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(The poem on Spasm states: The body is stiff and arched backward like a bow, consciousness is clouded similar to stroke, phlegm flows at the lips and mouth with twitching, spasms are identical to epilepsy.)

Xu Shuwei treated a patient whose neck was stiff and sinews were tight, unable to turn or shift position. Symptoms began in the afternoon and subsided by dusk. He believed this was due to wind pathogenic factors invading the Liver and Kidney organs. He stated that this illness must originate from the feet, as the tendons of the Shaoyin meridian ascend from the foot to the neck. Tendons are the external correspondence of the Liver. From noon to dusk is Yin within Yang, corresponding to the Lung metal. From Li (Wu hour) to Dui (You hour) is the time when Yin is prosperous and Yang is weak. Thus, *Lingbao Bi Fa* states: From Li to Qian, Kidney Qi is exhausted and Liver Qi is weak; the Liver and Kidney organs are invaded by pathogenic factors, hence the onset occurs at this time. Two papayas from Xuanzhou were used; the lid was removed and the pulp scooped out. Myrrh (2 liang) and Frankincense (2.5 qian) were placed inside the papaya, tied securely, and steamed over rice three to four times until soft, then ground into a paste. Each dose consisted of 3 qian, mixed with half a cup of fresh Rehmannia juice and two cups of unadulterated wine, warmed and taken warm. Simultaneously, Duliang Wan was administered, resulting in a cure.

Yi Silan treated Zongshi Yizhai, aged fifty-two, who had a history of indulgence in alcohol and sexual activity. In early September, he suddenly collapsed, fell into a coma, resembling stroke, with eyes closed, coarse breathing, cold extremities, rigid body, and locked jaw. Some diagnosed it as stroke, others as Qi stagnation or Phlegm obstruction; treatments with Wuyao Shunqi San and other formulas were ineffective. Another practitioner treated it as "Jia Yin" (concealed yin injury) using Fuzi Lizhong Tang, which exacerbated rattling phlegm. Five days later, Yi Silan was summoned. The six pulses were deep, fine, tight, and slippery, becoming more forceful upon pressure. Yi asked: "What disease is this?" The reply was: "Cold and dampness are struggling together; this is Spasm." Spasm belongs to the Bladder meridian; the primary treatment should be Qianghuo Shengshi Tang. First, Xixian San (one bi) was administered to induce vomiting of one to two bowls of phlegm, after which the stupor cleared. Subsequently, Shengshi Tang was given for six doses, leading to complete recovery. Bawei Wan was then used for conditioning for one month, restoring normal spirit. His brother Hongdao asked: "The disease lacks dizziness and tremors, so we know it is not stroke. However, it seems no different from stroke, phlegm obstruction, or Jia Yin. Why name it specifically as Spasm?" Yi answered: "Spasm arises from cold and dampness. Our royal clan tends to wear overly thick and warm clothing, so how could cold and dampness arise?" The *I Ching* states: This is caused by climate luck (Yunqi); those with deficient constitutions contract it. In the year Gui You, Wu and Gui transform into Fire. Gui represents deficient Fire. The classics state: When yearly Fire is deficient, Cold Water usurps its place. In late summer, Earth Qi is excessive. Earth is the child of Fire; the child avenges the mother, controlling Water. In the seventh and eighth months, the dominant Qi is Dampness, and the guest Qi is Water. Combined with Cold Water energy, Water is in command and does not submit to Earth's control. Thus, cold and dampness struggle together, causing Taiyang Qi to stagnate and fail to circulate. The main symptoms are stiffness in the spine, back, and neck, sudden inability to look back, waist feeling like it is broken, and neck feeling like it is pulled out. This is Spasm of the Bladder meridian. Hongdao said: "Spasm is formed by dampness. Wuyao Shunqi San moves Qi, guides out Phlegm, and removes dampness. Fuzi Lizhong removes cold. Why were they ineffective? Why did Shengshi Tang work quickly?" Yi said: "The key to recognizing disease lies in identifying pulse, form, and symptoms. The method of medication relies entirely on understanding meridians and Yunqi. When pulse and symptoms correspond, and medicines have meridian-guiding properties without violating Heavenly Harmony, considering the annual climate first ensures quick efficacy. The six parts of the pulse were all deep, fine, tight, and slippery. Deep indicates interior; Fine indicates dampness (this sentence is questionable; *Mai Jue* associates Ru pulse with dampness, not Xi pulse); Tight indicates Cold entering the interior; Forceful and Slippery indicate excess Cold and Dampness struggling together. If it were a deficiency pattern, the pulse would be tight and fine but not slippery. Physicians thought it was stroke; Wind pulses should be floating. Now it is not floating but deep, and there are no dizziness or tremor symptoms. Could it be stroke? Thought to be Qi/Phlegm obstruction; Phlegm/Qi pulses are not tight. Now the pulse is tight and the body is rigid. It is neither Qi nor Phlegm obstruction. Hence, diagnosed as Spasm. Previous use of Wuyao and Fuzi Lizhong Tang removed cold but not dampness, and dampness but not cold, without meridian-guiding drugs, how could they work? Shengshi Tang contains Cangzhu and Qianghuo, masters of the Taiyang meridian, clearing the whole body's joints; Fangfeng and Manjingzi overcome upper and lower dampness; Duhuo disperses Cold in the Shaoyin Kidney meridian. Once Cold and Dampness dissipate, how can the disease not heal?"

Zhang Luyu treated the young master of Gu Yihou in Wujiang, suffering from Rou Jing (Soft Spasm). He used Guizhi Tang and Liuwei Dihuang Wan, both added with Scorpion tails (Xiewei), resulting in a cure.

Zhu Danxi treated Wang Xiu, who suffered from severe Damp-Heat, foot pain, hand tendon spasm, and leg weakness. He prescribed Shengdi, Danggui, Chuanxiong, Baizhu (each 2 qian), Cangzhu (1 qian), Zhigancao roasted (3 fen), Mutong (5 fen), decocted in water to administer 30 pills of Dabu Wan. Dabu Wan must be fried warm before ingestion.

Zihe treated Old Man Ma from Xinzhai, aged fifty-nine. Because he failed to pay autumn taxes, he was beaten sixty strokes by officials, contracting Shock Qi, which developed into Feng Chu (Wind Twitching), lasting three years. During severe attacks, hands and feet trembled, unable to hold objects; eating required others to feed him; mouth and eyes opened wide, lips and tongue bitten raw; body shook like a puppet controlled by strings. Crowds gathered to watch each attack. At night, he felt feverish and removed all bedding. He spent his entire fortune seeking medical help, going bankrupt, yet the disease became more stubborn. Ma's son, an old minor clerk in the county, consulted Zihe. Zihe said: "This disease is very easy to treat. If it were midsummer, two applications of emesis (Yong) would remove the phlegm and cure it. Now, in autumn cold, sweating (Han) is indicated. If not cured, acupuncture at Shu points will surely cure it." First, Tongsheng San was used to induce sweating. Then, emetic agents were given, expelling three to four sheng of phlegm, clotted like chicken yolks, hot as boiling water. Due to hand tremors preventing self-probing, his wife probed his throat, causing swelling and injury to the pharynx, leading to stupor like drunkenness. After about one to two hours, he gradually regained consciousness, followed by several bowel movements. Immediately, his steps became lighter, tremors decreased, fever ceased, legs could walk, and hands could comb and dress himself. Before three emetic treatments, the disease was gone as if washed clean. Post-illness, he felt extreme cold. Zihe said: "Nourish with food; it will recede naturally." Since Wei Qi has not recovered after a major disease, dispersing Wind and guiding Qi is appropriate. Hot tonics must be avoided to prevent other diseases.

Commentary: This disease originated from Shock, involving depression/stagnation. Shock enters the Heart; if received, it causes Dian/Xian (Epilepsy). Here, the Heart did not receive it, but it transmitted to the Liver, causing spasms. This follows the principle of the Mother rescuing the Child. Liver disease conquers what it overcomes, generating Wind and Phlegm, producing unpredictable strange symptoms. Treatment via upper emesis and lower purgation follows the logic of simultaneous release and expulsion, which do not contradict each other. Zihe's case management for this symptom is particularly lawful.

An old man in Huangru village suffered from hand spasms and wheezing like sawing wood, unable to cover himself even in winter. Famous Physician Zhang, passing through Huyang en route to Huangru, had no time to prescribe medicine. He needled the Zhongzhu point above the posterior aspect of the great toe. He said: "There is no disease above the elbow; only hand spasms occur. This is what Zuo Shi called 'Wind Yin Mo Ji' (Wind affecting the extremities)." Alternatively, Houxi point (Hand Taiyang meridian) can be needled; located where the small finger bends and the crease ends.

Wanyan suffered from spasms, starting in the right arm and left foot, occurring about 60-70 times, with fixed gaze, stupor, and loss of recognition, lasting over a month. She sought treatment. First, 3-4 sheng of Cold-Phlegm was expelled. Next, Daoshui Yugong San was used to purge over twenty times. Then, Tongsheng San (acrid-cool formula) was taken, leading to recovery in a few days.

Xue Lizhai treated a woman with chronic internal heat and irregular menstruation. After menstruation, her limbs could not extend, keeping her bedridden for half a year. Treatments for Wind-Damp, Phlegm, and Fire showed no effect. Her pulse was floating and slow, slipping upon pressure. Named Spasm, attributed to Wind-Cold invasion. Jiawei Xiaoyao San plus Rougui and Fangfeng was used; four doses resulted in immediate relief. Bazhen Tang was then used for conditioning for over two months, leading to recovery.

Another woman, previously having delayed menstruation, suffered from inability to flex limbs due to labor and anger, named [Spasm]. This was Blood deficiency with Wind-Heat invasion. Bazhen Tang plus Gouteng and Chaihu was used initially for gradual improvement. Jiawei Xiaoyao San was added for conditioning, leading to full recovery.

Another woman with chronic Fire suddenly fell into stupor, experienced spasms, frequent stretching and yawning, limb tendon cramps, and rising phlegm-saliva. This was due to extreme dryness of Lung Metal and decline of Blood. Qingzao Tang was used, combined with Liuwei Dihuang Wan, leading to recovery soon.

Xue Lizhai treated a woman who, due to anger, had dripping menstruation lasting half a month. Upon anger, menstruation restarted; severely, she had locked jaw, tendon cramps, epistaxis, headache, phlegm-saliva, and twitching, with upward deviation of pupils. This was excessive Liver Fire. Xiao Chaihu Tang plus Shudi, Shanzhi, and Gouteng was used; no recurrence thereafter.

Another woman with chronic Yin deficiency suffered from generalized itching. Mistakenly taking Wind-dispelling drugs, she developed locked jaw and convulsions. Liver pulse was洪数 (Surging-Rapid). Xue said: "Liver Blood is Yin/Water; Liver Qi is Yang/Fire. This is Liver Meridian Blood deficiency with Fire excess." Tonify Yin/Blood, suppress Liver Fire using Siwu Tang, Maidong, Wuweizi, Gouteng, and Zhigancao for conditioning, leading to recovery.

Another woman postpartum had urinary incontinence, spontaneous sweating, red face, sometimes blue face, normal diet, and Liver pulse string-tight. This was Liver Meridian Blood dryness with Wind-Heat, classified as Spasm. Liver belongs to Wood, color Green; entering Heart makes it Red. Method: Nourish Yin/Blood, clear Liver Fire. Jiawei Xiaoyao San was used; several doses resolved all symptoms.

Xu Shuwei said: Zhang Decao, Vice Magistrate of Tongguan/Shexian, often spoke of his wife who suffered from tendon cramping, unable to flex/extend legs for over a year, requiring carrying when moving. He sought treatment from Yang Jilao of Sishui. Yang said: "This is a tendon disease. Take these three formulas for one year to cure." Spring/Summer: Yangxue Dihuang Wan (Shudi, Manjing, Shanzhuyu, Gouji, Difuzi, Baizhu, Ganqi, Qicao, Tianxiong, Cheqian, Bibi, Shanyao, Zexie, Niuxi). Autumn: Lingyang Tang (Lingyangjiao, Fuzi, Duhuo, Baishao, Fangfeng, Chuanxiong). Winter: Wutou Tang (Da Wutou, Xixin, Chuanjiao, Gancao, Qinjiao, Fuzi, Guanzi, Baishao, Ganjiang, Fuling, Fangfeng, Danggui, Duhuo).

Ma Yuanyi treated Mrs. Zhang, suffering from head/body trembling and hand/foot spasms, unresponsive to various treatments. Pulse was floating, deficient, and choppy. Floating indicates Qi deficiency; Choppy indicates Blood injury. Caused by worry, thought, labor, and depression, damaging the Yangming significantly. Yangming Stomach is the sea of Qi and Blood, binding sinews/bones and facilitating joints. If Qi/Blood are insufficient, sinews/nerves lose nourishment, causing trembling and restlessness. Zhongjing stated: "Sweating disturbs the channels; body trembling requires Fuling Guizhi Baizhu Gancao Tang." Sweating damages fluids, disturbing channels; how much more so when internal Qi/Blood are depleted? However, here external pathogens struggled with Fluid retention; thus, dispel fluid/pathogens to distribute fluids and nourish sinews/channels. This was damage from labor/depression; must strongly tonify Yangming to fill Qi/Blood throughout the body. Administered Ginseng and Milk; stabilized in two months.

Lizhai treated a man who developed Spasm after a cold, unconscious, with a three-cun patch of necrotic flesh rubbed off. This indicated Damp-Heat in the Bladder meridian; pulse was indeed rapid. He said: "This dead flesh is most toxic; remove it quickly, otherwise it will ulcerate healthy flesh, leading to death." Removal was performed; no pain was felt. Spasm continued, suspected to be triggered by removal. Said: "Wind-Heat persists." Patient refused, used Frankincense/Myrrh instead, worsening condition. Applied Wind-dispelling detoxification paste; used Chuntian Yin (Wind-dispelling, cooling blood, reducing fire, resolving phlegm) for cure. Jin Gongbu Zaiyang also suffered this after Typhoid, critically ill. Necrotic flesh removed, Shenxiao Danggui Gao applied, Neishu Huanglian Tang drunk. Delirium increased, pulse enlarged. Liangge San (two doses) followed by Siwu Tang plus Huangqin/Huanglian (several doses) led to cure. Those with sores often demand quick results; changing medicines after one or two doses without effect leads to error. One must consider disease severity and treatment urgency; expecting results in 2-3 doses is difficult. Sores involve deep, toxic, long-standing pathology with visible muscle damage, unlike invisible colds. How can results be expected overnight? Patients should reflect on this.

Wu Qiao treated Cheng Sisi, fat and white-skinned. Excessive application of sore medicines caused loose pores. Initially felt excessive sweating, worsening over time. Attacks brought sweat pouring like rain, cold reversal, opisthotonos, locked jaw, staring eyes, simultaneous phlegm/wheezing. After a long time, breath returned, urinary incontinence, unconsciousness, inability to speak. Condition deepened over ten days, occurring dozens of times daily. Physicians declined treatment. Wu Qiao examined prescriptions and said: "Classics state: Excessive sweating loses Yang. This is Rou Jing (Soft Spasm). You gentlemen missed it." He heavily used Renshen and [Ginseng root], then Fuzi, Guizhi, Shaoyao, then Longgu, Muli. Half a dose allowed sleep. Family thought he died, preparing to wail on the roof. Wu said: "Medicine acted correctly; sleeping indicates recovery, not death. Prepare porridge immediately." Soon, groaning and calling for porridge occurred. Small amount of soup taken; second dose cured. Recovered fully in three months. (*Taihan Ji*.)