Library

[Symptoms of Internal Injury Tendon Spasm] The skin is dry and scaling, with generalized dry itching. The hands and feet are difficult to move. Gradually, the muscles become dark and emaciated, and the tendons and vessels contract and spasm. This is a condition of tendon spasm caused by blood deficiency in the Liver Meridian. If both legs are stiff and cannot extend, or if pain alternates between left and right, gradually progressing to contraction of both arms, this is tendon spasm caused by damp-heat in the Stomach (Yangming) Meridian.

[Etiology of Internal Injury Tendon Spasm] The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "When meridians do not nourish, tendons become tight." It also states: "The Liver governs the tendons. If Liver Qi is hot, the tendon membranes become dry; when dry, the tendons become tight and spasmodic." It further states: "The Yangming (Stomach) Meridian primarily moistens the Zongjin (major tendons), binds the bones, and facilitates joint movement. If damp-heat is not dispelled, the large tendons become short, leading to tendon spasm."

[Pulse Signs of Internal Injury Tendon Spasm] A fine and rapid pulse at the Left Guan position indicates Blood heat in the Liver Meridian. A fine and choppy pulse at the Left Guan position indicates dryness of the Sea of Blood. A wiry and fine pulse at the Right Guan position indicates Blood deficiency in the Yangming (Stomach) Meridian.

[Treatment of Internal Injury Tendon Spasm] For Liver Meridian Blood heat, use Zhi Bai Si Wu Tang (Anemarrhena, Phellodendron, and Four Substances Decoction). Since the Liver governs Wind, and Wind arises from Blood deficiency, use Bu Gan San (Liver Tonifying Powder) combined with Gouteng Gao (Uncaria Paste). For dryness of the Sea of Blood, use Bu Yin Wan (Tonify Yin Pill). For Yangming deficiency, use Yiyi Ren San (Coix Seed Powder) combined with Jinyinteng Gao (Lonicera Vine Paste). For severe Yangming damp-heat, use Si Wei Shu Jin Tang (Four-Ingredient Tendons Relaxing Decoction).

Zhi Bai Si Wu Tang (Anemarrhena, Phellodendron, and Four Substances Decoction): Treats tendon spasm due to Liver Meridian Blood heat.
Ingredients: Zhi Mu (Anemarrhenae Rhizoma), Huang Bo (Phellodendri Cortex), Dang Gui (Angelicae Sinensis Radix), Sheng Di (Rehmanniae Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Bai Shao Yao (Paeoniae Radix Alba).

Bu Gan San (Liver Tonifying Powder)
Ingredients: Dang Gui (Angelicae Sinensis Radix), Bai Shao Yao (Paeoniae Radix Alba), Qiang Huo (Notopterygii Rhizoma et Radix), Qin Jiao (Gentianae Macrophyllae Radix).

Gouteng Gao (Uncaria Paste)
Ingredients: Gou Teng (Uncariae Ramulus cum Uncis), Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Sheng Di (Rehmanniae Radix), Bai Shao Yao (Paeoniae Radix Alba).

Bu Yin Wan (Tonify Yin Pill): Treats tendon spasm due to Liver Meridian Blood dryness.
Ingredients: Dang Gui (Angelicae Sinensis Radix), Sheng Di (Rehmanniae Radix), Bai Shao Yao (Paeoniae Radix Alba), Dan Pi (Moutan Cortex), Niu Xi (Achyranthis Bidentatae Radix), Mu Gua (Chaenomelis Fructus), Gui Ban (Testudinis Carapax et Plastrum), Hu Gu (Ossis Tigris [Note: Substitute legally permitted materials]), prepared into pills with Lamb Meat (Agni Caro).

Yiyi Ren San (Coix Seed Powder): Treats Wei syndrome (flaccidity) and tendon spasm due to Lung Heat, and simultaneously treats Yangming dampness.
Ingredients: Yi Yi Ren (Coicis Semen) (1 jin).
Preparation: Roasted, ground into powder, taken mixed with water.

Jinyinteng Gao (Lonicera Vine Paste): Treats tendon spasm due to Yangming Meridian damp-heat.
Ingredients: Jin Yin Teng (Lonicerae Japonicae Caulis) (1 jin), Qin Jiao (Gentianae Macrophyllae Radix) (4 liang), Mu Gua (Chaenomelis Fructus) (4 liang), Cang Zhu (Atractylodis Rhizoma) (4 liang), Huang Bo (Phellodendri Cortex) (4 liang).

Si Wei Shu Jin Tang (Four-Ingredient Tendons Relaxing Decoction): Treats tendon spasm due to Yangming Meridian damp-heat.
Ingredients: Qin Jiao (Gentianae Macrophyllae Radix), Mu Gua (Chaenomelis Fructus), Cang Zhu (Atractylodis Rhizoma), Huang Bo (Phellodendri Cortex).

Jia Mi Qing Wei Tang (Secret Formula for Clearing Stomach Heat)
Ingredients: Sheng Ma (Cimicifugae Rhizoma), Chuan Lian (Coptidis Rhizoma), Shan Zhi (Gardeniae Fructus), Dan Pi (Moutan Cortex), Sheng Di (Rehmanniae Radix), Mu Tong (Akebiae Caulis), Gan Cao (Glycyrrhizae Radix et Rhizoma).
Usage: Decocted in water. Take the decoction to grind raw Xi Jiao (Rhinocerotis Cornu [Note: Substitute legally permitted materials]) and ingest.

Jia Mi Shu Jin Wan (Secret Formula for Tendons Relaxing Pills)
Ingredients: Dang Gui (Angelicae Sinensis Radix) (2 liang), Bai Shao Yao (Paeoniae Radix Alba) (2 liang), Zhi Mu (Anemarrhenae Rhizoma) (2 liang), Huang Bo (Phellodendri Cortex) (2 liang), Qin Jiao (Gentianae Macrophyllae Radix) (4 liang), Mu Gua (Chaenomelis Fructus) (4 liang).
Preparation: Grind the above six herbs into fine powder.
Additional Ingredients: Jin Yin Teng (Lonicerae Japonicae Caulis) (2 jin), Gou Teng (Uncariae Ramulus cum Uncis) (1 jin), Tian Men Dong (Asparagi Radix) (6 liang), Huai Sheng Di (Rehmanniae Radix Preparata) (6 liang), Wei Ling Xian (Clematidis Radix et Rhizoma) (4 liang, soaked in wine), He Shou Wu (Polygoni Multiflori Radix) (4 liang, steamed).
Preparation: Decoct the above six herbs in water, remove dregs, reduce to a thick paste, mix with the previously prepared powder, and form into pills.

Commentary by Zhu Zhen: The *Huangdi Neijing* discusses Wei syndrome (flaccidity), stating: "If Lung heat scorches the leaves, Wei syndrome occurs. If Heart Qi is hot, Mai Wei (pulse flaccidity) occurs, with calves relaxed and unable to bear weight. If Liver Qi is hot, tendon membranes dry, causing tight and spasmodic tendons. If Spleen Qi is hot, the stomach becomes dry and thirsty, resulting in Rou Wei (muscle flaccidity). If Kidney Qi is hot, the waist and spine cannot lift, resulting in Gu Wei (bone flaccidity)." It further analyzes that: "All five zang organs develop Wei syndrome due to Lung heat overacting on them. Wei syndromes are primarily governed by excessive heat. Lung heat presents with white complexion and hair failure; Heart heat with red complexion and vessel overflow; Liver heat with green complexion and brittle nails; Spleen heat with yellow complexion and muscle twitching; Kidney heat with black complexion and brittle teeth." Regarding treatment, it summarizes: "Uniquely select the Yangming Meridian." The Yangming Meridian is the sea of the five zang and six fu organs, primarily moistening the Zongjin, binding the bones, and facilitating joint movement. Clearly, Yangming extensively accepts grain and water. Dietary heat substances first affect it. The five zang and six fu organs all receive Qi from the Stomach. If there is accumulated heat in the intestines and stomach, Yangming receives heat, and the Lung suffers fire punishment, resulting in Wei syndrome. The *Yuan Bing Shi* states: "Flaccidity of hands and feet is not due to external wind invasion, but arises from internal heat. Because Lung heat causes blood dryness, failing to nourish the hundred bones." Zhang Zihe said: "Wei syndrome arises from Lung heat overacting on the four zang organs. Treating it as cold is fatal." Zhu Danxi said: "Among those who treat Wei syndrome according to the *Neijing* principles, only Hejian has done so throughout history." Liu Zongnong said: "The discussion of Wei syndrome in the *Neijing* is very detailed. However, later medical texts are mostly erroneous because hand-foot paralysis resembles stroke, and difficulty walking resembles wind-bi. Thus, they mistakenly treat it with methods for stroke and bi syndromes, causing harm to this day."

Commentary by Zhu Zhen: The arguments of these masters are extremely correct, yet they have not fully elucidated the *Neijing*'s discussion on Wei syndrome, which points out that accumulated heat in Yangming transmits to the Lung. Treatment should uniquely select the Yangming Meridian to clear the source. This prevents the consumption of blood, thereby moistening the Zongjin, binding the bones, and facilitating joints. As stated later: "Yin and Yang converge at the Zongjin, meeting at Qichong, with Yangming as their leader, belonging to the Dai Meridian, and connecting to the Du Meridian. When Yangming disease occurs, Zongjin becomes hot and slack, and the Dai Meridian fails to pull, resulting in foot flaccidity." This describes how accumulated heat from rich foods causes internal injury leading to Wei syndrome. One must uniquely select Yangming; this is the true key to treating Wei syndrome. The *Neijing* details acupuncture for diseases, stating: "Deficiency requires tonification, excess requires draining." Now, saying "uniquely select Yangming" is because Wei syndrome is caused by Yangming excess heat. However, one should not rely solely on medication; acupuncture targeting Yangming is also a method. Furthermore, the *Shengqi Tongtian Lun* states: "Due to dampness, if damp-heat is not dispelled, large tendons become soft and short, small tendons become lax." This indicates that Wei and spasm syndromes involve not only internal injury but also external dampness invasion. If dispelled, long-standing dampness turns to heat, and long-standing heat turns to dryness. Dryness damages blood, also causing Wei and spasm. This clarifies that before damp-heat transforms into dry-heat, damp-clearing and heat-clearing methods can be used. If Wei and spasm are already established, heat-clearing and dryness-moistening methods should be used to moisten Zongjin. Misusing drying-dampness methods violates the principle of "moistening Zongjin." The *Neijing* also states: "Changes from rich foods often produce large carbuncles." Those who eat well but feel thirsty may develop brain carbuncles. It also states: "Excess Earth causes inability to move the limbs." This is truly accumulated heat from rich foods, not Liver-Kidney deficiency. Careful analysis shows that heat generated in the five zang organs produces toxins, leading to limb immobility and foot flaccidity/spasm, all arising from rich food accumulated heat. One must clear intestinal and stomach accumulated heat. Discussing contraindications for dry-heat drugs, even using yin-nourishing and fire-descending drugs is inappropriate if not targeting Liver-Kidney deficiency or the specific disease. Clearing gastrointestinal accumulated heat differs from other meridians. Heat in other meridians is easy to clear, but rich-food accumulated heat rises immediately after clearing. If one indulges in diet, drinking alcohol sends heat upward to the Lung. Strong flavors create rich-food accumulated heat. Even salt transforms via fire; excessive salty flavor can induce thirst and fever. Luo Longji said: "Even if medicine hits the mark, without bland diet, although daily heat-clearing herbs are taken, accumulated heat grows daily. Alternating cold and sudden heat, I know it cannot be completely successful." Rich-food accumulated heat is damp-heat from greasy and meaty foods. If damp-heat drains downward, carbuncles do not arise. If damp-heat cannot drain downward, it obstructs, swells, and produces toxins. If long-standing and transforming into dryness, with blocked urination and defecation, it becomes excess Earth, causing limb immobility. Therefore, clearing accumulated heat restores normal urination and defecation. When Spleen and Stomach are clear and harmonious, they transport and transform grain and water, generate essence and blood, moisten Zongjin, and facilitate joint movement.