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Huangdi asked: In Bi syndrome (Bi Syndrome, a condition characterized by blockage and pain), some cases involve pain, others do not; some involve numbness (Anesthesia/Numbness, loss of sensation), others coldness, others heat, others dryness, or dampness. What is the reason for this? Qibo replied: Pain occurs when there is an abundance of Cold pathogen (Han Qi); because of Cold, there is pain. Cases that are neither painful nor numb occur when the disease has been present for a long time and penetrated deeply; the circulation of Ying (Nutrient) Qi and Wei (Defensive) Qi becomes sluggish, and the meridians are occasionally empty; thus, there is no pain. The skin does not receive nourishment from Ying Qi; therefore, there is numbness. Cold sensations arise when Yang Qi is deficient and Yin Qi is abundant; these combine with the pathogenic factor, resulting in coldness. Heat sensations arise when Yang Qi is abundant and Yin Qi is deficient; the pathogenic factor prevails, and Yang overcomes Yin, resulting in heat. Those who experience excessive cold, sweating, and wetness do so because they have encountered an excess of Dampness (Shi). When Yang Qi is weak and Yin Qi is strong, the two energies interact, causing coldness and sweating with wetness. When Bi affects the bones, the body feels heavy; when it affects the vessels, blood coagulates and fails to flow; when it affects the tendons, flexion occurs but extension is impossible; when it affects the muscles, there is numbness; when it affects the skin, there is coldness. If all five conditions are present, there is no pain. Generally, Bi syndromes become contracted upon exposure to Cold and relaxed upon exposure to Heat.

Someone asked: Why can one meridian give rise to dozens of diseases, varying between pain, abscesses, heat, itching, obstruction, or numbness, with changes without end? What is the reason? The answer is: These are all generated by Evil Qi (Xie Qi). Another question was raised: Humans possess True Qi (Zhen Qi), Righteous Qi (Zheng Qi), and Evil Qi. What do these terms mean? True Qi is received from Heaven (congenital essence) and combines with Qi from water and grain to fill the body. Righteous Qi refers to Correct Wind (Zheng Feng), which comes from one direction and is not Deficient Wind (Xu Feng). (*Tai Su* states it is not Disaster Wind.) Evil Qi refers to Deficient Wind. Deficient Wind, as a thief-like pathogen, injures humans deeply and cannot depart on its own. Correct Wind injures humans superficially and departs on its own; its energy is weak and cannot damage True Qi, so it dissipates naturally. When Deficient Evil enters the human body, it causes shivering and trembling, raises the hair, and opens the Couli (pores). If it penetrates deeply and presses inward on the bones, it results in Bone Bi; if it presses on the tendons, it results in tendon spasms; if it presses into the vessels, it causes blood closure and obstruction, leading to abscesses; if it presses into the muscles and contends with Wei Qi, Yang predominance leads to heat, while Yin predominance leads to cold. Cold causes Qi to depart; departure leads to deficiency; deficiency leads to cold. If it presses on the skin, the Qi moves outward, opening the Couli and shaking the hair; the slight movement of Qi back and forth causes itching. If Qi remains and does not depart, it forms Bi; if Wei Qi does not depart, it causes numbness.

Disease in the bones manifests as heaviness of the bones, inability to lift them, soreness and pain in the bone marrow, and arrival of Cold Qi; this is named Bone Bi. Acupuncture should be deep, but care must be taken not to damage the vessels or flesh. The depth should extend from large muscle divisions to small ones. Stop needling when the bone heat subsides. Disease in the tendons manifests as tendon spasms, joint pain, and inability to walk; this is named Tendon Bi. Needling should target the tendons, penetrating the space between muscles, but avoiding the bone. Stop needling when the tendons feel warm and the illness resolves. Disease in the skin and muscles manifests as widespread pain; this is named Muscle Bi, caused by injury from Cold and Dampness. Needling should target large and small muscle divisions, using multiple needles inserted deeply, aiming for local warmth. Do not damage the sinews or bones; if damaged, abscesses or other complications may arise. Stop needling when all divisions feel warm.

It was asked: The human body is not cold due to lack of clothing, nor is there external Cold invasion; why does Cold generate from within? The answer is: Such individuals often suffer from Bi syndrome, with deficient Yang Qi and abundant Yin Qi, making the body feel cold as if emerging from water. It was further asked: Some people feel cold internally, unable to be warmed by hot water or fire, or by thick clothing, yet they do not shiver from freezing. What disease is this? The answer is: Such individuals typically have strong Kidney Qi but engage in watery labor, leading to decline of Taiyang (Bladder) Qi and depletion of Kidney essence/marrow. One Water cannot overcome Two Fires. The Kidney belongs to Water and governs the bones. If the Kidney fails to generate, Marrow will not fill, causing coldness to reach the bones. The reason they do not shiver is that the Liver is a Yang organ (one Yang), and the Heart is a Yang organ (two Yangs), whereas the Kidney is a solitary Yin organ. One Water cannot overcome the two upper Fires; thus, they do not shiver. This disease is named Bone Bi, and such individuals are prone to joint contracture. If Zhe Bi (Fixed Bi) persists and chronic Cold remains, it may develop into Liver Bi. For Bone Bi with joint immobility and pain, profuse sweating, and vexation, tonify the Foot-Yin meridians. For Jue Bi (Reversal Bi), where Reversal Qi ascends to the abdomen, select the Luo-Connecting points of the Yin and Yang meridians, treating the primary pathology by reducing Yang meridians and tonifying Yin meridians. For Feng Bi (Wind Bi) with persistent symptoms resembling "Yinluo" (wandering pain/weakness), where the feet feel like walking on ice or entering boiling water, accompanied by limb weakness, vexation, headache, occasional vomiting, oppression, dizziness followed by sweating, prolonged visual disturbance, emotional instability, shortness of breath, and unhappiness, death may occur within three years. For inability to lift the thigh and leg, take the patient's side and needle at Shuguan (Hubiao), using a Yuanli needle; a large needle is unsuitable. For knee pain, needle Dubi, using a Yuanli needle, inserting and withdrawing intermittently; a needle as thick as a pin is suitable for the knee without doubt.

For foot numbness, needle Fengfu. For coldness and numbness from the waist down to the feet, inability to sit up, and inability to lift the sacrum, treat with Yaoshu. For Bi syndrome, treat with Huiyin, Taiyuan, Xiaoluo, and Zhaohai. For lethargy and inability to move the body, associated with great warmth (or dampness), treat with Sanyangluo. For Bone Bi with vexation and fullness, treat with Shangqiu. For heat under the feet, treat with Guanyuan. For Bi with heavy calves, flaccid dorsum pedis, and heel pain, treat with Jiuxia Lian. For calf pain, foot weakness causing dropping of the foot, Damp Bi, and inability to stand long due to heat under the feet, treat with Tiaokou. For bitter Bi in the calves, inability to flex or extend the knees, and inability to walk, treat with Liangqiu. For cold Bi and numbness outside the knees, with inability to flex or extend, treat with Biguan. For skin pain, wasting, and Bi, treat with Waixiu. For pain on the lateral aspect of the knee, inability to flex or extend, and calf Bi with numbness, treat with Yangguan. For thigh Bi radiating to pain on the lateral thigh and knee, numbness, and tendon tension, treat with Yanglingquan. For pain in the muscle divisions due to Cold Qi, and upper/lower tendon Bi with numbness, treat with Zhongdu. For pain in the hip pivot with inability to lift, use a filiform needle with retention method for cold, determining the number of insertions based on the waxing and waning of the moon; relief is immediate. A long needle is also acceptable. For urgent pain radiating between the waist and hypochondrium, tight thigh tendons, calf pain with inability to flex or extend, and Bi with numbness, treat with Huantiao. For wind-cold starting from the little toe, involving Meridian Bi affecting the chest and hypochondrium with shifting pain, treat with Zhiyin. For trauma to the big toe, such as injury from stepping down from a cart affecting the back of the foot and toes, constituting Tendon Bi, treat with JieXi.