臂痛有六道经络,究其痛在何经络之间,以行本经药行其气血,血气通则愈矣。以两手伸直,其
臂贴身垂下,大指居前,小指居后而定之。则其臂 之前廉痛者,属阳明经,以升麻、白芷、干葛行
之;后廉痛者,属太阳经,以 本、羌活行之;外廉痛者,属少阳经,以柴胡行之;内廉痛者,属厥
阴经,以柴胡、青皮行之;内前廉痛者,属太阴经,以升麻、白芷、葱白行之;内后廉痛者,属少阴
经,以细辛、独活行之。并用针灸法,视其何经而取之。臂为风寒湿所搏,或饮液流入,或因提挈重
物,皆致臂痛。有肿者,有不肿者。除饮证外,其余诸痛,并可五积散,及乌药顺气散,或蠲痹汤。
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,蠲痹汤每服加苍术三匙,防己四分,或用五痹汤。
曾有挈重伤筋,以致臂痛,宜琥珀散、劫劳散,或和气饮,每服加白姜黄半钱,以姜黄能入臂故也。
痰饮流入四肢,令人肩背酸疼,两手软痹,医误以为风,则非其治。宜导痰汤加木香、姜黄各半钱,
如未效,轻者指迷茯苓丸,重者控涎丹。(控涎丹加去油木鳖子一两,桂五钱,治臂痛。每服二十丸,
加至三十丸。)外有血虚不荣于筋而致臂痛,宜蠲痹汤、四物汤各半帖,和匀煎服。有气血凝滞经络
不行而致臂痛,宜舒筋汤。治臂痛,半夏一钱,陈皮半钱,茯苓五分,苍术二钱,威灵仙五分,酒芩、
白术、南星、香附各一钱,甘草少许。红花、神曲炒为末。姜黄四两,甘草、羌活各一两,白术二两。
茯苓丸,治臂痛如神。赤茯苓、防风、细辛、白术、泽泻、官桂各半两,栝蒌根、紫菀、附子、黄 、
芍药、甘草炙各七钱半,生地黄、牛膝、(酒浸)山芋、独活、半夏、(酒浸)山茱萸各二钱半,为细末,炼
蜜丸如桐子大。每服十丸,温酒下。
【手气手肿痛】或掌指连臂膊痛,宜五痹汤、蠲痹汤。薄桂味淡,能横行手臂,令他药至痛处。
白姜黄能引至手臂尤妙。
臂痛涉及六条经络,必须究明疼痛位于哪条经络之间,从而使用本经的药物来疏通该经络的气血,气血通畅则疼痛自愈。判定方法为:将双手伸直,手臂自然下垂贴于身体两侧,大拇指在前,小指在后。此时,若手臂前侧疼痛,属于阳明经(手阳明大肠经),可用升麻、白芷、干葛(葛根)引药入经;后侧疼痛,属于太阳经(手太阳小肠经),可用藁本、羌活引药入经;外侧疼痛,属于少阳经(手少阳三焦经),可用柴胡引药入经;内侧疼痛,属于厥阴经(手厥阴心包经),可用柴胡、青皮引药入经;内侧前侧疼痛,属于太阴经(手太阴肺经),可用升麻、白芷、葱白引药入经;内侧后侧疼痛,属于少阴经(手少阴心经),可用细辛、独活引药入经。同时配合针灸疗法,根据所属经络选取相应穴位治疗。
手臂因风寒湿邪侵袭搏结,或饮邪流入经脉,或因提举重物损伤,均可导致臂痛。有的伴有肿胀,有的不肿。除饮邪所致者外,其余各种臂痛,均可使用五积散(Wuji San, Five Accumulations Powder)、乌药顺气散(Wuyao Shunqi San, Linnaeae Root and Magnolia Bark Powder)或蠲痹汤(Juanbi Tang, Bi-Syndrome Dispelling Decoction)。若是坐卧时受风湿侵袭,或睡眠时手臂露在被子外面受寒邪袭击导致的臂痛,适宜使用五积散、蠲痹汤、乌药顺气散。若确知是湿邪致病,蠲痹汤每服加苍术三匙、防己四分,或使用五痹汤(Wubi Tang, Five Bi Syndrome Decoction)。
曾有因提举重物严重损伤筋脉导致臂痛的,适宜使用琥珀散(Hupo San, Amber Powder)、劫劳散(Jie Lao San, Labor-Exhausting Relief Powder)或和气饮(Heqi Yin, Harmonizing Qi Decoction),每服加白姜黄半钱,因为姜黄能入臂部经络的缘故。痰饮流入四肢,令人肩背酸痛,两手软弱麻木,医生误认为是风邪而治疗,则不对症。适宜使用导痰汤(Daotan Tang, Phlegm-Resolving Decoction)加木香、姜黄各半钱,如果无效,轻症用指迷茯苓丸(Zhimi Fuling Wan, Finger-Mystifying Poria Pill),重症用控涎丹(Kongxian Dan, Fluid-Draining Pill)。(控涎丹中加入去油木鳖子一两、桂枝五钱,可治臂痛。每次服用二十丸,逐渐增加至三十丸。)
此外,还有因血虚不能濡养筋脉而导致臂痛的,适宜将蠲痹汤、四物汤(Sini Tang, Four Substances Decoction)各取半帖,混合均匀煎服。有因气血凝滞、经络不通而导致臂痛的,适宜使用舒筋汤(Shujin Tang, Sinew-Relaxing Decoction)。
治疗臂痛的一个方剂组成:半夏一钱,陈皮半钱,茯苓五分,苍术二钱,威灵仙五分,酒炒黄芩、白术、天南星、香附各一钱,甘草少许。红花、神曲炒后研为末。另一个方剂组成:姜黄四两,甘草、羌活各一两,白术二两。
茯苓丸,治疗臂痛效果如神。组成:赤茯苓、防风、细辛、白术、泽泻、官桂(肉桂)各半两,栝蒌根(瓜蒌根)、紫菀、附子、黄芪、芍药、炙甘草各七钱半,生地黄、牛膝(酒浸)、山芋(山药)、独活、半夏(酒浸)、山茱萸各二钱半。研为细末,炼蜜制成梧桐子大小的丸药。每次服用十丸,温酒送下。
【手气手肿痛】或者手掌手指连及手臂疼痛,适宜使用五痹汤、蠲痹汤。薄桂(肉桂的一种)味道淡,能横行于手臂,引导其他药物到达疼痛部位。白姜黄能引导药力至手臂,尤为巧妙。
Arm pain involves six meridians; one must investigate which meridian the pain resides in, then administer herbs belonging to that specific meridian to circulate its Qi and Blood. Once Qi and Blood flow freely, the condition will resolve. The diagnostic method is as follows: extend both hands with arms hanging naturally by the sides, thumb forward and little finger backward. If pain occurs on the anterior aspect of the arm, it belongs to the Yangming Meridian (Hand-Yangming Large Intestine Meridian); use Shengma (Cimicifugae Rhizoma), Baizhi (Angelicae Dahuricae Radix), and Gange (Puerariae Lobatae Radix) to guide the herbs. If pain is on the posterior aspect, it belongs to the Taiyang Meridian (Hand-Taiyang Small Intestine Meridian); use Ben (Ligustici Rhizoma et Radix) and Qianghuo (Notopterygii Rhizoma et Radix). If pain is on the lateral aspect, it belongs to the Shaoyang Meridian (Hand-Shaoyang Triple Energizer Meridian); use Chaihu (Bupleuri Radix). If pain is on the medial aspect, it belongs to the Jueyin Meridian (Hand-Jueyin Pericardium Meridian); use Chaihu (Bupleuri Radix) and Qingpi (Citri Reticulatae Pericarpium Viride). If pain is on the anteromedial aspect, it belongs to the Taiyin Meridian (Hand-Taiyin Lung Meridian); use Shengma (Cimicifugae Rhizoma), Baizhi (Angelicae Dahuricae Radix), and Congbai (Allii Fistulosi Bulbus). If pain is on the posteromedial aspect, it belongs to the Shaoyin Meridian (Hand-Shaoyin Heart Meridian); use Xixin (Asari Radix et Rhizoma) and Duhuo (Angelicae Pubescentis Radix). Acupuncture and moxibustion should be applied simultaneously, selecting points according to the affected meridian.
Arm pain may result from the entrapment of Wind-Cold-Dampness pathogens, the infiltration of fluid retention into the channels, or injury from lifting heavy objects. It may present with swelling or without swelling. Excluding cases caused by fluid retention, other types of arm pain can be treated with Wuji San (Wuji San, Five Accumulations Powder), Wuyao Shunqi San (Wuyao Shunqi San, Linnaeae Root and Magnolia Bark Powder), or Juanbi Tang (Juanbi Tang, Bi-Syndrome Dispelling Decoction). If arm pain results from sitting or lying down while exposed to Wind-Dampness, or sleeping with arms outside the covers exposing them to Cold pathogens, Wuji San (Wuji San, Five Accumulations Powder), Juanbi Tang (Juanbi Tang, Bi-Syndrome Dispelling Decoction), and Wuyao Shunqi San (Wuyao Shunqi San, Linnaeae Root and Magnolia Bark Powder) are appropriate. If dampness is confirmed as the cause, add Cangzhu (Atractylodis Rhizoma) three spoons and Fangji (Stephaniae Tetrandrae Radix) four fen to each dose of Juanbi Tang (Juanbi Tang, Bi-Syndrome Dispelling Decoction), or use Wubi Tang (Wubi Tang, Five Bi Syndrome Decoction).
For arm pain caused by severe tendon injury from lifting heavy objects, Hupo San (Hupo San, Amber Powder), Jie Lao San (Jie Lao San, Labor-Exhausting Relief Powder), or Heqi Yin (Heqi Yin, Harmonizing Qi Decoction) are suitable. Add Bai Jianghuang (Curcumae Longae Rhizoma) half a qian per dose, as Jianghuang enters the arm meridians. When phlegm-fluids infiltrate the four limbs, causing soreness and pain in the shoulders and back, along with weakness and numbness in both hands, misdiagnosing this as Wind pathogen leads to incorrect treatment. Daotan Tang (Daotan Tang, Phlegm-Resolving Decoction) added with Muxiang (Aucklandiae Radix) and Jianghuang (Curcumae Longae Rhizoma), half a qian each, is indicated. If ineffective, mild cases are treated with Zhimi Fuling Wan (Zhimi Fuling Wan, Finger-Mystifying Poria Pill), and severe cases with Kongxian Dan (Kongxian Dan, Fluid-Draining Pill). (To treat arm pain, Kongxian Dan (Kongxian Dan, Fluid-Draining Pill) can be modified by adding one liang of de-oiled Mengzi (Momordicae Semen) and five qian of Guizhi (Cinnamomi Ramulus). Take twenty pills per dose, gradually increasing to thirty.)
Additionally, arm pain may arise from Blood deficiency failing to nourish the sinews. In such cases, combine half a portion of Juanbi Tang (Juanbi Tang, Bi-Syndrome Dispelling Decoction) and Sini Tang (Sini Tang, Four Substances Decoction), mix evenly, and decoct for administration. For arm pain caused by stagnation of Qi and Blood obstructing the meridians, Shujin Tang (Shujin Tang, Sinew-Relaxing Decoction) is indicated.
Another prescription for treating arm pain consists of: Banxia (Pinelliae Rhizoma) one qian, Chenpi (Citri Reticulatae Pericarpium) half a qian, Fuling (Poria) five fen, Cangzhu (Atractylodis Rhizoma) two qian, Weilingxian (Syneirae Caulis) five fen, Jiuhuangqin (Scutellariae Radix fried with wine), Baizhu (Atractylodis Macrocephalae Rhizoma), Nanting (Arisomatis Tuber), and Xiangfu (Cyperi Rhizoma) one qian each, and Gancao (Glycyrrhizae Radix et Rhizoma) a small amount. Honghua (Carthami Flos) and Shenqu (Massa Medicata Fermentata) are stir-fried and ground into powder. Another formula contains: Jianghuang (Curcumae Longae Rhizoma) four liang, Gancao (Glycyrrhizae Radix et Rhizoma) and Qianghuo (Notopterygii Rhizoma et Radix) one liang each, and Baizhu (Atractylodis Macrocephalae Rhizoma) two liang.
Fuling Wan (Fuling Wan, Poria Pill) treats arm pain with miraculous effect. Ingredients: Chi Fuling (Poria with Red Skin), Fangfeng (Saposhnikoviae Radix), Xixin (Asari Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Zexie (Alismatis Rhizoma), and Guigui (Cinnamomi Cortex) each half a liang; Guagualugen (Trichosanthis Radix), Ziwan (Asternatis Radix), Fuzi (Aconiti Lateralis Radix Praeparata), Huangqi (Astragali Radix), Shaoyao (Paeoniae Radix), and Zhigancao (Glycyrrhizae Radix et Rhizoma processed with honey) each seven qian half; Shengdihuang (Rehmanniae Radix), Niuxi (Achyranthis Bidentatae Radix soaked in wine), Shanyu (Dioscoreae Rhizoma), Duhuo (Angelicae Pubescentis Radix), Banxia (Pinelliae Rhizoma soaked in wine), and Shanzhuyu (Corni Fructus) each two qian half. Grind into fine powder, process with refined honey into pills the size of paulownia seeds. Take ten pills per dose with warm wine.
[Hand Qi and Swollen/Painful Hands] If pain extends from the palm and fingers to the arm, Wubi Tang (Wubi Tang, Five Bi Syndrome Decoction) and Juanbi Tang (Juanbi Tang, Bi-Syndrome Dispelling Decoction) are suitable. Bo Gui (Cinnamomi Cortex, thin variety) has a bland flavor and can travel horizontally through the arms, guiding other herbs to the painful area. Bai Jianghuang (Curcumae Longae Rhizoma) effectively guides medicinal action to the arms and is particularly excellent.