Pediatric five stiffness refers to symptoms such as stiffness and inflexibility in the head, neck, hands, feet, chest, diaphragm, muscles, and other areas, making it difficult to bend, stretch, or move.

In ancient literature, the content of pediatric five stiffness was not entirely consistent. For example, the "Gujin Yitong" states: "The head is stiff and cannot look down, the chest and diaphragm are congested, the palms and soles of the feet are cold as ice and stiff, known as five stiffness." Youke Tiejing refers to a condition where the liver is affected by wind pathogens, causing the head, neck, hands, and feet to become stiff like wood. Youyou Jicheng names hand stiffness, foot stiffness, waist stiffness, muscle stiffness, and neck stiffness as five stiffness.

This condition is commonly seen in infants and young children under two years of age. If deficient early treatment or improper treatment is administered, it often becomes a chronic condition or life-threatening.

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1. Fetal Cold︰The newborn has a weak constitution, with coldness throughout the body, cool limbs, lying stiffly with little movement, breathing with the head tilted back, weak breath, faint and feeble crying, inability to suckle, localized skin stiffness, pale or slightly purplish-dark lips and tongue, thin white coating, deep and faint pulse, and pale and sluggish finger venules. This condition is commonly seen in premature or weak newborns due to insufficient innate fetal endowment, severe deficiency of genuine yang, and inadequate qi and blood; or due to cold weather, improper care, and inadequate warmth; or postnatal exposure to other illnesses, further depleting yang qi, leading to cold congealing and blood stagnation, obstructed qi and blood circulation, and yang qi failing to warm the skin and nourish the extremities. As a result, the skin is cold, stiff, and inflexible, making it difficult to bend, stretch, or move; accompanied by faint and weak crying, feeble breath, poor activity, and inability to suckle—symptoms and signs of yang deficiency, qi weakness, and blood stagnation. Treatment should focus on tonifying qi and warming yang, using Ginseng and Aconite Decoction, along with proper warmth and care. Wind-cold congealing into five stiffnesses is mainly caused by wind-cold stagnation, preventing yang qi from circulating freely and impairing the nourishment of qi and blood. This leads to the loss of warmth in the head, neck, chest, diaphragm, muscles, and limbs, resulting in stiffness and inflexibility, making it difficult to bend, stretch, or move. Treatment should prioritize dispelling wind and dispersing cold, while also harmonizing qi and blood, using Minor Life-Prolonging Decoction. For milder cases, Lindera Qi-Regulating Powder may be used.
2. External Contractionwind-cold︰Stiffness and rigidity of the head and neck, difficulty in turning, stiff and cold extremities, head tilting back while breathing, bluish complexion and cold breath, qi stagnation and pain extending to the chest and diaphragm, pale tongue texture, white tongue coating, deep and faint pulse manifestation, and faint and stagnant finger veins that are not prominent. $Fetal cold five stiffness and wind-cold five stiffness! Both conditions are often caused by yang deficiency in the child’s constitution, compounded by exposure to cold pathogens. Fetal cold five stiffness is commonly seen in premature or weak newborns due to congenital fetal endowment insufficiency, severe deficiency of true yang, and inadequate qi and blood. It may also result from cold weather, improper care, insufficient warmth, or postnatal exposure to other illnesses, further depleting yang qi. Cold congeals and stagnates the blood, impairing the smooth flow of qi and blood, and yang qi fails to warm the skin and nourish the extremities. Consequently, the skin becomes cold, stiff, and inflexible, making it difficult to bend, stretch, or move. Additional symptoms and signs include weak and faint crying, feeble breath, poor activity, and inability to suckle, all indicative of yang deficiency, qi weakness, and blood stagnation. Treatment should focus on tonifying qi and warming yang, and Ginseng and Aconite Decoction may be used, along with proper warmth and care. Wind-cold congealing five stiffness primarily arises from wind-cold stagnation, preventing yang qi from dispersing and leading to inadequate nourishment of qi and blood. As a result, the head, neck, chest, diaphragm, muscles, and extremities lose warmth, manifesting as stiffness and inflexibility, making movement difficult. Treatment should prioritize dispelling wind and dispersing cold, while also harmonizing qi and blood. Minor Life-Prolonging Decoction is recommended, or for milder cases, Lindera Qi-Regulating Powder may be used.
3. Liver and Spleen Disharmony︰The limbs are stiff and convulsive, with poor appetite and weak qi, and the blue veins of the abdomen are faintly visible. The muscles are tense, tight, and unrelaxed. In severe cases, the face turns blue and the abdomen becomes hard, the tongue is blue with white coating, the pulse is wiry and thin, and the fingerprints appear bluish-purple. This is mostly due to spleen deficiency leading to insufficient transformation and nourishment, liver excess causing disharmony of the tendons and vessels, and wood overacting on earth, resulting in spleen qi failing to nourish the extremities. Hence, symptoms such as cold and stiff hands and feet, as well as tendon and vessel spasms, are observed. Generally, it is also accompanied by retention of food, manifesting as a hard abdomen, poor appetite and weak qi, blue veins of the abdomen, tightness, and lack of relaxation. Treatment should focus on warming and activating spleen yang, resolving food retention, and relieving spasms. The modified Six Gentlemen Decoction can be flexibly applied for treatment.

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1. Yixue Gangmu．Pediatrics．Five Stiffnesses and Five Types of Flaccidity: "The five stiffnesses refer to conditions like convulsions, as mentioned in the classics, where sudden rigidity and stiffness are all attributed to wind. The five types of flaccidity refer to conditions like atrophy."