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Article 1 Question: How is Blood Bi (Blood Obstruction) acquired? The Master said: Those who live in luxury and ease have weak bones but abundant flesh. If they become heavily fatigued, sweat while sleeping, and toss and turn frequently, adding to this exposure to slight wind, they will contract this disease. The pulse will be naturally fine and choppy, with a slight tightness at the Cunkou (radial artery at the wrist) and Guan positions. Acupuncture should be used to guide the Yang Qi, harmonizing the pulse; when the tightness disappears, recovery ensues.

Blood in the skin and meridians that coagulates and fails to flow is termed Blood Bi. "Bi" implies inferiority and adherence. When Zheng Qi (Upright Qi) is weak and blood exhibits a stagnant quality, it is called Bi. Zhang Zhongjing sets up a Q&A to explain that those of high status often have excessive desires, leading to depletion of essence and empty marrow, resulting in weak bones. Their rich nourishment leads to hot, thin, and floating Qi, hence abundant flesh. Weak bones cannot strengthen internally; abundant flesh cannot resist externally. Both are incapable of withstanding fatigue. If burdened by official duties or sexual activity, exhausting sinews and bones and laboring the form, internal heat arises and Qi floats further, causing sweating and倦卧 (weariness lying down). Since Essence is deficient and Qi floats, fatigue causes irritability and sweating; the Floating Yang has not yet settled, causing joint pain and inability to sleep peacefully, hence frequent tossing and turning is common. Tossing generates slight wind, meaning the wind takes advantage of the pores opening during sweating. Qi moves blood. Where wind pathogen invades, Qi retreats inward leaving blood behind; without Qi's guidance, blood tends to coagulate, resulting in Blood Bi. This explains the initial cause. A fine pulse reflects declining Yang and weak Qi; a choppy pulse reflects sluggish blood flow. When Jing-Han Qi (vital Qi) fills and flows freely, blood circulates without stagnation. A naturally fine and choppy pulse indicates shallow and soft Yang driving force, consequently slow Yin blood flow. This describes the general pulse pattern. "Slight tightness" refers to a Xuan (Bowstring) pulse that is thin and slightly urgent. Xuan corresponds to Wood and Wind pathogen; being thin and small indicates Yang decline. Cunkou corresponds to Exterior, Guan to Interior. From Cunkou to above Guan corresponds to Ying (Nutritive) level. A Wind-robber and weak Yang pulse at the Ying level confirms Blood Bi. In short, if the six pulses are generally fine and Yang-deficient, with choppy/sluggish blood, plus a thin, tight Xuan pulse at Cunkou-Guan, it indicates Wind-robber and weak Yang, marking the onset of Blood Bi.

Acupuncture technique: Insert a filiform needle in three stages. Wait one or two breaths, or three or four breaths, until the True Yang Qi of the meridian protects the acupoint and wraps the needle, making the needle tip feel heavy and immobile. Then, slowly push and rotate from the tight area. This guides Yang Qi like winding thread to the point below. Hence, "Acupuncture guides Yang Qi." Yang is Zheng Qi; when Zheng recovers, Wind dissipates, and obstructed blood moves with Qi. Thus, harmonized pulse and disappeared tightness indicate cure. If pulse remains unharmonized and tightness persists after acupuncture, does this correspond to the variation in Huangqi Guizhi Wuwu Tang where Ginger is increased and Licorice removed? This section discusses treatment for early-stage disease. Since the obstructed blood is not yet old, guiding the body's own Yang Qi to lead it restores flow. Emphasis on "Cunkou and Guan" indicates these areas correspond to Upper and Exterior levels (shoulders, back, elbows, arms, meridians, skin). The obstruction is superficial, suitable for acupuncture to guide Qi. Meridians and points are detailed elsewhere.

Article 2 Blood Bi presents with both Yin and Yang pulses being fine, Cunkou and Guan pulses fine, and Chi pulse slightly tight. Externally, the body feels numb and insensible, resembling Feng Bi (Wind Bi). It is treated with Huangqi Guizhi Wuwu Decoction.

Huangqi Guizhi Wuwu Decoction Formula
Huangqi (Astragali Radix), Guizhi (Cinnamomi Ramulus), Shaoyao (Paeoniae Radix Alba) [each 3 liang], Shengjiang (Zingiberis Rhizoma Recens) [6 liang], Dazao (Jujubae Fructus) [12 pieces].
The above five herbs are boiled in 6 sheng of water to obtain 2 sheng. Take 7 ge warm, three times daily.

"Blood Bi" encompasses the description of the "luxurious person" from Article 1, indicating an established Bi syndrome. "Yin and Yang" refer to positions before (Cun) and after (Chi) the Guan pulse. "Fine" is a synonym for the previous "fine and choppy," implying all six pulses are generally fine and choppy, especially at Cunkou and Guan, revealing deficiency of vital Qi. Only at Chi, alongside fine, there is slight tightness. Slight tightness is a Bi pulse; Chi slight tightness indicates pathology in the Lower/Interior, affecting chest, abdomen, legs, and feet. "Body numbness" is detailed elsewhere. Feng Bi and Blood Bi share the same pathogen but differ in injury mechanism. In Feng Bi, Wind injures Qi, which retreats carrying blood inward. In Blood Bi, Wind injures Qi, which retreats abandoning blood, causing it to stagnate. Thus, Blood Bi is like people retreating, while Feng Bi is like yielding ground. "Resembling Feng Bi" refers only to numbness; "External symptoms" should be read as one phrase because Blood Bi includes pulling pain unlike Feng Bi. The formula is chosen because the condition stems from Qi deficiency and blood stasis with Wind invasion, causing Zheng Qi to lower and blood to coagulate. Tonifying Qi is primary, dispelling Wind secondary, moving blood tertiary. Adding Huangqi (tonifying Qi) to Guizhi Tang (dispelling Wind) achieves harmony between promoting Yang and activating blood. Doubling Shengjiang (acrid-warm) promotes Huangqi's action and helps Floating Yang recover. Removing Gancao (Licorice) from Guizhi Tang prevents sweet-slowing properties from lingering in the Middle/Upper, as the Bi is in the Lower/Yin areas (chest, abdomen, legs). Unlike Guizhi Tang, no hot porridge is consumed to avoid sweating which might further deplete Qi and Blood in this Qi-deficient and blood-stagnant state.

Article 3 For a man who is otherwise healthy, a large pulse indicates Lao (Consumptive Disease); extreme emptiness also indicates Lao.

"Ping Ren" (healthy person) refers to someone without acute illness. Conditions like heatstroke or alcohol intoxication can cause temporary floating-large pulses, indicating imbalance. If a person is normally healthy but presents a large pulse spontaneously, it indicates Lao. The Kidney is the organ of strength, storing Essence and transforming Qi. When Essence is full, effort allows Essence to drive Qi outward; rest allows Essence to retain Qi inward. Thus, even with labor, one does not feel depleted. If Essence declines and Qi weakens, forced labor causes Spirit to float and Qi to expand, resulting in a large pulse. This describes the superficial aspect of the pulse. The "extreme emptiness" clause expands on this, describing the deep aspect: light pressure yields large, heavy pressure yields empty—this is a Lao pulse. Even if light pressure is not large, but heavy pressure reveals extreme emptiness, it is also a Lao pulse. A healthy person should not be extremely empty; this results from prior overexertion driving subtle Yang and deficient Qi from the Interior/Lower outward, leaving the center empty. Although both are Lao, pulses differ (floating-large vs. extreme empty) due to variations in Exterior/Interior Qi density. Dense Exterior Qi leads to labor without sweat, causing irritability and Qi stagnation externally, showing floating-large pulse. Deficient Exterior Qi leads to sweating during labor, with Interior Qi rushing forward uncontrollably; thus, no floating-large pulse externally, but extreme emptiness internally. From here to Article 17, changes in pulse and symptoms stem from the "heavy fatigue" mentioned in Article 1. Labor sweat exposed to Wind causes Wind to stagnate Blood, resulting in Blood Bi. If not exposed to slight Wind but developing Lao independently, various manifestations occur.

Disciple asks: In Shanghan Lun, only pre/post-menstrual phases and Heat entering Blood Chamber have specific sections for women; others apply to both sexes. Similarly, in Jingui Yaolue, except for Pregnancy, most articles apply to both. Yet in the Lao volume, Articles 3, 4, 5, 7, and 10 specify "Men." Specifying "Men" implies exclusion of women. Articles 6, 8, 9, 13, 14 discuss male-specific issues (cold genitals, spermatorrhea, blood loss). Article 9 mentions "Woman dream intercourse," Article 13 mentions "Woman miscarriage/bleeding." These exceptions highlight that the rest discuss men. If Lao were exclusive to men, why do so many women suffer and die from Lao-like conditions? Since both sexes share Heaven and Earth's Yin-Yang and parental Essence/Blood, their pathology mechanisms should be identical. Why did Zhongjing neglect women? Answer: Profound question! This is the mystery of Yin-Yang and the secret of Xu-Qi. Zhongjing derived this through observation and codified it. Later scholars like Li Dongyuan and Zhu Danxi may not have fully grasped it. Listen: Heaven establishes its pole in Yin but functions through Yang; Earth establishes its pole in Yang but functions through Yin. Men inherit Heaven's transformation, establishing root in Liver/Kidney, functioning through Heart/Lung. Heart/Lung house Spirit/Qi. If Root Yin is deficient below and cannot support, Spirit Yang becomes weak above. Forceful use of Qi leads to "Lao" (strain). Thus, Lao originates in Liver/Kidney but manifests in Upper Jiao Qi level. Women inherit Earth's transformation, establishing root in Heart/Lung, functioning through Liver/Kidney. Liver/Kidney store Blood. If Root Yang is empty above and cannot lift, Blood Yin leaks downward. Conditions like metrorrhagia, leukorrhea, bleeding, strangury involve Blood. Lack of blood continuity leads to "Ku" (Withering). Thus, Ku originates in Heart/Lung but manifests in Lower Jiao Blood level. Lao is Qi disease in men; Ku is Blood disease in women. Initial symptoms differ, hence "Lao" specifies men. However, Ku involves Heart/Lung failing to lift, causing Blood loss; long-term Yin loss leads to Yang deficiency, allowing turbid Yin to rise, causing irritability, shortness of breath, phlegm, cough—resembling Male Lao. Conversely, Lao involves Liver/Kidney failing to secure, causing Yang to vacate upward; long-term Yang emptiness leads to Essence loss, causing residual Yang to sink, resulting in blood loss, spermatorrhea, night sweats, undigested food—resembling Female Ku. Hence, discussing Male Lao includes references to Female Dream Intercourse/Miscarriage. Also, why do women seemingly lack Lao? Lao relates to Qi. Women follow Earth, their Qi is static. Even with desire, they lack sexual exertion (Point 1). They lack roles requiring physical strain/support (Point 2). Even poor rural women doing chores have simple minds and solid Lung Qi, resisting Lao. Thus, women lack Lao. What causes the mistaken diagnosis? Root lies in Hand-Shaoyin (Heart). Adverse conditions: Regret and Anger. Favorable conditions: Infatuation and Unfaithfulness. These mirror Cang Gong's "desiring a man but unable to obtain." Gradual fading of spirit and Qi leads to downward leakage. Anger causes Fire to stagnate, leading to neck masses, breast swelling, dizziness, and separation of Yin-Yang, incurable. Favorable conditions involve sexual arousal. Internal origin: Abundant Essence drives Qi up, stirring Heart Fire. External origin: Sensory input stimulates Heart, transmitting to Mingmen (Ministerial Fire). Union of Lord and Minister Fire causes movement in genitalia. Sexual intercourse disperses Fire into Water and Qi into Essence, resolving stagnation. However, illicit affairs or excessive indulgence cause Fire to flow horizontally into the Dai Mai (Girdle Vessel), causing waist pain and urinary/bowel urgency, followed by white discharge. Long-term Heart Qi deficiency and Kidney Essence loss create a pathway for leakage. Promiscuity accelerates "Ku" (withering) more than infatuation. These factors disrupt natural Yin-Yang interaction, causing internal chaos. Leukorrhea and strangury are transformations of Yin Blood. Blood loss leads to Qi decline, irregular menstruation, failure of new blood generation, resulting in Ku and death. Cang Gong's "desiring a man" refers to internal causes in unmarried women; married women with infatuation or unfaithfulness face external causes with similar pathology. Disciple requests recording this to clarify Male Lao and Female Ku together. I agree and append this note.

Article 4 Men with pale complexion primarily suffer from thirst and blood loss. Sudden asthma and palpitations, with a floating pulse, indicate Interior deficiency.

This explains Lao stems from Yin deficiency. One sentence on color, three on symptoms, two on pulse. The face gathers organ essence; color reflects Yin-Yang and Qi-Blood. Qi fills externally, Blood lines internally, like white silk wrapping red/purple dye, showing abundance. This is a good sign of deep Qi-Blood. Pale/thin color in women is excluded due to menstrual cycles. In men, from youth to maturity, Yin Blood is the root. Thin color indicates Qi present but insufficient Blood to support it. Color thinness signifies Blood deficiency; lack of self-moistening requires external water, hence thirst. Men's Blood should not be deficient; visible deficiency implies blood loss via vomiting or epistaxis. Thirst and blood loss derive from thin color. Asthma and palpitations derive from blood loss. Vomiting/epistaxis result from deficiency of Zong Qi (Gathering Qi) in Heart/Lung and upward rush of Lower Jiao Qi, forcing blood out upper orifices. Rushing Qi causes sudden asthma; deficient Zong Qi causes sudden palpitations. Floating pulse confirms Interior deficiency, matching color/symptoms. Floating indicates exteriorization without interior substance, caused by Upper Jiao Qi emptiness leading to blood loss, which further depletes Interior Blood. Without treating Upper Jiao with Guizhi Longgu Muli Tang or Jianzhong Tang to fill Zong Qi, and Lower Jiao with Xiexin Tang or Shenqi Wan to save Yin Blood, progression to fatal Lao is likely. Analyzing the onset: Root is Upper Jiao Yang/Qi emptiness causing asthma, palpitations, blood loss, thirst, and pale color. Initially, Upper Jiao Yang deficiency is mild; shock/worry/vomiting temporarily damage Spirit/Qi. Treating with Guizhi Longgu Muli or Jianzhong Tang secures Upper to control Lower, preventing Qi rush and blood loss. Once blood is lost, Qi loses root and weakens further, becoming unbearable—this is Lao. Empty Upper Jiao Qi is mild; untreated blood loss is severe. Pale color and floating pulse describe diagnostic methods...