PAINFUL OBSTRUCTION (BI SYNDROME)

GENERAL

Etiology	Invasion of Wind, Cold and Damp or Wind, Heat and Damp in the Meridians Weakness of the body due to Yang Deficiency Qi and Blood Deficiencies due to childbirth or long term illness causing Wei Qi Deficiency Overstraining, hence weakening the body A Yang excess constitution, a Yin Deficient constitution or long standing Wind-Cold-Damp, stagnation may turn into Heat Bi
Clinical Manifestations	With a strong constitution, the etiologic factors may include: Living for a long period of time in Cold areas Lacking adequate protection against Cold weather Prolonged exposure to Cold at work (air conditioning) Sleeping in areas exposed to Wind, rain, snow or fog Living in Damp climates Exposure to Wind and rain Working in water Exposure to Wind, Cold or Damp after physical exertion with sweating Entering the water while sweating Wearing wet clothes Chronic Bi can lead to Qi and Blood Stagnation with Phlegm Stasis. This generates swelling and joint deformation. This is much more difficult to treat. Special characteristics: Recalcitrant to treatment Joint swelling and pain Swelling is hard Pain is excruciating Limbs are numb Blood Stasis: T: Purple spots C: White P: Thin and choppy Phlegm Stagnation: T: Normal C: White and greasy P: Soggy and even It usually starts gradually. In the initial stages, treatment is aimed at relieving the Excess condition. Secondary phase - Excess type: The pathogen has not been cleared and moves deeper into the tissues and organs. Chest Bi - Heart blockage: Uncomfortable feeling in the chest Palpitations Asthmatic panting Irritability
Treatment Principle	Eliminate Wind Warm Cold (Clear Heat) Expel Damp Clear the Channels
Herb Formulas	Juan Bi Tang San Bi Wan Jia Jian Gan Cao Fu Zi Tang Early-Stage: Ma Huang Tang Ge Gen Tang Yi Yi Ren Tang Ma Huang Jia Zhu Tang Da Qing Long Tang Yue Bi Jia Zhu Tang Yue Bi Tang Qiang Huo Sheng Shi Tang Wang Qiang Huo Sheng Shi Tang Shen Qiang Huo Sheng Shi Tang Advanced cases: Feng Shi Han Tang Shoulder pain so severe, it feels like it is about to break off: Chai Hu Gui Zhi Tang Chinese Patent Medicine: Shuang Bao Su Kou Fu Ye Bei Jing Feng Wang Jing Bei Jing Ling Zhi Feng Wang Jing Bei Jing Feng Ru Jing Pian
Points	General pain: 1. GB-30, GB-34, GB-39, LI-4, LI-11, LI-15, SJ-4, SP-21, ST-41, UB-17, UB-62 2. HT-3, GB-38, LU-5, SJ-10, UB-40 3. SI-3, UB-62, SP-21, UB-17 Fever: DU-14 Head and face: Distal points: LI-4, ST-44 Proximal points: SI-18, ST-2, ST-3, ST-6 Ear: Check point, Mandible, Maxilla, Ear Shenmen, Sympathetic Neck and back of the head: 1. DU-14, GB-20, UB-10 2. Anmian, DU-14, LU-7, Luozhen, SI-3 Chest and ribs: GB-34, LIV-14, PC-5, PC-6 Back and spine: DU-26, Huatoujiaji, Niushangxue, SI-3, UB-23, UB-37, UB-40, UB-52 Mandibular joint: 1. ST-7, GB-2, LI-4 2. LI-4, SI-19, SJ-17, ST-7 Ear: 1. Ahshi, Sympathetic 2. Ahshi, Sympathetic, Shenmen Joint deformity: UB-11 GB-39, ST-40, UB-11 Upper limbs: 1. DU-14, LI-4, LI-10, LI-11, LI-15, LU-2, SI-3, SI-11, SJ-3, SJ-5, SJ-10, SJ-21 2. Baxie, LI-4, LI-11, LI-15, SJ-5 Pain in the shoulder joint: 1. LI-15, SI-10, SJ-14, SJ-15, SJ-19, Jianneiling 2. SI-9, LI-15, SJ-14 3. LI-15, SI-9, SI-10, SJ-14 4. SJ-14, SI-11, LI-15, 5. Jianneiling, LI-15, SJ-14, SI-11, SJ-3, GB-34 6. GB-21, GB-34, Jianhou (1.5 cun superior to the posterior axillary fold), Jianneiling, LI-15, LU-2, LU-5, LU-9, SI-9, ST-38 Shoulder pain so severe, it feels like it is about to break off: SI-6, UB-10 Pain in the scapula: 1. LI-11, UB-43, SI-12, SI-14, UB-13 2. SI-11, SI-12, SI-14 UB-43 Pain in the elbow: 1. LI-4, LI-11, LI-10, LU-5, PC-3, SJ-5, SJ-6, SJ-10 2. LI-4, LI-11, LU-5, SJ-5, SJ-10 3. LU-5, SI-4 4. LI-4, LI-11, SJ-10 5. HT-3, LI-4, LI-11, LI-12, SJ-10 Pain in the forearm, wrist and hand: LI-5, PC-7, SI-4, SI-5, SJ-4, SJ-5 Pain in the wrist: 1. SJ-4, SJ-5, LI-4, LI-5, LI-11, LU-8, LU-9, SI-3, SI-5 2. SJ-4, PC-7, Sifeng, Shangbaxie 3. SJ-4, SI-5, SJ-5 4. SI-4, LU-9 5. LI-5, LI-10, SI-4, SJ-4, SJ-5, PC-7, Sifeng, Shangbaxie Pain of the metacarpals: LI-5, LI-10, SI-4, SJ-4, SJ-5, PC-7, Sifeng, Shangbaxie Stiffness and pain of the fingers: 1. SI-5, SI-3, LI-4 2. SJ-4, PC-7, Sifeng, Shangbaxie 3. Source points according to the nerve, SI-3, LI-3, Baxie 4. SI-3, SI-4 5. LI-5, LI-10, SI-4, SJ-4, SJ-5, PC-7, Sifeng, Shangbaxie Numbness and pain in the fingers: 1. SI-3, SI-4, LI-3, Bafeng, Baxie, Shixuan 2. SJ-4, PC-7, Sifeng, Shangbaxie 3. Baxie, SI-3, SJ-3, SJ-5 Pain in the back: DU-3, DU-12, DU-26 Pain in the spine: 1. DU-2, DU-14, DU-16, GB-30, UB-13, UB-14, UB-40, UB-60 2. DU-2, DU-4, DU-12, GB-20, GB-25, GB-30, ST-41, UB-23, UB-40, UB-52, UB-60 3. Huatoujiaji, DU-15, UB-37 4. Huatoujiaji, DU-26, UB-37, UB-40 Lumbar pain: 1. DU-2, DU-3, DU-12, DU-26, UB-23, UB-25, UB-31, UB-32, UB-33, UB-34 2. DU-3 3. DU-3, Shiqizhuixia, UB-26, UB-30, UB-40, UB-60 4. KI-4, UB-64 Sacroiliac pain: UB-27, UB-28, Ahshi Lower limbs: 1. DU-2, GB-30, GB-31, GB-34, GB-43, LIV-7, ST-34, ST-36, ST-41, UB-32, UB-40, UB-60 2. Bafeng, GB-30, GB-34, GB-39, GB-40, ST-35, ST-36, ST-41 Lower back and legs: 1. GB-30, GB-34, UB-10, UB-25, UB-36, UB-37, UB-40, UB-60, Yaotong #1, Yaotong #2, Yaotong #3 Hip joint pain: 1. GB-29, GB-30, GB-39, ST-32, UB-54 2. Bleed the Jing-Well point of the Gall Bladder tendino-muscular channel 3. GB-29, GB-30, UB-37, UB-51 4. GB-41 or GB-42 + SJ-3 opposite + GB-40, GB-37, GB-34, GB-31 5. GB-41 + SJ-5, GB-29, Jiankua 6. ST-31, UB-36, UB-40 7. GB-30, GB-34, LIV-3, UB-65 8. GB-24, GB-30, GB-34, GB-39 Ear: Hip, Lumbar spine, Shenmen, Thalamus, Adrenal Endocrine Thigh pain: 1. GB-31, GB-34, ST-33, UB-36, UB-54 Lateral aspect of the thigh: GB-31, ST-32, UB-36, UB-37 Tibia pain: UB-57, UB-58 Knee joint pain: 1, GB-34, SP-9, ST-32, ST-35 (lateral), ST-35 (medial). UB-40, Heding 2. GB-34, GB-31, ST-33 3. ST-34, ST-35, GB-34 4. ST-34, ST-35, GB-33, GB-34, SP-9 5. Bleed UB-40, needle GB-34, SP-9 6. Heding, Xixia, GB-34, SP-9, ST-34, ST-35, ST-36 7. GB-34, LIV-7, LIV-8, Neixiyan, SP-6, SP-9, ST-33 8. LIV-8, SP-10, ST-34, ST-35 9. GB-34, SP-9, ST-35 10. Heding, ST-35 Numbness and pain in the legs: GB-39, ST-36, UB-57, UB-58 Ankle pain: 1. GB-40, KI-2, KI-3, KI-6, LIV-4, SP-5, SP-21, UB-60 2. ST-41, KI-3, SP-5, UB-60 3. UB-60, UB-62 4. GB-35, GB-40, KI-3, KI-8, ST-41, UB-60 5. GB-40, SP-5, ST-41 6. KI-3, ST-41, UB-60 With swelling of the ankle: + SP-6, SP-9 Toe pain: 1. Bafeng, KI-3, ST-41, UB-60 2. Bafeng, GB-40, SP-5, ST-41 With swelling of the toes: + SP-6, SP-9 3. Bafeng, ST-41 or ST-42 Metatarsophalangeal pain: Shangbafeng, GB-38, SP-4, SP-5, UB-65 Numbness and pain in the toes: 1. GB-44, LIV-2, SP-4, ST-44, UB-65, Bafeng 2. SP-4, UB-65, Bafeng Wind in the joints of the toes and fingers that cannot be flexed or extended: UB-58 To calm the mind and ease pain: DU-20, HT-3, HT-7, LI-4, LIV-3, PC-6, Taiyang Chest Bi - Heart blockage: HT-7, PC-4, PC-6 Chronic: Acupuncture + moxibustion Acute: Plum blossom area + GB-38, GB-41, SJ-5, SP-5 Swelling: 1. Plum blossom area + Plum blossom back Shu points of the corresponding area 2. REN-9, SP-9, ST-28, UB-39 moxa or moxa needle if no fever Muscular or early-stage Bi: Luo points on the opposite side Brachial pain: SI-7, + GB-20, GB-21, or SJ-15 Damage ring finger: SJ-5 (opposite side) Base of the thumb: LU-7, LI-6 (opposite side, LU-9 or LI-5 (same side) Hip: KI-6 (right side), GB-37 (left side) Pain behind the knee: GB-40, SP-4, UB-58 (opposite side) Summertime treatment (prevents recurrence in th winter): Upper extremities: moxa LI-11 Lower extremities extremities: moxa ST-36 Upper back : moxa UB-38 Lower back: moxa UB-23

WANDERING BI (XING BI) - WIND PREDOMINANT BI (FENG BI)

Clinical Manifestations	Migrating pain in the joints especially the : Shoulders Elbows Knees Wrists Fingers Upper back and neck Multiple joints Pain quality changes May move from soreness to numbness to aching Sensitivity varies Pain often appears abruptly, acutely or paroxysmal and then disappears Limited range of motion Chills and fever Aversion to Wind Symptoms are worse in windy weather Sore throat General body aches Maybe perspiration T: Pink C: Thin and white or Sticky and yellow P: Superficial and moderate
Treatment Principle	Eliminate Wind Warm Cold Expel Damp Clear the Channels
Herb Formulas	Juan Bi Tang Fang Feng Tang Fang Feng Tang Jia Jian Da Fang Feng Tang Da Qin Jiao Tang Qu Feng Tang Arthritis #1 For Wind Invasion With Underlying Yang Deficiency: Xiao Xu Ming Tang modified
Points	DU-14, GB-39, SJ-6 With a fever: + LI-11 With deformities: + UB-11 DU-14, DU-16, GB-20, GB-3, GB-34, LI-4, LI-11, LIV-3, PC-9, UB-11, UB-12 For general body aches, moving pain and a fever: LI-4, LIV-3 For muscle aches and spasms: GB-34, LIV-3 For Wind-Cold symptoms: moxa DU-14, DU-16 For Wind-Heat symptoms: DU-14, GB-20, LI-11 To dispel Blood and unblock the Channels: 1. DU-16, GB-20, GB-31, SI-12, SJ-17, SP-10, UB-12, UB-17 2. DU-1, GB-41, LI-11, SJ-5, ST-36, UB-40 3. DU-20, GB-20, GB-30 To disperse Qi and relieve external symptoms: 1. LI-4, UB-12, SJ-5, GB-31, GB-20 2. GB-41, DU-1, LI-11, ST-36, UB-40 3. UB-17, SI-12, DU-16, GB-20, UB-12, SJ-17, SP-10, GB-31 4. DU-20, GB-20, GB-30 DU-14, DU-16, GB-20, GB-31, LI-4, LI-8, LI-11, LU-7, SJ-5, SJ-10, ST-36, UB-12, UB-13 For predominance of Dampness: GB-34, LU-7, REN-9, SP-9, ST-40 UB-20 + General points

PAINFUL BI (TONG BI) - COLD PREDOMINANT BI (HAN BI)

Clinical Manifestations	Excruciating sharp, stabbing joint pain Pain alleviated by warmth and aggravated by Cold Pain with fixed location Few joints are involved The joints cannot be flexed or extended No local redness or Heat Painful area often feels cold to the touch Pain worse at night and better during the day Pain mostly affects low back and lower extremities Pain intense but short lived Pain changes over days or weeks Ankylosis (stiffness) of joint Aversion to Cold Maybe chills with a slight fever Anhidrosis Frequent nocturnal urination T: Pink or Pale C: Thin and white (thicker than for Wind-Bi) P: Superficial and tight or Wiry and tight - maybe slow
Treatment Principle	Warm the channels Activate Qi and Blood
Herb Formulas	Ma Huang Tang Ma Huang Jia Zhu Tang Ge Gen Tang Wu Tou Tang Wu Tou Tang Jia Jian Qu Han Bi Tang Yue Bi Tang Ma Xing Yi Gan Tang Fu Ling Tang Jia Jian Er Hao Bi Syndrome #1 Wu Fu Ma Xin Gui Jiang Tang With signs of toxicity: Lu Dou Gan Cao Tang With vomiting but no diarrhea: Ge Gen Jia Ban Xia Tang Early stage: Ma Huang Jia Zhu Tang Wu Ji San With exterior Deficiency: Gui Zhi Jia Fu Zi Tang With Liver and Kidney Deficiency: Da Fang Feng Tang
Points	LI-11, REN-6, ST-36 With pain in the upper extremities, shoulder and scapula: + SI-5 To regulate the Qi of the low back and legs: + UB-10 GB-30, GB-31, GB-35, LI-4, SJ-5, ST-34, UB-12, UB-13 Moxa DU-4, DU-14, REN-4, REN-6, ST-36, UB-20 Moxa REN-4, UB-23 Moxa REN-8, UB-43, moxa or moxa needle DU-4, DU-14, REN-4, REN-6, UB13, UB-23, needle LIV-13, REN-12, REN-17 For severe general Internal Cold: Moxa REN-8, moxa needle DU-4 For cold Bi affecting the joints: moxa needle SJ-4, ST-42 For cold Bi with Spleen Yang Deficiency: moxa needle REN-12, UB-20 For cold Bi with Spleen and Stomach Yang Deficiency: moxa needle REN-12, UB-20, UB-21 To warm and circulate channels and collaterals: LIV-3, moxa LI-4, ST-36, GB-34, GB-31, SJ-5, SJ-4, UB-23, REN-4 or Moxa UB-23, REN-4, GB-39 Arm pain: moxa needle GB-21, LI-8, LI-9, LI-10, LI-11, LI-13, LU-9 + General points

FIXED BI (ZHAO BI) - DAMP PREDOMINANT BI (SHI BI)

Clinical Manifestations	Numbness and heaviness of the extremities Soreness and fixed pain of joints Stiffness or numbness of the muscles or skin Pain worse on cloudy or rainy days Maybe peripheral or systemic edema Pain is alleviated by pressure and warmth Pain lingers and is recalcitrant to treatment Worse during cloudy or wet weather Limited movement Edema Maybe stifling sensation in chest Maybe anorexia or indigestion Maybe abdominal distention Maybe loose or semi-liquid stools T: Pink or Pale C: Greasy and white P: Slow, moderate and soft
Treatment Principle	Expel Damp Clear the channels
Herb Formulas	Yi Yi Ren Tang Jia Jian Han Shi Bi Tang Yue Bi Jia Zhu Tang Gui Zhi Jia Zhu Fu Tang Fang Ji Huang Qi Tang Fu Ling Tang Jia Jian Er Hao Gan Cao Fu Zi Tang For lower limbs: Yue Bi Tang For Wind Invasion With Underlying Yang Deficiency: Xiao Xu Ming Tang modified With Blood Deficiency and Blood Stagnation: Shu Jing Huo Xue Tang With Cold and/or Heat: Shu Jin Li An San
Points	DU-1, GB-30, GB-34, LI-13, SJ-8, SP-5, ST-32, ST-36, ST-38, UB-38 SP-6, SP-9 GB-34, LU-7, REN-9, SP-9, ST-40, UB-20 KI-5, REN-3, SP-6, SP-9, ST-28, UB-20, UB-28, UB-40 With weakness of the lower back: UB-23, UB-28 To activate urination: REN-3, SP-6, SP-9, UB-28 For a stronger effect: + KI-5 To eliminate Dampness and ease sinews: 1. SJ-6, GB-34, SP-5, SP-6, SP-9, LI-10, ST-36, ST-40 2. UB-20, SP-9 When affected by weather changes: 1. SJ-5, UB-35, ST-36, SP-5 2. SP-5, ST-38, ST-36 3. LI-13, ST-32, UB-38, GB-30, GB-34, SJ-8, DU-1 Lower back pain: moxa DU-2 Legs: GB-29, GB-30, UB-40 + General points

WIND-DAMP BI WITH DAMP ACCUMULATION

Clinical Manifestations	Acute joint swelling and pain, especially hands and feet Heaviness of the joints Numbness of the joints Stiffness of the joints Fever Heaviness of the body Coldness of the body Aversion to Wind Aversion to Dampness Dizziness Likes pressure Fatigue Pale complexion Preference for warmth Painful legs Difficulty walking Limitation of arm movement Nausea Vomiting Diarrhea Aversion to Food Windstroke T: Pale C: Thick and white or Greasy and white P: Thready and slippery or Floating and slippery
Treatment Principle	Eliminate Wind Resolve Dampness Reduce swelling Move Qi Warm the channels
Herb Formulas	Xi Tong Wan
Points	General points

WIND-DAMP-BI WITH BLOOD DEFICIENCY AND BLOOD STASIS

Clinical Manifestations	Muscle aches Joint pain Radiating pain in the legs Low back pain Edema Numbness in the lower extremities Pain in the trunk and extremities Abdominal pain Sciatica Aversion to Wind and Cold Knee pain T: Pale or Pink with purple spots C: Normal P: Choppy or Taut
Treatment Principle	Unblock and relax the channels Activate the Blood Break up Blood Stasis Dispel Wind-Dampness Strengthen the tendons
Herb Formulas	Shu Jing Huo Xue Tang
Points	General points

WIND-COLD-DAMP BI WITH INTERIOR HEAT

Clinical Manifestations	Fever and chills with fever predominant or with unremitting fever Severe joint pain Swelling with localized Heat Aversion to Wind and Cold Headache Dry mouth Thirst Irritability
Treatment Principle	Scatter Wind-Cold Expel Dampness Clear Heat
Herb Formulas	Da Qiang Huo Tang Gui Zhi Shao Yao Zhi Mu Tang
Points	Sedation technique DU-14, GB-34, LI-4, LI-11, SJ-5, SP-9, SP-10, ST-25, UB-12 followed by tonification at SP-6, ST-36, UB-20.

WIND-DAMP-HEAT BI

Clinical Manifestations	Generalized body aches and pains Irritability Heavy sensation in the shoulder and back Discomfort or a constricted sensation in the area of the chest and diaphragm Multiple sores, carbuncles furuncles or abscesses Redness Itching Persistent swelling Chest pain Fever Thirst Aching and painful extremities Aching and painful joints Unbearable swelling and pain of the lower extremities Shoulder stiffness T: Normal C: Greasy and slightly yellow P: Wiry and rapid or Soft and moderate or Soft, superficial and slow or Slippery and rapid or Deep and tight
Treatment Principle	Resolve Dampness Clear Heat Disperse Wind Stop pain Activate the Blood Tonify Qi and Blood
Herb Formulas	Dang Gui Nian Tong Tang Sang Zhi Shi Gao Zhi Mu Tang Xuan Bi Tang With Blood Stagnation: Shang Zhong Xia Tong Yong Tong Feng Wan
Points	DU-14, DU-20, GB-20, LI-1, LI-4, LI-11, LU-11, PC-5, SP-10, UB-12 With general Heat or fever: LI-4, LI-11 With Blood Heat: LI-11, SP-10 For Damp-Heat Bi: GB-34, LI-11, SJ-5, SJ-6, SP-9 + General points

HEAT (HEAT PREDOMINANT) BI (RE BI)

Clinical Manifestations	Arthralgia involving one or several joints of the extremities Knee swelling is frequent Local redness and Heat Swelling with excruciating pain Severe limitation of movement Pain better during the day and worse at night The pain is relieved by Cold Fever Sometimes slight chills and fever Thirst Dryness of the mouth and tongue Irritability Nervousness Restlessness Aversion to Heat Desire for Cold drinks Dark urine T: Pink or Red C: Thin and yellow or Dry yellow P: Rolling and rapid maybe slippery
Treatment Principle	Clear Heat Relieve toxicity Activate the Blood Clear the channels For Wind-Damp-Heat Bi: Eliminate Dampness
Herb Formulas	Bai Hu Jia Gui Zhi Tang Jia Jian Gui Zhi Shao Yao Zhi Mu Tang Jia Wei Xuan Bi Tang Shi Re Bi Tang Du Huo Ji Sheng Tang modified Heat Bi #1 Dang Gui Nian Tong Tang Early stage: Ma Xing Shi Gan Tang Liu Shen Wan With unremittingly high fever: Ma Xing Shi Gan Tang modified + Zi Xue Dan With red, swollen excruciatingly painful joints: Bai Hu Tang plus Xi Jiao Tang modified With marked Deficiency Heat: Zeng Ye Tang modified With combined Wind-Cold and Wind-Heat: Ma Huang Lian Qiao Chi Shao Dou Tang modified Gui Zhi Shao Yao Zhi Mu Tang With combined Damp and pathogenic Heat: Xuan Bi Tang For burning pain, inflammation, bleeding, autoimmune diseases and septicemia: Xi Jiao Di Huang Tang
Points	LI-4, ST-43 DU-8, DU-9, DU-11, DU-12, DU-14, LI-4, LI-11 To clear Heat and remove toxins: 1. LI-4, LI-11, SJ-5, UB-17, ST-44, GB-20, LIV-2 2. DU-14, LI-11 3. LI-4, LI-11, DU-14, DU-8, DU-9, DU-11, DU-12 4. DU-9, SI-4, LIV-2, LIV-13 Nourish Fluids by tonifying Spleen, Lung and / or Kidneys according to symptomatology. For severe cases, cool Blood and eliminate toxins: SP-10, LIV-2 + General points

STUBBORN (CHRONIC) BI (WAN BI)

Clinical Manifestations	Chronic Bi with many recurrences Joints are stiff and deformed Areas surrounding the joints are slightly purple Pain is excruciating Fixed location Maybe painful numbness Joint may be red, swollen and painful or Icy cold and worse in cold weather and better with warmth Maybe fever T: Purple spots C: White P: Thin and choppy
Treatment Principle	Break up Blood Stasis Resolve Phlegm Break up hardness Clear Damp-Heat or Expel Wind-Cold and Damp
Herb Formulas	Shen Tong Zhu Yu Tang Xiao Huo Luo Dan Da Huo Luo Dan Yi Shen Juan Bi Wan
Points	DU-11, DU-12, DU-14, two extra points four finger breadths lateral to DU-11 and 2 extra points four finger breadths lateral to DU-12 LI-4, LI-10, REN-12, SP-6, SP-10, ST-40, ST-35, SJ-6, UB-17 Sedation technique Ashi points, GB-41, LI-4, LI-11, LI-15, SJ-11, SP-8, SP-10, UB-17, UB-18, UB-57 After sedation the same points are moxaed with direct-skin moxa or by warming the needles. For Deficiency: + DU-4, REN-17, SP-6, BL-20, BL-23 + General points

SKIN BI (PI BI) (TISSUE) (SECONDARY PHASE)

Etiology	Invasion by Wind, Cold, Damp and Heat leading to Qi and Blood Stagnation of the channels and collaterals of the skin. Excess grief, over worrying - usually worse in Autumn
Clinical Manifestations	Numbness of the skin Local or general swelling Thickness of skin Cold sensations Shortness of breath Superficial breathing (panting) Blockage of collaterals by Wind-Cold (beginning stage): Swelling of the skin with pale color Low temperature Aversion to Cold Discomfort of neck and upper back Muscle pain Joint pain T: Pale C: White P: Tight and rough Accumulation of Phlegm-Damp in the collaterals: Swelling of the skin with tightness and thickness Heaviness of the head and body Lassitude Anorexia Chest fullness Abdominal fullness Loose stools T: Pale and flabby C: Thick greasy P; Wiry and slippery or Deep and slow Qi Deficiency with Blood Stagnation: Thick, hard skin Dry, rough skin Brown or purplish color Emaciation Dry eyes and mouth Dim complexion T: Thin with purplish color C: Scanty P: Deep, thready and rough Kidney Yang Deficiency: Thick, hard skin Skin tension Smooth, cold skin Dark brown color Cold extremities Lumbago Painful legs Hair loss Loose teeth Dizziness Impotence T: Pale C: Thin, white P: deep and slow
Treatment Principle	Blockage of collaterals by Wind-Cold (beginning stage): Dispel Wind Activate the Blood Dispel Cold Harmonize the collaterals Accumulation of Phlegm-Damp in the collaterals: Resolve Dampness Eliminate Phlegm Activate Blood and Harmonize the collaterals Qi Deficiency with Blood Stagnation: Tonify Qi Benefit Blood, Activate Blood Eliminate Blood Stasis Kidney Yang Deficiency: Warm the Kidneys T tonify Yang Activate Blood Eliminate Blood Stasis
Herb Formulas	Blockage of collaterals by Wind-Cold (beginning stage): Ma Huang Fu Zi Xi Xin Tang modified Accumulation of Phlegm-Damp in the collaterals: Ling Gui Zhu Gan Tang modified Qi Deficiency with Blood Stagnation: Tao Hong Si Wu Tong modified Kidney Yang Deficiency: You Gui Yin modified
Points	General points

LUNG BI (FEI BI) (ORGAN) (SECONDARY PHASE)

Etiology	Follows prolonged Skin Bi (Pi Bi) or is the result of external invasion
Clinical Manifestations	Dyspnea Shortness of breath Panting Chills / fever Chest fullness Chest oppression Anxiety Over worrying
Treatment Principle
Herb Formulas
Points	LU-9, LU-1, UB-13 + General points

MUSCLE BI (JI BI, ROU BI) (TISSUE) (SECONDARY PHASE)

Etiology	Invasion by Wind, Cold, Damp and Heat leading to consumption of muscle tissue. Excess rich, greasy food, alcohol, irregular eating habits
Clinical Manifestations	General symptoms: Muscle soreness and pain Muscle numbness Muscle weakness Paralytic sensations Heavy sensations of the limbs Heavy body Heavy head Extreme tiredness Fatigue on exertion Spontaneous perspiration Excessive perspiration with exertion Digestive problems Muscle emaciation or atrophy Invasion by Toxic Heat: Muscle pain Aversion to touch or pressure High fever Thirst Scattered red spots all over body Spots mostly on eyelids and face Spots bright red Restlessness Desires cold drinks Insomnia Maybe coma Constipation Dark yellow urine T: Deep red C: Dry, yellow P: Forceful and rapid Damp-Heat: Muscle soreness and pain Muscle swelling and heaviness Lassitude Feverish feeling Slight perspiration Anorexia Chest fullness Sallow complexion Loose stools T: Red C: Yellow and greasy P: Slippery and rapid Cold-Dampness: Muscle soreness and pain Muscle numbness Weak extremities Coldness and pain of the limbs Aversion to Cold Painful joints T: Pale C: White and greasy P: Deep, thready and soft Spleen and Kidney Deficiency: Muscle weakness and numbness Pale complexion Muscle softness and atrophy Emaciation Difficulty swallowing Aversion to Cold T: Pale C: White P: Deep and thready
Treatment Principle	Invasion by Toxic Heat: Clear Heat Remove toxins Cool the Blood Eliminate Blood Stasis Damp-Heat: Clear Heat Eliminate Dampness Circulate the collaterals Cold Dampness: Dispel Cold Resolve Dampness Circulate the meridians Spleen and Kidney Deficiency : Warm the Spleen and Kidneys Tonify Qi and Blood
Herb Formulas	Invasion by Toxic Heat: Xi Jiao Di Huang Tang modified Damp-Heat: Er Miao San modified Cold Dampness: Ling Gui Zhu Gan Tang modified Spleen and Kidney Deficiency: Muscle Bi #1
Points	General points

SPLEEN BI (PI BI) (ORGAN) (SECONDARY PHASE)

Etiology	Prolonged Muscle Bi or Excessive perspiration during exertion in a draft or Wind - due to Wei Qi weakness, pathogens may invade the abdomen directly.
Clinical Manifestations	Weakness of the extremities Chest oppression Vomiting Poor digestion Shortness of breath Cough with Phlegm Excessive watery saliva Chest fullness T: Pale, swollen with teethmarks C: Slippery or Greasy P: Weak and Slippery or Greasy
Treatment Principle
Herb Formulas
Points	SP-3, UB-20, LIV-13 + General points

VASCULAR BI (MAI BI) (TISSUE) (SECONDARY PHASE)

Etiology	Poor diet - too much food drink, and smoking causing Internal Heat which consumes Qi and Yin. Combined with External attack causes Blood Stagnation in the vessels. Worse in Summer. Wind, Cold, Damp, Heat and Toxin Invasion into the Blood vessels, leading to Qi and Blood Stagnation. Long-term presence of pathogenic factors leading to Qi and Blood Deficiencies.
Clinical Manifestations	General manifestations: Stabbing fixed pain Pain aggravated at night Painful muscles and joints Uneasiness in the Heart Uncomfortable sensations in the chest Distress in the chest Anxiety Depression Aversion to Cold Fullness in the body (like gas) Epigastric fullness Sudden shortness of breath Dryness of the upper throat Frequent belching Burning sensations on the skin Red or purple spots on or under the skin Weakness or disappearance of the pulse Numbness, soreness and pain of the affected limbs. Low temperature of the affected limb Numbness of the limbs Aggravation of the above symptoms by Cold Pale complexion T: Pale Blood Stasis due to Cold: Affected limb is cold Aversion to Cold Numbness of the limbs Worse with Cold Pale face T: Pale C: White P: Weak or disappeared Phlegm-Damp Accumulation: Affected limb is heavy and sore Weak limbs Difficulty walking Lassitude Chest fullness Anorexia T: Pale with teethmarks C: Greasy and white P: Weak or disappeared Toxic Heat with Blood Stasis: Affected limb is red, hot and sore Red face Headache Red, swollen joints with red spots Anorexia Perspiration Thirst Dry mouth Constipation T: Deep red or Purplish C: Yellow P: Rapid Qi and Blood Deficiency: Affected limbs are numb Emaciation Fatigue Anorexia Palpitations Pale face Dizziness Aversion to Cold T: Pale C: White P: Weak or disappeared
Treatment Principle	Weakness or disappearance of the pulse Warm the channels Dispel Cold Circulate Blood in the collaterals Blood Stasis due to Cold: Warm the meridians Dispel Cold and Circulate Blood Phlegm-Damp Accumulation: Eliminate Phlegm Resolve Dampness Circulate the collaterals Toxic Heat with Blood Stasis: Clear Heat Resolve Toxins Activate the Blood Qi and Blood Deficiency: Tonify Qi and Blood Circulate the collaterals
Herb Formulas	Blood Stasis due to Cold: Yang He Tang modified Phlegm-Damp Accumulation: Sang Zi Yang Qin Tang modified Toxic Heat with Blood Stasis: Si Miao Yong An Tang modified Qi and Blood Deficiency: Shi Quan Da Bu Tang modified
Points	General points + UB-17, SP-10

HEART BI (XIN BI) (ORGAN) (SECONDARY PHASE)

Etiology	Prolonged Vascular Bi or Heart Blood Deficiency plus a new attack of Wind-Cold-Damp
Clinical Manifestations	Blood Stasis pain symptoms Palpitations Dyspnea Asthma Frequent throat dryness Continuous sighing Restless Nervousness Always moving Excited or agitated behavior Anxiety Fear of everything Easily panic stricken
Treatment Principle
Herb Formulas
Points	HT-7, PC-4, PC-6 + General points

TENDON BI (JIN BI) (TISSUE) (SECONDARY PHASE)

Etiology	A Wind-Cold-Damp attack on someone who is frustrated, angry, depressed or quick tempered.
Clinical Manifestations	General Manifestations: Pain and weakness of the tendons and joints Joints can be bent but not stretched Excessive eating and drinking Excessive desire to eat (bulimia) Insatiability Nightmares Horrible dreams of fighting etc. Frequent urination Cold-Dampness: Contracting pain in the affected limb Heaviness Limited movement Pain worse at night Pain worse in Damp weather Preference for warmth T: Pale C: White, greasy P: Deep and thready or Slow and slippery Damp-Heat: Stabbing or burning pain along some channels Bitter taste in the mouth Dry throat T: Red C: Yellow and greasy P: Slippery and rapid Blood Stagnation: Stabbing pain with fixed location Dislike of pressure or touch Worse at night Worse when resting T: Purple C: White P: Choppy
Treatment Principle	Warm the channels Dispel Cold Eliminate Dampness Relax the tendons Cold-Dampness: Warm the channels Dispel Cold Eliminate Dampness Relax the tendons Damp-Heat: Clear Heat Eliminate Dampness Relax the tendons Harmonize the collaterals Blood Stagnation: Activate the Blood Eliminate Blood Stagnation Harmonize the collaterals Stop pain
Herb Formulas	Cold-Dampness: Tendon Bi #1 Damp-Heat: Si Miao San modified Blood Stagnation: Shen Tong Zhu Yu Tang modified
Points	General points

LIVER BI (GAN BI) (ORGAN) (SECONDARY PHASE)

Etiology	Prolonged Tendon Bi
Clinical Manifestations	Extreme weakness of tendons and limbs Headache (Liver Yang Rising) Frequent bad dreams Nightmares Thirst Frequent urination Costal pain Flank pain Hypochondriac pain and distention Abdominal distention Lumbago Low back pain Cold lower extremities
Treatment Principle	Disperse Wind-Dampness Stop Bi pain Tonify the Kidneys and Liver Tonify Qi Nourish the Blood
Herb Formulas	Du Huo Ji Sheng Tang
Points	LIV-3, LIV-14, UB-18 To circulate the collaterals and harmonize the tendons: GB-34, GB-37, GB-40, LIV-3, LIV-5, LIV-14, LIV-8, SP-6, UB-18 + General points

BONE BI (GU BI) (TISSUE) (SECONDARY PHASE)

Etiology	Wind-Cold Damp attacking a person with Kidney Qi (Jing) and Yang Deficiencies - caused by excessive sexual intercourse
Clinical Manifestations	Soreness and in the joints and bones Numbness of the body and limbs Heaviness of the body and limbs Stiff joints which are difficult to move
Treatment Principle	Tonify the Kidneys Nourish Jing and Blood
Herb Formulas	Du Huo Ji Sheng Tang modified
Points	Moxa general points plus UB-23, UB-11 + General points

KIDNEY BI (SHEN BI) (ORGAN) (SECONDARY PHASE)

Etiology	Prolonged Bone Bi
Clinical Manifestations	Curved back and waist Difficulty straightening up Stiff, swollen joints Alkalosis Weakness of the lower extremities Difficulty walking Hair loss Difficulty flexing or extending knees, elbows, shoulders, hips and trunk
Treatment Principle	Disperse Wind-Dampness Stop Bi pain Tonify the Kidneys and Liver Tonify Qi Nourish the Blood
Herb Formulas	Du Huo Ji Sheng Tang
Points	To warm the Kidneys and benefit the bones: KI-3, SP-6, REN-6, GB-39, GB-34 or KI-3, UB-23 , GB-25 + General points

SPECIAL BI (FU BI) INTESTINE BI (CHANG BI) (HOLLOW ORGAN) (SECONDARY PHASE)

Etiology	Pathogen reaches the Intestines, blocking Qi flow locally: Small Intestine: the Pure cannot be separated form the Impure. Large Intestine: some fluids may not be reabsorbed.
Clinical Manifestations	Abdominal swelling and distension Diarrhea Difficult urination Painful urination Severe thirst Soreness and pain
Treatment Principle
Herb Formulas
Points	LI-11, SI-8, UB-25, UB-27, ST-25, REN-4 + General points

SPECIAL BI (FU BI) URINARY BLADDER BI (BAO BI) (HOLLOW ORGAN) (SECONDARY PHASE)

Etiology	Pathogen reaches the Urinary Bladder, blocking Qi flow locally.
Clinical Manifestations	Lower abdominal swelling, distension, fullness and tenderness - worse with pressure Difficult urination Dysuria
Treatment Principle
Herb Formulas
Points	UB-40, UB-28, REN-3 + General points

DEFICIENT BI (XU BI) DEFICIENT QI AND BLOOD BI (QI XUE XU BI) (SECONDARY PHASE)

Etiology	Chronic Bi weakens Qi and Blood and the pathogen is retained. Constitutional Qi and Blood Deficiencies, severe hemorrhage or Kidney and Spleen Yang Deficiencies.
Clinical Manifestations	Bones and joints sore and painful Worse with movement Face is dull yellow Spasms or contractures of muscles and sinews Palpitations Asthenia Shortness of breath Spontaneous sweating Weight loss Poor appetite Diarrhea T: Pale C: None or White P: Soggy and Weak or Thin and Faint
Treatment Principle	Harmonize and Tonify Qi and Blood
Herb Formulas	Huang Qi Gui Zhi Wu Wu Tang modified Dang Gui Sheng Jiang Yang Rou Tang modified When Qi Deficiency predominates: Bu Zhong Yi Qi Tang modified When Blood Deficiency predominates: Si Wu Tang modified For Qi and Blood Deficiency with Liver and Kidney Deficiency: Du Huo Ji Sheng Tang modified San Bi Tang With Cold predominant: Du Huo Ji Sheng Tang modified With Heat predominant: Du Huo Ji Sheng Tang modified For pronounced Dampness with loose stools: Du Huo Ji Sheng Tang modified For Blood Stasis: Du Huo Ji Sheng Tang modified For Qi and Blood Deficiency with Qi and Blood Stagnation (contractions of the hands and feet): Gai Ding San Bi Tang
Points	REN-6, REN-4, ST-36, LIV-3, UB-18, GB-34, LI-4 Upper limbs: LI-15, LI-14, LI-10, SJ-14, SJ-5, SI-9, Jianneiling Lower limbs: GB-30, GB-31, GB-34, ST-36, ST-41, UB-60 Back: Huatoujiaji, UB-18, UB-23, UB-54 + General points

DEFICIENT BI (XU BI) DEFICIENT YANG BI (YANG XU BI) (SECONDARY PHASE)

Etiology	Long term illness leads to Yang Deficiency which may lead to Wei Qi Deficiency, allowing pathogens to easily penetrate deeply.
Clinical Manifestations	Painful, numb bones and joints Deformed bones and joints Localized Cold sensation Muscles and sinews atrophied Pale, lusterless face Cold body and limbs Spine bent forward (hunched) Weak, sore low back Weak, sore knees Profuse urination Watery stools Daybreak diarrhea T: Pale C: White P: Deep and Weak With Spleen Yang Deficiency : Anorexia Weakness Shortness of breath
Treatment Principle	Warm the Yang Augment Qi
Herb Formulas	Zhen Wu Tang modified With Excess Cold causing excruciating stabbing pain in the extremities: Fu Zi Ba Wu Tang When pain is eliminated, tonify Qi and nourish Blood, Nourish and warm Kidneys and Liver and strengthen sinews and bones with some of the following: Rx. Astragali Huang Qi, Rx. Angelica Sinensis Dang Gui, Hb. Epimedii Yin Yang Huo, Hb. Taxilli Sang Ji Sheng, Rx. Dipsaci Xu Duan, Rx. Morindae Ba Ji Tian, Rz. Cibotii Gou Ji, Cx. Eucommiae Du Zhong, Rx. Achyranthis Bidentatae Niu Xi, Lignum Pini Nodi Song Jie With severe pain: Yi Shen Juan Bi Wan Xiao Jin Dan With Qi Deficiency: Fu Zi Tang
Points	Moxa KI-3, GB-34, GB-39, SP-6, REN-6 Moxa DU-4, UB-23, UB-18, REN-6, REN-17, REN-12 + General points

DEFICIENT BI (XU BI) DEFICIENT YIN BI (YIN XU BI) (SECONDARY PHASE)

Etiology	Long term illness or excess hot drying herbs leads to Yin Deficiency, interfering with the nourishment of sinews and bones. Blood Deficiency can generate internal Wind, leading to tension and tightness of tendons and vessels.
Clinical Manifestations	Bone and joint pain is prolonged without improvement Sinews and vessels are tense and tight Pain is worse with movement Irritability General soreness and weakness Restlessness Night sweats Vertigo Tinnitus Facial flushing Hot flashes Unremitting low grade fever Afternoon fever Low back pain Knees weak Joints may be red, hot, swollen and deformed Significant decrease in range of motion Symptoms worse at night Dry mouth Anorexia Dry, hard stools T: Red C: Little or none P: Thready
Treatment Principle	Nourish Kidney and Liver Yin
Herb Formulas	Liu Wei Di Huang Wan modified Deficient Bi #1 Deficient Bi #2
Points	UB-23, KI-3, KI-15, KI-21, LIV-3 + General points

DEFICIENT QI, BLOOD AND KIDNEY JING BI WITH DAMP-HEAT

Clinical Manifestations	Weakness of the knees Soreness of the lower back Lumbago Atrophy of the leg muscles Lower back weakness Knee pain Difficulty walking Emaciation Impotence Poor memory Dizziness Night sweats Five-sole Heat Aggravation of the pain by Damp weather Pale complexion Profuse urination at night Tinnitus Hair loss Sensation of warmth Thirst Dry skin T: Red or Pale and flabby with teethmarks C: Little or Thin and white P: Thready and weak, especially in the Kidney positions
Treatment Principle	Tonify the Liver and Kidneys Strengthen the tendons and bones Eliminate Damp-Heat Tonify Kidney Jing Relieve rheumatic pain
Herb Formulas	Deficient Bi #3
Points	ST-25, Xiyan, Heding, SP-6, SP-9, GB-34, KI-3 + General points

KIDNEY JING DEFICIENCY BI WITH WIND-COLD-DAMP AND BLOOD STAGNATION

Clinical Manifestations	Low back pain Sciatica Leg pain Preference for pressure and warmth Pain worse at night Limitation of joint movement Local feeling of Cold Stabbing pain Muscle spasms Referred pain toward the legs Lower back weakness Nocturia Stiffness of the back Numbness of the legs Feebleness of the knees Tinnitus T: Pale or Purplish C: Thin and white or Thin, white and greasy P: Slippery or Wiry or Thready
Treatment Principle	Dispel Wind-Cold-Damp Invigorate the Blood Smooth the channels Harmonize the collaterals Benefit the muscles Tonify Kidney Jing Stop pain
Herb Formulas	Yao Tong Ling
Points	Huatuojiaji, DU-3, UB-23, UB-40, GB-30 For sciatica, use five or six of the following: UB-25, UB-26, UB-37, UB-54, UB-57, UB-60, UB-65, SP-6, ST-36 + General points

CHRONIC BI WITH PHLEGM ACCUMULATION AND BLOOD STASIS

Clinical Manifestations	Long-term Bi with joint swelling and possible deformity Limited flexion and extension T: Purplish C: White and greasy P: Choppy
Treatment Principle	Resolve Phlegm Eliminate Blood Stasis Circulate the collaterals Alleviate pain
Herb Formulas	Tao Hong Yin modified Tao Hong Yin Jia Jian Shu Feng Huo Xue Tang
Points	General points

YANG DEFICIENCY WITH INTERNAL COLD-DAMPNESS

Clinical Manifestations	Lower abdominal pain and Cold Abdomen feels chilled Aching bones and joints Muscle ache Whole body pain Aversion to Cold, especially at the back Cold limbs No Thirst Lower abdominal pain and Cold Abdomen feels chilled Maybe fever No thirst T: Normal C: White and slippery P: Deep and faint or Forceless or Choppy and slow or Wiry
Treatment Principle	Dispel Cold Warm the channels Assist Yang Dispel Dampness Relieve pain
Herb Formulas	Fu Zi Tang Dang Gui Si Ni Tang Si Ni Tang Yang He Tang
Points

BLOOD STAGNATION

Clinical Manifestations	Severe pain in the joints and muscles Numbness Poor circulation Constant, fixed pain The pain can result from, trauma, surgery or degeneration Muscle ache of the neck, back, legs and shoulder Hip pain Whole body pain Neck and spine pain Shoulder pain Elbow pain Pain at the waist Arm pain Low back pain Leg pain T: Dark C: Normal P: Choppy
Treatment Principle	Move Qi Activate the Blood Break up Blood Stasis
Herb Formulas	Huo Luo Xiao Ling Dan Shen Tong Zhu Yu Tang Qi Li San Die Da Wan Xue Fu Zhu Yu Tang Fu Yuan Huo Xue Tang
Points	Sedation technique Ashi points, GB-41, LI-4, LI-11, LI-15, SJ-11, SP-8, SP-10, UB-17, UB-18, UB-57 After sedation the same points are moxaed with direct-skin moxa or by warming the needles. For Deficiency: + DU-4, REN-17, SP-6, BL-20, BL-23

PHLEGM DAMPNESS IN THE UPPER JIAO OBSTRUCTING THE CHANNELS

Clinical Manifestations	Pain in the upper arm Aches and pains in the wrist, forearm and elbow T: Pink C: Slippery P: Slippery
Treatment Principle	Dry Dampness Transform Phlegm Dispel Wind Dredge the Channels Relieve pain
Herb Formulas	Er Zhu Tang
Points

WIND-PHLEGM

Clinical Manifestations	Chronic pain Puffy swelling Tremors Possibly itchiness Light headedness Chest discomfort Nausea Numbness Dizziness Vertigo Tinnitus Sputum in the throat Chest fullness and distention Epigastric fullness and distention Hypertension T: Dark and swollen C: Greasy P: Slippery and wiry or Soft
Treatment Principle	Resolve Phlegm Subdue Wind
Herb Formulas	Ban Xia Bai Zhu Tian Ma Tang Xiao Huo Luo Dan Da Huo Luo Dan
Points	Sedation technique followed by moxa: DU-3, REN-12, ST-36, ST-40, UB-13, UB-20, UB-43, UB-59 Sedation technique: GB-20, GB-31, GB-33, GB-38, LI-4, LI-11, LU-7, SJ-5

PAINFUL OBSTRUCTION (BI SYNDROME)

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