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The occurrence of carbuncles, ulcers, sores, and swellings is due to the accumulation of toxins in the five zang organs and six fu organs, leading to stagnation. Thus, they arise (the original text reads "all exist"). This is not solely caused by the obstruction of Ying (Nutritive) and Wei (Defensive) Qi. Their manifestation has specific locations, and their governing organs have specific affiliations. For instance, those manifesting on the throat and tongue are due to heart toxins; those manifesting on the skin, hair, and muscles are due to spleen toxins; those manifesting in the bone marrow are due to kidney toxins. (The section on liver toxins is missing.) Those manifesting in the lower body are yin toxins; those manifesting in the upper body are yang toxins; those manifesting externally are fu organ toxins; those manifesting internally are zang organ toxins. Therefore, internal lesions are termed "huai" (destruction), external lesions are termed "kui" (ulceration), favorable progression is "cong" (following), and unfavorable progression is "ni" (rebellious). Lesions in the upper body develop rapidly, while those in the lower body develop slowly. Infections involving the six fu organs are easier to treat, whereas those involving the five zang organs are difficult to cure. Furthermore, lesions near bones often present with cold syndromes, while those in deficient areas often present with heat syndromes. If lesions near bones persist without healing, blood may transform into "gu" (a type of accumulation disease); if areas of deficiency persist without healing, qi may transmit to form "lou" (fistula). Conditions forming "gu" typically involve more itching and less pain, or itching preceding pain. Conditions forming "lou" typically involve more pain and less itching, or neither pain nor itching. Internal deficiency with external excess leads to more itching and less pain; external deficiency with internal excess leads to more pain and less itching. Unstoppable bleeding indicates a high mortality rate, while proper pus discharge indicates survival. Symptoms such as uncontrolled vomiting and irregular eating habits are all consequences of carbuncles and ulcers. The variety of symptoms can be countless, but the key lies in detailed examination. Treatment methods are listed in the subsequent chapters.

What is the difference between Hong Kong Jiao (Jiaqi/Foot Qi) and Qi Jiao in human diseases? Qi Jiao refers to conditions where emotional factors such as anger, joy, worry, and thought, along with pathogenic qi of cold, heat, and toxicity, enter from the interior and inject into the feet. Hong Kong Jiao refers to conditions where pathogenic qi of wind, cold, summer-heat, and dampness enters from the exterior into the feet and knees, gradually transmitting inward. However, both internal and external causes involve pathogens depriving the righteous qi, resulting in similar clinical manifestations. Nevertheless, treatment strategies differ regarding priority and sequence. Therefore, categories must be distinguished. If one treats them uniformly without investigating their origins, it will be impossible to achieve a rational cure. When pathogenic qi from emotions and temperature changes flows into the thigh joints or injects into the feet and knees, presenting symptoms similar to various wind syndromes, Li Jie (joint pain and deformity), Pian Ku (hemiplegia), and carbuncles/swellings, but located specifically in the feet and knees, it is termed Qi Jiao. If the pathogen enters from the exterior into the feet and then transmits from the feet to the viscera, it is termed Hong Kong Jiao. For treating Qi Jiao, address the interior first and the exterior second; for treating Hong Kong Jiao, address the exterior first and the interior second. Excess syndromes are treated with draining methods, and deficiency syndromes are treated with tonifying methods.

Furthermore, why are cases of Hong Kong Jiao more common? This is because the Heart and Lung meridians originate in the hands, while the Spleen, Kidney, and Liver meridians originate in the feet. The hands receive clear pathogens, while the feet receive turbid pathogens. Human physical hardship primarily falls upon the hands, feet, and ears, with the feet bearing the heaviest burden. Consequently, pathogenic qi of wind, cold, summer-heat, and dampness frequently attacks the feet. Thus, Hong Kong Jiao is prevalent. Patients suffering from this disease develop it gradually. Initially, when symptoms are subtle, they are unnoticed; even if noticed, they are misunderstood. Physicians may misdiagnose it as other ailments rather than Hong Kong Jiao, leading to unclear treatment and delayed care until the condition becomes severe, placing the patient in danger. Starting from minor issues, it progresses to major syndromes, invading the viscera and damaging the four limbs, head, neck, abdomen, and back. Even when the disease is not yet critical, it remains undetected. It may manifest due to other triggers, resembling Taiyang syndrome (Shanghan), heatstroke, abdominal and back pain, numbness in limbs and joints, disordered speech, mental confusion, occasional asthma and fatigue, sudden blindness or deafness, inability to eat, visceral blockage, spasms and inability to move freely, flaccidity and lack of control, facial deviation and twitching, or trembling of hands and feet. There are myriad complex presentations that few understand. Consequently, ignorant people suffer helplessly and die without recourse. Would not benevolent individuals find this tragic? I now narrate the beginning and end to briefly instruct future students; please reflect deeply. Causes include sexual intercourse after drunkenness, sleeping outdoors after full meals, cooling off in the wind, indulging in pleasure facing the moon, sleeping soundly before drying off after bathing, traveling immediately after intercourse, standing long in low-damp places, lingering by water edges, walking in rain, exposure to cold, sweating from overexertion, dietary issues arising from sorrow, and violating taboos, all leading to disease. Pathogenic qi attacking the upper part harms the head and eyes; attacking the middle part affects the heart and abdomen; manifesting in the lower part damages the waist and feet; spreading to the sides hinders the joints. Thousands of symptoms belong to Qi Jiao, but those originating in the feet and knees are specifically termed Hong Kong Jiao. Morphological signs and pulse patterns require detailed clarification. A floating and wiry pulse indicates wind origin; a soggy and weak pulse indicates dampness origin; a surging and rapid pulse indicates heat origin; a slow and choppy pulse indicates cold origin; a slippery and faint pulse indicates deficiency origin; a firm and hard pulse indicates excess origin. Disease in the upper part arises from the upper; disease in the lower part arises from the lower; disease in the middle part arises from the middle. Knotted pulses indicate qi stagnation; scattered pulses indicate sorrow; tight pulses indicate anger; thin pulses indicate grief. Wind pathogens are cured by inducing sweating; damp pathogens are cured by warming; heat pathogens are cured by resolving/clearing; cold pathogens are cured by moxibustion/warming compresses. Deficiency is treated by tonification, excess by purging, qi stagnation by moving qi, sorrow by comforting, anger by pleasing, and grief by harmonizing. One who masters these principles is called a good physician. Furthermore, if Hong Kong Jiao transmits to the Heart and Kidneys, ten out of ten cases are fatal. Transmission to the Heart presents as mental confusion, forgetfulness, vomiting, inability to eat, restless sleep, and instability of the mouth and eyes, accompanied by a cun position pulse at the left hand that fluctuates in size and presence. Transmission to the Kidneys presents as swelling of the waist and feet, urinary retention, incessant groaning, black discoloration of the eyes and forehead, qi rushing upward to the chest and abdomen causing asthma, and an absent chi position pulse at the left hand. Careful examination is essential.