大意
伤于湿者。下先受之。（经文）故香港脚之疾。实水湿所为也。（发明） 然有挟痰挟火气虚血虚之不同。（汇补）
内因
由脾肾虚弱。劳碌犯房。为风寒暑湿所侵。或乳酪醇酒。饮食浓味。损伤脾胃。湿热下注肾肝而成。（医鉴）
外候
初起其势甚微。惟先从气冲穴隐核痛起。及两足屈弱。转筋掣急。或缓纵不随。或膝膑枯槁。或足胫红肿。
其上升也。小腹不仁。心烦胸闷。痰壅气逆。闻食即呕。或泻或闭。胸中忡悸。不欲见光。错乱妄语。精神昏愦。
恶寒发热。头疼身痛。状若伤寒。但初起必先足胫掀赤红肿。膝膑软弱顽麻为异。平复之后。或一旬或半
月。复作如故。足胫肿大。脚如虫行。上走腰背心腹。（汇补）
病分南北
北方地高。陵居土燥。多酒面 酪。湿从内生。南方地卑。川泽土润。多山岚瘴气。邪从外感。然北方虽无卑
地。亦有践雨冒露之外显。南方纵无 酪。亦有鱼腥瓜果之内湿。可见内外之湿。南北俱有。宜随症而辨。
不可以地限之也。（汇补）
病分干湿
湿香港脚者。筋脉弛而浮肿。或生 疮之类。但肿重而不上升。此属湿胜。宜利湿疏风。干香港脚者。筋脉蜷缩。
枯细不肿。因他病而发。有时上冲。此以热胜。宜凉血清火。（汇补）
病分寒热
感湿热而发。必四肢俱热。感寒湿而发。必四肢俱寒。（汇补）
人分肥瘦
肥人多湿痰生热。瘦人多血虚有火。必先有内因。然后邪从外入。故化痰清热。因人而施。（汇补）
病分表里
湿热上干三阳。则寒热头痛。呕恶不食。身痛且重。湿热流注三阴。则胸满怔忡。遍身转筋。二便闭涩。（入门）
脉症总辨
自汗走注。脉浮弦为风胜。无汗挛急。脉沉涩为寒胜。肿满重着。脉濡细为湿胜。烦渴便赤。脉洪数为暑胜。
膏粱之火下乘者。顽痹不仁。脉沉有力。肾肝之阴不充者。软缓少力。脉亦空虚。（三因方）
香港脚死症
凡香港脚致上攻胸膈。呕吐不止。喘急抬肩。自汗淋漓。乍寒乍热。脉短促者死。入心则兼恍惚谬妄。眠卧不
安。小腹痹胀。左寸乍大乍小乍有乍无者死。入肾则腰脚皆肿。小便不通。呻吟额黑。气冲胸满。左尺绝者
死。若见症虽危。脉未绝者。宜分虚实救之。虚者四物汤加黄柏。以附子末津调涂涌泉穴。若气实者。用五
子五皮散、薏苡仁散。或用槟榔末三钱童便调下。如上气喘促。初起有表邪者。疏散之。小青龙汤加槟榔。
实者五子五皮饮。或用苏叶、桑皮、前胡、杏仁、生姜。若已经攻泄分利。致不得眠。及上气喘促者。属虚。八味
汤大剂冷服。脾胃虚者。参、术补之。初起攻胃呕逆。二陈平胃汤加木瓜。小便不通。实者五苓加木瓜。虚者
八味丸加车前、牛膝。（汇补）
香港脚病戒
恚怒则烦心。大语则伤肺。纵欲则伤肾。醉饱则伤脾。犯之均使病发。古称壅疾。宜疏通气道为先。凡甘湿
补剂。及药汤淋洗。恐邪入经络。皆在所禁。（汇补）
治分诸症
湿多宜利湿。热多宜清热。上升者兼降。下陷者兼升。表症兼发散。里症兼攻下。不可太过。亦不可不及。太
过则损脾。不及则病不去。（汇补）
用药
香港脚俱属湿热。初宜辛凉发散。继宜分利二便。与湿同治。用二术以祛湿。知、柏、芩、栀以清热。归、芍以调血。
木瓜、槟榔以行气。羌独活以利关节。兼散风湿。木通、防己、牛膝以引药下行。且消肿除湿。气虚肥白者。用
养气。瘦人血燥者。用滋阴。若湿痰湿热瘀血。壅滞经络者。非肉桂、草乌、附子辛温。不能开结行经。但不可
单用多用。须以黄柏辛凉佐之可耳。大率气在下。用苍术、防风、升麻、羌活。以提其湿。冲上。用黄柏、独活、防
己、木瓜。以降其热。赤肿为血热。用赤芍、苦参、黄芩、萆 清之。黄白为寒湿。用干姜、肉桂、浓朴、苍术温之。实热便闭者。大黄、槟榔微下之。食积下注者。神曲、麦芽、苍术、半夏消之。脾虚滑泄。山药、苡仁补之。至于表症
宜汗。麻黄左经汤。里症宜下。泽泻散。表里双解。大黄左经汤。理气。大腹皮散。调血。薏苡仁酒。入肾欲死。牛
膝散加大黄救之。入心欲死。八味丸救之。外用附子末。津调涂涌泉穴。引势下行。故治分先后。不可初起
遽补。久虚反攻。以致实实虚虚。
【附湿火】
有肾火挟湿。溢于皮肉。红肿如云痕在足胫之间。按之热且痛者。湿火也。甚则红势自足而起。渐行至股
上。而入腹升心者不治。宜预防之。二妙丸。有外感瘟疫症患脚痛者。俗呼绝足伤寒。（汇补）
【附附骨疽】
环跳穴（在胯眼） 及腿根彻痛不已。外皮如故。脉沉数滑者。防生附骨疽。乃毒瓦斯着骨。人多误为湿热。及至脓
成。气血大亏。已不可救。不知鹤膝风与附骨疽。惟肾虚者多患之。因真气虚弱。邪得深入。若真气壮实。外
邪焉能为害。前人用附子以温肾。又能行药势散寒邪也。亦有体虚之人。夏秋露卧。为冷气所袭。寒热伏
结。多成此症。不能转动。乍寒乍热而无汗。按之痛应骨者是也。若经久不消。阴极生阳。寒化为热。则为脓
溃。若被贼风所伤。患处不甚热而洒淅恶寒。不时汗出。熨之痛少止。须大防风汤及火龙膏贴之。设用寒
凉。必成废疾。或挛曲偏枯。或痿弱不起。坚硬如石为石疽。皮肉俱腐为缓疽。大抵下部道远。非桂、附不能
直达。况肾主骨。而臀以下俱属肾。舍桂、附不可。（薛氏）
【附脚心痛】
脚心痛多属虚劳。不可用克药。宜大圣散补养气血。
香港脚选方
大圣散
川芎 当归 人参 黄 麦冬 炙甘草 茯苓 木香
入木瓜末一钱。酒调服。仍用草乌、川椒、白芷煎汤洗。
麻黄左经汤 治香港脚初起。有表症。可发散者。
麻黄 干葛 细辛 苍术 茯苓 防己
桂枝 羌活 防风 甘草
加味泽泻汤 治香港脚传里。有实症。可攻者。
泽泻 赤苓（中） 枳壳 木通（上） 猪苓 槟榔 牵牛
加赤芍、陈皮。 水煎。
大黄左经汤 治香港脚兼表里者。
大黄 细辛 茯苓 防己 羌活 黄芩
前胡 枳壳 浓朴 甘草 杏仁 姜 枣
大腹皮散 治香港脚上冲。胸腹满闷。肢节心烦。
腹皮 苏梗 木通 桑皮 乌药 木瓜
半夏 赤芍 青皮 独活 枳壳 姜 葱
薏苡仁酒 治香港脚虚软无力。时常顽木作痛。
薏仁 牛滕 海桐皮 五加皮 防风 萆
当归 杜仲 白芍 地骨皮 灵仙
牛膝散 治香港脚入肾。小便闷痛。气喘面黑欲绝者。
牛膝（二两） 桂心（八钱） 当归（一两） 朴硝（五钱） 小茴 木瓜（各七钱）
八味丸 治肾气入心。小腹不仁。上冲喘急。呕吐自汗之危症。（方见中风）
大防风汤 健步丸（二方见痿症）
杉木汤 治香港脚入肝。左胁有块。痞塞欲绝者。
杉木节（一升） 橘叶（一升或皮） 槟榔（七枚） 童便（三升）
共煮一升。分二服。得快利。停后服。
二妙丸
苍术 黄柏加牛膝。名潜行散。
火龙膏
生姜（八两取汁） 乳香 没药（各五钱） 麝香（一钱） 牛胶（二两切片）
先将姜汁、牛胶溶化。方下乳香、没药调匀。待少温。下麝香。即成膏矣。
羌活导滞汤 治香港脚初发。一身尽痛。或肢节肿痛。便溺阻隔。先以此汤导之。后用当归拈痛汤。
羌活 独活 防己 归尾 枳实 大黄
当归拈痛汤
当归 白术 苍术 黄芩 羌活 防风
泽泻 猪苓 茵陈 干葛 苦参 人参 知母 升麻 甘草
治湿热香港脚方
紫苏 黄柏 芍药 木瓜 泽泻 木通
枳壳 槟榔 苍术 甘草 香附 羌活 防己
痛。加木香。肿甚。加腹皮。发热。加大黄、黄芩。
简便方 治香港脚上冲。腹胀满闷。
用威灵仙末。酒调下二钱。痛减一分。则药亦减一分，或灸风市肩 曲池三穴。或七壮。或五
十壮。甚验。
又方 用甘遂末。调敷红肿处。内服浓甘草汤。即散。又方用蓖麻叶蒸捣裹之。一日二三易。即消。
洗法
川椒 葱头 生姜
煎汤洗之。单治湿热而成者。
【大意】
被湿邪所伤，湿气首先侵犯下部。（出自经文）所以香港脚（足部肿痛、麻木等症）这种病，实际上是由水湿引起的。（李用粹的发明论述）然而，有的兼夹痰饮，有的兼夹火邪，有的是气虚，有的是血虚，情况各不相同。（《证治汇补》的观点）
【内因】
由于脾肾虚弱，过度劳累或房事不节，导致身体被风寒暑湿等外邪侵袭；或者食用乳酪、烈酒以及味道浓厚的食物，损伤了脾胃，致使湿热下注于肾和肝而发病。（《医鉴》观点）
【外候】
疾病初起时，症状很轻微，只是先从气冲穴出现隐痛的小硬结，接着两腿脚屈伸无力，肌肉痉挛抽搐，或者松弛瘫软不能随意运动，或者膝盖骨干枯萎缩，或者小腿红肿。
如果病势向上发展，会出现小腹感觉迟钝，心烦胸闷，痰多气逆，闻到食物气味就想呕吐，或者腹泻或者便秘，心中悸动不安，不喜欢见光，胡言乱语，精神昏沉糊涂。
伴有怕冷发热，头痛身痛，症状像伤寒。但初起时必须先从小腿掀红肿胀为特征，这与普通伤寒不同之处在于膝盖软弱麻木。病情平复后，过十天或半个月，又像以前一样复发，小腿肿大，脚底感觉像有虫子爬，病气上行至腰背心腹。（《证治汇补》描述）
【病分南北】
北方地势高，居住在山陵地带，土壤干燥，人们多饮酒、面食和乳酪，湿气从体内产生；南方地势低洼，河川沼泽湿润，人们多受山间岚气和瘴气影响，邪气从外部感受。然而北方虽然地势不高，也有踩雨冒露的外在湿气；南方即使没有乳酪，也有鱼腥瓜果导致的内在湿气。可见内外湿气，南北都有，应当根据症状来辨别，不可以用地域来限制。（《证治汇补》观点）
【病分干湿】
湿性香港脚，表现为筋脉弛缓且浮肿，或者生疮之类，但肿胀沉重而不向上蔓延，这属于湿邪偏胜，适宜利湿疏风；干性香港脚，表现为筋脉蜷缩，干枯细小不肿，因其他疾病引发，有时向上冲逆，这属于热邪偏胜，适宜凉血清火。（《证治汇补》观点）
【病分寒热】
感受湿热而发的，必定四肢都发热；感受寒湿而发的，必定四肢都发冷。（《证治汇补》观点）
【人分肥瘦】
肥胖的人多生湿痰化热，消瘦的人多血虚有火。必须先有内因，然后邪气才从外部侵入。所以化痰清热，要根据个人体质施治。（《证治汇补》观点）
【病分表里】
湿热上犯三阳经，则出现寒热往来、头痛、呕吐恶心不想吃饭、身体疼痛且沉重；湿热流注三阴经，则出现胸满心悸、全身抽筋、大小便闭塞不通。（《中医入门》观点）
【脉症总辨】
自汗且疼痛游走不定，脉象浮弦，是风邪偏胜；无汗且肢体拘挛紧急，脉象沉涩，是寒邪偏胜；肿胀沉重着滞，脉象濡细，是湿邪偏胜；烦躁口渴、小便赤黄，脉象洪数，是暑邪偏胜；膏粱厚味之火下行乘袭者，出现顽痹麻木不仁，脉象沉而有力；肾肝之阴不足者，出现肢体软弱无力，脉象也空虚。（《三因方》观点）
【香港脚死症】
凡是香港脚导致病气上攻胸膈，呕吐不止，喘急抬肩，大汗淋漓，忽冷忽热，脉象短促的，主死。病入心则兼见恍惚谵妄，睡眠不安，小腹痹痛胀满，左手寸口脉忽大忽小、忽有忽无的，主死。病入肾则腰脚皆肿，小便不通，呻吟且额头发黑，气冲胸满，左手尺部脉绝的，主死。如果见到症状虽然危急，但脉象未绝的，应当分辨虚实进行救治。虚证的用四物汤加黄柏，用附子粉末以唾液调匀涂敷涌泉穴。若气实者，用五子五皮散、薏苡仁散，或者用槟榔末三钱，童便调服。如果如上气喘促，初起有表邪的，用疏散法，小青龙汤加槟榔。实证用五子五皮饮，或者用苏叶、桑白皮、前胡、杏仁、生姜。如果已经经过攻下泄利治疗，导致无法入睡及上气喘促的，属于虚证，用八味丸大剂量冷服。脾胃虚者，用人参、白术补益。初起攻胃致呕吐逆气的，用二陈平胃汤加木瓜。小便不通，实证用五苓散加木瓜，虚证用八味丸加车前子、牛膝。（《证治汇补》描述）
【香港脚病戒】
愤怒会导致心烦，大声说话会伤肺，纵欲会伤肾，醉饱会伤脾。触犯这些都会使疾病发作，古人称为“壅疾”，应当以疏通气道为先。凡是甘腻滋补的药物，以及药汤淋洗，恐怕邪气深入经络，都在禁忌之列。（《证治汇补》观点）
【治分诸症】
湿多适宜利湿，热多适宜清热，病势上升的兼用降逆，病势下陷的兼用升提，表证兼用发散，里证兼用攻下。不可太过，也不可不及。太过则损伤脾胃，不及则病邪不去。（《证治汇补》观点）
【用药】
香港脚都属于湿热，初起适宜辛凉发散，随后适宜分利二便，与湿同治。用苍术、白术祛湿，知母、黄柏、黄芩、栀子清热，当归、白芍调血，木瓜、槟榔行气，羌活、独活利关节兼散风湿，木通、防己、牛膝引药下行且消肿除湿。气虚体胖色白者，用补气药；瘦人血燥者，用滋阴药。如果是湿痰、湿热、瘀血壅滞经络的，非肉桂、草乌、附子辛温之品不能开结行经，但不可单独多用，须以黄柏辛凉佐制即可。大致而言，病气在下，用苍术、防风、升麻、羌活，以提举湿气；病气冲上，用黄柏、独活、防己、木瓜，以降泄热邪。红肿为血热，用赤芍、苦参、黄芩、萆薢清解；黄白为寒湿，用干姜、肉桂、厚朴、苍术温化。实热便秘者，用大黄、槟榔微下之；食积下注者，用神曲、麦芽、苍术、半夏消导；脾虚滑泄者，用山药、薏苡仁补益。至于表证宜发汗，用麻黄左经汤；里证宜攻下，用泽泻散；表里双解，用大黄左经汤；理气，用大腹皮散；调血，用薏苡仁酒。病入肾欲死者，用牛膝散加大黄救治；病入心欲死者，用八味丸救治。外用附子末，唾液调涂涌泉穴，引病势下行。所以治疗要分先后，不可初起就急于进补，久虚反而攻伐，以致造成实证实虚、虚证实治的错误。
【附湿火】
有肾火挟带湿气，溢出于皮肉之间，红肿如云痕状位于足胫之间，按压时热且痛的，是湿火。严重时红色自足而起，逐渐行至大腿，并进入腹部上冲心脏的，属不治之症，应当预防。可用二妙丸。有外感瘟疫症状患脚痛的，俗称“绝足伤寒”。（《证治汇补》描述）
【附附骨疽】
环跳穴（在胯沟眼处）及腿根彻痛不止，外皮如常，脉象沉数滑的，要防止发生附骨疽。这是毒瓦斯附着于骨骼，人们多误认为是湿热。等到脓成，气血大亏，已不可救。不知道鹤膝风与附骨疽，多是肾虚者患病。因为真气虚弱，邪气得以深入。如果真气壮实，外邪怎么能成为危害？前人用附子以温肾，又能行药势散寒邪。也有体虚之人，夏秋季节露天睡觉，被冷气侵袭，寒热伏结，多形成此症，不能转动，忽冷忽热而无汗，按压时痛连骨骼的就是。如果经久不消，阴极生阳，寒化为热，则为脓溃。如果被贼风所伤，患处不甚热而洒淅恶寒，不时出汗，熨烫后疼痛稍止，须用大防风汤及火龙膏贴敷。如果使用寒凉药物，必成废疾，或者挛曲偏枯，或者痿弱不起。坚硬如石的是石疽，皮肉俱腐的是缓疽。大致下部路途遥远，非桂枝、附子不能直达。况且肾主骨，臀部以下都属于肾，舍去桂枝、附子不可。（薛己观点）
【附脚心痛】
脚心痛多属于虚劳，不可用克伐药物，宜用大圣散补养气血。
【香港脚选方】
大圣散
川芎、当归、人参、黄芪、麦冬、炙甘草、茯苓、木香
加入木瓜末一钱，酒调服。仍用草乌、川椒、白芷煎汤清洗。
麻黄左经汤 治疗香港脚初起，有表证，可发散者。
麻黄、干葛、细辛、苍术、茯苓、防己
桂枝、羌活、防风、甘草
加味泽泻汤 治疗香港脚传变入里，有实证，可攻下者。
泽泻、赤茯苓、枳壳、木通、猪苓、槟榔、牵牛
加赤芍、陈皮，水煎。
大黄左经汤 治疗香港脚兼有表里证者。
大黄、细辛、茯苓、防己、羌活、黄芩
前胡、枳壳、厚朴、甘草、杏仁、生姜、大枣
大腹皮散 治疗香港脚上冲，胸腹满闷，肢节心烦。
大腹皮、苏梗、木通、桑白皮、乌药、木瓜
半夏、赤芍、青皮、独活、枳壳、生姜、葱白
薏苡仁酒 治疗香港脚虚软无力，时常麻木作痛。
薏苡仁、牛膝、海桐皮、五加皮、防风、萆薢
当归、杜仲、白芍、地骨皮、威灵仙
牛膝散 治疗香港脚入肾，小便闷痛，气喘面黑欲死者。
牛膝（二两）、桂心（八钱）、当归（一两）、朴硝（五钱）、小茴香、木瓜（各七钱）
八味丸 治疗肾气入心，小腹不仁，上冲喘急，呕吐自汗的危症。（方剂见中风章节）
杉木汤 治疗香港脚入肝，左胁有肿块，痞塞欲死者。
杉木节（一升）、橘叶（一升或橘皮）、槟榔（七枚）、童便（三升）
共煮取一升，分两次服用，得大便通畅后停服后半剂。
火龙膏
生姜（八两取汁）、乳香、没药（各五钱）、麝香（一钱）、牛皮胶（二两切片）
先将姜汁、牛皮胶溶化，再放入乳香、没药调匀。待稍温，放入麝香，即成膏。
羌活导滞汤 治疗香港脚初发，一身尽痛，或肢节肿痛，大小便阻隔，先用此汤导滞，后用当归拈痛汤。
羌活、独活、防己、当归尾、枳实、大黄
当归拈痛汤
当归、白术、苍术、黄芩、羌活、防风
泽泻、猪苓、茵陈、干葛、苦参、人参、知母、升麻、甘草
治湿热香港脚方
紫苏、黄柏、芍药、木瓜、泽泻、木通
枳壳、槟榔、苍术、甘草、香附、羌活、防己
痛甚，加木香；肿甚，加大腹皮；发热，加大黄、黄芩。
简便方 治疗香港脚上冲，腹胀满闷。
用威灵仙末，酒调下二钱。痛减一分，则药量亦减一分，或者灸风市、肩髃、曲池三穴，每次七壮，或者五十壮，非常有效。
[General Principle]
Injury by dampness: the lower part is affected first. (From the classic text) Therefore, Hong Kong Foot (a disease characterized by swelling, pain, and numbness of the feet) is actually caused by water-dampness. (Li Yongcui's commentary) However, there are differences in cases complicated by phlegm, fire, Qi deficiency, or Blood deficiency. (View from *Zhengzhi Huibu*)
[Internal Causes]
Due to Spleen and Kidney weakness, overexertion, or excessive sexual activity, the body is invaded by Wind, Cold, Summerheat, or Dampness; or consumption of dairy, strong wine, and rich-flavored foods damages the Spleen and Stomach, causing Damp-Heat to sink into the Liver and Kidneys, resulting in the disease. (View from *Yi Jian*)
[External Manifestations]
At the onset, the condition is very mild, starting with a dull pain and a small hard lump at Qichong (ST30), followed by weakness and inability to flex the legs, muscle spasms, or flaccid paralysis. It may present with withered knees, redness and swelling of the calves, or upward progression causing abdominal insensitivity, irritability, chest oppression, phlegm obstruction, air rebellion, nausea upon smelling food, diarrhea or constipation, palpitations, photophobia, delirium, and mental confusion.
It may be accompanied by aversion to cold, fever, headache, and body ache, resembling Taiyang syndrome (Cold Damage). However, the distinguishing feature at onset is redness and swelling of the calves and weak, numb knees. After recovery, it recurs after ten days or half a month, with swollen calves and a sensation of insects crawling on the feet, with pathogenic qi ascending to the waist, back, heart, and abdomen. (Description from *Zhengzhi Huibu*)
[Northern vs. Southern Diseases]
The North has high terrain, dry soil, and people consume much alcohol, wheat products, and dairy, generating internal dampness. The South has low terrain, moist soil, and people are exposed to mountain miasma and pestilential qi, contracting external pathogens. However, even in the North without lowlands, there is external dampness from walking in rain and dew; even in the South without dairy, there is internal dampness from fish, seafood, and fruits. Thus, both internal and external dampness exist in both regions; differentiation must be based on symptoms, not restricted by geography. (View from *Zhengzhi Huibu*)
[Dry vs. Wet Types]
Wet Hong Kong Foot presents with flaccid meridians and edema, or sores, but the swelling is heavy and does not ascend; this belongs to excess Dampness, suitable for promoting urination to drain dampness and dispersing Wind. Dry Hong Kong Foot presents with contracted meridians, dryness, thinness, and no swelling, often arising from other diseases, sometimes ascending; this belongs to excess Heat, suitable for cooling the Blood and clearing Fire. (View from *Zhengzhi Huibu*)
[Cold vs. Heat Types]
Caused by Damp-Heat: limbs are invariably hot. Caused by Cold-Damp: limbs are invariably cold. (View from *Zhengzhi Huibu*)
[Fat vs. Thin Individuals]
Fat individuals tend to generate Phlegm-Damp transforming into Heat; thin individuals tend to have Blood deficiency with Fire. Internal factors must exist first before external pathogens enter. Therefore, resolving Phlegm and clearing Heat should be tailored to the individual. (View from *Zhengzhi Huibu*)
[Exterior vs. Interior]
Damp-Heat affecting the Yang meridians causes alternating chills and fever, headache, nausea, anorexia, body ache, and heaviness. Damp-Heat flowing into the Yin meridians causes chest fullness, palpitations, generalized spasms, and obstruction of urination and defecation. (View from *Zhongyi Rumeng*)
[Pulse and Symptom Differentiation]
Spontaneous sweating and wandering pain with a floating, wiry pulse indicate Wind excess. No sweating and stiffness with a deep, choppy pulse indicate Cold excess. Swelling, fullness, and heaviness with a soggy, fine pulse indicate Dampness excess. Irritability, thirst, and dark urine with a surging, rapid pulse indicate Summerheat excess. Fire from rich diet sinking down causing stubborn bi-syndrome with insensitivity and a deep, forceful pulse indicates excess heat/toxin. Insufficiency of Kidney and Liver Yin causing softness, weakness, and a empty pulse indicates deficiency. (View from *Sanyin Fang*)
[Prognosis of Fatal Cases]
If Hong Kong Foot ascends to attack the chest and diaphragm, with incessant vomiting, panting with shoulder lifting, profuse sweating, alternating chills and fever, and a short, abrupt pulse, death ensues. If entering the Heart, accompanied by恍惚 (mental confusion), delirium, insomnia, abdominal bi-pain and fullness, and a left Cun pulse that fluctuates between large/small and present/absent, death ensues. If entering the Kidney, with swelling of waist and feet, urinary retention, groaning, black forehead, chest fullness from Qi rebellion, and an absent left Chi pulse, death ensues. If symptoms are critical but the pulse remains, differentiate deficiency and excess for rescue. For deficiency, use Siwu Tang (Four Substances Decoction) with Huangbai (Phellodendron Bark); apply Fuzi (Aconite Root) powder mixed with saliva to Yongquan (KI1). For excess Qi, use Wuzi Wupi San (Five Seeds and Five Peels Powder) or Yiyiren San (Coix Seed Powder), or Binglang (Areca Seed) powder taken with child's urine. If panting occurs at onset with exterior pathogens, disperse them using Xiao Qinglong Tang (Minor Blue Dragon Decoction) plus Binglang. For excess patterns, use Wuzi Wupi Yin or Su Ye (Perilla Leaf), Sangpi (Mulberry Bark), Qianhu (Peucedanum Root), Xingren (Apricot Seed), Shengjiang (Fresh Ginger). If previous purgative/diuretic treatments cause insomnia and panting, it is deficiency; use Bawei Wan (Eight-Ingredient Pill) in large doses, taken cold. For Spleen/Stomach deficiency, tonify with Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala Rhizome). For initial stomach attack with vomiting, use Erchen Pingwei Tang (Two-Aged and Stomach-Calming Decoction) plus Mugua (Chaenomeles Fruit). For urinary retention, excess uses Wuling San (Five-Ingredient Powder with Poria) plus Mugua; deficiency uses Bawei Wan plus Cheqianzi (Plantago Seed) and Niuxi (Achyranthes Root). (Description from *Zhengzhi Huibu*)
[Precautions for Hong Kong Foot]
Anger causes heart vexation; loud talking injures the Lung; indulgence in sex injures the Kidney; drunkenness and overeating injure the Spleen. Violating these triggers the disease, historically called "Obstruction Disease." Prioritize unblocking the Qi mechanism. Sweet, cloying, tonifying medicines, and herbal washes are forbidden as they may trap pathogens in the meridians. (View from *Zhengzhi Huibu*)
[Treatment Based on Symptoms]
For excess Dampness, promote urination to drain dampness; for excess Heat, clear Heat; for ascending pathology, combine with descending methods; for sinking pathology, combine with ascending methods; for exterior syndromes, combine with diaphoresis; for interior syndromes, combine with purgation. Do not be too extreme nor insufficient. Too extreme damages the Spleen; insufficient fails to remove the pathogen. (View from *Zhengzhi Huibu*)
[Medication Principles]
Hong Kong Foot generally belongs to Damp-Heat. Initially, use acrid-cool diaphoretics; subsequently, separate and drain the two bowels. Treat with damp-draining herbs like Atractylodes (Zhu Yu) to remove dampness; Zhi Mu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark), Huangqin (Scutellaria Root), and Zhizi (Gardenia Fruit) to clear Heat; Danggui (Angelica Sinensis Root) and Shaoyao (Peony Root) to regulate Blood; Mugua (Chaenomeles Fruit) and Binglang (Areca Seed) to move Qi; Qianghuo (Notopterygium Rhizome) and Duhuo (Angelica Pubescens Root) to benefit joints and disperse Wind-Damp; Mutong (Akebia Stem), Fangji (Stephania Root), and Niuxi (Achyranthes Root) to guide medicine downward, reduce swelling, and drain dampness. For Qi-deficient, fat, pale individuals, use Qi-tonics; for thin, blood-dry individuals, use Yin-nourishers. If Damp-Phlegm, Damp-Heat, or Blood stasis obstructs the meridians, only acrid-warm herbs like Rougui (Cinnamon Bark), Caowu (Aconitum Carmichaelii Lateral Root), and Fuzi (Aconite Root) can open knots and move meridians, but they must not be used alone or in large doses; they must be assisted by Huangbai (Phellodendron Bark) to balance the acrid-cool nature. Generally, for pathology below, use Cangzhu (Atractylodes Lancea Rhizome), Fangfeng (Saposhnikovia Root), Shengma (Cimicifuga Rhizome), and Qianghuo to lift dampness; for pathology ascending, use Huangbai, Duhuo, Fangji, and Mugua to descend Heat. Redness and swelling indicate Blood Heat, treated with Chishao (Red Peony Root), Kushen (Sophora Root), Huangqin, and Bibi (Dioscorea Hypoglauca Rhizome) to clear. Yellowish-white indicates Cold-Damp, treated with Ganjiang (Dried Ginger), Rougui, Houpo (Magnolia Bark), and Cangzhu to warm. Excess Heat with constipation is slightly purged with Dahuang (Rhubarb Root) and Binglang. Food stagnation sinking down is resolved with Shenqu (Massa Fermentata), Maiya (Germinated Hordeum Fruit), Cangzhu, and Banxia (Pinellia Tuber). Spleen deficiency with loose stools is tonified with Shanyao (Dioscorea Rhizome) and Yiyiren (Coix Seed). Exterior syndromes require sweating (Mahuang Zuo Jing Tang); interior syndromes require purging (Zexie San); exterior-interior dual resolution uses Dahuang Zuo Jing Tang; Qi regulation uses Dafupi San; Blood regulation uses Yiyiren Jiu (Coix Seed Wine). For fatal Kidney involvement, use Niuxi San plus Dahuang; for fatal Heart involvement, use Bawei Wan. Topically, apply Fuzi powder with saliva to Yongquan (KI1) to guide pathology downward. Treatment must follow sequence: do not tonify initially, nor purge late deficiency, to avoid exacerbating excess or deficiency.
[Appendix: Damp-Fire]
Kidney Fire carrying Dampness overflowing into skin and flesh causes redness and swelling like cloud marks between the calves. Pressing reveals heat and pain; this is Damp-Fire. If severe, redness starts from the foot, ascends to the thigh, enters the abdomen, and attacks the Heart, it is untreatable; prevention is key. Use Ermiao Wan (Two Marvels Pill). External pestilential fevers causing foot pain are colloquially called "Jue Zu Shang Han" (Absolute Foot Cold Damage). (Description from *Zhengzhi Huibu*)
[Appendix: Gu Abscess]
Throbbing pain from Huantiao (GB30) to the root of the leg, with normal skin surface and deep, rapid, slippery pulse, suggests risk of Gu Abscess (Bone Abscess). This is toxin attaching to bone, often mistaken for Damp-Heat. Once pus forms, Qi and Blood are severely depleted, making it incurable. Note that Crane Knee Wind and Gu Abscess mostly affect those with Kidney deficiency due to weak True Qi allowing deep pathogen invasion. If True Qi is strong, external pathogens cannot harm. Ancients used Fuzi to warm the Kidney and promote drug action to disperse Cold. Also, weak individuals sleeping outdoors in summer/autumn may contract Cold Qi, leading to latent Cold-Heat binding, causing immobility, alternating chills/fever, no sweating, and bone-deep pain on pressure. If unresolved, Yin extreme generates Yang, Cold transforms to Heat, leading to pus rupture. If injured by Thief Wind, with mild heat, aversion to cold, spontaneous sweating, and pain relief with warming, use Da Fangfeng Tang (Great Saposhnikovia Decoction) and Huolong Gao (Fire Dragon Plaster). Using cold/cool herbs will cause disability, deformity, or flaccidity. Hard as stone is Shi Ju (Stone Abscess); rotting flesh is Huan Ju (Slow Abscess). Lower body paths are distant; only Cinnamon and Aconite can reach them. Since Kidney governs bones and the buttocks/lower limbs belong to the Kidney, Cinnamon and Aconite are indispensable. (View from Xue Ji)
[Appendix: Sole Pain]
Sole pain mostly belongs to Deficiency Consumption; do not use attacking drugs. Use Dasheng San (Great Sage Powder) to tonify Qi and Blood.
[Selected Formulas for Hong Kong Foot]
Dasheng San (Great Sage Powder)
Chuanxiong, Danggui, Renshen, Huangqi, Maidong, Zhi Gancao, Fuling, Muxiang
Add Mugua powder (1 qian), take with wine. Wash with decoction of Caowu, Chuanjiao, and Baizhu.
Mahuang Zuo Jing Tang (Ephedra Left Meridian Decoction)
Treats early-stage Hong Kong Foot with exterior syndrome suitable for diaphoresis.
Mahuang, Gange, Xixin, Cangzhu, Fuling, Fangji
Guizhi, Qianghuo, Fangfeng, Gancao
Jiawei Zexie Tang (Modified Alisma Decoction)
Treats Hong Kong Foot transmitting to the interior with excess syndrome suitable for purging.
Zexie, Chifuling, Zhike, Mutong, Zhuling, Binglang, Qianniu
Add Chishao, Chenpi. Decoct in water.
Dahuang Zuo Jing Tang (Rhubarb Left Meridian Decoction)
Treats Hong Kong Foot with both exterior and interior syndromes.
Dahuang, Xixin, Fuling, Fangji, Qianghuo, Huangqin
Qianhu, Zhike, Houpo, Gancao, Xingren, Shengjiang, Dazao
Dafupi San (Greater Abdominal Skin Powder)
Treats Hong Kong Foot ascending with chest/abdominal fullness and limb vexation.
Fupi, Sugeng, Mutong, Sangpi, Wuyao, Mugua
Banxia, Chishao, Qingpi, Duhuo, Zhike, Shengjiang, Congbai
Yiyiren Jiu (Coix Seed Wine)
Treats Hong Kong Foot with weakness and frequent numbness/pain.
Yiren, Niuxi, Haitongpi, Wujia Pi, Fangfeng, Bibi
Danggui, Duzhong, Baishao, Digupi, Lingxian
Niuxi San (Achyranthes Powder)
Treats Hong Kong Foot entering the Kidney with painful urinary difficulty, panting, black face, and impending death.
Niuxi (2 liang), Guixin (8 qian), Danggui (1 liang), Poxiao (5 qian), Xiaohui, Mugua (7 qian each)
Bawei Wan (Eight-Ingredient Pill)
Treats critical Kidney Qi entering the Heart with abdominal insensitivity, ascending panting, vomiting, and sweating. (See Stroke chapter for formula)
Da Fangfeng Tang, Jianbu Wan (See Flaccidity Syndrome chapter)
Shanmu Tang (Fir Wood Decoction)
Treats Hong Kong Foot entering the Liver with left hypochondriac mass and severe obstruction.
Shanjiejie (1 sheng), Jiuye or Jupi (1 sheng), Binglang (7 pieces), Tongbian (3 sheng)
Boil to 1 sheng, divide into two doses. Stop after bowel movement.
Ermiao Wan (Two Marvels Pill)
Cangzhu, Huangbai. Adding Niuxi makes Qianxing San.
Huolong Gao (Fire Dragon Plaster)
Shengjiang juice (8 liang), Rushxiang, Moyao (5 qian each), Shexiang (1 qian), Niu Jiao (2 liang slices)
Melt ginger juice and glue, add frankincense and myrrh, mix. When warm, add musk.
Qianghuo Daozhi Tang (Notopterygium Guiding Stagnation Decoction)
Treats initial Hong Kong Foot with whole-body pain, joint swelling, and urinary/fecal obstruction. Use this first to guide stagnation, then Danggui Nian Tong Tang.
Qianghuo, Duhuo, Fangji, Dangweiqi, Zhishi, Dahuang
Danggui Nian Tong Tang (Angelica Pain-Numbing Decoction)
Danggui, Baizhu, Cangzhu, Huangqin, Qianghuo, Fangfeng
Zexie, Zhuling, Yinchern, Gange, Kushen, Renshen, Zhimu, Shengma, Gancao
Formula for Damp-Heat Hong Kong Foot
Zisu, Huangbai, Shaoyao, Mugua, Zexie, Mutong
Zhike, Binglang, Cangzhu, Gancao, Xiangfu, Qianghuo, Fangji
Pain: add Muxiang. Severe swelling: add Fupi. Fever: add Dahuang, Huangqin.
Simple Formula
Treats Hong Kong Foot ascending with abdominal fullness.
Take Weilingxian powder (2 qian) with wine. Reduce dose as pain subsides. Or moxa Fengshi, Jianyu, Quchi (7 or 50 moxa cones). Very effective.
Another Formula
Apply Gansui powder to red/swollen areas; internally take concentrated Gancao decoction to dissipate. Another method: steam and mash Bi Ma Ye (Castor Leaf), wrap application, change 2-3 times daily until resolved.
Washing Method
Chuanjiao, Congtou, Shengjiang
Decoct and wash. For cases solely caused by Damp-Heat.