历代医家对本病有着详细的论述。如陆清洁说：“痹病虽分十六种，一言以蔽之，气机不舒而已。”陈修园说：“痹者，闭也，闭而为病，痹斯名。”这也是气机不舒之意。林珮琴说： “诸痹风、寒、湿三气杂合而犯其经络之疾也。”“行痹、痛痹、着痹，痹证之大纲，又以所遇之时而命名，非此外别有骨、筋、脉等痹也。”尤在泾：“痹者，闭也。五脏六腑之正气为邪所闭，则痹而不仁也。”根据上述说法，经脉闭阻，关节疼痛为痹病之主症，这是没有疑问的。但反过来讲，所有的关节疼痛是否都是痹病呢?不是的，绝对不是的。因为关节疼痛一症，还有化脓性的，有结核性的，有梅毒性的，及外伤性等，都不可以痹病称之。只有因风、寒、湿三气形成的关节疼痛才叫作痹病。不但如此，就是单纯的风、寒、湿任何一气形成的关节痛，如果重点不在关节，也不能叫作痹病。
《素问·痹论》云： “风、寒、湿三气杂至合而为痹。其风气胜者为行痹，寒气胜者为痛痹，湿气胜者为着痹也。”《景岳全书。风痹》说：“痹者，闭也。以气血为邪所闭，不得通行而病也。”又说：“诸痹总由其真阴衰弱，精血亏损，故三气得以乘之而为此病。”秦伯未说：“痹者，感受风寒湿邪而气血不和，引起肌肉或关节发痛、麻木一类的病证。”可见气血亏虚，三气乘虚侵入，使经络闭阻，脉道阻塞，致气血不能正常运行，因而出现局部肿痛，或遍身走注，或关节屈伸不得，或肌肉麻木不仁，而成为痹证。但由于三种外邪侵人人体的数量多寡不同，因而表现出的证候也不同，如行痹为风邪至甚，痛痹为寒邪至甚，着痹为湿邪至甚。
痹证初起即新痹，多为实证；痹证日久不愈即久痹，多见正虚邪实、虚实间夹的证候。其基本病变机制可以概括为以下三种新情况：
1．风寒湿邪或风湿热邪乘虚侵入人体，流注经络关节，日久不去，气血运行不畅之病变日甚，血脉瘀阻，津液凝聚，以致瘀血痰浊阻痹经络，出现皮肤瘀斑、关节周围结节、关节肿大、屈伸不利等症。
2．久痹不愈，气血耗伤，常出现气血两虚或肝肾亏损的证候，这在各种痹证病久之后均易见到。
3．痹证迁延不愈，正虚邪实，由经络而病及脏腑，出现脏腑痹的难治或不治性证候。
痹证疼痛四大特征
痹证的主要症状是肢体关节疼痛，或肿痛，或重着，或屈伸不利，或痛无定处，或麻木不仁等。其疼痛有下述几个特点：
1。疼痛的部位：痹证的疼痛，不论上下左右，全部或一部，多在四肢的关节部位，或筋骨部分，也有波及到腰背胸胁的，只有胸痹专在胸背，于四肢无碍。
2．疼痛的程度：一般外感风寒的新痹，疼痛剧烈，有的肢体运动受到妨碍，有的不敢转侧，有的不敢屈伸，以手按之，有的咬牙切齿，有的呻吟呼唤。
3。疼痛的时间：痹证疼痛的时间一般很长，有数月的，有数年的，甚或数十年及终身不愈的。这由治疗的及时与否，治法的得当与否决定。如果初起治疗保养得法，可能时间缩短些，但总不如感冒疼痛那样疗效来得快。痹证疼痛多与季节、气候、昼夜等节律变化有明显的关系。多数为昼轻夜重；天晴时轻，天阴时重；夏秋时轻，春冬时重。
4．疼痛的特点：痹证的疼痛呈多样性，有上下移动者；有左右上下不定者；有时痛时止者，痛时如蛇咬、如针刺、如蝎螫；有疼痛固定不移者；有疼痛兼麻木者；有疼痛的部位肿胀发热发红者；有初起疼痛较剧，逐渐变为不知痛痒，不能运动，不能转侧，关节不能屈伸者等。 新痹当祛邪为务 久痹宜寓散于补 痹证的发生，是由于风、寒、湿、热等外邪侵袭人体，闭阻经络，气血运行不畅所致，以肌肉、筋骨、关节发生酸痛、麻木、重着、屈伸不利，甚或关节肿大灼热为主要特征。痹证初病属实，久则多呈正虚邪实、虚实夹杂之候。《素问·痹论》曰： “五脏皆有合。病久而不去者，内舍于其合也。”“其人脏者死，其留连筋骨者疼久，其留皮肤间者易已。”说明痹证迁延不愈，复感于邪，会内舍其合，而引起脏腑痹，甚至形成入脏之死证。因此，治痹当分新久，新痹首当祛邪为务，久痹则宜寓散于补。 一、治痹大法 1．通经活血、疏散邪滞为治痹总則 治痹总以通经活血、疏散邪滞为大法。随所感风、寒、湿、热诸邪气之轻重及临床见证寒、热、虚、实之不同而加以对证立法施治，为痹证总的治法。
2．新痹当以祛邪为务
痹证新起，多为实证，不可骤用参芪归地滋腻之品，以防气郁湿滞，闭门留寇。宜以行湿流气、疏散邪气之祛邪法为主。初起因风、寒、湿三气尚未变热，可根据三气之法治之．
风气盛之行痹，以散风为主，御寒利湿辅之，再参以补血之剂。盖治风先治血．血行风自灭也。寒气盛之痛痹，以散寒为主，疏风燥湿辅之，再参以补火之剂，盖非大辛大温不能释其凝寒也。湿气盛之着痹，以利湿为主，祛风散寒仍不可缺，再参以补脾补气之剂，因为脾强可以胜湿，气足自不顽麻。若邪郁病久，风变为火，寒变为热，湿变为痰，又当于通经活血、疏散邪滞剂中再参以降火清热豁痰之品。
3．久痹宜补泻兼施，寓散于补
痹证日久而不愈，多成正虚邪实、虚实间夹之证。治痹虽以通经活血、疏散邪滞为总法，但当久痹正虚兼邪实之时，不可单用通散祛邪之法，而应着眼于正虚邪实、本虚标实，治宜补中兼散，寓散于补。如四物、四君之中加疏散风寒、燥湿化痰、活血祛瘀或行气散结之品等。同时，治疗久痹，最宜峻补真阴，阴液充足，则气血流行，风寒湿邪随血液循环而去。若过用风湿痰滞等药而再伤其阴气，必反增重其疾矣。 二、痹证治疗九法 1．补气血法 张寿甫云：人身之气化，壮旺流行而周身痹者、瘀者、滞者，不治自愈。即偶不愈，治之亦宜为功。陈修园言：痛风口久不愈，必大补气血以为胜邪之本。故补气血为治痹之第一要法。方如小续命汤、黄芪桂枝五物汤、三痹汤等。
2．散风寒法
痹证初起，脉浮紧，头痛发热恶寒者，宜用发散风寒之法，如麻黄汤。日久者，则不可散也，散之则肢体痿废不用。久痹而兼风寒者，不可单用通散，而宜补中兼散，寓散于补。如《医通》言：治(久)痹而用风散通达之剂，医之过也。痹证非不有风，然风人阴分与寒湿互结，扰乱其血脉，致身中之阳气不通于阴，故致痹也。古云多有用麻黄、白芷者，以麻黄能通阳，白芷能行营卫，然已人四君、四物等汤中，非专发表也。 3．疏通血络法 包括活血、行血、消瘀诸法。古人云：治风先治血，血行风自灭。活血行血宜用红花、桃仁、赤芍、归尾之类，方如活络效灵丹之类。陈修园云：痛风日久不愈，痛久必人络也。诸方俱宜加银花、木通、红花、刺蒺藜之类。
4．祛痰法
陈修园云：痛久则郁，郁而为热，热则生痰。必加入制南星、半夏、贝母、竹沥、姜汁之类。
5。清热法
包括清热、泻火诸法。陈修园曰：痛久则郁，郁而为热。用药如瓜蒌根、黄柏、川棟子之类。其中清热多用甘寒，如石膏、知母之类；泻火多用苦寒，如黄芩、黄连之属。 6。柔润熄风法 陈修园云：久服辛热之药不效时，宜用此法。用药如玉竹、黑芝麻、僵蚕、生芪、当归、菊花、蒺藜、阿胶、炙草、桑寄生之类。
7．针刺法
以患部与循经取穴为主，亦可采用阿是穴。行痹、热痹用毫针泻法浅刺，并可用皮肤针叩刺；痛痹多灸，深刺留针，如疼痛剧烈者，可兼用揿针或隔姜灸；着痹多针灸并施。或兼用温针、皮肤针和拔火罐法。
8．行气法
用于痹证初起．，取气行则血行，行湿流气之意。用药如陈皮、枳壳、杏仁之类。 9．祛寒胜湿法 为寒湿痹证正治之法，以川乌、草乌搜风胜湿祛寒，苍术、白术燥湿，当归养荣，乳香、没药活血散血，止痛消肿。方如寒湿方。 三、久痹治验举隅 李老将痹证总分为新痹与久痹两大类。认为新痹多实，当以祛邪为务，根据风、寒、湿、热诸邪之偏胜，施以相应的疏风、散寒、除湿、清热等法，不难辨治，因病属初起，气、血、阴、阳未虚，攻邪用药少有顾忌，故易于治愈。久痹不愈，则多呈正虚邪实，虚实间夹，甚至耗气伤血，形成内舍脏腑之复杂证候。具体讲容易出现下述三种病理变化：一者，风、寒、湿痹或热痹日久不愈，气血津液运行不畅之病变日甚，血脉瘀阻，津液凝聚，终致瘀血痰浊闭阻经络，出现皮肤瘀斑，关节周围结节，关节肿大痛甚，屈伸不利等；二者，久痹不愈，耗气伤血，因而出现不同程度的气血亏虚或脾肾阳虚或肝肾亏损的证候，这种情况，在痹证病久之后均易见到；三者，痹久不愈，病变会由表及里，由经络而及脏腑，出现脏腑痹的复杂危重证候。如《素问·痹论》曰：“心痹者，脉不通，烦则心下鼓，暴上气而喘。”又《金匮翼·痹证统论》曰：“久(痹)不已，则人五脏，烦满而喘呕者，肺也；上气，嗌干，厥胀者，心也；多饮数溲，夜卧则惊者，肝也；尻以代踵，脊以代头者，肾也；四肢懈惰，发咳呕沫者，脾也。大抵显脏证则难治矣。”总之，久痹不愈，反复发作，则易出现痰瘀阻络、气血阴阳亏虚及脏腑痹的证候，且每多出现寒热虚实间夹的复杂证候。治痹虽以通经活血、疏散邪滞为总的法则，但当久痹正虚兼邪实之时，不可单用通散祛邪之法，而应时时不忘正虚邪实，本虚标实，仔细审查虚实寒热的孰多孰少，治则总宜补中兼散，寓散于补。
(一)气血两虚案
案一 周某，女，30岁。门诊号：82986。
]964年12月3日初诊：下肢软弱无力，肌肤麻木不仁3月余。舌质红无苔，脉虚。此系气血两虚、风湿痹阻之证。治宜益气养血，祛风胜湿。处方：
党参9克 生黄芪4．5克 当归9克 生白芍9克 生白术7．5克 生苡仁9克 僵蚕6克 木瓜7．5克 桑枝30克 炙甘草3克
2剂，水煎服。
二诊：服药后肌肤麻木消失，但仍感下肢困软，背困。处方：
生黄芪15克 黄柏6克 怀牛膝4．5克 木瓜9克生苡仁30克
2剂，水煎服．
三诊：诸症若失，继服上方6剂，诸症消失。
按：此证属气血两虚，风湿痹阻，故重用参、芪益气，归、芍补血敛阴，四味合用气血双补之力较强。白术、苡米、炙甘草健脾燥湿，补中益气，以助气血化源。诸药配伍。以治气血亏虚之本。方中重用桑枝，以祛风通络，僵蚕祛风泄热，木瓜舒筋活络，和胃化湿，三味祛风通络，配白术、苡仁共能祛风胜湿以治其标。：二诊后重用黄芪。意在加强补气血之功，另用怀牛膝补肝肾，并能引药下行直达病所，所以除风湿痹痛。
案二 刘某，女，30岁。门诊号：24005。
1959年]2月28日初诊：下肢酸困、浮肿、乏力2月余。伴腰困，食欲不振，苔薄白，脉细弱。证属气血两虚、水湿停留之虚痹证候。治宜益气健脾，燥湿祛风。处方：
生黄芪9克 防己9克 生白术9克 木瓜7．5克 怀牛膝6克 秦艽4。5克 炙甘草3克
2剂，水煎服。
二诊：服上方后，下肢酸困浮肿减轻，仍感乏力。上方加当归7。5克。
继服上药8剂，诸症消失。
(二)气虚血痹案
案一 田某，女，45岁。门诊号：59804。
1963年1月3日初诊：恶寒，下肢麻木，肌肤不仁，自觉发冷，舌头亦冷，已1月余，苔薄白，脉微涩而紧。证属气虚血痹。治宜益气温经，和营通痹。方用加味黄芪桂枝五物汤：
生黄芪7．5克 桂枝7．5克 生白芍7。5克 怀牛膝6克 防己7．5克 生姜3片 大枣4枚
2剂，水煎服。
二诊：服上药后，下肢麻木消失，皮肤恢复知觉，恶寒减轻，汗出较多，齿龈冷，大便多，日行3—4次。上方加生白术7．5克，茯苓7。5克，附子3克。
2剂，水煎服。
三诊：服上方后恶寒已去，大便基本恢复正常，继服上方4剂，以巩固疗效。
案二 赵某，男，32岁。门诊号：95209。
1965年12月13日初诊：双膝以下酸困，有凉感，素有遗精病，已有4年，每夜遗精多次。喜凉性饮食。苔薄白，脉沉迟。证属上热下寒，气虚血痹。治宜益气和营通痹。方用加味黄芪桂枝五物汤加味：
生黄芪9克 桂枝9克 生白芍9克 怀牛膝6克 防己7．5克 秦艽4．5克 知母9克 生姜3克 大枣3枚
2剂，水煎服。
二诊：服上药后，膝关节酸困减轻，仍有遗精。上方加芡实7．5克，继服2剂。
共服上方12剂，诸症消除。
按：此二例均为气虚血痹之证，系由素体不足，体疲汗出，卫阳不固，微风侵袭，邪滞血脉，痹阻不通所致。李老在仲景黄芪桂枝五物汤之基础上，妙加怀牛膝、防己，成加味黄芪桂枝五物汤，意在益气温经、和营通痹的基础上助以牛膝之益肝肾，强筋骨，散瘀血，防己助黄芪以益气固表。另牛膝尚能引药下行，直抵病所。案一二诊针对患者恶寒、便溏等脾肾阳虚证候，加用白术、茯苓、附子以温阳健脾。案二虽亦为气虚血痹之证，但同时兼有上热下寒、寒热错杂之候，故用加味黄芪桂枝五物汤加知母，以清肺胃之热而泻火，加芡实以收敛固精。
(三)虚寒夹湿案
历代医家对本病有着详细的论述。如陆清洁说：“痹病虽分十六种，一言以蔽之，气机不舒而已。”陈修园说：“痹者，闭也，闭而为病，痹斯名。”这也是气机不舒之意。林珮琴说： “诸痹风、寒、湿三气杂合而犯其经络之疾也。”“行痹、痛痹、着痹，痹证之大纲，又以所遇之时而命名，非此外别有骨、筋、脉等痹也。”尤在泾：“痹者，闭也。五脏六腑之正气为邪所闭，则痹而不仁也。”根据上述说法，经脉闭阻，关节疼痛为痹病之主症，这是没有疑问的。但反过来讲，所有的关节疼痛是否都是痹病呢?不是的，绝对不是的。因为关节疼痛一症，还有化脓性的，有结核性的，有梅毒性的，及外伤性等，都不可以痹病称之。只有因风、寒、湿三气形成的关节疼痛才叫作痹病。不但如此，就是单纯的风、寒、湿任何一气形成的关节痛，如果重点不在关节，也不能叫作痹病。
《素问·痹论》云： “风、寒、湿三气杂至合而为痹。其风气胜者为行痹，寒气胜者为痛痹，湿气胜者为着痹也。”《景岳全书。风痹》说：“痹者，闭也。以气血为邪所闭，不得通行而病也。”又说：“诸痹总由其真阴衰弱，精血亏损，故三气得以乘之而为此病。”秦伯未说：“痹者，感受风寒湿邪而气血不和，引起肌肉或关节发痛、麻木一类的病证。”可见气血亏虚，三气乘虚侵入，使经络闭阻，脉道阻塞，致气血不能正常运行，因而出现局部肿痛，或遍身走注，或关节屈伸不得，或肌肉麻木不仁，而成为痹证。但由于三种外邪侵人人体的数量多寡不同，因而表现出的证候也不同，如行痹为风邪至甚，痛痹为寒邪至甚，着痹为湿邪至甚。
痹证初起即新痹，多为实证；痹证日久不愈即久痹，多见正虚邪实、虚实间夹的证候。其基本病变机制可以概括为以下三种新情况：
1．风寒湿邪或风湿热邪乘虚侵入人体，流注经络关节，日久不去，气血运行不畅之病变日甚，血脉瘀阻，津液凝聚，以致瘀血痰浊阻痹经络，出现皮肤瘀斑、关节周围结节、关节肿大、屈伸不利等症。
2．久痹不愈，气血耗伤，常出现气血两虚或肝肾亏损的证候，这在各种痹证病久之后均易见到。
3．痹证迁延不愈，正虚邪实，由经络而病及脏腑，出现脏腑痹的难治或不治性证候。
痹证疼痛四大特征
痹证的主要症状是肢体关节疼痛，或肿痛，或重着，或屈伸不利，或痛无定处，或麻木不仁等。其疼痛有下述几个特点：
1．疼痛的部位：痹证的疼痛，不论上下左右，全部或一部，多在四肢的关节部位，或筋骨部分，也有波及到腰背胸胁的，只有胸痹专在胸背，于四肢无碍。
2．疼痛的程度：一般外感风寒的新痹，疼痛剧烈，有的肢体运动受到妨碍，有的不敢转侧，有的不敢屈伸，以手按之，有的咬牙切齿，有的呻吟呼唤。
3．疼痛的时间：痹证疼痛的时间一般很长，有数月的，有数年的，甚或数十年及终身不愈的。这由治疗的及时与否，治法的得当与否决定。如果初起治疗保养得法，可能时间缩短些，但总不如感冒疼痛那样疗效来得快。痹证疼痛多与季节、气候、昼夜等节律变化有明显的关系。多数为昼轻夜重；天晴时轻，天阴时重；夏秋时轻，春冬时重。
4．疼痛的特点：痹证的疼痛呈多样性，有上下移动者；有左右上下不定者；有时痛时止者，痛时如蛇咬、如针刺、如蝎螫；有疼痛固定不移者；有疼痛兼麻木者；有疼痛的部位肿胀发热发红者；有初起疼痛较剧，逐渐变为不知痛痒，不能运动，不能转侧，关节不能屈伸者等。
新痹当祛邪为务 久痹宜寓散于补
痹证的发生，是由于风、寒、湿、热等外邪侵袭人体，闭阻经络，气血运行不畅所致，以肌肉、筋骨、关节发生酸痛、麻木、重着、屈伸不利，甚或关节肿大灼热为主要特征。痹证初病属实，久则多呈正虚邪实、虚实夹杂之候。《素问·痹论》曰： “五脏皆有合。病久而不去者，内舍于其合也。”“其人脏者死，其留连筋骨者疼久，其留皮肤间者易已。”说明痹证迁延不愈，复感于邪，会内舍其合，而引起脏腑痹，甚至形成入脏之死证。因此，治痹当分新久，新痹首当祛邪为务，久痹则宜寓散于补。
一、治痹大法
1．通经活血、疏散邪滞为治痹总則
治痹总以通经活血、疏散邪滞为大法。随所感风、寒、湿、热诸邪气之轻重及临床见证寒、热、虚、实之不同而加以对证立法施治，为痹证总的治法。
2．新痹当以祛邪为务
痹证新起，多为实证，不可骤用参芪归地滋腻之品，以防气郁湿滞，闭门留寇。宜以行湿流气、疏散邪气之祛邪法为主。初起因风、寒、湿三气尚未变热，可根据三气之法治之．
风气盛之行痹，以散风为主，御寒利湿辅之，再参以补血之剂。盖治风先治血．血行风自灭也。寒气盛之痛痹，以散寒为主，疏风燥湿辅之，再参以补火之剂，盖非大辛大温不能释其凝寒也。湿气盛之着痹，以利湿为主，祛风散寒仍不可缺，再参以补脾补气之剂，因为脾强可以胜湿，气足自不顽麻。若邪郁病久，风变为火，寒变为热，湿变为痰，又当于通经活血、疏散邪滞剂中再参以降火清热豁痰之品。
3．久痹宜补泻兼施，寓散于补
痹证日久而不愈，多成正虚邪实、虚实间夹之证。治痹虽以通经活血、疏散邪滞为总法，但当久痹正虚兼邪实之时，不可单用通散祛邪之法，而应着眼于正虚邪实、本虚标实，治宜补中兼散，寓散于补。如四物、四君之中加疏散风寒、燥湿化痰、活血祛瘀或行气散结之品等。同时，治疗久痹，最宜峻补真阴，阴液充足，则气血流行，风寒湿邪随血液循环而去。若过用风湿痰滞等药而再伤其阴气，必反增重其疾矣。
二、痹证治疗九法
1．补气血法
张寿甫云：人身之气化，壮旺流行而周身痹者、瘀者、滞者，不治自愈。即偶不愈，治之亦宜为功。陈修园言：痛风口久不愈，必大补气血以为胜邪之本。故补气血为治痹之第一要法。方如小续命汤、黄芪桂枝五物汤、三痹汤等。
2．散风寒法
痹证初起，脉浮紧，头痛发热恶寒者，宜用发散风寒之法，如麻黄汤。日久者，则不可散也，散之则肢体痿废不用。久痹而兼风寒者，不可单用通散，而宜补中兼散，寓散于补。如《医通》言：治(久)痹而用风散通达之剂，医之过也。痹证非不有风，然风人阴分与寒湿互结，扰乱其血脉，致身中之阳气不通于阴，故致痹也。古云多有用麻黄、白芷者，以麻黄能通阳，白芷能行营卫，然已人四君、四物等汤中，非专发表也。
3．疏通血络法
包括活血、行血、消瘀诸法。古人云：治风先治血，血行风自灭。活血行血宜用红花、桃仁、赤芍、归尾之类，方如活络效灵丹之类。陈修园云：痛风日久不愈，痛久必人络也。诸方俱宜加银花、木通、红花、刺蒺藜之类。
4．祛痰法
陈修园云：痛久则郁，郁而为热，热则生痰。必加入制南星、半夏、贝母、竹沥、姜汁之类。
5．清热法
包括清热、泻火诸法。陈修园曰：痛久则郁，郁而为热。用药如瓜蒌根、黄柏、川棟子之类。其中清热多用甘寒，如石膏、知母之类；泻火多用苦寒，如黄芩、黄连之属。
6．柔润熄风法
陈修园云：久服辛热之药不效时，宜用此法。用药如玉竹、黑芝麻、僵蚕、生芪、当归、菊花、蒺藜、阿胶、炙草、桑寄生之类。
7．针刺法
以患部与循经取穴为主，亦可采用阿是穴。行痹、热痹用毫针泻法浅刺，并可用皮肤针叩刺；痛痹多灸，深刺留针，如疼痛剧烈者，可兼用揿针或隔姜灸；着痹多针灸并施。或兼用温针、皮肤针和拔火罐法。
8．行气法
用于痹证初起．，取气行则血行，行湿流气之意。用药如陈皮、枳壳、杏仁之类。
9．祛寒胜湿法
为寒湿痹证正治之法，以川乌、草乌搜风胜湿祛寒，苍术、白术燥湿，当归养荣，乳香、没药活血散血，止痛消肿。方如寒湿方。
三、久痹治验举隅
李老将痹证总分为新痹与久痹两大类。认为新痹多实，当以祛邪为务，根据风、寒、湿、热诸邪之偏胜，施以相应的疏风、散寒、除湿、清热等法，不难辨治，因病属初起，气、血、阴、阳未虚，攻邪用药少有顾忌，故易于治愈。久痹不愈，则多呈正虚邪实，虚实间夹，甚至耗气伤血，形成内舍脏腑之复杂证候。具体讲容易出现下述三种病理变化：一者，风、寒、湿痹或热痹日久不愈，气血津液运行不畅之病变日甚，血脉瘀阻，津液凝聚，终致瘀血痰浊闭阻经络，出现皮肤瘀斑，关节周围结节，关节肿大痛甚，屈伸不利等；二者，久痹不愈，耗气伤血，因而出现不同程度的气血亏虚或脾肾阳虚或肝肾亏损的证候，这种情况，在痹证病久之后均易见到；三者，痹久不愈，病变会由表及里，由经络而及脏腑，出现脏腑痹的复杂危重证候。如《素问·痹论》曰：“心痹者，脉不通，烦则心下鼓，暴上气而喘。”又《金匮翼·痹证统论》曰：“久(痹)不已，则人五脏，烦满而喘呕者，肺也；上气，嗌干，厥胀者，心也；多饮数溲，夜卧则惊者，肝也；尻以代踵，脊以代头者，肾也；四肢懈惰，发咳呕沫者，脾也。大抵显脏证则难治矣。”总之，久痹不愈，反复发作，则易出现痰瘀阻络、气血阴阳亏虚及脏腑痹的证候，且每多出现寒热虚实间夹的复杂证候。治痹虽以通经活血、疏散邪滞为总的法则，但当久痹正虚兼邪实之时，不可单用通散祛邪之法，而应时时不忘正虚邪实，本虚标实，仔细审查虚实寒热的孰多孰少，治则总宜补中兼散，寓散于补。
(一)气血两虚案
案一 周某，女，30岁。门诊号：82986。
1964年12月3日初诊：下肢软弱无力，肌肤麻木不仁3月余。舌质红无苔，脉虚。此系气血两虚、风湿痹阻之证。治宜益气养血，祛风胜湿。处方：
党参9克 生黄芪4．5克 当归9克 生白芍9克 生白术7．5克 生苡仁9克 僵蚕6克 木瓜7．5克 桑枝30克 炙甘草3克
2剂，水煎服。
二诊：服药后肌肤麻木消失，但仍感下肢困软，背困。处方：
生黄芪15克 黄柏6克 怀牛膝4．5克 木瓜9克生苡仁30克
2剂，水煎服．
三诊：诸症若失，继服上方6剂，诸症消失。
按：此证属气血两虚，风湿痹阻，故重用参、芪益气，归、芍补血敛阴，四味合用气血双补之力较强。白术、苡米、炙甘草健脾燥湿，补中益气，以助气血化源。诸药配伍。以治气血亏虚之本。方中重用桑枝，以祛风通络，僵蚕祛风泄热，木瓜舒筋活络，和胃化湿，三味祛风通络，配白术、苡仁共能祛风胜湿以治其标。：二诊后重用黄芪。意在加强补气血之功，另用怀牛膝补肝肾，并能引药下行直达病所，所以除风湿痹痛。
案二 刘某，女，30岁。门诊号：24005。
1959年12月28日初诊：下肢酸困、浮肿、乏力2月余。伴腰困，食欲不振，苔薄白，脉细弱。证属气血两虚、水湿停留之虚痹证候。治宜益气健脾，燥湿祛风。处方：
生黄芪9克 防己9克 生白术9克 木瓜7．5克 怀牛膝6克 秦艽4．5克 炙甘草3克
2剂，水煎服。
二诊：服上方后，下肢酸困浮肿减轻，仍感乏力。上方加当归7．5克。
继服上药8剂，诸症消失。
(二)气虚血痹案
案一 田某，女，45岁。门诊号：59804。
1963年1月3日初诊：恶寒，下肢麻木，肌肤不仁，自觉发冷，舌头亦冷，已1月余，苔薄白，脉微涩而紧。证属气虚血痹。治宜益气温经，和营通痹。方用加味黄芪桂枝五物汤：
生黄芪7．5克 桂枝7．5克 生白芍7．5克 怀牛膝6克 防己7．5克 生姜3片 大枣4枚
2剂，水煎服。
二诊：服上药后，下肢麻木消失，皮肤恢复知觉，恶寒减轻，汗出较多，齿龈冷，大便多，日行3—4次。上方加生白术7．5克，茯苓7．5克，附子3克。
2剂，水煎服。
三诊：服上方后恶寒已去，大便基本恢复正常，继服上方4剂，以巩固疗效。
案二 赵某，男，32岁。门诊号：95209。
1965年12月13日初诊：双膝以下酸困，有凉感，素有遗精病，已有4年，每夜遗精多次。喜凉性饮食。苔薄白，脉沉迟。证属上热下寒，气虚血痹。治宜益气和营通痹。方用加味黄芪桂枝五物汤加味：
生黄芪9克 桂枝9克 生白芍9克 怀牛膝6克 防己7．5克 秦艽4．5克 知母9克 生姜3克 大枣3枚
2剂，水煎服。
二诊：服上药后，膝关节酸困减轻，仍有遗精。上方加芡实7．5克，继服2剂。
共服上方12剂，诸症消除。
按：此二例均为气虚血痹之证，系由素体不足，体疲汗出，卫阳不固，微风侵袭，邪滞血脉，痹阻不通所致。李老在仲景黄芪桂枝五物汤之基础上，妙加怀牛膝、防己，成加味黄芪桂枝五物汤，意在益气温经、和营通痹的基础上助以牛膝之益肝肾，强筋骨，散瘀血，防己助黄芪以益气固表。另牛膝尚能引药下行，直抵病所。案一二诊针对患者恶寒、便溏等脾肾阳虚证候，加用白术、茯苓、附子以温阳健脾。案二虽亦为气虚血痹之证，但同时兼有上热下寒、寒热错杂之候，故用加味黄芪桂枝五物汤加知母，以清肺胃之热而泻火，加芡实以收敛固精。
Historical medical experts have provided detailed discussions on this disease. For instance, Lu Qingjie stated: "Although Bi syndrome (Bi Bing) is divided into sixteen types, it can be summarized in one phrase: the stagnation of Qi mechanism." Chen Xiuyuan said: "Bi means obstruction; when obstruction causes illness, it is named Bi." This also refers to the stagnation of Qi mechanism. Lin Peiqin stated: "All forms of Bi are diseases where Wind, Cold, and Dampness pathogens mix and invade the meridians and collaterals." "Xing Bi (Wandering Bi), Tong Bi (Painful Bi), and Zhuo Bi (Fixed Bi) are the main categories of Bi syndrome, named according to the prevailing pathogenic factor at the time, not implying other distinct bone, tendon, or vessel Bis outside these." You Zaijing stated: "Bi means obstruction. When the righteous Qi of the five zang organs and six fu organs is obstructed by pathogens, numbness and loss of sensation occur." Based on these statements, there is no doubt that meridian obstruction and joint pain are the primary symptoms of Bi syndrome. However, conversely, are all joint pains considered Bi syndrome? No, absolutely not. Because joint pain can also be purulent, tuberculous, syphilitic, or traumatic, none of which should be called Bi syndrome. Only joint pain caused by the combination of Wind, Cold, and Dampness is termed Bi syndrome. Moreover, even if joint pain is caused solely by any one of Wind, Cold, or Dampness, if the focus is not on the joints, it cannot be called Bi syndrome.
The *Su Wen: Bi Lun* states: "When Wind, Cold, and Dampness mix and arrive together, they form Bi. If Wind predominates, it is Xing Bi (Wandering Bi); if Cold predominates, it is Tong Bi (Painful Bi); if Dampness predominates, it is Zhuo Bi (Fixed Bi)." The *Jing Yue Quan Shu: Feng Bi* states: "Bi means obstruction. It occurs when Qi and Blood are obstructed by pathogens and cannot flow freely." It further states: "All Bis generally arise from the weakness of True Yin and the deficiency of Essence and Blood, allowing the three pathogens to take advantage and cause this disease." Qin Bowei stated: "Bi refers to illnesses such as pain and numbness in muscles or joints caused by contracting Wind, Cold, and Dampness pathogens and subsequent disharmony of Qi and Blood." Thus, it is evident that when Qi and Blood are deficient, the three pathogens invade due to this deficiency, obstructing the meridians and vessels, preventing the normal circulation of Qi and Blood. This results in local swelling and pain, wandering pain throughout the body, inability to flex and extend joints, or muscle numbness and loss of sensation, thereby forming Bi syndrome. However, because the quantity of the three external pathogens invading the human body varies, the manifested syndromes differ. For example, Xing Bi is due to extreme Wind pathogen, Tong Bi to extreme Cold pathogen, and Zhuo Bi to extreme Dampness pathogen.
At the onset of Bi syndrome, known as Xin Bi (New Bi), it is mostly excess syndrome; long-standing Bi syndrome, known as Jiu Bi (Old Bi), often presents with righteous deficiency mixed with pathogenic excess, or a complex pattern of both deficiency and excess. Its basic pathological mechanisms can be summarized in the following three new situations:
1. Wind-Cold-Dampness or Wind-Damp-Heat pathogens invade the body through deficiency, flowing into the meridians and joints. Over time, the pathology of impaired Qi and Blood circulation worsens, leading to blood stasis and condensation of body fluids, resulting in blood stasis and turbid phlegm obstructing the meridians. Symptoms include skin ecchymosis, nodules around joints, joint swelling, and limited mobility.
2. Long-standing Bi syndrome consumes Qi and Blood, often presenting with patterns of dual deficiency of Qi and Blood or deficiency of Liver and Kidney, which are commonly seen after various Bi syndromes have persisted for a long time.
3. Prolonged Bi syndrome involves righteous deficiency and pathogenic excess, progressing from meridians to affect the zang-fu organs, resulting in difficult-to-treat or incurable patterns of Zang-Fu Bi.
Four Major Characteristics of Pain in Bi Syndrome
The main symptoms of Bi syndrome are pain in the limbs and joints, or swelling and pain, heaviness, limited mobility, wandering pain, or numbness and loss of sensation. The pain has the following characteristics:
1. Location of Pain: The pain of Bi syndrome, whether upper or lower, left or right, partial or total, is mostly located in the joints of the four limbs or the sinews and bones. It may also involve the waist, back, chest, and hypochondrium. Only Xiong Bi (Chest Bi) is specifically located in the chest and back, without affecting the four limbs.
2. Degree of Pain: Generally, new Bi contracted from external Wind-Cold involves severe pain. Some patients have restricted limb movement, some dare not turn their bodies, some dare not flex or extend, some grind their teeth upon pressure, and some moan or call out.
3. Duration of Pain: The duration of pain in Bi syndrome is generally long, lasting months, years, or even decades, sometimes lifelong. This depends on the timeliness of treatment and the appropriateness of the method. If treated and cared for properly at the onset, the duration may be shortened, but the efficacy is never as rapid as that for common cold pain. Bi syndrome pain often has an obvious relationship with rhythmic changes such as seasons, climate, and day/night cycles. Most cases are lighter during the day and heavier at night; lighter on sunny days and heavier on cloudy days; lighter in summer and autumn, and heavier in spring and winter.
4. Nature of Pain: The pain in Bi syndrome is diverse. It may move up and down; be irregular in location; come and go intermittently, feeling like snake bites, needle pricks, or scorpion stings when present; remain fixed in one place; be accompanied by numbness; present with swelling, heat, and redness at the painful site; or start severely and gradually progress to loss of pain and temperature sensation, immobility, inability to turn, and inability to flex or extend joints.
For New Bi, Expelling Pathogens is Paramount; For Old Bi, Dispersal Should Be Embedded within Tonification
The occurrence of Bi syndrome is caused by external pathogens such as Wind, Cold, Dampness, and Heat invading the body, obstructing the meridians, and impairing the smooth flow of Qi and Blood. Its main features are soreness, pain, numbness, heaviness, and limited mobility in muscles, sinews, bones, and joints, or even joint swelling and burning heat. Early-stage Bi syndrome is characterized by excess; long-standing Bi syndrome often presents with righteous deficiency mixed with pathogenic excess, or a complex pattern of both deficiency and excess. The *Su Wen: Bi Lun* states: "Each of the five zang organs has its corresponding exterior. When the disease persists for a long time, it enters internally into its corresponding organ." "If it enters the zang organs, death ensues; if it lingers in sinews and bones, pain lasts long; if it remains between the skin, it is easy to cure." This indicates that prolonged Bi syndrome, compounded by re-infection with pathogens, will enter internally into its corresponding organ, causing Zang-Fu Bi, and even forming fatal patterns involving the zang organs. Therefore, treating Bi requires distinguishing between new and old stages. For New Bi, expelling pathogens is paramount; for Old Bi, dispersal should be embedded within tonification.
I. General Principles for Treating Bi Syndrome
1. Unblocking Meridians, Invigorating Blood, and Dispersing Pathogenic Stagnation as the General Principle
The general principle for treating Bi is unblocking meridians, invigorating blood, and dispersing pathogenic stagnation. Treatment methods are formulated based on the severity of contracted Wind, Cold, Dampness, or Heat pathogens and the clinical manifestations of Cold, Heat, Deficiency, or Excess, constituting the overall treatment approach for Bi syndrome.
2. For New Bi, Expelling Pathogens is Paramount
New-onset Bi syndrome is mostly excess syndrome. One should not abruptly use cloying and greasy tonics like Ginseng, Astragalus, Angelica, and Rehmannia, to prevent Qi stagnation and Dampness retention, effectively locking the thief inside. The primary method should be dispelling dampness, moving Qi, and dispersing pathogens. At the onset, since Wind, Cold, and Dampness have not yet transformed into Heat, treatment should follow the laws for these three pathogens.
For Xing Bi dominated by Wind, dispersing Wind is primary, assisting with Cold-resisting and Dampness-draining methods, and supplementing with blood-nourishing formulas. As the saying goes, "To treat Wind, first treat Blood; when Blood flows, Wind extinguishes itself." For Tong Bi dominated by Cold, dispersing Cold is primary, assisting with Wind-dispersing and Dampness-drying methods, and supplementing with Fire-tonifying agents, as only strongly pungent and warm herbs can resolve congealed Cold. For Zhuo Bi dominated by Dampness, draining Dampness is primary, while Wind-dispersing and Cold-resolving are indispensable, supplemented by Spleen-tonifying and Qi-supplementing agents, because a strong Spleen can overcome Dampness, and sufficient Qi prevents stubborn numbness. If pathogens stagnate for a long time, Wind transforms into Fire, Cold into Heat, and Dampness into Phlegm, then fire-clearing, heat-purging, and phlegm-resolving herbs should be added to the meridian-unblocking and blood-invigorating formulas.
3. For Old Bi, Tonification and Purging Should Be Combined, Embedding Dispersal within Tonification
Long-standing Bi syndrome often results in righteous deficiency mixed with pathogenic excess, or a complex pattern of both deficiency and excess. Although the general principle for treating Bi is unblocking meridians and invigorating blood, when facing righteous deficiency with pathogenic excess in old Bi, one should not rely solely on dispersing and purging methods. Instead, attention should be paid to the underlying deficiency and manifest excess. Treatment should combine tonification with dispersal. For example, adding herbs that disperse Wind-Cold, dry Dampness, resolve Phlegm, invigorate blood, remove stasis, or move Qi and dissipate nodules to Si Wu Tang (Four Substances Decoction) or Si Jun Zi Tang (Four Gentlemen Decoction). Furthermore, treating old Bi best suits vigorous tonification of True Yin. When Yin fluids are sufficient, Qi and Blood circulate, and Wind-Cold-Dampness pathogens are eliminated via blood circulation. Overusing herbs for Wind-Dampness and Phlegmatic stagnation will further damage Yin Qi, inevitably worsening the disease.
II. Nine Methods for Treating Bi Syndrome
1. Tonifying Qi and Blood Method
Zhang Shoufu stated: "When the body's Qi transformation is robust and circulating smoothly, systemic Bi, stasis, and stagnation heal spontaneously. Even if they occasionally do not heal, treatment yields merit." Chen Xiuyuan said: "For chronic gout that does not heal, one must greatly tonify Qi and Blood as the foundation for overcoming pathogens." Thus, tonifying Qi and Blood is the primary method for treating Bi. Formulas include Xiao Xu Ming Tang (Minor Continuation of Life Decoction), Huang Qi Gui Zhi Wu Wu Tang (Astragalus and Cinnamon Twig Five Substance Decoction), and San Bi Tang (Three Bi Decoction).
2. Dispersing Wind and Cold Method
For early-stage Bi syndrome with floating and tight pulse, headache, fever, and aversion to cold, the method of dispersing Wind and Cold should be used, such as Ma Huang Tang (Ephedra Decoction). For long-standing cases, dispersal is contraindicated; dispersing them leads to flaccidity and paralysis of the limbs. For old Bi combined with Wind-Cold, one should not use pure dispersal but rather combine tonification with dispersal. As stated in *Yi Tong*: "Using wind-dispersing and unblocking agents to treat (old) Bi is a physician's error." Bi syndrome does involve Wind, but Wind entering the Yin aspect binds with Cold and Dampness, disturbing the blood vessels, preventing Yang Qi from reaching the Yin, thus causing Bi. Ancient texts mention using Ma Huang (Ephedra) and Bai Zhi (Angelica Dahurica), as Ma Huang can unblock Yang and Bai Zhi can circulate Ying and Wei, but when already included in Si Jun Zi or Si Wu decoctions, they are not primarily for releasing the exterior.
3. Unblocking Blood Collaterals Method
Includes invigorating blood, moving blood, and eliminating stasis. The ancients said: "To treat Wind, first treat Blood; when Blood flows, Wind extinguishes itself." For invigorating and moving blood, use herbs like Hong Hua (Carthamus), Tao Ren (Prunus Persica), Chi Shao (Red Peony Root), and Gui Wei (Angelica Sinensis Tail), in formulas like Huo Luo Xiao Ling Dan (Meridian-Unblocking Efficacious Spirit Pill). Chen Xiuyuan stated: "For chronic gout that does not heal, long-standing pain inevitably enters the collaterals." All formulas should add Jin Yin Hua (Lonicera Flower), Mu Tong (Akebia Stem), Hong Hua (Carthamus), and Ci Ji Li (Tribulus Fruit).
4. Resolving Phlegm Method
Chen Xiuyuan stated: "Long-standing pain leads to stagnation, stagnation generates Heat, and Heat generates Phlegm." Must add processed Tian Nan Xing (Arisaema Cum Bile), Ban Xia (Pinellia Tuber), Bei Mu (Fritillaria Bulb), Zhu Li (Bamboo Sap), and Jiang Zhi (Ginger Juice).
5. Clearing Heat Method
Includes clearing heat and purging fire. Chen Xiuyuan stated: "Long-standing pain leads to stagnation, stagnation generates Heat." Use herbs like Gua Lou Gen (Trichosanthes Root), Huang Bo (Phellodendron Bark), and Chuan Lian Zi (Melia Fruit). For clearing heat, sweet-cold herbs like Shi Gao (Gypsum) and Zhi Mu (Anemarrhena Rhizome) are often used; for purging fire, bitter-cold herbs like Huang Qin (Scutellaria Root) and Huang Lian (Coptis Rhizome) are used.
6. Softening, Moistening, and Extinguishing Wind Method
Chen Xiuyuan stated: "When long-term use of acrid-warm herbs is ineffective, this method should be used." Use herbs like Yu Zhu (Polygonatum Odoratum Rhizome), Hei Zhi Ma (Sesame Seed), Jiang Can (Bombyx Batryticatus), Sheng Huang Qi (Raw Astragalus), Dang Gui (Angelica Sinensis), Ju Hua (Chrysanthemum Flower), Ji Li (Tribulus Fruit), E Jiao (Donkey-Hide Gelatin), Zhi Gan Cao (Prepared Licorice Root), and Sang Ji Sheng (Taxillus Branch).
7. Acupuncture Method
Primarily selecting points at the affected area and along the meridians, Ashi points (pain points) can also be used. For Xing Bi and Re Bi (Heat Bi), shallow needling with reducing method using filiform needles is applied, and scalp needles can be used for tapping. For Tong Bi, moxibustion is frequent, with deep insertion and retaining the needle; for severe pain, pressing needles or ginger-separated moxibustion can be combined. For Zhuo Bi, acupuncture and moxibustion are applied together, possibly combined with warming needle, scalp needle, and cupping therapy.
8. Moving Qi Method
Used for early-stage Bi syndrome, based on the principle that moving Qi moves Blood, and moving Dampness moves Qi. Use herbs like Chen Pi (Citrus Peel), Zhi Ke (Aurantii Fructus), and Xing Ren (Apricot Seed).
9. Dispelling Cold and Overcoming Dampness Method
This is the correct treatment for Cold-Damp Bi syndrome. Use Chuan Wu (Aconitum Carmichaelii Dehan) and Cao Wu (Aconitum Kusnezoffii Reichb) to search out Wind, overcome Dampness, and dispel Cold; Cang Zhu (Atractylodes Rhizome) and Bai Zhu (Atractylodes Macrocephala Rhizome) to dry Dampness; Dang Gui (Angelica Sinensis) to nourish Ying; Ru Xiang (Olibanum) and Mo Yao (Myrrha) to invigorate blood, dissipate blood stasis, relieve pain, and reduce swelling. Formula includes Han Shi Fang (Cold-Dampness Formula).
III. Examples of Successful Treatments for Old Bi
Old Master Li generally divides Bi syndrome into two major categories: New Bi and Old Bi. He believes New Bi is mostly excess and requires expelling pathogens. Based on the predominance of Wind, Cold, Dampness, or Heat pathogens, corresponding methods of dispersing Wind, resolving Cold, removing Dampness, and clearing Heat are applied, making differentiation and treatment straightforward. Since the disease is in its early stage, Qi, Blood, Yin, and Yang are not yet deficient, so there are few concerns in using attacking herbs, making it easy to cure. Old Bi that does not heal often presents with righteous deficiency mixed with pathogenic excess, or a complex pattern of both deficiency and excess, even consuming Qi and Blood, forming complex patterns of internal involvement of zang-fu organs. Specifically, three pathological changes are prone to occur: First, long-standing Wind-Cold-Damp Bi or Heat Bi leads to worsening impairment of Qi, Blood, and Body Fluid circulation, blood stasis, and fluid condensation, ultimately causing blood stasis and turbid phlegm to obstruct meridians, presenting with skin ecchymosis, nodules around joints, severe joint swelling and pain, and limited mobility. Second, long-standing Bi consumes Qi and Blood, resulting in varying degrees of dual deficiency of Qi and Blood, or deficiency of Spleen-Kidney Yang, or deficiency of Liver and Kidney, which are commonly seen after long-standing Bi. Third, prolonged Bi progresses from the exterior to the interior, from meridians to zang-fu organs, presenting with complex and critical patterns of Zang-Fu Bi. As the *Su Wen: Bi Lun* states: "In Heart Bi, the vessels are blocked; irritability causes palpitations under the heart, sudden upward rushing of Qi and wheezing." Also, the *Jin Gui Yi: Bi Zheng Tong Lun* states: "If (Bi) does not cease, it enters the five zang organs. Irritation, fullness, wheezing, and vomiting indicate Lung Bi; upward rushing of Qi, dry throat, and cold distension indicate Heart Bi; excessive drinking, frequent urination, and waking in fright at night indicate Liver Bi; sitting on the heels with the spine replacing the head indicates Kidney Bi; flaccidity of the four limbs, coughing, and vomiting foam indicate Spleen Bi. Generally, when zang organ signs appear, treatment is difficult." In summary, recurrent and non-healing old Bi easily leads to patterns of Phlegm-Stasis obstructing collaterals, deficiency of Qi, Blood, Yin, and Yang, and Zang-Fu Bi, often presenting with complex patterns mixing Cold, Heat, Excess, and Deficiency. Although the general principle for treating Bi is unblocking meridians and invigorating blood, when facing righteous deficiency with pathogenic excess in old Bi, one should not rely solely on dispersing and purging methods. One must always remember righteous deficiency with pathogenic excess, underlying deficiency with manifest excess, carefully examine the proportion of deficiency/excess and cold/heat, and the treatment principle should generally combine tonification with dispersal, embedding dispersal within tonification.
(Case 1: Dual Deficiency of Qi and Blood)
Case 1: Zhou, Female, 30 years old. Outpatient No.: 82986.
First visit on December 3, 1964: Weakness and lack of strength in lower limbs, numbness and loss of sensation in skin for over 3 months. Red tongue body without coating, deficient pulse. This is a pattern of dual deficiency of Qi and Blood with Bi obstruction by Wind-Dampness. Treatment should tonify Qi and nourish Blood, dispel Wind and overcome Dampness. Prescription:
Dang Shen 9g, Raw Huang Qi 4.5g, Dang Gui 9g, Raw Bai Shao 9g, Raw Bai Zhu 7.5g, Raw Yi Yi Ren 9g, Jiang Can 6g, Mu Gua 7.5g, Sang Zhi 30g, Zhi Gan Cao 3g.
2 doses, decocted in water and taken orally.
Second visit: After taking the medicine, skin numbness disappeared, but still felt heaviness and softness in lower limbs and back. Prescription:
Raw Huang Qi 15g, Huang Bo 6g, Huai Niu Xi 4.5g, Mu Gua 9g, Raw Yi Yi Ren 30g.
2 doses, decocted in water and taken orally.
Third visit: All symptoms vanished. Continued taking the above prescription for 6 doses, and all symptoms disappeared.
Commentary: This case belongs to dual deficiency of Qi and Blood with Wind-Damp Bi obstruction. Therefore, heavy use of Shen and Qi tonifies Qi, Gui and Shao nourishes Blood and conserves Yin. These four herbs combined have strong power to tonify both Qi and Blood. Bai Zhu, Yi Mi, and Zhi Gan Cao strengthen the Spleen, dry Dampness, tonify Middle and benefit Qi, aiding the source of Qi and Blood generation. The combination of herbs treats the root of Qi and Blood deficiency. Heavy use of Sang Zhi in the formula dispels Wind and unblocks collaterals; Jiang Can dispels Wind and drains Heat; Mu Gua relaxes sinews, activates collaterals, harmonizes Stomach, and transforms Dampness. These three herbs dispel Wind and unblock collaterals, combined with Bai Zhu and Yi Ren, can collectively dispel Wind and overcome Dampness to treat the branch. After the second visit, heavy use of Huang Qi aims to strengthen the function of tonifying Qi and Blood. Additionally, Huai Niu Xi tonifies Liver and Kidney and guides the medicine downward directly to the disease site, thus eliminating Wind-Damp Bi pain.
Case 2: Liu, Female, 30 years old. Outpatient No.: 24005.
First visit on December 28, 1959: Soreness, heaviness, edema, and fatigue in lower limbs for over 2 months. Accompanied by lumbar heaviness, poor appetite, thin white coating, fine and weak pulse. Pattern belongs to dual deficiency of Qi and Blood with Water-Dampness retention, a deficiency-type Bi syndrome. Treatment should tonify Qi and strengthen Spleen, dry Dampness and dispel Wind. Prescription:
Raw Huang Qi 9g, Fang Ji 9g, Raw Bai Zhu 9g, Mu Gua 7.5g, Huai Niu Xi 6g, Qin Jiao 4.5g, Zhi Gan Cao 3g.
2 doses, decocted in water and taken orally.
Second visit: After taking the above prescription, soreness, heaviness, and edema in lower limbs were reduced, but fatigue remained. Added Dang Gui 7.5g to the above prescription.
Continued taking the above medicine for 8 doses, and all symptoms disappeared.
(Case 2: Qi Deficiency and Blood Bi)
Case 1: Tian, Female, 45 years old. Outpatient No.: 59804.
First visit on January 3, 1963: Aversion to cold, numbness in lower limbs, insensitivity of skin, subjective feeling of cold, tongue also feels cold, for over 1 month. Thin white coating, faint, choppy, and tight pulse. Pattern belongs to Qi deficiency and Blood Bi. Treatment should benefit Qi and warm meridians, harmonize Ying and unblock Bi. Formula: Modified Huang Qi Gui Zhi Wu Wu Tang:
Raw Huang Qi 7.5g, Gui Zhi 7.5g, Raw Bai Shao 7.5g, Huai Niu Xi 6g, Fang Ji 7.5g, Fresh Ginger 3 slices, Large Date 4 pieces.
2 doses, decocted in water and taken orally.
Second visit: After taking the above medicine, numbness in lower limbs disappeared, skin sensation recovered, aversion to cold was reduced, sweating increased, gums felt cold, frequent stools, 3-4 times per day. Added Raw Bai Zhu 7.5g, Fu Ling 7.5g, Fu Zi 3g to the above prescription.
2 doses, decocted in water and taken orally.
Third visit: After taking the above prescription, aversion to cold had gone, bowel movements basically returned to normal. Continued taking the above prescription for 4 doses to consolidate therapeutic effect.
Case 2: Zhao, Male, 32 years old. Outpatient No.: 95209.
First visit on December 13, 1965: Soreness and heaviness below both knees, with a cool sensation. History of seminal emission for 4 years, multiple emissions per night. Prefers cool foods. Thin white coating, deep and slow pulse. Pattern belongs to Upper Heat and Lower Cold, Qi deficiency and Blood Bi. Treatment should benefit Qi, harmonize Ying, and unblock Bi. Formula: Modified Huang Qi Gui Zhi Wu Wu Tang with additions:
Raw Huang Qi 9g, Gui Zhi 9g, Raw Bai Shao 9g, Huai Niu Xi 6g, Fang Ji 7.5g, Qin Jiao 4.5g, Zhi Mu 9g, Fresh Ginger 3 slices, Large Date 3 pieces.
2 doses, decocted in water and taken orally.
Second visit: After taking the above medicine, knee soreness and heaviness were reduced, but seminal emission continued. Added Qian Shi 7.5g to the above prescription, continued for 2 doses.
Total of 12 doses of the above prescription taken, all symptoms eliminated.
Commentary: Both cases belong to Qi deficiency and Blood Bi, caused by constitutional insufficiency, fatigue and sweating, insecure Wei Yang, invasion of slight Wind, pathogen stagnation in blood vessels, and obstruction of Bi. Old Master Li, based on Zhang Zhongjing's Huang Qi Gui Zhi Wu Wu Tang, skillfully added Huai Niu Xi and Fang Ji to create Modified Huang Qi Gui Zhi Wu Wu Tang. The intent is to assist Niu Xi in benefiting Liver and Kidney, strengthening sinews and bones, and dissipating blood stasis, and Fang Ji assisting Huang Qi in benefiting Qi and securing the exterior, on the basis of benefiting Qi, warming meridians, harmonizing Ying, and unblocking Bi. Additionally, Niu Xi can guide the medicine downward, reaching the disease site directly. For Cases 1 and 2, addressing the patient's Spleen-Kidney Yang deficiency symptoms such as aversion to cold and loose stools, Bai Zhu, Fu Ling, and Fu Zi were added to warm Yang and strengthen Spleen. Case 2, although also Qi deficiency and Blood Bi, simultaneously presented with Upper Heat and Lower Cold, mixed Cold and Heat. Therefore, Modified Huang Qi Gui Zhi Wu Wu Tang was used with Zhi Mu to clear Heat from Lung and Stomach and purge fire, and Qian Shi was added to astringe and secure essence.
(Case 3: Deficient Cold with Dampness)