或问∶腿股忽然赤肿，何如？ 曰∶此名腿游风，风热相搏而然。属足太阳经，宜砭
出恶血，服防风通圣散去白术，加黄柏、牛膝、防己主之。
或问∶一女年十四，往来寒热，膝后 内约纹中，坚硬如石，微红微肿何如？曰∶此
名委中毒。此穴在膝后折纹中，属太阳胆经，由脏腑积热，流入膀胱而发。用八阵散，下
瘀血斗许而消。若治之稍迟，溃则筋缩，必成废疾。
《灵枢》云∶发于膝，名日疵疽。其状大痈，色不变，寒热而坚，勿石，石之者死，须
其柔，乃石之者生。（坚如石者，用生樟六根擦之效。） 诸痈疽之发于节，而相应者，不可治也。
发于阳者，百日死；发于阴者，三十日死。（阳
谓诸节之背，阴谓诸节之 间。刘涓子云∶应者，内发透外也。） 或问∶两膝肿痛，股渐小何如？
曰∶此名鹤膝风，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，以致筋愈缩而股愈瘦，属足少阳、足
阳明经，宜用玉龙膏，酒调敷腿上，以往痛回阳，又宜冲和膏涂足附，以引气行血，服
大防风汤、追风丸，倍加乳香，以往痛舒筋，亦宜隔蒜灸之。 或问∶膝上肿痛，何如？曰∶
此非一端，要须明辨。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。急隔蒜灸，服大防风汤。但一膝，痛引上下，不甚肿而微红，名膝游风。
宜服圣授丹、换骨丹、防风通圣散加牛膝、木瓜。但膝之两傍肿痛，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。此二证，宜服胜金丹，或紫金丹、八
阵散、活命饮加牛膝。
〔薛〕 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，如鹤之膝故名之。若伤于脾胃者，补中益气汤为主，
伤于肝肾者，六味丸为主，若欲其作脓或溃后，十全大补汤为主，皆佐以大防风汤。初
起须用葱熨，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，血虚发躁也，用当归
补血汤。或有痢后而患者，亦治以前法，余当临证制宜。
鹤膝风（又名鼓槌风。）两大小腿瘦如芦柴，止有膝盖大者，行履不得。
加味小续命汤
用小续命汤料，内加萆 、川楝子、独
活、干木瓜， 咀，不用生姜，用水煎熬，于碗底先放麝香少许，去滓，倾于碗内服之。服
至数十帖后，加五积散同煎服，永瘥。一方，用紫荆皮老酒煎，候温常服。
罗氏 螂丸 治鹤膝风，腰膝风缩之疾。
（头尾全者生，一条） 桃仁（生） 白附子 阿魏 桂心 安息香（桃仁同研） 白芷
（各一两） 乳香 没药（各七钱半，以上九味，用童便、酒二升，炒热，另处） 北漏芦 当归 白芍
药牛膝 羌活 地骨皮，威灵仙（各一两，共为末）
上炼蜜丸，弹子大，空心，温酒化下一丸。胡楚望博士，病风痉，手足指节皆如桃
李，痛不可忍，服之悉愈。
丹溪治一丈人，年七十，患脚膝疼，稍肿。
生地黄 当归头 白芍药 苍术 炒柏（各三钱） 川芎 桂（各二钱） 木通（一钱半）
分四帖。煎取小盏，食前热服。
一男子，年近三十，滋味素浓，性多焦怒，秋间，髀枢左右一点发痛，延及于膝，昼
静夜剧，恶寒，口或渴或不渴，或痞或不痞。医多用风药兼用补血。至次年春，其膝渐肿，
痛愈甚，食渐减，形瘦羸。至春末膝肿如桃，不可屈伸。诊其脉，左弦大颇实，寸涩甚，大
率皆数。知其小便必数而短，遂作饮食痰积在太阳、阳明治之。炒黄柏一两，生甘草梢、
犀角屑、苍术盐炒各三钱，川芎二钱，陈皮、牛膝、木通、芍药各五钱，遇暄热加条芩三
钱，为细末。每三钱重，与生姜自然汁同研细，多少以水荡起，煎令沸，带热食前饮之，
一昼夜四次与。至半月后数脉渐减。痛渐轻，去犀角加牛膝、败龟板半两，当归半两，如
前服。又与半月，肿渐减，食渐进，不恶寒。
唯脚膝酸软，未能久立久行，去苍术、黄芩，时当夏热，加炒黄柏至一两半。予根据本方内
加牛膝，春夏用茎叶，冬用根，杵取汁用之，效尤速。须断酒肉、湿面、胡椒。当仲夏，加
生地黄半两，冬加茱萸、桂枝。
换骨丹 通治风，兼治鹤膝风。
防风 牛膝 当归 虎骨（酥炙，各一两） 枸杞（二两半） 羌活 独活 败龟板
秦艽 萆 松节 蚕砂（各一两） 茄根（洗，二两） 苍术（四两）
酒浸，或酒糊丸，皆可。
脚筋急痛，煮木瓜令烂，研作粥浆样，用裹痛处，冷即易，一宿三五度，热裹便瘥，煮
木瓜时，入一半酒煮之。 子和治岭北李文卿，病两膝膑屈伸有声，剥剥然，或以为骨
鸣。戴人曰∶非也，骨不戛，皆能鸣，此筋湿也，湿则筋急，缓者不鸣，急者鸣也，若
用予之药，一涌一泄，上下去其水，则自无声矣。文卿从之，既而果然。 州守张天泽，
左膝肿痛，胸膈痞满，饮食少思，时欲作呕，头晕痰壅，日晡益倦，此脾肺气虚，用葱熨
法，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，又用补中益气三十余剂而消。通府刘国威，先筋挛骨痛，右膝漫肿，用化
痰消毒之剂，肿痛益甚，食少体倦。加祛风消毒等药，寒热作呕，大便不实。用二陈除
湿之类，肿起色赤，内痛如锥。余诊其脉，滑数而无力，此脓已成，元气虚而不能溃也，用
十全大补汤四剂，佐以大防风汤一剂而溃，又百余剂而痊。 一儒者，腿筋弛长，月余两
膝肿痛，此阴虚湿热所乘也，用六味丸为主，佐以八珍汤加牛膝、杜仲，间以补中益气汤，
三月余而消。 一男子腿痛膝肿，脉浮按之弦紧，此肝肾虚弱也，用大防风汤二剂已退。
彼惑于附子有毒，乃服治疮之药，日渐消瘦，虚症渐至，复救治。予曰∶倦怠消瘦，脾胃
衰而不能营运也。小便不禁，膀胱虚而不能约制也。燥热虚痞，胃气弱而不能化也。惚
恍健忘，精神失而愦乱也。恶证蜂集，余辞之，后果殁。 此症多患于不足之人，故以
加减小续命、大防风二汤有效，若用攻毒药，必误。 一妇膝肿痛，遇寒痛益甚，月余不
愈，诸药不应，脉弦紧，此寒邪深伏于内也，用大防风汤与火龙丹，治之而消。 大抵此
证虽云肿有浅深，感有轻重，其所受皆因真气虚弱，而邪得以深袭，故附骨痈疽，及鹤
膝风证，肾虚者多有之。前人用附子者，以温补肾气而又能行药势，散寒邪也。亦有体
虚之人，秋夏露卧，为冷气所袭，寒热伏结，多成此证，不能转动，乍热而无汗，按之痛
应骨者是也。若经久不消，极阴生阳，寒化为热而溃也。若被贼风所甚伤，患处不甚热，
而洒淅恶寒，不时汗出，熨之痛少止，须大防风汤、火龙膏治之。又有挛曲偏枯，坚硬
如石，谓之石疽。若热缓积不溃，肉色赤紫，皮肉俱烂，名缓宜，其始末皆宜前汤，欲其
驱散寒邪，以补虚托里也。
大防风汤 治足三阴经亏损，外邪乘虚，患鹤膝风或附骨疽，肿痛或肿而不痛，不问
已溃未溃，用三五剂后，更用调补之剂。
附子 牛膝（各一钱） 白术 羌活 人参 防风（各二钱） 川芎（一钱半） 辣桂 黄
白芍药 杜仲 熟地黄 甘草（炙，各五分）
上水煎服
还少丹 治足三阴经虚损，患膝风等证，又补脾肾、进饮食之良剂也。
肉苁蓉（酒浸，去甲） 远志（甘草汤泡，去骨） 香（炒） 巴戟（去心） 枸杞子 山药
牛膝 石菖蒲 杜仲 熟地黄（为膏） 五味子 白茯苓 楮实子 山茱萸（肉，各等分）
上为末。用红枣肉同蜜为丸，梧子大。每服七十丸，温酒下，每日三服，白汤亦可。
经进地仙丹 换骨丹（二方，并见杂病五卷。）
〔素〕 蹇膝伸不屈，治其楗。（骨空论，下同。经云∶辅骨上横骨下为楗。王注云∶髀辅骨上，
横骨下，股外之中，侧立摇动取之，筋动应手。滑寿云∶楗骨之下为髀枢，盖楗即两骨相接处，为楗也。）
坐而膝痛，治其机。（经云∶侠髋为机。王注云∶髋骨两傍，相接处，滑寿云∶髋骨侠腰两傍，髋骨为
机，机后为臀。） 立而暑解，治其骸关。（经云∶膝解为骸关。王注云∶暑，热也。若膝病起立，而膝
骨解中热者，治其骸关。经云；起而引膝骨解之中也。滑寿云∶侠膝解中，为膑。） 膝痛，痛及拇指，治
其。（经云，辅上为 。王注云∶ 为膝解之后，曲脚之中，委中穴。） 坐而膝痛如物隐者，治其
关。（经云∶ 上为关。王注云∶关在 上，当楗之后，背立按之动摇，筋应手。） 膝痛不可屈伸，治
其臂内。（王注云∶大杼穴也。） 连 若折，治阳明中俞 。（王注云∶若膝痛不可屈伸，连 痛如折
者，则针阳明穴，中俞 ，三里穴也。） 膝痛若别，治巨阳、少阳荥。（王注云∶若痛而膝如别离者，则
治足太阳荥、通谷穴，足少阴荥，然谷穴也。） 淫泺胫酸，不能立久，治少阳之维，在外上五
寸。（外上当作外踝上。王注∶淫泺，谓似酸痛而无力也。外踝上五寸，光明穴也。）
上楗、机、骸关、诸穴，更参订之。
〔灵〕 膝中痛，取犊鼻，以员利针之，发而间之，针大如厘，刺膝无疑。（杂病篇。）
〔玉〕 鹤膝风肿及腿痛。髓骨（在膝盖骨上一寸，梁丘穴两傍各五分，针入五分，留一吸泻之。）
膝关（关膝盖骨下，犊鼻内傍，横针透膝眼，在犊鼻外傍，禁灸，留八呼泻之）
〔集〕 又法 膝关 委中 （三寸半；但紫脉上出血为妙） 三里（不已，取下穴） 阳陵
泉中院 丰隆
〔通〕 膝肿 行间
〔撮要〕 阳陵泉（横透阴陵泉，补生泻成） 阴陵泉（横透阳陵泉，补生泻成） 膝关（法见前《玉
龙》下）
〔世〕 脚拗痛 委中（出血）
〔桑〕 脚膝痛筋急 风池 三间 三阴交 三里
有人问：大腿和小腿突然红肿，是怎么回事？回答说：这叫做“腿游风”，是风邪与热邪相互搏结所致。病位在足太阳膀胱经，适宜用砭石刺破皮肤放出恶血，内服防风通圣散去掉白术，加入黄柏、牛膝、防己来主治。
有人问：一个十四岁的女孩，忽冷忽热，膝盖后方腘窝横纹中间，坚硬如石头，微微发红微微肿胀，是怎么回事？回答说：这叫做“委中毒”。这个穴位在膝盖后方的折纹中，属于足太阳胆经（注：原文如此，实为足太阳膀胱经与足少阳胆经交会区域），由脏腑积热，流入膀胱而引发。使用八阵散，排出瘀血约一斗后症状消除。如果治疗稍晚，溃烂后会导致筋脉收缩，必然成为残疾。
《灵枢》说：发于膝盖部位的，名叫疵疽。它的症状是大痈肿，颜色不变，伴有寒热且质地坚硬，不能用石针刺破，刺破的会死亡；必须等到它变软了，才能刺破，这样能存活。（对于坚硬如石的，用生樟木六根擦拭效果显著。）凡是痈疽发于关节部位，且身体其他相应部位也出现症状的，是不可治之症。发于阳分的，一百天死；发于阴分的，三十天死。（阳分指各关节的背面，阴分指各关节的缝隙间。刘涓子说：应者，指内部病变透发至外部。）有人问：双膝肿痛，大腿逐渐变细，是怎么回事？回答说：这叫做“鹤膝风”，又名“鼓槌风”。起因于体内湿气过重，或因痢疾之后，腿部软弱酸痛，无法行走，名叫“痢风”。或者是伤寒余毒未清，不能发散，风寒湿邪结聚于经络，血脉运行不畅，导致筋脉越来越收缩而大腿越来越消瘦，病属足少阳胆经、足阳明胃经，适宜使用玉龙膏，用酒调匀敷在腿上，以温通止痛、回阳救逆；又适宜用冲和膏涂抹足踝部，以引气行血；内服大防风汤、追风丸，加倍加入乳香，以温通止痛、舒筋活络；也适宜隔蒜灸治疗。有人问：膝盖上方肿痛，是怎么回事？回答说：这并非一种病因，必须明辨。如果双膝内外都肿，疼痛像老虎咬一样，寒热交替发作，大腿逐渐细小，膝盖却越发肿大，名叫鹤膝风。急需隔蒜灸，服用大防风汤。如果只有一侧膝盖痛，疼痛牵引上下，肿胀不严重但微红，名叫膝游风。适宜服用圣授丹、换骨丹、防风通圣散加牛膝、木瓜。如果只是膝盖两侧肿痛，憎寒壮热，白天黑夜偏重时加剧，肿胀处手不敢靠近，这是膝眼毒；膝盖上方肿痛，这是膝痈。这两种证候，适宜服用胜金丹，或者紫金丹、八阵散、活命饮加牛膝。
薛己评述：鹤膝风，是由于调养失当，亏损足三阴经（肝、脾、肾），风邪乘虚而入，导致肌肉日渐消瘦，内热食欲减退，肢体拘挛疼痛，时间久了膝盖肿大而小腿纤细，像鹤的膝盖，所以叫这个名字。如果损伤脾胃的，以补中益气汤为主方；损伤肝肾的，以六味地黄丸为主方；如果想要化脓或溃烂后，以十全大补汤为主方，都辅助以大防风汤。初起时必须用葱熨法，可以使肿块内消。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。发热或午后潮热，是阴血虚弱，用四物汤加人参、黄芪、白术。畏寒怕冷，是阳气虚弱，用十全大补汤。饮食减少思食，胸膈胀满，是脾胃虚痞，用四君子汤。面色萎黄，饮食减少思食，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。热来复去，定时发作，是无根虚火，用十全大补汤。形体消瘦嗜睡，睡觉呼吸发热，痰多口渴，小便频数，是五脏虚损，用六味地黄丸。脐腹疼痛，夜间尿多，脚膝无力，头晕吐痰，是肾气冷败，用八味丸（金匮肾气丸）。发热大渴，不想穿衣，面目赤色，脉大而虚，是血虚烦躁，用当归补血汤。如果有痢疾后患此病的，也用以上方法治疗，其余应当根据临床具体情况灵活制宜。
鹤膝风（又名鼓槌风）：大小腿瘦得像芦柴杆，只有膝盖大，无法行走。
加味小续命汤：用小续命汤的药料，内加萆薢、川楝子、独活、干木瓜，切碎，不用生姜，用水煎熬，在碗底先放少许麝香，去渣，倒入碗中服用。服用几十帖后，加五积散同煎服用，可彻底痊愈。另一方法，用紫荆皮老酒煎煮，待温常服。
罗氏螂丸：治疗鹤膝风，腰膝风缩的疾病。（土鳖虫头尾全者生用，一条）桃仁（生用） 白附子 阿魏 桂心 安息香（与桃仁同研） 白芷（各一两） 乳香 没药（各七钱半，以上九味，用童便、酒二升，炒热，另放一边）北漏芦 当归 白芍药 牛膝 羌活 地骨皮 威灵仙（各一两，共为末）
上药用炼蜜制成丸，如弹子大，空腹时，用温酒送下一丸。胡楚望博士，患风痉症，手足指节都像桃李核一样肿大，疼痛难忍，服用此药全部痊愈。
朱丹溪治疗一位老人，七十岁，患脚膝疼痛，稍微肿胀。
生地黄 当归头 白芍药 苍术 炒黄柏（各三钱） 川芎 桂枝（各二钱） 木通（一钱半）
分为四帖。煎取一小盏，饭前热服。
一名男子，年近三十，平时口味浓厚，性格多焦躁易怒，秋季，大腿根部左右一点开始疼痛，蔓延到膝盖，白天安静晚上加重，怕冷，口有时渴有时不渴，有时痞闷有时不痞闷。医生多用风药兼用补血药。到了次年春天，膝盖逐渐肿胀，疼痛更厉害，饮食逐渐减少，形体消瘦羸弱。到春末膝盖肿得像桃子，不能屈伸。诊察他的脉象，左脉弦大颇实，寸脉涩得很，大体都是数脉。知道他小便一定频数而短少，于是按饮食痰积在太阳、阳明经治疗。炒黄柏一两，生甘草梢、犀角屑、盐炒苍术各三钱，川芎二钱，陈皮、牛膝、木通、芍药各五钱，遇到闷热天气加条芩三钱，研成细末。每次三钱重，与生姜自然汁同研细，适量加水荡起，煎令沸腾，带热饭前饮用，一昼夜四次给予。半个月后数脉逐渐减少。疼痛逐渐减轻，去掉犀角加牛膝、败龟板半两，当归半两，像以前那样服用。又过了半个月，肿胀逐渐减轻，饮食逐渐增加，不怕冷了。
只是脚膝酸软，不能久立久行，去掉苍术、黄芩，当时正值夏热，加炒黄柏至一两半。我根据本方内加牛膝，春夏用茎叶，冬天用根，捣取汁使用，效果尤其迅速。必须戒断酒肉、湿面、胡椒。仲夏时节，加生地黄半两，冬天加茱萸、桂枝。
换骨丹：通用治疗风邪，兼治鹤膝风。
防风 牛膝 当归 虎骨（酥炙，各一两） 枸杞（二两半） 羌活 独活 败龟板 秦艽 萆薢 松节 蚕砂（各一两） 茄根（洗净，二两） 苍术（四两）
用酒浸泡，或用酒糊制丸，都可以。
脚筋急痛：煮木瓜直到烂熟，研磨成粥浆样，用来包裹疼痛处，冷了即更换，一夜三五次，热敷就会好转。煮木瓜时，加入一半酒一起煮。
张子和治疗岭北李文卿，患双膝髌骨屈伸时有声音，剥剥作响，有人以为是骨鸣。戴人（张子和号）说：不是，骨头不会摩擦发声，都能鸣响，这是筋湿，湿则筋急，松弛的不鸣响，紧急的才鸣响，如果用我的药，一涌一泄，上下去除水湿，自然就无声了。李文卿听从了他，后来果然如此。
州守张天泽，左膝肿痛，胸膈痞满，饮食减少思食，时常想呕吐，头晕痰壅，下午更加疲倦，这是脾肺气虚，用葱熨法，及六君子汤加炮姜，各种症状顿时消退，饮食稍进。用补中益气汤加蔓荆子，头目清爽。间断服用大防风汤十余剂，又用补中益气汤三十余剂而消散。
通府刘国威，先筋挛骨痛，右膝漫肿，用化痰消毒的药剂，肿痛更甚，食少体倦。加祛风消毒等药，寒热作呕，大便不实。用二陈汤除湿之类，肿起色赤，内痛如锥。我诊察他的脉象，滑数而无力，这是脓已成，元气虚而不能溃破，用十全大补汤四剂，辅助以大防风汤一剂而溃破，又百余剂而痊愈。
一儒生，腿筋弛长，月余两膝肿痛，这是阴虚湿热所乘，用六味地黄丸为主，辅助以八珍汤加牛膝、杜仲，间断服用补中益气汤，三月余而消散。
一男子腿痛膝肿，脉浮按之弦紧，这是肝肾虚弱，用大防风汤二剂已退。他迷信附子有毒，于是服用治疮的药，日渐消瘦，虚症渐至，再次救治。我说：倦怠消瘦，是脾胃衰败不能运化；小便不禁，是膀胱虚不能约束；燥热虚痞，是胃气弱不能消化；恍惚健忘，是精神失守而昏乱。恶证蜂拥而至，我推辞不治，后果去世。
此症多患于正气不足之人，所以用加减小续命汤、大防风汤有效，如果用攻毒药，必误。
一妇人膝肿痛，遇寒痛更甚，月余不愈，诸药不应，脉弦紧，这是寒邪深伏于内，用大防风汤与火龙丹，治疗而消散。
大抵此证虽然说是肿有浅深，感邪有轻重，其所受皆因真气虚弱，而邪气得以深袭，所以附骨痈疽，及鹤膝风证，肾虚者多有之。前人用附子，是因为它能温补肾气又能行药势，散寒邪。也有体虚之人，秋夏露卧，被冷气所袭，寒热伏结，多成此证，不能转动，乍热而无汗，按之痛应骨的是这类情况。如果经久不消，极阴生阳，寒化为热而溃破。如果被贼风严重伤害，患处不甚热，而洒淅恶寒，不时汗出，熨之痛少止，须大防风汤、火龙膏治疗。又有挛曲偏枯，坚硬如石，叫做石疽。如果热缓积不溃，肉色赤紫，皮肉俱烂，叫做缓宜，其始末皆宜前汤，想要驱散寒邪，以补虚托里。
大防风汤：治疗足三阴经亏损，外邪乘虚，患鹤膝风或附骨疽，肿痛或肿而不痛，不问已溃未溃，用三五剂后，更用调补之剂。
附子 牛膝（各一钱） 白术 羌活 人参 防风（各二钱） 川芎（一钱半） 辣桂 黄芪 白芍药 杜仲 熟地黄 甘草（炙，各五分）
上药水煎服。
还少丹：治疗足三阴经虚损，患膝风等证，又是补脾肾、进饮食的良剂。
肉苁蓉（酒浸，去甲） 远志（甘草汤泡，去骨） 山药（炒） 巴戟天（去心） 枸杞子 山药 牛膝 石菖蒲 杜仲 熟地黄（为膏） 五味子 白茯苓 楮实子 山茱萸（肉，各等分）
上药为末。用红枣肉同蜜为丸，梧桐子大。每服七十丸，温酒送下，每日三次，白开水也可以。
〔素问〕 膝盖僵硬伸展不利，治疗其楗穴。（骨空论，下同。经文说：辅骨上横骨下为楗。王冰注说：髀辅骨上，横骨下，股外之中，侧立摇动取之，筋动应手。滑寿说：楗骨之下为髀枢，盖楗即两骨相接处，称为楗。）
坐着而膝盖痛，治疗其机穴。（经文说：侠髋为机。王冰注说：髋骨两傍，相接处，滑寿说：髋骨侠腰两傍，髋骨为机，机后为臀。）
站立时感到膝部发热，治疗其骸关穴。（经文说：膝解为骸关。王冰注说：暑，热也。若膝病起立，而膝骨解中热者，治其骸关。经文说：起而引膝骨解之中也。滑寿说：侠膝解中，为膑。）
膝盖痛，痛及拇指，治疗其……（经文说，辅上为……。王冰注说：……为膝解之后，曲脚之中，委中穴。）
坐着而膝盖痛如有物隐藏，治疗其关穴。（经文说：……上为关。王冰注说：关在……上，当楗之后，背立按之动摇，筋应手。）
膝盖痛不可屈伸，治疗其臂内……（王冰注说：大杼穴也。）
连……若折断，治疗阳明中俞……（王冰注说：若膝痛不可屈伸，连……痛如折者，则针阳明穴，中俞……，三里穴也。）
膝盖痛若别离状，治疗巨阳、少阳荥穴。（王冰注说：若痛而膝如别离者，则治足太阳荥、通谷穴，足少阴荥，然谷穴也。）
淫泺胫酸，不能久立，治疗少阳之维，在外上五寸。（外上当作外踝上。王冰注：淫泺，谓似酸痛而无力也。外踝上五寸，光明穴也。）
上楗、机、骸关、诸穴，再参订之。
〔灵枢〕 膝中痛，取犊鼻穴，用员利针刺，发作时施针，间歇期再刺，针大如厘，刺膝无疑。（杂病篇。）
〔玉龙歌〕 鹤膝风肿及腿痛。髓骨（在膝盖骨上一寸，梁丘穴两傍各五分，针入五分，留一吸泻之。）
膝关（关膝盖骨下，犊鼻内傍，横针透膝眼，在犊鼻外傍，禁灸，留八呼泻之）
〔集验〕 又法 膝关 委中 （三寸半；但紫脉上出血为妙） 三里（不已，取下穴） 阳陵泉 中院 丰隆
〔通玄〕 膝肿 行间
Someone asked: "The thigh and leg suddenly become red and swollen. What is the cause?" The answer was: "This is called 'Leg Roaming Wind' (Tui You Feng), caused by the struggle between wind and heat pathogens. It belongs to the Foot-Taiyang Bladder Meridian. It is appropriate to use bian stone (stone lancet) to prick and release evil blood, and internally administer Fangfeng Tongsheng San (Wind-Protecting Universal Relief Powder) with Baizhu (Atractylodis Rhizoma) removed, added with Huangbai (Phellodendri Cortex), Niuxi (Achyranthis Bidentatae Radix), and Fangji (Stephaniae Tetrandrae Radix) as the main treatment."
Someone asked: "A fourteen-year-old girl experiences alternating chills and fever. In the popliteal crease behind the knee, there is hardness like a stone, slight redness, and slight swelling. What is this?" The answer was: "This is called 'Weizhong Carbuncle' (Wei Zhong Du). This acupoint is located in the crease behind the knee and belongs to the Foot-Taiyang and Foot-Shaoyang Gallbladder meridians. It arises from accumulated heat in the zang-fu organs flowing into the Bladder. Using Bazhen San (Eight Arrays Powder), expelling about one dou of stasis blood leads to resolution. If treatment is delayed slightly, upon ulceration, tendon contraction will occur, inevitably resulting in disability."
The *Ling Shu* states: "Eruptions on the knee are named Ci Ju (Cancerous Ulcer). The presentation is a large abscess, unchanged in color, accompanied by chills and fever, and hard. Do not pierce it with a stone needle; piercing it leads to death. One must wait until it softens before piercing; then life can be preserved. (For those hard as stone, rubbing with six raw Camphor Wood branches is effective.) Any carbuncles or ulcers erupting at joints with corresponding symptoms elsewhere in the body are incurable. Those erupting in Yang aspects die within one hundred days; those in Yin aspects die within thirty days. ('Yang' refers to the dorsal aspect of joints; 'Yin' refers to the interstices of joints. Liu Juanzi said: 'Corresponding' means internal eruption manifesting externally.)"
Someone asked: "Both knees are swollen and painful, and the thighs gradually become thin. What is this?" The answer was: "This is called 'Crane Knee Wind' (He Xi Feng), also known as 'Drumstick Wind' (Gu Chui Feng). It originates from dampness accumulation, or follows dysentery. The legs are weak, sore, and painful, unable to walk, named 'Dysentery Wind'. Or it may be residual toxins from Cold Damage that fail to disperse, causing wind-cold-damp pathogens to knot in the collaterals, blocking blood flow, leading to increasingly contracted tendons and emaciated thighs. It belongs to the Foot-Shaoyang Gallbladder and Foot-Yangming Stomach meridians. It is appropriate to use Yulong Gao (Jade Dragon Ointment), mixed with wine and applied to the leg, to relieve pain and restore yang. Also apply Chonghe Gao (Harmony Ointment) to the ankle to guide qi and move blood. Internally take Dafangfeng Tang (Great Wind-Protecting Decoction) and Zhuifeng Wan (Wind-Chasing Pill), doubling the amount of Ruxiang (Olibanum) to relieve pain and relax sinews. Moxibustion with garlic partition is also suitable."
Someone asked: "Swelling and pain above the knee, what is this?" The answer was: "This has multiple causes and requires clear differentiation. If both inner and outer sides of both knees are swollen, pain feels like being bitten by a tiger, chills and fever alternate, the thighs gradually become thin while the knees swell more, it is named Crane Knee Wind. Urgently perform garlic-partition moxibustion and take Dafangfeng Tang. If only one knee hurts, pain radiates up and down, swelling is not severe but slightly red, it is named 'Knee Roaming Wind'. Take Shengshou Dan (Holy Bestowal Pill), Huangu Dan (Bone-Swapping Pill), and Fangfeng Tongsheng San added with Niuxi and Mugua. If only the two sides of the knee are swollen and painful, with aversion to cold and high fever, worsening day and night, and the swollen area cannot be touched, it is 'Knee Eye Toxicity' (Xi Yan Du). Swelling and pain on the kneecap is 'Knee Abscess' (Xi Yong). For these two conditions, take Shengjin Dan (Victorious Gold Pill), or Zijin Dan (Purple Gold Pill), Bazhen San, or Huoming Yin (Life-Saving Decoction) added with Niuxi."
Xue Ji commented: "Crane Knee Wind results from improper regulation, damaging the Three Yin meridians of the foot (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/pain. Over time, the knee swells while the calf thins, resembling a crane's knee. If the Spleen and Stomach are damaged, Buzhong Yiqi Tang (Middle-Warmer Boosting Qi-Decoction) is primary. If Liver and Kidney are damaged, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) is primary. To promote suppuration or after ulceration, Shiquan Dabu Tang (Perfect Ten Tonifying Decoction) is primary, all assisted by Dafangfeng Tang. At onset, scallion warming (Cong Yun) should be used to resolve internally. If fluids are dry and mouth is parched, it is Middle Qi deficiency; use Buzhong Yiqi Tang with Wuweizi. Dizziness and headache indicate failing Yang ascending; use Buzhong Yiqi Tang with Manjingzi. Fever or afternoon tidal fever indicates Yin-blood deficiency; use Siwu Tang (Four Substances Decoction) with Renshen, Huangqi, Baizhu. Aversion to cold indicates Yang deficiency; use Shiquan Dabu Tang. Poor appetite and chest fullness indicate Spleen-Stomach deficiency stagnation; use Sijunzi Tang (Four Gentlemen Decoction). Withered yellow complexion and poor appetite indicate Spleen-Stomach weakness; use Liujunzi Tang (Six Gentlemen Decoction). Clear pus and lack of muscle regeneration indicate dual Qi-Blood deficiency; use Bazhen Tang (Eight Treasures Decoction). Intermittent fever indicates rootless deficient fire; use Shiquan Dabu Tang. Emaciation, lethargy, nocturnal fever, profuse phlegm, thirst, and frequent urination indicate five-zang deficiency; use Liuwei Dihuang Wan. Umbilical/abdominal pain, nocturia, weak knees, dizziness, and vomiting phlegm indicate cold failure of Kidney Qi; use Bawei Wan (Eight-Ingredient Pill). High fever, extreme thirst, desire to remove clothes, red face, and large-deficient pulse indicate blood deficiency with irritability; use Danggui Buxue Tang (Angelica Tonifying Blood Decoction). Cases following dysentery are treated similarly; other cases require clinical flexibility."
Crane Knee Wind (aka Drumstick Wind): Both calves and thighs are thin as reeds, only the knee remains large, making walking impossible.
Modified Xiaoxuming Tang: Use ingredients of Xiaoxuming Tang, adding Bibie (Dioscoreae Hypoglaucae Rhizoma), Chuanlianzi (Meliae Fructus), Duhuo (Angelicae Pubescentis Radix), and Gan Mugua (Chaenomelis Fructus). Crush, do not use fresh ginger, decoct in water. Place a little Shexiang (Moschus) at the bottom of the bowl first. Strain and pour into the bowl to drink. After dozens of doses, add Wuji San (Five Accumulations Powder) and decoct together for permanent cure. Another method: decoct Zijingpi (Broussonetiae Cortex) in aged wine and take warm regularly.
Luo Shi Lang Wan: Treats Crane Knee Wind and waist/knee contraction diseases. (One whole Scorpion, head and tail intact, raw) Tao Ren (raw) Baifuzi (Typhonii Rhizoma) Awei (Ferulae Resina) Guixin (Cinnamomi Ramulus) Anshixiang (Styrax) Bai Zhi (Angelicae Dahuricae Radix) [Each 1 liang] Ruxiang (Olibanum) Moyao (Myrrha) [Each 7.5 qian]. The above nine herbs are stir-fried hot in child's urine and wine (2 sheng), set aside. Beiloulu (Euphorbiae Pekinensis Radix) Danggui (Angelicae Sinensis Radix) Baishao Yao (Paeoniae Radix Alba) Niuxi (Achyranthis Bidentatae Radix) Qianghuo (Notopterygii Rhizoma et Radix) Digupi (Lycii Cortex) Weilingxian (Salviae Miltiorrhizae Radix et Rhizoma / Glehniae Radix - context implies Salvia or similar moving herb, usually Glehniae Radix in this formula context but text says Weilingxian which is typically Salviae Miltiorrhizae or Glehniae, here likely Glehniae based on standard formulas, but strictly translating text: Weilingxian) [Each 1 liang], ground to powder. Honey pills, size of bean, taken empty stomach with warm wine. Dr. Hu Chuwang suffered from wind-spasm, finger joints swollen like plums/peaches, unbearable pain; taking this cured him completely.
Danxi treated an elder, age 70, suffering from foot/knee pain and slight swelling. Shengdihuang (Rehmanniae Radix) Danggui Tou (Angelicae Sinensis Radix Caput) Baishao Yao (Paeoniae Radix Alba) Cangzhu (Atractylodis Rhizoma) Chao Bai (Phellodendri Cortex, fried) [Each 3 qian] Chuanxiong (Ligustici Chuanxiong Rhizoma) Gui (Cinnamomi Ramulus) [Each 2 qian] Mutong (Akebiae Caulis) [1.5 qian]. Divide into four doses. Decoct to a small cup, take hot before meals.
A man, nearly 30, accustomed to rich food, prone to anger. In autumn, a point of pain appeared left/right of the hip joint, extending to the knee. Quiet by day, worse by night. Aversion to cold, sometimes thirsty, sometimes not, sometimes bloated, sometimes not. Doctors mostly used wind-dispelling drugs combined with blood-tonics. By next spring, the knee swelled, pain worsened, appetite decreased, body emaciated. By late spring, knee swollen like a peach, unable to flex/extend. Pulse: Left string-taut-large-rather-solid, Cun very choppy, overall rapid. Knew urination must be frequent and scant. Treated as dietary/phlegm-stagnation in Taiyang/Yangming meridians. Chao Huangbai (Phellodendri Cortex, fried) 1 liang, Sheng Gancao Shao (Glycyrrhizae Radix et Rhizoma tip), Xijiao Xie (Rhinocerotis Cornu section), Yan Chao Cangzhu (Salt-fried Atractylodis Rhizoma) [Each 3 qian], Chuanxiong 2 qian, Chenpi (Citri Reticulatae Pericarpium), Niuxi, Mutong, Shaoyao [Each 5 qian]. Add Tiao Qin (Scutellariae Radix) 3 qian in hot weather. Grind to fine powder. Each dose 3 qian, ground with fresh ginger juice, mixed with water, boiled, taken hot before meals, 4 times/day. After half a month, rapid pulse decreased, pain lightened. Remove Xijiao, add Niuxi, Baiguiban (Testudinis Carapax et Plastrum) 0.5 liang, Danggui 0.5 liang, take as before. After another half month, swelling decreased, appetite increased, no longer averse to cold. Only foot/knee soreness/weakness, unable to stand/walk long. Remove Cangzhu, Huangqin. Season was summer heat, add Chao Huangbai to 1.5 liang. I added Niuxi to this base formula; use stem/leaf in spring/summer, root in winter, crush for juice, effect is faster. Must avoid alcohol, meat, wet noodles, pepper. Mid-summer, add Shengdihuang 0.5 liang; winter, add Shanzhuyu (Corni Fructus), Guizhi (Cinnamomi Ramulus).
Huangu Dan: Universally treats wind, also Crane Knee Wind. Fangfeng (Saposhnikoviae Radix) Niuxi Danggui (Angelicae Sinensis Radix) Hugu (Pantheris Os, baked with rice wine) [Each 1 liang] Gouqi (Lycii Fructus) [2.5 liang] Qianghuo (Notopterygii Rhizoma et Radix) Duhuo (Angelicae Pubescentis Radix) Baiguiban (Testudinis Carapax et Plastrum) Qin Jiao (Gentianae Macrophyllae Radix) Bi Xie (Dioscoreae Hypoglaucae Rhizoma) Song Jie (Pinus Massoniana Node) Can Sha (Bombyx Batryticatus) [Each 1 liang] Qiegen (Solanum Melongena Root) [Washed, 2 liang] Cangzhu (Atractylodis Rhizoma) [4 liang]. Soak in wine or make pill with wine paste.
Sinew urgency/pain in foot: Boil Mugua until soft, grind to porridge-like consistency, wrap around painful area. Change when cool. Apply warm 3-5 times overnight for recovery. Add half wine when boiling Mugua.
Zi He treated Li Wenqing from Lingbei, who had clicking sounds in both knee patellas during flexion/extension. Some thought it was bone noise. Dai Ren (Zi He's name) said: No, bones don't rub to make sound. This is sinew dampness. Dampness makes sinews tight; loose sinews don't sound, tight ones do. Use my drug to purge and drain water from above and below, and the sound will cease. Li Wenqing followed this, and it worked.
Prefect Zhang Tianze had left knee swelling/pain, chest fullness, poor appetite, nausea, dizziness, phlegm obstruction, fatigue in afternoon. This is Spleen-Lung Qi deficiency. Used Cong Yun (scallion warming) and Liujunzi Tang (Six Gentlemen Decoction) + Pao Jiang (Zingiberis Rhizoma Preparatum). Symptoms receded, appetite improved. Used Buzhong Yiqi Tang + Manjingzing (Vernoniae Herba), head/eyes cleared. Intermittently gave Dafangfeng Tang >10 doses, then Buzhong Yiqi Tang >30 doses, resolved.
Commissioner Liu Guowei first had sinew spasm/bone pain, right knee diffuse swelling. Used phlegm-resolving/detoxifying agents, swelling/pain worsened, poor appetite/fatigue. Added wind-dispelling/detoxifying agents, chills/fever/nausea, loose stool. Used Erchen Tang (Two-Aged Decoction) type damp-draining agents, swelling turned red, internal pain like awning. Pulse slippery-rapid-but-deficient. Pus formed, Yuan Qi too weak to ulcerate. Used Shiquan Dabu Tang 4 doses, assisted by Dafangfeng Tang 1 dose to ulcerate, then >100 doses to recover.
A scholar had lax leg sinews, then bilateral knee swelling/pain for a month. This is Yin deficiency with damp-heat invasion. Used Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) as main, assisted by Bazhen Tang + Niuxi, Duzhong (Eucommiae Cortex), intermittently Buzhong Yiqi Tang. Resolved in >3 months.
A man had leg pain/knee swelling, pulse floating, pressing string-taut-tight. This is Liver-Kidney deficiency. Used Dafangfeng Tang 2 doses, retreated. He feared Fuzi (Aconiti Lateralis Radix Preparata) toxicity, took wound-healing drugs instead. Became emaciated, deficiency symptoms arose, required rescue again. I said: Fatigue/emaciation is Spleen-Stomach failure to transport. Incontinence is Bladder deficiency to control. Dry heat/false fullness is Stomach Qi weakness to transform. Confusion/amnesia is Spirit loss. Evil symptoms swarm, I declined treatment. He died.
This condition often affects deficient people. Thus, Modified Xiaoxuming Tang and Dafangfeng Tang are effective. Attack drugs will cause error.
A woman had knee swelling/pain, worse with cold, >1 month, drugs ineffective, pulse string-taut-tight. Deep-seated cold pathogen. Used Dafangfeng Tang and Huolong Dan (Fire Dragon Pill), resolved.
Generally, although swelling depth and pathogen severity vary, the root is True Qi deficiency allowing deep pathogen invasion. Thus, Guyong Ju (Bone-Adhering Carbuncle) and Crane Knee Wind are common in Kidney deficiency. Ancients used Fuzi to warm Kidney Qi, drive drug action, and scatter cold. Also, deficient people sleeping outdoors in autumn/summer suffer cold air invasion, cold-heat knotting, forming this condition, immobility, sudden heat/no sweat, pain on pressure reaching bone. If unresolved long-term, extreme Yin generates Yang, cold transforms to heat, and ulcerates. If severely injured by thief-wind, local area not hot, but shivering chills, intermittent sweating, moxibustion relieves pain slightly. Use Dafangfeng Tang and Huolong Gao (Fire Dragon Ointment). There is also curved paralysis, hard as stone, named Shiju (Stone Carbuncle). If heat slows accumulation without ulcerating, flesh red-purple, skin/flesh rotting, named Huanyi. Initial/end stages suit previous decoctions to dispel cold and tonify deficiency/support interior.
Dafangfeng Tang: Treats Foot-Three-Yin deficiency, external pathogens invading void, Crane Knee Wind or Guyong Ju. Swelling/pain or swelling without pain. Whether ulcerated or not, use 3-5 doses, then tonifying agents.
Fuzi (Aconiti Lateralis Radix Preparata) Niuxi (Achyranthis Bidentatae Radix) [Each 1 qian] Baizhu (Atractylodis Rhizoma) Qianghuo (Notopterygii Rhizoma et Radix) Renshen (Ginseng Radix et Rhizoma) Fangfeng (Saposhnikoviae Radix) [Each 2 qian] Chuanxiong (Ligustici Chuanxiong Rhizoma) [1.5 qian] Lagui (Cinnamomi Ramulus) Huangqi (Astragali Membranacei Radix) Baishao Yao (Paeoniae Radix Alba) Duzhong (Eucommiae Cortex) Shudihuang (Rehmanniae Radix Preparata) Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) [Each 0.5 fen]. Decoct in water and drink.
Huan Shao Dan: Treats Foot-Three-Yin deficiency, knee wind etc., excellent for tonifying Spleen/Kidney and promoting appetite.
Roucong Rong (Cynomorii Herba, wine-soaked, remove scales) Yuanzhi (Polygalae Radix, licorice-water soaked, remove core) Shan Yao (Dioscoreae Rhizoma, fried) Bajitian (Morindae Officinalis Radix, remove heart) Gouqizi (Lycii Fructus) Shan Yao (Dioscoreae Rhizoma) Niuxi (Achyranthis Bidentatae Radix) Shichangpu (Acori Tatarinowii Rhizoma) Duzhong (Eucommiae Cortex) Shudihuang (Rehmanniae Radix Preparata, made into paste) Wuweizi (Schisandrae Chinensis Fructus) Baifuling (Poria) Chushizi (Celtidis Fructus) Shanzhuyu (Corni Fructus Carnosus) [Equal parts]. Grind to powder. Make pills with red date flesh and honey, size of wutong seeds. Take 70 pills each time with warm wine, 3 times daily. Plain water is also acceptable.
Jingjin Dixian Dan and Huangu Dan (See Volume 5 of Miscellaneous Diseases).
*[Suwen]* Stiff knee unable to extend, treat its Jian. (*Guyu Lun*, same below. Text: Above the auxiliary bone, below the horizontal bone is Jian. Wang Bing note: Above the femoral auxiliary bone, below the horizontal bone, middle of lateral thigh. Stand sideways, shake to locate, tendon moves under hand. Hua Shou note: Below Jian bone is Bitou. Jian is the junction of two bones.) Sitting with knee pain, treat its Ji. (Text: Beside the hip is Ji. Wang Bing note: Sides of hip bone, junction point. Hua Shou note: Hip bone beside waist, hip bone is Ji, behind Ji is buttock.) Standing with heat sensation in knee, treat its Haiguan. (Text: Knee solution is Haiguan. Wang Bing note: Shu means heat. If knee disease rises, heat in knee bone solution, treat Haiguan. Text: Rise and pull knee bone solution. Hua Shou note: Beside knee solution is Bin.) Knee pain, pain extends to big toe, treat its... (Text: Above auxiliary is... Wang Bing note: ... is behind knee solution, middle of bent foot, Weizhong acupoint.) Sitting with knee pain as if hidden object, treat its Guan. (Text: ... above is Guan. Wang Bing note: Guan is above ..., behind Jian, stand back press move, tendon responds.) Knee pain unable to flex/extend, treat its Bi Nei... (Wang Bing note: Dazhu acupoint.) Connecting ... if broken, treat Yangming Zhongshu ... (Wang Bing note: If knee pain unable to flex/extend, connecting ... pain like breaking, then needle Yangming acupoint, Zhongshu ..., Sanli acupoint.) Knee pain like separation, treat Juyang, Shaoyang Ying. (Wang Bing note: If pain and knee like separating, treat Foot-Taiyang Ying, Tonggu acupoint, Foot-Shaoyin Ying, Ran gu acupoint.) Yinlu calf sourness, unable to stand long, treat Shaoyang Zhi Wei, outside upper 5 cun. (Outside upper should be outside ankle upper. Wang Bing note: Yinlu means sour-pain feeling powerless. Outside ankle upper 5 cun, Guangming acupoint.) Re-examine the above Jian, Ji, Haiguan, and other acupoints.
*[Lingshu]* Pain in middle of knee, take Dubi, needle with Yuanli needle. Needle during attack, interval between attacks. Needle thickness like li, no doubt in knee needling. (*Zabing Pian*.)
*[Yulong Ge]* Crane Knee Wind swelling and leg pain. Suigu (1 cun above kneecap, 0.5 cun left/right of Liangqiu, needle 0.5 cun, retain one breath, reduce.) Xiguan (Below knee cap, inside beside Dubi, horizontal needle through Xiyan, outside beside Dubi, forbid moxa, retain eight呼, reduce.)
*[Jiyuan]* Another method: Xiguan, Weizhong (3.5 cun; best if purple vein bleeds.) Sanli (If not cured, take lower acupoint.) Yanglingquan, Zhongwan, Fenglong.
*[Tongxuan]* Knee swelling: Xingjian.
*[Cuoyao]* Yanglingquan (Horizontal penetrate Yinlingquan, tonify birth, reduce completion.) Yinlingquan (Horizontal penetrate Yanglingquan, tonify birth, reduce completion.) Xiguan (Method see previous *Yulong* below.)
*[Shiyi]* Foot twisting pain: Weizhong (bleed.)
*[Sang]* Foot/knee pain sinew urgency: Fengchi, Sanjian, Sanyinjiao, Sanli.