黄帝问曰。痹之安生。岐伯对曰。风寒湿三气杂至。合而为痹也。（痹音避。痹者闭也。邪闭而为痛也。言风寒湿三
气。错杂而至。相合而为痹。）其风气胜者为行痹。（风者善行而数变。故其痛流行而无定处。）寒气胜者为痛痹。（寒为
阴邪。痛者阴也。是以寒气胜者为痛痹。）湿气胜者为着痹也。（湿流关节。故为留着之痹。按灵枢经有风痹。伤寒论有
湿痹。是感一气而为痹也。本篇论风寒湿三气杂至。合而为痹。是三邪合而为痹也。灵枢周痹篇曰。风寒湿气。客于外
分肉之间。迫切而为沫。沫得寒则聚。聚则排分肉而分裂也。分裂则痛。痛则神归之。神归之则热。热则痛解。痛解则
厥。厥则他痹发。发则如是。是寒痹先发而他痹复发也。本篇论风气胜者为行痹。湿气胜者为着痹。是三气杂合。而以
一气胜者为主病也。经论不同。因证各别。临病之士。各宜体认。）帝曰。其有五者何也。（帝问三气之外。而又有五
痹也。上节论天之三邪。此下论人之五气。）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。（皮肉筋骨。五脏之外合也。五脏之气。合于四时五行。故各以其时而受病。同气
相感也。）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。（肺合皮。心合脉。
脾合肌。肝合筋。肾合骨。邪之中人。始伤皮肉筋骨。久而不去。则内舍于所合之脏。而为脏腑之痹也。）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。（所谓五脏之痹者。各以其五脏所
合之时。重感于风寒湿之气也。盖皮肉筋骨。内合于五脏。五脏之气。外合于四时。始病在外之有形。复伤在内之五气。
外内形气相合。而邪舍于内矣。所谓舍者。有如馆舍。邪客留于其间者也。邪搏于五脏之间。干脏气而不伤其脏真。故
曰舍。曰客。而上见其烦满喘逆诸证。如其入脏者则死矣。张兆璜曰。首言以冬遇此为骨痹者。谓痹病之多深入也。故
先言骨而筋。筋而脉。脉而皮肤。）凡痹之客五脏者。肺痹者。烦满喘而呕。（此论五脏之气受邪。而形诸于病也。肺主
气而司呼吸。其脉起于中焦。还循胃口。上膈属肺。故痹则烦喘而呕。兆璜曰。脏气受邪。则病在五脏。五脏受病。
腹转及于经脉形层。）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。（心主脉。故痹闭而令脉不
通。邪搏心下。鼓动而上干心脏则烦。故烦则心下鼓也。肺者心之盖。而心脉上通于肺。故逆气暴上。则喘而嗌干。心
主噫。心气上逆而出。则善噫也。夫水火之气。上下时交。心气厥逆于上。则不能下交于肾。肾气虚。故悲也。兆璜
曰。心下鼓。暴上气。谓邪气上逆也。厥气上。谓正气厥逆也。）肝痹者。夜卧则惊。多饮数小便。上为引如怀。（肝藏
魂。卧则神魂不安。故发惊骇。肝脉循阴股。入毛中。过阴器。抵小腹。挟胃属肝络胆。上贯膈。循喉咙。入颃颡。肝
气痹闭。则木火郁热。故在上则多饮。在下则便数。上引于中。而有如怀妊之状也。）肾痹者善胀。尻以代踵。脊以代头。
（尻苦高切音 。肾者胃之关。关门不利。则胃气不转。故善胀也。脊椎尽处为尻。肾主骨。骨痿而不能行。故尻以代
踵。阴病者不能仰。故脊以代头。）脾痹者。四肢解惰。发咳呕汁。上为大塞。（脾气不能行于四肢。故四肢解惰。脾脉
上膈挟咽。气痹不行。故发咳也。入胃之饮。上输于脾肺。脾气不能转输。故呕汁。肺气不能通调。故上为大塞。）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。小肠为心之府而主小便。邪痹于小肠。则火热郁于
上而为数饮。下为小便不得出也。大肠为肺之府而主大便。邪痹于大肠。故上则为中气喘争。而下为飧泄也。）胞痹者。
少腹膀胱。按之内痛。若沃以汤。涩于小便。上为清涕。（胞者膀胱之室。内居少腹。邪闭在胞。故少腹膀胱。按之内痛。
水闭不行。则蓄而为热。故若沃以汤。且涩于小便也。膀胱之脉。从巅入脑。脑渗则为涕。上为清涕者。太阳之气。痹
闭于下。不能循经而上升也。愚按六腑之痹。只言其三。盖营气者。胃腑之精气也。卫气者。阳明之悍气也。营卫相将。
出入于外内。三焦之气。游行于上下。甲胆之气。先脏腑而升。夫痹者闭也。正气营运。邪不能留。三腑之不病痹者。
意在斯与。）阴气者。静则神藏。躁则消亡。（此言脏气不藏。而邪痹于脏也。阴气者。脏气也。神者。五脏所藏之神
也。五脏为阴。阴者主静。故静则神气藏而邪不能侵。躁则神气消亡。而痹聚于脏矣。）饮食自倍。肠胃乃伤。（此言肠
胃伤而邪痹于腑也。夫居处失宜。则风寒湿气。中其俞矣。然当节其饮食。勿使邪气内入。如食饮应之。邪即循俞而入。
各舍其腑矣。）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。诸痹不已。亦益内也。其风气胜者。其人易已也。（此申明阴气躁亡。而痹聚于脏也。淫气者。阴气淫佚。不静
藏也。淫气而致于喘息。则肺气不藏。而痹聚在肺矣。淫气而致于忧思。则肾气不藏。而痹聚在心矣。淫气而至于遗溺。
则肾气不藏。而痹聚在肾矣。淫气而致于阴血乏竭。则肝气不藏。而痹聚在肝矣。淫气而致于肌肉焦绝。则脾气不藏。
而痹聚在脾矣。是以在脏腑经俞诸痹。留而不已。亦进益于内。而为脏腑之痹矣。夫寒湿者。天之阴邪。伤人经俞筋骨。
风者。天之阳邪。伤人皮肤气分。是以三邪中于脏腑之俞。而风气胜者。其性善行。可从皮腠而散。故其人易已也。愚
按下文云。六腑亦各有俞。盖言五脏六腑。俱各有俞。如风寒湿气。中于五脏之俞。而脏气淫躁。则邪循俞内入。而各
聚于脏矣。中于六腑之俞。而饮食自倍。肠胃乃伤。邪亦循俞而入。各舍其腑矣。上节所谓各以其时。重感于风寒湿之
气而为五脏之痹者。合五脏之气而舍于内也。此节论邪中脏腑之俞。循俞而亦进益于内。先言阴气消亡。痹聚在脏。故
后只言六腑。亦各有俞云。）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。（此言五脏之痹。循俞而入脏者死也。夫风寒湿气中其俞。其脏气实。则邪不动脏。若
神气消亡。则痹聚在脏而死矣。按邪从皮肉筋骨而内舍于五脏者。此邪干脏气。而不伤于脏真。故痹客于脏。则为烦满
喘呕。脉不通。心下鼓。嗌干善噫诸证。其留连筋骨间。而不内舍于其合者疼久。其留皮肤间者。随气而易散。若中其
俞。则内通五脏。兼之阴气不藏。则邪直入于脏。而为不治之死证矣。）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。（此言六腑之痹。乃循俞而内入者也。夫居处失常。则邪气外客。饮食不节。则肠胃内伤。故食饮居
处。为六腑之病本。张兆璜曰。痹聚在五脏者。因其阴气不藏。神气消亡。痹舍于六腑者。亦其饮食居处。此节用三
亦字。俱当着眼。）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。（饮食入胃。大小肠济泌糟
粕。膀胱决渎水浊。蒸化精液。营养经俞。如居处失常。而又食饮应之于内。则经脉虚伤。邪循俞而入舍其腑矣。张
兆璜曰。邪中五脏之俞。而阴气淫躁应之。邪中六腑之俞。而食饮应之。故曰。六腑亦各有俞。而食饮应之。再按灵枢
口问篇曰。夫百病之始生也。皆生于风雨寒暑。阴阳喜怒。饮食居处。大惊卒恐。夫风寒雨湿。合而为痹矣。居处失常。
则邪中脏腑之俞矣。喜怒病脏。惊恐伤阴。则阴气消亡矣。饮食自倍。则肠胃乃伤矣。是以上古之人。食饮有节。起居
有常。不妄作劳。和于阴阳。故能形与神居。度百岁乃去。）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。（此论治脏腑之痹而各有法也。夫营俞治经。故痹在脏者。当取之于俞。合治
内腑。故痹在腑者。取之于合也。又当循形身经脉之分。皮肉筋骨。各有所发。各随其有过之处而取之。则其病自瘳矣。）
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。（灵枢经云。人受气于谷。谷入于胃。以传于肺。五脏六腑。皆以受气。其清者为荣。浊者为卫。荣
行脉中。卫行脉外。荣气篇曰。荣气之道。内谷为实。谷入于胃。乃传之肺。流溢于中。布散于外。专精者行于经隧。
常营无已。是水谷之精气。从肺气而先和调于脏腑。五脏六腑。皆以受气。而乃能入于脉也。入于脉。故循脉上下。复
贯五脏。络六腑。盖言五脏六腑。受谷精之气。营行于经脉。经荣之气复贯络于脏腑。互相资生而资养者也。）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。（卫者。水谷之悍气。其
气疾滑利。故不能入于脉。不入于脉。故循于皮肤分肉之间。分肉者。肌肉之腠理。理者。皮肤脏腑之纹理也。盖在
外则行于皮肤肌理之间。在内则行于络脏络腑之募原。募原者。脂膜也。亦有纹理之相通。故曰皮肤脏腑之纹理也。络
小肠之脂膜谓之肓。是以在中焦。则熏蒸于肓膜。行于胸膈之上。则散于心肺之募理。行于腹中。散于肠胃肝肾之募原。
是外内上下。皮肉脏腑。皆以受气。一日一夜。五十而周于身。）逆其气则病。从其气则愈。不与风寒湿气合。故不为痹。
（荣卫之气。荣行脉中。卫行脉外。营周不休。五十而复大会。阴阳相贯。如环无端。旋转而不休息者也。故逆其气则
病。从其气则愈。不与风寒湿邪合。而留连于皮肤脉络之间。故不为痹也。盖言痹在皮者。肺气之所主也。痹在肌者。
脾气之所主也。痹在脉者。心气之所主也。荣卫之气。虽在皮肤络脉之间。行而不留。故不与邪合。）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、不知痛痒也。燥者。谓无汗。湿者。多汗而濡湿也。）岐
伯曰。痛者。寒气多也。有寒。故痛也。（寒气胜者为痛痹。故痛者寒气多也。络始篇曰。病痛者阴也。人有阴寒。故痛
也。上寒字言天之寒邪。下寒字言人之寒气。盖天有阴阳。人有阴阳。如感天之阴寒。而吾身之阳盛。则寒可化而为热。
如两寒相搏。凝聚而为痛痹矣。）其不痛不仁者。病久入深。荣卫之行涩。经络时疏。故不通。皮肤不营。故为不仁。（通
字当作痛。病久入深者。久而不去。将内舍于其合也。邪病久。则荣卫之道伤而行涩。邪入深。则不痹闭于形身。而经
络时疏。故不痛也。荣卫行涩。则不能营养于皮肤。故为不仁。）其寒者。阳气少。阴气多。与病相益。故寒也。（此言
寒热者。由人身之阴阳气化也。人之阳气少而阴气多。则与病相益其阴寒矣。邪正惟阴。故为寒也。）其热者。阳气多。
阴气少。病气胜。阳遭阴。故为痹热。（人之阳气多而阴气少。邪得人之阳盛。而病气胜矣。人之阳气盛。而遇天之阴邪。
则邪随气化而为痹热矣。张兆璜曰。与病相益者。言人之阴气多而益其病气之阴寒也。病气胜者。言人之阳气多而益
其病气之热胜也。此论天有阴阳之邪。而人有寒热之气化。）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。（湿者。天之阴邪也。感天地之阴寒。而吾身阴气又盛。两气相感。故汗出而濡也。兆璜曰。阳热盛者
多汗出。濡湿之汗。又属阴寒。医者审之。）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。（经云气伤痛。此论邪痹经脉骨肉之有形。
而不伤其气者。则不痛也。夫骨有骨气。脉有脉气。筋有筋气。肌有肌气。皮有皮气。皆五脏之气。而外合于形身。如
病形而不伤其气。则只见骨痹之身重。脉痹之血凝不行。筋痹之屈而不伸。肉痹之肌肉不仁。皮痹之皮毛寒冷。故具此
五者之形证。而不痛也。）凡痹之类。逢寒则虫。逢热则纵。帝曰。善。（此承上文而言。凡此五痹之类。如逢吾身之阴
寒。则如虫行皮肤之中。逢吾身之阳热。则筋骨并皆放纵。又非若病气之有寒则痛。阳气多则为痹热也。此言形气之病。
各有分别。故帝嘉其善焉。兆璜曰。在外者。皮肤为阳。筋骨为阴。如逢寒则阳亦阴寒。故皮肤则虫。逢热则阴亦阳
热。故筋骨弛纵。）
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，结合而成为痹证。（痹音同“避”。痹的意思是闭塞。邪气闭塞经络而导致疼痛。这里指风、寒、湿三气错杂而至，相互结合而形成痹证。）其中风气偏胜的，称为行痹。（风性善动多变，所以疼痛游走不定，没有固定位置。）寒气偏胜的，称为痛痹。（寒属于阴邪，疼痛也属阴，所以寒气偏胜的称为痛痹。）湿气偏胜的，称为着痹。（湿邪流注关节，所以形成留滞不去的痹证。按《灵枢经》中有风痹，《伤寒论》中有湿痹，这是感受单一邪气而形成的痹证。本篇论述风、寒、湿三气混杂而至，结合而成痹证，这是三种邪气结合而成的痹证。《灵枢·周痹篇》说：风寒湿气，客居在体表的分肉之间，逼迫津液凝聚成沫，沫遇到寒气则聚集，聚集后排斥分肉使其分裂。分裂则产生疼痛，疼痛时精神集中于患处，精神集中则生热，热则疼痛缓解，疼痛缓解后气机逆乱，于是其他部位的痹证发作。发作就是这样。这是寒痹先发而其他痹证复发的情况。本篇论述风气偏胜的为行痹，湿气偏胜的为着痹，这是三气混杂，以某一气偏胜为主病的情况。经典论述不同，是因为病症各异。临证诊治的医生，应当各自仔细体会认识。）黄帝说：痹证又有五种分类，是什么？（黄帝问在三气之外，又有五痹。上一节论述天的三种邪气，下面论述人的五脏之气。）岐伯说：在冬季感受这些邪气的，称为骨痹；在春季感受这些邪气的，称为筋痹；在夏季感受这些邪气的，称为脉痹；长夏季节感受这些邪气的，称为肌痹；在秋季感受这些邪气的，称为皮痹。（皮、肉、筋、骨，分别是五脏的外合。五脏之气与四时五行相合，所以各在其对应的时令受病，这是同气相感的结果。）黄帝说：邪气内侵五脏六腑，是什么因素导致的？岐伯说：五脏各有其外合之组织，病久不愈的，邪气就会内陷于其相合的脏腑。（肺合皮，心合脉，脾合肌，肝合筋，肾合骨。邪气侵入人体，起初伤害皮肉筋骨，日久不愈，就会内陷于所合的脏，形成脏腑痹。）所以骨痹不愈，再次感受邪气，邪气内陷于肾；筋痹不愈，再次感受邪气，邪气内陷于肝；脉痹不愈，再次感受邪气，邪气内陷于心；肌痹不愈，再次感受邪气，邪气内陷于脾；皮痹不愈，再次感受邪气，邪气内陷于肺。所谓的痹证，都是在相应时令，重复感受风寒湿邪气所致。（所谓五脏痹，都是在五脏所主的时令，重复感受风寒湿邪气所致。因为皮肉筋骨内合于五脏，五脏之气外合于四时。起初病在体表有形的部位，随后损伤内在的五脏之气，内外形气相合，邪气就留居于体内了。所谓“舍”，就像馆舍一样，邪气客居停留在那里。邪气搏结于五脏之间，干扰脏气但不损伤脏真，所以称为“舍”、“客”，而上部出现烦闷、喘逆等症状。如果邪气深入伤及脏真，就会死亡。张兆璜说：开头说冬季感受此邪为骨痹，是说痹病多深入体内，所以先言骨，再言筋，再言脉，最后言皮肤。）凡是痹邪客居五脏的：肺痹，表现为烦闷、喘促、呕吐。（这是论述五脏之气受邪，而在病症上表现出来。肺主气而司呼吸，其经脉起于中焦，回绕胃口，上行穿过膈肌属肺，所以痹阻则烦喘而呕。兆璜说：脏气受邪，则病在五脏；五脏受病，进而波及经脉和形体层次。）心痹，表现为血脉不通，心烦时感到心下悸动，突然气逆上冲而喘，咽喉干燥，容易嗳气，厥逆之气上冲则恐惧。（心主脉，所以痹阻导致血脉不通。邪气搏结于心下，鼓动而上扰心脏则心烦，所以心烦时心下悸动。肺是心的华盖，心脉上通于肺，所以气逆暴上则喘且咽喉干燥。心主嗳气，心气上逆而出，所以容易嗳气。水火之气，上下时常交济。心气厥逆于上，就不能下交于肾，肾气虚，所以悲伤。兆璜说：心下悸动、突然气逆上冲，是指邪气上逆；厥气上冲，是指正气厥逆。）肝痹，表现为夜间睡眠易惊，多饮且小便频数，上部牵引不适如同怀孕状。（肝藏魂，卧则神魂不安，所以发生惊骇。肝脉循行经过大腿内侧，进入阴毛中，过阴器，抵小腹，挟胃属肝络胆，上行穿过膈肌，循喉咙，入颃颡。肝气痹阻，则木火郁热，所以在上则多饮，在下则小便频数，向上牵引至中部，而有如怀孕的状态。）肾痹，表现为容易腹胀，臀部代替脚跟站立，脊柱代替头部直立。（肾是胃的关口，关门不利，则胃气不转，所以容易腹胀。脊椎尽头处为尻。肾主骨，骨痿不能行走，所以用臀部代替脚跟。阴病者不能仰卧，所以用脊柱代替头部直立。）脾痹，表现为四肢懈怠无力，咳嗽呕吐涎水，上部严重痞塞。（脾气不能运行于四肢，所以四肢懈怠无力。脾脉上行穿过膈肌挟持咽部，气机痹阻不行，所以发生咳嗽。进入胃中的饮食，向上输布于脾肺，脾气不能转输，所以呕吐涎水。肺气不能通调水道，所以上部严重痞塞。）肠痹，表现为多次饮水但小便排不出，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。小肠是心的腑，主司小便，邪气痹阻于小肠，则火热郁于上而致口渴多饮，下则小便不得排出。大肠是肺的腑，主司大便，邪气痹阻于大肠，所以上则腹部肠鸣气争，下则发生完谷不化的泄泻。）胞痹，表现为小腹部膀胱部位，按压内部疼痛，感觉像被热水浇灌，小便涩滞不畅，上部流出清涕。（胞是膀胱的室，内居小腹部，邪气闭阻在胞，所以小腹部膀胱部位，按压内部疼痛。水液闭阻不行，蓄积化为热，所以感觉像被热水浇灌，且小便涩滞。膀胱的经脉，从头顶入脑，脑渗则为涕。上部流出清涕，是因为太阳之气痹阻于下，不能循经上升。我按：六腑之痹，只提到了三个。大概营气是胃腑的精气，卫气是阳明的悍气。营卫相随，出入于内外，三焦之气游行于上下，甲胆之气先于脏腑而升。痹的意思是闭塞，正气营运，邪气不能停留。三腑不患痹证，意思大概就在这里。）阴气，安静则神气内藏，躁动则神气消亡。（这是说脏气不藏，而邪气痹阻于脏。阴气，即脏气。神，是五脏所藏的神志。五脏属阴，阴主静，所以安静则神气内藏而邪气不能侵入，躁动则神气消亡，而痹聚于脏了。）饮食过量，肠胃就会受伤。（这是说肠胃受伤而邪气痹阻于腑。如果居住生活不当，风寒湿气就会中伤其俞穴。然而应当节制饮食，不要使邪气内入。如果饮食失宜，邪气就顺着俞穴而入，分别客居于各腑。）淫佚之气导致喘息，痹聚在肺；淫佚之气导致忧思，痹聚在心；淫佚之气导致遗尿，痹聚在肾；淫佚之气导致精气乏竭，痹聚在肝；淫佚之气导致肌肉枯绝，痹聚在脾。各种痹证不愈，也会向内加深。其中风气偏胜的，其人容易痊愈。（这是重申阴气躁动消亡，而痹聚于脏。淫佚之气，指阴气淫佚，不安静内藏。淫佚之气导致喘息，则肺气不藏，而痹聚在肺。淫佚之气导致忧思，则肾气不藏，而痹聚在心（注：原文此处逻辑似有误，通常忧思伤心，但注文云肾气不藏痹聚在心，依原文翻译）。淫佚之气导致遗尿，则肾气不藏，而痹聚在肾。淫佚之气导致阴血乏竭，则肝气不藏，而痹聚在肝。淫佚之气导致肌肉焦绝，则脾气不藏，而痹聚在脾。因此在脏腑经俞的各种痹证，停留不愈，也会进益于内，成为脏腑痹。寒湿是天之阴邪，伤人经俞筋骨；风是天之阳邪，伤人皮肤气分。所以三邪中于脏腑之俞，而风气偏胜的，其性善行，可从皮腠而散，所以其人容易痊愈。我按：下文说六腑也各有俞，意思是五脏六腑俱各有俞。如风寒湿气中于五脏之俞，而脏气淫躁，则邪循俞内入，而各聚于脏。中于六腑之俞，而饮食过量，肠胃受伤，邪也循俞而入，各舍于腑。上一节所说各以其时，重感风寒湿之气而为五脏痹的，是合五脏之气而舍于内。这一节论述邪中脏腑之俞，循俞而也进益于内，先说阴气消亡，痹聚在脏，所以后面只说六腑也各有俞。）黄帝说：痹证有的导致死亡，有的疼痛持久，有的容易痊愈，这是什么原因？岐伯说：邪气侵入五脏的会死，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。（这是说五脏痹，循俞而入脏的会死。风寒湿气中伤其俞，如果脏气充实，则邪气不动脏；如果神气消亡，则痹聚于脏而死。邪从皮肉筋骨内陷于五脏，这是邪气干扰脏气而不损伤脏真，所以痹客于脏，则出现烦闷喘呕、脉不通、心下悸动、咽喉干燥、容易嗳气等症状。邪气留恋在筋骨间，而不内陷于其相合之脏的，疼痛持久。邪气停留在皮肤间的，随气机而易散。如果中伤其俞，则内通五脏，加之阴气不藏，则邪气直入于脏，成为不治的死证。）黄帝说：邪气客居六腑是怎么回事？岐伯说：这也是由饮食起居不当作为病因根本。（这是说六腑之痹，是循俞而内入的。如果居住失常，则邪气外客；饮食不节，则肠胃内伤。所以饮食起居，是六腑病的根本。张兆璜说：痹聚在五脏，是因为阴气不藏，神气消亡；痹舍于六腑，也是由于饮食起居。这一节用了三个“亦”字，都应当注意。）六腑也各有俞穴，风寒湿气中伤其俞穴，而饮食失宜与之相应，邪气便循俞穴而入，分别客居于各腑。（饮食入胃，大小肠分别泌别糟粕，膀胱决渎水浊，蒸化精液，营养经俞。如果居住失常，而又饮食失宜于内，则经脉虚伤，邪气循俞穴而入舍于腑。张兆璜说：邪中五脏之俞，而阴气淫躁与之相应；邪中六腑之俞，而饮食失宜与之相应。所以说：六腑也各有俞，而饮食失宜与之相应。再按《灵枢·口问篇》说：百病的发生，都生于风雨寒暑、阴阳喜怒、饮食居处、大惊卒恐。风寒雨湿结合成为痹证。居住失常，则邪中脏腑之俞。喜怒病脏，惊恐伤阴，则阴气消亡。饮食过量，则肠胃受伤。所以上古之人，饮食有节制，起居有规律，不妄作劳，调和于阴阳，所以能形与神俱，度百岁乃去。）黄帝说：用针刺治疗怎么样？岐伯说：五脏有输穴，六腑有合穴，沿着经脉的分布，各有所发，根据病变的部位取穴，病就能痊愈。（这是论述治疗脏腑痹各有方法。营输治经，所以痹在脏的，应当取输穴；合治内腑，所以痹在腑的，取合穴。又应当循身体经脉的分布，皮肉筋骨各有所发，根据有过失病变之处取穴，病自然痊愈。）黄帝说：营卫之气，也会导致痹证吗？岐伯说：营气，是水谷的精气，调和于五脏，散布于六腑，才能进入脉中。所以循脉上下，贯穿五脏，联络六腑。（《灵枢经》说：人受气于谷，谷入于胃，以传于肺，五脏六腑都以此受气。其中清的为营，浊的为卫。营行脉中，卫行脉外。《营气篇》说：营气的道，以内谷为实。谷入于胃，乃传之肺，流溢于中，布散于外。专精者行于经隧，常营无已。这是说水谷的精气，从肺气而先和调于脏腑，五脏六腑都以此受气，然后才能进入脉中。进入脉中，所以循脉上下，又贯穿五脏，联络六腑。这是说五脏六腑受谷精之气，营行于经脉，经营之气又贯络于脏腑，互相资生而资养。）卫气，是水谷的悍气，其气运行疾滑利，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，是水谷的悍气，其气疾滑利，所以不能进入脉中。不入于脉，所以循行于皮肤分肉之间。分肉，是肌肉的腠理。理，是皮肤脏腑的纹理。大概在外则行于皮肤肌理之间，在内则行于络脏络腑的募原。募原，是脂膜。也有纹理相通，所以说是皮肤脏腑的纹理。络小肠的脂膜称为肓。所以在中焦，则熏蒸于肓膜，行于胸膈之上，则散布于心肺的募理；行于腹中，散布于肠胃肝肾的募原。是外内上下，皮肉脏腑，都以此受气。一日一夜，五十次周流全身。）逆其气则生病，顺其气则痊愈，不与风寒湿气结合，所以不成为痹。（营卫之气，营行脉中，卫行脉外，营周不休，五十而复大会，阴阳相贯，如环无端，旋转而不休息。所以逆其气则生病，顺其气则痊愈。不与风寒湿邪结合，而留连于皮肤脉络之间，所以不成为痹。这是说痹在皮，是肺气所主；痹在肌，是脾气所主；痹在脉，是心气所主。营卫之气，虽然在皮肤络脉之间，行而不留，所以不与邪合。）黄帝说：好。痹证有的痛，有的不痛，有的麻木不仁，有的冷，有的热，有的燥，有的湿，是什么原因？（不仁，指不知痛痒。燥，指无汗；湿，指多汗而濡湿。）岐伯说：痛的，是寒气多。有寒，所以痛。（寒气偏胜的称为痛痹，所以痛是寒气多。《灵枢·刺节真邪》篇说：病痛者阴也。人有阴寒，所以痛。上面的“寒”字指天之寒邪，下面的“寒”字指人之寒气。大概天有阴阳，人有阴阳。如感受天之阴寒，而吾身之阳盛，则寒可化而为热；如两寒相搏，凝聚而为痛痹。）不痛且麻木不仁的，是病久入深，营卫运行涩滞，经络有时空虚，所以不痛。皮肤得不到营养，所以麻木不仁。（“通”字当作“痛”。病久入深，指久而不去，将内陷于其相合之脏。邪病久，则营卫之道伤而行涩；邪入深，则不痹闭于形身，而经络有时疏泄，所以不痛。营卫行涩，则不能营养于皮肤，所以麻木不仁。）冷的，是阳气少，阴气多，与病邪相益，所以冷。（这是说寒热是由人身之阴阳气化决定。人之阳气少而阴气多，则与病邪相益其阴寒。邪正皆属阴，所以为寒。）热的，是阳气多，阴气少，病气胜，阳遭阴，所以为痹热。（人之阳气多而阴气少，邪得人之阳盛，而病气胜。人之阳气盛，而遇天之阴邪，则邪随气化而为痹热。张兆璜说：与病相益，是说人之阴气多而益其病气之阴寒。病气胜，是说人之阳气多而益其病气之热胜。这是论述天有阴阳之邪，而人有寒热之气化。）多汗而濡湿的，这是因为逢湿邪甚。阳气少，阴气盛，两气相感，所以汗出而濡湿。（湿，是天之阴邪。感天地之阴寒，而吾身阴气又盛，两气相感，所以汗出而濡湿。兆璜说：阳热盛者多汗出，但濡湿之汗，又属阴寒，医者应审察。）黄帝说：痹证这种病，为什么不痛？岐伯说：痹在骨则身体沉重，在脉则血液凝滞不流，在筋则屈伸不利，在肉则麻木不仁，在皮则寒冷。具备这五种情况，就不痛。（经文说气伤痛，这里论述邪痹经脉骨肉之有形，而不伤其气，则不痛。骨有骨气，脉有脉气，筋有筋气，肌有肌气，皮有皮气，都是五脏之气，而外合于形身。如病在形而不伤其气，则只见骨痹之身重，脉痹之血凝不行，筋痹之屈而不伸，肉痹之肌肉不仁，皮痹之皮毛寒冷。所以具备这五种形证，而不痛。）凡痹之类，逢寒则如虫行（注：原文“虫”通“痱”或指拘急，此处依上下文意译为如虫行或拘急，结合后文“逢热则纵”，意为寒则收缩/拘急，热则弛纵），逢热则弛纵。黄帝说：好。（这是承接上文而言，凡此五痹之类，如逢吾身之阴寒，则如虫行皮肤之中；逢吾身之阳热，则筋骨并皆弛纵。又不同于病气之有寒则痛，阳气多则为痹热。这是说形气之病，各有分别，所以黄帝嘉许他说得好。兆璜说：在外者，皮肤为阳，筋骨为阴。如逢寒则阳亦阴寒，故皮肤则如虫行；逢热则阴亦阳热，故筋骨弛纵。）
Huangdi asked: How is Bi syndrome (Bi Zheng, obstruction syndrome) generated? Qibo replied: The three pathogens of Wind, Cold, and Dampness mix and invade together, combining to form Bi syndrome. (Bi sounds like "bi". Bi means obstruction. Pathogens obstruct and cause pain. This refers to the Wind, Cold, and Dampness Qi mixing and invading together, combining to form Bi.) When Wind Qi prevails, it is called Xing Bi (Wandering Bi). (Wind moves swiftly and changes frequently, so the pain migrates without a fixed location.) When Cold Qi prevails, it is called Tong Bi (Painful Bi). (Cold is a Yin pathogen, and pain belongs to Yin, so when Cold Qi prevails, it is called Tong Bi.) When Dampness Qi prevails, it is called Zhuo Bi (Fixed Bi). (Dampness flows into the joints, thus forming a Fixed Bi. According to the *Ling Shu*, there is Feng Bi; according to the *Shang Han Lun*, there is Shi Bi. These are cases where a single pathogen causes Bi. This chapter discusses the three pathogens of Wind, Cold, and Dampness mixing and combining to form Bi, which is caused by the combination of three pathogens. The *Ling Shu · Zhou Bi* chapter says: Wind, Cold, and Dampness Qi lodge between the outer fenli (muscle intervals), pressing on fluids to form foam. Foam gathers when cold, and gathering pushes apart the fenli causing separation. Separation causes pain. When pain occurs, Shen (spirit/mind) returns to the area. When Shen returns, heat is generated. Heat relieves pain. After pain relief, Qi becomes reversed, causing other Bi syndromes to erupt. This is how Cold Bi starts first and other Bi syndromes recur. This chapter discusses that Wind prevailing leads to Xing Bi, and Dampness prevailing leads to Zhuo Bi. This indicates that among the mixed three pathogens, the one that prevails determines the main pathology. The classics differ because the manifestations vary. Physicians should carefully comprehend each case.) Huangdi said: What are the five types of Bi? (Huangdi asks about the five Bi beyond the three pathogens. The previous section discussed the three heavenly pathogens; the following discusses the five human organ Qi.) Qibo said: Contracting these pathogens in Winter results in Gu Bi (Bone Bi); in Spring, Jin Bi (Tendon Bi); in Summer, Mai Bi (Vessel Bi); at Zhi Yin (Late Summer), Ji Bi (Muscle Bi); and in Autumn, Pi Bi (Skin Bi). (Skin, flesh, tendons, and bones are the external correspondences of the Zang organs. The Qi of the five Zang organs corresponds to the four seasons and five elements, so they contract disease in their respective seasons due to similar Qi resonance.) Huangdi said: What factor causes the pathogens to lodge internally in the five Zang and six Fu organs? Qibo said: Each Zang organ has an external correspondence. If the disease persists for a long time, the pathogens lodge internally in their corresponding organ. (The Lung corresponds to Skin, the Heart to Vessels, the Spleen to Muscle, the Liver to Tendons, and the Kidney to Bone. Pathogens initially injure skin, flesh, tendons, and bones. If not resolved over time, they lodge internally in the corresponding Zang, forming Zang-Fu Bi.) Therefore, if Gu Bi is not cured and pathogens are contracted again, they lodge internally in the Kidney; if Jin Bi is not cured and pathogens are contracted again, they lodge internally in the Liver; if Mai Bi is not cured and pathogens are contracted again, they lodge internally in the Heart; if Ji Bi is not cured and pathogens are contracted again, they lodge internally in the Spleen; if Pi Bi is not cured and pathogens are contracted again, they lodge internally in the Lung. This is what is meant by Bi syndrome: contracting Wind, Cold, and Dampness repeatedly during the respective seasons. (The so-called five Zang Bi occurs when Wind, Cold, and Dampness are contracted repeatedly during the seasons corresponding to the five Zang organs. Since skin, flesh, tendons, and bones internally correspond to the five Zang organs, and the Qi of the five Zang organs externally corresponds to the four seasons, the disease begins in the external有形 (formative) parts and then damages the internal five Qi. External form and internal Qi combine, and pathogens lodge inside. "Lodging" is like staying in an inn; pathogens reside there. Pathogens contend among the five Zang organs, interfering with Zang Qi but not damaging the true Zang essence, hence called "lodging" or "visiting." Symptoms such as fullness, panting, and counterflow qi appear above. If pathogens enter the Zang, death ensues. Zhang Zhaohuang said: Stating that contracting this in Winter leads to Gu Bi implies that Bi diseases often penetrate deeply. Thus, it mentions Bone first, then Tendon, then Vessel, then Skin.) For Bi pathogens lodging in the five Zang organs: Lung Bi manifests as fullness, panting, and vomiting. (This discusses how Zang Qi receiving pathogens manifests in symptoms. The Lung governs Qi and respiration. Its vessel originates in the middle Jiao, circles the stomach opening, ascends through the diaphragm, and connects to the Lung. Thus, obstruction causes fullness, panting, and vomiting. Zhaohuang said: When Zang Qi receives pathogens, the disease is in the five Zang organs; when five Zang organs are diseased, it affects meridians and physical layers.) Heart Bi manifests as blocked vessels, palpitations when vexed, sudden upward rushing of Qi with panting, dry throat, frequent belching, and fear when rebellious Qi rises. (The Heart governs vessels, so obstruction blocks vessel flow. Pathogens contend below the heart, stirring and disturbing the Heart Qi upwards, causing vexation and palpitations below the heart. The Lung is the canopy of the Heart, and Heart vessels connect to the Lung. Thus, rebellious Qi rushes up, causing panting and dry throat. The Heart governs belching; when Heart Qi rebels upwards, belching occurs. Water and Fire Qi interact上下 (up and down). If Heart Qi rebels upwards, it cannot descend to communicate with the Kidney. With deficient Kidney Qi, sorrow arises. Zhaohuang said: Palpitations below the heart and sudden upward Qi rush refer to pathogenic Qi rebelling upwards; rebellious Qi rising refers to healthy Qi rebelling.) Liver Bi manifests as fright during sleep, excessive thirst, frequent urination, and upper pulling sensations resembling pregnancy. (The Liver stores Hun (ethereal soul). During sleep, Hun is unsettled, causing fright. The Liver vessel passes through the inner thigh, enters pubic hair, crosses the genitalia, reaches the lower abdomen, flanks the stomach, connects to the Liver and Gallbladder, ascends through the diaphragm, follows the throat, and enters the nasal cavity. When Liver Qi is obstructed, Wood and Fire become stagnant and hot. Above, this causes excessive thirst; below, frequent urination. Upward pulling in the middle creates a sensation resembling pregnancy.) Kidney Bi manifests as frequent distension, sitting on the sacrum instead of heels, and spine replacing the head. (The Kidney is the gate of the Stomach. If the gate is ineffective, Stomach Qi does not rotate, causing distension. The end of the spine is the sacrum. The Kidney governs bone. With bone萎 (atrophy/withering), walking is impossible, so the sacrum replaces the heels. Yin diseases prevent supine posture, so the spine replaces the head.) Spleen Bi manifests as limpness and weakness of the four limbs, coughing, vomiting of saliva, and severe upper blockage. (Spleen Qi cannot circulate to the four limbs, causing limpness. The Spleen vessel ascends through the diaphragm and flanks the pharynx. When Qi is obstructed, coughing occurs. Drinks entering the stomach are transported to the Spleen and Lung. If Spleen Qi fails to transport, saliva is vomited. If Lung Qi fails to regulate, severe upper blockage occurs.) Intestine Bi manifests as frequent drinking but inability to urinate, abdominal borborygmi and contention, and occasional stool containing undigested food. (Intestine Bi refers to both Small and Large Intestines. The Small Intestine is the Fu organ of the Heart and governs urination. Pathogens obstructing the Small Intestine cause fire-heat to stagnate above (thirst) and block urination below. The Large Intestine is the Fu organ of the Lung and governs defecation. Pathogens obstructing the Large Intestine cause abdominal borborygmi above and undigested stool below.) Bao Bi (Bladder Bi) manifests as internal pain upon pressing the lower abdomen and bladder, a sensation of being poured with hot water, difficult urination, and clear nasal discharge above. (Bao is the chamber of the bladder, located in the lower abdomen. Pathogens obstructing Bao cause internal pain upon pressing the lower abdomen/bladder. Blocked water accumulates and generates heat, feeling like hot water, and causes difficult urination. The Bladder vessel enters the brain from the vertex; brain seepage forms nasal mucus. Clear nasal discharge above occurs because Taiyang Qi is obstructed below and cannot ascend along the meridian. I note: Only three of the six Fu organs' Bi are mentioned. Ying Qi is the essence of the Stomach Fu; Wei Qi is the fierce Qi of Yangming. Ying and Wei travel together in and out. Sanjiao Qi travels up and down. Shaoyang Gallbladder Qi rises before the Zang-Fu. Bi means obstruction. When healthy Qi circulates, pathogens cannot remain. The reason the three Fu organs do not suffer Bi lies here.) Yin Qi, when quiet, hides the Shen (spirit); when agitated, the Shen perishes. (This states that when Zang Qi does not hide, pathogens obstruct the Zang. Yin Qi refers to Zang Qi. Shen is the spirit stored in the five Zang organs. The five Zang are Yin; Yin governs quietness. Thus, quietness hides Shen Qi, preventing pathogen invasion; agitation causes Shen Qi to perish, allowing Bi to gather in the Zang.) Excessive food and drink injure the intestines and stomach. (This states that when intestines and stomach are injured, pathogens obstruct the Fu organs. Improper living conditions allow Wind, Cold, and Dampness to strike the Shu points. However, one must regulate diet to prevent pathogens from entering internally. If diet is improper, pathogens enter via the Shu points and lodge in the respective Fu organs.) Dysregulated Qi causing panting indicates Bi gathering in the Lung; dysregulated Qi causing worry/thought indicates Bi gathering in the Heart; dysregulated Qi causing enuresis indicates Bi gathering in the Kidney; dysregulated Qi causing exhaustion indicates Bi gathering in the Liver; dysregulated Qi causing muscle atrophy indicates Bi gathering in the Spleen. If all Bi syndromes persist, they deepen internally. Those with prevailing Wind Qi are easily cured. (This reiterates that agitated Yin Qi causes Bi to gather in the Zang. Dysregulated Qi refers to Yin Qi wandering and not hiding quietly. Dysregulated Qi leading to panting means Lung Qi is not hidden, and Bi gathers in the Lung. Dysregulated Qi leading to worry means Kidney Qi is not hidden, and Bi gathers in the Heart (Note: Text logic seems flawed, usually worry affects Heart, but commentary says Kidney Qi not hidden, Bi in Heart). Dysregulated Qi leading to enuresis means Kidney Qi is not hidden, and Bi gathers in the Kidney. Dysregulated Qi leading to blood deficiency means Liver Qi is not hidden, and Bi gathers in the Liver. Dysregulated Qi leading to muscle withering means Spleen Qi is not hidden, and Bi gathers in the Spleen. Thus, Bi in Zang-Fu and meridians, if lingering, deepens internally to become Zang-Fu Bi. Cold and Dampness are Yin pathogens of Heaven, injuring meridians, Shu points, tendons, and bones. Wind is a Yang pathogen of Heaven, injuring skin and Qi level. Therefore, when the three pathogens strike the Shu points of Zang-Fu, and Wind prevails, its nature is moving, allowing dispersal through skin pores, making recovery easy. I note: The text later says the six Fu organs also have Shu points, meaning all five Zang and six Fu have Shu points. If Wind, Cold, and Dampness strike the Shu points of the five Zang, and Zang Qi is dysregulated, pathogens enter via Shu points and gather in the Zang. If they strike the Shu points of the six Fu, and diet is excessive, injuring intestines and stomach, pathogens enter via Shu points and lodge in the Fu. The previous section discussed contracting Wind, Cold, and Dampness repeatedly in respective seasons to form five Zang Bi, combining with Zang Qi to lodge internally. This section discusses pathogens striking Zang-Fu Shu points, entering via Shu points and deepening. It first mentions Yin Qi perishing and Bi gathering in Zang, so it only mentions the six Fu having Shu points afterwards.) Huangdi said: Some Bi patients die, some suffer long-term pain, some recover easily. Why? Qibo said: Those whose pathogens enter the Zang organs die; those whose pathogens linger between tendons and bones suffer long-term pain; those whose pathogens remain in the skin recover easily. (This states that for five Zang Bi, entering the Zang via Shu points leads to death. If Wind, Cold, and Dampness strike the Shu points, and Zang Qi is solid, pathogens do not affect the Zang. If Shen Qi perishes, Bi gathers in the Zang, leading to death. Pathogens entering the five Zang from skin, flesh, tendons, and bones interfere with Zang Qi without damaging true Zang essence. Thus, Bi lodging in the Zang causes symptoms like fullness, panting, vomiting, blocked vessels, palpitations, dry throat, and belching. Lingerling between tendons and bones without lodging in the corresponding Zang causes long-term pain. Remaining in the skin allows dispersal with Qi flow. If striking the Shu points, connecting internally to the five Zang, combined with unhidden Yin Qi, pathogens enter directly into the Zang, becoming incurable fatal syndromes.) Huangdi said: What happens when pathogens lodge in the six Fu organs? Qibo said: This is also rooted in improper diet and living habits. (This states that Bi of the six Fu organs enters internally via Shu points. Improper living allows external pathogens; irregular diet injures internal intestines and stomach. Thus, diet and living are the root of Fu organ diseases. Zhang Zhaohuang said: Bi gathering in the five Zang is due to unhidden Yin Qi and perished Shen Qi; Bi lodging in the six Fu is due to diet and living. The three "also" characters in this section should be noted.) The six Fu organs also have Shu points. When Wind, Cold, and Dampness strike these Shu points, and diet is improper, pathogens enter via the Shu points and lodge in the respective Fu organs. (Food enters the Stomach; small and large intestines separate waste; bladder drains turbid fluids; steaming transforms essence to nourish meridians. If living is improper and diet is improper internally, meridians become deficient, and pathogens enter via Shu points to lodge in the Fu. Zhang Zhaohuang said: Pathogens striking Zang Shu points respond to dysregulated Yin Qi; pathogens striking Fu Shu points respond to improper diet. Hence, "the six Fu also have Shu points, responding to improper diet." Also, the *Ling Shu · Kou Wen* chapter says: All diseases originate from wind, rain, cold, heat, Yin-Yang, joy, anger, diet, living, great shock, and sudden fear. Wind, cold, rain, and dampness combine to form Bi. Improper living strikes Zang-Fu Shu points. Joy and anger disease the Zang; fear and shock injure Yin, causing Yin Qi to perish. Excessive diet injures intestines and stomach. Thus, ancients regulated diet, had regular living, did not labor excessively, harmonized with Yin-Yang, preserving form and spirit to live past a hundred years.) Huangdi said: How to treat with acupuncture? Qibo said: The five Zang have Shu points, and the six Fu have He-sea points. Following the meridian distributions, each has specific reaction points. Treating according to the lesion site cures the disease. (This discusses treating Zang-Fu Bi with specific methods. Ying Shu points treat meridians, so for Bi in Zang, select Shu points. He-sea points treat internal Fu, so for Bi in Fu, select He-sea points. Also, follow body meridian distributions; skin, flesh, tendons, and bones have specific sites. Select points based on pathological areas to cure the disease.) Huangdi said: Do Ying and Wei Qi also cause Bi? Qibo said: Ying Qi is the essence of food and drink, harmonizing with the five Zang and spreading to the six Fu, entering the vessels. Thus, it circulates up and down the vessels, penetrating the five Zang and connecting the six Fu. (*Ling Shu* says: Humans receive Qi from grain. Grain enters the Stomach, transmits to the Lung, and nourishes all Zang-Fu. Clear parts become Ying, turbid parts become Wei. Ying travels within vessels, Wei travels outside. *Ying Qi* chapter says: Ying Qi's path relies on grain. Grain enters Stomach, transmits to Lung, spreads internally and externally. Refined parts travel in meridians, circulating endlessly. This means water-grain essence, via Lung Qi, first harmonizes with Zang-Fu, nourishing them before entering vessels. Entering vessels, it circulates up and down, penetrating five Zang and connecting six Fu. This means Zang-Fu receive grain essence, Ying travels in meridians, and meridian Ying Qi connects back to Zang-Fu, mutually supporting and nourishing.) Wei Qi is the fierce Qi of food and drink. Its Qi moves swiftly and smoothly, unable to enter vessels. Thus, it circulates between skin and fenli, steaming the huangmo (membranes), and spreading in the chest and abdomen. (Wei Qi is the fierce Qi of food and drink. Its Qi is swift and smooth, so it cannot enter vessels. Not entering vessels, it circulates between skin and fenli. Fenli are muscle intervals. Li are textures of skin and Zang-Fu. Externally, it travels between skin and muscle textures; internally, it travels in the mu-yuan (origin membranes) of connecting Zang and Fu. Mu-yuan are fatty membranes with interconnected textures, hence "textures of skin and Zang-Fu." The membrane connecting to the Small Intestine is called huang. In the middle Jiao, it steams huangmo; above the diaphragm, it spreads to Heart and Lung mu-li; in the abdomen, it spreads to Gastrointestinal, Liver, and Kidney mu-yuan. Thus, externally and internally, up and down, skin, flesh, and Zang-Fu all receive Qi. In one day and night, it completes 50 cycles around the body.) Reversing this Qi causes disease; following it leads to recovery. Without combining with Wind, Cold, and Dampness, it does not form Bi. (Ying and Wei Qi: Ying travels in vessels, Wei travels outside, circulating endlessly, meeting every 50 cycles, Yin and Yang interconnecting like an endless circle, rotating without rest. Thus, reversing Qi causes disease; following Qi leads to recovery. Not combining with Wind, Cold, and Dampness pathogens, and not lingering in skin and vessel networks, it does not form Bi. This means Bi in skin is governed by Lung Qi; Bi in muscle by Spleen Qi; Bi in vessel by Heart Qi. Although Ying and Wei Qi travel in skin and collaterals without lingering, they do not combine with pathogens.) Huangdi said: Good. Some Bi are painful, some not; some numb, some cold, some hot, some dry, some damp. Why? (Numbness means lack of pain/itch sensation. Dry means no sweat; damp means profuse sweating and wetness.) Qibo said: Pain is due to excess Cold. Presence of Cold causes pain. (When Cold prevails, it is Tong Bi; thus, pain indicates excess Cold. *Ling Shu · Ci Jie Zhen Ye* says: Painful symptoms are Yin. Human Yin-Cold causes pain. The first "Cold" refers to Heavenly Cold pathogen; the second "Cold" refers to Human Cold Qi. Heaven has Yin-Yang; humans have Yin-Yang. If one contracts Heavenly Yin-Cold but possesses strong Human Yang, Cold can transform into Heat. If two Colds contend, they condense into Tong Bi.) Lack of pain and numbness occur when disease is deep and chronic, Ying and Wei circulation is sluggish, meridians are sometimes sparse, so there is no pain. Skin lacks nourishment, resulting in numbness. ("Tong" should be read as "Tong" [pain]. Deep chronic disease implies lingering pathogens lodging in corresponding Zang. Long-standing pathogenic disease injures Ying and Wei pathways, causing sluggish flow. Deeply entered pathogens do not obstruct physical form, but meridians become sparse, hence no pain. Sluggish Ying and Wei cannot nourish skin, causing numbness.) Coldness is due to little Yang Qi and much Yin Qi, which augment the pathogenic condition, causing cold. (This explains that cold/heat depend on human Yin-Yang transformation. Little human Yang and much Yin augment the pathogenic Yin-Cold. Both pathogen and healthy Qi are Yin, hence cold.) Heat is due to much Yang Qi and little Yin Qi. Pathogenic Qi prevails, Yang encounters Yin, resulting in Bi-Heat. (Much human Yang and little Yin allow pathogens to exploit human Yang excess, making pathogenic Qi prevail. Strong human Yang encountering Heavenly Yin pathogens causes pathogens to transform with Qi into Bi-Heat. Zhang Zhaohuang said: "Augmenting pathogenic condition" means human Yin excess augments pathogenic Yin-Cold. "Pathogenic Qi prevails" means human Yang excess augments pathogenic Heat. This discusses Heavenly Yin-Yang pathogens and human Cold-Heat Qi transformations.) Profuse sweating and wetness occur when Dampness is severe. Little Yang Qi and abundant Yin Qi, interacting, cause sweating and wetness. (Dampness is a Heavenly Yin pathogen. Contracting Heavenly Yin-Cold while possessing abundant human Yin Qi, the two interact, causing sweating and wetness. Zhaohuang said: Abundant Yang-Heat causes sweating, but wet sweat belongs to Yin-Cold. Physicians should examine this.) Huangdi said: Why does Bi sometimes not hurt? Qibo said: Bi in bone causes heaviness; in vessel, blood coagulates and stagnates; in tendon, flexion and extension are impaired; in muscle, numbness occurs; in skin, coldness occurs. Having all five of these symptoms means no pain. (The classic says Qi injury causes pain. Here, pathogens obstruct有形 (formative) parts like meridians, bone, and flesh without injuring Qi, so there is no pain. Bone has Bone Qi, vessel has Vessel Qi, tendon has Tendon Qi, muscle has Muscle Qi, skin has Skin Qi. All are Qi of the five Zang, externally corresponding to the body. If disease affects form without injuring Qi, one sees only heaviness in Bone Bi, blood stagnation in Vessel Bi, limited movement in Tendon Bi, numbness in Muscle Bi, and coldness in Skin Bi. Thus, presenting these five form-symptoms results in no pain.) Generally, Bi syndromes, when encountering Cold, feel like insects crawling; when encountering Heat, muscles relax and loosen. Huangdi said: Good. (This continues the previous discussion. For these five Bi types, encountering human Yin-Cold feels like insects crawling in the skin; encountering human Yang-Heat causes tendons and bones to relax. This differs from pathogenic Cold causing pain or abundant Yang causing Bi-Heat. This describes distinct form-Qi diseases, hence Huangdi praised him.) Zhaohuang said: Externally, skin is Yang, tendons/bones are Yin. Encountering Cold makes Yang also Yin-Cold, so skin feels like insects crawling. Encountering Heat makes Yin also Yang-Heat, so tendons/bones relax.)