bubble_chart Concept

Limb pain refers to the symptom of pain in the tendons, muscles, and joints of the upper or lower limbs, or both upper and lower limbs of a patient.

Limb pain was first mentioned in Neijing, such as "pain in the limbs and joints," "bone pain," "arm pain," "foot pain," "pain in the waist and thighs," and "pain in the thighs, knees, hips, calves, and feet." The "Treatise on Cold Damage Diseases" and Jingui Yaolue record "multiple arthralgia pain," "limb pain," and "joint pain." Later generations referred to "pain wind," "wind-induced waist and leg pain," "wind wandering pain," "shoulder and arm pain," "finger pain," "thigh pain," "foot pain," "heel pain," "foot heart pain," "leg pain," and the "Willow Cane Disease" in mountainous and hilly areas as conditions within the scope of limb pain.

Neijing discusses Bi disease, such as "migratory impediment (migratory impediment)," "agonizing arthralgia (agonizing arthralgia)," "fixed arthralgia (fixed arthralgia)," "heat arthralgia," "sinew impediment," "vessel impediment," "muscle impediment," "skin impediment," "bone impediment," "general Bi-syndrome," and "multiple impediments," which also primarily present with limb pain as the main symptom and sign.

For the convenience of clinical differentiation, this section focuses on limb pain, while shoulder pain, arm pain, waist and spine pain, knee swelling and pain, and foot pain are discussed in separate entries.

bubble_chart Pattern Analysis

1. Wind-evil Obstructing the Collaterals︰Pain in the limbs and joints, migratory pain, most commonly seen in the wrists, elbows, knees, and ankles, with limited joint flexion and extension, sometimes accompanied by chills and fever (exterior pattern). The tongue coating is thin white or greasy, and the pulse is often floating. This belongs to migratory arthralgia. Zhubing Yuanhou Lun states: "Wind evil moves with qi. When qi is deficient, pathogenic qi prevails and contends with healthy qi, causing pain that arises with deficiency, hence it has no fixed location." Shengji Zonglu·Various Bi Syndromes states: "Wind is yang qi, adept at moving and changing rapidly. Thus, when wind qi prevails, it causes migratory arthralgia, manifesting as pain that moves unpredictably up, down, left, or right without lingering, wherever it goes, obstructing qi and blood." The pain often affects multiple limb joints, wandering without fixed location. When wind predominates, exterior patterns are often observed, such as aversion to wind, fever, thin white tongue coating, and a floating-tight pulse. If wind evil is particularly severe, the treatment should focus on dispelling wind, assisted by dispersing cold and draining dampness, combined with blood-tonifying herbs—since treating wind first requires treating blood, as blood circulation naturally extinguishes wind. The formula used is modified Saposhnikovia Root Decoction.
2. Cold Obstruction of Collaterals︰Cold pain in the limb joints, fixed pain location, aversion to cold with cold limbs, local skin not red, aggravated by cold and relieved by warmth, white tongue coating, and wiry-tight pulse. This belongs to pain obstruction (痛痹). Shengji Zonglu states in the "Treatise on Various Obstructions": "It is due to cold qi entering the channels and lingering, congealing and not moving. The pain originates from excessive cold qi; when cold qi is excessive, yang qi is deficient and yin qi is abundant." Severe pain with a fixed location is always accompanied by cold limbs. In cases of cold predominance, cold patterns are often observed, such as fear of cold, cold limbs, clear and abundant urine, thin white tongue coating, and mostly deep-tight pulse. When cold pathogens are particularly severe, the treatment should focus on dispersing cold, and it is even more necessary to use pungent warming and tonifying methods to release the cold congealing. The recommended formulas are Aconite Main Root Decoction with modifications, or Dispersing Wind and Activating Blood Decoction, Minor Harmonizing Collaterals Elixir, and others with modifications.
3. Damp Phlegm︰The joints are sore and painful, heavy and immobile, or there is numbness of the skin and insensitivity. If left untreated for a long time, the muscles become stiff and the joints deformed, leading to disability. The tongue coating is white and greasy, and the pulse is soggy and slow. This belongs to fixed impediment (zhu bi). Shengji Zonglu states in the "Treatise on Impediment": "When the damp qi of the earth is sensed, it harms the skin, flesh, sinews, and vessels. This is because dampness belongs to earth, and the nature of earth is sluggish. When the qi of the constructive and defensive levels lingers together with dampness, the dampness becomes excessive and thus fixed and immobile. The signs include profuse sweating and sogginess, which are due to the exuberance of yin qi." The pain is heavy, fixed, and immobile, or accompanied by numbness and soreness. When dampness is predominant, dampness patterns are often seen, such as heavy and fatigued limbs, chest oppression, a white and greasy tongue coating, and a soggy and slow pulse. The disease causes and mechanisms of the three are different, and the treatment principles vary greatly. When dampness evil is particularly severe, the method should focus on draining dampness, assisted by dispelling wind and dissipating cold. The formulas used may include Coix Seed Decoction or Chushi Juanbi Tang with modifications. When wind, cold, and dampness evils combine, the formula Sanbi Tang with modifications may be used.
4. Pathogenic Heat Obstructing Collaterals︰Due to a constitution that is inherently heat-prone, with excessive yang qi and internal accumulated heat, even though affected by wind-cold dampness pathogens, the clinical manifestations differ from those of wind-cold dampness obstruction. Jingui Yi stated: "When the organs, viscera, and meridians already harbor accumulated heat, and are then invaded by wind-cold dampness, the heat becomes constrained by cold, and qi cannot circulate freely. Over time, the cold also transforms into heat, leading to sudden obstruction and oppression." Symptoms include redness and pain in the joints of the limbs. The treatment should focus on clearing heat, supplemented by dispelling wind and removing dampness. The prescription used is White Tiger Decoction Plus Cinnamon Twig with modifications. If pathogenic heat transforms into fire, causing swollen and red joints, muscle spasms, high fever, and extreme thirst, the prescription used is Rhinoceros Horn Decoction with modifications.
5. Dampness-heat︰Swollen and red joints, dark and turbid urine, heavy and painful limbs, slippery or soggy and rapid pulse, red tongue with yellow and greasy coating, may be accompanied by red nodules on the skin. This condition arises from external contraction of dampness-heat pathogens, or pre-existing dampness aggravated by pathogenic heat, or prolonged dampness transforming into heat, leading to the accumulation and obstruction of dampness-heat in the meridians. The treatment principle is clearing heat and drying dampness, and the recommended formulas are Two Wonderful Herbs Powder or {|104|}Angelica Pain-Relieving Decoction{|105|} with modifications.
6. Deficiency of Both Qi and Blood︰Joint aching pain worsens after exertion, accompanied by muscle wasting, pale complexion, pale lips and nails, shortage of qi and reluctance to speak, mental fatigue and lethargy, vertigo, fear of wind, spontaneous sweating, thin and weak pulse, pale tongue texture, and thin coating. If accompanied by static blood, the joint pain is like a锥刺 (pricking), fixed in location and tender to touch, with scaly skin, emaciation or joint deformity and stiffness, dark tongue texture with ecchymosis, thin and greasy coating, and thin and rough pulse. If accompanied by phlegm-dampness, there is limb and arm pain, heavy body sensation, head feeling wrapped, swollen tongue texture, white and greasy coating, and wiry and slippery pulse. Deficiency of qi and blood fails to warm and nourish the Jingmai, leading to pain in the limbs and joints, often accompanied by pale complexion, muscle wasting, mental fatigue, and reluctance to speak. Since blood follows qi, qi deficiency results in poor blood circulation, leading to Jingmai obstruction. The syndrome must manifest as limb pain like a锥刺 (pricking), fixed in location, emaciation, scaly skin, stiff joints, and ecchymosis on the tongue edge. The treatment should focus on tonifying qi and nourishing the nutrient system, invigorating blood and resolving stasis. The prescription includes Taohong Yin (Peach and Carthamus Decoction) with added Astragalus Root, Tangshen, Cinnamon Twig, and Sichuan Lovage Rhizome, supplemented with insect-based stasis-removing agents such as scorpion, Earthworm, dung beetle, pangolin scales, centipede, and black-tail snake, or combined with Major Collaterals-Activating Pill, Minor Harmonizing Collaterals Elixir, or musk pill. Additionally, qi deficiency leads to dysfunction of the spleen in transportation, not only causing insufficiency in generation and transformation but also easily resulting in internal retention of phlegm-turbidity. The key diagnostic points include limb and arm pain, heavy body sensation, and white and greasy tongue coating. The treatment should focus on tonifying qi and regulating the nutrient system, clearing up phlegm and unblocking collaterals. The prescription includes Guishao Liu Jun Wan (Angelica and Peony Six Gentlemen Pill) combined with Poria Pill.
7. Liver and Kidney Deficiency︰The tendons and bones are slack or tense, aching pain, dizziness and blurred vision, brittle nails, soreness and weakness in the waist and knees, tinnitus and hearing loss, loose teeth and hair loss, impotence and seminal emission, the chi pulse is wiry, thin, deep, and weak. If it is due to predominant yin deficiency, there will be hot pain in the joints of the limbs with a preference for coolness, bone pain that worsens at night, flushed cheeks and red lips, a bright red tongue texture with little coating, or a deep red and dry tongue. If it is due to predominant yang deficiency, there may also be swelling and weakness in both feet, loose stools, clear and abundant urine, and cold hands and feet. The liver governs the tendons, and the kidneys govern the bones. Deficiency of the liver and kidneys leads to malnourishment of the tendons and bones, clinically often manifesting as slack or tense tendons and bones, aching pain, soreness and weakness in the waist and knees. The treatment should focus on tonifying the liver and kidneys, and promoting the flow of qi to harmonize the collaterals. The formula used is Pubescent Angelica and Taxillus Decoction with modifications.

The symptoms of limb pain are externally caused by wind, cold, dampness, and heat, while internally they are related to qi and blood deficiency, liver-kidney depletion, as well as blood stasis and phlegm turbidity. It is essential to carefully differentiate based on the disease cause, the nature of the pain, and accompanying symptoms. Only through pattern differentiation and treatment can good therapeutic effects be achieved.

bubble_chart Documentation

1. Zhubing Yuanhou Lun．"The condition of pain in the four limbs without a fixed location: When the pain in the four limbs has no fixed location, the hands, feet, and joints all suddenly ache, not in one place. The painful area does not swell, and the color does not change, but there is a pulling pain inside the flesh, like being pricked by an awl or knife. This is caused by the body being weak and invaded by wind evil. The wind evil moves with the qi, and when the qi is deficient, the pathogenic qi prevails, clashing with the healthy qi, causing pain that arises with the deficiency, hence it has no fixed location."
2. Zhengyin Maizhi．Bi disease discussion: "The symptom of migratory impediment is wandering pain, moving up and down, left and right without settling, hence it is called migratory impediment." "The symptom of agonizing arthralgia is severe pain and suffering, with hands and feet cramped and tight, slightly relieved by heat and worsened by cold, hence it is called agonizing arthralgia." "The symptom of warm impediment is either numbness in one place, or inability to lift the four limbs and hands and feet, or inability to turn the body, or dampness turning into heat, heat turning into dryness, causing contraction and cramping pain, curled and difficult to stretch, hence it is called fixed arthralgia." "The symptom of heat arthralgia is extreme heat in the muscles, dry lips, unbearable pain in the bones and tendons, and a sensation like mice running over the body. As mentioned in the Neijing, when yang qi is excessive and yin qi is insufficient, yang alone is strong, hence it is the symptom of heat arthralgia."