素问：痹论篇第四十三

Su Wen: Treatise on Bi Syndromes, Chapter 43

Overall Paraphrase

The Yellow Emperor asked: How do Bi syndromes (impediment disorders) arise? Qi Bo replied: When wind, cold, and dampness—three pathogenic qi—invade the body in a mixed, entangled manner, they combine to form Bi syndrome (a condition of blockage and obstruction, characterized chiefly by pain, numbness, and heaviness). Among these, where wind pathogen predominates, it is called Migratory Bi (with wandering, shifting pain); where cold pathogen predominates, it is called Painful Bi (with severe, intense pain); where dampness pathogen predominates, it is called Fixed Bi (with heaviness, numbness, and immobility).

The Yellow Emperor asked: Bi syndromes are also divided into five types—how is this? Qi Bo replied: Those who contract wind-cold-dampness pathogenic qi in winter tend to develop Bone Bi; those contracting it in spring develop Sinew Bi; those contracting it in summer develop Vessel Bi; those contracting it during long summer (the yin transition period) develop Muscle Bi; those contracting it in autumn develop Skin Bi.

The Yellow Emperor asked: Bi syndromes can also invade inward to the five viscera and six bowels—what qi causes this? Qi Bo replied: Each of the five viscera has a corresponding body tissue with which it is paired (kidneys pair with bones, liver with sinews, heart with vessels, spleen with flesh, lungs with skin). When Bi of the five body tissues does not resolve over time, and pathogenic qi is again encountered, it will transmit inward to the paired viscus. Thus, when Bone Bi fails to resolve and external pathogen is again contracted, it enters the kidneys internally; when Sinew Bi fails to resolve and external pathogen is again contracted, it enters the liver internally; when Vessel Bi fails to resolve and external pathogen is again contracted, it enters the heart internally; when Muscle Bi fails to resolve and external pathogen is again contracted, it enters the spleen internally; when Skin Bi fails to resolve and external pathogen is again contracted, it enters the lungs internally. In summary, the five viscera Bi syndromes form when each viscus, during its governing season, repeatedly contracts wind-cold-dampness pathogenic qi.

Symptoms of Bi pathogen invading the five viscera: Lung Bi—oppression and fullness, wheezing, vomiting; Heart Bi—impeded blood vessels, palpitation beneath the heart with vexation, sudden qi rising with wheezing, dry throat, frequent belching, and fear when rebellious qi rushes upward; Liver Bi—easily startled during sleep at night, thirst with frequent drinking, frequent urination, abdominal distension as if pregnant; Kidney Bi—tendency to abdominal bloating, inability to walk with the feet, using the buttocks in place of the heels, a curved spine with the head unable to lift, the back of the head towering above the crown; Spleen Bi—fatigue and weakness of the four limbs, cough with vomiting of clear water, blockage in the chest and stomach duct; Intestinal Bi—frequent drinking of water but difficult urination, rebellious qi in the abdomen with wheezing, occasional diarrhea with undigested food; Bladder Bi—pain on palpation of the lower abdomen and bladder region, burning heat as if scalded with hot water, astringent and difficult urination, with clear nasal discharge from the upper part.

When the essential qi of the five viscera is calm, it can be stored internally; when agitated, it dissipates and wastes away. Excessive eating and drinking cause injury to the stomach and intestines. Rebellious qi causing wheezing indicates Bi qi gathering in the lungs; rebellious qi causing brooding and anxiety indicates Bi qi gathering in the heart; rebellious qi causing enuresis indicates Bi qi gathering in the kidneys; rebellious qi causing exhaustion and fatigue indicates Bi qi gathering in the liver; rebellious qi causing muscle wasting indicates Bi qi gathering in the spleen. When various Bi syndromes persist long without resolution, they also gradually transmit inward; among them, where wind pathogen predominates, the patient recovers more easily.

The Yellow Emperor asked: Some with Bi syndromes die, some suffer prolonged pain, and some recover readily—what is the reason? Qi Bo replied: When Bi pathogen penetrates deeply into the five viscera, the condition is severe and may lead to death; when pathogenic qi lingers between sinews and bones, pain is prolonged; when pathogenic qi remains only between the skin and superficial layers, recovery is easy.

The Yellow Emperor asked: What is the reason for Bi pathogen invading the six bowels? Qi Bo replied: This is also due to improper diet and disharmony of the living environment, which serve as the internal root of disease onset. Each of the six bowels has its Shu points, and when wind-cold-dampness pathogenic qi attacks these Shu points, combined with internal injury from irregular eating and drinking, the pathogenic qi enters along the Shu points and settles separately in the respective bowels. The Yellow Emperor asked: How does one treat this with needling? Qi Bo replied: The five viscera have Shu points, and the six bowels have He points. Along the pathways of the channels and vessels, each has its site of disease manifestation. By regulating according to the channel, viscus, and bowel where the pathogen resides, the disease can be cured. (This passage on ancient acupuncture theory is provided for scholarly study only and does not constitute treatment advice.)

The Yellow Emperor asked: Can nutritive qi and defensive qi also cause Bi syndromes in humans? Qi Bo replied: Nutritive qi (the gentle, harmonizing portion of water-and-grain essence) can harmonize the five viscera, spread to the six bowels, and then enter the vessels. Therefore, it moves up and down along the channels, threading through the five viscera and linking the six bowels. Defensive qi (the fierce, swift portion of water-and-grain essence that moves outside the vessels) is by nature rapid and slippery; it cannot enter the vessels, so it moves within the skin and between the muscles, warming the membranes and spreading through the chest and abdomen. When defensive qi moves rebelliously, disease arises; when it follows its proper order, recovery occurs. Defensive qi does not combine with wind-cold-dampness pathogenic qi, so it does not itself form Bi syndromes.

The Yellow Emperor said: Well said. Some cases of Bi involve pain, some no pain, some numbness with loss of sensation, some manifest as cold, some as heat, some with dry skin, some with moistness and profuse sweating—what is the reason? Qi Bo replied: Those with pain have a predominance of cold qi; when cold is present, there is pain. Those with no pain but numbness are cases of longstanding disease where pathogen has entered deeper layers, with sluggish movement of nutritive and defensive qi, and the channels sometimes empty, so qi and blood do not connect, and the skin lacks nourishment—hence numbness with loss of sensation. Those manifesting cold are those whose constitution has less yang qi and more yin qi, which aligns with the nature of the pathogen, hence cold. Those manifesting heat are those whose constitution has more yang qi and less yin qi, with pathogenic qi in excess; yang qi is constrained by yin pathogen, hence becoming Bi with heat. Those with profuse sweating and moist skin contracted dampness pathogen to an excessive degree, with less yang qi and more yin qi; dampness and yin qi respond to each other, so there is sweating and moistness. The Yellow Emperor asked: In Bi syndrome there are those without pain—what is the principle here? Qi Bo replied: When Bi is in the bones, there is a sensation of heaviness; in the vessels, blood clots and does not flow; in the sinews, flexion and extension become difficult; in the flesh, numbness with loss of sensation; in the skin, coldness. In these five situations, there may be no pain. In all types of Bi, encountering cold causes the sinews and vessels to contract and tighten, while encountering heat causes the sinews and vessels to relax and loosen. The Yellow Emperor said: Well said.

🧠 In-Depth Understanding

Core Principles 💡

• General Framework of Bi Syndromes: This chapter establishes its thesis with “wind, cold, and dampness—three qi arriving in combination—form Bi,” emphasizing that Bi syndrome results from a combination of external pathogens, not a single one, but an entangling of all three.
• Three Classifications of Bi: According to pathogen predominance, Bi is divided into Migratory Bi (wind predominance), Painful Bi (cold predominance), and Fixed Bi (dampness predominance), reflecting the diagnostic approach of “same disease, different causes.”
• Transmission from Five Body-Tissue Bi to Five Viscera Bi: Correspondence by season and five body tissues reveals the layered nature of external pathogen invasion. When Bi of the five body tissues fails to resolve over time and pathogens are again encountered, transmission moves inward along the “five body tissues—five viscera” pairing relationship, forming the five viscera Bi. This reflects the holistic perspective of Chinese medicine and the pattern of disease moving from the exterior to the interior.
• Relationship of Nutritive and Defensive Qi to Bi: Nutritive qi moves within the vessels; defensive qi moves outside the vessels. When both circulate normally, they do not combine with wind-cold-dampness pathogens; therefore nutritive and defensive qi themselves do not directly cause Bi syndrome. Bi syndrome necessarily requires the participation of external pathogens—this is an important qualification regarding pathogenesis.
• Mechanisms Underlying Symptom Variation in Bi: The predominance of cold or heat, the relative abundance or deficiency of yin and yang, and the depth of pathological location explain different manifestations including pain, absence of pain, numbness, cold, heat, dryness, and dampness. Those with superficial pathogen location recover readily; those with deep location recover with difficulty; those entering the viscera are critical.

Modern Perspective 🌟

• Bi Pattern Is Not Equivalent to Any Single Modern Disease: The “Bi” in this chapter is a broad disease concept involving pain, numbness, heaviness, and movement impairment in joints, muscles, sinews, vessels, and skin. It bears symptomatic similarity to modern rheumatic and immune diseases (such as rheumatoid arthritis and osteoarthritis) and peripheral neuropathies, but cannot be directly equated with them.
• The Environmental Factor of “Wind, Cold, and Dampness”: Modern medicine generally considers that environmental factors such as cold and humidity are not usually direct causes of conditions like arthritis, but they may exacerbate existing symptoms or trigger them by affecting local blood circulation, muscle tension, and pain perception thresholds. This partially overlaps with the ancients’ empirical observation, though with different pathogenic explanations.
• The View of Transmission from Exterior to Interior: The transmission from five body-tissue Bi to five viscera Bi reflects the dynamic pathological perspective of Chinese medicine. However, “entering the viscera leads to death” should be understood as a clinical judgment of deep pathogen location and severe condition, not as an inevitable literal death. In modern clinical settings, when diseases resembling “Bi” involve internal organs, this does suggest the risk of systemic disease or complications requiring timely medical attention.
• Acupuncture Rationale of Shu and He Points: The mention of “the five viscera have Shu, the six bowels have He” belongs to the classical meridian-based acupoint selection approach of Chinese medicine. Modern acupuncture research continues to explore its mechanisms, and all needling must be performed by qualified practitioners—never self-administered.
• Textual Issues: In the phrase “遇寒则虫” in the original text, most historical annotators regard “虫” as a scribal error for “急,” reading it as “upon encountering cold, the sinews and vessels tighten and constrict,” which better fits the context.

Health Guidance ⚡

• Avoid Wind, Cold, and Dampness: Living environments should be warm and dry; avoid prolonged stays in damp areas, sweating in drafts, exposure to rain and cold; take precautions to stay warm in cold, damp weather.
• Moderate Activity: Sinews and bones benefit from movement, but should not be overworked; engage in gentle stretching appropriate to one's condition to promote the flow of qi and blood.
• Eat and Drink with Moderation: Do not overeat or binge drink; protect the stomach and intestines; reduce internally generated dampness and turbidity to avoid burdening the body through dietary excess.
• Maintain Emotional Equanimity: The essential qi of the five viscera remains stored when at peace and dissipates when agitated; avoid excessive worry, agitation, and rumination to maintain emotional stability.
• Seek Medical Attention Promptly: For joint or muscle pain, numbness, swelling, or restricted movement, consult a qualified healthcare institution at the earliest opportunity. Do not self-diagnose solely by consulting this text.

📚 Related Knowledge

• Related Concepts: Correspondence between five body tissues and five viscera (bones pair with kidneys, sinews with liver, vessels with heart, flesh with spleen, skin with lungs); nutritive qi and defensive qi (nutritive moves within vessels, defensive outside); five Shu points and He points (meridian and acupoint theory).
• Further Reading: Su Wen, Treatise on the Communication of Vital Yang (chapter 3) on wind, cold, and dampness causing disease; Ling Shu, Treatise on Systemic Bi and Pain (chapter 27); Su Wen, Treatise on Atrophy (chapter 44) for differential identification with Bi syndrome; Jin Gui Yao Lue, Chapters on Wind-Stroke and Acute Arthritis on the understanding of migratory joint pain.

Note: This content is based on classical Chinese medical texts for purposes of traditional cultural study and research only. It does not constitute any medical diagnosis, medication, or treatment advice. Please seek medical attention if you experience discomfort.