Bi syndrome — general aching

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Textbook Prescriptions Musculoskeletal

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

Points

SI3 Houxi bilateral

Confluent point of the Du vessel; frees yang qi along the spine
BL62 Shenmai bilateral

Confluent point of the Yang Qiao; pairs with SI3 to free the back and limbs
SP21 Dabao bilateral

Great Luo of the Spleen on the lateral chest; treats pain spread over the whole body
BL17 Geshu bilateral

Influential point of the blood; moves blood to ease widespread pain
- ⚠ Pneumothorax

Needling Safety

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

BL17 Geshu
- ⚠ Pneumothorax risk: too deep an insertion can puncture the pleura. World Health Organization 1999, Section II §5.2 (Lung and pleura), p. 25

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 many joints and muscles at once, without a single focuswandering 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. SP21 lies over the lateral chest wall and BL17 over the upper back: needle obliquely and shallow to avoid pneumothorax. Widespread aching with fever, weight loss or morning stiffness needs medical assessment for inflammatory or systemic disease.

About

The book's prescription for bi when the aching is spread all over the body rather than in one joint.

Rationale

SI3 and BL62 open the Du and Yang Qiao vessels, which run the length of the back and legs. SP21, the great Luo point, governs pain that has no fixed place, and BL17 moves blood; together they treat the whole body rather than a region.

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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