或问子疑《素问》痉因于湿，而又谓六淫之邪
皆能致痉，亦复有湿痉一条，岂不自相矛盾乎？曰∶吾所疑者诸字皆字，似湿之一字，不能包括诸痉，
惟风可以该括，一也；再者湿性柔，不能致强，初起之湿痉，必兼风而后成也。且俗名痉为惊风，原有
急慢二条。所谓急者，一感即痉，先痉而后病；所谓慢者，病久而致痉者也。一感即痉者，只要认证
真，用药确，一二帖即愈，易治也。病久而痉者，非伤脾阳，肝木来乘；即伤胃汁肝阴，肝风鸱张，一虚
寒，一虚热，为难治也。吾见湿因致痉，先病后痉者多，如夏月小儿暑湿泄泻暴注，一昼夜百数十
行，下多亡阴，肝乘致痉之类，霍乱最能致痉，皆先病后痉者也。当合之杂说中《风论》一条参看。以
卒得痉病而论，风为百病之长，六淫之邪，皆因风而入。以久病致痉而论，其强直背反螈 之状，皆
肝风内动为之也。似风之一字。可以包得诸痉。要知痉者筋病也，知痉之为筋病，思过半矣。
六淫致痉，实证也；产妇亡血，病久致痉，风家误下，温病误汗，疮家发汗者，虚痉也。风寒、风湿
致痉者，寒证也；风温、风热、风暑、燥火致痉者，热痉也（按此皆螈证属火，后世统谓之痉矣，后另有
论）。俗称慢脾风者，虚寒痉也；本论后述本脏自
病者，虚热痉也（亦系螈证）
有人问：我怀疑《素问》认为痉病是由于湿邪引起的，但又说六淫之邪都能导致痉病，并且专门列出一条关于湿痉的论述，这岂不是自相矛盾吗？回答说：我所疑惑的是，“诸”字泛指各种情况，似乎“湿”这一个字，不能包括所有的痉病，只有“风”才可以概括全部，这是第一点；再者，湿的性质柔顺，不能导致身体强直，初起时的湿痉，必定兼有风邪才能形成。而且俗名将痉病称为惊风，原本就有急性和慢性两条。所谓急性的，是一感邪即发痉病，先出现痉病症状而后有其他病症；所谓慢性的，是患病日久才导致痉病的。一感邪即发痉病的，只要辨证准确，用药确切，一二剂药就能痊愈，容易治疗。患病日久才发痉病的，不是损伤了脾阳，导致肝木乘虚克制脾土；就是损伤了胃汁和肝阴，导致肝风鸱张（形容肝风内动之势猛烈），一种是虚寒证，一种是虚热证，都难以治疗。我看见因湿邪导致痉病，先有其他病症后出现痉病的很多，比如夏季小儿因暑湿泄泻暴注（急剧腹泻），一昼夜达百数十次，下利过多导致亡阴，肝木乘虚致痉之类，霍乱最能导致痉病，都是先有其他病症后出现痉病的。应当结合杂说中的《风论》一条参看。从突然得痉病来看，风为百病之长，六淫之邪，都是因风而入体。从久病导致痉病来看，其身体强直、角弓反张、抽搐的症状，都是肝风内动造成的。看来“风”这一个字，可以包罗所有的痉病。要知道痉病是筋脉的病变，知道痉病属于筋脉病变，就理解了一大半了。
六淫导致痉病，属于实证；产妇失血，久病导致痉病，治风家误用攻下法，治温病误用发汗法，治疮家误用发汗法的，属于虚痉。风寒、风湿导致痉病的，属于寒证；风温、风热、风暑、燥火导致痉病的，属于热痉（按：这些都属于抽搐证属火，后世统称为痉病了，后面另有论述）。俗称慢脾风的，属于虚寒痉；本论后面叙述的本脏自病的，属于虚热痉（也属于抽搐证）。
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).