周痹患定无歇止，左右不移上下行，似风偏废只足手，口眼无斜有痛疼。
【注】周痹，或痛、或肿，或手、或足，患有定处，痛无歇止。或从上病及于下，或
从下病及于上，而不似众痹痛有歇止，左右相移流走也。周痹，或两手，或两足，或只
手足，或偏废不仁不用，而似中风，但不口眼 斜，身有痛疼也。
痹在筋骨痛难已，留连皮脉易为功，痹久入脏中虚死，脏实不受复还生。
【注】痹在筋骨则受邪深，故痛久难已。痹在皮脉则受邪浅，故易治也。凡痹病日久内
传，所合之脏，则为五脏之痹。若其人中虚受邪，则难治多死，其人脏实而不受邪，复还于
外，则易治多生。假如久病皮痹，复感于邪，当内传肺而为肺痹，若无胸满而烦喘咳之证，
则是脏实不受邪。余脏仿此。
肺痹烦满喘咳嗽，肾胀尻踵脊代头。脾呕痞硬肢懈堕，心烦悸噫恐时休，数饮卧惊
肝太息，饮秘胀泻在肠究，胞秘沃痛鼻清涕，三焦胃附胆无忧。
【注】久病皮痹，复感于邪，见胸满而烦喘咳之证，是邪内传于肺，则为肺痹也。久
病骨痹，复感于邪，而见腹胀，尻以代踵，足挛不伸．脊以代头，伛偻不直之证，是邪内
传于肾，则为肾痹也，久病肌痹，复感于邪，而见呕涎心下痞硬，四肢懈堕之证。是邪内
传于脾，则为脾痹也。久病脉痹，复感于邪。而见心烦、心悸、嗌干，噫气，有时则恐之
证，是邪内传于心，则为心痹也。久病筋痹，复感于邪，而见喜饮小便数多，夜卧则惊太
息之证。是邪内传于肝，则为肝痹也。久痹不已复感于邪，脏实不受而传腑者，凡见喜
饮小便秘，不胀则泻，不泻则胀之证，是邪内传于大小肠，则为肠痹也。凡见少腹胞中，
按如沃汤状而痛，小便秘涩，鼻流清涕之证，是邪内传于膀胱，则为胞痹也。三焦之痹附
于膀胱，从水道也。胃痹附于大、小二肠，从传化也。胆为清净之府，不受痹邪，故曰无
忧也。
小续命汤 增味五痹汤
痹虚加减小续命，痹实增味五痹汤，麻桂红花芷葛附，虎羊 草二防羌。
【注】痹虚，谓气虚之人病诸痹也，宜用加减小续命汤，风胜行痹倍防风，寒胜痛痹
倍附子，湿胜着痹倍防己，皮痹加黄 或桂枝，皮脉痹加姜黄或加红花，肌痹加葛根或
加白芷，筋痹加羚羊角或加续断，骨痹加虎骨或加狗脊。有汗减麻黄，便溏减防己，寒
胜减黄芩加干姜，热胜减附子加石膏，加减治之。痹实，谓气血实之人病诸痹也，宜用
增味五痹汤，即麻黄、桂枝，红花、白芷、葛根、附子、虎骨、羚羊角、黄 、甘草、防
风、防己、羌活也，行痹以羌活、防风为主，痛痹以麻黄、附子为主，着痹以防己，羌活
为主，皮痹以黄 、桂枝皮为主，脉痹以红花。桂枝为主，肌痹以葛根。白芷为主，筋
痹以羚羊角为主，骨痹以虎骨为主，增味于五痹治之可也。
木通汤 附子五苓散 苍术五苓散
三痹木通长流水，湿加防己风羌防，寒痹附麻分汗入，胞肠五苓附子苍。
【注】三痹，谓行痹、痛痹、着痹也，宜用木通一味，不见水者二两，以长流水二碗，
煎一碗，热服取微汗，不愈再服，以愈为度。若其痛上下、左右流走相移者，加羌活、防
风以祛风邪，其痛苦甚者，有汗加附子，无汗加麻黄，以去寒邪，其痛重着难移者，加
防己以胜湿邪。其所应加之药，不可过三钱，弱者俱减半服。胞痹宜用五苓散加附子，肠
痹宜五苓散加苍术，以利寒饮也。五苓散方在伤寒门。
三痹汤 独活寄生汤
三痹十全无白术，牛秦续杜细独防，独活加桑除 续，入脏乘虚久痹方。
【注】三痹，谓三痹汤，即十全大补汤无白术，加牛膝、秦艽、续断、杜仲，细辛、独
活，防风也，独活，谓独活寄生汤，根据三痹汤方加桑寄生，除去黄 ，续断也。此皆治
五痹不已，乘虚入脏，反留连日久，调理痹病之方也。
黄 益气汤
黄 益气虚皮痹，皮麻不知痒与疼，补中益气加红柏，味秋芩夏桂加冬。
【注】气实麻木，用小续命汤加麻黄治之。气虚麻木，用黄 益气汤，即补中益气汤加
红花、黄柏也，秋加五味子，夏加黄芩，冬加桂枝皮。
蠲痹汤 加味升阳散火汤
蠲痹冷痹身寒厥，附归 草桂羌防，肌热如火名热痹，羚犀升阳散火汤。
【注】蠲痹汤，即附子、当归、黄 、炙草、官桂、羌活、防风，治痹病而身寒无热，
四肢厥冷，名曰冷痹也。加味升阳散火汤，即内伤门升阳散火汤加羚羊角、犀角，治痹病
而肌热如火，名曰热痹也。
Zhou Bi (General Bi Syndrome) is characterized by continuous pain without cessation, fixed location moving up and down the body; it resembles hemiplegia caused by wind-stroke but is limited to the hands or feet, with no deviation of the mouth and eyes, only accompanied by pain.
[Note] Zhou Bi may present with pain or swelling, affecting either the hands or feet. The affected area is fixed, and the pain is unceasing. The pathology may move from upper to lower limbs or from lower to upper limbs. This differs from Zhong Bi (Clustered Bi Syndrome), where pain is intermittent and migrates left and right. Zhou Bi may affect both hands, both feet, or only one hand and one foot, presenting with unilateral numbness and dysfunction resembling stroke, yet without facial deviation, manifesting solely as bodily pain.
When Bi pathogen resides in the sinews and bones, pain is difficult to resolve; when it resides in the skin and vessels, it is easy to treat. If Bi lingers for a long time and enters the Zang organs, death ensues if the Zang Qi is deficient; however, if the Zang organs are solid and resist the pathogen, the pathogen returns outward, and life is preserved.
[Note] When Bi affects the sinews and bones, the pathogenic invasion is deep, hence the chronic and refractory pain. When Bi affects the skin and vessels, the invasion is superficial, hence it is easily treated. Generally, if Bi disease persists and transmits internally to its corresponding Zang organ, it becomes one of the Five Zang Bi syndromes. If the patient has internal deficiency allowing pathogen entry, prognosis is poor with high mortality. If the Zang organs are robust and reject the pathogen, the pathogen returns to the exterior, leading to easier treatment and survival. For example, if chronic Pi Bi (Skin Bi) is re-exposed to pathogens and transmits to the Lung, forming Lung Bi, the absence of chest fullness, irritability, wheezing, and cough indicates that the Zang is solid and rejecting the pathogen. The same logic applies to other Zang organs.
Lung Bi presents with irritability, chest fullness, wheezing, and cough; Kidney Bi presents with abdominal distension, inability to extend the legs (sitting on the heels), and spinal curvature (stooping); Spleen Bi presents with vomiting, epigastric stuffiness and hardness, and flaccidity of the four limbs; Heart Bi presents with mental restlessness, palpitations, belching, and periodic fear; Liver Bi presents with frequent drinking, nocturnal startles, and sighing; Intestine Bi presents with thirst, alternating constipation and diarrhea, and abdominal distension; Bladder (Pao) Bi presents with urinary retention, pain in the lower abdomen feeling like hot water pouring, and clear nasal discharge; Bi of the San Jiao, Stomach, and Gallbladder requires no worry.
[Note] Chronic Pi Bi re-infected with pathogens, presenting with chest fullness, irritability, wheezing, and cough, indicates transmission to the Lung, forming Lung Bi. Chronic Gu Bi (Bone Bi) re-infected, presenting with abdominal distension, inability to extend legs, and spinal curvature, indicates transmission to the Kidney, forming Kidney Bi. Ji Bi (Muscle Bi) re-infected, presenting with vomiting of saliva, epigastric stuffiness/hardness, and limb flaccidity, indicates transmission to the Spleen, forming Spleen Bi. Mai Bi (Vessel Bi) re-infected, presenting with heart vexation, palpitations, dry throat, belching, and periodic fear, indicates transmission to the Heart, forming Heart Bi. Jin Bi (Sinew Bi) re-infected, presenting with preference for drinking, frequent urination, nocturnal startles, and sighing, indicates transmission to the Liver, forming Liver Bi. If chronic Bi persists and re-infected, but Zang organs are solid and transmit to Fu organs, presenting with thirst, urinary retention, alternating bloating and diarrhea, this is transmission to the Large and Small Intestines, forming Chang Bi (Intestine Bi). If presenting with lower abdominal bladder pain feeling like hot water pouring, urinary difficulty, and clear nasal discharge, this is transmission to the Bladder, forming Pao Bi. San Jiao Bi attaches to the Bladder via the water passages. Stomach Bi attaches to the intestines via transformation and transportation. The Gallbladder is a pure and clear Fu organ and does not accept Bi pathogens, hence "no worry."
Xiaoxuting Decoction (Minor Continuation Life Decoction) and Zengwei Wubi Tang (Modified Five-Bi Decoction).
For Deficient Bi, use Modified Xiaoxuting Decoction; for Excess Bi, use Modified Five-Bi Decoction. Ingredients include Ephedrae Herba (Mahuang), Cinnamomi Ramulus (Guizhi), Carthami Flos (Honghua), Angelicae Dahuricae Radix (Baizhi), Puerariae Radix (Gegen), Aconiti Lateralis Radix Praeparata (Fuzi), Ossis Tigris (Hugu), Cervi Cornu Degelatinatum (Lingyangjiao), Astragali Radix (Huangqi), Glycyrrhizae Radix et Rhizoma (Gancao), Saposhnikoviae Radix (Fangfeng), and Notopterygii Rhizoma et Radix (Qianghuo).
[Note] "Deficient Bi" refers to Bi syndrome in patients with Qi deficiency, treated with Modified Xiaoxuting Decoction. For Wind-dominant Xing Bi (Moving Bi), double Fangfeng; for Cold-dominant Tong Bi (Painful Bi), double Fuzi; for Damp-domininal Zhuo Bi (Fixed Bi), double Fangji. For Pi Bi, add Huangqi or Guizhi; for Pi-Mai Bi, add Jianghuang or Honghua; for Ji Bi, add Gegen or Baizhi; for Jin Bi, add Lingyangjiao or Xuduan; for Gu Bi, add Hugu or Gouji. If sweating, reduce Mahuang; if loose stools, reduce Fangji; if Cold excess, reduce Scutellariae Radix (Huangqin) and add dried ginger; if Heat excess, reduce Fuzi and add Gypsum. Adjust accordingly. "Excess Bi" refers to Bi syndrome in patients with robust Qi and Blood, treated with Modified Five-Bi Decoction, comprising Mahuang, Guizhi, Honghua, Baizhi, Gegen, Fuzi, Hugu, Lingyangjiao, Huangqi, Gancao, Fangfeng, Fangji, and Qianghuo. For Xing Bi, prioritize Qianghuo and Fangfeng; for Tong Bi, prioritize Mahuang and Fuzi; for Zhuo Bi, prioritize Fangji and Qianghuo; for Pi Bi, prioritize Huangqi and Guizhi Cortex; for Mai Bi, prioritize Honghua and Guizhi; for Ji Bi, prioritize Gegen and Baizhi; for Jin Bi, prioritize Lingyangjiao; for Gu Bi, prioritize Hugu. These modifications apply to the treatment of the Five BIs.
Mutong Tang (Akebia Decoction), Fuzi Wuling San (Aconite Five-Ingredient Powder with Poria), and Cangzhu Wuling San (Atractylodes Five-Ingredient Powder with Poria).
San Bi uses Mutong Tang decocted in flowing water; add Fangji for Dampness; add Qianghuo and Fangfeng for Wind; use Fuzi and Mahuang for sweating in Cold Bi; use Wuling San plus Fuzi for Pao Bi, and Wuling San plus Cangzhu for Chang Bi.
[Note] "San Bi" refers to Xing Bi, Tong Bi, and Zhuo Bi. Use a single herb, Mutong (Akebiae Caulis), 2 liang, decocted in 2 bowls of flowing water to 1 bowl. Take hot to induce slight sweating. Repeat if necessary until cured. If pain migrates up/down/left/right, add Qianghuo and Fangfeng to dispel Wind. If pain is severe, add Fuzi if sweating, or Mahuang if no sweating, to dispel Cold. If pain is heavy and fixed, add Fangji to overcome Dampness. Added herbs should not exceed 3 qian; reduce dose by half for weak patients. For Pao Bi, use Wuling San plus Fuzi; for Chang Bi, use Wuling San plus Cangzhu, to drain cold fluids. See Shanghan Lun chapter for Wuling San formula.
Sanbi Tang (Three-Bi Decoction) and Duhuo Jisheng Tang (Angelica and Santalum Decoction).
Sanbi Tang is Shiquan Dabu Tang (Ten Significant Tonifying Decoction) minus Baizhu, plus Achyranthis Bidentatae Radix (Niuxi), Gentianae Macrophyllae Radix (Qinjiao), Dipsaci Radix (Xuduan), Eucommiae Cortex (Duzhong), Asari Radix et Rhizoma (Xixin), and Duhuo. Duhuo Jisheng Tang is based on Sanbi Tang, adding Sangjisheng (Taxilli Fructus), removing Huangqi and Xuduan.
[Note] "San Bi" refers to Sanbi Tang: Shiquan Dabu Tang minus Baizhu, plus Niuxi, Qinjiao, Xuduan, Duzhong, Xixin, Duhuo, and Fangfeng. "Duhuo" refers to Duhuo Jisheng Tang, which adds Sangjisheng to Sanbi Tang and removes Huangqi and Xuduan. These formulas treat persistent Five-Bi that penetrates the Zang organs due to deficiency and lingers chronically.
Huangqi Yiqi Tang (Astragalus Qi-Nourishing Decoction).
Huangqi Yiqi Tang treats Pi Bi caused by Qi deficiency, presenting with skin numbness lacking sensation of itch or pain. It is Buchong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Honghua and Phellodendri Cortex (Huangbai), with Schisandrae Fructus (Wuweizi) added in autumn, Scutellariae Radix (Huangqin) in summer, and Guizhi Cortex in winter.
[Note] Numbness due to Qi excess is treated with Xiaoxuting Decoction plus Mahuang. Numbness due to Qi deficiency is treated with Huangqi Yiqi Tang, which is Buchong Yiqi Tang plus Honghua and Huangbai, adding Wuweizi in autumn, Huangqin in summer, and Guizhi Cortex in winter.
Juanbi Tang (Bi-Dispelling Decoction) and Jiawei Shengyang Sanhuo Tang (Modified Raising Yang and Dispersing Fire Decoction).
Juanbi Tang treats Leng Bi (Cold Bi) with cold body and cold extremities, containing Fuzi, Danggui, Huangqi, Zhi Gancao, Guizhi, Qianghuo, and Fangfeng. Re Bi (Heat Bi) presents with muscle heat like fire, treated with Jiawei Shengyang Sanhuo Tang.
[Note] Juanbi Tang consists of Fuzi, Danggui, Huangqi, Zhi Gancao, Guizhi, Qianghuo, and Fangfeng. It treats Bi syndrome with cold body, no fever, and cold extremities, named Leng Bi. Jiawei Shengyang Sanhuo Tang is Shengyang Sanhuo Tang from the Internal Injury chapter plus Lingyangjiao and Xijiao (Rhinocerotis Cornu), treating Bi syndrome with intense muscle heat, named Re Bi.