【歌】风湿寒邪相杂至，袭人经络因成痹。寒者痛而风者行，湿为重着不移处。或中皮脉肌骨筋，内舍心
肝脾肾肺。
筋挛不仁类乎风，局方风痹同论治。因袭既久未能明，近代明师始分异。内经风痹各有条，诸痹所因出陈氏。
【论】《内经》云∶风、湿、寒三气杂至而为痹。其风气胜者为行痹，寒气胜者为痛痹，湿气胜者为着痹。
又云∶以冬遇此为骨痹，以春遇此为筋痹，以夏遇此为脉痹，以至阴遇此为肌痹，以秋遇此为皮痹。久而不已，
内舍于合，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、湿之邪气也。又云∶淫气喘息，痹聚在肺。淫气忧思，痹聚在心。淫气遗溺，痹聚在肾。淫气乏渴，痹聚
在肝。淫气肌绝，痹聚在脾。故风气胜者易已，留连于筋骨间者病久，其留皮肤间易已，入脏者死。若此者，
可以见其浅深之受证也。然五脏痹各有形状之不同，浅深之各异，善治者，审其所因，辨其所形，真知其在皮
肤、血脉、筋骨、脏腑浅深之分而调之，斯无危痼之患矣。若一概混作风治而用风燥热药，谬矣！
【脉】风湿寒气，合而为痹。浮涩而紧，三脉乃备。
五痹名状
肺痹者，烦满喘呕。心痹者，脉不通，烦则心下鼓暴，上气嗌干而呕，善噫，厥气上则恐。肝痹，夜卧则
惊，多饮，数小便，上为引如怀。肾痹，善胀，尻以代踵，脊以当头。脾痹，四肢怠惰，发咳呕汁，上为大塞，
五痹汤主之。（方见后风痹。）
风痹
脉尺、寸俱浮微，身体不仁，血气凝聚，手足拘挛者，风痹也，防风汤。风、寒、湿气客留于脾，手足缓
弱，顽痹不仁，三痹汤、五痹汤。
防风汤
治风痹、血痹。
防风（一钱半） 当归（一钱） 赤茯苓（八分） 秦艽（八分） 赤芍药（八分） 黄芩（八分） 独活
（八分） 桂心（五分） 杏仁（十四粒） 甘草（五分）
姜水煎服。
三痹汤
治风、寒、湿痹。
川续断（钱半） 杜仲（姜炒，钱半） 防风（钱半，去芦） 桂心（钱半） 细辛（钱半） 人参
（钱半，去芦） 白茯苓（钱半） 当归（酒浸，钱半） 甘草（钱半） 白芍药（钱半） 生地黄（一钱） 秦
艽（一钱，去芦） 川芎（一钱） 独活（一钱，去芦） 牛膝（酒浸，去芦，一钱） 黄 （一钱）
每服七钱，姜三片，枣二枚，水煎服。
五痹汤
治五脏痹。
羌活（一两，去芦） 白术（一两） 片子姜黄（去土，一两） 防己（一两） 甘草（炙，半两）
每服四钱，姜三片，水煎，服。
湿痹
湿胜，脉沉缓，留住不去，四肢麻木拘急，浮肿，茯苓川芎汤。风湿痹，脚膝肿痛，行步艰难，腰、膝、
臂、髀大骨痛，苍术散。手足流注疼痛，麻痹不仁，难以屈伸，当归拈痛汤。（方见香港脚。）
茯苓川芎汤
赤茯苓（一两） 桑白皮（一两） 防风（半两） 肉桂（半两） 麻黄（去节，半两） 川芎（半两）
芍药（半两） 当归（半两） 甘草（半两）
每用五钱，姜、枣煎服。
苍术散
治湿热成痹。
苍术（四两，泔浸） 黄柏（四两，酒炒） 虎胫骨（酥炙，二两） 防风（一两）
末之，每服二钱，白汤调下。
寒痹
身体烦疼，项背拘急，或重或痛，举体艰难，手足冷痹，腰腿沉重无力者，蠲痹汤。痛痹，四肢拘倦，
浮肿痛着，故寒气盛者为痛痹，川芎茯苓汤。（方见前湿痹。）骨节疼痛，皮肤不仁，肌肉重着及四肢缓纵不
仁者，附子汤。寒湿痹痛，薏苡仁汤。
蠲痹汤
治寒痹。
当归（一钱半） 芍药（一钱半） 黄 （一钱半） 羌活（一钱半） 甘草（一钱） 片子姜黄（一钱半）
姜、枣煎服。
附子汤
治寒痹。
生附子（四钱） 白芍药（二钱） 肉桂（二钱） 白茯苓（二钱） 人参（二钱） 白术（一钱二分）
甘草（一钱）
上锉，作二帖，姜三片，枣二枚，水煎服。
薏苡仁汤
当归（一两） 芍药（炒，一两） 薏苡仁（一两） 麻黄（一两） 肉桂（一两） 甘草（炙，一两）
苍术（米泔浸，炒，四两）
上锉，每服七钱，生姜三片，煎服。
自汗减麻黄，热减桂。
【歌诀】风、湿、寒三种邪气混杂侵袭人体，侵入经络从而形成痹证。寒气偏盛则疼痛剧烈，风气偏盛则疼痛游走不定，湿气偏盛则肢体沉重固定不移。病邪或侵犯皮、脉、肌、骨、筋等体表组织，或内传于心、肝、脾、肾、肺等脏腑。
筋脉拘挛且感觉迟钝类似风邪致病，宋代《局方》将此类风痹混同论治。由于病因长期未能阐明，近代名医才开始将其区分开来。《黄帝内经》对风痹各有详细论述，各种痹证的成因出自陈氏（指陈无择）的著作。
【论述】《黄帝内经》说：风、湿、寒三气混杂侵袭人体而形成痹证。其中风气偏胜的叫行痹（以疼痛游走为特征），寒气偏胜的叫痛痹（以疼痛剧烈为特征），湿气偏胜的叫着痹（以肢体沉重固定为特征）。
又说：在冬季感受这些邪气成为骨痹，在春季感受成为筋痹，在夏季感受成为脉痹，在长夏（至阴之时）感受成为肌痹，在秋季感受成为皮痹。如果久治不愈，病邪会内传于相合的脏腑，所以骨痹久不愈，再次感受邪气，就会内传于肾。筋痹久不愈，再次感受邪气，就会内传于肝。脉痹久不愈，再次感受邪气，就会内传于心。肌痹久不愈，再次感受邪气，就会内传于脾。皮痹久不愈，再次感受邪气，就会内传于肺。所谓的痹证，都是在相应季节，再次感受风、寒、湿邪气所致。
又说：出现喘息症状的，痹邪聚积在肺。出现忧思情绪的，痹邪聚积在心。出现遗尿症状的，痹邪聚积在肾。出现口渴乏力的，痹邪聚积在肝。出现肌肉萎缩绝食的，痹邪聚积在脾。因此，风气偏胜的容易治愈，病邪留连在筋骨间的病程较长，病邪停留在皮肤间的容易治愈，病邪进入脏腑的预后不良致死。像这种情况，可以看出病邪受侵的深浅程度。然而五脏痹各自有不同的表现形态，病位的浅深也各不相同。善于治疗的人，审察其病因，辨别其症状，真正了解病邪是在皮肤、血脉、筋骨还是脏腑，并据此进行调理，这样就没有危险和顽固难愈的祸患了。如果一概混同按风邪治疗而使用风燥热性的药物，那就错了！
【脉诊】风、湿、寒三气结合形成痹证。脉象浮、涩、紧，这三种脉象具备（提示风寒湿邪气存在）。
五痹的名称与症状
肺痹的症状是：烦闷胀满，气喘呕吐。心痹的症状是：血脉不通，心烦时心跳剧烈如鼓击，气逆上冲，咽喉干燥而呕吐，容易嗳气，厥逆之气上冲则恐惧。肝痹的症状是：夜间睡眠易惊，多饮，小便频数，上部牵引感如同怀孕。肾痹的症状是：容易腹胀，臀部代替脚跟站立（形容腰脊弯曲严重），脊柱代替头部直立（形容驼背严重）。脾痹的症状是：四肢倦怠懒惰，发作咳嗽并吐出涎液，上部严重痞塞不通，可用五痹汤主治。（方剂见后文的风痹部分。）
风痹
脉象尺部和寸部都浮而微弱，身体麻木不仁，血气凝聚，手足拘挛的，是风痹，用防风汤治疗。风、寒、湿邪气客居停留于脾经，导致手足软弱无力，顽麻不仁，用三痹汤、五痹汤治疗。
防风汤
治疗风痹、血痹。
防风（一钱半） 当归（一钱） 赤茯苓（八分） 秦艽（八分） 赤芍药（八分） 黄芩（八分） 独活（八分） 桂心（五分） 杏仁（十四粒） 甘草（五分）
用姜水煎服。
三痹汤
治疗风、寒、湿痹。
川续断（钱半） 杜仲（姜炒，钱半） 防风（钱半，去芦头） 桂心（钱半） 细辛（钱半） 人参（钱半，去芦头） 白茯苓（钱半） 当归（酒浸，钱半） 甘草（钱半） 白芍药（钱半） 生地黄（一钱） 秦艽（一钱，去芦头） 川芎（一钱） 独活（一钱，去芦头） 牛膝（酒浸，去芦头，一钱） 黄芪（一钱）
每次服用七钱，加生姜三片，大枣二枚，水煎服。
五痹汤
治疗五脏痹。
羌活（一两，去芦头） 白术（一两） 片子姜黄（去泥土，一两） 防己（一两） 甘草（炙，半两）
每次服用四钱，加生姜三片，水煎服。
湿痹
湿气偏胜，脉象沉缓，邪气滞留不去，四肢麻木拘急，浮肿，用茯苓川芎汤治疗。风湿痹，脚膝肿痛，行走困难，腰、膝、臂、大腿大骨疼痛，用苍术散治疗。手足流注性疼痛，麻痹不仁，难以屈伸，用当归拈痛汤治疗。（方剂见香港脚篇。）
茯苓川芎汤
赤茯苓（一两） 桑白皮（一两） 防风（半两） 肉桂（半两） 麻黄（去节，半两） 川芎（半两） 芍药（半两） 当归（半两） 甘草（半两）
每次用五钱，加姜、枣煎服。
苍术散
治疗湿热形成的痹证。
苍术（四两，淘米水浸泡） 黄柏（四两，酒炒） 虎胫骨（酥炙，二两） 防风（一两）
研成末，每次服用二钱，用白开水调下。
寒痹
身体烦疼，项背部拘急，或沉重或疼痛，全身活动艰难，手足冷痹，腰腿沉重无力的，用蠲痹汤治疗。痛痹，四肢拘挛疲倦，浮肿疼痛固定，因寒气盛而称为痛痹，用川芎茯苓汤治疗。（方剂见前文湿痹部分。）骨节疼痛，皮肤麻木不仁，肌肉沉重及四肢弛缓不仁的，用附子汤治疗。寒湿痹痛，用薏苡仁汤治疗。
蠲痹汤
治疗寒痹。
当归（一钱半） 芍药（一钱半） 黄芪（一钱半） 羌活（一钱半） 甘草（一钱） 片子姜黄（一钱半）
加姜、枣煎服。
附子汤
治疗寒痹。
生附子（四钱） 白芍药（二钱） 肉桂（二钱） 白茯苓（二钱） 人参（二钱） 白术（一钱二分） 甘草（一钱）
以上切碎，分为两帖，加生姜三片，大枣二枚，水煎服。
薏苡仁汤
当归（一两） 芍药（炒，一两） 薏苡仁（一两） 麻黄（一两） 肉桂（一两） 甘草（炙，一两） 苍术（米泔水浸，炒，四两）
以上切碎，每次服用七钱，生姜三片，煎服。
若有自汗症状减去麻黄，有热象减去肉桂。
[Verse] Wind, dampness, and cold pathogenic factors mix and invade the human body, entering the meridians to form Bi syndrome (Obstruction Syndrome). When Cold is predominant, pain is severe; when Wind is predominant, pain migrates; when Dampness is predominant, heaviness remains fixed. The pathogen may affect the skin, vessels, muscles, bones, or sinews externally, or internally lodge in the Heart, Liver, Spleen, Kidney, or Lung.
Sinew spasm with insensibility resembles Wind-pathogen disease. The Song Dynasty's *Ju Fang* (Formulary of the Imperial Medical Bureau) treated such Wind-Bi indiscriminately. Because the etiology remained unclear for a long time, modern renowned physicians began to differentiate it. *Huangdi Neijing* (The Yellow Emperor's Inner Canon) details Wind-Bi separately, and the causes of various Bis are described by Chen (referring to Chen Wuyue).
[Dissertation] *Huangdi Neijing* states: "When Wind, Dampness, and Cold three qi mix and invade, Bi syndrome is formed." When Wind is predominant, it is called Xing-Bi (Migratory Bi); when Cold is predominant, it is called Tong-Bi (Painful Bi); when Dampness is predominant, it is called Zhuo-Bi (Fixed Bi).
It further states: Contracting these pathogens 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). If not cured over time, the pathogen moves inward to the corresponding Zang-Fu organs. Thus, if Bone Bi persists and the patient contracts evil again, it lodges in the Kidney. If Sinew Bi persists and the patient contracts evil again, it lodges in the Liver. If Vessel Bi persists and the patient contracts evil again, it lodges in the Heart. If Muscle Bi persists and the patient contracts evil again, it lodges in the Spleen. If Skin Bi persists and the patient contracts evil again, it lodges in the Lung. This is what is meant by Bi syndrome: contracting Wind, Cold, and Dampness repeatedly at their respective seasons.
It also states: Dyspnea indicates Bi accumulation in the Lung. Melancholy and worry indicate Bi accumulation in the Heart. Enuresis indicates Bi accumulation in the Kidney. Thirst and fatigue indicate Bi accumulation in the Liver. Muscle atrophy and anorexia indicate Bi accumulation in the Spleen. Therefore, cases dominated by Wind are easy to cure; those lingering between sinews and bones have a prolonged course; those remaining in the skin are easy to cure; those entering the Zang-Fu organs result in death. From this, one can discern the depth of the pathological invasion. However, each of the Five Zang Bis has distinct manifestations and varying depths of involvement. A skilled practitioner examines the cause, differentiates the symptoms, and truly understands whether the pathogen is in the skin, vessels, sinews, bones, or Zang-Fu, treating accordingly to avoid dangerous and chronic conditions. Treating all cases uniformly as Wind-disease using acrid-warm and drying herbs is erroneous!
[Pulse Diagnosis] Wind, Dampness, and Cold combine to form Bi. A pulse that is Floating, Choppy, and Tight indicates the presence of these three pathogens.
Five Bis: Names and Symptoms
Lung Bi manifests as irritability, fullness, dyspnea, and vomiting. Heart Bi manifests as blocked vessels; upon irritation, palpitations like drumbeats occur, accompanied by rebellious Qi, dry throat, vomiting, frequent belching, and fear when rebellious Qi ascends. Liver Bi manifests as fright during sleep, excessive thirst, frequent urination, and a pulling sensation in the upper body resembling pregnancy. Kidney Bi manifests as distension, inability to stand upright properly (using buttocks instead of heels), and severe kyphosis (spine replacing the head). Spleen Bi manifests as limb lethargy, coughing with salivation, and severe upper jiao obstruction. It is primarily treated with Wu Bi Tang (Five Bi Decoction). (Formula see Wind-Bi below.)
Wind Bi
A pulse that is Floating and slightly weak at both Chi and Cun positions, accompanied by bodily insensibility, blood-Qi stagnation, and spasms of the hands and feet, indicates Wind Bi, treated with Fangfeng Tang (Saposhnikovia Decoction). When Wind, Cold, and Dampness lodge in the Spleen meridian causing weakness of the limbs, stubborn numbness, and insensibility, treat with San Bi Tang (Three Bi Decoction) or Wu Bi Tang (Five Bi Decoction).
Fangfeng Tang (Saposhnikovia Decoction)
Treats Wind Bi and Blood Bi.
Fangfeng (Radix Saposhnikoviae, 1.5 qian) Danggui (Radix Angelicae Sinensis, 1 qian) Chifuling (Poria with Red Core, 0.8 qian) Qinjiao (Rhizoma Gentianae Macrophyllae, 0.8 qian) Chishao Yao (Radix Paeoniae Rubra, 0.8 qian) Huangqin (Radix Scutellariae, 0.8 qian) Duohuo (Radix Angelicae Pubescentis, 0.8 qian) Guixin (Cortex Cinnamomi, 0.5 qian) Xingren (Semen Armeniacae Amarum, 14 grains) Gancao (Radix Glycyrrhizae, 0.5 qian)
Decoct with ginger water and take orally.
San Bi Tang (Three Bi Decoction)
Treats Wind, Cold, and Damp Bi.
Chuanxuduan (Radix Dipsaci, 1.5 qian) Duzhong (Cortex Eucommiae, stir-fried with ginger, 1.5 qian) Fangfeng (Radix Saposhnikoviae, de-rhizome, 1.5 qian) Guixin (Cortex Cinnamomi, 1.5 qian) Xixin (Herba Asari, 1.5 qian) Renshen (Radix Ginseng, de-rhizome, 1.5 qian) Bai Fuling (Poria, 1.5 qian) Danggui (Radix Angelicae Sinensis, soaked in wine, 1.5 qian) Gancao (Radix Glycyrrhizae, 1.5 qian) Baishao Yao (Radix Paeoniae Alba, 1.5 qian) Shengdihuang (Radix Rehmanniae Recens, 1 qian) Qinjiao (Rhizoma Gentianae Macrophyllae, de-rhizome, 1 qian) Chuanxiong (Rhizoma Chuanxiong, 1 qian) Duohuo (Radix Angelicae Pubescentis, de-rhizome, 1 qian) Niuxi (Radix Achyranthis Bidentatae, soaked in wine, de-rhizome, 1 qian) Huangqi (Radix Astragali, 1 qian)
Take 7 qian per dose, with 3 slices of ginger and 2 dates, decocted in water.
Wu Bi Tang (Five Bi Decoction)
Treats Five Zang Bis.
Qianghuo (Rhizoma et Radix Notopterygii, de-rhizome, 1 liang) Baizhu (Rhizoma Atractylodis Macrocephalae, 1 liang) Pianzi Jianghuang (Tuber Curcumae Longae, cleaned, 1 liang) Fangji (Radix Stephaniae Tetrandrae, 1 liang) Gancao (Radix Glycyrrhizae, honey-fried, 0.5 liang)
Take 4 qian per dose, with 3 slices of ginger, decocted in water.
Damp Bi
When Dampness is predominant, the pulse is Deep and Slow, with pathogens lingering, causing numbness and spasms of the four limbs, and edema. Treat with Fuling Chuanxiong Tang (Poria and Ligusticum Decoction). For Wind-Damp Bi with swelling and pain in the feet and knees, difficulty walking, and pain in the waist, knees, arms, and thighs, treat with Cangzhu San (Atractylodes Powder). For flowing pain in the hands and feet, numbness, insensibility, and difficulty flexing/extending, treat with Danggui Niangong Tang (Angelica Analgesic Decoction). (Formula see Hongjiaojiao/Charley Horse section.)
Fuling Chuanxiong Tang (Poria and Ligusticum Decoction)
Chifuling (Poria with Red Core, 1 liang) Sangbaipi (Cortex Mori Radicis, 1 liang) Fangfeng (Radix Saposhnikoviae, 0.5 liang) Rougui (Cortex Cinnamomi, 0.5 liang) Mahuang (Herba Ephedrae, de-jointed, 0.5 liang) Chuanxiong (Rhizoma Chuanxiong, 0.5 liang) Shaoyao (Radix Paeoniae, 0.5 liang) Danggui (Radix Angelicae Sinensis, 0.5 liang) Gancao (Radix Glycyrrhizae, 0.5 liang)
Take 5 qian per dose, decocted with ginger and dates.
Cangzhu San (Atractylodes Powder)
Treats Bi caused by Damp-Heat.
Cangzhu (Rhizoma Atractylodis Latifoliae, soaked in rice wash water, 4 liang) Huangbai (Cortex Phellodendri, wine-fried, 4 liang) Hu Jinggu (Os Tibiae Tigris, roasted with butter, 2 liang) Fangfeng (Radix Saposhnikoviae, 1 liang)
Grind into powder. Take 2 qian per dose, mixed with warm water.
Cold Bi
Body pain with irritability, stiffness in the neck and back, heaviness or pain, general difficulty in movement, cold numbness of hands and feet, and heavy, weak waist and legs are treated with Juanbi Tang (Expel Bi Decoction). Tong Bi (Painful Bi) involves spasmodic fatigue of the four limbs, edema, and fixed pain due to excess Cold. Treat with Chuanxiong Fuling Tang (Ligusticum and Poria Decoction). (Formula see Damp Bi above.) Joint pain, skin insensibility, muscle heaviness, and flaccid insensibility of the limbs are treated with Fuzi Tang (Aconite Decoction). Cold-Damp Bi pain is treated with Yiyiren Tang (Coix Seed Decoction).
Juanbi Tang (Expel Bi Decoction)
Treats Cold Bi.
Danggui (Radix Angelicae Sinensis, 1.5 qian) Shaoyao (Radix Paeoniae, 1.5 qian) Huangqi (Radix Astragali, 1.5 qian) Qianghuo (Rhizoma et Radix Notopterygii, 1.5 qian) Gancao (Radix Glycyrrhizae, 1 qian) Pianzi Jianghuang (Tuber Curcumae Longae, 1.5 qian)
Decoct with ginger and dates.
Fuzi Tang (Aconite Decoction)
Treats Cold Bi.
Sheng Fuzi (Radix Aconiti Lateralis Preparata, raw, 4 qian) Baishao Yao (Radix Paeoniae Alba, 2 qian) Rougui (Cortex Cinnamomi, 2 qian) Bai Fuling (Poria, 2 qian) Renshen (Radix Ginseng, 2 qian) Baizhu (Rhizoma Atractylodis Macrocephalae, 1.2 qian) Gancao (Radix Glycyrrhizae, 1 qian)
Cut into pieces, divide into two doses. Decoct with 3 slices of ginger and 2 dates.
Yiyiren Tang (Coix Seed Decoction)
Danggui (Radix Angelicae Sinensis, 1 liang) Shaoyao (Radix Paeoniae, stir-fried, 1 liang) Yiyiren (Semen Coicis, 1 liang) Mahuang (Herba Ephedrae, 1 liang) Rougui (Cortex Cinnamomi, 1 liang) Gancao (Radix Glycyrrhizae, honey-fried, 1 liang) Cangzhu (Rhizoma Atractylodis Latifoliae, soaked in rice wash water, stir-fried, 4 liang)
Cut into pieces. Take 7 qian per dose, decocted with 3 slices of fresh ginger.
If spontaneous sweating occurs, reduce Mahuang. If heat signs are present, reduce Rougui.