经云∶风寒湿三气杂至，合而成痹。风气胜者为行痹。据述证由右足膝盖，痛引腿胛，
渐移
于左，状类行痹。行痹属风，治以驱逐，理不为谬。但邪之所凑，其气必虚，况童质禀薄，
肾元未充，驱逐过猛，血气受亏。肝主筋，筋无血养则挛急，脾主肉，肉无气煦则枯瘦，以
致腓日干，髀日肿，足不任地，酿成废疾矣。古云∶治风先治血，血行风自灭。闻所服诸方
，非全无治血之品也。无如桂麻羌独，药性太狠，难以监制，故只见其害，不见其益。在病
初血气未衰，犹可辅驱并行，今则疲惫如斯，尚有何风可逐，何络可通?倘再求速功，见病
医病，非但病不能医。而命亦难保矣。要知疾即成废，欲图转泽回枯，诚非易事，惟有培补
肝肾一法。膝为筋府，肝肾之脉，丽于足，足得血而能步。复有调养脾胃一法。四肢皆禀气
于胃，脾病不能为胃行其津液，脉道不利，筋骨肌肉皆无气以生，故不用焉。脾强胃健，四
肢得禀谷气，脉道流行，自能充肤。热肉二法，虽不言治病，然治病之旨，在其中矣。
安波按∶此症虽经治痊如语，而童质先禀薄弱，已见一斑，大约不寿之征矣。
曩议和中通腑，大便解后，痞闷渐舒，谷食稍进，时候寒暄不常，质虚最宜加感，以致
寒热
愈而复作。日来寒象虽除，热犹未净，脉虚近急，是属节外生枝，尚非本证变幻，特元亏未
复，腠理空疏，起居最宜谨慎。若谓此番寒热不关外感，全属内伤，则是阴阳两虚，奇经为
病，不应急骤至此。且内伤之寒热，当在日晡，日日如是，不能偶然。其状洒淅，亦不若此
之重。据理推详，似当不类，现下大便又复旬余未解，腹中虽无所苦，总觉欠舒，呆补惟恐
不
受。所以然者，病由湿凝气滞而起，医药庞杂，胃腑欠和，输化失职故耳。淡养胃气，甘益
脾阴，参以润肠，不至蹭蹬再生，自可渐跻蔗境。复诊便虽半月半圊，腹无所苦，下不嫌迟
，毋庸亟亟。日前感复，寒热作后，至今申刻仍有微潮。热时口渴，交戌汗出始退，固属余
波未清，但热久津液必伤，商进养阴，阴血下润则便通，非徒退热已也。感证反复，热盛阴
伤，肠枯便结，叠进养阴濡液，热退餐加，脉急已平，神采渐转。据述昨午便圊燥粪依然，
努挣艰难，足见病魔经久，元气受亏，津液未充。便通犹防复闭，按救阳气当用建中，救阴
液须投复脉，宗《千金》方法，佐以人乳团鱼燕窝，血肉有情，且俟液复虚回，胃强脾健，
再议善后之图。
安波按∶便闭一证，病患每有一通为愈之意。盖粪呆物也，必藉中气之迭送，故便时
努力
则易下。屡见病后有一二月之久，体已撤消，始得畅然下注，可见便闭一途，非徒补血润肠
为能事，而益气顺气之助，岂可漠然不道乎？是以经文中气不足，溲便乃变。
《黄帝内经》说：风、寒、湿三种邪气混杂侵袭人体，结合而成痹证。风气偏胜的称为行痹。根据所述症状，疼痛从右足膝盖开始，牵引至小腿肚（腓肠肌部位），逐渐转移到左侧，症状类似行痹。行痹属于风邪致病，治疗应当以驱散邪气为主，这在道理上并非错误。但是，邪气之所以能聚集侵犯人体，是因为正气必然虚弱，何况患者是儿童体质禀赋薄弱，肾中元气尚未充盈，如果驱邪太过猛烈，会导致血气受损。肝主管筋脉，筋脉没有血液滋养就会发生拘挛紧急；脾主管肌肉，肌肉没有阳气温煦就会干枯消瘦，从而导致小腿日渐干瘪，大腿日渐肿胀，双脚无法支撑身体站立，最终酿成残疾。古人说：治疗风病首先要调理血液，血液运行通畅，风邪自然消散。听说所服用的各方剂中，并非完全没有调理血液的药物。无奈其中桂枝、麻黄、羌活、独活等药物药性过于峻猛，难以制约控制，所以只看到其危害，看不到其益处。在疾病初期，血气尚未衰弱时，还可以采用扶正与驱邪并行的方法；如今患者已疲惫到这种地步，还有什么风邪可逐，什么经络可通？如果再追求速效，见病医病，不仅病治不好，性命也难保全了。要知道疾病既然已经形成残疾，想要使其恢复生机，确实不是容易的事，只有培补肝肾这一种方法。膝部是筋脉汇聚之处，肝经和肾经的经脉附着于足部，足部得到血液滋养才能行走。另外还有一种调养脾胃的方法。四肢都依赖胃气来提供营养，如果脾病不能为胃输送津液，脉道就不通畅，筋骨肌肉都没有气机产生，所以会出现这种情况。只要脾气强健、胃气调和，四肢就能获得水谷精气的滋养，脉道流通，自然能使皮肤丰满、肌肉温热。这两种方法，虽然表面上没有直接谈论治病，但治病的宗旨，其实就包含在其中了。
安波按语：这个病症虽然经过治疗后痊愈如言语所说，但患儿先天禀赋薄弱，已可见一斑，大概是不长寿的征兆了。
之前建议采用调和中和、疏通腑气的方法，大便解出后，痞闷感逐渐缓解，饮食稍微增加。由于时节气候冷暖无常，体质虚弱最容易再次感受外邪，导致寒热症状好了又发作。近日寒象虽然消除，余热仍未清净，脉象虚而接近急促，这属于节外生枝的情况，尚非原本病证的变幻，只是元气亏损尚未恢复，腠理（毛孔）空疏，起居最应该谨慎。如果说这次的寒热与外感无关，完全属于内伤，那就是阴阳两虚，奇经八脉患病，不应该如此急骤地出现。况且内伤引起的寒热，应当出现在下午3点到7点之间（日晡），每天都是这样，不会偶然发生。那种战栗的感觉，也不像这次这么严重。根据道理详细推究，似乎不像是内伤。现在大便又过了十几天没有解出，腹部虽然没有什么痛苦，总觉得不舒服。单纯进补恐怕身体承受不了。之所以这样，是因为疾病由湿气凝结、气机阻滞而起，用药庞杂混乱，胃腑不和，运化功能失职所致。用清淡的方法养胃气，用甘味的方法益脾阴，配合润肠通便的药物，不至于停滞不前再生变端，自然可以逐渐进入良好的状态。复诊时，大便虽然半个月才解一次，腹部没有痛苦，排便慢一点也无妨，不必急于求成。前几天因感冒复发，寒热发作之后，直到下午3点到5点（申刻）仍有轻微低热。发热时口渴，到了晚上7点到9点（戌时）出汗后才退去，这固然属于余波未清，但发热久了津液必然受伤，商议进用养阴的药物，阴血下润则大便通畅，不仅仅是为了退热而已。感冒症状反复，热盛伤阴，肠道干枯导致便秘，连续使用养阴滋润的药物后，热退食欲增加，脉象急促已平复，神采逐渐恢复。据描述昨天中午排出干燥粪便依然困难，用力挣扎艰难，足以见病魔经久，元气受亏，津液未充。大便通畅后还要防止再次闭塞，按照理论，救阳气应当使用建中汤类方剂，救阴液须投用复脉汤类方剂，遵循《千金方》的方法，佐以人乳、团鱼、燕窝等血肉有情之品，暂且等待津液恢复、虚损回转，胃强脾健之后，再讨论善后的方案。
安波按语：大便秘结这一病症，病患往往认为排出一通就算痊愈。因为粪便确实是呆滞之物，必须依靠中气的不断推送，所以排便时用力就容易下行。屡次见到病后有一两个月的时间，身体已经消瘦，才得以顺畅排泄，可见治疗便秘一途，不仅仅是补血润肠就能胜任的，益气顺气的辅助作用，怎么能忽视不提呢？因此经文中说，中气不足，大小便就会发生变化。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When Wind, Cold, and Dampness pathogenic factors mix and invade the body together, they combine to form Bi syndrome (Obstruction Syndrome). When Wind is predominant, it is called Xing Bi (Wandering Bi). According to the described symptoms, pain started from the right knee, radiating to the calf muscles, and gradually shifted to the left, resembling Wandering Bi. Wandering Bi belongs to Wind pathogen; treatment should focus on expelling the pathogen, which is not incorrect in principle. However, where pathogenic factors gather, Qi must be deficient. Moreover, the patient is a child with weak constitutional endowment and unfulfilled Kidney Yuan Qi (Original Qi). If expulsion is too vigorous, Blood and Qi will be depleted. The Liver governs the sinews; without Blood nourishment, sinews become spasmodic and tight. The Spleen governs the muscles; without Yang Qi warming, muscles become emaciated. This leads to the calves becoming increasingly dry and the thighs increasingly swollen, rendering the feet unable to bear weight, eventually resulting in disability. The ancients said: "To treat Wind, first treat the Blood; when Blood flows, Wind extinguishes itself." I heard that the various prescriptions taken were not entirely devoid of blood-regulating herbs. Unfortunately, herbs such as Guizhi Tang (Cinnamon Twig Decoction), Mahuang Tang (Ephedra Decoction), Qianghuo (Notopterygii Rhizoma et Radix), and Duhuo (Angelicae Pubescentis Radix) have overly harsh properties, making them difficult to control, so only harm was seen, not benefit. In the early stage of the disease, when Blood and Qi were not yet depleted, supporting healthy Qi and expelling pathogens could be done simultaneously. Now that the patient is this exhausted, what Wind remains to be expelled, and what collaterals remain to be unblocked? If one continues to seek quick results and treats the disease merely by its symptoms, not only will the disease not be cured, but life may also be endangered. One must realize that once a disease has resulted in disability, restoring vitality is indeed not an easy task. There is only one method: tonifying the Liver and Kidneys. The knee is the residence of sinews, and the meridians of the Liver and Kidneys attach to the feet; the feet can walk only when nourished by Blood. Another method is to regulate the Spleen and Stomach. All four limbs derive Qi from the Stomach. If Spleen disease prevents the Stomach from distributing fluids, the meridians become obstructed, and sinews, bones, and muscles lack Qi generation, hence these conditions arise. If Spleen Qi is strong and Stomach Qi is healthy, the four limbs receive grain Qi, meridians flow smoothly, and naturally the skin becomes plump and muscles warm. These two methods, although not explicitly discussing disease treatment, contain the essence of treating diseases.
An Bo's commentary: Although this case was reportedly cured as stated, the child's prior weak constitution is evident, suggesting a sign of short lifespan.
Previously, it was advised to harmonize the middle and unblock the fu organs. After bowel movement, the feeling of fullness and oppression gradually relieved, and food intake slightly increased. Due to fluctuating seasonal temperatures and cold, the weak constitution was prone to external contraction, causing fever and chills to recur after remission. Recently, although the cold signs have disappeared, residual heat remains. The pulse is deficient and approaching rapidity. This is an additional complication, not a transformation of the primary syndrome. It is merely that Yuan Qi deficiency has not recovered, and the couli (pores) are loose; daily life requires utmost caution. To claim that this episode of fever and chills is unrelated to external contraction and entirely due to internal injury would imply Yin and Yang dual deficiency and disease of the extraordinary vessels, which should not appear so abruptly. Furthermore, fever and chills due to internal injury typically occur during the Shen hour (3-5 PM) or You hour (5-7 PM), persisting daily, not occasionally. The sensation of shivering is not as severe as this. Based on reasoning, it seems unlikely to be internal injury. Currently, bowel movements have not occurred for over ten days. Although there is no abdominal pain, there is a general discomfort. Pure tonification might not be tolerated. The reason is that the disease originated from dampness coagulation and Qi stagnation; miscellaneous medications confused the Stomach Fu, leading to dysfunction of transportation and transformation. Using bland methods to nourish Stomach Qi and sweet methods to benefit Spleen Yin, combined with moistening intestines, will prevent stagnation and new complications, allowing gradual improvement. On follow-up, although bowel movements occurred only once every half month, there was no abdominal distress. Slow defecation is acceptable; there is no need to rush. Previously, due to recurrent external contraction, mild tidal fever persisted until the Shen hour (3-5 PM) after fever and chills subsided. Thirst during fever, sweating at the Xu hour (7-9 PM) leading to resolution, indicates residual waves have not cleared. However, prolonged heat damages fluids. We discussed advancing yin-nourishing herbs; if Yin blood moistens downward, bowels will unblock, serving not just to reduce fever. With recurrent external contraction, excessive heat damaging Yin, intestinal dryness causing constipation, continuous use of yin-nourishing and fluid-moistening herbs led to heat reduction, increased appetite, normalized rapid pulse, and returning spirit. Described yesterday noon, dry stool passage remained difficult, straining hard, showing the pathogen has been long-standing, Yuan Qi is depleted, and fluids are unfulfilled. After bowel unblocking, prevention of re-obstruction is needed. According to theory, to rescue Yang Qi, Jianzhong Tang (Middle-Builder Decoction) should be used; to rescue Yin fluids, Maiguan Tongmai Tang (Pulse-Recovering Decoction) should be administered. Following the *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold) method, supplemented with human milk, soft-shelled turtle, and swallow's nest—substances with emotional affinity (blood and flesh)—we wait for fluid recovery and virtual return, until Stomach strength and Spleen health are restored, then discuss follow-up plans.
An Bo's commentary: In cases of constipation, patients often believe that one successful evacuation constitutes a cure. Feces are indeed stagnant matter, requiring continuous pushing by Middle Qi; thus, effort during defecation facilitates passage. It is frequently observed that after illness, even after a month or two when the body has emaciated, smooth defecation finally occurs. This shows that treating constipation is not solely about tonifying Blood and moistening intestines; the assistance of boosting Qi and smoothing Qi cannot be ignored. Therefore, the classics state: "When Middle Qi is insufficient, urination and defecation change."