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[Ping An]: This section from the beginning of the chapter to "Feng shi ze zong Huangdi yue shan" is found in *Suwen* (Basic Questions), Volume 12, Chapter 43, "Bi Syndrome". From "Huangdi wen yu Qibo yue Zhou bi zhi zai shen ye" to "Yin yang zhi bing ye", it is found in *Lingshu* (Spiritual Pivot), Volume 5, Chapter 27, "Zhou Bi". From "Wen yue ren you shen han" to "Bu xiang you ye yue si", it is found in *Suwen*, Volume 9, Chapter 34, "Ni Diao Lun". From "Feng bi yin bing" to the end, it is found in *Lingshu*, Volume 5, Chapter 24, "Jue Bing". Additionally, from the beginning of the chapter to "Gu bu wei bi Huangdi yue shan", it is found in *Jia Yi Jing* (Classic of Absolute Certainty), Volume 10, Part 1, Upper. From "Wen yue bi huo tong huo bu tong" to "Feng shi ze zong Huangdi yue shan", it is found in *Jia Yi Jing*, Volume 10, Part 1, Lower. From "Huangdi wen yu Qibo yue Zhou bi zhi zai shen ye" to "Zhuan yin er xing zhi", it is found in *Jia Yi Jing*, Volume 10, Part 1, Upper. From "Wen yue ren you shen han" to "Shi ren dang luan jie", it is found in *Jia Yi Jing*, Volume 10, Part 1, Lower. From "Wen yue ren zhi rou ke zhe" to "Bu xiang you ye yue si", it is found in *Jia Yi Jing*, Volume 12, Chapter 3. From "Feng bi yin bing" to the end, it is found in *Jia Yi Jing*, Volume 10, Part 1, Lower.

Huangdi asked Qibo: How is Bi syndrome (Obstruction Syndrome) generated?
Qibo replied: The three pathogenic factors of Wind (Feng), Cold (Han), and Dampness (Shi) mix and invade together; when they combine, they form Bi syndrome. ([Ping An]: In *Jia Yi Jing*, "Bi an sheng" is written as "Bi jiang an sheng"; in *Suwen*, it is "Bi zhi an sheng". In *Jia Yi Jing*, "Za zhi he er wei bi" is written as "He zhi za er wei bi".) When Wind predominates, it is called Xing Bi (Wandering Bi); when Cold predominates, it is called Tong Bi (Painful Bi); when Dampness predominates, it is called Zhuo Bi (Fixed Bi). (If the three combine and one prevails, it receives a specific name for Bi. Thus, if Wind is predominant among the three, it is named Xing Bi, meaning the Bi lesion moves and does not stay fixed, hence "Xing Bi". If Cold is predominant, Yin Qi is excessive causing pain, hence "Tong Bi". If Dampness is predominant, it stays and does not move, hence "Zhuo Bi". "Zhuo" means staying. These three types of disease are formed by the three pathogens together, differing from other diseases which may have cold or heat, pain or no pain, all collectively named Bi.)

Question: What are the "Five Bies"?
([Ping An]: In *Suwen* and *Jia Yi Jing*, "Qi wu zhe" is written as "You wu zhe".)
Answer: Those who encounter these [three pathogens] in Winter become Gu Bi (Bone Bi); those who encounter them in Spring become Jin Bi (Tendon Bi); those who encounter them in Summer become Mai Bi (Vessel Bi); those who encounter them at Zhi Yin (Late Summer/Earth time) become Ji Bi (Muscle Bi); and those who encounter them in Autumn become Pi Bi (Skin Bi). (In Winter, the body cannot regulate itself well; encountering these three pathogens forms three types of Bi, all called Bone Bi because Winter corresponds to Bone/Kidney. The other four seasons follow this pattern. Zhi Yin refers to the sixth month, governed by the Spleen.)

Question: Why does Bi syndrome internalize into the Five Zang and Six Fu organs? What Qi causes this?
(We know the principle of the five seasons feeling the three pathogens to form the five Bies; but why does Bi syndrome internalize into the Zang-Fu organs?)
Answer: Each of the Five Zang organs has a corresponding exterior tissue. If the disease persists for a long time without resolving, it internalizes into its corresponding organ. ([Ping An]: *Suwen* adds "zhe" after "bu qu"; "Nei she qi he" is written as "Nei she yu qi he ye" in *Suwen* and "Nei she yu he" in *Jia Yi Jing*. Therefore it is said: If Gu Bi does not resolve, and one again feels evil, it internalizes into the Kidney; if Jin Bi does not resolve, and one again feels evil, it internalizes into the Liver; if Mai Bi does not resolve, and one again feels evil, it internalizes into the Heart; if Ji Bi does not resolve, and one again feels evil, it internalizes into the Spleen; if Pi Bi does not resolve, and one again feels evil, it internalizes into the Lung. (The correspondences of the Five Zang include the correspondences within the Five Shu points of the Five Zang. All meridians come from outside to connect with the Five Zang, so connection is internalization. Thus, the five Bies of Bone, Tendon, Vessel, Muscle, and Skin, if persistent, internalize into their correspondences. At the time of correspondence, if again exposed to pathogenic Qi, it transfers into the Zang. Entering the Zang leads to death. [Ping An]: Yuan edition note says "Ru zang zhe si ye", where "Zang" was mistakenly printed as "Fu".) The so-called Bi syndrome occurs when one repeatedly feels Cold and Warm Qi during the respective seasons. ([Ping An]: "Han Wen" is written as "Feng Han Shi" in *Suwen* and *Jia Yi Jing*. Also, *Suwen* has a passage here "Fan bi zhi ke wu zang zhe... Bi ju zai pi", which Xin Jiao Zheng states was originally in *Yin Yang Bie Lun* in the Quan Yuanqi edition and moved here by Wang Bing. In this book, it is in *Yin Yang Za Shuo*.])

All Bies, if unresolving, also increase internally. Among them, if Wind predominates, the person is easily cured. (When the five Bies do not resolve, each season brings repeated exposure to thief-evil Cold/Warm Qi, increasing the internal Bi of the Five Zang, which leads to death. If Wind increases, it is easily cured. [Ping An]: *Suwen* and *Jia Yi Jing* write "Yi yi yu nei" as "Yi yi nei ye". Note: The character "Er" in "Er zhong gan" is missing in the Yuan edition.)

Question: Why does some Bi lead to death, some cause long-lasting pain, and some are easily cured? What is the reason?
(Bi severity does not exceed these three aspects, hence the question. [Ping An]: *Suwen* adds "Bi" after "Yue".)
Answer: Those that enter the Zang die, (Because Zang stores Shen/Spirit, Bi entering leads to death.) Those lingering between Sinews and Bones cause long-lasting pain, (Pathogens adhere and connect between Sinews and Bones, causing pain there.) Those flowing between the Skin are easily cured. (Flowing in the superficial skin layers, moving and shallow, thus easily cured. [Ping An]: *Suwen* writes "Liu" as "Liu"; *Jia Yi Jing* writes "Liu Lian".)

Question: How do pathogens lodge in the Six Fu organs?
Answer: This also arises from improper diet and living conditions becoming the root of disease. Each of the Six Fu organs has Shu points. When Wind, Cold, and Dampness strike these Shu points, internal factors from diet and living respond, following the Shu points inward, lodging in their respective Fu organs. (Above discusses Bi entering Zang; below discusses the cause of Bi entering Fu. External evils of Wind, Cold, Dampness strike Fu Shu points; internal evils of diet/living respond. Internal draws external, so Bi enters Six Fu. The Shu points are also the He-Sea points of the Fu. [Ping An]: *Suwen* and *Jia Yi Jing* omit "You" after "Ci Ye"; "Shu" is written as "Yu", same below.)

Question: How should acupuncture be used to treat it?
Answer: The Five Zang have Shu points, the Six Fu have He-Sea points. Following the divisions of the meridians, each has its manifestation site. Treating according to the affected site will cure the disease. (Treating Bi involves taking the Shu points of the Five Zang. Question: The key to treating Bi is "pain as Shu point"; now we take Zang Shu points, how to reconcile? Answer: For painful Bi, pain can serve as the Shu point; for non-painful Bi, how can pain be the Shu point? Thus, one must judge appropriateness and select the correct point; this is the physician's intent. To treat Fu Bi, one should take the He-Sea points, precisely because Zang and Fu Shu and He-Sea points are where Zang-Fu meridian Qi emerges, so observe and purge accordingly. [Ping An]: *Suwen* writes "Ge zhi qi yu" as "Ge sui qi guo"; *Jia Yi Jing* writes "Ge zhi qi guo"; Yuan edition writes "Yu" as "Dao".)

Question: Do Ying (Nutrient) and Wei (Defensive) Qi also combine with human Bi?
(This asks about Ying and Wei Qi, which one combines with the three pathogens to form Bi? [Ping An]: *Suwen* and *Jia Yi Jing* write "He" as "Ling".)
Answer: Ying Qi is the essence of water and grain. It harmonizes within the Five Zang and spreads throughout the Six Fu, then enters the vessels. Thus, it flows down the vessels, penetrating the Five Zang and connecting with the Six Fu. (Ying, Wei, Blood, and Qi circulate along meridians, penetrating Five Zang, regulating spirit. Connecting with Six Fu, spreading harmonious Qi (Chen means rise), thus combining with the three pathogens to form Bi. However, the twelve meridians: Zang meridians penetrate Zang and connect Fu, Fu meridians penetrate Fu and connect Zang; all are Ying Qi. Why is it said here that Ying Qi only penetrates Zang and connects Fu? This statement only highlights one aspect; the penetration and connection of Zang and Fu meridians are the same. [Ping An]: *Suwen* and *Jia Yi Jing* write "Zhi xia" as "Shang Xia". Note: "Mai" in "Twelve Jing Zang Mai" was mistakenly printed as "Fu" in Yuan edition.)

Wei Qi is the fierce Qi of water and grain. Its nature is swift and slippery. It cannot enter the vessels, so it follows inside the skin, between the muscle intervals, steaming at the Wei-Mu points of the Stomach, and dispersing in the chest and abdomen. Reversing its Qi causes rapid illness; following its Qi leads to recovery. It does not combine with Cold, Damp, or Wind, thus it does not form Bi. Huangdi said: Excellent. (Wei Qi, the fierce Qi of water and grain, has a swift nature, walking between skin and muscle intervals, steaming at Stomach Mu points, thus dispersing in chest and abdomen. Obstruction leads to carbuncles and sores; patency prevents illness, therefore it does not combine with the three pathogens to form Bi. [Ping An]: *Suwen* and *Jia Yi Jing* write "Pi fu zhi nei" as "Pi fu zhi zhong"; "Wei Mu" as "Mang Mo"; "Ze ji zuo ze bing". *Jia Yi Jing* writes "Piao"; "San yu xiong fu" as "Ju yu xiong fu", note says: *Suwen* writes "San".)

Question: Why is Bi sometimes painful, sometimes not; sometimes insensate, sometimes cold, sometimes hot, sometimes dry, sometimes damp? What is the reason?
(The states of Bi caused by the three pathogens total seven, hence asking for explanation.)
Answer: Pain occurs when Cold is abundant, compounded by thin clothing exposing one to cold, hence pain. (Internal Cold is abundant, plus thin clothing generates external cold; internal and external cold combine, so Bi presents with pain. [Ping An]: *Suwen* and *Jia Yi Jing* write "You yi han gu wei tong" as "You han gu tong".)
Insensibility (Bu Ren) occurs when the disease is deep and chronic, Ying and Wei flow is obstructed, meridians are occasionally empty and sparse. Sparseness without pain, skin lacks nourishment, hence insensibility. Coldness occurs when Yang Qi is scarce and Yin Qi is abundant, adding to the pathological state, hence cold. ("Ren" implies intimacy/sensation. Ying, Wei, and Meridian Qi are sparse and obstructed, failing to nourish skin; Shen does not reach the skin, so skin feels no pain or itch, named Bu Ren. The felt Yang-Warm Qi is scarce, Yin-Cold Qi is abundant, combining with the existing disease, so Bi manifests as cold. [Ping An]: *Suwen* and *Jia Yi Jing* write "Qi bu ren zhe" as "Qi bu tong bu ren zhe". *Jia Yi Jing* writes "Shu er bu tong" as "Gu bu tong"; *Suwen* writes "Gu bu tong". Xin Jiao Zheng notes: "*Jia Yi Jing* writes 'Bu tong' as 'Bu tong', detailing that this section discusses both 'no pain' and 'insensibility'; later mentioning 'no pain' reiterates the emphasis on 'no pain'.")
Heat occurs when Yang Qi is abundant and Yin Qi is scarce. Pathogenic Qi overcomes Yang and encounters Yin, hence Bi Heat. (Felt Yang-Warm Qi is abundant, Yin-Cold Qi is scarce. Yin and Yang Qi meet and clash; Yang excess becomes disease, hence Bi Heat. [Ping An]: *Jia Yi Jing* writes "Zao" as "Cheng".)
Excessive cold with sweating and wetness occurs when Dampness is severe, Yang Qi is scarce, and Yin Qi is abundant. The two Qi interact, hence cold sweat and wetness. (Felt Yang Qi is scarce; Damp interacts with Cold, hence cold and sweating wetting clothes. [Ping An]: *Jia Yi Jing* adds "Chu" after "Han" in "Qi duo han"; *Suwen* omits "Han" before "Han". "Feng shi shen": *Jia Yi Jing* writes "Shen" as "Sheng". *Suwen* omits "Han" in "Gu han han chu ru".)

Why is there Bi without pain?
Answer: Bi in Bone causes heaviness; Bi in Vessel causes blood coagulation and stagnation; Bi in Sinew causes flexion without extension; Bi in Muscle causes insensibility; Bi in Skin causes coldness. Possessing all five results in no pain. Generally, Bi types contract when encountering Cold and relax when encountering Dampness. Huangdi said: Excellent. (Three pathogens combine to form Bi, located in five areas. One possessing all five has Bi. This Bi is painless, hence "non-painful Bi". Some say Bi is painful; this does not fully explain Bi. "Bu zhi" means not feeling pain and insensibility. [Ping An]: *Jia Yi Jing* and *Suwen* write "Ning" for " "; "Bu zhi" as "Bu ren". *Suwen* writes "Ze ji" as "Ze chong"; "Feng shi" as "Feng re".)

Huangdi asked Qibo: Zhou Bi (Circulating Bi) moves up and down the body, follows meridians up and down, responds left and right, with gaps smaller than a space. I wish to know if this pain is in the blood vessels or between the muscle intervals? What causes this? The pain moves too quickly to needle; when pain accumulates, there is no time to decide treatment, yet the pain stops. What mechanism causes this? I wish to hear the reason. (Zhou Bi: Evil resides between muscle intervals, preventing Zheng Qi from circulating fully. Evil combines with circulation to form Bi, hence Zhou Bi. Now Huangdi's intent describes pain circulating up/down, moving everywhere, named Zhou Bi. Qibo's intent suggests this movement across various sites could be Zhong Bi, not Zhou Bi. "Jian bu ji xia zhen": During pain, before one can needle, the pain has already moved. [Ping An]: Note "Xun xing shang xia" variant is "Xun xing shang xia".)

Qibo answered: This is Zhong Bi (Multiple Bi), not Zhou Bi.
Huangdi said: I wish to hear about Zhong Bi.
Qibo answered: Zhong Bi resides in specific locations, alternating onset and cessation, alternating residence and rising. Right corresponds to left, left to right. It does not circulate fully; it alternates onset and rest. (Meaning Zhong Bi appears at left/right locations, alternating body parts, unable to circulate fully, hence Zhong Bi. Ju/Qi refers to stillness/motion.)
Huangdi said: Excellent. How to needle?
Qibo answered: To needle this, even if pain has ceased, one must needle the site where the pain stopped, to prevent recurrence. (However, Zhong Bi resides in fixed body locations, only pain has pauses and outbreaks. So even if pain stops, one must needle the site of pause to prevent rising. [Ping An]: Note: Character above "Ling" is missing left side, right side remains; Yuan edition prints "San", likely error, leaving blank space.)
Huangdi said: Excellent. I wish to hear what Zhou Bi is like.
Qibo answered: Zhou Bi resides in the blood vessels, following meridians upward and downward, unable to move left or right, residing in its specific location. (Meaning Zhou Bi status: Bi is in blood vessels, following meridians up/down, unable to stay fixed left/right, merely obstructing True Qi, preventing Ying Qi from circulating fully, hence named Zhou Bi. [Ping An]: *Lingshu* writes "Xun mai yi xia" as "Sui mai yi xia".)
Huangdi said: Excellent. How to needle?
Qibo answered: If pain moves from top to bottom, first needle below to block it, then needle above to release it. If pain moves from bottom to top, first needle above to block it, then needle below to release it. (Needling method for Zhou Bi: Observe Bi moving down; first needle before the downward progression to stop entry; then needle behind the Bi to drain Qi. For Bi moving up, apply similarly. [Ping An]: *Lingshu* writes "E" as "Guo", note says also "E"; *Jia Yi Jing* writes "Tong", note says one version "E".)
Huangdi said: Excellent. How is this pain generated? Why is it named so? (Asking for the origin of Zhou Bi and the etymology of its name.)
Qibo answered: Wind, Cold, and Dampness lodge between muscle intervals, pressing fluids to form foam. Foam gathers when cold; gathering presses and splits muscle intervals. Splitting causes pain. (Three pathogens form Zhou Bi, following meridians to muscle intervals. Qi gathers and presses muscles, splitting flesh causes pain. [Ping An]: *Lingshu* and *Jia Yi Jing* write "Er lie fen" as "Er fen lie".) Pain draws Shen (Spirit/Mind) to the site. Shen arriving generates heat. Heat resolves pain. Pain resolution leads to Jue (Reversal/Collapse). Jue triggers Bi in other areas, thus recurring. (Bi pain guides Shen to pain. Shen and pain persist, heat gathers, pain resolves. Here pain resolves and Jue occurs, then other areas hurt. Zhou Bi pauses and rises thus. [Ping An]: *Lingshu* and *Jia Yi Jing* repeat "Fa" after "Fa". Note: "Tong sheng", Yuan edition mistakenly prints "Bing" for "Tong".)
Huangdi said: Excellent. I have grasped its meaning.

Internally it is not in the Zang, externally it has not erupted in the Skin, dwelling alone between muscle intervals, True Qi cannot circulate fully, hence named Zhou Bi. (Explaining the name Zhou Bi. [Ping An]: *Lingshu* and *Jia Yi Jing* add "Er" before "Wai". *Jia Yi Jing* writes "Ming yue" as "Ming yue".)

Therefore, to needle Bi, one must first palpate the six meridians below, observing deficiency and excess, (Six meridians refer to Three Yin and Three Yang. Palpating the six meridians below the Bi lesion for deficiency/excess, this is point one. [Ping An]: *Jia Yi Jing* writes "Xia zhi liu jing" as "Shang xia zhi da jing".) as well as large collaterals with blocked blood, (Palpating fifteen large collaterals to know patency/blockage, this is point two. [Ping An]: *Lingshu* and *Jia Yi Jing* write "Er jie bu tong" as "Jie er bu tong".) and deficient, sunken, empty pulses, regulate them, use moxibustion/warming to open tightness, and guide/rotate to promote Qi flow. Huangdi said: Excellent. I have grasped its meaning and its application. (Again palpating meridians to know deficiency/sunkenness, this is point three. Then apply warming therapy, mild warming to regulate, use guiding exercises to relieve tightness, rotate to move Qi, then needle. This is the key to treating Bi, relaxing tension. [Ping An]: *Lingshu* and *Jia Yi Jing* add "Er" before "Tiao", "Zhi" after "Tong". "Jin" *Lingshu* writes "Jian"; *Jia Yi Jing* adds "Zhe" after "Jin".) Ren Jiu (Nine Regions) refers to the principles of meridians, the disease of Yin and Yang of the twelve meridians. (Grasping application means understanding humans conform to Nine Regions, and meridian Yin-Yang diseases. [Ping An]: *Lingshu* omits "Ren" before "Jiu".)

Question: A person feels cold internally, hot water/fire cannot warm them, thick clothing cannot warm them, yet they do not shiver/chill. What disease is this? (Body cold but not feeling cold, disease is hard to know, hence asking. [Ping An]: *Suwen* omits "Ye" after "Re" and "Wen"; this text has "Shi Wei"; *Jia Yi Jing* same.)
Answer: This person has historically strong Kidney Qi, engages in watery labor, Tai Yang Qi declines, Kidney essence dries up and fails to grow. One Water cannot overcome Two Fires. Kidney is Water and governs bones. If Kidney fails to generate, Marrow cannot fill. Hence cold reaches the bone. (Su means prior. Person's Kidney Qi was previously strong, Foot Tai Yang Kidney Fu declined, Kidney essence dried up, unable to nourish/grow. With one Kidney Fu Water vs. Heart/Liver Two Yangs in the body, attacked by Yang, one Water cannot defeat two Yangs, hence reverse cold reaching marrow, clothes/fire cannot warm. [Ping An]: *Suwen* writes "Er zhu gu" as "Er sheng yu gu".)
The reason for not shivering is that Liver is One Yang, Heart is Two Yang, Kidney is solitary Zang. One Water cannot overcome the upper Two Fires, hence no shivering. This disease is named Gu Bi (Bone Bi). This person will suffer joint contraction. (Although cold reaches bone, Two Yangs still prevail, hence no shivering, leading to Bone Bi. This person will suffer joint contraction. One version "Luan" is "Bian"; having this disease必然 alters joint structure. [Ping An]: *Jia Yi Jing* writes "Shang er huo" as "Shang xia huo"; *Suwen* omits "Shang".)

Question: What is the condition of heavy/kua muscles in a person? Even near cotton/wadding, they still feel kua. What disease is this?
Answer: Ying Qi is deficient, Wei Qi is solid. If Wei Qi is deficient, there is insensibility and inability to use; if Ying and Wei are both deficient, there is insensibility and inability to use, muscles feel like kua (heavy/unfeeling). Body and Will/Zhi lose connection, termed death. (Kua sounds like Ke. Some versions write "Gou". Both mean extreme insensibility. Thus even with cotton/wadding warmth, still insensible is called Kua. Knowing that near cotton/wadding yields sensation is Bu Ren. Ying deficient Wei solid, Qi reaches sensation, hence still Ren. If Ying solid Wei deficient, flesh is insensible. If Ying and Wei both deficient, extreme insensibility, hence flesh like Kua. Ru means same. Extreme flesh insensibility means Shen cannot connect, hence death. [Ping An]: *Suwen* writes "Wei qi xu ze bu ren er bu yong" as "Rong qi xu ze bu ren,")