论曰骨极之病，本于肾脏中风，肾主身之骨髓，风邪中其脏，则历骨，故为骨极，所谓
骨极者，令人酸削，齿苦痛，手足烦疼，不可以立，不欲行动是也，然骨有极虚寒，有极实
热，皆由肾受邪气，若气阴则虚，虚则寒，寒故面肿垢黑，腰脊痛，不能久立，屈伸不利，
其气衰，则发堕齿槁，腰背相引而痛，痛甚即咳唾亦甚，气阳则实，实则热，热故面色 ，
隐曲膀胱不通，牙齿脑髓苦痛，手足酸削，耳鸣色黑，是骨极之至也，宜随证补泻，当治其
微，若甚则足少阴气绝，而骨枯发无膏泽，是为骨先死，骨绝者不可治，其 而切痛，伸缩
不得者，不过十日则死矣。
治骨极虚寒，面肿垢黑，腰脊痛，不能久立，屈伸不利，梦寐惊悸，上气，小腹里急，
痛引腰脊，四肢常苦寒冷，小便或白，肾沥汤方
人参 芍药 麦门冬（去心焙） 生干地黄（焙） 当归（切焙各一两半） 甘草（炙
锉）
芩（去黑心半
上一十四味，除肾外，粗捣筛，每服五钱匕，先用水二盏，煮羊肾一只，至一盏半，除
肾下药末，并大枣二枚去核，同煎至一盏，去滓空心日午夜卧服，若遗小便，加桑螵蛸二十
枚，切破炒。
治骨极骨髓中疼，酒浸芍药散方
芍药（五两） 生地黄（切焙三两） 虎骨（酒浸炙二两）
上三味，粗捣筛，以酒一升，浸一宿焙干，再捣罗为散，每服三钱匕，空腹温酒调下，
日午夜卧再服。
治骨极膀胱不通，大小便闭塞，面色枯黑，耳虚鸣烦热，二黄汤方
大黄（锉炒） 黄芩（去黑心各一两） 栀子仁（十四枚） 甘草（炙锉半两）
上四味，粗捣筛，每服五钱匕，水一盏半，煎至一盏，下芒硝半钱匕，去滓分温二服，
空心日午各一。
治骨极色黑 痛，隐曲膀胱不通，小便壅塞，四肢满急，大黄汤方
大黄（锉炒） 大戟（锉炒） 赤茯苓（去黑皮） 甘遂（炮） 黄芩（去黑心各一两）
芫花（
上七味，粗捣筛，每服三钱匕，水一盏半，入枣二枚劈破，煎至一盏，去滓温分二服，
空心日午各一。
治骨极腰脊痛，风虚气衰，不能久立，脑髓酸痛，补虚壮元，木瓜汤方
木瓜（五枚将 砂十两研细汤浸绢滤澄清银石器煮成膏后将木瓜削去皮切片以 砂霜拌
匀碗内蒸令熟收藏旋用每料用木瓜三两） 雀（四十只去头足肠胃醋煮烂砂盆研布绞取肉以
日焙捣
（去根） 肉苁蓉
芦头一两半） 香子（
上一十四味，除膏外，捣罗为末，用前膏搜丸，如梧桐子大，每服三十丸，煨生姜盐汤
下。
治骨极腰脊痛，不能久立，发堕齿槁，手足疼甚，骨碎补丸方
骨碎补（炒） 附子（炮裂去皮脐） 肉豆蔻（去壳各二两） 蒺藜子（炒去角） 杜
仲（去粗
一两） 芎 （三
上一十二味，捣罗为末，炼蜜和丸，如梧桐子大，每服空心温酒下三十丸。
论述说：骨极这种病，根源在于肾脏感受风邪。肾主管身体的骨髓，风邪侵入肾脏，就会侵蚀骨骼，因此称为骨极。所谓骨极，表现为身体酸痛消瘦，牙齿剧烈疼痛，手足烦扰疼痛，无法站立，不愿活动。然而，骨极有极度虚寒和极度实热两种情况，都是由肾脏受邪气所致。如果肾气阴亏虚，则表现为虚寒，虚寒导致面部浮肿、面色污秽发黑，腰脊疼痛，不能久站，屈伸不利；肾气衰弱，则头发脱落、牙齿枯槁，腰背相互牵引而痛，疼痛严重时咳嗽吐痰也加重。如果肾阳气盛，则表现为实热，实热导致面色晦暗（原文缺字，据语境推测为晦暗或赤），隐蔽部位及膀胱气化不通，牙齿和脑髓剧烈疼痛，手足酸痛消瘦，耳鸣、面色发黑，这是骨极的严重阶段。应当根据证候进行补泻治疗，并在病情轻微时及时干预。如果病情严重到足少阴肾经之气断绝，导致骨骼枯萎、头发失去光泽滋润，这就是“骨先死”，骨气绝者不可治愈。如果出现腹部胀满且切痛，伸缩不得的情况，不超过十天就会死亡。
治疗骨极虚寒证，症状包括面部浮肿、面色污秽发黑，腰脊疼痛，不能久站，屈伸不利，睡眠中惊悸，气逆上冲，小腹部拘急疼痛并牵引腰脊，四肢常感寒冷，小便色白，使用肾沥汤方：
人参、芍药、麦门冬（去心焙干）、生干地黄（焙干）、当归（切片焙干，各一两半）、甘草（炙后锉碎）、黄芩（去黑心，半两）……（原文此处有脱漏，似指其他药材及剂量，但仅列出部分）。
以上十四味药，除去羊肾，将药材粗捣筛过。每次服用五钱匕，先用水二盏，煮一只羊肾，煮至一盏半时，加入除羊肾外的药末，以及去核的大枣两枚，同煎至一盏，去渣，空腹、日中、半夜、睡前服用。若伴有遗尿，加桑螵蛸二十枚，切碎炒制。
治疗骨极骨髓中疼痛，使用酒浸芍药散方：
芍药（五两）、生地黄（切片焙干，三两）、虎骨（酒浸后炙烤，二两）。
以上三味药，粗捣筛过，用酒一升浸泡一夜，取出焙干，再次捣碎过筛成散剂。每次服用三钱匕，空腹时用温酒调服，半夜和睡前再服一次。
治疗骨极膀胱不通，大小便闭塞，面色枯黑，耳虚鸣响伴烦热，使用二黄汤方：
大黄（锉碎炒制）、黄芩（去黑心，各一两）、栀子仁（十四枚）、甘草（炙后锉碎，半两）。
以上四味药，粗捣筛过。每次服用五钱匕，用水一盏半，煎至一盏，加入芒硝半钱匕，去渣，分两次温服，空腹和日中各服一次。
治疗骨极面色发黑、腹痛（原文缺字，据语境推测为腹痛或身痛），隐蔽部位及膀胱不通，小便壅塞，四肢胀满拘急，使用大黄汤方：
大黄（锉碎炒制）、大戟（锉碎炒制）、赤茯苓（去黑皮）、甘遂（炮制）、黄芩（去黑心，各一两）、芫花（……原文此处有脱漏）。
以上七味药，粗捣筛过。每次服用三钱匕，用水一盏半，加入劈破的两枚大枣，煎至一盏，去渣，分两次温服，空腹和日中各服一次。
治疗骨极腰脊疼痛，因风虚导致气衰，不能久站，脑髓酸痛，用于补虚壮元，使用木瓜汤方：
木瓜（五个，取砂十两研细，用汤浸泡后用绢布过滤澄清，在银石器中煮成膏，然后将木瓜削去皮切片，用砂霜拌匀，在碗内蒸熟收藏，随用随取，每料用木瓜三两）、雀（四十只，去头足肠胃，醋煮烂，在砂盆中研磨，用布绞取肉汁，晒干后捣碎……原文此处有脱漏）、肉苁蓉（去鳞甲，一两半）、芦头（……原文此处有脱漏）、香子（……原文此处有脱漏）。
以上十四味药，除去药膏外，其余捣碎过筛成末，用前面的药膏调和制成丸剂，如梧桐子大小。每次服用三十丸，用煨生姜盐汤送服。
治疗骨极腰脊疼痛，不能久站，头发脱落、牙齿枯槁，手足疼痛严重，使用骨碎补丸方：
骨碎补（炒制）、附子（炮裂后去皮脐）、肉豆蔻（去壳，各二两）、蒺藜子（炒后去刺）、杜仲（去粗皮……原文此处有脱漏）、川芎（……原文此处有脱漏）。
以上十二味药，捣碎过筛成末，用炼蜜和匀制成丸剂，如梧桐子大小。每次空腹时用温酒送服三十丸。
Discussion states: The disease of Bone Extremity (Gu Ji) originates from Wind pathogen invading the Kidney. The Kidney governs the bone marrow of the body. When Wind pathogen invades the Kidney organ, it penetrates the bones, thus termed Bone Extremity. Specifically, Bone Extremity causes soreness and emaciation of the body, severe toothache, vexing pain in the hands and feet, inability to stand, and reluctance to move. However, Bone Extremity presents as either extreme deficiency-cold or extreme excess-heat, both caused by the Kidney receiving pathogenic factors. If Kidney Qi and Yin are deficient, it manifests as deficiency-cold; cold leads to facial edema, dirty and black complexion, lower back and spine pain, inability to stand for long periods, and difficulty in flexion and extension. As Kidney Qi declines, hair falls out and teeth become dry; the lower back and waist pull each other causing pain, and severe pain exacerbates coughing and expectoration. If Kidney Yang is excessive, it manifests as excess-heat; heat leads to a dull complexion (text missing), obstruction in the genital area and Bladder, severe pain in teeth and brain marrow, soreness and emaciation of hands and feet, tinnitus, and blackish complexion. This represents the utmost stage of Bone Extremity. Treatment should follow syndrome differentiation with tonification or purgation, addressing the condition when it is mild. If it progresses to the point where Qi of Foot-Shaoyin (Kidney Meridian) is exhausted, resulting in withered bones and hair lacking luster and moisture, this is "Bone Death First"; cases of Bone Exhaustion are incurable. If abdominal distension with cutting pain occurs, accompanied by inability to extend or flex, death will occur within ten days.
For treating Bone Extremity deficiency-cold, with symptoms of facial edema, dirty black complexion, lower back and spine pain, inability to stand long, difficulty in movement, nightmares and palpitations, rebellious Qi, urgency and pain in the lower abdomen radiating to the spine, constant cold sensation in four limbs, and white urine, use Shenli Decoction (Shen Li Tang):
Ren Shen (Ginseng Radix), Shao Yao (Paeoniae Radix Alba), Mai Men Dong (Ophiopogonis Tuber), Sheng Gan Di Huang (Rehmanniae Radix Recens), Dang Gui (Angelicae Sinensis Radix, each 1.5 liang), Zhi Gan Cao (Prepared Licorice Root), Huang Qin (Scutellariae Radix, half liang)... [Text indicates fourteen ingredients total, but list is incomplete].
The above fourteen ingredients, excluding Sheep Kidney, are coarsely crushed and sieved. Take 5 qian bi per dose. First, boil one Sheep Kidney in two zhan of water until reduced to one and a half zhan. Add the coarse powder of the herbs (excluding the kidney) and two pitted Jujubes. Simmer until reduced to one zhan. Strain and take on an empty stomach, at noon, midnight, and before sleep. If urinary incontinence is present, add twenty Sang Piao Xiao (Mantis Egg Case), chopped and stir-fried.
For treating Bone Extremity with pain in the bone marrow, use Jiu Jin Shao Yao San (Wine-Soaked Peony Powder):
Shao Yao (Paeoniae Radix Alba, five liang), Sheng Di Huang (Rehmanniae Radix, three liang), Hu Gu (Tiger Bone, two liang, wine-soaked and roasted).
The above three ingredients are coarsely crushed and sieved. Soak in one sheng of wine overnight, then roast until dry. Crush and sieve again into a powder. Take 3 qian bi per dose, mixed with warm wine on an empty stomach. Take another dose at midnight and before sleep.
For treating Bone Extremity with Bladder obstruction, constipation of both large and small intestines, withered black complexion, empty ringing in ears with vexing heat, use Er Huang Tang (Two Yellows Decoction):
Da Huang (Rhei Radix et Rhizoma, chopped and stir-fried), Huang Qin (Scutellariae Radix, each one liang), Zhi Zi Ren (Gardeniae Semen, fourteen pieces), Zhi Gan Cao (Prepared Licorice Root, half liang).
The above four ingredients are coarsely crushed and sieved. Take 5 qian bi per dose. Boil in one and a half zhan of water until reduced to one zhan. Add Mang Xiao (Natrii Sulfas, half qian bi). Strain and divide into two warm doses. Take on an empty stomach and at noon.
For treating Bone Extremity with black complexion and abdominal pain, obstruction in the genital area and Bladder, obstructed urination, and fullness/urgency in the four limbs, use Da Huang Tang (Rhubarb Decoction):
Da Huang (Rhei Radix et Rhizoma, chopped and stir-fried), Da Ji (Euphorbiae Pekinensis Radix, chopped and stir-fried), Chi Fu Ling (Polyporus with Red Skin, remove black skin), Gan Sui (Kansui Radix, processed), Huang Qin (Scutellariae Radix, each one liang), Yuan Hua (Genkwa Flos... text incomplete).
The above seven ingredients are coarsely crushed and sieved. Take 3 qian bi per dose. Add two cracked Jujubes to one and a half zhan of water. Boil until reduced to one zhan. Strain and divide into two warm doses. Take on an empty stomach and at noon.
For treating Bone Extremity with lower back and spine pain due to Wind-deficiency and Qi decline, inability to stand long, and sour/aching pain in brain marrow, used for tonifying deficiency and strengthening Yuan Qi, use Mu Gua Tang (Papaya Decoction):
Mu Gua (Chaenomeles Fructus, five fruits; prepare paste using Shi Liu Sha [Lithium Carbonis Sulphas? Text unclear, likely a mineral or specific processing agent] ten liang ground fine, soaked in decoction, filtered through silk cloth, boiled in silver/copper vessel into paste. Slice peeled Mu Gua, mix with paste powder, steam in bowl until cooked, store for use. Use 3 liang Mu Gua per formula), Que (Sparrow, forty birds, remove head, feet, viscera, boil in vinegar until soft, grind in mortar, squeeze meat juice through cloth, sun-dry and crush... text incomplete), Rou Cong Rong (Cistanche Stem, remove scales, one and a half liang), Lu Tou (Asparagus Fern Shoot... text incomplete), Xiang Zi (Fennel Seed... text incomplete).
The above fourteen ingredients, excluding the paste, are crushed and sieved into powder. Mix with the prepared paste to form pills the size of Sophora seeds. Take thirty pills per dose, washed down with decoction of baked ginger and salt.
For treating Bone Extremity with lower back and spine pain, inability to stand long, hair loss, dry teeth, and severe hand/foot pain, use Gu Sui Bu Wan (Drynaria Pill):
Gu Sui Bu (Drynariae Rhizoma, stir-fried), Fu Zi (Aconiti Lateralis Radix Praeparata, processed, split, remove skin and umbilicus), Rou Dou Kou (Myristicae Semen, remove shell, each two liang), Ji Li Zi (Tribuli Fructus, stir-fried, remove spines), Du Zhong (Eucommiae Cortex, remove rough bark... text incomplete), Chuan Xiong (Ligustici Chuanxiong Rhizoma... text incomplete).
The above twelve ingredients are crushed and sieved into powder. Mix with refined honey to form pills the size of Sophora seeds. Take thirty pills per dose on an empty stomach, washed down with warm wine.