Atrophy+Syndrome

Atrophy Syndrome, or wei syndrome, refers to a group of disorders whose symptoms range from flaccidity and weakness in the sinews & muscles to diminished muscle mass. Muscular atrophy may be localized or systemic. The lower extremities are often most affected resulting in weakness and difficulty ambulating. As the capacity for voluntary movement diminishes, unremitting wei syndrome progresses to a total loss of mobility of the extremities.

Atrophy syndrome is often caused by injuries to the internal organs, especially insufficient essence and blood, and Yin deficiency w/ excessive fire; therefore, symptoms pertaining to heat or deficiency are common.

Relevant Biomedical Disorders
Myasthenia gravis Multiple sclerosis Polyneuritis or Guillain-Barre disease Acute myelitis (inflammation of the spinal cord) Sequela of infectious diseases of the CNS including poliomyelitis

Etiology and Pathogenesis
The main pathomechanism of Atrophy Syndrome/Wĕi Zhèng is lack of nourishment and moistening of the sinews (muscles, tendons, and vessels). External and internal evils can both cause this condition and can mutually affect each other.

External Heat evil or prolonged febrile disease: this can cause Lung Heat, which injures fluids and impairs the dispersing and descending functions of the Lung. Moisture and nourishment are not disseminated to the sinews and muscles; the extremities are affected, becoming weak and flaccid with decreased motor control.

Exposure to Dampness or irregular diet: these result in accumulation of Dampness in the sinews and muscles that transforms into Damp-Heat, obstructing the flow of Qi and Blood and consuming body fluids. The sinews and muscles lose nourishment, become weak and flaccid, lose mass and atrophy.

Weak constitution, chronic disease, unhealthy lifestyle, aging, excessive sexual activity result in: Spleen/Stomach vacuity: inefficient rotting and ripening and transforming and transporting results in Qi, Blood, Body Fluids, and Essence vacuity. Qi vacuity causes impaired circulation of Blood and Body Fluids; vacuous Blood and Body Fluids fail to nourish and moisten the sinews, muscles, and bones causing atrophy.

Liver and Kidney vacuity: the Liver governs the sinews and stores the Blood to nurses sinews, while the Kidney governs the bones and stores the Essence that produces Marrow to nourish the bones. If the Liver and Kidney are vacuous, they are unable to support their related tissues and there will be flaccidity and weakness of the sinews and bones.

Deficiency vs. Excess
The majority of patterns for Wĕi Zhèng present as deficiency/vacuity rather than excess/repletion and Heat rather than Cold, although patterns of temporary repletion or mixed vacuity and repletion are possible.

Repletion patterns are characterized by acute onset and rapid progression so that immobility and loss of muscle mass occur in a relatively short period of time. Vacuity patterns are characterized by gradual onset and slow progression, and the lower extremities are most often affected.

Differential Diagnosis
Painful Obstruction Syndrome ,Wind Stroke, and Atrophy Syndrome all in full pathology of the extremities. Painful Obstruction Syndrome is characterized by soreness, pain, heaviness and reduced ROM or difficult movements of the joints and muscles. Occasionally, numbness and swelling are present. Muscular atrophy can occur in Painful Obstruction Syndrome if a painful extremity is not exercised, but flaccidity is not present.

Atrophy Syndrome is characterized by weakness and flaccidity of the extremities and atrophy of the muscles. The pattern of affected limbs can be random, and pain is not a common symptom. Wind Stroke: muscular flaccidity and atrophy are possible sequelae to Wind Stroke. However, the symptoms affect only one side of the body and are accompanied by numbness of the limbs and facial paralysis.

Lung Heat w/ fluid Injury
Fever during the initial stage of the illness, or a fever followed by weakness, rapidly developing flaccidity and immobility of the extremities with muscular atrophy, and dry skin High fever, thirst & sweating: - Ren Shen, E Jiao; + Zhi Mu, Jin Yin Hua, Lian Qiao, Bei Sha Shen, increase the dosage of Shi Gao (30) Dry cough w/ scanty sputum or copious phlegm: + Bei Mu, Gua Lou In cases where fever is abated, w/ loss of appetite and severe dry mouth and throat, indicating injury to the Lung as well as the Stomach Yin, the prescription is changed to boost the stomach and generate liquids. Use Yi Wei Tang
 * Symptoms:** Irritability, thirst, cough, scanty sputum, scanty urine and dry stool
 * Tongue:** Red tongue w/ yellow coat
 * Pulse:** Thin & rapid (Thready)
 * Treatment Strategy:** Clear heat, moisten dryness, nourish the lung and generate the fluid
 * Acupuncture:** BL-13, LU-5
 * Formula:** Qing Zao Jiu Fei Tang
 * Modifications:**

Damp Heat Accumulation
Heaviness of the limbs, weak and flaccid extremities w/ occasional numbness, and slight swelling in the affected extremities; most often affects the lower extremities Strengthen the effect of draining damp-heat via urination: + Mu Tong, Fang Ji, Bi Xie Predominance of dampness presenting white slimy tongue coat: + Hou Po (9g.), Fu Ling (12g.), Hua Shi (12g.) To disinhibit dampness and free the connections: - Dang Gui, Gui Ban; + Yi Yi Ren (30g.), Mu Tong (9g.), Can Sha (9g.), Mu Gua (9g.) Excessive heat injuring the Yin w/ irritability, red tongue and scanty coating: - Cang Zhu + Sheng Di Huang (9g.), Gui Ban, Mai Men Dong (9g.), Tian Hua Fen (12g.) Numbness of the limbs w/ limited ROM in the affected joints, purple tongue, and thready choppy pulse: + Chi Shao (9g.), Dan Shen (9g.), Tao Ren (6g.), Hong Hua (6g) During rainy summer weather: + Huo Xiang (9g), Pei Lan(9g.)
 * Symptoms:** Possibly fever, stifling sensation in the chest & epigastrium, and dark, scanty, painful and difficult urination
 * Tongue:** Red tongue w/ yellow greasy coat
 * Pulse:** Soft & rapid [possibly slippery]
 * Treatment Strategy:** Clear heat and drain dampness
 * Acupuncture:** BL-20, SP-9
 * Formula:** Jia Wei Er Miao San or Si Miao Wan
 * Modifications:**

Deficiency of the Spleen and Stomach
gradual onset of Flaccidity and weakness of the extremities aggravated by exertion, gradual loss of muscle mass, fatigue, lassitude, & shortness of breath Accompanied by food stasis: + Gu Ya (12g.), Mai Ya (12g.), Shan Zha (12g.), Shen Qu (12g.) Chills and cold extremities: + Zhi Fu Zi (6g.), Gan Jiang (6g.) with Qi and Blood deficiency: + Huang Qi (12g.), Dang Gui (12g.) Obesity w/ excessive phlegm: use Liu Jun Zi Tang Significant Qi deficiency or Qi sinking: use Bu Zhong Yi Qi Tang
 * Symptoms:** Poor appetite, loose stool, sallow complexion & abdominal distention, facial puffiness
 * Tongue:** Pale tongue w/ thin white coat
 * Pulse:** Thin & forceless [thready]
 * Treatment Strategy:** Strengthen the Spleen & Stomach; augment the Qi
 * Acupuncture:** CV-12, Sp-6, BL-20
 * Formula:** Shen Ling Bai Zhu San
 * Modifications:**

Deficiency of the Liver and Kidney
Slow and gradual onset, weak and flaccid lower limbs, soreness and weakness of the lower back and spine, the inability to stand for a long time. Total loss of mobility and severe loss of muscle mass can result with exacerbation Enhance the effects of nourishing the Liver & Kidney, strengthening the sinews & bones: + Zhu Gu Sui, Niu Xi Sallow complexion, palpitations, pink tongue, and weak thready pulse: + Huang Qi, Dang Shen, Dang Gui, Ji Xue Teng Strong heat: - Suo Yang, Gan Jiang or use Zhi Bai Di Huang Wan Prolonged illness with injury of Yin that led to injury of Yang with physical cold, cold extremities, copious clear urine, impotence, pale tongue and deep thready forceless pulse: - Huang Bai, Zhi Mu; + Lu Jiao Jiao (9g.), Bu Gu Zhi (9g.), Ba Ji Tian (9g.), Rou Gui (6g.)
 * Symptoms:** Dizziness & vertigo, hair loss, dry throat, tinnitus, fatigue, nocturnal emmision, enuresis and irregular menstruation
 * Tongue:** Red tongue w/ scanty coat
 * Pulse:** Thready and rapid
 * Treatment Strategy:** Tonify the Liver and Kidney, nourish the Yin and clear heat
 * Formula:** Hu Qian Wan
 * Modifications:**

Blood Stasis
chronic flaccidity and weakness of the limbs with muscular atrophy; numbness of the limbs, dark-colored skin, possible muscular pain, blood vessels may be visible on the skin surface Tao Ren (Peach kernel) 9g Hong Hua (Carthamus flower) 9g Huai Niu Xi (Achyranthes root) 9g
 * Tongue:** purple with thin, white coating
 * Pulse:** Choppy
 * Treatment Strategy:** Move Qi, quicken the Blood, eliminate stasis, open the channels and collaterals
 * Formula:** Sheng Yu Tang +

Acupuncture
Upper Limbs: LI-15, LI-11, LI-4, TW-5, Jia Ji, Yang Ming channel Pai Ci Lower Limbs: ST-31, ST-34, ST-35, ST-41, GB-39, GB-34], GB-30, [SP-10], Jia Ji, Yang Ming channel Pai Ci Lung Heat: + LU-5, BL-13 Damp-Heat: + SP-9, BL-20 Spleen/Stomach def: + CV-6, [CV-4], SP-6, ST-36, BL-20, BL-21 Liver/Kidney Yin Def: + BL-18, BL-23, SP-6, CV-4, KI-3, LR-3 Blood Stasis: CV6, SP6, SP10, BL40 Korean Sa-Am protocol: Lung tonification - LU-9(+), SP-3(+), LU-10(-), HT-8(-)
 * Manipulation:** Reducing method for heat patterns, reinforcing for deficient patterns, puncture on the affected side
 * Prescription:** Based on the affected limbs
 * Supplementary Points:**

Practical Hints
To treat Wĕi Zhèng, strategies addressing the Yang Ming channels and organs should be adopted. The Yang Ming “organs” in this case refer to the Spleen and Stomach because they generate and are the source of Qi, Blood, Essence and body fluids. Located in the Middle Burner, they send vital substances to the Lung for dissemination to the entire body. They also supply the Liver and Kidney with Blood and Essence to nourish the sinews and bones.

The Spleen governs the muscles and provides them with nourishment. Strengthening the Spleen and Stomach will ensure their proper function and an adequate supply of vital substances. Sufficient nourishment and moistening significantly contribute to recovery from Wĕi Zhèng; therefore, when planning acupuncture or herbal treatment, the Yang Ming should be the focus.

Common treatment strategies include supplementing the Spleen and Stomach, clearing Heat from the Stomach, and clearing Heat and draining Dampness. The most common points include: ST36, BL20, BL21, SP6, GB34, and GB39. Other strategies, such as clearing Heat from the Lung, moistening the Lung, supplementing the Liver and Kidneys, and supplementing Blood and Essence, should be adopted according to the pattern.

A strategy [Kidwell] was taught in the acupuncture department at Chengdu University of TCM for treating Wĕi Zhèng was to “harmonize Yin and Yang” by treating the Du Mai and Ren Mai using one of the following methods: Superficial threading along the Du Mai and Ren Mai with long needles, alternating between the two channels from treatment to treatment.

Acupuncture for Wĕi Zhèng
 * Plum Blossom** needling along the Du Mai and Ren Mai, alternating between the two channels from treatment to treatment.

Needling the major points along the Du Mai and Ren Mai (GV3/4/14/16/20/26; CV 3/4/6/12/17/23/24), alternating between the two channels from treatment to treatment.
 * Moxa** along the Du Mai and Ren Mai, alternating between the two channels from treatment to treatment.