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(Continuing from the previous text) If the condition is mild, one may decoct a Quince Soup (Mugua Tang) for administration; gradually increase the dosage to fifty pills, taken on an empty stomach before meals.

[Jisheng Fang] Qilin Jie San (Kylin Blood Powder): Treats cold-dampness invading the meridians, causing unbearable pain.
Formula: Xuejie (Dragon's Blood), Nan Ruxiang (Southern Frankincense), Moyao (Myrrh), Baishao (White Peony Root), Danggui (Angelica Sinensis) (each 6 qian); Shizhi (Leech) (crushed and stir-fried until smoke ceases); Shexiang (Musk) (each 3 qian); Hu Jinggu (Tiger Tibia Bone) (roasted with butter until yellow, 5 qian).
The above eight ingredients are ground into a fine powder, mixed evenly. Take 3 qian per dose, administered with warm wine before meals.

[Zhu Danxi] Chentong San (Pain-Relieving Powder):
Formula: Ruxiang (Frankincense), Moyao (Myrrh), Taoren (Peach Seed), Honghua (Safflower), Danggui (Angelica Sinensis), Dilong (Earthworm), Wulingzhi (Trogopterus Feces), Niuxi (Achyranthes Root) (soaked in wine), Qianghuo (Notopterygium Rhizome) (soaked in wine), Xiangfu (Cyperus Rhizome) (soaked in urine), Sheng Gancao (Raw Licorice Root).
If phlegm-heat is present, add Jiuhuangqin (Wine-processed Scutellaria Root) and Jiuhuangbai (Wine-processed Phellodendron Bark).
General principles for treating Tongfeng (Gouty Arthritis): Use Cangzhu (Atractylodes Rhizome), Nanting (Arisaema Rhizome), Chuanxiong (Ligusticum Rhizome), Baizhi (Angelica Dahurica), Danggui (Angelica Sinensis), Jiuhuangqin (Wine-processed Scutellaria Root). For conditions located in the upper body, add Qianghuo (Notopterygium Rhizome), Weilingxian (Salvia Miltiorrhiza or Clematis Root), Guizhi (Cinnamon Twig). For conditions located in the lower body, add Niuxi (Achyranthes Root), Fangji (Stephania Root), Mutong (Akebia Stem), Huangbai (Phellodendron Bark). Bo Gui (Thin Cinnamon Bark), used for Tongfeng, is odorless and thin; uniquely, it can travel horizontally through the arms, guiding Nanting and Cangzhu to the site of pain.

Upper, Middle, and Lower Jiao Tongfeng General Formula:
Formula: Nanting (Arisaema Rhizome, 2 liang), Taixiong (Ligusticum Chuanxiong, 1 liang), Baizhi (Angelica Dahurica, 5 qian), Taoren (Peach Seed, 5 qian), Guizhi (Cinnamon Twig, 3 qian, for horizontal movement in arms), Han Fangji (Stephania Tetrandra, half liang, for descending action), Longdancao (Gentiana Root, half liang, for descending action), Cangzhu (Atractylodes Rhizome, soaked in rice water overnight, 2 liang), Huangbai (Phellodendron Bark, 2 liang, wine-fried), Honghua (Safflower, 1.5 qian, wine-washed), Shenqu (Medicated Leaven, 1 liang, fried), Qianghuo (Notopterygium Rhizome, 3 qian, for circulating through all bone joints), Weilingxian (Clematis Root, 2 qian, remove rhizome, for ascending and descending action).
Grind the above into powder, make pills with wheat paste. Take 100 pills before meals.

[Shiyi Fang] Fuling Wan (Poria Pill): Treats arm pain with miraculous effect (formula see Supplement). Kongyan Dan (Controlling Phlegm Fluid Pill): Treats shoulder, back, and arm pain with miraculous effect (formula see Xingbi section).
Add 1 liang of de-oiled Moguizi (Momordica Seed) and 5 qian of Guizhi (Cinnamon Twig) to Kongyan Dan to treat arm pain. Take 20 pills initially, increasing to 30 pills, which is effective.

[Zhu Danxi] Treating Arm Pain:
Formula: Banxia (Pinellia Tuber, 1 qian), Chenpi (Citrus Peel, half qian), Fuling (Poria, 5 fen), Cangzhu (Atractylodes Rhizome, 2 qian), Weilingxian (Clematis Root, 3 fen), Jiuhuangqin (Wine-processed Scutellaria Root, 1 qian), Baizhu (Atractylodes Macrocephala, 1 qian), Nanting (Arisaema Rhizome, 1 qian), Xiangfu (Cyperus Rhizome, 1 qian), Gancao (Licorice Root, a little).

[Shiyi Fang] Treating Arm Pain:
Formula: Honghua (Safflower, fried), Shenqu (Medicated Leaven, fried to light yellow), both ground into powder. Mix and take.

Jianghuang San (Curcuma Powder): Treats arm pain caused neither by wind nor phlegm.
Formula: Jianghuang (Curcuma Longa Rhizome, 4 liang), Gancao (Licorice Root), Qianghuo (Notopterygium Rhizome) (each 1 liang), Baizhu (Atractylodes Macrocephala, 2 liang).
For pain below the waist, add Haitongpi (Sarcandla Bark), Danggui (Angelica Sinensis), Shaoyao (Peony Root).

[Li Dongyuan] states: Arm pain involves six meridians. One must determine which meridian the pain resides in, then use herbs belonging to that meridian to regulate Qi and Blood. When Qi and Blood flow freely, the condition resolves. If superficial pains are treated with purgatives, it is incorrect; detailed differentiation is required.
Regarding Li Dongyuan's statement "Arm pain involves six meridians, using meridian-specific herbs to move Qi and Blood": This is determined by extending both arms straight down along the sides of the body, with the thumb forward and the little finger backward.
Pain on the anterior aspect of the arm belongs to the Yangming Meridian, treated with Shengma (Cimicifuga Rhizome), Baizhi (Angelica Dahurica), Gange (Pueraria Root).
Pain on the posterior aspect belongs to the Taiyang Meridian, treated with Gaoben (Ligusticum Wallichii Rhizome), Qianghuo (Notopterygium Rhizome).
Pain on the lateral aspect belongs to the Shaoyang Meridian, treated with Chaihu (Bupleurum Root).
Pain on the medial aspect belongs to the Jueyin Meridian, treated with Chaihu (Bupleurum Root), Qingpi (Aurantii Fructus Perforatus).
Pain on the anteromedial aspect belongs to the Taiyin Meridian, treated with Shengma (Cimicifuga Rhizome), Baizhi (Angelica Dahurica), Congbai (Scallion White).
Pain on the posteromedial aspect belongs to the Shaoyin Meridian, treated with Xixin (Asarum Root), Duhuo (Angelica Pubescens).
Acupuncture and moxibustion should be combined, selecting points based on the affected meridian.

Foot pain: New onset is treated as Tongfeng (Gouty Arthritis); chronic cases, if not Hongkong Foot (Gouty Arthritis affecting the foot), are treated as Hexikeng Feng (Crane's Knee Wind/Osteoarthritis). Each has its own category. Tongfeng often stems from Blood deficiency, allowing Cold and Heat pathogens to invade. (Treatment methods see Blood Heat and Blood Deficiency sections).

[Zhu Danxi] Zhang Ziyuan suffers from Qi and Blood deficiency with Phlegm, turbid white urine, intermittent Yin Fire, and recurrent Tongfeng (Gouty Arthritis).
Formula: Renshen (Ginseng Root, 1 liang), Baizhu (Atractylodes Macrocephala, 2 liang), Shudi (Prepared Rehmannia Root, 2 liang), Chuan Huangbai (Phellodendron Bark, fried, each 2 liang), Shanyao (Dioscorea Rhizome), Haishi (Calcitum/Floating Calcium, high quality, 1 liang, fried), Suoyang (Cynomorium Herb), Ganjiang (Dried Ginger, baked, half liang), Nanting (Arisaema Rhizome, 1 liang), Baiguiban (Testudo Carapace, 2 liang, roasted).
Make pills using congee, size of wutong seeds. Take with light salt water.

For Tongfeng (Gouty Arthritis) with Phlegm-Heat, first purge with Zhouche Wan (Boat Vehicle Pill), Daoshui Wan (Water-Guiding Pill), or Shenxiong Wan (Miraculous Xiong Pill), then regulate Blood with Chentong San (Pain-Relieving Powder). If Phlegm-Heat is present, add Jiuhuangqin (Wine-processed Scutellaria Root) and Jiuhuangbai (Wine-processed Phellodendron Bark) to Chentong San.
Another formula for Tongfeng:
Formula: Nuomi (Glutinous Rice, 1 zhan), Huangzhizhu Gen (Rhododendron Root, 1 bunch), Heidou (Black Soybean, half zhan).
Decoct the above with one bowl of water and one bowl of wine until half dry. Drink slowly. It induces severe vomiting and diarrhea; after one dose, pain stops, and mobility returns.

[Dairen/Liu Wansu] A man over sixty suffered pain in the lower back, sacrum, spine, and hips for years without cure. He was calm during the day but restless at night, experiencing recurring severe pain, leading to suicidal thoughts. Symptoms subsided at dawn and flared at dusk, requiring manual pounding of the painful areas. Pain gradually decreased after the rooster crowed in the fifth watch and ceased near sunrise. Dairen palpated his pulse: both hands were deep, slippery, firm, strong, and tense like a drawn bowstring. He said, "Although the patient is emaciated, he can tolerate treatment." However, pain in the lower back, sacrum, spine, and hips indicates hard, dry stool. Others reported: "Every five to seven days, or eight to nine days, he passes one or two pieces of dry stool, hard as pellets, accompanied by whole-body itching, wrinkled, dry skin resembling bran." Having determined the excess nature of the disease, Dairen employed a Yin method (purging), using Dachengqi Tang (Major Order the Qi Decoction) with Ginger and Jujube as guides, adding 2 qian of Qianniu Toumo (Front-end Powder of Morning Glory Seed). He dared not call it a purgative directly. Patients prefer warmth and fear cold, accept tonification but resist purgation. This bias is long-standing, compounded by conflicting opinions. The decoction was given warm, starting with small amounts and increasing over three days. By evening, four to five bowel movements occurred, filling about half a basin. Inspection revealed hard, dry fecal masses mixed with stagnant blood and visceral waste, foul-smelling. Within moments, pain reduced by ninety percent. The patient fell into a deep sleep, breathing normally. Upon waking the next day, he felt hungry and asked for porridge. After consuming lukewarm food and sleeping another day or two, the pain completely resolved. Dietary therapy followed, with daily doses of Dao Yin Wan (Guiding and Pulling Pill) and Ganlu San (Sweet Dew Powder) to lubricate the bowels. Recovery took over forty days. Chang Zhongming's wife experienced hot, painful hands every winter. Dairen said, "The four limbs are the root of all Yang meridians. When Yang disperses in summer, there is no pain; when Yang converges in autumn/winter, pain occurs." He purged heavily with Sanhua Shenyao Wan (Three Flowers Miraculous Aid Pill), and the heat cleared.

In the theory of Six Qi (Yunqi), Bi Syndrome (Obstruction Syndrome) is divided into two types:
First, Damp-Bi. The Classic states: "When Taiyin governs the year, excessive dampness causes swelling, bone pain, and Yin-Bi." Yin-Bi is characterized by tenderness that cannot be pinpointed by pressure; it is treated with bitter-hot herbs.
Second, Dry-Bi. The Classic states: "When Yangming arrives, it causes pain in the sacrum, yin region, thighs, knees, thighs (thighs), and feet." It also states: "When Metal Qi is excessive, Dryness flows widely, causing severe pain in the sacrum, yin region, thighs, knees, thighs, and feet."

[Huangdi Neijing] Methods of acupuncture and moxibustion for various pains require first clarifying the meridians, then distinguishing depth. The meridians refer to the twelve meridians of the hands and feet.
Pain on the anterior aspect of the hand belongs to the Yangming Meridian. The Classic states: "Diseases generated by the Hand-Yangming Meridian include pain in the front of the shoulder, and pain/uselessness of the thumb and index finger."
Pain on the posterior aspect belongs to the Taiyang Meridian. The Classic states: "When the Hand-Taiyang Meridian moves, diseases include shoulder pain as if pulled out, elbow pain as if broken." Generated diseases include pain in the shoulder, elbow, and outer-posterior aspect of the arm.
Pain on the lateral aspect takes the Shaoyang Meridian. The Classic states: "Diseases generated by the Hand-Shaoyang Meridian include pain behind the ear, shoulder, elbow, and outer arm, and uselessness of the ring and little fingers." It also states: "When pathogenic factors lodge in the collaterals of the Hand-Shaoyang, they cause pain in the outer arm, inability to raise the hand to the head. Puncture one cun above the nail corner of the middle and ring fingers, left side treating right, right side treating left."
Pain on the medial aspect takes the Jueyin Meridian. The Classic states: "When the Hand-Jueyin Meridian moves, diseases include heat in the palm, spasm of the elbow and arm, and axillary swelling."
The Classic states: "Diseases generated by the Foot-Yangming Meridian include swelling and pain of the knee patella, pain along the chest, breast, Qichong point, outer thigh (Futu area), dorsum of the foot, and uselessness of the middle toe."
Pain on the posterior aspect of the foot belongs to the Taiyang Meridian. The Classic states: "When the Foot-Taiyang Meridian moves, diseases include headache, eyes feeling as if falling out, neck feeling as if pulled, spinal pain, waist feeling as if broken, inability to bend the thigh, popliteal fossa feeling bound, calf feeling torn. This is called Anjue. Generated diseases include pain in the neck, back, waist, sacrum, calf, and sole, and uselessness of the little toe."
Pain on the lateral aspect belongs to the Shaoyang Meridian. The Classic states: "Diseases generated by the Foot-Shaoyang Meridian include pain in the chest, hypochondrium, ribs, hip, knee, extending to the outer leg, Jiegu point, anterior to the lateral malleolus, and all joints, with uselessness of the ring and little toes." It also states: "If the thigh cannot be lifted, take the point laterally, in Shu Zhong (Huantiao), using Yuanli Needle; large needles should not be used." It also states: "When pathogenic factors lodge in the collateral of the Foot-Shaoyang, they cause stagnation in Shu Zhong, pain in the hip preventing lifting. Puncture Shu Zhong with a filiform needle. In cold patterns, retain the needle for a long time, counting according to the waxing and waning of the moon, for immediate relief."
Pain on the medial aspect belongs to the Taiyin Meridian. The Classic states: "Diseases generated by the Foot-Taiyin Meridian include swelling and coldness of the inner thigh and knee, and uselessness of the big toe."
Pain on the posteromedial aspect belongs to the Shaoyin Meridian. The Classic states: "Diseases generated by the Foot-Shaoyin Meridian include pain in the inner-posterior spine and thigh, and heat/pain in the sole."
Pain on the anteromedial aspect belongs to the Jueyin Meridian. The Classic states: "When the Foot-Jueyin Meridian moves, diseases include lower back pain, inability to bend or extend."

For pain in these twelve meridians of the hands and feet, apply tonification, sedation, rapid retention, or moxibustion based on excess/deficiency, cold/heat, and sinking conditions. (Full text above is found in the Acupuncture Section, Twelve Meridian Articles. Excess sedate, deficiency tonify, heat treat rapidly, cold retain, sinking moxa.)

Depth refers to the layers of skin, vessels, flesh, sinews, and bones. Disease in the skin is regulated by treating the skin, i.e., selecting blood collaterals. Disease in the vessels is regulated by treating the vessels, i.e., selecting the blood vessels of the twelve hand and foot meridians. Disease in the flesh is regulated by treating the muscle spaces. The Neijing states: "Disease in skin and muscle with widespread pain is named Ji-Bi (Muscle Bi). Caused by cold-damp, puncture large and small muscle spaces, use multiple needles deeply to generate heat. Do not injure sinews and bones; injury leads to abscess. If altering the heat in various parts, stop when the disease heat clears." Disease in sinews is regulated by treating sinews. The Classic states: "Disease in sinews with spasms and joint pain, inability to walk, is named Jin-Bi (Sinew Bi). Puncture up to the sinew, between muscle spaces, do not strike the bone." Disease in bones is regulated by treating bones. The Classic states: "Disease in bones with heaviness, inability to lift, soreness in marrow, cold qi reaching bones, is named Gu-Bi (Bone Bi). Deep puncture without injuring vessels or flesh. Pathway through large and small muscle spaces. Stop when bone heat clears." It also states: "Evil in Kidney causes bone pain and Yin-Bi. Yin-Bi cannot be pressed to find tenderness. Take Yongquan and Kunlun. If blood stasis exists, drain it all." It also states: "Gu-Bi with joint immobility and pain, sweating, vexation, take Three-Yang meridians to tonify (or Three-Yin)."

This addresses the depth of skin, vessels, flesh, sinews, and bones, taking points according to location.
Furthermore, for chronic Bi remaining in the body, observe blood collaterals and drain all stagnant blood.
Chronic Tongbi (Painful Bi) entering organs and bowels: Acupuncture methods see the Various Bis section.

[Yulong Ge] Whole-body pain: Puncture only at the painful spot, regardless of specific meridian points, avoiding sinews and bones. These are called Tianying Points (Ah Shi points).

[Cuoyao] Arm pain: Jianyu, Shousanli, Waiguan.

[Zhaoying] Arm pain and numbness: Jianyu, Jianjing, Quchi.

[Jicheng] Arm numbness and pain: Jianyu, Quchi, Shou Shanglian, Hegu. If ineffective, add: Jianjing, Lieque.

[Yulong Ge] Arm pain radiating to wrist: Yemen (parallel needling backwards to Yangchi, sedation), Zhongzhu (parallel needling to Wangu, sedation).

[Cuoyao] Medial arm pain: Jingqu (1 fen, avoid moxa), Lingdao (1 fen, supine needle, forward 3 fen), Shaohai (5 fen).

[Li Dongyuan] Arm soreness and spasm: Zhouleou, Xiaoyin, Chize, Qian Gu, Houxi.

[Jiaying Jing] Arm unable to reach head: Chize governs. Arm unable to lift, head/neck pain, swollen throat unable to swallow: Qiangu governs. Elbow/arm/wrist pain, neck swelling unable to turn head, urgent head/neck pain/dizziness, heavy shoulders/scapula, little finger pain: Qiangu governs. Elbow pain unable to dress oneself, dizziness, chin pain, dark face, aversion to wind, shoulder pain unable to turn: Guanchong governs. Elbow pain radiating to shoulder, inability to flex/extend, chills/fever, neck/shoulder/back pain, wasting-thirst numbness: Tianjing governs (Qianjin Fang says: scapular muscle numbness). Swishing sensation in elbow, medial arm pain unable to reach head: Waiguan governs. Elbow pain: Chize governs.

[Cuoyao] Wrist pain: Yangxi, Quchi.

[Yulong Ge] Wrist weakness and pain: Wangu (horizontal insertion 3 fen, sedate if painful, tonify if weak), Quchi (same tonification/sedation).

[Cuoyao] Five finger contracture: Sanjian (1 fen, sedate then tonify/moxa), Qiangu (1 fen, sedate/moxa). All five fingers painful: Yangchi, Waiguan, Hegu.

Hip pain and leg wind: Huantiao (in hip pivot, lie on side, extend lower leg, flex upper leg to needle. Depth 3.5 cun, more sedation than tonification, retain 8 breaths). Juliao (1.2 cun, retain 8 breaths, sedate). Weizhong bleeding.

[Biaoyou Fu] Hip pain and foot inversion: Huantiao, Xuanzhong (Zhaoying calls it Qiuxu, needle 5 fen, retain 3 breaths, moxa 3 cones).

[Jicheng] Hip pain and leg wind, inability to turn, difficult movement: Huantiao (3.5 cun moxa 77 cones), Fengshi (moxa 14 cones), Juliao (3.5 cun moxa 35 cones), Weizhong, Kunlun, Zusanli, Yanglingquan. If ineffective, take lower points: Wushu, Yangfu.

Waist and foot pain: Weizhong, Kunlun, Renzhong.

[Sang] Side leg wind: Jiegu, Taichong.

[Li Dongyuan] Spleen pivot pain, cold/heat in calves, pain on outer skin/bone of foot: Linqi (1 fen), Foot Three Yin (1.5 cun), Yangfu.

[Jiaying Jing] Pain in hip pivot, unable to lift, needle with filiform needle, retain according to moon phases (or breath counts) for immediate relief, long needle also works. Waist and hypochondrium pulling pain, stiff sinews/calf pain, inability to flex/extend, numbness: Huantiao governs.

[Li Dongyuan] Tight hip sinews and calf pain, flaccid wasting-numbness, cold knees, outer aspect unable to flex/extend, damp-bi with swelling: Fengshi, Zhongdu, Yangguan, Xuanzhong.

Leg pain: Yanglingquan, Zusanli, Futu, Yinshi.

Knee/leg spasm, pain radiating to hypochondrium, discoloration (blue, black, sallow, or withered like rotten wood): Fengshi (moxa), Yanglingquan, Ququan, Kunlun.

Outer knee/leg pain, thigh swelling/soreness, turning to wasting-numbness, or knee/calf heat, inability to walk: Xiaxi (5 fen), Biguan, Guangming (each 1 cun).

Hip Bi radiating to outer knee/thigh acute pain, calf soreness, audible shaking, joint soreness inability to walk: Yinlingquan, Jiegu, Zhongfeng.

[Jiaying Jing] Outer knee pain, heat disease no sweat, outer eye red/pain, dizziness, bilateral forehead pain, reverse cold/tears, tinnitus, hyperhidrosis, eye itch, chest pain unable to turn, pain moving locations: Xiaxi governs. Outer knee pain unable to flex/extend, calf Bi numbness: Yangguan governs. Hip Bi radiating to outer knee/thigh pain/numbness, tendon tightness: Yanglingquan governs. Inner knee pain radiating to patella, unable to flex/extend, connecting to abdomen, radiating to throat pain: Xiguan governs.

[Li Dongyuan] Inner knee/leg pain radiating to patella, unable to flex/extend, connecting to abdomen, radiating to throat pain: Taichong (5 fen), Zhongfeng, Xiguan.

Calf soreness/cold, heat in soles, inability to stand long, damp-Bi numbness: Zhongdu, Chongyang, Chengshan, Chengjin.

Calf cold, heavy limbs, shortness of breath, difficulty speaking, inability to lie flat: Zhiyang, Sanyinjiao.

[Jiaying Jing] Bi-heavy calf, foot collapse, heel pain: Jubu Bulian (Feiyang?) governs. Calf pain, foot weakness losing footing, damp-Bi, heat in soles, inability to stand long: Tiaokou governs. Calf soreness/severe Bi, knee unable to flex/extend, unable to walk: Liangqiu governs.

[Yulong Ge] Straw-shoe wind: Kunlun (sedate, retain 6 breaths), Taixi (sedate, retain 6 breaths), Shenmai (5 fen, more sedation than tonification, retain 2 breaths, avoid moxa).

[Cuoyao] Straw-shoe wind, ankle pain: Kunlun (penetrate Taixi), Qiuxu, Shangqiu (each 1.5 cun, sedate/moxa).

[Jicheng] Another method: Kunlun, Qiuxu, Shangqiu, Zhaohai (if ineffective, take posterior points), Taichong, Jiexi.

Ankle useless/wasting, unable to sit/get up, hip/foot pain: Guangming (parallel 5 fen), Qiuxu (straight 5 fen).

Wrist loose/unable to hold, inverted foot unable to bear calf soreness: Ran Gu, Fubai, Kunlun.

[Cuoyao] Lateral malleolus red/swollen/painful: Shenmai (0.5 cun sedate).

[Zhaoying] Ankle encircling wind: Quchi (if lateral ankle pain, additionally puncture Sun Luo Foot-Shaoyang between little toe 3 fen. If medial ankle pain, additionally puncture Dadu 3 fen. If anterior wrist pain, puncture Xingjian 6 fen).

[Jicheng] Another method: Taichong, Linqi, Xingjian, Neiting. If ineffective, take lower points: Kunlun, Qiuxu.

[Cuoyao] Pain at bone before base of big toe: Taichong (pluck needle to bleed).

All five toes painful, unable to touch ground: Yongquan (2 fen), Ran Gu (1 fen).

[Jiaying Jing] Wind-cold starting from little toe, vessel Bi up/down, involving chest/hypochondrium, pain moving locations: Zhiyin governs. Heat/pain in soles, unable to sit long, damp-Bi unable to walk: Sanyinjiao governs. Bone Bi vexation/fullness: Shangqiu governs. Skin pain/wasting-numbness: Waiqiu governs. Cold qi in muscle spaces causing pain, upper/lower Bi numbness: Zhongdu governs.