《原病式》列麻证在六气燥金诸涩条下释之曰∶物得湿则滑泽，干则涩滞，麻犹涩也。由水液聚
少而燥涩，气行壅滞而不得滑泽通行，气强攻冲而为麻也。俗方治
麻病，多用乌、附者，令气行之暴甚，以故转麻，因之冲开道路以得通利而麻愈也。然六气不必一气
独为病，气有相兼，若亡液为燥，或麻木无热证，即当此法。或风热胜湿为燥，因而病麻，则宜以退
风散热，活血养液，润燥通气之凉药调之。东垣则曰麻者气之虚也，真气弱不能流通，填塞经络，四
肢俱虚，故生麻木不仁。或在手，或在足，或通身皮肤尽麻者，皆以黄 、人参、白术、甘草、五味、
芍药、当归、升麻、柴胡之类，随时令所兼之气出入为方，但补其虚，全不用攻冲之剂。窃详刘李二
公，生同时，居同地，无世运方土之异宜，何乃凡病遽有补攻之别如此，盖因悟入圣人之道不同。刘
以人禀天赋本无亏欠，因邪入搅乱其气而后成病，所以攻邪为要，邪退则正气自安。李以人之真气，
荣养百骸，周于性命，凡真气失调、少有所亏，则五邪六淫便得乘间而入，所以补正为要，正复则邪
气自却。今宜酌量二公之法，当攻当补，从中调治，无执泥其说。丹溪又分麻木为二，以麻止习习然，
尚无气血攻冲不行之状，木则气血已痹不仁，莫知其痛痒也。疠风初起者，其手足必先木，而后皮肤
疡溃。与夫瘫痪者，手足亦时麻木，当自求之本门。《素问》曰∶荣气虚则不仁，卫气虚则不用，荣
卫俱虚，则不仁且不用。《灵枢》曰∶卫气不行则
为麻木。东垣治麻痹，必补卫气而行之，盖本诸此。浑身麻木不仁，或左或右，半身麻木，或面或
头，或手臂，或脚腿，麻木不仁，并神效黄 汤。皮肤间有麻木，此肺气不行也，芍药补气汤。如肌
肉麻，必待泻营气而愈。如湿热相合，四肢沉痛，当泻湿热。治杜彦达左手右腿麻木，右手大指次指
亦常麻木至腕，已三四年矣。诸医不效，求治明之，明之遂制人参益气汤，服二日便觉手心热，手指
中间如气满胀，至三日后，又觉两手指中间皮肉如不敢触者，似痒痛满胀之意，指上瑟瑟，不敢用手
擦旁触之，此真气遍至矣。遂于两手指甲旁，各以三棱针一刺之，微见血如黍粘许，则痹自息矣。又
为处第二第三服之大效。左腿麻木沉重，除湿补气汤。《金匮》方，血痹阴阳俱微，寸口关上微，尺
中小紧，外证身体不仁，如风痹状，黄 桂枝五物汤主之。李正臣夫人病，诊得六脉中俱弦，洪缓相
合，按之无力。弦在其上，是风热下陷入阴中，阳道不行。其证闭目则浑身麻木，昼减而夜甚，觉而
目开则麻木渐退，久则绝止。常开其目，此证不作，惧其麻木，不敢合眼，故不得眠。身体皆重，时
有痰嗽，觉胸中常是有痰而不利，时烦躁，气短促而喘，肌肤充盛，饮食大小便如常，惟畏麻木不敢
合眼为最苦，观其色脉形病相应而不逆。《内经》曰∶阳
盛目而动轻，阴病闭目而静重。又云∶诸脉皆属于目。《灵枢》曰∶开目则阳道行，阳气遍
布周身，闭目则阳道闭而不行，如昼夜之分，知其阳衰而阴旺也。且麻木为风，虽三尺之童皆以为然，
细校之则非。如久坐而起，亦有麻木。假为绳系缚之人，释之觉麻木作而不敢动，久则自已。以此验
之，非有风邪，乃气不行也。不须治风，当补其肺中之气，则麻木自去矣。知其经脉，阴火乘其阳分，
火动于中为麻木也，当兼去阴火则愈矣。时痰嗽者，秋凉在外，湿在上作也，当实其皮毛以温剂。身
重脉缓者，湿气伏匿而作也。时见躁作，当升阳助气益血，微泻阴火，去湿通行经脉，调其阴阳则已。
非五脏六腑之本有邪也，补气升阳和中汤主之。李夫人，立冬严霜时得病，四肢无力，乃痿厥，湿热
在下焦也。醋心者，是浊气不降欲满也。合眼麻木者，阳道不行也。开眼不麻木者，目开助阳道，故
阴寒之气少退也。头旋眩晕者，风气下陷于血分不伸越而作也。温经除湿汤主之。湿气风证不退，眩
运麻木不已，除风湿，羌活汤主之。停蓄支饮，手足麻痹，多睡 冒，茯苓汤主之。《本事方》治风
寒湿痹，麻木不仁。粥法∶川乌生为末，用白米作粥半碗，入药末四
钱，同米用慢火熬熟，要稀薄不要稠，下姜汁一茶匙许，蜜三大匙，搅匀，空心啜之，温为佳。如是
湿，更入薏苡仁二钱，增米作一钟。服此粥，治四肢不随，痛重不能举者。左氏曰∶风淫末疾，谓四
肢为四末也。脾主四肢，风邪客于肝则淫脾，脾为肝克故疾在末。谷气引风湿之药径入脾经，故四肢
得安。然必真有风寒中于卫气，致卫气不行而不仁者，外必有恶风寒等证，然后可服。荣虚卫实，肌
肉不仁，致令 重，名曰肉苛。宜前胡散、苦参丸。丹溪曰∶手麻是气虚，木是湿痰死血。十指麻木，
胃中有湿痰死血。气虚者，补中益气汤，或四君子加黄 、天麻、麦门冬、川归。湿痰者，二陈汤加
苍、白术，少佐附子行经。死血者，四物汤加桃仁、红花、韭汁。戴人以苦剂涌寒痰，次与淡剂。白
术（除湿）、茯苓（利水）、桂（伐木）、姜、附（寒胜加之）。《内经》针灸着痹分新久，新者汤
熨灸之，久者 针刺之。（取三里）。陕帅郭巨济偏枯，二指着痹，足不能伸，迎洁古治之，以长针
刺委中，深至骨而不知痛，出血一二升，其色如墨，又且缪刺之，如是者六七次，服药三月，病良愈。
大理少卿韩珠泉，遍身麻痹，不能举动，求治于予，予以神效黄 汤方加减授之，用 一两二钱，参、
芍各六钱。他称是一服减半，彼欲速效，遂并两剂为一服之，旬日而病
如失矣。予以元气初复，宜静以养之，完固而后可出。渠不能从，盛夏遽出见朝谒客，劳顿累日，偶
从朝房出，上马忽欲坠仆，从者扶至陈虚舟比部寓，邀予视之，予辞不治，数日而殁。呜呼，行百里
者，半于九十，可不戒哉。
《原病式》将“麻木”这一症状列在六气中燥金等涩滞的条目下进行解释，说道：物体沾湿则滑润，干燥则涩滞，麻木的感觉就像涩滞一样。这是由于体内津液聚集减少而变得燥涩，气机运行壅滞而不能滑润通畅，气机强盛攻冲身体，从而产生麻木感。世俗的方剂治疗麻木病，多使用乌头、附子，使气行变得猛烈迅速，因此原本麻木的部位转为感觉异常（如热、胀、痛），借此冲开经络道路以使其通畅，麻木也就痊愈了。然而，六气致病不一定只有一种气单独为病，气邪往往相互兼夹。如果是津液耗亡导致燥证，或者出现麻木但没有热象，就应当采用这种方法。如果是风热胜湿转化为燥，因而导致麻木，则适宜用退风散热、活血养液、润燥通气的凉性药物来调理。
李东垣则认为：麻木是气虚的表现，真气虚弱不能流通，填塞经络，四肢都虚弱，所以产生麻木不仁。无论是发生在手上、脚上，还是全身皮肤都麻木，都用黄芪、人参、白术、甘草、五味子、芍药、当归、升麻、柴胡这类药物，根据时令兼夹的气邪变化来组方，只是补益其虚损，完全不用攻冲的药物。我仔细考察刘完素和李东垣二位先生，他们生于同时代，居住在同一地区，没有时代变迁和地域差异的不同，为什么对于同样的病症，竟然有补法和攻法的如此大的区别呢？大概是因为他们领悟圣人之道的方式不同。刘完素认为人的天赋禀赋本来没有亏欠，是因为邪气侵入搅乱了气机而后才生病，所以以攻逐邪气为要务，邪气退去则正气自然安宁。李东垣认为人的真气荣养百骸，周流于性命之间，凡是真气失调、稍有亏虚，五邪六淫便得以乘虚而入，所以以补益正气为要务，正气恢复则邪气自然退却。现在应当斟酌两位先生的方法，该攻则攻，该补则补，从中调和治理，不要固执拘泥于某一种说法。
朱丹溪又将麻木分为两种：麻木只是感觉像虫蚁爬行（习习然），还没有气血攻冲不通的状态；木则是气血已经痹阻而不仁，不知道痛痒。麻风病初起时，手足必定先出现木的感觉，然后皮肤溃烂。还有瘫痪病人，手足也时常麻木，应当在本门疾病中寻求根本原因。《素问》说：营气虚则不仁，卫气虚则功能减退（不用），营卫俱虚，则既不知痛痒又功能减退。《灵枢》说：卫气不行则为麻木。李东垣治疗麻痹，一定补益卫气并推动其运行，就是依据这个原理。浑身麻木不仁，或左或右，半身麻木，或面部头部，或手臂，或脚腿，麻木不仁，都用神效黄芪汤。皮肤间有麻木，这是肺气不行，用芍药补气汤。如果肌肉麻木，必须待泻除营气之实邪才能痊愈。如果湿热相合，四肢沉重疼痛，应当泻除湿热。
治疗杜彦达左手右腿麻木，右手大拇指和食指也常麻木至手腕，已经三四年了。各位医生治疗无效，求治于明之，明之于是配制人参益气汤，服用两天后便觉得手心发热，手指中间感觉像有气充满肿胀，到了第三天，又觉得两手指中间的皮肉好像不敢触碰，有似痒痛满胀的意思，手指瑟瑟发抖，不敢用手擦拭或旁边触碰，这是真气遍至的表现。于是在两手指甲旁，各用三棱针刺一下，微微见血如黍米粘许大小，则痹症自然平息了。又为他处方第二、第三服药，效果显著。左腿麻木沉重，用除湿补气汤。《金匮要略》方：血痹阴阳俱微，寸口关上脉微，尺中小紧，外证身体不知痛痒，像风痹的样子，用黄芪桂枝五物汤主治。
李正臣夫人患病，诊得六脉中皆弦，洪缓相合，按之无力。弦脉在上部，是风热下陷入阴分中，阳道不行。其症状是闭眼则浑身麻木，白天减轻而夜间加重，醒来睁开眼睛则麻木逐渐消退，久了就停止。经常睁着眼睛，此证就不会发作，因为害怕麻木，不敢合眼，所以不得睡眠。身体沉重，时有痰嗽，觉得胸中常有痰而不利索，时常烦躁，气短促而喘，肌肤充盛，饮食大小便如常，唯独害怕麻木不敢合眼是最痛苦的。观察其色脉形病相应而不逆乱。《内经》说：阳盛则目动而身轻，阴病则闭目而静重。又说：诸脉皆属于目。《灵枢》说：睁眼则阳道运行，阳气遍布周身，闭眼则阳道闭塞而不行，如同昼夜之分，可知其阳衰而阴旺。而且麻木归咎于风，虽然是三尺孩童都知道，但仔细推敲则并非如此。比如久坐后起身，也会有麻木。假如是被绳子捆绑的人，解开后觉得麻木发作而不敢动，久了自然会好。以此验证，不是有风邪，而是气不行。不需要治风，应当补益肺中之气，则麻木自然去除。知道其经脉，阴火乘袭其阳分，火动于中导致麻木，应当兼去阴火则痊愈。时有痰嗽，是因为秋凉在外，湿气在上焦作祟，应当充实皮毛用温剂。身体沉重脉缓，是湿气伏匿而发作。时常见到躁动，应当升阳助气益血，微泻阴火，去湿通行经脉，调和阴阳即可。这不是五脏六腑根本有邪气，用补气升阳和中汤主治。
李夫人，在立冬严霜时得病，四肢无力，属于痿厥，是湿热在下焦。反酸（醋心），是浊气不降欲满溢。合眼麻木，是阳道不行。睁眼不麻木，是睁眼帮助阳道运行，所以阴寒之气稍退。头晕眩晕，是风气下陷于血分不能伸越而发作。用温经除湿汤主治。湿气风证不退，眩晕麻木不已，用除风湿羌活汤主治。停蓄支饮，手足麻痹，多睡嗜卧，用茯苓汤主治。《本事方》治疗风寒湿痹，麻木不仁。粥法：川乌生研为末，用白米煮半碗粥，加入药末四钱，同米用慢火熬熟，要稀薄不要稠，加入姜汁一茶匙左右，蜂蜜三大匙，搅匀，空腹喝下，温热为佳。如果是湿邪重，再加薏苡仁二钱，增加米量煮成一钟。服此粥，治疗四肢不能随意运动，痛重不能举起的病症。左氏说：风淫末疾，谓四肢为四末。脾主四肢，风邪客于肝则淫脾，脾被肝克制所以病在四肢末端。谷气引导风湿药径入脾经，所以四肢得以安宁。但是必须真有风寒中于卫气，导致卫气不行而不仁的，外边一定有恶风寒等症状，然后才可以服用。营虚卫实，肌肉不仁，导致身体沉重，名叫肉苛。宜用前胡散、苦参丸。
丹溪说：手麻是气虚，木是湿痰死血。十指麻木，胃中有湿痰死血。气虚者，用补中益气汤，或四君子汤加黄芪、天麻、麦门冬、川当归。湿痰者，用二陈汤加苍术、白术，少佐附子行经。死血者，用四物汤加桃仁、红花、韭汁。戴人用苦剂涌吐寒痰，其次给予淡剂。白术（除湿）、茯苓（利水）、桂（伐木）、姜、附（寒胜加之）。《内经》针灸治疗着痹分新久，新病用汤熨灸法，久病用针刺法。（取穴三里）。陕帅郭巨济患偏枯，两手拇指食指着痹，足不能伸展，请洁古治疗，用长针刺委中，深至骨而不知痛，出血一二升，颜色如墨，又用缪刺法，像这样做了六七次，服药三个月，病大愈。大理少卿韩珠泉，遍身麻痹，不能举动，求治于我，我用神效黄芪汤方加减授给他，用黄芪一两二钱，人参、芍药各六钱。别人都说是一服减半，他想要速效，于是把两剂药合并为一服服用，十天病就好了。我认为他元气初复，宜静养，完固之后才可外出。他没有听从，盛夏突然出去见朝谒客人，劳顿数日，偶然从朝房出来，上马忽然想跌倒，随从扶到陈虚舟比部寓所，邀请我看病，我推辞不治，几天后去世了。唉，走百里路的人，走到九十里时往往只算一半，能不警惕吗？
The *Yuan Bing Shi* (Treatise on the Origin of Diseases) lists "numbness" under the categories of dryness and metal in the Six Qi, explaining it as follows: Objects become slippery when wet and stagnant when dry; numbness is akin to stagnation. This arises because body fluids are scarce and dry, causing qi circulation to be obstructed and unable to flow smoothly. When qi becomes strong and attacks forcefully, numbness results. Secular prescriptions for treating numbness often employ Aconitum carmichaelii (Wutou, 乌头) and Aconitum kusnezoffii (Fuzi, 附子) to make qi move violently and rapidly. Consequently, the numb area transforms into a sensation of movement or discomfort, thereby breaking through the blockage to restore smooth flow, and the numbness heals. However, disease caused by the Six Qi does not necessarily stem from a single qi acting alone; pathogenic factors often combine. If fluid depletion leads to dryness, or if numbness occurs without heat signs, this method should be adopted. If wind-heat overcomes dampness to create dryness, resulting in numbness, it is appropriate to use cool herbs that dispel wind, clear heat, invigorate blood, nourish fluids, moisten dryness, and unblock qi.
Li Dongyuan stated that numbness is due to qi deficiency. When true qi is weak and cannot circulate, it fills and blocks the meridians, leaving the limbs deficient, thus generating numbness and insensitivity. Whether occurring in the hands, feet, or all over the skin, one should use herbs such as Astragali Radix (Huangqi, 黄芪), Ginseng Radix (Renshen, 人参), Atractodis Rhizoma (Baizhu, 白术), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草), Schisandrae Fructus (Wuweizi, 五味子), Paeoniae Radix Alba (Baishao, 芍药), Angelicae Sinensis Radix (Danggui, 当归), Bupleuri Radix (Chaihu, 柴胡), and Cimicifugae Rhizoma (Shengma, 升麻). Formulas are adjusted according to seasonal pathogenic factors, focusing solely on tonifying deficiency, without using attacking or purging agents. Upon careful examination, Liu Wansu and Li Dongyuan lived in the same era and region, with no differences in time or geography, yet their approaches to similar diseases differed drastically between attacking and tonifying. This is likely because their understanding of the Way of the Sages differed. Liu believed that human constitution is originally complete; illness arises only when pathogens disrupt qi. Therefore, expelling pathogens is key; once pathogens recede, healthy qi settles naturally. Li believed that true qi nourishes the body and sustains life; any deficiency allows six excesses and five evils to invade. Thus, tonifying healthy qi is key; once healthy qi is restored, pathogens retreat. One should now weigh both methods, deciding whether to attack or tonify based on the situation, harmonizing treatment without rigid adherence to either view.
Zhu Danxi distinguished between numbness and woodiness. "Numbness" refers to a tingling sensation (like insects crawling) without the full obstruction of qi and blood. "Woodiness" implies that qi and blood are already blocked, leading to insensitivity where pain and itch are unknown. In early leprosy, the hands and feet first become wooden, followed by skin ulceration. Paralysis patients also experience intermittent numbness in the limbs; the root cause must be sought within that category. The *Suwen* states: Deficiency of Ying (Nutritive) qi causes insensitivity; deficiency of Wei (Defensive) qi causes motor impairment. When both are deficient, there is both insensitivity and motor impairment. The *Ling Shu* states: When Wei qi does not circulate, numbness occurs. Li Dongyuan treated paralysis by tonifying and promoting Wei qi, based on this principle. For whole-body numbness, hemibody numbness, facial/head numbness, or arm/leg numbness, Shenxiao Huangqi Tang (Miraculous Effect Decoction of Astragalus) is used. Skin-level numbness indicates non-circulation of Lung qi; Shaoyao Buqi Tang (Paeonia Qi-Tonifying Decoction) is used. Muscle numbness requires draining Ying qi to heal. If damp-heat combines causing heavy, painful limbs, damp-heat should be drained.
Du Yanda suffered from numbness in the left hand and right leg, and the right thumb and index finger extending to the wrist, for three to four years. Previous treatments failed. Mingzhi prescribed Renshen Yiqi Tang (Ginseng Qi-Qi Revitalizing Decoction). After two doses, the palms felt hot, and the spaces between fingers felt swollen with qi. By the third day, the skin between fingers felt hypersensitive, like itching or pain, trembling slightly, avoiding touch. This indicated true qi had reached these areas. Pricking the nail beds with a three-edged needle released a small amount of dark blood, stopping the bi-syndrome. Subsequent doses were highly effective. For heavy, numb left leg, Chushi Buqi Tang (Dampness-Removing Qi-Tonifying Decoction) was used. According to the *Jin Gui Yao Lue*, blood bi involves deficiency of yin and yang, with faint pulses at the cunkou and guankou positions and slight tightness at the chikou position. External symptoms include body insensitivity resembling wind-bi. Huangqi Guizhi Wuwu Tang (Astragalus and Cinnamon Twig Five-Ingredient Decoction) is the primary formula.
Madam Li Zhengchen presented with wiry, surging, and slow pulses that were forceless upon pressure. The wiry pulse above indicated wind-heat sinking into the yin, blocking the yang pathway. Symptoms included whole-body numbness when eyes were closed, worse at night, improving upon waking/opening eyes. Fear of numbness prevented sleep. Body heaviness, phlegm cough, chest congestion, irritability, shortness of breath, and robust complexion were noted, except for the distress of numbness preventing eye closure. Pulse and condition matched without contradiction. The *Neijing* states: Yang excess causes eye movement and lightness; yin disease causes closed eyes and heaviness. Also, all meridians connect to the eyes. The *Ling Shu* states: Opening eyes promotes yang circulation throughout the body; closing eyes blocks it, like day and night. This indicates yang deficiency and yin excess. Although laypeople attribute numbness to wind, close inspection shows otherwise. Rising after prolonged sitting causes numbness; releasing bound limbs causes temporary numbness. This proves it is qi stagnation, not wind pathogen. Tonifying Lung qi resolves it. Here, yin fire invaded the yang aspect, causing internal heat and numbness; clearing yin fire is necessary. Autumn cold and upper jiao dampness caused phlegm cough; warming agents should strengthen the exterior. Heaviness and slow pulse indicate latent dampness. Irritability suggests raising yang, boosting qi and blood, mildly draining yin fire, removing dampness, and regulating yin-yang. Buqi Shengyang Hezhong Tang (Qi-Tonifying, Yang-Raising, Middle-Harmonizing Decoction) is indicated.
Madam Li fell ill during late autumn frost with limb weakness (wei-jue syndrome), indicating damp-heat in the lower jiao. Acid regurgitation indicated failing descent of turbid qi. Numbness with closed eyes indicated blocked yang; relief with open eyes indicated yang support. Dizziness indicated wind qi sinking into blood. Wenjing Chushi Tang (Meridian-Warming, Dampness-Removing Decoction) was used. For persistent wind-damp dizziness and numbness, Chu Fengshi Qianghuo Tang (Wind-Damp Dispelling, Notopterygium Decoction) was used. For retained fluid causing limb paralysis and lethargy, Fuling Tang (Poria Decoction) was used. The *Benshi Fang* treats wind-cold-damp bi with a porridge recipe: Raw Chuanwu powder mixed into white rice porridge, cooked thin, with ginger juice and honey, taken warm on an empty stomach. Add Coicis Semen (Yiyiren, 薏苡仁) for dampness. This treats limb immobility and heaviness. Zuoshi stated: Wind affects the extremities. Spleen governs limbs; liver wind invades spleen, causing disease in extremities. Grain qi guides damp-wind herbs to the spleen meridian. However, this is only suitable if external wind-cold has blocked wei qi, accompanied by aversion to wind/cold. Ying deficiency and Wei excess causing muscle insensitivity and heaviness is called "rouke" (flesh tyranny); Qianhu San (Peucedani Radix Powder) and Kushen Wan (Sophora Pill) are indicated.
Danxi said: Hand numbness is qi deficiency; woodiness is damp-phlegm and dead blood. Numbness in ten fingers indicates damp-phlegm and dead blood in the stomach. For qi deficiency, Buzhong Yiqi Tang (Middle-Boosting Qi-Qi Revitalizing Decoction) or Sijunzi Tang plus Astragalus, Gastrodia, Ophiopogon, and Danggui is used. For damp-phlegm, Erchen Tang plus Cangzhu and Baizhu, with a little Fuzi, is used. For dead blood, Siwu Tang plus Peach Kernel and Safflower is used. Dairen used bitter emetics for cold phlegm, followed by bland diuretics. Baizhu removes dampness; Fuling promotes urination; Guizhi suppresses liver; Jiang and Fuzi treat cold. The *Neijing* distinguishes new vs. old zhe-bi (heavy bi): new cases use moxa/warm compresses; old cases use acupuncture (e.g., Zusanli). General Guo Juji had hemiplegia and bi in thumbs/index fingers, unable to extend legs. Jiegu treated him by deep needling Weizhong until bone, draining dark blood, and using Miao-stitching, repeated several times, plus herbal medicine for three months, resulting in great recovery. Han Zhuquan had whole-body paralysis. I prescribed modified Shenxiao Huangqi Tang with large doses of Astragalus, Ginseng, and Paeonia. He combined two doses into one for speed, recovering in ten days. I advised rest to consolidate yuan qi, but he ignored this, attending court in summer, exhausting himself, and falling off his horse. He died shortly after. As the saying goes, one who travels a hundred li considers ninety li only half done; one must beware.