风热、风湿、血虚、有痰。大法用苍术、南星、芎、归、白芷、酒芩。在上者，加羌活、威灵仙、桂枝；在下
者，加牛膝、防己、木通、黄柏。血虚者，多用芎、归，佐以桃仁、红花；风湿，苍、白术之类，佐以竹沥、姜汁行
气药；风热，羌活、防风之类，佐以行气药。痰，以二陈加南星之类。薄、桂治痛风，乃无味而薄者，烛此能横行手臂，
引领南星、苍术等至痛处。下行用炒柏，引领南星、苍术等治。治上中下痛风方∶南星（二两姜制） 台芎（一两）
白芷（五钱） 桃仁（五钱） 神曲（三钱） 桂枝（三钱，横行手臂） 汉防己（五钱，下行） 草
龙胆（五钱，下行） 苍术（米泔水浸一宿炒，二两） 黄柏（酒炒一两） 红花（酒
洗一钱） 羌活（三钱，走通身骨节，一作三两） 威灵仙（酒洗去芦三钱，上行） 上末之，曲糊丸，食前汤下百粒。
张子原气血两虚，有痰便浊，阴火痛风方∶人参（一两） 白术（二两） 熟地黄（二两） 山药（一两）
海石（好者一两） 川黄柏（炒黑色二两） 锁阳（五钱） 南星（一两） 败龟板
（酒炙二两） 干姜（烧灰五钱，取其不走） 上为末，粥丸服之。痛风方∶糯米一盏，黄踯躅根一把，黑豆半盏，
上件用酒水各一碗煮，徐徐服之。大吐大泻，一服住，便能行动。控涎丹治一身及胁走痛，痰挟死血加桃仁泥丸。
痰带湿热者，先以舟车丸，或导水神芎丸下，后服趁痛散，入方∶乳香、没药、桃仁、红花、当归、地黄、酒炒五
灵脂、酒浸牛膝、羌活、香附、便浸生甘草，痰热加酒芩、酒柏，上为末，酒调二钱。二妙散治筋骨疼痛，因热因
湿者，有气加气药，血虚加补血药，痛甚者须以生姜、自然汁，热辣服之，黄柏炒，苍术炒，制去皮为末，生姜研入
汤，上二味煎沸服，二物皆有雄壮之气，表实者少酒佐之。龙虎丹治走注疼痛，或麻木不遂，或半身痛∶苍术（一两
）白芷（一两） 草乌（一两，三味共为粗末，水拌湿，盒器内发热过，再入后药） 乳香（二钱） 没药（二钱
）当归（五钱） 牛膝（五钱） 上俱作末，酒糊丸，如弹子大，温酒化下。八珍丸治一切痛风，香港脚头风∶乳香（
三钱） 没药（三钱） 代赭石（三钱） 穿山甲（三钱生用） 川乌（一两，不去皮尖生用） 草乌（五钱，
不去皮尖生用） 羌活（五钱） 全蝎（二十一个，头尾全者） 上末之，醋糊丸，桐子大，每服十一丸。治痛风走
注痛∶黄柏（二钱酒炒） 苍术（二钱酒炒） 上作一服煎就，调威灵仙末为君，羊角灰为臣，苍耳为佐，芥子为使，
用姜一片，入药末一钱，擂细，以前药再温服。饮酒湿疼痛风∶黄柏（酒炒五分） 威灵仙末（酒炒五分）
苍术（二钱炒） 陈皮（一钱） 芍药（一钱） 甘草（三钱） 羌活（二钱） 上为末服。痢后脚软，骨疼或膝肿
者，此亡阴也，宜芎、归、地黄等补药治之。气虚加参、 ∶挟风湿加羌、防、白术之类。若作风治反燥其阴。
气实表实骨节痛方∶滑石（六钱） 甘草（一钱） 香附（三钱） 片芩（三钱） 上为末，姜汁糊为丸。治食积
肩腿痛∶酒板（一两） 酒霄叶（五钱） 香附（五钱） 辣芥子 凌柏花
酒糊丸，四物加陈皮甘草汤下。治肢节肿痛，痛属火，肿属湿，此湿热为病，兼之外受风寒而发动于经络之中，湿热流
注肢节之间而无已也∶苍术（五分） 麻黄（一钱去根节） 防风（五分） 荆芥穗（五分） 羌活（五分） 独
活（五分） 白芷（五分） 归须（三分） 赤芍药（一钱） 威灵仙（五分） 片芩（五分） 枳实（五分） 桔
梗（五分） 葛根（五分） 川芍（五分） 甘草（三分） 升麻（三分） 上煎服。病在下，加酒
炒黄柏，妇人加酒红花，肿多加槟榔、大腹皮、泽泻，食前服。更加没药一钱尤妙，定痛故也。通身疼痛或风湿∶葳
灵仙（一钱） 赤芍药（一钱） 麻黄（去节一钱） 羌活 独活 归须 芎 防风 白芷 木香（以上各一钱半
）苍术（一钱） 桃仁（七个） 甘草（三分） 上煎服。肢节烦疼，肩背沉重，胸膈不利，及遍身
疼痛，下注于足胫肿痛，当归拈痛汤。一男子年三十六，业农而贫，秋深忽浑身发热，两臂膊及腕，两足及胯皆痛如
锻，日轻夜重。医加风药则愈痛，血药则不效，以待死而已，两手脉皆涩而数，右甚于左，其饮食如平日，因痛而形
瘦如削。用苍术（一钱半） 生附（一片） 生甘草（二钱） 麻黄（五分） 桃仁（九个研） 酒黄柏（一钱半） 上
作一帖煎，入姜汁些少，令辣，服至四帖后去附子，加牛膝一钱重，八帖后气上喘促，不得睡，痛却减意，其血虚必服
麻黄过剂，阳虚祛发动而上奔，当补血而镇之，遂以四物汤减芎加人参五钱、五味子十二粒，以其味酸，收敛逆上之气，
作一帖服，至二帖喘定而安。后三日脉之数减大半，涩如旧，问其痛，则曰不减，然呻吟之声却无，察其气似无力，自
谓不弱，遂以四物汤加牛膝、白术、人参、桃仁、陈皮、甘草、槟榔、生姜三片，煎服至五十帖而安复。因举重痛复作，
饮食亦少，亦以此药加黄 三钱，又十帖方全愈。大率痛风，因血受热。一老人性急作劳，两腿痛甚；一妇性急味浓，
病痛风数月；一少年患
痢，服涩药，效致痛风（俱见《医要》），一人足跟痛，有痰，有血热，治用四物汤加黄柏、知母、牛膝之类。身
虚痒痛四物加黄芩煎，调萍末服。凡治痛风，分在上、在下者治。因于风者，小续命汤极验；因于湿者，苍术、白
术之类，佐以行气药；因于痰者，二陈汤加减用之。诸痒为虚，盖血不荣肌腠，所以痒也。当以滋补药，以养阴血，血
和肌腠，痒自不作矣。
Wind-heat, wind-dampness, blood deficiency, phlegm. The general principle of treatment uses Cangzhu (Atractylodis Rhizoma), Nanxing (Arisaematis Rhizoma Preparatum), Xiong (Chuanxiong Rhizome), Gui (Angelicae Sinensis Radix), Baizhi (Angelicae Dahuricae Radix), and Jiu Qin (Scutellariae Radix prepared with wine). For conditions located in the upper part, add Qianghuo (Notopterygii Rhizoma et Radix), Weilingxian (Clematidis Radix et Rhizoma), and Guizhi (Cinnamomi Ramulus); for conditions located in the lower part, add Niuxi (Achyranthis Bidentatae Radix), Fangji (Stephaniae Tetrandrae Radix), Mutong (Akebiae Caulis), and Huangbai (Phellodendri Cortex). For blood deficiency, use more Xiong and Gui, assisted by Taoren (Persicae Semen) and Honghua (Carthami Flos); for wind-dampness, use Cangzhu and Baizhu (Atractylodis Macrocephalae Rhizoma), assisted by Zhuli (Bambusae Sapta) and Jiangzhi (Zingiberis Recensis Juice) to move qi; for wind-heat, use Qianghuo and Fangfeng (Saposhnikoviae Radix), assisted by qi-moving herbs. For phlegm, use Erchen Tang (Two-Cured Decoction) plus Nanxing. Bo Gui (Cinnamomi Cortex with thin flavor) treats gouty pain because its thin flavor allows it to traverse the arms, guiding Nanxing and Cangzhu to the painful areas. For downward treatment, use Chao Bai (Phellodendri Cortex stir-fried) to guide Nanxing and Cangzhu.
Formula for treating gouty pain in the upper, middle, and lower jiao: Nanxing (2 liang, processed with ginger), Taixiong (1 liang), Baizhi (5 qian), Taoren (5 qian), Shenqu (3 qian), Guizhi (3 qian, traverses arms), Han Fangji (5 qian, moves downward), Cao Longdan (Gentianae Radix, 5 qian, moves downward), Cangzhu (soaked in rice water overnight, stir-fried, 2 liang), Huangbai (wine-stir-fried, 1 liang), Honghua (wine-washed, 1 qian), Qianghuo (3 qian, circulates through whole body joints, alternatively 3 liang), Weilingxian (wine-washed, de-rhizomed, 3 qian, moves upward). Grind all into fine powder, make pills with Shenqu paste, take 100 pills before meals with decoction.
Zhang Ziyuan had both qi and blood deficiency, phlegm, turbid urine, and yin-fire gouty pain. Formula: Renshen (Ginseng Radix, 1 liang), Baizhu (2 liang), Shudihuang (Rehmanniae Radix Praeparata, 2 liang), Shanyao (Dioscoreae Rhizoma, 1 liang), Haishi (Pumex, 1 liang of good quality), Chuan Huangbai (Stir-fried until black, 2 liang), Suoyang (Cynomorii Herba, 5 qian), Nanxing (1 liang), Baiguiban (Testudinis et Chelonis Carapax et Plastrum, wine-roasted, 2 liang), Ganjiang (Burned to ash, 5 qian, to prevent dispersion). Grind into powder, make pills with congee, take orally.
Gouty pain formula: Nuomi (Oryza Sativa Glutinosa, 1 zhan), Huangzhizhu Gen (Rhododendri Mollis Radix, 1 ba), Heidou (Sojae Semen Nigrum, 0.5 zhan). Bo these ingredients in one bowl of wine and one bowl of water, take slowly. After severe vomiting and diarrhea, one dose stops symptoms and restores mobility. Kongyan Dan (Controlling Phlegm Pill) treats wandering pain throughout the body and hypochondrium; if phlegm clots with dead blood, add Taoren paste to make pills.
For phlegm with damp-heat, first purge with Zhouche Wan (Boat Vehicle Pill) or Daoshui Shenxiong Wan (Water-Guiding Divine Xiong Pill), then take Chentong San (Following Pain Powder). Ingredients: Ruxiang (Boswelliae Resina), Moyao (Myrrhae Resina), Taoren, Honghua, Danggui (Angelicae Sinensis Radix), Dihuang (Rehmanniae Radix), Jiuchao Wulingzhi (Trogopteri Excrement stir-fried with wine), Jiu Jin Niuxi (Achyranthis Bidentatae Radix soaked in wine), Qianghuo, Xiangfu (Cyperi Rhizoma), Bianjin Sheng Gancao (Licorice Root soaked in urine), Jiuchao Huangqin (Scutellariae Radix stir-fried with wine), Jiubai (Phellodendri Cortex stir-fried with wine). Grind into powder, mix with wine, take 2 qian.
Ermiao San (Two Marvels Powder) treats bone and tendon pain due to heat and dampness. If there is qi stagnation, add qi-moving herbs; if blood deficiency, add blood-nourishing herbs. For severe pain, take with fresh ginger juice, hot and spicy. Stir-fry Huangbai and Cangzhu, remove skin, grind to powder. Grind ginger into soup, boil the two herbs, and take. Both herbs have strong energy; for exterior excess, add a little wine.
Longhu Dan (Dragon-Tiger Pill) treats wandering pain, numbness and paralysis, or hemibody pain: Cangzhu (1 liang), Baizhi (1 liang), Caowu (Aconiti Kusnezoffii Radix, 1 liang). These three are coarsely ground, moistened with water, heated in a box vessel, then the following are added: Ruxiang (2 qian), Moyao (2 qian), Danggui (5 qian), Niuxi (5 qian). Grind all into powder, make pills with wine paste, size of a bullet, dissolve in warm wine.
Bazhen Wan (Eight Treasures Pill) treats all gouty pain, Hongkong foot (podagra), and head wind: Ruxiang (3 qian), Moyao (3 qian), Daizheshi (Hematitum, 3 qian), Chuanshanjia (Manis Squama, 3 qian, raw), Chuanwu (Aconiti Radix, 1 liang, raw, unpeeled tip), Caowu (1 liang, raw, unpeeled tip), Qianghuo (5 qian), Quanxie (Scorpio, 21 pieces, complete head and tail). Grind into powder, make pills with vinegar paste, size of tung tree seeds, take 11 pills per dose.
Treating wandering gouty pain: Huangbai (2 qian, wine-stir-fried), Cangzhu (2 qian, wine-stir-fried). Decoct as one dose, mix with Weilingxian powder as the chief herb, Yangjiao Hui (Ash of Horn) as deputy, Can'er (Xanthii Fructus) as assistant, Jiezi (Sinapis Semen) as guide. Add one slice of ginger, mix with 1 qian of powder, mash finely, and re-warm with the previous decoction to drink.
Alcohol-induced damp-pain wind: Huangbai (0.5 qian, wine-stir-fried), Weilingxian powder (0.5 qian, wine-stir-fried), Cangzhu (2 qian, stir-fried), Chenpi (Citri Reticulatae Pericarpium, 1 qian), Shaoyao (Paeoniae Radix, 1 qian), Gancao (3 qian), Qianghuo (2 qian). Grind into powder and take.
After dysentery, soft legs, bone pain, or knee swelling indicates Yin exhaustion. Treat with tonics like Xiong, Gui, and Dihuang. For qi deficiency, add Renshen and Baizhu; for wind-dampness, add Qianghuo, Fangfeng, and Baizhu. Treating as wind pathogen will dry out Yin.
Formula for excess qi and excess exterior joint pain: Huashi (Talcum, 6 qian), Gancao (1 qian), Xiangfu (3 qian), Pian Qin (Scutellariae Radix, 3 qian). Grind into powder, make pills with ginger juice paste.
Treating food stagnation shoulder and leg pain: Jiu Banlangen (Isatidis Radix prepared with wine, 1 liang), Jiu Xiao Ye (Perillae Folium prepared with wine, 5 qian), Xiangfu (5 qian), La Jiezi (Sinapis Semen), Ling Baihua. Make pills with wine paste, take with Siwu Tang (Four Substances Decoction) plus Chenpi and Gancao decoction.
Treating limb joint swelling and pain: Pain belongs to fire, swelling belongs to dampness. This is a disease of damp-heat, combined with external wind-cold activating in meridians, causing damp-heat to flow into joints without cessation: Cangzhu (0.5 fen), Mahuang (Ephedrae Herba, 1 qian, remove root and nodes), Fangfeng (0.5 fen), Jingjie Sui (Schizonepetae Spica, 0.5 fen), Qianghuo (0.5 fen), Duhuo (Angelicae Pubescentis Radix, 0.5 fen), Baizhi (0.5 fen), Guixu (Angelicae Sinensis Radix tips, 0.3 fen), Chi Shaoyao (Paeoniae Radix Rubra, 1 qian), Weilingxian (0.5 fen), Pian Qin (0.5 fen), Zhishi (Aurantii Fructus Immaturus, 0.5 fen), Jiegeng (Platycodonis Radix, 0.5 fen), Gegen (Puerariae Lobatae Radix, 0.5 fen), Chuanxiong (0.5 fen), Gancao (0.3 fen), Shengma (Cimicifugae Rhizoma, 0.3 fen). Decoct and take. For lower body conditions, add wine-stir-fried Huangbai; for women, add wine Honghua; for excessive swelling, add Binglang (Arecae Semen), Dafupi (Arecae Pericarpium), and Zexie (Alismatis Rhizoma). Take before meals. Adding Moyao (1 qian) is excellent for pain relief.
Whole body pain or wind-dampness: Weilingxian (1 qian), Chi Shaoyao (1 qian), Mahuang (de-node, 1 qian), Qianghuo, Duhuo, Guixu, Xiong, Fangfeng, Baizhi, Muxiang (Aucklandiae Radix, all 1.5 qian), Cangzhu (1 qian), Taoren (7 seeds), Gancao (0.3 fen). Decoct and take.
Irritating pain in limbs and joints, heavy shoulders and back, chest diaphragm discomfort, whole body pain, descending to swollen and painful shanks and feet: Danggui Niantsong Tang (Angelica and Costus Decoction for Pain).
A 36-year-old male farmer, poor, suddenly developed whole-body fever in late autumn. Pain in both arms and wrists, both feet and hips felt like forging, lighter by day, heavier by night. Doctors adding wind-dispelling herbs increased pain; blood-invigorating herbs were ineffective. Pulse was choppy and rapid in both hands, right worse than left. Diet normal, but emaciated due to pain. Prescription: Cangzhu (1.5 qian), Sheng Fuzi (Aconiti Lateralis Radix Preparata, raw, 1 slice), Sheng Gancao (raw Licorice Root, 2 qian), Mahuang (0.5 fen), Taoren (9 seeds, crushed), Jiu Huangbai (wine-stir-fried Phellodendri Cortex, 1.5 qian). Decoct one dose, add small amount of ginger juice to make it spicy. After four doses, remove Fuzi, add Niuxi (1 qian). After eight doses, patient experienced shortness of breath and insomnia, though pain decreased. This was due to excessive Mahuang in blood-deficient patients, causing deficient yang to rise. Tonify blood and calm rising qi. Use Siwu Tang minus Xiong, add Renshen (5 qian) and Wuweizi (Schisandrae Fructus, 12 grains) to astringe rising qi. One dose taken, after two doses breathing stabilized. Three days later, rapid pulse reduced significantly, choppy pulse returned. Pain persisted but moaning ceased. Qi seemed weak, though patient denied weakness. Prescribed Siwu Tang plus Niuxi, Baizhu, Renshen, Taoren, Chenpi, Gancao, Binglang, and 3 slices of ginger. Decoct and take. After fifty doses, recovered. Pain recurred after lifting heavy objects, appetite decreased. Added Huangbai (3 qian) to same prescription. After ten more doses, fully recovered.
Generally, gouty pain arises from blood heating. An elderly man with impatient nature overworked, suffered severe leg pain; a woman with impatient nature and rich diet suffered gout for months; a youth with dysentery took astringents, leading to gout (all seen in *Yi Yao*). A person with heel pain had phlegm and blood heat, treated with Siwu Tang plus Huangbai, Zhimu (Anemarrhenae Rhizoma), and Niuxi. Body deficiency with itching pain: Siwu Tang plus Huangqin decocted, mixed with Ping (Lemna Minoris) powder.
In treating gout, distinguish upper and lower locations. Due to wind: Xiaoxuming Tang (Minor Continuation Life Decoction) is very effective. Due to dampness: Cangzhu and Baizhu, assisted by qi-moving herbs. Due to phlegm: Erchen Tang modified. All itching is deficiency; blood fails to nourish muscle and pores, hence itching. Use tonic herbs to nourish yin blood; when blood harmonizes and nourishes muscles and pores, itching ceases.