Cold to the bone. - Understanding ‘Bi Syndrome’ and beating Winter pain.


Are you experiencing the pain that can come with the chilly mornings that extend into frosty days and colder nights?

Painful joints are a part of life for a significant portion of the population. In Winter even those who do not have chronic pre-existing conditions may find themselves battling the deep bone pain that can come with the chilly mornings that extend into frosty days and colder nights.

There are many external and internal factors that can result in the experience of pain and the weather is absolutely one of them.


When we explore pain from a Traditional Chinese Medicine (TCM) perspective, we consider that the Qi (energy) flow around the body has been hindered and become stagnant or blocked.


In this article we will explain Qi and its role in our experience of health. We will explore the influence of the external cold weather on our experience of pain and explain the TCM classification of Bi Syndrome.


Of course, we will also run through the way Acupuncture and Traditional Chinese Medicine can be used to support patients experiencing Bi Syndrome Pain to re-establish balance.

What is Qi?

Pronounced “chee” Qi is our vital energy.

TCM considers this body that we inhabit as one whole entity. All of its connecting parts and its internal and external influences working together to form our experience of life and health. Where there is balance and harmony of all these factors, we experience health. Where there is an imbalance this can influence the entire system and result in dis-ease and ill health.

Pronounced “chee” Qi is our vital energy. It is the innate life force that runs within us and its very existence along with its associated properties make up much of the core principle of TCM.


Qi holds many roles around the body:

  • It drives production and movement of blood and fluid around the body.

  • It assists in maintaining our temperature ideally at optimal levels for all functioning.

  • It has a protective action, for ease of explanation you could liken it to the western medicine understanding of the “immune system”.

  • It works to ‘hold’ everything in its place and it has a transformative function aiding metabolization and other transformative functions.

Qi is derived from two sources.

We have Qi that is present from conception, our innate vital substance and in addition to that we can also acquire Qi throughout life from our surrounds, from food and water, air, and nature.


There are many types of Qi. Here is an example of 4.

  • Prenatal Qi (Yuan Qi) contains the prenatal and congenital properties. Inherited from the parents this Qi is stored in the kidney.

  • Lung Qi (Zong Qi) is made in the lungs. It is formed from oxygen taken in by the lungs and food essence from spleen and stomach.

  • Nutritive Qi (Ying Qi) governs the nourishment of the body. Derived from food essence created by stomach and spleen.

  • Protective Qi (Wei Qi) is our suit of armour against illness. Wei Qi is pushed to the surface by the dispersing action of the lungs and circulates on the skin in order to protect the body from external pathogens.

How does the cold weather influence our Qi?


If you have had a treatment with a Chinese Medicine practitioner in the past you will know we are not, as a general rule, fans of the cold. We see cold to have a negative effect on our bodies. It results in restricted movement, slowing the flow of Qi and Blood. When water freezes it ceases to move. The cold has the same impact on our blood and Qi.


Have you noticed stiffness and pain in your neck after leaving it exposed to a chilly day or if a cold wind suddenly picks up? This is a result of impaired flow of Qi through that localised area.


“If there is free flow there is no pain; If there is no free flow there is pain”

– Traditional Chinese saying.


This is why we Acupuncturists are such big fans of layers and scarves and generally dressing sensibly with the weather in mind!

Does your athritic or joint pain flare up in the cold?

In addition to the direct result of cold on our exposed skin, the winter chill, damp, or wind can expose us to pathogenic invasion due to a deficiency of our Nutritive Qi and Protective Qi. When there are internal imbalances resulting in deficiency of Qi or impairment of blood flow the body will become vulnerable.


It then becomes easy for what we term “external invasions”, from events such as the changing seasons and cold weather.


This can negatively influence our health and further deplete our Qi.


A common example of this is when we see arthritis, old joint injuries and other musculoskeletal conditions aggravated by cold damp weather or wind.

Bi Syndrome


In ancient classical TCM texts the symptoms and pathogens of ‘Bi’ Syndrome are described in detail. The main manifestations are listed as pain, numbness, heaviness, heat sensation and limited range of motion of the muscles and tendons because of deformity and swelling of the joints.


‘Bi’ syndrome is considered to be caused by channel obstruction and inhibited flow of qi and blood due to insufficient healthy qi (vital energy), insecurity of the healthy wei qi (see above - immune like barrier) and external contraction of wind, cold, dampness and heat.

There are many types of Bi Syndrome. These are dependent on their unique pathogenic influences. Typically, we see pathogenic influences paired in combination for example wind and cold.


Here are three Bi Syndromes that may be most relevant during these cold and unstable winter months:

1. Migratory (Wandering) Bi:

As suggested in the name, Wandering Bi Syndrome involves pain that is in more than one location at a time or that moves around the body.

  • Pain in the muscles and joints.

  • Pain in multiple and changing locations.

  • Pain can change in intensity.

  • Decreased movement.

The TCM treatment is to invigorate blood and dispel wind.

2. Painful (Cold) Bi

This pain is fixed to one area and is aggravated by cold and improved with warmth.

  • Severe fixed pain.

  • Aggravated by cold and alleviated by warmth.

  • Movement is limited but there is no localised redness of the skin or signs of heat.

TCM treatment is to warm the channels and dissipate cold.


3. Fixed (Damp) Bi

Characterised by a dull ache. This pain localised pain can be described as having a heaviness.

  • Pain and heavy sensation in joints and muscles.

  • Swelling and numbness.

  • Pain is localised.

  • Pain notably worse in cloudy and wet weather.

The TCM treatment is to eliminate the dampness and remove turbidity.

Acupuncture and Traditional Chinese Medicine to support Winter pain:


This blog has talked about the impact of external influences on our experience of pain and certainly patients will present in clinic due to pain and discomfort that has clearly coincided with the onset of winter however it’s important for optimal and long lasting relief that we identify what the deficiency was that resulted in the invasion of the external pathogen in the first place.


Acupuncture, additional Traditional Chinese Medicine therapies and dietary and lifestyle adjustments will be utilised to resolve the imbalance as shown above in addition to addressing underlying internal deficiencies and strengthening the Qi.

Moxa particularly useful to warm the channels and invigorate movement of Qi.

Moxibustion is a Traditional Chinese Medicine therapy that can be particularly useful to warm the channels and invigorate movement of Qi. ‘Moxa’comes in a variety of forms. It is made from the dried herb mugwort and can be used in a variety of ways in clinic. In the treatment room it can be used as a long cigar shaped stick that is lit with the smouldering end held close to the skin to warm and activate the relevant areas and acupuncture points. It can also be applied in small cones directly to the skin on the appropriate point or attached to the handle of an acupuncture needle sending gentle warmth to the point via the needle. The heat and herbal properties of the moxa stimulate the flow of Qi to the area which in turn encourages blood flow and healing.


Herbal liniments are also wonderful for relieving painful Bi Syndrome conditions. We have several different liniments that we keep on hand in the treatment room and available for patients to take home. Each has different herbal ingredients and the type of conditions they are suited to vary.

The line up of our favourite liniments
  • Zheng Gu Shui - We love this one for blood stagnation type pain. Treating trauma, bruising, strains and fractures and sore joints. Zheng Gu Shui roughly translates to “Bone healing water”

  • Po Sum On - Eases and soothes muscular tension and stress. Could also be used for lung / chest discomfort from bronchial cough conditions and to aid in the relief of tummy pains

  • Eagle Brand medicated oil - Moves and regulates Liver Qi. It is awesome for Arthritis, rheumatism, strains, and sprains. Scott is more inclined to choose Eagle when dealing with ‘hot’ arthritic conditions

  • Woodlock - Another awesome Qi mover. We love this for muscle pain, cramps, and spasm but it can also work wonders for arthritis and rheumatism

For more tips on managing Winter Health make sure you check out Scott's blog on Scott Stephens Acupuncture called Winter Health - Seasonal living for better health.

If you would like to chat with us about how we can support you to manage aches and pains through these cooler months (or any time) please do not hesitate to be in touch. You can contact us online via the contact page or on PH (03)59061494.