鹤膝风者。胫细而膝肿是也。经云。膝者筋之府。屈伸不能。行则偻俯。筋将惫矣。治宜祛
风顺气。活血壮筋。十全大补加杜仲、牛膝、羌活。或五积散加松节。血少虚寒而痛者。四物加
荆芥、牛膝。送活络丹。气血流动。更服八味丸加鹿茸、牛膝调理。正气旺而患自除矣。兼风湿
者。换骨丹。下利后膝肿痛。风邪乘虚入三阴经也。大防风汤。服药不能应手者。外用雷火针法。
每日淬之。不必着伤肌肉也。方用蕲艾五钱。丁香五分。麝香三分。合研匀。入纸筒中。痛处衬
粗纸三五层。点火淬之。以筋脉活动为度。数日自效。又鹤膝风初起。漫肿不红。屈伸不便者。
乘未溃时。用陈年芥菜子研细。以姜汁、葱涕和白蜜。调涂一伏时。患处起 。 干脱皮自愈。
上二法。若脓成者。不可用也。妇人鹤膝风证。因胎产经行失调。或郁怒亏损肝脾。而为外感所
伤。或先肢体筋挛。继而膝渐大。腿渐细。如鹤膝之状。若肿高赤痛者易治。漫肿不赤痛者难治。
二三月溃而脓稠者易治。半载后溃而脓清者难治。误用攻伐。复伤元气。尤为难治也。大要当固
元气为主。若食少体倦者。六君子汤。晡热内热。寒热往来者。逍遥散。发热恶寒者。十全大补
汤。少寐惊悸者。归脾汤。月经过期者。补中益气汤。月经先期者。加味逍遥散。肾水虚弱者。
六味地黄丸。肾虚风袭者。安肾丸、肾气丸参用。凡溃后当大补脾胃。若脓出反痛。或寒热烦渴
等证。皆属气血亏损。一于培补。庶保终吉。
喻嘉言曰。鹤膝风者。即风寒湿之痹于膝者也。如膝骨日大。上下肌肉日枯。且未可治其膝。先
养血气使肌肉渐荣。后治其膝可也。此与治偏枯之证。大同小异。急溉其未枯者。使气血流行而
复荣。倘不知此。但用麻黄、防风等散风之药。鲜有不全枯者。故治鹤膝风而急攻其痹。必并其
足痿而不用矣。古方治小儿鹤膝风。用六味地黄丸加鹿茸、牛膝。不治其风。其义是善。盖小儿
非必为风寒湿所痹。多因先天所禀肾气衰薄。阴寒凝聚于腰膝。故以六味丸补肾中之水。以鹿茸
补肾中之火。以牛膝引至骨节而壮其裹撷之筋。此治本不治标之良法也。
鹤膝风，是指小腿纤细而膝盖肿大的一种病症。《内经》说：“膝是筋的汇聚之处。”如果屈伸不利，行走时弯腰驼背，说明筋脉已经衰败了。治疗应当以祛风顺气、活血壮筋为主。可以使用十全大补汤加入杜仲、牛膝、羌活；或者使用五积散加入松节。如果是血虚寒凝导致疼痛的，用四物汤加入荆芥、牛膝，并送服活络丹。待气血流通后，再服用八味丸加入鹿茸、牛膝进行调理，正气旺盛则疾病自然消除。如果兼有风湿邪气的，使用换骨丹。如果在腹泻之后出现膝盖肿痛，这是风邪乘虚侵入三阴经所致，使用大防风汤。如果服药后效果不明显的，采用外用的雷火针法。每天施灸一次，不必损伤肌肉。方药组成：蕲艾五钱，丁香五分，麝香三分，混合研匀，装入纸筒中。在疼痛处垫上粗纸三五层，点燃后熏灼患处，以筋脉活动自如为度，数日后自见疗效。另外，鹤膝风初起时，漫肿而不发红，屈伸不便的，趁未溃破时，用陈年的芥菜子研成细粉，用姜汁、葱白汁和白蜜调和，涂抹在患处一个时辰（约两小时），患处起泡、脱皮后即可自愈。上述两种方法，如果脓液已经形成的，不可使用。
妇女患鹤膝风，是因为胎产或月经失调，或因郁怒导致肝脾亏损，从而受到外感邪气侵袭。起初表现为肢体筋脉拘挛，继而膝盖逐渐肿大，腿部逐渐变细，形状像鹤膝一样。如果肿胀高突、色红且疼痛的，容易治疗；如果漫肿、不红且不痛的，难以治疗。如果在二三个月内溃破且脓液稠厚的，容易治疗；如果在半年以后溃破且脓液清稀的，难以治疗。如果误用攻伐药物，再次损伤元气，就更为难治了。总之，治疗应以固护元气为主。如果食欲不振、身体疲倦的，使用六君子汤；如果有午后发热、内部发热、寒热往来的，使用逍遥散；如果有发热恶寒的，使用十全大补汤；如果睡眠少、易惊悸的，使用归脾汤；如果月经过期不来的，使用补中益气汤；如果月经提前的，使用加味逍遥散；如果肾水虚弱的，使用六味地黄丸；如果肾虚又受风邪侵袭的，安肾丸和肾气丸配合使用。凡是溃破之后，应当大力补益脾胃。如果脓液流出后反而疼痛，或者有寒热、烦躁口渴等症状，都属于气血亏损，应当专注于培补元气，这样才能保证最终痊愈。
喻嘉言说：鹤膝风，就是风寒湿邪痹阻于膝关节的疾病。如果膝盖骨头日益肿大，上下肌肉日益干枯，此时不可以直接治疗膝盖，而应当先养血气，使肌肉逐渐恢复荣润，然后再治疗膝盖。这与治疗偏枯（半身不遂）的证候大同小异。急于灌溉那些尚未干枯的部位，使气血流行从而恢复荣润。如果不知道这个道理，只使用麻黄、防风等疏散风邪的药物，很少有不被耗伤至完全干枯的。所以治疗鹤膝风如果急于攻逐痹阻，必然会导致足部痿废不能使用。古方治疗小儿鹤膝风，使用六味地黄丸加入鹿茸、牛膝，不直接治风，这种立意是很好的。因为小儿不一定都是被风寒湿邪痹阻，多是因为先天禀赋不足，肾气衰弱薄弱，阴寒凝聚在腰膝部位。所以用六味丸补肾中的真水，用鹿茸补肾中的真火，用牛膝引导药力到达骨节以强壮包裹支撑的筋脉。这是治本而非治标的良法。
He Xi Feng (Crane Knee Wind) refers to a condition characterized by thin calves and swollen knees. The *Classic of Acupuncture* states: "The knee is the mansion of sinews." If there is inability to flex and extend, and stooping while walking, it indicates that the sinews are exhausted. Treatment should focus on dispelling wind, regulating qi, invigorating blood, and strengthening sinews. One may use *Shiquan Dabu Tang* (Complete Great Tonifying Decoction) added with *Duzhong* (Eucommiae Cortex), *Niuxi* (Achyranthis Bidentatae Radix), and *Qianghuo* (Notopterygii Rhizoma et Radix); or *Wuji San* (Five Accumulations Powder) added with *Songjie* (Pinus Massoniana Node). For pain due to blood deficiency and cold deficiency, use *Siwu Tang* (Four Substances Decoction) added with *Jingjie* (Schizonepetae Spica) and *Niuxi*, administered together with *Huoluo Dan* (Meridian-Unblocking Pill). Once qi and blood flow smoothly, further administer *Bawei Wan* (Eight-Ingredient Pill) added with *Lurong* (Cervi Cornu Degelatinatum) and *Niuxi* for regulation; when righteous qi is robust, the disease will naturally resolve. If complicated by wind-dampness, use *Huangu Dan* (Bone-Changing Pill). If knee swelling and pain occur after diarrhea, it is because wind pathogen has invaded the Three Yin meridians due to deficiency; use *Da Fangfeng Tang* (Great Saposhnikovia Decoction). If oral medication yields no immediate effect, apply the external *Leihuo Zhen Fa* (Thunder-Fire Needle Method). Apply once daily without damaging the muscle tissue. The formula consists of 5 qian of Qiai (Artemisia argyi from Qichun), 5 fen of Dingxiang (Caryophylli Flos), and 3 fen of Shexiang (Moschus), ground uniformly and placed in a paper tube. Place three to five layers of coarse paper over the painful area, ignite the tube, and cauterize until sinew and vessel mobility is restored; efficacy appears within a few days. Additionally, for early-stage He Xi Feng presenting as diffuse swelling without redness and limited mobility, before ulceration occurs, grind aged Mustard Seed (Sinapis alba semen) into fine powder, mix with ginger juice, scallion white juice, and honey, and apply to the affected area for one shichen (two hours). Blistering and peeling skin will lead to self-healing. These two methods are contraindicated if pus has formed.
In women, He Xi Feng arises from irregularities in pregnancy, childbirth, or menstruation, or from liver-spleen damage due to depression and anger, leading to injury by external pathogens. Initially, limb sinew spasms occur, followed by gradual knee enlargement and leg thinning, resembling a crane's knee. Cases with high, red, and painful swelling are easy to treat; those with diffuse, non-red, non-painful swelling are difficult. Ulceration with thick pus within two to three months is easy to treat; ulceration with clear pus after half a year is difficult. Misuse of purgative therapies injuring primordial qi makes treatment even more difficult. Generally, securing primordial qi is paramount. For poor appetite and fatigue, use *Liujunzi Tang* (Six Gentlemen Decoction); for afternoon fever, internal heat, and alternating chills and fever, use *Xiaoyao San* (Free and Easy Wanderer Powder); for fever and aversion to cold, use *Shiquan Dabu Tang*; for insomnia and palpitations, use *Guipi Tang* (Spleen-Restoring Decoction); for delayed menstruation, use *Buzhong Yiqi Tang* (Middle-Warmer-Boosting Qi-Supplementing Decoction); for early menstruation, use *Jiawei Xiaoyao San* (Modified Free and Easy Wanderer Powder); for weak kidney water, use *Liusheng Dihuang Wan* (Six-Ingredient Rehmannia Pill); for kidney deficiency with wind invasion, use *Anshen Wan* (Kidney-Calming Pill) and *Shenqi Wan* (Kidney-Qi Pill) interchangeably. After ulceration, strongly tonify spleen and stomach. If pain persists despite pus discharge, or if symptoms such as chills, fever, irritability, and thirst appear, these indicate qi and blood deficiency; focus entirely on tonification to ensure ultimate recovery.
Yu Jiayan stated: He Xi Feng is essentially bi-syndrome (painful obstruction) of wind-cold-dampness at the knee. If the knee bone enlarges daily while upper and lower muscles waste away, do not treat the knee directly first; instead, nourish blood and qi to gradually restore muscle nutrition, then treat the knee. This is largely similar to treating pianku (hemiplegia/paralysis). Urgently irrigate the parts not yet wasted to restore qi-blood circulation and nutrition. Ignoring this and using only wind-dispersing herbs like Mahuang (Ephedrae Herba) and Fangfeng (Saposhnikoviae Radix) rarely fails to cause complete wasting. Thus, aggressively attacking the bi-obstruction in He Xi Feng will inevitably lead to foot痿废 (flaccidity/uselessness). Ancient formulas for pediatric He Xi Feng used *Liusheng Dihuang Wan* added with Lurong and Niuxi, focusing on not treating wind directly, which is a sound principle. Children’s cases are often not caused by wind-cold-damp bi, but rather by congenital kidney qi deficiency and thinness, with yin-cold condensing in the waist and knees. Therefore, Liusheng Dihuang Wan tonifies kidney water, Lurong tonifies kidney fire, and Niuxui guides the action to the joints to strengthen the surrounding sinews. This is an excellent method of treating the root rather than the branch.