一人股内侧痛久。医作痛风治。月余罔效。脓熟肉浓。不能穿穴。因溃入腹。精神昏愦。粥药不进。请予视
之。脉细如丝。气息奄奄欲绝。曰。可治。以铍针刺腹。脓大泄数升。然皆清脓如水。疮口如蟹吐沫。疑其透
膜。曰、无伤也。投以参、 、附子。加以厥阴引经药。大剂服之。再食前吞八味地黄丸百丸。食大进。日HT 饭
升余。肉数脔。旬日而愈。所以知其可治者。溃疡之脉。洪实者死。微细者生。今脉微细。形症相合。知其受
补也。所以信其不透膜。即透膜亦可治者。无恶候也。服八味丸者。使肾气旺而上升。则胃口开而纳食
也。泻脓虽多。更进以开胃药。使多食粱肉以补之。肌自速生。此治溃疡之大法也。
神授卫生散 绀珠丹 内疏黄连汤 贵金丸 补中益气汤 六味地黄丸 十全大补汤 六君子汤
刺委中穴法 按穴灸法 八珍汤 保元大成汤 香砂六君子汤（俱见首卷） 逍遥散（见瘰 门）
槟苏败毒散
经络 经曰。肉之小会为溪。溪者。二肘二膝四腕也。又曰。脾病在溪。又曰。肾有邪其气留于两膝。诸筋
皆属于节。筋病皆属于节。又属乎肝也。筋病无多食酸。忌用风药。诸痈发于节而相应者。不治。（应为内发透外也）
发于阳者百日死。发于阴者三十日死。（阳为诸节之背阴为诸节 间也）
疽 发于膝。灵枢云。其状大痈。色不变。寒热而坚。勿石。石之者死。柔之者生。
膝痈 膝盖肿痛也。初起。用卫生散加牛膝。或用加味二妙散。
膝眼风 膝之两傍有穴。名鬼眼穴。初起肿痛如锥。寒热偏剧。宜绀珠丹和之。
鹤膝风 两膝内外皆肿。寒热间作。痛如虎咬。股渐细而膝愈大是也。属足少阳阳明二经。初宜绀珠
丹汗之。外以玉龙膏酒调敷之。以住痛回阳。如汗后肿痛不减。阴寒深伏也。大防风汤温之。或加乳
香以住痛舒筋。灸膝眼穴二七壮。甚者见青筋。痛引足心。灸三阴交穴二七壮。待膝伸直为止。再甚
者。则于膝顶上灸七壮。乃秘穴也。
游膝风 只一膝痛引上下为异耳。发微热。不甚肿。初宜绀珠丹汗之。
石疽 肿不变色。漫肿疼痛。坚硬如石。此寒气之肿也。或捣生商陆根。加盐少许敷之。
缓疽 其热缓慢。积日不溃。久乃黯紫。皮肉俱烂。二症俱宜温补。
按上诸症。虽云肿有浅深。感有轻重。其所受皆因真气虚而邪气得以深袭之也。故附骨疽、鹤膝风
等症。由肾虚者多有之。前人用附子者。为温补肾气。又能行药势以散寒邪也。亦有体虚露卧。为冷
气所袭者。则不能转侧。乍热而无汗。按之其痛应骨。为贼风所伤者。则不甚热而恶寒。不时汗出。熨
之而痛少止。俱服大防风汤。敷玉龙膏可愈。如失治。则变挛曲偏枯之败症矣。又两膝肿痛而腿
筋弛长者。由阴虚湿热所乘也。主以六味丸。佐以八珍汤加牛膝、杜仲。间以补中益气汤。又脾胃虚
者。以补中益气汤。若精涸口干。中气不足也。加五味子。头晕头痛。阳气不升也。加蔓荆子。肝肾伤
者则形瘦嗜卧。寝息发热。痰盛作渴。小便频数。五脏虚损也。俱宜六味地黄汤。脐腹疼痛。夜多漩溺。
脚膝无力。头晕吐痰。肾气冷败也。俱宜八味地黄丸。脓成及溃后畏寒憎寒者。阳气虚也。水清
稀不生肌肉者。气血虚也。虚热往来有时而动者。无根虚火也。俱宜十全大补汤。
按上三汤。俱佐以大防风汤为要。再如食少腹胀。脾胃虚也。四君子汤。面色痿黄。脾胃弱也。六君子
汤。发热晡热。阴血虚也。四物加参、 、白术。发热大渴而不欲近衣。面目赤色。脉大而虚者。血虚发燥
也。当归补血汤。
委中毒 生膝后折纹中。坚硬如石。微肿微红。由胆经积热流入膀胱也。治缓则筋缩而成废疾。宜刺
委中穴筋上。出紫黑血。又宜服逐瘀活血等药。候瘀血下。自消。
上水鱼 生折纹之侧。结长核如鱼。作肿痛。宜用针乱刺核上。出其恶血。再以活瘀之药敷之。
有一位患者大腿内侧疼痛日久。医生将其当作痛风治疗，一个多月毫无效果。脓液已经成熟，肌肉腐烂，但无法破溃排脓。后来疮口溃烂深入腹部，导致精神昏沉迷糊，连粥和药都吃不下。请我诊治。脉象细如丝线，气息微弱几乎要断绝。我说：可以治愈。用铍针刺入腹部，排出大量脓液，达数升之多。然而排出的都是像水一样清稀的脓液，疮口形状像螃蟹吐沫，我怀疑是穿透了腹膜。我说：没有大碍。给予人参、[缺失药材]、附子，并加入厥阴经引经药，大剂量服用。饭前再吞服八味地黄丸一百粒。食欲大增，每天能吃下一升多米饭，长出几块好肉，十天后痊愈。之所以知道可以治愈，是因为溃疡病的脉象，洪大实强者主死，微细者主生。现在脉象微细，形体症状相符合，说明身体能够承受补益。之所以相信没有穿透腹膜，即使穿透也可以治愈，是因为没有恶性的征候。服用八味地黄丸，是为了使肾气旺盛而上升，从而胃口打开而能进食。虽然泻出大量脓液，但通过进开胃药，促使多吃粮食肉类来补益身体，肌肉自然迅速生长。这是治疗溃疡的大法。
神授卫生散、绀珠丹、内疏黄连汤、贵金丸、补中益气汤、六味地黄丸、十全大补汤、六君子汤、刺委中穴法、按穴灸法、八珍汤、保元大成汤、香砂六君子汤（均见于首卷）、逍遥散（见瘰疬门）、槟苏败毒散。
经络：经文说，肉的细小会合处称为“溪”。“溪”，指的是两肘、两膝、四腕共八个部位。又说，脾病发生在溪。又说，肾脏有邪气，其气停留在两膝。所有的筋都归属于关节，筋病都归属于关节，又归属于肝。筋病患者不要多吃酸味食物，忌用风药。各种痈疽发于关节且相应部位受累的，难以治愈。（应当是内部病变透发至外部）。发于阳经的百日死，发于阴经的三十日死。（阳指各关节的背面，阴指各关节的间隙）。
疽：发于膝盖。《灵枢》说，其症状为大痈，颜色不变，伴有寒热且坚硬，不可用石针切开。用石针切开的会死，使其柔化的能活。
膝痈：膝盖肿痛。初起时，使用卫生散加牛膝，或者使用加味二妙散。
膝眼风：膝盖两侧有穴位，名为鬼眼穴。初起时肿痛如锥刺，寒热症状剧烈，适宜用绀珠丹调和。
鹤膝风：两膝内外皆肿，寒热交替发作，疼痛如虎咬，大腿逐渐变细而膝盖愈发肿大，这就是鹤膝风。属于足少阳经和足阳明经。初起适宜用绀珠丹发汗，外用玉龙膏调酒敷贴，以止痛回阳。如果发汗后肿痛不减，说明阴寒深伏体内，用大防风汤温补。或者加乳香以止痛舒筋。灸膝眼穴十四壮。严重的出现青筋，疼痛牵引足心，灸三阴交穴十四壮，直到膝盖伸直为止。更严重的，则在膝盖顶上灸七壮，这是秘传穴位。
游膝风：只有一只膝盖疼痛，并牵引上下部位，这是与其他病症不同的地方。发热轻微，肿胀不严重。初起适宜用绀珠丹发汗。
石疽：肿胀不变色，漫肿疼痛，坚硬如石头，这是寒气引起的肿胀。或者捣碎生商陆根，加少许盐敷贴。
缓疽：热势缓慢，积久不溃烂，时间久了变为暗紫色，皮肉俱烂。这两种病症都适宜温补。
以上诸症，虽然说肿胀有浅深之分，感受邪气有轻重之别，但其根本原因都是因为真气虚弱，使得邪气得以深入侵袭。所以附骨疽、鹤膝风等症，肾虚的患者多有发生。前人使用附子，是为了温补肾气，又能行药势以散寒邪。也有体质虚弱露宿野外，被冷气侵袭的，则不能转动侧身，忽热而无汗，按压时疼痛应骨，这是被贼风所伤，则不太热而恶寒，不时出汗，熨烫后疼痛稍止，都服用大防风汤，敷贴玉龙膏可愈。如果失治，则会变成挛曲偏枯的败症。又有两膝肿痛而腿筋弛长松弛的，是由于阴虚湿热乘虚而入所致。主治用六味丸，佐以八珍汤加牛膝、杜仲，间服补中益气汤。又是脾胃虚弱的，用补中益气汤。如果精血枯竭口干，是中气不足，加五味子。头晕头痛，是阳气不升，加蔓荆子。肝肾损伤的则形体消瘦嗜睡，睡眠呼吸发热，痰多口渴，小便频数，这是五脏虚损，都适宜六味地黄汤。脐腹疼痛，夜间多尿，脚膝无力，头晕吐痰，是肾气冷败，都适宜八味地黄丸。脓成及溃后畏寒憎寒的，是阳气虚；脓水清稀不生肌肉的，是气血虚；虚热往来有时而动的，是无根虚火，都适宜十全大补汤。
以上三种汤剂，都佐以大防风汤为关键。又如食少腹胀，是脾胃虚，用四君子汤。面色萎黄，是脾胃弱，用六君子汤。发热或午后发热，是阴血虚，用四物汤加人参、[缺失药材]、白术。发热大渴而不想靠近衣物，面目赤色，脉大而虚的，是血虚发燥，用当归补血汤。
委中毒：生在膝盖后方折纹中，坚硬如石，微肿微红，由胆经积热流入膀胱所致。治疗迟缓则筋缩而成废疾。适宜刺委中穴筋上，放出紫黑色血液。又适宜服用逐瘀活血等药物，等待瘀血下行，自然消散。
A patient suffered from long-term pain in the medial aspect of the thigh. The physician treated it as Gout (Tongfeng, 痛风), but after more than a month, there was no effect. The pus had matured and the flesh was rotting, yet it could not penetrate to form an opening. Eventually, it ulcerated into the abdomen, causing mental confusion and stupor, with an inability to take even porridge or medicine. I was consulted. The pulse was fine like a thread, and the breath was faint, nearly perishing. I said, "It is treatable." Using a Pi Needle (Biren, 铍针), I punctured the abdomen, draining several sheng (a unit of volume) of large amounts of pus. However, all the pus was clear and watery, and the wound opening resembled crab bubbles. I suspected penetration of the peritoneum. I said, "There is no harm." I administered Ren Shen (Ginseng Root, 人参), [Missing Herb], and Fu Zi (Aconite Lateral Root, 附子), along with herbs guiding to the Jueyin Meridian (Liver and Pericardium). These were taken in large doses. Before meals, one hundred pills of Sheliu Dihuang Wan (Eight-Ingredient Rehmannia Pill, 八味地黄丸) were swallowed. Appetite greatly improved; daily rice intake exceeded one sheng. Several pieces of healthy flesh grew, and recovery occurred within ten days. The reason I knew it was treatable was that for ulcerative conditions, a洪实 (Hongshi, surging and excess) pulse indicates death, while a微细 (Weixi, fine and thin) pulse indicates life. Now the pulse is fine and thin, consistent with the physical symptoms, indicating the body can accept tonification. The reason I believed the peritoneum was not penetrated, or even if it were, it was still treatable, was the absence of malignant signs. Taking Sheliu Dihuang Wan aims to strengthen Kidney Qi (Kidney Energy, 肾气) so it rises, thereby opening the Stomach appetite and allowing food intake. Although much pus was drained, advancing stomach-opening medicines encourages eating grains and meats to tonify the body, leading to rapid muscle regeneration. This is the major principle for treating ulcers.
Shen Shou Wei Sheng San (Divine Grant Hygiene Powder, 神授卫生散), Zhenzhu Dan (Azure Pearl Pill, 绀珠丹), Neishu Huanglian Tang (Internal Draining Coptis Decoction, 内疏黄连汤), Guijin Wan (Noble Gold Pill, 贵金丸), Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction, 补中益气汤), Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill, 六味地黄丸), Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction, 十全大补汤), Liujunzi Tang (Six Gentlemen Decoction, 六君子汤), Ci Weizhong Xue Fa (Puncturing Weizhong Acupoint Method, 刺委中穴法), An Xue Jiu Fa (Pressing Acupoint Moxibustion Method, 按穴灸法), Bazhen Tang (Eight Treasures Decoction, 八珍汤), Baoyuan Dacheng Tang (Preserve Origin Great Achievement Decoction, 保元大成汤), Xiangsha Liujunzi Tang (Aucklandia and Amomum Six Gentlemen Decoction, 香砂六君子汤) (all seen in Volume One); Xiaoyao San (Free and Easy Wanderer Powder, 逍遥散) (seen in the Scrofula section); Bin Su Baidu San (Betel Nut and Eclipta Detoxifying Powder, 槟苏败毒散).
Meridians: The Classic states, "The small gatherings of flesh are called Xi (Creeks)." "Xi" refers to the two elbows, two knees, and four wrists. It also states, "Spleen disease occurs at the Xi." And again, "When the Kidneys have pathogenic factors, their Qi remains in the two knees." All tendons belong to the joints; tendon diseases belong to the joints, and further belong to the Liver. Patients with tendon diseases should not eat much sour food and should avoid Wind-dispelling medicines. Various abscesses arising at joints with corresponding involvement are difficult to cure. (This implies internal pathology manifesting externally). Those arising in Yang meridians die in one hundred days; those arising in Yin meridians die in thirty days. (Yang refers to the dorsal aspects of joints, Yin to the interstices).
Ju (Deep Abscess): Arising at the knee. The Ling Shu (Spiritual Pivot) states: "Its appearance is a large abscess, color unchanged, accompanied by chills and fever, and hard. Do not stone (incise) it. Those who incise it die; those who soften it live."
Knee Abscess (Xi Yong): Swelling and pain of the knee joint. At onset, use Wei Sheng San added with Niu Xi (Achyranthes Root, 牛膝), or Jiawei Ermiao San (Modified Two Marvels Powder, 加味二妙散).
Knee Eye Wind (Xi Yan Feng): There are acupoints on both sides of the knee named Guiyan (Ghost Eye, 鬼眼). At onset, swelling and pain feel like awl piercing, with severe chills and fever. Zhenzhu Dan is suitable to harmonize.
Crane Knee Wind (He Xi Feng): Swelling on both inner and outer aspects of both knees, alternating chills and fever, pain like tiger biting, with thighs gradually thinning and knees enlarging. This belongs to the Foot Shaoyang (Lesser Yang) and Foot Yangming (Stomach) meridians. Initially, use Zhenzhu Dan to induce sweating. Externally, apply Yulong Gao (Jade Dragon Ointment, 玉龙膏) mixed with wine to stop pain and restore Yang. If swelling and pain persist after sweating, it indicates deep-seated Yin-Cold. Use Dafangfeng Tang (Great Wind-Expelling Decoction, 大防风汤) to warm. Or add Ru Xiang (Frankincense Resin, 乳香) to stop pain and relax tendons. Moxibustion on Xiyan points, 14 moxa cones. In severe cases with visible blue veins and pain radiating to the sole, moxibustion on Sanyinjiao (SP6), 14 cones, until the knee straightens. Even more severe cases: seven cones on the top of the knee, a secret point.
Wandering Knee Wind (You Xi Feng): Pain in only one knee radiating up and down is the difference. Mild fever, slight swelling. Initially, use Zhenzhu Dan to induce sweating.
Stone Ju (Shi Ju): Swelling without color change, diffuse swelling and pain, hard as stone. This is swelling caused by Cold-Qi. Alternatively, crush fresh Shanglu (Phytolacca Root, 商陆) root, add a little salt, and apply.
Slow Ju (Huan Ju): Heat is slow, accumulating over days without ulceration, eventually turning dark purple with skin and flesh rotting. Both conditions require warming and tonifying.
Regarding the above conditions, although swelling has depth and pathogenic invasion has severity, the root cause is always deficiency of True Qi (Zhengqi, 真气), allowing pathogens to invade deeply. Thus, Gujue (Bone-attached Abscess, 附骨疽) and He Xi Feng are common in patients with Kidney Deficiency. Ancients used Fu Zi to warm and tonify Kidney Qi and to promote drug action to disperse Cold-Pathogens. There are also cases of weak constitution sleeping outdoors, invaded by Cold Air, unable to turn or lie sideways, with intermittent heat but no sweat, and pain upon pressure reaching the bone; this is injury by Thief-Wind (Zefeng, 贼风), characterized by mild heat, aversion to cold, and spontaneous sweating. Moxibustion stops pain slightly. All such cases should take Dafangfeng Tang and apply Yulong Gao for cure. If neglected, they become deformities like contracture or hemiplegia. Again, bilateral knee swelling with flaccid leg tendons is due to Yin-Deficiency with damp-heat invasion. Treat primarily with Liuwei Wan, assisted by Bazhen Tang added with Niu Xi and Duzhong (Eucommia Bark, 杜仲), interspersed with Buzhong Yiqi Tang. For Spleen-Stomach deficiency, use Buzhong Yiqi Tang. If essence is depleted and mouth dry, it is Middle-Jiao Qi deficiency; add Wuweizi (Schisandra Berry, 五味子). For dizziness and headache, it is failure of Yang Qi to ascend; add Manjingzi (Vernonia Seed, 蔓荆子). For Liver-Kidney damage, emaciation, lethargy, night fevers, excessive phlegm, thirst, and frequent urination indicate Five Viscera deficiency; use Liuwei Dihuang Tang. For umbilical/abdominal pain, nocturia, weak legs/knees, dizziness, and vomiting phlegm, it is Cold-Decay of Kidney Qi; use Sheliu Dihuang Wan. For fear of cold after pus formation and ulceration, it is Yang Qi deficiency. For clear, thin pus failing to generate flesh, it is Blood and Qi deficiency. For deficient heat coming and going at times, it is Rootless Deficient Fire. All these should use Shiquan Dabu Tang.
For the above three decoctions, adding Dafangfeng Tang is essential. For example, poor appetite and abdominal distension indicate Spleen-Stomach deficiency; use Sijunzi Tang (Four Gentlemen Decoction, 四君子汤). Withered yellow complexion indicates weak Spleen-Stomach; use Liujunzi Tang. Fever or afternoon fever indicates Yin-Blood deficiency; use Siwu Tang (Four Substances Decoction, 四物汤) added with Ren Shen, [Missing Herb], and Baizhu (Atractylodes Macrocephala Rhizome, 白术). Fever, great thirst, aversion to removing clothes, red face and eyes, and large empty pulse indicate Blood deficiency with Dryness; use Danggui Buxue Tang (Angelica Tonifying Blood Decoction, 当归补血汤).
Weizhong Poison (Wei Zhong Du): Occurs in the crease behind the knee, hard as stone, slightly swollen and red. Caused by accumulated Heat in the Gallbladder Meridian flowing into the Bladder Meridian. Delayed treatment leads to tendon contraction and disability. Puncture the tendon at Weizhong (BL40) acupoint to release purple-black blood. Also administer Huayu Huoxue (Blood-invigorating and Stasis-resolving) medicines. After stasis clears, it resolves naturally.
Shangshuiyu (Upper Water Fish): Occurs on the side of the crease, forming a long nodule like a fish, causing swelling and pain. Prick the nodule repeatedly with a needle to release evil blood, then apply Huoxue (Blood-invigorating) medicines.