Diagnosis and treatment according to differentiation
1.Identification of similar syndromes:
disease and flaccidity syndome are all marked by symptoms of limbs or joints,
both of them may interchange. So it is necessary to distinguish these two
disease. But arthralgia syndrome is mainly characterized by aching pain, a heavy
feeling, swelling in tendons, bones, muscles and joints, incapability of flexing
and extending. Sometimes, it is accompanied with numbness, but no paralysis.
While flaccidity syndrome is characterized by atrophy and debility of the limbs,
wasting and atrophy of muscle, no pain in the limbs or joints.If arthralgia
syndrome lasts for a long time , the patient can hardly motion due to pain
limbs, which leads to wasting and atrophy of muscles, joint deformity ,
ankylosis .But it is accompanied with flaccidity and weakness of the lower limbs
.So it is seen in clinic that arthralgia syndrome coverts into flaccidity
syndrome . For a patient of arthralgia syndrome , due to deficiency of vital-qi
he infects exogenous pathogen that obstructs the channels causing stagnation of
qi and blood then, arthralgia
syndrome will occur . So it is seen in clinic that flaccidity syndrome
accompanies with arthralgia syndrome.
points of differentiation of symptoms
2.1 Identifying arthralgia due to wind-cold-dampness
pathogen with arthritis of heat of type: The former is marked as wandering pain
and swelling of limbs or joints, no
heat symptoms. The latter is marked by redness, swelling, burning sensation,
pain of joints with irritability .
2.2 Identifying excess of wind, cold, dampness pathogen:
Excess of wind pathogen leads to wandering aching pain in the limbs and joints;
excess of cold pathogen leads to steady pain in the limbs and joints; excess of
dampness pathogen leads to
swelling, a heavy feeling, aching pain in the joints.
2.3 Identifying blockage of phlegm and blood stasis in
channels: With the prolongation of the course of the disease, it is marked as
swelling of joints, even joint deformity, incapability of flexing and extending,
purplish tongue with greasy coating, uneven thready pulse .
Differentiation of excess and deficiency of syndromes: At the beginning of
arthralgia syndrome, if marked by
continuous pain in the limbs and joints, even fever, it mostly belongs to the
category of excess syndrome. When arthralgia syndrome is not cured through
long-term treatment and occurs reapeatedly, marked by obscure pain in the limbs
and joints, symptoms of deficiency of the liver and kidney such as listlessness,
lassitude in loin and knees, dysphoia with
feverish sensation in the chest , palms and soles, etc. it belongs to deficiency
syndrome or deficiency syndrome miggling with excess syndrome.
syndrome is caused by invasion of pathogenic wind, cold, dampness, heat, so its
basic therapeutic principle is expelling the wind, dispersing cold, eliminating
dampness, clearing away heat and dredging the channels. In the late stage of it,
the method of tonification should be used in combination for the consumptive
case. “Yi Xue Wu Xin·Bi” generalized the treatment of arthralgia syndrome.
Namely, expelling the wind is the basic principle in treatment of wind
arthralgia assisted with dispersing cold and eliminating dampness. The
ingredients enriching the blood are generally used combination. It is so called
that drugs connecting with blood system can be used to treat the syndrome caused
by invasion of pathogenic wind. Blood flowing smoothly in the vessels can get
wind pathogen to be dispelled by itself. Dispersing cold is the basic principle
in treatment of arthralgia aggravated by cold, assisted with eliminating
wind-dampness. The ingredients warming yang are generally used un combination.
It is so called that drugs of warm nature can make qi and blood flow smoothly
which will not lead to pain, yet cold make blood coagulate which will lead to
pain. Eliminating dampness is the basic principle in treatment of damp
arthralgia , assisted with expelling wind clearing away cold. The ingredients
reinforcing the spleen are generally used in combination, It is so called that
sufficient spleen-qi can remove dampness and numbness will not occur on account
of sufficiency of qi and blood. The above content may be referred to in
syndrome and treatment:
4.1 arthralgia due to wind-cold-dampness
4.1.1 Wind arthralgia
Main symptoms: wandering aching pain in the limbs or joints.
Accompanying symptoms: aversion to wind, fever, a feeling of
wind in the joints, incapability of flexing and extending.
Tongue and pulse: light red tongue with thin and white
Pathogenic wind-cold retaining in channels can obstruct qi and blood flowing in
vessels, which is marked as aching pain in the limbs or joints, incapability of
flexing and extending. Wind arthalgia is characterized by pain wandering in
right, left, upper, lower joints. Qi and blood flowing unsmoothly in the
channels of limbs, disharmony of nurient qi with defensive qi can lead to a
feeling of wind in the joints, aversion to wind, fever. Pathogenic wind-cold
dampness invading the skin, muscles and channels
shows thin and white coating, floating pulse.
Treatment: expelling wind and dredging channel, dispelling
cold and removing dampness, assisted with enriching blood and promoting blood
4.1.2 Arthralgia aggravated by cold
symptoms: unsteady pain in the limbs and joints, which becomes severe when
accompanied with the affection of coldness, and gets alleviated when warmed .
symptoms: ankylosis, incapability of flexing and extending, red color of the
skin and heat sensation in the joints.
and pulse: normal tongue, thin and white coating or white and moist coating,
floating and tense pulse.
of symptoms: Pathogenic wind, cold, dampness obstructing the meridians and
excess of cold pathogen lead to severe pain with fixed spots, because pathogenic
cold is a kind of yin pathogen and has the property of coagulation and
constriction. Qi and blood in meridians flow smoothly when warmed, so that pain
may get alleviated. Qi and blood coagulates in meridians when accompanied with
the affection of coldness, so that pain will get more severe. Stagnation of
yang-qi due to cold coagulation leads to qi and blood flowing unsmoothly, which
is marked as ankylosis, incapa- bility of flexing and extending, no redness,
swelling, heat sensation in the local skin. Severe pain caused by cold
coagulation shows thin and white coating or white and moist coating, tense and
expelling pathogenic cold from channel, expelling wind and removing dampness.
symptoms: swelling, a heavy feeling, pain in the limbs and joints, mumbness.
symptoms: aching of the whole body, listless, heavy sensation in hands and feet,
and pulse: normal tongue with white and greasy coating, soft and moderate pulse.
Because damp pathogen is heavy, turbid, viscous and stagnant in nature, invasion
of pathogenic wind, cold, dampness and excess of damp pathogen leads to
swelling, a heavy feeling, pain in the limbs and joints. Damp pathogen obstructs
the meridians, so that qi and blood flow roughly in vessels, which is marked by
numbness. Dampness is a kind of yin pathogen and causes stagnation of yang-qi,
which is marked as aching in the whole body, listlessness, heavy sensation in
hands and feet, incapability of flexing and extending. Pathogenic dampness not
being eliminated shows white and greasy coating, soft and moderate pulse.
removing dampness and dredging channel, expelling wind and clearing away cold.
Arthritis of heat type:
symptoms: pain and a feeling of burning heat in joints with red color of the
skin. The pain is either single or multiple, which becomes severe when pressed,
gets alleviated when cooled.
symptoms: fever, aversion to wind sweating, thirst, dysphoria.
and pulse: red tongue with yellow and dry coating slippery and rapid pulse.
Pathogenic heat stagnating in meridians and joints results in accumulation of qi
and blood, which is marked by pain and a feeling of burning heat in joints with
red color of the skin, severe pain in one or many joints. Accumulation of heat
leads to stagnation qi and blood, which is marked by pain becoming severe when
pressed and getting allievated when cooled. Pathogenic heat lingering and
disharmony between ying and wei lead to fever, aversion to cold. Inward invasion
of pathogenic heat causes excess of internal heat, which is marked as high
fever, sweating, thirst and liking drink, dysphorsia. Accumulation of heat and
blockage of dampness show as red tongue with yellow and dry coating, rapid and
the patients of arthralgia syndrome, due to wind-heat-dampness and excess of
pathogenic qi or hyperactivity of yang-qi the local and general symptoms will be
severe. The onset of the disease is sudden and it easily affects five Zang-organs,
which make the pathogenic changes various.
clearing away heat and dredging
channel, expelling wind and eliminating dampness.
Bi is a syndrome characterized by arthrocele, ankylosis, joint deformity,
wasting of limbs. If arthralgia syndrome lasts for a long time, it will occur.
The illness name has been accepted in civil lecture discussion and clinic. Wang
Bi is similar to obstruction of the kidney channel. As Huang Di Nei Jing said
obstruction of the kidney channel is manifestated as inability to stand up
straightly as if the function of heels is replaced by the sacral bone and humped
thoracic vertebrae is higher than head. We discuss it in the chapter. It is
favorable to clinic study and treatment of it .
symptoms: arthrocele, joint deformity, ankylosis, incapability of flexing and
ankyloses of the whole body.
symptoms: aching pain in the limbs and joints getting suvere obviously, a
feeling of pain arising from the
bones. The pain is light in the day time and becomes serious at night or in
cloudy and rainy day. On the initial stage of the illness, will ankylosis occur
in cloudy the morning, further in all day, often accompanied by lassitude in
loin and knees, fatigue weakness, liking warm and aversion to cold, irregular
menstruation for female, emission and impotence for male.
and pulse: red, pale of dark tongue with ecchymoses; white or yellowing coating;
deep thready or taut pulse with weakness in chi.
The kidney, as congential foundation, houses the primordial yin and yang; stores
essence; forms marrow and dominates the bones. The liver stores blood and is in
charge of tendons. The liver and the kidney have a common source. Blood and
vital essence produce each other. Due to inherent defect, malnutrion after
birth, deficiency of the kidney and liver and faint muscles and bones, exogenous
pathogen easily affects the body. Therefore, to a person of constitution of
yin-deficiency, wind-cold pathogen invades the body
and easily retains in the tendons and bones. With the prolongation of
arthralgia syndrome, the kidney-yin is impaired so as to make exogenous pathogen
enter the tendons and bones. Deficiency of blood and vital essence failing to
nourish the tendons and bones leads to spasm with loose bones, then, joint
deformity, ankylosis and incapblity of flexing and extending, finally debility
of limbs. Invasion of cold pathogen which is coagulative and constrictive in
nature causes extreme pain getting severe in rainy and day as if it arises from
the bones, liking warm and aversion to cold. Daytime belongs to yang dominating
stability; night belongs to yin dominating movement. Movement makes blood and qi
flow smoothly; stability makes blood and qi flow roughly. So the pain is light
in the daytime and severe at night. Ankylosis will occur in the morning and get
allievated after movement. The loin is the residence of the kidney. The liver
dominates tendons. Deficiency of the liver and kidney causes lassitude in loin
and knees, fatigue and weakness. Malnutrion of Chong and Ren channels leads to
menstruation for female. The kidney-essence fails to control for male who is
marked by emission and impotence. The case of deficiency of yin is marked by red
tongue; the case of yang deficiency is marked by pale tongue. Stagnation of
collaterals due to deficiency of blood and vital essence leads to dark tongue,
or even with ecchymoses and petechiae. Excess of pathogenic cold-dampness leads
to white coating or greasy coating. Accumulation of pathogen converting into
heat leads to yellow or greasy coating. Deep pulse indicates interior syndrome;
thready pulse indicates deficiency syndrome; taut pulse indicates pain; faint
pulse in chi indicates deficiency of the kidney.
tonifying the kidney and dispersing cold, assisted with expelling wind and
eliminating dampness, nourishing the liver and the tendons, clearing and
activating the channels and collaterals.
arthralgia syndrome lasts for a long time, besides the symptoms caused by
obstruction of pathogenic
cold-dampness in the meridian and joints, yet there appears symptoms caused by
deficiency of qi and blood or deficiency of the liver and kidney due to
impairment of vital-qi. To treat them, doctors should give consideration to both
the incidental and fundamental. Reinforcement and elimination are used in
combination, i.e, expelling wind, dispersing cold and eliminating dampness with
either tonifying qi and blood or nourishing the kidney and liver. In order to
tonify qi and blood,doctors use modified Si Jun Zi Decoction, Si Wu Decoction,
Yang Rong Decoction or Gui Pi Decoction; in order to nourish the liver and
kidney, doctors use modified You Gui Pill, Zuo Gui Pill,Du Huo Ji Sian
Decoction, or Jian Bu Hu Qian Pill. Arthralgia syndrome affects inward the heart
with the prolongation of the course of the disease, which is marked by
palpitation and shortness of breath which become aggravated after movement,
lusterless complexion, pale tongue, rapid and feeble or knotted and intermittent
pulse.Tonifying qi and nourishing the heart are used to treat them. Prescibe
modified Zhi Gan Zao Decoction. It is of benefit for patients to use acupuncture
and moxibustion, massage, fumigation and washing in combination besides oral
and nursing measure
there occurs extreme pain in the joints, arthroncus, limited movement and high
fever at the initial stage of the disease, the patient should have a rest in bed
and will make himself comfortable by regulating his posture so that the pain can
the condition of the disease is steady and pain in limbs and joints is
allievated, the patient should increase movement in order to strengthen his
health, above all, recover the joint function.
residence of the patient should have proper temperature and fresh air.
Especially, keep the affected limb warm so as to relieve the pain, promote
recovery and prevent reoccurrence of the disease.
attention to cat nutrient food so as to strengthen the resistance force. Eat
little pungent and irritant food. The patient of arthralgia aggravated by cold
shouldn,t eat uncooked and cold food, but eat food warm in nature,
such as mutton, beaf and so on. They should also eat much vegetable or fruit.
apply a heat bag of herbs or plaster to the affected part. Steam or wash the
whole body by decoction. Necessarily, therapy of acupuncture, moxibustion and
massage may be used in combination.
its complication occurs, the illness should be diagnosed and treated in time.
syndrome is often seen in clinic. Deficiency of vital-qi, as a interior factor,
combining with invasion of pathogenic wind, cold,dampness, heat which is
considered as a exterior factor, leads to the disease. It is characterized by
pain, aching or heavy sensation and numbness in the muscles,bones, joints,
arthrocele, incapability of flexing and extending. The condition of the disease
is closely related to the changes of climate. The pathogenesis of arthralgia
syndrome is that qi and blood can,t
flow smoothly due go blockage of collaterals and channels. Clinically, it is
divided into two types: arthalgia due to wind-cold- dampness and arthritis of
heat type. In recent years, with deep study of Wang Bi, the range of it is
enlarged. In arthralgia due to wind-cold- dampness, wind arthralgia is mainly
caused by invasion of pathogenic wind, marked by wandering pain; arthralgia
aggravated by cold is mainly by invasion of pathogenic cold, marked by extreme
pain in fixed position; damp arthralgia is mainly caused by pathogenic dampness,
marked by pain in fixed position with a heavy sensation, arthroncus and
numbness. Arthritis of heat type is marked by redness, swelling, burning heat
and pain in the joints. Wang Bi is a obstinate disease, marked by pain slight in
the daytime and severe at night as if it arises from the bones, arthrocele,
doctors treat arthralgia syndrome, they should figure out the relationship
between vital-qi and pathogen. According to the course, the onset, the condition
of the disease and characteristics of syndrome, it is necessary to define the
nature of it, the urgency and severity of the fundamental and the incidental. In
general, on the initial stage of the disease, it is manifested as deficiency
syndrome and it should be treated by eliminating the pathogenic factor, clearing
and activating the channels and collaterals. The protracted disease that is
marked by deficiency syndrome miggling with excess syndrome should be treated by
strengthening the body resistance to eliminate pathogenic factors, clearing and
activating the channels and collaterals or by eliminating the pathogenic factor,
promoting blood circulation and resolving masses accompanied with strengthening
the body resistance. It is so called that doctors should treat the incidental
under urgent situation; when the condition of the disease permits, both the
incidental and the fundamental are taken in consideration . Expelling wind,
dispersing cold, eliminating dampness and clearing away heat, as basic
therapeutic methods of arthralgia syndrome, are assisted with eliminating
phlegm, resolying masses, promoting blood circulation to remove blood stasis,
strengthening the spleen, replenishing qi, warming yang, nourishing the kidney,
enriching the blood and nourishing the liver according to the practical
conditions. Moreover, in treatment of pain in the various parts, the medicinal
guide should be added to the recipe for promoting the curative effect. For those
of pain in the upper limbs, notopterygium root, chuanxiong rhizome, turmaria and
cinnamon twig are used; for those of pain in the lower limbs, achyranthes
root, pubescent angelica root, chaenomeles fruit and manshurian aristolochia
root are used; for those of pain in the neck or nape, pueraria root are
used;for those of pain in the lumbar vertbrae, loranthus mulberry mistletoe,
eucommia bark, cibot rhizome and pyrola are used. Pay attention to regulate the
function of the spleen and stomach during treatment of arthralgia syndrome,
which is favorable to treatment and recovery. Besides, when arthralgia due to
wind-cold-dampness is marked by extreme pain, prepared aconite root and
Sichuan aconite root are used for, eliminating wind, eliminating dampness and
warming the channels to relieve pain. Because poisonous prepared aconite root
and Sichuan aconite root are pungent in flavor and hot in nature, it is unfit to
take them for a long time or in large dosage. They should be administrated in
small dosages at the beginning and increased gradually. After taking them, if
the patient is marked by intoxication symptoms such as tingling sensation
in lips and tongue, numbuess in hands and feet, nausea, palpitation, slow
pulse and so on, the dosage of them should be reduced in accordance with
practical conditions or discontinued . If necessarily, the measures should be
made to rescue him in time. For those of dragging pain and spasm of limbs which
can,t be cured by ordinary drugs due to long-term course of the
disease, the animal drugs expelling wind from collaterals and channels such as
agkistrodon acutus, black-tail snake, prepared pangolin scales, earthworm,
hornet nest and scorpoin are used for dredging channel to relieve pain. The
drugs are mostly pungent in flavour, hot in nature and drastic in function. Some
of them are poisonous and some are irritant. So it is unfit to take them in
large dosage or for a long time. They are used in pills or powders. As soon as
the patients, condition improves, they can,t
the treatment of arthralgia syndrome, the patients should increase physical
exercises, prevent the invasion of pathogenic wind-cold-dampness and change the
clothes according to the weather, which plays an important role in prevention or
reoccurrence and treatment. Generally, if arthralgia syndrome
is treated in time, its prognosis will be favorable. But it occurs
repeatedly and it is lingering . As a protracted disease, it can lead to
obstruction of phlegm and blood-stasis which is marked by joint deformity; it
can also affect interior Zang organs which leads to deficiency of qi and blood
or deficiency or liver-yin and kidney-yin. On this condition, it is so deep and
serious that it can be difficulty cured and its prognosis is poor. Doctors
should deal it with positively referring to this chapter.