【歌】遍体烦疼曰痛风，湿痰风热苦相攻。或因血弱寒凝涩，流注浑身骨节中。
【论】夫痛风者，遍身骨节走痛是也，古人谓之白虎历节风。大率因血受热已自沸腾，或涉冷受湿取凉，
热血得寒则污浊凝涩，不得营运，所以作痛。夜痛甚者，行于阴分也。亦有阴湿与痰流注为痛者，有因痰与热
者。盖肥人多是湿痰流注经络，瘦人多是血虚与热。大法以行气流湿疏风，导滞血，养新血，降阳升阴。治有
先后，须验肿与不肿，及上下部分，引而导之。
痰
因痰者，二陈汤加酒芩、羌活、南星、苍术、竹沥、姜汁。（方见痰证。）湿痰痛风，酒 、酒威灵
仙、苍术、羌活、甘草、干姜、陈皮、芍药。痰挟死血，一身走痛者，控涎丹。（方见胁痛。）
湿
因湿者，二术加羌活、白芷、黄柏、防风、竹沥、姜汁，
或二妙散。（方见香港脚。）肢节肿痛，脉滑，苍术、南星、木香、枳壳、槟榔、防己、黄柏。风湿相搏痛者，
甜瓜子丸。
甜瓜子丸
干木瓜（两半） 威灵仙（两半） 甜瓜子（二两，炒黄） 川乌（炮，五钱）
末之，酒糊丸桐子大，每三十丸，酒下。
血虚（附死血）
血虚痛，芎归汤加桃仁、红花、薄桂、威灵仙，取横行手膊。（方见头痛。）肢节肿痛，脉涩，死血
也，四物汤加桃仁、红花。（方见血证。）寒湿相搏，血郁经络作痛者，麒麟竭散。
麒麟竭散
血竭（六钱） 乳香（六钱） 没药（六钱） 白芍药（六钱） 当归（六钱） 水蛭（二钱，炒焦） 麝
香（二钱） 虎胫骨（酥炙，五钱）
末之，每服三钱，食前酒调下。
风热
风者，小续命汤去附子，加羌活、防风、酒炒黄芩。在上，威灵仙、桂枝；在下，牛膝、防己、黄柏。
（方见中风。）湿热，当归拈痛汤。（方见香港脚。）瘦人肢痛，血虚火盛也，四物汤加黄芩、黄柏、羌活、防
风、柴胡。（方见血证。）
[Verse]
Generalized pain throughout the body is termed *Tongfeng* (Gout). It arises from the mutual assault of Dampness, Phlegm, Wind, and Heat. Sometimes it is due to Blood deficiency and Cold coagulation causing stagnation, flowing into the bone joints throughout the body.
[Dissertation]
*Tongfeng* (Gout) refers to wandering pain in the bone joints throughout the body; in ancient times, it was called "White Tiger Li Jie Feng" (White Tiger Wandering Joint Wind). Generally, it occurs because the Blood has been heated to a state of boiling, or due to exposure to cold, dampness, or seeking coolness. When hot Blood encounters Cold, it becomes turbid and stagnant, failing to circulate normally, thus causing pain. Pain that worsens at night indicates the pathogen is traversing the Yin aspect. There are also cases where Yin-Dampness and Phlegm flow into the meridians causing pain, or where Phlegm and Heat combine. Typically, obese individuals suffer from Damp-Phlegm flowing into the meridians, while thin individuals suffer from Blood deficiency with internal Heat. The general treatment principle involves promoting Qi circulation to resolve Dampness, dispersing Wind, guiding out stagnation and blood stasis, nourishing new Blood, descending Yang, and ascending Yin. Treatment must follow a sequence, requiring examination of whether swelling is present and whether the lesion is located in the upper or lower parts, thereby guiding the therapeutic action accordingly.
**Due to Phlegm:**
For cases caused by Phlegm, use *Erchen Tang* (Two-Cured Decoction) plus Jiuhuangqin (Scutellariae Radix fried with wine), Qianghuo (Notopterygii Rhizoma et Radix), Nanting (Arisaematis Tuber processed), Cangzhu (Atractylodis Rhizoma), Zhuli (Bambusae Caulis in Succedaneum), and Jiangzhi (Zingiberis Rhizoma Juice). (Formula see Chapter on Phlegm Syndrome.) For Damp-Phlegm *Tongfeng*, use Jiuzhuru (Atractylodis Rhizoma soaked in wine), Jiuwanglingxian (Salviae Miltiorrhizae soaked in wine), Cangzhu, Qianghuo, Gancao (Glycyrrhizae Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma), Chenpi (Citri Reticulatae Pericarpium), and Shaoyao (Paeoniae Radix Alba). If Phlegm clots with Dead Blood (Blood Stasis) causing wandering pain throughout the body, use *Kongxian Dan* (Control Fluid Pellets). (Formula see Chapter on Hypochondriac Pain.)
**Due to Dampness:**
For cases caused by Dampness, use Erzhu (Cangzhu and Baizhu) plus Qianghuo, Baizhi (Angelicae Dahuricae Radix), Huangbai (Phellodendri Cortex), Fangfeng (Saposhnikoviae Radix), Zhuli, and Jiangzhi, or use *Ermiao San* (Two-Awesome Powder). (Formula see Chapter on Hong Kong Foot / Podagra.) If there is swelling and pain in the limb joints with a slippery pulse, use Cangzhu, Nanting, Muxiang (Aucklandiae Radix), Zhike (Aurantii Fructus Immaturus), Binglang (Arecae Semen), Fangji (Stephaniae Tetrandrae Radix), and Huangbai. For pain caused by Wind-Dampness interlocking, use *Tianguazi Wan* (Sweet Melon Seed Pills).
**Tianguazi Wan**
Gan Mugua (Chaenomelis Fructus, 1.5 liang), Weilingshen (Salviae Miltiorrhizae, 1.5 liang), Tianguazi (Benincasae Semen, 2 liang, stir-fried until yellow), Chuanwu (Aconiti Radix Praeparata, 5 qian).
Grind into fine powder, mix with wine paste to form pills the size of tung tree seeds. Take 30 pills each time, washed down with wine.
**Blood Deficiency (Including Dead Blood/Stasis)**
For pain due to Blood deficiency, use *Xionggui Tang* (Ligusticum and Angelica Decoction) plus Taoren (Persicae Semen), Honghua (Carthami Flos), Bao Gui (Cinnamomi Ramulus), and Weilingshen, utilizing their property to travel horizontally along the arms. (Formula see Chapter on Headache.) If there is swelling and pain in the limb joints with a choppy pulse, this indicates Dead Blood (Blood Stasis); use *Siwu Tang* (Four Substances Decoction) plus Taoren and Honghua. (Formula see Chapter on Blood Syndromes.) For pain caused by Cold-Dampness interlocking and Blood depression in the meridians, use *Qilinjie San* (Kirin Blood Powder).
**Qilinjie San**
Xuejie (Dracaenae Sangue, 6 qian), Ruxiang (Olibanum, 6 qian), Moyao (Myrrha, 6 qian), Baishaoyao (Paeoniae Radix Alba, 6 qian), Danggui (Angelicae Sinensis Radix, 6 qian), Shuizhi (Hirudo, 2 qian, stir-fried until scorched), Shexiang (Moschus, 2 qian), Hu Jinggu (Pantheris Tibia prepared with butter, 5 qian).
Grind into fine powder. Take 3 qian each time, mixed with wine before meals.
**Wind-Heat**
For cases caused by Wind, use *Xia Xuming Tang* (Minor Xu Ming Decoction) minus Fuzi (Aconiti Lateralis Radix Praeparata), plus Qianghuo, Fangfeng, and Jiuchao Huangqin (Scutellariae Radix fried with wine). For lesions in the upper part, add Weilingshen and Guizhi (Cinnamomi Ramulus); for lesions in the lower part, add Niuxi (Achyranthis Bidentatae Radix), Fangji, and Huangbai. (Formula see Chapter on Stroke.) For Damp-Heat, use *Danggui Niang Tong Tang* (Angelica Relieving Pain Decoction). (Formula see Chapter on Hong Kong Foot.) For limb pain in thin individuals, which is due to Blood deficiency and flourishing Fire, use *Siwu Tang* plus Huangqin, Huangbai, Qianghuo, Fangfeng, and Chaihu (Bupleuri Radix). (Formula see Chapter on Blood Syndromes.)