Chapter Sixteen. Syndromes caused by external wind, damp, cold or heat and formula composition
CHAPTER OUTLINE
This chapter introduces the principles, methods and strategies for the composition of formulas that expel exterior wind, damp, cold and heat from the skin, subcutaneous region, meridians and collaterals. They are used to treat Bi syndrome, Wei syndrome and certain skin disorders.
Syndromes caused by external wind, damp, cold or heat
Manifestations
Main symptoms
Pain of the body and headache, which worsen in cold, humid and windy weather; tingling, heavy, swollen, stiff and numb limbs and joints; swelling of joints with a red color and a warm or burning sensation; weakness of muscles and joints, difficulty with moving and walking for a long period of time; facial paralysis or facial spasm; skin disorders that are characterized by itchy, weeping, red skin lesions that are influenced by changes in the weather.
Secondary symptoms
Weakness, stiffness and numbness of muscles and joints and deep pain in the bones, which lead to difficulty in moving and walking; recurrent skin disorders.
Tongue
Purple or bluish tongue with a white coating, or pale and flabby with a white coating.
Pulse
Wiry or tight, weak or thready.
Associated disorders in western medicine
Rheumatic arthritis, rheumatoid arthritis, cervical or lumbar spondylosis, osteoarthritis, sciatica, Raynaud’s disease, vasculitis, pulmonary heart disease, rheumatic heart disease, coronary heart disease, migraine, hemiplegia after cerebrovascular accident, paralysis, facial paralysis, facial spasm, skin diseases that are influenced by changes in the weather and are characterized by itchy, weeping, red or dry skin lesions.
Analysis of the syndrome
The exogenous pathogenic wind, dampness, cold or heat can cause different syndromes, such as Bi syndrome (painful obstruction syndrome), Wei syndrome (weakness of muscles and paralysis) and skin diseases. They are often seen in cold, humid and windy places, among people who are weak in Defensive-Qi due to poor constitution or a weakened health condition.
• As soon as pathogenic wind, cold or heat, and dampness invade the body and have passed the superficial region, they may obstruct the Qi movement and blood circulation in the meridians and collaterals, and cause pain of associated muscles and joints in the related regions.
• If wind is predominant, the symptoms show a moving feature, such as pain migrating from one place to another, tingling, spasm and twitch of muscles and itch of skin.
• In conditions where cold is predominant, pain is severe and worsens in cold weather.
• If dampness is predominant, the symptoms show a heavy and lingering feature – for example, chronic heaviness and swelling of limbs and joints, chronic itchy and weeping skin disorder.
• If damp-heat invades the body, or is transformed from stagnation of other pathogenic factors, it may obstruct the meridians and cause swelling of the joints with a red color and a warm or burning sensation, and red and weeping skin lesions.
When the pathogenic factors have remained in the body for a long period of time, deficiency of the Kidney, Liver, Qi and blood may coexist with the exogenous pathogenic factors.
• When the muscles and joints are not nourished and supported by Qi and blood, they become weak, stiff and numb, and the skin disorders become recurrent and chronic.
• If the Kidney and Liver are injured, patients will suffer from stiffness of the joints and deep pain in the bones, which lead to difficulties with moving and walking.
• A purple, bluish tongue and a wiry or tight pulse indicate the heaviness of the obstruction; a pale, flabby tongue and a weak, thready pulse indicate the deficiency. A yellow and moist tongue coating and a rapid pulse indicate the existence of wind, damp and heat.
(See Figure 16.1 on page 345.)
Treatment principle: Expel exogenous pathogenic factors, promote Qi and blood circulation, tonify the Kidney and Liver, and tonify Qi and blood
Herb selection principles and formula composition strategies
First priority
• If wind, dampness and cold invade the skin, muscles and meridians, it is important to select pungent, bitter and warm herbs that enter the Bladder, Liver and Kidney meridians, and can directly expel wind, dampness and cold.
• If wind, dampness and heat invade the skin, muscles and meridians, it is important to select pungent, bitter and neutral herbs to expel wind-dampness along with cold herbs to clear heat.
Second priority
• Select herbs that promote blood circulation, open up the meridians and collaterals, and remove the obstructions of stagnant blood, dampness and phlegm.
Third priority
• Select herbs that nourish the Yin and blood, tonify the Qi and warm the Yang in order to establish body resistance.
• For treating chronic conditions, herbs that tonify the Kidney and Liver, break up congealed blood and invigorate the collaterals are selected.
CAUTIONS
1. Pay attention to the conditions of Yin, blood and body fluids:
Because the herbs that expel wind, damp and cold are mostly warm, pungent and bitter, and have a drying nature, they should be used with caution in patients who suffer from deficiency of Yin, blood or body fluids.
2. Caution when using toxic herbs:
Although herbs that expel wind, damp and cold have very good results in alleviating pain and relieving the suffering of patients, some of these are toxic and overdose may lead to poisoning and even death. As toxicity is influenced by the growing habitat of the herbs, the processing method and the patient’s sensitivity, this may vary greatly. Another feature is that the toxic dose is very close to the therapeutic dose, thus the dosage and therapeutic duration should be controlled carefully.
Structure of the formula and selection of the herbs
Chief: Directly expel wind-cold-dampness or wind-damp-heat
Qiang Huo ( Notopterygii rhizoma) and Du Huo ( Angelicae pubescentis radix)
Qiang Huo and Du Huo are commonly used to expel wind, dampness and cold from the body and to treat Bi syndrome. They are often used together to treat pain, heaviness, stiffness, tingling sensations and numbness of the affected regions of the body.
Qiang Huo is pungent, bitter and warm. It enters the Bladder meridian primarily and the Liver and Kidney meridians secondly. Its pungent and warm nature gives Qiang Huo strong dispersing and ascending abilities. It is very effective and quick in expelling wind, dampness and cold in the superficial regions of the body such as the skin, subcutaneous region and muscles, especially in the upper half of the body. It is suitable for selection as chief in the formula for treating general pain, headache and stiffness of the back.
Du Huo is also pungent, bitter and warm, but much gentler in nature than Qiang Huo. It enters the Kidney meridian and is especially effective in eliminating wind, dampness and cold from the deeper regions of the body, particularly the lower half. Because of its nature, Du Huo eliminates pathogenic factors from the body in a more constant and gentle way. It is more suitable for chronic cases of arthritis and other disorders of the muscles and joints when patients complain that the pain is deep in the bones and joints. Because it enters the Kidney meridian and treats Bi syndrome, Du Huo is more effective for treating disorders of the knees, back and heels.
Comparing their function, Qiang Huo is warmer and has better results in eliminating cold and relieving pain; Du Huo is more effective in eliminating damp and has better results in treating heaviness and numbness of the body and joints. Qiang Huo and Du Huo are often used together to expel the wind, dampness and cold in the entire body and in acute, sub-acute and chronic conditions.
Fu Zi ( Aconiti radix lateralis preparata)*, Chuan Wu ( Aconiti carmichaeli radix)*, Cao Wu ( Aconiti kusnezoffii radix)*, Xi Xin ( Asari herba)*, Wei Ling Xian ( Clematidis radix) and Gui Zhi ( Cinnamomi cassiae ramulus)
These six herbs are effective for treating Bi syndrome as a result of cold. They are very hot and pungent, and have strong ascending and dispersing abilities. They can strongly disperse wind, cold and dampness, intensively warm the meridians, accelerate the movement of Qi and blood, and thus effectively relieve pain.
Fu Zi enters the Heart, Spleen and Kidney meridians. It is swift and violent in its action of spreading warmth, scattering cold, drying dampness and warming the meridians. Because of its strength, it is considered a herb that enters the 12 regular meridians. It is used as chief to treat Bi syndrome, especially when cold is predominant with symptoms of severe cramping pain.
Chuan Wu and Cao Wu have functions similar to those of Fu Zi but they are stronger in expelling cold and warming the interior. They are also stronger in opening the meridians and stopping pain. They are suitable to treat Bi syndrome when wind and cold are predominant.
Xi Xin is very pungent and warm, and enters the Lung, Heart and Kidney meridians. Its pungent and aromatic smell gives it a penetrating ability, allowing it to enter the deeper regions of the body. No matter how deep the wind and cold invade, and how tight the tissues may be, Xi Xin is very effective in eliminating them and opening the meridians and collaterals, thereby alleviating pain. It is often selected as chief when the pain is severe and deep in the bones, accompanied by a purple or bluish tongue with a white coating, and a deep, slow and wiry pulse. They indicate that cold is predominant and has entered the Kidney meridian.
Wei Ling Xian is pungent, salty and warm, and enters the Bladder meridian. It has dispersing, moving and opening abilities. It moves very quickly and has quite a strong action of expelling wind and transforming dampness. Wei Ling Xian is very effective in opening up the meridians and collaterals, and it can treat numbness and tingling sensations of the limbs.
Gui Zhi is pungent, sweet and warm, and enters the Heart, Lung and Bladder meridians. Unlike Fu Zi, which spreads the warmth quickly, and unlike Xi Xin, which expels cold from deep regions, it expels wind and alleviates pain by warming the meridians, activating and tonifying the Heart-Yang, promoting the blood circulation and relaxing the tendons. It has a sweet taste, which makes this herb move more slowly than the others, but since it can tonify the Heart and its action lasts longer, the condition of the patients can be improved steadily.
Except for Gui Zhi, these herbs are poisonous, especially Cao Wu. They must be used after processing, and even then the dosage must be controlled carefully. Large dosage or long-term use may consume the Yin and further injure the Yang, especially when the Yang of the internal organs is weak. Again except for Gui Zhi, these herbs are pungent and hot, move quickly and recklessly, and can consume the Qi and Yin. They can improve the condition of patients quickly but briefly. For these reasons, it is recommended that some sweet and warm herbs can be added to the formula to tonify the Qi and Yin in order to reduce the side effects of these harsh herbs.
Huang Bai ( Phellodendri cortex) and Yi Yi Ren ( Coicis semen)
These two herbs are usually used for Bi syndrome caused by wind, dampness and heat. They are also selected for treating some skin disorders caused by damp-heat.
Huang Bai is bitter and cold, and enters the Kidney and Bladder meridians. It can dry dampness and reduce heat in the Lower-Jiao. It is suitable for use when the joints in the lower part of the body are red, warm and swollen and the skin lesions are red, itchy and weeping.
Yi Yi Ren is sweet, bland and slightly cold, and enters the Spleen, Stomach and Lung meridians. This herb can eliminate dampness, promote urination and clear heat. It is suitable for use when the joints are swollen with a burning sensation and the skin lesions are red, itchy and weeping.
Sang Zhi ( Mori ramulus), Luo Shi Teng ( Trachelospermi caulis) and Xi Xian Cao ( Sigesbeckiae herba)
These herbs are usually used to treat Bi syndrome caused by wind, dampness and heat.
Sang Zhi is bitter and neutral, and enters the Liver meridian. It is the twig of the plant, and can open the meridians and expel wind and dampness. It is particularly selected when edema and cramp of the limbs are present.
Xi Xian Cao is pungent, bitter and cold, and enters the Liver and Kidney meridians. It enters the deep regions of the body, the tendons and the bones. It searches out and expels wind, dampness and heat. It is selected when a Bi syndrome is at the active stage and the joints are swollen and painful with a burning sensation. Moreover, it can eliminate wind-dampness and treat heaviness and numbness of the limbs. Because it enters the Liver and Kidney meridians, Xi Xian Cao is especially effective in treating weakness and stiffness of the knees and back, pain of the bones, numbness and a tingling sensation of the limbs.
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