答曰。臂痛有数证。有因寒而得之者。或因伏痰者。有形寒饮冷伤肺者。有汗出伤阻者。夫
肝主诸筋。肝经虚弱。风寒入伤。与气血相搏。筋寒则急。上连两臂俱痛。宜服醒风汤理
气
汤主之。若或左或右。痛不能举臂者。此繇伏痰在内。中脘停滞。脾气不能流行。止与气搏
。流伏于左则左痛。在右则右痛。若右臂痛深连于骨。如斧槌。其气自嗌已下至脐。左右气
不相通彻。其痛发时。气上奔急。令人闷绝。肌肉日消。浆粥不下。心中烦闷。此繇形寒饮
冷。肺被寒结留滞于右边。若无故一臂无力。痛不能举。袭袭似汗。偏阻一边。肌肉时复掣
痛。或有不仁。手不能近头。久成偏枯。宜服百风汤主之。百风汤。治四肢垂曳。骨节疼痛
。(又名省风汤)
独活(三钱) 芎 防风 当归 桂心(各二两) 茯苓 附子 细辛 天麻(一两) 干蝎(
炒) 甘草(一两)
上为 咀。每服三钱。水一盏半。姜五片。煎七分。去滓。食前稍热服。茯苓丸。治伏痰臂
痛。
茯苓(一两) 半夏(二两) 枳壳(去穣麸炒半两) 风化朴硝(一分)
上为细末。姜汁煮糊为丸。如桐子大。每服三十丸。食前姜汤下。
理气汤。治痰饮臂痛。
上为粗末。每服五钱。水二盏。姜五片。煎一盏。去滓食前服。
Answer: Arm pain presents with several syndromes. Some are caused by cold pathogen, some by latent phlegm, some by external cold and cold drinks injuring the Lung, and some by wind obstruction following sweating.
The Liver governs all sinews (tendons). If the Liver meridian is deficient, wind-cold invades and injures, contending with Qi and Blood. Cold in the sinews causes contraction, extending upward to connect with both arms, resulting in bilateral arm pain. It is appropriate to administer Xingfeng Tang (Revive Wind Decoction) or Liqi Tang (Regulate Qi Decoction) as the primary treatment.
If the pain occurs on either the left or right side, and the arm cannot be lifted, this arises from latent phlegm stagnating internally at Zhongwan (CV12), where Spleen Qi fails to circulate freely, contending only with Qi. When the flow of phlegm stagnates on the left, the left side hurts; when it stagnates on the right, the right side hurts.
If the right arm pain is severe, penetrating to the bone, feeling like being struck by an axe or mallet, with Qi obstructed from the throat down to the umbilicus, and Qi not flowing smoothly between left and right, then during pain attacks, Qi rushes upward urgently, causing suffocation and fainting. Muscles waste away daily, and even thin gruel cannot be swallowed. The heart feels restless and depressed. This results from external cold and cold drinks, causing Lung Qi to be congealed and stagnant on the right side.
If suddenly one arm becomes weak and painful, unable to lift, accompanied by intermittent sensations resembling sweating, unilateral channel obstruction, recurrent muscle twitching pain, or numbness where the hand cannot reach the head, prolonged illness may lead to hemiplegia (Biangu). It is appropriate to administer Baifeng Tang (Hundred Wind Decoction) as the primary treatment. Baifeng Tang treats flaccidity and dragging of the four limbs and joint pain. (Also known as Shengfeng Tang).
Du Huo (Radix Angelicae Pubescentis, 3 qian), Xiong (Rhizoma Chuanxiong), Fang Feng (Saposhnikoviae Radix), Dang Gui (Radix Angelicae Sinensis), Gui Xin (Cortex Cinnamomi, each 2 liang), Fu Ling (Poria, 1 liang), Fu Zi (Radix Aconiti Lateralis Preparata), Xi Xin (Herba Asari), Tian Ma (Rhizoma Gastrodiae, each 1 liang), Gan Xie (Scorpio, stir-fried), Gan Cao (Radix Glycyrrhizae, each 1 liang).
Crush the above herbs into coarse pieces. Take 3 qian per dose, add 1.5 zhan of water and 5 slices of fresh ginger, decoct until 0.7 zhan remains, strain, and take warm before meals.
Fuling Wan (Poria Pill) treats arm pain due to latent phlegm.
Fu Ling (Poria, 1 liang), Ban Xia (Rhizoma Pinelliae Preparata, 2 liang), Zhi Ke (Fructus Aurantii, de-albendo, bran-fried, 0.5 liang), Fenghua Puxiao (Natrii Sulfas Exsiccatus, 1 fen).
Grind the above into fine powder, use ginger juice to cook paste for pills, sized like paulownia seeds. Take 30 pills per dose, wash down with ginger soup before meals.
Liqi Tang (Regulate Qi Decoction) treats arm pain due to phlegm-fluid retention.
[Formula composition omitted in source text context, referring to previous mention] Grind into coarse powder. Take 5 qian per dose, add 2 zhan of water and 5 slices of fresh ginger, decoct until 1 zhan remains, strain, and take before meals.