东垣云。臂痛者。有六道经络。各加引经药乃验。以两手伸直垂下。大指居前。小指居后而定
之。臂 之前廉痛者属阳明。升麻、白芷、干葛为引经。后廉属太阳。 本、羌活。外廉属少阳。
柴胡、连翘。内廉属厥阴。柴胡、当归。内前廉属太阴。升麻、白芷、葱白。内后廉属少阴。细
辛、当归。
臂痛为风寒湿所搏。或因饮液流入。或因提挈重物。皆致臂痛。有肿者。有不肿者。除饮证
外。其余诸痛。并宜五积散、
蠲痹汤选用。虚人必加人参以助药力。若坐卧为风湿所搏。或睡后手出被外。为寒所袭而痛者。
五积散。审知是湿痹经络。血凝气滞作痛。蠲痹汤。挈重伤筋。以致臂痛。宜和气调血。十全大
补汤。痰饮流入四肢。肩背酸疼。两臂软痹。导痰加木香、片子姜黄、姜制白术。若作风治误矣。
中脘留伏痰饮。臂痛难举。手足不能转移。指迷茯苓丸。丹溪治臂痛。以二陈汤加酒炒黄芩、苍
术、羌活。
手痛 经云。手屈不伸者其病在筋。薏苡仁汤。伸而不屈者其病在骨。近效白术附子汤、十
味锉散选用。
手气 手肿痛曰手气。或指掌连臂膊痛。悉属风热挟痰。蠲痹汤。薄桂味辛淡。能横行手臂。
引调气血。药至痛处。片子姜黄。能引至手臂。惟湿痛最妙。又有肿痛时常脱骱者。此属湿痰。
倍用苍术乃效。
石顽治礼科姜如农次媳。春初患发热头疼腹痛。咳逆无痰。十指皆紫黑而痛。或用发表顺气
不效。延余诊之。脉来弦细而数。右大于左。曰。此怀抱不舒。肝火郁于脾土而发热。热蒸于肺
故咳。因肺本燥。故无痰。脾受木克。故腹痛。阳气不得发越。故头疼。四肢为诸阳之本。阳气
不行。气凝血滞。故十指疼紫。其脉弦者。肝也。数者。火也。细者。火郁于血分也。遂以加味
逍遥散加桂枝。于土中达木。三剂而诸证霍然。十指亦不疼紫矣。
Li Dongyuan stated: Arm pain involves six meridians, and it is only effective when specific guiding herbs (herbs that guide other medicines to a specific meridian) are added. The method for determination is as follows: extend both hands straight down with the thumb in front and the little finger at the back. Pain on the anterior aspect of the arm belongs to the Yangming Meridian; Shengma (Cimicifugae Rhizoma), Baizhi (Angelicae Dahuricae Radix), and Gange (Puerariae Lobatae Radix) serve as guiding herbs. Pain on the posterior aspect belongs to the Taiyang Meridian; Gaoben (Ligustici Chuanxiong Rodis et Rhizoma) and Qianghuo (Notopterygii Rhizoma et Radix). Pain on the lateral aspect belongs to the Shaoyang Meridian; Chaihu (Bupleuri Radix) and Lianqiao (Forsythiae Fructus). Pain on the medial aspect belongs to the Jueyin Meridian; Chaihu (Bupleuri Radix) and Danggui (Angelicae Sinensis Radix). Pain on the anteromedial aspect belongs to the Taiyin Meridian; Shengma (Cimicifugae Rhizoma), Baizhi (Angelicae Dahuricae Radix), and Congbai (Allii Fistulosi Bulbus). Pain on the posteromedial aspect belongs to the Shaoyin Meridian; Xixin (Asari Radix et Rhizoma) and Danggui (Angelicae Sinensis Radix).
Arm pain is caused by the binding of Wind-Cold-Dampness pathogens, or by fluid retention flowing into the limbs, or by lifting heavy objects, all of which can cause arm pain. There may be swelling or no swelling. Except for cases involving fluid retention, other types of pain are suitable for Wujisan (Five Accumulations Decoction) or Juanbitang (Bi-Suppression Decoction). For patients with deficiency constitution, Renshen (Ginseng Radix) must be added to assist the medicinal power. If the pain results from being exposed to Wind-Damp while sitting or lying, or from sleeping with hands outside the covers and being attacked by Cold, use Wujisan (Five Accumulations Decoction). If it is confirmed that Damp-Bi obstruction of the meridians causes pain due to blood stasis and Qi stagnation, use Juanbitang (Bi-Suppression Decoction). For arm pain caused by injury to sinews and bones from carrying heavy loads, harmonize Qi and nourish Blood using Shiquan Dabu Tang (Ten Significant Tonifying Decoction). If Phlegm-Fluid flows into the four limbs causing soreness and pain in the shoulders and back, and soft numbness in both arms, use Daotan Tang (Phlegm-Expelling Decoction) plus Muxiang (Aucklandiae Radix), Pianzi Jianghuang (Curcumae Longae Rhizoma), and Bai Zhu (Atractylodis Macrocephalae Rhizoma) processed with ginger. Treating this as Wind syndrome would be a mistake. If Phlegm-Fluid lingers in the Zhongwan (CV12) area causing arm pain difficult to lift, and inability to move hands and feet, use Zhimi Fuling Wan (Fungus Pill for Pointing Away Confusion). Zhu Danxi treated arm pain using Erchen Tang (Two Aged Substances Decoction) plus Huangqin (Scutellariae Radix) stir-fried with wine, Cangzhu (Atractylodis Rhizoma), and Qianghuo (Notopterygii Rhizoma et Radix).
Hand Pain The *Classic of Acupuncture and Moxibustion* states: Hand flexion without extension indicates pathology in the sinews; Yiyiren Tang (Coix Seed Decoction). Extension without flexion indicates pathology in the bones; Jinxiao Baizhu Fuzi Tang (Near-Efficacy Atractylodes and Aconite Decoction) or Shiwei Cusan (Ten-Ingredient Powder) may be selected.
Hand Qi Swelling and pain of the hand is called Hand Qi. Pain extending from fingers and palms to the arm is attributed to Wind-Heat combined with Phlegm, treated with Juanbitang (Bi-Suppression Decoction). Bo Gui (Thin Cinnamon Bark) has a pungent and bland flavor, capable of traversing the arms horizontally to guide and regulate Qi and Blood. Pianzi Jianghuang (Curcumae Longae Rhizoma) guides the medicine to the painful area in the arms and is particularly effective for Damp-pain. In cases where swelling and pain are accompanied by frequent subluxation of joints, this belongs to Damp-Phlegm; increasing the dosage of Cangzhu (Atractylodis Rhizoma) yields efficacy.
Shiwang (Luo Mei) treated the second daughter-in-law of Official Jiang Runong. In early spring, she suffered from fever, headache, abdominal pain, cough with air reflux and no sputum, and purple-black painful discoloration of all ten fingers. Treatment with exterior-releasing and Qi-regulating herbs was ineffective. Upon consultation, the pulse was wiry, fine, and rapid, with the right side larger than the left. He said: This is due to constrained emotions, with Liver Fire郁结 (stagnating) in Spleen Earth causing fever, and heat steaming the Lung causing cough. Since the Lung is naturally dry, there is no sputum. The Spleen is controlled by Wood (Liver), causing abdominal pain. Yang Qi cannot diffuse outward, causing headache. The four limbs are the root of all Yang Qi; when Yang Qi does not flow, Qi coagulates and Blood stagnates, causing pain and purple discoloration of the ten fingers. A wiry pulse indicates Liver; a rapid pulse indicates Fire; a fine pulse indicates Fire stagnating in the Blood level. Therefore, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) plus Guizhi (Cinnamomi Ramulus) was prescribed to reach Wood from within Earth. After three doses, all symptoms resolved abruptly, and the ten fingers ceased to be painful and discolored.