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Whenever there is swelling and pain in the elbows and knees, while the arms or legs are thin, this condition is called He Xi Feng (Crane's Knee Wind), named for its resemblance to a crane's knee. In some cases, only both knees are swollen with withered and thin calves, unable to flex or extend, commonly known as Gu Chui Feng (Drumstick Wind). This is generally caused by the flow and accumulation of Wind, Cold, and Dampness pathogens. However, swelling and pain indicate the presence of pathogenic stagnation, while withering and thinness indicate Blood deficiency. Treatment must primarily focus on nourishing Qi and Blood. If Wind is present, disperse it concurrently; if Cold and Dampness are present, dispel them concurrently. If heat arises from pathogenic constraint, nourish Yin and clear Fire, ensuring recovery. If it occurs after dysentery, it is called Li Hou Feng (Post-Dysentery Wind); since diarrhea and dysentery cause loss of Yin, tonifying the Kidney is especially appropriate. For predominance of Cold, San Qi Yin (Three Qi Decoction), Wu Ji San (Five Accumulations Powder), or Da Fang Feng Tang (Great Saposhnikovia Decoction) are suitable. For predominance of Dampness, Wu Ling San (Five Ingredient Powder with Poria) or Li Zhong Tang (Regulate the Middle Decoction) are suitable. For predominance of Heat, Bao Yin Jian (Preserve the Yin Decoction) or Da Qin Jiao Tang (Major Gentian Decoction) are suitable. If Yang Qi insufficiency leads to deterioration affecting the four limbs, formulas such as You Gui Wan (Right Restoration Pill), Li Yin Jian (Regulate Yin Decoction), or Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill) are indispensable.

Xue Lizhai stated: He Xi Feng results from improper lifestyle management, leading to depletion of the Foot Three Yin Meridians (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 and pain. Over time, the knees enlarge while the calves become thin, resembling a crane's knee. If the Spleen and Stomach are damaged, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is primary. If the Liver and Kidneys are damaged, Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) is primary. To promote suppuration or treat post-ulceration, Shi Quan Da Bu Tang (Complete Great Tonifying Decoction) is primary, assisted by Da Fang Feng Tang. In the early stage, Cong Yun Fa (Scallion Moxibustion/Fomentation) can resolve it internally. If fluids are dry and the mouth is parched due to insufficient Middle Qi, add Wu Wei Zi (Schisandra Fruit) to Bu Zhong Yi Qi Tang. For dizziness and headache due to failing rising of Yang Qi, add Man Jing Zi (Vitex Fruit). For fever or afternoon tidal fever due to Yin-Blood deficiency, use Si Wu Tang (Four Substance Decoction) added with Ren Shen (Ginseng Root), Huang Qi (Astragalus Root), and Bai Zhu (Atractylodes Rhizome). For aversion to cold due to Yang Qi deficiency, use Shi Quan Da Bu Tang. For poor appetite and chest/epigastric distension due to Spleen-Stomach deficiency obstruction, use Si Jun Zi Tang (Four Gentlemen Decoction). For sallow complexion and poor appetite due to Spleen-Stomach weakness, use Liu Jun Zi Tang (Six Gentlemen Decoction). For thin pus and lack of muscle regeneration due to dual Qi-Blood deficiency, use Ba Zhen Tang (Eight Treasure Decoction). For intermittent fever without root due to deficient fire, use Shi Quan Da Bu Tang. For emaciation, lethargy, nocturnal fever during sleep, profuse phlegm, thirst, and frequent urination due to five-zang deficiency, use Liu Wei Wan (Six-Ingredient Pill). For umbilical/abdominal pain, nocturia, weak legs/knees, dizziness, and vomiting phlegm due to cold failure of Kidney Qi, use Ba Wei Wan (Eight-Ingredient Pill). For high fever, extreme thirst, desire to remove clothing, red face, and large-deficient pulse due to Blood deficiency causing dryness, use Dang Gui Bu Xue Tang (Angelica Tonifying Blood Decoction). Cases following dysentery should be treated similarly, adjusting according to clinical presentation.

Furthermore, each formula has specific indications. For weak constitutions where pathogens invade bone boundaries and block meridians, non-acrid-warm herbs like Fu Zi (Aconite Lateral Root) and Rou Gui (Cinnamon Bark) are required to disperse Cold in joints and cuticles, and unblock Qi-Blood in meridians; otherwise, recovery is impossible. The Materia Medica states that Fu Zi treats Cold-Damp flaccidity, spasmodic knee pain, and inability to walk; aided by Bai Zhu (Atractylodes Macrocephala Rhizome), it is a holy medicine for Cold-Damp. It also states that Rou Gui promotes blood vessels, resolves stasis, strengthens bones/joints, treats Wind-Bi, bone spasms, and soft legs, and guides other herbs. When using Shi Quan Da Bu Tang for these conditions, one must not omit Rou Gui nor add less than Fu Zi. Without these two, how can the efficacy of Ren Shen and Huang Qi be mobilized, or the nature of Xiong Gui (Ligusticum Chuanxiong Rhizome) and Dang Gui (Angelica Sinensis Root) be strengthened, to assist Qi-Blood, unblock meridians, support severe deficiency, and achieve certain efficacy? Since these conditions occur at critical joint points, delayed treatment allows Qi-Blood stagnation to turn into pus and drain away, exhausting Qi-Blood with no hope of recovery. Some cases arise from sleeping exposed in autumn/summer, where Cold attacks and internal Heat generates, forming Gu Ju (Bone Abscess). Others involve "Thief Wind" clashing with limbs, causing deep bone pain worsening with Cold, relieved slightly by heat fomentation; these require Da Fang Feng Tang, applied with mashed garlic on the lesion, covered with moxa and burned; replace garlic when burnt, even if skin breaks. If unresolved long-term, extreme Yin generating Yang leads to ulceration and discharge, potentially causing hemiplegia or fistulas; treat with Nei Sai San (Internal Blocking Powder) and moxibustion with Fu Zi cakes. Cases with large pulses or thirst are untreatable due to true Qi deficiency and pathogenic excess.

Mr. Zhang suffered from this condition, bedridden for half a year, draining pus for three months. He reported initial use of Da Fang Feng Tang without Fu Zi, then Shi Xuan San (Ten Provisions Powder) before ulceration, and now Shi Quan Da Bu Tang without Rou Gui, all ineffective. Observing weak pulse and symptoms, I prescribed Shi Quan Da Bu Tang with 1 qian of Shu Fu Zi (Prepared Aconite Lateral Root) per dose. After over 30 doses, slight improvement occurred. Fu Zi was reduced by 5 fen, continued for another 30 doses until near cure. Finally, Fu Zi was removed entirely, and after another 30 doses, full recovery was achieved.

A man had left knee swelling for three months without ulceration. I reasoned that in a weak constitution, Wind pathogens invaded bone joints, causing Qi stagnation, leading to enlarging knees and thinning calves, named He Xi Feng. I prescribed Da Fang Feng Tang, which resolved the swelling after over 30 doses.

Prefect Zhang Tianze had left knee swelling/pain, chest/epigastric oppression, poor appetite, nausea, dizziness, phlegm obstruction, and worsening fatigue in the afternoon, indicating Spleen-Lung Qi deficiency. I used scallion fomentation and Liu Jun Zi Tang plus Pao Jiang (Roasted Ginger), rapidly reducing symptoms and improving appetite. Then, Bu Zhong Yi Qi Tang plus Man Jing Zi cleared the head and eyes. Intermittently, Da Fang Feng Tang for over 10 doses, followed by Bu Zhong Yi Qi Tang for over 30 doses, resolved the condition. (Note by Xue Ji)