经曰∶风寒湿三气杂至，合而为痹也。夫六淫之邪，暑燥火为阳，风寒湿为阴，阴气迭乘，营
卫不通，经脉阻滞，筋骨肉三部俱病，而三痹之症作矣。其风气胜者为行痹。风为阴中之阳，中人
最速其性善走，窜入经络，故历节作痛而为行痹。寒气胜者为痛痹。寒为阴中之阴，乘于肌肉筋骨
之间，营卫闭塞，筋骨拘挛，不通则痛故为痛痹。湿气胜者为着痹。着者重着难移。湿从土化，病
在肌肉不在筋骨，所谓腰间如带五千钱者是也。古有三痹汤，今复自制三方，以附于后。
风痹者，血不营筋，风入节络，当以养血为第一，通络次之，去风又次之。若不补血而先事搜
风，营愈燥而筋益拘挛，殊非治法。先用大剂补血去风，后即加入参、苓白术以补气分，营卫平调，
方无偏胜之患。温经养营汤主之。
温经养营汤（自制）
生地（三钱切片红花炒） 熟地（三钱切片砂仁炒） 白芍（一钱五分酒炒） 当归（二钱）
枸杞（三钱） 鹿筋（五钱切片） 木瓜（一钱酒炒） 川断（二钱） 独活（一钱酒炒）
桂枝（五分） 秦艽（一钱） 甜瓜子（三钱炒研） 木香（五分） 红枣（十枚） 姜（
三片） 桑枝（一尺）
风气胜者为行痹，去风必先养血。本方以鹿筋、枸杞为主药，以归、芍、二地大养阴血，以桂枝、
姜、枣调和营卫，以川断、独活、秦艽、桑枝、木瓜、甜瓜子搜风通络，再加一味木香以调气。立
方已极周匝，而先生尚有风去血活之后，减轻风药，再加补气药之叮咛，可见良医之用心无微不至
矣。祖怡注。
痛痹者，营卫受寒，不通而痛，宜调养气血，温通经络，龙火汤主之。
龙火汤（自制）
苁蓉（三钱） 肉桂（五分） 党参（四钱） 茯苓（二钱） 白术（一钱）
当归（二钱酒炒） 白芍（一钱酒炒） 木香（五分） 川断（二钱） 独活（一钱酒炒）
角霜（四钱） 蚕砂（三钱） 红枣（十枚） 姜（三片）
寒气胜者为痛痹，止痛必先去寒。角霜、苁蓉、肉桂，是本方之主药。参、术、苓以补气，归
、芍以养血，川断、独活、蚕砂以去风寒湿，姜、枣、木香调营卫之气。着重在龙火，而寒无立足
之地矣。祖怡注。
着痹者，病在肌肉当补土燥湿，立极汤主之。
立极汤（自制）
党参（四钱） 附子（六分） 当归（二钱） 茯苓（三钱） 白术（一钱）
茅术（一钱） 破故纸（一钱五分） 杜仲（二钱） 川断（二钱） 独活（一钱） 牛膝
（二钱） 红枣（五枚） 姜（三片） 苡仁（一两煎汤代水）
湿气胜者为着痹，去湿必先崇土。湿胜必先阳微，附子、茅术、故纸是本方之主药。以参、苓
、白术助主药以回阳而扶土。病虽在肌肉，亦不能置筋骨而不问，仲、断、独活、苡仁健筋骨，而
未尝无益于肌肉。以当归、牛膝、姜、枣利血脉而和营卫，着重在扶阳气以胜湿。 三痹多起于营
卫不通，故俱用姜、枣，而当归、川断、独活，亦为必不可少之要药。祖怡注。
三痹之外，又有脏腑之痹，症治详后。
肺痹者，烦满喘而呕。此一条明是肺胃同病。肺居至高，脉循胃口，肺气受邪，从胃而上，清
肃之令不能下行，故烦满而喘。其作呕，则胃亦受邪，水谷之气不安也。桑朴汤主之。
桑朴汤（自制）
桑皮（二钱） 浓朴（一钱） 橘红（一钱） 半夏（一钱） 茯苓（二钱） 沉香（
五分） 苏子（一钱五分） 杏仁（三钱） 蒌皮（二钱） 贝母（二钱） 郁金（二钱）
佛手（五分） 姜（三片）
桑朴汤，命名以桑皮泻肺、浓朴平胃为主药。用《金匮》半夏浓朴汤全方，以苏子易苏叶。彼
治咽中如有炙脔，此治烦满喘而呕，皆所以利气。橘红、蒌皮、杏仁宣肺化痰，沉香、郁金、佛手
和胃利气，贝母通治痰郁。其中浓朴、杏仁治喘，浓朴治满，半夏治呕，皆长沙古法。肺胃同治，
先生始终不肯放松一呕字。祖怡注。
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。此一条乃心经主病而兼肾
病也。心为生血之脏，百脉皆朝于心。心脉支者挟咽，直者上肺。心营不足，故脉不通。心气不舒
，故心下鼓，暴上气而喘。嗌干善噫，则支脉与直脉俱病也。厥气乃肾之邪，水来克火，神衰而恐
。恐属于肾，肾病应于心，故为兼病也。宜养心营，通心气，火能生土，则可以制水矣。通阳抑阴
煎主之。
通阳抑阴煎（自制）
当归（二钱） 琥珀（一钱） 辰砂（五分） 丹参（三钱） 远志（五分甘草水炒）
沉香（五分） 破故纸（一钱五分） 益智仁（一钱） 茯神（二钱） 白术（一钱） 枣（
二枚） 姜（三片）
本方以辰砂、琥珀为主药，而以茯神、远志安心气，以丹参、当归养心血，白术、姜、枣扶脾
而和营卫，故纸益智、沉香温命门而通肾气。心脾之血相通，心肾之气相合。上方沉香同郁金则治
肺，此方沉香同琥珀则治心气痹，泻之即所以安之也。祖怡注。
肝痹者，夜卧则惊，多饮，数小便，上为引，如怀。此一条乃肝经主病，而波及脾胃者也。肝
为多血之脏，而主藏魂。肝受邪则魂不安，而夜卧惊悸。木郁生火，积而成热，故多饮而小便数也。
上为引者，渴而引饮也。如怀者，腹大如怀物也。此由肝火上升犯胃，故胃热而渴；肝气下行克脾，
故脾弱而胀也。宜养血疏肝，兼调脾胃，三灵汤主之。
三灵汤（自制）
当归（二钱） 白芍（一钱） 羚羊角（一钱五分） 龙齿（二钱） 石决（六钱）
半夏曲（三钱） 柴胡（一钱） 葛根（二钱） 茯神（二钱） 白术（一钱） 青
皮（一钱） 冬瓜子（三钱煎汤代水）
本方以羚羊、龙齿、石决为主药，故名为三灵。当归、白芍是肝家之血药，柴胡、青皮是肝家
之气药，茯神、白术以顾心脾。肝非心不灵，肝病先实脾。葛根、半夏曲、冬瓜子所以和胃，胃和
而肝不能犯，肝病除而脾胃安矣。祖怡注。
肾痹者，善胀，尻以代踵，脊以代头。旧解谓肾为脾胃之关，肾痹则邪及脾胃，故腹善胀。尻
以代踵者，足挛不能伸。脊以代头者，身偻不能直。此说近似而未畅。盖善胀者，乃肾中真阳不运
，重阴凝结所致。尻以代踵者，缘少阴之脉斜走足心，出于然谷之下，循内踝之后，别入跟中，肾
痹则两足废而不能行也。脊以代头者，乃精气耗散，天柱不振也。当发肾中之阳，使重阴解散，精
气来复，庶几首与足渐有起色。消阴来复汤主之。
消阴来复汤（自制）
鹿茸（一钱） 附子（八分） 枸杞（三钱） 菟丝（四钱） 当归（二钱）
破故纸（一钱五分） 益智仁（一钱） 小茴香（一钱） 牛膝（二钱） 木香（五分）
独活（一钱酒炒） 金毛脊（二钱去毛切片） 枣（二枚） 姜（三片）
肾中之阳，命门也，督脉也。鹿茸血肉有情，善能补督脉，天柱骨督脉所主也。附子补肾阳要
药，枸、菟能补八脉，故纸温肾命，益智温脾肾，当归、姜、枣和营卫，毛脊健脊足，二香温胃肠
，独活、牛膝健两足。痹为阴病，阴盛必伤阳，救阳不得不用温补温通，此原则也，亦定法也。祖
怡注。
脾痹者，四肢懈惰，发咳呕汁，上为大塞。此一条乃脾病而兼肺胃病也。脾主四肢，脾病故四
肢懈惰。土败则金衰，故发咳。脾病则胃亦病，故呕汁。地气不升，天气不降，干金之令不行，故
上为大塞也。安贞汤主之。
安贞汤（自制）
党参（四钱） 炮姜（六分） 当归（二钱） 半夏（一钱） 茯苓（三钱）
白术（一钱） 浓朴（一钱） 砂仁（一钱） 桑皮（二钱） 杏仁（三钱） 苏子
（一钱五分） 陈香橼皮（六分）
本方以理中、四君去甘草，加当归以活血补血，桑皮苏子、杏仁以泻肺，浓朴、砂仁、香橼以
利气。寒去肺开，气顺而大塞通矣。祖怡注。
肠痹者，数饮而出不得，中气喘争，时发飧泄。小肠上通胃口，下接大肠。病在小肠，郁而成热
，故渴而数饮。下焦之气闭塞不通，故小溲不得出。气化不及膀胱，水不下行，逆而犯肺，故中气
喘争。小水不入州都，而并入大肠，故时发飧泄也。加味木通汤主之。
加味木通汤（自制）
木通（二钱） 橘红（一钱） 半夏（一钱五分） 赤苓（二钱） 贝母（二钱）
桑皮（二钱） 杏仁（三钱） 瞿麦（二钱） 牛膝（二钱） 车前（二钱）
灯芯（三尺）
本方以木通为主药，即认定肠为小肠也。心与小肠为表里，而赤苓、车前、瞿麦、灯芯、牛膝
莫非利湿之品，使郁热从水道而去，即所以治数饮而出不得也，水谷分而飧泄止矣。气喘不免有痰
阻，半、贝、橘、杏化痰。即所以通气而平喘也。祖怡注。
胞痹者，少腹膀胱按之内痛，若沃以汤，涩于小便，上为清涕。膀胱气闭，水液满而不出，故
按之内痛。气有余则生火，内有热，故如汤之沃也。足太阳之脉，起于目内 ，上额交巅，其直者
从巅入络脑。膀胱气闭，故小便下涩，清涕上流也。利济汤主之。
利济汤（自制）
泽泻（一钱五分） 沉香（五分） 枳壳（一钱） 青皮（一钱） 赤苓（二钱）
当归（二钱） 赤芍（一钱） 广皮（一钱） 牛膝（二钱） 车前（二钱） 小
蓟根（五钱）
膀胱，太阳寒水之腑也。按之内痛。涩于小便，不但水停不肯去，亦且有蓄血为之阻。泽泻、
赤苓、车前所
以去停水；当归、赤芍、牛膝、小蓟所以行蓄血；沉香、枳壳、青陈皮所以利气，气利则停水蓄血
亦必随之而去矣。祖怡注。
痹证一门，立方虽不多，而选药则极有尺度。盖痹之为害，气血不通也。十方之中，八方皆
用当归，气味俱浓，能行能补，血中气药，无出当归之右，先生重用之，即所以重视之也。惟桑朴
汤、木通汤二方不用者，以其病不在血也。用沉香者有桑朴汤、抑阴煎、利济汤三方，以气痹已极
，非枳、朴、香、砂、郁金、小茴、青、陈、橼、苏、杏所能胜任，惟有沉香之大力，能摧枯拉朽
，无坚不破也。虚证之所大忌，即实证之大将也。初学于此等处，必须深入研究。祖怡又注。
The *Yellow Emperor's Inner Classic* states: When Wind, Cold, and Dampness (Feng, Han, Shi) three pathogens mix and invade together, they combine to form Bi Syndrome (Obstruction Syndrome). Among the Six Excesses (Liu Yin), Summerheat, Dryness, and Fire are Yang pathogens, while Wind, Cold, and Dampness are Yin pathogens. When Yin pathogens alternate in attacking, Ying (Nutritive Qi) and Wei (Defensive Qi) fail to circulate smoothly, meridians become blocked, and the three parts—Tendons (Jin), Bones (Gu), and Flesh (Rou)—all suffer disease, thus giving rise to the symptoms of the Three BIs. When Wind pathogen predominates, it is called Moving Bi (Xing Bi). Wind is a Yang within Yin; it invades the human body most rapidly. Its nature is agile and wandering,窜入 (penetrating) into the meridians, causing pain in the joints that moves about, hence termed Moving Bi. When Cold pathogen predominates, it is called Painful Bi (Tong Bi). Cold is a Yin within Yin; it attacks between the muscles, tendons, and bones, blocking Ying and Wei, causing stiffness and spasm of tendons and bones. "Where there is no free flow, there is pain," hence termed Painful Bi. When Dampness pathogen predominates, it is called Fixed Bi (Zhuo Bi). "Fixed" means heavy and fixed, difficult to move. Dampness transforms from Earth; the disease lies in the flesh, not in the tendons and bones. This is what is meant by "the waist feeling as if carrying five thousand coins." In ancient times, there was San Bi Tang (Three Bi Decoction); now I have self-formulated three new prescriptions, attached below.
For Wind Bi (Moving Bi), blood fails to nourish the tendons, and Wind pathogen enters the joint collaterals. Treatment should prioritize nourishing Blood first, unblocking collaterals second, and expelling Wind third. If one does not nourish Blood but first engages in searching for Wind, Ying Blood becomes drier, and tendons become more spasmodic, which is entirely contrary to proper treatment principles. First use a large dose of herbs to nourish Blood and expel Wind; subsequently add Ren Shen (Codonopsis Ginseng), Fu Ling (Poria), and Bai Zhu (Atractylodes Macrocephala Rhizome) to tonify Qi. When Ying and Wei are balanced and harmonized, there will be no risk of imbalance. The primary prescription is Wen Jing Yang Ying Tang (Warming Meridians and Nourishing Ying Decoction).
**Wen Jing Yang Ying Tang (Self-formulated)**
Sheng Di Huang (Rehmannia Root, 3 qian, sliced, stir-fried with Hong Hua/Safflower)
Shu Di Huang (Prepared Rehmannia Root, 3 qian, sliced, stir-fried with Sha Ren/Amomum Fruit)
Bai Shao (White Peony Root, 1.5 qian, wine-fried)
Dang Gui (Angelica Sinensis, 2 qian)
Gou Qi Zi (Goji Berry, 3 qian)
Lu Jin (Deer Tendon, 5 qian, sliced)
Mu Gua (Chinese Quince Fruit, 1 qian, wine-fried)
Chuan Duan (Dipsacus Root, 2 qian)
Du Huo (Angelica Pubescens Root, 1 qian, wine-fried)
Gui Zhi (Cinnamon Twig, 0.5 qian)
Qin Jiao (Gentiana Macrophylla Root, 1 qian)
Tian Gua Lou Zi (Trichosanthes Seed, 3 qian, stir-fried and crushed)
Mu Xiang (Costus Root, 0.5 qian)
Hong Zao (Jujube, 10 pieces)
Sheng Jiang (Fresh Ginger, 3 slices)
Sang Zhi (Mulberry Twig, 1 chi)
When Wind pathogen predominates, it is Moving Bi; expelling Wind must begin with nourishing Blood. This formula uses Lu Jin and Gou Qi Zi as principal herbs; Dang Gui, Bai Shao, Sheng Di Huang, and Shu Di Huang greatly nourish Yin and Blood; Gui Zhi, Sheng Jiang, and Hong Zao harmonize Ying and Wei; Chuan Duan, Du Huo, Qin Jiao, Sang Zhi, Mu Gua, and Tian Gua Lou Zi search for Wind and unblock collaterals; plus Mu Xiang to regulate Qi. The formulation is extremely comprehensive. However, the author further advises that after Wind is removed and Blood flows freely, the dosage of Wind-expelling herbs should be reduced, and Qi-tonifying herbs added. This reveals the meticulous care of a good physician. Note by Zu Yi.
Painful Bi occurs when Ying and Wei are invaded by Cold, leading to obstruction and pain. It is suitable to regulate and tonify Qi and Blood, and warm and unblock the meridians. The primary prescription is Long Huo Tang (Dragon Fire Decoction).
**Long Huo Tang (Self-formulated)**
Rong Rui (Cistanche Stem, 3 qian)
Rou Gui (Cinnamon Bark, 0.5 qian)
Dang Shen (Codonopsis Root, 4 qian)
Fu Ling (Poria, 2 qian)
Bai Zhu (Atractylodes Macrocephala Rhizome, 1 qian)
Dang Gui (Angelica Sinensis, 2 qian, wine-fried)
Bai Shao (White Peony Root, 1 qian, wine-fried)
Mu Xiang (Costus Root, 0.5 qian)
Chuan Duan (Dipsacus Root, 2 qian)
Du Huo (Angelica Pubescens Root, 1 qian, wine-fried)
Jiao Shuang (Antler Glue, 4 qian)
Can Sha (Silkworm Frass, 3 qian)
Hong Zao (Jujube, 10 pieces)
Sheng Jiang (Fresh Ginger, 3 slices)
When Cold pathogen predominates, it is Painful Bi; stopping pain requires first expelling Cold. Jiao Shuang, Rong Rui, and Rou Gui are the principal herbs of this formula. Dang Shen, Bai Zhu, and Fu Ling tonify Qi; Dang Gui and Bai Shao nourish Blood; Chuan Duan, Du Huo, and Can Sha expel Wind, Cold, and Dampness; Sheng Jiang, Hong Zao, and Mu Xiang harmonize Ying and Wei Qi. The emphasis is on warming Dragon Fire, leaving no place for Cold to stand. Note by Zu Yi.
Fixed Bi involves disease in the muscles; it requires tonifying Earth (Spleen/Stomach) and drying Dampness. The primary prescription is Li Ji Tang (Establishing Ultimate Decoction).
**Li Ji Tang (Self-formulated)**
Dang Shen (Codonopsis Root, 4 qian)
Fu Zi (Prepared Aconite Root, 0.6 qian)
Dang Gui (Angelica Sinensis, 2 qian)
Fu Ling (Poria, 3 qian)
Bai Zhu (Atractylodes Macrocephala Rhizome, 1 qian)
Mao Zhu (Atractylodes Lancea Rhizome, 1 qian)
Po Gu Zhi (Cibotium Barometz Spore, 1.5 qian)
Du Zhong (Eucommia Bark, 2 qian)
Chuan Duan (Dipsacus Root, 2 qian)
Du Huo (Angelica Pubescens Root, 1 qian)
Niu Xi (Achyranthes Root, 2 qian)
Hong Zao (Jujube, 5 pieces)
Sheng Jiang (Fresh Ginger, 3 slices)
Yi Yi Ren (Coix Seed, 1 liang, decocted water used instead of regular water)
When Dampness pathogen predominates, it is Fixed Bi; removing Dampness requires strengthening Earth (Spleen). Dampness predominance implies Yang deficiency. Fu Zi, Mao Zhu, and Po Gu Zhi are the principal herbs. Dang Shen, Fu Ling, and Bai Zhu assist the principal herbs to restore Yang and support Earth. Although the disease is in the muscles, the tendons and bones cannot be ignored; Du Zhong, Chuan Duan, Du Huo, and Yi Yi Ren strengthen tendons and bones, benefiting the muscles as well. Dang Gui, Niu Xi, Sheng Jiang, and Hong Zao promote blood circulation and harmonize Ying and Wei. The focus is on supporting Yang Qi to overcome Dampness. The Three BIs often originate from blocked Ying and Wei, so all use Sheng Jiang and Hong Zao; Dang Gui, Chuan Duan, and Du Huo are also essential herbs. Note by Zu Yi.
Beyond the Three BIs, there are Zang-Fu BIs. Symptoms and treatments are detailed below.
Lung Bi presents with irritability, fullness, wheezing, and vomiting. This clearly indicates simultaneous Lung and Stomach disease. The Lung resides at the highest position, and its meridian passes through the stomach opening. When Lung Qi is invaded by pathogens, it follows Stomach Qi upward; the clear descending function cannot go down, causing irritability, fullness, and wheezing. Vomiting occurs because the Stomach is also invaded, disturbing the Qi of food and drink. The primary prescription is Sang Po Tang (Mulberry Bark and Magnolia Bark Decoction).
**Sang Po Tang (Self-formulated)**
Sang Bai Pi (Mulberry Root Bark, 2 qian)
Hou Po (Magnolia Bark, 1 qian)
Ju Hong (Tangerine Red Peel, 1 qian)
Ban Xia (Pinellia Tuber, 1 qian)
Fu Ling (Poria, 2 qian)
Chen Xiang (Agarwood, 0.5 qian)
Su Zi (Perilla Fruit, 1.5 qian)
Xing Ren (Apricot Seed, 3 qian)
Lou Pi (Trichosanthes Peel, 2 qian)
Bei Mu (Fritillaria Bulb, 2 qian)
Yu Jin (Turmeric Tuber, 2 qian)
Fo Shou (Fingered Citron Fruit, 0.5 qian)
Sheng Jiang (Fresh Ginger, 3 slices)
Sang Po Tang is named after its principal herbs: Sang Bai Pi to drain Lung heat and Hou Po to calm the Stomach. It uses the complete formula of Ban Xia Hou Po Tang from *Jin Gui Yao Lue*, substituting Su Zi for Su Ye. The original treats globus hystericus (feeling of a lump in the throat); this formula treats irritability, fullness, wheezing, and vomiting, all aiming to benefit Qi. Ju Hong, Lou Pi, and Xing Ren diffuse Lung Qi and resolve phlegm; Chen Xiang, Yu Jin, and Fo Shou harmonize the Stomach and benefit Qi; Bei Mu treats phlegm stagnation generally. Hou Po and Xing Ren treat wheezing; Hou Po treats fullness; Ban Xia treats vomiting—all are ancient methods of Zhang Zhongjing. Treating Lung and Stomach simultaneously, the author never relaxes his focus on "vomiting." Note by Zu Yi.
Heart Bi presents with blocked pulses, palpitations like drumming when irritated, sudden upward rushing of Qi with wheezing, dry throat, frequent belching, and fear when rebellious Qi rushes upward. This indicates Heart Meridian disease complicated by Kidney disease. The Heart is the organ that generates Blood; all vessels converge at the Heart. The Heart vessel branch circles the throat, and the straight branch goes up to the Lung. Insufficient Heart Ying leads to blocked pulses. Uncomfortable Heart Qi causes palpitations and sudden upward rushing with wheezing. Dry throat and frequent belching indicate both branch and straight vessels are diseased. Rebellious Qi is the pathogen of the Kidney; Water overcomes Fire, spirit declines, causing fear. Fear belongs to the Kidney; Kidney disease affects the Heart, hence it is a complication. Treatment should nourish Heart Ying and unblock Heart Qi. Fire generates Earth, thereby controlling Water. The primary prescription is Tong Yang Yi Yin Jian (Unblocking Yang and Suppressing Yin Decoction).
**Tong Yang Yi Yin Jian (Self-formulated)**
Dang Gui (Angelica Sinensis, 2 qian)
Hu Po (Amber, 1 qian)
Chen Sha (Cinnabar, 0.5 qian)
Dan Shen (Salvia Miltiorrhiza Root, 3 qian)
Yuan Zhi (Polygala Root, 0.5 qian, stir-fried with Licorice water)
Chen Xiang (Agarwood, 0.5 qian)
Po Gu Zhi (Cibotium Barometz Spore, 1.5 qian)
Yi Zhi Ren (Alpinia Oxyphylla Fruit, 1 qian)
Fu Shen (Poria with Hostwood, 2 qian)
Bai Zhu (Atractylodes Macrocephala Rhizome, 1 qian)
Da Zao (Jujube, 2 pieces)
Sheng Jiang (Fresh Ginger, 3 slices)
This formula uses Chen Sha and Hu Po as principal herbs; Fu Shen and Yuan Zhi calm Heart Qi; Dan Shen and Dang Gui nourish Heart Blood; Bai Zhu, Sheng Jiang, and Da Zao support Spleen Qi and harmonize Ying and Wei; Po Gu Zhi, Yi Zhi Ren, and Chen Xiang warm the Ming Men (Gate of Life) and unblock Kidney Qi. Heart and Spleen Blood connect; Heart and Kidney Qi merge. In the previous formula, Chen Xiang combined with Yu Jin treats Lung Bi; here, Chen Xiang combined with Hu Po treats Heart Qi Bi. Draining excess is a way to calm. Note by Zu Yi.
Liver Bi presents with fright during sleep, excessive thirst, frequent urination, upper pulling sensations, and abdominal distension resembling pregnancy. This indicates Liver Meridian disease affecting the Spleen and Stomach. The Liver stores abundant Blood and houses the Hun (Ethereal Soul). When invaded by pathogens, Hun becomes unsettled, causing night frights. Wood stagnation generates Fire, accumulating into Heat, causing excessive thirst and frequent urination. "Upper pulling" refers to thirst leading to drinking. "Resembling pregnancy" refers to abdominal distension. This arises from Liver Fire rising to invade the Stomach (causing Stomach Heat and thirst) and Liver Qi descending to suppress the Spleen (causing Spleen weakness and bloating). Treatment should nourish Blood, soothe the Liver, and regulate the Spleen and Stomach. The primary prescription is San Ling Tang (Three Spirits Decoction).
**San Ling Tang (Self-formulated)**
Dang Gui (Angelica Sinensis, 2 qian)
Bai Shao (White Peony Root, 1 qian)
Ling Yang Jiao (Serow Horn, 1.5 qian)
Long Chi (Dragon Teeth/Fossilized Mammal Bones, 2 qian)
Shi Jue Ming (Abalone Shell, 6 qian)
Ban Xia Qu (Pinellia Fermented Paste, 3 qian)
Chai Hu (Bupleurum Root, 1 qian)
Ge Gen (Kudzu Root, 2 qian)
Fu Shen (Poria with Hostwood, 2 qian)
Bai Zhu (Atractylodes Macrocephala Rhizome, 1 qian)
Qing Pi (Green Tangerine Peel, 1 qian)
Dong Gua Zi (Winter Melon Seed, 3 qian, decocted water used instead of regular water)
This formula uses Ling Yang Jiao, Long Chi, and Shi Jue Ming as principal herbs, hence the name "Three Spirits." Dang Gui and Bai Shao are Blood herbs for the Liver; Chai Hu and Qing Pi are Qi herbs for the Liver; Fu Shen and Bai Zhu protect Heart and Spleen. The Liver needs the Heart to be agile; treating Liver disease begins by solidifying the Spleen. Ge Gen, Ban Xia Qu, and Dong Gua Zi harmonize the Stomach; when the Stomach is harmonized, the Liver cannot invade. With Liver disease resolved, Spleen and Stomach are safe. Note by Zu Yi.
Kidney Bi presents with frequent abdominal distension, walking on the buttocks instead of heels (foot contracture preventing extension), and bowing the spine instead of holding the head upright (spinal curvature preventing standing). Old interpretations say the Kidney is the gate of Spleen and Stomach; Kidney Bi allows pathogens to affect Spleen and Stomach, causing abdominal distension. "Walking on buttocks" means feet are contracted and cannot extend. "Bowing spine" means the body is curved and cannot straighten. This explanation is approximate but incomplete. I believe "frequent distension" is caused by failure of True Yang in the Kidney and congealment of Heavy Yin. "Walking on buttocks" occurs because the Shaoyin Kidney Meridian斜走 (diagonally traverses) the sole, exits below Ran Gu, follows behind the medial malleolus, and enters the heel; Kidney Bi renders both feet useless for walking. "Bowing spine" is due to exhaustion of Essence and Qi, failing to support the Tian Zhu (Heavenly Pillar/Spine). One must stimulate Yang in the Kidney to dissolve Heavy Yin and restore Essence and Qi, so the head and feet may gradually improve. The primary prescription is Xiao Yin Lai Fu Tang (Eliminating Yin and Restoring Life Decoction).
**Xiao Yin Lai Fu Tang (Self-formulated)**
Lu Rong (Deer Antler, 1 qian)
Fu Zi (Prepared Aconite Root, 0.8 qian)
Gou Qi Zi (Goji Berry, 3 qian)
Tu Si Zi (Dodder Seed, 4 qian)
Dang Gui (Angelica Sinensis, 2 qian)
Po Gu Zhi (Cibotium Barometz Spore, 1.5 qian)
Yi Zhi Ren (Alpinia Oxyphylla Fruit, 1 qian)
Xiao Hui Xiang (Fennel Fruit, 1 qian)
Niu Xi (Achyranthes Root, 2 qian)
Mu Xiang (Costus Root, 0.5 qian)
Du Huo (Angelica Pubescens Root, 1 qian, wine-fried)
Jin Mao Ji (Cibotium Rhizome with Golden Hair, 2 qian, hair removed and sliced)
Da Zao (Jujube, 2 pieces)
Sheng Jiang (Fresh Ginger, 3 slices)
Yang in the Kidney is the Ming Men (Gate of Life) and the Du Mai (Governor Vessel). Lu Rong is a substance with life force, excellent for tonifying the Du Mai; the Tian Zhu bone is governed by the Du Mai. Fu Zi is a key herb for tonifying Kidney Yang; Gou Qi Zi and Tu Si Zi can tonify the Eight Extraordinary Vessels; Po Gu Zhi warms the Kidney and Ming Men; Yi Zhi Ren warms Spleen and Kidney; Dang Gui, Sheng Jiang, and Da Zao harmonize Ying and Wei; Jin Mao Ji strengthens the spine and feet; Mu Xiang and Xiao Hui Xiang warm the intestines and stomach; Du Huo and Niu Xi strengthen the legs. Bi syndrome is a Yin disease; Yin excess inevitably damages Yang. Saving Yang requires Warm Tonification and Warm Unblocking; this is the principle and fixed method. Note by Zu Yi.
Spleen Bi presents with flaccidity and lethargy of the four limbs, coughing, vomiting of saliva, and severe upper obstruction. This indicates Spleen disease complicating Lung and Stomach diseases. The Spleen governs the four limbs; Spleen disease causes limb flaccidity. When Earth fails, Metal weakens, causing cough. Spleen disease affects the Stomach, causing vomiting of saliva. Earth Qi fails to ascend, Heaven Qi fails to descend, the Metal command fails to operate, causing severe upper obstruction. The primary prescription is An Zhen Tang (Peaceful Stability Decoction).
**An Zhen Tang (Self-formulated)**
Dang Shen (Codonopsis Root, 4 qian)
Pao Jiang (Roasted Ginger, 0.6 qian)
Dang Gui (Angelica Sinensis, 2 qian)
Ban Xia (Pinellia Tuber, 1 qian)
Fu Ling (Poria, 3 qian)
Bai Zhu (Atractylodes Macrocephala Rhizome, 1 qian)
Hou Po (Magnolia Bark, 1 qian)
Sha Ren (Amomum Fruit, 1 qian)
Sang Bai Pi (Mulberry Root Bark, 2 qian)
Xing Ren (Apricot Seed, 3 qian)
Su Zi (Perilla Fruit, 1.5 qian)
Chen Xiang Yuan Pi (Citron Peel, 0.6 qian)
This formula uses Li Zhong Tang and Si Jun Zi Tang minus Gan Cao, adding Dang Gui to invigorate and nourish Blood; Sang Bai Pi, Su Zi, and Xing Ren to drain Lung; Hou Po, Sha Ren, and Chen Xiang Yuan Pi to benefit Qi. With Cold removed and Lung opened, Qi becomes smooth and severe obstruction is cleared. Note by Zu Yi.
Intestine Bi presents with frequent drinking but inability to urinate, turbulent Qi in the middle jiao with rumbling, and occasional diarrhea with undigested food. The Small Intestine connects upward to the stomach opening and downward to the Large Intestine. Disease in the Small Intestine stagnates and generates Heat, causing thirst and frequent drinking. Qi closure in the Lower Jiao prevents urination. Qi transformation fails to reach the Bladder; water does not flow down, reverses to attack the Lung, causing turbulent Qi in the middle. Urine does not enter the Zhou Du (Bladder) but merges into the Large Intestine, causing occasional diarrhea with undigested food. The primary prescription is Jia Wei Mu Tong Tang (Modified Wood Through-worth Decoction).
**Jia Wei Mu Tong Tang (Self-formulated)**
Mu Tong (Akebia Stem, 2 qian)
Ju Hong (Tangerine Red Peel, 1 qian)
Ban Xia (Pinellia Tuber, 1.5 qian)
Chi Fu Ling (Red Poria, 2 qian)
Bei Mu (Fritillaria Bulb, 2 qian)
Sang Bai Pi (Mulberry Root Bark, 2 qian)
Xing Ren (Apricot Seed, 3 qian)
Qu Mai (Dianthus Herb, 2 qian)
Niu Xi (Achyranthes Root, 2 qian)
Che Qian Zi (Plantago Seed, 2 qian)
Deng Xin (Juncus Medulla, 3 chi)
This formula uses Mu Tong as the principal herb, identifying the intestine as the Small Intestine. Heart and Small Intestine are interior-exterior pairs. Chi Fu Ling, Che Qian Zi, Qu Mai, Deng Xin, and Niu Xi are all damp-draining herbs, allowing stagnant Heat to exit via the urinary pathway, treating frequent drinking without urination. Separating water and grain stops diarrhea. Wheezing likely involves phlegm obstruction; Ban Xia, Bei Mu, Ju Hong, and Xing Ren resolve phlegm, benefiting Qi and calming wheezing. Note by Zu Yi.
Bladder Bi (Bao Bi) presents with internal pain upon pressing the lower abdomen/bladder area, a sensation as if scalded by hot water, dysuria, and clear nasal discharge above. Bladder Qi is closed; fluid fills but cannot exit, causing internal pain upon pressure. Excess Qi generates Fire; internal Heat causes the scalding sensation. The Foot Taiyang Bladder Meridian starts at the inner canthus, crosses the forehead, meets at the vertex, and the straight branch enters from the vertex to connect with the brain. Bladder Qi closure causes lower dysuria and upper clear nasal discharge. The primary prescription is Li Ji Tang (Benefit and Rescue Decoction).
**Li Ji Tang (Benefit and Rescue Decoction)**
Ze Xie (Alisma Rhizome, 1.5 qian)
Chen Xiang (Agarwood, 0.5 qian)
Zhi Ke (Aurantii Fructus Immaturus, 1 qian)
Qing Pi (Green Tangerine Peel, 1 qian)
Chi Fu Ling (Red Poria, 2 qian)
Dang Gui (Angelica Sinensis, 2 qian)
Chi Shao (Red Peony Root, 1 qian)
Guang Pi (Broad-leaved Mandarin Peel, 1 qian)
Niu Xi (Achyranthes Root, 2 qian)
Che Qian Zi (Plantago Seed, 2 qian)
Xiao Ji Gen (Cirsium Root, 5 qian)
The Bladder is the Fu organ of Taiyang Cold Water. Internal pain upon pressure and dysuria indicate not only water retention but also obstructing Blood stasis. Ze Xie, Chi Fu Ling, and Che Qian Zi remove retained water; Dang Gui, Chi Shao, Niu Xi, and Xiao Ji Gen move blood stasis; Chen Xiang, Zhi Ke, Qing Pi, and Guang Pi benefit Qi. When Qi flows, retained water and blood stasis will necessarily follow and depart. Note by Zu Yi.
In the category of Bi Syndrome, although the number of formulas is small, the selection of herbs has precise measure. Generally, the harm of Bi lies in the blockage of Qi and Blood. Among ten formulas, eight use Dang Gui. It has strong flavor and potency, capable of moving and tonifying; it is the Qi herb within Blood, unmatched by any other. The author's heavy use of Dang Gui reflects its importance. Only Sang Po Tang and Mu Tong Tang do not use Dang Gui, because their pathology is not in the Blood. Chen Xiang is used in three formulas: Sang Po Tang, Yi Yin Jian, and Li Ji Tang, because Qi Bi is extreme; Zhi Ke, Hou Po, Mu Xiang, Sha Ren, Yu Jin, Xiao Hui Xiang, Qing Pi, Chen Pi, Chen Xiang Yuan Pi, Su Zi, and Xing Ren cannot handle it alone. Only Chen Xiang has the power to destroy decay and pull apart rot, breaking every barrier. What is taboo for Deficiency syndromes is the general for Excess syndromes. Beginners must study these aspects deeply. Note by Zu Yi again.