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Pathogenic factors retained in the body, clashing with the true Qi circulating in Ying and Wei (Nutritive and Defensive levels), result in Painful Bi syndrome. If the pathogen does not obstruct its pathways of circulation and exit, pain will not occur, only Wei-Bi (flaccidity and numbness). Depending on the location of the Bi syndrome, if Yang is excessive and Yin deficient, it manifests as Heat-Bi; if Yin is excessive and Yang deficient, it manifests as Cold-Bi. Although it is said that Wind, Cold, and Dampness mixing together cause Bi syndrome, in the "Su Wen: Chapter on Four Seasons Acupuncture Reversals and Conformities," it is stated regarding the Six Channels that both excess and deficiency can lead to Bi. The commentary notes: Bi means pain; does this not imply that internal Qi disorders also cause pain? Furthermore, bodily pain differs in the skin, flesh, vessels, sinews, and bones externally. Due to different pathogenic factors, names must be correctly assigned; without correct naming, how can treatment be applied? If the cause is the Six Excesses (Six Pathogenic Factors), one must treat the pathogen. If it is a disorder of internal Qi, one must tonify or sedate the Qi. For diseases in the Six Channels and the four limbs, treatment should follow the nature of the Qi. Therefore, when formulating prescriptions, one must distinguish the heaviness, lightness, slowness, and urgency of herbs, ensuring they are appropriate, to truly understand the classics. Causes include Wind, Dampness, Phlegm, Fire, Blood Deficiency, and Blood Stasis. A floating pulse indicates Wind. A slow and fine pulse indicates Dampness. A slippery pulse indicates Phlegm. A surging and large pulse indicates Fire. A hollow pulse indicates Blood Deficiency. A choppy pulse indicates Blood Stasis. For cases caused by Wind, modify Xiao Xu Ming Tang (Minor Continuation of Life Decoction) or Wu Yao Shun Qi San (Aucklandia Regulating Qi Powder) by removing Gan Jiang (Dried Ginger) and adding Qiang Huo (Notopterygium Rhizome) and Fang Feng (Saposhnikovia Root). For cases caused by Dampness, which flare up during rainy weather with heavy body sensation, use Chu Shi Juan Tong Tang (Dampness-Removing Pain-Relieving Decoction), assisted by Zhu Li (Bamboo Sap) and Jiang Zhi (Ginger Juice), or Da Ju Pi Tang (Large Tangerina Peel Decoction). For injury from Dampness combined with Wind-Cold, presenting with sweating, heavy body, aversion to wind, wheezing and chest fullness, vexing pain in bone joints resembling Li Jie Feng (Erythema Nodosum-like condition), cold Bi extending from below the navel to the feet with inability to flex and extend, use Fang Ji Huang Qi Tang (Stephania and Astragalus Decoction) or Wu Bi Tang (Five Bi Decoction). For cases caused by Phlegm, use Wang Yin Jun's Huo Tan Tang (Phlegm-Expelling Decoction), Er Chen Tang (Two Aged Ingredients Decoction) with Ginger Juice and Bamboo Sap; for severe cases, Kong Xian Dan (Saliva-Controlling Pill). For cases caused by Fire, use Qian Xing San (Hidden Movement Powder) with Bamboo Sap. For Damp-Heat, use Er Miao San (Two Marvels Powder). For Blood Deficiency, use Si Wu Cang Zhu Ge Ban Tang (Equal Parts Rehmannia-Atractylodes Formula based on Four Substances) taken with Huo Xue Dan (Blood-Invigorating Pill). For Blood Stasis, use Xiong Gui Tao Ren Hong Hua Shui Zhi (Ligusticum, Angelica, Peach Kernel, Safflower, Leech) with a small amount of She Xiang (Musk). Fat people tend to have Damp-Phlegm. Thin people tend to have Blood Deficiency and Heat. For upper body pain, use Qiang Huo, Gui Zhi (Cinnamon Twig), Jie Geng (Platycodon Root), and Wei Ling Xian (Clematis Root). For lower body pain, use Niu Xi (Achyranthes Root), Fang Ji, Mu Tong (Akebia Stem), and Huang Bo (Phellodendron Bark). For upper body swelling and pain, use Wu Ji San (Five Accumulations Powder) or Wu Yao Shun Qi San with Sheng Jiang (Fresh Ginger) and Cong Bai (Scallion White) decocted to induce sweating. For lower body swelling and pain, use Wu Ling San (Five Ling Powder), Ba Zheng San (Eight Rights Powder), or Da Ju Pi Tang, adding Deng Xin Cao (Juncus Effusus) and Zhu Ye (Bamboo Leaf) to promote urination. If swelling and pain are accompanied by constipation, Da Chai Hu Tang (Major Bupleurum Decoction) or Fang Feng Tong Sheng San (Saposhnikovia Unblocking Prosperity Powder) should be used. After the major symptoms subside, treatment should address the root cause to prevent recurrence; avoid mutton, Fa Jiu (Medicated Wine), wet noodles, and sexual exertion. When Cold and Damp combine, causing pain at Naohu (GV17), aversion to cold, stiffness of neck sinews and spine, pain in shoulders, back, scapulae, and genitals, knee cap pain with weakness in walking, good appetite, heavy body, and a pulse that is deep, slow, surging above but rapid at the top, use Cang Fu Jian San (Atractylodes and Magnolia Re-decoction Powder). For eyes swollen and painful like fire, pain in sinews and bones of both feet and Futu (ST32), weak knees, heavy body, lower back pain, night-time aversion to cold, cough with phlegm, stiffness and pain in neck and jaw sinews/bones, excessive eye discharge and tearing, poor appetite, use Huan Jin Tang (Sinew-Relaxing Decoction). When Wind-Damp invades the Kidney channel, causing blood vessel stagnation, swelling and pain in waist and back, inability to turn sideways, skin insensitivity, whole-body numbness, upper puffiness of neck/head/eyes, constant tinnitus, downward flow causing heavy/painful/weak legs making walking difficult, neck/back stiffness preventing comfort, use Huo Xue Ying Tong Wan (Blood-Invigorating Pain-Responding Pill). If quiet by day and active by night, with bone-penetrating pain like a tiger bite, it is named Bai Hu Bing (White Tiger Disease). Pain like pulling indicates excess Cold; swelling/fullness like detachment indicates excess Dampness; sweating indicates excess Wind; seek corresponding remedies among the aforementioned herbs. Common prescription: Hu Gu (Tiger Bone) 2 liang, Xi Jiao Xie (Rhinoceros Horn Shavings - *Note: Use substitutes in modern practice*), Chen Xiang (Aquilaria Wood), Qing Mu Xiang (Aucklandia Root), Dang Gui (Angelica Sinensis), Chi Shao Yao (Red Peony Root), Niu Xi, Qiang Huo, Qin Jiao (Gentiana Macrophylla Root), Gu Sui Bu (Drynaria Rhizome), Tao Ren (Peach Kernel) each 1 liang, Gan Cao (Licorice Root) half liang, Hu Ye (Oak Leaf) one handful. Take 5 qian per dose, decoct in water, add a little She Xiang before taking. One patient contracted Wind-Damp, developing White Tiger Li Jie Feng syndrome, with whole-body twitching pain and inability to walk for three years, unresponsive to hundreds of prescriptions. One day he dreamed of being cured by Mu Tong Tang, so he took Si Wu Tang with Mu Tong, but it failed. Later, he took 2 liang of Mu Tong, finely chopped, decocted in running water, and drank it in one dose. About an hour later, his whole body itched severely, turning red with bean-sized rashes. His family panicked, wiping them away. Sweating occurred down to the waist, stopping there, and upper body pain ceased. The next day, he took it again as before; red rashes appeared on the lower body, and sweating extended to the soles of the feet. After the sweat dried, his whole body felt comfortable and pain-free. Within a month, his vigorous Qi recovered, and he walked as before. This was effective for several others. The principle is: obstruction causes pain, freedom from obstruction relieves pain.

Irrigation Method: The "Ling Shu" states that Cold Bi disease, remaining unchecked, causes intermittent pain and skin insensitivity. For commoners, use fire acupuncture. For nobles, use medicinal irrigation. Use 20 jin of pure wine, 1 sheng of Shu Jiao (Sichuan Pepper), 1 jin of Gan Jiang (Dried Ginger), 1 jin of Gui Xin (Cinnamon Heart). These four ingredients are crushed and soaked in wine. Add 1 jin of cotton wadding and 4 zhang of fine white cloth into the wine. Place the mixture in fermenting horse manure heat source, seal and coat tightly to prevent leakage. Leave for five days and nights. Remove cloth and wadding, dry them in the sun, then re-soak until all juice is extracted. Each soaking must last the prescribed duration. Dry them again. Mix the dregs with wadding, wrap in cloth to make multiple towels, 6-7 chi long. Use live mulberry charcoal to heat the towels, and apply to the acupoints treated for Cold Bi, allowing heat to penetrate to the lesion site. When cool, reheat and apply. Repeat thirty times. Wipe sweat with towel, thirty times. Enter the room immediately, avoiding wind. Irrigate after every needling session. Thus the disease resolves. This is called "Internal Heat" (Nei sounds like Na).

The "Wai Tai Mi Yao" prescribes 5 sheng of three-year strong vinegar, heated to three or four boils. Cut 2-3 sheng of Scallion White, boil once, strain. Wrap in hot cloth and apply to the diseased area until healed.

Fumigation and Washing Method: Use 1 dou of Camphor Wood chips, place in a large barrel. Place a legless stool beside the barrel. Pour one dan of fast-flowing boiling water into the barrel. Place a low stool nearby, sit by the barrel, put feet in the barrel, surround outside with straw mats to prevent steam from entering the eyes.

[Joint Swelling and Pain] Pain belongs to Fire, swelling belongs to Dampness. Combined with Wind-Cold activating in the meridians and flowing into the joints, use Ma Huang (Ephedra Stem) de-jointed and Chi Shao Yao (Red Peony Root) each 1 qian; Fang Feng, Jing Jie (Schizonepeta), Qiang Huo, Du Huo (Angelica Pubescens), Bai Zhi (Angelica Dahurica), Cang Zhu (Atractylodes Lancea), Wei Ling Xian, Jiu Pian Qin (Wine-fried Scutellaria Root), Zhi Shi (Immature Bitter Orange), Jie Geng, Ge Gen (Pueraria Root), Chuan Xiong (Ligusticum Chuanxiong) each 5 fen; Dang Gui, Gan Cao, Sheng Ma (Cimicifuga Rhizome) each 2 fen. For Lower Jiao, add Jiu Huang Bo (Wine-fried Phellodendron Bark); for more swelling, add Bin Lang (Areca Seed) and Da Fu Pi (Betel Nut Rind); for more pain, add Mo Yao (Myrrh); for women, add Jiu Hong Hua (Wine-fried Safflower). For Wind-Damp clumping causing joint pain, use Da Qiang Huo Tang (Major Notopterygium Decoction). The "Jin Gui Yao Lue" formula for various joint pains, emaciated body, foot swelling as if detached, vertigo, shortness of breath, nausea, uses Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon Twig, Peony, and Anemarrhena Decoction). Fat people often suffer from Wind-Damp and Phlegm-Fluid flowing in meridians causing pain; use Nan Xing (Arisaema Cum Bile) and Ban Xia (Pinellia Tuber). Thin people have Blood Deficiency and Heat; use Si Wu Tang plus Fang Feng, Qiang Huo, Jiu Qin. Thin people who are irritable with pain and fever have Blood Heat; use Si Wu Tang plus wine-fried Qin and Bo. A soggy-slippery pulse requires drying dampness: Cang Zhu, Nan Xing, combined with Qi-moving herbs: Mu Xiang (Aucklandia Root), Zhi Ke (Bitter Orange), Bin Lang. A choppy-rapid pulse indicates Blood Stasis: Chuan Xiong, Dang Gui, Tao Ren paste, Hong Hua, plus Da Huang (Rhubarb) to mildly purge. Fatigue and weakness with pain require Ren Shen (Ginseng), Bai Zhu (Atractylodes Macrocephala), Nan Xing, Ban Xia. Wind-Heat forming Li Jie Feng attacking fingers causing red swelling and numbness, even spreading to shoulders, back, and knees, flaring with summer heat or constipation, use Niu Bang Zi San (Arctium Seed Powder). This disease involves Phlegm in the chest/diaphragm; over time, red swelling attaches to joints, persisting, eventually becoming Leprosy (Li Feng). Treat early.