证治诸说 夫臂痛者，其说有五∶若臂痛，筋脉挛急，
不得屈伸，遇寒则剧，由肝虚，为风寒邪气留于经络，故筋
挛干急而痛，脉紧而细者，宜以小续命汤，或以异功五积散，加全蝎、麝香煎，甚者以柏子仁丸（出《妇人
良方》引《指迷方》，凡十三味，系温养之剂）。若臂痛不能举，时复转移，或左或右，此由中脘伏痰，脾气
滞而不行，则上下不运而痛，其脉沉细，宜茯苓丸或控涎丹。若臂痛流走，上下无常，外连肌肉，牵引背胛，
时发时止，由荣卫之气循行失度，遂受风毒之气，行于血中，随血上下，新故相搏则痛，宜小续命汤兼麝香
丸（当考），甚者以白芥子散。若卒然一臂无力，痛不能举， 似汗，肌肉时复掣痛，手不及头，此寒
湿客搏而筋缓也，宜以异功五积散，加全蝎、麝香煎，甚者以四君子汤加芍药、附子、生姜煎服。若气
血凝滞，经络不行，臂痛不能举者，舒经汤。（《管见良方》）
臂为风寒湿所搏，或饮液流入，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
宜五积散及乌药顺气散（按∶《得效》治风证，《医鉴》治因于气者）或蠲痹汤。外有血虚一证，血不荣
于筋，或致臂痛，宜蠲痹汤、四物汤各半帖，和匀煎服。乳妇以臂枕儿，伤于风寒，多有臂痛，亦宜于此
选用。若坐卧为风湿所搏，或睡后手在被外，为寒邪所袭，遂令臂痛，宜五积散及蠲痹汤、乌
药顺气散。审知是湿，蠲痹汤，每服加苍术三匙，防己四分，或用五痹汤。曾因挈重伤筋，以致臂痛，
宜琥珀散（用芍、莪、牡、棱、刘寄奴、玄胡、乌药、归、地、桂）、劫劳散（《类方》用虚劳方，然当
是《和剂·伤寒》门中方）或和气饮（《类方》用升麻和气饮，然当是五积散加麻黄），每
服加白姜黄半钱，以姜黄能入臂故也。（《要诀》）
臂连肩背酸痛，两手软痹，由痰饮流入四肢也。偶提重
物忽痛，伤筋也。因搐臂筋痛，伤于寒也。臂痛不能举，或
痛无定处，由脾虚邪气相搏也。臂痛不能举物，气血凝滞也。（《尊生书》）
和血诸方 舒经汤，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，煎至七分，去滓温服。如腰以下疾，空心服。腰以上疾，食后服。
（《妇人良方》）（按∶据《事证方后集》，此本王伯举方，其说颇详，宜参。）《管见良方》治气血凝滞，
经络不行，肩痛不能举。一方，加沉香、生姜煎。《叶氏》五痹汤，大治风痰饮攻作臂膊疼痛，于本方去海
桐皮、归、芍。（亦见《事证方后集》，有说。）《杨氏》蠲痹汤，于本方去白术、海桐皮，
加黄 。（详见《痹》门。《医鉴》臂痛因湿者。）《得效》活络汤，治风湿臂痛，诸药不效者，
于本方去姜黄、桐皮、芍药，加独活、川芎。
红花四物汤，治妇人臂疼，又如瘫痪。刘立之云∶是血证，四物汤加红花煎服见效。（《朱氏》）
白芥子散，治臂痛，外连肌肉，牵引背胛，时发时止，此由荣卫之气循行失度，留滞经络，
与正气相搏，其痛发则有似瘫痪。
真白芥子 木鳖子（各二两麸炒） 没药（别研） 桂心 木香（各半两）
上为细末，入研药令停，每服一钱，温酒调下。（《妇人良方》）
服桑枝法，桑枝一小升，细切炒香，以水三大升，煎取二升，一日服尽，无时。政和间，
予尝病两臂痛，服诸药不效，根据此作数剂，臂痛即愈。（《本事》）
利气方 流气饮子。（按∶此不举主治，当是治气滞臂
痛。《得效》列之白芥子散后，曰∶治同上。）
紫苏叶 青皮 桔梗 大黄（煨） 当归 芍药 乌药 茯苓 川芎 黄 枳壳
（去穣麸炒） 防风（各半两） 甘草 橘皮（各三分） 木香 皮连大腹（二两锉姜汁）
上 咀，每服五钱，水二盏，姜三片，枣一枚，煎一盏，去滓服。（《妇人良方》）《得效》去大黄。
温经诸方 拾味锉散，治臂痛，连筋及骨，举动艰难。此药亦益血养筋生力。
当归（一两去土洗净切焙干） 黄 （二两炙） 白芍药（二两） 芎
（一两半不见火） 防风（一两半） 附子（三两炮制去皮脐） 白
术（一两半） 茯苓（七钱半） 熟干地黄（七钱半略洗净用少酒熬令干焙之） 肉桂（一两去粗皮不见火）
上件并修制了毕，然后秤之， 咀，每服四钱重，水一大满盏，生姜七片。枣子三个掰开，同煎
至七分，去滓通口服，食后临卧日三服。须温覆浓衣，畏寒去处。（《叶氏》）
臂痛多日风，其脉濡而来反急，明其湿。用苍术、附子各等分，木香一分，姜煎，帛盖，屋上露
星一宿，次日重汤暖服愈。（《永类》引《续易简》）
消痰诸方 治痰，茯苓元，本治臂痛，具《指迷方》中。云有人臂痛不能举，手或左（《妇
人良方》此有“或”字）右，时复转移。由伏痰在内，中脘停滞，脾气不流行，上与
气搏。四肢属脾，滞而气不下，故上行攻臂，其脉沉细者是也。后人谓此臂痛，乃痰证也（方出《
痰涎》中）。累有人为痰所苦，夜间两臂常若有人抽牵，两手战灼，至于茶盏亦不能举，只以
此药治之，皆随服随愈。（《是斋》）
半夏汤，治肩臂痛。
半夏（二两洗七遍切作薄片） 白茯苓（二两锉）
上为细末，每服二钱，水二盏，煎至八分，入姜汁一哈 壳许，再煎至七分，食后温热服。（《叶氏》）
又小半夏汤，治痰饮头眩及臂痛，于本方加甘草、橘、姜，水煎。
痰饮流入四肢，肩臂酸疼，两臂软痹，导痰加木香、片子姜黄、姜制白术，若作风治误矣。（《医通》）
控涎丹，加去油木鳖子一两，桂五钱，治臂痛，每服二十丸，加五三十丸。（《纲目》）
芎活汤，治水饮停蓄，注于经络，发为臂痛，皆因脾土有亏，平日多饮水浆，不能传化所致。
川芎 半夏（汤洗） 白茯苓 川独活 陈皮 枳壳（去穣炒各半两） 白术 甘草（各一分）
上为散，每服三钱，水一盏半，生姜同煎，去滓，食后停少时温服。（《得效》）
凉热方 热证，防风通圣散。（《得效》）
[Theories and Treatments for Arm Pain] Regarding the theories of arm pain, there are five main perspectives:
First, if the arm is painful, with tendons and vessels cramped and tight, unable to flex or extend, and worsening upon exposure to cold, this is due to Liver deficiency, where Wind-Cold pathogenic factors remain in the meridians, causing tendon cramping and pain. If the pulse is tight and fine, Xiao Xuming Tang (Minor Continuation of Life Decoction) is appropriate, or Yigong Wuji San (Yi-Gong Five Accumulations Powder) added with Quanjie (Scorpio) and Shexiang (Musk) decocted. For severe cases, Baizi Ren Wan (Biota Seed Pill) is indicated (from *Furen Liangfang* citing *Zhimifang*, consisting of thirteen ingredients, a warming and nourishing formula).
Second, if the arm is painful and cannot be raised, with the pain shifting position from time to time, either left or right, this is caused by latent phlegm-fluids in the Zhongwan region (CV12), where Spleen Qi stagnates and fails to circulate, leading to obstruction of upper and lower movement and pain. If the pulse is deep and fine, Fuling Wan (Poria Pill) or Kongxian Dan (Phlegm-Fluid Expelling Pellet) is indicated.
Third, if arm pain wanders without fixed location, moving up and down, extending outward to muscles, and pulling on the back and scapula, occurring intermittently, this is due to the abnormal circulation of Ying (Nutritive) and Wei (Defensive) Qi, allowing Wind-Toxicity to invade and travel within the blood, clashing with new and old blood to cause pain. Xiao Xuming Tang combined with Shexiang Wan (Musk Pill) [to be verified] is indicated; for severe cases, Baijiezi San (White Mustard Seed Powder) is used.
Fourth, if suddenly one arm becomes weak, painful and unable to be raised, with apparent sweating, muscle twitching and pain, and the hand unable to reach the head, this is due to Cold-Dampness lodging and attacking, causing flaccidity of the tendons. Yigong Wuji San added with Quanjie (Scorpio) and Shexiang (Musk) is indicated; for severe cases, Sijunzi Tang (Four Gentlemen Decoction) added with Shaoyao (Peony Root), Fuzi (Prepared Aconite Root), and Shengjiang (Fresh Ginger) is indicated.
Fifth, if Qi and Blood stagnate and meridians are blocked, causing arm pain and inability to raise the arm, Shujing Tang (Meridian-Relaxing Decoction) is used (from *Guanjian Liangfang*).
Arm pain can result from the attack of Wind-Cold-Dampness, fluid accumulation in the channels, or lifting heavy objects. It may present with swelling or without. Excluding fluid-patterns, other types of pain generally respond to Wuji San (Five Accumulations Powder), Wuyao Shunqi San (Lindera Regulating Qi Powder) [Note: *Dexiao Fang* treats wind patterns; *Yijian* treats patterns due to Qi stagnation], or Juanbi Tang (Dispelling Bi Decoction). Additionally, there is a Blood Deficiency pattern where Blood fails to nourish the tendons, potentially causing arm pain. Juanbi Tang and Siwu Tang (Four Substances Decoction) in equal halves, mixed and decocted together, are indicated. Lactating women who rest their arms on infants may suffer Wind-Cold injury, often resulting in arm pain; these formulas are also suitable. If sitting or lying exposes the body to Wind-Dampness, or sleeping with hands outside the covers invites Cold Evil, causing arm pain, Wuji San, Juanbi Tang, and Wuyao Shunqi San are indicated. If dampness is confirmed, Juanbi Tang with additional Cangzhu (Atractylodes Rhizome) and Fangji (Stephania Root), or Wubi Tang (Five Bi Decoction), is used. For arm pain due to previous heavy lifting injuring tendons, Hupo San (Amber Powder) [containing Shaoyao, Ezhu, Muli, Sanleng, Liu Jinu, Yuanhu, Wuyao, Danggui, Dihuang, Rougui], Jielao San (Exhaustion-Seizing Powder) [Note: *Leifang* cites a consumptive disease formula, but likely refers to one from *Heji Jufang* under Cold Damage], or Heqi Yin (Harmonizing Qi Drink) [Note: *Leifang* cites Shengma Heqi Yin, but likely refers to Wuji San plus Mahuang], each taken with Banqian (half a qian) of Bai Jianghuang (Turmeric Tuber) because Jianghuang enters the arm meridians, are indicated (from *Yaojue*).
Arm pain radiating to the shoulder and back with soreness, accompanied by soft numbness in both hands, is caused by phlegm-fluids flowing into the four limbs. Sudden pain after lifting heavy objects indicates tendon injury. Pain from pulling the arm indicates Cold injury. Arm pain with inability to raise the arm, or pain without fixed location, is due to Spleen deficiency clashing with pathogenic factors. Inability to lift objects indicates Qi and Blood stagnation (from *Zunsheng Shu*).
[Formulas for Harmonizing Blood] Shujing Tang treats arm pain and is also known as Wubi Tang; it also treats diseases below the waist.
Pianzi Jianghuang (4 liang), Gancao (Licorice Root), Qianghuo (Notopterygium Rhizome) (1 liang each), Baizhu (Atractylodes Macrocephala Rhizome), Haitongpi (Sassafras Cortex), Danggui (Angelica Sinensis Root), Chishaoyao (Red Peony Root) (2 liang each).
Grind into coarse powder. Take 3 qian per dose, decoct in 1.5 cups of water until 0.7 cup remains, strain, and take warm. For diseases below the waist, take on an empty stomach. For diseases above the waist, take after meals (from *Furen Liangfang*). [Note: According to *Shizheng Fanghouji*, this originates from Wang Boju's formula, with detailed explanations; refer to it.] *Guanjian Liangfang* uses it for Qi and Blood stagnation blocking meridians, causing shoulder pain and inability to raise the arm. One variation adds Chenxiang (Agarwood) and Shengjiang (Fresh Ginger). Ye Shi's Wubi Tang primarily treats arm pain caused by Wind-Phlegm-Fluid attacking; remove Haitongpi, Danggui, and Shaoyao from the base formula (also seen in *Shizheng Fanghouji*). Yang Shi's Juanbi Tang removes Baizhu and Haitongpi from the base formula and adds Huangqi (Astragalus Root) (See *Bi* section; *Yijian* applies it to dampness-induced arm pain). *Dexiao Fang*'e Huoluo Tang treats Wind-Damp arm pain unresponsive to other drugs; remove Jianghuang, Tongpi, and Shaoyao from the base formula and add Duhuo (Angelica Pubescens Root) and Chuanxiong (Ligusticum Rhizome).
Honghua Siwu Tang (Red Flower Four Substances Decoction) treats arm pain in women, resembling paralysis. Liu Lizhi states this is a Blood pattern; adding Honghua (Safflower) to Siwu Tang yields effective results (from *Zhu Shi*).
Baijiezi San (White Mustard Seed Powder) treats arm pain extending to muscles and pulling the back/scapula, intermittent in nature. This is due to abnormal circulation of Ying and Wei Qi, stagnating in meridians and clashing with Healthy Qi, causing pain that resembles paralysis.
Zhen Baijiezi (True White Mustard Seed), Mugua Zi (Momordica Seed) (2 liang each, stir-fried with bran), Moyao (Myrrh) (separately ground), Guixin (Cinnamon Twig Bark), Muxiang (Vladimiria Root) (0.5 liang each).
Grind into fine powder, mix with the ground Myrrh. Take 1 qian per dose, mix with warm wine (from *Furen Liangfang*).
Method for consuming Mulberry Branch: Take a small sheng of Mulberry Branch (Sangzhi), cut finely, stir-fry until fragrant. Decoct in 3 large cups of water until 2 cups remain. Consume throughout the day in divided doses. During the Zhenghe era, I suffered from bilateral arm pain; various medicines failed. Following this method for several doses cured my pain (from *Benshi Fang*).
[Formulas for Promoting Qi Flow] Liuqi Yinzi (Flowing Qi Drink). [Note: Indications not listed here, likely for Qi-stagnation arm pain. *Dexiao Fang* lists it after Baijiezi San, stating "Indications same as above."]
Zisu Ye (Perilla Leaf), Qingpi (Green Tangerine Peel), Jiegeng (Platycodon Root), Dahuang (Rhubarb Root, baked), Danggui, Shaoyao, Wuyao, Fuling, Chuanxiong, Huangqi, Zhike (Bitter Orange Fruit, pith removed, bran-fried), Fangfeng (0.5 liang each), Gancao, Jupi (Tangerine Peel) (0.3 liang each), Muxiang, Lianpi (Coptis Cortex), Dafupi (Areca Peel) (2 liang, cut, processed with ginger juice).
Cut into pieces. Take 5 qian per dose, decoct in 2 cups of water with 3 slices of ginger and 1 jujube until 1 cup remains, strain, and take (from *Furen Liangfang*). *Dexiao Fang* omits Dahuang.
[Formulas for Warming Meridians] Shiwei Cusan (Ten-Ingredient Cut Powder) treats arm pain extending to tendons and bones, making movement difficult. This formula also benefits Blood, nourishes tendons, and generates strength.
Danggui (1 liang, cleaned, cut, dried), Huangqi (2 liang, honey-fried), Baishaoyao (2 liang), Xiong (Chuanxiong) (1.5 liang, avoid direct fire), Fangfeng (1.5 liang), Fuzi (3 liang, processed, skin and umbilicus removed), Baizhu (1.5 liang), Fuling (0.75 liang), Shudihuang (Prepared Rehmannia Root) (0.75 liang, lightly cleaned, boiled with little wine until dry, then dried), Rougui (Cinnamon Bark) (1 liang, outer bark removed, avoid direct fire).
Process all ingredients, weigh them, cut into pieces. Take 4 qian per dose, decoct in one full cup of water with 7 slices of ginger and 3 cracked jujubes until 0.7 cup remains, strain, and take orally. Take three times daily after meals and before sleep. Keep warm with thick clothing, protecting areas sensitive to cold (from *Ye Shi*).
For chronic arm pain with Wind, where the pulse is soggy yet rapid/tight, indicating Dampness: Use Cangzhu and Fuzi in equal parts, plus 1 part Muxiang, decocted with ginger. Cover with cloth, expose to starlight on the roof overnight, and reheat in a double boiler the next day for warm consumption (from *Yonglei Fang* citing *Xu Yijian Fang*).
[Formulas for Resolving Phlegm] To treat Phlegm, Fuling Wan (Poria Pill) originally treats arm pain, detailed in *Zhimifang*. It records a case of arm pain with inability to raise the arm, shifting left or right, migrating positions. This is due to latent Phlegm-Fluids stagnating in Zhongvan, causing Spleen Qi to fail to circulate, clashing upward with Qi. The four limbs belong to the Spleen; when Qi stagnates and fails to descend, it attacks the arms upward. The pulse is deep and fine. Later physicians identified this arm pain as a Phlegm pattern (Formula from *Tanxian* section). Repeatedly, patients suffering from Phlegm experienced nightly sensations of being pulled in both arms, trembling and burning hands, unable to lift even a teacup. Treating only with this formula resulted in immediate recovery (from *Shizhai Ba Yi Xuanfang*).
Banxia Tang (Pinellia Decoction) treats shoulder and arm pain.
Banxia (Pinellia Tuber, washed seven times, sliced thinly) (2 liang), Baifuling (White Poria) (2 liang, cut).
Grind into fine powder. Take 2 qian per dose, decoct in 2 cups of water until 0.8 cup remains, add ginger juice equivalent to half a clam shell, decoct until 0.7 cup remains, and take warm after meals (from *Ye Shi*).
There is also Xiaobanxia Tang (Minor Pinellia Decoction) for Phlegm-Fluid dizziness and arm pain; add Gancao, Jupi, and Shengjiang to the base formula and decoct with water.
When Phlegm-Fluids flow into the four limbs causing shoulder/arm soreness and soft numbness, use Daotan Tang (Major Phlegm-Resolving Decoction) added with Muxiang, Pianzi Jianghuang, and ginger-processed Baizhu. Treating this as a Wind pattern would be an error (from *Yitong*).
Kongxian Dan (Phlegm-Fluid Expelling Pellet) added with 1 liang of defatted Mugua Zi and 0.5 liang of Guixin treats arm pain. Take 20 pills per dose, increasing to 50-30 pills (from *Bencao Gangmu*).
Xionghuo Tang (Ligusticum and Notopterygium Decoction) treats Water-Fluid retention pouring into meridians, causing arm pain. This is due to Spleen Earth deficiency and habitual excessive drinking of fluids, failing to transmit and transform.
Chuanxiong, Banxia (washed with hot water), Baifuling, Chuan Duhuo, Chenpi, Zhike (pith removed, fried, 0.5 liang each), Baizhu, Gancao (0.1 liang each).
Grind into powder. Take 3 qian per dose, decoct in 1.5 cups of water with ginger, strain, and take warm shortly after meals (from *Dexiao Fang*).
[Cooling and Heating Formulas] For Heat Patterns, use Fangfeng Tongsheng San (Wind-Protecting Universal Rescue Powder) (from *Dexiao Fang*).