时疫初起，膝痛发热者，邪在太阳经也，独活、槟榔、牛膝为主。兼软者，湿甚也，苍术为主。然此特太阳
之一证，初起以解表邪大势为先，膝痛专药一、二味而已。若经汗、下，表邪大势已解，则当察其邪气之有无，
正气之虚实，专治下部。不然，恐致残废。倘余邪不尽，
留于下部，则仍有热证。如骨蒸，小便黄赤，以黄柏、苡仁清湿热，槟榔、木通通壅滞；筋挛则秦艽、木瓜；筋缓
则苍术、防己；红肿则赤芍、丹皮、续断、芎、归。若无
余邪见心悸，二便频数，尺脉虚小，则当以补肾为急，六味加牛膝、枸杞、知、柏滋益阴精。
时疫初起，胫痛酸者，太阳经脉之郁也，独活为主。兼挛者，治在筋，加秦艽、木瓜；兼肿者，治在肉，
加木通、赤芍、槟榔；兼软者，属湿温，俗名软脚温，往往一、二日即死，宜白虎加苍术汤，或苍术、黄柏。
此与膝痛颇同，未经汗、下，则解表之大势加一、二味胫痛专
药。表证已解，惟留此证，当专治之。若屡经汗、下而见虚证，亦以补肾为主。
时疫初起足痛，有原素有香港脚痼疾者。但治时疫，于
解表药中，微加槟榔、木通。若已经汗、下，表里俱平而足痛不止，则消息其肾家虚实，同膝胫痛法治之。
时疫初起，肩臂痛酸者，手太阳经脉受邪也。解表，则痛自已。经汗、下后而肩臂痛者，有经隧阻滞、血脉空
虚之别∶经隧阻滞者，脉多有力，证多热渴，以清热活血为主，黄芩、赤芍、归尾、红花之类；血脉空虚者，证多
萎困，脉多芤、涩，养血益气为主，四物合参、 之类。
At the initial stage of epidemic febrile disease (Shi Yi), if knee pain accompanied by fever occurs, it indicates that the pathogenic factor is in the Taiyang Meridian (Foot-Taiyang Bladder Meridian). The main herbs are Du Huo (Radix Angelicae Pubescentis), Bing Lang (Arecae Semen), and Niu Xi (Radix Achyranthis Bidentatae). If accompanied by weakness and flaccidity of the limbs, it indicates severe dampness, with Cang Zhu (Rhizoma Atractylodis Macrocephalae) as the main herb. However, this is merely one manifestation of Taiyang involvement. In the initial stage, the primary strategy should be to resolve the exterior pathogen; only one or two specific herbs for knee pain are needed. If after sweating or purgation therapies the major exterior pathogen has been resolved, one must observe whether residual pathogens remain and assess the deficiency or excess of healthy qi, focusing treatment specifically on the lower body. Otherwise, disability may result. If residual pathogens linger in the lower body, heat symptoms will persist. For example, in cases of bone-steaming fever (a sensation of heat emanating from the bone marrow) and yellow-red urine, Huang Bo (Cortex Phellodendri) and Yi Yi Ren (Semen Coicis) can clear damp-heat, while Bing Lang (Arecae Semen) and Mu Tong (Caulis Akebiae Trifoliatae) can unblock stagnation. For tendon spasms, use Qin Jiao (Radix Gentianae Macrophyllae) and Mu Gua (Fructus Chaenomelis); for tendon laxity, use Cang Zhu (Rhizoma Atractylodis Macrocephalae) and Fang Ji (Radix Stephaniae Tetrandrae); for redness and swelling, use Chi Shao (Radix Paeoniae Rubra), Dan Pi (Cortex Moutan), Xu Duan (Radix Dipsaci), Xiong (Radix Chuanxiong), and Gui (Radix Angelicae Sinensis). If there are no residual pathogens but palpitations, frequent urination and defecation, and a deficient and small chi pulse (at the radial artery) appear, tonifying the Kidney becomes urgent. Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) added with Niu Xi (Radix Achyranthis Bidentatae), Gou Qi (Fructus Lycii), Zhi Mu (Rhizoma Anemarrhenae), and Huang Bo (Cortex Phellodendri) should be used to nourish yin essence.
At the initial stage of epidemic febrile disease, if pain and soreness occur in the shank (calf), it is due to stagnation of the Taiyang meridian qi, with Du Huo (Radix Angelicae Pubescentis) as the main herb. If accompanied by spasms, the pathology lies in the tendons; add Qin Jiao (Radix Gentianae Macrophyllae) and Mu Gua (Fructus Chaenomelis). If accompanied by swelling, the pathology lies in the flesh; add Mu Tong (Caulis Akebiae Trifoliatae), Chi Shao (Radix Paeoniae Rubra), and Bing Lang (Arecae Semen). If accompanied by flaccidity, it belongs to damp-warmth disease, commonly known as "Soft Leg Warmth" (Ruan Jiao Wen), which often leads to death within one or two days. Bai Hu Jia Cang Zhu Tang (White Tiger Decoction plus Atractylodes) or simply Cang Zhu (Rhizoma Atractylodis Macrocephalae) and Huang Bo (Cortex Phellodendri) are suitable. This condition is quite similar to knee pain. If not yet treated with sweating or purgation, add one or two specific herbs for shank pain to the general strategy of resolving the exterior. Once exterior symptoms are resolved and only this symptom remains, treat it specifically. If deficiency symptoms appear after repeated sweating and purgation, tonifying the Kidney is also the main approach.
If foot pain occurs at the initial stage of epidemic febrile disease in patients who originally had chronic gout (Hong Kong Foot / Jiao Qi), simply treat the epidemic febrile disease by slightly adding Bing Lang (Arecae Semen) and Mu Tong (Caulis Akebiae Trifoliatae) to the exterior-resolving formula. If sweating and purgation have already been performed, and both interior and exterior conditions are balanced but foot pain persists, assess the deficiency or excess of the Kidney system and treat it according to the methods for knee and shank pain.
At the initial stage of epidemic febrile disease, if pain and soreness occur in the shoulder and arm, it is because the Hand-Taiyang Small Intestine Meridian is affected. Resolving the exterior will cause the pain to subside naturally. If shoulder and arm pain persist after sweating and purgation, there are two distinctions: obstruction of the meridians and vessels versus emptiness of blood vessels. In cases of meridian and vessel obstruction, the pulse is usually forceful, and symptoms often include heat and thirst; treatment focuses on clearing heat and invigorating blood, using herbs such as Huang Qin (Radix Scutellariae), Chi Shao (Radix Paeoniae Rubra), Gui Wei (Tail of Radix Angelicae Sinensis), and Hong Hua (Flos Carthami). In cases of blood vessel emptiness, symptoms often include emaciation and fatigue, and the pulse is usually cun-kou kou (floating, large, and empty like a scallion stalk) or se (choppy); treatment focuses on nourishing blood and augmenting qi, using Si Wu Tang (Four-Substance Decoction) combined with Ren Shen (Radix Ginseng), etc.