臂痛须分经络。外廉中间属手少阳三焦，外上廉属手阳明大肠，外下廉属手太阳小肠，
内
臂细无力而痛，此肝肾气虚，风邪客于营卫，气血不得周养于四肢也。
脾病则两臂不举而痛，脾不布胃阳于臂，故痛而不举。阳升而健布也。
验案
一妇臂痛无定处，此脾虚不能统摄气血，失其转运，血凝气滞而痛也。用白术、薏苡仁
、莲肉、神曲、人参、炙甘草、砂仁、白芍、陈皮，糊丸服。乃不治痛而治脾，不治标而治
一人素病梦遗，左腿环跳痛，脉浮大而涩，针之而愈。后两臂不举而痛，脉紧而有力
。此湿热流于经络也。当先利其湿热，后以大补气血为主。用川芎、当归、白芍、牛膝、虎
骨、苍术、黄柏，服时加酒一杯；湿热退，多服人参、炙甘草、黄 、麦冬、白术、归身、
枣仁、杜仲、五味、肉桂、黄柏，煎服愈。
一女两臂痛而不举，脉数而虚，用黄 建中汤加秦艽、山栀。盖脾气虚而血不荣于臂也
；脉数者，血虚则火起也。故用建中汤补血，秦艽、山栀清血中之火，所以愈也。
内跨痛及膝以下痛者，必用牛膝通经；痛直下至足跟者，须用防己、木瓜行湿；两髀或
两腿痛，四物汤加羌活、肉桂；久痛去羌活，重用生姜；痛连腰者加杜仲、牛膝；痛连于腹
加补骨脂、炮姜、肉桂、小茴之类。凡痛若遇泄泻，只调理脾胃，则加白术之类。
风热脚膝痛，下体肿痛，苍术、黄柏二味水煎。
验案
一人内伤证，二膝痛极。二膝属血分，痛者，虚寒也。四物汤送下和中丸，则血流通不滞，自然得愈。
Pain in the arms must be differentiated by meridians. The middle part of the lateral aspect of the arm belongs to the Hand-Shaoyang Sanjiao Meridian (Hand Triple Energizer); the upper lateral aspect belongs to the Hand-Yangming Large Intestine Meridian; and the lower lateral aspect belongs to the Hand-Taiyang Small Intestine Meridian.
Thinness, weakness, and pain in the medial aspect of the arm indicate deficiency of Qi in the Liver and Kidneys, with Wind pathogen lodging in the Ying (Nutritive) and Wei (Defensive) levels, preventing Qi and Blood from circulating to nourish the four limbs.
Disease of the Spleen results in the inability to raise both arms accompanied by pain, because the Spleen fails to distribute Stomach Yang to the arms; thus, there is pain and immobility. When Yang rises and distributes vigorously, [symptoms resolve].
Clinical Case 1:
A woman suffered from arm pain with no fixed location. This was due to Spleen deficiency failing to control and transport Qi and Blood, leading to Blood stasis and Qi stagnation causing pain. Baizhu Tang (Atractylodis Rhizoma Decoction) ingredients were used: Atractylodis Macrocephalae Rhizoma (Baizhu), Coicis Semen (Yiyiren), Nelumbinis Semen (Lianrou), Medicated Leaven (Shenqu), Ginseng Radix et Rhizoma (Renshen), Glycyrrhizae Radix et Rhizoma Preparata (Zhigancao), Amomi Fructus (Sharen), Paeoniae Radix Alba (Baishao), and Citri Reticulatae Pericarpium (Chenpi), made into pills with paste. This treats the Spleen rather than the pain, addressing the root rather than the branch.
A man who had a history of nocturnal emissions suffered pain at the Huantiao acupoint (GB30) on the left leg. His pulse was floating, large, and choppy. He was cured by acupuncture. Later, he developed inability to raise his arms accompanied by pain, with a tight and forceful pulse. This indicated Damp-Heat flowing into the meridians. First, Damp-Heat should be cleared, followed by major tonification of Qi and Blood. Chuanxiong Tang (Chuanxiong, Angelicae Sinensis Radix, Paeoniae Radix Alba, Achyranthis Bidentatae Radix, Tiger Bone [now substituted], Atractylodis Rhizoma, Phellodendri Cortex) was prescribed, taken with a cup of wine. After Damp-Heat subsided, prolonged administration of Ginseng Radix et Rhizoma (Renshen), Glycyrrhizae Radix et Rhizoma Preparata (Zhigancao), Astragali Radix (Huangqi), Ophiopogonis Radix (Maidong), Atractylodis Rhizoma (Baizhu), Angelicae Sinensis Radix (Guishen), Ziziphi Spinosae Semen (Suanzaoren), Eucommiae Cortex (Duzhong), Schisandrae Fructus (Wuweizi), Cinnamomi Cortex (Rougui), and Phellodendri Cortex (Huangbai) in decoction cured him.
A young woman suffered from arm pain and inability to raise her arms. Her pulse was rapid and deficient. Huangqi Jianzhong Tang (Astragalus Decoction for Building the Middle) was administered with added Gentianae Macrophyllae Radix (Qinjiao) and Gardeniae Fructus (Shanzhi). This occurred because Spleen Qi deficiency led to Blood failing to nourish the arms; a rapid pulse indicates Fire arising from Blood deficiency. Thus, Jianzhong Tang was used to tonify Blood, while Qinjiao and Shanzhi cleared Fire from the Blood, resulting in recovery.
For pain in the medial thigh extending below the knee, Niuxi (Achyranthis Bidentatae Radix) must be used to unblock the meridians. For pain extending straight down to the heel, Fangji (Stephaniae Tetrandrae Radix) and Mugua (Chaenomelis Fructus) are required to move Dampness. For pain in both thighs or legs, Siwu Tang (Four Substances Decoction) is added with Notopterygii Rhizoma et Radix (Qianghuo) and Cinnamomi Cortex (Rougui). For chronic pain, remove Qianghuo and heavily use Fresh Ginger (Shengjiang). If pain extends to the waist, add Duzhuo (Eucommiae Cortex) and Niuxi (Achyranthis Bidentatae Radix). If pain extends to the abdomen, add Psoraleae Fructus (Buguzhi), Prepared Ginger Root (Paojiang), Cinnamomi Cortex (Rougui), and Foeniculum Fructus (Xiaohui). Whenever pain is accompanied by diarrhea, only regulate the Spleen and Stomach, adding herbs such as Baizhu (Atractylodis Macrocephalae Rhizoma).
For Wind-Heat causing foot and knee pain, with swelling and pain in the lower body, Cangzhu (Atractylodis Rhizoma) and Huangbai (Phellodendri Cortex) are decocted in water.
Clinical Case 2:
A patient with internal injury syndrome suffered extreme pain in both knees. The knees belong to the Blood level; pain here indicates Deficiency-Cold. Siwu Tang (Four Substances Decoction) was used to deliver Zhonghe Wan (Harmonizing Pill), promoting smooth Blood flow without stagnation, leading to natural recovery.