Acupuncture and Moxibustion,   Chinese Medical College teaching materials. Edited by Nanjing  Medical College. Shanghai science and technology publishing house.

Bi involves obstruction and blockage. An external evil attacks and invades the channels and collaterals, qi and blood become obstructed and unable to move smoothly which causes the emergence of limb and joint achiness, pain, and numbness.  A severe pathocondition, it is clinically quite commonly seen.

              Disease etiology and process

There are many reasons for the emergence of this disease such as improper care in daily life, unconsolidated defensive qi, vacant interstices, or sweating in a draft after overworking, wading through water and being veiled in cold, longtime residence and sleep in damp place, and so forth therefore resulting in wind-cold-damp intrusion overwhelming vacuous channels and collaterals with obstruction and blockage emerging as wind-cold-damp bi. Moreover, the cause can be exuberant body heat, with the contraction of a wind-cold-damp evil which depresses and transforms into heat and emerges as heat bi.

            Distinguishing the patterns

A) Wind-cold-damp bi: Joint achiness and pain, possibly one section of a muscle with severe numbness, with no recovery for several days. It can occur as limb hypertonicity [extreme tension of the muscles or arteries] and extreme cases of joint swelling and enlargement. Also within this experience of the three evils – wind, cold and damp, one may prevail and they are not the same and can therefore be distinguished. Wind prevailing is moving bi, cold prevailing is painful bi, and damp prevailing is fixed bi.

1)      Moving Bi: Upper and lower limbs, right and left, with pain upon walking and moving. The pain is not fixed in one place, and occasionally there is a combination of heat and cold in the local area. The tongue is yellow and greasy, the pulse is floating.

2)      Painful Bi:  Everywhere throughout the body or maybe only in local areas it is achy and painful. The pain has a fixed location, it is relieved by heat and exacerbated by exposure to cold. The tongue fur is white and the pulse stringlike and tight.

3)      Fixed Bi:  There is numbness in the flesh and muscles, the joints of the limbs are achy and painful, the pain has a fixed location, it is easily influenced by overcast and rainy days which causes the pain to worsen. The pulse is sogyy and languid and the tongue fur white and slimy.

B) Heat Bi:   Joint achiness and pain partially hot and swollen with pain so severe that it cannot even be approached, joint disability involving one or possibly more joints accompanied by fever, thirst etc. and is a whole body condition with dry yellow tongue fur and a slippery rapid pulse.

Treatment

The governing method for point selection is to follow the channel and treat distally far away from the affected area, the local area itself and A-shi points. For moving bi and heat bi use fine needles, draining method and shallow insertion. One can also use seven star needles with tapping method. For painful be, increase the amount of moxibustion, insert the needles deeply and retain the needle according to the severity of the pain. One can use intradermal needles or ginger moxa. For fixed bi apply both acupuncture and moxibustion, or warming needle, intradermal needles as well as cupping.

Presrcription

Shoulder area, LI-15, SJ-14, SI-10

Elbow and upper arm, LI-11, LI-4, SJ-10, AJ-5, LU-5

Wrist area SJ-4, SJ-5, LI-5, SI-4

Back area DU-26, Du-12, Du-3

Upper thigh and Hip, GB-30, GB-29, GB-39

Leg, UB-54, UB-36, GB-34

Knee, St-35, St-34, Sp-9, GB-40

Ankle, UB-62, Kid-6, Ub-60, GB-40

For moving bi add UB-17 and Sp-10

For painful bi add UB-23 and ren-4

For fixed bi add UB-23 and Sp-5

For heat bi add Du-14, LI-11 and a-shi points.

Explanation of the formula:

This formula is governed by the essential root of disease in the channels and collaterals. Accordingly, the selection of point locations is carried out in order to course and free the channels and collaterals’ obstruction of qi and blood, cause the channel qi to flow smoothly, strengthen the defensive and exterior qi, under the principle that wind-cold-damp will be unable to remain attached and the bi pain will be relieved.  Disease in the skin, muscles and flesh must be shallowly needled while disease in the sinews and bones must be deeply needled and the needle retained. According to the condition, use the appropriate treatment principles and method of operation and it should follow that the condition will change. Du-14 and LI-11 clear heat and induce sweat to treat beat bi; UB-17 and Sp-10 are essential points for quickening the blood and therefore treat moving bi. By moving blood, the wind will extinguish itself. For fixed bi select Sp-5 and St-36 on the basis of water and damp remaining due to spleen not transforming. Spleen rules the four limbs, so moving the spleen is the root treatment for damp, hence its use in order to strengthen the movement of the spleen and stomach and transform damp. As for longterm painful bi, yang qi declines, therefore moxa both ren-4 and UB-23 in order to benefit the source of the fire, stimulate the yang qi and expel the cold evil.