\r鹤膝风\p04-a41a187.bmp\r
王肯堂曰∶两膝肿痛,股渐小,曰鹤膝风,一名鼓槌风。起于中湿,或因痢后
脚弱缓,痛不能行履,名曰痢风。或伤寒余毒,不能发散,风寒湿气结于经络,血
脉不流以致筋愈缩而股愈细,属足少阳、足阳明经。(《准绳》)
又曰∶膝上肿痛,此非一端,须要辨明,若两膝内外皆肿,痛如虎咬之状,寒
热间作,股渐细小,膝愈肿大,名鹤膝风。急宜隔蒜灸,服大防风汤倍加乳香以住痛
舒筋。但一膝痛引上下,不甚肿而微红,名膝游风。膝之两旁肿痛,憎寒壮热,昼夜
偏剧,肿处手不可近,为膝眼毒。膝盖上肿痛者,为膝痈。(《准绳》)
又曰∶膝内 近折纹之处,结核肿痛,但核形长如鱼之状,名上水鱼。
陈实功曰∶鹤膝风乃三阴亏损不足之证,上下腿细,惟膝眼肿大,状如仙鹤膝
行。初起寒热交作,亦宜汗解,如汗后肿痛仍不见消,此阴寒深伏,以大防风汤温
暖经络,重者兼灸膝眼二穴,敷以琥珀膏,亦可渐渐收功。如以上诸法治之不效,终
成痼疾,不必勉强消之,只宜先天大造丸、史国公药酒常常服之,或可转重就轻,移
步行履,尚可图也。(《正宗》)
岐天师曰∶此乃因湿而战,立而行房,水气袭衣,故成此疾。(《秘录》)
李子永曰∶鹤膝风,古人多用大防风汤,内气血药并用,以病在下焦阴分故也。
如岐天师除去血药,想用宜于初起之时,如病久古方恐不可废。
冯鲁瞻曰∶膝间肿痛不消,防成鹤膝风,以膝肿如鹤足胫细,脉多弦紧是也。乃
三阴经虚寒湿流注为患,人多误为湿热,乃至脓成,气血大亏,已不可救矣。不知此
证与附骨疽俱肾虚者多患之。因真气衰弱,邪气得以深袭,前人用附子者,以温补肾
经,又能行药势散寒邪也。故体虚之人,为冷气所袭,经久不消,极阴生阳,寒化为
热而溃也。若误用寒凉,必成废疾,或挛曲偏枯,或痿弱不起,或坚硬如石为石疽,
或日久始溃,皮肉俱腐为缓疽,下部道远,非桂附不能下达也,况肾主骨,而臀以下
俱属肾,非桂附不能入其经而宣行也。(《锦囊》)
《可法良规》云∶鼓槌鹤膝起于中湿,盖足膝属肝,肝有风寒湿气,则血脉阻滞
不能流行,注膝成病,下股之血脉有去而无返,是以愈瘦愈冷而筋愈缩,上腿之血
脉有积而无散,是以愈肿愈热而肌愈削,其源若起于流注,则肉凝者必烂,烂则冷毒
腐骨,腐骨一出,神仙无术,遂成难治废疾。当皮肤未破之时,则肌肉尚未死,急
以玉龙膏热酒调敷膝之上腿,回接阳气以住骨痛,又以冲和膏敷上腿冷处,引其气
血,使流动而下通贯血脉。又以玉龙膏敷
骨胶处,以接引所引之血脉,以驱散所积之阴气,内服追风丸倍加乳没,则无有不愈者矣。
又云∶一切湿痰湿热,或死血凝滞等证,患在关节,流注不行,非用辛温开发
腠理,流通隧道,使气行血和,焉能得效。人畏附子有毒,多不肯服,若用童便炮制,
何毒之有,况中病即已,又不常服,何足为虑。经曰∶有是病用是药者此也。故大
防风汤、活络丹,治香港脚、鹤膝风证多效。
张真人曰∶此病乃立而行房,风湿侵于两膝,故成此疾。然治法绝不治肾,止
治气而自愈,亦不必治风湿也。(《良方补遗》)
《心法》曰∶鹤膝风一名游膝风,又名鼓槌风。痢后得者为痢风。单生者轻,双
生者最重,溃后如出白浆,浮皮肿痛仍前,不可用蚀药,只宜用芙蓉叶、菊花叶各五
钱研末,大麦米饮拌匀贴之,亦可止痛,或豆腐渣蒸热捏作饼,贴之亦可,此证系外证中之败证,收功甚难。
王肯堂说:两膝肿胀疼痛,大腿逐渐变细,称为鹤膝风,又名鼓槌风。此病起于体内湿气过重,或因痢疾后导致腿部软弱无力、行动不便,这种情形被称为痢风。或者是伤寒病的余毒未能发散,风寒湿邪结聚在经络中,导致血脉运行不畅,致使筋脉收缩而大腿更加纤细,这属于足少阳经和足阳明经的病变。(《医学准绳六要》)
又说:膝盖上方出现肿痛,原因不止一种,必须仔细辨别。如果两膝内外都肿胀,疼痛像被老虎咬一样,寒热交替发作,大腿逐渐变细,膝盖却越发肿大,这叫鹤膝风。应当紧急采用隔蒜灸法,服用大防风汤并加倍加入乳香以止痛舒筋。但如果只有一侧膝盖疼痛并向上向下牵引,肿胀不明显且微红,这叫膝游风。膝盖两侧肿痛,憎恶寒冷且高热,白天黑夜疼痛加剧,肿胀部位手不能靠近,这叫膝眼毒。膝盖骨上方肿痛,这叫膝痈。(《医学准绳六要》)
又说:膝盖内侧靠近关节褶皱处,出现结核状肿块并肿痛,但肿块形状细长像鱼一样,这叫上水鱼。
陈实功说:鹤膝风是三阴经亏损不足的证候,上下小腿纤细,只有膝盖眼肿大,形状像仙鹤行走时的膝盖。初起时寒热交替发作,也适宜用发汗法解除表邪,如发汗后肿痛仍未消退,这是阴寒之邪深伏体内,应用大防风汤温暖经络,重症者兼灸膝眼两个穴位,外敷琥珀膏,也可以渐渐取得疗效。如果用上述各种方法治疗无效,最终会成为顽固性疾病,不必勉强消除它,只宜常服先天大造丸、史国公药酒,或许可以减轻病情,恢复行走能力,还有希望。(《外科正宗》)
岐天师说:这是因为在潮湿环境中站立并立即行房事,水气侵袭衣物,从而形成此病。(《石室秘录》)
李子永说:鹤膝风,古人多用大防风汤,因为该方内气血药物并用,是由于病位在下焦阴分的原因。如果像岐天师那样除去血药,适用于疾病初起之时;如果病程长久,古方恐怕不可废弃。
冯鲁瞻说:膝盖间肿痛不消,防止发展成鹤膝风,因为膝盖肿胀如鹤足,小腿纤细,脉象多弦紧。这是由于三阴经虚寒,湿邪流注为患,人们多误认为是湿热,以至于化脓,导致气血大亏,已经不可救治了。不知道此证与附骨疽都是肾虚者多患。因为真气衰弱,邪气得以深入侵袭,前人使用附子,是为了温补肾经,又能推动药势散除寒邪。所以体质虚弱的人,被冷气侵袭,经久不消,极致的阴中生阳,寒邪转化为热而溃破。如果误用寒凉药物,必然成为废疾,或者拘挛弯曲偏瘫,或者痿弱不起,或者坚硬如石成为石疽,或者日久才溃破,皮肉俱腐成为缓疽。下部距离远,非桂枝、附子不能下达,况且肾主骨,臀部以下都属于肾,非桂枝、附子不能进入其经脉而宣通运行。(《外科锦囊》)
《可法良规》说:鼓槌鹤膝起于体内湿气,因为足膝属于肝,肝有风寒湿邪,则血脉阻滞不能流通,注积于膝部成病。下股的血脉有去无回,所以越来越瘦冷而筋脉越缩;上腿的血脉有积无散,所以越来越肿热而肌肉越削。其源头若起于流注,则肌肉凝结者必腐烂,腐烂则冷毒腐蚀骨骼,骨骼一腐烂,神仙也无办法,遂成为难治的废疾。当皮肤未破时,肌肉尚未死亡,紧急用玉龙膏热酒调匀敷于膝盖上方的腿部,回接阳气以止住骨痛,又用冲和膏敷于上腿冷处,引导其气血,使流动而下贯通血脉。又用玉龙膏敷于骨胶处(指膝关节连接处),以接引所引导的血脉,驱散所积聚的阴气,内服追风丸加倍加入乳香、没药,就没有不痊愈的了。
又说:一切湿痰湿热,或死血凝滞等证,患病在关节,流注不行,不用辛温药物开发腠理,流通隧道,使气行血和,怎么能见效?人们害怕附子有毒,多不肯服用,如果用童便炮制,有什么毒性呢?况且中病即止,又不常服,有什么值得忧虑的?经书说:“有病就用相应的药”,就是这个道理。所以大防风汤、活络丹,治疗香港脚、鹤膝风证大多有效。
张真人说:此病是因为站立时行房,风湿侵入两膝,从而形成此病。然而治疗方法完全不治肾,只治气而自愈,也不必专门治风湿。(《良方补遗》)
《医宗心法》说:鹤膝风一名游膝风,又名鼓槌风。痢疾后得的是痢风。单侧发病的轻,双侧发病的最重,溃破后流出白色浆液,浮皮肿痛依旧,不可使用腐蚀药物,只宜用芙蓉叶、菊花叶各五钱研成末,与大麦米饮拌匀贴敷,也可以止痛,或者用豆腐渣蒸热捏成饼,贴敷也可以。此证属于外科中的败证,收功非常困难。
Crane's Knee Wind (He Xi Feng)
Wang Kentang stated: Swelling and pain in both knees, with the thighs gradually becoming thinner, is called Crane's Knee Wind, also known as Drumstick Wind. It arises from internal dampness, or occurs after dysentery leading to leg weakness and inability to walk, a condition named Dysentery Wind. Alternatively, it may result from residual toxins of Cold Damage (Shanghan) failing to be dispersed, where wind-cold-damp pathogens knot in the meridians, causing blood vessels to stagnate, resulting in contracted tendons and thinner thighs; this belongs to the Foot Shaoyang and Foot Yangming meridians. (*Zhunsheng*)
Furthermore, he stated: Swelling and pain above the knee have various causes and must be distinguished carefully. If both knees are swollen inside and out, with pain like being bitten by a tiger, alternating chills and fever, thinning thighs, and increasingly swollen knees, it is named Crane's Knee Wind. Immediate garlic-separated moxibustion should be applied, and Da Fangfeng Tang (Great Prevention Decoction) with added Rhizoma Costi (Ruxiang, 乳香) should be taken to relieve pain and relax tendons. However, if pain in only one knee radiates up and down, with slight swelling and mild redness, it is named Knee Wandering Wind (Xi You Feng). Swelling and pain on both sides of the knee, accompanied by aversion to cold and high fever, worsening day and night, with the swollen area too painful to touch, is named Eye of the Knee Toxin (Xi Yan Du). Swelling and pain above the kneecap is named Knee Carbuncle (Xi Yong). (*Zhunsheng*)
Furthermore, he stated: At the inner side of the knee near the crease, tubercles appear with swelling and pain; if the nodule is long and shaped like a fish, it is named Upper Water Fish (Shang Shui Yu).
Chen Shigong stated: Crane's Knee Wind is a syndrome of deficiency in the Three Yin meridians, with slender lower legs but swollen knee joints, resembling the knee of a crane walking. Initially, there are alternating chills and fever, and sweating therapy is appropriate. If swelling and pain persist after sweating, it indicates deep-seated yin-cold; Da Fangfeng Tang (Great Prevention Decoction) should be used to warm the meridians. In severe cases, moxibustion at the two Xianyan points (Knee Eye acupoints) combined with topical application of Hupo Gao (Amber Ointment) can gradually yield results. If these treatments fail, it becomes a chronic disease; rather than forcing resolution, continuous intake of Xiantian Dazao Wan (Premature Creation Pill) and Shi Guogong Medicinal Wine may alleviate severity and restore mobility. (*Zhengzong*)
Master Qi stated: This illness arises from standing in dampness and engaging in sexual intercourse immediately, allowing water qi to penetrate clothing, thus causing this disease. (*Milu*)
Li Ziyong stated: For Crane's Knee Wind, ancients often used Da Fangfeng Tang (Great Prevention Decoction), combining qi- and blood-invigorating herbs, because the pathology resides in the lower jiao yin aspect. Removing blood herbs, as Master Qi suggested, suits the initial stage; however, for chronic cases, ancient formulas should not be discarded.
Feng Luzhan stated: Persistent swelling and pain in the knees may develop into Crane's Knee Wind, characterized by swollen knees like crane feet and thin calves, with a wiry and tight pulse. This is caused by deficiency-cold and dampness flowing into the Three Yin meridians. People often mistakenly diagnose it as damp-heat, leading to suppuration and severe depletion of qi and blood, rendering it incurable. One should know that this condition, along with Gu Ben Ju (Bone-Attached Abscess), is common in those with kidney deficiency. Due to weakened true qi, pathogens invade deeply. Ancients used Fuzi (Aconite Root) to warm and tonify the Kidney meridian and to promote the action of other herbs to disperse cold. Thus, in weak individuals invaded by cold air, prolonged non-resolution leads to extreme yin generating yang, transforming cold into heat and causing ulceration. Misuse of cold-cooling herbs will inevitably lead to disability, such as contracture, hemiplegia, paralysis, hardness like stone (Stone Ju), or slow ulceration with rotting flesh (Slow Ju). The lower body is distant; only Cinnamon Twig (Guizhi, 桂枝) and Aconite Root (Fuzi, 附子) can reach it. Moreover, the Kidney governs bones, and the area below the buttocks belongs to the Kidney; only Cinnamon Twig and Aconite Root can enter its meridians and circulate effectively. (*Jinnang*)
*Ke Fa Liang Gui* states: Drumstick Crane's Knee Wind arises from internal dampness. Since the feet and knees belong to the Liver, wind-cold-damp in the Liver obstructs blood flow, accumulating in the knees. Blood in the lower thighs flows out without returning, becoming thinner and colder with contracted tendons; blood in the upper thighs accumulates without dispersing, becoming more swollen and hot with wasting muscles. If the source is from flowing injection (Liu Zhu), condensed flesh will rot, and rotting flesh will corrode bone; once bone corrodes, even immortals cannot cure it, resulting in intractable disability. While the skin is intact, muscle is not yet dead; urgently apply Yulong Gao (Jade Dragon Ointment) mixed with hot wine to the upper leg above the knee to restore yang qi and stop bone pain. Apply Chonghe Gao (Harmony Ointment) to the cold areas of the upper leg to guide qi and blood to flow downward through the vessels. Apply Yulong Gao (Jade Dragon Ointment) to the joint connection to guide the vessels and disperse accumulated yin qi. Internally take Zhui Feng Wan (Wind-Chasing Pill) with added Rhizoma Costi (Ruxiang, 乳香) and Resina Commiphorae (Moyao, 没药); all cases will heal.
It further states: For all conditions involving damp-phlegm, damp-heat, or stagnant blood in the joints, where flow is obstructed, efficacy cannot be achieved without pungent-warm herbs to open the interstices, unblock the collaterals, and harmonize qi and blood. People fear the toxicity of Aconite Root (Fuzi, 附子) and refuse to take it. However, processed with child's urine, what toxicity remains? Moreover, it is stopped once the disease is cured and not taken continuously; why worry? The Classics say: "Use the appropriate medicine for the disease." Therefore, Da Fangfeng Tang (Great Prevention Decoction) and Huoluo Dan (Meridian-Activating Pill) are effective for Hong Kong Foot (Charcot Joint/Gout) and Crane's Knee Wind.
Zhenren Zhang stated: This disease arises from engaging in sexual intercourse while standing, allowing wind-damp to invade both knees. However, treatment does not focus on the Kidneys; healing qi alone suffices, and specific treatment for wind-damp is unnecessary. (*Liangfang Buyi*)
*Xinfa* states: Crane's Knee Wind is also named Wandering Knee Wind or Drumstick Wind. Cases arising after dysentery are Dysentery Wind. Unilateral occurrence is mild; bilateral is most severe. After ulceration, white fluid discharges, and floating skin remains swollen and painful. Corrosive medicines should not be used. Instead, use five qian each of Hibiscus Leaf (Furong Ye, 芙蓉叶) and Chrysanthemum Leaf (Juhua Ye, 菊花叶), ground into powder, mixed with barley water, and applied topically to relieve pain. Alternatively, steamed tofu dregs molded into cakes can be applied. This condition is a difficult-to-treat failure among external diseases, making recovery very hard.