Chen. Long-standing pain inevitably enters the collaterals (Luo Mai). Qi and blood fail to circulate, leading to yellowing of the skin; this is not jaundice. (This is due to blood stasis and obstruction in the collateral vessels.)
Prescription: Inulae Flos (Xuanfu Hua), Xinjiang (New Crimson Dye), Scallion Stem (Qingcong), Fried Peach Kernel (Chao Taoren), Tail of Angelica Sinensis Root (Danggui Wei)

Pang (48 years old). When collaterals are deficient, pain occurs. The patient is advanced in years, with complexion and pulse indicating decline. Originally, aromatic and acrid dispersants like Cyperi Rhizoma (Xiangfu) and Amomi Fructus (Doukou) cannot be effective. If physicians do not understand the methods for treating collateral diseases, treatment will only lead to further exhaustion.
Prescription: Fried Peach Kernel (Chao Taoren), Scallion Tube (Qingcong Guan), Cinnamon Twig (Guizhi), Raw Deer Antler (Sheng Lujiao), Tail of Angelica Sinensis Root (Guiwei)
This is a modified version of Xuanfu Hua Tang. The salty descending action of Inulae Flos is removed, and the ascending action of Deer Antler is added. Only the scallion tube in the formula can descend and unblock downwards; the rest are acrid and dispersing, moving horizontally, so that the medicinal power can reach every corner of the collaterals.

Second visit. Using acrid-moistening methods to unblock collaterals. The condition improved for twenty days but recurred due to overexertion, leading to vomiting above and constipation below. This constitutes Guange syndrome (obstruction at both upper and lower orifices), which is difficult to treat. Moreover, the pain has returned. Temporarily administer Yang-unblocking therapy.
Prescription: Asafoetida Pill (awei Wan), 4 qian, divided into four doses.

Li (46 years old). Accumulated injury enters the collaterals; Qi and blood become stagnant, causing loss of normal circulation. This is what is meant by "pain results from obstruction." For chronic illness, slow attacking methods should be used to avoid severe damage to healthy Qi.
Prescription: Peach Kernel (Taoren), Angelica Sinensis Root Tip (Guixu), Powdered Aquilaria Wood (Jiangxiang Mo), Small Fennel (Xiaohui), Pangolin Scales (Chuanshanjia), Tribulus Fruit (Bajili), Turmeric Rhizome Slice (Pian Jianghuang), Roasted Costus Root (Weimuxiang), Leek White Juice (Feibai Zhi) made into pills.

Yang (31 years old). Pain started in the tendons throughout the body, spreading to the abdomen, resulting in anorexia and constipation. The disease has been long-standing, entering the collaterals, making it difficult to eradicate completely.
Prescode: Radix Angelicae Sinensis Body (Guishen), Cinnamon Twig (Chuan Guizhi), Poria (Fuling), Biota Seed (Baiziren), Polygala Root (Yuanzhi), Scallion Tube (Qingcong Guan)

Zhang. Pain is a chronic condition; one must investigate the cause of its onset. Currently, there is bi-syndrome obstruction, distension, and stuffiness, with discomfort after eating. Following frequent vomiting, the rash has clearly emerged. This indicates that stale and accumulated Qi is knotted and consolidated. Through vomiting, the meridian Qi is now unblocked. Following Zhang Zhongjing's example for treating chestful agitation (Aonao), use Zhizi Chi Tang as the main prescription.

Second visit. The chest feels slightly relieved, but the waist and abdomen feel bound. There is a tendency for the Qi tunnels to open, yet the blood collaterals remain tightly knotted. The body fears cold and shivers. This is due to the dysfunction of Ying and Wei Qi, not comparable to aversion to cold caused by Yang deficiency. It is proposed to use methods to vent and unblock the collaterals.
Prescription: Angelica Sinensis Root Tip (Guixu), Powdered Aquilaria Wood (Jiangxiang), Scallion Tube (Qingcong Guan), Curcuma Aromatica Rhizome (Yujin), Xinjiang (Xinjiang), Biota Seed (Baiziren)

Huang. Pain causes Qi chaos and fever. The head does not hurt, there is no thirst or desire to drink, and the pulse is not floating. This is not an external contraction. Temporarily use Jinling San for one dose.
Prescription: Melia Toosendan Fruit (Jinlingzi), Fried Corydalis Rhizome (Chao Yanhusu), Fried Peach Kernel (Chao Taoren), Longan Aril (Guiyuan)

Second visit. Pain is slightly relieved by heavy pressure, indicating one aspect of collateral deficiency. On the other hand, Qi rebels and is chaotic, but acrid-aromatic Qi-breaking agents must be avoided. Following Zhang Zhongjing's discussion on Gan Zhuo (Liver Fixation) disease, apply the method of Xuanfu Hua Tang from Jingui Yaolue.
Prescription: Inulae Flos (Xuanfu Hua), Xinjiang (Xinjiang), Scallion Tube (Qingcong Guan), Peach Kernel (Taoren), Biota Seed Frost (Baizishuang), Tail of Angelica Sinensis Root (Guiwei)

Wang (Elderly woman). The pulse is small and choppy. Due to long-term depression, epigastric pain radiates to the back and hypochondrium. The disease has entered the blood collaterals, lingering for years. Additionally, having been vegetarian for several years has led to deficiency of the Yangming Stomach Qi, causing inability to raise the shoulders and arms. It is difficult to achieve quick results hastily; slow regulation is appropriate. It is proposed to tonify and moisten the blood collaterals. Do not use drying-hot herbs that consume Yin fluids.
Prescription: Angelica Sinensis Root Tip (Guixu), Biota Seed (Baiziren), Cinnamon Twig Wood (Guizhi Mu), Peach Kernel (Taoren), Raw Deer Antler (Sheng Lujiao), Turmeric Rhizome Slice (Pian Jianghuang)

Zhu. From the vertex of the head to the feet, there is numbness and stabbing pain, with intense heat. (This is latent heat hidden in the Yin divisions.)
Prescription: Zishen Wan

Zhang. Initially exposed to Cold-Dampness, which transformed into Heat over time, penetrating deeply into the Yin division. Pain must be severe at night. Physicians using blood-nourishing and wind-dispelling methods cannot directly penetrate the Yin division. It is proposed to use Dongyuan's Zishen Wan to search out and eliminate deep-seated latent pathogens.
Prescription: Cinnamon Bark (Rougui, 8 qian, avoid fire), Phellodendron Bark (Huangbai, 4 liang), Anemarrhena Rhizome (Zhimu, 4 liang). All stir-fried with salt water, made into water-honey pills.

Wang. The pulse is rapid and fine. Sudden pain is accompanied by hot swelling, and the pain comes rapidly. Considering the circulation of the Five Elements and Six Qi, nothing is faster than Fire and Wind. In old age, lipids and fluids have been consumed for a long time. The Qi of the human body must ascend on the left and descend on the right. Ministerial Fire resides in the Liver, Dragon Fire arises from the Kidney, and both emerge from the Yin. The root lies in prior deficiency of the foundation, lacking the function of storage and containment. Take Dongyuan's Zishen Wan, 3 qian daily, delivered with Qishi Soup, to drain latent heat in the Yin.

Xu (21 years old). Pain is due to disharmony of Qi and blood in the collaterals. Physicians must differentiate meridians and collaterals. Diseases of the Liver and Kidneys in the lower jiao inevitably involve the Eight Extraordinary Vessels. Ignorance of this principle leads to ineffectiveness. (Disharmony of Liver-Kidney and Extraordinary Vessel collaterals)
Prescription: Deer Antler Glue (Lujiaoshuang), Eucommia Bark (Sangjisheng), Lycium Fruit (Qizi), Angelica Sinensis Root (Danggui), Astragalus Complanatus Seed (Shayuan), Anemone Root (Baiwei), Dendrobium Stem (Chuan Shihu), Raw Eucommia Bark (Sheng Duzhong)

Fan. After illness, essence and spirit have not recovered. Excessive speech damages Qi; walking and moving tendons is called relapse due to labor. Sweet-warm herbs should be given to harmonize and nourish Qi and blood. Lower jiao pain is due to inherent deficiency of the Liver and Kidneys.
Prescription: Ginseng Root (Renshen), Angelica Sinensis Root stir-fried with Small Fennel (Xiaohui Xiang Ban Chao Danggui), Tribulus Fruit (Shayuan Jili), Spirit-calming Poria (Fushen), Fried Lycium Fruit (Chao Qizi), Charred Chrysanthemum Flower (Juhua Tan)

The Classic states: "All pain, itching, and sores belong to the Heart." The Heart governs Sovereign Fire, so naturally, one should discuss this from the perspective of Heat. However, this refers only to sores. In surgery, whether carbuncles or ulcers, there are Yin and Yang syndromes; one cannot solely adhere to Heat in discussion. Furthermore, in the "Treatise on Asking About Pain," among the fourteen items mentioned, only "Heat remaining in the Small Intestine" is primarily Heat; the rest are primarily Cold pathogen invasion. Therefore, most pain conditions are due to Cold, accounting for seven or eight tenths, while those due to Heat account for only two or three tenths. To distinguish between Cold and Heat, simply examine the painful area: does it prefer Cold and dislike Heat, or prefer Heat and dislike Cold? This reveals the nature of the condition. Regarding the treatment of Qi and Blood deficiency and excess, the ancients generally established legislation based on the character "Tong" (Unblocking/Regulating), which was already perfect. This "Tong" should not be mistakenly interpreted as purgative or draining methods. It means "unblocking Qi and Blood, then pain ceases." However, one must distinguish between Qi level and Blood level. At the Qi level, only move Qi; do not use heavy medicine for mild disease to attack the Blood. At the Blood level, one must simultaneously treat Qi, as "when Qi moves, Blood follows." If the syndrome is excess, with Qi stagnation and Blood coagulation, unblocking Qi and dispersing Blood will cure it. If the syndrome is deficiency, with weak Qi unable to propel and deficient Blood unable to nourish, treatment should tonify Qi and Blood, incorporating unblocking within tonification. This is a general outline. As for various pain syndromes, the threads are numerous. Internal causes (Seven Emotions) first injure the Zang-Fu organs before reaching the muscles and body; external causes (Six Qi) first injure the muscles and body before entering the Zang-Fu organs. This is an inevitable principle. For internal issues, consult the Neijing Tu (Inner Landscape Diagram); for external issues, observe the Jingluo Tu (Meridian and Collateral Diagram). The pathways of the Twelve Meridians: Hand Three Yin meridians go from Zang to Hand; Hand Three Yang meridians go from Hand to Head; Foot Three Yang meridians go from Head to Foot; Foot Three Yin meridians go from Foot to Abdomen. In any prescription, it is necessary to add guiding herbs (Jing Yao), or supplement with external therapies such as acupuncture, cupping, scraping, poultices, moxibustion, washing, massage, or Dao Yin exercises, which makes achieving success easier. Additionally, there are pains from falls and sprains, Yin abscesses and internal carbuncles, accumulations and masses, roundworms and pinworms, hernias and bi-syndromes, sand-swelling and evil poisoning. One must clearly differentiate the syndrome aspects and not treat them indiscriminately. Observing the cases of pain syndromes in various categories, there are many good methods, too numerous to list. If summarizing the main gist, it is supplementation and purging, Cold and Warmth, using only Acrid-Moistening and Venting-Unblocking methods, avoiding Sour-Cold and Astringent-Stop methods to prevent retaining pathogens. This hits the mark of the condition. However, the unique brilliance lies especially in the method of treating collaterals. Generally, long-standing pain inevitably enters the collaterals. Whether the Qi and Blood in the collaterals are deficient or excess, cold or hot, even slight retention of pathogens can cause pain. This was not detailed by the ancients, but Mr. Ye was able to analyze and clarify it, passing this down as instruction to later generations. Truly worthy of being a brilliant physician of his generation. (Commentary by Hua Yutang)

Xu's Commentary: These discussions seem precise and flawless in differentiation, but they are actually superficial talk. No disease cannot be fitted into these patterns. Yet, regarding the true essence of this syndrome, they have never truly understood it. Figures like Xue Lizhai and Zhang Jingyue were trapped in this thinking their whole lives. Their theories became more complex, yet farther from the Dao. A wave of superficial talk, whereas ancient sages, when treating a disease, always had a primary formula. Despite thousands of variations, it never deviated from the root. This principle has thus vanished.