Library

1. When the physical constitution and vital energy are exhausted, and there is no desire for food, it is incurable.
2. When all teeth fall out, the gums are purple-black with bleeding, and there is putrefaction, ulceration, and foul odor, it is incurable.
3. When the legs are severely swollen and rotting, or thin and dry/withered, it is incurable.

Xi Yong (Knee Abscess): The swelling is red in color and painful; Ju (Knee Ulcer/Gangrene) resembles an abscess but is not red in color. Softness and pliability indicate a favorable prognosis (Shun), while hardness indicates an unfavorable prognosis (Ni). This is caused by pathogenic factors invading the Spleen, Kidney, and Liver meridians.
[Annotation] Xi Yong arises at the knee, characterized by redness, swelling, and pain, belonging to Excess patterns of Qi and Blood. Ju also arises at the knee, with swelling similar to an abscess, but the color does not change, accompanied by alternating chills and fever, belonging to Deficiency patterns of Qi and Blood. Softness and pliability indicate a favorable prognosis; hardness like stone indicates an unfavorable prognosis. The Classics state: "The small gatherings of flesh are called Xi." The term "Xi" refers to the two elbows, two knees, and two wrists. Generally, Spleen diseases manifest in the Xi; when the Kidney has pathogenic factors, their Qi remains in the two knees; generally, tendon diseases belong to the joints. Since tendons are the surplus of the Liver, they also belong to the Liver. Therefore, diseases occurring at the Xi gatherings are all caused by pathogenic factors from the Spleen, Kidney, and Liver meridians taking advantage of weakness. Throughout, internal and external treatment methods should follow the protocols for Swollen Sores (Zhongyang) and Ulcerated Sores (Ku Yang) sections in the Carbuncle and Ulcer chapters. Only when both knees are affected simultaneously does it constitute a failure syndrome (Bai Zheng), which is untreatable.

Xi Yan Feng (Wind at the Knee Eye): Arises at the Gui Yan point (also known as the Knee Eye point), with pain like a cone piercing and swelling. It is caused by deficiency in the Lower Jiao allowing invasion of Wind-Damp-Cold pathogens, leading to inability to flex and extend smoothly; warm dispersal methods are effective.
[Annotation] This condition arises at the Xi Yan point, also named the Gui Yan point, located in the hollows between the bones below the knee on both left and right sides. Due to inherent deficiency in the Lower Jiao, external pathogens easily invade. Initially, there is hidden pain in the knee eye. If Wind is predominant, the pain migrates unpredictably; if Cold is predominant, the pain feels like cone piercing; if Dampness is predominant, external swelling appears. Inability to flex indicates disease in the tendons; inability to extend indicates disease in the bones; difficulty in movement and shifting indicates chronic cold and entrenched cold syndromes. Clinical differentiation must be detailed. Initially, administer Wan Ling Dan to warm and disperse, after which the pain stops. Subsequently, administer Du Huo Ji Sheng Tang to promote circulation and tonify. For cases with slow response, combine with fire needle acupuncture at the Xi Yan point; this is a method of turning heavy into light. Unilateral knee involvement is mild; bilateral knee involvement is severe. If the left knee heals and then the right knee becomes diseased, or vice versa, it is named Guo Xi Feng (Passing Over the Knee Wind), which is dangerous. The treatment method is the same as above.

Du Huo Ji Sheng Tang
Ingredients: Du Huo (Radix Angelicae Pubescentis), Sang Ji Sheng (Herba Taxilli) [if genuine is unavailable, substitute with Chuan Xu Duan (Radix Dipsaci)], Ren Shen (Radix Ginseng), Fu Ling (Poria), Chuan Xiong (Rhizoma Chuanxiong, washed with wine), Fang Feng (Radix Saposhnikoviae), Gui Xin (Cortex Cinnamomi), Du Zhong (Cortex Eucommiae, stir-fried with ginger juice, remove fibers), Niu Xi (Radix Achyranthis Bidentatae), Qin Jiao (Radix Gentianae Macrophyllae), Xi Xin (Herba Asari) [each 1.5 qian], Dang Gui (Radix Angelicae Sinensis, washed with wine), Bai Shao (Radix Paeoniae Alba, stir-fried with wine), Shu Di Huang (Radix Rehmanniae Preparata), Gan Cao (Radix Glycyrrhizae) [each 1 qian]. Decoction method: Add five slices of fresh ginger and two bowls of water, decoct until reduced to 0.7 bowl. Take before meals.
[Formula Song]: Du Huo Ji Sheng Tang treats Liver and Kidney deficiency, where Cold-Dampness settles in the knees causing swelling and pain. It contains Ren Shen, Fu Ling, Si Wu Tang (Four Substance Decoction), Fang Feng, Gui Xin, along with Du Zhong, Niu Xi, Qin Jiao, Gan Cao, and Xi Xin, which are appropriate.
Wan Ling Dan (See section on Swollen Sores)