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In the "Zhou Bi" (Generalized Bi) chapter of the *Ling Shu* (Spiritual Pivot), the Yellow Emperor asked: When Zhou Bi disease occurs in the body, the pain migrates up and down following the meridians, with corresponding reactions between the upper and lower left and right sides, leaving no empty space. I wish to know if this pain is within the blood vessels or between the fen rou (muscle intervals)? What causes this? When the pain shifts, there is not enough time to insert a needle; when the pain arises, there is not enough time to determine the treatment, yet the pain has already ceased. What principle makes this happen? I wish to hear the reason. Qibo replied: This is Zhong Bi (Multiple Bi), not Zhou Bi. The Yellow Emperor said: I wish to understand Zhong Bi. Qibo said: Each part of Zhong Bi is located in its own place, alternating in onset and cessation, appearing and disappearing alternately, with the right responding to the left and the left to the right, but it does not circulate around the whole body; it alternates in attack and rest. To treat this, even if the pain has ceased, one must still needle the original site of pain to prevent recurrence.

According to this statement, the pain that appears suddenly and stops, moving up and down, is because the pathogenic factors are located in separate places; where it hurts here, it stops there, and where it hurts there, it stops here, or each hurts and stops independently, rising and falling mutually. Since there are many sites of Bi obstruction, it is named Zhong Bi. Because the pathogens rely on the meridian pathways, and the qi and blood in the meridians flow continuously, the movement and stillness of the pathogens are irregular. Movement causes pain, stillness causes cessation. Since the meridians are symmetrical on the left and right, the pain necessarily corresponds on both sides, and cessation occurs near the meridians. It alternates in attack and rest and cannot circulate throughout the entire body, so it is not called Zhou Bi. In needling treatment, although the pain may have stopped, one must needle the original painful area to eliminate the pathogen and prevent the pain from returning.

The Yellow Emperor asked: How about Zhou Bi? Qibo said: Zhou Bi resides within the blood vessels, moving up along the meridians and down along the meridians, without spreading to the left or right, corresponding to its specific location. The Yellow Emperor asked: How should it be needled? Qibo said: If the pain moves from above downwards, first needle the lower part to intercept it, then needle the upper part to eradicate it; if the pain moves from below upwards, first needle the upper part to intercept it, then needle the lower part to eradicate it.

This passage states that the pathogen is within the blood vessels, and the twelve regular meridians traverse the entire body, hence it is called Zhou Bi. The pain travels up and down but does not spread left or right because the pathogen follows the ascending and descending qi of yin and yang, which differs from Zhong Bi. For pain originating from above and moving down, the Bi syndrome is primarily above, so one first needles the lower part to drain the branch (symptom), then needles the upper part to remove the root (cause). For pain originating from below and moving up, the Bi syndrome is primarily below, so one first needles the upper part to drain the branch, then needles the lower part to remove the root. As for Zhong Bi, the pathogen relies on the exterior of the meridians. The qi outside the meridians is expansive; the pathogen may be close to or far from the meridians. Close to the meridian, it moves and causes pain; far from the meridian, it is still and pain ceases. Because the qi is expansive, when it moves, it necessarily follows the meridian pathways, causing left-right correspondence.

The Yellow Emperor asked: How is this pain generated? Qibo said: Wind, cold, and dampness pathogens lodge between the fen rou (muscle intervals), pressing upon fluids to form phlegm-rheum (mo). When this phlegm-rheum encounters cold, it aggregates. Aggregation pushes apart the fen rou, causing separation. Separation results in pain. Pain draws the shen (spirit/mind) to the area. When the shen gathers there, heat is generated. Heat resolves the pain. Once the pain resolves, jue (qi reversal/stagnation) occurs, leading to the emergence of Bi symptoms in other areas. This process repeats. This condition is internally not in the zang-fu organs, nor externally manifested in the skin, but resides exclusively between the fen rou. Because the true qi cannot circulate fully, it is named Zhou Bi.

The previous text mentioned pathogens within the blood vessels. Blood vessels reside within the fen rou, which is where wei qi (defensive qi) circulates. Wind, cold, and dampness pathogens first injure the wei qi; over time, they invade ying qi (nutritive qi) and enter the blood vessels. As they move from superficial to deep levels, pressing against the wei qi to form phlegm-rheum, and aggregating due to cold, they push apart the fen rou, causing separation and pain. Pain focuses the heart-mind (shen); where the heart-mind goes, qi also arrives. Thus, yang qi reaches the painful area via the heart's direction, generating heat. Heat disperses cold and relieves pain. Upon relief, qi becomes jue (stagnant/reversed) and fails to harmonize. Lack of harmony causes Bi symptoms to flare up elsewhere, repeating the cycle. Meridians connect internally to the zang-fu, while pathogens obstruct ying and wei qi without entering the five viscera. Since ying and wei qi are in the fen rou, the pathology does not reach the skin. Therefore, yuan qi (original qi) cannot circulate throughout the body. Internally and externally, muscles are obstructed by pathogens, hence the name Zhou Bi. If one considers the pathogen in the blood vessels and the meridians circulating the whole body, the meaning also justifies the name Zhou Bi. Regarding the phenomenon where pain resolves in one area only to flare up in another, the principle is similar to Zhong Bi. In Zhong Bi, pathogens obstruct the wei level near the meridians; in Zhou Bi, pathogens obstruct the muscle tissue and enter the blood vessels. Thus, their pain follows the meridians up and down, differing from the left-right correspondence seen in Zhong Bi.