JOURNAL OF CHINESE MEDICINE NUMBER 47 JANUARY 1995Classification of Bi Syndrome by Sun Pei-Lin and Luc Vangermeersch T he Chinese character ‘bi’ signifies blockage or obstruction, and in TCM this term is used to signify stagnation of qi and blood in the jing (channels) and luo (collaterals) due to attack by pathogenic factors such as wind, cold, dampness etc. Bi primarily gives rise to pain, swelling and restricted movement. For Western practitioners of TCM, bi is mostly associated with rheumatic diseases in the wider sense and there is indeed considerable overlap between these two concepts. However the category of bi syndrome is considerably wider than rheumatic diseases, whilst the typical classification of rheumatic diseases used in Western medicine is unknown in TCM, for example the differentiation between degenerative disorders (e.g. arthritis) and autoimmune disorders (e.g. rheumatoid arthritis). This is due to a fundamentally different, and very original, conception of the aetiology of these disorders developed by the Chinese before the Han dynasty (i.e. before the 2nd century BC). They stressed at one and the same time an external and an internal causation, whilst Western medicine focuses uniquely on internal dysfunction and takes no account of external factors. The two principal names of this disorder in TCM are feng shi (wind-damp) and bi zheng (bi syndrome). The term ‘wind-damp’ stresses that these two pathogens are considered the primary factors giving rise to bi and is primarily a popular term, less used within the academic medical tradition which favours bi zheng. Aetiology and Pathology Bi is frequently encountered in regions where the climate is damp, cold and windy, in both sexes and at all ages. Children and young adults, however, are less frequently affected than the aged. From these primary observations, traditional Chinese doctors deduced that climatic factors such as wind, cold and damp could invade the body if the body condition was weak. Two important factors, therefore, are necessary to give rise to bi: i. the zheng qi (the qi, blood, yin, yang and most especially wei qi) must be deficient, for example weak or elderly patients, and ii. the xie qi, i.e. the pathogenic factors (wind, cold, damp etc.) must be strong. The pathogenic factors attack the body via the skin, and more particularly the pores. Having penetrated the body in this way, they next attack the channels (entering via the ShuStream points) and then progressively invade the entire channel system giving rise to a peripheral blockage in the circulation of qi and blood. This results in pain which is still confined to the muscles and joints of the affected limb. This is the first or superficial stage of bi syndrome, limited to the channels, of moderate intensity and generally reversible, notwithstanding the fact that the symptoms are acute. It should be noted that in this initial phase, also known as the stage of san bi (three bi), the pathogens wind, cold and damp always combine. That is to say that in the presence of only two pathogens there will be no bi. Thus if only wind and cold are involved, there may be a pattern of exterior wind-cold but no bi, and the same is the case for wind and damp. One of the pathogens, however, may predominate and TCM therefore differentiates this stage according to the primary pathogen: i. Feng bi (wind bi) in which wind predominates. ii. Han bi (cold bi) in which cold predominates. iii. Shi bi (damp bi) in which dampness predominates. There is another important characteristic that must be considered in the early stages of bi and that is the possible development of heat. Re bi (hot or febrile bi) is an additional category of superficial bi characterised by pain, redness, heat sensation and limited function of the affected joints. iv. Aetiology and pathology of febrile bi Two principal conditions may give rise to febrile bi: i. attack by exterior heat, principally wind-damp-heat; in this case pathogenic cold is not involved unless it was already present in the interior. ii. the transformation of wind-cold-damp into heat within the body due to the presence of interior heat; this is known as huo hua (transformation into heat). There are many possible causes for the development of interior heat, for example: i. over-consumption of greasy, spicy foods and alcohol, ii. emotional factors such as stress, repression, perfectionism etc. which cause stagnation of Liver qi and hence Liver fire, iii. over-exertion, infectious diseases, chronic diseases etc. which give rise to yin deficiency with empty heat. If exterior wind, cold and dampness attack the body when on the one hand wei qi is deficient and on the other there is accumulation of interior heat, then they will transform into heat and give rise to symptoms of febrile bi in the muscles and joints. In the majority of cases, this transformation is incomplete and the pattern of febrile bi shows a mixed picture of heat, wind, cold and dampness in which heat predominates. 8 adhesive capsulitis (frozen shoulder). • According to symptoms: wandering bi. the gravity of the disease depends on the relative condition of the healthy qi of the body (zheng and wei) and the virulence of the pathogenic factor (xie). • Sequelae of traumatic injury such as scars which cause pain with change of weather. • intermediate stage: attack on the tissues. numerous methods of classifying bi syndrome according to aetiology. capsulae.e. if the development of the disease is not arrested by treatment. • Peripheral vascular diseases: such as Buerger’s disease. sweating. Liver bi.JOURNAL OF CHINESE MEDICINE NUMBER 47 JANUARY 1995 Development of Bi Syndrome Ultimately.g. thirst. This manifests with pronounced and chronic pain. especially the joints and related structures i. cold or heat. rheumatoid arthritis. tendons. thromboangeitis obliterans. Classification of Bi syndrome There have been. to offer sufficient resistance. • According to aetiology: wind bi. for example: Xiong Bi (chest bi) for obstructive disorders of the chest Diagnosis Bi syndrome is characterised by pain. synoviae. However the nature of the pain will vary from one patient to the next: very severe pain suggesting powerful pathogenic factors or a significant stagnation of qi and blood. Heberden’s rheumatism. Summary To review this presentation so far. intercostal neuralgia. Heart bi. limitation of movement etc. sciatica etc. also trigeminal neuralgia. In the initial stage some patients will have fever. there will be a vigorous battle in the superficial layers of the organism between their healthy energy and the pathogenic factors which are attempting to invade the organism. synovitis. these external pathogens will not only penetrate the superficial (skin) level and invade the channels and collaterals. fibrositis. heat and dampness may progress from the exterior layer (biao) to the interior layer (li) of the body and reach the body tissues. or polyarthritis chronica evolutiva (PCE). we can say that: i. The final deep stage of bi syndrome occurs when the zangfu are invaded. muscles and other fibrous tissues. ii. cold bi. producing a blockage of qi and blood in the muscles and joints (first stage). then the result will be the appearance of a superficial syndrome. the pathology of bi is divided into three major stages: • superficial stage: attack on the channels.g. sheaths. numbness and limitation of movement. • According to the five tissues involved: cutaneous bi. tissues affected. • Inflammation: acute rheumatic arthritis e. In current practice. symptoms moderately acute. The most common symptoms are pain and limitation of movement. bursae. • Bursitis. yet no one will become ill if their wei qi is sufficiently strong. Bladder bi. or if the body is unable. • According to the zang involved: Lung bi. capsulitis. periarthritis. possibly with acute attacks. in healthy people whose zheng qi and wei qi are strong. iv. symptoms chronic and extremely severe. whose zheng and wei qi are weak and who are consistently exposed to harmful pathogenic wind. cold and dampness or wind. Kidney bi. the classifications according to aetiology and symptoms are most commonly used. damp bi and heat bi. and limitation of movement. due to weakness. • Metabolic: gouty arthritis. • Degenerative: osteoarthritis or arthrosis deformans. symptoms. Bai Hu Feng (white tiger wind) for severely painful bi due to wind. irreversible swelling and deformity of the joints. • Neuralgia: the most common is lumbar neuralgia. but can also reach the level of the body tissues (intermediate stage) and the zangfu (deep stage) and provoke interior disharmony. tendon bi. Cao Xie Feng (straw sandal wind) for damp-heat with swelling of the feet. Correspondence with Western medicine The concept of bi syndrome in TCM can encompass the following diseases in terms of modern medicine: • Rheumatic diseases: inflammation. chronic rheumatic arthritis e. in the case of the old or feeble. • According to the fu involved: intestinal bi. Most people are carriers of a cold pathogenic factor. myositis or muscular rheumatism etc. rheumatic fever. a wind-cold syndrome (rather than bi syndrome) will appear and resolve spontaneously. tendinitis. • According to locality: chest bi (xiong bi). symptoms severe and recurrent. sore throat and general discomfort as in the case of 9 . bone bi. bi syndrome is always characterised by the presence of the same pathogenic factors: windcold-dampness or wind-damp-heat which are the cause of the obstruction and give rise to pain. Bi syndrome is generally a progressive disorder. v. Li Jie Feng (polyarticular wind) for acute rheumatic arthritis. Spleen bi. If the pathogen cannot penetrate to the deeper internal layers. usually at the taiyang or shaoyang level. damp. Instead. wind. such as angina pectoris. vascular bi. or injury to the five zang. • deep stage: attack on the internal organs. numbness and heavy sensations in the muscles and joints. degeneration or metabolic disorders of the connective tissue structures of the body. suppurative arthritis and gout. This is the intermediate stage of bi syndrome with the symptoms becoming more severe and tending to recur or become chronic. muscle bi. historically. He Xi Feng (crane’s knee wind) for a kind of tubercular arthritis. iii. scapulo-humeral periarthritis. painful bi. infectious (purulent) arthritis. Whatever the stage. or obstructive bronchitis with phlegm. Within TCM there are special terms also for different kinds of bi syndrome. systemic lupus erythematosus (SLE) which are autoimmune diseases. fixed bi. blood and body fluids. wind-damp or wind-heat. degree of interior disharmony etc. indicating the development into bi syndrome. or contracting. In addition. Numbness In TCM the term ma mu denotes numbness. The onset of symptoms is often sudden. and blood stasis in the muscles and joints. DIFFERENTIATION Wind Bi (Feng Bi) also known as Wandering Bi (Xing Bi) This is an attack of the ‘three bi’ (combined wind-colddamp) in which wind predominates. 2. cold. In clinical practice. however. The Spleen qi must be sufficient to ensure proper nourishment of the muscles. In addition the following symptoms may be present: • aversion to wind or draught and aggravation of symptoms in windy weather • chills. blood and jing which consequently fail to nourish the tissues. Swelling and deformity of the joints The joints allow movement. Later joint and muscle pains will manifest. Shi numbness is due to such factors as accumulation of damp and phlegm. These factors will give rise to obstruction of the channels by qi and blood. In shi patterns. yin and yang giving rise to malnutrition of the muscles and joints. and may or may not be accompanied by numbness and/or swelling. damp and heat complicated by phlegm and blood stasis in the joints aggravates their malnutrition and thus their deformity. Wind is a yang pathogen with the tendency to rise to the upper part of the body. Invasion by exterior pathogens provokes a blockage of the pores giving rise to retention of fluid in the skin which then swells. Xu numbness is due to deficiency of qi and blood which fail to adequately nourish the muscles and joints. Penetration by pathogenic factors slows down their circulation and gives rise to poor nutrition of the joints and hence deformity. muscles. Symptoms may equally rapidly disappear. This type often presents in patients with an improper diet (for example over-consumption of greasy foods and/or alcohol). they are particularly acute and intense. The symptoms are moving. Swelling of the joints may also be provoked by accumulation of dampness due to Spleen deficiency. Xu pain will mostly manifest in the last stage. there will be limitation of movement of the joints. blood and body fluids in the joints giving rise to accumulation of water and hence swelling. stabbing. location. This shi pain will normally be present in the initial and intermediate stages. To this end it is first of all necessary to have a good understanding of the principal symptoms. Treatment is given according to the relative preponderance of each. Thickening and discolouration of the skin The mechanism of these changes is the same as for swelling and deformity of the joints. blood and body fluids are the substances which nourish the skin. attack by exterior pathogens can provoke stagnation of qi. this symptom may be due to a xu or shi pattern. At the same time Liver blood (which nourishes the tendons) and Kidney jing (which nourishes the bones and marrow) must be sufficient. so for example the pain may be sharp. and in xu patterns to impaired nourishment of the jingluo. On the other hand. The pain will be severe. 10 . from one joint to another. Reaching a correct diagnosis of bi syndrome requires that one make a clear differentiation of symptoms according to aetiology. arms and hands. or the sensation that the muscle is dead. Qi. will not present with these clear symptoms. for example. They must be suitably nourished by qi. The nature of the symptoms is variable. It varies according to its shi or xu nature. thus it will frequently affect the head. shoulders. thus the pain may move around the body. Limitation of flexion and extension Normal flexion and extension are the result of the mechanical co-ordination and effective function of different tissues such as the joints themselves. blood. tendons etc. numbness may be due to a shi or xu pattern. the muscles. invasion of the tissues by pathogenic factors causes a local stagnation of qi and blood and thus aggravates the limitation of the movements of flexion and extension. tendons and bones. 4. mu signifies absence of normal sensation. 3. also known as Painful Bi (Tong Bi) This is an attack of the ‘three bi’ (combined wind-colddamp) in which cold predominates. we may see patients with shi/xu mixed at any stage. Shi pain will frequently be induced by an attack of exterior wind-cold-damp or by phlegm and blood stasis. Like pain. The majority of cases. stage. acute and paroxysmal.JOURNAL OF CHINESE MEDICINE NUMBER 47 JANUARY 1995 an attack of wind-cold. neck. The character for ma signifies pricking or tingling. Wind bi has four principal characteristics: 1. distending. wandering and erratic. The pain sensation can be fixed or mobile. Chronic accumulation of wind. beginning rapidly or slowly. Xu pain is caused by poor functioning of the zangfu with deficiency of qi. When there is deficiency of qi. changing to numbness and then to soreness or distention. or chills and fever • sweating due to the opening of the pores by pathogenic wind invasion Tongue: thin white and superficial coating Pulse: floating (fu) and moderate (huan) Cold Bi (Han Bi). Analysis of principal symptoms Pain Pain is the most common symptom of bi syndrome. however. In Bai Hu Feng. As with the other principal symptoms. Prolonged swelling of the skin causes it to become thickened and in chronic cases induces stagnation of qi and blood and hence hardening and discolouration. pain is due to obstruction. The muscle and joint pains may be the only symptoms. It prevents all movement. This type of bi. differentiation is not made according to aetiology as in the stage of the three bi. if pathogenic cold is added. The patient will complain of heaviness sensations. • irritability. rainy. In the stage of the five bi. shooting.JOURNAL OF CHINESE MEDICINE NUMBER 47 JANUARY 1995 Cold freezes. Chills are due to the attempt of the body to maintain normal temperature. The pulse is soggy (ru) or slippery (hua) and moderate (huan). the stagnation is especially severe and so also is the pain. especially in the epigastric region • sometimes sudden dyspnoea • dryness in the upper part of the throat • frequent belching • burning sensation in the skin Heat Bi (Re Bi) Heat bi is a distinct category among the superficial bi syndromes. This is due to the tendency of dampness to be heavy and sluggish (dampness is yin by nature and easily blocks the activity and movement of yang). buildings constructed on marshy ground etc. distress and anxiety. sometimes accompanied by slight chills. Body fluids therefore are eliminated as urine and hence there may an increase in clear urination. fixed. manifesting characteristics of the three bi described above. Vascular Bi (Mai Bi) and Heart Bi (Xin Bi) i. Cold congeals the qi and blood locally fixing the symptoms in one place. • fever. it cannot be cold bi. head or even the whole body. the disease will progressively penetrate more deeply and reach the level of the ‘five bi’ in which the five tissues and the five zang are involved. The swelling may be of the whole body or of the joints and there may be subcutaneous retention of water. Pulse: rapid (shuo) and slippery (hua) reflecting the presence of both heat and dampness. fatigue and numbness of the limbs. sticky. damp walls. discomfort. It can never be a mild pain. Vascular bi primarily involves disorders of blood such as blood stasis which blocks the vessels and causes pain: • pain typical of blood stasis: sharp. The symptoms will be aggravated by damp. Another symptom of cold bi is ankylosis or stiffness. with the addition of local or systemic signs of the predominant heat. This pattern is also known as fixed bi since it is very localised and rarely shifts in location. restlessness and agitation • painful joints with swelling. The deeper penetration of wind-colddamp-heat due to weakness of the zheng qi can affect the five zang and their corresponding body tissues. After invading the organism it provokes a yang reaction in the superficial layers: the pores close tightly and the patient does not perspire. At a later stage the affected parts become swollen and painful. especially in the region of the Heart • mental depression • sensation of fullness and distention. The tongue is pale with a thin white coating (slightly thicker than in the wind bi pattern). Cold is a yin pathogen. Differentiation according to the stage of penetration Primary attack: the stage of the three bi This is the first stage of bi syndrome which is superficial and can be described in the four clinical pictures given above. for example frozen shoulder. It generally precedes the final stage since the tissues are considered to be more superficial than the zangfu and the pathogenic factors invade the body from the exterior towards the interior. It appears when the ‘three bi’ (wind-colddamp) invade an organism which shows signs of interior 11 . • pain of the muscles and joints Stagnation of blood and qi on the interior may also give rise to: • uneasiness. The prolonged presence of the three bi will lead to the stage of the five bi. There may be fever due to muscular fibrillation yet shivering cold will predominate. heat sensation and difficulty in movement as seen in acute inflammatory arthritis Tongue: red body with yellow coating. Alternatively heat bi may simply be due to attack of exterior wind-damp-heat. We can distinguish two patterns according to the degree of penetration: Intermediate stage: bi of the five tissues (wu zhu bi) Final stage: bi of the five zang (wu zang bi) In the intermediate stage the zang are not yet affected. The pulse is floating (fu). The tongue coating is thick. is characterised by intense. The symptoms are often mixed. redness. white and wet (it is never dry). if the pain is intense the pulse can be wiry (xian). The pain of damp bi is never sharp or acute but rather deep. The term bi already denotes blockage and hence pain. It never appears suddenly but slowly and progressively. The patient has aversion to cold and may sometimes present with a low fever. aggravated at night etc. but the fever and sensations of heat predominate • intolerance of heat • thirst and dry mouth. but according to the locality of the disease: Damp Bi (Shi Bi) also known as Fixed Bi (Zhao Bi) This is the third of the ‘three bi’ in which pathogenic dampness predominates. damp localities. tight (jin) and slow (chi). overcast or foggy weather. heat and subsequently transform into wind-damp-heat. therefore. stabbing pain that is fixed in location (blood stasis due to cold). piercing. It is also aggravated by cold weather or by application of therapeutic measures that are cold in nature. if the pain is mild therefore. intense and dull. If the progress of the pathogenic factors cannot be arrested. The pain of cold bi will be ameliorated by movement and warmth and aggravated by cold and immobility. contracts and obstructs. especially in the right middle (guan) position which corresponds to the Spleen Skin Bi (Pi Bi) and Lung Bi (Fei Bi) i. or is due to invasion of the skin by exterior pathogenic factors which give rise to stagnation of the Lung qi: • dyspnoea.JOURNAL OF CHINESE MEDICINE NUMBER 47 JANUARY 1995 • red or purple spots on or beneath the skin (eruptions. irritability. weakness. angry and excitable. after an attack of windcold-damp. psychological desire to eat (bulimia). insatiability • nightmares. The principal symptoms of skin bi are: • numbness and cold sensation of the skin • shortness of breath. dietary adjustment is therefore of major importance in the treatment of vascular bi. and is induced by a new attack of wind-cold-damp. paraesthesia. According to five phase theory these emotions are linked to the Lung. Heart bi mostly follows chronic vascular bi. Tendon bi mostly affects the function of the muscles: • weakness and pain of the tendons and joints • the joints may be flexed but not extended (as in Dupuytren’s contracture where the fingers remain in the flexed position) • excessive intake of food and drink. exhaustion on the slightest effort • spontaneous sweating. As with vascular bi. body and/or head • extreme fatigue. Lung bi follows chronic skin bi. rather than their function. asthma • frequent dryness of the throat • restlessness. In addition to pain of the kind experienced in vascular bi. greater susceptibility to panic Tendon Bi (Jin Bi) and Liver Bi (Gan Bi) i. Tendon bi occurs more often in springtime. and in whom. ii. Heart erethism • dyspnoea. which is also governed by the Lung. a time also when it can more easily evolve towards the deeper stage of the organs. excited and agitated manner • anxiety. Skin bi occurs most often in Autumn. or rapid shallow respiration (like a panting dog) According to TCM the Lung governs the skin. rubella-like rash) Vascular bi develops in those who overeat and drink and smoke to excess. sensation of cold. impaired digestion • excessive watery salivation Tongue: the body is swollen with teethmarks. loss of force of the four limbs • heaviness of the limbs. Spleen bi often follows a persistent case of muscle bi or follows excessive sweating due to intense physical effort which is followed by exposure to draught or wind. cold persists in the tendons which are especially sensitive to cold. or who indulge in irregular eating etc. poor digestion. principally affects the muscle tissues and the connective tissue. Vascular bi appears more often in summer. When pathogenic factors invade the skin. restlessness Muscle Bi (Ji Bi) or Flesh Bi (Rou Bi) and Spleen Bi (Pi Bi) i. Muscle bi. malabsorption etc. fearfulness. At this time also it may most easily penetrate to the level of the zangfu giving rise to Spleen bi. mus- Bone Bi (Gu Bi) and Kidney Bi (Shen Bi) i. In addition there will be sensations of shivering chills and cold since the blocked wei qi cannot warm the skin. ii. The dyspnoea is due to the exterior-interior relationship of the skin and Lung. aversion to cold • fever • fullness and oppression of the chest • anxiety. Muscle bi occurs most often during the second (lunar) month of summer. Symptoms of blockage (numbness or impaired sensitivity of the skin) therefore appear. therefore. These habits generate excessive interior heat and exhaust qi and yin. which is affected in this pattern: • pain. or flesh bi. the wei qi. horrible dreams of struggle • frequent urination Tendon bi principally affects those who are frustrated. stiffness. cannot circulate properly in the superficial layers. shortness of breath. reaching the middle jiao where the qi can become blocked producing symptoms of abdominal accumulation: • weakness of the four limbs • oppressive and weighty feeling in the chest • shortness of breath and full sensation in the chest • productive cough • vomiting. the season where it can most easily develop into the deeper stage of Liver bi. Invasion of wind-cold-damp into the channels and collaterals of an organism already weakened in this way easily leads to blood stasis and provokes vascular bi. sweating on the least effort • digestive disorders. there is • palpitations. a time also when it can most easily penetrate to the zangfu level and give rise to Lung bi. It may also develop in a person with Heart blood xu. giving rise to Heart bi. In addition to acupuncture and herbal medicine. The principal symptoms of bone bi are: 12 . It is the bulk of the muscles. numbness. panting • chills. ii. Liver bi usually follows a case of chronic tendon bi: • extreme weakness of the tendons and limbs • headache due to uprising of Liver yang • numerous nightmares • thirst • excessive urination • pain of the ribs and flanks • hypochondriac pain and distention • abdominal distention • lower back pain • sensation of cold in the feet and lower limbs cular paralysis. the coating slippery or greasy Pulse: weak (ruo) and slippery (hua). ii. Interior emotional factors such as severe grief or worry are considered to be the principal cause of skin bi. muscle bi occurs in those who overindulge in rich and greasy food and alcohol. Deficiency of wei qi allows the pathogen to penetrate directly into the body. These two patterns are equally deep stages and are comparable to the bi of the five zang. difficult urination Differentiation according to Locality Chest Bi or Thorax Bi (Xiong Bi) Chest bi is an important concept in TCM which goes beyond the Western medicine concept of rheumatism. zang and fu Weakness of the limbs with limitation of movement due to paresis or paralysis. since it involves the zang. limitation of movement due to stiffness and pain Musculoskeletal disorder Windstroke Disorder of qi and blood. It is a popular term designating certain illnesses which can be classified as a special kind of bi syndrome. fullness and extreme sensitivity of the lower abdomen which is aggravated by pressure • dysuria. which belongs to the ‘five bi’. appears after a long history of bi. or a pulmonary disease. shortness of breath. the pure portion of food and drink cannot be separated from the impure portion. the principal ones being: • pulmonary diseases: asthma. Bladder Bi (Bao Bi) In addition to bi of the zang. yin and yang. they can only appear after invasion of pathogenic wind-cold-damp. impairment of sensitivity Disorder of the central nervous system Location 13 . Bone bi occurs most often in winter. thick and sticky Intestine Bi (Chang Bi). If the Large Intestine is affected. pleurisy. Chest bi is due either to blockage of yang in the chest deriving from invasion by pathogenic factors or to accumulation of phlegm-dampness in the chest from interior disharmony. These different causes have similar symptoms: • pain of the chest and ribs occurring in the whole chest. If.JOURNAL OF CHINESE MEDICINE NUMBER 47 JANUARY 1995 • soreness and pain of the joints and bones • numbness and heaviness of the body and limbs • stiffness of the joints with immobility The Kidneys govern the bones. Kidney bi. limbs and trunk • weakness of the lower limbs • difficulty in walking • loss of hair. muscular atrophy. elbows. pleurodynia Comparison between Bi and Wei Syndromes Bi syndrome Pathology Symptoms Obstruction of the channels Pain of the muscles and joints mostly related to weather changes. • sensation of swelling and distention in the abdomen • diarrhoea • dysuria • pronounced thirst • bi syndrome soreness and pain Bladder Bi Bladder bi is due to attack by pathogenic qi and subsequent blockage of the Bladder qi mechanism: • sensation of swelling. Kidney bi most often occurs after a chronic bout of bone bi and manifests with the following symptoms: • stooped posture. absence of pain. TCM also describes two particular kinds of bi of the fu. one part of the fluids cannot be reabsorbed: Correspondence with Western medicine There are numerous causes of thoracic pain. If the Small Intestine is affected. difficulty in standing erect after bending • stiffness and swelling of the joints. ii. oppressive sensation in the chest • cough accompanied by expectoration which can be profuse. distention. In the same way. ‘three hair scalp’ (san mao) Organ bi. ankylosis • limited flexion and extension of the knees. pneumonia. at the time of an attack by pathogenic wind-cold-damp there is an underlying Kidney deficiency. the flanks or the upper back • dyspnoea. Chest bi corresponds to rheumatic pain of the chest. bone bi can easily develop. Excessive sexual activity which exhausts the qi and yang of the Kidneys is considered the principal cause of bone bi. and invasion of the Kidneys is in effect the ultimate stage of all the syndromes of bi. bronchitis. Intestine Bi Pathogenic factors attack the intestines and cause a local blockage of qi. the precordial region. angina pectoris. absence of muscular atrophy Diffuse involvement Wei syndrome Deficiency of jing and blood Weakness of the limbs. paresis or paralysis. no relation to weather changes Bilateral involvement of the four limbs or unilateral Location Comparison between Bi syndrome and Windstroke Bi syndrome Pathology Symptoms Obstruction of the channels Pain of the muscles and joints mostly related to weather changes. is considered the deepest stage of bi syndrome. the season when it can also penetrate most easily to the zangfu level and give rise to Kidney bi. especially. Western diseases corresponding to Wei syndrome • nerve root compression with neuritis • polyneuritis • syringomelia • amyotrophic lateral sclerosis (Charcot’s disease) • multiple sclerosis • progressive muscular dystrophy (Aran-Duchenne type) • myasthenia • poliomyelitis Differentiation between Bi and Windstroke Windstroke. we can understand that chest bi is not a rheumatic disease in the Western sense of the term. (the majority of these are described in TCM as true heart pain (zhen xin tong) as in the Jin Gui Yao Lue written by Zhang Zhong Jing in the 3rd century. myocardial infarction. July/August/September 1993. the limbs become weak and their movement is limited. herpes zoster etc. literally “attack by wind”. No. dysphasia and hemiplegia as seen in cerebrovascular accident/CVA). 6. attack of interior wind corresponding to CVA. ii. is divided into different clinical stages according to location. Paresis is followed by paralysis. like bi. weakness and emptiness of the channels. The two principal types according to TCM are i. The tendons become slack.: • windstroke affecting the channels and collaterals only • windstroke affecting the fu • windstroke affecting the zang This article was first published in Médecine Chinoise & Médecines Orientales. impairing their motor function. Differentiation with Other Diseases Differentiation between Bi and Wei The term wei refers to a plant which is in need of water and therefore withers and wilts. muscles and zangfu. • rheumatic diseases: muscular or articular rheumatism • other chest diseases From this.JOURNAL OF CHINESE MEDICINE NUMBER 47 JANUARY 1995 • cardiac diseases: angina pectoris. refers to apoplexy (sudden loss of consciousness accompanied by facial paralysis. 14 . Windstroke. severity etc. This image corresponds clinically to decline of fluids and blood leading to malnutrition. cardiomyopathy etc. attack by exterior wind causing facial paralysis. • nervous system diseases: intercostal neuralgia.