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Bi Syndrome (Obstruction Syndrome) refers to a condition characterized by numbness, stiffness, and loss of sensation, where the patient is unaware of pain or itching. The etiology of this disease mostly arises from the mixed invasion of Wind, Cold, and Dampness pathogens, varying in depth and severity. Initially, it was understood that "unawareness of pain and itching" was merely one aspect of Bi Syndrome, indicating an incomplete comprehension of its meaning. However, upon reviewing the text, Bi Syndromes affecting the Zang-Fu organs include Heart Bi causing obstruction of vessels, Liver Bi causing drawing sensations in the lower abdomen resembling pregnancy, Kidney Bi prone to abdominal distension, Spleen Bi causing severe abdominal blockage, Intestine Bi preventing urination after drinking, Bladder Bi causing internal pain and dysuria, up to Bi accumulation in the Lung or Heart, all implying a state of stagnation and obstruction. Thus, Bi Syndrome is also named for "closure" (obstruction). (The four sentences "Yin Qi, when still, stores the Spirit" appearing elsewhere in the chapter are highly refined in meaning but irrelevant to Bi Syndrome, likely due to bamboo slip dislocation.)

The Yellow Emperor asked: How does Bi Syndrome arise? Qibo replied: When Wind, Cold, and Dampness mix and invade together, they combine to form Bi Syndrome. If Wind predominates, it is called Xing Bi (Wandering Bi); if Cold predominates, it is called Tong Bi (Painful Bi); if Dampness predominates, it is called Zhuo Bi (Fixed Bi). (Although they combine to form Bi, their origins differ. Wind, being Yang, affects Yang aspects, leading to wandering Bi; Cold, being Yin, affects Yin aspects, leading to painful Bi; Dampness affects skin, flesh, tendons, and vessels, leading to fixed and lingering Bi. Note: Zhuo [fixed] implies immobility.)

The Yellow Emperor asked: Why are there five types? Qibo said: Contracting these pathogens in Winter results in Gu Bi (Bone Bi); in Spring, Jin Bi (Tendon Bi); in Summer, Mai Bi (Vessel Bi); during the late summer (Zhi Yin), Ji Bi (Muscle Bi); and in Autumn, Pi Bi (Skin Bi). (Note: This refers to Wind, Cold, and Dampness. Contracting these pathogens in Winter leads to Bi in bones, etc., which is a general statement.)

The Yellow Emperor asked: What causes the pathogens to enter internally and lodge in the Zang-Fu organs? Qibo said: Each Zang organ has a corresponding exterior tissue. If the disease persists without resolution, it enters internally into its corresponding Zang. Thus, if Bone Bi persists and re-exposure occurs, it lodges in the Kidney; if Tendon Bi persists, it lodges in the Liver; if Vessel Bi persists, it lodges in the Heart; if Muscle Bi persists, it lodges in the Spleen; if Skin Bi persists, it lodges in the Lung. Such Bi Syndromes occur when one contracts Wind, Cold, and Dampness again during the respective seasonal associations. (Note: "Correspondence" refers to relationships like Kidney-Bone, Liver-Tendon. Pathogens enter from outside to inside; if tendons/bones are obstructed and external pathogens are contracted again, they inevitably affect the Liver/Kidney, termed lodging in their correspondence. The following five paragraphs detail this internal lodging.)

When Bi pathogens lodge in the Zang organs:
Lung Bi manifests as irritability, fullness, wheezing, and vomiting. (Due to organ qi relating to respiration and meridians circling the stomach region.)
Heart Bi manifests as vessel obstruction, palpitations when irritable, sudden upward rushing of Qi with wheezing, dry throat, frequent belching, and fear when rebellious Qi ascends to the Heart. (Heart corresponds to vessels; pathogen obstruction causes vessel dysfunction. Internal disturbance causes irritability. The Pericardium meridian originates in the chest, and the Heart meridian originates in the heart, both connecting via the diaphragm. Branches ascend to the throat and lungs. Irritation causes palpitations and upward Qi rush. Belching releases pressure. Rebellious Qi frightening the Heart spirit causes fear.)
Liver Bi manifests as fright during sleep, excessive thirst, frequent urination, and upward pulling sensations in the lower abdomen resembling pregnancy. (Liver governs fright. Its meridian circles the genitals and ascends to the lower abdomen, causing these symptoms.)
Kidney Bi manifests with frequent abdominal distension, inability to stand upright using heels (using buttocks instead of heels), and stooping posture (spine replacing the head). (Kidney is the gate of the Stomach; obstruction causes distension. "Buttocks replacing heels" indicates leg contracture; "Spine replacing head" indicates spinal curvature. These describe severe distension and immobility. Kidney is the source of vital Qi; its obstruction leads to this state.)
Spleen Bi manifests as flaccidity and weakness of the four limbs, coughing, vomiting of fluids, and severe upper jiao blockage. (Earth governs the four limbs; meridian pathways explain the other symptoms.)
Intestine Bi manifests as frequent drinking but inability to urinate, abdominal Qi turbulence, and occasional undigested stool diarrhea. (Pathogens in intestines obstruct Qi transmission, causing stagnation and diarrhea.)
Bladder Bi manifests as internal pain in the lower abdomen/bladder area upon pressure (feeling like hot water pouring), dysuria, and clear nasal discharge above. (Heat in the bladder causes pain and dysuria; rising heat causes clear nasal discharge. Cold condensation can also cause Bladder Bi with cold pain and retention, treatable with Cinnamon Twig and Aconite Decoction.)

Rebellious Qi causing wheezing indicates Bi accumulating in the Lung; rebellious Qi causing worry/thought indicates Bi accumulating in the Heart; rebellious Qi causing enuresis indicates Bi accumulating in the Kidney; rebellious Qi causing exhaustion indicates Bi accumulating in the Liver; rebellious Qi causing muscle atrophy indicates Bi accumulating in the Spleen. (Rebellious Qi refers to erratic Qi entering according to the affected organ. Note: Some editions place this section in the Treatise on Differentiating Yin and Yang.)

If various Bi Syndromes persist, they deepen internally. Those dominated by Wind are easier to cure (as they remain superficial compared to deep Zang-Fu involvement).

The Yellow Emperor asked: Why do some die, some suffer long-term pain, and some recover easily? Qibo said: Invasion of Zang organs leads to death (loss of Spirit); lingering in sinews/bones causes long-term pain (fixed location); remaining in skin allows easy recovery (superficial).

The Yellow Emperor asked: How does Bi affect the Fu organs? Qibo said: This stems from diet and lifestyle. Fu organs have Shu points; Wind/Cold/Dampness attack these points, and improper diet facilitates entry, lodging in the respective Fu. (Fu are Yang/superficial; lifestyle factors weaken defense, allowing pathogens to enter.)

The Yellow Emperor asked: How to treat with acupuncture? Qibo said: Zang organs have Shu points, Fu organs have He-Sea points. Following meridian distributions and treating specific lesions (Guo) leads to recovery (Chou). (Note: "Guo" means lesion/error, not just pathway. "Chou" means cure.)

The Yellow Emperor asked: Do Ying (Nutrient) and Wei (Defensive) Qi cause Bi? Qibo said: Ying Qi is essence of food/water, harmonizing Zang, distributing to Fu, entering vessels to circulate everywhere. Wei Qi is fierce/hasty Qi of food/water, too rapid to enter vessels. It circulates in skin/muscle spaces, warming Huang membrane and chest/abdomen. If Wei Qi flows smoothly, health prevails; if reversed, disease occurs. Since Wei Qi does not combine with Wind/Cold/Dampness internally, it does not form Bi itself. (However, Wei Qi deficiency allows pathogens to enter, leading to Bi involving Ying Qi but sparing Wei Qi initially.)

The Yellow Emperor asked: Why do some Bi cases hurt, others not, some numb, some cold, some hot, some dry, some damp? Qibo said: Pain is due to excess Cold (Cold causes Qi/Blood stasis). Lack of pain and numbness indicates deep disease, sluggish Ying/Wei flow, and empty meridians. Skin lack of Ying nourishment causes numbness. Cold sensation arises from deficient Yang and excess Yin. Heat sensation arises from excess Yang and deficient Yin (Yang overcoming Yin). Sweating and dampness result from severe Dampness combined with weak Yang and strong Yin (Yin and Dampness resonate).

The Yellow Emperor asked: Why is Bi sometimes painless? Qibo said: Bi in bone causes heaviness; in vessels, blood stagnation; in tendons, flexion inability; in flesh, numbness; in skin, coldness. Possessing these five signs results in no pain. Generally, Bi tightens with Cold and relaxes with Heat. (Note: Painless Bi varies by location. Cold causes pain; thus, many painless cases exist. Cold causes contraction; Heat causes relaxation.)