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The dorsum of both feet suddenly becomes red and swollen, accompanied by fever. Both shins exhibit edema and pain. People mistakenly believe this to be a disease of Cold Damage (Shanghan), but who would know that it is actually a manifestation of Hong Kong Foot (Gouty Arthritis/Damp-Heat Bi)? Although the category of Hong Kong Foot exists within the scope of Cold Damage syndromes, Hong Kong Foot is not Cold Damage. Hong Kong Foot results from the infection of Damp-Heat pathogens, which first invade from the lower part; whereas Cold Damage is caused by Wind-Cold pathogens invading first from the upper part. Therefore, Cold Damage is a Yang syndrome, while Hong Kong Foot is a Yin disease.

For conditions where Damp-Heat descends, treatment should focus on the lower body. If Wind-dispelling herbs are used to dissipate the pathogen, the Dampness evil will instead invade upwards, because Wind-dispelling herbs are mostly ascending in nature. When Yang ascends with Yin pathogens, once they reach the Heart, death ensues; this is not what is meant by Yin transforming into Yang. Therefore, when treating Hong Kong Foot, one must absolutely not use methods for Cold Damage. Instead, one should drain Damp-Heat downwards; as Dampness flows downward, the bodily heat will naturally resolve. The formula prescribed is Xiao Fu San (Dorsum-Reducing Powder): Poria (Fu Ling) [1 liang], Artemisiae Scopariae Herba (Yin Chen) [1 qian], Stephaniae Tetrandrae Radix (Fang Ji) [1 qian], Gardeniae Fructus Preparatus (Chao Zhizi) [1 qian], Coicis Semen (Yi Yi Ren) [1 liang], Alismatis Rhizoma (Ze Xie) [3 qian], Chaenomelis Fructus (Mu Gua) [1 qian]. Decoct in water and take orally. After one dose, urination becomes smooth; after two doses, bodily heat resolves; after another two doses, foot swelling subsides; continuing for two more doses leads to complete recovery.

This formula promotes diuresis, causing all Damp-Heat Qi to excrete downward through the Bladder. Even if pathogenic factors exist, they will be entirely dispersed along with the dampness, eliminating the need for separate pathogen-dispersing measures. The Bladder belongs to the Taiyang (Greater Yang) channel. When Wind pathogens initially invade, they often reside in the Bladder. If the Bladder’s function is well-promoted and fluids flow freely, where can the pathogen remain? Moreover, Hong Kong Foot originally lacks Wind pathogens; it is merely an obstruction of Qi in the Bladder, preventing downward flow and causing heat in the upper body. By treating the lower body to restore flow, how could the upper body fail to open? With free flow of Qi between the upper and lower, bodily heat resolves spontaneously. Using Wind-dispersing herbs would guide Yin-Dampness into the Yang aspect, resulting in an incurable condition. Thus, pathogen-dispersing herbs must absolutely not be used. Even if Hong Kong Foot occurs in winter, dispersing herbs are contraindicated, let alone during spring, summer, or autumn.

For this syndrome, Shun Dao Tang (Smooth-Guiding Decoction) is also effective.
Poria (Fu Ling), Alismatis Rhizoma (Ze Xie) [5 qian each], Cinnamomi Cortex (Rou Gui) [3 fen], Chaenomelis Fructus (Mu Gua) [1 qian], Gentianae Radix (Long Dan Cao) [1 qian], Plantaginis Semen (Che Qian Zi) [3 qian]. Decoct in water and take orally.