【脉】 寸口喘而坚，痹在心；喘而浮，痹在肺；长而左右弹，痹在肝；大而虚
，痹在脾；坚而大，痹在肾。
【因】 风，风为行痹。风性善行。寒，寒为痛痹。寒主收引。湿，湿为着痹。
湿本重滞。三气致痹之原，或外兼他患有之。若舍此而能痹，未有也。
【证】 其合而为痹也。以冬遇者，骨痹；春遇者，筋痹；夏遇者，脉痹；长夏
遇者，肌痹；秋遇者，皮痹。久而不去，内舍五脏之合。待舍其合，难治矣。
《痹论》中议痹，乃三气皆可客于五脏，其风、寒、湿乘虚而客之故也。筋痹不去，内
舍于肝；皮痹不去，内舍于肺；肌痹不去，内舍于脾；脉痹不去，内舍于心；骨痹不去，内
舍于肾。其客于心，则烦心，上气嗌干，恐噫，厥胀是也。其客于肺，使人烦满而喘吐。其
客于肝，多饮数溲，小腹痛如怀妊，夜卧则惊。其客于脾，四肢解堕，发渴呕沫，上为大塞
。其客于肾，善胀，尻以代踵，脊以代头。其客于肠，数饮而小便不得，中气喘争，时发飧
泄。夫大肠乃传道之官，为冲和之气，三气乘虚客之，而和气闭矣。水道不通，使糟粕不化
，故喘争飧泄也。其客于胞，小腹膀胱，按之内痛。若沃以汤，小便涩，上为清涕。夫三气
客于胞中，则气不能化出，故胞满而水道不通，随经出鼻窍。其客于血脉，随脉流通上下，
升降一身，谓之周痹。
华佗论痹 乃邪气合四时不正之气，感于脏腑所为。有气、血、筋、肉、骨之分
。其气痹者，愁思喜怒，过则气结于上，久而不消则伤肺，正气衰，邪气胜。留于上，则胸
腹痛而不能食；注于下，则腰脚重而不能行；贯于舌，则不言；遗于腹，则不溺。壅则痛，
流则麻。右寸脉沉而迟涩者是也。其血痹者，饮酒过多，怀热太甚，或寒折于经络，或湿犯
于营卫，因而血搏，渐成枯削失血之证。左寸脉结而不流利是也。其肉痹者，饮食不节，肥
美之为。肉不荣，肤不泽，则纹理疏，三气入之，则四肢缓而不收持。右关脉举按皆无力而
涩也。其筋痹者，由叫怒无时，行步奔急，淫邪伤肝，肝失其气，寒热客之，流入筋会，使
筋急而不舒。左关脉弦急而数，浮沉有力是也。其骨痹者，乃嗜欲伤于肾气，内消而不能闭
禁，邪气妄入。脉迟则寒，数则热，浮则风，濡则湿，滑则虚。治法各随其宜。
麻木余辨 是风湿热下陷入血分阴中，阳气不行。其证合目则浑身麻。亦有痰在
血分痒者，血不营肌腠。
【治】附子汤 治风、寒、湿痹。
附子（炮去皮脐） 桂枝 白芍 甘草 茯苓 人参（各三钱） 白术（一两）
行痹，加麻黄桂汤；痛痹，加附子、姜茯汤；胞痹，加四苓；肠痹，加平胃、茱萸、草
肉、豆蔻等。
戴人法 苦剂涌寒痰，次与痰剂。使白术（除湿）、茯苓（养肾水）、桂（伐木）、姜
、附（寒胜加）。
麻木方 人参（助阳道） 当归（行阴） 生甘草（去热） 白术 茯苓（除湿热） 升麻
柴胡 白芍 苍术 黄柏。痰，加二陈。
忍冬藤膏 治五痹拘挛。
【脉象】 寸口脉搏动急促且坚实，是痹证在心；急促而浮，是痹证在肺；脉长且左右弹指，是痹证在肝；脉大且虚，是痹证在脾；脉坚硬且大，是痹证在肾。
【病因】 风邪所致，称为行痹（疼痛游走不定）。风的性质善于行走。寒邪所致，称为痛痹（疼痛剧烈固定）。寒性主收敛牵引。湿邪所致，称为着痹（肢体沉重酸痛固定）。湿性本重浊滞涩。导致痹证的三种邪气根源，或者是外感兼有其他疾病而致病。如果舍弃这三种邪气而能导致痹证，是没有的。
【证候】 三气合而为痹。如果在冬季感受邪气，则为骨痹；春季感受，则为筋痹；夏季感受，则为脉痹；长夏（夏末秋初）感受，则为肌痹；秋季感受，则为皮痹。病久不愈，内传并留舍于五脏所主的形体组织。等到内传留舍于五脏，就难以治疗了。《黄帝内经·痹论》中讨论痹证，乃是风、寒、湿三气皆可客居于五脏，是因为风、寒、湿邪乘人体正气虚弱而侵入的缘故。筋痹久不去除，内传留舍于肝；皮痹久不去除，内传留舍于肺；肌痹久不去除，内传留舍于脾；脉痹久不去除，内传留舍于心；骨痹久不去除，内传留舍于肾。邪气客居于心，则出现心烦，气逆上冲，咽喉干燥，恐惧嗳气，四肢厥冷胀满等症状。邪气客居于肺，使人烦闷胀满而喘息呕吐。邪气客居于肝，多饮且小便频数，小腹痛如怀孕状，夜间睡觉则惊悸。邪气客居于脾，四肢懈怠无力，发生口渴呕吐涎沫，上部出现严重的痞塞不通。邪气客居于肾，容易腹胀，尾骶部着地代替脚跟（形容腰脊弯曲严重），脊柱高耸代替头部（形容身体极度佝偻）。邪气客居于肠，多次饮水但小便不通，腹中气机冲逆作响，时常发生完谷不化的泄泻。大肠是传导之官，维持冲和之气，风、寒、湿三气乘虚侵入，导致和气闭塞。水道不通，使糟粕不能正常转化，所以出现气逆作响和完谷不化的泄泻。邪气客居于胞（此处指膀胱或下焦相关部位），小腹膀胱部位，按压内部感到疼痛。感觉像被热水浇灌一样灼热，小便涩滞，向上表现为清涕流出。因为风、寒、湿三气客居于胞中，导致气不能气化排出，所以胞部胀满而水道不通，邪气随经络上行出于鼻窍。邪气客居于血脉，随着脉络流通上下，升降于一身，称为周痹（全身性痹证）。
华佗论痹 认为痹证乃是邪气结合四时不正之气，感应于脏腑所致。分为气痹、血痹、筋痹、肉痹、骨痹五种。其中气痹者，因忧愁思虑、喜怒过度，导致气结于上部，日久不消散则伤肺，正气衰弱，邪气亢盛。邪气停留于上部，则胸腹痛而不能进食；流注于下部，则腰脚沉重而不能行走；侵入舌部，则不能言语；遗留在腹部，则不能排尿。气壅滞则痛，气流窜则麻木。右寸脉沉迟且涩，就是气痹的表现。血痹者，因饮酒过多，体内积热太甚，或者寒邪折损经络，或者湿邪侵犯营卫，因而血液搏结凝滞，逐渐形成枯瘦失血的证候。左寸脉结代且不流利，就是血痹的表现。肉痹者，因饮食不节制，过食肥甘厚味所致。肌肉不得荣养，皮肤失去光泽，则纹理疏松，风、寒、湿三气侵入，则四肢弛缓不能收持。右关脉举按皆无力且涩，就是肉痹的表现。筋痹者，因无节制地呼叫发怒，行走奔跑急迫，淫邪损伤肝脏，肝失其气，寒热邪气客居其中，流入筋会，使筋脉拘急而不舒展。左关脉弦急而数，浮取沉取都有力，就是筋痹的表现。骨痹者，乃因嗜欲过度损伤肾气，内部精气消减而不能闭藏禁固，邪气妄自侵入。脉迟表示寒，脉数表示热，脉浮表示风，脉濡表示湿，脉滑表示虚。治疗方法应各自根据适宜情况而定。
关于麻木的辨析 这是风湿热邪下陷陷入血分阴分中，阳气不能运行。其症状是闭上眼睛时浑身麻木。也有因痰在血分导致瘙痒的，是因为血不能荣养肌肤腠理。
【治法】 附子汤 治疗风、寒、湿痹。
附子（炮制去皮脐） 桂枝 白芍 甘草 茯苓 人参（各三钱） 白术（一两）
行痹，加用麻黄桂枝汤；痛痹，加用附子、干姜、茯苓汤；胞痹，加用四苓散；肠痹，加用平胃散、吴茱萸、草肉（肉豆蔻）、豆蔻等药。
戴人法 用苦味药剂涌吐寒痰，随后给予化痰药剂。使用白术（除湿）、茯苓（滋养肾水）、桂枝（伐木/疏肝）、生姜、附子（寒邪胜时加入）。
麻木方 人参（助阳道） 当归（行阴血） 生甘草（清热） 白术 茯苓（除湿热） 升麻 柴胡 白芍 苍术 黄柏。若有痰，加用二陈汤。
[Pulse] The pulse at the Cun Kou (Inch Port) is rapid and firm, indicating Bi syndrome (Obstruction Syndrome) in the Heart; rapid and floating, indicating Bi syndrome in the Lung; long and rebounding to the left and right, indicating Bi syndrome in the Liver; large and deficient, indicating Bi syndrome in the Spleen; firm and large, indicating Bi syndrome in the Kidney.
[Etiology] Wind pathogen causes Xing Bi (Wandering Bi), characterized by migrating pain. The nature of wind is agile and mobile. Cold pathogen causes Tong Bi (Painful Bi), characterized by severe, fixed pain. The nature of cold is contracting and pulling. Dampness pathogen causes Zhuo Bi (Fixed Bi), characterized by heaviness and fixed soreness. The nature of dampness is heavy and stagnant. The root causes of Bi syndrome induced by these three pathogens are either external contraction combined with other diseases, or solely due to these factors. There is no case where Bi syndrome occurs without these three pathogens.
[Manifestations] When the three pathogens combine to form Bi syndrome: contraction in Winter results in Gu Bi (Bone Bi); in Spring, Jin Bi (Sinew Bi); in Summer, Mai Bi (Vessel Bi); in Late Summer, Ji Bi (Muscle Bi); in Autumn, Pi Bi (Skin Bi). If the condition persists for a long time, it transmits inward and resides in the organs associated with these tissues. Once it resides within the Zang-Fu organs, it becomes difficult to treat. In the "Bi Lun" chapter of the *Huangdi Neijing*, it is discussed that Wind, Cold, and Dampness can all lodge in the Zang-Fu organs because these pathogens invade when the body's righteous Qi is deficient. If Jin Bi does not resolve, it transmits inward to the Liver; if Pi Bi does not resolve, it transmits inward to the Lung; if Ji Bi does not resolve, it transmits inward to the Spleen; if Mai Bi does not resolve, it transmits inward to the Heart; if Gu Bi does not resolve, it transmits inward to the Kidney. When lodging in the Heart, it causes mental restlessness, rebellious Qi rising, dry throat, fear, belching, and cold distension of the limbs. When lodging in the Lung, it causes vexation, fullness, wheezing, and vomiting. When lodging in the Liver, it causes excessive drinking, frequent urination, lower abdominal pain resembling pregnancy, and night terrors. When lodging in the Spleen, it causes flaccidity and weakness of the four limbs, thirst, vomiting of frothy saliva, and severe upper jiao obstruction. When lodging in the Kidney, it causes easy distension, inability to stand upright (relying on the sacrum as heels), and spinal curvature (spine replacing the head). When lodging in the Intestines, it causes frequent drinking but inability to urinate, abdominal rumbling and qi conflict, and occasional diarrhea with undigested food. The Large Intestine is the official of transmission and transformation, maintaining harmonious Qi. When Wind, Cold, and Dampness invade due to deficiency, this harmonious Qi becomes blocked. The water passages do not flow freely, causing improper transformation of waste, leading to rumbling and diarrhea. When lodging in the Bao (Bladder/Lower Jiao area), pressing the lower abdomen and bladder causes internal pain. It feels like being poured with hot water, urine is scanty and painful, and clear nasal discharge occurs above. Because Wind, Cold, and Dampness lodge in the Bao, Qi cannot transform and exit, causing Bao distension and blocked water passages, with pathogens following the meridians to emerge from the nasal orifices. When lodging in the blood vessels, circulating up and down along the meridians, ascending and descending throughout the body, it is called Zhou Bi (General Bi).
Hua Tuo on Bi Syndrome states that Bi syndrome is caused by evil pathogens combining with abnormal Qi of the four seasons, affecting the Zang-Fu organs. It is divided into Qi Bi, Blood Bi, Sinew Bi, Muscle Bi, and Bone Bi. Qi Bi arises from excessive worry, thought, anger, or joy, causing Qi to knot in the upper body. If unresolved, it damages the Lung, weakening righteous Qi and allowing evil Qi to prevail. Stagnating in the upper body causes chest and abdominal pain and anorexia; flowing to the lower body causes heavy waist and legs and inability to walk; penetrating the tongue causes aphasia; lingering in the abdomen causes urinary retention. Stagnation causes pain, while flow causes numbness. A deep, slow, and choppy pulse at the Right Cun indicates Qi Bi. Blood Bi arises from excessive alcohol consumption, excessive internal heat, cold damaging the collaterals, or dampness invading Ying and Wei levels, causing blood stasis and gradually leading to emaciation and blood loss. A knotted and non-smooth pulse at the Left Cun indicates Blood Bi. Muscle Bi arises from irregular diet and excessive rich foods. Muscles lack nourishment, skin lacks luster, pores become loose, and Wind, Cold, and Dampness invade, causing flaccid limbs that cannot be controlled. A weak and choppy pulse at the Right Guan indicates Muscle Bi. Sinew Bi arises from uncontrolled shouting and anger, hurried walking or running, and pathogenic invasion damaging the Liver. Loss of Liver Qi allows Cold and Heat to lodge, flowing into the sinew hubs, causing sinew tightness and stiffness. A wiry, rapid, and forceful pulse at the Left Guan indicates Sinew Bi. Bone Bi arises from excessive desires damaging Kidney Qi, leading to internal depletion and failure to secure essence, allowing evil Qi to enter. A slow pulse indicates Cold, rapid indicates Heat, floating indicates Wind, soggy indicates Dampness, and slippery indicates Deficiency. Treatment methods should be adapted accordingly.
Differentiation of Numbness: This is caused by Wind-Damp-Heat sinking into the Blood level and Yin aspect, preventing Yang Qi from circulating. The symptom is whole-body numbness when closing the eyes. There are also cases of itching due to Phlegm in the Blood level, where Blood fails to nourish the muscle and interstices.
[Treatment] Fuzi Tang (Aconite Decoction) treats Wind, Cold, and Damp Bi.
Prepared Fuzi (processed, peeled, navel removed) Cinnamon Twig White Peony Root Licorice Poria Ginseng (each 3 qian) Atractylodes Macrocephala Rhizome (1 liang).
For Xing Bi (Wandering Bi), add Mahuang Guizhi Tang (Ephedra and Cinnamon Twig Decoction); for Tong Bi (Painful Bi), add Fuzi, Shengjiang (Fresh Ginger), and Fuling (Poria) decoction; for Bao Bi, add Si Ling San (Four Poria Powder); for Chang Bi (Intestinal Bi), add Pingwei San (Calm the Stomach Powder), Evodia Fruit, Nutmeg, and Cardamom.
Dai Ren Method: Use bitter agents to induce vomiting of Cold Phlegm, followed by phlegm-resolving agents. Use Baizhu (to remove dampness), Fuling (to nourish Kidney Water), Guizhi (to subdue Wood/Liver), Shengjiang (Fresh Ginger), and Fuzi (add if Cold prevails).
Numbness Formula: Ginseng (to assist Yang Dao), Danggui (to move Yin/Blood), Raw Licorice (to clear heat), Baizhu, Fuling (to remove damp-heat), Shengma, Chaihu, Baishao, Cangzhu, Huangbai. If Phlegm is present, add Erchen Tang (Two-Chen Decoction).
Jinyingteng Gao (Lonicera Japonica Vine Paste) treats spasticity caused by the Five Bis (Skin, Vessel, Muscle, Sinew, Bone Bi).