（《素问·痹论》全）
黄帝问曰∶痹之安生？岐伯对曰∶风寒湿三气杂至，合而为痹也。（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。痹音秘。）其风气胜者为行痹，（风者善行数变，故为行痹，凡走注历节疼痛之类皆是也。）寒气胜者为
痛痹，（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。）湿气胜者为着痹也。（着痹者，
肢体重着不移，或为疼痛，或为顽木不仁，湿从土化，病多发于肌肉，）帝曰∶其有五者何也？岐伯曰∶以冬遇此者为骨
痹，以春遇此者为筋痹，以夏遇此者为脉痹，以至阴遇此者为肌痹，以秋遇此者为皮痹。（遇此者，指上文之三气也。冬
主骨，春主筋，夏主脉，土王之时主肌肉，秋主皮，故邪气之至，各有所应。）帝曰∶内舍五脏六腑，何气使然？岐伯曰∶
五脏皆有合，病久而不去者，内舍于其合也。（皮肉筋骨脉，皆有五脏之合，病在外而久不去，则各因其合而内连于脏矣。）
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，重感于风寒湿之气也。（舍者，邪入而居之
也。时，谓气王之时，五脏各有所应也。病久不去，而复感于邪，气必更深，故内舍其合而入于脏。）凡痹之客五脏者，
肺痹者，烦满喘而呕。（肺在上焦，其脉循胃口，故为烦满喘而呕。又五脉五脏之痹，见脉色类三十四。）心痹者，脉不
通，烦则心下鼓，暴上气而喘，嗌干善噫，厥气上则恐。（心合脉而痹气居之，故脉不通。心脉起于心中，其支者上挟咽，
其直者却上肺，故病此诸证。厥气，阴气也。心火衰则邪乘之，故神怯而恐。嗌音益。噫，伊芳、隘二音。）肝痹者，夜卧
则惊，多饮数小便，上为引如怀。（肝藏魂，肝气痹则魂不安，故主夜卧惊骇。肝脉下者过阴器抵少腹，上者循喉咙之后
上入颃颡，故为病如此。）肾痹者，善胀，尻以代踵，脊以代头。（肾者胃之关，肾气痹则阴邪乘胃，故腹善胀。尻以代
踵者，足挛不能伸也。脊以代头者，身偻不能直也。以肾脉入跟中，上 内，出 内廉贯脊属肾，故为是病。尻，开高
切。）脾痹者，四肢解堕，发咳呕汁，上为大塞。（脾主四肢，故令懈堕。其脉属脾络胃，上膈挟咽，今其气痹不行，故
发咳呕汁，甚则上焦痞隔，为大塞不通也。）肠痹者，数饮而出不得，中气喘争，时发飧泄。（肠痹者，兼大小肠而言。
肠间病痹，则下焦之气不化，故虽数饮而水不得出。水不出则本末俱病，故与中气喘争。盖其清浊不分，故时发飧泄。
飧音孙。）胞痹者，少腹膀胱按之内痛，若沃以汤，涩于小便，上为清涕。（胞，膀胱之脬也。义详气味类三。膀胱气闭，
故按之则内痛。水闭不行，则蓄而为热，故若沃以汤，且涩于小便也。膀胱之脉从巅入络脑，故上为清涕。胞、脬俱音
抛。沃音屋。）阴气者，静则神藏，躁则消亡，（阴气者，脏气也。五脏者，所以藏精神魂魄志意者也。人能安静，则邪
不能干，故精神完固而内藏。若躁扰妄动，则精气耗散，神志消亡，故外邪得以乘之，五脏之痹因而生矣。）饮食自倍，
肠胃乃伤。（六腑者，所以受水谷而化物者也。若过用不节，致伤肠胃，则六腑之痹因而生矣。）淫气喘息，痹聚在肺；
淫气忧思，痹聚在心；淫气遗溺，痹聚在肾；淫气乏竭，痹聚在肝；淫气肌绝，痹聚在脾。（淫气，邪乱之气也。五脏之
痹，上文虽已详言，然犹有其辨者如此，又可因之以知其聚在何脏也。）诸痹不已，亦益内也。（在表者不去，必日内而
益深矣。）其风气胜者，其人易已也。（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。）帝曰∶痹，其时有死者，或疼久者，或易已者，其故何也？岐伯曰∶其入脏者死，其留连筋骨间者疼久，其留皮肤
间者易已。（入脏者死，伤真阴也。留连筋骨者疼久，邪之深也。留皮肤者易已，邪之浅也。）帝曰∶其客于六腑者何也？
岐伯曰∶此亦其食饮居处，为其病本也。（水谷之寒热，感则害及六腑，居处之邪气，感则伤在六阳，故食饮居处，为六
腑致病之本。）六腑亦各有俞，风寒湿气中其俞，而食饮应之，循俞而入，各舍其腑也。（俞言周身之穴，凡邪可入，皆
谓之俞，非荥俞背俞之谓。食伤于内，邪中于外，表里相应，故得乘虚而入舍于府。）帝曰∶以针治之奈何？岐伯曰∶五
脏有俞，六腑有合，循脉之分，各有所发，各随其过，则病瘳也。（五脏有俞，六腑有合，乃兼脏腑而互言也。各有所发，
即所出为井也。各随其过，即所过为原也。五脏五俞，六腑六俞，皆可随病所在而刺之也。五俞六俞义详经络类十四、
十六。）帝曰∶荣卫之气亦令人痹乎？岐伯曰∶荣者，水谷之精气也，和调于五脏，洒陈于六腑，乃能入于脉也，故循脉
上下，贯五脏，络六腑也。（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∶谷入于胃，脉道乃行，水入于经，其血乃成，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，其气 疾滑利，不能入于脉
也，故循皮肤之中，分肉之间，熏于肓膜，散于胸腹。（卫气者，阳气也，阳气之至，浮盛而疾，故曰悍气。 ，急也。
皮肤之中、分肉之间，脉之外也。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。则肓之为义，不独以胸膈为言，又可知也。膜，
筋膜也。义详后七十一。卫气不入于脉，无所不至，故其行如此。如《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 疾，而先行于四末分肉皮肤之间而不休者也。《本藏篇》曰∶卫气者，所以温分肉，充皮肤，
肥腠理，司开阖者也。皆与此节互有发明。悍音旱。 音飘。肓音荒。膜音莫，又莫胡切。）逆其气则病，从其气则愈，
不与风寒湿气合，故不为痹。（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。）帝曰∶善。痹或痛或不痛，或不仁，或寒或热，或燥或湿，其故何也？（不
仁者，不知痛痒，肌肤顽木之谓。）岐伯曰∶痛者，寒气多也，有寒故痛也。（寒多则血脉凝滞，故必为痛，如《终始篇》
曰∶病痛者阴也。）其不痛不仁者，病久入深，荣卫之行涩，经络时疏，故不通。（通当作痛，《甲乙经》亦然。疏，空虚
也。荣卫之行涩而经络时疏，则血气衰少，血气衰少则滞逆亦少，故为不痛。《逆调论》曰∶荣气虚则不仁，卫气虚则不
用。）皮肤不营，故为不仁。（不营者，血气不至也。）其寒者，阳气少，阴气多，与病相益，故寒也。（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。）其热者，阳气多，阴气少，病气胜，阳遭阴，
故为痹热。（遭，逢也。阳盛遭阴，则阴气不能胜之，故为痹热。）其多汗而濡者，此其逢湿甚也。阳气少，阴气盛，两
气相感，故汗出而濡也。（两气者，寒湿两气也。《脉要精微论》曰∶阴气有余为多汗身寒。其义即此。）帝曰∶夫痹之为
病，不痛何也？岐伯曰∶痹在于骨则重，在于脉则血凝而不流，在于筋则屈不伸，在于肉则不仁，在于皮则寒，故具此
五者，则不痛也。（具此五者，则筋骨皮肉血脉之间，气无不痹，故不得为痛也。）凡痹之类，逢寒则虫，逢热则纵。帝
曰∶善。（虫，《甲乙经》作急，于义为得。盖逢寒则筋挛，故急。逢热则筋弛，故纵也。）
（《素问·痹论》全文）
黄帝问道：痹证是如何产生的？岐伯回答说：风、寒、湿三种邪气混杂侵袭人体，结合而发为痹证。（痹，就是闭塞的意思。看《阴阳别论》说：一阴一阳结滞，称为喉痹。《至真要大论》说：食痹导致呕吐。这些都可以知道是闭塞的含义。所以风、寒、湿三气混杂侵袭，就会壅塞闭阻经络，气血运行不畅从而病发为痹，即属于痛风、麻木不仁之类的病症。痹读音同“秘”。）其中风气偏胜的，称为行痹，（风性善动多变，所以称为行痹，凡是疼痛游走不定、历节疼痛等都属于此类。）寒气偏胜的，称为痛痹，（阴寒之气，客居在肌肉筋骨之间，就会凝结不散，阳气不能运行，所以疼痛剧烈难忍，也就是痛风。）湿气偏胜的，称为着痹。（着痹，肢体沉重固定不移，或者疼痛，或者麻木不仁，湿邪从土化生，病变多发生在肌肉部位。）
黄帝说：为什么有这五种分类呢？岐伯说：在冬季感受这种邪气的，称为骨痹；在春季感受这种邪气的，称为筋痹；在夏季感受这种邪气的，称为脉痹；在长夏（至阴之时）感受这种邪气的，称为肌痹；在秋季感受这种邪气的，称为皮痹。（所谓“感受这种邪气”，指上文提到的风、寒、湿三气。冬季主骨，春季主筋，夏季主脉，土旺之时主肌肉，秋季主皮，所以邪气侵袭时，会分别应合相应的组织器官。）
黄帝说：邪气内传舍留于五脏六腑，是什么道理呢？岐伯说：五脏各有与其相合的组织，如果病久不愈，邪气就会内传舍留于其相合的脏腑。（皮、肉、筋、骨、脉，都有对应五脏的相合关系，病邪在体表日久不去，就会根据其相合关系内连于脏腑。）所以骨痹不愈，再次感受邪气，就会内传舍留于肾；筋痹不愈，再次感受邪气，就会内传舍留于肝；脉痹不愈，再次感受邪气，就会内传舍留于心；肌痹不愈，再次感受邪气，就会内传舍留于脾；皮痹不愈，再次感受邪气，就会内传舍留于肺。所谓的痹证，都是在相应季节，再次感受风寒湿邪气所致。（“舍”，指邪气侵入并居留。所谓“时”，指五行气旺的季节，五脏各有所应。病久不去，又复感邪气，邪气必然更深，所以内传舍留于相合的脏腑。）
凡是痹邪客居于五脏的：肺痹，表现为烦闷、喘息和呕吐。（肺位于上焦，其经脉循行经过胃脘部，所以出现烦闷、喘息和呕吐。另外五种脉脏之痹的表现，参见脉色类第三十四篇。）心痹，表现为血脉不通，心烦时感觉心下悸动如鼓，突然气逆而上喘，咽喉干燥，容易嗳气，厥逆之气上冲则感到恐惧。（心合脉，痹气占据脉中，所以血脉不通。心脉起于心中，其分支上行挟咽，直行者向上入肺，所以出现这些症状。厥气，指阴气。心火衰微则邪气乘虚而入，所以神志怯弱而恐惧。嗌音同“益”。噫，音同“伊”或“隘”。）肝痹，夜间睡眠易惊骇，多饮且小便频数，上部气逆牵引如同怀孕。（肝藏魂，肝气痹阻则魂不安定，所以主要表现夜间睡眠惊骇。肝脉下行经过阴器抵少腹，上行循喉咙之后上入颃颡，所以生病如此。）肾痹，容易腹胀，臀部代替脚跟站立（足挛缩不能伸展），脊柱代替头部直立（身体弯曲不能挺直）。（肾是胃的关口，肾气痹阻则阴邪乘袭胃腑，所以腹部容易胀满。臀部代替脚跟，是因为足部挛缩不能伸展。脊柱代替头部，是因为身体佝偻不能挺直。因为肾脉入足跟中，上行过内踝，出于内踝前缘贯穿脊柱属肾，所以发生这种病。尻音同“开高切”。）脾痹，四肢懈怠无力，发作咳嗽、呕吐涎汁，上部严重痞塞不通。（脾主四肢，所以使人懈怠无力。脾脉属脾络胃，上行穿过膈膜挟持咽喉，现在脾的气机痹阻不行，所以发作咳嗽、呕吐涎汁，严重时上焦痞隔，成为严重的堵塞不通。）肠痹，频繁饮水但排尿困难，腹部肠鸣气争，时常发生完谷不化的泄泻。（肠痹，兼指大肠和小肠。肠道发生痹阻，则下焦气化功能失常，所以虽然频繁饮水但水液不得排出。水液排不出则本末都生病，所以与腹部气机相争。大概是因为清浊不分，所以时常发生完谷不化的泄泻。飧音同“孙”。）胞痹，小腹部膀胱处按压内部疼痛，感觉像被热水浇灌一样，小便涩滞不利，上部流出清涕。（胞，即膀胱之脬。含义详见气味类第三篇。膀胱气机闭塞，所以按压则内部疼痛。水液闭塞不行，蓄积化为热邪，所以感觉像被热水浇灌，并且小便涩滞。膀胱经脉从头顶入络于脑，所以上部流出清涕。胞、脬都音同“抛”。沃音同“屋”。）
阴气，安静时精神内守，躁动时精气消亡。（阴气，指脏气。五脏，是用来藏精神、魂、魄、志、意的器官。人若能安静，则邪气不能干扰，所以精神完固而内藏。如果躁扰妄动，则精气耗散，神志消亡，所以外邪得以乘虚而入，五脏的痹证因此产生。）饮食过量，肠胃就会受伤。（六腑，是用来受纳水谷并消化食物的器官。如果过度使用不加节制，导致损伤肠胃，那么六腑的痹证因此产生。）
邪气紊乱导致喘息，痹聚在肺；邪气紊乱导致忧思，痹聚在心；邪气紊乱导致遗尿，痹聚在肾；邪气紊乱导致乏力衰竭，痹聚在肝；邪气紊乱导致肌肉萎缩，痹聚在脾。（淫气，指邪乱之气。五脏之痹，上文虽然已经详细论述，但仍有这样的辨别方法，也可以据此知道痹聚在哪个脏腑。）各种痹证不愈，也会逐渐向内深入。（在表层的病邪不去除，必定向内传入而日益加深。）其中风气偏胜的，这种人容易痊愈。（风为阳邪，可以发散，所以容易痊愈。然而寒湿两种痹证，治愈较为困难，因为阴邪留滞，不易消散。）
黄帝说：痹证，有的会导致死亡，有的疼痛持久，有的容易痊愈，这是什么原因呢？岐伯说：邪气侵入五脏的会死亡，邪气留恋在筋骨间的疼痛持久，邪气停留在皮肤间的容易痊愈。（侵入五脏的会死亡，因为损伤了真阴。留恋在筋骨的疼痛持久，因为邪气深重。停留在皮肤的容易痊愈，因为邪气浅表。）
黄帝说：邪气客居在六腑是怎么回事呢？岐伯说：这也是以饮食起居作为发病的根本。（水谷的寒热，感受后危害六腑；居住环境的邪气，感受后伤害六阳经，所以饮食起居，是六腑致病的根本。）六腑也各有腧穴，风寒湿邪中伤其腧穴，加上饮食不当相应地影响，邪气顺着腧穴进入，各自舍留于相应的腑。（腧穴泛指周身穴位，凡邪气可进入的地方，都称为腧穴，并非专指荥穴、俞穴或背俞穴。饮食损伤于内，邪气中伤于外，表里相应，所以得以乘虚而入舍留于腑。）
黄帝说：用针刺治疗怎么样呢？岐伯说：五脏有腧穴，六腑有合穴，沿着经脉的分布，各有所发的部位，根据病邪所在的部位进行针刺，病就能痊愈。（五脏有腧穴，六腑有合穴，这是兼谈脏腑而言。各有所发，指出井穴。各随其过，指出原穴。五脏五腧穴，六腑六腧穴，都可以随着病邪所在而针刺。五腧穴和六腧穴的含义详见经络类第十四、十六篇。）
黄帝说：营卫之气也会导致痹证吗？岐伯说：营气，是水谷的精微之气，调和于五脏，布散于六腑，才能进入脉中，所以沿经脉上下运行，贯通五脏，联络六腑。（营气，属于阴气，由水谷精微所化生，所以称为水谷之精气。《卫气篇》说：精气在经脉中运行的称为营气。《正理论》说：食物进入胃，脉道才开始运行，水进入经脉，血液才形成。谷物进入胃，传输到肺，五脏六腑都接受其气，其中清的部分为营，浊的部分为卫，营行于脉中，卫行于脉外，所以对于脏腑脉络无所不到。）卫气，是水谷的悍气，其气急疾滑利，不能进入脉中，所以循行于皮肤之中，分肉之间，熏蒸于肓膜，散布于胸腹。（卫气，属于阳气，阳气到达时，浮盛而疾速，所以称为悍气。剽，急也。皮肤之中、分肉之间，是脉之外。肓，泛指腔腹肉理之间，上下空隙之处，都称为肓。如《刺禁论》说：膈肓之上，中有父母。《左传》说膏之上、肓之下，都是指膈上。又《腹中论》说：其气溢于大肠而着于肓，肓的原气在脐下。《九针十二原篇》说：肓的原气，出于脖胦。《胀论》说：陷于肉、肓而中气穴。那么肓的含义，不仅限于胸膈，也可以知道了。膜，指筋膜。含义详见后第七十一篇。卫气不入于脉，无所不到，所以它的运行如此。如《卫气篇》说：其浮气之不循经的为卫气。《邪客篇》说：卫气，出于其悍气之剽疾，而先行于四肢末端、分肉、皮肤之间而不休息。《本藏篇》说：卫气，是用来温养分肉，充实皮肤，肥厚腠理，主管开阖的。这些都与此节互相发明。悍音同“旱”。剽音同“飘”。肓音同“荒”。膜音同“莫”，又音同“莫胡切”。）违背营卫之气的正常运行就会生病，顺应它就会痊愈，如果不与风寒湿邪气结合，就不会形成痹证。（营卫之气，只不可违背，所以违背它就生病，顺应它就痊愈。然而它不像皮肉筋骨血脉脏腑那样有形质，没有痕迹可附着，所以不与三气结合，大概是因为无形也就没有痹证。）
黄帝说：好。痹证有的疼痛，有的不疼痛，有的麻木不仁，有的怕冷，有的发热，有的干燥，有的湿润，这是什么原因呢？（不仁，指不知痛痒，肌肤麻木僵硬的意思。）岐伯说：疼痛的，是因为寒气多，有寒所以疼痛。（寒气多则血脉凝滞，所以必然疼痛，如《终始篇》说：病痛属于阴。）那些不疼痛且麻木不仁的，是因为病久入深，营卫运行涩滞，经络有时空虚，所以不痛。（“通”应当作“痛”，《甲乙经》也是这样解释。疏，指空虚。营卫运行涩滞而经络有时空虚，则血气衰少，血气衰少则滞逆也少，所以不痛。《逆调论》说：营气虚则不仁，卫气虚则不用。）皮肤得不到营养，所以麻木不仁。（不营，指血气不到达。）那些发冷的，是因为阳气少，阴气多，与病邪相互助长，所以发冷。（凡是病寒的，不一定全由于外寒，只要阳气不足，阴气有余，就会寒从中生，与病邪相互助长，所以成为寒证。）那些发热的，是因为阳气多，阴气少，病气胜，阳遭遇阴，所以成为痹热。（遭，逢也。阳盛遭遇阴，则阴气不能胜过它，所以成为痹热。）那些多汗且湿润的，这是因为遇到了很重的湿邪。阳气少，阴气盛，两气相互感应，所以出汗且湿润。（两气，指寒湿两气。《脉要精微论》说：阴气有余为多汗身寒。意思就在这里。）
黄帝说：痹证作为一种疾病，为什么不痛呢？岐伯说：痹在骨则沉重，在脉则血液凝滞不流动，在筋则屈曲不能伸展，在肉则麻木不仁，在皮则寒冷，所以具备这五种情况，就不痛了。（具备这五种情况，则筋骨皮肉血脉之间，气无不痹阻，所以不会疼痛。）大凡痹证之类，遇到寒邪则拘急，遇到热邪则弛纵。黄帝说：好。（“虫”，《甲乙经》作“急”，从义理上讲更恰当。大概是因为遇到寒邪则筋脉挛缩，所以急。遇到热邪则筋脉弛缓，所以纵也。）
(Full text of "Treatise on Bi Syndrome" from *Suwen*)
The Yellow Emperor asked: How is Bi syndrome (Bi Zheng, obstruction syndrome) generated? Qibo replied: The three pathogens—wind, cold, and dampness—mix and invade together, combining to form Bi syndrome. (Bi means obstruction. As stated in the "Treatise on Differences between Yin and Yang": When one Yin and one Yang knot together, it is called throat Bi. In the "Great Treatise on the Most Essential and Demanding Principles": Food Bi leads to vomiting. From these, it can be known that they all refer to the meaning of obstruction. Thus, when wind, cold, and dampness mix and invade, they obstruct and close the meridians, causing blood and qi to fail to circulate, resulting in Bi syndrome, which belongs to conditions like gout and numbness. Bi is pronounced "mi".) When wind is predominant, it is called Moving Bi (Xing Bi), (Wind moves swiftly and changes frequently, hence it is called Moving Bi; this includes conditions where pain migrates through joints.) When cold is predominant, it is called Painful Bi (Tong Bi), (Yin-cold pathogen lodges between muscles, flesh, sinews, and bones, condensing and not dispersing, preventing the circulation of Yang qi, thus causing unbearable pain, also known as gout.) When dampness is predominant, it is called Fixed Bi (Zhuo Bi). (Fixed Bi involves heavy limbs that remain fixed in place, or pain, or numbness and insensitivity. Dampness transforms according to Earth, and diseases often occur in the muscles.)
The Emperor said: Why are there five types? Qibo said: Contracting this [pathogen] in winter results in Bone Bi; in spring, Sinew Bi; in summer, Vessel Bi; during the late summer (the time of Zhiyin/Earth), Muscle Bi; and in autumn, Skin Bi. (Contracting this refers to the aforementioned three pathogens: wind, cold, and dampness. Winter governs bones, spring governs sinews, summer governs vessels, the time when Earth prospers governs muscles, and autumn governs skin. Thus, when pathogenic qi invades, it corresponds to each respective tissue.)
The Emperor said: What causes the pathogen to enter and lodge internally in the Five Zang and Six Fu organs? Qibo said: Each Zang organ has its corresponding exterior tissue. If the disease persists for a long time without resolving, the pathogen will enter and lodge in its corresponding Zang organ. (Skin, muscle, sinew, bone, and vessel all have correspondences with the Five Zang organs. If the pathogen remains in the exterior for a long time, it will connect internally to the Zang organs according to their correspondences.) Therefore, if Bone Bi does not resolve and the patient is re-exposed to pathogens, it enters and lodges in the Kidney. If Sinew Bi does not resolve and the patient is re-exposed, it enters and lodges in the Liver. If Vessel Bi does not resolve and the patient is re-exposed, it enters and lodges in the Heart. If Muscle Bi does not resolve and the patient is re-exposed, it enters and lodges in the Spleen. If Skin Bi does not resolve and the patient is re-exposed, it enters and lodges in the Lung. This is what is meant by Bi syndrome: contracting wind, cold, and dampness repeatedly during their respective seasons. ("Lodge" means the pathogen enters and resides. "Season" refers to the time when the Qi is prosperous; each Zang organ has its corresponding season. If the disease persists and the patient is re-exposed, the Qi becomes deeper, thus entering and lodging in the corresponding Zang organ.)
Regarding Bi pathogens lodging in the Five Zang organs:
Lung Bi presents with vexation, fullness, wheezing, and vomiting. (The Lung is located in the Upper Jiao, and its meridian passes through the stomach area, hence causing vexation, fullness, wheezing, and vomiting. See Chapter 34 on Pulse and Color for details on the five Vessel-Zang Bi syndromes.)
Heart Bi presents with blocked vessels; when vexed, there is palpitation in the heart region; sudden upward rushing of Qi leading to wheezing; dry throat; frequent belching; and fear when rebellious Qi ascends. (The Heart corresponds to vessels, and Bi qi occupies them, causing blockage. The Heart meridian originates in the heart, branches ascend to flank the throat, and the main branch goes up to the lung, hence these symptoms. Rebellious Qi refers to Yin Qi. When Heart Fire declines, pathogens take advantage, causing spiritual timidity and fear. Yi sounds like "yi". Yi (belch) sounds like "yi" or "ai".)
Liver Bi presents with fright during sleep at night, excessive drinking, frequent urination, and upper body pulling sensations resembling pregnancy. (The Liver stores the Hun soul. When Liver Qi is obstructed, the Hun is unsettled, hence fright during sleep. The Liver meridian descends past the genitalia to the lower abdomen and ascends along the back of the throat to the nasopharynx, hence these symptoms.)
Kidney Bi presents with frequent abdominal distension, inability to extend the legs (standing on the buttocks instead of heels), and spinal curvature (the spine replacing the head). (The Kidney is the gate of the Stomach. When Kidney Qi is obstructed, Yin pathogens attack the Stomach, causing abdominal distension. Standing on the buttocks indicates leg contracture preventing extension. Spinal curvature indicates a hunched back unable to straighten. Since the Kidney meridian enters the heel, ascends past the medial malleolus, pierces the spine, and connects to the Kidney, these symptoms arise. Kao sounds like "kai gao qie".)
Spleen Bi presents with flaccidity and weakness of the four limbs, coughing, vomiting of saliva, and severe upper Jiao obstruction. (The Spleen governs the four limbs, hence causing flaccidity. Its meridian connects to the Spleen, links to the Stomach, crosses the diaphragm, and flanks the throat. Now, with Spleen Qi obstructed, it causes coughing and vomiting of saliva; severely, it causes upper Jiao stagnation, leading to major obstruction.)
Intestine Bi presents with frequent drinking but inability to urinate, abdominal rumbling and Qi contention, and occasional diarrhea with undigested food. (Intestine Bi refers to both Large and Small Intestines. Bi in the intestines impairs Lower Jiao Qi transformation, so although water is drunk frequently, it cannot exit. If water does not exit, both root and branch are diseased, causing Qi contention in the middle. Because clear and turbid substances are not separated, occasional diarrhea with undigested food occurs. Sun sounds like "sun".)
Bladder Bi (Pao Bi) presents with internal pain upon pressing the lower abdomen over the bladder, a sensation as if scalded by hot water, difficult and scanty urination, and clear nasal discharge above. (Pao refers to the bladder sac. Meaning detailed in Chapter 3 on Flavor and Qi. Bladder Qi is closed, hence internal pain upon pressure. Water closure leads to heat accumulation, hence the scalding sensation and difficult urination. The Bladder meridian enters the brain from the vertex, hence clear nasal discharge. Pao and Pao sound like "pao". Wo sounds like "wu".)
Yin Qi, when quiet, allows the Spirit to reside within; when agitated, it dissipates. (Yin Qi refers to Zang Qi. The Five Zang organs store Spirit, Hun, Po, Yi, and Zhi. If a person remains calm, pathogens cannot interfere, so Spirit and Essence remain solid and stored internally. If agitated and restless, Essence and Qi dissipate, Spirit and Mind perish, allowing external pathogens to invade, giving rise to Zang Bi.) Excessive eating and drinking injures the intestines and stomach. (The Six Fu organs receive water and grain and transform them. If used excessively without restraint, damaging the intestines and stomach, Fu Bi arises.)
Disordered Qi causing wheezing indicates Bi gathering in the Lung; Disordered Qi causing worry and thought indicates Bi gathering in the Heart; Disordered Qi causing enuresis indicates Bi gathering in the Kidney; Disordered Qi causing exhaustion indicates Bi gathering in the Liver; Disordered Qi causing muscle atrophy indicates Bi gathering in the Spleen. (Yin Qi here refers to chaotic pathogenic Qi. Although Zang Bi was detailed earlier, this distinction helps identify where the Bi gathers.) All Bi syndromes, if unresolved, will gradually move inward. (Pathogens remaining in the exterior must enter inward and deepen.) When Wind is predominant, recovery is easier. (Wind is a Yang pathogen and can be dispersed, hence easy to cure. However, Cold and Damp Bi are harder to cure because Yin pathogens linger and are difficult to move.)
The Emperor said: Some Bi patients die, some suffer chronic pain, and some recover easily. What is the reason? Qibo said: Those whose pathogens enter the Zang organs die; those whose pathogens linger between sinews and bones suffer chronic pain; those whose pathogens remain in the skin recover easily. (Entering Zang organs damages True Yin, leading to death. Lingering in sinews and bones causes chronic pain due to deep pathogen location. Remaining in the skin is easy to cure due to shallow pathogen location.)
The Emperor said: What about pathogens lodging in the Six Fu organs? Qibo said: This also stems from diet and living habits as the root cause. (Cold and heat from food and drink harm the Six Fu organs when contracted; pathogens from living environments injure the Six Yang meridians. Thus, diet and living habits are the root of Fu organ disease.) The Six Fu organs also have Shu points. When wind, cold, and dampness strike these Shu points, and dietary factors respond accordingly, the pathogen enters along the Shu points and lodges in the respective Fu organs. (Shu points refer to acupoints throughout the body where pathogens can enter, not just Ying-Shu or Back-Shu points. Internal injury from diet and external invasion by pathogens correspond internally and externally, allowing entry into the Fu organs via deficiency.)
The Emperor said: How should acupuncture treatment be applied? Qibo said: The Five Zang organs have Shu points, and the Six Fu organs have He-Sea points. Following the distribution of the meridians, there are specific sites of manifestation. Treating according to the site of the pathology will lead to recovery. (Zang Shu and Fu He points are discussed together. Specific sites of manifestation refer to Jing-Well points. Treating according to the site refers to Yuan-Source points. The Five Shu points of the Zang and six Shu points of the Fu can all be needled according to the location of the disease. Details on Five and Six Shu points are in Chapters 14 and 16 of the Meridians section.)
The Emperor said: Do Ying and Wei Qi also cause Bi syndrome? Qibo said: Ying Qi is the essence of water and grain, harmonized in the Five Zang organs and distributed in the Six Fu organs, entering the vessels to circulate up and down, penetrating the Zang organs and connecting the Fu organs. (Ying Qi is Yin Qi, transformed from water and grain essence. As stated in the "Wei Qi Chapter": Essence-Qi circulating in the meridians is Ying Qi. The "Zheng Li Lun" states: When food enters the stomach, the vessel pathways begin to flow; when water enters the vessels, blood is formed. Grain enters the stomach, transmits to the Lung, and nourishes all Zang and Fu organs. The clear part becomes Ying, the turbid part becomes Wei. Ying circulates within the vessels, Wei circulates outside. Thus, it reaches everywhere in the Zang-Fu and meridians.) Wei Qi is the fierce Qi of water and grain. Its nature is swift and slippery, unable to enter the vessels. It circulates among the skin and between the muscles, steaming the Huang membranes and dispersing in the chest and abdomen. (Wei Qi is Yang Qi. When Yang Qi arrives, it is floating, vigorous, and swift, hence called Fierce Qi. Biao means swift. Between skin and muscles is outside the vessels. Huang refers to any cavity or space between flesh and tissues. As per the "Acupuncture Taboos Chapter": Above the diaphragm and Huang lies the Parents. The "Zuo Zhuan" mentions above the Gao and below the Huang, referring to above the diaphragm. The "Fu Zhong Lun" states: Qi overflows into the large intestine and attaches to the Huang; the source of Huang is below the navel. The "Nine Needles and Twelve Original Points Chapter" states: The source of Huang emerges from the neck. The "Zhang Lun" states: Sinking into the flesh and Huang hits the Qi points. Thus, Huang is not limited to the chest and diaphragm. Mo refers to fascia. Meaning detailed in Chapter 71. Since Wei Qi does not enter the vessels, it reaches everywhere, moving as described. The "Wei Qi Chapter" states: Floating Qi not following meridians is Wei Qi. The "Xie Ke Chapter" states: Wei Qi, emerging from its fierce and swift nature, precedes in the extremities, muscles, and skin without rest. The "Ben Cang Chapter" states: Wei Qi warms the muscles, fills the skin, thickens the pores, and controls opening and closing. These all elucidate this section. Han sounds like "han". Biao sounds like "piao". Huang sounds like "huang". Mo sounds like "mo", also "mo hu qie".) Violating this Qi causes disease; following it leads to recovery. Since it does not combine with wind, cold, and dampness, it does not form Bi. (Ying and Wei Qi should not be violated; violation causes disease, compliance brings recovery. Unlike the tangible tissues and organs, they leave no trace, hence do not combine with the three pathogens to form Bi, as formlessness implies no Bi.)
The Emperor said: Good. Bi syndrome presents with pain or no pain, numbness, cold or heat, dryness or dampness. What is the reason? (Numbness refers to lack of sensation to pain and itch, stiffness and wood-like texture of the skin and flesh.) Qibo said: Pain is caused by excess cold; presence of cold leads to pain. (Excess cold causes blood vessel stasis, inevitably leading to pain, as stated in the "Zhong Shi Chapter": Painful diseases belong to Yin.) Conditions with neither pain nor numbness occur when the disease is deep and chronic, Ying and Wei Qi flow sluggishly, and meridians are occasionally empty, hence no pain. (In the "Jia Yi Jing", "tong" should be read as "tong" [pain]. Shu means empty. Sluggish Ying/Wei flow and empty meridians indicate deficient blood and Qi; less deficiency means less stasis, hence no pain. The "Ni Diao Lun" states: Deficient Ying Qi causes numbness; deficient Wei Qi causes immobility.) Lack of nourishment in the skin causes numbness. (Lack of nourishment means blood and Qi do not reach.) Cold sensations arise from deficient Yang Qi and excess Yin Qi, which mutually reinforce the pathology, causing cold. (Not all cold diseases stem from external cold; insufficient Yang and excess Yin generate cold internally, reinforcing the condition, resulting in a cold syndrome.) Heat sensations arise from abundant Yang Qi and deficient Yin Qi; the pathogenic Qi prevails, and Yang encounters Yin, causing Bi heat. (Zao means encounter. When Yang is excessive and encounters Yin, Yin cannot overcome it, resulting in Bi heat.) Profuse sweating and wetness occur when encountering severe dampness. With deficient Yang and abundant Yin, the two Qi interact, causing sweating and wetness. (The two Qi refer to cold and damp. The "Mai Yao Jing Wei Lun" states: Excess Yin leads to profuse sweating and body cold. This explains the meaning.)
The Emperor said: Why does Bi syndrome sometimes present without pain? Qibo said: When Bi is in the bone, it feels heavy; in the vessels, blood coagulates and does not flow; in the sinews, flexion occurs without extension; in the muscles, there is numbness; in the skin, there is cold. Possessing all five of these conditions results in no pain. (With all five conditions, Qi is obstructed in sinews, bones, skin, muscles, and vessels, hence no pain.) Generally, Bi syndromes tighten when exposed to cold and relax when exposed to heat. The Emperor said: Good. (In the "Jia Yi Jing", "chong" is written as "ji" [tight/spasm], which makes more sense. Exposure to cold causes sinew spasm, hence tightness. Exposure to heat causes sinew relaxation, hence laxity.)