钱仲阳云∶鹤膝者，乃禀受肾虚，血气不充，致肌肉瘦薄，骨节呈薄，如鹤之膝也。行迟者
，亦因禀受肝肾气虚，肝主筋，肾主骨，肝藏血，肾藏精，血不足，则筋不荣，精不足，则
骨不立，故不能行也。鹤膝用六味地黄丸加鹿茸以补其血气，血气既充，则其肌肉自生。行
迟用地黄丸加牛膝、五加皮、鹿茸，以补其精血，精血既足，则其筋骨自坚。凡此皆肝肾之
虚也，虚而热者，用六味地黄丸。虚而寒者，用八味丸。若手拳挛者，用薏苡仁丸。足拳挛
者，用海桐皮散。脾胃亏损，肾脏虚弱，寒邪所乘而膝渐肿者，佐以补中益气汤，及大防风汤
。
治验
一小儿体瘦腿细，不能行，齿不坚，发不茂，属足三阴经虚也。用六味丸、补中益气汤，年
余诸症悉愈。
一小儿六岁，面色 白，眼白睛多，久患下痢，忽声音不亮，腿足无力，先用四神丸止其痢
；后用地黄丸加牛膝、五加皮、鹿茸补其肾，两月余渐能行，半载后，其声音亮。后停食，
另用消食丸，连泻五六次，去后益频，五更侵晨为甚，声音复喑，步履复难，而腿足作痛。
仍服前丸，兼补中益气汤而愈。
一小儿七岁，左腿自膝下至胫细小，行步无力，用地黄丸加鹿茸、五味子、牛膝为主，佐以
补中益气汤，半载腿膝渐强而能步。毕姻后，其腿内热，足心如炙，唾痰口渴。余谓∶当补
脾肾。不信，另用滋阴丸，痰热益甚；服四物、黄柏、知母之类，饮食日少；服二陈、青皮
、枳壳之类，胸满吐血；服犀角地黄汤，唾血不时，大便频数。复请视，仍泥实火，余辞不
能治。恪服犀角地黄丸，而唾血益甚，不时发热。后复恳治，余曰∶两足心热，唾痰口干，
肾虚水泛也。饮食少思，胸膈痞满，唾血不止，脾虚失摄也。昼发夜伏，夜作昼止，不时而
热，无根虚火也。遂用四君子及八珍汤、地黄丸，间服而愈。
四神丸 治脾虚胃弱，大便不实，饮食不思，或泄利腹痛等症。（方见惊泻）
薏苡仁丸 治禀受肝气怯弱，致两膝挛缩，两手伸展无力。
当归（焙） 秦艽 薏苡仁 酸枣仁 防己 羌活（各一两）
上为末，炼蜜丸，鸡豆大。每服一丸，麝香荆芥汤下。
海桐皮散 治禀受肾气不足，血气未荣，脚趾拳缩，不能伸展。
海桐皮 牡丹皮 当归（酒浸） 熟地黄 牛膝（酒浸。各一两） 山茱萸 补骨脂（各五钱）
上为末，每服一钱，葱白煎汤，食前服。
五加皮散 治四五岁不能行。
真五加皮 川牛膝（酒浸二日） 木瓜干（各等分）
上为末，每服二钱，空心米汤调下，一日二服，服后再用好酒半盏，与儿饮之，仍量儿大小
。
益气养荣汤 治气血损伤，四肢颈项等处患肿，不问软硬、赤白痛否，日晡发热，或溃而不
敛者，并宜服之。
人参 茯苓 陈皮 贝母 香附 当归（酒拌） 川芎 黄 （盐水拌炒） 熟地黄（酒拌） 芍药（炒。
各五分） 甘草（炙） 桔梗（炒） 柴胡（各三分） 白术（炒，一钱）
上姜水煎服，大人倍用。
八珍汤（即四君、四物二汤，四君见内钓，四物见急惊）
四神丸（方见惊渴）
六味丸
八味丸（即六味丸加肉桂、附子，二方见肾脏）
消食丸（方见呕吐乳）
补中益气汤（方见虚羸）
大防风汤（方见鹤膝风）
四君子汤（方见内钓）
Qian Zhongyang stated: "Crane-knee deformity" (He Xi Feng) results from congenital Kidney deficiency, where Qi and Blood are insufficient, leading to emaciated muscles and exposed, slender joints, resembling the knee of a crane. Delayed walking is also due to congenital deficiency of Liver and Kidney Qi. The Liver governs the sinews, and the Kidneys govern the bones; the Liver stores Blood, and the Kidneys store Essence (Jing). When Blood is deficient, sinews lack nourishment; when Essence is deficient, bones fail to stand firm, thus preventing walking. For crane-knee deformity, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill, a formula for tonifying Kidney Yin) is used with Lu Rong (Cervus Nippon Antler) to tonify Qi and Blood. Once Qi and Blood are充盈 (full), muscles will naturally grow. For delayed walking, Dihuang Wan is used with Niu Xi (Achyranthes Root), Wu Jia Pi (Acanthopanax Bark), and Lu Rong to tonify Essence and Blood. Once Essence and Blood are sufficient, sinews and bones will naturally become firm. All these conditions stem from Liver and Kidney deficiency. If deficiency accompanied by heat signs exists, use Liuwei Dihuang Wan; if deficiency accompanied by cold signs exists, use Bawei Wan (Eight-Ingredient Pill, i.e., Jin Gui Shen Qi Wan). If the hands are curled and contracted, use Yiyi Ren Wan (Coix Seed Pill). If the feet are curled and contracted, use Haitong Pi San (Haitong Bark Powder). If Spleen and Stomach damage occurs alongside Kidney weakness, with cold pathogenic factors invading causing gradual knee swelling, assist treatment with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Dafangfeng Tang (Major Wind-Expelling Decoction).
Clinical Cases:
One child was thin with slender legs, unable to walk, with weak teeth and sparse hair. This belonged to deficiency of the Three Yin Meridians of the Foot (Taiyin Spleen, Shaoyin Kidney, Jueyin Liver). Liuwei Dihuang Wan and Buzhong Yiqi Tang were used, and after more than a year, all symptoms resolved.
Another six-year-old child had a pale complexion, prominent whites in the eyes, and suffered from chronic dysentery. Suddenly, his voice became hoarse, and his legs and feet lacked strength. First, Sishen Wan (Four Spirits Pill) was used to stop the dysentery; subsequently, Dihuang Wan with added Niu Xi, Wu Jia Pi, and Lu Rong was used to tonify the Kidneys. After two months, he gradually gained the ability to walk, and after half a year, his voice became clear. Later, he experienced food stagnation, and Xiaoshi Wan (Digestive Pill) was administered separately. He suffered diarrhea five or six times consecutively, followed by even more frequent bowel movements, particularly severe at dawn (Wugeng). His voice became hoarse again, walking became difficult, and his legs and feet hurt. He continued taking the previous pills and concurrently took Buzhong Yiqi Tang, resulting in recovery.
Another seven-year-old child had a left leg that was thin from the knee down to the tibia, with weak walking ability. The main prescription was Dihuang Wan with added Lu Rong, Wuweizi (Schisandra Fruit), and Niu Xi, assisted by Buzhong Yiqi Tang. After half a year, his leg and knee strength improved, enabling him to walk. After marriage, he experienced internal heat in the legs, burning sensations in the soles of his feet, and coughed up phlegm with thirst. I advised tonifying the Spleen and Kidneys. He did not believe me and instead used Ziyin Wan (Nourishing Yin Pill), which exacerbated the phlegm-heat. Taking Siwu Tang (Four Substances Decoction), Huangbai (Phellodendron Bark), and Zhimu (Anemarrhena Rhizome) reduced his appetite. Taking Erchen Tang (Two-Aged Decoction), Qingpi (Aurantium Peel), and Zhike (Aurantii Fructus) caused chest fullness and hematemesis. Taking Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) led to intermittent hemoptysis and frequent stools. Upon re-examination, he still insisted on a diagnosis of Excess Fire. I declined treatment. He persistently took Xijiao Dihuang Wan, worsening the hemoptysis and causing intermittent fever. He later pleaded for treatment again. I said: Heat in both soles, phlegm expectoration, and dry mouth indicate Kidney deficiency with water flooding. Reduced appetite, chest diaphragm stuffiness, and persistent hemoptysis indicate Spleen deficiency failing to control blood. Fever occurring during the day and subsiding at night, or vice versa, indicates rootless deficient fire. Thus, Sijunzi Tang (Four Gentlemen Decoction), Bazhen Tang (Eight Treasures Decoction), and Dihuang Wan were used alternately, leading to recovery.
Sishen Wan: Treats Spleen deficiency and Stomach weakness, loose stools, anorexia, or diarrhea with abdominal pain. (Formula see Jingxie chapter)
Yiyi Ren Wan: Treats congenital Liver Qi timidity, leading to knee contraction and inability to extend the hands.
Danggui (Roasted) Qinjiao Yiyiren Suanzao Ren Fangji Qianghuo (Each 1 liang)
Grind into powder, make pills with refined honey, size of a chicken bean. Take one pill per dose, washed down with Shexiang Jingjie Tang (Musk and Schizonepeta Decoction).
Haitong Pi San: Treats congenital Kidney Qi insufficiency, where Qi and Blood fail to nourish, causing toe curling and inability to extend.
Haitongpi Mudanpi Danggui (Soaked in Wine) Shudihuang Niuxi (Soaked in Wine. Each 1 liang) Shanzhuyu Buguzhi (Each 5 qian)
Grind into powder. Take 1 qian per dose, washed down with Congbai Tang (Scallion White Decoction) before meals.
Wujia Pi San: Treats inability to walk in children aged four or five.
Zhen Wujia pi Chuan Niuxi (Soaked in wine for two days) Mugua gan (Equal parts)
Grind into powder. Take 2 qian per dose, mixed with rice water on an empty stomach, twice daily. After dosing, give the child half a cup of good wine, adjusting according to the child's size.
Yiqi Yangrong Tang: Treats Qi and Blood injury, swelling in limbs, neck, etc., regardless of hardness, color (red/white), or pain. Also suitable for afternoon fever (Shibu) or ulcers that fail to heal.
Renshen Fuling Chenpi Beimu Xiangfu Danggui (Mixed with wine) Chuanxiong Huangqi (Stir-fried with salt water) Shudihuang (Mixed with wine) Shaoyao (Stir-fried. Each 5 fen) Gancao (Honey-fried) Jiegeng (Stir-fried) Chaihu (Each 3 fen) Baizhu (Stir-fried, 1 qian)
Decoct with ginger water. Adult dosage is doubled.
Bazhen Tang (Combination of Sijunzi Tang and Siwu Tang; Sijunzi Tang see Neidiao chapter, Siwu Tang see Jijing chapter)
Sishen Wan (Formula see Jingke chapter)
Liuwei Wan
Bawei Wan (Liuwei Dihuang Wan plus Rougui and Fuzi; both formulas see Zangshen chapter)
Xiaoshi Wan (Formula see Outu Ru chapter)
Buzhong Yiqi Tang (Formula see Xu lei chapter)
Da Fangfeng Tang (Formula see He Xifeng chapter)
Sijunzi Tang (Formula see Neidiao chapter)