San Bi Tang: A Classic TCM Formula for Relieving Arthralgia and Boosting Vitality
- Hongji Medical
- Feb 22
- 4 min read
Updated: May 7
San Bi Tang is a revered traditional Chinese medicine (TCM) prescription, first documented in Shiyi Dexiao Fang and later expanded upon in Furen Liangfang, a Yuan Dynasty medical text blending theory and clinical practice.
This formula is designed to treat arthralgia (joint pain) caused by Qi and blood stagnation, stiffness, and invasion of wind, cold, and dampness.
By replenishing Qi and blood, dispelling pathogenic factors, and warming the meridians, San Bi Tang offers relief for chronic joint pain and related conditions, making it a cornerstone of TCM for musculoskeletal health.
Composition of the Formula
San Bi Tang combines a variety of herbs, organized according to the TCM principle of “monarch, minister, assistant, and envoy”:
Monarch Herbs:
Ren Shen (Ginseng): Greatly boosts vital Qi, strengthens the body’s resistance, and expels pathogens.
Huang Qi (Astragalus): Enhances Qi, consolidates the body’s exterior, and supports immunity.
Minister Herbs:
Fu Ling (Poria): Strengthens the spleen, promotes diuresis, and clears dampness, enhancing Qi replenishment.
Gan Cao (Licorice): Harmonizes the formula, supports spleen Qi, and aids in moisture elimination.
Adjuvant Herbs:
Dang Gui (Angelica sinensis): Nourishes and invigorates blood circulation.
Chuan Xiong (Ligusticum chuanxiong): Promotes Qi and blood flow, unblocking meridians.
Bai Shao (White Peony Root): Nourishes blood, strengthens Yin, and relieves pain.
Sheng Di Huang (Raw Rehmannia): Nourishes Yin, cools blood, and supports circulation.
Additional Adjuvants:
Du Zhong (Eucommia): Nourishes the liver and kidneys, strengthening tendons and bones.
Niu Xi (Achyranthes bidentata): Promotes blood flow and directs herbs downward.
Xu Duan (Dipsacus): Supports liver and kidney health, fortifying musculoskeletal structure.
Warming Herbs:
Gui Xin (Cinnamon Heart): Warms meridians, dispels cold, and relieves pain.
Xi Xin (Asarum): Clears cold and unblocks channels for pain relief.
Pathogen-Dispelling Herbs:
Du Huo (Angelica pubescens): Clears dampness from the lower body and relieves pain.
Fang Feng (Saposhnikovia): Expels wind and alleviates surface symptoms.
Qin Jiao (Gentiana macrophylla): Dispels wind-dampness and relaxes muscles.
Harmonizing Herbs:
Sheng Jiang (Ginger): Balances the body’s nutrient and defensive systems, supporting digestion.
Da Zao (Jujube): Strengthens the spleen and harmonizes the formula.
This comprehensive blend addresses both the root causes (Qi and blood deficiency) and symptoms (wind, cold, dampness) of arthralgia.
Pathogenesis: Understanding the Condition
San Bi Tang targets Bi syndrome, a condition caused by insufficient Qi and blood combined with the invasion of wind, cold, and dampness.
Weak Qi and blood reduce the body’s defensive strength, making it susceptible to these external pathogens. Once inside, wind, cold, and dampness block the meridians, impairing Qi and blood flow and causing symptoms like joint pain, numbness, swelling, and stiffness.
San Bi Tang is particularly effective for chronic arthralgia, such as that seen in rheumatic arthritis, with symptoms including joint soreness, lower back pain, knee discomfort, and limb numbness.
Therapeutic Effects of San Bi Tang
San Bi Tang offers multiple benefits:
Replenishing Qi and Blood: Ginseng, astragalus, and blood-nourishing herbs like Dang Gui and Bai Shao boost vitality, strengthen immunity, and fortify the body against pathogens.
Dispelling Wind and Dampness: Du Huo, Fang Feng, and Qin Jiao expel wind and dampness, relieving joint pain and swelling.
Warming Meridians and Unblocking Channels: Gui Xin and Xi Xin warm the body, disperse cold, and improve circulation to alleviate pain.
Nourishing Liver and Kidneys: Du Zhong, Niu Xi, and Xu Duan strengthen tendons and bones, enhancing joint function.
Promoting Circulation and Pain Relief: Chuan Xiong, Niu Xi, and Bai Shao improve blood flow and reduce discomfort.
By addressing both the root (deficiency) and symptoms (pathogenic invasion), San Bi Tang restores balance and promotes lasting relief.
Modern Applications of San Bi Tang
In modern medicine, San Bi Tang is widely used for arthralgia-related conditions, particularly:
Rheumatic arthritis and rheumatoid arthritis.
Osteoarthritis and joint stiffness.
Lumbar disc herniation and scapulohumeral periarthritis (frozen shoulder).
Pharmacological studies highlight its anti-inflammatory, analgesic, and immunomodulatory effects, which reduce joint inflammation, pain, and swelling while regulating the immune system.
These properties make it a valuable treatment for autoimmune and inflammatory joint disorders.
Beyond traditional Bi syndrome, San Bi Tang is applied to conditions involving Qi and blood deficiency or wind-cold-damp invasion.
Clinical trials and case studies continue to expand its use, often combining it with therapies like acupuncture or physical therapy to enhance outcomes, reduce side effects, and improve patients’ quality of life.
Precautions for Use
When using San Bi Tang, consider the following:
Contraindications: Its warming nature makes it unsuitable for patients with Yin deficiency or excessive internal heat. It should also be avoided in cases with unresolved external symptoms due to its tonic herbs.
Syndrome Differentiation: Tailor the formula to the patient’s condition. For cold-damp arthralgia, add herbs like Sheng Di Huang or Chuan Xiong; for severe deficiency, include more tonics like Ren Shen or Fu Ling.
Medical Supervision: Consult a TCM practitioner to adjust the formula and ensure safe use, especially for chronic or complex conditions.
Conclusion
San Bi Tang is a powerful TCM formula that effectively treats arthralgia by replenishing Qi and blood, expelling wind, cold, and dampness, and warming the meridians. Rooted in centuries-old medical wisdom, its comprehensive approach addresses both the symptoms and underlying causes of joint pain, making it a go-to remedy for conditions like rheumatoid arthritis and osteoarthritis.
Modern research and clinical applications, often paired with complementary therapies, underscore its enduring value. With proper syndrome differentiation and professional guidance, San Bi Tang offers a holistic path to relief and improved mobility for those suffering from chronic joint issues.
