Bi syndrome — ankle

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Textbook Prescriptions Pain — Lower Limb

Essentials of Chinese Acupuncture (Beijing, Shanghai and Nanjing Colleges of Traditional Chinese Medicine, 1980) — the standard prescriptions of the Chinese colleges.

Points

ST41 Jiexi affected side

Jing-River of the Stomach at the front of the ankle; opens the joint
SP5 Shangqiu affected side

Jing-River of the Spleen in front of the medial malleolus; frees the inner front
GB40 Qiuxu affected side

Yuan-Source of the Gallbladder in front of the lateral malleolus; frees the outer front
BL60 Kunlun affected side

Jing-River of the Bladder behind the lateral malleolus; frees the outer back
- Pregnancy: contraindicated
KI3 Taixi affected side

Yuan-Source of the Kidney behind the medial malleolus; frees the inner back

Needling Safety

Cited hazards for these points. Tick what applies to the patient to see the cautions that follow from it.

Treatment Principle

Clear wind, cold and damp from the channels of the affected region so that qi and blood flow freely and the sinews loosen.

Indications

aching and stiffness of the anklewandering bi: pain moving from joint to joint, chills and fever, thin sticky tongue coat, floating rapid pulsepainful bi: pain eased by warmth and worse for cold, no local inflammation, thin white coatfixed bi: fixed aching, heaviness and numbness of skin and muscle, flares in damp or overcast weather, white sticky coat, deep slow pulsefebrile bi: hot, red, swollen, tender joints with fever and thirst, yellow coat, slippery rapid pulse

Method

Treat the painful region with nearby and distal points on the yang channels that cross it, and match the technique to the type: needling alone for wandering (wind) bi; moxibustion first with needling in support for painful (cold) bi, using intradermal needles or moxa on ginger slices if the pain is severe; needles and moxa together, or the warming needle, for fixed (damp) bi; and needling with the reducing method for febrile (heat) bi.

⚠ Cautions

A hot, swollen joint with fever needs septic arthritis excluded, and in a young patient rheumatic fever with carditis, before acupuncture; gout and rheumatoid arthritis need medical management alongside it. BL60 is contraindicated in pregnancy.

About

The book's regional prescription for bi affecting the ankle, for any of the four bi types.

Rationale

Five points ring the ankle: one at the front, two in front of the malleoli and two behind them. Each sits on a different channel crossing the joint, so the whole circumference is treated.

Clinical Notes

Whatever the region, the book adds GV14 when there is fever and BL11 when a joint has become deformed. It equates bi with rheumatic fever, rheumatic and rheumatoid arthritis, and gout.

Sources

Beijing College of Traditional Chinese Medicine, et al. Essentials of Chinese Acupuncture. Beijing: Foreign Languages Press, 1980. Chapter III, Bi Syndromes (Painful Joints), p. 369–371.

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