痹，闭也，血气凝涩不行也。有风寒湿三气之痹，有皮肌脉筋骨，五脏外合之痹，六腑有俞，五脏亦
有俞；五脏有合，六腑亦有合，故有五脏六腑之痹。荣卫流行，则不为痹，痹之为病，或痛、
或不痛、或不仁、或寒、或热、或燥、或湿，举而论之，故曰《痹论》。
黄帝问曰∶痹之安生？
周身经脉不和，拘挛闭痹，从何而生？
岐伯对曰∶风寒湿三气杂至，合而为痹也。其风气胜者为行痹，寒气胜者为痛痹，湿气胜
者为着痹也。
痹之生也，生于风寒湿三气，杂至于身，合于经脉而为痹也。三邪之中，复有偏胜，其风气胜者，风
无定体，故为行痹。寒气胜者，阴盛阳虚，故为痛痹。湿气胜者，留滞不行，故为着痹也。
帝曰∶其有五者何也？
四时合五行，其因时受邪，而有五痹者何也？
岐伯曰∶以冬遇此者为骨痹，以春遇此者为筋痹，以夏遇此者
为脉痹，以至阴遇此者为肌痹，以秋遇此者为皮痹。
痹，闭也。闭主冬，故论痹始于冬，以冬时遇此风寒湿三气者，则为骨痹；以春时遇此风寒湿三气者，
则为筋痹；以夏时遇此风寒湿三气者，则为脉痹；以长夏至阴遇此风寒湿三气者，则为肌
痹；以秋时遇此风寒湿三气者，则为皮痹，须知五痹，虽有在骨在筋在脉在肌在皮深浅之不同，亦以风
寒湿三邪之偏胜者，而有行痹痛痹着痹之各异也。
帝曰∶内舍五脏六腑，何气使然？
皮肌脉筋骨，既合四时之气，若内舍五脏六腑，则何气使然？
岐伯曰∶五脏皆有合，病久而不去者，内舍于其合也。
合，外内相合也，肾合骨，肝合筋，心合脉，脾合肌，肺合
皮，五脏皆有合也，痹病久而不去者，内舍于其所合，而为脏痹也。
故骨痹不已，复感于邪，内舍于肾。筋痹不已，复感于邪，内舍于肝。脉痹不已，复感于邪，内舍于
心。肌痹不已，复感于邪，内舍于脾。皮痹不已，复感于邪，内舍于肺。所谓痹者，各以其时，重感于风寒湿气也。
重，平声。病久不去，则逾年矣，故骨痹不已，至冬复感于邪，则内舍于肾。筋痹不已，至春复感
于邪，则入舍于肝。脉痹不已，至夏复感于邪，则内舍于心。肌痹不已，至至阴复感于邪，则
内舍于脾。皮痹不已，至秋复感于邪，则内舍于肺。所谓内舍五脏
之痹者，乃病久不去，亦多以其时，重感于风寒湿之气也。
凡痹之客五脏者，肺痹者烦满，喘而呕。
重感于邪，则入于脏，故申言凡痹之客五脏者，肺脉起于中焦，为心之盖，故肺痹者，烦满，肺
主呼吸，脉循胃口，肺痹故喘而呕。
心痹者，脉不通，烦则心下鼓，暴上气而喘，嗌干，善噫，厥气上则恐。
心主脉，故心痹者脉不通。心虚则烦，故烦则心下鼓。鼓，犹动也。心脉上肺，故暴上气而喘。
《经脉》论云，心是动则病嗌干。《宣明五气篇》云，病心为噫。故嗌干善噫。心气下交于肾，
心厥气上，不交于肾，则恐。
肝痹者，夜卧则惊，多饮数小便，上为引如怀。
数，音朔，下同。人卧血归于肝，故肝痹者，夜卧则惊，木郁则热，故多饮，郁而不升，故数小便。
《经脉》论云，肝病丈夫 疝，妇人少腹肿，故上为引于下，有如怀物之状。
肾痹者，善胀，尻以代踵，脊以代头。
人之生气，发原于肾，生气不升，故善胀。尻，尾骨也。尾骨下
蹲，以代踵，足骨痿也；脊骨高耸以代头，天柱倾也。
脾痹者，四肢解堕发咳，呕汁，上为大塞。
脾主四肢，故脾痹者，四肢懈惰；土灌四旁，痹则上气不灌，气惟上逆，故发咳。入胃之饮，借
脾气以散精，痹则不能散精，故呕汁。脾气不能转输，则肺不能通调，故上为大塞。凡此皆痹之客于五脏也。
肠痹者，数饮而出不得，中气喘争，时发飧泄。
肠，小肠大肠也。小肠为心之腑。《灵枢·经水》论云，手太阳外合淮水，内合于小肠，而水道出焉。
小肠痹，则热郁于上，故数饮。气滞于下，故小便出不得。大肠为肺之腑。大肠痹，则中气
逆于上，故喘争；清浊混于下，故时发飧泄。
胞痹者，少腹膀胱，按之内痛，若沃以汤，涩于小便，上为清涕。
胞痹，即膀胱痹也。膀胱居于胞中，胞中位于少腹。故胞痹者，少腹膀胱，按之内痛，其痛也，若沃以
沸汤之热，膀胱之气不出于皮毛，则涩于小便，胞中之血，不渗于肤腠，则上为清涕。言
六腑之痹，不及胃胆三焦者，肠胃皆受糟粕，言肠不必更言胃矣。胞为经血之海，胆为中精之府，言胞不必
更言胆矣。三焦者，中渎之府，水道出焉，属膀胱。言膀胱，不必更言三焦矣，凡此言痹之客于六腑也。
阴气者，静则神藏，躁则消亡。
藏，如字。结上文藏痹之意。五脏为阴，以静为本，故阴气
者，宁静则神气内藏，躁扰不宁，则神气消亡，神气亡，致有五脏之痹矣。
饮食自倍，肠胃乃伤。
结上文腑痹之意。六腑为阳，传化饮食，若饮食自倍，则传化
有愆，而肠胃乃伤，肠胃伤，致有六腑之痹矣。
淫气喘息，痹聚在肺。淫气忧思，痹聚在心。淫气遗溺，痹聚
在肾。淫气乏竭，痹聚在肝。淫气肌绝，痹聚在脾。
溺，鸟去声。申明躁则消亡者，如淫乱之气，使人喘息而躁，
则痹聚在肺，而肺气消亡矣。淫乱之气，动人忧思而躁，则痹聚在心，而心气消亡矣。淫乱之气，令人遗
溺而躁，则痹聚在肾，而肾气消亡矣。淫乱之气，使气血乏竭而躁，则痹聚在肝，而肝气消亡
矣。淫乱之气，使肌肉断绝而躁，则痹聚在脾，而脾气消亡矣，此淫气内乱，致有五脏之痹，以明静则神
藏，躁则消亡之意。
诸痹不已，亦益内也，其风气胜者，其人易已也。
易，去声，下同。益，增也，申明肠胃乃伤者，诸腑痹不已，亦增五内之病也。其腑痹而风气胜者，
风以散之，不但不增内病，而其人之痹且易已也，以明肠胃乃伤之腑痹，重则益内，轻则易己之意。
帝曰∶痹其时有死者，或疼久者，或易已者，其故何也？
其病且有死者，有疼久者，今有易已者，其故何也？并举以问，殆欲详明易已之痹。
岐伯曰∶其入脏者，死，其留连筋骨间者，疼久，其留皮肤间者，易已。
痹时有死者，乃入藏者死，或疼久者，其留连筋骨间者，疼久，若其易已者，乃留于皮肤间者，易已。
帝曰∶其客于六腑者何也？
帝欲详明六腑之易已，故为是问。
岐伯曰∶此亦其食饮居处，为其病本也。
饮食自倍，肠胃乃伤，是为六腑之痹，故申言此亦其食饮居处，犹言食饮自倍，居处失宜，以为腑痹
之病本也。
六腑亦各有俞，风寒湿气中其俞，而食饮应之，循俞而入，各舍其腑也。
中，去声。五脏皆有合，而六腑亦各有俞，风寒湿三气中其俞，而食饮无节以应之，则风寒湿之邪，循
俞穴而入，各舍其腑也，与五脏之病久不去，复感于邪，内舍于其合者，同一义也。
帝曰∶以针治之奈何？
以针治六腑之痹，奈何？
岐伯曰∶五脏有俞，六腑有合，循脉之分，各有所发，各随其过，则病瘳也。
不但六腑有俞，而五脏有俞，不但五脏有合，而六腑有合，循其六腑经脉之分行，各有所发之部，各随
其所过之路，因而针之，病可瘳也，此腑痹之所以易已也。
帝曰∶荣卫之气，亦令人痹乎？
承上文五脏六腑之痹，复问荣卫之气，亦令人痹乎？
岐伯曰∶荣者水谷之精气也，和调于五脏，洒陈于六腑，乃能入于脉也，故循脉上下，
贯五脏、络六腑也。
《灵枢·荣气》篇云∶荣气之道，内谷为实，谷入于胃，乃传之肺，流溢于中，布散于外，精专
者，行于经隧，是荣气者，乃水谷之精气，以相资益也。其气先和调于五脏，次洒陈于六腑，乃能
资益其荣，而入行于脉中也。荣行脉中，故荣气循脉上下，从内出外，内则贯五脏，外则络六腑也。
卫者，水谷之悍气也，其气 疾滑利，不能入于脉也，故循皮肤之中，分肉之间，熏于
盲膜，散于胸腹。
《灵枢·卫气》论云，其精气之行于经者为荣气，其浮气之不循经者为卫气，是卫者，乃水谷之
悍气，以相辅助也。其气 疾滑利，不能化精气而入行于脉中也，不入于脉，故但循于皮肤之中，
以及分肉之间，内则气熏于盲膜，外则气散于胸腹。
逆其气则病，从其气则愈，不与风寒湿气合，故不为痹。
承上文荣行脉中，卫行脉外之意，而言逆其荣卫之气则病，从其荣卫之气则愈。荣卫之气，循行不息，
不与风寒湿三气相合，是以不为痹也，承五脏六腑之痹，而申明荣卫之不为痹者如此。
帝曰∶善。痹或痛，或不痛，或不仁，或寒，或热，或燥，或湿，其故何也？
荣行脉中，卫行脉外，营运不息，故不为痹。所以风气胜而痹易已，帝故善之。复问痹或有身痛者，
或有身不痛者，或有不知痛痒而不仁者，或有身寒者，或有身热者，或有无汗而燥者，或有有
汗而湿者，其故何也？
岐伯曰∶痛者寒气多也，有寒故痛也。
痹之痛者，寒邪之气多也，身有寒，故痛也。寒气胜者，为痛痹，此之谓也。
其不痛不仁者，病久入深，荣卫之行涩，经络时疏，故不痛，
皮肤不营，故为不仁。
次痛，旧本讹通，今改。其痹之不痛与不仁者，痹病久而邪入深，病久则荣卫之行，失其常度而
涩矣。入深，则经脉络脉，时疏于外矣。荣卫行涩，经络时疏，血气外而不内，故不痛。其不仁
者，皮肤之血气，不营运于通体，皮肤不营，血气内而不外，故不知痛痒而为不仁。
其寒者，阳气少，阴气多，与病相益，故寒也。
其痹之有寒者，以人身阳气少，阴气多，阴气多而与病相益，故寒也。
其热者，阳气多，阴气少，病气胜，阳遭阴，故为痹热。
其痹之有热者，以人身阳气多，阴气少，阳气多则病阳气胜，
阳气胜而遭阴气之不胜，故为痹热。
其多汗而濡者，此其逢湿甚也。阳气少，阴气盛，两气相感，故汗出而濡也。
其痹之多汗而濡者，此其逢湿气之甚也。其人身亦阳气少，阴气盛，湿，阴类也。阴气盛而逢湿，
是两气相感，故汗出而濡湿也，知阴气盛而主湿，则知阳气盛而主燥矣。此申明痛痒寒热燥湿之痹者如此。
帝曰∶夫痹之为病，不痛何也？
凡痹必痛，今夫痹之为病，有不痛者，何也？
岐伯曰∶痹在于骨，则重；在于脉，则血凝而不流；在于
筋，则屈不伸，在于肉，则不仁；在于皮，则寒。故具此五者，则不痛也。
外内之气，不相交合则痛，病有形之皮肉筋脉骨，而气机得以
相交则不痛。如痹但在于骨，而筋脉皮肉之气自和，则身重而不痛；痹但在于脉，而皮肉筋骨之气自和，
则血凝不流而不痛；痹但在于筋，而皮肉骨脉之气自和，则屈不伸而不痛；痹但在于肉而皮
骨筋脉之气自和，则不仁而不痛；痹但在于皮，而骨肉筋脉之气自和，则寒而不痛，故不痛者。具此在骨在
脉在筋在肉在皮五者，余气得以相通，则不痛也。
凡痹之类，逢寒则虫，逢热则纵。
承上文痛痒寒热燥湿之痹，而曰凡痹之类。类，犹合也。谓寒合于湿，热合于燥也。如湿痹逢寒，
则寒湿相薄，故生虫，虫生则痒矣。燥痹逢热，则筋骨不濡，故纵。纵，弛纵也。弛纵则痛矣。
帝曰∶善。
上文未言燥痹，于此明之，帝故曰善。
Bi (Obstruction Syndrome) refers to blockage, where blood and qi congeal and fail to circulate. There are Bi syndromes caused by the three pathogens of Wind, Cold, and Dampness; there are Bi syndromes corresponding to the skin, muscle, vessels, sinews, bones, and the external correspondences of the Zang organs; the Fu organs have Shu points, and the Zang organs also have Shu points; the Zang organs have internal-external correspondences, and the Fu organs also have correspondences. Therefore, there are Bi syndromes of the Zang and Fu organs. When Ying (Nutritive) and Wei (Defensive) Qi circulate freely, Bi does not occur. As a disease, Bi may manifest as pain, no pain, numbness, cold sensation, heat sensation, dryness, or dampness. Discussing all these aspects comprehensively, it is called "Treatise on Bi" (Bi Lun).
The Yellow Emperor asked: How does Bi arise?
When the meridians throughout the body are disharmonious, leading to spasms and obstruction, from where does it originate?
Qibo replied: The three pathogens—Wind, Cold, and Dampness—mix and invade together, combining to form Bi. If Wind Qi is predominant, it is called Xing Bi (Wandering Bi); if Cold Qi is predominant, it is called Tong Bi (Painful Bi); if Dampness Qi is predominant, it is called Zhuo Bi (Fixed/Heaviness Bi).
Bi arises from Wind, Cold, and Dampness mixing in the body and combining with the meridians to form Bi. Among these three pathogens, one may be predominant. Predominant Wind, having no fixed form, results in Wandering Bi. Predominant Cold, characterized by Yin excess and Yang deficiency, results in Painful Bi. Predominant Dampness, which lingers and stagnates, results in Fixed Bi.
The Yellow Emperor asked: Why are there five types of Bi?
The four seasons correspond to the Five Phases. Due to seasonal pathogenic invasion, why do five types of Bi arise?
Qibo said: Contracting this [Wind-Cold-Damp] in Winter results in Gu Bi (Bone Bi); in Spring, Jin Bi (Sinew Bi); in Summer, Mai Bi (Vessel Bi); during the late summer (Zhi Yin period), Ji Bi (Muscle Bi); and in Autumn, Pi Bi (Skin Bi).
Bi means blockage. Blockage corresponds to Winter, so the discussion of Bi begins with Winter. Contracting Wind, Cold, and Dampness in Winter leads to Bone Bi; in Spring, Sinew Bi; in Summer, Vessel Bi; in late summer, Muscle Bi; and in Autumn, Skin Bi. It must be understood that although the five Bies differ in depth (bone, sinew, vessel, muscle, skin), they also vary as Wandering, Painful, or Fixed Bi due to the predominance of Wind, Cold, or Dampness.
The Yellow Emperor asked: What causes the pathogens to enter and reside within the Zang and Fu organs?
Since skin, muscle, vessels, sinews, and bones correspond to the four seasons' Qi, what causes them to internally reside in the Zang and Fu organs?
Qibo said: Each Zang organ has an external correspondence. If Bi persists for a long time without resolving, it will internally reside in its corresponding Zang organ.
"Correspondence" refers to the mutual connection between interior and exterior. Kidney corresponds to bone; Liver to sinews; Heart to vessels; Spleen to muscle; Lung to skin. Each Zang has such a correspondence. If Bi persists, it internally resides in its corresponding Zang, forming Zang Bi.
Thus, if Bone Bi persists and re-exposure to pathogens occurs, it internally resides in the Kidney. If Sinew Bi persists and re-exposure occurs, it resides in the Liver. If Vessel Bi persists and re-exposure occurs, it resides in the Heart. If Muscle Bi persists and re-exposure occurs, it resides in the Spleen. If Skin Bi persists and re-exposure occurs, it resides in the Lung. This is referred to as Bi, occurring when one re-contracts Wind, Cold, and Dampness during their respective seasons.
"Prolonged" implies more than a year. Thus, if Bone Bi persists into Winter and re-exposure occurs, it enters the Kidney. If Sinew Bi persists into Spring, it enters the Liver. If Vessel Bi persists into Summer, it enters the Heart. If Muscle Bi persists into late summer, it enters the Spleen. If Skin Bi persists into Autumn, it enters the Lung. These internal Zang Bies result from prolonged illness and re-exposure to Wind, Cold, and Dampness during the appropriate seasons.
Regarding Bi residing in the Zang organs: Lung Bi manifests as irritability, fullness, panting, and vomiting.
Re-exposure allows entry into the Zang. The Lung meridian originates in the middle jiao and covers the Heart; thus, Lung Bi causes irritability and fullness. The Lung governs respiration, and its meridian passes through the stomach region; thus, it causes panting and vomiting.
Heart Bi manifests as blocked vessels, palpitations upon irritation, sudden upward rushing of Qi causing panting, dry throat, frequent belching, and fear when rebellious Qi ascends.
The Heart governs vessels, so Heart Bi involves vessel blockage. Heart deficiency causes irritability, leading to palpitations ("drumming"). The Heart meridian ascends to the Lung, causing sudden Qi rush and panting. The *Jingmai* chapter states Heart disorders cause dry throat; the *Xuanming Wuqi* chapter states Heart disease causes belching. Normally, Heart Qi descends to the Kidney; if rebellious Qi ascends without descending, fear ensues.
Liver Bi manifests as fright during sleep, excessive thirst, frequent urination, and upper-body pulling sensations resembling pregnancy.
Blood returns to the Liver during sleep; thus, Liver Bi causes night frights. Wood stagnation generates heat, causing thirst. Stagnation prevents ascending, causing frequent urination. The *Jingmai* chapter mentions Liver disease causes hernia in men and lower abdominal swelling in women, explaining the pulling sensation.
Kidney Bi manifests as frequent distension, walking with the sacrum replacing the heels (due to weak leg bones), and the spine erecting to replace the head (due to tilting of the Tianzhu pillar/spine).
Life Qi originates in the Kidney; failure to ascend causes distension. The sacrum replaces the heels when squatting due to leg weakness; the spine rises high, replacing the head's position.
Spleen Bi manifests as flaccidity of the four limbs, coughing, vomiting of clear fluid, and severe upper obstruction.
The Spleen governs the four limbs, causing flaccidity. Earth Qi normally nourishes all directions; Bi prevents this, causing Qi rebellion and coughing. The Spleen disperses essence from ingested fluids; Bi prevents this, causing vomiting of clear fluid. Spleen failure to transport affects Lung water regulation, causing upper obstruction. These are manifestations of Bi in the Zang organs.
Intestine Bi manifests as frequent drinking but inability to urinate, abdominal Qi turbulence, and occasional undigested stool diarrhea.
"Intestines" refer to Small and Large Intestines. The Small Intestine is the Fu of the Heart. Its disorder causes Heat stagnation above (thirst) and Qi stagnation below (urinary retention). The Large Intestine is the Fu of the Lung. Its disorder causes Middle Jiao Qi rebellion (panting/turbulence) and mixing of clear/turbid below (undigested diarrhea).
Bao (Bladder/Uterus) Bi manifests as internal pain upon pressing the lower abdomen/bladder, a sensation of boiling heat, difficult urination, and clear nasal discharge above.
"Bao Bi" is Bladder Bi. The Bladder resides in the lower abdomen. Pressure causes internal pain like boiling water. Bladder Qi failing to reach the skin causes urinary difficulty; Bao blood failing to seep into the skin causes clear nasal discharge. The text omits Stomach, Gallbladder, and San Jiao because discussing Intestines covers the Stomach; Bao covers the Gallbladder; and Bladder covers the San Jiao (which connects to the Bladder). These describe Bi in the Fu organs.
Yin Qi: Stillness allows Spirit to reside; agitation causes Spirit to perish.
This summarizes Zang Bi. Zang organs are Yin, rooted in stillness. Stillness keeps Spirit inside; agitation causes Spirit to perish, leading to Zang Bi.
Excessive food and drink injure the intestines and stomach.
This summarizes Fu Bi. Fu organs are Yang, responsible for digestion. Excess intake disrupts transformation, injuring the intestines/stomach, leading to Fu Bi.
Licentious Qi causing panting indicates Bi gathering in the Lung. Licentious Qi causing worry indicates Bi gathering in the Heart. Licentious Qi causing enuresis indicates Bi gathering in the Kidney. Licentious Qi causing exhaustion indicates Bi gathering in the Liver. Licentious Qi causing muscle atrophy indicates Bi gathering in the Spleen.
"Liao" sounds like "niao". This explains how licentious/agitated Qi destroys Spirit. Agitated Qi causing panting gathers Bi in the Lung; worrying Qi gathers Bi in the Heart; enuresis Qi gathers Bi in the Kidney; exhausting Qi gathers Bi in the Liver; muscle-atrophying Qi gathers Bi in the Spleen. This illustrates that internal disorder leads to Zang Bi, confirming that stillness preserves Spirit while agitation destroys it.
If various Bies persist, they deepen internally. However, if Wind is predominant, recovery is easier.
"Yi" means easy. Persistent Fu Bi deepens internal disease. However, if Wind predominates in Fu Bi, Wind disperses the pathogen, preventing internal deepening and facilitating easier recovery. This contrasts severe internal deepening with mild, easily cured cases.
The Yellow Emperor asked: Why does Bi sometimes cause death, sometimes chronic pain, and sometimes resolve easily?
Why do some cases die, some suffer chronic pain, and some recover easily?
Qibo said: Those entering the Zang die; those lingering in sinews and bones suffer chronic pain; those remaining in the skin recover easily.
Death results from Zang involvement. Chronic pain results from lingering in sinews/bones. Easy recovery results from remaining in the skin.
The Yellow Emperor asked: What about Bi in the Fu organs?
Seeking clarification on why Fu Bi recovers easily.
Qibo said: This is also due to improper diet and lifestyle being the root cause.
Excessive eating/drinkings injures the intestines/stomach, causing Fu Bi. Improper diet and living habits are the root of Fu Bi.
The Fu organs each have Shu points. Wind, Cold, and Dampness strike these points, and dietary/lifestyle factors respond, allowing pathogens to enter via the points and reside in the respective Fu organs.
Pathogens strike the Shu points, and unregulated diet/lifestyle facilitates entry via these points into the Fu organs. This parallels the mechanism of Zang Bi, where prolonged illness and re-exposure lead to internal residence.
The Yellow Emperor asked: How should acupuncture treat this?
How to use acupuncture for Fu Bi?
Qibo said: The Zang organs have Shu points, and the Fu organs have He-sea points. Following the meridian divisions and sites of manifestation, treating according to the location of the pathology will cure the disease.
Treating along the meridian pathways at the specific locations of pathology using Shu and He-sea points can cure the disease, explaining why Fu Bi is easily cured.
The Yellow Emperor asked: Do Ying and Wei Qi also cause Bi?
Following the discussion on Zang/Fu Bi, asking if Ying/Wei Qi can cause Bi.
Qibo said: Ying Qi is the refined essence of food and drink. It harmonizes with the Zang organs, spreads to the Fu organs, and enters the vessels. Thus, it circulates up and down the vessels, connecting the Zang and Fu organs.
Ying Qi comes from grain, enters the Stomach, transmits to the Lung, and flows through the meridians. It harmonizes the Zang and Fu before entering the vessels. Since Ying moves within the vessels, it connects the interior Zang and exterior Fu.
Wei Qi is the fierce Qi of food and drink. It moves swiftly and smoothly, cannot enter the vessels, and thus circulates within the skin and between muscles, steaming the blind membranes and dispersing in the chest and abdomen.
Wei Qi is the floating Qi that does not follow the meridians. It moves swiftly, stays outside the vessels, circulates in the skin/muscles, steams the interior membranes, and disperses in the chest/abdomen.
Violating this Qi causes disease; following it leads to health. Since it does not combine with Wind, Cold, or Dampness, it does not cause Bi.
Adhering to normal Ying/Wei circulation prevents disease. Since Ying/Wei Qi circulates continuously and does not combine with Wind/Cold/Dampness, it does not form Bi. This clarifies why Ying/Wei Qi itself does not cause Bi.
The Yellow Emperor said: Excellent. Why does Bi sometimes cause pain, sometimes no pain, sometimes numbness, sometimes cold, sometimes heat, sometimes dryness, sometimes dampness?
Acknowledging that free Ying/Wei flow prevents Bi and Wind-predominant Bi is easy to cure, the Emperor asks about the varying symptoms: pain, no pain, numbness, cold, heat, dryness, dampness.
Qibo said: Pain is due to abundant Cold; presence of Cold causes pain.
Pain in Bi is caused by excess Cold pathogens. This corresponds to Painful Bi.
Those with no pain and numbness have had the disease for a long time, entering deeply. Ying and Wei circulation becomes sluggish, and meridians become intermittently empty, hence no pain. The skin lacks nourishment, resulting in numbness.
Long-standing Bi allows pathogens to penetrate deeply. Sluggish Ying/Wei flow and intermittent meridian emptiness prevent pain. Lack of blood/qi nourishment to the skin causes numbness.
Cold sensation occurs when Yang Qi is scarce and Yin Qi is abundant; Yin assists the pathological Cold, causing coldness.
Cold sensation arises from bodily Yang deficiency and Yin excess. The excess Yin combines with the pathogenic Cold, intensifying the cold feeling.
Heat sensation occurs when Yang Qi is abundant and Yin Qi is scarce; the pathogenic Yang overcomes the deficient Yin, resulting in Bi-heat.
Heat sensation arises from bodily Yang excess and Yin deficiency. The excess pathogenic Yang confronts the insufficient Yin, generating heat.
Profuse sweating and dampness occur when encountering severe Dampness. Yang is scarce, Yin is abundant; the two energies interact, causing sweating and dampness.
Profuse sweating/dampness results from severe Dampness exposure combined with bodily Yang scarcity and Yin abundance. Dampness is Yin-type; Yin abundance interacting with external Dampness causes sweating and wetness. Knowing Yin governs Dampness implies Yang governs Dryness. This explains the variations in pain, numbness, cold, heat, dryness, and dampness.
The Yellow Emperor asked: If Bi always causes pain, why are there cases without pain?
If Bi invariably causes pain, why are there painless cases?
Qibo said: If Bi is in the bone, the body feels heavy; in the vessel, blood coagulates and fails to flow; in the sinew, flexion without extension; in the muscle, numbness; in the skin, cold. Possessing any of these five conditions results in no pain.
Pain arises from lack of interaction between interior and exterior Qi. When Bi affects only one有形 (tangible) tissue (bone, vessel, sinew, muscle, skin) while the Qi of the other tissues remains harmonious, pain does not occur. For example, Bi in the bone causes heaviness but no pain if other tissues are harmonious. Similarly, Bi in vessels causes stasis but no pain if others are harmonious. Thus, possessing any of the five localized conditions allows residual Qi to communicate, preventing pain.
Generally, Bi aggravated by Cold produces itching (like insect bites); Bi aggravated by Heat leads to flaccidity.
Cold combines with Dampness; Heat combines with Dryness. Cold-Damp Bi causes itching (insect-like sensation). Heat-Dry Bi causes sinews/bones to lose moisture, leading to flaccidity (relaxation). Flaccidity can lead to pain.
The Yellow Emperor said: Excellent.
The text previously omitted Dry Bi; now clarified, hence the Emperor's approval.