Originally published October, 2025 by Skye Sturgeon.
Obstruction Syndrome (Bì zhèng 痺症) is a common diagnosis for musculoskeletal aches and mild pain (Tòng 痛), both acute and chronic. There may also be a decreased range of motion, inflammation, swelling, and numbness. Primarily, these issues are due to minor injury or dysfunction of joints and related soft tissues, including muscles, tendons, and ligaments. For a broader discussion of the different types of Bi syndrome, see the article the article discussing Wind and Damp Bi.
Mayway Herbs offers ten formulas to assist herbalists in prescribing remedies for Obstruction Syndrome. We've created this user-friendly Wind Damp Bi formulas comparison chart to compare these formulas at a glance.
Three of these formulas are similarly named, and this article will provide a more in-depth analysis and assistance in deciding which one may be appropriate for your patient. An Eight Principles diagnostic assessment is essential. The formulas that will be discussed are:
- Juan Bi Wan /Clear Channel Teapills
- San Bi Wan /Three Obstructions Teapills
- Xuan Bi Wan /Drain Obstruction Teapills
Juan Bi Wan
Clear Channels Teapills/ Juan Bi Wan 蠲痺丸 (MW# 3369); Literally, ‘Remove Painful Obstruction’.
This classic Wind Dampness formula from the Yang Family Formulas, dating from the 12th century CE, is the one to choose when the patient’s complaint includes neck, shoulder or upper back stiffness. The muscle or joint pain may be intermittent, and patients may describe pain in the joints that worsens with damp, cold weather and lack of activity, and improves with the application of heat and with movement. In addition, they may describe heaviness or numbness in the limbs, and difficulty walking. There may be signs or symptoms of Ying and Wei Qi Deficiency, such as fatigue, weakness in the limbs, or perhaps an aversion to Wind or Cold. Dampness may be indicated if the tongue has a thick white coat, possibly with teethmarks. The pulse may be slippery and somewhat slow.
TCM Functions: Expels Wind-Damp, Moves Qi, Invigorates the Blood, Unblocks and Warms the Channels and Collaterals to Disperse Cold, and Eliminates Bi to stop pain.
Herbs in Juan Bi Wan
| PIN YIN NAME | BOTANICAL NAME | TCM FUNCTION |
| Sang zhi | Morus alba twig | Expels Wind, clears the Channels, eases the joints, stops spasms and regulates water metabolism, especially useful for muscle spasms and painful obstruction of the upper extremities. |
| Hai feng teng | Piper kadsura stem | Expels Wind-Damp, clears the Channels, disperses Cold, and stops pain. Especially good for immobile joints. |
| Dang gui | Angelica sinensis root | Nourishes Blood, invigorates and harmonizes Blood, disperses Cold and stops pain. |
| Qiang huo | Notopterygium incisum root & rhizome | Releases the Exterior, disperses Cold, expels Wind-Cold-Dampness, unblocks painful obstruction, alleviates pain, increases joint mobility and guides Qi to the Tai Yang and Du Channels. |
| Du huo | Angelica pubescens root | Releases the Exterior, dispels Wind Cold Dampness, opens the Channels, and stops pain. |
| Qin jiao | Gentiana macrophylla root | Clears Heat, expels Wind-Dampness, relaxes the sinews, clears Deficiency Heat and resolves Dampness. |
| Chuan xiong | Ligusticum chuanxiong rhizome | Activates Blood, regulates Qi, expels Wind Cold and stops pain. |
| Mu xiang | Aucklandia lappa root | Moves Qi, revives the Spleen, dispels Dampness, improves fluid metabolism, and sedates pain. |
| Gui zhi | Cinnamomum cassia twig | Releases External Wind Cold from the muscle layer, harmonizes the Ying and Wei, warms the Channels and Collaterals, relieves pain, disperses Cold, unblocks Yang, transforms Qi, warms and facilitates the flow of Yang Qi in the chest and warms and facilitates the flow of Blood through the vessels. |
| Ru xiang | Boswellia carterii resin | Breaks up Blood Stagnation, invigorates the Blood, regulates Qi, relaxes the sinews, opens the Channels, reduces swelling, and treats localized pain. |
| Zhi gan cao | Glycyrrhiza uralensis root-honey-fried | Moderates and harmonizes the harsh properties of the other herbs and prevents injury to Zheng Qi. |
If the Ying and Wei Qi deficiency is obvious and chronic, consider a course of Yu Ping Feng San/ Jade Screen Teapills (MW# 3357). Juan Bi Wan is contraindicated during pregnancy. Do not use if there is Damp Heat present. Use with caution in Yin Deficiency. Use with caution in hemorrhagic disorders or with patients on anti-coagulant therapy.
San Bi Wan
Three Obstructions Teapills/ San Bi Wan 三痺丸, (MW#3386)
This traditional formula, dating from the Yuan Dynasty, is intended for patients diagnosed as Wind Cold Damp Bi with underlying Qi and Blood or Liver and Kidney Deficiency.
Wind Cold Damp Bi describes chronic arthralgia caused by an Excess invasion in a patient with an underlying deficiency of Kidney Qi and Yang, and Liver Blood. The patient may present with symptoms such as aching, heaviness, numbness, stiffness, spasm or severe pain in various locations throughout the body, especially the low back and lower extremities, bone and tendon weakness, aching tendons, or mild tremors of the head, hands and feet. Symptoms may be exacerbated in cold and damp weather, or during changes in the weather and may be accompanied by fatigue, pale face, cold intolerance, breathlessness, and dizziness. The pain may be ameliorated by heat or warmth and exacerbated by pressure. The tongue may appear pale, with a white coat and the pulse is often thin, deficient, weak, slow or slightly wiry. All these signs point to pain caused by Cold Damp obstructing the free flow of Qi and Blood.
TCM Functions: Dispel Wind Damp, Nourish the Liver and Kidneys, Tonify Qi and Nourish Blood, Warm the Kidney Yang, and Warm the Channels and Collaterals to expel the pathogenic influence.
Herbs in San Bi Wan
| PIN YIN NAME | BOTANICAL NAME | TCM FUNCTION |
| Xu duan | Dipsacus asperoides root | Tonifies the Liver and Kidneys, strengthens sinews and bones, promotes the movement of Blood, alleviates pain, generates flesh and reconnects sinews and bones. |
| Chao Du zhong | Eucommia ulmoides bark-fried | Tonifies the Kidneys and Liver, strengthens the sinews and bones and aids the smooth flow of Qi and Blood. |
| Fang feng | Saposhnikovia divaricata root | Releases the exterior, expels External Wind, expels Wind-Dampness, alleviates pain, expels Internal Wind and stops spasms. |
| Rou gui | Cinnamomum cassia bark | Warms the Kidneys, Spleen and Heart, strengthens the Yang and Ming Men Fire, disperses deep Cold, warms the Channels, unblocks the Channels and Vessels, alleviates pain and assists the generation of Qi and Blood. |
| Ren shen | Panax ginseng root | Tonifies Qi in deficient patients with Exterior conditions. |
| Fu ling | Poria cocos fungus | Promotes urination, leaches out Dampness, strengthens the Spleen and harmonizes the Middle Jiao. |
| Dang gui | Angelica sinensis root | Tonifies, invigorates and harmonizes the Blood, disperses Cold and stops pain due to Blood Stasis. |
| Jiu chao bai shao | Paeonia lactiflora root-wine-fried | Nourishes the Blood, calms Liver Yang and Liver Wind, softens the Liver and alleviates pain. |
| Huang qi | Astragalus membranaceus root | Tonifies Qi and Blood and relieves numbness and pain. |
| Jiu chao niu xi | Achyranthes bidentata root-wine-fried | Invigorates the Blood, dispels Blood Stasis, expels Wind, drains Dampness, tonifies the Kidneys and Liver and strengthens the tendons and bones. |
| Zhi gan cao | Glycyrrhiza uralensis root-prep | Tonifies the Spleen, augments Qi, moderates spasms, alleviates pain and moderates and harmonizes the harsh properties of other herbs. |
| Qin jiao | Gentiana macrophylla root | Expels Wind Damp, opens the Channels and soothes the sinews and Collaterals. |
| Sheng di huang | Rehmannia glutinosa root-raw | Clears Heat and cools the Blood. |
| Chuan xiong | Ligusticum chuanxiong rhizome | Invigorates the Blood, promotes the movement of Qi, expels Wind and alleviates pain. |
| Du huo | Angelica pubescens root | Dispels Wind Damp, alleviates pain, disperses Wind Cold Damp and releases the Exterior. |
San Bi Wan is contraindicated during pregnancy and during the early stages of acute infection or illness, such as cold or flu. Use with caution for conditions due to Yin deficiency or excess Heat.
Xuan Bi Wan
Xuan Bi Teapills/ 宣痺丸 (MW# 3356) aka Drain Away Obstruction Pills
This formula was first described in the Treatise of Warm Diseases/ Wēn bìng tiáo biàn 溫病條辨 in the 18th Century. This formula is designed to treat Wind Damp Heat Bi largely by clearing and resolving Damp Heat by promoting urination and unblocking painful urinary dysfunction.
Wind Damp Heat Bi is defined when Damp Heat obstructs the Channels and joints with symptoms of acute or chronic, painful, red, hot, swollen or disfigured joints, heaviness and aching in the joints and limbs that may be worse in hot humid weather, reduced mobility, thirst, dry mouth, and throat. The pain may be severe and is often worse at night. Symptoms may also be accompanied by fever and chills, shivering, yellow complexion, and scanty, dark urination. The formula is also used for Wei (atrophy) Syndrome due to Damp Heat, presenting with heaviness, weakness and flaccidity of the lower limbs, or lower limb numbness accompanied by slight edema. Signs to look for include a tongue that is swollen, possibly red, with a greasy, yellow or gray coat and a pulse that is slippery and rapid.
TCM Functions: Dispel Wind Damp, Clear and Resolve Damp Heat, Unblock the Channels and Collaterals, and Promote urination.
Herbs in Xuan Bi Wan
| PIN YIN NAME | BOTANICAL NAME | TCM FUNCTION |
| Yi yi ren | Coix lacryma jobi seed | Promotes urination, strengthens the Spleen, clears Heat, expels Wind Damp, soothes numbness and clears Damp Heat. |
| Han fang ji | Stephania tetrandra root | Expels Wind Damp, purges Damp Heat, alleviates pain, promotes urination and reduces edema |
| Xing ren | Prunus armeniaca seed | Regulates the Lung's water metabolism function. |
| Lian qiao | Forsythia suspensa fruit | Clears relatively superficial Heat and promotes urination. |
| Huai niu xi | Achyranthes bidentata root | Nourishes Liver and Kidney Yin, strengthens the sinews and bones and benefits the joints; Clears Damp Heat in the Lower Jiao causing knee or lower back pain. |
| Huang bai | Phellodendron chinense bark | Drains Damp Heat especially from the Lower Jiao, including red, swollen, painful knees, legs or feet |
| Cang zhu | Atractylodes lancea rhizome | Dispels Wind Dampness, harmonizes the Stomach and transforms turbid Dampness |
| Zhi zi | Gardenia jasminoides fruit | Clears Heat, eliminates irritability, drains Damp Heat and reduces swelling. |
| Jiang ban xia | Pinellia ternata rhizome-gingered | Dries Dampness, transforms Phlegm, descends Rebellious Qi, and reduces swelling. |
| Mu tong (san ye) | Akebia trifoliata stem | Promotes urination and unblocks painful urinary dysfunction; removes pain & stiffness of the joints due to Heat Bi |
Xuan Bi Wan is contraindicated during pregnancy and in conditions due to Wind Cold Damp. Use with caution in Spleen deficient patients with a tendency to loose stools, diarrhea, poor appetite or chronic digestive weakness. Use with caution in Yin deficiency. In conclusion, one can easily see that these ‘Bi’ formulas are used in very different circumstances.
Summary of Uses
- Juan Bi Wan for muscle or joint pain due to Wind Cold Damp Bi, especially in the Du or Tai Yang Channels
- San Bi Wan for chronic muscle or joint pain due to Wind Cold Damp Bi with underlying Qi and Blood or Liver and Kidney Deficiency.
- Xuan Bi Wan for painful, red, hot, swollen or disfigured joints, with possible urination difficulties due to Wind Damp Heat Bi.
References
- American Dragon, https://www.americandragon.com
- Bensky, D. et al., Chinese Herbal Medicine Materia Medica, 3rd ed., Eastland Press: 2004.
- Bensky, D. & Barolet, R., Formulas & Strategies, Eastland Press: 1990.
- Sacred Lotus Chinese Medicine, https://www.sacredlotus.com
- Wrinkle, A. et al., A Practitioner’s Formula Guide, Elemental Essentials Press: 2008.
