RHEUMATOID ARTHRITIS

GENERAL

Clinical Manifestations	Beginning Stage: Disabling inflammatory disease Chronic Synovitis Joint Lesions Pannus-Corneal vascularization (localized malignant inflammatory proliferation) Immunological origin- auto immune Self sustained Rheumatoid nodules Lung symptoms Vessel Problems Pericardium problems Above three conditions alternate with joint problems Fever Chronic Stage: Beginning stage may last several months or years and may not progress beyond this point More often moves on, intermittently with Worsening of joints New invasion of healthy joints May affect organs Qi and Blood circulation slowed Blood and turbid Phlegm stagnate joints (stubborn Bi) Joints show chronic inflammation Pain occurs spontaneously or from pressure or with movement Pain and stiffness worse at night and on awakening Disappears late in the morning or afternoon and require a long period of warming up Sensitive to weather Locations of joint pain depend on patient (antalgic attitudes)
Treatment Principle
Herb Formulas	Juan Bi Tang San Bi Wan Jia Jian Qu Gui Bai Zhu Tang She Cong San Early-Stage: Qiang Huo Sheng Shi Tang Wang Qiang Huo Sheng Shi Tang Shen Qiang Huo Sheng Shi Tang With Qi and Blood Deficiency or Kidney and Liver Deficiency: Du Huo Ji Sheng Tang For Wind Invasion With Underlying Yang Deficiency: Xiao Xu Ming Tang modified For muscle spasms in the calves: Shao Yao Gan Cao Tang With muscular atrophy: Hu Qian Wan modified
Points	General pain: 1. GB-30, GB-34, GB-39, LI-4, LI-11, LI-15, SJ-4, SP-21, ST-41, UB-17, UB-62 2. Bizhong, GB-30, LI-4, LI-11, LI-15, ST-36 3. DU-14, LI-4, LI-11, LI-15, SJ-5, UB-11 4. GB-41, KI-5, KI-7, LIV-1, LIV-2, LIV-8, LU-8, SI-2, SI-3, SI-5, SP-1, SP-3, ST-41, ST-43, UB-66 To control the balance of Fire and water: + HT-8, KI-10 To control Dampness: + ST-36 Pain in the shoulder joint: 1. LI-15, SI-10, SJ-14, SJ-15, SJ-19, Jianneiling 2. SI-9, LI-15, SJ-14 3. SJ-14 Pain in the scapula: LI-11, UB-43, SI-12, SI-14, UB-13 Pain in the elbow: 1. LI-4, LI-11, LI-10, LU-5, PC-3, SJ-5, SJ-6, SJ-10 2. PC-3 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 3. LI-5, PC-7 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. Baxie 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: 1. GB-29, GB-30, GB-39, ST-32, UB-54 2. Bleed the Jing-Well point of the Gall Bladder tendino-muscular channel 3. GB-41 or GB-42 + SJ-3 opposite + GB-40, GB-37, GB-34, GB-31 4. GB-41 + SJ-5 5. GB-29, Jiankua 6. ST-31, UB-36, UB-40 7. GB-31 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 4. ST-35 Numbness and pain in the legs: GB-39, ST-36, UB-57, UB-58 Ankle pain: 1. GB-40, KI-2, KI-3, KI-6, LIV-4, SP-5, SP-21, UB-60 2. UB-60 Numbness and pain in the toes: 1. GB-44, LIV-2, SP-4, ST-44, UB-65, Bafeng 2. Bafeng To calm the mind and ease pain: DU-20, HT-3, HT-7, LI-4, LIV-3, PC-6, Taiyang

WIND COLD WITH UNDERLYING QI AND YANG DEFICIENCY

Clinical Manifestations	Slight fever Strong chills Anhidrosis Headache Cold extremities Fatigue with a constant desire to lie down Drowsiness Pale face Lassitude Low voice Weak voice T: Pale C: White P: Floating, big and forceless or Deep and forceless
Treatment Principle	Tonify Yang Augment Qi Release the Exterior Induce sweating
Herb Formulas	Zai Zao San With underlying Yang Deficiency: Ma Huang Fu Zi Xi Xin Tang
Points	General points

SHAO YANG WITH FLUID ACCUMULATION

Clinical Manifestations	Alternating chills and fever (chills predominate) or Chills without fever Sensation of irritability in the chest Sweating from the head Fatigue Gastrointestinal weakness Heavy head Neuralgia Epigastric distension Lower abdominal pain Tension around pubic bone Periumbilical pain Urinary difficulty T: Moist C: White and slippery P: Superficial and wiry
Treatment Principle	Disperse Clumping Harmonize the Shao Yang Warm the Interior Dispel Cold
Herb Formulas	Chai Ling Tang
Points	GB-41, SJ-5, moxa or moxa needle REN-4, REN-6, REN-8, REN-12, SJ-6, ST-25, ST-36

JUE YIN COLD

Clinical Manifestations	Long standing cold hands and feet that are cold to the touch and feel cold to the patient Maybe lumbago and leg pain Abdominal pain and distention Midline pain Uterine pain Chills Diarrhea Menstrual abdominal pain Maybe chest pain Increased sweating, particularly of the feet Increased salivation Spasm and pain of the limbs Scanty urination Pain at the waist, hips, legs and feet Sciatica Joint pain Irregular menstruation Abdominal Cold Migraine headache Vaginal discharge T: Pale C: White P: Deep and thready (may be almost imperceptible).
Treatment Principle	Warm the channels Disperse Cold Nourish the Blood Unblock the Blood vessels
Herb Formulas	Dang Gui Si Ni Tang
Points	Moxa REN-4, REN-6, REN-8, REN-9, REN-12, ST-25

WEI STAGE: SUMMERHEAT WITH DAMP

Clinical Manifestations	Fever and chills, fever more pronounced or Tidal fever Abdominal distention Thirst Sweat Stifling sensation in the chest Restlessness Gastric disturbances: Heaviness Nausea Severe diarrhea Scanty urine T: Red tip and edges C: Greasy white or yellow P: Rapid and soft
Treatment Principle	Disperse Wind Clear Heat Resolve Damp
Herb Formulas	Chai Ling Tang
Points	Bleed UB-40, needle DU-14, DU-23, DU-24, GB-20, LI-4, LI-11, REN-9, SJ-5, SP-6, SP-9, ST-8, ST-28, Taiyang, UB-12, UB-20

WIND-COLD-DAMP BI WITH FORMATION OF HEAT (MIXED COLD AND HEAT)

Clinical Manifestations	Joint redness, swelling, Heat and pain Stiffness and inflexibility Initially the pain eases when exposed to coolness Later, coolness does not help. but warmth does Dry mouth Bitter taste in the mouth Parched throat Insomnia Agitation Irritability T: Red C: Yellow or Slimy and yellow P: Wiry and rapid
Treatment Principle	Scatter Cold Eliminate Dampness Clear Heat Unblock the channels
Herb Formulas	Gui Zhi Shao Yao Zhi Mu Tang modified RA #1 modified Du Huo Ji Sheng Tang modified With severe Wind, Cold, Dampness and/or Heat with Qi Deficiency: Dang Shao Di Huang Tang modified
Points	LI-4, LI-11, REN-4 For jaw impediment: + SJ-17, ST-7 For cervical impediment: + GB-12, GB-20, UB-10 For thoracic vertebral impediment: + Huatuojiaji, 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-12, SI-8 For wrist impediment: + SI-4, SJ-4, SJ-5 For upper extremity metacarpal and phalangeal impediment: + Baxie, ST-41, 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 choose tender points For lower extremity metatarsal and phalangeal impediment: + Bafeng, GB-41, LIV-3, SP-4, ST-41

WIND-COLD-DAMP BI - WIND PREDOMINANT

Clinical Manifestations	Migrating pain in the joints especially the : Shoulders Elbows Wrists Fingers Upper back and neck Pain quality changes 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
Treatment Principle	Relieve Wind Dredge the channels Relieve Cold Resolve Dampness
Herb Formulas	Fang Feng Tang modified Qu Feng Tang Juan Bi Tang Da Fang Feng Tang Da Qin Jiao Tang Rheumatoid Arthritis #1 With Qi and Blood Deficiency: Juan Bi Tang #1 For Wind Invasion With Underlying Yang Deficiency: Xiao Xu Ming Tang modified
Points	GB-34, SP-10, ST-34, ST-35, UB-17 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-COLD-DAMP BI - COLD PREDOMINANT

Clinical Manifestations	Early stage: Early morning stiffness, heaviness, numbness and/or restricted movement Joint pain, especially in the wrist, ankle, knee and elbow Excruciating sharp, stabbing joint pain The affected joints may feel Cold Muscle pain There may be numbness and heaviness in the limbs The pain is worse with Cold and better with warmth The pain is aggravated by Wind The pain aggravated by Dampness 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 Muscle weakness Numbness of the muscles and skin Hemiplegia, especially of the upper limbs Slight muscle edema Heaviness of the joints Aversion to Cold The pain worse at night Local inflammation Deviation of the eyes and mouth Spasm of the limbs Ankylosis (stiffness) of joint Aversion to Cold Maybe chills with a slight fever Anhidrosis Frequent nocturnal urination T:Pink or Pale or Slightly purple or purple spots C: Thick and white or Thin and white (thicker than for Wind-Bi) P: Slippery or Slightly superficial or slightly rough or Slow and Soft or Wiry and tight or Floating and wiry or Superficial and tight
Treatment Principle	Relieve Wind Dredge the channels Relieve Cold Resolve Dampness
Herb Formulas	Fang Feng Tang modified Qu Feng Tang Ma Huang Tang Ma Huang Jia Zhu Tang Ge Gen Tang Wu Tou Tang Jia Jian Qu Han Bi Tang Yue Bi Tang Gan Cao Fu Zi Tang Wen Jing Juan Bi Tang Jia Jian Han Shi Bi Tang Early stage: Ma Huang Jia Zhu Tang Wu Ji San With signs of toxicity: Lu Dou Gan Cao Tang With exterior Deficiency: Gui Zhi Jia Fu Zi Tang With Qi and Blood Deficiency: Juan Bi Tang #1 With Blood Stagnation: Huang Qi Gui Zhi Wu Wu Tang Le Feng Wan
Points	GB-34, SP-10, ST-34, ST-35, UB-17 + general 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 + general points or Moxa UB-23, REN-4, GB-39 + general points GB-20, REN-4, UB-17, UB-23 For jaw impediment: + LI-4, SJ-17, ST-7 For cervical impediment: + GB-12, GB-20, UB-10 For thoracic vertebral impediment: + Huatuojiaji, 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 metacarpal and phalangeal impediment: + Baxie, ST-41, 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 choose tender points For lower extremity metatarsal and phalangeal impediment: + Bafeng, GB-41, LIV-3, SP-4, ST-41

WIND-COLD-DAMP BI - DAMP PREDOMINANT

Clinical Manifestations	Aversion to Wind, Cold and Dampness Numbness and heaviness of the extremities Stiff and painful muscles and joints Soreness and fixed pain of joints Limited movement Pain aggravated by Wind Sensitive to climatic changes Pain aggravated by Cold Numbness of muscles Pain worse on cloudy or rainy days 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 Maybe peripheral or systemic edema Pain is alleviated by pressure and warmth Pain lingers and is recalcitrant to treatment Limited movement Maybe stifling sensation in chest Maybe anorexia or indigestion Maybe abdominal distention Maybe loose or semi-liquid stools T: Pale or Purplish C: Thin, white and greasy P: Thready and slippery or Floating and rolling or Slow, moderate and soft
Treatment Principle	Relieve Wind Dredge the channels Relieve Cold Resolve Dampness
Herb Formulas	Fang Feng Tang modified Qu Feng Tang San Bi Wan Jia Jian Yi Yi Ren Tang Jia Jian Han Shi Bi Tang Yue Bi Jia Zhu Tan Qiang Huo Sheng Shi Tang Wen Jing Juan Bi Tang Jia Jian Yue Bi Tang Yi Yi Ren Tang With Blood Deficiency: Wang Qiang Huo Sheng Shi Tang With Qi and Blood Deficiency: Juan Bi Tang #1 With Accumulation of Phlegm-Damp in the collaterals: Ling Gui Zhu Gan Tang modified With Wei Qi Deficiency: Fang Ji Huang Qi Tang With sweating that does not reduce the fever: Zhen Wu Tang With Cold and/or Heat: Shu Jin Li An San
Points	GB-34, SP-10, ST-34, ST-35, UB-17 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

WIND-COLD-DAMP BI WITH QI DEFICIENCY

Clinical Manifestations	High fever accompanied by severe chills and shivering Aversion to Cold Pain worse at night Difficult movement Local inflammation Migratory pain Soreness and pain of the extremities Nasal congestion with sonorous breathing Anhidrosis Pain and stiffness of the head and neck Focal distention and fullness of the chest and diaphragm A productive cough May have numbness and heaviness in the limbs Body aches Lumbago Nasal obstruction Cough with sputum Stuffy nose Joint pain Pain worse with Cold and better with warmth Pain aggravated by Wind Pain aggravated by Dampness Pain is stabbing Muscle weakness Pain alleviated by movement Slight muscle edema Heaviness of the joints Cold joints Headache Dizziness T: Pale or Slightly purple or Purple spots C: White or thin, white, greasy P: Slippery or Slightly superficial or Superficial and soft or Slightly rough or Slow and Soft or Wiry and tight or Superficial and rapid that is forceless under pressure
Treatment Principle	Release the Exterior Augment Qi Remove Wind-Cold-Damp Eliminate Painful Obstruction Circulate Qi and Blood Stop pain
Herb Formulas	Ren Shen Bai Du San
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

WIND-COLD-DAMP 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 Gui Zhi Shao Yao Zhi Mu Tang
Points	General points

WIND-DAMP-HEAT

Clinical Manifestations	Generalized body aches and pains Joint swelling, pain and heaviness Restricted movement Irritability Heavy sensation in the shoulder and back Discomfort or a constricted sensation in the area of the chest and diaphragm Redness of the affected joints Affected joints are burning hot to the touch symptoms are better with cold Multiple sores, carbuncles furuncles or abscesses Itching Persistent swelling Chest pain Maybe vomiting Fever Sweating Aversion to Wind Thirst, may not have a desire to drink Aching and painful extremities Unbearable swelling and pain of the lower extremities Shoulder stiffness Short, reddish urination T: Normal or Red 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 Heat Bi #1 San Miao Wan Bai Hu Gui Zhi Tang Jia Wei Bai Hu Jia Gui Zhi Tang Feng Shi Fang Yi Hao With Dampness and Heat both vigorous: Feng Shi Fang Er Hao
Points	DU-14, LI-4, LI-11, SJ-5 For jaw impediment: + LI-4, SJ-17, ST-7 For cervical impediment: + GB-12, GB-20, UB-10 For thoracic vertebral impediment: + Huatuojiaji, 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 metacarpal and phalangeal impediment: + Baxie, ST-41, 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 choose tender points For lower extremity metatarsal and phalangeal impediment: + Bafeng, GB-41, LIV-3, SP-4, ST-41 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

HEART YANG NOT VIGOROUS: WATER QI INSULTS THE HEART WITH LUNG AND SPLEEN DEFICIENCY

Clinical Manifestations	Fullness in the chest and hypochondrium Palpitations Shortness of breath Coughing up clear, watery sputum Dizziness Vertigo (when standing) Dyspnea Anxiety Tinnitus Difficult urination Mild edema Cold feet Headache Migraine Weak abdomen T: Pale and swollen C: White and slippery or greasy P: Slippery and wiry or soggy or Soft or Deep and tight
Treatment Principle	Warm and transform Phlegm and congested Fluids Strengthen the Spleen Resolve Dampness Improve metabolic function
Herb Formulas	Ling Gui Zhu Gan 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: 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

HEART YANG NOT VIGOROUS: WATER QI INSULTS THE HEART WITH KIDNEY YANG DEFICIENCY

Clinical Manifestations	Abdominal pain aggravated by Cold Urinary difficulty Deep, aching heaviness in the extremities Generalized edema Loose stools Dizziness Heavy sensation in the head Palpitations Cough Epigastric palpitations Aversion to Cold Watery diarrhea No thirst Leukorrhea Hiccup Profuse perspiration Cold limbs Headaches A husky voice Hair loss Asthma Generalized twitching Tidal flushing of the genitals by Dampness Water buildup leading to hernia Impotence Prone to infections Prone to allergies Prone to Wind erysipelas Diarrhea Constipation Chest pain Mental and emotional disorders Light-headedness Nasal obstruction with clear mucus Impaired visual acuity	Prone to dormant papules A sensation of something being stuck in the throat Incessant sneezing Swelling and pain of the teeth or gums Feeling of unsteadiness as if one were about to fall Distended or heavy sensation of the head Palpitations Gradual weight gain Dyspnea Abdominal distention and fullness Pitting edema Scanty urination Chills Weak knees Seminal emissions Flaccid abdomen Muscular aching Chronic lower back pain Nausea Cyclic vomiting Fever, perspiration does not reduce fever Vertigo Impaired memory Shivering and trembling Catches cold easily Severe fatigue Aches and pains in the body or extremities Flank pain Wheezing T: Pale or Dark purple and swollen with teeth marks C: White and slippery P: Deep, thready and forceless or Deep and thready
Treatment Principle	Warm Yang Promote urination
Herb Formulas	Zhen Wu 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: 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

LIVER BLOOD WITH KIDNEY YIN AND YANG DEFICEINCY AND PHLEGM STAGNATION

Clinical Manifestations	Joint and muscular atrophy Joint stiffness Inflexibility Deformation Unceasing aching and pain which is worse on exposure to Cold and during the winter and better with warmth and during the summer Dizziness Tinnitus Frequent long, clear urination Nocturia Low back and knee pain and coldness T: Pale C: White P: Deep, weak and slow
Treatment Principle	Tonify the Kidneys Warm Yang Nourish the Liver Soothe the sinews Scatter nodulations Unblock the channels
Herb Formulas	Shen Qi Wan modified
Points	DU-4, REN-4, UB-23 For jaw impediment: + SJ-17, ST-7 For cervical impediment: + GB-12, GB-20, UB-10 For thoracic vertebral impediment: + Huatuojiaji, 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-12, SI-8 For wrist impediment: + SI-4, SJ-4, SJ-5 For upper extremity metacarpal and phalangeal impediment: + Baxie, ST-41, 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 choose tender points For lower extremity metatarsal and phalangeal impediment: + Bafeng, GB-41, LIV-3, SP-4, ST-41

KIDNEY YANG DEFICIENCY

Clinical Manifestations	Lumbago: low back feels cold, weak and aching Feeling chilled Aversion to Cold Cold limbs General debility Pale face Urinary frequency with abundant, clear urine or Oliguria with edema Maybe nocturia Lassitude Withdrawn, subdued behavior Knees feel cold and aching Dizziness Tinnitus Impotence Spermatorrhea Premature ejaculation Low libido Female infertility ("uterus cold and infertile") Maybe anorexia Maybe loose stools Maybe chronic diarrhea or "cock crow" diarrhea T: Pale and swollen C: Thin and white P: Deep and thready - maybe slow
Treatment Principle	Warm and Reinforce Kidney Yang
Herb Formulas	Jin Gui Shen Qi Wan (Ba Wei Di Huang Wan) Yang He Tang modified
Points	Moxa or moxa needle DU-4, KI-3, REN-4, UB-23 For chronic diarrhea, rectal prolapse and Vanquished Yang: + moxa DU-20, REN-8 For Kidney Yang Deficiency impotence: moxa or moxa needle DU-4, DU-20, KI-3, REN-4, UB-23 For Kidney Yang Deficiency (Cock Crow) Diarrhea: moxa or moxa needle DU-20, KI-3, REN-4, UB-23

KIDNEY YANG DEFICIENCY WITH WATER FLOODING

Clinical Manifestations	Edema of whole body particularly at and below the waist Pitting edema Low back pain, aching and heaviness Abdominal distention with full sensations Oliguria Cold limbs Face gray and congested or pale Feeling nervous and cold with mental weariness In severe cases: Ascites Edema of scrotum T: Pale and swollen C: Thin, white or Thick, white and sticky P: Deep and thready
Treatment Principle	Warm the Kidneys Promote diuresis
Herb Formulas	Zhen Wu 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: 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

KIDNEY YIN DEFICIENCY WITH FIRE RISING

Clinical Manifestations	Dizziness Tinnitus or deafness Poor memory Aching, soreness or weakness of the low back Spermatorrhea or Premature ejaculation Aching in the bones Aching in the leg and heel Dry mouth Thirst Night sweats Five Sole Heat Malar flush Low grade fever in the afternoon Dry throat, maybe recurrent sore throat Dry stools and/or Constipation Urine short and red Heightened libido If Heart Fire also Flares: Insomnia Frequent dreams Palpitations If Liver Yang also Rises: Dizziness Blurred vision T: Red C: Little or None P: Thready and rapid
Treatment Principle	Nourish Yin Subdue Fire
Herb Formulas	Zhi Bai Di Huang Wan
Points	KI-1, KI-2, KI-3, KI-6, KI-9, KI-10, REN-4, SP-6, UB-23 If Heart Fire also Flares: HT-7, PC-7, UB-15 If Liver Yang also Rises: LIV-3, UB-18

QI AND BLOOD DEFICIENCY WITH PHLEGM STAGNATION

Clinical Manifestations	Late stage Joint rigidity and deformities Aching and painful joints Swollen, distended and deformed joints Inhibited joint movement A somber, white facial complexion Palpitations Shortness of breath Fatigue Lassitude T: Pale C: White P: Deep, thready wiry and/or tight
Treatment Principle	Tonify Q!i Nourish the blood Transform Phlegm Dispel Stasis unblock and activate the channels
Herb Formulas	For predominant Cold: Huang Qi Gui Zhi Wu Wu Tang For lingering Wind=Damp-Heat: Dang Gui Nuan Tong Tang
Points	SP-6, ST-36 For jaw impediment: + SJ-17, ST-7 For cervical impediment: + GB-12, GB-20, UB-10 For thoracic vertebral impediment: + Huatuojiaji, 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-12, SI-8 For wrist impediment: + SI-4, SJ-4, SJ-5 For upper extremity metacarpal and phalangeal impediment: + Baxie, ST-41, 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 choose tender points For lower extremity metatarsal and phalangeal impediment: + Bafeng, GB-41, LIV-3, SP-4, ST-41

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 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 BI

Etiology	Latent Heat which is reactivated by a new external attack or Wind-Cold-Damp stagnates and creates Heat
Clinical Manifestations	Inflammatory condition Arthralgia involving one or several joints of the extremities Localized pain, redness, Heat and swelling Can be accompanied by fever during crisis (high fever with aversion to Wind which is not abated by sweating) Pain is hot, burning or shooting Swelling with excruciating pain Pain intensity is high (worse late at night) Pain persists in the morning with stiffness Severe limitation of movement Fever Maybe slight chills Thirst Dryness of the mouth Irritability Nervousness Restlessness Aversion to Heat Desire for Cold drinks T: Normal or Red C: Thin and yellow P: Wiry and rapid or 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 Bai Hu Jia Gui Zhi Tang Jia Jian Gui Zhi Shao Yao Zhi Mu Tang Jia Wei Xuan Bi Tang Shi Re Bi Tang Early stage: Ma Xing Shi Gan Tang Liu Shen Wan With unremittingly high fever: Ma Xing Shi Gan Tang modified plus 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 Wind-Damp-Heat Bi: Er Miao San Si Miao San With Liver Fire: Dang Gui Long Hui Wan
Points	DU-14, GB-40, KI-6, LI-11, UB-60, UB-62 To clear Heat and remove toxins: LI-4, LI-11, SJ-5, UB-17, ST-44, GB-20, LIV-2 or DU-14, LI-11 or LI-4, LI-11, DU-14, DU-8, DU-9, DU-11, DU-12 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

DAMP-HEAT BI

Clinical Manifestations	Vomiting Diarrhea Spasms Cramps Thirst Irritability Oliguria with reddish urine Restlessness Arthralgia with a burning sensation, redness and swelling Abdominal pain T: Pink C: Thick, dry and yellow or Yellow and greasy P: Soggy and rapid or Floating and rapid or Floating, soft and rapid
Treatment Principle	Clear Heat Resolve Dampness Separate the clear from the turbid Alleviate pain
Herb Formulas	Can Shi Tang Xuan Bi Tang Si Miao San
Points	General points

STUBBORN BI (WAN BI) - (CHRONIC)

Clinical Manifestations	Chronic Bi with many recurrences Joints are stiff and deformed Joints deep red Areas surrounding the joints are slightly purple Dark red or purple cheeks Palpitations Joint pain Pain is excruciating Fixed location Maybe painful numbness Joint may be red, swollen and painful or Icy cold and worse in cold weather and better with warmth Maybe fever Chest oppression and pain Fearful throbbing T: Dark purplish or Purple spots C: White P: Choppy or Thin and choppy
Treatment Principle	Break up Blood Stasis Resolve Phlegm Break up harnesses Clear Damp-Heat or Expel Wind-Cold and Damp
Herb Formulas	Tao Hong Yin Lei Feng Wan Shen Tong Zhu Yu Tang Xiao Huo Luo Dan Da Huo Luo Dan Yi Shen Juan Bi Wan Tong Qiao Huo Xue Tang Kidney Yang Deficiency with Blood Stagnation: Wen Jing Tang
Points	Bafeng, Baxie, GB-34, GB-31, LI-4, LIV-3 LI-4, LI-10, REN-12, SP-6, SP-10, ST-40, ST-35, SJ-6, UB-17 + General points

VASCULAR BI

Etiology	Poor diet - too much food drink, and smoking causing Internal Heat which consumes Qi and Yin. Combined with External attack causes Blood Stagnation in the vessels. Worse in Summer. Wind, Cold, Damp, Heat and Toxin Invasion into the Blood vessels, leading to Qi and Blood Stagnation. Long-term presence of pathogenic factors leading to Qi and Blood Deficiency.
Clinical Manifestations	General manifestations: Stabbing fixed pain Pain aggravated at night Painful muscles and joints Uneasiness in the Heart Uncomfortable sensations in the chest Distress in the chest Anxiety Depression Aversion to Cold Fullness in the body (like gas) Epigastric fullness Sudden shortness of breath Dryness of the upper throat Frequent belching Burning sensations on the skin Red or purple spots on or under the skin Weakness or disappearance of the pulse Numbness, soreness and pain of the affected limbs. Low temperature of the affected limb Numbness of the limbs Aggravation of the above symptoms by Cold Pale complexion T: Pale Blood Stasis due to Cold: Affected limb is cold Aversion to Cold Numbness of the limbs Worse with Cold Pale face T: Pale C: White P: Weak or disappeared
Treatment Principle	Weakness or disappearance of the pulse Warm the channels Dispel Cold Circulate Blood in the collaterals Blood Stasis due to Cold: Warm the meridians Dispel Cold and Circulate Blood
Herb Formulas	Blood Stasis due to Cold: Yang He Tang modified
Points	General points + UB-17, SP-10

DEFICIENT BI

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 For Spleen and Kidney Yang Deficiency: Dang Gui Shao Yao San For Liver and Kidney Yin Deficiency and/or Qi and Blood Deficiency: Du Huo Ji Sheng Tang
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 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

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