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Since ancient times, leg pain in a person does not necessarily accompany arm pain, nor does arm pain necessarily accompany leg pain. As for cases where both legs and arms hurt simultaneously, the causes of pain in the legs and arms are generally similar.

However, during my forty-plus years of clinical practice, I have cured an uncountable number of cases involving simultaneous pain in both legs and arms. The only exception was when I treated an elderly woman in Fengtian (modern-day Shenyang). Her legs and arms hurt simultaneously, yet the etiologies causing the leg pain and arm pain were different. I now record this medical case in detail below.

An elderly woman surnamed Tong from Fengtian, aged fifty-seven, gradually began to feel pain in her four limbs during the mid-winter season. After consulting physicians and taking over thirty doses of herbal medicine, her condition worsened to the point where she was bedridden and unable to turn over, suffering from ceaseless day-and-night pain. By early January of the new year, she sought my consultation. Her pulse on both left and right sides was floating and forceful, and there was a thin white coating on her tongue. I determined that she had concurrent exogenous heat pathogen. Aspirin is effective in inducing sweating to resolve exogenous conditions and also treats limb pain. Therefore, I prescribed one and a half grains (approximately 3 grams) of Aspirin, taken with sugar water to induce sweating. Upon visiting her the next day, she reported that her pain had slightly subsided after sweating, allowing her to turn over independently. However, her pulse remained forceful. Consequently, I administered a decoction containing Forsythiae Fructum (Lianqiao), Trichosanthis Radix (Huafen), Angelicae Sinensis Radix (Danggui), Salviae Miltiorrhizae Radix et Rhizoma (Danshen), Paeoniae Radix Alba (Baishao), Frankincense (Ruxiang), and Myrrh (Moyao). After administration, the pain in her arms decreased by more than half, but the pain in her legs intensified. She stated that warmth relieved the pain in her legs and that if she took hot-natured medicines, the pain would heal. Thus, I changed the prescription to include Angelicae Sinensis Radix (Danggui), Achyranthis Bidentatae Radix (Niuxi), Dipsaci Radix (Xuduan), Cuscutae Semen/Dogspine? (Gouji - *Note: Gouji refers to Lycium bark/root or sometimes Dog spine depending on context, here likely Lycii Cortex/Radix or specific bone-strengthening herb*), Drynariae Rhizoma (Gusuibu), Frankincense (Ruxiang), and Acanthopanacis Cortex (Wujiaopi). After two doses, the leg pain showed improvement, but the arm pain worsened again. This presented a situation where, within one body, the legs feared cold while the arms feared heat. Since the legs feared cold, the pain must be caused by congealed cold; since the arms feared heat, the pain must be caused by congealed heat. After much deliberation, I found it difficult to prescribe. Upon careful pulse diagnosis, the previous signs of heat had disappeared, and the left Guan position (corresponding to the Liver) could not withstand heavy pressure. Suddenly, I realized that this pattern of upper heat and lower cold was due to slight deficiency of Liver Wood, or concomitant stagnation of Liver Qi. The Ministerial Fire (Xianghuo, the fire associated with physiological activity) housed within the Liver failed to descend to warm the lower limbs, hence the legs feared cold; meanwhile, the fire was constrained in the Upper Jiao because the deficient Liver could not disperse it, hence the arms feared heat. Previously, I treated a friend, Mr. Liu, who frequently experienced heat in his left arm. His Liver pulse was deficient and stagnant. He was cured by administering a formula that tonified and soothed the Liver. Applying this analogy to the current case, I understood that the key to regulating the mechanism of upper heat and lower cold lies in tonifying and regulating Liver Wood. Therefore, I prescribed again: Pure Cornus Officinalis Fruit (Yurou) 1 liang, Angelicae Sinensis Radix (Danggui) and Paeoniae Radix Alba (Baishao) each 5 qian, Frankincense (Ruxiang), Myrrh (Moyao), and Dipsaci Radix (Xuduan) each 4 qian, Forsythiae Fructum (Lianqiao) and Glycyrrhizae Radix et Rhizoma (Gancao) each 3 qian. One dose was decocted and taken daily. Additionally, I instructed her to take one and a half grains of Aspirin daily, divided into three doses. After several days, she was completely cured. In this formula, Yurou was used in large quantity because it possesses the most complete Wood Qi among herbs. Within its sour and astringent nature, it has a freely diffusing character, making it excellent for both tonifying and soothing the Liver. The *Shennong Bencao Jing* states that it expels cold-dampness bi-syndrome. Pain in the four limbs must also involve obstruction and blockage. Moreover, with Danggui, Baishao, Ruxiang, and Moyue acting as assistant and guide herbs, the efficacy was achieved very rapidly.