Bi syndrome — elbow

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Textbook Prescriptions Pain — Upper Limb

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

Points

LI11 Quchi affected side

He-Sea of the Large Intestine at the lateral elbow crease; opens the joint
LU5 Chize affected side

He-Sea of the Lung on the cubital crease; frees the front of the elbow
TE10 Tianjing affected side

He-Sea of the Sanjiao behind the olecranon; frees the back of the elbow
TE5 Waiguan affected side

Sanjiao point on the forearm; carries the effect down the shaoyang course
LI4 Hegu affected side

Yuan-Source of the Large Intestine; distal point that moves qi along yangming
- Pregnancy: contraindicated

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 of the elbow with stiffness on bending or straighteningwandering 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. LI4 is contraindicated in pregnancy.

About

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

Rationale

Three He-Sea points surround the elbow on the lateral, anterior and posterior sides, so each channel that crosses the joint is treated where it passes over it. TE5 and LI4 extend the same two yang channels towards the hand, adding distal pull to the local work.

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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