胫细而膝肿是也。为风寒湿三气。合痹于膝而成。初起。发热头痛。宜五积散。痢后变
成者亦宜之。若久病。为足三阴虚。宜十全大补汤。加附子牛膝杜仲防风羌活主之。又治初
起外法。用陈年白芥子研末。以姜汁葱汁调涂一伏时。患处起泡。泡干脱皮。自愈。
五积散。（四十二）十全大补汤。（十一）
又按。鹤膝风多是虚寒。香港脚多是湿热。一攻一补。治法各判。然香港脚有肾虚气喘小腹
痹者。肾气丸必不可缓。鹤膝风有赤热 肿者。二妙散桂枝芍药知母汤。亦所必需。此活法
也。
脚之肿大是也。东垣云。南方卑湿。其湿从外以袭入。北方常食膻乳。又饮酒太过。脾
胃有伤。不能运化。其湿从中以流下。初起发热恶寒。似伤寒症。若上气喘急。及上少腹不
仁。恐致攻心不救。若患久不治。即成痼矣。此症名壅疾。不可骤补。
一香港脚肿痛不可忍。宜
鸡鸣散。（一百零八）
香港脚气喘。少腹不仁。须防其入心。宜后方。香港脚服鸡鸣散愈后。亦宜之。用桂附地黄
丸。（十五）一两胫大。为湿香港脚。两胫不肿。或顽麻。或挛急。或缓纵。名干香港脚。宜
四物汤。加牛膝独活苍术黄柏木瓜泽泻肉桂之类。（九）
积者。五脏所生。推之不移。属阴。聚者。六腑所成。推之则移。属阳。当辨其新久虚
实而施治。内经云。大积大聚。不可犯也。衰其大半而止。过则死。此治积聚之法也。
脉宜沉实。 忌虚弱。
一积聚新病。审其可用发散者。宜用
五积散。（四十二）
一积聚新病。审其可用消导攻下者。宜用
备急丸。（五十三）
平胃散。加入 蓄瞿麦炒大麦芽川芎。以上八味。各用五钱。沉香木香各一钱五
分。大黄酒浸二两。共为细末。每服三钱。姜汤送下。忌油腻动气之物。及房事一月。药须
黄昏服。勿食晚饭。大小便见恶物为度。（八十）肝之积在左胁下。名曰肥气。去苍术。加
柴
胡鳖甲青皮莪术。○肺之积在右胁下。名曰息贲。加白豆蔻桑白皮郁金。○心之积起脐上。
上至心。下大如臂。名曰伏梁。去苍术。加肉桂黄连石菖蒲莪术。○脾之积在胃脘。腹大如
盘。名曰痞气。原方不加减。○肾之积在脐下。发于小腹。上冲心而痛。名曰奔豚。上方去
苍术大黄陈皮麦芽 蓄。加茯苓四两。肉桂附子当归吴茱萸各五钱。川楝子李根白皮膈一两。
淡盐汤送下。或炼蜜为小丸。吞下四钱更佳。○凡热积。加黄连黄芩。寒积。加姜桂附子。
酒积。加葛根。痰积。加半夏。水积。加桑白皮赤小豆。血积。加桃仁红花。肉积。加阿魏
山楂。果积。加麝香草果。
一久病及虚弱之人。不可径用前药。或先服补药。然后攻之。或攻药去病之半。而即补
之。或服攻药三日。服补药一日。神而明之。存乎其人。若愈后。必以补药收功。宜
六君子汤。（二）
香砂六君子汤。（三）
附子理中汤。（一百零七）
以上三方。唯脐下动气。去白术。加肉桂一钱五分。
服攻药。大下积血。自汗不止。气弱不能转动者。宜急进
参附汤。若贫者。以当归补血汤。加附子三钱代之。（一百零五）
这是指小腿纤细而膝盖肿胀的症状。这是由于风、寒、湿三种邪气，合而为痹，阻滞于膝关节所致。疾病初起时，出现发热、头痛，适宜使用五积散（Wuji San, Five Accumulations Powder）。因痢疾后转化而成的此类病症，也适宜使用此方。若是久病，属于足三阴经（肝、脾、肾）虚损，适宜使用十全大补汤（Shiquan Dabu Tang, Ten-Ingredient Great Tonifying Decoction），并加入附子（Aconite）、牛膝（Achyrathes Root）、杜仲（Eucommia Bark）、防风（Saposhnikovia Root）、羌活（Notopterygium Rhizome）来主治。另外治疗初起的外治法：取陈年的白芥子研成粉末，用姜汁和葱汁调和后涂抹患处，持续一个时辰（约两小时）。患处起泡，待泡干脱皮后，即可自愈。
又按语：鹤膝风多属虚寒证，香港脚（脚气病）多属湿热证。一为攻邪，一为补虚，治疗方法截然不同。然而，若香港脚患者伴有肾虚气喘、小腹部痹痛者，肾气丸（Shenqi Wan, Kidney Qi Pill）不可不用；若鹤膝风患者出现红肿热痛者，二妙散（Ermiao San, Two Marvels Powder）配合桂枝芍药知母汤（Guizhi Shaoyao Zhimu Tang, Cinnamon Twig, Peony and Anemarrhena Decoction）也是必需的。这是灵活变通的治疗方法。
这是指脚部肿大症状。李东垣说：南方地势低洼潮湿，湿气从外部侵袭人体；北方人常食用膻腥乳酪，加之饮酒过度，损伤脾胃，导致不能运化水湿，湿气从中焦产生并向下行注。疾病初起时，出现发热、恶寒，类似伤寒症状。若出现上气喘急，以及小腹感觉迟钝或麻木，恐怕会导致邪气攻心而无法救治。如果患病日久不治疗，就会成为顽固难愈的疾病。此症名为“壅疾”，不可骤然进补。
有一例香港脚肿痛剧烈难以忍受的病例，适宜使用鸡鸣散（Jiming San, Rooster Crow Powder）。（第一百零八条）
若香港脚患者出现气喘、小腹感觉迟钝，须防止病邪入心，适宜使用后方（指下文提到的方剂）。香港脚患者服用鸡鸣散痊愈后，也适宜使用此方。使用桂附地黄丸（Guifu Dihuang Wan, Cinnamon and Aconite Rehmannia Pill）。（第十五条）
一侧小腿粗大，属于湿性香港脚；双侧小腿不肿，但出现顽麻、拘挛紧急或弛缓无力，称为干性香港脚。适宜使用四物汤（Siwu Tang, Four Substance Decoction），加入牛膝、独活、苍术、黄柏、木瓜、泽泻、肉桂等药物。（第九条）
积聚类疾病中，“积”是由五脏产生的，推之不移位，属阴；“聚”是由六腑形成的，推之可移动，属阳。应当辨别病的新久、虚实来进行治疗。《内经》说：对于巨大的积聚，不可轻易攻伐，当病势衰退大半时就应停止，过度攻伐会导致死亡。这就是治疗积聚的原则。脉象宜沉实，忌见虚弱脉象。
对于新发的积聚病，审查其可以使用发散法的，适宜使用五积散。（第四十二条）
对于新发的积聚病，审查其可以使用消导攻下法的，适宜使用备急丸（Beiji Wan, Emergency Rescue Pill）。（第五十三条）
平胃散（Pingwei San, Calm the Stomach Powder），加入萹蓄、瞿麦、炒大麦芽、川芎。以上八味药，各用五钱，沉香、木香各一钱五分，大黄用酒浸渍二两，共研为细末。每次服用三钱，用姜汤送服。忌食油腻及易引起气滞的食物，并禁房事一个月。药物须在黄昏时服用，不要进食晚饭。以大小便排出污秽之物为度。（第八十条）
肝脏的积块位于左胁下，名为肥气，在原方基础上去掉苍术，加入柴胡、鳖甲、青皮、莪术。○肺脏的积块位于右胁下，名为息贲，加入白豆蔻、桑白皮、郁金。○心脏的积块起于脐上，向上延伸至心口，下部宽大如手臂，名为伏梁，去掉苍术，加入肉桂、黄连、石菖蒲、莪术。○脾脏的积块位于胃脘部，腹部胀大如盘，名为痞气，原方不加减。○肾脏的积块位于脐下，发作于小腹，气上冲至心口且疼痛，名为奔豚，上方去掉苍术、大黄、陈皮、麦芽、萹蓄，加入茯苓四两，肉桂、附子、当归、吴茱萸各五钱，川楝子、李根白皮各一两，用淡盐汤送服。或者炼蜜制成小丸吞服，每次四钱效果更佳。○凡是热性积块，加入黄连、黄芩；寒性积块，加入干姜、肉桂、附子；酒积，加入葛根；痰积，加入半夏；水积，加入桑白皮、赤小豆；血积，加入桃仁、红花；肉积，加入阿魏、山楂；果积，加入麝香、草果。
对于久病及身体虚弱的人，不可直接使用上述攻伐药物。可以先服用补益药物，然后再行攻伐；或者在使用攻伐药物去除一半病邪后立即转为补益；或者服用攻伐药物三天后，服用一天补益药物。其中的神妙变化，取决于医生的判断。若病情好转后，必须以补益药物来巩固疗效，适宜使用六君子汤（Liujunzi Tang, Six Gentlemen Decoction）。（第二条）
香砂六君子汤（Xiangsha Liujunzi Tang, Magnolia Bark and Amomum Six Gentlemen Decoction）。（第三条）
附子理中汤（Fuzi Lizhong Tang, Aconite Regulate the Middle Decoction）。（第一百零七条）
以上三个方剂，若患者脐下有动气感，需去掉白术，加入肉桂一钱五分。
若服用攻伐药物后，大量排出积血，自汗不止，气弱无法转动身体者，适宜急进参附汤（Shenfu Tang, Ginseng and Aconite Decoction）。若患者贫穷，可用当归补血汤（Danggui Buxue Tang, Angelica Tonify Blood Decoction）加入三钱附子来替代。（第一百零五条）
This refers to the symptom of a slender lower leg with swollen knees. It is caused by the combination of wind, cold, and dampness pathogens forming Bi syndrome (obstruction syndrome) in the knee joint. In the early stage, presenting with fever and headache, Wuji San (Coptis and Pinellia Powder) is indicated. This formula is also suitable for cases arising after dysentery. For chronic conditions involving deficiency of the three Yin meridians of the foot (Liver, Spleen, Kidney), Shiquan Dabu Tang (Ten-Ingredient Great Tonifying Decoction) should be used, modified with Aconite (Radix Aconiti Lateralis Preparata), Achyrathes Root (Radix Achyranthis Bidentatae), Eucommia Bark (Cortex Eucommiae), Saposhnikovia Root (Radix Saposhnikoviae), and Notopterygium Rhizome (Rhizoma Notopterygii). Additionally, an external treatment for the early stage involves grinding aged white mustard seed (Sinapis alba seed) into powder, mixing it with ginger juice and scallion juice, and applying it to the affected area for one *shi* (approx. two hours). Blistering will occur; once the blisters dry and the skin peels off, spontaneous recovery ensues.
Wuji San. (Article 42) Shiquan Dabu Tang. (Article 11)
Further Note: He Xi Feng (Crane Knee Wind, resembling rheumatoid arthritis with knee swelling) is mostly due to deficiency-cold, whereas Hong Kong Jiao (Foot Qi / Beriberi) is mostly due to damp-heat. One requires attacking the pathogen, the other tonification; their treatments are distinct. However, if Foot Qi presents with Kidney deficiency, wheezing, and Bi pain in the lower abdomen, Shenqi Wan (Kidney Qi Pill) is indispensable. If Crane Knee Wind presents with redness, heat, and swelling, Ermiao San (Two Marvels Powder) combined with Guizhi Shaoyao Zhimu Tang (Cinnamon Twig, Peony and Anemarrhena Decoction) is also necessary. This illustrates flexible application of methods.
This refers to the symptom of swelling in the feet. Li Dongyuan stated: In the south, where the land is low and damp, dampness invades from the exterior; in the north, where people often consume mutton and dairy, and drink excessively, the Spleen and Stomach are damaged and fail to transform fluids, causing dampness to generate internally and flow downward. In the early stage, presenting with fever and aversion to cold, it resembles Cold Damage (Shanghan) syndrome. If accompanied by upper body wheezing and urgency, or insensitivity in the lower abdomen, one must fear that the pathogen may attack the Heart, leading to untreatable conditions. If left untreated for a long time, it becomes a stubborn disease. This condition is named Yong Ji (Obstructive Disease) and should not be treated with sudden tonification.
In a case of severe, unbearable pain and swelling due to Foot Qi, Jiming San (Rooster Crow Powder) is indicated. (Article 108)
If Foot Qi presents with wheezing and insensitivity in the lower abdomen, preventing the pathogen from entering the Heart is crucial; the following formula is indicated. After recovery from Foot Qi using Jiming San, this formula is also appropriate. Use Guifu Dihuang Wan (Cinnamon and Aconite Rehmannia Pill). (Article 15)
Swelling in one lower leg indicates Damp Foot Qi. If both lower legs are not swollen but present with numbness, spasms, cramping, or flaccidity, it is called Dry Foot Qi. Siwu Tang (Four Substance Decoction) is indicated, modified with Achyrathes Root, Notopterygium Rhizome, Atractylodes Macrocephala Rhizome, Phellodendron Bark, Chaenomelis Fructus, Alisma Rhizome, and Cinnamon Bark. (Article 9)
Regarding accumulation disorders: "Ji" (Mass) arises from the Zang organs, is fixed and immovable, and belongs to Yin. "Ju" (Gathering) arises from the Fu organs, is movable upon palpation, and belongs to Yang. Treatment must distinguish between new/chronic onset and deficiency/excess. The *Neijing* states: For large accumulations, do not attack aggressively; stop when the pathogen has declined by more than half. Over-attacking leads to death. This is the principle for treating accumulations. The pulse should be deep and solid; a weak pulse is contraindicated.
For newly acquired accumulation disorders, if dispersion is deemed appropriate, Wuji San is indicated. (Article 42)
For newly acquired accumulation disorders, if purgative and resolving methods are deemed appropriate, Beiji Wan (Emergency Rescue Pill) is indicated. (Article 53)
Pingwei San (Calm the Stomach Powder), modified with Polygonum Aviculare Herb, Smartweed Herb, Stir-fried Barley Sprout, and Ligusticum Chuanxiong Rhizome. The above eight herbs are each used at 5 qian. Agarwood Wood and Costus Root are each used at 1.5 qian. Rhubarb is soaked in wine, 2 liang. All are ground into fine powder. Take 3 qian per dose, washed down with ginger decoction. Avoid greasy foods and foods that cause Qi stagnation, and abstain from sexual intercourse for one month. Take the medicine at dusk, without eating dinner. Continue until foul matter is expelled via stool or urine. (Article 80)
The Liver's mass is located under the left hypochondrium, named Fei Qi (Fat Qi). Remove Atractylodes Macrocephala Rhizome, add Bupleurum Root, Turtle Shell, Green Tangerine Peel, and Curcuma Longa Rhizome. ○ The Lung's mass is located under the right hypochondrium, named Xi Ben (Breathing Accumulation). Add White Cardamom Seed, Mulberry Root Bark, and Turmeric Tuber. ○ The Heart's mass starts above the umbilicus, extends up to the heart, and is wide as an arm below, named Fu Liang (Hidden Beam). Remove Atractylodes Macrocephala Rhizome, add Cinnamon Bark, Coptis Rhizome, Acorus Rhizome, and Curcuma Longa Rhizome. ○ The Spleen's mass is in the epigastrium, with the abdomen enlarged like a plate, named Pi Qi (Stagnant Qi). Do not modify the original formula. ○ The Kidney's mass is below the umbilicus, originating in the lower abdomen, rushing up to the heart with pain, named Ben Tun (Running Piglet). Remove from the above formula: Atractylodes Macrocephala Rhizome, Rhubarb, Dried Tangerine Peel, Barley Sprout, and Polygonum Aviculare Herb. Add Alisma Rhizome (4 liang), Cinnamon Bark, Aconite, Angelica Sinensis Radix, and Evodia Fruit (each 5 qian), Toosendan Fruit, and Chinese Privet Root Bark (each 1 liang). Wash down with light salt water. Alternatively, refine honey to make small pills and swallow; taking 4 qian per dose is better. ○ For Heat accumulations, add Coptis Rhizome and Scutellaria Root. For Cold accumulations, add Dried Ginger, Cinnamon Bark, and Aconite. For Wine accumulations, add Kudzu Root. For Phlegm accumulations, add Pinellia Tuber. For Water accumulations, add Mulberry Root Bark and Adzuki Bean. For Blood accumulations, add Peach Kernel and Safflower. For Meat accumulations, add Asafetida and Hawthorn Fruit. For Fruit accumulations, add Musk and Tsaoko Cardamom Fruit.
For chronic diseases and weak individuals, do not directly use the aforementioned attacking medicines. One may first administer tonifying medicines before attacking, or switch to tonification immediately after the attacking medicine has eliminated half of the pathology, or take attacking medicine for three days followed by tonifying medicine for one day. The subtle application depends on the practitioner. Upon recovery, tonifying medicines must be used to consolidate the result. Liujunzi Tang (Six Gentlemen Decoction) is indicated. (Article 2)
Xiangsha Liujunzi Tang (Magnolia Bark and Amomum Six Gentlemen Decoction). (Article 3)
Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction). (Article 107)
For the above three formulas, if there is pulsating Qi below the umbilicus, remove Atractylodes Macrocephala Rhizome and add Cinnamon Bark (1.5 qian).
If, after taking attacking medicines, there is massive expulsion of accumulated blood, continuous spontaneous sweating, and weakness preventing movement, Shenfu Tang (Ginseng and Aconite Decoction) should be administered urgently. For poor patients, Danggui Buxue Tang (Angelica Tonify Blood Decoction) with 3 qian of Aconite can be used as a substitute. (Article 105)