风寒湿气，合而为痹。浮涩而紧，三脉乃备。
痹之一证，无如《素问》痹论之精且详矣。其言邪客之多少，传变之浅深，证
状之虚实，腑脏之死生，荣卫形体之异，寒热阴阳之分，皆辞义显明，不可增损一字，兹录全文于下。
黄帝问曰∶痹之安生？岐伯对曰∶风、寒、湿三气杂至，合而为痹也。其风气
胜者为行痹，寒气胜者为痛痹，湿气胜者为着痹也。帝曰∶其有五者，何也？岐伯
曰∶以冬遇此者为骨痹，以春遇此者为筋痹，以夏遇此者为脉痹，以至阴遇此者为
肌痹，以秋遇此者为皮痹。帝曰∶内舍五脏六腑，何气使然？岐伯曰∶五脏皆有合。
病久而不去者，内舍于其合也。故骨痹不已，复感于邪，内合于肾。筋痹不已，复
感于邪，内舍于肝。脉痹不已，复感于邪，内舍于心。肌痹不已，复感于邪，内舍
于脾。皮痹不已，复感于邪，内舍于肺。所谓痹者，各以其时，重感于风、寒、湿
之气也。凡痹之客五脏者∶肺痹者，烦满、喘而呕。（宜当归汤、紫苏子汤之类。）心痹者，脉
不通，烦则心下鼓，暴上气而喘，嗌干善噫，厥气上则恐。（宜茯神汤之类。）肝痹者，夜
卧则惊，多饮，数小便，上为引如怀。（宜萆 丸、奇效人参散之类。）肾痹者，善胀，尻以代
踵，脊以代头。（宜加味五痹汤、奇效人参散之类。）脾痹者，四肢懈堕，发咳呕汁，上为大塞。
（宜温中法曲丸、黄 丸之类。）肠痹者，数饮而出不得，中气喘争，时发飧泄。（宜茯苓川芎汤之类。）
胞痹者，少腹膀胱，按之内痛。若沃以汤，涩于小便，上为清涕。（宜肾沥汤之类。）阴气
者，静则神藏，躁则消亡。饮食自倍，肠胃乃伤。淫气喘息，痹聚于肺。淫气忧思，
痹聚于心。淫气遗溺，痹聚于肾。淫气乏竭，痹聚于肝。淫气肌绝，痹聚在脾。诸
痹不已，亦益内也。其风气胜者，其人易已也。帝曰∶痹其时有死者，或疼久者，
或易已者，其故何也？岐伯曰∶其入脏者死。其留连筋骨间者疼久，其留皮肤间者
易已。帝曰∶其客于六腑者何也？岐伯曰∶此亦其食饮居处为其病本也。六腑亦各
有俞，风、寒、湿气中其俞，而食饮应之，循俞而入，各舍其腑也。帝曰∶以针治
之，奈何？岐伯曰∶五脏有俞，六腑有合。循脉之分，各有所发。各随其过，则病
瘳也。帝曰∶荣卫之气，亦令人痹乎？岐伯曰∶荣者，水谷之精气也。和调于五脏，
洒陈于六腑，乃能入于脉也。故循脉上下，贯五脏，络六腑也。卫者，水谷之悍气
也。其气 疾滑利，不能入于脉也。故循皮肤之中，分肉之间，熏于肓膜，散于胸
腹。逆其气则病，从其气则愈。不与风、寒、湿气合，故不为痹。帝曰∶善。痹或
痛，或不痛，或不仁，或寒，或热，或燥，或湿，其故何也？岐伯曰∶痛者，寒气
多也。有寒，故痛也。其不痛不仁者，病久入深，荣卫之行涩，经络时疏，故不通。
皮肤不营，故为不仁。其寒者，阳气少，阴气多，与病相益，故寒也。其热者，阳
气多，阴气少，病气胜，阳遭（《甲乙经》作乘。）阴，故为痹热。其多汗而濡者，此其逢
湿甚也。阳气少，阴气盛，两气相感，故汗出而濡也。帝曰∶夫痹之为病，不痛何
也？岐伯曰∶痹在于骨，则重。在于脉，则血凝而不流。在于筋，则屈不伸。在于
肉，则不仁。在于皮，则寒。故具此五者，则不痛也。凡痹之类，逢寒则虫，（《甲乙
经》作急。）逢热则纵。帝曰∶善。其脉浮涩而紧者，浮为风，涩为湿，紧为寒。乃一
脉中见此三种，始为三邪杂合。若杂合中，邪有偏胜，则又当审脉之浮多、涩多、
紧多，以别之也。主方十一首，固与本论腑脏证对，殊不知三邪之变见于形体者，
不可胜纪。论中虽分行、痛、着三种，而三种之证未经列出。如痛痿走注、麻木不
仁、拳挛重着等证，似与前方漠不相关。若概治之，恐迂缓无裨。故又选对证名方
于后，以便采用焉。（行痹宜仙灵脾散、三因控涎丹。痛痹宜乌药顺气散、丹溪二妙散。着痹宜东
垣神效黄 汤、温经除湿汤、史国公浸酒之类。）
Wind, cold, and dampness pathogens combine to form Bi syndrome (Obstruction Syndrome). The pulse presents as floating, choppy, and tight, indicating the presence of all three pathogens.
Regarding Bi syndrome, no text is more precise and detailed than the "Bi Lun" (Treatise on Bi) in the *Su Wen* (Basic Questions) of the *Huangdi Neijing*. It elaborates on the quantity of invading pathogens, the depth of transmission, the deficiency or excess of symptoms, the prognosis of zang-fu organs, the differences between Ying-Wei (Nutritive and Defensive Qi) and physical forms, and the distinctions between cold, heat, yin, and yang. The language is clear and explicit, leaving no room for addition or deletion. The full text is recorded below.
The Yellow Emperor asked: How does Bi syndrome arise? Qibo replied: When wind, cold, and dampness mix and invade together, they form Bi syndrome. If wind prevails, it is called Xing Bi (Wandering Bi); if cold prevails, it is called Tong Bi (Painful Bi); if dampness prevails, it is called Zhuo Bi (Fixed Bi). The Emperor asked: Why are there five categories? Qibo said: Contracting this pathogen in winter results in Gu Bi (Bone Bi); in spring, Jin Bi (Sinew Bi); in summer, Mai Bi (Vessel Bi); during the late summer (Zhi Yin), Ji Bi (Muscle Bi); and in autumn, Pi Bi (Skin Bi). The Emperor asked: What causes the pathogens to enter internally and lodge in the zang-fu organs? Qibo said: Each of the five zang organs has an external correspondence. If the disease persists without resolution, the pathogen enters internally into its corresponding organ. Thus, if Gu Bi persists and re-exposure occurs, it lodges in the Kidney; if Jin Bi persists, it lodges in the Liver; if Mai Bi persists, it lodges in the Heart; if Ji Bi persists, it lodges in the Spleen; if Pi Bi persists, it lodges in the Lung. This is what is meant by Bi syndrome: contracting wind, cold, and dampness repeatedly during their respective seasons.
When Bi pathogens lodge in the five zang organs:
Lung Bi manifests as chest fullness, panting, and vomiting. (Suitable formulas include Dang Gui Tang [Angelica Decoction] and Zi Su Zi Tang [Perilla Seed Decoction].)
Heart Bi manifests as blocked vessels, palpitations when vexed, sudden upward rushing of qi with panting, dry throat, frequent belching, and fear when rebellious qi ascends. (Suitable formulas include Fu Shen Tang [Poria Decoction].)
Liver Bi manifests as fright during sleep, excessive thirst, frequent urination, and a pulling sensation in the upper body resembling pregnancy. (Suitable formulas include Bi Xie Wan [Dioscorea Hypoleuca Pill] and Qi Xiao Ren Shen San [Miraculous Ginseng Powder].)
Kidney Bi manifests as frequent abdominal distension, where the buttocks replace the heels in walking, and the spine replaces the head in posture. (Suitable formulas include Jia Wei Wu Bi Tang [Modified Five Bi Decoction] and Qi Xiao Ren Shen San.)
Spleen Bi manifests as flaccidity and weakness of the four limbs, coughing with spitting of fluids, and severe obstruction in the upper body. (Suitable formulas include Wen Zhong Fa Qu Wan [Warm Middle Method Pill] and Huang Qi Wan [Astragalus Pill].)
Intestine Bi manifests as frequent drinking but inability to urinate, abdominal borborygmi and contention, and occasional stool containing undigested food. (Suitable formulas include Fu Ling Chuan Xiong Tang [Poria and Ligusticum Decoction].)
Bladder Bi manifests as internal pain upon pressing the lower abdomen and bladder area. It feels like being scalded with hot water, with difficult and scanty urination, and clear nasal discharge above. (Suitable formulas include Shen Li Tang [Kidney Infusion Decoction].)
Yin qi, when quiet, stores the spirit; when agitated, it dissipates. Doubling food intake damages the stomach and intestines. Pathogenic qi causing panting gathers Bi in the Lung; pathogenic qi causing worry and thought gathers Bi in the Heart; pathogenic qi causing enuresis gathers Bi in the Kidney; pathogenic qi causing exhaustion gathers Bi in the Liver; pathogenic qi causing muscle atrophy gathers Bi in the Spleen. If various Bi syndromes persist, they will further penetrate inward. Those with prevailing wind are easier to cure.
The Emperor asked: Why do some Bi cases result in death, while others have prolonged pain or recover easily? Qibo said: Invasion of the zang organs leads to death. Pathogens lingering between sinews and bones cause prolonged pain; those remaining in the skin are easily cured. The Emperor asked: What happens when pathogens lodge in the six fu organs? Qibo said: This also stems from improper diet and lifestyle. The six fu organs each have Shu points. Wind, cold, and dampness attack these Shu points, and dietary responses facilitate entry, following the Shu points to lodge in the respective fu organs. The Emperor asked: How should acupuncture be used? Qibo said: The five zang have Shu points, and the six fu have He-sea points. Following the meridian pathways, specific points are activated. Treating according to the location of the pathology cures the disease. The Emperor asked: Do Ying and Wei qi also cause Bi? Qibo said: Ying qi is the essence of water and grain. It harmonizes with the five zang and spreads to the six fu, entering the vessels to circulate up and down, connecting the zang and fu. Wei qi is the fierce qi of water and grain. It is swift and slippery, cannot enter the vessels, and instead circulates within the skin and between muscles, steaming the Huang membrane and spreading in the chest and abdomen. Violating its flow causes disease; following its flow promotes health. Since it does not combine with wind, cold, and dampness, it does not form Bi.
The Emperor asked: Why does Bi sometimes cause pain, sometimes not; sometimes numbness, sometimes cold, sometimes heat, sometimes dryness, sometimes dampness? Qibo said: Pain is due to excess cold; thus, cold causes pain. Lack of pain and numbness occur when the disease is deep and chronic, Ying-Wei flow is sluggish, and meridians are occasionally empty, leading to lack of sensation. Skin malnourishment causes numbness. Cold sensations arise from deficient Yang and excess Yin, which exacerbate the pathogenic cold. Heat sensations arise from abundant Yang and deficient Yin, where pathogenic Qi overcomes Yin, resulting in Bi-Heat. Excessive sweating and wetness occur due to severe dampness invasion, where deficient Yang and abundant Yin interact, causing sweat and moisture.
The Emperor asked: Why is there no pain in certain Bi conditions? Qibo said: Bi in bone causes heaviness; in vessels, blood coagulation and stagnation; in sinews, flexion without extension; in flesh, numbness; in skin, cold. Possessing any of these five characteristics results in no pain. Generally, Bi aggravated by cold causes spasms (Ji), while Bi aggravated by heat causes flaccidity.
The Emperor asked: Regarding the floating, choppy, and tight pulse: Floating indicates wind, Choppy indicates dampness, and Tight indicates cold. Seeing all three in one pulse confirms the mixture of three pathogens. If one pathogen predominates among the mixed pathogens, one must examine whether the floating, choppy, or tight aspect is more prominent to differentiate.
There are eleven principal formulas, which correspond to the zang-fu syndromes discussed. However, the variations of the three pathogens manifesting in the physical form are countless. Although the treatise categorizes them into Wandering, Painful, and Fixed Bi, it does not list all specific symptoms. Conditions such as migrating pain, numbness, clenched fists, and heaviness seem unrelated to the previous formulas. General treatment may be too slow and ineffective. Therefore, selected famous formulas for specific syndromes are listed below for reference. (For Wandering Bi: Xian Ling Pi San [Epimedium Powder], San Yin Kong Xian Dan [Three Causes Phlegm-Fluid Pill]; for Painful Bi: Wu Yao Shun Qi San [Maytenus Qi-Circulating Powder], Dan Xi Er Miao San [Danxi Two Marvels Powder]; for Fixed Bi: Dong Yuan Shen Xiao Huang Qi Tang [Dongyuan Miraculous Astragalus Decoction], Wen Jing Chu Shi Tang [Warm Meridians Expel Dampness Decoction], Shi Guo Gong Jin Jiu [Shi Guo Gong Infused Wine]).