内经言。挛皆属肝。肝主筋故也。有热有寒。有虚有实。热挛者。经所谓肝气热则筋膜干。
筋膜干则筋急而挛。六味丸加牛膝、当归之类。因于湿。首如裹。湿热不攘。大筋 短。小筋弛
长。 短为拘。弛长为痿。先搐瓜蒂散。次与羌活胜
湿汤。虚邪搏筋。则筋急。五积散。血虚则筋急。增损四物汤。剧劳筋脉拘急。疼痛少眠者。黄
丸。更于暖室中近火按摩为佳。虚风袭于经脉。手足拘挛。屈伸短缩。腹痛。爪甲唇俱青。转
筋。不思饮食。甚则舌卷囊缩。木瓜散。拘挛瘫痪。口目 斜。骨节疼酸。行步不正者。舒筋三
圣散。痹湿筋挛骨痛者。续断丸。误汗漏风。筋挛缩急。或方士用木鳖发汗。见风筋脉拘挛者。
并宜桂枝汤倍桂加归、附。病初起者。分表里治。如戴人用甘遂末三钱。 猪肾一枚。细批破。
少用盐椒淹透。掺药末在内。荷叶包裹煨熟。温酒细嚼。则上吐下泻而愈。
石顽曰。挛证人悉知为寒。不知亦有属血枯而热者。盖寒则胫逆而痛。热则胫热而枯。至于
湿热下流。又为实证。则疼肿便秘。以此辨之。虚实寒热。可判然胸臆矣。
〔诊〕挛者拘挛。浮缓属风。沉细为湿。洪缓湿热。涩细寒湿。虚大气衰。小弱血虚。尺中弦
弱。肾虚精竭。若久病而脉反实强。乍病而见虚涩。虽有合剂。难于图治也。
石顽治包山劳俊卿。年高挛废。山中诸医用木瓜、独活、防己、 、威灵仙之类。将半年
余。乃致跬步不能动移。或令服八味丸。亦不应。诊其脉。尺中微浮而细。时当九夏。自膝至足。
皆寒冷如从水中出。知为肾虚风雨所犯而成是疾。遂授安肾丸方。终剂而能步履连。服二料。终
无痿弱之状矣。
《内经》说，所有的挛缩都归属于肝脏，因为肝主管筋脉。其中有热证和寒证，有虚证和实证。热性挛缩，正如经文所说：“肝气热则筋膜干，筋膜干则筋急而挛。”治疗可用六味地黄丸加牛膝、当归等药物。因湿邪引起的，感觉头部沉重像被包裹一样；若湿热不除，会导致大筋缩短，小筋松弛延长。缩短表现为拘急，松弛延长表现为痿软。治疗应先服用瓜蒂散催吐，再给予羌活胜湿汤。虚邪侵袭筋脉，导致筋脉拘急，可用五积散。血虚也会导致筋脉拘急，可用增损四物汤。过度劳累导致筋脉拘急、疼痛且睡眠减少的，可用黄丸（注：原文此处可能有脱字或特指某方，依原文保留），并在温暖的房间中靠近火源进行按摩效果更佳。虚风侵袭经脉，导致手足拘挛、屈伸不利、身体短缩、腹痛、指甲和嘴唇发青、转筋、不想吃东西，严重时出现舌头卷曲、阴囊收缩，可用木瓜散。对于拘挛瘫痪、口眼歪斜、骨节疼痛酸楚、行走不稳者，可用舒筋三圣散。对于痹症湿邪导致的筋挛骨痛者，可用续断丸。误用发汗法导致汗出不止而受风邪，引起筋脉拘挛紧缩，或者被江湖术士用木鳖子发汗后，见风即出现筋脉拘挛的，都适宜使用桂枝汤加倍桂枝并加入当归、附子。疾病初起时，应分辨表里进行治疗。例如戴人（张从正）曾用甘遂末三钱，配合一枚猪肾，将猪肾细细剖开，少加盐和胡椒腌制透彻，将药末填入其中，用荷叶包裹煨熟，温酒细细咀嚼服用，通过上吐下泻而痊愈。
石顽（张璐号）说，人们都知道挛缩多属于寒证，却不知道也有属于血枯生热的情况。大概寒邪会导致小腿逆冷且疼痛，热邪则导致小腿发热且干枯。至于湿热下注，又属于实证，会出现疼痛肿胀和大便秘结。据此可以辨别虚实寒热，心中便有了清晰的判断。
【诊法】所谓挛，即拘挛。脉象浮缓属于风邪，沉细属于湿邪，洪缓属于湿热，涩细属于寒湿。脉虚表示大气衰弱，脉小弱表示血虚，尺部脉弦弱表示肾虚精竭。如果是久病而脉象反而实强，或者是刚发病就见到虚涩的脉象，即使有对症的方剂，也难以治愈。
石顽治疗包山的劳俊卿，此人年事已高，患挛缩症导致瘫痪。山中的医生们使用木瓜、独活、防己、[缺字]、威灵仙等药物，治疗了半年多，结果导致他连一步路都不能移动。有人让他服用八味丸，也没有见效。我诊察他的脉象，尺部脉微浮而细。当时正值盛夏，他从膝盖到脚，都寒冷得像刚从水里出来一样。我知道这是肾虚又遭受风雨邪气侵袭而形成的疾病。于是传授给他安肾丸的方子，服完一疗程就能连续行走，服用两料药后，最终没有留下痿弱的后遗症。
The *Neijing* (Inner Canon) states that all spasms and contractures are associated with the Liver, as the Liver governs the sinews. These conditions may involve Heat or Cold, Deficiency or Excess. In cases of Heat-induced spasm, as stated in the classics: "When Liver Qi is hot, the fascia becomes dry; when the fascia is dry, the sinews become tight and contract." Treatment may involve Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) supplemented with Achyranthis Bidentatae Radix (Niuxi) and Angelicae Sinensis Radix (Danggui). When caused by Dampness, the head feels heavy as if wrapped; if Damp-Heat is not resolved, the large sinews shorten while the small sinews relax and lengthen. Shortening manifests as constraint (Ju), while relaxation and lengthening manifest as flaccidity (Wei). Initially, Gouti San (Melon Stamen Powder) should be administered to induce vomiting, followed by Qianghuo Shengshi Tang (Notopterygium Decoction to Overcome Dampness). When Deficient pathogenic factors invade the sinews, causing tension, Wuji San (Five Accumulations Powder) is indicated. Blood Deficiency also leads to sinew tension, treatable with Zengsun Siwu Tang (Modified Four Substances Decoction). For severe fatigue leading to sinew and vessel spasm, pain, and insomnia, Huang Wan (Yellow Pill) is used; additionally, massage near a fire source in a warm room is beneficial. When Deficient Wind attacks the meridians, resulting in limb contracture, limited flexion and extension, shortening of the body, abdominal pain, cyanosis of nails and lips, muscle cramps, anorexia, and in severe cases, tongue retraction and scrotal contraction, Mugua San (Papaya Powder) is prescribed. For contracture and paralysis accompanied by deviation of the mouth and eyes, soreness and pain in bone joints, and unsteady gait, Shujin Sansheng San (Sinew-Relaxing Three-Saints Powder) is appropriate. For Bi syndrome with Dampness causing sinew contracture and bone pain, Xuduan Wan (Dipsacus Pill) is suitable. If improper sweating therapy leads to persistent sweating and exposure to Wind, causing sinew contracture and tightness, or if folk healers use Momordica charantia seeds (Mubiezi) to induce sweating, resulting in Wind-triggered sinew spasm, Guizhi Tang (Cinnamon Twig Decoction) with increased Cinnamomi Ramulus (Guizhi) plus Angelicae Sinensis Radix (Dangui) and Aconiti Lateralis Radix Praeparata (Fuzi) is recommended. In the early stages of the disease, differentiation between Exterior and Interior patterns is necessary. For instance, Dai Ren (Zhang Congzheng) once treated a case using 3 qian of Kansui Radix powder placed inside a slit pork kidney marinated with salt and pepper, wrapped in lotus leaves and baked. The patient chewed it slowly with warm wine, achieving cure through simultaneous vomiting and purgation.
Shiwan (Zhang Lu's pseudonym) remarks that while everyone knows spasms often belong to Cold, they fail to recognize those caused by Blood exhaustion generating Heat. Generally, Cold causes coldness and pain in the lower legs, whereas Heat causes heat and wasting. Conversely, downward flow of Damp-Heat constitutes an Excess pattern, presenting with painful swelling and constipation. Based on these distinctions, one can clearly discern Deficiency/Excess and Cold/Heat in one's mind.
[Diagnosis] Spasm refers to contracture. A floating and moderate pulse indicates Wind; a deep and fine pulse indicates Dampness; a surging and moderate pulse indicates Damp-Heat; a choppy and fine pulse indicates Cold-Damp. A deficient pulse suggests衰败 of Great Qi; a small and weak pulse indicates Blood Deficiency; a wiry and weak pulse at the Chi position indicates Kidney Deficiency and essence depletion. If a chronic illness presents with a surprisingly strong and excess pulse, or if an acute illness presents with a deficient and choppy pulse, treatment will be difficult even with appropriate formulas.
Shiwan treated Lao Junqing from Baoshan, an elderly man suffering from spastic paralysis. Physicians in the mountains had used Papaya (Mugua), Angelica Pubescens Root (Duhuo), Stephania Tetrandra Root (Fangji), [missing character], and Notopterygium Root (Qianghuo/Wanglingxian) for over half a year, resulting in his inability to move even a step. Administration of Bawei Wan (Eight-Ingredient Rehmannia Pill) was also ineffective. Upon diagnosis, his Chi pulse was slightly floating and fine. It was mid-summer, yet from his knees down to his feet, he felt cold as if emerging from water. I determined this was due to Kidney Deficiency compounded by Wind and Rain pathogens. I prescribed Anshen Wan (Kidney-Anchoring Pill). After completing one course, he could walk continuously; after two courses, no signs of flaccidity remained.