《内经》谓风寒湿三气杂至合而为痹。其风胜者为行痹。（行痹者，行而不定也，称为走注疼
痛及历节之类是也。）寒气胜者为痛痹。（痛痹者，疼痛苦楚，世称为痛风及白虎、飞尸之类是也。）
湿气胜者为着痹。（着痹者，着而不移，世称为麻木不仁之类是也。痹者闭也，五脏六腑正气为邪气
所闭，则痹而不仁。《灵枢》云∶病患一臂不遂，时复移在一臂者，痹也，非风也。《要略》曰∶风
病当半身不遂，若但臂不遂者，痹也。）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。（凡风寒湿所为行痹、痛痹、着痹之病，又以所遇之时，所客之处
而命其名，非此行痹、痛痹、着痹之外，又别有骨痹、筋痹、脉痹、肌痹、皮痹也。）陈无择云∶三
气袭人经络，入于骨则重而不举，入于脉则血凝不流，入于筋则屈而不伸，入于肉则不仁，入于皮则
寒。久不已则入五脏，烦满喘呕者，肺也。上气嗌干，厥胀者，心也。多饮数溲，夜卧则惊者，肝也。
尻以代踵，脊以代头者，肾也。四肢懈惰，发咳呕沫者，脾也。大抵显脏证则难治矣。又有肠痹、胞
痹，及六腑各有俞，风寒湿所中，治之随其腑俞以施针灸之法，仍服发散等剂，则病自除。又有血痹、
周痹、支饮作痹，皆以类相从也。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，宜防风汤。寒痹者，四肢挛痛，关节浮肿，宜五积散。湿痹者，留而不移，汗多，四肢缓弱，
皮肤不仁，精神昏塞，宜茯苓川芎汤。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，宜升麻汤。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，
宜疏风凉血之剂。肠痹者，数饮而小便不通，中气喘争，时作餐泄，宜五苓散加桑皮、木通、麦门冬，
或吴茱萸散。胞痹者，少腹膀胱按之内痛，若沃以汤，涩于小便，上为清涕，宜肾着汤、肾沥汤。血
痹者，邪入于阴血之分，其状，体常如被风所吹，骨弱劳瘦，汗出，卧则不时摇动，宜当归汤。周痹
者，在血脉之中，上下游行，周身俱痛也。宜蠲痹汤。支饮者，手足麻痹，臂痛不举，多睡眩冒，忍
尿不便，膝冷成痹，宜茯苓汤。五脏痹，宜五痹汤。肝痹，加酸枣仁、柴胡。心痹，加远志、茯苓、
麦门冬、犀角。脾痹，加浓朴、枳实、砂仁、神曲。肺痹，加半夏、紫菀、杏仁、麻黄。肾痹，加独
活、官桂、杜仲、牛膝、黄 、萆 。痹在五脏之合者可治，其入藏者死。
【诊】粗理而肉不坚者，善病痹。关中薄泽为风，冲浊为痹。浮络多青则痛，黑则痹。络脉暴
黑者，留久痹也。脉大而涩，为痹。脉来急，亦为痹。肺脉微大为肺痹，引胸背起，恶日光。心脉微
为心痹，引背善泪出。右寸沉而迟涩，为皮痹。
左寸结不流利，为血痹。右关脉举按皆无力而涩，为肉痹。左关弦紧而数，浮沉有力，为筋痹。迟为
寒。数为热。濡为湿。滑为痰。豁大、弦小为虚。
《黄帝内经》说，风、寒、湿三种邪气混杂侵袭人体，结合而发为痹证。其中风邪偏胜的称为行痹。（行痹的特点是疼痛游走不定，世称走注疼痛及历节病等属于此类。）寒邪偏胜的称为痛痹。（痛痹的特点是疼痛剧烈痛苦，世称痛风及白虎历节、飞尸等属于此类。）湿邪偏胜的称为着痹。（着痹的特点是重着固定不移，世称麻木不仁等属于此类。）痹的意思是闭塞，五脏六腑的正气被邪气闭塞，就会发生痹证而导致麻木不仁。《灵枢》说：病人一只手臂不能活动，有时疼痛转移到另一只手臂的，是痹证，不是中风。《金匮要略》说：中风病应当表现为半身不遂，如果仅仅是手臂不能活动，那是痹证。如果在冬季感受这种邪气，称为骨痹；在春季感受，称为筋痹；在夏季感受，称为脉痹；在长夏（至阴之时）感受，称为肌痹；在秋季感受，称为皮痹。（凡是风、寒、湿引起的行痹、痛痹、着痹病症，又根据所感受的时节、邪气停留的部位来命名，并不是在行痹、痛痹、着痹之外，另外有骨痹、筋痹、脉痹、肌痹、皮痹这五种独立的病类。）陈无择说：三气侵袭人的经络，进入骨骼则沉重难以抬起，进入血脉则血液凝滞不流动，进入筋脉则屈曲不能伸展，进入肌肉则感觉麻木，进入皮肤则怕冷。久治不愈则邪气深入五脏，出现烦闷喘促呕吐症状的是肺痹。出现气逆咽喉干燥、四肢厥冷胀满的是心痹。出现多饮多尿、夜间睡眠惊悸的是肝痹。出现臀部着地代替脚跟行走、脊柱弯曲头部前倾的是肾痹。出现四肢懈怠无力、咳嗽吐沫的是脾痹。大抵上如果出现脏腑的症状就难以治疗了。又有肠痹、胞痹，以及六腑各有其俞穴，风寒湿邪中伤，治疗时随其腑俞施用针灸方法，同时服用发散等药剂，病自然消除。又有血痹、周痹、支饮引发的痹证，都是按类别归类的。风痹者，疼痛游走上下，随着虚邪与血气相搏结，聚于关节，导致筋脉弛缓不收，宜用防风汤。寒痹者，四肢拘挛疼痛，关节浮肿，宜用五积散。湿痹者，病位固定不移，汗多，四肢软弱无力，皮肤麻木不仁，精神昏沉闭塞，宜用茯苓川芎汤。热痹者，脏腑移热，又遇外邪客居搏结于经络，留滞不行，阳遭其阴，所以发生痹证，心中烦闷，肌肉热极，身体上有如老鼠爬行的感觉，嘴唇口角反裂，皮肤颜色改变，宜用升麻汤。三气合而为痹，则皮肤坚硬厚厚，或肌肉酸痛，这是邪气中伤周身，搏结于血脉，多年不愈，则形成瘾疹风疮，搔抓不痛，头发脱落，宜用疏风凉血的药剂。肠痹者，频繁饮水但小便不通，腹部气机冲撞争鸣，时常发生完谷不化的泄泻，宜用五苓散加桑白皮、木通、麦门冬，或者吴茱萸散。胞痹者，小腹部膀胱部位按压内部疼痛，像浇了热水一样灼热，小便涩滞不畅，上部流出清涕，宜用肾着汤、肾沥汤。血痹者，邪气侵入阴血之分，其症状是身体常常像被风吹拂的感觉，骨骼脆弱形体消瘦，出汗，睡觉时不时摇动，宜用当归汤。周痹者，在血脉之中，上下游走，全身都疼痛。宜用蠲痹汤。支饮者，手足麻痹，手臂疼痛不能高举，嗜睡眩晕，强忍小便不便，膝盖寒冷成痹，宜用茯苓汤。五脏痹，宜用五痹汤。肝痹，加酸枣仁、柴胡。心痹，加远志、茯苓、麦门冬、犀角。脾痹，加厚朴、枳实、砂仁、神曲。肺痹，加半夏、紫菀、杏仁、麻黄。肾痹，加独活、官桂、杜仲、牛膝、黄柏、萆薢。痹证在五脏之合（五体）的可治，如果传入五脏脏器的则预后不良致死。
【诊法】纹理粗糙且肌肉不坚实的人，容易患痹证。关中地区风气薄而湿润易招致风邪，水气冲浊易致痹证。浮络多青色则疼痛，黑色则痹阻。络脉突然变黑的，是久留的痹证。脉象大而涩，是痹证。脉来急促，也是痹证。肺脉微大为肺痹，牵引胸背起病，厌恶阳光。心脉微弱为心痹，牵引背部，容易流泪。右寸脉沉而迟涩，为皮痹。左寸脉结而不流利，为血痹。右关脉举按皆无力而涩，为肉痹。左关脉弦紧而数，浮沉有力，为筋痹。脉迟为寒。脉数为热。脉濡为湿。脉滑为痰。脉豁大、弦小为虚。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states that Bi syndrome (Bi Syndrome, obstruction syndrome caused by wind, cold, and dampness pathogens) arises when the three pathogens of wind, cold, and dampness mix and invade the body together. When wind is predominant, it is called Xing Bi (Wandering Bi). (Xing Bi is characterized by wandering pain, known in the world as migrating pain or Li Jie disease.) When cold is predominant, it is called Tong Bi (Painful Bi). (Tong Bi is characterized by severe, agonizing pain, known in the world as Tong Feng [Gout] or Bai Hu Li Jie [White Tiger Joint Pain].) When dampness is predominant, it is called Zhuo Bi (Fixed Bi). (Zhuo Bi is characterized by fixed heaviness, known in the world as numbness and insensitivity.) "Bi" means obstruction; when the righteous qi of the five zang organs and six fu organs is obstructed by pathogenic factors, Bi syndrome occurs, leading to numbness and insensitivity. The *Lingshu* (Spiritual Pivot) states: If a patient has one arm that cannot move, and the pain sometimes shifts to the other arm, this is Bi syndrome, not stroke (Zhong Feng). The *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) states: Stroke should present with hemiplegia; if only the arm is immobile, it is Bi syndrome. If contracted in winter, it is called Gu Bi (Bone Bi); in spring, Jin Bi (Sinew Bi); in summer, Mai Bi (Vessel Bi); during the late summer period (Zhi Yin), Ji Bi (Muscle Bi); and in autumn, Pi Bi (Skin Bi). (Regarding diseases of Xing Bi, Tong Bi, and Zhuo Bi caused by wind, cold, and dampness, their names are further determined by the season of contraction and the location of the pathogen; there are no separate entities of Gu Bi, Jin Bi, Mai Bi, Ji Bi, and Pi Bi distinct from the former three.) Chen Wuyue stated: When the three pathogens invade the meridians and collaterals, entering the bones causes heaviness and inability to lift; entering the vessels causes blood coagulation and stagnation; entering the sinews causes flexion without extension; entering the muscles causes numbness; and entering the skin causes cold intolerance. If prolonged and untreated, the pathogens enter the five zang organs: Fan Man Chuan Ou (vexation, fullness, wheezing, and vomiting) indicates Fei Bi (Lung Bi); Shang Qi Yi Gan, Jue Zhang (rebellious qi, dry throat, and cold extremities with distension) indicates Xin Bi (Heart Bi); Duo Yin Shu Sou, Ye Wo Ze Jing (excessive drinking, frequent urination, and night terrors) indicates Gan Bi (Liver Bi); Kao Yi Dai Zhong, Ji Yi Dai Tou (sitting on the buttocks instead of walking on heels, spine bent forward replacing the head) indicates Shen Bi (Kidney Bi); Si Zhi Xie Duo, Fa Ke Ou Mo (limb flaccidity, coughing, and foaming vomit) indicates Pi Bi (Spleen Bi). Generally, if zang organ symptoms manifest, the condition is difficult to treat. There are also Chang Bi (Intestinal Bi) and Bao Bi (Bladder/Uterus Bi), and each of the six fu organs has its Shu points; when attacked by wind, cold, and dampness, treatment involves acupuncture at the respective fu Shu points combined with dispersing herbal formulas, which will eliminate the disease. There are also Xue Bi (Blood Bi), Zhou Bi (Circulating Bi), and Bi caused by Zhi Yin (Branching Fluid Retention), all categorized by similarity. Feng Bi (Wind Bi) features wandering pain up and down; as the deficiency-pathogen interacts with blood and qi, it gathers in the joints, causing sinews and vessels to relax and fail to contract; Fang Feng Tang (Saposhnikiae Decoction) is indicated. Han Bi (Cold Bi) features limb spasms and pain with joint swelling; Wu Ji San (Five Accumulations Powder) is indicated. Shi Bi (Damp Bi) features fixed location, excessive sweating, weak limbs, skin numbness, and mental cloudiness; Fu Ling Chuan Xiong Tang (Poria and Ligusticum Decoction) is indicated. Re Bi (Heat Bi) features heat shifting from the zang-fu, compounded by external pathogens lodging in the meridians, where yang encounters yin, causing obstruction, chest stuffiness, extreme muscle heat, a sensation like mice crawling on the body, cracked lips and mouth, and skin discoloration; Sheng Ma Tang (Cimicifugae Decoction) is indicated. When the three pathogens combine to cause Bi, the skin becomes thick and hard, or muscles ache; this is pathogens invading the whole body and binding in the blood vessels. If unresolved for years, it forms E Zhen Feng Chuang (Urticaria and Wind Sores), which do not itch but cause hair loss; dispersing-wind and cooling-blood formulas are indicated. Chang Bi features frequent drinking with urinary obstruction, abdominal rumbling, and occasional undigested diarrhea; Wu Ling San (Five-Ingredient Powder with Poria) plus Sang Bai Pi (Morus Bark), Mu Tong (Akebia Stem), and Mai Men Dong (Ophiopogon Tuber), or Wu Zhu Yu San (Evodia Powder), is indicated. Bao Bi features internal pain upon pressing the lower abdomen/bladder area, a sensation of hot water pouring over it, scanty/difficult urination, and clear nasal discharge above; Shen Zhuo Tang (Kidney Dampness Decoction) and Shen Li Tang (Kidney Infusion Decoction) are indicated. Xue Bi features pathogens entering the yin-blood level, presenting as a constant feeling of wind blowing on the body, weak bones, emaciation, sweating, and restless sleep; Dang Gui Tang (Angelica Decoction) is indicated. Zhou Bi features pathogens circulating within the blood vessels, causing pain throughout the body; Juan Bi Tang (Expel Bi Decoction) is indicated. Zhi Yin presents with numbness in limbs, arm pain preventing elevation, somnolence, dizziness, difficulty holding urine, and cold knees leading to Bi; Fu Ling Tang (Poria Decoction) is indicated. Five Zang Bi is treated with Wu Bi Tang (Five Bi Decoction): for Gan Bi, add Suan Zao Ren (Ziziphus Seed) and Chai Hu (Bupleurum Root); for Xin Bi, add Yuan Zhi (Polygala Root), Fu Ling (Poria), Mai Men Dong (Ophiopogon Tuber), and Xi Jiao (Rhinoceros Horn); for Pi Bi, add Hou Po (Magnolia Bark), Zhi Shi (Immature Bitter Orange), Sha Ren (Amomum Fruit), and Shen Qu (Medicated Leaven); for Fei Bi, add Ban Xia (Pinellia Tuber), Zi Wan (Aster Root), Xing Ren (Apricot Seed), and Ma Huang (Ephedra); for Shen Bi, add Du Huo (Angelica Pubescens), Guan Gui (Cinnamon Twig), Du Zhong (Eucommia Bark), Niu Xi (Achyranthes Root), Huang Bo (Phellodendron Bark), and Bi Xie (Dioscorea Hypoglauca Rhizome). Bi affecting the exterior associations of the zang organs is treatable; if it enters the zang organs themselves, it is fatal.
[Diagnosis] Individuals with coarse skin texture and loose flesh are prone to Bi syndrome. In the Guan-Zhong region, thin wind leads to wind disorders, while turbid water qi leads to Bi. Numerous blue floating collaterals indicate pain; black indicates Bi obstruction. Sudden blackening of collaterals indicates long-standing Bi. A pulse that is large and choppy indicates Bi. A rapid pulse also indicates Bi. A slightly large lung pulse indicates Fei Bi, with radiation to the chest and back and aversion to sunlight. A slightly weak heart pulse indicates Xin Bi, with radiation to the back and tendency to weep. A deep, slow, and choppy right cun pulse indicates Pi Bi. A knotted and non-smooth left cun pulse indicates Xue Bi. A right guan pulse that is powerless upon both lifting and pressing, and is choppy, indicates Rou Bi (Muscle Bi). A left guan pulse that is wiry, tight, rapid, and forceful at both superficial and deep levels indicates Jin Bi. Slow pulse indicates Cold. Rapid pulse indicates Heat. Soft pulse indicates Dampness. Slippery pulse indicates Phlegm. Vast and wiry-small pulses indicate Deficiency.