（论一首 方一首 灸法二首）
论曰∶骨极者，主肾也。肾应骨，骨与肾合。又曰∶以冬遇病为骨痹，骨痹不已，复感
于邪，内舍于肾，耳鸣见黑色，是其候也。若肾病则骨极，牙齿苦痛，手足 疼，不能久立，
屈伸不利，身痹脑髓酸。以冬壬癸日中邪伤风，为肾风。风历骨，故曰骨极。若气阴，阴则
虚，虚则寒，寒则面肿垢黑，腰脊痛不能久立，屈伸不利。其气衰则发堕齿槁，腰背相引而
痛，痛甚则咳唾甚。若气阳，阳则实，实则热，热则面色 隐曲，膀胱不通，牙齿脑髓苦痛，
手足 ，耳鸣色黑，是骨极之至也。须精别阴阳，审其清浊，知其分部，视其喘息。善治
病者，始于皮肤筋脉，即须治之。若入脏腑，则半死矣。
扁鹊云∶骨绝不治， 而切痛，伸缩不得，十日死。骨应足少阴，少阴气绝则骨枯。发
无泽，骨先死矣。
治骨极，主肾热病，则膀胱不通，大小便闭塞，颜焦枯黑，耳鸣虚热方。
大黄（切，别渍水一升） 黄芩（各三两） 栀子（十四枚） 甘草（一两） 芒硝（二
两）
上五味 咀，以水四升，先煮黄芩、栀子、甘草，取一升五合，去滓，下大黄，又煮
两沸，下芒硝，分三服。
（论述一篇，方剂一首，灸法两首）
论述说：骨极证，主要与肾有关。肾对应骨骼，骨骼与肾相合。又说：在冬季感受病邪称为骨痹，如果骨痹久治不愈，再次感受邪气，邪气内传归属于肾，出现耳鸣、面色发黑等症状，这就是其征候。如果是肾病导致骨极，牙齿剧烈疼痛，手足疼痛，不能长时间站立，屈伸活动不利，身体麻木，脑髓酸痛。如果在壬日或癸日的冬季，因中风邪气伤及肾脏，称为肾风。风邪遍历骨骼，所以称为骨极。如果人体阴气不足，阴虚则生虚寒，虚寒则导致面部浮肿、面色晦暗发黑，腰脊疼痛不能久立，屈伸不利。如果肾气衰败，则头发脱落、牙齿枯槁，腰背相互牵引而痛，疼痛严重时会出现咳嗽、吐痰严重。如果人体阳气亢盛，阳实则生热，热盛则面色红赤隐现于皮肤之下，膀胱气化不利导致小便不通，牙齿和脑髓剧烈疼痛，手足麻木或抽搐，耳鸣、面色发黑，这是骨极证发展到极致的表现。必须精细辨别阴阳，审察气血的清浊，了解病变所在的部位，观察患者的呼吸喘息情况。善于治病的人，治疗应从皮肤、筋脉开始，及时进行治疗。如果病邪深入脏腑，患者就有一半死亡的危险了。
扁鹊说：骨绝证无法治愈，患者感到极度疼痛，身体伸缩困难，十天后会死亡。骨骼对应足少阴肾经，足少阴肾经的气机衰竭则骨骼枯萎。毛发失去光泽，说明骨骼之气先已衰竭死亡。
治疗骨极证，主治肾热病，表现为膀胱不通，大小便闭塞，颜面焦枯发黑，耳鸣伴有虚热症状的方剂如下：
大黄（切片，另外用一升水浸泡） 黄芩（各三两） 栀子（十四枚） 甘草（一两） 芒硝（二两）
以上五味药捣碎成粗末，用水四升，先煎煮黄芩、栀子、甘草，取汁一升五合，滤去药渣，加入大黄，再煮沸两次，最后加入芒硝，分三次服用。
对于腰背僵硬不便，筋脉挛缩麻痹，虚热导致闭塞的症状，艾灸第二十一椎（即第十四胸椎棘突下旁开1.5寸处），距离中线各一寸五分，艾炷数量根据患者年龄而定（随年壮）。
(One treatise, one formula, two moxibustion methods)
The treatise states: Guji (Bone Extremity Syndrome) is primarily governed by the Kidney. The Kidney corresponds to the bones, and the bones harmonize with the Kidney. It is also said that contracting disease in winter is termed Gubi (Bone Bi Syndrome). If Gubi persists and is not cured, subsequent exposure to pathogenic factors allows the evil to enter internally and reside in the Kidney. Tinnitus and a blackish complexion are its signs. If Kidney disease leads to Guji, there is severe toothache, pain in the hands and feet, inability to stand for long periods, difficulty in flexion and extension, body numbness, and soreness of the brain marrow. If wind pathogens injure the Kidney on Ren or Gui days in winter, it is called Shenfeng (Kidney Wind). Since wind traverses the bones, it is termed Guji. If Yin qi is deficient, deficiency generates cold; cold causes facial edema and a dull, blackish complexion, lumbar and spinal pain preventing prolonged standing, and difficulty in flexion and extension. When Qi declines, hair falls out and teeth become dry; the waist and back pull each other in pain, and severe pain leads to severe coughing and expectoration. If Yang qi is excessive, excess generates heat; heat causes a reddish complexion hidden beneath the skin, bladder dysfunction leading to urinary retention, severe pain in the teeth and brain marrow, numbness or spasms in the hands and feet, tinnitus, and a blackish complexion. This represents the extreme stage of Guji. One must carefully distinguish Yin and Yang, examine the clarity and turbidity of Qi and Blood, know the distribution of the pathology, and observe breathing. A skilled healer begins treatment at the level of the skin and sinews, treating them promptly. If the pathogen enters the Zang-Fu organs, half of the patients will die.
Bian Que said: Gujue (Bone Exhaustion) is incurable. The patient experiences extreme pain, cannot extend or flex the body, and dies within ten days. Bones correspond to the Foot-Shaoyin (Kidney) channel. When the Qi of Shaoyin exhausts, the bones wither. Hair loses luster, indicating that the Qi of the bones has died first.
To treat Guji, specifically for Kidney Heat Disease presenting with bladder dysfunction, blockage of urination and defecation, a scorched and blackish face, tinnitus, and deficiency-heat, use the following formula:
Dahuang (Rhubarb Root), sliced and separately soaked in one sheng of water; Huangqin (Scutellaria Root), three liang; Zhizi (Gardenia Fruit), fourteen pieces; Gancao (Licorice Root), one liang; Mangxiao (Mirabilite), two liang.
Crush the above five herbs into coarse powder. Use four sheng of water. First decoct Huangqin, Zhizi, and Gancao until one sheng and five he remain. Strain out the dregs. Add Dahuang and boil for two more boils. Then add Mangxiao. Divide into three doses.
For symptoms of stiffness and inconvenience in the waist and back, sinew contraction and bi-numbness, and blockage due to deficiency-heat, apply moxibustion to the second-one vertebra (Th14 paravertebral area), 1.5 cun lateral to the midline on both sides. The number of moxa cones should correspond to the patient's age (Sui Nian Zhuang).
For difficulty in urination, abdominal distension and fullness accompanied by deficiency and fatigue, apply moxibustion to Xiaochangshu (BL27). The number of moxa cones should correspond to the patient's age (Sui Nian Zhuang).