诸痹，风寒湿三气杂合，而犯其经络之阴也。风多则引注，寒多则掣痛，湿多则重着，良由营卫先虚，
腠理不密，风寒湿乘虚内袭，正气为邪气所阻，不能宣行，因而留滞，气血凝涩，久而成痹。或肌肉麻顽，或肢
节挛急，或半体偏枯，或偏身走注疼痛，其不痛者，病久入深也。故在骨则重而不举，在血则凝而不流，在
筋则屈而不伸，在肉则麻木不仁，在皮则皴揭不荣，皆痹而不痛。盖痹者，闭而不通，邪在阴分也。故经以病
在阳为风，在阴为痹，阴阳俱病为风痹。经言三气杂合，专言痹病所因也。在阴为痹，分言表里有殊也。阴阳
俱病，表症更兼里症也。《经·痹论》曰∶风寒湿三气杂至，合而为痹。痹非偏受一气。其风胜者为行痹，风
行而不定，如走注之类。寒胜者为痛痹，寒凝则阳气不行，痛有定处即痛风。湿胜者为着痹，重着不移，或
肿痛，或不仁，湿从土化，病发肌肉，即麻木也。以冬遇此为骨痹，冬气在骨。以春遇此为筋痹，春气在筋。
以夏遇此气为脉痹，夏气在脉。以至阴遇此为肌痹，长夏气在肌肉。以秋遇此为皮痹，秋气在皮。行痹、痛痹、
着痹痹症大纲。又以所遇之时而命名，非此外别有骨筋脉等痹也。五脏皆有合病，久而不去者，内舍于其合。
经云∶诸痹不已，亦溢内也。风胜者易已，留皮肤者易已，留筋骨者痛久，其入脏者死。凡痹逢寒则急，逢热
则纵。故骨痹不已，复感于邪，内舍于肾；筋痹不已，复感于邪，内舍于肝；脉痹不已，复感于邪，内舍于心；
血痹不已，复感于邪，内舍于脾；皮
痹不已，复感于邪，内舍于肺。此经病入脏也。经论五痹之入脏者曰，肺痹烦满，喘而呕；心痹脉不通，烦
则心下鼓，暴上气而喘，嗌干善噫，厥气上则恐；肝痹夜卧则惊，多饮，数小便，上为引如怀；肾痹善胀，尻
以代踵，脊以代头；脾痹四肢懈惰，发咳呕汁，上为大塞。其入腑者，别有肠痹胞痹，另详本门。此五脏之痹，
各以其时，重感于风寒湿之气也。风胜脉必浮，寒胜脉必涩，湿胜脉必缓。三痹各有所胜，用药以胜者为主，
而兼者佐之。治行痹散风为主，兼去寒利湿，参以补血，血行风自灭也。防风汤。治痛痹温寒为主，兼疏风渗
湿，参以益火，辛温解凝寒也。加减五积散。治着痹利湿为主，兼去风逐寒，参以补脾补气，土强可胜湿也。
川芎茯苓汤加 、术。其症有风湿，羌活胜湿汤、史公酒。有寒湿，苡仁汤、三痹汤。痹而身寒，如从水中出
者，属寒湿，附子丸。有湿热，加味三妙散、苍术散。肩背沉重，肢节疼痛，下注足胫，属湿热。当归拈痛汤。
有风热，肤麻瘾疹，消风散。有暑湿，清暑益气汤。有冷痹，风冷顽麻，巴戟天汤。有热痹，热毒流注骨节，
千金犀角散。有营热，四物汤去川芎，加钩藤、丹皮。有营虚，当归建中汤。有卫虚，防己黄 汤。有气痹，
痹在气分，蠲痹汤。有血痹，痹在血分，因劳汗出，卧被风吹，血凝于肤，黄 桂枝五物汤加当归。有瘀血，
败血入络，桃红饮，煎成入麝香。有停痰，遍身走痛，二陈汤加羌活、白芥子、风化硝，姜汁泛丸。有支饮，
臂痛不举，眩冒麻痹，指迷茯苓丸。有在经，木防己汤。有入络，活络饮加桑寄生、威灵仙、钩藤、牛膝，
或活络丹。治法总以补助真元，宣通脉络，加活血丹合续断丹，或人参散之类。使气血流畅，则痹自已。
〔风寒湿合痹〕气血凝滞，身重而痛，手足挛急。石顽改定三痹汤，或通痹散。
〔周痹〕真气不能周于身，浑身痹痛。风寒湿气客于肉分，内不在脏，外未发皮，命曰周痹。蠲痹汤加
桂枝、白术、狗脊、薏米。
〔行痹〕遍身走注不定，上半身甚者，乌药顺气散。下半身甚者，虎骨散加减。
〔痛痹〕历节挛痛，疏风活血汤。痛甚者，五灵散。
〔着痹〕留着定处，身重酸疼，天阴即发，除湿蠲痛汤加蚕砂、防己、薏米。不应，补中益气汤加附子、
羌活、黄柏。
〔骨痹〕即寒痹痛痹也，苦痛切骨，安肾丸。
〔筋痹〕即风痹也，风热攻注，筋弛脉缓，羚羊角散。若湿邪入筋，续断丹。
〔脉痹〕即热痹也。《金匮》云∶经湿则痹，络热则痿。风湿郁热，经隧为壅。升麻汤去桂、麻，加萆 、
石膏，或秦艽四物汤，后用人参丸。
〔肌痹〕即湿痹着痹也。浑身上下左右麻木，属卫气不行。神效黄 汤。皮肤麻木，属肺气不行。本方去
荆芥，倍黄 ，加防风。肌肉麻木，属营气不行。本方去蔓荆，加桂枝、羌活、防风。丹溪曰∶麻为气虚，
木为湿痰败血。
〔皮痹〕邪在皮毛，搔如隔帛，或瘾疹风疮，宜疏风养血。秦艽地黄汤。
〔五脏痹〕经病入脏，邪胜正虚，五痹汤。肾痹，本方加独活、肉桂、杜仲、牛膝、黄 、萆 。肝痹，
本方加枣仁、柴胡。心痹，本方加远志、茯神、麦冬、犀角。脾痹，本方加浓朴、枳实、砂仁、神曲。肺痹，
本方加半夏、杏仁、麻黄、紫菀。
《入门》曰，痹初起，骤用参、 、归、地，则气郁滞，邪不散，只以行湿流气药主之。久而不愈，宜
峻补真阴，使气血流行，则病邪随去。（参景岳论。）
痹与痿相似，但痿属虚，痹属实。痿因血虚火盛，肺叶焦而成。痹因风寒湿邪侵入而成也。痹又为中风之一，
然受病各异。痹兼三气，邪为阴受，中风邪为阳受也。《尊生书》曰，阳者表与上，阴者里与下也。痹与风痿，
形症虽相似，医治之法，可相混乎？（沈氏集说）
治痹而用风门通套之剂，医之过也。痹症非不有风，然风入阴分，与寒湿互结，扰乱其血脉，致身中之
阳不通于阴，故致痹也。古方多有用麻黄、白芷者，以麻黄能通阳气，白芷能行营卫，然已入四君四物等汤中，
非专发表也。致于攻里，则从无用之者，
以攻里药皆苦寒，用之则阳愈结，其痹转入诸腑而成死症矣。（《医通》）
戴人曰∶痹病以湿热为主，风寒为兼，其脉沉涩。乃治此者不分经络表里脏腑，便作香港脚寒湿治，而用
乌附乳没燥热，以致便尿涩滞，前后俱闭，虚躁日甚，肌肉日削，饮食不下，虽华扁亦难措手矣。
Various Bi syndromes (Bi syndrome) result from the mixed invasion of Wind, Cold, and Dampness pathogens into the Yin aspects of the meridians. When Wind is predominant, pain migrates; when Cold is predominant, there is pulling and cramping pain; when Dampness is predominant, the body feels heavy and fixed. This is primarily due to a prior deficiency of Ying (Nutritive Qi) and Wei (Defensive Qi), with loose Cou Li (skin texture and pores), allowing Wind, Cold, and Dampness to invade internally upon weakness. The Zheng Qi (Upright Qi) is obstructed by the pathogens and cannot circulate freely, leading to stagnation. Over time, Qi and Blood become congealed and sluggish, resulting in Bi syndrome. Manifestations may include numbness and stiffness of muscles, contracture and cramping of limbs and joints, hemiplegia, or wandering pain throughout the body. Cases without pain indicate that the disease has progressed deeply over a long period. Thus, if the pathogen is in the bones, heaviness prevents lifting; in the blood, congealment prevents flow; in the tendons, flexion prevents extension; in the flesh, numbness and loss of sensation occur; in the skin, roughness and lack of luster appear. These are all forms of Bi syndrome without pain. Essentially, Bi means obstruction and blockage, with the pathogen residing in the Yin aspect. Therefore, classics state that pathology in Yang is termed Feng (Wind), in Yin is termed Bi, and in both Yin and Yang is termed Feng-Bi. The statement that three pathogens mix refers specifically to the etiology of Bi. Pathology in Yin distinguishes between exterior and interior differences. Pathology in both Yin and Yang implies exterior symptoms accompanied by interior symptoms. The *Huangdi Neijing·Bi Lun* states: "When Wind, Cold, and Dampness mix and arrive together, they combine to form Bi." Bi is not caused by a single pathogen alone. When Wind is excessive, it is called Xing-Bi (Wandering Bi); Wind moves unpredictably, resembling wandering pain. When Cold is excessive, it is called Tong-Bi (Painful Bi); Cold congeals and obstructs Yang Qi, causing fixed-point pain, also known as Gout. When Dampness is excessive, it is called Zhuo-Bi (Fixed Bi); the body feels heavy and immobile, with swelling, pain, or numbness. Dampness transforms according to Earth, affecting muscles, manifesting as numbness. If contracted in Winter, it becomes Gu-Bi (Bone Bi) because Winter Qi resonates with bones. If contracted in Spring, it becomes Jin-Bi (Tendon Bi) because Spring Qi resonates with tendons. If contracted in Summer, it becomes Mai-Bi (Vessel Bi) because Summer Qi resonates with vessels. If contracted during the late summer (Zhi Yin), it becomes Ji-Bi (Muscle Bi) because Late Summer Qi resonates with muscles. If contracted in Autumn, it becomes Pi-Bi (Skin Bi) because Autumn Qi resonates with skin. Xing-Bi, Tong-Bi, and Zhuo-Bi are the major categories of Bi. They are named based on the season of contraction, implying no separate Bone, Tendon, Vessel, etc., Bi exist outside this framework. Each Zang organ has an associated tissue; if Bi persists, it transmits inward to its corresponding Zang. Classics say: "If various Bis do not resolve, they overflow into the interior." Wind-predominant cases are easily cured; those remaining in the skin are easily cured; those lingering in sinews and bones cause prolonged pain; those entering the Zang organs lead to death. All Bis tighten in cold and relax in heat. Thus, unresolved Gu-Bi transmitting pathogens enters the Kidney; unresolved Jin-Bi enters the Liver; unresolved Mai-Bi enters the Heart; unresolved Xue-Bi (Blood Bi) enters the Spleen; unresolved Pi-Bi enters the Lung. This describes meridian pathology entering the Zang. Regarding five Bis entering Zang: Fei-Bi causes irritability, fullness, wheezing, and vomiting; Xin-Bi causes blocked pulses, palpitations when irritable, sudden upward Qi rebellion with wheezing, dry throat, frequent belching, and fear when rebellious Qi rises; Gan-Bi causes night terrors, polydipsia, frequent urination, and upper abdominal distension resembling pregnancy; Shen-Bi causes easy bloating, where the sacrum replaces the heels and the spine replaces the head in posture; Pi-Bi causes limb flaccidity, coughing with saliva emission, and severe upper obstruction. Transmission to Fu organs involves Chang-Bi (Intestine Bi) and Bao-Bi (Bladder Bi), detailed elsewhere. These Zang Bis occur when re-exposed to Wind, Cold, and Dampness during their respective seasons. Wind-dominant pulse is floating; Cold-dominant is choppy; Damp-dominant is slow. Treatment prioritizes the dominant pathogen, assisting with others. For Xing-Bi, dispel Wind primarily, assist with expelling Cold and draining Dampness, and nourish Blood ("when Blood moves, Wind extinguishes"). Use Fangfeng Tang. For Tong-Bi, warm and disperse Cold primarily, assist with dispersing Wind and percolating Dampness, and tonify Fire ("acrid-warm resolves congealed Cold"). Use Jiajian Wuji San. For Zhuo-Bi, drain Dampness primarily, assist with expelling Wind and driving out Cold, and tonify Spleen and Qi ("strong Earth overcomes Dampness"). Use Chuanxiong Fuling Tang plus Atractylodes macrocephala (Baizhu) and Atractylodes lancea (Cangzhu). For Wind-Damp, use Qianghuo Shengshi Tang or Shi Gong Jiu. For Cold-Damp, use Yiren Tang or Sanbi Tang. Bi with cold body sensation like emerging from water indicates Cold-Damp; use Fuzi Wan. For Damp-Heat, use Jiawei Sanmiao San or Cangzhu San. Heavy shoulders/back and joint pain radiating to calves indicates Damp-Heat; use Danggui Niangong Tang. For Wind-Heat with skin numbness and hives, use Xiaofeng San. For Summerheat-Damp, use Qingshu Yiqi Tang. For Cold Bi with stubborn numbness, use Bajitian Tang. For Heat Bi with toxic heat flowing to joints, use Qianjin Xijiao San. For Ying-Heat, use Siwu Tang minus Chuanxiong, plus Uncaria rhynchophylla (Gouteng) and Moutan Cortex (Danpi). For Ying-Deficiency, use Danggui Jianzhong Tang. For Wei-Deficiency, use Fangji Huangqi Tang. For Qi-Bi (pathology in Qi level), use Juanbi Tang. For Xue-Bi (pathology in Blood level, due to exertion/sweat exposed to wind causing blood stasis in skin), use Huangqi Guizhi Wuwu Tang plus Danggui. For Blood Stasis entering collaterals, use Taohong Yin with Moschus (Shexiang) added after decoction. For Phlegm retention with wandering pain, use Erchen Tang plus Qianghuo, Baijiezi, and Fenghua Xiao, pilled with Ginger Juice. For Zhī-Yin (fluid retention) with arm pain, dizziness, and numbness, use Zhimi Fuling Wan. For pathology in meridians, use Mufangji Tang. For pathology entering collaterals, use Huoluo Yin plus Sangjisheng, Lingzhi Xian, Gouteng, and Niuxi, or Huoluo Dan. General treatment supplements True Yuan and unblocks collaterals, using Huoxue Dan combined with Xuduan Dan or Renshen San. Ensuring smooth Qi and Blood flow cures Bi spontaneously.
[Wind-Cold-Damp Combined Bi] Qi and Blood stagnation, heavy painful body, cramping hands/feet. Shiwen's modified Sanbi Tang or Tongbi San.
[Zhou-Bi / Circulating Bi] True Qi fails to circulate the body, causing generalized Bi pain. Wind-Cold-Dampness lodges in muscle layers, neither internal to Zang nor external to Skin, termed Zhou-Bi. Use Juanbi Tang plus Guizhi, Baizhu, Gouji, and Yimi.
[Xing-Bi / Wandering Bi] Wandering pain everywhere, worse in upper body: Yaoyao Shunqi San. Worse in lower body: Hugu San modified.
[Tong-Bi / Painful Bi] Joint cramping pain: Shufeng Huoxue Tang. Severe pain: Wuling San.
[Zhuo-Bi / Fixed Bi] Fixed pain, heavy soreness, worse on cloudy days: Chushi Juantong Tang plus Can Sha, Fangji, and Yimi. If ineffective: Buzhong Yiqi Tang plus Fuzi, Qianghuo, and Huangbai.
[Gu-Bi / Bone Bi] Same as Cold/Painful Bi, bone-deep pain: Anshen Wan.
[Jin-Bi / Tendon Bi] Same as Wind-Bi, Wind-Heat attacking tendons causing laxity: Lingyangjiao San. If Dampness enters tendons: Xuduan Dan.
[Mai-Bi / Vessel Bi] Same as Heat Bi. *Jinkui Yaolue* states: "Damp in meridians causes Bi, Heat in collaterals causes Wei." Wind-Damp郁 Heat obstructs meridians. Use Shengma Tang minus Guizhi/Mahuang, plus Bibai and Shigao, or Qinjiao Siwu Tang, followed by Renshen Wan.
[Ji-Bi / Muscle Bi] Same as Damp/Fixed Bi. Generalized numbness indicates Wei Qi failure: Shenxiao Huangqi Tang. Skin numbness indicates Lung Qi failure: Modify base formula by removing Jingjie, doubling Huangqi, adding Fangfeng. Muscle numbness indicates Ying Qi failure: Remove Manjingzi, add Guizhi, Qianghuo, Fangfeng. Danxi said: Numbness is Qi deficiency; Woodiness is Damp-Phlegm and ruined Blood.
[Pi-Bi / Skin Bi] Pathogen in skin/hair, itching like rubbing through silk, or hives/wind sores: Dispel Wind and nourish Blood. Use Qinjiao Dihuang Tang.
[Five Zang Bis] Meridian pathology entering Zang, excess pathogen/deficient Zheng: Wu Bi Tang. Shen-Bi: Add Duhuo, Rougui, Duzhong, Niuxi, Huangqi, Bibai. Gan-Bi: Add Zaoren, Chaihu. Xin-Bi: Add Yuanzhi, Fushen, Maidong, Xijiao. Pi-Bi: Add Houpo, Zhishi, Sharen, Shenqu. Fei-Bi: Add Banxia, Xingren, Mahuang, Ziwan.
*Rumen* states: Early Bi should not be treated abruptly with Ginseng, Astragalus, Angelica, or Rehmannia, as this causes Qi stagnation and traps pathogens; use damp-draining and Qi-moving herbs initially. Chronic cases require strong tonification of True Yin to promote Qi/Blood flow, expelling pathogens. (Referencing Jingyue's theory.)
Bi resembles Wei syndrome, but Wei is Deficiency while Bi is Excess. Wei arises from Blood deficiency and Fire excess scorching Lung leaves. Bi arises from Wind-Cold-Damp invasion. Bi is also a type of Stroke (Zhong Feng), but etiologies differ. Bi combines three pathogens invading Yin; Stroke pathogens invade Yang. *Zunsheng Shu* states: Yang refers to Exterior/Upper; Yin refers to Interior/Lower. Though Bi and Wind-Wei share similar forms/symptoms, can treatments be confused? (Shen's Collection)
Using generic Wind-dispelling formulas for Bi is a physician's error. Bi does involve Wind, but Wind entering Yin combines with Cold/Damp, disturbing blood vessels, preventing Yang from reaching Yin. Ancient formulas used Mahuang and Baizhi to unblock Yang and move Ying/Wei, but always within Sizhun/Siwu contexts, not for pure exterior release. Interior-attacking bitter-cold herbs are never used, as they congeal Yang further, turning Bi into fatal Fu-organ pathology. (*Yitong*)
Dairen (Zhang Congzheng) stated: Bi is primarily Damp-Heat with Wind-Cold as secondary, pulse deep/choppy. However, practitioners often misdiagnose it as Hong Kong Foot (Gout/Cold-Damp) regardless of meridian/Zang-Fu status, using hot/drying herbs like Aconite and Myrrh. This leads to urinary/fecal retention, increasing deficiency/restlessness, muscle wasting, and anorexia, making it incurable even by Hua Tuo or Bian Que.