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Gout is also known as Painful Bi Syndrome (Tongbi). The Classics state that when Heat predominates, there is pain; when Dampness predominates, there is swelling. Generally, this involves boiling and surging of Blood-Heat. It may result from exposure to cold, sitting on damp ground, or wind exposure, where hot blood encounters cold and condenses into turbid masses. Some present with swelling like a gourd, while others experience pain described as pulling or twitching. Because the pain wanders through the joints and is severe, resembling a tiger bite, it is named White Tiger Arthritis (Baihu Lijie Feng).

For pain in the upper body, the treatment should focus on dispelling Wind, resolving phlegm, clearing Heat, and inducing slight sweating. For pain in the lower body, the treatment should focus on draining Dampness, moving Qi, harmonizing Blood, and soothing Wind. Yin Deficiency presents with a wiry and scattered pulse, requiring detailed differentiation. For example, if an elderly person experiences tendon pain upon movement, this is because Blood fails to nourish the tendons, termed Tendon Withering (Jinku), which is difficult to treat.

Crane Knee Wind (Hexikou Feng) results from deficiency of the Foot Three Yin Meridians, allowing Wind Pathogens to enter due to emptiness, leading to internal Heat, reduced appetite, limb spasms, and pain. The knee bones become progressively enlarged while the muscles above and below remain withered and thin. If the damage involves the Liver and Kidney, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) is the primary formula. If symptoms include dry mouth and dizziness, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is added. If there is reduced intake, chest and abdominal distension, and diarrhea, Liujunzi Tang (Six-Gentlemen Decoction) is used. If suppuration is imminent or has occurred after ulceration, Shiquan Dabu Tang (Perfect Ten Tonifying Decoction) is used, assisted by Dafangfeng Tang (Great Wind-Dispelling Decoction). In the initial stage, Congyun (Scallion Moxibustion/Fomentation) must be applied to internally resolve clear and thin pus and promote muscle regeneration; Bajun Tang (Eight-Gentlemen Decoction) or Shiquan Dabu Tang may also be used. For cold pain in the umbilical and abdominal regions, weakness in the legs and knees, dizziness, expectoration, and frequent urination, Bawei Wan (Eight-Ingredient Pill) is prescribed.

Ancient formulas for pediatric Crane Knee Wind use Liuwei Dihuang Wan plus Rylurus (Deer Antler) and Achyranthes Root (Niuxi), totaling eight ingredients, without directly treating Wind. This approach is highly commendable. Children are not necessarily afflicted by Wind-Cold-Damp Bi; rather, it often stems from congenital deficiency of Kidney Qi, causing Yin-Cold to accumulate in the waist and knees without resolving. External signs reveal internal pathology. Therefore, Liuwei Dihuang Wan tonifies Water in the Kidneys, Rylurus tonifies Fire in the Kidneys, and Niuxi guides the herbs to the joints to strengthen the tendons surrounding them. This is a method of treating the root rather than the branch.

Whenever elbows and knees are swollen and painful, but the arms are thin, it is called Crane Knee Wind due to its resemblance to a crane's knee. Sometimes only the two knees are swollen, with withered legs unable to flex or extend, commonly known as Drumstick Wind. This is generally caused by the flow and accumulation of Wind, Cold, and Damp pathogens. Swelling and pain indicate pathogenic stagnation; withering and thinness indicate Blood Deficiency. Treatment must primarily nourish Blood. If Wind is present, disperse Wind; if Cold-Damp is present, expel Cold-Damp; if pathogens stagnate and transform into Heat, nourish Yin and clear Fire. If it develops after dysentery, it is due to Yin loss from diarrhea, requiring particular emphasis on tonifying the Kidneys. If the swelling is hard, painless, and pale in color, it is incurable.

Quxi San (Knee-Bending Powder): Treats Crane Knee Wind. Polygonum multiflorum He Shouwu (steeped in male urine and dried), Trichosanthes Root Tianhuafen, Schizonepeta Spike Jingjie Sui, Deer Antler Lurong (each 5 qian), Sophora Root Kushen (steeped in female urine and dried), Saposhnikovia Root Fangfeng, Coix Seed Yiyiren, Achyranthes Root Niuxi (each 1 qian), Soap Nut Flesh Feizaoheme. Grind all into coarse powder. Use 3 qian each time, combined with a cold rice ball (4 liang), boar fat (6 qian), glutinous rice, and mung beans (a pinch each). Add four bowls of water, decoct until one bowl remains, and divide into three doses for warm administration.

Warming Compress Prescription: Treats Cold-Damp Bi pain and numbness with insensitivity. Aconite Root Chuanwu, Aconite Root Caowu, Long Pepper Bibo, Nardus Gan-song, Kaempferia Rhizome Shannai (each 5 qian). Grind into coarse powder, heat in a pan, wrap in cloth, and apply as a compress to the painful area.

Another prescription for various pains in the legs, knees, back, waist, chest, and abdomen: Use Sichuan Peppercorn Chuanjiao (powdered), fresh Ginger Shengjiang (chopped, equal parts), Scallion Cong (three stalks), Salt Yan (a pinch), and Wheat Bran Xiaomai Fumian (4–5 he). Stir-fry over low heat until hot, wrap in cloth, and apply as a compress to the affected area. This is also effective.