钱仲阳云∶鹤膝者，乃禀受肾虚，血气不充，致肌肉瘦薄，骨节呈薄，如鹤之膝也。行迟者
，亦因禀受肝肾气虚，肝主筋，肾主骨，肝藏血，肾藏精，血不足，则筋不荣，精不足，则
骨不立，故不能行也。鹤膝用六味地黄丸加鹿茸以补其血气，血气既充，则其肌肉自生。行
迟用地黄丸加牛膝、五加皮、鹿茸，以补其精血，精血既足，则其筋骨自坚。凡此皆肝肾之
虚也，虚而热者，用六味地黄丸。虚而寒者，用八味丸。若手拳挛者，用薏苡仁丸。足拳挛
者，用海桐皮散。脾胃亏损，肾脏虚弱，寒邪所乘而膝渐肿者，佐以补中益气汤，及大防风汤
。
治验
一小儿体瘦腿细，不能行，齿不坚，发不茂，属足三阴经虚也。用六味丸、补中益气汤，年
余诸症悉愈。
一小儿六岁，面色 白，眼白睛多，久患下痢，忽声音不亮，腿足无力，先用四神丸止其痢
；后用地黄丸加牛膝、五加皮、鹿茸补其肾，两月余渐能行，半载后，其声音亮。后停食，
另用消食丸，连泻五六次，去后益频，五更侵晨为甚，声音复喑，步履复难，而腿足作痛。
仍服前丸，兼补中益气汤而愈。
一小儿七岁，左腿自膝下至胫细小，行步无力，用地黄丸加鹿茸、五味子、牛膝为主，佐以
补中益气汤，半载腿膝渐强而能步。毕姻后，其腿内热，足心如炙，唾痰口渴。余谓∶当补
脾肾。不信，另用滋阴丸，痰热益甚；服四物、黄柏、知母之类，饮食日少；服二陈、青皮
、枳壳之类，胸满吐血；服犀角地黄汤，唾血不时，大便频数。复请视，仍泥实火，余辞不
能治。恪服犀角地黄丸，而唾血益甚，不时发热。后复恳治，余曰∶两足心热，唾痰口干，
肾虚水泛也。饮食少思，胸膈痞满，唾血不止，脾虚失摄也。昼发夜伏，夜作昼止，不时而
热，无根虚火也。遂用四君子及八珍汤、地黄丸，间服而愈。
四神丸 治脾虚胃弱，大便不实，饮食不思，或泄利腹痛等症。（方见惊泻）
薏苡仁丸 治禀受肝气怯弱，致两膝挛缩，两手伸展无力。
当归（焙） 秦艽 薏苡仁 酸枣仁 防己 羌活（各一两）
上为末，炼蜜丸，鸡豆大。每服一丸，麝香荆芥汤下。
海桐皮散 治禀受肾气不足，血气未荣，脚趾拳缩，不能伸展。
海桐皮 牡丹皮 当归（酒浸） 熟地黄 牛膝（酒浸。各一两） 山茱萸 补骨脂（各五钱）
上为末，每服一钱，葱白煎汤，食前服。
五加皮散 治四五岁不能行。
真五加皮 川牛膝（酒浸二日） 木瓜干（各等分）
上为末，每服二钱，空心米汤调下，一日二服，服后再用好酒半盏，与儿饮之，仍量儿大小
。
益气养荣汤 治气血损伤，四肢颈项等处患肿，不问软硬、赤白痛否，日晡发热，或溃而不
敛者，并宜服之。
人参 茯苓 陈皮 贝母 香附 当归（酒拌） 川芎 黄 （盐水拌炒） 熟地黄（酒拌） 芍药（炒。
各五分） 甘草（炙） 桔梗（炒） 柴胡（各三分） 白术（炒，一钱）
上姜水煎服，大人倍用。
八珍汤（即四君、四物二汤，四君见内钓，四物见急惊）
四神丸（方见惊渴）
六味丸
八味丸（即六味丸加肉桂、附子，二方见肾脏）
消食丸（方见呕吐乳）
补中益气汤（方见虚羸）
大防风汤（方见鹤膝风）
四君子汤（方见内钓）
钱仲阳说：鹤膝风，是由于先天禀赋肾虚，血气不充盈，导致肌肉消瘦瘦薄，骨节显露细小，就像鹤的膝盖一样。行走迟缓，也是因为先天禀赋肝肾气虚。肝主司筋脉，肾主司骨骼，肝藏血，肾藏精。血不足，则筋脉得不到濡养；精不足，则骨骼无法挺立支撑，所以不能行走。治疗鹤膝风用六味地黄丸（由熟地黄、山茱萸、山药、泽泻、牡丹皮、茯苓组成的补肾阴方剂）加鹿茸来补益血气，血气既然充盈，肌肉自然生长。治疗行走迟缓用地黄丸加牛膝、五加皮、鹿茸，以补益精血，精血既然充足，筋骨自然坚固。凡是这些情况都属于肝肾虚弱。虚而伴有热象的，用六味地黄丸；虚而伴有寒象的，用八味丸（即金匮肾气丸）。如果手部拳曲挛缩的，用薏苡仁丸。足部拳曲挛缩的，用海桐皮散。如果是脾胃亏损，肾脏虚弱，寒邪侵袭导致膝盖逐渐肿胀的，辅助使用补中益气汤和大防风汤。
医案记录：
有一个小儿身体瘦弱，腿部纤细，不能行走，牙齿不坚固，头发稀疏，这属于足三阴经（足太阴脾经、足少阴肾经、足厥阴肝经）虚弱。使用六味地黄丸和补中益气汤，一年多后各种症状全部痊愈。
有一个六岁的小儿，面色㿠白，眼白部分较多，长期患有下痢，突然声音嘶哑，腿脚无力。先用四神丸止住腹泻；后来用地黄丸加牛膝、五加皮、鹿茸补肾，两个多月后渐渐能行走，半年后声音变得响亮。后来出现停食（消化不良），另外服用消食丸，连续腹泻五六次，之后排便更加频繁，在五更天清晨尤为严重，声音再次嘶哑，步履再次困难，而且腿脚疼痛。仍然服用之前的药丸，兼服补中益气汤而痊愈。
有一个七岁的小儿，左腿从膝盖以下到小腿细小，行走无力，以地黄丸加鹿茸、五味子、牛膝为主药，辅助以补中益气汤，半年后腿膝渐渐强壮并能行走。结婚后，其腿部内侧发热，脚心像被火烤一样烫，咳吐痰涎且口渴。我说：应当补益脾肾。他不相信，另用滋阴丸，痰热更加严重；服用四物汤、黄柏、知母之类的药物，饮食日渐减少；服用二陈汤、青皮、枳壳之类的药物，胸膈胀满并吐血；服用犀角地黄汤，不时唾血，大便次数频繁。再次请我诊治，他仍固执认为是实火，我推辞说治不了。他坚持服用犀角地黄丸，唾血更加严重，不时发热。后来又恳求诊治，我说：两脚心发热，咳吐痰涎口干，这是肾虚水液泛滥的表现。饮食减少思虑，胸膈痞闷胀满，唾血不止，这是脾虚失去统摄功能的表现。白天发作晚上潜伏，晚上发作白天停止，不时发热，这是无根的虚火。于是使用四君子汤及八珍汤、地黄丸，交替服用而痊愈。
四神丸 治疗脾虚胃弱，大便不成形，不想吃东西，或者泄泻腹痛等症状。（方剂见惊泻章节）
薏苡仁丸 治疗先天禀赋肝气怯弱，导致两膝挛缩，两手伸展无力。
当归（焙干） 秦艽 薏苡仁 酸枣仁 防己 羌活（各一两）
以上研为细末，炼蜜制成丸药，大小如鸡豆。每次服用一丸，用麝香荆芥汤送服。
海桐皮散 治疗先天禀赋肾气不足，血气未能荣润，脚趾拳曲收缩，不能伸展。
海桐皮 牡丹皮 当归（酒浸） 熟地黄 牛膝（酒浸。各一两） 山茱萸 补骨脂（各五钱）
以上研为细末，每次服用一钱，用葱白煎汤，饭前服用。
五加皮散 治疗四五岁还不能行走。
真五加皮 川牛膝（酒浸两天） 木瓜干（各等分）
以上研为细末，每次服用二钱，空腹时用米汤调服，一天两次，服药后再给儿童喝半盏好酒，仍需根据儿童体型大小调整剂量。
益气养荣汤 治疗气血损伤，四肢、颈项等处发生肿胀，无论软硬、颜色红白或疼痛与否，下午申时发热，或者溃破后不愈合的，都适宜服用此方。
人参 茯苓 陈皮 贝母 香附 当归（酒拌） 川芎 黄芪（盐水拌炒） 熟地黄（酒拌） 芍药（炒。各五分） 甘草（炙） 桔梗（炒） 柴胡（各三分） 白术（炒，一钱）
以上用姜水煎服，成人用量加倍。
Qian Zhongyang stated: "Crane-knee deformity" (He Xi Feng) results from congenital Kidney deficiency, where Qi and Blood are insufficient, leading to emaciated muscles and exposed, slender joints, resembling the knee of a crane. Delayed walking is also due to congenital deficiency of Liver and Kidney Qi. The Liver governs the sinews, and the Kidneys govern the bones; the Liver stores Blood, and the Kidneys store Essence (Jing). When Blood is deficient, sinews lack nourishment; when Essence is deficient, bones fail to stand firm, thus preventing walking. For crane-knee deformity, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill, a formula for tonifying Kidney Yin) is used with Lu Rong (Cervus Nippon Antler) to tonify Qi and Blood. Once Qi and Blood are充盈 (full), muscles will naturally grow. For delayed walking, Dihuang Wan is used with Niu Xi (Achyranthes Root), Wu Jia Pi (Acanthopanax Bark), and Lu Rong to tonify Essence and Blood. Once Essence and Blood are sufficient, sinews and bones will naturally become firm. All these conditions stem from Liver and Kidney deficiency. If deficiency accompanied by heat signs exists, use Liuwei Dihuang Wan; if deficiency accompanied by cold signs exists, use Bawei Wan (Eight-Ingredient Pill, i.e., Jin Gui Shen Qi Wan). If the hands are curled and contracted, use Yiyi Ren Wan (Coix Seed Pill). If the feet are curled and contracted, use Haitong Pi San (Haitong Bark Powder). If Spleen and Stomach damage occurs alongside Kidney weakness, with cold pathogenic factors invading causing gradual knee swelling, assist treatment with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Dafangfeng Tang (Major Wind-Expelling Decoction).
Clinical Cases:
One child was thin with slender legs, unable to walk, with weak teeth and sparse hair. This belonged to deficiency of the Three Yin Meridians of the Foot (Taiyin Spleen, Shaoyin Kidney, Jueyin Liver). Liuwei Dihuang Wan and Buzhong Yiqi Tang were used, and after more than a year, all symptoms resolved.
Another six-year-old child had a pale complexion, prominent whites in the eyes, and suffered from chronic dysentery. Suddenly, his voice became hoarse, and his legs and feet lacked strength. First, Sishen Wan (Four Spirits Pill) was used to stop the dysentery; subsequently, Dihuang Wan with added Niu Xi, Wu Jia Pi, and Lu Rong was used to tonify the Kidneys. After two months, he gradually gained the ability to walk, and after half a year, his voice became clear. Later, he experienced food stagnation, and Xiaoshi Wan (Digestive Pill) was administered separately. He suffered diarrhea five or six times consecutively, followed by even more frequent bowel movements, particularly severe at dawn (Wugeng). His voice became hoarse again, walking became difficult, and his legs and feet hurt. He continued taking the previous pills and concurrently took Buzhong Yiqi Tang, resulting in recovery.
Another seven-year-old child had a left leg that was thin from the knee down to the tibia, with weak walking ability. The main prescription was Dihuang Wan with added Lu Rong, Wuweizi (Schisandra Fruit), and Niu Xi, assisted by Buzhong Yiqi Tang. After half a year, his leg and knee strength improved, enabling him to walk. After marriage, he experienced internal heat in the legs, burning sensations in the soles of his feet, and coughed up phlegm with thirst. I advised tonifying the Spleen and Kidneys. He did not believe me and instead used Ziyin Wan (Nourishing Yin Pill), which exacerbated the phlegm-heat. Taking Siwu Tang (Four Substances Decoction), Huangbai (Phellodendron Bark), and Zhimu (Anemarrhena Rhizome) reduced his appetite. Taking Erchen Tang (Two-Aged Decoction), Qingpi (Aurantium Peel), and Zhike (Aurantii Fructus) caused chest fullness and hematemesis. Taking Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) led to intermittent hemoptysis and frequent stools. Upon re-examination, he still insisted on a diagnosis of Excess Fire. I declined treatment. He persistently took Xijiao Dihuang Wan, worsening the hemoptysis and causing intermittent fever. He later pleaded for treatment again. I said: Heat in both soles, phlegm expectoration, and dry mouth indicate Kidney deficiency with water flooding. Reduced appetite, chest diaphragm stuffiness, and persistent hemoptysis indicate Spleen deficiency failing to control blood. Fever occurring during the day and subsiding at night, or vice versa, indicates rootless deficient fire. Thus, Sijunzi Tang (Four Gentlemen Decoction), Bazhen Tang (Eight Treasures Decoction), and Dihuang Wan were used alternately, leading to recovery.
Sishen Wan: Treats Spleen deficiency and Stomach weakness, loose stools, anorexia, or diarrhea with abdominal pain. (Formula see Jingxie chapter)
Yiyi Ren Wan: Treats congenital Liver Qi timidity, leading to knee contraction and inability to extend the hands.
Danggui (Roasted) Qinjiao Yiyiren Suanzao Ren Fangji Qianghuo (Each 1 liang)
Grind into powder, make pills with refined honey, size of a chicken bean. Take one pill per dose, washed down with Shexiang Jingjie Tang (Musk and Schizonepeta Decoction).
Haitong Pi San: Treats congenital Kidney Qi insufficiency, where Qi and Blood fail to nourish, causing toe curling and inability to extend.
Haitongpi Mudanpi Danggui (Soaked in Wine) Shudihuang Niuxi (Soaked in Wine. Each 1 liang) Shanzhuyu Buguzhi (Each 5 qian)
Grind into powder. Take 1 qian per dose, washed down with Congbai Tang (Scallion White Decoction) before meals.
Wujia Pi San: Treats inability to walk in children aged four or five.
Zhen Wujia pi Chuan Niuxi (Soaked in wine for two days) Mugua gan (Equal parts)
Grind into powder. Take 2 qian per dose, mixed with rice water on an empty stomach, twice daily. After dosing, give the child half a cup of good wine, adjusting according to the child's size.
Yiqi Yangrong Tang: Treats Qi and Blood injury, swelling in limbs, neck, etc., regardless of hardness, color (red/white), or pain. Also suitable for afternoon fever (Shibu) or ulcers that fail to heal.
Renshen Fuling Chenpi Beimu Xiangfu Danggui (Mixed with wine) Chuanxiong Huangqi (Stir-fried with salt water) Shudihuang (Mixed with wine) Shaoyao (Stir-fried. Each 5 fen) Gancao (Honey-fried) Jiegeng (Stir-fried) Chaihu (Each 3 fen) Baizhu (Stir-fried, 1 qian)
Decoct with ginger water. Adult dosage is doubled.
Bazhen Tang (Combination of Sijunzi Tang and Siwu Tang; Sijunzi Tang see Neidiao chapter, Siwu Tang see Jijing chapter)
Sishen Wan (Formula see Jingke chapter)
Liuwei Wan
Bawei Wan (Liuwei Dihuang Wan plus Rougui and Fuzi; both formulas see Zangshen chapter)
Xiaoshi Wan (Formula see Outu Ru chapter)
Buzhong Yiqi Tang (Formula see Xu lei chapter)
Da Fangfeng Tang (Formula see He Xifeng chapter)
Sijunzi Tang (Formula see Neidiao chapter)