Flaccidity syndrome is a disorder characterized by muscular flaccidity and weakness of the limbs with impeded voluntary movement resulting in muscular atrophy. The lower limbs are frequently affected, but the whole body may be involved. Muscular flaccidity occurring in myelitis, progressive muscular dystrophy, acute infectious multiple neuritis, progressive myodystrophy, myasthenia gravis, periodic paralysis, progressive spinal myodystrophia, hysterical paralysis, etc., may be differentiated and treated with the principles mentioned in this section.

Etiology and Pathogenesis

The causes of flaccidity syndrome are either exogenous or endogenous and dampness-heat and wind-cold are the common exogenous pathogenic factors. Deficiency of spleen and stomach, improper food intake, overstrain, congenital insufficiency, longstanding illness and sexual indulgence may damage the liver and kidneys, leading to insufficiency of qi, blood and body fluids and malnutrition of tendons, muscles and meridians. Whether exogenous or endogenous in origin, the pathogenesis can be summarized as:

• Impairment of lungs by heat or fire coming from emotional upsets with failure of body fluid distribution
• Impediment of qi and blood circulation by dampness-heat
• Hypofunction of spleen and stomach, leading to failure of nutrient transportation
• Deficiency of liver and kidneys, resulting in malnutrition of tendons and muscles

The prognosis of flaccidity-syndrome due to exogenous pathogenic factors is comparatively more favorable and may be cured when the treatment is given in time, while cases of endogenous origin is more intractable. But in case of hyperactivity of evils and deficiency of healthy qi, damage of yin and qi by heat of retention of heat-dampness, complications such as yang-exhaustion syndrome may develop, which manifests itself as dyspnea, shortness of breath, dysphasia, polyhidrosis, cyanosis of lips and nails, cold extremities and thready pulse.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

(a) Differentiation between asthenia and sthenia syndromes: In general, those of exogenous origin with sudden onset and rapid progress are mostly attributed to sthenia-syndrome, while those of endogenous origin with insidious onset, slow progress and prolonged cause are attributed to asthenia-syndrome. However, coexistence of both syndromes is not rare.

(b) Identification of complications: Although the spleen, stomach, liver and kidneys are the organs chiefly involved, complications frequently develop during the course of the disease, such as phlegm-dampness, blood stasis, dampness-heat warm evil, retention of food, etc.

B. Therapeutic principles

It has been stated in ancient literature that one should "select points only from the yangming meridians for the treatment of flaccidity-syndrome." This may achieve two purposes, i.e., eliminating pathogenic evil from yangming meridians and tonifying the deficient yangming. For cases due to exogenous pathogenic factors, the general principles is to eliminate evil, including clearing away sthenia-heat from yangming, eliminating dampness-heat, etc. For cases caused by impairment of internal organs, regulating spleen and stomach is the major principle, and invigorating liver and kidneys, nourishing blood and dredging meridians may be employed if necessary. When complications appear, the therapy of eliminating phlegm, removing blood stasis, clearing away stagnated heat, relieving food retention, etc., should be applied accordingly.

Classification and Treatment

A. Consumption of body fluids by lung-heat

Manifestations: High fever, flaccidity of limbs, muscular atrophy, vexation, thirst, dry throat, cough, dry stool, oliguria with yellow urine, red tongue with yellow coating and thready and rapid pulse.

Therapeutic principles: Clear away heat, moisten dryness, nourish the lungs and produce body fluids.

Prescription: The Modified Decoction of Clearing Away Dryness and Saving the Lungs

Gypsum Fibrosum (decocted first) 30 g
Radix Ophiopogonis 10 g
Cortex Mori Radicis 10 g
Semen Coicis 30 g
Folium Mori 10 g
Semen Armeniacae Amarum 10 g
Radix Scrophulariae 15-30 g
Rhizoma Anemarrhenae 10 g
Fructus Forsythiae 12 g
Fructus Trichosanthis 24 g

Remarks: In case of domination of heat and severe damage of qi and yin which manifests itself as dyspnea, cyanosis of lips and nails, dysphagia, polyhidrosis and cold extremities, apply Decoction of Ginseng and Aconiti Lateralis praeparata containing Radix Genseng (10 g, decocted separately), Radix Aconiti lateralis praeparata (6-10 g), Radix Glycyrrhizae Praeparata (6-10 g), or use the Powder for Restoring Pulse Beat containing Radix Ginseng (10 g, decocted separately), Radix Ophiopogonis 915 g) and Fructus Schisandrae 910g).

B. Retention of dampness-heat

Manifestations: Flaccidity, heaviness or numbness or edema of limbs (especially the lower ones), fever, dyspnea, yellow greasy tongue coating and smooth and rapid pulse.

Therapeutic principles: Clear away heat and dampness.

Prescription: The Modification of Two Wonder Drugs Powder

Semen Coicis 30 g
Rhizoma Atractylodis 10 g
Cortex Phellodendri 10 g
Radix Achyranthis Bidentatae 12 g
Poria 18 g
Fructus Chaenomelis 15 g
Rhizoma Dioscoreae Hypoglaucae 15 g
Radix Paeoniae Rubra 12 g
Radix Glycyrrhizae 6 g

Remarks: Add Cortex Magnoliae Officinalis and Fructus Amomi Cardamomum for cases with chest and stomach oppression and fullness due to domination of dampness. Add herba Agastachis and herba Eupatorii for cases occurring during the rainy season. Add Radix Ophiopogonis and Radix Rehmanniae for cases with vexation and thirst due to severe heat impairing yin.

C. Deficiency of spleen and stomach

Manifestations: Weakness of limbs aggravated by movement or fatigue, spiritlessness, poor appetite, loose stool, pale tongue with thin white coating and thready and weak pulse.

Therapeutic principles: Tonify the spleen, and benefit qi.

Prescription: The Modification of Powder of Ginseng, Poria and Atractylodis Macrocephalae

Poria 15 g
Radix Codonopsis Pilosulae 10 g
Rhizoma Atractylodis Macrocephalae 12 g
Rhizoma Dioscoreae 12 g
Semen Coicis (fried) 30 g
Radix Astragali 15 g
Pericarpium Citri Reticulatae 10 g
Fructus Amomi 6 g
Radix Glycyrrhizae Praeparata 10 g

Remarks: Add Radix Aconiti Lateralis Praeparata (6-10 g) and Rhizoma Zingiberis (dried, 3-6 g) for cases with coldness of limbs and aversion to cold due to yang-deficiency. Add Cortex Phellodendri, Talcum and Fructus Chaenomelis for cases with yellow greasy tongue coating and thready and smooth pulse due to dampness-heat.

D. Deficiency of liver and kidneys

Manifestations: Insidious onset of flaccidity of lower limbs, lumbago, dizziness, tinnitus, nocturnal emissions, fecal and urinary incontinence, muscular twitching, irregular menstruation, red tongue with little coating and thready and rapid pulse.

Therapeutic principles: Tonify the liver and kidneys, nourish yin, and clear away heat.

Prescription: The Modification of Huqian Pill

Radix Rehmanniae Praeparata 30-60 g
Radix Aconiti Lateralis Praeparata 6-9 g
Radix Astragali 15 g
Radix Achyranthis Bidentatae 12 g
Herba Cynomorii 10 g
Fructus Psoraleae 12 g
Herba Epimedii 10 g
Radix Angelicae Sinensis 12 g
Radix Paeoniae Alba 12 g
Cortex Phellodendri 6 g
Rhizoma Anemarrhenae 10 g

Remarks: Omit Cynomorii and Aconiti Lateralis Praeparata, and add Fructus Lycii, Colla Cornus Cervi and bone marrow of pig or cow for cases with severe heat manifested by feverish sensation over palms, soles and the chest, hectic fever, night sweating, dryness of mouth and sore throat. Add Radix Morindae Officinalis, Cortex Cinnamomi and Herba Epimedii, and omit Phellodendri and Anemarrhenae for cases with coldness of limbs, aversion to cold and impotence due to deficient yin involving yang.

Experiential Prescriptions

A. Pulvis Placenta Hominis or its fresh sample; appropriate amount taken daily.

B. Bone marrow of pig or cow cooked with beans; taken daily; for cases with poor appetite, the bone marrow is dried and prepared as powder and taken after being mixed with sugar and rice powder or cooked and mixed with sugar and rice powder.

Copyright 1995 Hopkins Technology