据谕病原始末，考诸经云∶肝主筋。身之所束者，筋也。所以荣筋者血也，病本血不荣
筋，
而跗筋之血，又耗于足瘤之渗漏，加之时疫热邪，深入经络，足跗之大筋，得热而短。经又
云∶肝气热，胆泄口苦，筋膜干，则筋急而挛者是矣。然治挛固难，而治浊亦不易。虽津液
藏于膀胱，气化能出，但肺为生水之源，金燥则水不生。诸病水液混浊，皆属于热，义可
知
矣。进而求之筋挛血涸，使非养血荣筋不可也。然徒知荣养，而不明夫辅金制木之法，亦不
可也。苟以金制木而木反荣，筋反舒矣。且金清则水生而热降，此荣筋即可以治浊也。水足
则木畅而筋柔，此治浊即可以荣筋也。明见谅以为然。
安波按∶金清则水生而热降，此荣筋即可以治浊。拟《准绳》人参清肺法，冀其治节
之令
行，则膀胱气化出矣。所谓不治浊而治浊也。复以朱氏虎潜法，以濡养营卫，壮阴潜阳，所
谓水足则水畅，不荣筋而筋自荣也。
两尺细涩，肝肾下亏，必得之醉而使内也。壮时血气方刚，故无所苦。自强仕以来，渐
觉目
盲不能远视，耳如蝉吟蛙鼓，虚里其动应衣，阖目转盼，则身非己有，腰膝酸楚，行步不正
，种种病状，就衰之征。经云∶肝开窍于目，肾开窍于耳，目得血而能视，耳得血而能听，
血气衰耗，不能上充，故视听失其常度。心为君主之官，血虚心无所养，故掣动不安。脑为
髓海，下通命门，上气不足，头为之苦倾。腰者肾之府，肾惫则惮于转侧。膝者筋之府，筋
惫则艰于屈伸。方用人参为君，形不足温之以气；地黄河车龟鹿胶为佐，精不足补之以味，
更用山萸五味，摄纳肾气归元，气旺精充，百骸司职，收视而视明，返听而听聪矣。
安波按∶方议皆精妙入化。
According to your description of the onset and progression of the illness, consulting the classics reveals: The Liver governs the sinews (tendons). What binds the body are the sinews. What nourishes the sinews is Blood. The root of the disease lies in Blood failing to nourish the sinews; furthermore, the Blood supplying the sinews on the dorsum of the foot has been depleted due to leakage from a tumor-like lesion on the foot. Additionally, pathogenic heat from an epidemic pestilence has penetrated deeply into the meridians, causing the large sinew on the dorsum of the foot to shorten and contract upon receiving heat. The classics further state: When Liver Qi is hot, Gallbladder bile leaks causing bitter taste in the mouth; when the sinew membrane is dry, sinews become tense and contractile. This is exactly such a case. However, treating sinew contraction is indeed difficult, and treating turbid urine is also not easy. Although fluids are stored in the Bladder and exit through Qi transformation, the Lung is the source of water generation; if Lung Metal is dry, water is not produced. All pathological fluids that are turbid belong to Heat, so the principle is clear. Proceeding further, for cases of sinew contraction and Blood exhaustion, it is imperative to nourish Blood to benefit the sinews. Yet, merely knowing to nourish and tonify, without understanding the method of assisting Lung Metal to control Liver Wood, is insufficient. If one uses Metal to control Wood, and Wood thereby becomes flourishing, the sinews will relax. Moreover, when Metal is clear, Water is generated and Heat descends; thus, nourishing the sinews can simultaneously treat turbid urine. When Water is sufficient, Wood flows freely and sinews become supple; thus, treating turbid urine can reciprocally nourish the sinews. I trust you understand this clearly.
An Bo’s commentary: When Lung Metal is clear, Water is generated and Heat descends; nourishing the sinews can thereby treat turbid urine. I have formulated Ren Shen Qing Fei San (Ginseng Decoction to Clear the Lungs) from *Zhun Sheng* (Standard of Medical Precision), hoping it will restore the Lung’s function of regulating Qi and water passages, thereby enabling normal Qi transformation in the Bladder. This is what is meant by “treating turbidity without directly targeting turbidity.” Furthermore, I employ Zhu Danxi’s Hu Qian Wan (Tiger Crouch Pill) to moisten and nourish Ying and Wei (Nutritive and Defensive Qi), strengthen Yin to anchor Yang. This is what is meant by “when Water is sufficient, Wood flows freely,” where sinews are naturally nourished without direct intervention.
The pulse at both Chi positions (Kidney positions) is fine and choppy, indicating deficiency of the Liver and Kidneys in the lower Jiao. This must stem from intercourse while intoxicated. In youth, when Blood and Qi were vigorous, there was no suffering. Since becoming an official, gradually experiencing blurred vision unable to see far, tinnitus sounding like cicadas or frogs, palpitations in the Zhen Dong area (precardial region) visible through clothing, a sensation of dissociation when closing eyes and turning them, soreness and weakness in the waist and knees, and unsteady gait—all these symptoms are signs of decline. The classics state: The Liver opens into the eyes, and the Kidneys open into the ears. Eyes see when nourished by Blood; ears hear when nourished by Blood. With the depletion of Blood and Qi, they fail to ascend and fill the head, causing vision and hearing to lose their normal function. The Heart is the Sovereign Official; with Blood deficiency, the Heart lacks nourishment, leading to twitching and restlessness. The Brain is the Sea of Marrow, connecting downward to the Ming Men (Gate of Life); with insufficiency of Upper Qi, the head feels heavy and inclined. The Waist is the residence of the Kidney; when Kidneys are fatigued, turning and side-bending become difficult. The Knees are the residence of the Sinews; when Sinews are fatigued, flexion and extension become arduous. The prescription uses Ren Shen (Ginseng Root) as the Sovereign herb; for deficiency of form, warm Qi is used. Di Huang (Rehmannia Root), He Che Da Zao (Placenta Humanis), Gui Jiao (Tortoise Shell Glue), and Lu Jiao Jiao (Deer Antler Glue) serve as Assistant herbs; for deficiency of essence, rich flavors are used. Additionally, Shan Yu Rou (Cornus Fruit) and Wu Wei Zi (Schisandra Berry) are used to gather and secure Kidney Qi back to its origin. With abundant Qi and充盈 Essence, all bones and joints perform their functions, vision returns to clarity, and hearing returns to acuity.
An Bo’s commentary: The discussion of the formula is exquisite and transcendent.