An Analysis on the Origin and Development of Nomenclature of Bi Syndrome

Lamei ZHOU1, Donglin HAO

1. Department of Rheumatology and Immunology, Wuxi Hospital of Traditional Chinese Medicine, Wuxi 214000, China; 2. Department of Rheumatology and Immunology, Suzhou Hospital of Traditional Chinese Medicine, Suzhou 215000, China

Abstract The literatures in more than 40 medical history books and classical medical works about TCM name and classification of Bi syndrome were systematically sorted out, summarized and analyzed, which basically reflected the academic origin of Bi syndrome in ancient and modern Chinese medicine. Through the research on the academic origin of the nomenclature of arthralgia syndrome in traditional Chinese medicine, the changes of the nomenclature of arthralgia syndrome in traditional Chinese medicine were clearly grasped, which was of great significance for the further standardization of the nomenclature of arthralgia syndrome.

Key words Bi syndrome, Traditional Chinese medicine, Nomenclature

1 Introduction

Bi syndrome is the disorder of Ying, Wei, Qi and Xue of the body, the pathogenic wind, cold, wet and heat attack the human body; or weakened body resistance, endogenetic phlegm turbidity, blood stasis, heat toxin, and fighting of positive and evil block the meridians, skin, muscles and bones, and Qi and blood in the viscera, thereby losing in nourishment. It is characterized by pain, swelling, sore, numbness, stiffness, deformity and activity limitation of the joints, muscles and limbs, and even involves the viscera. Through the research on the academic origin of the nomenclature of Bi syndrome in traditional Chinese medicine, the changes of the nomenclature of Bi syndrome in traditional Chinese medicine were clearly grasped, which was of great significance for the further standardization of the nomenclature of Bi syndrome.

2 On the naming of bi syndrome in the main works of the Pre-Qin and Han Dynasties

IntheInternalCanonofMedicine, Bi syndrome generally referred to all kinds of diseases caused by evil Qi blocking limbs, meridians and viscera, including limb arthralgia and viscera arthralgia[1]. InPlainQuestions, Bi syndrome was divided into fixed arthralgia, migratory arthralgia and arthralgia aggravated by cold according to the pathogenic factor. According to the different seasons of onset, the remaining parts of pathogenic factors can be divided into five kinds of arthralgia: bone arthralgia, muscular rheumatism, vessel impediment, muscle arthralgia and numbness of the skin, which were five kinds of relatively shallow of arthralgia syndromes when pathogenic factors invaded the body. If you have been ill for a long time, asthenic healthy Qi with pathogen lingering, or being invaded by exogenous pathogen repeatedly, these can transmit to the internal organs and then cause the impediment of the internal organs of the body (kidney impediment, liver impediment, heart impediment, spleen impediment, lung impediment, intestines impediment and bladder impediment). Posthemiplegic paralysis referred to the disease of hemi-anesthesia. The main symptoms of food impediment were that the upper abdomen was stuffy and pain after eating into the stomach, and the stomach was comfortable after vomiting. InMiraculousPivot·GeneralArthralgia, there were mobile algesia and general arthralgia according to different clinical manifestations of external pathogenic invasion of muscle surface. Watery abdominal mass referred to the syndrome of water stagnation due to the stagnation of liver qi and the inability to transport and transform water. Retention of arthralgia referred to the arthralgia syndrome that can not be removed for a long time. Distant arthralgia referred to the arthralgia syndrome that cannot be cured for a long time. Deep arthralgia referred to the arthralgia syndrome in the deeper part of human body. The research on the nomenclature of Bi syndrome inHuangdiNeijingwas more in-depth, and every physician in the future was based on it. InHuatuo’sZhongzangClassic, wandering arthritis, cold arthralgia, dampness arthralgia and heat arthralgia were mentioned, especially the etiology and pathogenesis of Qi arthralgia, flesh impediment, blood arthralgia, tendon arthralgia and bone arthralgia were emphatically described. On the basis ofHuangdiNeijing, Zhang Zhongjing had his own unique research on Bi syndrome. InTreatiseonColdPathogenicDiseases, body pain was mentioned in many places, the syndrome of Shaoyin disease with body pain belonged to the syndrome of deficiency of Yang Qi and excess of cold and dampness, body pain and joint pain caused by cold and dampness stagnation of muscles and joints belonged to arthralgia syndrome. InSynopsisofGoldenChamber, it referred to the disease names of rheumatism, dampness arthralgia, severe and migratory arthralgia, kidney dampness, blood arthralgia and other arthralgia syndromes, the names of arthralgia syndromes were mainly described by symptoms, etiology and pulse condition.

3 On the naming of bi syndrome in the main works of the Sui and Tang Dynasties

InGeneralTreatiseonCausesandManifestationsofAllDiseases, there were rheumatic arthralgia, wind arthralgia, rheumatic insensitivity, wind cold, limb contracture, no bending and stretching and other diseases. According to the pulse diagnosis, it referred to blood arthralgia, and also referred to tendinous pain, vessel impediment, muscle arthralgia, skin arthralgia and bone arthralgia. The description of the disease was mainly based on the etiology and pathogenesis, which showed that it gradually paid attention to the etiology and pathogenesis. According toEssentialRecipesforEmergentUseWorthaThousandGold, wind arthralgia, dampness arthralgia, general arthralgia, tendinous pain, vessel impediment, muscle arthralgia, skin arthralgia, bone arthralgia and bladder impediment had their own syndromes and different types of pulse, furthermore, arthralgia in the muscle sometimes attacked, and sometimes did not attack, the left side would affect the left side, the right side would also affect the right side, which was called partial arthralgia.EssentialRecipesforEmergentUseWorthaThousandGoldbasically inherited the treatise on the name of Bi syndrome inHuangdiNeijing, and its treatise on Bi was mainly based on the combination of etiology and symptoms, but the symptoms of Bi were different from those inHuangdiNeijing. In addition to Bi syndrome and severe and migratory arthralgia, white tiger disease was first put forward inArcaneEssentialsfromtheImperialLibrary.

4 On the naming of bi syndrome in the main works of the Song, Jin and Yuan Dynasties

According to the discussion on the name of Bi syndrome inGoldenMirrorofMedicine, it was concluded that the cause of three types of arthralgia(migratory arthralgia, cold arthralgia and fixed impediment) was wind-cold-dampness, five types of arthralgia referred to the arthralgia of tendon, bone, vessel, muscle and skin; the person who had the syndrome of wind-prevail and cold-prevail had a very bitter pain, which was called pain arthralgia; the person who had the syndrome of dampness had localized pain disorder, which was called fixed arthralgia. In autumn, if you encountered this evil, you would feel pain and itch even though the skin was numb. In summer, if you encountered this evil, the blood in the pulse would not circulate and walk, and the color would change. To meet this evil in the long summer for the muscle arthralgia, then the muscle was indomitable. In spring, when encountering this evil, it would cause tendon contracture to bend rather than stretch. If you encountered this evil in winter, you would have severe bone pain and bone could not lift. Those who had viscera pain were also referred to as the arthralgia of the five internal organs. The person with general arthralgia would pain or swell or could not use on the hands or feet or only limbs, suffering from pain without rest in a fixed position either from the upper part to the below, or from the below part to the upper, but did not like all other arthralgia pain, which could stop and could not move up between left and right but could move up and down, these were like apoplexy, but mouths and eyes did not slant, the body had pain. InGeneralRecordsofHolyUniversalRelief, all kinds of arthralgia were divided into arthralgia of pain, fixed arthralgia, migratory arthralgia, arthralgia of wind and cold, wind-damp impediment, stagnation of qi, pyretic arthralgia, arthralgia of heart, arthralgia of liver, arthralgia of spleen, arthralgia of lung, arthralgia of kidney, arthralgia of skin, arthralgia of muscle, arthralgia of blood, arthralgia of bone, arthralgia of tendon and arthralgia of pulse. According to the discussion on the name of Bi syndrome inPreionsforUniversalRelief, rheumatism, cold dampness, wind toxin and beriberi were the same disease but had different names, and wandering arthritis, heart impediment and heat arthralgia were also mentioned in this book. The Bi syndrome inZiShengJingwas named wandering arthritis, shoulder arthralgia and pain, and foot paralysis. The above five works had played a little role on the basis ofHuangdiNeijing, with little change, it was mentioned that arthralgia of wind and cold, wind toxin, beriberi and foot paralysis were all named as arthralgia syndrome, for example, it was proposed that arthralgia was the combination of wind, cold and dampness, its content was essentially described inHuangdiNeijing. Zhu Danxi put forward the name of gout for the first time inFurtherDiscoursesonthePropertiesofThings·Gout, and set up "Gout Festival" inFurtherDiscoursesonthePropertiesofThings. There were "gout" monographs inDanxi’sMasteryofMedicine,DanXiZhiFaXinYaoand other books. InTreatiseonSpleenandStomach, Liu Wansu mentioned the arthralgia of pain, the arthralgia of cold and all kinds of damp arthralgia. InClearSynopsisonRecipes, it was mentioned that there were seven kinds of syndromes,i.e. syndrome of migratory arthralgia, syndrome of pain arthralgia, syndrome of fixed arthralgia, syndrome of general arthralgia, syndrome of cell arthralgia, syndrome of intestinal impediment, and syndrome of heat arthralgia, the presentation of syndrome meant the disease location, disease nature, pathogenesis and clinical manifestation of Bi syndrome.

5 On the naming of bi syndrome in the main works of the Ming Dynasty

InRequiredReadingsforMedicalProfessionals, it recorded migratory arthralgia, pain paralysis, fixed arthralgia, skin impediment, bladder impediment, heart impediment, liver impediment, lung impediment, spleen impediment and kidney impediment; and it was also believed that the muscular rheumatism was wandering arthritis, which was called "traveling influx" in ancient times and is now called filariasis. Vessel impediment was pyretic arthralgia, muscle arthralgia was fixed arthralgia and dampness arthralgia, bone arthralgia was cold arthralgia and pain arthralgia. InLongevityandLifePreservation, it discussed that floating pulse was paralysis; tight pulse was pain arthralgia; uneven and hollow pulse was dampness arthralgia, had dead blood, and was numb, no pain and itch; it classified Bi syndrome by pulse, and discussed the etiology, pathogenesis and symptom characteristics of gout. According toStandardsforDiagnosisandTreatment, migratory arthralgia was traveling influx, joint running, and so on. Pain paralysis was also known as gout and white tiger, Feishi and so on. Fixed arthralgia was benumbed and unresponsive. Those with arthralgia were caused by the obstruction of Qi and blood. The Qi and blood in the meridians and collaterals of the five viscera and six entrails were blocked by wind, cold and dampness and other evil Qi, which caused pain and numbness in the limbs and joints. InIntroductiontoMedicine, there were many names for a disease, arthralgia wind (with numbness), stubborn numbness, pain and numbness around the whole body were also called general arthralgia, which believed that the main symptoms of Bi syndrome included pain and numbness. InLeiZhengZhiCai, pulse arthralgia was heart arthralgia, tendinous pain was wandering arthritis, bone arthralgia was cold arthralgia and pain arthralgia, muscle arthralgia was dampness arthralgia and fixed arthralgia. InGuJinYiJian, it referred to pain arthralgia. InLeiZhengZhiCaiandGuJinYiJian, the discussion of Bi syndrome naming was relatively simple. Gout was mentioned inYiXueZhengZhuan, which mainly inherited the discussion of Zhu Danxi in Yuan Dynasty, and expounded one arthralgia with many names, and discussed the pathogenesis of arthralgia syndrome deeply, which was close to the current understanding.

6 On the naming of bi syndrome in the main works of the Qing Dynasty

According toZhengYinMaiZhi, wandering arthritis was also called migratory arthralgia, cold arthralgia was also called pain arthralgia, dampness arthralgia was also called fixed arthralgia, heat arthralgia was still called heat arthralgia. On the basis of inheriting the predecessors, it put forward that the contracture of tendons including the contracture of external tendons (cold dampness, damp heat) and the contracture of internal tendons (blood heat of liver channel, damp heat of Yang brightness channel) were all arthralgia syndrome, which was caused by dampness. InMedicalInsights, on the basis of the predecessors on migratory arthralgia, pain arthralgia and fixed arthralgia, it was recorded that if you had arthralgia for a long time, your legs and feet were withered and thin, and your knees were swollen, it’s called arthroncus of knee. According to the symptoms, crane-knee syndrome was put forward. InSyndromeIdentificationsandTreatment, migratory arthralgia was Gui Jian, pain paralysis was gout, fixed arthralgia was benumbed and unresponsive. Cold obstruction was called Bi, it may itch and paralyze, or may be weak in hands and feet, and was similar to impotence. InConfucians’DutiestoParents, arthralgia was caused by numbness or pain. On the basis of the previous arthralgia, it was considered that numbness was also arthralgia. InYiJi, arthralgia(also called gout), migratory arthralgia was muscular rheumatism, which was caused by wind; fixed arthralgia was muscular rheumatism, which was caused by dampness; bone arthralgia was pain arthralgia, which was caused by cold; arthralgia in the middle of the body showed swollen and aching pain, and arthralgia in the lower part of the body was dribbling urinary block of foot, the names of skin, muscle, tendon, bone, chest, waist, throat and pulse arthralgia were detailedly described, and the names of spleen, lung, heart and liver, kidney, cell and intestinal obstruction were discussed, several kinds of arthralgia names with the same symptoms were discussed and named according to the location of arthralgia remaining. InZhangShiYiTong, blood arthralgia was discussed, and gout(Lijie) was mentioned. InJinKuiYi, it recorded that migratory arthralgia, pain arthralgia and fixed arthralgia were caused by wandering arthritis, cold arthralgia and dampness arthralgia, as well as qi-stagnating arthralgia and blood arthralgia. InIncisiveLightontheSourceofMiscellaneousDisease, according to different parts of arthralgia, it can be divided into bone arthralgia, vessel impediment, tendinous pain, flesh impediment and skin arthralgia. Due to the external evils such as wind, cold, dampness and heat attacking the human body, it can be divided into migratory arthralgia (in ancient times, it was called traveling influx, and today it is called shank erysipelas, and commonly known as Gui Jian Feng), pain arthralgia(gout, also known as severe and migratory arthralgia), heat arthralgia and general arthralgia(because triple initial Qi were all over the body, the whole body was in pain). It was emphasized that the pain range was wide and the degree was severe, thus severe and migratory arthralgia was put forward; "one of the symptoms of pain arthralgia was that the pain circulated through hundred joints of the whole body, so it was called acute arthritis; the pain was more like a tiger’s bite, so it was called severe and migratory arthralgia". InJingyue’sCompleteWorks, it was believed that wandering arthritis was gout, and pain of joint-running wind was migratory arthralgia. InYiXueChuanDeng, it was believed that gout was also known as severe and migratory arthralgia. InShiFangMiaoYong, it held that arthralgia was similar to gout, but wandering arthritis caused Yang disease, arthralgia caused Yin disease. The above five works discussed in detail the pain arthralgia, gout, and severe and migratory arthralgia, their symptoms were mixed and were not clearly distinguished, which were actually the same diseases with different names. InCorrectiononErrorsinMedicalClassics, it pointed out that "shoulder pain, arm pain, back pain, leg pain, or the pain of the whole body were generally known as Bi syndrome", the proposal of Bi syndrome made the name of Bi syndrome develop further, which was close to the current name of Bi syndrome.

7 Conclusions

To sum up, the research on the nomenclature of Bi syndrome inHuangdiNeijingwas more in-depth, and later generations of physicians were based on it. On the basis ofHuangdiNeijing, Zhang Zhongjing had his unique research on Bi syndrome, and mentioned the name of Bi syndrome, such as damp disease, damp arthraligia, rheumatism, severe and migratory arthralgia, affection of kidney by cold-dampness and blood arthralgia, and so on, the name of Bi syndrome was mainly described by symptoms. The description of diseases inGeneralTreatiseonCausesandManifestationsofAllDiseasesmainly focused on the etiology and pathogenesis, and gradually paid attention to the etiology and pathogenesis. The main works of Tang and Song Dynasties were basically based on theHuangdiNeijing, which had little change. Zhu Danxi of Yuan Dynasty put forward the name of "Gout" for the first time. Liu Wansu mentioned the syndrome of migratory arthralgia, syndrome of pain arthralgia, syndrome of fixed arthralgia, syndrome of general arthralgia, and so on, which meant Bi syndrome had its disease location, disease nature, pathogenesis and clinical manifestation. In Ming and Qing Dynasties,LongevityandLifePreservationclassified Bi syndrome by types of pulse. InStandardsforDiagnosisandTreatment, the same diseases with many names were discussed. InIntroductiontoMedicine, the main symptoms of Bi syndrome included pain and numbness. According toZhengYinMaiZhi, on the basis of inheriting the predecessors, it put forward that the contracture of tendons including the contracture of external tendons and the contracture of internal tendons were all arthralgia syndrome, which was caused by dampness. InJinKuiYi, it recorded that arthralgia were caused by heat arthralgia and cold arthralgia, as well as qi-stagnating arthralgia and blood arthralgia. InIncisiveLightontheSourceofMiscellaneousDisease,Jingyue’sCompleteWorksandYiXueChuanDeng, pain arthralgia, gout, and severe and migratory arthralgia were discussed in detail, and drew the conclusion that pain arthralgia, gout, and severe and migratory arthralgia were the same disease with different names. InCorrectiononErrorsinMedicalClassics, it pointed out that the proposal of Bi syndrome made the name of Bi syndrome close to the current name of Bi syndrome.

The name of "Bi syndrome" has still been used in the fifth edition textbook ofInternalMedicineofTraditionalChineseMedicine; in the currentDiagnosticEfficacyofStandardTCMSyndrome, arthralgia has been divided into six categories of disease, namely wind-damp impediment, arthralgia, gout, bone arthralgia, muscle arthralgia and skin arthralgia, the modern medical diseases included in each disease category have been defined. At present, most medical experts think that Bi syndrome can be divided into wandering arthritis, cold arthralgia, dampness arthralgia, heat arthralgia, irritable arthralgia, arthralgia of wind, cold and dampness, and wetness-heat arthralgia according to the pathogenesis; it can be divided into skin impediment, muscle arthralgia, bone arthralgia, vessel impediment, tendinous pain, blood arthralgia and qi-stagnating arthralgia according to the disease location; according to the characteristics of clinical symptoms, it can be divided into migratory arthralgia, pain arthralgia, fixed arthralgia, general arthralgia, joint running, gout, arthroncus of knee, omalgia, obstinate arthralgia and lame impediment; according to the duration of the disease, it can be divided into sudden arthralgia, lingering arthralgia, protracted arthralgia and obstinate arthralgia; according to the syndrome, it can be divided into arthralgia and deficient arthralgia, and so on[2]. There are many problems in the name of arthralgia syndrome in traditional Chinese medicine, for example, a disease name includes many diseases with very different nature, and a disease name has many diseases, the name of the disease is ancient and obscure, which is difficult to communicate and understand; through the research on the academic origin of the name of arthralgia syndrome in traditional Chinese medicine, it was of great significance to clearly grasp the change of the name of arthralgia syndrome in traditional Chinese medicine, so as to further standardize the research on the name of arthralgia syndrome.