This article looks in detail at "Bi" syndrome and the Three Treasures remedies which treat it. "Bi", also called "Painful Obstruction Syndrome" indicates pain, soreness, or numbness of muscles, tendons and joints. It is probably the most universal of all diseases affecting practically everyone at some time or another of one's life in all parts of the globe.

"Bi", literally meaning "obstruction", can be caused by one or a combination of the following:

•       invasion of external Wind
•       invasion of external Cold
•       invasion of external Dampness

However, in prolonged cases of Painful Obstruction Syndrome other pathological conditions may play a part in the development of the disease. First of all, Wind, Cold and Damp will obstruct the circulation of Qi, Blood and Body Fluids. After some time, Phlegm may develop. Phlegm may lead to stasis of Blood. The stasis of Blood in the channels further obstructs proper circulation and therefore is another cause of pain. In many cases of chronic Bi syndrome, stasis of Blood is a factor. For example, Cold and Dampness are frequent causes of Painful Obstruction syndrome of the lower back. After repeated episodes of invasion of the lower back by Cold and Dampness, the prolonged retention of pathogenic factors may lead to chronic stasis of Blood in the area. The ache then becomes more or less constant and more severe. Stasis of Blood also causes pronounced stiffness due to stagnant Blood not nourishing and moistening sinews.

Therefore, external Wind, Cold and Dampness may lead to:

•       Qi stagnation
•       Blood stagnation
•       Phlegm

The above syndromes can (but do not always) occur against a background of Deficiency of either Qi, Yin, Yang or Blood.

DIFFERENTIATION OF BI SYNDROME

Wind Painful Obstruction Syndrome (Wandering Bi): caused by Wind and characterized by soreness and pain of muscles and joints, limitation of movement, pain moving from joint to joint.

Damp Painful Obstruction Syndrome (Fixed Painful Bi): caused by Dampness and characterized by pain, soreness and swelling in muscles and joints with a feeling of heaviness and numbness of the limbs, the pain being fixed in one place and aggravated by damp weather.

Cold Painful Obstruction Syndrome (Aching Painful Bi): caused by Cold and characterized by severe pain in a joint or muscle, limitation of movement, usually unilateral.

Heat Painful Obstruction Syndrome (Febrile Bi): originates from any of the previous 3 types when the pathogenic factor turns into Heat in the Interior. There is usually an underlying Yin deficiency. Characterized by pain and heat in the joints which feels hot to touch, redness and swelling of the joints, limitation of movement and severe pain.

Phlegm Painful Obstruction Syndrome (Bony Bi): Develops from any of the previous four types and is only ever chronic. Characterized by muscular atrophy, swelling and deformity of the bones in the joints.

THE THREE TREASURES REMEDIES

As always, a remedy must be prescribed only after a thorough case history has been taken, on the basis of the symptoms, pulse and tongue.

Clear Channels
Pattern: Damp-Heat in the joints, Blood stasis
Action: Drain Dampness, expel Wind, clear Heat, benefit the joints, invigorate Blood
Indications: sub-acute Painful Obstruction Syndrome from Damp-Heat, painful, swollen, hot and red joints, rheumatoid arthritis, gout
Tongue: Swollen with sticky-yellow coating
Pulse: Slippery, Rapid

Benefit the Sinews
Pattern: Blood stasis, Phlegm and Dampness in the joints, Kidney deficiency
Action: invigorate Blood, resolve Phlegm, expel Wind-Dampness, dry Dampness
Indications: chronic Bi, chronic joint pain with swelling of the joints and bone deformities, rigidity of joints
Tongue: Pale, red or purple, swollen, sticky coating
Pulse: Choppy or slightly Slippery

Brocade Sinews
Pattern: Chronic Wind-Damp Painful Obstruction (Bi) Syndrome with Liver-Blood and/or Liver-Yin deficiency
Action: Nourish Liver-Blood and Liver-Yin, benefit sinews, expel Wind-Dampness from the joints
Indications: Chronic soreness and slight swelling of the joints, dizziness, numbness or tingling or limbs.
Tongue: Pale and thin if there is Liver-Blood deficiency or red and thin without coating if there is Liver-Yin deficiency
Pulse: Choppy or Fine, possibly only on the left side.

Nourish the Root and Clear Wind
Pattern: chronic Wind-Damp Painful Obstruction (Bi) Syndrome occurring against a background of Kidney-Yin deficiency
Action: Nourish the kidneys and Liver, strengthen bones and sinews, expel Wind-Dampness in the joints
Indications: lower backache, knee-ache, sciatica, ache in joins
Tongue: Red without coating or with a rootless coating
Pulse: Weak on both rear positions or Floating-Empty

CASE HISTORIES

Case History 1

A 52-year old woman had been suffering from rheumatoid arthritis since the birth of her last child 17 years ago. Two months before she came for treatment, she had had a bad flare up. Her wrists, hands, knees, ankles and feet were extremely swollen and hot. She had a severe restriction of movement. Her pulse was Slippery-Rapid and her tongue was Red.

I diagnosed severe Damp-Heat in the joints with an underlying deficiency of Liver-Blood and Yin. I prescribed 9 tablets of Clear Channels a day to treat the Manifestation, and gave her acupuncture to treat the underlying deficiency. After 3 months, the flare-up had subsided. The joints were less swollen and hot and the patient’s mobility was less restricted.

Case History 2

A 64-year old woman had been experiencing a lot of pain in the fingers of both hands for the past year. On top of this, the fingers were swollen and quite deformed. She also complained of frequent lower backache and a weak feeling in her knees. She said she felt very stiff on waking in the morning and this feeling eased off gradually as the day went on but never quite left her. Her tongue was Pale and partially Peeled and her pulse was slightly Floating-Empty.
The pain and deformity in her fingers and handsrobably began as an invasion of Cold and Dampness but, over the year, turned into stagnation of Phlegm. There is an underlying deficiency of Blood (seen in the Pale tongue) and Yin (the tongue is partially peeled and the pulse Floating-Empty). The back and knee problems also point towards Kidney-Yin deficiency. I prescribed 6 Benefit the Sinews a day and after six months the condition was ninety percent better.

Case History 3

A 57-year-old woman had been suffering from chronic lower backache for the past ten years. An MRI scan had shown a severe deterioration of the intervertebral discs. Her backache was worse with exercise and better with rest. She also complained of hot flushes and nightsweats. Her tongue was slightly Red and completely without coating with some cracks in the central area. Her pulse was Slippery, and Weak on both Rear positions.

I diagnosed Kidney- and Liver-Yin deficiency and prescribed 6 tablets of Nourish the Root and Clear Wind a day. Given the severe deterioration of the intervertebral discs, this backache could not be cured completely but the continuous administration of the above remedy greatly relieved the pain and allowed her to lead a normal life.


By Giovanni Maciocia