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According to the *Gui Yi Chao*: When the arm hangs down, lesions may occur in two locations: below the radial styloid process (Jiegu) and above the bulge of the forearm muscles (E). The swelling resembles the size of a chicken or duck egg. This is caused by the disharmony of Ying (Nutritive Qi) and Wei (Defensive Qi). Such conditions tend to manifest as solid masses without penetrating inward. They should be resolved quickly or treated with early incision and drainage. If lesions arise at both elbows, extending from below the radial styloid process to the hand, occurring above the small bones, although presenting as excess patterns, they involve the large and small sinews and bones, leading to limited mobility. Hanging the arm causes a dragging pain. If the pus is deep and reaches the bone, it damages the sinews and vessels, resulting in clenched fists, inability to extend, spasms, and contractions. In such cases, one should urgently administer medications that relax the sinews and vessels.

According to the *Xuan Ji Jing*: Lesions on the lateral aspect of the arm are termed "Yong" (Carbuncle); those on the medial aspect are called "Yudu Fa" (Fish Belly Eruption); swelling in the upper segment of the arm extending to the Jianliao acupoint is called "Bi Feng Du" (Arm Wind-Toxin). The appropriate treatment is Huoming Yin (Life-Saving Decoction) augmented with Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Guizhi (Cinnamomi Ramulus), and Jiegeng (Platycodonis Radix), decocted with equal parts water and wine. Additionally, Dueming Dan (Life-Extending Pill), Zijin Dan (Purple Gold Pill), and Shengjin Dan (Gold-Winning Pill) may be selected based on the condition. For robust patients with interior excess syndromes, Yili Jin Dan (One-Pill Golden Pill) or Bazhen San (Eight-Array Powder) should be used to purge the interior. If there is diffuse swelling without a head, and detoxifying herbs fail to resolve it, Shiquan Dabu Tang (Decoction for Complete Great Tonification) augmented with Guizhi (Cinnamomi Ramulus) and Jiegeng (Platycodonis Radix) should be used to support the expulsion of toxins. If vomiting occurs and the patient has not eaten for several days, healing will follow once the abscess ruptures and pus drains.

[Case Record]
A man nearing sixty years of age suffered from severe swelling of the right arm in May, extending from the shoulder to the fingers. The skin color changed and became cold. The six pulses were deep, fine, and faint. This indicates that both the pulse and symptoms reflect Cold; this is Fugu Yong (Bone-Adhering Carbuncle). Treatment was delayed. A burning needle (Fanzhen) was used to open the abscess, yielding thin, clear pus. The following afternoon, it was opened again. Subsequently, persistent hiccups (Inversion of Stomach Qi) developed. Dingxiang Shidi San (Tianfei and Clove Powder) was administered; after two doses, symptoms slightly alleviated. However, the next day, hiccups worsened, accompanied by spontaneous diarrhea, cold pain in the umbilical and abdominal region, abdominal distension, reduced appetite, and episodes of dizziness and confusion. Moxibustion was applied to fourteen moxa cones at the point where blackness ends below the left nipple. Then, Tuoli Wenzhong Tang (Support Interior and Warm Middle Decoction) was prescribed at a dosage of 1.5 liang. Someone argued, "All painful sores and ulcers belong to Heart Fire." Furthermore, since it was midsummer, was it appropriate to use ginger and aconite? I replied, "The Classics state: fine pulse, cold skin, diarrhea of both bowels, and inability to eat constitute the 'Five Deficiencies' syndrome. Moreover, hiccups indicate deficiency-cold in the Stomach. This case presents contradictory internal and external signs; one must disregard the season and treat according to the syndrome." Consequently, the prescription was administered. All symptoms disappeared, appetite doubled, the sore became warm, and the pus turned normal. After several doses of Wuxiang Tang (Five-Aromatic Decoction), he recovered after more than a month. (Wang Ji's Note: This syndrome mostly belongs to Deficiency-Cold. This formula specifically uses pungent-hot herbs to treat the cold, avoiding Ginseng and Atractylodes to tonify deficiency. This is likely because the hiccups and abdominal fullness are due to Qi stagnation. Presumably, although old, his pulse and symptoms showed deficiency but his physique was substantial, differing from hiccups caused by Yin deficiency.)

Another patient had a single swollen area on the arm, non-painful and non-red, with a weak pulse, reluctance to eat, and occasional vomiting. Liujunzi Tang (Six-Gentlemen Decoction) augmented with Huoxiang (Pogostemonis Herba) and Shaoyao (Paeoniae Radix) stir-fried with wine stopped the vomiting and improved appetite. Subsequently, twenty-plus doses of Bazhen Tang (Eight-Treasure Decoction) were given. Once pus formed, it was lanced, and the patient recovered after taking Shiquan Dabu Tang (Decoction for Complete Great Tonification). The following year, after contracting Shanghan (Cold Damage), the arm swelled slightly and hurt, indicating residual toxin from the Cold Damage, though without exterior symptoms, only weakness remained. Tenxuan San (Ten-Auspicious Powder) was first given for four doses, using Renshen (Ginseng Radix et Rhizoma), [missing character], Chuanxiong (Ligustici Chuanxiong Rhizoma), and Danggui (Angelicae Sinensis Radix) to support Yuan Qi (Original Qi); Fangfeng (Saposhnikoviae Radix), Jiegeng (Platycodonis Radix), Baizhi (Angelicae Dahuricae Radix), and Houpo (Magnoliae Officinalis Cortex) to disperse swelling and knots; Rougui (Cinnamomi Cortex) to guide the medicine and break blood stasis. Swelling subsided by three or four tenths. Then, Bazhen Tang (Eight-Treasure Decoction) was used until the abscess ruptured and healed. In winter, the arm hurt again. Due to taking wind-dispelling herbs, tendon cramping and severe pain ensued. This was Blood deficiency failing to nourish the sinews, and Sinew deficiency failing to bind the bones. Jiawei Shiquan Dabu Tang (Modified Decoction for Complete Great Tonification) was taken for one hundred doses, leading to recovery.

A female patient had arm swelling that ulcerated but failed to heal for a long time, with alternating chills and fever, five-palm heat, poor appetite, and amenorrhea. Xiaoyao San (Free and Easy Wanderer Powder) was taken for over a month, bringing slight relief. Then, Bazhen Tang (Eight-Treasure Decoction) augmented with Mudanpi (Moutan Cortex) and Xiangfu (Cyperus Rhizoma) was taken for another month, restoring menstruation. Huangqi (Astragali Radix) and Bailian (Houttuyniae Rhizoma) were added, and she recovered after two months.

A male patient had arm swelling and toxic pain. After taking cold-natured herbs, he had poor appetite and loose stools. I used Lizhong Wan (Regulate the Middle Pill) for two doses, then Liujunzi Tang (Six-Gentlemen Decoction) augmented with Sharen (Amomi Fructus) and Huoxiang (Pogostemonis Herba), followed by interior-supporting herbs. He recovered after the abscess ruptured. Generally, for severe sore pain, if the constitution is thick with Fire, bitter-cold herbs are suitable. If the constitution is thin, Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) augmented with Huangqin (Scutellariae Radix) and Lianzi (Nelumbinis Semen) is appropriate. For lower body lesions, add Huangbai (Phellodendri Cortex); for obese patients, add Jingjie (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Duhuo (Angelicae Pubescentis Radix), and Qianghuo (Notopterygii Rhizoma et Radix), utilizing the principle that Wind can overcome Dampness.

A female patient had a lump on the left arm in the Gallbladder meridian region, which did not ulcerate for about a year. It was hard, painless, with unchanged skin color, weak pulse, poor appetite, delayed menstruation, and afternoon fever. Pain occurred with overexertion or anger. This is a Deficiency syndrome. Prescription included Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma), [missing character], Shaoyao (Paeoniae Radix), Zhebei Mu (Fritillariae Thunbergii Bulbus), Yuanzhi (Polygalae Radix), Xiangfu (Cyperus Rhizoma), Jiegeng (Platycodonis Radix), Mudanpi (Moutan Cortex), and Gancao (Glycyrrhizae Radix et Rhizoma). After over a hundred doses, it dissipated.

A male patient had an arm fistula, dry mouth, fever, preference for non-thin pus, and a slow pulse. Moxibustion with Douchi Bing (Fermented Soybean Cake) was applied. Bazhen Tang (Eight-Treasure Decoction) was taken, augmented with Maidong (Ophiopogonis Tuber), Wuweizi (Schisandrae Fructus), Ruan Chaihu (Bupleuri Radix), and Digupi (Lycii Cortex). Recovery took over three months. Later, due to sexual exhaustion, the wound re-ulcerated with thin pus and a large pulse. He refused treatment and died. Hejian said: Deficiency caused by disease is mild, as the pathogenic factor is shallow and Yuan Qi (Original Qi) is not yet exhausted. If, after initial recovery, diet, fatigue, or sexual activity leads to emaciation, this deficiency causing damage is severe, as the disease process has passed and Yuan Qi is depleted.

A child had varicella toxin on the arm; pressing it caused rebound swelling, indicating tension from pus. It was lanced, and interior-supporting herbs led to recovery.

A female patient had an arm lump that ulcerated but did not heal. Moxibustion with Douchi Bing (Fermented Soybean Cake) was applied, followed by interior-supporting herbs, leading to recovery.

A man over thirty, naturally frail and unable to tolerate cold food, had an arm lesion with a weak pulse. Interior-supporting herbs resolved it, but he had poor appetite, occasional bloating, acid regurgitation, and gradual emaciation. Shenling (Ginseng and Atractylodes formulas) were ineffective. The Right Chi pulse was weak, indicating Mingmen Fire (Gate of Life Fire) deficiency failing to generate Earth (Spleen/Stomach). Bawei Wan (Eight-Ingredient Pill) was used to tonify the source of Earth. Appetite gradually returned, and he recovered.

An elderly woman had a tubercle on the left arm that ulcerated after more than a year, with thin pus and failure to heal. Shiquan Dabu Tang (Decoction for Complete Great Tonification) was taken. Externally, Fuzi Bing (Aconite Cake) moxibustion and tonifying plasters were used. With proper care, recovery occurred after one hundred doses.

A man burdened by worry and mental labor, nearing fifty, had red and swollen bumps like millet grains on the lateral left arm. I said, "Do not underestimate this! Several jin of Dushen Tang (Single Ginseng Decoction) would be ideal." After several doses, it stopped. More than ten days later, during a storm uprooting trees, a red line appeared on the sore, winding around the back to the right hypochondrium. A large dose of Renshen Tang (Ginseng Decoction) augmented with Chuanxiong (Ligustici Chuanxiong Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma) was given, and he stabilized after two months.

A female patient had arm pain with tendon cramping preventing flexion and extension, worsening with cold, and a tight, fine pulse. This is what Liangfu described as Liver Qi deficiency, where Wind-Cold flows into the blood vessels and meridians, obstructs the sinews, and causes dryness, tension, and pain. Shujin Tang (Relax Sinews Decoction) was used first, followed by Siwu Tang (Four-Agent Decoction) augmented with Mudanpi (Moutan Cortex), Zelán (Leonuri Herba), and Baizhu (Atractylodis Macrocephalae Rhizoma), leading to recovery. There are also cases of arm pain preventing lifting or pain shifting left and right, caused by latent Phlegm in Zhongwan (CV12) and stagnant Spleen Qi. Fuling Wan (Poria Pill) or Kongyan Dan (Controlling Fluids Pill) should be used.

A person had arm tubercles like millet grains extending to the neck, resembling Scrofula (Luoli). This is Wind-Dampness flowing and depositing. Jiajian Xiao Mingtang (Modified Minor Rescue Decoction) and Duhuo Jisheng Tang (Angelica and Drynaria Decoction for Sustaining the Life) were used, along with interior-supporting herbs augmented with large doses of Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma). Recovery occurred after one hundred doses. (Wang Ji's Note: This entry lists symptoms but no pulse, treating it as Wind-Dampness flow-deposit, implying specific observations were made at the time. The subsequent recovery after a hundred doses of tonics confirms that Deficiency was ultimately the key.)

A three-year-old child had painful toxic lesions on the arm. Jiedu Wan (Detoxifying Pills) and Shengong San (Divine Merit Powder) applied topically resolved it. (Symptoms and pulse details are missing, implying specific observations were made at the time.) I once treated arm toxicity with constipation and restlessness; Wufu Huadu Dan (Five-Fortunes Toxin-Transforming Pill) was also effective. If pus has formed, urgent lancing is required. Use a paper wick dipped in sesame oil to probe the sore, then apply a plaster. If the child is calm, medication is unnecessary; wait for pus to form, drain it, and continue applying [missing character].

A male patient had a carbuncle on the arm with a rapid pulse. One dose of Huaihua Jiu (Sophora Flower Wine) immediately reduced the severity. Subsequent doses of Jinyinhua (Lonicerae Japonicae Flos), Huangqi (Astragali Radix), and Gancao (Glycyrrhizae Radix et Rhizoma) for over ten doses resolved it. (Sophora Flower acts swiftly on Damp-Heat; caution is advised in Stomach Cold.)

Yin Lao came from a poor family, suffering physically and mentally, with congenital hernia. In early winter, a carbuncle arose from the Hand-Yangming Large Intestine meridian. By the fourth day, thick pus formed, and the entire outer arm was swollen and painful. Located within the Left and Right Hand-Yangming meridians, the pulses were wiry, surging, slow, and forceful upon pressure. This resulted from the Eight Winds (Ba Feng). Pulse diagnosis indicated the pathogen was in the Exterior: diet was normal, bowel/bladder function normal, abdomen harmonious, taste intact—indicating it was not in the Interior. No aversion to wind/cold, only heat and irritability, pulse not floating—indicating it was not strictly in the superficial Exterior. With Interior and Exterior harmonized, the pathogen lay within the meridians. Thus, "coagulation in blood vessels constitutes Yong" applies. Since Yong arises in the upper half of the body, Wind enters from above, confirming the Eight Wind variation. As the lesion was confined to the meridians, the method should be to dispel Cold and harmonize Qi and Blood in the meridians to prevent coagulation. Baizhi Shengma Tang (Angelica and Cimicifuga Decoction) was appropriate. (Wang Ji's Note: This formula addresses the whole body, considering Yangming as the center. Regarding individual meridians, Yangming itself has Exterior, Interior, and Middle agents; Taiyang has similar formulas; other meridians can be inferred similarly.)

A man over thirty had an arm carbuncle that ulcerated without pain, with thin pus and a weak pulse. Danxi said: Deep ulceration without pain indicates severe Stomach Qi deficiency, resulting in insensitivity. Dongyuan said: Thin pus and unhealed wounds indicate Qi and Blood deficiency; major tonification is required. He did not listen, took detoxifying herbs, became more deficient in Qi and Blood, and died. Danxi said: Upon seeing swelling and pain, combine with pulse and symptoms. If deficiency exists, immediately tonify Qi and Blood to ensure safety. He also said: Ulcers involve internal and external deficiency; tonification and connection are primary. Here, good advice was ignored, relying on personal wisdom; how could death be avoided?

A man over forty had arm toxicity with pain and vomiting. Taking interior-supporting detoxifying herbs worsened the condition. Liangge San (Cool the Chest Powder) was given for two doses, rapidly reducing symptoms. Siwu Tang (Four-Agent Decoction) augmented with Huangqin (Scutellariae Radix) and Lianzi (Nelumbinis Semen) for four doses resolved it. (Wang Ji's Note: This is referred to as Heat-Toxin from the swelling attacking the Heart, causing vomiting.)

A person had swelling and pain in both arms. Taking interior-supporting herbs worsened the condition daily. I stated: Swelling belongs to Dampness, pain belongs to Fire. This is Damp-Heat flowing into the meridians. Renshen Baidu San (Ginseng Rescue the Periphery Powder) augmented with Weilingxian (Syneilesis Herba), Jiu Chao Huangqin (Wine-processed Scutellariae Radix), and Nanting (Arisaematis Rhizoma) was used. Gradual improvement occurred over several doses. Siwu Tang (Four-Agent Decoction) augmented with Cangzhu (Atractylodis Rhizoma), Huangbai (Phellodendri Cortex), and Jiegeng (Platycodonis Radix) for over twenty doses resolved it. (Note: Interior-supporting herbs worsened the condition daily, so treatment shifted to Damp-Heat.)

A Minister had a purple blister on the left elbow, with red swelling at the base. The Large Intestine pulse was Khou (Hollow). I said: Khou pulse indicates blood loss or blood accumulation. The Minister said: Bloody dysentery had not healed. Shaoyao Tang (Peony Decoction) was given for two doses, followed by Renshen Baidu San (Ginseng Rescue the Periphery Powder) for two doses. Both the sore and dysentery healed. (Wang Ji's Note: Shaoyao Tang was used for bloody dysentery, and Baidu San for the purple blister. The recorded symptoms and pulse were not very detailed. Observing the treatment methods, they largely belonged to Blood-Heat approaching Excess.)

Baizhi Shengma Tang (Angelica and Cimicifuga Decoction) treats carbuncles on the arm.
Baizhi (Angelicae Dahuricae Radix) (1.5 qian)
Shengma (Cimicifugae Rhizoma)
Jiegeng (Platycodonis Radix) (each 1 qian)
Jiu Huangqin (Wine-processed Scutellariae Radix) (4 qian)
Sheng Huangqin (Raw Scutellariae Radix) (3 qian)
Honghua (Carthami Flos)
Gancao (Glycyrrhizae Radix et Rhizoma), roasted (each 0.5 qian)
Prepare as one dose. Decoct with two zhong of water and half a zhong of wine until eight-tenths remain. Take after meals.