从来人之腿疼者未必臂疼，臂疼者未必腿疼，至于腿臂一时并疼，其致疼之因，腿与臂大抵相同矣。
而愚临证四十余年，治愈腿臂一时并疼者不胜记。独在奉曾治一媪，其腿臂一时并疼，而致腿疼臂疼
之病因则各异，今详录其病案于下。
奉天佟姓媪，年五十七岁，于仲冬渐觉四肢作疼，延医服药三十余剂，浸至卧床不能转侧，昼夜疼痛
不休。至正月初旬，求为诊视，其脉左右皆浮而有力，舌上微有白苔，知其兼有外感之热也。西药阿斯匹林
善发外感之汗，又善治肢体疼痛，俾用一瓦半，白糖水送下，以发其汗。翌日视之，自言汗后疼稍愈，能自
转侧。而其脉仍然有力，遂投以连翘、花粉、当归、丹参、白芍、乳香、没药诸药，两臂疼愈强半，而腿疼
则加剧。自言两腿得热则疼减，若服热药其疼当愈。于斯又改用当归、牛膝、续断、狗脊、骨碎补、没药、
五加皮诸药，服两剂后腿疼见愈，而臂疼又加剧。是一人之身，腿畏凉、臂畏热也。夫腿既畏凉，其疼也
必因有凝结之凉；臂既畏热，其疼也必因有凝结之热。筹思再三，实难疏方。细诊其脉，从前之热象已无，
其左关不任重按。恍悟其上热下凉者，因肝木稍虚，或肝气兼有郁滞，其肝中所寄之相火不能下达，所以两
腿畏凉；其火郁于上焦，因肝虚不能敷布，所以两臂畏热。向曾治友人刘××左臂常常发热，其肝脉虚
而且郁，投以补肝兼舒肝之剂而愈，以彼例此，知旋转上热下凉之机关，在调补其肝木而已。遂又为疏方用净
萸肉一两，当归、白芍各五钱，乳香、没药、续断各四钱，连翘、甘草各三钱，每日煎服一剂。又俾于每
日用阿斯匹林一瓦分三次服下。数日全愈。方中重用萸肉者，因萸肉得木气最全，酸敛之中大具条畅
之性，是以善补肝又善舒肝。《神农本草经》谓其逐寒湿痹，四肢之作疼，亦必有痹而不通之处也。
况又有当归、白芍、乳香、没药以为之佐使，故能奏效甚捷也。
自古以来，人的腿疼未必伴随臂疼，臂疼也未必伴随腿疼。至于腿和臂同时疼痛的情况，导致疼痛的原因，在腿和臂上大体是相同的。
然而，我在临证四十多年中，治愈腿和臂同时疼痛的病例数不胜数。唯独在奉天（今沈阳）治疗一位老妇人时，她的腿和臂同时疼痛，但导致腿疼和臂疼的病因却各不相同，现将该病案详细记录如下。
奉天佟姓老妇人，五十七岁，在仲冬时节逐渐感到四肢疼痛，请医生服药三十多剂后，病情加重至卧床不起，无法翻身，昼夜疼痛不止。到了正月初旬，她请求我为其诊治。诊察发现，她的左右脉象都浮而有力，舌上有微薄的白苔，判断她兼有外感的热邪。西药阿司匹林善于发汗解除外感，又善于治疗肢体疼痛，于是让她服用一瓦半（约3克），用白糖水送服，以促使出汗。第二天复诊，患者自述出汗后疼痛稍减，能够自行翻身。但脉象依然有力，于是给她开连翘、天花粉、当归、丹参、白芍、乳香、没药等药物。服用后，两臂的疼痛减轻了一半以上，但腿疼反而加剧。患者自述双腿遇热则疼痛减轻，如果服用热性药物，疼痛应当痊愈。因此我又改用当归、牛膝、续断、狗脊、骨碎补、没药、五加皮等药物，服用两剂后腿疼初见好转，但臂疼又加剧了。这就出现了一个人身上，腿部怕冷、手臂怕热的现象。既然腿部怕冷，其疼痛必然由凝结的寒凉所致；既然手臂怕热，其疼痛必然由凝结的热邪所致。反复思考，实在难以处方。仔细诊脉，之前的热象已经消失，左关脉（对应肝脏）不耐重按。忽然领悟到，这种上热下凉的状况，是因为肝木稍显虚弱，或者肝气兼有郁滞，导致寄居于肝中的相火（人体生命活动的动力之火）不能下达温煦下肢，所以双腿怕冷；而火郁结在上焦，因肝虚不能疏泄布散，所以两臂怕热。以前曾治疗朋友刘某某左臂常常发热，其肝脉虚且郁，投用补肝兼舒肝的药剂而痊愈。以此为例类推，可知调理上热下凉的关键，在于调补肝木罢了。于是再次为她开具处方：使用净山茱萸一两，当归、白芍各五钱，乳香、没药、续断各四钱，连翘、甘草各三钱，每日煎服一剂。同时让患者每日分三次服用阿司匹林一瓦半。数日后完全痊愈。方中重用山茱萸，是因为山茱萸得木气最全，在酸敛之中具有条畅的特性，所以既善于补肝又善于舒肝。《神农本草经》记载它能驱除寒湿痹症，四肢疼痛也必然有痹阻不通的地方。况且又有当归、白芍、乳香、没药作为佐使药，所以能取得非常迅速的效果。
Since ancient times, leg pain in a person does not necessarily accompany arm pain, nor does arm pain necessarily accompany leg pain. As for cases where both legs and arms hurt simultaneously, the causes of pain in the legs and arms are generally similar.
However, during my forty-plus years of clinical practice, I have cured an uncountable number of cases involving simultaneous pain in both legs and arms. The only exception was when I treated an elderly woman in Fengtian (modern-day Shenyang). Her legs and arms hurt simultaneously, yet the etiologies causing the leg pain and arm pain were different. I now record this medical case in detail below.
An elderly woman surnamed Tong from Fengtian, aged fifty-seven, gradually began to feel pain in her four limbs during the mid-winter season. After consulting physicians and taking over thirty doses of herbal medicine, her condition worsened to the point where she was bedridden and unable to turn over, suffering from ceaseless day-and-night pain. By early January of the new year, she sought my consultation. Her pulse on both left and right sides was floating and forceful, and there was a thin white coating on her tongue. I determined that she had concurrent exogenous heat pathogen. Aspirin is effective in inducing sweating to resolve exogenous conditions and also treats limb pain. Therefore, I prescribed one and a half grains (approximately 3 grams) of Aspirin, taken with sugar water to induce sweating. Upon visiting her the next day, she reported that her pain had slightly subsided after sweating, allowing her to turn over independently. However, her pulse remained forceful. Consequently, I administered a decoction containing Forsythiae Fructum (Lianqiao), Trichosanthis Radix (Huafen), Angelicae Sinensis Radix (Danggui), Salviae Miltiorrhizae Radix et Rhizoma (Danshen), Paeoniae Radix Alba (Baishao), Frankincense (Ruxiang), and Myrrh (Moyao). After administration, the pain in her arms decreased by more than half, but the pain in her legs intensified. She stated that warmth relieved the pain in her legs and that if she took hot-natured medicines, the pain would heal. Thus, I changed the prescription to include Angelicae Sinensis Radix (Danggui), Achyranthis Bidentatae Radix (Niuxi), Dipsaci Radix (Xuduan), Cuscutae Semen/Dogspine? (Gouji - *Note: Gouji refers to Lycium bark/root or sometimes Dog spine depending on context, here likely Lycii Cortex/Radix or specific bone-strengthening herb*), Drynariae Rhizoma (Gusuibu), Frankincense (Ruxiang), and Acanthopanacis Cortex (Wujiaopi). After two doses, the leg pain showed improvement, but the arm pain worsened again. This presented a situation where, within one body, the legs feared cold while the arms feared heat. Since the legs feared cold, the pain must be caused by congealed cold; since the arms feared heat, the pain must be caused by congealed heat. After much deliberation, I found it difficult to prescribe. Upon careful pulse diagnosis, the previous signs of heat had disappeared, and the left Guan position (corresponding to the Liver) could not withstand heavy pressure. Suddenly, I realized that this pattern of upper heat and lower cold was due to slight deficiency of Liver Wood, or concomitant stagnation of Liver Qi. The Ministerial Fire (Xianghuo, the fire associated with physiological activity) housed within the Liver failed to descend to warm the lower limbs, hence the legs feared cold; meanwhile, the fire was constrained in the Upper Jiao because the deficient Liver could not disperse it, hence the arms feared heat. Previously, I treated a friend, Mr. Liu, who frequently experienced heat in his left arm. His Liver pulse was deficient and stagnant. He was cured by administering a formula that tonified and soothed the Liver. Applying this analogy to the current case, I understood that the key to regulating the mechanism of upper heat and lower cold lies in tonifying and regulating Liver Wood. Therefore, I prescribed again: Pure Cornus Officinalis Fruit (Yurou) 1 liang, Angelicae Sinensis Radix (Danggui) and Paeoniae Radix Alba (Baishao) each 5 qian, Frankincense (Ruxiang), Myrrh (Moyao), and Dipsaci Radix (Xuduan) each 4 qian, Forsythiae Fructum (Lianqiao) and Glycyrrhizae Radix et Rhizoma (Gancao) each 3 qian. One dose was decocted and taken daily. Additionally, I instructed her to take one and a half grains of Aspirin daily, divided into three doses. After several days, she was completely cured. In this formula, Yurou was used in large quantity because it possesses the most complete Wood Qi among herbs. Within its sour and astringent nature, it has a freely diffusing character, making it excellent for both tonifying and soothing the Liver. The *Shennong Bencao Jing* states that it expels cold-dampness bi-syndrome. Pain in the four limbs must also involve obstruction and blockage. Moreover, with Danggui, Baishao, Ruxiang, and Moyue acting as assistant and guide herbs, the efficacy was achieved very rapidly.