臂细无力，不任重，此乃肝肾气虚，风邪客滞于荣卫之间，使气血不能周养四肢，故有此证候。肝主
项背与臂膊，肾主腰胯与脚膝，其二脏若偏虚，则随其所主而生病焉。今此症乃肝气偏虚，宣专补肝，兼
肾。（《鸡蜂》）
四肢痛 四肢痛无常处者，手足支节皆卒然而痛，不在一处。其痛处不肿，色亦不异，但肉里掣痛，
如锥刀所刺。由体虚受于风邪，风邪随气而行，气虚之时，邪气则胜，与正气交争相击，痛随虚而生，故无
常处也。（《病源论》）
一女子，两手足自四末痹至肱膝，方痛而不省人事，作
痰气服四七汤愈。（《永类》）
肢节疼，须用羌活，去风湿亦用之。如肥人肢节痛，多是风湿与痰饮流注经络而痛，宜南星、半夏。瘦
人肢节痛，是血虚，宜四物加防风、羌活。如瘦人性躁急而肢节痛发热，是血热，宜四物加黄芩、酒炒黄柏。
肢节痛肿脉滑者，当用燥湿，宜苍术、南星，兼行气药木香、枳壳、槟榔，在下者加汉防己。如肢节痛肿脉涩数
者，此是瘀血，宜桃仁、红花、当归、川芎及大黄微利之。如倦怠无力而肢节痛，此是气虚，兼有痰
饮流注，宜参、术、星、半。（《丹溪》）
十指疼痛 治手足十指疼痛麻木。孙盈仲尝患此，其祖善医，云有风而非虚，以此药治之而愈。
附子 木香
上二味等分，锉为粗末，用姜如常法煎，木香随气虚实加减。如治足弱，去附子，用乌头甚妙。（《是斋》）
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。（《医通》）
手痛 经曰手屈不伸者，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。（《医通》）
臂腿一两点痛 治臂腿之间，忽一两点痛，着骨不可忍。
芫花根
上一味，研为细末，米醋调，随大小敷之，立止。庐州郭医云∶此陶成一医者，曾以治一妇人产后而得
此疾者良验。但敷贴不住，须以纸花覆其上，用绢帛扎定也。（《是斋》）
腿痛 腿痛有血虚、血寒、寒湿、风湿、湿热、流注、
阴虚、阳虚、肾虚风袭之殊。（《医通》）（原详载证治，又有大股痛，并宜参。）
膝痛 经云∶膝者筋之府，屈伸不能，行则偻附，筋将惫矣。故膝痛无有不因肝肾虚者，虚则风寒
湿气袭之。又曰∶身半以下者，湿中之也。故治膝胫之痛，又须以去湿为主。大抵痛在筋者，多挟风热，则屈
不伸而肿，兼阴虚者则热而不肿。因卧湿地，流入脚膝，痹弱疼重，《千金》独活寄生汤。夏月湿热沉重而
痛，当归拈痛汤。痛在骨者，多兼寒饮，重而屈伸不利，常若拭不干状。（《医通》）
予冬月膝亦酸疼，灸犊鼻而愈，以此见药与灸不可偏废也。若灸膝关、三里亦得。但按其穴酸疼，即是
受病处，灸之不拘。（《资生》）
足痛、足心痛 尺脉虚弱，缓涩而紧，病为足痛，或者痿病。（《崔氏脉诀》）
脚下有结物，牢 如石，痛如锥刀所刺，此由肾经虚，风毒之气伤之，与血气相击，故痛而结 不散。（《病源论》）
足心及踝骨热疼者，为肾虚湿着，命门火不归经，肾着汤下八味丸。肥人多湿痰流注，足心作痛，但久坐
卧，起则痛甚，行动则缓，宜肾着汤合二妙散（用黄柏、苍术）。慎不可用补肾药，及血药助阴，愈增其剧。（《医通》）
脚根痛 脚根颓者，脚跟忽痛，不得着地，世呼为脚跟颓。（《病源论》）
足跟痛，有痰有血热，血热四物加黄柏、知母、牛膝之类。（《丹溪》）
肾脏阴虚者，则足胫时热而足跟痛，六味丸加龟版、肉桂。阳虚者，则不能久立而足跟痛，八味丸。挟
湿者，必重着而肿。肥人，湿痰流注。凡下部痛，多用药酒，殊不知病甚于冬者，为寒湿，故宜用酒；若春夏
甚而秋冬减者，此属湿热，若用药酒，是反助其湿也。（《医通》）
Arm thinness and weakness, inability to bear weight, is due to deficiency of Qi in the Liver and Kidney, with Wind pathogen lodging and stagnating between Ying (Nutritive) and Wei (Defensive) levels, preventing Qi and Blood from fully nourishing the four limbs, thus causing this syndrome. The Liver governs the nape, back, and arms; the Kidney governs the waist, hips, and knees. If these two Zang organs are deficient, disease arises according to their respective domains. This current case involves deficiency of Liver Qi; treatment should specifically tonify the Liver and concurrently tonify the Kidney. (*Jifeng*)
Pain in the Four Limbs: Pain in the four limbs without a fixed location, where all joints of the hands and feet suddenly become painful, not confined to one spot. The painful area is not swollen, nor is the color abnormal, but there is pulling pain within the muscles, as if pierced by an awl or knife. This occurs because the body is weak and has contracted Wind pathogen. The Wind pathogen moves with the Qi; when Qi is deficient, the pathogenic factor prevails, clashing with the healthy Qi. Pain arises with the deficiency of healthy Qi, hence the lack of a fixed location. (*Zhubing Yuanhou Lun*)
A woman experienced numbness and bi-syndrome extending from the distal ends of her hands and feet up to her upper arms and knees, followed by sudden pain and loss of consciousness. She was cured by taking Siqi Tang. (*Yonglei*)
Joint pain requires the use of Qianghuo (Notopterygii Rhizoma et Radix), which also dispels Wind-Damp. In obese individuals, joint pain is often caused by Wind-Damp and Phlegm-Fluid flowing into the meridians; Nanxing (Arisaematis Rhizoma Praeparatum) and Banxia (Pinelliae Rhizoma) are suitable. In thin individuals, joint pain is due to Blood deficiency; Siwu Tang (Four Substances Decoction) added with Fangfeng (Saposhnikoviae Radix) and Qianghuo is suitable. If a thin person has an irritable temperament, joint pain accompanied by fever, it indicates Blood Heat; Siwu Tang added with Huangqin (Scutellariae Radix) and Jiuhuangbai (Phellodendri Cortex Praeparated with Wine) is suitable. For joint pain and swelling with a slippery pulse, dampness-drying herbs are indicated, such as Cangzhu (Atractylodis Rhizoma) and Nanxing, combined with Qi-moving herbs like Muxiang (Aucklandiae Radix), Zhike (Aurantii Fructus), and Binglang (Arecae Semen). For lower limb involvement, add Hanfangji (Stephaniae Tetrandrae Radix). If joint pain and swelling present with a choppy and rapid pulse, this indicates Blood stasis; Taoren (Persicae Semen), Honghua (Carthami Flos), Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), and Dahuang (Rhei Radix et Rhizoma) to induce mild purgation are suitable. If fatigue and weakness accompany joint pain, this is Qi deficiency with Phlegm-Fluid flow; Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Nanxing, and Banxia are suitable. (*Danxi Xinfa*)
Pain in Ten Fingers: Treatment for pain and numbness in the ten fingers of hands and feet. Sun Yingzhong once suffered from this. His grandfather, a skilled physician, diagnosed it as Wind pathogen rather than deficiency, and cured him with the following prescription. Fuzi (Aconiti Lateralis Radix Praeparata), Muxiang (Aucklandiae Radix). These two ingredients in equal parts, coarsely crushed, decocted with Ginger as usual. The dosage of Muxiang is adjusted according to the excess or deficiency of Qi. For treating weak feet, remove Fuzi and use Wutou (Aconiti Radix); this is very effective. (*Shizhai*)
Shiwen treated the second daughter-in-law of Official Jiang Runong. In early spring, she suffered from fever, headache, abdominal pain, cough with no sputum, and purple-black painful fingers. Previous treatments using exterior-releasing and Qi-regulating methods failed. Upon my examination, the pulse was wiry, fine, and rapid, stronger on the right than the left. I stated: "This is due to constrained emotions, causing Liver Fire to郁 (stagnate) in Spleen Earth, resulting in fever; heat steaming the Lung causes cough. Since the Lung is naturally dry, there is no sputum. The Spleen is overcome by Liver Wood, causing abdominal pain. Yang Qi cannot diffuse, causing headache. The four limbs are the root of all Yang; when Yang Qi does not circulate, Qi stagnates and Blood congeals, causing pain and purple discoloration of the fingers. A wiry pulse indicates Liver; rapid indicates Fire; fine indicates Fire constrained in the Blood level." Thus, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) added with Guizhi (Cinnamomi Ramulus) was used to reach out the Liver within the Earth element. After three doses, all symptoms resolved, and the finger pain and discoloration ceased. (*Yitong*)
Hand Pain: The Classics state: "If the hand is flexed but cannot extend, the disease is in the sinews; use Yiyiren Tang (Coix Seed Decoction). If extended but cannot flex, the disease is in the bones; select Baixu Fuzi Tang (Atractylodes Macrocephala and Prepared Aconite Root Decoction) from *Jinxiao* or Shiwei Cusan (Ten-Ingredient Coarse Powder)." (*Yitong*)
Localized Pain in Arm and Leg: Treatment for sudden, sharp pain at one or two points in the arm or leg, adhering to the bone and unbearable. Yuanhuagen (Genkwa Flos Root Bark). Grind this single ingredient into a fine powder, mix with rice vinegar, and apply according to the size of the lesion; pain stops immediately. Physician Guo from Luzhou said: This was effectively used by Physician Tao Chengyi to treat a woman who developed this condition postpartum. However, the paste may not stay in place; cover it with paper flowers and secure it tightly with silk cloth. (*Shizhai*)
Leg Pain: Leg pain varies by pattern: Blood deficiency, Blood cold, Cold-Damp, Wind-Damp, Damp-Heat, Liu Zhu (flowing accumulation), Yin deficiency, Yang deficiency, and Wind attack due to Kidney deficiency. (*Yitong*) (The original text details syndromes and treatments; thigh pain is also included for reference.)
Knee Pain: The Classics say: "The knee is the mansion of the sinews. Inability to flex and extend, walking while stooping and leaning, indicates that the sinews are exhausted." Therefore, knee pain is invariably due to Liver and Kidney deficiency, allowing Wind-Cold-Damp to invade. It is also said: "The lower half of the body is prone to Dampness." Thus, treating knee and shin pain must prioritize dispelling Dampness. Generally, pain in the sinews often involves Wind-Heat, leading to inability to extend and swelling; if combined with Yin deficiency, there is heat without swelling. Sleeping on damp ground allows Dampness to flow into the feet and knees, causing bi-syndrome, weakness, and heavy pain; Du Huo Ji Sheng Tang (Angelica Pubescens and Sangjisheng Decoction) from *Qianjin Fang* is used. In summer, with heavy Damp-Heat pain, Danggui Nian Tong Tang (Angelica Sinensis and Analgesic Decoction) is used. Pain in the bones often involves Cold-Fluid, causing heaviness, difficulty in flexion and extension, and a sensation as if wiping away moisture that doesn't dry. (*Yitong*)
My knees also ached in winter; moxibustion at Dubi (ST35) cured me. This shows that herbal medicine and moxibustion should not be neglected. Moxibustion at Xiguan (EX-LE4) and Zusanli (ST36) is also effective. Press the acupoint; if it feels sore and painful, that is the affected site. Moxibustion need not be restricted to specific points. (*Zisheng*)
Foot Pain and Sole Pain: A weak Chi (cun) pulse, slow, choppy, and tight, indicates foot pain or potentially Wei syndrome (flaccidity syndrome). (*Cui Shi Mai Jue*)
A lump under the foot, hard as stone, painful as if pierced by an awl or knife, is caused by Kidney Meridian deficiency, where Wind-Toxin attacks and clashes with Qi and Blood, causing pain and persistent lumpiness. (*Zhubing Yuanhou Lun*)
Heat and pain in the sole and ankle bones indicate Kidney deficiency with Dampness adherence, and Mingmen Fire failing to return to its source. Use Shen Zhuo Tang (Kidney-Laden Decoction) to deliver Bawei Wan (Eight-Ingredient Pill). Obese people often have Phlegm-Damp flowing into the soles, causing pain that worsens upon rising after prolonged sitting or lying, but eases with movement. Shen Zhuo Tang combined with Er Miao San (Two Marvels Powder, using Huangbai and Cangzhu) is suitable. Do not use Kidney-tonifying herbs or Blood-nourishing herbs that aid Yin, as this will exacerbate the condition. (*Yitong*)
Heel Pain: "Gen Tui" refers to sudden heel pain preventing contact with the ground, commonly known as Heel Tui. (*Zhubing Yuanhou Lun*)
Heel pain can be due to Phlegm or Blood Heat. For Blood Heat, use Siwu Tang added with Huangbai, Zhimu, and Niuxi. (*Danxi Xinfa*)
For Kidney Yin deficiency, with frequent heat in the shins and heel pain, use Liuwei Wan (Six-Ingredient Pill) added with Gui Ban (Testudinis Carapax et Plastrum) and Rougui (Cinnamomi Cortex). For Yang deficiency, with inability to stand for long periods and heel pain, use Bawei Wan (Eight-Ingredient Pill). With Dampness, there is heaviness and swelling. In obese individuals, it is Phlegm-Damp flowing downward. For pain in the lower body, medicinal wine is often used. However, if the condition is worse in winter, it is Cold-Damp, and wine is appropriate. If worse in spring/summer and better in autumn/winter, it is Damp-Heat; using medicinal wine would反而 (counterproductively) assist the Dampness. (*Yitong*)