Bi syndrome — lumbar region

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Textbook Prescriptions Pain — Low Back

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

Points

GV3 Yaoyangguan midline

Du channel point below L4; frees the yang of the lower 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 lumbar regionwandering 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. Severe pain at night, fever, weight loss or leg weakness and numbness call for investigation for fracture, infection, malignancy or nerve compression first.

About

The book's single-point regional prescription for bi affecting the lower back, for any of the four bi types.

Rationale

GV3 lies on the midline of the lumbar spine, where the Du channel governs the yang qi of the back. Used alone it serves as the local point for the region, in keeping with the book's approach of choosing points on the channels that cross the painful area.

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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