Painful Joints ("Bi" Syndromes)

SYMPTOMS AND SIGNS: "Bi" is a group of symptoms caused by the obstruction of Qi and blood circulation. Symptoms include soreness, heavy, painful, or numbing of joints, muscle or tendons. In prolonged cases, contracture of the extremities, or even swelling or deformity of joints may be present. "Bi" syndromes are seen in rheumatic fever, rheumatic arthritis, rheumatoid arthritis and gout. 

WESTERN MEDICINE ABOUT R.A.: Rheumatoid Arthritis (RA) is a chronic syndrome characterized by nonspecific inflammation of the peripheral joints, usually symmetrical relative to both the extremity and the body; and resulting in progressive destruction of articular and periarticular structures. 

ETIOLOGY AND PATHOLOGY: Bi means obstruction of circulation of Qi and blood which usually results from invasion of the channels and collaterals by wind, cold and damp factors due to the following reasons: 

  1. Weakness of defensive (protective) Qi. 
  2. Wind, cold and damp factors attacking externally when perspiration occurs during exposure to wind or water; also dwelling in damp places, or wading in water or exposure to the changes in weather. 
  3. Predisposition of body type, such as Yang excessive or Yin deficiency body type can easily change those pathogenic factors into heat. 

DIFFERENTIATION

In Bi syndromes, wind, cold and damp factors usually combine together. During the diagnosis and treatments, we need to differentiate its type by checking which one is the predominant factor. Therefore, there are four major types of Bi syndromes mostly seen in clinic practice: Xin Bi (Moving Bi) predominated by wind factor; Tong Bi (Painful Bi) predominated by cold factor; Zhuo Bi (Fixed Bi) predominated by dampfactor; Re Bi (Febrile Bi) predominated by heat factors. In the chronic stage, they are usually accompanied by Qi, blood, kidney and spleen deficiency.

1. Xin Bi (Moving Bi):

Indications: Painful joints or four limbs, pain is moving
from joint to joint or from one place to another, stiff or limited joint movements, or some wind heat or wind cold symptoms, such as fever, aversion to wind, white thin or greasy tongue coating, floating pulse.

Treatment & Formulas: Dispel wind and promote the circulation; assisted by eliminating cold and damp factors. 

Products:

    • Yue Pi Jia Zhu Tang (Atractylodes Combination, Item No. 2205): This treats acute sore, or painful muscles and joints with wind cold and interior heat. 
    • Ge Gen Tang (Pueraria Combination, Item No. 2222): It treats Bi symptoms with wind cold signs, such as aversion to cold, stiff neck and back, no perspiration, etc. 
    • Su Jing Huo Xue Tang (Clematis and Stephania Combination, Item No. 2198): This treats the Bi syndromes with three factors combined together. 
    • Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon and Anemarrhena Combination, Item No. 2162): This treats wind cold Bi syndromes with the sign of internal heat, such as swollen joints, hot sensation at local area, white greasy plus yellowish tongue coating, rapid pulse.

2. Tong Bi (Painful Bi):

Indications: Painful joints, pain is fixed, and aggravated by cold, limited activities of joints, there is no red, swollen, or hot sensation in the painful areas, white thin tongue coating, wiry and tight pulse. 

Treatment & Formulas: Eliminate cold and relieve the pain, dispel cold and damp factors. 

Products:

    • Shi Wei Tso San (Astragalus and Aconite Formula, Item No. 2016): It eliminates cold and damp retention, dispels wind and promotes the Qi and blood circulation so as to relieve painful joints. 
    • Gui Zhi Jia Lin Zhu Fu Tang (Cinnamon Atractylodes and Aconite Combination, Item No. 2160): This dispels wind cold factor, and eliminates dampness at the same time. 

3. Zhuo Bi (Fixed Bi):

Indications: Painful joints, heavy or swollen, fixed pain area, heaviness of four limbs, limited activities, numbness of skin and muscle, white and greasy tongue coating, thready and slow pulse. 

Treatment & Formulas: Eliminate dampness and promote the circulation of channels and collaterals, dispel wind and cold factors at the same time. 

Products:

    • Ma Xing Yi Gan Tang (Ma-huang and Coix Combination, Item No. 2177): This dispels wind and eliminates dampness relieving the Bi obstruction. 
    • Fang Ji Huang Qi Tang (Stephania and Astragalus Combination, Item No. 2102): This eliminates dampness, dispels the wind factor and strengthens the Wei Qi (defensive Qi). 
    • Gui Zhi Jia Lin Zhu Fu Tang (Cinnamon Atractylodes and Aconite Combination, Item No. 2160): It warms and eliminates the dampness, dispels wind and cold factors. 
    • Su Jing Huo Xue Tang (Clematis and Stephania Combination, Item No. 2198):This eliminates dampness, dispels wind cold factors, and promotes the circulation of blood. 
    • Er Zhu Tang (Atractylodes and Arisaema Combination, Item No. 2002): This is atypical formula for the typical Bi Syndrome in predominance of damp factor, dispels wind and cold at the same time. 
    • Yi Yi Ren Tang (Coix Combination, Item No. 2266): It is the first choice of formulas to treat Zhuo Bi.

4. Re Bi (Febrile Bi):

Indications: Painful joints, local swollen and redness, refuse touching, feels better when cold, pain can move from one place to another, limited activities, usually multiple joints affected, mostly accompanied with wind heat symptoms, such as fever, aversion to wind, perspiration, thirsty, restlessness, etc. Dry and yellow tongue coating, slippery and rapid pulse.

Treatment & Formulas: Clear heat and promote the Qi and blood circulation, dispel wind and eliminate the dampness. 

Products:

    • Dang Gui Lian Tong Tang (Tang-kuei an Anemarrhena Combination, Item No. 2234): This is the first choice formula for febrile Bi syndrome. 
    • Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon and Anemarrhena  Combination, Item No. 2162): It treats Bi syndrome in late stages when wind, cold and damp factors changed into heat after long periods of stagnation. 

5. Bi Syndrome In Xu (deficiency) Type

(1). Bi Syndrome in Qi and Blood Deficient type:

Indications: Chronic painful joints, swollen and deformity of joints, limited activities, contraction of the extremities, numbness of four limbs or skin and muscles, general fatigue, shortness of breath, dizziness, blurry vision, poor appetite, loose stools, pale tongue body, white and thin tongue coating, weak pulse. 

Treatment & Formulas: Tonify the Qi and blood, promote the Qi and blood circulation so as to relieve the obstructions. 

Products:

    • Chuan Bi Tang (Chiang Huo and Tumeric Combination, Item No. 2276): It tonifies Qi and blood, dispels wind and cold factors, eliminates the dampness. 
    • Ba Xien Tang (Tang-kuei and Gentia Combination, Item No. 2009): It is used for chronic Bi syndrome in serious Qi and blood deficient situations. 
    • San Bi Tang (Tuhuo and Gentian Combination, Item No. 2022): It treats Bi syndrome in Qi, blood, and kidney Yang deficiency situations. 

(2). Bi Syndrome in Kidney Yin-Yang Deficient Type: 

Indications: Chronic painful joint, pale or swollen at local area, deformity or contraction of local area and extremities, pain worse at night, numbness in knees and feet, general fatigue, soreness and weakness of the lumbar region, seminal emission, prospermia, leukorrhea, dizziness and blurring of visions, pale and enlarged tongue body, white thin tongue coating in kidney Yang deficiency, red and shrink tongue body, dry and thin, or no tongue coating in kidney Yin deficiency, weak and slow pulse in kidney Yang deficiency, weak and rapid pulse in Yin deficiency. 

Treatment & Formulas: Tonify kidney Yang and Yin, promote the circulation of Qi and blood, dispel wind, cold and damp factors at the same time. 

Products:

    • Du Huo Ji Sheng Tang (Tuhuo and Vaeicum Combination, Item No. 2260): It treats Yang deficient Bi syndrome.
    • Zhi Bai Di Huang Tang (Anemarrhena, Phellodendron & Rehmannia Formula, Item No. 2123): It treats Yin deficient Bi. 

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