麻木,营卫滞而不行之症。《灵枢》云∶卫气不行,则为麻木。《素问》云∶营气虚则不仁,卫气虚则不
用,营卫俱虚则不仁且不用。如人坐久,压着一边,亦为麻木。东垣以为气不行,当补肺气。丹溪以麻为气虚,
木为湿痰败血,于不仁中,确分为二。盖麻虽不关痛痒,只气虚而风痰凑之,如风翔浪沸,木则肌肉顽痹,湿痰
挟败血,阻滞阳气,不能遍运,为病较甚,俱分久暂治之。治麻以气虚为本,风痰为标。用生姜为响导,枳壳
开气,半夏逐痰,羌活、防风散风,木通、威灵仙、白僵蚕行经络。手臂用桑枝,足股用牛膝,病减用补中
益气汤,重加参、 以固本。治本以桂附为响导,乌药、木香行气,当归、杞子、桃仁、红花和血,穿山甲、
牙皂通经络,病减,用八珍汤以培虚。此外如浑身麻木,卫气不行者,神效黄 汤。皮肤麻木,肺气不行者,
芍药补气汤加防风。肌肉麻木,营气不行者,八仙汤。暑月麻木,热伤元气者,人参益气汤。冷风麻痹,足屈
不伸者,独活寄生汤。腿足麻木,忽如火灼,属湿热下注。二妙丸加牛膝,不应,加肉桂。手臂麻,属气虚。
补中益气汤加桑枝、姜黄。立斋治何孟春,臂麻目泪,为气虚有痰,用补中益气汤,兼服六味丸而愈。十指麻
木,属胃中湿痰败血。二术二陈汤加桃仁、红花,少加附子行经。指尖麻,属经气虚。沈氏桑尖汤。面麻木,
属阳气虚。牛皮胶煨化,和肉桂末浓涂之。口舌麻木,吐痰涎。止麻消痰汤。气虚加人参,血虚加当归身。
合目则浑身麻木,开眼则止,东垣以为阳衰,湿伏阴分。用三痹汤去乌头,加黄柏、苍术。腹皮麻痹,多煮葱
白食之即愈。一块不知痛痒,遇阴寒益甚,属痰挟死血,宜活血行气。二陈汤加川芎、当归、怀牛膝、韭汁,
白芥子研末,葱姜汁调敷外。专因血瘀,四物汤加韭汁、桃仁、红花。专因气滞,开结舒筋汤。有自头麻至心
窝而死,或自足心麻至膝盖而死。麻骨方。妇人因悒郁气结,致发麻痹者,当舒郁。逍遥散加香附、川芎。
《沈氏尊生书》曰∶治麻木,须补助气血,不可专用消散。方书有谓大指次指,忽然麻木不仁者,三年内须防
中风。宜服地黄
饮子,或十全大补汤加羌活、秦艽。若古法服愈风汤、天麻丸,开其元腑,漏其真液,适以招风取中,预防云
乎哉。
麻木,是营气与卫气运行滞涩、不能正常流通的病证。《灵枢》说:卫气运行不畅,就会发生麻木。《素问》说:营气虚弱则感觉迟钝(不仁),卫气虚弱则肢体运动失灵(不用),营卫两虚则既感觉迟钝又运动失灵。就像人坐久了,压迫到身体一侧,也会出现麻木。李东垣认为这是气机不行,应当补益肺气。朱丹溪认为“麻”是气虚所致,“木”是湿痰和败血所致,在“不仁”的症状中,确实将其分为两类。大概来说,“麻”虽然不涉及疼痛或瘙痒,只是气虚导致风痰侵袭,如同风吹浪涌;而“木”则是肌肉顽固麻痹,湿痰挟带败血,阻滞阳气,使其不能遍布全身,病情相对较重。两者都需根据病程的久暂来治疗。
治疗“麻”,以气虚为本,风痰为标。用生姜作为引导药,枳壳开理气机,半夏祛除痰浊,羌活、防风疏散风邪,木通、威灵仙、白僵蚕疏通经络。手臂麻木用桑枝,大腿小腿麻木用牛膝。病情减轻后,使用补中益气汤,加重人参、黄芪以固护根本。
治疗“木”,以桂枝、附子作为引导药,乌药、木香行气,当归、枸杞子、桃仁、红花调和血液,穿山甲、牙皂疏通经络。病情减轻后,使用八珍汤以培补虚损。
此外,如浑身麻木,因卫气不行者,用神效黄芪汤。皮肤麻木,因肺气不行者,用芍药补气汤加防风。肌肉麻木,因营气不行者,用八仙汤。暑天麻木,因热伤元气者,用人参益气汤。冷风引起的麻痹,足部弯曲不能伸展者,用独活寄生汤。腿足麻木,忽然像火烧一样,属于湿热下注。用二妙丸加牛膝,若无效,再加肉桂。手臂麻木,属于气虚。用补中益气汤加桑枝、姜黄。
薛立斋治疗何孟春,手臂麻木且流泪,认为是气虚有痰,用补中益气汤,兼服六味地黄丸而痊愈。十个手指麻木,属于胃中湿痰败血。用二术二陈汤加桃仁、红花,少量加入附子以通行经络。指尖麻木,属于经气虚。用沈氏桑尖汤。面部麻木,属于阳气虚。用牛皮胶煨化,混合肉桂末浓涂患处。口舌麻木,伴有吐痰涎。用止麻消痰汤。气虚加人参,血虚加当归身。闭眼时浑身麻木,睁眼则停止,李东垣认为是阳气衰弱,湿气潜伏在阴分。用三痹汤去掉乌头,加黄柏、苍术。腹部皮肤麻痹,多煮葱白食用即可痊愈。
局部一块不知痛痒,遇阴寒天气加重,属于痰挟死血,宜活血行气。用二陈汤加川芎、当归、怀牛膝、韭汁,白芥子研成末,用葱姜汁调匀外敷。专因血瘀者,用四物汤加韭汁、桃仁、红花。专因气滞者,用开结舒筋汤。有的从头部麻木发展到心窝处而死,有的从足心麻木发展到膝盖处而死。可用麻骨方。妇人因忧郁气结,导致发麻痹的,应当疏解郁结。用逍遥散加香附、川芎。
《沈氏尊生书》说:治疗麻木,必须补助气血,不可专用消散之法。医书中有说大拇指和食指忽然麻木不仁的,三年内须防中风。宜服用地黄饮子,或十全大补汤加羌活、秦艽。如果沿用古法服用愈风汤、天麻丸,开启元腑,漏泄真液,恰好会招致风邪引发中风,这哪里能算是预防呢?
Numbness and loss of sensation are syndromes characterized by the stagnation and failure of Ying-Qi (Nutritive Qi) and Wei-Qi (Defensive Qi) to circulate normally. The *Ling Shu* states: "When Wei-Qi fails to circulate, numbness occurs." The *Su Wen* states: "When Ying-Qi is deficient, there is insensibility (Bu Ren); when Wei-Qi is deficient, there is loss of motor function (Bu Yong); when both Ying-Qi and Wei-Qi are deficient, there is both insensibility and loss of motor function." For instance, sitting for a long time and compressing one side of the body also causes numbness. Li Dongyuan considered this due to the failure of Qi movement and advocated tonifying Lung Qi. Zhu Danxi regarded "numbness" (Ma) as caused by Qi deficiency, and "woodiness/loss of sensation" (Mu) as caused by damp-phlegm and blood stasis, accurately distinguishing these two within the symptom of insensibility. Generally, "numbness," though not involving pain or itching, results from Qi deficiency allowing wind-phlegm to gather, resembling wind blowing over boiling waves. "Woodiness," however, involves stubborn paralysis of muscles, where damp-phlegm combined with blood stasis obstructs Yang Qi, preventing it from circulating throughout the body; this condition is relatively more severe. Both should be treated according to the duration of the illness.
The treatment of "numbness" addresses Qi deficiency as the root and wind-phlegm as the branch. Fresh Ginger (Sheng Jiang) is used as a guiding herb, Zhi Ke opens the Qi mechanism, Ban Xia eliminates phlegm, Qiang Huo and Fang Feng disperse wind, Mu Tong, Wei Ling Xian, and Bai Jiang Can unblock the meridians. For arm numbness, Sang Zhi is used; for thigh and leg numbness, Niu Xi is used. As symptoms subside, Bu Zhong Yi Qi Tang is administered, with increased doses of Ren Shen and Huang Qi to consolidate the root.
The treatment of "woodiness" uses Gui Zhi and Fu Zi as guiding herbs, Wu Yao and Mu Xiang promote Qi circulation, Dang Gui, Gou Qi Zi, Tao Ren, and Hong Hua harmonize the blood, Shan Jia Qiong and Ya Siao unblock the meridians. As symptoms subside, Ba Zhen Tang is administered to nourish deficiency.
Additionally, for whole-body numbness due to the failure of Wei-Qi circulation, Shen Xiao Huang Qi Tang is used. For skin numbness due to the failure of Lung Qi circulation, Shao Yao Bu Qi Tang added with Fang Feng is used. For muscle numbness due to the failure of Ying-Qi circulation, Ba Xian Tang is used. For summer-month numbness due to heat damaging Yuan Qi, Ren Shen Yi Qi Tang is used. For cold-wind-induced paralysis with flexed legs that cannot extend, Du Huo Ji Sheng Tang is used. For leg and foot numbness feeling suddenly like burning, attributed to damp-heat pouring downward, Er Miao Wan added with Niu Xi is used; if ineffective, Rou Gui is added. Arm numbness attributed to Qi deficiency is treated with Bu Zhong Yi Qi Tang added with Sang Zhi and Jiang Huang.
Xue Lizhai treated He Mengchun, who suffered from arm numbness and tearing eyes, diagnosing it as Qi deficiency with phlegm. He prescribed Bu Zhong Yi Qi Tang concurrently with Liu Wei Di Huang Wan, resulting in recovery. Numbness of all ten fingers is attributed to damp-phlegm and blood stasis in the Stomach. Er Zhu Er Chen Tang added with Tao Ren and Hong Hua, with a small amount of Fu Zi to promote meridian circulation, is used. Numbness of the finger tips is attributed to deficiency of Jing-Qi. Shen Shi Sang Jian Tang is used. Facial numbness is attributed to Yang Qi deficiency. Niu Pi Jiao (Cowhide Gelatin) is roasted until melted and mixed with Rou Gui powder for thick topical application. Numbness of the mouth and tongue accompanied by salivation is treated with Zhi Ma Xiao Tan Tang. Add Ren Shen for Qi deficiency, and Dang Gui Shen for Blood deficiency. Whole-body numbness upon closing the eyes, which ceases upon opening them, was considered by Li Dongyuan as Yang decline with dampness lurking in the Yin aspect. San Bi Tang without Wu Tou, added with Huang Bo and Cang Zhu, is used. Paralysis of the abdominal skin can be cured by consuming boiled Cong Bai (Scallion White).
A localized patch of insensibility that worsens in cold and yin conditions is attributed to phlegm combined with dead blood (severe blood stasis), requiring blood-invigorating and Qi-promoting methods. Er Chen Tang added with Chuan Xiong, Dang Gui, Huai Niu Xi, and Jiu Zhi (Leek Juice), with Bai Jie Zi powder mixed with Cong Jiang juice for external application. Cases solely due to blood stasis are treated with Si Wu Tang added with Jiu Zhi, Tao Ren, and Hong Hua. Cases solely due to Qi stagnation are treated with Kai Jie Shu Jin Tang. Some cases progress from head numbness to the heart pit leading to death, or from sole numbness to the knee leading to death. Ma Gu Fang is indicated. For women whose paralysis is caused by depression and Qi knotting, soothing depression is required. Xiao Yao San added with Xiang Fu and Chuan Xiong is used.
The *Shen Shi Zun Sheng Shu* states: "In treating numbness, one must supplement Qi and Blood, and should not rely solely on dispersing methods." Medical texts state that sudden numbness and insensibility of the thumb and index finger indicate a risk of stroke within three years. It is advisable to take Di Huang Yin Zi, or Shi Quan Da Bu Tang added with Qiang Huo and Qin Jiao. If ancient methods such as Yu Feng Tang or Tian Ma Wan are used, they open the Yuan-Fu and leak the True Fluid, which merely invites wind and induces stroke, rather than serving as prevention.