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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.