Numbness refers to the loss of skin sensation, where one cannot feel pain or itch. If it occurs in the limbs, it is called limb numbness.

Numbness is referred to as "buren" in Neijing and Jingui Yaolue, falling under the categories of "bi" and "apoplexy." The "Zhubing Yuanhou Lun" describes the state of "buren" as "when the skin is scratched, it feels as if it is covered by clothing." Suwen Bingji Qiyi Baomingji first introduced the term "numbness." Zhu Dan-xi said: "The terms 'ma' and 'mu' are divided from 'buren' into two." This shows that numbness and buren are synonymous.

This article mainly discusses limb numbness; if it presents as hemiplegic numbness, it will be described separately.

bubble_chart Pattern Analysis

1. Wind-cold Entering the Collaterals︰Numbness of the limbs accompanied by pain, aggravated by cold weather, along with aversion to wind, cold hands and feet, soreness and heaviness in the lower back and knees, a pale and dark tongue texture with white and moist coating, and a floating or wiry pulse. This condition is caused by loose striae and interstice, invasion of wind-cold, Jingmai cervical malignancy with cachexia, and disharmony of qi and blood. The onset has a clear history of exposure to external pathogens, but clinically, it can be divided into cases where wind pathogens are predominant and cases where cold pathogens are predominant. When wind pathogens are predominant, the numbness is migratory without a fixed affected area, or may be accompanied by grade I deviation of the mouth and eyes, with a mostly floating pulse. Treatment should focus on dispelling wind and protecting the defensive qi, using the formula Astragalus and Cinnamon Twig Five Ingredients Decoction. When cold pathogens are predominant, the numbness is accompanied by pain, with a fixed affected area, cold hands and feet, marked aversion to cold, and soreness and heaviness in the lower back and knees, with a mostly wiry and tight pulse. Treatment should focus on warming the meridians and dissipating cold, using the formula Angelica Cold-Extremities Decoction.
2. Qi and Blood Deficiency︰Numbness and weakness in the limbs, inability to lift, {|###|}complexion shallow yellow and dull, accompanied by shortness of breath and flusteredness, dizziness, insomnia, forgetfulness, etc. The tongue texture is pale red with thin white coating, and the pulse is thin and weak. This often occurs due to improper overstrain, or is seen after vomiting and diarrhea damaging the middle burner, or excessive loss of blood, frequent childbirth, or prolonged Rebing, or it may appear after other debilitating illnesses. When both qi and blood are deficient, the vessels become empty, and the limbs lose their nourishment, leading to numbness. If the condition leans toward qi deficiency, the complexion appears pale white, the limbs are weak and unable to lift, accompanied by flusteredness, shortness of breath, a weak pulse, and a pale red tongue texture. If it leans toward blood deficiency, the complexion is dull, the skin is dry, accompanied by dizziness, blurred vision, insomnia, forgetfulness, a thin or rapid pulse, and a tender red tongue texture. The commonality between the two is that both are deficiency patterns—one of qi deficiency and the other of blood deficiency—manifesting as numbness without pain, presenting a general picture of deficiency. For qi deficiency-induced limb numbness, treatment should focus on tonifying and replenishing qi and blood, using Middle-Tonifying Qi-Replenishing Decoction. For blood deficiency-induced limb numbness, the treatment should nourish blood and regulate qi, using Shenying Yangzhen Dan. If the deficiency of qi and blood is balanced without leaning toward either, Eight Precious Ingredients Decoction can be used to tonify both qi and blood.
3. Qi Stagnation and Blood Stasis︰Numbness of the limbs accompanied by distending pain, which is relieved by pressure, a dull complexion, purple lips, purple ecchymosis visible on the tongue texture, a thin and slightly dry tongue coating, and a choppy pulse. "When qi moves, blood moves; when qi stagnates, blood stagnates," but there are also cases where blood stasis leads to qi stagnation. Although qi stagnation and blood stasis often occur together, clinically there are distinctions between cases where qi stagnation predominates and those where blood stasis predominates. Cases where qi stagnation predominates are mostly attributed to emotional disturbances and disruption of qi movement; cases where blood stasis predominates are commonly seen in trauma or prolonged illness entering the collaterals. Stagnation of qi and blood obstructs the meridians, depriving the nutritive yin of nourishment and the defense qi of warmth, hence resulting in limb numbness. The common feature of both is: numbness accompanied by distension, which is relieved by pressure. The relationship between the two is: in the early stages, the disease is in the qi level, but as the illness persists, it enters the blood level, progressing from qi stagnation to blood stasis. The key points for differentiation are: in cases where qi stagnation predominates, the numbness fluctuates in severity but is rarely accompanied by pain, the pulse is wiry and lacks suppleness, and the tongue is pale-dark without ecchymosis; in cases where blood stasis predominates, the numbness is accompanied by persistent pain, the skin appears dull, the lips are cyanotic, the pulse is deep and choppy, and ecchymosis is invariably present on the tongue texture. For qi stagnation, the appropriate method is to move qi and unblock the collaterals, commonly using Notopterygium Wind-Dispelling Decoction; for blood stasis, the method is to invigorate the blood and unblock the collaterals, often employing Peach Kernel, Carthamus and Four-Ingredient Decoction.
4. Internal Stirring of Liver Wind︰Numbness of the limbs accompanied by tremor, along with dizziness, headache, dysphoria, irritability, insomnia, dreamfulness, etc. The tongue texture is dark with scant coating, and the pulse is wiry and forceful. Liver yang is inherently exuberant, and when combined with emotional imbalance, yang movement generates wind, leading to the onset of illness. The key points of pattern differentiation are numbness accompanied by obvious tremor, along with dizziness, headache, dysphoria, irritability, and a wiry, forceful pulse. Treatment should focus on cooling the liver and extinguishing wind. The recommended formula is Lingyang Gouteng Tang (Antelope Horn and Uncaria Decoction).
5. Wind Phlegm︰Numbness in the limbs accompanied by itching, or occasional tremors, along with dizziness, heaviness in the shoulders and back, or nausea, excessive phlegm, etc. The tongue texture is slightly dark with thin greasy coating, and the pulse is wiry-slippery or soggy. Prolonged retention of phlegm-fluid is triggered by wind pathogens, leading to wind-phlegm obstructing the meridians and causing the disease. The key diagnostic points are numbness often accompanied by itching, dizziness, back heaviness, greasy tongue coating, etc. Treatment should focus on expelling wind and resolving phlegm, using Phlegm-Guiding Decoction combined with Jade Screen Powder.
6. Dampness-heat︰Numbness in the lower limbs accompanied by a burning pain sensation, with feverishness upon palpation of the affected limb, and in severe cases, a desire to step on cool ground. The tongue texture is dark, with a yellow-white and greasy coating, and the pulse is wiry and rapid or soggy and rapid. This condition is caused by dampness-heat stagnation obstructing the collaterals, preventing qi and blood from reaching the extremities. The key diagnostic points include: numbness in the lower limbs with a burning pain sensation, particularly pronounced heat in both feet, to the extent that stepping on cool ground is necessary for relief, a rapid pulse, and a yellow-greasy tongue coating. Treatment should focus on {|###|}clearing heat and draining dampness{|###|} to unblock the collaterals, using the modified Two Wonderful Herbs Powder.

In clinical practice, it is rare to see all four limbs numb; more commonly, numbness is seen in both upper limbs, both lower limbs, or a single limb. In clinical differentiation, it is important to distinguish between deficiency and excess syndromes. In deficiency pattern, the affected limb is weak and powerless, while in excess pattern, the affected limb is painful and swollen, which is the main difference between the two. In terms of treatment, "treat deficiency with tonification, and excess with purgation." The tonifying method should focus on tonifying qi and blood, and strengthening the middle energizer. For excess pattern, methods include dispelling wind, dispersing cold, resolving phlegm, activating blood, moving stagnation, and extinguishing wind. As for pattern of complex deficiency and excess, it is necessary to determine which is more severe, weigh the urgency, and treat according to the pattern.

The symptom of numbness has been listed by medical practitioners throughout history as one of the precursors of apoplexy. Zhang Sanxi said, "Middle-aged people who feel occasional numbness in the thumb, or insensitivity; or weakness in the hands and feet, or slight twitching of the muscles, will inevitably suffer a sudden apoplexy within three years." ("Apoplexy Special Issue") Wang Qing-ren in Yilin Gaicuo also recorded limb numbness as a precursor symptom of apoplexy. Especially, numbness caused by wind phlegm obstructing the collaterals and internal stirring of liver wind is particularly prone to lead to apoplexy. Therefore, actively treating numbness of the limbs is of great significance in preventing apoplexy.

1. Suwen-Nitiao Lun ""nutrient-qi deficiency resulting in numbness，defensive-qi deficiency resulting in flaccidity，deficiency of both nutrient and defensive qi leads to insensitivity and immobility."
2. Danxi Xinfa"Numbness in the hands and feet is due to qi deficiency. Wooden sensation in the hands and feet is due to damp phlegm and dead blood. Numbness in the ten fingers is due to damp phlegm and dead blood in the stomach."
3. Zabing Yuanliu Xizhu．The Origin and Flow of Numbness: "Numbness is a disease of wind deficiency and also involves cold-dampness, phlegm, and blood disorders. Numbness is neither itching nor pain, but feels like millions of tiny insects crawling inside the muscles, or like the sound of insects crawling all over the body, which does not stop when pressed and worsens when scratched, resembling the sensation of hemp. Wooden sensation is neither itching nor pain, but feels like one's own muscles are as unresponsive as someone else's, not feeling when pressed or pinched, resembling the thickness of wood. ... Qi deficiency is the root, wind phlegm is the branch. First, use Fresh Ginger Rhizome as a guide, Submature Bitter Orange to open qi, Pinellia to expel phlegm, Saposhnikovia Root and Notopterygium to disperse wind, Akebia Stem and Toothpick to unblock the meridians, Stiff Silkworm as the holy medicine for treating insect-like crawling. Use Mulberry Twigs for the arms, add Achyranthes Root for the legs and feet. When the disease lessens, use Middle-Tonifying Qi-Replenishing Decoction with more ginseng and astragalus. If the wooden sensation persists day and night for years, it is due to dead blood stagnating inside, with external wind-cold. Yang qi is deficient and unable to move. First, use cinnamon and aconite as guides, Lindera and Aucklandia Root to move qi, Chinese Angelica, Donkey-hide Gelatin, Peach Kernel, and Carthamus to activate blood, Akebia Stem, Toothpick, and Pangolin Scales to unblock the meridians. When the disease lessens, use Eight Precious Ingredients Decoction to greatly tonify qi and blood, which is always effective. This is the general method for treating numbness. ... The method of treatment must always focus on supplementing qi and blood as the fundamental approach, and not solely rely on dispersing methods. Remember this well. For those with numbness and insensitivity in the thumb and index finger, beware of apoplexy within three years. Take all preventive measures and regularly takeTen Major Tonics Decoctionwith Notopterygium and Gentian."