一人年将六十。五月患右臂膊肿盛。上至肩。下至手指。色变。皮肤凉。六脉沉细而微。
症俱寒。乃附骨痈也。开发已迟。以燔针启之。脓清稀解。次日肘下再开之。加吃逆不绝。
与丁香柿蒂散两服稍缓。次日吃逆尤甚。自利。脐腹冷痛。腹满食减。时发昏愦。灸左乳下
黑尽处二七壮。又处托里温中汤一两半与服。或曰。诸痛疮疡皆属心火。又时当盛暑而用
姜、附可乎。予曰。经云脉细皮寒。泻利前后。饮食不入。是为五虚。况吃逆胃中虚寒。此
症内外相反。须当舍时从症。遂投之。诸症悉去。饮食倍进。疮势温。脓色正。复用五香汤
数服。月余而愈。
机按此症多属虚寒。此方专用辛热以治其寒。不用参、术以补其虚。盖因吃逆腹满。乃
气郁壅也。想必其人年虽老。脉症虽虚。而形体颇实。非阴虚吃逆比。
一挥使臂肿一块。不痛不赤。脉弱懒食。时呕。以六君子（二）加藿香。酒炒芍药。呕止
。再以八珍汤（十四）二十余剂。脓成刺之。又以十全大补而愈。次年伤寒。后臂复肿。微痛
。乃伤寒余毒也。然无表症。俱虚弱耳。先用十宣散四剂。取参、 、芎、归扶助元气。防
风、桔梗、白芷、浓朴行散肿结。肉桂引经破血。肿退三四。再用八珍汤。肿溃而愈。至冬
臂复作痛。因服祛风药。反筋挛痛甚。此血虚不能养筋。筋虚不能束骨。用加味十全大补汤
（十三）百贴而愈。
一女臂患肿。溃久不敛。寒热交作。五心烦热。饮食少思。月水不通。以逍遥散月余少可。
更服八珍汤。（十四）加牡丹皮、香附。又月余经通。再加黄 、白蔹。两月余而愈。（此凭
一人臂肿。患毒作痛。服寒凉药。食少。大便不实。予用理中丸二服。更以六君子加砂
仁、藿香。再以托里。脓溃而愈。
此因治不应而变方也。
凡疮痛甚者。若禀浓有火。宜苦寒药。若禀薄者。宜补中益气汤。加芩、连之类。在下
加黄柏。人肥加荆、防、独、羌之类。取其风能胜湿也。
一妇左臂胆经部分结肿一块。年许不溃。坚硬不痛。肉色不变。脉弱少食。月水过期。
发热。遇劳或怒则痛。此不足症也。与参、 、归、术、芎、 、芍药、贝母、远志、香附
、桔梗、牡丹皮、甘草百余帖而消。（此因症脉也。）
大抵妇病多起于郁。郁则气血受伤。百病生矣。
一人臂患漏。口干发热。喜脓不清稀。脉来迟缓。灸以豆豉饼。服八珍汤。（十四）加麦
门、五味、软柴胡、地骨皮、三月余而愈。后因房劳复溃。脓清脉大。辞不治。果殁。
河间曰。因病致虚为轻。盖病势尚浅。元气未虚也。若病初愈。或饮食、劳倦、房劳、
加至羸损。此因虚致损则为重。病势已过。元气已索故也。
一儿臂患痘毒作炒。按之复起。此脓胀痛也。刺之。以托里而愈。
一妇臂结一块。已溃不敛。灸以豆豉饼。更服托里药而愈。
一人年逾三十。素怯弱。不能食冷。臂患一毒。脉虚弱。予以托里药而消。但饮食少思
作胀。或吞酸。日渐羸瘦。参芩等药不应。右尺脉弱。此命门火衰。不能生土。遂以八味丸
补土之原。饮食渐进而愈。（此凭脉症也。）
一媪左臂结核。年余方溃。脓清不敛。以十全大补汤。（十三）外用附子饼灸。及贴补药
膏。调护得宜。百帖而愈。（此凭症也。）
一人多虑神劳。年近五十。左膊外侧。红肿如粟。予曰。勿轻视。得独参汤数斤乃佳。
而止。旬余值大风拔木。疮上起一红线。绕背抵右肋。与大料人参汤。加芎、术补剂。两月
而安。机按此条。因形因经而为治也。
一妇臂痛。筋挛不能屈伸。遇寒则剧。脉紧细。比良甫所谓肝气虚为风寒流于血脉经络
于筋。筋不荣则干急为痛。先用舒筋汤。（八三）更用四物汤。（九）加牡丹皮、泽兰、白术而
愈。亦有臂痛不能举。或转左右作痛。由中脘伏痰。脾气滞不行。宜茯芩丸。（百二十五）或控
涎丹治之。（此因脉处治之。）
一人手臂结核如粟。延至颈项。状似瘰 。此风湿流注。用加减小续命汤。（七五）及独
活寄生汤。（七六）更以托里药。倍加参、 、归、术。百帖而愈。
机按此条。有症无脉。认作风湿流注而治。当时必有所见也。后用补剂百贴而愈。是终
于虚也。一儿三岁。臂患毒。 痛。服解毒丸。搽神功散（七十）而消。（此条症脉。不详。
当时必有所见。）
尝治臂毒。便闭烦躁。服五福化毒丹（百九）亦效。若脓成急刺。用纸捻醮麻油 疮内。
以膏药贴之。若儿安静。不必服药。候有脓取去。仍用 贴。
一人肩患疽。脉数。饮槐花酒一服。势顿退。再与金银花、黄 、甘草十余服而平。（
槐花治湿热之功最为神速。胃寒不宜过剂。
尹老家贫。形志皆苦。自幼颓疝。孟冬于手阳明大肠经分出痈。第四日稠脓。臂外皆肿
在手阳明左右经中。其脉俱弦。按之洪缓有力。此得自八风之变。以脉断之。邪气在表。饮
食如常。大小便如故。腹中和。口知味。知不在里也。不恶风寒。只热躁。脉不浮。知不在
表也。表里既和。邪在经脉之中。故曰凝于血脉为痈是也。痈出身半以上。故风从上受。因
知为八风之变。而疮只在经脉之中。法当却寒。调和经脉中血气。使无凝滞。可愈矣。宜用
以白芷升麻汤。（百四一）
机按此方。举一身而言。故阳明为一身之中。若以各经言之。而阳明亦自有表里中三等
之剂。太阳亦有表里之中之方。余经皆可以类推也。
一人年逾三十。臂患痈溃而不痛。脓稀脉弱。丹溪曰。疽溃深而不痛者。胃气大虚。不
也。东垣曰。脓水清稀。疮口不合。气血俱虚也。理宜大补。彼不听。服消毒药。气血愈虚
丹溪曰。才见肿痛。参之脉症。倘有虚弱。便与滋补气血。可保终吉。又曰。溃疡内外
皆虚。补接为主。兹则见善不从。自用己智。宁免死乎。
一人年逾四十。臂患毒。 痛作呕。服托里消毒药愈盛。予用凉膈散二剂顿退。更以四
物汤加芩、连四剂而消。
机按此则所谓肿疡热毒攻心而作呕也。
一人两臂肿痛。服托里药日盛。予谓肿属湿。痛属火。此湿热流注经络也。用人参败毒
加威灵仙、酒炒黄芩、南星数剂渐愈。更以四物汤。（九）加苍术、黄柏、桔梗二十余剂而消
。按此托里药日盛。故改作湿热治也。
一尚书左臂肘患一紫泡。根畔肿赤。大肠脉芤。予谓芤主失血。或积血。公曰。血痢未
瘳。以芍药汤（九二）二剂。更以人参败毒散（六四）二剂。疮痢并愈。
机按用芍药汤以治血痢。用败毒散以治紫泡。但所录脉症未甚详悉。观其所治。多属血
热而近实也。
A patient nearing sixty years of age. In the fifth month, he suffered from severe swelling of the right arm, extending up to the shoulder and down to the fingers. The skin color changed, and the skin felt cold. All six pulses were deep (Chen), fine (Xi), and faint (Wei).
The symptoms all indicated a Cold pattern; this was an Fu Gu Yong (Bone-attached Abscess). Treatment had been delayed. A burning needle (Fan Zhen) was used to puncture it, and thin pus drained out. The next day, another incision was made below the elbow. He developed incessant hiccups (Ni).
Two doses of Ding Xiang Shi Di San (Clove and Persimmon Calyx Powder) were administered, providing slight relief. The next day, the hiccups became even more severe, accompanied by spontaneous diarrhea, cold pain in the umbilical and abdominal region, abdominal fullness, and reduced appetite. He frequently experienced dizziness and confusion. Moxibustion was applied to the point at the lower edge of the left nipple for fourteen moxa cones (Er Qi Zhuang). Then, Tuo Li Wen Zhong Tang (Interior-Supporting and Middle-Warming Decoction), 1.5 liang, was prescribed. Someone asked: "All painful sores and ulcers belong to Heart Fire. Moreover, it is the height of summer; is it appropriate to use ginger and aconite?" I replied: "The Classics state that fine pulse, cold skin, diarrhea before and after, and inability to eat constitute the 'Five Deficiencies' (Wu Xu). Furthermore, hiccups indicate deficiency-cold in the Stomach. This case presents contradictory internal and external signs; one must disregard the season and follow the symptoms." Thus, the medicine was administered. All symptoms disappeared, food intake doubled, the sore became warm, and the pus turned normal. Several doses of Wu Xiang Tang (Five-Aromatic Decoction) were then given, and he recovered within a month.
Wang Ji's commentary: This syndrome mostly belongs to deficiency-cold. This formula specifically uses acrid-hot herbs to treat the cold, rather than using Ginseng and Atractylodes to tonify deficiency. Because the hiccups and abdominal fullness are due to Qi stagnation and obstruction. It is likely that although this person was old and his pulse and symptoms appeared deficient, his physical constitution was quite solid, unlike cases of hiccups caused by Yin deficiency.
Another patient had a single swollen lump on the arm, which was neither painful nor red. The pulse was weak, with reluctance to eat and occasional vomiting. Liu Jun Zi Tang (Six-Gentlemen Decoction) was used with added Huo Xiang (Patchouli) and Shaoyao (Peony Root) stir-fried with wine. The vomiting stopped. Subsequently, Ba Zhen Tang (Eight-Treasure Decoction) was taken for over twenty doses. Once the pus formed, it was lanced. Finally, Shiquan Dabu Tang (Perfect Golden Tonifying Decoction) cured him. The following year, he contracted Shang Han (Cold Damage), and the posterior arm swelled again with mild pain; this was residual toxin from the Cold Damage. However, there were no exterior symptoms, only weakness. First, Shi Xuan San (Ten-Vitality Powder) was given for four doses, using Ren Shen (Ginseng), [missing character], Chuan Xiong (Sichuan Lovage Rhizome), and Dang Gui (Angelica Sinensis) to support Yuan Qi (Primal Qi); Fang Feng (Siler Root), Jie Geng (Platycodon Root), Bai Zhi (Angelica Dahurica), and Hou Po (Magnolia Bark) to move Qi and dissipate swelling and nodules; Rou Gui (Cinnamon Bark) to guide the herbs and break blood stasis. The swelling subsided by three or four parts, and then Ba Zhen Tang was used, leading to healing after ulceration. In winter, the arm pain recurred. Due to taking wind-dispelling drugs, tendon spasms and severe pain ensued. This was blood deficiency failing to nourish the tendons, and tendon deficiency failing to bind the bones. Jia Wei Shiquan Dabu Tang (Modified Perfect Golden Tonifying Decoction) was taken for one hundred doses, resulting in recovery.
A female patient had arm swelling that ulcerated but failed to heal for a long time. She experienced alternating chills and fever, five-palm heat (heat in palms, soles, and chest), poor appetite, and amenorrhea. Xiao Yao San (Free and Easy Wanderer Powder) was taken for over a month, showing slight improvement. Then, Ba Zhen Tang was taken with added Mu Dan Pi (Moutan Cortex) and Xiang Fu (Cyperus Rhizome). After another month, menstruation resumed. Huang Qi (Astragalus Root) and Bai Lian (Bletilla Rhizome) were added, and she recovered after two months.
Relying on another case: An arm swelling with toxic pain worsened by cold-cooling medicines led to poor appetite and loose stools. I used Li Zhong Wan (Regulate the Middle Pill) for two doses, followed by Liu Jun Zi Tang with Sha Ren (Amomum Fruit) and Huo Xiang, and subsequently interior-supporting methods. Healing occurred after pus drainage.
This was a change of prescription due to ineffective initial treatment.
Generally, for severe sore pain: if the constitution is robust with fire, bitter-cold herbs are suitable. If the constitution is frail, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Huang Qin (Scutellaria Root) and Huang Lian (Coptis Rhizome) is suitable. Add Huang Bo (Phellodendron Bark) for lower body lesions. For obese individuals, add Jing Jie (Schizonepeta Spike), Fang Feng, Du Huo (Angelicopsis Root), and Qiang Huo (Notopterygium Rhizome), utilizing the principle that wind can overcome dampness.
A woman had a swollen lump in the Gallbladder meridian area of the left arm, persisting for about a year without ulceration. It was hard and painless, with unchanged muscle color. The pulse was weak, with poor appetite and delayed menstruation. Fever occurred, and pain arose upon exertion or anger. This was a deficiency syndrome. Over one hundred doses of Ren Shen, [missing character], Dang Gui, Bai Zhu (Atractylodes Macrocephala Rhizome), Chuan Xiong, [missing character], Shaoyao, Bei Mu (Fritillaria Bulb), Yuan Zhi (Polygala Root), Xiang Fu, Jie Geng, Mu Dan Pi, and Gan Cao (Licorice Root) resolved it. (Diagnosed based on symptoms and pulse.)
Generally, women's diseases often originate from depression/stagnation (Yu). Stagnation injures Qi and Blood, giving rise to myriad diseases.
A male patient had an arm fistula (Lou), dry mouth, fever, and preference for clear/thin pus. The pulse was slow and moderate. Moxibustion with Dou Chi Bing (Fermented Soybean Cake) was applied, and Ba Zhen Tang was taken with added Mai Men Dong (Ophiopogon Tuber), Wu Wei Zi (Schisandra Fruit), Ruan Chai Hu (Soft Bupleurum Root), and Di Gu Pi (Lycium Bark). Recovery took over three months. Later, due to sexual exhaustion, it relapsed and ulcerated. With clear pus and a large pulse, he refused treatment and died.
He Jian stated: Deficiency caused by disease is mild, as the pathogenic factor is still shallow and Yuan Qi is not yet exhausted. If, after initial recovery, one suffers from dietary irregularities, fatigue, or sexual excess leading to emaciation, this is damage caused by deficiency, which is severe, because the disease process has passed and Yuan Qi is depleted.
A child had chickenpox/toxin on the arm causing itching. Pressing it caused it to rebound; this was distending pain from pus. It was pricked, and interior-supporting methods led to recovery.
A woman had a lump on the arm that ulcerated but did not heal. Moxibustion with Dou Chi Bing was applied, followed by interior-supporting medicines, resulting in recovery.
A man over thirty years old was naturally timid and weak, unable to tolerate cold foods. He had a toxic sore on the arm with a weak pulse. Interior-supporting medicines resolved it. However, he had poor appetite, abdominal distension, and acid regurgitation, becoming increasingly emaciated. Herbs like Ren Shen and Huang Qin were ineffective. The Right Chi pulse was weak, indicating Ming Men (Gate of Life) fire decline failing to generate Earth (Spleen/Stomach). Ba Wei Wan (Eight-Ingredient Pill) was used to tonify the source of Earth. Food intake gradually increased, and he recovered. (Diagnosed based on pulse and symptoms.)
An elderly woman had a tubercle on the left arm that ulcerated after over a year. With clear pus and failure to heal, Shiquan Dabu Tang was used. Externally, Fu Zi Bing (Aconite Cake) moxibustion and tonifying ointments were applied. With proper care, one hundred doses resulted in recovery. (Diagnosed based on symptoms.)
A man burdened by excessive worry and mental labor, nearing fifty, had red swelling like millet grains on the lateral aspect of the left upper arm. I said: Do not underestimate this; several jin of Du Shen Tang (Single Ginseng Decoction) would be ideal. But he stopped after a small amount. Ten days later, during a storm that uprooted trees, a red line appeared on the sore, winding around the back to the right hypochondrium. Large-dose Ren Shen Tang was given, supplemented with Chuan Xiong and Bai Zhu tonics. He stabilized in two months. Wang Ji's commentary: This treatment was based on the manifestation and meridian involved.
A woman had arm pain with tendon spasms preventing flexion and extension, worsening with cold. The pulse was tight and fine. As Bi Liangfu described, Liver Qi deficiency allows Wind-Cold to flow into the blood vessels and meridians affecting the tendons. When tendons lack nourishment, they become dry and tense, causing pain. Shu Jin Tang (Tendon-Relaxing Decoction) was used first, followed by Si Wu Tang (Four-Substance Decoction) with added Mu Dan Pi, Ze Lan (Lygodium Spore), and Bai Zhu. She recovered. There are also cases of arm pain preventing lifting or shifting pain left and right, caused by latent phlegm in the Zhong Wan (Conception Vessel 12) and stagnant Spleen Qi. Fu Ling Wan (Poria Pill) or Kong Yan Dan (Saliva-Draining Pill) should be used. (Treated based on pulse.)
A male patient had arm tubercles like millet grains extending to the neck, resembling Luo Li (scrofula). This was Wind-Dampness flowing and depositing. Jia Wei Xiao Xu Ming Tang (Modified Minor Continuation-to-Life Decoction) and Du Huo Ji Sheng Tang (Angelica and Sangjisheng Decoction) were used, along with interior-supporting medicines with doubled Ren Shen, [missing character], Dang Gui, and Bai Zhu. One hundred doses resulted in recovery.
Wang Ji's commentary: This case had symptoms but no detailed pulse description, diagnosed as Wind-Dampness flowing and depositing, implying specific observations were made at the time. Later, one hundred doses of tonifying agents cured it, indicating the root was ultimately deficiency.
A three-year-old child had toxic sores on the arm causing [missing character] pain. Jie Du Wan (Detoxifying Pills) and Shen Gong San (Divine Efficacy Powder) applied externally resolved it. (Symptoms and pulse details are incomplete; specific observations were likely made at the time.)
I once treated arm toxins with constipation and irritability; Wu Fu Hua Du Dan (Five-Fortune Detoxifying Pills) was also effective. If pus forms, lance urgently. Use a paper wick dipped in sesame oil to probe the sore, then apply plaster. If the child is calm, medication is unnecessary. Wait for pus to drain, remove it, and continue applying [missing character].
A man had a carbuncle on the shoulder with a rapid pulse. One dose of Huai Hua Jiu (Sophora Flower Wine) quickly reduced the severity. Ten to twelve doses of Jin Yin Hua (Honeysuckle Flower), Huang Qi, and Gan Cao brought peace. (Huai Hua is extremely fast in treating damp-heat, but should not be overdosed in Stomach Cold.)
Old Man Yin was poor, suffering physically and mentally. Since childhood, he had a hernia. In early winter, a carbuncle appeared branching off the Hand-Yangming Large Intestine Meridian. By the fourth day, thick pus formed, and the entire outer arm swelled within the Left and Right Yangming channels. The pulses were wiry (Xian), feeling surging, slow, strong, and forceful upon pressure. This resulted from the Eight Winds (Ba Feng) variations. Pulse diagnosis indicated the pathogen was in the Exterior: diet was normal, bowel/bladder function normal, abdomen harmonious, taste intact—indicating it was not in the Interior. No aversion to wind/cold, only heat and restlessness, pulse not floating—indicating it was not in the Exterior. With Interior and Exterior harmonized, the pathogen was in the meridians. Thus, coagulation in blood vessels constitutes a carbuncle. Carbuncles appearing above the waist are affected by Wind from above. Knowing this is a variation of the Eight Winds, and the sore is solely in the meridians, the method should be to dispel cold and harmonize Qi and Blood in the meridians to prevent stagnation, ensuring recovery. Yi Bai Zhi Sheng Ma Tang (Angelica and Cimicifuga Decoction) was suitable.
Wang Ji's commentary: This formula addresses the whole body, regarding Yangming as the center. Speaking of individual meridians, Yangming itself has Exterior, Interior, and Middle formulas. Taiyang also has such formulas. Other meridians can be inferred similarly.
A man over thirty had an arm carbuncle that ulcerated without pain, with thin pus and a weak pulse. Danxi said: Deeply ulcerated jū without pain indicates severe Stomach Qi deficiency, unable to [heal]. Dongyuan said: Clear/thin pus and non-healing wounds indicate Qi and Blood deficiency. Great tonification is appropriate. He did not listen, taking detoxifying medicines instead, further depleting Qi and Blood. Danxi said: Upon seeing swelling and pain, consult pulse and symptoms. If deficiency exists, immediately tonify Qi and Blood to ensure ultimate auspiciousness. Also said: Ulcerations involve both interior and exterior deficiency; tonification and connection are primary. Here, he ignored good advice, relying on his own wisdom. How could he avoid death?
A man over forty had arm toxicity causing [missing character] pain and vomiting. Interior-supporting detoxifying medicines aggravated it. Two doses of Liang Ge San (Cool the Diaphragm Powder) rapidly reduced symptoms. Four doses of Si Wu Tang with Huang Qin and Huang Lian resolved it.
Wang Ji's commentary: This is what is called heat-toxin attacking the Heart from a swelling sore, causing vomiting.
A man had painful swelling in both arms. Taking interior-supporting medicines daily worsened the condition. I stated: Swelling belongs to Dampness, pain belongs to Fire. This is Damp-Heat flowing and depositing in the meridians. Ren Shen Bai Du San (Ginseng and Detoxifying Powder) with Wei Ling Xian (Veratrum Stem), Jiu Chao Huang Qin (Wine-fried Scutellaria), and Nan Xing (Arisaema Rhizome) for several doses gradually improved it. Twenty doses of Si Wu Tang with Cang Zhu (Atractylodes Lancea Rhizome), Huang Bo, and Jie Geng resolved it. Note: Since interior-supporting medicines worsened the condition, treatment was changed to address Damp-Heat.
A Minister had a purple blister on the left elbow. The base was swollen and red. The Large Intestine pulse was Kou (hollow). I stated: Kou indicates blood loss or blood accumulation. The Minister said: Bloody dysentery has not healed. Two doses of Shao Yao Tang (Peony Decoction) and two doses of Ren Shen Bai Du San cured both the sore and dysentery.
Wang Ji's commentary: Shao Yao Tang was used for bloody dysentery, and Bai Du San for the purple blister. The recorded symptoms and pulse were not very detailed. Observing the treatment, it mostly belonged to Blood Heat approaching excess.