I had the wonderful opportunity to finish my last acupuncture course at South Baylo University School of Oriental Medicine this past quarter. It has been a labor of love. Three years later, still with questions, I have come to appreciate the depth and complexity of traditional Chinese medicine, and I'm fully aware that my knowledge and skills are in its infancy.

I finished up my last acupuncture course with Acupuncture Theory & Therapy B with Dr. Zhao Wang. Dr. Wang, an acupuncture purist, challenged the entire class to focus on the treatment of diseases and condition from the classics. I would like to share highlights from one of his lectures as a different approach in treating bi syndromes, but before sharing those highlights, we must remember that as our health care system in the United States becomes more intertwined with many other disciplines, it is important for all practioners to recognize and differentiate different diseases from both the Eastern and Western mind frame.

According to the classics, bi syndrome is the imbalance of the yin qi and wei qi meridians. The imbalance of these two meridians creates a circulatory dysfunction of qi, which manifests itself in specific clinical symptoms. To understand and treat bi syndrome, one must consider factors such as time, season and symptoms. For example, in the summer time, the zang/fu organ that is mostly affected is the heart, and the tissue structures involved are the vessels from which the patient will present the symptoms closely related to vessel bi syndrome. In the spring, the zang/fu organ mostly affected is the liver, and the tissue structures involved are the tendons from which the patient will present with symptoms closely related to tendon bi syndrome. The following chart is a review of the Five Element phases, which reveal the interconnectedness of tissues, organs and our environment.

Body	Wood	Fire	Earth	Metal	Water
Yin organ	Liver	Heart	Spleen	Lung	Kidney
Yang organ	Gallbladder	Small intestine	Stomach	Large intestine	Urinary bladder
Sense	Sight	Speech	Taste	Smell	Hearing
Tissue	Tendon	Vessels	Muscles	Skin & Hair	Bone
Emotion	Anger	Joy	Meditation	Worry	Fear
Taste	Sour	Bitter	Sweet	Pungent	Salty
Sounds	Shouting	Laughing	Singing	Crying	Groaning
Consciousness	Soul	Spirit	Mind	Corporal-Soul	Will power
Seasons	Spring	Summer	Late summer	Autumn	Winter
Climate	Wind	Heat	Humidity	Dryness	Cold
Direction	East	South	Center	West	North
Color	Green	Red	Yellow	White	Black
Number	8	7	5	9	6

The most common symptom associated with muscle bi syndrome is the sensation of numbness. For skin bi syndrome, it is the sensation of coldness; for bone bi syndrome, it is the sensation of heaviness. Bi syndromes generally do not always have to have the association of pain or discomfort as a symptom.

According to the classics, the reason why there is a close association of cause and effect of a bi syndrome and the zang/fu organ is simply because external pathogenic factors can affect the internal zang/fu organs through the meridians and channels. Therefore, liver problems can cause tendon bi syndrome, just as chronic tendon problems can cause liver problems. The table below synopsizes the various types of bi syndrome and its relationship with the zang/fu organ and its associated symptoms.

Tissue	Zang/Fu Organ	Symptoms	Syndrome
Skin & Hair	Lung	Cough, asthma, sensation of chest fullness	Lung Bi
Vessels	Heart	Palpitation, asthma, shortness of breath	Heart Bi
Tendon	Liver	Easy to wake up at night, need to drink a lot of H2O, frequent urination, distention on the side of the chest	Liver Bi
Muscles	Spleen	Four-limb weakness and tightness, coughing & vomiting	Spleen Bi
Skin, Hair or Vessels	Large intestine or small intestine	Need to drink a lot of water, difficulty urinating, diarrhea	Intestinal Bi
Bone	Kidney	Weak foot strength, difficulty walking and abdominal distention	Kidney Bi
Bone	Urinary bladder	Lower abdominal heat sensation, difficult urination, runny nose	Bladder Bi

When treating bi syndrome, it is vitally important to focus on your differential diagnosis with both your Western medical and TCM skills. According to the classics, bi syndromes have been traditionally treated focusing on the 5-shu points and also the back shu/front mu points. For example, for wind bi syndromes, UB17 is always used; for damp bi syndromes, SP9 is always used; and for cold bi syndromes, UB23 and Ren 3/4 have been traditionally used. To achieve maximum results, bi syndromes must be treated from the root with the focus of the body as a whole.

Point selection is critical. One must first identify the dysfunctional meridian/channel and focus on regulating it. If any of the five zang organs are involved, then you must use back shu/ front mu and the 5-shu points. If any of the six fu organs are involved, then you must use he-sea and lower he-sea points to regulate the dysfunctional meridian/channel. For example, if a patient has been diagnosed with tennis elbow, locate the Large Intestine meridian. Find the Liver point (tendon problem) on the large intestine meridian and use the 5-shu points, because the condition is closely related to the five zang organs. Below is a table of the 5-shu points and their relationship with the five zang organs.

Jing-Well	Ying-Spring	Shu-Stream	Jing-River	He-Sea
Liver	Heart	Spleen	Lung	Kidney

Not only is point selection critical, acupuncture technique is also crucial. The table below shows the five methods of acupuncture in relation to the five zang organs.

Technique	Method	Function	Bi Syndrome
Ban puncture	Puncture shallow (under the skin), do not damage the muscles & quickly withdraw	Dispel pathogenic qi from the exterior	Skin bi syndrome
Bao puncture	Puncture several needles around the point, puncture deeply and through the meridian to cause minimal bleeding after the withdrawal of the needle	Dispel blood stagnation at the meridian	Vessel bi syndrome
Guan puncture	Select points around the joint where the muscles and tendons attach, puncture deeply but avoid any bleeding	Used for tendons or joint pain	Tendon bi syndrome
Hego puncture	Use three needles, the first one perpendicularly and the other two obliquely, and retain the needle	Dispel pathogenic qi from the muscle	Muscle bi syndrome
Shu puncture	Puncture perpendicularly deeply to the bone	Symptoms related to bone problems	Bone bi syndrome

It is essential to practice skillfully and wisely, because just as acupuncture can heal, it can also damage. As health care practitioners we have been entrusted with the health of our patients, which is not only honorable but a sacred task. We must continually strive to be the best practitioners we can be. Michael Jordan in an interview was asked, "How does it feel to be the greatest basketball player that has ever played the game?" He responded, "I am not the greatest player that has ever played the game, because I'm still learning the game." Humility is an attribute of a scholar.

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