Two TCM Formulas for Flaccid Weakness of the Lower Limbs

During the May Day holiday in Beijing this year, I met a cancer patient who had consulted me ten years earlier for radiation enteritis. This patient had developed some relatively uncommon symptoms: her brain’s motor control over the lower limbs was intact, but her lower limbs were weak and flaccid. Although she could make all the movements, she lacked the strength to walk and was forced to use a wheelchair. Many examinations were done, all normal. She had visited several hospitals in Beijing, but none of the doctors could give a clear diagnosis, and therefore no treatment plan.

Her family suspected that radiation therapy for cervical cancer years earlier had damaged the nerves, and that year after year the symptoms had gradually worsened. This patient had previously had radiation enteritis with bloody stools for many years and needed frequent blood transfusions to keep her blood counts roughly normal. She sought care everywhere with poor results. Later she came to me; I had her take Baiji (Bletillae Rhizoma) ground into a fine powder, mixed with plain water, three times a day, 1–3 g each time. After a period of use, her radiation enteritis unexpectedly resolved completely.

So after she lost the ability to walk last year, she kept hoping that I could, as before, think of a way for her. Because I was at school and time was limited, the matter was delayed until this year. Reviewing her records, I saw that she had shown signs of this tendency as early as five years ago.

Her first symptoms were numbness in both legs. Five years ago her entire left leg was numb with no supportive strength; her calf had a recurring sensation of swelling from the inside out (though no actual swelling was visible). Her right leg was somewhat better than the left but was also numb. She had no sensation on the sole of the left foot, and touching the sole felt hot. She had lower back pain, discomfort when standing, and slight relief after activity.

This symptom appears in many middle-aged and elderly people; it is the atrophy-flaccidity syndrome (wei zheng) recorded in ancient TCM texts. This condition differs from paralysis: in paralysis the brain cannot command the limbs, whereas in wei zheng the basic movements can be performed but the legs are weak and limp. Early wei zheng presents as bodily weakness and fatigue of the limbs; as the disease progresses, the feet become weak and unable to walk. TCM treatment of wei zheng often uses kidney-tonifying and bone-strengthening herbs.

The longer the course of this disease, the harder it is to treat; treatment should begin when early symptoms appear. Searching the literature, I found two formulas among Gong Tingxian’s proven formulas that treat this condition; they are reprinted below.

Chu Wei Siwu Tang (Atrophy-Relieving Four-Substance Decoction) — suitable for those with early symptoms of wei zheng

Treats bodily weakness with limp, weary limbs.

Danggui (Angelicae Sinensis Radix; washed in wine), Chuanxiong (Ligusticum Chuanxiong Rhizoma), Baishao (Paeoniae Alba Radix; wine-fried), Shudihuang (Rehmanniae Praeparata Radix), one qian each; Tusizi (Cuscutae Semen; washed in wine), Roucongrong (Cistanches Herba; washed in wine), Baizhu (Atractylodis Macrocephalae Rhizoma; root removed, oil-fried), seven fen each; Buguzhi (Psoraleae Fructus), five fen. Crush the above, decoct in water, and take on an empty stomach.

Jianbu Siwu Tang (Step-Strengthening Four-Substance Decoction) — suitable for those whose feet are weak and unable to walk

When blood is deficient and fails to nourish the lower body, the feet become weak and unable to walk.

Danggui (washed in wine), Chuanxiong, Baishao (wine-fried), Shudihuang, one qian each; Niuxi (Cyathulae/ Achyranthis Bidentatae Radix; root removed, washed in wine), Mugua (Chaenomelis Fructus), Chuan Xuduan (Dipsaci Radix), seven fen each. Crush the above, decoct in water, and take on an empty stomach.

In the above two formulas, one qian may be converted to 3 g today, and one fen to 0.3 g. The course of treatment for wei zheng is long, so each dose should not be too large; an excessive dosage injures the stomach, which is why Gong’s doses are all small. After taking the above formulas for one to two weeks and seeing some effect, one may prepare them as pills according to the same proportions, three times a day, 6–9 g each time, for slow, gradual treatment.

I believe these two formulas are reasonably composed. Although wei zheng may look very serious, with proper medication and persistent treatment it can be relieved. Just like this patient’s earlier radiation enteritis—the symptoms looked frightening, but the medication was simple and the results were excellent—so do not underestimate seemingly simple treatments.