When Yang qi moves recklessly, wind also arises. It is proposed to discard acrid (pungent) herbs and use salty ones. If there is concern that the malaria pathogen from the journey has not been fully cleared, causing stagnation in the collaterals, simultaneously employing methods to unblock and purge gently would also be excellent. (Liver Yin deficiency with Malaria pathogen entering blood collaterals)
Shu Di Huang (Prepared Rehmannia Root), Gui Jiao (Tortoise Shell Glue), E Jiao (Donkey-hide Gelatin), Qiu Shi (Autumn Stone), Tian Dong (Asparagus Tuber), Mai Dong (Ophiopogon Tuber), Wu Wei Zi (Schisandra Berry), Fu Shen (Poria with Hostwood), made into honey pills, taken in the morning.
Tao Ren (Peach Seed), Chuan Shan Jia (Pangolin Scales), Gan Di Long (Dried Earthworm), Fu Xiong (Chuanxiong Rhizome), Gui Xu (Root of Angelica Sinensis), Dan Pi (Moutan Cortex), Hong Hua (Carthamus Flower), Sha Yuan Zi (Astragalus Complanatus Seed), Xiang Fu Zhi (Extract of Cyperus Rotundus), made into pills, taken at night.

Certain patient: Zhang Zhongjing stated that heat in the meridians leads to Bi syndrome, while heat in the collaterals leads to Wei syndrome. Now, Bi pain has persisted for many days, and the pulse indicates tendon tension. Heat has entered the Yin aspect and blood, making the Lower Jiao symptoms particularly severe. As it is said, the Upper Jiao belongs to Qi, and the Lower Jiao belongs to Blood. (Heat entering the Blood aspect of the Lower Jiao)
Bai Zi Ren (Biota Seed), Dang Gui (Angelica Sinensis Root), Dan Pi (Moutan Cortex), Gou Teng (Uncaria Ramulus cum Uncis), Chuan Hu (Dendrobium Nobile Stem), Sha Yuan Zi (Astragalus Complanatus Seed).

Re-examination: Bi pain, especially severe in the right knee.
Sheng Hu Gu (Tiger Bone - *Note: Use substitutes in practice*), Bai Zi Ren (Biota Seed), Niu Xi (Achyranthes Root), Bi Xie (Dioscorea Hypoglauca Rhizome), Yi Yi Ren (Coix Seed), Fu Ling (Poria).

Certain patient (48 years old): The pulse is wiry and forceful; the right ankle is swollen and painful. Warmth and massage provide slight relief. This is Bi syndrome caused by the mixing of Wind, Cold, and Dampness pathogens invading the meridian tunnels. Acrid-warm herbs should be used, with the key being to diffuse and unblock meridian Qi. (Wind-Cold-Dampness invading the meridian tunnels of the Lower Jiao)
Huo Luo Dan (Living Meridian Pill), one pill, taken with aged wine.

Certain patient: Bi pain is located in the tendons and bones of the lateral malleolus, hindering walking. Pathogens remain in the collaterals; drugs with searching and eliminating properties must be used.
Chuan Wu (Aconitum Carmichaelii Lateral Root), Quan Xie (Scorpion), Di Long (Earthworm), Shan Jia (Pangolin Scales), Da Hei Dou Pi (Skin of Black Soybean).

Certain patient: After illness, excessive consumption of rich and greasy foods led to Qi stagnation and Heat constraint. The mouth feels sticky with saliva, and joint pain occurs frequently in the finger joints. Treatment should focus on diffusing and unblocking from the Qi aspect. (Qi stagnation and Heat constraint)
Su Geng (Perilla Stem), Xing Ren (Apricot Seed), Lou Pi (Trichosanthes Peel), Yu Jin (Curcuma Root), Ban Xia Qu (Pinellia Fermented Paste), Ju Hong (Citrus Reticulata Pericarpium).

Chen patient (54 years old): Excessive labor causes restless steaming of Yang Qi. In middle age, body fluids decline, leading to internal wind rotation and whole-body Bi pain. This is not an external guest pathogen; the method should harmonize both the Yangming and Jueyin channels. (Liver-Stomach deficiency and stagnation)
Huang Qi (Astragalus Root), Sheng Bai Zhu (Raw Atractylodes Macrocephala Rhizome), Zhi Shou Wu (Prepared Fleeceflower Root), Dang Gui (Angelica Sinensis Root), Bai Ji Li (Tribulus Fruit), Hei Dou Pi (Skin of Black Soybean).

Zhang patient (53 years old): Restlessness and depression cause Yang to transform into internal Heat and Wind. The *Neijing* states that when Heat dominates, Wind dissipates, requiring Sweet-Cold herbs. Previous discussion noted that wine drinkers dislike Sweet flavors, and due to excessive phlegm and poor appetite, they also avoid cloying and stagnating Sweet-greasy herbs. Therefore, herbs clearing Shaoyang Gallbladder Heat were used, as Wine Qi first enters the Liver and Gallbladder. Wine juice dampness adheres to the intestines and stomach; the principle is to unblock Stomach Qi. With the flow of intestinal and stomach Qi mechanisms, appetite increases, and slippery discharge decreases significantly. Currently, Qi Heat rises upward around noon, and meridian Bi pain is reduced compared to usual. The main treatment uses Sweet-Cold to harmonize Yang, assisted by diffusing and unblocking meridians. (Liver-Gallbladder Wind-Heat)
Tong Sang Zhi (Young Mulberry Twig), Ling Yang Jiao (Antelope Horn), Tian Men Dong (Asparagus Tuber), Gou Qi Zi (Goji Berry), Bai Ji Li (Tribulus Fruit), Dan Pi (Moutan Cortex), Fu Ling (Poria), Huo Shan Shi Hu (Dendrobium Officinale Stem), decocted together into a paste.

Certain patient (Surname unknown): Blood deficiency with Wind-Bi, swelling and pain in bone joints.
Ling Yang Jiao (Antelope Horn), Xi Sheng Di (Rehmannia Root), Yuan Shen (Scrophularia Root), Dang Gui (Angelica Sinensis Root), Gui Zhi (Cinnamon Twig), Sang Zhi (Mulberry Twig), Bai Ji Li (Tribulus Fruit).

Jin patient (32 years old): Bi pain in the lower body, heavy and fixed. Logically, this must be Cold-Dampness. However, the left pulse is rapid, and nocturnal emissions occur three or four times a month. The painful area lacks distinct form; could it be aggregation of the Six Excess pathogens? Yet the tunnels are deep, and medicinal efficacy is hard to achieve quickly. Moxibustion is assisted to hope for efficacy. (Essence and Blood deficiency)
Gou Qi Zi (Goji Berry), Rou Cong Rong (Cistanche Stem), Hu Gu Jiao (Tiger Bone Glue - *Use substitute*), Mi Jiao Jiao (Elk Antler Glue), Du Zhong (Eucommia Bark), Sang Shen Zi (Mulberry Fruit), Tian Dong (Asparagus Tuber), Sha Yuan Zi (Astragalus Complanatus Seed), Fu Ling (Poria), gelatin dissolved and made into pills.

Sun patient: The right pulse is large; Yangming is empty. Shortness of breath, flickering pain. (Qi deficiency)
Ren Shen (Ginseng Root), Sheng Huang Qi (Raw Astragalus Root), Shu Bai Zhu (Cooked Atractylodes Macrocephala Rhizome), Zhi Cao (Honey-fried Licorice Root), Guang Pi (Tangerine Peel), Dang Gui (Angelica Sinensis Root), Bai Shao (White Peony Root), Ban Xia (Pinellia Tuber), Fang Feng Gen (Saposhnikovia Root), Qiang Huo (Notopterygium Rhizome).

Re-examination: Qi tonification brought considerable peace. It is understood that Bi pain above half the body is due to insufficient Yang.
Ren Shen (Ginseng Root), Huang Qi (Astragalus Root), Shu Yu Zhu (Cooked Atractylodes Rhizome), Zhi Cao (Honey-fried Licorice Root), Gui Zhi (Cinnamon Twig), Gui Shen (Body of Angelica Sinensis Root), Bai Shao (White Peony Root), Chuan Qiang (Notopterygium Rhizome).

Shen patient: Bi pain on the right, weak Qi with phlegm.
Sheng Bai Zhu (Raw Atractylodes Macrocephala Rhizome), Chuan Gui Zhi (Cinnamon Twig), Chuan Du Huo (Angelica Pubescens Root), Pian Jiang Huang (Turmeric Rhizome Slice), Bai Fu Ling (White Poria), Chen Fang Ji (Stephania Tetrandra Root).

Wang patient: Acrid-aromatic herbs that move and penetrate can diffuse and unblock Dampness stagnating in the Qi aspect of the meridian tunnels, possessing the ability to remove disease but lacking the benefit of tonifying deficiency. Generally, medicines first distribute from the Middle Palace (Spleen/Stomach) to the various meridians. The Middle Jiao is the root of Ying (Nutritive) Qi. When Ying Qi loses nourishment, rotation becomes dull. However, attacking disease requires relying on the bias of medicinal Qi. Changing prescriptions morning and evening is not the way to completely eliminate disease. Instead, a tonifying Ying prescription is administered at night. (Ying Qi deficiency)
Ren Shen (Ginseng Root), Fu Ling (Poria), Gui Zhi Mu (Cinnamon Twig Wood), Zhi Cao (Honey-fried Licorice Root), Dang Gui (Angelica Sinensis Root), Chao Bai Shao (Stir-fried White Peony Root), Nan Zao (Chinese Jujube).

Wu patient (36 years old): Tendons are lax with severe pain; pathogens remain, obstructing Zheng (Upright) Qi. During warm weather, acupuncture is occasionally used to diffuse and unblock collaterals. In initial tonification of Qi and Blood, it is necessary to assist with diffusion and unblocking of collaterals. (Tendon Bi)
Sheng Huang Qi (Raw Astragalus Root), Fang Feng (Saposhnikovia Root), Gui Zhi (Cinnamon Twig), Chao Hei Chang Shan (Stir-fried Black Dichroa Root), Gui Shen (Body of Angelica Sinensis Root), Qing Ju Ye Zhi (Juice of Green Chrysanthemum Leaf).

Certain patient: Bi pain偏向 (biased towards) the left, worse at night; Qi in the Blood does not circulate. (Qi stagnation in Blood)
Gui Xu (Root of Angelica Sinensis), Sang Zhi (Mulberry Twig), Yi Yi Ren (Coix Seed), Bai Ji Li (Tribulus Fruit), Jiang Huang (Turmeric Rhizome), Mu Fang Ji (Stephania Herba).

Liu patient (38 years old): The *Rites of Zhou* collects toxic drugs for medical affairs because stubborn and chronic diseases adhere to the body shell, not involving Zang-Fu deficiency. Thus, toxic drugs must be used to attack and extract, preventing pathogens from remaining and condensing in Qi and Blood to achieve effect. Once effective, the *Classic* says: "To treat disease with great toxicity, remove five-tenths." At this time, one should only protect the body and avoid emotional labor, which constitutes complete success. Foolish people say medicine removes the root, not knowing that Heaven and Earth Qi have victory and return, and so does the human body. Grain food nourishes life and can defend against illness throughout life. Can the bias of medicinal drugs be taken for long? Have you not observed alchemists refining and taking metal-stone elixirs, with carbuncles erupting and death occurring frequently? (Blood deficiency with collateral涩/stagnation)
He Shou Wu (Fleeceflower Root), Hei Ma Zi (Black Sesame Seed), pills coated with Sang Zhi Gui Zhi Tang (Mulberry Twig and Cinnamon Twig Decoction).

Certain patient: Pulse is deep and slightly rapid; Heat remains in the Ying (Nutritive) aspect. Bone joints still have slight pain. It is suitable to unblock collaterals and assist in clearing Ying Heat. (Heat in Ying aspect)
Gou Teng (Uncaria Ramulus cum Uncis), Xi Sheng Di (Rehmannia Root), Gui Xu (Root of Angelica Sinensis), Bai Ji Li (Tribulus Fruit), Dan Pi (Moutan Cortex), Pian Jiang Huang (Turmeric Rhizome Slice).

This condition resembles Wind disease, but Wind affects Yang, while Bi affects Yin, hence it is often heavy and sinking-painful. In the *Neijing*, it does not exceed the Three Qi of Wind, Cold, and Dampness. However, the commands of the four seasons can all become pathogens, and the Qi of the Five Zang organs can each receive disease. Actually, "Bi" means closure and obstruction. Zheng Qi is blocked by pathogens, and Zang-Fu and collaterals cannot flow freely. All result from loss of Qi and Blood, loose interstices, allowing Wind, Cold, and Dampness to invade externally in deficiency, remaining internally, causing Damp-Phlegm, turbid Blood, flowing and condensing to produce the disease. Thus, the Classic says: "Three Qi mixed arrive, combining to form Bi." It also says: "Wind dominance forms Moving Bi, Cold dominance forms Painful Bi, Damp dominance forms Heavy Bi," and the meanings of Bone Bi, Tendon Bi, Vessel Bi, Muscle Bi, and Skin Bi. It can be known that Bi symptoms are not caused by receiving just one Qi exclusively. However, symptoms are manifold, and treatments differ. I cannot describe them all. Here, clarifying Mr.'s methods for treating Bi:
For those where Wei (Defensive) Yang is loose, Wind pathogen enters collaterals forming Bi, the main treatment is diffusing and unblocking meridians, using Sweet-Cold to remove Heat.
For those where meridians are injured, Yang Qi fails to protect, forming Bi, the main treatment is warming, nourishing, unblocking, and tonifying, supporting vital Qi.
For those where Summerheat injures Qi and Damp-Heat enters collaterals forming Bi, the main treatment is using agents to soothe and unblock collaterals, making Clear Yang flow.
For those with Wind-Damp swelling and pain forming Bi, the main treatment is using Ren Shen and Bai Zhu to tonify Qi, assisted by Wind herbs to strengthen Qi.
For those where Damp-Heat injures Qi and Warm-Heat enters blood collaterals forming Bi, the main treatment is consolidating Wei Yang to repel pathogens, and diffusing and unblocking Ying collaterals, treating the Extraordinary Vessels concurrently.
For those with Liver Yin deficiency, Malaria pathogen entering collaterals forming Bi, the main treatment is Salty-Bitter nourishing Yin, assisted by gentle purging and unblocking.
For those where Cold-Damp enters collaterals forming Bi, the main treatment is slightly unblocking Yang, assisted by unblocking and tonifying.
For those where Qi stagnation and Heat constraint form Bi, the main treatment is diffusing and unblocking from the Qi aspect.
For those with Liver-Stomach deficiency and stagnation forming Bi, the treatment is tonifying both Jueyin and Yangming.
For those where Wind-Cold-Dampness enters meridian tunnels of the Lower Jiao forming Bi, the main treatment is Acrid-Warm to diffuse and unblock meridian Qi.
For those where Liver-Gallbladder Wind-Heat forms Bi, the main treatment is Sweet-Cold to harmonize Yang, diffusing and unblocking collaterals.
For those with Blood deficiency, collateral stagnation, and Ying deficiency forming Bi, the main treatment is nourying Ying and Blood.
Furthermore, Zhou Bi (General Bi), Xing Bi (Moving Bi), Zhi Bi (Limb Bi), Jin Bi (Tendon Bi), and Bi formed by the mixture of Wind, Cold, and Dampness, do not exceed methods of smoothing Qi and Blood, expelling pathogens and nourishing Zheng, and diffusing and unblocking collaterals. Thus, Zhang Jingyue said: The method for treating Bi is only suitable for severely tonifying True Yin and diffusing and unblocking collaterals, allowing Qi and Blood to flow freely. One must not overuse Wind-drying herbs to further injure Yin Qi. These are words of profound insight. (Commentary by Zou Zijiu)

Xu's Commentary: The cases contain much repetition and can be deleted. Since it is known that Wind, Cold, and Dampness cause Bi, it is clear they all belong to external pathogens. The use of Ren Shen and warming-tonifying drugs accounts for two out of ten cases, which may risk retaining pathogens. For all diseases of the physical form, external treatment should be used. Without understanding external treatment methods, even if oral medication hits the disease, it only achieves half of medical skill.