bi syndrome

February 18, 2001

I was reviewing Bi syndrome in class the other day in order to introduce

herbs from the dispel wind damp category. I have never found the

concept of bi syndrome to be as intuitively satisfying as other diseases

attributed to external factors, such as taiyang cold damage, windstrike

or four level heat in the wei aspect. Most diseases attributed to bi

syndrome in american TCM clinics do not come on suddenly from exposure

to the climatic factors. They are often gradual internal processes like

osteoarthritic degeneration. However they are often worsened acutely by

cold or damp. But ultimately, they also lead to constant pain, but this

maybe due to accumulated blood stasis over time. These disease are

often treated with classic warming and supplementing bi syndrome

formulas like du huo ji sheng wan. It is also fairly common to shift

emphasis in serious cases to a little more direct blood invigoration.

However du huo ji sheng wan still has seven herbs that dispel wind damp

(du huo, ji sheng, du zhong, xi xin , fang feng, niu xi and qin jiao)

albeit from five different categories and possessing mutually enhancing

properties such as blood moving, kidney supplementing and exterior

resolving. But at the point that the pain has become constant, should

this still be the emphasis. I mean at some point shouldn't the branch

be treated (i.e. the wind damp dispelled) and only the root require

further treatment.

I remember working with AIDs patients in the early 90's experiencing

late stage painful neuropathies who received their most benefit from

yang supplement and warm interior herbs? The patients often had

diarrhea, abdominal pain, impotence, weak pulse and pale tongues, so

conformationally this made sense. But this was after we had tried

unsuccessfully with blood movers and dispel wind herbs for some time.

So this has me wondering whats the best way to maintain osteoarthritic

patients on herbs. Herbs for bi appear to largely work as

antiinflammatories and for analgesia. On the other hand, kidney tonics

seem to alter neurotransmitters, hormone production, response and

metabolism and immune function, changes in which can be attributed as

various mechanisms through which degeneration occurs from a modern

perspective. Certainly most of the dispel wind damp herbs seem safe,

but perhaps after some time one might want to emphasize herbs that treat

both root and branch like ji sheng, du zhong, rou gui and niu xi.

Various autoimmune diseases can be fairly sudden and acute. They are

likely primed by common viruses causing changes in the immune system

which are then the initiator of autoimmunity at some time after the

initial infection. However when the time comes, the onset can be quite

acute. And the diseases can be remittent and recurrent. This would

certainly have the character of wind and with the intermittent flareups,

the inference would be that either repeated acute invasions were

occurring or perhaps emergence of latent heat moving outwards and

causing external sx. However the sx often become constant and this may

be indicative that repeated " invasion " has led to blood stasis. This

may happen immediately at onset if the patient has preexisting stasis or

depression conditions.

I guess the question arises as to what underlying signs and sx accompany

these diseases. They usually present with some kind of vacuity and

blood stasis, both of which are pathomechanisms that allow external

pathogens to invade and cause bi. Many experienced px tx these

autoimmune dz with herbs for blood stasis, dampheat and vacuity. Expel

wind damp herbs maybe used, but more as branch herbs to relieve pain and

direct the action of the formula to the joints and muscles. Others use

formulas for yin fire. But standard chronic bi formulas are often too

warming and supplementing for AI diseases. So can we call these

diseases Bi when they are treated this way?

--

Chinese Herbal Medicine

February 18, 2001

I was reviewing Bi syndrome in class the other day in order to introduceherbs from the dispel wind damp category. I have never found theconcept of bi syndrome to be as intuitively satisfying as other diseasesattributed to external factors, such as taiyang cold damage, windstrikeor four level heat in the wei aspect.

>>>I also find the bi syndrome principles insufficient in the treatment of musculoskeletal disorders.

I often use the staging form a tissue perspective to design treatment. In general pain can be divided into several stages. The first is dysfunction were the tissues are intact and the pain is due to overstress, to postural causes etc. The patient usually has pain that is position and postural related. The pain is better w/movement, changeable and usually related to stagnation (qi, or qi blood, dampness etc). The second stage results from tissue frailer and due to increase tissue demand to Qi Blood etc and lack of supply. Here the patient develops instability and treatments such as chiropractic etc only help for a short time. There is tissue failure and deficiency of nutrients. The body eventually tried to stabilize the situation and develops bone spurs, joint thickening etc. In my experience using the above principles to decide which herbs to use results in better outcomes. For example I often use blood braking, strong moving and penetrating herbs in older patient instead of tonifing ala due hou ji seng.

Alon

February 19, 2001

Todd

Dan Bensky wrote a very good article on BI syndrome for an Australian journal

entitled Ten methods, ten formulas.

I can send it to you.Are you still atPCOM 7445 Mission Valley Rd San Diego

92108.

And please before a lot of other CHA members reply " send me one too " , Todd may

be able to put it up on the library if he doesn't become bankrupt paying for all

the CHA web space.

> I was reviewing Bi syndrome in class the other day in order to introduce

> herbs from the dispel wind damp category. I have never found the

> concept of bi syndrome to be as intuitively satisfying as other diseases

> attributed to external factors, such as taiyang cold damage, windstrike

> or four level heat in the wei aspect. Most diseases attributed to bi

> syndrome in american TCM clinics do not come on suddenly from exposure

> to the climatic factors. They are often gradual internal processes like

> osteoarthritic degeneration. However they are often worsened acutely by

> cold or damp. But ultimately, they also lead to constant pain, but this

> maybe due to accumulated blood stasis over time. These disease are

> often treated with classic warming and supplementing bi syndrome

> formulas like du huo ji sheng wan. It is also fairly common to shift

> emphasis in serious cases to a little more direct blood invigoration.

> However du huo ji sheng wan still has seven herbs that dispel wind damp

> (du huo, ji sheng, du zhong, xi xin , fang feng, niu xi and qin jiao)

> albeit from five different categories and possessing mutually enhancing

> properties such as blood moving, kidney supplementing and exterior

> resolving. But at the point that the pain has become constant, should

> this still be the emphasis. I mean at some point shouldn't the branch

> be treated (i.e. the wind damp dispelled) and only the root require

> further treatment.

>

> I remember working with AIDs patients in the early 90's experiencing

> late stage painful neuropathies who received their most benefit from

> yang supplement and warm interior herbs? The patients often had

> diarrhea, abdominal pain, impotence, weak pulse and pale tongues, so

> conformationally this made sense. But this was after we had tried

> unsuccessfully with blood movers and dispel wind herbs for some time.

> So this has me wondering whats the best way to maintain osteoarthritic

> patients on herbs. Herbs for bi appear to largely work as

> antiinflammatories and for analgesia. On the other hand, kidney tonics

> seem to alter neurotransmitters, hormone production, response and

> metabolism and immune function, changes in which can be attributed as

> various mechanisms through which degeneration occurs from a modern

> perspective. Certainly most of the dispel wind damp herbs seem safe,

> but perhaps after some time one might want to emphasize herbs that treat

> both root and branch like ji sheng, du zhong, rou gui and niu xi.

>

> Various autoimmune diseases can be fairly sudden and acute. They are

> likely primed by common viruses causing changes in the immune system

> which are then the initiator of autoimmunity at some time after the

> initial infection. However when the time comes, the onset can be quite

> acute. And the diseases can be remittent and recurrent. This would

> certainly have the character of wind and with the intermittent flareups,

> the inference would be that either repeated acute invasions were

> occurring or perhaps emergence of latent heat moving outwards and

> causing external sx. However the sx often become constant and this may

> be indicative that repeated " invasion " has led to blood stasis. This

> may happen immediately at onset if the patient has preexisting stasis or

> depression conditions.

>

> I guess the question arises as to what underlying signs and sx accompany

> these diseases. They usually present with some kind of vacuity and

> blood stasis, both of which are pathomechanisms that allow external

> pathogens to invade and cause bi. Many experienced px tx these

> autoimmune dz with herbs for blood stasis, dampheat and vacuity. Expel

> wind damp herbs maybe used, but more as branch herbs to relieve pain and

> direct the action of the formula to the joints and muscles. Others use

> formulas for yin fire. But standard chronic bi formulas are often too

> warming and supplementing for AI diseases. So can we call these

> diseases Bi when they are treated this way?

>

> --

>

> Director

> Chinese Herbal Medicine

>

> Chinese Herbal Medicine, a voluntary organization of licensed healthcare

practitioners, matriculated students and postgraduate academics specializing in

Chinese Herbal Medicine, provides a variety of professional services, including

board approved online continuing education.

>

February 19, 2001

, Heiko Lade <heiko@l...> wrote:

>

> Dan Bensky wrote a very good article on BI syndrome for an Australian journal

entitled Ten methods, ten formulas.

>

> I can send it to you.Are you still atPCOM 7445 Mission Valley Rd San Diego

92108.

> And please before a lot of other CHA members reply " send me one too " , Todd

may be able to put it up on the library if he doesn't become bankrupt paying for

all the CHA web space.

Thanks Heiko.

We should Dan's permission to reprint unless you own the journal in

question. My address is still the same, though. I appreciate your

concern about the cost of CHA. But I am making plans to earn some

money and do not want to inhibit anyone from posting, etc. It'll all

work out in the end, I'm sure.

February 19, 2001

This may be off the point in terms of your original query, but I think we

need to remember that patterns (zheng) are not the same as disease causes

(bing yin). If we say that a person presents a wind cold damp PATTERN of

impediment, that does not necessarily mean that they have been invaded by

wind, cold, or dampness externally. What it means is that the pattern

presents symptoms which have the characteristics of wind, cold, and

dampness. Similarly, if we say that a patient presents a wind damp heat

PATTERN of impediment, then what we are saying is that their sign-symptom

picture is characteristic of wind, dampness, and heat. In this case, it may

be possible to say that wind simply means an unseen evil qi, the disease

cause. Then the cold damp or damp heat symptoms are how the patient

manifests the struggle between righteous and evil qi. To me, this is a very

important point in Chinese medicine which many students and even some

practitioners seem, at least in my experience, to misunderstand. This also

holds true for wind heat and wind cold PATTERNS of gan mao (common colds or

flus). The patient has been invaded by an unseen airborne pathogen (i.e.,

wind evils) and then, depending on their righteous qi, they then develop

predominantly heat symptoms (sore throat and fever) or cold symptoms

(chills and muscle aches).

Bob

> [Original Message]

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> 2/18/2001 2:27:05 AM

> bi syndrome