此症皆因发汗太过。邪热未解。血气已伤。筋肉失养所致。宜大补气血。人参养荣汤之类。
邵评∶惕、抽掣也。 、跳动也。筋惕肉 。因血液亏少。热邪内伏。筋肉无液滋养。热
入阴中而燔灼。致筋抽而肉跳。乃虚候也。故治以大补气血之法。
若未经过表。由其人素禀血少。邪热传于血脉之中。火性动惕而然。当作血虚火
燥生风治。宜加味逍遥散。去白术。加生地、钩藤。（此条参西塘感症）
邵评∶未经表汗而筋抽肉跳。由其人素禀血虚。不待汗而阴液已伤。邪热入于
阴分。阴亏火旺。血热生风。故见此症。治以清营化邪。滋液熄风之法。与上条之汗后纯虚不同。
若伤寒未经过汗。六七日经脉动惕。其肉不 。潮热谵语。大便闭结。小便赤涩。以
手按脐旁硬痛。此有燥矢也。加味大柴胡汤。
邵评∶此是实热。与上之虚症大异。当合参之。
如伤寒十余日。曾三四次发汗过多。遂变肉 身振。筋脉动惕。此因汗多伤其气血。加味
人参养荣汤主之。
邵评∶伤寒日久不解。正气已虚。又复发汗过多。阴血亦耗。气血两虚。筋肉失于
滋养。而见 振动惕之症。宜大补气血为治。
如汗后虚烦不得眠。筋惕肉 。此血虚兼火也。十味温胆汤。去五味。加柴、芍、川连。
邵评∶汗后虚烦。肝胆有火。阴亏挟痰。故见不眠惕 等症。宜用补气化痰两和
胆胃之法。
此病症皆因发汗太过，导致邪热未解而血气已伤，筋肉失于滋养所致。治疗宜大补气血，可用人参养荣汤（Ren Shen Yang Rong Tang, Ginseng and Blood-Nourishing Decoction）之类方剂。
邵评：惕（Ti, palpitation/twitching）、抽掣（Chou Che, convulsion/spasm）是指筋脉抽搐；肉（Rou, twitching/jerking）是指肌肉跳动。筋惕肉（Jin Ti Rou, muscle twitching and trembling）是由于血液亏少，热邪内伏，筋肉缺乏津液滋养，热邪深入阴分而燔灼，导致筋脉抽搐、肌肉跳动，这属于虚证候。因此治疗应采用大补气血的方法。
若未经过表证阶段（即未发汗），由于患者素体血少，邪热传入血脉之中，火性主动导致惕动，应按血虚火燥生风来治疗。宜用加味逍遥散（Jia Wei Xiao Yao San, Modified Free and Easy Wanderer Powder），去掉白术（Bai Zhu, Atractylodis Rhizoma），加入生地（Sheng Di, Rehmanniae Radix）、钩藤（Gou Teng, Uncariae Ramulus cum Uncis）。
邵评：未经发汗而出现筋抽肉跳，是由于患者素体血虚，尚未发汗而阴液已受损。邪热进入阴分，导致阴亏火旺，血热生风，故出现此症。治疗应以清营化邪、滋液熄风为法。这与上一条所述汗后纯虚的情况不同。
若伤寒病未经过发汗，经过六七日，经脉动惕，肌肉不跳动，伴有潮热（Chao Re, tidal fever）、谵语（Chan Yu, delirium）、大便闭结、小便赤涩，用手按压脐旁感到硬痛，这是有燥屎（Zao Shi, dry feces/impaction）积聚。宜用加味大柴胡汤（Jia Wei Da Chai Hu Tang, Modified Major Bupleurum Decoction）。
邵评：此为实热证，与上述的虚证截然不同，应当综合参详。
如伤寒十余日，曾三四次发汗过多，遂变为身体振颤、筋脉动惕。这是因为汗出过多损伤了气血，宜用加味人参养荣汤主治。
邵评：伤寒日久不解，正气已虚，又再次发汗过多，导致阴血耗损，形成气血两虚，筋肉失去滋养，而出现振颤动惕的症状。治疗宜大补气血。
如发汗后出现虚烦不得眠，伴筋惕肉，这是血虚兼有火邪。宜用十味温胆汤（Shi Wei Wen Dan Tang, Ten-Ingredient Gallbladder-Warming Decoction），去掉五味子（Wu Wei Zi, Schisandrae Fructus），加入柴胡（Chai Hu, Bupleuri Radix）、芍药（Shao Yao, Paeoniae Radix）、川连（Chuan Lian, Coptidis Rhizoma）。
This syndrome is caused by excessive sweating, which leaves the pathogenic heat unresolved while damaging the blood and qi, resulting in a loss of nourishment to the muscles and sinews. Treatment should focus on greatly tonifying blood and qi; formulas such as Ren Shen Yang Rong Tang (Ginseng and Blood-Nourishing Decoction) are appropriate.
Commentary by Shao: "Ti" refers to palpitations or twitching; "Chou Che" refers to spasms or convulsions; "Rou" refers to muscle jerking. Jin Ti Rou (muscle twitching and trembling) occurs due to a deficiency of blood, with latent pathogenic heat that fails to nourish the muscles and sinews with fluids. The heat enters the Yin level and scorches, causing sinew spasms and muscle tremors. This is a deficiency pattern. Therefore, treatment should employ the method of greatly tonifying blood and qi.
If the exterior stage has not been treated with sweating, and the patient has a constitutional deficiency of blood, pathogenic heat may transmit into the blood vessels. Since fire nature is active and agitating, this causes twitching. It should be treated as wind generated from blood deficiency and fire-dryness. Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) is indicated, with Bai Zhu (Atractylodis Rhizoma) removed, and Sheng Di (Rehmanniae Radix) and Gou Teng (Uncariae Ramulus cum Uncis) added.
Commentary by Shao: Sinew spasms and muscle twitching without prior sweating indicate that the patient's constitutional blood deficiency leads to damage of Yin fluids even before sweating. Pathogenic heat enters the Yin level, causing Yin deficiency and hyperactive fire, leading to wind generation from blood heat. Thus, these symptoms appear. Treatment should clear the Ying level, resolve pathogens, nourish fluids, and extinguish wind. This differs from the pure deficiency described in the previous clause following sweating.
If Taiyang cold injury has not undergone sweating, and after six or seven days, the meridians exhibit twitching but the muscles do not jerk, accompanied by tidal fever, delirium, constipation, dark and scanty urination, and hardness/pain upon pressing around the umbilicus, this indicates the presence of dry fecal impaction. Jia Wei Da Chai Hu Tang (Modified Major Bupleurum Decoction) is indicated.
Commentary by Shao: This is an excess-heat pattern, significantly different from the aforementioned deficiency pattern. They must be considered together.
If cold injury persists for more than ten days, and excessive sweating has occurred three or four times, it may transform into body tremors and meridian twitching. This is due to excessive sweating damaging both blood and qi. Jia Wei Ren Shen Yang Rong Tang (Modified Ginseng and Blood-Nourishing Decoction) should be used as the principal formula.
Commentary by Shao: When cold injury lingers, righteous qi becomes deficient. Subsequent excessive sweating further depletes Yin blood, resulting in dual deficiency of blood and qi. The muscles and sinews lose nourishment, manifesting as tremors and twitching. Treatment should focus on greatly tonifying blood and qi.
If post-sweating deficiency vexation prevents sleep, accompanied by muscle twitching, this indicates blood deficiency combined with fire. Shi Wei Wen Dan Tang (Ten-Ingredient Gallbladder-Warming Decoction) is indicated, with Wu Wei Zi (Schisandrae Fructus) removed, and Chai Hu (Bupleuri Radix), Shao Yao (Paeoniae Radix), and Chuan Lian (Coptidis Rhizoma) added.
Commentary by Shao: Post-sweating deficiency vexation arises from fire in the Liver and Gallbladder, with Yin deficiency complicated by phlegm, leading to insomnia and twitching. Treatment should employ the method of tonifying qi, resolving phlegm, and harmonizing the Gallbladder and Stomach.