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(Full text of "Treatise on Bi Syndrome" from *Suwen*)

The Yellow Emperor asked: How is Bi syndrome (Bi Zheng, obstruction syndrome) generated? Qibo replied: The three pathogens—wind, cold, and dampness—mix and invade together, combining to form Bi syndrome. (Bi means obstruction. As stated in the "Treatise on Differences between Yin and Yang": When one Yin and one Yang knot together, it is called throat Bi. In the "Great Treatise on the Most Essential and Demanding Principles": Food Bi leads to vomiting. From these, it can be known that they all refer to the meaning of obstruction. Thus, when wind, cold, and dampness mix and invade, they obstruct and close the meridians, causing blood and qi to fail to circulate, resulting in Bi syndrome, which belongs to conditions like gout and numbness. Bi is pronounced "mi".) When wind is predominant, it is called Moving Bi (Xing Bi), (Wind moves swiftly and changes frequently, hence it is called Moving Bi; this includes conditions where pain migrates through joints.) When cold is predominant, it is called Painful Bi (Tong Bi), (Yin-cold pathogen lodges between muscles, flesh, sinews, and bones, condensing and not dispersing, preventing the circulation of Yang qi, thus causing unbearable pain, also known as gout.) When dampness is predominant, it is called Fixed Bi (Zhuo Bi). (Fixed Bi involves heavy limbs that remain fixed in place, or pain, or numbness and insensitivity. Dampness transforms according to Earth, and diseases often occur in the muscles.)

The Emperor said: Why are there five types? Qibo said: Contracting this [pathogen] in winter results in Bone Bi; in spring, Sinew Bi; in summer, Vessel Bi; during the late summer (the time of Zhiyin/Earth), Muscle Bi; and in autumn, Skin Bi. (Contracting this refers to the aforementioned three pathogens: wind, cold, and dampness. Winter governs bones, spring governs sinews, summer governs vessels, the time when Earth prospers governs muscles, and autumn governs skin. Thus, when pathogenic qi invades, it corresponds to each respective tissue.)

The Emperor said: What causes the pathogen to enter and lodge internally in the Five Zang and Six Fu organs? Qibo said: Each Zang organ has its corresponding exterior tissue. If the disease persists for a long time without resolving, the pathogen will enter and lodge in its corresponding Zang organ. (Skin, muscle, sinew, bone, and vessel all have correspondences with the Five Zang organs. If the pathogen remains in the exterior for a long time, it will connect internally to the Zang organs according to their correspondences.) Therefore, if Bone Bi does not resolve and the patient is re-exposed to pathogens, it enters and lodges in the Kidney. If Sinew Bi does not resolve and the patient is re-exposed, it enters and lodges in the Liver. If Vessel Bi does not resolve and the patient is re-exposed, it enters and lodges in the Heart. If Muscle Bi does not resolve and the patient is re-exposed, it enters and lodges in the Spleen. If Skin Bi does not resolve and the patient is re-exposed, it enters and lodges in the Lung. This is what is meant by Bi syndrome: contracting wind, cold, and dampness repeatedly during their respective seasons. ("Lodge" means the pathogen enters and resides. "Season" refers to the time when the Qi is prosperous; each Zang organ has its corresponding season. If the disease persists and the patient is re-exposed, the Qi becomes deeper, thus entering and lodging in the corresponding Zang organ.)

Regarding Bi pathogens lodging in the Five Zang organs:
Lung Bi presents with vexation, fullness, wheezing, and vomiting. (The Lung is located in the Upper Jiao, and its meridian passes through the stomach area, hence causing vexation, fullness, wheezing, and vomiting. See Chapter 34 on Pulse and Color for details on the five Vessel-Zang Bi syndromes.)
Heart Bi presents with blocked vessels; when vexed, there is palpitation in the heart region; sudden upward rushing of Qi leading to wheezing; dry throat; frequent belching; and fear when rebellious Qi ascends. (The Heart corresponds to vessels, and Bi qi occupies them, causing blockage. The Heart meridian originates in the heart, branches ascend to flank the throat, and the main branch goes up to the lung, hence these symptoms. Rebellious Qi refers to Yin Qi. When Heart Fire declines, pathogens take advantage, causing spiritual timidity and fear. Yi sounds like "yi". Yi (belch) sounds like "yi" or "ai".)
Liver Bi presents with fright during sleep at night, excessive drinking, frequent urination, and upper body pulling sensations resembling pregnancy. (The Liver stores the Hun soul. When Liver Qi is obstructed, the Hun is unsettled, hence fright during sleep. The Liver meridian descends past the genitalia to the lower abdomen and ascends along the back of the throat to the nasopharynx, hence these symptoms.)
Kidney Bi presents with frequent abdominal distension, inability to extend the legs (standing on the buttocks instead of heels), and spinal curvature (the spine replacing the head). (The Kidney is the gate of the Stomach. When Kidney Qi is obstructed, Yin pathogens attack the Stomach, causing abdominal distension. Standing on the buttocks indicates leg contracture preventing extension. Spinal curvature indicates a hunched back unable to straighten. Since the Kidney meridian enters the heel, ascends past the medial malleolus, pierces the spine, and connects to the Kidney, these symptoms arise. Kao sounds like "kai gao qie".)
Spleen Bi presents with flaccidity and weakness of the four limbs, coughing, vomiting of saliva, and severe upper Jiao obstruction. (The Spleen governs the four limbs, hence causing flaccidity. Its meridian connects to the Spleen, links to the Stomach, crosses the diaphragm, and flanks the throat. Now, with Spleen Qi obstructed, it causes coughing and vomiting of saliva; severely, it causes upper Jiao stagnation, leading to major obstruction.)
Intestine Bi presents with frequent drinking but inability to urinate, abdominal rumbling and Qi contention, and occasional diarrhea with undigested food. (Intestine Bi refers to both Large and Small Intestines. Bi in the intestines impairs Lower Jiao Qi transformation, so although water is drunk frequently, it cannot exit. If water does not exit, both root and branch are diseased, causing Qi contention in the middle. Because clear and turbid substances are not separated, occasional diarrhea with undigested food occurs. Sun sounds like "sun".)
Bladder Bi (Pao Bi) presents with internal pain upon pressing the lower abdomen over the bladder, a sensation as if scalded by hot water, difficult and scanty urination, and clear nasal discharge above. (Pao refers to the bladder sac. Meaning detailed in Chapter 3 on Flavor and Qi. Bladder Qi is closed, hence internal pain upon pressure. Water closure leads to heat accumulation, hence the scalding sensation and difficult urination. The Bladder meridian enters the brain from the vertex, hence clear nasal discharge. Pao and Pao sound like "pao". Wo sounds like "wu".)

Yin Qi, when quiet, allows the Spirit to reside within; when agitated, it dissipates. (Yin Qi refers to Zang Qi. The Five Zang organs store Spirit, Hun, Po, Yi, and Zhi. If a person remains calm, pathogens cannot interfere, so Spirit and Essence remain solid and stored internally. If agitated and restless, Essence and Qi dissipate, Spirit and Mind perish, allowing external pathogens to invade, giving rise to Zang Bi.) Excessive eating and drinking injures the intestines and stomach. (The Six Fu organs receive water and grain and transform them. If used excessively without restraint, damaging the intestines and stomach, Fu Bi arises.)

Disordered Qi causing wheezing indicates Bi gathering in the Lung; Disordered Qi causing worry and thought indicates Bi gathering in the Heart; Disordered Qi causing enuresis indicates Bi gathering in the Kidney; Disordered Qi causing exhaustion indicates Bi gathering in the Liver; Disordered Qi causing muscle atrophy indicates Bi gathering in the Spleen. (Yin Qi here refers to chaotic pathogenic Qi. Although Zang Bi was detailed earlier, this distinction helps identify where the Bi gathers.) All Bi syndromes, if unresolved, will gradually move inward. (Pathogens remaining in the exterior must enter inward and deepen.) When Wind is predominant, recovery is easier. (Wind is a Yang pathogen and can be dispersed, hence easy to cure. However, Cold and Damp Bi are harder to cure because Yin pathogens linger and are difficult to move.)

The Emperor said: Some Bi patients die, some suffer chronic pain, and some recover easily. What is the reason? Qibo said: Those whose pathogens enter the Zang organs die; those whose pathogens linger between sinews and bones suffer chronic pain; those whose pathogens remain in the skin recover easily. (Entering Zang organs damages True Yin, leading to death. Lingering in sinews and bones causes chronic pain due to deep pathogen location. Remaining in the skin is easy to cure due to shallow pathogen location.)

The Emperor said: What about pathogens lodging in the Six Fu organs? Qibo said: This also stems from diet and living habits as the root cause. (Cold and heat from food and drink harm the Six Fu organs when contracted; pathogens from living environments injure the Six Yang meridians. Thus, diet and living habits are the root of Fu organ disease.) The Six Fu organs also have Shu points. When wind, cold, and dampness strike these Shu points, and dietary factors respond accordingly, the pathogen enters along the Shu points and lodges in the respective Fu organs. (Shu points refer to acupoints throughout the body where pathogens can enter, not just Ying-Shu or Back-Shu points. Internal injury from diet and external invasion by pathogens correspond internally and externally, allowing entry into the Fu organs via deficiency.)

The Emperor said: How should acupuncture treatment be applied? Qibo said: The Five Zang organs have Shu points, and the Six Fu organs have He-Sea points. Following the distribution of the meridians, there are specific sites of manifestation. Treating according to the site of the pathology will lead to recovery. (Zang Shu and Fu He points are discussed together. Specific sites of manifestation refer to Jing-Well points. Treating according to the site refers to Yuan-Source points. The Five Shu points of the Zang and six Shu points of the Fu can all be needled according to the location of the disease. Details on Five and Six Shu points are in Chapters 14 and 16 of the Meridians section.)

The Emperor said: Do Ying and Wei Qi also cause Bi syndrome? Qibo said: Ying Qi is the essence of water and grain, harmonized in the Five Zang organs and distributed in the Six Fu organs, entering the vessels to circulate up and down, penetrating the Zang organs and connecting the Fu organs. (Ying Qi is Yin Qi, transformed from water and grain essence. As stated in the "Wei Qi Chapter": Essence-Qi circulating in the meridians is Ying Qi. The "Zheng Li Lun" states: When food enters the stomach, the vessel pathways begin to flow; when water enters the vessels, blood is formed. Grain enters the stomach, transmits to the Lung, and nourishes all Zang and Fu organs. The clear part becomes Ying, the turbid part becomes Wei. Ying circulates within the vessels, Wei circulates outside. Thus, it reaches everywhere in the Zang-Fu and meridians.) Wei Qi is the fierce Qi of water and grain. Its nature is swift and slippery, unable to enter the vessels. It circulates among the skin and between the muscles, steaming the Huang membranes and dispersing in the chest and abdomen. (Wei Qi is Yang Qi. When Yang Qi arrives, it is floating, vigorous, and swift, hence called Fierce Qi. Biao means swift. Between skin and muscles is outside the vessels. Huang refers to any cavity or space between flesh and tissues. As per the "Acupuncture Taboos Chapter": Above the diaphragm and Huang lies the Parents. The "Zuo Zhuan" mentions above the Gao and below the Huang, referring to above the diaphragm. The "Fu Zhong Lun" states: Qi overflows into the large intestine and attaches to the Huang; the source of Huang is below the navel. The "Nine Needles and Twelve Original Points Chapter" states: The source of Huang emerges from the neck. The "Zhang Lun" states: Sinking into the flesh and Huang hits the Qi points. Thus, Huang is not limited to the chest and diaphragm. Mo refers to fascia. Meaning detailed in Chapter 71. Since Wei Qi does not enter the vessels, it reaches everywhere, moving as described. The "Wei Qi Chapter" states: Floating Qi not following meridians is Wei Qi. The "Xie Ke Chapter" states: Wei Qi, emerging from its fierce and swift nature, precedes in the extremities, muscles, and skin without rest. The "Ben Cang Chapter" states: Wei Qi warms the muscles, fills the skin, thickens the pores, and controls opening and closing. These all elucidate this section. Han sounds like "han". Biao sounds like "piao". Huang sounds like "huang". Mo sounds like "mo", also "mo hu qie".) Violating this Qi causes disease; following it leads to recovery. Since it does not combine with wind, cold, and dampness, it does not form Bi. (Ying and Wei Qi should not be violated; violation causes disease, compliance brings recovery. Unlike the tangible tissues and organs, they leave no trace, hence do not combine with the three pathogens to form Bi, as formlessness implies no Bi.)

The Emperor said: Good. Bi syndrome presents with pain or no pain, numbness, cold or heat, dryness or dampness. What is the reason? (Numbness refers to lack of sensation to pain and itch, stiffness and wood-like texture of the skin and flesh.) Qibo said: Pain is caused by excess cold; presence of cold leads to pain. (Excess cold causes blood vessel stasis, inevitably leading to pain, as stated in the "Zhong Shi Chapter": Painful diseases belong to Yin.) Conditions with neither pain nor numbness occur when the disease is deep and chronic, Ying and Wei Qi flow sluggishly, and meridians are occasionally empty, hence no pain. (In the "Jia Yi Jing", "tong" should be read as "tong" [pain]. Shu means empty. Sluggish Ying/Wei flow and empty meridians indicate deficient blood and Qi; less deficiency means less stasis, hence no pain. The "Ni Diao Lun" states: Deficient Ying Qi causes numbness; deficient Wei Qi causes immobility.) Lack of nourishment in the skin causes numbness. (Lack of nourishment means blood and Qi do not reach.) Cold sensations arise from deficient Yang Qi and excess Yin Qi, which mutually reinforce the pathology, causing cold. (Not all cold diseases stem from external cold; insufficient Yang and excess Yin generate cold internally, reinforcing the condition, resulting in a cold syndrome.) Heat sensations arise from abundant Yang Qi and deficient Yin Qi; the pathogenic Qi prevails, and Yang encounters Yin, causing Bi heat. (Zao means encounter. When Yang is excessive and encounters Yin, Yin cannot overcome it, resulting in Bi heat.) Profuse sweating and wetness occur when encountering severe dampness. With deficient Yang and abundant Yin, the two Qi interact, causing sweating and wetness. (The two Qi refer to cold and damp. The "Mai Yao Jing Wei Lun" states: Excess Yin leads to profuse sweating and body cold. This explains the meaning.)

The Emperor said: Why does Bi syndrome sometimes present without pain? Qibo said: When Bi is in the bone, it feels heavy; in the vessels, blood coagulates and does not flow; in the sinews, flexion occurs without extension; in the muscles, there is numbness; in the skin, there is cold. Possessing all five of these conditions results in no pain. (With all five conditions, Qi is obstructed in sinews, bones, skin, muscles, and vessels, hence no pain.) Generally, Bi syndromes tighten when exposed to cold and relax when exposed to heat. The Emperor said: Good. (In the "Jia Yi Jing", "chong" is written as "ji" [tight/spasm], which makes more sense. Exposure to cold causes sinew spasm, hence tightness. Exposure to heat causes sinew relaxation, hence laxity.)