bubble_chart Concept

Emaciation of the limbs refers to the symptom of muscle atrophy in the upper and lower limbs caused by a certain

disease cause. The

Neijing records terms such as "脱肉" (loss of flesh), "肌肉削" (thinning of muscles), "肌肉萎" (muscle atrophy), "破䐃脱肉" (ruptured flesh and loss of flesh), and "emaciation with sagging flesh," which refer to severe muscle atrophy in prominent areas such as the elbows, knees, and thighs, as well as noticeable thinning of muscles in the legs, arms, and buttocks. Suwen

．Yinyang Bie Lun also mentions "风消" (wind-induced emaciation), which refers to a condition where extreme heat produces wind, leading to a deficiency of yin essence, muscle wasting, and overall emaciation, not limited to the limbs.

{|112|}Jingui Yaolue{|113|} also records "消鑠肌肉" (melting of muscles), which refers to the consumption of body fluids due to excessive heat, leading to muscle wasting. Among these, "酸削" (sore and thin) refers to muscle atrophy accompanied by soreness and weakness. {|114|} Emaciation is different from fleshy flaccidity; emaciation specifically refers to muscle atrophy, while fleshy flaccidity is primarily characterized by weakness or paralysis. Later literature often discusses "羸瘦" (emaciation) and "尫羸" (frail and emaciated), which refer to overall emaciation and decline in both spirit and form, not limited to the limbs.

bubble_chart Pattern Analysis

1. Spleen-stomach Weakness︰It is commonly seen in adolescents, characterized by emaciated limbs, particularly noticeable in the shoulders and buttocks, weakness in the upper limbs, a waddling gait in the lower limbs, inward or outward turning of the ankles, arched dorsum of the feet, pale {|###|}complexion{|###|}, {|###|}mental fatigue{|###|} and lethargy, poor appetite, {|###|}shortage of qi{|###|} leading to reluctance to speak, faint and low voice, pale tongue with white coating and tooth marks on the edges, and a thin, soft pulse. This condition is often caused by irregular diet, postnatal maladjustment, {|###|}spleen-stomach weakness{|###|}, and insufficient {|###|}generation and transformation{|###|} of qi and blood, resulting in the inability of water and grain essence to nourish the muscles of the limbs. Suwen. Taiyin Yangming Lun: "The limbs cannot receive the qi of water and grain, leading to a daily decline in qi, obstruction of the meridians, and lack of qi to nourish the tendons, bones, and muscles, rendering them useless." This syndrome is commonly observed in picky-eating adolescents with {|###|}anorexia{|###|}. The spleen governs the four limbs; if spleen transportation is impaired, it cannot distribute {|###|}body fluids{|###|} for the stomach, resulting in poor appetite and limb weakness. Insufficient {|###|}middle qi{|###|} leads to {|###|}mental fatigue{|###|} and lack of strength, {|###|}shortage of qi{|###|} causing reluctance to speak, faint and low voice, pale tongue with white coating and tooth marks, and a thin, soft pulse. Treatment should focus on {|###|}tonifying middle and replenishing qi{|###|}, using Middle-Tonifying Qi-Replenishing Decoction with modifications.
2. Kidney Essence Insufficiency︰It is commonly seen in infants, characterized by emaciated muscles, inability to raise hands or stand, delayed development, and intellectual disability, often accompanied by the five retardations (delayed standing, walking, teething, hair growth, and speech) and the five kinds of flaccidity (softness of the head and neck, mouth, hands, feet, and muscles), a pale tongue with white coating, and deep-thin pulse. It is mostly caused by congenital deficiency, improper postnatal feeding, leading to {|###|}kidney essence insufficiency{|###|}, emptiness of the sea of marrow, and depletion of {|###|}healthy qi{|###|}, which affects the infant's growth and development, resulting in emaciated limbs, the five retardations and five kinds of flaccidity, intellectual disability, and other symptoms. The treatment should focus on {|###|}tonifying the kidney and replenishing essence{|###|}, using modified Six-Ingredient Rehmannia Pill as the prescription. If postnatal care is appropriate, with attentive nurturing and active treatment, better outcomes can be achieved.
3. Liver-kidney Yin Deficiency︰The muscles are emaciated, the limbs are weak and trembling, the gait is unsteady, muscular twitching, and even slurred speech, coughing during swallowing, soreness in the waist and weakness in the legs, dizziness and blurred vision, vexing heat in the chest, palms and soles, restless sleep at night, a red tongue with scant coating, and a thready-rapid or wiry-thready pulse. This is often due to constitutional yin deficiency or severe damage to yin and blood after other illnesses, leading to liver and kidney insufficiency. The liver stores blood and governs the sinews, while the kidney stores essence and governs the bones. Liver-kidney yin deficiency results in weak sinews and wilting bones, with emaciation and weakness in the limbs. Insufficient liver yin leads to ascendant hyperactivity of liver yang, transforming into wind and causing tremors, hence muscular twitching and limb trembling. The foot shaoyin kidney channel runs along the throat and embraces the root of the tongue, so kidney yin deficiency causes slurred speech and difficulty swallowing. Kidney deficiency leads to emptiness in the lumbar region, and yin deficiency generates internal heat, resulting in soreness in the waist, vexing heat in the chest, palms and soles, restless sleep, a red tongue with scant coating, and a thready-rapid pulse. Treatment should focus on nourishing water to moisten wood, nourishing yin and subduing yang, using Anemarrhena, Phelloendron and Rehmannia Pill or Major Yin-Tonifying Pill with modifications. If yin deficiency affects yang, use Hidden Tiger Pill with modifications.
4. Spleen-kidney Yang Deficiency︰The muscles are emaciated, the limbs are weak, the muscles are cold and the body is chilly, with severe emaciation, tinnitus, deafness, soreness in the waist and weakness in the legs, seminal emission, impotence, clear urine, loose stools, a pale and swollen tongue with thin white coating, and a deep and slow pulse. This is often due to constitutional weakness or damage to yang qi after other illnesses, leading to spleen and stomach yang deficiency. The spleen governs transportation and transformation, while the kidney governs warming and nourishing. If spleen transportation fails, body fluids cannot be distributed, and if kidney yang is insufficient, it cannot warm and steam, resulting in body fluids failing to nourish the muscles, tendons, and bones of the limbs. This causes emaciation or severe wasting of the muscles, weakness in the limbs, tinnitus, deafness, impotence, seminal emission, soreness in the waist, and weakness in the legs. Yang deficiency leads to external cold, hence the chilly body and cold limbs, clear urine, loose stools, a pale and swollen tongue, and a deep and slow pulse. The treatment should focus on warming and tonifying the spleen and kidney, using the Golden Chamber Kidney Qi Pill supplemented with ginseng, white atractylodes rhizome, and Chinese yam.
5. Deficiency of Both Qi and Blood︰The muscles are emaciated, the complexion is pale, mental fatigue is severe, dizziness and blurred vision occur, palpitation and shortness of breath are present, spontaneous sweating and night sweats are observed, appetite is poor, the tongue is pale with scant coating, and the pulse is faint and thin. These symptoms often represent the further progression of the aforementioned conditions, namely qi deficiency affecting blood and yang deficiency affecting yin. Due to the mutual rooting of yin and yang and the interconnectedness of qi and blood, the late stage (third stage) often leads to dual deficiency of qi and blood. This manifests as emaciated muscles, weakness in the limbs, dizziness and blurred vision, severe mental fatigue, palpitation and shortness of breath, spontaneous sweating and night sweats, a pale tongue with scant coating, and a faint, thin pulse. The treatment should focus on powerful tonification of primordial qi and nourishing yin blood, using Ginseng Yangying Decoction.

Liver-kidney yin deficiency and spleen-kidney yang deficiency with emaciated limbs: The common point of these two syndromes is kidney deficiency, but one is mainly characterized by yin deficiency, focusing on the liver and kidney; the other is mainly characterized by yang deficiency, focusing on the spleen and kidney. Both are commonly seen in young adults. This is significantly different from kidney essence insufficiency with emaciated limbs due to congenital deficiency, which occurs in infants. The differentiation between spleen-kidney yang deficiency and spleen-stomach weakness is that the former may manifest as cold body and limbs, clear and abundant urine, impotence, seminal emission, and other yang deficiency symptoms; the latter may manifest as reduced appetite, mental fatigue, low voice, and reluctance to speak, which are qi deficiency symptoms.

Emaciated limbs are mainly due to deficiency pattern. When the body is weak, external pathogens are more likely to invade, often leading to a deficiency syndrome mixed with excess symptoms and signs. Clearing external pathogens during deficiency may also exacerbate the progression of the condition.

Additionally, Suwen{103|}．{104|}Wei Lun{105|} proposes the treatment principle of "treating flaccidity only by focusing on yangming," which is not only applicable to acupuncture but also has guiding significance for internal medicine clinical practice. When the spleen and stomach are strong, the source of transformation is sufficient, and when qi and blood are vigorous, atrophy-flaccidity disease and emaciated limbs can be cured.

bubble_chart Documentation

1. "Chinese Medicine Clinical Essentials: Emaciation of the Limbs": "Local muscle emaciation in the limbs is commonly seen in atrophy-flaccidity diseases, such as crane knee wind, etc. In cases of severe or prolonged illness, the discovery of significant muscle wasting in the arms or shins, anciently referred to as 'flesh detachment', is one of the incurable symptoms and signs."
2. "Chinese Medicine Clinical Essentials: Emaciation": "Progressive emaciation of the body is commonly seen in deficiency and detriment disease patterns. Since the spleen governs the muscles, it is essential to nourish the qi and blood of the middle energizer in conjunction with the main symptoms."
3. Muscle emaciation, with the complete loss of major muscles in the limbs being the most severe... In women, becoming emaciated to the point of being skin and bones without any apparent illness, Dongyi Baojian once specifically pointed out, is also considered to be due to insufficient qi and blood, recommending the use of ginseng decoction to take Gu Ling Wan."