Bi-syndrome is a disorder resulting from the obstruction of meridians,
sluggishness of qi and blood circulation after the invasion of pathogenic wind,
cold, dampness or heat, and characterized by pain, numbness and heaviness of
muscles, tendons and joints or swelling, hotness and limitation of movement of
joints. Rheumatic arthritis, rheumatoid arthritis, osteoarthritis, tuberculous
arthritis, pyogenic arthritis, muscular rheumatism, sciatica, gout, etc., may be
classified and treated as discussed in this section.
Etiology and Pathogenesis
The deficiency of healthy qi and the invasion of pathogenic factors are two
basic causes of this disorder. Low body resistance, lack of physical exercise
and fatigue or weakening during menstruation and puerperium may lead to
deficiency of healthy qi, and climatic variations and environmental change may
induce the invasion of exogenous pathogenic factors such as wind, cold, heat and
dampness. Owing to the difference of body constitutions and the variance of
pathogenic factors, there are various types and manifestations of bi-syndrome.
For example, a patient with yang-deficiency constitution is susceptible to the
effects of wind, cold and dampness, and a bi-syndrome of wind-cold-dampness type
may develop. A patient with a constitution of yang-predominance or
yin-deficiency and yang-hyperactivity is susceptible to the effects of wind,
dampness and heat, and liable to get the bi-syndrome of wind-dampness-heat type.
A longstanding base of bi-syndrome may develop as follows: (1) Accumulation of
cold, wind and dampness may form heat, or overuse of acrid-dry drugs may produce
heat and consume yin; manifestations similar to wind-dampness-heat bi-syndrome
occur. (2) Prolonged retention of pathogenic agents leads to stagnation of qi,
blood and phlegm; ecchymosis, subcutaneous and periarticular nodules, swelling,
deformity and limitation of movement of joints may ensue. (3) Prolonged illness
leads to consumption of qi and blood and deficiency of the liver and kidneys,
and the corresponding manifestations may occur. (4) Bi-syndrome may be
complicated by an attack of exogenous pathogenic factors, and zang-fu organs may
be involved, cardiac bi-syndrome being the common complication.
Syndrome Differentiation
A. Syndrome differentiation
(a) Bi-syndrome of wind-dampness-heat type is differentiated from that of
wind-cold-dampness type by its characteristics of redness, swelling, hotness and
pain of joints.
(b) Bi-syndrome with wind as the predominant pathogenic agent is characterized
by migratory arthralgia, while that with cold as the predominant agent by
localized and severe pain, and that with dampness as the predominant agent by
the sensation of heaviness and numbness.
(c) Bi-syndrome at its onset usually appears as a superficies and
sthenia-syndrome, and a chronic case of bi-syndrome appears as a combination of
asthenia and sthenia syndromes.
B. Therapeutic principles
For incipient bi-syndrome, expelling pathogenic factors should be the main
therapeutic principle, including dispelling wind, dispersing cold, clearing away
heat, eliminating dampness and dredging meridians and collaterals. For a weak
patient suffering from bi-syndrome or a chronic case with deficiency of healthy
qi, in addition to the therapy for expelling pathogenic factors, tonifying the
spleen, liver, kidneys and blood should also be employed. For cases complicated
by phlegm and blood stasis, activating blood circulation, dissipating blood
stasis and masses and eliminating phlegm should be applied.
Classification and Treatment
A. Bi-syndrome of wind-cold-dampness type
(a) Migratory bi-syndrome
Manifestations: Arthralgia moving from one joint to another with limitation of
movement, fever, aversion to wind, thin and white tongue coating and floating
pulse.
Therapeutic principles: Disperse wind and cold, dredge meridians, and eliminate
dampness.
Prescription: The Modification of Ledebouriellae Decoction
Radix Ledebouriellae 10 g
Radix Gentianae macrophyllae 10 g
Rhizoma seu Radix Notopterygii 10 g
Radix Angelicae Pubescentis 10 g
Ramulus Cinnamomi 6 g
Herba Ephedrae 5 g
Radix Clematidis 10 g
Rhizoma Atractylodis 10 g
Caulis Spatholobi 30 g
(b) Pain bi-syndrome
Manifestations: Localized and severe arthralgia which can be relieved by heat
and aggravated by cold, no local redness or heat, limitation of movement, white
and thin tongue coating and wiry and tense pulse.
Therapeutic principles: Warm the meridians, disperse cold and wind, and
eliminate dampness.
Prescription: The Modification of Aconiti Praeparata Decoction
Radix Aconiti Praeparata 5-10 g
Herba Ephedrae 3-9 g
Ramulus Cinnamomi 6-10 g
Radix Paeoniae Rubra 12 g
Radix Glycyrrhizae Praeparata 6 g
Squama Manitis Praeparata 9 g
Radix Astragali 10 g
Rhizoma Zingiberis Recens 3 g
Fructus Jujubae 5 pcs
(c) Localized by-syndrome
Manifestations: Localized arthralgia with heaviness and swelling of the joint,
numbness of muscles and skin, white and greasy tongue coating and soft-floating
and slow pulse.
Therapeutic principles: Eliminate dampness, dredge the meridians, and expel wind
and cold.
Prescription: The Modification of Coicis Decoction
Semen Coicis 15-30 g
Rhizoma Atractylodis 10 g
Radix Stephaniae Tetrandrae 10 g
Radix Clematidis 12 g
Radix Ledebouriellae 10 g
Radix Angelicae Pubescentis 10 g
Rhizoma seu Radix Notopterygii 10 g
Ramulus Cinnamomi 10 g
Herba Ephedrae 3-6 g
Radix Aconiti Praeparata 5 g
Squama Manitis Praeparata 10 g
B. Bi-syndrome of wind-dampness-heat type
Manifestations: Migratory arthralgia with local hotness, redness, swelling and
tenderness which can be relieved by cold, limitation of movement, fever,
aversion to wind, sweating, thirst, intermittent appearance of erythema or
subcutaneous and periarticular red nodules, yellow tongue coating and smooth and
rapid pulse.
Therapeutic principles: Clear away heat, dredge the meridians, expel wind, and
eliminate dampness.
Prescription: The Modification of White Tiger Decoction Adding Ramulus Cinnamomi
Gypsum Fibrosum 30 g
Ramulus Cinnamomi 6-9 g
Semen Coicis 15-30 g
Radix Ledebouriellae 10 g
Radix Stephaniae Tetrandrae 10 g
Rhizoma Anemarrhenae 10 g
Radix Paeoniae Rubra 10 g
Radix Glycyrrhizae 6 g
Radix Gentianae Macrophyllae 10 g
Caulis Lonicerae 30 g
Lumbricus 10 g
C. Wind bi-syndrome
Manifestations: Lingering arthralgia with swelling, rigidity, disformity and
limited movement of joints, pain (being milder in daytime and aggravated at
night), lumbago, desire for warmth and aversion to cold, irregular menstruation
or emission and impotence, dark red or dull tongue with white or yellow and thin
coating and wiry and deep pulse with weakness of chi pulse.
Therapeutic principles: Tonify the kidneys, nourish blood and tendons, expel
wind and cold, eliminate dampness, and dredge the meridians.
Prescription: The Modified Decoction of Ramulus Cinnamomi, Paeoniae and
Anemarrhenae adding Os Tigris Powder
Radix Rehmanniae Praeparata 12 g
Fructus Psoraleae 10 g
Rhizoma Drynariae 12 g
Radix Achyranthis Bidentatae 12 g
Ramulus Cinnamomi 6-10 g
Radix Aconiti Lateralis Praeparata 3-10 g
Herba Ephedrae 3-6 g
Radix Paeoniae Rubra 10 g
Radix Paeoniae Alba 10 g
Radix Ledebouriellae 10 g
Semen Coicis 15-30 g
Radix Clematidis 12 g
Squama Manitis Praeparata 10 g
Rhizoma Anemarrhenae 10 g
Os Tigris (decocted separately) 6-10 g
Furthermore, for the cases with a prolonged course and severe pain, reptiles and
insects such as Agkistrodon Acutus, Zaocys, Squama Manitis, Scorpio Scolopendra,
Lumbricus, etc., should be applied to dredge collaterals, arrest pain, expel
wind and eliminate dampness. Guiding drugs are also used according to the
location of pain to increase the therapeutic effect. For example, Rhizoma seu
Radix Notopterygii, Rhizoma Chuanxiong, Rhizoma Curcumae Longae and Ramulus
Cinnamomi are added for cases with pain of upper limb; Radix Achyranthis
Bidentatae, Fructus Chaenomelis, Radix Stephaniae Tetrandrae and Caulis Akebiae
for those with pain of lower limb; Radix Puerariae for those with cervicodynia;
and Ramulua Taxilli, Cortex Eucommiae and Rhizoma Cibotii for backache. Besides,
the regulation of the spleen and stomach should not be neglected.
Experiential Prescriptions
A. Caulis Trachelospermi (12 g), Radix Gentianae macrophyllae (12 g), Herba
Lycopidii (12 g) and Fructus Liquidambaris 912 g); prepared as decoction;
applicable to the mild case of wind-cold-dampness bi-syndrome.
B. Semen Coicis ( 15 g), Radix Achyranthis Bidentatae 915 g) and herba
Siegesbeckiae (15-30 g); prepared as decoction; applicable to the mild case of
bi-syndrome of wind-cold-dampness type.
C. Agkistrodon Acutus (1set) and Fructus Lycii (60 g) infused in one liter of
white or yellow wine for at least 2 weeks; taken 1 to 2 times a day in small
amount; applicable to cases of wind-dampness-cold bi-syndrome with a weak
constitution.
Copyright 1995 Hopkins Technology
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