Bi syndrome — toes

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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

SP4 Gongsun affected side

Luo-Connecting point of the Spleen on the medial arch; frees the big-toe side
BL65 Shugu affected side

Shu-Stream of the Bladder on the lateral border; frees the little-toe side
EX-LE10 Bafeng four points on each affected foot

Extra points in the toe webs; open the joints of each toe directly

Needling Safety

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

No cited needling data yet for EX-LE10. 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

numbness and aching of the toe jointswandering 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 when the toes are numb and painful, for any of the four bi types.

Rationale

SP4 and BL65 sit on the inner and outer borders of the foot, and Bafeng lies between the toes themselves. The pattern mirrors the finger prescription, with border points plus web points.

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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