徐可豫治吴兴沈中刚内子。膝肿痛。右先剧。以热熨则攻左。熨左攻右。俱熨则雷鸣上
胸。已而背悉若受万棰者。独元首弗及。发则面黛色。脉罔辨。昏作旦辍。日 弱甚。医望
色辄却。谓勿救。徐视脉竟。曰。是湿淫所中。继复惊伤胆。疾虽剧。可治。即令以帛缠胸
少间。探咽喉间。涌青白涎沫几斗许。涌定。徐曰。今兹疾发。至腹则弗上面。面弗青矣
至昏膝痛。仍加熨。鸣果弗及胸止。三鼓已定。皆如徐言。越三昏。不复作。遂痊。
震按湿则生痰。惊则痰阻。古有惊痰沃胆之说。所以面青也。痰随气动。所以升降作痛
也。一吐而愈。是得戴人心法者。
州守张天泽。左膝肿痛。胸膈痞满。饮食少思。时作呕。头眩痰壅。日晡殊倦。用葱熨
法。及六君加炮姜。诸证顿退。饮食稍进。用补中益气加蔓荆子。头目清爽。肢体康健。间
与大防风汤十余剂。补中益气三十余剂。而消。
一妇人发热口干。月经不调。半载后。肢体倦怠。二膝肿痛。作足三阴血虚火燥治之。
用六味地黄丸。两月余。形体渐健。饮食渐进。膝肿渐消。半载而痊。
震按此是立斋医案。虽仅二条。而治法大备。盖鹤膝风乃足三阴经亏损。寒湿乘虚而入
故所用四方。是要药。若欲作脓。或溃后。又宜十全大补汤。若兼头晕吐痰。小便频数。须
佐以八味丸。皆要法也。惟初起时。以葱熨。或雷火针使其内消为妙。又预防法。用艾绒缝
入护膝。将大红绢作里面。着肉缚之。昼夜不脱。可免此病。
徐可豫治疗吴兴沈中刚的妻子。患者膝盖肿胀疼痛,右侧先发作且症状剧烈。用热物熨烫患处时,疼痛转移至左侧;熨烫左侧时,疼痛又转移至右侧。如果两侧同时熨烫,则体内气机轰鸣并上冲至胸部。随后,背部感觉如同遭受了万根棍棒殴打一般疼痛,唯独头部未受影响。发病时面色呈青黑色,脉象难以辨识,病情在清晨开始发作,到黄昏时停止,每天身体极度虚弱。医生观察面色后便退缩回避,认为无法救治。徐可豫诊察完脉象后说:“这是湿邪侵袭所致,随后又因惊恐损伤了胆腑。疾病虽然严重,但可以治愈。”随即让人用布带缠绕胸部片刻,然后探喉催吐,涌出青白色的涎沫多达几斗。待呕吐平息后,徐可豫说:“现在这个病发作时,气逆至腹部就不会再上冲面部,面部也不会发青;若气逆至昏沉部位导致膝痛,继续熨烫,气鸣果然不再上冲至胸部而停止。到了三更天,症状完全安定。大家都像徐可豫预言的那样。过了三个黄昏(约一天半),病症不再复发,于是痊愈。”
俞震按语:湿气会产生痰饮,惊恐会导致痰浊阻滞,古人有“惊痰沃胆”的说法,所以会出现面色发青的症状。痰随气机运动,所以上下升降引发疼痛。通过一次催吐而痊愈,这是得到了戴元礼(戴人)治疗心法的人。
州守张天泽,左膝盖肿胀疼痛,胸膈部痞塞胀满,饮食减少且缺乏食欲,时常作呕,头晕目眩,痰多壅盛,傍晚时分特别疲倦。使用葱熨法,以及六君子汤加入炮姜,各种症状顿时消退,饮食稍微增加。接着使用补中益气汤加入蔓荆子,头目清爽,肢体康健。期间配合服用大防风汤十余剂,补中益气汤三十余剂,最终病愈消散。
有一位妇人发热口干,月经不调。半年后,出现肢体倦怠,双膝肿胀疼痛。按照足三阴经血虚火燥来治疗,使用六味地黄丸。两个多月后,形体逐渐健壮,饮食逐渐增加,膝盖肿胀逐渐消退,半年后痊愈。
俞震按语:这是薛己(立斋)的医案。虽然只有两条,但治疗方法非常完备。大概鹤膝风是由于足三阴经亏损,寒湿乘虚而入,所以所用的四方是主要药物。如果想要化脓,或者溃破之后,又适宜使用十全大补汤。如果兼有头晕、吐痰、小便频数,需要佐以八味丸。这些都是关键的治疗方法。只有在初起阶段,用葱熨或雷火针使其内部消散才是妙法。另外预防方法是用艾绒缝入护膝中,将大红绢作为内衬,贴着肉绑缚,昼夜不脱下,可以避免此病。
Xu Keyu treated the wife of Shen Zhonggang from Wuxing. The patient suffered from swelling and pain in the knees, with the right side being more severe initially. When hot compresses were applied to one knee, the pain shifted to the other; applying them to the left caused the pain to shift to the right. If both were compressed simultaneously, rumbling noises occurred in the chest. Subsequently, the entire back felt as if beaten by ten thousand sticks, except for the head. During attacks, the face turned dark blue/black, and the pulse was indistinguishable. The condition started in the morning and ceased at dusk, leaving the body extremely weak daily. Physicians, upon observing the complexion, retreated, deeming it incurable. After examining the pulse, Xu said, "This is caused by the invasion of dampness (Shi), followed by injury to the Gallbladder due to fright (Jing). Although the disease is severe, it is treatable." He then instructed that the chest be bound tightly with a cloth for a moment, after which the throat was stimulated to induce vomiting, expelling several dou of greenish-white phlegm and saliva. Once the vomiting subsided, Xu stated, "Now, when this disease attacks, if the qi rises to the abdomen, it will not reach the face, and the face will not turn cyanotic; if it leads to dizziness and knee pain, continuing the hot compression will stop the rumbling from reaching the chest. By the third watch (midnight), symptoms stabilized completely, exactly as Xu predicted. After three dusk periods, the disease did not recur, and she recovered."
Yu Zhen commented: Dampness generates phlegm, and fright obstructs phlegm. The ancients spoke of "fright-phlegm flooding the Gallbladder," which explains the cyanotic complexion. Phlegm moves with the qi, causing pain through ascending and descending movements. Recovery after a single emesis indicates mastery of Dai Yuanli's therapeutic methods.
Zhang Tianze, Prefect, suffered from swelling and pain in the left knee, fullness and stagnation in the chest and diaphragm, reduced appetite, occasional vomiting, dizziness, and copious phlegm obstruction. He felt particularly fatigued in the late afternoon. Treatment with scallion hot compression (Cong Yun Fa) and Liu Jun Zi Tang (Six Gentlemen Decoction) added with Pao Jiang (Roasted Ginger) caused all symptoms to recede immediately, and food intake slightly increased. Subsequently, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) added with Man Jing Zi (Vitex Fruit) cleared the head and eyes, restoring health to the limbs. Intermittently, Da Fang Feng Tang (Great Saposhnikovia Decoction) was administered for over ten doses, and Bu Zhong Yi Qi Tang for over thirty doses, leading to complete resolution.
A woman suffered from fever and dry mouth, along with irregular menstruation. Half a year later, she experienced limb fatigue and swelling and pain in both knees. She was treated for deficiency of blood and dryness of fire in the Three Yin Meridians of the Foot using Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia). After more than two months, her physique gradually strengthened, food intake increased, and knee swelling subsided. She recovered after half a year.
Yu Zhen commented: This is a medical case record by Xue Ji (Li Zhai). Although only two cases are recorded, the therapeutic methods are comprehensive. Generally, Crane's Knee Wind (He Xi Feng) results from deficiency of the Three Yin Meridians of the Foot, allowing cold-dampness to enter due to deficiency. Therefore, the four formulas used are essential. If suppuration occurs or after ulceration, Shi Quan Da Bu Tang (Ten Complete Great Tonifying Decoction) is appropriate. If accompanied by dizziness, expectoration, and frequent urination, Ba Wei Wan (Eight-Ingredient Pill) should be added. These are key methods. Only in the initial stage is it excellent to use scallion hot compression or Lei Huo Zhen (Thunder Fire Needle) to resolve it internally. Additionally, for prevention, mugwort wool can be sewn into knee guards, lined with red silk against the skin, worn day and night without removal, to prevent this disease.