千金论云何以得之于脚 问曰。风毒中人。随处皆得作病。何偏着于脚也。答曰。夫人有五
脏。心肺二脏经络。所起在手十指。肝肾与脾三脏经络。所起在足十趾。夫风毒之气。皆起于地。
地之寒暑风湿。皆作蒸气。足常履之。所以风毒之中人也。必先中脚。久而不瘥。遍及四肢腹背
头项也。微时不觉。痼滞乃知。经云。次传间传是也。
论得已便令人觉否 凡香港脚病皆由感风毒所致。得此病。多不令人即觉。会因他病一度。乃
始发动。或奄然大闷。经三两日不起。方乃觉之。诸小庸医。皆不识此疾。漫作余病治之。莫不
尽毙。故此病多不令人识也。始起甚微。食饮
嬉戏。气力如故。惟卒起脚屈弱不能动。有此为异耳。黄帝云。缓风湿痹是也。
论风毒相貌 夫有脚未觉异。而头项臂膊已有所苦。有诸处皆悉未知。而心腹五内已有所困。
又风毒之中人也。或见食呕吐。憎闻食臭。或腹痛下痢。或大小便秘涩不通。或胸中冲悸。不欲
见光明。或精神昏愦。或喜迷妄。语言错乱。或壮热头痛。或身体酷冷疼烦。或觉转筋。或肿不
肿。或 腿顽痹。或时缓纵不随。或复百节挛急。或小腹不仁。此皆香港脚状貌也。亦云风毒香港脚
之候也。其候难知。当须细意察之。不尔必失其机要。一朝病成。难可以理。妇人亦尔。又有妇
人产后。春夏取凉。多中此毒。深宜慎之。其热闷掣 。惊悸心烦。呕吐气上。皆其候也。又但
觉脐下冷痞。 然不快。兼小便淋沥。不同生平。即是香港脚之候。顽弱名缓风。疼痛为湿痹。
论得之所由 凡四时之中。皆不得久立久坐湿冷之地。亦不得因酒醉汗出。脱衣靴袜。当风
取凉。皆令香港脚。若暑月久坐久立湿地者。则热湿之气蒸入经络。病发必热。四肢酸疼烦闷。若
寒月久坐久立湿冷地者。即冷湿之气上入经络。病发则四体酷冷转筋。若当风取凉得之者。病发
则皮肉顽痹。诸处 动。渐渐向头。凡常之日。忽然暴热。人皆不能忍得者。当于此时。必得顿
取于寒以快意也。卒有暴寒。复不得受之。皆生病也。世有勤功力学之士。一心注意于事。久坐
行立于湿地。不时动转。冷风来击入于经络。不觉成病。故风毒中人。或先中手足十指。因汗毛
孔开。腠理疏通。风如急箭。或先中足心。或先中足趺。或先中膝以下 胫表里者。若人初觉。
即灸所患处二三十壮即愈。不复发也。黄帝云。当风取凉。醉已入房。能成此疾。
论冷热不同 问曰。何故得者。有冷有热。答曰。足有三阴三阳。寒中三阳。所患必冷。暑
中三阴。所患必热。故有表里
冷热不同。热者治以冷药。冷者疗以热药。以意消息之。脾受阳毒即热顽。肾受阴湿即寒痹。
论须疗缓急 凡小觉病候有异。即须大怖畏。决意急治之。勿缓。气上入腹。或肿或不肿。
胸胁逆满。气上肩息。急者死不旋踵。宽者数日必死。不可不急疗也。但看心下急。气喘不停。
或自汗数出。或乍寒乍热。其脉促短而数。呕吐不止者皆死。
论虚实可服药不可服药 凡香港脚之疾。皆由气实而死。终无一人以服药致虚而殂。故香港脚之人。
皆不得大补。亦不可大泻。终不得畏虚。故预止汤不服也。如此者皆死不治。
论脉候法 凡香港脚虽殊。诊候不异。而三部之脉。要须不违四时者为吉。其逆四时者勿治。
余如脉经所说。此中不复具载。其人本黑瘦者易治。肥大肉浓赤白者难愈。黑人耐风湿。赤白不
耐风冷。瘦人肉硬。肥人肉软。肉软则受疾至深。难愈也。
论肿不肿 凡人久患香港脚。不自知别。于后因有他疾发动。治之得瘥。后直患呕吐而复脚弱。
余为诊之。乃告为香港脚。病者曰。某平生不患脚肿。何因名为香港脚。不肯服汤。余医以为石发。
孤疑之间。不过一旬而死。故香港脚不得一向以肿为候。亦有肿者。有不肿者。其以小腹顽痹不仁
者。脚多不肿。小腹顽后。不过三五日。即令人呕吐者。名香港脚入心。如此者死在旦夕。凡患脚
气到心难治。以其肾水克心火故也。
论须慎不慎 凡香港脚之病。极须慎房室。羊肉牛肉。鱼蒜蕺菜。菘菜蔓青。瓠子酒面。酥油
乳麋。猪鸡鹅鸭。有方用鲤鱼头。此等并切禁。不得犯之。并忌大怒。惟得食粳粱粟米。酱豉葱
韭薤。椒姜橘皮。又不得食诸生果子。酸酢之食。犯
者皆不可瘥。又大宜生牛乳生栗子。
论灸法 凡香港脚初得脚弱。便速灸之。并服竹沥汤。灸讫可服八风散。无不瘥者。惟急速治
之。若人但灸而不能服散。服散而不灸。如此者半瘥半死。虽得瘥者。或至一二年复更发动。觉
得。便根据此须速灸之及服散者。治十十愈。此病轻者。虽不即死。治之不当。根源不除。久久期
于杀人。不可不精以为意。初风市穴灸百壮。重者五六百壮。勿令顿灸。三报之。次伏兔穴灸百
壮。亦可五十壮。次犊鼻穴灸五十壮至百壮。次膝眼穴灸百壮。次三里穴灸百壮。次上廉穴灸百
壮。次下廉穴灸百壮。次绝骨穴灸百壮。凡此诸穴灸。不必一顿灸尽壮数。可日日报灸之。三日
之中灸令尽壮数为佳。凡病一脚则灸一脚。病两脚则灸两脚。凡脚弱病。皆多两脚。又一方云。
如觉脚恶。便灸三里及绝骨各一处。两脚恶者。合四处灸之。多少随病轻重。大要虽轻。不可减
百壮。不瘥速以次灸之。
论服汤药色目 风毒之气。入人体中。脉有三品。内外证候相似。但脉有异耳。若脉浮大而
缓。宜服续命汤。两剂应瘥。若风盛。宜作越婢汤加白术四两。胡洽云。若恶风者。更加附子一
枚。若脉浮大紧转快。宜作竹沥汤。若病患脉微而弱。宜服风引汤。此脉多是因虚而得之。若大
虚短气力乏。其间可作补汤。随病冷热而用之。若未愈。更服竹沥汤。若病患脉浮大而紧快。此
是三品之中最恶脉也。或沉细而快者。此脉正与浮大而紧者同是恶脉。浮大者病在外。沉细者病
在内。治当消息以意逆之。虽其形尚可。而手脚未至弱极。数日之中。气上。即便命终。如此之
脉。往往有人得之。无一存者。急服竹沥汤。日服一剂。切要汤势常令相及。勿令半日之中空无
汤也。此汤竹汁多服之。若不极热。辄停在胸心。更为人患。每服当使极热。若服竹沥汤得下者。
必佳也。续命汤治风毒病初得。似时行毒病而脉浮缓。
终不变快。此不治。或数日而死。或十日而死。或得便不识人。或发黄。或发斑。或目赤。或下
部穿烂者。此最急。得之即先服续命汤一剂。须服葛根、麻黄汤下之。若此不折。更与续命汤两
三剂必瘥。夫香港脚之病。先起岭南。稍来江东。得之无渐。或微觉疼痹。或两胫肿满。或行起涩
弱。或上入腹不仁。或时冷热。小便秘涩。喘息气冲喉。气急欲死。食呕不下。气上逆者。皆其
候也。若觉此证。先与犀角旋复花汤。宜久服之。以气下小便利为度。
按东垣云。香港脚实由水湿。然有二焉。南方卑湿。清湿袭虚。则病起于下。此是外感。北方
常食膻乳。又饮酒太过。脾胃有伤。不能运化。水湿下流。此因内而至外者也。香港脚两胫肿。是
为壅疾。皆当疏下。然太过则损脾。不及则病不去。南方多见两足粗大。与疾偕老者。初起治宜
槟榔汤。或四七汤、香苏散。并加槟榔、橘皮以宣通其气。不使其壅。壅既成者。砭去恶血。然
后服药。经云。蓄则肿热。砭石之也。
香港脚之病。初起甚微。饮食如故。人多不觉。惟卒然脚膝屈弱。或肿。或不肿。或顽痹。或
缓纵。或挛急。皆是湿邪为患。其肿者为湿香港脚。不肿者为干香港脚。香港脚之发。必身痛发热大。
类伤寒。不可妄用伤寒等药。若卒起脚弱。或少腹不仁。或转筋呕逆。或腹痛下利。或二便秘涩。
或惊悸妄错。但两胫肿赤。便作香港脚治。风胜者。自汗走注。脉浮弦。越婢加术汤。寒胜者。无
汗挛急掣痛。脉迟涩。酒浸牛膝丸。湿胜者。肿痛重着。脉迟细。除湿汤。冷痹恶风者。非术、
附、麻黄并用。必不能开。越婢加术附汤汗之。或麻黄附子细辛汤加桂枝、白术亦妙。脚痹冷痛。
或时哄热。不可屈伸者。千金独活汤。风冷脚痹疼痛。挛弱不可屈伸。千金乌头汤。暑胜者。烦
渴身热。或成水泡疮。脉洪。清燥汤。香港脚头疼身热。肢节疼痛。或一脚偏患软弱 曳。状如偏
风者。小续命加木瓜。三阳经受热。毒瓦斯流脚踝上。 赤肿痛。
寒热如疟。自汗恶风。或无汗恶寒。败毒散加苍术。三阴受寒。湿着于脚膝上。枯瘦色淡。少腹
不仁。腹急疼痛。上气喘急。八味丸加沉香。香港脚上入腹。腹急上冲胸。气欲绝。千金半夏汤。
香港脚冲心。疼痛肿满。大小便秘。沉香导气汤。香港脚遍身肿痛。喘促烦闷者。木通散。因香港脚而
服补剂太过小便不通者。姜汁炒黑山栀、木通、赤芍、赤茯苓、当归、生甘草梢。不时煎服。脚
气初发。一身尽疼。或肢节肿。便溺阻隔。此属湿热。先以羌活导滞汤导之。后以当归拈痛汤除
之。香港脚上入少腹不仁。崔氏八味丸。香港脚入腹。喘急腹胀。苏子降气汤。佐以养正丹。下气甚
捷。香港脚迫肺。令人喘嗽。小青龙汤加槟榔。香港脚呕逆。恶心畏食。生料平胃散加木香。大便秘。
加煨大黄。香港脚风毒。生疮肿痛。心神烦热。犀角散。香港脚冲心。火气逆上也。金铃子散加茴香、
酒黄柏。另以附子末。津调敷涌泉穴。香港脚初发。从足起至膝胫骨肿疼者。千金蓖麻叶裹法。脚
气注踝成孔。至下半日疼甚者。此香港脚流成漏也。以人中白火炙。敷疮口良。香港脚冲心。矾石一
两。酸浆水一斗五升。煎三五沸。浸脚良。活人书云。凡香港脚服补药。及用汤药渫洗。逼邪入于
经络。皆医之大禁也。大抵香港脚肿痛。并属湿热。或兼风兼暑。当详春夏病因六淫治之。至于枯
瘦而热者。属阴虚。瘦弱而寒者。属阳虚。当作本证治之。
〔诊〕脉浮弦起于风。濡弱起于湿。洪数起于热。迟涩起于寒。沉而伏。毒在筋骨也。指下涩
涩不调。毒在血分也。夏暑脚膝冷痛。其脉阳濡阴弱。湿温也。香港脚多从暑湿得之。
石顽治文学褚廷嘉精脱气伤。喘汗蒸热如淋。六脉浮芤。按之乏力。势不得不从事温补。遂
猛进黄 建中。易桂心加人参。数帖而安。因有香港脚痼疾。恒服肾气丸不彻。六七年来。宿患未
除。坚恳石顽铲绝病根。乃汇取术附、桂
附、 附、参附等法。兼采八风散中菊花。鳖甲汤中鳖甲、贝齿、羚羊、犀角。风引汤中独活、
防己。竹沥汤中姜汁、竹沥为丸。共襄祛风逐湿之功。服后必蒸蒸汗出。不终剂而数年之疾顿愈。
非深达法存千金妙义。乌能及此。
《千金方》论述道：为什么这种病会发生在脚上呢？有人问：风毒侵袭人体，在任何部位都可能发病，为什么偏偏集中在脚部呢？回答说：人有五脏，心和肺的经络起始于手十指；肝、肾和脾三脏的经络起始于足十趾。风毒之气，都产生于地面。地面的寒、暑、风、湿，都会化作蒸气。脚经常踩踏在地面上，所以风毒侵袭人体时，必定先中伤脚部。如果时间久了不痊愈，就会蔓延到四肢、腹部、背部、头部和颈部。病情轻微时并不觉得难受，直到病邪深重滞留体内才察觉。正如医经所说：“次传”、“间传”的道理就是这样。
关于患病后是否立刻让人察觉：凡是香港脚（脚气）病，都是由感受风毒引起的。得了这个病，大多不会让人立刻察觉。往往因为其他疾病发作一次，才开始引发此病。或者突然感到极度烦闷，经过两三天不能起床，这才发觉。许多平庸的医生，都不认识这种病，随意当作其他疾病治疗，结果没有不致人死亡的。所以这种病大多不被人们所识别。起初症状很轻微，饮食嬉戏如常，气力也正常，只有突然起来时脚屈曲软弱不能活动，这才是异常之处。黄帝说：这就是“缓风湿痹”。
关于风毒的外在表现：有的人脚还没有感觉异常，但头项、手臂已经感到痛苦；有的全身各处都还没感觉不适，但心腹五脏已经感到困顿。另外，风毒侵袭人体，有的看见食物就呕吐，厌恶闻食物的气味；有的腹痛腹泻；有的大小便秘结不通；有的胸中悸动冲撞，不想见光亮；有的精神昏沉糊涂，有的喜欢胡言乱语、神志错乱；有的高热头痛；有的身体酷冷疼痛烦躁；有的感觉肌肉抽搐；有的肿胀，有的不肿；有的腿部麻木不仁，有的时而松弛无力不受控制，有的又全身关节拘挛紧急；有的小腹知觉迟钝。这些都是香港脚的症状表现。也称为风毒香港脚的证候。这些证候难以知晓，必须仔细体察，否则一定会错失治疗的关键时机。一旦病成，就很难用常理来解释了。妇女也是如此。又有妇女产后，在春夏季节贪凉，多被这种毒气侵袭，应当非常谨慎。那些热闷牵引感、惊悸心烦、呕吐气逆，都是其证候。又如果觉得脐下寒冷痞硬，心中怏怏不快，兼有小便淋漓不畅，与平时不同，这就是香港脚的证候。肢体顽弱称为“缓风”，疼痛称为“湿痹”。
关于得病的原因：四季之中，都不应该久站或久坐于湿冷的地方，也不应该在酒醉汗出时，脱去衣服鞋袜，对着风取凉，这些都会导致香港脚。如果在暑天久坐或久立于湿地，那么热湿之气会蒸腾进入经络，发病时必定发热，四肢酸痛烦闷。如果在寒天久坐或久立于湿冷地，那么冷湿之气会上入经络，发病则四肢酷冷、转筋。如果是因对着风取凉而得的，发病时皮肉麻木不仁，各处跳动，渐渐向头部蔓延。平常的日子里，忽然遇到暴热，人都不能忍受的时候，此时一定要通过迅速接触寒气来求得舒适。但如果突然遭遇暴寒，又不能承受，都会生病。世间有勤奋功力学问的人，一心专注于事务，久坐站立在湿地，不时活动，冷风袭来侵入经络，不知不觉就形成了疾病。所以风毒侵袭人体，有时先中伤手足十指，因为汗毛孔张开，腠理疏通，风邪像急箭一样射入；有时先中伤足心；有时先中伤足背；有时先中伤膝盖以下小腿的表里部位。如果人刚感觉到不适，立即在患处艾灸二三十壮就能痊愈，不再复发。黄帝说：当风取凉，酒后行房，能造成这种疾病。
关于冷热性质的不同：有人问：为什么得病的人，有的表现为冷证，有的表现为热证？回答说：足部有三阴经和三阳经。寒邪中伤三阳经，所患必定是冷证；暑邪中伤三阴经，所患必定是热证。所以有表里、冷热的不同。热证用寒凉药物治疗，冷证用温热药物治疗，要根据具体情况斟酌处理。脾受到阳毒侵袭就会变成热性顽痹，肾受到阴湿侵袭就会变成寒性痹痛。
关于必须治疗缓急：凡是稍微感觉到病候有异常，就必须非常恐惧警惕，决意紧急治疗，不要拖延。如果气逆入腹，或者肿胀或不肿胀，胸胁胀满逆气，气逆上冲肩部呼吸急促，急症者转眼之间就会死亡，稍宽裕的几天内也必死，不可不紧急治疗。只要看心下急迫，气喘不停，或者自汗频频，或者忽冷忽热，脉象促短而数，呕吐不止的，都是死证。
关于虚实及是否可服药：凡是香港脚的疾病，都是因为气实而死，从来没有一个人因为服药导致虚损而死亡的。所以患有香港脚的人，都不能大补，也不可大泻，最终不要因为害怕虚损而停止服用汤药。像这样（畏虚停药）的，都是死证无法救治。
关于脉候诊断法：凡是香港脚虽然表现各异，但诊候原则是一致的。三部脉象，必须要顺应四时变化才是吉兆。违背四时的脉象就不要治疗了。其余内容如同《脉经》所说，这里不再详细记载。原本肤色黑且瘦的人容易治愈，肥大肉浓、肤色赤白的人难愈。黑人耐受风湿，赤白肤色不耐受风冷。瘦人肌肉坚硬，肥人肌肉松软。肌肉松软则受病深入，难以治愈。
关于肿胀与否：凡人长期患有香港脚，自己不知道区别，后来因为其他疾病发作，治疗得好转后，直接出现呕吐并且脚软弱。我诊治他，告诉他这是香港脚。病人说：我平生不患脚肿，为什么叫香港脚？不肯服汤药。我把他误认为是石发（一种皮肤病），在他犹豫怀疑之间，不过十天就死了。所以香港脚不能一向以肿胀作为唯一征候。也有肿胀的，也有不肿胀的。其中小腹顽痹不仁的，脚大多不肿。小腹顽痹之后，不过三五天，就会让人呕吐的，名叫“香港脚入心”。这样的，死在旦夕之间。凡是患脚气传到心脏的很难治，因为肾水克制心火的关系。
关于必须谨慎与不慎的后果：凡是香港脚的病，极须禁忌房事。羊肉、牛肉、鱼、蒜、蕺菜、菘菜、蔓青、瓠子、酒、面、酥油、乳糜、猪、鸡、鹅、鸭等，除了方书中提到可以用鲤鱼头的以外，这些都严禁食用，不得触犯。并忌大怒。只可以吃粳米、高粱、粟米，酱、豉、葱、韭、薤，椒、姜、橘皮。又不可以吃各种生果子、酸醋类的食物，犯禁的都不可痊愈。又大宜吃生牛乳、生栗子。
关于灸法：凡是香港脚初起脚弱，便迅速进行艾灸，并服用竹沥汤。灸完后可以服用八风散，没有不痊愈的。只是要急速治疗。如果人只艾灸而不能服散剂，或者服散剂而不艾灸，这样的半愈半死。即使得到痊愈，可能一两年后又再次发作。察觉到后，便根据此法必须迅速艾灸及服散剂的，治疗十个能好十个。这病轻的，虽然不立刻致死，治疗不当，根源不除，久而久之必然杀人，不可不精心在意。初起灸风市穴一百壮，重症者五六百壮，不要让一次性灸完，分三次完成。其次灸伏兔穴一百壮，也可以五十壮。其次灸犊鼻穴五十壮至一百壮。其次灸膝眼穴一百壮。其次灸三里穴一百壮。其次灸上廉穴一百壮。其次灸下廉穴一百壮。其次灸绝骨穴一百壮。凡这些穴位艾灸，不必一次性灸完所有壮数，可以每天分次灸。三天之内灸完所有壮数为佳。凡是病一只脚则灸一只脚，病两只脚则灸两只脚。凡是脚弱病，大多两只脚都病。又一方说：如果觉得脚恶，便灸三里及绝骨各一处，两脚恶者，合四处灸之。多少随病情轻重，大体即使病轻，也不能少于百壮。不愈则依次再灸。
关于服用汤药的色目（分类与对应）：风毒之气，进入人体，脉象有三种品级，内外证候相似，但脉象不同。如果脉浮大而缓，宜服用续命汤，两剂应痊愈。如果风盛，宜用越婢汤加白术四两。胡洽说：如果恶风者，再加附子一枚。如果脉浮大紧转快，宜用竹沥汤。如果病患脉微而弱，宜服用风引汤。这种脉多是因虚而得的。如果大虚短气乏力，其间可以制作补汤，随病冷热而使用。如果未愈，再服竹沥汤。如果病患脉浮大而紧快，这是三品之中最恶劣的脉象。或者沉细而快的，这种脉正与浮大而紧的是同样的恶脉。浮大的病在外，沉细的病在内。治疗应当斟酌心意去推测它。虽然外形尚可，而手脚还未至极度虚弱，数日之中，气上冲，即便命终。这样的脉，往往有人得之，无一存活。急服竹沥汤，每日服一剂，切要使汤势连续不断，不要让半天之中空无汤药。此汤竹汁多服之，如果不极热，辄停在胸心，更成为人的祸患。每次服用应当使极热。如果服竹沥汤得下者，一定很好。续命汤治疗风毒病初得，似时行毒病而脉浮缓，终不变快，此不治。或数日而死，或十日而死。或者得病便不识人，或者发黄，或者发斑，或者目赤，或者下部穿烂者，这是最急的，得之即先服续命汤一剂，须服葛根、麻黄汤下之。如果此法不折服，再给续命汤两三剂必痊愈。夫香港脚之病，先起岭南，稍来江东，得之无渐，或微觉疼痹，或两胫肿满，或行起涩弱，或上入腹不仁，或时冷热，小便秘涩，喘息气冲喉，气急欲死，食呕不下，气上逆者，皆其候也。若觉此证，先与犀角旋复花汤，宜久服之，以气下小便利为度。
按东垣说：香港脚确实由于水湿引起，然而有两种情况。南方地势卑湿，清湿侵袭虚弱之处，则病起于下，这是外感。北方常食膻腥乳制品，又饮酒太过，脾胃受伤，不能运化，水湿下流，这是因内而至外的。香港脚两胫肿，是为壅疾，都应当疏泄通下。然而太过则损伤脾，不及则病不去。南方多见两足粗大，与疾偕老者。初起治疗宜用槟榔汤，或四七汤、香苏散，并加槟榔、橘皮以宣通其气，不使其壅滞。壅滞既成者，砭刺去除恶血，然后服药。经云：蓄积则肿热，用砭石治疗。
香港脚之病，初起甚微，饮食如故，人多不觉。惟卒然脚膝屈弱，或肿，或不肿，或顽痹，或缓纵，或挛急，皆是湿邪为患。其肿者为湿香港脚，不肿者为干香港脚。香港脚之发，必身痛发热大，类伤寒，不可妄用伤寒等药。若卒起脚弱，或少腹不仁，或转筋呕逆，或腹痛下利，或二便秘涩，或惊悸妄错，但两胫肿赤，便作香港脚治。风胜者，自汗走注，脉浮弦，越婢加术汤。寒胜者，无汗挛急掣痛，脉迟涩，酒浸牛膝丸。湿胜者，肿痛重着，脉迟细，除湿汤。冷痹恶风者，非术、附、麻黄并用，必不能开，越婢加术附汤汗之。或麻黄附子细辛汤加桂枝、白术亦妙。脚痹冷痛，或时哄热，不可屈伸者，千金独活汤。风冷脚痹疼痛，挛弱不可屈伸，千金乌头汤。暑胜者，烦渴身热，或成水泡疮，脉洪，清燥汤。香港脚头疼身热，肢节疼痛，或一脚偏患软弱曳，状如偏风者，小续命加木瓜。三阳经受热，毒瓦斯流脚踝上，赤肿痛，寒热如疟，自汗恶风，或无汗恶寒，败毒散加苍术。三阴受寒，湿着于脚膝上，枯瘦色淡，少腹不仁，腹急疼痛，上气喘急，八味丸加沉香。香港脚上入腹，腹急上冲胸，气欲绝，千金半夏汤。香港脚冲心，疼痛肿满，大小便秘，沉香导气汤。香港脚遍身肿痛，喘促烦闷者，木通散。因香港脚而服补剂太过小便不通者，姜汁炒黑山栀、木通、赤芍、赤茯苓、当归、生甘草梢，不时煎服。脚气初发，一身尽疼，或肢节肿，便溺阻隔，此属湿热，先以羌活导滞汤导之，后以当归拈痛汤除之。香港脚上入少腹不仁，崔氏八味丸。香港脚入腹，喘急腹胀，苏子降气汤，佐以养正丹，下气甚捷。香港脚迫肺，令人喘嗽，小青龙汤加槟榔。香港脚呕逆，恶心畏食，生料平胃散加木香，大便秘，加煨大黄。香港脚风毒，生疮肿痛，心神烦热，犀角散。香港脚冲心，火气逆上也，金铃子散加茴香、酒黄柏，另以附子末，津调敷涌泉穴。香港脚初发，从足起至膝胫骨肿疼者，千金蓖麻叶裹法。脚气注踝成孔，至下半日疼甚者，此香港脚流成漏也，以人中白火炙，敷疮口良。香港脚冲心，矾石一两，酸浆水一斗五升，煎三五沸，浸脚良。活人书云：凡香港脚服补药，及用汤药渫洗，逼邪入于经络，皆医之大禁也。大抵香港脚肿痛，并属湿热，或兼风兼暑，当详春夏病因六淫治之。至于枯瘦而热者，属阴虚，瘦弱而寒者，属阳虚，当作本证治之。
〔诊〕脉浮弦起于风，濡弱起于湿，洪数起于热，迟涩起于寒。沉而伏，毒在筋骨也。指下涩涩不调，毒在血分也。夏暑脚膝冷痛，其脉阳濡阴弱，湿温也。香港脚多从暑湿得之。
石顽（作者自称）治疗文学褚廷嘉精脱气伤，喘汗蒸热如淋，六脉浮芤，按之乏力，势不得不从事温补。遂猛进黄芪建中，易桂心加人参，数帖而安。因有香港脚痼疾，恒服肾气丸不彻，六七年来，宿患未除，坚恳石顽铲绝病根。乃汇取术附、桂附、附子、参附等法，兼采八风散中菊花，鳖甲汤中鳖甲、贝齿、羚羊、犀角，风引汤中独活、防己，竹沥汤中姜汁、竹沥为丸。共襄祛风逐湿之功。服后必蒸蒸汗出，不终剂而数年之疾顿愈。非深达法存千金妙义，乌能及此。
The *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold) discusses: Why does this disease occur in the feet? A question is raised: Wind-toxin invades the human body and can cause illness anywhere, why does it specifically concentrate on the feet? The answer is: Humans have five zang organs. The meridians of the Heart and Lung originate in the ten fingers of the hands; the meridians of the Liver, Kidney, and Spleen originate in the ten toes of the feet. The qi of wind-toxin arises from the ground. The cold, heat, wind, and dampness of the ground all transform into vapor. The feet constantly tread upon the ground, so when wind-toxin invades the human body, it must first strike the feet. If left untreated for a long time, it will spread to the four limbs, abdomen, back, head, and neck. When the condition is mild, one does not feel discomfort; only when the pathogen becomes entrenched and stagnant does one realize it. As stated in the medical classics: this follows the principles of "sequential transmission" (Ci Zhuan) and "intermittent transmission" (Jian Zhuan).
Regarding whether one feels the onset immediately: All cases of Hongxiang Jiao (Hongxiang Foot / Beriberi) are caused by contracting wind-toxin. Upon contracting this disease, one usually does not feel it immediately. It often triggers after another illness occurs. Or one may suddenly feel extreme oppression and stuffiness, unable to get out of bed for two or three days, before realizing it. Many mediocre physicians do not recognize this disease and arbitrarily treat it as other illnesses, resulting invariably in death. Therefore, this disease is rarely recognized by people. Initially, the symptoms are very subtle; diet, play, and strength remain normal. The only anomaly is that upon suddenly standing up, the feet are flexed, weak, and immobile. Huang Di said: This is called "Huan Feng Shi Bi" (Lax Wind-Damp Bi Syndrome).
Regarding the external manifestations of wind-toxin: In some cases, the feet feel no abnormality, but the head, neck, arms, and elbows already suffer pain. In others, the whole body feels fine, but the heart, abdomen, and internal organs feel distressed. Furthermore, when wind-toxin invades the human body, some may vomit at the sight of food or detest the smell of food; some may experience abdominal pain and diarrhea; some may have constipation of both stool and urine; some may feel palpitations and rushing sensations in the chest, avoiding bright light; some may suffer from mental confusion and drowsiness, delirium, and disordered speech; some may have high fever and headache; some may feel extreme cold with painful irritability; some may feel muscle twitching; some may swell, while others do not; some may have numb legs; some may occasionally feel flaccid and unresponsive; some may experience generalized joint spasms and tightness; some may have insensitivity in the lower abdomen. These are all manifestations of Hongxiang Jiao. They are also referred to as signs of Wind-Toxin Hongxiang Jiao. These signs are difficult to discern and require careful observation; otherwise, one will surely miss the key to treatment. Once the disease is established, it cannot be explained by ordinary logic. Women are subject to this as well. Additionally, women after childbirth who seek coolness in spring and summer are often afflicted by this toxin and should exercise great caution. Symptoms such as heat-induced oppression, pulling sensations, palpitations, irritability, vomiting, and rebellious qi are all signs. Also, if one feels cold stagnation below the umbilicus, a sense of dissatisfaction, accompanied by dribbling urination, which differs from one's usual state, these are signs of Hongxiang Jiao. Flaccid weakness is named "Huan Feng" (Lax Wind), and pain is named "Shi Bi" (Damp Bi).
Regarding the causes of contraction: Throughout the four seasons, one should not stand or sit for long periods in damp and cold places. One should not remove clothes, shoes, or socks to cool off in the wind while drunk and sweating. All these actions can lead to Hongxiang Jiao. If one sits or stands for a long time in wetlands during hot months, the qi of damp-heat will steam into the meridians. Upon onset, there will be fever, soreness, pain, and irritability in the four limbs. If one sits or stands for a long time in damp-cold places during cold months, the qi of cold-dampness will enter the meridians. Upon onset, the four limbs will be extremely cold with tetany. If contracted by cooling off in the wind, the skin and flesh will become numb, with twitching in various areas gradually moving toward the head. On ordinary days, when sudden intense heat makes people unbearable, one might seek relief by rapidly exposing oneself to cold. However, if one encounters sudden severe cold and cannot endure it, illness will result. There are scholars who work diligently and focus entirely on their tasks, sitting or standing for long periods in wet places without moving frequently. When cold wind strikes and enters the meridians, they unknowingly develop the disease. Thus, wind-toxin invading the human body may first strike the ten fingers of the hands and feet because the hair pores are open and the cou-li (interstices) are loose, allowing wind to strike like an urgent arrow. It may first strike the sole of the foot, the dorsum of the foot, or the interior and exterior of the area below the knees. If one feels discomfort initially, moxibustion applied to the affected area for 20–30 moxa cones will cure it, preventing recurrence. Huang Di said: Cooling off in the wind and engaging in sexual activity after drinking can cause this disease.
Regarding differences between cold and heat types: A question is asked: Why do some patients present with cold syndromes and others with heat syndromes? The answer is: The feet contain three Yin and three Yang meridians. Cold striking the Yang meridians results in cold syndromes; heat/striking the Yin meridians results in heat syndromes. Therefore, there are differences in exterior/interior and cold/heat. Heat syndromes are treated with cold medicines; cold syndromes are treated with hot medicines, adjusting according to judgment. If the Spleen receives Yang toxin, it becomes a hot, numb Bi syndrome; if the Kidney receives Yin dampness, it becomes a cold Bi syndrome.
Regarding the urgency of treatment: Whenever one senses even slight abnormalities in symptoms, one must be greatly alarmed and resolve to treat it urgently, without delay. If qi rebels into the abdomen, swelling or non-swelling occurs, chest and hypochondrium feel full and rebellious, and qi rushes to the shoulder causing shortness of breath, the acute case will die instantly, and the less acute case will die within days. Urgent treatment is essential. Signs of impending death include urgency in the epigastrium, continuous panting, frequent spontaneous sweating, alternating chills and fever, a rapid, short, and hurried pulse, and incessant vomiting.
Regarding deficiency/excess and the necessity of taking decoctions: All Hongxiang Jiao diseases result in death due to excess qi; never has anyone died from becoming deficient due to medication. Therefore, patients with Hongxiang Jiao should not receive heavy tonification, nor heavy purgation. One must not fear deficiency and stop taking decoctions. Those who do so face untreatable death.
Regarding pulse diagnosis: Although Hongxiang Jiao presents differently, the diagnostic principles are consistent. Pulses in the three positions must conform to the four seasons to be auspicious. Pulses contrary to the four seasons indicate untreatable conditions. Other details follow the *Mai Jing* (Pulse Classic) and are not repeated here. Patients who are naturally dark-skinned and thin are easier to cure; those who are fat, fleshy, with red or white complexions are difficult to cure. Dark-skinned individuals tolerate wind and dampness; red/white complexions do not tolerate wind and cold. Thin individuals have firm flesh; fat individuals have soft flesh. Soft flesh allows disease to penetrate deeply, making it hard to cure.
Regarding swelling or lack thereof: People suffering from chronic Hongxiang Jiao often do not distinguish it. Later, triggered by another illness, after treatment improves, direct vomiting and foot weakness occur. I diagnosed him as Hongxiang Jiao. The patient said: "I have never had swollen feet; why is this called Hongxiang Jiao?" He refused decoctions. I mistakenly diagnosed it as "Shi Fa" (Stone Eruption/Skin Disease). Within ten days of his hesitation, he died. Thus, Hongxiang Jiao cannot always be identified by swelling. Some swell, some do not. Cases with numbness/insensitivity in the lower abdomen often have non-swollen feet. After numbness in the lower abdomen, vomiting occurs within 3–5 days; this is named "Hongxiang Jiao entering the Heart." Such cases die soon. Hongxiang Jiao reaching the Heart is difficult to treat because Kidney Water overcomes Heart Fire.
Regarding precautions and negligence: Hongxiang Jiao requires strict abstinence from sexual intercourse. Mutton, beef, fish, garlic, Houttuynia, Chinese cabbage, turnip, bottle gourd, alcohol, wheat noodles, butter, milk porridge, pork, chicken, goose, duck, etc., are strictly forbidden, except carp heads used in specific formulas. Anger must also be avoided. Only rice, sorghum, millet, soy sauce, fermented bean curd, scallions, leeks, wild garlic, pepper, ginger, and tangerine peel are suitable. Raw fruits and sour/vinegar foods must be avoided, or recovery is impossible. Raw cow's milk and raw chestnuts are highly recommended.
Regarding moxibustion method: For early-stage Hongxiang Jiao with foot weakness, apply moxibustion quickly and take Zhu Li Tang (Bamboo Juice Decoction). After moxibustion, take Ba Feng San (Eight Winds Powder). Recovery is assured if treated urgently. Those who only use moxibustion without powder, or powder without moxibustion, will be half-cured, half-dead. Even if cured, relapse may occur in 1–2 years. Upon sensing recurrence, immediate moxibustion and powder administration yields 100% success. Though mild cases may not kill immediately, improper treatment leaving the root causes leads to death eventually. Begin by moxibusting Fengshi (GB31) with 100 cones, or 500–600 for severe cases. Do not apply all at once; divide into three sessions. Next, moxibustiate Futu (ST32) with 100 cones (or 50). Next, Dubi (ST35) with 50–100 cones. Next, Xiyan (EX-LE5) with 100 cones. Next, Zusanli (ST36) with 100 cones. Next, Shanglianxu (ST37) with 100 cones. Next, Xialianxu (ST38) with 100 cones. Next, Yangjiao (GB39) with 100 cones. These points need not be exhausted in one session; daily application over three days to complete the count is ideal. Treat one foot if one is affected, both if both are. Another method suggests moxibusting Zusanli and Yangjiao on each affected foot (four points total) based on severity. Even for mild cases, do not reduce below 100 cones. If ineffective, proceed to subsequent points.
Regarding classification of herbal decoctions: Wind-toxin entering the body presents three pulse categories, with similar external/internal signs but distinct pulses. If the pulse is floating, large, and slow, Xuming Tang (Continuing Life Decoction) is indicated; two doses should cure. If wind is dominant, Yueshi Tang (Dispersing the Mason Decoction) plus 4 liang of Baizhu (Atractylodis Rhizoma) is indicated. Hu Qia adds Fuzi (Aconiti Lateralis Radix Praeparata) if aversion to wind exists. If the pulse is floating, large, tight, and rapid, Zhu Li Tang (Bamboo Juice Decoction) is indicated. If the pulse is faint and weak, Fengyin Tang (Wind-Guiding Decoction) is indicated, often due to deficiency. If severely deficient with shortness of breath and fatigue, tonic decoctions adjusted for cold/heat may be used. If unresolved, resume Zhu Li Tang. If the pulse is floating, large, tight, and rapid, this is the worst pulse category. A deep, fine, and rapid pulse is equally ominous. Floating/large indicates exterior disease; deep/fine indicates interior disease. Treatment requires careful deduction. Even if appearance is okay, if qi rebels upward within days leading to death, this pulse is fatal. Emergency administration of Zhu Li Tang, one dose daily, ensuring continuous intake without gaps, is crucial. Bamboo juice must be taken hot; cold juice stagnates in the chest/heart causing harm. If Zhu Li Tang induces downward movement, it is excellent. Xuming Tang treats early wind-toxin resembling epidemic toxicity with floating/slow pulses that do not become rapid; this is untreatable, leading to death in days. Symptoms include confusion, jaundice, macules, red eyes, or ulceration of the lower body—these are emergencies. Administer Xuming Tang immediately, followed by Gegen Mahuang Tang (Pueraria and Ephedra Decoction) to purge. If ineffective, more Xuming Tang will cure. Hongxiang Jiao originated in Lingnan, spreading to Jiangdong. Onset is gradual: slight pain/numbness, swollen shins, stiff/weak gait, abdominal numbness, alternating cold/heat, urinary difficulty, wheezing with qi rushing to the throat, suffocation sensation, vomiting, rebellious qi. If these signs appear, administer Xijiao Xuanfuhua Tang (Rhinoceros Horn and Inula Flower Decoction) for prolonged use until qi descends and urination clears.
According to Dong Yuan: Hongxiang Jiao is indeed caused by water-dampness, arising from two sources. In the south, low and damp terrain allows clear dampness to invade deficiency, starting from below (external contraction). In the north, consumption of mutton/dairy and excessive alcohol damages the Spleen/Stomach, impairing transformation and transportation, causing water-dampness to flow downward (internal origin leading to external manifestation). Swollen shins indicate obstruction; treatment requires draining. Over-draining harms the Spleen; under-draining fails to remove disease. Southerners often have thick legs aging with the disease. Initial treatment uses Binglang Tang (Areca Seed Decoction), Siqi Tang (Four Seven Decoction), or Xiangsu San (Fragrant Perilla Powder), adding Binglang and Chenpi to circulate qi and prevent obstruction. If obstruction is established, bloodletting with Bian stones removes evil blood before administering medicine. As stated: accumulation causes swelling and heat, treated with Bian stones.
Hongxiang Jiao begins subtly with normal diet and unnoticed symptoms, suddenly presenting with weak/flexed knees, swelling or non-swelling, numbness, flaccidity, or spasms—all caused by dampness. Swelling indicates Damp Hongxiang Jiao; non-swelling indicates Dry Hongxiang Jiao. Outbreaks involve significant body pain and fever, resembling Taiyang disease (Shanghan); do not misuse Shanghan medications. If sudden foot weakness, lower abdominal numbness, tetany/vomiting, abdominal pain/diarrhea, constipation, palpitations/delirium, or red/swollen shins occur, treat as Hongxiang Jiao. Wind dominance: spontaneous sweating, wandering pain, floating/string-taut pulse → Yueshi Jia Zhu Tang. Cold dominance: no sweating, spasms/pain, slow/fine pulse → Jiujin Niuxi Wan (Wine-Soaked Achyranthes Pill). Damp dominance: swelling/heaviness, slow/fine pulse → Chushi Tang (Dampness-Removing Decoction). Cold-Bi with aversion to wind: requires Baizhu, Fuzi, and Mahuang together; Yueshi Jia Zhu Fu Tang to induce sweat, or Mahuang Fuzi Xixin Tang plus Guizhi and Baizhu. Cold-numb painful feet, intermittent heat, inability to flex/extend → Qianjin Duhuo Tang. Wind-cold foot Bi pain, spastic weakness → Qianjin Wutou Tang. Summer-heat dominance: irritability/thirst/fever, vesicles, surging pulse → Qingzao Tang. Headache/fever/joint pain, unilateral weakness resembling hemiplegia → Xiao Xuming Tang plus Mugua. Three Yang meridians receiving heat/toxin flowing to ankles: red/swollen/painful, chills/fever like malaria, sweating/aversion to wind or no sweating/cold aversion → Baidu San plus Cangzhu. Three Yin meridians receiving cold/damp settling on knees/shins: emaciated/pale complexion, lower abdominal numbness, abdominal urgency/pain, upper asthma → Liuwei Wan (Eight Ingredient Pill) plus Chenxiang. Hongxiang Jiao entering abdomen, abdominal urgency rushing to chest, near-death qi → Qianjin Banxia Tang. Hongxiang Jiao rushing to Heart, pain/swelling, constipation → Chenxiang Daoqi Tang. Generalized swelling/pain, panting/oppression → Mutong San. Urinary retention due to excessive tonification for Hongxiang Jiao → Jiangzhi Chao Heishanzhi, Mutong, Chishao, Chifuling, Danggui, Sheng Gancao Shao, decocted intermittently. Early foot qi with whole-body pain/joint swelling, urinary/fecal blockage (Damp-Heat) → Qianghuo Daozhi Tang initially, then Danggui Niantong Tang later. Hongxiang Jiao entering lower abdomen numbness → Cui Shi Liuwei Wan. Hongxiang Jiao entering abdomen, asthma/bloating → Suzi Jiangqi Tang assisted with Yangzheng Dan. Hongxiang Jiao pressing on Lungs causing cough/wheeze → Xiao Qinglong Tang plus Binglang. Hongxiang Jiao vomiting/nausea/appetite loss → Shengliao Pingwei San plus Muxiang; add Weida Huang for constipation. Wind-toxin sores/swelling/mental heat → Xijiao San. Hongxiang Jiao rushing to Heart, fire rebelling upward → Jinlingzi San plus Huixiang and Jiu Huangbai; apply Fuzi powder mixed with saliva to Yongquan (KI1). Early Hongxiang Jiao swelling/pain from foot to knee/shin → Qianjin Castor Leaf Wrap Method. Foot qi injecting into ankle forming ulcers, worsening pain in afternoon (Hongxiang Jiao turning into fistula) → Apply calcined Renzhongbai to wound. Hongxiang Jiao rushing to Heart → Alum 1 liang, Fermented Rice Water 1.5 dou, boil briefly, soak feet. *Liuren Shu* states: Taking tonics or washing with decoctions for Hongxiang Jiao forces pathogens into meridians—a major medical prohibition. Generally, Hongxiang Jiao swelling/pain belongs to Damp-Heat, possibly combined with Wind or Summer-heat; treat according to Six Evils in Spring/Summer. Emaciation with heat indicates Yin deficiency; weakness with cold indicates Yang deficiency; treat as primary syndromes.
[Diagnosis] Floating/string-taut pulse originates from Wind; soggy/weak from Damp; surging/rapid from Heat; slow/fine from Cold. Deep and hidden indicates toxin in sinews/bones. Rough/irregular pulse under fingers indicates toxin in Blood level. Summer heat with cold/pain in knees/shins, Yang pulse soggy/Yin pulse weak indicates Damp-Warmth. Hongxiang Jiao mostly contracts from Summer-Heat/Dampness.
Shiwan (author's pseudonym) treated Scholar Chu Tingjia for Qi depletion injury, presenting with panting, sweating, steaming heat resembling strangury, six pulses floating and hollow (Kou), weak upon pressure. Warm tonification was necessary. He aggressively administered Huangqi Jianzhong Tang, substituting Rouguizhi with Renshen. Several doses brought peace. Due to chronic Hongxiang Jiao, he had been taking Shenqi Wan incompletely for six-seven years without removing the root cause. He earnestly requested Shiwan to eradicate the disease. Shiwan combined methods of Zhufu, GuiFu, Fuzi, and Shenfu, incorporating Ju Hua from Ba Feng San, Biejia, Beichi, Lingyang, and Xijiao from Biejia Tang, Duhuo and Fangji from Fengyin Tang, and Jiangzhi and Zhuli from Zhu Li Tang, processed into pills. Together they aided in dispelling wind and driving out dampness. After ingestion, profuse sweating occurred, and the multi-year disease was cured before the course finished. Without profound understanding of the subtle meanings preserved in Qianjin, how could one achieve this?