Chapter contents

INTRODUCTION

Observation of the limbs includes observation of their skin, muscles, blood vessels and sinews. Therefore, although the overall condition of the limbs is related to the Stomach and Spleen, observation of the skin, muscles, sinews and blood vessels can reveal the state of the Lungs, Spleen, Liver and Heart respectively.

The symptoms and signs relative to the four limbs are in Chapters 64, 65 and 66 of Part 5.

ATROPHY OF THE FOUR LIMBS

Interrogation, Chapter 39; Symptoms and Signs, Chapter 64

Atrophy of the four limbs may range from a very slight thinning of the muscles to a complete wasting of the muscles such as is seen in the advanced stage of some neurological problems (e.g. motor neurone disease). The most common cause of atrophy of the limb muscles is a deficiency of the Stomach and Spleen, which results from the Stomach’s not transporting the Food-Essences there. Another possible cause of atrophy of the four limbs, which usually involves the Heart, Spleen and Liver, is Qi and Blood deficiency. In more advanced stages, atrophy of the four limbs may be caused by Liver- and Kidney-Yin deficiency, or Spleen- and Kidney-Yang deficiency.

In children, atrophy of the four limbs is due either to a deficiency of Stomach and Spleen or to a congenital Kidney-Essence deficiency and it is one of the Five Flaccidities seen in children (see Ch. 90). The Chinese name for the condition that causes a child to have flaccid leg muscles and swollen knees is Crane Knee Wind, which is due to a deficiency of Yin of the three leg channels combined with invasion of Damp-Cold in the knees.

Box 18.1 summarizes the patterns underlying atrophy of the limbs.

FLACCIDITY OF THE FOUR LIMBS

Interrogation, Chapter 39; Symptoms and Signs, Chapter 64

The term ‘flaccidity’ indicates that the muscles are flaccid, soft and limp but not atrophied (as in atrophy of the muscles).

In acute cases, flaccidity of the four limbs may be due to invasion of Wind-Heat in the Lungs, later becoming interior Heat and injuring the Body Fluids of the Stomach and Spleen. In chronic cases, the flaccidity may result from Damp-Heat affecting the Stomach and Spleen in Full cases, or from a deficiency of the Stomach and Spleen in Empty conditions. In severe, chronic cases, flaccidity of the four limbs is often due to a deficiency of Kidney-Yin.

In children under 5 years, acute cases of flaccidity of the four limbs are due to an invasion of Wind-Heat that quickly progresses to the Interior, turns into interior Heat and damages the Body Fluids, which leads to malnourishment of the channels; this is the pathology of limb flaccidity caused by infectious diseases such as poliomyelitis. In interior conditions, flaccidity of the four limbs in children is due to retention of Damp-Heat or to Qi deficiency with Blood stasis occurring against a background either of poor hereditary constitution or of poor postnatal nutrition.

Box 18.2 summarizes the patterns underlying flaccidity of the limbs.

RIGIDITY OF THE FOUR LIMBS

Symptoms and Signs, Chapter 64

Rigidity of the four limbs means that the patient is unable to flex or extend the wrist, elbow, knee or ankle joints. It has many causes. In acute cases with sudden onset, it is due to invasion of Wind; such a rigidity is obviously of short duration and resolves itself once the Wind has been expelled.

In interior conditions, one common cause of rigidity of the four limbs is Liver-Yang rising or Liver-Wind in the elderly. Another is of course seen in Painful Obstruction (Bi) Syndrome, especially when caused by Dampness complicated by Phlegm in chronic cases, in which case the limb rigidity is accompanied by swelling and pain of the joints.

In the elderly, an inability to flex the joints is often due to retention of Phlegm in the channels together with internal Wind. A rigidity of the limbs accompanied by pain in the joints or muscles, or both, and worsening at night, is due to Blood stasis.

In Empty conditions, rigidity of the limbs may be due to a deficiency of Liver- and Kidney-Yin, or of Spleen- and Kidney-Yang, and this is more common in the elderly.