东垣治一朝贵。年近四十。身体充肥。香港脚始发。头面浑身支节微肿。皆赤色。足胫赤
肿。痛不可忍。手近皮肤。其痛转甚。起而复卧。卧而复起。日夕苦楚。春间李为治之。其
人以北土高寒。故多饮酒。积久伤脾。不能运化。饮食下流之所致。投以当归拈痛汤一两二
钱。其痛减半。再服。肿悉除。只有右手指末微赤肿。以三棱针刺指爪甲端。多出黑血。赤
肿全去。数日后。因食湿面。肢体觉痛。再以枳实五分。大黄酒煨三钱。当归一钱。羌活一
钱五分。名曰枳实大黄汤。利两行而痛止。夫香港脚水湿之为也。面滋其湿。血壅而不行。故
肢节烦痛。经云。风能胜湿。羌活辛温。透关节去湿。故以为主。血留而不行则痛。当归之
辛温。散壅止痛。枳实之苦寒。治痞消食。故以为臣。大黄苦寒。以导面之湿热。并治诸老
血留结。取其峻快。故以为使也。
张戴人治毗陵马姓。患肾脏风。忽一足发肿如瓠。自腰以下。钜细通为一律。痛不可忍
欲转侧。两人扶之方可动。或欲以铍刀决之。张曰。此肾脏风攻注脚膝也。乃以甘遂一两
木鳖子二个。一雄一雌为末。 猪腰子二个。批开。药末一钱糁匀。湿纸裹数重。慢火煨
熟。五更初细嚼。米饮下。积水多则利多。少则利少也。宜软饮将息。若病患一脚。切看左
右。如左脚。用左边腰子。右脚。用右边腰子。药末只一钱。辰巳间。下脓水如水晶者数升
实时痛止。再以赤乌散涂贴其膝。方愈。
项彦章治史佥宪足病。发则两足如柱。溃黄水。逾月乃已。已辄发。六脉沉缓。沉为里
有湿。缓为厥为风。此风湿毒。俗名湿香港脚是也。以神芎丸、舟车神佑丸。大下浊水而愈。
震按此二条。即北方治法也。
赵良仁云。予至吴中。有徐孟达患两足酸重。不任行动。发则肿痛。一日于不发时诊脉
三部皆大。搏手如葱管无力。身半以上则肥盛。盖其膏粱外家御。嗜欲无穷。精血不足。湿
热太盛。因用益精血于其下。清湿热于其上。二方与之。或言香港脚无补法。故不肯服。三月
后痛作。一医用南方法。治不效。一医用北法泻之。即死于溺器上。吁。业岐黄者。虚实之
辨。盖可以忽乎哉。
丹溪治一妇足肿。用生地、黄柏、苍术、南星、红花、牛膝、龙胆草、川芎。治之而愈
立斋治一妇人。脚患筋挛骨痛。诸药不应。脉紧。用大防风汤。二剂顿退。又二剂而安
江应宿曰。予友人佘近峰贾秣陵。年五十余。患脚痛。卧不能起。年余。胫与腿肉俱消
邑医徐古塘。昔患痹疾治愈。求其成方。初用当归拈痛汤。二服效。次用十全大补汤。加
枸杞子、防己、牛膝、萆 。朝用六味地黄丸。加虎胫骨、牛膝、川萆 、鹿角胶。服三年
双铄如初。徐云。久久服之。自获大益。幸勿责效于旦夕。信然。
震按香港脚之病。近来罕见。或有足胫赤肿。痛不可忍者。即俗所谓流火也。或有手足互
换而痛。肢节微肿。或热或赤色者。即书所谓行痹也。治法不外去湿清热凉血。亦有用术、
附、桂枝者。要在辨其虚实。及湿热寒湿之分耳。戴人项公之治法。殊可不必。若东垣案。
全似周痹治法。拈痛汤分消其湿热也。枳实大黄汤。驱逐其湿热也。若朱案亦痹证治法。薛
案江案用补。稍觉不同。外有柳柳州所纂干香港脚。左胁有块。大如石。痞绝且死。以杉木节
橘叶、槟榔、童便煎。利之而愈。蔡元长忽如有虫自足心行至腰间。即晕绝。灸风市穴而
愈。及杨梅仁治童贯。捶田螺敷两股治董守约。今仅存其说。未有合其证而可以试用者。故
不详录。
孙东宿曰。一贫士两足不酸不痛。每行动。绝不听其所用。或扭于左而又坠于右。或扭
于右而又坠于左。之字而行。不能一步正走。此亦目之希觏。书所未载。予臆度之。由筋软
不能束骨所致。故行动则偏斜扭坠也。夫筋者。肝之所主。肝属木。木纵不收。宜益金以制
之。用人参、黄 、白芍以补肺金。苡仁、虎骨、龟板、杜仲以壮筋骨。加铁华粉以专制肝
木。炼蜜丸。早晚服之。竟愈。
震按此非香港脚。而附于此者。从其类以便览也。
〔附〕张季明曰。一士人得脚弱病。百药不效。予令其用杉木为桶。濯足。又令排樟脑
于两股间。以脚绷系定。月余而安健如初。
江篁南治一少年。夏月因以冷水浸两足跟。又坐湿地。患足跟肿痛。不能移步。致卧数
月。乃教以干土圾一块。挖一凹如足跟大。炭火烧红。去火。用醋一碗沃之。任其渗干。即
以
足跟临土圾。初略悬高熏之。渐渐近之。其下体骨节。皆酸快不可言。且有微汗。连换土砖
熏三四日而愈。
予西席钟沧柱先生。少年得脚弱病。酸楚无力。兼小便艰难。欲便必久立始通。服大补
肝肾药不应。乃求治于何嗣宗先生。用六味地黄丸加黄牛腿骨髓一具而愈。因悟前之治病者
道在迩而求诸远也。何系江南大名家。当时佳案必多。惜余生也晚。不获亲炙其风徽。无
从抄录。
李东垣治疗一位朝廷权贵。年龄接近四十岁。身体肥胖壮实。香港脚（足部湿热肿痛之病）刚刚发作。头面及全身关节轻微肿胀，颜色都发红。小腿红肿，疼痛难以忍受，手刚靠近皮肤，疼痛就加剧。起身又躺下，躺下又起身，日夜痛苦不堪。春季时李东垣为他治疗，认为此人因为北方土地高寒，所以多饮酒，日久损伤脾脏，导致运化功能失常，饮食水湿下流所致。于是给予当归拈痛汤一两二钱服用，疼痛减轻了一半。再次服用后，肿胀全部消除，只有右手指尖微微发红肿胀。用三棱针刺破指甲边缘，放出大量黑血，红肿完全消失。几天后，因为吃了湿面，肢体感觉疼痛。再次使用枳实五分、大黄酒制三钱、当归一钱、羌活一钱五分，名为枳实大黄汤。服药后大便通畅两次，疼痛停止。这香港脚是由于水湿邪气引起的。面部滋生湿气，血液壅滞而不运行，所以关节烦扰疼痛。经书说：风能胜湿。羌活辛温，能透达关节去除湿气，所以作为主药。血液停留不运行则疼痛，当归辛温，能散除壅滞止痛；枳实苦寒，能治疗痞满消食积，所以作为辅药；大黄苦寒，能引导面部的湿热下行，并治疗各种陈旧性瘀血结聚，取其峻猛快速之力，所以作为使药。
张戴人治疗毗陵的马姓患者。患有肾脏风（一种以浮肿、疼痛为特征的疾病），忽然一只脚肿得像葫芦一样，从腰部以下粗细一致，疼痛难以忍受想要翻身，需要两个人搀扶才能移动。有人想用铍刀切开排脓。张戴人说：这是肾脏风邪攻注到脚膝部位。于是用甘遂一两、木鳖子两个（一雄一雌）研成粉末。取猪腰子两个，剖开，将药末一钱撒匀，用湿纸包裹多层，慢火煨熟。五更时分细细嚼碎，米汤送服。体内积水多则腹泻多，少则腹泻少。适宜喝软饮调养。如果病人只有一只脚患病，要看左右侧。如果是左脚，用左边的腰子；右脚，用右边的腰子。药末只用一钱。辰时巳时之间，排出如水晶般的脓水几升，当时疼痛停止。再用赤乌散涂抹贴敷膝盖，才痊愈。
项彦章治疗史佥宪的足病。发作时双脚像柱子一样粗，溃烂流出黄水，超过一个月才好。好了之后又复发。六脉沉缓，沉脉表示里有湿，缓脉表示厥逆和风邪。这是风湿毒邪，俗名叫湿香港脚。使用神芎丸、舟车神佑丸，通过剧烈泻下浊水而痊愈。
俞震按语：这两条案例，就是北方的治疗方法。
赵良仁说：我到了吴中地区，有徐孟达患两足酸重，无法行走。发作时肿痛。有一天在不发作的时候诊脉，三部脉都很大，搏指有力但如葱管般中空无力。身体半以上肥胖壮盛。大概是因为他享受膏粱厚味，纵欲无度，精血不足，湿热太盛。因此我在下部补益精血，在上部清利湿热。给他用了两个方剂。有人说香港脚没有补法，所以他不肯服用。三个月后疼痛发作，一个医生用南方的方法治疗无效，一个医生用北方的泻法治疗，结果死在便桶上。唉，从事中医的人，虚实辨证难道可以忽视吗？
朱丹溪治疗一位妇女足肿，用地黄、黄柏、苍术、南星、红花、牛膝、龙胆草、川芎治疗而痊愈。
薛立斋治疗一位妇人，脚患筋挛骨痛，各种药物无效，脉紧，使用大防风汤，两剂后症状顿减，又两剂后安稳。
江应宿说：我的朋友余近峰在秣陵经商，五十多岁。患脚痛，卧床不能起身。一年多来，小腿和大腿肌肉都消瘦。同乡医生徐古塘，以前患痹疾治愈，我求取他的成方。起初用当归拈痛汤，两服见效。接着用十全大补汤，加枸杞子、防己、牛膝、萆薢。早上服用六味地黄丸，加虎胫骨、牛膝、川萆薢、鹿角胶。服用三年，双腿恢复如初。徐医生说：长久服用，自然获得大益处，希望不要指望在早晚间见效。确实如此。
俞震按语：香港脚这个病，近来很少见。如果有足胫红肿，疼痛难以忍受的，就是俗称为流火的病。如果有手足交替疼痛，关节轻微肿胀，或发热或发红的，就是书中所说的行痹。治疗方法不外乎祛湿、清热、凉血。也有使用白术、附子、桂枝的。关键在于辨别虚实，以及湿热与寒湿的区别罢了。张戴人、项彦章的治疗方法，殊为不必采用。若李东垣的案例，全像是周痹的治疗方法，拈痛汤分消其湿热，枳实大黄汤驱逐其湿热。若朱丹溪的案例也是痹证治法，薛立斋和江应宿的案例用补法，稍微有些不同。另外有柳宗元编纂的关于香港脚的案例，左侧胁下有肿块，大如石头，痞塞窒息快要死了，用杉木节、橘叶、槟榔、童便煎服，通利大便而痊愈。蔡元长忽然觉得好像有虫子从足心行至腰间，随即晕厥，灸风市穴而痊愈。还有杨梅仁治疗童贯，捶打田螺敷在两股治疗董守约。现在仅存其说法，没有符合这些证候可以试用的，所以不详录。
孙东宿说：一位贫寒读书人两足不酸不痛，每次行动，完全不听使唤。或者扭向左边又跌向右边，或者扭向右边又跌向左边。呈“之”字形行走，不能正步走一步。这也是罕见的景象，书中未记载。我推测其原因，是由筋软弱不能约束骨骼所致。所以行动时偏斜扭坠。筋由肝所主，肝属木，木气放纵不收敛，宜益金以制约它。用人参、黄芪、白芍来补肺金；苡仁、虎骨、龟板、杜仲来强壮筋骨；加铁华粉来专门克制肝木。炼蜜为丸，早晚服用。竟然痊愈了。
〔附〕张季明说：一位士人得脚弱病，百药无效。我让他用杉木做桶，洗脚。又让他将樟脑排在两股之间，用脚绷固定。一个多月后安康如初。
江篁南治疗一位少年，夏天因用冷水浸泡两脚跟，又坐在湿地，患足跟肿痛，不能移步，导致卧床数月。于是教他用干土块一块，挖一个凹坑如足跟大小，用炭火烧红，撤去火，用一碗醋浇在上面，任其渗透干燥。立即将足跟贴近土块。开始略微悬高熏蒸，渐渐靠近。其下肢骨节，都酸痛舒适不可言状，且有微汗。连续更换土砖熏蒸三四天而痊愈。
我的西席老师钟沧柱先生，年轻时得脚弱病，酸楚无力，兼有小便困难，想小便必须久站才能通。服用大补肝肾的药物无效。于是求治于何嗣宗先生。使用六味地黄丸加上一具黄牛腿骨髓而痊愈。由此悟出之前治病的人，道理就在近处却向远处寻求。何先生是江南的大名家，当时的佳案一定很多，可惜我出生太晚，未能亲炙其风采，无从抄录。
Li Dongyuan treated a court nobleman. He was nearly forty years old, with a robust and obese physique. The Hongjiaojiao (a disease characterized by damp-heat swelling and pain in the feet) had just started. His head, face, and whole body joints were slightly swollen, all with a reddish color. His lower legs were red and swollen, with unbearable pain; the pain intensified even when his hand merely approached the skin. He would get up only to lie down again, lying down only to get up again, suffering bitterly day and night. In spring, Li Dongyuan treated him, reasoning that since this person lived in the high and cold northern lands, he drank much alcohol, which over time damaged the Spleen, impairing its transformation and transportation functions, causing dietary fluids and dampness to flow downward. He prescribed Danggui Nian Tong Tang (Angelica Sinensis Decoction for Relieving Pain) of one tael and two qian. The pain reduced by half. After taking it again, the swelling completely subsided, leaving only slight redness and swelling at the tip of the right index finger. Using a three-edged needle to prick the end of the fingernail, a large amount of dark blood was released, and the redness and swelling entirely disappeared. A few days later, after eating wet noodles, he felt pain in his limbs. He was then given Zhishi Dahuang Tang (Immature Bitter Orange and Rhubarb Decoction), consisting of Zhishi (Immature Bitter Orange Fruit) 5 fen, Dahuang (Rhubarb Root and Rhizome) 3 qian (stir-fried with wine), Danggui (Angelica Sinensis Root) 1 qian, and Qianghuo (Notopterygium Rhizome and Root) 1.5 qian. After two bowel movements, the pain ceased. This Hongjiaojiao is caused by water-dampness pathogenic factors. Dampness accumulates on the face, blood becomes stagnant and fails to circulate, thus causing vexatious pain in the joints. The Classics state: "Wind can overcome dampness." Qianghuo is acrid and warm, penetrating the joints to dispel dampness, so it serves as the sovereign herb. When blood remains and fails to circulate, pain occurs; Danggui is acrid and warm, dispersing stagnation and relieving pain; Zhishi is bitter and cold, treating fullness and digesting food accumulation, so they serve as minister herbs; Dahuang is bitter and cold, guiding the damp-heat from the face downward and treating various old blood stasis and clots, utilizing its fierce and rapid action, so it serves as an envoy herb.
Zhang Dairen treated a patient surnamed Ma from Piling. He suffered from Shenzang Feng (Kidney Wind, a condition characterized by edema and pain). Suddenly, one foot swelled like a gourd, uniform in thickness from the waist down. The pain was unbearable, making turning difficult; he needed two people to support him to move. Someone suggested using a Pi Dao (scalpel) to incise it. Zhang said, "This is Kidney Wind pathogenic factors attacking and flooding the feet and knees." He used Gansui (Kansui Root) one tael and Mubiezi (Strychnos Seed) two pieces (one male, one female), ground into powder. Two pig kidneys were sliced open, one qian of the powder was sprinkled evenly inside, wrapped in multiple layers of wet paper, and slow-roasted. At dawn (Wu geng), it was chewed thoroughly and swallowed with rice drink. If there was more accumulated fluid, there would be more diarrhea; if less, less diarrhea. Soft drinks were recommended for recuperation. If only one foot was affected, one must check the left or right side. For the left foot, use the left kidney; for the right foot, use the right kidney. Only one qian of powder was used. Between Chen and Si hours (7 AM - 9 AM), several sheng of pus-like fluid, clear as crystal, were discharged, and the pain stopped immediately. Then, Chiwu San (Red Crow Powder) was applied to the knee, leading to recovery.
Xiang Yanzhang treated Shi Jianxian's foot disease. Upon onset, both feet became as thick as pillars, ulcerating and oozing yellow fluid, lasting over a month before resolving, only to recur. The six pulses were deep and moderate. Deep indicates internal dampness; moderate indicates Jue (cold extremities) and Wind. This is Wind-Damp toxicity, commonly known as Wet Hongjiaojiao. He used Shenxiong Wan (Shenxiong Pill) and Zhouche Shenyao Wan (Boat Vehicle Divine Protection Pill), achieving cure through drastic purgation of turbid fluids.
Yu Zhen's commentary: These two cases represent treatment methods from the North.
Zhao Liangren said: "When I arrived in Wuzhong, Xu Mengda suffered from soreness and heaviness in both feet, unable to walk. Upon onset, swelling and pain occurred. On one occasion, during a remission period, his pulses in all three positions were large, beating forcefully yet feeling hollow like green onion stalks. His upper body was obese. This was likely due to his consumption of rich foods, endless desires, insufficient essence and blood, and excessive damp-heat. Therefore, I tonified essence and blood below and cleared damp-heat above, giving him two formulas. Some said Hongjiaojiao has no tonification method, so he refused to take them. Three months later, the pain returned. One doctor used southern methods without effect; another used northern purgative methods, resulting in his death on the chamber pot. Alas, practitioners of Qi-Huang medicine, how can we neglect the differentiation of deficiency and excess?"
Zhu Danxi treated a woman with swollen feet using Dihuang (Rehmannia Root), Huangbai (Phellodendron Bark), Cangzhu (Atractylodes Rhizome), Nanxing (Pinellia Tuber), Honghua (Carthamus Flower), Niuxi (Achyranthes Root), Longdancao (Gentiana Root), and Chuanxiong (Ligusticum Rhizome), resulting in a cure.
Xue Lizhai treated a woman with tendon spasms and bone pain in the foot, unresponsive to various medicines. Her pulse was tight. He used Dafangfeng Tang (Great Wind-Expelling Decoction). After two doses, symptoms significantly improved; after two more doses, she was stable.
Jiang Yingsu said: "My friend She Jin Feng, a merchant in Maling, aged over fifty, suffered from foot pain, unable to rise from bed. For over a year, the flesh of his calves and thighs wasted away. I sought a proven prescription from local physician Xu Gutang, who had previously cured Bi syndrome (painful obstruction). Initially, Danggui Nian Tong Tang was used, effective after two doses. Next, Shiquan Dabu Tang (Ten Ingredients Great Tonifying Decoction) was used, added with Gouqizi (Goji Berry), Fangji (Stephania Root), Niuxi (Achyranthes Root), and Bibi (Dioscorea Hypoglauca Rhizome). In the morning, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) was taken, added with Hu Jinggu (Tiger Bone), Niuxi (Achyranthes Root), Chuan Bibi (Dioscorea Hypoglauca Rhizome), and Lujiao Jiao (Deer Antler Glue). After three years of administration, his legs recovered as before. Dr. Xu said: 'Long-term use will bring great benefit; do not expect immediate results.' Indeed."
Yu Zhen's commentary: The disease of Hongjiaojiao is rarely seen recently. If there is redness and swelling of the lower legs with unbearable pain, it is commonly called Liuhuo (Flowing Fire). If there is alternating pain in hands and feet, slight joint swelling, heat, or redness, it is what the books call Xingbi (Migratory Bi). Treatment methods mainly involve dispelling dampness, clearing heat, and cooling blood. Sometimes Baizhu (Atractylodes Macrocephala Rhizome), Fuzi (Aconite Lateral Root), and Guizhi (Cinnamon Twig) are used. The key lies in differentiating deficiency and excess, and distinguishing between damp-heat and cold-damp. The methods of Dairen and Mr. Xiang are largely unnecessary. Dr. Li Dongyuan's case resembles the treatment of Zhoubi (General Bi); Niantong Tang disperses damp-heat, while Zhishi Dahuang Tang expels damp-heat. Zhu's case also follows Bi syndrome treatment. Xue's and Jiang's cases use tonification, which is slightly different. Additionally, there is a case compiled by Liu Zongyuan regarding Hongjiaojiao: a mass like a stone appeared under the left hypochondrium, causing suffocation and near-death. It was cured by decocting Shanmu Jie (Cedar Wood Knots), Juye (Orange Leaf), Binglang (Areca Seed), and Tongbian (Child's Urine) to induce purgation. Cai Yuanchang suddenly felt as if a bug crawled from the sole of his foot to his waist, followed by fainting; he was cured by moxa application to Fengshi (GB31). There are also cases of Yang Meiren treating Tong Guan, and crushing snails to apply to the thighs to treat Dong Shouyue. These exist only as records now, without matching syndromes for trial, so they are not recorded in detail.
Sun Dongsu said: "A poor scholar had no soreness or pain in both feet, but upon movement, they did not obey his will. They would twist left and fall right, or twist right and fall left, walking in a zigzag pattern, unable to walk straight. This is a rare sight not recorded in books. I speculate it is caused by weak tendons failing to bind the bones, leading to deviation and falling during movement. Tendons are governed by the Liver, which belongs to Wood. When Wood energy is lax and unrestrained, Metal should be strengthened to control it. Ren Shen (Ginseng Root), Huangqi (Astragalus Root), and Baishao (White Peony Root) were used to tonify Lung Metal; Yiren (Coix Seed), Hugu (Tiger Bone), Guiban (Turtle Shell), and Duzhong (Eucommia Bark) to strengthen tendons and bones; Tiehua Fen (Iron Flower Powder) to specifically restrain Liver Wood. These were processed into honey pills, taken morning and evening, resulting in a complete cure."
Yu Zhen's commentary: This is not Hongjiaojiao, but attached here for categorization and ease of reference.
[Appendix] Zhang Jiming said: "A scholar suffered from Jiaoruo (Foot Weakness) disease, unresponsive to hundreds of medicines. I instructed him to wash his feet in a bucket made of Shanmu (Fir wood). I also instructed him to place Zhangnao (Camphor) between his thighs and secure it with leg bandages. After more than a month, he recovered fully."
Jiang Huangnan treated a young man who, in summer, soaked his heels in cold water and sat on damp ground, developing painful swelling in the heels, unable to take steps, resulting in months of bed rest. He taught him to take a block of dry soil, dig a concavity the size of a heel, heat it red with charcoal, remove the fire, pour a bowl of vinegar onto it, let it soak and dry. Then, place the heel against the soil block. Initially, keep it slightly high to fumigate, gradually bringing it closer. The lower limb joints became extremely sore yet comfortable, accompanied by slight sweating. Changing the soil bricks for fumigation over three to four days led to recovery.
My former tutor, Mr. Zhong Cangzhu, suffered from Jiaoruo disease in his youth, with soreness, weakness, and difficulty urinating, requiring prolonged standing to void. Tonifying Liver and Kidney medicines were ineffective. He sought treatment from Mr. He Sizong, who used Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) plus one cow hind leg marrow, resulting in a cure. I realized that previous physicians sought far away what lay close at hand. Mr. He was a prominent master in Jiangnan, and surely had many excellent cases. Regrettably, I was born too late to personally learn from him and could not copy them.