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Painful Bi (Tongbi) is caused by an excess of Cold pathogen, leading to a deficiency of Yang Qi and an abundance of Yin Qi. Where there should be free flow but obstruction occurs, pain results. The pain in Bi syndrome arises because Cold enters the meridians, causing Qi and Blood to move slowly, stagnate, and fail to circulate. Treatment should aim to guide and unblock Yang Qi, warm and moisten the meridians; when Qi and Blood are warmed, they will circulate freely, eliminating stagnation and blockage. Liu Hejian stated: In Bi syndrome, the body feels cold as if just emerging from water due to the non-circulation of Qi and Blood; this does not necessarily require direct injury by Cold pathogens. Therefore, in treating Painful Bi, although it is appropriate to warm and disperse Cold pathogens, it is even more crucial to promote the circulation of stagnant Qi and Blood.

Moyao San (Myrrh Powder) treats wandering pain throughout all joints of the body.
Myrrha (2 liang, ground separately), Tiger Bone (4 liang, roasted with su [animal fat])
Grind into fine powder. Take 5 qian per dose, administered with wine, three times daily.

Yili Jin Dan (One Pill Golden Elixir)
Caowutou (Aconiti Kusnezoffii Radix, chopped and stir-fried), Wulingzhi (Trogopterori Faeces, each 1 liang), Dilong (Pheretima, skin removed, stir-fried), Mubiezi (Strychni Semen, each half liang), Baijiaoxiang (Boswelliae Resina, 1 liang, ground separately), Danggui (Angelicae Sinensis Radix, radix removed, 1 liang), Shexiang (Moschus, 1 qian, ground separately)
Grind into fine powder, make pills using glutinous rice paste, size of wu zi (wuju fruit seeds). Take 3 pills per dose with warm wine. Slight sweating after medication indicates efficacy. The original formula also included Ximo (Fine Inkstone) and Ruxiang (Boswelliae Resina) each half liang, and Moyao 1 liang. Bashen Dan contains Fangfeng but lacks Danggui, Ximo, Shexiang, and Moyao, made into pills with wheat flour paste. Take 10 pills with wine; it is said that sweating will dissipate all numbness.

Zhuo Bi (Fixed Bi) is caused by an excess of Dampness. Dampness belongs to the Earth element; Earth's nature is heavy and slow. When Ying and Wei Qi remain together with Dampness, they become fixed and immobile. Symptoms often include sweating and damp skin; the disease tends to manifest in the lower body. There are variations involving accompanying Cold or Heat, involvement of the Qi level or Blood level, requiring careful differentiation for treatment.

Jingyan Jiawei Ermiao Wan (Empirical Modified Erniao Pills) (See formula under "Hongkong Foot Swollen Knees").
This is a formula for treating Damp-Heat in the lower jiao affecting the Blood level. It treats painful wet Bi in both legs, burning like fire starting from the dorsum pedis and spreading to the waist and hips, or presenting as numbness and flaccidity. All these are caused by Damp-Heat, which this formula addresses. Another version omishes Bibi and includes 1 liang of Hu Jinggu (Tiger Tibia Bone).
It also treats women with foot pain and aversion to cold, worsening at night and improving during the day.
Shengdi (Rehmanniae Radix), Baishao (Paeoniae Radix Alba), Guishao (Radix Angelicae Sinensis tip, each 5 qian), Huangbai (Phellodendri Cortex, stir-fried), Huangqin (Scutellariae Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Cangzhu (Atractylodis Rhizoma), Chenpi (Citri Reticulatae Pericarpium, each 3 qian), Niuxi (Achyranthis Bidentatae Radix, 2 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 1 qian)
Divide into four doses, decoct in water, take while hot.
Note: Deficiency of the Three Yin Meridians of the Foot combined with Damp-Heat invasion often causes foot pain. Cangzhu and Baizhu, along with Huangbai and Huangqin, jointly eliminate Damp-Heat; Shengdi, Baishao, Danggui, and Niuxi nourish Yin; Chenpi and Gancao harmonize the Middle Jiao. When Yin is sufficient, Heat is easily cleared; when Middle Qi is harmonized, Dampness is easily removed. This shares the same mechanism as the modified Erniao Wan.

Chure Juan Tong Tang (Remove Heat and Relieve Pain Decoction) is used for Wet Bi where Qi-level involvement predominates, to separate and resolve it.
Cangzhu (Soaked in rice wash water, stir-fried), Baizhu, Qianghuo (Notopterygii Rhizoma et Radix), Fuling (Poria), Zexie (Alismatis Rhizoma), Chenpi (each 1 qian), Gancao (0.5 qian)
Decoct in water, add Jiangzhi (Zingiberis Recens Juice) and Zhuli (Bambusae Caulis in Taenia) two to three spoons each.

Da Qianghuo Tang (Great Notopterygium Decoction)
Qianghuo, Shengma (Cimicifugae Rhizoma, each 1 qian), Duhuo (Angelicae Pubescentis Radix, 0.7 qian), Cangzhu, Fangfeng (Saposhnikoviae Radix), Gancao, Weilingxian (Clematidis Radix et Rhizoma), Fuling, Danggui, Zexie (each 0.5 qian)
Cut into pieces for one dose. Add two cups of water, decoct to one cup, take warm. One dose before meals and one after meals. Avoid alcohol, wheat products, raw/cold, and hard foods.

Luo Qianfu stated: Zhang Da from Zhengding had a habit of drinking alcohol excessively. In May, he developed swelling and pain in finger joints with limited flexion and extension, similarly affecting his knees. He experienced epigastric fullness, heaviness of the body, anorexia, nausea upon eating, sallow complexion, and shortness of spirit. In June, he sought my treatment. His pulse was deep and slow; a slow pulse indicates Spleen issues. The Nan Jing states: Shu points govern weight and joint pain; Shu points are governed by the Spleen, and the limbs belong to the Spleen. Given his excessive alcohol consumption and seasonal factors amplifying Dampness, which flowed into the limbs, swelling and pain resulted. The Nei Jing states: All dampness-induced swelling and fullness belong to Spleen Earth. Zhang Zhongjing stated: When Dampness flows into joints, it causes limb discomfort and pain. The Nei Jing also states: For internal Dampness excess, treat with bitter-warm methods, use bitter flavors to disperse, and bland flavors to leach out. Furthermore, Wind overcomes Dampness. Qianghuo and Duhuo are bitter-warm, penetrating joints to overcome Dampness, thus serving as Sovereign herbs. Shengma is bitter-ping; Weilingxian, Cangzhu, and Fangfeng are bitter-acrid-warm dispersants, serving as Minister herbs. Blood stagnation causes pain; Danggui is acrid-warm to disperse it. Gancao is sweet-warm to tonify Qi. Zexie is salty-ping; Fuling is sweet-ping. They guide Dampness and promote urination via bland leaching, allowing the medicinal properties to combine and disperse Dampness up and down.