痹之为病，《内经》详矣，前人所论，多不出行痹、痛痹、着痹三证。历节是痹之类，既有专门。麻木
亦即痹，明人析而立门谬矣。许叔重曰∶痹，湿病也。岂以三气中湿最为患乎。
名义 痹者闭也，五脏六腑感于邪气，乱于真气，闭而不仁，故曰痹。（《中藏》）
夫所谓不仁者，或周身，或四肢，唧唧然麻木不知痛痒，如绳扎缚初解之状，古方名为麻痹者
是也。（《正传》）
麻木，不仁之疾也。但麻为木之微，木为麻之甚耳。（《统旨》）
源候总说 痹者，风寒暑湿之气中于人脏腑之为也。入腑则病浅易治，入脏则病深难治。而有风痹，
有寒痹，有湿痹，有热痹，有气痹，而又有筋、骨、血、肉、气之五痹也。大凡风寒暑湿之邪，入于肝则名筋
痹，入于肾则名骨痹，入于心则名血痹，入于脾则名肉痹，入于肺则名气痹，感病则同，其治乃异云云。病或
痛或痒，或淋或急，或缓而不能收持，或拳而不能舒张，或行立艰难，或言语謇涩，或半身不遂，或四肢拳
缩，或口眼偏邪，或手足欹侧，或能行步而不能言语，或能言语而不能行步，或左偏枯，或右壅滞，或
上不通于下，或下不通于上，或大腑闭塞（一作小便秘涩），
或左右手疼痛，或得疾而即死，或感邪而未亡，或喘满而不
寐，或昏冒而不醒，种种诸证皆出于痹也。痹者，风寒暑湿之气中于人，则使之然也。其于脉候形证治疗
之法，亦各不同焉。（《中藏》）（按∶此所论病甚似中风，更有气血肉筋骨五证详说，又与《痹论》异趣，
故今存此条，余不具录。）
风寒湿三气所以杂至，合而为痹，浅则客于肌肤，深则留于骨髓，阳多者行流散徒而靡常，阴多者凝泣滞
碍而有着，虽异状殊态，然即三气以求之，则所谓痹者可得而察矣。且痹害于身，其为疾也，初若无足治，至
其蔓而难图，则偏废弗举，四体不随，皆自诒伊芳戚者也，可不慎哉。（《圣济》）
痹虽有五，感只有三，须明上下冷热虚实。此患多因中气不足，卫护之气不严，使风寒湿三气侵入荣卫
肌肉筋骨之间。痹者闭也，闭塞不通之貌。宛如布帛粘于肌肉之上，筋骨不融之兆。然风湿多侵乎上，而肩
背麻木，手腕疼重；寒湿多侵乎下，脚腿木重；若上下俱得（得字疑侵），故身如
板侠，脚如石坠，久则肌肉不仁，当审其脉冷热虚实。（《心统》）
大凡痹气惟营气受之，营气行经络血脉之中故也。卫气性悍，另行脉外，故不受病。大抵病凡属外感者，
只有风寒湿三气，人易受而易成病；血脉感此三邪，亦容易稽留而为病。所受不定，或一或二或三亦不拘者，
若一则轻，若二则重，若三遍身皆病则深矣。以脉症详其孰胜孰少，孰有孰无而治之。（《百问》）
脉候 风痹、湿痹、周痹、筋痹、脉痹、肌痹、皮痹、
骨痹、胞痹，各有证候，形如风状，得脉别也。脉微涩，其证身体不仁。（《千金》）
诊其脉大涩者为痹，脉来急者为痹，脉涩而紧者为痹也。（《圣惠》）
风寒湿气，合而为痹。浮涩而紧，三脉乃称。（《四言举要》）
寸口脉浮濡，属气虚，麻在上体。尺浮而濡，麻在下体。
脉涩而芤，属死血，为麻木，不知痛痒。（《医统》）
行痹痛痹着痹（轻重寒热） 夫痹之为状，麻木不仁，以风湿寒三气合而成之。故《内经》曰风气
胜者为行痹，风则阳受之，故其痹行，旦剧而夜静，世俗莫知。反呼为走注疼痛虎咬之疾。寒气胜者为痛痹，
寒则阴受之，故其痹痛，旦静而夜剧，世俗不知，反呼为鬼忤。湿气胜者为着痹，湿胜则筋脉皮肉受之，故其
痹着而不去，肌肉削而着骨，世俗不知，反呼为偏枯。此病之作，多在四时阴雨之时，及三月九月太阳寒水用
事之月，故草枯水寒为甚。或濒水之地，劳力之人，辛苦失度，触冒风雨，寝处津湿，痹从外入。况五
方土地，寒暑殊气，刚柔异禀，食饮起居莫不相戾。故所受之邪各有浅深，或痛或不痛，或仁或不仁，或筋
屈而不能伸，或引而不缩，寒则虫行，热则纵缓，不相乱也。（《事亲》）
风痹一证，即今人所谓痛风也，盖痹者闭也，以血气为邪所闭，不得通行而病也。如《痹论》曰风气胜者
为行痹，盖风者善行数变，故其为痹，则走注历节，无非定所，是为行痹，此阳邪也。曰寒气胜者为痛痹，以
血气受寒，则凝而留聚，聚则为痛，是为痛痹，此阴邪也。曰湿气胜者为着痹，以血气受湿则濡滞，濡滞则肢
体沉重，而疼痛顽木，留着不移，是为着痹，亦阴邪也。凡此三者，即痹之大则也。此外如五脏六
腑之痹，则虽以饮食居处皆能致之，然必重感于邪而内连脏气，则合而为痹矣。若欲辨其轻重，则在皮肤
者轻，在筋骨者甚，在脏腑者更甚。若欲辨其寒热，则多热者方是阳证，
无热者便是阴证。然痹本阴邪，故惟寒者多而热者少，此则不
可不察。（《景岳》）
行痹者。行而不定也。今称为走注疼痛及历节风之类是也。痛痹者。疼痛苦楚。世称为痛风及白虎飞尸
之类是也。着痹者。着而不移。世称为麻木不仁。必着而不移。则河间所谓气之道路着而麻者得矣。或
痛着一处。始终不移者是也。（赤水）
行痹者，痛处行而不定，走注历节疼痛之类，当散风为主，御风利气仍不可废，更须参以补血之剂，
盖治风先治血，血行风自灭也。痛痹者，寒气凝结，阳气不行，故痛有定处，俗名痛风是也，治当散寒为主，
疏风燥湿仍不可缺，更参以补火之剂，非大辛大温，不能释其凝寒之害也。着痹者，肢体重着不移，疼痛麻木
是也，盖气虚则麻，血虚则木，治当利湿为主，祛风解寒亦不可缺，更须参以理脾补气之剂，盖土强自能胜
湿，而气旺自无顽麻也。（按∶三痹治法全取《必读》。）骨痹者，即寒痹、痛痹也，其证痛苦攻心，四肢
挛急，关节浮肿。筋痹者。即风痹、行痹也，其证游行不定，与血气相搏，聚于关节，筋脉弛纵，或赤或肿。
脉痹者，即热痹也，脏腑移热，复遇外邪客搏经络，留而不行，其证肌肉热极，皮肤如鼠走，唇口反裂，皮肤
色变。肌痹者，即着痹、湿痹也，留而不移，汗出，四肢痿弱，皮肤麻木不仁，精神昏塞。皮痹者，即寒
痹也，邪在皮毛，瘾疹风疮，搔之不痛，初起皮中如虫行状。以上诸证，又以所遇之时而命名，
非行痹、痛痹、着痹外。又有皮、脉、筋、肌、骨之痹也。（《医通》）
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，故痛如虎
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
微甚之别也）。（《医碥》）
风痹者，游行上下，随其虚邪与血气相搏，聚于关节，筋脉弛纵而不收也。寒痹者，四肢挛痛，关
节浮肿也。湿痹者，留而不移，汗多，四肢缓弱，皮肤不仁，精神昏塞。热痹者，脏腑移热，复遇外邪客搏经
络，留而不行，阳遭其阴，故 痹 然而闷，肌肉热极，体上如鼠走之状，唇口反裂，
皮肤色变也。三气合而为痹，则皮肤顽浓，或肌肉酸痛，此为邪中周身，搏于血脉，积年不已，则成瘾疹
风疮，搔之不痛，头发脱落也。（《统旨》）（按∶以上诸说，大意相似，然稍有异同，仍并录之。）
风湿痹 风湿痹病之状，或皮肤顽浓，或肌肉酸痛，风寒湿三气杂至，合而成痹，其风湿气多
而寒气少者，为风湿痹也。由血气虚，则受风湿而成此病，久不瘥，入于经络，搏
于阳经，亦变令身体手足不随。（《病源论》）
风湿之气客在肌肤，初始为痹；若伤诸阳之经，阳气行则迟缓，而机关弛纵，筋脉不收
摄，故风湿痹而复身体手足不随也。（同上）
风痹 痹者，风寒湿三气杂至，合而成痹，其状肌肉顽浓或疼痛，由人体虚，腠理开，故受风
邪也。病在阳曰风，在阴曰痹，阴阳俱病曰风痹。（《病源》）（按∶又有风痹手
足不随候，大抵与风湿痹相似。）
夫风顽麻者，由荣气虚，卫气实，风寒入于肌肉之间，使血气不能流通，其状，搔
之皮肤下似隔衣是也。诊其寸口脉缓，则皮肤不仁，脉数者生，牢急者死。（《圣惠》）
血痹 血痹者，由体虚邪入于阴经故也。血为阴，邪入于血而痹，故为血痹也。其状，形体如被微
风所吹。此由忧乐之人，骨弱肌肤盛，因疲劳汗出，卧不时动摇，肤腠开，为风邪所侵也。（《病源论》）
《寿夭刚柔篇》云。病在阳者名曰风，病在阴者名曰痹，阴阳俱病名曰风痹。风痹云者，以阳邪而入于
阴之谓也。故虽驱散风邪，又必兼以行血之剂。又有血痹者，以血虚而风中之，亦阳邪入阴之所致也。盖即风
痹之症，而自风言之则为风痹，就血言之则为血痹矣。若其他风病而未入于阴者，则固不得谓之痹症矣。
（《金匮翼》）（按∶经于血痹条，既云如风痹状，则其自有别明矣。先君子曰∶据《巢源》，
风痹乃顽麻疼痛兼有，而血痹则唯顽麻而无疼痛，岂可混同乎，盖尤氏说欠当，姑存之。）
支饮为痹（湿痰死血） 外有支饮，亦令人痹。（《济生》）（按∶原有茯苓汤，治支饮，
手足麻痹，多睡眩冒。其方系二陈加枳、桔。）
手足麻者，属气虚。手足木者，有湿痰死血。十指麻木，是胃中有湿痰死血。（《丹溪》）
抑郁成痹 有一种别无外感，亦无内伤，只因情志抑郁而成痹者，余治疗
数人皆得奇效，此书中所未载也。（《百问》）
痹痿之别 痹痿厥三证，皆起于元精之内虚，而成于风湿寒热之外袭。自肌肉入而伤之浅者，则
为痹痿。风湿挟寒而袭者，则结滞而为痹，其证多痛，甚者或顽而无知，治之当以燥湿及辛热发散之药。风
湿挟热而袭者，则浸灌蒸郁而为痿，其证不痛，但筋骨不用，甚者亦顽而无知，治之亦当
以燥湿及酸寒收引之药。世医不知其真，乃谓痹为外感，痿
为内伤，误矣。（《医学管见》）
痿与痹二症天渊不同，痿本虚症，有补无泻，虽久痿于床褥，其形色绝无病状，惟有软弱无力，起居
日废，行步艰难，并未有痛楚者也。若痹症为不足中之有余，有余者因风寒湿三气合而为痹，有泻无补，形
神色脉皆枯，必为麻木疼痛，行动艰难者也。故痹病在表，本风寒湿之外感，受病在经络血脉之中，气血闭
涩之故。痿症在里，属精神气血不足，受病在五脏六腑之中，由不能充周之故，所以治法亦别也。（《百问》）
痿痹相似而不同，痹为外感，痿属内伤；痹虽有内伤而外感多，痿非无外感而内伤甚。（《素问释义》）
腹皮麻痹 如腹皮麻顽也，凡人夏月洗浴后，往往露腹当风，其腠理开，邪因入皮毛，适与卫气
相值，因搏击而为麻顽不仁，宜多煮葱白食之自愈。（《尊生书》）（按∶《本
草纲目》引《危氏方》云∶腹皮麻痹不仁者，多煮葱白吃之自愈。盖此所本。）
恶证 其卧床不能行动，久泻不食者，难治。（《心统》）
着痹不移， 肉破，身热脉涩者，不治。（《医通》）
治例 痹证之风胜者，治当从散，宜败毒散、乌药顺气散之类主之。若以风胜而兼微火者，宜
大秦艽汤或九味羌活汤之类主之。痹证之寒胜者，但察其表里俱无热证，即当从温治之，宜五积散或
小续命汤、甘草附子汤之类主之。若寒甚气虚者，宜《三因》附子汤之类主之。痹证之湿胜者，其
体必重，或多寒，或多痰，或多汗，皆脾弱阴寒证也。若羌活胜湿汤，乃兼风散湿之剂也；五积散，乃温
经散湿之剂也；真武汤，乃温中除湿之剂也；《三因》附子汤，乃补脾燥湿之剂
也，调气平胃散（系平胃散对匀气散），乃行气行湿之剂也；
五苓散，乃利水导湿之剂也；二陈汤、六君子汤，乃化痰去湿之剂也。大抵治湿者欲其燥，欲燥者宜从暖，盖
脾土喜燥而恶湿，喜暖而恶寒，故温脾即所以治湿也。然又有湿热之为病者，必见内热之证，滑数之脉，方可
治以清凉，宜二妙散（用黄柏、苍术）及加味二妙丸（上方加归尾、牛膝、萆 、防己、龟板）、当归拈痛
汤（见香港脚）之类主之。其有热甚者，如抽薪饮（用苓、柏、斛、栀、木通、泽泻、枳壳、
甘草）之类亦可暂用，先清其火而后调其气血。（《景岳》）
痹症之实者，宜五积散。黄 五物汤，为痹症属虚者之总方。（《时方妙用》）
麻木，脉微弱，或弦大无力，病久体羸者，属气虚，补中益气汤加熟附子一片，夏月对生脉散或清燥
汤。（《医通》）（按∶《中暑》门，人参益气汤，宜并考。）
痹，忌下、收敛、酸寒、苦寒、咸寒，宜辛散、行气、燥湿、甘温、淡渗。（《本草经疏》）
治分四端 若邪在肌肉之时，或针、或汗、或灸俱易成功，不然，至人筋骨之际，必不易治，患者
痹病这种疾病，《黄帝内经》中已有详细论述，前人的讨论大多没有超出行痹、痛痹、着痹这三种证型。历节病（关节剧烈疼痛且变形）属于痹病的范畴，但已有专门的论述。麻木也是痹病的一种表现，明代医家将其单独列为一门是错误的。许慎说：“痹，就是湿病。”难道是因为风、寒、湿三气中，湿气致病最为严重吗？
名义：所谓“痹”，就是闭塞的意思。五脏六腑感受邪气，导致真气紊乱，气血闭塞而失去知觉，所以称为痹。（出自《中藏经》）
所谓“不仁”，有时是全身，有时是四肢，感觉唧唧作响般的麻木，不知道痛痒，就像绳子刚解开时的状态，古代方书称之为“麻痹”的，就是这个意思。（出自《医学正传》）
麻木，是不仁的疾病。只是麻是木的轻微表现，木是麻的严重表现罢了。（出自《医宗统旨》）
源候总说：痹病，是风、寒、暑、湿之气侵入人体脏腑所致。邪气入腑，病情浅表容易治疗；邪气入脏，病情深重难以治疗。其中有风痹、寒痹、湿痹、热痹、气痹，还有筋痹、骨痹、血痹、肉痹、气痹这五体之痹。大凡风、寒、暑、湿邪气，侵入肝脏则称为筋痹，侵入肾脏则称为骨痹，侵入心脏则称为血痹，侵入脾脏则称为肉痹，侵入肺脏则称为气痹，感邪致病的原因相同，但治疗方法却不同等等。病症或痛或痒，或淋沥不畅或拘急，或松弛无法持握，或拳曲无法伸展，或行走站立困难，或言语蹇涩，或半身不遂，或四肢蜷缩，或口眼歪斜，或手足倾斜，或能行走但不能说话，或能说话但不能行走，或左侧偏枯，或右侧壅滞，或上不通下，或下不通上，或大肠闭塞（一说小便涩滞），或左右手疼痛，或患病即死，或感邪而未亡，或喘满不能入睡，或昏沉不醒，种种症状都源于痹病。痹病，是风、寒、暑、湿之气侵入人体，才导致这样的结果。至于脉象、体征和治疗法则，也各不相同。（出自《中藏经》）（按语：此处所论病症很像中风，又有气血肉筋骨五证的详细说明，又与《素问·痹论》意趣不同，故今保留此条，其余不录。）
风、寒、湿三气混杂而至，合而为痹。病位浅则客居肌肤，病位深则留滞骨髓。阳气多者，病势流动散漫而无常态；阴气多者，病势凝滞阻碍而有定处。虽然症状千差万别，但只要从这三气去探究，所谓的痹病就可以察明了。况且痹病危害身体，起初似乎不值得治疗，等到蔓延难治时，就会半身不遂、四肢不听使唤，这都是自己招致的忧患，能不谨慎吗？（出自《圣济总录》）
痹病虽然有五种分类，但感邪只有三种（风、寒、湿），必须辨明上下、冷热、虚实。这种病患多因中气不足，卫外之气不固，致使风、寒、湿三气侵入营卫、肌肉、筋骨之间。痹，就是闭塞，指闭塞不通的样子。就像布帛粘在肌肉上，筋骨不能融通的征兆。然而风湿多侵袭上部，导致肩背麻木，手腕疼痛沉重；寒湿多侵袭下部，导致腿脚麻木沉重；如果上下都受侵（“得”字疑为“侵”字之误），则身体像夹在板子里一样僵硬，脚像坠着石头一样沉重，时间久了肌肉失去知觉，应当审察脉象的冷、热、虚、实。（出自《医学心统》）
大凡痹气只由营气承受，因为营气运行在经络血脉之中。卫气性质剽悍，另行于脉外，所以不受病邪侵害。大致来说，凡是外感病，只有风、寒、湿三气，人容易受邪也容易发病；血脉感受这三邪，也容易稽留而致病。受邪不一定固定，或单一、或两种、或三种也不拘泥，若一种邪气致病则轻，两种则重，三种邪气遍身皆病则深了。通过脉症详细辨别哪种邪气胜、哪种少，有还是没有，然后进行治疗。（出自《世医得效方·百问》）
脉候：风痹、湿痹、周痹、筋痹、脉痹、肌痹、皮痹、骨痹、胞痹，各有证候，形态如风状，通过脉象来区别。脉象微涩，其证表现为身体不仁。（出自《千金要方》）
诊察脉象大而涩的是痹病，脉来急促的是痹病，脉涩而紧的是痹病。（出自《太平圣惠方》）
风、寒、湿邪气，合而为痹。浮、涩、紧三脉与之相称。（出自《四言举要》）
寸口脉浮濡，属于气虚，麻木出现在上半身。尺脉浮而濡，麻木出现在下半身。脉涩而芤，属于死血（瘀血），表现为麻木，不知痛痒。（出自《医统正脉全书》）
行痹、痛痹、着痹（轻重寒热）：痹病的状貌，是麻木不仁，由风、湿、寒三气合而成。所以《黄帝内经》说：风气胜者为行痹，风邪属阳，所以其痹痛游走不定，早晨重晚上轻，世人不知道，反而称之为走注疼痛如虎咬的疾病。寒气胜者为痛痹，寒邪属阴，所以其痹痛有定处，早晨轻晚上重，世人不知道，反而称之为鬼忤。湿气胜者为着痹，湿邪胜则筋脉皮肉受之，所以其痹痛附着不去，肌肉消瘦而紧贴骨头，世人不知道，反而称之为偏枯。这种病的发生，多在四季阴雨之时，以及三月、九月太阳寒水主令的月份，所以草木枯萎、水寒之时尤为严重。或者在水边之地，劳力之人，辛苦失度，触犯风雨，睡卧潮湿之处，痹邪从外而入。何况五方土地，寒暑气候不同，禀赋刚柔各异，饮食起居无不相违背。所以所受邪气各有深浅，或痛或不痛，或麻木或不麻木，或筋屈而不能伸，或牵引而不收缩，遇寒则如虫行，遇热则纵缓，互不混淆。（出自《医学入门·事亲》）
风痹一证，就是今人所说的痛风。大概“痹”就是闭塞，因血气被邪气闭塞，不得通行而生病。如《素问·痹论》说：风气胜者为行痹，盖因风性善行数变，所以其为痹，则走注历节，没有固定位置，这就是行痹，这是阳邪。说寒气胜者为痛痹，因血气受寒，则凝结而留聚，聚则为痛，这就是痛痹，这是阴邪。说湿气胜者为着痹，因血气受湿则濡滞，濡滞则肢体沉重，而疼痛顽木，留着不移，这就是着痹，也是阴邪。以上三者，就是痹病的大原则。此外如五脏六腑之痹，虽然饮食居处都能导致，但必须再次感邪并内连脏气，才会合而为痹。若想辨别轻重，在皮肤者轻，在筋骨者重，在脏腑者更重。若想辨别寒热，多热的才是阳证，无热的便是阴证。然而痹本属阴邪，所以寒的多而热的少，这一点不可不察。（出自《景岳全书》）
行痹，是指疼痛游走不定。现在称为走注疼痛及历节风之类的疾病。痛痹，是指疼痛苦楚。世人称为痛风及白虎飞尸之类的疾病。着痹，是指附着不移。世人称为麻木不仁。必定附着不移，这就是河间所说的气之道路阻塞而麻木，或者痛着一处始终不移的情况。（出自《赤水玄珠》）
行痹，痛处行走不定，走注历节疼痛之类，治疗当以祛风为主，御风利气也不可废弃，还必须参用补血药剂，因为治风先治血，血行风自灭。痛痹，是寒气凝结，阳气不行，所以痛有定处，俗名痛风，治疗当以散寒为主，疏风燥湿仍不可缺，更要参用补火药剂，非大辛大温之药，不能解除其凝寒的危害。着痹，肢体重着不移，疼痛麻木，这是因为气虚则麻，血虚则木，治疗当以利湿为主，祛风解寒也不可缺，还必须参用理脾补气药剂，因为土强自能胜湿，气旺自然没有顽固麻木。（按语：三痹治法完全取自《必读》）。骨痹，就是寒痹、痛痹，其证痛苦攻心，四肢挛急，关节浮肿。筋痹，就是风痹、行痹，其证游行不定，与血气相搏，聚于关节，筋脉弛纵，或红或肿。脉痹，就是热痹，脏腑移热，又遇外邪客搏经络，留而不行，其证肌肉热极，皮肤如鼠走，唇口反裂，皮肤色变。肌痹，就是着痹、湿痹，留而不移，汗出，四肢痿弱，皮肤麻木不仁，精神昏塞。皮痹，就是寒痹，邪在皮毛，瘾疹风疮，搔之不痛，初起皮中如虫行状。以上诸证，又以所遇之时而命名，除了行痹、痛痹、着痹之外，还有皮、脉、筋、肌、骨之痹。（出自《医学心悟·医通》）
风气胜者为行痹（风性善行动，嘘其寒湿走注不定，所以痹痛也走而不定），寒气胜者为痛痹（血气痹滞无不痛，而寒之痛为甚，因为寒则凝，其滞而不通，比风湿尤甚，所以痛如虎咬，世人呼为白虎风），湿气胜者为着痹（不如风胜者之流走，只是附着不移，也不如寒胜者之痛甚，只是略痛，或仅麻木不仁，因为湿如水而寒如冰，腠理的松滑与紧涩有异，则气血之行，其为阻滞冲击者，固有微甚之别）。（出自《医碥》）
风痹，游行上下，随其虚邪与血气相搏，聚于关节，筋脉弛纵而不收。寒痹，四肢挛痛，关节浮肿。湿痹，留而不移，汗多，四肢缓弱，皮肤不仁，精神昏塞。热痹，脏腑移热，又遇外邪客搏经络，留而不行，阳遭其阴，所以痹然而闷，肌肉热极，体上如鼠走之状，唇口反裂，皮肤色变。三气合而为痹，则皮肤顽厚，或肌肉酸痛，此为邪中周身，搏于血脉，积年不已，则成瘾疹风疮，搔之不痛，头发脱落。（出自《医宗统旨》）（按语：以上诸说，大意相似，但稍有异同，仍一并记录。）
风湿痹：风湿痹病的状貌，或皮肤顽厚，或肌肉酸痛，风寒湿三气杂至，合而成痹，其中风湿气多而寒气少的，称为风湿痹。由于血气虚弱，则受风湿而成此病，久不痊愈，入于经络，搏于阳经，也会变为身体手足不随。（出自《诸病源候论》）
风湿之气客居在肌肤，初始为痹；如果损伤诸阳之经，阳气行则迟缓，而机关弛纵，筋脉不收摄，所以风湿痹而复见身体手足不随。（同上）
风痹：痹病，是风、寒、湿三气杂至，合而成痹，其状肌肉顽厚或疼痛，由于人体虚弱，腠理开泄，所以受风邪。病在阳曰风，在阴曰痹，阴阳俱病曰风痹。（出自《诸病源候论》）（按语：又有风痹手足不随候，大体与风湿痹相似。）
夫风顽麻，是由于营气虚，卫气实，风寒入于肌肉之间，使血气不能流通，其状，搔之皮肤下似隔衣是也。诊察寸口脉缓，则皮肤不仁，脉数者生，牢急者死。（出自《太平圣惠方》）
血痹：血痹，是由于体虚邪入于阴经所致。血为阴，邪入于血而痹，所以称为血痹。其状，形体如被微风吹拂。这是由于忧乐之人，骨弱肌肤盛，因疲劳汗出，卧不时动摇，肤腠开，为风邪所侵。（出自《诸病源候论》）
《灵枢·寿夭刚柔篇》说：病在阳者名曰风，病在阴者名曰痹，阴阳俱病名曰风痹。所谓风痹，是指阳邪而入于阴。所以即使驱散风邪，又必须兼用行血药剂。又有血痹，是因血虚而风中之，也是阳邪入阴所致。大概就是风痹的症状，从风的角度讲叫风痹，从血的角度讲叫血痹。如果其他风病而未入于阴的，则固然不能称为痹症。（出自《金匮翼》）（按语：经文在血痹条中，既然说如风痹状，则其自有区别。先父说：据《巢氏病源》，风痹乃顽麻疼痛兼有，而血痹则唯顽麻而无疼痛，岂可混同呢？盖尤氏之说欠妥当，姑且存之。）
支饮为痹（湿痰死血）：外有支饮，也令人患痹病。（出自《济生方》）（按语：原有茯苓汤，治支饮，手足麻痹，多睡眩冒。其方系二陈汤加枳壳、桔梗。）
手足麻，属于气虚。手足木，有湿痰死血。十指麻木，是胃中有湿痰死血。（出自《丹溪心法》）
抑郁成痹：有一种别无外感，亦无内伤，只因情志抑郁而成痹者，我治疗数人都得奇效，此书中未记载。（出自《世医得效方·百问》）
痹痿之别：痹、痿、厥三证，都起于元精之内虚，而成于风湿寒热之外袭。自肌肉入而伤之浅者，则为痹痿。风湿挟寒而袭者，则结滞而为痹，其证多痛，甚者或顽而无知，治疗当以燥湿及辛热发散之药。风湿挟热而袭者，则浸灌蒸郁而为痿，其证不痛，但筋骨不用，甚者亦顽而无知，治疗也当以燥湿及酸寒收引之药。世医不知其真，乃谓痹为外感，痿为内伤，这是错误的。（出自《医学管见》）
痿与痹两症天渊不同，痿本是虚症，有补无泻，虽久痿于床褥，其形色绝无病状，惟有软弱无力，起居日废，行步艰难，并未有痛楚者也。若痹症为不足中之有余，有余者因风寒湿三气合而为痹，有泻无补，形神色脉皆枯，必为麻木疼痛，行动艰难者也。故痹病在表，本风寒湿之外感，受病在经络血脉之中，气血闭涩之故。痿症在里，属精神气血不足，受病在五脏六腑之中，由不能充周之故，所以治法亦别也。（出自《世医得效方·百问》）
痿痹相似而不同，痹为外感，痿属内伤；痹虽有内伤而外感多，痿非无外感而内伤甚。（出自《素问释义》）
腹皮麻痹：如腹皮麻顽也，凡人夏月洗浴后，往往露腹当风，其腠理开，邪因入皮毛，适与卫气相值，因搏击而为麻顽不仁，宜多煮葱白食之自愈。（出自《尊生书》）（按语：《本草纲目》引《危氏方》云：腹皮麻痹不仁者，多煮葱白吃之自愈。盖此所本。）
恶证：其卧床不能行动，久泻不食者，难治。（出自《医学心统》）
着痹不移，肉破，身热脉涩者，不治。（出自《医学心悟·医通》）
治例：痹证之风胜者，治当从散，宜败毒散、乌药顺气散之类主之。若以风胜而兼微火者，宜大秦艽汤或九味羌活汤之类主之。痹证之寒胜者，但察其表里俱无热证，即当从温治之，宜五积散或小续命汤、甘草附子汤之类主之。若寒甚气虚者，宜《三因方》附子汤之类主之。痹证之湿胜者，其体必重，或多寒，或多痰，或多汗，皆脾弱阴寒证也。若羌活胜湿汤，乃兼风散湿之剂也；五积散，乃温经散湿之剂也；真武汤，乃温中除湿之剂也；《三因方》附子汤，乃补脾燥湿之剂也；调气平胃散（系平胃散对匀气散），乃行气行湿之剂也；五苓散，乃利水导湿之剂也；二陈汤、六君子汤，乃化痰去湿之剂也。大抵治湿者欲其燥，欲燥者宜从暖，盖脾土喜燥而恶湿，喜暖而恶寒，故温脾即所以治湿也。然又有湿热之为病者，必见内热之证，滑数之脉，方可治以清凉，宜二妙散（用黄柏、苍术）及加味二妙丸（上方加归尾、牛膝、萆薢、防己、龟板）、当归拈痛汤（见香港脚）之类主之。其有热甚者，如抽薪饮（用茯苓、黄柏、石斛、栀子、木通、泽泻、枳壳、甘草）之类亦可暂用，先清其火而后调其气血。（出自《景岳全书》）
痹症之实者，宜五积散。黄芪桂枝五物汤，为痹症属虚者之总方。（出自《时方妙用》）
麻木，脉微弱，或弦大无力，病久体羸者，属气虚，补中益气汤加熟附子一片，夏月对生脉散或清燥汤。（出自《医学心悟·医通》）（按语：《中暑》门，人参益气汤，宜并考。）
痹，忌下法、收敛、酸寒、苦寒、咸寒，宜辛散、行气、燥湿、甘温、淡渗。（出自《本草经疏》）
治分四端：若邪在肌肉之时，或针、或汗、或灸俱易成功，不然，至人筋骨之际，必不易治，患者
Bi Syndrome (Obstruction Syndrome) is a disease extensively detailed in the *Huangdi Neijing* (Yellow Emperor's Inner Canon). Previous discussions mostly did not go beyond the three types: Xing Bi (Moving Bi), Tong Bi (Painful Bi), and Zhuo Bi (Fixed Bi). Li Jie (Severe joint pain with deformity) belongs to the category of Bi, but has its own specialized treatises. Numbness (Ma Mu) is also a manifestation of Bi; it was erroneous for Ming dynasty physicians to establish it as a separate category. Xu Shen stated: "Bi refers to dampness disease." Is it because among the pathogenic factors of wind, cold, and dampness, dampness causes the most severe harm?
**Nomenclature**: The term "Bi" means obstruction. When the Zang and Fu organs are affected by pathogenic factors, causing chaos in the True Qi (Zheng Qi), leading to closure and loss of sensation, it is called Bi. (*Zhongzang Jing*)
The so-called "loss of sensation" (Bu Ren) may affect the whole body or just the limbs, feeling like a buzzing numbness where pain and itch are unknown, similar to the sensation after tight ropes are untied. Ancient formulas call this "Ma Bi" (Paralysis/Numbness). (*Yixue Zhengchuan*)
Numbness is a disease of loss of sensation. "Ma" (tingling/numbness) is mild, while "Mu" (wood-like insensibility) is severe. (*Yizong Tongzhi*)
**General Overview of Etiology and Pathogenesis**: Bi syndrome results from the invasion of wind, cold, summer-heat, and dampness into the Zang and Fu organs. Invasion of the Fu organs leads to superficial disease that is easy to treat; invasion of the Zang organs leads to deep disease that is difficult to treat. There are Wind Bi, Cold Bi, Damp Bi, Heat Bi, and Qi Bi, as well as the Five Bi of sinew, bone, blood, flesh, and qi. Generally, when wind, cold, summer-heat, and dampness invade the Liver, it is named Sinew Bi; invading the Kidney, Bone Bi; invading the Heart, Blood Bi; invading the Spleen, Flesh Bi; invading the Lung, Qi Bi. Although the cause of infection is the same, the treatments differ. Symptoms may include pain or itching, strangury or urgency, flaccidity unable to hold objects, or curling unable to extend; difficulty walking or standing; slurred speech; hemiplegia; curling of four limbs; deviation of mouth and eyes; tilting of hands and feet; ability to walk but not speak, or speak but not walk; left-side atrophy; right-side stagnation; upper blockage preventing lower flow, or lower blockage preventing upper flow; constipation of the Large Intestine (or alternatively, difficult urination); pain in either hand; death immediately upon illness; survival despite pathogen invasion; panting and fullness with insomnia; or coma without waking. All these various symptoms originate from Bi syndrome. Bi syndrome occurs when wind, cold, summer-heat, and dampness invade the human body, causing such conditions. The pulse signs, manifestations, and treatment methods vary accordingly. (*Zhongzang Jing*) [Note: The disease discussed here resembles Stroke (Zhong Feng). It also provides detailed explanations of the five syndromes of Qi, Blood, Flesh, Sinew, and Bone, which differs in interest from the *Bi Lun*. Therefore, this section is preserved, and others are omitted.]
When wind, cold, and dampness mix and arrive together, they combine to form Bi. Superficially, they lodge in the skin and muscles; deeply, they remain in the bone marrow. Those with more Yang energy exhibit flowing, scattered, and irregular patterns; those with more Yin energy exhibit coagulated, stagnant, and obstructed patterns with fixed locations. Although the appearances are diverse, investigating these three pathogens allows one to understand Bi. Moreover, Bi harms the body. Initially, it may seem unworthy of treatment, but once it spreads and becomes difficult to manage, it leads to paralysis and limbs that do not obey, all of which are self-inflicted sorrows. Can one not be cautious? (*Shengji Zonglu*)
Although Bi has five classifications, the pathogenic invasions are only three (wind, cold, dampness). One must clarify the levels (upper/lower), temperature (hot/cold), and excess/deficiency. This condition often arises from deficiency of Middle Qi and lack of strict defense by Wei Qi (Defensive Qi), allowing wind, cold, and dampness to invade Ying Qi (Nutritive Qi), Wei Qi, muscles, sinews, bones, and joints. Bi means obstruction, describing a state of blockage. It is like cloth sticking to muscles, indicating that sinews and bones cannot integrate. Wind-dampness often invades the upper body, causing numbness in the shoulders and back, and heavy pain in the wrists; cold-dampness often invades the lower body, causing numbness and heaviness in the legs. If both upper and lower are invaded (the character 'de' is suspected to be a typo for 'qin' invade), the body feels stiff like being clamped in boards, and the feet feel heavy like stones. Over time, muscles lose sensation. One must examine the pulse for cold, heat, deficiency, and excess. (*Yixue Xintong*)
Generally, Bi Qi is borne only by Ying Qi (Nutritive Qi) because Ying Qi circulates within the meridians and blood vessels. Wei Qi (Defensive Qi) is fierce in nature and circulates outside the vessels, so it does not suffer from disease. Basically, external contraction diseases involve only wind, cold, and dampness, which humans easily contract and develop into illness. Blood vessels receiving these three evils also easily retain them and become diseased. The reception is not fixed; it may be one, two, or three pathogens, not strictly limited. If one pathogen, the disease is light; if two, it is heavy; if three cover the whole body, it is deep. Detailed analysis of pulses and symptoms determines which pathogen prevails or is absent, guiding treatment. (*Shiyi Defang*)
**Pulse Signs**: Wind Bi, Damp Bi, Zhou Bi (General Bi), Sinew Bi, Vessel Bi, Muscle Bi, Skin Bi, Bone Bi, and Bladder Bi each have specific signs, resembling wind patterns, distinguished by pulses. A faint and choppy pulse indicates loss of sensation in the body. (*Qianjin Yaofang*)
A large and choppy pulse indicates Bi; a rapid pulse indicates Bi; a choppy and tight pulse indicates Bi. (*Taiping Shenghui Fang*)
Wind, cold, and dampness combine to form Bi. Floating, choppy, and tight pulses correspond to this. (*Siyan Juyao*)
Floating and soft pulse at the Cun (Inch) position indicates Qi deficiency, with numbness in the upper body. Floating and soft pulse at the Chi (Cubit) position indicates numbness in the lower body. Choppy and hollow (Kou) pulse indicates dead blood (stasis), manifesting as numbness and loss of pain/itch sensation. (*Yitong Zhengmai Quanshu*)
**Xing Bi, Tong Bi, Zhuo Bi (Severity, Cold, Heat)**: The appearance of Bi is numbness and loss of sensation, formed by the combination of wind, dampness, and cold. Thus, the *Neijing* states: Excess wind leads to Xing Bi (Moving Bi). Wind is Yang, so the Bi moves, worsening in the morning and quiet at night. People do not know this and mistakenly call it "moving injection pain" or "tiger-bite disease." Excess cold leads to Tong Bi (Painful Bi). Cold is Yin, so the pain is fixed, quiet in the morning and severe at night. People do not know this and mistakenly call it "ghost possession." Excess dampness leads to Zhuo Bi (Fixed Bi). Dampness affects sinews, vessels, skin, and flesh, so the Bi sticks and does not leave, muscles emaciate and adhere to bones. People do not know this and mistakenly call it "hemiplegia." This disease often occurs during rainy seasons of the four seasons, and in the months of March and September when Solar Cold Water governs, making withered grass and cold water particularly severe. Or in waterside areas, laborers who work hard without measure, exposed to wind and rain, sleeping in damp places, allow Bi to enter from outside. Furthermore, the five directions have different climates of cold and heat, and constitutions of rigidity and flexibility differ; diet and daily life often contradict these. Thus, the received pathogens vary in depth, resulting in pain or no pain, numbness or no numbness, sinew flexion inability to extend, or traction without curling. Cold causes crawling sensations; heat causes flaccidity. They do not mix. (*Yixue Rumen*)
Wind Bi is what modern people call Gout (Tong Feng). "Bi" means obstruction; blood and Qi are blocked by pathogens, failing to circulate smoothly, causing disease. As the *Bi Lun* states: Excess wind leads to Xing Bi. Wind is good at moving and changing rapidly, so the Bi moves through joints without fixed location, hence Xing Bi, which is a Yang pathogen. Excess cold leads to Tong Bi. Blood and Qi receive cold, coagulating and gathering; gathering causes pain, hence Tong Bi, which is a Yin pathogen. Excess dampness leads to Zhuo Bi. Blood and Qi receive dampness, becoming moist and stagnant; stagnation causes limb heaviness, painful wood-like insensibility, and fixed location, hence Zhuo Bi, also a Yin pathogen. These three are the general principles of Bi. Additionally, Zang and Fu Bi can be caused by diet and lifestyle, but require secondary pathogen invasion connecting internally to Zang Qi to form Bi. To distinguish severity: superficial in skin is light; in sinews and bones is severe; in Zang and Fu is even more severe. To distinguish cold and heat: much heat indicates Yang syndrome; no heat indicates Yin syndrome. However, Bi is originally a Yin pathogen, so cold is common and heat is rare. This must be observed carefully. (*Jingyue Quanshu*)
Xing Bi means moving without fixation. Now called moving injection pain and Li Jie Feng (Joint Migrating Wind). Tong Bi means painful suffering. World calls it Tong Feng (Gout) and Bai Hu Fei Shi (White Tiger Flying Corpse). Zhuo Bi means fixed without movement. World calls it numbness and loss of sensation. Must be fixed without movement, which is He Jian's description of Qi pathways being blocked leading to numbness, or pain fixed in one place, never moving. (*Chishui Xuanzhu*)
For Xing Bi, where pain moves without fixation, such as moving injection and joint pain, treatment should focus on dispersing wind. Preventing wind and promoting Qi flow should not be abandoned. One must also supplement with blood-nourishing agents, because treating wind requires treating blood first; when blood flows, wind extinguishes itself. For Tong Bi, cold Qi congeals, Yang Qi does not move, so pain is fixed, commonly known as Gout. Treatment should focus on dispersing cold. Dispersing wind and drying dampness is still indispensable. One must also refer to fire-supplementing agents; only great acrid-warm medicines can release the harm of congealed cold. For Zhuo Bi, limbs are heavy and fixed, with pain and numbness. Qi deficiency causes Ma (tingling), Blood deficiency causes Mu (insensibility). Treatment should focus on draining dampness. Dispelling wind and resolving cold is still indispensable. One must also refer to Spleen-regulating and Qi-tonifying agents. Because strong Earth naturally overcomes dampness, and abundant Qi eliminates stubborn numbness. [Note: Treatment of the Three Bis is entirely taken from *Bidu*]. Gu Bi (Bone Bi) is Han Bi (Cold Bi) and Tong Bi. Symptoms: painful attack on the heart, tetany of four limbs, joint swelling. Jin Bi (Sinew Bi) is Feng Bi (Wind Bi) and Xing Bi. Symptoms: wandering without fixation, fighting with blood and Qi, gathering at joints, sinew and vessel flaccidity, redness or swelling. Mai Bi (Vessel Bi) is Re Bi (Heat Bi). Visceral heat transfers, meeting external pathogens attacking meridians, staying and not moving. Symptoms: extreme muscle heat, skin feeling like mice running, cracked lips and mouth, skin color change. Ji Bi (Muscle Bi) is Zhuo Bi (Fixed Bi) and Shi Bi (Damp Bi). Staying without moving, sweating, limb flaccidity, skin numbness and loss of sensation, mental confusion. Pi Bi (Skin Bi) is Han Bi (Cold Bi). Pathogen in skin and hair, urticaria and wind sores, scratching causes no pain, initially skin feels like insects crawling. Above symptoms are also named according to the time encountered. Besides Xing, Tong, and Zhuo Bi, there are also Pi, Mai, Jin, Ji, and Gu Bi. (*Yitong*)
Excess wind leads to Xing Bi (Wind is active, blowing cold and dampness to move不定ly, so Bi pain also moves不定ly). Excess cold leads to Tong Bi (Blood and Qi obstruction causes pain, and cold pain is severe because cold coagulates, causing stagnation and blockage, worse than wind-damp, so pain is like tiger bite, world calls it Bai Hu Feng). Excess dampness leads to Zhuo Bi (Not flowing like wind excess, but fixed without moving; not as painful as cold excess, just slightly painful or only numbness. Damp is like water, cold is like ice; pore looseness/slippage vs tightness/roughness differs, so Qi and Blood flow obstruction impact has differences in degree). (*Yique*)
Feng Bi (Wind Bi): Wandering up and down, following deficient evil fighting with blood and Qi, gathering at joints, sinew and vessel flaccidity and failure to gather. Han Bi (Cold Bi): Tetany and pain of four limbs, joint swelling. Shi Bi (Damp Bi): Fixed without moving, excessive sweating, limb flaccidity, skin numbness, mental confusion. Re Bi (Heat Bi): Visceral heat transfers, meeting external pathogens attacking meridians, staying and not moving. Yang encounters Yin, so Bi feels stifled. Extreme muscle heat, body feels like mice running, cracked lips/mouth, skin color change. Three pathogens combine to form Bi, skin becomes thick and tough, or muscle soreness/pain. This is evil entering the whole body, fighting in blood vessels. Accumulating over years, it becomes urticaria/wind sores, scratching causes no pain, hair falls out. (*Yizong Tongzhi*) [Note: The above theories are similar in main idea but have slight differences; recorded together.]
**Feng Shi Bi (Wind-Damp Bi)**: The appearance of Wind-Damp Bi disease is either thick/tough skin or sore/painful muscles. Wind, cold, and dampness mix and combine to form Bi. Where wind-damp Qi is abundant and cold Qi is scarce, it is called Wind-Damp Bi. Due to deficiency of blood and Qi, one receives wind-damp and forms this disease. If not cured for a long time, it enters meridians, fights in Yang meridians, and can transform into body and limb immobility. (*Zhubing Yuanhou Lun*)
Wind-damp Qi lodges in skin and muscles, initially forming Bi; if damaging Yang meridians, Yang Qi movement becomes slow, joints become flaccid, sinews and vessels fail to gather, so Wind-Damp Bi recurs with body and limb immobility. (Same source)
**Feng Bi (Wind Bi)**: Bi is formed by mixing wind, cold, and dampness. Appearance is thick/tough skin or pain. Due to human body deficiency, pores open, receiving wind evil. Disease in Yang is called Feng, in Yin is called Bi, in both Yin and Yang is called Feng Bi. (*Zhubing Yuanhou Lun*) [Note: There is also a symptom of Feng Bi with limb immobility, largely similar to Wind-Damp Bi.]
Regarding Wind, Stubbornness, and Numbness: Due to deficiency of Ying Qi and excess of Wei Qi, wind and cold enter between muscles, preventing smooth circulation of blood and Qi. Appearance: scratching skin feels like隔着衣 (隔着衣服 -隔着 clothes). Pulse at Cun Kou is slow, then skin is insensitive; pulse is rapid indicates survival, firm and urgent indicates death. (*Taiping Shenghui Fang*)
**Xue Bi (Blood Bi)**: Blood Bi is due to body deficiency allowing evil to enter Yin meridians. Blood is Yin; evil enters blood causing Bi, hence Blood Bi. Appearance: body feels like blown by gentle breeze. This is due to people of worry/joy, weak bones and lush skin, fatigued and sweating, sleeping restlessly, pores open, invaded by wind evil. (*Zhubing Yuanhou Lun*)
The *Shou Yao Gang Rou Pian* says: Disease in Yang is named Feng, disease in Yin is named Bi, disease in both Yin and Yang is named Feng Bi. Feng Bi refers to Yang evil entering Yin. Therefore, even if dispelling wind evil, one must simultaneously use blood-moving agents. There is also Blood Bi, caused by blood deficiency allowing wind to strike, also resulting from Yang evil entering Yin. Essentially, it is the symptom of Feng Bi; speaking from wind, it is Feng Bi; speaking from blood, it is Blood Bi. Other wind diseases that have not entered Yin cannot be called Bi syndrome. (*Jinkui Yi*) [Note: The Classic, in the Blood Bi section, says "like Feng Bi," implying distinct differences. My late father said: According to *Chaoyuan*, Feng Bi includes stubbornness, numbness, and pain, while Blood Bi includes only stubbornness and numbness without pain. How can they be confused? You Shi's theory is inappropriate; preserving it tentatively.]
**Zhi Yin as Bi (Damp Phlegm and Dead Blood)**: External Zhi Yin (Fluid Retention) also causes Bi. (*Jisheng Fang*) [Note: Originally Fur Tang treats Zhi Yin, limb numbness, excessive sleep, dizziness. Formula is Er Chen Tang plus Zhi Ke and Jie Geng.]
Limb numbness (Ma) belongs to Qi deficiency. Limb insensibility (Mu) involves damp-phlegm and dead blood. Numbness of ten fingers indicates damp-phlegm and dead blood in the Stomach. (*Danxi Xinfa*)
**Depression Forming Bi**: There is a type with no external contraction, no internal injury, but Bi formed solely by emotional depression. I treated several people with miraculous effects, not recorded in this book. (*Shiyi Defang*)
**Distinction between Bi and Wei (Flaccidity)**: Bi, Wei, and Jue all start from internal deficiency of Yuan Jing (Primordial Essence) and are completed by external invasion of wind, cold, dampness, and heat. Entering from muscles, shallow injury leads to Bi and Wei. Wind-damp挟寒 (accompanied by cold) condenses and stagnates to form Bi; symptoms are mostly painful, severe cases may be stubborn and insensible. Treatment should use drying-damp and acrid-warm dispersing herbs. Wind-damp挟热 (accompanied by heat) floods and steams to form Wei; symptoms are not painful, only sinew/bone dysfunction, severe cases may be stubborn and insensible. Treatment should use drying-damp and sour-cold astringent herbs. Physicians of the world do not know the truth, claiming Bi is external contraction and Wei is internal injury; this is wrong. (*Yixue Guan Jian*)
Wei and Bi are worlds apart. Wei is essentially a deficiency syndrome, tonification only, no purging. Even if bedridden for a long time, appearance shows no disease signs, only weakness and powerlessness, daily activities abolished, walking difficult, without any pain. Bi is excess within deficiency. The excess comes from wind, cold, dampness combining to form Bi; purging only, no tonification. Appearance, spirit, color, and pulse are withered; must have numbness, pain, and difficult movement. Thus, Bi is in the exterior, originally external contraction of wind, cold, dampness; disease located in meridians and blood vessels due to Qi and Blood obstruction/stagnation. Wei is in the interior, belonging to deficiency of Spirit, Qi, and Blood; disease located in Zang and Fu organs due to inability to nourish fully. Hence, treatments differ. (*Shiyi Defang*)
Wei and Bi are similar but different. Bi is external contraction; Wei is internal injury. Although Bi has internal injury, external contraction is predominant. Although Wei has external contraction, internal injury is severe. (*Suwen Shiyi*)
**Abdominal Skin Numbness**: Like abdominal skin numbness and stubbornness. Usually, after bathing in summer, people expose their bellies to wind. Pores open, evil enters skin/hair, coinciding with Wei Qi, fighting to cause numbness and insensibility. Boiling lots of scallion whites to eat will cure it spontaneously. (*Zunsheng Shu*) [Note: *Bencao Gangmu* cites *Wei Shi Fang*: Abdominal skin numbness and insensibility cured by boiling scallion whites. This is the source.]
**Malignant Signs**: Bedridden, unable to move, chronic diarrhea, not eating: difficult to treat. (*Yixue Xintong*)
Zhuo Bi fixed without moving, flesh breaking, body heat, choppy pulse: incurable. (*Yitong*)
**Treatment Examples**: For Bi with wind excess, treatment should disperse. Use Baidu San or Wuyao Shunqi San. If wind excess with slight fire, use Da Qin Jiao Tang or Jiuwei Qianghuo Tang. For Bi with cold excess, if no heat signs in exterior or interior, treat with warmth. Use Wuji San, Xiao Xuming Tang, or Gancao Fuzi Tang. If cold is severe with Qi deficiency, use San Yin Fang Fuzi Tang. For Bi with damp excess, the body must be heavy, or have much cold, phlegm, or sweat; all are Spleen weakness and Yin-cold syndromes. Qianghuo Shengshi Tang disperses wind and dampness; Wuji San warms meridians and disperses dampness; Zhenwu Tang warms middle and drains dampness; San Yin Fang Fuzi Tang tonifies Spleen and dries dampness; Tiaoqi Pingwei San (Pingwei San mixed with Duiqi San) moves Qi and dampness; Wuling San promotes urination and guides dampness; Er Chen Tang and Liu Junzi Tang resolve phlegm and drain dampness. Generally, treating dampness desires dryness; desiring dryness suits warmth. Spleen Earth likes dryness and dislikes dampness, likes warmth and dislikes cold; thus warming Spleen treats dampness. However, there are damp-heat diseases. Must see internal heat signs and slippery-rapid pulse before treating with cooling. Use Ermiao San (Huangbai, Cangzhu) or Jiawei Ermiao Wan (above formula plus Guiwei, Niuxi, Bibi, Fangji, Guiban), or Danggui Niantong Tang (see Hongjiao). For severe heat, Chouxin Yin (Fuling, Huangbai, Shihu, Zhizi, Mutong, Zexie, Zhike, Gancao) can be temporarily used, clearing fire first, then regulating Qi and Blood. (*Jingyue Quanshu*)
Excess Bi syndrome: Use Wuji San. Huangqi Guizhi Wuwu Tang is the general formula for deficiency-type Bi. (*Shifang Miaoyong*)
Numbness, faint pulse, or string-taut/large but powerless pulse, chronic disease with emaciation: belongs to Qi deficiency. Use Buzhong Yiqi Tang plus one piece of Prepared Fuzi. In summer, pair with Shengmai San or Qingzao Tang. (*Yitong*) [Note: *Zhongshu* section, Renshen Yiqi Tang, should be consulted together.]
Bi contraindicates purgatives, astringents, sour-cold, bitter-cold, salty-cold. Suitable for acrid-dispersing, Qi-moving, drying-damp, sweet-warm, bland-permeating. (*Bencao Jingshu*)
**Treatment Divided into Four Aspects**: If pathogen is in muscles, acupuncture, sweating, or moxibustion are all easy to succeed. Otherwise, reaching sinews and bones, it will not be easy to treat. Patient...