Wei Syndromes

The wei syndrome is characterized by flaccidity or atrophy of the limbs with motor impairment . It is also called flaccid lame , for the leg is usually involved . The wei syndrome was first described in Chapter 44 of Plain Questions as a syndrome mainly caused by heat in the lung with the lobes scorched . The physicians of later generations further developed this theory . Zhang Jingyue ( 1156 - 1228 A . D . ) pointed out , It is not a few cases of wei syndromes that are due to the injury of primary qi leading to deficiency of essence which fails to irrigate , or deficiency of blood which fails to nourish .

On the treatment of wei syndromes , Chapter 44 of Plain Questions puts forward the theory : Only points along the Yangming Meridians are selected in treating wei syndromes . The stomach is believed to be the sea of water and food , and the source of acquired essence . The Foot - Yangming Meridian is enriched with qi and blood . The twelve meridians , tendons , bones , and muscles need the acquired qi and blood for nourishment , while the production of blood in the liver and essence in the kidney depends upon the transformation of water and food . Therefore , regulating the function of the Stomach Meridian of Yangming is the main principle in treating the wei syndromes . In clinical practice , treatment is determined according to differentiation of the syndrome as well as locality , etiology and pathogenesis of the disease . In a chronic bi syndrome there may be prolonged motor impairment of the joint because of pain . In this case there develops muscular atrophy or flaccidity of the limb on account of disuse . It should be differentiated from the wei syndrome which is characterized by absence of pain .

Etiology and Pathogenesis

Burning heat in the lung :

The muscular flaccidity or atrophy of the limb results from nourishment of the tendons due to exhaustion of body fluid . This condition may be caused by invasion of the lung by exogenous pathogenic heat , or excessive heat remaining in the lung after an illness .

Damp heat :

Exogenous pathogenic damp invades in the body , and the accumulation of damp is eventually transformed into heat which damages the muscles and tendons . Hence , the muscles and tendons become flaccid . The wei syndromes may also be caused by excessive intake of greasy food which produces internal accumulation of damp - heat , resulting in stagnation of qi and blood in the meridians and collaterals .

Deficiency of yin in the liver and kidney :

Since the liver stores blood and controls the tendons , and the kidney stores essence and dominates the bones' prolonged illness or indulgent sexual activity causes loss of essence and blood , resulting in malnutrition of the tendons . Conditions affecting the proper function of the liver and kidney may therefore also give rise to the wei syndrome .

Trauma :

Contusion causes injury of the meridians and leads to retarded flow ofqi and blood in the meridians . As a result , the muscles and tendons are poorly nourished , and become flaccid . Thus occurs the wei syndrome .

Differentiation

Heat in the lung :

Main manifestations : Muscular flaccidity of the lower limbs with motor impairment , accompanied by fever , cough , irritability , thirst , scanty and brownish urine , reddened tongue with yellow coating , thready and rapid or rolling and rapid pulse .

Analysis : Fever and cough are the results of the invasion of the lung by the pathogenic heat . Irritability , thirst and scanty , brownish urine indicate that the body fluid has been damaged by the internal heat . Muscular flaccidity and motor impairment result from malnutrition of the tendons and muscles and damage of essence and body fluid . The thready , rapid pulse and reddened tongue with yellow coating indicate that the body fluid has been injured by heat . The rolling , rapid pulse is associated with excessive heat .

Damp heat :

Main manifestations : Flaccid or slight swollen legs , a little hot sensation on touch , general heaviness , sensation of fullness in the chest and epigastric region , painful urination , hot and brownish urine , yellow sticky tongue coating , soft and rapid pulse .

Analysis : Flaccidity of the legs is due to the stagnation of qi and blood in the tendons and muscles caused by prolonged accumulation of internal damp - heat . General heaviness is also due to accumulation of damp - heat . When damp - heat is accumulated in the chest , fullness sensation in the chest and epigastrium results . Hot , brownish urine , and painful urination suggest the downward flow of damp heat . Yellow sticky tongue coating , and soft rapid pulse are signs of damp - heat .

Deficiency of yin of the liver and kidney :

Main manifestations : Muscular flaccidity of the lower limbs with motor impairment , combined with soreness and weakness of the lumbar region , seminal emission , prospermia , leukorrhoea , dizziness , blurring of vision , reddened tongue , thready and rapid pulse .

Analysis : In deficiency of yin of the liver and kidney the muscles , tendons and bones are poorly nourished essence and blood , and hence occurs muscular flaccidity with motor impairment . Soreness and weakness of the lumbar region , seminal emission and leucorrhoea are the result of deficiency of essence in the kidney . Since the kidney is located in the lumbar region , it stores essence , and its meridians connect with the Chong Meridian and the Ren Meridian . Dizziness and blurring of vision are caused by preponderance of yang in the liver arising from deficiency of yin in the kidney . Reddened tongue , thready and rapid pulse are signs of deficiency of yin of the liver and kidney .

Trauma :

Main manifestations : History of trauma , flaccid paralytic limbs , may be accompanied with incontinence of urine and feces , relaxed or hesitant pulse , pink or dark purplish tongue with thin white coating .

Analysis : Flaccid paralytic limbs arise from obstruction of the circulation of qi and blood at the injured site of trauma . Incontinence of urine and feces is mainly due to dysfunction of the kidney which fails to control urine and feces . In case of trauma , the Du Meridian which dominates the yang qi of the whole body is affected , and the qi activity of all zang - fu organs may be impaired , including the function of the kidney in controlling urine and feces . Damage of qi of the kidney causes incontinence of urine and feces . Hesitant pulse and dark purplish tongue indicate blood stasis .

Treatment

Method : Main points are selected from the Yangming Meridians to promote circulation of qi in the meridians , and to nourish the tendons and bones . If heat or damp heat in the lung is the main etiological factor , the reducing method should be used to dissipate heat . In case of deficiency of yin in the liver and kidney , the reinforcing method should be employed . For trauma , puncture the points on the affected side with even movement . Prescription :

Upper limb : Jianyu ( LI 15 ) , Quchi ( LI 11 ) , Hegu ( LI 4 ) , Waiguan ( SJ 5 ) .

Lower limb : Biguan ( S 31 ) , Huantiao ( G 30 ) , Xuehai ( Sp 10 ) , Liangqiu ( S 34 ) , Zusanli ( S 36 ) , Yanglingquan ( G 34 ) , Jiexi ( S 41 ) , Xuanzhong ( G 39 ) . Supplementary points :

Heat in the lung : Chize ( L5 ) , Feishu ( B 13 ) . Damp heat : Pishu ( B 20 ) , Yinlingquan ( Sp9 ) .

Deficiency of yin in the liver and kidney : Ganshu ( B 18 ) , Shenshu ( B 23 ) .

Trauma : Huatuojiaji points at the corresponding level of spinal injury .

Incontinence of urine : Zhongji ( Ren 3 ) , Sanyinjiao ( Sp 6 ) .

Incontinence offeces : Dachangshu ( B 25 ) , Ciliao ( B 32 ) .

Explanation : In the above prescription points the Yangming Meridians are predominating . This is based upon the statement in Internal Classic : Only points along the Yangming Meridians are selected to treat paralysis of the limbs . Yanglingquan ( G 34 ) and Xuanzhong ( G 39 ) , the Influential Points of tendon and marrow respectively , are added to enhance the effect of nourishing the tendons and bones . Feishu ( B 13 ) and Chize ( L 5 ) are used to dissipate heat from the lung . Pishu ( B 20 ) and Yinlingquan ( Sp 9 ) eliminate damp heat . Ganshu ( B 18 ) and Shenshu ( B 23 ) are chosen to tonify the yin in the liver and kidney . Huatuojiaji points are selected to regulate qi in the Du Meridian . Zhongji ( Ren 3 ) and Sanyinjiao ( Sp 6 ) are taken to adjust the qi in the kidney and bladder . Dachangshu ( B 25 ) and Ciliao ( B 32 ) improve the function of the large intestine .

Remarks

The wei syndrome is seen in acute myelitis , progressive myatrophy , myathenia gravis , multiple neuritis , sequellae of poliomyelitis , periodic paralysis , hysterical paralysis , traumatic paraplegia , etc .

Since the wei syndrome needs a long period of treatment , the patients should cooperate with the doctor during the treatment . Tapping with subcutaneous needles in the affected areas and along the affected meridians may also be added to the treatment .