Library

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.