何左 湿浊之气，从下而受，由下及上，由经络而入脏腑，太阴健运失常，阳明通降失司，腿足浮
肿，大腹胀满，胸闷气逆，不能平卧，面色灰黄，脉左弦右濡滑，香港脚冲心重症，香港脚谓之壅疾。急拟逐湿下行。
紫苏梗（一钱五分） 连皮苓（五钱） 陈木瓜（五钱） 苦桔梗（一钱） 海南子（三钱） 陈广皮（三钱）
汉防己（三钱） 淡吴萸（一钱五分） 生熟苡仁（各五钱） 福泽泻（二钱） 连皮生姜（三片）
二诊 昨进逐湿下行之剂，大便先结后溏，气逆略平，而大腹胀满，腿足浮肿，依然如旧。面无华
色，舌苔白腻，脉左弦细，右濡滑。蕴湿由下而上，由经络而入脏腑，脾胃运化无权，香港脚重症，还虑冲
心之变。前法既获效机，仍守原意出入。
照前方加川牛膝（三钱）、冬瓜皮（五钱）。
三诊 腿足肿略减，两手背亦肿，大腹胀满虽松，胸闷气升，难以平卧。身热不壮，口干且苦，面
色无华，舌苔薄腻微黄，脉象濡小而滑。脾主四肢，脾弱水湿泛滥，浊气上干，肺胃之气，失于下降，恙
势尚在重途，未敢轻许不妨。再仿五苓合鸡鸣散加减，逐湿下行。
川桂枝（五钱） 福泽泻（二钱） 陈木瓜（三钱） 大腹皮（三钱） 酒炒黄芩（八分） 猪苓（三钱）
川牛膝（二钱） 淡吴萸（八分）
连皮苓（五钱） 陈皮（三钱） 冬瓜皮（五钱） 汉防己（三钱） 生熟苡仁（各五钱） 连皮生姜（三片）
四诊 香港脚肿势减，大腹胀满亦松，小溲渐多，水湿有下行之势。身热时轻时剧，口苦且干，面无华
色，舌苔腻黄，脉象濡小而滑。浊气留恋募原，脾胃运化无权，能得不增他变，可望转危为安。香港脚壅
疾，虽虚不补，仍宜五苓合鸡鸣散加减，逐湿下行，运脾分消。
前方去吴萸，加地枯萝（三钱）。
五诊 肿势大减，大腹胀满渐松，小溲渐多，水湿有下行之渐。纳少嗳气，且见咳嗽，舌苔薄白而
腻，脉象弦小而滑。浊气聚于募原，水湿未能尽化，太阴健运失常，阳明通降失司也。前法颇合，毋庸更张。
川桂枝（六分） 泽泻（一钱五分） 大腹皮（二钱） 光杏仁（三钱） 连皮苓（四钱） 生熟苡仁（各三钱）
陈皮（一钱） 淡吴萸（八分） 陈木瓜（三钱） 连皮生姜（三片） 粉猪苓（二钱） 牛膝（二钱）
汉防己（三钱） 地枯萝（三钱）
六诊 肿势十去七八，胀满大减，小溲渐多，水湿浊气，已得下行，沟渎通则横流自减，理固然也。
苔腻未化，纳谷不旺，余湿未楚，脾胃运化未能如
常。去疾务尽，仍守前法。
前方去地枯萝，加生白术（一钱五分）、冬瓜皮（四钱）。
赵左 香港脚上冲入腹，危险之极，变生顷刻，勉方作万一之幸，破釜沉舟，迟则无济矣。
熟附子（五钱） 云茯苓（八钱） 陈木瓜（五钱） 花槟榔（三钱） 淡干姜（三钱） 生白术（三钱）
淡吴萸（二钱） 黑锡丹（包，三钱）
He, Left. The damp-turbid qi is contracted from the lower part, spreading upward from below, entering the zang-fu organs via the meridians and collaterals. This leads to dysfunction of the Spleen's healthy transportation (Taiyin Jianyun) and failure of the Stomach's descending function (Yangming Tongjiang). Symptoms include edema of the legs and feet, abdominal distension and fullness, chest tightness with rebellious Qi unable to lie flat, grayish-yellow complexion, with a wiry pulse on the left and a soggy-slippery pulse on the right. This is a severe case of Hongjiao (a disease characterized by swelling and pain in the limbs, here referring to severe edema or gout-like conditions) rushing to the heart; Hongjiao is also called Yongji (disease of pathogenic stagnation). Urgently prescribe a method to drive down dampness.
Zisu Geng (Perilla Stem), 1.5 qian; Lianpi Ling (Poria with Skin), 5 qian; Chen Mugua (Dried Chaenomelis Fructus), 5 qian; Ku Jiegeng (Bitter Platycodon Root), 1 qian; Hainan Zi (Areca Seed), 3 qian; Chen Guangpi (Aged Tangerine Peel), 3 qian; Han Fangji (Stephania Tetrandra Root), 3 qian; Dan Wuyu (Evodia Fruit), 1.5 qian; Sheng Shu Yiren (Raw and Processed Coix Seed), 5 qian each; Fu Zexie (Alisma Rhizome), 2 qian; Lianpi Shengjiang (Ginger with Skin), 3 slices.
Second visit: After taking the damp-draining downward-decending decoction yesterday, the stool was initially dry then loose, and the rebellious Qi has slightly calmed. However, abdominal distension and leg/foot edema remain unchanged. The face lacks luster, tongue coating is white and greasy, pulse is wiry-thin on the left and soggy-slippery on the right. Accumulated dampness moves upward from below, entering the zang-fu from the meridians. The Spleen and Stomach lack the power of transformation. Hongjiao is a severe condition; we must still fear the complication of rushing to the heart. Since the previous method showed signs of efficacy, we maintain the original intent with modifications.
Add Chuanniu Xi (Cyathulae Radix), 3 qian; Donggua Pi (Winter Melon Peel), 5 qian to the previous formula.
Third visit: Edema of the legs and feet has slightly decreased, but both hands' dorsums are also swollen. Abdominal distension is somewhat relieved, yet there is chest tightness and rising Qi, making it difficult to lie flat. There is body heat but not high fever, dry mouth with bitter taste, lackluster complexion, thin-greasy slightly yellow tongue coating, and a soggy-small-slippery pulse. The Spleen governs the four limbs; Spleen weakness causes water-dampness to overflow, turbid Qi attacks upward, and Lung and Stomach Qi fail to descend. The illness remains serious; do not lightly promise safety. Again, imitate Wu Ling San combined with Jiming San with modifications to drive down dampness.
Chuan Guizhi (Cinnamon Twig), 5 qian; Fu Zexie (Alisma Rhizome), 2 qian; Chen Mugua (Dried Chaenomelis Fructus), 3 qian; Dafupi (Betel Nut Husk), 3 qian; Jiuchao Huangqin (Scutellaria Root fried with wine), 0.8 fen; Zhuling (Polyporus), 3 qian; Chuanniu Xi (Cyathulae Radix), 2 qian; Dan Wuyu (Evodia Fruit), 0.8 fen; Lianpi Ling (Poria with Skin), 5 qian; Chenpi (Tangerine Peel), 3 qian; Donggua Pi (Winter Melon Peel), 5 qian; Han Fangji (Stephania Tetrandra Root), 3 qian; Sheng Shu Yiren (Raw and Processed Coix Seed), 5 qian each; Lianpi Shengjiang (Ginger with Skin), 3 slices.
Fourth visit: Hongjiao swelling has reduced, abdominal distension is relaxed, urination has gradually increased, indicating dampness-water moving downward. Body heat fluctuates in intensity, mouth is bitter and dry, face lacks luster, tongue coating is greasy and yellow, pulse is soggy-small-slippery. Turbid Qi lingers in the Mu Yuan (Membrane Source); Spleen and Stomach lack transformation power. If no other complications arise, danger may turn to safety. As Hongjiao is a stagnant disease, even if deficiency exists, tonification is not appropriate. Continue using Wu Ling San combined with Jiming San with modifications to drive down dampness, strengthen Spleen transport, and separate/disperse.
Remove Wuyu from the previous formula; add Dikuluo (Radish Root), 3 qian.
Fifth visit: Swelling has greatly reduced, abdominal distension is gradually relaxing, urination is increasing, dampness-water shows signs of descending. Poor appetite with belching, accompanied by coughing. Tongue coating is thin-white and greasy, pulse is wiry-small-slippery. Turbid Qi gathers at the Mu Yuan; dampness-water is not fully resolved. Taiyin Spleen's healthy transportation is abnormal, Yangming Stomach's descending function fails. The previous method fits well; no need to change.
Chuan Guizhi (Cinnamon Twig), 0.6 fen; Zexie (Alisma Rhizome), 1.5 qian; Dafupi (Betel Nut Husk), 2 qian; Guang Xingren (Apricot Seed), 3 qian; Lianpi Ling (Poria with Skin), 4 qian; Sheng Shu Yiren (Raw and Processed Coix Seed), 3 qian each; Chenpi (Tangerine Peel), 1 qian; Dan Wuyu (Evodia Fruit), 0.8 fen; Chen Mugua (Dried Chaenomelis Fructus), 3 qian; Lianpi Shengjiang (Ginger with Skin), 3 slices; Fen Zhuling (Polyporus), 2 qian; Niuxi (Achyranthes Root), 2 qian; Han Fangji (Stephania Tetrandra Root), 3 qian; Dikuluo (Radish Root), 3 qian.
Sixth visit: Swelling has subsided by 70-80%, distension greatly reduced, urination increased, water-dampness and turbid Qi have descended. When channels are clear, lateral flow naturally decreases; this is logical. Greasy coating persists, appetite is poor, residual dampness remains, Spleen-Stomach transformation has not returned to normal. To eliminate disease thoroughly, continue the previous method.
Remove Dikuluo from the previous formula; add Sheng Baizhu (Atractylodes Macrocephala Rhizome), 1.5 qian; Donggua Pi (Winter Melon Peel), 4 qian.
Zhao, Left. Hongjiao rushing upward into the abdomen is extremely dangerous, with changes occurring in an instant. Prescribe tentatively for a slim chance, burning bridges behind us; delay will be useless.
Shu Fuzi (Prepared Aconite Lateralis Radix), 5 qian; Yun Fuling (Poria), 8 qian; Chen Mugua (Dried Chaenomelis Fructus), 5 qian; Hua Binglang (Betel Nut), 3 qian; Gan Jiang (Dried Ginger), 3 qian; Sheng Baizhu (Atractylodes Macrocephala Rhizome), 3 qian; Dan Wuyu (Evodia Fruit), 2 qian; Heixi Dan (Black Tin Pill), wrapped, 3 qian.