既浓而高，则令除去。此膏粱之疾，其治宜泻，或三化汤，或调胃承气汤选用。若脾虚则不用也。《经》谓土
不及则卑陷。卑，下也；陷，坑也。四肢皆禀气于胃，而不能至经，必因于脾乃得禀受。今脾病不能与胃行其
津液，四肢不得禀水谷气，气日以衰，脉道不利，筋骨肌肉皆无气以生，故不用焉。治用十全散加减四物汤。（《保命集》）
经义
黄帝问曰∶痹之安生？岐伯对曰∶风、寒、湿三气杂至，合而为痹。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∶以冬遇此为骨痹；以春遇此
为筋痹；以夏遇此为脉痹；以至阴遇此为肌痹；以秋遇此为皮痹。○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∶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，营卫之行涩，经络时疏，故不痛。皮肤不荣，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，阳乘阴，故为痹热。其多汗而濡者，此其逢湿甚也。阳气少，阴气盛，雨
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，逢寒则急，逢热则纵。○卧
出而风吹之，血凝于肤者为痹。（《素问》）
病在阳者命曰风；病在阴者命曰痹；阴阳俱病命曰风痹。○屈而不伸者，其病在筋；伸而不屈者，其病
在骨。（《灵枢》）
哲言
经热则痹，络血则痿。○邪中于经则痹，邪中于络则痿。（叶天士）
痹∶有痹于分肉者；有痹于营卫者；有痹于躯壳之内胸胁之间者；有痹于气分者；有痹于血分者。痹于
分肉者，则痛痹、周痛之类是也；痹于营卫者，则中风、四肢苦烦之类是也；痹于躯壳之内胸胁之间者，胸痹
之类是也；痹于气分者，黄胆之类是也；痹于血分者，血痹之类是也。痹虽同而痹之所在不同，证亦因之迥异，
不可不察也。○痉病非风不成，虽有寒亦附于风而已；痹病非寒不成，虽有风亦附于寒而已。（魏荔彤）
风痹一证，即今人所谓痛风也。盖痹者，闭也，以血气为邪所闭，不得通行而病也。如《痹论》曰∶风
气胜者为行痹。盖风者善行数变，故其为痹，则走注历节，无有定所，此阳邪也。
曰∶寒气胜者为痛痹。以血气受寒则凝涩留聚，聚则为痛，此阴邪也。曰∶湿气胜者为着痹。以血气受湿则濡
滞，濡滞则肢体沉重而疼痛顽木，留着不移，亦阴邪也。凡此三者，即痹之大则也。此外如脏腑之痹，虽以饮
食居处皆能致之，然必重感于邪，而内连脏气，则合而为痹矣。若辨其轻重，则在皮肤者轻，在筋骨者甚，在
脏腑者更甚。若辨其寒热，则多热者方是阳证，无热者便是阴证。然痹本阴邪，惟寒者多而热者少，此则不
可不察。○《经》曰∶风寒湿三气杂至，合而为痹。又曰∶在阳者命曰风，在阴者命曰痹，何也？盖三气之合，
乃专言痹证之所因也。曰在阳为风，在阴为痹，又分言表里之有殊也。如风之与痹，本皆由感邪所致，但外有
表证，而见发热头疼等证，或得汗即解者，是皆有形之谓，此以阳邪在阳分，是即伤寒、中风之属也。故病在
阳者命曰风。若既受寒邪，而初无发热头疼等证，或有汗，或无汗，而筋骨之痛如故，及延绵久不能愈者，是
皆无形之谓，此以阴邪直走阴分，即诸痹之属也。故病在阴者命曰痹。其或既有表证，而疼痛又不能愈，此即
半表半里、阴阳俱病之证。故阴阳俱病者，命曰风痹。此所以风病在阳而痹病在阴也。然则诸痹者皆在阴分，
亦总由真阴衰弱，精血亏损，故三气得以乘之。《经》曰∶邪入于阴则痹，正谓此也。（张景岳）
补编
太阳病，骨节疼痛而烦，脉沉而细者，此名为湿痹。湿痹之候，小便不利，大便反快，但当利其小便。○
血痹病从何得之？曰∶夫尊荣人骨弱肌肤盛，重因疲劳汁出，卧不时动摇，加被微风，遂得之。但以脉自微涩，
在寸口、关上小紧，宜针引阳气，令脉和紧去则愈。○血痹阴阳俱微，寸口、关上微，尺中小紧，外证身体不
仁如风痹状，黄 桂枝五物汤主之。（《金匮》）
治行痹者，散风为主，而以除寒祛湿佐之，参以补血之剂。所谓治风先治血，血行风自灭也。治痛痹者，
散寒为主，而以疏风燥湿
佐之，参以补火之剂。所谓热则流通，寒则凝塞，通则不痛也。治着痹者，燥湿为主，而以祛风散寒佐之，参
以补脾之剂。盖土旺则能胜湿，而气足自无麻顽也。（程钟龄）
痛痹一证，肝肾为病，筋脉失于荣养，虚火乘于经络，红肿疼痛。若肿痛而不红，得温稍定者，又属虚寒
也。初起恶寒发热，类于伤寒，多肿痛于四肢经络之间，或左右移动，或上下游行，脉或大而数，或细而数，
或细而涩，或大而空。医家认作风、寒、湿三气杂至之说，概以外邪为治，病势渐增，阴液渐耗，虚虚之祸，
不可胜言。盖风自内动，湿热内生者，属阴虚有火，表之、清之，证变虚损者居多。寒自内发，寒湿内生者，
属阳虚无火，表之、清之，证变中风者居多。即其人体实，果系外邪侵入，服表散清凉之药痛止肿消，亦必用
扶脾益血之品以收后效。又有过服热药，胃中蕴热日深，筋脉不利，手足肿痛如锥，以阳明主宗筋，筋热则痛，
历关节而为热痹。证见口渴面赤，便秘溺短，脉数大有力，或洪大有力，所谓历节白虎风证。治宜芩、连、知、
柏、生地、石膏、元参之属，清热降火。然后热解筋舒，而痛方定。医家泥于风、寒、湿三气杂至之说，非表
散风寒，则温经利湿，愈服愈热。虽然，《内经》有入脏者死，留连筋骨间者痛久，留皮肤间者易已之旨。足
见内生之风、寒、湿三气，鼓舞于经络之中者，恐用攻耗之药，而脏气空虚，真阴欲竭。外入之风、寒、湿三
气，鼓舞于经络之中者，恐用攻耗之药，而脏气受敌，真阳欲脱。况痹者，闭也。脉络涩而少宣通之机，气血
凝而少流动之势。治法非壮水益阴，则补气生阳；非亟亟于救肝肾，则 于培脾胃，斯病退而根本不摇。倘
泥三气杂至为必不可留之邪，日从事于攻伐，实者安而虚者危矣。（《会心录》）
痛痹之证，多有昼轻夜重者，正阴邪之在阴分也。其有遇风、雨、阴、晦而甚者，此阴邪侮阳之寒证也。
或得暖遇热而甚者，此湿热伤阴之火证也。有火者宜从清凉，有寒者宜从温热。
若筋脉拘滞，伸缩不利者，此血虚、血燥之证也，非养血养气不可。○治痹之法，最宜峻补真阴，使血气流行，
则寒邪随去。若过用风湿等药，再伤阴气，必反增其病矣。（张景岳）
痹者，闭而不通之谓。正气为邪所阻，脏腑经络不能畅达，皆由气血亏损，腠理疏豁，风寒湿三气得以乘
虚外袭，留滞于内，致湿痰、浊血流注凝涩而得之。有卫阳疏，风邪入络而为痹者，治以宣通经脉，甘寒去热。
有经脉受伤阳气不能护持而为痹者，治以温养通补，扶持生气。有暑伤气，湿热入络而为痹者，用舒通络脉之
剂，使清阳流行。有风湿肿痛而为痹者，用参、术益气，佐以风药。有湿热伤气，及湿热入血络而为痹者，用
固卫阳以却邪，及宣通营络兼治奇经。有肝阴虚，疟邪入络而为痹者，治以寒苦滋阴，通逐缓攻。有寒湿入络
而为痹者，以微通其阳，兼以通补为治。有气滞热郁而为痹者，从气分宣通为治。有肝胃虚滞而为痹者，以两
补厥阴、阳明为治。有风、寒、湿入下焦经隧而为痹者，用辛温宣通经气为主。有肝胆风热而为痹者，用甘寒
和阳、宣通脉络为主。有血虚络涩及营虚而为痹者，以养营、养血为主。又有周痹、行痹、肢痹、筋痹，及风、
寒、湿三气杂合之痹，亦不外乎流畅气血，祛邪养正，宣通脉络诸法。（《临证指南》）
肩背、肢节、骨腕、筋会之处注痛，多属痰凝气滞。不拘男女，取神旺气长者，令以口对患处，不呵不吸，
极力努气，使气透入，觉暖至热，又易一人，以愈为度。肾虚腰痛，令掌心摩擦万遍，或令进气于肾俞之穴。
丹田冷者，亦摩擦而进气于脐轮，其功尤烈。○痿痹疾者，偎卧于壮阴之怀，久之，生气和浃，病气潜消。（韩飞霞）
凡治痹证，不明其理，以风门通套药施之者，医之罪也。（《医门法律》）
选案
陆文湖，两足麻木，自服活血之剂不效，改服攻痰之剂又不
效。半载后，两手亦麻，左脐下有尺许不知痛痒。余曰∶此《经》所谓着痹也。脉大无力，气血皆损，用神效
黄汤加茯苓、白术、当归、地黄，十剂有效。更用十全大补汤五十剂始安。（李士材）
周巡台太夫人，先患手臂不仁，次渐足膝无力。服二陈、六君百剂，两足不能起立。更服鹿茸、虎胫、人
参，疼痛非常。予谓积热在肠胃，治宜用攻。公畏甚。予曰∶贼在关内，不速歼除，能安枕乎？公攒眉不敢，
乃之曰∶予家制有河车大造丸，权服半月，再攻何如？公许诺。私以承气合白虎为丸与服，五日而痛止，十
日而能行，更以回天丸调治三月而愈。○郑秋田令眷，左胫浮肿，服苡仁防风汤，胫消，膝上麻痛，呕吐寒热。
数日后，腿忽肿大，其色时黑时红，形如马面，目口鼻俱全，敷药不退。予取旧驿络头烧灰，和贝母、白芥、
干马粪末，敷二次而消。内服加减漏芦汤，寒热亦止，改服八珍汤调理而愈。（程华仲）
一人年七十外。患尾闾骨痛，脉沉迟细涩。其痛在督脉之根，督脉属阳，则阳分虚矣。方用鹿角胶以补
督派，参、附温补下元而宣阳气，加归、地、枸杞、杜仲、续断、牛膝、五加皮以补髓养血，用酒煎以行药力，
数服而效。○一老人早起梳洗，忽右手自肩膊至指尖其痛非常，不能屈伸。医谓老人血虚，余思血虚痛不应如是
之骤，亦不至如此之甚。脉浮数而紧，乃风寒无疑，方用羌、防、秦艽、川芎、五加皮、桂枝、桑枝、当归，
服二剂痛减，手能运动，乃去羌活，加黄 ，倍当归，再服四剂而愈。（吴天士）
一人感受风湿，得白虎历节风证，偏身抽痛，足不履地者三年，百治不效。一夕，梦人与木通汤。遂以
木通二两，长流水煎，服后一时许，偏身痒甚，上体发红丹如豆大，汗出至腰，上体便不痛矣。次日如前煎服，
下体又发红丹，汗出至足，通身舒
畅。一月后，人壮气复，步履如初。后治数人皆验，盖痛则不通，通则不痛也。（《证治准绳》）
湖南一行主人风疾在榻，交易写算，尚能应客。一卖药者在门，拥挤多人，有碍客商，恶之，命驱去。卖
药者顾谓曰∶勿驱我，我为尔起足疾。主人耐之。问足废几年？曰∶三年矣。又问痛否？曰∶阴雨时掣痛。令
铲骡蹄底下皮两许，酒洗炙末，炙乳香一钱和入，分三日酒冲服。三日后，能下榻移步，再服一料疾愈。江斯
荇亲见其治，问予曰∶骡蹄治疯疾，书有之乎？予曰∶未之见也。问何以速效？予曰∶骡马善行去风，其力在
蹄，加乳香，借酒力，安得不速？阿胶，骡皮所煎，尚能去风，况骡蹄乎？此虽在方书之外，实在理法之中，
录之以广见识。（许宣治）
附麻木
麻，犹痹也，虽不知痛痒，尚觉气微流行；木则非惟不知痛痒，气亦不觉流行。（《医学入门》）
麻木，因营卫之行涩，经络凝滞所致。多见于手足者，以经脉皆起于指端，四末行远，气血罕到故也。不
可误作风治。（《证治汇补》）
麻木为风，三尺童子皆知之。细核则有区别，如人久坐亦麻木，绳缚之人亦麻木，此非有风，乃气不行也。
当行其气，则麻木自去矣。（李东垣）
麻是气虚，木是湿痰、死血。然则曰麻、曰木者，以不仁中分而为二也。虽然亦有气血俱虚，但麻而不木
者；亦有虚而感湿，麻木兼作者；又有因虚而感风、寒、湿三气乘之，周身掣痛麻木并作者，古方谓之周痹。
治宜先汗后补，以类推治。（朱丹溪）
附痒
诸痛痒疮，皆属心火。（《素问》）
痛者阴也，痒者阳也。○足厥阴虚则暴痒，任脉虚则痒搔。（《灵枢》）
人近火气者，热微则痒，热甚则痛，附近则灼而为疮，皆火之用也。痒者，美疾也，故火旺于夏，而万物
蕃美也。炙之以火，渍之以汤，而痒转甚者，热之所使也。因而痒去者，热令皮肤缓纵，腠理疏通，阳气得泄，
热散而去故也。夏热肤痒，而以冷水沃之不去者，寒能收敛，腠理闭密，阳气郁结，不能散越，怫热内作故也。
痒得爬而解者，痒为火化，爬令皮肤辛辣而属金化，辛能散，故金化见则火分解矣。或谓痛为实，痒为虚者，
非谓虚为寒也，正谓热之微甚。（刘河间）
诸痒为虚，血不荣于肌腠，所以痒也。当用滋补药以养阴血，血和肌泽，痒自不作。（《丹溪心法》）
附鹤膝风
If the patient's constitution is robust and the condition belongs to diseases caused by rich and greasy diet, treatment should employ purgation. One may select Sanhua Tang (Three Transformations Decoction) or Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction). However, if there is Spleen deficiency, these formulas should not be used. The *Classic* states: "When Earth Qi is insufficient, it sinks." "Bei" (low) refers to being low; "Xian" (sink) refers to a pit. The four limbs receive Qi from the Stomach, but Stomach Qi cannot directly reach the meridians; it must rely on the Spleen's transportation to be distributed to the limbs. Now, due to Spleen disease, it cannot assist the Stomach in transporting fluids and nutrients. The four limbs do not receive water and grain Qi, leading to a daily decline of Qi, unsmooth meridian pathways, and a lack of Qi generation for sinews, bones, muscles, and flesh, resulting in flaccidity and inability to use them. Treatment utilizes Shiquan San (Ten Complete Powder) modified with Siwu Tang (Four Substances Decoction). (From *Baoming Ji*)
Scriptural Meaning
The Yellow Emperor asked: How does Bi syndrome arise? Qibo replied: The three pathogens—Wind, Cold, and Dampness—mix and invade together, combining to form Bi syndrome. When Wind pathogen predominates, it is called Xing Bi (Wandering Bi); when Cold predominates, it is called Tong Bi (Painful Bi); when Dampness predominates, it is called Zhuo Bi (Fixed Bi). The Emperor asked: Why are there five categories? Qibo said: Contracting this in Winter results in Gu Bi (Bone Bi); in Spring, Jin Bi (Sinew Bi); in Summer, Mai Bi (Vessel Bi); during the late summer (Zhiyin period), Ji Bi (Muscle Bi); and in Autumn, Pi Bi (Skin Bi). The Emperor asked: Some Bi cases result in death, some have prolonged pain, and some heal easily. What is the reason? Qibo said: If the pathogen enters the Zang organs, death ensues; if it lingers between sinews and bones, pain persists; if it stays in the skin, it heals easily. The Emperor asked: Some Bi cases are painful, some are not; some involve numbness, some cold, some heat, some dryness, some dampness. What is the cause? Qibo said: Pain arises from excessive Cold; thus, Cold causes pain. Lack of pain and numbness occur because the disease has penetrated deeply over time, causing sluggish Ying and Wei circulation and occasional emptiness in the meridians, hence no pain. The skin loses nourishment, resulting in numbness. Cold sensations arise from deficient Yang Qi and abundant Yin Qi, which combine with the pathogen, causing cold. Heat sensations arise from abundant Yang Qi and deficient Yin Qi, where the pathogenic heat overwhelms the Yin, leading to Re Bi (Hot Bi). Profuse sweating and dampness occur when encountering severe Dampness. With deficient Yang and abundant Yin, the external rain/dampness resonates internally, causing sweat and dampness. The Emperor asked: Why does Bi sometimes not hurt? Qibo said: When Bi is in the bone, the body feels heavy; in the vessels, blood coagulates and stagnates; in the sinews, flexion and extension are impaired; in the flesh, there is numbness; in the skin, there is cold. Possessing all five conditions results in no pain. Generally, Bi syndromes contract when exposed to Cold and relax when exposed to Heat. Sleeping and then going out into the wind causes blood to coagulate in the skin, forming Bi. (From *Su Wen*)
Diseases in the Yang aspect are called Feng (Wind); diseases in the Yin aspect are called Bi; diseases affecting both Yin and Yang are called Feng Bi. Flexion without extension indicates disease in the sinews; extension without flexion indicates disease in the bones. (From *Ling Shu*)
Philosophical Sayings
Heat in the Jing meridians leads to Bi; blood stasis in the Luo collaterals leads to Wei (Flaccidity). Pathogens striking the Jing meridians cause Bi; pathogens striking the Luo collaterals cause Wei. (Ye Tianshi)
Bi can obstruct the Fenrou (muscle intervals); it can obstruct Ying and Wei; it can obstruct the interior of the torso between the chest and hypochondrium; it can obstruct the Qi level; it can obstruct the Blood level. Obstruction in the muscle intervals corresponds to Tong Bi and Zhou Bi; obstruction in Ying and Wei corresponds to Zhong Feng (Wind Stroke) and vexation in the four limbs; obstruction in the chest/hypochondrium corresponds to Xiong Bi (Chest Bi); obstruction at the Qi level corresponds to Huang Dan (Jaundice); obstruction at the Blood level corresponds to Xue Bi (Blood Bi). Although Bi is similar, its location differs, leading to vastly different manifestations, which must be carefully observed. Jing Spasm requires Wind to manifest; even if Cold is present, it attaches to Wind. Bi requires Cold to manifest; even if Wind is present, it attaches to Cold. (Wei Litong)
Feng Bi is what modern people call Tong Feng (Gout). "Bi" means closure; Qi and Blood are blocked by pathogens and cannot flow freely, causing disease. As stated in the *Bi Lun*: Wind predominance causes Xing Bi. Wind moves quickly and changes frequently, so this type of Bi wanders through joints without a fixed location; this is a Yang pathogen. Cold predominance causes Tong Bi. Qi and Blood congeal and stagnate due to Cold, accumulating to cause pain; this is a Yin pathogen. Dampness predominance causes Zhuo Bi. Qi and Blood become sticky and stagnant due to Dampness, causing heavy, painful, numb limbs that remain fixed; this is also a Yin pathogen. These three are the general principles of Bi. Additionally, Zang-Fu Bi can be caused by diet and lifestyle, but it requires repeated exposure to pathogens connecting internally to Zang Qi to form Bi. Regarding severity: Skin involvement is mild; Sinew/Bone involvement is severe; Zang-Fu involvement is most severe. Regarding Cold/Heat: Cases with much heat are Yang syndromes; those without heat are Yin syndromes. However, Bi is inherently a Yin pathogen, mostly Cold with little Heat; this must be noted. The *Classic* says: Wind, Cold, and Dampness mix to form Bi. It also says: In Yang it is called Feng, in Yin it is called Bi. Why? The combination of the three pathogens explains the etiology of Bi. Saying "In Yang is Feng, in Yin is Bi" distinguishes exterior from interior. Feng and Bi both result from pathogen invasion, but if there are exterior signs like fever and headache, or resolution after sweating, these are tangible pathogens; Yang pathogens in the Yang aspect belong to Shang Han (Cold Damage) and Zhong Feng. Thus, disease in Yang is called Feng. If Cold pathogen is contracted without initial fever/headache, with or without sweat, but joint/bone pain persists or drags on, these are intangible pathogens; Yin pathogens moving directly into the Yin aspect belong to various Bis. Thus, disease in Yin is called Bi. If exterior signs exist but pain persists, it is a Half-Exterior/Half-Interior syndrome affecting both Yin and Yang, called Feng Bi. This explains why Feng is in Yang and Bi is in Yin. All Bis reside in the Yin aspect, generally due to deficiency of True Yin and depletion of Essence and Blood, allowing the three pathogens to invade. The *Classic* says: "Pathogens entering Yin cause Bi," referring to this. (Zhang Jingyue)
Supplement
Taiyang disease with bone/joint pain and irritability, with a deep and fine pulse, is named Shi Bi (Damp Bi). Signs of Shi Bi include difficult urination and loose stools; treatment should focus on promoting urination. Xue Bi (Blood Bi) arises how? It affects noble persons with weak bones but full flesh. Due to fatigue and sweating, combined with restless sleep and exposure to slight wind, they contract it. The pulse is slightly choppy and faint, tight at Cun and Guan positions. Acupuncture should guide Yang Qi; when the pulse harmonizes and tightness disappears, healing occurs. Xue Bi with both Yin and Yang deficiency shows faint pulses at Cun/Guan and slight tightness at Chi. Exterior signs include body numbness resembling Feng Bi. Huangqi Guizhi Wuwu Tang (Astragalus and Cinnamon Twig Five-Ingredient Decoction) is indicated. (From *Jin Gui Yao Lue*)
Treating Xing Bi focuses on dispersing Wind, assisted by dispelling Cold and Dampness, supplemented with Blood-nourishing agents. "To treat Wind, first treat Blood; when Blood flows, Wind extinguishes itself." Treating Tong Bi focuses on dispersing Cold, assisted by venting Wind and drying Dampness, supplemented with Fire-warming agents. "Heat promotes flow; Cold causes blockage; flow prevents pain." Treating Zhuo Bi focuses on drying Dampness, assisted by dispelling Wind and Cold, supplemented with Spleen-tonifying agents. When Earth is strong, it overcomes Dampness; when Qi is sufficient, numbness and stiffness disappear. (Cheng Zhongling)
Tong Bi involves Liver and Kidney pathology, where sinews and vessels lose nourishment, and deficient fire attacks the meridians, causing redness, swelling, and pain. If swollen/painful but not red, and relieved by warmth, it belongs to Deficient Cold. Initial stages mimic Shang Han with aversion to cold and fever, often with swelling/pain in limb meridians, moving left/right or up/down. Pulses may be large-rapid, fine-rapid, fine-choppy, or large-empty. Physicians clinging to the "Wind-Cold-Damp mixing" theory often treat solely with exterior-dispelling methods, worsening the condition and depleting Yin fluids, causing "deficiency of deficiency." Wind moving internally with endogenous Damp-Heat belongs to Yin deficiency with fire; exterior-releasing or clearing methods often lead to consumptive disorders. Cold originating internally with endogenous Cold-Damp belongs to Yang deficiency without fire; such treatments often lead to stroke-like symptoms. Even if the constitution is solid and exogenous pathogens invaded, once pain/swelling subside with cooling/dispersing herbs, Spleen-fortifying and Blood-nourishing herbs are needed for recovery. Overuse of hot herbs can deepen stomach heat, causing sinew vessel dysfunction and stabbing pain in hands/feet. Since Yangming governs the tendons, tendon heat causes pain spreading through joints as Re Bi. Symptoms include thirst, red face, constipation, short urine, and forceful rapid/large pulses, known as Li Jie Bai Hu Feng (White Tiger Joint Pain). Treatment uses Huang Qin, Huang Lian, Zhi Mu, Huang Bo, Sheng Di, Shi Gao, Xuan Shen to clear heat and descend fire. Once heat resolves and sinews relax, pain settles. Physicians stuck on the "Wind-Cold-Damp" theory only disperse Wind/Cold or warm meridians/drain dampness, increasing heat. Although the *Nei Jing* states entry into Zang causes death, lingering in sinews/bones causes long pain, and staying in skin heals easily, this highlights that endogenous Wind/Cold/Damp stirring in meridians risks emptying Zang Qi and exhausting True Yin if attacked harshly. Exogenous Wind/Cold/Damp stirring in meridals risks depleting True Yang if attacked harshly. Bi means closure; meridians are choppy lacking ventilation, Qi/Blood stagnate lacking flow. Treatment must either strengthen Water/nourish Yin or tonify Qi/generate Yang; urgently saving Liver/Kidney or cultivating Spleen/Stomach ensures the root remains stable. Clinging to "three pathogens" as invincible evils and constantly attacking harms the deficient while stabilizing the excess. (From *Huixin Lu*)
Tong Bi often worsens at night, indicating Yin pathogens in the Yin aspect. Worsening in wind/rain/cloudy weather indicates Yin pathogens insulting Yang (Cold syndrome). Worsening with warmth/heat indicates Damp-Heat injuring Yin (Fire syndrome). Those with fire require cooling; those with cold require warming. If sinews/vessels are stiff with limited movement, it is Blood deficiency/dryness, requiring Blood and Qi nourishment. Treating Bi best employs vigorous tonification of True Yin to promote Qi/Blood flow, driving out Cold. Overusing Wind-Damp drugs injures Yin and worsens the disease. (Zhang Jingyue)
Bi means closure and obstruction. Healthy Qi is blocked by pathogens; Zang-Fu and meridians cannot flow smoothly. This stems from Qi/Blood deficiency and loose cou li, allowing Wind/Cold/Damp to invade and stagnate internally, causing Phlegm-Damp and turbid blood to flow and coagulate. If Wei Yang is loose and Wind enters collaterals, treat by unblocking meridians with Sweet-Cold herbs to clear heat. If meridians are injured and Yang cannot protect, treat with Warm-Nourishing-Unblocking methods to support vital Qi. If Summerheat injures Qi and Damp-Heat enters collaterals, use agents to soothe/unblock collaterals to allow Clear Yang to flow. If Wind-Damp causes swelling/pain, use Ren Shen and Bai Zhu to tonify Qi, assisted by Wind-draining herbs. If Damp-Heat injures Qi and enters Blood collaterals, secure Wei Yang to expel pathogens and unblock Ying collaterals, addressing Extraordinary Vessels. If Liver Yin is deficient and Malaria pathogens enter collaterals, treat with Bitter-Cold herbs to nourish Yin and gently purge. If Cold-Damp enters collaterals, mildly unblock Yang and combine with tonification. If Qi stagnation and Heat depression cause Bi, unblock from the Qi level. If Liver/Stomach deficiency/stagnation causes Bi, tonify Jueyin and Yangming. If Wind/Cold/Damp enter lower Jiao channels, use Pungent-Warm herbs to unblock channel Qi. If Liver/Gallbladder Wind-Heat causes Bi, use Sweet-Cold herbs to harmonize Yang and unblock collaterals. If Blood deficiency/collateral chopiness or Ying deficiency causes Bi, nourish Ying and Blood. Zhou Bi, Xing Bi, Zhi Bi, Jin Bi, and mixed Wind/Cold/Damp Bi all follow methods of flowing Qi/Blood, expelling pathogens, nourishing healthy Qi, and unblocking collaterals. (From *Lin Zheng Zhi Nan*)
Pain at shoulders, back, joints, wrists, and tendon hubs often stems from Phlegm condensation and Qi stagnation. Regardless of gender, select a person with robust spirit and ample Qi. Have them place their mouth against the affected area, inhaling/exhaling normally, but forcefully pushing Qi inward until warmth/heat is felt. Switch persons until healed. For Kidney deficiency lumbar pain, rub palms ten thousand times or direct Qi into Shenshu acupoints. For cold Dantian, rub and direct Qi into the navel area; efficacy is potent. For Wei-Bi diseases, lie close to a person with strong Yin essence; over time, vital Qi harmonizes and disease Qi dissipates. (Han Feixia)
Any physician treating Bi without understanding its principles, using generic Wind-door remedies, commits medical error. (From *Yi Men Fa Lv*)
Selected Cases
Lu Wenhu suffered numbness in both feet. Self-administered Blood-activating herbs failed; Phlegm-attacking herbs also failed. Six months later, hands became numb, and an area one chi below the left umbilicus lost pain/itch sensation. I diagnosed this as Zhuo Bi per the Classic. Pulse was large but powerless, indicating Qi/Blood damage. Prescribed Shenxiao Huangqi Tang plus Fu Ling, Bai Zhu, Dang Gui, and Di Huang. Effective after ten doses. Continued with Shiquan Dabu Tang for fifty doses until recovered. (Li Shicai)
Madam Zhou, wife of Inspector Zhou, first had arm numbness, progressing to leg/knee weakness. Took Er Chen Tang and Liu Jun Zi Tang for a hundred doses, becoming unable to stand. Took Deer Antler, Tiger Tibia, and Ginseng, causing severe pain. I stated: Accumulated heat in intestines/stomach requires purging. He feared this greatly. I said: If the thief is inside the pass, will you sleep peacefully without eliminating him? He frowned but agreed, suggesting his family's Heche Dazao Wan for half a month before purging. I secretly made pills combining Chengqi Tang and Baihu Tang. Pain stopped in five days; walking resumed in ten days. Regulated with Huitian Wan for three months until cured. Lady Zheng Qiutian had left shin edema. Yi Ren Fang Feng Tang reduced swelling, but knee numbness/pain, vomiting, and chills/fever appeared. Days later, leg swelled massively, color shifting black/red, shape like a horse face. Topical meds failed. I used ash from old post-station mule hooves mixed with Bei Mu, Bai Jie Zi, and dried manure powder. Applied twice to resolve swelling. Internally prescribed Jian Lou Lu Tang; chills/fever ceased. Regulated with Bazhen Tang until cured. (Cheng Huazhong)
A man over seventy suffered tailbone pain with deep-slow-fine-choppy pulse. Pain located at the root of the Du Meridian (Yang aspect), indicating Yang deficiency. Formula: Lu Jiao Jiao to tonify Du Meridian; Ren Shen and Fu Zi to warm lower Yuan and disseminate Yang; Dang Gui, Di Huang, Gou Qi, Du Zhong, Xu Duan, Niu Xi, Wu Jia Pi to tonify marrow and nourish Blood. Decocted in wine to promote action. Effective after several doses. An elderly man suddenly experienced severe pain from right shoulder to fingertips upon waking/combing, unable to flex/extend. Doctor attributed it to Blood deficiency. I reasoned Blood deficiency pain wouldn't be so sudden/severe. Pulse was floating-rapid-tight, confirming Wind-Cold. Formula: Qiang Huo, Fang Feng, Qin Jiao, Chuan Xiong, Wu Jia Pi, Gui Zhi, Sang Zhi, Dang Gui. Two doses reduced pain, restoring hand movement. Removed Qiang Huo, added Huang Qi, doubled Dang Gui. Four more doses cured him. (Wu Tianshi)
A man contracted Wind-Damp, developing Bai Hu Li Jie Feng (White Tiger Joint Pain). Unilateral twitching pain prevented walking for three years; hundreds of treatments failed. One night, he dreamed of receiving Mutong Tang. He took two liang of Tong Cao (Mutong), decocted in running water. After one hour, severe itching occurred, upper body developed red bean-sized rashes, sweating down to waist, and upper body pain ceased. Next day, same dose caused lower body rash/sweating to feet, leaving whole body comfortable. After one month, strength returned, gait normal. Treated several others successfully. "Pain implies blockage; unblocked implies no pain." (From *Zheng Zhi Zhun Sheng*)
A Hunan merchant bedridden with wind-disease could still trade/write. A medicine seller crowded the door, annoying the merchant who ordered him away. The seller said: Don't drive me away; I will cure your foot disease. Merchant endured. Asked: How long paralyzed? Seller: Three years. Pain? Seller: Twitching pain in rainy weather. Seller instructed scraping two qian of mule hoof sole skin, washing/frying/grinding, mixing with one qian fried Ru Xiang, dividing into three doses taken with wine. After three days, merchant could get up/walk. Another dose cured him. Jiang Sixing witnessed this and asked: Does any book mention mule hooves for wind-disease? I said: No. Asked about speed: Mules/horses excel at walking/driving away Wind; power lies in hooves. Added Ru Xiang and wine enhance speed. E-jiao comes from mule hide and drives away Wind; surely hooves work. Though outside standard formularies, it aligns with principle. Recorded to broaden knowledge. (Xu Xuanzhi)
Appendix: Numbness
Ma (Numbness) is like Bi; though pain/itch are unknown, slight Qi flow is felt. Mu (Woodiness) means not only unknown pain/itch, but no Qi flow perceived. (From *Yi Xue Ru Men*)
Numbness results from sluggish Ying/Wei circulation and stagnant meridians. Common in hands/feet because meridians originate at finger/toe tips, traveling far where Qi/Blood rarely reach. Do not mistake for Wind treatment. (From *Zheng Hui Hui Bu*)
Everyone knows numbness is Wind. Careful analysis shows distinction: Sitting long causes numbness; being tied causes numbness. This is not Wind, but Qi stagnation. Promote Qi flow, and numbness vanishes. (Li Dongyuan)
Ma is Qi deficiency; Mu is Damp-Phlegm and Dead Blood. Ma/Mu divide "Bu Ren" (Insensitivity) into two. Sometimes Qi/Blood dual deficiency causes only Ma; sometimes deficiency with Dampness causes both Ma and Mu; sometimes deficiency allows Wind/Cold/Damp invasion causing whole-body twitching pain and numbness, called Zhou Bi. Treat by sweating first, then tonifying, applying logic analogously. (Zhu Danxi)
Appendix: Itching
All pain, itching, and sores belong to Heart Fire. (From *Su Wen*)
Pain is Yin; Itch is Yang. Liver Channel deficiency causes sudden itching; Ren Mai deficiency causes scratching itch. (From *Ling Shu*)
Approaching fire: Mild heat causes itch; severe heat causes pain; close contact causes burning sores. All are effects of Fire. Itch is a "beautiful illness"; Fire peaks in Summer, making things flourish. Burning/moistening increases itch due to heat. Resolving itch via heat relaxes skin, opens cou li, vents Yang, and dissipates heat. Summer heat itch resistant to cold water: Cold contracts and closes cou li, trapping Yang Qi, causing internal stifling heat. Scratching relieves itch because itch transforms via Fire; scratching makes skin pungent (Metal nature); Pungency disperses, so Metal transformation breaks down Fire. Some say pain is Excess, itch is Deficiency; this doesn't mean Deficiency is Cold, but refers to degrees of Heat. (Liu Hejian)
All itching is Deficiency; Blood fails to nourish muscle/cou li, causing itch. Use tonifying herbs to nourish Yin/Blood. When Blood harmonizes and skin moistens, itch ceases. (From *Dan Xi Xin Fa*)
Appendix: Crane Knee Wind