[总诀]手为四末属脾经，两掌中心属少阴。厥热两条须辨治，热潮时节要分明。
手发厥冷，或兼泄利清谷者，脾肾之虚寒也。宜附子理中汤。
干姜（三钱） 附子（三钱） 党参（三钱） 白术（三钱） 甘草（炙，二钱）
歌曰∶脾肾虚寒手冷僵，不离术附与干姜。
再加参草调中胃，四末阳回正气昌。
手发潮热，兼见谵语舌黑者，胃中有燥屎也。宜调胃承气汤。
枳壳（二钱） 朴硝（三钱） 大黄（二钱） 浓朴（二钱） 甘草（一钱）
歌曰∶手热还同谵语增，胃中燥屎有明征。
草梢枳朴能调胃，加入硝黄气可承。
手心发热，多在入夜以后者，瘀血在阴分也。宜四物化瘀汤。
生地（三钱） 当归（三钱） 川芎（一钱） 白芍（三钱） 丹皮（三钱） 桃仁（三钱） 荆芥（炒，
二钱） 麦冬（三钱） 桑叶（三钱） 浮麦（三钱） 竹叶（三钱） 灯心（一钱） 蒲黄（二钱） 地骨
皮（二钱）
歌曰∶手心夜热地归芎，化血桃丹芍芥同。
桑竹全蒲灯草心，麦冬浮麦养阴崇。
手腕疼痛，或兼身痛拘急者，风、寒、湿合痹也。宜五物逐瘀汤。
桂枝（二钱） 当归（三钱） 黄 （二钱） 苡仁（三钱） 甘草（一钱） 生姜（三片）
歌曰∶手及身疼风湿痹，逐瘀汤内用 归。
苡能除湿甘能缓，再入生姜与桂枝。
（伯未按∶可加姜黄、秦艽各二钱。）
手心发热，必在午饭以后者，脾胃停饮食也。宜加味平脾汤。
苍术（二钱） 浓朴（二钱） 陈皮（二钱） 甘草（一钱） 神曲（二钱） 白芍（二钱） 酒军（一
钱）
歌曰∶手心饭后热脾伤，苍术陈皮浓朴良。
再入草梢同建曲，酒军白芍细推详。
手腕麻木，通腕皆痛不仁者，血虚生风湿也。宜养血消风汤。
当归（三钱） 白芍（三钱） 川芎（一钱） 秦艽（二钱） 苡仁（二钱） 桑皮（二钱） 竹茹（二
钱） 僵蚕（二钱） 红花（一钱） 荆芥（一钱） 续断（二钱） 生地（三钱） 钩藤（二钱） 清酒（
一杯）
歌曰∶血虚腕痛总因风，和血艽归地芍芎。
苡竹桑藤蚕作引，红花芥续酒煎同。
（伯未按∶大活络丹亦可服。）
[General Principle]
The hands, as the extremities of the four limbs, belong to the Spleen Meridian (Pí Jīng); the centers of both palms belong to the Shaoyin Heart Meridian (Shàoyīn Xīn Jīng). The treatments for Cold Reversal Syndrome (Jué Zhèng) and Heat Syndrome must be distinguished and treated separately; the timing of tidal fever (Cháo Rè) must be clearly identified.
When the hands feel cold and reversed (Jué Lěng), or are accompanied by diarrhea with undigested food in the stool (Xiè Lì Qīng Gǔ), this indicates Deficiency-Cold of the Spleen and Kidney (Pí Shèn Xū Hán). Fuzi Lizhong Tang (Aconite Decoction for Regulating the Middle) is appropriate.
Ingredients: Ganjiang (Dried Ginger, 3 qian), Fuzi (Prepared Aconite Root, 3 qian), Dangshen (Codonopsis Root, 3 qian), Baizhu (Atractylodes Rhizome, 3 qian), Gancao (Licorice Root, roasted, 2 qian).
The verse states: When Spleen and Kidney deficiency-cold causes stiff cold hands, one cannot depart from Baizhu, Fuzi, and Ganjiang.
Adding Renshen (Ginseng) and Gancao regulates the Middle Jiao (Zhōng Jiào); when Yang Qi returns to the four extremities, Zheng Qi (Upright Qi) flourishes.
When the hands present with tidal fever (Cháo Rè), accompanied by delirious speech (Zhān Yǔ) and a black tongue coating, this indicates Dry Stool (Zào Shǐ) in the Stomach (Wèi). Tiaowei Chengqi Tang (Stomach-Regulating Downbearing Decoction) is appropriate.
Ingredients: Zhiqiao (Bitter Orange Fruit, 2 qian), Puxiao (Mirabilite, 3 qian), Dahuang (Rhubarb Root, 2 qian), Houpo (Magnolia Bark, 2 qian), Gancao (Licorice Root, 1 qian).
The verse states: Hand heat combined with increased delirium is a clear sign of dry stool in the stomach.
Gancao cao (Licorice Tip), Zhiqiao, and Houpo can regulate the Stomach; adding Xiaoshi (Mirabilite) and Dahuang allows the Qi to be borne downward.
Heat in the palm that mostly occurs after nightfall indicates Blood Stasis (Xue Yu) in the Yin aspect (Yīn Fèn). Siwu Huayu Tang (Four Substances Blood-Invigorating Decoction) is appropriate.
Ingredients: Shengdi (Rehmannia Root, 3 qian), Danggui (Angelica Sinensis Root, 3 qian), Chuanxiong (Ligusticum Rhizome, 1 qian), Baishao (White Peony Root, 3 qian), Danpi (Moutan Cortex, 3 qian), Taoren (Peach Kernel, 3 qian), Jingjie (Schizonepeta Spike, stir-fried, 2 qian), Maidong (Ophiopogon Tuber, 3 qian), Sangye (Mulberry Leaf, 3 qian), Fumai (Floating Wheat, 3 qian), Zhuye (Bamboo Leaf, 3 qian), Xincaogen (Juncus Effusus Stem, 1 qian), Huyang (Polygonum Catapodium, 2 qian), Digupi (Cortex Lycii, 2 qian).
The verse states: For night heat in the palms, use Shengdi, Danggui, and Chuanxiong; to transform blood, combine Taoren, Danpi, Baishao, and Jingjie.
Sangye, Zhuru (Bamboo Shavings), Quanyanghe (Polygonum Catapodium), and Dengxincao (Juncus Stem), along with Maidong and Fumai, revere the nourishment of Yin.
Pain in the wrist, or accompanied by body pain and muscle spasms/tightness, indicates Bi Syndrome (Bì Zhèng) caused by the combination of Wind, Cold, and Dampness. Wuwu Zhuyu Tang (Five-Ingredient Blood-Invigorating Decoction) is appropriate.
Ingredients: Guizhi (Cinnamon Twig, 2 qian), Danggui (Angelica Sinensis Root, 3 qian), Huangqi (Astragalus Root, 2 qian), Yiyiren (Coix Seed, 3 qian), Gancao (Licorice Root, 1 qian), Shengjiang (Fresh Ginger, 3 slices).
The verse states: Pain in the hands and body due to Wind-Damp Bi uses Danggui within the Zhuyu Tang.
Yiyiren removes Dampness, Gancao relieves tension; add Shengjiang and Guizhi.
(Note by Bo: Jianghuang (Turmeric Rhizome) and Qinjiao (Gentiana Macrophylla Root), each 2 qian, may be added.)
Heat in the palm that necessarily occurs after lunch indicates Food Stagnation (Shí Jī) in the Spleen and Stomach. Jiawei Pingpi Tang (Modified Spleen-Calming Decoction) is appropriate.
Ingredients: Cangzhu (Atractylodes Lancea Rhizome, 2 qian), Houpo (Magnolia Bark, 2 qian), Chenpi (Tangerine Peel, 2 qian), Gancao (Licorice Root, 1 qian), Shenqu (Medicated Leaven, 2 qian), Baishao (White Peony Root, 2 qian), Jiu Jun (Wine-processed Dahuang/Rhubarb, 1 qian).
The verse states: Post-prandial hand heat indicates Spleen injury; Cangzhu, Chenpi, and Houpo are effective.
Add Gancao cao (Licorice Tip) and Jianqu (Medicated Leaven); Jiu Jun and Baishao require careful consideration.
Numbness in the wrist, with pain and insensibility throughout the entire wrist, indicates Wind-Dampness generated by Blood Deficiency (Xu Feng). Yangxue Xiaofeng Tang (Blood-Nourishing Wind-Dispersing Decoction) is appropriate.
Ingredients: Danggui (Angelica Sinensis Root, 3 qian), Baishao (White Peony Root, 3 qian), Chuanxiong (Ligusticum Rhizome, 1 qian), Qinjiao (Gentiana Macrophylla Root, 2 qian), Yiyiren (Coix Seed, 2 qian), Sangpi (Morus Alba Bark, 2 qian), Zhuru (Bamboo Shavings, 2 qian), Jiangcan (Bombyx Batryticatus, 2 qian), Honghua (Carthamus Flower, 1 qian), Jingjie (Schizonepeta Spike, 1 qian), Xuduan (Dipsacus Root, 2 qian), Shengdi (Rehmannia Root, 3 qian), Gouteng (Uncaria Rhynchophylla, 2 qian), Qingjiu (Clear Wine, 1 cup).
The verse states: Blood-deficiency wrist pain is generally due to Wind; harmonize blood with Qinjiao, Danggui, Shengdi, Baishao, and Chuanxiong.
Yiyiren, Zhuru, Sangpi, Gouteng, and Jiangcan serve as guides; Honghua, Jingjie, and Xuduan are decocted together with wine.
(Note by Bo: Dahuo Luo Dan (Great Active Meridian Pill) may also be taken.)