Bi Syndrome (Arthralgia Syndrome)
By Prof Engin CAN (Enqin Zhang)
Contact e-mail: firstname.lastname@example.org
Tel: 0044 078 461 93488
The word "Bi" 痹 in Chinese means an obstruction. Bi Syndrome refers the syndrome characterized by the obstruction of qi and blood in the meridians due to the invasion of external pathogenic wind, cold and dampness, manifested as soreness, pain, numbness, heavy sensation, swelling of joints, limbs, limitation of movements and so on.
As joint pain is one of most common symptoms in Bi syndrome, so some Western doctors and editors often translate Bi syndrome into “Arthralgia Syndrome”.
Clinically, Bi syndrome covers many different acute or chronic diseases in Western medicine, such as; rheumatic diseases, rheumatoid arthritis, osteoarthritis, fibrositis, lupus, gout, neuralgia and others.
In TCM there are many effective therapies for Bi syndrome, including acupuncture, moxibustion and herbal medicines.
Aetiology and Pathology
According to TCM theory and our clinical experiences, Bi syndrome can be caused due to either external factors or internal factors.
(1) External factors - the invasion of the muscles, joints and meridians by pathogenic wind, cold and dampness. In Chapter 43 of The Bi Syndrome of Plain Questions, a part of The Yellow Emperor’s Canon of Internal Medicine (BC475-221), says that “if pathogenic wind, cold and dampness invade the body together, it will lead to obstruction in the meridians and Bi syndrome may take place”. Clinically, we can also see that Bi syndrome is more common in the areas where the weather is cold, wet and windy.
(2) Internal factors - general weakness of the body as well as the defensive qi: This condition may cause the weakened resistance to pathogens, marked by dysfunction of skin and pores as well as defensive qi. As a result pathogenic wind, cold and dampness can easily invade the body causing Bi syndrome, this was described by the book -Prescriptions for Succouring the Sickness/Ji Sheng Fang, by Dr Yan Honghe, in 1253, which states “it is because of weakness of the body with poor function of defensive qi that invasion of pathogenic wind, cold and dampness can result in Bi syndrome”.
Now we can see that the basic pathology of Bi syndrome is the obstruction of qi and blood in the meridians, due to the invasion of pathogenic wind, cold and dampness. According to TCM theory, if the meridians are open and the qi and blood are circulating smoothly and normally, there will be no pain; but if the meridians are obstructed and the flow of qi and blood are blocked, pain will arise.
However, the constitution of the body differs from person to person, for example, with people that live in the same condition, some will suffers from Bi syndrome, while other will not be affected.
After suffering Bi syndrome, if a patient has excess yang by nature as well as accumulated heat, the wind-cold-dampness type of Bi syndrome may transfer into heat type of Bi syndrome.
Additionally, if pathogenic wind, cold and dampness stay in the meridians and cause an obstruction for a long time, the basic pathogenesis may change into blood stasis type of Bi syndrome. This is why clinically we often see some long-term patients with Bi syndrome manifested as blood stasis type.
According to Chapter 43 the Bi Syndrome of Plain Questions 素問 of Yellow Emperor’s Canon of Internal Medicine 黃帝內經 the Bi condition can also develop and turn into bone bi, tendon bi, blood- vessel bi, muscle bi and skin bi. Further more as the five zang organs are connected externally with their corresponding meridians and tissues, so pathogens linger in the meridians and tissues including bone, tendon, blood vessel, muscle and skin, they may gradually seep into the internal organs. For example, bone bi may develop into kidney bi; tendon bi into liver bi; blood vessel bi into heart bi (clinically this is most common); muscle bi into spleen bi; skin bi into lung bi and so on.
Clinically, we classify Bi syndrome into following 6 different types:
1. Wind Bi 風痹 (wandering arthralgia 行痹) syndrome: wandering arthralgia, accompanied with aversion to wind, white or greasy fur and floating pulse.
2. Cold Bi 寒痹 (painful arthralgia 痛痹) syndrome: severe stabbing arthralgia with fixed location as well as local cold sensation, alleviated by warmth, aggravated by cold, white fur and tight pulse.
3. Dampness Bi 濕痹 (fixed arthralgia 著痹) syndrome: soreness and fixed pain in the joints with local swelling and numbness, aggravated on cloudy and rainy days, white and greasy fur, soft and slow pulse.
4. Heat Bi 熱痹 (heat arthralgia) syndrome: arthralgia with local redness, swelling and burning sensation, accompanied with fever, sweating and thirst, yellow and greasy fur, slippery and rapid pulse.
5. Blood Stasis Bi 瘀血痹 syndrome: long-term intermittent arthralgia with swelling, rigidity and deformity of joints, numbness of limbs, purplish dim tongue with ecchymosis, white or greasy fur, thready and unsmooth pulse.
6. Heart Bi syndrome 心痹: palpitation, chest stuffiness, pectoral pain, shortness of breath, even bluish discoloration of face, lips and finger nail, cold limbs, dark red tongue with little coating, faint or hesitant pulse. (Notes: This type is often seen in the patents with mitral stenosis and mitral incompetence of rheumatic heart disease).
Bi Syndrome Seen in Western Medicine
In Western medicine, many diseases may be manifested as “Bi (arthralgia) syndrome”, but most of the time it can be seen in the following diseases:
It generally occurs as delayed sequel to group A haemolytic streptococcal infection. Rheumatism involves the connective tissues in the heart, joints, skin and vessels. It commonly appears in young adults between the ages of 20-30 and manifests as migratory polyarthritis. The large joints of extremities are most frequently affected, marked by redness, swelling, heat sensation and pain of the joints during acute stage, some patients may also have annular erythema, subcutaneous nodules, chorea and other symptoms. Laboratory tests show elevated erythrocyte sedimentation rate (ESR), positive C-reactive protein or increased white cell count etc. Repeated reoccurrences may cause heart valvular diseases.
2. Rheumatoid arthritis
Its aetiology and pathogenesis have not been fully known so far, but most scholars believe that it’s a kind of autoimmune disease with abnormity of humoral immunity and cellular immunity, manifesting as symmetric polyarthritis mostly with small joints of hands, wrists, and feet involved. This is marked by pain, swelling and rigidity of joints usually aggravated in the morning and alleviated by exertion.
Laboratory tests show blood sedimentation (ESR) increased, blood RF positive, etc. It doesn’t cause heart valvular disease.
It is also manifested as a type of Bi (arthralgia) syndrome, caused by the breakdown and eventual loss of the cartilage of one or more joints. Before the age of 45, it occurs more in males; while after age 55, more in females. It commonly affects the hand, feet, spine and large weigh-bearing joints such as the hips and knees, and manifests as joints pain and swelling, finally leading to limitation of joint mobility.
1. Acupuncture and Moxibustion
Dazhui (Du 14), Hegu (LI 4), Quchi (LI 11), Jianyu (LI 15), Waiguan (SJ 5), Wangu (SI 4), Huantiao (G 30), Xuanzhong (G 39), Jiaji (Extra15), Fengshi (G 31), Yanglingquan (G 34), Dubi (S 35), Kunlun (B 60)
Notes: you can choose local acupoints according to locations of Bi syndrome.
For Wind Bi (wandering arthralgia) syndrome, add:
Fengmen (B 12), Xuehai (Sp10)
For Cold Bi (painful arthralgia) syndrome, add:
Weiyang (B 39), Guanyuan (Ren 4)
For Dampness Bi (fixed arthralgia) syndrome, add:
Fenglong (S 40), Yinlingquan (Sp 9)
For Heat Bi (heat arthralgia) syndrome, add:
Quchi (LI 11), Erjian (LI 2).
For Blood Stasis Bi syndrome, add:
Xuehai (Sp10), Geshu (B17);
For Heart Bi syndrome, add:
Tongli (H 5), Xinshu (B 15).
Method: Select 6-12 acupoints for each treatment according to the location of pain.
For wind Bi (wandering arthralgia) syndrome, heat bi (heat arthralgia) syndrome and blood stasis Bi syndrome, the reducing method is advisable.
For cold Bi (painful arthralgia) syndrome and dampness Bi (fixed arthralgia) syndrome, the needles should be retained for 30 minutes and moxibustion is also recommended.
2. Herbal Therapies
Therapeutic principle: dispersing pathogenic wind, cold, and dampness.
1) Basic Herbal Recipe:
Modified Juan Pi Tang/Decoction for Treating Bi Syndrome 蠲痹湯 - for Bi syndrome of cold, wind and dampness types.
Source: Medical Revelations (Yi Xue Xin Wu) 醫學心悟, by Dr. Chen Guopeng, 1732
Qianghuo (Rhizoma seu Radix Notopterygii) 羌活 10g