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Li Dongyuan treated a court nobleman. He was nearly forty years old, with a robust and obese physique. The Hongjiaojiao (a disease characterized by damp-heat swelling and pain in the feet) had just started. His head, face, and whole body joints were slightly swollen, all with a reddish color. His lower legs were red and swollen, with unbearable pain; the pain intensified even when his hand merely approached the skin. He would get up only to lie down again, lying down only to get up again, suffering bitterly day and night. In spring, Li Dongyuan treated him, reasoning that since this person lived in the high and cold northern lands, he drank much alcohol, which over time damaged the Spleen, impairing its transformation and transportation functions, causing dietary fluids and dampness to flow downward. He prescribed Danggui Nian Tong Tang (Angelica Sinensis Decoction for Relieving Pain) of one tael and two qian. The pain reduced by half. After taking it again, the swelling completely subsided, leaving only slight redness and swelling at the tip of the right index finger. Using a three-edged needle to prick the end of the fingernail, a large amount of dark blood was released, and the redness and swelling entirely disappeared. A few days later, after eating wet noodles, he felt pain in his limbs. He was then given Zhishi Dahuang Tang (Immature Bitter Orange and Rhubarb Decoction), consisting of Zhishi (Immature Bitter Orange Fruit) 5 fen, Dahuang (Rhubarb Root and Rhizome) 3 qian (stir-fried with wine), Danggui (Angelica Sinensis Root) 1 qian, and Qianghuo (Notopterygium Rhizome and Root) 1.5 qian. After two bowel movements, the pain ceased. This Hongjiaojiao is caused by water-dampness pathogenic factors. Dampness accumulates on the face, blood becomes stagnant and fails to circulate, thus causing vexatious pain in the joints. The Classics state: "Wind can overcome dampness." Qianghuo is acrid and warm, penetrating the joints to dispel dampness, so it serves as the sovereign herb. When blood remains and fails to circulate, pain occurs; Danggui is acrid and warm, dispersing stagnation and relieving pain; Zhishi is bitter and cold, treating fullness and digesting food accumulation, so they serve as minister herbs; Dahuang is bitter and cold, guiding the damp-heat from the face downward and treating various old blood stasis and clots, utilizing its fierce and rapid action, so it serves as an envoy herb.

Zhang Dairen treated a patient surnamed Ma from Piling. He suffered from Shenzang Feng (Kidney Wind, a condition characterized by edema and pain). Suddenly, one foot swelled like a gourd, uniform in thickness from the waist down. The pain was unbearable, making turning difficult; he needed two people to support him to move. Someone suggested using a Pi Dao (scalpel) to incise it. Zhang said, "This is Kidney Wind pathogenic factors attacking and flooding the feet and knees." He used Gansui (Kansui Root) one tael and Mubiezi (Strychnos Seed) two pieces (one male, one female), ground into powder. Two pig kidneys were sliced open, one qian of the powder was sprinkled evenly inside, wrapped in multiple layers of wet paper, and slow-roasted. At dawn (Wu geng), it was chewed thoroughly and swallowed with rice drink. If there was more accumulated fluid, there would be more diarrhea; if less, less diarrhea. Soft drinks were recommended for recuperation. If only one foot was affected, one must check the left or right side. For the left foot, use the left kidney; for the right foot, use the right kidney. Only one qian of powder was used. Between Chen and Si hours (7 AM - 9 AM), several sheng of pus-like fluid, clear as crystal, were discharged, and the pain stopped immediately. Then, Chiwu San (Red Crow Powder) was applied to the knee, leading to recovery.

Xiang Yanzhang treated Shi Jianxian's foot disease. Upon onset, both feet became as thick as pillars, ulcerating and oozing yellow fluid, lasting over a month before resolving, only to recur. The six pulses were deep and moderate. Deep indicates internal dampness; moderate indicates Jue (cold extremities) and Wind. This is Wind-Damp toxicity, commonly known as Wet Hongjiaojiao. He used Shenxiong Wan (Shenxiong Pill) and Zhouche Shenyao Wan (Boat Vehicle Divine Protection Pill), achieving cure through drastic purgation of turbid fluids.
Yu Zhen's commentary: These two cases represent treatment methods from the North.

Zhao Liangren said: "When I arrived in Wuzhong, Xu Mengda suffered from soreness and heaviness in both feet, unable to walk. Upon onset, swelling and pain occurred. On one occasion, during a remission period, his pulses in all three positions were large, beating forcefully yet feeling hollow like green onion stalks. His upper body was obese. This was likely due to his consumption of rich foods, endless desires, insufficient essence and blood, and excessive damp-heat. Therefore, I tonified essence and blood below and cleared damp-heat above, giving him two formulas. Some said Hongjiaojiao has no tonification method, so he refused to take them. Three months later, the pain returned. One doctor used southern methods without effect; another used northern purgative methods, resulting in his death on the chamber pot. Alas, practitioners of Qi-Huang medicine, how can we neglect the differentiation of deficiency and excess?"

Zhu Danxi treated a woman with swollen feet using Dihuang (Rehmannia Root), Huangbai (Phellodendron Bark), Cangzhu (Atractylodes Rhizome), Nanxing (Pinellia Tuber), Honghua (Carthamus Flower), Niuxi (Achyranthes Root), Longdancao (Gentiana Root), and Chuanxiong (Ligusticum Rhizome), resulting in a cure.
Xue Lizhai treated a woman with tendon spasms and bone pain in the foot, unresponsive to various medicines. Her pulse was tight. He used Dafangfeng Tang (Great Wind-Expelling Decoction). After two doses, symptoms significantly improved; after two more doses, she was stable.

Jiang Yingsu said: "My friend She Jin Feng, a merchant in Maling, aged over fifty, suffered from foot pain, unable to rise from bed. For over a year, the flesh of his calves and thighs wasted away. I sought a proven prescription from local physician Xu Gutang, who had previously cured Bi syndrome (painful obstruction). Initially, Danggui Nian Tong Tang was used, effective after two doses. Next, Shiquan Dabu Tang (Ten Ingredients Great Tonifying Decoction) was used, added with Gouqizi (Goji Berry), Fangji (Stephania Root), Niuxi (Achyranthes Root), and Bibi (Dioscorea Hypoglauca Rhizome). In the morning, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) was taken, added with Hu Jinggu (Tiger Bone), Niuxi (Achyranthes Root), Chuan Bibi (Dioscorea Hypoglauca Rhizome), and Lujiao Jiao (Deer Antler Glue). After three years of administration, his legs recovered as before. Dr. Xu said: 'Long-term use will bring great benefit; do not expect immediate results.' Indeed."

Yu Zhen's commentary: The disease of Hongjiaojiao is rarely seen recently. If there is redness and swelling of the lower legs with unbearable pain, it is commonly called Liuhuo (Flowing Fire). If there is alternating pain in hands and feet, slight joint swelling, heat, or redness, it is what the books call Xingbi (Migratory Bi). Treatment methods mainly involve dispelling dampness, clearing heat, and cooling blood. Sometimes Baizhu (Atractylodes Macrocephala Rhizome), Fuzi (Aconite Lateral Root), and Guizhi (Cinnamon Twig) are used. The key lies in differentiating deficiency and excess, and distinguishing between damp-heat and cold-damp. The methods of Dairen and Mr. Xiang are largely unnecessary. Dr. Li Dongyuan's case resembles the treatment of Zhoubi (General Bi); Niantong Tang disperses damp-heat, while Zhishi Dahuang Tang expels damp-heat. Zhu's case also follows Bi syndrome treatment. Xue's and Jiang's cases use tonification, which is slightly different. Additionally, there is a case compiled by Liu Zongyuan regarding Hongjiaojiao: a mass like a stone appeared under the left hypochondrium, causing suffocation and near-death. It was cured by decocting Shanmu Jie (Cedar Wood Knots), Juye (Orange Leaf), Binglang (Areca Seed), and Tongbian (Child's Urine) to induce purgation. Cai Yuanchang suddenly felt as if a bug crawled from the sole of his foot to his waist, followed by fainting; he was cured by moxa application to Fengshi (GB31). There are also cases of Yang Meiren treating Tong Guan, and crushing snails to apply to the thighs to treat Dong Shouyue. These exist only as records now, without matching syndromes for trial, so they are not recorded in detail.

Sun Dongsu said: "A poor scholar had no soreness or pain in both feet, but upon movement, they did not obey his will. They would twist left and fall right, or twist right and fall left, walking in a zigzag pattern, unable to walk straight. This is a rare sight not recorded in books. I speculate it is caused by weak tendons failing to bind the bones, leading to deviation and falling during movement. Tendons are governed by the Liver, which belongs to Wood. When Wood energy is lax and unrestrained, Metal should be strengthened to control it. Ren Shen (Ginseng Root), Huangqi (Astragalus Root), and Baishao (White Peony Root) were used to tonify Lung Metal; Yiren (Coix Seed), Hugu (Tiger Bone), Guiban (Turtle Shell), and Duzhong (Eucommia Bark) to strengthen tendons and bones; Tiehua Fen (Iron Flower Powder) to specifically restrain Liver Wood. These were processed into honey pills, taken morning and evening, resulting in a complete cure."

Yu Zhen's commentary: This is not Hongjiaojiao, but attached here for categorization and ease of reference.

[Appendix] Zhang Jiming said: "A scholar suffered from Jiaoruo (Foot Weakness) disease, unresponsive to hundreds of medicines. I instructed him to wash his feet in a bucket made of Shanmu (Fir wood). I also instructed him to place Zhangnao (Camphor) between his thighs and secure it with leg bandages. After more than a month, he recovered fully."

Jiang Huangnan treated a young man who, in summer, soaked his heels in cold water and sat on damp ground, developing painful swelling in the heels, unable to take steps, resulting in months of bed rest. He taught him to take a block of dry soil, dig a concavity the size of a heel, heat it red with charcoal, remove the fire, pour a bowl of vinegar onto it, let it soak and dry. Then, place the heel against the soil block. Initially, keep it slightly high to fumigate, gradually bringing it closer. The lower limb joints became extremely sore yet comfortable, accompanied by slight sweating. Changing the soil bricks for fumigation over three to four days led to recovery.

My former tutor, Mr. Zhong Cangzhu, suffered from Jiaoruo disease in his youth, with soreness, weakness, and difficulty urinating, requiring prolonged standing to void. Tonifying Liver and Kidney medicines were ineffective. He sought treatment from Mr. He Sizong, who used Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) plus one cow hind leg marrow, resulting in a cure. I realized that previous physicians sought far away what lay close at hand. Mr. He was a prominent master in Jiangnan, and surely had many excellent cases. Regrettably, I was born too late to personally learn from him and could not copy them.