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Li Dongyuan stated: "Hongxiangjiao (Gout/Jiaqi) is indeed caused by water-dampness, but there are two types. In the south, where the terrain is low and damp, clear-cold dampness invades the deficient areas, causing diseases to arise from below; this is an external contraction. In the north, people often consume mutton and dairy products and drink excessive alcohol, injuring the Spleen and Stomach, leading to an inability to transform and transport fluids; water-dampness flows downward, which is an internal injury manifesting externally."

Hongxiangjiao differs in dry and wet types. If both shins are swollen, it is called Wet Hongxiangjiao, a condition of obstruction/stagnation; sudden tonification is inappropriate. Instead, Jiming San should be used to unblock the lower body and prevent stagnation. If obstruction has already formed, bloodletting with bi-shi (stone needles) should be performed to remove evil blood before administering medicine. If the shins are not swollen, or if there is numbness and pain, tendon spasms, or flaccidity, it is called Dry Hongxiangjiao. It should be treated primarily with Siwu Tang (Four Substance Decoction) added with Niuxi (Achyranthes Root), Mugua (Chaenomeles Fruit), Cangzhu (Atractylodis Rhizoma), Huangbai (Phellodendri Cortex), Rougui (Cinnamon Bark), and Zexie (Alisma Rhizoma). Although neither type should be suddenly tonified, if the Three Yin meridians are affected, presenting with panting and shortness of breath, or ascending to the lower abdomen causing insensibility, Bawei Wan (Eight-Ingredient Pill / Jin Gui Shen Qi Wan) should be urgently administered to warm fire and promote diuresis. Externally, one liang of Fanshi (Alum) and fifteen sheng of sour bean curd juice are boiled for three to five boils for soaking. Zhu Danxi advocated using equal parts of Baijiezi (White Mustard Seed) and Baizhi (Angelicae Dahuricae Radix) ground into powder, mixed with ginger juice for application.

In Hongxiangjiao symptoms, if the lower abdomen is numb and insensible, vomiting may occur within three to five days. This is called "Hongxiangjiao entering the Heart," a fatal condition.

To treat "Hongxiangjiao entering the Heart," Zhang Zhongjing used Shenqi Wan (Kidney Qi Pill) to unblock Bladder Qi and stabilize Kidney Water, preventing the pathogen from attacking the Heart. Chao Yuanfang used Fengyin Tang (Wind-Guiding Decoction), utilizing the heavy nature of minerals to descend easily, overcoming damp-heat and preventing the pathogen from attacking the Heart. Both formulas are miraculous agents for saving critical conditions: one treats Kidney Qi deficiency, the other treats severe damp-heat. They should be selected based on symptoms.

A floating and wiry pulse arises from Wind; a soggy and weak pulse arises from Dampness; a surging and rapid pulse arises from Heat; a slow and choppy pulse arises from Cold. A deep and hidden pulse indicates toxin in the sinews and bones; a choppy and irregular sensation under the fingers indicates toxin in the Blood level. Cold pain in the feet and knees during summer heat, with a soggy Yang pulse and weak Yin pulse, indicates Damp-Warmth. Hongxiangjiao is mostly contracted from Summer-Heat and Dampness.

Question: Why do some cases present with Cold and others with Heat? Answer: The feet contain the Three Yin and Three Yang meridians. Cold invading the Three Yang meridians results in Cold disease; Summer-Heat invading the Three Yin meridians results in Heat disease. Thus, there are distinctions of interior/exterior and cold/heat. For different cold and heat patterns, Heat is treated with Cold medicines, and Cold is treated with Hot medicines. One must deliberate according to the situation: when the Spleen receives Yang toxin, it becomes a hot, stubborn Bi syndrome; when the Kidney receives Yin dampness, it becomes a cold Bi syndrome.