Clinical Experience of Chief Physician Zhou Lamei in Using Diaphoresis to Treat Impediment Disease

Lijun LU, Li CHENG, Lamei ZHOU

Department of Rheumatology, Wuxi Traditional Chinese Medicine Hospital, Wuxi 214000, China

Abstract This paper discusses and summarizes the clinical experience of chief physician Zhou Lamei in the treatment of the impediment disease (arthralgia) by using internal treatment sweating method and external treatment diaphoresis. It is pointed out that diaphoresis plays an important role in the treatment of arthralgia.

Key words Impediment disease (arthralgia), Diaphoresis treatment, Clinical experience

1 Introduction

The impediment disease, also called arthralgia, is a common clinical disease with the main symptoms of soreness, swelling and pain of joints and muscles, stiffness, difficulty in flexion and extension, fear of wind and cold, and apathy. According to Internal Classic, the combination of wind, cold and dampness leads to the impediment disease. According toSynopsisofPrescriptionsoftheGoldenChamber·SyndromeDifferentiationandTreatmentofConvulsive,Damp,SummerHeatStrokeDisease, when wind and damp pathogens evade, the whole body will pain. As stated inConfucian’sDutiesTotheirParents, in case of hit by wind or rain, and dampness in bedroom, the impediment pathogen will evade. Many physicians believe that wind-cold-dampness is an important factor of impediment disease, and diaphoresis plays an important role in the treatment of impediment disease. We discussed the clinical experience of chief physician Zhou Lamei in treating the impediment disease by using diaphoresis.

2 Treatment of impediment disease using diaphoresis

2.1 Internal treatment sweating methodAs indicated inSynopsisofPrescriptionsoftheGoldenChamber, for treating the wind and dampness diseases, sweating method could be used. After slightly sweating, wind and dampness pathogens would disappear. According toDiscussionandAnnotationsonSynopsisofPrescriptionsoftheGoldenChamber, wind is acute, so it can be removed rapidly, while dampness is slow, so it should be eliminated gently. If sweating strongly, the acute wind is removed, but dampness still remains inside, then the disease is not cured. Thus, sweating should be gently, to remove both wind and dampness. This stresses the key of using diaphoresis to treat the impediment disease lies in the proper sweating. In bothSynopsisofPrescriptionsoftheGoldenChamberandTreatiseonColdDamageDiseases, prescriptions and formulas manifesting the sweating method include Mahuang Jiazhu Decoction, Mahuang Xingren Yiyiren Gancao Decoction, Fangji Huangqi Decoction, Guizhi Fuzi Decoction, Wutou Decoction, Gegen Decoction, Huangqi Guizhi Wuwu Decoction,etc., as well as famous Qianghuo Shengshi Decoction, Fangfeng Decoction, and Baihu Guizhi Decoction. Most of these prescriptions are still widely used in the clinical treatment of impediment disease.

Case 1: female, 46 years old, suffered from back pain, neck pain, heavy and weak limbs, anhidrosis, aversion to wind, loose stool, pale red and fat tongue, thin and greasy tongue coating with teeth marks, wiry and weak pulse under the environment of air conditioning in summer. The course of the disease was 2 years. Combined with the symptoms, the syndrome differentiation of tongue and pulse, her disease belonged to spleen deficiency and dampness obstruction, and the treatment method was to induce diaphoresis and relieve exterior syndrome, invigorate the spleen and promote diuresis, relax the tendons and dredge the collaterals. The Modified Gegen Decoction was used: 10 g of Cinnamomi Ramulus (Guizhi), 10 g of Paeoniae Radix Alba (Baishao), 6 g of Glycyrrhizae Radix Et Rhizoma (Gancao), 10 g of Zingiberis Rhizoma Recens (Shengjiang), 10 g of Jujubae Fructus (Dazao), 10 g of Ephedrae Herb (Mahuang), 45 g of Puerariae Lobatae Radix (Gegen), 20 g of Astragali Radix (Huangqi), 15 g of Atractylodis Macrocephalae Rhizoma (Baizhu), and 10 g of Notopterygii Rhizoma Et Radix (Qianghuo), 7 doses decocted with water for oral administration. Gegen Decoction is fromTreatiseonColdDamageDiseasesand is mainly used to treat external wind, cold and dampness such as stiffness of neck and back, anhidrosis, aversion to wind, or purgation, combined with heavy limbs and fatigue, sometimes loose stool, pale red and fat tongue, thin and greasy tongue coating with teeth marks, wiry and weak pulse with spleen deficiency and dampness obstruction. Astragali Radix and Atractylodis Macrocephalae Rhizoma were added to replenish qi, invigorate the spleen, promote diuresis, and Notopterygii Rhizoma Et Radix to dispel wind-dampness, relieve arthralgia, and relieve exterior syndrome. At the second visit, the patient’s symptoms of neck pain and back pain were significantly alleviated, but she still had heavy limbs, no sweat, aversion to wind, pale red and fat tongue, thin and greasy coating with teeth marks, and wiry and weak pulse, so the Puerariae Lobatae Radix was reduced to 15 g. Then, 10 g of Codonopsis Radix (Dangshen) and 10 g of Saposhnikoviae Radix (Fangfeng) were added and decocted with water for oral administration, the symptoms of limb heaviness, anhidrosis and aversion to wind were relieved.

2.2 External treatment diaphoresisA method for treating the impediment disease by medicinal hot application has been proposed as early as inA-BClassicofAcupunctureandMoxibustion, that is, cloth repeatedly soaked in liquid medicine and dried in the shade is heated and then hot applied to the part where arthralgia occurs, and after the patient sweats, the cloth is heated and dried, and the process is repeated. At that same time, it has the function of dispelling cold and can relieve arthralgia with acupuncture therapy. InConfucian’sDutiesTotheirParents, it proposed the sweating methods without using medicines, including bathing, greenhouse sweating, needling, conduction exercise, pressing tiptoes, and emotional sweating,etc.At present, traditional Chinese medicine hot medicinal compress, traditional Chinese medicine fumigation and immersion bathing are widely used in clinic to improve symptoms by direct sweating effect. Traditional Chinese medicine fumigation and immersion bathing method[1]is achieved through the penetration effect of hot water vapor, so that the drug directly acts on the diseased joints and muscles, with the help of drugs and physical warming, through sweating, the pathogenic wind, cold and dampness are expelled from the outside.

Case 2: male, 42 years old, working in the cold storage, fear of cold, the knee joint was cold and painful, the lower limbs were cold and numb, he wore cotton-padded clothes when he came to visit the doctor in summer, the course of disease was more than 10 years, the tongue was pale and dark, the fur was white and greasy, and the pulse was wiry and deep. According to the syndrome differentiation of tongue and pulse combined with symptoms, his disease belonged to cold-dampness obstruction. According to the theory ofInternalClassic, if there is a pathogen, water form is the sweat. If it is in the skin, it is caused by sweat. The pathogen can be released by sweating. If the pathogen is eliminated, the disorder will not occur. Fumigation bed of traditional Chinese medicine was used for treatment, and the medicine was formulated by the chief physician Zhou Lamei. The prescription consists of Angelicae Dahuricae Radix (Baizhi), Notopterygii Rhizoma Et Radix, Polygoni Multiflori Caulis (Shouwuteng), Spatholobi Caulis, Trachelospermi Caulis Et Folium (Luoshiteng), Clematidis Radix Et Rhizoma (Weilingxian), Liquidambaris Fructus (Lulutong), Herb of Tuberculate Speranskia (Tougucao), Carthami Flos (Honghua), Chuanxiong Rhizoma (Chuanxiong),Angelicae Sinensis Radix (Danggui)、Artemisiae Argyi Folium (Aiye), Cinnamomi Ramulus, and Wenyujin Rhizoma Concisum (Pianjianghuang). It has passed the hospital ethics, and has functions of dispelling cold and relieving pain, promoting blood circulation and dredging collaterals, once a day, 30 min each time, 10 times in total. When the traditional Chinese medicine fumigation bed is used for fumigation treatment, steam is used for hot compressing, and the sweat pathogen is fumigated and evaporated, so that the evil comes out with the sweat, the evil goes out, and the cold pain symptom is relieved. It has a good effect on improving microcirculation, relaxing bones and relieving pain. After treatment, the symptoms of patient’s fear of cold were relieved.

3 Conclusions

According to the chief physician Zhou Lamei, diaphoresis is often combined with relieving exterior syndrome and dispelling cold, replenishing qi and warming Yang, nourishing yin and yang in the treatment of impediment disease. Ephedrae Herb and Cinnamomi Ramulus are representative drugs for relieving exterior syndrome and inducing sweating. Ephedrae Herb is pungent, warm and dispersible, and can relieve pain and arthralgia. Cinnamomi Ramulus can induce diaphoresis, relieve muscles, warm and dredge meridians, and treat arthralgia due to deficiency and excess of cold and heat through compatibility of different drugs. Astragali Radix and Aconiti Lateralis Radix Praeparata (Fuzi) can be combined for benefiting qi and warming yang. Codonopsis Radix、Paeoniae Radix Alba and Angelicae Sinensis Radix can be combined for nourishing yin and harmonizing nutrient. Stephaniae Tetrandrae Radix (Fangji) can be combined for invigorating qi and consolidating the exterior, inducing diuresis and reducing swelling. Branches and vine drugs can be combined for relaxing muscle and tendons and dredging collaterals, and insect medicines can be combined for expelling wind and relieving pain. Aconiti Lateralis Radix Praeparata and Aconiti Radix (Chuanwu) can be combined for dispelling the cold and warming meridians. Gypsum Fibrosum (Shigao) can be combined for relieving muscle and clearing heat. When diaphoresis is used in the clinical treatment of rheumatism, attention should first be paid to slight sweating. As stated inTreatiseonColdDamageDiseases·DifferentiationandTreatmentofDiaphoresisandPulseSyndrome, when using decoction for sweating, moderate sweating is appropriate, do not use the whole decoction, which suggests that excessive sweating should be avoided, so as to damage the yang qi and yin fluids. During the treatment, slight sweating can be repeated, till the symptoms are relieved. During sweating, it is necessary to keep the body fluids. InTreatiseonColdDamageDiseases, sweating prescription of hot gruel are mentioned several times, which can boost the drug effect and nourish the body fluids.