一、形气衰败，饮食不思者不治。
一、牙齿俱落，紫黑流血，腐溃秽臭者不治。
一、腿大肿腐烂，或细干枯者不治。
膝痈 肿色红疼， 疽如痈色不红，宣软为顺坚硬逆，脾肾肝经邪所乘。
【注】膝痈生于膝盖，色红、 肿疼痛，属气血实； 疽亦生在膝盖，肿大如痈，其
色不变，寒热往来，属气血虚。宣软为顺，坚硬如石者为逆。经云∶肉之小会为溪。溪者，
二肘、二膝、四腕也。凡脾病在溪；肾有邪，其气留于两膝；凡筋病皆属于节，筋乃肝之
余，故又属肝，是以溪会有病，皆从脾、肾、肝三经邪气乘之也。始终内、外治法、俱按
痈疽肿疡，溃疡门，惟两膝俱生属败证，不可治也。
\r膝痈图\p04-34a194.bmp\r
膝眼风在鬼眼生，疼痛如锥胖肿形，下虚风湿寒侵袭，屈伸不遂温散灵。
【注】此证生于膝眼穴，又名鬼眼穴，在膝盖之下，左右两骨空陷中，由下焦素虚，外
邪易于侵袭，先从膝眼隐隐作疼，如风胜，其痛则走注不定；寒胜，则痛如锥刺；湿胜，则
外见胖肿。屈不能伸，其病在筋；伸不能屈，其病在骨；动移不遂，沉寒痼冷之候也，惟
在临证宜详辨之。初服万灵丹温散之，其痛即止，次服独活寄生汤宣补之。效迟者，兼
用火针针膝眼穴，此转重就轻之法也。单膝生者轻，双膝生者重。若左膝方愈，复病右
膝，右膝方愈，复病左膝者，名过膝风，属险，治法同前。
\r膝眼风图\p04-34a195.bmp\r
独活寄生汤
独活 桑寄生（如无真者，以川续断代之） 人参 茯苓 川芎（酒洗） 防风 桂心 杜仲（姜汁
炒，去丝） 牛膝 秦艽 细辛（各一钱五分） 当归
（酒洗） 白芍（酒炒） 熟地 甘草（各一钱） 生姜五片，水二盅，煎七分，食前服。
【方歌】独活寄生肝肾虚，寒湿注膝肿痛居，参苓四物防风桂，杜膝秦艽甘细宜。
万灵丹（见肿疡门）
一、形体元气衰败，没有食欲的，属于不治之症。
一、牙齿全部脱落，牙龈呈紫黑色并流血，腐烂溃烂且气味恶臭的，属于不治之症。
一、腿部严重肿胀腐烂，或者细瘦干枯的，属于不治之症。
膝痈（膝盖部位的痈肿）：肿胀部位颜色发红且疼痛；疽（膝盖部位的疽肿）像痈一样但颜色不红，质地松软为顺证，坚硬为逆证，这是由于脾、肾、肝三经邪气侵袭所致。
【注】膝痈生于膝盖处，颜色红、肿胀疼痛，属于气血实证；疽也生在膝盖处，肿大如同痈，但颜色不变，伴有寒热往来症状，属于气血虚证。质地松软为顺证，坚硬如石头的为逆证。医经说：“肉的细小交汇之处称为溪。”所谓“溪”，指的是双侧肘部、双侧膝部和双侧腕部。凡是脾病多表现在溪；肾有邪气，其气滞留于双膝；凡是筋病都归属于关节，筋是肝的余气所化，所以又归属于肝，因此溪汇聚之处生病，都是从脾、肾、肝三经的邪气乘虚侵袭所致。治疗上始终按照内治和外治方法，均参照痈疽中的肿疡门和溃疡门章节，只有双膝同时发病属于败证，无法治愈。
膝眼风（膝关节周围的风湿痹痛）：生于鬼眼穴（即膝眼穴），疼痛如锥刺，伴有肿胀，因下焦虚弱，风湿寒邪侵袭，导致屈伸不利，使用温散疗法效果灵验。
【注】此证生于膝眼穴，又名鬼眼穴，位于膝盖下方左右两骨之间的凹陷处，由于下焦素来虚弱，外邪容易侵袭，起初从膝眼隐隐作痛，若风邪偏胜，疼痛则游走不定；寒邪偏胜，则疼痛如锥刺；湿邪偏胜，则外部出现浮肿。屈而不能伸，病在筋；伸而不能屈，病在骨；活动转移不便，是沉寒痼冷的征候，只有在临证时应当详细辨别。初起服用万灵丹以温散邪气，疼痛即可停止，随后服用独活寄生汤以宣通补益。见效慢的，兼用火针针刺膝眼穴，这是转重就轻的治疗方法。单侧膝盖发病较轻，双侧膝盖发病较重。如果左膝刚痊愈，右膝又发病，或右膝刚痊愈，左膝又发病的，名叫过膝风，属于险证，治疗方法同前。
独活寄生汤
药材组成：独活、桑寄生（如果没有真品，用川续断代替）、人参、茯苓、川芎（酒洗）、防风、桂心、杜仲（姜汁炒，去丝）、牛膝、秦艽、细辛（各一钱五分）、当归（酒洗）、白芍（酒炒）、熟地黄、甘草（各一钱）。煎服法：生姜五片，水二盅，煎至七分，饭前服用。
【方歌】独活寄生汤主治肝肾虚，寒湿注于膝部导致肿痛，方中含有人参、茯苓及四物汤（当归、川芎、白芍、熟地）、防风、桂心，加上杜仲、牛膝、秦艽、甘草、细辛适宜。
万灵丹（见肿疡门章节）
1. When the physical constitution and vital energy are exhausted, and there is no desire for food, it is incurable.
2. When all teeth fall out, the gums are purple-black with bleeding, and there is putrefaction, ulceration, and foul odor, it is incurable.
3. When the legs are severely swollen and rotting, or thin and dry/withered, it is incurable.
Xi Yong (Knee Abscess): The swelling is red in color and painful; Ju (Knee Ulcer/Gangrene) resembles an abscess but is not red in color. Softness and pliability indicate a favorable prognosis (Shun), while hardness indicates an unfavorable prognosis (Ni). This is caused by pathogenic factors invading the Spleen, Kidney, and Liver meridians.
[Annotation] Xi Yong arises at the knee, characterized by redness, swelling, and pain, belonging to Excess patterns of Qi and Blood. Ju also arises at the knee, with swelling similar to an abscess, but the color does not change, accompanied by alternating chills and fever, belonging to Deficiency patterns of Qi and Blood. Softness and pliability indicate a favorable prognosis; hardness like stone indicates an unfavorable prognosis. The Classics state: "The small gatherings of flesh are called Xi." The term "Xi" refers to the two elbows, two knees, and two wrists. Generally, Spleen diseases manifest in the Xi; when the Kidney has pathogenic factors, their Qi remains in the two knees; generally, tendon diseases belong to the joints. Since tendons are the surplus of the Liver, they also belong to the Liver. Therefore, diseases occurring at the Xi gatherings are all caused by pathogenic factors from the Spleen, Kidney, and Liver meridians taking advantage of weakness. Throughout, internal and external treatment methods should follow the protocols for Swollen Sores (Zhongyang) and Ulcerated Sores (Ku Yang) sections in the Carbuncle and Ulcer chapters. Only when both knees are affected simultaneously does it constitute a failure syndrome (Bai Zheng), which is untreatable.
Xi Yan Feng (Wind at the Knee Eye): Arises at the Gui Yan point (also known as the Knee Eye point), with pain like a cone piercing and swelling. It is caused by deficiency in the Lower Jiao allowing invasion of Wind-Damp-Cold pathogens, leading to inability to flex and extend smoothly; warm dispersal methods are effective.
[Annotation] This condition arises at the Xi Yan point, also named the Gui Yan point, located in the hollows between the bones below the knee on both left and right sides. Due to inherent deficiency in the Lower Jiao, external pathogens easily invade. Initially, there is hidden pain in the knee eye. If Wind is predominant, the pain migrates unpredictably; if Cold is predominant, the pain feels like cone piercing; if Dampness is predominant, external swelling appears. Inability to flex indicates disease in the tendons; inability to extend indicates disease in the bones; difficulty in movement and shifting indicates chronic cold and entrenched cold syndromes. Clinical differentiation must be detailed. Initially, administer Wan Ling Dan to warm and disperse, after which the pain stops. Subsequently, administer Du Huo Ji Sheng Tang to promote circulation and tonify. For cases with slow response, combine with fire needle acupuncture at the Xi Yan point; this is a method of turning heavy into light. Unilateral knee involvement is mild; bilateral knee involvement is severe. If the left knee heals and then the right knee becomes diseased, or vice versa, it is named Guo Xi Feng (Passing Over the Knee Wind), which is dangerous. The treatment method is the same as above.
Du Huo Ji Sheng Tang
Ingredients: Du Huo (Radix Angelicae Pubescentis), Sang Ji Sheng (Herba Taxilli) [if genuine is unavailable, substitute with Chuan Xu Duan (Radix Dipsaci)], Ren Shen (Radix Ginseng), Fu Ling (Poria), Chuan Xiong (Rhizoma Chuanxiong, washed with wine), Fang Feng (Radix Saposhnikoviae), Gui Xin (Cortex Cinnamomi), Du Zhong (Cortex Eucommiae, stir-fried with ginger juice, remove fibers), Niu Xi (Radix Achyranthis Bidentatae), Qin Jiao (Radix Gentianae Macrophyllae), Xi Xin (Herba Asari) [each 1.5 qian], Dang Gui (Radix Angelicae Sinensis, washed with wine), Bai Shao (Radix Paeoniae Alba, stir-fried with wine), Shu Di Huang (Radix Rehmanniae Preparata), Gan Cao (Radix Glycyrrhizae) [each 1 qian]. Decoction method: Add five slices of fresh ginger and two bowls of water, decoct until reduced to 0.7 bowl. Take before meals.
[Formula Song]: Du Huo Ji Sheng Tang treats Liver and Kidney deficiency, where Cold-Dampness settles in the knees causing swelling and pain. It contains Ren Shen, Fu Ling, Si Wu Tang (Four Substance Decoction), Fang Feng, Gui Xin, along with Du Zhong, Niu Xi, Qin Jiao, Gan Cao, and Xi Xin, which are appropriate.
Wan Ling Dan (See section on Swollen Sores)