据谕病原始末，考诸经云∶肝主筋。身之所束者，筋也。所以荣筋者血也，病本血不荣
筋，
而跗筋之血，又耗于足瘤之渗漏，加之时疫热邪，深入经络，足跗之大筋，得热而短。经又
云∶肝气热，胆泄口苦，筋膜干，则筋急而挛者是矣。然治挛固难，而治浊亦不易。虽津液
藏于膀胱，气化能出，但肺为生水之源，金燥则水不生。诸病水液混浊，皆属于热，义可
知
矣。进而求之筋挛血涸，使非养血荣筋不可也。然徒知荣养，而不明夫辅金制木之法，亦不
可也。苟以金制木而木反荣，筋反舒矣。且金清则水生而热降，此荣筋即可以治浊也。水足
则木畅而筋柔，此治浊即可以荣筋也。明见谅以为然。
安波按∶金清则水生而热降，此荣筋即可以治浊。拟《准绳》人参清肺法，冀其治节
之令
行，则膀胱气化出矣。所谓不治浊而治浊也。复以朱氏虎潜法，以濡养营卫，壮阴潜阳，所
谓水足则水畅，不荣筋而筋自荣也。
两尺细涩，肝肾下亏，必得之醉而使内也。壮时血气方刚，故无所苦。自强仕以来，渐
觉目
盲不能远视，耳如蝉吟蛙鼓，虚里其动应衣，阖目转盼，则身非己有，腰膝酸楚，行步不正
，种种病状，就衰之征。经云∶肝开窍于目，肾开窍于耳，目得血而能视，耳得血而能听，
血气衰耗，不能上充，故视听失其常度。心为君主之官，血虚心无所养，故掣动不安。脑为
髓海，下通命门，上气不足，头为之苦倾。腰者肾之府，肾惫则惮于转侧。膝者筋之府，筋
惫则艰于屈伸。方用人参为君，形不足温之以气；地黄河车龟鹿胶为佐，精不足补之以味，
更用山萸五味，摄纳肾气归元，气旺精充，百骸司职，收视而视明，返听而听聪矣。
安波按∶方议皆精妙入化。
据您所述病情的始末，查阅经典医籍可知：肝主管筋脉。身体中约束肢体的，就是筋。所以滋养筋脉的是血液，疾病的根本在于血液不能滋养筋脉，而足背部的筋脉之血，又因足部瘤疮的渗漏而耗损，加上当时流行的疫疠热邪，深入经络，导致足背的大筋受热而收缩变短。医经又说：肝气热盛，胆汁外泄则口苦，筋膜干燥，就会出现筋脉拘急挛缩的症状，正是如此。然而治疗筋脉挛缩固然困难，治疗小便浑浊也不容易。虽然津液储藏于膀胱，依靠气化作用才能排出，但肺是生水之源，肺金燥热则水源不生。各种病证中的水液混浊，都属于热证，道理也就显而易见了。进而探究，对于筋脉挛缩、血液枯竭的病证，如果不采用养血以滋养筋脉的方法是不可行的。然而如果只知道滋养荣补，而不明白“辅佐肺金以制约肝木”的治疗方法，也是不行的。如果用清金制木的方法使肝木得以柔和，筋脉就会舒展。况且肺金清肃则水源充足而热势下降，这样通过滋养筋脉就可以同时治疗小便浑浊了。肾水充足则肝木条达而筋脉柔韧，这样治疗小便浑浊就可以反过来滋养筋脉了。明察此理并谅解，认为我说得对吗？
安波按语：肺金清肃则水源充足而热势下降，通过滋养筋脉就可以治疗小便浑浊。我拟定了《医学准绳六要》中的人参清肺法，希望它能恢复肺主治节的功能，那么膀胱的气化功能就能正常行使了。这就是所谓的“不治浊而浊自除”。再配合朱丹溪的虎潜丸法，来濡养营卫，壮阴潜阳，这就是所谓的水源充足则肝木条达，不刻意荣养筋脉而筋脉自然得到滋养。
双侧尺脉细涩，这是肝肾下部亏虚的表现，一定是因为醉酒之后行房事所致。年轻时血气正旺盛，所以没有什么痛苦。自从做官以来，逐渐觉得眼睛昏花不能远视，耳朵里像蝉鸣蛙鼓一样嘈杂，心窝处跳动剧烈甚至衣服都随之颤动，闭上眼睛转动眼珠时，感觉身体不属于自己，腰膝酸软疼痛，行走不稳，种种病症表现，都是衰老衰退的迹象。医经说：肝开窍于目，肾开窍于耳，眼睛得到血液滋养就能视物，耳朵得到血液滋养就能听声，现在血气衰败耗损，不能向上充养头目，所以视听功能失去了正常的限度。心是君主之官，血虚则心无所养，所以出现抽搐牵动、心神不安。脑为髓海，向下连通命门，上部气不足，头部就会感到沉重倾斜。腰部是肾脏的外府，肾气疲惫则难以转身侧卧。膝盖是筋脉的外府，筋脉疲惫则难以屈伸。处方用人参作为君药，形体虚弱用温补气的方法；地黄、河车（紫河车）、龟板胶、鹿角胶作为臣佐药，精髓不足用厚味滋补的方法；更用山茱萸、五味子，收敛摄纳肾气归于本源，气旺精充，全身脏腑各司其职，视力恢复清明，听力恢复聪敏。
安波按语：方剂的议论都精妙入神。
According to your description of the onset and progression of the illness, consulting the classics reveals: The Liver governs the sinews (tendons). What binds the body are the sinews. What nourishes the sinews is Blood. The root of the disease lies in Blood failing to nourish the sinews; furthermore, the Blood supplying the sinews on the dorsum of the foot has been depleted due to leakage from a tumor-like lesion on the foot. Additionally, pathogenic heat from an epidemic pestilence has penetrated deeply into the meridians, causing the large sinew on the dorsum of the foot to shorten and contract upon receiving heat. The classics further state: When Liver Qi is hot, Gallbladder bile leaks causing bitter taste in the mouth; when the sinew membrane is dry, sinews become tense and contractile. This is exactly such a case. However, treating sinew contraction is indeed difficult, and treating turbid urine is also not easy. Although fluids are stored in the Bladder and exit through Qi transformation, the Lung is the source of water generation; if Lung Metal is dry, water is not produced. All pathological fluids that are turbid belong to Heat, so the principle is clear. Proceeding further, for cases of sinew contraction and Blood exhaustion, it is imperative to nourish Blood to benefit the sinews. Yet, merely knowing to nourish and tonify, without understanding the method of assisting Lung Metal to control Liver Wood, is insufficient. If one uses Metal to control Wood, and Wood thereby becomes flourishing, the sinews will relax. Moreover, when Metal is clear, Water is generated and Heat descends; thus, nourishing the sinews can simultaneously treat turbid urine. When Water is sufficient, Wood flows freely and sinews become supple; thus, treating turbid urine can reciprocally nourish the sinews. I trust you understand this clearly.
An Bo’s commentary: When Lung Metal is clear, Water is generated and Heat descends; nourishing the sinews can thereby treat turbid urine. I have formulated Ren Shen Qing Fei San (Ginseng Decoction to Clear the Lungs) from *Zhun Sheng* (Standard of Medical Precision), hoping it will restore the Lung’s function of regulating Qi and water passages, thereby enabling normal Qi transformation in the Bladder. This is what is meant by “treating turbidity without directly targeting turbidity.” Furthermore, I employ Zhu Danxi’s Hu Qian Wan (Tiger Crouch Pill) to moisten and nourish Ying and Wei (Nutritive and Defensive Qi), strengthen Yin to anchor Yang. This is what is meant by “when Water is sufficient, Wood flows freely,” where sinews are naturally nourished without direct intervention.
The pulse at both Chi positions (Kidney positions) is fine and choppy, indicating deficiency of the Liver and Kidneys in the lower Jiao. This must stem from intercourse while intoxicated. In youth, when Blood and Qi were vigorous, there was no suffering. Since becoming an official, gradually experiencing blurred vision unable to see far, tinnitus sounding like cicadas or frogs, palpitations in the Zhen Dong area (precardial region) visible through clothing, a sensation of dissociation when closing eyes and turning them, soreness and weakness in the waist and knees, and unsteady gait—all these symptoms are signs of decline. The classics state: The Liver opens into the eyes, and the Kidneys open into the ears. Eyes see when nourished by Blood; ears hear when nourished by Blood. With the depletion of Blood and Qi, they fail to ascend and fill the head, causing vision and hearing to lose their normal function. The Heart is the Sovereign Official; with Blood deficiency, the Heart lacks nourishment, leading to twitching and restlessness. The Brain is the Sea of Marrow, connecting downward to the Ming Men (Gate of Life); with insufficiency of Upper Qi, the head feels heavy and inclined. The Waist is the residence of the Kidney; when Kidneys are fatigued, turning and side-bending become difficult. The Knees are the residence of the Sinews; when Sinews are fatigued, flexion and extension become arduous. The prescription uses Ren Shen (Ginseng Root) as the Sovereign herb; for deficiency of form, warm Qi is used. Di Huang (Rehmannia Root), He Che Da Zao (Placenta Humanis), Gui Jiao (Tortoise Shell Glue), and Lu Jiao Jiao (Deer Antler Glue) serve as Assistant herbs; for deficiency of essence, rich flavors are used. Additionally, Shan Yu Rou (Cornus Fruit) and Wu Wei Zi (Schisandra Berry) are used to gather and secure Kidney Qi back to its origin. With abundant Qi and充盈 Essence, all bones and joints perform their functions, vision returns to clarity, and hearing returns to acuity.
An Bo’s commentary: The discussion of the formula is exquisite and transcendent.