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Hong Kong Foot (a disease characterized mainly by swelling, pain, numbness, or weakness of the feet) presents with four types of pulses: a slow pulse indicates Cold, a rapid pulse indicates Heat, a floating and slippery pulse indicates Wind, and a soft and thin pulse indicates Dampness.

This syndrome of Hong Kong Foot is named "Jue" in classic medical texts, called "Huan Feng" (Slow Wind) in the Han Dynasty, and was only referred to as "Hong Kong Foot" after the Song and Qi dynasties. Chen Wuyue stated that the four pathogenic factors of Wind, Cold, Summer-heat, and Dampness can all cause this condition. In my current clinical practice, eight or nine out of ten cases are caused by Cold-Dampness. The classics state: "Clear dampness invades the body, and diseases arise from below." This is indeed true. When the disease first begins, symptoms are very slight and easy to resolve; therefore, people often ignore it without noticing, and even if noticed, they do not treat it promptly. Once the pathogen penetrates deeply and the course becomes prolonged, the condition worsens progressively, potentially leading to flaccidity, bi-syndrome (painful obstruction), loss of sensation, or the pathogen entering the abdomen and rushing to the Heart, resulting in death. This is truly lamentable. All six meridians of the foot—Three Yin and Three Yang—can manifest this syndrome. However, those arising in the Three Yang meridians are mild, while those in the Three Yin meridians are severe. Since the Three Yin meridians belong to the Zang organs and their pathways are located internally, pathogens rarely reach them unless the Zang Qi is severely deficient. Regardless of whether the syndrome is Yin or Yang, at its onset, it largely resembles Taiyang Disease (Cold Damage), presenting with headache, fever, aversion to cold, and vomiting. The distinguishing features are the inability to flex and extend the feet, or pain and redness.

In Yang syndromes, there is often aversion to cold, high fever, and headache, or bone and joint pain, vomiting, thirst, and irritability, or shouting and delirium, or legs and feet becoming red, purple, extremely hot, swollen, and painfully tender to touch, or stubborn bi-syndrome with numbness. The affected area is mostly on the lateral aspect of the leg (Yang region). Along the pathways of the Three Yang meridians, the complexion is lustrous, and the pulse is mostly floating.

In Yin syndromes, there is often aversion to cold, or even cold extremities (Jue Ni), without fever or with only slight fever, no headache, or bone pain and tendon contraction, vomiting and counterflow qi, lethargy and silence, abdominal pain and diarrhea, fear of light, closure of urination and defecation, mental restlessness and palpitations, insensitivity in the lower abdomen, or chest oppression and mental confusion. The affected site may be swollen and painful or not swollen, slightly red and hot, or conversely extremely cold. The affected area is mostly on the medial aspect of the leg (Yin region). Along the pathways of the Three Yin meridians, the complexion is dark and sallow, and the pulse is mostly deep. These are the general characteristics of Yin and Yang syndromes. If distinguished in detail:

Taiyang Meridian involvement presents with fever, headache, aversion to cold, dizziness, stiff neck, and pain in the waist, spine, body, and from the lateral malleolus to the lateral side of the little toe. (Suitable formulas include Zhang Zhongjing's Mahuang Tang [Ephedra Decoction], Guizhi Tang [Cinnamon Twig Decoction], Jiuwei Qianghuo Tang [Nine-Ingredient Notopterygium Decoction], Baidu San [Decoction for Resolving Toxins], and Jiyan Mahuang Zuojing Tang [Collected Proven Ephedra Left-Meridian Decoction].)

Yangming Meridian involvement presents with mild fever (like feathers covering the body), dry mouth and nose, frequent yawning, abdominal distension, and pain from the thigh, knee, patella, lateral aspect downwards to the dorsum of the foot and the medial side of the middle toe. (Suitable formulas include Dexiao Xiong Zhi Xiang Su San [Effective Ligusticum, Angelica Dahurica, and Perilla Powder] and Dahuang Zuojing Tang [Rhubarb Left-Meridian Decoction].)

Shaoyang Meridian involvement presents with alternating chills and fever, bitter taste, hypochondriac pain, facial dirtiness, dizziness and painful eyes, swelling and pain of scrofula (Madao Xia Yi) in the axilla, and pain from the lateral thigh and knee to the various joints of the lateral malleolus. (Suitable formulas include Xiao Chaihu Tang [Minor Bupleurum Decoction] and Banxia Zuojing Tang [Pinellia Left-Meridian Decoction].)

Combined illness of the Three Yang meridians presents with aversion to cold and high fever, spontaneous sweating and aversion to wind, or anhidrosis and aversion to cold, dizziness and heaviness, pulling pain in joints, contracture of hands and feet, painful cold bi-syndrome, flaccidity and paralysis of waist and legs, mental agitation with rising qi, vomiting and diarrhea, with a floating, wiry, tight, or rapid pulse. (Suitable formulas include Da Liao Shenmi Zuojing Tang [Large-Dose Mysterious Left-Meridian Decoction] and Jia Wei Baidu San [Modified Decoction for Resolving Toxins].)

Taiyin Meridian involvement presents with abdominal fullness, chest and diaphragm stuffiness, tightness of the tongue root, and pain along the tibia, anterior-medial aspect of the thigh and knee, posterior-medial aspect of the medial malleolus, to the medial end of the big toe. (Suitable formulas include Weiling Tang [Stomach and Five Ingredients Decoction] and Liwu Fuzi Tang [Six-Ingredient Aconite Decoction].)

Shaoyin Meridian involvement presents with pain in the waist and spine, qi rushing up to the chest and throat, hunger but inability to eat, black complexion, dysuria, excessive fearfulness, and pain in the little toe, sole of the foot, medial malleolus, heel, and medial aspect of the leg. (Suitable formulas include Mahuang Fuzi Xixin Tang [Ephedra, Aconite, and Asarum Decoction] and Jingui Shiwu Wan [Eight-Ingredient Pill from the Golden Cabinet].)

Jueyin Meridian involvement presents with unilateral pain in the waist and hypochondrium, contracture of the feet, dry throat, vomiting and counterflow qi, profuse diarrhea, and distending pain in the upper lateral aspect of the big toe connected to the dorsum of the foot, ascending to the medial aspect of the leg, circling around the genitals along the thigh, and the areas beside the navel in the lower abdomen. (Suitable formulas include Zhuyu Mugua Tang [Cornus and Papaya Decoction] and Shenyang Zhenzhen Dan [Divine Response Nourishing True Pill].)

Combined illness of the Three Yin meridians presents with contracture of the four limbs, wheezing and chest fullness, closure and difficulty of urination, mental heat and irritability, generalized edema, weak feet, and flaccidity preventing walking. (Suitable formulas include Jia Wei Baidu San [Modified Decoction for Resolving Toxins] and Zhuidu Tang [Poison-Chasing Decoction].)

Regarding the above six meridians: Flowing fluids with spontaneous sweating indicate excess Wind (pulse mostly floating and slippery; suitable to increase usage of Qianghuo, Du Huo, Fang Feng, Guizhi). Anhidrosis with pain indicates excess Cold (pulse mostly slow; suitable to increase usage of Guizhi, Fuzi, Ganjiang, Xixin). Heat and irritability indicate excess Summer-heat (pulse mostly rapid; suitable to increase usage of Huangqin, Huangbai, Mugua, Xiangru). Heaviness and swelling indicate excess Dampness (pulse mostly soft and thin; suitable to increase usage of Cangzhu, Zexie, Yiyiren, Fangji, Fuling). As for herbs such as Fangji, Mugua, Yiyiren (Coix Seed), Binglang, Cangzhu, Huangbai, Rougui, Guizhi, Bajitian, Weirui (Polygonatum Odoratum), Mutong, Qianghuo, Zhike, Zexie, Sangzhi, etc., one should adjust the dosage according to which pathogenic factor is predominant and double the dose of herbs suitable for the specific syndrome, rather than being confined to a single formula. Li Dongyuan stated that this disease, due to the low-lying terrain of the South, is caused by external invasion of Cold-Dampness into the meridians. In contrast, the North has high terrain and little external water-dampness; thus, cases there are caused by internal injury from alcohol and dairy, with Damp-Heat sinking downward. Therefore, the South should be treated as Cold-Dampness, and the North as Damp-Heat. Although this viewpoint was novel, it may not be entirely accurate. Is it true that the South, despite being low-lying, lacks people who indulge in rich foods and alcohol? Is it true that the North, despite being high, lacks activities involving wading and washing? It depends on the skilled physician to carefully observe the signs and pulses and differentiate accordingly. This is the proper approach.