（拘急）
痉者角弓反张。掣者手足抽扯。拘急者头勾足局。肘膝相构。伤寒中风。凡遇此等。分三面治之。失血家亦
宜分三面施治。而用药略有不同。眉列如左。
角弓反张者。太阳经病也。无汗用葛根汤。有汗用桂枝加葛根汤。血家病此。多是血燥生风。筋灼而挛。麻
桂皆其所忌。前方不中与也。宜四物汤。加葛根防风荆芥独活羚羊角桑寄生续断杏仁治之。
手足抽掣。口目斜引者。少阳经病也。伤寒中风。用大秦艽汤。此方风药虽多。尚兼滋补。血家病此。亦可借
用。再加阿胶羚羊角人参天花粉。以柔润熄风。则与血家更宜。而前拘急属阳明经。伤寒中风。得此者。三
一承气汤治之。血家得此为阳明津液大虚。筋为之缩。法宜大生津液。玉女煎。加天花粉玉竹葛根竹茹
人参麦门冬白芍枳壳治之。
又曰。肝主筋。肝病则惊骇。筋挛。今且不必缕分。总以治肝为主。四物汤。加羚羊角酸枣仁木瓜荆芥黄芩治之。
此乃血家发痉之治法。非通治诸痉之法。读者须知。
暑者。湿热合气之谓也。热蒸则湿动。湿郁则热遏。湿热合化。是为暑气。月令所谓土润溽暑。此之谓矣。热
甚则心烦口渴。脉数溺赤。湿甚则泄痢肿满。喘急闭闷。病状不一。总系热湿二气而已。血家阴虚湿热之
邪。尤易感受。宜统以大清凉饮治之。湿甚者。再加防己。虽不能尽暑之治法。然本此方以推展之。可以得
变通之妙。
又有阴暑。实非暑也。乃夏月伏阴内动之寒症。毋循名而失实。疫者四时不正恶戾臭秽之气。触人为病。
病气又能传染。是名曰疫。沉冬则无。夏秋常有。其气触人。皆从口鼻而入。内伏脏腑之中。发作则壮热头
痛。变疟动痢。狂躁肿急。不一其形。虽有外证。不得发表。但解其里。则表气自和。清温败毒饮。加酒大黄治
之。血家阴虚。疫邪易发。故并言之。另有瘟疫专书。详明者多。宜细查阅。此第举其大意耳。
（拘急）
所谓“痉”，是指身体向后反折如弓状。所谓“掣”，是指手足抽搐牵引。所谓“拘急”，是指头部弯曲、足部蜷缩，肘部和膝盖相互靠拢。在伤寒或中风病中，凡是遇到这些症状，应当从三个方面进行治疗。失血患者出现此类症状，也应当分三个方面施治，但用药略有不同。具体列举如下：
身体向后反折如弓状的，属于太阳经病变。无汗的服用葛根汤；有汗的服用桂枝加葛根汤。失血患者患此病，多是因为血虚干燥而生内风，筋脉被灼热而挛急。麻黄和桂枝都是其所禁忌的，前面的方剂不适用。适宜使用四物汤，加入葛根、防风、荆芥、独活、羚羊角、桑寄生、续断、杏仁来治疗。
手足抽搐牵引，口眼向一侧歪斜牵引的，属于少阳经病变。伤寒或中风患者，服用大秦艽汤。这个方子虽然风药较多，但也兼有滋补作用。失血患者患此病，也可以借用此方。再加入阿胶、羚羊角、人参、天花粉，以柔润熄风，则更适合失血患者。而前面提到的拘急症状属于阳明经病变。伤寒或中风患者得此病，用三一承气汤治疗。失血患者得此病，是因为阳明津液严重亏虚，导致筋脉收缩。治法应当大生津液，使用玉女煎，加入天花粉、玉竹、葛根、竹茹、人参、麦门冬、白芍、枳壳来治疗。
又说：肝主司筋脉，肝病则会出现惊骇、筋脉挛急。现在暂且不必详细区分，总之以治疗肝脏为主。使用四物汤，加入羚羊角、酸枣仁、木瓜、荆芥、黄芩来治疗。这是失血患者发生痉病的治法，并非通治所有痉病的法则。读者需要知晓这一点。
暑邪，是湿热合气的说法。热气蒸腾则湿气流动，湿气郁结则热气受阻，湿热化合，就形成了暑气。月令中所说的“土润溽暑”，指的就是这种情况。热邪严重时会出现心烦、口渴、脉搏快、小便赤红；湿邪严重时会出现泄泻、痢疾、肿胀、胀满、气喘急促、闭塞闷乱。病症表现不一，但总归是热和湿两种邪气罢了。失血患者本身阴虚，更容易感受湿热邪气。适宜统以大清凉饮治疗。湿邪严重的，再加防己。虽然这不能完全涵盖暑病的所有治法，但基于此方进行推演变化，可以获得变通的妙处。
又有“阴暑”，其实并不是暑邪，而是夏季体内潜伏的阴寒之气发动所致的寒症。不要只循着名字而失去了对实质的认识。疫邪，是四季中不正的、恶毒臭秽的气，接触人体而致病。这种病气能够传染，所以称为“疫”。冬季没有，夏秋季节常有。这种气接触人体，都从口鼻进入，潜伏在脏腑之中。发作时出现高热、头痛，变为疟疾或引发痢疾，狂躁、肿胀、紧急，形态不一。虽然有外在证候，但不能使用发汗解表的方法。只要解除内部的病邪，体表的正气自然调和。使用清温败毒饮，加入酒大黄来治疗。失血患者阴虚，疫邪容易发作，所以一并论述。另有专门论述瘟疫的书籍，详细说明者很多，应该仔细查阅。这里只是列举其大意罢了。
(Contraction and Spasm)
"Jing" (Spasm) refers to the body arching backward like a bow. "Che" (Traction/Convulsion) refers to the twitching and pulling of the hands and feet. "Juji" (Contraction) refers to the head bending forward and feet curling up, with elbows and knees drawing close together. In cases of Shanghan (Cold Damage) or Zhongfeng (Wind Strike), whenever such symptoms occur, treatment should be divided into three aspects. Patients with a history of blood loss presenting these symptoms should also be treated according to these three aspects, though the herbal prescriptions will differ slightly. They are listed as follows:
Body arching backward like a bow is a disease of the Taiyang Meridian (Taiyang Channel). For those without sweating, Gegen Tang (Kudzu Decoction) is used; for those with sweating, Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Decoction) is used. When patients with a history of blood loss suffer from this condition, it is mostly due to blood dryness generating internal wind, causing the sinews to be scorched and contract. Mahuang (Ephedrae Herba) and Guizhi (Cinnamomi Ramulus) are contraindicated, and the aforementioned formulas are not suitable. Instead, Siwu Tang (Four Substances Decoction) should be used, added with Gegen (Puerariae Lobatae Radix), Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Spica), Duhuo (Angelicae Pubescentis Radix), Lingyangjiao (Saigae Tataricae Cornu), Sangjisheng (Taxilli Caulis), Xuduan (Dipsaci Radix), and Xingren (Armeniacae Semen Amarum) for treatment.
Twitching and pulling of the hands and feet, with the mouth and eyes deviated to one side, is a disease of the Shaoyang Meridian (Shaoyang Channel). For Shanghan or Zhongfeng, Da Qin Jiao Tang (Great Saposhnikovia Decoction) is used. Although this formula contains many wind-dispelling herbs, it also includes nourishing ingredients. Patients with a history of blood loss suffering from this can also borrow this formula. By adding Ejiao (Asini Corii Colla), Lingyangjiao (Saigae Tataricae Cornu), Renshen (Ginseng Radix et Rhizoma), and Tianhuafen (Trichosanthis Radix) to soften and extinguish wind, it becomes even more suitable for blood-deficient patients. The previously mentioned contraction belongs to the Yangming Meridian (Yangming Channel). For Shanghan or Zhongfeng patients with this, Sanyichengqi Tang (Three-One Purging Decoction) is used. For patients with a history of blood loss, this condition arises from severe deficiency of Yangming fluids, causing the sinews to shrink. The treatment method should focus on greatly generating fluids, using Yunu Jian (Jade Woman Decoction), added with Tianhuafen (Trichosanthis Radix), Yuzhu (Polygonati Odorati Rhizoma), Gegen (Puerariae Lobatae Radix), Zhuru (Bambusae Caulis in Taeniam), Renshen (Ginseng Radix et Rhizoma), Maimendong (Ophiopogonis Radix), Baishao (Paeoniae Radix Alba), and Zhiqiao (Aurantii Fructus Immaturus) for treatment.
It is also said: The Liver governs the sinews; Liver disease leads to fright and convulsions of the sinews. For now, there is no need to distinguish them in detail; the general principle is to treat the Liver. Use Siwu Tang (Four Substances Decoction), added with Lingyangjiao (Saigae Tataricae Cornu), Suanzaoren (Ziziphi Spinosae Semen), Mugua (Chaenomelis Fructus), Jingjie (Schizonepetae Spica), and Huangqin (Scutellariae Radix) for treatment. This is the treatment method for spasms in patients with a history of blood loss, not a universal method for all types of spasms. Readers must understand this.
Shu (Summerheat) refers to the combination of dampness and heat. When heat steams, dampness moves; when dampness stagnates, heat is obstructed. The transformation of dampness and heat constitutes Summerheat Qi. This corresponds to what the monthly ordinances describe as "moist summer heat." When heat is severe, there is mental restlessness, thirst, rapid pulse, and red urine. When dampness is severe, there is diarrhea, dysentery, swelling, fullness, panting, urgency, and oppression. The clinical manifestations vary, but they all stem from the two pathogens of heat and dampness. Patients with a history of blood loss, who have Yin deficiency, are particularly susceptible to damp-heat pathogens. It is appropriate to use Da Qingliang Yin (Great Clearing and Cooling Drink) generally. If dampness is severe, add Fangji (Stephaniae Tetrandrae Radix). Although this cannot cover all treatments for Summerheat, extending from this formula allows for flexible adaptation.
There is also "Yin Shu" (Yin Summerheat), which is actually not Summerheat, but a cold syndrome caused by latent Yin-cold moving internally during summer. One should not follow the name and lose sight of the reality. Yi (Epidemic) refers to the abnormal, malignant, foul-smelling Qi of the four seasons that contacts humans and causes disease. This pathogenic Qi is contagious, hence the name "Epidemic." It does not occur in winter but is common in summer and autumn. This Qi enters the human body through the mouth and nose, lying dormant within the Zang-Fu organs. Upon onset, it presents with high fever, headache, transforming into malaria or triggering dysentery, mania, swelling, and urgency, with varied forms. Although there are exterior signs, surface-releasing methods should not be used. Only by resolving the interior pathology will the exterior Qi harmonize naturally. Use Qingwen Baidu Yin (Clear Warmth and Resolve Toxin Drink), added with Jiuhuang (Prepared Rhubarb), for treatment. Patients with a history of blood loss have Yin deficiency, making them prone to epidemic pathogens, so it is discussed here as well. There are other specialized books on epidemics with detailed explanations; readers should consult them carefully. Here, only the general outline is presented.