1. Acupuncture Treatment of Diseases Orthopedics 3: Wei Syndrome 痿证

2. Definition: 1.Is marked by weakness, muscular atrophy and motor impairments of the limbs, usually the lower limbs are affected. 2.Wei Syndrome is commonly seen in myelitis, multiple neuritis, MG and traumatic nerve impairment in western medicine.

3. Causes and Pathogenesis : 1.Main cause: The invasion of external pathogenic dampness and heat to the channels and collaterals caused a malnutrition of the tendons and muscles resulting in dysfunction in distribution of the body fluid by the lung. 2.Exhaustion of body fluid due to high fever or other illness caused by dampness and heat. 3.Impairment of the spleen due to improper food intake leading to formation of internal heat and dampness resulting in flaccid muscles and tendons. 4.Malnutrition of the tendons and muscles resulting from overstrain or insufficiency of the essence and blood in the liver and kidney after a long illness.

4. Clinical Manifestations: Chief symptoms: i.Weakness, muscle flaccidity or atrophy and motor impairment of the limbs.

5. Clinical Manifestations: 1.Consumption of body fluid by lung heat type Stated manifestations with: i.Fever with perspiration. ii.Sudden onset of flaccid limbs after fever has subsided. iii.Thirst. iv.Concentrated urine. v.Red tongue with thin/thick/greasy yellow coating. vi.Wiry, rapid pulse.

6. Clinical Manifestations: 2.Accumulation of damp heat type Stated manifestations with: i.Chronic flaccid limbs especially lower limbs. ii.Swelling and numbness or hot sensation on the affected limbs. iii.Concentrated urine. iv.Red tongue. v.Sticky tongue coating. vi.Soggy, rapid pulse.

7. Clinical Manifestations: 3.Deficiency of spleen and stomach type Stated manifestations with: i.Prolong limb flaccidity. ii.Poor appetite. iii.Abdominal fullness. iv.Loose stools. v.Sallow complexion. vi.Lassitude and fatigue. vii.Pale tongue. viii.Thin white tongue coating. ix.Thready pulse.

8. Clinical Manifestations: 4.Insufficiency of kidney and liver type Stated manifestations with: i.Flaccid limbs after prolong illness with muscular atrophy. ii.Serious emaciation. iii.Soreness and weakness of the loins and knees. iv.Tinnitus. v.Dizziness. vi.Reddish tongue. vii.Scant tongue coating. viii.Thready, rapid pulse.

9. Treatment : General principle Adjust Yangming channel. Tonify qi and blood. Remove obstruction from the collaterals and restore functions of the tendons. Principle channels: 1.Large Intestine channel (upper limbs). 2.Stomach, Spleen, Gall Bladder channel (lower limbs). 3.EX-O acupoints.

10. Principle acupoints : For upper limbs: 1.LI 11 Quchi 曲池， LI15 Jianyu 肩禺， LI 4 Hegu 合谷. 2.EX-B2 Jiaji (neck and chest). For lower limbs: 1.ST 36 Zusanli 足三里， GB 31 Fengshi 风市， GB 34 Yanglingquan 阳陵泉. 2.EX-B2 Jiaji (lumbar area).

11. Prescription explanation (Principle acupoint): 1.The Yangming channel is enriched with qi and blood, has the function of moistening all tendons, ligaments and muscles required for movements of the joints. Therefore, most points are selected from the Yangming channel. Jiaji is located 0,5 cun lateral to the GV, can regulate Yin and Yang and activate qi and blood circulation.

12. Principle of treatment 1. Consumption of body fluid by lung heat type Adjust Yangming channel. Tonify qi and blood. Remove obstruction from the collaterals and restore functions of the tendons. Disperse heat. Principle acupoints: as stated Supplementary acupoints: 1.LU 5 Chize 尺泽. 2.BL 13 肺腧.

13. Principle of treatment 2.Accumulation of damp heat type Adjust Yangming channel. Tonify qi and blood. Remove obstruction from the collaterals and restore functions of the tendons. Disperse dampness and heat. Supplementary acupoints: 1.SP 9 Yinglingquan 阴陵泉. 2.GV 14 Dazhui 大椎.

14. Principle of treatment 3.Deficiency of spleen and stomach type Adjust Yangming channel. Tonify qi and blood. Remove obstruction from the collaterals and restore functions of the tendons. Tonify spleen and stomach. Supplementary acupoints: 1.BL 20 Pishu 脾俞. 2.BL 21 Weishu 胃俞. 3.CV 12 Zhongwan 中脘.

15. Principle of treatment 4.Insufficiency of kidney and liver type Adjust Yangming channel. Tonify qi and blood. Remove obstruction from the collaterals and restore functions of the tendons. Tonify kidney and liver (nourish). Supplementary acupoints: 1.BL 18 Ganshu 肝俞. 2.BL 23 Shenshu 肾俞.

16. TCM medical advises: 1.Require long term treatment. 2.Better to combine with medications and physiotherapy. 3.Proper care on foot and sores. 4.Avoid cold and raw food.