高云。痹。闭世。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。
痹之安生 甲乙。之。作将。
合而为痹也 张云。痹者。闭也。观阴阳别论曰。一阴一阳结。谓之喉痹。至真要大论曰。食痹而
吐。是皆闭塞之义可知也。故风寒湿三气杂至。则壅闭经络。血气不行。而病为痹。即痛风不仁之属。华佗中
藏经云。痹者。风寒暑湿之气。中于人脏腑之为也。痹者。闭也。五脏六腑。感于邪气。乱于真气。闭而不仁。
故曰痹。郑玄注易通卦验云。痹者。气不达为病。简按经中。痹有四义。有为病在于阴之总称者。见于寿夭刚
柔篇。有专为闭塞之义者。如食痹喉痹。是也。有为麻痹之痹。王注云 痹者。是也。有为痛风历节之义。如
本篇行痹痛痹着痹之类。是也。此他总不离乎闭塞
之义。学人宜细玩焉。一切经音义。引苍颉篇云。痹。手足不仁也。
行痹 马云。其风气胜者。风以阳经而受之。故为行痹之证。如虫行于头面四体也。张云。风者善行
数变。故为行痹。凡走注历节疼痛之类。皆是也。简按张根据楼氏纲目。下痛痹着痹同。张氏医通云。行痹者。
走注无定。风之用也。越脾加术附汤。
痛痹 马云。其寒气胜者。则寒以阴经受之。故当为痛痹之证。寒气伤血。而伤处作痛也。张云。阴
寒之气。客于肌肉筋骨之间。则凝结不散。阳气不行。故痛不可当。即痛风也。张氏医通云。痛痹者。痛无定
处。乃湿气伤肾。肾不生肝。肝风挟湿。流走四肢。肩 疼痛。拘急浮肿。金匮乌头汤。身体痛如欲折。肉如
锥刺刃割。千金附子汤。
着痹 马云。其湿气胜者。则湿以皮肉筋脉而受之。故当为着痹之证。当沉着不去。而举之不痛也。
张云。着痹者。肢体重着不移。或为顽木不仁。湿从土化。病多发于肌肉。简按陈氏三因方云。肿满重着为湿
胜。此似以着痹为湿香港脚矣。○志云。灵枢有风痹。伤寒论有湿痹。是感一气而为痹也。本篇。论风寒湿三气
错杂而至。相合而为痹也。周痹篇曰。风寒湿气。客于外分肉之间。迫切而为沫。沫得寒则聚。聚则排分肉。
而分裂也。分裂则痛。痛则神归之。神归之则热。热则痛解。痛解则厥。厥则他痹发。发则如是。是寒痹先发。
而他痹复发也。本篇论风气胜者为行痹。湿气胜者为着痹。是三气杂合。而以一气胜者。为主病也。经论不同。
因证各别。临病之士。各宜体认。张氏医通云。着痹者。痹着不仁。或左或右。半身麻木。或面或头。或手臂。
或脚腿麻木不仁。并宜神效黄 汤。
以冬遇此者为骨痹 楼云。凡风寒湿所为。行痹痛痹着痹之病。冬遇此者为骨痹。春遇此者为筋痹。
夏遇此者为脉痹。长春遇此者为肌痹。秋遇此者为皮痹。皆以所遇之时。所客之处命名。非此行痹痛痹着痹之
外。又别有骨痹筋痹脉痹肌痹皮痹也。
重感于风寒湿之气也 甲乙。无重字。
心下鼓 马云。鼓字为句。心下鼓战也。高云。心虚则烦。故烦则心下鼓。鼓。犹动也。简按王注
鼓满。误。
上为引如怀 高云。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。
尻以代踵脊以代头 高云。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。简按王以拘急释之。诸注并同。高以痿弱解之。义各别。
胞痹 张云。胞。膀胱之脬也。高云。即膀胱痹也。简按刘熙释名云。胞。 也。 。空虚之言也。
主以虚承水 也。或曰膀胱。言其体短而横广也。知胞即是膀胱。吴以女子之胞注之。非也。
按之内痛若沃以汤 简按百病始生篇云。积。其着于伏冲之脉者。揣之应手而动。发手则热气下于
两股。如汤沃之状。并言肌热之状。据此则内痛作两髀。似是。
上为清涕 志云。膀胱之脉。从巅入脑。脑渗则为涕。上为清涕者。太阳之气。痹闭于下。不能循
经而上升也。（张氏医通云。胞者。膀胱之脬也。膀胱气闭。则水道不行。故按之内痛。若以热汤沃之。小便
得外热之助。方得稍通。而犹滞涩不利。则治宜温助气化可知。膀胱之脉。从巅入络脑。故上为清涕。以太阳
经气不固。而精气上脱。又须温补无疑。盖缘精泄之后。寒热乘虚。入于膀胱之内。而致小便淋沥不通。茎中
痛引谷道。甚则脐腹胀痛。此属津液枯竭之故。误与利水药。必致喘逆胀急而死。老人阴虚泉竭。多有此证。
曾见膀胱胀破。淋沥无度。
时虽暂绶。不久即毙。又小便不禁门。有治胞痹。用肾沥汤加减桑螵蛸散医案一则。当参考。）
阴气者静则云云 马云。此言脏腑所以成痹者。以其内伤为本。而后外邪得以乘之也。阴气者。营气
也。阴气精专。随宗气以行于经脉之中。惟其静。则五脏之神自藏。而不消亡。若躁则五脏之神消亡。而不能
藏矣。所以有五痹者。必重感于邪。而成五脏之痹也。至于六腑之所以成痹者。何哉。饮食固所以养人。而倍
用适所以害人。故饮食自倍。肠胃乃伤也。肠胃既伤。则邪得以乘俞入之。而为痹矣。按生气通天论云。阳气
者。精则养神。柔则养筋。论卫气也。此节云云。论营气也。王注分脏腑。看书有法。但不知阴气为营气耳。
简按此十九字。吴移于生气通天论。未知旧经果然否。今且根据马注。
淫气 滑云。王注云云。如此则属内伤。非风寒湿三气杂至。而为外伤者。宣明五气篇云。邪入于
阴则为痹。所谓邪者。岂指淫气而言耶。马云。邪气浸淫。喘息靡宁。正以肺主气。惟痹聚在肺。故喘息若是。
（下文意并同。）志云。此申明阴气躁亡。而痹聚于脏也。淫气者。阴气淫佚。不静藏也。淫气而致于喘息。
则肺气不藏。而痹聚在肺矣。（下文意并同。）吴云。气失其平。谓之淫气。痹聚者。风寒湿三气凝聚也。简
按生气通天论云。风客淫气。精乃亡。邪伤肝也。说文。淫。浸淫随理也。徐曰。随其脉理。而浸渍也。
乏竭 马云。邪气浸淫。阴血乏竭。正以肝主血。惟痹聚在肝。
肌绝 马云。邪气浸淫。肌气阻绝。正以脾主肉。惟痹聚在脾。吴云。肌肉断裂也。志云。肌肉焦绝。
亦益内也 马云。或云。亦益内。作入房。说亦通。志
云。亦者。言不止在皮肉筋骨之合于内也。简按马或说。属未安。（医通。益。作滥。）
易已也 张云。风为阳邪。可以散之。故易已。然则寒湿二痹。愈之较难。以阴邪留滞。不易行也。
食饮居处 高云。犹言食饮自倍。居处失宜。乃腑痹之病本也。
六腑亦各有俞 马云。六腑之分肉。皆各有俞穴。风寒湿之三气。外中其俞。而内之饮食失节应之。
则邪气循俞而入。按三百六十五穴。皆可以言俞。今曰俞者。凡六腑之穴。可以入邪。而王注止以足太阳在背
之六俞穴为解。则又理之不然者也。
五脏有俞六腑有合 张云。乃兼脏腑。而互言也。汪昂云。按六腑。前文只列肠痹胞痹。三焦有名无
形。胆附于肝。胃为脏腑之海。故不复别言痹也。
各有所发各随其过 马云。循脏腑经脉所行之分。各有所发病之经。乃随其病之所在而刺之。则或俞
或合。其病无有于不瘳也。志云。各随其有过之处而取之。简按张以所发为井穴。过字。吴张高根据王注。读为
平声。并非也。
荣者水谷之精气也 张云。荣气者。阴气也。由水谷精微之所化。故为水谷之精气。卫气篇曰。精气
之行于经者。为营气。正理论曰。云云。夫谷入于胃。以传于肺。五脏六腑。皆以受气。其清者为营。浊者为
卫。营在脉中。卫在脉外。故于脏腑脉络。则无所不至。
卫者水谷之悍气也 张云。卫气者。阳气也。阳气之至。浮盛而疾。故曰悍气。 。急也。本脏篇曰。
卫气者。所以温分肉。充皮肤。肥腠理。司开阖者也。卫气篇曰。其浮气之不循经者。为卫气。邪客篇曰。卫
气者。出其悍气之栗疾。
而先行于四末分肉皮肤之间。而不休者也。皆与此节。互有发明。
肓膜 张云。肓者。凡腔腹肉理之间。上下空隙之处。皆谓之肓。如刺禁论曰。膈肓之上。中有父母。
左传曰。膏之上肓之下者。是皆言膈上也。又腹中论曰。其气溢于大肠。而着于肓。肓之原。在齐下。九针十
二原篇曰。肓之原。出于脖 。胀论曰。陷于肉肓。而中气穴。则肓之为气。不独以胸膈为言。可知也。膜。
筋膜也。简按王注空虚之处。吴注腹中论稍同。张误读以为此注。乃与举痛论小肠膜原注略同。不可从。扁鹊
传。搦荒。说苑。作肓莫。即肓膜也。
散于胸腹 甲乙。散。作聚。
故不为痹 张云。营卫之气。但不可逆。故逆之则病。从之则愈。然非若皮肉筋骨血脉脏腑之有形者
也。无迹可着。故不与三气为合。盖无形亦无痹也。
有寒故痛也 简按王注。全本于灵周痹篇文。
故不通 诸注。并根据甲乙。通。作痛。今从之。
皮肤不营 张云。逆调论曰。荣气虚则不仁。卫气虚则不用。不营者。血气不至也。马云。以其皮
肤之中。少气血以为之营运。高同。志云。不能营养于皮肤。
阳气少阴气多 张云。凡病寒者。不必尽由于外寒。但阳气不足。阴气有余。则寒从中生。与病相
益。故为寒证。志云。此言寒热者。由人身之阴阳气化也。人之阳气少。而阴气多。则与病相益其阴寒矣。
病气胜 张兆璜云。与病相益者。言人之阴气多。而益其病气之阴寒也。病气胜者。言人之阳气多。
而益其病气之热胜也。
阳遭阴故为痹热 吴。遭作乘。云。旧作阳遭阴。未当。
今根据甲乙。改阳乘阴。为近理。简按甲乙无痹。亦近是。滑云。或热下。有或燥问。今此无答辞。
两气相感 张云。寒湿两气也。脉要精微论曰。阴气有余。为多汗身寒。其义即此。张兆璜云。阳热
盛者多汗出。濡湿之汗。又属阴寒。医者审之。
不痛也 汪昂云。痛则血气犹能周流。五者为气血不足。皆重于痛。故不复作痛。诸解欠明。
逢寒则虫 马云。虫。甲乙作急。王氏以为如虫行者。非。盖风胜为行痹。非逢寒也。张云。逢寒则
筋挛。故急。逢热则筋弛。故纵也。吴同。简按志仍王注。高云。寒湿相薄。故生虫。太误。巢源云。凡痹之
类。逢热则痒。逢寒则痛。
高云：痹，即闭塞。指血气凝滞涩阻、运行不畅。有因风寒湿三气侵袭所致的痹证，也有因皮、肌、脉、筋、骨及五脏外合部位受邪所致的痹证。六腑有输穴，五脏也有输穴；五脏有五体相合，六腑也有相应的相合关系。因此有五脏六腑的痹证。营卫之气流行通畅，则不会发生痹证。痹病作为一类疾病，有的表现为疼痛，有的不痛，有的麻木不仁，有的发冷，有的发热，有的干燥，有的潮湿。这里全面论述了这些情况，所以称为《痹论》。
痹证是如何产生的？（《甲乙经》中“之”字作“将”字解。）
风寒湿三气杂合而至导致痹证。张云：痹，就是闭塞的意思。看《阴阳别论》说：“一阴一阳结，谓之喉痹。”《至真要大论》说：“食痹而吐。”这些都可知是闭塞的含义。所以风寒湿三气混杂而至，就会壅塞闭阻经络，使血气不行，从而形成痹病，也就是痛风、麻木不仁这一类病症。华佗《中藏经》说：痹，是风寒暑湿之气侵入人体脏腑造成的。痹，就是闭塞。五脏六腑感受邪气，扰乱真气，闭塞而不仁，所以叫痹。郑玄注《易通卦验》说：痹，是气机不达而致病。简按：经文中的“痹”有四层含义。一是作为病位在阴分的总称，见于《寿夭刚柔篇》；二是专指闭塞之义，如食痹、喉痹等；三是作为麻痹之痹，王冰注说“痹者……”；四是作为痛风、历节之义，如本篇的行痹、痛痹、着痹等。其他总离不开闭塞的含义，学者应当仔细玩味。《一切经音义》引用《苍颉篇》说：痹，是指手足麻木不仁。
行痹：马云：风气偏胜的，风邪通过阳经受邪，所以成为行痹的证候。就像虫子在头面四肢爬行一样。张云：风性善行数变，所以称为行痹。凡是走注不定、历节疼痛之类的，都是行痹。简按：张氏依据楼氏《纲目》，下文痛痹、着痹同理。《张氏医通》说：行痹的特点是走注无定处，这是风邪的作用。可用越脾加术附汤治疗。
痛痹：马云：寒气偏胜的，寒邪通过阴经受邪，所以应当成为痛痹的证候。寒气伤血，受伤处就会疼痛。张云：阴寒之气，客居于肌肉筋骨之间，就会凝结不散，阳气不能运行，所以疼痛难以忍受，也就是痛风。《张氏医通》说：痛痹的特点是痛无定处，乃是湿气伤肾，肾不生肝，肝风挟湿，流走四肢，导致肩背疼痛，拘急浮肿。可用《金匮要略》乌头汤治疗，症状如身体疼痛像要折断，肌肉像被锥子刺、刀刃割一样。可用《千金方》附子汤治疗。
着痹：马云：湿气偏胜的，湿邪通过皮肉筋脉受邪，所以应当成为着痹的证候。湿气沉着不去，举按之不痛。张云：着痹的特点是肢体沉重固定不移，或者顽木不仁。湿从土化，病多发于肌肉。简按：陈氏《三因方》说：肿满重着是湿胜的表现。这似乎把着痹当作湿脚气了。○志云：《灵枢》中有风痹，《伤寒论》中有湿痹，这是感受单一气邪而形成的痹证。本篇论述的是风寒湿三气错杂而至，相合而形成痹证。《周痹篇》说：风寒湿气，客居在外分肉之间，迫切津液化为沫，沫遇到寒则聚集，聚集则排挤分肉，使其分裂。分裂则疼痛，疼痛则神气归于患处，神气归于患处则生热，热则疼痛缓解，疼痛缓解则气机逆乱，气机逆乱则其他痹证发作。发作时就是这样。这是寒痹先发，而其他痹证复发的情况。本篇论述风气偏胜者为行痹，湿气偏胜者为着痹，这是三气杂合，以某一气偏胜为主病的情况。经文论述不同，因为证候各有区别，临证医生应当各自体会认识。《张氏医通》说：着痹的特点是痹着不仁，或左或右，半身麻木，或者面部、头部、手臂、脚腿麻木不仁。都宜用神效黄芪汤治疗。
冬季遇到这种情况的叫骨痹：楼云：凡是风寒湿所造成的行痹、痛痹、着痹等疾病，冬季遇到这种情况的叫骨痹，春季遇到的叫筋痹，夏季遇到的叫脉痹，长夏（四季之末各十八天）遇到的叫肌痹，秋季遇到的叫皮痹。都是以发病的季节和邪气客居的部位来命名，并不是在行痹、痛痹、着痹之外，另外又有骨痹、筋痹、脉痹、肌痹、皮痹。
心下悸动：马云：“鼓”字断句，心下鼓战也。高云：心虚则烦，所以心烦则心下悸动。鼓，就是动的意思。简按：王冰注解释为鼓满，是错误的。
上部牵引如同怀胎：高云：《经脉论》说：肝病，男子患疝气，女子少腹肿胀。所以上部牵引向下，好像怀物的样子。
尾骨代替脚跟，脊背代替头部：高云：尻，尾骨。尾骨下蹲，用来代替脚跟，这是骨痿。脊骨高耸用来代替头部，这是天柱骨倾倒。简按：王冰用拘急来解释，诸家注释都一样。高用痿弱来解释，含义各不相同。
胞痹：张云：胞，就是膀胱的脬。高云：就是膀胱痹。简按：刘熙《释名》说：胞，是空虚的意思。空虚是用来盛水的。有人说膀胱，是说它形体短而横广。知道胞就是膀胱，吴昆用女子的胞宫来注释，是不对的。
按压内部疼痛，好像用热水浇烫：简按：《百病始生篇》说：积病，附着在伏冲脉的，触摸时应手而动，抬手后热气下行至两股，像热水浇烫的样子。并描述了肌肉发热的状况。据此，内痛作两髀（大腿），似乎是正确的。
上部流出清涕：志云：膀胱的经脉，从头顶入脑，脑渗液则为涕。上部流出清涕，是因为太阳之气痹闭于下部，不能循经上升。（《张氏医通》说：胞，是膀胱的脬。膀胱气闭，则水道不通，所以按压内部疼痛，像用热汤浇烫一样。小便得到外部热气的帮助，才能稍微通畅，但仍然滞涩不利，那么治疗宜温助气化可知。膀胱的经脉，从头顶入络脑，所以上部流出清涕。因为太阳经气不固，精气上脱，又必须温补无疑。大概是因为精泄之后，寒热乘虚进入膀胱内部，导致小便淋沥不通，茎中痛引谷道，甚至脐腹胀痛。这属于津液枯竭的缘故。误用利水药，必定导致喘逆胀急而死。老人阴虚泉竭，多有此证。曾见过膀胱胀破，淋沥无度，虽然暂时缓解，不久即死。又在小便不禁门，有一则治疗胞痹，用肾沥汤加减桑螵蛸散的医案，当参考。）
阴气安静则云云：马云：这是说脏腑之所以形成痹证，是因为内伤为本，然后外邪得以乘虚而入。阴气，就是营气。阴气精专，随宗气在经脉中运行。只有安静，五脏的神气才能自藏而不消亡。如果躁动，五脏的神气就会消亡，而不能藏守。所以有五痹，一定是再次感受邪气，而成五脏之痹。至于六腑之所以形成痹证，为什么呢？饮食固然养人，但过度使用反而害人。所以饮食加倍，肠胃就受伤了。肠胃既已受伤，邪气就能乘虚进入输穴，而形成痹证。按《生气通天论》说：阳气者，精则养神，柔则养筋。这是论述卫气。这一节说的是营气。王冰区分脏腑，看书有法度，只是不知道阴气就是营气。简按：这十九个字，吴崑移到了《生气通天论》，不知旧经是否果真如此。现在暂且根据马注。
淫气：滑云：王冰注云云。如果是这样，则属于内伤，不是风寒湿三气杂至的外伤。《宣明五气篇》说：邪入于阴则为痹。所说的邪，难道是指淫气吗？马云：邪气浸淫，喘息不得安宁。正因为肺主气，只有痹聚在肺，所以喘息如此。（下文意思相同。）志云：这是申明阴气躁动消亡，而痹聚在脏。淫气，就是阴气淫佚，不静藏。淫气导致喘息，则肺气不藏，而痹聚在肺了。（下文意思相同。）吴云：气失去平衡，叫做淫气。痹聚，是风寒湿三气凝聚。简按：《生气通天论》说：风客淫气，精乃亡，邪伤肝也。《说文》：淫，浸淫随理也。徐锴曰：随其脉理，而浸渍也。
乏竭：马云：邪气浸淫，阴血乏竭。正因为肝主血，只有痹聚在肝，才会出现阴血乏竭。
肌绝：马云：邪气浸淫，肌气阻绝。正因为脾主肉，只有痹聚在脾，才会出现肌气阻绝。吴云：肌肉断裂。志云：肌肉焦绝，也是益内（过度房事）所致。
亦益内：马云：有人说，“亦益内”作“入房”解，说法也通。志云：亦，是说不仅在于皮肉筋骨的内合。简按：马氏的说法，属未安。（《医通》中，“益”作“滥”。）
容易痊愈：张云：风为阳邪，可以发散，所以容易痊愈。那么寒湿二痹，治愈较难，因为阴邪留滞，不易行散。
饮食居处：高云：犹言饮食自倍，居处失宜，这是腑痹的病本。
六腑也各有输穴：马云：六腑的分肉，都各有输穴。风寒湿三气，从外部中伤其输穴，内部饮食失节相应，则邪气循输穴而入。按三百六十五穴，都可以称为俞。现在说俞，凡是六腑的穴位，都可以入邪。而王冰只以足太阳在背部的六个俞穴来解释，那又是道理不对的。
五脏有输穴，六腑有合穴：张云：这是兼论脏腑，互文见义。汪昂说：按六腑，前文只列肠痹、胞痹。三焦有名无形，胆附于肝，胃为脏腑之海，所以不再分别论述痹证。
各有所发，各随其过：马云：循脏腑经脉所行的分部，各有所发病的经脉，于是随着病所在之处而针刺，无论是取输穴还是合穴，病没有不愈的。志云：各随着有过失（病邪所在）的地方而取穴。简按：张氏认为所发是井穴。“过”字，吴、张、高根据王冰注，读为平声，并不正确。
荣气是水谷的精气：张云：荣气，就是阴气。由水谷精微所化，所以称为水谷的精气。《卫气篇》说：精气之行于经者，为营气。《正理论》说：云云。谷物进入胃，传送到肺，五脏六腑都接受其气。其中清的为营，浊的为卫。营在脉中，卫在脉外。所以在脏腑脉络中，无处不到。
卫气是水谷的悍气：张云：卫气，就是阳气。阳气到来，浮盛而疾速，所以叫悍气。悍，急也。《本脏篇》说：卫气者，所以温分肉，充皮肤，肥腠理，司开阖者也。《卫气篇》说：其浮气之不循经者，为卫气。《邪客篇》说：卫气者，出其悍气之栗疾，先行于四末分肉皮肤之间，而不休者也。都与这一节互相发明。
肓膜：张云：肓，凡是腔腹肉理之间，上下空隙之处，都叫肓。如《刺禁论》说：膈肓之上，中有父母。《左传》说：膏之上，肓之下者。这都是说膈上。又《腹中论》说：其气溢于大肠，而着于肓。肓之原，在齐下。《九针十二原篇》说：肓之原，出于脖胦。《胀论》说：陷于肉肓，而中气穴。则肓之为气，不只以胸膈为限，可知了。膜，就是筋膜。简按：王冰注空虚之处，吴崑注《腹中论》稍同。张氏误读以为此注，乃与《举痛论》小肠膜原注略同，不可从。《扁鹊传》搦荒，《说苑》作肓莫，即肓膜。
散于胸腹：《甲乙经》中，“散”作“聚”。
所以不为痹：张云：营卫之气，只不可逆乱。所以逆乱则病，顺从则愈。然而不像皮肉筋骨血脉脏腑那样有形质。没有痕迹可着，所以不与三气相合。大概无形也就没有痹证。
因为有寒所以痛：简按：王冰注，完全基于《灵枢·周痹篇》的文意。
所以不通：诸家注释，都根据《甲乙经》，通，作痛。现在依从它。
皮肤得不到营养：张云：《逆调论》说：荣气虚则不仁，卫气虚则不用。不营，就是血气不到达。马云：因为皮肤之中，缺少气血来营运。高云同上。志云：不能营养于皮肤。
阳气少阴气多：张云：凡病寒的，不一定全由于外寒。只要阳气不足，阴气有余，则寒从中生，与病相益，所以成为寒证。志云：这是说寒热，是由人身之阴阳气化决定的。人的阳气少，而阴气多，则与病相益其阴寒了。
病气胜：张兆璜说：与病相益，是说人的阴气多，而增加病气的阴寒。病气胜，是说人的阳气多，而增加病气的热胜。
阳遭阴故为痹热：吴崑：遭作乘。云：旧作阳遭阴，不当。现在根据《甲乙经》，改阳乘阴，更近理。简按：《甲乙经》无“痹”字，也近是。滑云：或热下，有或燥问，今此处无答辞。
两气相感：张云：寒湿两气。《脉要精微论》说：阴气有余，为多汗身寒。其义即在此。张兆璜说：阳热盛者多汗出，濡湿之汗，又属阴寒。医者审察。
不痛：汪昂说：痛则血气犹能周流。五痹者为气血不足，皆重于痛，所以不再作痛。诸解欠明。
逢寒则虫：马云：虫，《甲乙经》作急。王氏以为是如虫行者，非。盖风胜为行痹，不是逢寒。张云：逢寒则筋挛，所以急。逢热则筋弛，所以纵。吴崑同。简按：志仍用王冰注。高云：寒湿相薄，所以生虫。太错误。巢元方说：凡痹之类，逢热则痒，逢寒则痛。
Gao Yun: Bi (Obstruction) refers to the stagnation and涩 (astringent/stagnant) flow of Ying and Wei Qi, leading to impaired circulation. There are Bi syndromes caused by the invasion of Wind, Cold, and Dampness pathogens, as well as those affecting the skin, muscles, vessels, sinews, bones, and their corresponding internal organs. The Six Fu Organs have Shu points, and the Five Zang Organs also have Shu points; the Five Zang Organs have their respective connections, and the Six Fu Organs also have connections. Therefore, there are Bi syndromes of the Five Zang and Six Fu Organs. When Ying and Wei Qi circulate freely, Bi does not occur. As a category of disease, Bi may present with pain, without pain, or with numbness; it may manifest as cold, heat, dryness, or dampness. This chapter comprehensively discusses these manifestations, hence the title "Treatise on Bi" (Bi Lun).
How is Bi generated? (In the *Jia Yi Jing*, the character "Zhi" is interpreted as "Jiang".)
The mixture of Wind, Cold, and Dampness pathogens leads to Bi. Zhang Yun: Bi means obstruction. As stated in the *Yin Yang Bie Lun*: "When one Yin and one Yang knot together, it is called Hou Bi (Throat Obstruction)." In the *Zhi Yao Da Yao Lun*: "Shi Bi (Food Obstruction) causes vomiting." These illustrate the meaning of obstruction. Thus, when Wind, Cold, and Dampness mix and invade, they block the meridians, causing Qi and Blood to stagnate, resulting in Bi syndrome, which includes conditions like gout and numbness. Hua Tuo's *Zhong Zang Jing* states: Bi is caused by Wind, Cold, Summer-heat, and Dampness invading the Zang and Fu organs. Bi means obstruction. When the Five Zang and Six Fu organs are affected by pathogens, disturbing the True Qi, they become blocked and numb, hence called Bi. Zheng Xuan's commentary on the *Yi Tong Gua Yan* states: Bi is a disease caused by the failure of Qi to penetrate. Briefly noted: The term "Bi" in the classic has four meanings. First, as a general term for diseases located in the Yin aspects, seen in the *Shou Yao Gang Rou Pian*. Second, specifically referring to obstruction, such as Shi Bi and Hou Bi. Third, referring to numbness/paralysis, as Wang Bing notes. Fourth, referring to gout and Li Jie (wandering joint pain), such as the Xing Bi, Tong Bi, and Zhuo Bi discussed in this chapter. All these essentially revolve around the concept of obstruction; scholars should study this carefully. The *Yi Qie Jing Yin Yi* cites the *Cang Jie Pian*: Bi refers to numbness of the hands and feet.
Xing Bi (Wandering Bi): Ma Yun: When Wind pathogen predominates, it affects the Yang meridians, resulting in Xing Bi. It feels like insects crawling on the head, face, and limbs. Zhang Yun: Wind is characterized by rapid movement and frequent changes, hence called Xing Bi. Conditions involving wandering pain and joint pain fall under this category. Briefly noted: Zhang follows Lou's *Gang Mu*; the same logic applies to Tong Bi and Zhuo Bi below. The *Zhang Shi Yi Tong* states: Xing Bi is characterized by unpredictable wandering pain, which is the action of Wind. Yue Pi Jia Zhu Fu Tang can be used.
Tong Bi (Painful Bi): Ma Yun: When Cold pathogen predominates, it affects the Yin meridians, resulting in Tong Bi. Cold damages Blood, causing pain at the affected site. Zhang Yun: Yin-Cold pathogen lodging between muscles, sinews, and bones condenses and does not dissipate, preventing Yang Qi from circulating, leading to unbearable pain, i.e., gout. The *Zhang Shi Yi Tong* states: Tong Bi features pain without fixed location, caused by Dampness injuring the Kidney, failing to nourish the Liver, allowing Liver Wind to carry Dampness to the limbs, causing shoulder/back pain, stiffness, and edema. Wutou Tang from the *Jin Gui Yao Lue* can be used; symptoms include body pain as if breaking, and muscle pain like needle pricks or knife cuts. Fuzi Tang from the *Qian Jin Fang* can also be used.
Zhuo Bi (Fixed Bi): Ma Yun: When Dampness pathogen predominates, it affects the skin, muscles, sinews, and vessels, resulting in Zhuo Bi. Dampness is heavy and lingering, and pressing the area does not elicit pain. Zhang Yun: Zhuo Bi is characterized by heavy, fixed limbs, or woody numbness. Dampness transforms according to Earth, so diseases often occur in the muscles. Briefly noted: Chen's *San Yin Fang* states that swelling, fullness, and heaviness indicate excess Dampness. This seems to equate Zhuo Bi with damp-type foot ailment. ○ Zhi Yun: The *Ling Shu* mentions Feng Bi, and the *Shang Han Lun* mentions Shi Bi, indicating Bi caused by a single pathogen. This chapter discusses the mixed invasion of Wind, Cold, and Dampness forming Bi. The *Zhou Bi Pian* states: Wind, Cold, and Dampness lodge between the fen li, compressing fluids into foam. Foam gathers when cold, pushing apart the fen li and causing splitting. Splitting causes pain; pain draws Shen (Spirit/Mind) to the area; Shen generates heat; heat relieves pain; relief leads to Qi reversal; reversal triggers other Bi syndromes. This describes Cold Bi occurring first, followed by recurrence of other Bi. This chapter emphasizes that when Wind predominates, it is Xing Bi; when Dampness predominates, it is Zhuo Bi. This indicates that among the mixed pathogens, the predominant one determines the main pathology. Classics differ because syndromes vary; clinicians must discern accordingly. The *Zhang Shi Yi Tong* states: Zhuo Bi features fixed numbness, hemibody numbness, or numbness of the face, head, arms, or legs. Shen Xiao Huang Qi Tang is suitable.
Bone Bi contracted in Winter: Lou Yun: For diseases caused by Wind, Cold, and Dampness (Xing, Tong, Zhuo Bi), if contracted in Winter, it is Bone Bi; in Spring, Sinew Bi; in Summer, Vessel Bi; in Late Summer, Muscle Bi; in Autumn, Skin Bi. These are named after the season of contraction and the location of the pathogen, not implying separate entities beyond Xing, Tong, Zhuo Bi.
Re-exposure to Wind, Cold, and Dampness: The *Jia Yi Jing* omits the character "Chong" (re-).
Palpitations beneath the heart: Ma Yun: "Gu" (drum/palpitation) ends the sentence; palpitations beneath the heart. Gao Yun: Heart deficiency causes irritability; thus, irritability leads to palpitations beneath the heart. "Gu" means movement. Briefly noted: Wang Bing's interpretation of "fullness" is incorrect.
Upper part pulls as if pregnant: Gao Yun: The *Jing Mai Lun* states: Liver disease causes hernia in men and lower abdominal swelling in women. Thus, upper pulling downward resembles pregnancy.
Sacrum replaces heels, spine replaces head: Gao Yun: Kao is the coccyx. Squatting with the coccyx replaces the heels, indicating Bone痿 (Wei - flaccidity). The upright spine replaces the head, indicating collapse of Tian Zhu (Heavenly Pillar). Briefly noted: Wang Bing interprets this as spasm/cramping, consistent with other commentators. Gao interprets it as flaccidity/weakness, differing in meaning.
Bao Bi (Bladder Bi): Zhang Yun: Bao is the bladder sac. Gao Yun: It is Bladder Bi. Briefly noted: Liu Xi's *Shi Ming* says: Bao implies emptiness, used to hold water. Some say Bladder is named so because it is short and wide. Knowing Bao is the Bladder, Wu Kun's annotation using the female uterus is incorrect.
Internal pain upon pressure, as if scalded with hot water: Briefly noted: The *Bai Bing Shi Sheng Pian* states: Accumulations attaching to the Fu Chong vessel pulse upon touch, and upon releasing hand, heat flows down to both thighs, resembling scalding. This describes muscle heat. Based on this, interpreting internal pain as thigh pain seems correct.
Clear discharge from above: Zhi Yun: The Bladder meridian enters the brain from the vertex; brain seepage produces mucus. Clear discharge upward occurs because Tai Yang Qi is obstructed below and cannot ascend along the meridian. (*Zhang Shi Yi Tong* adds: Bao is the bladder sac. Bladder Qi obstruction blocks water passages, causing internal pain upon pressure, feeling like hot water pouring. Urine gains slight passage due to external heat but remains stagnant. Treatment should warm and assist Qi transformation. The Bladder meridian connects to the brain, hence clear discharge. Since Tai Yang Qi is insecure and Essence leaks upward, warming and tonifying is essential. After essence loss, Cold/Heat invade the Bladder, causing dribbling, penile pain radiating to the anus, and abdominal distension. This is due to fluid exhaustion. Diuretics will cause death. Elderly with Yin deficiency often suffer this. I have seen bladder rupture with uncontrollable dribbling; though temporarily relieved, death follows soon. Refer to a case in the Incontinence section treating Bao Bi with Shen Li Tang modified Sang Piao Xiao San.)
Yin Qi being quiet...: Ma Yun: This explains that internal injury is the root of Bi, allowing external pathogens to invade. Yin Qi is Ying Qi. It is refined and travels with Zong Qi in the meridians. Only when quiet can the Spirits of the Five Zang remain stored. If restless, they perish. Thus, Five Zang Bi requires re-exposure to pathogens. Why do Six Fu Bi occur? Diet nourishes but excess harms. Doubling food intake injures the intestines and stomach. Once injured, pathogens enter via Shu points, causing Bi. The *Sheng Qi Tong Tian Lun* discusses Wei Qi (Yang); this section discusses Ying Qi (Yin). Wang Bing distinguishes Zang/Fu correctly but fails to identify Yin Qi as Ying Qi. Briefly noted: Wu Kun moved these 19 characters to the *Sheng Qi Tong Tian Lun*; uncertain if original. Following Ma Yun for now.
Excessive Qi (Yin Qi): Hua Yun: Wang Bing's note implies internal injury, not external Wind/Cold/Dampness. The *Xuan Ming Wu Qi Pian* says: Pathogens entering Yin cause Bi. Does "pathogen" refer to Yin Qi? Ma Yun: Pathogenic infiltration causes panting. Lung governs Qi; Bi gathering in Lung causes panting. (Same for subsequent text.) Zhi Yun: This clarifies that restless Yin Qi perishes, and Bi gathers in Zang. Yin Qi here means excessive/dissipated Yin Qi that fails to store. Excessive Qi leads to panting, Lung Qi fails to store, and Bi gathers in Lung. Wu Yun: Imbalance of Qi is called Yin Qi. Bi gathering is the condensation of Wind, Cold, and Dampness. Briefly noted: The *Sheng Qi Tong Tian Lun* says: Wind lodges in Yin Qi, Essence perishes, Evil injures Liver. *Shuo Wen*: Yin means infiltrating along channels. Xu Kai says: Infiltrating along channel pathways.
Exhaustion: Ma Yun: Pathogenic infiltration exhausts Yin Blood. Liver governs Blood; Bi gathering in Liver causes exhaustion.
Muscle Severance: Ma Yun: Pathogenic infiltration blocks Muscle Qi. Spleen governs flesh; Bi gathering in Spleen causes severance. Wu Yun: Muscle tearing. Zhi Yun: Scorched/severed muscles, also due to excessive intercourse.
Also Excessive Intercourse: Ma Yun: Some interpret "also benefit interior" as "intercourse," which is plausible. Zhi Yun: "Also" implies not just internal connection of skin/muscle/sinew/bone. Briefly noted: Ma's view is unsettled. (*Yi Tong* reads "Yi" as "Lan" - excessive).
Easy to Cure: Zhang Yun: Wind is Yang pathogen, easily dispersed, hence easy to cure. Cold/Damp Bi are harder to cure as Yin pathogens linger and resist movement.
Diet and Dwelling: Gao Yun: Refers to overeating and improper living conditions, the root of Fu Bi.
Six Fu Organs Also Have Shu Points: Ma Yun: The fen li of Six Fu have Shu points. External Wind/Cold/Dampness strikes these points, internal dietary irregularity responds, pathogens enter via Shu. All 365 points can be Shu. Wang Bing limits Shu to the six Back-Shu points on the Foot Tai Yang, which is incorrect.
Five Zang Have Shu, Six Fu Have He: Zhang Yun: Discusses Zang and Fu mutually. Wang Ang notes: Previous text only lists Chang Bi and Bao Bi. San Jiao has name but no form; Gallbladder attaches to Liver; Stomach is the Sea of Zang/Fu, so no separate Bi discussion.
Manifestations Vary, Treat According to Fault: Ma Yun: Follow the meridian pathways of Zang/Fu to find the affected channel; needle according to the location, whether Shu or He point, and the disease will resolve. Zhi Yun: Select points based on the location of the fault/pathogen. Briefly noted: Zhang considers "manifestation" as Jing-Well points. "Guo" (fault) is read as level tone by Wu, Zhang, Gao following Wang Bing, which is incorrect.
Ying Qi is the Essence-Qi of Grain and Water: Zhang Yun: Ying Qi is Yin Qi, transformed from grain/water essence. *Wei Qi Pian* states: Essence traveling in meridians is Ying Qi. *Zheng Li Lun* states: Food enters stomach, transmits to Lung, nourishing all Zang/Fu. Clear part is Ying, turbid part is Wei. Ying is within vessels, Wei outside. Thus, Ying reaches all Zang/Fu and collaterals.
Wei Qi is the Fierce Qi of Grain and Water: Zhang Yun: Wei Qi is Yang Qi. Yang Qi arrives floating, abundant, and swift, hence "Fierce." Fierce means urgent. *Ben Zang Pian* states: Wei warms fen li, fills skin, plumps cou li, controls opening/closing. *Wei Qi Pian* states: Floating Qi not following meridians is Wei Qi. *Xie Ke Pian* states: Wei Qi sends out its fierce, swift energy, moving ahead in extremities, fen li, and skin without rest. These sections complement each other.
Huang Mo (Diaphragm Membrane): Zhang Yun: Huang refers to spaces between cavities and tissues. *Ci Jin Lun* says: Above Ge Huang lies Parents (Heart/Lung). *Zuo Zhuan* mentions above Gao, below Huang. *Fu Zhong Lun* says: Qi overflows to Large Intestine, attaches to Huang. Source of Huang is below navel. *Jiu Zhen Shi Er Yuan Pian* says: Source of Huang emerges from Bo Yang. *Zhang Lun* says: Sunken into muscle Huang, hitting Qi points. Thus, Huang is not limited to chest/diaphragm. Mo is fascia. Briefly noted: Wang Bing defines empty space; Wu Kun's note on *Fu Zhong Lun* is similar. Zhang misread this note, confusing it with Small Intestine membrane origin in *Ju Tong Lun*. Incorrect. *Bian Que Zhuan* mentions "Nuo Huang"; *Shuo Yuan* writes "Huang Mo", i.e., Huang Mo.
Scattered in Chest and Abdomen: The *Jia Yi Jing* reads "San" (scatter) as "Ju" (gather).
Therefore, No Bi: Zhang Yun: Ying and Wei Qi must not reverse. Reversal causes disease; compliance brings health. Unlike solid organs/tissues, they have no form/traces, so they do not combine with the three pathogens. Formless means no Bi.
Pain Due to Cold: Briefly noted: Wang Bing's note relies on the *Ling Shu Zhou Bi Pian*.
Therefore, No Unblocking (Pain): Commentators follow *Jia Yi Jing*, reading "Tong" (unblock) as "Tong" (pain). We follow this.
Skin Not Nourished: Zhang Yun: *Ni Diao Lun* states: Ying deficiency causes numbness; Wei deficiency causes immobility. "Not nourished" means Qi/Blood do not reach. Ma Yun: Lack of Qi/Blood circulation in skin. Gao agrees. Zhi Yun: Cannot nourish the skin.
Less Yang Qi, More Yin Qi: Zhang Yun: Cold diseases are not always external. If Yang is deficient and Yin excessive, Cold generates internally, exacerbating the condition, resulting in Cold syndrome. Zhi Yun: Cold/Heat depend on human Yin/Yang transformation. Less Yang and more Yin exacerbates internal Cold.
Pathogen Qi Prevails: Zhang Zhaohuang says: "Exacerbating pathogen" means excess Yin increases pathogenic Cold. "Pathogen Qi prevails" means excess Yang increases pathogenic Heat.
Yang Encounters Yin Causes Bi-Heat: Wu Kun: "Zao" (encounter) should be "Cheng" (overcome). Old text "Yang encounters Yin" is inappropriate. Following *Jia Yi Jing*, changing to "Yang overcomes Yin" is more logical. Briefly noted: *Jia Yi Jing* lacks "Bi", which is also plausible. Hua Yun: Or heat below, or dryness question; no answer here.
Two Qi Interact: Zhang Yun: Cold and Dampness. *Mai Yao Jing Wei Lun* states: Excess Yin causes sweating and cold body. Same meaning. Zhang Zhaohuang says: Excess Yang heat causes sweating; moist sweat belongs to Yin/Cold. Clinicians must examine carefully.
No Pain: Wang Ang says: Pain indicates Qi/Blood still circulate. Five Bi involve Qi/Blood deficiency, heavier than pain, hence no pain. Other explanations are unclear.
Meeting Cold Causes "Chong": Ma Yun: "Chong" is "Ji" (urgent/spasm) in *Jia Yi Jing*. Wang Bing's "like insect crawling" is wrong. Wind predominance causes Xing Bi, not triggered by Cold. Zhang Yun: Meeting Cold causes sinew spasm (urgent); meeting Heat causes sinew relaxation (slack). Wu Kun agrees. Briefly noted: Zhi follows Wang Bing. Gao Yun: Cold/Damp clash causes "Chong". Highly erroneous. Chao Yuanfang states: Bi types itch in Heat, hurt in Cold.