What is Wei-syndrome (痿证) in TCM?
In TCM, Wei-syndrome (WS) is a condition of flaccidity and weakness in the limbs without pain or obstruction. The muscles feel soft and powerless; the person can move their limbs, but they cannot sustain strength or normal function. Unlike Bi syndrome, there is no stiffness or blockage, the problem is not obstruction but lack of nourishment and activation. It reflects a failure of the muscles and sinews to be properly nourished, often related to patterns such as Spleen deficiency failing to support the muscles, or Liver and Kidney depletion.
In Western medical terms, WS can be understood as a problem affecting the motor unit pathway responsible for voluntary movement. This may involve damage to the upper motor neurons (e.g. Multiple Sclerosis), lower motor neurons (e.g. Motor Neuron Disease), peripheral nerves (e.g. Peripheral Neuropathy) (1), neuromuscular junction (e.g. Myasthenia Gravis) (2), or the muscle tissue itself (e.g. Polymyositis or Muscular Dystrophy). Therefore, WS generally overlaps with neuromuscular disorders that mainly present with muscle weakness rather than pain or sensory problems.
WS usually starts in the lower limbs, patients may first notice tripping, foot drop (3), or getting tired easily when walking. Over time, the weakness can spread to the upper limbs and then to the proximal muscles such as the hips and shoulders. In more severe cases, the respiratory muscles may also be affected. This lower-to-upper or distal-to-proximal pattern of progression is similar to that seen in many Western motor neuron and muscle disorders.
Case Sharing:
One morning, I received a message from a female patient in her 60s complaining of weakness in her limbs when getting out of bed. She also occasionally experiences cramping in the middle of the night and numbness in her calves. In addition, she suffers from insomnia and digestive issues, including tummy bloated and constipation for over a few months.
Following a thorough in-person consultation, the patient reported a history of prolonged overwork and inadequate self-care. She described her main concern as, “I can move, but there’s no strength in my legs.” Based on the clinical presentation and symptom manifestations, a diagnosis of Wei-Syndrome was made according to TCM principles.
Pulse & Tongue Diagnosis:
TCM Diagnosis:
- Spleen Qi-deficiency
- Kidney Essence-deficiency
- Liver-blood deficiency
From a TCM perspective, the primary treatment focus is to tonify the Spleen and nourish the Liver and Kidneys. In addition, strengthening the muscles and promoting overall energy levels are essential aspects of the therapeutic strategy. Therefore, treatment aims to:
- Tonify the Spleen-Qi to improve transformation and transportation
- Tonify the Kidneys to strengthen the bones and support the lower limbs
- Restore Qi and Blood to enhance overall vitality
Acupoints:
- LV-3, GB-43 (regulate Qi)
- KI-3, DU-4, BL-23 (tonify Kidney)
- SP-6, LV-8 (nourishing Blood)
- Abdominal Acupuncture: the points for guiding Qi downwards to the Lower Jiao
- Scalp Acupuncture: Vasomotor Area, Motor Area (with Electroacupuncture)...etc
BuZhongYiQi Tang (4) was prescribed for two weeks. This classical TCM formula is used to tonify Qi, particularly that of the Spleen and Stomach.
Feedback:
The patient reported improved sleep quality, significantly increased energy levels, and a reduction in nocturnal cramping during the night.
This case suggests that limb weakness without pain may present as WS in TCM. Chronic overwork, impaired digestion, and age-related decline in Kidney Essence may result in insufficient nourishment of the muscles, leading to fatigue and reduced limb strength. Treatment therefore focuses on strengthening the Spleen, nourishing the Liver and Kidneys, and restoring Qi and Blood to improve muscle function and overall vitality.
At the same time, similar symptoms may overlap with neuromuscular conditions in Western medicine. An integrative approach supports appropriate referral when necessary, while providing holistic management to improve strength, functional capacity, and quality of life.
