Bi syndrome — scapula

Star

Textbook Prescriptions Pain — Shoulder

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

Points

SI11 Tianzong affected side

Small Intestine point in the infraspinous fossa; frees the centre of the shoulder blade
SI12 Bingfeng affected side

Small Intestine point in the supraspinous fossa; releases the upper border
SI14 Jianwaishu affected side

Small Intestine point beside the upper thoracic spine; clears the medial border
- ⚠ Pneumothorax
BL43 Gaohuang affected side

Bladder point beside the scapula at T4; moves qi and blood along the inner edge
- ⚠ Pneumothorax

Needling Safety

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

SI14 Jianwaishu
- ⚠ Pneumothorax risk: too deep an insertion can puncture the pleura. World Health Organization 1999, Section II §5.2 (Lung and pleura), p. 25
BL43 Gaohuang
- ⚠ 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 over the shoulder blade, often spreading to the upper backwandering 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. SI14, BL43 and to a lesser extent SI12 lie over the apex of the lung or the chest wall: needle obliquely and shallow to avoid pneumothorax.

About

The book's regional prescription for bi pain of the scapular area, for any of the four bi types.

Rationale

Three hand-taiyang points map the shoulder blade from its centre to its upper and medial borders, and BL43 covers the inner edge from the foot-taiyang side. Local points along the channels that run over the scapula are the book's whole rationale for the bi prescriptions.

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.

📝 Notes

Public notes from the community and your own private notes on Bi syndrome — scapula.

No notes yet.

Back to Point Combinations