〔大〕夫妇人臂痛，筋脉挛急，不得屈伸，遇寒则剧，由肝虚为风寒邪气流于血脉，
客于经络，搏于筋，筋不荣则干急而痛，其脉紧细，宜服柏子仁丸、舒筋汤。若臂痛不
能举，或左或右，时复转移一臂，由中脘伏痰，脾气滞而不行，上与气相搏，四肢皆属
于脾，脾气滞而气不下，上攻于臂故痛，其脉沉细，宜茯苓丸、控涎丹。
〔薛〕前证若肝血虚，用加味逍遥散。中气虚，用补中益气汤。血气俱虚，用八珍
汤。风热血燥，用秦艽地黄汤。脾肾虚寒，用柏子仁丸。脾胃实热，用茯苓丸。水不能生
木，用六味丸、逍遥散。怒动肝火，用小柴
胡加川芎、当归。眩晕晡热，用四物、柴、栀、丹皮。晡热月经不调，用加味逍遥散。食少
体倦，无寐盗汗，用加味归脾汤。先太宜人遍身作痛，筋骨尤甚，不能屈伸，口干目赤，头眩痰壅，
胸膈不利，小便赤短，夜间殊甚，遍身作痒如虫行，此属肝肾气虚而热也。用六味地黄丸料加山栀、
柴胡而愈。
柏子仁丸 （《指迷》）
柏子仁 干地黄（各二两，自制） 茯苓 枳壳（去幅，麸炒） 覆盆子（炒） 北五味子（杵，炒）
附子（炮） 石斛（去根切，酒蒸炒） 鹿茸（酥炙） 酸枣仁（炒） 桂心 沉香 黄 （蜜水炙，各一两，一方
云，等分）
上为细末，炼蜜为丸如梧桐子大。空心酒下三十丸。
舒筋汤 治臂痛。又名五痹汤，亦治腰下疾。
片子姜黄（四两） 甘草 羌活（各一两） 白术 海桐皮 当归 赤芍药（各二两）
上为粗末，每服三钱，水一盏半，煎七分，去滓温服。如腰以下疾，空心服；腰以上疾，食后服。
茯苓丸 治臂痛不能举手，或左或右，时复转移，由伏痰在内，中脘停滞，脾气不行，
上与气搏，四肢属脾，脾滞而气不升，故上行攻臂，其脉沉细者是也。后人谓此臂痛，乃痰证也，用
以治痰，无不效者。予尝以此药治人，随服随愈。世所谓痰药多矣，未有立效如茯苓丸速也。
茯苓（一两） 半夏（二两） 枳壳（半两，去幅麸炒） 风化朴硝（半两）
上为末，姜汁煮糊丸如梧子大。生姜汤下二十丸，食后服。
控涎丹 凡人忽患胸背、手足、颈项、腰胯隐痛不可忍，连筋骨牵引钓痛，坐卧不宁，
时时走易不定，俗医不晓，谓之走疰，便用药及针灸，皆无益。又疑是风毒结聚，欲为
痈疽，乱以药贴，亦非也。此乃痰涎伏在心膈上下，变为此疾，或令人头痛不可举，或
神意昏倦多睡，或饮食无味，痰唾稠粘，夜间喉中如锯声，多流唾涎，手脚重，腿冷，脾
气脉不通，误认为瘫痪，亦非也。凡有此疾，但以此药，不过数服即愈。
甘遂（去心） 大戟（去皮） 真白芥子（炒，各等分）
上为细末，糊丸如梧桐子大。临卧淡姜汤下五七丸，如疾猛，再加至十丸。
白芥子散 治臂痛牵引背胛，或辍或作，由荣卫循行失度，痰滞经络，或似瘫痪。
真白芥子 木鳖子（各三两，麸炒） 没药（另研） 桂心 木香（各半两）
上为末，每服一钱，温酒下。
愚按∶前三方，脾气虚弱者，必佐以六君子汤。中气虚弱者，必佐以补中益气汤。气
血虚者，必佐以八珍汤。脾气郁滞者，必佐以归脾汤。肝经怒气者，必佐以逍遥散。若
专用前方治之，胃气益虚，病气益甚，不可不谨。
流气饮 治七情气滞，胸胁闷痞，咽喉不利，呕喘面浮，二便不调，或气攻肩背，胁
肋作痛，或香港脚喘急，腹胀便闭，元气充实者，宜用此药。慎之。
紫苏叶 黄 （炒） 青皮（去白） 当归 半夏（姜制） 乌药 芍药（炒） 茯苓
桔梗 防风（各五钱） 川芎 陈皮（各七钱五分） 枳实（麸炒） 木香（各二钱五分）
甘草（炙，一两二钱半） 大腹子（姜制，一两）
上每服半两，姜枣水煎服。
四物汤 治血滞中风，血虚手足不遂。如臂痛，加红花煎。
交加散加木瓜、牛膝，治冷痹肩臂作痛。即人参败毒和五积散。
乌药顺气散加羌活、木瓜，治外邪气滞，筋骨作痛，或痰气不利。（方见杂病中气。）
秦艽地黄汤 治肝胆经风热血燥，肩臂疼痛，或筋脉引急，或时牵痛。其内证发热，
或寒热晡热，月经不调，或肢体酸痛等证。
秦艽 熟地黄（自制） 当归（各一钱） 川芎
芍药 牡丹皮 白术 茯苓（各一钱五分） 钓藤钩（一钱） 柴胡 甘草（炙，各三分）
上水煎服。
【大】妇女手臂疼痛，筋脉拘挛紧急，不能屈伸，遇寒冷则病情加重，这是由于肝血虚损，风寒邪气流入血脉，客居于经络，与筋相搏结，导致筋失濡养而干枯紧急并产生疼痛，其脉象紧细，适宜服用柏子仁丸、舒筋汤。如果手臂疼痛且不能抬起，或左或右，时常转移至另一只手臂，这是由中脘部潜伏的痰湿所致，脾气滞涩运行不畅，向上与气机相互搏结，四肢皆归属于脾，脾气滞涩而气机不能下行，反而上攻于手臂故引起疼痛，其脉象沉细，适宜服用茯苓丸、控涎丹。
【薛】上述病症若属肝血虚，使用加味逍遥散。中气虚，使用补中益气汤。气血俱虚，使用八珍汤。风热兼血燥，使用秦艽地黄汤。脾肾虚寒，使用柏子仁丸。脾胃实热，使用茯苓丸。肾水不能生肝木（水不涵木），使用六味丸、逍遥散。愤怒引动肝火，使用小柴胡汤加川芎、当归。眩晕及午后发热，使用四物汤加柴胡、栀子、牡丹皮。午后发热伴月经不调，使用加味逍遥散。饮食减少、身体疲倦、失眠及盗汗，使用加味归脾汤。先母遍身疼痛，筋骨尤为严重，不能屈伸，口干目赤，头晕痰多壅盛，胸膈不适，小便短赤，夜间症状特别严重，遍身瘙痒如虫爬行，这属于肝肾气虚而有内热。使用六味地黄丸药料加栀子、柴胡而痊愈。
柏子仁丸（出自《指迷方》）
柏子仁 干地黄（各二两，自制） 茯苓 枳壳（去瓤，麸炒） 覆盆子（炒） 北五味子（捣碎，炒）
附子（炮制） 石斛（去根切段，酒蒸炒） 鹿茸（酥炙） 酸枣仁（炒） 桂心 沉香 黄芪（蜜水炙，各一两，另一版本说等分）
以上药物研为细末，用炼蜜制成如梧桐子大小的丸剂。空腹时以酒送服三十丸。
舒筋汤 治疗手臂疼痛。又名五痹汤，也治疗腰部以下的疾病。
片子姜黄（四两） 甘草 羌活（各一两） 白术 海桐皮 当归 赤芍药（各二两）
以上药物研为粗末，每次服用三钱，加水一盏半，煎至七分，去渣温服。如果是腰部以下的疾病，空腹服用；腰部以上的疾病，饭后服用。
茯苓丸 治疗手臂疼痛不能举手，或左或右，时常转移，这是由于体内潜伏痰湿，中脘停滞，脾气不行，向上与气机搏结，四肢属脾，脾滞而气不升，所以上行攻击手臂，其脉象沉细就是这种情况。后人认为这种臂痛是痰证，用此药治痰，没有不有效的。我曾以此药治病，随服随愈。世间所谓的化痰药很多，但没有像茯苓丸见效这么快的。
茯苓（一两） 半夏（二两） 枳壳（半两，去瓤麸炒） 风化朴硝（半两）
以上研为末，用姜汁煮糊制成如梧子大小的丸剂。生姜汤送下二十丸，饭后服用。
控涎丹 凡人忽然患胸背、手足、颈项、腰胯隐痛不可忍受，牵连筋骨牵引作痛，坐卧不安，时时游走不定，俗医不懂，称之为走疰，便用药及针灸，都无益。又怀疑是风毒结聚，欲成痈疽，乱贴药膏，也不对。这是因为痰涎伏在心膈上下，变为此疾，有时使人头痛不能举，或神志昏倦多睡，或饮食无味，痰唾稠粘，夜间喉中如锯声，多流唾涎，手脚沉重，腿冷，脾气脉不通，误认为是瘫痪，也不对。凡是有此疾，只用此药，不过数服即愈。
甘遂（去心） 大戟（去皮） 真白芥子（炒，各等分）
以上研为细末，糊丸如梧桐子大小。临睡前用淡姜汤送下五到七丸，如果病势猛烈，再加至十丸。
白芥子散 治疗手臂疼痛牵引背部肩胛，或停或发，由于营卫循行失度，痰滞经络，或类似瘫痪。
真白芥子 木鳖子（各三两，麸炒） 没药（另研） 桂心 木香（各半两）
以上研为末，每次服用一钱，温酒送下。
愚按：前三方，脾气虚弱者，必须佐以六君子汤。中气虚弱者，必须佐以补中益气汤。气血虚者，必须佐以八珍汤。脾气郁滞者，必须佐以归脾汤。肝经怒气者，必须佐以逍遥散。如果专用前方治疗，胃气更虚，病气更甚，不可不谨慎。
流气饮 治疗七情气滞，胸胁闷痞，咽喉不利，呕喘面浮，二便不调，或气攻肩背，胁肋作痛，或香港脚喘急，腹胀便闭，元气充实者，适宜用此药。慎之。
紫苏叶 黄芪（炒） 青皮（去白） 当归 半夏（姜制） 乌药 芍药（炒） 茯苓
桔梗 防风（各五钱） 川芎 陈皮（各七钱五分） 枳实（麸炒） 木香（各二钱五分）
甘草（炙，一两二钱半） 大腹子（姜制，一两）
以上每次服用半两，姜枣水煎服。
四物汤 治疗血滞中风，血虚手足不遂。如臂痛，加红花煎。
交加散加木瓜、牛膝，治疗冷痹肩臂作痛。即人参败毒散合五积散。
乌药顺气散加羌活、木瓜，治疗外邪气滞，筋骨作痛，或痰气不利。（方见杂病中气。）
秦艽地黄汤 治疗肝胆经风热血燥，肩臂疼痛，或筋脉引急，或时牵痛。其内证发热，或寒热午后发热，月经不调，或肢体酸痛等证。
秦艽 熟地黄（自制） 当归（各一钱） 川芎
芍药 牡丹皮 白术 茯苓（各一钱五分） 钩藤（一钱） 柴胡 甘草（炙，各三分）
以上用水煎服。
[Da] Women suffering from arm pain, with tendons and vessels contracting and tightening, unable to flex or extend. The condition worsens upon exposure to cold. This is caused by Liver blood deficiency allowing Wind-Cold pathogenic factors to flow into the blood vessels, lodging in the collaterals, and clashing with the tendons. When the tendons fail to receive nourishment, they become dry, tight, and painful. The pulse is tight and thin. It is appropriate to administer Baizi Ren Wan (Platycladus Seed Pill) or Shujin Tang (Tendon-Relaxing Decoction). If the arm pain prevents lifting the arm, occurring alternatively on the left or right, and frequently shifting from one arm to the other, this is due to latent phlegm in the Zhongwan (CV12) region. The Spleen Qi is stagnant and fails to circulate; it clashes upward with Qi. Since the four limbs belong to the Spleen, when Spleen Qi is stagnant and cannot descend, it attacks upward to the arms, causing pain. The pulse is deep and thin. It is appropriate to administer Fuling Wan (Poria Pill) or Kongxian Dan (Phlegm-Draining Elixir).
[Xue] For the aforementioned conditions: if due to Liver Blood deficiency, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder); if due to Middle Qi deficiency, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); if due to simultaneous Qi and Blood deficiency, use Bazhen Tang (Eight Treasure Decoction); if due to Wind-Heat with Blood dryness, use Qinjiao Dihuang Tang (Gentiana Macrophylla and Rehmannia Decoction); if due to Spleen-Kidney Yang deficiency-cold, use Baizi Ren Wan; if due to Stomach-Spleen Excess Heat, use Fuling Wan; if Kidney Water fails to generate Liver Wood (Water failing to nourish Wood), use Liuwei Wan (Six-Ingredient Pill with Rehmannia) and Xiaoyao San; if anger stirs Liver Fire, use Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Chuanxiong and Danggui; if accompanied by vertigo and afternoon fever, use Siwu Tang (Four Substance Decoction) plus Chaihu, Zhizi, and Mudanpi; if afternoon fever is accompanied by irregular menstruation, use Jiawei Xiaoyao San; if there is poor appetite, fatigue, insomnia, and night sweats, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction). My late mother suffered from generalized body pain, particularly severe in the sinews and bones, with inability to flex or extend, dry mouth, red eyes, dizziness, copious phlegm obstruction, chest and diaphragm discomfort, short dark urine, symptoms worsening significantly at night, and generalized itching as if insects were crawling. This belonged to Qi deficiency of the Liver and Kidney with internal heat. She was cured using the ingredients of Liuhuang Diwang Wan (Six-Ingredient Rehmannia Pill) supplemented with Zhizi and Chaihu.
Baizi Ren Wan (from *Zhi Mi Fang*)
Bai Zi Ren (Biota Seed), Gan Di Huang (Rehmannia Root) [each 2 liang, homemade]; Fu Ling (Poria), Zhi Ke (Aurantium Fruit, pith removed, stir-fried with bran); Fu Pen Zi (Rubus Fruit, stir-fried); Bei Wu Wei Zi (Schisandra Berry, pounded, stir-fried); Fu Zi (Aconite Root, processed); Shi Hu (Dendrobium Stem, roots removed, sliced, steamed and stir-fried with wine); Lu Rong (Deer Antler Velvet, roasted with butter); Suan Zao Ren (Ziziphus Seed, stir-fried); Gui Xin (Cinnamon Twig Heart); Chen Xiang (Aquilaria Wood); Huang Qi (Astragalus Root, honey-roasted) [each 1 liang; another version states equal parts].
Grind all into a fine powder. Mix with refined honey to form pills the size of paulownia seeds. Take 30 pills orally on an empty stomach with wine.
Shujin Tang (Tendon-Relaxing Decoction) Treats arm pain. Also known as Wubi Tang (Five Bi Syndrome Decoction); also treats diseases below the waist.
Pianzi Jiang Huang (Curcuma Longa Rhizome Slice) [4 liang]; Gan Cao (Licorice Root), Qiang Huo (Notopterygium Rhizome) [each 1 liang]; Bai Zhu (Atractylodes Macrocephala Rhizome), Hai Tong Pi (Sarcandla Bark), Dang Gui (Angelica Sinensis Root), Chi Shao Yao (Red Peony Root) [each 2 liang].
Grind into coarse powder. Take 3 qian per dose, add 1.5 cups of water, decoct to 0.7 cup, remove dregs, and take warm. For diseases below the waist, take on an empty stomach; for diseases above the waist, take after meals.
Fuling Wan (Poria Pill) Treats arm pain preventing the raising of the hand, alternating left or right, frequently shifting. This is due to latent phlegm inside, stagnation at Zhongwan, failure of Spleen Qi to move, clashing upward with Qi. The four limbs belong to the Spleen; when Spleen Qi stagnates and does not ascend, it attacks upward to the arm. The pulse is deep and thin. Later generations considered this arm pain to be a Phlegm syndrome. Using this to treat phlegm yields invariably effective results. I have used this medicine to treat patients, who recovered immediately upon taking it. There are many so-called phlegm-resolving medicines in the world, but none act as swiftly as Fuling Wan.
Fu Ling (Poria) [1 liang]; Ban Xia (Pinellia Tuber) [2 liang]; Zhi Ke (Aurantium Fruit, pith removed, stir-fried with bran) [0.5 liang]; Feng Hua Pu Xiao (Weathered Mirabilite) [0.5 liang].
Grind into powder. Use ginger juice to cook paste and form pills the size of paulownia seeds. Take 20 pills with Ginger Decoction after meals.
Kongxian Dan (Phlegm-Draining Elixir) When a person suddenly suffers from unbearable hidden pain in the chest, back, hands, feet, neck, nape, waist, and hips, radiating to the sinews and bones causing pulling pain, restlessness in sitting and lying, and frequent migration without fixed location. Unskilled folk physicians do not understand this, calling it "Zou Zhu" (Wandering Miasma), and apply medicines or acupuncture, which are of no benefit. They may suspect Wind-Toxin accumulation intending to form carbuncles or ulcers, applying random medicinal plasters, which is also incorrect. This is actually caused by phlegm-fluids lurking above and below the heart and diaphragm, transforming into this disease. It may cause headache making it impossible to lift the head, or mental confusion, lethargy, and excessive sleep, or loss of taste in food, thick and sticky sputum, sawing sounds in the throat at night, excessive salivation, heavy hands and feet, cold legs, and blockage of Spleen Qi meridians. Misidentifying this as paralysis is also incorrect. For anyone with this disease, using only this medicine will result in recovery within a few doses.
Gan Sui (Radix Kansui, heart removed); Da Ji (Radix Euphorbiae Humifusae, skin removed); Zhen Bai Jie Zi (White Mustard Seed, stir-fried) [equal parts].
Grind into fine powder. Form pills with paste the size of paulownia seeds. Take 5-7 pills with light Ginger Decoction before retiring. If the disease is fierce, increase to 10 pills.
Bai Jie Zi San (White Mustard Seed Powder) Treats arm pain radiating to the shoulder blades, intermittent in nature. Caused by disorderly circulation of Ying and Wei, phlegm stagnation in collaterals, or resembling paralysis.
Zhen Bai Jie Zi (White Mustard Seed); Mu Bie Zi (Momordica Seed) [each 3 liang, stir-fried with bran]; Mo Yao (Myrrh, separately ground); Gui Xin (Cinnamon Twig Heart); Mu Xiang (Aucklandia Root) [each 0.5 liang].
Grind into powder. Take 1 qian per dose with warm wine.
Commentary: For the first three formulas, if Spleen Qi is weak, they must be assisted with Liujunzi Tang (Six Gentlemen Decoction). If Middle Qi is weak, they must be assisted with Buzhong Yiqi Tang. If Qi and Blood are deficient, they must be assisted with Bazhen Tang. If Spleen Qi is depressed and stagnant, they must be assisted with Guipi Tang. If Liver Channel Qi is agitated by anger, they must be assisted with Xiaoyao San. If only the aforementioned formulas are used exclusively, Stomach Qi will become further deficient, and pathogenic factors will intensify. One must be cautious.
Liuqi Yin (Flowing Qi Drink) Treats Qi stagnation due to Seven Emotions, chest and hypochondriac fullness and oppression, throat discomfort, vomiting and wheezing with facial edema, irregular urination and defecation, or Qi attacking the shoulders and back causing costal pain, or gout with panting and urgency, abdominal distension with constipation. Suitable for those with sufficient Yuan Qi. Use with caution.
Zi Su Ye (Perilla Leaf); Huang Qi (Astragalus Root, stir-fried); Qing Pi (Citrus Peel, white pith removed); Dang Gui (Angelica Sinensis Root); Ban Xia (Pinellia Tuber, ginger-processed); Wu Yao (Lindera Root); Shao Yao (Peony Root, stir-fried); Fu Ling (Poria); Jie Geng (Platycodon Root); Fang Feng (Saposhnikovia Root) [each 5 qian]; Chuan Xiong (Ligusticum Rhizome); Chen Pi (Citrus Peel) [each 7.5 qian]; Zhi Shi (Immature Aurantium Fruit, stir-fried with bran); Mu Xiang (Aucklandia Root) [each 2.5 qian]; Gan Cao (Licorice Root, honey-roasted) [1.25 liang]; Da Fu Zi (Areca Seed, ginger-processed) [1 liang].
Take 0.5 liang per dose, decoct with Ginger and Jujube, and drink.
Siwu Tang (Four Substance Decoction) Treats stroke due to Blood stagnation, hemiplegia due to Blood deficiency. For arm pain, add Hong Hua (Carthamus Flower) and decoct.
Jiaojia San (Intermingled Powder) plus Mu Gua (Chaenomeles Fruit) and Niu Xi (Achyranthes Root) treats Cold-Bi causing shoulder and arm pain. This is essentially Renshen Baidu San (Ginseng Toxin-Resolving Decoction) combined with Wuji San (Five Accumulations Powder).
Wuyao Shunqi San (Lindera Regulating Qi Powder) plus Qiang Huo (Notopterygium Rhizome) and Mu Gua (Chaenomeles Fruit) treats external pathogenic Qi stagnation causing bone and sinew pain, or Phlegm-Qi obstruction. (Formula seen in Miscellaneous Diseases section on Qi.)
Qinjiao Dihuang Tang (Gentiana Macrophylla and Rehmannia Decoction) Treats Wind-Heat and Blood dryness in the Liver and Gallbladder channels, causing shoulder and arm pain, tendon contraction, or occasional pulling pain. Internal symptoms include fever, alternating chills and fever with afternoon fever, irregular menstruation, or limb soreness and pain.
Qin Jiao (Gentiana Macrophylla Rhizome); Shu Di Huang (Prepared Rehmannia Root, homemade); Dang Gui (Angelica Sinensis Root) [each 1 qian]; Chuan Xiong (Ligusticum Rhizome); Shao Yao (Peony Root); Mu Dan Pi (Moutan Cortex); Bai Zhu (Atractylodes Macrocephala Rhizome); Fu Ling (Poria) [each 1.5 qian]; Gou Teng Uncaria Hook (1 qian); Chai Hu (Bupleurum Root); Gan Cao (Licorice Root, honey-roasted) [each 0.3 qian].
Decoct with water and take.