Journal of Traditional Chinese Medicine, June 2010, Vol. 30, No. 2 145

Lecture Bi Syndrome (Arthralgia Syndrome)

ZHANG En-qin ᓴᘽࢸ Manager &Chief Dr of EVERWELL Chinese Medical Centre, London Clinic7, London, U.K

The word ‘Bi’ (⯍) in Chinese means an obstruction. 2. Internal factors - general weakness of the body as Bi Syndrome refers the syndrome characterized by well as the defensive qi:1 the obstruction of qi and blood in the meridians due This condition may cause the weakened resistance to to the invasion of external pathogenic wind, cold and pathogens, marked by dysfunction of skin and pores dampness, manifested as soreness, pain, numbness, as well as defensive qi. As a result pathogenic wind, heavy sensation, swelling of joints and limbs, lim- cold and dampness can easily invade the body itation of movements and so on. causing Bi syndrome, this was described in the book As joint pain is one of most common symptoms in Bi -Prescriptions for Succouring the Sickness / Ji Sheng ⌢⫳ᮍ syndrome, so some western doctors and editors often Fang ( ), by Dr YAN Hong-he, in 1253, which translate Bi syndrome into ‘Arthralgia Syndrome’. stated that ‘it is because of weakness of the body with poor function of defensive qi that invasion of Clinically, Bi syndrome covers many different acute pathogenic wind, cold and dampness can result in Bi or chronic diseases in Western medicine, such as syndrome’. rheumatic diseases, rheumatoid arthritis, osteo- Now we can see that the basic pathology of Bi arthritis, fibrositis, lupus, gout, neuralgia and others. syndrome is the obstruction of qi and blood in the In TCM there are many effective therapies for Bi meridians, due to the invasion of pathogenic wind, syndrome, including acupuncture, moxibustion and cold and dampness. According to TCM theory, if the herbal medicines. meridians are open and the qi and blood are Aetiology and Pathology circulating smoothly and normally, there will be no pain; but if the meridians are obstructed and the flow According to TCM theory and the author’s clinical of qi and blood are blocked, pain will arise’. experiences, Bi syndrome can be caused by either external factors or internal factors. However, the constitution of the body differs from person to person, for example, with people that live 1. External factors – the invasion of the muscles, in the same condition, some suffer from Bi syndrome, joints and meridians by pathogenic wind, cold and while other will not be affected. After suffering Bi dampness: syndrome, if a patient has excess yang by nature as In Chapter 43 the Bi Syndrome of Su Wen (㋴䯂Plain well as accumulated heat, the wind-cold-dampness Questions), a part of The Yellow Emperor’s Canon of type of Bi syndrome may transfer into heat type of Bi .Internal Medicine (咘Ᏹݙ㒣, BC475-221), said that syndrome ‘if pathogenic wind, cold and dampness invade the Additionally, if pathogenic wind, cold and dampness body together, it will lead to obstruction in the stay in the meridians and cause an obstruction for a meridians and Bi syndrome may take place’. Clinically, we can also see that Bi syndrome is more Correspondence to: Prof. ZHANG En-qin common in the areas where the weather is cold, wet Email: [email protected] and windy. Tel: 44-7846193488 146 Journal of Traditional Chinese Medicine, June 2010, Vol. 30, No. 2

long time, the basic pathogenesis may change into tongue with ecchymosis, white or greasy fur, thready blood stasis type of Bi syndrome. This is why and unsmooth pulse. clinically we often see some long-term patients with 6. Heart Bi syndrome (ᖗ⯍): Palpitation, chest Bi syndrome manifested as blood stasis type. stuffiness, pectoral pain, shortness of breath, even bluish discoloration of face, lips and finger nail, According to Chapter 43 the Bi Syndrome of Su Wen cold limbs, dark red tongue with little coating, faint of Yellow Emperor’s Canon of Internal Medicine the or hesitant pulse. (Notes: This type is often seen in Bi condition can also develop and turn into bone Bi, the patents with mitral stenosis and mitral tendon Bi, blood-vessel Bi, muscle Bi and skin Bi. incompetence of rheumatic heart disease). Further more as the five zang organs are connected externally with their corresponding meridians and Bi Syndrome in Western Medicine tissues, so pathogens linger in the meridians and In western medicine, many diseases may manifests as tissues including bone, tendon, blood vessel, muscle ‘Bi (arthralgia) syndrome’, but mostly seen in the and skin, they may gradually seep into the internal following diseases: organs. For example, bone Bi may develop into 1. Rheumatism kidney Bi; tendon Bi into liver Bi; blood vessel Bi into heart Bi (clinically this is most common); muscle It generally occurs as delayed sequel to group A Bi into spleen Bi; skin Bi into lung Bi and so on. haemolytic streptococcal infection. Rheumatism involves the connective tissues in the heart, joints, Differential Diagnosis skin and vessels. It commonly appears in young Clinically, the author classify Bi syndrome into adults between the ages of 20–30 and manifests as following 6 different types: migratory polyarthritis. The large joints of ext- 1. Wind Bi (亢⯍ wandering arthralgia 㸠⯍) remities are most frequently affected, marked by syndrome: Wandering arthralgia without fixed loc- redness, swelling, heat sensation and pain of the ation, accompanied with aversion to wind, white or joints during acute stage, some patients may also greasy fur and floating pulse. have annular erythema, subcutaneous nodules, chorea and other symptoms. Laboratory tests show elevated 2. Cold Bi (ᆦ⯍ painful arthralgia ⮯⯍) syndrome: erythrocyte sedimentation rate (ESR), positive Severe stabbing arthralgia with fixed location as well C-reactive protein or increased white cell count etc. as local cold sensation, alleviated by warmth, Repeated reoccurrences may cause heart valvular aggravated by cold, white fur and tight pulse. diseases, such as mitral stenosis (marked by diastolic 3. Dampness Bi (⑓⯍ fixed arthralgi ⴔ⯍) murmur) , mitral incompetence (systolic murmur), syndrome: Soreness and fixed pain in the joints with etc. local swelling and numbness, aggravated on cloudy 2. Rheumatoid arthritis and rainy days, white and greasy fur, soft and slow pulse. Its aetiology and pathogenesis have not been fully known so far, but most scholars believe that it’s a ⛁⯍ 4. Heat Bi ( heat arthralgia) syndrome: kind of autoimmune disease with abnormity of Arthralgia with local redness, swelling and burning humoral immunity and cellular immunity, man- sensation, accompanied with fever, sweating and ifesting as symmetric polyarthritis mostly with small thirst, yellow and greasy fur, slippery and rapid pulse. joints of hands, wrists, and feet involved. This is 5. Blood Stasis Bi ˄⯔㸔⯍˅syndrome: Long-term marked by pain, swelling and rigidity of joints intermittent arthralgia with swelling, rigidity and usually aggravated in the morning and alleviated by deformity of joints, numbness of limbs, purplish dim exertion. Laboratory tests show blood sedimentation Journal of Traditional Chinese Medicine, June 2010, Vol. 30, No. 2 147

rate (ESR) increased, blood RF positive, etc. It does Method: Select 6–12 acupoints for each treatment not cause heart valvular disease. according to the location of pain. 3. Osteoarthritis For wind Bi (wandering arthralgia) syndrome, heat Bi It is also manifested as a type of Bi (arthralgia) (heat arthralgia) syndrome and blood stasis Bi syndrome, caused by the breakdown and eventual syndrome, the reducing method is advisable. loss of the cartilage of one or more joints. Before the For cold Bi (painful arthralgia) syndrome and age of 45, it occurs more in males; while after age 55, dampness Bi (fixed arthralgia) syndrome, the needles more in females. It commonly affects the hand, feet, should be retained for 30 minutes and moxibustion is spine and large weigh-bearing joints such as the hips also recommended. and knees, and manifests as joints pain and swelling, finally leading to limitation of joint mobility. 2. Herbal Therapies Therapeutic principle: dispersing pathogenic wind, 4. Fibrositis cold, and dampness. It is a chronic condition marked by stiffness and 1) Basic Herbal Recipe: tenderness of muscles, tendons and joints, also Modified Juan Pi Tang ( 㸆⯍∸ Decoction for accompanied with restlessness, sleep-awakening Treating Bi Syndrome) for Bi syndrome of cold, wind feeling tired, fatigue, anxiety, depression, disturbance and dampness types. in bowel function. Its cause is not known yet. Source: Yi Xue Xin Wu (एᄺᖗᙳ Medical TCM Treatments Revelations), by Dr. CHEN Guo-peng, 1732. 1. Acupuncture and Moxibustion Ingredients: Qianghuo (㕠⌏ Rhizoma seu Radix Basic Acupoints: Notopterygii) 10g, Duhuo (⣀⌏ Radix Angelica Dazhui (GV 14), Hegu (LI 4), Quchi (LI 11), Jianyu Pubescentis) 10g, Guizhi (Ḗᵱ Ramulus Cinnamomi) (LI 15), Waiguan (TE 5), Wangu (TE 4), Huantiao 10g, Qinjiao (⾺㡑 Radix Gentianae Mocrofhyllae) (GB 30), Xuanzhong (GB 39), Jiaji (EX-BZ), 12g, Danggui (ᔧᔦ Radix angelicae sinensis) 10g, Fengshi (GB 31), Yanglingquan (GB 34), Dubi (ST Chuanxiong (Ꮁ㡢 Rhizoma Ligustici Chuanxiong) 35), Kunlun (BL 60). Notes: you can choose local 10g, Haifengteng ( ⍋亢㮸 Caulis Piperis Futo- acupoints according to locations of Bi syndrome. kadsurae) 30g, Jixueteng (叵㸔㮸 Caulis Spatholobi) Supplementary Acupoints: 30g, Sangzhi (ḥᵱ Ramulus Mori) 30g. For Wind Bi (wandering arthralgia) syndrome, add: Administration: All the above herbs should first be Fengmen (BL 12), Xuehai (SP 10). soaked in a pot of water for 2 hours or more and then For Cold Bi (painful arthralgia) syndrome, add: placed over a high fire until boiling. Then they are to Weiyang (BL 39), Guanyuan (CV 4) be simmered over a low fire for 25–30 minutes. For Dampness Bi (fixed arthralgia) syndrome, add: Finally, drain the herbal liquid from the boiled herbs Fenglong (ST 40), Yinlingquan (SP 9) to obtain the decoction for oral use. Drink half in the For Heat Bi (heat arthralgia) syndrome, add: Quchi morning and the other half in the evening. (LI 11), Erjian (LI 2). For Wind Bi (wandering arthralgia) syndrome, add: For Blood Stasis Bi syndrome, add: Xuehai (SP10), Weilingxian ( ࿕♉ҭ Radix Clematidis) 12g, Geshu (BL 17); Fangfeng (䰆亢 Radix Ledebouriellae) 10g. For Heart Bi syndrome, add: Tongli (HT 5), Xinshu For Cold Bi (painful arthralgia) syndrome, add: (BL 15). Baizhi ( ⱑ㢋 Radix Angelicae Dahuricae) 12g, 148 Journal of Traditional Chinese Medicine, June 2010, Vol. 30, No. 2

Yuanhu (ᓊ㚵㋶ Rhizoma Corydalis) 9g. Indications: It can be used for Wind Bi (亢⯍ 㸠⯍ For Dampness Bi (fixed arthralgia) syndrome, add: wandering arthralgia ) syndrome; also for exogenous wind-dampness syndrome marked by Yiyiren (㭣㢵ҕ Semen Coicis) 30g, Cangzhu (㢡ᴃ heaviness and pain of head, waist and back, or Rhizoma atractylodis) 12g. general pain of the body, with difficulty in turning For Heat Bi (heat arthralgia) syndrome, add: round. Rendongteng ( ᖡހ㮸 Caulis Lonicerae) 30g, The author’s experience: Clinically the author use Huangbai (咘ᶣ Cortex Phellodendri) 10g. this recipe for rheumatic arthritis, common cold and For Blood Stasis Bi syndrome, add: Ruxiang (ч佭 migraine of wind-damp type. Resina Olibani) 10g, Moyao (≵㥃 Myrrha) 10g, b) Duhuo Jisheng Tang (⣀⌏ᆘ⫳∸ Decoction of Dilong (ഄ啭 Lumbricus) 12g. Pubescent Angelica and Loranthus) for Cold Bi For Heart Bi syndrome, add: Yuzhu (⥝ネ Rhizoma syndrome. Polygonati Odorati) 21g, Tinglizhi (㩊㢜ᄤ Semen Source: Qianjin Yao Fang (ग䞥㽕ᮍ Thousand Lepidii seu Descurainiae) 9g, Huangqi (咘㡾 Radix Ducat Formulae), by Dr SUN Si-miao in 652. Astragali seu Hedysari) 30g, Dangshen (ܮখ Radix Ingredients: Duhuo (⣀⌏ Radix Angelicae Pub- Codonopsis) 15g. escentis) 9g, Xixin (㒚䕯 Herba cum Radice Asari) 䰆亢 2) The Original Herbal Prescriptions for Different 3g, Fangfeng ( Radix Ledebouriellae Divaricatae) 6g, Qinjiao (⾺㡑 Radix Gentianae Mocrofhyllae) 6g, Types of Bi Syndrome Sangjisheng (ḥᆘ⫳Ramulus Loranthi) 6g, Duzhong a) Qianghuo Sheng Shi Tang (㕠⌏㚰⑓∸ Decoction (ᴰӆ Cortex Eucommiae Ulmoidis) 6g, Niuxi (⠯㝱 of Notopterygium for Dispersing Dampness) for Radix Achyranthis Bidentatae) 6g, Rougui (㙝Ḗ Wind Bi syndrome. Cortex Cinnamomi Cassiae) 6g, Danggui ( ᔧᔦ Ꮁ㡢 ) Source: Nei Wai Shang Bian Huo Lun (ݙ໪Ӹ䕼ᚥ Radix Angelicae Sinensis) 6g, Chuanxiong Rhizoma Chuanxiong) 6g, Shengdihuang (⫳ഄ咘 䆎 Clarifying Doubts about Injury from Internal and Radix Rehmanniae Glutin- osae˅6g, Baishao (ⱑ㡡 External Causes) by Dr LI Gao , in 1247. Radix Paeoniae Alba) 6g, Renshen (Ҏখ Radix Ingredients: Qianghuo (㕠⌏ Rhizoma seu Radix Ginseng) 6g, Fuling (㤃㢧 Sclerotium Poriae Cocos) Notopterygii) 9g, Duhuo (⣀⌏ Radix Angelicae 6g, Zhigancao (♭⫬㤝 Radix Glycyrrhizae Pra- Pubescentis) 9g, Gaoben (㮕ᴀ Rhizoma et Radix eparatae) 6g. Liguistici) 4.5g, Fangfeng (䰆亢 Radix Ledebouri- Administration: The source text advises to coarsely ♭⫬㤝 ellae) 4.5g, Zhigancao ( Radix Glycyrrhizae grind the above ingredients. However, today the Ꮁ㡢 Praeparatae) 4.5g, Chuanxiong ( Rhizoma normal dosage of Sangjisheng is 15–30, the dosages Ligustici Chuanxiong) 4.5g, Manjingzi ( 㫧㤚ᄤ of others except Xixin are about 9–12 g. Fructus Viticis) 3g. For preparing the decoction: All the above herbs Administration: All the above herbs should first be should first be soaked in a pot of water for 2 hours or soaked in a pot of water for 2 hours or more, and then more, and then placed over a high fire until boiling. placed over a high fire until boiling. Then they are to Then they are to be simmered over a low fire for be simmered over a low fire for 25–30 minutes. 25–30 minutes. Finally, strain the herbal liquid from Finally, strain the herbal liquid from the boiled herbs the boiled herbs to obtain the decoction for oral use. to obtain the decoction for oral use. Drink half in the Drink half in the morning and the other half in the morning and the other half in the evening. evening. Journal of Traditional Chinese Medicine, June 2010, Vol. 30, No. 2 149

Indications: It can be used for Cold Bi (ᆦ⯍ painful Source: Wen Bing Tiao Bian (⯳⮙ᴵ䕼 Systematic arthralgia ⮯⯍) syndrome, marked by heavy and Differentiation of Warm Disease) by Dr WU Ju-tong , painful sensation at fixed location in the back and in 1798. lower extremities accompanied by weakness and Ingredients: Guangfangji ( ᑓ䰆Ꮕ Radix Ari- stiffness, an aversion to cold and attraction to warmth, stolochiae Fangchi) 15g, Xingren (ᴣҕ Semen Pruni palpitation, shortness of breath, or local paresthesia Armeniacae) 15g, Yiyiren (㭣㢵ҕ Semen Coicis or numbness. Amarum) 15g, Cansha ( 㱩≭ Excrementum The author’s experiences: The author usually use this Bombycis Mori ) 9g, Banxia (ञ໣ Rhizoma Pinelliae recipe for chronic rheumatoid arthritis, osteoarthritis, Ternatae) 9g, Lianqiao ( 䖲㖬 Fructus Forsythiae lumbar spondylopathy, sciatica and sequelae of Suspensae) 9g, Zhizi ( ᷔᄤ Fructus Gardeniae poliomyelitis of cold Bi type. Jasminoidis) 9g, Huashi ( ⒥⷇ Talcum) 15g, c) Yiyiren Tang (㭣㢵ҕ∸ Coix Seed Decoction) Chixiaodou˄䌸ᇣ䈚 Semen Phaseoli Calcarati) 9g. for Dampness Bi syndrome. Administration: Decoct the herbs for oral use. Source: Ming Yi Zhi Zhang (ৡएᣛᥠ Displays of Indications: For Heat Bi (⛁⯍ heat arthralgia) Enlightened Physicians) by Dr HUANG Fu-zhong, in syndrome, marked by heat and pain in the joints, 16th century. reduced mobility, fever and shaking chills, a lustreless, yellow complexion, scanty urine, yellow 咏咘 Ingredients: Mahuang ( Herba Ephedrae) 6g. and greasy fur of tongue. Note: In the UK, it is not allowed, for Damp Bi, they The author’s experiences: The author use the recipe may use Mugua (᳼⪰ Fructus Chaenomelis) instead acute rheumatic arthritis, infective arthritis and other of Mahuang. Danggui (ᔧᔦ Radix Angelicae conditions marked by heat-damp Bi syndrome. Sinensis) 9g, Cangzhu (㢡ᴃ Rhizoma Atractylodis) 9g, Yiyiren (㭣㢵ҕSemen Coicis) 24g, Guizhi (Ḗᵱ e) Shu Feng Huo Xue Tang (⭣亢⌏㸔∸ Decoction Ramulus Cinnamomi Cassiae) 6g, Baishao (ⱑ㡡 for Dispersing Wind and Promoting Blood Radix Paeoniae Lactiflorae) 6g, Zhigancao (♭⫬㤝 Circulation) for Blood Stasis Bi syndrome. Radix Glycyrrhizae Praeparatae) 3g. Source: Dong Yi Bao Jian (ϰएᅱ䡈 Precious Mirror Administration: All the above herbs should first be of Oriental Medicine) by Dr XU Sun, a Korean, in soaked in a pot of water for 2 hours or more, and then 1611. placed over a high fire until boiling. Then they are to Ingredients: Danggui (ᔧᔦ Radix Angelicae Sinensis) be simmered over a low fire for 25–30 minutes. 2.5g, Chuanxiong (Ꮁ㡢 Rhizoma Chuanxiong) 2.5g, Finally, strain the herbal liquid from the boiled herbs Weilingxian (࿕♉ҭ Radix Clematidis ) 2.5g, Baizhi to obtain the decoction for oral use. Drink half in the (ⱑ㢋 Radix Angelicae Dahuricae) 2.5g, Hanfangji morning and the other half in the evening. ( ∝䰆Ꮕ Radix Stephaniae Tetrandrae) 2.5g, Huangbai ( 咘ᶣ Cortex Phellodendri ) 2.5g, Indications: It can be used for Dampness Bi (⑓⯍ Dannanxing (㚚फ᯳ Arisaemae cum Bile) 2.5g, fixed arthralgia ⴔ⯍) syndrome, marked by swelling Cangzhu ( 㢡ᴃ Rhizoma Atractylodis ) 2.5g, and pain in the joints (usually of the hands and feet), Qianghuo (㕠⌏ Rhizoma seu Radix Notopterygii) numbness, and difficulty in moving the joints, or 2.5g, Guizhi ( Ḗᵱ Ramulus Cinnamomi) 2.5g, accompanied by fever. Honghua (㑶㢅 Flos Carthami) 1g, Ganjiang (ᑆྰ The author’s experiences: The author use this recipe Rhizoma Zingiberis) 1g. for rheumatic arthritis of dampness Bi type. Administration: Decoct above herbs to make d) Xuan Bi Tang (ᅷ⯍∸ Decoction for Relieving decoction, drink the decoction, half in morning, Bi Syndrome) for Heat Bi syndrome. another half in evening. 150 Journal of Traditional Chinese Medicine, June 2010, Vol. 30, No. 2

Indications: It can be used for Blood Stasis Bi (㸔⯍) Ingredients: Tianma ( ໽咏 Rhizoma Gastrodiae), syndrome, marked by sharp pain in all the joints due Qianghuo (㕠⌏ Rhizoma seu Radix Notopterygii), to Blood stasis caused by wind, dampness and Duhuo (⣀⌏ Radix Angelicae Pubescentis), Duzhong phlegm. Notes: This is a Korean formula. The above (ᴰӆ Cortex Eucommiae), Huainiuxi (ᗔ⠯㝱 Radix dosages are from Japanese sources. According to my Achyranthis Bidentatae), Bixie ( 㧚㾷 Rhizoma own experience, the dosage for each herb should be Dioscoreae Hypohlaucae), Danggui ( ᔧᔦ Radix at 10g. Angelicae Sinensis), Shudihuang ( ❳ഄ咘 Reh- manniae Praeparatae), Xuanshen (Radix Scrop- f) Xin Bi Tang (ᖗ⯍∸ Decoction for Heart Bi hulariae) ⥘খ. Syndrome) for Heart Bi syndrome. Indications: For Bi syndrome marked by Wind Bi Source: The author’s experienced recipe. type accompanied with deficiency of the kidney and Ingredients: Danggui (ᔧᔦ Radix Angelicae Sinensis) blood. 15g, Chuanxiong (Ꮁ㡢 Rhizoma Chuanxiong) 15g, Chishao (䌸㡡 Radix Paeoniae Rubrae) 15g, Ruxiang Administrations: 12 pills each time, 2 times a day. (ч佭 Olibanum) 9g, Lulutong (䏃䏃䗮 Fructus b) Xiao Huo Luo Dan (ᇣ⌏㒰Ѝ Pill for activating Liquidambaris) 15g, Qianghuo (㕠⌏ Rhizoma seu energy flow in the meridian and collaterals) Radix Notopterygii) 9g, Sangjisheng (ḥᆘ⫳ Herba Ingredients: Zhichuanwu ( ࠊᎱР Radix Aconiti Taxilli Chinensis) 15g, Weilingxian (࿕♉ҭ Radix Praeparatae) 180g, Zhicaowu (ࠊ㤝Р Radix Kus- Clematidis) 9g, Yuzhu (⥝ネ Rhizoma Polygonati nezoffii Praeparatae) 180g, Dilong (ഄ啭 Pheretima Odorati) 21g, Tinglizi (㩊㢜ᄤ Semen Lepidii seu Aspergillum) 180g, Zhitiannanxing ( ࠊ໽फ᯳ Descurainiae) 9g, Huangqi (咘㡾 Radix Astragali) Rhizoma Arisaematis Praeparatae) 180, Ruxiang (ч 15g. 佭 Olibanum) 66g, Moyao (≵㥃 Myrrha) 66g. Administration: All the above herbs should first be Administration: Make the above herbs into pills, 3g soaked in a pot of water for 2 hours or more, and then (8 pills ) each time, 1–2 times a day. placed over a high fire until boiling. Then they are to Indications: It can be used for treating Bi syndrome be simmered over a low fire for 25–30 minutes. of cold type or blood stasis type. It can be also used Finally, strain the herbal liquid from the boiled herbs for infertile and dysmenorrhea. Notes: Zhichuanwu to obtain the decoction for oral use. Drink half in the (ࠊᎱР Radix Aconiti Praeparatae) and Zhicaowu morning and the other half in the evening. (ࠊ㤝Р Radix Kusnezoffii Praeparatae) are not The author’s experiences: Since 1985, the author has allowed to use in the UK, because the ingredients used this recipe for rheumatic heart disease of Heart Zhichuanwu and Zhicaowu. Zhichuanwu contain Bi syndrome (mitral stenosis and mitral inc- Wutoujian (aconine) which is highly toxic. So if you ompetence) marked by palpitation, chest stuffiness, make a decoction of the herbs in other countries pectoral pain, shortness of breath, even bluish except the UK, both herbs must be boiled for more discoloration of face, lips and finger nail, cold limbs, than one – two hours until no numbness of the mouth dark red tongue with little coating, faint or hesitant and tongue is felt according to traditional processing pulse. It is effective to relieve symptoms. method, because the long time boiling can change its Wutoujian / aconine into Wutoucijia (sub-aconine) 3) Common Herbal Pills which has just 1–2 % of Wutoujian’ toxin with the 偅亢Ќ a) Qu Feng Wan ( Pills for Dispersing same efficacy. Additionally, when we meet patients Wind) with aconite poisoning, we should give patient Source: Asante Academy of Chinese Medicine, UK Atropine injection and other supporting therapies on Journal of Traditional Chinese Medicine, June 2010, Vol. 30, No. 2 151

time to save our patients. Myalgia) c) Mugua Wan (᳼⪰Ќ Chaenomeles Fruit Pill) Ingredients: Methyl Salicylate ( ∈ᴼ䝌⬆䝃 Metthylsalicylatum), Menthol (㭘㥋㛥 Borneolum), Main ingredients: Mugua ( ᳼⪰ Fructus Camphor (ބ⠛ Camphora), Lemongrass extract (㢌 Chaenomelis), Danggui ( ᔧᔦ Radix Angelicae 佭⍌㝣 Extractum Herbae Cymbopogonis), Bel- Sinensis), Chuanxiong ( Ꮁ㡢 Rhizoma Liguistici ladonna liquid extract ( 乴㣘⌕⍌㝣 Extractum Chuanxiong), Baizhi ( ⱑ㢋 Radix Angelicae Belladonnae Liquidum). Dahuricae), Weilingxian (࿕♉ҭ Radix Clematidis) Gouji (⢫㛞 Rhizoma Cibotii ), Niuxi (⠯㝱 Radix Actions: Dispelling wind, cold and dampness and Achyranthis Bidentatae), Haifengteng (⍋亢㮸 Coulis promoting blood circulation to relieve pains. Piperis Kadsurae), Jixueteng ( 叵㸔㮸 Caulis Indications: Rheumatic arthritis, myalgia and sprain. Spatholobi), Renshen (Ҏখ Radix Ginseng). Administration: External use, plaster it on the Administration: 8 pills each time, 2 times a day. affected area, and then change it within 6–12 hours. Indication: For Bi syndrome marked by numb limbs, Caution: It should be used with care to pregnant pantalgia, debility of loins and legs, dysbasia , etc. d) Er Miao Wan (Ѡ཭Ќ Two Wonderful Ingredients women; but not to the patients with adhesive plaster Pill) allergy and local ulceration. b) Gou Pi Gao (⢫Ⲃ㝣 Dog-skin Plaster) Ingredients: Huangbai (咘ᶣ Cortex Phellodendri), Cangzhu (㢡ᴃ Rhizoma Atractylodis) Main Ingredients: ngpi ( 䴦Ⲃ Pericarpium Citri Reticulatae Viride), ngxiang (ϕ佭 Flos Caryophylli), Indications: For Bi syndrome of damp-heat type. uanxiong (Ꮁ㡢 Rhizoma Chuanxiong), nggui (ᔧᔦ Administration: 8 pills each time, 3 times a day. Radix Angelicae Sinensis), Qianghuo (㕠⌏ Rhizoma 㝄Ќ Pill for seu Radix Notopterygii), Dafengzi (໻ᵿᄤ Semenعe) Shu Jin Jian Yao Wan (㟦ㄟ Relieving Rigidity of Muscle and Tendon and Chaulmoograe), Tianma (໽咏 Rhizoma Gastrodiae), Strengthening Loins) Duzhong (ᴰӆ Cortex Eucommiae). Ingredients: Jinyingzi ( 䞥 ᄤ Fructus Rosae Actions: Expelling wind and dispersing cold, relaxing Laevigatae), Jixueteng (叵㸔㮸 Caulis Spatholobi), muscle and tendons, promoting blood circulation Qianjinba (ग᭸ᢨ Radix Flemingiae Philippiensis) and alleviating pain. Heilaohu 咥㗕㰢( Radix Kadsurae Coccineae), Indications: Bi syndrome due to wind, cold and Fengmi ( ዄ㳰 Mel), Ruxiang ( ч佭 Olibanum), dampness, pain of loins and lower extremities, Niudali ( ⠯໻࡯ Radix Millettiae Speciosae ), numbness of limbs and trunk, traumatic injuries. It Sangjisheng (ḥᆘ⫳ Herba Taxilli), Tusizi (㦳ϱᄤ can be used to treat rheumatalgia, neuralgia, and Semen Cuscutae), Nuzhengzi ( ཇ䋲ᄤ Fructus redness, swelling and pain caused by sprain, etc. Ligustri Lucidi), Yanhusuo ( ᓊ㚵㋶ Rhizoma Administration: Warm it soft and then apply it to the Corydalis), Liangmianzhen ( ϸ䴶䩜 Radix affected areasˈ change it every 6–12 hours. Zanthoxyli). Indications: for Bi syndrome. Life Style and Diet Advice Administrations: 12 pills each time, 2 times a day. 1. Living Environment: The ancient Chinese ‘Fengshui’ method is the theory and art which studies 4) External Treatment how to establish an ideal environment beneficial to a) Shang Shi Zhi Tong Gao (Ӹ⑓ℶ⮯㝣 Adhesive prolonging life as well as preventing and treating Plaster for Relieving Sprain, Rheumatalgia and diseases including Bi syndrome. It is the com- 152 Journal of Traditional Chinese Medicine, June 2010, Vol. 30, No. 2

prehensive theory of ancient architectural planning physical exercise, such as Taiji and Qi Gong. Taiji is and design integrating geography, ecology, arch- more of a slow type of exercise type, very useful to itecture, ethics and aesthetics etc. According to patients with Bi syndrome. While Qi Gong is a kind Fengshui, people should live at a place with clear and of exercise for self-developing Qi Energy (including plentiful water source, fresh air, sufficient sunlight, natural body’s defensive qi). good vegetation as well as quiet, secluded and References beautiful landscape. Because wind, cold and dam- 1. Zhu M. The Medical Classic of the Yellow Emperor pness are the main factors to cause Bi syndrome, we (English edition). Foreign Language Press; 2001, 2005. should suggest patients with Bi syndrome to live in 2. Dan Bensky, Randall Barolet. Chinese Herbal Medicine the environment which is full sunlight, less wind, Formulae & Strategies. Eastland Press, U.S.A; 1990. cold and dampness. 3. Zhang EQ. A Practical English-Chinese Library of TCM. 2. Physical Exercises: TCM has many type of Shanghai TCM University Press; 1990: 4.