《鬼遗》云∶垂臂两处发，接骨下臂鹅上，起如鸡鸭卵大，皆由荣卫不调所为也。喜患
实处而不透内，亦宜急消，或发穴早疗。两臂肘起，在接骨下引手，至小骨之上发痈疖，
此处虽实，奈连大小筋骨，举动不便，垂手多坠疼，如脓深沉彻骨，即伤筋脉，拳缩不
舒搐撮，宜急以缓慢筋脉药饵治之。《玄机》云∶在臂外为痈。在臂内为鱼肚发，在
臂上节肿连肩髁，为臂风毒。宜活命饮加羌活、独活、桂枝、桔梗，水酒各半煎服，及
夺命丹、紫金丹、胜金丹选用。壮实有里证者，一粒金丹、八阵散下之。若漫肿无头，服
败毒之药不能消者，宜十全大补汤加桂枝、桔、梗托之。有呕吐而数日不食者，溃出脓则愈。
〔治验〕
一人年将六十，五月患右臂膊肿盛，上至肩，下至手指，色变皮肤凉，六脉沉细而
微，此脉证俱寒，乃附骨痈也。开发已迟，以燔针启之，脓清稀解；次日时下再开之，加
吃逆不绝。与丁香柿蒂散，两服稍缓，次日吃逆尤甚，自利，脐腹冷痛，腹满食减，时
发昏愤，灸左乳下黑尽处二七壮，又处托里温中汤一两半与服。或曰∶诸痛疮疡，皆属
心火。又时当盛暑，而用姜附可乎？予曰∶经云，脉细皮寒，泻利前后，饮食不入，是为
五虚。况吃逆胃中虚寒，此证内外相反，须当舍时从证。遂投之，诸证悉去，饮食倍进，
疮势温，脓色正，复用五香汤数服，月余而愈。（机按∶此证多属虚寒，此方专用辛热以治其寒，
不用参术以补其虚，盖固吃逆腹满，乃气都壅也。想必其人年虽老，脉证虽虚而形体颇实，非阴虚吃逆
比。） 一挥使，臂肿一块，不痛不赤，脉弱懒
食，时呕。以六君子加藿香、酒炒芍药，呕止食进，再以八珍汤二十余剂，脓成刺之，又
以十全大补汤而愈。次年伤寒后，臂复肿微痛，乃伤寒余毒也，然无表证，但虚弱耳。先
用十宣散四剂，取参、 、芎、归扶助元气，防风、桔梗、白芷、浓朴行散肿结，肉桂引
经破血，肿退三四，再用八珍汤脓溃而愈。至冬臂复作痛，因服祛风药，反筋挛痛甚，此
血虚不能养筋，筋虚不能束骨，用加味十全大补汤百帖而愈。 一女臂患肿，溃久不敛，
寒热交作，五心烦热，饮食少思，月水不通，以逍遥散月余少可，更服八珍汤加丹皮、香
附，又月余经通，再加黄 、白蔹，两月余而愈。 一人臂肿、患毒作痛，服寒凉药，食
少大便不实。予用理中丸二服，更以六君子加砂仁、藿香，再以托里，脓溃而愈。凡疮
痛甚者，若禀浓有火，宜苦寒药。若禀薄者，宜补中益气汤加芩、连之类，在下加黄柏，人
肥加荆防、独、羌之类，取其风能胜湿也。一妇左臂，胆经部分，结肿一块，年许不溃。
坚硬不痛，肉色不变，脉弱少食，月水过期，日晡发热。过劳或怒则痛，此不足证也。与
参、 、归、术、芎、 、芍药、贝母、远志、香附、桔梗、丹皮、甘草，百余帖而消。
一人臂患漏，口干发热，喜脓不清稀，脉来迟缓，灸以豆豉饼。服八珍汤，加麦门、五
味、软柴胡、地骨皮，三月余而愈，后因房劳，复溃脓清，脉大，辞不治，果殁。河间
曰∶因病致虚为轻，盖病势尚浅，元气未虚也。若病初愈，或饮食、劳倦、房室，加至
羸损，此因虚致损则为重，病势已过，元气已索故也。一儿臂患痘毒，作炒按之复起，
此脓胀痛也，刺之，以托里药愈。 一妇臂结一块，已溃不敛，灸以豆豉饼，更服托里
药而愈。 一人年逾三十，素怯弱，不能食冷，臂患一毒，脉虚弱，予以托里药而消，但
饮食少思，或作胀，或吞酸，日渐羸瘦，参苓等药不应，右尺脉弱，此命门火衰不能生
土，遂以八味丸补土之原，饮食渐进而愈。一媪左臂结核，年余方溃，脓清不敛，以十
全大补汤，外用附子饼灸，及贴补药膏，调护得宜，百帖而愈。 一人多虑神劳，年近
五十，左膊外侧红肿如粟。予曰∶勿轻视！得独参汤数斤乃佳。数帖而止，旬余值大风拔
木，疮上起一红线，绕背抵右肋，兴大料人参汤加芎术补剂，两月而安。 一妇臂痛，筋
挛不能屈伸，遇寒则剧，脉紧细，此良甫所谓肝气虚，为风寒流于血脉经络，搏于筋，筋
不荣，则干急为痛，先用舒筋汤，次用四物汤加牡丹皮、泽兰、白术而愈。亦有臂痛不
能举，或转左右作痛，由中脘伏痰，脾气滞不行，宜茯苓丸或控涎丹治之。 一人手臂
结核如粟，延至颈项，状似瘰 ，此风湿流注。用加减小续命汤，及独活寄生汤，更以
托里药、倍加参、 、归、术，百帖而愈。（机按∶此条有证无脉，认作风湿流注而治，当时必有所
见也。后用补剂百帖而愈，是终不离于虚也。）一儿三岁，臂患毒 痛，服解毒丸，搽神功散
而消。（此条证脉不详，当时必有所见。）尝治臂毒，便闭烦躁，服五福化毒丹亦效。若脓成急刺，
用纸捻醮麻油 疮内，以膏药贴之。若儿安静，不必服药，候有脓取去，仍用 贴。一人臂患疽，
脉数，饮槐花酒一服，势顿退；再与金银花、黄 、甘草十余服而平。（槐花治湿热之功最为神速，胃寒不
宜过剂。） 尹老家贫，形志皆苦，自幼颓疝，孟冬于手阳明大肠经分出痈，第四日稠脓，臂外皆肿痛，在手
阳明左右经中，其脉俱弦，按之洪缓有力，此得自八风之变。以脉断之，邪气在表，饮食
如常，大小便如故，腹中和，口知味，知不在里也，不恶风寒，只热躁，脉不浮，知不
在表也，表里既和，邪在经脉之中，故曰∶凝于血脉为痈是也。痈出身半以上，故风从上
受，因知为八风之变，而疮只在经脉之中，法当却寒，调和经脉中血气，使无凝滞可愈矣，
宜以白芷升麻汤。（机按∶此方举一身而言，故阳明为一身之中，若以各经言之，而阳明亦自有表里中
三等之剂，太阳亦有表里之中之方，余经皆可以类推
也。） 一人年逾三十，臂患痈，溃而不痛，脓稀脉弱。丹溪曰∶疽溃深而不痛者，胃气大
虚，不知痛也。东垣曰∶脓水清稀，疮口不合，气血俱虚也，理宜大补。彼不听，服消
毒药，气血愈虚，遂不救。丹溪曰∶才见肿痛，参之脉证，倘有虚弱，便与滋补气血可
保终吉。又曰∶溃疡内外皆虚，补接为主。兹则见善不从，自用己智，宁免死乎。 一人
年逾四十，臂患毒， 痛作呕，服托里消毒药愈盛。予用凉膈散二剂顿退，更以四物汤
加苓、连四剂而消。（机按∶此所谓肿疡热毒攻心而作呕也。） 一人两臂肿痛，服托里药日盛。予
谓∶肿属湿，痛属火，此湿热流注经络也，用人参败毒散加威灵仙、酒炒黄芩、南星，数
剂渐愈，更以四物汤加苍术、黄柏、桔梗二十余剂而消。（按∶此托里药日盛，故改作湿热治也。）
一尚书，左臂肘患一紫泡，根畔肿赤，大肠脉芤。予谓∶芤主失血或积血。公曰∶血
痢未瘳，以芍药汤二剂，更以人参败毒散二剂，疮痢并愈。（机按∶用芍药汤以治血痢，用败毒
散以治紫泡，但所录脉证未甚详悉，观其治法，多属血热而近实也。）
白芷升麻汤 治臂上生痈。
白芷（一钱半） 升麻 桔梗（各一钱） 酒黄芩（四钱） 生黄芩（三钱） 红花 甘草（炙，各半钱）
上作一服。水二盅，酒半盅，煎至八分，食后服。
《鬼遗抄》说：手臂垂下时，在两个部位发病，位于接骨（桡骨茎突）下方、臂鹅（前臂肌肉隆起处）上方，肿块大小如同鸡鸭蛋，这都是由于营卫之气不调所致。这种病喜欢发生在实处而不向内部穿透，也应当尽快消除，或者尽早切开排脓治疗。两臂肘部发病，位于接骨下方并牵引至手部，在小骨之上发生痈疖，此处虽然表现为实证，但连接着大小筋骨，导致活动不便，垂手时多有坠痛感；如果脓液深沉彻骨，就会损伤筋脉，出现手指拳缩、不能舒展、抽搐拘挛的症状，应当急忙使用舒缓筋脉的药物进行治疗。
《玄机经》说：发于臂外侧的为痈；发于臂内侧的称为鱼肚发；发于臂上节肿胀并连及肩髎穴的，称为臂风毒。适宜使用活命饮加羌活、独活、桂枝、桔梗，用水和酒各半煎服，以及选用夺命丹、紫金丹、胜金丹。体质壮实且有里证的患者，服用一粒金丹、八阵散攻下。如果是漫肿无头，服用败毒药物不能消散的，适宜使用十全大补汤加桂枝、桔梗以托毒外出。如果有呕吐且数日不进食的情况，溃破流出脓液后就会痊愈。
【治验】
有一人将近六十岁，五月患右臂膊肿胀严重，向上至肩部，向下至手指，皮肤颜色改变且发凉，六脉沉细而微弱，这是脉象与证候都属寒的表现，乃是附骨痈。治疗已经延误，用燔针（烧红的针）开启排脓，流出的脓液清稀；第二天下午再次切开排脓，随后出现不停打嗝（呃逆）。给予丁香柿蒂散，服用两剂后稍缓解，第二天打嗝更加严重，伴有自发性腹泻，脐腹冷痛，腹部胀满，食欲减退，时常发作昏闷。灸左乳下黑色尽处十四壮，又给予托里温中汤一两半服用。有人说：“各种疼痛疮疡，都属于心火。”又说当时正值盛夏，使用姜、附子等大热药可以吗？我说：“经典记载，脉细、皮寒、前后二便泄利、饮食不入，这称为五虚证。况且打嗝是胃中虚寒所致，这个证候内外表现相反，应当舍去时令而从证候论治。”于是投以此药，所有症状全部去除，饮食加倍增加，疮势转温，脓色正常，又服用几剂五香汤，一个多月后痊愈。（王机按：此证多属于虚寒，此方专门用辛热药来治疗其寒，不用参、术来补其虚，大概是因为打嗝、腹满是气机壅滞所致。想必此人虽然年老，脉证虽虚但形体颇实，不同于阴虚引起的打嗝。）
另一患者，手臂肿胀一块，不痛不红，脉弱，懒食，时常呕吐。使用六君子汤加藿香、酒炒芍药，呕吐停止，食欲增进，再服用二十余剂八珍汤，脓成后刺破，又以十全大补汤治愈。次年伤寒后，手臂再次轻微肿胀疼痛，这是伤寒余毒所致，然而没有表证，只是身体虚弱而已。先用十宣散四剂，取人参、[缺字]、川芎、当归扶助元气，防风、桔梗、白芷、浓朴行散肿结，肉桂引经破血，肿胀消退三四分，再用八珍汤，脓溃后痊愈。到了冬天手臂再次作痛，因为服用祛风药，反而导致筋挛疼痛加剧，这是血虚不能养筋，筋虚不能束骨，使用加味十全大补汤一百帖而愈。
一女患者手臂患病肿胀，溃破久不收敛，寒热交替发作，五心烦热，饮食少思，月经不通，服用逍遥散月余后稍有好转，更服用八珍汤加丹皮、香附，又过月余月经通畅，再加黄芪、白蔹，两个月多后痊愈。
一人手臂肿胀，患毒作痛，服用寒凉药后，食少大便不实。我用理中丸两服，再以六君子汤加砂仁、藿香，接着用托里药，脓溃后痊愈。凡是疮痛严重的，如果禀赋浓厚有火，宜用苦寒药。如果禀赋薄弱者，宜用补中益气汤加黄芩、黄连之类，在下肢加黄柏，人肥胖加荆芥、防风、独活、羌活之类，取其风能胜湿的道理。
一妇患者左臂，胆经部分，结肿一块，一年左右未溃。坚硬不痛，肉色不变，脉弱少食，月经过期，傍晚发热。过度劳累或发怒则痛，这是不足证。给予人参、黄芪、当归、白术、川芎、[缺字]、芍药、贝母、远志、香附、桔梗、丹皮、甘草，百余帖后消散。
一人手臂患漏管，口干发热，喜欢脓液不清稀，脉来迟缓，用豆豉饼灸法。服用八珍汤，加麦门冬、五味子、软柴胡、地骨皮，三月多后痊愈，后来因房事劳累，再次溃破脓液清稀，脉大，拒绝治疗，果然死亡。河间说：因病致虚为轻症，因为病势尚浅，元气未虚。如果病初愈，或因饮食、劳倦、房室不慎，加重至羸损，这因虚致损则为重症，因为病势已过，元气已耗尽的缘故。
一小儿手臂患痘毒，按压后复起，这是脓胀痛，刺破后，用托里药治愈。
一妇手臂结块，已溃不敛，用豆豉饼灸，再服用托里药而愈。
一人年过三十，素来怯弱，不能食冷，手臂患一毒，脉虚弱，给予托里药而消散，但饮食少思，有时腹胀，有时吞酸，日渐消瘦，服用参苓等药无效，右尺脉弱，这是命门火衰不能生土，遂用八味丸补土之原，饮食渐进而痊愈。
一老妇人左臂结核，一年多才溃破，脓清不敛，用十全大补汤，外用附子饼灸，及贴补药膏，调护得当，一百帖后痊愈。
一人多虑神劳，年近五十，左膊外侧红肿如粟米状。我说：“不要轻视！得独参汤数斤才好。”服用数帖后停止，十多天后遇到大风拔木，疮上起一道红线，绕背抵右肋，用大料人参汤加川芎、白术补剂，两个月后安宁。
一妇患者臂痛，筋挛不能屈伸，遇寒则加剧，脉紧细，这是良甫所说的肝气虚，风寒流于血脉经络，搏结于筋，筋失荣养，则干枯紧急而为痛，先用舒筋汤，次用四物汤加牡丹皮、泽兰、白术而愈。也有臂痛不能举，或转动左右作痛，由中脘伏痰，脾气滞不行，宜用茯苓丸或控涎丹治疗。
一人手臂结核如粟米，延至颈项，状似瘰疬，这是风湿流注。用加减小续命汤，及独活寄生汤，更以托里药、倍加人参、黄芪、当归、白术，一百帖后痊愈。（王机按：此条有证无脉，认作风湿流注而治，当时必有所见也。后用补剂百帖而愈，是终不离于虚也。）
一儿三岁，手臂患毒疼痛，服用解毒丸，搽神功散而消散。（此条证脉不详，当时必有所见。）曾治臂毒，便秘烦躁，服用五福化毒丹也有效。若脓成急刺，用纸捻蘸麻油探入疮内，以膏药贴之。若儿童安静，不必服药，候有脓取出，仍用[缺字]贴。
一人手臂患疽，脉数，饮用槐花酒一服，势头顿退；再与金银花、黄芪、甘草十余服而平。（槐花治湿热之功最为神速，胃寒不宜过剂。）
尹老家贫，形志皆苦，自幼患颓疝，孟冬时节在手阳明大肠经分出痈，第四天出稠脓，臂外皆肿痛，在手阳明左右经中，其脉俱弦，按之洪缓有力，这是得自八风之变。以脉断之，邪气在表，饮食如常，大小便如故，腹中和，口知味，知道不在里；不恶风寒，只热躁，脉不浮，知道不在表。表里既和，邪在经脉之中，所以说：“凝于血脉为痈”就是这种情况。痈出身半以上，所以风从上受，因此知道是八风之变，而疮只在经脉之中，法当驱除寒气，调和经脉中血气，使无凝滞即可痊愈，适宜用白芷升麻汤。（王机按：此方举一身而言，故阳明为一身之中，若以各经言之，而阳明亦自有表里中等之剂，太阳亦有表里中之方，其余各经皆可类推。）
一人年过三十，手臂患痈，溃破而不痛，脓稀脉弱。丹溪说：疽溃深而不痛的，是胃气大虚，不知痛也。东垣说：脓水清稀，疮口不合，是气血俱虚，理应大补。他不听，服用消毒药，气血更虚，最终不治身亡。丹溪说：刚见到肿痛，参合脉证，倘有虚弱，便给予滋补气血可保终吉。又说：溃疡内外皆虚，以补接为主。此时见善不从，自用己智，怎能避免死亡呢？
一人年过四十，手臂患毒，疼痛作呕，服用托里消毒药后病情更盛。我用凉膈散两剂顿退，再以四物汤加黄芩、黄连四剂而消散。（王机按：此所谓肿疡热毒攻心而作呕也。）
一人两臂肿痛，服用托里药后日益加重。我说：肿属湿，痛属火，这是湿热流注经络，用人参败毒散加威灵仙、酒炒黄芩、南星，数剂渐愈，再以四物汤加苍术、黄柏、桔梗二十余剂而消散。（按：此托里药日盛，故改作湿热治也。）
一尚书，左臂肘患一紫泡，根畔肿赤，大肠脉芤。我说：芤脉主失血或积血。公曰：血痢未愈，用芍药汤两剂，更以人参败毒散两剂，疮痢并愈。（王机按：用芍药汤以治血痢，用败毒散以治紫泡，但所录脉证未甚详悉，观其治法，多属血热而近实也。）
白芷升麻汤 治疗臂上生痈。
白芷（一钱半） 升麻 桔梗（各一钱） 酒黄芩（四钱） 生黄芩（三钱） 红花 甘草（炙，各半钱）
以上作一服。水二盅，酒半盅，煎至八分，食后服。
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.