痹，闭也，血气凝涩不行也。有风寒湿三气之痹，有皮肌脉筋骨，五脏外合之痹，六腑有俞，五脏亦
有俞；五脏有合，六腑亦有合，故有五脏六腑之痹。荣卫流行，则不为痹，痹之为病，或痛、
或不痛、或不仁、或寒、或热、或燥、或湿，举而论之，故曰《痹论》。
黄帝问曰∶痹之安生？
周身经脉不和，拘挛闭痹，从何而生？
岐伯对曰∶风寒湿三气杂至，合而为痹也。其风气胜者为行痹，寒气胜者为痛痹，湿气胜
者为着痹也。
痹之生也，生于风寒湿三气，杂至于身，合于经脉而为痹也。三邪之中，复有偏胜，其风气胜者，风
无定体，故为行痹。寒气胜者，阴盛阳虚，故为痛痹。湿气胜者，留滞不行，故为着痹也。
帝曰∶其有五者何也？
四时合五行，其因时受邪，而有五痹者何也？
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。
痹，闭也。闭主冬，故论痹始于冬，以冬时遇此风寒湿三气者，则为骨痹；以春时遇此风寒湿三气者，
则为筋痹；以夏时遇此风寒湿三气者，则为脉痹；以长夏至阴遇此风寒湿三气者，则为肌
痹；以秋时遇此风寒湿三气者，则为皮痹，须知五痹，虽有在骨在筋在脉在肌在皮深浅之不同，亦以风
寒湿三邪之偏胜者，而有行痹痛痹着痹之各异也。
帝曰∶内舍五脏六腑，何气使然？
皮肌脉筋骨，既合四时之气，若内舍五脏六腑，则何气使然？
岐伯曰∶五脏皆有合，病久而不去者，内舍于其合也。
合，外内相合也，肾合骨，肝合筋，心合脉，脾合肌，肺合
皮，五脏皆有合也，痹病久而不去者，内舍于其所合，而为脏痹也。
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，重感于风寒湿气也。
重，平声。病久不去，则逾年矣，故骨痹不已，至冬复感于邪，则内舍于肾。筋痹不已，至春复感
于邪，则入舍于肝。脉痹不已，至夏复感于邪，则内舍于心。肌痹不已，至至阴复感于邪，则
内舍于脾。皮痹不已，至秋复感于邪，则内舍于肺。所谓内舍五脏
之痹者，乃病久不去，亦多以其时，重感于风寒湿之气也。
凡痹之客五脏者，肺痹者烦满，喘而呕。
重感于邪，则入于脏，故申言凡痹之客五脏者，肺脉起于中焦，为心之盖，故肺痹者，烦满，肺
主呼吸，脉循胃口，肺痹故喘而呕。
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，故心痹者脉不通。心虚则烦，故烦则心下鼓。鼓，犹动也。心脉上肺，故暴上气而喘。
《经脉》论云，心是动则病嗌干。《宣明五气篇》云，病心为噫。故嗌干善噫。心气下交于肾，
心厥气上，不交于肾，则恐。
肝痹者，夜卧则惊，多饮数小便，上为引如怀。
数，音朔，下同。人卧血归于肝，故肝痹者，夜卧则惊，木郁则热，故多饮，郁而不升，故数小便。
《经脉》论云，肝病丈夫 疝，妇人少腹肿，故上为引于下，有如怀物之状。
肾痹者，善胀，尻以代踵，脊以代头。
人之生气，发原于肾，生气不升，故善胀。尻，尾骨也。尾骨下
蹲，以代踵，足骨痿也；脊骨高耸以代头，天柱倾也。
脾痹者，四肢解堕发咳，呕汁，上为大塞。
脾主四肢，故脾痹者，四肢懈惰；土灌四旁，痹则上气不灌，气惟上逆，故发咳。入胃之饮，借
脾气以散精，痹则不能散精，故呕汁。脾气不能转输，则肺不能通调，故上为大塞。凡此皆痹之客于五脏也。
肠痹者，数饮而出不得，中气喘争，时发飧泄。
肠，小肠大肠也。小肠为心之腑。《灵枢·经水》论云，手太阳外合淮水，内合于小肠，而水道出焉。
小肠痹，则热郁于上，故数饮。气滞于下，故小便出不得。大肠为肺之腑。大肠痹，则中气
逆于上，故喘争；清浊混于下，故时发飧泄。
胞痹者，少腹膀胱，按之内痛，若沃以汤，涩于小便，上为清涕。
胞痹，即膀胱痹也。膀胱居于胞中，胞中位于少腹。故胞痹者，少腹膀胱，按之内痛，其痛也，若沃以
沸汤之热，膀胱之气不出于皮毛，则涩于小便，胞中之血，不渗于肤腠，则上为清涕。言
六腑之痹，不及胃胆三焦者，肠胃皆受糟粕，言肠不必更言胃矣。胞为经血之海，胆为中精之府，言胞不必
更言胆矣。三焦者，中渎之府，水道出焉，属膀胱。言膀胱，不必更言三焦矣，凡此言痹之客于六腑也。
阴气者，静则神藏，躁则消亡。
藏，如字。结上文藏痹之意。五脏为阴，以静为本，故阴气
者，宁静则神气内藏，躁扰不宁，则神气消亡，神气亡，致有五脏之痹矣。
饮食自倍，肠胃乃伤。
结上文腑痹之意。六腑为阳，传化饮食，若饮食自倍，则传化
有愆，而肠胃乃伤，肠胃伤，致有六腑之痹矣。
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。
溺，鸟去声。申明躁则消亡者，如淫乱之气，使人喘息而躁，
则痹聚在肺，而肺气消亡矣。淫乱之气，动人忧思而躁，则痹聚在心，而心气消亡矣。淫乱之气，令人遗
溺而躁，则痹聚在肾，而肾气消亡矣。淫乱之气，使气血乏竭而躁，则痹聚在肝，而肝气消亡
矣。淫乱之气，使肌肉断绝而躁，则痹聚在脾，而脾气消亡矣，此淫气内乱，致有五脏之痹，以明静则神
藏，躁则消亡之意。
诸痹不已，亦益内也，其风气胜者，其人易已也。
易，去声，下同。益，增也，申明肠胃乃伤者，诸腑痹不已，亦增五内之病也。其腑痹而风气胜者，
风以散之，不但不增内病，而其人之痹且易已也，以明肠胃乃伤之腑痹，重则益内，轻则易己之意。
帝曰∶痹其时有死者，或疼久者，或易已者，其故何也？
其病且有死者，有疼久者，今有易已者，其故何也？并举以问，殆欲详明易已之痹。
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。
痹时有死者，乃入藏者死，或疼久者，其留连筋骨间者，疼久，若其易已者，乃留于皮肤间者，易已。
帝曰∶其客于六腑者何也？
帝欲详明六腑之易已，故为是问。
岐伯曰∶此亦其食饮居处，为其病本也。
饮食自倍，肠胃乃伤，是为六腑之痹，故申言此亦其食饮居处，犹言食饮自倍，居处失宜，以为腑痹
之病本也。
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。
中，去声。五脏皆有合，而六腑亦各有俞，风寒湿三气中其俞，而食饮无节以应之，则风寒湿之邪，循
俞穴而入，各舍其腑也，与五脏之病久不去，复感于邪，内舍于其合者，同一义也。
帝曰∶以针治之奈何？
以针治六腑之痹，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。
不但六腑有俞，而五脏有俞，不但五脏有合，而六腑有合，循其六腑经脉之分行，各有所发之部，各随
其所过之路，因而针之，病可瘳也，此腑痹之所以易已也。
帝曰∶荣卫之气，亦令人痹乎？
承上文五脏六腑之痹，复问荣卫之气，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·荣气》篇云∶荣气之道，内谷为实，谷入于胃，乃传之肺，流溢于中，布散于外，精专
者，行于经隧，是荣气者，乃水谷之精气，以相资益也。其气先和调于五脏，次洒陈于六腑，乃能
资益其荣，而入行于脉中也。荣行脉中，故荣气循脉上下，从内出外，内则贯五脏，外则络六腑也。
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
盲膜，散于胸腹。
《灵枢·卫气》论云，其精气之行于经者为荣气，其浮气之不循经者为卫气，是卫者，乃水谷之
悍气，以相辅助也。其气 疾滑利，不能化精气而入行于脉中也，不入于脉，故但循于皮肤之中，
以及分肉之间，内则气熏于盲膜，外则气散于胸腹。
逆其气则病，从其气则愈，不与风寒湿气合，故不为痹。
承上文荣行脉中，卫行脉外之意，而言逆其荣卫之气则病，从其荣卫之气则愈。荣卫之气，循行不息，
不与风寒湿三气相合，是以不为痹也，承五脏六腑之痹，而申明荣卫之不为痹者如此。
帝曰∶善。痹或痛，或不痛，或不仁，或寒，或热，或燥，或湿，其故何也？
荣行脉中，卫行脉外，营运不息，故不为痹。所以风气胜而痹易已，帝故善之。复问痹或有身痛者，
或有身不痛者，或有不知痛痒而不仁者，或有身寒者，或有身热者，或有无汗而燥者，或有有
汗而湿者，其故何也？
岐伯曰∶痛者寒气多也，有寒故痛也。
痹之痛者，寒邪之气多也，身有寒，故痛也。寒气胜者，为痛痹，此之谓也。
其不痛不仁者，病久入深，荣卫之行涩，经络时疏，故不痛，
皮肤不营，故为不仁。
次痛，旧本讹通，今改。其痹之不痛与不仁者，痹病久而邪入深，病久则荣卫之行，失其常度而
涩矣。入深，则经脉络脉，时疏于外矣。荣卫行涩，经络时疏，血气外而不内，故不痛。其不仁
者，皮肤之血气，不营运于通体，皮肤不营，血气内而不外，故不知痛痒而为不仁。
其寒者，阳气少，阴气多，与病相益，故寒也。
其痹之有寒者，以人身阳气少，阴气多，阴气多而与病相益，故寒也。
其热者，阳气多，阴气少，病气胜，阳遭阴，故为痹热。
其痹之有热者，以人身阳气多，阴气少，阳气多则病阳气胜，
阳气胜而遭阴气之不胜，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。
其痹之多汗而濡者，此其逢湿气之甚也。其人身亦阳气少，阴气盛，湿，阴类也。阴气盛而逢湿，
是两气相感，故汗出而濡湿也，知阴气盛而主湿，则知阳气盛而主燥矣。此申明痛痒寒热燥湿之痹者如此。
帝曰∶夫痹之为病，不痛何也？
凡痹必痛，今夫痹之为病，有不痛者，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。
外内之气，不相交合则痛，病有形之皮肉筋脉骨，而气机得以
相交则不痛。如痹但在于骨，而筋脉皮肉之气自和，则身重而不痛；痹但在于脉，而皮肉筋骨之气自和，
则血凝不流而不痛；痹但在于筋，而皮肉骨脉之气自和，则屈不伸而不痛；痹但在于肉而皮
骨筋脉之气自和，则不仁而不痛；痹但在于皮，而骨肉筋脉之气自和，则寒而不痛，故不痛者。具此在骨在
脉在筋在肉在皮五者，余气得以相通，则不痛也。
凡痹之类，逢寒则虫，逢热则纵。
承上文痛痒寒热燥湿之痹，而曰凡痹之类。类，犹合也。谓寒合于湿，热合于燥也。如湿痹逢寒，
则寒湿相薄，故生虫，虫生则痒矣。燥痹逢热，则筋骨不濡，故纵。纵，弛纵也。弛纵则痛矣。
帝曰∶善。
上文未言燥痹，于此明之，帝故曰善。
痹，就是闭塞的意思，指血气凝滞、运行不畅。有由风寒湿三气引起的痹证，有对应皮、肌、脉、筋、骨以及五脏外合关系的痹证；六腑有输穴，五脏也有输穴；五脏有相合关系，六腑也有相合关系，因此有五脏六腑的痹证。营卫之气流行通畅，就不会发生痹证；痹证作为疾病，有的表现为疼痛，有的不痛，有的麻木不仁，有的发冷，有的发热，有的干燥，有的潮湿，全面论述这些情况，所以称为《痹论》。
黄帝问道：痹证是如何产生的？
周身经脉不和，导致拘挛闭塞，是从哪里产生的呢？
岐伯回答说：风、寒、湿三种邪气混杂侵入人体，结合在一起就形成了痹证。其中风气偏胜的，称为行痹（游走性痹证）；寒气偏胜的，称为痛痹（疼痛性痹证）；湿气偏胜的，称为着痹（重着性痹证）。
痹证的发生，源于风、寒、湿三气混杂于身体，与经脉相结合而形成痹证。在这三种邪气中，又有偏胜的情况：风气偏胜的，因为风邪没有固定形态，所以形成行痹；寒气偏胜的，因为阴盛阳虚，所以形成痛痹；湿气偏胜的，因为湿邪留滞不行，所以形成着痹。
黄帝问：那为什么又有五种痹证呢？
四时对应五行，因季节不同而感受邪气，从而产生五种痹证，这是为什么呢？
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。
痹，就是闭塞。闭塞主要对应冬季，所以论述痹证从冬季开始。如果在冬季感受风、寒、湿三气，就形成骨痹；在春季感受风、寒、湿三气，就形成筋痹；在夏季感受风、寒、湿三气，就形成脉痹；在长夏至阴之时感受风、寒、湿三气，就形成肌痹；在秋季感受风、寒、湿三气，就形成皮痹。需要知道的是，这五种痹证，虽然病位在骨、筋、脉、肌、皮的深浅有所不同，但也因风、寒、湿三邪的偏胜不同，而有行痹、痛痹、着痹的区别。
黄帝问：邪气内传舍居于五脏六腑，是什么气使然呢？
皮、肌、脉、筋、骨既然对应四时之气，如果内传舍居于五脏六腑，那么是什么气导致的呢？
岐伯说：五脏都有与其相合的组织，如果痹病日久不愈，就会内传舍居于其相合的脏腑。
所谓“合”，是指内外相合的关系。肾合骨，肝合筋，心合脉，脾合肌，肺合皮，五脏都有相合的关系。痹病日久不愈，就会内传舍居于其所合的脏腑，从而形成脏痹。
所以，骨痹如果不愈，再次感受邪气，就会内传舍居于肾。筋痹如果不愈，再次感受邪气，就会内传舍居于肝。脉痹如果不愈，再次感受邪气，就会内传舍居于心。肌痹如果不愈，再次感受邪气，就会内传舍居于脾。皮痹如果不愈，再次感受邪气，就会内传舍居于肺。所谓的痹证，都是在相应的季节，再次感受风、寒、湿邪气所致。
“重”读平声。病情长久不愈，就超过了一年。所以骨痹不愈，到了冬季再次感受邪气，就会内传舍居于肾；筋痹不愈，到了春季再次感受邪气，就会内传舍居于肝；脉痹不愈，到了夏季再次感受邪气，就会内传舍居于心；肌痹不愈，到了长夏至阴之时再次感受邪气，就会内传舍居于脾；皮痹不愈，到了秋季再次感受邪气，就会内传舍居于肺。所谓内传五脏的痹证，都是因病久不愈，也多是在相应的季节，再次感受风、寒、湿邪气所致。
凡是痹邪客居五脏的：肺痹表现为烦闷胀满，气喘且呕吐。
再次感受邪气，就会进入脏腑，所以进一步说明凡是痹邪客居五脏的情况。肺脉起于中焦，位于心的上方（为心之盖），所以肺痹会出现烦闷胀满；肺主呼吸，经脉循行经过胃的上口，所以肺痹会导致气喘和呕吐。
心痹表现为血脉不通，心烦时感到心下悸动，突然气逆上冲而气喘，咽喉干燥，容易嗳气，厥逆之气上冲则会产生恐惧感。
心主血脉，所以心痹表现为血脉不通。心气虚弱则心烦，所以心烦时感到心下悸动。“鼓”即跳动的意思。心脉上行至肺，所以突然气逆上冲而气喘。《经脉》篇说，心经发病会咽喉干燥。《宣明五气》篇说，心病表现为嗳气。所以会出现咽喉干燥和容易嗳气。心气本应下交于肾，如果心气厥逆上冲，不能下交于肾，就会产生恐惧感。
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。
“数”读朔音，下同。人卧睡时血液归于肝脏，所以肝痹患者夜间睡眠易惊；木气郁结则生热，所以多饮；气机郁结不能上升，所以小便频数。《经脉》篇说，肝病男子患疝气，女子少腹肿胀，所以上部牵引下部，有如怀物之感。
肾痹表现为容易腹胀，尾骨着地代替脚跟行走，脊柱高耸代替头部直立。
人体的生气，发源于肾，生气不能升发，所以容易腹胀。“尻”是尾骨。尾骨下蹲，以代替脚跟（足骨痿弱无力）；脊柱高耸，以代替头部（天柱骨倾斜）。
脾痹表现为四肢懈怠无力，引发咳嗽，呕吐清水，上部严重痞塞不通。
脾主四肢，所以脾痹患者四肢懈怠无力；土气灌溉四旁，痹阻则上焦之气不能灌溉，气机上逆，所以引发咳嗽。进入胃中的水饮，依赖脾气来散布精微，痹阻则不能散布精微，所以呕吐清水。脾气不能转输，则肺气不能通调水道，所以上部出现严重痞塞。凡此种种，都是痹邪客居五脏的表现。
肠痹表现为多次饮水但小便排不出，腹部肠间气机紊乱作响，时常发生完谷不化的泄泻。
“肠”指小肠和大肠。小肠是心的腑。《灵枢·经水》篇说，手太阳小肠经外合淮水，内合于小肠，水道由此而出。小肠痹阻，则热邪郁结于上，所以多饮；气机阻滞于下，所以小便排不出。大肠是肺的腑。大肠痹阻，则中焦之气逆乱于上，所以气喘争鸣；清浊之气混淆于下，所以时常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，感觉像灌了热水一样灼热，小便涩滞不畅，上部流出清涕。
“胞痹”即膀胱痹。膀胱位于胞中，胞中位于小腹。所以胞痹患者小腹部膀胱处，按压内部疼痛，那种疼痛感，就像灌了沸水般的灼热；膀胱的气机不能出于皮毛，则小便涩滞不畅；胞中的血液不能渗入肤腠，则上部流出清涕。这里论述六腑的痹证，没有提到胃、胆、三焦，是因为肠胃都受纳糟粕，说了肠就不必再说胃了。胞是经血汇聚的海，胆是中精之府，说了胞就不必再说胆了。三焦是中渎之府，水道由此而出，隶属于膀胱。说了膀胱，就不必再说三焦了。凡此种种，是论述痹邪客居六腑的情况。
阴气，安静时神气内藏，躁动时神气消亡。
“藏”按字面读音。总结上文关于脏痹的意思。五脏属阴，以安静为本，所以阴气宁静则神气内藏，躁扰不宁则神气消亡，神气消亡，从而导致五脏痹证。
饮食过量一倍，肠胃就会受伤。
总结上文关于腑痹的意思。六腑属阳，负责传化饮食，如果饮食过量一倍，则传化功能失常，肠胃就会受伤，肠胃受伤，从而导致六腑痹证。
淫乱之气导致喘息，痹邪聚积在肺。淫乱之气导致忧思，痹邪聚积在心。淫乱之气导致遗尿，痹邪聚积在肾。淫乱之气导致气血乏竭，痹邪聚积在肝。淫乱之气导致肌肉断绝，痹邪聚积在脾。
“溺”读鸟去声。进一步说明躁动则神气消亡的道理，比如淫乱之气，使人喘息而躁动，则痹邪聚积在肺，肺气消亡；淫乱之气，扰动人心致忧思而躁动，则痹邪聚积在心，心气消亡；淫乱之气，令人遗尿而躁动，则痹邪聚积在肾，肾气消亡；淫乱之气，使气血乏竭而躁动，则痹邪聚积在肝，肝气消亡；淫乱之气，使肌肉断绝而躁动，则痹邪聚积在脾，脾气消亡。这是淫乱之气在内扰乱，导致五脏痹证，以此阐明安静则神气内藏，躁动则神气消亡的道理。
各种痹证如果不愈，也会逐渐向内深入。其中风气偏胜的，病人容易痊愈。
“易”读去声，下同。“益”意为增加。进一步说明肠胃受伤的情况，各种腑痹如果不愈，也会增加五脏内部的病变。如果是腑痹且风气偏胜，风邪能散解邪气，不仅不会增加内脏病变，而且病人的痹证也容易痊愈，以此阐明肠胃受伤的腑痹，重则向内深入，轻则容易痊愈的道理。
黄帝问：痹证有时有死亡的，有的疼痛长久不愈，有的容易痊愈，这是什么原因呢？
有的病有死亡的情况，有的疼痛长久，有的容易痊愈，这是什么原因呢？一并提问，大概是想要详细阐明容易痊愈的痹证。
岐伯说：邪气传入五脏的，会死亡；邪气留恋在筋骨之间的，疼痛长久；邪气停留在皮肤间的，容易痊愈。
痹证有时有死亡的情况，那是邪气入脏者死；有的疼痛长久，是邪气留恋在筋骨之间者疼久；有的容易痊愈，是邪气停留在皮肤间者易愈。
黄帝问：邪气客居六腑的情况是怎样的呢？
黄帝想要详细阐明六腑痹证容易痊愈的原因，所以这样问。
岐伯说：这也是由于饮食起居不当，成为疾病的根本。
饮食过量一倍，肠胃就会受伤，这就是六腑痹证，所以进一步说明这也是由于饮食起居不当，也就是饮食过量，居住处所失宜，作为腑痹病的根本原因。
六腑也各有输穴，风、寒、湿邪气中伤其输穴，而饮食起居与之相应，邪气顺着输穴进入，各自舍居于相应的腑。
“中”读去声。五脏都有相合关系，六腑也各有输穴，风、寒、湿三邪气中伤其输穴，而饮食无节制以响应它，那么风、寒、湿邪气，顺着俞穴进入，各自舍居于相应的腑，这与五脏因病久不愈，再次感受邪气，内传舍居于其相合脏腑的道理是一样的。
黄帝问：用针刺治疗怎么样呢？
用针刺治疗六腑痹证，怎么做呢？
岐伯说：五脏有输穴，六腑有合穴，沿着经脉的分界，各有所发生的部位，根据邪气停留的过路之处进行针刺，病就能痊愈。
不仅是六腑有输穴，五脏也有输穴；不仅是五脏有合穴，六腑也有合穴。沿着六腑经脉的分行，各有所发生的部位，根据邪气停留的路径，因而进行针刺，病就可以痊愈，这就是腑痹之所以容易痊愈的原因。
黄帝问：营卫之气，也会导致人得痹证吗？
承接上文关于五脏六腑痹证的讨论，又问营卫之气，是否也会导致人得痹证呢？
岐伯说：营气是水谷的精微精气，调和于五脏，洒布陈设于六腑，才能进入脉中，所以沿着经脉上下运行，贯通五脏、联络六腑。
《灵枢·营气》篇说：营气的运行之道，以内谷为充实，谷物进入胃中，然后传送到肺，流溢于中，布散于外，精纯专一的，运行于经隧之中。营气是水谷的精微精气，相互资助增益。其气先调和于五脏，其次洒布于六腑，才能资助荣气，进入并运行于脉中。营行于脉中，所以营气沿着经脉上下运行，从内出外，对内贯通五脏，对外联络六腑。
卫气，是水谷的悍烈之气，其气运行疾速滑利，不能进入脉中，所以沿着皮肤之中，分肉之间，熏蒸于盲膜，散布于胸腹。
《灵枢·卫气》篇说，运行于经脉中的精气是营气，浮行不循经脉的是卫气。卫气是水谷的悍烈之气，相互辅助。其气运行疾速滑利，不能化为精气而进入运行于脉中，不入于脉，所以只循行于皮肤之中，以及分肉之间，对内熏蒸于盲膜，对外散布于胸腹。
违背营卫之气的正常运行就会生病，顺应营卫之气就会痊愈，营卫之气不与风、寒、湿邪气结合，所以不会形成痹证。
承接上文营行脉中、卫行脉外的意思，来说明违背营卫之气就会生病，顺应营卫之气就会痊愈。营卫之气循环运行不息，不与风、寒、湿三邪气相合，因此不会形成痹证，承接五脏六腑痹证，而申明营卫之气不形成痹证的原因如此。
黄帝说：好。痹证有的疼痛，有的不痛，有的麻木不仁，有的发冷，有的发热，有的干燥，有的潮湿，这是什么原因呢？
营行脉中，卫行脉外，营运不息，所以不会形成痹证。之所以风气偏胜而痹证容易痊愈，黄帝对此表示赞许。又问痹证有的身体疼痛，有的身体不痛，有的不知痛痒而不仁，有的身体发冷，有的身体发热，有的无汗而干燥，有的有汗而潮湿，这是什么原因呢？
岐伯说：疼痛的，是因为寒气多，因为有寒所以疼痛。
痹证疼痛的，是因为寒邪之气多，身体有寒，所以疼痛。寒气偏胜的，称为痛痹，说的就是这个道理。
那些不痛且不仁的，是因为病久入深，营卫运行涩滞，经络时而空虚，所以不痛，皮肤得不到濡养，所以麻木不仁。
“次痛”二字，旧本讹误为“通”，今改为“次”。那些痹证不痛且不仁的，是因为痹病日久邪气入深，病久则营卫的运行失去常度而变得涩滞。入深，则经络脉络，在外部时而疏漏。营卫运行涩滞，经络时而疏漏，血气向外而不向内，所以不痛。那些不仁的，是因为皮肤的血气，不在全身营运，皮肤得不到濡养，血气在内而不向外，所以不知痛痒而成为不仁。
那些发冷的，是因为阳气少，阴气多，阴气与病邪相助，所以发冷。
痹证发冷的，是因为人身阳气少，阴气多，阴气多而与病邪相助，所以发冷。
那些发热的，是因为阳气多，阴气少，病气偏胜，阳气遭受阴气压制，所以形成痹热。
痹证发热的，是因为人身阳气多，阴气少，阳气多则病邪阳气偏胜，阳气偏胜而遭受阴气不胜的对抗，所以形成痹热。
那些多汗而湿润的，是因为逢受了甚重的湿气。阳气少，阴气盛，两气相互感应，所以出汗而湿润。
痹证多汗而湿润的，是因为逢受了甚重的湿气。其人也是阳气少，阴气盛，湿属于阴类。阴气盛而逢受湿气，是两气相互感应，所以出汗而湿润。知道阴气盛而主湿，就知道阳气盛而主燥了。此处申明了疼痛、瘙痒、寒冷、发热、干燥、潮湿等痹证的情况。
黄帝问：痹证作为疾病，为什么不痛呢？
凡是痹证必然疼痛，现在痹证作为疾病，有不痛的，是什么原因呢？
岐伯说：痹邪在骨，则身体沉重；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，则发冷。所以具备这五种情况，就不会疼痛。
内外之气不相交合就会疼痛，病在有形的皮肉筋脉骨，而气机得以相交就不会疼痛。比如痹邪仅在骨，而筋脉皮肉之气自然调和，则身重而不痛；痹邪仅在脉，而皮肉筋骨之气自然调和，则血凝不流而不痛；痹邪仅在筋，而皮肉骨脉之气自然调和，则屈曲不能伸展而不痛；痹邪仅在肉，而皮骨筋脉之气自然调和，则麻木不仁而不痛；痹邪仅在皮，而骨肉筋脉之气自然调和，则发冷而不痛。所以不痛的，是具备了在骨、在脉、在筋、在肉、在皮这五种情况，其余之气得以相通，就不会疼痛。
凡是痹证之类，逢受寒邪则如虫行作痒，逢受热邪则弛纵无力。
承接上文关于疼痛、瘙痒、寒冷、发热、干燥、潮湿的痹证，而说凡是痹证之类。“类”犹言合。指寒合于湿，热合于燥。比如湿痹逢受寒邪，则寒湿相迫，所以生虫，虫行则痒。燥痹逢受热邪，则筋骨不濡润，所以弛纵。“纵”即弛纵。弛纵则会疼痛。
黄帝说：好。
上文未提及燥痹，在此阐明，黄帝所以说好。
Bi (Obstruction Syndrome) refers to blockage, where blood and qi congeal and fail to circulate. There are Bi syndromes caused by the three pathogens of Wind, Cold, and Dampness; there are Bi syndromes corresponding to the skin, muscle, vessels, sinews, bones, and the external correspondences of the Zang organs; the Fu organs have Shu points, and the Zang organs also have Shu points; the Zang organs have internal-external correspondences, and the Fu organs also have correspondences. Therefore, there are Bi syndromes of the Zang and Fu organs. When Ying (Nutritive) and Wei (Defensive) Qi circulate freely, Bi does not occur. As a disease, Bi may manifest as pain, no pain, numbness, cold sensation, heat sensation, dryness, or dampness. Discussing all these aspects comprehensively, it is called "Treatise on Bi" (Bi Lun).
The Yellow Emperor asked: How does Bi arise?
When the meridians throughout the body are disharmonious, leading to spasms and obstruction, from where does it originate?
Qibo replied: The three pathogens—Wind, Cold, and Dampness—mix and invade together, combining to form Bi. If Wind Qi is predominant, it is called Xing Bi (Wandering Bi); if Cold Qi is predominant, it is called Tong Bi (Painful Bi); if Dampness Qi is predominant, it is called Zhuo Bi (Fixed/Heaviness Bi).
Bi arises from Wind, Cold, and Dampness mixing in the body and combining with the meridians to form Bi. Among these three pathogens, one may be predominant. Predominant Wind, having no fixed form, results in Wandering Bi. Predominant Cold, characterized by Yin excess and Yang deficiency, results in Painful Bi. Predominant Dampness, which lingers and stagnates, results in Fixed Bi.
The Yellow Emperor asked: Why are there five types of Bi?
The four seasons correspond to the Five Phases. Due to seasonal pathogenic invasion, why do five types of Bi arise?
Qibo said: Contracting this [Wind-Cold-Damp] in Winter results in Gu Bi (Bone Bi); in Spring, Jin Bi (Sinew Bi); in Summer, Mai Bi (Vessel Bi); during the late summer (Zhi Yin period), Ji Bi (Muscle Bi); and in Autumn, Pi Bi (Skin Bi).
Bi means blockage. Blockage corresponds to Winter, so the discussion of Bi begins with Winter. Contracting Wind, Cold, and Dampness in Winter leads to Bone Bi; in Spring, Sinew Bi; in Summer, Vessel Bi; in late summer, Muscle Bi; and in Autumn, Skin Bi. It must be understood that although the five Bies differ in depth (bone, sinew, vessel, muscle, skin), they also vary as Wandering, Painful, or Fixed Bi due to the predominance of Wind, Cold, or Dampness.
The Yellow Emperor asked: What causes the pathogens to enter and reside within the Zang and Fu organs?
Since skin, muscle, vessels, sinews, and bones correspond to the four seasons' Qi, what causes them to internally reside in the Zang and Fu organs?
Qibo said: Each Zang organ has an external correspondence. If Bi persists for a long time without resolving, it will internally reside in its corresponding Zang organ.
"Correspondence" refers to the mutual connection between interior and exterior. Kidney corresponds to bone; Liver to sinews; Heart to vessels; Spleen to muscle; Lung to skin. Each Zang has such a correspondence. If Bi persists, it internally resides in its corresponding Zang, forming Zang Bi.
Thus, if Bone Bi persists and re-exposure to pathogens occurs, it internally resides in the Kidney. If Sinew Bi persists and re-exposure occurs, it resides in the Liver. If Vessel Bi persists and re-exposure occurs, it resides in the Heart. If Muscle Bi persists and re-exposure occurs, it resides in the Spleen. If Skin Bi persists and re-exposure occurs, it resides in the Lung. This is referred to as Bi, occurring when one re-contracts Wind, Cold, and Dampness during their respective seasons.
"Prolonged" implies more than a year. Thus, if Bone Bi persists into Winter and re-exposure occurs, it enters the Kidney. If Sinew Bi persists into Spring, it enters the Liver. If Vessel Bi persists into Summer, it enters the Heart. If Muscle Bi persists into late summer, it enters the Spleen. If Skin Bi persists into Autumn, it enters the Lung. These internal Zang Bies result from prolonged illness and re-exposure to Wind, Cold, and Dampness during the appropriate seasons.
Regarding Bi residing in the Zang organs: Lung Bi manifests as irritability, fullness, panting, and vomiting.
Re-exposure allows entry into the Zang. The Lung meridian originates in the middle jiao and covers the Heart; thus, Lung Bi causes irritability and fullness. The Lung governs respiration, and its meridian passes through the stomach region; thus, it causes panting and vomiting.
Heart Bi manifests as blocked vessels, palpitations upon irritation, sudden upward rushing of Qi causing panting, dry throat, frequent belching, and fear when rebellious Qi ascends.
The Heart governs vessels, so Heart Bi involves vessel blockage. Heart deficiency causes irritability, leading to palpitations ("drumming"). The Heart meridian ascends to the Lung, causing sudden Qi rush and panting. The *Jingmai* chapter states Heart disorders cause dry throat; the *Xuanming Wuqi* chapter states Heart disease causes belching. Normally, Heart Qi descends to the Kidney; if rebellious Qi ascends without descending, fear ensues.
Liver Bi manifests as fright during sleep, excessive thirst, frequent urination, and upper-body pulling sensations resembling pregnancy.
Blood returns to the Liver during sleep; thus, Liver Bi causes night frights. Wood stagnation generates heat, causing thirst. Stagnation prevents ascending, causing frequent urination. The *Jingmai* chapter mentions Liver disease causes hernia in men and lower abdominal swelling in women, explaining the pulling sensation.
Kidney Bi manifests as frequent distension, walking with the sacrum replacing the heels (due to weak leg bones), and the spine erecting to replace the head (due to tilting of the Tianzhu pillar/spine).
Life Qi originates in the Kidney; failure to ascend causes distension. The sacrum replaces the heels when squatting due to leg weakness; the spine rises high, replacing the head's position.
Spleen Bi manifests as flaccidity of the four limbs, coughing, vomiting of clear fluid, and severe upper obstruction.
The Spleen governs the four limbs, causing flaccidity. Earth Qi normally nourishes all directions; Bi prevents this, causing Qi rebellion and coughing. The Spleen disperses essence from ingested fluids; Bi prevents this, causing vomiting of clear fluid. Spleen failure to transport affects Lung water regulation, causing upper obstruction. These are manifestations of Bi in the Zang organs.
Intestine Bi manifests as frequent drinking but inability to urinate, abdominal Qi turbulence, and occasional undigested stool diarrhea.
"Intestines" refer to Small and Large Intestines. The Small Intestine is the Fu of the Heart. Its disorder causes Heat stagnation above (thirst) and Qi stagnation below (urinary retention). The Large Intestine is the Fu of the Lung. Its disorder causes Middle Jiao Qi rebellion (panting/turbulence) and mixing of clear/turbid below (undigested diarrhea).
Bao (Bladder/Uterus) Bi manifests as internal pain upon pressing the lower abdomen/bladder, a sensation of boiling heat, difficult urination, and clear nasal discharge above.
"Bao Bi" is Bladder Bi. The Bladder resides in the lower abdomen. Pressure causes internal pain like boiling water. Bladder Qi failing to reach the skin causes urinary difficulty; Bao blood failing to seep into the skin causes clear nasal discharge. The text omits Stomach, Gallbladder, and San Jiao because discussing Intestines covers the Stomach; Bao covers the Gallbladder; and Bladder covers the San Jiao (which connects to the Bladder). These describe Bi in the Fu organs.
Yin Qi: Stillness allows Spirit to reside; agitation causes Spirit to perish.
This summarizes Zang Bi. Zang organs are Yin, rooted in stillness. Stillness keeps Spirit inside; agitation causes Spirit to perish, leading to Zang Bi.
Excessive food and drink injure the intestines and stomach.
This summarizes Fu Bi. Fu organs are Yang, responsible for digestion. Excess intake disrupts transformation, injuring the intestines/stomach, leading to Fu Bi.
Licentious Qi causing panting indicates Bi gathering in the Lung. Licentious Qi causing worry indicates Bi gathering in the Heart. Licentious Qi causing enuresis indicates Bi gathering in the Kidney. Licentious Qi causing exhaustion indicates Bi gathering in the Liver. Licentious Qi causing muscle atrophy indicates Bi gathering in the Spleen.
"Liao" sounds like "niao". This explains how licentious/agitated Qi destroys Spirit. Agitated Qi causing panting gathers Bi in the Lung; worrying Qi gathers Bi in the Heart; enuresis Qi gathers Bi in the Kidney; exhausting Qi gathers Bi in the Liver; muscle-atrophying Qi gathers Bi in the Spleen. This illustrates that internal disorder leads to Zang Bi, confirming that stillness preserves Spirit while agitation destroys it.
If various Bies persist, they deepen internally. However, if Wind is predominant, recovery is easier.
"Yi" means easy. Persistent Fu Bi deepens internal disease. However, if Wind predominates in Fu Bi, Wind disperses the pathogen, preventing internal deepening and facilitating easier recovery. This contrasts severe internal deepening with mild, easily cured cases.
The Yellow Emperor asked: Why does Bi sometimes cause death, sometimes chronic pain, and sometimes resolve easily?
Why do some cases die, some suffer chronic pain, and some recover easily?
Qibo said: Those entering the Zang die; those lingering in sinews and bones suffer chronic pain; those remaining in the skin recover easily.
Death results from Zang involvement. Chronic pain results from lingering in sinews/bones. Easy recovery results from remaining in the skin.
The Yellow Emperor asked: What about Bi in the Fu organs?
Seeking clarification on why Fu Bi recovers easily.
Qibo said: This is also due to improper diet and lifestyle being the root cause.
Excessive eating/drinkings injures the intestines/stomach, causing Fu Bi. Improper diet and living habits are the root of Fu Bi.
The Fu organs each have Shu points. Wind, Cold, and Dampness strike these points, and dietary/lifestyle factors respond, allowing pathogens to enter via the points and reside in the respective Fu organs.
Pathogens strike the Shu points, and unregulated diet/lifestyle facilitates entry via these points into the Fu organs. This parallels the mechanism of Zang Bi, where prolonged illness and re-exposure lead to internal residence.
The Yellow Emperor asked: How should acupuncture treat this?
How to use acupuncture for Fu Bi?
Qibo said: The Zang organs have Shu points, and the Fu organs have He-sea points. Following the meridian divisions and sites of manifestation, treating according to the location of the pathology will cure the disease.
Treating along the meridian pathways at the specific locations of pathology using Shu and He-sea points can cure the disease, explaining why Fu Bi is easily cured.
The Yellow Emperor asked: Do Ying and Wei Qi also cause Bi?
Following the discussion on Zang/Fu Bi, asking if Ying/Wei Qi can cause Bi.
Qibo said: Ying Qi is the refined essence of food and drink. It harmonizes with the Zang organs, spreads to the Fu organs, and enters the vessels. Thus, it circulates up and down the vessels, connecting the Zang and Fu organs.
Ying Qi comes from grain, enters the Stomach, transmits to the Lung, and flows through the meridians. It harmonizes the Zang and Fu before entering the vessels. Since Ying moves within the vessels, it connects the interior Zang and exterior Fu.
Wei Qi is the fierce Qi of food and drink. It moves swiftly and smoothly, cannot enter the vessels, and thus circulates within the skin and between muscles, steaming the blind membranes and dispersing in the chest and abdomen.
Wei Qi is the floating Qi that does not follow the meridians. It moves swiftly, stays outside the vessels, circulates in the skin/muscles, steams the interior membranes, and disperses in the chest/abdomen.
Violating this Qi causes disease; following it leads to health. Since it does not combine with Wind, Cold, or Dampness, it does not cause Bi.
Adhering to normal Ying/Wei circulation prevents disease. Since Ying/Wei Qi circulates continuously and does not combine with Wind/Cold/Dampness, it does not form Bi. This clarifies why Ying/Wei Qi itself does not cause Bi.
The Yellow Emperor said: Excellent. Why does Bi sometimes cause pain, sometimes no pain, sometimes numbness, sometimes cold, sometimes heat, sometimes dryness, sometimes dampness?
Acknowledging that free Ying/Wei flow prevents Bi and Wind-predominant Bi is easy to cure, the Emperor asks about the varying symptoms: pain, no pain, numbness, cold, heat, dryness, dampness.
Qibo said: Pain is due to abundant Cold; presence of Cold causes pain.
Pain in Bi is caused by excess Cold pathogens. This corresponds to Painful Bi.
Those with no pain and numbness have had the disease for a long time, entering deeply. Ying and Wei circulation becomes sluggish, and meridians become intermittently empty, hence no pain. The skin lacks nourishment, resulting in numbness.
Long-standing Bi allows pathogens to penetrate deeply. Sluggish Ying/Wei flow and intermittent meridian emptiness prevent pain. Lack of blood/qi nourishment to the skin causes numbness.
Cold sensation occurs when Yang Qi is scarce and Yin Qi is abundant; Yin assists the pathological Cold, causing coldness.
Cold sensation arises from bodily Yang deficiency and Yin excess. The excess Yin combines with the pathogenic Cold, intensifying the cold feeling.
Heat sensation occurs when Yang Qi is abundant and Yin Qi is scarce; the pathogenic Yang overcomes the deficient Yin, resulting in Bi-heat.
Heat sensation arises from bodily Yang excess and Yin deficiency. The excess pathogenic Yang confronts the insufficient Yin, generating heat.
Profuse sweating and dampness occur when encountering severe Dampness. Yang is scarce, Yin is abundant; the two energies interact, causing sweating and dampness.
Profuse sweating/dampness results from severe Dampness exposure combined with bodily Yang scarcity and Yin abundance. Dampness is Yin-type; Yin abundance interacting with external Dampness causes sweating and wetness. Knowing Yin governs Dampness implies Yang governs Dryness. This explains the variations in pain, numbness, cold, heat, dryness, and dampness.
The Yellow Emperor asked: If Bi always causes pain, why are there cases without pain?
If Bi invariably causes pain, why are there painless cases?
Qibo said: If Bi is in the bone, the body feels heavy; in the vessel, blood coagulates and fails to flow; in the sinew, flexion without extension; in the muscle, numbness; in the skin, cold. Possessing any of these five conditions results in no pain.
Pain arises from lack of interaction between interior and exterior Qi. When Bi affects only one有形 (tangible) tissue (bone, vessel, sinew, muscle, skin) while the Qi of the other tissues remains harmonious, pain does not occur. For example, Bi in the bone causes heaviness but no pain if other tissues are harmonious. Similarly, Bi in vessels causes stasis but no pain if others are harmonious. Thus, possessing any of the five localized conditions allows residual Qi to communicate, preventing pain.
Generally, Bi aggravated by Cold produces itching (like insect bites); Bi aggravated by Heat leads to flaccidity.
Cold combines with Dampness; Heat combines with Dryness. Cold-Damp Bi causes itching (insect-like sensation). Heat-Dry Bi causes sinews/bones to lose moisture, leading to flaccidity (relaxation). Flaccidity can lead to pain.
The Yellow Emperor said: Excellent.
The text previously omitted Dry Bi; now clarified, hence the Emperor's approval.