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(Numbness)

The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When Wind, Cold, and Dampness pathogens mix and invade together, they combine to form Bi Syndrome (Obstruction Syndrome). (Bi means obstruction or stagnation. It refers to the Qi and Blood in the body being blocked and stagnant by these three pathogens.) When Wind is predominant, it is called Xing Bi (Wandering Bi), (Wind has a moving nature; it disperses Cold and Dampness and moves unpredictably, so the pain of Bi also wanders without fixed location.) When Cold is predominant, it is called Tong Bi (Painful Bi), (Stagnation of Qi and Blood inevitably causes pain, but the pain caused by Cold is the most severe. Because Cold causes coagulation, its obstruction and blockage are more severe than Wind and Dampness, thus the pain is intense like being bitten by a tiger; the world calls this "White Tiger Wind".) When Dampness is predominant, it is called Zhuo Bi (Fixed Bi), (Unlike Wind predominance which flows and moves, it stays fixed and does not shift; unlike Cold predominance which causes severe pain, it only causes slight pain or merely numbness and insensitivity. Generally, Dampness is like water, and Cold is like ice. The looseness and slipperiness versus tightness and roughness of the Cou Li (interstices/skin pores) differ, so the degree of obstruction and impact on the flow of Qi and Blood naturally has distinctions in severity.) This is named the Three BIs.

The *Jing* (Canon) further classifies them by season: Contracting it in Winter results in Gu Bi (Bone Bi), (Bones feel heavy and difficult to lift, accompanied by soreness and pain.) Contracting it in Spring results in Jin Bi (Sinew Bi), (Tendons become spasmodic and cannot extend.) Contracting it in Summer results in Mai Bi (Vessel Bi), (Blood vessels do not flow smoothly and skin color changes.) Contracting it in Late Summer results in Ji Bi (Muscle Bi), (Muscles are numb and insensitive, unaware of pain or itching.) Contracting it in Autumn results in Pi Bi (Skin Bi), (Skin tightens when exposed to Cold and relaxes when exposed to Heat; although numb, one still perceives pain and itching.) This is named the Five BIs.

It is also stated: If the Five BIs do not heal after a long time and are re-infected by pathogens, they will transmit to their respective Zang organs. For example, if chest fullness, irritability, panting, and coughing appear, this is Skin transmitting to Lung, becoming Fei Bi (Lung Bi). If vomiting of phlegm and saliva, epigastric stuffiness and hardness, and flaccidity of the four limbs appear, this is Muscle transmitting to Spleen, becoming Pi Bi (Spleen Bi). If irritability, palpitations, dry throat, frequent belching, and fear due to rebellious Qi rising upward appear (such as fear and palpitations caused by Kidney Cold rushing to the Heart), this is Vessel transmitting to Heart, becoming Xin Bi (Heart Bi). If frequent fright, irritability, hypochondriac distension, polydipsia, and frequent urination appear, this is Sinew transmitting to Liver, becoming Gan Bi (Liver Bi). If abdominal distension appears, with the sacrum replacing the heels (tendon spasm preventing leg extension) and the spine replacing the head (kyphosis preventing upright posture), this is Bone transmitting to Kidney, becoming Shen Bi (Kidney Bi). Once Bi enters the Five Zang organs, death ensues. It is also said that transmission can occur to the Fu organs. Frequent drinking but inability to urinate, mid-jiao panting and urgency, and occasional diarrhea with undigested food (if no diarrhea, then distension; if no distension, then diarrhea) constitute Chang Bi (Intestinal Bi). (Referring to Large and Small Intestines; citing Intestines covers the Stomach.) Pain upon pressing the lower abdomen and Bladder area, feeling as if scalded by hot soup, astringency in urination, and clear nasal discharge above constitute Bao Bi (Bladder Bi). (Bao refers to the Bladder; see detailed discussion in the Lin Zheng section.) The omission of Dan Bi (Gallbladder Bi) is a missing text error. There are also names for Zhong Bi (Multifocal Bi) and Zhou Bi (Circulating Bi). They are described as staying in specific locations, resting and then recurring, shifting left and right, alternating between attack and rest, named Zhong Bi. If within the blood vessels, it only moves up and down along the meridians without shifting left and right, it is named Zhou Bi. (Zhou Bi resembles hemiplegia from Stroke, but differs in having pain without facial paralysis.) According to the aforementioned various BIs, they all originate from Wind, Cold, and Dampness pathogens; they are distinguished only by the site of disease involvement, but fundamentally, the pathology is the same.

Furthermore, Wind is essentially Cold (as explained in the *Malaria Treatise*). Although termed Wind-Cold-Dampness, Cold and Dampness alone suffice to cover the entirety. If Zheng Qi (Upright Qi) is strong while Cold and Dampness are mild, the condition will wander without severe pain; if Zheng Qi is strong but Cold and Dampness are also severe, it will not wander much but cause severe pain; if Zheng Qi is weak and Cold and Dampness are severe, it will be fixed and immobile, causing little pain or merely numbness. The *Jing*'s statement "Wind predominance leads to Wandering Bi" distinguishes between External Wind and Internal Wind. Speaking of External Wind, it is shallow Cold that only injures Wei Qi (Defensive Qi). (Wind predominance implies pathogenic factors bias towards the Defensive level.) It does not heavily obstruct, hence it can move freely without severe pain. Speaking of Internal Wind, it refers to the Qi of the human body. Thus, it can be known that when the *Jing* speaks of Wind, it implicitly includes Qi. Regarding pain from Cold, it must result from vigorous Qi impacting; regarding fixation from Dampness, it must result from weak Qi failing to transport. These can be deduced. Numbness (Ma) is neither pain nor itch; it feels like thousands of small insects crawling chaotically, like scattered hemp seeds, observable in foot numbness. Wood-like sensation (Mu) involves no itch, no pain, and even no numbness; it feels rigid like an object, where one's own muscles feel like others' muscles—unresponsive to pressure and scratching, just as wood lacks sensation. Liu Hejian discussed Ma, attributing it to Qi stagnation/roughness; Li Dongyuan attributed it to Qi deficiency. Generally, strong Qi allows movement, so there is no numbness; complete absence of Qi prevents movement, so there is no numbness either; only when Qi is deficient and fails to circulate smoothly, stagnating in place, and agitating Body Fluids and Phlegm, causing chaotic turbulence, does numbness arise. (If Blood is dry and depleted, Qi cannot move smoothly, wandering chaotically through voids, also causing numbness.) Some say it is caused by Wind, which is erroneous. Observing people who sit for a long time and stand up experience foot numbness, or whose limbs are bound tightly by rope and feel numb upon release, is it not because Qi was stagnant for a long time, and upon standing or release, becomes slightly unblocked, agitating the long-stagnant Blood? Mrs. Li Zhengchen suffered from numbness, which decreased during the day and worsened at night, and worsened with eyes closed but improved with eyes open. During the day and with eyes open, Yang Qi moves externally, allowing Qi to flow freely, hence improvement. Furthermore, if External Cold and Dampness can cause Bi, how could Internal Cold and Dampness fail to cause Bi? Cold causes Qi stagnation and Blood roughness; Dampness causes Phlegm retention and fluid accumulation. Observing Bi caused by Stasis Blood and Phlegm-Fluid, which initially had no external contraction, confirms this. Moreover, Internal Wind also causes Bi. Internal Wind is the rapid manifestation of Heat Qi; excessive Heat generates Dampness and Phlegm. Extreme Heat dries up Blood; dead Blood blocks the collaterals, leading to obstruction and Bi. Also, holding urine can cause Bi. (If urine does not pass, Qi does not move, causing sudden Bi, necessarily with cold knees.) Branch-fluid retention (Zhi Yin) causing arm numbness serves as an analogy; understanding lies with the wise.