凡肘膝肿痛，臂 细小者，名为鹤膝风，以其象鹤膝之形而名之也。或止以两膝肿大
，腿枯细，不能屈伸，俗又谓之鼓槌风，总不过风寒湿三气流注之为病也。然肿痛者，必
有邪滞，枯细者，必有血虚。凡治此者，必宜以养气滋血为主。有风者兼散其风，有寒湿者，
兼去其寒湿。若果由邪郁成热者，必宜滋阴清火，自无不愈。其有痢后而成者，又名痢后风
，此以泻痢亡阴，尤宜壮肾。凡寒胜者，宜三气饮、五积散，或大防风汤之类主之。湿胜者，
宜五苓散、理中汤之类主之。热胜者，宜保阴煎，大秦艽汤之类主之。若以阳气不足，而败及
四肢者，非右归丸、理阴煎及八味地黄丸之类不可。
立斋曰∶鹤膝风，乃调摄失宜，亏损足三阴经，风邪乘虚而入，以致肌肉日瘦，内热
减食，肢体挛痛，久则膝大而腿细，如鹤之膝，故尔名之。若伤于脾胃者，用补中益气汤为主。
若伤于肝肾者，六味地黄丸为主。若欲其作脓，或溃后者，十全大补汤为主。皆佐以大防风
汤。初起者，须用葱熨法，可以内消。若津涸口干，中气不足也，补中益气汤加五味子。头
晕头痛，阳气不升也，补中益气汤加蔓荆子。发热晡热，阴血虚弱也，用四物参、 、白术
。畏寒憎寒，阳气虚弱也，用十全大补汤。饮食少思，胸膈膨胀，脾胃虚痞也，用四君子汤
。面色痿黄，饮食少思，脾胃虚弱也，用六君子汤。脓水清稀，肌肉不生，气血俱虚也，用
八珍汤。热来复去，有时而动，无根虚火也，用十全大补汤。形瘦嗜卧，寝息发热，痰盛作
渴，小便频数，五脏虚损也，用六味丸。脐腹疼痛，夜多漩溺，脚膝无力，头晕吐痰，肾气
冷败也，用八味丸。发热大渴，不欲近衣，面目赤色，脉大而虚，血虚发燥，用当归补血汤
。或有痢后而患者，亦治以前法，余当临证制宜。
又曰∶夫立方之义，各有所宜。凡体气虚弱，邪入骨界，遏绝隧道，若非用附桂辛温之
药，开散关节腠理之寒邪，通畅隧道经络之气血，决不能愈。且《本草》云，附子治寒湿痿
，拘挛膝痛，不能行步，以白术佐之，为寒湿之圣药。又云，桂通血脉，消瘀血，坚骨节
，治风痹骨挛脚软，宣导诸药。及十全大补汤以治前证，不但不可去桂，亦不可不加附子，
无此二味，何以行参 之功，健芎归之性，而补助血气，使之宣通经络，扶大虚之证，以收
必效之功哉。况前证在骨节之间，关键之地，治之不速，使血气循环，至此郁而为脓，从此
而泄，气血沥尽，无可生之理矣。亦有秋夏露卧，为寒所袭， 热内作，遂成附骨疽。亦有
贼风搏于肢节，痛彻于骨，遇寒尤甚，以热熨之则少减，尤当以大防风汤治之，更以蒜捣烂
摊患处，用艾铺蒜上烧之，蒜坏再易，皮肤尚破无妨。若经久不消，则极阴生阳，溃而出水
，必致偏枯，或为漏证，宜服内塞散，及附子饼灸之。或脉大，或发渴者，俱不治，以其真
气虚而邪气实也。
张上舍，患前证，伏枕半载，流脓三月。彼云∶初服大防风汤去附子，将溃服十宣散，
今用十全大补汤而去肉桂，俱不应。视其脉证甚弱，予以十全大补汤，每帖加熟附子一钱，
服三十余剂少愈。乃去附子五分，又服三十余剂将愈。却全去附子，更三十余剂而痊。
一男子，左膝肿大，三月不溃。予谓体虚之人，风邪袭于骨节，使气滞而不行，故膝
愈大而腿愈细，名曰鹤膝风，遂以大防风汤，三十余剂而消。
州守张天泽，左膝肿痛，胸膈痞闷，饮食少思，时欲作呕，头晕痰壅，日晡益倦，此脾
肺气虚也。用葱熨，及六君加炮姜，诸证顿退，饮食少进。用补中益气加蔓荆子，头目清
爽。间与大防风汤十余剂，又用补中益气汤，三十余剂而消。（薛按）
凡是肘部和膝盖出现肿痛，而手臂或腿部却细小的人，这种病称为鹤膝风，是因为它的形状像鹤的膝盖而得名。有的仅仅表现为双膝肿大，小腿枯细，不能屈伸活动，民间又称之为鼓槌风，这总归是风寒湿三种邪气流注经络所导致的疾病。然而，出现肿痛的情况，必定有邪气滞留；出现枯细的情况，必定是血虚所致。凡治疗此病，必须以补气养血为主要原则。如果有风邪，兼用散风的方法；如果有寒湿，兼用祛除寒湿的方法。如果确实是由邪气郁结化热引起的，必须采用滋阴降火的方法，自然没有不痊愈的。如果是痢疾之后引发的，又叫做痢后风，这是因为泻痢导致阴液亡失，尤其应当补肾壮阳。凡是寒邪偏盛的，适宜使用三气饮、五积散，或者大防风汤之类的方剂主治。湿邪偏盛的，适宜使用五苓散、理中汤之类的方剂主治。热邪偏盛的，适宜使用保阴煎、大秦艽汤之类的方剂主治。如果是由于阳气不足，进而败坏波及四肢的，非用右归丸、理阴煎及八味地黄丸之类的方剂不可。
薛立斋说：鹤膝风，是由于调养摄生不当，亏损了足三阴经（肝、脾、肾），风邪乘虚而入，导致肌肉日渐消瘦，内热且食欲减退，肢体拘挛疼痛，时间久了则膝盖肿大而小腿细瘦，像鹤的膝盖一样，所以这样命名它。如果是损伤脾胃的，以补中益气汤为主治方。如果是损伤肝肾的，以六味地黄丸为主治方。如果想要促使脓液形成，或者溃破之后的，以十全大补汤为主治方。这些都要配合大防风汤使用。初起阶段，必须使用葱熨法，可以使内部消散。如果津液枯竭口干，是中气不足，用补中益气汤加五味子。头晕头痛，是阳气不升，用补中益气汤加蔓荆子。发热或傍晚发热，是阴血虚弱，用四物汤加入人参、黄芪、白术。畏寒憎冷，是阳气虚弱，用十全大补汤。饮食减少思虑，胸膈膨胀，是脾胃虚痞，用四君子汤。面色萎黄，饮食减少思虑，是脾胃虚弱，用六君子汤。脓水清稀，肌肉不生，是气血俱虚，用八珍汤。热势来去无常，有时发作，是无根虚火，用十全大补汤。形体消瘦嗜睡，睡眠呼吸发热，痰多口渴，小便频数，是五脏虚损，用六味地黄丸。脐腹疼痛，夜间多尿，脚膝无力，头晕吐痰，是肾气冷败，用八味地黄丸。发热大渴，不想穿衣，面目红色，脉大而虚，是血虚发燥，用当归补血汤。或者有痢疾之后患病的，也以前面所述方法治疗，其余情况应当根据临床实际灵活变通。
又说：创立方剂的意义，各有其适宜的用途。凡是体质虚弱，邪气侵入骨界，阻塞隧道，如果不是使用附子、肉桂等辛温的药物，来开散关节腠理的寒邪，通畅隧道经络的气血，决不能痊愈。而且《本草》记载，附子治疗寒湿痿痹、拘挛膝痛、不能行走，以白术辅助它，是治疗寒湿的圣药。又说，肉桂通行血脉，消除瘀血，坚固骨节，治疗风痹骨挛脚软，宣导各种药物。以及用十全大补汤治疗上述病症，不但不能去掉肉桂，也不能不加附子，没有这两味药，怎么能发挥人参、黄芪的功效，增强川芎、当归的药性，从而补助血气，使它们宣通经络，扶持极度虚弱的证候，以收到必然有效的功效呢？况且上述病症在骨节之间，关键之地，治疗如果不迅速，使气血循环到这里郁结化为脓液，从此流出，气血沥尽，就没有再生的道理了。也有在秋夏露宿，被寒气侵袭，热气在内发作，遂成附骨疽的。也有贼风搏结于肢节，疼痛彻骨，遇寒更严重，用热敷则稍微减轻，尤其应当用大防风汤治疗，再用大蒜捣烂敷在患处，用艾绒铺在蒜上烧灼，蒜坏了再换新的，皮肤即使破损也无妨。如果经久不消退，则极阴生阳，溃破流水，必定导致偏瘫，或者成为漏证，适宜服用内塞散，并用附子饼灸之。如果脉象大，或者发渴的，都属于不治之症，因为真气虚而邪气实。
张舍人，患有前文所述的病症，卧床半年，流脓三个月。他说：起初服用大防风汤去掉了附子，快要溃破时服用十宣散，现在用十全大补汤去掉了肉桂，都不见效。查看他的脉证非常虚弱，我给予十全大补汤，每帖加入熟附子一钱，服用三十多剂后稍微好转。于是去掉五分附子，又服用三十多剂快要痊愈。后来完全去掉附子，再服用三十多剂而痊愈。
一个男子，左膝肿大，三个月未溃破。我认为这是体质虚弱之人，风邪侵袭骨节，使气滞而不运行，所以膝盖越来越大而小腿越来越细，名叫鹤膝风，于是用大防风汤，三十多剂后消散。
州守张天泽，左膝肿痛，胸膈痞闷，饮食减少思虑，时常想要呕吐，头晕痰壅，傍晚更加疲倦，这是脾肺气虚。使用葱熨法，以及六君子汤加炮姜，各种症状顿时减退，饮食稍微增加。使用补中益气汤加蔓荆子，头目清爽。间或服用大防风汤十余剂，又用补中益气汤，三十多剂后消散。（薛己按语）
Whenever there is swelling and pain in the elbows and knees, while the arms or legs are thin, this condition is called He Xi Feng (Crane's Knee Wind), named for its resemblance to a crane's knee. In some cases, only both knees are swollen with withered and thin calves, unable to flex or extend, commonly known as Gu Chui Feng (Drumstick Wind). This is generally caused by the flow and accumulation of Wind, Cold, and Dampness pathogens. However, swelling and pain indicate the presence of pathogenic stagnation, while withering and thinness indicate Blood deficiency. Treatment must primarily focus on nourishing Qi and Blood. If Wind is present, disperse it concurrently; if Cold and Dampness are present, dispel them concurrently. If heat arises from pathogenic constraint, nourish Yin and clear Fire, ensuring recovery. If it occurs after dysentery, it is called Li Hou Feng (Post-Dysentery Wind); since diarrhea and dysentery cause loss of Yin, tonifying the Kidney is especially appropriate. For predominance of Cold, San Qi Yin (Three Qi Decoction), Wu Ji San (Five Accumulations Powder), or Da Fang Feng Tang (Great Saposhnikovia Decoction) are suitable. For predominance of Dampness, Wu Ling San (Five Ingredient Powder with Poria) or Li Zhong Tang (Regulate the Middle Decoction) are suitable. For predominance of Heat, Bao Yin Jian (Preserve the Yin Decoction) or Da Qin Jiao Tang (Major Gentian Decoction) are suitable. If Yang Qi insufficiency leads to deterioration affecting the four limbs, formulas such as You Gui Wan (Right Restoration Pill), Li Yin Jian (Regulate Yin Decoction), or Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill) are indispensable.
Xue Lizhai stated: He Xi Feng results from improper lifestyle management, leading to depletion of the Foot Three Yin Meridians (Liver, Spleen, Kidney), allowing Wind pathogens to enter due to deficiency. This causes muscles to waste away daily, internal heat, reduced appetite, and limb spasms and pain. Over time, the knees enlarge while the calves become thin, resembling a crane's knee. If the Spleen and Stomach are damaged, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is primary. If the Liver and Kidneys are damaged, Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) is primary. To promote suppuration or treat post-ulceration, Shi Quan Da Bu Tang (Complete Great Tonifying Decoction) is primary, assisted by Da Fang Feng Tang. In the early stage, Cong Yun Fa (Scallion Moxibustion/Fomentation) can resolve it internally. If fluids are dry and the mouth is parched due to insufficient Middle Qi, add Wu Wei Zi (Schisandra Fruit) to Bu Zhong Yi Qi Tang. For dizziness and headache due to failing rising of Yang Qi, add Man Jing Zi (Vitex Fruit). For fever or afternoon tidal fever due to Yin-Blood deficiency, use Si Wu Tang (Four Substance Decoction) added with Ren Shen (Ginseng Root), Huang Qi (Astragalus Root), and Bai Zhu (Atractylodes Rhizome). For aversion to cold due to Yang Qi deficiency, use Shi Quan Da Bu Tang. For poor appetite and chest/epigastric distension due to Spleen-Stomach deficiency obstruction, use Si Jun Zi Tang (Four Gentlemen Decoction). For sallow complexion and poor appetite due to Spleen-Stomach weakness, use Liu Jun Zi Tang (Six Gentlemen Decoction). For thin pus and lack of muscle regeneration due to dual Qi-Blood deficiency, use Ba Zhen Tang (Eight Treasure Decoction). For intermittent fever without root due to deficient fire, use Shi Quan Da Bu Tang. For emaciation, lethargy, nocturnal fever during sleep, profuse phlegm, thirst, and frequent urination due to five-zang deficiency, use Liu Wei Wan (Six-Ingredient Pill). For umbilical/abdominal pain, nocturia, weak legs/knees, dizziness, and vomiting phlegm due to cold failure of Kidney Qi, use Ba Wei Wan (Eight-Ingredient Pill). For high fever, extreme thirst, desire to remove clothing, red face, and large-deficient pulse due to Blood deficiency causing dryness, use Dang Gui Bu Xue Tang (Angelica Tonifying Blood Decoction). Cases following dysentery should be treated similarly, adjusting according to clinical presentation.
Furthermore, each formula has specific indications. For weak constitutions where pathogens invade bone boundaries and block meridians, non-acrid-warm herbs like Fu Zi (Aconite Lateral Root) and Rou Gui (Cinnamon Bark) are required to disperse Cold in joints and cuticles, and unblock Qi-Blood in meridians; otherwise, recovery is impossible. The Materia Medica states that Fu Zi treats Cold-Damp flaccidity, spasmodic knee pain, and inability to walk; aided by Bai Zhu (Atractylodes Macrocephala Rhizome), it is a holy medicine for Cold-Damp. It also states that Rou Gui promotes blood vessels, resolves stasis, strengthens bones/joints, treats Wind-Bi, bone spasms, and soft legs, and guides other herbs. When using Shi Quan Da Bu Tang for these conditions, one must not omit Rou Gui nor add less than Fu Zi. Without these two, how can the efficacy of Ren Shen and Huang Qi be mobilized, or the nature of Xiong Gui (Ligusticum Chuanxiong Rhizome) and Dang Gui (Angelica Sinensis Root) be strengthened, to assist Qi-Blood, unblock meridians, support severe deficiency, and achieve certain efficacy? Since these conditions occur at critical joint points, delayed treatment allows Qi-Blood stagnation to turn into pus and drain away, exhausting Qi-Blood with no hope of recovery. Some cases arise from sleeping exposed in autumn/summer, where Cold attacks and internal Heat generates, forming Gu Ju (Bone Abscess). Others involve "Thief Wind" clashing with limbs, causing deep bone pain worsening with Cold, relieved slightly by heat fomentation; these require Da Fang Feng Tang, applied with mashed garlic on the lesion, covered with moxa and burned; replace garlic when burnt, even if skin breaks. If unresolved long-term, extreme Yin generating Yang leads to ulceration and discharge, potentially causing hemiplegia or fistulas; treat with Nei Sai San (Internal Blocking Powder) and moxibustion with Fu Zi cakes. Cases with large pulses or thirst are untreatable due to true Qi deficiency and pathogenic excess.
Mr. Zhang suffered from this condition, bedridden for half a year, draining pus for three months. He reported initial use of Da Fang Feng Tang without Fu Zi, then Shi Xuan San (Ten Provisions Powder) before ulceration, and now Shi Quan Da Bu Tang without Rou Gui, all ineffective. Observing weak pulse and symptoms, I prescribed Shi Quan Da Bu Tang with 1 qian of Shu Fu Zi (Prepared Aconite Lateral Root) per dose. After over 30 doses, slight improvement occurred. Fu Zi was reduced by 5 fen, continued for another 30 doses until near cure. Finally, Fu Zi was removed entirely, and after another 30 doses, full recovery was achieved.
A man had left knee swelling for three months without ulceration. I reasoned that in a weak constitution, Wind pathogens invaded bone joints, causing Qi stagnation, leading to enlarging knees and thinning calves, named He Xi Feng. I prescribed Da Fang Feng Tang, which resolved the swelling after over 30 doses.
Prefect Zhang Tianze had left knee swelling/pain, chest/epigastric oppression, poor appetite, nausea, dizziness, phlegm obstruction, and worsening fatigue in the afternoon, indicating Spleen-Lung Qi deficiency. I used scallion fomentation and Liu Jun Zi Tang plus Pao Jiang (Roasted Ginger), rapidly reducing symptoms and improving appetite. Then, Bu Zhong Yi Qi Tang plus Man Jing Zi cleared the head and eyes. Intermittently, Da Fang Feng Tang for over 10 doses, followed by Bu Zhong Yi Qi Tang for over 30 doses, resolved the condition. (Note by Xue Ji)