腿痛亦属六经。前廉为阳明。白芷、升麻、干葛为引经。后廉太阳。羌活、防风。外廉少阳。
柴胡、羌活。内廉厥阴。青皮、吴茱萸。内前廉太阴。苍术、白芍。内后廉少阴。独活、泽泻。
痛有血虚血寒。寒湿风湿。湿热流注。阴虚阳虚。肾虚风袭之殊。
血虚者。足不任地。行则振掉。脉细弱。六味丸加巴戟、续断、杜仲、鹿茸。血寒者。经急。脉
沉。喜汤火。严冬尤甚。舒筋三圣散。湿者两腿隐隐痛。或麻瞀作肿身沉重。肢节疼痛。恶风不
欲去衣。脉浮涩。或浮细。除风湿羌活汤。脉沉。白术附子汤。肥人。导痰汤加减。湿热者。痛
自腰胯以至足胫。或上或下。或红或肿。小便赤涩。脉濡大而数。当归拈痛汤。流注者。郁痰留
于腰胁有块。互换作痛。恶心头眩。脉沉滑或弦。二陈汤加羌活、白术。阴虚者。肌体羸瘦。足
心及胫热痛。左尺细数。或两尺数盛。虎潜丸去橘皮加肉桂。阳虚者。两足浮肿无力。大便泻。
小便短少。痛不能动。左尺虚大。或两尺浮迟。脾与命门俱虚。先用补中益气加桂、附。后用八
味丸。肾虚风袭。则下体痿弱。骨节疼痛。喘咳失精。腰腹腿胫俱痛。尺中浮大而数。安肾丸。
大股痛 痛而喜按者。肝肾虚寒而湿气痹着也。四斤丸二方选用。痛不可按者。败血也。川
芎肉桂汤。或舒筋三圣散。酒调服。妇人产后多有此证。宜加穿山甲、桃仁。虚人。十全大补汤
加附子、穿山甲。有湿热者。痛虚心肿。而沉重不能转侧。二妙散加羌、防、升、柴、术、草之
类。或除湿汤、渗湿汤选用。寒热而胆痛者。须防发痈。
Leg pain is also categorized within the framework of the Six Channels (Liujing). Pain on the anterior aspect of the thigh belongs to the Yangming Channel; Bai Zhi (Angelicae Dahuricae Radix), Sheng Ma (Cimicifugae Rhizoma), and Gan Ge (Puerariae Radix) are used as guiding herbs. Pain on the posterior aspect belongs to the Taiyang Channel, treated with Qiang Huo (Notopterygii Rhizoma et Radix) and Fang Feng (Saposhnikoviae Radix). Pain on the lateral aspect belongs to the Shaoyang Channel, treated with Chai Hu (Bupleuri Radix) and Qiang Huo. Pain on the medial aspect belongs to the Jueyin Channel, treated with Qing Pi (Citri Reticulatae Pericarpium Viride) and Wu Zhu Yu (Evodiae Fructus). Pain on the anteromedial aspect belongs to the Taiyin Channel, treated with Cang Zhu (Atractylodis Rhizoma) and Bai Shao (Paeoniae Radix Alba). Pain on the posteromedial aspect belongs to the Shaoyin Channel, treated with Du Huo (Angelicae Pubescentis Radix) and Ze Xie (Alismatis Rhizoma).
The etiologies and pathogenesis of leg pain vary, including Blood Deficiency (Xue Xu), Blood Cold (Xue Han), Cold-Dampness (Han Shi), Wind-Dampness (Feng Shi), Damp-Heat Flowing Accumulation (Shi Re Liu Zhu), Yin Deficiency (Yin Xu), Yang Deficiency (Yang Xu), and Kidney Deficiency with Wind Invasion (Shen Xu Feng Xi).
In cases of Blood Deficiency, the feet cannot bear weight, trembling occurs upon walking, and the pulse is fine and weak. Treatment uses Liuwei Wan (Six-Ingredient Pill with Rehmannia) added with Ba Ji Tian (Morindae Officinalis Radix), Xu Duan (Dipsaci Radix), Du Zhong (Eucommiae Cortex), and Lu Rong (Cervi Cornu Pantotrichum). In cases of Blood Cold, the meridians feel tight, the pulse is deep, and the patient prefers heat from hot water or fire; symptoms worsen in severe winter. Treatment uses Shujin Sansheng San (Three-Saint Decoction for Relaxing Tendons). In cases of Dampness, there is a dull pain in both legs, or numbness, dizziness, swelling, heaviness of the body, and joint pain. The patient fears wind and dislikes removing clothes; the pulse is floating and choppy, or floating and fine. Treatment uses Chufengshi Qianghuo Tang (Decoction to Remove Wind-Dampness with Notopterygium); if the pulse is deep, use Baizhu Fuzi Tang (Atractylodes and Aconite Decoction). For obese individuals, Daotan Tang (Phlegm-Guiding Decoction) is modified. In cases of Damp-Heat, pain extends from the waist and hips to the shins, moving up or down, with redness or swelling, and dark, scanty urination. The pulse is soggy, large, and rapid. Treatment uses Danggui Niantong Tang (Angelica Decoction to Relieve Pain). In cases of Flowing Accumulation (phlegm-nodules), stagnant phlegm remains in the waist and hypochondrium forming masses, causing shifting pain, nausea, and dizziness. The pulse is deep and slippery, or wiry. Treatment uses Erchen Tang (Two-Aged Decoction) added with Qiang Huo and Bai Zhu. In cases of Yin Deficiency, the body is emaciated, with hot pain in the soles and shins. The left Chi position pulse is fine and rapid, or both Chi positions are rapidly full. Treatment uses Hujian Wan (Tiger-Hiding Pill) with Ju Pi (Citri Reticulatae Pericarpium) removed and Rou Gui (Cinnamomi Cortex) added. In cases of Yang Deficiency, both feet are swollen and weak, stool is loose, urine is short, and pain prevents movement. The left Chi position pulse is deficient and large, or both Chi positions are floating and slow. This indicates deficiency of both the Spleen and Mingmen (Gate of Vitality). Initially, Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment Qi) is used with Rou Gui and Fu Zi; subsequently, Bawei Wan (Eight-Ingredient Pill) is administered. When Kidney Deficiency is complicated by Wind Invasion, there is flaccidity of the lower body, bone and joint pain, asthma and cough, seminal emission, and pain throughout the waist, abdomen, thighs, and shins. The Chi pulse is floating, large, and rapid. Treatment uses Anshen Wan (Kidney-Calming Pill).
Severe Thigh Pain: Pain that is relieved by pressure indicates Liver and Kidney deficiency-cold with Bi obstruction due to dampness. One of the two formulas of Sijin Wan (Four-Jin Pill) is selected. Pain that cannot be pressed indicates blood stasis. Treatment uses Chuanxiong Rougui Tang (Ligusticum and Cinnamon Twig Decoction) or Shujin Sansheng San, taken with wine. This condition is common in postpartum women; Shan Zha (Manis Squama) and Tao Ren (Persicae Semen) should be added. For deficient patients, Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction) is used with Fu Zi and Shan Zha. If damp-heat is present, accompanied by chest vexation, local swelling, and heaviness preventing turning over, Ermiao San (Two-Marvel Powder) is added with Qiang Huo, Fang Feng, Sheng Ma, Chai Hu, Bai Zhu, and Gan Cao, or Chushi Tang (Dampness-Removing Decoction) and Shenshi Tang (Dampness-Seeping Decoction) are selected. If chills and fever occur with gallbladder area pain, one must guard against the development of an abscess (Yong).