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Tremor (Chan) refers to shaking; vibration (Zhen) refers to shivering and agitation. These are also manifestations of wind and fire agitating the body, caused by deficiency of Kidney Water. (Water governs stillness; when deficient, internal wind and fire arise causing agitation.) Excessive Liver Wood weakens Spleen Earth. The Spleen is the root of the four limbs, and the four limbs are the extremities of the Spleen; thus it is said that Wind pathogen easily causes disease in the extremities. (In some cases, only the head shakes while the hands and feet remain still, which indicates upward rushing of Liver Qi.) When Wind and Fire are excessive and the Spleen is deficient, the Spleen cannot transport fluids, leading to accumulation of Phlegm-Dampness; treatment should include resolving Phlegm. He Zizheng treated Old Man Ma, who suffered from Wind convulsions for three years with severe trembling, like a puppet pulled by strings. He first induced sweating with Fangfeng Tongsheng San (see Stroke), then administered emetics to vomit one or two *sheng* of Phlegm, followed by purgatives five to seven times. Several days later, he vomited another three or four *sheng* of Phlegm and had several bowel movements before recovery. The patient felt extreme cold because Wei Qi had not yet recovered; he was regulated with herbs that disperse Wind and regulate Qi. Warm-tonic herbs were avoided to prevent aggravating Fire. For cases where Wind and Fire interact excessively, Cui Gan Wan (Liver-Subduing Pill) is used. For Qi deficiency, Shen Zhu Tang (Ginseng and Atractylodes Decoction) is used. (Qi deficiency fails to circulate throughout the body, and the four limbs move due to鼓动 by Deficient Wind.) For Heart Blood deficiency, Bu Xin Wan (Heart-Nourishing Pill) is used. If accompanied by Phlegm, Daotan Tang (Phlegm-Resolving Decoction) with Zhuli (Bamboo Sap) is added. For elderly patients with shivering and trembling, Dingzhen Wan (Stabilizing Vibration Pill) is used.

(Jiu Feng Jiao / Wine-Wind Foot, Jiao Wan Chuang / Ankle Ulcer, Gen Qian Zhu Kong / Heel Puncture Hole)
The term "Xianggang Jiao" (Hong Kong Foot, commonly known as Beriberi) originated with Su Jing of the Jin Dynasty and did not exist in ancient times. However, its symptoms of swelling, pain, numbness, and hardness correspond to Bi Syndrome described in the *Classic*; flaccidity and inability to contract correspond to Wei Syndrome; and severe upward rushing of Qi to the heart and abdomen corresponds to Jue Ni (Reversal Cold/Heat). This disease is caused by Dampness, either external invasion of water-dampness or internal accumulation of fluid retention. Initially, it often presents with cold signs, showing only numbness and hardness; subsequently, Dampness stagnates and transforms into Heat, resulting in swelling and pain. Evaporation of Damp-Heat causes swelling, while stagnation of Blood and Qi causes pain. If exacerbated by external Wind-Cold, the Heat cannot dissipate, and pain intensifies. Since the Qi and Blood in both legs are stagnant and unable to flow, the Qi and Blood throughout the body fail to circulate freely, leading to stagnation and fever. Because Qi fails to circulate to the exterior, the patient experiences chills (Sasha E Han), and the presentation resembles Taiyang Disease (Cold Damage). Flaccidity results from tendons becoming soft and weak due to Damp-Heat steaming them. (Objects exposed to Damp-Heat inevitably become soft.) Severe upward rushing occurs because blockage below forces rebellion upwards. Treatment must distinguish the ratio of Dampness to Heat: if Dampness exceeds Heat, swelling is prominent but pain is mild; if Heat exceeds Dampness, swelling is mild but pain is severe. There are cases with only Dampness and no Heat, presenting as swelling without pain, vulgarly called Wet Xianggang Jiao; there are cases with only Heat and no Dampness, presenting as hot pain without swelling (severe cases show wasting), vulgarly called Dry Xianggang Jiao. (Although termed 'no Dampness', old Phlegm and foul saliva must still be present.) In the initial stage, feeling cold, numbness, and swelling, moxibustion of 20–30 cones on the affected area draws Dampness outward, followed by drinking damp-dispelling medicinal wine to unblock meridians and scatter pathogens. Herbs such as Mahuang (Ephedrae Herba), Chuanwu (Aconiti Radix Preparata), Shengjiang (Zingiberis Rhizoma Recens), and Fuzi (Aconiti Lateralis Radix Preparata) are suitable. Mahuang disperses, allowing Dampness to exit via the exterior; Chuanwu is acrid and hot, moving freely without staying put, to unblock meridians; Ginger and Aconium disperse Cold; Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Shengma (Cimicifugae Rhizoma), and Gegen (Puerariae Lobatae Radix) lift and disperse, utilizing the principle that "Wind overcomes Dampness"; Baizhu (Atractylodis Macrocephalae Rhizoma) and Cangzhu (Atractylodis Rhizoma) dry Dampness, utilizing the principle that "Earth controls Water"; along with Fuling (Poria), Zhuling (Polyporus), and Zexie (Alismatis Rhizoma) to promote urination. This is the general method for treating Cold-Dampness. (Yiren Jiu / Coix Seed Wine, Duhuo Jisheng Tang / Notopterygium and Poria Decoction may be used.) If initially presenting with hot pain but no swelling, this indicates Blood deficiency in the Three Yin channels, with Yang pathogen sinking and transforming into Heat that does not dissipate, causing blood vessel obstruction and pain; absence of Dampness explains the lack of swelling. Treatment should clear Heat and nourish Blood using Siwu Tang (Four Substances Decoction) and Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), adding Niuxi (Achyranthis Bidentatae Radix), Huangbai (Phellodendri Cortex), and Zhimu (Anemarrhenae Rhizoma).
Additionally, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to lift sinking Yang Qi. This is the general method for treating Deficient Heat. Excess Heat involves combined Damp-Phlegm, presenting with swelling and pain. For constipation, use Qianghuo Daozhi Tang (Notopterygium Guiding Stasis Decoction) to mildly purge, followed by Danggui Niantong Tang (Angelica Joint-Pain Resolving Decoction). For aversion to cold and fever, use Jiawei Baidu San (Modified Detoxifying Powder), followed by Danggui Niantong Tang. For burning pain extending to the waist and hips, use Jiawei Ermiao Wan (Modified Two Marvels Pill). For unbearable pain, use Wuji San (Five Accumulations Powder) with three Quanxie (Scorpion), decocted in wine. Generally, for Damp-Heat congestion, treatment should focus on unblocking; Huoluo Dan (Meridian-Unblocking Pill) is most effective. For deeply entrenched pathogens, only this can penetrate. Once congestion is established, Bian (stone pricking) must be used to release evil blood to curb the momentum before administering medicine. This condition requires meridian-specific medication: the anterior aspect belongs to the Yangming channel, with Baizhi (Angelicae Dahuricae Radix), Shengma, and Gegen as guiding herbs; the posterior aspect belongs to the Taiyang channel, with Qianghuo and Fangfeng as guides; the lateral aspect belongs to the Shaoyang channel, with Chaihu (Bupleuri Radix) as a guide; the medial aspect belongs to the Jueyin channel, with Qingpi (Citri Reticulatae Pericarpium Viride), Chuanxiong (Ligustici Chuanxiong Rhizoma), and Wuzhuyu (Evodiae Fructus) as guides; the anteromedial aspect belongs to the Taiyin channel, with Cangzhu and Baishao (Paeoniae Radix Alba) as guides; the posteromedial aspect belongs to the Shaoyin channel, with Duhuo (Angelicae Pubescentis Radix) as a guide. One must also check for external pathogens: Wind sensation implies spontaneous sweating, Cold sensation implies absence of sweating; add dispersing herbs accordingly. (Add Qianghuo and Fangfeng for Wind; add Mahuang and Xixin (Asari Radix et Rhizoma) for Cold.) If the disease is severe and attacks upward, causing insensitivity in the lower abdomen, vomiting after eating, pain in the back, spine, and body, and chest/hypochondriac pain, it is a critical condition. If insensitivity in the lower abdomen appears, within two to three days it will attack the Heart, causing irritability, panting, vomiting, headache, dizziness, insomnia, delirium, blackening of the eyes and forehead, profuse sweating, short and rapid pulse, fluctuating or absent Left Cun pulse, and absent Chi pulse; these are all untreatable, known as "attacking the Heart leads to death." Several formulas are listed below. Zhu Danxi used Siwu Tang plus fried Huangbai, and applied Fuzi powder mixed with saliva to Yongquan (KI1) acupoint, followed by moxibustion to draw Heat downward. (Suitable for Blood deficiency with upward-rushing Heat.) Jingui Shenqi Wan (Eight-Ingredient Pill from the Golden Cabinet) treats Xianggang Jiao ascending to lower abdominal insensitivity. (Suitable for Kidney Cold with upward-rushing Damp-Qi.) Alternatively, Zhuyu Wan (Cornelian Cherry Pill) or Zhuyu Mugua Tang (Cornelian Cherry and Papaya Decoction). Areca nut powder taken with child's urine. Dafuzi San (Betel Nut Powder). Sanwan San (Three Epigastrium Powder). Sangbaipi San (Mulberry Bark Powder). (All suitable for Excess patterns.) Xijiao San (Rhinoceros Horn Powder). (Suitable for Heat patterns.) Chenxiang San (Agarwood Powder). (Suitable for non-Heat patterns.) Ziye (Perilla Leaf) 3 liang, fried Sangbaipi (Mori Cortex) 2 liang, Qianhu (Peucedani Radix) 1 liang; take 8 qian per dose. Binglang (Arecae Semen) 2 pieces, Xingren (Armeniacae Semen Amarum) 20 kernels (skin and tip removed), Shengjiang 5 slices; decoct in water and drink. Suzi Jiangqi Tang (Perilla Seed Descending Qi Decoction), assisted by Yangzheng Dan (Upright-Conserving Pill) or Simo Yin (Four-Mouth Drink). (See Qi disorders. Suitable for urgent asthma.) Bawei Pingwei San (Eight-Ingredient Pingwei Powder), for those with poor appetite, use Shengliao Pingwei San (Raw Material Pingwei Powder), plus 1 qian Mugua (Chaenomelis Fructus). Banxia San (Pinellia Powder). Jupi Tang (Tangerine Peel Decoction). (All suitable for vomiting and nausea.) People in Lingnan who love alcohol often suffer from this, named Jiufeng Jiao (Wine-Wind Foot). It is caused by alcohol's Damp-Heat damaging the Spleen, failing to transform and transport, causing sinking and condensation into Phlegm-Saliva that cannot resolve. The pain is unbearable, feeling as heavy as a stone pressing on the foot even from mosquitoes or flies. Treatment rarely succeeds because clearing Damp-Heat is easy, but resolving consolidated Phlegm is difficult. *Zhunsheng* records treating Minister Lian Pingzhang with Danggui Niantong Tang, effective after two doses. After recurrence from eating wet noodles, Qianghuo (acrid-warm, penetrating joints to remove Dampness) was used as the Sovereign herb; Danggui (acrid-warm, dispersing stagnation) and Zhike (bitter-cold, digesting food) as Ministers; Dahuang (bitter-cold, guiding Damp-food downward and removing old blood) as Attendant. Full recovery ensued. Also: Kaoyan Dan (Saliva-Controlling Pill) plus 1 qian Yanzhi (Vermilion), 1 liang Binglang, 1 liang Mugua, 0.5 liang Juanbai (Serpylli Herba) (boiled in salt water for half a day, then plain water for half a day), made into pills. Take 30 pills, increasing to 50; expelling evil matter brings immediate relief. Also: Weilingxian (Syneilesidis Rhizoma) powder, honey pills sized like paulownia seeds, taken with wine, 80 pills; expels evil matter resembling green pus or peach gum. One should imitate this approach: first clear Damp-Heat to allow Qi-Blood circulation, then use light-clearing herbs like Shengma and Chaihu to lift Phlegm upward, use Kaoyan Dan and other softening/resolving agents to attack it, and finally use Bian to remove evil blood. *Huren Shu* states: Xianggang Jiao contraindicates tonic medicines and prohibits hot water washing. Note: This applies to excess pathogenic congestion, hence tonics are forbidden. It also applies to excessive Dampness about to rush upward, fearing that washing will steam and raise the Dampness. However, if Dampness is sinking in the feet and cannot exit externally, washing is appropriate to guide it out. Use Fangfeng, Jingjie (Schizonepetae Herba), Weilingxian, Caowu (Aconiti Radix), Chuanjiao (Zanthoxyli Pericarpium), Baizhi, Wuyao (Linderae Radix), Cangzhu, Zisu (Perillae Folium), etc., decocted in hot water for washing. Keep feet warm with slight sweating, and have someone massage them frequently. Walk after meals to dissipate Damp-Heat. Dinner should be light or skipped, as night food is hard to digest and obstructs Qi-Blood. For ankle ulcers in Xianggang Jiao with swelling and pain, use Loulu (Rhapontici Radix), Bailian (Pleurospermatis Radix), Wujiaopi (Acanthopanacis Cortex), Huaibaipi (Mori Cortex Albus), Gancao (Glycyrrhizae Radix et Rhizoma) each 7.5 qian, and Jili (Tribuli Fructus) 2 liang; decoct in water, strain, and wash in a windless place. For irritability, use Xijiao San. For a hole injecting into the heel, deep about half cun, with exceptional pain every afternoon, burn Renzhongbai (Dentis Humanis Ossis Calcinatum) over fire until water exudes, and drip into the wound.