It can be caused by:

1. Qi-Blood deficiency
2. Yin deficiency
3. Yang deficiency

Qi-Blood Deficiency Bi

The qi-xue deficiency can come from a Full Bi or an Empty Bi.

Vicious circle:

1. Full Bi can create Empty Bi,
2. which can create Ying-Wei deficiency (lack of nutritive and defensive energy),
3. which gives qi-blood deficiency (propulsion and nutrition),
4. does not nourish muscles, tendons and joints
5. more vulnerable to a new wind-cold-damp attack -> which can generate a Full Bi attack

Symptoms

• Pain more dull, chronic, moderate.
• The pain worsens after physical exertion (important!!, in the evening, at night they increase)
• Painful muscle contractures occasionally if there is Liver-Blood deficiency.
• There are certain signs of Wei Syndrome: atrophy, weakness (due to general Qi deficiency or multiple organ deficiency)
• Affecting channels in biao-li relationship. Eg: Kidney-Qi deficiency reflected in Bladder channel.
• Pulse: if Qi-deficient the pulse is forceless, Blood-deficient is fine.
• Complexion: pale
• Tongue: normal or pale with coating.

Treatment

Tonify Qi-Blood, Invigorate Blood, unblock the channels, muscle-tendon groups.

Most important points:

• Tonify Qi: BL-43, CV-6, ST-36
• Tonify Blood: SP-6, BL-17, BL-20, ST-36
• Raise Yang: GV-4, CV-4, KI-3, BL-23
• Strengthen muscles-tendons: GB-34, GB-39, BL-11

Yang Deficiency Bi

Symptoms

• Due to Yang deficiency the pain can be of variable intensity depending on the temperature. Sensitive to cold, worsens with cold.
• The pain also tends to improve with heat (because it is Empty-Cold).
• Worsens with physical exertion.
• Lower back and lower limbs are the most affected.
• Can affect Du Mai: patient bent forward.
• There are symptoms of Spleen- and Kidney-Yang deficiency. Cold and general tiredness. Constipation or pasty stools. Does not sweat. Sleeps well, somnolence. Abundant and clear urine.
• Tongue: pale with thin coating, can be swollen with teeth marks if more of Spleen-Yang deficiency

Treatment

Moxibustion is essential

• GV-4, BL-23
• CV-4, KI-3, KI-7
• ST-36, SP-6, BL-20
• BL-11, GB-34, GB-39
• GV-20 (raises the Yang)

Yin Deficiency Bi

Chronic Bi, it is due to Kidney-Essence deficiency and/or Liver-Yin deficiency.

Symptoms

• Lack of nourishment of tendons muscles and bones
• Less intense pains, worsen at night as Yin is consumed.
• Limited mobility, Ma Mu, deformities
• Feet and hands with tendon retraction (fluid is consumed, lack of nutrition and elasticity).
• Pain can have heat symptoms. Hotter joints. Burning sensation, deep heat.
• Symptoms of lower back and lower limbs (Kidney)
• Symptoms of the whole body (Liver)
• General symptoms of Liver-Yin deficiency or Kidney-Essence deficiency.
• Red tongue with little or no coating. or with peeled patches.
• Fine rapid pulse.

Treatment

• Tonify Kidney Yin (like for Yang and Qi): KI-3, KI-7, BL-23
• More Yin: KI-6
• Produce Qi: BL-43, CV-4, ST-36
• General Yin: SP-6
• If there is heat: Rong and King points of the affected channel.
• General for muscles-tendons-bones: GB-34, GB-39, BL-11
• If the Shen is agitated by heat: PC-6, PC-7, HT-7

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