1. Acupuncture Treatment of Diseases
Orthopedics 2: Bi-Syndrome 痹症

2. Definition:
Bi-syndrome (Bi means obstruction) is characterized by the obstruction of qi and blood in the channels and collaterals caused by the invasion of pathogenic wind, cold and damp.
It is manifested as soreness, pain, numbness, heaviness and limited movement of the muscles, tendons and joints.
Or swelling and a hot sensation in the joint.
Bi-syndrome can be seen in RA, Rheumatic fever, OA, fibrositis and neuralgia in western medicine.

3. Causes and Pathogenesis :
External factors
Invasion of external evils which leads to obstruction of qi and blood in the muscles, joints, channels and collaterals.
Subdivided into Wandering Bi (wind), Fixed Bi (dampness) ,Painful Bi (Cold) and Heat Bi.
Internal factors
Constitutional weakness leading to deficiency of the defensive qi.

4. Clinical Manifestations:
Chief symptoms:
Pain of the muscles and joints with limited movement.

5. Clinical Manifestations:
Wandering Bi (Wind) type
Stated manifestations with:
Migrating pain.
May be febrile.
Aversion to wind.
Pale tongue with thin white coating.
Floating pulse.

6. Clinical Manifestations:
Painful Bi (Cold) type
Stated manifestations with:
Severe pain with fixed location that is relieved by warmth and worsen by cold.
No local redness and heat.
Light coloured tongue.
Thin white tongue coating.
Wiry, tight pulse.

7. Clinical Manifestations:
Fixed Bi (Dampness) type
Stated manifestations with:
Soreness and pain, heavy sensation, swelling or numbness of the limbs and joints.
Worsen by or may recur on rainy days.
Pale tongue.
White sticky tongue coating.
Slippery pulse.

8. Clinical Manifestations:
Heat Bi (Heat) type
Stated manifestations with:
Heat, swelling and excruciating pain of one or severe joints with limited movement.
Fever.
Aversion to wing.
Thirst.
Restlessness.
Red tongue.
Dry and yellow tongue coating.
Rapid pulse.

9. Treatment : General principle
Activate qi circulation and nourish blood to remove obstruction.
Strengthening kidney fire to expel the cold evil.
Improve the function of the spleen and stomach to eliminate dampness.
Expel wind and heat and relieve swelling.
Principle channels:
Local points.
Ashi acupoints.

10. Principle acupoints :
Local acupoints.
Ashi acupoint 阿是穴.

11. Prescription explanation (Principle acupoint):
Ashi acupoints 阿是穴:
Together with the local and distal acupoints along the involved channel chosen to activate qi and blood circulation in the local area and to regulate ying and wei qi in order to remove obstruction caused by wing, cold, damp and heat form the channels and collaterals.

12. Principle of treatment
Wandering Bi (Wind) type
Activate qi circulation and invigoarate blood to remove obstruction.
Expel wind and relieve swelling.
Principle acupoints: as stated
Supplementary acupoints:
BL 17 Geshu 膈腧.
SP10 血海.

13. Principle of treatment
Painful Bi (Cold) type
Activate qi circulation and nourish blood to remove obstruction.
Strengthening kidney fire to expel the cold evil.
Supplementary acupoints:
BL 23 Shenshu 肾俞
CV 4 Guanyuan 关元.

14. Principle of treatment
Fixed Bi (Dampness) type
Activate qi circulation and nourish blood to remove obstruction.
Improve the function of the spleen and stomach to eliminate dampness.
Supplementary acupoints:
SP 9 Yinglingquan 阴陵泉.
ST 36 Zusanli 足三里.

15. Principle of treatment
Heat Bi (Heat) type
Activate qi circulation and nourish blood to remove obstruction.
Expel wind and heat and relieve swelling.
Supplementary acupoints:
GV 14 Dazhui 大椎.
LI 11 Quchi 曲池.

16. TCM medical advises:
Avoid cold and raw food.
Avoid invasion by pathogenic wind, cold and damp.