附散寒湿也，木香、槟榔、香附、乌药宣行气道之剂也，红花、桃仁活血行凝之剂
也，牛膝、杜仲、萆 、虎骨壮筋骨之剂也，参、 、白术、归、芍、地黄补养气
血之剂也，合宜而用，则或攻或补，皆可奏功。（《锦囊》）
又曰∶香港脚初起甚微，多不令人识也。食饮嬉戏，气力如故，惟卒起脚屈弱不能
动为异耳。南北所感，虽有内外之殊，然皆由肾虚，妇人病此者，亦由血海虚而得
之，与男子肾虚同也。若入腹冲心，呕吐不止，危在顷刻，宜八味丸温以逐之。入
肾则腰脚肿，小便不通，目额皆有黑气，冲胸喘而呻吟，左尺脉绝者死。盖肾虚阳衰
之人多犯此，肾乘心水克火也。故肾气香港脚，当以金匮肾气丸预为服之也。
又曰∶南方自外而入者，止下胫肿痛，北方自内而致者，乃或致于手节也。治法
初用解散，次必推荡大便，以导其邪气。
经曰∶卧出汗而风吹之，凝于肤者为痹，凝于脉者为泣，凝于足者为厥。
《至真要大论》云∶太阴之胜，火气内郁，流散于外，足胫 肿，饮发于中，
肿于下。凡内伤酒食，脾胃营运之气有亏，不能上升，乃下流乘其肝肾之位，注于足
胫，加之房事不节，邪气乘虚，乃为香港脚，久而不愈，遂成痼疾。坚硬如石谓之石疽，
肉色紫赤，皮肉溃烂，名为缓疽，惟宜温补。
又曰∶香港脚或见食呕吐，憎闻食气，腹痛作泻，或二便阻塞，或精神昏愦，或妄
语错乱，或壮热头痛，有类伤寒，名香港脚
攻心多死。
又曰∶其脉浮弦者风，濡弱者湿，洪数者热，迟者寒，微者虚，牢坚者实，结
则因气，散则因忧，紧则因怒，细则因悲。
又曰∶妇人脚十指如热油煎者，皆由荣卫气虚，湿毒之气流滞经络，上攻心则
心痛，下攻脚则脚痛，脚指如焚，如香港脚之类，经云热厥是也。
《医论》曰∶香港脚之疾，皆由脾肾二经虚弱，坐卧行动之间，而为风寒暑湿之气
所干，流注而成此疾。得病之始，多不令人便觉，必感他病，乃始发动，或奄然太
闷，经两三日方觉之，先从脚起，或缓弱疼痹，行起忽倒，或胫肿满，或足膝枯细，
或心中忪悸，或小腹不仁，大小便秘涩，或举体转筋，骨节酸疼，或恶闻食气，见食
吐逆，或胸满气急，壮热憎寒，传足六经，外证与伤寒相似，但卒然脚痛为异耳。其
为候不一，若寒中三阳所患必冷，暑中三阴所患必热，脉浮而弦者起于风，濡而弱
者起于湿，洪而数者起于热，迟而涩者起于寒，风者汗之，湿者燥之，热者清之，寒
者温之，又当随四时表里虚实治之，切不可用温补及汤淋洗，此医家之大戒也。盖
补则气实，多致不救，淋洗则邪毒入内，亦难治矣。治之不早，使毒瓦斯入腹冲心，攻
筑作痛，喘满上气，呕吐异常，此则渐致倾危，其可忽耶！
林氏曰∶或问足跗肿痛，明系湿热，如何谓之香港脚？既以气称，亦不失为湿热，如
何又有外感内因之别，干湿寒热之异，甚至冲心呕逆，谵语神昏，以致于死也？答
曰∶此一气字，自与平常湿热不同，盖非一朝一夕所致，此证虽由湿热微邪，然而
沉伏于足三阴经既久，不能发泄，郁蒸为热，瘀而红肿，肿而后痛，且足三阴之脉
从足之内踝而上，至于大小腹，更由腹而上溢手包络咽嗌之间，故肿痛必然牵引经
络，而郁蒸之气又自下而上逆于心胸，遂至寒热似疟，恶心呕逆，所以有类伤寒之
别名。况病发之初，未有不由外感内因，或暴怒房劳所触发，于是内外兼证夹杂，仓
卒难辨，初学临证，茫然昧于用药，倘使表里虚实之不别，补泻寒热之妄投，未有
不至于冲心危殆者也。（《活人编》）
又曰∶或问虽曰香港脚，亦不过湿热久郁而成，有何利害以至于死？若果可以致
人于死，则其证更凶于伤寒，何以又谓之类伤寒耶？况曰类者，亦正与伤寒相近，故
亦有七日而愈，七日而死，十四日而愈，十四日而死，据此岂不可谓之香港脚伤寒乎？答
曰∶香港脚与伤寒原属二证，难以溷淆，只有寒热呕逆，及三阴三阳传变深浅，与伤
寒相似，故曰类也。若论致死之因，凡风寒暑湿之邪，无有不由于经络而传于六腑，
以至五脏，自轻至重，自重至危，何独香港脚为然，而必与伤寒并论哉。
又曰∶脉与形证，此证湿热为本，客邪触发为标。发时还从足 红肿微痛而起，
肿甚则痛愈甚，而郁蒸之气由经络入于足三阳之腑，故有寒热交作，畏寒烦躁，恶
心呕逆，烦渴引饮，喘急谵语，恶食而复能食，二便秘结不通，其脉浮洪弦数有力
者，谓之干香港脚，乃三阳经受病也。若二便通利，汗多不渴，恶心呕逆，汤饮不受，
肢厥戴阳，神昏谵语，六脉沉伏细软无力者，谓之湿香港脚，乃三阴经受病也。
又曰∶香港脚治法，干香港脚初则疏散，中则和解，末则润下。湿香港脚初亦疏散，中亦和解，末则宜乎清补。
此外，还有散寒祛湿的方剂；木香、槟榔、香附、乌药是宣通行气道的药物；红花、桃仁是活血行瘀的药物；牛膝、杜仲、萆薢、虎骨是强壮筋骨的药物；人参、茯苓、白术、当归、芍药、地黄是补养气血的药物。只要使用得当，无论是攻邪还是补虚，都能取得疗效。（出自《锦囊》）
又说：香港脚（一种以足胫肿痛、软弱无力为主要表现的疾病）初起时症状很轻微，人们往往不能识别。此时饮食嬉戏如常，气力也正常，只有突然发作时脚部屈曲软弱不能活动这一异常表现。南北两地所感病因，虽有内外之殊，但根本原因都是肾虚。妇女患此病，也是由于血海空虚所致，与男子肾虚致病相同。如果病邪入腹冲心，呕吐不止，生命危在旦夕，宜用八味丸温阳逐邪。如果病邪入肾，则腰脚肿胀，小便不通，眼目额头出现黑气，胸中胀满气喘且呻吟，左尺脉绝者死。这是因为肾虚阳衰的人多犯此病，肾水乘袭心脏，克制心火。因此，对于肾气型香港脚，应当预先服用金匮肾气丸进行预防。
又说：南方由外感引起的，仅表现为小腿肿痛；北方由内伤导致的，有时会导致手部关节病变。治疗方法初期先用解散表邪的方法，随后必须通导大便，以引导邪气排出。
经典记载：睡觉出汗后受风吹，寒气凝结于皮肤则为痹证，凝结于血脉则为涩滞，凝结于足部则为厥证。
《素问·至真要大论》说：太阴湿土之气偏胜，火气郁结在内，流散于体表，导致足胫肿胀，饮邪发于中焦，水肿见于下部。凡是内伤酒食，导致脾胃运化之气亏损，清气不能上升，反而下流侵犯肝肾之位，注于足胫，再加上房事不节制，邪气乘虚而入，就形成香港脚，久治不愈，便成为顽固性疾病。坚硬如石的不叫石疽，肉色紫赤、皮肉溃烂的名为缓疽，只适宜用温补法治疗。
又说：香港脚患者可能出现进食后呕吐，厌恶闻食物气味，腹痛腹泻，或者大小便阻塞，或者精神昏沉迷糊，或者胡言乱语错乱，或者高热头痛，症状类似伤寒，称为香港脚攻心，多数死亡。
又说：脉象浮弦的属于风邪，濡弱的属于湿邪，洪数的属于热邪，迟的属于寒邪，微弱的属于虚证，牢坚的属于实证，结脉是因为气滞，散脉是因为忧思，紧脉是因为愤怒，细脉是因为悲伤。
又说：妇女十个脚趾感觉像被热油煎灼一样，这都是因为营卫之气虚弱，湿毒之气流滞于经络，上攻于心则心痛，下攻于脚则脚痛，脚趾如火烧般疼痛，类似于香港脚的症状，经书中所说的“热厥”就是这种情况。
《医论》说：香港脚这种疾病，都是由脾肾两经虚弱，在坐卧行动之间，受到风寒暑湿等邪气的干扰，流注而成。发病之初，人们往往不易察觉，必定感受其他病症后才开始发作，或者突然感到极度闷乱，经过两三天才发觉。病情先从脚部开始，有的表现为缓慢软弱疼痛麻木，行走时突然跌倒；有的表现为小腿肿胀饱满，或者足膝枯瘦细小；有的心中悸动不安，或者小腹感觉迟钝；有的大小便秘涩不通，或者全身转筋，骨节酸痛；有的厌恶闻食物气味，见食则吐逆；有的胸满气急，高热恶寒。病邪传变至足六经，外在症状与伤寒相似，只是突然脚痛这一特征不同。其表现不一，若寒邪侵入三阳经，患病必然怕冷；暑邪侵入三阴经，患病必然发热。脉浮而弦的起于风邪，濡而弱的起于湿邪，洪而数的起于热邪，迟而涩的起于寒邪。风邪用汗法，湿邪用燥法，热邪用清法，寒邪用温法。还应当根据四季、表里、虚实来治疗，切不可使用温补及汤药淋洗，这是医家的大忌。因为补益会导致气实，多致无法救治；淋洗则使邪毒内入，也难以治疗。治疗不及时，使毒瓦斯入腹冲心，攻筑作痛，喘满上气，呕吐异常，这就会逐渐导致倾覆危险，怎么可以忽视呢！
林氏说：有人问足背肿痛，明显是湿热，为什么称为香港脚？既然以“气”命名，也不失为湿热，为什么又有外感内因的区别，干湿寒热的差异，甚至发展到冲心呕逆、谵语神昏以致死亡？回答说：这个“气”字，自然与平常的湿热不同，这不是一朝一夕造成的。此证虽然由湿热微邪引起，然而沉伏于足三阴经已久，不能发泄，郁蒸化为热，瘀阻而红肿，肿而后痛。而且足三阴经脉从足内踝向上，至于大小腹部，再由腹部向上溢入手厥阴心包络和咽喉之间，所以肿痛必然牵引经络，而郁蒸之气又自下而上逆于心胸，遂至寒热似疟，恶心呕逆，所以有类似伤寒的别名。况且病发之初，没有不是由外感内因，或暴怒、房劳所触发的，于是内外兼证夹杂，仓促间难以辨别，初学者临证，茫然不懂用药，倘若不辨别表里虚实，妄投补泻寒热之药，没有不导致冲心危殆的。（出自《活人编》）
又说：有人问虽然说是香港脚，也不过是湿热久郁而成，有什么利害以至于死？如果真的能致人于死，那么其证候比伤寒更凶险，为什么又说类似伤寒呢？况且说“类”，也正是与伤寒相近，所以也有七日痊愈、七日死亡，十四日痊愈、十四日死亡的，据此难道不可以称为香港脚伤寒吗？回答说：香港脚与伤寒原本属于两种证候，难以混淆，只有寒热呕逆，以及三阴三阳传变深浅，与伤寒相似，所以说“类”。若论致死的原因，凡风寒暑湿之邪，无不通过经络传于六腑，以至五脏，从轻到重，从重到危，何止香港脚是这样，何必一定要与伤寒并论呢？
又说：脉象与形证，此证以湿热为本，客邪触发为标。发作时还从足部红肿微痛而起，肿得厉害则痛得更厉害，而郁蒸之气由经络进入足三阳之腑，所以有寒热交替发作，畏寒烦躁，恶心呕逆，烦渴引饮，喘急谵语，厌恶食物却又想吃，大小便秘结不通，其脉浮洪弦数有力的，称为干香港脚，是三阳经受病。如果大小便通利，汗多不渴，恶心呕逆，汤水难进，四肢厥冷戴阳，神昏谵语，六脉沉伏细软无力的，称为湿香港脚，是三阴经受病。
Furthermore, there are formulas for dispersing cold and eliminating dampness; *Muxiang* (Aucklandiae Radix), *Binglang* (Arecae Semen), *Xiangfu* (Cyperii Rhizoma), and *Wuyao* (Linderae Radix) are agents that promote the circulation of Qi in the air passages; *Honghua* (Carthami Flos) and *Taoren* (Persicae Semen) are agents that invigorate blood and resolve stasis; *Niuxi* (Achyranthis Bidentatae Radix), *Duzhong* (Eucommiae Cortex), *Bixie* (Dioscoreae Hypoglaucae Rhizoma), and *Hugu* (Pantheris Os) are agents that strengthen sinews and bones; *Renshen* (Ginseng Radix), *Fuling* (Poria), *Baizhu* (Atractylodis Macrocephalae Rhizoma), *Danggui* (Angelicae Sinensis Radix), *Shaoyao* (Paeoniae Radix), and *Dihuang* (Rehmanniae Radix) are agents that nourish Qi and Blood. If used appropriately, whether attacking pathogens or tonifying deficiency, efficacy can be achieved. (From *Jinnang*)
It is also said: In the early stage of Hongjiaojiao (a disease characterized by swelling and pain in the lower legs and weakness), symptoms are very subtle, often unrecognized by people. Diet, play, and physical strength remain normal; the only abnormality is the sudden onset of foot flexion weakness and immobility. Although the etiology differs between internal and external factors in the North and South, the root cause is always Kidney Deficiency. Women suffering from this condition do so due to emptiness of the Sea of Blood, which is the same as Kidney Deficiency in men. If the pathogen enters the abdomen and attacks the Heart, with incessant vomiting, life is in imminent danger. It is appropriate to use *Bawei Wan* (Eight-Ingredient Pill) to warm and expel the pathogen. If the pathogen enters the Kidney, there will be swelling of the waist and feet, obstruction of urination, black qi around the eyes and forehead, chest fullness with wheezing and groaning, and death if the left Chi pulse is absent. This is because individuals with Kidney Deficiency and Yang Decline are prone to this disease; Water of the Kidney overacts on the Heart, suppressing Fire. Therefore, for Kidney-Qi type Hongjiaojiao, one should take *Jinkui Shenqi Wan* (Golden Cabinet Kidney Qi Pill) in advance for prevention.
It is also said: Those contracted externally in the South manifest only as swelling and pain in the lower shins; those caused internally in the North may affect the hand joints. The treatment method initially uses dispersion to release the exterior, followed by purging the bowels to guide out the pathogenic factors.
The Classics state: Sweating while sleeping and then being exposed to wind causes凝 (coagulation/stagnation). When it coagulates in the skin, it becomes Bi Syndrome (Obstruction); when it coagulates in the vessels, it becomes Qi stagnation; when it coagulates in the feet, it becomes Jue (Cold Reversal).
The *Treatise on the Great Truth and Necessity* (*Zhi Zhen Yao Da Lun*) says: When Taiyin Dampness prevails, Fire Qi is depressed internally and flows outward, causing swelling of the lower legs and thighs, fluid retention in the middle, and edema in the lower body. Any internal injury from alcohol and food leads to a deficit in the Spleen and Stomach's transportation and transformation Qi. Unable to ascend, it flows downward and attacks the Liver and Kidney positions, pouring into the lower legs and thighs. Added to irregular sexual activity, pathogens invade the deficiency, resulting in Hongjiaojiao. If not cured for a long time, it becomes a stubborn disease. Hardness like stone is called Shiju (Stone Abscess); flesh color purple-red with ulcerated skin and flesh is named Huanju (Slow Abscess), which requires only warm tonification.
It is also said: Hongjiaojiao may present with vomiting after eating, aversion to the smell of food, abdominal pain with diarrhea, or obstruction of both urine and stool; mental confusion; delirious speech; high fever and headache. These resemble Shanghan (Cold Damage), named "Hongjiaojiao attacking the Heart," which is mostly fatal.
It is also said: A floating and wiry pulse indicates Wind; a soggy and weak pulse indicates Dampness; a surging and rapid pulse indicates Heat; a slow pulse indicates Cold; a minute pulse indicates Deficiency; a firm and hard pulse indicates Excess; a knotted pulse is due to Qi stagnation; a scattered pulse is due to worry; a tight pulse is due to anger; a fine pulse is due to sorrow.
It is also said: When women's ten toes feel as if scalded by hot oil, it is all due to deficiency of Ying (Nutritive) and Wei (Defensive) Qi, with Damp-Toxin flowing and stagnating in the meridians. Attacking upward to the Heart causes Heart pain; attacking downward to the feet causes foot pain, with toes burning like fire. This resembles Hongjiaojiao, which the Classics refer to as "Heat Jue."
The *Medical Treatise* states: The disease of Hongjiaojiao is caused by weakness in the Spleen and Kidney meridians. During sitting, lying, moving, or acting, one is interfered with by Wind, Cold, Summerheat, and Dampness, leading to flow and accumulation. At the beginning of the illness, it is often imperceptible. It must be triggered by another illness to start, or one may suddenly feel extremely stifled, realizing it only after two or three days. It starts from the feet: sometimes presenting as slow weakness, pain, and numbness, falling suddenly when walking; sometimes lower leg swelling and fullness, or withered and thin feet and knees; sometimes palpitations in the heart, or insensitivity in the lower abdomen; sometimes constipation of urine and stool; sometimes general muscle spasms and soreness of bone joints; sometimes aversion to food smells, vomiting upon seeing food; sometimes chest fullness and shortness of breath, high fever with aversion to cold. The pathogen transmits through the Foot Six Meridians, and external signs resemble Shanghan, except for the sudden foot pain. Manifestations vary: if Cold affects the Three Yang meridians, the patient feels cold; if Summerheat affects the Three Yin meridians, the patient feels hot. A floating and wiry pulse arises from Wind; a soggy and weak pulse arises from Dampness; a surging and rapid pulse arises from Heat; a slow and choppy pulse arises from Cold. For Wind, use sweating; for Dampness, use drying; for Heat, use clearing; for Cold, use warming. One must also treat according to the four seasons, interior/exterior, and deficiency/excess. Warm tonification and herbal foot baths must strictly be avoided; this is a major taboo for physicians. Tonification leads to Qi excess, often resulting in untreatable conditions; foot baths allow pathogenic toxins to enter inward, making them difficult to treat. If treatment is delayed, allowing toxic vapors to enter the abdomen and attack the Heart, causing pounding pain, wheezing, fullness, and abnormal vomiting, it gradually leads to collapse and danger. How can this be neglected!
Lin Shi said: Someone asked, "Swelling and pain of the dorsum of the foot clearly indicate Damp-Heat, why is it called Hongjiaojiao? Since it is named 'Qi,' it is still Damp-Heat. Why are there distinctions between external contraction and internal causes, dry/wet, cold/heat, even progressing to attacking the Heart, vomiting, delirium, coma, and death?" The answer is: This 'Qi' is different from ordinary Damp-Heat. It is not caused overnight. Although this syndrome originates from slight Damp-Heat pathogens, they have been dormant in the Foot Three Yin meridians for a long time, unable to vent, becoming stagnant and steaming into Heat, stasis causing redness and swelling, swelling followed by pain. Moreover, the Foot Three Yin meridians run from the medial malleolus up to the lower abdomen, then further up to the pericardium and throat. Thus, swelling and pain necessarily involve the meridians, and the steaming Qi reverses upward to the chest and heart, leading to chills and fever resembling malaria, nausea, and vomiting. Hence the alias 'resembling Shanghan.' Furthermore, at the onset, the disease is invariably triggered by external contraction and internal causes, such as sudden anger or sexual fatigue. Thus, internal and external mixed syndromes occur, making differentiation difficult in haste. Beginners, confused about medication, if they fail to distinguish interior/exterior and deficiency/excess, and recklessly administer tonifying/purging and cold/hot drugs, will inevitably lead to critical conditions of attacking the Heart. (From *Huren Bian*)
It is also said: Someone asked, "Although it is called Hongjiaojiao, it is merely long-standing Damp-Heat stagnation. What harm is there to cause death? If it can indeed kill, its severity exceeds Shanghan. Why call it 'resembling' Shanghan? Since it is similar, there are cases of recovery/death in seven days or fourteen days. Based on this, could it not be called Hongjiaojiao Shanghan?" The answer is: Hongjiaojiao and Shanghan originally belong to two different syndromes and cannot be confused. Only the chills, fever, vomiting, and the depth of transmission through the Three Yin and Three Yang meridians resemble Shanghan, hence the term 'resembling.' Regarding the cause of death, any pathogen of Wind, Cold, Summerheat, or Dampness transmits from meridians to the Six Fu organs, and then to the Five Zang organs, from mild to severe, and from severe to critical. Why single out Hongjiaojiao to compare with Shanghan?
It is also said: Regarding pulses and manifestations, this syndrome has Damp-Heat as the root and triggering pathogens as the branch. Onset begins with slight redness, swelling, and pain in the feet. Severe swelling leads to severe pain, and the steaming Qi enters the Fu organs of the Foot Three Yang meridians via the channels. Thus, there are alternating chills and fever, aversion to cold, irritability, nausea, vomiting, thirst with desire to drink, panting, delirium, aversion to food yet ability to eat, and constipation of both urine and stool. If the pulse is floating, surging, wiry, rapid, and forceful, it is called Dry Hongjiaojiao, indicating disease in the Three Yang meridians. If urine and stool are free, sweating is profuse without thirst, but there is nausea, vomiting, inability to tolerate fluids, cold limbs with floating Yang (dai yang), coma, and delirium, and the six pulses are deep, hidden, fine, soft, and powerless, it is called Wet Hongjiaojiao, indicating disease in the Three Yin meridians.
It is also said: Treatment methods for Hongjiaojiao: For Dry Hongjiaojiao, initially disperse and diffuse, mid-stage harmonize, late stage moisten and purge. For Wet Hongjiaojiao, initially disperse and diffuse, mid-stage harmonize, late stage clear and tonify.