【脉】 浮弦者风，濡弱者湿，洪数者热，迟涩者寒，微滑者虚，牢坚者实，结
则因气，紧则因怒，细则因悲。
入心则恍惚妄谬，呕吐，食不入，眠不安，左寸脉乍大乍小者死。
入肾则腰脚俱肿，小便不通，呻吟，目额皆黑，冲胸而喘，左尺脉绝者死。
【因】 湿之病。南方之人，自外而感；北方之人，自内而致。南方之人，当风
取凉，醉房
，久坐湿地，或履风湿毒瓦斯，血气虚弱，邪气并行虚腠，邪气盛，正气少，故血气涩，涩则
脾虚，虚则弱，病发热。四肢酸痛烦闷者，因暑月冷湿得之；四肢结持弱者，因寒月冷湿得
之。北方之人，因 酪醇酒之湿热下注，积久而成肿满瘀痛也。治宜下药，泄越其邪。
【证治】 因病胫肿，小腹不仁，头痛烦心，痰壅吐逆，时寒热，便泄不通，甚
至攻心而势
迫，治之不可后也。此壅之痰壅未成，当宜通之，调以黄柏、苍术类；壅既成，当砭恶血，
而后以药治之。
攻心香港脚，乃血虚而有湿热也，治宜四物加柏。筋动转而痛者，乃血受实热也，治加桃
仁、芩、连；有痰流注，加竹沥、姜汁、南星是也。
李曰∶湿淫所胜，治以苦温。以苦辛发之，透关节胜湿为佐；以苦寒泄之，流湿
清热为臣。故主当归拈痛汤一方治之。
中脚膝论 自内，喜、怒、忧、思，寒热邪毒之气，注于脚膝，状类诸风，谓之
香港脚也。自
外，风、寒、暑、湿，皆有不正之气，中于脚膝，谓之香港脚也。实者利之，虚者益之，六淫
随六法以治之，七情随六气以散之。
《三因》论 乃风、寒、暑毒瓦斯袭之也。风则脉浮，寒则脉紧，湿则脉细，表则
脉浮，里则脉沉；寒则痛，湿则重，暑则烦，风则行，随其所中经络而治之。
太阳经则头项腰脊背痛，六淫中之论同前，宜以麻黄左金汤。
麻黄 干葛 细辛 白术 茯苓 防风 防己 羌活 桂枝 甘草
阳明则寒热呻欠，鼻干腹胀，膝膑赛中腹外皆痛，六淫亦然，宜大黄左金汤。
大黄 细辛 茯苓 防风 防己 羌活 黄芩 前胡 枳壳 浓朴 杏仁。
少阳则口苦胁痛面垢，体无膏泽，头目颔锐痛，六淫亦同，宜半夏左金汤。
半夏 干葛 细辛 白术 茯苓 桂枝 柴胡 麦冬
三阳合病，寒热，关节重痛，手足拘挛，冷痹，上气，呕吐，下利，脉必浮弦紧数，合
前三方以发之。
太阴腹满，咽连舌急，胸膈痞满，骨节烦疼，四肢拘急，浮肿，宜六物附汤。
炮附 桂枝（各四两） 甘草（二两） 茯苓（三两） 防己（四两） 白术（三两）
少阴上气喘急，小腹不仁，腰脊足心 皆痛，六淫亦然，宜八味丸主之。
牡丹皮 泽泻 茯苓 桂枝 香附 山药 山茱萸 熟地黄
厥阴胁腰偏疼，阴器抵小腹夹脐诸处胀痛，一如中风，宜神应养真丹。
当归 天麻 川芎 羌活 木瓜 熟地 芍药
《三因》元并脏腑不同故也。
当归拈痛汤 治湿热肢节烦痛，肩背沉重，胸膈不利，身痛 肿。
羌活 炙甘草 黄芩（酒炒） 茵陈叶（酒炒） 当归（各五钱） 人参 苦参（酒洗） 升麻
葛根 苍术（各二钱） 知母（酒洗） 防风 泽泻（各三钱） 猪苓 白冬术（各五分）
煎服。
羌活导滞汤 治前证便溺阻隔，先以药导之，服前方及此方。
羌活 独活（各五钱） 防己（三钱） 大黄（酒煨，一两） 当归（三钱） 麸炒枳实（三钱）
槟榔 甘遂 赤芍 威灵仙 葶苈 泽泻（各一两） 乳香（另研） 没药（各五钱） 黑丑
（炒，三钱） 大戟（一两半，炒） 陈皮（二两）。
香港脚方 治湿热。
生地 黄柏（酒炒） 苍术（盐、酒炒） 白术 川芎 防己 槟榔 犀角 甘草 木通
黄连 黄芩（二味热加之） 竹沥 姜汁（二味痰加之） 石膏（热时加） 桃仁（便实加） 牛膝
（溺涩加）
食积流注方 苍术 黄柏 防己 南星 川芎 白芷 犀角 槟榔 龟板（血虚
加）
血积转筋方（见论） 治攻心香港脚。
阮氏方 治膝痛脚骨热，或赤肿行步难。
苍术四两，泔浸一日夜；盐炒黄柏四两，酒浸一日夜。炙焦， 咀服。
[Pulse] A floating and wiry pulse indicates Wind; a soggy and weak pulse indicates Dampness; a surging and rapid pulse indicates Heat; a slow and choppy pulse indicates Cold; a faint and slippery pulse indicates Deficiency; a firm and hard pulse indicates Excess; a knotted pulse is due to Qi stagnation; a tight pulse is due to anger; a thin pulse is due to sorrow.
If the pathogen enters the Heart, symptoms include mental confusion, delirium, vomiting, inability to eat, and restless sleep. If the left Cun (Cun position on the radial artery) pulse fluctuates between large and small, it is a sign of death.
If the pathogen enters the Kidney, symptoms include swelling of both the waist and feet, obstruction of urination, groaning, blackening of the eyes and forehead, panting with Qi rushing to the chest. If the left Chi (Chi position on the radial artery) pulse is absent, it is a sign of death.
[Etiology] This disease belongs to Dampness pathology. People in the South contract it externally; people in the North develop it internally. Southerners often cool off in the wind, engage in sexual activity after drinking, sit for long periods on damp ground, or wear shoes contaminated by Wind-Damp toxic vapors. When Blood and Qi are deficient, pathogens invade the loose interstices (Cou Li). When pathogens are strong and righteous Qi is weak, Blood and Qi become stagnant. Stagnation leads to Spleen deficiency; deficiency leads to weakness and fever. Soreness, pain, and irritability in the four limbs result from contracting cold-dampness during summer months; stiffness and weakness in the four limbs result from contracting cold-dampness during winter months. Northerners suffer from swelling, fullness, blood stasis, and pain caused by the downward pouring of damp-heat from cheese and rich wine accumulated over time. Treatment should employ purgative herbs to drain and disperse the pathogens.
[Syndrome Differentiation and Treatment] Due to the disease, there is swelling of the shins, insensitivity of the lower abdomen, headache, irritability, phlegm congestion, vomiting and reflux, alternating chills and fever, diarrhea or constipation. In severe cases, the pathogen attacks the Heart with urgent severity, requiring immediate treatment. If phlegm congestion has not yet fully formed, it should be unblocked and regulated with herbs such as Huangbai (Phellodendri Cortex) and Cangzhu (Atractylodis Rhizoma). If congestion has already formed, bad blood should be pricked out, followed by herbal treatment.
"Attack-the-Heart" Hongjiao (Gout/Feet Blackness), characterized by Blood deficiency with damp-heat, should be treated with Siwu Tang (Four Substances Decoction) plus Huangbai (Phellodendri Cortex). If tendons twitch and turn with pain, indicating real heat in the Blood, add Taoren (Persicae Semen), Huangqin (Scutellariae Radix), and Lianlian (Coptidis Rhizoma). If there is phlegm flowing and depositing, add Zhuli (Bambusae Caulis in Taenia), Jiangzhi (Zingiberis汁), and Nanting (Arisaematis Rhizoma).
Li said: When Dampness prevails excessively, treat with bitter-warm methods. Use bitter-pungent herbs to disperse, assisting with joint penetration and dampness overcoming; use bitter-cold herbs to drain, assisting with fluid movement and heat clearing. Therefore, the primary treatment is Danggui Niangong Tang (Angelica Sinensis Decoction for Painful Obstruction).
Discussion on Middle Foot and Knee Pathogens: Internally, emotions like joy, anger, worry, and thought, combined with cold, heat, and toxic qi, pour into the feet and knees, resembling various Wind diseases, called Hongjiao (Gout/Feet Blackness). Externally, improper Qi such as Wind, Cold, Summer-Heat, and Dampness strike the feet and knees, also called Hongjiao (Gout/Feet Blackness). For Excess patterns, use draining methods; for Deficiency patterns, use tonifying methods. Treat the Six Exogenous Pathogens according to the Six Methods, and dissipate the Seven Emotions according to the Six Qi theories.
Discussion from "San Yin Fang": It is attacked by Wind, Cold, Summer-Heat, and toxic vapors. Wind causes a floating pulse; Cold causes a tight pulse; Dampness causes a thin pulse; Exterior patterns cause a floating pulse; Interior patterns cause a deep pulse. Cold causes pain; Dampness causes heaviness; Summer-Heat causes irritability; Wind causes wandering pain. Treat according to the meridians affected.
Taiyang Meridian involvement causes pain in the head, neck, waist, and spine. The discussion on the Six Exogenous Pathogens is the same as above; use Mahuang Zuojin Tang (Ephedra Left Metal Decoction).
Herbs: Ephedrae Herba (Mahuang), Puerariae Radix (Gegen), Asari Radix (Xixin), Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Fuling), Saposhnikoviae Radix (Fangfeng), Stephaniae Tetrandrae Rhizoma (Fangji), Notopterygii Rhizoma et Radix (Qianghuo), Cinnamomi Ramulus (Guizhi), Glycyrrhizae Radix et Rhizoma (Gancao).
Yangming Meridian involvement causes alternating chills and fever, groaning and yawning, dry nose, abdominal distension, and pain in the kneecaps and outer abdomen. The Six Exogenous Pathogens are similar; use Dahuang Zuojin Tang (Rhubarb Left Metal Decoction).
Herbs: Rhei Radix et Rhizoma (Dahuang), Asari Radix (Xixin), Poria (Fuling), Saposhnikoviae Radix (Fangfeng), Stephaniae Tetrandrae Rhizoma (Fangji), Notopterygii Rhizoma et Radix (Qianghuo), Scutellariae Radix (Huangqin), Peucedani Radix (Qianhu), Aurantii Fructus (Zhike), Magnoliae Officinalis Cortex (Houpo), Armeniacae Semen Amarum (Xingren).
Shaoyang Meridian involvement causes bitter taste, hypochondriac pain, greasy complexion, lack of luster in the body, and pain in the head, eyes, and jaw. The Six Exogenous Pathogens are similar; use Banxia Zuojin Tang (Pinellia Left Metal Decoction).
Herbs: Pinelliae Rhizoma (Banxia), Puerariae Radix (Gegen), Asari Radix (Xixin), Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Fuling), Cinnamomi Ramulus (Guizhi), Bupleuri Radix (Chaihu), Ophiopogonis Radix (Maidong).
Combined disease of the Three Yang meridians involves alternating chills and fever, heavy and painful joints, spasm of hands and feet, cold bi-syndrome, upward rushing Qi, vomiting, and diarrhea. The pulse must be floating, wiry, tight, and rapid. Combine the previous three formulas to disperse the pathogen.
Taiyin Meridian involvement involves abdominal fullness, stiffness connecting the throat to the tongue, chest and diaphragm oppression, bone and joint soreness, limb spasms, and edema. Use Liuwu Fuzi Tang (Six-Ingredient Aconite Decoction).
Herbs: Prepared Aconiti Lateralis Radix (Paofu), Cinnamomi Ramulus (Guizhi) [each 4 liang], Glycyrrhizae Radix et Rhizoma (Gancao) [2 liang], Poria (Fuling) [3 liang], Stephaniae Tetrandrae Rhizoma (Fangji) [4 liang], Atractylodis Rhizoma (Baizhu) [3 liang].
Shaoyin Meridian involvement involves panting and急促 breathing, insensitivity of the lower abdomen, and pain in the waist, spine, and soles of the feet. The Six Exogenous Pathogens are similar; use Liuwei Wan (Eight-Ingredient Pill) as the main treatment.
Herbs: Moutan Cortex (Mudanpi), Alismatis Rhizoma (Zexie), Poria (Fuling), Cinnamomi Ramulus (Guizhi), Cyperi Rhizoma (Xiangfu), Dioscoreae Rhizoma (Shanyao), Corni Fructus (Shanzhuyu), Rehmanniae Radix Praeparata (Shudihuang).
Jueyin Meridian involvement involves pain on one side of the hypochondrium and waist, distending and painful swelling where the genitals meet the lower abdomen and flank the navel, resembling stroke. Use Shenyang Zhen Dan (Divine Response Nourishing True Pill).
Herbs: Angelicae Sinensis Radix (Danggui), Gastrodiae Rhizoma (Tianma), Chuanxiong Rhizoma (Chuanxiong), Notopterygii Rhizoma et Radix (Qianghuo), Papaveris Pericarpium (Mugua), Rehmanniae Radix Praeparata (Shudi), Paeoniae Radix Alba (Shaoyao).
The "San Yin Fang" states that the root causes differ among organs and bowels.
Danggui Niangong Tang treats painful obstruction of limbs and joints due to damp-heat, heaviness of shoulders and back, chest and diaphragm discomfort, and body pain/swelling.
Herbs: Notopterygii Rhizoma et Radix (Qianghuo), Honey-fried Glycyrrhizae Radix et Rhizoma (Zhi Gancao), Scutellariae Radix (Huangqin, wine-fried), Artemisiae Scopariae Herba (Yinchenye, wine-fried), Angelicae Sinensis Radix (Danggui) [each 5 qian], Ginseng Radix (Renshen), Sophorae Flavescentis Radix (Kushen, wine-rinsed), Cimicifugae Rhizoma (Shengma), Puerariae Radix (Gegen), Atractylodis Rhizoma (Cangzhu) [each 2 qian], Anemarrhenae Rhizoma (Zhimu, wine-rinsed), Saposhnikoviae Radix (Fangfeng), Alismatis Rhizoma (Zexie) [each 3 qian], Polyporus (Zuling), White Atractylodis Rhizoma (Baizhu) [each 5 fen]. Decoct and take.
Qianghuo Daozhi Tang treats the aforementioned conditions with obstruction of urination and defecation. First use medication to guide stagnation, then take the previous formula and this one.
Herbs: Notopterygii Rhizoma et Radix (Qianghuo), Angelicae Pubescentis Radix (Duhuo) [each 5 qian], Stephaniae Tetrandrae Rhizoma (Fangji) [3 qian], Rhei Radix et Rhizoma (Dahuang, wine-baked) [1 liang], Angelicae Sinensis Radix (Danggui) [3 qian], Bran-fried Aurantii Fructus Immaturus (Zhishi) [3 qian], Arecae Semen (Binglang), Kansui Radix (Gansui), Red Peony Root (Chishao), Spirit Weed (Weilingxian), Lepidium Seed (Tingli), Alismatis Rhizoma (Zexie) [each 1 liang], Frankincense (Ruxiang, separately ground), Myrrh (Moyao) [each 5 qian], Morning Glory Seed (Heiqiu, fried) [3 qian], Euphorbiae Pekinensis Radix (Daji, baked) [1.5 liang], Tangerine Peel (Chenpi) [2 liang].
Hongjiao Formula treats damp-heat.
Herbs: Rehmanniae Radix (Shengdi), Phellodendri Cortex (Huangbai, wine-fried), Atractylodis Rhizoma (Cangzhu, salt and wine-fried), Atractylodis Rhizoma (Baizhu), Chuanxiong Rhizoma (Chuanxiong), Stephaniae Tetrandrae Rhizoma (Fangji), Arecae Semen (Binglang), Rhinocerotis Cornu (Xijiao), Glycyrrhizae Radix et Rhizoma (Gancao), Akebiae Caulis (Mutong). Add Huanglian (Coptidis Rhizoma) and Huangqin (Scutellariae Radix) if heat is severe; add Zhuli (Bambusae Caulis in Taenia) and Jiangzhi (Zingiberis汁) if phlegm is present; add Shigao (Gypsum Fibrosum) if fever occurs; add Taoren (Persicae Semen) if stool is solid; add Niuxi (Achyranthis Bidentatae Radix) if urination is difficult.
Food Stagnation Flowing Deposit Formula: Cangzhu (Atractylodis Rhizoma), Huangbai (Phellodendri Cortex), Fangji (Stephaniae Tetrandrae Rhizoma), Nanting (Arisaematis Rhizoma), Chuanxiong (Chuanxiong Rhizoma), Baizhi (Angelicae Dahuricae Radix), Xijiao (Rhinocerotis Cornu), Binglang (Arecae Semen), Guiban (Testudinis Carapax et Plastrum, add if Blood deficiency).
Blood Stasis and Tendon Spasm Formula (see discussion): Treats Attack-the-Heart Hongjiao.
Ruan's Formula treats knee pain, hot foot bones, or red swelling making walking difficult.
Herbs: Cangzhu (Atractylodis Rhizoma) 4 liang, soaked in rice water for one day and night; Salt-fried Huangbai (Phellodendri Cortex) 4 liang, soaked in wine for one day and night. Roast until scorched, grind, and take.