脉浮而濡属气虚。关前得之。麻在上体。关后得之。麻在下体也。脉浮而缓属湿。为麻
痹。
脉紧而浮属寒。为痛痹。脉涩而芤属死血。为木。不在痛痒。内经曰。风寒湿三气合而为痹。
故寒气胜者为痛痹。湿气胜者着痹。河间曰。留着不去。四肢麻木拘挛也。经又曰。痛者。
寒气多也。有寒。故痛也。其不痛不仁者。病久入深。荣卫之行涩。经络时疏。故不痛。皮
肤不荣。故为不仁。夫所谓不仁者。或周身。或四肢。唧唧然麻木不知痛痒。如绳扎缚初解
之状。古方名为麻痹者是也。丹溪曰。麻是气虚。木是湿痰死血。然则曰麻曰木者。以不仁
中而分为二也。虽然亦有气血俱虚。但麻而不木者。亦有虚而感湿。麻木兼作者。又有因
虚而风寒湿三气乘之。故周身掣痛。兼麻木并作者。古方谓之周痹。治法。宜先汗而后补。
医者亦各以类推而治之。不可执一见也。
一论麻木。遍身手足俱麻者。此属气血两虚。宜
加味八仙汤
当归（酒洗） 川芎 熟地黄（各六分） 白芍（酒炒八分） 人参（六分） 白术（去芦二钱
）陈
皮（八分） 半夏曲（七分） 白茯苓（去皮一钱） 桂枝（三分） 柴胡（四分） 羌活（五分
）防风（五分） 秦艽（六分） 牛膝（六分） 甘草（炙三分）
上锉一剂。生姜一片。枣一枚。水煎。食远服。气虚。加黄 蜜炒八分。
一论麻是浑身气虚也。
加减益气汤
黄 （蜜炒） 人参 白术（去芦） 陈皮 当归（各一钱） 升麻 柴胡 木香（各五分
）香附 青皮（去穣） 川芎（各七分） 桂枝 甘草（各三分）
上锉一剂。生姜、枣煎服。
一论十指尽麻。并面目皆麻。此亦气虚也。补中益气汤。根据前方去青皮、川芎、桂枝
加麦冬、羌活、防风、乌药。共十四味。一论木是湿痰死血也。
双合汤
当归 川芎 白芍 生地黄 陈皮 半夏（姜炒各一钱） 桃仁（去皮尖八分） 白茯
苓（去皮一钱） 红花（三分） 白芥子（一钱） 甘草（三分）
上锉一剂。姜十片。水煎熟。入竹沥、姜汁同服。
一论手足麻痹。因湿所致也。香苏散。（方见感冒）根据本方加苍术、麻黄、桂枝、白芷、
羌活、木瓜。
一论感风湿。手膊或痛或木。或遍身麻木。五积散。（方见中寒）
一论妇人七情六郁。气滞经络。手足麻痹。宜
开结舒经汤
紫苏 陈皮 香附 台乌 川芎 苍术（米泔浸） 羌活 南星 半夏 当归（各八
分） 桂枝（四分） 甘草（三分）
上锉。生姜三片。入姜汁、竹沥服。
一论口舌麻木。延及嘴角头面亦麻。或呕吐痰涎。或头晕眼花。恶心。遍身麻木。宜
止麻消痰饮
黄连 半夏 栝蒌仁 黄芩 白茯苓 桔梗 枳壳（麸炒） 陈皮 天麻 细辛
南星 甘草
上锉。生姜三片。水煎服。血虚。加当归。气虚。加人参。亦有十指麻木。胃中有湿痰
死血
加苍术、白术。少佐熟附子。行经中死血者。四物汤加红花、桃仁、韭叶。忌生冷鱼腥。发
风发热之物。
一论十指酸痛。麻木不仁。
大附子木香各等分。每服三钱。姜三片。水一碗。煎七分服。
一论妇人遍身麻痹。谓之不仁。皆因血分受风湿所致。用祛风散。送下五补丸。
祛风散
生川乌 白术（去芦） 白芷（各三钱） 甘草（二钱）
上为细末。酒调。吞下五补丸。
五补丸
黄 （蜜炒一两） 人参（五钱） 附子（一个） 当归（三钱） 白芍（酒炒五钱）
上为细末。炼蜜为丸。如梧子大。每服六七十丸。祛风散送下。
一论不仁者。谓不凝和也。痛痒不知。针灸不知是也。经曰。诸乘虚寒。而郁冒不仁。
盖其
血气虚弱。不能周流于一身。于是正气为邪气所伏。故肢体顽麻。不知痛痒。遇寒。厥如死
尸。而郁且冒也。用麻桂各半汤。不愈者。补中益气汤入姜汁。设或汗如油。喘不休。喘而直视
水浆不入者。皆为绝症也。
一论风热血燥。皮肤瘙痒。头面手足麻木。
清凉润燥汤
当归（酒洗） 生地黄（各一钱半） 黄连 黄芩 白芍（煨） 川芎（各一钱） 天麻
防风 羌活 荆芥（各八分） 细辛（六分） 甘草（五分）
上锉。水煎。食远服。麻甚。加川乌炮三分。
一论面上木处。可用
桂枝为末。用牛皮胶。和少水化开。调敷之。浓一二分。若脚底硬木处。可将牛皮胶熔
化。
入姜汁调和。仍入南星末五钱和匀。用浓纸摊贴二三分。乘半热。裹贴脚底。用温火烘之。
此外治也。
一治两手指麻木。四肢困倦。怠惰嗜卧。乃热伤元气也。
黄 （八钱） 人参（五钱） 白芍（三钱） 柴胡（二钱五分） 升麻（二钱） 五味子（百四
十粒） 生甘草（五钱） 炙甘草（二钱）
上锉。水煎。稍热。空心服。
一治两腿麻木。沉重无力。多汗。喜笑。口中涎下。身重如山。语声不出。右寸脉洪大
黄 （三钱） 当归（二钱） 苍术（四钱） 陈皮（五钱） 本（三钱） 黄柏（酒炒一钱）
柴胡（三钱） 升麻（一钱） 知母（酒炒一钱） 五味子（一钱） 生甘草（二钱五分）
上每锉一钱。水煎。空心服。少待以早饭压之。
一治皮肤间有麻木。乃肝气不行故也。
黄 （一两） 白芍（一两半） 橘皮（一两半不去白） 泽泻（五钱） 炙甘草（一两）
上锉。水煎。温服。
A pulse that is floating and soft indicates Qi deficiency. If found at the cun position (proximal to the bar), numbness occurs in the upper body; if found at the chi position (distal to the bar), numbness occurs in the lower body. A pulse that is floating and slow indicates Dampness, manifesting as numbness and Bi syndrome (painful obstruction).
A pulse that is tight and floating indicates Cold, manifesting as painful Bi syndrome. A pulse that is choppy and hollow indicates fixed blood (stasis), manifesting as anesthesia (loss of sensation). This condition does not involve pain or itching. The *Neijing* states: Wind, Cold, and Dampness combine to cause Bi syndrome. Therefore, when Cold prevails, it is painful Bi; when Dampness prevails, it is adherent Bi. Liu Hejian stated: When pathogenic factors remain lodged and do not depart, it leads to numbness and spasms of the four limbs. The classics further state: Pain is due to excessive Cold; the presence of Cold causes pain. Those who experience no pain but have insensitivity (Bu Ren) suffer from long-standing disease that has penetrated deeply. The circulation of Ying and Wei (Nutritive and Defensive Qi) becomes sluggish, and the collaterals are occasionally empty and sparse, hence there is no pain. The skin lacks nourishment, hence there is insensitivity. What is called "insensitivity" refers to a state where either the whole body or the four limbs feels a buzzing numbness, devoid of pain or itch, resembling the sensation after ropes binding the body are first untied. Ancient formulas call this Ma Mu (numbness and paralysis). Zhu Danxi said: Numbness (Ma) is due to Qi deficiency; anesthesia (Mu) is due to Damp-Phlegm and fixed blood. Thus, Ma and Mu are distinguished from Bu Ren. Although there are cases of both Qi and Blood deficiency presenting only with numbness without anesthesia, there are also cases where deficiency leads to Dampness invasion, causing both numbness and anesthesia simultaneously. Furthermore, due to deficiency, Wind, Cold, and Dampness may invade, causing whole-body pulling pain accompanied by numbness. Ancient formulas call this Zhou Bi (generalized Bi). The treatment method should be to induce sweating first, then tonify. Physicians should treat according to these principles and not adhere rigidly to a single view.
First discussion on numbness: When the entire body and hands/feet are numb, this belongs to dual deficiency of Qi and Blood. Use Jia Wei Ba Xian Tang (Modified Eight Immortals Decoction).
Herbs: Dang Gui (Radix Angelicae Sinensis, washed with wine), Chuan Xiong (Rhizoma Chuanxiong), Shu Di Huang (Radix Rehmanniae Preparata) (each 6 fen); Bai Shao (Radix Paeoniae Alba, stir-fried with wine, 8 fen); Ren Shen (Radix Ginseng, 6 fen); Bai Zhu (Rhizoma Atractylodis Macrocephalae, remove rhizome, 2 qian); Chen Pi (Pericarpium Citri Reticulatae, 8 fen); Ban Xia Qu (Fructus Trichosanthis Fermentatus, 7 fen); Bai Fu Ling (Sclerotium Poriae Cocos, remove bark, 1 qian); Gui Zhi (Ramulus Cinnamomi, 3 fen); Chai Hu (Radix Bupleuri, 4 fen); Qiang Huo (Rhizoma Notopterygii, 5 fen); Fang Feng (Radix Saposhnikoviae, 5 fen); Qin Jiao (Radix Gentianae Macrophyllae, 6 fen); Niu Xi (Radix Achyranthis Bidentatae, 6 fen); Gan Cao (Radix Glycyrrhizae, honey-fried, 3 fen).
Decoct one dose with one slice of Sheng Jiang (Rhizoma Zingiberis Recens) and one date (Zao). Take orally after meals. If Qi deficient, add Huang Qi (Radix Astragali, honey-fried, 8 fen).
Second discussion: Numbness is due to systemic Qi deficiency.
Jia Jian Yi Qi Tang (Modified Tonifying Qi Decoction)
Herbs: Huang Qi (Radix Astragali, honey-fried), Ren Shen (Radix Ginseng), Bai Zhu (Rhizoma Atractylodis Macrocephalae, remove rhizome), Chen Pi (Pericarpium Citri Reticulatae), Dang Gui (Radix Angelicae Sinensis) (each 1 qian); Sheng Ma (Caulis Cimicifugae), Chai Hu (Radix Bupleuri), Mu Xiang (Radix Aucklandiae) (each 5 fen); Xiang Fu (Rhizoma Cyperi), Qing Pi (Pericarpium Citri Reticulatae Viride, remove pith), Chuan Xiong (Rhizoma Chuanxiong) (each 7 fen); Gui Zhi (Ramulus Cinnamomi), Gan Cao (Radix Glycyrrhizae) (each 3 fen).
Decoct one dose with Sheng Jiang (Rhizoma Zingiberis Recens) and dates. Take orally.
Third discussion: Numbness of all ten fingers, along with numbness of the face and eyes, also belongs to Qi deficiency. Use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Based on the previous formula, remove Qing Pi (Pericarpium Citri Reticulatae Viride), Chuan Xiong (Rhizoma Chuanxiong), and Gui Zhi (Ramulus Cinnamomi); add Mai Dong (Radix Ophiopogonis), Qiang Huo (Rhizoma Notopterygii), Fang Feng (Radix Saposhnikoviae), and Wu Yao (Linderae Radix). Total fourteen herbs.
Fourth discussion: Anesthesia (Mu) is caused by Damp-Phlegm and fixed blood.
Shuang He Tang (Double Combination Decoction)
Herbs: Dang Gui (Radix Angelicae Sinensis), Chuan Xiong (Rhizoma Chuanxiong), Bai Shao (Radix Paeoniae Alba), Sheng Di Huang (Radix Rehmanniae), Chen Pi (Pericarpium Citri Reticulatae), Ban Xia (Rhizoma Pinelliae, stir-fried with ginger, each 1 qian); Tao Ren (Semen Persicae, remove skin and tip, 8 fen); Bai Fu Ling (Sclerotium Poriae Cocos, remove bark, 1 qian); Hong Hua (Flos Carthami, 3 fen); Bai Jie Zi (Semen Mustardae, 1 qian); Gan Cao (Radix Glycyrrhizae, 3 fen).
Decoct one dose with ten slices of Sheng Jiang (Rhizoma Zingiberis Recens). Cook thoroughly. Mix with Zhu Li (Nodus Bambusae in Taedia) and Jiang Zhi (Succus Zingiberis Recens) before taking.
Fifth discussion: Numbness and paralysis of hands and feet caused by Dampness. Use Xiang Su San (Aucklandia and Perilla Powder). (Formula see Cold Damage chapter). Add Cang Zhu (Rhizoma Atractylodis Lanceae), Ma Huang (Herba Ephedrae), Gui Zhi (Ramulus Cinnamomi), Bai Zhi (Radix Angelicae Dahuricae), Qiang Huo (Rhizoma Notopterygii), and Mu Gua (Fructus Chaenomelis) to this base formula.
Sixth discussion: Contracting Wind-Dampness, causing arm pain or anesthesia, or generalized numbness. Use Wu Ji San (Five Accumulations Powder). (Formula see Internal Cold chapter).
Seventh discussion: In women, Seven Emotions and Six Stagnations lead to Qi stagnation in collaterals, causing numbness and paralysis of hands and feet. Use Kai Jie Shu Jing Tang (Open Knots and Unblock Collaterals Decoction).
Herbs: Zi Su (Folium Perillae), Chen Pi (Pericarpium Citri Reticulatae), Xiang Fu (Rhizoma Cyperi), Tai Wu (Linderae Radix), Chuan Xiong (Rhizoma Chuanxiong), Cang Zhu (Rhizoma Atractylodis Lanceae, soaked in rice water), Qiang Huo (Rhizoma Notopterygii), Nan Xing (Rhizoma Arisaematis), Ban Xia (Rhizoma Pinelliae), Dang Gui (Radix Angelicae Sinensis) (each 8 fen); Gui Zhi (Ramulus Cinnamomi, 4 fen); Gan Cao (Radix Glycyrrhizae, 3 fen).
Decoct. Add three slices of Sheng Jiang (Rhizoma Zingiberis Recens), Zhu Li (Nodus Bambusae in Taedia), and Jiang Zhi (Succus Zingiberis Recens) before taking.
Eighth discussion: Numbness of mouth and tongue extending to corners of mouth and face. Or vomiting phlegm-saliva, dizziness, blurred vision, nausea, and generalized numbness. Use Zhi Ma Xiao Tan Yin (Stop Numbness and Resolve Phlegm Drink).
Herbs: Huang Lian (Rhizoma Coptidis), Ban Xia (Rhizoma Pinelliae), Gua Lou Ren (Semen Trichosanthis), Huang Qin (Radix Scutellariae), Bai Fu Ling (Sclerotium Poriae Cocos), Jie Geng (Radix Platycodi), Zhi Ke (Fructus Aurantii, bran-fried), Chen Pi (Pericarpium Citri Reticulatae), Tian Ma (Rhizoma Gastrodiae), Xi Xin (Herba Asari), Nan Xing (Rhizoma Arisaematis), Gan Cao (Radix Glycyrrhizae).
Decoct. Add three slices of Sheng Jiang (Rhizoma Zingiberis Recens), decoct in water, and take. If Blood deficient, add Dang Gui (Radix Angelicae Sinensis). If Qi deficient, add Ren Shen (Radix Ginseng). There are also cases of ten-finger numbness due to Damp-Phlegm and fixed blood in the stomach; add Cang Zhu (Rhizoma Atractylodis Lanceae) and Bai Zhu (Rhizoma Atractylodis Macrocephalae). Add a small amount of Shu Fu Zi (Radix Aconiti Lateralis Preparata) to move fixed blood in the channels. Use Si Wu Tang (Four Substances Decoction) plus Hong Hua (Flos Carthami), Tao Ren (Semen Persicae), and Jiu Ye (Folium Allii Tuberosi). Avoid raw/cold foods, fish/fowl, and wind-inducing/heat-generating substances.
Ninth discussion: Soreness and pain of ten fingers, numbness, and insensitivity.
Da Fu Zi (Radix Aconiti Lateralis Preparata) and Mu Xiang (Radix Aucklandiae) in equal parts. Take 3 qian per dose with three slices of Sheng Jiang (Rhizoma Zingiberis Recens) and one bowl of water, decoct to 0.7 bowls, and take.
Tenth discussion: Generalized numbness and paralysis in women, called Bu Ren (insensitivity), is caused by Wind-Damp invading the Blood aspect. Use Qu Feng San (Expel Wind Powder) to deliver Wu Bu Wan (Five Tonics Pill).
Qu Feng San (Expel Wind Powder)
Herbs: Sheng Chuan Wu (Radix Aconiti Kusnezoffii Cruda), Bai Zhu (Rhizoma Atractylodis Macrocephalae, remove rhizome), Bai Zhi (Radix Angelicae Dahuricae) (each 3 qian); Gan Cao (Radix Glycyrrhizae, 2 qian).
Grind into fine powder. Mix with wine and swallow Wu Bu Wan (Five Tonics Pill).
Wu Bu Wan (Five Tonics Pill)
Herbs: Huang Qi (Radix Astragali, honey-fried, 1 liang), Ren Shen (Radix Ginseng, 5 qian), Fu Zi (Radix Aconiti Lateralis Preparata, one piece), Dang Gui (Radix Angelicae Sinensis, 3 qian), Bai Shao (Radix Paeoniae Alba, wine-fried, 5 qian).
Grind into fine powder. Make pills with refined honey, size of wutong seeds. Take 60-70 pills per dose, delivered by Qu Feng San (Expel Wind Powder).
Eleventh discussion: Bu Ren (insensitivity) means lack of harmony and cohesion. One cannot feel pain or itch, nor sensation from acupuncture. The classics state: Various pathogens attacking deficiency and cold lead to depression, vertigo, and insensitivity. This is because Qi and Blood are weak and cannot circulate throughout the body. Thus, righteous Qi is subdued by pathogenic factors, leading to stiff numbness of limbs and loss of pain/itch sensation. Upon exposure to cold, extremities become cold like a corpse, accompanied by depression and vertigo. Use Ma Gui Ge Ban Tang (Equal Parts of Ephedra and Cinnamon Twig Decoction). If ineffective, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Jiang Zhi (Succus Zingiberis Recens). If sweat is like oil, panting does not cease, panting with staring eyes, and inability to take fluids, these are terminal conditions.
Twelfth discussion: Wind-Fire and Blood dryness causing skin itching, and numbness of head, face, hands, and feet.
Qing Liang Run Zao Tang (Clear Heat and Moisten Dryness Decoction)
Herbs: Dang Gui (Radix Angelicae Sinensis, wine-washed), Sheng Di Huang (Radix Rehmanniae) (each 1.5 qian); Huang Lian (Rhizoma Coptidis), Huang Qin (Radix Scutellariae), Bai Shao (Radix Paeoniae Alba, baked), Chuan Xiong (Rhizoma Chuanxiong) (each 1 qian); Tian Ma (Rhizoma Gastrodiae), Fang Feng (Radix Saposhnikoviae), Qiang Huo (Rhizoma Notopterygii), Jing Jie (Herba Schizonepetae) (each 8 fen); Xi Xin (Herba Asari, 6 fen); Gan Cao (Radix Glycyrrhizae, 5 fen).
Decoct. Take orally after meals. If numbness is severe, add Pao Chuan Wu (Processed Radix Aconiti Kusnezoffii Cruda, 3 fen).
Thirteenth discussion: For numbness on the face, use Gui Zhi (Ramulus Cinnamomi) ground into powder. Mix with Niu Pi Jiao (Colla Corii Asini) dissolved in a little water. Apply as a paste, thickness 1-2 fen. For hard, anesthetized areas on the soles of feet, melt Niu Pi Jiao (Colla Corii Asini), mix with Jiang Zhi (Succus Zingiberis Recens), add Nan Xing (Rhizoma Arisaematis) powder (5 qian), and mix evenly. Spread on thick paper, thickness 2-3 fen. While still warm, wrap and apply to the sole. Warm with mild fire. This is external treatment.
Fourteenth treatment: Numbness of two fingers, fatigue of four limbs, lethargy, and desire to sleep. This is Heat damaging Yuan Qi (Original Qi).
Herbs: Huang Qi (Radix Astragali, 8 qian), Ren Shen (Radix Ginseng, 5 qian), Bai Shao (Radix Paeoniae Alba, 3 qian), Chai Hu (Radix Bupleuri, 2.5 qian), Sheng Ma (Caulis Cimicifugae, 2 qian), Wu Wei Zi (Fructus Schisandrae, 140 grains), Sheng Gan Cao (Radix Glycyrrhizae, 5 qian), Zhi Gan Cao (Radix Glycyrrhizae, honey-fried, 2 qian).
Decoct. Take slightly warm on an empty stomach.
Fifteenth treatment: Numbness of two legs, heaviness and weakness, profuse sweating, excessive laughter, drooling, body feeling heavy as a mountain, inability to speak, and a large, forceful pulse at the right cun position.
Herbs: Huang Qi (Radix Astragali, 3 qian), Dang Gui (Radix Angelicae Sinensis, 2 qian), Cang Zhu (Rhizoma Atractylodis Lanceae, 4 qian), Chen Pi (Pericarpium Citri Reticulatae, 5 qian), Ben Cao (Radix Ligustici Wallichii, 3 qian), Huang Bo (Cortex Phellodendri, wine-fried, 1 qian), Chai Hu (Radix Bupleuri, 3 qian), Sheng Ma (Caulis Cimicifugae, 1 qian), Zhi Mu (Rhizoma Anemarrhenae, wine-fried, 1 qian), Wu Wei Zi (Fructus Schisandrae, 1 qian), Sheng Gan Cao (Radix Glycyrrhizae, 2.5 qian).
Take 1 qian per dose, decoct in water, and take on an empty stomach. Wait a while, then eat breakfast to settle the medicine.
Sixteenth treatment: Numbness in the skin, caused by Liver Qi stagnation.
Herbs: Huang Qi (Radix Astragali, 1 liang), Bai Shao (Radix Paeoniae Alba, 1.5 liang), Ju Pi (Pericarpium Citri Reticulatae, 1.5 liang, do not remove white pith), Ze Xie (Rhizoma Alismatis, 5 qian), Zhi Gan Cao (Radix Glycyrrhizae, honey-fried, 1 liang).
Decoct. Take warm.