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(This is a Bi syndrome (Bi Syndrome) formed by the combination of Wind-Cold-Dampness (Wind-Cold-Dampness). Therefore, it is generally referred to as Bi syndrome. In the *Shanghan Lun* (Treatise on Cold Pathogenic Diseases), it is collectively called Damp-Bi (Damp-Bi). When Wind pathogen predominates, it is named Wind-Damp; when Cold pathogen predominates, it is named Cold-Damp.)

[Etiology] The body is first injured by Dampness, and subsequently complicated by Wind and Cold. However, injury by Dampness must be distinguished into internal and external causes. Dampness acquired from the exterior often results from dwelling in damp environments, wading through water, or having clothes wetted by rain and sweat. Dampness injuring from the interior often results from excessive consumption of tea and alcohol, or greedily eating melons and fruits. The *Neijing* (Inner Canon) generally refers to this as Bi, and further differentiates its variations within similarities into three types: Xing-Bi (Wandering Bi), Zhuo-Bi (Fixed Bi), and Tong-Bi (Painful Bi). In reality, all are caused by the invasion of Wind, Cold, and Dampness, flowing into the meridians and collaterals to form the condition.

[Symptoms] In Damp-Bi, the whole body feels heavy and painful, with joints being particularly painful; limbs feel numb and insensible. There is headache, aversion to cold, fever, restlessness, difficult urination, and loose stools. Wind-Damp mostly injures the upper body, causing numbness in the shoulders and back, stiffness and pain in the wrists, heaviness in the head, nasal congestion, aversion to wind, and slight sweating. Pain throughout the body has no fixed location. Cold-Damp mostly injures the lower body, causing wood-like heaviness in the legs and feet, soreness and pain in the ankles and knees, feeling as if weighed down by stones, aversion to cold, absence of sweating, and pain throughout the body with a fixed location. If in the skin, there is dullness and lack of sensation; if in the muscles, the four limbs are insensible; if in the sinews, flexion without extension; if in the vessels, blood coagulates and fails to flow; if in the bones, heaviness prevents lifting. When Dampness predominates, the tongue coating is white, slippery, and greasy. When Wind predominates, the tongue coating is white, thin, and moist. When Cold predominates, the tongue coating is white, slippery, and pale.

[Pulse] A pulse that is deep, soggy, and fine corresponds to what the *Neijing* calls Zhuo-Bi (Fixed Bi) due to predominant Dampness, and what the *Shanghan Lun* describes as the signs of Damp-Bi. A pulse that is floating, soggy, wiry, and slow corresponds to what the *Neijing* calls Xing-Bi (Wandering Bi) due to predominant Wind, and what the *Shanghan Lun* describes as Wind-Damp struggling together. A pulse that is deep, soggy, wiry, and slow corresponds to what the *Neijing* calls Tong-Bi (Painful Bi) due to predominant Cold, and what the *Shanghan Lun* describes as contracting Cold-Damp.

[Treatment] For Zhuo-Bi (Fixed Bi), drying Dampness is the primary method, assisted by dispelling Wind and scattering Cold. Huoxiang Zhengqi Tang (Agaric Rectifying Qi Decoction) plus Qianghuo (Notopterygii Rhizoma et Radix) and Fangfeng (Saposhnikoviae Radix) (each 1.5 qian). For Xing-Bi (Wandering Bi), dispersing Wind is the primary method, assisted by scattering Cold and drying Dampness. Guizhi Jupi Tang (Cinnamon Twig and Tangerine Peel Decoction) plus Zhi Chuanwu (Prepared Aconiti Radix) (0.5 fen) and Zhi Cangzhu (Prepared Atractylodis Rhizoma) (1 qian). For Tong-Bi (Painful Bi), scattering Cold is the primary method, assisted by dispelling Wind and percolating Dampness. Suqiang Dabiao Tang (Perilla and Notopterygium Reaching the Exterior Decoction) plus Jiuchao Yanhusuo (Alcohol-fried Corydalis Rhizoma) and Quan Danggui (Whole Angelicae Sinensis Radix) (each 1.5 qian). This is the method for treating the three BIs separately. Sometimes, Suqiang Dabiao Tang alone is used, plus Chuan Guizhi (Cinnamomi Ramulus) and Guang Taoren (Persicae Semen) each 1.5 qian, along with Xiaohuoluo Dan (Minor Revitalizing the Collaterals Pill) (Zhi Chuanwu, Zhi Caowu, Zhi Nanxing each 6 liang; Ming Ruxiang, Jing Moyao, Gan Dilong each 2 liang 2 qian; made into pills with Paohua water, each pill weighing about 1 qian; take 1 pill for mild cases, 2 pills for severe cases, dissolved in Shijiu (Baijiu) juice). Decoct with half running water and half aged wine. This is the method for treating the three BIs combined. For new diseases located in the skin, muscle, vessels, and collaterals, this has been verified without error. If the condition lingers in the sinews and bones, becoming chronic with no pain or sensation, leading to hemiplegia or paralysis of the hands and feet, strengthening sinews and bones must be the primary method, assisted by invigorating blood and moving qi. Juanbi Fangwei Tang (Dispelling Bi Preventing Atrophy Decoction) (Tou Yangjinggu 2 qian, Zhi Su Hujiangu 1 qian, Jiuchao Tou Tijin 1 qian, Yanshui Chao Duzhong 3 qian, Jiuchao Chuanduan 2 qian, Zhi Qu Mao Gouji 2 qian, Zhi Huainiuxi 3 qian, Gusuibu 6 qian, Sheng Huangqi 1 liang, Quan Danggui 3 qian; decoct with half wine and half water). Take one pill of Yili Jinwan (Dan Shen/Monkshood Pill) (Fan Mubie baked to remove oil, Wulingzhi, Zhi Caowu, Gan Dilong, Yunxiang each 1.5 liang; Ming Ruxiang, Jing Moyao, Danggui each 7.5 qian; Dangmenzi 2.5 qian; Chen Jingmo 1.5 qian (burned until smoke ceases); all ground into fine powder, mixed uniformly, made into pills with glutinous rice paste, size of a chicken egg; take 1 pill per dose, up to 2 for extreme severity, taken with medicinal soup or dissolved in warm wine). Long-term use may yield results.

[Xiu's Commentary] "Wind-Cold-Dampness Shanghan" is merely a folk name in rural areas. Master Yu adheres to the principles of the classics, treating according to symptoms with precision and clarity, truly deserving the title of an old famous doctor with profound learning. However, for new and mild cases of this condition, those who can tolerate pungent-dispersing and aromatic-drying herbs will respond easily. I have successfully used Wuling San (Five-Ingredient Powder with Poria) plus Qianghuo for Zhuo-Bi, Guizhi Tang (Cinnamon Twig Decoction) plus Erwu (Chuanwu and Caowu) for Xing-Bi, and Mahuang Tang (Ephedra Decoction) plus Baizhu and Fuzi for Tong-Bi, with effects as immediate as a drumstick striking a drum. For chronic and severe cases where blood stasis transforms into fire, fluids stagnate and transform into phlegm, the skin loses nourishment, meridians become sparse, large sinews soften and shorten, small sinews relax and lengthen, leading to numbness and paralysis of the hands and feet, and bone atrophy bedridden, treatment is most difficult. As the saying goes, "Gout (Tongfeng) is easy to treat, Wood-Wind (Mufeng) is hard to cure," which is indeed a proverb born of experience. Only by using Zhuli Tang (Bamboo Juice Decoction) from *Waitai Mi Yao* (Essential Prescriptions Worth a Thousand Gold for Emergencies), taken with Danxi Shenxiao Huoluo Dan (Danxi's Divine Effectiveness Revitalizing Collaterals Pill), can one generate fluids, wash away phlegm, invigorate blood, and unblock collaterals to gradually achieve efficacy. Intermittently take Shigongjiu (Lord Shi's Wine) to nourish blood, dispel wind, relax sinews, and revitalize collaterals. Meanwhile, instruct family members to find skilled acupuncturists to puncture every seven days, then every fourteen days, to unblock the meridians. Treat both internally and externally.

[Lian's Verification] Bi refers to the loss of sensation in the limbs, heaviness, and inability to move. Although Wind, Cold, and Dampness can combine, Wind, Dampness, and Heat can also combine. Initially, the pathogen attacks the Jing-Qi (Meridian Qi); subsequently, it lingers in the blood collaterals; finally, it damages the brain-nerves (nervous system). Thus, the condition starts with pain, progresses to numbness/obstruction (Bi), and ends with atrophy/paralysis (Wei). Pain is still relatively easy to treat. The Xing-Bi and Tong-Bi discussed in the *Neijing* are later referred to as Gout (Tongfeng). The primary approach is to invigorate blood, dispel wind, and unblock the meridians. Qiangfang Xingbi Tang (Qianghuo and Fangfeng Decoction for Wandering Bi) is the main formula (Qianghuo and Fangfeng each 1 qian; Qinjiao and Chuanduan each 2 qian; Weilingxian and Quan Danggui each 2 qian; Ming Ruxiang, Jing Moyao, Du Honghua each 5 fen; decoct first with Tong Sangzhi and Qing Songzhen each 1 liang, using the decoction as water; Gu Songyuan's empirical formula). As the ancient song says, "To treat wind, first treat the blood; when blood flows, wind extinguishes itself." If there is pain in the shoulders, back, waist, legs, and whole body, with fixed locations and heaviness preventing movement, it is Cold congealing and blood stasis. The correct method is to unblock stasis, scatter Cold, and unblock collaterals. Shentong Zhuyu Tang (Body Pain Blood Stasis Expelling Decoction) modified (Quan Danggui, Guang Taoren, Luoshi Teng each 3 qian; Pian Jianghuang, Du Honghua, Chuanxiong each 8 fen; Huainiuxi, Wulingzhi (wine-fried), Hutoujiao, Qinjiao each 1.5 qian; Qing Zhigancao 7 fen; Wang Qingren's empirical formula), taken with Xuming Dan (Reviving Life Pill) (Original Xiaohuoluo Dan formula plus Qianghuo, Tianma, Jiangcan each 2 liang; Baifuzi, Quanxie, Chensha, Xionghuang, Qingfen each 1 liang; Pian Nao 0.5 qian, Dangmenzi 1.25 qian; ground finely, then add Bingpian and Moshe and mix well; made into pills with glutinous rice flour paste, each pill weighing 5 fen, sealed in wax; also known as Shenshou Baosheng Dan, more potent than Xiaohuoluo Dan; take 1 pill for mild cases, 2 for severe). Externally, apply Fengliaoxingjiu (Feng Liaoxing's Medicated Wine) to rub all painful areas of the body (using cotton cloth soaked in wine). Internal and external treatment yields frequent rapid results. If neglected, external Wind-Cold pathogens and internal collateral stasis injuries will all transform into Heat. All pungent-dispersing, Wind-scattering, and drying-hot herbs are contraindicated. I have used Yu's Wuzhi Yizhi Jian (Five Juices One Branch Decoction) combined with Qingxuan Yure Tang (Clearing and Venting Heat Expelling Stasis Decoction) (Huo Shu Lusun and Xian Pipaye each 1 liang; Xuanjinhua wrapped in gauze 3 qian; Xinjiang 1.5 qian; Qing Congguan cut 2 cun; Guang Yujin juice 4 spoons stirred in; Cao Renbo's empirical formula from Changshu). It has proven effective in many cases. Regarding Zhuo-Bi, the world calls it numbness and insensitivity, commonly known as Wood-Wind (Mufeng). This is a step beyond Gout. It is caused by collateral stasis compressing the nerves, causing them to lose sensory and motor function. As Master Danxi said, "Ma (numbness) is Qi deficiency; Mu (wood-like insensitivity) is Damp-phlegm and blood stasis." Initially, use Chushi Juanbi Tang (Dampness Removing Bi Dispelling Decoction) modified (Du Cangzhu and Chi Ling each 2 qian; Sheng Baizhu, Zexie, Guangpi each 1.5 qian; Chuan Guizhi 8 fen; Huashi mixed and ground 4 qian wrapped in gauze; Danshili 3 ladles; Jiangzhi 3 drops; mixed and stirred in; decoct first with Jiuchao Sangzhi and Qing Songzhen each 1 liang, using the decoction as water; Lin Yitong's empirical formula), taking 1-2 pills of Xiaohuoluo Dan. If Dampness stagnates and transforms into Heat, lingering in joints and limb collaterals, use Fangji Yiren Tang (Stephania and Coix Decoction) (Jiuchao Mujing, Du Chidou, Chuan Bixie, Dadoujuan, Mian Yinchen each 3 qian; Wan Cansha 4 qian wrapped in gauze; Zhi Cangzhu, Xuan Mugua each 8 fen; Chuan Bai 5 fen; Mutong 1 qian; decoct first with Sheng Yiren and Jiuchao Sangzhi each 1 liang, using the decoction as water; Ye Xi Hu Zaizi's empirical formula), followed by Tao Ren Kongxian Dan (Peach Kernel Controlling Phlegm Fluids Pill) (Taoren ni, Wei Gansui, Zhi Daji, Baijiezi each 1 liang; Jiangzhi and Zhuli, pounded into paste to make pills, size of sesame seeds; take 7-10 pills per dose; Danxi's *Xinfa Fuyu Fang*). Vigorously purge Damp-Heat, Phlegm, and Stasis, unblock meridians to open collaterals. Use external electrotherapy to accelerate blood circulation and stimulate nerves, frequently achieving full recovery. When the condition progresses from Bi to Wei (atrophy/paralysis), with quadriplegia, nerve paralysis occurs, completely losing sensory and motor functions. Although Changsha (Zhang Zhongjing) stated that heat in the Jing causes Bi and heat in the Luo causes Wei, there are differences between upper/lower and left/right. For upper paralysis and right-sided paralysis, it is mostly Yang deficiency with Yin coagulation. Often use Qingren Buyang Huanwu Tang (Qingren Tonifying Yang Restoring Five Tenths Decoction), followed by Renshen Zaizao Wan (Ginseng Recreating Life Pill). For lower paralysis and left-sided paralysis, it is mostly Yin deficiency with collateral heat. Often use Zhongchun Jiling Gao (Zhongchun Gathering Spirit Paste) or Siwu Jiangfu Tang (Four Substances Red Covering Decoction), followed by Gu's Modified Huyang Wan (Gu's Added Tiger Tendon Pill). Intermittently use Hejian Dihuang Yinzi (Hejian Rehmannia Elixir) removing Yurou, Wuweizi, and Guizhi; or usejutong Zhuanxi Dasheng Gao (Jutong Exclusive Nourishing Life Paste). External treatment still uses electrotherapy, achieving 50-60% recovery.

[Rongzhai's Commentary] There is another type of "Wind-Dampness Syndrome" that does not yet reach the degree of "Bi," as described in Lei Shaoyi's *Shi Bing Lun* (Treatise on Seasonal Diseases): "In Wind-Dampness disease, symptoms include headache and fever, slight sweating and aversion to cold, vexing pain in bone joints, body weight and slight swelling, deficient urination, and a floating-slow pulse." I believe that when encountering such symptoms, one must analyze whether Wind or Dampness predominates. If Wind predominates, it will inevitably transform into Heat. Treatment should first use Qiwei Congbai Tang (Seven-Ingredient Scallow White Decoction) (Fangfeng 1 qian, Suzhi tender branch 1.5 qian, Shengjiangpi 1 qian, Dansh douchi 3 qian, Qinjiao 1.5 qian, Luoshi Teng 3 qian, fresh Congbai 4 pieces,嫩的 Sangzhi 1 liang) to unblock collaterals and dispel Wind, allowing Wind-Dampness to resolve through slight sweating. Next, use Mufangji Tang (Stephania Decoction) modified (Mufangji 1.5 qian, Tongcao 1 qian, Sheng Yiren 4 qian, Qing Songzhen 3 qian, Guizhi 0.7 qian mixed with Huashi 5 qian, Sigualuo 2 qian, Jiao Sangzhi 1 liang) to promote diuresis and clear Heat, allowing Dampness that has transformed into Heat to be excreted via urine. Finally, use Wuye Maogen Tang (Five Leaves and Imperata Decoction) (Sangye 2 qian, Dan Zhuyeqe 2 qian, Pipaye 5 qian de-haired, Lanye 3 qian, Sheng Cebeiye 2 qian, Xian Maogen 1 liang) to clear residual Heat. If Dampness predominates, one must attend to the patient's deficiency of Yang Qi. Ye Tianshi's statement "When Dampness predominates, Yang becomes weak" is a powerful revelation! Medication should combine sweating and diuresis to harmonize; use Guizhi Fuzi Tang (Cinnamon Twig and Prepared Aconite Decoction) as the main pungent-sweet dispersing agent, and Wuling San (Five-Ingredient Powder with Poria) as the auxiliary pungent-light percolating agent—Guizhi, Fupian, Fuling, Cangzhu, Gancao, Zexie, Qinjiao, fresh Ginger, Red Dates—imitating Zhang Zhongjing's method of "slowly inducing slight sweating." Because "slowly" removes both Wind and Dampness, while "rapidly" removes Wind but leaves Dampness lingering. This is the treatment method for the primary disease of "Wind-Cold-Dampness Shanghan." There is also a type called "Lijie Gout" (Joint-Passing Gout), with symptoms of headache, fever, spasmodic pain in limbs and joints. *Bingyuan*, *Qianjin*, and *Waitai* all call it Lijie Feng (Joint-Passing Wind), named so because the pain travels through the joints of the four limbs. Symptomatic therapy, based on Mr. He Lianchen's experience, is analyzed as follows. He said: "For Lijie Gout caused by Cold, use pungent-warm dispersing; caused by Heat, use pungent-coat light揚 (lifting). This is established; but one must differentiate treatment based on pain characteristics. If joint spasms and pain, with difficulty in flexion and extension, it is Blood deficiency and fluid dryness; the method is to nourish Blood and moisten dryness, Siwu Tang (Four Substances Decoction) plus Shouwu, Mugua, Qizi, Ganju. If joint swelling and pain, worsening on rainy days, it is Wind-Damp entering collaterals; the method is to drive out Wind and revitalize collaterals, Da Qianghuo Tang (Great Notopterygium Decoction) plus Xiaohuoluo Dan. If joint piercing pain, relieved by pounding/massage, it is Wind-Damp in the meridians; the method is to scatter Wind and overcome Dampness, Lingxian Chutong Yin (Weilingxian Pain-Relieving Drink). If joint vexing pain, with heavy shoulders and back, it is Damp-Heat struggling; the method is to resolve Dampness and drain Heat, Danggui Niantsong San (Angelica Drainage Pain Powder) modified. If joint stabbing pain, fixed and unmoving, it is Blood stasis blocking collaterals; the method is to eliminate stasis and revitalize collaterals, Chengtong San (Following Pain Powder) modified. If joint hot pain, worse at night, it is Yin Fire burning sinews; the method is to nourish Yin and descend Fire, Siwu Tang combined with Jia'er Miao Wan (Added Two Marvels Pill). If joint wood-like pain, with heavy body, it is Damp-Phlegm and dead blood; the method is to expel Phlegm and revitalize collaterals, Banxia Lingzhu Tang (Pinellia, Poria, Atractylodes Decoction) plus Xiaohuoluo Dan. If joint hidden pain, with shortness of breath and deep pulse, it is retained fluid; the method is to dispel fluid and wash away Phlegm, Banxia Lingzhu Tang plus Zhimi Fuling Wan (Point-Missing Poria Pill). For chronic Lijie pain, it is pathogenic toxin retention; the method is to attack toxin with toxin, alternating Musk Pill (Shexiang Wan) and Frankincense Pain-Stopping Pill (Ruxiang Ting Tong Wan). For Lijie numb-pain, it is Qi and Blood stagnation; the method is to unblock Qi and revitalize collaterals, Qianjin Fangji Tang (Million Years Stephania Decoction) plus Wuling San. Causes vary, so prescriptions and medications differ; thus, the *Neijing* teaches that treating disease requires seeking the root cause."

Mr. Cao Yingfu, based on experimental use of classical formulas, said: "Joint pain, named Lijie. This condition arises from external Wind pathogen, inadequate sweating, and long-standing Dampness flowing into joints. Pulse is slow and slippery, indicating Cold-Damp. Mild cases use Guizhi Shaoyao Zhimu Tang (Cinnamon Twig, Peony, Anemarrhena Decoction); severe cases require Wutou Tang (Aconite Decoction). I once treated a male surnamed Wu, using Jing Mahuang 3 qian, Sheng Baishao, Sheng Huangqi each 3 qian, Zhi Gancao 3 qian, two slices of Wutou, decocted separately with one bowl of honey until half remains. This entirely follows the *Jinkui* (Essential Prescriptions of the Golden Cabinet) method."