喻嘉言曰∶鹤膝风者,即风寒湿之痹于膝也。如膝骨日大,上下肌肉日枯,且未可治其
膝,先养其气血,使肌肉滋荣,后治其膝可也。此与治偏枯之症大同小异。急溉其未枯者,
使气血流行而复荣。倘不知此,但麻黄、防风等散风之药,鲜不全枯者。故治鹤膝风而急攻
其痹,必并其足痿而不用矣。
大防风汤
治邪袭足三阴,腿膝疼痛,及痢后胫膝痛,鹤膝风、附骨疽症,但赤热
肿者禁用。
四君子汤去茯苓,加肉桂、附子、黄 、牛膝、杜仲、熟地、白芍、川芎、羌活、防风
。
五积散(方见《附方》)
治少阴伤寒,及外感风寒,胸满恶食,呕吐腹痛,寒热往来,香港脚冷秘,寒疝寒疟等症。
孙心典按∶鹤膝风多是虚寒,香港脚多是湿热。一补一攻,治法各判。然香港脚有肾气素虚
,气喘小腹痹者,肾气丸必不可缓。鹤膝赤热 肿者,二妙散、桂枝芍药知母汤亦必所需,此活法也。
二妙散
治湿热痿症。
黄柏 苍术(去皮,盐水炒)
水煎服。
三气汤 桂枝芍药知母汤(俱见《金匮》)
见 膏(《种福堂》)
专治风寒湿骨节痛,历节痛风,痿痹麻木不仁,鹤膝风,偏
头风,漏肩风等症。并治跌扑闪挫等伤,阴证无名肿毒,已破烂者勿贴,小儿孕妇勿贴。
活短头发(晒干,二两,用壮年人剃下者) 大黄 灵仙 雄鼠粪(各一两) 川乌 草乌 刘寄奴
(各八钱) 土鳖(大者二十个) 羌活 独活 红花 当归 蛇床子 苍术 生南星 生半夏 白
芥子 桃仁(各一两)
上十八味,俱切碎。
樟冰(一两) 甘松 山奈 花椒 猪牙皂 山甲(炙,研) 荜拔(以上各三钱,不必去油,同乳
香炙热,同众药研细) 乳香 白芷(各五钱)
上十味,研极细末。
鲜烟叶汁(一斤,松香六两收,晒干) 鲜商陆根汁(一斤,松香六两收) 鲜闹羊花汁(半斤,松香三两
收) 鲜艾叶汁(半斤,松香三两收) 白凤仙花汁(半斤,松香三两收) 生姜汁(半斤,松香三两收) 韭汁
(半斤,松香三两收) 葱汁(半斤,松香三两收) 大蒜(四两,松香二两收)
用足秤,秤麻油三斤四两,先将头发入油,熬至半炷香,再将前药入油。熬至焦黄色,不
可太枯,即滤去渣。入前松香熬化,再将丝绵滤去渣。再熬至油面起核桃花纹,先加入极细
密陀僧四两 再徐徐加入西硫黄末一斤。投此二味时,务须慢慢洒入,不可太多太骤。以滴
水成珠,离火待温,然后掺入细药搅匀。瓷器收贮,熬时须用桑枝不住手搅,青布摊贴。每
张净药重四钱,临时加肉桂末五厘、细辛末二厘。
喻嘉言说:鹤膝风,就是风寒湿邪痹阻于膝关节。如果膝盖骨骼日渐肿大,而上下肌肉日渐枯瘦,此时不可直接治疗膝盖,而应先调养气血,使肌肉得到滋养和荣润,然后再治疗膝盖。这与治疗偏枯(半身不遂)的病症大同小异。应当急切地灌溉那些尚未枯败的部位,使气血流通并恢复荣润。倘若不懂得这个道理,仅仅使用麻黄、防风等疏散风邪的药物,很少有不导致病情更加枯败的。因此,治疗鹤膝风如果急于攻逐痹邪,必然会导致足部痿软无力甚至无法使用。
大防风汤
治疗邪气侵袭足三阴经,导致腿膝疼痛,以及痢疾后出现的小腿和膝盖疼痛,鹤膝风、附骨疽等症,但如果是红肿热痛者禁用。
配方:四君子汤去掉茯苓,加入肉桂、附子、黄芪、牛膝、杜仲、熟地黄、白芍、川芎、羌活、防风。
五积散(方剂见《附方》)
治疗少阴伤寒,以及外感风寒,胸中胀满、厌恶饮食、呕吐腹痛、寒热往来、脚气冷秘、寒疝、寒疟等症。
孙心典按语:鹤膝风多属于虚寒证,脚气多属于湿热证。一为补法,一为攻法,治疗方法截然不同。然而,脚气若伴有肾气素来虚弱、气喘、小腹痹痛者,肾气丸是必须使用的。鹤膝风若出现赤热肿胀者,二妙散、桂枝芍药知母汤也是必需的,这是灵活变通的治疗方法。
二妙散
治疗湿热引起的痿证。
药材:黄柏、苍术(去皮,用盐水炒制)。
用法:水煎服。
见膏(出自《种福堂》)
专门治疗风寒湿邪引起的骨节疼痛,历节痛风,痿痹麻木不仁,鹤膝风,偏头风,漏肩风等症。并治疗跌打损伤、闪挫等外伤,阴证无名肿毒。已经破溃腐烂者勿贴,小儿及孕妇勿贴。
配方:活短头发(晒干,二两,需用壮年人剃下的)、大黄、威灵仙、雄鼠粪(各一两)、川乌、草乌、刘寄奴(各八钱)、土鳖虫(大的二十个)、羌活、独活、红花、当归、蛇床子、苍术、生南星、生半夏、白芥子、桃仁(各一两)。
以上十八味药,全部切碎。
樟冰(一两)、甘松、山奈、花椒、猪牙皂、穿山甲(炙后研碎)、荜拔(以上各三钱,不必去油,同乳香一起炙热,与众药一起研成细末)、乳香、白芷(各五钱)。
以上十味药,研成极细粉末。
鲜烟叶汁(一斤,用六两松香收膏,晒干)、鲜商陆根汁(一斤,用六两松香收膏)、鲜闹羊花汁(半斤,用三两松香收膏)、鲜艾叶汁(半斤,用三两松香收膏)、白凤仙花汁(半斤,用三两松香收膏)、生姜汁(半斤,用三两松香收膏)、韭菜汁(半斤,用三两松香收膏)、葱汁(半斤,用三两松香收膏)、大蒜(四两,用二两松香收膏)。
称取足量的芝麻油三斤四两,先将头发放入油中,熬至燃半炷香的时间,再将前面的药物放入油中。熬至焦黄色,不可太枯焦,随即滤去药渣。加入前面的松香使其熔化,再用丝绵滤去杂质。继续熬至油面出现核桃花纹状,先加入极细密的密陀僧四两,再徐徐加入西硫黄粉一斤。投放这两味药时,务必慢慢洒入,不可太多太急。以滴水成珠为标准,离火待温,然后掺入细药粉搅匀。装入瓷器中储存。熬制时必须用桑枝不停地搅拌,用青布摊涂贴敷。每张净药重四钱,使用时临时加入肉桂末五厘、细辛末二厘。
Yu Jiayan stated: He Xi Feng (Crane's Knee Wind) is essentially a Bi syndrome (obstruction and pain syndrome) of wind, cold, and dampness pathogenic factors affecting the knee joint. If the knee bones become progressively enlarged while the muscles above and below become progressively emaciated, one should not directly treat the knee at this stage. Instead, one must first nourish the Qi and Blood to ensure the muscles are moistened and flourishing, and only then proceed to treat the knee. This approach is largely similar to the treatment of Pian Ku (Hemiplegia). One should urgently irrigate those parts that have not yet withered, allowing the Qi and Blood to circulate and regain their luster. If this principle is ignored and one merely employs dispersing wind herbs such as Ephedrae Herba (Mahuang) and Saposhnikoviae Radix (Fangfeng), it is rare that the condition will not deteriorate further into emaciation. Therefore, if treating He Xi Feng by hastily attacking the Bi obstruction, it will inevitably lead to Wei syndrome (flaccidity syndrome) of the feet, rendering them unusable.
Da Fang Feng Tang (Great Saposhnikovia Decoction)
Indications: Pathogenic factors invading the three Yin meridians of the foot, causing pain in the legs and knees; pain in the shins and knees following dysentery; He Xi Feng (Crane's Knee Wind); Fu Gu Ju (Bone-attached Carbuncle). Contraindicated in cases characterized by redness, heat, and swelling.
Composition: Si Jun Zi Tang (Four Gentlemen Decoction) minus Poria (Fu Ling), plus Cinnamon Twig (Rou Gui), Aconite Root (Fu Zi), Astragalus Root (Huangqi), Achyranthes Root (Niuxi), Eucommia Bark (Duzhong), Prepared Rehmannia Root (Shudi), White Peony Root (Baishao), Szechuan Lovage Rhizome (Chuanxiong), Notopterygium Rhizome (Qianghuo), and Saposhnikovia Radix (Fangfeng).
Wu Ji San (Five Accumulations Powder) (Formula see "Attached Formulas")
Indications: Shaoyin Taiyang disease (Cold damage affecting the Shaoyin channel); external contraction of wind-cold; chest fullness, aversion to food, vomiting, abdominal pain; alternating chills and fever; Hong Jiao (Gout/Cramp) with cold constipation; Han Shan (Cold Hernia); cold malaria.
Sun Xindian's commentary: He Xi Feng (Crane's Knee Wind) is mostly due to deficiency-cold, whereas Hong Jiao (Gout/Cramp) is mostly due to damp-heat. One requires tonification, the other requires purgation/attack; their treatment methods are distinct. However, for Hong Jiao accompanied by inherent Kidney Qi deficiency, panting, and bi-sensation in the lower abdomen, Shen Qi Wan (Kidney Qi Pill) is indispensable. For He Xi Feng presenting with redness, heat, and swelling, Er Miao San (Two Marvels Powder) and Guizhi Shaoyao Zhimu Tang (Cinnamon Twig, Peony, and Anemarrhena Decoction) are also essential. This represents flexible application of treatment principles.
Er Miao San (Two Marvels Powder)
Indications: Damp-heat causing Wei syndrome (flaccidity syndrome).
Ingredients: Phellodendri Cortex (Huangbai), Atractylodis Rhizoma (Cangzhu - peeled and stir-fried with salt water).
Administration: Decoct in water and take orally.
San Qi Tang (Three Qi Decoction)
Guizhi Shaoyao Zhimu Tang (Cinnamon Twig, Peony, and Anemarrhena Decoction) (Both see "Jin Gui Yao Lue")
Jian Gao (Ointment) (From "Zhong Fu Tang")
Specializes in treating bone and joint pain caused by wind-cold-dampness, Li Jie Tong Feng (Polyarticular Gout), Wei Bi (Flaccid Bi) with numbness and insensitivity, He Xi Feng (Crane's Knee Wind), Pian Tou Feng (Hemicrania), Lou Jian Feng (Frozen Shoulder). Also treats traumatic injuries from falls, twists, and sprains; Yin-type unnamed swellings and sores. Do not apply to already ulcerated lesions. Do not apply to children or pregnant women.
Ingredients: Short human hair (freshly cut from young adults, dried, 2 liang); Rhubarb (Dahuang); Notopterygium Rhizome (Weilingxian); Male Rat Feces (Xiongshufen) (each 1 liang); Sichuan Aconite Root (Chuanwu); Chinese Aconite Root (Caowu); Persicaria Hirta (Liujinu) (each 8 qian); Tibetium Ground Beetle (Tubiechun - large ones, 20 pieces); Notopterygium Rhizome (Qianghuo); Angelica Pubescens Root (Duhuo); Safflower (Honghua); Chinese Angelica Root (Danggui); Cnidium Fruit (Shechuangzi); Atractylodes Rhizome (Cangzhu); Raw Arisaema Tuber (Sheng Nanxing); Raw Pinellia Tuber (Sheng Banxia); White Mustard Seed (Baijiezhi); Peach Kernel (Taoren) (each 1 liang).
The above eighteen ingredients are all chopped.
Camphor (Zhangbing); Sweet Scabious Flower (Gansong); Sand Ginger (Shannai); Sichuan Pepper (Huajiao); Pig Tooth Soap Pod (Zhuyazao); Pangolin Scales (Shanjia - roasted and ground); Long Pepper Fruit (Bibo) (each 3 qian above; oil need not be removed; roast together with Frankincense until hot, then grind finely with the other herbs); Frankincense (Ruxiang); Angelica Dahurica Root (Baizhi) (each 5 qian).
The above ten ingredients are ground into an extremely fine powder.
Fresh Tobacco Leaf Juice (1 jin, preserved with 6 liang Rosin, dried); Fresh Mercurialis Annua Root Juice (1 jin, preserved with 6 liang Rosin); Fresh Ricinus Communis Flower Juice (Banjin, preserved with 3 liang Rosin); Fresh Mugwort Leaf Juice (Banjin, preserved with 3 liang Rosin); White Impatiens Balfourii Flower Juice (Banjin, preserved with 3 liang Rosin); Fresh Ginger Juice (Banjin, preserved with 3 liang Rosin); Leek Juice (Banjin, preserved with 3 liang Rosin); Scallion Juice (Banjin, preserved with 3 liang Rosin); Garlic (4 liang, preserved with 2 liang Rosin).
Measure Sesame Oil (MAYOU) accurately at 3 jin 4 liang. First, put the hair into the oil and simmer until half an incense stick has burned. Then add the aforementioned medicines to the oil. Simmer until scorched yellow, but do not let it become too charred. Filter out the dregs. Add the previously prepared Rosin and melt it. Filter again using silk cotton. Continue simmering until the surface of the oil shows walnut-shell patterns. First, add 4 liang of very fine Litharge (Miduoseng). Then, slowly add 1 jin of Western Sulfur powder. When adding these two ingredients, sprinkle them in slowly; do not add too much or too quickly. The consistency is ready when a drop forms a bead in water. Remove from fire and let cool slightly. Then mix in the fine medicinal powder evenly. Store in porcelain containers. During preparation, stir constantly with mulberry branches. Apply by spreading on blue cloth. Each patch contains 4 qian of pure ointment. Before use, temporarily add 5 li of Cinnamon Twig powder and 2 li of Asarum Root powder.