Bi Qi Capsule

What It Is

• Bi Qi Capsule (痹祺胶囊, Bi-Qi Jiaonang) is a proprietary Traditional Chinese Medicine (TCM) formulation marketed in China for ailments involving joints, muscles, and connective tissues.
• Its registration number in China is Z10910026.
• It is sold in capsule form (hard capsule, ~0.3 g per capsule) and typically comes as 48 capsules per box.
• The listed indications (in TCM terms) include joint pain, stiffness, swelling of joints, muscle soreness, soft‐tissue injury, rheumatoid arthritis, lumbar strain, etc.
• In TCM theory, the capsule is said to “benefit qi and nourish blood, dispel wind and remove dampness, promote blood circulation and relieve pain.”

Ingredients / Composition (approximate, as disclosed):

Some of the principal herbs (and in some cases processed parts) reported in Bi Qi include:

• Strychnos nux-vomica (processed) — “Ma Qian Zi” — a potent and potentially toxic seed.
• Codonopsis pilosula (Dang Shen)
• Radix Salvia miltiorrhiza (Dan Shen)
• Notoginseng (Panax notoginseng, San Qi)
• Rhizoma Atractylodis macrocephalae (Bai Zhu)
• Rhizoma Ligustici chuanxiong (Chuan Xiong)
• Radix Achyranthis bidentata (Niu Xi)
• Glycyrrhiza (Licorice root, Gan Cao)
• Earthworm (Di Long) is also sometimes listed.

Because of the inclusion of Strychnos nux-vomica, a well-known toxic herb (containing strychnine and brucine), the formulation carries potential risks if misused or overdosed. (Note: in many herbal formulas, such ingredients are “processed” to reduce toxicity, but risk remains.)

How It Works (Proposed / Hypothesized Mechanisms)

Because Bi Qi is a complex herbal composite, its “mechanism of action” is not fully elucidated, but research — both animal models and network pharmacology / systems biology — offers some insight.

Preclinical (animal) Evidence:

• In a collagen-induced arthritis (CIA) rat model (a classical model for rheumatoid arthritis), Bi Qi reduced joint swelling, inflammatory infiltrates, synovial hyperplasia, and cartilage damage. It lowered serum levels of TNF-α and IL-18. BioMed Central
• It also reduced expression of osteopontin and cartilage oligomeric matrix protein, markers associated with joint damage. BioMed Central
• In studies of osteoarthritis (OA) models, Bi Qi was found to alleviate cartilage destruction, modulate synovial inflammation, and possibly modulate macrophage activation in joint tissues. Frontiers
• Suggested anti‐inflammatory pathways include inhibition of NO / iNOS and COX-2 expression, which are proinflammatory pathways. Frontiers

Network pharmacology / systems-level analyses:

• A recent paper studied Bi Qi in the context of gout (uric-acid crystal–mediated joint inflammation). They identified candidate molecular targets (e.g. PTGS2, TNF, KCNA5) and pathways tied to immunity, inflammation, and metabolic regulation.
• The same research suggests that Bi Qi may modulate innate immunity, inflammatory signaling, and metabolic processes relevant to gout. MDPI

In summary, Bi Qi likely acts via multi-target, multi-pathway modulation of inflammatory, immune, and joint-tissue homeostasis processes. But much of the evidence is preclinical or predictive (in silico) rather than from large, high-quality human trials.

Why It’s (Potentially) Important / Its Clinical Relevance

• Complementary / alternative treatment: In China, Bi Qi is used as a complementary or alternative therapy alongside conventional treatments, especially for rheumatoid arthritis (RA) and other musculoskeletal disorders.
• Synergy or safety advantage: In a randomized controlled pilot trial, Bi Qi + methotrexate (MTX) was compared with leflunomide + MTX in patients with RA over 24 weeks. The Bi Qi arm achieved ~81.2% ACR20 (a standard measure of improvement) and had fewer reported adverse effects (11.4% vs ~40% in LEF group). BioMed Central
• Meta-analyses suggest that Bi Qi (alone or combined with MTX) might have better efficacy than MTX alone in RA, with acceptable safety — though the quality of evidence is variable. spandidos-publications.com
• For cervical spondylosis, a meta-analysis of 8 trials (758 participants) found that Bi Qi (or in combination with conventional therapy) significantly improved pain (VAS scores) compared to controls, with no significant difference in adverse reactions. francis-press.com
• Because rheumatoid arthritis (and other joint diseases) involve inflammation, synovial proliferation, cartilage degradation, the potential of a herbal formula with anti-inflammatory and cartilage-protective effects is of clinical interest.
• From a translational science perspective, Bi Qi serves as a candidate for integrative approaches blending TCM and modern pharmacology to identify novel lead compounds or multi-target strategies.

However: the evidence is not yet strong enough to supplant standard therapies. Its role is more as an adjunct or investigational therapy in many settings.

Considerations, Risks, Uncertainties, and Caveats

Because Bi Qi is a complex herbal product (including potentially toxic herbs), you must approach it carefully. Below are key considerations:

Toxicity / Safety Concerns:

• The inclusion of Strychnos nux-vomica (Ma Qian Zi) is a red flag: this herb contains strychnine and brucine, which are neurotoxic in overdose. Processed forms may reduce toxicity, but risk remains.
• Some sources caution that the medicine “contains potent poisonous herbs, so it should not be taken in excess or for a long time.”
• The published literature often states that adverse reactions and contraindications are “uncertain” or “not well clarified.”
• In human trials combining Bi Qi + MTX vs LEF + MTX, the Bi Qi arm had fewer reported side effects, but the trial was small, short duration, and may not capture rare or long-term risks. BioMed Central

Contraindications / Warnings:

• Pregnancy: most sources list pregnancy as a contraindication. Yaya's Chinese Health Store
• Athletes / doping: one listing says “athlete with caution.” (Possibly due to herbal doping concerns or residues) Yaya's Chinese Health Store
• Use with other drugs: herbal–drug interactions are possible; concurrent use with immunosuppressants, anti-inflammatory drugs, or other herbal supplements may yield interactions.
• Long-term use: caution is often advised regarding extended use, especially given toxicity risks of certain herbal ingredients. Buy Traditional Chinese Medicine Online
• Dosing: standard dosing is 4 capsules, 2–3 times daily (i.e. 8–12 capsules/day) in many product descriptions.

Quality control / standardization:

• As with many herbal formulations, batch-to-batch consistency, purity, contamination (heavy metals, pesticides), and accurate labeling are important challenges.
• The precise content of bioactive constituents (e.g. strychnine, tanshinone IIA, salvianolic acid, etc.) can vary, affecting efficacy and safety. BioMed Central

Level of evidence / scientific uncertainties:

• Much of the mechanistic evidence is preclinical (animal models) or based on network pharmacology / in silico predictions.
• The human clinical evidence is limited in scale, duration, and rigor (few large, placebo-controlled trials).
• It is unclear which component(s) of Bi Qi are most pharmacologically active, or how they synergize or antagonize.
• Because of the complexity, it is hard to isolate which mechanism(s) are responsible for observed effects.

Regulatory and legal issues (outside China):

• In many countries, Bi Qi may not be registered or approved; importation could be restricted.
• Herbal supplement regulation is less stringent in many jurisdictions, so safety/quality oversight may be weaker.
• Liability and standard of care: using Bi Qi in place of proven therapies for rheumatoid arthritis or other serious conditions could be risky.

Monitoring and clinical oversight:

• Patients using Bi Qi, especially in combination with conventional medications (e.g. DMARDs, NSAIDs, immunosuppressants), should be monitored for liver function, kidney function, hematologic status, neurological symptoms, etc.
• If any signs of toxicity (e.g. nausea, dizziness, neurological symptoms) occur, discontinue and seek medical attention. Some sources mention that if symptoms like nausea/dizziness occur, certain antidotal measures (e.g. glycyrrhiza decoction) are sometimes suggested. Buy Traditional Chinese Medicine Online