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Heat-induced spasm refers to what the Classics state: "When Liver Qi is hot, the fascia becomes dry; when the fascia is dry, the sinews become tense and contract." (For the full text, see the section on Atrophy Syndrome).

It also states: "Due to dampness. The head feels heavy as if wrapped. If damp-heat is not dispelled, the large sinews shorten and shrink, while the small sinews relax and lengthen. Shortening leads to constraint (spasm), and relaxing/lengthening leads to atrophy-like conditions." (For the full text, see the section on Yin and Yang. Zhu Danxi said: "The shortening of the large sinews is due to heat damaging the blood, which fails to nourish them, thus causing spasm. The relaxation and lengthening of the small sinews are due to dampness damaging the sinews, which fail to bind the bones, thus causing weakness and atrophy.")

[Dan] Wang Xiu suffered from severe damp-heat. After foot pain, his hand sinews became spasmodic, and his feet were weak.
Prescription: Shengdi Huang (Rehmanniae Radix), Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma) (each 2 qian), Cang Zhu (Atractylodis Rhizoma) (1.5 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) (3 fen), Mu Tong (Akebiae Caulis). Decoct in water, and take with 30 pills of Da Bu Wan (Great Tonifying Pill). Da Bu Wan must be taken after being stir-fried until warm.

[Ji Sheng Fang] Yi Yi Ren San (Coix Seed Powder): Treats sinew and vessel spasms, and chronic wind-damp bi syndrome.
Usage: Yi Yi Ren (Coicis Semen) (1 sheng, pounded into powder, mixed with 2 sheng of water, take a few spoonfuls of the sediment to make porridge, eat on an empty stomach. Yan Yi states: "There are two types of acute tendon contraction. According to Su Wen, when large sinews are heated, they shrink and shorten due to heat, causing acute contraction that cannot extend; Coix Seed can be used here. However, if the contraction is due to cold as mentioned in Su Wen, it should not be used.")

Cold-induced spasm refers to what the Classics state: "When cold is excessive, sinews contract and bones ache."

[Ben Cao Yan Yi] Zhang Decao, Vice Magistrate of Tongguan County, often spoke of his wife who previously suffered from sinew spasms, unable to flex or extend her legs. After a year, any movement caused severe constraint and pulling. He sought medical advice from Yang Jilao of Sishui. Yang said: "This is a disease of the sinews, suitable for treating with the following three formulas." She recovered after one year.

To treat extreme sinew deficiency, Yang Xue Di Huang Wan (Blood-Nourishing Rehmannia Pill) is taken during spring and summer.
Prescription: Shu Di Huang (Prepared Rehmanniae Radix) (1 fen), Man Jing Zi (Vittariae Fructus) (1 fen), Shan Zhu Yu (Corni Fructus) (5 fen), Hei Gou Ji (Polystichi Rhizoma, black variety, fried), Di Fu Zi (Kochiae Fructus), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Gan Qi (Drynariae Rhizoma? Note: Text says Gan Qi, likely Drynariae Rhizoma or similar, but literally 'Dry Lacquer' - context suggests herb), Xi Cao (Oryctodermis Larva, fried), Tian Xiong (Aconiti Lateralis Radix Praeparata? Note: Text says Tian Xiong, usually prepared Aconite root), Che Qian Zi (Plantaginis Semen) (each 3 fen), Bi Xie (Dioscoreae Hypoglaucae Rhizoma), Shan Yu (Dioscoreae Rhizoma, i.e., Shan Yao), Ze Xie (Alismatis Rhizoma), Niu Xi (Achyranthis Bidentatae Radix) (each 1 liang).
Preparation: Pound all ingredients into fine powder, mix with refined honey, and pound into pills the size of tung tree seeds. Take 50 pills each time, washed down with warm wine, on an empty stomach or before sleep.

To treat bi syndrome of sinews causing limb joint constriction pain, Ling Yang Tang (Antelope Horn Decoction) is taken in autumn.
Prescription: Ling Yang Jiao (Saiga Tataricae Cornu), Rou Gui (Cinnamomi Cortex), Fu Zi (Aconiti Lateralis Radix Praeparata), Du Huo (Angelicae Pubescentis Radix) (each 1 liang 3 qian 5 fen), Bai Shao (Paeoniae Radix Alba), Fang Feng (Saposhnikoviae Radix), Xiong (Chuan Xiong, Ligustici Chuanxiong Rhizoma) (each 1 liang).
Preparation: Pound into coarse powder. Take 5 da qian each time, add 1.5 zhan of water and 3 slices of fresh ginger, decoct until 0.8 zhan remains, strain, and drink the clear liquid. Can be taken 2-3 times daily.

To treat cold-damp-bi lingering in sinews and vessels, causing curling up and inability to turn or move, Wu Tou Tang (Aconite Decoction) is taken in winter.
Prescription: Da Wu Tou (Aconiti Radix), Xi Xin (Asari Radix et Rhizoma), Chuan Jiao (Zanthoxyli Pericarpium), Gan Cao (Glycyrrhizae Radix et Rhizoma), Qin Jiao (Gentianae Macrophyllae Radix), Fu Zi (Aconiti Lateralis Radix Praeparata), Guan Gui (Cinnamomi Cortex), Bai Shao (Paeoniae Radix Alba) (each 7 fen), Gan Jiang (Zingiberis Rhizoma Recens), Bai Fu (Bai Fu Ling, Poria), Fang Feng (Saposhnikoviae Radix, honey-fried), Dang Gui (Angelicae Sinensis Radix) (each 1 liang), Du Huo (Angelicae Pubescentis Radix) (1 liang 3 qian 5 fen).
Preparation: Pound into coarse powder. Take 3 qian each time, add 1.5 zhan of water and 2 jujubes, decoct until 0.8 zhan remains, strain, and take on an empty stomach before meals.

[Qian Jin Fang] Yi Yi Ren Tang (Coix Seed Decoction): Treats sinew spasms preventing flexion and extension.
Prescription: Bai Lian (Ampelopsis Radix), Yi Yi Ren (Coicis Semen), Shao Yao (Paeoniae Radix), Gui Xin (Cinnamomi Ramulum), Suan Zao Ren (Ziziphi Spinosae Semen), Gan Jiang (Zingiberis Rhizoma Recens), Niu Xi (Achyranthis Bidentatae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma) (each 1 liang), Fu Zi (Aconiti Lateralis Radix Praeparata) (3 pieces).
Preparation: Crush the nine herbs. Soak in 3 dou of strong wine overnight, simmer gently for three boils. Take 1 sheng each time, three times daily. If able to walk with a cane, tolerate alcohol well. Those intolerant to alcohol take 5 he.

[Li Dongyuan] Huo Xue Tong Jing Tang (Invigorating Blood and Unblocking Meridian Decoction): In December of the Gui Mao year, Dong Jianjun of Lingshou County, after heavy snow cleared, traveled to Zhending. Suddenly feeling a violent wind attack causing him to fall, pulse diagnosis revealed all six pulses were extremely wiry, forceful and full upon deep pressure. Symptoms included hand spasms, constipation, red and hot face. This was the initial invasion of wind-cold. The four limbs belong to the Spleen. When wind-cold pathogens injure the body, they cause twitching, urgency, and spasmodic bi, which is wind invading the extremities, with cold remaining on the exterior. The Nei Jing states: "Cold causes sinew contraction," which applies here. The patient usually drinks alcohol, leading to internal excess heat affecting the intestines and stomach, hence constipation and red/hot face. Internally, the Hand and Foot Yangming meridians are affected; externally, the Foot Taiyin Spleen meridian is affected by wind-cold. Use Gui Zhi (Cinnamomi Ramulus) and Gan Cao (Glycyrrhizae Radix et Rhizoma) to expel cold and relieve urgent twitching. Use Huang Bo (Phellodendri Cortex) bitter and cold, slippery to drain excess and moisten dryness, urgently saving Kidney Water. Use Sheng Ma (Cimicifugae Rhizoma) and Ge Gen (Puerariae Lobatae Radix) to raise Yang Qi and circulate Hand and Foot Yangming meridians, preventing obstruction. Further use Gui Zhi's acrid and hot nature to enter the Hand Yangming meridian as a guiding drug to moisten dryness. Use Shao Yao (Paeoniae Radix) and Gan Cao (Glycyrrhizae Radix et Rhizoma) specifically to tonify Spleen Qi, preventing wind-cold invasion, suppressing Wood evil, and benefiting Lung Metal. Add Ren Shen (Ginseng Radix et Rhizoma) to tonify Yuan Qi as an assistant. Add Dang Gui Shen (Angelicae Sinensis Radix radix part) to relieve internal urgency, harmonize blood, and moisten dryness. Named Huo Xue Tong Jing Tang.
Prescription: Sheng Ma (Cimicifugae Rhizoma) (1 qian), Ge Gen (Puerariae Lobatae Radix) (1 qian), Gui Zhi (Cinnamomi Ramulus) (2 qian), Dang Gui (Angelicae Sinensis Radix) (1 qian), Ren Shen (Ginseng Radix et Rhizoma) (1 qian), Shao Yao (Paeoniae Radix) (5 fen), Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) (1 qian), Jiu Bai (Jiu Huang Bo, Wine-processed Phellodendri Cortex) (2 qian).
Preparation: Cut into pieces the size of hemp seeds. Combine all as one dose, add 2 zhan of water, decoct to 1 zhan, strain, and take hot. Let the patient stay in a warm room near fire, massage and rub hands until recovery.

Deficiency-induced spasm refers to what the Classics state: "Deficient evils contend with sinews, resulting in sinew spasm." It also states: "If vessels do not nourish, sinews become tense" (Full text in Diagnosis of Life and Death section).
Additionally, Zhang Zhongjing stated: "Blood deficiency leads to sinew tension." All these indicate that blood vessels failing to nourish sinews result in spasm. Therefore, Dan Xi treats spasm using Si Wu Tang (Four Substances Decoction) modifications, and Ben Shi Fang treats extreme sinew tension with Yang Xue Di Huang Wan (Blood-Nourishing Rehmannia Pill), based on this principle.

[Ling Shu] Yellow Emperor asked: There are eight emptiness points in humans, how are they used for diagnosis? Qi Bo replied: To diagnose the five Zang organs. Yellow Emperor asked: How? Qi Bo replied: Pathogens in Heart and Lung remain in the two thighs (Bi). Pathogens in Kidney remain in the two popliteal fossae (Guo). These eight emptiness points are chambers of joints, where True Qi gathers and Blood and Qi flow. If Blood and Qi are solid, pathogens do not linger. If they linger, they damage meridians, joints cannot flex or extend, thus causing spasm.

[Dan] A villager had a hunched back and contracted feet, becoming disabled. I diagnosed his pulse as deep, wiry, and choppy in both hands. I gave him Dai Ren Wei Shen San (Dai Person's Roasted Kidney Powder), inducing vomiting and diarrhea. Over a month, vomiting and diarrhea alternated. After three doses, he recovered. (Wei Shen San usage: 3 qian of Gan Sui (Kansui Radix) powder, pig kidney sliced thinly, marinated with salt and pepper, insert powder inside, wrap in lotus leaf, heat, chew and swallow with warm wine.)

All spasms belong to the Liver. The Classics state: "The Liver governs the sinews of the body." It also states: "When Yangming rebounds severely, it enters the Liver, causing fright and sinew spasm." And: "When Spleen transfers cold to Liver, abscesses and sinew spasms occur."

[Ji Sheng Fang] Dispels all wind-damp bi and limb spasms. Cang Er Zi (Xanthii Fructus) 3 liang, pounded to powder, decoct in 1.5 sheng water to obtain 7 he, strain, and sip slowly.

[Shi Liao Ben Cao] Wine-boiled Mu Gua (Chaenomelis Fructus) porridge, applied to wrap painful areas of acute sinew tension. Excellent. (Formula seen in Crane Knee Wind section).

Nei Jing Acupuncture Method: Treating spasm distinguishes between sinew spasm and vessel spasm. For sinew spasm, the Classics state: "Disease in sinews, sinew spasm with joint pain, inability to walk, named Sinew Bi. Prick the sinews. Prick between muscle divisions, do not hit bone. When disease originates in sinews, stop when sinews feel warm and disease resolves" (Full text in Painful Bi section). For sinew-vessels, the Classics state: "Hand Jueyin meridian changes cause palm heat, elbow/wrist spasm, axillary swelling. Differentiate deficiency/excess, cold/heat. If sunken, extract. This is treating sinew-vessel spasm" (Full text in Acupuncture Section Twelve Meridians). Also: "The divergent channel of Shaoyang is named Waiguan (TE5), 2 cun from wrist. Elbow spasm takes this divergent point" (Full text in Acupuncture Section Fifteen Luo Vessels). Also: "Evil lodging in Foot Taiyin collateral causes rigid back, pulling胁 pain. Prick starting from neck, count vertebrae beside spine, press hard until tender, prick beside it three times" (Full text in Acupuncture Section Miao Ci Collaterals). This treats collateral spasm.

[Qian Jin Fang] Moxibustion for sinew tension preventing walking: Inner ankle sinew tension, moxa 40 cones on inner ankle; outer ankle sinew tension, moxa 30 cones on outer ankle, immediate cure.

[Yu Ji Wei Yi] Both elbows spasmodic: Qu Chi (LI11) (Insert 9 fen, first reduce then tonify, tonify 4 breaths, reduce 9 inhalations). Chi Ze (LU5) (Arm bent like a bow, insert 5 fen, first tonify then reduce).

[Biao You Fu] Sinew spasm and bone pain: Hun Men (BL47) (Tonify).

[Zhang Zhongwen] Chan Mountain Moxibustion Method: Treats foot sinew spasms. (See Low Back Pain section. Where the inner and outer curves of both feet meet at the tip).

[Cuo Yao] Knee flexion sinew tension unable to extend: Qu Quan (LR8) (Insert 1.5 cun).

[Guai Dan Ji) Knee sinew constraint unable to open: Both knees (Outer curve meeting tip, i.e., Wei Yang (BL39), moxa 27 cones).

[Jia Yi Jing) Both hands spasmodic unable to extend, axillary hemiplegia and numbness, hand muscles wasted small sinew tension: Da Ling (PC7) governs. Axillary constraint, sudden vessel tension pulling胁 pain, inward pulling Heart/Lung: [Missing Character in Source, likely Neiguan PC6 or similar, but source text has gap] governs.