| Purpose:Bi-syndrome, a collective term for symptoms such as stiffness or deformity of joints, is a common clinical symptom and recognized as tingling, pain, numbness, swelling, burning pain associated with redness, difficulties in bending and stretching of skin, joints, muscles, tendons and bones, etc. It is equivalent to bones and joints diseases such as Osseous arthtritis, Rheumatoid arthritis, Ankylosing Spondylitis, Hyperostosis in western medical science. The disease, chronic in nature, occurred repeatedly or gradually, without clear causes, is highly related to connective tissue diseases and self-immunity system and has high rate of disability and mortality. Although responsive to Corticosteroids and immunosuppressive drugs in a certain degree, western medicine practitioners still have no specific treatment for this disease. Chinese medicine practitioners, however, have researched into Bi-syndrome for a long period of time and accumulated wealth of experience worth further exploring. The holistic approach used by chinese medicine practitioners, with "discern patterns and institute treatment" as the basis, has an advantage of combined effects in treating Bi-syndrome. Recent medical researches have also proved that use of chinese medicine is effective to treat Bi-syndrome and has received much public attention. As both historic and current medical practitioners are keen to find out a means to treat Bi-syndrome, a systematic review of the literatures by historic scholars and consolidation of their findings on Bi-syndrome has significant values to both academic research and clinical treatment.In the past decade, scholars from different fields have separately researched and analyzed Bi-syndrome from four perspectives, namely literature review, related diseases in western medical science, etiology of the disease, and treatment methods. Regarding research into related diseases in western medical science, it covers Rheumatoid arthritis, rheumatic fever, Primary sciatica, Hyperostosis, etc. Diseases such as Thromboangiitis Obliterans, Polymyositis, Scleroderma, Brucellosis, Erythema nodosum, Induration red spots, Nodular vasculitis and Systemic lupus erythematosus, etc., which have symptoms similar to those of Bi-syndrome, are categorized as "pulse numbness", "muscle numbness", "virtual numbness" and "skin numbness" in chinese medical science for discussion. About etiology of the disease, scholars usually researched by four aspects, namely "exterior pathogenic invasion", "viscera disorder", "diseases caused by phlegm and blood stasis", "Pathogenic Qi", "co-existence of phlegm and blood stasis with internal organs disorder". The six approaches to treat Bi-syndrome are the "viscera", "Qi, blood and Yin Yang", "diseases associated with meridians", "phlegm and blood stasis", "cold and heat" and "by stage of the disease" approaches respectively.Although there is significant development in respect of treatments for Bi-syndrome by chinese medicine practitioners based on the above findings, the focus is still on clinical research without much work done on literature review. Details reported so far were mainly those from some classic books such as "Nei Jing" and "Jin Gui". Therefore, there is a need for a systematic literature review of the origins and developments of Bi-syndrome found in the medical relics unearthed from the Han Mawangdui and the classic books such as "Nei Nan Shang Han Jin Gui" etc., chronologically from the Jin, Tang, Jin, Yuan to the Ming and Qing Dynasties. There is also a need to categorize the characteristics of different treatment methods adopted by various historic scholars with a view to providing current medical practitioners with insight into the clinical approaches to treat Bi-syndrome.Research methodology:Review the relevant historic and modern literatures with importance accorded to first hand information and attention to convergence of theoratic and academic view points, and apply information technology to facilitate collection, compilation, categorization, and analyses of the mass volume of information.1. Review historic literatures on Bi-syndrome and counter check origins of modern literatures. This covers Qing Dynasty's "Gu Jin Tu Shu Ji Cheng Yi Bu Quan Lu" edited by Chen Menglei, "Ming Qing Ming Yi Quan Shu Da Cheng" published by the Chinese Traditional Medicine Publishing House, "Chinese Hundred Years Hundred Renowned TCM Practician's Clinical Collection" edited by Zhang Wenkang and published by the Chinese Traditional Medicine Publishing House. Collect from a number of databases (e. g. China Journal Full-text Database(CJFD)) relevant theses and journals on treating Bi-syndrome with chinese medicine published in the past decade. About 2175 theses were extracted of which 326 (15%) were on researches into principles and theories, 1051 (48.4%) on clinical studies,316 (14.5%) on successful clinical trials, 175 (8%) on treatment with special prescriptions,185 (8.5%) on experimental studies,69 (3.2%) on literature review, and 53 (2.4%) on others respectively.2. Through chronological study of the origins and developments of the Bi-syndrome and categorization of the characteristics of different treatment methods adopted by various historic scholars, provide a comprehensive understanding of handling Bi-syndrome in chinese medical science. This dissertation will be divided into three parts:Literature review on chinese medicine practitioners'understanding and experience in Bi-syndrome chronologically from the early Qin Dynasty to the past ten decades, with a view to knowing the derivation and evolution of Bi-syndrome.Literature review on the theories of the treatment methods by categorizing the concepts, causes, keys of diagnosis, medication, clinical case studies and preventive measures with a view to better defining Bi-syndrome in Chinese medical science.An Annex in the form of a database containing information related to Bi-syndrome collected through literature reviews and compilation of clinical data to facilitate future reference. Results:Through chronological study of the origins and developments of the Bi-syndrome and categorization of the characteristics of different treatment methods adopted by various historic scholars, provide a comprehensive understanding of handling Bi-syndrome in chinese medical science. It is found that the academic beliefs of historic scholars in treating Bi-syndrome can be broadly characterized as:Treatment of Bi-syndrome by chinese medicine practitioners was originated from the era of "Nei Jin";In the era of Wei, Jin, Sui and Tang, the understanding of Bi-syndrome was further enhanced in terms of theories and clinical studies. Bi-syndrome was considered to be an invasion of meridian by pathogenic factors (i. e. "wind", "cold", "dampness"), or phlegm and blood stasis, leading to tingling and spasm in joints and muscle. It was also considered to cover limbs, meridian, viscera related illnesses caused by Bi-syndrome.Significant progress has been made in the era of Song, Jin and Yuan, where the theory proposed by Zhu Zhenheng-"Gout-Blood, heat and phlegm as factors" has long-lasting impact on the future methods to treat Bi-syndrome i. e. Bi-syndrome could be cured by improving the blood and Qi circulation with a view to minimizing blood stasis, and through thinning the phlegm to achieve detoxification.The era of Ming and Qing where the theories and clinical studies of treating Bi-syndrome with chinese medicine have gained more grounds. That is, painful limbs and joints as the main symptom with "numbness in viscera, blood and Qi, and five orifices" etc., classified as internal medical illnesses. This approach, in certain extent, has consolidated the thoughts of various famous practitioners.This is one of the distinct features of this dissertation as there is still no comprehensive categorization of TCM's understandings and beliefs on Bi-syndrome prevailing in these four periods with reference to historical literatures.A systematic presentation of the characteristics of TCM's clinical treatment for Bi-syndrome. Although there are generalized and localized beliefs of Bi-syndrome, academics nowadays generally consider the disease as an invasion of the meridian by pathogenic factors (i. e. "wind", "cold", "dampness"), and numbness caused by poor circulation of blood and Qi, leading to pain, tingling and apasm in joints and muscles i. e. the localized belief. In fact, Bi-syndrome is mainly caused by deficiency in Qi (i.e. the basis), with exterior pathogens related to "wind", "cold", "dampness" and'heat" as catalysts (i.e. factors). Prolonged Bi-syndrome without proper treatment will lead to poor circulation of blood and Qi, hence numbness of meridians by phlegm and blood stasis, resulting in hardening of areas surrounding the joints, swollen joints, difficulties in bending and stretching of joints, and ecchymosis on skin. Ones suffering from Bi-syndrome for a long period of time can be recognized by swollen joint with atrophy. Main symptoms of Bi-syndrome include painful joints, limbs tingling, numbness, difficulties in bending and stretching of skin, joints, muscles, tendons and bones, swollen and deformed joints, skin hyper trophy, etc.At present, the agreed view to treat Bi-syndrome is first identify the differences between numbness caused by "wind", "cold" and "dampness" and those by "heat", then pay attention to possible symptoms like vacuity of Qi and blood as well as visceral illnesses for chronic patients. Use different medications for different types of the syndrome. Use eliminating the "wind", "cold", "dampness", clearing away "heat", and clearing meridian-Qi and regulating Qi and blood) as the basis of treatment, supplemented with drugs that would replenish Qi and nourish blood at a later stage where appropriate. In case of prolonged disturbance by Bi-syndrome, one should consider the case as phlegm and blood stasis instead of numbness of meridians caused by phlegm and blood stasis, and supplemented with drugs that would activate blood and resolve phlegm as the treatment method.The third part, an Annex to this dissertation, is a database of Bi-syndrome related information collected by the author through review of literatures and compilation of clinical data during his study of the doctorate programme to facilitate future reference. This is also a method of historic scholars to pass on their knowledge and experience.This is the second distinct feature of this dissertation as there is also no comprehensive analyses of the beliefs, causes, characteristics of symptoms, and various treatments for Bi-syndrome with reference to the academic knowledge of some famous chinese medicine practitioners, and use of information technology to establish a database containing relevant information to facilitate future reference.Conclusion:The first part of this dissertation analyzes and summarizes the various understandings and findings of historic scholars on Bi-syndrome in the past two thousand years, chronologically from early Qin Han to Ming Qing. The second part is a categorization of the concepts, causes, symptoms, medication, clinical case studies and preventive measures in relation to Bi-syndrome. Current academics consider Bi-syndrome as a kind of illness in which "wind", "cold" and "dampness" invade the meridians leading to poor circulation of blood and Qi hence resulting in tingling, pain and numbness in joints and muscle. The part is a database of Bi-syndrome related information to facilitate future reference, a practice of historic scholars to passing on their knowledge and experience and a characteristic of research study through review of chinese medicine literatures.Treatment for Bi-syndorme using chinese medicine covers the experience of scholars of the past two thousand years (i.e. from the Qin Han to Ming Qing Dynasties) and efforts of academics of the past ten decades. This dissertation has tried to provide the academic sector with a clear understanding of Bi-syndrome both in breath and depth, covering concepts, origins, views of historic scholars, causes of the syndrome, treatment, etc. It aims to provide sophisticated and concrete principles and theories as well as clinical treatments for Bi-syndrome for future reference through literature review and categorization of the findings and experience of both academics and renowed chinese medicine practitioners.
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