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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.

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Only on movement of joint on affected side in late stage. 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. Sometimes myoatrophy with failure of movement. Spasm or convulsion or numbness or even pain. Xu Long Gradual onset Develops from Shi type or seen in patients with poor constitution or long lingering disorder. tendons and blood vessels. no deficiency of zang-fu. the tendons and bones are deprived of nourishment. pain of joint or wandering pain. cold. At late stage rigidity swelling and deformity of joints. 4 extremities seriously weak. Location Pain In general no pain. In a few cases pain appears on pressure eg early stage of infantile paralysis 2 . Mainly in muscles. No significant atrophy of muscles. Weakness of limbs or failure of movement. No endogenous factor. Local pain. resulting in atrophy. The KID stores Jing (the material base maintaining normal physiological activity of the zang-fu) and controls bones. deformity of hand and foot (wrist and ankle joints mainly) on affected side. difficulty in flexing and extending. Symptoms only involve joints and surrounding muscles.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. Wei syndrome is broadly classified as of Shi and Xu types. Hemiplegia. significant emaciation or myoatrophy. Bi Only exogenous factors including wind. Windstroke Hyperactivity of LIVYang or upward disturbance of LIV-Wind or retention of phlegmdamp. Soreness and pain of joints. and it is important to differentiate between them. gradual appearance of myoatrophy at late stage. 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. eg in infantile paralysis pain can be observed in the early stage. whilst the LIV stores blood and controls tendons. Movement free on healthy side. As a result of KID and LIV Xu. damp and heat.

Sore throat is due to heat in the LU channel which passes through the throat. Tongue: body red. Pathology: Invasion of LU and ST by pathogenic heat consumes yin fluid which fails to nourish muscles. *Editor's note: 1) (T) indicates reinforcing method. 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). cough. Yin Xu leads to hyperactivity of fire . here used both to eliminate heat in ST and as a local point for the limbs. 3 .(T) ST-45 to eliminate heat in Yangming channels.(⊥) ST-34 Xi-Cleft point.(⊥) LU-5 to reduce and cool LU. Pulse: thready and rapid. Retention of pathogenic heat in the LU interferes with dispersing function therefore cough.in this case the HE is affected therefore restlessness. Treatment principle: Clear heat and moisten LU. dry stool.(⊥) 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. urine yellow and concentrated. 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. (⊥) indicates reducing method. to tonify yin of KID. used for acute disorders. BL-13 to clear heat in LU. LU fails in supplying fluid to moisten skin (LU dominate skin) therefore dry skin.(⊥) The above prescription can be used to treat infantile paralysis or myelitis.(T) SP-6 to tonify yin.(T) KID-3 to promote water. 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 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. fur yellow. Dispersing Du-14 will eliminate heat. dryness of throat.

SP-9 to strengthen SP and eliminate damp (⊥).-11. sallow and withered complexion. Hegu (L. GB-31: used for weakness of lower extremities. 4 . Treatment principle: Tonify SP and strengthen ST. weak and forceless. fever may be observed but not high. strengthen muscles and bones. Invasion by damp-heat leads to slight swelling and numbness.I. These three points must be punctured two or even three times a day. Pathology: Xu of ST and SP results in poor appetite. Retain needles for over 30 minutes and manipulate every 5 to 10 minutes. L. Quchi (L. ST-36 to strengthen SP and ST to eliminate damp (T).I. Yinlingquan (SP-9) .I.JOURNAL OF CHINESE MEDICINE NUMBER 10 MAY 1982 2) Invasion of pathogenic damp-heat: Clinical manifestations: Weakness and relaxation of the lower extremities. Weakness of SP and ST and subsequent failure to produce sufficient qi and blood gives rise to facial pallor. Loose stool is due to Xu of SP . yellow urine. Pulse: thready. loose dilute stool. Tongue: flabby and tooth-printed with thin white fur.-4). Femur-Futu (ST-32). can also be used for infantile paralysis or sequelae of wind-stroke (use even manipulation) . 3) Weakness of ST and SP: Clinical manifestations: Little food intake. 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. Explanation of prescription: Du-14. Stool may contain semi-digested or undigested food. Fengshi (GB-31).I. L. Retention of damp-heat internally leads to stuffiness in chest and epigastric region.-11). stuffiness in chest and epigastric region. in some cases slight swelling and numbness of the lower extremities.-4: this is a routine prescription used to eliminate heat and is here used to eliminate damp-heat (⊥). Zusanli (ST-36). Treatment principle: Eliminate damp and heat. ST-32.fluid which descends to the large intestine. Prescription: Dazhui (Du-14).SP fails to transform.

Mingmen (Du-4).JOURNAL OF CHINESE MEDICINE NUMBER 10 MAY 1982 Prescription: Pishu (BL-20). Add Fengchi (GB-20) and Zanzhu (BL-2) in case of dizziness and vertigo. 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. also appearing at late stage of other Wei syndromes. Biguan (ST-31). SP-3 Yuan-Source point of the SP channel (T) . (T) REN-4 a point where original yin and original yang gather (ie KID-Yin and KID-Yang). nocturnal emission. Taibai (SP-3). Tongue: red body. KID-3 to strengthen KID. Du-4 treat with needle only if KID-Yin-Xu symptoms are present (T). REN-12: combine Front-Mu and Back-Shu points of ST and SP in two groups and use in alternate treatments (T). Yanglingquan (GB-34) Taixi (KID-3) Guanyuan (REN-4). Zhangmen (LIV-13). incontinence of urine and enuresis. atrophy of muscles especially of dower extremities. ST-31 to help the movement of the thigh by tonifying tendon and bone. blurring of the vision. BL-21. soreness of the lumbar region. All the above points may be treated with needling combined with moxibustion. Shenshu (BL-23). LIV-13. BL-23 to strengthen LIV and KID (T). Zhongwan (REN-12). Prescription: Ganshu (BL-18). To strengthen function of the SP in transportation and transformation. 5 . Used to treat either KID-Yin-Xu or KID-Yang-Xu (T). In syndromes 1) and 2) moxibustion is contra-indicated. 4) Xu of LIV and KID: Clinical manifestations: Gradual onset. little fur. Add Tinghui (GB-2) in case of tinnitus. Often used for weakness and atrophy of legs with the above points. Treatment principle: Tonify LIV and KID. to aid the effect of the above four points (T). Weishu (BL-21). Du-3 the only point of the Du channel used for the lower extremities. Pulse: deep and thready. Explanation of prescription: BL-20. Zusanli (ST-36). ST-36 general tonic point. vertigo. Yaoyangguan (Du-3). Explanation of prescription: BL-18. tinnitus. use moxibustion if KID-Yang-Xu. frequently selected for loose stools containing undigested food. GB-34 controls tendons (T).

but it may involve the upper extremities or even the throat. In case of vomiting and diarrhoea add Neiguan (P-6) Tianshu (ST-25) Zusan]i (ST-36). Shixuan (all Extra points). prolonged treatment may be necessary. This most]y involves the dower extremities. Usually occurs in late summer/early autumn.-11). Ear]y paralysis can affect any part of the body. in some cases one and in some cases both limbs.nd massage. In the ear]y stage there may be pain. and may complain of stiffness of the nape or soreness of the back and loins. If the bladder is affected there will be incontinence or retention of urine. In the later stage the latter two syndromes are usually seen.1. 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.I. 6 . In China treatment is given daily or every other day. At the onset continuous high fever is seen accompanied by discomfort. In a very few patients there may be coma. in courses of ten treatments. using for example: Dazhui (Du-14) Waiguan (SJ-5) Hegu (L. There may be spasm of the leg and in some cases vibration of the 4 extremities. muscles and jingluo are finally deprived of nourishment.POLIOMYELITIS This is also classified as Wei syndrome. paralysis can be observed. The earlier the condition can be treated. 1 to 6 days after subsidence of fever. It is frequent]y seen in children aged 3 to 5 years but can occur in adults.-4). It is rare to see the upper limbs affected or the upper and dower limbs of both sides. In case of high fever add Quchi (L. Children are restless if covered with heavy bedclothes. with the dower extremities being the most common. INFANTILE PARALYSIS . There is no pain in the later stage when paralysis is evident. dislike being touched. Treatment: In the early stage treat to disperse exogenous pathogenic factors. If there is paralysis of the abdominal muscles there will be ballooning of the abdomen when children cry. In case of convulsion and coma treat these as priority eg convulsions: Yintang. Taiyang. and frequently with gastrointestinal symptoms and cough. Occasionally the face may be paralysed. Aetiology: Invasion of toxic pathogenic heat injures the jingluo causing obstruction of jingluo and stagnation of qi and blood. In addition to acupuncture treatment. "as wei syndrome requires a long period of treatment. it is necessary to win the patient's co-operation and confidence". functional exercises are generally recommended as wel I as physiotherapy . a]] over the body. with inability to turn over in bed. Sifeng.. Eventually there occurs atrophy of the muscles and serious deformity. with difficulty in swallowing. convulsions and even sudden death. especially pain on pressure.JOURNAL OF CHINESE MEDICINE NUMBER 10 MAY 1982 The first two syndromes are seen in the early stage of Wei syndrome. Tendons. and in some cases many courses are required. As the "Essentials" says.

Paralysis of nape: Tianzhu (BL-10). Hegu (L.-4) and HuatuoJiaji points of the 5th to 7th cervical vertebrae.I. Treatment of paralysis: Principle: In the early stage remove obstruction of jingluo by activating circulation of qi and blood. insufficient strength to chew food. Zusanli (ST-36). Poor results are obtained after 2 to 3 months.JOURNAL OF CHINESE MEDICINE NUMBER 10 MAY 1982 coma: Renzhong (Du-26).-4). Divide prescription into two groups and use alternately.-9). Jiexi (ST-41). Zanzhu (BL-2) Sizhukong (SJ-23) Yanglao (S. Paralysis of upper limbs: Dazhui (Du-14) Jianyu (L. Shenshu (BL-23).I.-11).I. Huantiao (GB-30). In treating later than this use points such as Ganshu (BL-18). usually in children. In the late stage tonify LIV and KID and warm up jingluo. The earlier treatment for infantile paralysis is given the better the therapeutic results. Qiuxu (GB-40). Zusanli (ST-36). Femer-Juliao (GB-29). Yanglingquan (GB-34).6). upper eyelids droop down. Shixuan. inability to speak clearly. with a strong nasal sound. Hegu (L.-4).I. Tianrong(S.l. treat once daily with no retention of needles. 2) Main symptom is difficulty in swallowing especially on eating and drinking.-15). Shenshu (Du-12). Hegu (L.I.I.I. Taixi (KID-3). Tianzong (S. usually there is double vision. Kunlun (BL-60). Taichong (LIV-3). Treatment: Yangbai (GB-14) through to Yuyao (Extra). In case of facial paralysis use routine points. HuatuoJiaji points of 1st to 5th lumbar vertebrae. Biguan (ST-31). Waiguan (SJ-5). Xuanzhong (GB-39). Paralysis of lower limbs: Yaoyangguan (Du-3). Treat respiratory symptoms such as cough or dyspnoea according to clinical manifestations.-17) Paralysis of abdominal muscles: Zhongwan (REN-12) Tianshu (ST-25) Qihai (REN-6) Daheng ( SP-15). Fengshi (GB-31). Jianzhen (S. 7 . frequently seen in clinic. 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.

Treat once daily in early period of myasthenia gravis and every other day in chronic cases. 3) Develops from first two syndromes or seen at onset. Xiaguan (ST-7). Jiache (ST-6). (GB-20). 8 . Tongli (HE-5).-18) Tiantu (REN-22). Fengchi.I. involves weakness of muscles usually around joints.JOURNAL OF CHINESE MEDICINE NUMBER 10 MAY 1982 Treatment: Neck-Futu (L. This prescription may also be used for difficulty in swallowing due to epilepsy. Zusanli (ST-36). Treatment: Use points similar to those used to treat upper and lower extremities in infantile paralysis.