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Q: How is the disease of Blood Bi (Blood Obstruction) contracted? The Master said: Those who live in luxury and ease have weak bones but abundant flesh. Due to fatigue and sweating, combined with restless tossing during sleep, exposure to slight wind leads to this condition. If the pulse is subtly choppy (Se), with a slight tightness (Jin) at the Cunkou (Radial Artery proximal segment) and Guan (Middle segment) positions, it is appropriate to use acupuncture to guide Yang Qi. When the pulse becomes harmonious and the tightness disappears, the patient will recover.

[Annotation]
Li Jie (Joint Pain Disease) belongs to injury of Qi; Qi injury causes pain, hence the manifestation of pain. Blood Bi belongs to injury of Blood; Blood injury causes swelling/stasis, hence the manifestation of numbness. The previous section clarified that pathogenic factors gather in the Qi level; this section clarifies that pathogenic factors coagulate in the Blood level, thus named Blood Bi. "Those in luxury" refers to people accustomed to rich and fatty foods. Because they consume sweet and greasy foods, their bones are weak while their muscles are abundant. Consequently, they cannot tolerate fatigue. Fatigue leads to sweating, and sweating opens the Cou Li (pores). They also cannot endure prolonged lying down; restlessness during sleep exposes them to slight wind, leading to illness. This describes how individuals with rich diets have an exterior abundance but interior deficiency, making them susceptible even to slight wind pathogens. How do we know it is Blood Bi? By body numbness and a subtle choppy pulse, indicating pathogenic coagulation in the Blood. The slight tightness at Cunkou and Guan is also the pulse corresponding to slight Wind-Cold pathogens. Acupuncture can guide meridians to treat various Bi syndromes; thus, acupuncture should be used to guide Qi and Blood to drain the pathogen, making the pulse smooth and harmonious. As the tightness vanishes and the pathogen disperses, Blood Bi naturally unblocks.

[Collected Annotations]
Zhou Yangjun stated: Among all people, only those living in luxury experience physical comfort but mental distress. Physical comfort leads to abundant flesh; mental distress leads to weak bones. Weak bones mean poor endurance of labor; abundant flesh means insecure Wei Qi (Defensive Qi). Slight fatigue or exhaustion leads to sweating. Sweating depletes Yang Qi, allowing even slight wind to invade, causing Blood obstruction. A subtle pulse indicates insufficient Yang; a choppy pulse indicates obstructed Yin/Blood. These are the fundamental pulses of Blood Bi. At the site of pathogen entry, a slight tightness appears. "Slight" reflects the constraint of healthy Qi; "Tight" signifies the invasion of Cold pathogen. However, Zhang Zhongjing explicitly mentions "slight wind," yet why is there a Cold pulse? Pathogens follow the blood vessels up and down, obstructing fluids and juices, inevitably causing pain; thus, pain manifests as a Tight pulse. Acupuncture drains the pathogen and guides Yang outward, allowing the pathogen to leave and healthy Qi to extend.

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In Blood Bi, both Yin and Yang pulses are subtle. The Cunkou and Guan pulses are subtle, while the Chi (distal segment) pulse is slightly tight. The external symptom is body numbness and insensitivity, resembling Feng Bi (Wind Bi). Huangqi Guizhi Wuwu Tang (Astragalus and Cinnamon Twig Five-Ingredient Decoction) is the primary formula.

[Annotation]
This passage elaborates on the pulse and symptoms from the previous section to clarify treatment. The previous section mentioned six pulses being subtle and choppy, with slight tightness at Cunkou and Guan. This section states that both Yin and Yang, as well as Cunkou and Guan, are subtle, and the Chi position is also slightly tight. Synthesizing these, we understand that in Blood Bi, the pulses at floating/sinking levels and at Cunkou, Guan, and Chi positions all exhibit subtlety, choppy quality, and slight tightness. Subtle indicates Deficiency; Choppy indicates Stagnation; Slight Tight indicates Pathogen. Thus, these are the diagnostic signs for Blood Bi. The external symptom of Blood Bi is body stiffness/numbness and loss of pain/temperature sensation, described as "resembling Feng Bi." However, unlike Feng Bi which features wandering joint pain, this does not present such symptoms. Huangqi Guizhi Wuwu Tang is prescribed to nourish Ying (Nutritive) and Wei (Defensive) Qi as the root, and to dispel Wind and scatter pathogens as the branch.

[Collected Annotations]
Zhou Yangjun stated: This supplements the previous section regarding cases where Bi syndrome has occurred but failed to resolve via acupuncture guidance. Now, the Cunkou pulse is subtle, progressing to both Yin and Yang being subtle, with both Cun and Guan positions subtle, and Chi slightly tight. Since slight tightness appears at Chi, the pathogen has penetrated deeper and is harder to expel. Why? Where healthy Qi is deficient, there is room for pathogens. Internal/external pulses are called Yin/Yang; upper/lower positions are also called Yin/Yang. With Chi showing slight tightness, the subtlety clearly indicates deficiency internally and externally. Regarding symptoms, if summarized by "insensitivity," pain and numbness are distinct; here, insensitivity is severe, so it is likened to Feng Bi, though it is not true Feng Bi. Therefore, Huangqi consolidates Wei Qi, Shaoyao (Peony) nourishes Yin, Guizhi (Cinnamon Twig) harmonizes Ying and Wei, strengthens the interior and exterior, and drives pathogens out. Ginger (Shengjiang) promotes Stomach Qi, and Jujube (Dazao) benefits the Spleen. This is the appropriate and unchangeable treatment.