Bi Syndrome (or as Robert's dad calls it, the Wen-Ding-Dang)

Chronic pain is one of the most commonly treated conditions in our clinic. A National Health Interview Survey from 2007 found that about a quarter of adults in the United States experience some type of chronic pain, and in that year, about 3.1 million of them turned to acupuncture for relief. We notice that these chronic pain patients typically experience worse or more frequent pain in the colder winter months. I'll try to explain why that's the case. Let's discuss Bi Syndrome.


Bi Syndrome ( 痹证 bi zheng), also called "impediment syndrome" or "painful obstruction," is a Chinese Disease indicated by pain, particularly of the joints, and sometimes numbness. This is typically arthritis and arthralgia, lumbar disc disease, sciatica, gout, and pain from old injuries. The nature and location of the pain vary depending on the level of penetration of the pathogenic influences and whether cold or heat is also involved. The pain is caused by obstruction of the meridians - remember from an earlier blog post, we said, "If there is free flow, then there is no pain; if there is pain, then there is no free flow" (Tong zhi bu tong; bu tong zhi tong) - and with Bi Syndrome, the obstruction is caused by wind and dampness (and more often than not, cold, as well). Most acupuncturists will automatically think of wind-cold-damp obstruction when they hear Bi Syndrome because it most commonly presents as a combination of those three evils. 

When talking about the cause of Bi Syndrome, there is always this idea of pathogenic qi penetrating the body, at least to some degree, and entering the joint spaces (via the meridians that cross those joints). Wind, in Chinese medicine, is often thought to be the mechanism or vehicle by which pathogens enter the body. This is true for Bi Syndrome as well as infectious diseases - think of a virus that's "airborne." You can also think of wind as a representation of the weather, with cold and damp being characteristics of the atmosphere with regard to temperature and barometric pressure. How often did your grandmother predict rain or fog using her achy bones? That subtle yet noticeable change in the air is wind-dampness.

But how does it get inside your body? As I mentioned before, the wind-dampness penetrates into the interior tissues of the body and lodges in meridians associated with major joints. It enters through the couli or "interstices" of the body - the open spaces. On the surface of the body, these are your pores, and at a deeper level, these are the spaces between body tissues. In a healthy person, these interstices are closed, and the body is protected from invasion by external pathogens. When the qi is weak, however, the opening and closing of the pores is not properly regulated, and wind-dampness can get it. This is usually at or near the site of a weakened joint, as well. 

From Treatment Decisions Categorized According to Pattern by 19th century writer Lin Pei-Qin:

All [cases of] painful obstruction ... intrinsically [develop] from a primary deficiency of protective and nutritive qi. If the pores and interstices are not firm, wind-cold avails itself of [this] deficiency to assault the interior. The normal qi [then] becomes blocked by the pathogens and is unable to disseminate or move. As it lodges and stagnates, the qi and blood congeal and stagnate, which, over time, causes painful obstruction. 

If you consider back pain caused by disc degeneration or knee pain due to worn cartilage, there is or has been over a long period of time a deficiency situation at the local area. The lubricating and nourishing fluids that keep our joints working well are comprised of blood and yin fluid, so a deficiency of either allows these tissues to become malnourished and susceptible increased and premature wearing out. This deficiency also allows wind-dampness to enter and fill that space, obstructing proper circulation and further nourishment. When you sustain a trauma to an area, say a blow to the shoulder during your football days, you disrupt the qi at the site of the injury. The severity of the injury, ie the force of the blow, determines how deep that disruption goes. The mechanics of opening and closing of the couli and flow of qi, blood, and yin through the meridians at the area are all potentially disrupted. So whether it's a case of getting old and wearing out your joints or just one bad fall, car wreck, tackle, etc., that joint becomes vulnerable to invasion of wind-dampness and thus pain caused by Bi Syndrome.  

The herbal forumlas we used to treat these conditions have as their chief ingredients herbs that expel wind-dampness from the meridians, such as du huo, qiang huo, fang feng, or qin jiao. Depending on pattern, they are combined with assisting herbs from three other groups of herbs. The first group of herbs are blood-invigorating herbs such as chuan xiong, rou gui/gui zhi, niu xi, or dang gui. They are used because, as pointed out in the Convenient Reader of Established Formulas, "To treat wind, first treat the blood; when the blood moves, the wind will be extinguished." The second group of herbs are herbs that tonify the qi and nourish the blood, such as ren shen, huang qi, gan cao, dang gui, shao yao, or shu di huang. They work to support the body as well as mediate the drying and dispersing actions of the chief herbs. The third group includes herbs that tonify the Liver and augment the Kidneys such as du zhong, sang ji sheng, and niu xi. The Kidneys govern the bones, while the Liver governs the sinews. Where painful obstruction penetrates to the bones and sinews, usually in more chronic patterns that involve weakness of the lower back and knees, it is therefore essential to tonify the Liver blood and Kidney qi. 

In my clinical experience, I have found that emphasizing the treatment of blood stasis is paramount in treating Bi Syndrome. Of course, this is far from a new concept. Qing dynasty physicians already emphasized the role of blood stasis in the treatment of chronic pain. Wang Qing-Ren, contemporary of Lin Pei-Qin (quoted above), was a big proponent of this strategy and launched a full-scale attack on older treatment techniques in an essay entitled "Painful Obstruction Patterns are Characterized by Static Blood." Included in his seminal Corrections of Errors Among Physicians, his discussion declares: "Generally, [when] one drives out wind-cold or eliminates damp-heat, it becomes even more difficult to invigorate the already congealing blood." The herbs that expel wind and dry dampness also dry up blood and slow qi, so it's important to promote movement (and nourishment) at the same time. 

On a more practical level, trauma causes blood stasis! When you slip on the ice and bruise your tailbone, that bruise is literally static blood. The micro-tears in your rotator cuff that slowly form scar tissue are causing blood stasis, as that's what a scar is in Chinese medicine. Some bruises heal, and others only appear to fade from the surface - that's why that whiplash from a car wreck in 1995 still gives you trouble. Furthermore, maybe patients come to us after surgery (or surgeries), and the scarring created during the procedure, which in itself is a type of trauma to the local tissue, leads to more blood stasis, complicating the condition and creating more painful obstruction.