（麻木）
《内经》谓∶风寒湿三气杂至，合而为痹。（痹、闭滞也。身中血气为三者之邪所闭滞。）风气
胜者为行痹，（风善行动，嘘其寒湿走注不定，故痹痛亦走而不定。）寒气胜者为痛痹，（血气痹滞无不痛
者，而寒之痛为甚。以寒则凝，其滞而不通，比风湿尤甚，故痛若虎咬，世呼为白虎风是也。）湿气胜者
为着痹，（不如风胜者之流走，但着而不移；亦不如寒胜者之痛甚，但略痛，或但麻木不仁。
盖湿如水而寒如冰，
腠理之松滑与紧涩有异，则气血之行，其为阻滞冲击者，固有微甚之分也。）是名三痹。
《经》又分，以冬得之为骨痹，（骨重不举而酸疼。）春得之为筋痹，（筋挛不伸。）夏得之为脉
痹，（血脉不流而色变。）长夏得之为肌痹，（肌肉不仁，不知痛痒。）秋得之为皮痹，（皮逢寒则急，逢热
则纵，虽麻木，尚知痛痒。）是名五痹。
又谓∶五痹久不愈，重感于邪，则各传其脏。如见胸满烦喘咳嗽，是皮传
肺，为肺痹也。呕吐痰涎，心下痞硬，四肢懈惰，是肌传脾、为脾痹。心烦心悸，
嗌干善噫，厥气上则恐，（如肾寒冲心则恐悸之类。）是脉传心，为心痹。多惊善怒，胁
胀，多饮，小便数，是筋传肝，为肝痹。善胀，尻以代踵，（足挛不伸也。）脊以代头，（伛偻
不直也。）是骨传肾，为肾痹。痹入五脏则死矣。又谓传腑。数饮而小便不通，中气喘
急，时作飧泄，（不泻则胀，不胀则泻。）为肠痹。（大小肠也，举肠该胃。）小腹膀胱按之痛，
若沃以汤，涩于小便，上为清涕，为胞痹。（胞即膀胱，详淋证门。）不言胆者，缺文也。又
有众痹、周痹之名。谓各在其处，歇而复起，左右相移，更发更休，名众痹。
若在血脉之中，止随脉以上下，而不左右相移，名周痹。（周痹似中风之偏废，然有痛而无口
眼斜为异矣。）按以上诸痹，总皆风寒湿三气为患，特以其受病之所在，区别言之耳，
要其病本则一也。
再按风，即寒也，（说见疟论。）虽曰风寒湿，实寒湿二者足以尽之。气为寒湿所闭，
气盛而寒湿微者，则走注而不甚痛；若气盛而寒湿亦盛者，则不甚流走而痛剧；气
弱而寒湿甚者，则着而不行，亦不甚痛，或但麻木也。《经》所谓风胜为行痹者，风
有外风内风。以外风言，即寒之浅者，止伤于卫，（风胜犹云邪偏胜于卫。）不甚闭遏，故能
流走而不甚痛。若以内风言，则即人身之气矣。是《经》言风即兼言气可知矣。至
寒之痛，必由于气盛冲击；湿之着，必由于气弱不运，固可推而得之耳。麻者非痛
非痒，如千万小虫乱行，如麻之乱也，观于脚麻可知。木者不痒不痛，并不麻，顽
然一物，自己肌肉如他人肌肉，按之不知，搔之不觉，如木之无知也。河间论麻，
谓是气涩，东垣谓是气虚。盖气盛能行，不麻；全无气不行，亦不麻；惟气衰不能
营运流利，停滞此处，嘘其津液痰涎，纷乱沸动所致也。（若血液燥涸者，气行不得滑利，纷
然而窜走其空隙，亦麻。）或言风者误也。观人之久坐而起则脚麻，及绳缚久，释之，则亦
麻，岂非气久不行，得起得释而微通，嘘其久滞之血液而然哉？李正臣夫人病麻，
昼减而夜甚，又闭目则甚，开目则否。盖昼与开目，则阳行于外，气得流通，故减
也。再按外感之寒湿能痹，岂内生之寒湿独不痹乎？寒能滞气涩血，湿能停痰聚液，
观之瘀血痰饮之为痹，而初无外感者，可见矣，不特此也。内生之风亦为痹，内风
者，热气之 疾者也，热盛亦生湿、生痰矣。热甚则血枯，死血阻塞经隧，则亦不
通而痹矣。又忍尿亦成痹。（尿不行则气亦不行而乍痹，必膝冷。）支饮臂麻木，一隅三反，
是在明者。
（麻木）
《黄帝内经》说：风、寒、湿三种邪气混杂侵袭人体，结合在一起形成痹证。（痹，意为闭滞。指身体中的气血被这三种邪气所闭阻停滞。）风气偏胜的称为行痹，（风性善动，吹散其寒湿并游走不定，所以痹痛也游走不定。）寒气偏胜的称为痛痹，（气血闭滞没有不痛的，而寒邪导致的疼痛最为剧烈。因为寒性凝滞，导致阻滞不通的程度比风湿更严重，所以疼痛剧烈如虎咬，世人称之为白虎风。）湿气偏胜的称为着痹，（不像风邪偏胜那样流走不定，而是固定不移；也不像寒邪偏胜那样疼痛剧烈，只是轻微疼痛，或者仅仅表现为麻木不仁。大概湿气像水一样，寒气像冰一样，腠理的松弛滑润与紧涩不同，那么气血的运行，其所受到的阻滞冲击程度，自然有细微差别。）这叫做三痹。
《内经》又根据发病季节进行分类：冬季得之为骨痹，（骨骼沉重难以抬起且酸痛。）春季得之为筋痹，（筋脉拘挛不能伸展。）夏季得之为脉痹，（血脉运行不畅且颜色改变。）长夏（季夏）得之为肌痹，（肌肉麻木不仁，不知痛痒。）秋季得之为皮痹，（皮肤遇寒则紧缩，遇热则松弛，虽然麻木，但尚知痛痒。）这叫做五痹。
又说：五种痹证久治不愈，再次感受邪气，就会各自传变到相应的脏腑。如果出现胸满、烦躁气喘、咳嗽，这是皮痹传肺，成为肺痹。出现呕吐痰涎、心下痞塞坚硬、四肢懈怠无力，这是肌痹传脾，成为脾痹。出现心烦心悸、咽喉干燥、容易嗳气，厥逆之气上冲则恐惧，（如肾寒上冲于心导致的恐惧心悸之类。）这是脉痹传心，成为心痹。出现多惊易怒、胁肋胀满、多饮、小便频数，这是筋痹传肝，成为肝痹。出现腹部胀满、尾骶部代替脚后跟行走（足部拘挛不能伸展）、脊柱弯曲代替头部前倾（驼背不能直立），这是骨痹传肾，成为肾痹。痹证传入五脏就会导致死亡。又说会传变到六腑。频繁饮水但小便不通，中焦气喘急促，时常发生完谷不化的泄泻，（不腹泻时就腹胀，不腹胀时就腹泻。）这是肠痹。（指大小肠，举肠可概括包括胃。）小腹膀胱部位按压疼痛，感觉像热水浇灌，小便涩滞不利，向上表现为清涕流出，这是胞痹。（胞即膀胱，详见淋证章节。）没有提到胆痹，是原文缺漏之处。又有众痹、周痹的名称。说它们各自停留在特定部位，休息后又发作，左右相互转移，交替发作和停止，称为众痹。如果在血脉之中，只随经脉上下流动，而不左右转移，称为周痹。（周痹类似于中风引起的半身不遂，然而只有疼痛而没有口眼歪斜，这是它的不同之处。）
按照以上各种痹证，总归都是风、寒、湿三种邪气致病，只是根据受病部位的不同加以区别论述罢了，究其病本则是一致的。
再按：风，其实就是寒，（说法见《疟论》篇。）虽然说风寒湿，实际上寒湿二者足以概括全部。如果正气盛而寒湿轻微，就会游走不定而疼痛不重；如果正气盛而寒湿也盛，就不会太游走而疼痛剧烈；如果正气弱而寒湿严重，就会固定不移，也不怎么痛，或者仅仅麻木。《内经》所说的“风胜为行痹”，风有外风和内风之分。从外风来说，就是较浅的寒邪，只伤及卫气，（风胜犹言邪气偏胜于卫分。）不太闭遏，所以能流走而不甚痛。如果从内风来说，那就是人身的气了。由此可见，《内经》所说的风就兼带了气的含义。至于寒邪导致的疼痛，必定是由于气盛冲击所致；湿气导致的固定不移，必定是由于气弱不能运化所致，这都可以推演得出。麻，不是痛也不是痒，像千万只小虫乱爬，像麻籽杂乱一样，看脚麻就知道了。木，不痒也不痛，甚至不麻，僵硬得像一块木头，自己的肌肉像别人的肌肉一样，按压不知道，搔抓没感觉，像木头没有知觉一样。刘河间论述麻，认为是气涩；李东垣认为是气虚。大概气盛能运行，就不麻；完全没有气而不能运行，也不麻；只有气衰不能营运流利，停滞在此处，吹嘘津液痰涎，纷乱沸腾动荡所致。（如果是血液燥竭，气行不得滑利，纷然窜走于空隙之间，也会麻。）有人说这是风邪造成的，是错误的。看人久坐起来脚麻，以及绳子绑久了松开时也麻，难道不是因为气长久不行，起来或松开后微微通畅，吹嘘长久停滞的血液而造成的吗？李正臣的妻子患麻木症，白天减轻晚上加重，闭眼时加重，睁眼时则不然。大概白天和睁眼时，阳气行于外部，气得流通，所以减轻。再按：外感寒湿能导致痹证，难道内生的寒湿独独不会导致痹证吗？寒能使气滞血涩，湿能停痰聚液，观察瘀血痰饮导致的痹证，起初并没有外感因素，就可以明白了，不仅如此。内生的风也会导致痹证，内风，是热气躁动的疾速表现，热盛也会生湿、生痰。热极则血枯，死血阻塞经络隧道，也就不能通畅而成为痹证。还有忍尿也能成痹。（尿液不通则气也不通而突然痹阻，必然膝盖发冷。）支饮导致手臂麻木，以此类推，在于明理之人去领悟。
(Numbness)
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When Wind, Cold, and Dampness pathogens mix and invade together, they combine to form Bi Syndrome (Obstruction Syndrome). (Bi means obstruction or stagnation. It refers to the Qi and Blood in the body being blocked and stagnant by these three pathogens.) When Wind is predominant, it is called Xing Bi (Wandering Bi), (Wind has a moving nature; it disperses Cold and Dampness and moves unpredictably, so the pain of Bi also wanders without fixed location.) When Cold is predominant, it is called Tong Bi (Painful Bi), (Stagnation of Qi and Blood inevitably causes pain, but the pain caused by Cold is the most severe. Because Cold causes coagulation, its obstruction and blockage are more severe than Wind and Dampness, thus the pain is intense like being bitten by a tiger; the world calls this "White Tiger Wind".) When Dampness is predominant, it is called Zhuo Bi (Fixed Bi), (Unlike Wind predominance which flows and moves, it stays fixed and does not shift; unlike Cold predominance which causes severe pain, it only causes slight pain or merely numbness and insensitivity. Generally, Dampness is like water, and Cold is like ice. The looseness and slipperiness versus tightness and roughness of the Cou Li (interstices/skin pores) differ, so the degree of obstruction and impact on the flow of Qi and Blood naturally has distinctions in severity.) This is named the Three BIs.
The *Jing* (Canon) further classifies them by season: Contracting it in Winter results in Gu Bi (Bone Bi), (Bones feel heavy and difficult to lift, accompanied by soreness and pain.) Contracting it in Spring results in Jin Bi (Sinew Bi), (Tendons become spasmodic and cannot extend.) Contracting it in Summer results in Mai Bi (Vessel Bi), (Blood vessels do not flow smoothly and skin color changes.) Contracting it in Late Summer results in Ji Bi (Muscle Bi), (Muscles are numb and insensitive, unaware of pain or itching.) Contracting it in Autumn results in Pi Bi (Skin Bi), (Skin tightens when exposed to Cold and relaxes when exposed to Heat; although numb, one still perceives pain and itching.) This is named the Five BIs.
It is also stated: If the Five BIs do not heal after a long time and are re-infected by pathogens, they will transmit to their respective Zang organs. For example, if chest fullness, irritability, panting, and coughing appear, this is Skin transmitting to Lung, becoming Fei Bi (Lung Bi). If vomiting of phlegm and saliva, epigastric stuffiness and hardness, and flaccidity of the four limbs appear, this is Muscle transmitting to Spleen, becoming Pi Bi (Spleen Bi). If irritability, palpitations, dry throat, frequent belching, and fear due to rebellious Qi rising upward appear (such as fear and palpitations caused by Kidney Cold rushing to the Heart), this is Vessel transmitting to Heart, becoming Xin Bi (Heart Bi). If frequent fright, irritability, hypochondriac distension, polydipsia, and frequent urination appear, this is Sinew transmitting to Liver, becoming Gan Bi (Liver Bi). If abdominal distension appears, with the sacrum replacing the heels (tendon spasm preventing leg extension) and the spine replacing the head (kyphosis preventing upright posture), this is Bone transmitting to Kidney, becoming Shen Bi (Kidney Bi). Once Bi enters the Five Zang organs, death ensues. It is also said that transmission can occur to the Fu organs. Frequent drinking but inability to urinate, mid-jiao panting and urgency, and occasional diarrhea with undigested food (if no diarrhea, then distension; if no distension, then diarrhea) constitute Chang Bi (Intestinal Bi). (Referring to Large and Small Intestines; citing Intestines covers the Stomach.) Pain upon pressing the lower abdomen and Bladder area, feeling as if scalded by hot soup, astringency in urination, and clear nasal discharge above constitute Bao Bi (Bladder Bi). (Bao refers to the Bladder; see detailed discussion in the Lin Zheng section.) The omission of Dan Bi (Gallbladder Bi) is a missing text error. There are also names for Zhong Bi (Multifocal Bi) and Zhou Bi (Circulating Bi). They are described as staying in specific locations, resting and then recurring, shifting left and right, alternating between attack and rest, named Zhong Bi. If within the blood vessels, it only moves up and down along the meridians without shifting left and right, it is named Zhou Bi. (Zhou Bi resembles hemiplegia from Stroke, but differs in having pain without facial paralysis.) According to the aforementioned various BIs, they all originate from Wind, Cold, and Dampness pathogens; they are distinguished only by the site of disease involvement, but fundamentally, the pathology is the same.
Furthermore, Wind is essentially Cold (as explained in the *Malaria Treatise*). Although termed Wind-Cold-Dampness, Cold and Dampness alone suffice to cover the entirety. If Zheng Qi (Upright Qi) is strong while Cold and Dampness are mild, the condition will wander without severe pain; if Zheng Qi is strong but Cold and Dampness are also severe, it will not wander much but cause severe pain; if Zheng Qi is weak and Cold and Dampness are severe, it will be fixed and immobile, causing little pain or merely numbness. The *Jing*'s statement "Wind predominance leads to Wandering Bi" distinguishes between External Wind and Internal Wind. Speaking of External Wind, it is shallow Cold that only injures Wei Qi (Defensive Qi). (Wind predominance implies pathogenic factors bias towards the Defensive level.) It does not heavily obstruct, hence it can move freely without severe pain. Speaking of Internal Wind, it refers to the Qi of the human body. Thus, it can be known that when the *Jing* speaks of Wind, it implicitly includes Qi. Regarding pain from Cold, it must result from vigorous Qi impacting; regarding fixation from Dampness, it must result from weak Qi failing to transport. These can be deduced. Numbness (Ma) is neither pain nor itch; it feels like thousands of small insects crawling chaotically, like scattered hemp seeds, observable in foot numbness. Wood-like sensation (Mu) involves no itch, no pain, and even no numbness; it feels rigid like an object, where one's own muscles feel like others' muscles—unresponsive to pressure and scratching, just as wood lacks sensation. Liu Hejian discussed Ma, attributing it to Qi stagnation/roughness; Li Dongyuan attributed it to Qi deficiency. Generally, strong Qi allows movement, so there is no numbness; complete absence of Qi prevents movement, so there is no numbness either; only when Qi is deficient and fails to circulate smoothly, stagnating in place, and agitating Body Fluids and Phlegm, causing chaotic turbulence, does numbness arise. (If Blood is dry and depleted, Qi cannot move smoothly, wandering chaotically through voids, also causing numbness.) Some say it is caused by Wind, which is erroneous. Observing people who sit for a long time and stand up experience foot numbness, or whose limbs are bound tightly by rope and feel numb upon release, is it not because Qi was stagnant for a long time, and upon standing or release, becomes slightly unblocked, agitating the long-stagnant Blood? Mrs. Li Zhengchen suffered from numbness, which decreased during the day and worsened at night, and worsened with eyes closed but improved with eyes open. During the day and with eyes open, Yang Qi moves externally, allowing Qi to flow freely, hence improvement. Furthermore, if External Cold and Dampness can cause Bi, how could Internal Cold and Dampness fail to cause Bi? Cold causes Qi stagnation and Blood roughness; Dampness causes Phlegm retention and fluid accumulation. Observing Bi caused by Stasis Blood and Phlegm-Fluid, which initially had no external contraction, confirms this. Moreover, Internal Wind also causes Bi. Internal Wind is the rapid manifestation of Heat Qi; excessive Heat generates Dampness and Phlegm. Extreme Heat dries up Blood; dead Blood blocks the collaterals, leading to obstruction and Bi. Also, holding urine can cause Bi. (If urine does not pass, Qi does not move, causing sudden Bi, necessarily with cold knees.) Branch-fluid retention (Zhi Yin) causing arm numbness serves as an analogy; understanding lies with the wise.