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Furthermore, there are formulas for dispersing cold and eliminating dampness; *Muxiang* (Aucklandiae Radix), *Binglang* (Arecae Semen), *Xiangfu* (Cyperii Rhizoma), and *Wuyao* (Linderae Radix) are agents that promote the circulation of Qi in the air passages; *Honghua* (Carthami Flos) and *Taoren* (Persicae Semen) are agents that invigorate blood and resolve stasis; *Niuxi* (Achyranthis Bidentatae Radix), *Duzhong* (Eucommiae Cortex), *Bixie* (Dioscoreae Hypoglaucae Rhizoma), and *Hugu* (Pantheris Os) are agents that strengthen sinews and bones; *Renshen* (Ginseng Radix), *Fuling* (Poria), *Baizhu* (Atractylodis Macrocephalae Rhizoma), *Danggui* (Angelicae Sinensis Radix), *Shaoyao* (Paeoniae Radix), and *Dihuang* (Rehmanniae Radix) are agents that nourish Qi and Blood. If used appropriately, whether attacking pathogens or tonifying deficiency, efficacy can be achieved. (From *Jinnang*)

It is also said: In the early stage of Hongjiaojiao (a disease characterized by swelling and pain in the lower legs and weakness), symptoms are very subtle, often unrecognized by people. Diet, play, and physical strength remain normal; the only abnormality is the sudden onset of foot flexion weakness and immobility. Although the etiology differs between internal and external factors in the North and South, the root cause is always Kidney Deficiency. Women suffering from this condition do so due to emptiness of the Sea of Blood, which is the same as Kidney Deficiency in men. If the pathogen enters the abdomen and attacks the Heart, with incessant vomiting, life is in imminent danger. It is appropriate to use *Bawei Wan* (Eight-Ingredient Pill) to warm and expel the pathogen. If the pathogen enters the Kidney, there will be swelling of the waist and feet, obstruction of urination, black qi around the eyes and forehead, chest fullness with wheezing and groaning, and death if the left Chi pulse is absent. This is because individuals with Kidney Deficiency and Yang Decline are prone to this disease; Water of the Kidney overacts on the Heart, suppressing Fire. Therefore, for Kidney-Qi type Hongjiaojiao, one should take *Jinkui Shenqi Wan* (Golden Cabinet Kidney Qi Pill) in advance for prevention.

It is also said: Those contracted externally in the South manifest only as swelling and pain in the lower shins; those caused internally in the North may affect the hand joints. The treatment method initially uses dispersion to release the exterior, followed by purging the bowels to guide out the pathogenic factors.

The Classics state: Sweating while sleeping and then being exposed to wind causes凝 (coagulation/stagnation). When it coagulates in the skin, it becomes Bi Syndrome (Obstruction); when it coagulates in the vessels, it becomes Qi stagnation; when it coagulates in the feet, it becomes Jue (Cold Reversal).

The *Treatise on the Great Truth and Necessity* (*Zhi Zhen Yao Da Lun*) says: When Taiyin Dampness prevails, Fire Qi is depressed internally and flows outward, causing swelling of the lower legs and thighs, fluid retention in the middle, and edema in the lower body. Any internal injury from alcohol and food leads to a deficit in the Spleen and Stomach's transportation and transformation Qi. Unable to ascend, it flows downward and attacks the Liver and Kidney positions, pouring into the lower legs and thighs. Added to irregular sexual activity, pathogens invade the deficiency, resulting in Hongjiaojiao. If not cured for a long time, it becomes a stubborn disease. Hardness like stone is called Shiju (Stone Abscess); flesh color purple-red with ulcerated skin and flesh is named Huanju (Slow Abscess), which requires only warm tonification.

It is also said: Hongjiaojiao may present with vomiting after eating, aversion to the smell of food, abdominal pain with diarrhea, or obstruction of both urine and stool; mental confusion; delirious speech; high fever and headache. These resemble Shanghan (Cold Damage), named "Hongjiaojiao attacking the Heart," which is mostly fatal.

It is also said: A floating and wiry pulse indicates Wind; a soggy and weak pulse indicates Dampness; a surging and rapid pulse indicates Heat; a slow pulse indicates Cold; a minute pulse indicates Deficiency; a firm and hard pulse indicates Excess; a knotted pulse is due to Qi stagnation; a scattered pulse is due to worry; a tight pulse is due to anger; a fine pulse is due to sorrow.

It is also said: When women's ten toes feel as if scalded by hot oil, it is all due to deficiency of Ying (Nutritive) and Wei (Defensive) Qi, with Damp-Toxin flowing and stagnating in the meridians. Attacking upward to the Heart causes Heart pain; attacking downward to the feet causes foot pain, with toes burning like fire. This resembles Hongjiaojiao, which the Classics refer to as "Heat Jue."

The *Medical Treatise* states: The disease of Hongjiaojiao is caused by weakness in the Spleen and Kidney meridians. During sitting, lying, moving, or acting, one is interfered with by Wind, Cold, Summerheat, and Dampness, leading to flow and accumulation. At the beginning of the illness, it is often imperceptible. It must be triggered by another illness to start, or one may suddenly feel extremely stifled, realizing it only after two or three days. It starts from the feet: sometimes presenting as slow weakness, pain, and numbness, falling suddenly when walking; sometimes lower leg swelling and fullness, or withered and thin feet and knees; sometimes palpitations in the heart, or insensitivity in the lower abdomen; sometimes constipation of urine and stool; sometimes general muscle spasms and soreness of bone joints; sometimes aversion to food smells, vomiting upon seeing food; sometimes chest fullness and shortness of breath, high fever with aversion to cold. The pathogen transmits through the Foot Six Meridians, and external signs resemble Shanghan, except for the sudden foot pain. Manifestations vary: if Cold affects the Three Yang meridians, the patient feels cold; if Summerheat affects the Three Yin meridians, the patient feels hot. A floating and wiry pulse arises from Wind; a soggy and weak pulse arises from Dampness; a surging and rapid pulse arises from Heat; a slow and choppy pulse arises from Cold. For Wind, use sweating; for Dampness, use drying; for Heat, use clearing; for Cold, use warming. One must also treat according to the four seasons, interior/exterior, and deficiency/excess. Warm tonification and herbal foot baths must strictly be avoided; this is a major taboo for physicians. Tonification leads to Qi excess, often resulting in untreatable conditions; foot baths allow pathogenic toxins to enter inward, making them difficult to treat. If treatment is delayed, allowing toxic vapors to enter the abdomen and attack the Heart, causing pounding pain, wheezing, fullness, and abnormal vomiting, it gradually leads to collapse and danger. How can this be neglected!

Lin Shi said: Someone asked, "Swelling and pain of the dorsum of the foot clearly indicate Damp-Heat, why is it called Hongjiaojiao? Since it is named 'Qi,' it is still Damp-Heat. Why are there distinctions between external contraction and internal causes, dry/wet, cold/heat, even progressing to attacking the Heart, vomiting, delirium, coma, and death?" The answer is: This 'Qi' is different from ordinary Damp-Heat. It is not caused overnight. Although this syndrome originates from slight Damp-Heat pathogens, they have been dormant in the Foot Three Yin meridians for a long time, unable to vent, becoming stagnant and steaming into Heat, stasis causing redness and swelling, swelling followed by pain. Moreover, the Foot Three Yin meridians run from the medial malleolus up to the lower abdomen, then further up to the pericardium and throat. Thus, swelling and pain necessarily involve the meridians, and the steaming Qi reverses upward to the chest and heart, leading to chills and fever resembling malaria, nausea, and vomiting. Hence the alias 'resembling Shanghan.' Furthermore, at the onset, the disease is invariably triggered by external contraction and internal causes, such as sudden anger or sexual fatigue. Thus, internal and external mixed syndromes occur, making differentiation difficult in haste. Beginners, confused about medication, if they fail to distinguish interior/exterior and deficiency/excess, and recklessly administer tonifying/purging and cold/hot drugs, will inevitably lead to critical conditions of attacking the Heart. (From *Huren Bian*)

It is also said: Someone asked, "Although it is called Hongjiaojiao, it is merely long-standing Damp-Heat stagnation. What harm is there to cause death? If it can indeed kill, its severity exceeds Shanghan. Why call it 'resembling' Shanghan? Since it is similar, there are cases of recovery/death in seven days or fourteen days. Based on this, could it not be called Hongjiaojiao Shanghan?" The answer is: Hongjiaojiao and Shanghan originally belong to two different syndromes and cannot be confused. Only the chills, fever, vomiting, and the depth of transmission through the Three Yin and Three Yang meridians resemble Shanghan, hence the term 'resembling.' Regarding the cause of death, any pathogen of Wind, Cold, Summerheat, or Dampness transmits from meridians to the Six Fu organs, and then to the Five Zang organs, from mild to severe, and from severe to critical. Why single out Hongjiaojiao to compare with Shanghan?

It is also said: Regarding pulses and manifestations, this syndrome has Damp-Heat as the root and triggering pathogens as the branch. Onset begins with slight redness, swelling, and pain in the feet. Severe swelling leads to severe pain, and the steaming Qi enters the Fu organs of the Foot Three Yang meridians via the channels. Thus, there are alternating chills and fever, aversion to cold, irritability, nausea, vomiting, thirst with desire to drink, panting, delirium, aversion to food yet ability to eat, and constipation of both urine and stool. If the pulse is floating, surging, wiry, rapid, and forceful, it is called Dry Hongjiaojiao, indicating disease in the Three Yang meridians. If urine and stool are free, sweating is profuse without thirst, but there is nausea, vomiting, inability to tolerate fluids, cold limbs with floating Yang (dai yang), coma, and delirium, and the six pulses are deep, hidden, fine, soft, and powerless, it is called Wet Hongjiaojiao, indicating disease in the Three Yin meridians.

It is also said: Treatment methods for Hongjiaojiao: For Dry Hongjiaojiao, initially disperse and diffuse, mid-stage harmonize, late stage moisten and purge. For Wet Hongjiaojiao, initially disperse and diffuse, mid-stage harmonize, late stage clear and tonify.