经云。膝者筋之府。屈伸不能。行则偻俯。筋将惫矣。故膝痛无有不因肝肾虚者。虚则风寒
湿气袭之。又曰。身半以以下者。湿中之也。故治膝胫之病。又须以去湿为主。大抵痛在筋者。多
挟风热。则屈不伸而肿。二妙散加羌、防、升、柴。兼阴虚者则热而不肿。虎潜丸。或二妙加牛
膝、肉桂。因卧湿地。流入脚膝。痹弱疼重。千金独活寄生汤。夏月湿热沉重而
痛。当归拈痛汤。痛在骨者多兼寒饮。重而屈伸不利。常若拭不干状。附子丸、川芎肉桂汤、活
络丹、铁弹丸选用。虚寒挟风湿而痛。虎骨四斤丸。如肝肾虚热。筋骨痿弱。颤掉而痛。鹿茸四
斤丸。若痛在冲阳及肉者。属足阳明经。痛在委中 肠者。属足太阳经。在外廉者。属少阳。在
内廉者。属三阴。随其经而取之。
足跟痛 肾脏阴虚者。则足胫时热而足跟痛。六味丸加龟板、肉桂。阳虚者。则不能久立而
足跟痛。八味丸。挟湿者。必重着而肿。换骨丹、史国公药酒。肥人湿痰流注。导痰汤加木瓜、
萆、防己。虚人。用补中益气、十全大补汤。并少加附子为引。凡下部痛。多用药酒。殊不知
病甚于冬者。为寒湿。故宜用酒。若春夏甚而秋冬减者。此属湿热。若用药酒。是反助其湿也。
足心痛 足心及踝骨热疼者。为肾虚湿着。命门火不归经。肾着汤。下八味丸。肥人多湿痰
流注。足心作痛。但久坐卧。起则痛甚。行动则缓。宜肾着汤合二妙散。慎不可用补骨药及血药
助阴。愈增其剧。
戴人治一人。两膝膑屈伸有声剥剥然。此筋湿也。湿则筋急。有独缓者不鸣。急者鸣也。乃
一涌一泄。上下去其水。水去则自然无声矣。
The *Yellow Emperor's Inner Classic* states: The knee is the mansion of sinews. If flexion and extension are impossible, and walking requires stooping, it indicates that the sinews are exhausted. Therefore, knee pain invariably stems from deficiency of the Liver and Kidney. Deficiency allows Wind-Cold-Dampness to invade. It is also stated: The lower half of the body is prone to Dampness invasion. Thus, in treating diseases of the knee and shank, dispelling Dampness must be the primary approach. Generally, pain located in the sinews often involves Wind-Heat, manifesting as inability to extend and swelling; *Er Miao San* (Two Marvels Powder) added with *Qianghuo* (Notopterygii Rhizoma), *Fangfeng* (Saposhnikoviae Radix), *Shengma* (Cimicifugae Rhizoma), and *Chaihu* (Bupleuri Radix) may be used. In cases complicated by Yin deficiency, there is heat without swelling; *Hu Qian Wan* (Tiger Crouching Pill) is indicated. Alternatively, *Er Miao San* added with *Niuxi* (Achyranthis Bidentatae Radix) and *Rougui* (Cinnamomi Cortex) can be employed. When lying on damp ground causes Dampness to flow into the feet and knees, resulting in Bi syndrome, limb weakness, and heavy painful sensation, *Qian Jin Du Huo Ji Sheng Tang* (Thousand Golden Decoction for Expelling Wind-Dampness and Nourishing the Sinews) is used. For summer heat-dampness heaviness causing pain, *Danggui Niang Tong Tang* (Angelica Decoction for Relieving Pain) is prescribed. Pain located in the bones often accompanies Cold-Fluid retention, feeling heavy with limited flexion and extension, resembling a state that cannot be dried off; *Fuzi Wan* (Aconite Pill), *Chuanxiong Rougui Tang* (Ligusticum and Cinnamon Twig Decoction), *Huo Luo Dan* (Meridian-Unblocking Pill), or *Tie Dan Wan* (Iron Pellet Pill) may be selected according to the condition. For deficiency-cold complicated by Wind-Dampness causing pain, *Hugu Sijin Wan* (Tiger Bone Four-Jin Pill) is indicated. In cases of Liver-Kidney deficiency-heat leading to flaccidity and weakness of sinews and bones, trembling and pain occur; *Lurong Sijin Wan* (Deer Antler Four-Jin Pill) is used. If pain is located at Chongyang (ST42) and the flesh, it belongs to the Foot-Yangming Meridian; if pain is at Weizhong (BL40) and the popliteal fossa, it belongs to the Foot-Taiyang Meridian; if on the lateral margin, it belongs to Shaoyang; if on the medial margin, it belongs to the Three Yin meridians. Treatment should select points according to the affected meridian.
**Heel Pain:** Kidney Yin deficiency leads to frequent heat in the shanks and heel pain; *Liuwei Wan* (Six-Ingredient Pill with Rehmannia) added with *Guiban* (Testudinis Carapax et Plastrum) and *Rougui* (Cinnamomi Cortex) is used. Yang deficiency results in inability to stand for long periods and heel pain; *Bawei Wan* (Eight-Ingredient Pill, i.e., *Jinkui Shenqi Wan*) is indicated. Complicated by Dampness, there is necessarily heaviness, stagnation, and swelling; *Huangu Dan* (Bone-Changing Pill) or *Shi Guogong Yaojiu* (Minister Shi’s Medicinal Wine) may be used. Obese individuals often suffer from Phlegm-Dampness flowing and depositing; *Daotan Tang* (Phlegm-Expelling Decoction) added with *Mugua* (Chaenomelis Fructus), *Bixie* (Dioscoreae Hypoglaucae Rhizoma), and *Fangji* (Stephaniae Tetrandrae Radix) is prescribed. For deficient persons, *Buzhong Yiqi Tang* (Decoction for Boosting the Middle and Augmenting Qi) or *Shiquan Dabu Tang* (Ten Complete Great Tonifying Decoction) is used, with a small amount of *Fuzi* (Aconiti Lateralis Radix Praeparata) added as a guiding herb. Generally, pain in the lower parts is treated with medicinal wines. However, one must realize that conditions worsening in winter are due to Cold-Dampness, making wine therapy appropriate. Conversely, conditions worsening in spring and summer but alleviating in autumn and winter belong to Heat-Dampness; using medicinal wine would counterproductively augment Dampness.
**Sole Pain:** Heat and pain in the sole and ankle bones indicate Kidney deficiency with Dampness adhering, and Mingmen Fire failing to return to its source; *Shenzhe Tang* (Kidney-Attaching Decoction) or *Xia Bawei Wan* (Lower Eight-Ingredient Pill) is used. Obese individuals often experience sole pain due to Phlegm-Dampness flowing and depositing; pain worsens upon rising after prolonged sitting or lying, but eases with movement. *Shenzhe Tang* combined with *Er Miao San* is suitable. One must strictly avoid using bone-tonifying herbs and blood-invigorating herbs that nourish Yin, as this will exacerbate the condition.
Zhang Dairen treated a patient whose patellae made a "pop-pop" sound during flexion and extension of both knees. This was caused by Dampness in the sinews. Dampness causes sinew tension; relaxed sinews do not make noise, while tense ones do. He applied bleeding at Yongquan (KI1) and purgation to drain water from above and below. Once the water was removed, the sound naturally ceased.