How to Treat Different Types of Arthritis and “Bi Syndrome”

Bi Syndrome

Treating arthritis or any other painful obstructive syndrome appropriately requires assessment of the underlying energetic patterns and constitutional tendencies. There is no “one size fits all” treatment plan, but rather thoughtful consideration must be given to the individual’s specific symptoms and circumstances.

Bi Syndrome (or painful obstruction) includes various patterns of obstruction and stagnation of Qi and Blood by pathogenic factors of external Wind, Cold, Damp or Heat. These invade and lodge between skin, bones, muscles, and channels, resulting in signs and symptoms like joint and muscle pain, redness, swelling and inflammation, deformity, and stiffness. In addition, there can be internal engendered factors like Heat caused by vacuities and depressions in organs.

In all patterns of Bi syndrome related to arthritis and rheumatic conditions, Wind-Damp is the common underlying energetic. Joints are very susceptible to Dampness caused by dysregulation of Qi, Blood, and Fluids, which is further affected and influenced by climate and temperature.

Aggravation of Cold indicates a Wind-Damp-Cold Bi, and aggravation with swelling and redness by heat indicates a Wind-Damp-Heat Bi. Bi syndrome is commonly seen as a combination of patterns like this. Qi, Blood and Fluid stagnation patterns are also associated, as are underlying deficiencies.

Types of Bi and Herbal Applications:

The 4 main individual Bi patterns are Wind Bi, Damp Bi, Cold Bi, and Heat Bi. In addition, there is a 5th pattern called Bone Bi. Following are descriptions of the patterns and examples of types of treatment. Although examples of single herbs are mentioned for teaching, more often complex formulas of complementary herbs comprise the treatment strategy.

1. Wind Bi: Changeability and migrating pain that moves from joint to joint and/or fluctuates in severity and frequency are the distinguishing signs of Wind Bi. There is limitation of movement, possibly stiffness, tics, spasms, cramps, and itchiness. There may be aversion to wind and dizziness. The tongue may tremble or be deviated. The pulse is floating and slightly fast.

Appropriate Wind Bi Herbs: are stimulating, antispasmodic and diaphoretic, drain Dampness and dispel Wind. They would decrease or regulate Vata and possibly decrease Pitta or Kapha depending on their secondary characteristics. Examples are:

1. Black Cohosh Root (Actaea racemosa): is slightly cold, sweet, acrid and bitter. It affects the Liver, Lung, Spleen, Stomach and Large Intestine. It is antispasmodic, sedative, nervine and calms Liver Wind. Among its many uses, it is indicated for spasms, cramps, achy pains and rheumatism.
2. Cinnamon Branches (gui zhi): are sweet, pungent and warm. They affect the Lung, Heart, and Bladder, dispel Wind-Cold-Dampness, and release exterior Wind-Cold. They are diaphoretic, stimulant, anti-rheumatic, and diuretic, and are indicated for arthritic pain.

Adjunctive chi treatment with massage: sharp or pointed chi is used to eliminate any pathogens present and restore tissue healing processes. Soft balancing chi is used to reduce pain and spasm, and reset homeostasis. Spreading the chi softly will prevent migrating pains. Massage is always soft with local acupoints used that also serve to bring chi to specific areas.

Treating arthritis or any other painful obstructive syndrome appropriately requires assessment of the underlying energetic patterns and constitutional tendencies. There is no “one size fits all” treatment plan, but rather thoughtful consideration must be given to the individual’s specific symptoms and circumstances.

2. Damp Bi: Fixed pain in constant locations with soreness, heaviness, swelling, and numbness of joints and extremities characterize this pattern. Damp Bi worsens in damp weather. There may be cloudy or turbid urine, loose stools, and copious sticky discharges. There also may be little thirst and dizziness. The tongue possibly has a coat and the pulse may be slow and slightly slippery.

Appropriate Damp Bi Herbs: are diuretic, and drain Dampness and expel Wind. They decrease or regulate Vata, and may decrease Kapha.

1. Birch Bark, Leaf or Bud (Betula pubescens): is warm and spicy and acts on the Stomach and Spleen to dispel Wind-Damp and drain Dampness. It is a potent diuretic and is astringent. It is indicated in arthritis, achy joints and rheumatism.
2. Turmeric Rhizome (Curcuma longa): is warm, bitter and spicy. It acts on the Liver, Spleen, Stomach, and Gallbladder. It is anti-inflammatory, analgesic, astringent, invigorates the Blood, breaks up Blood Stasis, moves Qi and dispels Wind-Damp. It is also used in Ayurveda for Heat Bi symptoms.

Adjunctive chi treatment with massage: dryness is encouraged by removal of inflammation and excess fluid. Balancing and soft penetrating chi massage is used to accomplish this. 

3. Cold Bi: Severe fixed pain in one joint or muscle is a distinguishing feature of Cold Bi. There will also be limited movement of the affected area, and sensitivity to coldness with a preference for heat. Other possible symptoms include no thirst or sweating, chilliness, clear or white discharges, pale colour, and listlessness. The tongue may be pale and the pulse tight.

Appropriate Cold Bi Herbs: dispel Wind, dispel Cold, drain Dampness and Warm. They decrease or regulate Vata, and decrease Kapha.

1. Brewer’s Angelica Root (Angelica brewei radix): is warm, acrid and bitter, and affects the Kidney, Lung, and Bladder. Brewers Angelica dispels Wind-Damp, invigorates the channels, releases Wind-Cold, and moves Blood and Qi. It is indicated in Wind-Damp-Cold arthritis and rheumatism, especially where there is pain and stiffness of the upper body.
2. Ginger Officinale Rhizome (gan jiang): is hot and spicy. It affects the Lung, Spleen, Stomach, and Heart. It is stimulant, diuretic, warms the Interior, and dispels Wind-Cold-Damp. It unblocks the channels in Wind-Cold-Damp Bi.

Adjunctive chi treatment with massage: heat chi with primary balancing chi spread over and past the affected area to equalize the circulation. This dilates both proximal and distal circulatory channels to remove cold and warm tissues evenly. Massage technique is firm but gentle.

4. Heat Bi: Joints are red, hot to the touch and swollen. There is very severe pain with limitation of movement. Damp heat may cause fever and sweating, there may be a preference for cold, restlessness, irritability and strong body odors. The tongue may be red, and the pulse slippery and fast.

Appropriate Heat Bi Herbs: expel Wind, dispel Heat, Cool and drain Dampness. They decrease or regulate Vata, and decrease Pitta.

1. Meadowsweet (Fillipendula ulmaria): Cool, bitter and astringent, Meadowsweet affects the Liver, Bladder and Large Intestine to dispel Wind-Dampness, release Wind-Heat, drain Dampness, and alleviate spasms. It is an anti-rheumatic and anti-inflammatory and indicated in gout, rheumatism, arthritis, and tendonitis.
2. Sigesbeckia Orientalis (xi xian cao): Cold, pungent and bitter, it affects the Liver and Kidney to dispel Wind-Dampness, unblock collaterals, invigorate channels, calm Liver Yang rising and Liver Fire, clear Damp-Heat, expel Wind and calm Shen. Sigesbeckia is indicated in Wind-Damp-Heat with joint pain and inflammation, spasms, cramps, and numbness. If there is underlying Liver or Kidney deficiency, it strengthens bones and tendons. It calms Shen to treat restlessness and irritability.

Adjunctive chi treatment with massage: cooling and balancing chi is used to reduce heat and inflammation. Massage is firm and slow, and the tissues are soothed to naturally drain.

5. Bone Bi: Painful swelling of joints with deformity of the bones indicates chronic and persistent obstruction/stagnation turning to Phlegm. There is limitation of movement and contraction of tendons. There is no thirst, and possibly body heaviness with no sweating and a cough with copious white sputum. The tongue is possibly swollen with a sticky white coat and the pulse is slippery.

Appropriate Bone Bi Herbs: dispel Wind, alleviate Stagnation, drain Dampness and transform Phlegm. They decrease or regulate Vata, and decrease Kapha.

1. Clematis Chinensis Root (wei ling xian): is warm, pungent and salty, affecting the Bladder. Clematis root dispels Wind-Damp and transforms Phlegm and Fluids. It is indicated in arthritis and rheumatism of the Wind-Damp type and is good for alleviating restricted movement, numbness, and spasm due to its strong dispersing energy that unblocks and promotes flow of Blood and Fluids.
2. Guggul (Commiphora Mukul and associated formulas): Bitter, pungent, astringent, sweet and heating, Guggul works on all tissues as a deep detoxifier and anti-inflammatory. It scrapes the channels and treats cold congealing Kapha and Vata, phlegm and ama. It is indicated in arthritis, rheumatism, and gout. There are commonly used formulas that can be used in Bi treatment which combine guggul with other herbs, such as Yogaraj Guggulu, Punarnavadi Guggulu, Amritadi Guggulu, and Kaishore Guggulu.

Adjunctive chi treatment with massage: sublime chi with the introduction of shen (mind force) to dissolve abnormal calcifications. This is an advanced treatment method.