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[From *Suwen* (Basic Questions)] The Yellow Emperor asked: How is Bi syndrome generated? Qibo replied: When Wind, Cold, and Dampness mix and invade together, they combine to form Bi syndrome. When Wind is predominant, it is called Xing Bi (Moving Bi), characterized by wandering pain that does not stay in one place, such as the so-called "Zou Zhu" pain and Li Jie disease. When Cold is predominant, it is called Tong Bi (Painful Bi), characterized by severe and bitter pain, commonly known as Tong Feng (Gout) and Bai Hu Fei Shi. When Dampness is predominant, it is called Zhuo Bi (Fixed Bi), characterized by heaviness and immobility, commonly known as numbness and loss of sensation. All cases of numbness and loss of sensation are fixed and immobile; as He Jian described, this is Qi stagnation causing numbness. Or, pain fixed in one spot that never moves is also Zhuo Bi.

The Yellow Emperor asked: Why are there five types? Qibo said: Those who contract these pathogens in Winter become Gu Bi (Bone Bi); in Spring, Jin Bi (Tendon Bi); in Summer, Mai Bi (Vessel Bi); at Zhi Yin (Late Summer), Ji Bi (Muscle Bi); and in Autumn, Pi Bi (Skin Bi). [Note: For any illness caused by Wind, Cold, and Dampness classified as Xing Bi, Tong Bi, or Zhuo Bi, contracting them in Winter leads to Gu Bi, Spring to Jin Bi, Summer to Mai Bi, Late Summer to Ji Bi, and Autumn to Pi Bi. These names are derived from the time of contraction and the location where the pathogen resides. It does not mean that Gu Bi, Jin Bi, Mai Bi, Ji Bi, and Pi Bi exist separately outside of Xing Bi, Tong Bi, and Zhuo Bi.]

The Yellow Emperor asked: What causes the internal transmission to the Zang and Fu organs? Qibo said: Each Zang organ has a corresponding exterior tissue. If the disease persists for a long time without resolving, the pathogen enters internally into its corresponding Zang. Thus, if Gu Bi does not resolve and the patient is re-exposed to pathogens, it enters the Shen (Kidney). If Jin Bi does not resolve, it enters the Gan (Liver). If Mai Bi does not resolve, it enters the Xin (Heart). If Ji Bi does not resolve, it enters the Pi (Spleen). If Pi Bi does not resolve, it enters the Fei (Lung). This is what is meant by Bi syndrome: repeatedly contracting Wind, Cold, and Dampness during their respective seasons.

Regarding Bi pathogens residing in the Five Zang organs: Fei Bi presents with irritability and fullness, wheezing, and vomiting. Xin Bi presents with obstruction of vessels; when irritated, there is palpitation in the epigastrium like a drum; sudden upward rushing of Qi leading to wheezing; dry throat; frequent belching; and fear when rebellious Qi rises. Gan Bi presents with fright during sleep, excessive drinking, frequent urination, and upper abdominal distension resembling pregnancy. Shen Bi presents with frequent bloating; walking on the buttocks instead of heels (Kao Yi Dai Zhong); and the spine arching up replacing the head. Pi Bi presents with flaccidity and weakness of the four limbs, coughing, vomiting of saliva, and severe upper jiao obstruction. Chang Bi (Intestinal Bi) presents with frequent drinking but inability to urinate, borborygmus in the middle jiao, and occasional stool containing undigested food (Treatment see Stool with Undigested Food section). Bao Bi (Bladder Bi) presents with internal pain upon pressing the lower abdomen and bladder, a sensation as if scalded by hot water, difficult urination, and clear nasal discharge above (Treatment see Lin Syndrome section).

If abnormal Qi causes wheezing, the Bi pathogen gathers in the Lung. If abnormal Qi causes sorrow and worry, the Bi pathogen gathers in the Heart. If abnormal Qi causes enuresis, the Bi pathogen gathers in the Kidney. If abnormal Qi causes fatigue and exhaustion, the Bi pathogen gathers in the Liver. If abnormal Qi causes muscle atrophy, the Bi pathogen gathers in the Spleen. (Wang Bing's commentary states: Abnormal Qi refers to erratic Qi, which enters as Bi according to the ruling organ.) If all Bi syndromes do not resolve, they will further penetrate inward. Among them, those with predominant Wind are easier to cure.

The Yellow Emperor asked: Some Bi patients die, some suffer prolonged pain, and some recover easily. What is the reason? Qibo said: Those whose pathogens enter the Zang organs die; those whose pathogens linger between sinews and bones suffer prolonged pain; those whose pathogens remain in the skin recover easily.

The Yellow Emperor asked: What about pathogens lodging in the Six Fu organs? Qibo said: This also stems from improper diet and lifestyle as the root cause. The Six Fu organs each have Shu points. When Wind, Cold, and Dampness attack these Shu points, and dietary intake responds to them, the pathogens follow the Shu points inward and lodge in their respective Fu organs.

The Yellow Emperor asked: How should acupuncture be used for treatment? Qibo said: The Five Zang organs have Shu points, and the Six Fu organs have He-Sea points. Following the distribution of the meridians, each has specific reaction sites. Treating according to the location of the pathology will lead to recovery. (See *Bi Lun* chapter).

Contracting Wind, Cold, and Dampness in Winter results in Gu Bi. If unresolved, it enters internally to the Kidney, causing Kidney distension, leg spasms, walking on buttocks instead of heels, body curling, and spine arching to replace the head. Acupoints: Tai Xi (KI3), Wei Zhong (BL40).

Contracting Wind, Cold, and Dampness in Spring results in Jin Bi. If unresolved, it enters internally to the Liver, causing fright during sleep, excessive drinking, and frequent urination. Acupoints: Tai Chong (LR3), Yang Ling Quan (GB34).

Contracting Wind, Cold, and Dampness in Summer results in Mai Bi. If unresolved, it enters internally to the Heart, causing epigastric fullness, sudden wheezing, dry throat, frequent belching, and fear. Acupoints: Da Ling (PC7), Xiao Hai (SI8).

Contracting Wind, Cold, and Dampness in Late Summer results in Ji Bi (Muscle Bi). If unresolved, it enters internally to the Spleen, causing flaccidity of the four limbs, coughing, and vomiting of saliva. Acupoints: Tai Bai (SP3), Zu San Li (ST36).

Contracting Wind, Cold, and Dampness in Autumn results in Pi Bi. If unresolved, it enters internally to the Lung, causing irritability, fullness, wheezing, and vomiting. Acupoints: Tai Yuan (LU9), He Gu (LI4).

The Yellow Emperor asked: Do Ying (Nutrient) and Wei (Defensive) Qi also cause Bi syndrome? Qibo said: Ying Qi is the essence of water and grain, harmonized within the Five Zang, distributed throughout the Six Fu, and then enters the vessels. Thus, it circulates up and down the vessels, penetrating the Five Zang and connecting the Six Fu. Wei Qi is the fierce Qi of water and grain; its movement is rapid and slippery, unable to enter the vessels. Therefore, it circulates within the skin and between muscles, steaming the Huang membranes, and dispersing in the chest and abdomen. Violating its flow causes disease; following its flow leads to health. Because it does not combine with Wind, Cold, and Dampness, it does not form Bi syndrome.

The Yellow Emperor said: Excellent. In Bi syndrome, why is there sometimes pain, sometimes no pain, sometimes numbness, sometimes cold, sometimes heat, sometimes dryness, sometimes dampness? Qibo said: Pain is due to excess Cold; because there is Cold, there is pain (Treatment see Tong Bi). No pain and numbness occur because the disease has penetrated deeply over a long time; Ying and Wei circulation becomes sluggish, meridians are occasionally empty, thus sensation is absent, and the skin lacks nourishment, resulting in numbness (Treatment see Zhuo Bi). Cold sensations arise from deficient Yang Qi and abundant Yin Qi, which exacerbate the pathological cold (Treatment see Tong Feng section, wine-soaked cloth compress). Heat arises from abundant Yang Qi and deficient Yin Qi; the pathogenic factor prevails, Yang invades Yin, resulting in Re Bi (Heat Bi). Profuse sweating and wetness occur when encountering severe Dampness; with deficient Yang and abundant Yin, the two energies interact, causing sweating and wetness.

The Yellow Emperor asked: Regarding Bi syndrome, why is there no pain? Qibo said: When Bi is in the bone, the body feels heavy; in the vessel, blood coagulates and fails to flow; in the sinew, flexion occurs without extension; in the muscle, there is numbness; in the skin, there is cold. Possessing any of these five conditions results in no pain. Generally, Bi syndromes become tense when exposed to Cold and relaxed when exposed to Heat. The Yellow Emperor said: Excellent. (All from *Bi Lun*).

[Li Dongyuan] Sheng Ma Tang: Treats Re Bi (Heat Bi), where muscles are extremely hot, the body feels as if mice are crawling on it, lips and mouth turn outward/retract, skin color changes, and treats various wind disorders.
Sheng Ma (Cimicifugae Rhizoma, 3 liang), Fu Shen (Poria with Hostwood, peeled), Ren Shen (Ginseng Radix), Fang Feng (Saposhnikoviae Radix), Xi Jiao (Rhinocerotis Cornu, sliced), Ling Yang Jiao (Caprae Hircus Cornu, sliced), Qiang Huo (Notopterygii Rhizoma et Radix, each 1 liang), Guan Gui (Cinnamomi Cortex, 0.5 liang).
Grind into powder. Take 4 qian per dose, add 2 zhan of water, 2 pieces of crushed fresh ginger, and a little Zhu Li (Bambusa Textilis Sap), decoct until 1 zhan remains, take warm, at any time.

[From *Suwen*] Shao Yin excess leads to Pi Bi (Skin Bi) and Yin Zhen (Urticaria); deficiency leads to Fei Bi (Lung Bi). Tai Yin excess leads to Rou Bi (Muscle Bi) and Han Zhong (Cold Middle); deficiency leads to Pi Bi (Spleen Bi). Yang Ming excess leads to Mai Bi (Vessel Bi) and periodic body heat; deficiency leads to Xin Bi (Heart Bi). Tai Yang excess leads to Gu Bi (Bone Bi) and body heaviness; deficiency leads to Shen Bi (Kidney Bi). Shao Yang excess leads to Jin Bi (Tendon Bi) and hypochondriac fullness; deficiency leads to Gan Bi (Liver Bi) (*Si Shi Ni Cong Lun*). Fei pulse slightly large indicates Fei Bi, pulling on chest and back, aversion to sunlight. Xin pulse slightly weak indicates Xin Bi, pulling on the back, tendency to weep. (Full text see Diagnosis).

[From *Lingshu*] The Yellow Emperor asked: How can one identify those prone to Bi syndrome? Shao Yu answered: Those with coarse texture and unfirm flesh are prone to Bi syndrome. The Yellow Emperor asked: Is there a high-low distinction in Bi syndrome? Shao Yu answered: To know high and low, observe the respective regions. (*Wu Bian Lun*)

The area between the eyebrows (Que Zhong): thin and luster indicates Wind; turbid indicates Bi (*Se Fen*). Floating collaterals appearing blue indicate pain; black indicates Bi (Full text see Skin). Collateral vessels appearing suddenly black indicate long-standing Bi (Full text see Yin Yang).

[From *Suwen*] A choppy pulse indicates Bi (*Ping Ren Qi Xiang Lun*).