大意
荣血虚则不仁。卫气虚则不用。不用不仁。即麻木之类欤。（汇补）
内因
麻木因荣卫之行涩。经络凝滞所致。其症多见于手足者。以经脉皆起于指端。四末行远。气血罕到故也。
若兼虚火。则肌肉 动。不可误作风治。（汇补）
外候
麻者。非痒非痛。或四肢。或周身。唧唧然不知痛痒。如绳扎缚初松之状。（正传）在手多兼风湿。在足多兼寒
湿。（汇补）木者。不痒不痛。按之不知。搔之不觉。如木之浓。常木为瘀血。间木为湿痰。（入门）死血者。只在一处。
不肿不痛。但紫黑色而木。湿痰走注。有核肿起。白色不变。（绳墨）
麻木分辨
麻犹痹也。虽不知痛痒。尚觉气微流行。木则非惟不知痛痒。气亦不觉流行。（入门）
麻痹有分
痿属血虚。木属气虚。二者均谓之痹。皆不足病也。其症不痛。惟风寒湿三气杂至为痹者。乃有余之病。故
多痛。有气血俱虚。但麻而不木者。有虚而感湿。麻木兼作者。有因虚而风寒湿三气乘之。周身掣痛。麻木
并作者。古称之曰周痹。（正传）
十指麻木
手足乃胃土之末。十指麻木。乃胃中有食积湿痰死血所致。亦有气血大虚而得者。最宜力辨。（丹溪）
舌本麻木
心脾肝肾四脏之络。皆合舌本。故脾肾亏。湿痰风火乘间而入。均使舌本麻木。（汇补）
半身麻木
左右者。阴阳之道路。左半手足麻木者。责风邪与血少。右半手足麻木者。责气虚与湿痰。（汇补）
眩晕麻木
有遍身麻木。随即眩晕不省。良久方苏者。其症有三。或风中于外。或痰动于中。或心虚所致。盖心之所养
者血。所藏者神。气虚则营运不到。而血亦罕至。由是心失所养而成昏晕。（汇补）
脉法
脉浮而濡。属气虚。关前得之。麻在上。关后得之。麻在下。脉涩而芤。死血为木。不知痛痒。（医鉴）
治法
治宜祛风理气。养血清痰。（绳墨）初病。不可骤用参、 、归、地。恐气血凝滞。邪郁经络不散。若久而纯属正虚
者。又当大补荣卫。（汇补）
用药
麻。以四君子加黄 、天麻、陈皮、香附。木。用四物加红花、牛膝、桃仁、丹皮。以行死血。痰。用二陈加苍术、
竹沥、姜汁、白芥子。以行湿痰。或挟风邪者。五积散主之。（汇补）
麻木选方
补气和中升阳汤 治闭目则浑身麻木。开目渐退。昼减夜甚。此气不行故也。 即补中益气汤
苍术 草豆蔻 泽泻 茯苓 黄柏 白芍 佛耳草 生甘草
气不运。加木香。
人参益气汤 治两手麻木。四肢困倦。怠惰嗜卧。热伤元气者。
人参 黄 白芍 升麻 柴胡 五味子 生甘草 炙甘草
水煎。热服。
神效黄 汤
人参 黄 （各二钱） 白芍（一钱） 蔓荆子（二分） 甘草（一钱） 陈皮（五分）
[General Principle]
Deficiency of Ying Blood (Nutritive Blood) leads to loss of sensation (Bu Ren). Deficiency of Wei Qi (Defensive Qi) leads to motor impairment (Bu Yong). The combination of motor impairment and loss of sensation constitutes the category of numbness and anesthesia (Ma Mu). (From *Zhengzhi Huibu*)
[Etiology: Internal Factors]
Numbness and anesthesia are caused by the sluggish circulation of Ying and Wei Qi, resulting in stagnation in the meridians. This symptom is most common in the hands and feet because the meridians originate from the tips of the fingers and toes; these four extremities are distant from the center, so Qi and Blood rarely reach them.
If accompanied by deficient fire, muscle twitching may occur, which should not be mistakenly treated as Wind pathogen. (From *Zhengzhi Huibu*)
[External Manifestations]
"Ma" (numbness/tingling) is neither itching nor pain. It may affect the limbs or the whole body, presenting as a subtle sensation of unknown itch or pain, resembling the feeling when ropes binding the body are first loosened. (From *Jingyue Quanshu: Zhengzhuan*) In the hands, it is often combined with Wind-Dampness; in the feet, it is often combined with Cold-Dampness. (From *Zhengzhi Huibu*)
"Mu" (anesthesia/heaviness) involves no itching or pain; pressing it yields no sensation, and scratching it produces no feeling, feeling heavy and stiff like wood. Chronic "Mu" is often due to Blood Stasis (Si Xue), while intermittent "Mu" is often due to Damp-Phlegm. (From *Yizong Bidu*) Numbness caused by Si Xue (Dead Blood/Stasis) is localized to one area, without swelling or pain, but appearing purplish-black and numb. Numbness caused by the migration of Damp-Phlegm presents with nodular swelling, with unchanged skin color. (From *Yizong Shengmo*)
[Differentiation of Ma and Mu]
"Ma" is similar to Bi Syndrome (Obstruction); although there is no sensation of pain or itch, there is still a perception of slight Qi flow. "Mu" implies not only a lack of pain and itch sensation but also a complete absence of perceived Qi flow. (From *Yizong Bidu*)
[Distinction between Paralysis and Anesthesia]
Wei Syndrome (Atrophy) belongs to Blood deficiency, while the sensation of "Mu" belongs to Qi deficiency. Both are termed Bi, representing diseases of insufficiency. Their symptoms do not involve pain. Only when Bi syndrome is caused by the mixed invasion of Wind, Cold, and Dampness does it belong to an excess disease, thus often involving pain. There are cases of dual Qi and Blood deficiency presenting only as "Ma" without "Mu"; cases of deficiency combined with Dampness where both "Ma" and "Mu" appear; and cases where deficiency allows Wind, Cold, and Dampness to invade, causing full-body pulling pain along with numbness, historically called Zhou Bi (Generalized Bi). (From *Jingyue Quanshu: Zhengzhuan*)
[Numbness of the Ten Fingers]
The hands and feet are the extremities of the Stomach Earth. Numbness of the ten fingers is caused by food retention, Damp-Phlegm, and Si Xue (Stasis) in the Stomach. It can also result from severe deficiency of Qi and Blood, requiring careful differentiation. (From Zhu Danxi)
[Numbness of the Tongue Root]
The collaterals of the Heart, Spleen, Liver, and Kidney all converge at the root of the tongue. Therefore, deficiency of the Spleen and Kidney allows Damp-Phlegm, Wind, and Fire to enter opportunistically, causing numbness of the tongue root. (From *Zhengzhi Huibu*)
[Hemibody Numbness]
The left and right sides are the pathways of Yin and Yang. Numbness of the left hand and foot is attributed to Wind pathogen and Blood deficiency; numbness of the right hand and foot is attributed to Qi deficiency and Damp-Phlegm. (From *Zhengzhi Huibu*)
[Dizziness and Numbness]
Some patients experience full-body numbness followed immediately by dizziness and unconsciousness, recovering only after a long time. This presentation has three causes: external Wind attack, internal Phlegm movement, or Heart deficiency. The Heart nourishes Blood and houses the Shen (Spirit). When Qi is deficient, transportation fails, and Blood rarely reaches the Heart, leading to Heart malnourishment and fainting/dizziness. (From *Zhengzhi Huibu*)
[Pulse Diagnosis]
A floating and soggy pulse indicates Qi deficiency. If found at the Guan anterior (Cun position), numbness is in the upper body; if found at the Guan posterior (Chi position), numbness is in the lower body. A choppy and hollow (Kou) pulse indicates Si Xue (Stasis) causing "Mu" (anesthesia) and loss of pain/itch sensation. (From *Yixue Jian*)
[Treatment Principles]
Treatment should focus on dispelling Wind, regulating Qi, nourishing Blood, and clearing Phlegm. (From *Yizong Shengmo*) In the early stage, sudden use of tonics such as Renshen (Ginseng), Huangqi (Astragalus), Danggui (Angelica), and Dihuang (Rehmannia) should be avoided, lest they cause Qi and Blood stagnation and trap pathogens in the meridians. However, if the condition persists and is purely due to Zheng Xu (Righteous Qi deficiency), then major tonification of Ying and Wei is indicated. (From *Zhengzhi Huibu*)
[Medication]
For "Ma", use Sijunzi Tang (Four Gentlemen Decoction) plus Huangqi (Astragalus), Tianma (Gastrodia Rhizome), Chenpi (Tangerine Peel), and Xiangfu (Cyperus Rhizome). For "Mu", use Siwu Tang (Four Substances Decoction) plus Honghua (Safflower), Niuxi (Achyranthes Root), Taoren (Peach Kernel), and Danpi (Moutan Cortex) to move Si Xue (Stasis). For Phlegm, use Erchen Tang (Two Aged Things Decoction) plus Cangzhu (Atractylodes Rhizome), Zhuli (Bamboo Juice), Jiangzhi (Ginger Juice), and Baijiezhi (White Mustard Seed) to move Damp-Phlegm. If complicated by Wind pathogen, Wujisan (Five Accumulations Powder) is the primary formula. (From *Zhengzhi Huibu*)
[Selected Formulas for Numbness]
**Buqi Hezhong Shengyang Tang (Qi-Tonifying and Middle-Regulating Yang-Raising Decoction)**
Indications: Full-body numbness upon closing eyes, gradually subsiding upon opening eyes; worse at night, better during the day. Etiology: Failure of Qi movement.
Composition: Essentially Buzhong Yiqi Tang modified.
Ingredients: Cangzhu (Atractylodis Rhizoma), Caodoukou (Cardamomi Fructus), Zexie (Alismatis Rhizoma), Fuling (Poria), Huangbai (Phellodendri Cortex), Baishao (Paeoniae Radix Alba), Foercao (Petasitae Herba), Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma).
Modification: Add Muxiang (Aucklandiae Radix) if Qi does not circulate.
**Renshen Yiqi Tang (Ginseng Qi-Nourishing Decoction)**
Indications: Numbness of both hands, fatigue of the four limbs, lethargy and desire to lie down, caused by Heat damaging Yuan Qi.
Ingredients: Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Baishao (Paeoniae Radix Alba), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Wuweizi (Schisandrae Fructus), Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma), Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma).
Administration: Decoct in water, take warm.
**Shenxiao Huangqi Tang (Miraculous Astragalus Decoction)**
Ingredients: Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix) [2 qian each], Baishao (Paeoniae Radix Alba) [1 qian], Manjingzi (Viticis Semen) [2 fen], Gancao (Glycyrrhizae Radix et Rhizoma) [1 qian], Chenpi (Citri Reticulatae Pericarpium) [0.5 qian].