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Wind, cold, and dampness are three pathogenic factors that mix and invade the body together, resulting in Bi syndrome (a disease condition caused by the obstruction of meridians and channels, leading to impaired circulation of blood and qi). When wind is predominant, it is called Moving Bi (characterized by wandering pain and joint pain throughout the body); when cold is predominant, it is called Painful Bi (yin-cold qi attacks muscles and bones/tendons, yang qi fails to circulate freely, thus causing pain); when dampness is predominant, it is called Fixed Bi (the pathogen remains fixed in one location, manifesting as either pain or numbness/woodiness. Dampness transforms according to Earth, and the pathology resides in the muscles).

If this pathogenic combination is encountered in winter, it results in Bone Bi (Winter governs bones; here referring to wind, cold, and dampness); if encountered in spring, it results in Sinew Bi (Spring governs sinews); if encountered in summer, it results in Vessel Bi (Summer governs vessels); if encountered in late summer (Changxia), it results in Flesh/Muscle Bi (Late summer governs muscles); if encountered in autumn, it results in Skin Bi (Autumn governs skin). Each of the Zang organs has a corresponding exterior tissue association. If the disease persists for a long time without resolving, the pathogen will penetrate inward and lodge in the associated Zang organ.

Lung Bi manifests as vexation, fullness, wheezing, and vomiting (as the Lung meridian passes through the stomach region). Heart Bi manifests as blocked vessels, vexation with palpitations felt as drumming below the heart, sudden upward rushing of Qi with wheezing, dry throat, frequent belching, and fear induced by rebellious Qi ascending (fear arises because Kidney water rebels upward). Liver Bi manifests as fright during sleep, excessive thirst, frequent urination, and pulling pain extending from top to bottom with abdominal distension resembling pregnancy (pulling sensations, abdomen enlarged as if pregnant). Kidney Bi manifests as frequent bloating, walking on the buttocks instead of heels (because the feet cannot extend), and bowing the head so that the head replaces the crown (because the head cannot be lifted). Spleen Bi manifests as flaccidity and lethargy of the four limbs, coughing with vomiting of saliva, and severe upper obstruction/blockage (diaphragmatic blockage). Intestine Bi manifests as frequent drinking but inability to urinate, abdominal borborygmi and Qi contention, and occasional diarrhea with undigested food (due to closure of Qi in the lower Jiao, where fluids mix with the large intestine). Bladder/Pao Bi manifests as pain in the lower abdomen over the bladder upon pressure, a sensation as if scalded by hot water, difficult and scanty urination, and clear nasal discharge above (‘Pao’ is synonymous with ‘Pa’, meaning bladder; ‘Pa’ is pronounced pao).

Each of the Fu organs also has its Shu points. Wind, cold, and dampness pathogens strike these Shu points, and dietary irregularities correspondingly trigger them. The pathogens enter along the Shu points and lodge in their respective Fu organs.

Painful conditions are due to an excess of cold; the presence of cold causes pain. Conditions that are neither painful nor sensitive (numb) occur when the disease has persisted for a long time and penetrated deeply. The circulation of Ying (Nutrient) and Wei (Defensive) Qi becomes sluggish, and the meridians become occasionally sparse/deficient, hence there is no pain (old texts erroneously read ‘blocked’); the skin lacks nourishment from Ying blood, hence numbness occurs (lack of Ying blood nourishment). Cold-type Bi is characterized by deficient Yang Qi and abundant Yin Qi; Yin and the pathogenic factor mutually reinforce each other, generating internal cold (cold generates from within). Heat-type Bi is characterized by abundant Yang Qi and deficient Yin Qi; the pathogenic factor prevails, and Yang encounters Yin (changed to ‘Yang overwhelms Yin’ in *Jia Yi Jing*), resulting in Bi-Heat (Yang abundance meeting Yin, where Yin cannot overcome Yang). Profuse sweating and moist skin occur when dampness is severe; deficient Yang Qi and abundant Yin Qi interact, causing sweating and moisture.

When Bi affects the bones, the body feels heavy; when it affects the vessels, blood coagulates and fails to flow; when it affects the sinews, flexion occurs but extension is impossible; when it affects the flesh, there is numbness; when it affects the skin, there is coldness. Therefore, possessing these five characteristics defines the nature of the Bi syndrome (Note: The original text states “thus possessing these five means no pain,” which may imply specific diagnostic criteria or contains textual corruption, but literally translates to: if these five conditions are present, there is no pain). Generally, Bi syndromes contract and tighten when exposed to cold, and relax and slacken when exposed to heat.