偏枯。半身不遂也。二曰风痱。身无痛痒。四肢不收也。三曰风 。奄忽不知人也。四曰风痹。诸痹类风状也。由此观
之。则风 类厥症。风痹类痹 。大抵风痹痿厥四症。多有相类之处。又按灵枢寿夭刚柔篇。病在阳者曰风。病在阴者
曰痹。阴阳俱病曰风痹。病有形而不痛者。阳之类也。无形而痛者。阴之类也。）（风论）
【素】风寒湿三气杂至。合而为痹也。（合中有分。分中有合。）其风气胜者为行痹。（三气各以一气主病。合中有分。
风者善行数变。故走易不定者。为行痹。俗谓之流火。）寒气胜者为痛痹。（阴寒为痛。）湿气胜者为着痹也。（着而不移。）
其有五者何也。以冬遇此者为骨痹。（肾主骨。此指风寒湿也。灵枢长刺节论。骨重不可举。骨髓酸痛。名骨痹。）以春
遇此者为筋痹。（肝主筋。长刺节论。筋挛骨痛。不可以行。名筋痹。）以夏遇此者为脉痹。（心主脉。）以至阴（四季。）
遇此者为肌痹。（脾主肌肉。长刺节论。肌肤尽痛。名曰肌痹。）以秋遇此者为皮痹。（肺主皮。）内舍五脏六腑。何气使
然。曰。五脏皆有合。病久而不去者。内舍于其合也。（如肝合筋。心合脉等。凡病皆然。久而内舍。则为脏腑之痹矣。）
故骨痹不已。复感于邪。内舍于肾。（经邪入脏。下同。）筋痹不已。复感于邪。内舍于肝。脉痹不已。复感于邪。内舍
于心。肌痹不已。复感于邪。内舍于脾。皮痹不已。复感于邪。内舍于肺。所谓痹者。各以其时。（气旺之月。）重感于
风寒湿之气也。肺痹者。烦满（王海藏曰。烦出于肺。盖心火旺。则金燥也。）喘而呕。（肺主气。故喘。脉循胃口。故
呕。）心痹者。脉不通。（心主脉。）烦则心下鼓。（火扰故烦。血不足。则心下鼓动。）暴上气而喘。（心脉上肺。火盛克
金。故上气而喘。）嗌干。（心脉挟咽。）善噫。（心为噫。）厥气上则恐。（肾志恐。肾水上逆而凌心。）肝痹者。夜卧则惊。
（肝主惊。寐则神藏于肝。）多饮。数小便。上为引如怀。（肝脉环阴器。抵小腹。故便数。痛引小腹。状如怀妊。）肾痹
者。善胀。（肾者。胃之关。关门不利。故胀。）尻以代踵。脊以代头。（尻。苦高切。臀也。肾脉起足下。足不能行。而
以尻代之。肾脉贯脊。头反下而脊高。皆蜷屈之状也。）脾痹者。四肢解堕。（脾主四肢。）发咳呕汁。上为大塞。（脾脉
络胃。上膈挟咽。故呕咳而上焦隔塞。）肠痹者。数饮而出不得。（肠中有热。故多饮。而小便复难。）中气喘争。时发飧
泄。（邪正奔喘交争。时或通利。则又为飧泄。）胞痹者。少腹膀胱按之内痛。若沃以汤。涩于小便。（膀胱在少腹之内。
胞在膀胱之内。胞受风寒湿气。郁而为热。故然。）上为清涕。（精室与髓海相通。小便既涩。太阳经气不得下行。故上
烁其脑。而为清涕。）阴气者。静则神藏。躁则消亡。（五脏皆属阴而藏神。王注。此言五脏受邪而为痹也。）饮食自倍。
肠胃乃伤。（王注。此言六腑受邪而为痹也。脏以躁动致伤。腑以饮食见损。）淫气。（气妄行而过者。）喘息。痹聚在肺。
淫气忧思。痹聚在心。淫气遗溺。痹聚在肾。淫气竭乏。（阴血枯竭。）痹聚在肝。淫气肌绝。（肌气阻绝。不知痛痒。）
痹聚在脾。诸痹不已。亦益内也。（即前内合数条。）其风气胜者。其人易已也。（风为阳邪。寒湿为阴邪。）其入脏者死。
（一脏痹则五脏不能流通。故死。）其留连筋骨间者痛久。其留皮肤间者易已。六腑亦各有俞。（俞穴。王注。谓膀胱经
六俞。内通六腑。马注。凡六腑之穴。皆可入邪。）风寒湿气中其俞。而食饮应之。（饮食失节。）循俞而入。各舍其腑也。
（六腑痹。昂按。六腑前文只列肠痹胞痹。三焦有名无形。肌附于脾。胃为脏腑之海。故不复别言痹也。）痹或痛或不痛。
或不仁。或寒或热。或燥或湿。何也。曰。痛者。寒气多也。有寒故痛也。（阴寒凝聚而作痛。）其不痛不仁者。病久入
深。营卫之行涩。（气血不足。）经络时疏。（空疏。）故不痛。（素问作不通。疑误。甲乙经作不痛。今从之。不痛者重。）
皮肤不营。（无血充养。）故为不仁。（顽痹麻木。）其寒者。阳气少。阴气多。与病相益。故寒也。（本感寒湿。而阴气复
益之。）其热者。阳气多。阴气少。病气胜。阳遭阴。故为痹热。（风为阳邪。卫气又胜。阴不能胜阳。）其多汗而濡者。
此其逢湿甚也。阳气少。阴气盛。两气相感。（阴气。湿气。）故汗出而濡也。痹病不痛何也。痹在于骨则重。在于脉则
血凝而不流。在于筋则屈不伸。在于肉则不仁。在皮则寒。故具此五者。故不痛也。（痛则血气犹能周流。五者为气血不
足。皆重于痛。故不复作痛。诸解欠明。）凡痹之类。逢寒则急。（寒则筋急。急字素问作虫。王注。如虫行皮中。甲乙
经作急。今从之。）逢热则纵。（热则筋弛。故痿论专言热。）营卫之气。亦令人痹乎。曰。营者。水谷之精气也。和调于
五脏。（六阴经。）洒陈于六腑。（六阳经。）乃能入于脉也。（正理论曰。谷入于胃。脉道乃行。水入于经。其血乃成。）
故循脉上下。贯五脏。络六腑也。（荣行脉中。）卫者。水谷之悍气也。其气 疾滑利。不能入于脉也。（卫行脉外。）故
循皮肤之中。分肉之间。（肉之腠理。）薰于肓膜。（膏肓。膈膜。）散于胸腹。（此卫气所行之处。灵枢本藏篇。卫气者。
所以温分肉。充皮肤。肥腠理。司开阖者也。）逆其气则病。（二气有所阻逆。）从（顺也。）其气则愈。不与风寒湿气合。
故不为痹。（痹论。）
【素】肺热叶焦。则皮毛虚弱急薄着。则生痿 也。（肺主皮毛。传精布气。肺热叶焦。则不能输精于皮毛。故虚弱
急薄。皮肤燥着。而痿 不能行。犹木皮剥。则不能行津于枝干而枯也。）心气热。则下脉厥而上。（心热盛则火独光。
肾脉下行者。随火厥逆而上。）上则下脉虚。虚则生脉痿。（心主脉。）枢折挈。（枢纽之间。如折如挈。）胫纵而不任地也。
肝气热。则胆泄口苦。（胆为肝之府。热则胆汁溢。）筋膜干。筋膜干则筋急而挛。发为筋痿。（肝主筋。）脾气热。则胃
干而渴。（不能为胃行其津液。）肌肉不仁。（不知痛痒。）发为肉痿。（脾主肉。）肾气热。则腰脊不举。（腰为肾府。肾脉
贯脊。）骨枯而髓减。发为骨痿。（肾主骨。）何以得之。曰。肺者。藏之长也。为心之盖也。有所失亡。所求不得。则发
肺鸣。（心志不遂。火上炎而烁肺。金受火克。故喘息有音也。）鸣则肺热叶焦。故五脏因肺热叶焦。发为痿 也。（肺者。
相傅之官。为气之主。治节出焉。人身之运动。皆由于肺。肺热叶焦。则气无所主。而失其治节。故痿 而手足不随也。）
悲哀太甚。则胞络绝。绝则阳气内动。（胞络属心。而络于胞中。悲则心系急。肺布叶举。胞络阻绝。卫气不得外出而内
动。）发则心下崩数溲（溺。）血也。故大经空虚。（亡血故虚。）发为肌痹。传为脉痿。（先为肌肉顽痹。次为脉痿。胫不
任地。）思想无穷。所愿不得。意淫于外。（妄想。）入房太甚。宗筋弛纵。发为筋痿。及为白淫。（白物淫溢而下。浊带
之类。）生于肝。（肝主筋。）使内也。（房劳。）有渐于湿。（渐渍水湿。）以水为事。（好饮酒浆。）若有所留。（水湿留着。）
居处相湿。肌肉濡渍。痹而不仁。发为肉痿。得之湿地也。（地之湿气。感则害皮肉筋脉。）有所远行劳倦。逢大热而渴。
渴则阳气内伐。内伐则热舍于肾。肾者水脏也。今水不胜火。则骨枯而髓虚。故足不任身。发为骨痿。生于大热也。（肾
恶燥。）肺热者。色白而毛败。心热者。色赤而络脉溢。肝热者。色苍而爪枯。（爪者筋之余。）脾热者。色黄而内蠕（音
软。）动。肾热者。色黑而齿槁。（齿者骨之余。）治痿者独取阳明。何也。阳明者。五脏六腑之海。（胃为水谷之海。）主
闰（润同。）宗筋。（阴毛横骨上下之竖筋。络胸腹经腹背。上头项。下 臀。）宗筋主束骨而利机关也。冲脉者。经脉之
海也。（受十二经之血。为血海。）主渗灌溪谷。（肉之大会为谷。小会为溪。）与阳明合于宗筋。（冲脉循腹挟脐旁五分而
上。阳明脉亦挟脐旁一寸五分而上。宗筋脉于中。）阴阳（三阴。三阳。）总宗筋之会。会于气街。（阴毛两旁动脉处。）
而阳明为之长。皆属于带脉。而络于督脉。（带脉起于季胁。周回一身。如束带然。阳明与带脉相属。而复络于督脉。）
故阳明虚则宗筋纵。带脉不引。故足痿不用也。（不为人用。）（痿论）
【素】阳气衰于下。则为寒厥。阴气衰于下。则为热厥。（下不足。则厥逆而上。）热厥之为热也。必起于足下者何
也。阳气起于足五指之表。（足三阳脉。）阴脉者。集于足下。而聚于足心。（足三阴脉。）故阳气胜。则足下热也。（阴不
足。）寒厥之为寒也。必从五指而上于膝者何也。阴气起于五指之里。（足三阴脉。）集于膝下。而聚于膝上。故阴气胜。
则从五指至膝上寒。其寒也。不从外。皆从内也。（阴盛生内寒。不由外感。）寒厥何失而然也。前阴者。宗筋之所聚。
太阴阳明之所合也。（脾胃之脉。皆辅近宗筋。甲乙经作厥阴者。众筋之所聚。亦自一说。）春夏则阳气多而阴气少。秋
冬则阴气盛而阳气衰。此人者质壮。以秋冬夺于所用。（多欲夺阴。）下气上争不能复。（不能归经。）精气溢下。（阴精下
泄。）邪气因从之而上也。气因于中。（寒从内发。即前不从外之意。张注。言人之气。由中焦水谷所生。亦通。）阳气衰
不能渗营其经络。阳气日损。阴气独在。故手足为之寒也。热厥何如而然也。酒入于胃。则络脉满而经脉虚。脾主为胃
行其津液者也。阴气虚则阳气入。（阳主卫外。阴虚则阳内伐。所谓阴不足则阳凑之也。）阳气入则胃不和。胃不和则精
气竭。（不能生精生气。）精气竭则不营其四肢也。（此亦独取阳明之义。）此人必数醉若饱以入房。气聚于脾中不得散。
酒气与谷气相薄。热盛于中。故热遍于身。内热而溺赤也。夫酒气盛而 悍。肾气日衰。（烁其阴精。）阳气独胜。故手
足为之热也。厥或腹满。或暴不知人。或至半日。远至一日乃知人者。何也。阴气盛于上则下虚。下虚则腹胀满。（寒盛
则胀。）阳气盛于上则下气重上。而邪气逆。逆则阳气乱。阳气乱则不知人也。（热盛则不知人。）巨阳之厥。则肿首头重。
足不能行。（脉上巅。下 贯 。）发为 仆。（上重下轻。）阳明之厥。则癫疾。欲走呼。腹满不得卧。面赤而热。妄见
而妄言。（昂按。阳明多血多气。详本症。病皆有余。与虚而厥者不同。）少阳之厥。则暴聋。颊肿而热。胁痛 （足骨。）
不可以运。（皆经脉所过。）太阴之厥。则腹满 胀。后不利。不欲食。食则呕。不得卧。（皆脾病兼胃。）少阴之厥。则
口干溺赤。（肾热。）腹满心痛。（脉络心。注胸中。）厥阴之厥。则少腹肿痛。（脉抵小腹。）腹胀。（肝主胀。为木盛克土。）
泾溲不利。（肝火。）好卧屈膝。（筋衰。）阴缩肿。 内热。（脉络阴器。上 内廉。）（厥论）
【灵】夫百病者。多以旦慧昼安。夕加夜甚。何也。曰。春生夏长。秋收冬藏。是气之常也。人亦应之。以一日分
为四时。朝则为春。日中为夏。日入为秋。夜半为冬。朝则人气始生。病气衰。故旦慧。日中人气长。长则胜邪。故安。
夕则人气始衰。邪气始生。故加。夜半人气入藏。邪气独居于身。故甚也。其时有反者。何也。是不应四时之气。藏独
主其病者。（一脏独主其病。故不能应一日分四时之气。）是必以藏气之所不胜时者甚。（如脾病不能胜旦之木。肺病不能
胜昼之火。肝病不能胜夕之金。心病不能胜夜之水。故至其时反加甚也。）以其所胜时者起也。（如肺气能胜旦之木。肾
气能胜昼之火。心气能胜夕之金。脾气能胜夜之水。至其所胜之时。则慧且安。不能拘于旦慧昼安夕加夜甚之说也。顺
气一日分为四时。）
Pianku (hemiplegia), which is paralysis of half the body. The second is Fengfei (wind flaccidity), where the body has no pain or itching, and the four limbs cannot be controlled. The third is Fengyin (wind aphasia), sudden loss of consciousness and inability to recognize people. The fourth is Fengbi (wind bi-syndrome), where various bi-syndromes resemble wind diseases. From this, we can see that Fengyin resembles Jue syndrome (reversal syndrome), and Fengbi resembles Bi syndrome (obstruction syndrome). Generally speaking, the four syndromes of Wind, Bi, Wei (flaccidity), and Jue have many similarities. Furthermore, according to the *Lingshu: Shou Yao Gang Rou* chapter, diseases in the Yang aspect are called Feng; diseases in the Yin aspect are called Bi; diseases affecting both Yin and Yang are called Fengbi. Diseases with physical manifestations but no pain belong to the Yang category; diseases without physical manifestations but with pain belong to the Yin category. (From *Suwen: Feng Lun*)
[Suwen] When Cold, Wind, and Dampness three pathogens mix and invade, they combine to form Bi syndrome. (Combination involves distinction, and distinction involves combination.) Among them, when Wind Qi prevails, it is called Xingbi (wandering bi-syndrome). (Each of the three pathogens dominates the disease individually, so there is distinction within combination. Wind is agile and changes rapidly, so wandering and unpredictable symptoms are called Xingbi, commonly known as flowing fire.) When Cold Qi prevails, it is called Tongbi (painful bi-syndrome). (Yin-Cold causes pain.) When Dampness Qi prevails, it is called Zhuobi (fixed bi-syndrome). (Heavy and fixed, not moving.) What are these five types of Bi? If one encounters these pathogens in Winter, it is called Gu Bi (bone bi-syndrome). (Kidney governs bones; here referring to Cold, Wind, and Dampness. *Lingshu: Chang Ci Jie Lun* states: heavy bones unable to lift, soreness and pain in bone marrow, named Gu Bi.) If encountered in Spring, it is called Jin Bi (tendon bi-syndrome). (Liver governs tendons. *Chang Ci Jie Lun*: tendon spasm and bone pain, inability to walk, named Jin Bi.) If encountered in Summer, it is called Mai Bi (vessel bi-syndrome). (Heart governs vessels.) If encountered in Late Summer (the last eighteen days of each season), it is called Ji Bi (muscle bi-syndrome). (Spleen governs muscles. *Chang Ci Jie Lun*: pain throughout skin and muscles, named Ji Bi.) If encountered in Autumn, it is called Pi Bi (skin bi-syndrome). (Lung governs skin.) How do pathogens enter the Zang and Fu organs internally? It is said: Each Zang organ has a corresponding exterior tissue. If the disease persists for a long time, it enters internally into its corresponding Zang organ. (e.g., Liver corresponds to tendons, Heart to vessels, etc. This applies to all diseases; prolonged internal transmission leads to Zang-Fu Bi syndromes.) Therefore, if Gu Bi does not heal and pathogens are contracted again, it enters internally into the Kidney. (Pathogens from meridians entering Zang organs, same for below.) If Jin Bi does not heal and pathogens are contracted again, it enters internally into the Liver. If Mai Bi does not heal and pathogens are contracted again, it enters internally into the Heart. If Ji Bi does not heal and pathogens are contracted again, it enters internally into the Spleen. If Pi Bi does not heal and pathogens are contracted again, it enters internally into the Lung. The so-called Bi syndromes occur because, during their respective seasons (months when Qi is prosperous), they are repeatedly exposed to Cold, Wind, and Dampness. Symptoms of Lung Bi include vexation and fullness (Wang Haicang says: vexation originates from Lung, as Heart Fire prosperity causes Metal dryness), wheezing and vomiting (Lung governs Qi, hence wheezing; meridian passes through stomach opening, hence vomiting). Symptoms of Heart Bi include obstruction of vessels (Heart governs vessels), vexation with palpitations in the epigastrium (Fire disturbance causes vexation, blood deficiency causes heart palpitations), sudden upward rushing of Qi with wheezing (Heart meridian connects to Lung, excessive Fire overcomes Metal, causing upward Qi rush and wheezing), dry throat (Heart meridian flanks pharynx), frequent belching (Heart relates to belching). Reversal Qi rising upward causes fear (Kidney will is fear, Kidney Water counterflows to harass Heart). Symptoms of Liver Bi include nightmares upon sleeping (Liver governs fright, spirit resides in Liver during sleep), polydipsia, frequent urination, and upward牵引 (pulling sensation) in the lower abdomen resembling pregnancy (Liver meridian circles genitalia and reaches lower abdomen, hence frequent urination; pain pulls lower abdomen, resembling pregnancy). Symptoms of Kidney Bi include frequent abdominal distension (Kidney is the gate of Stomach; if gate function fails, distension occurs), walking on buttocks instead of heels, and hunching back instead of holding head upright (Kao refers to buttocks. Kidney meridian starts at sole; inability to walk leads to using buttocks; Kidney meridian penetrates spine; head lowers while spine rises, showing curled posture). Symptoms of Spleen Bi include flaccidity and weakness of four limbs (Spleen governs four limbs), coughing and vomiting of saliva, and severe upper jiao obstruction (Spleen meridian connects to Stomach, passes diaphragm and flanks pharynx, hence cough/vomit and upper jiao blockage). Symptoms of Intestine Bi include drinking frequently but inability to urinate (Heat in intestines causes thirst, yet urination is difficult), middle abdominal wheezing and contention, and occasional stool with undigested food (Xiang Zheng struggle causes wheezing; when unblocked, it becomes loose stools with undigested food). Symptoms of Bao Bi (uterus/bladder bi) include internal pain upon pressing the lower abdomen bladder area, feeling like being poured with hot water, and dysuria (Bladder is in lower abdomen, Bao is inside Bladder; Cold/Wind/Damp stagnates and transforms into Heat, causing this). Upper symptoms include clear nasal discharge (Essence chamber connects to Marrow Sea; dysuria prevents Taiyang Qi from descending, scorching brain, causing clear discharge). Yin Qi, when quiet, hides the Spirit; when agitated, it dissipates. (All Zang organs belong to Yin and hide Spirit; Wang Bing's note: this describes Zang organs becoming Bi due to pathogenic invasion.) Doubling food intake injures the intestines and stomach. (Wang Bing's note: this describes Fu organs becoming Bi due to pathogenic invasion. Zang organs are injured by agitation; Fu organs are damaged by diet.) Errant Qi (Qi moving recklessly): Wheezing indicates Bi gathering in Lung; Errant Qi manifesting as worry/thought indicates Bi gathering in Heart; Errant Qi manifesting as enuresis indicates Bi gathering in Kidney; Errant Qi manifesting as exhaustion indicates Bi gathering in Liver; Errant Qi manifesting as muscle atrophy (blockage of muscle Qi, loss of pain/itch sensation) indicates Bi gathering in Spleen. All Bi syndromes, if unhealed, will also progress internally. (Refers to previous sections on internal correspondence.) Those with prevailing Wind Qi are easier to cure. (Wind is Yang pathogen; Cold/Damp are Yin pathogens.) Invasion into Zang organs leads to death. (Bi in one Zang obstructs circulation of all five Zangs, hence death.) Pathogens lingering between sinews and bones cause prolonged pain; those staying in skin are easily cured. The six Fu organs also have Shu points. (Shu points: Wang Bing notes these are the six Back-Shu points on Bladder meridian connecting internally to six Fu organs. Ma Shi notes: any point of the six Fu organs can allow pathogen entry.) Cold, Wind, and Dampness invading these Shu points, combined with improper diet, allows pathogens to follow the Shu points and settle in their respective Fu organs. (Note on Fu Bi: Previous text only listed Intestine Bi and Bao Bi. Sanjiao has name but no form; muscles attach to Spleen; Stomach is the sea of Zang-Fu, so no separate Bi discussion.) Bi may present with pain or no pain, numbness, cold or heat, dryness or dampness. Why? Pain is due to excess Cold. Cold causes pain. (Yin-Cold condensation causes pain.) No pain and numbness occur because the disease is deep and chronic, causing sluggish Ying and Wei flow. (Deficiency of Qi and Blood.) Meridians become sparse. (Emptiness.) Hence no pain. (*Suwen* says "no flow," likely an error; *Jiayi Jing* says "no pain," now adopted. No pain indicates severe condition.) Skin lacks nourishment. (No blood supply.) Hence numbness. (Stiff bi-syndrome with numbness.) Coldness occurs because Yang Qi is deficient and Yin Qi is abundant, adding to the pathological state. (Originally contracted Cold/Damp, further exacerbated by Yin excess.) Heat occurs because Yang Qi is abundant and Yin Qi is deficient; pathogenic Qi prevails, Yang confronts Yin, resulting in Bi-Heat. (Wind is Yang pathogen, Wei Qi is strong, Yin cannot overcome Yang.) Profuse sweating and wetness occur because of severe Dampness exposure. Yang Qi is weak, Yin Qi is strong, two Qi interact. (Yin Qi refers to Dampness.) Hence sweating and wetness. Why does Bi sometimes not hurt? Bi in bone causes heaviness; in vessel causes blood stasis; in sinew causes flexion without extension; in flesh causes numbness; in skin causes coldness. Having these five conditions results in no pain. (Pain implies Qi/Blood can still circulate; the above five indicate Qi/Blood deficiency, heavier than pain, hence no pain. Various explanations are unclear.) Generally, Bi syndromes contract when exposed to Cold, causing tension. (Cold causes sinew tension. "Tension" in *Suwen* is written as "worm," Wang Bing notes: like worms moving under skin; *Jiayi Jing* writes "tension," now adopted.) Exposed to Heat, they relax. (Heat causes sinew relaxation; hence *Wei Lun* focuses on Heat.) Can Ying and Wei Qi cause Bi? Answer: Ying Qi is the essence of grain and water, harmonized in five Zang organs (Six Yin meridians), distributed to six Fu organs (Six Yang meridians), then enters vessels. (*Zheng Li Lun*: Grain enters Stomach, vessel pathways flow; water enters meridians, blood forms.) Thus, it flows up and down vessels, penetrating five Zang and connecting six Fu. (Ying flows within vessels.) Wei Qi is the fierce Qi of grain and water, swift and slippery, unable to enter vessels. (Wei flows outside vessels.) Thus, it flows among skin and muscle layers. (Muscle pores.) Mists over Huang membrane. (Gao-Huang, diaphragm.) Scatters in chest and abdomen. (Where Wei Qi travels. *Lingshu: Ben Cang*: Wei Qi warms fenrou, fills skin, thickens pores, controls opening/closing.) Opposing this Qi causes disease. (Obstruction of these two Qi.) Following (obeying) this Qi leads to recovery; not combining with Cold, Wind, Dampness means no Bi. (*Bi Lun*)
[Suwen] Lung Heat with scorched leaves causes weakness, tightness, thinning, and adherence of skin and hair, leading to Wei Bi (flaccidity inability to walk). (Lung governs skin/hair, transmits essence/spreads Qi. Lung Heat scorches leaves, failing to transmit essence to skin/hair, causing weakness/tightness/dryness/adherence, and flaccidity preventing walking, like peeled bark failing to transport fluids to branches, causing withering.) Heart Qi Heat causes lower vessels to reverse upward. (Excessive Heart Heat makes Fire shine alone; Kidney vessels descending reverse upward with Fire.) Upward reversal makes lower vessels empty; emptiness generates Mai Bi (vessel flaccidity). (Heart governs vessels.) Pivot breaks and cannot lift. (Pivot joint like broken/lifted.) Calves extend but cannot bear weight. Liver Qi Heat causes gallbladder leakage and bitter taste. (Gallbladder is Liver's palace; Heat causes bile overflow.) Fascia dries; dried fascia causes tendon tension and contraction, generating Jin Wei (tendon flaccidity). (Liver governs tendons.) Spleen Qi Heat causes dry mouth and thirst. (Cannot transport fluids for Stomach.) Muscle numbness. (Loss of pain/itch sensation.) Generates Rou Wei (flesh flaccidity). (Spleen governs flesh.) Kidney Qi Heat causes inability to raise waist and spine. (Waist is Kidney's residence; Kidney meridian penetrates spine.) Bones wither and marrow decreases, generating Gu Wei (bone flaccidity). (Kidney governs bones.) How are these acquired? Answer: Lung is the chief of Zang organs, cover of Heart. Loss or unfulfilled desires cause Lung sounds. (Unfulfilled Heart will, Fire flares up scorching Lung, Metal overcome by Fire, causing wheezing sounds.) Sounds lead to Lung Heat and scorched leaves. Thus, all five Zang organs, due to Lung Heat and scorched leaves, develop Wei Bi. (Lung is Minister Official, master of Qi, source of regulation. Human movement depends on Lung. Lung Heat scorches leaves, Qi has no master, loses regulation, causing flaccidity and limb immobility.) Excessive grief severs Bao Luo (pericardium collaterals); severance causes internal movement of Yang Qi. (Bao Luo belongs to Heart, connects to uterus; grief tightens Heart ties, lifts Lung leaves, blocks Bao Luo, Wei Qi cannot exit externally but moves internally.) Onset causes Heart collapse and frequent hematuria. Thus, major vessels become empty. (Blood loss causes deficiency.) Develops Ji Bi, transmitting to Mai Bi. (First muscle numbness/bi, then vessel flaccidity, calves unable to bear weight.) Endless thinking, unfulfilled wishes, mind wanders externally. (Delusions.) Excessive sexual intercourse causes Zong Jin (major sinews) to relax, developing Jin Wei and Bai Yin (white discharge overflowing, like turbid leukorrhea). Originates in Liver. (Liver governs tendons.) Internal exertion. (Sexual fatigue.) Gradual immersion in dampness. (Soaking in water/dampness.) Working with water. (Loving alcohol/water.) Residual retention. (Water/dampness lingers.) Living in damp places, muscles soak, bi-syndrome with numbness develops as Rou Wei. Acquired from damp ground. (Ground dampness harms skin/flesh/sinews/vessels.) Long travel and fatigue, encountering intense heat and thirst; thirst causes internal attack by Yang Qi; internal attack stores Heat in Kidney. Kidney is Water organ; now Water cannot overcome Fire, bones wither, marrow empties, feet cannot support body, developing Gu Wei. Acquired from intense heat. (Kidney dislikes dryness.) Lung Heat: white complexion, ruined hair. Heart Heat: red complexion, overflowing collateral vessels. Liver Heat: dark complexion, withered nails. (Nails are surplus of tendons.) Spleen Heat: yellow complexion, internal蠕动 (quivering/movement). Kidney Heat: black complexion, withered teeth. (Teeth are surplus of bones.) Treating Wei syndromes exclusively takes Yangming. Why? Yangming is the sea of five Zang and six Fu organs. (Stomach is sea of grain/water.) Mainly moistens Zong Jin. (Vertical sinews above/below pubic bone, connecting chest/abdomen, passing back/front, head/neck, buttocks.) Zong Jin binds bones and facilitates joints. Chong Mai is the sea of twelve meridians. (Receives blood from twelve meridians, sea of blood.) Mainly infiltrates Xi Gu (valleys of flesh). (Large muscle gatherings are valleys, small are streams.) Combines with Yangming at Zong Jin. (Chong meridian ascends 0.5 cun lateral to umbilicus; Yangming meridian ascends 1.5 cun lateral to umbilicus; Zong Jin meridian is in between.) Yin and Yang (Three Yin, Three Yang) converge at Zong Jin, meeting at Qichuan. (Arterial pulse beside pubic hair.) Yangming leads them. All belong to Dai Mai (Girdle Vessel) and connect to Du Mai (Governor Vessel). (Dai Mai starts at hypochondrium, encircles body like a belt; Yangming connects to Dai Mai, linking to Du Mai.) Thus, Yangming deficiency causes Zong Jin relaxation, Dai Mai fails to pull, leading to foot flaccidity and non-use. (Unable to serve functions.) (*Wei Lun*)
[Suwen] Yang Qi deficiency below leads to Han Jue (Cold Reversal). Yin Qi deficiency below leads to Re Jue (Heat Reversal). (Deficiency below causes reversal ascending upward.) Why does Re Jue heat always start from the soles? Yang Qi originates at the surface of the five toes. (Foot Three Yang meridians.) Yin meridities gather at the soles and converge at the sole center. (Foot Three Yin meridians.) Thus, Yang Qi prevalence causes hot soles. (Yin deficiency.) Why does Han Jue cold always rise from toes to knees? Yin Qi originates at the interior of the five toes. (Foot Three Yin meridities.) Gathers below knees and converges above knees. Thus, Yin Qi prevalence causes cold from toes to knees. This cold does not come from outside, but arises from within. (Yin excess generates internal cold, not external contraction.) Why did Han Jue occur? Anterior yin is the gathering place of Zong Jin, and the convergence of Taiyin and Yangming. (Spleen/Stomach meridians flank Zong Jin. *Jiayi Jing* says Jueyin, gathering of many sinews, another view.) Spring/Summer: more Yang, less Yin. Autumn/Winter: more Yin, less Yang. This robust person, however, exhausts themselves in Autumn/Winter (excessive desire depletes Yin). Lower Qi struggles upward and cannot return. (Cannot return to meridians.) Essence overflows downward. (Yin essence leaks downward.) Pathogenic Qi follows upward. Qi stagnates in the middle. (Cold originates internally, i.e., not from outside. Zhang Zhongjing note: Qi generated from Middle Jiao grain/water, also valid.) Yang Qi deficiency fails to nourish meridians; Yang Qi daily diminishes, Yin Qi remains alone, hence cold hands/feet. How does Re Jue occur? Wine enters Stomach, collateral vessels fill, main vessels empty. Spleen transports fluids for Stomach. Yin Qi deficiency allows Yang Qi entry. (Yang guards exterior; Yin deficiency allows internal Yang attack, i.e., Yin insufficiency attracts Yang.) Yang Qi entry causes Stomach disharmony; Stomach disharmony causes essence/Qi exhaustion. (Failure to generate essence/Qi.) Essence/Qi exhaustion fails to nourish four limbs. (This is also the principle of taking Yangming exclusively.) Such persons often drink heavily or engage in sex after full meals. Qi gathers in Spleen, unable to disperse. Wine Qi and Grain Qi contend, Heat盛 in middle, hence Heat pervades body, internal heat, red urine. Wine Qi is vigorous and fierce, Kidney Qi daily declines. (Scorches Yin essence.) Yang Qi alone prevails, hence hot hands/feet. Jue syndromes may have abdominal fullness, or sudden unconsciousness, lasting half a day to a day. Why? Yin Qi excess above causes below deficiency; below deficiency causes abdominal fullness. (Cold excess causes distension.) Yang Qi excess above causes lower Qi to rush upward, pathogenic Qi reverses; reversal causes Yang Qi chaos; Yang Qi chaos causes unconsciousness. (Heat excess causes unconsciousness.) Ju Yang Jue: swollen head, heavy head, inability to walk. (Meridian goes to vertex, penetrates heel.) Leads to falling. (Top-heavy, bottom-light.) Yangming Jue: mania, wanting to run/shout, abdominal fullness, inability to lie down, red face, heat, hallucinations, delirious speech. (Note: Yangming has much blood/Qi; symptoms show excess, different from deficiency Jue.) Shaoyang Jue: sudden deafness, swollen hot cheeks, flank pain, inability to move. (All meridian pathways.) Taiyin Jue: abdominal fullness, bloating, bowel difficulty, anorexia, vomiting after eating, inability to lie down. (Spleen disease involving Stomach.) Shaoyin Jue: dry mouth, red urine. (Kidney Heat.) Abdominal fullness, heart pain. (Meridian connects to Heart, enters chest.) Jueyin Jue: lower abdominal swelling/pain. (Meridian reaches lower abdomen.) Abdominal distension. (Liver governs distension, Wood excess overcomes Earth.) Urinary/intestinal dysfunction. (Liver Fire.) Preference for lying with bent knees. (Sinew decline.) Genital shrinkage/swelling, internal heat. (Meridian connects to genitalia, inner thigh.) (*Jue Lun*)
[Lingshu] Hundred diseases often improve in morning, stabilize in day, worsen in evening, and peak at night. Why? Answer: Spring birth, Summer growth, Autumn harvest, Winter storage, this is the norm of Qi. Humans correspond. Dividing day into four times: Morning is Spring, Noon is Summer, Sunset is Autumn, Midnight is Winter. Morning: Human Qi begins to grow, Pathogenic Qi declines, hence improvement. Noon: Human Qi grows, growth overcomes pathogen, hence stability. Evening: Human Qi begins to decline, Pathogenic Qi begins to grow, hence worsening. Midnight: Human Qi enters Zang, Pathogenic Qi dwells alone in body, hence severity. Cases contrary to this? Why? Not responding to Four Times Qi, only one Zang dominates the disease. (One Zang dominating disease cannot respond to daily four times.) Severity occurs at times when Zang Qi is overcome. (e.g., Spleen disease cannot overcome Morning Wood, Lung disease cannot overcome Day Fire, Liver disease cannot overcome Evening Metal, Heart disease cannot overcome Night Water, hence worsening at these times.) Recovery occurs at times when Zang Qi overcomes. (e.g., Lung Qi overcomes Morning Wood, Kidney Qi overcomes Day Fire, Heart Qi overcomes Evening Metal, Spleen Qi overcomes Night Water, at overcoming times, improvement/stability occurs, not bound by "morning improve, day stable, evening worsen, night severe" rule. Aligning Qi divides day into four times.)