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Huangdi asked: What happens when pathogenic factors invade the six fu organs? Qibo replied: This is also because improper diet and lifestyle serve as the root cause of the disease. Each of the six fu organs has its corresponding Shu points (Back-Shu acupoints). When wind, cold, and dampness pathogens attack these Shu points, and internal injury from diet responds to it, the pathogens follow the Shu points inward and settle in their respective fu organs.

This refers to external pathogens being guided deep into the body by internal pathogens; thus, improper diet and lifestyle are the root causes. The six fu organs each have Shu points; when pathogens strike the Shu points and internal injuries respond, the pathogens take advantage of the deficiency to enter and settle in the fu organs, forming Bi syndrome (obstruction syndrome).

Huangdi asked: Do Ying (Nutrient) Qi and Wei (Defensive) Qi also cause Bi syndrome? Qibo replied: Ying Qi is the essence-qi derived from food and water. It harmonizes within the five zang organs and spreads throughout the six fu organs, only then entering the vessels. Therefore, it circulates up and down along the vessels, penetrating the five zang organs and connecting with the six fu organs. Wei Qi is the fierce qi derived from food and water. Its nature is swift, slippery, and smooth; it cannot enter the vessels. Therefore, it circulates within the skin and between the muscle layers, steaming the blind membranes (phrenic membrane), and dispersing in the chest and abdomen. If one goes against this qi's normal flow, illness occurs; if one follows it, recovery ensues. Since it does not combine with wind, cold, or dampness pathogens, it does not form Bi syndrome.

The previous text mentioned that pathogens settling in joints form Bi syndrome, and further stated that pathogens enter via Shu points and settle in the fu organs. Thus, Huangdi again asked whether Ying and Wei Qi receiving pathogens can also form Bi syndrome. However, Ying Qi is the essence-qi of food and water, known as "the clear part becomes Ying." Its nature is pure and gentle, so it harmonizes in the five zang organs and spreads in the six fu organs, irrigating like gentle waves before entering the vessels. Hence it is said that "Ying circulates within the vessels," meaning it moves up and down along the vessels, penetrating zang and connecting with fu. Wei Qi is the fierce qi of food and water, known as "the turbid part becomes Wei." Its nature is swift and slippery, so it cannot enter the vessels. Hence it is said that "Wei circulates outside the vessels," meaning it moves within the skin and between muscle layers, steaming the blind membranes, and dispersing in the chest and abdomen. These are Ying and Wei Qi, originating from the same source but flowing differently. If pathogens are contracted and disrupt the qi's flow, illness occurs; if the qi flows smoothly, health is maintained. Because they do not combine with wind, cold, and dampness, they do not form Bi syndrome. Generally, Ying and Wei Qi circulate internally and externally; if obstructed by pathogens, symptoms such as fever, chills, and headache may appear. Those forming Bi syndrome result from mixed wind-cold-damp pathogens that fail to fully dissipate from the exterior, remaining stagnant in joints and Shu points, adhering to form Bi syndrome, progressing from superficial to deep, as explained above.

Huangdi asked: In Bi syndrome, some cases involve pain, others no pain, some numbness, some cold, some heat, some dryness, some dampness. What is the reason for this? Qibo replied: Pain is caused by an excess of cold; because there is cold, there is pain. Cases without pain and with numbness occur because the disease has lasted long and penetrated deeply; the circulation of Ying and Wei Qi becomes sluggish, and meridians become occasionally sparse and unblocked, resulting in no pain. The skin lacks nourishment from Ying blood, leading to numbness. Cold sensations arise because Yang qi is deficient and Yin qi is abundant, reinforcing the pathological condition, hence the feeling of cold. Heat sensations arise because Yang qi is abundant and Yin qi is deficient; the pathogenic factor prevails, and Yang is constrained by Yin, resulting in hot Bi syndrome. Profuse sweating and moisture occur because of severe exposure to dampness; Yang qi is deficient and Yin qi is excessive, and the two energies interact, causing sweating and dampness.

Human yin and yang, qi and blood each have their own predominance. Wind, cold, and dampness pathogens vary in quantity, and injuries differ in depth and location (exterior vs. interior). Therefore, symptoms are diverse. If a person has less Yang and more Yin, it reinforces the pathogen and manifests as cold; if Yang is abundant and Yin deficient, Yang is constrained by Yin, stagnating to produce heat; if dampness is heavy, there is profuse sweating, as dampness is a Yin pathogen indicating Yang deficiency. External pathogens also possess yin-yang attributes and change according to the individual's yin-yang predominance. Therefore, treatment must be based on a thorough examination of yin-yang, exterior-interior, deficiency-excess, and cold-heat.

Huangdi asked: Regarding Bi syndrome as a disease, why is there sometimes no pain? Qibo replied: When Bi affects the bones, the body feels heavy; when it affects the vessels, blood coagulates and fails to flow; when it affects the tendons, flexion occurs but extension is difficult; when it affects the flesh, there is numbness; when it affects the skin, there is cold. Possessing all five of these conditions results in no pain. Generally, Bi-type conditions become tense upon encountering cold and relaxed upon encountering heat.

The previous text stated that pain indicates excess cold. Cases without pain must indicate an excess of wind-damp pathogens. Dampness stagnates and adheres, presenting five aspects: heaviness, blood coagulation, tendon rigidity, flesh numbness, and skin cold. Therefore, possessing these five conditions, rather than excess cold, results in no pain. Generally, Bi syndrome encounters cold causing meridian tension and much pain; encounters heat causing meridian relaxation and no pain. Cold combined with dampness causes heaviness and adherence; heat combined with dampness causes profuse sweating; combined with wind, pain migrates. If migrating pain is bound by cold, it will certainly hurt; combined with dampness, it will certainly sweat. Although changes are numerous, they ultimately fall within the four categories of yin-yang and deficiency-excess.