Bi syndrome — shoulder

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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

LI15 Jianyu affected side

Large Intestine point at the front of the acromion; opens the joint where yangming crosses it
TE14 Jianliao affected side

Sanjiao point behind the acromion; frees the shaoyang course over the joint
SI9 Jianzhen affected side

Small Intestine point at the posterior axillary fold; releases the back of the joint
SI10 Naoshu affected side

Small Intestine point below the scapular spine; clears obstruction over the posterior capsule

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 of the shoulder joint with limited movementwandering 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.

About

The book's regional prescription for bi affecting the shoulder joint. It suits wind, cold, damp or heat bi; the type decides the technique, not the points.

Rationale

All four points sit on the joint itself, one on each yang channel that crosses it: hand yangming at the front, shaoyang at the side and taiyang behind. Needled together they ring the shoulder, so obstruction is opened on every surface of the capsule.

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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