张子和曰∶痹之为状，麻木不仁，以风寒湿三气合而成之。故《内经》曰∶风气胜者为行痹。风则
阳受之，故其痹行，旦剧而夜静。世俗不知，反呼为走注疼痛、虎咬之疾。寒气胜者为痛痹。寒则阴受之，
故其痹痛，旦静而夜剧。世俗不知，反呼为鬼忤。湿气胜者为着痹。湿胜则筋脉皮肉受之，故其痹不去，
肌肉削而着骨。世俗不知，反呼为偏枯。
痹则从外入，所受之邪各有浅深，或痛或不痛，或仁或不仁，或筋屈而不能伸，或引而不缩，寒则虫行，
热则缩缓，不相乱也。
皮痹不已，而成肉痹；肉痹不已，而成脉痹，脉痹不已，而成筋痹；筋痹不已，而成骨痹。久而不已，
乃舍其合。若脏腑俱病，虽有智者不能善图也。
凡病痹，其脉沉涩。其病以湿热为源，风寒为兼，三气合而为痹。
李士材曰∶痹病初在外，久而不去，则各因其合，而内舍于脏。在外者祛之犹易，入脏者攻之实难。
治外者散邪为亟，治脏者养正为先。治行痹者散风为主，御寒利湿仍不可废，大抵参以补血之剂，盖治
风先治血，血行风自灭也。治痛痹者散寒为主，疏风燥湿仍不可缺，大抵参以补火之剂，非大辛大温不能
释其凝寒之害也。治着痹者利湿为主，祛风解寒亦不可缺，大抵参以补脾补气之剂，盖土强可以胜湿，而
气足自无顽麻也。分条治法，别列于左。
筋痹即风痹也，游行无定，上下左右，随其虚邪与气血相搏，聚于关节，或赤或肿，筋脉弛纵，古称走
注，今名流
火，防风汤主之，如意通圣散、桂心散、没药散、虎骨丸、十生丹、一粒金丹、乳香应痛丸。
脉痹即热痹也，脏腑移热，复遇外邪，客搏经络，留而不行，故 痹，肌肉热极，唇口反裂，皮肤色
变，升麻汤主之。
肌痹即着痹，湿痹也，留而不移，汗多，四肢缓弱，皮肤不仁，精神昏塞，今名麻木，神效黄 汤
主之。
皮痹者，邪在皮毛，瘾疹风疮，搔之不痛，宜疏风养血。
骨痹即寒痹，痛痹也，痛苦切心，四肢挛急，关节浮肿，五积散主之。
喻嘉言曰∶痹症非不有风，然风入于阴分，与寒湿互结，扰乱其血脉，致身中之阳不通于阴，故致痹
也。古方多有用麻黄、白芷者，以麻黄能通阳气，白芷能行荣卫也，然入在四君、四物等药之内，非专发表
明矣。至于攻里之药，从无用之者，以攻里之药皆属苦寒，用之则阳愈不通，其痹转入诸腑，而成危症者
多矣。
朱丹溪痛风论曰∶气行脉外，血行脉内，昼夜五十营，此平人之造化也。得寒则行迟而不及，得热
则行速而太过，内伤于七情，外感于六淫，则气血之运，或迟或速，而病作矣。痛风者，大率因血受热已
自沸腾，其后或涉于水，或立湿地，或扇取凉，或卧当风，寒凉外搏，热血得寒，污浊凝滞，所以作痛。
夜则痛甚，行于阴也。治以辛热之剂，流散寒湿，开发腠理，其血得行，与气相和，其病自安，然亦有数
种。
东阳傅文年逾六十，性急作劳，患两腿痛，动则更甚。予视之曰∶此兼虚症，当补血温血，病当自安。
遂与四物汤加桃仁、陈皮、牛膝、生甘草，煎入生姜汁，研潜行散，热饮三四十帖而安。
又朱宅阃内，年近三十，食味甚浓，性躁急，患痛风挛缩数月，予视之曰∶此挟痰与气症，当和
血疏气导痰，病自安。遂以潜行散入生甘草、牛膝、炒枳壳、通草，陈皮、桃仁、姜汁，煎服半年而安。
又邻鲍六，年二十余，因患血痢，用涩药取效，后患痛风，叫号撼邻。予视之曰∶此恶血入经络症，
血受湿热，久必凝浊，所下未尽，留滞隧道，所以作痛。经久不治，恐成偏枯。遂与四物汤加桃仁、红花、
牛膝、黄芩，陈皮、生甘草，煎入生姜汁，研潜行散，入少酒饮之，数十剂而安。
张三锡曰∶痛风即《内经》痛痹。但今人多内伤，气血亏损，湿痰阴火流滞经络，或在四肢，或在腰背，
痛不可当，一名白虎历节风是也。大抵湿多则肿，热多则痛，阴虚则脉数而重在夜，气虚则脉大而重在昼。
肢节痛须用羌活，去风湿亦宜用之。如肥人肢节痛，多是风湿，与痰饮流注经络而痛，宜南星、半夏。
如瘦人肢节痛，是血虚，宜四物汤加防风、羌活。如瘦人性躁急、肢节痛、发热，是血热，宜四物加酒炒
黄芩、黄柏。如肢节肿痛脉滑者，常用燥湿，宜苍术、南星，兼行气药木香、枳壳、槟榔，在下加汉防己。
若肢节肿痛脉涩数者，此是淤血，宜桃仁、红花、当归、川芎，及大黄微利之。如倦怠无力而肢节痛，此是
气虚。兼有痰饮流注，宜参、术、星、半。
戴院使曰∶臂痛有血虚一症，血不荣于筋，或致臂痛，宜蠲痹汤、四物汤各半煎服。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，蠲痹汤加苍术、
防己三四分。
方约之曰∶风、痿之别，痛则为风，不痛则为痿。经曰∶痛则为实，不痛则为虚，曰风曰痿，虚实二者
而已。东垣曰∶
气盛病盛，气衰病衰。何则？人之气血充实，而风寒客于经络之间，则邪正交攻，而疼痛作矣。人之气血
虚弱，而痰火起于手足之内，则正不胜邪，而痿痹作矣。故丹溪先生曰∶痿症切不可作风治，而用风药。
盖以风为实而痿为虚也。曰散邪曰补虚，岂可紊乱乎？
附香港脚
张三锡曰∶香港脚委属湿热。《内经》曰∶诸湿肿满，皆属脾土。又曰∶伤于湿者，下先受之。盖脾主
四肢，足居于下，而足多受其湿，湿郁成热，湿热相搏，其病作矣。是以先从气冲穴隐核痛起，及两足红
肿，或恶寒发热，状若伤寒，是其候也。或一旬，或半月，复作如故，渐至足筋肿大如瓠者有之。古方名为
缓风，宋元以来呼为香港脚。原其所由，非止一端；有从外感而得者，有从内伤而得者。所感虽有内外之
殊，其湿热为患则一也。凡香港脚初起，其势甚微，饮食起居如故。惟卒起脚屈弱不能动为异耳。
风痹
薛立斋曰∶手足不随，由风寒湿三气合而为痹。风多者为风痹，其状肌肤尽痛。诸阳之经皆起于手足，
而循行于身体，风寒之气客于肌肤始为痹，复伤阳经，随其虚处而停滞，与血气相搏，血气行则迟缓，故风
痹而手足不随也。
若风邪淫旺，或怒动肝火，血燥筋挛，用加味逍遥散。脾肺气虚不能滋养筋骨，或肝脾血虚而筋痿痹，
用六味丸。服燥药而筋挛者，用四物汤加生甘草。气血俱虚，用八珍汤。
何《医林集要》等方，新刊《丹溪心法》附录，云若人大拇指麻木不仁，或手足少力，或肌肉微掣，
三年内必有大风之证，宜先服八风汤、天麻丸、防风通圣散以预防之？不知河间云∶风者，病之末也。所
以中风有瘫痪者，非谓肝木
之风内中，亦非六淫风邪外袭，良由五志过极，心火炽盛，肾水虚衰不能制之，则阴虚阳实而热气拂郁，
心神昏冒，筋骨无所用，而卒倒无知也。治法当以固元气为主。若遽服八风等药，则反伤元气，适足以招
风取中。医风先医血，此论得之经曰∶风客淫气，精乃亡，邪伤肝也。夫风搏则热盛，热盛则水干，水干
则气不荣，精乃亡。此风病之所由作也。
张子和说：痹证的表现为肢体麻木、不知痛痒，是由风、寒、湿三种邪气结合而形成的。所以《内经》说：风气偏胜的叫行痹。风邪属于阳邪，容易侵犯阳分，所以这种痹证疼痛游走不定，早晨加重而夜间安静。世俗之人不懂，反而称之为走注疼痛、虎咬之疾。寒气偏胜的叫痛痹。寒邪属于阴邪，容易侵犯阴分，所以这种痹证疼痛剧烈，早晨安静而夜间加重。世俗之人不懂，反而称之为鬼忤。湿气偏胜的叫着痹。湿邪偏胜则筋脉皮肉受病，所以这种痹证缠绵不去，肌肉消瘦且紧附于骨。世俗之人不懂，反而称之为偏枯。
痹证是从外部侵入的，所受的邪气有深有浅，有的疼痛，有的不痛；有的麻木，有的不麻；有的筋脉拘屈不能伸展，有的牵引而不收缩；遇寒则感觉如虫行，遇热则筋脉收缩弛缓，这些症状互不混淆。
皮痹如果不愈，就会发展成肉痹；肉痹如果不愈，就会发展成脉痹；脉痹如果不愈，就会发展成筋痹；筋痹如果不愈，就会发展成骨痹。如果日久不愈，病邪就会内舍于相合的脏腑。如果五脏六腑都受病，即使有智慧的人也无法妥善救治了。
凡是患痹证，其脉象多沉涩。其病因以湿热为根源，风寒为兼夹，三气结合而形成痹证。
李士材说：痹病初起在体表，日久不愈，就会根据其相合的脏腑，内舍于脏。在体表的容易祛除，进入脏腑的攻治确实困难。治疗在表的以祛散邪气为急务，治疗在里的以扶正养正为先。治疗行痹的以疏散风邪为主，御寒利湿也不可废弃，大抵参用补血药剂，因为治风先治血，血行风自灭。治疗痛痹的以散寒为主，疏风燥湿也不可缺少，大抵参用补火药剂，非大辛大温之药不能解除其凝寒的危害。治疗着痹的以利湿为主，祛风解寒也不可缺少，大抵参用补脾补气药剂，因为土强可以胜湿，气足自然没有顽麻。分条列出的治法，分别列举在下面。
筋痹即风痹，疼痛游走无定处，上下左右，随着虚处邪气与气血相搏结，聚于关节，或红或肿，筋脉弛纵，古称走注，今名流火，用防风汤主治，如意通圣散、桂心散、没药散、虎骨丸、十生丹、一粒金丹、乳香应痛丸也可使用。
脉痹即热痹，脏腑移热，又遇外邪，客居于经络，停留不行，所以导致痹证，肌肉热极，嘴唇口角反裂，皮肤颜色改变，用升麻汤主治。
肌痹即着痹，也是湿痹，病邪停留不移，汗多，四肢缓弱，皮肤麻木不仁，精神昏塞，今名麻木，用神效黄芪汤主治。（注：原文“黄 汤”据语境及常用方推测为黄芪汤类，此处保留原文空缺或依常理补全，鉴于要求忠实原文，此处译为“神效黄芪汤”或保留“神效黄[芪]汤”，考虑到学术严谨性，若原文缺字，通常指黄芪。此处按常见医籍补全为黄芪，若严格对应原文空缺，可译为“神效黄[某]汤”。根据《古今名医汇粹》通行本，此处多为“神效黄芪汤”。）
骨痹即寒痹，也是痛痹，痛苦切心，四肢挛急，关节浮肿，用五积散主治。
喻嘉言说：痹症并非没有风邪，然而风邪进入阴分，与寒湿互结，扰乱血脉，导致身体中的阳气不能通达于阴分，所以形成痹证。古方中多有使用麻黄、白芷的，因为麻黄能通阳气，白芷能行营卫之气，但这些药物是配合在四君子汤、四物汤等药物之内使用的，显然不是专门用来发表发汗的。至于攻里的药物，从来没有人使用它们，因为攻里的药物都属于苦寒性质，使用它们则阳气更加不通，痹证转入各腑，成为危重病症的情况很多。
朱丹溪论痛风说：气运行于脉外，血运行于脉内，昼夜循环五十周，这是正常人的生理造化。遇到寒邪则运行迟缓而不及，遇到热邪则运行迅速而太过，内伤于七情，外感于六淫，则气血的运行，或迟或速，疾病就发作了。痛风患者，大率是因为血液受热已经沸腾，之后或者涉水，或者站立在潮湿之地，或者扇风取凉，或者卧当风口，寒凉之邪从外部搏击，热血遇到寒凉，污浊凝滞，所以产生疼痛。夜间疼痛更甚，是因为病行于阴分。治疗用辛热药剂，流散寒湿，开发腠理，使血液得以运行，与气相调和，病自然痊愈，但也有几种情况。
东阳人傅文，年过六十，性格急躁且劳累过度，患两腿疼痛，活动后更严重。我诊视他说：这是兼有虚证，应当补血温血，病自然会好。于是给予四物汤加桃仁、陈皮、牛膝、生甘草，煎煮时加入生姜汁，另研潜行散，热饮三十至四十帖而痊愈。
又朱宅主母，年近三十，饮食口味很浓，性情暴躁急躁，患痛风挛缩数月，我诊视她说：这是挟带痰气和气机郁滞，应当和血疏气导痰，病自然会好。于是用潜行散加入生甘草、牛膝、炒枳壳、通草、陈皮、桃仁、姜汁，煎服半年而痊愈。
又邻居鲍六，二十多岁，因患血痢，用收敛固涩药取得疗效，后来患痛风，叫喊声震动邻居。我诊视他说：这是恶血进入经络的证候，血液受湿热困扰，日久必然凝滞浑浊，痢疾未尽，留滞于隧道（经络），所以产生疼痛。经久不治疗，恐怕会形成偏枯。于是给予四物汤加桃仁、红花、牛膝、黄芩、陈皮、生甘草，煎煮时加入生姜汁，另研潜行散，加入少量酒送服，数十剂而痊愈。
张三锡说：痛风即《内经》所说的痛痹。但现在人多有内伤，气血亏损，湿痰阴火流滞于经络，或在四肢，或在腰背，疼痛难忍，一名白虎历节风。大抵湿气多则肿胀，热气多则疼痛，阴虚则脉数且重在夜间，气虚则脉大且重在白天。肢节疼痛须用羌活，去除风湿也宜用羌活。如果是肥胖之人肢节疼痛，多是风湿，加上痰饮流注经络而痛，宜用南星、半夏。如果是瘦人肢节疼痛，是血虚，宜用四物汤加防风、羌活。如果是瘦人性情急躁、肢节疼痛、发热，是血热，宜用四物汤加酒炒黄芩、黄柏。如果是肢节肿痛脉滑者，常用燥湿药，宜用苍术、南星，兼用行气药木香、枳壳、槟榔，在下部加汉防己。如果肢节肿痛脉涩数者，这是淤血，宜用桃仁、红花、当归、川芎，以及大黄轻微通下。如果倦怠无力而肢节疼痛，这是气虚。兼有痰饮流注，宜用人参、白术、南星、半夏。
戴院使说：臂痛有一种证候是血虚，血不能荣养筋脉，可能导致臂痛，宜用蠲痹汤、四物汤各半煎服。如果是坐卧时被风湿所搏击，或者睡觉后手露在被外，被寒邪侵袭，遂令臂痛，宜用五积散及蠲痹汤、乌药顺气散。确知是湿邪，蠲痹汤加苍术、防己三四分。
方约之说：风和痿的区别，疼痛的是风，不疼痛的是痿。经书说：疼痛的是实证，不疼痛的是虚证，说是风或是痿，不过是虚实两种罢了。东垣先生说：气盛则病盛，气衰则病衰。为什么呢？人的气血充实，风寒客居在经络之间，则邪正交争，疼痛就发作了。人的气血虚弱，痰火起于手足内部，则正气不胜邪气，痿痹就发作了。所以丹溪先生说：痿证切不可当作风证来治，而使用风药。因为风是实证而痿是虚证。说是散邪，说是补虚，岂可混乱呢？
附：香港脚
张三锡说：香港脚确实属于湿热。《内经》说：各种湿邪导致的肿胀满闷，都归属于脾土。又说：受伤于湿邪的，下部先受之。因为脾主四肢，足位于下方，而足部多受湿邪，湿郁结成热，湿热相搏，疾病就发作了。所以先从气冲穴隐核处疼痛开始，进而两足红肿，或者恶寒发热，状若伤寒，这是其征候。或者十天，或者半个月，再次发作如故，逐渐发展到足筋肿大像葫芦一样的情况也有。古方名为缓风，宋元以来称为香港脚。推究其由来，不止一端；有从外感而得的，有从内伤而得的。所感虽有内外之别，但其湿热为害是一样的。凡香港脚初起，其势很微弱，饮食起居如常。只有突然发生脚屈弱不能动是异常之处。
薛立斋说：手足不能随意运动，由风、寒、湿三气结合而成痹。风邪偏多的叫风痹，其表现是肌肤全部疼痛。诸阳经都起于手足，而循行于身体，风寒之气客居在肌肤始成痹，再伤及阳经，随着其虚处而停滞，与血气相搏，血气运行则迟缓，所以风痹导致手足不能随意运动。
如果风邪淫旺，或者怒动肝火，导致血燥筋挛，用加味逍遥散。脾肺气虚不能滋养筋骨，或者肝脾血虚而筋痿痹，用六味地黄丸。服用燥药而导致筋挛者，用四物汤加生甘草。气血俱虚，用八珍汤。
何氏《医林集要》等方，新刊《丹溪心法》附录中说：如果人大拇指麻木不仁，或者手足少力，或者肌肉微颤，三年内必有大风（中风）的证候，宜先服八风汤、天麻丸、防风通圣散以预防它？不知道河间先生说过：风，是病的末梢表现。所以中风有瘫痪者，并非谓肝木之风内中，也不是六淫风邪外袭，实在是由于五志过极，心火炽盛，肾水虚衰不能制约，则阴虚阳实而热气拂郁，心神昏冒，筋骨无所用，而卒然倒下无知觉。治法应当以固护元气为主。如果仓促服用八风等药，则反而损伤元气，恰好足以招致风邪而致病中。医治风病先医治血，这个论述符合经书所说：风客居并扰乱气机，精气乃亡，邪气伤肝。风搏结则热盛，热盛则水干，水干则气不荣养，精气乃亡。这就是风病产生的原因。
Zi Hezi stated: The manifestation of Bi syndrome (Bi Syndrome, characterized by numbness and pain) involves numbness and insensibility, caused by the combination of Wind, Cold, and Dampness pathogens. Thus, the *Neijing* (Classic of Internal Medicine) states: When Wind pathogen predominates, it is called Xing Bi (Wandering Bi). Wind belongs to Yang and affects Yang aspects; therefore, this type of Bi moves about, worsening in the morning and quieting at night. The common people, unaware of this, mistakenly call it "Zou Zhu" (migratory pain) or the disease of a tiger bite. When Cold pathogen predominates, it is called Tong Bi (Painful Bi). Cold belongs to Yin and affects Yin aspects; therefore, this type of Bi causes severe pain, quieting in the morning and worsening at night. The common people, unaware of this, mistakenly call it "Gui Wu" (ghost affliction). When Dampness pathogen predominates, it is called Zhuo Bi (Fixed Bi). When Dampness predominates, it affects sinews, vessels, skin, and flesh; therefore, this Bi lingers without resolving, muscles emaciate, and it adheres to the bone. The common people, unaware of this, mistakenly call it "Pian Ku" (hemiplegia/paralysis).
Bi syndrome enters from the exterior; the pathogens received have varying depths. Some cause pain, some do not; some cause numbness, some do not; some involve sinew flexion with inability to extend, some involve traction without retraction; feeling like insects crawling when cold, or contraction and flaccidity when hot; these symptoms do not confuse one another.
If Pi Bi (Skin Bi) persists, it develops into Rou Bi (Flesh Bi); if Rou Bi persists, it develops into Mai Bi (Vessel Bi); if Mai Bi persists, it develops into Jin Bi (Sinew Bi); if Jin Bi persists, it develops into Gu Bi (Bone Bi). If prolonged and unresolved, the pathogen resides in the corresponding Zang-Fu organs. If all Zang and Fu organs are diseased, even a wise person cannot manage it well.
Generally, for Bi syndrome, the pulse is deep and choppy. The root cause is Damp-Heat, with Wind and Cold as concurrent factors; the combination of these three creates Bi.
Li Shicai stated: Bi syndrome begins on the exterior; if prolonged and unresolved, it enters the Zang organs according to their correspondences. Exterior cases are easy to dispel; interior Zang cases are difficult to treat. For exterior treatment, dispelling pathogens is urgent; for interior treatment, nourishing righteousness (Zheng Qi) is primary. For treating Xing Bi, dispersing Wind is primary, but warding off Cold and draining Dampness must not be abandoned; generally, blood-nourishing formulas are added, because treating Wind requires treating Blood first; when Blood flows, Wind extinguishes itself. For treating Tong Bi, dispersing Cold is primary, but diffusing Wind and drying Dampness must not be lacking; generally, Fire-nourishing (warming) formulas are added, only strong acrid-warm herbs can release the harm of congealed Cold. For treating Zhuo Bi, draining Dampness is primary, but dispelling Wind and resolving Cold must not be lacking; generally, Spleen-qi tonifying formulas are added, because strengthening Earth overcomes Dampness, and sufficient Qi eliminates stubborn numbness. The specific treatments are listed below.
Jin Bi is equivalent to Feng Bi (Wind Bi), moving without fixed location, up, down, left, right, interacting with Qi and Blood at deficiency sites, gathering in joints, appearing red or swollen, with flaccid sinews. Anciently called "Zou Zhu," now called "Liu Huo" (Flowing Fire). It is primarily treated with Fangfeng Tang (Saposhnikovia Decoction), Ruyi Tongsheng San, Guixin San, Moyao San, Hugut Wan, Shisheng Dan, Yili Jindan, or Rushuang Yingtong Wan.
Mai Bi is equivalent to Re Bi (Heat Bi). Heat shifts from Zang-Fu, combined with external pathogens, lodging in meridians and stagnating. This causes Bi, extreme heat in muscles, cracked lips and mouth, and changed skin color. It is primarily treated with Shengma Tang (Cimicifuga Decoction).
Ji Bi is equivalent to Zhuo Bi and Shi Bi (Damp Bi). The pathogen stays fixed, with excessive sweating, flaccid limbs, insensible skin, and mental cloudiness. Now called numbness. It is primarily treated with Shenxiao Huangqi Tang (Miraculous Effect Astragalus Decoction).
Pi Bi involves pathogens in the skin and hair follicles, presenting as urticaria or wind sores, painless upon scratching. It should be treated by dispersing Wind and nourishing Blood.
Gu Bi is equivalent to Han Bi (Cold Bi) and Tong Bi. It causes heart-piercing pain, limb spasms, and joint swelling. It is primarily treated with Wuji San (Five Accumulations Powder).
Yu Jiayan stated: Bi syndrome does involve Wind, but Wind enters the Yin aspect, binding with Cold and Dampness, disturbing blood vessels, preventing Yang from communicating with Yin, thus causing Bi. Ancient formulas often used Mahuang (Ephedrae Herba) and Baizhi (Angelicae Dahuricae Radix) because Mahuang unblocks Yang Qi and Baizhi circulates Ying and Wei. However, they were used within formulas like Sijunzi Tang (Four Gentlemen Decoction) and Siwu Tang (Four Substances Decoction), clearly not for exclusive exterior-releasing purposes. Interior-purging herbs were never used because they are bitter-cold; using them further blocks Yang, leading Bi into the Fu organs and becoming critical conditions frequently.
Zhu Danxi discussed Gout (Tongfeng): Qi moves outside the vessels, Blood moves inside, circulating fifty times daily; this is normal physiology. Cold slows movement, causing deficiency; Heat speeds movement, causing excess. Internal injury from Seven Emotions, external invasion from Six Evils, causes Qi and Blood transport to become slow or fast, triggering disease. Gout usually occurs because Blood has been heated to boiling, then exposed to water, damp ground, cooling fans, or drafts. External Cold attacks, Hot Blood meets Cold, turbidity stagnates, causing pain. Pain worsens at night because the pathogen travels in Yin. Treatment uses acrid-hot formulas to disperse Cold-Damp, open pores, allow Blood to flow, harmonize with Qi, and restore health. There are several variations.
Fu Wen from Dongyang, over sixty, impatient and overworked, suffered leg pain worsening with movement. I diagnosed deficiency mixed with excess, advised nourishing and warming Blood. Prescribed Siwu Tang plus Taoren (Persicae Semen), Chenpi (Citri Reticulatae Pericarpium), Niuxi (Achyranthis Bidentatae Radix), and Gancao (Glycyrrhizae Radix et Rhizoma), decocted with Shengjiang juice (Fresh Ginger Juice), mixed with Qianxing San, taken hot. Thirty to forty doses cured him.
The wife of the Zhu family, nearly thirty, rich diet, irritable, suffered gouty contraction for months. I diagnosed phlegm and Qi stagnation. Advised harmonizing Blood, diffusing Qi, and guiding out Phlegm. Prescribed Qianxing San plus Gancao, Niuxi, Chao Zhike (Stir-fried Aurantii Fructus), Tongcao (Tetrapanacis Medulla), Chenpi, Taoren, and Jiangzhi (Ginger Juice), decocted and taken. Half a year of treatment cured her.
Neighbor Bao Liu, over twenty, had dysentery with bloody stools, treated with astringents successfully, later developed gout, screaming loudly. I diagnosed evil Blood entering collaterals. Blood affected by Damp-Heat, long-term stagnation causes turbidity. Residual blood remained in tunnels (collaterals), causing pain. Untreated, it might become hemiplegia. Prescribed Siwu Tang plus Taoren, Honghua (Carthami Flos), Niuxi, Huangqin (Scutellariae Radix), Chenpi, Gancao, decocted with Shengjiang juice, mixed with Qianxing San, taken with a little wine. Dozens of doses cured him.
Zhang Sanxi stated: Gout is Tong Bi from the *Neijing*. But modern people often have internal injuries, Qi and Blood deficiency, Damp-Phlegm and Yin Fire stagnating in meridians, affecting limbs or back, unbearable pain, also known as Baihu Lijie Feng (White Tiger Joint-Wandering Wind). Generally, more Dampness causes swelling, more Heat causes pain. Yin deficiency leads to rapid pulse, worse at night; Qi deficiency leads to large pulse, worse during day. Limb/joint pain requires Qianghuo (Notopterygii Rhizoma et Radix) to remove Wind-Damp. For obese people with limb pain, it is Wind-Damp with Phlegm-Fluids in collaterals; use Nanxing (Arisaematis Rhizoma Preparatum) and Banxia (Pinelliae Rhizoma). For thin people with limb pain, it is Blood deficiency; use Siwu Tang plus Fangfeng (Saposhnikoviae Radix) and Qianghuo. For thin people with irritability, limb pain, and fever, it is Blood Heat; use Siwu Tang plus Jiuhuang Qin (Alcohol-fried Scutellariae Radix) and Huangbai (Phellodendri Cortex). For swollen/painful joints with slippery pulse, use drying-Damp herbs like Cangzhu (Atractylodis Rhizoma) and Nanxing, combined with Qi-moving herbs Muxiang (Aucklandiae Radix), Zhike, and Binglang (Arecae Semen); add Hanfangji (Stephaniae Tetrandrae Radix) for lower body. For swollen/painful joints with choppy-rapid pulse, it is Blood Stasis; use Taoren, Honghua, Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), and slight purgation with Dahuang (Rhei Radix et Rhizoma). For fatigue and weakness with limb pain, it is Qi deficiency with Phlegm-Fluids; use Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Nanxing, and Banxia.
Envoy Dai stated: Arm pain can be due to Blood deficiency, where Blood fails to nourish sinews. Use Juanbi Tang (Eliminate Bi Decoction) and Siwu Tang in equal halves. If sitting/sleeping exposes one to Wind-Damp, or sleeping with hands outside covers invites Cold, causing arm pain, use Wuji San, Juanbi Tang, or Wuyao Shunqi San. If confirmed as Dampness, add Cangzhu and Fangji (Stephaniae Tetrandrae Radix) 3-4 fen to Juanbi Tang.
Fang Yuexi stated: The difference between Wind and Wei syndrome (Flaccidity): Pain indicates Wind, no pain indicates Wei. The Classics say: Pain is Excess, no pain is Deficiency. Wind and Wei are merely Excess and Deficiency. Dongyuan said: Strong Qi means strong disease, weak Qi means weak disease. Why? When Qi and Blood are full, Wind-Cold lodges in meridians, Evil and Righteous fight, causing pain. When Qi and Blood are weak, Phlegm-Fire arises internally, Righteous cannot overcome Evil, causing Wei-Bi. Thus, Danxi said: Wei syndrome must not be treated as Wind using Wind-dispersing herbs. Wind is Excess, Wei is Deficiency. Dispelling Evil vs. Tonifying Deficiency—how can they be confused?
Appendix: Hongxiangjiao (Charley Horse / Gouty Arthritis of Lower Limbs)
Zhang Sanxi stated: Hongxiangjiao belongs to Damp-Heat. *Neijing* says: All Dampness causing swelling/fullness belongs to Spleen Earth. Also: Injury by Dampness affects the lower part first. Spleen governs limbs; feet are lowest, receiving much Dampness. Dampness stagnates into Heat, Damp-Heat struggles, disease arises. It starts with pain at Qichong point (ST30), then red/swollen feet, aversion to cold/fever resembling Taiyang disease. Recurs every ten days or half month, eventually legs swell like gourds. Ancient name: Huan Feng. Song/Yuan era name: Hongxiangjiao. Causes vary: external invasion or internal injury. Though origins differ, Damp-Heat pathology is the same. Early stage is mild, diet/lifestyle normal. Only sudden foot weakness/inability to move is abnormal.
Wind Bi
Xue Lizhai stated: Inability to move limbs results from Wind-Cold-Damp combining into Bi. Predominant Wind is Wind Bi, manifesting as whole-body skin/muscle pain. Yang meridians start at limbs, traverse body. Wind-Cold lodges in skin forming Bi, damages Yang meridians, stagnates at deficiency sites, fights Qi/Blood. Qi/Blood flow slows, causing Wind Bi and limb paralysis.
If Wind pathogen is rampant, or anger stirs Liver Fire, causing dry Blood and sinew spasm, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). Spleen/Lung Qi deficiency failing to nourish sinews/bones, or Liver/Spleen Blood deficiency causing sinew flaccidity/Bi, use Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). Spasm from drying herbs: use Siwu Tang plus Gancao. Qi and Blood both deficient: use Bazhen Tang (Eight Treasures Decoction).
He’s *Yilin Jiyao* and new edition of *Danxi Xinfa* appendix state: If thumb is numb/insensible, limbs weak, or muscles twitch, severe Wind (Stroke) will occur within three years. Prevent with Bafeng Tang, Tianma Wan, or Fangfeng Tongsheng San. This ignores Hejian’s view: Wind is the end-stage of disease. Stroke paralysis is not Liver Wind internal attack nor Six Evils external invasion, but Five Emotions exceeding limits, Heart Fire blazing, Kidney Water deficient failing to control, leading to Yin deficiency/Yang excess, heat stagnation, mental confusion, sinew/bone dysfunction, sudden collapse. Treatment must consolidate Yuan Qi. Premature use of Bafeng etc. harms Yuan Qi, inviting Wind. Treating Wind requires treating Blood first. As Classics say: Wind invades disrupting Qi, Essence perishes, Evil damages Liver. Wind struggle causes Heat, Heat dries Water, Water dry causes Qi failure, Essence perishes. This is the origin of Wind disease.