Bi syndrome — knee

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Textbook Prescriptions Pain — Knee

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

Points

ST34 Liangqiu affected side

Xi-Cleft of the Stomach above the patella; relieves acute pain of the knee
ST35 Dubi affected side

Stomach point in the lateral eye of the knee; opens the joint space
EX-LE4 Neixiyan affected side

Extra point in the medial eye of the knee; pairs with ST35 to open the joint
GB34 Yanglingquan affected side

He-Sea of the Gallbladder and meeting point of the sinews; relaxes the tendons below the knee
- ⚠ Nerve
GB33 Xiyangguan affected side

Gallbladder point on the lateral side above the knee; frees the outer joint
SP9 Yinlingquan affected side

He-Sea of the Spleen below the medial knee; drains damp and frees the inner joint

Needling Safety

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

GB34 Yanglingquan
- ⚠ 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)

No cited needling data yet for EX-LE4. No flag here does not mean no risk.

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 knee, sometimes with swellingwandering 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. ST35 and Neixiyan enter the joint space: use strict asepsis and do not needle into a joint that may be infected.

About

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

Rationale

The two eyes of the knee open the joint space from both sides, ST34 and GB33 work above the joint and GB34 and SP9 below it. Six points thus encircle the knee on the yangming, shaoyang and taiyin channels that cross it.

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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