张子和曰∶痹之为状，麻木不仁，以风寒湿三气合而成之。故《内经》曰∶风气胜者为行痹。风则
阳受之，故其痹行，旦剧而夜静。世俗不知，反呼为走注疼痛、虎咬之疾。寒气胜者为痛痹。寒则阴受之，
故其痹痛，旦静而夜剧。世俗不知，反呼为鬼忤。湿气胜者为着痹。湿胜则筋脉皮肉受之，故其痹不去，
肌肉削而着骨。世俗不知，反呼为偏枯。
痹则从外入，所受之邪各有浅深，或痛或不痛，或仁或不仁，或筋屈而不能伸，或引而不缩，寒则虫行，
热则缩缓，不相乱也。
皮痹不已，而成肉痹；肉痹不已，而成脉痹，脉痹不已，而成筋痹；筋痹不已，而成骨痹。久而不已，
乃舍其合。若脏腑俱病，虽有智者不能善图也。
凡病痹，其脉沉涩。其病以湿热为源，风寒为兼，三气合而为痹。
李士材曰∶痹病初在外，久而不去，则各因其合，而内舍于脏。在外者祛之犹易，入脏者攻之实难。
治外者散邪为亟，治脏者养正为先。治行痹者散风为主，御寒利湿仍不可废，大抵参以补血之剂，盖治
风先治血，血行风自灭也。治痛痹者散寒为主，疏风燥湿仍不可缺，大抵参以补火之剂，非大辛大温不能
释其凝寒之害也。治着痹者利湿为主，祛风解寒亦不可缺，大抵参以补脾补气之剂，盖土强可以胜湿，而
气足自无顽麻也。分条治法，别列于左。
筋痹即风痹也，游行无定，上下左右，随其虚邪与气血相搏，聚于关节，或赤或肿，筋脉弛纵，古称走
注，今名流
火，防风汤主之，如意通圣散、桂心散、没药散、虎骨丸、十生丹、一粒金丹、乳香应痛丸。
脉痹即热痹也，脏腑移热，复遇外邪，客搏经络，留而不行，故 痹，肌肉热极，唇口反裂，皮肤色
变，升麻汤主之。
肌痹即着痹，湿痹也，留而不移，汗多，四肢缓弱，皮肤不仁，精神昏塞，今名麻木，神效黄 汤
主之。
皮痹者，邪在皮毛，瘾疹风疮，搔之不痛，宜疏风养血。
骨痹即寒痹，痛痹也，痛苦切心，四肢挛急，关节浮肿，五积散主之。
喻嘉言曰∶痹症非不有风，然风入于阴分，与寒湿互结，扰乱其血脉，致身中之阳不通于阴，故致痹
也。古方多有用麻黄、白芷者，以麻黄能通阳气，白芷能行荣卫也，然入在四君、四物等药之内，非专发表
明矣。至于攻里之药，从无用之者，以攻里之药皆属苦寒，用之则阳愈不通，其痹转入诸腑，而成危症者
多矣。
朱丹溪痛风论曰∶气行脉外，血行脉内，昼夜五十营，此平人之造化也。得寒则行迟而不及，得热
则行速而太过，内伤于七情，外感于六淫，则气血之运，或迟或速，而病作矣。痛风者，大率因血受热已
自沸腾，其后或涉于水，或立湿地，或扇取凉，或卧当风，寒凉外搏，热血得寒，污浊凝滞，所以作痛。
夜则痛甚，行于阴也。治以辛热之剂，流散寒湿，开发腠理，其血得行，与气相和，其病自安，然亦有数
种。
东阳傅文年逾六十，性急作劳，患两腿痛，动则更甚。予视之曰∶此兼虚症，当补血温血，病当自安。
遂与四物汤加桃仁、陈皮、牛膝、生甘草，煎入生姜汁，研潜行散，热饮三四十帖而安。
又朱宅阃内，年近三十，食味甚浓，性躁急，患痛风挛缩数月，予视之曰∶此挟痰与气症，当和
血疏气导痰，病自安。遂以潜行散入生甘草、牛膝、炒枳壳、通草，陈皮、桃仁、姜汁，煎服半年而安。
又邻鲍六，年二十余，因患血痢，用涩药取效，后患痛风，叫号撼邻。予视之曰∶此恶血入经络症，
血受湿热，久必凝浊，所下未尽，留滞隧道，所以作痛。经久不治，恐成偏枯。遂与四物汤加桃仁、红花、
牛膝、黄芩，陈皮、生甘草，煎入生姜汁，研潜行散，入少酒饮之，数十剂而安。
张三锡曰∶痛风即《内经》痛痹。但今人多内伤，气血亏损，湿痰阴火流滞经络，或在四肢，或在腰背，
痛不可当，一名白虎历节风是也。大抵湿多则肿，热多则痛，阴虚则脉数而重在夜，气虚则脉大而重在昼。
肢节痛须用羌活，去风湿亦宜用之。如肥人肢节痛，多是风湿，与痰饮流注经络而痛，宜南星、半夏。
如瘦人肢节痛，是血虚，宜四物汤加防风、羌活。如瘦人性躁急、肢节痛、发热，是血热，宜四物加酒炒
黄芩、黄柏。如肢节肿痛脉滑者，常用燥湿，宜苍术、南星，兼行气药木香、枳壳、槟榔，在下加汉防己。
若肢节肿痛脉涩数者，此是淤血，宜桃仁、红花、当归、川芎，及大黄微利之。如倦怠无力而肢节痛，此是
气虚。兼有痰饮流注，宜参、术、星、半。
戴院使曰∶臂痛有血虚一症，血不荣于筋，或致臂痛，宜蠲痹汤、四物汤各半煎服。若坐卧为风湿所
搏，或睡后手在被外，为寒邪所袭，遂令臂痛，宜五积散及蠲痹汤、乌药顺气散。审知是湿，蠲痹汤加苍术、
防己三四分。
方约之曰∶风、痿之别，痛则为风，不痛则为痿。经曰∶痛则为实，不痛则为虚，曰风曰痿，虚实二者
而已。东垣曰∶
气盛病盛，气衰病衰。何则？人之气血充实，而风寒客于经络之间，则邪正交攻，而疼痛作矣。人之气血
虚弱，而痰火起于手足之内，则正不胜邪，而痿痹作矣。故丹溪先生曰∶痿症切不可作风治，而用风药。
盖以风为实而痿为虚也。曰散邪曰补虚，岂可紊乱乎？
附香港脚
张三锡曰∶香港脚委属湿热。《内经》曰∶诸湿肿满，皆属脾土。又曰∶伤于湿者，下先受之。盖脾主
四肢，足居于下，而足多受其湿，湿郁成热，湿热相搏，其病作矣。是以先从气冲穴隐核痛起，及两足红
肿，或恶寒发热，状若伤寒，是其候也。或一旬，或半月，复作如故，渐至足筋肿大如瓠者有之。古方名为
缓风，宋元以来呼为香港脚。原其所由，非止一端；有从外感而得者，有从内伤而得者。所感虽有内外之
殊，其湿热为患则一也。凡香港脚初起，其势甚微，饮食起居如故。惟卒起脚屈弱不能动为异耳。
风痹
薛立斋曰∶手足不随，由风寒湿三气合而为痹。风多者为风痹，其状肌肤尽痛。诸阳之经皆起于手足，
而循行于身体，风寒之气客于肌肤始为痹，复伤阳经，随其虚处而停滞，与血气相搏，血气行则迟缓，故风
痹而手足不随也。
若风邪淫旺，或怒动肝火，血燥筋挛，用加味逍遥散。脾肺气虚不能滋养筋骨，或肝脾血虚而筋痿痹，
用六味丸。服燥药而筋挛者，用四物汤加生甘草。气血俱虚，用八珍汤。
何《医林集要》等方，新刊《丹溪心法》附录，云若人大拇指麻木不仁，或手足少力，或肌肉微掣，
三年内必有大风之证，宜先服八风汤、天麻丸、防风通圣散以预防之？不知河间云∶风者，病之末也。所
以中风有瘫痪者，非谓肝木
之风内中，亦非六淫风邪外袭，良由五志过极，心火炽盛，肾水虚衰不能制之，则阴虚阳实而热气拂郁，
心神昏冒，筋骨无所用，而卒倒无知也。治法当以固元气为主。若遽服八风等药，则反伤元气，适足以招
风取中。医风先医血，此论得之经曰∶风客淫气，精乃亡，邪伤肝也。夫风搏则热盛，热盛则水干，水干
则气不荣，精乃亡。此风病之所由作也。
Zi Hezi stated: The manifestation of Bi syndrome (Bi Syndrome, characterized by numbness and pain) involves numbness and insensibility, caused by the combination of Wind, Cold, and Dampness pathogens. Thus, the *Neijing* (Classic of Internal Medicine) states: When Wind pathogen predominates, it is called Xing Bi (Wandering Bi). Wind belongs to Yang and affects Yang aspects; therefore, this type of Bi moves about, worsening in the morning and quieting at night. The common people, unaware of this, mistakenly call it "Zou Zhu" (migratory pain) or the disease of a tiger bite. When Cold pathogen predominates, it is called Tong Bi (Painful Bi). Cold belongs to Yin and affects Yin aspects; therefore, this type of Bi causes severe pain, quieting in the morning and worsening at night. The common people, unaware of this, mistakenly call it "Gui Wu" (ghost affliction). When Dampness pathogen predominates, it is called Zhuo Bi (Fixed Bi). When Dampness predominates, it affects sinews, vessels, skin, and flesh; therefore, this Bi lingers without resolving, muscles emaciate, and it adheres to the bone. The common people, unaware of this, mistakenly call it "Pian Ku" (hemiplegia/paralysis).
Bi syndrome enters from the exterior; the pathogens received have varying depths. Some cause pain, some do not; some cause numbness, some do not; some involve sinew flexion with inability to extend, some involve traction without retraction; feeling like insects crawling when cold, or contraction and flaccidity when hot; these symptoms do not confuse one another.
If Pi Bi (Skin Bi) persists, it develops into Rou Bi (Flesh Bi); if Rou Bi persists, it develops into Mai Bi (Vessel Bi); if Mai Bi persists, it develops into Jin Bi (Sinew Bi); if Jin Bi persists, it develops into Gu Bi (Bone Bi). If prolonged and unresolved, the pathogen resides in the corresponding Zang-Fu organs. If all Zang and Fu organs are diseased, even a wise person cannot manage it well.
Generally, for Bi syndrome, the pulse is deep and choppy. The root cause is Damp-Heat, with Wind and Cold as concurrent factors; the combination of these three creates Bi.
Li Shicai stated: Bi syndrome begins on the exterior; if prolonged and unresolved, it enters the Zang organs according to their correspondences. Exterior cases are easy to dispel; interior Zang cases are difficult to treat. For exterior treatment, dispelling pathogens is urgent; for interior treatment, nourishing righteousness (Zheng Qi) is primary. For treating Xing Bi, dispersing Wind is primary, but warding off Cold and draining Dampness must not be abandoned; generally, blood-nourishing formulas are added, because treating Wind requires treating Blood first; when Blood flows, Wind extinguishes itself. For treating Tong Bi, dispersing Cold is primary, but diffusing Wind and drying Dampness must not be lacking; generally, Fire-nourishing (warming) formulas are added, only strong acrid-warm herbs can release the harm of congealed Cold. For treating Zhuo Bi, draining Dampness is primary, but dispelling Wind and resolving Cold must not be lacking; generally, Spleen-qi tonifying formulas are added, because strengthening Earth overcomes Dampness, and sufficient Qi eliminates stubborn numbness. The specific treatments are listed below.
Jin Bi is equivalent to Feng Bi (Wind Bi), moving without fixed location, up, down, left, right, interacting with Qi and Blood at deficiency sites, gathering in joints, appearing red or swollen, with flaccid sinews. Anciently called "Zou Zhu," now called "Liu Huo" (Flowing Fire). It is primarily treated with Fangfeng Tang (Saposhnikovia Decoction), Ruyi Tongsheng San, Guixin San, Moyao San, Hugut Wan, Shisheng Dan, Yili Jindan, or Rushuang Yingtong Wan.
Mai Bi is equivalent to Re Bi (Heat Bi). Heat shifts from Zang-Fu, combined with external pathogens, lodging in meridians and stagnating. This causes Bi, extreme heat in muscles, cracked lips and mouth, and changed skin color. It is primarily treated with Shengma Tang (Cimicifuga Decoction).
Ji Bi is equivalent to Zhuo Bi and Shi Bi (Damp Bi). The pathogen stays fixed, with excessive sweating, flaccid limbs, insensible skin, and mental cloudiness. Now called numbness. It is primarily treated with Shenxiao Huangqi Tang (Miraculous Effect Astragalus Decoction).
Pi Bi involves pathogens in the skin and hair follicles, presenting as urticaria or wind sores, painless upon scratching. It should be treated by dispersing Wind and nourishing Blood.
Gu Bi is equivalent to Han Bi (Cold Bi) and Tong Bi. It causes heart-piercing pain, limb spasms, and joint swelling. It is primarily treated with Wuji San (Five Accumulations Powder).
Yu Jiayan stated: Bi syndrome does involve Wind, but Wind enters the Yin aspect, binding with Cold and Dampness, disturbing blood vessels, preventing Yang from communicating with Yin, thus causing Bi. Ancient formulas often used Mahuang (Ephedrae Herba) and Baizhi (Angelicae Dahuricae Radix) because Mahuang unblocks Yang Qi and Baizhi circulates Ying and Wei. However, they were used within formulas like Sijunzi Tang (Four Gentlemen Decoction) and Siwu Tang (Four Substances Decoction), clearly not for exclusive exterior-releasing purposes. Interior-purging herbs were never used because they are bitter-cold; using them further blocks Yang, leading Bi into the Fu organs and becoming critical conditions frequently.
Zhu Danxi discussed Gout (Tongfeng): Qi moves outside the vessels, Blood moves inside, circulating fifty times daily; this is normal physiology. Cold slows movement, causing deficiency; Heat speeds movement, causing excess. Internal injury from Seven Emotions, external invasion from Six Evils, causes Qi and Blood transport to become slow or fast, triggering disease. Gout usually occurs because Blood has been heated to boiling, then exposed to water, damp ground, cooling fans, or drafts. External Cold attacks, Hot Blood meets Cold, turbidity stagnates, causing pain. Pain worsens at night because the pathogen travels in Yin. Treatment uses acrid-hot formulas to disperse Cold-Damp, open pores, allow Blood to flow, harmonize with Qi, and restore health. There are several variations.
Fu Wen from Dongyang, over sixty, impatient and overworked, suffered leg pain worsening with movement. I diagnosed deficiency mixed with excess, advised nourishing and warming Blood. Prescribed Siwu Tang plus Taoren (Persicae Semen), Chenpi (Citri Reticulatae Pericarpium), Niuxi (Achyranthis Bidentatae Radix), and Gancao (Glycyrrhizae Radix et Rhizoma), decocted with Shengjiang juice (Fresh Ginger Juice), mixed with Qianxing San, taken hot. Thirty to forty doses cured him.
The wife of the Zhu family, nearly thirty, rich diet, irritable, suffered gouty contraction for months. I diagnosed phlegm and Qi stagnation. Advised harmonizing Blood, diffusing Qi, and guiding out Phlegm. Prescribed Qianxing San plus Gancao, Niuxi, Chao Zhike (Stir-fried Aurantii Fructus), Tongcao (Tetrapanacis Medulla), Chenpi, Taoren, and Jiangzhi (Ginger Juice), decocted and taken. Half a year of treatment cured her.
Neighbor Bao Liu, over twenty, had dysentery with bloody stools, treated with astringents successfully, later developed gout, screaming loudly. I diagnosed evil Blood entering collaterals. Blood affected by Damp-Heat, long-term stagnation causes turbidity. Residual blood remained in tunnels (collaterals), causing pain. Untreated, it might become hemiplegia. Prescribed Siwu Tang plus Taoren, Honghua (Carthami Flos), Niuxi, Huangqin (Scutellariae Radix), Chenpi, Gancao, decocted with Shengjiang juice, mixed with Qianxing San, taken with a little wine. Dozens of doses cured him.
Zhang Sanxi stated: Gout is Tong Bi from the *Neijing*. But modern people often have internal injuries, Qi and Blood deficiency, Damp-Phlegm and Yin Fire stagnating in meridians, affecting limbs or back, unbearable pain, also known as Baihu Lijie Feng (White Tiger Joint-Wandering Wind). Generally, more Dampness causes swelling, more Heat causes pain. Yin deficiency leads to rapid pulse, worse at night; Qi deficiency leads to large pulse, worse during day. Limb/joint pain requires Qianghuo (Notopterygii Rhizoma et Radix) to remove Wind-Damp. For obese people with limb pain, it is Wind-Damp with Phlegm-Fluids in collaterals; use Nanxing (Arisaematis Rhizoma Preparatum) and Banxia (Pinelliae Rhizoma). For thin people with limb pain, it is Blood deficiency; use Siwu Tang plus Fangfeng (Saposhnikoviae Radix) and Qianghuo. For thin people with irritability, limb pain, and fever, it is Blood Heat; use Siwu Tang plus Jiuhuang Qin (Alcohol-fried Scutellariae Radix) and Huangbai (Phellodendri Cortex). For swollen/painful joints with slippery pulse, use drying-Damp herbs like Cangzhu (Atractylodis Rhizoma) and Nanxing, combined with Qi-moving herbs Muxiang (Aucklandiae Radix), Zhike, and Binglang (Arecae Semen); add Hanfangji (Stephaniae Tetrandrae Radix) for lower body. For swollen/painful joints with choppy-rapid pulse, it is Blood Stasis; use Taoren, Honghua, Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), and slight purgation with Dahuang (Rhei Radix et Rhizoma). For fatigue and weakness with limb pain, it is Qi deficiency with Phlegm-Fluids; use Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Nanxing, and Banxia.
Envoy Dai stated: Arm pain can be due to Blood deficiency, where Blood fails to nourish sinews. Use Juanbi Tang (Eliminate Bi Decoction) and Siwu Tang in equal halves. If sitting/sleeping exposes one to Wind-Damp, or sleeping with hands outside covers invites Cold, causing arm pain, use Wuji San, Juanbi Tang, or Wuyao Shunqi San. If confirmed as Dampness, add Cangzhu and Fangji (Stephaniae Tetrandrae Radix) 3-4 fen to Juanbi Tang.
Fang Yuexi stated: The difference between Wind and Wei syndrome (Flaccidity): Pain indicates Wind, no pain indicates Wei. The Classics say: Pain is Excess, no pain is Deficiency. Wind and Wei are merely Excess and Deficiency. Dongyuan said: Strong Qi means strong disease, weak Qi means weak disease. Why? When Qi and Blood are full, Wind-Cold lodges in meridians, Evil and Righteous fight, causing pain. When Qi and Blood are weak, Phlegm-Fire arises internally, Righteous cannot overcome Evil, causing Wei-Bi. Thus, Danxi said: Wei syndrome must not be treated as Wind using Wind-dispersing herbs. Wind is Excess, Wei is Deficiency. Dispelling Evil vs. Tonifying Deficiency—how can they be confused?
Appendix: Hongxiangjiao (Charley Horse / Gouty Arthritis of Lower Limbs)
Zhang Sanxi stated: Hongxiangjiao belongs to Damp-Heat. *Neijing* says: All Dampness causing swelling/fullness belongs to Spleen Earth. Also: Injury by Dampness affects the lower part first. Spleen governs limbs; feet are lowest, receiving much Dampness. Dampness stagnates into Heat, Damp-Heat struggles, disease arises. It starts with pain at Qichong point (ST30), then red/swollen feet, aversion to cold/fever resembling Taiyang disease. Recurs every ten days or half month, eventually legs swell like gourds. Ancient name: Huan Feng. Song/Yuan era name: Hongxiangjiao. Causes vary: external invasion or internal injury. Though origins differ, Damp-Heat pathology is the same. Early stage is mild, diet/lifestyle normal. Only sudden foot weakness/inability to move is abnormal.
Wind Bi
Xue Lizhai stated: Inability to move limbs results from Wind-Cold-Damp combining into Bi. Predominant Wind is Wind Bi, manifesting as whole-body skin/muscle pain. Yang meridians start at limbs, traverse body. Wind-Cold lodges in skin forming Bi, damages Yang meridians, stagnates at deficiency sites, fights Qi/Blood. Qi/Blood flow slows, causing Wind Bi and limb paralysis.
If Wind pathogen is rampant, or anger stirs Liver Fire, causing dry Blood and sinew spasm, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). Spleen/Lung Qi deficiency failing to nourish sinews/bones, or Liver/Spleen Blood deficiency causing sinew flaccidity/Bi, use Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). Spasm from drying herbs: use Siwu Tang plus Gancao. Qi and Blood both deficient: use Bazhen Tang (Eight Treasures Decoction).
He’s *Yilin Jiyao* and new edition of *Danxi Xinfa* appendix state: If thumb is numb/insensible, limbs weak, or muscles twitch, severe Wind (Stroke) will occur within three years. Prevent with Bafeng Tang, Tianma Wan, or Fangfeng Tongsheng San. This ignores Hejian’s view: Wind is the end-stage of disease. Stroke paralysis is not Liver Wind internal attack nor Six Evils external invasion, but Five Emotions exceeding limits, Heart Fire blazing, Kidney Water deficient failing to control, leading to Yin deficiency/Yang excess, heat stagnation, mental confusion, sinew/bone dysfunction, sudden collapse. Treatment must consolidate Yuan Qi. Premature use of Bafeng etc. harms Yuan Qi, inviting Wind. Treating Wind requires treating Blood first. As Classics say: Wind invades disrupting Qi, Essence perishes, Evil damages Liver. Wind struggle causes Heat, Heat dries Water, Water dry causes Qi failure, Essence perishes. This is the origin of Wind disease.