陈临川云∶凡头痛身热,肢节痛,大便秘,或呕逆而脚屈弱者,香港脚也。轻者可与
香苏散加木瓜、槟榔、生姜煎服,然后随证治之。要知有香港脚之人,先从脚起,或先缓
弱疼痹,或行起忽倒,或两胫肿满,或脚膝枯细,或心中忪悸,或小腹不仁,皮顽不知
疼痛,或举体转筋,或见食呕逆,恶闻食气,或胸满气急。或遍体酸痛,皆香港脚之候。黄
帝所谓缓风湿痹是也。顽弱为缓风,疼痛为湿痹。寒中三阳,所患必冷,小续命汤主之。
(煎成,入生姜自然汁最妙。)暑中三阴,所患必热,小续命汤去附子,减桂一半主之。大烦躁者,
紫雪最良。若无紫雪,以百合、薄荷煎冷水调服极妙。大便秘者,脾约丸、麻仁丸、三
和散主之。仍针灸为佳。服补药与汤淋洗,皆医家之大禁也。
夫妇人香港脚,与丈夫不同。男子则肾脏虚弱,为风湿所乘。女子以胞络气虚,为风
毒所搏。是以胞络属于肾也,肾主于腰脚,又肝脾肾三脏经络起于足十趾,若脏腑虚损,则
风邪先客于脚,从下而上,动于气,故名香港脚也。此皆由体虚,或当风取凉,或久坐卑
湿,或产后劳损,或恚怒悲伤肝,则心气不足,致月候不通。因其虚伤风毒,传入筋骨,
则令皮肤不仁,筋骨疼痛,肢体不随,筋脉拘挛,或时冷疼,或发肿满,或两脚痹弱,或
举体转筋,目眩心烦,见食呕吐,精神昏愦,肢节烦疼,小便赤黄,大便秘涩。如此证候,
其妇人香港脚,疗之与丈夫不同,以其气血不调,胎妊产损伤之。是以疗寡妇及尼与妻外家
殊别,即其义也。
〔薛〕严用和先生云∶前证初患不觉,因他病乃发,先从脚起,或缓弱痹痛不能行
履,或两胫肿满,或足膝细小,或心中怔忡,或小腹不仁,或举体转筋,或见食作呕,或
胸满气急,遍体酸痛,其脉浮而弦者,因于风。濡而弱者,因于湿。洪而数者,因于热。
迟而涩者,因于寒。男子由于肾气亏损,女子血海虚弱,七情所致。窃谓前证若足三阴
虚弱,用还少丹。(杂病虚劳。)若脾气虚寒,用八味丸。(杂病虚劳。)若饮食停滞,臀腿酸胀,浮
肿作痛,此脾气下陷,用六君子(杂病虚劳。)少加柴胡、升麻;不应,须用八味丸。若发热
口渴,月经不调,两腿无力,此足三阴血虚火燥,用六味、八味二丸兼服。前证西方之
人多患之,原素食乳酪,脾胃壅滞,胫足肿满。至于南方,亦有因膏粱浓味,湿热下注
而患者。故古人谓之壅疾,所用之方,多疏通发散之剂。然感于房劳过度,亏损三阴,治
法又当以固本为主。故六物附子,为元气虚弱,寒邪内侵之圣药。
大腹皮散 治妇人风毒香港脚,肢节烦疼,心神昏闷,并宜服之。
大腹皮 桑白皮 木通(去皮) 羌活(去芦) 赤芍药 荆芥 独活(去芦)
青橘皮(去白) 干木瓜(各一两) 枳壳(去瓤,麸炒) 紫苏叶(各二两)
上 咀,每服八钱,水一中盏半,生姜五片,葱白七寸,煎至一大盏,去滓食前温服。
紫苏饮 治妇人风毒香港脚,心腹痞塞,痰饮停积,不思饮食,脚重虚肿。
紫苏叶 木通(去皮) 茴香 桑根白皮(各一两) 独活(去芦) 羌活(去芦)
干木瓜 青橘皮(去白) 甘草(炙,各半两) 大腹皮(半两) 枳壳(去瓤麸炒,二两) 荆芥(半两)
上 咀,每服八钱,水一大盏半,生姜五片,连须葱白一茎,煎至一大盏,去滓温
服,不拘时,日进二服。
四白散 治男子妇人血虚发热,夜多盗汗,不进饮食,四肢羸瘦,筋脉拘挛,脚痛
不能行立。
黄 (去芦) 浓朴(姜制) 益智仁 陈皮(去白) 藿香 白扁豆 白术(去芦,各一两)
白茯苓(去皮) 白豆蔻仁 人参(去芦) 甘草(炙) 天台乌药(各半两) 芍药(一两半)
檀香 沉香(各二钱半)
上为细末,每服三钱,水一盏,生姜三片,枣子一枚,煎至七分,和 温服,日
进二服。诸证减退,只有脚挛痛不能行,服苍术丸治之。
苍术丸 大治干湿香港脚,筋脉拘挛疼痛,不能行履,兼补下部。
乳香(另研) 没药(各二钱,另研) 川牛膝(酒浸) 青盐(各半两,研) 熟艾(四钱,米糨过,研末)
全蝎(一钱,炒、研) 川乌头(三钱,炮,去皮脐)
上件为细末,入研药令匀,用大木瓜一枚,切一头留作盖,去幅,入上件药于木瓜内,将
盖签定,安于黑豆中,蒸令极烂,取出去皮,连药研成膏,却入生苍术末不以多少,拌令得所,丸如梧桐
子大。每服五十丸,空心用木瓜汤下,或温盐酒亦得,日进三服,忌血与蒜。
余证方沦,并详杂病本门。
陈临川说:凡是出现头痛、身体发热、四肢关节疼痛、大便秘结,或者呕吐逆气且脚部屈伸无力的,就是香港脚(一种以足胫肿重、软弱无力为主要表现的疾病)。病情较轻的,可以用香苏散加入木瓜、槟榔、生姜煎服,然后根据具体证候进行治疗。要知道患有香港脚的人,病邪通常先从脚部发起,有的先表现为脚部迟缓虚弱、疼痛麻木;有的行走时突然跌倒;有的两侧小腿肿胀饱满;有的脚膝枯瘦细小;有的心中悸动不安;有的小腹感觉迟钝麻木;有的皮肤僵硬不知疼痛;有的全身肌肉抽搐痉挛;有的见到食物就呕吐逆气,厌恶食物的气味;有的胸部胀满、呼吸急促;有的全身酸痛。这些都是香港脚的征候。这就是《黄帝内经》所说的“缓风湿痹”。其中,肢体迟缓软弱称为“缓风”,疼痛称为“湿痹”。如果是寒邪侵入三阳经,患病部位必然发冷,用小续命汤主治。(煎好药后,加入生姜自然汁效果最好。)如果是暑热之邪侵入三阴经,患病部位必然发热,用小续命汤去掉附子,将桂枝用量减半来主治。如果烦躁非常严重,紫雪是最有效的药物。如果没有紫雪,用百合、薄荷煎冷水调服也非常妙。如果大便秘结,用脾约丸、麻仁丸、三和散主治。同时配合针灸治疗效果更佳。服用补益药以及用汤药淋洗患处,都是医家的大忌。
妇女患香港脚,与男子不同。男子是因为肾脏虚弱,被风湿邪气侵袭。女子是因为胞络(子宫及其脉络)气虚,被风毒邪气搏结。因为胞络隶属于肾,肾主管腰部和脚部,而且肝、脾、肾三条阴经的经络都起于足十趾,如果脏腑虚损,那么风邪就会先客居于脚部,从下向上发展,扰动气机,所以名叫香港脚。这都是因为体质虚弱,或者迎风取凉,或者久坐低洼潮湿之地,或者产后劳损,或者愤怒悲伤伤及肝脏,导致心气不足,致使月经不通畅。因为体虚受到风毒侵袭,邪气传入筋骨,就会导致皮肤麻木不仁,筋骨疼痛,肢体不能随意运动,筋脉拘挛抽搐,有时冷痛,有时肿胀饱满,有时两脚麻木软弱,有时全身抽搐痉挛,头晕目眩,心烦意乱,见到食物就呕吐,精神昏沉迷糊,四肢关节烦扰疼痛,小便赤黄,大便秘涩。像这样的证候,治疗妇女香港脚与男子不同,因为妇女的气血不调,且有胎孕、生产造成的损伤。因此,治疗寡妇、尼姑与普通妻子的方法有所区别,就是这个道理。
薛己引用严用和先生的话说:上述病症初起时并不觉得明显,往往因其他疾病而发作,病邪先从脚部发起,有的表现为脚部迟缓虚弱、麻木疼痛不能行走,有的两侧小腿肿胀饱满,有的足膝细小,有的心中惊悸怔忡,有的小腹感觉迟钝麻木,有的全身肌肉抽搐痉挛,有的见到食物就作呕,有的胸部胀满、呼吸急促,全身酸痛。其脉象浮而弦的,是因为风邪;脉象濡而弱的,是因为湿邪;脉象洪而数的,是因为热邪;脉象迟而涩的,是因为寒邪。男子是由于肾气亏损,女子是血海虚弱,加上七情(喜、怒、忧、思、悲、恐、惊)所致。我认为,上述病症如果是足三阴经(肝、脾、肾)虚弱,用还少丹。(出自杂病虚劳篇。)如果是脾气虚寒,用八味丸。(出自杂病虚劳篇。)如果是饮食停滞,臀部和大腿酸胀,浮肿疼痛,这是脾气下陷,用六君子汤(出自杂病虚劳篇),少加柴胡、升麻;如果无效,必须用八味丸。如果有发热口渴、月经不调、两腿无力,这是足三阴经血虚火燥,用六味地黄丸、八味丸两方兼服。上述病症西方人容易患此病,原本是因为素食乳酪,导致脾胃壅滞,小腿和足部肿胀饱满。至于南方,也有因为食用膏粱厚味(油腻精细的食物),湿热下注而患病的。所以古人称之为“壅疾”,所用的方剂,多是疏通发散的药物。然而,如果是由于房事过度,亏损了三阴经,治疗方法又应当以固本为主。所以六物附子汤,是元气虚弱、寒邪内侵的圣药。
大腹皮散:治疗妇女风毒香港脚,四肢关节烦扰疼痛,心神昏闷,都适宜服用。
药材:大腹皮、桑白皮、木通(去皮)、羌活(去芦头)、赤芍药、荆芥、独活(去芦头)、青橘皮(去白)、干木瓜(各一两)、枳壳(去瓤,麸炒)、紫苏叶(各二两)。
制法:切碎,每次服用八钱,用水一中盏半,生姜五片,葱白七寸,煎至一大盏,去渣,饭前温服。
紫苏饮:治疗妇女风毒香港脚,心腹部痞塞胀满,痰饮停积,不思饮食,脚部沉重虚肿。
药材:紫苏叶、木通(去皮)、茴香、桑根白皮(各一两)、独活(去芦头)、羌活(去芦头)、干木瓜、青橘皮(去白)、甘草(炙,各半两)、大腹皮(半两)、枳壳(去瓤麸炒,二两)、荆芥(半两)。
制法:切碎,每次服用八钱,用水一大盏半,生姜五片,带须葱白一茎,煎至一大盏,去渣温服,不拘时间,每日进服两次。
四白散:治疗男子妇人血虚发热,夜间多盗汗,不进饮食,四肢消瘦,筋脉拘挛,脚痛不能行走站立。
药材:黄芪(去芦头)、浓朴(姜制)、益智仁、陈皮(去白)、藿香、白扁豆、白术(去芦头,各一两)、白茯苓(去皮)、白豆蔻仁、人参(去芦头)、甘草(炙)、天台乌药(各半两)、芍药(一两半)、檀香、沉香(各二钱半)。
制法:研为细末,每次服用三钱,用水一盏,生姜三片,枣子一枚,煎至七分,调和温度温服,每日进服两次。各种证候减退后,只有脚部挛痛不能行走,服用苍术丸治疗。
苍术丸:主要治疗干湿香港脚,筋脉拘挛疼痛,不能行走,兼补下部。
药材:乳香(另研)、没药(各二钱,另研)、川牛膝(酒浸)、青盐(各半两,研)、熟艾(四钱,米浆煮过,研末)、全蝎(一钱,炒、研)、川乌头(三钱,炮制,去皮脐)。
制法:将上述药材研为细末,加入已研好的药令其均匀,取一个大木瓜一个,切去一头作为盖子,挖去内部果肉,将上述药材放入木瓜内,将盖子盖好固定,放在黑豆中,蒸至极烂,取出后去皮,连同药一起研成膏状,再放入生苍术末适量,拌匀,制成梧桐子大小的丸药。每次服用五十丸,空腹时用木瓜汤送下,或者温盐酒也可以,每日进服三次,忌食血类和蒜类。
其余证候的方论,详见杂病本门。
Chen Linchuan stated: Whenever there is headache, fever, pain in the limbs and joints, constipation, or vomiting with weakness and flexion of the feet, this is Hong Kong Jiao (a disease characterized by swelling and heaviness of the lower legs and weakness). For mild cases, Xiangsu San (Perilla and Cyperus Powder) can be administered with added Mu Gua (Chaenomeles Fruit), Bing Lang (Areca Seed), and Sheng Jiang (Fresh Ginger), decocted and taken orally. Subsequently, treatment should be tailored to the specific syndrome. It must be known that patients with Hong Kong Jiao typically develop symptoms starting from the feet. Symptoms may initially present as slowness, weakness, pain, and numbness in the feet; sudden collapse while walking; swelling and fullness in both calves; emaciation of the feet and knees; palpitations in the heart; insensitivity in the lower abdomen; skin induration with loss of pain sensation; generalized muscle spasms; nausea and vomiting upon seeing food or smelling food odors; chest distension and shortness of breath; or generalized body soreness. All these are manifestations of Hong Kong Jiao. This corresponds to what the Yellow Emperor described as "Huan Feng Shi Bi" (Sluggish Wind-Dampness Bi Syndrome). Slowness and weakness constitute "Huan Feng" (Sluggish Wind), while pain constitutes "Shi Bi" (Dampness Bi). If cold pathogen invades the Three Yang meridians, the affected areas will necessarily feel cold; Xiao Xuming Tang (Minor Continuation of Life Decoction) is the primary formula. (It is best to add fresh ginger juice after decoction.) If summer-heat pathogen invades the Three Yin meridians, the affected areas will necessarily feel hot; Xiao Xuming Tang should be used without Fu Zi (Aconite Lateral Root) and with Gui Zhi (Cinnamon Twig) reduced by half. For severe restlessness, Zi Xue (Purple Snow) is most effective. If Zi Xue is unavailable, Bai He (Lily Bulb) and Bo He (Mint) decocted in cold water for administration is also excellent. For constipation, Pi Yue Wan (Splee Restriction Pill), Ma Ren Wan (Hemp Seed Pill), or San He San (Three Harmonies Powder) should be used. Acupuncture and moxibustion are still preferred. Taking tonifying medicines and washing the affected parts with herbal decoctions are major taboos among physicians.
Women suffering from Hong Kong Jiao differ from men. In men, it arises from Kidney deficiency allowing Wind-Dampness to invade. In women, it arises from Qi deficiency in the Bao Luo (Uterine Collaterals) allowing Wind-Toxin to bind. Since the Bao Luo belongs to the Kidney, and the Kidney governs the waist and feet, and the meridians of the Liver, Spleen, and Kidney all originate at the ten toes of the feet, if the Zang-Fu organs are deficient, Wind Pathogen first lodges in the feet, ascending from below and disturbing Qi, hence the name Hong Kong Jiao. These conditions result from constitutional weakness, exposure to wind while cooling off, prolonged sitting in damp lowlands, postpartum overexertion, or anger/sorrow injuring the Liver, leading to Heart Qi deficiency and obstruction of menstruation. Due to deficiency allowing Wind-Toxin invasion, the pathogen transmits into the sinews and bones, causing skin insensitivity, bone and sinew pain, inability to move limbs freely, sinew constriction and spasms, intermittent cold pain, swelling, foot numbness and weakness, generalized spasms, dizziness, irritability, vomiting upon seeing food, mental confusion, joint soreness, dark yellow urine, and constipation. For such syndromes, treating women differs from men because women have irregular Qi and Blood, and suffer damage from pregnancy and childbirth. Therefore, treating widows, nuns, and ordinary wives requires distinct approaches, which illustrates this principle.
Xue Ji quoted Mr. Yan Yonghe: The aforementioned condition is often unnoticed at onset and manifests due to other illnesses, starting from the feet. Symptoms include foot slowness, weakness, numbness, and pain preventing walking; calf swelling; thin feet and knees; heart palpitations; abdominal insensitivity; generalized spasms; nausea upon seeing food; chest distension and shortness of breath; and generalized soreness. A pulse that is Floating and Wiry indicates Wind. Damp and Weak indicates Dampness. Surging and Rapid indicates Heat. Slow and Choppy indicates Cold. In men, it stems from Kidney Qi depletion; in women, from Blood Sea deficiency and Seven Emotions. I suggest that if the Three Yin meridians of the foot are weak, use Huan Shao Dan (Restore Youth Pill). If Spleen Qi is deficient and cold, use Ba Wei Wan (Eight-Ingredient Pill). If food stagnation causes hip and thigh soreness/swelling/pain, indicating Spleen Qi sinking, use Liu Jun Zi Tang (Six Gentlemen Decoction) with added Chai Hu (Bupleurum Root) and Sheng Ma (Cimicifuga Rhizome); if ineffective, Ba Wei Wan is required. If fever, thirst, irregular menstruation, and leg weakness occur, indicating Blood deficiency and Fire dryness in the Three Yin meridians of the foot, use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) and Ba Wei Wan together. People in the West are prone to this condition, originally due to vegetarian diets rich in dairy, causing Spleen-Stomach congestion and calf/foot swelling. In the South, it also occurs due to rich, greasy foods causing Damp-Heat pouring downward. Thus, ancients called it "Yong Ji" (Congestion Disease), using formulas that mostly unblock and disperse. However, if caused by excessive sexual activity damaging the Three Yin, treatment must focus on consolidating the root. Therefore, Liu Wu Fu Zi Tang (Six-Ingredient Aconite Decoction) is a sacred medicine for Yuan Qi deficiency and internal Cold invasion.
Da Fu Pi San (Betel Nut Peel Powder): Treats Wind-Toxin Hong Kong Jiao in women, featuring joint soreness, mental confusion, and malarial-like symptoms.
Ingredients: Da Fu Pi (Areca Peel), Sang Bai Pi (Mulberry Root Bark), Mu Tong (Akebia Stem), Qiang Huo (Notopterygium Rhizome), Chi Shao Yao (Red Peony Root), Jing Jie (Schizonepeta Spike), Du Huo (Angelica Pubescens Root), Qing Ju Pi (Green Tangerine Peel), Gan Mu Gua (Dried Chaenomeles Fruit), Zhi Ke (Bitter Orange Fruit), Zi Su Ye (Perilla Leaf).
Preparation: Coarsely crush. Take 8 qian per dose, decoct with 1.5 cups of water, 5 slices of Fresh Ginger, and 7 cun of Scallion White until reduced to 1 cup. Strain and take warm before meals.
Zi Su Yin (Perilla Infusion): Treats Wind-Toxin Hong Kong Jiao in women, featuring epigastric fullness, phlegm-fluid retention, anorexia, and heavy, swollen feet.
Ingredients: Zi Su Ye (Perilla Leaf), Mu Tong (Akebia Stem), Hui Xiang (Fennel Fruit), Sang Gen Bai Pi (Mulberry Root Bark), Du Huo (Angelica Pubescens Root), Qiang Huo (Notopterygium Rhizome), Gan Mu Gua (Dried Chaenomeles Fruit), Qing Ju Pi (Green Tangerine Peel), Zhi Gan Cao (Prepared Licorice Root), Da Fu Pi (Betel Nut Peel), Zhi Ke (Bitter Orange Fruit), Jing Jie (Schizonepeta Spike).
Preparation: Coarsely crush. Take 8 qian per dose, decoct with 1.5 cups of water, 5 slices of Fresh Ginger, and one stalk of Scallion White with roots until reduced to 1 cup. Strain and take warm at any time, twice daily.
Si Bai San (Four Whites Powder): Treats Qi and Blood deficiency with fever, night sweats, anorexia, emaciated limbs, sinew constriction, and foot pain preventing walking.
Ingredients: Huang Qi (Astragalus Root), Hou Po (Magnolia Bark), Yi Zhi Ren (Alpinia Oxyphylla Fruit), Chen Pi (Tangerine Peel), Huo Xiang (Patchouli Herb), Bai Bian Dou (White Hyacinth Bean), Bai Zhu (Atractylodes Macrocephala Rhizome), Bai Fu Ling (Poria), Bai Dou Kou (White Cardamom Seed), Ren Shen (Ginseng Root), Zhi Gan Cao (Prepared Licorice Root), Tian Tai Yu Dao (Tiantai Arisaema Rhizome), Shao Yao (Peony Root), Tan Xiang (Sandalwood Wood), Chen Xiang (Agarwood Wood).
Preparation: Grind into fine powder. Take 3 qian per dose, decoct with 1 cup of water, 3 slices of Fresh Ginger, and one Jujube until reduced to 0.7 cup. Take warm, twice daily. Once other symptoms subside but foot spasm/pain persists, treat with Cang Zhu Wan.
Cang Zhu Wan (Atractylodes Pill): Primarily treats Dry/Wet Hong Kong Jiao, sinew constriction/pain, inability to walk, and tonifies the lower body.
Ingredients: Ru Xiang (Olibanum), Mo Yao (Myrrh), Chuan Niu Xi (Cyathula Root), Qing Yan (Rock Salt), Shu Ai Ye (Prepared Mugwort Leaf), Quan Xie (Scorpion), Chuan Wu Tou (Aconitum Carmichaelii Lateral Root).
Preparation: Grind ingredients into fine powder. Mix thoroughly. Cut the top off one large Mu Gua (Chaenomeles), remove flesh, insert herbs, seal with the top, place in black beans, and steam until very soft. Remove skin, grind with herbs into paste, mix with sufficient raw Cang Zhu (Atractylodes Rhizome) powder, and form pills the size of paulownia seeds. Take 50 pills on an empty stomach with Mu Gua soup or warm salt wine, three times daily. Avoid blood products and garlic.
Discussions on other syndromes are detailed in the main section on Miscellaneous Diseases.