源候总说 凡人百骸四体，肌肉皮肤，关节脉络，总而谓之身。风淫湿滞，血刺痰攻，皆能作痛。至
于骨之酸疼，或寒或热，入里彻骨，则倍蓰千万，大不侔焉。盖骨为髓之藏，髓者饮食五味之实秀也，髓虚
则骨虚，势所必至矣。痛在于身，风之证以走注知之，湿之证以重着验之，血有筋脉钻刺之证，痰有眩晕咳
唾之证。驱风除湿，行血豁痰，对证一投，犹冀可以旦暮起。病入于肾，此劳极损伤之不可救药者也，其
能生乎。然则身痛之与骨痛，毫厘千里之差，于此不可以无辨。虽然，酒家之癖，多为项肿臂痛。盖热在上焦，
不能清利，故酝酿日久，生痰涎，聚饮气，流入于项臂之间，不肿则痛耳。然而曰痰，曰涎，曰饮，又有理一分
殊之别。伏于包络，随气上浮，客肺壅嗽而发动者，痰也。聚于脾元，随气上溢，口角流出而不禁者，涎也。
惟饮主于胃府，为呕为吐，此则胃家之病，学人不可不知。（《直指》）（按∶《医说》引《医余》曰∶通真
子云∶筋紧而骨束，是以骨痛。师曰∶水不胜火，煎熬得骨痛。宜考。）
身体痛者，种种不同，风寒湿痰者多。风寒痛，明知得于寒邪，而脉浮紧。湿痰留滞关节，一身尽痛。有
风湿相搏，肢体重痛。有阴毒伤寒，身如被杖之痛者。有湿郁而周身作痛，有伤食滞而身作痛，痰滞经络而
作块痛，致于骨节酸疼，或寒或热，皆宜随证审其病机，素昔所感寒热虚实而施治之，无不中也。（《医统》）
凡身痛之甚者，亦当察其表里，以分寒热。其若感寒作痛者，或上或下，原无定所，随散而愈，此表
邪也。若有定处，而别无表证，乃痛痹之属，邪气虽亦在经，此当以里证
视之，但有寒热之异耳。若因火盛者，或肌肤灼热，或红肿不
消，或内生烦渴，必有热证相应，治宜以清以寒。若并无热候，而疼痛不止，多属阴寒，以致血气凝滞而然。
经曰∶痛者寒气多也，有寒故痛也。必温其经，使血气流通，其邪自去矣。凡劳损病剧，而忽加身痛之甚者，
此阴虚之极，不能滋养筋骨而然，营气惫矣，无能为也。（《景岳》）
风湿贼风（附骨疽之别） 风身体疼痛者，风湿搏于阳气故也。阳气虚者，腠理易开，而为风湿所折，
使阳气不得发泄，而与风湿相搏于分肉之间，相击故疼痛也。诊其脉浮而紧者，则身体疼痛。（《病源论》）
凡贼风，其人体卒无热，中暴风冷，即骨解深痛，不废转动，按之应骨痛也，久即结痛，或结瘰 ，其
附骨疽，久即肿而结脓，以此为异耳。若治附骨作贼风，则增益，病深脓多，若治贼风作附骨，即加风冷，
遂成瘰 偏枯挛曲之疾也。疗之为效，都在其始耳，此非天下至精，其孰能与于此。若候附骨与贼风为异者，
附骨之始未肿，但痛而已。其贼风但痛不热。附骨则其上壮热，四体乍寒乍热，小便赤，大便涩，而无汗。若
得下却热，并开发腠理，便得消也。纵不消尽，亦得浮浅近外。凡贼风但夜痛，骨不可按抑，不得回转，痛
处不壮热，亦不乍寒乍热，多觉身体索索然冷，欲得热熨，痛处即小宽，时复有汗出，此为贼风证也，
宜针灸熨爆，诸服治风药即愈。（《千金》）
气痛 或身中忽有痛处，如似打扑之状，名曰气痛。痛不可忍，游走不住，发作有时，痛则小热，痛
定则寒。此皆由冬时受温气，至春暴寒，风来折之，不成温病，乃作气痛。宜先服五香连翘汤，摩丹参膏，
又以白酒煎杨柳皮，及暖熨之。有赤气点点者，即刺出血也。（《千金》）（按∶此说本
出《肘后》。五香连翘汤、丹参膏并出《千金·痈疽》中，宜
参。）
血滞作痛（久痛入络） 身体疼痛，非湿则痰，固也。人有挟刀锯之惊，而又馁在其中，为风寒水湿
所伤，致使心窍凝滞。于是经络壅闭，血不流行，肌肉骨节为之刺痛。治法，当归、川芎、芍药、、白芷、灵
脂、大黄、甘草利之，黑物小片而下，其痛有瘳。（《直指》）
身体胸腹，隐热隐疼，拘急足冷，此血之为病也。以其饮酒嗜欲，伏热受暑得之。淮热毒、暑毒、酒毒
为能伤血，瘀血未去，新血不荣身体，所以隐痛拘急。其里热足冷者，血之证也。用柴胡、黄芩、青皮、枳
壳、灵脂、桃仁、木通、甘草作剂，多入大黄以利之。俟其流利已尽，小腹略无结急，即以当归、川芎一倍，
橘皮、半夏、枳壳、北梗、木通、甘草半之，调其气血，于是有瘳。血属于心，木通以通其心窍，
心窍既通，经络之流行可知矣。（同上）
久痛必入络，气血不行，发黄非疸也。痛而重按少缓，是为络虚。（《临证指南》）（按∶又华玉堂曰∶
络中气血，虚实寒热，稍有留邪，皆能致痛。此乃古人所未及详言，而先生独能剖析明辨者。）
治例 湿热相搏，肩背沉重，疼痛上热，胸膈不利，遍身上下沉重疼痛，当归拈痛汤。身体拘急，
皆属虚寒与寒湿、风湿，小续命汤随证加减。（《医通》）
在气分者，但行其气，不必病轻药重，攻动其血。在血分者，则必兼乎气治，所谓气行则血随之是也。
若症之实者，气滞血凝，通其气而散其血则愈。症之虚者，气馁不能充运，
血衰不能滋荣，治当养气补血，而兼寓通于补。（《临证指南》）
补气利害 或问∶先哲谓诸痛为实，诸痒为虚。丹溪亦
曰∶诸痛不可用参、 ，盖补其气旺不通而痛愈甚。然则凡病痛者，例不可用参、 等药乎？曰∶以上所论诸
痛，特指其气实者为言耳。如暴伤风寒，在表作痛，或因七情九气怫郁，不得宣通而作痛者，固不可用补气药
也。若夫劳役伤形，致身体解 而作痛者，或大便后及大泻痢后，气血虚弱，身体疼痛，及四肢麻痹而痛；
或妇人产后气血俱虚，致身体百节疼痛等病，其可不用参、 等补气药乎，学人毋执一也。（《正传》）
除湿驱风诸方 生附除湿汤、五苓散，并主伤湿身痛。（《直指》）
身疼风证，乌药顺气散，又名通气驱风汤，加川芎。（《得效》）
和血诸方 若关节疼痛，蒲黄八两，附子一两炮，合末之，服一钱匕，日三，稍增至方寸匕。（《肘后》）
黄 建中汤，加川芎、当归，治血刺身痛。（《直指》）
麒麟竭散，治寒湿搏于经络，疼痛不可忍。
血竭 南乳香 没药 水蛭（杆碎炒令烟尽） 麝香 白芍药 当归（各秤一分） 虎胫骨（
涂酥炙黄一□六分)
上件药八味，每味各为细末，各抄一钱和匀，每眼三钱，温酒调下，食前服之，痛立止，痛甚者不过
二服。（《御药》）（又有虎骨丸，见《历节》，宜参。）
逐涎诸方 治风毒留客日深，气虚邪实，攻击不定，走注疼痛，趁痛丸方。
大戟（刮去皮） 甘遂 白芥子（各一两）
上三味捣罗为末，用大麦面一两和匀，醋调作膏子，慢火炙黄熟，再捣罗，用薄面糊为丸，如梧桐子大，
每服十丸，渐加至十五丸，空心用冷酒下，病甚不入大麦面亦得。（《圣
济》）（即控涎丹，见《痰涎》。）
滚痰丸，一切遍身，无故游走疼痛，或肿或挛，或如常，痛无定所，或俗名寒湿，不肿在一处，
酸软沉滞者，消息服之。（《养生主论》）
熏法 若身中有掣痛不仁不随处者，取干艾叶一纠许丸之，内瓦甑下，塞余孔，唯留一目，
以痛处着甑目，下烧艾以熏之，一时间愈矣。（《肘后》）
调摄法 痛家不可食浓味与肉，大能助火。若食肉味痛愈盛者，并鱼腥面酱酒醋皆断去之。（《医通》）
General Discussion from *Zhuzhu Bingyuan Houlun*: The entire body, including bones, limbs, muscles, skin, joints, and collaterals of a person, is collectively referred to as the "body" (Shen). Invasion by wind pathogen, stagnation of dampness, stabbing pain due to blood stasis, and attack by phlegm turbidity can all cause pain. As for the soreness and pain of bones, whether caused by cold or heat, penetrating deep into the interior reaching the bone marrow, the suffering is tens of millions of times greater than ordinary body pain, completely incomparable. This is because bones are the storage of marrow, and marrow is the essence derived from the five flavors of food and drink; when marrow is deficient, bones become deficient, which is an inevitable trend. When pain occurs in the body, wind-induced patterns are identified by wandering pain, while damp-induced patterns are verified by heavy and fixed sensations. Blood stasis presents with drilling and stabbing pain in tendons and vessels, while phlegm-fluid retention presents with dizziness, coughing, and expectoration. If one can dispel wind, remove dampness, promote blood circulation, resolve phlegm, and administer medication according to the syndrome, there is hope for recovery within a short time. However, if the pathogen enters the Kidney, this is an incurable condition caused by extreme exhaustion and damage; how can life be sustained? Thus, there is a difference of miles between body pain and bone pain, which must be distinguished carefully.
Nevertheless, habitual drinkers often suffer from swelling of the neck and pain in the arms. This is because heat pathogen remains in the Upper Jiao and cannot be cleared and drained; after long-term fermentation, it generates phlegm-saliva and accumulates fluid-qi, flowing into the neck and arm regions, causing pain if not swollen. However, there are distinctions among phlegm (Tan), saliva (Xian), and fluid (Yin) based on the principle of "one origin but diverse manifestations." Phlegm lurks in the Pericardium, floats upward with Qi, lodges in the Lung causing cough and attacks. Saliva gathers in the Spleen-Stomach Yuan Qi, overflows upward with Qi, and flows uncontrollably from the corners of the mouth. Fluid primarily resides in the Stomach Fu organ, manifesting as vomiting; this is a disease of the Stomach, which students of medicine must know. (From *Zhizhi Fang*) [Note: *Yi Shuo* quotes *Yi Yu*: Tong Zhenzi said, tight tendons and bound bones cause bone pain. The Master said, water failing to control fire, boiling and scorching, causes bone pain. This should be investigated.]
Body pain varies greatly, mostly caused by wind-cold-dampness and phlegm. Wind-cold pain, clearly caused by cold pathogen, presents with a floating and tight pulse. Damp-phlegm stagnating in joints causes whole-body pain. Some cases involve wind-dampness clashing, causing heavy limb pain. Yin-toxin Shanghan causes pain like being beaten with a staff. Dampness郁结 causes generalized pain; food stagnation causes body pain; phlegm-stagnation in collaterals causes lump-like pain leading to joint soreness, either cold or hot. One must examine the pathogenesis according to symptoms and treat based on prior exposure to cold, heat, deficiency, or excess, ensuring accuracy. (From *Yi Tong*)
For severe body pain, one must inspect the exterior and interior to distinguish cold and heat. If pain is caused by cold invasion, moving up or down without fixed location, resolving as the pathogen disperses, it is an exterior pathogen. If there is a fixed location without other exterior signs, it belongs to Painful Obstruction (Tong Bi); although the pathogen is in the meridians, it should be viewed as an interior pattern, differing only in cold or heat. If caused by excessive fire, presenting with burning skin, persistent redness/swelling, or internal thirst, corresponding heat signs exist, requiring clearing and cooling treatment. If no heat signs exist but pain persists, it likely belongs to Yin-Cold, causing Qi and blood stagnation. The Classics state: "Pain is due to much cold; because there is cold, there is pain." One must warm the meridians to circulate Qi and blood, allowing the pathogen to depart. In severe consumptive diseases, sudden severe body pain indicates extreme Yin deficiency failing to nourish sinews and bones, with exhausted Ying-Qi, rendering it hopeless. (From Zhang Jingyue's *Jingyue Quanshu*)
Wind-Dampness and Thief-Wind (Differentiation from Osteomyelitis/Deep Bone Abscess): Wind causing body pain results from wind-dampness clashing with Yang Qi. Those with deficient Yang Qi have easily open pores, allowing wind-dampness to strike, preventing Yang Qi from venting, leading to clashes between wind-dampness and flesh spaces, causing pain. A floating and tight pulse indicates body pain. (From *Bingyuan Lun*)
Thief-Wind typically presents with sudden onset without fever; upon contracting stormy cold, deep bone pain occurs immediately, though movement is not impaired, and pressure elicits bone pain. Over time, it may form painful nodules or scrofula. Deep Bone Abscess (Fu Gu Ju) differs by eventually swelling and forming pus. Treating Deep Bone Abscess as Thief-Wind worsens the condition, deepening the pathology and increasing pus. Treating Thief-Wind as Deep Bone Abscess adds wind-cold, potentially leading to scrofula, hemiplegia, contractures, and deformities. Treatment efficacy depends on early accurate diagnosis, achievable only by highly skilled physicians. Differentiation: Deep Bone Abscess starts with pain before swelling. Thief-Wind involves pain without heat. Deep Bone Abscess features high fever, alternating chills and fever in limbs, dark urine, constipation, and anhidrosis. Reducing heat and opening pores leads to resolution. Even if not fully resolved, it becomes superficial. Thief-Wind features night pain, unpressable bones, immobility, no local heat, no alternating chills/fever, feeling of cold shivering, desire for warmth, slight relief with heat, occasional sweating. This is Thief-Wind, treated with acupuncture, moxibustion, hot compresses, and wind-dispelling herbs. (From *Qianjin Fang*)
Qi Pain: Sudden localized pain resembling bruising, named Qi Pain. Unbearable, wandering, periodic, slightly hot during pain, cold after cessation. Caused by winter warmth qi, spring cold snap, and wind injury, failing to become Warm Disease but becoming Qi Pain. Treat with Wuxiang Liaoqiao Tang, massage Danshen Gao, decoct willow bark in white wine, and apply heat. Red spots indicate need for pricking to bleed. (From *Qianjin Fang*) [Note: Originates from *Zhouhou Beiji Fang*. Wuxiang Liaoqiao Tang and Danshen Gao are in *Qianjin Fang: Yongju*, consult there.]
Blood Stagnation Pain (Long-standing pain entering collaterals): Body pain is usually damp or phlegm. Trauma/fear combined with starvation and wind-cold-dampness injury causes Heart orifice stagnation. Meridian blockage prevents blood flow, causing stabbing pain in muscles and joints. Treatment: Dang Gui, Chuan Xiong, Shao Yao, Bai Zhi, Ling Zhi, Da Huang, Gan Cao to promote drainage. Passage of black fragments alleviates pain. (From *Zhizhi Fang*)
Hidden heat and pain in chest/abdomen, stiffness, cold feet indicate blood pathology. Caused by alcohol indulgence, latent heat, summerheat. Damp-heat/toxin, summerheat toxin, alcohol toxin injure blood; unresolved blood stasis prevents new blood from nourishing the body, causing hidden pain and stiffness. Internal heat with cold feet is a blood sign. Formula: Chai Hu, Huang Qin, Qing Pi, Zhi Ke, Ling Zhi, Tao Ren, Mu Tong, Gan Cao, plus extra Da Huang for drainage. Once smooth and abdominal tension eases, use doubled Dang Gui and Chuan Xiong, halved Ju Pi, Ban Xia, Zhi Ke, Jie Geng, Mu Tong, Gan Cao to harmonize Qi and blood. Blood relates to the Heart; Mu Tong opens Heart orifices, facilitating meridian flow. (Same source)
Long-standing pain enters collaterals; stagnant Qi/blood causes yellowing (not Jaundice). Pain relieved by deep pressure indicates Collateral Deficiency. (From *Lin Zheng Zhi Nan*) [Note: Hua Yutang added: Any residual pathogen in collateral Qi/blood, regardless of deficiency/excess/cold/heat, causes pain. This was not detailed by ancients but clarified by Mr. Ye.]
Treatment Principles: Damp-heat clashing causing heavy shoulders/back, upper body heat, chest oppression, generalized heaviness/pain: Dang Gui Nian Tong Tang. Stiffness/body pain due to deficiency-cold, cold-damp, or wind-damp: Xiao Xuming Tang adjusted per syndrome. (From *Yi Tong*)
Patterns in Qi level: Move Qi only, avoid heavy drugs attacking Blood. Patterns in Blood level: Must treat Qi simultaneously, as "when Qi moves, Blood follows." Excess patterns (Qi stagnation/Blood concretion): Unblock Qi, disperse Blood. Deficiency patterns (Qi failure to move, Blood failure to nourish): Tonify Qi and Blood, incorporating unblocking within tonification. (From *Lin Zheng Zhi Nan*)
Pros and Cons of Tonifying Qi: Question: Ancients say "All pain is Excess, all itching is Deficiency." Danxi said "Pain should not use Ren Shen, Huang Qi," fearing that boosting Qi without resolving stagnation worsens pain. Should all pain patients avoid these? Answer: Previous discussions referred specifically to Qi Excess. Sudden wind-cold exterior pain or emotional Qi depression causing pain should indeed avoid Qi tonics. However, labor-induced physical depletion causing laxity/pain, post-defecation/diarrhea Qi/Blood deficiency causing pain/numbness, or postpartum Qi/Blood deficiency causing joint pain require Ren Shen, Huang Qi etc. Do not be dogmatic. (From *Yi Xue Zheng Zhuan*)
Damp-Removing/Wind-Dispelling Formulas: Sheng Fu Zi Chu Shi Tang, Wu Ling San for dampness-induced body pain. (From *Zhizhi Fang*)
Body pain wind syndrome: Wu Yao Shun Qi San (also called Tong Qi Qu Feng Tang) plus Chuan Xiong. (From *Ji Sheng Fang*)
Blood-Harmonizing Formulas: Joint pain: Pu Huang 8 liang, Pao Fu Zi 1 liang, powder, take 1 qian bi three times daily, increase to 1 fang cun bi. (From *Zhouhou Beiji Fang*)
Huang Qi Jian Zhong Tang plus Chuan Xiong, Dang Gui for blood-stabbing body pain. (From *Zhizhi Fang*)
Qilin Jie San for unbearable pain from cold-damp clashing in collaterals. Ingredients: Xue Jie, Nan Ru Xiang, Mo Yao, Shui Zhi (fried until smoke stops), She Xiang, Bai Shao Yao, Dang Gui (each 1 fen), Hu Jing Gu (sulfured, roasted yellow, 1 □ 6 fen). Powder each separately, mix 1 qian of each, take 3 qian with warm wine before meals. Pain stops immediately; severe cases resolve in two doses. (From *Yu Yao Yuan Fang*) [See Hu Gu Wan in *Li Jie* section.]
Phlegm-Expelling Formulas: For deep-seated wind-toxin, Qi deficiency with pathogen excess, wandering pain: Chen Tong Wan. Da Ji (peeled), Gan Sui, Bai Jie Zi (each 1 liang). Powder, mix with 1 liang barley flour, vinegar paste, slow-fire roast until yellow/hard, pound again, bind with thin flour paste into pill size of paulownia seeds. Take 10 pills, increase to 15, fasting with cold wine. Barley flour optional for severe cases. (From *Sheng Ji Zong Lu*) [This is Kong Xian Dan, see *Tan Xian* section.]
Gun Tan Wan for wandering body pain, swelling, contracture, or normal appearance with undefined pain location, or so-called cold-damp with localized soreness/heaviness. Use with discretion. (From *Yang Sheng Zhu Lun*)
Moxibustion Method: For pulling pain, numbness, non-fixed pain: Take dry mugwort, roll into ball, place under clay steamer, seal holes leaving one opening. Apply painful area to opening, burn mugwort below to fumigate. Cured in one interval. (From *Zhouhou Beiji Fang*)
Dietary Regulation: Pain patients should avoid rich flavors and meat, which generate fire. If meat worsens pain, also avoid fishy odors, noodles, soy sauce, wine, and vinegar. (From *Yi Tong*)