According to traditional Chinese medicine, osteoarthritis is analogous to Bi syndrome. Bi refers to stiffness and blockage of circulation of Qi and Blood in the meridians. Bi syndrome involves pain in muscles, tendons, bones and joints as well as difficult movement or deformation of these structures.1 Bi syndrome involving the musculoskeletal system is a result of invasion from Wind, Cold, Damp and Heat. In the authors opinion arthritis pain from Bony Bi syndrome is one of the most common reasons for cases to seek treatment with acupuncture and herbs with or without the use of Western therapeutics.
Musculoskeletal Bi syndrome can be divided into excess patterns associated with Wind, Cold, Damp and Heat; and bony Bi a deficiency pattern which includes kidney Qi, Yin and Yang. Bony Bi is the most advanced condition and the affected joints have chronic arthritis.
Wind Bi syndrome is also called wandering Bi and the patient shows signs of migrating pain. There is invasion of Wind-Cold- Damp, but primarily Wind from the exterior. The Wind obstructs Qi and Blood flow in the muscles, bones and meridians which cause pain. There is a rapid onset of clinical signs of pain in the joints. The pain gets worse when the patient is exposed to Wind. The tongue is pale with a thin coating and the pulse is superficial. The treatment principle is to eliminate the Wind and invigorate the channels, eliminate Cold and disperse Damp.
- Acupuncture Points: GB-20 (eliminate Wind), LIV-3 (invigorate Qi to eliminate Wind and Stagnation), BL-17 (invigorate and activate Blood), SP-10 (invigorate and activate Blood)
- Herbal Medicine: Fang Feng Tang (Siler Powder)
- Clear the Wind-Cold-Damp, move Blood and clear Stagnation
Cold Bi syndrome is also called painful Bi and the patient shows signs of severe pain. The primary pathogen is cold in addition there is a combination of Wind and Damp too. The coldness obstructs Qi and Blood flow. The joints are painful and there is restriction in their movements. The pain gets worse when the patient is exposed to cold and there is pain relief with heat exposure. The tongue is purple with a slight pale coating and the pulse is wiry and slow. The treatment principle is to eliminate the Cold and warm the Channels and also clear the Wind-Damp.
- Acupuncture Points: BL-23, Bai-hui, GV-4, Shen-shu, Shen-peng, local points (all points for warming Yang and eliminating Cold)
- Herbal Medicine: Du Huo Ji Sheng Tang (Dok’s Formula)
- Clear the Cold-Wind-Damp, tonify the Kidney Yang, nourish and move Blood and clear Stagnation
Damp Bi syndrome is also called fixed Bi and the patient shows signs of marked joint stiffness. The primary pathogen is Damp and in addition there is a combination of Wind and Cold. The Damp obstructs the flow of Qi and Blood. There is more stiffness than pain. The pain gets worse when the patient is exposed to cold and damp conditions and there is pain relief with heat and dryness. The tongue is pale with a greasy coating and the pulse is soft and slow. The treatment principle is to eliminate the Damp and the Wind-Cold.
- Acupuncture Points: SP-6, SP-9 (resolve Damp), ST-36, BL-20,BL-21 (strengthen Spleen to resolve Damp), local points invigorate Qi flow.
- Herbal Medicine: Yi Yi Ren Tang (Coix Formula)
- Clear the Damp-Wind-Cold, move Blood and resolve Stagnation
Heat Bi syndrome is also called febrile Bi and the patient shows signs of acute onset of local inflammation. This may happen in cases of myositis or immune-mediated polyarthritis. The primary pathogen is Heat. The Wind-Cold-Damp causes stagnation which turns into Heat. The patient has acute inflammation of the muscles or joints and this shows clinically as pain, redness, swelling and heat. The patient may have a fever. The tongue is red with a yellow coating and the pulse is strong and fast. The treatment principle is to clear the Heat and eliminate the Wind-Damp.
- Acupuncture Points: GV-14 (clears Heat and eliminates Wind, invigorates Yang, Qi and Blood), LI-4, LI-11 (clears Wind-Heat), ST-44 , Er-jian, Wei-jian (clears Heat)
- Herbal Medicine: Bai Hu Si Miao Tang
- Clear Heat-Wind-Cold-Damp
Bony Bi syndrome is the chronic form of the Bi syndromes and the bones are being affected. The patient has difficulty getting up and walking. Hip dysplasia, degenerative joint disease, spondylosis and intervertebral disc disease are all part of this syndrome. These are classified as deficiencies of Kidney Yang, Yin and Qi.
Kidney Yang Deficiency
The chronic exposure to Cold-Damp and aging leads to Kidney Yang Deficiency and the Kidney fails to support the bones, back and knees. In Kidney Yang Deficiency Bony Bi syndrome the patient’s back and extremities are cold. The lameness is worse in cold or damp conditions and the patient is seeking warm places. The tongue is pale and wet and the pulse is deep and weak. The treatment principle is to tonify the Kidney Yang and to eliminate the Wind-Cold-Damp.
- Acupuncture Points: BL-11 (strengthen bones), BL-23 (tonify Kidney), BL-40 (strengthen lower back and hind limbs), BL-60 (disperse Wind and relaxes the muscles), GB-34 (influential point for tendons and strengthens the hind limbs), GB-39 (influential point for bone marrow to strengthen the bones), Bai-hui (warm Kidney Yang and strengthen the back), Jian-jiao (classical point for canine hip dysplasia), combined with local points
- Herbal Medicine: Sang Ji Sheng San (Loranthus Powder)
- Tonify Kidney Yang and eliminate Wind-Cold-Damp Kidney Yin Deficiency (Bone Steaming)
The chronic exposure to Wind-Damp and Heat along with aging leads to Kidney Yin Deficiency and the Kidney fails to nourish the bones. In Kidney Yin Deficiency Bony Bi syndrome the patient is seeking cool places. The tongue is pink or red and the pulse is deep and weaker on the left side. The treatment principle is to tonify the Kidney Yin and to eliminate the Wind-Damp.
- Acupuncture Points: BL-23, KID-3 (tonify the Kidney), KID-1 KID-6, KID-10 (Tonify Kidney Yin), SP-6 (Tonify Yin), combined with local points
- Herbal Medicine: Qin Jiao San
- Nourish Yin and clear the false Heat, clear Wind-Damp-Heat
Kidney Yin and Qi/Yang Deficiency
In Kidney Yin and Qi/Yang Deficiency Bony Bi syndrome the patient has more severe arthritis and weakness of the back and limbs. The patient may seek either cool or warm areas. The tongue is either pale and wet or red and dry and the pulse is weak on both sides. The treatment principle is to tonify the Kidney Yin and Yang and to eliminate the Wind-Damp.
- Acupuncture Points: KID-3 (nourish Kidney and strengthen the low back), KID-10 (nourish Kidney Qi and Yin), BL-23(tonify Kidney), BL-26 (tonifies Yuan-source Qi), LIV-3 (move Stagnation), SP-6, SP-9 (strengthen SP, clear Damp, Tonify Yin), ST-36, LI-10 (general Qi tonic points), LI-11 (clear Wind-Heat and tonify Qi and Blood), Shen-shu, Shen-peng, Shen-jiao (classical points to tonify Kidney), combined with local points
- Herbal Medicine: Di Gu Pi San
- Tonify Kidney Yin and Qi and eliminate Wind-Damp
An 11-year old castrated male 70 pound mix breed dog that presented with chronic history of stiffness and arthritis (May 2007). Radiographs from November 2001 showed bilateral hip dysplasia. The patient was on a course of Metacam 1.5mg/ml 2.33mls once a day and Tramadol 50mg/tablet ½ - 1 tablet every 12 hours as needed for pain control.
On presentation he was very stiff in his hips and stifles. There was crepitance in hips and stifles that was not only felt but also audible on palpation. The owners complained that the western medications were not working. The patient preferred cool areas, was restless at night, panted all the time. His tongue was red and dry and his pulses were weak and deep on both sides. At this point the diagnosis was made of Bony Bi Syndrome with the Kidney Yin and Qi/Yang deficiency pattern.
The initial point formula included BL-11 (Influential point for the bones) strengthen the bones, BL-23 (Kidney Back-Shu point) tonify the Kidney, BL-40 (Commission of the middle) strengthen the low back and hind limbs, BL-54, GB-29, GB-30 local points for the hip, GB-34 (Influential point for tendons and ligaments, and local point for the stifle, ST-36 (Rear leg 3 mile point) tonify Qi and Blood and local point for the stifle, LI-10 (Front leg 3 mile point) balance, KID-3 nourish Kidney and strengthen lower back, GV-14 clear Heat and eliminate Wind, invigorate Yang, Qi and Blood, Bai-hui warm the Kidney Yang and strengthen the back for 15 minutes using dry needle technique. He was to be re-evaluated in one week.
The next appointment the owner reported that Sammy showed some improvement in his ambulation and sleeping better for the first 2 to 3 days and then the effects started to wean. The acupuncture sessions were preformed weekly for the next 4 weeks and then we added in Di Gu Pi San starting at 3 capsules every 12 hours. This herbal medicine was chosen based on his diagnosis. Di Gu Pi San nourishes Yin, clears the deficient Heat, tonifies the Kidney Yang and dispels Wind-Damp.
The patient continued to improve clinically despite the obvious progression of the boney arthritis. Ultimately the patient was becoming more painful and stiff and a year after adding in the Eastern therapies, needed to be humanely euthanized. The owner was convinced, as well as the staff, that had it not been for the acupuncture and herbal therapies, the patient would have not had the quantity let alone the quality of life that he had for his last year.
- Xie H. Xie’s Veterinary Acupuncture. Ames, Iowa: Blackwell Publishing 2007:247.
- Xie H. Chinese Veterinary Herbal Handbook 2nd Edition. Reddick, FL: Chi Institute of Chinese Medicine 2008:185.