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Someone asked: "The thigh and leg suddenly become red and swollen. What is the cause?" The answer was: "This is called 'Leg Roaming Wind' (Tui You Feng), caused by the struggle between wind and heat pathogens. It belongs to the Foot-Taiyang Bladder Meridian. It is appropriate to use bian stone (stone lancet) to prick and release evil blood, and internally administer Fangfeng Tongsheng San (Wind-Protecting Universal Relief Powder) with Baizhu (Atractylodis Rhizoma) removed, added with Huangbai (Phellodendri Cortex), Niuxi (Achyranthis Bidentatae Radix), and Fangji (Stephaniae Tetrandrae Radix) as the main treatment."

Someone asked: "A fourteen-year-old girl experiences alternating chills and fever. In the popliteal crease behind the knee, there is hardness like a stone, slight redness, and slight swelling. What is this?" The answer was: "This is called 'Weizhong Carbuncle' (Wei Zhong Du). This acupoint is located in the crease behind the knee and belongs to the Foot-Taiyang and Foot-Shaoyang Gallbladder meridians. It arises from accumulated heat in the zang-fu organs flowing into the Bladder. Using Bazhen San (Eight Arrays Powder), expelling about one dou of stasis blood leads to resolution. If treatment is delayed slightly, upon ulceration, tendon contraction will occur, inevitably resulting in disability."

The *Ling Shu* states: "Eruptions on the knee are named Ci Ju (Cancerous Ulcer). The presentation is a large abscess, unchanged in color, accompanied by chills and fever, and hard. Do not pierce it with a stone needle; piercing it leads to death. One must wait until it softens before piercing; then life can be preserved. (For those hard as stone, rubbing with six raw Camphor Wood branches is effective.) Any carbuncles or ulcers erupting at joints with corresponding symptoms elsewhere in the body are incurable. Those erupting in Yang aspects die within one hundred days; those in Yin aspects die within thirty days. ('Yang' refers to the dorsal aspect of joints; 'Yin' refers to the interstices of joints. Liu Juanzi said: 'Corresponding' means internal eruption manifesting externally.)"

Someone asked: "Both knees are swollen and painful, and the thighs gradually become thin. What is this?" The answer was: "This is called 'Crane Knee Wind' (He Xi Feng), also known as 'Drumstick Wind' (Gu Chui Feng). It originates from dampness accumulation, or follows dysentery. The legs are weak, sore, and painful, unable to walk, named 'Dysentery Wind'. Or it may be residual toxins from Cold Damage that fail to disperse, causing wind-cold-damp pathogens to knot in the collaterals, blocking blood flow, leading to increasingly contracted tendons and emaciated thighs. It belongs to the Foot-Shaoyang Gallbladder and Foot-Yangming Stomach meridians. It is appropriate to use Yulong Gao (Jade Dragon Ointment), mixed with wine and applied to the leg, to relieve pain and restore yang. Also apply Chonghe Gao (Harmony Ointment) to the ankle to guide qi and move blood. Internally take Dafangfeng Tang (Great Wind-Protecting Decoction) and Zhuifeng Wan (Wind-Chasing Pill), doubling the amount of Ruxiang (Olibanum) to relieve pain and relax sinews. Moxibustion with garlic partition is also suitable."

Someone asked: "Swelling and pain above the knee, what is this?" The answer was: "This has multiple causes and requires clear differentiation. If both inner and outer sides of both knees are swollen, pain feels like being bitten by a tiger, chills and fever alternate, the thighs gradually become thin while the knees swell more, it is named Crane Knee Wind. Urgently perform garlic-partition moxibustion and take Dafangfeng Tang. If only one knee hurts, pain radiates up and down, swelling is not severe but slightly red, it is named 'Knee Roaming Wind'. Take Shengshou Dan (Holy Bestowal Pill), Huangu Dan (Bone-Swapping Pill), and Fangfeng Tongsheng San added with Niuxi and Mugua. If only the two sides of the knee are swollen and painful, with aversion to cold and high fever, worsening day and night, and the swollen area cannot be touched, it is 'Knee Eye Toxicity' (Xi Yan Du). Swelling and pain on the kneecap is 'Knee Abscess' (Xi Yong). For these two conditions, take Shengjin Dan (Victorious Gold Pill), or Zijin Dan (Purple Gold Pill), Bazhen San, or Huoming Yin (Life-Saving Decoction) added with Niuxi."

Xue Ji commented: "Crane Knee Wind results from improper regulation, damaging the Three Yin meridians of the foot (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/pain. Over time, the knee swells while the calf thins, resembling a crane's knee. If the Spleen and Stomach are damaged, Buzhong Yiqi Tang (Middle-Warmer Boosting Qi-Decoction) is primary. If Liver and Kidney are damaged, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) is primary. To promote suppuration or after ulceration, Shiquan Dabu Tang (Perfect Ten Tonifying Decoction) is primary, all assisted by Dafangfeng Tang. At onset, scallion warming (Cong Yun) should be used to resolve internally. If fluids are dry and mouth is parched, it is Middle Qi deficiency; use Buzhong Yiqi Tang with Wuweizi. Dizziness and headache indicate failing Yang ascending; use Buzhong Yiqi Tang with Manjingzi. Fever or afternoon tidal fever indicates Yin-blood deficiency; use Siwu Tang (Four Substances Decoction) with Renshen, Huangqi, Baizhu. Aversion to cold indicates Yang deficiency; use Shiquan Dabu Tang. Poor appetite and chest fullness indicate Spleen-Stomach deficiency stagnation; use Sijunzi Tang (Four Gentlemen Decoction). Withered yellow complexion and poor appetite indicate Spleen-Stomach weakness; use Liujunzi Tang (Six Gentlemen Decoction). Clear pus and lack of muscle regeneration indicate dual Qi-Blood deficiency; use Bazhen Tang (Eight Treasures Decoction). Intermittent fever indicates rootless deficient fire; use Shiquan Dabu Tang. Emaciation, lethargy, nocturnal fever, profuse phlegm, thirst, and frequent urination indicate five-zang deficiency; use Liuwei Dihuang Wan. Umbilical/abdominal pain, nocturia, weak knees, dizziness, and vomiting phlegm indicate cold failure of Kidney Qi; use Bawei Wan (Eight-Ingredient Pill). High fever, extreme thirst, desire to remove clothes, red face, and large-deficient pulse indicate blood deficiency with irritability; use Danggui Buxue Tang (Angelica Tonifying Blood Decoction). Cases following dysentery are treated similarly; other cases require clinical flexibility."

Crane Knee Wind (aka Drumstick Wind): Both calves and thighs are thin as reeds, only the knee remains large, making walking impossible.

Modified Xiaoxuming Tang: Use ingredients of Xiaoxuming Tang, adding Bibie (Dioscoreae Hypoglaucae Rhizoma), Chuanlianzi (Meliae Fructus), Duhuo (Angelicae Pubescentis Radix), and Gan Mugua (Chaenomelis Fructus). Crush, do not use fresh ginger, decoct in water. Place a little Shexiang (Moschus) at the bottom of the bowl first. Strain and pour into the bowl to drink. After dozens of doses, add Wuji San (Five Accumulations Powder) and decoct together for permanent cure. Another method: decoct Zijingpi (Broussonetiae Cortex) in aged wine and take warm regularly.

Luo Shi Lang Wan: Treats Crane Knee Wind and waist/knee contraction diseases. (One whole Scorpion, head and tail intact, raw) Tao Ren (raw) Baifuzi (Typhonii Rhizoma) Awei (Ferulae Resina) Guixin (Cinnamomi Ramulus) Anshixiang (Styrax) Bai Zhi (Angelicae Dahuricae Radix) [Each 1 liang] Ruxiang (Olibanum) Moyao (Myrrha) [Each 7.5 qian]. The above nine herbs are stir-fried hot in child's urine and wine (2 sheng), set aside. Beiloulu (Euphorbiae Pekinensis Radix) Danggui (Angelicae Sinensis Radix) Baishao Yao (Paeoniae Radix Alba) Niuxi (Achyranthis Bidentatae Radix) Qianghuo (Notopterygii Rhizoma et Radix) Digupi (Lycii Cortex) Weilingxian (Salviae Miltiorrhizae Radix et Rhizoma / Glehniae Radix - context implies Salvia or similar moving herb, usually Glehniae Radix in this formula context but text says Weilingxian which is typically Salviae Miltiorrhizae or Glehniae, here likely Glehniae based on standard formulas, but strictly translating text: Weilingxian) [Each 1 liang], ground to powder. Honey pills, size of bean, taken empty stomach with warm wine. Dr. Hu Chuwang suffered from wind-spasm, finger joints swollen like plums/peaches, unbearable pain; taking this cured him completely.

Danxi treated an elder, age 70, suffering from foot/knee pain and slight swelling. Shengdihuang (Rehmanniae Radix) Danggui Tou (Angelicae Sinensis Radix Caput) Baishao Yao (Paeoniae Radix Alba) Cangzhu (Atractylodis Rhizoma) Chao Bai (Phellodendri Cortex, fried) [Each 3 qian] Chuanxiong (Ligustici Chuanxiong Rhizoma) Gui (Cinnamomi Ramulus) [Each 2 qian] Mutong (Akebiae Caulis) [1.5 qian]. Divide into four doses. Decoct to a small cup, take hot before meals.

A man, nearly 30, accustomed to rich food, prone to anger. In autumn, a point of pain appeared left/right of the hip joint, extending to the knee. Quiet by day, worse by night. Aversion to cold, sometimes thirsty, sometimes not, sometimes bloated, sometimes not. Doctors mostly used wind-dispelling drugs combined with blood-tonics. By next spring, the knee swelled, pain worsened, appetite decreased, body emaciated. By late spring, knee swollen like a peach, unable to flex/extend. Pulse: Left string-taut-large-rather-solid, Cun very choppy, overall rapid. Knew urination must be frequent and scant. Treated as dietary/phlegm-stagnation in Taiyang/Yangming meridians. Chao Huangbai (Phellodendri Cortex, fried) 1 liang, Sheng Gancao Shao (Glycyrrhizae Radix et Rhizoma tip), Xijiao Xie (Rhinocerotis Cornu section), Yan Chao Cangzhu (Salt-fried Atractylodis Rhizoma) [Each 3 qian], Chuanxiong 2 qian, Chenpi (Citri Reticulatae Pericarpium), Niuxi, Mutong, Shaoyao [Each 5 qian]. Add Tiao Qin (Scutellariae Radix) 3 qian in hot weather. Grind to fine powder. Each dose 3 qian, ground with fresh ginger juice, mixed with water, boiled, taken hot before meals, 4 times/day. After half a month, rapid pulse decreased, pain lightened. Remove Xijiao, add Niuxi, Baiguiban (Testudinis Carapax et Plastrum) 0.5 liang, Danggui 0.5 liang, take as before. After another half month, swelling decreased, appetite increased, no longer averse to cold. Only foot/knee soreness/weakness, unable to stand/walk long. Remove Cangzhu, Huangqin. Season was summer heat, add Chao Huangbai to 1.5 liang. I added Niuxi to this base formula; use stem/leaf in spring/summer, root in winter, crush for juice, effect is faster. Must avoid alcohol, meat, wet noodles, pepper. Mid-summer, add Shengdihuang 0.5 liang; winter, add Shanzhuyu (Corni Fructus), Guizhi (Cinnamomi Ramulus).

Huangu Dan: Universally treats wind, also Crane Knee Wind. Fangfeng (Saposhnikoviae Radix) Niuxi Danggui (Angelicae Sinensis Radix) Hugu (Pantheris Os, baked with rice wine) [Each 1 liang] Gouqi (Lycii Fructus) [2.5 liang] Qianghuo (Notopterygii Rhizoma et Radix) Duhuo (Angelicae Pubescentis Radix) Baiguiban (Testudinis Carapax et Plastrum) Qin Jiao (Gentianae Macrophyllae Radix) Bi Xie (Dioscoreae Hypoglaucae Rhizoma) Song Jie (Pinus Massoniana Node) Can Sha (Bombyx Batryticatus) [Each 1 liang] Qiegen (Solanum Melongena Root) [Washed, 2 liang] Cangzhu (Atractylodis Rhizoma) [4 liang]. Soak in wine or make pill with wine paste.

Sinew urgency/pain in foot: Boil Mugua until soft, grind to porridge-like consistency, wrap around painful area. Change when cool. Apply warm 3-5 times overnight for recovery. Add half wine when boiling Mugua.

Zi He treated Li Wenqing from Lingbei, who had clicking sounds in both knee patellas during flexion/extension. Some thought it was bone noise. Dai Ren (Zi He's name) said: No, bones don't rub to make sound. This is sinew dampness. Dampness makes sinews tight; loose sinews don't sound, tight ones do. Use my drug to purge and drain water from above and below, and the sound will cease. Li Wenqing followed this, and it worked.

Prefect Zhang Tianze had left knee swelling/pain, chest fullness, poor appetite, nausea, dizziness, phlegm obstruction, fatigue in afternoon. This is Spleen-Lung Qi deficiency. Used Cong Yun (scallion warming) and Liujunzi Tang (Six Gentlemen Decoction) + Pao Jiang (Zingiberis Rhizoma Preparatum). Symptoms receded, appetite improved. Used Buzhong Yiqi Tang + Manjingzing (Vernoniae Herba), head/eyes cleared. Intermittently gave Dafangfeng Tang >10 doses, then Buzhong Yiqi Tang >30 doses, resolved.

Commissioner Liu Guowei first had sinew spasm/bone pain, right knee diffuse swelling. Used phlegm-resolving/detoxifying agents, swelling/pain worsened, poor appetite/fatigue. Added wind-dispelling/detoxifying agents, chills/fever/nausea, loose stool. Used Erchen Tang (Two-Aged Decoction) type damp-draining agents, swelling turned red, internal pain like awning. Pulse slippery-rapid-but-deficient. Pus formed, Yuan Qi too weak to ulcerate. Used Shiquan Dabu Tang 4 doses, assisted by Dafangfeng Tang 1 dose to ulcerate, then >100 doses to recover.

A scholar had lax leg sinews, then bilateral knee swelling/pain for a month. This is Yin deficiency with damp-heat invasion. Used Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) as main, assisted by Bazhen Tang + Niuxi, Duzhong (Eucommiae Cortex), intermittently Buzhong Yiqi Tang. Resolved in >3 months.

A man had leg pain/knee swelling, pulse floating, pressing string-taut-tight. This is Liver-Kidney deficiency. Used Dafangfeng Tang 2 doses, retreated. He feared Fuzi (Aconiti Lateralis Radix Preparata) toxicity, took wound-healing drugs instead. Became emaciated, deficiency symptoms arose, required rescue again. I said: Fatigue/emaciation is Spleen-Stomach failure to transport. Incontinence is Bladder deficiency to control. Dry heat/false fullness is Stomach Qi weakness to transform. Confusion/amnesia is Spirit loss. Evil symptoms swarm, I declined treatment. He died.

This condition often affects deficient people. Thus, Modified Xiaoxuming Tang and Dafangfeng Tang are effective. Attack drugs will cause error.

A woman had knee swelling/pain, worse with cold, >1 month, drugs ineffective, pulse string-taut-tight. Deep-seated cold pathogen. Used Dafangfeng Tang and Huolong Dan (Fire Dragon Pill), resolved.

Generally, although swelling depth and pathogen severity vary, the root is True Qi deficiency allowing deep pathogen invasion. Thus, Guyong Ju (Bone-Adhering Carbuncle) and Crane Knee Wind are common in Kidney deficiency. Ancients used Fuzi to warm Kidney Qi, drive drug action, and scatter cold. Also, deficient people sleeping outdoors in autumn/summer suffer cold air invasion, cold-heat knotting, forming this condition, immobility, sudden heat/no sweat, pain on pressure reaching bone. If unresolved long-term, extreme Yin generates Yang, cold transforms to heat, and ulcerates. If severely injured by thief-wind, local area not hot, but shivering chills, intermittent sweating, moxibustion relieves pain slightly. Use Dafangfeng Tang and Huolong Gao (Fire Dragon Ointment). There is also curved paralysis, hard as stone, named Shiju (Stone Carbuncle). If heat slows accumulation without ulcerating, flesh red-purple, skin/flesh rotting, named Huanyi. Initial/end stages suit previous decoctions to dispel cold and tonify deficiency/support interior.

Dafangfeng Tang: Treats Foot-Three-Yin deficiency, external pathogens invading void, Crane Knee Wind or Guyong Ju. Swelling/pain or swelling without pain. Whether ulcerated or not, use 3-5 doses, then tonifying agents.
Fuzi (Aconiti Lateralis Radix Preparata) Niuxi (Achyranthis Bidentatae Radix) [Each 1 qian] Baizhu (Atractylodis Rhizoma) Qianghuo (Notopterygii Rhizoma et Radix) Renshen (Ginseng Radix et Rhizoma) Fangfeng (Saposhnikoviae Radix) [Each 2 qian] Chuanxiong (Ligustici Chuanxiong Rhizoma) [1.5 qian] Lagui (Cinnamomi Ramulus) Huangqi (Astragali Membranacei Radix) Baishao Yao (Paeoniae Radix Alba) Duzhong (Eucommiae Cortex) Shudihuang (Rehmanniae Radix Preparata) Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) [Each 0.5 fen]. Decoct in water and drink.

Huan Shao Dan: Treats Foot-Three-Yin deficiency, knee wind etc., excellent for tonifying Spleen/Kidney and promoting appetite.
Roucong Rong (Cynomorii Herba, wine-soaked, remove scales) Yuanzhi (Polygalae Radix, licorice-water soaked, remove core) Shan Yao (Dioscoreae Rhizoma, fried) Bajitian (Morindae Officinalis Radix, remove heart) Gouqizi (Lycii Fructus) Shan Yao (Dioscoreae Rhizoma) Niuxi (Achyranthis Bidentatae Radix) Shichangpu (Acori Tatarinowii Rhizoma) Duzhong (Eucommiae Cortex) Shudihuang (Rehmanniae Radix Preparata, made into paste) Wuweizi (Schisandrae Chinensis Fructus) Baifuling (Poria) Chushizi (Celtidis Fructus) Shanzhuyu (Corni Fructus Carnosus) [Equal parts]. Grind to powder. Make pills with red date flesh and honey, size of wutong seeds. Take 70 pills each time with warm wine, 3 times daily. Plain water is also acceptable.

Jingjin Dixian Dan and Huangu Dan (See Volume 5 of Miscellaneous Diseases).

*[Suwen]* Stiff knee unable to extend, treat its Jian. (*Guyu Lun*, same below. Text: Above the auxiliary bone, below the horizontal bone is Jian. Wang Bing note: Above the femoral auxiliary bone, below the horizontal bone, middle of lateral thigh. Stand sideways, shake to locate, tendon moves under hand. Hua Shou note: Below Jian bone is Bitou. Jian is the junction of two bones.) Sitting with knee pain, treat its Ji. (Text: Beside the hip is Ji. Wang Bing note: Sides of hip bone, junction point. Hua Shou note: Hip bone beside waist, hip bone is Ji, behind Ji is buttock.) Standing with heat sensation in knee, treat its Haiguan. (Text: Knee solution is Haiguan. Wang Bing note: Shu means heat. If knee disease rises, heat in knee bone solution, treat Haiguan. Text: Rise and pull knee bone solution. Hua Shou note: Beside knee solution is Bin.) Knee pain, pain extends to big toe, treat its... (Text: Above auxiliary is... Wang Bing note: ... is behind knee solution, middle of bent foot, Weizhong acupoint.) Sitting with knee pain as if hidden object, treat its Guan. (Text: ... above is Guan. Wang Bing note: Guan is above ..., behind Jian, stand back press move, tendon responds.) Knee pain unable to flex/extend, treat its Bi Nei... (Wang Bing note: Dazhu acupoint.) Connecting ... if broken, treat Yangming Zhongshu ... (Wang Bing note: If knee pain unable to flex/extend, connecting ... pain like breaking, then needle Yangming acupoint, Zhongshu ..., Sanli acupoint.) Knee pain like separation, treat Juyang, Shaoyang Ying. (Wang Bing note: If pain and knee like separating, treat Foot-Taiyang Ying, Tonggu acupoint, Foot-Shaoyin Ying, Ran gu acupoint.) Yinlu calf sourness, unable to stand long, treat Shaoyang Zhi Wei, outside upper 5 cun. (Outside upper should be outside ankle upper. Wang Bing note: Yinlu means sour-pain feeling powerless. Outside ankle upper 5 cun, Guangming acupoint.) Re-examine the above Jian, Ji, Haiguan, and other acupoints.

*[Lingshu]* Pain in middle of knee, take Dubi, needle with Yuanli needle. Needle during attack, interval between attacks. Needle thickness like li, no doubt in knee needling. (*Zabing Pian*.)

*[Yulong Ge]* Crane Knee Wind swelling and leg pain. Suigu (1 cun above kneecap, 0.5 cun left/right of Liangqiu, needle 0.5 cun, retain one breath, reduce.) Xiguan (Below knee cap, inside beside Dubi, horizontal needle through Xiyan, outside beside Dubi, forbid moxa, retain eight呼, reduce.)

*[Jiyuan]* Another method: Xiguan, Weizhong (3.5 cun; best if purple vein bleeds.) Sanli (If not cured, take lower acupoint.) Yanglingquan, Zhongwan, Fenglong.

*[Tongxuan]* Knee swelling: Xingjian.

*[Cuoyao]* Yanglingquan (Horizontal penetrate Yinlingquan, tonify birth, reduce completion.) Yinlingquan (Horizontal penetrate Yanglingquan, tonify birth, reduce completion.) Xiguan (Method see previous *Yulong* below.)

*[Shiyi]* Foot twisting pain: Weizhong (bleed.)

*[Sang]* Foot/knee pain sinew urgency: Fengchi, Sanjian, Sanyinjiao, Sanli.