bubble_chart Concept

Stiffness of the limbs refers to two conditions: one is the rigidity of the muscles and tendons of the limbs, where the limbs are extended and cannot be flexed; the other is the stiffness of the joints of the limbs due to some reason, resulting in the inability to flex or extend.

As early as in the book Neijing, there is a record of "stiffness". Subsequent literature often describes this symptom in Rebing and wind diseases, mostly referring to the rigidity and extension of the limbs. Additionally, prolonged pain and numbness, lack of nourishment to the tendons and vessels, leading to fixed joints and inability to flex or extend, is often referred to as stiffness of the limb joints. This entry discusses both of these conditions.

Spasmodic contraction is different from stiffness; it refers to the constriction and flexion of the limbs, with the muscles of the hands and feet contracting and unable to extend or flex, thus differing from the aforementioned stiffness.

Opisthotonos refers to the stiffness of the head and neck, with the back bending and arching backward, which is different from the stiffness of the limbs.

Constriction refers to the spasm and contraction of the limbs, making it difficult to extend, thus also differing from the aforementioned stiffness.

Spasm of the limbs refers to the twitching of the limbs, which is different from the stiffness of the limbs and the inability to move.

The syndrome of wind phlegm surging upward (such as in epilepsy) often presents with stiffness of the limbs before the onset of generalized convulsions; patients with liver depression and blood deficiency (such as in visceral agitation) often experience stiffness and spasm of the limbs due to the surging of liver qi to the chest and heart after anger. The differential analysis of these two conditions will be discussed in the entry on limb spasms. Warm febrile diseases often lead to heat stirring liver wind, resulting in spasms, stiffness, and opisthotonos of the limbs, such as in wind-warmth, summerheat warmth, and dampness warm diseases, which will also be differentiated in the entry on limb spasms.

bubble_chart Pattern Analysis

1. Wind-cold Dampness Obstructing Collaterals︰It often manifests as prolonged arthralgia, stiffness and inflexibility of the limb joints, fixed joints, pain in the joints and muscles, occasional swelling, and over time, muscle wasting may be observed. When wind qi predominates, there is migratory pain in the limbs; when cold qi predominates, there is fixed cold pain in the limbs; when dampness qi predominates, there is heaviness, soreness, and pain. The tongue is pale white with a white or greasy coating, and the pulse is deep, wiry, and tight, or wiry and slippery. It is mostly caused by external pathogens invading the meridians, leading to prolonged limb arthralgia, obstruction of meridian qi and blood flow, compounded by immobility due to pain, worsening qi stagnation and blood stasis, and malnutrition of the tendons around the joints, resulting in joint stiffness and inflexibility. When wind-cold-dampness pathogens are involved, there is pain in the limbs, either migratory or fixed and heavy, with local swelling but no redness. For wind qi predominance, use the method of dispersing wind, dredging meridians, and activating collaterals, modified with Saposhnikovia Root Decoction; for cold qi predominance, use the method of warming meridians, dissipating cold, and harmonizing collaterals, modified with Aconite Main Root Decoction; for dampness qi predominance, use the method of invigorating the spleen, draining dampness, and unblocking collaterals, modified with Coix Seed Decoction.
2. Invasion of Wind Pathogen︰Fever and chills, stiff neck and head, rigid limbs, joint pain, and in severe cases, opisthotonos and lockjaw with inability to open the mouth, white and greasy tongue coating, and wiry-tight pulse. If caused by wind-heat or pathogenic wind transforming into heat, there may be high fever, red tongue, yellow coating, and rapid pulse. The transformation of heat is not limited to the meridians but can also invade the zang-fu organs. In addition to rigid limbs, there are often accompanying symptoms such as fever with aversion to wind, stiff neck, opisthotonos, lockjaw with inability to open the mouth, frequent convulsions, and even unconsciousness. The treatment involves clearing heat and extinguishing wind, using Antelope Horn and Uncaria Decoction or Liquid-Increasing Purgative Decoction combined with Jade-like Vitality Powder with modifications.
3. Dampness-heat︰It is often accompanied by dampness-heat arthralgia symptoms. If prolonged, the limbs become stiff, and the joints of the limbs cannot flex or extend. The joints are red, swollen, and painful, and multiple nodular erythema can be seen on the skin of the ankles. The patient has fever, a head feeling as if wrapped, and limb fatigue. Over time, the muscles of the limbs may become emaciated, the joints may become red, swollen, and enlarged, the tongue may appear red at the edges and swollen with a yellow, greasy coating, and the pulse may be wiry, slippery, and rapid. It is mostly caused by external pathogens invading the meridians/channels, leading to prolonged limb arthralgia. The qi and blood in the meridians/channels become obstructed and flow poorly. Additionally, due to pain, the limbs cannot move, further aggravating qi and blood stasis. The tendons and vessels around the joints lose nourishment, causing the joints to stiffen and preventing flexion and extension. In cases caused by dampness-heat pathogens, there is burning distending pain, along with local redness and swelling or painful nodular erythema around the joints. For cases dominated by dampness, the method of invigorating the spleen and draining dampness to unblock the collaterals is used, with modifications of Coix Seed Decoction. For cases of dampness-heat obstructing the collaterals, the method of clearing heat and draining dampness to unblock the collaterals is employed, with the formula selected as modified Two Wonderful Herbs Powder.
4. Phlegm-fire Stirring Wind︰The onset is often sudden, with excessive extension and rigidity of the limbs, making them unable to bend, stiff neck, and possible convulsions. The face may be red, breathing may be labored, and there may be fever, unconsciousness, and phlegm sounds in the throat. The tongue is red with yellow, greasy coating, and the pulse is wiry, slippery, and rapid. In cases of phlegm-fire stirring wind, the condition often arises from an inherently excessive dampness constitution, with the patient presenting a lump at the left hypochondrium and deficiency. When triggered by overacting of the five minds, it transforms into fire and stirs wind, causing phlegm-fire to surge upward to the vertex. This differs from general apoplexy hemiplegia, as it often affects both sides of the body, progresses violently, and is accompanied by severe headache, vomiting, and rapid unconsciousness. Treatment should focus on clearing up phlegm and purging fire, cooling the nutrient level and opening the orifices. First, use Peaceful Palace Bovine Bezoar Pill or Supreme Treasured Pill, followed by Qi-Clearing and Phlegm-Resolving Pill modified as a decoction with adjustments.
5. Internal Stirring of Liver Wind︰The patient usually exhibits symptoms of hyperactivity of liver yang, such as dizziness, headache, tinnitus, blurred vision, irritability, facial flushing, and red eyes. Occasionally, sudden episodes may occur, manifesting as a stiff tongue and slurred speech, clouded consciousness, and coarse breathing, which rapidly progress to hemiplegia or hyperextension and rigidity of both upper and lower limbs, though the wrists are often flexed with fingers clenched together. There may also be intermittent convulsions, a red tongue with dry yellow coating, and a wiry, rapid pulse. Liver yang transforming into wind often arises from preexisting hyperactivity of liver yang, but it can also be triggered by excessive emotional agitation or strenuous heavy lifting, leading to an upward surge of blood and qi. This condition differs from typical apoplexy with hemiplegia, as it often affects both sides of the body, progresses violently, and is accompanied by severe headache, vomiting, and rapid loss of consciousness. Treatment involves pacifying the liver and subduing yang, cooling the nutrient level, and opening the orifices. The Peaceful Palace Bovine Bezoar Pill may be administered first, followed by modified Antelope Horn and Uncaria Decoction.
6. Liver and Kidney Deficiency︰The patient experiences dizziness, blurred vision, tinnitus like cicadas, insomnia, forgetfulness, irritability, uncontrollable crying and laughing, dull expression, intellectual impairment, appearing demented or foolish, and even unconsciousness. The limbs gradually become stiff, with difficulty swallowing and choking, the lower limbs extended and rigid while the hands are flexed. Despite unconsciousness, the eyes remain open. The tongue is pale red, and the pulse is wiry, thin, and weak, especially at the chi position. This may be due to aging and physical decline, improper rest, {|###|}yin-yang disharmony{|###|}, or insufficiency of liver and kidney essence, unconsolidated kidney qi, and internal stirring of deficient wind. The treatment involves {|###|}nourishing water to moisten wood{|###|}, using a modified Six-Ingredient Rehmannia Pill combined with Three-Carapace Pulse-Restoring Decoction with adjustments.
7. Qi Stagnation and Blood Stasis︰Often there is first external injury or poisoning, followed by stiff and rigid limbs that cannot bend, eyes open yet unconsciousness and inability to recognize people or speak, incontinence of urine and feces, and over time scaly skin. The tongue is pale red, possibly with static blood spots, a thin white coating, and a deep, thin, choppy pulse. Over time, symptoms such as pale complexion, spontaneous sweating, and a pale white tongue may appear. It is mostly caused by head trauma, birth injury, static blood stagnation, or chaotic qi movement. Treatment involves tonifying qi, resolving stasis, and unblocking collaterals. The recommended formula is Yang-Tonifying Five-Returning Decoction with modifications.
8. Yang Qi Deficiency and Decline︰The limbs are rigid, the complexion is pale, there is reversal cold of the hands and feet, the spirit is unclear, the patient is silent, the eyes are open but do not recognize people, the limbs may occasionally twitch, there is incontinence of urine and stool, the tongue is pale with thin white and moist fur, and the pulse is deep, thin, rough, and knotted. This is mostly caused by prolonged illness depleting and damaging the body, leading to the outward leakage of yang qi, resulting in the sinews and vessels losing warmth. The method of warming yang and invigorating blood to resolve stasis should be used, and Cinnamon Twig plus Aconite Decoction can be employed with the addition of blood-activating and stasis-resolving medicinals.

In the differentiation of the condition of rigid limbs, two situations must be noted. One is the pain caused by wind-cold dampness or dampness-heat obstructing the collaterals, which over time leads to the inability to flex and extend the joints, resulting in fixation. The other situation is the rigidity of the limb muscles caused by phlegm-fire or liver yang transforming into wind. The disease causes and mechanisms of disease are different in these two cases, and so are the treatment methods. As for the invasion of wind evil, which transforms into heat and attacks the zang-fu organs, the condition is critical and must be carefully distinguished.

bubble_chart Documentation

1. Suwen-Zhizhenyao Da Lun: "All sudden muscular spasm and rigidity is ascribed to wind.。"
2. Jingyue Quanshu-Convulsive Disease: "Indeed, erroneous diaphoresis (sweat-inducing therapy) inevitably damages the blood and fluids, while misguided purgation invariably injures the true yin. When yin-blood is impaired, blood dryness ensues; blood dryness then deprives the tendons of nourishment. Deprived of this nourishment, the tendons manifest as spasms, convulsions, rigidity, and opisthotonos—such pathological developments become inevitable."