Bi Syndromes

Bi syndromes are . the syndromes characterized by obstruction ofqi and blood in meridians and collaterals due to invasion of pathogenic wind , cold and damp , and manifested by soreness , pain , numbness and heavy sensation of the limbs and joints , and limitation of movement .

Clinically , bi syndromes are common in the areas where the weather is cold , wet and windy , occurring in persons of either sex and any age . In mild cases there are only soreness and pain in limbs and joints , aggravated by the change of weather . In severe cases the soreness and pain are marked and recur repeatedly , accompanied by swelling of the joints and even deformity and limitation of movement .

Bi syndromes may be classified into four types according to etiology and manifestations :

• Wandering bi is characterized by migrating pain and caused chiefly by pathogenic wind ;
• Painful bi is characterized by severe pain and caused chiefly by pathogenic cold ;
• Fixed bi is characterized by marked soreness , numbness and heaviness and caused chiefly by pathogenic damp ; and
• Heat bi is characterized by heat manifestations and sudden onset .

Etiology and Pathogenesis

Attack of pathogenic factors on individuals with weakened body resistance :

Bi syndromes are caused by obstruction of qi and blood due to 1 . invasion of the meridians and collaterals by pathogenic wind , cold and damp ; 2 . general weakness of the body with deficiency of yang qi ; and 3 . dysfunction of the pores , and weakness of defensive yang . The book Prescriptions for Succoring the Sickness points out , It is because of weakness of the body with poor function of the pores that invasion of wind , cold and damp to produce Bi syndromes is possible .

Body constitution :

The body constitution differs in the natures of heat and cold . In case of the body constitution with exuberant yang qi and accumulated heat , invasion of pathogenic wind , cold and damp will give rise to heat bi . Furthermore , long - standing wind , cold and damp Bi syndromes may turn into heat Bi as the pathogenic factors in the meridians and collaterals are transformed into heat .

Differentiation

Wandering bi :

Main manifestations : Wandering pain in the joints , especially the wrists , elbows , knees and ankles ; limitation of movement , chills and fever , thin and sticky tongue coating , superficial and tight or superficial and slow pulse .

Analysis : Pain in the joints is a common manifestation of all the Bi syndromes caused by wind , cold and damp that obstruct qi and blood circulation in meridians and collaterals . As stated in Chinese medicine , There is pain if there is obstruction . Wandering pain is due mainly to invasion by pathogenic wind which is characterized by constant movement and changes . Chills and fever result from the struggle between antipathogenic factors and pathogenic factors after the invasion . Superficial tense or superficial slow pulse indicates invasion of exogenous pathogenic wind on the exterior of body ; and thin and sticky tongue coating shows the initial stage of invasion by pathogenic wind , cold and damp .

Painful bi :

Main manifestations : Severe stabbing pain in the joints , alleviated by warmth and aggravated by cold , with fixed localization but no local redness and hotness , thin and white tongue coating , string - taut and tense pulse .

Analysis : Severe pain is due to retarded circulation of qi and blood in the meridians and collaterals caused by excessive cold . Cold is a yin pathogenic factor , characterized by causing contraction . The pain is localized because of the congealing effect of cold . Pain alleviated by warmth suggests that heat improves the circulation of blood . Cold causes further stagnation of blood , and hence aggravates the pain . The absence of local redness and hotness is characteristic of affection by pathogenic cold . String - taut and tense pulse is associated with cold and pain . White tongue coating is a signof pathogenic cold .

Fixed bi :

Main manifestations : Numbness and heavy sensation of the limbs , soreness and fixed pain of the joints , aggravated on cloudy and rainy days , white and sticky tongue coating and soft pulse .

Analysis : Pathogenic damp is characterized by heaviness . When it is in an excessive state , it invades the limbs and joints , causing retarded circulation of qi and blood , and resulting in numbness and heaviness . Pathogenic damp is a yin factor , characterized by viscosity and stagnation . So the pain caused by damp is also fixed in location . The condition becomes worse on cloudy and rainy days for the weather change brings about more stagnation of qi and blood . Soft pulse and white sticky tongue coating indicate the presence of pathogenic damp .

Heat bi :

Main manifestations : Arthralgia involving one or several joints , local redness , swelling and excruciating pain with limitation of movement , accompanied by fever and thirst , yellow tongue coating , rolling and rapid pulse .

Analysis : Local redness , swelling and pain of the joints are the result of the transformation of pathogenic factors into heat . Movement is limited because of swelling and deformity of joints . Fever , thirst , yellow tongue coating , rolling and rapid pulse are the signs of excessive heat .

In addition , bi syndromes may also be classified according to the locality of the diseased area as follows :

Skin bi : Numbness of the skin with cold sensation .

Muscle bi : Soreness , numbness and pain of the muscles .

Tendon bi : Soreness , pain and stiffness of the tendons and muscles .

Vessel bi : Pain due to blockage of vessels . Bone bi : Soreness , heaviness and pain of joints which fail to perform their functions of lifting , extension and flexion .

Treatment

Ahshi points together with the local and distal points along the yang meridians supplying the diseased areas are selected for the purpose of eliminating wind , cold and damp . Wandering bi , heat bi and tendon bi are mainly treated by the reducing method . Subcutaneous needles may also be applied . For painful bi and vessel bi , it is better to use moxibustion , and apply needling as an adjuvant treatment with deep insertion and prolonged retaining of the needles . For severe pain , intradermal needles or indirect moxibustion with ginger may be used . Fixed bi , skin bi , muscle bi and bone bi also be treated by combined acupuncture and moxibustion , or together with warming needle , or tapping plus cupping . Prescriptions :

Pain in the shoulder joint : Jianyu ( LI 15 ) , Jianliao ( SJ 14 ) , Jianzhen ( SJ 19 ) , Naoshu ( SI 10 ) .

Pain in the scapula : Tianzong ( SI II ) , Bingfeng ( SI 12 ) , Jianwaishu ( SI 14 ) , Gaohuang ( B 43 ) .

Pain in the elbow : Quchi ( LI II ) , Chize ( L5 ) , Tianjing ( SJ 10 ) , Waiguan ( SJ 5 ) , Hegu ( LI 4 ) .

Pain in the wrist : Yangchi ( SJ 4 ) , Yangxi ( LI 5 ) , Yanggu ( SI 5 ) , Waiguan ( SJ 5 ) .

Stiffness of the fingers : Yanggu ( SI 5 ) , Hegu ( LI 4 ) , Houxi ( SI 3 ) .

Numbness and pain in the fingers : Houxi ( SI 3 ) , Sanjian ( LI 3 ) , Baxie ( Extra ) .

Pain in the lumbar region : Renzhong ( Du 26 ) , Shenzhu ( Du 12 ) , Yaoyangguan ( Du 3 ) .

Pain in the hip joint : Huantiao ( G 30 ) , Juliao ( G 29 ) , Xuanzhong ( G 39 ) .

Pain in the thigh region : Zhibian ( B 54 ) , Chengfu ( B 36 ) , Yanglingquan ( G 34 ) .

Pain in the knee joint : Heding ( Extra ) , Dubi ( S 35 ) , Medial Xiyan ( Extra ) , Yanglingquan ( G 34 ) , Yinlingquan ( Sp 9 ) .

Numbness and pain in the leg : Chengshan ( B 57 ) , Feiyang ( B 58 ) .

Pain in the ankle : Jiexi ( S 41 ) , Shangqiu ( Sp 5 ) , Qiuxu ( G 40 ) , Kunlun ( B 60 ) , Taixi ( Љ‡ ) .

Numbness and pain in the toes : Gongsun ( Sp 4 ) , Shugu ( B 65 ) , Bafeng ( Extra ) .

Pain in the back : Shuigou ( Du 26 ) , Shenzhu ( Du 12 ) , Yaoyangguan ( Du 3 ) .

General pain : Houxi ( SI 3 ) , Shenmai ( B 62 ) , Dabao ( Sp 21 ) , Geshu ( B 17 ) , Jianyu ( LI 15 ) , Quchi ( LI 11 ) , Hegu ( LI 4 ) , Yangchi ( SJ 4 ) , Huantiao ( G 30 ) , Yanglingquan ( G 34 ) , Xuanzhong ( G 39 ) , Jiexi ( S 41 ) .

Supplementary points : 1 . Wandering bi , vessel bi : Geshu ( B 17 ) , Xuehai ( Sp 10 ) ; 2 . Painful bi : Shenshu ( B 23 ) , Guanyuan ( Ren 4 ) ; 3 . Fixed bi : Zusanii ( S 36 ) , Shangqiu ( Sp 5 ) ; 4 . Heat bi : Dazhui ( Du14 ) , Quchi ( LI II ) ; 5 . Tendon bi : Yanglingquan ( G 34 ) ; and 6 . Bone bi : Dazhu ( B II ) , Xuanzhong ( G 39 ) .

Explanation : The above prescriptions are formulated by selection of the local and distal points on the meridians supplying the diseased areas . The principle of the treatment is to remove obstruction from the meridians and collaterals and to regulate ying ( nutrient qi ) and wei ( defensive qi ) for elimination of wind , cold and damp . When the skin and muscles are diseased , shallow insertion should be used . When bones and tendons are affected , deep insertion with retaining of the needles is recommended . The methods of acupuncture and moxibus - tion depend on symptoms and signs . Houxi ( SI 3 ) communicates with the Du Meridian , and Shenmai ( B 6 ) with the Yangqiao Meridian . They are a set of the Eight Confluent points for the treatment of the diseases of the shoulder , back , lumbar region , legs , muscles , tendons and bones . Dabao ( Sp 21 ) is the major Luo - ( Connecting ) point of the spleen which connects qi of the whole body , and Geshu ( B 17 ) is the Influential Point of the blood . Combination of these two points can be used to treat general pain . Dazhui ( Du 14 ) and Quchi ( LI II ) are used to treat heat bi . Geshu ( B 17 ) and Xuehai ( Sp 10 ) have the function of activating and nourishing the blood . The selection is based on the principle : Wind will be naturally eliminated if blood circulates smoothly . Fengchi ( G 20 ) , the most important point for dispelling wind , can be combined with Geshu ( B 17 ) and Xuehai ( Sp 10 ) to treat wandering bi and vessel bi . Shangqiu ( Sp 5 ) and Zusanii ( S 36 ) strengthen the function of spleen and stomach and eliminate damp to relieve the fixed bi . Guanyuan ( Ren 4 ) and Shenshu ( B 23 ) strengthen the kidney fire and relieve the painful bi . Yanglingquan ( G 40 ) , the Influential Point of the tendon , is used to treat the tendon bi . Dazhu ( B II ) , the Influential Point of the bone , Xuanzhong ( G 39 ) , the Influential Point of the marrow , can be used together in treating the bone bi .

Remarks

Bi syndromes may include such diseases as rheumatic fever , rheumatic arthritis , rheumatoid arthritis , fibrositis , neuralgia and gout .

Cutaneous needle and cupping : Heavy tapping to induce slight bleeding along the two sides of the spine or the local area of the affected joint plus cupping is often used for the treatment of skin bi and muscle bi associated with numbness , and bone bi characterized by stiffness and limitation of movement or deformity of the joint .

Acupuncture is effective in treating mild bi syndromes . For severe cases , a long period of treatment is necessary . In chronic cases with exhaustion of ying ( nutrient qi ) and wei ( defensive qi ) and undernourishment of tendons and muscles , the bi syndrome may turn into a wei syndrome .