汤氏 香港脚宿恙，不离湿热，恰逢梅夏，阴雨溽蒸。舌痕灰黄，食少不饥，药忌浊腻，脾恶湿也。再以衰
年肝肾脉虚，寒热，足肿带下，腰痛季胁，自左注右，不能侧卧，乃阳维带脉兼病，治从络脉，佐理脾阳。仿古
饮子法，浊药清投。熟地炭（钱半）、沙苑子（盐水炒）、杞子（焙。各二钱）、牛膝（酒炒炭）、归须（酒拌，各一钱）、
砂仁壳（八分）、茯苓、薏苡、生杜仲、桑寄生、续断（各二钱）、糯稻根须（两半）。一剂痛止，再剂食进，
多服并香港脚不数发。
（膝游风 膝眼毒 膝痈附）
膝者筋之府，屈伸不利，两膝壅肿，内外皆痛，腿细膝粗，如鹤之膝，是名鹤膝风。多由足三阴经亏损，
风邪乘之使然。治在活血荣筋，兼理风湿。十全大补汤加杜仲、牛膝、羌活、独活。初起漫肿不红，屈伸不利，
用葱熨法内消之，或隔蒜灸，内服大防风汤。切忌针刺。或用陈芥子研细，葱姜汁和白蜜调涂。一伏时，患上
起泡，泡干皮脱，自愈。若寒热齐作，五积交加散加乌药、僵蚕。若皮色不变，大腿通肿，神效散。若无根虚
火，倏忽发热，十全大补汤。血虚发热面赤，脉大而渴，当归补血汤。阴虚形瘦发热，六味地黄汤。若挟湿热，
苍龟丸，或二妙散。若系
风湿，换骨丹、散膝汤。若侵水湿，蒸膝汤。食少面黄，六君子汤。中气不足，补中益气汤。屈伸不利，活络
丹。成脓溃烂，大防风汤。脓清肌肉不生，或头晕吐痰，八味地黄丸加鹿茸、牛膝。由脚软渐成鹤膝，独活寄
生汤。但一膝引痛，上下不甚肿而微红者，名膝游风。防风通圣散加木瓜、牛膝，或换骨丹。或膝两旁肿痛，
憎寒壮热，肿处手不可近者，名膝眼毒。胜金丹、仙方活命饮加牛膝。或膝盖上肿痛，亦发寒热，名膝痈。治
同上。
《医通》曰∶妇人鹤膝风，因郁怒致损肝脾，而为风邪所袭，或先肢体筋挛，膝渐大，腿渐细，如鹤膝状。
其肿高赤痛者易治，漫肿不红痛者难治。二三月溃而脓稠者易治，半载后溃而脓清者难治。误用攻伐，复伤元
气，尤为难治。宜固元气为主。其食少体倦，六君子汤。晡热内热，寒热往来，逍遥散。发热恶寒，十全大补
汤。惊悸少寐，归脾汤。月经过期，补中益气汤。月经先期，加味逍遥散。肾阴虚弱，六味地黄丸。凡溃后宜
大补脾胃，若脓出反痛，或寒热烦渴，皆属气血亏损，治以培补为宜。八珍汤。
小儿鹤膝风，多因先天肾气衰薄，阴寒凝聚于腰膝。古方以六味丸补肾水，以鹿茸引至骨节而壮里，此
治本良法也。
喻嘉言曰∶鹤膝风，即风寒湿之痹于膝者也，如膝骨日大，上下肌肉日枯，未可先治其膝，宜养气血，使
肌肉渐荣，再治其膝可也。此与治偏枯之症，大同小异，急溉其未枯者，使气血流行而复荣。倘不如此，但
用麻黄防风等散风之药，鲜有不全枯者。故治鹤膝而急攻其痹，必并其足痿而不用矣。
汤氏患有香港脚（足部肿胀疼痛的慢性病症）这一宿疾，其病机离不开湿热。恰逢梅雨夏季，阴雨连绵，湿气蒸腾。舌苔呈现灰黄色，食欲减退且无饥饿感，用药忌讳滋腻厚重之品，因为脾脏厌恶湿邪。考虑到患者年事已高，肝肾脉象虚弱，伴有寒热往来、足部肿胀、带下病、腰痛及季胁疼痛，疼痛从左侧放射至右侧，无法侧卧，这是阳维脉和带脉同时患病。治疗应从络脉入手，辅以调理脾阳。仿照古方饮子的方法，将浊重之药以清淡的方式投用。处方：熟地黄炭（一钱半）、沙苑子（盐水炒制）、枸杞子（焙干，各二钱）、牛膝（酒炒成炭）、当归须（酒拌，各一钱）、砂仁壳（八分）、茯苓、薏苡仁、生杜仲、桑寄生、续断（各二钱）、糯稻根须（一两半）。服用一剂后疼痛停止，再服一剂后食欲增进，长期服用并减少了香港脚的发作次数。
（附：膝游风、膝眼毒、膝痈）
膝盖是筋脉汇聚之处，若屈伸不利，双膝壅肿，内外皆痛，小腿纤细而膝盖粗大，状如鹤膝，称为鹤膝风。多由足三阴经亏损，风邪乘虚侵袭所致。治疗在于活血荣养筋脉，兼理风湿。可用十全大补汤加杜仲、牛膝、羌活、独活。初起时漫肿不红，屈伸不利，可用葱熨法内消，或隔蒜灸，内服大防风汤。切忌针刺。也可用陈芥子研细，用葱姜汁和白蜜调匀涂抹。敷贴一个时辰（两小时），患处起泡，泡干皮脱，即可自愈。若寒热同时发作，五积交加散加乌药、僵蚕。若皮色不变，大腿通体肿胀，用神效散。若无根虚火，突然发热，用十全大补汤。血虚发热面赤，脉大而渴，用当归补血汤。阴虚形瘦发热，用六味地黄汤。若夹杂湿热，用苍龟丸，或二妙散。若属风湿，用换骨丹、散膝汤。若侵及水湿，用蒸膝汤。食少面黄，用六君子汤。中气不足，用补中益气汤。屈伸不利，用活络丹。已成脓溃烂，用大防风汤。脓液清稀肌肉不生，或头晕吐痰，用八味地黄丸加鹿茸、牛膝。因脚软渐成鹤膝，用独活寄生汤。仅一膝牵引疼痛，上下不甚肿而微红的，名为膝游风。用防风通圣散加木瓜、牛膝，或换骨丹。若膝两旁肿痛，憎寒壮热，肿处手不可触碰的，名为膝眼毒。用胜金丹、仙方活命饮加牛膝。若膝盖上肿痛，也发寒热，名为膝痈。治疗方法同上。
《医宗金鉴》说：妇人患鹤膝风，因郁怒导致肝脾受损，而为风邪所袭，或先出现肢体筋挛，膝盖逐渐变大，小腿逐渐变细，状如鹤膝。肿胀高突、发红疼痛的容易治疗，漫肿不红疼痛的难治。二三个月溃破且脓液稠厚的容易治疗，半年后溃破且脓液清稀的难治。误用攻伐药物，再次损伤元气，尤为难治。应以固护元气为主。饮食少、身体疲倦的，用六君子汤。午后发热、内热、寒热往来的，用逍遥散。发热恶寒的，用十全大补汤。惊悸失眠的，用归脾汤。月经过期不来的，用补中益气汤。月经提前的，用加味逍遥散。肾阴虚弱的，用六味地黄丸。凡是溃破后宜大补脾胃，若脓出反而疼痛，或寒热烦渴，都属于气血亏损，治疗以培补为宜。用八珍汤。
小儿鹤膝风，多因先天肾气衰薄，阴寒凝聚于腰膝。古方用六味丸补肾水，以鹿茸引药力至骨节以壮里阳，这是治本的好方法。
喻嘉言说：鹤膝风，就是风寒湿痹阻于膝盖的疾病，如膝盖骨头日渐增大，上下肌肉日渐枯瘦，不可先治膝盖，宜先养气血，使肌肉逐渐荣润，然后再治膝盖。这与治疗偏枯（半身不遂）的症状大同小异，急于灌溉尚未枯瘦的部位，使气血流行而恢复荣润。如果不这样做，只用麻黄、防风等疏散风邪的药物，很少有不导致全身完全枯瘦的。所以治疗鹤膝风如果急于攻逐痹阻，必然会导致足痿废不用。
Tang suffered from Hongxiangjiao (a chronic condition characterized by swelling and pain in the feet), a lingering ailment rooted in Damp-Heat. Coinciding with the plum rain season of early summer, continuous rainfall and humid heat prevailed. The tongue coating was grayish-yellow, appetite was poor with no sense of hunger, and medications should avoid heavy, greasy substances because the Spleen dislikes Dampness. Considering her advanced age and deficient pulses of the Liver and Kidney, accompanied by alternating cold and fever, swollen feet, leukorrhea, lower back pain, and hypochondriac pain radiating from left to right such that she cannot lie on her side, this indicates concurrent disease of the Yangwei Vessel and Dai Vessel. Treatment should focus on the collaterals, assisted by regulating Spleen-Yang. Following the method of ancient Yinzi formulas, heavy/turbid medicines are administered in a clear/light manner. Prescription: Shudi Tan (Charred Rehmanniae Radix, 1.5 qian), Shayuanzi (Astragali Complanati Semen, stir-fried with salt water), Gouqizi (Lycii Fructus, roasted, each 2 qian), Niuxi (Achyranthis Bidentatae Radix, stir-fried with wine into charcoal), Guixu (Radix Angelicae Sinensis Pinnula, mixed with wine, each 1 qian), ShaRen Qiao (Amomi Fructus Pericarpium, 8 fen), Fuling (Poria), Yiyiren (Coicis Semen), Sheng Duzhong (Eucommiae Cortex, raw), Sangjisheng (Taxilli Herba), Xuduan (Dipsaci Radix, each 2 qian), Nuodaogenxu (Oryza Sativa Rootlet, 1 liang). After one dose, pain ceased; after two doses, appetite improved; long-term use reduced the frequency of Hongxiangjiao attacks.
(Attached: Xiyoubing [Wandering Knee Wind], Xiyan Du [Knee Eye Toxicity], Xi Yong [Knee Abscess])
The knee is the mansion of sinews. If flexion and extension are difficult, both knees are congested and swollen, painful internally and externally, with thin calves and thick knees resembling a crane's knee, it is named He Xin Feng (Crane Knee Wind). This is mostly caused by deficiency of the three Yin meridians of the foot, allowing Wind pathogen to invade. Treatment involves invigorating blood and nourishing sinews, while addressing Wind-Damp. Use Shiquan Dabu Tang (Decoction for Ten Complete Tonifications) added with Duzhong, Niuxi, Qianghuo, and Duhuo. In the initial stage with diffuse swelling without redness and difficulty in movement, apply Cong Yun (Scallion Moxibustion) to resolve internally, or Garlic-separated moxibustion, and orally administer Dafangfeng Tang (Great Wind-Expelling Decoction). Acupuncture needle insertion is strictly contraindicated. Alternatively, grind aged Mustard Seed (Jiezi) into fine powder, mix with juice of scallion and ginger and white honey, and apply topically. After one fu period (approx. 2 hours), blisters form on the affected area; when blisters dry and skin peels off, self-healing occurs. If cold and fever occur simultaneously, use Wuji Jiaozao San (Five Accumulations Mixed Powder) added with Wuyao and Jiangcan. If skin color remains unchanged but the thigh is diffusely swollen, use Shenxiao San (Miraculous Effect Powder). If there is rootless deficient fire causing sudden fever, use Shiquan Dabu Tang. For blood-deficiency fever with red face, large pulse, and thirst, use Danggui Buxue Tang (Decoction for Nourishing Blood with Danggui). For yin-deficiency emaciation with fever, use Liuwei Dihuang Tang (Six-Ingredient Pill with Rehmannia). If complicated by Damp-Heat, use Canggui Wan (Cassia Twig Pill) or Ermiao San (Two Marvels Powder). If due to Wind-Damp, use Huangu Dan (Bone-Changing Elixir) or Sanxi Tang (Dispersing Knee Decoction). If invaded by Water-Damp, use Zhengxi Tang (Steaming Knee Decoction). For poor appetite and sallow complexion, use Liujunzi Tang (Six Gentlemen Decoction). For insufficiency of Middle Qi, use Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting Qi). For difficulty in flexion and extension, use Huoluo Dan (Collateral-Activating Pill). For suppuration and ulceration, use Dafangfeng Tang. For clear pus with non-regenerating muscle, or dizziness with phlegm expectoration, use Bawei Dihuang Wan (Eight-Ingredient Pill with Rehmannia) added with Lurong (Deer Antler Velvet) and Niuxi. For gradual development of Crane Knee Wind from weak legs, use Duhuo Jisheng Tang (Decoction for Expelling Wind-Damp and Nourishing Liver and Kidney). If only one knee pulls with pain, not significantly swollen above and below but slightly red, it is named Xiyoubing (Wandering Knee Wind). Use Fangtong Tongsheng San (Wind-Penetrating Supreme Survival Powder) added with Mugua and Niuxi, or Huangu Dan. If swelling and pain occur on both sides of the knee, with aversion to cold and high fever, where the swollen area cannot be touched, it is named Xiyan Du (Knee Eye Toxicity). Use Shengjin Dan (Supreme Gold Elixir) or Xianfang Huoming Yin (Immortal Formula for Preserving Life Decoction) added with Niuxi. If swelling and pain occur on the kneecap, also with chills and fever, it is named Xi Yong (Knee Abscess). Treatment is the same as above.
*Yitong* states: Women suffering from Crane Knee Wind often have liver and spleen damage due to depression and anger, followed by Wind pathogen invasion. Initially, limb sinew spasms may occur, with knees gradually enlarging and calves thinning, resembling a crane's knee. Cases with high, red, and painful swelling are easy to treat; those with diffuse, non-red, and painless swelling are difficult. Ulceration with thick pus within two to three months is easy to treat; ulceration with clear pus after half a year is difficult. Misuse of purgatives further damages Yuan Qi, making treatment particularly difficult. The primary approach should be consolidating Yuan Qi. For poor diet and fatigue, use Liujunzi Tang. For afternoon fever, internal heat, and alternating cold and fever, use Xiaoyao San (Free and Easy Wanderer Powder). For fever and aversion to cold, use Shiquan Dabu Tang. For palpitations and insomnia, use Guipi Tang (Spleen-Restoring Decoction). For delayed menstruation, use Buzhong Yiqi Tang. For early menstruation, use Jia Wei Xiaoyao San (Modified Free and Easy Wanderer Powder). For kidney yin deficiency, use Liuwei Dihuang Wan. After ulceration, it is essential to strongly tonify the Spleen and Stomach. If pain persists after pus discharge, or if there is chills, fever, and irritability/thirst, these belong to Qi and Blood deficiency; treatment should focus on tonification using Bazhen Tang (Eight Treasures Decoction).
Pediatric Crane Knee Wind is mostly due to congenital weakness of Kidney Qi, with Yin-Cold condensing in the waist and knees. Ancient formulas use Liuwei Wan (Six-Ingredient Pill) to tonify Kidney Water, and Lurong (Deer Antler Velvet) to guide the medicine to the bone joints to strengthen interior Yang; this is an excellent method for treating the root.
Yu Jiayan stated: Crane Knee Wind is Bi syndrome of Wind, Cold, and Damp obstructing the knee. As the knee bones enlarge daily and upper/lower muscles atrophy daily, one should not treat the knee first. Instead, nourish Qi and Blood to allow muscles to gradually become robust, then treat the knee. This is largely similar to treating Pian Ku (hemiplegia); urgently irrigate the parts not yet atrophied to restore Qi and Blood circulation and robustness. If this is not done, and only Wind-dispelling drugs like Mahuang (Ephedrae Herba) and Fangfeng (Saposhnikoviae Radix) are used, few cases will avoid total atrophy. Therefore, treating Crane Knee Wind by urgently attacking the Bi obstruction will inevitably lead to foot flaccidity and inability to use the limbs.