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This refers to the symptom of a slender lower leg with swollen knees. It is caused by the combination of wind, cold, and dampness pathogens forming Bi syndrome (obstruction syndrome) in the knee joint. In the early stage, presenting with fever and headache, Wuji San (Coptis and Pinellia Powder) is indicated. This formula is also suitable for cases arising after dysentery. For chronic conditions involving deficiency of the three Yin meridians of the foot (Liver, Spleen, Kidney), Shiquan Dabu Tang (Ten-Ingredient Great Tonifying Decoction) should be used, modified with Aconite (Radix Aconiti Lateralis Preparata), Achyrathes Root (Radix Achyranthis Bidentatae), Eucommia Bark (Cortex Eucommiae), Saposhnikovia Root (Radix Saposhnikoviae), and Notopterygium Rhizome (Rhizoma Notopterygii). Additionally, an external treatment for the early stage involves grinding aged white mustard seed (Sinapis alba seed) into powder, mixing it with ginger juice and scallion juice, and applying it to the affected area for one *shi* (approx. two hours). Blistering will occur; once the blisters dry and the skin peels off, spontaneous recovery ensues.

Wuji San. (Article 42) Shiquan Dabu Tang. (Article 11)

Further Note: He Xi Feng (Crane Knee Wind, resembling rheumatoid arthritis with knee swelling) is mostly due to deficiency-cold, whereas Hong Kong Jiao (Foot Qi / Beriberi) is mostly due to damp-heat. One requires attacking the pathogen, the other tonification; their treatments are distinct. However, if Foot Qi presents with Kidney deficiency, wheezing, and Bi pain in the lower abdomen, Shenqi Wan (Kidney Qi Pill) is indispensable. If Crane Knee Wind presents with redness, heat, and swelling, Ermiao San (Two Marvels Powder) combined with Guizhi Shaoyao Zhimu Tang (Cinnamon Twig, Peony and Anemarrhena Decoction) is also necessary. This illustrates flexible application of methods.

This refers to the symptom of swelling in the feet. Li Dongyuan stated: In the south, where the land is low and damp, dampness invades from the exterior; in the north, where people often consume mutton and dairy, and drink excessively, the Spleen and Stomach are damaged and fail to transform fluids, causing dampness to generate internally and flow downward. In the early stage, presenting with fever and aversion to cold, it resembles Cold Damage (Shanghan) syndrome. If accompanied by upper body wheezing and urgency, or insensitivity in the lower abdomen, one must fear that the pathogen may attack the Heart, leading to untreatable conditions. If left untreated for a long time, it becomes a stubborn disease. This condition is named Yong Ji (Obstructive Disease) and should not be treated with sudden tonification.

In a case of severe, unbearable pain and swelling due to Foot Qi, Jiming San (Rooster Crow Powder) is indicated. (Article 108)

If Foot Qi presents with wheezing and insensitivity in the lower abdomen, preventing the pathogen from entering the Heart is crucial; the following formula is indicated. After recovery from Foot Qi using Jiming San, this formula is also appropriate. Use Guifu Dihuang Wan (Cinnamon and Aconite Rehmannia Pill). (Article 15)

Swelling in one lower leg indicates Damp Foot Qi. If both lower legs are not swollen but present with numbness, spasms, cramping, or flaccidity, it is called Dry Foot Qi. Siwu Tang (Four Substance Decoction) is indicated, modified with Achyrathes Root, Notopterygium Rhizome, Atractylodes Macrocephala Rhizome, Phellodendron Bark, Chaenomelis Fructus, Alisma Rhizome, and Cinnamon Bark. (Article 9)

Regarding accumulation disorders: "Ji" (Mass) arises from the Zang organs, is fixed and immovable, and belongs to Yin. "Ju" (Gathering) arises from the Fu organs, is movable upon palpation, and belongs to Yang. Treatment must distinguish between new/chronic onset and deficiency/excess. The *Neijing* states: For large accumulations, do not attack aggressively; stop when the pathogen has declined by more than half. Over-attacking leads to death. This is the principle for treating accumulations. The pulse should be deep and solid; a weak pulse is contraindicated.

For newly acquired accumulation disorders, if dispersion is deemed appropriate, Wuji San is indicated. (Article 42)

For newly acquired accumulation disorders, if purgative and resolving methods are deemed appropriate, Beiji Wan (Emergency Rescue Pill) is indicated. (Article 53)

Pingwei San (Calm the Stomach Powder), modified with Polygonum Aviculare Herb, Smartweed Herb, Stir-fried Barley Sprout, and Ligusticum Chuanxiong Rhizome. The above eight herbs are each used at 5 qian. Agarwood Wood and Costus Root are each used at 1.5 qian. Rhubarb is soaked in wine, 2 liang. All are ground into fine powder. Take 3 qian per dose, washed down with ginger decoction. Avoid greasy foods and foods that cause Qi stagnation, and abstain from sexual intercourse for one month. Take the medicine at dusk, without eating dinner. Continue until foul matter is expelled via stool or urine. (Article 80)

The Liver's mass is located under the left hypochondrium, named Fei Qi (Fat Qi). Remove Atractylodes Macrocephala Rhizome, add Bupleurum Root, Turtle Shell, Green Tangerine Peel, and Curcuma Longa Rhizome. ○ The Lung's mass is located under the right hypochondrium, named Xi Ben (Breathing Accumulation). Add White Cardamom Seed, Mulberry Root Bark, and Turmeric Tuber. ○ The Heart's mass starts above the umbilicus, extends up to the heart, and is wide as an arm below, named Fu Liang (Hidden Beam). Remove Atractylodes Macrocephala Rhizome, add Cinnamon Bark, Coptis Rhizome, Acorus Rhizome, and Curcuma Longa Rhizome. ○ The Spleen's mass is in the epigastrium, with the abdomen enlarged like a plate, named Pi Qi (Stagnant Qi). Do not modify the original formula. ○ The Kidney's mass is below the umbilicus, originating in the lower abdomen, rushing up to the heart with pain, named Ben Tun (Running Piglet). Remove from the above formula: Atractylodes Macrocephala Rhizome, Rhubarb, Dried Tangerine Peel, Barley Sprout, and Polygonum Aviculare Herb. Add Alisma Rhizome (4 liang), Cinnamon Bark, Aconite, Angelica Sinensis Radix, and Evodia Fruit (each 5 qian), Toosendan Fruit, and Chinese Privet Root Bark (each 1 liang). Wash down with light salt water. Alternatively, refine honey to make small pills and swallow; taking 4 qian per dose is better. ○ For Heat accumulations, add Coptis Rhizome and Scutellaria Root. For Cold accumulations, add Dried Ginger, Cinnamon Bark, and Aconite. For Wine accumulations, add Kudzu Root. For Phlegm accumulations, add Pinellia Tuber. For Water accumulations, add Mulberry Root Bark and Adzuki Bean. For Blood accumulations, add Peach Kernel and Safflower. For Meat accumulations, add Asafetida and Hawthorn Fruit. For Fruit accumulations, add Musk and Tsaoko Cardamom Fruit.

For chronic diseases and weak individuals, do not directly use the aforementioned attacking medicines. One may first administer tonifying medicines before attacking, or switch to tonification immediately after the attacking medicine has eliminated half of the pathology, or take attacking medicine for three days followed by tonifying medicine for one day. The subtle application depends on the practitioner. Upon recovery, tonifying medicines must be used to consolidate the result. Liujunzi Tang (Six Gentlemen Decoction) is indicated. (Article 2)

Xiangsha Liujunzi Tang (Magnolia Bark and Amomum Six Gentlemen Decoction). (Article 3)

Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction). (Article 107)

For the above three formulas, if there is pulsating Qi below the umbilicus, remove Atractylodes Macrocephala Rhizome and add Cinnamon Bark (1.5 qian).

If, after taking attacking medicines, there is massive expulsion of accumulated blood, continuous spontaneous sweating, and weakness preventing movement, Shenfu Tang (Ginseng and Aconite Decoction) should be administered urgently. For poor patients, Danggui Buxue Tang (Angelica Tonify Blood Decoction) with 3 qian of Aconite can be used as a substitute. (Article 105)