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Huangdi asked Qibo: "When Zhou Bi (Generalized Bi Syndrome) exists in the body, the pain migrates up and down following the meridians. The pain on the upper and lower, left and right sides corresponds to each other with minimal gaps. I wish to ask: Is this pain located within the blood vessels (Xue Mai), or between the muscles (Fen Rou)? How does it cause such a condition? When the pain shifts, there is not enough time to insert the needle; when the pain occurs, there is not enough time to determine the treatment, yet the pain has already ceased. What principle causes this? I wish to hear the reason."

Qibo replied: "This is Zhong Bi (Clustered Bi Syndrome), not Zhou Bi."

This chapter discusses the interlacing distribution of Jing Mai (Primary Meridians) and Luo Mai (Collaterals). The Primary Meridians refer to the twelve regular meridians of the Zang-Fu organs, which circulate through the upper and lower parts of the body. The Collaterals refer to the twelve major collaterals of the Zang-Fu organs; Yin meridians connect to Yang, and Yang meridians connect to Yin; the left side influences the right, and the right side influences the left. Bi syndrome refers to Wind, Cold, and Dampness pathogens mixing between the skin and muscles. If the pathogen remains in the skin and overflows into the major collaterals, it is called Zhong Bi; if the pathogen remains in the muscles and rebels against the primary meridians, it is called Zhou Bi. Huangdi asked generally about the blood vessels and muscles above and below, left and right. Although all belong to Yin and Yang and Qi and Blood, there are differences in the depth of skin and muscle, and the interlacing of meridians and collaterals. Therefore, Qibo distinguished between Zhou Bi and Zhong Bi. "Tong" (Pain) refers to pain caused by movement. "Not enough time to determine treatment" means that when the pathogen lodges on the left, the right becomes diseased; when the right is excess, the left becomes diseased. Due to this shifting between left and right, there is not enough time to insert the needle. According to the *Yu Ban* chapter: "The Qi received by humans comes from grain; grain enters the Stomach. The Stomach is the sea of water-grain, Qi, and Blood. Just as the sea moves cloud-like Qi across the world, so too does the Stomach output Qi and Blood through the Jing Sui (Meridian Channels). The Jing Sui are the major collaterals of the five Zang and six Fu organs. This states that the Qi and Blood exiting the Stomach organ spread to the skin via the major collaterals, just as the sea's clouds spread across the world. Thus, when pathogens lodge in the skin and overflow into the major collaterals, it is named Zhong Bi, meaning the pathogen is in a vast, numerous area."

Huangdi said: "I wish to hear about Zhong Bi."

Qibo responded: "Zhong Bi resides in specific locations. It alternately erupts and ceases, alternately rests and rises. The right responds to the left, and the left responds to the right. It cannot circulate throughout the whole body; it alternates erupting and resting."

Huangdi said: "Excellent. How should it be needled?"

Qibo said: "To needle this condition, even if the pain has ceased, one must still needle the affected site to prevent recurrence."

"Residing in specific locations" means the pathogen is blocked in the major collaterals, interlacing with the primary meridians. "Alternately erupting and ceasing, alternately resting and rising" means that while pain persists on the left, the pulse on the right first becomes diseased. "Right responds to left, left responds to right" means that when the left is excess, the right becomes diseased; when the right is excess, the left becomes diseased. Because it alternates erupting and resting, it cannot circulate throughout the whole body. Disease on the left causes pain on the right, and disease on the right causes pain on the left. Therefore, needle the painful site. Although the disease has ceased, one must needle the site of the pathology to prevent recurrence.

Huangdi said: "Excellent. I wish to hear about Zhou Bi."

Qibo said: "Zhou Bi resides within the blood vessels. It follows the meridians upward or downward but cannot move left or right. It stays in its respective location."

Huangdi said: "How should it be needled?"

Qibo said: "If the pain moves from top to bottom, first needle the lower part to intercept the pathogen, then needle the upper part to eliminate the root. If the pain moves from bottom to top, first needle the upper part to intercept the pathogen, then needle the lower part to eliminate the root."

The three Yin and three Yang meridians of the hands and feet move upward from below and downward from above, intersecting and returning. Thus, Zhou Bi resides within the blood vessels, moving up and down with the meridian Qi, but cannot move left or right. "Staying in its respective location" means it differs from collaterals, which each occupy their own spots. "Guo" (Intercept/Pass) means causing the pathogen to pass beyond the muscles and skin to exit. "Tuo" (Eliminate/Shed) means causing the root of the disease to detach from within the meridians. Shen Liangchen stated: "The up and down of meridians, and the left and right of collaterals, should correspond to the Si Tian (Heavenly Command) and Zai Quan (Earthly Authority) and the intervening Qi. The meridians and collaterals of the Zang-Fu organs collectively integrate with the Six Qi of Heaven. Needling later to 'Tuo' (eliminate) has the same meaning as 'must needle the site.'"

Huangdi said: "Excellent. How is this pain generated? Why is it named so?"

Qibo said: "Wind, Cold, and Dampness pathogens lodge between the outer muscles, pressing tightly to form phlegm-fluids (Mo). When these fluids encounter Cold, they condense. Condensation pushes against the muscles, causing them to split. Splitting causes pain. When there is pain, the Spirit (Shen) returns to it. When the Spirit returns, heat is generated. Heat resolves the pain. Resolution leads to Jue (Reversal/Cold extremities). Jue causes other Bi syndromes to erupt. Eruption occurs thus."

This explains the cause of Zhou Bi: the pathogen lodges between the muscles and rebels within the meridians. "Fen Rou" refers to the interstices of the muscles. "Mo" refers to saliva/phlegm formed by the struggle between Wind and Dampness under pressure. When Mo encounters Cold, it condenses; condensation pushes against the muscles, splitting their interstices, thus causing pain. When there is pain, the Heart focuses on the painful spot, and the Shen also gathers there. Shen gathering generates heat; heat resolves the pain. Resolution leads to Jue rebellion within the meridians. Jue within the meridians causes the Zhou Bi to erupt, manifesting as movement up and down along the meridians. This disease is internally not in the Zang organs, externally not erupted on the skin, but resides solely between the muscles. Because the True Qi (Zhen Qi) cannot circulate fully, it is named Zhou Bi.

Huangdi said: "Excellent. I have grasped its meaning. (This sentence may be an interpolation and should connect to the following text.) This disease is internally not in the Zang organs, externally not erupted on the skin, but resides solely between the muscles. Because the True Qi cannot circulate fully, it is named Zhou Bi."

To treat Bi syndrome, one must first palpate and trace the six meridians below, observing their deficiency or excess, and check the major collaterals for blood stagnation and blockage, or for deficiency where the pulse sinks into emptiness. Then regulate them. Use moxibustion/warming therapy to unblock them. For those that are hard and pulling, rotate and guide the Qi to promote circulation.

When pathogens lodge in the body, they first settle in the hair follicles and skin. If they remain, the interstices open; if they remain, they penetrate deeply into the muscles. If they remain, they enter the collaterals. If they remain, they enter the primary meridians, connecting internally to the five Zang organs. Here, the pathogen is in the muscles and rebels within the meridians. Thus, it is internally not in the Zang, externally not out of the skin, residing solely between the muscles, preventing the True Qi from circulating fully, hence named Zhou Bi. True Qi refers to the primal Qi of the five Zang organs. The San Jiao (Triple Burner) communicates through the muscle interstices. It is received from Heaven and combines with Grain Qi to nourish the body. When pathogenic fluids condense in the interstices, the True Qi cannot nourish the body. Hence, "Zhou" means unable to circulate due to obstruction.

"The six meridians below" refers to the twelve primary meridians of the Zang-Fu organs, originating from the feet and integrating with the Six Qi. When the pathogen is in the muscles, the muscles are excess and the meridians are deficient. When rebelling within the meridians, the meridians are excess and the muscles are deficient. Therefore, one must observe deficiency and excess to select points. This is the method for needling Zhou Bi. Blood stagnation in the major collaterals indicates the pathogen is in the major collaterals. Deficiency with sunken pulses indicates collateral Qi deficiency sinking inward. Warming therapy opens the sunken Qi to communicate outward. Hardness and pulling indicate collateral knotting becoming firm; thus, one must rotate and guide to promote circulation. This is the method for regulating Zhong Bi. Zhang Kaizhi said: "The pathogen is in the muscles; internally it enters the meridians, externally it exits the skin. Hence 'externally not erupted on the skin' means the pathogen in the meridians and muscles should still exit through the skin."

Huangdi said: "Excellent. I have grasped its meaning and also its principles. The Nine Needles follow the logic of the meridians, explaining the diseases of Yin and Yang in the twelve primary meridians."

"Principles" (Shi) refers to the matter of assessing normal and abnormal conditions. Generally, if the pathogen is in the skin and remains without entering the meridians, overflowing into the major collaterals, it produces strange and constant diseases. Thus, Huangdi said, "I have grasped its meaning," referring to understanding the pathogen in the muscles and meridians; "and also its principles," referring to knowing the matters of the pathogen in the major collaterals. The Nine Needles follow the constant logic of compliance, used to clarify the diseases of Yin and Yang in the twelve primary meridians. Shen Shi said: "Observing what Huangdi said, he considers the theory of the Nine Needles to be the logic of meridian compliance, used to clarify human Yin and Yang, Qi and Blood, beginnings and endings, entry and exit, corresponding to the Great Dao of Heaven and Earth. Students should seek principles within needling techniques and not let supreme principles be obscured by the needles themselves. The intent of the sages in establishing words is likely here."