大意
风寒湿三气杂至。合而为痹。其风气胜者为行痹。寒气胜者为痛痹。湿气胜者为着痹。（内经）行痹者。痛无
定处。俗名流火。亦曰走注。今呼为鬼箭也。痛痹者。痛有定处。即今之痛风也。着痹者。即今之麻木不仁也。
闭塞不通谓之痹。或痛痒麻痹。或手足缓弱。与痿相类。但痿症不痛。痹症多痛。四肢肌肉不为我用。为异耳。（汇补）
内因
由元精内虚。而三气所袭。不能随时祛散。流注经络。久而成痹。（医鉴）以春遇此为筋痹。以夏遇此为脉痹。
以秋遇此为皮痹。以至阴六月遇此为肌痹。以冬遇此为骨痹。各因其时。重感于风寒湿也。（经文）
外候
大抵痹之为病。在骨则重而不举。在脉则血凝不流。在筋则屈而不伸。在肉则四肢不仁。在皮则顽不自
觉。遇寒则急。遇热则纵。烦满喘呕者。是痹客于肺。烦心上气。嗌干善噫。厥胀满者。是痹客于心。多饮数小
便。小腹满如怀妊。夜卧则惊者。是痹客于肝。善胀。尻以代踵。脊以代头者。是痹客于肾。四肢懈怠。发咳呕
沫。上为大塞者。是痹客于脾。（入门）
脾分上下
风湿多侵于上。肩背麻木。手腕硬痛。寒湿多侵于下。脚腿木重。足膝疼酸。上下俱得。身如板夹。脚如石坠。（汇
补）
痹久成痿
虚之所在。邪必凑之。邪入皮肤血脉。轻者易治。留连筋骨。久而不痛不仁者难治。（汇补）其不痛不仁者。病
久入深。荣卫之行涩。经络时疏。故不痛。皮肤不荣。故不仁。（内经）
总治
治当辨其所感。注于何部。分其表里。须从偏胜者为主。（大全）风宜疏散。寒宜温经。湿宜清燥。审虚实标本
治之。有余则发散攻邪。不足则补养气血。若不痛。但麻痹不仁。与痿同治。（汇补）
分治
治行痹。散风为主。御寒利湿。仍不可废。参以补血之剂。乃治风先治血。血行风自灭也。治痛痹。散寒为主。
疏风燥湿。仍不可缺。大抵参以补火之剂。非大辛大温。不能释其凝寒之害也。治着痹。利湿为主。祛风解
寒。亦不可缺参以补气之剂。盖土强可以胜湿。而气足自无顽麻也。（必读）
治分始末
初起强硬作痛。宜祛风化痰。沉重者。宜流湿行气。久则须分气血虚实。痰瘀多少治之。（汇补）
脉法
脉涩而紧为痹。脉大而涩为痹。脉来急为痹。（严氏）
用药
主以四物汤。加羌活、防风、秦艽、红花、姜黄等。风胜。加白芷。湿胜。加苍术、南星。热胜。加黄柏。寒胜。
加独活、肉桂。上体。加桂枝、威灵仙。下体。加牛膝、防己、萆 、木通、黄柏。初起发表。用升阳散湿汤。调理。
用当归拈痛汤。久而元气虚弱。用补中益气汤。
按湿热痰火。郁气死血。留经络四肢。悉能为麻为痹。或痛或痒。轻而新者。可以缓治。久而重者。必加川乌、
附子。祛逐痰湿。壮气行经。断不可少。大便阻滞。必用大黄。昧者畏其峻利。多致狐疑。不知邪毒流满经络。
非川乌、附子。岂能散结燥热。结滞肠胃。非大黄岂能润燥。要在合宜耳。故筋痹。即风痹也。游行不定。上下
左右。随其虚邪。与血气相搏于关节。或赤或肿。筋脉弛纵者。防风汤。脉痹。即热痹也。脏腑移热。复遇外邪。
客于经络。留而不行。故为 痹。肌肉热极。唇口反裂。皮肤色变。升麻汤。肌痹。即湿痹着痹也。留而不移。汗
多四肢缓弱。皮肤不仁。精神昏塞。俗名麻木。宜茯苓川芎汤。皮痹者。邪在皮毛。瘾疹风疮。搔之不痛。宜疏
风养血。骨痹。即寒痹痛痹也。痛苦切心。四肢挛急。关节浮肿。宜加减五积散。周痹者。周身俱痛。宜蠲痹汤。
血痹者。邪入阴分。若被风吹。骨弱劳疲汗出。卧则摇动。宜当归汤。支饮者。手足麻痹。臂痛不举。多睡眩冒。
忍尿不便。膝冷成痹。茯苓汤。（汇补）
痹症选方
防风汤（河间） 治风胜为行痹。上下行走掣痛。
防风 当归 赤苓 杏仁（各一钱） 黄芩 秦艽 葛根（各二钱） 羌活（八分） 桂枝 甘草（各五分）
加姜。水煎。入酒半杯服。
茯苓汤 治寒胜为痛痹。肿痛拘挛。无汗。
赤苓（一钱半） 桑皮 防风（各一钱） 官桂（五分） 川芎（一钱二分） 芍药 麻黄（各一钱） 姜 枣
茯苓川芎汤 治着痹。四肢重着。流注于经。拘挛浮肿。
即上茯苓汤。加苍术、炙草、大枣。温服。欲出汗。以温粥投之。
升麻汤（河间） 治湿痹。肌肉热极。体上如鼠走。唇口反纵。皮肤色变。兼治诸风热。
升麻 茯苓 人参 防风 犀角（镑） 羚羊角（镑）
羌活（各一钱） 官桂（三分） 生姜 竹沥
五痹汤 治三气客于肌体。手足缓弱。麻痹不仁。
片姜黄 羌活 白术 防己（各一钱） 甘草（五分） 生姜
症在上下。分食前食后。热服。
茯苓汤 治多饮停蓄。手足麻痹。多睡眩冒。
即二陈汤加枳实、桔梗。
蠲痹汤 治周痹。及手足冷痹。脚腿沉重。背项拘急。
赤芍 当归 黄 姜黄 羌活（各一钱半） 甘草（五分）
姜枣煎。
当归汤
当归（二钱） 赤芍（一钱五分） 独活 防风 赤苓 黄芩 秦艽（各一钱） 甘草（六分） 桂心（三分） 生
姜
羌活汤 治白虎历节风毒。攻注骨节疼痛。发作不定。
羌活 附子 秦艽 桂心 木香 川芎 当归 牛膝 桃仁 骨碎补 生姜
虎骨散 治白虎肢节痛。发则痛不可忍。
虎骨 甘草 全蝎（去毒各五钱） 麝香（一分） 天麻 防风 牛膝 僵蚕 当归 乳香 桂心 白花蛇（酒浸
取肉各二两）
每服三钱。豆淋酒下。
续断丸 治风湿流注。四肢浮肿。肌肉麻痹。
当归 续断 萆 （各一两） 川芎（七钱半） 乳香（五钱） 天麻 防风 附子（各一两） 没药（五钱）
蜜丸。温酒下。
[General Principles]
The three pathogenic factors of Wind, Cold, and Dampness mix together to invade the body, combining to form Bi Syndrome (Obstruction Syndrome). When Wind is predominant, it is called Moving Bi (Xing Bi); when Cold is predominant, it is called Painful Bi (Tong Bi); when Dampness is predominant, it is called Fixed Bi (Zhuo Bi). (*Huangdi Neijing* / *Yellow Emperor's Inner Canon*) Moving Bi refers to pain with no fixed location, commonly known as "Flowing Fire," also called "Wandering Injection," and currently referred to as "Ghost Arrow." Painful Bi refers to pain with a fixed location, which corresponds to modern Gout. Fixed Bi corresponds to modern numbness and insensitivity. Obstruction and blockage are defined as Bi. Some present with pain, itching, or paralysis; others present with flaccidity and weakness of the limbs and hands/feet, resembling Wei Syndrome (Atrophy Syndrome). However, Wei Syndrome does not involve pain, whereas Bi Syndrome often involves pain; the difference lies in the inability of the limbs and muscles to function voluntarily. (*Zhengzhi Huibu* / *Compendium of Syndrome Differentiation and Treatment*)
[Etiology: Internal Factors]
Due to internal deficiency of Yuan Jing (Primordial Essence), the three pathogenic factors of Wind, Cold, and Dampness invade and cannot be dispelled in time, flowing into the meridians and collaterals, eventually forming Bi Syndrome over time. (*Yijian* / *Medical Mirror*) If this occurs in Spring, it is Sinew Bi (Jin Bi); if in Summer, it is Vessel Bi (Mai Bi); if in Autumn, it is Skin Bi (Pi Bi); if in the sixth month (Late Summer), it is Muscle Bi (Ji Bi); if in Winter, it is Bone Bi (Gu Bi). This varies according to the season, involving repeated exposure to Wind, Cold, and Dampness. (Scripture)
[External Manifestations]
Generally, regarding Bi Syndrome: if the pathogen is in the bones, the body feels heavy and difficult to lift; if in the vessels, blood coagulates and fails to flow; if in the sinews, flexion occurs but extension is impossible; if in the flesh, the four limbs are numb and insensitive; if in the skin, the skin becomes hard and sensation is dull. Exposure to Cold causes contraction/spasm, while exposure to Heat causes relaxation/flaccidity. Irritability, fullness, wheezing, and vomiting indicate Bi pathogen lodging in the Lung; irritability, rebellious Qi, dry throat, and frequent belching indicate Bi pathogen lodging in the Heart; excessive drinking, frequent urination, lower abdominal fullness resembling pregnancy, and night terrors indicate Bi pathogen lodging in the Liver; easy bloating, sitting on the buttocks instead of walking on heels, and the spine bending so the head lowers indicate Bi pathogen lodging in the Kidney; limb lassitude, coughing with frothy sputum, and severe upper obstruction indicate Bi pathogen lodging in the Spleen. (*Yixue Rumen* / *Introduction to Medicine*)
[Spleen: Upper and Lower Involvement]
Wind-Dampness tends to invade the upper body, causing numbness in the shoulders and back, and stiffness/pain in the wrists and hands. Cold-Dampness tends to invade the lower body, causing heaviness/numbness in the legs and feet, and soreness/pain in the ankles and knees. If both upper and lower are affected, the body feels stiff like being clamped by boards, and the legs feel heavy like stones. (*Zhengzhi Huibu* / *Compendium of Syndrome Differentiation and Treatment*)
[Chronic Bi Leading to Wei]
Where Qi is deficient, pathogens gather. If pathogens enter the skin and blood vessels, the condition is mild and easier to treat. If they linger in the sinews and bones, becoming chronic without pain but with numbness, it is difficult to treat. (*Zhengzhi Huibu* / *Compendium of Syndrome Differentiation and Treatment*) Those who experience no pain but only numbness do so because the disease has been long-standing and deep; Ying and Wei Qi circulation is sluggish, and meridians are occasionally empty, hence no pain; the skin lacks nourishment, hence numbness. (*Huangdi Neijing* / *Yellow Emperor's Inner Canon*)
[General Treatment]
Treatment must distinguish the invading pathogen, determine the location, differentiate interior/exterior, and focus on the predominant pathogen. (*Jingyue Quanshu* / *Complete Works of Jingyue*) For Wind, use dispersing methods; for Cold, use warming meridians methods; for Dampness, use clearing/drying methods. Assess deficiency/excess and root/branch. For excess patterns, disperse and attack pathogens; for deficiency patterns, tonify Qi and Blood. If there is no pain, only numbness and insensitivity, treat similarly to Wei Syndrome. (*Zhengzhi Huibu* / *Compendium of Syndrome Differentiation and Treatment*)
[Specific Treatment]
For Moving Bi, prioritize dispersing Wind, while controlling Cold and draining Dampness is not abandoned; incorporate blood-nourishing formulas, following the principle that "treating Wind requires treating the Blood first; when Blood flows, Wind extinguishes itself." For Painful Bi, prioritize dispersing Cold, while venting Wind and drying Dampness is indispensable; generally incorporate fire-tonifying formulas, as only strongly acrid and warm herbs can relieve the harm of congealed Cold. For Fixed Bi, prioritize draining Dampness, while expelling Wind and resolving Cold is not omitted; incorporate Qi-tonifying formulas, because strengthening Earth (Spleen) overcomes Dampness, and sufficient Qi eliminates stubborn numbness. (*Jingyue Quanshu* / *Complete Works of Jingyue*)
[Treatment Stages]
In the initial stage with stiffness and pain, use wind-dispersing and phlegm-resolving methods; for heaviness, use damp-draining and Qi-moving methods. In chronic stages, differentiate Qi/Blood deficiency/excess and the degree of Phlegm/Stasis for treatment. (*Zhengzhi Huibu* / *Compendium of Syndrome Differentiation and Treatment*)
[Pulse Diagnosis]
A choppy and tight pulse indicates Bi; a large and choppy pulse indicates Bi; a rapid pulse indicates Bi. (Yan Shi)
[Herbal Medication]
The main formula is Siwu Tang (Four Substances Decoction), added with Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Qinjiao (Gentianae Macrophyllae Radix), Honghua (Carthami Flos), and Jianghuang (Curcumae Longae Rhizoma). If Wind is predominant, add Baizhi (Angelicae Dahuricae Radix); if Dampness is predominant, add Cangzhu (Atractylodis Rhizoma) and Nanting (Arisaematis Rhizoma Preparatum); if Heat is predominant, add Huangbai (Phellodendri Cortex); if Cold is predominant, add Duhuo (Angelicae Pubescentis Radix) and Rougui (Cinnamomi Cortex). For upper body involvement, add Guizhi (Cinnamomi Ramulus) and Weilingxian (Salviae Miltiorrhizae Radix et Rhizoma - *Note: Contextually usually Saposhnikoviae or similar, but text says Weilingxian*); for lower body involvement, add Niuxi (Achyranthis Bidentatae Radix), Fangji (Stephaniae Tetrandrae Radix), Bibi (Dioscoreae Hypoglaucae Rhizoma), Mutong (Akebiae Caulis), and Huangbai (Phellodendri Cortex). For initial exterior release, use Shengyang San Shi Tang (Raising Yang and Dispersing Dampness Decoction); for regulation, use Danggui Nian Tong Tang (Angelica Joint-Pain Relieving Decoction); for chronic Qi/Yuan deficiency, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).
Commentary: Damp-Heat, Phlegm-Fire, constrained Qi, and dead blood lingering in meridians and limbs can all cause numbness or Bi, with pain or itching. Mild and new cases can be treated slowly; chronic and severe cases require Chuanwu (Aconiti Radix Preparata) and Fuzi (Aconiti Lateralis Radix Preparata) to expel Phlegm-Dampness and strengthen Qi to move through meridians, which is absolutely essential. If stool is obstructed, Dahuang (Rhei Radix et Rhizoma) is necessary. Ignorant physicians fear its harsh purgative action and hesitate, not realizing that for pathogens flooding the meridians, without Chuanwu and Fuzai, how can knots be dispersed and heat dried? For stagnation in the intestines/stomach, without Dahuang, how can dryness be moistened? The key is appropriateness. Thus, Sinew Bi is Wind Bi, moving unpredictably, interacting with Blood/Qi at joints, causing redness/swelling and flaccid sinews; use Fangfeng Tang. Vessel Bi is Heat Bi, where organ heat combines with external pathogens lodging in meridians, causing extreme muscle heat, cracked lips/mouth, and skin color changes; use Shengma Tang. Muscle Bi is Damp/Fixed Bi, lingering in place, with excessive sweating, limb flaccidity, skin numbness, and mental cloudiness (commonly called numbness); use Fuling Chuanxiong Tang. Skin Bi involves pathogens in skin/hair follicles, presenting as hives/wind sores, painless upon scratching; use wind-dispersing and blood-nourishing methods. Bone Bi is Cold/Painful Bi, with heart-piercing pain, limb spasms, and joint swelling; use Jiawei Wuji San (Modified Five Accumulations Powder). Generalized Bi involves whole-body pain; use Juanbi Tang. Blood Bi involves pathogens entering Yin levels, triggered by wind, with weak bones, fatigue, sweating, and tossing in sleep; use Danggui Tang. Branchal Fluid Retention presents with limb numbness, arm pain preventing lifting, drowsiness, dizziness, difficulty urinating, and cold knees leading to Bi; use Fuling Tang. (*Zhengzhi Huibu* / *Compendium of Syndrome Differentiation and Treatment*)
[Selected Formulas for Bi Syndrome]
Fangfeng Tang (Hejian)
Indications: Wind predominance causing Moving Bi, wandering pulling pain up and down.
Ingredients: Fangfeng (1 qian), Danggui (1 qian), Chifuling (1 qian), Xingren (1 qian), Huangqin (2 qian), Qinjiao (2 qian), Gegen (2 qian), Qianghuo (0.8 fen), Guizhi (0.5 fen), Gancao (0.5 fen).
Preparation: Add fresh ginger, decoct in water, add half cup of wine before taking.
Fuling Tang
Indications: Cold predominance causing Painful Bi, swelling/pain, spasm, anhidrosis.
Ingredients: Chifuling (1.5 qian), Sangpi (1 qian), Fangfeng (1 qian), Guanzi Gui (0.5 fen), Chuanxiong (1.2 fen), Shaoyao (1 qian), Mahuang (1 qian), Fresh Ginger, Jujube.
Fuling Chuanxiong Tang
Indications: Fixed Bi, heavy limbs, pathogen flowing into meridians, spasm, edema.
Preparation: Same as above Fuling Tang, add Cangzhu, Zhi Gancao, and Dazao. Take warm. To induce sweating, drink warm rice porridge.
Shengma Tang (Hejian)
Indications: Damp-Bi, extreme muscle heat, sensation of rats running on body, inverted mouth/lips, skin color change. Also treats various Wind-Heat.
Ingredients: Shengma, Fuling, Renshen, Fangfeng, Xijiao (sliced), Lingyangjiao (sliced), Qianghuo (each 1 qian), Guanzi Gui (0.3 fen), Fresh Ginger, Zhuli (Bamboo Juice).
Wubi Tang
Indications: Three pathogens invading musculature, limb flaccidity, numbness.
Ingredients: Pian Jianghuang, Qianghuo, Baizhu, Fangji (each 1 qian), Gancao (0.5 fen), Fresh Ginger.
Administration: Take hot, divided between pre-meal and post-meal depending on lesion location.
Fuling Tang
Indications: Excessive drinking with fluid retention, limb numbness, drowsiness, dizziness.
Preparation: Erchen Tang (Two Aged Things Decoction) plus Zhishi and Jiegeng.
Juanbi Tang
Indications: Generalized Bi, cold Bi of hands/feet, heavy legs, neck/back stiffness.
Ingredients: Chishao, Danggui, Huangqi, Jianghuang, Qianghuo (each 1.5 qian), Gancao (0.5 fen).
Preparation: Decoct with Fresh Ginger and Jujube.
Danggui Tang
Ingredients: Danggui (2 qian), Chishao (1.5 fen), Duhuo, Fangfeng, Chifuling, Huangqin, Qinjiao (each 1 qian), Gancao (0.6 fen), Guixin (0.3 fen), Fresh Ginger.
Qianghuo Tang
Indications: Baihu Lijie Fengdu (White Tiger Rheumatism), attacking bone/joint pain, irregular onset.
Ingredients: Qianghuo, Fuzi, Qinjiao, Guixin, Muxiang, Chuanxiong, Danggui, Niuxi, Taoren, Gusui Bu, Fresh Ginger.
Hugu San
Indications: White Tiger limb/joint pain, unbearable pain upon onset.
Ingredients: Hugu (Tiger Bone), Gancao, Quanxie (de-toxicated, each 5 qian), Shexiang (0.1 fen), Tianma, Fangfeng, Niuxi, Jiangcan, Danggui, Ruxiang, Guixin, Baihuashe (wine-soaked, meat extracted, each 2 liang).
Dosage: 3 qian per dose, taken with Doulin Jiu (Bean-leavened Wine).
Xuduan Wan
Indications: Wind-Damp flowing injection, limb edema, muscle numbness.
Ingredients: Danggui, Xuduan, Bibi (each 1 liang), Chuanxiong (7.5 qian), Ruxiang (5 qian), Tianma, Fangfeng, Fuzi (each 1 liang), Moyao (5 qian).
Preparation: Honey pills, taken with warm wine.