bubble_chart Concept

Numbness of the skin, referred to as "numbness," refers to localized patchy or cord-like sensory disturbances in the skin. "Ma" (麻) describes a sensation as if insects are crawling inside the muscles, which persists upon pressing; "Mu" (木) refers to the absence of itching or pain in the skin, where pressing or pinching is not felt.

This condition has various names in classical medical texts. Huangdi Neijing refers to it as "buren" (不仁); Zhubing Yuanhou Lun not only calls it "buren" but also "obstinate impediment," "stubborn numbness," or "insensitivity to needle pricks"; Shoushi Baoyuan refers to it as "paralysis." Later generations also called it "stubborn numbness."

This section only discusses localized patchy or cord-like numbness of the skin. Conditions such as facial numbness, numbness of the tongue, numbness of the limbs, or hemiplegic numbness are not within the scope of this discussion.

bubble_chart Pattern Analysis

1. Wind-dampness Pestilent Qi︰Numbness in the hands and feet, localized patches of skin numbness may appear, along with erythema or white patches. The affected area lacks pain, cold, or heat sensation, and the skin becomes dry without sweating, with hair loss and fine, bran-like white scales. Over time, muscle atrophy and tendon contractures may occur, presenting as "claw-like hands," along with eyebrow loss and collapse of the nasal bridge. The tongue is red with a white or yellow greasy coating, and the pulse is wiry-rapid or slippery-rapid. This condition, known as wind-dampness pestilent qi numbness, often arises when individuals with weakened constitutions are exposed externally to pestilent qi (wind, dampness, or parasites) or come into contact with the clothing or belongings of infected individuals, allowing the toxic pathogens to invade the blood vessels. Here, the pestilent qi obstructs the skin, impairing the flow of qi and blood, leading to skin numbness and diminished or lost sensations of pain, touch, and temperature. The skin loses its nourishment, and qi-blood fails to moisten it, resulting in impaired striae and interstice opening and discharging. Consequently, the skin becomes dry without sweating, develops white bran-like scales, and may even lead to atrophy of the finger and toe muscles, presenting as "claw-like hands." Over time, symptoms such as eyebrow loss, collapse of the nasal bridge, and hoarseness may appear. Treatment should focus on dispelling wind, resolving dampness, activating blood circulation, and killing parasites. Prescriptions such as Bao'an Wanling Dan, Shenying Wind-Dispersing Powder, and Mofeng San may be taken alternately.
2. Damp Phlegm︰Numbness of the skin, accompanied by pain in adjacent joints, heaviness in the hands and feet, and difficulty in movement. If the numb area is struck by hand, temporary relief may be felt. Pulse manifestation: soggy and slow; tongue coating: white and greasy. Numbness due to phlegm-dampness obstruction is often caused by excessive consumption of tea, alcohol, pungent foods, greasy or rich meats, or indulgence in raw and cold foods, leading to injury of spleen yang and internal dampness. Additionally, residing in damp environments, sitting or lying on damp ground, or exposure to water and dampness can cause internal and external dampness pathogens to accumulate in the skin, preventing the smooth circulation of nutrient and defensive qi and blood. The clinical manifestations include heavy and clumsy limbs, numbness in fixed areas, and unchanged skin color. Striking or repeatedly rubbing the numb area may temporarily restore yang qi, providing a brief sense of relief. Treatment should focus on resolving phlegm and eliminating dampness, dredging meridians and activating collaterals. The recommended prescription is the Two Old Ingredients Decoction.
3. Deficiency of Both Qi and Blood︰The skin exhibits intermittent numbness and insensitivity, often worsening after activity and temporarily alleviating with rest. The local skin feels cold, prefers warmth, and occasionally experiences a crawling sensation or stabbing pain. This condition is commonly seen on the inner side of the upper limbs in menopausal women, accompanied by irregular menstruation or menorrhagia and metrostaxis. The tongue texture appears pale, and the pulse is thin and weak. The numbness due to qi and blood deficiency and weakness is mostly caused by prolonged illness and lack of nourishment, internal damage from the seven emotions, or conditions such as menorrhagia and metrostaxis in women or seminal emission in men. Suwen. Nitiao Lun records: "Deficiency of nutrient-qi leads to numbness, deficiency of defensive-qi leads to flaccidity, and deficiency of both results in insensitivity and dysfunction." This explains the mechanism. Therefore, the treatment should focus on tonifying and nourishing qi and blood, warming the meridians, and unblocking the collaterals. The recommended formula is Astragalus and Cinnamon Twig Five Ingredients Decoction.
4. Static Blood︰Numbness of the skin, known as "bù rén," often occurs in areas prone to compression, such as the waist, hips, and lateral thighs, with a fixed location that worsens at night. In severe cases, the skin does not feel pain when pricked or pinched. The tongue appears dark red or may have ecchymosis or petechiae, and the pulse is sluggish. This condition of static blood obstruction and numbness is mostly caused by traumatic injuries or internal stagnation of the seven emotions, leading to qi and blood stasis in the channels, resulting in stagnation of nutrient-defense qi and impeded circulation. Areas like the waist, hips, and lateral thighs, which are frequently compressed, are prone to qi-blood obstruction, making them common sites for this condition. At night, when yang enters yin, the circulation of qi and blood slows down, exacerbating the symptoms. Treatment should focus on invigorating blood and resolving stasis, as well as unblocking the meridians. The recommended formula is Blood House Stasis-Expelling Decoction.

Numbness of the skin, although also a sensory disorder, differs in clinical manifestations and treatment principles due to variations in the mechanism of disease, disease cause, and accompanying symptoms. Therefore, in clinical practice, it is essential to carefully differentiate and thoroughly understand its symptomatic characteristics. In addition to pharmacological treatment, acupuncture and moxibustion therapy can also be combined for better efficacy.

bubble_chart Documentation

1. Jingui Yaolue．Apoplexy Multiple Arthralgia Abnormal Pulse Syndrome and Treatment: "When the pathogen is in the collaterals, there is numbness of the skin; when the pathogen is in the channels, there is heaviness and impaired movement of the extremities."
2. Zhubing Yuanhou Lun．Volume 1: "Wind causing insensitivity is due to deficiency of the nutrient qi and excess of the defense qi, with wind-cold entering the muscles, causing the blood and qi to not flow smoothly. The condition is such that when scratching the skin, it feels as if there is a layer of clothing in between."
3. Zhubing Yuanhou Lun．Black and White Dermatosis: "All leprosy diseases are caused by aversion to wind and exposure to harmful influences. Initially, there are changes in the skin and hair, or itching as if insects are crawling... There is stubborn impediment in the hands and feet, and acupuncture does not cause pain."
4. Leizheng Zhicai．Numbness: "Numbness is a condition where the nutrient and defense qi stagnate and do not flow, such as when sitting for a long time and pressing on one side, which also causes numbness. Dongyuan believed that it is due to qi not flowing and that lung qi should be supplemented; Danxi believed that numbness is due to qi deficiency, and stiffness is due to damp phlegm and stagnant blood, clearly distinguishing the two in insensitivity. Although numbness does not involve pain or itching, it is due to qi deficiency with wind-phlegm gathering, like wind stirring waves; stiffness involves muscle obstinate impediment, with damp phlegm and stagnant blood obstructing yang qi, preventing it from circulating properly, making the condition more severe. Both should be treated according to their duration. Treating numbness focuses on qi deficiency as the root and wind-phlegm as the branch."