湿行气，四物汤主之。阴虚臀尖痛者，膀胱有火，加知母、黄柏及桂少许；有痰合二陈汤
加泽泻、前胡，木香为引；痛甚，加乳香、没药；热者，合大承气汤下之。两腿痛者，加牛
膝、陈皮，吞加味三妙丸；两腿痛甚，素虚性急，或痢后血流经络作痛者，加桃仁、牛膝、
陈皮、甘草、姜汁，煎熟调潜行散。如两腿间，忽一二点痛入骨不可忍者，用芫花根为末，
醋调敷痛处，以帕紧扎，产后有此疾者亦宜。两足痛者，当归拈痛汤。凡痛风丸散佐使，在
上，加羌活、威灵仙；在下，加牛膝、防己、木通、黄柏；在手臂，加桂枝，引至痛处。如
遍身痛
者，则问所起处加之。
风毒髓痛共一种。
痛风，百节酸疼无定处，久则变成风毒，痛入骨髓，不移其处，虎骨散、麝香丸
。如赤肿灼热者，败毒散；肢节肿痛，挟湿热者，麻黄赤芍汤主之。
湿痛如脱风汗黄，
外因湿证，肿满身痛如脱者，除湿汤；寒湿者，附子六物汤、捉虎丸；湿热者，
五苓散加苍术、防风、羌活、白芷、黄柏、竹沥、姜汁；走注者，四妙散；肢节肿、脉滑者
，加南星、木香、槟榔、苍术、黄柏、防己。湿气背伛偻，足挛成废者，用甘遂一钱为末，
入猪腰内煨食之，上吐下泻。风证黄汗出，面微红，掣痛热者，防风通圣散，或小续命汤去
附子，加羌活、黄芩；虚者，乌药顺气散、独活寄生汤。上体，金枣丹；下体，换腿丸。风
中肩
背，太阳气郁不可回顾，或肺气郁热，小便数而欠伸，宜通气防风汤、羌活胜湿汤。风湿相
搏痛者，甜瓜子丸、神仙飞步丹、龙虎丹、活络丹、乳香黑虎丹、活血应痛丸。风湿毒生疮
，单苍耳加羌活、防风十分之二为末，蜜丸梧子大，每百丸酒下，或单
丸一斤，加四物汤料各五钱，防风、羌活各三钱，川乌一钱半，
为
末蜜丸，空心茶、酒任下。风寒湿热成痹，臂髀腰脚骨热肿痛，行步艰难者，二妙苍柏散
等分，加虎胫骨减半，为末，水调服。
暑热烦疼寒掣（骨）髓。
暑湿相搏，面赤尿赤者，五苓散合败毒散，加当归、赤芍，或复元通圣散。结阳
肢肿，热毒流注，大便闭者，犀角汤。寒证肢节掣痛，小筋急痹者，五积散合顺元散，加
麝一厘。鹤膝痛者，五积散加松节、杉节；骨髓痛者，虎骨散。
七情刺痛食停痰，
内因七情，肢节胸胁刺痛，初必眩晕自汗，二陈汤加香附、枳壳、木香。如腰背
气动发痛者，枳甘散、流气饮子，俱加葱白煎服，后卧少时。如思虑伤心，痛从背起至胸
胁者，用人参四分，木通二分，煎汤，吞当归龙荟丸。饮食积痛风。初必胸满呕吐，二陈汤
加乌药、枳壳，或单苍耳丸。因食浓味，积痰脾胃，髀枢左右发痛一点，延及膝
肿大，恶寒夜剧者，潜行散为主，加甘草梢、苍术、犀角、
川
芎、陈皮、牛膝、木通、白芍，入姜汁煎服，病稍减，去犀角，加牛膝、龟板、归身尾，冬
月加桂，夏加黄芩。又有遍身游走，痒痛状如虫啮，遇痒而进饮食，则虫亦餍饫其间，庶不
致频频啮也，宜麝香丸。留饮四肢历节，气短脉沉，久则令人骨节蹉跌，恐为癫痫，宜导痰
汤加减。痰饮者，古半硝丸。气短倦怠者，六君子汤加南星。酒湿痛者，用黄柏、威灵仙各
五分，苍术二钱，陈皮、芍药各一钱，甘草三分，羌活二分，水煎服。
血气虚劳不荣（养关节腠）理。
血虚，四物汤加龟板、秦艽；有火者，调潜行散；有瘀血者，加大黄、桃仁、红
花微利之；性急发热者，加酒芩、黄柏；肢节肿痛，脉涩者，加桃仁；历年不愈者，倍加木
通。出汗或发红丹即愈，若不愈者，痛风丸、二妙苍柏散、三妙丸。气虚，历节痛如捶锻者
，四君子汤加桂、附、白芍。血气俱虚，挟痰火者，八物汤加羌活、防风、黄柏、龟板。劳
伤者，趁痛散、血风丸、劫劳散；阴虚者，虎潜丸、补阴丸。
治外流湿与疏风，
痛风，因外风热、风湿得者，初起与伤寒相似，宜分表里治之。表证，九味羌活
汤。气虚表实，骨节痛者，六一散加香附、黄芩，水煎或姜汁糊丸服。里证，五积交加散
加大黄。痰湿热者，导水丸。病愈后，大便闭稍虚者，麻子仁丸。骤痛不可忍者，用枫寄生
焙干浸酒，常服微醉。通用史国公浸酒方，万应膏。
调内活血和气尔。
属内因者，宜消瘀血，养新血，兼理痰火，则血自活，气自和，痛无不止。又不
愈者，间用升降之剂，或专养血补脾。如久病及亡血、产后病此者，俱不宜纯用风药燥血。
痹风（附麻木）
五痹皮脉肌筋骨，
痹者，气闭塞不通流也，或痛痒，或麻痹，或手足缓弱，与痿相类。但痿属内因
，血虚火盛，肺焦而成；痹属风寒湿三气侵入而成，然外邪非气血虚则不入，此所以痹久亦
能成痿。又痹为中风之一，但纯乎中风则阳受之，痹兼风寒湿三气，则阴受之，所以为病更
重。观宋明医钱仲阳，自患周痹偏废，不能全愈可见。
上多风湿下寒湿。
经言∶春为筋痹，夏为脉痹，仲夏为肌肉痹，秋为皮痹，冬为骨痹。言皮、脉、
肌、筋、骨，各以时而受风寒湿之邪也。大概风湿多侵乎上，肩背麻木，手腕硬痛；寒湿多
侵乎下，脚腿木重；若上下俱得，身如板挟，脚如石坠。须分风寒湿多少治之。风多，痛
走
不定；寒多，掣痛周身拘急，手足冷痹，与痛风无异；湿多，浮肿，重着一外不移。风多，
乌药顺气散、三痹汤、越婢汤、单 丸。
寒多，五
积散，加天麻、附子，或蠲痹汤。寒湿，五积交加散。湿多，川芎茯苓汤、当归拈痛汤、
防己
黄汤、羌活胜湿汤、续断丸。又冷痹，身寒不热，腰脚沉冷，即寒痹之甚者，三痹汤合
三五七散，或舒经汤、附子理中汤。又热痹，或湿生热，或风寒郁热，身上发鼠走，唇口反
纵，肌肉变色，宣明升麻汤。风寒湿热痹，二炒苍柏散等分，加虎胫骨、防风减半，水煎服
。
皮顽脉涩证多烦，肌肉不仁筋骨屈。
风寒湿三邪交侵，在皮则顽不自觉，遇寒则急，遇热则纵，应乎肺，其证气喘烦
满；在脉则血滞，六脉涩而紧，面无色，应乎心，其证心烦上气，嗌干善噫；在肌肉则四肢
不仁，应乎脾，其证怠惰呕吐；在筋则屈而不伸，应乎肝，其证夜卧多惊，溺涩，小腹痛
。在骨则重不能举，尻以代踵，脊以代头，应乎肾，其证心腹胀满。初入皮肤血脉，邪轻
易治；留连筋骨，久而不痛不仁者难治；久久不愈，五痹复感三邪，入五脏，卧不起床，泻
多食少，亦如中风入脏者死。
祛邪后分气血痰，
初起强硬作痛者，宜疏风豁痰；沉重者，宜流湿行气。久病，须分气血虚实，痰
瘀多少治之。气虚痹者，关节不充，一身如从水中出，阳虚阴盛也，四君子汤加肉桂、生附
，或川附丸。血虚痹者，皮肤不仁，济生防风汤，或黄 建中汤去饴加桂枝。挟瘀血者，四
物汤加桃仁、红花、竹沥、姜汁。挟痰者，手足痹麻，多睡眩晕，济生茯苓汤，或二陈汤加
竹沥、姜汁。肾脂枯涸不行，髓少筋弱，冻栗挛急者，十全大补汤、地仙丹。通用五痹汤，
擦痹法。
补早反令经络郁。
初病骤用参、 、归、地，则气血滞而邪郁经络不散。虚者，乌头粥、行湿流气
散主之。
麻属气虚木痰瘀，
此概言之耳。有因虚而风寒湿三气乘之，麻木并作者；有气血俱虚，但麻而不木
者。盖麻犹痹也，虽不知痛痒，尚觉气微流行，在手多兼风湿，在足多兼寒湿
。木则非惟不
知痛痒，气亦不觉流行，常木为瘀血碍气，间木为湿痰。总皆经络凝滞，血脉不贯，谓之不
仁，或兼虚火，则肌肉 动，不可误作风治
。周身
掣痛麻木者，谓之周痹，乃肝气不行也，宜先汗后补，黄 汤。开目麻木暂退，闭目甚者，
升阳和中汤。皮肤麻木者，补气汤。手足麻，气虚者，补中益气汤去当归、陈皮，加五味子
、白芍、生甘草。虚甚挟风者，补中益气汤正料，加乌药、附子、羌活、防风、天麻。十指
麻木，胃有湿痰死血者，二陈汤加二术、红花、桃仁，少加附子以行经。左手脚腿偏麻疼痛
，右口角并眼牵引侧视者，表有风也，宜天麻黄 汤。两腿麻木者，导气汤。两脚麻木如火
热者，三妙丸。
治同痹风戒酒醋。
凡味酸伤筋则缓，味咸伤骨则痿，令人发热，变为痛痹、麻木等证。慎疾者，须
戒鱼腥、面酱、酒醋。肉属阳助火，但可量吃，若浓味过多，下必遗溺，上
必痞闷，先用二陈汤
加芍药、黄连降火，然后用本证药。
斑疹（附赤、白游风）
斑疹属火有二因，
斑属三焦无根之火，疹属心火，其上侵于肺则一也。外因初起，头疼身大热。
口知味者，忌大汗下，宜解肌微汗，有自吐泻者即愈。内因头或微疼，但手心热，脾胃虚者
，宜大补以降其火；体壮者，宜清肺以化其痰。
斑势掀发如锦纹；
有色痕而无头粒，重者红如锦绣成片，多发在胸腹。伤寒误温、误下，心火所主
。杂病全是风热挟痰，手少阳相火自里发外，治宜安里药多，发表药少。外感者，败毒散加
紫草，或升麻葛根汤加玄参。咽痛者，玄参升麻汤。狂言或见血者，阳毒升麻汤。渴者，化
斑汤。便闭者，防风通圣散微利之；便不甚闭，去硝、黄；身疼，加苍术、羌活；痰嗽加半
夏。热甚者，黑奴丸。斑烂者，黑膏。内伤发斑。轻如蚊迹、疹子者，多在手足，初起无头
疼身热，乃胃虚火游于外，宜调中益气汤、黄 建中汤。内伤痰热，上攻头面者，升麻葛根
汤，加玄参、贝母、黄芩、生地、麦门冬。内伤挟外感者，调中疏邪汤、参苏饮。
疹隐皮痒无肿痛，
疹有头粒，或如粟米，或如蚊虫咬迹微红，或随出随没，或没而又出。红沥隐
隐皮肤表分，欲出不出，但作搔痒，全无肿痛，名曰瘾疹，当春发，在伤寒最重，即温
毒也，升麻葛根汤加牛蒡子、荆芥、防风，或鼠粘汤。
出如粟米赤白分。
赤疹，因天热燥气乘之，稍凉则消，川芎茶调散、人参羌活散、胡麻散。里热者
，解毒汤。白疹，因天寒冷气折之，稍暖则消，惺惺散。里虚者，理中汤。似赤似白，微黄
隐于肌肉之间，四肢重着，此风热挟湿也。多因浴后感风，与汗出解衣而得，宜消风散；寒
，
加官桂；暑，加黄芩、柴胡；湿，加苍术、茯苓。如肢体不仁者，黄连橘皮汤。遍身疹多，
痛
极者，古苦皂丸。又有斑疹并出者，不可概用风药，恐变痰嗽渴呕疮疹。面生紫赤瘾疹、雀
子斑、汗斑，皆此类之缓者。
五色血毒风火炽，
疹色赤者，又名丹疹，或遍五色，因血盛热毒蓄于命门，被风毒逐动相火，则发
满遍身，甚则肌烂。寒月，升麻葛根汤；暑月，人参羌活散。热，加黄芩、玄参；冷，加黄
、
白芷（详小儿门）。外治土朱散，浮萍汤。
黑而入腹最伤人；
凡斑疹赤色身暖，自胸腹散四肢者，吉；黑色身凉，自四肢入腹者，死。旧分瘾
疹、丹疹各类，今合一，以其因治同也。
赤白游风属肝火，
面皮、颈项、身体皮肉变色，赤者，谓之赤癜；白者，谓之白癜。乃肝风搏于皮
肤，血气不和所生。赤属血，血热者，九味羌活汤加金银花、连翘，或四物汤加柴胡、山栀
、牡丹皮。虚者，逍遥散加山栀，或肾气丸。白属气，热者，败毒散，或小柴胡汤加防风、
连翘。虚者，补中益气汤加羌活、防风。如果系风毒者，胡麻散、单苍耳丸、单浮萍丸。此
疾久者，只宜滋养气血，则火自息，风自定，痒自止。若用祛风辛苦之剂，则肝血愈燥，风
火愈炽，元气愈虚，变为难治。
虚痒不止血难匀。
身上虚痒，血不荣于腠理故也，宜四物汤加黄芩，入紫浮萍末调服，或单凌霄花
为末，酒调服。遍身及头上，风屑痒者，单苦参丸，或薄荷、蝉蜕等分，为末，酒调服。
以上斑瘾、丹疹、癜、癣，大同小异，诸方通用。
Dampness obstructs Qi mechanism; Siwu Tang (Four Substances Decoction) is the primary formula. If there is pain at the tip of the buttocks due to Yin deficiency, this indicates Fire in the Bladder; add Zhi Mu (Anemarrhenae Rhizoma), Huang Bo (Phellodendri Cortex), and a small amount of Gui Zhi (Cinnamomi Ramulus). If Phlegm-Dampness is present, combine with Erchen Tang (Two-Cured Decoction), add Ze Xie (Alismatis Rhizoma), Qian Hu (Peucedani Radix), and use Mu Xiang (Aucklandiae Radix) as a guiding herb. If pain is severe, add Ru Xiang (Olibanum) and Mo Yao (Myrrha); if Heat is present, combine with Dachengqi Tang (Major Order the Qi Decoction) to purge downward. For pain in both legs, add Niu Xi (Achyranthis Bidentatae Radix) and Chen Pi (Citri Reticulatae Pericarpium), and swallow Jiawei Sanmiao Wan (Modified Three-Awesome Pill). If pain in both legs is severe, or if the constitution is deficient and irritable, or if blood flows into the meridians causing pain after dysentery, add Tao Ren (Persicae Semen), Niu Xi, Chen Pi, Gan Cao (Glycyrrhizae Radix et Rhizoma), and Jiang Zhi (Zingiberis Recens Juice); decoct and mix with Qianxing San (Qianxing Powder). If suddenly one or two points between the legs cause pain penetrating to the bone that is unbearable, use Yuan Hua Gen (Genkwa Flower Root) powdered, mixed with vinegar, applied to the painful area, and tightly bound with a cloth bandage; this is also suitable for postpartum cases with this condition. For pain in both feet, use Danggui Niangong Tang (Angelica Pain-Relieving Decoction). In general, for pills and powders treating Gouty Arthritis (Tongfeng), if the pathology is in the upper body, add Qiang Huo (Notopterygii Rhizoma et Radix) and Weiling Xian (Salviae Miltiorrhizae Radix? Note: Standard is Saposhnikoviae Radix); if in the lower body, add Niu Xi, Fang Ji (Stephaniae Tetrandrae Radix), Mu Tong (Akebiae Caulis), and Huang Bo; if in the arms, add Gui Zhi to guide the medicine to the painful site. If the whole body hurts, ask where the pain started and add herbs accordingly.
Wind-Toxin causing Marrow Pain is of the same category.
Gouty Arthritis (Tongfeng) presents as soreness and pain in all joints without fixed location; over time it transforms into Wind-Toxin, with pain penetrating the bone marrow and remaining fixed. Use Hugut San (Tiger Bone Powder) or Shexiang Wan (Musk Pill). If red, swollen, and burning hot, use Baidu San (Detoxification Powder); if joint swelling and pain are accompanied by Damp-Heat, use Mahuang Chishao Tang (Ephedra and Red Peony Decoction) as the main formula.
Dampness pain feels like detachment, accompanied by yellow sweat.
External Dampness syndrome with body swelling and whole-body pain feeling like detachment uses Chushi Tang (Dampness-Removing Decoction); Cold-Dampness uses Fuzi Liuwu Tang (Aconite Six-Substance Decoction) or Zhuohu Wan (Tiger-Catching Pill); Damp-Heat uses Wuling San (Five-Ingredient Powder with Poria) plus Cang Zhu (Atractylodis Rhizoma), Fang Feng (Saposhnikoviae Radix), Qiang Huo, Bai Zhi (Angelicae Dahuricae Radix), Huang Bo, Zhu Li (Bambusae Succus), and Jiang Zhi; if pain wanders, use Simiao San (Four-Awesome Powder); if joint swelling and slippery pulse are present, add Nan Xing (Arisaematis Rhizoma Praeparatum), Mu Xiang, Bing Lang (Arecae Semen), Cang Zhu, Huang Bo, and Fang Ji. Dampness causing back curvature and leg contracture leading to disability uses Gansui (Kansui Radix) one qian powdered, baked inside a pig kidney and eaten, inducing vomiting and diarrhea. Wind syndrome causing yellow sweat, slight facial redness, pulling pain, and heat uses Fangfeng Tongsheng San (Saposhnikovia Universal-Generating Powder) or Xiao Xuming Tang (Minor Rescue Life Decoction) minus Fuzi, plus Qiang Huo and Huang Qin; for deficiency, use Yaoyao Shunqi San (Lindera Regulating-Qi Powder) or Duhuo Jisheng Tang (Angelica Pubescens and Sangjisheng Decoction). For upper body, use Jin Zao Dan (Golden Date Pill); for lower body, use Huan Tui Wan (Leg-Changing Pill). Wind striking shoulder and back, Taiyang Qi stagnation preventing looking back, or Lung Qi stagnation with heat causing frequent urination and yawning, should use Tongqi Fangfeng Tang (Regulating-Qi Saposhnikovia Decoction) or Qianghuo Shengshi Tang (Notopterygium Overcoming-Dampness Decoction). Pain from Wind-Dampness intermingling uses Tianguazi Wan (Melon Seed Pill), Shenxian Feibu Dan (Immortal Swift-Walking Pill), Longhu Dan (Dragon-Tiger Pill), Huoluo Dan (Meridian-Unblocking Pill), Ruxiang Heihu Dan (Olibanum Black-Tiger Pill), or Huoxue Yingtong Wan (Invigorating-Blood Responding-Pain Pill). Wind-Damp-Toxin sores: single Cang Er (Xanthii Fructus) plus Qiang Huo and Fang Feng (two-tenths part) powdered, honey-pilled size of wutong seeds, 100 pills per dose with wine; or single Cang Er pill one jin, plus Siwu Tang ingredients each five qian, Fang Feng and Qiang Huo each three qian, Chuan Wu (Aconiti Radix Preparata) one and a half qian, powdered, honey-pilled, taken empty stomach with tea or wine. Bi syndrome from Wind-Cold-Damp-Heat, with hot, swollen, painful bones in arms, thighs, waist, and legs, difficult walking, uses Ermiao Cangbai San (Two-Awesome Atractylodes-Phellodendum Powder) equal parts, plus Tiger Tibia bone halved, powdered, taken with water.
Summerheat-Heat vexing pain, Cold penetrating marrow.
Summerheat-Dampness intermingling with red face and urine uses Wuling San combined with Baidu San, plus Dang Gui (Angelicae Sinensis Radix) and Chi Shao (Paeoniae Radix Rubra), or Fuyuan Tongsheng San. Jie Yang syndrome with limb swelling, Heat-Toxin flowing and pouring, and constipation uses Xijiao Tang (Rhinoceros Horn Decoction - note: substitute with Buffalo Horn in modern practice). Cold syndrome with pulling joint pain and small tendon Bi uses Wuji San (Five-Accumulations Decoction) combined with Shunyuan San, plus one li of She Xiang (Moschus). He Xi Feng (Crane-Knee Wind) pain uses Wuji San plus Song Jie (Pinus Node) and Shan Jie (Cryptomeriae Node); Marrow pain uses Hugut San.
Seven Emotions stabbing pain, Food Stagnation, Phlegm.
Internal Seven Emotions causing stabbing pain in limbs, chest, and hypochondrium, initially with dizziness and spontaneous sweating, uses Erchen Tang plus Xiang Fu (Cyperi Rhizoma), Zhi Ke (Aurantii Fructus), and Mu Xiang. If Qi movement in waist and back triggers pain, use Zhigan San (Zhi-Gan Powder) or Liuqi Yinzi (Flowing-Qi Infusion), both decocted with Cong Bai (Scallion White), followed by rest. If excessive thinking damages the Heart, pain starting from back to chest/hypochondrium, use Ren Shen (Ginseng Radix) four fen, Mu Tong two fen, decocted to swallow Danggui Longhui Wan (Angelica Gardenia Pill). Food stagnation causing Gouty Arthritis initially presents with chest fullness and vomiting; use Erchen Tang plus Wu Yao (Linderae Radix) and Zhi Ke, or single Cang Er Wan. Due to rich flavors causing Phlegm-Stagnation in Spleen/Stomach, pain at one point in hip pivot extending to knee swelling, aversion to cold, worse at night, uses Qianxing San as main formula, plus Gan Cao Shao (Licorice Tip), Cang Zhu, Xi Jiao (Rhinoceros Horn - note: substitute), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Chen Pi, Niu Xi, Mu Tong, Bai Shao (Paeoniae Radix Alba), with Jiang Zhi; when symptoms subside, remove Xi Jiao, add Niu Xi, Gui Ban (Testudinis Carapax et Plastrum), Dang Gui Shenwei (Angelica Body and Tail), Gui Zhi in winter, Huang Qin in summer. Wandering whole-body itching/pain like insect bites, eating relieves itching (worms sated), uses Shexiang Wan. Lingering Fluids causing limb joint pain, shortness of breath, deep pulse, potentially evolving into epilepsy, uses Daotan Tang (Phlegm-Resolving Decoction) modified. Phlegm-Fluids uses Gu Banxiao Wan (Ancient Half-Salt Pill). Shortness of breath and fatigue uses Liujunzi Tang (Six-Gentleman Decoction) plus Nan Xing. Alcohol-Dampness pain uses Huang Bo and Weiling Xian each five fen, Cang Zhu two qian, Chen Pi and Shao Yao each one qian, Gan Cao three fen, Qiang Huo two fen, decocted.
Blood-Qi Deficiency and Consumption failing to nourish joints and interstices.
Blood deficiency uses Siwu Tang plus Gui Ban, Qin Jiao (Gentianae Macrophyllae Radix); if Fire, take Qianxing San; if Blood Stasis, add Da Huang (Rhei Radix et Rhizoma), Tao Ren, Hong Hua (Carthami Flos) to mildly purge; if irritable and feverish, add Jiu Qin (Wine-fried Scutellariae Radix) and Huang Bo; if joint swelling/pain and choppy pulse, add Tao Ren; if chronic for years, double Mu Tong. Sweating or red rash indicates cure; if not, use Tongfeng Wan, Ermiao Cangbai San, Sanmiao Wan. Qi deficiency with joint pain like hammering uses Sijunzi Tang (Four-Gentleman Decoction) plus Gui Zhi, Fu Zi, Bai Shao. Blood and Qi dual deficiency with Phlegm-Fire uses Bawu Tang (Eight-Substance Decoction) plus Qiang Huo, Fang Feng, Huang Bo, Gui Ban. Consumption uses Chentong San (Following-Pain Powder), Xuefeng Wan (Blood-Wind Pill), Jie Lao San (Robbing-Consumption Powder); Yin deficiency uses Hujian Wan (Tiger-Hiding Pill) or Buyin Wan (Tonifying-Yin Pill).
Treating external flowing Dampness and dispersing Wind.
Gouty Arthritis caused by external Wind-Heat or Wind-Damp initially resembles Taiyang Disease; distinguish Exterior/Interior. Exterior syndrome uses Jiuwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction). Qi deficiency with Exterior excess and joint pain uses Liuyi San (Six-to-One Powder) plus Xiang Fu, Huang Qin, decocted or made into pills with Ginger Juice. Interior syndrome uses Wuji Jiaojia San (Five-Accumulations Mixed Powder) plus Da Huang. Phlegm-Damp-Heat uses Daoshui Wan (Water-Guiding Pill). After recovery, if constipated and slightly deficient, use Maziren Wan (Hemp Seed Pill). Sudden unbearable pain uses Fengjisheng (Taxillus) baked and soaked in wine, taken regularly until slightly drunk. General formulas: Shiguo Gong Soaked Wine, Wanying Gao (Universal-Efficacy Plaster).
Regulating interior, invigorating Blood, harmonizing Qi.
For internal causes, resolve Blood Stasis, nourish new Blood, regulate Phlegm-Fire; then Blood moves, Qi harmonizes, pain stops. If still unresolved, intermittently use ascending-descending agents, or specifically nourish Blood and tonify Spleen. For chronic illness, blood loss, or postpartum cases, avoid purely using Wind herbs to dry Blood.
Bi Wind (including Numbness).
Five Bi involve Skin, Vessels, Muscle, Tendon, Bone.
Bi is obstruction of Qi flow, presenting as pain/itching, numbness, or limb weakness, similar to Wei syndrome. However, Wei is internal, due to Blood deficiency and Fire flourishing scorching Lungs; Bi is caused by invasion of Wind-Cold-Damp, but external pathogens do not enter unless Qi/Blood are deficient, hence Bi can become Wei. Bi is also a type of Stroke; pure Stroke affects Yang channels, while Bi involving Wind-Cold-Damp affects Yin channels, making it more severe. This is evident from Qian Zhongyang's own case of Zhou Bi and hemiplegia which did not fully resolve.
Upper body mostly Wind-Damp, Lower body mostly Cold-Damp.
Classics state: Spring is Tendon Bi, Summer is Vessel Bi, Mid-Summer is Muscle Bi, Autumn is Skin Bi, Winter is Bone Bi. Skin, vessels, muscle, tendon, bone receive Wind-Cold-Damp according to season. Generally, Wind-Damp attacks upper body (shoulder/back numbness, wrist hard pain); Cold-Damp attacks lower body (leg heaviness/numbness); if both, body feels like clamped board, legs like stone weights. Treat based on proportion. Wind predominant: pain wanders; Cold predominant: pulling pain, rigidity, cold Bi in extremities (like Gout); Damp predominant: edema, heaviness, fixed. Wind predominant: Yaoyao Shunqi San, Sanbi Tang, Yuebi Tang, Dan [Missing Name] Wan. Cold predominant: Wuji San plus Tian Ma (Gastrodiae Rhizoma), Fu Zi, or Juanbi Tang. Cold-Damp: Wuji Jiaojia San. Damp predominant: Chuanxiong Fuling Tang, Danggui Niangong Tang, Fangji Huangqi Tang, Qianghuo Shengshi Tang, Xuduan Wan. Cold Bi (severe Cold Bi): body cold no fever, heavy/cold waist/legs, uses Sanbi Tang combined with Sanwuqi San, or Shujing Tang, Fuzi Lizhong Tang. Heat Bi (Damp generating Heat or Wind-Cold郁 Heat): skin feels like mice running, mouth corners relaxed, muscle color change, uses Xuanming Shengma Tang. Wind-Cold-Damp-Heat Bi uses Erchao Cangbai San equal parts, plus Tiger Tibia and Fang Feng halved, decocted.
Skin thick, pulse choppy, vexation; Muscle insensate, Tendon/Bone flexion.
Wind-Cold-Damp invading: In Skin, thick/unaware, tight in cold, loose in heat, corresponds to Lung, symptoms: asthma, vexation/fullness; In Vessels, Blood stasis, six pulses choppy/tight, pale face, corresponds to Heart, symptoms: heart vexation, upward Qi, dry throat, belching; In Muscle, limb insensibility, corresponds to Spleen, symptoms: lethargy, vomiting; In Tendon, flexion without extension, corresponds to Liver, symptoms: night terrors, difficult urination, lower abdominal pain; In Bone, heavy/unlifted, sitting on heels, spine replacing head, corresponds to Kidney, symptoms: abdominal distension/fullness. Early invasion of skin/vessels, pathogen light, easy to treat; lingering in tendon/bone, long-term insensibility/painless, difficult to treat; chronic, Five Bi re-infected by Three Pathogens entering Five Zang, bedridden, diarrhea/poor appetite, fatal like Stroke entering Zang.
After expelling pathogen, differentiate Qi, Blood, Phlegm.
Initial stiffness/pain: disperse Wind, resolve Phlegm; Heaviness: drain Damp, move Qi. Chronic: differentiate Qi/Blood deficiency/excess, Phlegm/Stasis quantity. Qi deficiency Bi: joints not filled, body feels emerging from water, Yang deficiency/Yin excess, uses Sijunzi Tang plus Rou Gui (Cinnamomi Cortex), Sheng Fu Zi, or Chuan Fu Wan. Blood deficiency Bi: skin insensibility, Jisheng Fangfeng Tang, or Huangqi Jianzhong Tang minus Yi Tang plus Gui Zhi. With Blood Stasis: Siwu Tang plus Tao Ren, Hong Hua, Zhu Li, Jiang Zhi. With Phlegm: limb numbness, sleepiness/dizziness, Jisheng Fuling Tang, or Erchen Tang plus Zhu Li, Jiang Zhi. Kidney essence dried, marrow scant, tendon weak, cold/shivering/contracture: Shiquan Dabu Tang, Dixian Dan. General: Wubi Tang, external rub for Bi.
Early tonification causes Meridian stagnation.
Using Ginseng, [Missing], Dang Gui, Di Huang abruptly in early disease causes Qi/Blood stagnation and pathogen trapped in meridians. For deficiency, use Wutou Zhou (Aconite Porridge) or Xingshi Liuqi San.
Numbness belongs to Qi deficiency, Wood, Phlegm, Stasis.
Generally speaking. Some due to deficiency allowing Wind-Cold-Damp attack, causing numbness/woodiness together; some Qi/Blood dual deficiency causing only numbness without woodiness. Numbness is like Bi; though pain/itch unknown, slight Qi flow felt. Hands often Wind-Damp, Feet often Cold-Damp. Woodiness means no pain/itch/Qi flow, often due to Blood Stasis blocking Qi, occasionally Phlegm-Damp. All are Meridian stagnation, Blood vessels not penetrating, called Insensibility; if with Deficient Fire, muscle twitching, do not mistake for Wind treatment. Whole-body pulling pain/numbness is Zhou Bi, Liver Qi stagnation, should sweat first then tonify, use Huang [Missing] Tang. Numbness recedes with eyes open, worsens closed: Shengyang Hezhong Tang. Skin numbness: Buqi Tang. Hand/Foot numbness, Qi deficiency: Buzhong Yiqi Tang minus Dang Gui, Chen Pi, plus Wu Wei Zi, Bai Shao, Sheng Gan Cao. Severe deficiency with Wind: Buzhong Yiqi Tang standard dose plus Wu Yao, Fu Zi, Qiang Huo, Fang Feng, Tian Ma. Ten fingers numbness, Stomach Damp-Phlegm/Stasis: Erchen Tang plus Er Zhu, Hong Hua, Tao Ren, slight Fu Zi to move meridians. Left hand/leg numbness/pain, right mouth corner/eye pulling sideways: Exterior Wind, use Tianma Huang [Missing] Tang. Both legs numb: Daoqi Tang. Both feet numb like fire: Sanmiao Wan.
Treatment same as Bi Wind, avoid alcohol/vinegar.
Sour flavor damages tendons (slack), Salty flavor damages bones (flaccid), causes fever, transforms into Painful Bi, numbness etc. Careful patients must avoid fishy smells, wheat paste, alcohol, vinegar. Meat is Yang assisting Fire, eat in moderation; too much rich flavor causes lower enuresis, upper chest stuffiness. First use Erchen Tang plus Shao Yao, Huang Lian to descend Fire, then use syndrome-specific medicine.
Macules/Rash (with Red/White Wandering Wind).
Macules/Rash belong to Fire, two causes.
Macules belong to Rootless Fire of San Jiao; Rash belongs to Heart Fire; both invade Lung externally. External cause initial: headache, high fever. If taste known, avoid heavy sweating/purging; use muscle-releasing mild sweating; spontaneous vomiting/diarrhea leads to cure. Internal cause: slight headache, palm heat. Spleen/Stomach deficiency: large tonification to descend Fire; robust constitution: clear Lung to transform Phlegm.
Macules erupt like brocade patterns.
Colored marks without granules, severe cases red like brocade patches, mostly on chest/abdomen. Typhoid misused warming/purging, governed by Heart Fire. Miscellaneous diseases: Wind-Heat with Phlegm, Shaoyang Ministerial Fire issuing from interior to exterior; treatment favors interior-stabilizing over exterior-releasing. External contraction: Baidu San plus Zicao (Arnebiae Radix), or Shengma Gegen Tang plus Xuanshen (Scrophulariae Radix). Sore throat: Xuanshen Shengma Tang. Delirium/bleeding: Yangdu Shengma Tang. Thirst: Huaban Tang. Constipation: Fangfeng Tongsheng San mild purge; less constipation, remove Mang Xiao, Da Huang; body pain, add Cang Zhu, Qiang Huo; phlegm-cough, add Banxia. Severe heat: Heinu Wan. Ulcerated macules: Hei Gao. Internal injury macules. Light like mosquito bites/rash, mostly hands/feet, initial no headache/fever, Stomach deficiency Fire wandering outward: Tiaozhong Yiqi Tang, Huangqi Jianzhong Tang. Internal injury Phlegm-Heat attacking head/face: Shengma Gegen Tang plus Xuanshen, Bei Mu, Huang Qin, Sheng Di, Maidong. Internal injury with external contraction: Tiaozhong Shuxie Tang, Shen Su Yin.
Rash hidden, skin itchy, no swelling/pain.
Rash has granules, like millet or mosquito bites slightly red, appears/disappears quickly. Red fluid hidden in skin surface, wanting to emerge but not, only itching, no swelling/pain, named Yin Zhen (Urticaria), occurs in Spring, severe in Typhoid, i.e., Warm Toxin. Uses Shengma Gegen Tang plus Niubang Zi, Jingjie, Fang Feng, or Shenniu Tang.
Emerging like millet, red/white differentiation.
Red Rash: Heaven heat/dryness attacks, subsides with coolness, uses Chuanxiong Chatiao San, Renshen Qianghuo San, Huma San. Interior Heat: Jiedu Tang. White Rash: Heaven cold air suppresses, subsides with warmth, uses Xingxing San. Interior Deficiency: Lizhong Tang. Red/White mixed, slightly yellow hidden in muscle, limb heaviness: Wind-Heat with Damp. Often from bathing catching wind or undressing after sweating. Uses Xiaofeng San; Cold, add Gu Gui; Summerheat, add Huang Qin, Chai Hu; Damp, add Cang Zhu, Fu Ling. Limb insensibility: Huanglian Jupi Tang. Whole body many rashes, extreme pain: Gu Kuzaowan. Macules/Rash appearing together: do not generally use Wind herbs, fear transforming into Phlegm-cough/thirst/vomiting/sores. Purple-red urticaria, freckles, sweat spots on face are milder forms of this category.
Five Colors Blood-Toxin Wind-Fire Flaring.
Red Rash, also named Dan Zhen, or five colors, due to Blood excess/Heat-Toxin stored in Mingmen, stirred by Wind-Toxin moving Ministerial Fire, erupts whole body, severe muscle rot. Cold month: Shengma Gegen Tang; Hot month: Renshen Qianghuo San. Heat, add Huang Qin, Xuanshen; Cold, add Huang Qi, Bai Zhi (see Pediatrics). External: Tuzhu San, Fuping Tang.
Black entering abdomen most harmful.
Red macules/rash, warm body, spreading from chest/abdomen to limbs: Auspicious; Black, cool body, spreading from limbs to abdomen: Fatal. Old texts separate Yin Zhen/Dan Zhen; now combined as cause/treatment same.
Red/White Wandering Wind belongs to Liver Fire.
Face/neck/body skin color change, Red called Chi Dian; White called Bai Dian. Liver Wind fighting skin, Qi/Blood disharmony. Red belongs to Blood, Blood Heat: Jiuwei Qianghuo Tang plus Jinyinhua, Lianqiao, or Siwu Tang plus Chai Hu, Shan Zhi, Mudan Pi. Deficiency: Xiaoyao San plus Shan Zhi, or Shenqi Wan. White belongs to Qi, Heat: Baidu San, or Xiao Chaihu Tang plus Fang Feng, Lianqiao. Deficiency: Buzhong Yiqi Tang plus Qiang Huo, Fang Feng. If Wind-Toxin: Huma San, Single Cang Er Wan, Single Fuping Wan. Chronic cases: only nourish Qi/Blood, Fire rests, Wind settles, itching stops. Using pungent/dry Wind herbs dries Liver Blood, flares Wind-Fire, depletes Yuan Qi, becomes difficult.
Deficiency itching unceasing, Blood uneven.
Body deficiency itching, Blood not nourishing interstices, uses Siwu Tang plus Huang Qin, mixed with Zifu Ping powder, or single Lingxiaohua powder with wine. Whole body/head wind-dander itch: Single Kushen Wan, or Bohe, Chantui equal parts powdered with wine.
Above macules/urticaria, Dan Zhen, Dian, Xuan are largely same, formulas generally applicable.