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Individuals suffering from Hongxiangjiao (a disease characterized by swelling, pain, or numbness in the feet, historically referred to as "Jiaqi" or foot qi) differ from those with Qijiao (foot disorders caused by rebellious Qi). When pathogenic toxins inject into the feet from within, it is named Hongxiangjiao. When pathogenic factors such as Wind-Cold, Summerheat, and Dampness enter the feet and knees from the exterior, it is named Qijiao. Both conditions result from pathogens depriving the body of Zhengqi (Upright Qi), causing similar pathological manifestations. However, treatment requires distinguishing between upper and lower levels and prioritizing urgency. Without understanding the underlying principles, recovery cannot be achieved.

Furthermore, emotions such as anger, joy, worry, and sorrow, along with Cold-Heat toxic pathogens, may flow into the limb joints or accumulate in the knees and feet. Their symptoms resemble various Wind syndromes, Lijie syndrome (severe joint pain and deformity), Piangu (hemiplegia), and Yongzhong (abscesses/swellings). Yet, if the pathology converges on the feet and knees, it is termed Qijiao. If pathogens enter from the exterior through the feet and penetrate the Zang-Fu organs, it is termed Hongxiangjiao. Treatment for Hongxiangjiao should address the exterior first and the interior subsequently; excess patterns are treated with purgation/drainage, while deficiency patterns are treated with tonification.

Why are there so many cases of Hongxiangjiao? The Heart and Lung meridians originate in the hands, while the Spleen, Kidney, and Liver meridians originate in the feet. Hands are susceptible to Qingxie (Clear/Light pathogens), whereas feet are susceptible to Zhuoxie (Turbid/Heavy pathogens). Among the body parts that endure hardship, the hands, feet, and ears are most taxed, with the feet bearing the heaviest burden. Therefore, Wind-Cold, Summerheat, and Dampness frequently attack the feet, leading to a higher incidence of Hongxiangjiao.

However, this disease develops gradually, initially due to ignorance of its etiology. Physicians often fail to recognize it as Hongxiangjiao, misdiagnosing it as other ailments. Unclear treatments and delayed interventions allow the condition to worsen, leaving patients in dire straits. Starting subtly, it progresses to severe manifestations, invading the Zang-Fu organs and damaging the four limbs. Early symptoms in the head, neck, abdomen, and back may be mild, leading to a lack of awareness until it is too late.

The disease manifests according to time and geography, sometimes resembling Shanghan (Cold Damage), sometimes Zhongshu (Summerheat Stroke), or presenting with abdominal and back pain, numbness in the limbs and joints, disordered speech, mental confusion, occasional asthma and fatigue, sudden blindness or deafness, inability to eat, obstruction of the Zang-Fu organs, muscle spasms and immobility, flaccidity and loss of control, facial deviation and twitching, or trembling of the hands and feet. These myriad symptoms are often misunderstood by those lacking medical insight. Consequently, ignorant people suffer helplessly, dying without access to proper treatment. Would not benevolent physicians feel sorrow upon witnessing this? I now recount the origins and progression of this disease to instruct future students.

Causes include engaging in sexual activity after drunkenness, sleeping outdoors after overeating, cooling off in the wind, indulging in pleasure under the moon, falling asleep deeply before drying off after bathing, exposing oneself to wind immediately after intercourse, standing long in low and damp areas, lingering in wet environments, walking in the rain, sleeping in cold conditions, sweating from exertion followed by emotional distress, and violating dietary or lifestyle prohibitions. Such actions invite pathogenic Qi. If this abnormal Qi attacks the upper part, it harms the head and eyes; if it attacks the middle, it disrupts the Heart and Abdomen; if it attacks the lower part, it causes dysfunction in the waist and feet; if it attacks the sides, it impedes the limbs. All these myriad manifestations belong to Qijiao. Those originating in the feet and knees are specifically called Hongxiangjiao. Morphological signs and pulse characteristics must also be clearly understood.

A floating and wiry pulse indicates origin from Wind; a soggy and weak pulse indicates origin from Dampness; a surging and rapid pulse indicates origin from Heat; a slow and choppy pulse indicates origin from Cold; a slippery and faint pulse indicates origin from Deficiency; a firm and hard pulse indicates origin from Excess. Pathology in the upper part stems from the upper; pathology in the lower part erupts from the lower; pathology in the middle erupts from the middle. A knotted pulse arises from Qi stagnation; a scattered pulse arises from Worry; a gathered pulse arises from Anger; a thin pulse arises from Sorrow.

Wind-induced diseases are cured by inducing sweating; Damp-induced diseases are cured by warming; Heat-induced diseases are cured by resolving/clearing; Cold-induced diseases are cured by moxibustion/warming packs. Deficiency is treated by tonifying; Excess is treated by draining; Qi stagnation is treated by promoting circulation; Worry is treated by soothing/broadening; Anger is treated by pleasing/calming; Sorrow is treated by harmonizing. One who masters these methods is considered a good physician.

If Hongxiangjiao transmits to the Heart and Liver, ten out of ten cases are fatal and incurable. When entering the Heart, symptoms include mental confusion, delirium, vomiting, inability to eat, and restless sleep. The Cun Kou pulse on the left hand becomes irregular—alternating between large and small, present and absent. When entering the Kidney, both the waist and feet swell, urination is obstructed, groaning is incessant, and the eye sockets and forehead turn black.