Bi syndrome — hip

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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

GB30 Huantiao affected side

Gallbladder point over the buttock; the main point for opening the hip
- ⚠ Nerve
BL37 Yinmen affected side

Bladder point on the back of the thigh; frees the posterior aspect
GB29 Juliao affected side

Gallbladder point at the lateral hip in front of the greater trochanter; frees the side of the joint

Needling Safety

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

GB30 Huantiao
- ⚠ Nerve injury has been reported after needling this point. Wu J, Hu Y, Zhu Y, Yin P, Litscher G, Xu S 2015, Table 3 (Peripheral nerve injury)

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 hip with difficulty walking or rotating the legwandering 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. GB30 is needled deeply near the sciatic nerve; withdraw slightly if an electric sensation shoots down the leg.

About

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

Rationale

GB30 and GB29 work the hip from the shaoyang side, behind and in front of the greater trochanter, while BL37 brings in the taiyang channel that runs down the back of the thigh. The three surround the joint on the lateral and posterior surfaces.

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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