As any clinician knows all too well, conditions involving pain are often the most common patient presentations in the clinic. As I treat patients daily for all types of pain ranging from joint pain to muscle pain to headaches, one common concept is now always a topic of the conversation: inflammation.
Discussions regarding the dangers of inflammation are found on every blog and social media site, and are the driving force behind marketing for the majority of supplements. I always use these discussions with patients to explain how Chinese medicine and acupuncture uniquely view the presentations of pain; and how each person’s pain, although similar in essence of discomfort, is expressed in unique pattern presentations.
Bi Syndromes
To help patients understand how their inflammatory conditions are unique, I discuss the important concept of bi syndromes – any disorder in which joint / muscle pain is the primary symptom. The term bi signifies painful stagnation, obstruction, or blockage; and besides the more obvious issues of qi stagnation / blood stasis, may be complicated by damp, cold, and heat.
Herbal Formulas Targeting Bi Syndromes
Relevant herbal formulas are generally grouped in the following categories: wind cold-damp bi, blood stagnation bi, cold bi, heat bi, and deficiency bi, with the specific “back pain” bi often added as well.
As patients frequently come in to appointments with literally bags of supplements targeting inflammation, I help them understand how this unique vision of seeing pain via the lens of bi syndromes is a more efficient and targeted therapy for their unique pain scenarios; and how Chinese medicine formulas can be used to quickly target their unique patterns, rather than just relying on generic “inflammation supplements.”
With that said, let’s focus on three herbal formulas that target the three most common bi syndromes I see in my clinic: wind cold-damp bi, blood stasis bi, and heat bi.
Wind Cold-Damp Bi
Wind cold-damp bi is often referred to as “wandering bi,” as the pain often moves around the body at various locations. However, it can also be consistent in location as well. This type of pain is typically aggravated by colder damp temperatures and weather fronts.
The pulse tends to be strong and slippery, but can also be strong and wiry; and the tongue presentation can range from a predictable pale body / wet coating to a pale, swollen body with teeth-marks and sticky coating.
The most common formula I tend to use and modify as needed in this syndrome is Juan Bi Tang, which disperses wind, removes damp, invigorates blood, boosts qi, nourishes blood, warms the channels and collaterals, and relieves pain.
This formula is particularly effective for patients who tend to also show deficiency symptoms or constitutional weakness and complain about changes in the weather exacerbating their pain. I also use this formula frequently with patients who are recovering from viral infections and experience old areas of pain resurfacing with concomitant fatigue.
For patients suffering from long-term pain with fatigue aggravated by weather changes and cold with acute flareups, I often combine this formula with the classic formula Du Huo Ji Sheng Wan – with extremely effective clinical results!
Blood stasis Bi
Blood stasis bi typically has the characteristics of more severe, often-stabbing pain with tingling, numbness, and often discoloration. Pain following injury, surgery, or degenerative disease can also fall into this category.
The most common herbal formula I use in these presentations is the classic Shen Tong Zhu Yu Tang, which invigorates the blood, expels blood stasis, opens the channels and collaterals, and relieves pain.
This formula is highly effective for almost any pain presentation and is particularly effective for pain which has been long-term due to old injuries. The pulse is typically wiry or choppy, often deep; the tongue is often dark purple with swollen sublingual veins (although often the tongue will not reflect this exactly).
I combine this formula with other pain formulas such as Juan Bi Tang and Du Huo Ji Sheng Tang for more expedient pain cessation. In such cases, the formulas are combined for two to three weeks until pain dramatically subsides, and then I remove this formula and keep the other formula, which targets the more obvious pattern. I personally feel this is one of the most underutilized formulas for pain!
Heat Bi
Heat bi typically presents with warm, swollen, red joints / muscles. This can often begin with wind cold-damp bi and blood stasis bi, and eventually progress into a heat presentation due to the buildup of blockage / stagnation. This heat bi syndrome can also occur rapidly in individuals with a warm constitution and due to chronic exposure to warm, damp climates.
Heat bi is the most obvious presentation that patients typically associate with the concept of inflammation. It is extremely common to see this syndrome in autoimmune conditions involving joints and joint tissue.
The formula Si Miao San is one of my most used herbal formulas for heat bi, having the actions of dispelling damp, clearing heat, dredging and opening the channels and collaterals, and relieving pain. Si Miao San contains the formulas Er Miao San and San Miao San, and is particularly effective for targeting pain and swelling in the knees and lower body overall.
I frequently use this formula in combination with Shen Tong Zhu Yu Tang for acute flareups of chronic injures with severe pain with body sensations of heaviness and weakness. This formula is extremely effective and shows how a seemingly simple four-herb formula can provide significant clinical results.
I also combine Si Miao Wan with Du Huo Ji Sheng Tang in cases of chronic back pain / knee pain due to surgery and heat sensations.
Clinical Takeaway
Teaching patients about bi syndromes can be an excellent opportunity to showcase the unique approach of Chinese medicine toward pain issues. Just as each person is a unique expression, so is their pain. Clinicians can also help patients see a much broader picture of the concept of “inflammation” and appreciate that even inflammation is not the same in each person.
