经云。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。
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。
行痹者。病处行而不定。走注历节疼痛之类。当散风为主。御寒利气。仍不可废。更须参以
补血之剂。盖治风先治血。血行风自灭也。痛痹者。寒气凝结。阳气不行。故痛有定处。俗名痛
风是也。治当散寒为主。疏风燥湿。仍不可缺。更须参以补火之剂。非大辛大温。不能释其凝寒
之害也。着痹者。肢体重着不移。疼痛麻木是也。盖气虚则麻。血虚则木。治当利湿为主。祛风
解寒。亦不可缺。更须参以理脾补气之剂。盖土强自能胜湿。而气旺自无顽麻也。骨痹者。即寒
痹痛痹也。其证痛苦攻心。四肢挛急。关节浮肿。筋痹者。即风痹行痹也。其证游行不定。与血
气相搏。聚于关节。筋脉弛纵。或赤或肿。脉痹者。即热痹也。脏腑移热。复遇外邪客搏经络。
留而不行。其证肌肉热极。皮肤如鼠走。唇口反裂。皮肤色变。肌痹者。即着痹湿痹也。留而不
移。汗出四肢痿弱。皮肤麻木不仁。精神昏塞。皮痹者。即寒痹也。邪在皮毛。瘾疹风疮。搔之
不痛。初起皮中如虫行状。以上诸证。又以所遇之时而命名。
非行痹痛痹着痹外。又有皮脉筋肌骨之痹也。
故骨痹不已。复感于邪。内舍于肾。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。肺痹者。烦满喘而呕。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。肝痹者。夜卧则惊。多饮数小便。上为引如怀。肾痹者。善胀。尻以代
踵。脊以代头。脾痹者。四肢懈惰。发咳呕汁。上为大塞。
肺痹则肺气不清。胃热上逆。故烦喘而呕。心痹则脉道不通。心火内衰。湿气凌心。故恐。
肝痹则血液阻滞。水饮客之。故上为引急。如有所怀也。肾痹则胃之关门不利。故善胀。浊阴湿
邪伤其阳气。所以脚挛不能伸。身偻不能直也。脾痹则阳气不运。故四肢懈惰。上焦痞塞也。
肠痹者。数饮而出不得。中气喘争。时发飧泄。
肠者。兼大小肠而言。肠间病痹。则下焦之气不化。故虽数饮。而小便不得出。则本末受病。
故与中气喘争。盖其清浊不分。故时发飧泄也。
胞痹者。少腹膀胱按之内痛。若沃以汤。涩于小便。上为清涕。
胞者膀胱之脬也。膀胱气闭。则水道不行。故按之内痛。若以热汤沃之。小便得外热之助。
方得稍通。而犹滞涩不利。则治宜温助气化。可知膀胱之脉。从巅入络脑。故上为清涕。以太阳
经气不固而精气上脱。又须温补无疑。盖缘精泄之后。寒气乘虚入于膀胱之内。而致小便淋沥不
通。茎中痛引谷道。甚则脐腹胀痛此。属津液枯竭之故。
误与利水药。必致喘逆胀急而死。老人阴虚泉竭。多有此证。曾见膀胱胀破。淋沥无度。时虽暂
宽。不久即毙。诸痹不已。亦益内也。其风气胜者。其人易已也。其入脏者死。其留连筋骨间者
疼久。其留皮肤间者易已。凡痹之类。逢寒则虫。逢热则纵。
寒从中生者。是人多痹气也。阳气少。阴气多。故身寒如从水中出。
人有身寒。汤火不能热。浓衣不能温。然不能冻栗。是人素肾气胜。以水为事。太阳气衰。
肾脂枯不长。一水不能胜两火。肾者水也。而生于骨。肾不生。则髓不能满。故寒甚至骨也。所
以不能冻栗者。肝。一阳也。心。二阳也。肾。孤脏也。一水不能胜二火。故不能冻栗。病名骨
痹。是人当挛节也。
素肾气胜。言禀气本充也。以水为事。言嗜欲无节。伤其真阳。无阳则阴无以生。故肾脂枯
不长。无阴则阳无以化。故寒甚至骨也。
病在阳者。命曰风。病在阴者。命曰痹。阴阳俱病。命曰风痹。
阳受风气。故在阳者命曰风。阴受湿气。故入阴则命曰痹。
风痹淫泺。病不可已者。足如履冰。时如入汤中。股胫淫泺。烦心。头痛。时呕时 。（闷
同。）眩已汗出。久则目眩。悲以喜恐。短气不乐。不出三年死也。
寒痹之为病也。留而不去。时痛而皮肤不仁。剌布衣者。以火淬之。刺大人者。以药熨之。
以醇洒二十斤。蜀椒一升。干姜一斤。桂心一斤。凡四种。皆 咀。渍酒中。用绵絮一斤。细布
四丈。并纳酒中。置酒马矢 中。盖封涂。勿使泄。五日五
夜。出布绵絮曝干之。干复渍。以尽其汁。每渍必 其日。乃出干。干并用滓与绵絮。复布为复
巾。长六七尺。为六七巾。则用之。生桑炭炙巾。以熨寒痹所刺之处。令热入至于病所。寒。复
炙巾以熨之。三十遍而止。汗出以巾拭身。亦三十遍止。起步内中。无见风。每刺必熨。如此病
已矣。此所谓内热也。
内。纳同。谓温其经。使热气内入。血脉流通也。布衣血气涩浊。故当以火淬之。即近世针
挑艾熨之类。周痹者。在于血脉之中。随脉以上。随脉以下。不能左右。各当其所。风寒湿气客
于分肉之间。迫切而为沫。沫得寒则聚。聚则排分肉而分裂也。分裂则痛。痛则神归之。神归之
则热。热则痛解。痛解则厥。厥则他痹发。发则如是。此内不在藏。而外未发于皮。独居分肉之
间。真气不能周。故命曰周痹。
金匮云。问曰。血痹病。从何得之。师曰。夫尊荣人骨弱肌肤盛。重因疲劳。汗出。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。今脉和。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。
血痹者。寒湿之邪。痹着于血分也。辛苦劳 之人。皮腠致密。筋骨坚强。虽有风寒湿邪。
莫之能客。惟尊荣奉养之人。肌肉丰满。筋骨柔脆。素常不胜疲劳。行卧动摇。或遇微风。则能
痹着为患。不必风寒湿之气杂至而为病也。上条言脉自微涩。而关寸小紧。为湿痹血分。所以阳
气不能外行。故宜针引阳气以和阴血。下条言阴阳俱微。而尺中小紧。为营卫俱虚。所以身体不
仁。故宜药通营卫。行散其痹。则紧去人安而愈矣。夫血痹者。即内经所谓在脉则血凝不流。仲
景直发其所以不流之故。言血既痹。脉自微涩。然或寸或关或尺。其脉见小急之处。即风入之
处也。故其针药所施。皆引风外出之法也。
肾着之病。其人身体重。腰中冷如坐水中。形如水状。反不渴。小便自利。饮食如故。病属
下焦。身劳汗出。衣里冷湿。久久得之。腰以下冷痛。腹重如带五千钱。甘姜苓术汤主之。
此证乃湿邪中肾之外廓。与肾脏无预也。虽腰中冷如坐水中。实非肾脏之真气冷也。今邪着
下焦。饮食如故。不渴。小便自利。且与肠胃之府无预。况肾脏乎。此不过身劳汗出。衣里冷湿。
久久得之。但用甘草、干姜、茯苓、白术。甘温淡渗行湿足矣。又何取暖肾壮阳哉。
诸肢节疼痛。身体 羸。脚肿如脱。头眩短气。温温欲吐。桂枝芍药知母汤主之。
此即总治三焦痹之法。头眩短气。上焦痹也。温温欲吐。中焦痹也。脚肿如脱。下焦痹也。
肢节疼痛。身体 羸。筋骨痹也。由是观之。当是风寒湿痹其营卫筋骨三焦之病。然湿多则肿。
寒多则痛。风多则动。用桂枝治风。麻黄治寒。白术治湿。防风佐桂枝。附子佐麻黄、白术。其
芍药、生姜、甘草。亦如桂枝汤之和其营卫也。知母治脚肿。引诸药下行。附子以行药势。开痹
之大剂也。
戴人云。痹病以湿热为源。风寒为兼。三气合而为痹。其脉沉涩。奈何治此者。不问经络。
不分脏腑。不分表里。便作寒湿香港脚。乌之附之。乳之没之。种种燥热攻之。中脘灸之。脐下烧
之。三里火之。蒸之熨之。汤之炕之。以致便溺涩滞。前后俱闭。虚躁转甚。肌肤日削。饮食不
下。虽遇扁华。亦难措手。若此者何哉。胸膈间有寒痰故也。痹病本不死。死于医之误也。
景岳全书云。观痹论曰。风寒湿三气杂至。合而为痹。而寿夭刚柔论又曰。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。但外有表证之见。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。又无变证。或有汗。或无汗。而筋骨之痛如故。及延绵久不能愈。而外无表证之见
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。而为此诸证。
经曰。邪入于阴则痹。正谓此也。是以治痹之法。最宜峻补真阴。使血气流行。则寒邪随去。若
过用风湿痰滞等药。而再伤阴气。必反增其病矣。
行痹者。走注无定。风之用也。经言病在阳者。命曰风。在阴者。命曰痹。阴阳俱病。命曰
风痹。越婢加术附汤。轻则羌、防、归、艽、葛、桂、赤茯、甘草、威灵仙、苍术、黄柏。若病
久大虚。非大补气血不可。如日从事乎散风清火。则脾肺必败。终致不起。痛痹者。痛有定处。
乃湿气伤肾。肾不生肝。肝风挟湿。流走四肢。肩 疼痛。拘急浮肿。金匮乌头汤加羌活、官桂。
服后啜热稀粥助其作汗乃解。身体痛如欲折。肉如锥刺刀割。千金附子汤。着痹者。痹着不仁。
经曰。营气虚则不仁。卫气虚则不用。营卫俱虚则。不仁且不用。灵枢云。卫气不行。则为麻木。
东垣治麻痹。必补卫气而行之。浑身麻木不仁。或左或右。半身麻木。或面或头。或手臂或脚腿。
麻木不仁。并宜神效黄 汤。皮肤间麻木。此肺气不行也。本方去蔓荆倍黄 加防风。如肌肉麻。
营气不行也。去蔓荆加桂枝、羌防。手足麻痹。臂痛不能举。多眠昏冒者。支饮也。气
口脉滑。指迷茯苓丸。脉浮者。二陈汤加桂枝、枳、桔。若手麻乃是气虚。十指麻乃是湿痰死血。
手指麻木是气不行。有顽痰死血也。导痰汤加乌药、苍术。风吹手足酸疼而肿。是寒湿。桂枝附
子汤。因于风者。百节走痛。乌药顺气散加羌活、南星、苍术。因于湿者。天阴即发。身体沉重
酸疼。除湿蠲痛汤。在上痛者。加桂枝、桔梗。在下痛者。加防己、木通。多汗。加黄 、防风。
自汗身重。防己黄 汤。寒湿不可屈伸者。乌头汤、活络丹选用。并外用摩风膏。因火者。五苓
散加酒芩、黄柏、竹沥、姜汁。因湿热者。肢节疼痛。肩背沉重。胸膈不利。下注足胫痛肿。当
归拈痛汤。热毒流入肢节疼痛。患处必热。千金犀角散。血瘀者。芎、归、桃仁、红花、威灵仙。
煎成入麝少许。血痹者。邪入于阴也。经云。人卧则血归于肝。汗出而风吹之。血凝于肤者为痹
是也。黄 桂枝五物汤。昼轻夜重。加当归。痹而身寒如从水中出者。属寒湿。附子丸。血气凝
滞。手足拘挛疼重。风寒湿三气杂至者。改定三痹汤。周痹者。真气不能周于身。故周身痹痛。
用蠲痹汤。行痹上半身甚。用乌药顺气散。下半身甚。用虎骨散。痛痹。用乌头汤。着痹。用除
湿蠲痛汤。不应。用补中益气加熟附子、羌活、苍术、黄柏。有痹遍身走痛无定。二陈汤加羌活、
风化硝。姜汁糊丸服。痹在骨。安肾丸。痹在筋。羚羊角散。痹在脉。人参丸。痹在肌肉。神效
黄汤。痹在皮。越婢汤加羌活、细辛、白蒺藜。痹在肠。吴茱萸散。痹在胞。肾沥汤。虚寒。
茯苓丸。虚寒甚者。巴戟丸。热痹。千金犀角散。冷痹。巴戟天汤。寒痹。宜以蜀椒、干姜、桂
心各四两。醇酒五斤。絮四两。布五尺。马矢火煨一伏时。将絮布曝干收尽。炙热熨之。着痹不
移。 肉破。身热脉涩者。不治。
凡治痹证。不明其理。以风门诸通套药施之者。医之过也。夫痹证非不有风。然风入在阴分
与寒湿互结。扰乱其血
脉。致身中之阳不通于阴。故致痹也。古方多有用麻黄、白芷者。以麻黄能通阳气。白芷能行营
卫。然已入在四物、四君子等药之内。非颛发表明矣。至于攻里之法。则从无有用之者。以攻里
之药皆属苦寒。用之则阳愈不通。其痹转入诸府而成死证多矣。可无明辨而深戒欤。
〔诊〕脉大而涩为痹。脉急亦为痹。肺脉微为肺痹。心脉微为心痹。右寸沉而迟涩为皮痹。左
寸结而不流利为血痹。右关脉举按皆无力而涩为肉痹。左关弦紧而浮沉有力为筋痹。
The *Classic of Medicine* (Huangdi Neijing) states: When Wind, Cold, and Dampness pathogenic factors mix and invade the body together, they combine to form Bi syndrome (Obstruction Syndrome). When Wind is predominant, it is called Moving Bi (Xing Bi); when Cold is predominant, it is called Painful Bi (Tong Bi); when Dampness is predominant, it is called Fixed Bi (Zhuo Bi).
If these pathogens are contracted in Winter, it is called Bone Bi; in Spring, Sinew Bi; in Summer, Vessel Bi; during the late summer period (Zhi Yin), Muscle Bi; and in Autumn, Skin Bi.
Moving Bi is characterized by lesions that move without a fixed location, such as pain flowing through various joints. Treatment should primarily focus on dispersing Wind, while also controlling Cold and regulating Qi. This cannot be neglected. Furthermore, blood-nourishing agents must be included. Because treating Wind requires first treating the Blood; when Blood flows freely, Wind naturally extinguishes.
Painful Bi is caused by the coagulation of Cold pathogen and the failure of Yang Qi to circulate, resulting in pain with a fixed location. It is commonly known as Gout. Treatment should primarily focus on dispelling Cold, while dispersing Wind and drying Dampness cannot be omitted. More importantly, fire-tonifying agents must be supplemented. Only large, acrid, and warm herbs can relieve the harm of coagulated Cold.
Fixed Bi manifests as heaviness and immobility of the limbs, accompanied by pain and numbness. This is because Qi deficiency causes numbness, and Blood deficiency causes woodiness (stiffness/numbness). Treatment should primarily focus on promoting urination to remove Dampness, while dispelling Wind and resolving Cold cannot be omitted. Furthermore, Spleen-regulating and Qi-tonifying agents must be supplemented. Because when Earth (Spleen) is strong, it naturally overcomes Dampness, and when Qi is abundant, there is no stubborn numbness.
Bone Bi is synonymous with Cold Bi and Painful Bi. Its symptoms include severe pain affecting the heart/mind, spasms and cramps of the four limbs, and edema of the joints.
Sinew Bi is synonymous with Wind Bi and Moving Bi. Its symptoms involve wandering movement, where pathogens contend with Qi and Blood, gathering at the joints, causing sinews and vessels to become flaccid and extended, with the area appearing red or swollen.
Vessel Bi is synonymous with Heat Bi. Internal heat from the Zang-Fu organs combines with external pathogens attacking the collaterals, causing stagnation. Symptoms include extreme heat in the muscles, skin sensation like mice crawling, cracking of the lips and mouth, and changes in skin color.
Muscle Bi is synonymous with Fixed Bi and Damp Bi. Pathogens remain stationary, accompanied by sweating, flaccidity and weakness of the four limbs, skin numbness and insensitivity, and mental confusion or obstruction.
Skin Bi is synonymous with Cold Bi. The pathogen resides in the skin and hair follicles, presenting as urticaria or wind sores. Scratching does not cause pain. Initially, the skin feels as if insects are crawling. The above various syndromes are named according to the season in which the pathogen was contracted.
Besides Moving Bi, Painful Bi, and Fixed Bi, there are also Skin, Vessel, Sinew, Muscle, and Bone BIs.
Therefore, if Bone Bi persists and the patient is re-exposed to pathogens, the disease transmits inward to store in the Kidney. If Sinew Bi persists, it transmits to the Liver. If Vessel Bi persists, it transmits to the Heart. If Muscle Bi persists, it transmits to the Spleen. If Skin Bi persists, it transmits to the Lung. This is what is meant by Bi syndrome: each type is caused by re-exposure to Wind, Cold, and Dampness during its corresponding season.
Lung Bi presents with irritability, fullness, wheezing, and vomiting. Heart Bi presents with obstruction of the vessels; when irritated, palpitations are felt below the heart; sudden upward rushing of Qi with wheezing; dry throat; frequent belching; and fear when rebellious Qi rises. Liver Bi presents with fright during sleep, excessive thirst, frequent urination, and upper-body pulling tightness resembling pregnancy. Kidney Bi presents with frequent distension, standing on the heels with the buttocks replacing the feet, and spinal curvature with the spine replacing the head. Spleen Bi presents with flaccidity and lethargy of the four limbs, coughing with vomiting of fluids, and upper-body blockage.
Lung Bi occurs because Lung Qi is unclear and Stomach Heat rebels upward, causing irritability, wheezing, and vomiting. Heart Bi occurs because the vessel pathway is obstructed and Heart Fire declines internally, allowing Dampness to overwhelm the Heart, leading to fear. Liver Bi occurs because Blood circulation is blocked and Water-Fluids reside within, causing upper-body pulling tightness as if pregnant. Kidney Bi occurs because the "gate" of the Stomach/Kidney fails to function properly, leading to distension. Turbid Yin and Damp pathogens damage Yang Qi, causing leg spasms preventing extension and spinal curvature preventing straightening. Spleen Bi occurs because Yang Qi fails to transport, leading to limb flaccidity and upper Jiao blockage.
Intestine Bi presents with frequent drinking but inability to urinate, abdominal Qi contention, and occasional diarrhea of undigested food.
"Intestine" refers to both the Large and Small Intestines. When Bi obstruction occurs in the intestines, Lower Jiao Qi transformation fails. Thus, despite frequent drinking, urine cannot be excreted. This indicates pathology at both root and branch, causing abdominal Qi contention. Because Clear and Turbid substances are not separated, occasional diarrhea of undigested food occurs.
Bladder Bi (Bao Bi) presents with internal pain upon pressing the lower abdomen and bladder, a sensation as if scalded by hot water, difficult and scanty urination, and clear nasal discharge from above.
"Bao" refers to the bladder sac. When Bladder Qi is closed, the water pathway does not flow, causing internal pain upon pressure, feeling like being poured with hot soup. With external heat assistance, urination may slightly improve but remains stagnant and difficult. Therefore, treatment should warm and assist Qi transformation. It is known that the Bladder meridian enters from the vertex and connects to the brain, hence the clear nasal discharge. This is due to the insecurity of Taiyang Qi and the leakage of Essence upwards, requiring warming and tonification undoubtedly. Generally, after Essence leakage, Cold pathogens enter the Bladder vacuity, causing dribbling urinary obstruction, penile pain radiating to the anus, and even umbilical and abdominal distension-pain. This belongs to the category of fluid exhaustion.
Mistakenly using diuretics will inevitably lead to death from wheezing, rebellion, and acute distension. Elderly people with Yin deficiency and depleted springs often have this syndrome. I have seen cases of bladder rupture with endless dribbling; although temporarily relieved, death follows soon. All BIs, if unhealed, will further affect the interior. Those with predominant Wind pathogen recover easily. Those transmitting to the Zang organs die. Those lingering in sinews and bones suffer long-term pain. Those lingering in the skin recover easily. Generally, Bi syndromes contract cold causing curling/spasms (Chong/Tuan), and contract heat causing flaccidity.
Those whose Cold arises from within have abundant Bi Qi. Yang Qi is deficient, Yin Qi is abundant, so the body feels cold as if emerging from water.
Some people feel cold internally; hot baths and fires cannot warm them, thick clothes cannot heat them, yet they do not shiver from cold. This is because their Kidney Qi is originally strong, but they engage in watery labor, causing Taiyang Qi to decline and Kidney essence to wither. One part Water cannot overcome two parts Fire. Kidney belongs to Water and generates bone. If Kidney does not generate, Marrow is not filled, so cold reaches the bone. The reason they do not shiver is that Liver is one Yang, Heart is two Yangs, and Kidney is an isolated Zang. One Water cannot overcome two Fires, so they do not shiver. This disease is named Bone Bi, and such persons will experience joint cramping.
"Suo Shen Qi Sheng" means the constitution is originally robust. "Yi Shui Wei Shi" means engaging in watery tasks without restraint, damaging True Yang. Without Yang, Yin cannot be generated, so Kidney essence withers. Without Yin, Yang cannot transform, so cold reaches the bone.
Disease in Yang is named Feng (Wind). Disease in Yin is named Bi. Disease in both Yin and Yang is named Feng-Bi.
Yang receives Wind pathogen, so disease in Yang is named Wind. Yin receives Damp pathogen, so entering Yin is named Bi.
Feng-Bi causing widespread soreness and weakness, if incurable, results in feet feeling like walking on ice, sometimes like entering hot water, with thigh and calf soreness, irritability, headache, occasional vomiting, occasional chest oppression (Men), dizziness followed by sweating, long-term visual disturbance, mood swings between sadness and fear, shortness of breath, and unhappiness. Death occurs within three years.
Cold Bi, if lingering and not expelled, causes intermittent pain and skin insensitivity. For commoners, treat with fire-quenching acupuncture (fire needles). For nobles, treat with herbal compresses.
Take 20 jin of pure wine, 1 sheng of Sichuan pepper (Shu Jiao), 1 jin of dried ginger (Gan Jiang), and 1 jin of cinnamon heart (Gui Xin). These four ingredients are crushed and soaked in wine. Add 1 jin of cotton wadding and 4 zhang of fine cloth into the wine. Place the container in horse manure fire, seal and coat tightly to prevent leakage. After five days and nights, remove the cloth and wadding and dry them in the sun. Dry again and soak repeatedly until all juice is extracted. Each soaking must last a full day before drying. Mix the dried residue with the wadding, wrap in cloth to make pads, 6-7 chi long, making 6-7 pads. Use mulberry charcoal to heat the pads and apply to the punctured sites of Cold Bi, ensuring heat penetrates to the lesion site. When cool, reheat and apply. Repeat 30 times. Wipe sweat with the pad, repeating 30 times. Move slightly indoors, avoiding wind. Apply compress after every needling. This cures the disease. This is called "Internal Heat."
"Nei" (Internal) implies "Na" (Insert/Nourish), meaning warming the meridians so heat enters internally, circulating the blood vessels. Commoners have turbid and sluggish Qi and Blood, so fire-quenching is used, similar to modern needle-pricking and moxibustion.
Zhou Bi (Circulating Bi) resides in the blood vessels, moving up and down with the vessels, not left or right, staying in its specific location. Wind, Cold, and Dampness lodge between the muscle intervals, forcing fluids into foam. Foam aggregates in cold, pushing apart muscle fibers and causing splitting. Splitting causes pain. Pain draws Shen (Spirit/Mind) to the area. Shen gathering generates heat. Heat resolves pain. Pain resolution leads to Qi reversal, triggering other Bi manifestations. This disease is neither internal in the Zang nor external on the skin, but resides solely between muscle fibers, where True Qi cannot circulate fully, hence named Zhou Bi.
The *Jin Gui Yao Lue* asks: From where does Blood Bi arise? The Master says: Noble and pampered individuals have weak bones and abundant flesh. Exacerbated by fatigue, sweating, restless sleep, and exposure to slight winds, they contract this disease. If the pulse is slightly choppy and fine at the Cunkou, and slightly tight at the Guan position, acupuncture should guide Yang Qi. If the pulse becomes harmonious and the tightness disappears, the patient heals.
Blood Bi involves deficiency in both Yin and Yang. The pulse is fine at Cunkou and Guan, and slightly tight at Chi. Externally, the body is insensitive, resembling Wind Bi. Huangqi Guizhi Wuwu Tang (Astragalus and Cinnamon Twig Five-Ingredient Decoction) is the primary formula.
Blood Bi is caused by Cold-Damp pathogens obstructing the Blood level. Hardworking individuals have dense pores and strong sinews/bones; Wind-Cold-Damp cannot invade. Only pampered individuals with soft sinews and bones, prone to fatigue and movement disturbances, contract Bi from slight winds. It does not require the mixture of all three pathogens. The previous section described Choppy/Fine pulse with Tight Guan/Cun as Damp-Bi in Blood level, where Yang cannot exit externally, so acupuncture guides Yang to harmonize Yin Blood. The next section describes Fine pulse at Chi with Tightness as Ying-Wei deficiency, causing body insensitivity, so herbs regulate Ying-Wei and disperse Bi, healing when tightness vanishes. Blood Bi corresponds to *Neijing*'s description of blood coagulation in vessels. Zhang Zhongjing reveals the cause: since Blood is Bi, the pulse is naturally Choppy/Fine. Wherever the pulse shows slight urgency (at Cun, Guan, or Chi), that is where Wind entered. Thus, acupuncture and herbs aim to expel Wind outward.
Shen Zhuo (Kidney Fixation) disease presents with heavy body, cold waist as if sitting in water, appearance like water retention, but no thirst, normal urination, and normal diet. The disease belongs to the Lower Jiao, caused by sweating from labor and cold-damp clothing over time. Cold pain below the waist, abdominal heaviness as if carrying 5,000 coins. Ganjiang Lingzhu Tang (Dried Ginger, Poria, and Atractylodes Macrocephala Decoction) is indicated.
This syndrome is Dampness lodging on the outer shell of the Kidney, not affecting the Kidney itself. Although the waist feels cold like sitting in water, it is not true Kidney Yang cold. The pathogen is in the Lower Jiao; diet is normal, no thirst, urination normal, unrelated to the Fu organs, let alone the Kidney. This is merely from labor sweating and cold-damp clothing. Using Licorice, Dried Ginger, Poria, and Atractylodes macrocephala for sweet-warm and bland-draining action to move Dampness is sufficient. There is no need for warming Kidney and strengthening Yang herbs.
Various joint pains, emaciated body, swollen legs as if detached, dizziness, shortness of breath, nausea. Guizhi Shaoyao Zhimu Tang (Cinnamon Twig, Peony, and Anemarrhena Decoction) is indicated.
This treats Bi of the Three Jiaos generally. Dizziness and shortness of breath indicate Upper Jiao Bi. Nausea indicates Middle Jiao Bi. Swollen legs indicate Lower Jiao Bi. Joint pain and emaciation indicate Sinew-Bone Bi. Thus, it is Wind-Cold-Damp Bi obstructing Ying-Wei, Sinews, Bones, and Three Jiaos. Dampness causes swelling, Cold causes pain, Wind causes movement. Cinnamon Twig treats Wind, Ephedra treats Cold, Atractylodes macrocephala treats Dampness. Saposhnikovia assists Cinnamon Twig. Aconite assists Ephedra and Atractylodes. Peony, Ginger, and Licorice harmonize Ying-Wei like Guizhi Tang. Anemarrhena treats leg swelling and guides herbs downward. Aconite promotes herb potency. This is a major formula for opening Bi.
Dairen said: Bi originates from Damp-Heat, with Wind-Cold as concurrent factors. The three combine to form Bi, with a deep and choppy pulse. Why do practitioners ignore meridians, Zang-Fu, and exterior-interior distinctions, treating it as Cold-Damp gout with Aconite, Ligusticum, Frankincense, and Myrrh, using various hot/dry methods, moxa on Zhongwan, burning near Qihai, fire needles on Zusanli, steaming, and fomentation? This leads to urinary/fecal obstruction, closure of front and back, worsening deficiency and restlessness, wasting muscles, and inability to eat. Even Bian Que or Hua Tuo would struggle. Why? Because there is Cold-Phlegm in the chest and diaphragm. Bi itself is not fatal; death results from medical error.
* Jingyue Quanshu* states: The *Bi Lun* says Wind-Cold-Damp mix to form Bi. The *Shou Yao Gang Rou Lun* says disease in Yang is Wind, disease in Yin is Bi. Why? The mixing of three pathogens explains the etiology of Bi. Saying "in Yang is Wind, in Yin is Bi" distinguishes exterior and interior. Wind and Bi both result from pathogenic invasion. If exterior signs appear, such as fever, headache, or relief after sweating, these are "有形" (有形之物 - tangible/formidable) conditions. This is Yang pathogen in Yang division, belonging to Cold Damage or Wind Strike. Hence, disease in Yang is named Wind. If Cold pathogen is received without initial fever/headache or transformation signs, with or without sweating, but bone/joint pain persists and lingers without exterior signs, these are "无形" (intangible/subtle) conditions. This is Yin pathogen moving directly into Yin division, belonging to various BIs. Hence, disease in Yin is named Bi. If exterior signs exist but pain persists, it is Half-Exterior/Half-Interior, disease in both Yin and Yang, named Feng-Bi. Thus, Wind disease is in Yang, Bi disease is in Yin. However, all BIs reside in Yin, generally due to True Yin deficiency and Blood/Essence depletion, allowing the three pathogens to invade. The Classic says: "Pathogen entering Yin causes Bi," referring to this. Therefore, treating Bi requires strongly tonifying True Yin to promote Blood/Qi circulation, driving out Cold. Overusing Wind-Damp-Phlegm stasis drugs damages Yin and worsens the disease.
Moving Bi wanders without fixation, driven by Wind. Classic: Disease in Yang is Wind, in Yin is Bi, both is Feng-Bi. Yuebi Jiashu Fuzi Tang is used. Mild cases use Qianghuo, Fangfeng, Danggui, Qiongjie, Gegen, Guizhi, Chifupi, Gancao, Lingxianxian, Cangzhu, Huangbai. If chronic and severely deficient, strong Qi and Blood tonification is needed. Daily use of Wind-dispersing and Fire-clearing drugs destroys Spleen and Lung, leading to death. Painful Bi has fixed pain, caused by Dampness injuring Kidney, Kidney failing to nourish Liver, Liver Wind carrying Dampness to limbs, causing shoulder/back pain, spasms, and edema. Jin Gui Wutou Tang plus Qianghuo, Guixin is used. Drink hot thin porridge after ingestion to induce sweating for resolution. Body pain as if breaking, muscle pain like knife/stabbing: Qianjin Fuzi Tang. Fixed Bi is stuck and insensitive. Classic: Ying deficiency causes insensitivity, Wei deficiency causes immobility, both cause insensitivity and immobility. *Ling Shu*: Wei Qi stagnation causes numbness. Dong Yuan treated numbness by tonifying and moving Wei Qi. Whole body numbness, unilateral, facial/head/arm/leg numbness: Shenxiao Huangqi Tang. Skin numbness is Lung Qi stagnation. Modify formula by removing Manjingzi, doubling Huangqi, adding Fangfeng. Muscle numbness is Ying Qi stagnation. Remove Manjingzi, add Guizhi, Qianghuo, Fangfeng. Hand/foot numbness, arm pain unable to lift, somnolence: Zhiyin (Fluid Retention). Qi Kou pulse slippery: Zhimi Fuling Wan. Floating pulse: Erchen Tang plus Guizhi, Zhike, Jiegeng. Hand numbness is Qi deficiency. Ten-finger numbness is Damp-Phlegm and Dead Blood. Finger numbness is Qi stagnation with stubborn Phlegm/Dead Blood. Daotan Tang plus Wuyao, Cangzhu. Wind-blown hand/foot soreness/swelling is Cold-Damp. Guizhi Fuzi Tang. Wind-induced joint wandering pain: Wuyao Shunqi San plus Qianghuo, Nanxing, Cangzhu. Damp-induced weather-dependent heaviness/soreness: Chushi Juantong Tang. Upper pain: add Guizhi, Jiegeng. Lower pain: add Fangji, Mutong. Profuse sweating: add Huangqi, Fangfeng. Spontaneous sweating and heaviness: Fangji Huangqi Tang. Cold-Damp immobility: Wutou Tang or Huoluo Dan. External Mofeng Gao. Fire-induced: Wuling San plus Jiuqin, Huangbai, Zhuli, Jiangzhi. Damp-Heat joint pain, shoulder/back heaviness, chest discomfort, descending to leg swelling: Danggui Niantsong Tang. Heat-toxin joint pain with local heat: Qianjin Xijiao San. Blood stasis: Xiong/gui, Taoren, Honghua, Lingxianxian. Add Shexiang (Musk)少许. Blood Bi is pathogen entering Yin. Classic: Blood returns to Liver during sleep; sweating exposed to wind causes blood coagulation in skin (Bi). Huangqi Guizhi Wuwu Tang. Lighter by day, heavier by night: add Danggui. Bi with cold like water immersion is Cold-Damp. Fuzi Wan. Blood/Qi stagnation with limb cramping/heaviness from mixed Wind-Cold-Damp: Gaiding Sanbi Tang. Zhou Bi is True Qi failing to circulate the body, causing whole-body pain. Juanbi Tang. Moving Bi worse in upper body: Wuyao Shunqi San. Worse in lower body: Huguo San. Painful Bi: Wutou Tang. Fixed Bi: Chushi Juantong Tang. Ineffective: Buzhong Yiqi Tang plus Shufuzi, Qianghuo, Cangzhu, Huangbai. Wandering pain everywhere: Erchen Tang plus Qianghuo, Fenghua Xiao, Jiangzhi pills. Bi in bone: Anshen Wan. Bi in sinew: Lingyangjiao San. Bi in vessel: Renshen Wan. Bi in muscle: Shenxiao Huangqi Tang. Bi in skin: Yuebi Tang plus Qianghuo, Xixin, Bajieli. Bi in intestine: Wuzhuyu San. Bi in Bao: Shenli Tang. Deficient-Cold: Fuling Wan. Severe Deficient-Cold: Bajie Wan. Heat Bi: Qianjin Xijiao San. Cold Bi: Bajitian Tang. Cold Bi: Soak Shu Jiao, Gan Jiang, Gui Xin (4 liang each) in 5 jin wine with 4 liang cotton and 5 chi cloth in horse manure fire for one Shichen. Dry thoroughly. Heat and apply. Fixed Bi with immobile muscle breakdown, body heat, and choppy pulse: Incurable.
In treating Bi, applying generic Wind-category drugs without understanding the principle is the physician's fault. Bi does involve Wind, but Wind enters Yin, binds with Cold-Damp, disrupts vessels, and prevents Yang from communicating with Yin, causing Bi. Ancient formulas used Mahuang and Baizhi to unblock Yang and move Ying-Wei, but these were combined with Siwu and Sijunzi, showing they were not purely for exterior release. Interior-purging drugs are bitter-cold; using them blocks Yang further, turning Bi into Fu organ death syndromes. This must be clearly distinguished and deeply avoided.
[Diagnosis] Pulse large and choppy indicates Bi. Rapid/tight pulse also indicates Bi. Fine Lung pulse indicates Lung Bi. Fine Heart pulse indicates Heart Bi. Deep, slow, and choppy Right Cun pulse indicates Skin Bi. Knotted and non-smooth Left Cun pulse indicates Blood Bi. Weak and choppy Right Guan pulse indicates Flesh Bi. String-tight and forceful Left Guan pulse indicates Sinew Bi.