挛者，久不伸，锢则难医，非如抽搐拘急暂病可比。其理不外寒则收引，热则
干缩二端，而寒者易治，热者难治，何则？寒虽收引而筋脉不枯，但用温热之剂以
去其寒，则阳回冻解而缩者以舒，不难治也。（亦有日久寒气聚沫结痰，包裹坚凝，药不能
攻者，然熨、洗、烙、灸法，皆可施也。）惟热而干缩者，日久槁枯已定，虽极力滋润，终难复
元耳。热者多虚，血液枯也。亦有实者，或为风寒所闭，或为痰涎所滞，血脉不得
流通，火性不受遏郁，激而暴发，陡然挛曲，（如蛇之动而挛曲，是其象也。）观脚之转筋抽缩
可见矣。寒者多实，血液痰湿为寒所凝滞。亦有虚者，阳气不足也。丹溪治一村夫，
背偻足挛，已成废人，脉沉弦而涩，用张子和煨肾散治之，吐泻两月余而愈。
（《准绳》谓即螈 。螈，拘急也， ，弛纵也。抽搐属螈，然亦微异。盖拘急者，
筋脉拘束紧急不
得伸舒，观脚指受寒筋急可见。抽搐，则频伸频缩也。）
抽搐者，手足频频伸缩也。或言搐搦者，搦谓十指频频开合，两拳紧捏也。
证属风火，风火为阳邪，主动而不宁。其不为躁扰而为搐搦者，血枯筋急也。若妄
加灼艾，或发其表，则死不旋踵。小儿急惊风多此证。宜泻木火，凉惊丸主之。血
虚，续断丸。肝邪盛，宜救脾者，小建中汤（见劳倦）加减。热伤元气，人参益气汤。（见
痹。）血气虚弱，内火盛，兼中外风，风火相煽，则不得不加发散之品，续命煮散。兼
心神昏愦者，独活汤。产后血虚发热，热盛生风得此，八珍汤（见虚损）加丹皮、钩藤，
以生阴血。不应，兼补脾胃以生血。小儿吐泻后，脾胃之阴气亏损，成慢惊风者，
亦多见此，为虚风虚热。若更阳气虚陷，其风火尤为无根之虚焰。虚者，十全大补
（见虚损）加桂、附；陷者，补中益气汤（见气）加桂、附。此等阳虚之证，肢体恶寒，脉微
细，为真状。若脉浮大，发热烦渴，为假象，不可泥于证属风火一语，以为实邪也。
若戴眼反折，汗出如珠，不治。（按血枯筋急，恐未尽然。观御痛者恒
握拳切牙，与小儿惊搐切牙捏拳
形状相同，可知此证必因风火内攻，有难于禁当者，故有此抵御情状。风火忽动忽息，故搐
搦有作有止，若果由血
枯筋急，则应缩多伸少，两拳常捏，且不必有切牙情状矣。抽搐，风木曲直之象也；
握搦切牙，病患禁当之情也。）
痉挛是指肢体长久不能伸展，若病程迁延日久、病邪固结则难以医治，这不像抽搐拘急那样属于暂时性的病症。其病机原理不外乎“寒主收引”和“热致干缩”两个方面。其中，寒证容易治疗，热证难以治疗，为什么呢？寒邪虽然导致筋脉收缩牵引，但筋脉并未干枯，只需使用温热性质的药物来祛除寒邪，阳气回复、冻结解除，收缩的筋脉就能舒展，治疗并不困难。（也有因日久寒气聚集成沫、凝结成痰，包裹筋脉使其坚硬凝固，药物无法攻治的情况，然而熨法、洗法、烙法、灸法等外治法都可以施用。）只有热邪导致的干缩，因为日久筋脉已经枯槁定型，即使极力使用滋润之法，终究也难以恢复元气。热证多属虚证，是因为血液枯竭所致。也有实证，或是被风寒闭塞，或是被痰涎阻滞，导致血脉不得流通，火性受到遏制郁积，激发而突然暴发，导致陡然挛曲（像蛇一样扭动挛曲，就是这种形象），观察脚部转筋抽缩的现象就可以看到了。寒证多属实证，是因为血液、痰湿被寒邪凝滞。也有虚证，是阳气不足所致。朱丹溪曾治疗一个村夫，背部弯曲、足部挛缩，已成废人，脉象沉弦而涩，用张子和的煨肾散治疗，经过两个多月的吐泻调理而痊愈。
《医学准绳六要》认为挛即螈疭。螈，指筋脉拘急；疭，指筋脉弛纵。抽搐属于螈疭范畴，但也略有不同。所谓拘急，是指筋脉拘束紧急不能伸展舒松，观察脚趾受寒后筋脉紧急的情况可见一斑。抽搐，则是指频繁地伸展和收缩。
抽搐，是指手足频繁地伸缩。有人说搐搦，搦是指十个手指频繁地开合，两拳紧紧捏合。此证属于风火为患，风火均为阳邪，性质主动而不安宁。之所以不表现为躁扰不安而表现为搐搦，是因为血液枯竭、筋脉紧急。如果错误地使用艾灸灼烧，或者发汗解表，患者就会立刻死亡。小儿急惊风多为此类证候。适宜清泻肝木与心火，以凉惊丸为主方。若属血虚，用续断丸。若肝邪亢盛，宜通过救脾来治疗，用小建中汤（见劳倦篇）加减。若热邪损伤元气，用人参益气汤（见痹证篇）。若气血虚弱，内火旺盛，兼感内外之风，风火相互煽动，则不得不加入发散的药物，用续命煮散。若兼有心神昏乱不清，用独活汤。产后血虚发热，热盛生风导致此证，用八珍汤（见虚损篇）加牡丹皮、钩藤，以滋生阴血。若无效，再兼补脾胃以生血。小儿在吐泻之后，脾胃阴气亏损，形成慢惊风的，也常见此证，属于虚风虚热。如果再加上阳气虚陷，那么风火就更是无根之虚焰。对于虚证，用十全大补汤（见虚损篇）加肉桂、附子；对于陷证，用补中益气汤（见气虚篇）加肉桂、附子。这类阳虚的证候，肢体怕冷，脉象微细，这是真寒假热的真实表现。如果脉象浮大，伴有发热、烦躁口渴，这是假象，不可拘泥于“证属风火”这一说法，而认为是实邪。如果出现戴眼（眼球固定向上视）、反折（身体角弓反张）、汗出如珠（冷汗淋漓如珠），则属不治之症。（按语：认为血枯筋急恐怕不完全正确。观察承受疼痛的人往往握拳切齿，与小儿惊搐时切齿捏拳的形状相同，可知此证必定是因为风火内攻，有难以抵御的情状，所以出现这种抵御的表现。风火忽动忽止，所以搐搦有时发作有时停止。如果果真是由血枯筋急引起，那么应该收缩多于伸展，两拳常捏，而且不必有切齿的情状了。抽搐，是风木之气曲直变化的形象；握拳、搦指、切齿，是病患难以忍受时的情状。）
Spasm refers to the inability of limbs to extend for a prolonged period. If the condition persists and becomes entrenched, it is difficult to treat, unlike twitching and cramping which are temporary ailments. The pathogenesis lies in two aspects: "cold causes contraction and drawing-in," and "heat causes dryness and shrinking." Among these, cold patterns are easier to treat, while heat patterns are difficult. Why? Although cold causes contraction and traction of the tendons and vessels, the tendons do not wither. By using warm and hot agents to dispel the cold, yang qi returns, the frozen state resolves, and the contracted tendons relax, making treatment not difficult. (However, there are cases where long-standing cold qi gathers into foam and condenses into phlegm, wrapping around and hardening the tissues so that medicinal decoctions cannot penetrate; in such cases, external therapies such as moxibustion warming, washing, cauterization, and moxibustion can be applied.) Only when heat causes dryness and shrinking, after a long duration, the tendons have become withered and fixed; even with vigorous efforts to moisten and nourish, recovery of original vitality is ultimately difficult. Heat patterns are often deficient, caused by the depletion of blood. There are also excess patterns, where either wind-cold blocks the exterior or phlegm-fluids stagnate, preventing the smooth flow of blood vessels. The nature of fire, being suppressed and stagnant,激ates and erupts suddenly, causing abrupt spasms and curling (like the movement of a snake coiling and twisting, which illustrates this image); this can be observed in the twitching and shrinking of calf muscles. Cold patterns are often excess, caused by the stagnation of blood, phlegm, and dampness due to cold. There are also deficient patterns, caused by insufficient yang qi. Danxi treated a village laborer who suffered from a hunched back and contracted feet, rendering him disabled. His pulse was deep, wiry, and choppy. He used Zhang Zihe's Wei Shen San (Roasted Kidney Powder) to treat him. After more than two months of induced vomiting and diarrhea, the patient recovered.
The *Zhunsheng* states that spasm is equivalent to *yu zong*. *Yu* refers to tendon constraint and urgency, while *zong* refers to flaccidity and relaxation. Twitching belongs to the category of *yu zong*, but there are slight differences. Constraint refers to tendons and vessels being tight and urgent, unable to extend and relax, as seen when toes become rigid due to cold. Twitching refers to frequent extension and flexion.
Twitching refers to the frequent extension and flexion of hands and feet. Some refer to it as *chu nuo*. *Nuo* means the ten fingers frequently opening and closing, and the fists tightly clenched. This syndrome belongs to wind-fire. Wind and fire are yang pathogens, characterized by activity and restlessness. The reason it manifests as twitching rather than restlessness is due to blood depletion and tendon urgency. If one recklessly applies moxibustion burning or induces sweating to release the exterior, death will follow immediately. Pediatric acute convulsive disease (Ji Jing Feng) often presents this syndrome. It is appropriate to drain liver wood and heart fire, primarily using Liang Jing Wan (Cool Convulsion Pill). If due to blood deficiency, use Xuduan Wan (Dried Stem Centaury Pill). If liver evil is excessive, it is advisable to save the spleen, using Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) with modifications. If heat damages yuan qi, use Renshen Yiqi Tang (Ginseng Qi-Boosting Decoction). If qi and blood are weak, internal fire is abundant, and there is an invasion of both internal and external wind, with wind and fire fanning each other, dispersing agents must be added; use Mingming Zhusan (Success Decoction). If accompanied by mental confusion and cloudiness, use Duhuo Tang (Angelica Pubescens Decoction). For postpartum blood deficiency with fever, where excessive heat generates wind leading to this condition, use Bazhen Tang (Eight Treasures Decoction) plus Mu Dan Pi (Moutan Cortex) and Gouteng (Uncaria Rhynchophylla) to generate yin blood. If ineffective, additionally tonify the spleen and stomach to generate blood. After pediatric vomiting and diarrhea, if the yin qi of the spleen and stomach is damaged, leading to slow convulsive disease (Man Jing Feng), this is also commonly seen, representing deficient wind and deficient heat. If yang qi is further deficient and sinking, the wind-fire becomes an even more rootless false flame. For deficiency, use Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) plus Rougui (Cinnamon Bark) and Fuzi (Aconite Lateral Root); for sinking, use Buzhong Yiqi Tang (Tonify the Middle and Boost Qi Decoction) plus Rougui and Fuzi. In these yang-deficient syndromes, aversion to cold in the limbs and a faint, fine pulse indicate true signs. If the pulse is floating and large, accompanied by fever, irritability, and thirst, these are false signs. One must not stick to the phrase "syndrome belongs to wind-fire" and assume it is an excess pathogen. If the eyes roll back (Dai Yan), the body arches backward (Fan Zhe), and sweat beads like pearls appear, it is untreatable. (Note: The assertion that blood depletion and tendon urgency is the sole cause may be incomplete. Observing those enduring pain often clench their teeth and fists, similar to the shape of pediatric convulsions involving teeth grinding and fist clenching, indicates that this condition must be due to internal attack by wind-fire, presenting a difficult-to-resist state, hence these defensive manifestations. Since wind-fire moves intermittently, twitching occurs and stops. If it were truly caused by blood depletion and tendon urgency, there should be more flexion than extension, fists constantly clenched, and no teeth-grinding would occur. Twitching represents the curving and straightening imagery of wind-wood; clenching, grasping, and teeth-grinding represent the patient's distress and resistance.)