灵枢云。贼风邪气之伤人也。令人病焉。今有不离屏蔽。不出室穴之中。卒然病者。不离贼
风邪气。其故何也。曰。此皆尝有所伤于湿气。藏于血脉之中。分肉之间。久留而不去。若有所
堕坠。恶血在内而不去。卒然喜怒不节。饮食不适。寒温不时。腠理闭而不通。其开而遇风寒。
则血气凝结。与故邪相袭。则为寒痹。其有热则汗出。汗出则受风。虽不遇贼风邪气。必有因加
而发焉。其毋所遇邪气。又毋怵惕之所志。卒然而病者。其故何也。惟有因鬼神之事乎。曰。此
亦有故邪留而未发。因而志有所恶。及有所慕。血气内乱。两气相搏。其所从来者微。视之不见。
听而不闻。故似鬼神。金匮云。寸口脉沉而弱。沉即主骨。弱即主筋。沉即为肾。弱即为肝。汗
出入水中。如水伤心。历节黄汗出。故曰历节。盛人脉涩小。短气。自汗出。历节疼。不可屈伸。
此皆饮酒汗出当风所致。
病历节不可屈伸疼痛。乌头汤主之。并治香港脚疼痛不可屈伸。
乌头汤治历节不可屈伸疼痛。复治香港脚疼痛不可屈伸。二者之病。皆是风寒伤于筋。麻黄开汗孔。
通腠理。散寒邪。解风痹。芍药以理血痹。甘草通经脉以和药。黄 益卫气。气壮则邪退。乌头
善走。入肝逐风寒。故筋脉之急者。必以乌头治之。然以蜜煎。取缓其性。使之留连筋骨。以利
其屈伸。且蜜之润又可益血养筋。兼制乌头燥热之毒。丹溪云。痛风者。大率因血受热。已自沸
腾。其后或涉冷水。或立湿地。或扇取凉。或卧当风。寒外搏热。血得风寒。汗浊凝涩。所以作
痛。夜则痛甚。行于阴也。治法。以辛热之剂疏散寒湿。开发腠理。其血得行。与气相和。其病
自安。然有数种。治法稍异。痛风而痛有常处。其痛上赤肿灼热。或浑身壮热。此欲成风毒。宜
败毒散。如肢节痛。须用羌活。去风湿亦宜用之。肥人肢节痛。多是风湿痰饮流注。宜导痰汤。
瘦人股节痛。是血枯。宜四物加羌、防。老人性急作劳。患两腿痛。动则痛甚。或血痢用涩药。
恶血流入经络隧道而变痛风。并宜四物加桃仁、陈皮、牛膝、生甘草。煎入生姜。研潜行散。有
瘀积者。加酒热服。并刺委中出血。然非二三十帖不效。壮年人性躁。兼嗜浓味。患痛风挛缩。
此挟痰与气证。导痰汤加牛膝、枳壳、通草、桃仁。煎入生姜。研潜行散热服。亦须多服乃效。
按湿热痰火死血郁于经络。四肢麻痹。或痛或痒。轻而新者。可以缓治。久而重者。必加乌、附
驱逐痰湿壮气行经。大便阻滞。必用大黄。昧者畏其峻攻。多致狐疑。不知邪毒流满经络。非乌、
附岂能散结。燥热结滞肠胃。非硝、黄岂能润燥。要在合宜耳。
历节 景岳全书曰。历节风痛。以其痛无定所。即行痹之属也。病源云。历节风痛是气血本
虚。或因饮酒腠理开。汗出当风所致。或因劳倦。调护不谨。以致三气之邪。遍历关节。与气血
相搏。而疼痛非常。或如虎之咬。故又有白虎历节之名。中藏经曰。历节疼痛者。因醉犯房而得
之。此其概也。大都痛痹之证。多有昼轻而夜重者。正阴邪之在阴
分也。其有遇风雨阴晦而甚者。此正阴邪侮阳之证也。或得暖遇热而甚者。此湿热伤阴之火证也。
有火者宜从清凉。有寒者宜从温热。若筋脉拘滞。伸缩不利者。此血虚血燥证也。非养血养气不
可。遍身骨节疼痛。肢节如槌。昼静夜剧。如虎啮之状。乃痛风之甚者也。必饮酒当风。汗出入
水。遂成斯疾。寒则仓公当归汤、千金大枣汤、防己汤选用。热则千金犀角汤、当归拈痛汤加姜
汁炒黄柏。掣者为寒。肿者为湿。汗者为风。三气杂至。伤于血脉之中。营卫涩滞不行。故痛。
用虎骨、犀角、沉香、青木香、当归、羌活、桂枝、秦艽、牛膝、骨碎补、桃仁、甘草。水煎入
麝少许。历节风毒攻注。骨节疼痛。发作不定。乌药顺气散。不应。五积散。四肢历节疼。其人
短气脉沉。为留饮。导痰汤加减。身体肿痛。一味木通。用二两煎服。身必发出红丹。汗出至足。
顷时即愈。外治之法。以蕲艾斤许。先以一半焙干。摊痛处。外铺灯心草一层。以指甲在痛傍。
不时攒之。冷则更递焙用。三次少歇。又顷如前再用。自四五度效。不可抚摩。抚摩则七窍闭郁
也。又法。好陈醋五大碗。煎沸。入葱白一斤。将葱裹痛处熨之。着即麻木也。
石顽曰。按痛风一证。灵枢谓之贼风。素问谓之痹。金匮名曰历节。后世更名白虎历节。多
由风寒湿气。乘虚袭于经络。气血凝滞所致。近世邪说盛行。而名之曰箭风。风毒肿溃。乃谓之
曰箭袋。禁绝一切汤药。恣行艾熨针挑。此虽灵枢刺布衣之法。而药熨之方。世绝不闻。使既病
之肌肉。复受无辜之痛楚。奈何懵懂无知。甘受其惑。良可慨夫。
《灵枢》说：贼风邪气伤害人体，使人患病。现在有人并不离开遮蔽物，不出居室之中，却突然生病，这并非不遭遇贼风邪气。这是什么缘故呢？回答说：这都是因为曾经被湿气所伤，湿气藏在血脉之中、分肉之间，长久停留而不消散；或者曾经有跌坠损伤，恶血留在体内没有去除；再加上突然喜怒情绪不节制，饮食不适应，寒温调节不及时，导致腠理闭塞不通。当腠理张开时又遇到风寒，就会使血气凝结，与原有的邪气相叠加，就形成寒痹。如果有热象就会出汗，出汗后容易受风，即使没有遭遇新的贼风邪气，也必定会因为诱因而发作。如果既没有遭遇外邪，又没有惊恐忧虑的情志刺激，却突然生病，这是什么缘故呢？难道是因为鬼神作祟吗？回答说：这也是因为有旧的邪气潜伏在体内尚未发作，加上情志上有厌恶或贪慕之事，导致血气内部紊乱，新旧两股气机相互搏结。这种病来的原因很细微，看也看不见，听也听不到，所以看起来像鬼神作怪一样。
《金匮要略》说：寸口脉沉而弱，沉脉主骨，弱脉主筋；沉脉对应肾，弱脉对应肝。出汗时进入水中，水湿伤心，出现历节病并伴有黄汗流出，所以称为历节。肥胖的人脉象涩小，短气，自汗出，历节疼痛，关节不可屈伸，这都是因为饮酒后出汗时吹了风所致。
病历节疼痛，关节不可屈伸，用乌头汤主治。同时也治疗香港脚（足部肿痛）疼痛不可屈伸。
乌头汤治疗历节疼痛不可屈伸，也治疗香港脚疼痛不可屈伸。这两种病，都是风寒损伤筋脉所致。麻黄能开启汗孔，疏通腠理，发散寒邪，解除风痹；芍药能调理血痹；甘草能通利经脉以调和药性；黄芪（原文“黄”后缺字，据方义补为黄芪）能补益卫气，卫气壮实则邪气退却；乌头善于走窜，入肝经驱逐风寒，所以筋脉拘急的人，必须用乌头来治疗。但是用蜂蜜煎煮，是为了缓和乌头的药性，使其留恋于筋骨之间，以利于关节屈伸。而且蜂蜜的滋润又能益血养筋，同时制约乌头燥热的毒性。
朱丹溪说：痛风这个病，大率是因为血液受热，已经自行沸腾，之后如果接触冷水，或站立在潮湿之地，或扇风取凉，或睡觉对着风口，寒气在外搏击热气，血液受到风寒，汗液变得浑浊凝涩，所以产生疼痛。夜间疼痛加剧，是因为病行于阴分。治疗方法，用辛热的药物疏散寒湿，开发腠理，血液得以运行，与气机相和谐，病自然痊愈。然而有多种类型，治疗方法略有不同。痛风且疼痛部位固定，疼痛处红肿灼热，或全身高热，这是将要形成风毒，宜用败毒散。如果是肢节疼痛，必须用羌活，祛除风湿也适宜用羌活。肥胖人肢节疼痛，多是风湿痰饮流注所致，宜用导痰汤。瘦人股节疼痛，是血枯所致，宜用四物汤加羌活、防风。老人性情急躁且劳累，患双腿疼痛，活动则疼痛加剧，或因血痢使用收敛涩药，导致恶血流入经络隧道而变成痛风，都宜用四物汤加桃仁、陈皮、牛膝、生甘草，煎药时加入生姜，再调入潜行散。有瘀积者，加酒热服，并针刺委中穴出血。然而不是服用二三十剂不会见效。壮年人性情急躁，兼嗜食浓味，患痛风导致肢体挛缩，这是挟带痰浊和气滞的证候，用导痰汤加牛膝、枳壳、通草、桃仁，煎药时加入生姜，再调入潜行散热服。也必须多服才能见效。
按语：湿热、痰火、死血郁结在经络中，导致四肢麻痹，或痛或痒。病情轻且新发的，可以缓慢治疗；病程久且严重的，必须加用乌头、附子来驱逐痰湿，壮气行经。如果大便阻滞，必须用大黄。庸医害怕其攻伐峻猛，往往导致犹豫不决。不知道邪毒流满经络，不用乌头、附子怎么能散结？燥热结滞肠胃，不用芒硝、大黄怎么能润燥通便？关键在于合乎病情适宜而已。
历节：张景岳在《景岳全书》中说：历节风痛，因为它疼痛无定处，属于行痹一类。《诸病源候论》说：历节风痛是由于气血本虚，或因饮酒后腠理开泄，汗出当风所致；或因劳倦，调护不慎，导致三气之邪遍历关节，与气血相搏，而疼痛剧烈，有时像老虎咬一样，所以又有白虎历节之名。《中藏经》说：历节疼痛，是因为醉酒行房事而得的。这大概是一般情况。大多痛痹这类病证，多有白天轻晚上重的特点，正是阴邪在阴分的表现。那些遇到风雨阴晦天气而加重的，正是阴邪侮阳的证候。有的得暖遇热反而加重的，这是湿热伤阴的火证。有火象的宜从清凉法治疗，有寒象的宜从温热法治疗。如果筋脉拘急僵硬，伸缩不利，这是血虚血燥的证候，非养血养气不可。遍身骨节疼痛，肢节像被槌打一样，白天安静晚上剧烈，像老虎咬噬的样子，这是痛风的严重阶段。必定是因为饮酒当风，汗出入水，遂成此疾。属寒的选用仓公当归汤、千金大枣汤、防己汤；属热的选用千金犀角汤、当归拈痛汤加姜汁炒黄柏。掣引感属于寒，肿胀属于湿，汗出异常属于风。三气杂合而至，伤于血脉之中，营卫涩滞不行，所以疼痛。用药可用虎骨、犀角、沉香、青木香、当归、羌活、桂枝、秦艽、牛膝、骨碎补、桃仁、甘草，水煎后加入少许麝香。历节风毒攻注，骨节疼痛，发作不定，用乌药顺气散；若无效，用五积散。四肢历节疼痛，其人短气脉沉，为留饮，用导痰汤加减。身体肿痛，单用一味木通，用量二两煎服，身体必发出红丹，汗出至足，片刻即可痊愈。外治方法：用蕲艾一斤许，先取一半焙干，摊在疼痛处，外面铺一层灯心草，用指甲在疼痛旁边不时攒刺，感觉冷了就更换焙热的继续用，三次后稍作休息，又像刚才那样再用，经过四五次就见效。不可抚摸，抚摸会导致七窍闭郁。另一种方法：好陈醋五大碗，煎沸，加入葱白一斤，将葱包裹疼痛处熨烫，一接触就会感到麻木。
石顽说：按痛风这一证候，《灵枢》称之为贼风，《素问》称之为痹，《金匮》名为历节，后世更名为白虎历节。多由风寒湿气，乘虚侵袭经络，导致气血凝滞所致。近代邪说盛行，将其命名为箭风，风毒肿溃，便称之为箭袋。禁止使用一切汤药，肆意进行艾熨针挑。这虽然是《灵枢》中刺布衣的方法，但药熨的方子，世上却完全没听说过。使得已经生病的肌肉，再次遭受无辜的痛苦，真是无奈啊，懵懂无知，甘愿受其迷惑，实在令人感慨。
The *Ling Shu* (Spiritual Pivot) states: "Zei wind and evil qi harm the human body, causing disease." Now, there are those who do not leave their shelter or exit their rooms, yet suddenly fall ill. This is not because they are spared from zei wind and evil qi. What is the reason? The answer is: This is all due to previous injury by dampness, which has hidden within the blood vessels and between the muscle layers, lingering for a long time without dispersing; or perhaps due to previous falls or injuries, with bad blood retained inside and not expelled; compounded by sudden unregulated emotions of joy or anger, inappropriate diet, and irregular exposure to cold and warmth, leading to the closure and obstruction of the cou li (skin pores and interstitial spaces). When the cou li open and encounter wind-cold, the blood and qi coagulate, combining with the existing evil qi, resulting in Cold Bi syndrome. If there is heat, sweating occurs; after sweating, one becomes susceptible to wind. Even without encountering new zei wind and evil qi, an attack will inevitably be triggered by these factors. If neither external evil qi nor frightful emotional disturbances are encountered, yet illness strikes suddenly, what is the reason? Is it solely due to ghosts and spirits? The answer is: This also involves old evil qi remaining latent and unmanifested, combined with mental aversion or longing, causing internal disorder of blood and qi, where two types of qi clash. The origin of this condition is subtle, invisible to the eye, and inaudible to the ear, thus appearing as if caused by ghosts and spirits.
The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: "At the cunkou pulse position, if the pulse is deep and weak, 'deep' indicates bone pathology, and 'weak' indicates tendon pathology; 'deep' corresponds to the Kidney, and 'weak' corresponds to the Liver. Sweating while entering water damages the Heart, leading to Li Jie disease with yellow sweat discharge, hence named Li Jie. In obese individuals, the pulse may be choppy and small, accompanied by shortness of breath, spontaneous sweating, Li Jie pain, and inability to flex or extend joints. These are all caused by drinking alcohol, sweating, and then being exposed to wind."
For Li Jie characterized by pain and inability to flex or extend joints, Wu Tou Tang (Aconite Decoction) is the primary treatment. It also treats Hong Kong Foot (podagra/foot swelling) pain with inability to flex or extend joints.
Wu Tou Tang treats Li Jie pain with joint stiffness and also Hong Kong Foot pain with stiffness. Both conditions result from wind-cold damaging the tendons. Ma Huang (Ephedrae Herba) opens the sweat pores, unblocks the cou li, disperses cold evil, and resolves wind-Bi; Shao Yao (Paeoniae Radix) regulates blood bi; Gan Cao (Glycyrrhizae Radix) unblocks meridians to harmonize the herbs; Huang Qi (Astragali Radix) tonifies Wei Qi (Defensive Qi); when Wei Qi is strong, evil retreats; Wu Tou (Aconiti Radix) moves freely, enters the Liver channel, and expels wind-cold. Therefore, cases of tendon spasm must be treated with Wu Tou. However, it is decocted with honey to缓 its potency, allowing it to linger in the sinews and bones to facilitate flexion and extension. Moreover, the moistening nature of honey nourishes blood and tendons, while simultaneously counteracting the dry-heat toxicity of Wu Tou.
Zhu Danxi stated: "Gout (Tong Feng) generally arises because the blood is heated and boiling. Subsequently, if one contacts cold water, stands on wet ground, fans oneself for coolness, or sleeps facing the wind, external cold combats internal heat. The blood, affected by wind-cold, becomes turbid and coagulated, causing pain. Pain worsens at night because the pathogen travels through the Yin aspects. The treatment method involves using acrid-hot agents to disperse cold-dampness and open the cou li. Once the blood circulates and harmonizes with Qi, the disease resolves naturally. However, there are several variations requiring slightly different treatments. For gout with fixed pain sites, redness, swelling, burning heat, or systemic high fever, indicating impending Wind Toxicity, Bai Du San (Detoxification Powder) is indicated. For limb joint pain, Qiang Huo (Notopterygii Rhizoma et Radix) is essential for dispelling wind-dampness. In obese individuals with limb joint pain, it is often due to wind-damp-phlegm-fluid accumulation; Dao Tan Tang (Phlegm-Dissolving Decoction) is appropriate. In thin individuals with thigh/joint pain, it is due to Blood deficiency; Si Wu Tang (Four Substances Decoction) plus Qiang Huo and Fang Feng is suitable. For elderly individuals with irritability and overwork, suffering from leg pain worsening with movement, or due to dysentery treated with astringents leading to bad blood entering the meridians and transforming into gout, Si Wu Tang plus Tao Ren (Persicae Semen), Chen Pi (Citri Reticulatae Pericarpium), Niu Xi (Achyranthis Bidentatae Radix), and raw Gan Cao, decocted with fresh ginger and mixed with Qian Xing San, is indicated. For cases with blood stasis, take warm with wine and prick Wei Zhong (BL40) to bleed. However, efficacy usually requires 20-30 doses. For young adults with irritable temper and preference for rich foods, suffering from gout-induced spasms due to phlegm and Qi stagnation, Dao Tan Tang plus Niu Xi, Zhi Ke (Aurantii Fructus), Tong Cao (Tetrapanacis Medulla), and Tao Ren, decocted with fresh ginger and mixed with Qian Xing San taken warm, is used. Multiple doses are necessary for effect.
Note: When damp-heat, phlegm-fire, and dead blood stagnate in the meridians, causing limb numbness, pain, or itching, mild and recent cases can be treated gradually. Severe and chronic cases require Wu Tou (Aconiti Radix) and Fu Zi (Aconiti Lateralis Radix Praeparata) to drive out phlegm-dampness and strengthen Qi to move through the meridians. If stool is obstructed, Da Huang (Rhei Radix et Rhizoma) is mandatory. Ignorant physicians fear harsh purgatives, leading to hesitation. They fail to realize that evil toxins filling the meridians cannot be dispersed without Wu Tou and Fu Zi, nor can dry-heat stagnation in the intestines be moistened without Xiao Shi (Natrii Sulfas) and Da Huang. The key lies in appropriateness.
Li Jie: Zhang Jingyue in *Jing Yue Quan Shu* states: "Li Jie wind-pain, due to its wandering pain location, belongs to Xing Bi (Wandering Bi)." The *Bing Yuan* states: "Li Jie wind-pain results from inherent deficiency of Qi and Blood, or from drinking alcohol causing open cou li and sweating into the wind; or from fatigue and improper care, allowing three evils to traverse joints, clashing with Qi and Blood, causing severe pain, sometimes like a tiger bite, hence the name White Tiger Li Jie." The *Zhong Zang Jing* states: "Li Jie pain is caused by indulging in sex after drunkenness." This covers the general overview. Most Bi syndromes involving pain are lighter during the day and heavier at night, reflecting Yin evil in the Yin aspect. Cases worsening in wind/rain/cloudy weather reflect Yin evil overwhelming Yang. Cases worsening with warmth/heat reflect Fire syndrome injuring Yin due to damp-heat. Cases with Fire signs should be treated with cooling methods; cases with Cold signs with warming methods. If tendons and vessels are stiff with limited mobility, it is Blood deficiency and dryness, requiring Blood and Qi nourishment. Whole-body joint pain, limbs feeling like hammered, quiet by day but severe by night like a tiger bite, represents severe Gout. This invariably stems from drinking in the wind, sweating, and entering water. For Cold patterns, select Cang Gong Dang Gui Tang, Qian Jin Da Zao Tang, or Fang Ji Tang. For Heat patterns, select Qian Jin Xi Jiao Tang or Dang Gui Nian Tong Tang plus Jiang Zhi Chao Huang Bo (Ginger-fried Phellodendri Cortex). Tugging sensations indicate Cold; swelling indicates Dampness; abnormal sweating indicates Wind. The three evils mix and enter the blood vessels, causing stagnation of Ying and Wei Qi, resulting in pain. Herbs may include Hu Gu (Bonis Os), Xi Jiao (Rhinocerotis Cornu - note: use substitutes legally), Chen Xiang (Aquilariae Lignum), Qing Mu Xiang (Aucklandiae Radix), Dang Gui (Angelicae Sinensis Radix), Qiang Huo, Gui Zhi (Cinnamomi Ramulus), Qin Jiao (Gentianae Macrophyllae Radix), Niu Xi, Gu Sui Bu (Drynariae Rhizoma), Tao Ren, Gan Cao. Decoct in water with a small amount of She Xiang (Moschus). For Li Jie wind-toxin attacking joints with unpredictable pain, use Wu Yao Shun Qi San; if ineffective, use Wu Ji San. For four-limb Li Jie pain with shortness of breath and deep pulse, indicating retained fluid, modify Dao Tan Tang. For body swelling and pain, use Mu Tong (Akebiae Caulis) alone, 2 liang decocted; red rashes will appear, sweating to the feet, resolving quickly. External treatment: Use 1 jin of Qi Ai (Artemisia argyi). Roast half until dry, apply to the painful area, cover with a layer of Deng Xin Cao (Junci Medulla), and frequently prick around the pain with fingernails. Replace with roasted portions when cold. Rest briefly after three cycles, then repeat. Efficacy appears after 4-5 sessions. Do not massage, as this causes blockage of the seven orifices. Another method: Boil 5 large bowls of aged vinegar, add 1 jin of Cong Bai (Allii Fistulosi Bulbus), wrap the painful area with the scallions for hot compress. Immediate numbness occurs.
Shi Wan stated: "Regarding Gout, the *Ling Shu* calls it Zei Wind, the *Su Wen* calls it Bi, and the *Jin Gui* names it Li Jie. Later generations renamed it White Tiger Li Jie. It mostly arises from wind-cold-dampness invading the meridians due to deficiency, causing Qi and Blood stagnation. Recently, heretical theories have prevailed, naming it Arrow Wind. When wind-toxin causes swelling and ulceration, it is called Arrow Bag. All herbal decoctions are forbidden, and only moxibustion and needle pricking are allowed. Although this resembles the *Ling Shu*'s method for commoners, the formulas for medicinal hot compresses are unknown in the world. This subjects already diseased muscles to innocent suffering. How lamentable it is to be ignorant and willingly deceived!"