10.7 Pattern-Based Prescriptions I: Pain, Bi Syndrome, Headache, and Musculoskeletal Conditions
Key Takeaways
Bi syndrome is classified as Wind (wandering), Cold (severe fixed pain), Damp (heavy, numb, fixed), or Heat (red, hot, swollen); add points and methods to match the type.
Headache points follow the channel: Yangming (frontal), Shaoyang (temporal), Taiyang (occipital), and Jueyin (vertex).
BL 40 is the command point for the back, and points such as Yao Tong Dian and Du 26 are used for acute lumbar sprain while the patient moves the back.
Facial paralysis (Bell's palsy) uses local face points with LI 4, with gentle stimulation in the acute phase.
Wei (atrophy) syndrome is treated mainly through the Yangming channels, following the classical principle from Su Wen Chapter 44.
10.7 Pattern-Based Prescriptions I: Pain, Bi Syndrome, Headache, and Musculoskeletal Conditions
Quick Answer: The 2026 ACPL outline asks you to select points "based on pattern differentiation, symptoms, and actions and indications of points." For pain, combine local and Ashi points with distal points on the affected channel and points for the pattern (Wind, Cold, Damp, Heat, Qi and Blood stagnation, or deficiency). The prescriptions below are common textbook combinations, not the only correct answers. On the exam, look for the option whose points match both the location and the pattern.
Bi (Painful Obstruction) Syndrome
| Type | Key features | Added points and methods |
|---|---|---|
| Wind (Xing Bi, wandering) | Pain moves between joints; aversion to wind | GB 20, BL 17 and SP 10 ("to treat Wind, first treat the Blood") |
| Cold (Tong Bi, painful) | Severe fixed pain, better with heat, worse with cold | Moxibustion, warm needle; BL 23, Ren 4 for underlying Yang deficiency |
| Damp (Zhuo Bi, fixed) | Heaviness, numbness, swelling; worse in damp weather | SP 9, ST 36, SP 5 |
| Heat (Re Bi) | Red, hot, swollen, very painful joints; fever, thirst | LI 11, Du 14, LI 4; no moxibustion. Acute hot, swollen joints need medical evaluation to exclude infection and gout |
Add local points for the affected joint, such as the shoulder points below.
Headache by Channel
| Location | Channel | Local and adjacent | Distal |
|---|---|---|---|
| Forehead | Yangming | Yintang, ST 8, GB 14 | LI 4, ST 44 |
| Temples and sides | Shaoyang | Taiyang, GB 8, SJ 23 | SJ 5, GB 41 |
| Occiput and neck | Taiyang | GB 20, BL 10, Du 16 | SI 3, BL 60 |
| Vertex | Jueyin | Du 20, Sishencong | LR 3 |
Add pattern points. For Liver Yang rising, use LR 3, GB 20, and KI 3. For Blood deficiency, use BL 17, SP 6, and ST 36. For Phlegm turbidity, use ST 40 and Ren 12. A sudden "worst headache of my life," a headache with fever and a stiff neck, or a headache with new neurological deficits is a medical emergency (Chapter 14).
Neck, Shoulder, and Upper Limb
| Condition | Prescription and reasoning |
|---|---|
| Stiff neck (torticollis, Lao Zhen) | Luo Zhen (dorsal hand) or SI 3 with the patient gently rotating the neck; then GB 20, GB 21, BL 10, and Ashi points |
| Shoulder pain and frozen shoulder | LI 15, SJ 14, Jianqian, SI 9, SI 10, Ashi points; distal ST 38 (Tiaokou) needled toward BL 57 while the patient moves the shoulder |
| Lateral epicondylitis (tennis elbow) | LI 11, LI 10, LI 12, Ashi points; moxibustion or electroacupuncture for chronic cases |
| Carpal tunnel syndrome | PC 7, PC 6, LU 9, and HT 7 area points with shallow needling, avoiding the median nerve; refer if weakness or thenar wasting develops |
Low Back Pain and Sciatica
The Four Command Points state "for the back, look to Weizhong," so BL 40 is a core distal point for back pain.
| Pattern | Key features | Points |
|---|---|---|
| Acute sprain (Qi and Blood stagnation) | Sudden onset after strain; sharp, fixed pain | Yao Tong Dian or Du 26 (midline pain) with the patient moving the back; BL 40 (sometimes bled); Ashi points |
| Cold-Damp | Heavy, cold pain worse in damp weather | BL 23, BL 25, Du 3, BL 40 with moxibustion or cupping |
| Kidney deficiency | Chronic dull ache, weak knees, worse with fatigue | BL 23, BL 52, Du 4, KI 3, with moxibustion for Yang deficiency |
| Blood stasis | Stabbing fixed pain, worse at night, purple tongue | BL 17, BL 40, SP 6, Huatuojiaji points |
| Sciatica | Pain from the buttock down the leg | Huatuojiaji L4-S1, GB 30, BL 36, BL 40, GB 34, BL 57, BL 60 by the channel of pain (Taiyang posterior, Shaoyang lateral) |
Refer urgently for saddle numbness, new bladder or bowel dysfunction, or progressive leg weakness (possible cauda equina syndrome).
Knee and Lower Limb
- Knee pain: Xiyan (medial and lateral, ST 35 is the lateral eye), Heding, SP 9, GB 34, ST 36, and Ashi points. Add moxibustion for Cold-Damp, or SP 10 and LI 11 for Heat.
- Ankle sprain: local points on the affected side (such as GB 40 and ST 41 for lateral sprains), mirror points on the opposite wrist, and distal points on the affected channel.
- Plantar heel pain: KI 3, KI 6, BL 60, and Ashi points at the heel.
Facial Paralysis (Bell's Palsy)
Wind invading the channels of the face: ST 4 threaded toward ST 6, ST 7, GB 14 (Yangbai), Taiyang, Qianzheng, SJ 17, and distal LI 4 ("the face and mouth are governed by Hegu"). In the acute phase (about the first week), use few local points with gentle stimulation; strengthen treatment in the recovery phase. Refer patients for medical evaluation to rule out stroke, which usually spares the forehead, and for consideration of early corticosteroids.
Wei (Atrophy) Syndrome
Su Wen Chapter 44 says to treat Wei syndrome by "taking Yangming alone," because Yangming supplies Qi and Blood to the muscles and sinews. Core points include LI 15, LI 11, LI 4 (upper limb) and ST 31, ST 32, ST 36, and ST 41 (lower limb), with Huatuojiaji points and pattern points such as SP 6 and BL 20 for Spleen deficiency. Progressive weakness requires medical evaluation.
A patient has a throbbing headache at the temples and the sides of the head, with irritability and a wiry pulse. Which distal points best match the channel involved?
LI 4 and ST 44
SJ 5 and GB 41
SI 3 and BL 60
LR 3 alone
A patient has heavy, numb, swollen knee pain that is fixed in location and worse in damp weather. Which type of Bi syndrome is this, and which points are typically added?
Wind Bi; add GB 20, BL 17, and SP 10
Heat Bi; add LI 11 and Du 14
Damp Bi; add SP 9, ST 36, and SP 5
Cold Bi; add bloodletting at the Jing-Well points
A patient strained his lower back lifting a box this morning and has sharp midline pain. Which approach is classical?
Needle Du 26 or Yao Tong Dian strongly while the patient gently moves the back
Apply direct scarring moxibustion to Du 4 to warm the Kidney Yang
Use only Back-Shu points such as BL 23 with reinforcing method and no distal points
Avoid all treatment for six weeks until the sprain heals on its own
Which principle from Su Wen Chapter 44 guides the treatment of Wei (atrophy) syndrome?
Take the Yangming channel alone
Treat the Taiyang channel alone
Bleed all the Jing-Well points
Needle only Back-Shu points
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