Bi-syndrome is a disorder resulting from the obstruction of meridians, sluggishness of qi and blood circulation after the invasion of pathogenic wind, cold, dampness or heat, and characterized by pain, numbness and heaviness of muscles, tendons and joints or swelling, hotness and limitation of movement of joints. Rheumatic arthritis, rheumatoid arthritis, osteoarthritis, tuberculous arthritis, pyogenic arthritis, muscular rheumatism, sciatica, gout, etc., may be classified and treated as discussed in this section.

Etiology and Pathogenesis

The deficiency of healthy qi and the invasion of pathogenic factors are two basic causes of this disorder. Low body resistance, lack of physical exercise and fatigue or weakening during menstruation and puerperium may lead to deficiency of healthy qi, and climatic variations and environmental change may induce the invasion of exogenous pathogenic factors such as wind, cold, heat and dampness. Owing to the difference of body constitutions and the variance of pathogenic factors, there are various types and manifestations of bi-syndrome. For example, a patient with yang-deficiency constitution is susceptible to the effects of wind, cold and dampness, and a bi-syndrome of wind-cold-dampness type may develop. A patient with a constitution of yang-predominance or yin-deficiency and yang-hyperactivity is susceptible to the effects of wind, dampness and heat, and liable to get the bi-syndrome of wind-dampness-heat type. A longstanding base of bi-syndrome may develop as follows: (1) Accumulation of cold, wind and dampness may form heat, or overuse of acrid-dry drugs may produce heat and consume yin; manifestations similar to wind-dampness-heat bi-syndrome occur. (2) Prolonged retention of pathogenic agents leads to stagnation of qi, blood and phlegm; ecchymosis, subcutaneous and periarticular nodules, swelling, deformity and limitation of movement of joints may ensue. (3) Prolonged illness leads to consumption of qi and blood and deficiency of the liver and kidneys, and the corresponding manifestations may occur. (4) Bi-syndrome may be complicated by an attack of exogenous pathogenic factors, and zang-fu organs may be involved, cardiac bi-syndrome being the common complication.

Syndrome Differentiation

A. Syndrome differentiation

(a) Bi-syndrome of wind-dampness-heat type is differentiated from that of wind-cold-dampness type by its characteristics of redness, swelling, hotness and pain of joints.

(b) Bi-syndrome with wind as the predominant pathogenic agent is characterized by migratory arthralgia, while that with cold as the predominant agent by localized and severe pain, and that with dampness as the predominant agent by the sensation of heaviness and numbness.

(c) Bi-syndrome at its onset usually appears as a superficies and sthenia-syndrome, and a chronic case of bi-syndrome appears as a combination of asthenia and sthenia syndromes.

B. Therapeutic principles For incipient bi-syndrome, expelling pathogenic factors should be the main therapeutic principle, including dispelling wind, dispersing cold, clearing away heat, eliminating dampness and dredging meridians and collaterals. For a weak patient suffering from bi-syndrome or a chronic case with deficiency of healthy qi, in addition to the therapy for expelling pathogenic factors, tonifying the spleen, liver, kidneys and blood should also be employed. For cases complicated by phlegm and blood stasis, activating blood circulation, dissipating blood stasis and masses and eliminating phlegm should be applied.

Classification and Treatment

A. Bi-syndrome of wind-cold-dampness type (a) Migratory bi-syndrome Manifestations: Arthralgia moving from one joint to another with limitation of movement, fever, aversion to wind, thin and white tongue coating and floating pulse. Therapeutic principles: Disperse wind and cold, dredge meridians, and eliminate dampness. Prescription: The Modification of Ledebouriellae Decoction
Radix Ledebouriellae 10 g
Radix Gentianae macrophyllae 10 g
Rhizoma seu Radix Notopterygii 10 g
Radix Angelicae Pubescentis 10 g
Ramulus Cinnamomi 6 g
Herba Ephedrae 5 g
Radix Clematidis 10 g
Rhizoma Atractylodis 10 g
Caulis Spatholobi 30 g

(b) Pain bi-syndrome

Manifestations: Localized and severe arthralgia which can be relieved by heat and aggravated by cold, no local redness or heat, limitation of movement, white and thin tongue coating and wiry and tense pulse.

Therapeutic principles: Warm the meridians, disperse cold and wind, and eliminate dampness.

Prescription: The Modification of Aconiti Praeparata Decoction

Radix Aconiti Praeparata 5-10 g
Herba Ephedrae 3-9 g
Ramulus Cinnamomi 6-10 g
Radix Paeoniae Rubra 12 g
Radix Glycyrrhizae Praeparata 6 g
Squama Manitis Praeparata 9 g
Radix Astragali 10 g
Rhizoma Zingiberis Recens 3 g
Fructus Jujubae 5 pcs

(c) Localized by-syndrome Manifestations: Localized arthralgia with heaviness and swelling of the joint, numbness of muscles and skin, white and greasy tongue coating and soft-floating and slow pulse.

Therapeutic principles: Eliminate dampness, dredge the meridians, and expel wind and cold.

Prescription: The Modification of Coicis Decoction

Semen Coicis 15-30 g
Rhizoma Atractylodis 10 g
Radix Stephaniae Tetrandrae 10 g
Radix Clematidis 12 g
Radix Ledebouriellae 10 g
Radix Angelicae Pubescentis 10 g
Rhizoma seu Radix Notopterygii 10 g
Ramulus Cinnamomi 10 g
Herba Ephedrae 3-6 g
Radix Aconiti Praeparata 5 g
Squama Manitis Praeparata 10 g

B. Bi-syndrome of wind-dampness-heat type

Manifestations: Migratory arthralgia with local hotness, redness, swelling and tenderness which can be relieved by cold, limitation of movement, fever, aversion to wind, sweating, thirst, intermittent appearance of erythema or subcutaneous and periarticular red nodules, yellow tongue coating and smooth and rapid pulse.

Therapeutic principles: Clear away heat, dredge the meridians, expel wind, and eliminate dampness.

Prescription: The Modification of White Tiger Decoction Adding Ramulus Cinnamomi

Gypsum Fibrosum 30 g
Ramulus Cinnamomi 6-9 g
Semen Coicis 15-30 g
Radix Ledebouriellae 10 g
Radix Stephaniae Tetrandrae 10 g
Rhizoma Anemarrhenae 10 g
Radix Paeoniae Rubra 10 g
Radix Glycyrrhizae 6 g
Radix Gentianae Macrophyllae 10 g
Caulis Lonicerae 30 g
Lumbricus 10 g

C. Wind bi-syndrome

Manifestations: Lingering arthralgia with swelling, rigidity, disformity and limited movement of joints, pain (being milder in daytime and aggravated at night), lumbago, desire for warmth and aversion to cold, irregular menstruation or emission and impotence, dark red or dull tongue with white or yellow and thin coating and wiry and deep pulse with weakness of chi pulse.

Therapeutic principles: Tonify the kidneys, nourish blood and tendons, expel wind and cold, eliminate dampness, and dredge the meridians.

Prescription: The Modified Decoction of Ramulus Cinnamomi, Paeoniae and Anemarrhenae adding Os Tigris Powder

Radix Rehmanniae Praeparata 12 g
Fructus Psoraleae 10 g
Rhizoma Drynariae 12 g
Radix Achyranthis Bidentatae 12 g
Ramulus Cinnamomi 6-10 g
Radix Aconiti Lateralis Praeparata 3-10 g
Herba Ephedrae 3-6 g
Radix Paeoniae Rubra 10 g
Radix Paeoniae Alba 10 g
Radix Ledebouriellae 10 g
Semen Coicis 15-30 g
Radix Clematidis 12 g
Squama Manitis Praeparata 10 g
Rhizoma Anemarrhenae 10 g
Os Tigris (decocted separately) 6-10 g

Furthermore, for the cases with a prolonged course and severe pain, reptiles and insects such as Agkistrodon Acutus, Zaocys, Squama Manitis, Scorpio Scolopendra, Lumbricus, etc., should be applied to dredge collaterals, arrest pain, expel wind and eliminate dampness. Guiding drugs are also used according to the location of pain to increase the therapeutic effect. For example, Rhizoma seu Radix Notopterygii, Rhizoma Chuanxiong, Rhizoma Curcumae Longae and Ramulus Cinnamomi are added for cases with pain of upper limb; Radix Achyranthis Bidentatae, Fructus Chaenomelis, Radix Stephaniae Tetrandrae and Caulis Akebiae for those with pain of lower limb; Radix Puerariae for those with cervicodynia; and Ramulua Taxilli, Cortex Eucommiae and Rhizoma Cibotii for backache. Besides, the regulation of the spleen and stomach should not be neglected.

Experiential Prescriptions

A. Caulis Trachelospermi (12 g), Radix Gentianae macrophyllae (12 g), Herba Lycopidii (12 g) and Fructus Liquidambaris 912 g); prepared as decoction; applicable to the mild case of wind-cold-dampness bi-syndrome.

B. Semen Coicis ( 15 g), Radix Achyranthis Bidentatae 915 g) and herba Siegesbeckiae (15-30 g); prepared as decoction; applicable to the mild case of bi-syndrome of wind-cold-dampness type.

C. Agkistrodon Acutus (1set) and Fructus Lycii (60 g) infused in one liter of white or yellow wine for at least 2 weeks; taken 1 to 2 times a day in small amount; applicable to cases of wind-dampness-cold bi-syndrome with a weak constitution.

Copyright 1995 Hopkins Technology