Library

[Background Information]
Book: Yangyi Quanquan (Complete Book of Surgeons)
Author: Gu Shicheng
Dynasty: Qing
Chapter: Main Discussion on Hong Kong Foot in Women of Jiangdu, Ganquan, and Yizheng Counties, Yangzhou Prefecture, Jiangsu Province
Category: Medical Treatise

Women in Jiangdu, Ganquan, and Yizheng counties of Yangzhou Prefecture in the Jiangnan region suffered from "Hong Kong Foot" (a disease characterized by swelling and pain in the lower legs and feet), starting around the 50th year of the Kangxi reign. Before this, such a condition did not exist. This ailment is caused by chaotic Qi of Yin and Yang, and it is not the same as the "Hong Kong Foot" associated with the Five Bi syndromes (Wind, Cold, Dampness, Heat, and Dryness obstruction syndromes) caused by damp-heat accumulation in men and women in ancient times. The cause of infection lies mostly in wealthy families whose members are proud in temperament, prone to anger at minor inconveniences, overly comfortable in life, irregular in diet, alternating between hunger and overeating, and fond of raw and cold foods. Some women suffer from delayed marriage, sudden cessation of menstruation, or unsuitable marital matches, leading to depression and emotional stagnation. This causes Liver Qi to knot and Spleen Qi to stagnate, injuring both the Liver and Spleen. Liver Blood declines daily, while Liver Qi becomes excessive; excessive Liver Qi lacks nourishment from Blood, leading to spasms and contracture of tendons and vessels. Spleen Qi becomes increasingly fatigued, Stomach Yang fails to thrive, and the Spleen loses its ability to transport and transform, gradually generating Damp-Heat. The epigastric region feels tight and uncomfortable. Combined with irregular eating habits and self-harm through the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sadness, Fear, Fright), the initial symptoms include irregular menstruation, epigastric pain, vomiting of sour water or green phlegm-saliva, soreness in the body and thighs, and gradual pain in the calves. There is often a blocking sensation of masses of varying lengths or shapes below the umbilicus, either on the left or right, which pulsates upon palpation. The pain spreads downwards; when the epigastric region feels slightly relieved, pain reaches the shins and dorsum of the foot, feeling hot like a brand. Subsequently, pain reaches the toes, with needle-like pain in the nail beds, causing day-and-night screaming, unable to live nor die. Sometimes foot pain subsides slightly, but the epigastric region remains distended and stuffy, sometimes turning the face blue and eyes rolling back. Unconsciousness may occur unless heavy pressure is applied to the chest, or a man presses his heels against it. Both feet require constant rubbing by women to alleviate pain. In severe cases, there are limb convulsions, head and neck trembling, fainting, and collapse. Recovery may take one to two hours or half a day. Regardless of constitution, if the patient fasts for seven days, pain gradually subsides; some take fourteen or twenty-one days. This depends on the appropriateness of the doctor's prescription and the family's mistake of giving porridge, which traps the pathogenic factor.

Historically, Hong Kong Foot was classified into Dry and Wet types. Dry Hong Kong Foot presents with dry, emaciated shins, dorsum, and toes, with pain but no sweat. Wet Hong Kong Foot presents with red, swollen shins, dorsum, and toes, with pain, sweat, and fluid oozing from toe webs. In Yangzhou, it is colloquially divided into Male and Female types. Male Hong Kong Foot involves swelling with white coloration; even if cured, fertility is unlikely due to severe depletion of Qi and Blood, resulting in delayed, scanty menstruation. Female Hong Kong Foot involves swelling with red coloration and burning heat; menstruation occurs early. If treated correctly, fertility can be expected. Generally, the root cause is inherent deficiency of the Liver and Spleen, allowing pathogens to enter due to deficiency. Treatment should address the specific trigger: disperse Wind-Cold if triggered by Wind-Cold; clear Summer-Heat-Dampness if triggered by Summer-Heat-Dampness; warm the Middle and resolve stagnation if triggered by raw/cold food; soothe the Liver and dissipate depression if triggered by anger. By addressing the pattern first, attacks will be milder. Patients should maintain a mindset of being ill even when well, taking pills in the morning focused on nourishing Blood, regulating menstruation, calming the Spirit, and dissipating depression, such as Tiaojing Yangxue Wan, Heche Dazao Wan, Yimu Bazhen Wan, Xiangfu Nv Jindan, or Yiqi Yangrong Wan. Since Yin-nourishing herbs can be cloying, morning doses leverage their "Yang within Yang" nature for easier digestion. Evening doses focus on strengthening the Spleen and harmonizing the Stomach, using formulas like Jiawei Liujunzi Wan, Jiawei Yigong San, Shuidie Zisheng Wan, or Hewei Jianpi Wan, preferably prepared as small water-pellets that dissolve quickly in the stomach during the night (Yin time). Consistent use for three years can permanently eliminate the disease. Patients must also change their temperament and dietary habits.

Regrettably, for forty to fifty years, women in Yangzhou have suffered from this, crying out in agony. Doctors have blindly applied ancient formulas for Five Bi Hong Kong Foot, using herbs like Fangji, Mugua, Qinjiao, Bixie, Weilingxian, Guizhi, Sangzhi, Cangzhu, Houpo, Wuyao, Binglang, Huangbai, Qiannianjian, Zuandifeng, Caoxie, Wujiapi, Haitongpi, Jiangxiangjie, Rougui, Fuzi, Ruxiang, Moyao, Hugu, and Qingpi. These are largely damaging to the Spleen and Liver, breaking Qi and injuring Yin, leaving doctors with few other options. This error stems from doctors fixating on Damp-Heat and the fear of "Hong Kong Foot rushing upward" causing fatal厥逆 (rebellious Qi and cold extremities). They prioritize forcing the pathogen downward, ignoring the patient's Righteous Qi. However, the disease originates from Liver-Spleen deficiency and rebellious Qi attacking the chest. Using harsh purgatives to force downward movement traps both Righteous Qi and Pathogenic Qi, akin to chasing thieves into a dead end, forcing them to escape violently. With nowhere to go in the ten toes, pain becomes excruciating. Overuse of these drugs damages Righteous Qi further, leading to empty "granaries" (digestive system), where Pathogenic Qi runs rampant upward, often fatally. Those with strong constitutions may recover in seven days; weak ones in fourteen; extremely weak in twenty-one. This mirrors the Six Meridian transmission of Shanghan (Cold Damage), where recovery coincides with the restoration of Heaven and Earth Qi, not merely drug efficacy. Early doctors lacked direction, misdiagnosed the cause as chaotic Yin-Yang Qi, and relied on increasing dosages of ineffective ancient formulas. They attributed death to "rushing upward," deeming it incurable. Many died without understanding the true cause. Since the Qin and Han dynasties, texts referred to conditions as Huanfeng, Ruojiao, or Jiaoqi, treating general Wind-Cold-Damp-Heat Bi syndromes, not this specific epidemic affecting women in Yangzhou. Ancient people were simpler, lived in richer soils, and had stronger constitutions. Yangzhou's soil is thin, people are more sensitive, weaker, pampered, comfort-seeking, emotionally volatile, and eat raw/cold foods, leading to Liver-Spleen stagnation. Ancients could not have predicted this specific demographic and environmental combination millennia later. If they had, they would have specified distinct formulas. This condition is unique to these three counties; neighboring areas do not report it. While Yangzhou is damp, causing skin sores or gastrointestinal bloating, or damp-heat descending to legs (red, swollen, weeping), these do not start with epigastric pain or the intense burning pain seen here. Applying ancient formulas is like adding fuel to fire. Some recover with Fangji, Mugua, etc., because they have excess Damp-Heat from rich diets. But applying this to those with deficient Damp-Heat due to poor Spleen function worsens the condition.

Gu Shicheng observes that Yangzhou residents eat poorly, favoring raw/cold foods, leading to Spleen-Stomach dampness. Even after fasting for weeks with no bowel movements, they may still socialize. Prescriptions with Cangzhu, Houpo, Xiangfu, Sharen, Jiang, Rougui, Yuzhu, and Fuzi help. Once eating resumes, decoctions stop. Relapses occur, and doctors repeat the same formulas, which patients trust blindly. However, the Spleen is the mother of all things, and the Stomach is the sea of grain and water. Initially, Cangzhu and Houpo are needed to level the obstructed Spleen Earth. Once leveled, growth can occur. Doctors and patients fail to understand agricultural principles: leveling high ground and filling low ground, then irrigating to grow crops. Constantly using Cangzhu and Houpo to "level the Stomach" turns fertile land into a stagnant pond, leading to Spleen-Stomach deficiency. Gu Shicheng proposes: for high/robust patterns, level the Stomach; for low/deficient patterns, strengthen the Spleen. Mild cases need simultaneous resolving and tonifying; severe cases need warming Fire to generate Earth, using Lizhong Tang with Ginger and Aconite, or Liujunzi Tang with Cinnamon and Aconite. Post-recovery, use Liujunzi Wan, Jiawei Yigong Wan, Jin Gui Shen Qi Wan, Qiwei Dihuang Wan, Guishao Liujunzi Wan, or Shuidie Zisheng Wan according to the pattern to permanently resolve Spleen-Stomach Damp-Heat. Having practiced in Yangzhou, Gu has seen many cases. Women scream, tear their hair, and grind their teeth. By investigating the root, he developed new methods that cure rapidly. Previous doctors misused purgatives, killing many. Now sharing this method to prevent future errors and accumulate virtue.

Hong Kong Foot affects the wealthy, not the working class. The wealthy are overfed, idle, irregular in eating, emotionally repressed or angry, injuring the Liver and Spleen. Working-class women labor, eat simple food, have unobstructed Qi and Blood, and thus resist the pathogen. When infected, symptoms start with chest oppression, epigastric pain, vomiting green phlegm, and a hard mass in the chest. Pain moves down to the legs; as leg pain increases, chest relief occurs, and vice versa, like a ball rolling in a bamboo tube. Mismanagement with greasy foods causes upward rushing of pathogenic Qi, leading to fainting and death. Severe cases require heavy pressure on the chest or men stepping on it to prevent fainting, and constant rubbing of feet. It requires extensive care, impossible for poor families. The "chaotic Yin-Yang Qi" is attracted by individual constitution. Transmission occurs among close female relatives (mother-daughter, sisters, sisters-in-law), though not always. Alcohol may temporarily numb pain but is generally contraindicated. Asking about pain triggers recurrence. Discussing the disease triggers attacks due to Liver deficiency and Gallbladder timidity. Fasting until pain stops and chest opens is key; resume with rice water, avoiding porridge initially. Dietary taboos include fish, shellfish, poultry, eggs, mushrooms, cucumbers, melons, gluten, cilantro, eggplant, beans, fermented products, garlic, chives, bamboo shoots, alcohol, sticky foods, preserved eggs, shrimp, kelp, yellow pomfret, peas, taro, water chestnuts, poppy seeds, radish, fungus, clams, vinegar, tangyuan, lamb, donkey meat, celery, spinach, round cakes, and watermelon. Avoid incense (Benzoin, Rue, Atractylodes) during outbreaks. Recovery time varies; post-menstrual onset lasts longer, while pre-menstrual onset resolves quickly with menstruation, indicating Liver-Spleen stagnation. Rest and abstinence from sex for one month are required. Avoid raw radish, watermelon, peaches, apricots, plums, lotus root, persimmons before menstruation. Avoid oily nuts (walnuts, almonds, peanuts, pine nuts) if vomiting green fluid. Maintain emotional stability and a "sick mindset" when well to prevent recurrence. Uncaria rhynchophylla (Gouteng) dispels Wind and relaxes tendons, serving as a holy medicine for pain relief; use generously.