Chapter contents

INTRODUCTION

This chapter deals with symptoms that may occur either in the arms or in the legs, or in all four limbs. Apart from the obvious influence of each channel on the limb it traverses, the four limbs are influenced primarily by the Spleen and Stomach in general.

WHY WE ASK

Generally speaking, questions about the four limbs are asked only when the patient presents with a problem specific to them. The main exceptions to this are when a patient presents with symptoms of Blood deficiency, in which case I always ask about numbness of the limbs, or when a patient has symptoms of Dampness, in which case I ask about any feeling of heaviness in the limbs.

WHEN WE ASK

I generally ask about problems in the limbs when the patient presents with a specific problem such as oedema, numbness or weakness of the limbs.

I also ask about the limbs in three other situations. When I suspect a Stomach-Qi deficiency I ask about weakness of the limbs, when I suspect a Kidney deficiency I ask about weakness of the knees, and when I suspect Phlegm or a Blood deficiency I ask about numbness or tingling of the limbs.

HOW WE ASK

When we ask about the limbs, we should make it clear that we mean all four limbs – that is, whether the patient has a problem such as weakness, heaviness or numbness of all limbs.

WEAKNESS OF THE LIMBS

Symptoms and Signs, Chapters 64 and 66

The three most common causes of weakness of the limbs are Stomach-Qi deficiency, a general Qi and Blood deficiency and a deficiency of Kidney-Yang. The Stomach carries the food essences to the four limbs and for this reason a weakness of Stomach-Qi is the most common cause of a feeling of weakness of the limbs. The Kidneys carry food essences and Blood to the legs; a weakness of the limbs in the elderly is more likely to be due to a Kidney deficiency.

Box 39.1 summarizes the patterns underlying weakness of the limbs.

DIFFICULTY IN WALKING (ATROPHY/FLACCIDITY OF LIMBS

Observation, Chapter 18; Symptoms and Signs, Chapter 64

Atrophy or flaccidity of the limbs causes a difficulty in walking; the most common example of this in Western patients is multiple sclerosis.

In the beginning stages, atrophy or flaccidity of the limbs is often due to a Stomach- and Spleen-Qi deficiency, failing to carry food essences to the limbs. In later stages, atrophy or flaccidity of the limbs, or both, is often due to a Yin deficiency of the Liver and Kidneys or a Yang deficiency of the Spleen and Kidneys.

Atrophy or flaccidity of the limbs in children is due to a deficiency of Kidney-Essence. A general deficiency of Qi and Blood may also cause atrophy or flaccidity of the limbs.

Box 39.2 summarizes the patterns underlying difficulty in walking.

FEELING OF DISTENSION OF THE LIMBS

Symptoms and Signs, Chapter 64

The five most common causes of a feeling of distension of the limbs are:

Qi stagnation causes a feeling of distension of the limbs, particularly in the hands and feet.

If the feeling of distension of the limbs is accompanied by a swelling under the skin and a sallow complexion, then it is due to Qi stagnation with Dampness. It should be noted that this swelling is not real oedema and finger pressure does not leave a dip in the skin. This type of distension and swelling of the limbs is very common in women suffering from premenstrual syndrome.

If the feeling of distension of the limbs is aggravated by overexertion and the lower legs have a purple colour, it is due to Blood stasis deriving from Qi deficiency.

If the feeling of distension of the limbs is accompanied by numbness, tingling, a feeling of heaviness and tremor, it is due to Wind-Phlegm.

A feeling of distension of the limbs may also be due to retention of Dampness in the muscles, which may be associated with Cold or Heat; in this case, there would also be a feeling of heaviness of the limbs.

Box 39.3 summarizes the patterns underlying a feeling of distension of the limbs.

FEELING OF HEAVINESS OF THE LIMBS

Symptoms and Signs, Chapters 64 and 66

Patients quite often spontaneously report a sensation of heaviness of the limbs although they may not necessarily use such terms. They often say that their legs ‘feel like lead’.

A feeling of heaviness of the limbs is more frequently experienced in the legs. A feeling of heaviness of the legs is always due to Dampness in the Lower Burner. The Dampness may be combined with Heat or Cold, and it may be Full or Empty. The feeling of heaviness from Full-Dampness is more pronounced than that from Dampness associated with Spleen-Qi deficiency.

When the Spleen-Qi deficiency is associated with Stomach-Qi deficiency, the feeling of heaviness is frequently experienced in all four limbs rather than just the legs. Similarly, when Phlegm causes a feeling of heaviness, it is experienced in all four limbs.

MUSCLE ACHE IN THE LIMBS

Symptoms and Signs, Chapter 64

Muscle ache in the limbs is nearly always due to retention of Dampness in the space between skin and muscles. This may be a Full or an Empty condition (associated with Spleen-Qi deficiency) and the Dampness may or may not be combined with Heat. If it is combined with Heat, the ache is more intense. In addition to the ache, there is a pronounced feeling of heaviness of the limbs. In a few cases, muscle ache in the limbs may be due to Liver-Blood deficiency, in which case it would be very mild and associated with tingling.

Muscle ache in the limbs is a common symptom in postviral fatigue syndrome.

NUMBNESS/TINGLING OF THE LIMBS

Symptoms and Signs, Chapter 64

‘Numbness’ here includes tingling in the limbs. Generally speaking, a feeling of numbness/tingling may be due to:

Blood deficiency usually causes tingling, whereas Phlegm and Wind tend to cause more numbness: with Wind, the numbness is often unilateral. However, these are only general rules.

Blood deficiency is a common cause of numbness/tingling of the limbs in younger people, especially women. In the elderly, a numbness of the limbs is very often caused by Wind or Wind-Phlegm obstructing the channels and, in the case of Wind, the numbness is often unilateral. Dampness or Damp-Heat may also cause numbness of the limbs and especially of the legs. In a few cases, numbness may be caused by stagnation of Qi and Blood in the limbs, in which case it is relieved by exercise.

Box 39.4 summarizes the patterns underlying numbness/tingling of the limbs.

GENERALIZED JOINT PAIN

Pain in multiple joints is generally due to Wind (Wind Painful Obstruction Syndrome) combined with Dampness or Cold, or both. If the site of the pain moves, affecting different joints every day, this strongly indicates Wind. A severe pain indicates Cold, whereas swelling of the joints indicates Dampness. In chronic conditions, Dampness frequently combines with Heat and causes swelling, redness and heat of the joints.