aversion to cold is due to Heat being severe internally. *Nei Jing* says: "Aversion to cold and shivering all belong to Heat." It also says: "Trembling as if losing spiritual control all belong to Fire." *Yuan Bing Shi* states: "When Heat disease is severe, one feels cold; this is Heat disease, truly not Cold." Ancients treated shivering with Dachengqi Tang to purge dry feces and achieve cure. Aversion to cold and shivering are clearly Heat patterns, differing only in deficiency and excess.

In miscellaneous diseases, fever is due to Yin deficiency in the lower part. *Nei Jing* says: "Yin deficiency generates Heat." Yang is outside, guarding Yin; Yin is inside, keeping Yang. If spirit wanders outward and desires are unregulated, Yin Qi is consumed, Yang has no attachment, and floats to the muscle surface, causing aversion to Heat. It is truly not Heat; it should be treated as Yin deficiency using tonifying and nourishing methods.