痛痹者，寒气偏胜，阳气少，阴气多也。夫宜通而塞，则为痛。痹之有痛，以寒气入经
而稽
迟，泣而不行也。治宜通引阳气，温润经络，血气得温而宣流，则无壅闭矣。河间云∶痹气
身寒，如从水中出者，气血不行，不必寒伤而作，故治痛痹者，虽宜温散寒邪，尤要宣流壅
闭也。
没药散 治遍身百节走注疼痛。
没药（二两，另研） 虎骨（四两，酥炙）
上为细末，每服五钱，酒下，日三服。
一粒金丹
草乌头（锉炒） 五灵脂（各一两） 地龙（去皮，炒） 木鳖子（各半两） 白胶香（一两，
另研） 当归（去芦，一两） 麝香（一钱，另研）
上为细末，糯米糊丸梧子大，每服三丸，温酒下，服药后微汗为效。原方有细墨、乳香
各半
两，没药一两。八神丹有防风，无当归、细墨、麝香、没药，面糊丸。酒服十丸，云汗出则
群麻自散。
着痹者，湿气胜也。夫湿，土气也，土性重缓，营卫之气与湿俱留，则着而不移，其症
多汗而濡，其病多着于下，有挟寒、挟热、在气、在血之异，须审而治之。
经验加味二妙丸（方见香港脚脚膝肿痛。）
治湿热在下在血之剂，两足湿痹疼痛，或如火燎，从足跗热起，渐至腰胯，或麻痹痿软
，皆是湿热为病，此药主之。一方无萆 ，有虎胫骨一两。
又治妇人脚疼怕冷，夜剧日轻。
生地 白芍 归梢（各五钱） 黄柏（炒） 黄芩 白术 苍术 陈皮（各三钱） 牛膝（二
钱） 甘草（一钱）
上分四服，水煎，带热服。
按∶足三阴虚而湿热袭之，多为脚痛，二术、二黄并除湿热，地、芍、归、膝益阴，陈
皮、甘草和中，阴气益则热易清，中气和则湿易除，与加味二妙同一机轴。
除热蠲痛汤 湿痹气分多者，用此分而消之。
苍术（米泔浸，炒） 白术 羌活 茯苓 泽泻 陈皮（各一钱） 甘草（五分）
水煎，入姜汁、竹沥各二三匙。
大羌活汤
羌活 升麻（各一钱） 独活（七分） 苍术 防风 甘草 威灵仙 茯苓 当归 泽泻（
各五分）
上锉作一服，水二盏，煎至一盏，温服，食前后各一服。忌酒面生冷硬物。
罗谦甫云∶真定张大，素嗜酒。五月间病手指节肿痛，屈伸不利，膝膑亦然，心下痞闷
体沉重，不欲食，食即欲吐，面色痿黄，精神短少。至六月间，求予治之。诊其脉，沉而缓，
缓者脾也。《难经》云∶俞主体重节痛，俞者脾之所主，四肢者脾之所属。盖其人素嗜酒
加之时助湿气大胜，流于四肢，故为肿痛。《内经》云∶诸湿肿满，皆属脾土。仲景云∶湿
流关节，肢体烦疼，此之谓也。《内经》云∶湿
淫于内，治以苦温，以苦发之，以淡渗之。又云∶风胜湿，羌活、独活苦温，透关节而胜湿
，故以为君；升麻苦平，威灵仙、苍术、防风，苦辛温发之者也，故以为臣；血壅而不流则
痛，当归辛温以散之，甘草甘温益气，泽泻咸平，茯苓甘平，导湿而利小便，以淡渗之，使
气味相合，上下分散其湿也。
痛痹，是由于寒气偏盛，导致阳气不足、阴气过盛所致。凡是应当通畅的经络却发生阻滞，就会产生疼痛。痹证之所以出现疼痛，是因为寒气侵入经脉，使气血运行迟缓、涩滞而不流通。治疗宜通引阳气，温润经络，使气血得到温煦而宣通流畅，则无壅塞闭阻之弊。刘河间说：痹证患者身体寒冷，如同刚从水中出来一样，这是因为气血不能运行，并非一定是寒邪直接损伤所致，所以治疗痛痹者，虽然适宜温散寒邪，但更重要的是宣通流布被壅闭的气血。
没药散，治疗全身各个关节游走性疼痛。
没药（二两，单独研磨），虎骨（四两，用酥油炙烤）
以上药物研成细末，每次服用五钱，用酒送服，每日三次。
一粒金丹
草乌头（切碎炒制），五灵脂（各一两），地龙（去皮带皮，炒制），木鳖子（各半两），白胶香（一两，单独研磨），当归（去芦头，一两），麝香（一钱，单独研磨）
以上药物研成细末，用糯米糊制成梧桐子大小的丸剂，每次服用三丸，用温酒送服，服药后微微出汗为有效。原方中还有细墨、乳香各半两，没药一两。八神丹中有防风，没有当归、细墨、麝香、没药，用面糊制丸。酒送服十丸，据说出汗后各种麻木症状自然消散。
着痹，是由于湿气偏盛所致。湿，属于土之气，土的特性是沉重且缓慢，营卫之气与湿邪俱留体内，就会附着固定不移，其症状多为出汗且皮肤湿润，其病变多发生在身体下部，有兼夹寒邪、兼夹热邪、在气分、在血分的不同，必须仔细辨证后进行治疗。
经验加味二妙丸（方剂见“香港脚脚膝肿痛”条下）。
这是治疗湿热在下焦且在血分的方剂，主治两足湿痹疼痛，或者如火烧般灼热，从足背热起，逐渐蔓延至腰胯，或者出现麻痹痿软，都是湿热致病，此药为主治方。另一版本方中没有萆薢，有一两虎胫骨。
又用于治疗妇人脚疼怕冷，夜间加重白天减轻。
生地，白芍，归梢（各五钱），黄柏（炒制），黄芩，白术，苍术，陈皮（各三钱），牛膝（二钱），甘草（一钱）
以上药物分为四服，水煎煮，趁热服用。
按语：足三阴经虚损而湿热侵袭，多导致脚痛，苍术、白术和黄柏、黄芩共同清除湿热，地黄、白芍、当归、牛膝滋补阴液，陈皮、甘草调和脾胃，阴气充足则热易清，中气调和则湿易除，这与加味二妙丸的原理相同。
除热蠲痛汤，适用于湿痹在气分较多的情况，用此方分别消除。
苍术（米泔水浸泡，炒制），白术，羌活，茯苓，泽泻，陈皮（各一钱），甘草（五分）
水煎煮，加入姜汁、竹沥各二三匙。
大羌活汤
羌活，升麻（各一钱），独活（七分），苍术，防风，甘草，威灵仙，茯苓，当归，泽泻（各五分）
以上药材切碎为一服量，用水两盏，煎至一盏，温服，饭前饭后各服一次。忌食酒、面食、生冷坚硬之物。
罗谦甫说：真定人张大，平时嗜好饮酒。五月间发病，手指关节肿痛，屈伸不利，膝盖也如此，心下痞闷，身体沉重，不想吃东西，吃了就想吐，面色萎黄，精神短少。到六月间，求我治疗。诊察他的脉象，沉而缓，缓脉主脾。《难经》说：俞穴主体重节痛，俞穴由脾所主，四肢也是脾所管辖。大概此人平素嗜酒，加之时令助长湿气大胜，流注于四肢，所以出现肿痛。《内经》说：各种湿邪导致的肿胀满闷，都归属于脾土。张仲景说：湿邪流注关节，肢体烦扰疼痛，说的就是这种情况。《内经》说：湿邪淫溢于内，用苦温之法治疗，用苦味发散它，用淡味渗利它。又说：风能胜湿，羌活、独活性味苦温，能透达关节而胜湿，所以作为君药；升麻苦平，威灵仙、苍术、防风，是用苦辛温之性发散湿邪，所以作为臣药；血液壅滞不流通则疼痛，当归辛温以散之，甘草甘温以益气，泽泻咸平，茯苓甘平，引导湿邪并通利小便，用淡味渗利之法，使药气味相合，上下分散湿邪。
Painful Bi (Tongbi) is caused by an excess of Cold pathogen, leading to a deficiency of Yang Qi and an abundance of Yin Qi. Where there should be free flow but obstruction occurs, pain results. The pain in Bi syndrome arises because Cold enters the meridians, causing Qi and Blood to move slowly, stagnate, and fail to circulate. Treatment should aim to guide and unblock Yang Qi, warm and moisten the meridians; when Qi and Blood are warmed, they will circulate freely, eliminating stagnation and blockage. Liu Hejian stated: In Bi syndrome, the body feels cold as if just emerging from water due to the non-circulation of Qi and Blood; this does not necessarily require direct injury by Cold pathogens. Therefore, in treating Painful Bi, although it is appropriate to warm and disperse Cold pathogens, it is even more crucial to promote the circulation of stagnant Qi and Blood.
Moyao San (Myrrh Powder) treats wandering pain throughout all joints of the body.
Myrrha (2 liang, ground separately), Tiger Bone (4 liang, roasted with su [animal fat])
Grind into fine powder. Take 5 qian per dose, administered with wine, three times daily.
Yili Jin Dan (One Pill Golden Elixir)
Caowutou (Aconiti Kusnezoffii Radix, chopped and stir-fried), Wulingzhi (Trogopterori Faeces, each 1 liang), Dilong (Pheretima, skin removed, stir-fried), Mubiezi (Strychni Semen, each half liang), Baijiaoxiang (Boswelliae Resina, 1 liang, ground separately), Danggui (Angelicae Sinensis Radix, radix removed, 1 liang), Shexiang (Moschus, 1 qian, ground separately)
Grind into fine powder, make pills using glutinous rice paste, size of wu zi (wuju fruit seeds). Take 3 pills per dose with warm wine. Slight sweating after medication indicates efficacy. The original formula also included Ximo (Fine Inkstone) and Ruxiang (Boswelliae Resina) each half liang, and Moyao 1 liang. Bashen Dan contains Fangfeng but lacks Danggui, Ximo, Shexiang, and Moyao, made into pills with wheat flour paste. Take 10 pills with wine; it is said that sweating will dissipate all numbness.
Zhuo Bi (Fixed Bi) is caused by an excess of Dampness. Dampness belongs to the Earth element; Earth's nature is heavy and slow. When Ying and Wei Qi remain together with Dampness, they become fixed and immobile. Symptoms often include sweating and damp skin; the disease tends to manifest in the lower body. There are variations involving accompanying Cold or Heat, involvement of the Qi level or Blood level, requiring careful differentiation for treatment.
Jingyan Jiawei Ermiao Wan (Empirical Modified Erniao Pills) (See formula under "Hongkong Foot Swollen Knees").
This is a formula for treating Damp-Heat in the lower jiao affecting the Blood level. It treats painful wet Bi in both legs, burning like fire starting from the dorsum pedis and spreading to the waist and hips, or presenting as numbness and flaccidity. All these are caused by Damp-Heat, which this formula addresses. Another version omishes Bibi and includes 1 liang of Hu Jinggu (Tiger Tibia Bone).
It also treats women with foot pain and aversion to cold, worsening at night and improving during the day.
Shengdi (Rehmanniae Radix), Baishao (Paeoniae Radix Alba), Guishao (Radix Angelicae Sinensis tip, each 5 qian), Huangbai (Phellodendri Cortex, stir-fried), Huangqin (Scutellariae Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Cangzhu (Atractylodis Rhizoma), Chenpi (Citri Reticulatae Pericarpium, each 3 qian), Niuxi (Achyranthis Bidentatae Radix, 2 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 1 qian)
Divide into four doses, decoct in water, take while hot.
Note: Deficiency of the Three Yin Meridians of the Foot combined with Damp-Heat invasion often causes foot pain. Cangzhu and Baizhu, along with Huangbai and Huangqin, jointly eliminate Damp-Heat; Shengdi, Baishao, Danggui, and Niuxi nourish Yin; Chenpi and Gancao harmonize the Middle Jiao. When Yin is sufficient, Heat is easily cleared; when Middle Qi is harmonized, Dampness is easily removed. This shares the same mechanism as the modified Erniao Wan.
Chure Juan Tong Tang (Remove Heat and Relieve Pain Decoction) is used for Wet Bi where Qi-level involvement predominates, to separate and resolve it.
Cangzhu (Soaked in rice wash water, stir-fried), Baizhu, Qianghuo (Notopterygii Rhizoma et Radix), Fuling (Poria), Zexie (Alismatis Rhizoma), Chenpi (each 1 qian), Gancao (0.5 qian)
Decoct in water, add Jiangzhi (Zingiberis Recens Juice) and Zhuli (Bambusae Caulis in Taenia) two to three spoons each.
Da Qianghuo Tang (Great Notopterygium Decoction)
Qianghuo, Shengma (Cimicifugae Rhizoma, each 1 qian), Duhuo (Angelicae Pubescentis Radix, 0.7 qian), Cangzhu, Fangfeng (Saposhnikoviae Radix), Gancao, Weilingxian (Clematidis Radix et Rhizoma), Fuling, Danggui, Zexie (each 0.5 qian)
Cut into pieces for one dose. Add two cups of water, decoct to one cup, take warm. One dose before meals and one after meals. Avoid alcohol, wheat products, raw/cold, and hard foods.
Luo Qianfu stated: Zhang Da from Zhengding had a habit of drinking alcohol excessively. In May, he developed swelling and pain in finger joints with limited flexion and extension, similarly affecting his knees. He experienced epigastric fullness, heaviness of the body, anorexia, nausea upon eating, sallow complexion, and shortness of spirit. In June, he sought my treatment. His pulse was deep and slow; a slow pulse indicates Spleen issues. The Nan Jing states: Shu points govern weight and joint pain; Shu points are governed by the Spleen, and the limbs belong to the Spleen. Given his excessive alcohol consumption and seasonal factors amplifying Dampness, which flowed into the limbs, swelling and pain resulted. The Nei Jing states: All dampness-induced swelling and fullness belong to Spleen Earth. Zhang Zhongjing stated: When Dampness flows into joints, it causes limb discomfort and pain. The Nei Jing also states: For internal Dampness excess, treat with bitter-warm methods, use bitter flavors to disperse, and bland flavors to leach out. Furthermore, Wind overcomes Dampness. Qianghuo and Duhuo are bitter-warm, penetrating joints to overcome Dampness, thus serving as Sovereign herbs. Shengma is bitter-ping; Weilingxian, Cangzhu, and Fangfeng are bitter-acrid-warm dispersants, serving as Minister herbs. Blood stagnation causes pain; Danggui is acrid-warm to disperse it. Gancao is sweet-warm to tonify Qi. Zexie is salty-ping; Fuling is sweet-ping. They guide Dampness and promote urination via bland leaching, allowing the medicinal properties to combine and disperse Dampness up and down.