痛风，痛痹之一症也，其痛有常处。掣者为寒，肿者为湿，汗者为风，三气入于经络，营卫不行，正邪交
战，故痛不止。《灵枢》谓之贱风，《素问》谓之痛痹，《金匮》谓之历节。后世更名白虎历节风，近世俗名
箭风。初因寒湿风郁痹阴分，久则化热攻
痛，至夜更剧。治以辛温，疏散寒湿风邪，开发腠理，宜十生丹。若痛处赤肿 热，将成风毒，宜败毒散。如
风湿攻注肢节疼痛，大羌活汤。其历节风，痛无定所，遍历骨节，痛如虎啮。又名白虎历节，盖痛风之甚者也。
或饮酒当风，汗出浴水，因醉犯房，皆能致之。其手指挛曲，身多 ，其肿如脱，渐至摧落，其痛如掣，
不可屈伸，须大作汤丸，不可例以常剂治。乌头汤主之。因于寒，宜从温散。防风天麻汤。因于火，宜从清凉。
犀角散加减。若筋脉挛痛，伸缩不利，系血虚燥。四物汤加木瓜、何首乌、甘杞子。肢节酸痛，脉沉短气，
系有留饮。半夏芩术汤，或导痰汤加减。肢节注痛，得捶摩而缓者，系风湿在经。灵仙除痛饮。肢节肿痛，
遇阴雨而甚者，系风湿入络。虎骨丸、没药散、或虎骨散。肢节烦痛，肩背沉重者，系湿热相搏。当归拈痛散。
肢节刺痛，停着不移者，系瘀血阻隧。趁痛散。肢节热痛者，系阴火灼筋。加味二妙散，或潜行散，用四物
汤间服。周身麻痛者，系气血凝滞。五灵丸。历节久痛者，系邪毒停留。乳香定痛丸、活络丹。肥人肢节痛，
多风湿痰饮流注。宜导痰汤。瘦人肢节痛，是血枯。宜四物汤加羌活、防风。老人性急作劳，患腿痛。宜四
物汤加桃仁、牛膝、陈皮、生甘草，煎成，入姜汁，或潜行散，有瘀积者，加热酒服，并刺委中穴出血。
风气游行，痛无常处，如虫行遍体，日静夜剧者，麝香丸主之。痛风历节二症，宜参酌治之。
东垣以痛风多属血虚，主用芎归，佐以桃仁、红花、薄桂、威灵仙，或趁痛散。丹溪以痛风先由血□□主用
四物黄芩、白芷。在上加羌活、桂枝、威灵仙、桔梗。在下加牛膝、防己、黄柏、木通。石顽以湿热挟痰挟
血入络痹痛，症重日久，必加乌、附，驱逐痰湿，壮气行经，便阻必用大黄，或畏峻攻，不知邪毒流注经络，
非乌附不能散结，燥热结滞肠胃，非硝黄岂能润燥乎？
痛风，是痛痹（以疼痛为主要表现的痹证）的一种症状，其疼痛部位固定。因寒邪所致者表现为牵引样疼痛，因湿邪所致者表现为肿胀，因风邪所致者表现为汗出，这三种邪气侵入经络，导致营卫之气运行不畅，正气与邪气相互交争，所以疼痛不止。《灵枢》称之为“贱风”，《素问》称之为“痛痹”，《金匮要略》称之为“历节”。后世改称为“白虎历节风”，近代世俗称为“箭风”。初期多因寒、湿、风邪郁闭于阴分，日久则化热攻冲作痛，到了夜间疼痛加剧。治疗宜用辛温药物，疏散寒、湿、风邪，开发腠理（皮肤毛孔及纹理），适宜使用十生丹。如果疼痛部位红肿发热，即将形成风毒，适宜使用败毒散。如果是风湿之邪攻注肢节导致疼痛，适宜使用大羌活汤。至于历节风，疼痛部位不固定，遍历全身骨节，疼痛如同老虎咬噬一般。又名白虎历节，这是痛风中较为严重的类型。或因饮酒时当风，出汗后洗浴冷水，或因醉酒行房事，都能导致此病。出现手指拘挛弯曲，身体多处麻木，肿胀严重如脱落感，逐渐至骨骼毁坏脱落，疼痛如牵引般剧烈，关节不可屈伸，必须大剂量制作汤剂或丸剂，不能按常规剂量治疗。主方为乌头汤。因寒邪所致，宜从温散角度治疗，可用防风天麻汤。因火邪所致，宜从清凉角度治疗，可用犀角散加减。如果是筋脉拘挛疼痛，伸缩不利，属于血虚燥盛，可用四物汤加木瓜、何首乌、甘杞子。如果是肢节酸痛，脉象沉短且气短，属于体内有留饮（水液代谢障碍停聚），可用半夏芩术汤，或导痰汤加减。如果是肢节疼痛，按压捶打按摩后缓解的，属于风湿在经脉，可用灵仙除痛饮。如果是肢节肿痛，遇阴雨天气加重的，属于风湿入络脉，可用虎骨丸、没药散，或虎骨散。如果是肢节烦扰疼痛，伴有肩背沉重的，属于湿热相搏结，可用当归拈痛散。如果是肢节刺痛，疼痛位置固定不移的，属于瘀血阻滞经络隧道，可用趁痛散。如果是肢节热痛，属于阴火灼伤筋脉，可用加味二妙散，或潜行散，配合四物汤交替服用。如果是周身麻木疼痛，属于气血凝滞，可用五灵丸。如果是历节风久痛不愈，属于邪毒停留，可用乳香定痛丸、活络丹。肥胖之人肢节疼痛，多是风湿痰饮流注所致，适宜使用导痰汤。消瘦之人肢节疼痛，是血枯所致，适宜使用四物汤加羌活、防风。老年人性格急躁且过度劳累，患腿痛的，适宜使用四物汤加桃仁、牛膝、陈皮、生甘草，煎煮完成后加入姜汁，或使用潜行散，如果有瘀积的，加热酒送服，并可针刺委中穴放血。风气游走不定，疼痛无固定位置，感觉像虫子爬遍全身，白天安静夜间加剧的，主方为麝香丸。痛风和历节这两个病症，应当参考上述方法进行治疗。
李东垣认为痛风多属于血虚，主张主要使用川芎、当归，佐以桃仁、红花、薄桂、威灵仙，或使用趁痛散。朱丹溪认为痛风起初由血虚引起，主张主要使用四物汤加黄芩、白芷。病位在上部加羌活、桂枝、威灵仙、桔梗；病位在下部加牛膝、防己、黄柏、木通。王肯堂（石顽）认为湿热挟带痰浊、瘀血进入络脉导致痹痛，症状严重且日久，必须加入乌头、附子，以驱逐痰湿，壮气行经；如果经络阻塞严重必须使用大黄，或者畏惧峻猛攻下，却不知道邪毒流注经络，非乌头、附子不能散结，燥热结滞肠胃，非芒硝、大黄岂能润燥呢？
Tongfeng (Gouty Arthritis) is a type of Tongbi (Bi Syndrome characterized by pain), with fixed sites of pain. Pulling pain indicates Cold, swelling indicates Dampness, and sweating indicates Wind. When these three pathogens enter the meridians, Ying and Wei Qi fail to circulate smoothly, leading to conflict between Zheng Qi (Upright Qi) and pathogenic factors, thus causing unceasing pain. The *Ling Shu* calls it "Jian Feng" (Humble Wind), the *Su Wen* calls it "Tong Bi", and the *Jin Gui Yao Lue* calls it "Li Jie". Later generations renamed it "Bai Hu Li Jie Feng" (White Tiger Li Jie Wind), while modern common parlance calls it "Jian Feng" (Arrow Wind). Initially, it arises from the depression of Cold, Dampness, and Wind in the Yin aspects; over time, it transforms into Heat that attacks and causes pain, worsening at night. Treatment should employ Acrid-Warm herbs to disperse Cold, Dampness, and Wind pathogens, open the Cou Li (skin pores and interstices), and Shi Sheng Dan is appropriate. If the painful area is red, swollen, and hot, indicating impending Wind-Toxin, Bai Du San is appropriate. If Wind-Dampness attacks the joints causing pain, Da Qiang Huo Tang is appropriate. Regarding Li Jie Feng, the pain has no fixed location, traversing all bone joints, feeling like being bitten by a tiger. Also known as Bai Hu Li Jie, it is a severe form of Tongfeng. It can be caused by drinking alcohol while exposed to wind, bathing in cold water after sweating, or engaging in sexual activity while drunk. Symptoms include curling of fingers, numbness in many parts of the body, severe swelling as if limbs were detached, gradual destruction and loss of tissue, pulling pain making flexion and extension impossible. Large doses of decoctions or pills are required; standard dosages are insufficient. Wu Tou Tang is the primary formula. For cases due to Cold, warm dispersion is indicated; Fang Feng Tian Ma Tang is suitable. For cases due to Fire, cooling is indicated; Xi Jiao San with modifications is suitable. For tendon and vessel spasms and pain with limited mobility, attributed to Blood Deficiency and Dryness, Si Wu Tang plus Mu Gua, He Shou Wu, and Gao Qi Zi is used. For joint soreness and pain with a deep, short pulse and shortness of breath, attributed to retained fluids (Liu Yin), Ban Xia Qin Zhu Tang or Dao Tan Tang with modifications is used. For joint pain relieved by percussion or massage, attributed to Wind-Dampness in the meridians, Ling Xian Chu Tong Yin is used. For joint swelling and pain worsening on rainy days, attributed to Wind-Dampness entering the collaterals, Hu Gu Wan, Mo Yao San, or Hu Gu San are used. For vexatious joint pain accompanied by heaviness in the shoulders and back, attributed to the interaction of Damp-Heat, Dang Gui Nian Tong San is used. For stabbing joint pain fixed in one place, attributed to Blood Stasis blocking the vessels, Chen Tong San is used. For hot joint pain, attributed to Yin Fire scorching the tendons, Jia Wei Er Miao San or Qian Xing San, taken alternately with Si Wu Tang, is used. For generalized numbness and pain, attributed to stagnation of Qi and Blood, Wu Ling Wan is used. For chronic Li Jie pain, attributed to lingering pathogenic toxins, Ru Xiang Ding Tong Wan or Huo Luo Dan is used. In obese individuals, joint pain is often due to the flow and accumulation of Wind-Dampness and Phlegm-Fluids; Dao Tan Tang is appropriate. In emaciated individuals, joint pain is due to Blood Emptiness; Si Wu Tang plus Qiang Huo and Fang Feng is appropriate. For elderly people who are irritable and overexert themselves, suffering from leg pain, Si Wu Tang plus Tao Ren, Niu Xi, Chen Pi, and Sheng Gan Cao is used. After decoction, add Jiang Zhi (Ginger Juice), or use Qian Xing San. If there is blood stasis, take with hot wine, and bleed at the Wei Zhong acupoint.
When Wind Qi travels freely with pain having no fixed location, feeling like insects crawling all over the body, quiet during the day but worse at night, She Xiang Wan is the primary formula. For Tongfeng and Li Jie, treatment should be considered comprehensively based on these methods.
Li Dongyuan believed Tongfeng mostly belongs to Blood Deficiency, primarily using Xiong Gui (Chuan Xiong and Dang Gui), assisted by Tao Ren, Hong Hua, Bo Gui, and Ling Xian, or Chen Tong Zhu. Zhu Danxi believed Tongfeng initially stems from Blood [Deficiency], primarily using Si Wu Tang plus Huang Qin and Bai Zhi. Add Qiang Huo, Gui Zhi, Ling Xian, and Jie Geng for upper body symptoms; add Niu Xi, Fang Ji, Huang Bo, and Mu Tong for lower body symptoms. Wang Kensheng (Shi Wan) believed that Damp-Heat carrying Phlegm and Blood Stasis enters the collaterals causing Bi pain. For severe and chronic cases, Wu Tou and Fu Zi must be added to expel Phlegm-Dampness, strengthen Qi, and move the meridians. If obstruction is severe, Da Huang is necessary. Or, fearing harsh purgatives, one fails to realize that pathogenic toxins flowing into the meridians cannot resolve nodules without Wu Tou and Fu Zi, nor can dry-heat stagnation in the intestines and stomach be moistened without Xiao Shi (Mang Xiao) and Da Huang?