Cargando...
Capítulo 27 de 81
黄帝内经·灵枢
The Yellow Emperor asked Qi Bo: When Zhou Bi (Circular Bi syndrome) manifests in the body, the pain moves up and down along the blood vessels, corresponding above and below, left and right, continuously and without gaps. I would like to ask: does this pain occur in the blood vessels, or between the muscle interstices (fascial gaps between muscles)? What causes this? The pain shifts extremely rapidly, so fast that before the needle can be inserted; when the pain is intense, before the treatment location can be determined, the pain has already stopped. What is the reasoning behind this? I wish to hear the explanation.
Qi Bo replied: What you have described is Zhong Bi (Multiple Bi syndrome), not Zhou Bi.
The Yellow Emperor said: Please explain Zhong Bi. Qi Bo replied: The characteristic of Zhong Bi is that pain occurs at various fixed locations, alternately arising and alternately ceasing—one spot heals while another flares up. Disease on the right affects the left, and disease on the left affects the right. However, it cannot circulate throughout the entire body; it merely alternates between onset and remission.
The Yellow Emperor said: Good. How should acupuncture treat this? Qi Bo replied: When needling this condition, even if the pain has already stopped, one must still needle the location where the pain originally occurred, to prevent it from recurring.
The Yellow Emperor said: Good. Now please explain what Zhou Bi is like. Qi Bo replied: Zhou Bi is located in the blood vessels. The pathogenic qi ascends with the blood vessels and descends with the blood vessels. It cannot move left or right, but instead stops at the corresponding blood vessel locations.
The Yellow Emperor asked: How should acupuncture treat this? Qi Bo replied: When the pain moves from above downward, first needle the point below to block (intercept) it, then needle the point above to remove (eliminate) the root cause. When the pain moves from below upward, first needle the point above to block it, then needle the point below to remove it.
The Yellow Emperor said: Good. Then how does this pain arise? And why is it named "Zhou Bi"? Qi Bo replied: The three pathogenic factors of wind, cold, and dampness invade the muscle interstices on the body surface, compressing the muscle interstices and generating a thin pathological fluid (mo). When this fluid encounters cold, it condenses. After condensing, it displaces and splits the muscle interstices, causing the muscular tissue to separate. Splitting produces pain. When pain occurs, the spirit-mind gathers at the site of pain; when the spirit gathers, heat is generated; after heat is generated, the pain is relieved. After the pain is relieved, the local qi and blood flow becomes rebellious (disordered and blocked), and this rebellion triggers bi pain to erupt elsewhere. When it erupts, the same cycle repeats.
The Yellow Emperor said: Good, I now understand the principle. This disease is neither internally in the organs nor externally manifested on the skin surface. It remains solely between the muscle interstices, causing the genuine qi (upright qi of the body) to be unable to circulate throughout the entire body—hence it is named "Zhou Bi." Therefore, when treating bi syndrome with acupuncture, one must first palpate and follow (press and trace along) the six channels (the three yin and three yang channels of the hands and feet) below the painful site, observe their deficiency or excess status, as well as whether the grand collateral vessels (major branches of the channels) have any stagnation or blockage, and locate where the channels sink due to deficiency and where the acupoints are emptied. Treatment should regulate these accordingly; use the ironing method (hot compress) to warm and unblock the channels. If there are localized areas of tendon and vessel tension or hardness, use turning and guiding (rotational push and traction) techniques to relax them.
The Yellow Emperor said: Good. I now understand the principle and know how to put it into practice. What has been discussed above is the principle by which the nine needles (nine ancient types of acupuncture needles) operate according to the movement of channel qi, and it is also the diagnostic and therapeutic guideline for diseases arising from yin-yang disharmony in the twelve channels.
The core of this chapter lies in distinguishing the location, pathogenesis, and treatment between "Zhong Bi" and "Zhou Bi," and thereby proposing the acupuncture strategy of "block first, then remove."
Zhong Bi vs. Zhou Bi—Location Determines Manifestation:
Zhong Bi is located in the muscle interstices, with pain "each in its own place," corresponding left-right, alternately erupting, but unable to circulate. Zhou Bi is located in the blood vessels, with pain moving up and down along the vessels, following the channel pathways, but unable to move left or right. The most essential difference between the two lies in the level of tissue where the pathogenic qi resides (muscular fascia vs. blood vessels), which determines the different patterns of pain migration. This reflects the consistent principle in the Ling Shu: "Location determines manifestation." Know where the disease is, and you know how it will present.
The Pathological Closed Loop: "Fluid accumulation—splitting—pain—spirit gathers—heat—pain resolves—rebellion—recurrence":
This is the most exquisite medical reasoning in this chapter. Wind-cold-dampness invasion → compresses muscle interstices → generates mo (pathological exudate) → encounters cold and condenses → displaces and splits the muscles → pain → spirit-mind gathers at the painful site → localized heat → temporary pain relief → but local qi and blood become rebellious and blocked → triggers bi pain elsewhere → the cycle repeats. This chain explains two key phenomena: first, why bi pain manifests and remits intermittently (pain resolution is not cure, but a precursor to rebellious transmission); second, why pain migrates (after local qi and blood blockade, the problem transmits along the channels to other locations). This is not a simple case of "treat where it hurts," but rather a dynamic cycle that treatment must interrupt.
"Block First, Then Remove"—The Order of Acupuncture:
The core idea of treatment is to cut off the momentum of the pathogenic qi, then eliminate the root cause. If the pain travels from above downward, first needle below to "block it" (like building a dam to intercept the downward torrent), then needle above to "remove it" (eliminate the pathogen at the source); and vice versa. This embodies the TCM treatment principle of "guide according to momentum, cut off transmission"—not chasing after the pain, but determining the direction of the pathogenic qi flow, first severing its path, then clearing its source.
"Genuine Qi Cannot Circulate"—The True Meaning Behind the Name Zhou Bi:
There is an easily misunderstood point: the "Zhou" in Zhou Bi does not refer to pain "circling throughout the body," but rather to the failure of upright qi to circulate. The pathogenic qi blocks the muscle interstices, preventing genuine qi from circulating normally throughout the entire body—hence the name "Zhou Bi." The naming focuses on the pathomechanism (qi failing to circulate), not the symptom (migrating pain).
General Treatment Framework for Bi: Palpate the Six Channels, Examine Deficiency/Excess, Unblock Grand Collaterals, Warm with Ironing, Turn and Guide:
The final summary provides the universal treatment guidelines for bi syndrome—first palpate and follow the six channels, determine deficiency and excess; locate grand collateral blockages; find sunken/deficient acupoints; use the ironing method to warm and unblock; apply turning and guiding techniques to areas of tendon tension. This is a complete clinical approach from diagnosis to multiple therapeutic modalities, embodying the Nei Jing principle of "reduce what is excessive, tonify what is deficient, unblock what is obstructed."
The Echo Between "Muscle Interstices" and Modern Fascia Science:
The "muscle interstices" described in the Nei Jing roughly correspond to the fascia of modern anatomy and the connective tissue spaces between muscles. Modern fascia research has confirmed that fascia is a continuous network throughout the body, rich in nerve endings with fluid (interstitial fluid) flowing within it. The description of wind-cold-dampness "lodging in the muscle interstices" causing "fluid accumulation" and pain bears a rough comparability to the modern understanding of fascial adhesion, fluid retention, and local inflammatory mediators irritating nerve endings to produce pain. Of course, the condensation and splitting of "mo" cannot be equated with modern pathology, but it reveals an important truth: the source of pain is not limited to fixed anatomical structures—it can also arise and conduct at the level of soft tissue interstices.
"Pain Migration" and Fascial Referred Pain/Conduction Pain:
The migrating pain of Zhou Bi "following the vessels up and down" can be partially correlated in modern medicine with referred pain or the trigger point conduction phenomena of myofascial pain syndrome. Modern research has found that an abnormal point (trigger point) within the fascial network can elicit pain distant from that location. The ancients explained pain moving from one site to another through "rebellion causing other bi to erupt," and while their mechanistic description (summarized as "rebellious qi") is rather vague, the observation that "pain can migrate and travel through the body" is a correct, verifiable clinical phenomenon.
Re-examining "When the Spirit Gathers, There Is Heat; When There Is Heat, Pain Resolves":
The ancients believed that when pain occurs, the spirit gathers locally to generate heat, and the heat relieves pain. In modern understanding, local heat sensation is more likely derived from inflammatory responses causing vasodilation and increased blood flow, rather than the gathering of "spirit." However, the phenomenon that "focusing attention on a painful area changes pain perception" is recognized in modern pain psychology—attentional focus alters the subjective experience of pain. The ancients summarized this psychophysiological interaction as "the spirit gathers," reflecting an early observation of mind-body integration, though the causal chain as stated should not be taken literally as physiological fact.
The Rationality of "Ironing to Unblock" and Heat Therapy:
Using the ironing method (hot compress) to warm and unblock the channels for wind-cold-dampness-induced bi pain remains widely used in modern physical therapy—thermotherapy promotes local blood circulation, relaxes muscles, reduces fascial tension, and relieves pain. Thousands of years later, this method still works, demonstrating that the ancients' empirical experience has a solid practical foundation.
Historical Limitations:
The descriptions of the formation, condensation, and splitting of "mo" are based on ancient gross observation and speculation, not modern anatomical or pathological evidence. The attribution of localized heat to "the spirit gathering" also carries a philosophical interpretation and should not be understood as physiological mechanism. Furthermore, acupuncture recommendations such as "must needle the site to prevent recurrence" arise from the therapeutic framework of that era, and their efficacy has not been validated by modern evidence-based medicine; they should not be taken as basis for modern medication or treatment recommendations.
Avoid Wind, Cold, and Dampness—Protect the Muscle Interstices:
The root of bi syndrome lies in wind, cold, and dampness invading the body surface. In daily life, pay attention to wind protection and warmth—especially the neck, shoulders, lower back, and joints—avoid prolonged exposure to damp, cold environments, and dry off promptly and change clothes after sweating from exercise so that cold-dampness cannot find an opportunity to invade.
Movement Dredges Qi; Stillness Stagnates Qi:
"Genuine qi failing to circulate" is the core pathomechanism of Zhou Bi. Maintain moderate exercise, especially activities like stretching, daoyin (guiding and leading), tai chi, and yoga that emphasize fascial unfolding and qi-blood flow, to help genuine qi circulate without cessation and reduce discomfort from qi and blood stagnation. Prolonged sitting and fixed postures are precisely what lead to poor local qi and blood flow.
Pain Is a Signal, Not an Enemy:
The ancients observed that pain can "move from place to place," reminding us that bodily discomfort often represents a local manifestation of overall imbalance. When one side is uncomfortable, don't just press and rub the specific spot; observe whether it relates to other areas, and adjust from lifestyle and holistic states rather than treating isolated symptoms.
Hot Compress to Warm and Unblock—A Safe and Simple Daily Care Practice:
"Ironing to unblock" provides a very safe, feasible non-medical care approach. For general discomfort from cold exposure or fatigue—such as muscle tightness or soreness—moderate warm compress can help relax muscles, promote circulation, and reduce tension. However, be careful that the temperature is moderate to avoid burns; if discomfort persists or worsens, seek medical attention promptly.
Related Concepts:
Further Reading:
This content is based on classical Chinese medicine texts and is provided solely for traditional cultural learning and study. It does not constitute any medical diagnosis, medication, or treatment advice. If you experience discomfort, please seek medical attention promptly.