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Yan stated: In ancient times, there was no concept of "Hongxiangjiao" (Gouty Arthritis/Chronic Lower Limb Edema). The *Neijing* (Classic of Internal Medicine) referred to it as "Jue" (Reversal/Cold Extremities), the Han and Wei periods called it "Huanfeng" (Languid Wind), and after the Song and Qi dynasties, it was termed "Hongxiangjiao". Although the names differ, the essence is the same. Initially, there may be no sensation; it may be triggered by other illnesses or manifest suddenly as severe oppression and confusion, only becoming apparent after two or three days. Symptoms often start from the feet: some present with sluggish weakness, pain, and numbness; some experience sudden collapse while walking; some have bilateral swelling and fullness in the lower legs; some have withered and thin feet and knees; some suffer from palpitations; some have insensitivity or numbness in the lower abdomen; some experience generalized muscle spasms; some vomit upon seeing food and detest the smell of food; some have chest fullness and shortness of breath; some have generalized body aches. These are the different manifestations of the syndrome.

Regarding the pulse: floating and wiry indicates etiology originating from Wind; soggy and weak indicates etiology originating from Dampness; surging and rapid indicates etiology originating from Heat; slow and choppy indicates etiology originating from Cold. Generally, Hongxiangjiao arises from Kidney Deficiency. However, women also suffer from Hongxiangjiao, which must be due to the emptiness of the Blood Sea (Uterus/Menstrual system) combined with emotional disturbances (Seven Emotions), leading to this disease. Given that many women suffer from this condition nowadays, it can be known that women contracting it due to Blood Sea emptiness is similar to men contracting it due to Kidney Deficiency. The medication for men and women is fundamentally the same, but if combined with herbs treating sorrow and indignation (emotional stagnation), efficacy is invariably achieved. One must assess the patient's constitution and add mild tonification; otherwise, Qi and Blood will decline daily, inevitably causing recurrence during the steaming heat of summer. This management is inevitable.

Chen Wuyue stated: Hongxiangjiao is not exclusively governed by one type of pathogenic factor, nor is it confined to a single meridian; thus, it differs from Stroke, Cold Damage, Summerheat, and Dampness injury. Furthermore, various mixed diseases arise, making differentiation difficult. One must locate the involvement of the Three Yin and Three Yang meridians, then examine the pulse for deficiency or excess to guide treatment. Spontaneous sweating and migratory pain indicate Wind predominance; absence of sweating and urgent pulling pain after taking medicine indicate Cold predominance; swelling, fullness, and heaviness indicate Dampness predominance; irritability, thirst, and heat accumulation indicate Summerheat predominance. When the four pathogens are mixed, one should deduce which pathogen is predominant, differentiate between exterior and interior, and apply treatment accordingly. A floating pulse indicates Wind, tight indicates Cold, slow and fine indicates Dampness, and surging and rapid indicates Heat. When appearing in the Yang meridians (exterior), dispersing methods are appropriate. A deep and wiry pulse also indicates Wind; deep and tight indicates Cold; deep and fine indicates Dampness; deep and rapid indicates Heat. When appearing in the Yin meridians (interior), warming and purgative/drainage methods are appropriate. If the pulse is extremely deficient and Qi is intermittent and weak, decoctions for tonification should be used, selected according to the cold or heat nature of the disease. The *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold) lists various syndromes but does not explain the involvement of Yin-Yang meridians or how to initiate treatment based on them.

Commentary: The aforementioned pulse and syndrome descriptions merely cover the Four Qi (Wind, Cold, Summerheat, Dampness). Regarding swelling and blister formation, these are signs of excess Damp-Heat or Heat-Toxin. Swelling accompanied by heaviness suggests excess Damp-Phlegm. Cases where swelling comes and goes, combined with disorders of Qi ascending and descending, are not detailed in the previous examples. Chen noted that after the Six Meridian syndromes appear, specific formulas follow.