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Zhang Zhongjing stated: Various cases of spasm (Jing, characterized by neck stiffness and convulsions) with neck rigidity all belong to dampness. He also said: In Taiyang disease (diseases affecting the Taiyang channel), excessive sweating can lead to spasm; if purgation is used for wind diseases, it leads to spasm, and subsequent sweating causes limb contraction and urgency. If sweating is induced in patients with sores/ulcers, it leads to spasm; these are caused by severe depletion of body fluids due to excessive sweating and purgation. Cases with sweating but no aversion to cold are called Soft Spasm (Rou Jing, spasm with sweating), because wind can scatter qi; Baizhu Tang (Atractylodes Macrocephala Decoction) added with Guixin (Cinnamon Twig) and Huangqi (Astragalus Root) is appropriate. Cases without sweating and with aversion to cold are called Hard Spasm (Gang Jing, spasm without sweating), because cold can obstruct blood flow; Gegen Tang (Kudzu Root Decoction) is appropriate. All these conditions result from internal injury to qi and blood, where sinews fail to receive nourishment and undergo changes; they are not caused by external wind. For changes resulting from beating injuries or labor-induced qi and blood deficiency, one should tonify qi and blood. If ineffective, use Dushen Tang (Single Ginseng Decoction); if accompanied by cold hands and feet, add Rongui (Cortex Cinnamomi) and Fuzi (Prepared Aconite Root). If treatment is delayed, rescue is unlikely. See Volume 5 of Miscellaneous Diseases for details.

One patient had internal ulceration with pus drained via needle puncture amounting to three to five bowls. Subsequently, a strong tonic was administered. The next day, high fever and sweating occurred, followed by cold feet, trismus (lockjaw), and opisthotonos (backward arching of the back). The collective physicians wished to administer diaphoretic agents. Xue Ji stated: This is spasm caused by extreme deficiency of qi and blood. If treated as external wind, it would be an error. Using Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) and similar medicines led to recovery. This condition often arises from excessive sweating and purgation in Shanghan (Cold Damage), or from qi and blood deficiency in postpartum women and ulcer patients. The proper approach is to regulate and tonify qi and blood. Administering attacking/depleting agents often leads to untreatable outcomes.

Another patient had been ill for over two months with unhealed sores. Due to anger, spasm occurred, and bleeding from the sores ensued. This was caused by anger stirring up Liver fire. Treatment with Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Shanzhi (Gardeniae Fructus), Fangfeng (Saposhnikoviae Radix), Jiegeng (Platycodonis Radix), Tianma (Gastrodiae Rhizoma), Gouteng (Uncariae Ramulus cum Uncis), and Gancao (Liquorice Root) resulted in immediate recovery.

Mr. Liu Zongnong stated: Spasm may arise from internal heat generated by wind-fire; from emotional disturbances, specifically anger; or from internal excess of damp-heat with phlegm-saliva obstructing the meridians. The appropriate treatment is to tonify deficiency and descend fire, strengthen Spleen earth to pacify Liver wood, and clear phlegm while removing dampness.

Another patient, after taking qi-moving agents, developed chest fullness, shortness of breath, poor appetite, fatigue, dark complexion, and thin pus. This indicated a syndrome of both physical form and primal qi being deficient. Initially, Liujunzi Tang (Six Gentlemen Decoction) added with Jiegeng (Platycodonis Radix) was administered for two doses to harmonize the chest and diaphragm qi. Subsequently, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used, with Shengma (Cimicifugae Rhizome) removed, and Fuling (Poria), Banxia (Pinelliae Tuber), Wuweizi (Schisandrae Fructus), and Maimendong (Ophiopogonis Radix) added. Primal qi gradually recovered, leading to healing. If the previous qi-moving agents had been used, they would have harmed the primal qi, likely leading to untreatable outcomes.