bubble_chart Concept

Spasm of the limbs refers to involuntary twitching of the limbs caused by various reasons. Twitching means contraction and pulling; convulsion refers to pulling and contracting. Therefore, all spasms, pulling, or continuous flexion and extension of the limbs that cannot be controlled voluntarily fall within the category of spasm.

As early as in the book Neijing, there are records of "convulsion". Convulsion refers to the tension and flexion of the tendons and vessels; relaxation refers to the relaxation and extension of the tendons and vessels. Therefore, convulsion, which involves alternating flexion and extension of the hands and feet, is different from general irregular spasms but is also a type of spasm. Neijing also contains records related to spasms such as "stiffness and convulsion", "epileptic convulsion muscular spasm", "epileptic dizziness", and "muscle twitching convulsion".

bubble_chart Pattern Analysis

1. Wind Evil Blocking the Collaterals︰Fever and chills, limb convulsions, stiff neck and back, muscle spasms, soreness or pain in the limbs, white and greasy or slightly yellow tongue coating, wiry and tight or rapid pulse. In terms of disease cause, wind-evil obstructing the collaterals is mostly caused by external contraction of wind-evil, amenorrhea of the collaterals, unfavorable circulation of qi and blood, or invasion of wind-toxin evil during trauma, leading to failure of nutrient-defense to disperse and resulting in malnutrition of the tendons and convulsions of the limbs. It may also be accompanied by symptoms of external contraction of wind-evil, such as fever and chills, headache, and body pain, or signs of the six meridians. If wind-evil invades a wound, in addition to limb convulsions, there may be lockjaw and opisthotonos. The treatment should focus on expelling wind and dredging collaterals, nourishing blood, and harmonizing the nutrient-defense system. The formula used is Major Gentian Decoction with modifications. For wind-toxin evil, Jade-like Vitality Powder or Five Tigers Wind-Chasing Powder with modifications can be used.
2. Wind-phlegm with Blood Stasis︰Paroxysmal convulsion, or making sounds like six domestic animals, upward staring of both eyes, frothing at the mouth, initial rigidity and spasm of the limbs followed by alternating flexion and extension with convulsive jerking, incontinence of urine and feces, and clouded consciousness, with normalcy after the episode. The tongue coating is white and greasy, and the pulse is wiry and slippery. There may also be a history of trauma preceding the convulsion, with the patient exhibiting scars from head injuries and static blood spots on the tongue. Wind-phlegm complicated by stasis often arises from severe fright or sudden terror damaging the liver and kidney, or from dietary irregularities injuring the spleen and stomach, leading to dysfunction of the spleen in transportation, accumulation of dampness into phlegm. Once the liver fails to maintain free flow, yang ascends and wind stirs, triggering accumulated phlegm, with liver wind carrying phlegm upward to congest, or with traumatic static blood causing counterflow of qi and blood, disrupting the distribution of essence and blood, resulting in paroxysmal convulsion. There are no external contraction symptoms, and the patient returns to normal after the episode. The treatment involves dispelling stasis and extinguishing wind, using Liver-Settling Wind-Extinguishing Decoction combined with Blood House Stasis-Expelling Decoction with modifications.
3. Yin Deficiency with Yang Hyperactivity Generating ︰Blurred vision, soreness and weakness in the waist and legs, numbness and stiffness, tinnitus, vertigo, vexing heat in the chest, palms and soles, flushed cheeks and red lips, hot skin worse at night, convulsions in the limbs after anger, a red tongue with scant coating, and a wiry, thin, and rapid pulse. This is mostly caused by prolonged overwork or chronic illness, leading to damage to yin essence, liver-kidney yin deficiency, malnutrition of the tendons and vessels, yin deficiency failing to restrain yang, liver yang hyperactivity, and internal stirring of liver wind, resulting in convulsions in the limbs. It presents with symptoms of liver-kidney yin deficiency (soreness and weakness in the waist and legs, blurred vision, vertigo, tinnitus, vexing heat in the chest, palms and soles, numbness and stiffness, a red tongue, and a wiry, thin, and rapid pulse). The treatment involves nourishing yin and subduing yang, pacifying the liver and extinguishing wind, using Liver-Settling Wind-Extinguishing Decoction or Gastrodia and Uncaria Drink with modifications.
4. Extreme Heat or Dampness-heat Generating Wind︰High fever, thirst, flushed face, coarse breathing, limb convulsions or persistent convulsions, neck stiffness, opisthotonos, upward gaze of the eyes, often accompanied by unconsciousness and delirious speech, yellow urine, dry stool, red tongue with yellow coating, and rapid, forceful pulse. If it is dampness-heat stirring wind, additional symptoms include lingering fever, heavy-headedness as if wrapped, red and swollen tongue, yellow and greasy coating, and slippery, rapid pulse. This is mostly due to dampness-heat pathogens, or excessive yang qi scorching and damaging yin fluids, leading to malnourishment of tendons and vessels, or due to invasion of dampness-heat, often seen in the late stage (third stage) of dampness-warm diseases, where dampness-heat carries wind—wind being the qi of wood—and wind movement causes limb convulsions. It exhibits heat signs (high fever, thirst, flushed face, red eyes, yellow urine, dry stool, red tongue with yellow coating, rapid pulse) or characteristics of dampness-heat (such as hidden fever, red and swollen tongue, yellow and greasy coating, slippery and rapid pulse, etc.). It belongs to extreme heat producing wind and is treated with the method of clearing heat and extinguishing wind, using Antelope Horn and Uncaria Decoction with modifications. For cases of dampness-heat, clearing heat and draining dampness is appropriate, as stated in the Wenre Jingwei chapter on dampness-heat diseases: "When dampness-heat invades the meridians and collaterals, fresh earthworm, gentian, Chinese clematis root, talc, cocklebur fruit, towel gourd stem, kadsura pepper stem, and wine-fried coptis should be used."
5. Spleen-kidney Yang Deficiency︰Cold body and limbs, pale face with clear eyes, continuous twitching of limbs, edema, anorexia, loose stool, sore waist and weak legs, bland taste in the mouth without thirst, clear and copious urine or scanty urine, pale tongue texture, swollen body with teeth marks, white and greasy tongue coating, deep and slow or deep and moderate pulse. The disease cause is mostly due to vomiting, diarrhea, deficiency-cold of spleen and stomach, decline of yang qi, Jingmai failing to warm and nourish, leading to limb convulsions. Therefore, it differs from wind generated by extreme heat, dampness-heat, or liver yang transforming into wind. Moreover, its symptoms are accompanied by clear signs of cold (cold body and limbs, pale face with clear eyes, no thirst, clear urine, loose stool, pale tongue with white coating, deep and slow pulse, etc.), which are distinctly different from signs of heat or dampness-heat. For this syndrome, treatment should focus on warming yang to consolidate the root, using modified Guzhen Decoction.
6. Liver Depressionblood Deficiency︰Melancholy, dreamfulness insomnia, chest tightness and discomfort, frequent sighing, pounding the chest and stamping the feet when encountering mental stimulation, alternating crying and laughing, or sudden collapse, limb convulsions accompanied by involuntary movements of the hands and feet, pale tongue, wiry and thin pulse. The patient has a predisposition to melancholy and restlessness, and when experiencing intense anger, liver qi surges upward, leading to chaotic qi movement, resulting in the inability to distribute qi and blood to the limbs, depriving the tendons and vessels of nourishment. Symptoms include liver depression and heart blood deficiency, such as chest tightness and discomfort, mental depression, frequent sighing, palpitation and forgetfulness, insomnia and dreamfulness, etc. Treatment should focus on nourishing blood and relaxing the liver, using Liver-Tonifying Decoction combined with Cold-Limbs Powder with modifications.
7. Blood Deficiency Producing Wind︰The constitution is weak, the complexion is pale or sallow, the limbs are numb, the hands and feet twitch slowly, there is muscle twitching and internal trembling, the lips and nails are pale, the tongue is pale with white coating, and the pulse is wiry and thin. The hand convulsions resemble the shape of a chicken's claw, commonly referred to as "chicken claw wind," which also falls under this category. The disease cause of blood deficiency producing wind is mainly due to various types of blood loss, such as menorrhagia and metrostaxis, bloody stool, or nutritional disorders, leading to insufficient generation and transformation of blood, resulting in malnutrition of the tendons and convulsions of the limbs. Convulsions often develop gradually, with tendon stiffness, numbness, and signs of blood deficiency (pale complexion, vertigo, pale lips and nails, and thin pulse). It is advisable to nourish blood and extinguish wind, Four Ingredients Decoction with modifications.
8. Poisoning-induced︰Accidental ingestion of toxic drugs, such as an overdose of nux vomica, or exposure to chemical poisons leading to convulsions in the limbs. The nature of the toxic substance varies, and so do the manifestations of convulsions and accompanying symptoms. Unlike the aforementioned symptoms and signs, the form of convulsions and associated symptoms differ depending on the specific toxic substance involved. A clear history of exposure to drugs or chemical industrial products can aid in differentiation.

The symptom of limb spasms has numerous disease causes and complex manifestations. However, the primary distinction should be made between external contraction, internal damage, or poisoning. For external contraction, attention should be paid to the characteristics of the pathogenic factors; for internal damage, it is necessary to observe the accompanying symptoms, such as abnormal exuberance of yin or yang, or the manifestations of deficiency; for poisoning, attention should be given to the medical history, which makes differentiation relatively straightforward.

bubble_chart Documentation

1. Rumen Shiqin．Wind Pattern．Wind Convulsion and Opisthotonos Two: "All wind conditions causing tremors and dizziness belong to the liver wood. The bending and straightening, movement and shaking are the functions of wind. Yang governs movement, Yin governs stillness. Due to excessive fire controlling metal, the weakened metal cannot balance wood, leading to the flourishing and self-affliction of liver wood."
2. Zhangshi Yitong．Convulsion: "The symptoms of convulsion mostly belong to the three meridians of heart, spleen, and liver. If there is spontaneous sweating, shortage of qi, and a rapid pulse that diminishes upon pressure, this is a deficiency of heart qi, treat with Wonderful Scent Powder. If there is excessive qi, unconsciousness, muscular spasm, and a full and large pulse, this is an excess of heart fire, treat with Redness-Removing Powder plus Scutellaria, Coptis, Gardenia, and Poria with Pine Rhinoceros Horn. If there is bodily fatigue, unconsciousness, and inability to speak, with a slow and moderate pulse and cold limbs, this is spleen deficiency generating wind, treat with Returning to Spleen Decoction plus Uncaria and Notopterygium. If there are alternating chills and fever, upward gaze and head shaking, and a wiry and rapid pulse, this is liver heat generating wind, treat with modified Peripatetic Powder plus Cinnamon Twig."