素问·痹论 Discourse on Bi (Blockage) Syndrome
黄帝问曰：痹之安生。歧伯对曰：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，湿气胜者为著痹也。帝曰：其有五者，何也。歧伯曰：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。帝曰：内舍五藏六府，何气使然。歧伯曰：五藏皆有合病，久而不去者，内舍于其合也。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。
凡痹之客五藏者，肺痹者，烦满喘而呕；心痹者，脉不通，烦则心下鼓，暴上气而喘，嗌乾善噫，厥气上则恐；肝痹者，夜卧则惊，多饮数小便，上为引如怀；肾痹者，善胀，尻以代踵，脊以代头；脾痹者，四支解墯，发咳呕汁，上为大塞；肠痹者，数饮而出不得，中气喘争，时发飱泄；胞痹者，少腹膀胱，按之内痛，若沃以汤，涩于小便，上为清涕。
阴气者，静则神藏，躁则消亡。饮食自倍，肠胃乃伤。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。帝曰：痹，其时有死者，或疼久者，或易已者，其故何也。歧伯曰：其入藏者死，其留连筋骨闲者疼久，其留皮肤闲者易已。
帝曰：其客于六府者何也。歧伯曰：此亦其食饮居处，为其病本也。六府亦各有俞，风寒湿气中其俞，而食饮应之，循俞而入，各舍其府也。帝曰：以针治之，柰何。歧伯曰：五藏有俞，六府有合，循脉之分，各有所发，各随其过，则病瘳也。
帝曰：荣卫之气，亦令人痹乎。歧伯曰：荣者水谷之精气也，和调于五藏，洒陈于六府，乃能入于脉也；故循脉上下，贯五藏络六府也。卫者水谷之悍气也，其气慓疾滑利，不能入于脉也；故循皮肤之中，分肉之闲，熏于肓膜，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。帝曰：善。痹或痛，或不痛或不仁，或寒，或热，或燥，或湿，其故何也。歧伯曰：痛者，寒气多也，有寒故痛也。其不痛不仁者，病久入深，荣卫之行涩，经络时踈，故不通，皮肤不营，故为不仁。其寒者，阳气少，阴气多，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。帝曰：夫痹之为病，不痛何也。歧伯曰：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。凡痹之类，逢寒则虫，逢热则纵。帝曰：善。
Huangdi asked: How does bi arise? Qibo replied: The three qi of wind, cold, and dampness arrive together and combine to form bi. Where wind qi predominates, it becomes wandering bi; where cold qi predominates, it becomes painful bi; where dampness qi predominates, it becomes fixed bi. Huangdi said: Why are there five kinds? Qibo said: One who encounters this in winter develops bone bi; one who encounters it in spring develops sinew bi; one who encounters it in summer develops vessel bi; one who encounters it in late summer develops muscle bi; one who encounters it in autumn develops skin bi. Huangdi said: What qi causes bi to lodge internally in the five viscera and six bowels? Qibo said: Each of the five viscera has a corresponding tissue that it governs; when the disease persists long without resolving, it lodges internally in that corresponding viscus. Thus, if bone bi does not resolve and the person is struck again by pathogenic qi, it lodges internally in the kidney; if sinew bi does not resolve and is struck again, it lodges in the liver; if vessel bi does not resolve and is struck again, it lodges in the heart; if muscle bi does not resolve and is struck again, it lodges in the spleen; if skin bi does not resolve and is struck again, it lodges in the lung. What is called bi arises, in each case according to its season, from repeated exposure to the qi of wind, cold, and dampness.
In general, when bi lodges in the five viscera: in lung bi, there is vexation and fullness, panting and vomiting; in heart bi, the vessels are obstructed, and when vexed there is throbbing below the heart, sudden upward surging of qi with panting, dryness of the throat with frequent belching, and when counterflow qi rises, there is fear; in liver bi, there is startling upon lying down at night, excessive drinking with frequent urination, and a sensation above as if pregnant; in kidney bi, there is frequent distension, the buttocks substituting for the heels, and the spine bent so that it substitutes for the head; in spleen bi, the four limbs are languid and weak, coughing arises with vomiting of fluid, and above there is great obstruction; in intestinal bi, there is frequent drinking yet inability to void, with qi in the middle panting and struggling, and periodic undigested-food diarrhea; in bladder bi, the lower abdomen and bladder are painful within when pressed, as though scalded with hot water, urination is difficult and unsmooth, and above there is clear nasal discharge.
As for yin qi: when it is calm, the spirit is stored; when it is agitated, it is dissipated and lost. Overeating and overdrinking injure the intestines and stomach. When excessive qi causes panting, bi collects in the lung; when excessive qi causes worry and brooding, bi collects in the heart; when excessive qi causes involuntary urination, bi collects in the kidney; when excessive qi causes exhaustion and depletion, bi collects in the liver; when excessive qi causes the flesh to waste away, bi collects in the spleen. When the various forms of bi persist without resolving, they also penetrate further inward; where wind qi predominates, the person is more easily cured. Huangdi said: In bi, sometimes there is death, sometimes prolonged pain, and sometimes easy cure — what is the reason for this? Qibo said: When it enters the viscera, it causes death; when it lingers between the sinews and bones, the pain is prolonged; when it remains between the skin, it is easily cured.
Huangdi said: What of bi lodging in the six bowels? Qibo said: This too has its root in diet and dwelling. The six bowels each also have their shu points; when wind, cold, and damp qi strike these shu points, and diet corresponds with and aggravates them, the pathogenic qi follows the shu points inward and lodges, in each case, in its corresponding bowel. Huangdi said: How is this treated with needling? Qibo said: The five viscera have their shu points, and the six bowels have their he, uniting, points; following the divisions of the vessels, each has its point of onset; by following and needling wherever the disorder has passed, the disease is cured.
Huangdi said: Can the nutritive and defensive qi also cause bi in a person? Qibo said: The nutritive qi is the essential qi of water and grain; it harmonizes and regulates the five viscera and spreads throughout the six bowels, and thus it is able to enter the vessels; hence it travels up and down along the vessels, penetrating the five viscera and connecting with the six bowels. The defensive qi is the fierce qi of water and grain; its qi is swift, rapid, and slippery, and it cannot enter the vessels; hence it travels within the skin and between the partitions of the flesh, steaming the huang membranes and dispersing through the chest and abdomen. When its qi is countered, disease results; when its qi is followed, the disease is cured. Since the defensive qi does not combine with the qi of wind, cold, and dampness, it does not become bi. Huangdi said: Good. In bi, there is sometimes pain, sometimes no pain but numbness, sometimes cold, sometimes heat, sometimes dryness, sometimes dampness — what is the reason for this? Qibo said: Where there is pain, cold qi predominates; because of the cold, there is pain. Where there is neither pain nor sensation, the disease has persisted long and penetrated deeply, so that the movement of nutritive and defensive qi becomes rough and impeded, the channels and network vessels become at times sparse and thus obstructed, and the skin is not nourished, hence numbness results. Where there is cold, yang qi is scant and yin qi abundant, reinforcing the disease, hence cold results. Where there is heat, yang qi is abundant and yin qi scant; the pathogenic qi overcomes the yang and encounters the yin, hence bi-heat results. Where there is profuse sweating with dampness, this is because dampness has been encountered severely; yang qi is scant and yin qi abundant, and when the two qi interact, sweat is emitted and dampness results. Huangdi said: Now, as bi is a disease, why is there sometimes no pain? Qibo said: When bi is in the bones, there is heaviness; when it is in the vessels, the blood congeals and does not flow; when it is in the sinews, the limb is bent and cannot be extended; when it is in the flesh, there is numbness; when it is in the skin, there is cold. Where all five of these are present together, there is no pain. In general, among the various kinds of bi, when cold is encountered the sinews contract, and when heat is encountered they become lax. Huangdi said: Good.