〔大〕夫妇人臂痛，筋脉挛急，不得屈伸，遇寒则剧，由肝虚为风寒邪气流于血脉，
客于经络，搏于筋，筋不荣则干急而痛，其脉紧细，宜服柏子仁丸、舒筋汤。若臂痛不
能举，或左或右，时复转移一臂，由中脘伏痰，脾气滞而不行，上与气相搏，四肢皆属
于脾，脾气滞而气不下，上攻于臂故痛，其脉沉细，宜茯苓丸、控涎丹。
〔薛〕前证若肝血虚，用加味逍遥散。中气虚，用补中益气汤。血气俱虚，用八珍
汤。风热血燥，用秦艽地黄汤。脾肾虚寒，用柏子仁丸。脾胃实热，用茯苓丸。水不能生
木，用六味丸、逍遥散。怒动肝火，用小柴
胡加川芎、当归。眩晕晡热，用四物、柴、栀、丹皮。晡热月经不调，用加味逍遥散。食少
体倦，无寐盗汗，用加味归脾汤。先太宜人遍身作痛，筋骨尤甚，不能屈伸，口干目赤，头眩痰壅，
胸膈不利，小便赤短，夜间殊甚，遍身作痒如虫行，此属肝肾气虚而热也。用六味地黄丸料加山栀、
柴胡而愈。
柏子仁丸 （《指迷》）
柏子仁 干地黄（各二两，自制） 茯苓 枳壳（去幅，麸炒） 覆盆子（炒） 北五味子（杵，炒）
附子（炮） 石斛（去根切，酒蒸炒） 鹿茸（酥炙） 酸枣仁（炒） 桂心 沉香 黄 （蜜水炙，各一两，一方
云，等分）
上为细末，炼蜜为丸如梧桐子大。空心酒下三十丸。
舒筋汤 治臂痛。又名五痹汤，亦治腰下疾。
片子姜黄（四两） 甘草 羌活（各一两） 白术 海桐皮 当归 赤芍药（各二两）
上为粗末，每服三钱，水一盏半，煎七分，去滓温服。如腰以下疾，空心服；腰以上疾，食后服。
茯苓丸 治臂痛不能举手，或左或右，时复转移，由伏痰在内，中脘停滞，脾气不行，
上与气搏，四肢属脾，脾滞而气不升，故上行攻臂，其脉沉细者是也。后人谓此臂痛，乃痰证也，用
以治痰，无不效者。予尝以此药治人，随服随愈。世所谓痰药多矣，未有立效如茯苓丸速也。
茯苓（一两） 半夏（二两） 枳壳（半两，去幅麸炒） 风化朴硝（半两）
上为末，姜汁煮糊丸如梧子大。生姜汤下二十丸，食后服。
控涎丹 凡人忽患胸背、手足、颈项、腰胯隐痛不可忍，连筋骨牵引钓痛，坐卧不宁，
时时走易不定，俗医不晓，谓之走疰，便用药及针灸，皆无益。又疑是风毒结聚，欲为
痈疽，乱以药贴，亦非也。此乃痰涎伏在心膈上下，变为此疾，或令人头痛不可举，或
神意昏倦多睡，或饮食无味，痰唾稠粘，夜间喉中如锯声，多流唾涎，手脚重，腿冷，脾
气脉不通，误认为瘫痪，亦非也。凡有此疾，但以此药，不过数服即愈。
甘遂（去心） 大戟（去皮） 真白芥子（炒，各等分）
上为细末，糊丸如梧桐子大。临卧淡姜汤下五七丸，如疾猛，再加至十丸。
白芥子散 治臂痛牵引背胛，或辍或作，由荣卫循行失度，痰滞经络，或似瘫痪。
真白芥子 木鳖子（各三两，麸炒） 没药（另研） 桂心 木香（各半两）
上为末，每服一钱，温酒下。
愚按∶前三方，脾气虚弱者，必佐以六君子汤。中气虚弱者，必佐以补中益气汤。气
血虚者，必佐以八珍汤。脾气郁滞者，必佐以归脾汤。肝经怒气者，必佐以逍遥散。若
专用前方治之，胃气益虚，病气益甚，不可不谨。
流气饮 治七情气滞，胸胁闷痞，咽喉不利，呕喘面浮，二便不调，或气攻肩背，胁
肋作痛，或香港脚喘急，腹胀便闭，元气充实者，宜用此药。慎之。
紫苏叶 黄 （炒） 青皮（去白） 当归 半夏（姜制） 乌药 芍药（炒） 茯苓
桔梗 防风（各五钱） 川芎 陈皮（各七钱五分） 枳实（麸炒） 木香（各二钱五分）
甘草（炙，一两二钱半） 大腹子（姜制，一两）
上每服半两，姜枣水煎服。
四物汤 治血滞中风，血虚手足不遂。如臂痛，加红花煎。
交加散加木瓜、牛膝，治冷痹肩臂作痛。即人参败毒和五积散。
乌药顺气散加羌活、木瓜，治外邪气滞，筋骨作痛，或痰气不利。（方见杂病中气。）
秦艽地黄汤 治肝胆经风热血燥，肩臂疼痛，或筋脉引急，或时牵痛。其内证发热，
或寒热晡热，月经不调，或肢体酸痛等证。
秦艽 熟地黄（自制） 当归（各一钱） 川芎
芍药 牡丹皮 白术 茯苓（各一钱五分） 钓藤钩（一钱） 柴胡 甘草（炙，各三分）
上水煎服。
[Da] Women suffering from arm pain, with spasmodic and tight tendons and vessels, unable to flex or extend. The condition worsens upon exposure to cold. This is caused by Liver blood deficiency, allowing Wind-Cold pathogenic factors to flow into the blood vessels, lodge in the meridians, and contend with the tendons. When the tendons fail to receive nourishment, they become dry, tight, and painful. The pulse is tight and fine. It is appropriate to administer Baizi Ren Wan (Platycladus Seed Pill) and Shujin Tang (Tendon-Relaxing Decoction). If the arm pain prevents lifting, occurring on either the left or right side, and frequently shifting between arms, this is due to latent phlegm in the Zhongwan (CV12) region. Spleen Qi stagnates and fails to circulate, rising to contend with Qi. Since the four limbs belong to the Spleen, when Spleen Qi stagnates and cannot descend, it attacks upward to the arm, causing pain. The pulse is deep and fine. It is appropriate to administer Fuling Wan (Poria Pill) and Kongxian Dan (Phlegm-Draining Pellet).
[Xue] For the aforementioned conditions: if due to Liver Blood deficiency, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder); if due to Middle Qi deficiency, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); if due to combined Qi and Blood deficiency, use Bazhen Tang (Eight Treasures Decoction); if due to Wind-Heat causing Blood dryness, use Qinjiao Dihuang Tang (Gentiana Macrophylla and Rehmannia Decoction); if due to Spleen and Kidney Yang deficiency-cold, use Baizi Ren Wan; if due to Excess Heat in the Spleen and Stomach, use Fuling Wan; if Kidney Water fails to generate Liver Wood (Water failing to nourish Wood), use Liuwei Wan (Six-Ingredient Pill with Rehmannia) and Xiaoyao San; if anger stirs Liver Fire, use Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Chuanxiong and Danggui; if accompanied by vertigo and afternoon tidal fever, use Siwu Tang (Four Substances Decoction) added with Chaihu, Zhizi, and Mudanpi; if accompanied by afternoon tidal fever and irregular menstruation, use Jiawei Xiaoyao San; if accompanied by poor appetite, fatigue, insomnia, and night sweats, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction). My late mother-in-law suffered from generalized body pain, particularly severe in the sinews and bones, unable to flex or extend, with dry mouth, red eyes, dizziness, copious phlegm obstruction, chest and diaphragm discomfort, short dark urine, worsening at night, and generalized itching as if insects were crawling. This belonged to Qi deficiency of the Liver and Kidney with internal heat. She was cured using Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) formula with added Zhizi and Chaihu.
Baizi Ren Wan (from *Zhi Mi Fang*)
Baizi Ren (Seed of Platycladus Orientalis), Shengdihuang (Prepared Root of Rehmannia Glutinosa) [each 2 liang, homemade]; Fuling (Poria); Zhike (Fruit of Aurantium Indicum, pith removed, stir-fried with bran); Fupenzi (Fruit of Rubus Chingii, stir-fried); Beiwuweizi (Fruit of Schisandra Chinensis, pounded, stir-fried); Fuzi (Prepared Root of Aconitum Carmichaelii); Shihu (Stem of Dendrobium Nobile, roots removed, sliced, steamed and stir-fried with wine); Lurong (Antler of Cervus Elaphus, roasted with butter); Suanzaoren (Seed of Ziziphus Jujuba, stir-fried); Guixin (Cinnamon Bark); Chenxiang (Aquilaria Agallocha); Huangqi (Root of Astragalus Membranaceus, honey-roasted, each 1 liang; another version states equal parts).
Grind all ingredients into a fine powder. Mix with refined honey to form pills the size of paulownia seeds. Take 30 pills with wine on an empty stomach.
Shujin Tang (Tendon-Relaxing Decoction) Treats arm pain. Also known as Wubi Tang (Five Bi Syndrome Decoction), it also treats diseases below the waist.
Pianzi Jianghuang (Rhizoma Curcumae Longae slice); Gancao (Licorice Root); Qianghuo (Rhizome of Notopterygium Incisum) [each 1 liang]; Baizhu (Atractylodes Rhizome); Haitongpi (Bark of Paederia Scandens); Danggui (Angelica Sinensis); Chi Shaoyao (Red Peony Root) [each 2 liang].
Grind into coarse powder. Each dose is 3 qian, decocted in 1.5 cups of water until reduced to 0.7 cup. Strain and take warm. For diseases below the waist, take on an empty stomach; for diseases above the waist, take after meals.
Fuling Wan (Poria Pill) Treats arm pain preventing the raising of the hand, occurring on either side, and frequently shifting. This is due to latent phlegm inside, stagnation at Zhongwan, failure of Spleen Qi to move, contending upward with Qi. The four limbs belong to the Spleen; when Spleen Qi stagnates and does not ascend, it attacks upward to the arm. The pulse is deep and fine. Later generations considered this arm pain to be a Phlegm syndrome. Using this to treat Phlegm yields invariably effective results. I have used this medicine to treat patients, who recovered immediately upon taking it. Although there are many phlegm-resolving medicines in the world, none act as swiftly as Fuling Wan.
Fuling (Poria) [1 liang]; Banxia (Pinellia Tuber) [2 liang]; Zhike (Fruit of Aurantium Indicum, pith removed, stir-fried with bran) [0.5 liang]; Fenghua Puxiao (Weathered Mirabilite) [0.5 liang].
Grind into powder. Use ginger juice to make a paste and form pills the size of paulownia seeds. Take 20 pills with ginger soup after meals.
Kongxian Dan (Phlegm-Draining Pellet) When a person suddenly suffers from unbearable hidden pain in the chest, back, hands, feet, neck, nape, waist, and hips, radiating to the sinews and bones, causing pulling pain, restlessness in sitting and lying, and constantly shifting locations. Ignorant physicians do not understand this, calling it "Zou Zhu" (Wandering Miasma), and prescribe drugs or acupuncture, which are of no benefit. Suspecting it might be Wind-Toxin accumulation intending to become an abscess or carbuncle, and applying random plasters, is also incorrect. This is actually phlegm-fluids lodged above and below the heart and diaphragm, transforming into this disease. It may cause headache so severe the head cannot be lifted, or mental confusion, lethargy, and excessive sleep, or loss of taste in food, thick and sticky sputum, sawing sounds in the throat at night, excessive salivation, heavy limbs, cold legs, and blockage of Spleen Qi pulses. Mistaking it for paralysis is also incorrect. For anyone with this disease, simply using this medicine will result in recovery within a few doses.
Gansui (Radix Kansui, heart removed); Daji (Radix Euphorbiae Pekinensis, skin removed); Zhen Baijiezi (True White Mustard Seed, stir-fried) [equal parts].
Grind into a fine powder. Form pills the size of paulownia seeds using paste. Take 5-7 pills with light ginger soup before going to bed. If the disease is fierce, increase to 10 pills.
Baijiezi San (White Mustard Seed Powder) Treats arm pain radiating to the shoulder blades, intermittent in nature. This is due to irregular circulation of Ying and Wei Qi, phlegm stagnation in the meridians, or symptoms resembling paralysis.
Zhen Baijiezi (True White Mustard Seed); Mugua Zi (Seed of Momordica Cochinchinensis) [each 3 liang, stir-fried with bran]; Moyao (Olibanum, separately ground); Guixin (Cinnamon Bark); Muxiang (Radix Aucklandiae) [each 0.5 liang].
Grind into powder. Take 1 qian each time, washed down with warm wine.
Commentary: For the first three formulas, if Spleen Qi is weak, they must be assisted with Liujunzi Tang (Six Gentlemen Decoction). If Middle Qi is weak, they must be assisted with Buzhong Yiqi Tang. If Qi and Blood are deficient, they must be assisted with Bazhen Tang. If Spleen Qi is stagnant, they must be assisted with Guipi Tang. If Liver Channel anger is present, they must be assisted with Xiaoyao San. If only these former formulas are used exclusively, Stomach Qi will become increasingly deficient, and pathogenic factors will intensify. One must be cautious.
Liuqi Yin (Flowing Qi Decoction) Treats Qi stagnation due to Seven Emotions, chest and hypochondriac fullness and oppression, throat discomfort, vomiting and wheezing with facial edema, irregular urination and defecation, or Qi attacking the shoulders and back with hypochondriac pain, or gout with panting and urgency, abdominal distension with constipation. It is suitable for those with sufficient Yuan Qi. Use with caution.
Zisu Ye (Perilla Leaf); Huangqi (Astragalus Root, stir-fried); Qingpi (Citrus Reticulata Peel, white pith removed); Danggui (Angelica Sinensis); Banxia (Pinellia Tuber, processed with ginger); Wuyao (Lindera Root); Shaoyao (Peony Root, stir-fried); Fuling (Poria); Jiegeng (Platycodon Root); Fangfeng (Saposhnikovia Root) [each 5 qian]; Chuanxiong (Ligusticum Chuanxiong); Chenpi (Citrus Reticulata Peel) [each 7.5 qian]; Zhishi (Immature Bitter Orange Fruit, stir-fried with bran); Muxiang (Radix Aucklandiae) [each 2.5 qian]; Gancao (Licorice Root, honey-roasted) [1.25 liang]; Dafuzi (Areca Seed, processed with ginger) [1 liang].
Each dose is 0.5 liang, decocted with ginger and jujube, and taken orally.
Siwu Tang (Four Substances Decoction) Treats stroke due to Blood stagnation, and hemiplegia due to Blood deficiency. For arm pain, add Honghua (Carthamus Tinctorius) and decoct.
Jiaojiao San (Interlacing Powder) added with Mugua (Chaenomeles Fruit) and Niuxi (Achyranthes Root) treats Cold-Bi syndrome with shoulder and arm pain. This is equivalent to Renshen Baidu San (Ginseng Detoxification Powder) combined with Wuji San (Five Accumulations Powder).
Wuyao Shunqi San (Lindera Regulating Qi Powder) added with Qianghuo and Mugua treats external pathogenic Qi stagnation, bone and sinew pain, or Phlegm-Qi obstruction. (Formula see Miscellaneous Diseases - Qi Stagnation.)
Qinjiao Dihuang Tang (Gentiana Macrophylla and Rehmannia Decoction) Treats Wind-Heat and Blood dryness in the Liver and Gallbladder channels, shoulder and arm pain, or tendon spasms, or occasional pulling pain. Internal symptoms include fever, alternating chills and fever with afternoon tidal fever, irregular menstruation, or limb soreness and pain.
Qinjiao (Gentiana Macrophylla Root); Shudihuang (Prepared Rehmannia Root); Danggui (Angelica Sinensis) [each 1 qian]; Chuanxiong (Ligusticum Chuanxiong); Shaoyao (Peony Root); Mudanpi (Moutan Cortex); Baizhu (Atractylodes Rhizome); Fuling (Poria) [each 1.5 qian]; Goutenggou (Uncaria Rhynchophylla Hook) [1 qian]; Chaihu (Bupleurum Root); Gancao (Licorice Root, honey-roasted) [each 0.3 qian].
Decoct in water and take orally.