San Bi Tang — Three Painful Obstruction Decoction

On this page

1. Overview
2. TCM pattern
3. Key herbs
4. Formula actions
5. Conditions treated
6. Cautions

Overview

San Bi Tang — the “Three Painful Obstruction Decoction” — is from Fu Ren Liang Fang. The “three Bi” refers to Wind-Bi (moving pain), Cold-Bi (severe pain) and Damp-Bi (heavy pain) — all three types of channel obstruction addressed simultaneously, with extra tonification of Qi and Blood to support chronic depletion from prolonged illness.

The formula is similar to Du Huo Ji Sheng Wan but uses more Qi-tonifying herbs and is targeted at upper body joint pain.

I prescribe San Bi Tang as part of bespoke herbal formulas from pharmaceutical-grade granules sourced from Sun Ten in Taiwan.

TCM pattern

San Bi Tang is prescribed for chronic Wind-Damp-Cold Bi syndrome with Qi-Blood deficiency:

• Chronic joint pain — moving, fixed, deep or heavy
• Stiffness, particularly in the morning
• Worse with cold and damp weather
• Concurrent fatigue and weakness
• Pale complexion
• Cold extremities
• Tongue — pale, white moist coat
• Pulse — deep, weak, possibly thin or slow

Key herbs

1. Qin Jiao, Du Huo — expel Wind-Damp from upper and lower body
2. Fang Feng, Xi Xin — disperse Wind
3. Gui Zhi — warms the channels
4. Ren Shen, Huang Qi, Bai Zhu, Fu Ling, Gan Cao — tonify Qi
5. Dang Gui, Bai Shao, Shu Di, Chuan Xiong — nourish Blood (Si Wu Tang core)
6. Niu Xi, Du Zhong — strengthen lower back and lower limbs

Formula actions

1. Disperses Wind-Damp-Cold
2. Tonifies Qi and Blood
3. Warms the channels
4. Relieves chronic joint pain

Conditions treated

1. Chronic rheumatoid arthritis with depletion — see rheumatoid arthritis
2. Osteoarthritis with deficiency
3. Polymyalgia rheumatica
4. Chronic fibromyalgia — see fibromyalgia
5. Convalescence after acute arthritis
6. Chronic neck and shoulder pain in older patients

Cautions

Not appropriate for hot-pattern arthritis (red, hot, swollen joints) or acute infectious arthritis.

Inflammatory arthritis needs rheumatology assessment and disease-modifying treatment; herbs are an adjunct.

Contains Xi Xin — use only properly processed pharmaceutical-grade preparations.

Use cautiously in pregnancy.

Always consult a qualified Chinese herbalist registered with the RCHM.

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