bubble_chart Concept

Limb wilting and paralysis refer to the condition where the four limbs are weak and powerless, slack and uncontrollable, or even muscle atrophy occurs, leading to functional impairment or loss. Zhengzhi Zhunsheng states: "Wilting refers to the weakness and powerlessness of the hands and feet, and the slackness and uncontrollability of the joints of the body." In ancient literature, Neijing refers to it as "atrophy-flaccidity." Wilting refers to the weakness and disuse of the limbs, while "bi" refers to the weakness and powerlessness of the lower limbs, and it proposes different names such as "skin wilting," "fleshy flaccidity," "sinew flaccidity," "vessel flaccidity," "bone wilting," and five zang-organs wilting. Jingui Yaolue．apoplexy multiple arthralgia abnormal pulse syndrome and treatment》 calls it "dry." Later medical practitioners all refer to it as "wilting."

Atrophy-flaccidity disease and Bi disease and beriberi can all cause four wilting impediment paralysis, but the clinical manifestations are different. Severe Bi disease, due to swelling, pain, and deformation of the limbs, can lead to muscle wasting and withering over time, resulting in limb movement disorders, with symptoms similar to atrophy-flaccidity disease. However, "bi" is caused by external factors, with joint pain or swelling, while "wilting" is mostly caused by internal factors, without joint pain or swelling. Although beriberi also causes slackness and weakness of the lower limbs, making it difficult to bear weight, beriberi is characterized by numbness, swelling, and pain in the lower limbs, belonging to pathogenic qi, while atrophy-flaccidity disease is characterized by limb disuse without pain, mostly due to qi and blood deficiency. "Migratory impediment flaccidity and cold extremities are four different syndromes... Diseases of the four extremities, if they move or are stiff, are due to wind; if they are numb or painful, they are due to 'bi'; if they are weak and unusable, they are due to 'wilting'; if they are reversed with cold and heat, they are due to 'jue'." (See Rumen Shiqin

) {|116|}Wilting and paralysis are included within paralysis, which can occur in the upper limbs, the lower limbs, or both simultaneously. If one side of the upper and lower limbs is paralyzed, it is called hemiplegia or half-body paralysis, which can be referred to in that entry.

bubble_chart Pattern Analysis

1. Lung Heat Damaging Fluids︰The symptoms include limpness and weakness of the four limbs, gradually leading to flaccidity and paralysis, which can occur in both the upper and lower limbs, but is more commonly seen in the lower limbs. In severe cases, muscle atrophy and limb deformities may be observed. It may also be accompanied by fever, cough, dry nose and throat, restlessness, thirst, scanty and dark urine, a red tongue with a yellow coating, and a thin, rapid pulse. This condition often occurs after acute Rebing. Due to the lung being a delicate zang-organ, it is vulnerable to pathogenic invasion, especially when warm-heat invades the lung, leading to lung heat damaging fluids, resulting in insufficient body fluids for distribution and the loss of nourishment to the tendons and vessels. The key points for differentiation are: after Rebing, the gradual onset of limpness and paralysis of the four limbs, accompanied by fever, coughing, dry throat, and other symptoms of lung heat and fluid depletion. Therefore, Suwen. Wei Lun states: "When lung heat scorches the lobes, the skin and hair become weak and thin, leading to atrophy-flaccidity." Treatment should focus on nourishing the lung and promoting fluid production, clearing heat and moistening dryness. The recommended formula is Dryness-Clearing Lung-Rescuing Decoction combined with Stomach-Tonifying Decoction with modifications.
2. Dampness-heat︰The initial stage [first stage] manifests as abnormal sensations in the limbs, followed by weakness and flaccidity of the hands and feet, drooping of the hands and feet, inability to function, heaviness and numbness of the limbs, chest and gastric stuffiness, sticky and turbid stools, reddish and painful urination with a burning sensation, yellow and greasy tongue coating, and a slippery and rapid pulse. This is often caused by the direct invasion of dampness-heat pathogens into the skin, muscles, and sinews. Suwen·Shengqi Tongtian Lun states: "Due to dampness, the head feels as if wrapped; if dampness-heat is not dispelled, the large sinews will contract and shorten, while the small sinews will relax and lengthen. Contraction leads to stiffness, and relaxation leads to flaccidity." Suwen·Wei Lun states: "Gradual exposure to dampness, engaging in water-related activities, or residing in damp environments can lead to stagnation, causing the muscles to become soaked, resulting in numbness and loss of sensation, and the development of fleshy flaccidity." Alternatively, excessive consumption of rich, sweet, or greasy foods, prolonged indulgence in spicy foods or medicinal wine, can generate dampness and transform into heat, leading to stagnation of dampness-heat and obstruction of the sinews. This is accompanied by drooping hands and feet, fever, and chest stuffiness. Treatment should focus on clearing heat and draining dampness, and the formula Modified Two Wonderful Herbs Powder can be adapted for use.
3. Spleen-Stomach Qi Deficiency︰The main clinical manifestations include weakness and flaccidity of the limbs, gradually leading to slackness and inability to contract, muscle atrophy and emaciation, accompanied by mental fatigue, reduced appetite, loose stools, or chronic diarrhea. The face appears puffy and lacks luster, with palpitations and insomnia, a pale tongue texture, and a thin, weak pulse. Prolonged qi deficiency that does not heal may progress to yang deficiency, manifesting as fear of cold, cold limbs, a pale complexion, undigested food in the stool, and clear, copious urine. The spleen and stomach are the foundation of the acquired constitution and the source of qi and blood generation and transformation. Suwen．Wei Lun states, "The Yangming is the sea of the five zang and six fu-organs, responsible for moistening all tendons, and all tendons govern binding the bones and facilitating joint movement." Congenital insufficiency, improper dietary habits, prolonged illness without proper care, or chronic diarrhea and dysentery can lead to a decline in the spleen and stomach's transformative functions, resulting in a lack of source for qi and blood generation and transformation. The skeleton, valleys, and tendons all lose their nourishment, leading to slackness of all tendons and eventual wilting and paralysis of the four limbs. This is accompanied by symptoms of qi deficiency such as mental fatigue, timidity, facial puffiness, and limb swelling. Neijing states, "In treating wilting disorders, focus solely on the Yangming," which precisely emphasizes the importance of supplementing the acquired spleen and stomach. Treatment should focus on tonifying the spleen and replenishing qi, with formulas such as Middle-Tonifying Qi-Replenishing Decoction or Ginseng, Poria and White Atractylodes Powder with modifications. For cases where qi deficiency progresses to yang deficiency, treatment should focus on warming the middle and tonifying qi, using modified Aconite Decoction. If accompanied by spleen-stomach yin deficiency (dry mouth, thirst, a red tongue with scant moisture), add Coastal Glehnia Root, Ophiopogon Tuber, and Polyghace Seche.
4. Liver-kidney Depletion︰The symptoms include sensory impairment or loss of pain sensation in one or both lower limbs, gradually leading to wilting impediment and disuse, soreness and weakness of the waist and spine, dizziness, tinnitus, seminal emission or diarrhea, or menstrual irregularities. The tongue is pale red with scant coating, and the pulse is deep and thin or thin and rapid. It is often caused by prolonged illness leading to physical weakness, internal depletion of liver and kidney yin-blood, or excessive indulgence depleting liver yin and kidney essence, all of which can result in wilting. Suwen．Wei Lun states: "Endless desires and unfulfilled wishes lead to excessive thoughts of indulgence. Overindulgence in sexual activity causes the tendons to slacken, resulting in sinew flaccidity.… Overexertion from long journeys or exposure to extreme heat causes thirst. Thirst leads to yang qi attacking internally, which in turn causes heat to lodge in the kidneys. The kidneys, being the organ of water, are now unable to overcome fire, resulting in desiccated bones and depleted marrow. Thus, the feet cannot support the body, leading to bone wilting." The liver governs the tendons and stores blood, while the kidneys govern the bones and store essence, housing true yin and true yang. Therefore, deficiency of liver and kidney essence and blood, and the loss of nourishment to the Jingmai, can lead to wilting impediment of the limbs, accompanied by symptoms such as soreness and weakness of the waist and spine, dizziness, and tinnitus. The treatment should focus on tonifying the liver and kidneys, enriching yin and clearing heat. Recommended formulas include Hidden Tiger Pill or Cervi Deer-Horn Glue Pill with modifications.
5. Static Blood︰The symptoms manifest as weakness or numbness in the limbs, muscle twitching, or even atrophy and disuse. The tongue appears purple with blue lips or ecchymosis, the blood vessels in the limbs appear bluish-purple, and the pulse is sluggish and choppy. It may result from traumatic injury, cold congealing the blood vessels, or qi deficiency leading to blood stagnation, causing slow and obstructed blood circulation that stagnates in the meridians and sinews, ultimately leading to limb atrophy and disuse. The key diagnostic features include a tongue with bluish-purple or blue spots, dry and rough skin, or even scaly skin, and a slow, choppy pulse. Treatment should focus on invigorating blood and resolving stasis: Peach Kernel, Carthamus and Four-Ingredient Decoction supplemented with Astragalus Root and Achyranthes Root.

The syndrome of flaccidity and paralysis is mostly due to deficiency patterns, although there are excess patterns, they are fundamentally rooted in deficiency with superficial excess. Throughout the ages, medical practitioners discussing flaccidity have predominantly emphasized yin deficiency, with treatment focusing on enriching yin. However, based on clinical observations, yang deficiency also occurs, thus the treatment of flaccidity should not rigidly adhere to a single approach.

bubble_chart Documentation

1. Jingyue Quanshu．Atrophy-Flaccidity Disease: "The meaning of atrophy-flaccidity disease, Neijing has discussed in detail. Observing the listed symptoms of the five zang-organs, all are said to be related to heat. And the symptoms of the five zang-organs are all summarized as lung heat scorching the leaves, leading to metal dryness and water deficiency, thus forming atrophy-flaccidity disease. ... Yet, it is not entirely fire pattern, this is the implication of excess and insufficiency, which can still be understood. Therefore, there are cases where fire arises from this, and there are also cases where original qi is damaged due to this. When original qi is damaged, essence deficiency cannot irrigate, and blood deficiency cannot nourish, which are also not few. If all are considered from the perspective of fire, then it is feared that those with true yang deficiency and earth decline with water depletion may not be able to endure. Therefore, one should consider the depth of cold and heat, assess the urgency of deficiency and excess, to apply treatment, so as to achieve the completeness of treating atrophy."