阳动风亦动矣。议去辛用咸。若疑虑途次疟邪未尽。致脉络留滞。兼以通逐缓攻亦妙。（肝阴虚疟邪入血络）
熟地 龟胶 阿胶 秋石 天冬 麦冬 五味 茯神 蜜丸晨服。
桃仁 穿山甲 干地龙 抚芎 归须 丹皮 红花 沙苑 香附汁丸。夜服。
某 仲景以经热则痹。络热则痿。今痹痛多日。脉中筋急。热入阴分血中。致下焦为甚。所谓上
焦属气。下焦属血耳。（热入下焦血分）
柏子仁 当归 丹皮 钩藤 川斛 沙苑
又 痹痛。右膝甚。
生虎骨 柏子仁 牛膝 萆 苡仁 茯苓
某（四八） 脉弦劲右足踝 肿痛。得暖得摩稍适。此风寒湿三气。混入经隧而为痹也。当用辛温。宣
通经气为要。（风寒湿入下焦经隧）
活络丹一丸。陈酒下。
某 痹痛在外踝筋骨。妨于行走。邪留经络。须以搜剔动药。
川乌 全蝎 地龙 山甲 大黑豆皮
某 病后过食肥腻。气滞热郁。口腻粘涎。指节常有痹痛。当从气分宣通方法。（气滞热郁）
苏梗 杏仁 蒌皮 郁金 半夏曲 橘红
陈（五四） 劳动太过。阳气烦蒸。中年液衰风旋。周身痹痛。此非客邪。法宜两调阳明厥阴。（肝胃虚滞）
黄 生白术 制首乌 当归 白蒺藜 黑 豆皮
张（五三） 烦劳郁勃之阳。变现热气内风。内经以热淫风消。必用甘寒。前议谓酒客不喜甘味。且痰
多食少。亦忌甘腻滋滞。用清少阳胆热者。酒气先入肝胆也。酒汁湿着。肠胃受之。理明以通
胃。胃肠气机流行。食加。滑泄颇减。今者气热。当午上冒。经络痹痛亦减于平日。主以和阳甘
寒。宣通经脉佐之。（肝胆风热）
童桑 羚羊角 天门冬 枸杞子 白蒺藜 丹皮 茯苓 霍山石斛 共熬膏。
某（氏） 血虚风痹。骨骱肿痛。
羚羊角 细生地 元参 当归 桂枝 桑枝 白蒺藜
金（三二） 痹痛在下。重着不移。论理必系寒湿。但左脉搏数。经月遗泄三四。痛处无形。岂是六淫邪
聚。然隧道深远。药饵未易奏功。佐以艾灸。冀得效灵。（精血虚）
枸杞子 肉苁蓉 虎骨胶 麋角胶 杜仲 桑椹子 天冬 沙苑 茯苓 溶胶丸。
孙 脉右大。阳明空。气短闪烁欲痛。（气虚）
人参 生黄 熟白术 炙草 广皮 当归 白芍 半夏 防风根 羌活
又 益气颇安。知身半以上痹痛。乃阳不足也。
人参 黄 熟于术 炙草 桂枝 归身 白芍 川羌
沈 痹痛在右。气弱有痰。
生于术 川桂枝 川独活 片姜黄 白茯苓 陈防己
王 辛香走窜。宣通经隧壅结气分之湿。有却病之能。无补虚之益。大凡药饵。先由中宫以布
诸经。中焦为营气之本。营气失养。转旋目钝。然攻病必藉药气之偏。朝夕更改。岂是去疾务
尽之道。另于暮夜进养营一贴。（营虚）
人参 茯苓 桂枝木 炙草 当归 炒白芍 南枣
吴（三六） 筋纵痛甚。邪留正痹。当此天暖。间用针刺以宣脉络。初补气血之中。必佐宣行通络
之治。（筋痹）
生黄 防风 桂枝 炒黑常山 归身 青菊叶汁
某 痹痛偏左。入夜尤甚。血中之气不行。（血中气滞）
归须 桑枝 苡仁 白疾黎 姜黄 木防己
刘（三八） 周礼采毒药以供医事。盖因顽钝沉痼。着于躯壳。非脏腑虚损。故必以有毒攻拔。使邪
不留存。凝着气血。乃效。既效矣。经云。大毒治病。十去其五。当此只宜爱护身体。勿劳情志。便
是全功道理。愚人必曰以药除根。不知天地之气。有胜有复。人身亦然。谷食养生。可御一生。
药饵偏胜岂可久服。不观方士炼服金石丹药。疽发而死者比比。（血虚络涩）
何首乌 黑芝麻 桑枝桂枝汤泛丸。
某 脉沉小数。营中留热。骱骨尚有微疼。宜通经络。佐清营热。（营中热）
钩藤 细生地 当归须 白蒺藜 丹皮 片姜黄
此 症与风病相似。但风则阳受之。痹则阴受之。故多重着沉痛。其在内经。不越乎风寒湿
三气。然四时之令。皆能为邪。五脏之气。各能受病。其实痹者。闭而不通之谓也。正气为邪
所阻。脏腑经络。不能畅达。皆由气血亏损。腠理疏豁。风寒湿三气。得以乘虚外袭。留滞于
内。致湿痰浊血。流注凝涩而得之。故经云。三气杂至。合而为痹。又云风胜为行痹。寒胜为
痛痹。湿胜为着痹。以及骨痹筋痹脉痹肌痹皮痹之义。可知痹病之症。非偏受一气足
以致之也。然而病症多端。治法亦异。余亦不能尽述。兹以先生治痹之法。为申明一二。有
卫阳疏。风邪入络而成痹者。以宣通经脉。甘寒去热为主。有经脉受伤。阳气不为护持而
为痹者。以温养通补。扶持生气为主。有暑伤气湿热入络而为痹者。用舒通脉络之剂。使
清阳流行为主。有风湿肿痛而为痹者。用参术益气。佐以风药壮气为主。有湿热伤气。及
温热入血络而成痹者。用固卫阳以却邪。及宣通营络。兼治奇经为主。有肝阴虚。疟邪入
络而为痹者。以咸苦滋阴。兼以通逐缓攻为主。有寒湿入络而成痹者。以微通其阳。兼以
通补为主。有气滞热郁而成痹者。从气分宣通为主。有肝胃虚滞而成痹者。以两补厥阴
阳明为治。有风寒湿入下焦经隧而为痹者。用辛温以宣通经气为主。有肝胆风热而成
痹者。用甘寒和阳。宣通脉络为主。有血虚络涩。及营虚而成痹者。以养营养血为主。又有
周痹行痹肢痹筋痹。及风寒湿三气杂合之痹。亦不外乎流畅气血。祛邪养正。宣通脉络
诸法。故张景岳云。治痹之法。只宜峻补真阴。宣通脉络。使气血得以流行。不得过用风
燥等药。以再伤阴气。亦见道之言也。（邹滋九）
徐评 案多重复。可删。既知风寒湿为痹。则尽属外邪可知。而用人参及温补之药者。十居
二三。恐有留邪之患。凡属形体之疾。当外治。不明外治之法。服药虽中病。仅得医术之半耳。
阳气妄动则风亦随之而动。建议去除辛散药物，改用咸味药物。如果疑虑旅途中的疟邪尚未清除，导致脉络阻滞不通，同时配合使用通利逐邪、缓和攻下的方法也很巧妙。（肝阴虚，疟邪侵入血络）
熟地黄、龟甲胶、阿胶、秋石、天冬、麦冬、五味子、茯神，制成蜜丸，早晨服用。
桃仁、穿山甲、干地龙、抚芎（川芎）、当归须、牡丹皮、红花、沙苑子、香附汁，制成丸药，晚上服用。
某患者，张仲景认为经脉有热则成痹证，络脉有热则成痿证。如今痹痛多日，脉象显示筋脉拘急，这是热邪深入阴分血中，导致下焦症状尤为严重。所谓上焦属气，下焦属血。（热邪深入下焦血分）
柏子仁、当归、牡丹皮、钩藤、川石斛、沙苑子。
又诊：痹痛，右侧膝盖尤为严重。
生虎骨、柏子仁、牛膝、萆薢、薏苡仁、茯苓。
某患者（四十八岁），脉象弦劲，右足踝部肿痛，得到温暖或按摩后稍感舒适。这是风寒湿三气混杂侵入经隧而形成的痹证。应当使用辛温药物，以宣通经气为关键。（风寒湿邪侵入下焦经隧）
活络丹一丸，用陈酒送服。
某患者，痹痛位于外踝筋骨处，妨碍行走。邪气留滞于经络，必须使用具有搜剔作用的动药。
川乌、全蝎、地龙、山甲（穿山甲）、大黑豆皮。
某患者，病后过食肥甘厚腻之物，导致气机阻滞、热邪郁结，口中黏腻且有涎沫，指节常有痹痛。应当从气分宣通的方法论治。（气滞热郁）
苏梗、杏仁、瓜蒌皮、郁金、半夏曲、橘红。
陈患者（五十四岁），劳动过度，阳气烦扰蒸腾，中年津液衰少，风旋内生，周身痹痛。这不是外来的客邪，治法适宜两调阳明和厥阴经。（肝胃虚滞）
黄芪、生白术、制何首乌、当归、白蒺藜、黑豆皮。
张患者（五十三岁），烦劳导致郁勃之阳化现热气内风。《内经》认为热盛则风消，必须使用甘寒药物。前次讨论认为嗜酒者不喜欢甘味，且痰多食少，也忌讳甘腻滋滞的药物。因此使用清泄少阳胆热的药物，因为酒气首先侵入肝胆。酒汁湿气附着，肠胃受之，道理在于疏通胃气，胃肠气机流行，食欲增加，滑泄症状颇见减轻。如今气热，常在中午向上冲冒，经络痹痛也比平日减少。主方以和阳甘寒为主，佐以宣通经脉。（肝胆风热）
童桑枝、羚羊角、天门冬、枸杞子、白蒺藜、牡丹皮、茯苓、霍山石斛，共同熬制成膏。
某患者（姓氏不详），血虚风痹，骨节肿痛。
羚羊角、细生地、玄参、当归、桂枝、桑枝、白蒺藜。
金患者（三十二岁），痹痛在下部，沉重固定不移。按理说必定是寒湿所致，但左脉搏数，每月遗精泄精三四次，疼痛部位没有明显形态改变，难道是六淫邪气聚集吗？然而隧道深远，药物不易见效，辅助艾灸，希望获得疗效。（精血虚）
枸杞子、肉苁蓉、虎骨胶、麋角胶、杜仲、桑椹子、天冬、沙苑子、茯苓，将胶溶化后制丸。
孙患者，脉象右部大，阳明经空虚，气短闪烁欲痛。（气虚）
人参、生黄芪、熟白术、炙甘草、广陈皮、当归、白芍、半夏、防风根、羌活。
又诊：益气之后颇为安稳，得知半身以上痹痛，乃是阳气不足所致。
人参、黄芪、熟于术、炙甘草、桂枝、归身、白芍、川羌活。
沈患者，痹痛在右侧，气弱且有痰。
生白术、川桂枝、川独活、片姜黄、白茯苓、陈防己。
王患者，辛香走窜的药物，能宣通经隧壅结的气分之湿，有祛除疾病的能力，但没有补益虚损的功效。大凡药物，先由中宫（脾胃）布散到各条经脉。中焦是营气的根本，营气失养，转旋迟钝。然而攻伐疾病必须借助药气的偏性，朝夕更改，这并非彻底去疾的道理。另外在夜晚进服一帖养营药物。（营虚）
人参、茯苓、桂枝木、炙甘草、当归、炒白芍、南枣。
吴患者（三十六岁），筋脉弛纵疼痛剧烈，邪气留滞正气痹阻。正值天气暖和，间或用针刺来宣通脉络。在初补气血的同时，必须佐以宣行通络的治疗。（筋痹）
生黄芪、防风、桂枝、炒黑常山、归身、青菊叶汁。
某患者，痹痛偏向左侧，入夜尤其严重，这是血中之气运行不畅。（血中气滞）
当归须、桑枝、薏苡仁、白蒺藜、姜黄、木防己。
刘患者（三十八岁），《周礼》采集毒药以供医事，是因为顽钝沉痼之疾附着于躯壳，并非脏腑虚损，所以必须用有毒的药物攻拔，使邪气不留存，凝着气血，才能见效。既然已经见效，《内经》说：“大毒治病，十去其五。”此时只宜爱护身体，不要劳累情志，便是全功的道理。愚昧的人一定说用药除根，不知道天地之气有胜有复，人身也是如此。谷物饮食养生，可以抵御一生。药饵的偏胜岂可久服？不看法士炼服金石丹药，疽发而死的人比比皆是。（血虚络涩）
何首乌、黑芝麻，用桑枝桂枝汤泛丸。
某患者，脉象沉小数，营分中留有热邪，骨节尚有微疼，适宜通利经络，佐以清营热。（营中热）
钩藤、细生地、当归须、白蒺藜、牡丹皮、片姜黄。
此症与风病相似，但风邪侵犯阳分，痹邪侵犯阴分，所以多重着沉痛。在《内经》中，不离乎风寒湿三气。然而四季时令，皆能为邪，五脏之气，各能受病。其实“痹”字，就是闭而不通的意思。正气被邪气所阻，脏腑经络不能畅达，皆由气血亏损，腠理疏豁，风寒湿三气得以乘虚外袭，留滞于内，导致湿痰浊血，流注凝涩而得病。所以《内经》说：“三气杂至，合而为痹。”又说：“风胜为行痹，寒胜为痛痹，湿胜为着痹。”以及骨痹、筋痹、脉痹、肌痹、皮痹的含义，可知痹病的症状，不是偏受一气就足以致病的。然而病症多端，治法亦异，我也不能完全叙述。这里根据先生治疗痹病的方法，申述一二：有卫阳疏泄，风邪入络而成痹的，以宣通经脉，甘寒清热为主；有经脉受伤，阳气不为护持而成痹的，以温养通补，扶持生气为主；有暑伤气、湿热入络而成痹的，用舒通脉络的药剂，使清阳流行为主；有风湿肿痛而成痹的，用人参、白术益气，佐以风药壮气为主；有湿热伤气，及温热入血络而成痹的，用固护卫阳以驱邪，及宣通营络，兼治奇经为主；有肝阴虚，疟邪入络而成痹的，以咸苦滋阴，兼以通逐缓攻为主；有寒湿入络而成痹的，以微通其阳，兼以通补为主；有气滞热郁而成痹的，从气分宣通为主；有肝胃虚滞而成痹的，以两补厥阴、阳明为治；有风寒湿入下焦经隧而成痹的，用辛温以宣通经气为主；有肝胆风热而成痹的，用甘寒和阳，宣通脉络为主；有血虚络涩，及营虚而成痹的，以养营养血为主。又有周痹、行痹、肢痹、筋痹，及风寒湿三气杂合之痹，也不外乎流畅气血、祛邪养正、宣通脉络诸法。所以张景岳说：治疗痹病的方法，只宜峻补真阴，宣通脉络，使气血得以流行，不得过用风燥等药，以再伤阴气。这也是见识深远的话。（邹滋九评）
徐评：医案多有重复，可以删减。既然知道风寒湿是痹的原因，那么都属于外邪可知。而使用人参及温补药物的，十居二三，恐怕有留邪的隐患。凡是属于形体上的疾病，应当采用外治法。如果不明白外治法，服药虽然对症，仅得医术的一半罢了。
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.