Clear Bi Formulas with both warming and clearing applications:
        Internal decoctions for painful wind conditions.

Li Shou-Shan  (1922- )  Da Lian city, TCM residential doctor

Clinically, Bi patterns can be divided into two types, one type is a cold dominant pattern, wind-cold-damp Bi, and one type is a heat dominant pattern, wind-damp-heat Bi.  Regardless of which type of Bi pattern, all are a combination of wind evil and damp evil.  The nature of wind is apt to moving and changing, while damp evil is heavy, fixed, and stagnant, therefore, cold evil or heat evil must turn concurrent wind and damp conditions into Bi patterns.  Because the degree of the severity of these evils vary, and the physique, yin and yang differ, there is transformation into two different Bi patterns.  Clinically, holding this concept in mind can fuel greater understanding. 

On the topic of treatment methods, one often sees both vacuity and repletion in these patterns.  These are vacuity signs with repletion in the joints.  In treating the above pattern, one should simultaneously consider both signs, and at the root regulate and rectify qi and blood.  Consider adding classical herbs and acupuncture for complete resolution.  If one sees limb and joint aching pain in the disease which travels and is not fixed and bending and stretching is inhibited, or if there is aversion to wind, fever, white, thin or slimy tongue fur and a tight and string-like or soggy and moderate pulse, then this is a wind-cold-damp Bi pattern.  Treat by boosting the qi and harmonizing the blood, dispelling the wind and eliminating damp.  Use a warming and opening strategy.  For a formula, use huang qi gui wu wu tang with a modified gui zhi fu zi tang.  Herbs used are huang qi, gui zhi, chi shao yao, dan shen, prepared fu zi, qiang hou, gan cao and draft wen bin tang.  I f wind is abundant then add fang feng and qin jiao.  If cold is abundant, then add chuan wu and xi xin.  If damp is abundant, then add bai zhu and fang ji.  If pain exists in the upper body, then add ge gun and a slice of sheng huang.  If pain exists in the lower body then add chuan niu xi and sang ji sheng.

Case Study 1: male, 35 years old

Patient had neck, shoulder, back cold pain reaching down to both knee joints for the past 3 years.  Wet weather or getting cold intensified the pain.  Recently, because of the cold climate, there was an increase in the severity of his pain which influenced sleep.  The joints were cold and painful, bending was inhibited and caused sounds of friction.  The complexion was dull, the tongue was pale red and the fur was white and glossy.  The pulse was deep, stringlike and fine.  Diagnosis is wind-cold-damp Bi, with wind-cold particularly abundant.  Treatment regulated and supplemented the qi and blood, expelled wind and dispelled cold, and warmed and moved the collaterals.  A modified Wen Bi Tang was prescribed:

Huang qi(30g), dan shen (20g), gui zhi(15g), zhi bai shao(15g), prepared fu zi(15g), chaun xiong(15g), xi xin(5g), qin jiao(15g), qiang hou(15g), and gan cao(10g).

Patient continuously took 12 packets and his symptoms disappeared.  He then took Bu Zhong Yi Qi Wan to stabilize the effects.

If, in the disease, one sees joint and muscle pain where the joints are scorching hot, red and swollen, sensitive to touch, inhibited flexion which becomes better with the application of cold, where the swelling and pain moves and is not fixed, or simultaneous fiver, sweating or aversion to wind, thirst, vexation heat, with a red tongue and yellow fur, and a slippery and rapid or soggy pulse, this is wind-heat-damp Bi pattern.  The treatment principle is to boost qi, harmonize blood, expel wind, clear heat, and disinhibit damp.  Use a clearing and diffusing strategy.  Use the formula Huang Qi Gui Zhi Wu Wu tang and modified Bai Hu Tang.  Herbs used: Gui zhi, sheng shi gao, zhi mu, fang ji, chi shao yao, bai zhu, huang qi, dan shen, and draft qing bi tang.  If wind is abundant, then add qin jiao and fang feng.  If heat is abundant, then add huang bai and ren dong teng.  If damp is abundant add yi mi and gu shi.  If swelling and pain exists in the upper part of the body, add ge gen.  If swelling and pain exist in the lower part of the body, add chaun niu xi.  If there are erythemic nodes, add dan pi, ju xue teng and ren dong teng.