唐以上所谓香港脚，即今之香港脚，而宋以降所谓香港脚，盖不过寻常脚痹、脚痛等，而作为香港脚，殆非今之脚
气，岂风会变迁时有不同乎。兹编一以《千金》、《外台》为宗，而于后世诸家，仅摘其要。虽然，又焉知后
来香港脚，更非今日之香港脚耶，医者宜因时措施也已。
名义 江东岭南，土地卑下，风湿之地，易伤于人，初得此病，多从下上，所以脚先屈弱，然后毒瓦斯
循经络，渐入腑脏，腑脏受邪气便喘满，以其病从脚起，故名香港脚。（《病源论》）
此病发，初得先从脚起，因即胫肿，时人号为香港脚，深师云脚弱者，即其义也。（《千金》）
晋宋以前名为缓风，古来无香港脚名，后以病从脚起，初发因肿满，故名香港脚也。又有不肿而缓弱，行卒屈
倒，渐至不仁，毒瓦斯上阴攻心便死，急不旋踵，宽延岁月耳。然则缓风毒瓦斯，得其总称矣。（《外台》引《苏
长史论》）（按《千金》曰∶黄帝云缓风湿痹是也。）
源由 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；肝肾与脾三藏经络所起，在足十指。夫风毒之气皆起于地，地之寒暑风湿皆作蒸气，足当履之，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。
（《千金》）（按∶《三因方》曰∶中风寒暑湿，得之顿而浅；香港脚，得之渐而深。《济生方》曰∶寒暑风湿
皆能致此，非特风毒而已矣。今推真人意，盖寒暑风湿郁蒸伤人，皆名风毒，非别有风毒者。陈严二
说，恐是 牾。《鸡峰方》曰∶香港脚毒湿多风少。）
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，皆成香港脚。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，则冷湿之气上入
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，必不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，久坐久立于湿地，不时动转，冷风来击，入于经络，不觉成病也。故风毒中人，或先
中手足十指，因汗毛孔开，腠理疏通，风如击箭，或先中足心，或先中足趺，或先中膝以下 胫表里。若欲使
人不成病者，初觉，即灸所觉处三二十壮，因此即愈，不复发也。黄帝云∶当风取凉，醉已入房，能成此疾。
（同上）
《苏长史论》曰∶香港脚之为病，本因肾虚，多中肥溢肌肤者，无问男女。若瘦而劳苦，肌肤薄实，皮肤浓
紧者，纵患亦无死忧。一瘥已后，又不可久立蒸湿等地，多饮酒食面，心情忧愤，亦使发动。（《外台》）
（按∶《千金》内补石斛秦艽散方后曰∶风气者，本因肾虚。）
《苏》凡香港脚病，多以春末夏初发动得之，皆因热蒸，情地忧愦，春发如轻，夏发更重，入秋少轻，至冬
自歇，大约如此，亦时有异于此候者。近入京以来，见在室女及妇人，或少年学士，得此病者，皆以不在江岭，
庸医不识，以为他病，皆错疗之，多有死者。风气毒行，天下遍有，非独江岭间也。既妇人亦病，又非由肾虚
而得。卑湿之土，斯病尤众，不为此疗，冤死极多，深用哀悼，无如之何。（同上）
《唐侍中论》云∶凡香港脚病者，盖由暑湿之气郁积于内，毒厉之气吹薄其外之所致也。（《医心》）
《徐思恭论》云∶此病多中闲乐人，亦因久立冷湿地，此病多或踏热来，即冷水浸脚，或房室过度，卧不
覆脚，或心情忧苦，居热蒸地，此皆实香港脚之滥觞也。（同上）
许仁则曰∶此病有数种∶有饮气下流以成香港脚，饮气即水气之渐；亦有肾气先虚，暑月承热，以冷水洗脚，
湿气不散，亦成香港脚；亦有肾气既虚，诸事不节，因居卑湿，湿气上冲，亦成香港脚。（《外台》）（《医心》
引《拯要方》）
内外异因 （南北之别） 此疾《外台秘要总录》亦说江东岭南大率有此，此盖清湿袭虚伤于下，故经
曰感则害人皮肉筋骨者也。故制方立论，皆详其当时土地所宜而治之。今观此方爽 （谓爽明 燥也，出《左
传》）而无卑湿之地，况腠理致密，外邪难侵，而有此疾者何也？盖多饮乳酪醇酒，水湿之属也，加以奉养过
度，以滋其湿水之润下，气不能 之，故下疰于足 ，积久而作肿满疼痛，此饮之下流之所致也，岂可与南方
之地同法而治哉。当察其地势高下，详其饮食居处，立为二法，一则治地之湿气，一则治饮气之下流，随其气
宜，用药施治，使无疾之苦，庶几合轩岐之旨哉。（《宝鉴》）（按《玉机》引《医学发明》）
香港脚之因有二∶一则自外而感，一则自内而致也。自外而感者，以阴寒水湿雨露之气，或坐卧湿地，致令
湿邪袭人皮肉筋脉，而凡清湿袭虚，则病始于下，致为腿足之病，此外因也。自内而致者，以肥甘过度，酒醴
无节，或多食乳酪湿热等物，致令热壅下焦，走注足胫，而日渐肿痛，或上连手节者，此内因也。然在古人，
谓南方卑湿，病多外因，北方嗜酒酪，病多内因，此固一说；然北方亦有寒湿，南方岂少酒湿，此固不必分南
北。（《景岳》）（按∶《纲目》、《准绳》并论以人论之，不必以南北分寒热，盖张氏所本。）
妇人香港脚因血虚 观乎香港脚，皆由肾虚而生；然妇人亦有病香港脚者，必因血海既虚，宿怀嗔恙，复感
悲伤，遂成斯疾，今妇人病此者甚众，则知妇人以血海虚而得之，与男子肾虚类矣。治妇人之法，与男子用药
固无异，但兼以治忧恚药，无不效也。（《济生》）
脉候 《短剧方》云∶脉浮大者病在表，沉细者病在里。脉浮大紧快者，三品之中最恶脉也。（《医心》）
病既入脏（《千金》作风毒之气入人体中），其脉有三品，内外证候相似，但脉异耳。若病患脉得浮大及
缓（《千金》作而缓），宜服续命汤两剂；若风盛，宜作越婢汤，加术四两。若脉转快而紧（《千金》作若脉
浮大紧转快），宜服竹沥汤。脉微而弱，宜服风引汤二三剂（《圣惠方》曰∶脉微而弱者，经言自瘥）按∶此
盖本于苏氏），此皆多是因虚而得。若大虚乏气短，可以间作补汤，随病体之冷热而用。若未愈，更作竹沥汤。
若病患脉浮大而紧快，此是三品之最恶脉。脉或沉细而快者，此脉正与浮大紧者同是恶脉。浮大者病在外，沉
细者病在内，治亦不异，当消息以意耳。其形或尚可，而手脚未及至弱，数日之内，上气即死。如此之脉（《
千金》此下曰∶往往有人得之，无一存者），急服竹沥汤日一剂，汤势恒令相及，勿令半日之内无汤也。（《
病源论》）（按∶此说宜录于治例中，然今有取论脉，故揭于斯。）
按《短剧》、《集验》香港脚脉三种，以缓脉为轻，沉紧为次，洪数者为下。自三十年凡见得此病者数百，
脉沉紧者多死，洪数者并生，缓者不疗自瘥。（《外台》引苏长史）
凡香港脚虽复诊候多涂，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。（《千
金》）
证状 香港脚之病，先起岭南，稍来江东，得之无渐，或微觉疼痹，或两胫小满，或行起忽弱，或小腹
不仁，或时冷时热，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。不即治，转上入腹，
便发气，则杀人。（《肘后》）（按∶小便秘涩以下五句，原文所无，今后《千金》补入。又小满《千金》作
肿满。）
凡香港脚病，皆由感风毒所致。得此病多不即觉，或先无他疾而忽得之，或因众病后得之。初甚微，饮食嬉
戏气力如故，当熟察之。其状自膝至脚有不仁，或若痹，或淫淫如虫所缘，或脚指及膝胫洒洒尔，或脚屈弱不
能行，或微肿，或酷冷，或痛疼，或缓纵不随，或挛急，或至困能饮食者，或有不能者，或见饮食而呕吐，恶
闻食臭，或有物如指发于 肠，径上冲心，气上者，或举体转筋，或壮热头痛，或胸心冲悸，寝处不欲见明，
或腹内苦痛而兼下者，或言语错乱有善忘误者，或眼浊精神昏愦者，皆此病之证也。若治之缓，便上入腹，入
腹或肿或不肿，胸胁满，气上便杀人，急者不全日，缓者或一二三月。初得此病，便宜速治之，不同常病。
（《病源论》）
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。（《千金》）
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，或有腹痛下痢，或大小便秘涩不通，或
胸中冲悸，不欲见光明，或精神 愦，或喜迷忘，语言错乱，或壮热头痛，或身体酷冷疼烦，或觉转筋，或肿
或不肿、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，宜深慎之。其热闷掣 ，惊悸心烦，呕吐气上，皆其候也。又但觉脐下冷痛， 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。（同上）
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，续服葛根汤、麻黄汤下之。若故
不折，更与续命汤两三剂，必瘥。此病大急，常令汤势相接，不可使半日阙汤，即便杀人。（同上）（按∶麻
黄汤系续命汤变方，葛根汤盖非仲景方，亦可推知。）
此诸香港脚（此上文见源由条），皆令人脚胫大，脚趺肿重，闷甚上冲心腹，满闷短气。中间有干湿二香港脚，
湿者脚肿，干者脚不肿，渐觉枯燥，皮肤甲错，须细察之。若先觉心腹胁肋刺痛，胸背满闷，吃食之后，此
状尔加，时时气短，手脚沉重，骨髓疼，多喝气，每食诸粘腻陈败臭物，即诸状转剧，此即饮气下流而成香港脚
者。（《外台》引许仁则）
干香港脚者，头痛腰脚酸疼，心间躁闷干渴，食饭粥饮药立吐，却遍出（疑身）汗出气喘者是。（《鸡峰》）
肿不肿 （干湿之称，见疑前款。） 凡人久患香港脚不自知，别于后因有他病发动，治之得瘥后，直患
吐呕而复脚弱。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
，狐疑之间，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。凡患香港脚，到心难治，以其肾水克
心火故也。（《千金》）
冷热等五种 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。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。（《千金》）
凡此有五种∶冷香港脚，热香港脚，平平香港脚，大虚香港脚，大实香港脚。（《外台》引苏）
肥瘦难易 其人木黑瘦者易治，肥大肉浓赤白者难愈；黑人耐风湿，赤白不耐风；瘦人肉硬，肥人肉
软，肉软则受疾至深，难已也。（《千金》）
香港脚似伤寒 头疼身热，支节痛，大便秘，或呕逆而脚屈弱者，此名香港脚也。伤寒只传足经，不传手
经。地之寒暑风湿皆作蒸气，足常履之，遂成香港脚，所以病证与伤寒相近。（《活人书》）（按∶此说本于通
真子《伤寒括要》）
四气偏胜 外证自汗走疰为风胜，无汗疼痛挛急为寒胜，肿满重着为湿胜，烦渴热顽为暑胜。四气兼
有，但推其多者为胜。（《三因》）
别证诸说 男子妇人初患香港脚，其病寒热，或头痛，忽然脚弱，有筋一条，自脚胫骨至臀及腰而起作
痛，皆因风寒暑湿之气相感而成。（《得效》）
《内经》曰∶诸湿肿满，皆属脾土。又曰∶伤于湿者，下先受之。盖脾主四肢，足居于下而多受其湿，湿
郁成热，湿热相搏，其病作矣。是以先从气冲穴隐核痛起，及两足胫红肿，或恶寒发热，状若伤寒，筋挛掣痛，
是其候也。或一旬或半月，复作如故，渐渐而致于足筋肿大如瓜瓠者，多有之矣。东南卑湿之地，比比皆是；
西北高燥之方，鲜或有之。原其所由，非止一端，有从外感而得者，有从内伤而致者，所感虽有内外之殊，其
为湿热之患则一也。（《正传》）
【背景信息】
书名：杂病广要 作者：日本·丹波元坚撰 朝代：清 章节：香港脚(1/4) 类别：综合
唐以前所说的“香港脚”，就是现在的“香港脚”；而宋代以后所说的“香港脚”，大概不过是寻常的脚部麻木、脚痛等症，将其作为“香港脚”来看待，几乎不是现在的脚气病。难道是风气习俗变迁导致病情有所不同吗？本编以《千金方》和《外台秘要》为宗旨，对于后世诸家医著，仅摘录其要点。虽然如此，又怎知后来的“香港脚”，不会变成不同于今日的“香港脚”呢？医生应当根据时代情况灵活施治。
名义（名称由来）
江东和岭南地区，地势低洼卑湿，属于风湿易侵之地，容易伤人。初患此病时，多从下部向上发展，所以脚先出现屈伸不利、软弱无力，然后毒邪之气顺着经络，逐渐侵入脏腑。脏腑受到邪气侵袭就会出现气喘、胸满等症状。因为此病从脚发起，所以命名为“香港脚”。（出自《诸病源候论》）
此病发作时，起初多从脚开始，随即小腿肿胀，当时的人称之为“香港脚”。深师说“脚弱”，就是这个意思。（出自《千金方》）
晋朝、宋朝以前称为“缓风”，古时候没有“香港脚”这个名称。后来因为病从脚起，初发时伴有肿胀，所以命名为“香港脚”。又有不肿胀但肢体软弱无力，行走突然跌倒，逐渐发展到感觉迟钝（麻木），毒邪之气上攻心脏致死的情况，发病急骤，来不及转身就死亡；若拖延时日，则能维持数月。这样看来，“缓风”和“毒邪之气”可以统称为此类疾病。（出自《外台秘要》引《苏长史论》）（按语：《千金方》说：黄帝认为这是缓风湿痹。）
源由（病因溯源）
问：风毒之气中人，随处都可能致病，为什么偏偏集中在脚部呢？答：人有五脏，心肺两脏的经络起始于手十指；肝肾与脾三脏的经络起始于足十指。风毒之气都产生于地面，地面的寒暑风湿都会化作蒸气，脚总是穿着鞋履接触地面，所以风毒侵害人体时，必定先中伤脚部。时间久了不痊愈，就会遍及四肢、腹部、背部、头部和颈部。轻微时不觉察，顽固滞留时才知晓，经书说的“次传”、“间传”就是这种情况。（出自《千金方》）（按语：《三因极一病证方论》说：中风寒暑湿，得之迅速且病位浅；香港脚，得之缓慢且病位深。《济生方》说：寒暑风湿都能导致此病，不仅仅是风毒而已。现在推究真人的意思，大概是寒暑风湿郁蒸伤人，都称为风毒，并非另有单独的风毒。陈氏和二氏的说法，恐怕是矛盾的。《鸡峰普济方》说：香港脚毒湿多而风少。）
在四季之中，都不宜久站或久坐于湿冷之地，也不应在酒醉汗出后，脱去衣靴袜，对着风取凉，这些都会导致香港脚。如果在暑天久站久坐湿地，热湿之气会蒸入经络，发病时必然发热，四肢酸痛烦闷。如果在寒天久站久坐湿冷地，冷湿之气会上入经络，发病时四肢极度寒冷并发生转筋（肌肉痉挛）。如果因对着风取凉而得病，发病时皮肉顽麻不仁，各处跳动，渐渐向头部蔓延。平常的日子，忽然暴热，人们都不能忍受，此时千万不要立刻贪凉受寒以求痛快。突然遇到暴寒，也不要承受，都会生病。世间有勤奋用功读书的人，一心专注于事务，久坐久立于湿地，不时活动身体，冷风吹袭，进入经络，不知不觉就成病了。所以风毒中人，有时先中伤手足十指，因为汗毛孔张开，腠理疏松，风邪如箭射一般；有时先中伤足心，有时先中伤足背，有时先中伤膝盖以下的胫骨内外侧。如果想让人不得病，刚感觉到不适时，立即艾灸所觉之处三二十壮，因此就能痊愈，不再复发。黄帝说：当风取凉，醉后行房，能造成这种疾病。（同上）
《苏长史论》说：香港脚这种病，本来是因为肾虚，多侵犯肥胖、肌肤丰溢的人，无论男女。如果瘦弱且劳苦，肌肤薄实，皮肤浓密紧致的人，即使患病也没有生命危险。一次痊愈之后，又不宜久站于湿热等地，多饮酒食面，心情忧愤，也会使疾病复发。（出自《外台秘要》）（按语：《千金方》内补石斛秦艽散方后说：风气之病，本来是因为肾虚。）
《苏长史论》又说：凡是香港脚病，多在春末夏初发作，都是因为热气蒸腾，心情忧郁烦躁。春天发作较轻，夏天发作更重，入秋稍轻，到了冬天自然歇止，大约如此，也有与此不同的情况。近来进入京城以来，见到未出嫁的女子及妇人，或者少年学士，得此病的，都不在江岭地区，庸医不认识，以为是其他病，都错误治疗，多有死者。风气毒邪流行，天下到处都有，不仅仅在江岭之间。既然妇人也患病，又不是因为肾虚而得的。卑湿之地，这种病尤其多，不为这种病治疗，冤死的人极多，深感哀悼，无可奈何。（同上）
《唐侍中论》说：凡是香港脚病，大概是由于暑湿之气郁积于内，毒厉之气吹迫于外所导致的。（出自《医心方》）
《徐思恭论》说：此病多侵犯闲适享乐之人，也因为是久立于冷湿地，此病多或者是踏热归来，就用冷水浸脚，或者是房事过度，睡觉不盖脚，或者是心情忧苦，居住在热蒸之地，这些都是香港脚的滥觞（起源）。（同上）
许仁则说：此病有好几种：有饮气下流而形成香港脚的，饮气即水气的渐进；也有肾气先虚，暑月承受热气，用冷水洗脚，湿气不散，也形成香港脚；也有肾气既虚，诸事不节制，因为居住卑湿，湿气上冲，也形成香港脚。（出自《外台秘要》）（《医心方》引《拯要方》）
内外异因（南北之别）
此疾《外台秘要总录》也说江东岭南大体有此病，这大概是清湿之气侵袭虚弱部位伤于下部，所以经书说感邪则伤害皮肉筋骨。因此制定方剂和立论，都详细根据当时的土地适宜情况来治疗。现在观察此地（北方）爽朗干燥而没有卑湿之地，况且腠理致密，外邪难侵，却还有此病是什么原因呢？大概是因为多饮乳酪醇酒，属于水湿之物，加上奉养过度，滋长了湿水的润下特性，气不能制约它，所以下注于足，积聚久了就作肿满疼痛，这是饮水之下流所导致的，怎么能与南方之地用同样的方法治疗呢？应当考察地势高下，详细分析饮食居处，确立两种治法，一则治疗地之湿气，一则治疗饮气之下流，随其气宜，用药施治，使无疾病之苦，或许符合轩岐（黄帝、岐伯）的宗旨吧。（出自《医学发明》）（按语：《玉机微义》引《医学发明》）
香港脚的成因有二：一则自外感受，一则自内生致。自外感受者，因阴寒水湿雨露之气，或坐卧湿地，致使湿邪侵袭人皮肉筋脉，而凡清湿侵袭虚弱部位，则病始于下，成为腿足之病，这是外因。自内生致者，因肥甘过度，酒醴无节制，或多食乳酪湿热等物，致使热壅下焦，走注足胫，而日渐肿痛，或上连手节者，这是内因。然而在古人看来，谓南方卑湿，病多外因，北方嗜酒酪，病多内因，这固然是其中一种说法；然而北方也有寒湿，南方难道缺少酒湿吗？这固不必分南北。（出自《景岳全书》）（按语：《本草纲目》、《医学准绳六要》都论述以人论之，不必以南北分寒热，这是张氏所依据的。）
妇人香港脚因血虚
看香港脚，都是由肾虚而生；然而妇人也有患香港脚的，必定是因为血海既虚，平素怀有嗔怒之恙，又感悲伤，遂成此疾。如今妇人患此病者甚众，可知妇人是因血海虚而得之，与男子肾虚类似。治疗妇人的方法，与男子用药固然无异，但兼以治疗忧恚（忧愁愤怒）的药物，没有不有效的。（出自《济生方》）
脉候
《短剧方》说：脉浮大的病在表，脉沉细的病在里。脉浮大紧快的，是三品中最恶的脉。（出自《医心方》）
病既入脏（《千金方》作风毒之气入人体中），其脉有三品，内外证候相似，只是脉象不同。如果病患脉得浮大及缓（《千金方》作而缓），宜服续命汤两剂；如果风盛，宜作越婢汤，加白术四两。如果脉转快而紧（《千金方》作若脉浮大紧转快），宜服竹沥汤。脉微而弱，宜服风引汤二三剂（《太平惠民和剂局方》曰：脉微而弱者，经言自瘥）按：这大概本于苏氏。这些都多是因虚而得。如果大虚乏气短，可以间歇服用补汤，随病体的冷热而用。如果未愈，再作竹沥汤。如果病患脉浮大而紧快，这是三品中最恶的脉。脉或沉细而快者，此脉正与浮大紧者同是恶脉。浮大者病在外，沉细者病在内，治疗也不异，应当斟酌心意而定。其形体或许尚可，而手脚还未到软弱程度，数日之内，上气即死。如此之脉（《千金方》此下曰：往往有人得之，无一存者），急服竹沥汤每日一剂，汤势常令相接，不要让半日之内无汤。（出自《诸病源候论》）（按：此说宜录于治例中，然而今有取论脉，故揭示于此。）
按《短剧》、《集验》香港脚脉三种，以缓脉为轻，沉紧为次，洪数者为下。自三十年凡见得此病者数百，脉沉紧者多死，洪数者并生，缓者不疗自瘥。（出自《外台秘要》引苏长史）
凡香港脚虽复诊候多涂，而三部之脉，要须不违四时者为吉，其逆四时者勿治，其余如《脉经》所说。（出自《千金方》）
证状
香港脚之病，先起于岭南，稍传到江东，得之无渐进过程，或微觉疼痹，或两胫小满，或行走突然软弱，或小腹不仁，或时冷时热，小便便秘涩滞，喘息气冲喉，气急欲死，食呕不下，气上逆者，都是其征候。不及时治疗，转而向上入腹，便发气，则杀人。（出自《肘后备急方》）（按：小便秘涩以下五句，原文所无，今后《千金方》补入。又小满《千金方》作肿满。）
凡香港脚病，都是由感风毒所致。得此病多不立即觉察，或先前无他疾而忽得之，或因众病后得之。初起很轻微，饮食嬉戏气力如故，应当仔细察看。其状自膝至脚有不仁，或像麻痹，或淫淫如虫所缘（像虫子爬行的感觉），或脚趾及膝胫洒洒尔（颤抖寒冷感），或脚屈弱不能行，或微肿，或酷冷，或疼痛，或缓纵不随（松弛无力），或挛急，或至困倦能饮食者，或有不能者，或见饮食而呕吐，恶闻食臭，或有物如指发于大肠，径上冲心，气上者，或举体转筋，或壮热头痛，或胸心冲悸，寝处不欲见明，或腹内苦痛而兼下利者，或言语错乱有善忘误者，或眼浊精神昏愦者，都是此病的证候。如果治疗迟缓，便上入腹，入腹或肿或不肿，胸胁满，气上便杀人，急者不全日，缓者或一二三月。初得此病，便宜速治之，不同于常病。（出自《诸病源候论》）
凡香港脚病，都是由感风毒所致。得此病多不令人立即觉察，会因为其他病，一度才始发动，或奄然大闷，经三两日不起，方才觉察。诸小庸医，都不认识此疾，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。（出自《千金方》）
有的人脚未觉异常，而头项臂膊已有所苦；有的各处皆悉未知，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，或有腹痛下痢，或大小便秘涩不通，或胸中冲悸，不欲见光明，或精神昏愦，或喜迷忘，语言错乱，或壮热头痛，或身体酷冷疼烦，或觉转筋，或肿或不肿、或腿部顽痹，或时缓纵不随，或复百节挛急，或小腹不仁，这都是香港脚状貌，也称风毒香港脚之候。其候难知，当须细意察之。不然，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，宜深慎之。其热闷掣疭，惊悸心烦，呕吐气上，都是其候。又但觉脐下冷痛，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。（同上）
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，续服葛根汤、麻黄汤下之。如果故不折，更与续命汤两三剂，必瘥。此病大急，常令汤势相接，不可使半日阙汤，即便杀人。（同上）（按：麻黄汤系续命汤变方，葛根汤盖非仲景方，亦可推知。）
这些香港脚（上文见源由条），都令人脚胫大，脚趺肿重，闷甚上冲心腹，满闷短气。中间有干湿二香港脚，湿者脚肿，干者脚不肿，渐觉枯燥，皮肤甲错，须细察之。如果先觉心腹胁肋刺痛，胸背满闷，吃食之后，此状更加严重，时时气短，手脚沉重，骨髓疼，多喝气，每食诸粘腻陈败臭物，即诸状转剧，这就是饮气下流而成香港脚者。（出自《外台秘要》引许仁则）
干香港脚者，头痛腰脚酸疼，心间躁闷干渴，食饭粥饮药立吐，却遍出（疑身）汗出气喘者是。（出自《鸡峰普济方》）
肿不肿（干湿之称，见疑前款。）
凡人久患香港脚不自知，别于后因有他病发动，治之得瘥后，直患吐呕而复脚弱。我为其诊之，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，狐疑之间，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。凡患香港脚，到心难治，以其肾水克心火故也。（出自《千金方》）
冷热等五种
问：何故得者有冷有热？答：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。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。（出自《千金方》）
凡此有五种：冷香港脚，热香港脚，平平香港脚，大虚香港脚，大实香港脚。（出自《外台秘要》引苏）
肥瘦难易
其人木黑瘦者易治，肥大肉浓赤白者难愈；黑人耐风湿，赤白不耐风；瘦人肉硬，肥人肉软，肉软则受疾至深，难已也。（出自《千金方》）
香港脚似伤寒
头疼身热，支节痛，大便秘，或呕逆而脚屈弱者，此名香港脚也。伤寒只传足经，不传手经。地之寒暑风湿皆作蒸气，足常履之，遂成香港脚，所以病证与伤寒相近。（出自《类证活人书》）（按：此说本于通真子《伤寒括要》）
四气偏胜
外证自汗走疰为风胜，无汗疼痛挛急为寒胜，肿满重着为湿胜，烦渴热顽为暑胜。四气兼有，但推其多者为胜。（出自《三因极一病证方论》）
别证诸说
男子妇人初患香港脚，其病寒热，或头痛，忽然脚弱，有筋一条，自脚胫骨至臀及腰而起作痛，皆因风寒暑湿之气相感而成。（出自《经验良方》）
《内经》说：诸湿肿满，皆属脾土。又说：伤于湿者，下先受之。盖脾主四肢，足居于下而多受其湿，湿郁成热，湿热相搏，其病作矣。是以先从气冲穴隐核痛起，及两足胫红肿，或恶寒发热，状若伤寒，筋挛掣痛，是其候也。或一旬或半月，复作如故，渐渐而致于足筋肿大如瓜瓠者，多有之矣。东南卑湿之地，比比皆是；西北高燥之方，鲜或有之。原其所由，非止一端，有从外感而得者，有从内伤而致者，所感虽有内外之殊，其为湿热之患则一也。（出自《医学正传》）
[Background Information]
Book: Zabing Guangyao (Comprehensive Requirements for Miscellaneous Diseases)
Author: Danbo Yuanjian (Japanese)
Dynasty: Qing
Chapter: Hongxiangjiao (1/4)
Category: Comprehensive
The "Hongxiangjiao" mentioned before the Tang Dynasty is the same as the modern "Hongxiangjiao"; however, the "Hongxiangjiao" mentioned since the Song Dynasty probably refers only to ordinary foot numbness and foot pain. Treating it as "Hongxiangjiao" is hardly the modern "Jiaqi" (Beriberi). Could it be that changes in customs and climates have led to differences in the disease? This compilation takes the *Qianjin Fang* (Prescriptions Worth a Thousand Gold) and the *Waitai Miyao* (Essential Prescriptions from the Imperial Library) as its main sources, extracting only the key points from later medical works. Nevertheless, how can we know that future "Hongxiangjiao" will not differ from today's? Physicians should adapt their treatments according to the times.
**Nomenclature**
In the Jiangdong and Lingnan regions, the land is low and damp, an environment prone to wind-dampness that easily injures people. When first contracting this disease, it often progresses upward from the lower body; thus, the feet initially become weak and difficult to flex. Subsequently, toxic qi travels along the meridians and gradually enters the zang-fu organs. Once the zang-fu are affected by pathogenic qi, symptoms such as panting and chest fullness occur. Because the disease originates from the feet, it is named "Hongxiangjiao" (Cantonese Foot / Beriberi). (*Zhubing Yuanhou Lun* [Treatise on the Pathogenesis and Symptoms of All Diseases])
When this disease manifests, it usually starts in the feet, followed by swelling of the shins. People at the time called it "Hongxiangjiao." Shenshi stated that "foot weakness" refers to this meaning. (*Qianjin Fang*)
Before the Jin and Song dynasties, it was called "Huanfeng" (Slow Wind); there was no name "Hongxiangjiao" in ancient times. Later, because the disease started in the feet and initially presented with swelling, it was named "Hongxiangjiao." There were also cases without swelling but with weakness, where walking suddenly caused falling, progressing to insensitivity (numbness). If toxic qi attacked the heart upwards, death would ensue rapidly, without time to turn around; if delayed, survival might extend for months. Thus, "Huanfeng" and "toxic qi" can be collectively termed this disease. (*Waitai Miyao*, citing *Lun by Director Su*) (Note: *Qianjin Fang* states: The Yellow Emperor considered this to be slow wind-damp bi.)
**Etiology**
Question: Why does wind-toxin affect people everywhere yet specifically target the feet? Answer: 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. Wind-toxin arises from the ground; the cold, heat, wind, and dampness of the earth all transform into vapors. Since the feet are always covered by shoes and contact the ground, when wind-toxin attacks the human body, it must first strike the feet. If untreated over time, it spreads to the four limbs, abdomen, back, head, and neck. Initially imperceptible, it becomes known only when it becomes entrenched. As the classics state, this is "sequential transmission" or "intermittent transmission." (*Qianjin Fang*) (Note: *Sanyin Fang* states: Contracting wind, cold, summer-heat, and dampness results in sudden and shallow illness; Hongxiangjiao develops gradually and deeply. *Jisheng Fang* states: Cold, summer-heat, wind, and dampness can all cause this, not just wind-toxin. Inferring the true intent, cold, summer-heat, wind, and dampness stifling and injuring humans are all named wind-toxin; there is no separate wind-toxin. Chen's and Er's theories may contradict each other. *Jifeng Fang* states: Hongxiangjiao toxin has much dampness and little wind.)
Throughout the four seasons, one should not stand or sit for long periods in cold, damp places, nor should one remove clothing, boots, or socks while drunk and sweating to cool off in the wind; these actions all lead to Hongxiangjiao. If standing or sitting on wet ground for a long time during summer, hot-damp qi steams into the meridians; upon onset, fever, soreness, and irritability in the four limbs occur. If standing or sitting on cold, damp ground in winter, cold-damp qi enters the meridians; upon onset, the four limbs become extremely cold with muscle cramps. If contracted by cooling off in the wind, the skin and flesh become numb and insensitive, with twitching in various areas gradually moving toward the head. On days of sudden extreme heat, which people find unbearable, one must not immediately seek cold relief for pleasure. Similarly, one should not endure sudden extreme cold; both cause illness. Scholars who study diligently, focusing entirely on their work, often sit or stand on wet ground for long periods without moving frequently. When cold wind strikes and enters the meridians, they unknowingly contract the disease. Thus, wind-toxin may first strike the ten fingers of the hands and feet due to open pores and loose cou-li (skin texture), with wind striking like arrows; or it may first strike the sole of the foot, the dorsum of the foot, or the interior and exterior of the lower legs below the knees. To prevent illness, upon initial sensation of discomfort, moxibustion should be applied to the affected area for 30-20 burns, leading to immediate cure and no recurrence. The Yellow Emperor said: Cooling off in the wind and engaging in sexual activity after drinking can cause this disease. (Ibid.)
*Lun by Director Su* states: Hongxiangjiao originates from Kidney deficiency and mostly affects those with obesity and abundant flesh, regardless of gender. However, thin individuals who labor and have tight, dense skin may suffer without fatal consequences. After recovery, one must avoid standing in humid places or consuming excessive alcohol and wheat products, and avoid sorrow and anger, as these can trigger relapse. (*Waitai Miyao*) (Note: Post-prescription note in *Qianjin Fang*'s Neibu Shihu Qinjiao San states: Wind diseases originate from Kidney deficiency.)
*Lun by Su* further states: Hongxiangjiao typically manifests in late spring and early summer due to heat steaming and mental distress. Spring onset is mild; summer onset is severe; autumn brings slight relief; winter sees natural remission, generally speaking, though variations exist. Since entering the capital, I have seen unmarried women, married women, and young scholars contracting this disease outside the Jiang-Ling region. Unqualified physicians, failing to recognize it, misdiagnose and mistreat them, causing many deaths. Wind-toxin spreads throughout the world, not just in Jiang-Ling. Since women also suffer, and it is not solely due to Kidney deficiency, it is particularly prevalent in low, damp areas. Failure to treat this leads to many unjust deaths, causing deep sorrow and helplessness. (Ibid.)
*Argument by Tang Shizhong* states: Hongxiangjiao is caused by the accumulation of summer-heat and dampness internally, combined with toxic qi pressing externally. (*Yixin Fang*)
*Argument by Xu Sigong* states: This disease often affects leisurely individuals, also resulting from prolonged standing on cold, damp ground. It often occurs after walking in heat and soaking feet in cold water, excessive sexual activity, sleeping without covering the feet, feeling distressed, or living in hot, steaming environments. These are the origins of Hongxiangjiao. (Ibid.)
Xu Renze states: There are several types of this disease: one type involves descending fluid qi forming Hongxiangjiao, where fluid qi is the gradual progression of water qi; another type involves pre-existing Kidney deficiency, exposure to summer heat, washing feet with cold water, and retained dampness forming Hongxiangjiao; another type involves Kidney deficiency, lack of moderation in activities, residence in low, damp areas, and rising dampness forming Hongxiangjiao. (*Waitai Miyao*) (*Zhengyao Fang* cited in *Yixin Fang*)
**Internal vs. External Causes (North-South Differences)**
*Waitai Miyao Zonglu* also mentions that Jiangdong and Lingnan predominantly suffer from this disease. This is because clear-dampness invades deficiency at the lower part, injuring skin, flesh, sinews, and bones as stated in the classics. Therefore, prescriptions and theories are detailed based on local conditions. Observing the current region (North), which is dry and lacks low, damp lands, and where cou-li is dense making external pathogens hard to invade, why does this disease still occur? It is likely due to excessive consumption of milk, cheese, and strong wine, which are water-damp substances. Coupled with excessive nourishment, this generates dampness that sinks downward. Qi fails to control it, so it deposits in the feet, accumulating over time to cause swelling, fullness, and pain. This results from the downward flow of fluids. How can it be treated the same as southern regions? One must examine terrain elevation and analyze diet and lifestyle, establishing two methods: one treating terrestrial dampness, the other treating the downward flow of fluids. Adapting medication to the specific qi allows for treatment free of suffering, hopefully aligning with the principles of Huangdi and Qibo. (*Yixue Faming*) (Note: *Yuji Weiyi* cites *Yixue Faming*)
There are two causes of Hongxiangjiao: external contraction and internal generation. External causes involve yin-cold, water-damp, rain, and dew, or sitting/lying on wet ground, allowing damp-pathogens to invade skin, flesh, sinews, and vessels. Clear-dampness invading deficiency starts at the lower part, causing leg and foot diseases. Internal causes involve excessive rich and sweet foods, unregulated wine consumption, or eating too much milk, cheese, and damp-heat substances, causing heat to stagnate in the lower jiao, flowing to the calves, causing progressive swelling and pain, or extending to hand joints. Ancient texts suggested southern dampness caused external factors, while northern wine/cheese habits caused internal factors. This is one view; however, the north also has cold-damp, and the south has wine-damp. Thus, dividing by North/South is unnecessary. (*Jingyue Quanshu*) (Note: *Bencao Gangmu* and *Yixue Zhunsheng* argue judging by person rather than geography for cold/heat, which Zhang Jiebin based his views on.)
**Women's Hongxiangjiao due to Blood Deficiency**
Hongxiangjiao arises from Kidney deficiency; however, women also suffer from it, necessarily due to emptiness of the Sea of Blood, compounded by chronic resentment and grief. Many women suffer from this now, indicating women contract it due to Sea of Blood deficiency, similar to men's Kidney deficiency. Treatment for women uses the same medicines as men but adds herbs for treating sorrow and anger, yielding excellent results. (*Jisheng Fang*)
**Pulse Diagnosis**
*Duanju Fang* states: Floating and large pulses indicate exterior disease; sinking and fine pulses indicate interior disease. Floating, large, tight, and rapid pulses are the worst among the three categories. (*Yixin Fang*)
When the disease enters the zang organs (referred to as wind-toxin entering the body in *Qianjin Fang*), there are three pulse categories. Exterior and interior symptoms are similar, differing only in pulse. If the patient's pulse is floating, large, and slow, administer Xuming Decoction for two doses. If wind is predominant, use Yeshi Decoction with four liang of Atractylodes. If the pulse becomes rapid and tight, use Bamboo Sap Decoction. If the pulse is faint and weak, use Fengyin Decoction for 2-3 doses (*Tai Ping Hui Min He Ji Ju Fang* states: Faint and weak pulses indicate spontaneous recovery according to classics—note: this likely derives from Su Shi). These are mostly due to deficiency. For severe deficiency with shortness of breath, tonifying decoctions can be given intermittently, adjusted for cold/heat patterns. If unresolved, prepare Bamboo Sap Decoction again. If the pulse is floating, large, tight, and rapid, it is the worst category. Sinking, fine, and rapid pulses are equally ominous. Floating/large indicates exterior; sinking/fine indicates interior; treatment principles remain similar, requiring careful judgment. If the physical form is acceptable but limbs are not yet weak, upper-jiao qi ascent can cause death within days. For such pulses (often fatal, per *Qianjin Fang*), urgently administer Bamboo Sap Decoction daily, ensuring continuous administration without gaps exceeding half a day. (*Zhubing Yuanhou Lun*) (Note: This theory belongs in treatment examples, but is placed here for pulse discussion.)
According to *Duanju* and *Jiyan*, there are three Hongxiangjiao pulses: slow is mild, sinking-tight is moderate, flooding-numerate is severe. In thirty years, observing hundreds of cases, sinking-tight pulses often resulted in death, flooding-numerate pulses survived, and slow pulses healed spontaneously without treatment. (*Waitai Miyao*, citing Director Su)
Although Hongxiangjiao diagnosis is complex, pulses in the three positions must not contradict the four seasons to be auspicious; contrary pulses should not be treated. Others follow *Mai Jing*. (*Qianjin Fang*)
**Symptoms**
Hongxiangjiao originated in Lingnan, spread to Jiangdong. Onset may be abrupt, with slight pain/numbness, mild shin fullness, sudden leg weakness, abdominal insensitivity, alternating cold/heat, urinary difficulty, panting with qi rushing to the throat, suffocation, vomiting inability to eat, and rebellious qi—all are signs. Without timely treatment, it moves upward into the abdomen, causing qi eruption, which is fatal. (*Zhouhou Beiji Fang*) (Note: Five sentences from urinary difficulty onwards are absent in original text, added later from *Qianjin Fang*. Also, "small fullness" in *Qianjin Fang* is "swelling/fullness".)
All Hongxiangjiao is caused by wind-toxin. Onset is often unnoticed, occurring suddenly without prior illness or after other diseases. Initially subtle, with normal appetite, playfulness, and strength, careful observation is needed. Signs include insensitivity from knee to foot, numbness, crawling sensations, trembling in toes/shins/knees, leg weakness preventing walking, slight swelling, extreme cold, pain, flaccidity, spasms, varying dietary tolerance, vomiting at sight/smell of food, objects rising from intestines to heart, whole-body cramps, high fever/headache, chest palpitations, aversion to light, abdominal pain with diarrhea, confusion/memory loss, cloudy eyes/dull spirit—all are symptoms. Delayed treatment allows upward movement into the abdomen, causing swelling or fullness, chest/hypochondriac distension, and fatal qi ascent. Acute cases die within a day; chronic cases last 1-3 months. Early treatment is crucial, unlike common diseases. (*Zhubing Yuanhou Lun*)
All Hongxiangjiao is caused by wind-toxin. Often unnoticed until triggered by another illness, presenting as sudden severe oppression, unable to rise for 2-3 days. Incompetent physicians misdiagnose and kill patients. Thus, it is unrecognized. Initial signs are subtle, with normal strength, except for sudden leg weakness preventing movement. (*Qianjin Fang*)
Some feel no foot abnormality but suffer in head/neck/arms; others feel no external issues but suffer internally. Wind-toxin may cause vomiting/aversion to food smell, abdominal pain/diarrhea, constipation, chest palpitations, aversion to light, dull spirit, forgetfulness/confusion, high fever/headache, extreme cold/pain, cramps, swelling/non-swelling, leg numbness, flaccidity, joint spasms, abdominal insensitivity—all are Hongxiangjiao manifestations, also called wind-toxin Hongxiangjiao signs. Signs are hard to detect, requiring careful observation. Otherwise, critical timing is missed, and once established, difficult to manage. Women are similar; postpartum women cooling off in spring/summer often contract this toxin, requiring caution. Heat/oppression/twitching, palpitations/irritability, vomiting/rebellious qi are signs. Cold/pain below navel, discomfort, and dribbling urination different from usual are also Hongxiangjiao signs. Flaccidity is called Huanfeng; pain is Shibi. (Ibid.)
Treating wind-toxin disease: Initially resembling epidemic toxin disease, with floating-slow pulse remaining unchanged. Untreated, death occurs in days or weeks, or patient loses consciousness, jaundice, macules, red eyes, or genital ulceration. This is most urgent. Upon onset, administer Xuming Decoction, followed by Gegen Decoction and Mahuang Decoction to purge. If ineffective, give Xuming Decoction 2-3 more doses for cure. This disease is extremely urgent; decoctions must be continuous, never missing half a day, or death ensues. (Ibid.) (Note: Mahuang Decoction is a variation of Xuming Decoction; Gegen Decoction may not be from Zhang Zhongjing.)
These Hongxiangjiao cases cause enlarged calves, swollen/heavy dorsum of foot, oppressive qi rushing to heart/abdomen, fullness, and shortness of breath. There are Dry and Wet types: Wet presents with foot swelling; Dry presents without swelling, with gradual dryness and rough skin ("fish scale" appearance). Careful observation is needed. If preceded by stabbing pain in heart/abdomen/hypochondrium, chest/back fullness worsening after eating, frequent shortness of breath, heavy limbs, bone marrow pain, sighing, and aggravation after eating sticky/stale/odorous foods, this is Hongxiangjiao caused by descending fluid qi. (*Waitai Miyao*, citing Xu Renze)
Dry Hongxiangjiao presents with headache, waist/leg soreness, mental restlessness/thirst, immediate vomiting of food/medicine, generalized sweating, and panting. (*Jifeng Puji Fang*)
**Swelling vs. Non-Swelling**
People often suffer from Hongxiangjiao unknowingly for years, only manifesting when triggered by other illnesses. After treatment resolves other issues, persistent vomiting and leg weakness reveal the true diagnosis. Patients deny ever having swollen feet, refusing treatment, suspecting stone toxicity. Hesitation leads to death within ten days. Thus, Hongxiangjiao cannot always be identified by swelling; some swell, some do not. Abdominal insensitivity usually accompanies non-swollen feet. If abdominal insensitivity is followed by vomiting within 3-5 days, it is called "Hongxiangjiao entering the Heart," fatal within days. Treatment is difficult when reaching the Heart because Kidney Water overcomes Heart Fire. (*Qianjin Fang*)
**Cold, Heat, and Five Types**
Question: Why do cases present as cold or heat? Answer: The feet have three Yin and three Yang meridians. Cold attacking Yang meridians causes cold pathology; Summer-heat attacking Yin meridians causes heat pathology. Thus, there are exterior/interior cold/heat distinctions. Treatments differ: heat with cold herbs, cold with hot herbs, adjusted by judgment. Spleen affected by Yang toxin causes heat-numbness; Kidney affected by Yin dampness causes cold-bi. (*Qianjin Fang*)
There are five types: Cold Hongxiangjiao, Heat Hongxiangjiao, Neutral Hongxiangjiao, Severe Deficiency Hongxiangjiao, Severe Excess Hongxiangjiao. (*Waitai Miyao*, citing Su)
**Obesity/Emaciation and Difficulty**
Thin, dark-skinned individuals are easier to treat; fat, fleshy, pale/red-skinned individuals are harder to cure. Dark-skinned people tolerate wind-damp; pale/red-skinned do not tolerate wind. Thin people have firm flesh; fat people have soft flesh. Soft flesh allows deeper disease penetration, making it harder to cure. (*Qianjin Fang*)
**Hongxiangjiao Similar to Shanghan**
Headache, fever, joint pain, constipation, or vomiting with leg weakness is named Hongxiangjiao. Shanghan transmits only through Foot meridians, not Hand meridians. Earth's cold/heat/wind/damp transform into vapors; feet constantly tread on them, forming Hongxiangjiao. Thus, symptoms resemble Shanghan. (*Leizheng Huoren Shu*) (Note: Based on Tongzhenzi's *Shanghan Kuoyao*)
**Dominance of Four Qi**
Exterior signs: Spontaneous sweating/spreading indicates Wind dominance; No sweat/pain/spasms indicates Cold dominance; Swelling/heaviness indicates Damp dominance; Irritability/thirst/heat-numbness indicates Summer-heat dominance. When four qi coexist, identify the dominant one. (*Sanyin Fang*)
**Other Symptom Discussions**
Men and women initially suffering Hongxiangjiao with chills/fever, headache, sudden leg weakness, and a painful tendon running from shin to buttock/waist are caused by interaction of wind/cold/summer-heat/dampness. (*Degong Fang*)
*Neijing* states: All dampness, swelling, and fullness belong to Spleen Earth. Also: Those injured by dampness are affected from below first. Spleen governs four limbs; feet are lowest and receive most dampness. Dampness stagnates into heat; damp-heat conflict causes disease. It often starts with pain at Qichong acupoint, red/swollen shins, chills/fever resembling Shanghan, tendon spasms/pain. Recurring every 10-15 days, eventually causing calf swelling like a gourd, common in Southeast low-damp areas, rare in Northwest high-dry areas. Origins vary, including external contraction and internal injury. Though causes differ internally/externally, the result is damp-heat pathology. (*Yixue Zhengchuan*)