JOURNAL OF CHINESE MEDICINE NUMBER 10 MAY 1982

WEI SYNDROME
by Dr. Su Xin Ming
The following lecture was given by Dr. Su Xin bSing during the recent Further Studies Course in Nanjing. Whilst the quality of the lecture and the interpretation was excellent, it was not possible to check the text of this lecture with Dr. Su and this should be borne in mind when reading it. Wei syndrome in TCM includes weakness of the limbs, impairment of movement of the limbs, and subsequently (late stage) muscular atrophy. It is most often seen clinically affecting the lower extremities. The Nei Jing ("Canon of Medicine") refers to "Wed Pi". "Wei" means withered, as in plants when they fail to receive a sufficient supply of water and nutrients. Atrophy can be seen when muscles, tendons and bones are deprived of nourishment. "Pi" means "failure of the foot to touch the ground". All similar clinical manifestations are summarised as Wei syndrome. This category therefore includes poliomyelitis and infantile paralysis, serious multiple neuritis, myelitis, progressive myoatrophy, myasthenia gravis, hysteric paralysis (often seen in the acupuncture clinic), periodic paralysis due to muscle weakness and sequelae due to inflammation of the CNS. Acupuncture therapy may only be used to alleviate the symptoms of the above unless due to functional rather than organic disturbances. AETIOLOGY 1) Pernicious warmth and heat injuring the lung and stomach. This is due to exogenous pathogenic factors which injure LU directly and ST indirectly, by invading the LU via the mouth and nose and resulting in continuous high fever. Longstanding retention of heat consumes LU-Yin resulting in low-grade fever. LU-Heat will further exert a harmful influence on ST resulting in general consumption of yin fluid. Deficiency of yin fails to supply muscles, tendons and bones leading to atrophy. 2) Invasion of exogenous damp - injuring muscles and tendons. This may be due to a number of causes: a) fog or mist, eg going to work early, before sunrise in foggy misty conditions, or working on water or in high mountains b) covering the body with wet clothes after profuse sweating c) working or living in a wet place d) living for a long time in a lowland area. 3) Irregular food intake. Irregular food intake means eating at irregular times. This causes weakness of ST and SP resulting in failure of ST to produce nutrients to nourish muscles etc. This category also includes overindulgence in greasy, pungent food and alcohol which give rise to damp heat in ST and SP.

JOURNAL OF CHINESE MEDICINE NUMBER 10 MAY 1982

4) Sexual excess: Sexual excess (including frequent nocturnal emission) results in loss of KID-Jing and weakness of KID and LIV. The KID stores Jing (the material base maintaining normal physiological activity of the zang-fu) and controls bones, whilst the LIV stores blood and controls tendons. As a result of KID and LIV Xu, the tendons and bones are deprived of nourishment, resulting in atrophy. Wei syndrome is broadly classified as of Shi and Xu types, and it is important to differentiate between them.
Differentiation of Shi and Xu types in Wei syndrome Shi Short Abrupt onset and develops very rapidly History of invasion of exagenous pathogenic damp or long-term relationship with wet place. Weakness of limbs or failure of movement. No significant atrophy of muscles. Spasm or convulsion or numbness or even pain, eg in infantile paralysis pain can be observed in the early stage. Xu Long Gradual onset Develops from Shi type or seen in patients with poor constitution or long lingering disorder. 4 extremities seriously weak; significant emaciation or myoatrophy. No pain

Duration of syndrome Onset History Main symptoms Accompanying symptoms

Differentiation of Wei syndrome from Bi syndrome (rheumatism and arthritis) and wind-stroke (stroke) Aetiology Wei Exogenous and endogenous factors. Exogenous: pathogenic damp-heat. Endogenous: deficiency of zang-fu. Mainly in muscles, tendons and blood vessels. Bi Only exogenous factors including wind, cold, damp and heat. No endogenous factor; no deficiency of zang-fu. Soreness and pain of joints; difficulty in flexing and extending. At late stage rigidity swelling and deformity of joints. Sometimes myoatrophy with failure of movement. Symptoms only involve joints and surrounding muscles. Local pain, pain of joint or wandering pain. Windstroke Hyperactivity of LIVYang or upward disturbance of LIV-Wind or retention of phlegmdamp. Hemiplegia, gradual appearance of myoatrophy at late stage, deformity of hand and foot (wrist and ankle joints mainly) on affected side. Movement free on healthy side. Only on movement of joint on affected side in late stage.

Location

Pain

In general no pain. In a few cases pain appears on pressure eg early stage of infantile paralysis

JOURNAL OF CHINESE MEDICINE NUMBER 10 MAY 1982

DIFFERENTIATION OF SYNDROMES AND TREATMENT 1) Injury of yin fluid due to heat in the LU: Clinical manifestations: Fever softness and weakness of the 4 extremities will follow subsidence of fever; dryness of skin accompanied by restlessness and thirst; cough; dryness of throat; urine yellow and concentrated; dry stool. Tongue: body red, fur yellow. Pulse: thready and rapid. Pathology: Invasion of LU and ST by pathogenic heat consumes yin fluid which fails to nourish muscles. LU fails in supplying fluid to moisten skin (LU dominate skin) therefore dry skin. Yin Xu leads to hyperactivity of fire - in this case the HE is affected therefore restlessness. Retention of pathogenic heat in the LU interferes with dispersing function therefore cough. Sore throat is due to heat in the LU channel which passes through the throat. Treatment principle: Clear heat and moisten LU. Prescription: Dazhui (Du-14) Feishu (BL-13) Chize (LU-5) Liangqiu (ST-34) Zusan]i (ST-36) Sanyinjiao (SP-6) Taixi (K1D-3) Lidui (ST-45). Explanation of prescription: Du-14 meeting of all yang channels with Du channel which governs yang channels () Du-14 is known as yang within yang. Dispersing Du-14 will eliminate heat. BL-13 to clear heat in LU.() LU-5 to reduce and cool LU.() ST-34 Xi-Cleft point, used for acute disorders; here used both to eliminate heat in ST and as a local point for the limbs.() ST-36 used according to the principle of "selecting points from Yangming channels to treat Wei syndrome". To strengthen ST to produce yin fluid to nourish tendons and muscles.(T) SP-6 to tonify yin.(T) KID-3 to promote water, to tonify yin of KID.(T) ST-45 to eliminate heat in Yangming channels.() The above prescription can be used to treat infantile paralysis or myelitis. *Editor's note: 1) (T) indicates reinforcing method, () indicates reducing method. 2) prescriptions are offered as a summation of long clinical experience but are not of course the only suitable selection of points and can be used flexibly.

JOURNAL OF CHINESE MEDICINE NUMBER 10 MAY 1982

2) Invasion of pathogenic damp-heat: Clinical manifestations: Weakness and relaxation of the lower extremities; fever may be observed but not high; in some cases slight swelling and numbness of the lower extremities; stuffiness in chest and epigastric region; yellow urine. Tongue: yellow sticky fur Pulse: rapid Pathology: Weakness and relaxation of the lower extremities is caused by invasion of the jingluo of the lower extremities by pathogenic damp-heat. Invasion by damp-heat leads to slight swelling and numbness. Retention of damp-heat internally leads to stuffiness in chest and epigastric region. Treatment principle: Eliminate damp and heat. Prescription: Dazhui (Du-14), Quchi (L.I.-11), Hegu (L.I.-4), Femur-Futu (ST-32), Fengshi (GB-31), Zusanli (ST-36), Yinlingquan (SP-9) . Explanation of prescription: Du-14, L.I.-11, L.I.-4: this is a routine prescription used to eliminate heat and is here used to eliminate damp-heat (). These three points must be punctured two or even three times a day. Retain needles for over 30 minutes and manipulate every 5 to 10 minutes. ST-32, GB-31: used for weakness of lower extremities; can also be used for infantile paralysis or sequelae of wind-stroke (use even manipulation) . ST-36 to strengthen SP and ST to eliminate damp (T). SP-9 to strengthen SP and eliminate damp (). 3) Weakness of ST and SP: Clinical manifestations: Little food intake; loose dilute stool; sallow and withered complexion. Tongue: flabby and tooth-printed with thin white fur. Pulse: thready, weak and forceless. Pathology: Xu of ST and SP results in poor appetite. Loose stool is due to Xu of SP - SP fails to transform- fluid which descends to the large intestine. Stool may contain semi-digested or undigested food. Weakness of SP and ST and subsequent failure to produce sufficient qi and blood gives rise to facial pallor. Treatment principle: Tonify SP and strengthen ST; strengthen muscles and bones.

JOURNAL OF CHINESE MEDICINE NUMBER 10 MAY 1982

Prescription: Pishu (BL-20), Weishu (BL-21), Zhangmen (LIV-13), Zhongwan (REN-12), Zusanli (ST-36), Taibai (SP-3), Biguan (ST-31), Yaoyangguan (Du-3). Explanation of prescription: BL-20, BL-21, LIV-13, REN-12: combine Front-Mu and Back-Shu points of ST and SP in two groups and use in alternate treatments (T). ST-36 general tonic point; to aid the effect of the above four points (T). SP-3 Yuan-Source point of the SP channel (T) . To strengthen function of the SP in transportation and transformation; frequently selected for loose stools containing undigested food. All the above points may be treated with needling combined with moxibustion. In syndromes 1) and 2) moxibustion is contra-indicated. ST-31 to help the movement of the thigh by tonifying tendon and bone. With Femur-Juliao (GB-29) and Huantiao (GB30) it is often used to promote the function of the lower extremities and aid movement of the hip joint in infantile paralysis and wind-stroke. Du-3 the only point of the Du channel used for the lower extremities. Often used for weakness and atrophy of legs with the above points. 4) Xu of LIV and KID: Clinical manifestations: Gradual onset, also appearing at late stage of other Wei syndromes; atrophy of muscles especially of dower extremities; soreness of the lumbar region; tinnitus; vertigo; blurring of the vision; nocturnal emission; incontinence of urine and enuresis. Tongue: red body, little fur. Pulse: deep and thready. Treatment principle: Tonify LIV and KID. Prescription: Ganshu (BL-18), Shenshu (BL-23), Mingmen (Du-4), Yanglingquan (GB-34) Taixi (KID-3) Guanyuan (REN-4), Add Tinghui (GB-2) in case of tinnitus. Add Fengchi (GB-20) and Zanzhu (BL-2) in case of dizziness and vertigo. Explanation of prescription: BL-18, BL-23 to strengthen LIV and KID (T). Du-4 treat with needle only if KID-Yin-Xu symptoms are present (T); use moxibustion if KID-Yang-Xu. GB-34 controls tendons (T). KID-3 to strengthen KID. (T) REN-4 a point where original yin and original yang gather (ie KID-Yin and KID-Yang). Used to treat either KID-Yin-Xu or KID-Yang-Xu (T).

JOURNAL OF CHINESE MEDICINE NUMBER 10 MAY 1982

The first two syndromes are seen in the early stage of Wei syndrome. In the later stage the latter two syndromes are usually seen. In addition to acupuncture treatment, functional exercises are generally recommended as wel I as physiotherapy ..nd massage. The earlier the condition can be treated, the better are the results that can be expected. Editor's note: It must be stressed that to obtain successful results in the treatment of Wei syndrome, prolonged treatment may be necessary. In China treatment is given daily or every other day, in courses of ten treatments, and in some cases many courses are required. As the "Essentials" says, "as wei syndrome requires a long period of treatment, it is necessary to win the patient's co-operation and confidence". INFANTILE PARALYSIS - POLIOMYELITIS This is also classified as Wei syndrome. It is frequent]y seen in children aged 3 to 5 years but can occur in adults. Usually occurs in late summer/early autumn. At the onset continuous high fever is seen accompanied by discomfort, and frequently with gastrointestinal symptoms and cough. 1 to 6 days after subsidence of fever, paralysis can be observed. This most]y involves the dower extremities, but it may involve the upper extremities or even the throat, with difficulty in swallowing. In a very few patients there may be coma, convulsions and even sudden death. In the ear]y stage there may be pain, especially pain on pressure, a]] over the body. Children are restless if covered with heavy bedclothes, dislike being touched, and may complain of stiffness of the nape or soreness of the back and loins, with inability to turn over in bed. There may be spasm of the leg and in some cases vibration of the 4 extremities. Ear]y paralysis can affect any part of the body, with the dower extremities being the most common; in some cases one and in some cases both limbs. It is rare to see the upper limbs affected or the upper and dower limbs of both sides. Occasionally the face may be paralysed. If there is paralysis of the abdominal muscles there will be ballooning of the abdomen when children cry. If the bladder is affected there will be incontinence or retention of urine. There is no pain in the later stage when paralysis is evident. Eventually there occurs atrophy of the muscles and serious deformity. Aetiology: Invasion of toxic pathogenic heat injures the jingluo causing obstruction of jingluo and stagnation of qi and blood. Tendons, muscles and jingluo are finally deprived of nourishment. Treatment: In the early stage treat to disperse exogenous pathogenic factors, using for example: Dazhui (Du-14) Waiguan (SJ-5) Hegu (L.1.-4). In case of high fever add Quchi (L.I.-11). In case of vomiting and diarrhoea add Neiguan (P-6) Tianshu (ST-25) Zusan]i (ST-36). In case of convulsion and coma treat these as priority eg convulsions: Yintang, Taiyang, Sifeng, Shixuan (all Extra points). 6

JOURNAL OF CHINESE MEDICINE NUMBER 10 MAY 1982

coma: Renzhong (Du-26), Shixuan, Hegu (L.I.-4), Taichong (LIV-3). Treat respiratory symptoms such as cough or dyspnoea according to clinical manifestations. Treatment of paralysis: Principle: In the early stage remove obstruction of jingluo by activating circulation of qi and blood. In the late stage tonify LIV and KID and warm up jingluo. Paralysis of upper limbs: Dazhui (Du-14) Jianyu (L.I.-15), Jianzhen (S.I.-9), Tianzong (S.l.-11), Waiguan (SJ-5), Hegu (L.I.-4) and HuatuoJiaji points of the 5th to 7th cervical vertebrae. Paralysis of lower limbs: Yaoyangguan (Du-3), Huantiao (GB-30), Femer-Juliao (GB-29), Biguan (ST-31), Fengshi (GB-31), Yanglingquan (GB-34), Zusanli (ST-36), Xuanzhong (GB-39), Jiexi (ST-41), Kunlun (BL-60), Qiuxu (GB-40), HuatuoJiaji points of 1st to 5th lumbar vertebrae. Divide prescription into two groups and use alternately. In case of facial paralysis use routine points. Paralysis of nape: Tianzhu (BL-10), Shenshu (Du-12), Tianrong(S.I.-17) Paralysis of abdominal muscles: Zhongwan (REN-12) Tianshu (ST-25) Qihai (REN-6) Daheng ( SP-15); treat once daily with no retention of needles. The earlier treatment for infantile paralysis is given the better the therapeutic results. Poor results are obtained after 2 to 3 months. In treating later than this use points such as Ganshu (BL-18), Shenshu (BL-23), Taixi (KID-3). MYASTHENIA GRAVIS There are three kinds of patients: 1) Paralysis of optical muscle 2) Paralysis of nerve connecting lower part of brain 3) General myasthenia gravis of whole body 1) May involve one or both eyes; upper eyelids droop down; usually there is double vision; frequently seen in clinic, usually in children. Treatment: Yangbai (GB-14) through to Yuyao (Extra), Zanzhu (BL-2) Sizhukong (SJ-23) Yanglao (S.I.6), Hegu (L.I.-4), Zusanli (ST-36). 2) Main symptom is difficulty in swallowing especially on eating and drinking; inability to speak clearly, with a strong nasal sound; insufficient strength to chew food. 7

JOURNAL OF CHINESE MEDICINE NUMBER 10 MAY 1982

Treatment: Neck-Futu (L.I.-18) Tiantu (REN-22), Fengchi, (GB-20), Jiache (ST-6), Xiaguan (ST-7), Tongli (HE-5), Zusanli (ST-36). This prescription may also be used for difficulty in swallowing due to epilepsy. 3) Develops from first two syndromes or seen at onset; involves weakness of muscles usually around joints. Treatment: Use points similar to those used to treat upper and lower extremities in infantile paralysis. Treat once daily in early period of myasthenia gravis and every other day in chronic cases.