Library

Dong'an stated: The varieties of medicinal materials are numerous, but their principles can be integrated. Their properties do not go beyond cold, heat, warm, and cool; their flavors do not go beyond pungent, sweet, sour, astringent, bitter, and salty. Cold substances cause coagulation and stagnation; heat substances promote circulation and movement; warm is the secondary degree of heat; cool is the mild degree of cold. Sour flavor necessarily has an astringent effect; astringent flavor necessarily has a consolidating effect; bitter flavor necessarily has a descending effect; pungent flavor necessarily has a dispersing effect; salty flavor can moisten and direct downwards; sweet flavor can moderate and harmonize the middle. Aromatic and drying substances have a penetrating and fierce nature; excessive use consumes Qi. Moistening and nourishing substances have a damp and wet nature; excessive use damages the Spleen. Digestive and resolving substances have a rather inferior (draining) nature; excessive use breaks Qi. Pushing and purging substances have a swift and fierce nature; excessive use damages Yin fluids. Diuretic and draining substances have a downward-flowing nature; excessive use causes leakage of Zheng Qi. All such cases can be inferred by analogy. Although these substances all possess the merit of eliminating disease, they should not be used with bias; as for tonifying substances, long-term or heavy use is acceptable, but one should avoid rigid tonification. Using substances that move stagnation and resolve accumulation ensures safety without drawbacks.

Zhang Jingyue stated: Jing illness (Spasm), is the "Chi Zong" (Convulsion/Clonic seizure) disease mentioned in the *Nei Jing* (Inner Canon). Writing "Jing" instead of "Chi Zong" is likely a transcription error. Its symptoms include opisthotonos (backward arching of the back), head shaking, trismus (lockjaw), upward staring of the eyes, neck stiffness, and limb contracture. It may also present with fever in the body and coldness in the feet, aversion to cold, and a red face. Zhongjing attributed it to the misuse of sweating and purging methods, leading to the loss of Yin. However, there are cases not caused by iatrogenic errors. Any case belonging to Yin deficiency and blood insufficiency, where the sinews and vessels cannot be nourished, resulting in twitching, convulsions, rigidity, and collapse, is this type of syndrome, though people often fail to recognize it. For instance, if a stroke patient exhibits this, it must be due to declining years and failing Yin. If a postpartum woman exhibits this, it must be due to excessive blood loss and exhaustion of the Chong and Ren vessels. If a patient with sores/ulcers exhibits this, it must be due to blood loss accompanying pus and depletion of Ying Qi. If a child exhibits this, it may be due to wind-heat damaging Yin, leading to acute convulsive disorder (Ji Jing); or due to sweating and purging causing loss of Yin, leading to chronic convulsive disorder (Man Jing). These are all Yin deficiency syndromes. Generally, if essence and blood are not depleted, even if pathogenic factors interfere, there will absolutely no be disease of sinew contracture. When the disease reaches a state of rigidity, its dryness is evident. In treating this, one should prioritize Qi and Blood first. If pathogens are severe, treat them concurrently; if pathogens are mild, no specific treatment is needed. The urgency lies in Yuan Qi; once Yuan Qi recovers and blood vessels flow, minor pathogens cannot remain. Nowadays, people mistakenly treat it as Wind, unaware that this is internally generated Wind-Dryness. Only tonification is suitable, as there is no external pathogen. Even if caused by injury to essence and deterioration of blood leading to dryness, treating it as Wind-Phlegm would likely lead to error.

Chen Wuyue stated: Internal deficiency of Qi and Blood, combined with external invasion by Wind, Cold, Dampness, and Heat, leads to Jing illness. Wind scatters Qi, hence there is sweating without aversion to cold, called Rou Jing (Soft Spasm); Cold congeals Blood, hence there is no sweating with aversion to cold, called Gang Jing (Hard Spasm). Investigating the cause, it mostly stems from blood loss, leaving sinews without nourishment, allowing pathogens to invade. The pathology is in the sinews and vessels; sinew contracture causes backward arching. The pathology is in the Blood; blood dryness causes sinew cramping. Zhongjing said: Taiyang disease, if too much sweat is induced, spasm results. Wind disease treated with purging leads to spasm. Patients with sores treated with sweating also develop spasm. This shows that most spasm cases result from iatrogenic errors, making excess and deficiency clear. Chen Wuyue identified the cause but was incomplete. He suggested external invasion by Wind-Cold-Damp-Heat makes Wind-Damp the primary pathogen, with deficiency secondary. He failed to realize that sweating inevitably damages Blood, and erroneous purging damages True Yin. Injury to Yin-Blood leads to Blood dryness; Blood dryness means sinews lose nourishment. Contracture, arching, and rigidity are inevitable consequences. Does one need Wind-Cold-Damp-Heat invasion to cause spasm? Must one suffer another pathogen to form spasm? Without pathogens, is there no spasm? If the focus is on dispersing Wind and removing Dampness, how can Blood dryness and Yin deficiency endure? Zhongjing associated spasm only with the Taiyang channel because the arching occurs in the back, where only the Taiyang and Du Mai channels run; mentioning Taiyang implies Du Mai. However, Zhongjing only discussed exterior patterns, not interior ones. The *Nei Jing* states: The Foot-Shaoyin channel penetrates the spine and connects to the Kidney; its straight branch rises from the Kidney through the Liver and Diaphragm. It also states: The Foot-Shaoyyin sinew runs along the inner spine, flanking the erector muscles up to the neck, knotting at the occiput, combining with the Foot-Taiyang channel. Furthermore: Disease of the Foot-Taiyang sinew causes spinal reversal and neck stiffness. Disease of the Foot-Shaoyyin sinew governs epilepsy, clonic seizures, and spasm. Yang diseases cause spinal reversal and inability to bend forward; Yin diseases cause inability to extend backward. Observing this, spasm involves both Taiyang and Shaoyin channels. The Bladder governs Jin-Ye (Body Fluids), and the Kidney stores Essence. Pathology in these two channels indicates Water deficiency. Treatment should prioritize True Yin.

Treatment Methods: Due to sweating or purging, Qi becomes deficient. Mild deficiency suits Sanyin Decoction (Three Yin Decoction) and Wufu Yin (Five Blessings Drink); severe deficiency with Yin excess and deep, fine pulse suits Daying Decoction (Great Camp Decoction) and Dabu Yuanyian Decoction (Great Tonification of Original Source Decoction). For excessive sweating, Sanyin Decoction, Shengui Tang (Ginseng and Angelica Decoction), and Renshen Jianzhong Tang (Ginseng Middle-Building Decoction) are suitable. For severe Yang deficiency, sweating, or Yang collapse, Shenfu Tang (Ginseng and Aconite Decoction), Fuzi Tang (Aconite Decoction), and Dabu Yuanyuan Decoction are suitable. For sweating accompanied by fire-heat dryness, Danggui Liuhuang Tang (Angelica Hexa-Huang Decoction) is suitable. Due to diarrhea, Weiguan Decoction (Stomach Gate Decoction) and Wenwei Yin (Warming Stomach Drink) are suitable. If diarrhea stops but spasm persists, Daying Decoction and Wufu Yin are suitable. If accompanied by Fire, with surging, rapid, slippery pulse and irritability/heat, Yiyin Decoction (One Yin Decoction) or Modified Yiyin Decoction is suitable. For severe Fire causing Yin-Blood exhaustion, Qinghua Yin (Clearing Transformation Drink) and Yuniu Jian (Jade Maiden Decoction) are suitable. If exterior pathogens remain unresolved, assess the severity of pathogens and Yin/Yang status. Slight fever with non-tight/non-rapid pulse indicates minor pathogens; simply tonify Zheng Qi with Wufu Yin. If exterior pathogens remain unresolved, Yin deficiency with no sweat, and body heat, Sanchasi Hu Yin (Three-Four Bupleurum Drink) and Buyin Yiqi Jian (Tonifying Yin and Boosting Qi Decoction) are suitable. If severe Yang deficiency, extreme Yin with fear of cold, and unresolved pathogens causing spasm, Dawenzhong Yin (Great Warming Middle Drink) is suitable. For abundant Phlegm, clear the Upper Jiao first. For Fire excess with Phlegm, Qingge Jian (Clearing Diaphragm Decoction) and Baolong Wan (Embracing Dragon Pill) are suitable. For Phlegm without Fire, Liu'an Jian (Six-Safe Decoction) is suitable. This condition mostly involves Deficient Phlegm and Deficient Fire; due to obstruction, temporary clearing is necessary. Once Phlegm-Qi opens slightly, regulate Qi and Blood. If accompanied by Dampness, follow Wang Haizang's method: Gang Jing uses Shenzhu Tang (Divine Efficacy Perilla Decoction) plus Qianghuo and Mahuang; Rou Jing uses Baizhu Tang (Atractylodes Macrocephala Decoction) plus Guixin and Huangqi.

Yu Jiayan stated: The *Suwen* says various spasms with neck stiffness belong to Dampness. *Qianjin Fang* expanded this, stating Taiyang Wind-stroke compounded by Cold-Damp transforms into spasm. This combines Wind, Cold, and Damp. *Jingui Yaolue* titles chapters on Spasm, Dampness, and Yue (Heatstroke), combining Heat, Dampness, and Heat. Yet Rou Jing and Gang Jing involve Wind-Cold. It also states excessive sweating causes spasm. Ancient and modern texts on spasm end here. Wang Haizang respected Zhongjing regarding spasm, showing great insight. Zhongjing cited only the Taiyang channel for spasm. Later practitioners, knowing it is Taiyang, used Guizhi Tang and Gegen Tang from *Jingui*, but found them ineffective, blaming Zhongjing's incompleteness. They failed to consider that external Six Excesses transmit from Taiyang through the Six Channels; if pathogens do not fully transmit, they persist, so all Three Yin and Three Yang can cause spasm. Though Zhongjing did not explicitly state this, his implicit meaning is clear: Taiyang transmitting to Yangming causes stiff neck and back; Shaoyang causes neck stiffness. Thus, all Three Yang have spasm. Do not Three Yin lack it? Wang Haizang said Three Yang and Taiyin cause spasm, omitting Shaoyin and Jueyin. He stated: Back arching belongs to Taiyang; looking down, limb traction, elbows/knees touching belongs to Yangming; unilateral eye deviation, unilateral limb tremor belongs to Shaoyang; fever, deep/fine pulse, abdominal pain belongs to Taiyin. Taiyin is treated with Fengwang Danggui Tang. Taiyang/Yangming spasm from excessive sweating is treated with Chaihu Plus Fengwang Tang. Shaoyang spasm from unresolved sweating with alternating chills/fever is treated with Zhi Fuzi San, Guixin Baizhu Tang, or Fuzi Fengwang San. Though omitting Shaoyin/Jueyin, the intent is there. His note on Baizhu Tang says "Upper resolves Three Yang, Lower pacifies Taiyin," implying transmission to Shaoyin/Jueyin leads to death. *Ling Shu* states Foot-Shaoyin sinew runs along inner spine to neck, combining with Taiyang sinew; pathology here governs epilepsy, clonic seizures, and spasm. Exterior Yang disease prevents bending forward; Interior Yin disease prevents extending backward. Thus, Foot-Shaoyin and Foot-Taiyang are interior/exterior pairs. Bending forward prevented indicates Taiyang exterior; extending backward prevented indicates Shaoyin interior. This distinction is precise. Taiyang governs exterior, so Yangming/Shaoyang govern exterior; Shaoyin governs interior, so Taiyin/Jueyin govern interior. Thus, Zhongjing's neck/back stiffness preventing forward bending refers to Taiyang spasm, encompassing Three Yang; body curling preventing backward extension refers to Shaoyin spasm, encompassing Three Yin. This is "drawing the bow without releasing the arrow." *Suwen* describes Kidney disease as preferring bloating, sitting on buttocks instead of walking, back replacing head, describing Shaoyin inability to extend backward. Haizang's description of looking down/elbow-knee contact is indeed Yin disease preventing extension, yet he labeled it Yangming spasm, which is inaccurate. Moreover, Zhongjing said: Shaoyin disease with diarrhea, if diarrhea stops, aversion to cold, curling up, warm hands/feet is treatable. Also: Shaoyin disease, aversion to cold, curling, occasional irritability, desire to remove covers is treatable, indicating warming therapy. For Taiyang with back aversion to cold, without waiting for curling, one should urgently warm Yin to prevent inability to extend. For Shaoyin with dry mouth/throat or pure green watery diarrhea, without waiting for neck stiffness, one should urgently purge Yang to prevent inability to bend. Visceral Yin excess has Fu signs first; Fu Yang extremity leads to visceral withering. These are subtle matters later scholars could not comment on. Additionally, children have fragile bodies and timid spirits, intolerant of external high fever, often developing spasm. Later generations named this Jing Feng (Startle Wind), using metallic/musk drugs, leading to death without realization. Postpartum women have empty Blood Chambers, susceptible to external Wind invading and causing spasm. Calling this Postpartum Startle Wind and prescribing blindly is lamentable.

The causes of spasm vary: external Six Excesses, excessive sweating, erroneous sweating in sore patients, erroneous purging in wind disease, fire blazing after moxibustion, inherent Yin-Blood deficiency, or inherent Yang Qi weakness. Thus, the root of spasm lies in either Loss of Yin or Loss of Yang. Loss of Yin: inherent deficiency of Jin-Ye, Essence, and Blood, unable to nourish sinews; urgent rescue of Yin is required. Loss of Yang: inherent thinness of Yang Qi, unable to fill and soften sinews; urgent rescue of Yang is required. Tonifying Yang when Yin is already depleted causes immediate Yin exhaustion; tonifying Yin when Yang is already thin causes immediate Yang exhaustion. Ignoring Shanghan, meridians, and pulse diagnosis leads to errors. No wonder mistakes occur.