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Questioner: I suspect that the *Suwen* (Plain Questions) attributes spasm to dampness, yet it also states that all six exogenous pathogens can cause spasm, and specifically lists a category of dampness-induced spasm. Is this not self-contradictory?

Responder: My doubt lies in the word "all" (zhu). It seems that "dampness" alone cannot encompass all types of spasm; only "wind" can cover them all. This is the first point. Furthermore, the nature of dampness is yielding and soft; it cannot cause rigidity. Initial dampness-induced spasm must be accompanied by wind to form. Moreover, in common parlance, spasm is called "startled wind" (Jingfeng), which originally has two categories: acute and chronic. The so-called "acute" type involves immediate onset of spasm upon pathogen invasion, where spasm precedes other symptoms. The so-called "chronic" type involves spasm resulting from prolonged illness. In cases where spasm occurs immediately upon invasion, if the pattern is correctly identified and medication accurately prescribed, recovery can occur within one or two doses; this is easy to treat. In cases where spasm results from prolonged illness, it is either due to damage to Spleen Yang, allowing Liver Wood to overact on the Spleen; or due to damage to Stomach fluids and Liver Yin, causing vigorous stirring of Liver Wind. One is a deficiency-cold pattern, the other a deficiency-heat pattern; both are difficult to treat. I have observed many cases of spasm caused by dampness where other illnesses preceded the spasm. For example, in summer, children suffering from severe diarrhea due to summerheat-dampness may defecate dozens of times a day. Excessive downward discharge leads to loss of Yin, and Liver Wood overacting causes spasm. Cholera is particularly prone to cause spasm; these are all cases where other illnesses precede spasm. These should be read in conjunction with the "Treatise on Wind" in miscellaneous discussions. Regarding sudden onset of spasm, wind is the leader of a hundred diseases, and all six exogenous pathogens enter through wind. Regarding spasm caused by prolonged illness, the manifestations of rigidity, opisthotonos, and convulsions are all caused by internal movement of Liver Wind. Thus, it seems the word "wind" can encompass all spasms. One must know that spasm is a disease of the sinews. Understanding that spasm is a disorder of the sinews constitutes more than half of the understanding.

Spasm caused by the six exogenous pathogens belongs to excess patterns. Spasm resulting from blood loss in postpartum women, prolonged illness, erroneous purgation in wind-patterns, erroneous sweating in warm diseases, and erroneous sweating in skin lesion patients belongs to deficiency spasm. Spasm caused by wind-cold and wind-dampness belongs to cold patterns. Spasm caused by wind-warmth, wind-heat, wind-summerheat, and dryness-fire belongs to heat spasm (Note: These all belong to convulsion patterns associated with fire; later generations collectively termed them as spasm; there is a separate discussion later). What is commonly known as slow spleen wind belongs to deficiency-cold spasm. What is described later in this treatise as the primary organ affecting itself belongs to deficiency-heat spasm (also belonging to convulsion patterns).