Treatment of Arthralgia Syndrome from Zang and Fu

Lamei ZHOU, Donglin HAO

1. Department of Rheumatology and Immunology, Wuxi Hospital of Traditional Chinese Medicine, Wuxi 214000, China; 2. Department of Rheumatology and Immunology, Suzhou Hospital of Traditional Chinese Medicine, Suzhou 215000, China

Abstract More than 30 medical history works and classical medical literatures about the theory and prescription of arthralgia syndrome from Zang and Fu were collected, summarized and analyzed, and the theory of treating arthralgia syndrome from Zang and Fu in the lung, spleen, liver and kidney basically reflected the academic thought of treating Bi syndrome from the viscera in traditional Chinese medicine books.

Key words Traditional Chinese medicine, Bi syndrome, Zang and Fu

1 Introduction

As early as in theHuatuo’sZhongzangClassic, it was recorded that the control of worry and consideration can nourish Qi, keeping the mood comfortable and happy and avoiding bad mental stimulation and excessive emotional fluctuation can reduce the occurrence of the disease, this is the best way for qi-stagnating arthralgia. For flesh impediment, it is suitable for regulating the viscera through diet regulation, regulating the spleen through normal daily life, and then reinforcing and reducing according toHuatuo’sZhongzangClassicto cure. For muscular rheumatism, it is suitable for invigorating blood and nourishing liver, warming Qi to nourish kidney, then taking Ertang pills to cure. InCollectedSupplementtoPattern, it was believed that if the person suffering from hard work and getting Bi syndrome is weak in vitality, if the person suffering from anger and getting Bi syndrome has a lot of liver fire, if the person suffering from cold syndrome and getting Bi syndrome has damp depression, if the person suffering from improper diet and getting Bi syndrome has spleen depression. In ancient and modern medical history documents, the treatment of Bi syndrome was discussed from lung, kidney, liver and spleen.

2 Treatment from lung

2.1 Theoretical discourseThe lung Qi is impaired and dispersed, the body surface cannot be protected due to the weakness of defensive Qi, and it is easy to be attacked by external evils. The functions of defensive Qi are maladjusted, such as warming the whole body, nourishing the internal organs, the external muscles, the skin and the hair, adjusting and controlling the opening and closing of Qi, and promoting the controlled excretion of sweat; wind, cold and dampness invade muscles and bones, joints, viscera and so on, which lead to Bi syndrome. InMiraculousPivot·FiveChanges, it was said that people with rough skin texture and weak muscles are prone to arthralgia. InPrescriptionsforSuccouringtheSick·AllKindsofPain, it was believed that people with deficiency of vital energy are easy to be attacked by external evils, after being invaded by wind, cold, dampness, heat and other evils, it is not easy to dispel them in time, leaving Qi and blood in meridians and collaterals blocking muscles and joints to form arthralgia syndrome. InGeneralTreatiseonCausesandManifestationsofAllDiseases·WanderingArthritis, it was also believed that arthralgia is caused by the combination of wind, cold and dampness, its muscles are stubborn and thick or painful, which is caused by the deficiency of human body and the opening of Qi, thereby suffering wind evil invasion.

2.2 Prescriptions for treatmentInSyndromeswithClear-CutTreatments, it was said that gout is initially caused by cold, dampness and wind stagnation, which will turn into heat and pain for a long time, and will be more severe at night, which can be treated by warmth and acridity, thereby evacuating cold, dampness and wind evils, and develop striae and interstitial space……. InTreatiseonColdPathogenicDiseases, it was recorded that Taiyang Disease is characterized by headache, fever, body pain, low back pain, bone joint pain, aversion to wind, no sweat and asthma, which is mainly caused by Ephedra Decoction. Those who have pain in the back and have normal defecation should be treated urgently with Ramuli Cinnamomi Decoction……. Article 21st ofDetailedAnalysisofEpidemicWarmDiseasessaid that the patient is suffering from all kinds of pain and fever, this is particularly severe in the late afternoon, this is called rheumatism; the disease mostly suffers from wind evil when sweating, or the patient stays in cold environment for a long time and suffers from wind cold, which leads to the disease, this can be treated with Ephedra, Bitter Apricot Seed, Coix Seed and Licorice Decoction. InDetailedAnalysisofEpidemicWarmDiseases, it put forward that if you want to cure Bi, you can only cure the crossroad of three Yins using plaster, almond and others. According to the composition of Mahuang Decoction, Guizhi Decoction and Ephedra, Bitter Apricot Seed, Coix Seed and Licorice Decoction, which has the effects of opening the inhibited lung-energy, diaphoresis relieving superficies and removing dampness, thus it is known that Bi syndrome can be treated from the lung.

3 Treatment from liver

3.1 Theoretical discourseEmotional factors, stagnation of liver Qi, obstruction of Qi, insufficiency of liver Yin blood, Yin asthenia generating intrinsic heat, extreme heat causing wind and external evils can cause Bi syndrome, for example, inHuatuo’sZhongzangClassic, it was recorded that patients with qi-stagnating arthralgia are worried, thinking, happy and angry too much, then Qi will stagnate in the upper body……. InIntroductiontoMedicine, it was recorded that arthralgia syndrome occurs due to the pain and numbness of the whole body, which is called general arthralgia, it means the stagnation of liver Qi. InNeiJingBoYi, it was said that emotional stress hurts the visceral-Qi, which is called Bi, it is not necessary to mix wind, cold and dampness to form Bi. Liver arthralgia refers to the stagnation of liver Qi and deficiency of blood vessels, which can not provide nutrients to the meridians, if the meridians are withered, they will vibrate and twitch. InFuQingzhu’sObstetricsandGynecology, it was recorded that shoulder pain is the disease of hand channel and liver qi stagnation……, the pain of hands and feet, which is caused by the liver, is the heat of the spleen channel, it should disperse the stagnation of the liver, and the pain of hands and feet will disappear naturally. InYiXueChuanDeng, it was said that the whole body aches, the daytime alleviates, and the night aggravates, the pain is all over the body as if bitten by a tiger……, some people have pain but not swelling, some people have swelling and pain, this is because of less liver meridians and fire preponderance in the hepatic system, extreme heat causing wind syndrome, and not exogenous wind evil. InYeAnCunZhen, Ye Tianshi said that Yin deficiency generates internal heat, while heat prevail leads to wind evil, the wind evil has the characteristics of indefinite movement and moving of disease position, it produces fire and heat, and its potential is growing, causing damage to muscles and collaterals, causing stagnation of meridians and Qi between muscles, and losing nourishment of meridians, the treatment can be carried out by expelling evil through the channels. InYiXueZhongZhongCanXiLu, it was said that liver deficiency can cause leg pain, …… Excessive anger injures the liver, if the liver injures people, the Qi and blood of the liver channel is insufficient, if the liver channel is stagnated, the Qi and blood of the liver channel will be disadvantageous, if the Qi and blood are injured, people will be weak. InYouKeJinZhen, it was believed that the internal cause of arthralgia is the insufficiency of liver blood, and the external cause is the cold and dampness, the liver dominates the whole body fascia and is related to limb movement. Both knees are sore, tendons are not supported, walking on flat ground is like high and low ground, and dampness is caused by liver disease. In many medical works, the stagnation of liver Qi, deficiency of liver Yin and blood, and wind heat of liver meridian can cause Bi syndrome.

3.2 Prescriptions for treatmentInFuQingzhu’sObstetricsandGynecology, it was recorded that hand and foot, heart and abdomen are all painful, will it be treated by hand? Or will it be treated by foot? It should be based on the treatment of liver. When the liver Qi is cleared, all the pain will heal itself. Do not treat the head for headache or the foot for foot, and the specific prescription is put forward, namely,Bupleurumchinense,GlycyrrhizauralensisFisch., orange peel,GardeniajasminoidesEllis,Cynanchumotophyllum, coix seed,Wolfiporiacocos,Angelicasinensis, andAtractylodeslancea(Thunb.) DC.,…… the Xiaoyan San will change. It can soothe the liver and remove dampness and fire, and it can cure all the meridians. InGuidetoClinicalPracticewithMedicalRecords·Arthralgia, it was recorded that Ye Tianshi used the prescriptions of the stem of noble dendrobium, radix asparagi, the fruit of Chinese wolfberry, antelope’s horn,TribulusterrestrisL., moutan bark and folium mori to treat Yin-fluid deficiency, effulgent liver-gallbladder fire, insufficiency of middle-warmer energy, and collapse of the spleen-qi, blazing wind and fire, walking through the meridians and collaterals of the whole body, resulting in the pain and heat of meridians and collaterals. InNvkeCuoyao, Xue Lizhai used Jiawei Xiaoyao San and RAMULUS UNCARIAE CUM UNCIS to cure the arthralgia syndrome of endogenous wind caused by anger, liver fire and liver blood deficiency. InZhengYinMaiZhi·Arthralgia, it said that Chaihu Shugan Powder can treat stagnation of liver Qi, hypochondriac pain, chest depression, depression and irritability, or belching, fullness of epigastric distention, and stringy pulse. Xiaoyao Powder or Liver-Tonifying Powder can treat liver blood deficiency and weak-taut pulse. Xiaoyao Powder, Chaihu Shugan Powder and Liver-Tonifying Powder have the effect of soothing the liver and nourishing the liver, thus it can be seen that Bi syndrome can be treated from the liver.

4 Treatment from spleen

4.1 Theoretical discourseMaladjusted diet, spleen dysfunction and stagnation of phlegm-wetness can cause Bi syndrome, inPlainQuestions·Arthralgia, it was said that there are transport points in the six Fu-organs, the wind-cold-wetness evil invades its transport points, and the pathological basis of food injury is corresponding to it, so the disease evil follows the transport points and stays in the corresponding Fu organs. InCollectedSupplementtoPattern, it was said that spleen depression is caused by improper diet and pain. InJingyue’sCompleteWorks, it was said that if the dampness of Bi syndrome prevails, the body will be heavy, or cold, or phlegm, or sweat, all of them will be the syndrome of Yin-cold due to the weakness of spleen. InRequiredReadingsforMedicalProfessionals, it was believed that it is necessary to treat arthralgia and dampness, dispel wind and cold, it’s mostly mixed with spleen tonic and Qi tonic. Invigorating the spleen can remove dampness. When Qi is sufficient, there will be no stubborn numbness. InGuidetoClinicalPracticewithMedicalRecords, Ye Tianshi pointed out that for the etiology of arthralgia, there are mainly three kinds of Qi: wind, cold and dampness, high fire leads to dampness and heat, and dampness and heat toxin lead to arthralgia; if the treatment of arthralgia but not the treatment of hidden evil, arthralgia will not be completely good, and is easy to relapse, there are different etiologies of wetness-heat syndrome and wind-cold-damp impediment. It was discussed that spleen depression, spleen deficiency and dampness heat accumulation are the important factors of Bi syndrome.

4.2 Prescriptions for treatmentInHuatuo’sZhongzangClassic, it was recorded that flesh impediment is suitable for regulating the viscera by controlling diet and nourishing the spleen by normal living. InTreatiseonSpleenandStomach, it was said that at the beginning of arthralgia syndrome, it should start from the spleen and stomach, and often use the medicine of ascending Yang and wind dryness, such as RHIZOMA ET RADIX NOTOPTERYGII, RADIX ANGELICAE PUBESCENTIS, FRUCTUS VITICIS, RHIZOMA CIMICIFUGAE, RADIX BUPLEURI,etc., to relieve the dampness and turbidity with its pungent fragrance, and the wind medicine can also remove the dampness, if the dampness is removed, the meridians will circulate. InMedicalInsights, it pointed out that the treatment of Bi is mainly to remove the dampness, dispel the wind and dispel the cold, and basically use the medicine of tonifying the spleen, which can remove the dampness, when Qi is sufficient, there will be no stubborn numbness. InLuoShiHuiYueYiJing, it was said that invigorating the spleen and eliminating dampness decoction can treat dampness and evil, heavy body pain, thin and astringent pulse. InPrinciplesforMedicalProfession, it was recorded that hand arthralgia and foot arthralgia, and joint dampness can be treated with COICIS SEMEN decoction. Invigorating the spleen and eliminating dampness decoction and COICIS SEMEN decoction have the effect of invigorating the spleen and promoting dampness, which shows that Bi syndrome can be treated from the spleen.

5 Treatment from kidney

5.1 Theoretical discourseKidney governs bones and is the storehouse of waist. Kidney deficiency can make the bones of the waist and knee soft, and exopathogens attack, which cause pain in the loins and knee, thereby resulting in arthralgia syndrome. InHuatuo’sZhongzangClassic, it was said that the kidney is damaged by lust, such as improper diet, excessive sexual affairs,etc., which leads to the deficiency of kidney Qi, exogenous evil takes advantage of the deficiency and enters into the kidney, it is easy to get Bi in the bone and form Bi in the bone. InEssentialRecipesforEmergentUseWorthaThousandGold, it was said that the patients with lumbago and backache are all from the weakness of kidney Qi, if they are not treated in time, they will flow into the feet and knees, which are partial dryness, cold arthralgia, mild weakness, severe pain, or lumbago and contracture of foot arthralgia. InTaipingHolyPreionsforUniversalRelief, it was recorded that cold arthralgia of the waist and feet is caused by wind, cold and dampness, all of them are due to the deficiency of kidney and marrow. InGeneralRecordsofHolyUniversalRelief, it was said that bone arthralgia is due to the weakness of kidney Qi, the kidney can play the role of spermatogenesis, when the spermatogenesis is full, the bone marrow will be filled, and when the bone marrow is full, the bone will be strong and strong. Tiangui belongs to the kidney, the gradual deficiency of Tiangui can lead to the lack of kidney fat, which will lead to the dryness of the marrow and bone arthralgia. The development of bone arthralgia is caused by the gradual deficiency of Tiangui, and bone arthralgia indicates cold arthralgia. Rheumatic arthralgia is caused by the Qi of rheumatism, which hurts people’s meridians and collaterals, which is weak in Qi and attacked by rheumatism……InBuJuJi·AllKindsofPain, it was said that for those who suffer from deficiency, deficiency of essence can’t change Qi, and Qi can’t change essence, if the innate vital spirit of a man is not enough, the road around the body will be blocked, and the Qi and blood can’t nourish the meridians, which is painful. Stagnation of Qi and blood due to deficiency can be one of the pathogenesis of pain syndrome. InGuJinYiJian, it was recorded that people with arthralgia can not feel the symptoms of pain, itching, cold and heat in their hands and feet, they are all affected by the deficiency of archaeus and vital essence, and are attacked by wind, cold and dampness, which can’t be dispelled at any time and flow into meridians and collaterals, thereby forming Bi syndrome. InJingyue’sCompleteWorks, it was said that all kinds of arthralgia syndrome are in the body, because of the disease and pathogenic factors, the Qi and blood blocking is not smooth, which belongs to Yin, it is also the weakness of vital energy in the kidney and the loss of blood essence. Therefore, the wind, cold and dampness three kinds of evil Qi are mixed and form arthralgia. According to the above medical works, Bi is caused by the deficiency of kidney Qi, the deficiency of kidney Yang, the deficiency of kidney Yin, the deficiency of kidney essence and external cold and dampness.

5.2 Prescriptions for treatmentInBianZhengLu, it was said that the method of treating arthralgia does not need to dispel pathogenic factors, but only the fire in the kidney. InYiXueZhongZhongCanXiLu, it emphasized that for those who have not been cured for a long time, we can tonifying their primordial Qi and make them circulate. InJingyue’sCompleteWorks, it was said that the treatment of arthralgia is most suitable for tonifying Yin, dredging the vein, and circulating Qi and blood, it is not allowed to use wind dryness drugs to avoid hurting Yang Qi again. InSyndromeswithClear-CutTreatments, it was said that the treatment of arthralgia has always been to invigorate the kidney and Qi, so that the vein is smooth, Qi and blood flow is smooth, gout can heal itself. InYiJi, it was said that the treatment of Bi syndrome is to make the vein smooth and Qi and blood smooth, and mainly to nourish the kidney yin. Many medical works have paid attention to the treatment of Bi. The specific prescriptions are as

follows: InEssentialRecipesforEmergentUseWorthaThousandGold, Duhuo Jisheng decoction can treat weak kidney Qi, cold pain in the back or partial dry, cold arthralgia and weak pain, or back pain and foot contracture, which caused by lying in the cold and wet place and suffering from gout. InTaipingHolyPreionsforUniversalRelief, Bushen pill can treat consumptive disease, which has the syndromes of asthenia and fatigue, heavy joints, inability to raise limbs, gradually less food and drink, emaciation and weakness. InGeneralRecordsofHolyUniversalRelief, Fangfeng pill is used to treat kidney deficiency and fatigue, pathogenic qi swooping in, cold and callous body, numb and stiff hands and feet, difficult move; or treat muscle jerking, causing pain in the lumbar spine and left and right sides of the waist, and can not eat. InBianZhengLu, it was said that people have pain in their feet and knees, and it’s hard to walk, when they press the skin and flesh, and it’s cool to the bone, people think it’s cold arthralgia. Duhuo Jisheng decoction, Bushen pill, Fangfeng pill and Zhenhuo decoction have the effect of tonifying kidney and warming Yang, which is the embodiment of Bi syndrome treated from kidney.

6 Conclusions

In clinic, Bi syndrome is usually caused by one or more internal organs, which needs to be treated at the same time, for example, inBuJuJi·AllKindsofPain, it was said that for those who suffer from deficiency, deficiency of essence can’t change Qi, and Qi can’t change essence, if the innate vital spirit of a man is not enough, the road around the body will be blocked, and the Qi and blood can’t nourish the meridians, which is painful. Stagnation of Qi and blood due to deficiency can be one of the pathogenesis of pain syndrome. If water fails to nourish wood, it will cause hypochondriac pain; if blood essence fails less, it will cause low back pain; if kidney Yin is exhausted, it will cause bone disease; if joint is not good, it will cause neck pain; if bone marrow is empty, it will cause back pain; if three yins are deficient, it will cause legs and knees pain, these are not caused by external evil invasion, but by liver and kidney deficiency. InHuatuo’sZhongzangClassic, it was recorded that for muscular rheumatism, it is suitable for invigorating blood and nourishing liver, warming Qi to nourish kidney. The treatment of Bi syndrome can be based on the lung mainly from benefiting qi and relieving superficies, based on the spleen mainly from fortifying the spleen and draining dampness, and based on the liver mainly from soothing and nourishing the liver, as well as based on the kidney from nourishing Yin and warming kidney, at the same time, it should be treated by dispersing the cold, expelling wind-evil and removing wetness and dredging the meridians from lung, spleen, liver and kidney simultaneously.