OSTEOARTHRITIS(DEGENERATIVE JOINT DISEASE)

GENERAL

Clinical Manifestations	Chronic non-inflammatory joint pain (Combines destructive alterations of cartilage + (epi-physical) bone modifications) Hip joint: Hip pain Maybe buttock pain Maybe lateral thigh (trochanteric) pain Maybe anterior inguinal symptoms Limited range of motion Stiffness Aggravated by use Relieved by rest Pain reproduced with passive internal rotation of the thigh Maybe limited hip flexion Night pain
Treatment Principle
Herb Formulas	Ma Xing Yi Gan Tang Advanced cases: Feng Shi Han Tang Cervical Osteoarthritis: Jia Wei Ge Gen Tang Ge Gen Tang modified For Blood Stagnation: Huo Luo Xiao Ling Dan Intractable: Si Ni Tang Mucoid arthritis: Yi Yi Ren Tang Tubercular arthritis: Yi Yi Ren Tang With muscular atrophy: Hu Qian Wan modified Chinese Patent Medicine: Jian Bu Hu Qian Wan
Points	General pain: GB-30, GB-34, GB-39, LI-4, LI-11, LI-15, SJ-4, SP-21, ST-41, UB-17, UB-62 Pain in the shoulder joint: 1. LI-15, SI-10, SJ-14, SJ-15, SJ-19, Jianneiling 2. SI-9, LI-15, SJ-14 Pain in the scapula: LI-11, UB-43, SI-12, SI-14, UB-13 Pain in the elbow: LI-4, LI-11, LI-10, LU-5, PC-3, SJ-5, SJ-6, SJ-10 Pain in the wrist: 1. SJ-4, SJ-5, LI-4, LI-5, LI-11, LU-8, LU-9, SI-3, SI-5 2. SJ-4, PC-7, Sifeng, Shangbaxie Stiffness of the fingers: 1. SI-5, SI-3, LI-4 2.SJ-4, PC-7, Sifeng, Shangbaxie Numbness and pain in the fingers: 1. SI-3, SI-4, LI-3, Bafeng, Baxie, Shixuan 2. SJ-4, PC-7, Sifeng, Shangbaxie Pain in the back: DU-3, DU-12, DU-26 Pain in the spine: DU-2, DU-14, DU-16, GB-30, UB-13, UB-14, UB-40, UB-60 Lumbar pain: DU-2, DU-3, DU-12, DU-26, UB-23, UB-25, UB-31, UB-32, UB-33, UB-34 Hip joint pain: GB-29, GB-30, GB-39, ST-32, UB-54 Bleed the Jing-Well point of the Gall Bladder tendino-muscular channel GB-41 or GB-42 + SJ-3 opposite + GB-40, GB-37, GB-34, GB-31 GB-41 + SJ-5 GB-29, Jiankua ST-31, UB-36, UB-40 Ear: Hip, Lumbar spine, Shenmen, Thalamus, Adrenal Endocrine Thigh pain: GB-31, GB-34, ST-33, UB-36, UB-54 Knee joint pain: 1. GB-34, SP-9, ST-32, ST-35 (lateral), ST-35 (medial). UB-40, Heding 2. GB-34, GB-31, ST-33 3. ST-34, ST-35, GB-34 Numbness and pain in the legs: GB-39, ST-36, UB-57, UB-58 Ankle pain: GB-40, KI-2, KI-3, KI-6, LIV-4, SP-5, SP-21, UB-60 Numbness and pain in the toes: GB-44, LIV-2, SP-4, ST-44, UB-65, Bafeng To calm the mind and ease pain: DU-20, HT-3, HT-7, LI-4, LIV-3, PC-6, Taiyang

TAI YANG ZHONG FENG WITH MUSCLE PAIN

Clinical Manifestations	Aversion to Wind Mild, or severe chills Fever which may be persistent Uneasiness from fever Spontaneous perspiration Headache Muscle aches and pain Stiff neck and shoulders Nausea Nasal irritation Nasal obstruction Tendency to snore Itchy throat T: Normal C: Thin and white P: Superficial and slow or Moderate and maybe weak
Treatment Principle	Create sweat to relieve the Exterior and expel Wind Harmonize Ying and Wei to protect digestion and nourish Wei Qi
Herb Formulas	Gui Zhi Qu Shao Yao Jia Fu Zi Tang
Points	Bitong, DU-16, GB-20, KI-7, LI-4, LI-20, LU-7, SJ-5, UB-12, UB-13, Yintang With stiff neck and shoulders: + GB-21 With Dampness: + SP-6, SP-9

TAI YANG ZHONG FENG WITH DAMPNESS

Clinical Manifestations	Aversion to Wind Mild, or severe chills Fever which may be persistent Uneasiness from fever Spontaneous perspiration Headache Nausea Dysentery Nasal irritation Nasal obstruction Tendency to snore Itchy throat T: Normal C: Thin and white P: Superficial and slow or Moderate and maybe weak Stiff neck and shoulders*.
Treatment Principle	Create sweat to relieve the Exterior and expel Wind Harmonize Ying and Wei to protect digestion and nourish Wei Qi
Herb Formulas	Ren Shen Bai Du San
Points	Bitong, DU-16, GB-20, KI-7, LI-4, LI-20, LU-7, SJ-5, SP-6, SP-9, UB-12, UB-13, Yintang + general points

WIND-COLD INVASION WITH INTERNAL HEAT

Clinical Manifestations	Severe fever and chills without sweat Intolerance of Cold Irritability Fidgeting Headache Cough Wheezing (asthma) Muscle aches General body aches Thirst Heaviness and aching of the entire body Shortness of breath Floating edema (severe) Restlessness Anhidrosis Fidgeting May be high fever Edema Dyspnea T: Normal C:Thin white or Yellow P: Floating and tight or Rapid or Tight and rapid or wiry and tight
Treatment Principle	Promote diaphoresis Release the Exterior Clear Interior Heat Relieve irritability
Herb Formulas	Da Qing Long Tang
Points	General points

TAI YANG SHANG HAN WITH KIDNEY YANG DEFICIENCY

Clinical Manifestations	Severe chills May have mild fever No sweat Aversion to Cold Cold extremities Cold sensation on back Pale face Extreme fatigue Muscle aching T: Pale with scallop C: White P: Deep, weak and thready
Treatment Principle	Warm Yang Expel Cold from the Exterior Dispel Cold from the Interior
Herb Formulas	Ma Huang Fu Zi Xi Xin Tang
Points	Moxa DU-4, DU-16, DU-20, UB-12, UB-15, UB-23

WIND-COLD INVASION DUE TO WEI QI DEFICIENCY

Clinical Manifestations	Hemiplegia Asymmetry of the face Paralysis of the face Slow and slurred speech Aphasia Fever and chills Semi-consciousness Loss of consciousness Convulsions Neck rigidity Limited movement of the joints Loss of consciousness Muscle spasms Low back pain Numbness of the muscles and skin Hemiplegia Urticaria T: ; Pale C: Thin and white P: Floating and Empty or Tense or Wiry and tense
Treatment Principle	Warm the channels Disperse Wind Releases Yang Supports the Qi
Herb Formulas	Xiao Xu Ming Tang Fang Ji Huang Qi Tang Wu Tou Tang Jia Jian
Points	General points

WIND-COLD-DAMP BI

Clinical Manifestations	Painful joints Heavy and painful sensations at fixed locations in lower back and extremities with weakness and stiffness or hypertonicity and immobility Aversion to Cold Attraction to warmth Palpitations Pain in the midline and back during pregnancy Pain worse at night General coldness Sallow complexion Wandering pain Pale complexion Shortness of breath May be paresthesia and numbness Cold pain in the low back and knees Limited movement Soreness, weakness and numbness of the joints Tinnitus Muscle spasms Dizziness T: Pale C: Thin and white or White and moist P: Thin, weak and slow or Deep, thready and weak or slippery
Treatment Principle	Disperse Wind-Dampness Warm Cold Stop Bi pain Tonify the Kidneys and Liver Tonify Qi Nourish the Blood
Herb Formulas	Gan Cao Fu Zi Tang Du Huo Ji Sheng Tang Astragalus and Drynaria Combination Qu Han Bi Tang Da Fang Feng Tang Han Shi Bi Tang Qu Gui Jia Bai Zhu Tang Jia Wei Huo Luo Dan Jian Ning San With sweating that does not reduce the fever: Zhen Wu Tang Edematous arthritis: Xiao Qing Long Tang Recurrent Wind-Cold-Damp Bi with Heat: Gui Zhi Shao Yao Zhi Mu Tang With Disharmony between the Ying and Wei: Juan Bi Tang #1 Cervical: Jia Wei Ge Gen Tang
Points	General points

WANDERING BI (XING BI) - WIND PREDOMINANT BI (FENG BI)

Clinical Manifestations	Migrating pain in the joints especially the : Shoulders Elbows Wrists Fingers Upper back and neck Pain quality changes Pain changes with the weather May move from soreness to numbness to aching Sensitivity varies Pain often appears abruptly, acutely or paroxysmal and then disappears Limited range of motion Chills and fever Aversion to Wind Sore throat General body aches Maybe perspiration T: Pink C: Thin and white P: Superficial and moderate or Flooding and moderate
Treatment Principle	Eliminate Wind Warm Cold Expel Damp Clear the Channels
Herb Formulas	Juan Bi Tang Juan Bi Tang #1 Fang Feng Tang modified Fang Feng Tang Jia Jian Da Fang Feng Tang Da Qin Jiao Tang Qu Feng Tang Arthritis #1 For Wind Invasion With Underlying Yang Deficiency: Xiao Xu Ming Tang modified
Points	GB-20, LIV-3, SP-10, UB-17 + general points For jaw impediment: + LI-4, SJ-17, ST-7 For cervical impediment: + GB-12, UB-10 For thoracic vertebral impediment: + Huatuojiaji at the level of impediment For sacrococcygeal impediment: + DU-4, UB-25, UB-31, UB-32, UB-33, UB-34, UB-40 For shoulder impediment: + HT-1, LI-15, SI-11 For elbow impediment: + LI-10, LI-11, LI-12, SI-8 For wrist impediment: + SI-4, SJ-4, SJ-5 For upper extremity phalangeal and metacarpal impediment: + Baxie, LI-3, SI-3 For sacroiliac impediment: + GB-29, GB-30, UB-26, UB-27, UB-30, UB-54 For hip impediment: + GB-30, GB-34 For knee impediment: + LIV-8, ST-35, UB-40, Xiyan For ankle impediment: + GB-40, KI-3, KI-6, SP-5, ST-41, UB-60, UB-62 For metatarsal and lower extremity phalangeal impediment: + Bafeng, GB-41, SP-4, ST-41 To disperse Qi and relieve external symptoms: LI-4, UB-12, SJ-5, GB-31 GB-20 or GB-41, DU-1, LI-11, ST-36, UB-40 or UB-17, SI-12, DU-16, GB-20, UB-12, SJ-17, SP-10, GB-31 or DU-20, GB-20, GB-30 + General points

WIND-DAMP

Clinical Manifestations	Joint swelling and pain, especially hands and feet Heaviness of the joints Numbness of the joints Stiffness of the joints Fever Heaviness of the body Coldness of the body Dizziness Likes pressure Fatigue Pale complexion Preference for warmth T: Pale C: Thick and white or Greasy and white P: Thready and slippery
Treatment Principle	Eliminate Wind Resolve Dampness Reduce swelling Move Qi Warm the channels
Herb Formulas	Yi Yi Ren Tang Jia Jian
Points	General points

WIND-COLD-DAMP BI WITH BLOOD STAGNATION

Clinical Manifestations	Aversion to Wind, Cold and Dampness Stiff and painful muscles and joints Limited movement Pain aggravated by Wind Sensitive to climatic changes Pain aggravated by Cold Numbness of muscles Pain aggravated by Dampness Cold joints Pain worse at night Low back pain or soreness Lumbago Fatigue Heaviness of the body Heaviness of the muscles Preference for warmth Weak joints Palpitations Pale face Joint deformity Shortness of breath Preference for dry weather T: Pale or Purplish C: Thin, white and greasy P: Thready and weak or Thready and slippery
Treatment Principle	Dispel Wind-Cold-Damp Nourish and Activate the Blood Break up Blood Stasis Eliminate Damp Stop pain
Herb Formulas	San Bi Wan Jia Jian
Points	General points

WIND-COLD-DAMPNESS WITH BLOOD STAGNATION AND PHLEGM

Clinical Manifestations	Chronic pain, weakness and numbness (especially in the lower extremities) due to Windstroke Muscle spasms Cramps Heaviness and pain in the lower back and legs Fixed or migrating pain in the bones in the bones and joints with reduced range of motion Long-term numbness or paralysis in the hands and feet T: Normal C: White and moist
Treatment Principle	Dispel Wind Eliminate Dampness Transform Phlegm Invigorate the Blood Unblock the collaterals Alleviate pain Warm the channels and collaterals
Herb Formulas	Xiao Huo Luo Dan
Points	General points

WIND-COLD-DAMPNESS WITH INTERNAL HEAT

Clinical Manifestations	Chills and fever (more chills than fever) Anhidrosis Headache Stiff neck Generalized ache and pains Slight thirst A bitter taste in the mouth T: Normal C: White P: Floating
Treatment Principle	Induce sweating Expel Wind-Cold Dispel Dampness Drain Interior Heat
Herb Formulas	Jiu Wei Qiang Huo Tang
Points	General points

PAINFUL BI (TONG BI) - COLD PREDOMINANT BI (HAN BI)

Clinical Manifestations	Excruciating sharp, stabbing joint pain Pain alleviated by warmth and aggravated by Cold Spasms and contractions Pain with fixed location The joints cannot be flexed or extended No local redness or Heat Painful area often feels cold to the touch Pain worse at night and better during the day Pain mostly affects low back and lower extremities Ankylosis (stiffness) of joint Aversion to Cold Maybe chills with a slight fever Anhidrosis Frequent nocturnal urination T: Pink or Pale C: Thin and white (thicker than for Wind-Bi) P: Superficial and tight or Wiry and tight - maybe slow
Treatment Principle	Warm the channels Scatter Cold Activate Qi and Blood Eliminate Dampness Expel Wind
Herb Formulas	Ma Huang Tang Ma Huang Jia Zhu Tang Ge Gen Tang Wu Tou Tang modified Wu Tou Tang Jia Jian Qu Han Bi Tang Yue Bi Tang Si Ni Tang modified Early stage: Ma Huang Jia Zhu Tang Wu Ji San With signs of toxicity: Lu Dou Gan Cao Tang With vomiting but no diarrhea: Ge Gen Jia Ban Xia Tang With Qi and Blood Deficiency: San Bi Tang With exterior Deficiency or less severe pain: Gui Zhi Jia Fu Zi Tang
Points	Moxa needle REN-4, UB-23 For jaw impediment: + LI-4, SJ-17, ST-7 For cervical impediment: + GB-12, UB-10 For thoracic vertebral impediment: + Huatuojiaji at the level of impediment For sacrococcygeal impediment: + DU-4, UB-25, UB-31, UB-32, UB-33, UB-34, UB-40 For shoulder impediment: + HT-1, LI-15, SI-11 For elbow impediment: + LI-10, LI-11, LI-12, SI-8 For wrist impediment: + SI-4, SJ-4, SJ-5 For upper extremity phalangeal and metacarpal impediment: + Baxie, LI-3, SI-3 For sacroiliac impediment: + GB-29, GB-30, UB-26, UB-27, UB-30, UB-54 For hip impediment: + GB-30, GB-34 For knee impediment: + LIV-8, ST-35, UB-40, Xiyan For ankle impediment: + GB-40, KI-3, KI-6, SP-5, ST-41, UB-60, UB-62 For metatarsal and lower extremity phalangeal impediment: + Bafeng, GB-41, SP-4, ST-41 To warm and circulate channels and collaterals: LIV-3, moxa LI-4, ST-36, GB-34, GB-31, SJ-5, SJ-4, UB-23, REN-4 or Moxa UB-23, REN-4, GB-39 + General points

FIXED BI (ZHUO BI) - DAMP PREDOMINANT BI (SHI BI)

Clinical Manifestations	Numbness and heaviness of the extremities Soreness, aching and fixed pain of joints Marked swelling of the affected area Pain worse on cloudy or rainy days Maybe peripheral or systemic edema Pain is alleviated by pressure and warmth Pain lingers and is recalcitrant to treatment Limited movement Difficulty flexing and extending the joint Pain is worse in the lower half of the body Maybe stifling sensation in chest Maybe anorexia or indigestion Maybe abdominal distention Maybe loose or semi-liquid stools T: Pink or Pale C: Greasy and white P: Slow, moderate and soft
Treatment Principle	Expel Damp Clear the channels Dispel Wind Scatter Cold
Herb Formulas	Yi Yi Ren Tang modified Yi Yi Ren Tang Jia Jian Han Shi Bi Tang Yue Bi Jia Zhu Tang Ma Xiong Yi Gan Tang Qiang Huo Sheng Shi Tang Qu Feng Tang Yi Yi Ren Tang Jia Jian Er Hao For Wind Invasion With Underlying Yang Deficiency: Xiao Xu Ming Tang modified With Qi Deficiency: Wang Qiang Huo Sheng Shi Tang With Blood Deficiency and Blood Stagnation: Shu Jing Huo Xue Tang With Cold and/or Heat: Shu Jin Li An San
Points	SP-9, ST-36 For jaw impediment: + LI-4, SJ-17, ST-7 For cervical impediment: + GB-12, UB-10 For thoracic vertebral impediment: + Huatuojiaji at the level of impediment For sacrococcygeal impediment: + DU-4, UB-25, UB-31, UB-32, UB-33, UB-34, UB-40 For shoulder impediment: + HT-1, LI-15, SI-11 For elbow impediment: + LI-10, LI-11, LI-12, SI-8 For wrist impediment: + SI-4, SJ-4, SJ-5 For upper extremity phalangeal and metacarpal impediment: + Baxie, LI-3, SI-3 For sacroiliac impediment: + GB-29, GB-30, UB-26, UB-27, UB-30, UB-54 For hip impediment: + GB-30, GB-34 For knee impediment: + LIV-8, ST-35, UB-40, Xiyan For ankle impediment: + GB-40, KI-3, KI-6, SP-5, ST-41, UB-60, UB-62 For metatarsal and lower extremity phalangeal impediment: + Bafeng, GB-41, SP-4, ST-41 To eliminate Dampness and ease sinews: SJ-6, GB-34, SP-5, SP-6, SP-9, LI-10, ST-36, ST-40 or UB-20, SP-9 When affected by weather changes: SJ-5, UB-35, ST-36, SP-5 or SP-5, ST-38, ST-36 or LI-13, ST-32, UB-38, GB-30, GB-34, SJ-8, DU-1 + General points

JUE YIN COLD

Clinical Manifestations	Excruciating sharp, stabbing joint pain Pain alleviated by warmth and aggravated by Cold Pain with fixed location The joints cannot be flexed or extended No local redness or Heat Painful area often feels cold to the touch Pain worse at night and better during the day Pain mostly affects low back and lower extremities Ankylosis (stiffness) of joint Aversion to Cold Maybe chills with a slight fever Anhidrosis Frequent nocturnal urination T: Pink or Pale C: Thin and white (thicker than for Wind-Bi) P: Superficial and tight or Wiry and tight - maybe slow
Treatment Principle	Warm the channels Activate Qi and Blood.
Herb Formulas	Ma Huang Tang Ma Huang Jia Zhu Tang Ge Gen Tang Wu Tou Tang Wu Tou Tang Jia Jian Qu Han Bi Tang Yue Bi Tang Si Ni Tang modified With signs of toxicity: Lu Dou Gan Cao Tang With vomiting but no diarrhea: Ge Gen Jia Ban Xia Tang Early stage: Ma Huang Jia Zhu Tang Wu Ji San With exterior Deficiency: Gui Zhi Jia Fu Zi Tang
Points	To warm and circulate channels and collaterals: LIV-3, moxa LI-4, ST-36, GB-34, GB-31, SJ-5, SJ-4, UB-23, REN-4 or Moxa UB-23, REN-4, GB-39 + General points

WIND OR WIND-HEAT INVASION DUE TO WEI QI DEFICIENCY (EARLY AND MIDDLE STAGES)

Clinical Manifestations	Aphasia Deviation of the mouth Lack of sensation and numbness of hands and feet Revulsed eyes Chills Fever Joint pain Muscle spasms Walking difficulty T: Normal C: Yellow or White P: Thready, floating and wiry or Floating, tight and wiry
Treatment Principle	Disperse Wind Clear Heat Nourishes Blood Invigorate the Blood
Herb Formulas	Da Qin Jiao Tang
Points	General points

WIND-DAMP-HEAT

Clinical Manifestations	Generalized body aches and pains Irritability Heavy sensation in the shoulder and back Discomfort or a constricted sensation in the area of the chest and diaphragm Multiple sores, carbuncles furuncles or abscesses Redness Itching Persistent swelling Chest pain Fever Thirst Aching and painful extremities Aching and painful joints Unbearable swelling and pain of the lower extremities Shoulder stiffness T: Normal C: Greasy and slightly yellow P: Wiry and rapid or Soft and moderate or Soft, superficial and slow or Slippery and rapid or Deep and tight
Treatment Principle	Resolve Dampness Clear Heat Disperse Wind Stop pain Activate the Blood Tonify Qi and Blood
Herb Formulas	Dang Gui Nian Tong Tang Bai Hu Jia Gui Zhi Tang Heat Bi #1 San Ren Tang Shen Qiang Huo Sheng Shi Tang Sang Zhi Shi Gao Zhi Mu Tang Shi Re Bi Tang
Points	General pain: GB-30, GB-34, GB-39, LI-4, LI-11, LI-15, SJ-4, SP-21, ST-41, UB-17, UB-62 Pain in the shoulder joint: 1. LI-15, SI-10, SJ-14, SJ-15, SJ-19, Jianneiling 2. SI-9, LI-15, SJ-14 Pain in the scapula: LI-11, UB-43, SI-12, SI-14, UB-13 Pain in the elbow: LI-4, LI-11, LI-10, LU-5, PC-3, SJ-5, SJ-6, SJ-10 Pain in the wrist: SJ-4, SJ-5, LI-4, LI-5, LI-11, LU-8, LU-9, SI-3, SI-5 Stiffness of the fingers: 1. SI-5, SI-3, LI-4 2. SJ-4, PC-7, Sifeng, Shangbaxie Numbness and pain in the fingers: 1. SI-3, SI-4, LI-3, Bafeng, Baxie, Shixuan 2. SJ-4, PC-7, Sifeng, Shangbaxie Pain in the back: DU-3, DU-12, DU-26 Pain in the spine: DU-2, DU-14, DU-16, GB-30, UB-13, UB-14, UB-40, UB-60 Lumbar pain: DU-2, DU-3, DU-12, DU-26, UB-23, UB-25, UB-31, UB-32, UB-33, UB-34 Hip joint pain: GB-29, GB-30, GB-39, ST-32, UB-54 Bleed the Jing-Well point of the Gall Bladder tendino-muscular channel GB-41 or GB-42 + SJ-3 opposite + GB-40, GB-37, GB-34, GB-31 GB-41 + SJ-5 GB-29, Jiankua ST-31, UB-36, UB-40 Ear: Hip, Lumbar spine, Shenmen, Thalamus, Adrenal Endocrine Thigh pain: GB-31, GB-34, ST-33, UB-36, UB-54 Knee joint pain: 1. GB-34, SP-9, ST-32, ST-35 (lateral), ST-35 (medial). UB-40, Heding 2. GB-34, GB-31, ST-33 3. ST-34, ST-35, GB-34 Numbness and pain in the legs: GB-39, ST-36, UB-57, UB-58 Ankle pain: GB-40, KI-2, KI-3, KI-6, LIV-4, SP-5, SP-21, UB-60 Numbness and pain in the toes: GB-44, LIV-2, SP-4, ST-44, UB-65, Bafeng To calm the mind and ease pain: DU-20, HT-3, HT-7, LI-4, LIV-3, PC-6, Taiyang

WIND-DAMP-HEAT WITH BLOOD STAGNATION

Clinical Manifestations	Sore, achy joints The pain moves from joint to joint
Treatment Principle	Clear Heat Dry Dampness Activate the Blood Dispel Wind
Herb Formulas	Shang Zhong Xia Tang Yong Tong Feng Wan
Points	General points

HEAT (HEAT PREDOMINANT) BI (RE BI)

Clinical Manifestations	Arthralgia involving one or several joints of the extremities Knee swelling is frequent Local redness and Heat Swelling with excruciating pain Severe limitation of movement Pain better during the day and worse at night The pain is relieved by Cold Fever Sometimes slight chills and fever Thirst with a desire to drink Dryness of the mouth and tongue Heart vexation Irritability Nervousness Restlessness Aversion to Heat Desire for Cold drinks Dark urine Anorexia Fatigue T: Pink or Red C: Thin and yellow or Dry yellow or Greasy and yellow P: Rolling and rapid maybe slippery
Treatment Principle	Clear Heat Relieve toxicity Activate the Blood Clear the channels For Wind-Damp-Heat Bi: Eliminate Dampness
Herb Formulas	Bai Hu Jia Gui Zhi Tang Jia Jian Gui Zhi Shao Yao Zhi Mu Tang Jia Wei Xuan Bi Tang Du Huo Ji Sheng Tang modified Heat Bi #1 Dang Gui Nian Tong Tang Bai Hu Jia Cang Zhu Tang modified Early stage: Ma Xing Shi Gan Tang Liu Shen Wan With unremittingly high fever: Ma Xing Shi Gan Tang modified + Zi Xue Dan With red, swollen excruciatingly painful joints: Bai Hu Tang plus Xi Jiao Tang modified With marked Deficiency Heat: Zeng Ye Tang modified With combined Wind-Cold and Wind-Heat: Ma Huang Lian Qiao Chi Shao Dou Tang modified Gui Zhi Shao Yao Zhi Mu Tang With combined Damp and pathogenic Heat: Xuan Bi Tang For Damp-Heat with fever not relieved by sweating, thirst with profuse drinking and a slimy, yellow tongue coat: Mu Fang Ji Tang modified For Heat and Yin Deficiency with pain which is worse at night: Qing Hao Bie Jia Tang modified
Points	DU-14, LI-4, LI-11 For jaw impediment: + LI-4, SJ-17, ST-7 For cervical impediment: + GB-12, UB-10 For thoracic vertebral impediment: + Huatuojiaji at the level of impediment For sacrococcygeal impediment: + DU-4, UB-25, UB-31, UB-32, UB-33, UB-34, UB-40 For shoulder impediment: + HT-1, LI-15, SI-11 For elbow impediment: + LI-10, LI-11, LI-12, SI-8 For wrist impediment: + SI-4, SJ-4, SJ-5 For upper extremity phalangeal and metacarpal impediment: + Baxie, LI-3, SI-3 For sacroiliac impediment: + GB-29, GB-30, UB-26, UB-27, UB-30, UB-54 For hip impediment: + GB-30, GB-34 For knee impediment: + LIV-8, ST-35, UB-40, Xiyan For ankle impediment: + GB-40, KI-3, KI-6, SP-5, ST-41, UB-60, UB-62 For metatarsal and lower extremity phalangeal impediment: + Bafeng, GB-41, SP-4, ST-41 LI-4, ST-43 To clear Heat and remove toxins: 1. LI-4, LI-11, SJ-5, UB-17, ST-44, GB-20, LIV-2 2. DU-14, LI-11 3. LI-4, LI-11, DU-14, DU-8, DU-9, DU-11, DU-12 4. DU-9, SI-4, LIV-2, LIV-13 Nourish Fluids by tonifying Spleen, Lung and / or Kidneys according to symptomatology. For severe cases, cool Blood and eliminate toxins: SP-10, LIV-2 + General points

SPLEEN AND LUNG QI DEFICIENCY

Clinical Manifestations	Protracted, incessant cough Expectoration of copious, clear, watery or white Phlegm Short, weak, breathing Asthma Spontaneous sweating Weak voice Reluctance to speak A general air of sadness or melancholy A waxy, pale complexion Rounded or hunched shoulders Four limbs tired Anorexia General lassitude Distention and pain of the epigastrium and abdomen Loose stools Severe cases: Frightens easily T: Pale with a thin crack C: White or White and greasy P: Thready and weak or Floating and weak
Treatment Principle	Reinforce the Spleen Benefit the Lungs Descend Lung Qi Disperse accumulation
Herb Formulas	Wu Ji San Chinese Patent Medicines: Su Zi Jiang Qi Wan Jiu Fei Su He Wan
Points	LU-9, REN-17, SP-3, ST-36, UB-13, UB-20, UB-43 + general points DU-12, DU-14, LU-5, LU-7, LU-9, PC-6, REN-6, ST-25, ST-36, UB-13, UB-20 + general points Ear: Lung, Spleen, Stomach Intestines, Abdomen

SPLEEN AND KIDNEY YANG DEFICIENCY

Clinical Manifestations	Enduring disease which does not improve Slight joint pain Stiffness of the sinews which prevents walking Sometimes deformation Maybe cold joints Lassitude Fatigue Poor appetite Body cold Limbs icy Aversion to Cold Complexion white and shiny Low back, knees and abdomen feel cold and painful Lower abdomen feels cold and painful Loose stools containing undigested food “Cock-crow” diarrhea (occurs at about 5 am) Edema of face and limbs Dysuria Frequent, copious urination Nocturia Severe: Abdominal ascites T: Pale, moist and swollen C: Thin and white or White and greasy P: Deep, thready, weak and maybe slow
Treatment Principle	Warm and Reinforce the Spleen and Kidneys Unblock the channels
Herb Formulas	Zhen Wu Tang modified
Points	Moxa or moxa needle DU-4, GB-39, REN-4, UB-11 For jaw impediment: + LI-4, SJ-17, ST-7 For cervical impediment: + GB-12, UB-10 For thoracic vertebral impediment: + Huatuojiaji at the level of impediment For sacrococcygeal impediment: +UB-25, UB-31, UB-32, UB-33, UB-34, UB-40 For shoulder impediment: + HT-1, LI-15, SI-11 For elbow impediment: + LI-10, LI-11, LI-12, SI-8 For wrist impediment: + SI-4, SJ-4, SJ-5 For upper extremity phalangeal and metacarpal impediment: + Baxie, LI-3, SI-3 For sacroiliac impediment: + GB-29, GB-30, UB-26, UB-27, UB-30, UB-54 For hip impediment: + GB-30, GB-34 For knee impediment: + LIV-8, ST-35, UB-40, Xiyan For ankle impediment: + GB-40, KI-3, KI-6, SP-5, ST-41, UB-60, UB-62 For metatarsal and lower extremity phalangeal impediment: + Bafeng, GB-41, SP-4, ST-41 Moxa or moxa needle REN-4, REN-12, SP-6, SP-9, ST-36, UB-20, UB-23

KIDNEY YANG DEFICIENCY

Clinical Manifestations	Aversion to Cold Watery stools with undigested food Lower back pain Weakness of the lower extremities A cold sensation in the lower half of the body Tenseness in the lower abdomen Pain and cramps in the lower abdomen Panting and irritability to the point of having difficulty lying down Will breathe most comfortably while leaning against something Nocturia May be numbness in the lower abdomen Urinary difficulty with edema or Spasmodic pain in the lower abdomen Excessive urination If severe, may be incontinence of urine May have persistent diarrhea Dysuria May have flushed face (Yang floating upward) Thirst with frequent, copious urination (Xiao Ke) Fatigue (severe) May have severe perspiration (Yang floating upward) Constipation Lassitude Pale face Edema of the face and feet Severe edema of the legs (may prevent walking) Maybe cough Maybe asthma T: Pale, may be swollen C: Thin, white and moist P: Deep, Deep and thready and/or Weak and slow
Treatment Principle	Warms and Tonifies Kidney Yang
Herb Formulas	Jin Gui Shen Qi Wan
Points	KI-3, UB-23 + General points

KIDNEY YANG DEFICIENCY WITH INTERNAL COLD

Clinical Manifestations	Extremely cold extremities Aversion to Cold Sleeping with knees drawn up Lethargy with a constant desire to sleep Vomiting Diarrhea with undigested food Abdominal pain and Cold Lack of thirst Coma Indigestion Edema Pale face Superficial fever Red face Cyanosis of the lips and nails T: Pale or Dark purple C: White and slippery P: Deep and thready or Deep and slow or Deep and faint
Treatment Principle	Warm Yang Warms the Middle Jiao Disperses Internal Cold
Herb Formulas	Si Ni Tang Yang He Tang
Points	General points

KIDNEY JING DEFICIENCY BI WITH WIND-COLD-DAMP AND BLOOD STAGNATION

Clinical Manifestations	Low back pain Sciatica Leg pain Preference for pressure and warmth Pain worse at night Limitation of joint movement Local feeling of Cold Stabbing pain Muscle spasms Referred pain toward the legs Lower back weakness Nocturia Stiffness of the back Numbness of the legs Feebleness of the knees Tinnitus T: Pale or Purplish C: Thin and white or Thin, white and greasy P: Slippery or Wiry or Thready
Treatment Principle	Dispel Wind-Cold-Damp Invigorate the Blood Smooth the channels Harmonize the collaterals Benefit the muscles Tonify Kidney Jing Stop pain
Herb Formulas	Yao Tong Ling
Points	moxa or moxa needle DU-3, GB-30, Huatuojiaji, needle SP-6, ST-3, UB-23, UB-25, UB-26, UB-37, UB- 40, UB-54, UB-57, UB-60, UB-65

YUAN QI DEFICIENCY

Clinical Manifestations	Exhaustion from long-term illness Low energy Lethargy Aversion to Cold Coolness of the extremities Impotence Spermatorrhea Aching and weakness of the lower back and knees Infertility Premature ejaculation Seminal emission Loose stools (sometimes with undigested food) Incontinence of urine Edema of the lower extremities Pale face Spontaneous perspiration Dizziness Enuresis T: Pale P: Deep, slow and weak
Treatment Principle	Warm and tonify Kidney Yang Replenish Jing Tonify the Blood
Herb Formulas	You Gui Wan
Points	Moxa UB-23, DU-4, REN-4, REN-6 General points

YANG DEFICIENCY WITH INTERNAL COLD-DAMP

Clinical Manifestations	Lower abdominal pain and Cold Abdomen feels chilled Aching bones and joints Muscle ache Whole body pain Aversion to Cold, especially at the back Cold limbs No Thirst Lower abdominal pain and Cold Abdomen feels chilled Maybe fever No thirst T: Normal C: White and slippery P: Deep and faint or Forceless or Choppy and slow or Wiry
Treatment Principle	Dispel Cold Warm the channels Assist Yang Dispel Dampness Relieve pain
Herb Formulas	Fu Zi Tang
Points

QI AND BLOOD STAGNATION

Clinical Manifestations	Severe pain in the joints and muscles Numbness Poor circulation Constant, fixed pain The pain can result from, trauma, surgery or degeneration Muscle ache of the neck, back, legs and shoulder Hip pain Whole body pain Neck and spine pain Shoulder pain Elbow pain Pain at the waist Arm pain Low back pain Leg pain T: Dark C: Normal P: Choppy
Treatment Principle	Move Qi Invigorate the Blood Break up Blood Stasis
Herb Formulas	Shen Tong Zhu Yu Tang
Points	General points

BLOOD DEFICIENCY

Clinical Manifestations	Hot sensations in the muscles and skin Red face Irritability Thirst with a preference for warm beverages or does not wish to drink Fatigue Fever Headache Slight perspiration hypermenorrhea during menstruation or after labor Purulent abscesses Red eyes Dry, feverish skin Postpartum fever Distress Postpartum headache Postpartum irregular menstruation Slow healing of wounds Excessive Blood loss after labor T: Pale P: Flooding, big, forceless and Deficient when pressed hard or Big and weak
Treatment Principle	TonifY Qi Generate Blood
Herb Formulas	Dang Gui Bu Xue Tang
Points	General points

DEFICIENT QI, BLOOD AND KIDNEY JING BI WITH DAMP-HEAT

Clinical Manifestations	Weakness of the knees Soreness of the lower back Lumbago Atrophy of the leg muscles Lower back weakness Knee pain Difficulty walking Emaciation Impotence Poor memory Dizziness Night sweats Five-sole Heat Aggravation of the pain by Damp weather Pale complexion Profuse urination at night Tinnitus Hair loss Sensation of warmth Thirst Dry skin T: Red or Pale and flabby with teethmarks C: Little or Thin and white P: Thready and weak, especially in the Kidney positions
Treatment Principle	Tonify the Liver and Kidneys Strengthen the tendons and bones Eliminate Damp-Heat Tonify Kidney Jing Relieve rheumatic pain
Herb Formulas	Deficient Bi #3
Points	ST-25, Xiyan, Heding, SP-6, SP-9, GB-34, KI-3 + General points

DEFICIENT BI (XU BI) YANG DEFICIENT BI (YANG XU BI) (SECONDARY PHASE)

Etiology	Long term illness leads to Yang Deficiency which may lead to Wei Qi Deficiency, allowing pathogens to easily penetrate deeply.
Clinical Manifestations	Painful, numb bones and joints Deformed bones and joints Localized Cold sensation Muscles and sinews atrophied Pale, lusterless face Cold body and limbs Spine bent forward (hunched) Weak, sore low back Weak, sore knees Profuse urination Watery stools Daybreak diarrhea T: Pale C: White P: Deep and Weak With Spleen Yang Deficiency : Anorexia Weakness Shortness of breath
Treatment Principle	Warm the Yang Augment Qi
Herb Formulas	Zhen Wu Tang modified With Excess Cold causing excruciating stabbing pain in the extremities: Fu Zi Ba Wu Tang When pain is eliminated, tonify Qi and nourish Blood, Nourish and warm Kidneys and Liver and strengthen sinews and bones with some of the following: Rx. Astragali Huang Qi, Rx. Angelica Sinensis Dang Gui, Hb. Epimedii Yin Yang Huo, Hb. Taxilli Sang Ji Sheng, Rx. Dipsaci Xu Duan, Rx. Morindae Ba Ji Tian, Rz. Cibotii Gou Ji, Cx. Eucommiae Du Zhong, Rx. Achyranthis Bidentatae Niu Xi, Lignum Pini Nodi Song Jie With severe pain: Yi Shen Juan Bi Wan Xiao Jin Dan
Points	Moxa KI-3, GB-34, GB-39, SP-6, REN-6 Moxa DU-4, UB-23, UB-18, REN-6, REN-17, REN-12 + General points

DEFICIENT BI (XU BI) DEFICIENT QI AND BLOOD BI (QI XUE XU BI) (SECONDARY PHASE)

Etiology	Chronic Bi weakens Qi and Blood and the pathogen is retained. Constitutional Qi and Blood Deficiencies, severe hemorrhage or Kidney and Spleen Yang Deficiencies.
Clinical Manifestations	Enduring joint pain with swelling and possibly slight deformation Bones and joints sore and painful Worse with movement Difficulty walking Difficulty seizing objects Inhibited flexion and extension of the affected joints Alternating periods of worsening and improvement Face is dull yellow or pale Spasms or contractures of muscles and sinews Palpitations Dizziness Asthenia Shortness of breath Spontaneous sweating Weight loss Poor appetite Weakness Fatigue Diarrhea T: Pale or Pale and swollen C: None or White P: Soggy and Weak or Thin and faint or Deep, thready and wiry
Treatment Principle	Harmonize and Tonify Qi and Blood
Herb Formulas	Huang Qi Gui Zhi Wu Wu Tang modified Dang Gui Sheng Jiang Yang Rou Tang modified Xu Ming Tang Dang Gui Bu Xue Tang + Si Jun Zi Tang modified With marked Wind-Dampness: Arthritis #2 With Cold: Shi Quan Da Bu Tang When Qi Deficiency predominates: Bu Zhong Yi Qi Tang modified When Blood Deficiency predominates: Si Wu Tang modified For Qi and Blood Deficiencies with Liver and Kidney Deficiencies: Du Huo Ji Sheng Tang modified With Cold predominant: Du Huo Ji Sheng Tang modified Shi Quan Da Bu Tang With Heat predominant: Du Huo Ji Sheng Tang modified For pronounced Dampness with loose stools:Du Huo Ji Sheng Tangmodified For Blood Stasis: Du Huo Ji Sheng Tang modified San Bi Tang Gai Ding San Bi Tang
Points	SP-6, ST-36 For jaw impediment: + LI-4, SJ-17, ST-7 For cervical impediment: + GB-12, UB-10 For thoracic vertebral impediment: + Huatuojiaji at the level of impediment For sacrococcygeal impediment: + DU-4, UB-25, UB-31, UB-32, UB-33, UB-34, UB-40 For shoulder impediment: + HT-1, LI-15, SI-11 For elbow impediment: + LI-10, LI-11, LI-12, SI-8 For wrist impediment: + SI-4, SJ-4, SJ-5 For upper extremity phalangeal and metacarpal impediment: + Baxie, LI-3, SI-3 For sacroiliac impediment: + GB-29, GB-30, UB-26, UB-27, UB-30, UB-54 For hip impediment: + GB-30, GB-34 For knee impediment: + LIV-8, ST-35, UB-40, Xiyan For ankle impediment: + GB-40, KI-3, KI-6, SP-5, ST-41, UB-60, UB-62 For metatarsal and lower extremity phalangeal impediment: + Bafeng, GB-41, SP-4, ST-41 REN-6, REN-4, ST-36, LIV-3, UB-18, GB-34, LI-4 Upper limbs: LI-15, LI-14, LI-10, SJ-14, SJ-5, SI-9, Jianneiling Lower limbs: GB-30, GB-31, GB-34, ST-36, ST-41, UB-60 Back: Huatoujiaji, UB-18, UB-23, UB-54 General points

DEFICIENT BI - (XU BI) - DEFICIENT YIN BI- (YIN XU BI) (SECONDARY PHASE)

Etiology	Long term illness or excess hot drying herbs leads to Yin Deficiency, interfering with the nourishment of sinews and bones. Blood Deficiency can generate internal Wind, leading to tension and tightness of tendons and vessels.
Clinical Manifestations	Bone and joint pain is prolonged without improvement Sinews and vessels are tense and tight A slight burning sensation, redness and swelling in the affected area Pain is worse with movement Pain is worse at night Slightly inhibited flexion and extension of the affected joints Tendency towards a thin body Irritability General soreness and weakness Restlessness Low back and knee soreness and weakness Five-Sole-Heat Night sweats Dizziness Vertigo Tinnitus Facial flushing Hot flashes Dry throat Unremitting low grade fever Afternoon fever Low back pain Knees weak Joints may be red, hot, swollen and deformed Maybe, significant decrease in range of motion Symptoms worse at night Dry mouth Anorexia Dry, hard stools T: Red C: Little or none P: Thready
Treatment Principle	Nourish Kidney and Liver Yin Harmonize the blood Unblock the channels
Herb Formulas	Liu Wei Di Huang Wan modified Du Huo Ji Sheng Tang modified Deficient Bi #1 Deficient Bi #2
Points	GB-39, KI-7, UB-11 For jaw impediment: + LI-4, SJ-17, ST-7 For cervical impediment: + GB-12, UB-10 For thoracic vertebral impediment: + Huatuojiaji at the level of impediment For sacrococcygeal impediment: + DU-4, UB-25, UB-31, UB-32, UB-33, UB-34, UB-40 For shoulder impediment: + HT-1, LI-15, SI-11 For elbow impediment: + LI-10, LI-11, LI-12, SI-8 For wrist impediment: + SI-4, SJ-4, SJ-5 For upper extremity phalangeal and metacarpal impediment: + Baxie, LI-3, SI-3 For sacroiliac impediment: + GB-29, GB-30, UB-26, UB-27, UB-30, UB-54 For hip impediment: + GB-30, GB-34 For knee impediment: + LIV-8, ST-35, UB-40, Xiyan For ankle impediment: + GB-40, KI-3, KI-6, SP-5, ST-41, UB-60, UB-62 For metatarsal and lower extremity phalangeal impediment: + Bafeng, GB-41, SP-4, ST-41 UB-23, KI-3, KI-15, KI-21, LIV-3 General points

COLD-DAMPNESS IN THE LOWER JIAO

Clinical Manifestations	Cold pain in the lower back and body Sciatica Copious urination Extreme heavy sensation in the lower back Absence of thirst T: Pale C: White P: Deep, thready and moderate
Treatment Principle	Warm Yang Strengthen the Spleen Dispel Cold Eliminate Dampness
Herb Formulas	Gan Cao Gan Jiang Fu Ling Bai Zhu Tang
Points

DAMP-HEAT IN THE LOWER JIAO

Clinical Manifestations	The lower back feels hot either to the patient or practitioner Pain in low back and knees The pain is aggravated by Heat , humid or rainy weather and is not improved by rest Aches and pains in the bones and sinews Weakness or atrophy of lower extremities Scanty yellow urine Red, hot, swollen and painful feet or knees Edema in lower legs Leukorrhea (thick, yellow, foul-smelling) Sores on lower extremities due to Damp Redness, swelling and pain of the knees with burning sensations Oliguria Eczema Irritability Feverishness Thirst T: Normal C: Yellow and greasy P: Soft and and rapid
Treatment Principle	Clear Damp-Heat from the Lower Jiao Ease the tendons Stop pain
Herb Formulas	Er Miao San modified Si Miao Wan Chinese Patent Medicines: Qian Jin Zhi Dai Wan Yu Dai Wan Shi Lin Tong Pian
Points	LI-11, SP-6, SP-9, ST-25, UB-25 General points + GB-34, KI-7, SP-9

HEAT EXCESS IN THE EXTERIOR AND INTERIOR

Clinical Manifestations	Dizziness Red, sore eyes Difficulty swallowing Nasal congestion and infection Thick, sticky nasal discharge and saliva Bitter taste in the mouth Dry mouth Focal distention in the chest and diaphragm Stifling sensation in the chest and diaphragm Manic behavior Carbuncles Heat rash Headache Acne Chills High fever Restlessness Urticaria Sore throat Swelling of the throat Skin rashes Skin ruptures or ulcers Tense abdomen Shoulder stiffness Numb extremities Fatigue Constipation Dysuria with reddish urine Dark, rough urination Obesity Fullness of the abdomen Fullness of the epigastrium Heaviness in the head T: Red C: White or Yellow and greasy P: Flooding and rapid or Wiry and slippery or Floating, smooth and rapid or Floating, slippery, rapid and wiry or Floating, slippery, rapid and overflowing
Treatment Principle	Disperse Wind Release the Exterior Drain Heat Unblock the bowels
Herb Formulas	Fang Feng Tong Sheng San
Points	General points

PHLEGM AND BLOOD STAGNATION

Clinical Manifestations	A long course of the disease Stiffness of the joints Inhibited flexion and extension Joint deformation Severe, fixed, stabbing pain which is worse with pressure Possible numbness Possible swollen joints Thickening and hardening of the articular tendons Possible darkness or discoloration of the affected joints Muscular atrophy around the articulation Possible subcutaneous nodules on or surrounding the joint T: Purple and dark with static spots or maculae C: White and greasy P: Soft, choppy and thready or Wiry and slippery
Treatment Principle	Invigorate the Blood Transform Blood Stasis Transform Phlegm Soften lumps Unblock the channels
Herb Formulas	Gui Zhi Fu Ling Wan Sou Feng Yin Jia Jian Without Phlegm: Shen Tong Zhu Yu Tang modified
Points	SP-10, ST-36, ST-40, UB-17 For jaw impediment: + LI-4, SJ-17, ST-7 For cervical impediment: + GB-12, UB-10 For thoracic vertebral impediment: + Huatuojiaji at the level of impediment For sacrococcygeal impediment: + DU-4, UB-25, UB-31, UB-32, UB-33, UB-34, UB-40 For shoulder impediment: + HT-1, LI-15, SI-11 For elbow impediment: + LI-10, LI-11, LI-12, SI-8 For wrist impediment: + SI-4, SJ-4, SJ-5 For upper extremity phalangeal and metacarpal impediment: + Baxie, LI-3, SI-3 For sacroiliac impediment: + GB-29, GB-30, UB-26, UB-27, UB-30, UB-54 For hip impediment: + GB-30, GB-34 For knee impediment: + LIV-8, ST-35, UB-40, Xiyan For ankle impediment: + GB-40, KI-3, KI-6, SP-5, ST-41, UB-60, UB-62 For metatarsal and lower extremity phalangeal impediment: + Bafeng, GB-41, SP-4, ST-41

BI SYNDROME OF THE BLOOD

Clinical Manifestations	Relatively superficial numbness without pain Paresthesia and numbness of the skin and flesh Paresthesia of the shoulders Neck and shoulder stiffness and pain Abdominal pain alleviated by warmth and pressure Pale complexion Hemiplegia Stiff tongue Flaccidity if the extremities Migratory pain Pain, weakness, tightness or spasms of the extremities Spontaneous sweating Shortness of breath Aphasia Excess salivation Aversion to wind T: Normal or Thick C: White or Smooth and white or White and greasy P: Faint, choppy and tight or Slightly rough and tight or Large and weak or Slow and large
Treatment Principle	Tonify Qi and Blood Warm and harmonize the channels and collaterals Harmonize the Ying and Wei Unblock painful obstruction Warm the Middle Jiao Dispel Cold Alleviate pain
Herb Formulas	Huang Qi Gui Zhi Wu Wu Tang
Points	General points

OSTEOARTHRITIS(DEGENERATIVE JOINT DISEASE)

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