Treatment of Arthralgia Syndrome from Eliminating Pathogen and Strengthening Vital Qi

Lamei ZHOU, Wen XU, 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 More than 40 medical history works and classical medical literatures about the theory and prescription of arthralgia syndrome treated from eliminating pathogen and strengthening vital qi were sorted out, summarized and analyzed, and the theory of treating arthralgia syndrome from eliminating pathogenic factors including dampness, heat, cold, phlegm and blood stasis, and strengthening vital qi basically reflected the academic thought of treating Bi syndrome from eliminating pathogen and strengthening vital qi in traditional Chinese medicine books.

Key words Arthralgia syndrome, Eliminating pathogen, Strengthening vital qi

1 Introduction

InPlainQuestions·Arthralgia, it was recorded that wind, cold and dampness are three kinds of Qi, which are combined to cause arthralgia, it was recognized that wind, cold and dampness are the causes of Bi syndrome. InStandardsforDiagnosisandTreatment·WiltingandImpediment, it was said that there are wind, dampness, phlegm, fire, blood deficiency and blood stasis in the body for arthritis. Medical history works and classical medical literatures about the theory and prescription of arthralgia syndrome treated from eliminating pathogen and strengthening vital qi were sorted out, summarized and analyzed, and it is of great significance to inherit and innovate traditional Chinese medicine to treat Bi syndrome. The gradual improvement of the understanding of the etiology and pathogenesis of Bi syndrome makes the treatment further developed.

2 Treatment of arthralgia syndrome from the evil

The treatment of arthralgia syndrome is mainly from the dampness, heat, cold, phlegm and blood stasis, among which the treatment of Bi syndrome based on the dampness plays an extremely important role in the treatment of removing pathogenic factors.

2.1Treatmentfromeliminatingdampness

2.1.1Theoretical discourse. InPlainQuestions·Arthralgia, it was said that people full of dampness have fixed arthralgia[1], it’s also the same in the book ofGeneralRecordsofHolyUniversalRelief. InPrescriptionsforSuccouringtheSick, it was recorded that arthralgia is a disease, cold pathogen causes pain arthralgia, wind pathogen causes migratory arthralgia, and dampness pathogen causes fixed arthralgia. It was discussed that dampness can cause fixed arthralgia. InConfucians’DutiestoParents, it was recorded that people who are suffering from arthralgia, when they are damp, their muscles, skin and flesh will be affected, therefore, their arthralgia does not go away, and their muscles and bones are clearly exposed. People who live in damp and work hard can also suffer from a certain type of arthralgia syndrome, they are exposed to wind and rain as well as live in damp places, then arthralgia gets in from the outside. The pathogenesis of Bi caused by dampness was discussed. InIntroductiontoMedicine, it was said that rheumatism often invades the upper body, resulting in numbness of the shoulder and back, and stiff pain of the wrist. Cold and dampness often invade the lower body, and the feet and legs are edematous. If the upper and lower parts of the body are both invaded, the body is as straight as a board, and the feet are as falling stones…… Dampness mostly leads to edema and arthralgia. The related symptoms of arthralgia caused by dampness were discussed.

2.1.2Prescriptions for treatment. InGeneralFormulaforMiscellaneousDiseases, it pointed out that for damp heat, the veins should be dredged to make lucid Yang circulate and move. For cold and dampness, Yang should be dredged slightly, and tonic should also be supplemented. If wind, cold and dampness enter into the lower Jiao and meridians, pungent and warm-natured drug should be used to warm and smooth the meridians. It put forward that the treatment of dampness includes dampness heat, cold dampness and wind-cold dampness. (i) Promoting urination and eliminating dampness. InSynopsisofGoldenChamber, it was recorded that for dampness arthralgia, the internal obstruction of dampness evil affects the bladder gasification, but the urination is not good; the large intestine with dampness tends to defecate quickly, so the method of urination should be used. InTwoNotesoftheCanonoftheGoldenCofferandJadeSheath, alleviating water retention and promoting urination can relieve Yang Qi, although there is moisture in the joints, it can still be relieved. It is discussed that both dampness and arthralgia can be treated by alleviating water retention and promoting urination. (ii) Relieving superficies syndrome and eliminating dampness. InSynopsisofGoldenChamber, it was recorded that when rheumatism joint ache breaks out, the whole body aches, the treatment of this disease should be sweating, every time it’s cloudy, rainy, windy or dusk, it’s very severe, it’s rainy and painful, the doctor says it can be treated by sweating, but after using the medicine of sweating, the disease can’t be cured. Why? Because for this sweating, after the sweating, the wind will go with the sweat, but the moisture really exists and is still there, so this disease is not cured. If you want to cure rheumatism, you need to sweat a little, so rheumatism can be cured. If you have rheumatism, you will have pain all over your body, you should use Mahuang Jiazhu Decoction to make you sweat and remove dampness, so that you can relieve the disease from the superficies and urination, remember not to use fire attack. InTreatiseonColdPathogenicDiseases, it was recorded that people with Taiyang disease have headache, fever, body pain, lumbago, bone joint pain, no sweat and asthma, afraid of the wind, which can be treated by Mahuang decoction. The patient’s body is full of pain and fever, and it is severe at the time of late afternoon, it is called rheumatism; most of the disease is caused by sweating when the wind blows or cold after a long injury, it can be treated with Ephedra, Bitter Apricot Seed, Coix Seed and Licorice Decoction. These discussed the method of sweating and eliminating dampness. (iii) Consolidating superficies and eliminating dampness. InSynopsisofGoldenChamber, it was recorded that people with rheumatism have severe body pain, floating pulse, heavy body, sweating and bad wind, Fangji Huangqi Decoction can be used to treat. For yellow sweat disease, two tibias are cold, if there is yellow sweat due to fever, it belongs to multiple arthralgia rather than yellow sweat. If the body aches heavily, perspires and thirsts, there is sweat above the waist but no sweat below the waist, the waist and hip ache, the moisture is in the skin, just like there is something in the skin, it is violent and can’t eat, the whole body aches heavily and fidgety, and the urination is not good, this is yellow sweat, which is treated with Guizhi and Huangqi decoction. InTreatiseonColdPathogenicDiseases, it was recorded that when the back aches, the stool is normal, it is urgent to treat and cure superficies syndrome, it’s better to use Sini Decoction to treat and cure interior syndrome and Guizhi Decoction to treat and cure the superficies syndrome. After sweating, the body aches and the pulse slows and sinks, Xinjia Decoction with cassia twig and peony as well as ginger of 50 g each, and ginseng of 100 g can be used to treat. All of them are the main prescriptions for consolidating superficies and eliminating dampness. (iv) Dispelling cold and removing dampness. InGeneralRecordsofHolyUniversalRelief, in the treatment of arthralgia caused by damp pathogen, cold and dampness should be removed and meridians should be passed, and the prescriptions of Shihu Powder, Cezi Soup, Fuzi Pill, Tianxiongjin Wine, Long-nosed Pit Viper Pill, Fuling Soup, Ganxie Powder, Mofenggaomozhi and Longhu Plaster can be used to treat. (v) Expelling wind-evil and removing dampness. InSynopsisofGoldenChamber, it was recorded that rheumatism is like typhoid fever, the course of disease has lasted for eight or nine days, the body is very painful and can’t turn around; if you don’t feel nauseous or thirsty, it respectively means there is no Shaoyang disease and Yangming disease; if the pulse is floating, it means the disease is on the surface, if the pulse is weak, it means there is Yang deficiency, if the pulse is astringent, it means there is deficiency of Yin and blood, Guizhi Fuzi Decoction can be used to treat. If the stool is hard and the urination is unobstructed, it should remove cassia twig and add Baizhu Decoction to treat. People who are sweating, shortness of breath without continuity, poor urination, feel cold in the wind and don’t want to take off their clothes, or have slight swelling, they should be treated with Gancaofuzi Decoction. InTreatiseonColdPathogenicDiseases, it was recorded that after sweating, people who suffer from Taiyang Disease are not only sweating, but also afraid of the wind, difficult to urinate, and the movement of their limbs is limited, so they are difficult to bend and stretch, they are treated with Guizhi and Fuzi Decoction. Thus, Guizhi Fuzi Decoction, Gancao Fuzi Decoction, and Guizhi and Fuzi Decoction are mainly used for expelling wind-evil and removing dampness[2-7].

2.2Treatmentfromthecold

2.2.1Theoretical discourse. The theory of cold pathogen causing arthralgia has been seldom discussed, Liu Wansu discussed "cold pathogen causes pain" in Clear Synopsis on Recipe, but there have been many related prescriptions.

2.2.2Prescriptions for treatment. As early as in theSynopsisofGoldenChamber, it has been recorded that for acute arthritis disease, the joint cannot be flexed or extended, and it is painful. It is mainly treated with Aconiti Decoction. People with cold abdominal colic have abdominal pain, cold hands and feet, numbness of limbs, if the body aches, it can be treated with Aconiti and Ramuli Cinnamomi Decoction. InTreatiseonColdPathogenicDiseases, people who suffer from Shaoyin disease for one or two days are not bitter or dry in mouth, and knowledgeable in food but cold in back, they are mainly treated with Fuzi decoction. Those who suffer from Shaoyin disease, such as body pain, cold hands and feet, pain in bone joints and sunken pulse, are mainly treated with Fuzi Decoction[2-6]. Aconiti Decoction, Aconiti and Ramuli Cinnamomi Decoction and Fuzi Decoction are all the prescriptions for warming Yang and dispersing cold, which are the classic prescriptions for treating Bi syndrome from the cold. Liu Wansu discussed "cold pathogen causes pain, cured by ventilating and warming meridians" inClearSynopsisonRecipes, which is the treatment method of Bi syndrome from the cold.

2.3Treatmentfromtheheat

2.3.1Theoretical discourse. InSynopsisofGoldenChamber, there is a saying that meridians heat leads to arthralgia. Ye Tianshi said that all along, arthralgia is a rheumatism composed of wind, cold and dampness, which caused by the high heat in summer and the damp heat from outside, the evil from outside lies in the meridians and collaterals, and the evil from inside lies in the viscera and collaterals. Therefore, there is a saying that "dampness and heat are in the meridians at the beginning, long-term disease and blood stasis heat enter the collaterals". According to the saying of arthralgia syndrome occurs with meridian fever, Wu Jutong, a scholar of febrile diseases in the Qing Dynasty, pointed out that "cold dampness causes arthralgia, and heat dampness causes arthralgia more often", and heat can be divided into dampness heat and stasis heat.

2.3.2Prescriptions for treatment. InTreatiseonColdPathogenicDiseases, it was said that people who have exogenous febrile disease without Shaoyin disease have mild and floating pulse, body pain, heavy body and occasionally light body, which can be treated by Daqinglong Decoction. The patients with concurrent disease of three yang channels are full of abdomen, heavy body, hard to turn around, bad speech, uninteresting food, dirty face, delirium, enuresis, sweating, delirium, sweating on the forehead, cold hands and feet, which can be treated by Baihu Decoction. For people suffering from exogenous febrile disease, the joints are irritated, hot and painful, and sometimes they vomit, which can be treated by Baihu and Guizhi Decoction. Those who get exogenous febrile disease for six or seven days, who have fever, slight aversion to cold, painful limbs and joints, and slight retching, and feel obstructed in epigastrium, and those who have not gone away with external syndrome, should be treated with Bupleuri and Ramuli Cinnamomi Decoction. InSynopsisofGoldenChamber, for all kinds of limb pain, swelling of body joints, emaciation of body, swelling and numbness of feet, which seem to be separated from the body, dizziness and shortness of breath, nausea and vomiting,but can not be vomited out, Cinnamon Twig, Peony and Anemarrhena Decoction can be used to treat. According to the symptoms and prescriptions, Daqinglong Decoction, Baihu Decoction, Baihu and Guizhi Decoction, Bupleuri and Ramuli Cinnamomi Decoction and Cinnamon Twig, Peony and Anemarrhena Decoction are the main prescriptions for treating arthralgia syndrome from heat. Ye Tianshi’s method of treating arthralgia syndrome is: clearing Yang and Ming meridians urgently will cure Bi syndrome. These are the methods of treating Bi syndrome from heat.

2.4Treatmentfromremovingbloodstasis

2.4.1Theoretical discourse. As early as in thePlainQuestions·Arthralgia, it has been recorded that when you go out just after sleeping, you will feel wind evil, if the blood coagulates on the skin, you will have Bi obstruction, if the blood coagulates on the meridians, you will have stasis, if the blood coagulates on the feet, you will have deadly cold feet. It put forward that blood coagulation causes arthralgia syndrome. InBianQueHeartBook, for those who suffer from Bi syndrome, Qi and blood in the meridians are blocked and stagnated outside the five zang organs, which are combined to form diseases, Yin and evil are Bi syndrome. InJingyue’sCompleteWorks·WanderingArthritis, it pointed out that those who suffer from Bi syndrome are caused by pathogenic factors such as obstruction of channels and obstruction of Qi; it put forward that the obstruction of Qi and blood leads to arthralgia. InCorrectiononErrorsinMedicalClassics, the significance of blood stasis in Bi syndrome is placed in a pivotal position[8].

2.4.2Prescriptions for treatment. InLongevityandLifePreservation, in order to treat blood stasis, vein contracture, limb pain and difficult walking, the first thing we should do is to activate blood circulation and regulate qi; it put forward that we should pay attention to the treatment of promoting blood circulation and regulating qi. InGeneralFormulaforMiscellaneousDiseases, at the beginning of Bi disease, the disease is only in the meridians and Qi; after a long time of illness, the disease has entered the collaterals and blood; people with blood stasis and pain can use insect medicine to dredge blood collaterals and then Yang Qi. This discussed that insect drugs can promote blood circulation and dredge collaterals to treat Bi syndrome. InCorrectiononErrorsinMedicalClassics, it was recorded that General Pain Stasis-Expelling Decoct can be used to treat body pain caused by blood stasis.

2.5Treatmentfromphlegm

2.5.1Theoretical discourse. InOrthodoxTransmissionofMedicine, it was said that the fat people with arthralgia syndrome are mostly due to rheumatism and phlegm flowing into the meridians, which block the movement of Qi and blood and cause pain, most of them are slippery veins. InPrinciplesforMedicalProfession, it pointed out that wind arthralgia, cold arthralgia and dampness arthralgia are all caused by phlegm in the chest; it was recognized that phlegm plays a certain role in the pathogenesis of Bi syndrome.

2.5.2Prescriptions for treatment. InDanxi’sMasteryofMedicine·Gout, it pointed out that all limbs are painful, which is called severe and migratory arthralgia, ……Because of phlegm, Erchen Decoction and wine are used to fry with Radix Scutellariae, Rhizoma et Radix Notopterygii and Rhizoma Atractylodis. It also pointed out that the pain of limbs and joints in fat people is mainly caused by rheumatism and phlegm flowing into meridians, which results in the blockage of meridians, Rhizoma Arisaematis and Rhizoma Pinelliaecan be used to treat. Erchen Decoction, Rhizoma Arisaematis and Rhizoma Pinelliaecan are the representative prescriptions for the treatment of Bi caused by phlegm[9].

3 Multiple pathogenic factors

In clinic, arthralgia is mainly caused by one or more pathogenic factors, but rarely by one.

InYiJi·Arthralgia, it was said that people with arthralgia syndrome have dampness, heat, phlegm, stagnation of Qi and blood, stagnation of meridians and collaterals, resulting in numbness and itching. InZhangShiYiTong, it discussed that people with blood stasis have cold and dampness evils, which are caused by blood stasis. InLongevityandLifePreservation, it was suggested that blood stasis, dampness and phlegm are stored between limbs, muscles and bones, and the apertures of the body, which cause pain. Those with heavy limbs are damp phlegm, and those with serious illness at night are blood stasis. InLeiZhengZhiCai·Arthralgia, it was recorded that those who suffer from Bi syndrome for a long time must have phlegm dampness and blood stasis. All of these discussed that dampness, heat, cold, phlegm and blood stasis are combined to cause Bi.

InIncisiveLightontheSourceofMiscellaneousDisease, it was recorded that severe and migratory arthralgia, also known as painful bi, is always treated mainly by relieving wind, expelling cold and eliminating dampness…… It held that wind, cold and dampness should be treated simultaneously. InJinKuiYi, it was recorded that for the treatment of migratory arthralgia, although it is to pass blood gas, it should be mainly used to treat wind. For the treatment of painful bi, it is suitable for clearing Yang Qi, moistening meridians and collaterals, and the blood Qi is warm and can circulate without occlusion. For fixed arthralgia, the disease is mainly in the lower body, sometimes cold and sometimes hot. The treatment of arthralgia in Qi and blood is different, which needs to be examined and treated differently. It held that wind, cold, heat, Qi and blood are all treated. InYiXueZhengZhuan, it was recorded that gout patients should be treated with the method of cold-pungent diaphoresis, which is to let cold and dampness flow away, to cure stagnation and to make blood and gas flow; inGuJinYiJian, it was recorded that arthralgia patients should be treated with the method of pungent and hot drugs, which is to let cold and dampness flow away, to cure stagnation and to make blood and gas flow; these are the treatment of dispersing cold, removing dampness, regulating qi and promoting blood circulation at the same time. InConfucians’DutiestoParents, it pointed out that wind, cold and dampness are three kinds of Qi, which are mixed together to form arthralgia, arthralgia patients with numbness of hands and feet can be treated with Yujin Powder to make them vomit; after stopping vomit, they can use Daoshui Pill and Tongjing Powder to make them vent; after stopping vent, they can use pungent and warm-natured drug to make them sweat; after sweating, they can take Radix Angelicae Sinensis, peony, milk, Moxingjing and blood, and so on. For all patients with cold and wind, arthralgia exists between the skin, hides in the meridians and stays, they have pain, numbness, swelling, itching and contracture of limbs, which can be treated by sweating. Thus, the combination of perspiration and catharsis combined with the drugs of activating blood circulation and dredging channels can be used to treat Bi syndrome, all of the above works highlight a variety of ways of removing pathogenic factors and treating Bi syndrome at the same time.

3.1TreatmentofarthralgiasyndromefromeliminatingpathogenandstrengtheningvitalqiRemoving dampness, clearing heat, dispersing cold, resolving phlegm, removing blood stasis and removing pathogenic factors play an important role in the treatment of Bi syndrome, at the same time, it is necessary to take into account the weakened body resistance, which should be treated together with strengthening vital qi. InThousandGoldenPreions, among the 32 commonly used drugs for arthralgia syndrome, there are 14 kinds of tonic drugs, it can be seen that both strengthening vital qi and expelling pathogenic factors are indispensable, only in this way can the symptoms be treated simultaneously and good results be achieved[10].

3.1.1Theoretical discourse. InSynopsisofGoldenChamber, it was recorded that people who are easygoing and hard-working, well-off and usually lack of work or exercise, although they seem to have good muscles, are actually weak in muscles and bones, loose in texture and weak in resistance to pathogenic factors, so they are prone to sweat after a little tiredness. In addition, they like to have nothing to worry about, so that they can’t sleep well, so they feel a little wind evil, and will get the syndrome of blood stasis. The external syndrome is numb, like wind arthralgia, but actually it is blood arthralgia. InStandardsforDiagnosisandTreatment, it was recorded that patients with painful bi have wind, dampness, phlegm, fire, blood deficiency and blood stasis. InYiXueZhengZhuan, on the whole, the blood deficiency is relatively hot, and the temperature of the blood itself is relatively high, in addition, when hot blood encounters water and gets wet, it will hurt…… It is mentioned that the deficiency of blood can cause Bi. InGeneralFormulaforMiscellaneousDiseases, it was recorded that people with arthralgia are prone to Yin invasion, so they suffer from more pain. Evil Qi hinders healthy qi and blocks meridians, all of which are caused by asthenic disease, and loose striae of the skin and muscles; wind, cold and dampness enter the body by taking advantage of the deficiency, and then stay in the body, resulting in wet phlegm, turbid blood and coagulation. InGuidetoClinicalPracticewithMedicalRecords, it pointed out that due to the wind, cold and dampness, the three Qi flow into the body and stay in the body, so that wet phlegm and turbid blood flow coagulate and get Bi syndrome. It was pointed out that internal deficiency leads to evil, phlegm dampness and stasis stay in the body and lead to Bi syndrome. The above four works all discussed that Bi syndrome is caused by body resistance weakened while pathogenic factors prevailing.

3.1.2Prescriptions for treatment. InSynopsisofGoldenChamber, the people who get blood impediment are weak in taking the pulse gently and pressing the pulse hard, weak in both inside and outside, weak in Cunkou pulse, a little tight in the ruler, and numb in the body; they have paralysis just like the symptoms of wind stagnation, however, wind stagnation can cause pain and blood stasis does not cause pain, Astragalus and Cinnamou Twig Five Ingredients Decoction can be used to treat. This can nourish qi to relive superficies and harmonize yingfen and weifen. InGeneralRecordsofHolyUniversalRelief, it was recorded that in the treatment of painful arthralgia, it is necessary to guide Ying and Wei, and warm meridians and collaterals, and after warming blood and Qi, it will be unblocked naturally……In the treatment, it is necessary to remove cold and dampness, pass meridians and collaterals, and then the disease can be cured. In the treatment of Bi syndrome, the cold and dampness should be dispelled and the meridians should be warmed. InRequiredReadingsforMedicalProfessionals, it was recorded that for migratory arthralgia, arthralgia aggravated by cold, and fixed arthralgia, the pathogenic factors should be dispelled urgently, and the internal Bi should be cured first. InGeneralFormulaforMiscellaneousDiseases, it pointed out that in the treatment of arthralgia, first of all, it is necessary to strengthen vital qi to eliminate pathogenic factors, clear the blood and dredge collaterals and nourish kidney yin, and can’t use wind and dryness products. InYiChaoLeiBian, it was recorded that the treatment of Bi syndrome should be based on clearing phlegm, dispelling wind and removing dampness, nourishing blood and removing blood stasis; inJingyue’sCompleteWorks, it was said that the treatment of Bi syndrome should be based on nourishing kidney yin and dredging collaterals. All of them are the general principles of strengthening vital qi to eliminate pathogenic factor. InYiXueXinWu, it was recorded that the treatment of migratory arthralgia should be mainly based on dispelling wind, complemented with removing cold and removing dampness, and generally mixed with blood tonic. The treatment of cold arthralgia should be mainly based on dispelling cold, complemented with dispelling pathogenic wind and removing dampness, and generally mixed with fire tonic. …… The treatment of fixed arthralgia should be mainly based on dispelling dry and dampness, complemented with expelling wind and removing cold, and generally mixed with spleen tonic. It was suggested that Bi syndrome should be treated by dispersing wind, cold, and dampness, complemented with nourishing blood, fire, spleen, as well as strengthening vital qi to eliminate pathogenic factor. InLongevityandLifePreservation, it was recorded that the treatment of general arthralgia should be first sweating and then tonifying;inStandardsforDiagnosisandTreatment, it was recorded that the treatment of fixed arthralgia (paralysis) should be recuperated by cooling drugs such as dispelling wind and heat, promoting blood circulation and nourishing fluid, moistening dryness and ventilating. These respectively discussed the specific treatment methods of general arthralgia and fixed arthralgia. InJingyue’sCompleteWorks, it discussed that if the wind of Bi syndrome prevails, the treatment should be based on dispelling. If the cold of Bi syndrome prevails, but there is no heat syndrome in its exterior and interior, that is to say, it should be treated from temperature. The syndrome of wind arthralgia is mostly due to deficiency and cold. Only Sanqiyin and Macro-Ledebouriellae Decoction can treat. For acute arthritis, if there is fire, it should be treated from cool; if there is cold, it should be treated from warm. If the muscles and veins are stagnant and the stretching is not good, it is the syndrome of blood deficiency and blood dryness, which must be nourishing blood and Qi. It can be divided into such two parts as the excess of evil Qi and the deficiency of Qi and blood, it should be treated by cooling, warming, nourishing blood and Qi. InGuShiYiJing, it was said that if the disease of stagnant pathogen lasts for a long time, it is appropriate to dredge the blood of meridians and collaterals, and to treat it with the mixture of formula for dispersing pathogenic stagnant and reducing fire, clearing heat and clearing phlegm……For fixed arthralgia, the treatment of this disease is mainly to activate blood to promote menstruation, and to evacuate pathogenic stagnation. For patients with painful arthralgia, if they feel cold and pain at the beginning, they can use Ramulus Cinnamomi and wine to fry and iron, after a long time, the cold will turn into heat and stop using. Although the method of tonifying pain can’t be used, it’s necessary to nourish qi and blood if the disease lasts for a long time, andPanax,Astragalusmongholicus,Atractylodesmacrocephalaand Rehmanniae Radix can be used at will. According to different types of migratory arthralgia, cold arthralgia and fixed arthralgia, they are mainly given the treatment of clearing heat, resolving phlegm, clearing collaterals and removing pathogenic factors, and complemented with the treatment of nourishing qi and blood. InIntroductiontoMedicine, it was said that at first, those who are painful should be treated with dispelling wind and eliminating phlegm, if it is serious, they should be treated with dispelling dampness and promoting the circulation of qi. The long-term disease needs to be treated according to qi deficiency and excess, and the amount of phlegm and blood stasis. People with Qi deficiency and arthralgia are not full of joints, and their whole body is like coming out of the water, they are Yang asthenia causing Yin sthenia, these can be treated with Sijunzi Decoction plus Cortex Cinnamomi and Shengfu, or Chuanfu Pill. InYiXueLiuYao, it was recorded that after a long time of illness, we should eliminate blood stasis, nourish new blood, and resolve phlegm and fire, then, blood circulates naturally and Qi naturally harmonizes, so that there is no one who is not cured. People who have been ill for a long time may occasionally use ascending and descending agents or tonify the spleen. Numbness is treated by dispelling wind and regulating qi, nourishing blood and clearing phlegm. People who are just sick should not usePanax,Astragalusmongholicus,AngelicasinensisandRehmanniaglutinosaLibosch to avoid stagnation of Qi and blood and stagnation of pathogenic Qi and blood channels. If a man who has been ill for a long time and healthy energy deficiency, he should reinforce Rong and Wei. InYiXueDaQuan, it was recorded that it should evacuate the wind, warm the meridians, dispel the cold, distinguish the deficiency from the real, and treat it fundamentally. If the disease is not completely cured, it can dispel pathogenic factors, otherwise it can nourish Qi and blood.……Arthralgia symptom become flaccidity for a long time, flaccidity will lead to deficiency and evil, if the disease lasts for a long time, we should observe the deficiency and excess of Qi and blood, and the amount of phlegm and blood stasis to treat it. In Yi Xue Xin Wu, in the treatment of Bi syndrome, the methods of invigorating blood, fire and spleen are closely related to the etiology and pathogenesis of Bi syndrome, strengthening healthy qi to eliminate pathogens as well as reinforcement and elimination in combination should be used[11]. The above-mentioned medical works have proposed that people who have just got the disease should be treated with the methods of removing pathogenic factors and collaterals, dispelling wind, dispersing cold, resolving phlegm and removing blood stasis; people who have been ill for a long time should be treated with nourishing blood, warming yang and nourishing qi and blood.

4 Conclusions

In this paper, more than 40 medical history works about Bi syndrome were systematically sorted out, summarized and analyzed in terms of removing dampness, clearing heat, dispersing cold, resolving phlegm, removing blood stasis and removing pathogenic factors, as well as the theory and treatment method of the combination of removing pathogenic factors and strengthening spleen, nourishing liver, tonifying kidney, nourishing Yin, benefiting qi, nourishing blood and strengthening Zheng, which basically reflected the academic thought source of removing pathogenic factors and strengthening Zheng to treat Bi syndrome in ancient and modern Chinese medicine, it is of great significance to inherit and innovate traditional Chinese medicine in the treatment of Bi syndrome.