Osteoarthritis (OA) has been treated with Chinese medicine (CM) for hundreds of years, albeit under the auspices of other clinical descriptors understood within the field of CM. This paper provides an overview of how OA is typically understood and treated within CM. OA has typically fallen under the clinical descriptor of ‘bi syndrome’ (painful obstruction syndrome). As theory continues to develop, however, new ideas are emerging regarding its pathogenesis that have consequences for treatment - that OA should be considered as a combination of ‘wei syndrome’ and bi syndrome. The therapeutic thrust of herbal medicine and acupuncture thus shifts from a focus on the Kidney zang to the Liver zang, and consequently different kinds of herbs are chosen within medicinal formulas.