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A man suffered from pain throughout his body, swelling of the buttocks and body, and spasm and tightness of the feet and knees. Li Zhongzi said: This is cold pathogen damaging the Ying Blood (nutritive blood), causing the vessels and sinews to be pulled and tightened, as described in the *Neijing* as Painful Bi Syndrome (痛痹). He used Wuyao Shunqi San (Wuyao Qi-Regulating Powder), and after seven doses, the symptoms decreased. White Atractylodes Rhizome (Baizhu) and Cinnamon Twig (Guizhi) were added, and he recovered after one month.

Feng Chuzhan treated Li Xiangguo (courtesy name) Zhifang, during the rebellion of Geng Jingzhong. Having labored hard in the military campaigns, his left arm was stiff and painful, unable to reach above his head or touch his back. Physicians had given wind-dispelling and collateral-unblocking remedies without effect, and his stool was round like a bullet. Because medical texts state that "stool like sheep dung" indicates an untreatable condition, he was deeply worried. Upon examination, the six pulses were large, slow, and lacking spirit, indicating long-standing deficiency of Middle Qi (Spleen/Stomach Qi), with Ying and Wei (nutritive and defensive) Qi unable to reach the extremities, presenting a picture similar to hemiplegia. As for his stool, it was due to insufficient Middle Qi and decline of Mingmen Fire (Gate of Life fire), leading to poor transportation and transformation, sluggish conduction, and waste material failing to descend smoothly, much like a dung beetle rolling a ball; thus it was round and large, unlike Guan Ge syndrome where dry fluids and narrow intestines cause black, small, sheep-dung-like stools. However, he should take Bawei Wan (Eight-Ingredient Pill) with Achyranthes Root (Niuxi) and Eucommia Bark (Duzhong) on an empty stomach to nourish the root; and Jiajian Guipi Tang (Modified Return to the Spleen Decoction) with Sweet Thin Cinnamon (Tian Bo Gui) after meals to strengthen the branch. When Yuan Yang (Primal Yang) flourishes, transportation becomes robust and bowel movements normalize; when Qi and Blood are充盈 (abundant), joints harmonize and arm stiffness heals spontaneously. Following this method, he recovered, with his spirit doubling.

Lu Buyuan treated Zhang Erru's illness: spinal pain, difficulty rising and bowing, a hunched posture, and severe discomfort. Pulse diagnosis indicated Essence deficiency, requiring a large dose of Guilu Sixian Gao (Turtle-Deer Four Immortals Paste), taken for three months for recovery. He did not believe it. Three years later, he sought treatment again. Lu used one dose of Sixian Gao assisted by Twenty grains of Toubing Dan (Ice-Penetrating Pill), resulting in complete recovery. When asked why, Lu said: This is Wind entering the Marrow after sexual intercourse, with unrefined Bone Qi, causing limited flexion and extension. Toubing Dan dispels Kidney Wind, while Sixian Gao fills the Marrow. With the disease gone and Essence full, the whole body harmonizes. Although he took tonifying Essence-Blood and dispelling Wind medicines during these three years, he did not know that medicines must not be used indiscriminately but must be precise and specific, penetrating the Marrow and bones to expel Wind from the bone, which is the correct method.

Sun Wen yuan treated Commander Cheng, aged 64. Previously, due to childlessness, he had taken too many drugs tonifying the Lower Yuan (Kidney). In winter, standing alone by a stream supervising work, he caught cold, resulting in bone and tendon pain. The Jianjing, Quepen, knees, ankles, and moving joints all became red, swollen, and painful, confining him to bed for three years. Some considered it Deficiency, Cold, Wind, or Dampness; hundred treatments failed. The thigh muscles wasted away completely, only the joint connections remained swollen and painful. Pulse was wiry, choppy, and forceful, indicating Damp-Heat, Phlegm, and Fire stagnated by Cold, obstructing the collaterals. Fortunately, the spirit in the eyes remained, and Stomach Qi was not fully damaged. His urine, upon standing in the vessel, precipitated into sand-like sediment, red and turbid. Large sores appeared below both knees and on the toes, scabs resembling boot nails, caused by previous intake of Spring Formulas. First, clear the stagnation in the collaterals, then strengthen the Spleen and resolve Phlegm, preventing new Phlegm formation, allowing Qi and Blood to grow daily, and finally use tonics to conclude treatment. Take one jin of fresh Clematis Root (Weilingxian), pack it in a new bamboo tube, add two jin of distilled spirits, seal the mouth, scrape off the green skin, boil in water until three incense sticks have burned, take out, dry, and powder. Make pills the size of paulownia seeds using Bamboo Sap paste. Take one qian with wine morning and evening, twice daily. After five days, half a bucket of sticky Phlegm accumulation was passed in stool, and swelling/pain reduced by more than half. Switch to decoction of Ginseng, Dendrobium, Atractylodes, Phellodendron, Coix Seed, Xanthium, Achyranthes, Wu Yao Leaf, Turtle Shell, Safflower, Rhinoceros Horn (substitute available), and Akebia Decoction for twenty doses, plus three days of the previous powder, passing another half bucket of Phlegm. Continue the decoction for half a month, plus three days of powder, reducing abdominal Phlegm. Then use Tiger Bone, Late Silkworm Sand, Atractylodes, Phellodendron, Salvia, Eucommia, Achyranthes Stem/Leaf, Coix Seed, Safflower, Five-finger Tree Bark, Xanthium, and Turtle Shell, made into paulownia-seed-sized pills with wine paste. Take 70-80 pills on an empty stomach, and externally take Danxi Baohe Wan after meals. Fully recovered in half a year.

Sun Zhi'an suffered from Gout. Both hands from Jianyu (below Giant Bone, above Arm Muscle) and Quchi (at elbow bend, above Sanli) to finger tips, and both feet from knees to heels/buttocks, had severe swelling and pain, with heat at the painful sites (Fire flowing and depositing), reduced diet, and confinement to bed for three years. Pulses were wiry, thin, and rapid. Face was blue (Liver color), muscles emaciated (Excess Fire), and calf/thigh muscles wasted (Three Yin deficiency). He said: This stems from weak constitution, excessive internal injury to Yin due to Lower Yuan deficiency. Yan region is cold; now Blood deficiency causes Sinews to lose nourishment, so Ying does not nourish internally, and Qi is bound by Cold, causing ten bones to spasm, so Wei does not protect externally. This is called Zhou Bi (General Bi). Treatment should nourish Blood and relax Sinews, disperse Dampness and moisten Dryness, unblocking collaterals. Once pain stops, immediately use major Yin-Blood tonics to fill the Lower Yuan. First give Tenaceous Bark, Atractylodes, Phellodendron, Xanthium, Angelica, Safflower, Coix Seed, Notopterygium, Saposhnikovia, Gentian, Red Bauhinia Bark for twenty doses. Sinews relaxed, swelling subsided, pain reduced by half. Then use Rehmannia, Turtle Shell, Achyranthes, Atractylodes, Phellodendron, Late Silkworm Sand, Xanthium, Coix Seed, Japanese Privet Vine, Angelica, Gentian for thirty doses, swelling and pain completely reduced. Advised: Yin is hard to fill but easy to damage. Must abstain from alcohol and sex to consolidate the root, so medicine can rely on it. Used Curculigo as Sovereign, Goji Berry, Achyranthes, Deer Glue, Tiger Bone, Ginseng as Ministers, Prepared Rehmannia, Phellodendron, Late Silkworm Sand, Poria, Xanthium as Assistants, Cinnamon Heart, Gentian, Alisma as Envoys. Honey pills, taken for 100 days, leg muscles filled, spirit restored.

Yu Dongfu said: This case discusses treatment and prescription with precision; Ye Tianshi's cases have this as a blueprint.

Xue Lizhai treated a man who first had leg swelling, then pain in all four limbs, wandering and worse at night. Dampness-clearing and toxin-resolving agents failed. Pulse slippery and choppy, indicating Damp-Phlegm and turbid Blood pathology. Used Erchen Tang with Atractylodes, Notopterygium, Peach Kernel, Safflower, Achyranthes, Polygonum, cured. For Damp-Phlegm/Damp-Heat or dead blood depositing in joints, non-pungent-warm agents are needed to open pores, unblock tunnels, move Qi and harmonize Blood to achieve cure.

A man had limb joint swelling and pain, pulse slow and rapid, indicating Damp-Heat syndrome. Used Jingfang Baidu San plus Ephedra; pain halved in two doses. Used Binglang Baidu San; swelling resolved in four doses. Then Siwu Tang with Two Atractolodes, Achyranthes, Quince; cured in several doses.

A woman had leg pain, sometimes wandering, shortness of breath, spontaneous sweating; various drugs failed. Pulse chi wiry and slow, indicating Cold-Damp flowing into Kidney Meridian. Used Fuzi Liuwu Tang; cured. People say Fuzi is toxic and refuse it. If processed with Child's Urine, what toxicity remains? Besides, infrequent use poses no worry. Xue Lizhai had Middle Qi deficiency, took Buzhong Yiqi Tang plus Fuzi for three years; where was the toxicity seen? Classic says: Have the disease, use the drug.

Feng Chuzhan treated Tang Mou, suffering bone/joint pain in left foot/hand, knife-like, crying day and night, spreading to right hand/foot. Wind-dispelling agents failed. Dry mouth/throat misdiagnosed as Flowing Fire, cooled with cold meds, vomited. Spirit exhausted, pulses洪 wiry, indicating long Qi/Blood deficiency, malnourished sinews/bones, impending paralysis. Use large amounts of Prepared Rehmannia, Angelica, White Peony to nourish Blood as Sovereign; Honeysuckle, Gentian to borrow Wind momentum to deliver drug power to sinews/bones as Minister; Achyranthes, Teasel Root, Eucommia to regulate sinews/bones as Assistant; Cinnamon Twig, Pine Joint to stimulate drug nature, traveling horizontally in arms as Guide; Ginseng, Atractylodes to secure Middle and nourish Origin. Regulated for half a month, gradually improved. Later, Shengmai Yin delivered with Bawei Wan plus Niuxi, Duzhong, Deer Antler, Schisandra (4-5 qian each), still taking previous formula at noon, could walk. Then major Qi/Blood tonics, strong sinews/bones to finish. Soon, his wife, worried day/night, got same disease, pulses deep minute, right hand/foot pain, then attacking interior, chest/epigastrium stuffy, nausea, extreme pain. Internal injury long-standing, Cold not exteriorly expelled, directly striking Yin division, urgent warming needed. Ginseng, Atractylodes 5 qian each, Cinnamon, Aconite 2 qian each, strong decoction, warm sip. Next day pulse rose slightly, chest pain/stuffiness greatly reduced, slight fever, left slightly painful, Yang returning to surface, Cold dispersing outward. Repeat formula, internal symptoms calmed. Hand/foot pain remained but mild. Ginseng/Atractylodes secure Middle as Sovereign, Angelica/Peony nourish Blood as Minister, Eucommia, Teasel, Achyranthes, Gentian, Cinnamon relax sinews/unblock collaterals as Assistant, fully cured. Gout only has Five Bi: Skin, Vessel, Muscle, Bone, Sinew Bi; no Zang-Fu Bi heard of. But Classic says: Cold dominance is Painful Bi. Also: Lingering in sinews/bones causes long pain; skin resolves easily; entering Zang is fatal. Be careful!

Xue Lizhai treated a woman, limb joint pain, inability to turn, aversion to wind/cold, spontaneous/drenching night sweats, short urination, refusing clothes even in summer, pulse floating tight. Wind-Cold invading Taiyang Meridian. Used Gancao Fuzi Tang; cured in one dose.

A woman with irregular menstruation and chronic gout, triggered by labor, relieved by heavy pressure. Qi/Blood deficiency. Used Shiquan Dabu Plus Du Huo for pain; Liuwei Wan, Xiaoyao San for menstruation.

A woman with limb pain, sallow complexion, alternating red/white, fever/aversion to cold, vomiting/diarrhea/poor appetite, abdominal/flank distension, irregular menses (flooding/spotting), profuse phlegm/wheezing, dizziness/headache, five-palm heat, thirst for hot drinks, forgetfulness/startle, night sweats/insomnia, bedridden for a year. All due to Liver/Spleen damage, Qi/Blood insufficiency. Used Shiquan Dabu + Jiawei Guipi Tang for over a month; all symptoms cured.

Zhang Zhongjing treated women with sixty-two types of Wind and stabbing abdominal blood/Qi pain, using Honglanhua Jiu (Red Blue Flower Wine). One ingredient, Safflower, boiled in one bowl of wine to half, drink half at once, then the rest shortly after.

Yu Jiayan treated Zhanglingshi's brother with damaged Shaoyang/Shao Yin from Cold Damage, lumbar flexion disability, screaming all night, hundred treatments failed. Pulse smooth/safe, pain greatly reduced. Disease not fatal, but fear of becoming disabled. Transferability lies in knife-like stabbing pain, showing Evil/Righteous struggle. No pain means Evil/Righteous merged. Great reduction in pain is worrying. Patient: Body disabled, how live? Better die fast. Want to save, no method. Thought long: Heat Evil entered lumbar, blood vessels closed long, cannot exit, only attack/scatter method. Long-standing Evil, Righteous totally deficient, attacking won't work. Used Taoren Chengqi Tang, adding large amounts of Cinnamon, Aconite, two large doses. Could rise strongly after. Made pills following previous intent, taken over ten days, fully safe. Not just past trial, nor temporary expedient, but has origin. Zhongjing for Jie Xiong (Chest Binding) has Fuzi Xiexin Tang, Aconite + Rhubarb together. Upper diseases mostly Qi, so use to drain Heart. Lower diseases mostly Blood, why not imitate intent, combine Taoren, Cinnamon to scatter waist blood knot? Later Jiang Gusheng's brother Cold Damage, lumbar flexion disability/pain, no thought, directly used this method, two doses cured.

Chen Hongzhang treated Shen Wotian, 70+, left arm/fingers spasmodic unable to extend, reduced food/exhausted spirit. Some said old age weakness, tonics worsened it. Chen diagnosed: Wind-Damp evil stagnant in Chest/Spleen, affecting four limbs. Used Erchen Tang + Mirabilite, Amomum, decocted with 3 liang Coix Seed juice, four doses, illness largely gone. Remove Mirabilite, continue Erchen, six doses, fully cured. (Wotian's handwritten notes.)

Xue Lizhai treated a woman, limb joint swelling/pain, shins/feet especially, spontaneous sweating/headache. Taiyang Meridian Damp-Heat. Used Mahuang Zuojin Tang, two doses cured.

Once someone with foot Bi took a boat, saw a bag, leaned foot on it. On shore, foot walked well. Asked contents, it was Quince. (*Bencao Bei Yao*).

Wang Zhizhong said: Noble person's middle finger spasmed, then ring finger. Physician moxed Jianliao, Quchi, Zhigou; cured. Zhigou is 3 cun behind wrist. Or mox Fengchi, often not Zhigou, or Hegu.

Li Jingzhong transmitted bone/tendon pain like clamped board, unbearable. Roasted donkey hoof claws to ash, powdered, taken with wine or water, instantly cured. (*Guang Biji*).

Xiong Note: This formula very effective for stubborn ulcers. Dry ones mixed with sesame oil applied; wet ones dusted.

Ma Yuanyi treated Mrs. Chen, Painful Bi, limb convulsions, whole body pain, unable to turn, dry mouth/restless. Pulse wiry/rapid/choppy, Yangming fluid deficiency generates Heat, extreme Heat generates Wind. Limb convulsions are Wind attacking extremities; dry mouth/restlessness is Fire Evil blazing internally. Only specifically nourish Yangming, do not treat Wind but Wind self-extinguishes, do not treat pain but pain self-removes. Use Raw Fleeceflower Root 1 liang, Raw Rehmannia 5 qian, Coptis, Scutellaria, Gentian, Fermented Pinellia, Aurantium, Platycodon 1 qian each. Four doses, symptoms reduced 60-70%, several more doses cured.

Zhang's son whole body pulling pain, head cannot turn, hand cannot grasp, foot cannot move, half a month. Pulse floating/deficient. Floating is Wind image, but internal pain also floating/weak. Pulse matches symptom: Labor/Fatigue injuring Middle, Yangming failure. Yangming is Sea of Five Zang/Six Fu, binds sinews/bones, benefits joints. Failure means Qi/Blood not nourishing, twelve meridians lack source/use. Wei empty, Ying flow unfavorable, fighting causing pain. Method: Major tonify Yangming Qi/Blood, different from Wind/Cold/Damp Bi. Ginseng 2 qian, Astragalus, Angelica 3 qian each, Roasted Licorice, Cinnamon Twig, Safflower 0.5 qian each, Gentian 1 qian. Two doses pulse harmonious, can turn. Remove Cinnamon, add Atractylodes, Cinnamon Bark, Goji, Prepared Rehmannia, regulate half month, safe. Diseases differ in deficiency/excess, methods vary. Wind/Cold/Damp: Qi stagnation internal = Bi, Evil occupying exterior = Pain, Excess type. Yangming Middle deficiency: Blood not nourishing sinews = Pain, Qi deficiency internal = non-movement, Deficiency type. Excess: Urgent to remove Evil, slow removal leads to change. Deficiency: Urgent to tonify Righteous, late tonification worsens over time. All diseases like this, not just this. Written as warning for treating disease by disease.

Yuan Mou Painful Bi, body/limbs pulling pain, sleepless all night, fever/dry mouth, chest full/middle pain, pulses wiry, right Guan particularly large, Stomach Heat blocking, Yangming Interior Excess. Yangming Qi cannot irrigate body, twelve meridians not smooth, limbs immobile. (Note: Contrasts with above, one deficiency one excess. Observing such cases inspires mind/knowledge.) Use Tiaowei Chengqi + Coptis, Gentian. One dose stool passes, two doses symptoms reduce 60-70%. Switch to Clear Stomach/Harmonize Middle agent, regulate, cured.

Wu Hanshang Gout fever, confusion/hallucinations, limb convulsions, constipation. Stomach fluid injured, Liver Wood generates Fire, internal blazing causes constipation/confusion, external attacking causes fever/body pain. Method: Nourish inside, Fire self-extinguishes, Wind self-removes, pain self-stops. Raw Fleeceflower, Trichosanthes Seed, Coptis, Anemarrhena, Aurantium, Platycodon, Cinnamon Twig, Gentian. One dose gradually reduces. But heart spirit uneasy, like in boat/clouds, uncontrollable. Switch Ginseng, Roasted Licorice, Raw Rehmannia, Ophiopogon, Polygala, Ziziphus Seed, Poria, Fritillaria, Tangerina Peel, Antelope Horn. Three doses, then Guipi Tang, regulate few days, safe.

Du Hanfei Whole body wandering swelling, hand cannot grasp, foot cannot step, three months. Pulse floating/large/rapid, fever/dry mouth. Yin deficiency generates internal Heat, Heat dominance generates Wind, Wind moves well, injures sinews/collaterals, flaccid/uncontrolled, reverses into flesh, attacks swelling/pain. Raw Rehmannia 5 qian, Wine-fried Scutellaria/Coptis 1 qian each, Safflower 0.5 fen. Bitter wins Heat, Pungent scatters Wind. Two doses sound sleep, several doses suffer lost.

Treatment for sudden sharp bone-deep pain in arm/leg. Genkwa Root, fine powder, rice vinegar mix, apply size appropriate, instant effect. Doctor says: Tao Chengyi's formula, treated postpartum woman effectively. But plaster doesn't stick, cover with paper flower, tie with white silk. (*Bai Bai Fang*).

Xue Lizhai treated Ministry Official Xu's wife, knee pain first, then whole body joint pain, pulse slow/slow, Qianghuo Shengshi Tang + Jingfang Baidu San + Damp-draining ineffective. Then Fuzi Bawu Tang, one dose pain retreated, two doses cured. If pulse large/rapid/pain, Renshen Baidu San suitable.

Zhang Zihe treated Tax Official, Wind/Cold/Damp Bi, heavy/swollen waist/legs, night pain severe, feet afraid of cold, five-six months, wrapped legs in boots. Waist/knee skin exposed to cold wind, flows into collaterals, pain worsens, wanders up/down,不定, extreme pain swells quickly, skin color unchanged, pores feel like insects walking. Every Wind/Cold, illness increases, diet decreases, limbs thin/weak, needs support, can walk/stand. Took Aconite, Ginger, Cinnamon, various hot/dry, burning needles, moxa, countless, three years uncured. One day Zhang pulsed, both hands deep/slipping/forceful. First Daoshui Wan, Tongjing San each one dose, that night diarrhea 20+ times, pain reduced half. Gradually Chi Fuling Tang, Chuanxiong Tang, Fangfeng Tang. These three in *Xuanming Lun*, Bi formulas. Three times daily, decoct 7-8 qian, profuse sweating, also Linglong Zao fumigation. If heat illness worsens, many ancient sweat methods exist, but vomiting inducing sweat rarely known. So said: Vomiting combined with sweating, good because of this.