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San San Yi Shu (Medical Books of the San San Collection), Second Series, Nineteenth Volume
Written by Dong Ji of the Song Dynasty, published by Qiu Jisheng

I have examined various classics regarding the disease of "Jiaoqi" (Foot Qi / Beriberi). Its origins are ancient. During the time of the Yellow Emperor, it was called "Jue" (Reversal/Cold Extremities); between the Two Han Dynasties, it was mostly referred to as "Huan Feng" (Sluggish Wind); after the Song and Qi dynasties, it was called "Jiao Ruo" (Weakness of the Legs); only in the Great Tang Dynasty did it come to be named "Jiaoqi". Although the names differ, the essence is the same. The cause of Jue disease lies in the coagulation of wind-toxin and dampness invading the Liver, Kidney, and Spleen meridians. The pulse originates from the ten toes of the feet. Moreover, wind-toxin arises from the earth; cold, heat, wind, and dampness all transform into steam. Since the feet constantly tread upon the ground, the pathogen transmits internally into the meridians, resulting in swelling, pain, spasms, and weakness, thus named Jiaoqi.

However, the causes of contracting the disease vary. If one sits or stands for long periods on wet ground in summer, damp-heat steams into the meridians; upon onset, fever occurs, accompanied by painful stuffiness in the four limbs. If one sits or stands on wet ground in winter, cold-dampness ascends into the meridians; upon onset, muscle spasms occur, and the whole body becomes extremely cold. If one exposes oneself to wind to cool down, the disease manifests as internal skin numbness and insensitivity, with a creeping sensation in various areas that gradually spreads toward the head and face. These three scenarios must be distinguished carefully. Unfortunately, later scholars fail to investigate deeply and prescribe treatments arbitrarily, turning mild cases into severe ones and making severe cases difficult to cure. Can one not be cautious?

After contracting the disease, conditions may be deficient or excess, cold or hot, depending on the patient's constitution. Thus, Jiaoqi presentations include mild and severe, dry and damp, yin and yang, excess and deficiency types.
Dry type: Wind-toxin resides in the collaterals, affecting the knees and calves, leading to emaciation or pain, spasms or flaccidity/weakness, panting and thirst, headache, constipation of both stool and urine, or skin numbness and insensitivity.
Damp type: Damp-toxin resides in the main meridians, causing swelling of the lower legs, with skin and flesh cracking into purple-white sores, internal suppuration and necrosis, diarrhea or constipation, or anal abscesses, irritability, and loss of appetite.
Yin type: Wind-toxin affects the Zang organs; patients fear light and prefer stillness, suffer from cold body and cold extremities, tendon spasms, or numbness of the lower abdomen.
Yang type: Wind-toxin affects the Fu organs; upon onset, the calves feel hot, tendons and vessels spasm and hurt, muscles relax and cannot hold posture, accompanied by alternating chills and fever, headache, irritability, preference for bright environments, shortness of breath, and mental confusion. This often arises from long-term use of warming and tonifying medicines, causing qi stagnation and constipation.
Deficient type: Unrestrained desires lead to emptiness of Ying and Wei (Nutritive and Defensive Qi), depletion of bone marrow, and failure to take tonics. The body becomes extremely cold, calves ache, knees are cold, spasms occur, mobility is lost, and breathing is rapid and panting. These are the differences in presentation.

Regarding pulses, Su Gong of the Tang Dynasty stated there are three types: a slow pulse indicates a mild case; a deep pulse indicates an intermediate case; a surging and rapid pulse indicates a severe case. A large, deep, and tight pulse is difficult to treat; a surging and rapid pulse is easy to treat; a slow pulse may resolve spontaneously without treatment. If treatment violates principles, even mild cases become severe; if treatment follows principles, even severe cases become mild. Generally, pulses conforming to the Four Seasons indicate survival, while those violating them indicate difficulty. A deep and tight pulse signifies pathogenic invasion into the interior causing bi-syndrome, hence severity. A deep, surging, and rapid pulse indicates excess Yang corresponding to Wind-Jue, hence ease of treatment. A slow pulse indicates weak pathogens, hence spontaneous recovery. Sun Simiao also discussed three grades of pulses where external and internal symptoms are similar but pulses differ. A floating, large, and slow pulse suggests using Xuming Tang (Continuing Life Decoction). If wind is prevalent, use Yebip Tang (Diaphoretic Decoction). If the pulse is floating and tight with severe movement, prepare Zhuli Tang (Bamboo Juice Decoction). If the pulse is faint and weak, use Fengyin Tang (Wind-Quelling Decoction). These pulses often stem from Yin deficiency. For extreme deficiency and shortness of breath, intermittent use of Tonifying Decoctions is appropriate, adjusted for cold or heat.

Ancient methods for treating this disease emphasized distinguishing wind and damp ratios. For wind-dominant and damp-minor cases, formulas like Fengyin Tang, Xuming Tang, and Yebip Tang were used. For damp-dominant and wind-minor cases, Duhuo Jisheng Tang (Notopterygium and Ligusticum Decoction) and Yiyi Tang (Coix Seed Decoction) were preferred. Uniform medication rarely yields miraculous results; careful consideration is key. In regions like Jianghuai, Lingnan, and Qinchuan, climates vary by season. Travelers from Jianghuai/Lingnan returning to Qinchuan with Jiaoqi should follow Jianghuai/Lingnan treatment protocols. Qinchuan is high and dry; even with spring rains, steam-dampness is rare, affecting crops and diet differently. Low, damp areas favor drying herbs; high, dry areas favor diaphoresis and diuresis. Many attribute Jiaoqi to Kidney deficiency and use tonics, yet few succeed. Although rooted in Kidney deficiency, wind-damp pathogens exacerbate the condition. When pathogens are strong, the condition presents as excess despite underlying deficiency; harsh tonics cause qi stagnation and distension. As *Qianjin Fang* states, abdominal distension requires purgation. *Suwen* notes Jiaoqi improves in autumn/winter because Yang is internal and Yin external, lacking steam-dampness. Thus, patients should adjust medication by season: diaphoresis/diuresis in spring/summer; mild tonification during remission in autumn/winter to calm Qi. Modern doctors often blindly tonify or purge, missing the middle way. In winter, mild tonification based on strength is necessary; otherwise, blood and Qi decline, leading to annual recurrences during humid seasons.

Some claim Jiaoqi stems solely from Kidney deficiency, asserting women are immune since they do not primarily govern the Kidneys. This is incorrect. Women suffer from blood-sea deficiency, compounded by stasis, anger, or grief. Many women suffer from this, confirming blood-sea deficiency parallels male Kidney deficiency. Treatment for women mirrors men's, supplemented by herbs for emotional distress.

In the Xining era, I walked in heavy snow and contracted cold-dampness, suffering recurrent attacks for ten years. Varying symptoms prompted me to study sources, compile ancient prescriptions, and test efficacious formulas, which I now record. While Jiaoqi shares common features, one-third varies; treatment must follow evidence. Common symptoms include cold extremities, weakness, numbness, pain, swelling, or sores. Post-recovery, seasonal dietary and medicinal regimens ensure efficacy. Paralysis is milder; standard Jiaoqi treatments work within a set timeframe. The following lists seasonal prescriptions.

Discussion: Ancient imperial physicians often became experts due to personal or familial illness, meticulously observing symptom variations and adjusting for cold, heat, and deficiency/excess. Figures like Sun Simiao, Zhen Quan, Su Gong, and Daoren exemplify this. "Seeing is better than hearing." I present proven effective formulas for clinical reference.

Discussion: Chronic qi accumulation combined with wind-toxin, treated only with tonics without diaphoresis/diuresis, can solidify toxins, causing constipation, high fever, panting, leg swelling/pain, urinary/fecal retention, and delirium. Treat with Zi Qi Hong Xue Fangfeng Tang, Shengong Wan, Jiaoxi Yin. For dysuria, use Jianggong Wan or Baipi Xiaodou San.

Discussion: Yang deficiency below causes Cold Jue: cold calves, spasms, soreness, knee pain, numbness, photophobia, and preference for stillness. Treat with Shinan Wan, Jinya Jiu, Cizi Jiu, Bawei Wan, Haitongpi San, Muxiang Yinzi, Songjie San, and moxibustion at Fengshi (GB31).

Discussion: Congenital qi deficiency and irregular lifestyle, or excessive purgation in winter leading to organ weakness, emaciated legs, extreme cold, fatigue, cold knees, and heavy spasms, require Fengyin Tang, Bawei Mugua Wan, Shinan Wan, Jinya Jiu, Cizi Jiu, and moxibustion at Jiexu (GB39) in winter to prevent abdominal toxin invasion.

Discussion: Acupuncture and moxibustion are crucial for Jiaoqi. Treating only with herbs without acupuncture/moxibustion reduces efficacy by half. Adjust needle depth based on body size. Use bronze mannequin standards. Position patient (sitting/standing/lying) according to point location. Su Gong advised moxibustion at painful spots rather than fixed points, akin to *Miaoci* techniques.
Initial moxibustion: Fengshi (GB31) for knee spasms, limp, discoloration, flaccidity.
Next: Fubu (ST32) for cold; per *Jiayi Jing*, ST meridian needling max 5 fen.
Next: Dubi (ST35) for knee pain/numbness; avoid if swollen.
Next: Xiyan (EX-LE7) for cold bi-pain.
Next: Zusanli (ST36) for back pain, knee weakness, abdominal distension, foot drop.
Next: Shanglian (EX-LE8) for difficult urination, yellow urine, delirium.
Next: Xialian (EX-LE9) for difficult urination, yellow urine.
Next: Jiexu (GB39) for wind-lao, edema, hip/knee pain, hemibi numbness, tendon contraction, limb inertia.

Discussion: Wind-damp-toxin in calves causes Jiaoqi. Untreated or mistreated with purgatives, toxins attack the abdomen, causing confusion, panting, and suffocation. Rapid detoxification is vital to prevent five-zang damage and Sanjiao/Ying-Wei blockage. Like impetigo spreading from fingers to heart (hard to treat) vs. heart to limbs (easy to treat), internal toxin invasion is severe. Mugua Zhuyu Tang (Papaya and Cornus Decoction) is best for critical abdominal invasion, preventing further toxin entry.

Discussion: Daily regimen: pills before meals, decoctions after. Spring/Summer: Fangfeng Xuming Tang, Yebip Tang, Zhuli Tang, Fenghuan Tang, Bafeng Tang, Duhuo Jisheng Tang, Haitongpi San. Constipation: Shengong Wan, Maren Wan, Sanwan San, Sanren Wan, Juxiang Wan, Runchang Wan. Dysuria: Baipi Xiaodou San, Jianggong Wan, Mutong San. Acupuncture/stones for close-symptom matches. Autumn/Winter (remission): Jinya Jiu, Cizi Jiu, Shenli Tang, Shinan Wan, Bawei Wan, Mugua Wan, Niuxi Wan, plus moxibustion. Year-round: Steam baths/moxibustion. Remove nails on Chou days. Strong individuals take Tianmendong Dajian (Asparagus Large Decoction) year-round. This formula treats Five Labors, Seven Injuries, Eight Winds, Thirteen Bi, Six Extremes. Qi Extreme: cold bi, abdominal pain, panting, fright, headache. Lung Extreme: cold bi, back pain, epigastric hardness, masses, dysuria, numbness. Pulse Extreme: blue complexion, belching,恍惚, gas, tongue stiffness, dry throat, aversion to wind, dizziness, delirium. Tendon Extreme: spasms, lower abdominal distension, heart pain, cold knees/joints. Bone Extreme: cold extremities, jaundice, wasting-thirst, abscesses, edema. Flesh Extreme: Zhu diseases, ghost-strikes, death/rebirth. All stem from Six Extremes/Seven Injuries, not just sexual excess. Emotional stress, wind-damp, cough, vomiting, bowel/bladder issues, nightmares, etc., are also addressed. Liver/Tendon injury: back pain, limited movement. Lung/Qi injury: hematuria. Marrow/Bone injury: impotence, shortness of breath, genital pain/cold, ulcers, sweating, confusion. This formula covers these.

Case: Cui Gong (Xining era) had wind-damp from Sichuan travel, worsened by summer humidity in Shoucheng. Swollen, weak, painful legs. Combined Yi Zhou Gu Zhi (Bone Juice) and Zhen Su (True Butter) from Sichuan. Half dose cured him. This formula suits all seasons/types, reflecting Sun Simiao’s wisdom. Rare ingredients make it hard to prepare; lamentable.

Discussion: Wind is Yang, ascending. Jiaoqi Qi rebels upward, generating heat, drying fluids, causing constipation. Robust/heat-excess types: Shengong Wan, Maren Wan, Dahuang Tang. Elderly/deficient/constipated types: Sanren Wan, Wuro Wan, Runchang Wan, Ju Pi Wan, Sanwan San. Choose wisely.

Discussion: Foot meridians receiving dampness and Bladder water retention cause swelling, rupture, purple skin ("Lower Pouring Kidney Wind"). Sores with pain/numbness: Duhuo Jisheng Tang, Yiyi Tang. Advanced infiltration: Huixiang Wan, Tianma Wan, Wushe Wan, rubbed with Chen Yuan Gao.

Discussion: Steam baths/moxibustion are vital for stagnant Jiaoqi. Boil decoctions first. Wrap clothes around lower legs/ankles. Pour warm soup slowly from knee down. Do NOT start at feet; ascend from knee to foot to expel wind via toenails. Starting at feet risks ascending toxin. Remove toenails afterward, preferably on Chou days or every 12 days.

Discussion: Humans follow Heaven/Earth, Yin/Yang. Seasonal changes affect Qi. Jiaoqi stems from Heavenly Five Qi and Earthly Five Elements. Treatment varies slightly but follows general rules.
Jan-Feb: Qi in Liver. Warm feet, thick socks. Di Huang Zhou (Rehmannia Porridge), Fangfeng Zhou, Zisu Zhou. Decoctions: Sangpi Jian, Zhuli, Fangfeng, Fengyin, Xuming, Fenghuan, Yebip, Duhuo, Haitongpi, Bafeng. Moxibustion/steam on knees/feet. Guided exercises/acupressure.
Mar-Apr: Qi in Spleen. Eat Scallions (Xie) to dissipate knots. Donghua powder for body. Prevailing wind herbs. Spring: Rise early, walk freely, loosen hair/form. Nourish life, do not kill. Warm food, remove wind-heat.
May-Jun: Qi in Head. Duhuo Jisheng Tang, Mugua Jiang (Papaya Drink). Summer: Early rise, no fear of sun. Calm mind, let Qi vent. Nourish growth.
Jul-Aug: Qi in Lungs. Keep lower body warm, change socks/shoes. Duhuo Jisheng Tang, Haitongpi San, Yiyi Tang. Autumn: Calm will, clear Lung Qi. Nourish completion.
Sep-Oct: Qi in Heart. Remission period. Mild tonification: Jinya Jiu, Cizi Jiu, Niuxi, Shinan, Mugua, Bawei Wan. No vigorous exercise.
Nov-Dec: Qi in Kidneys. Tonify Yuan Zhen. Moxibustion on waist/kidneys. Avoid moving Qi. Winter: Hide, wait for sun. Calm will. Nourish storage.

Clinical Cases:
Jiayou Era, Jan 26: Guo Zhongli (Dianzhi) sought Sun Zhao’s diagnosis. Long-term Jiaoqi, pain, fever/chills, distension, rebellious Qi. Hot meds worsened it. Sun prescribed Jiwei Yannian Fuling Yinzi to descend Qi, Liuwu Maren Wan to clear heat. Later, vomiting/irritability treated with Jufang Zixue (Purple Snow), highly effective. (Formulas see respective sections).

Xining Era: Cui Langzhong Zhi suffered Jiaoqi, swollen/weak/emaciated, unable to walk. Dong Ji prescribed Qianjin Fang Tianmendong Dajian. Cured permanently. (Formula see below).
Dong Wensi Zhongxing, stationed in Wenshang, suddenly had red/swollen/painful legs and hidden sole pain. Dong Ji gave pre/post-meal pills. Cured. Winter: Jinya Jiu and steam baths prevented recurrence.

Liang Chengyi’s son Liang: Knee pain, unable to kneel. Treated with Haitongpi San by Imperial Physician Yang Wenwei. Cured.
Wu Xuanyi Guan: Abdominal fullness/Jiaoqi in Wenshang. Treated with Shunqi Wan, Maren Wan, Shenxian Wan by Xi Yanshang. Cured.
Feng Shilang’s 15th Daughter: Leg weakness, unable to walk. Treated with Qianjin Fang Duhuo Jisheng Tang by Kong Yuan. Cured.

Dong Ji (Xining Era): Walked in snow, developed red/swollen/painful/weak legs in spring. Treated with Xijiao Yin, Shaonao Tang, Shujiao Tang, steam baths. Improved, then relapsed with全身 swelling, abdominal distension, shortness of breath, pale face, urinary/fecal retention. Treated with Binglang (Areca Nut) powder, Hezi (Chebula) powder, Sheng Qianniu (Morning Glory) powder, child’s urine, ginger. Profuse urination reduced swelling. Later leg sores treated with Tianma Wan, Wushe Wan, Chen Yuan Gao. Winter: Mugua Wan, pre-meal pills, Jinya Jiu restored strength.

End of Volume One of Essential Methods for Treating Jiaoqi.