BI SYNDROME

Giovanni Maciocia
 BI SYNDROME INTRODUCTION

“Bi Syndrome" indicates pain, soreness or numbness of muscles,

tendons and joints from invasion of external Wind, Cold or
Dampness.

"Bi" (痹) evokes the idea of "obstruction". In Chinese medicine it

means pain, soreness or numbness due to obstruction in the
circulation of Qi and Blood in the channels caused by invasion of
exterior Wind, Cold or Dampness.

The invasion of external climatic factors is due to a pre-existing and

temporary deficiency of the body's Qi and Blood which allows the
Wind, Cold and Dampness to penetrate.
 The "Discussion on the Origin of Symptoms in
Diseases" Zhu Bing Yuan Hou Lun (Chao Yuan Fang):
"Bi Syndrome is due to the "Bi Syndrome is due
combined invasion of Wind, to deficiency of Qi
Cold and Dampness, causing and Blood which
swelling and pain. It is due to allows Wind to
a weak body condition and the penetrate.”
space between skin and
muscles [Cou Li] being open,
which allows the Wind to
penetrate".

Bi Syndrome is an affliction of the channels alone, not the Internal

Organs. The pain and soreness are caused by obstruction in the
circulation of Qi and Blood in the channels by exterior Wind, Cold
or Dampness.
 The "Origin of Complicated Diseases" (1773) says:
"Bi means obstruction. The three evils [Wind, Cold and Dampness]
invade the body, obstruct the channels, Qi and Blood cannot
circulate...[so that] after some time Bi Syndrome develops.”

The invasion of external climatic factors is due to a pre-existing and

temporary deficiency of the body's Qi and Blood which allows the
Wind, Cold and Dampness to penetrate.

The "Treatment Strategies for Assorted Syndromes" (1839) says:

“Bi Syndrome...is due to deficiency of Ying and Wei Qi and to the
space between skin and muscles being open, thus allowing Wind-
Cold-Dampness to ride the deficiency. Qi becomes obstructed by the
pathogenic factors, it cannot circulate, it stagnates, Qi and Blood
congeal, and in time Bi Syndrome develops."
Thus, the relative strength of the climatic pathogenic factors and the
body's Qi at any given time is crucial to the development of Bi
Syndrome. This explains why we can be exposed to climatic factors
every day for long periods without developing Bi Syndrome. It is
only when the climatic factors are temporarily and relatively stronger
than our body's Qi, that they become pathogenic and cause Bi
Syndrome.
It is important to stress however, that the deficiency of body's Qi
necessary for the development of Bi Syndrome is only relative, i.e. in
relation to the strength of climatic pathogenic factors. It is not an
absolute deficiency, otherwise that would mean that anyone who
develops Bi Syndrome suffers from deficiency of Qi or Blood which
is not the case. Thus, Bi Syndrome is an affliction of the channels
alone, not the internal organs.

However, in chronic Bi Syndrome and in the elderly, internal factors

(deficiency of Qi and Blood) are important contributory factors to the
development of the disease as will be explained shortly.
Bi Syndrome is an affliction of the channels alone, not the Internal
Organs. The pain and soreness are caused by obstruction in the
circulation of Qi and Blood in the channels by exterior Wind, Cold
or Dampness.
The two classes of channels that are most involved in Bi Syndrome
are the Muscle and the Luo channels.
It may be useful here to revise the structure of main and secondary
channels and the energetic role of the Five Shu points on the limbs
as this will be relevant when we discuss the treatment of Bi
Syndrome.

To each main channel corresponds a network of secondary channels

formed by Luo channels, Muscle channels and Cutaneous Regions.

The Muscle channels integrate muscles and sinews within the

channel system. They are more superficial than the Main
channels and run alongside muscles.
 They are involved in any
muscular pathology such
as muscular weakness or
stiffness that may appear
in Bi Syndrome.

The Muscle channels are always involved in the pathology of Bi

Syndrome and other musculo-skeletal syndromes as the pathogenic
factors and Qi stagnation affect the muscles. The main symptoms of
a Muscle-channel pathology are a muscle ache, a feeling of
heaviness of the muscles, numbness, spasm and stiffness.

The Muscle channels basically integrate muscles and sinews within

the channel system. They are also more superficial than the main
channels and run alongside muscles. They are involved in any
muscular pathology such as muscular weakness or stiffness that may
appear in Bi Syndrome.
The Cutaneous regions represent twelve areas of the skin under
the influence of the twelve channels. They are the most
superficial areas of the channels and the zones through which
pathogenic factors penetrate the body to cause Bi Syndrome.

They are, of course, also the areas

through which therapy is effected by
inserting the acupuncture needles.

Of the Shu points along the channels below elbows and

knees, three are particularly important in the pathogenesis
and treatment of Bi Syndrome.

The Stream (Shu) point is the point at which external

pathogenic factors such as Cold, Dampness and Wind penetrate
the channel. It is also the point of concentration of the Wei Qi.
The River (Jing) point is the point from which pathogenic factors are
deviated to joints and sinews where they settle. This is why
pathogenic factors can settle in a joint for a long time without
penetrating deeper and affecting the internal organs.
The Connecting (Luo) point is the starting point of the Connecting
channel. Since these channels flow in the surface affecting muscles
and sinews, the Connecting point has an important application in the
treatment of Bi Syndrome.
Within the flow of Qi dynamics, joints are
important areas of convergence of Qi and Blood.

Through joints, Yin- and Yang-Qi meet, Exterior and Interior

converge and Qi and Blood enter and exit. Joints are also the places
where pathogenic factors converge after penetrating the channels,
causing obstruction to the flow of Qi and hence local stagnation of Qi
and Blood. This stagnation accounts for the pain caused by external
pathogenic factors in Bi Syndrome.
Invasion of pathogenic factors is made easier if the body condition is
weak leading to malnourishment of the joints. It is also made easier if
the joints are weakened by over-use through work or certain sports. In
these cases, the external pathogenic factors penetrate the body and settle
in the joints more easily due to the pre-existing condition of deficiency
of Qi and Blood.
Finally, the anatomical entity Cou Li described in ancient texts should
be mentioned. The term Cou Li indicates on the one hand the striae of
skin, muscles and internal organs, and on the other hand, the "space
between the skin and muscles". It is with this last meaning that the term
is used in the context of Bi Syndrome. The "space between skin and
muscles" is the space where body fluids circulate (giving rise to sweat)
and where Defensive Qi moves, protecting the body from external
pathogenic factors. When the Defensive Qi is deficient and the body
condition is weak, the space between skin and muscles is said to be
"open" and thus prone to invasion of Wind, Cold and Dampness.
The Connecting channels (Luo channels) connect the Yin and
Yang paired channels at the level of the limbs. For example, the
Lung and Large Intestine channels are connected in the forearm
via their respective Connecting points, LU-7 Lieque and L.I.-6
Pianli respectively.

More important than this, in the context of Bi Syndrome, the

Connecting channels represent a network which distributes Qi to
more superficial parts of the body, not covered by the main
channels. For this reason the Connecting channels are called Luo
Mai as opposed to Jing Mai which are the main channels.
 Luo conveys whilst Jing conveys the
the idea of a idea of longitudinal line.
"net"

Thus the main channels are longitudinal lines, whilst the

Connecting channels are a network of channels irrigating the
more superficial regions of the body. In particular, the
Connecting channels branch out into a smaller network of tiny
channels of which there are three types, the Minute, Superficial
and Blood channels.

Any external manifestation on the skin is a reflection of an

imbalance in these smaller channels. For example a
discolouration on the skin reflects the presence of a pathogenic
factor in the Superficial channels, bluish or greenish indicating
Cold, and red indicating Heat. Small venules appearing on the
skin reflect the state of the Blood channels, red indicating Heat in
the Blood and purple indicating stasis of Blood.
 Superficial Luo
The Connecting channels are like a network
of small channels occupying the space Luo channel
between the Main channels and the skin;
they also have a deeper energetic layer that Main channel
is deeper than the Main channels and is
related to Blood.
Deep Luo channel

External pathogenic factors generally invade the Connecting

channels first (as well as the Muscle channels). Through their
Superficial and Minute branches, down to the Connecting
channels proper, the Connecting channels represent the way of
penetration of pathogenic factors into the Main channels and then
the Internal Organs.
Chapter 62 of the “Simple Questions” says:

“External pathogenic factors penetrate the skin first, then the

Minute Connecting channels, when these are full they go to the
Connecting channels proper, when these are full they go to the
Main channels”.

Chapter 66 of the “Spiritual Axis” says:

“When pathogenic factors invade the body they penetrate the skin
first, when the skin is loosened, the space between skin and muscles
[cou li] is open and pathogenic factors will penetrate the hair
causing this to stand up. The pathogenic factors then enter the
Connecting channels which causes muscle ache; the pathogenic
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factors will then enter the Main channels.”
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The Connecting channels are always involved in the pathology
of Bi Syndrome: as the Connecting channels form like a
network of small channels running in all directions, and they are
restricted to the space between the Main channels and the skin,
they are particularly prone to “catching” and “trapping”
pathogenic factors such as Cold, Dampness or Wind: this results
in stagnation of Qi and Blood in the channels and the joints.
Another reason why Connecting channels are particularly prone
to being obstructed by pathogenic factors is that, unlike the
Main channels, they cannot flow through the large joints of the
body and are restricted to the space between the Main channel
and the skin. For this reason, they are particularly prone to
obstruction by pathogenic factors and to Qi stagnation.
The main symptom of involvement of the
Connecting channels in Bi Syndrome and
other musculo-skeletal syndromes is joint
pain.
The Deep (Blood) Connecting channels, a deeper energetic level
of the Connecting channels that is below that of the Main
channels, are involved in the pathology of chronic Bi Syndrome
when there is Phlegm in the joints (manifesting with bone
deformities) and Blood stasis causing rigidity and intense pain.
In muscular problems such as ache, spasm and stiffness, a
pathology of the Muscle channels is obviously primary
compared to that of the Connecting channels. By comparison, in
problems of joints such as the elbow, shoulder or knee, Qi
stagnation or Blood stasis in the joint is a primary pathology and
that is always a pathology of the Connecting channels.
In other words, we can say that a
pathology of the muscles obviously reflects
a pathology of the Muscle channels, while
one of the joints reflects primarily a
pathology of the Connecting channels and
secondarily one of the Muscle channels.
 a muscle ache
Muscle channels’ pathology a feeling of heaviness of the
in Bi Syndrome and other muscles
musculo-skeletal syndromes: stiffness.
spasm

Connecting channels’ pathology

in Bi Syndrome and other joint pain.
musculo-skeletal syndromes:

Deep (Blood) Connecting rigidity

channels’ pathology in Bi
Syndrome and other musculo-
skeletal syndromes: intense pain.
 2. AETIOLOGY

This is by definition invasion of external pathogenic factors such

as Wind, Cold or Dampness.

Wind

Wind is the most pernicious of all pathogenic

factors and one that is almost always
combined with the others. Exposure to wind
is an extremely important cause of Bi
Syndrome. Even though in modern
industrial societies housing is generally good
and our life is relatively more sheltered from
climatic pathogenic factors, dictates of
fashion or simply ignorance lead many people
to be exposed to disease-inducing weather
conditions.
 For example, people living
in cold and rainy countries
may tend to be over-
enthusiastic at the slightest
spell of sunny weather and
wear very little clothing
even though temperatures
may still be low.

It is also not infrequent to see

joggers running in extremely cold
and damp weather with very little
on: they also sweat profusely which
opens the pores and facilitates the
invasion of external Wind, Cold and
Dampness.
Some doctors think that "Wind" as an aetiological factor in
Chinese Medicine indicates a sudden change of weather and the
consequent inability of the body to adapt to it, rather than actual
wind. The body is more prone to invasion of Wind during spells of
unseasonable weather: this applies not only when it is
unseasonably cold, but also when it is unseasonably warm.
Apart from being exposed to adverse weather conditions, Bi
Syndrome can of course develop also from exposure to other
conditions, such as sitting on damp surfaces, wading in water,
living in a damp environment, etc.
Although the only aetiological factor in Bi Syndrome is weather,
there are other predisposing factors.
1) excessive sport or work activities
For example, excessive anaerobic exercise may
put a strain on the spine, leading to back-ache.
Constant repetition of certain movements at work is also a predisposing
factor, as this causes stagnation of Qi and Blood in an area which
becomes more prone to invasion of exterior pathogenic factors.
For example, the wrists in car mechanics become prone to
stagnation of Qi and Blood through repeated use of wrenches,
spanners and screw-drivers.
2) Underlying Blood or Yin deficiency, which leads to malnourishment of
the channels so that they become prone to invasion of external
pathogenic factors. Particularly in chronic Bi Syndrome or in the elderly,
an underlying Blood or Yin deficiency is nearly always a factor. In
treatment, it is important not only to expel Wind, Cold or Damp, but also
to nourish Blood or Yin.
3) Accidents, which cause either stagnation of Qi (if light) or Blood (if
serious) in an area. Even though one may seemingly recover perfectly
well after an accident, some stagnation of Blood may remain in the area.
Years later, exposure to external pathogenic factors leads to the
development of Bi Syndrome in that particular area.
This often explains the unilateral development of Bi Syndrome as the
climatic factors of Wind, Cold or Dampness settle in the area where
there is a pre-existing condition of stagnation of Blood caused by the
accident.
4) Emotional problems may also contribute to the causes of
Bi Syndrome either by causing stagnation of Qi (such as
from anger or resentment) which affects the channels, or by
causing depletion of Qi and Blood (such as from sadness,
grief and shock) which leads to malnourishment of the
channels.
 AETIOLOGY SUMMARY

•Wind: stiffness and wandering pain in several muscle groups.

In Connecting channels, Wind causes an ache that wanders
between joints.

•Cold: contraction, spasm and pain of muscles. In Muscle

channels, Cold causes pain and spasm. In Connecting channels,
Cold causes contraction and pain; alleviated by heat.

•Dampness: muscle ache, swelling, numbness and feeling heavy.

In Muscle channels, Dampness causes a muscle ache, a feeling
of heaviness of the muscles and numbness. In the Connecting
channels, Dampness causes muscle ache, swelling and a feeling
of heaviness of the limbs.
 3. IDENTIFICATION OF PATTERNS
Since very ancient times Bi Syndrome has been classified according to
the predominant pathogenic factor, i.e. Wind, Cold or Dampness.
For example the "Simple Questions" in chapter 43 says:
"The three pathogenic factors of Wind, Cold and Dampness give rise to Bi
Syndrome”.
Zhang Jie Bin (1563-1640) says:
"Bi Syndrome means obstruction...Wind-Cold-Dampness obstruct the
channels, Qi and Blood cannot circulate properly. Wind moves and
changes rapidly and causes Wandering Bi Syndrome. Cold (a Yin
pathogenic factor) invades the muscles, tendons and bones, it gathers and
knots and is difficult to disperse; this obstructs the movement of Yang-Qi
which causes severe pain and hence Bi Syndrome. Fixed Bi Syndrome [is
characterized by] heaviness, obstruction to circulation and pain caused by
Dampness in the muscles."
There are therefore three main types according to causative factor:
a) WIND BI SYNDROME (OR WANDERING BI SYNDROME)
This is caused by Wind and is characterized by soreness and pain
of muscles and joints, limitation of movement, with the pain
moving from joint to joint. In acute cases the pulse would be
Floating and slightly Rapid.
b) DAMP BI SYNDROME OR (FIXED BI SYNDROME)
This is caused by Dampness and is characterized by pain,
soreness and swelling in muscles and joints with a feeling of
heaviness and numbness of the limbs, the pain being fixed in one
place and aggravated by damp weather. In acute cases the pulse
would be Slow and slightly Slippery.

c) COLD BI SYNDROME (OR ACHING BI SYNDROME)

This is caused by Cold and is characterized by a severe pain in a
joint or muscle with limitation of movement, usually unilateral.
In acute cases the pulse is Tight.
d) HEAT BI SYNDROME: this originates from any of the
previous three types when the exterior pathogenic factor turns
into Heat in the Interior and gives rise to Heat Bi Syndrome.
This happens especially with an underlying deficiency of Yin.

It is characterized by pain and heat in the joints which feel hot to

the touch, redness and swelling of joints, limitation of movement
and severe pain. In acute cases there would be thirst, a fever
which does not abate after sweating and a Slippery and Rapid
pulse.

In this case, sweating does not bring the temperature down or

reduce the pain because it is due to Damp-Heat. Thus, this
syndrome is characterized not just by Heat, but Damp-Heat. In
fact, Dampness is the primary aspect of this syndrome and Heat
the secondary one.
e) BONE BI: this only occurs in chronic cases and develops from
any of the previous four types. Persistent obstruction of the joints
by pathogenic factors leads to retention of body fluids which turn
into Phlegm which further obstructs the joints and channels.
This leads to muscular atrophy and swelling and deformity of the
bones in the joints, which is an extreme form of Phlegm. At this
stage, Bi Syndrome becomes an interior syndrome affecting not
only muscles, joints and channels, but also the internal organs.

In prolonged cases of Bone Bi other pathological conditions may

play a part in the development of the disease. First of all, the
obstruction in the circulation of Qi, Blood and Body Fluids
caused by Phlegm may lead to Blood stasis. Blood stasis in the
channels further obstructs proper circulation and causes more
pain. In many cases of chronic Bi Syndrome, Blood stasis is a
factor.
 For example, Cold and Dampness are frequent
causes of Bi Syndrome of the lower back. After
repeated episodes of invasion of the lower back by
Cold and Dampness, the prolonged retention of
pathogenic factors may lead to chronic stasis of
Blood in the area. The ache then becomes more or
less constant and more severe. Stasis of Blood also
causes pronounced stiffness due to stagnant Blood
not nourishing and moistening sinews.
An important factor in chronic Bi Syndrome is Liver
and Kidney Xu. It is this that allows retention of
Phlegm and stasis of Blood. Liver-Blood nourishes
the sinews and when deficient the sinews and tendons
are not nourished, leading to aching and stiff joints.
Kidneys nourish bones and when deficient, the bones
are deprived of nourishment allowing Phlegm to
build up in the joints in the form of swellings.
To sum up, the factors which may be present in chronic Bi
Syndrome are:

i) a general deficiency of Qi and Blood which predisposes the

body to invasions of external pathogenic factors;

ii) the formation of Phlegm in the joints in the form of swellings

due to improper transformation of Body Fluids;

iii) stasis of Blood due to the long-standing obstruction in the

circulation of Blood caused both by the external pathogenic
factors and by Phlegm;

iv) deficiency of Liver and Kidneys which leads to

malnourishment of sinews and bones, the former causing ache
and stiffness, the latter contributing to the settling of Phlegm in
the joints.
Most doctors agree that all three factors (Wind, Cold and
Dampness) are present in every case, and each case can only be
differentiated according to the predominance of one factor over
the others. This is important in treatment, especially herbal
treatment. In fact, although herbal prescriptions for Bi
Syndrome emphasise expelling one of the pathogenic factors,
many of them include herbs to expel the other two.
A different classification of Bi Syndrome appears in the "Yellow
Emperor's Classic of Internal Medicine-Simple Questions". In chapter
43 Bi Syndrome is classified according to the tissue and organ affected:

"The 5 Yin organs are related to the five tissues where a chronic disease
can lodge itself. In Bone Bi the pathogenic factor reaches the Kidneys;
in Sinew Bi it reaches the Liver; in Blood Vessel Bi it reaches the Heart;
in Muscle Bi it reaches the Spleen and in Skin Bi it reaches the Lungs."
It then says: "Bi in the bones is serious, in the blood vessels it leads to
Blood stasis, in the sinews it causes stiffness, in the muscles it leads to
weakness and in the skin it causes Cold."
The "Simple Questions" thus classifies Bi Syndrome according to the
tissue affected, which is deduced according to the main manifestation,
i.e. feeling of cold in Skin Bi, weakness in Muscle Bi, stiffness in Sinew
Bi, Blood stasis in Blood Vessel Bi, and bone deformities in Bone Bi. It
also determines a difference in severity among the different types. In
the same chapter it says:

"When Bi Syndrome affects the organs it causes death, when it is

situated in the bones or sinews it becomes chronic, when it is situated in
the muscles or skin it goes easily."

Therefore, in the case of the muscles and Muscle channels, Bi

Syndrome causes a feeling of weakness of the muscles. However, it is
important to understand that classification according to tissues
involved should not a rigid rule: in clinical practice, different tissues
and different channels are involved.
Therefore, in Bi Syndrome, and especially in chronic conditions, it
would be unlikely to have a pathology of one class of channels only.
More often than not, the Muscle, Connecting and Main channels are
all involved, particularly the first two types.

An involvement of the Muscle channels will cause muscle ache and

stiffness or weakness: the pain is more diffuse in muscle groups rather
than being located in the joints. Other manifestations depend on the
pathogenic factor involved: if Wind, there will be stiffness and
wandering ache; if Cold, there will be more severe pain and
contraction and spasm; if Dampness, there will be heaviness and
swelling of the muscles.

An involvement of the Connecting channels will cause joint pain. Other

manifestations depend on the pathogenic factor involved: if Wind,
more than one joints are affected with the pain moving from joint to
joint; if Cold, there will be severe joint pain and possibly inability to
extend or abduct a limb; if Dampness, there will be ache and swelling
of a joint.
 CLINICAL NOTE BOX

In Bi Syndrome, it is common to see a pathology of both the

Muscle and the Connecting channels.

Muscle channels’ pathology: muscle ache and stiffness or

weakness. If Wind: stiffness and wandering ache; if Cold,
more severe pain and contraction and spasm; if
Dampness, heaviness and swelling of the muscles

Connecting channels’ pathology: joint pain. If Wind:

more than one joints are affected with the pain moving
from joint to joint; if Cold, severe joint pain and possibly
inability to extend or abduct a limb; if Dampness, ache
and swelling of a joint.
 SUMMARY OF DIFFERENTIATION
According to pathogenic factor
Wind Bi Syndrome
Damp Bi Syndrome
Cold Bi Syndrome

According to tissue involved:

Skin Bi Syndrome: feeling of cold

Muscle Bi Syndrome: muscle weakness
Sinew Bi Syndrome: stiffness
Blood-vessel Bi Syndrome: Blood stasis (intense pain)
Bone Bi Syndrome: bone deformities.
 4. TREATMENT
The aim of the treatment is simply to expel the pathogenic
factors which have invaded the channels, and eliminate the
resulting local stagnation of Qi and Blood in the channels.
The treatment of Bi Syndrome is a channel treatment by
definition and it only involves treating the Internal Organs as a
secondary aim. The most obvious and notable exception to this,
however, is chronic Bi Syndrome which does require treatment
of the internal organs too.
As a general principle, since the three pathogenic factors of
Wind, Cold and Dampness are usually all present in Bi
Syndrome (although with the predominance of one or two), the
treatment is aimed at expelling Wind, scattering Cold and
resolving Dampness.
 The "Essential Readings from Medical Masters" (1637) says:
"To treat Wind Bi Syndrome principally expel Wind, but secondarily also
scatter Cold and resolve Dampness and also nourish Blood. To
extinguish Wind, treat Blood; if Blood is harmonized, Wind is
automatically expelled. To treat Cold Bi Syndrome primarily scatter Cold,
but secondarily also expel Wind and dry Dampness, and also tonify Fire.
If Heat moves, Cold goes, proper circulation removes pain. To treat
Damp Bi Syndrome primarily dry Dampness, but secondarily also expel
Wind and scatter Cold, and also tonify the Spleen. If the Earth is strong,
Dampness goes, if Qi is strong there is no numbness [a symptom of
Dampness]."

This passage highlights two important principles in the treatment of Bi

Syndrome: firstly, that it is usually necessary to expel all three
pathogenic factors, and secondly, that it is also necessary to treat the
internal organs. This means treating Blood (i.e. the Liver) in the case
of Wind, tonifying Fire (i.e. Kidney-Yang) in the case of Cold and
strengthening the Spleen in the case of Dampness.
The ""Enlightenment of Medical Theory" (1732) confirms all of the
above in almost the same words and adds:

"To treat exterior problems first of all expel the pathogenic factors,
then also treat the internal organs and Upright Qi".

The treatment of chronic Bi Syndrome, in particular, requires a

more comprehensive approach. Besides expelling pathogenic
factors, it is necessary to nourish Blood, nourish Liver and Kidneys,
resolve Phlegm or move Blood, depending on the predominant
underlying condition. Prof Qiu Mao Liang advocates
benefiting the Kidneys and strengthening the Du mai to treat
chronic Bi Syndrome. The main reason for this approach is that the
penetration of external pathogenic factors which cause Bi
Syndrome is closely dependent on the strength of the Kidneys and
the Du mai.
The Wei Qi which protects the body from invasion of pathogenic
factors, is Yang in nature and has its root in Kidney-Yang and the
Du mai. When pathogenic factors invade the body to cause
Bi Syndrome, they will go through the skin, the space between
skin and muscles, the channels, the sinews and the bones. The
Liver nourishes the sinews and the Kidneys the bones: thus the
strength of sinews and bones depends on the nourishment, not
only of Blood and Essence of the Liver and Kidneys, but also on
the evaporation of fluids by Kidney-Yang which leads to the
formation of synovial fluid. When Liver and Kidneys are weak,
Blood and Essence are depleted, Kidney-Yang cannot evaporate
fluids, the Wei Qi is feeble and external pathogenic factors invade
the body causing Bi Syndrome. Thus, "benefiting the Kidneys"
involves both nourishing Liver-Blood and Kidney-Essence and
strengthening Kidney-Yang and the Du mai.
Strengthening the Du mai is necessary as this extraordinary
vessel is Yang in nature, arises from the Kidneys and spreads Wei
Qi all over the back along the Greater-Yang channels: these form
the first line of defense from invasion of external pathogenic
factors also because, as will be remembered, the Greater-Yang
channels "open towards the Exterior".

Strengthening the Du mai with

acupuncture simply means reinforcing
(also with moxa) points along this vessel,
especially Du-4 Mingmen, Du-12 Shenzhu
and Du-14 Dazhui, and opening the vessel
with the points S.I.-3 Houxi and BL-62
Shenmai. A particular combination to
warm Yang and strengthen the
Governing Vessel is direct moxa on Ren-4
Guanyuan and Du-14 Dazhui.
With herbal medicine, strengthening the Governing Vessel is
achieved by using some of the following substances (Lu Rong
being the most important one):
Lu Rong Lu Jiao Lu Jiao Jiao

Lu Jiao Shuang Fu Zi Rou Gui

Finally, another reason for adopting the treatment principle of
benefiting the Kidneys and strengthening the Du mai is to be able
to reduce the dosage of herbs. In fact, many formulae for Bi
Syndrome contain pungent and scattering herbs which are not
suitable for long-term use. By benefiting the Kidneys and
strengthening the Du mai the body resistance is raised, the
efficacy of the herbs is increased and therefore their dosages can
be correspondingly reduced.
The treatment of chronic Bi Syndrome, in particular, requires a
more comprehensive approach. Besides expelling pathogenic
factors, it is necessary to nourish Blood, nourish Liver and
Kidneys, resolve Phlegm or move Blood, depending on the
predominant underlying condition.
It is important to note that the acupuncture treatment
strategies outlined below apply not only to Bi Syndrome
but also to other musculo-skeletal problems such as
trauma, sport injuries and repetitive-strain injury.
 5. ACUPUNCTURE TREATMENT
In this section, I will discuss the acupuncture treatment in
general with particular emphasis on the target areas reached by
distal and local points. In point 5 below, I will discuss the distal
and local points specifically from the point of view of the
pathology of Muscle and Connecting channels.
In general, the treatment is based on the choice of points from
four possible groups:

a) distal points
b) local points (including Ah Shi points)
c) adjacent points
d) points according to pattern
e) general points.
 a) DISTAL POINTS

These are the points below elbows and knees which can treat
problems further up along the channel. One or more of these
points must always be used to treat Bi Syndrome. Distal
points "open" the channel, eliminate stagnation of Qi and
help to expel pathogenic factors. They are used with reducing
method in acute cases and even method in chronic cases.

Distal points are chosen according to the channel and area

involved. As a general principle, the more distal along a channel a
point is, the further up along the channel it extends its influence.
For example;

G.B.-34 while G.B.-39

Yanglingquan Xuanzhong
affects the affects the
shoulder joint neck.
Of course, this is not an absolute rule as it has many exceptions.
For example, the point G.B.-41 Zulinqi (which is below the point
G.B.-39 Xuanzhong and should therefore affect an area above the
neck), can affect the hip and breast.

Since the distal points are by definition those below elbows and
knees, it follows that in the case of wrists, fingers, ankles and toes,
there are no distal points, with few exceptions. Or, to put it
differently, in these cases the distal and local points coincide.
Distal points do not always need to be chosen from the affected
channel as distal points on one channel can affect another. This
particularly applies to channels of the same polarity on upper
and lower limb, and especially the Yang ones, e.g. Greater Yang
(Small Intestine and Bladder), Lesser Yang (Triple Burner and
Gall Bladder) and Bright Yang (Large Intestine and Stomach)
which connect in the face area directly. For the purpose of
treatment, one could almost look upon the Yang channels of arm
and leg as one channel. This connection opens up possibilities in
terms of treatment as distal points can be chosen not only on the
affected channel but also on its related channel of the same
polarity and opposite potential (e.g. Large Intestine and Stomach
within the Bright-Yang system).
Distal points of related Yang channels can also be chosen
according to the correspondence of joints in the upper and lower
limbs:
Shoulder Hip Elbow Knee Wrist Ankle
=
= =

For example, if tenderness and swelling appears in the wrist along

the Triple Burner channel, one can use a distal point on the
channel of the same polarity and opposite potential, i.e. the Gall
Bladder channel.
Because of the
correspondence between
wrist and ankle, the point
will be G.B.-40 Qiuxu.
The main distal points for Bi Syndrome according to channels
are:

Lungs: LU-7 Lieque Bladder: BL-60 Kunlun

Large Intestine: L.I.-4 Hegu Kidneys: KI-4 Dazhong

Stomach: ST-40 Fenglong Pericardium: P-6 Neiguan

Spleen: SP-5 Shangqiu Triple Burner: T.B.-5 Waiguan

Heart: HE-5 Tongli Gall-Bladder: G.B.-41 Zulinqi

Small Intestine: S.I.-3 Houxi Liver: LIV-5 Ligou

The choice of distal points must also be made on the basis of the area
involved. The main distal points according to areas are:
Neck: G.B.-39 Xuanzhong, S.I.-3 Houxi, T.B.-5 Waiguan,
T.B.-8 Sanyangluo, Bl-60 Kunlun. Secondary points: ST-40
Fenglong and KI-4 Dazhong.
Shoulder: T.B.-5 Waiguan, L.I.-4 Hegu, LU-7 Lieque,
T.B.-1 Guanchong, L.I.-1 Shangyang, ST-38 Tiaokou, BL-58
Feiyang.
Elbow: L.I.-4 Hegu, T.B.-5 Waiguan, L.I.-1 Shangyang.
Wrist: ST-36 Zusanli, SP-5 Shangqiu, G.B.-40 Qiuxu.
Fingers: no distal points (see above).
Lower back: BL-40 Weizhong, BL-60 Kunlun, BL-59 Fuyang,
BL-62 Shenmai.
Sacrum: BL-40 Weizhong, BL-58 Feiyang.
Hip: G.B.-41 Zulinqi, BL-62 Shenmai.
Knee: SP-5 Shangqiu, S.I.-5 Yanggu.
Ankle: no distal points.
Toes: L.I.-4 Hegu.
b) LOCAL POINTS
The main local points according to area are:
Neck: BL-10 Tianzhu, G.B.-20 Fengchi.

Shoulder: L.I.-15 Jianyu, T.B.-14 Jianliao, Jianneiling (extra-point).

Elbow: L.I.-11 Quchi, T.B.-10 Tianjing, S.I.-8 Xiaohai.
Wrist: T.B.-4 Yangchi, L.I.-5 Yangxi, S.I.-5 Yanggu, S.I.-4 Wangu,
P-7 Daling.
Fingers: T.B.-3 Zhongzhu, L.I.-3 Sanjian, Baxie (extra points).
Lower back: BL-23 Shenshu, BL-26 Guanyuanshu, BL-
25 Dachangshu, BL-24 Qihaishu, Shiqizhuixia (extra
point), Du-3 Yaoyangguan.
 Sacrum: BL-32 Ciliao, Shiqizhuixia, BL-27 Xiaochangshu,
BL-28 Pangguangshu.
Hip: G.B.-30 Huantiao, G.B.-29 Juliao.
Knee: Xiyan (extra points), ST-36 Zusanli, SP-9
Yinlingquan, LIV-7 Xiguan, LIV-8 Ququan, KI-10 Yingu,
G.B.-34 Yanglingquan, BL-40 Weizhong, SP-10 Xuehai.
Ankle: SP-5 Shangqiu, G.B.-40 Qiuxu, ST-41 Jiexi, BL-60
Kunlun.
Toes: Bafeng (extra points), SP-3 Taibai.

Ah Shi points (tender points) are also local points and form an
important part of the treatment of Bi Syndrome. In most cases,
these will coincide with normal channel points, but if other points
are tender on pressure, they can be needled in addition to normal
points.
c) ADJACENT POINTS
The main adjacent points according to areas are:

Neck: G.B.-21 Jianjing, Du-14 Dazhui, BL-11 Dashu.

Shoulder: S.I.-9 Jianzhen, S.I.-10 Naoshu, S.I.-11 Tianzong, S.I.-12
Bingfeng, S.I.-13 Quyuan, S.I.-14 Jianwaishu, S.I.-15 Jianzhongshu,
T.B.-15 Tianliao, G.B.-21 Jianjing, L.I.-14 Binao, T.B.-13 Naohui.
Elbow: L.I.-13 Wuli, L.I.-10 Shousanli, L.I.-14 Binao.
Wrist: T.B.-5 Waiguan, LU-7 Lieque.
Fingers: T.B.-5 Waiguan.
Lower back: no adjacent points.

Sacrum: BL-23 Shenshu.

Hip: G.B.-31 Fengshi.
Knee: SP-10 Xuehai, ST-34 Liangqiu.
Ankle: KI-7 Fuliu, G.B.-34 Yanglingquan, ST-36 Zusanli.
Toes: SP-4 Gongsun, ST-41 Jiexi, G.B.-34 Yanglingquan, SP-9 Yinlingquan.
 d) POINTS ACCORDING TO PATTERN
The main points to use according to pattern are:

i. Wind Bi Syndrome: BL-12 Fengmen, G.B.-31 Fengshi, G.B.-39

Xuanzhong, Du-14 Dazhui, T.B.-6 Zhigou, BL-17 Geshu, BL-18
Ganshu. All these points expel Wind, apart from the last two
which nourish Blood and are chosen according to the principle of
"nourishing Blood in order to extinguish Wind".

In acute cases, one uses the reducing method and in chronic cases
the even method. In case of Wind Bi Syndrome, it is particularly
important to try and obtain the propagation of the needling
sensation along the channel. The use of points according to
syndrome is especially important for Wind Bi Syndrome as, in
this case, the pain moves from joint to joint.

The "Great Compendium of Acupuncture" (1601) suggests the

use of LU-5 Chize and G.B.-38 Yangfu for Wind Bi Syndrome.
ii. Cold Bi Syndrome: ST-36 Zusanli, Ren-6 Qihai,
S.I.-5 Yanggu, Bl-10 Tianzhu, Du-14 Dazhui, Du-3
Yaoyangguan, BL-23 Shenshu, Ren-4 Guanyuan. In
this case, one uses the reinforcing method and moxa.

Moxa on the needle is the best form of moxibustion

for Cold Bi Syndrome. It combines the benefit of
needling with that of the heat penetrating the muscle
and joint via the needle.

The "Compendium of Acupuncture" suggests the following

points for Cold Bi Syndrome: L.I.-11 Quchi, LU-7 Lieque,
G.B.-30 Huantiao, G.B.-31 Fengshi, BL-40 Weizhong, SP-5
Shangqiu, LIV-4 Zhongfeng, G.B.-41 Zulinqi.
iii. Damp Bi Syndrome: SP-9 Yinlingquan, SP-6 Sanyinjiao,
G.B.-34 Yanglingquan, ST-36 Zusanli, BL-20 Pishu. Use the
reducing method in acute cases and even method in chronic
ones. BL-20 should be reinforced in either case. Moxa is also
applicable. If the joints are swollen (as they usually are in Damp
Bi Syndrome), one can lightly tap the affected joint with the
plum-blossom needle until very tiny droplets of blood appear
and then direct the smoke of burning moxa onto it.

The "Compendium of Acupuncture" suggests using BL-17

Geshu for Damp Bi Syndrome.
iv. Heat Bi Syndrome: ST-43 Xiangu, L.I.-4 Hegu, L.I.-11 Quchi,
Du-14 Dazhui. Use reducing method in acute cases and even
method in chronic ones. Positively no moxa. Note the use of
Dazhui for both Cold Bi Syndrome and Heat Bi Syndrome (as
well as Wind Bi Syndrome). When used with moxa, this point
tonifies Yang, whilst when used with needle only (reducing
method) it clears Heat.

v. Bone Bi Syndrome: BL-11 Dashu and G.B.-39 Xuanzhong,

with even method.
vi. Chronic Bi Syndrome

Qi-Blood Deficiency: reinforce ST-36 Zusanli, SP-6 Sanyinjiao,

Ren-4 Guanyuan, LIV-8 Ququan, BL-20 Pishu and BL-23
Shenshu.

Phlegm in joints: ST-40 Fenglong, SP-9 Yinlingquan, SP-6

Sanyinjiao, Ren-12 Zhongwan, Ren-9 Shuifen, BL-20 Pishu.
Ren-12 and BL-20 should be reinforced, while all the others
should be reduced or needled with even method.

Stasis of Blood: SP-10 Xuehai, BL-17 Geshu, P-6 Neiguan, SP-6

Sanyinjiao, L.I.-11 Quchi, all with reducing or even method.

Deficiency of Liver and Kidneys: reinforce LIV-8 Ququan, KI-3

Taixi, SP-6 Sanyinjiao, G.B.-39 Xuanzhong, BL-18 Ganshu, BL-
23 Shenshu, Ren-4 Guanyuan, BL-11 Dashu, G.B.-34
Yanglingquan, ST-36 Zusanli.
vi. Chronic Bi Syndrome

Some of the points mentioned above are general points

which treat the condition underlying each pattern. These
are:

Wind: nourish Blood with BL-17 Geshu.

Cold: tonify Yang with Du-14 Dazhui (direct moxa) and BL-
23 Shenshu.

Dampness: tonify the Spleen with BL-20 Pishu.

 FAMILIES

SUPPLEMENTS

• Brocade Sinews: chronic Bi from Liver-Blood Xu

• Nourish the Root and Clear Wind: chronic Bi in the elderly

from Liver- and Kidney-Yin Xu

• Clear Channels: acute or sub-acute Bi from Damp-Heat

(swollen, red and hot joints, rheumatoid arthritis)

• Invigorate the Root: chronic Bi of the lower back and legs

against a background of Kidney-Yang deficiency

• Benefit the Sinews: chronic Bi with long-term retention of

Phlegm in the joints and
4/20/2020 FreeBlood stasis, joint deformities. 60
Template from
www.brainybetty.com
 6. HERBAL THERAPY
The patterns discussed are:
a) Wind Bi Syndrome
b) Cold Bi Syndrome
c) Damp Bi Syndrome
d) Heat Bi Syndrome
e) Chronic Bi Syndrome
i. Qi-Blood deficiency and Liver-Kidney deficiency
ii. Phlegm stagnating in joints
iii. Stasis of Blood in joints
iv. Sinews-Bones Bi Syndrome
In the way of review, the main expelling Wind-Dampness herbs
classified as warm or cold are:

Du Huo Radix Hai Feng Teng

Angelicae Caulis Piperis
Warm kadsurae
pubescentis

Can Sha
Bombycis Faeces

Mu Gua Fructus
Wu Jia Pi Cortex Chaenomelis
Acanthopanacis
 Warm
Wu Shao She Wei Ling Xian Song Jie Lignum
Zaocys Radix Clematidis Pini Nodi

Cold
Xi Xian Cao Herba Qin Jiao Radix
Siegesbeckiae Gentianae macrophyllae
Mu Fang Ji Radix
Cocculi
Sang Zhi Ramulus Mori Hai Tong Pi Cortex Si Gua Luo Fructus
Erythrinae Retinervus Luffae

Kuan Jin Teng Caulis Luo Shi Teng Ren Dong Teng (or Yin
Tinosporae sinensis Caulis Hua Teng) Caulis
Trachelospermi Lonicerae
 6. TREATMENT ACCORDING TO MUSCLE AND CONNECTING
CHANNELS
I shall now illustrate the clinical use of the Muscle and Connecting
channels in the treatment of Bi Syndrome. I shall discuss their pathology
and treatment together using various joints as examples. This is also to
highlight the fact that, in Bi- and other musculo-skeletal syndromes,
there is usually a combined pathology of the Muscle and the Connecting
channels.
The joints I shall use as clinical examples are:
Elbow Shoulder Neck Knee
For each joint, I shall describe the following aspects:
The muscles of the The Muscle channels flowing through the
joint joint
The Connecting channels The distal Muscle Connecting
flowing through the joint points channels channels

The local points The adjacent points

 a) ELBOW i. Muscles
Biceps brachii Brachialis Brachioradialis Triceps Anconeus

The three flexors of the elbow The two extensors of the elbow
The brachialis originates on the anterior side of the humerus and attaches
to the coronoid process. The biceps brachii arises from a short and a long
head. The short head originates at the coracoid process of the scapula.
The long head originates at the supraglenoid tubercle of the scapula.
Muscle fibres from both heads insert into the tuberosity of the radius.
The brachioradialis originates on the lateral supracondylar ridge of the
humerus and inserts just proximal to the styloid process of the radius.
The medial and lateral heads of the triceps originates from the humerus
and the long head originates from the infraglenoid tubercle of the scapula.
These heads come together into one tendon to insert into the olecranon
process. The anconeus is a triangle shaped muscle that originates from the
lateral epicondyle and inserts into both the olecranon process and the
posterior surface of the ulna just adjacent to the process.
However, other muscles of the forearm affect the elbow, i.e. the
extensor/supinator and flexor/pronator muscles in the forearm. These
muscles affect the elbow because they provide dynamic stabilization at
the elbow for skilled hand movements. It is these muscles that are
usually involved in the pathology of repetitive-strain injury. Two of
these muscles particularly affect the elbow:
Extensor digitorum communis Extensor carpi radialis

ii. Muscle channels

Obviously all Arm Muscle channels flow through the elbow, i.e. the
Large Intestine, Triple Burner, Small Intestine, Lung, Pericardium
and Heart channels.
In general, the Muscle channels most commonly involved are the
Large Intestine, Triple Burner, Small Intestine and Lung in this order
of frequency: therefore, the Yang channels are primarily involved.
 The Large Intestine Muscle channel is the one that
is most involved in pathologies of the elbow as it
influences particularly the extensor carpi radialis
and extensor digitorum muscles. The Triple Burner
channel influences particularly the extensor carpi
ulnaris and, like the Large Intestine, also the
extensor carpi radialis muscle. Frequently, the
Muscle channels of both the Large Intestine and
Triple Burner are involved. The Small Intestine
Muscle channel affects primarily the flexor muscles
and especially the flexor carpi ulnaris and flexor
digitorum profundus.

A pathology of the Muscle channels will manifest

with a stiff feeling of the muscles of the elbow and a
hardness on palpation. When the Muscle channels
are affected, there is also pain on gripping something
with the hand. In chronic cases, the muscles may
become weak and flaccid: in such a case, the Muscle
channels are in a state of emptiness.
iii. Connecting channels
Obviously all Arm Connecting channels flow through the elbow but four
are particularly involved in its pathology:
Large Small Intestine
Intestine Triple
Burner and Lung.
A pathology of the Connecting channels manifests with intense
pain in the elbow joint, the location depending on the channel
involved.
If the pain is primarily on the lateral side, the
Large Intestine Connecting channel is affected; if
on the posterior surface of the elbow, the Triple
Burner Connecting channel is affected; if on the
medial side of the elbow, the Small Intestine
channel is affected.
iv. Distal points
The main distal points for affliction of the Muscle channels in the
elbow are:
- L.I.-1 Shanyang for the Large Intestine Muscle
channel
- T.B.-1 Guanchong for the Triple Burner channel
- S.I.-1 Shaoze for the Small Intestine channel
The main distal points for affliction of the Connecting channels in the
elbow are the Connecting points, i.e.:
- L.I.-6 Pianli for the Large Intestine Connecting channel
- T.B.-5 Waiguan for the Triple Burner Connecting channel
- S.I.-7 Zhizheng for the Small Intestine Connecting channel

Other distal points should be considered as follows:

- T.B.-8 Sanyangluo is the meeting point of the three Yang channels of the
arm and I select it when two or three Yang channels are involved: for
example, involvement of the Large Intestine and Triple Burner channel is
common.
- G.B.-13 Touwei, upper Meeting point of the three Arm Muscle channels:
I add this point to the distal and local points in chronic cases to facilitate
the movement of Qi among the three Arm Yang channels.
- Connecting point of related Yin channel on the other side, i.e.; if the
elbow problem occurs along the Large Intestine channel on the right arm,
I would select LU-7 Lieque on the left side.
v. Local points
The choice of local points has to be guided by the affected channel. The
main local points I use are the following:

- An Ah Shi point just medial to the lateral condyle of the humerus,

approximately 1 cun behind L.I.-11 Quchi. As this is not a recognized
extra point, I call this “epicondyle point”. I find this local point more
effective than L.I.-11 Quchi. It is particularly effective when used with
moxa on the needle.
- L.I.-11 Quchi: I use this point as a local point especially when there is
heat in the joints (i.e. the joints feel hot to the touch). It is also good as a
general point to benefit the sinews; in order to exploit this particular
function of this point, I may use this point in combination with the
epicondyle point described above.

- T.B.-10 Tianjing: I use this as a local point when the affected channel is
the Triple Burner channel.
- S.I.-8 Xiaohai: I use this as a local point when the affected channel is the
Small Intestine channel.
vi. Adjacent points
Two adjacent point are particularly important in case the elbow pain
radiates upwards or downwards:
- L.I.-12 Zhouliao, 1 cun above L.I.- - L.I.-10 Shousanli is selected if
11 Quchi, is selected if the pain the elbow pain radiates
radiates upwards. downwards.

When selecting adjacent points, I always bear in mind stimulating the

“horizontal” movement of Qi among the three Yang, i.e. Greater Yang,
Bright Yang and Lesser Yang and among the three Yin, i.e. Greater Yin,
Lesser Yin and Terminal Yin. This has the effect of further effecting the
removal of obstructions from the affected channel. In the case of the elbow,
I select adjacent points on other Yang channels to facilitate the
“horizontal” movement of Qi between the Bright Yang, Lesser Yang and
Greater Yang channels. For example, if the Large Intestine channel is
affected, I may select an adjacent point from the Lesser Yang (Triple
Burner) or Greater Yang (Small Intestine), i.e. either T.B.-10 Tianjing or
S.I.-8 Xiaohai.
b) SHOULDER i. Muscles Trapezius
Main muscles: Deltoid

Rotator cuff muscles

Subscapularis Supraspinatus Infraspinatus

Teres minor

+ musculotendinous
attachments.
The subscapularis muscle originates on the scapula and inserts
on the lesser tuberosity of the humerus. The supraspinatus and
infraspinatus originate in the scapula and insert on the greater
tuberosity. The teres minor originates on the scapula and inserts
on the greater tuberosity. The subacromial space lies underneath
the acromion, the coracoid process, the acromioclavicular joint
and the coracoacromial ligament. A bursa in the subacromial
space provides lubrication for the rotator cuff.
There are three articulations in the shoulder and two of them are
particularly relevant to its pathology:
The acromio-clavicular articulation, i.e. that between the acromion of the
scapula and the end of the clavicle (where the point L.I.-15 Jianyu is
situated).
The gleno-humeral articulation, i.e. that between the head of the humerus
and the glenoid fossa of the scapula (near where the point S.I.-10 Naoshu
is situated).
ii. Muscle channels
The main Muscle channels that affect the shoulder are those of the Large
Intestine, Triple Burner, Small Intestine and Lungs, in order of
importance.

The Muscle channels affecting each muscle are as follows:

Trapezius: Bladder, Gall-Bladder, Small Intestine, Triple Burner.
Large Intestine
Deltoid: Bladder, Gall-Bladder, Small Intestine, Triple Burner,
Large Intestine, Lung
 Infraspinatus: Bladder, Small Intestine, Large Intestine
Teres minor: Bladder, Small Intestine
Supraspinatus: Large Intestine
Subscapularis: Large Intestine, Lung
From this list, we can seen that the three Muscle channels that influence
the most muscles of the shoulder are the Large Intestine, Small Intestine
and, surprisingly, Bladder Muscle channels.
The Muscle channels affecting the shoulder joint are obviously those of
the three Arm channels, i.e. Large Intestine, Triple Burner and Small
Intestine. However, there are other Muscle channels affecting the
shoulder:
The Bladder Muscle channel has a branch that separates on the back and
ascends to the posterior axillary crease and then reaches the acromion [at
L.I.-15 Jianyu]; yet another branch crosses beneath the axilla and ascends the
chest to emerge at the supraclavicular fossa [ST-12 Quepen]; these two
branches join at the neck, forming like a holster-strap circling the shoulder.
This particular branch of the Bladder Muscle channel explains the use of BL-
58 Feiyang as a distal point for acute rigidity and pain of the shoulder.
The Gall-Bladder Muscle channel skirts the anterior part of the
deltoid muscle. This pathway explains the use of G.B.-34
Yanglingquan as a distal point for rigidity and pain of the
shoulder.

The Lung Muscle channel skirts the anterior part of the deltoid
muscle. LU-7 Lieque can be used as a distal point for shoulder
pain when this occurs along the anterior aspect of the shoulder.

A pathology of the Muscle channels of the shoulder manifests

with stiffness and rigidity: if abduction of the arm is difficult, the
Large Intestine Muscle channel is involved; if touching the other
shoulder with the affected arm is difficult, the Lung Muscle
channel is involved; if touching the tip of the scapula on the same
side is difficult, the Small Intestine or Bladder channel is
involved.
iii. Connecting channels
The main Connecting channels that affect the shoulder are those of the
Large Intestine, Triple Burner, Small Intestine and Lungs, in order of
importance.
The Connecting channels of the channels that flow into the shoulder affect
the articulations of the shoulder: in particular the Large Intestine
Connecting channel affects the acromio-clavicular articulation and the
Small Intestine Connecting channel the gleno-humeral articulation.
As we have seen, the Connecting channels are particularly prone to
stagnation of Qi or stasis of Blood and the shoulder joint is frequently
affected by these pathologies. As discussed in chapter 12, while the Main
channels can course through the large joints, the Connecting channels, being
restricted to the space outside the Main channels and being like a “net” of
small channels, cannot course through the large joints: this results in Qi
and/or Blood stagnation in these joints.
The shoulder joint is a place where Qi and Blood are “trapped” in the
Connecting channels resulting in stagnation of Qi and/or Blood. Qi
stagnation in the shoulder manifests with pain; Blood stasis manifests with
an intense pain that is often worse at night and a pronounced rigidity of the
joint.
iv. Distal points: The main distal points for the Muscle channels of the
shoulder according to the channel involved are:

L.I.-1 Shangyang for S.I.-3 Houxi for the T.B.-1 Guanchong for the
the Large Intestine Small Intestine Triple Burner
The main distal points for the Connecting channels according to the channel
involved are:
L.I.-6 Pianli for the S.I.-7 Zhizheng for the T.B.-5 Waiguan for the
Large Intestine Small Intestine Triple Burner
Other distal points to be considered are:
ST-38 Tiaokou: this is a distal point for acute rigidity and pain of the shoulder
joint. It is usually needled first with the patient sitting up (on the same side as
the affected shoulder). The needle is manipulated vigorously with reducing
method while the patient gently moves the arm up and down. This
manipulation is continued for about 10 minutes and it is then followed by the
treatment with local points. The needling of ST-38 Tiaokou removes
obstructions from the Large Intestine Connecting channel (due to the
relationship between the Large Intestine and the Stomach within the Bright
Yang). ST-38 is therefore selected when the Large Intestine channel in the
shoulder is primarily affected.
G.B.-34 Yanglingquan: this is used as a distal point for acute rigidity
and pain of the shoulder. G.B.-34 is needled in the same way as ST-38
Tiaokou. G.B.-34 is selected if the Triple Burner Connecting channel
in the shoulder is primarily affected.
BL-58 Feiyang: this point is selected as a distal point for acute rigidity
and pain of the shoulder and it is needled with the same procedure as
for ST-38 Tiaokou. It is selected when the Small Intestine Connecting
channel in the shoulder is primarily affected.
LU-7 Lieque can be used as a distal point for shoulder problems when
both the Large Intestine and Lung Connecting channels are involved
and the shoulder pain radiates towards the anterior part of the
shoulder.

G.B.-13 Touwei, upper Meeting point of the three Arm Muscle

channels: I add this point to the distal and local points in chronic cases
to facilitate the movement of Qi among the three Arm Yang channels.
Connecting point of related Yin channel on the other side. In chronic
cases, I frequently add the Connecting point of the related channel on the
opposite side. For example, if the shoulder problem occurs along the
Large Intestine channel on the right side, I would select LU-7 Lieque on
the left side; if the main affected channel were the Triple Burner on the
right, I would add P-6 Neiguan on the left. The rationale behind this is
that, in chronic cases, pathogenic factors have penetrated deeper and
often into the corresponding Yin channel. Using the Connecting point of
the related Yin channel will help to push pathogenic factors outwards
towards the surface.
v. Local points
L.I.-15 Jianyu: this is a major local point when the Large Intestine
Connecting channel is affected. It affects the acromio-clavicular
articulation and the rotator cuff muscles.
T.B.-14 Jianliao: this is selected when the Triple Burner Connecting
channel is affected.
S.I.-10 Naoshu: this is selected when the Small Intestine Connecting
channel is affected (see below).
Jianneiling extra point (on the anterior aspect of the shoulder
joint, midway between L.I.-15 Jianyu and the anterior axillary
crease): this point is used if the pain occurs on the anterior
aspect of the shoulder joint (from involvement of the Lung
Muscle channel).

vi. Adjacent points

S.I.-11 Tianzong is an important adjacent point: in shoulder
problems, I always palpate this point to check for tenderness
even if the channel involved is the Large Intestine or Triple
Burner channel. I do this because the local points L.I.-15 Jianyu
and T.B.-14 Jianliao affect the acromio-clavicular articulation
while S.I.-10 Naoshu and S.I.-11 Tianzong affect the gleno-
humeral articulation and the rotator cuff muscles. I find the use
of some Small Intestine channels on the scapula essential in the
treatment of shoulder-joint problems. I generally use S.I.-11
while the patient is sitting so that I can apply moxa on the needle.
S.I.-13 Quyuan is another important adjacent point. It is nearly
always very tender on palpation. Like S.I.-11 is affects the gleno-
humeral articulation and the rotator cuff muscles. I generally
needle S.I.-13 with the patient sitting so that I can apply moxa on
the needle.
When selecting adjacent points, I always bear in mind
stimulating the “horizontal” movement of Qi among the three
Yang, i.e. Greater Yang, Bright Yang and Lesser Yang and
among the three Yin, i.e. Greater Yin, Lesser Yin and Terminal
Yin. This has the effect of further effecting the removal of
obstructions from the affected channel. In the case of the
shoulder, I select adjacent points on other Yang channels to
facilitate the “horizontal” movement of Qi between the Bright
Yang, Lesser Yang and Greater Yang channels. For example, if
the Large Intestine channel is affected, I may select an adjacent
point from the Lesser Yang (Triple Burner) or Greater Yang
(Small Intestine), i.e. either T.B.-14 Jianliao or S.I.-10 Naoshu.
 c) NECK
In musculo-skeletal problems, the neck differs from other joints such
as the elbow or knee in that it is frequently affected not only by
external pathogenic factors but also by a pathology of the Internal
Organs and particularly the Liver. In fact, the neck contains a large
number of muscles and Liver-Qi stagnation or Liver-Yang rising
frequently affect the neck causing muscle ache and stiffness (and, of
course, headaches).
i. Muscles
The muscles of the neck are as follows:
Back of neck Superficial:
splenius
trapezius splenius capitis cervicis
Deep:

sub-occipital muscles semispinatus capitis

longissimus capitis

longissimus
cervicis
levator scapulae
Lateral side of neck Superficial: trapezius

sterno-cleido-mastoid

Deep:

splenius capitis levator scapulae scalenes omohyoid

ii. Muscle channels
The Muscle channels affecting each muscle are as follows:
Trapezius: Bladder, Gall-Bladder, Small Intestine, Triple Burner. Large
Intestine
Splenius capitis: Bladder, Small Intestine
Splenius cervicis: Bladder
Sub-occipital muscles: Bladder
Longissimus capitis: Bladder
Sub-occipital muscles: Bladder
Levator scapulae: Bladder, Small Intestine, Triple Burner, Large Intestine
Longissimus cervicis: Bladder
Scalenes: Bladder, Small Intestine, Large Intestine, Gall-Bladder, Stomach
Sterno-cleido-mastoid: Small Intestine, Triple Burner, Large Intestine,
Bladder, Gall-Bladder, Stomach
Omohyoid: Bladder, Stomach
As can be observed from the above list, the Bladder Muscle affects all muscles
of the neck both of its posterior and lateral aspects. As can be observed,
besides the Bladder, the next Muscle channel that affects the most muscles is
the Small Intestine. This observation is reflected in the importance of the
points from the Bladder and Small Intestine channels as distal point for neck
problems.

Another aspect that is evidenced by the Table is that two muscles of the lateral
side of the neck, i.e. the scalenes (deep muscles) and the sterno-cleido-mastoid
(superficial muscle), are affected by all six Muscle channels.

As we have seen above, there are six Muscle channels that affect the neck:
Bladder, Gall-Bladder, Small Intestine, Triple Burner, Large Intestine,
Stomach. These are distributed as follows between the posterior and the
lateral aspect of the neck:

Posterior aspect of neck

Bladder, Small Intestine

Lateral aspect of the neck

Gall-Bladder, Small Intestine, Triple Burner, Large Intestine and Stomach
However, the separation between the Muscle channels affecting the
posterior and the lateral sides of the neck is not so rigid: for
example, the levator scapulae (on the posterior aspect of the neck),
is influenced not only by the Bladder and Small Intestine Muscle
channels, but also by the Muscle channels of the Triple Burner and
Large Intestine.

A pathology of the Muscle channels of the neck manifests with

stiffness, rigidity and pain. This is a very common condition in both
acute and chronic cases. In acute conditions, neck problems are
caused by invasion of Wind and/or Cold or trauma. In chronic
conditions, neck problems are caused by Qi stagnation in the
Muscle channels deriving from poor posture and emotional stress.
Emotional stress frequently affects the muscles of the neck. In
particular, emotions such as anger, resentment, frustration, worry,
fear and anxiety cause Qi to rise to the neck and head leading to
stagnation of Qi in the neck. This causes a chronic ache and
stiffness of the neck.
iii. Connecting channels
The principal Connecting channels affecting the neck are as
follows:
Bladder Gall-Bladder Stomach
Small Intestine Triple Burner Large Intestine

A pathology of the Connecting channels of the neck includes Qi

stagnation or Blood stasis. The main difference between the pathology
of the Muscle and Connecting channels of the neck lies in muscle
stiffness: a pathology of the Muscle channels always causes a
pronounced stiffness of the muscles while that of the Connecting
channels causes primarily pain. Of course pain is also a symptom of a
Muscle channel pathology but, the more intense the pain, the more the
Connecting channels are involved.
Moreover, whenever there is Blood stasis, the Connecting (and not the
Muscle) channels are involved: Blood stasis manifests with an intense,
stabbing pain that is often aggravated at night and rigidity of the neck.
Considering the large number of muscles and of Muscle channels converging
in the small area of the neck, another interesting observation can be made: in
neck problems, a pathology of the Muscle channels is primary compared to
that of the Connecting channels precisely because the neck is so richly
provided with many large and small muscles. By comparison, in problems of
joints such as the elbow, shoulder or knee, Qi stagnation or Blood stasis in the
joint is a primary pathology and that is always a pathology of the Connecting
channels.
iv. Distal points
The main distal points for the neck Muscle channels according to the channel
involved are:
BL-67 Zhiyin: this point affects the Bladder Muscle channel in the neck
treating neck ache

S.I.-1 Shaoze: this point treats the Small Intestine Muscle channel and frees
the neck.
G.B.-44 Zuqiaoyin affects the Muscle channel of the Gall-Bladder and it
works on the neck and head.
T.B.-1 Guanzhong L.I.-1 Shanyang
The main distal points for the Connecting channels of the neck according to
channel are:
BL-60 Kunlun: this is the main distal point to remove obstructions from
the Connecting channels of the neck. It affects primarily the posterior
aspect of the neck.
BL-64 Jinggu: this point affects the neck and upper back.
G.B.-39 Xuanzhong: this is a distal point to remove obstructions from the
Connecting channel of the Gall-Bladder in the neck. It is used when the
neck pain occurs on the lateral sides and there is pronounced rigidity with
inability to turn the neck. The needles are inserted bilaterally and
manipulated with a reducing method for about 10 minutes while the
patient is asked to turn the neck gently from side to side.

Juegu extra point: this point is located on the Gall-Bladder channel and is
above G.B.-39 Xuanzhong. It is located by palpating the fibula; at a certain
point, the fibula disappears under the muscle and cannot be felt any longer:
the name of the point means disappearing bone . The point is situated on
the fibula at the point where it cannot be palpated any longer. It is used in the
same way as G.B.-39 Xuanzhong. In my experience, the extra point Juegu is
more effective than G.B.-39 to treat neck ache.
S.I.-3 Houxi: this is the main point on the Small Intestine channel for
neck problems. It treats both the posterior and the lateral aspects of
the neck. It removes obstructions from the Small Intestine Connecting
channel and treat Bi Syndrome: it is particularly effective in expelling
Wind.
S.I.-7 Zhizheng is the Connecting point and removes obstructions from
the Small Intestine Connecting point.
T.B.-5 Waiguan is an important point to remove obstructions from the
Triple Burner Connecting channel. It eliminates Qi stagnation and
Blood stasis from the Connecting channel: it has the added function of
expelling Wind from the channel.
L.I.-6 Pianli is used to remove obstructions from the Large Intestine
Connecting channel.

ST-40 Fenglong removes obstructions from the Stomach Connecting

channel and it can treat neck ache because the Connecting channel
ascends to the nape of the neck (besides flowing to the front of the
neck)
Other distal points include the following:
BL-59 Fuyang is the Accumulation (Xi) point of the Bladder channel.
Like all Accumulation points, it can be used to boost the removal of
obstructions from the Connecting channel. It is therefore used to boost
the action of another Bladder distal point (such as BL-60 Kunlun).
S.I.-6 Yanglao, Accumulation point of the Small Intestine, is used to
boost the action of another Small Intestine point (such as S.I.-3 Houxi).
S.I.-6 has many indications related to the arm, shoulder and neck.
G.B.-36 Waiqiu, Accumulation point of the Gall-Bladder, is used to
boost the action of another Gall-Bladder point (such as G.B.-39
Xuanzhong). It is indicated for pain of the neck.
T.B.-7 Huizong, Accumulation point of the Triple Burner, is used to
boost the action of another Triple Burner point (such as T.B.-5
Waiguan).
L.I.-7 Wenliu, Accumulation point of the Large Intestine, is used to
boost the action of the another Large Intestine point (such as L.I.-6
Pianli).
S.I.-18 Quanliao is the Meeting point of the three Leg Yang
Muscle channels and it will therefore affect the Bladder, Gall-
Bladder and Stomach Muscle channels. The Meeting point is
used in chronic cases when two or three of the Muscle channels
are involved.1

G.B.-13 Benshen is the Meeting point of the three Arm Yang

Muscle channels and it will therefore affect the Large Intestine,
Triple Burner and Small Intestine channels. The Meeting point is
used in chronic cases when two or three of the Muscle channels
are involved.
v. Local points
BL-10 Tianzhu: this is an important local point for neck ache
deriving from the Bladder channel. It affects the whole Bladder
channel in the back. It is also one of the “exit” points of the Eye
System which means that is stimulates the horizontal movement
of Qi from the face towards the occiput.
G.B.-20 Fengchi: this is an important local point for neck ache
deriving from the Gall-Bladder channel. It affects the whole Bladder
channel in the back. It is also one of the exit points of the Eye
System which means that is stimulates the horizontal movement of Qi
from the face towards the occiput. It is also a point of the Yang Linking
Vessel and it expels Wind and subdues Yang: it is therefore indicates
for neck ache and stiffness deriving from Liver-Yang rising.

T.B.-15 Tianliao: this is an important local point for neck problems. It

is nearly always tender on pressure. Being a point of the Lesser Yang
(the hinge between the Greater Yang and Bright Yang), it will affect
also the Small Intestine and Large Intestine channels.

S.I.-16 Tianchuang: this is a good local point for neck problems,

especially those deriving from Liver-Yang rising. In fact, it is a
Window of Heaven point and, as such, it regulates the ascending and
descending of Qi to and from the head. It affects more the posterior
aspect of the neck.
T.B.-16 Tianyou: this is a good local point for neck problems, especially those
deriving from Liver-Yang rising. In fact, it is a Window of Heaven point and,
as such, it regulates the ascending and descending of Qi to and from the head.
It affects more the lateral aspect of the neck.
vi. Adjacent points
G.B.-21 Jianjing: I use this point to stimulate the descending of Qi from the
head and chest. It is therefore a useful adjacent point for neck problems
deriving from Liver-Yang rising.
S.I.-11 Tianzong: this is an important adjacent point for neck ache on the
posterior aspect of the neck from involvement of the Greater Yang channels.
It is nearly always tender and I needle it with moxa on the needle (patient
sitting up).
S.I.-13 Quyuan: this is an important adjacent point for neck ache on the
posterior aspect of the neck from involvement of the Greater Yang channels.
It is nearly always tender and I needle it with moxa on the needle (patient
sitting up).
BL-11 Dashu: this point is indicated for neck ache of the posterior aspect of
the neck. Being a point of the Sea of Blood and a Gathering point for bones, it
is particularly indicated in chronic neck ache in the elderly.
Finally, when selecting adjacent points, I always bear in mind
stimulating the horizontal movement of Qi among the three
Yang, i.e. Greater Yang, Bright Yang and Lesser Yang and
among the three Yin, i.e. Greater Yin, Lesser Yin and Terminal
Yin. This has the effect of further effecting the removal of
obstructions from the affected channel. In the case of the neck,
we need to stimulate the movement of Qi among the three Yang
channels. For example, if the neck ache occurs on the posterior
aspect of the neck (Greater Yang area) and we select BL-10
Tianzhu, it is good to stimulate the movement of Qi among the
Yang channels by selecting, for example, T.B.-16 Tianyou of the
Lesser Yang channels.
d) KNEE
The knee is frequently affected by Bi Syndrome, especially that
from Cold or Dampness; in addition, the knee is a joint that is
frequently affected by trauma and sport injuries.

i. Muscles
The main muscles affecting the knee are as follows:

Gastrocnemius: has its origin in the

medial head-posterior surface of
distal tibia just superior to medial
condyle; its insertion in calcaneal
tendon
Plantaris inferior: has its
origin in the interior part of
lateral supracondylar line of
femur and oblique popliteal
ligament of knee; its
insertion in the calcaneal
tendon
Soleus: has its origin in the
soleal line and medial border of
tibia and in the posterior aspect
of fibular head; its insertion in
the calcaneal tendon
Popliteus: has its origin
in the posterior surface
of proximal tibia; its
insertion in the lateral
femoral condyle
ii. Muscle channels
The Muscle channels coursing through and over the knee are the following:
Stomach Muscle channel: it runs along the tibia and bifurcates below the
knee into two branches that run either side of the knee. This is the most
important Muscle channel affecting the knee as it runs along its medial and
lateral aspect. It affects the popliteus, tibialis anterior and soleus muscles.
Gall-Bladder Muscle channel: runs along the lateral aspect of the knee. It
affects the tibialis anterior.

Bladder Muscle channel: the Bladder Muscle channel ascends past the
lateral side of the lower leg to converge at the lateral aspect of the knee;
another branch ascends along the Achilles tendon to the lateral aspect of the
popliteal fossa; another branch ascends along the lateral surface of the calf
to reach the medial side of the popliteal fossa and runs parallel with the
above-mentioned branch in the popliteal fossa. It affects the soleus and
gastrocnemius muscles.

Spleen Muscle channel: it ascends the medial aspect of the tibia to converge
at the medial aspect of the knee. It affects the soleus and gastrocnemius
muscles.
Liver Muscle channel: it ascends the medial side of the leg to the medial
aspect of the tibia to converge at the medial condyle. It affects the soleus and
gastrocnemius muscles.

Kidney Muscle channel: it ascends the leg and converges at the medial
condyle of the tibia. It then joins with the Spleen Muscle channel. It affects the
soleus and gastrocnemius muscles.

Therefore, we can see that, unlike other joints that are affected primarily by
Yang Muscle channels (such as the shoulder), the knee is affected equally by
Yang and Yin Muscle channels.

The Muscle channel that affects the most muscles of the knee is the Stomach
Muscle channel (it affects popliteus, tibialis anterior and soleus). Secondly,
the muscles of the knee that are affected by the most Muscle channels are the
soleus and gastrocnemius (they are affected by Bladder, Spleen, Liver and
Kidney Muscle channels).
A pathology of the Muscle channels of the knee manifests with stiffness and
rigidity or weakness of the muscles. In chronic conditions, the muscles
around the knee may become weak: this reflects a Deficiency condition of the
Muscle channels.
iii. Connecting channels

The Connecting channels affecting the knee are all the Leg Yin and Yang
channels. As we have seen, the Connecting channels, being restricted to the
space outside the Main channels and being like a net of small channels, they
cannot course through the large joints and, as a result, they are particularly
prone to stagnation of Qi or stasis of Blood: the knee joint is a place where Qi
and Blood are trapped in the Connecting channels resulting in stagnation of
Qi and/or Blood. Qi stagnation in the knee manifests with pain; Blood stasis
manifests with an intense pain that is often worse at night and a pronounced
rigidity of the joint.
Stagnation of Qi in the Connecting channels of the knee frequently results
from invasion of external pathogenic factors, especially Cold or Dampness.
iv. Distal points
The main distal points for the Muscle channels of the knee are as follows:

ST-45 Lidui: all Well (Jing) points can be used to affect the Muscle channels.

G.B.-44 Zuqiaoyin BL-67 Zhiyin SP-1 Yinbai

KI-1 Yongquan LIV-1 Dadun

The main distal points for the Connecting channels of the knee are as
follows:
ST-40 Fenglong: the Connecting point removes obstructions from the
Connecting channel. This is used for afflictions of the anterior aspect of the
knee and patella.
SP-4 Gongsun: Connecting point to remove obstructions from the
Connecting channel. This is used for afflictions of the medial side of the knee.
KI-4 Dazhong: Connecting point to remove obstructions from the
Connecting channel. This is used for afflictions of the medial side of the knee.
LIV-5 Ligou: Connecting point to remove obstructions from the Connecting
channel. This is used for afflictions of the medial side of the knee.
G.B.-43 Xiaxi: this point removes obstructions from the Connecting channel
of the Gall-Bladder. It is used for pain on the lateral side of the knee.
BL-66 Tonggu: this point removes obstructions from the Connecting channel
of the Bladder. It is used for pain on the posterior side of the knee.
SP-5 Shangqiu: this point removes obstructions from the Connecting
channel of the Spleen. It is used for pain on the medial side of the knee.
KI-2 Rangu: this point removes obstructions from the Connecting channel
of the Kidney. It is used for pain on the medial side of the knee.
LIV-4 Zhongfeng: this point removes obstructions from the Connecting
channel of the Liver. It is used for pain on the medial side of the knee.
BL-63 Jinmen, Accumulation point of the Bladder channel, is used to
boost the action of another Bladder point (such as BL-66 Tonggu).
G.B.-36 Waiqiu, Accumulation point of the Gall-Bladder, is used to boost
the action of another Gall-Bladder point (such as G.B.-39 Xuanzhong).
ST-34 Liangqiu, Accumulation point of the Stomach channel: see below
under “local points”.
KI-5 Shuiquan, Accumulation point, is used to boost the action of another
Kidney point (such as KI-2 Rangu).
LIV-6 Zhongdu, Accumulation point, is used to boost the action of another
Liver point (such as LIV-4 Zhongfeng).
SP-8 Diji, Accumulation point, is used to boost the action of another
Spleen point (such as SP-4 Gongsun).
S.I.-18 Quanliao, Meeting point of the 3 Yang of the leg, can be used as a
distal point for afflictions of the Yang Muscle channels of the knee in
chronic conditions. It is particularly selected when more than one
Muscle channel is involved.
Ren-3 Zhongji, Meeting point of the 3 Yin of the leg, can be used as a
distal point for afflictions of the Yin Muscle channels of the knee in
chronic conditions. It is particularly selected when more than one
Muscle channel is involved.

v. Local points:

SP-9 Yinlingquan: this is an important local point for pain or swelling of

the medial aspect of the knee. Besides functioning as a local point, this
point also drains Dampness, so it is particularly indicated when the knee
is swollen.

ST-36 Zusanli: this is a very important local point for pain on the
anterior aspect of the knee and on the patella. It is also for pain that is
experienced inside the knee joint. It also drains Dampness.
ST-35 Dubi: this is an important local point for pain inside the knee
joint and over the patella or also for pain on the lateral aspect of the
knee.
Xiyan extra points: these are important local points for pain inside the
knee joint. They are a pair of points just below the patella, one on the
lateral and the other on the medial side (Xiyan on the lateral side
coincides with ST-35 Dubi).
LIV-8 Ququan: this is a local point for pain on the medial aspect of the
knee. Besides functioning as a local point, it is important to use when
the knee pain occurs against a background of Liver-Blood deficiency.
LIV-7 Xiguan: as its name implies ( Knee Gate ), this is an important
local point for knee pain on its medial aspect.
KI-10 Yingu: this is a local point for knee pain on the medial and
posterior aspects. Apart from functioning as a local point, it nourishes
Kidney-Yin and it is therefore particularly indicated for medial knee
pain in the elderly occurring against a background of Kidney
deficiency.
BL-40 Weizhong is an important local point for knee pain on its posterior
aspect. Apart from this, it is particularly indicated when the knee is
swollen.
G.B.-34 Yanglingquan is an important local point for knee pain on its
lateral aspect. Apart from functioning as local point, G.B.-34 is the
Gathering point for sinews and it will therefore help the healing of
muscles and sinews in the knee joint.
G.B.-33 Xiyangguan: as its name implies (“Yang Gate of the Knee”), this
is a local point for knee pain on the lateral aspect.
vi. Adjacent points:
SP-10 Xuehai: I use this point frequently as an adjacent point as, in joint
problems, it is always effective to use an adjacent point that is located
above the joint. Apart from this, this point is particularly indicated if the
knee is affected by Blood stasis.
ST-34 Liangqiu, Accumulation point of the Stomach channel, is an
extremely important point because, besides being a local point for the
knee, it is the Accumulation point and, as such, it stops pain and removes
obstructions from the Connecting channel
Finally, when selecting adjacent points, I always bear in mind
stimulating the “horizontal” movement of Qi among the three Yang, i.e.
Greater Yang, Bright Yang and Lesser Yang and among the three Yin,
i.e. Greater Yin, Lesser Yin and Terminal Yin. This has the effect of
further effecting the removal of obstructions from the affected channel.
In the case of the knee, I would select adjacent points to stimulate the
movement of Qi among the three Yang for afflictions of the anterior
and lateral sides of the knee and of the three Yin for afflictions of the
posterior aspect of the knee.

For example, if I selected some Stomach channel points to treat a pain

in the knee joint, I would add either G.B.-34 Yanglingquan or G.B.-33
Xiyangguan to stimulate the movement of Qi between the Bright Yang
and Lesser Yang channels. If I selected KI-10 Yingu to treat a pain on
the posterior aspect of the knee, I would add a point such as LIV-7
Xiguan to stimulate the movement of Qi between the Lesser Yin and
the Terminal Yin channels.
 THREE TREASURES SUPPLEMENTS
BROCADE SINEWS Nourish Liver-Blood, nourish sinews,
expel Wind-Dampness from the channels
NOURISH THE ROOT AND CLEAR WIND Nourish
Liver- and Kidney-Yin, expel Wind-Dampness from
channels
CLEAR CHANNELS Resolve Damp-Heat from the
channels and sinews, invigorate Blood
BENEFIT THE SINEWS Invigorate Blood, eliminate stasis
and resolve Phlegm from the joints
INVIGORATE THE ROOT Tonify Kidney-Yang, nourish
Liver-Blood and expel Wind-Dampness from the
channels
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