发明曰夫香港脚之疾实水湿之所为也盖湿之害人皮肉筋脉而属于下然亦有二焉一则自外而
感一
则自内而致其治法自应不同故详析而论之其为病也有证而无名香港脚之称自晋苏敬始而关中河
朔无有也惟南方地下水寒其清湿之气中于人必自足始故经曰清湿袭虚则病起于下或者难曰今
兹北方其地则风土高寒其人则腠理致密而复多此疾者岂是地之湿气感之而为邪答曰南方之疾
自外而感者也北方之疾自内而致者也(二论见前)其自外而入者止于下胫肿而痛自内而致者乃
或至于手节也经曰足胫肿曰水太阴所至为 肿此但言其自外者也所治之法前人方论备矣自内
而致者治法则未有也
谨按前论南北二方香港脚之由己颇详尽而发明更具此者大抵言是证主于水湿而成故重宣此
义合前二论之旨也自内致者古无其法然观东垣所出数方则意例兼备之矣
发明曰内经论南方者其地下水土弱雾露之所聚也汇东岭南大率如此春夏之交山川蒸菀风
湿毒
气为甚足或感之遂成瘴毒香港脚其候则脚先屈弱渐至痹疼胫微肿小腹不仁头痛烦心痰壅逆脯作
寒热便溲不通甚者攻心而势迫治之诚不可缓支法存所以留意经方偏善此术者岂非江东岭表此
疾得之多欤
谨按南方温热多阴雨土湿之气因热蒸菀人肤腠故疏豁体虚者多感此疾及有远行足热乃过
溪涧
为水寒所伤而致者至其传变为证不一况瘴毒乎然近江东证多主于水湿亦有夹风夹寒者其发时
则或肿或痛湿热胜者成水泡疮或成赤肿丹毒或如疝气攻上引下皆宜详悉分治
【发明】
香港脚这一疾病，实际上是由水湿邪气引起的。湿气侵害人体，损伤皮肉筋脉，且病位多在下部。然而，致病原因主要有两种：一种是从外部感受邪气，另一种是从内部产生。因此，它们的治疗方法应当不同，所以详细分析并论述如下。
这种病症有症状表现却没有专门的病名，“香港脚”这一称呼始于晋代的苏敬。在关中、河朔地区（北方）并没有这种病，只有在南方，由于地下水寒冷，清冷潮湿之气侵入人体，必定从足部开始。所以《内经》说：“清湿之邪侵袭虚处，疾病便起于下部。”有人质疑说：“如今北方地区，地势高寒，人的腠理致密，却也有很多人患此病，这难道不是地里的湿气感之为邪吗？”回答说：“南方的疾病是从外部感受邪气所致；北方的疾病则是从内部产生所致。（关于南北两论的详细解释见前文。）”
从外部侵入的，病变仅局限于小腿，出现肿胀和疼痛；从内部产生的，甚至可能波及手部关节。《内经》说：“足胫肿胀称为水病，这是太阴脾经病变导致的肿胀。”这里只讲了从外部感受的情况。前人对于治疗方法的方论已经非常完备了，但对于从内部产生的病症，治疗方法则尚未确立。
我谨按前文对南北两地香港脚成因的论述已经相当详尽，而这里的“发明”部分更是着重阐明了此证主要由水湿形成的观点，综合了前两篇论述的主旨。对于从内部产生的病症，古代没有现成的治法，但观察李东垣所提出的几个方剂，其意例已经具备。
【发明】
《内经》论述南方地区时提到，那里地势低洼，水土薄弱，是雾露聚集的地方。江东、岭南地区大体也是如此。在春夏之交，山川之间湿热蒸腾，风湿毒气盛行。如果足部受到感染，就会形成瘴毒型香港脚。其症状表现为脚先变得屈伸无力，逐渐发展到麻木疼痛，小腿轻微肿胀，小腹感觉迟钝，头痛，心烦，痰多气逆，胸部忽冷忽热，大小便不通畅。严重时毒气攻心，病情危急，治疗确实不可迟缓。支法存之所以留意经方，特别擅长治疗此术，岂不是因为江东、岭表地区此类疾病多发吗？
我谨按：南方气候温热，多阴雨，土中湿气因热气蒸腾而弥漫，导致人体肤腠疏松，体质虚弱者容易感染此疾。此外，还有长途跋涉后足部发热，经过溪涧时被水寒之气所伤而致病的。至于其传变形成的证候不一，更何况是瘴毒呢？然而近来的江东病例，大多以水湿为主，也有夹杂风邪或寒邪的。发作时，或者肿胀，或者疼痛；湿热偏胜的，形成水泡疮，或者变成赤肿丹毒；或者像疝气一样攻冲上下。这些都应当详细辨别，分别治疗。
[Innovation]
The disease of Hongxiangjiao (Hong Kong foot / Gouty arthritis) is essentially caused by water-dampness. Dampness harms the human body, damaging the skin, flesh, sinews, and vessels, and its pathology predominantly resides in the lower part. However, there are two origins: one is contracted from the exterior, and the other arises from the interior. Therefore, their treatment methods should differ; thus, a detailed analysis follows.
This condition presents with symptoms but lacks a specific disease name. The term "Hongxiangjiao" originated with Su Jing during the Jin Dynasty. It was absent in the Guanzhong and Heshuo regions (the North). It only exists in the South, where underground water is cold. The clear-cold damp qi invades the human body, necessarily starting from the feet. Hence, the *Classic* states: "When clear-cold dampness attacks deficiency, illness arises from below." Some may object: "Currently, in the Northern regions, although the terrain is high and cold, and people's couli (pores/skin texture) are dense, many still suffer from this disease. Is it not due to local dampness acting as an evil pathogen?" The answer is: Southern diseases are contracted from the exterior; Northern diseases arise from the interior. (Detailed discussions on the North and South are found in previous sections.)
Exterior invasion results in swelling and pain limited to the lower legs. Interior origin may extend to the hand joints. The *Classic* states: "Swelling of the feet and shins is termed Water disease; swelling occurring at the Taiyin [Spleen] stage." This refers only to the exterior contraction. Predecessors have provided ample formulas and theories for treatment, but methods for interior-origin cases remain undefined.
Upon review, the previous discussion on the causes of Hongxiangjiao in both North and South is quite comprehensive. The present "Innovation" further emphasizes that this syndrome is primarily formed by water-dampness, synthesizing the主旨 (main themes) of the preceding two discussions. Although ancient texts lacked methods for interior-origin cases, observing several formulas proposed by Li Dongyuan reveals that their principles and examples are already well-established.
[Innovation]
The *Neijing* describes southern regions as having low terrain, weak earth and water qualities, and being gathering places for fog and dew. The Jiangdong and Lingnan areas are largely similar. During the transition between spring and summer, heat and moisture vaporize in mountains and rivers, making wind-damp toxic qi prevalent. If the feet are affected, miasma-toxic Hongxiangjiao forms. Its manifestations include initial weakness and flexion difficulty of the feet, progressing to numbness and pain, slight swelling of the shins, insensitivity of the lower abdomen, headache, vexation, phlegm obstruction with counterflow, alternating chills and fever in the chest, and obstruction of urination and defecation. In severe cases, the toxin attacks the heart, creating an urgent situation requiring immediate treatment. Zhifacun paid attention to classical formulas and excelled in treating this technique, likely because such diseases were more common in Jiangdong and Lingnan regions.
Upon review: Southern climates are warm and humid with frequent rain. Earth dampness, steamed by heat, permeates the skin and couli. Those with loose couli and deficient constitutions are prone to infection. Additionally, long-distance travelers whose feet become hot may be injured by cold water when crossing streams. The resulting transformations vary, let alone miasma-toxin cases. Recent cases in Jiangdong are mostly dominated by water-dampness, sometimes complicated by wind or cold. At onset, there may be swelling or pain. When damp-heat prevails, blistering sores form, or red swelling resembling erysipelas occurs. Alternatively, it may act like hernia qi attacking upwards and downwards. All these require detailed differentiation and separate treatments.