WeiSyndromeLecturedbyProfEnginCAN/EnqinZhangSeniorConsultantandProfinChineseMedicineChiefAuthorofAPractical-EnglishLibraryofTCM-14BooksManagerandChiefDrofEVERWELLChineseMedicalCentreLondonClinic7,36GerrardStreet,W1D5QA(Thishandoutisforyear4ofTCMstudentsofMiddlesexUniversity)E-mail:prof.engincan@hotmail.co.ukLecturingDate&Time:Thursday,11/12/2008at1.30-4.30pmLecturingAddress:MiddlesexUniversityArchwayCampus,London,theU.K.WeiinChinesemeansflaccidity.InTCMWeiSyndromereferstoasyndromemarkedbymuscularflaccidityoratrophyofthelimbswithmotorimpairment.Clinically,Weisyndromemaymanifestasjustweaknessofthelimbsatthebeginning,andtheneventuallyleadingtomuscularflaccidityandatrophyofthelimbs.InWesternmedicine,WeiSyndromecoversmanyconditionssuchassequelaeofencephalitis,spinalcordtrauma,muscularatrophyduetopolio,multiplesclerosis(MS)andtumoursintheCNS,etc.ThoughthereisnocertaincuringtherapyformosttypesofWeisyndrometodayinbothWesternmedicineandTCM,IstillintroducebasictheoryandsomeexperienceintreatingWeiSyndromewithacupunctureandherbalmedicine.Dearstudents,perhapsyouwillbetheonetodiscoveranewtherapyforourpatientswithWeisyndromeinnearfuture.AetiologyandPathologyAccordingtoTCMtheory,WeiSyndromecanbecausedbyeitherexternalorinternalfactors.1)Heatinthelung:WeisyndromewasfirstdescribedinTheChapter44WeiSyndromeinPlainQuestionsofYellowEmperorsCanonofInternalMedicine(475-221BC).Itsayswhenthelungisinvadedbyaheatpathogen,exhaustingbodyfluids,thelobesofthelungbecomeatrophied-adryWeicondition,.whentheheatlingerschronically,paralysisofextremitiesresults.Thatiseitherexternalpathogenicheatinvadesthelungorexcessiveinternalheataccumulatesinthelung.Bothcandamagethelung-yinandthebodyfluids,resultinginmalnourishmentofmusclesandtendons,whichmaydevelopintomuscularflaccidityandevenatrophyofthelimbs,asaresultWeisyndrometakesplace.2)Dampnessandheatinthebody:theChapter44WeiSyndromeinPlainQuestionsofYellowEmperorsCanonofInternalMedicinestatesthatifonepersonisexposedtodamppathogenoveraperiodoftime,themuscleswillbeinvadedbydampness.Thisconditioncauseslocalnumbness,muscleflaccidityi.e.Weisyndrome.AccordingtotheXiaJing(CanonofXiaDynasty),Weiconditionisalwayscausedbyexposuretoenvironmentaldampness.Fromtheaboveandclinicalexperience,wecanunderstandthatWeisyndromeiscausedbyexternalpathogenicdampnessorwithheatinvadingthebody,whichcandamagethemeridiansandthebodyfluid,themusclesandtendonscannotbenourishedproperly.However,itcanalsobecausedbyinternalpathogenicdampnessandheataccumulatedinthebodybecauseofexcessiveintakeofgreasyorhotfoods,leadingtostagnationofqiandbloodinthemeridians,sothereisnotenoughbodyfluids,qiandbloodtosupplythemusclesandtendons.Eventuallythisconditionmaydevelopintomuscularflaccidityoratrophyoflimbs,andWeisyndromeoccurs.3)Deficiencyoftheliverandkidney:TCMbelievesthattheliverstoresblood,andthekidneystoreslifeessence,thebloodandessencesupplyandnourishallthetissuesincludingmusclesandtendons.Prolongedillnessorindulgentsexualactivitiescancauseexcessivelossofbloodandessencethusresultingindeficiencyandinabilitytonourishthetendons,muscles,bonesandmeridians,thereforeWeisyndromemayoccur.AccordingtoChapter44WeiSyndromeinPlainQuestionsofYellowEmperorsCanonofInternalMedicine,Weisyndromeofparalysisoftheligamentiscausedbyaliverdisorder,itistheresultofoverindulgenceinsexanddepletionofthekidney-essence.4)Deficiencyofqiandblood:inmostTCMbooks,thedeficiencyofqiandbloodisnotconsideredasamainfactortocauseWeiSyndrome,butfromourexperienceitisaveryimportantfactorandalsoacommonclinicalpatternofWeiSyndrome,somechroniccasesinparticular.Itgenerallyresultsfromdeficiencyofthespleenandstomachorimproperdiet,whichcausesthedeficiencyofqiandblood,leadingtomalnutritionofthemusclesandtendons,andthenWeisyndrometakesplace.5)Trauma:itcandirectlycauseinjuryoftissuesincludingmuscles,tendonsandbonesaswellasmeridians,resultinginbloodstasisandqistagnation.Musclesandtendonsarenotnourishedproperly,themeridiansarenotfunctioningnormally,markedbynumbnessandinability,thereforeWeisyndromecomesintobeing.DifferentialDiagnosisWeisyndromecanbeclassifiedas5patternsclinically:1)Heatinthelung:itmaymanifestasfever,coughingwithyellowsputum,irritability,drynessinthethroat,thirst,drystoolandscantyurinationatbeginning,thengraduallydevelopingintomuscularflaccidityofthelowerlimbswithmotorimpairment,redtonguewithyellowfurandrapidandslipperypulse.2)Damp-heatinthebody:muscularflaccidityofthelegswithwarmthandasensationofgeneralheavinessofthewholebodyoraccompaniedbyoedema,afullfeelinginthechestandgastricregion,yellowanddarkurinationwithburningsensation,redtonguewithyellowandgreasyfur,softandrapidpulse.3)Deficiencyoftheliverandthekidney:thistypeofWeisyndromeismostlyseeninelderlypeople.Typicallysymptomsaremuscularflaccidityofthelimbscomeonslowly,amildtomoderateamountofmotorweaknessinthelegs,accompaniedwithsorenessandweaknessoftheloinandknees,dizzinessandblurringofvision,impotenceorseminalemission,lightredtonguewithlessfur,threadyandrapidpulse.4)Deficiencyofqiandblood:muscularflaccidityoratrophyofthelimbswithmotorimpairment,markedbylassitude,listlessness,shortbreath,weakvoice,sweatingonslightexertion,dizziness,palpitation,paletonguewithwhitethinfur,andweakpulse.5)Traumadamage:thepatienthadahistoryoftrauma,manifestedasflaccidityorparalysisofthelimbs,oraccompaniedwithincontinenceofurinationanddefecation,darkpurplishtonguewithwhitethinfur,andastringentpulse.DiagnosisinWesternMedicineClinicallythereare2diseaseswhichareoftendiagnosedandtreatedasaWeiSyndromeinTCM.1)Polio:Thefullnameofpolioispoliomyelitis,orcalledinfantileparalysis,itisaviralparalyticdisease.Theviruspoliovirus(PV)entersthebodyorally,infectingtheintestinallining,which mayproceedtothebloodstreamandintothecentralnervoussystemcausingweaknessandevenparalysis.Ithasdeclinedrapidlysincetheintroductionofanoralpoliovaccineinthe1960s.Accordingtoresearch,approximately4-8%ofpolioinfectionsconsistofaminor,non-specificillnesswithoutclinicalorlaboratoryevidenceofcentralnervoussysteminvasion.Clinically,theremightbe3syndromesobservedwiththeaboveformofpolioinfection,manifestedasupperrespiratorytractinfectionsymptomssuchassorethroatandfever;orgastrointestinaldisturbancessuchasnausea,vomiting,abdominalpain,constipationorrarelydiarrhoea;orsymptomsofinfluenza-likeillness.Poliocanbediagnosedbylaboratorytestsincludingviralisolation,serologyandcerebrospinalfluid(CSF),etc.2)MultipleSclerosis(MS):Itisachronicneurologicaldiseasethatinvolvesthecentralnervoussystemspeciallythebrain,spinalcordandopticnerves,causingtheproblemswithmusclecontrolandstrength,vision,balance,sensationandmentalfunctions.Themostcommonearlysymptomsincludemuscleweakness,legdragging,stiffness,atendencytodropthings,heavinessoffeeling,clumsinessorlackofcoordination;andvisualsymptomssuchasblurred, foggyorhazyvision,eyeballpain,blindnessordoublevision.Additionally,therearesensory]symptomssuchastingling,pinsandneedles,numbness,abandliketightnessaroundthetrunkorlimbs,etc.FurtherdiagnostictestsarealsoneededsuchasanMRIScan,alumbarpuncture(spinaltap),evokedpotentials,etc.toconfirmthediagnosis.TCMTreatments:1.AcupunctureAccordingtotheChapter44WeiSyndromeinPlainQuestionsofYellowEmperorsCanonofInternalMedicine,themainacupointsforthetreatmentofWeisyndromeshouldbeselectedfromtheYangmingMeridian,itsaysthatWhentreatingWeisyndrome,doctorshouldtargetYangmingMeridian,..asYangmingisthesourceofnourishingforallthezang-fuinternalviscera,onlywiththisnourishmentcanthetendons,bones,andjointsbelubricated.However,IthinkthatitisjustoneofTCMtherapies,weshouldselectmoreacupointsfromothermeridiansaswell.BasicAcupoints:Upperlimbs:Erjian(LI2)Sanjian(LI3)Hegu(LI4)Waiguan(SJ5)Shousanli(LI10)Quchi(LI11)Binao(LI14)Janyu(LI15)Lowerlimbs:Taichong(Liv3)Jiexi(S41)Fenglong(S40)Zusanli(S36)Yanglingquan(G34)Xuehai(Sp10)Biguan(S31)Futu(S32)SupplementaryAcupoints:Forheatinthelung,add,Chize(L5)Kongzui(L6)Yuji(L10)Shaoshang(L11)Fordamp-heatinthebody,add,Sanyinjiao(Sp6)Yinlingquan(Sp9)Pishu(B20)Sanjiaoshu(B22)Fordeficiencyoftheliverandkidney,add,Xingjian(Liv2)Ligou(Liv5)Taixi(K3)Fuliu(K7)Fordeficiencyofqiandblood,add,Xinshu(B15)Feishu(B13)Pishu(B20)Weishu(B21)Fortraumadamage,add,Huatuojiaji(Extra15)pointsatthecorrespondinglevelofspinalinjuries.Forincontinenceofurination,add,Zhongji(Ren3)Guanyuan(Ren4)Qihai(Ren6)Shenshu(B23)Pangguangshu(B28)Forincontinenceofdefecation,add,Tianshu(S25)Dachangshu(B25)Ciliao(B32)Baihui(Du20)Method:select10-20acupointsforeachtreatmentaccordingtothelocationofmuscularflaccidity.Forheatinthelunganddamp-heatinthebody,thereducingmethodisadvisable;Fordeficiencyoftheliverandkidney,thereinforcingmethodshouldbeapplied;Fortraumadamage,strongstimulationshouldbeused.Ourexperienceshowsthatforalltheabovetypes,duringacupuncturetreatments,wemayalsoconnecttheneedleswithelectronicacupuncturetreatmentinstrumentsuchasBMZ-INerveandMuscleStimulatorwhichismoreeffectiveforsomemuscularflaccidityconditions.2.HerbalTherapy 1)HeatinthelungTherapeuticprinciple:clearingawayheatfromthelungtorestorefunctionsofthelimbs.Formula:ModifiedQingZaoJiuFeiTang/DecoctionforClearingDrynesstoSavetheLung/Source:YiMenFaLu/PrincipleandProhibitionforMedicalProfession,byDrYuChang,in1658.Ingredients:Dongsangye(FoliumMori)10gShigao(GypsumFibrosum(decoctedfirst)15gRenshen(RadixGinseng)3gMaimendong(Radixophiopogonis)10gXingren(SemenPruniArmeniacae)9gMudanpi(CortexMoutanRadicis)9gXuanshen(RadixScrophulariae)10gZhimu(RhizomaAnemarrhenae)9gLianqiao(FructusForsythiae)10gGualou(FructusTrichosanthis)15gHuangqi(RadixAstragali)20gDirections:Alltheaboveherbsshouldbemixedanddecoctedinwaterfor20-30minutestomakeadecoction,andfinallytakethedecoctionorally,halfinthemorningandtheotherhalfintheevening.2)Damp-heatinthebodyTherapeuticprinciple:clearawaydampnessandheattorestorefunctionsofthelimbs.Formula:ModifiedErMiaoSan/PowderofTwoWonderfulIngredientsSource:DanXiXinFa/DanxisExperientialTherapy,byDrZhuDanxi,in1481.Ingredients:Yiyiren(SemenCoicis)20gCangzhu(RhizomaAtractylodis)10gHuangbai(CortexPhellodendri)10gNiuxi(RadixAchyranthisBidentatae)12gFuling(Poria)10gBixie(RhizomaDioscoreaeHypoglaucae)12gChishao(RadixPaeoniaeRubra)10gGancao(RadixGlycyrrhizae)9gHuangqi(RadixAstragali)20gDirections:Alltheaboveherbsshouldbemixedanddecoctedinwaterfor20-30minutestomakeadecoction,andfinallytakethedecoctionorally,halfinthemorningandtheotherhalfintheevening.3)DeficiencyoftheliverandthekidneyTherapeuticprinciple:nourishingtheliverandthekidneytorestoremovementsoflimbs.Formula:ModifiedHuQianWan/DelitescentTigerPillSource:DanXiXinFa/DanxisExperientialTherapy,byDrZhuDanxi,in1481.Ingredients:Huangbai(CortexPhellodendri)9gChaozhimu(RhizomaAnemarrhenaePraeparatae)9gShudihuang(RhizomaRehmaniaePraeparatae)15gChenpi(PericarpiumCitrireticulatae)9gBaishaoyao(RadixPaeoniaeAlba)15gSuoyang(HerbaCynomorii)10gGanjiang(RhizomaZingiberis)9gHuangqi(RadixAstragali)20gDanggui(RadixAngelicaeSinensis)10gNiuxi(RadixAchyranthisBidentatae)9gDirections:Alltheaboveherbsshouldbemixedanddecoctedinwaterfor20-30minutestomakeadecoction,andfinallytakethedecoctionorally,halfinthemorningandtheotherhalfintheevening.4)DeficiencyofqiandbloodTherapeuticprinciple:invigoratingqiandnourishingbloodtorestorethemovementsoflimbs.Formula:ShiQuanDaBuTang/PillofTenPowerfulTonicsSource:TaipingHui-MinHeJiJiuFang,byTaiPingHui-MinJu(PublicWelfarePharmacyBureauinChineseSongDynastyinAD1200.Ingredients:Danggui(RadixAngelicaeSinensis)10gChuanxiong(RhizomaLigusticiChuanxiong)9gBaishaoyao(RadixPaeoniaeAlba)10gShudihuang(RhizomaRhemanniaePraeparatae)15gRenshen(RadixGinseng)6gBaizhu(RhizomaAtractylodisMacrocephalae)10gFuling(Poria)9gZhigancao(RadixGlycyrrhizaePraeparatae)9gHuangqi(RadixAstragali)20gRougui(CortexCinnamomi)9gShengjiang(RhizomaZingiberisRecens)2slicesDazao(FructusZiziphiJujubae)3piecesDirections:Alltheaboveherbsshouldbemixedanddecoctedinwaterfor25-30minutestomakeadecoction,andfinallytakethedecoctionorally,halfinthemorningandtheotherhalfintheevening.Ortakepills,8pillseachtime,3timesaday,continuetotakeitfor3-6months.5)TraumadamageTherapeuticprinciple:removingbloodstasistorestorethemovementsofthelimbs.Formula:ModifiedBuYangHuanWuTang/DecoctionforInvigoratingYangandRecuperationSource:YiLinGaiCuo/CorrectionsonofErrorsamongPhysicians,byDrWangQingren,in1830.Ingredients:Shenghuangqi(RadixAstragaliseuHedysari)20gDanggui(RadixAngelicaeSinensis)10gChishaoyao(RadixPaeoniaeRubra)10gChuanxiong(RhizomaLigusticiChuanxiong)10gHonghua(FlosCarthami)9gTaoren(SemenPersicae)9gXuduan(RadixDipsaci)10gDuzhong(CortexEucommiae)10gNiuxi(RadixAchyranthisBidentatae)10gDirections:Alltheaboveherbsshouldbemixedanddecoctedinwaterfor20-30minutes,thentobetakenorally,halfinthemorningandtheotherhalfintheevening.LifeStyleandDietaryAdvice1.RegulatingemotionsPatientswithWeisyndromearesusceptibletodepressiveemotionssuchaspessimism,melancholiaandimpetuosityduetotheirdisabilities.Foradults,itisadvisableforthemtoselectproperpsychologicalhealthpreservationmethods,suchascalligraphy,painting,playingtheguitar,etc;forchildrenandjuveniles,weshouldencouragethemtoplaywithtoys,whichencouragestherehabilitationofthelimbswithmuscularflaccidityaswellasregulatesemotion.2.HealthexercisesSomehealthexercisesarehelpfulforpatientswithWeisyndromes,forthosewithflaccidityofupperlimbs,wemaysuggestwritingChineseorJapanesecharacters,playingcatchorknittingetc;forthosewithflaccidityoflowerlimbs,learningtorideatricycleorotherlegexercises.3.DietarytherapyForpatientswithflacciditymarkedbydeficiencyoftheliverandthekidney,thefollowingformulamayhelp:Dry300gofcattlebonemarrowoverafireandgrinditintopowder.Parch300gofblacksesameuntiltheysmellfragrantandgrinditintoapowder.Thenaddalittlesugartothepowder(totaste)andmixandstirthetypesofpowderevenly,take9g,2timesaday.Forpatientswithflacciditymanifestedasdeficiencyofqiandblood,wecanaskthemtoeatHenStewedwith Danggui(RadixAngelicaeSinensis.Forpatientswithflaccidityofbloodstasistype,theycouldtryPeachKernelGruel,etc.Notes:NewDevelopmentsinTCMandWesternMedicine:1.HerbalMedicine:BrandName:FuKangNing/JixuecaoZongdaiPian,EnglishandLatinNames:Centella,Asiaticcentella/HerbaCentellae,producedinShanghai,itcanrelievesymptoms.2.InterferonTherapyforMS:Interferon()isaproteinthatoccursnaturallyinthebodyinverysmallamounts.ItalsobemadeasadrugforMS.Thereare3maintypes:Alpha,beta,andgamma.BrandName:Avonex(U.S.,Canada)ChemicalName:Interferonbeta-1aThismedicationistakenbysubcutaneousinjection.AnotherBrandName:BrandName:Rebif.ChemicalName:Interferonbeta-1aNote:IthasbeenapprovedbyU.S.FoodandDrugAdministration.ProperUsage:Rebifisgiven3times,aweek,subcutaneously(betweenthefatlayerjustundertheskinandmuscles). Startat8.8mcg,3timesaweek,graduallyincreaseover4-weekperiodtothe44mcgdoseinordertoreducethesideeffects.TwoNewOralUsageofInterferon:1.Interferonbeta-1b(IFN-beta-1b,Betaseron,025mg,everyotherday.2.Interferonbeta1a(IFN-beta-la,Avonex,30mcg,once/week.Functions:toinhibitreleaseofIFNgamma&tumournecrosisfactorandpartiallyrestoresuppressorcellfunctionandattenuatediseaseactivity.Notes:AlltheabovecanbeprescribedonlybyWesterndoctorsintheU.K.References:1.TheMedicalClassicoftheYellowEmperor(Englishedition),TranslatedbyDrMingZhu,publishedbyForeignLanguagePress,in2001,2005.2.ChineseHerbalMedicineFormulae&Strategies,byDrDanBensky&Dr.RandallBarolet,publishedbyEastlandPress,U.S.Ain1990.3.APracticalEnglish-ChineseLibraryofTCM,byProfEnqinZhang(EnginCAN),publishedbyShanghaiTCMUniversityPressinApril1990;March,1999.Notes:Formoreinformation,pleaseringmeon07846193488;orGoogle-EnqinZhang