bubble_chart Concept

Spasm of limbs refers to the symptoms of tightness and stiffness in the hands and feet, with difficulty in flexion and extension.

This condition has been extensively discussed in Neijing. For example, "拘急" (Liuyuan Zhengji Da Lun), "muscular spasm" (Shicongrong Lun), "䯒急攣" (Jue Lun), and "攣節" (Nitiao Lun). In the "Cold-Damage Disease Treatise," there are also records of "spasm of limbs," "兩脛拘攣," and "腳擘急."

Tightness and stiffness are different from rigidity, spasm, and tremor. Rigidity refers to hard muscles that can be extended but not flexed. Spasm refers to the mutual pulling of the limbs during extension and contraction. Tremor refers to the shaking and trembling of the limbs, which should be clinically distinguished. Finger spasms are discussed separately in a dedicated section.

bubble_chart Pattern Analysis

1. External Contractionwind-cold︰fever aversion to wind and cold, stiffness in the neck and back, spasm of limbs, sweating or without sweating, headache and body pain, thin white and moist tongue coating, floating and tight pulse. Mostly caused by the invasion of wind-cold pathogens into the Taiyang Meridian, leading to obstruction of meridian qi. The contracting nature of cold results in spasm of limbs, stiffness in the neck and back, headache, and aching joints. Treatment should focus on dispelling wind and dispersing cold, soothing sinews and harmonizing collaterals. For severe cold without sweating, use Pueraria Decoction; if sweating is present, use Trichosanthis Fruit Cinnamon Twig Decoction.
2. Accumulation of Cold-dampness︰Head feels wrapped, limbs heavy and fatigued, epigastric stuffiness with anorexia, puffy and dull complexion, reversal cold of hands and feet, spasm of limbs, or accompanied by joint and muscle heaviness with aching pain, pale and swollen tongue with white greasy coating, deep and slow pulse. Mostly caused by cold-dampness invasion or constitutional yang deficiency with dampness excess. Cold induces contraction, dampness is sticky and stagnant, sinews and vessels are constrained by cold-dampness, leading to disharmony of qi and blood, hence spasm and contraction of limbs. Treatment should focus on warming yang and draining dampness, using modified Stomach Poria Decoction.
3. Dampness-heat︰Feverish body with heavy limbs, heaviness of head as if wrapped, epigastric fullness and anorexia, nausea with a tendency to vomit, spasm of limbs with tightness, feverish feeling in palms and soles, yellowish urine, red and enlarged tongue texture with yellow greasy coating, slippery and rapid pulse. Mostly caused by exposure to dampness-heat pathogens, or spleen deficiency with excessive dampness, dampness stagnation transforming into heat, dampness-heat accumulation leading to dry tendons and membranes, resulting in tendon tension and spasm. Suwen. Shengqi Tongtian Lun states: "Due to dampness, the head feels as if wrapped; if dampness-heat is not dispelled, the large tendons become soft and short, the small tendons slack and long—softness and shortness lead to contraction, slackness and length lead to flaccidity." Treatment should focus on clearing heat and drying dampness, using modified Two Wonderful Herbs Powder.
4. Exuberant Heat and Yin Deficiency︰The fever is intense, with neck stiffness, spasms of the limbs, and even convulsions. Urine is scanty and dark, stools are dry and accumulated, or there may be confusion, delirious speech, upward staring of the eyes, head shaking, red lips, dry throat, a red tongue with yellow and dry coating, and a wiry, rapid pulse. This is often caused by external contraction of warm febrile disease pathogens; or by overacting of the five minds, internal damage from overstrain, imbalance of visceral qi, excessive yang and fire, scorching and damage to yin fluids, and contraction of the sinews and vessels, which may even trigger liver wind convulsions unceasingly. Treatment should focus on clearing warmth and draining heat, pacifying the liver and extinguishing wind. The recommended formulas are Palace-Clearing Decoction combined with Antelope Horn and Uncaria Decoction with modifications.
5. Yang Exhaustionliquid Collapse︰Vomiting, diarrhea, profuse sweating, aversion to cold, cold and cramped extremities, pale tongue with thin white coating, deep or faint and thin pulse. Mostly caused by persistent vomiting, diarrhea, or profuse sweating leading to yang exhaustion and liquid collapse. Yang exhaustion results in loss of warmth to the tendons, while liquid collapse leads to lack of nourishment to the vessels, hence the contraction of tendons and vessels, and spasm of limbs. Treatment should focus on restoring yang to rescue from collapse, using Cold-Extremities Decoction with the addition of Ginseng.
6. Liver Blood Deficiency︰Blurred vision, dizziness, tinnitus, numbness of the skin, muscular twitching, spasm of the limbs, pale nails, pale tongue texture, and wiry-thin pulse. Mostly caused by excessive loss of blood or spleen deficiency failing to transport the essence of water and grains, leading to no source for generation and transformation, resulting in the lack of nourishment to the tendons and vessels, hence the spasm and curling of the limbs. Liver blood deficiency is due to insufficient nutrient-blood, which develops gradually. Treatment should focus on tonifying blood and nourishing the liver. The recommended formula is Four Ingredients Decoction with modifications.

The differentiation of the syndrome of spasm and tension primarily lies in distinguishing between external contraction and internal damage. External contraction of wind-cold, warm-heat, cold-dampness, or dampness-heat can all lead to illness. Internal damage, on the other hand, is often due to insufficiency of yin blood or decline of yang qi, and should be carefully discerned based on the disease cause and clinical symptoms and signs.

bubble_chart Documentation

1. Zhubing Yuanhou Lun．Wind causing stiffness and inability to flex or extend the limbs: "This is due to physical weakness, the striae and interstices opening, and wind evil residing in the sinews. Encountering impediment in spring leads to sinew impediment, causing the sinews to contract. Xieke the joints, leading to muscular spasm; Xieke the taiyang network in the foot, causing stiffness and tension in the shoulders and back. The foot jueyin is the liver's channel, and the liver governs all sinews, flourishing in spring. When its channels and collaterals are weak, encountering wind evil injures the sinews, causing stiffness and spasm in the limbs, making them unable to flex or extend."