Rheumatism (2nd Edition) (Specialty and Specific Diseases, Famous Doctors' Clinical Experience Series)

Author: Tao Xiaohua / Country: Mainland China
Publisher:
Publish Date: 2006-07-14
Features:
10. Xie Haizhou's Diagnostic and Treatment Experience (1) Emphasizing the Removal of Pathogenic Factors, Especially Dampness, and Not Neglecting External Pathogens in Treating Bi Syndrome: Bi syndrome is caused by the invasion of wind, cold, and damp pathogenic factors into the human body, leading to impaired blood and Qi circulation. Regardless of whether it is cold, heat, or wind bi syndrome, dampness is often involved. Treatment should focus on dispelling wind, dispersing cold, and eliminating dampness. However, wind can dissipate quickly, cold can be removed by warmth, but dampness is difficult to eliminate rapidly. Dampness not only plays a significant role in the onset, progression, and resolution of bi syndrome but is also one of the reasons for its chronicity. Clinically, symptoms such as joint swelling and pain, aching and heavy sensation in the joints, and difficulty in flexion and extension are common. Xie emphasizes regulating the metabolism of body fluids and ensuring smooth Qi flow. He adopts methods such as ventilating the lungs, regulating the spleen, and warming the kidneys, with a priority on regulating the spleen, as strengthening the spleen eliminates the source of internal dampness. For example, when treating rheumatoid arthritis with symptoms of hand swelling and pain, Xie often uses up to 45g of raw coix seed, reflecting the idea of strengthening the spleen to eliminate dampness. Depending on the location of the dampness, sweating is recommended if it is above, and diuresis if it is below, to provide an outlet for the pathogen. In terms of pathogenesis, Xie believes that dampness often combines with cold, and treatment should lean toward warming and resolving dampness. Additionally, the recurrence and chronicity of the disease are often related to external pathogens. Many bi syndrome patients exhibit red and swollen throats, which should not be underestimated. In such cases, herbs like belamcanda chinensis, scutellaria baicalensis, menispermum dauricum, and isatis indigotica may be added. If the external pathogen is pronounced and the throat is severely swollen, treating the symptom immediately can help control the condition and improve efficacy. For individuals with superficial deficiency, who often develop bi syndrome due to weak exterior defense, treatment should combine consolidating the exterior with dispelling wind and dispersing cold. The formula Yu Ping Feng San (Jade Screen Wind Screen Decoction) is often modified for this purpose.
(2) Dispelling Cold Often Involves Warming Yang, and Clearing Heat Should Be Combined with Nourishing Yin: Xie believes that yang deficiency leads to cold, and cold pathogens often cause yang deficiency. Therefore, the onset of cold bi syndrome is closely related to the (fluctuation) of yang (exterior yang and kidney yang), with the root cause being insufficient kidney yang. If exterior yang is deficient or the individual has a constitutionally weak yang, they are more prone to cold bi syndrome, which should be treated by warming yang. Formulas such as Wu Tou Tang (Aconite Decoction) or Mahuang Fu Zi Xixin Tang (Ephedra Aconite Fineleaf Honeysuckle Decoction) are used, often combined with herbs like psoralea corylifolia, morinda officinalis, and cinnabar. Ephedra ventilates the lungs and dispels pathogens, aconite warms yang and disperses cold and pain, and fineleaf honeysuckle penetrates the exterior and interior. Adding herbs that warm the kidneys further enhances yang, allowing cold to subside. However, when wind, cold, and damp pathogens accumulate for a long time, they may transform into heat, resulting in heat bi syndrome. Additionally, in the initial stage or acute exacerbation of rheumatoid arthritis, symptoms of heat bi syndrome may appear, such as red, swollen, and painful small joints, localized heat, sweating, thirst, high fever, or systemic low-grade fever and discomfort. Treatment should focus on ventilating the channels and clearing heat, using formulas like Bai Hu Jia Gui Zhi Tang (White Tiger with Cassia Twig Decoction) or Bai Hu Jia Cang Zhu Tang (White Tiger with Atractylodes Rhizome Decoction). However, it must be noted that excessive heat can deplete fluids, and chronic heat bi syndrome often exhibits symptoms of yin deficiency. Xie places great emphasis on protecting yin when treating heat bi syndrome, often adding nourishing yin herbs like raw rehmannia, white peony root, scutellaria baicalensis, and white (forsythia) during heat-clearing treatments. This ensures that clearing heat does not harm yin, and nourishing yin helps reduce heat, achieving a synergistic effect.
(3) Cold and Heat Intermingling Require (), and Qi and Blood Deficiency Should Be Replenished: Xie believes that both cold and heat bi syndromes should be treated with a combination of warming and clearing methods, incorporating into the treatment. Formulas like Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon Twig and White Peony Root with Anemarrhena Decoction) are often modified and combined with herbs like mulberry branches, lu lu tong, loofah, and chicken blood vine to promote the unobstruction of meridians and regulate qi and blood. Dispelling cold and clearing heat can alleviate all symptoms. During the diagnosis and treatment of bi syndrome, Xie observed that postpartum women are disproportionately affected by this condition, as their qi and blood are often depleted after childbirth, making them susceptible to wind, cold, and damp pathogens. Such bi syndromes are often complex, requiring a combination of attacking and reinforcing methods to support the body while eliminating pathogens. Formulas like Yu Ping Feng San (Jade Screen Wind Screen Decoction) combined with blood-nourishing herbs or Ba Zhen Tang (Eight Treasure Decoction) with wind-dispelling and dampness-eliminating herbs are commonly used.
(4) For Chronic Bi Syndrome, Use Insect Herbs to Dispel Pathogens, and for Persistent Bi Syndrome, Prioritize Warming the Kidneys: Joint pain is the primary symptom of bi syndrome. Over time, bi syndrome can lead to phlegm and blood stasis obstructing meridians, causing fixed joint pain, limited mobility, or even deformity. Broad-acting blood-activating herbs have little effect, and insect herbs are often necessary, such as scorpion, centipede, cicada, earthworm, tragopan, and bumblebee nest. Snake herbs like cobra, white-banded keelback, and qin snake are also frequently used. These herbs are often toxic and should not be used excessively or for prolonged periods, and should be combined with herbs that nourish the liver and kidneys. Since the liver governs tendons and the kidneys govern bones, chronic bi syndrome can affect the skeletal system, causing swelling, pain, deformation, and difficulty in flexion and extension, leading to persistent or stubborn bi syndrome. Therefore, Xie places great emphasis on the liver and kidneys when treating bi syndrome, especially persistent or stubborn cases, advocating for warming kidney yang and strengthening tendons and bones. Commonly used herbs include prepared rehmannia, psoralea corylifolia, achyranthes, asparagus, eucommia, cinnabar, alisma orientale, and morinda officinalis. In clinical practice, Xie has some unique herbal experiences for bi syndrome, such as using 45g of raw coix seed and 20g of qing feng teng for hand pain and swelling; 20g of prepared rehmannia for ankle swelling and pain; and 20g of white peony root and 10g of papaya for calf pain and calf spasms. P21-23