三三医书第二集第十九种
宋董汲撰 裘吉生刊行
汲尝考诸经脚气之疾，其来久矣，在黄帝时名为厥，两汉之间多为缓风，宋齐
之后，谓为脚弱，至于大唐，始名脚气，其号虽殊，其实一也，厥病之由，虽皆凝风
毒湿气中于肝肾脾经，其脉起于足十指，且风毒之气出于地，寒暑风湿皆作
蒸气足常履之，故内传经络因成肿痛挛弱，乃名脚气，然感疾之由，若在夏月
久坐立于湿地，则湿热之气蒸入经络，病则发热，四肢疼闷，若在冬月久坐立
于湿地则冷湿之气上入经络，病则转筋，百体酷冷，若当风取?，得之病则皮
内顽痹，诸处蠕动，渐渐向头面，此三者尤宜辨知，但后学不能深察，即妄为治
疗，轻者变重，重者难治，可不慎哉，其既得之后，或虚或实，或冷或热，皆由素禀
故脚气之候，有轻有重，有干有湿，有阴有阳，有实有虚，干者风毒在络膝腿致
或瘦或痛，或挛或缓弱不遂，喘渴头痛，大小便闭，或顽痹不仁。湿者湿毒在经
腿肿皮肉紫白裂破作疮内自脓坏大便或泄或秘或为便痈烦躁不欲饮食。
阴者风毒在藏恶明好静即身冷足厥筋挛或小腹不仁阳者风毒在府病发
即身胫热筋脉抽痛为缓纵不收寒热头痛喜嗔 ?好明处器促精神昏愦者
因常服补暖药壅秘而生故为寒热喘满喜妄误语壮热头痛虚者嗜欲无节
荣卫空虚骨髓枯竭复不饵补药身体酷冷两胫酸痛膝冷转筋不能行动喘
促此其候之不同也若论其脉则唐苏恭尝谓有三脉缓为轻沈为次洪数为
下大 沈紧者为难治洪数者易治缓者不疗自瘥若疗之违法虽轻亦重疗
之得理虽重亦轻大抵脉顺四时者生违四时者难治盖脉沈紧为邪入裹伤
痹也故重沈洪数者阳有余与风厥相应故易治缓者邪气微故自瘥又孙思
邈之论亦云脉有三品内外证候相似但脉有异若脉浮大而缓宜服续命汤
若素风盛以越婢汤若脉浮而紧转驶而作竹沥汤若脉微而弱宜风引汤此
脉多是阴虚而得之若大虚短气宜间作补汤随病冷热而用之然古人治此
有门大率风多而湿少及服风引续命越婢之类湿多而风少即宜独活寄生
汤薏苡汤之类若一 用药则难奇效全当消息之至如江淮岭南秦川四时
气候随异如此人久在江淮及岭南宦客风毒在藏府或归秦中脚气发动亦
根据江淮岭南法为治盖秦川地原高亢春夏纵经霖霪少有蒸湿所以禾黍五
榖受气不同水菜鱼肉食饮全异其地卑湿者则蒸热相仍利于燥药土地高
亢者则时宜汗利又如诸方脚气本以肾虚或者用药补益十未有全其一二
者盖虽由肾虚因感风湿故邪气益盛盛则虽虚而实反将峻补故壅气生喘
满千金云腹胀非泻不愈者正谓是也又素问脚气之人只壮以秋冬良由阳
内而阴外无蒸疾之气故有风毒之人须准四时服食即无发动故春夏宜汗
利秋冬乘疾小歇宜以诸药小滋补之则气平而不作今之医者只以家传之
学不能深究其理但一向补益或只?下盖不得中道也若在冬月须当随人
盛衰微有滋补若不然则致使血气日衰必使年年遇蒸热而作此理之然也
昔人有云脚气有肾虚而生或者以妇人不主于肾便谓无此疾者非也盖妇
人虽不专主于肾而必因血海虚乘宿块嗔恚感激悲伤遂成此疾兼今妇人
病此者甚众则知妇人以血海虚而得之与男子肾虚类矣凡治妇人之法与
男子用药故无有异但兼以治忧恚药无不效也汲昔熙宁年因行大雪中为
寒湿冷气相乘遂成兹疾十年之间凡七八发动每发至剧而证候差异一旬
之内变候不等因深思其源博求古方采摘要法累试神方不敢私隐传而录
之脚气发动大抵虽同然三分论之一分有异当根据法循证治之乃瘥其同者
手足厥缓弱顽痹不人肿痛或疮小愈之后仍宜根据四季法服食无不效者若
夫痿厥不能动者比此为微但只以诸脚气法治之指期可效谨根据四时之宜
方药之法其名录之于后
论曰古之太医往往因自病或亲属有疾故究心积虑遂为高医良由日见变
候斟酌冷热虚实悉所经历则唐孙真人甄权苏恭深师道人之类皆其入也
谚曰千闻不如一见此之谓也今具实经病脚气人已尝试用得效方别为一
们所贵临时有可根据也
论曰人有久蓄积气因感风毒成疾之后或一向补益不经汗利即使风毒成
实因致秘积壮热喘满脚肿赤痛大小便秘喜妄误语者是其候也宜紫气红
雪防风汤神功圆角犀饮如小便涩即服绛宫圆白皮小豆散治之
论曰阳气衰于下则为寒厥其人足胫寒筋挛急胫酸膝冷痛或顽痹不仁恶
明好静此其候也宜以石南圆金牙酒侧子酒八味圆海桐皮散木香饮子松
节散及灸风市穴即愈
论曰人有禀赋气虚及兴居不节或谓脚气不可滋补冬月略不小补但服?
泻药过度使藏虚而两脚削身体酷冷少力膝冷转筋挛紧而重者是其候也
宜风引汤八味木瓜圆石南圆金牙酒侧子酒及灸绝骨穴于冬时服之即免
毒气入腹疾不作也
论曰凡针灸孔穴主对者穴名在上病状在下其脚气一病最宜针灸灸而不
针者非也针灸而不药尤非也脚气初得便速针灸若专以药不针灸则可半
差矣然尺寸之法人有长短肤有肥瘦皆须精思准折之不得一概致有差失
尺寸之准以铜人随中指中纹为是若坐点穴者坐灸之卧点穴者卧灸之立
点穴者立灸之不根据此者徒破肉耳苏恭有云脚气始发通随痛处灸不必根据
穴者亦如素问缪刺之法亦可根据用
初灸风市（主两膝挛痛引?拘急?躄或青或黄枯黧如腐木缓纵痿痹）
次灸伏兔（主中寒按甲乙经云足阳明经刺可五分不可过也）次灸犊鼻
（主膝中痛不仁难跪此穴肿不可灸亦不可刺）次灸膝两眼（主膝冷痹
痛）次灸三里穴（主腰疼不能久立膝痿腹胀满内廉痛足痿失履不收）
次灸上廉穴（主小便难赤黄狂言非常）次下灸廉穴（主小便难赤黄）
次灸绝骨穴（主风劳身肿髀枢痛膝骨酸血痹不仁筋缩诸节酸折四肢懈
惰不收风劳身重）
论曰风湿毒气中于足胫遂为脚气若久而不治或治之一向用?下药藏气
虚弱毒势内攻入腹闷乱烦喘气不得息若下不速以凑毒之药必致恶气内
薰五藏使三焦荣卫不通则治疗为难譬由浸淫疮从四指流向心腹者不治
从心腹流向四肢者易治此疮毒不由经络外自皮肤者尚尔又?风毒因经
络受邪而内达五藏者欤如此势极内攻入腹者无出木瓜茱萸汤最救困急
服饵之后虽使恶毒邪湿盛来无由入矣
论曰凡脚气治法大抵每日须进食前丸食后丸在春夏当服防风续命越婢
竹沥风缓八风独活寄生海桐皮等汤若大便秘则服神功丸麻仁丸三脘散
三仁丸橘香丸润肠丸若小便不通即服白皮小豆散绛宫丸木通散尤宜针
石之类取证最亲者服之秋冬脚气正是小歇当服金牙侧子酒肾沥汤石南
丸八味丸木瓜丸牛膝丸及灸亦取证亲者用之四时之中皆宜淋炸蒸熨寅
日去手甲理发丑日濯足去脚甲令深取大去风气故也有力之人当作天门
冬大煎四时不阙服之此最脚气之要方但难得药材尔病者宜知此方天门
冬大煎治男子五劳七伤八风十三痹伤中六极一气极则多寒痹腹痛喘息
惊恐头痛二肺极则寒痹腰痛心下坚有积聚小便不利手足不仁三脉极则
颜色苦青逆噫嘻恍惚失气状似悲泣之后苦舌强咽喉干寒热恶风不可动
不嗜食苦眩喜怒妄言四筋极则拘挛少腹坚胀心痛膝寒冷四肢骨节皆疼
痛五骨极则肢节厥逆黄疸消渴痈疽妄发重病浮肿如水病状六肉极则发
疰如鬼击不复言甚者至死复生众医所不治此皆六极七伤所致非独房室
之为也忧恚积思喜怒悲欢复随风湿结气欬时呕吐食物为便大小便不利
时泄利重下溺血气上吐下乍寒乍热卧不安席小便赤黄时时恶梦与死人
共食饮入家神室魂飞魄散筋极则伤肝伤肝则腰背相引难作俛仰气极则
伤肺伤肺则小便有血目不名髓极则阴痿不起住而不交骨极则伤肾伤肾
则短气不可久立阴疼恶寒甚者卵缩阴下生疮湿痒瘙之不欲住汗出神昏
为肾病甚者多遭风毒四肢顽痹手足浮肿名曰脚弱肾所不治此悉主之熙
宁年间有济南崔公即中直先自川中病风得安时其子生须城簿迎侍于此
经夏涉履蒸湿脚为之肿弱挛痛于沂州取得 骨汁川中得真酥遂合成半
剂服之即应细详此方通四时括众虚实寒热率皆主对乃之孙真人之用心
处疗有如此者世之人或有药品繁多求索难得遂于受疾而惮于修至良可
叹也
论曰风阳物也性上腾脚气厥之人气多上行不顺薄而生热内枯津液遂为
秘滞如肥泽壮实热风盛者当以神功丸麻仁丸大黄汤之类如老人津液少
及素虚遇秘者当服三仁丸五柔丸润肠丸橘皮丸三脘散之类此二候不同
切宜斟酌而用也
论曰足经受卑湿之气及膀胱宿有停水甚者攻注肿破皮肉顽紫世所谓下
注肾风者乃其候也亦有成疮但肿痛痹弱者宜独活寄生汤薏苡汤其已攻
注者宜茴香丸天麻丸乌蛇丸及陈元膏摩之
论曰凡脚气人足经留滞淋炸蒸熨最为要然当先煎?成诸汤玉琳炸时自
膝下至踝以故衣裹数重随将温汤徐徐沃汤在膝下慎不可先炸两足须自
膝炸至足益风气从足甲出若先炸足及风毒上行入腹切宜慎之炸讫后去
足甲为良当用丑日或十二日一去之
论曰夫人法天地之形禀阴阳而生四时寒暑推移人气不定脚气发动必由
天之五气地之五行治之虽其间变易小有不同而大法不过如此故谨序月
令条法于其下凡正月二月天气正方地气始发人气在肝宜导和气加厚袜
以暖足宜进地黄粥补虚防风粥以去四肢风紫苏粥以去壅气及桑皮煎竹
沥防风风引续命风缓越婢独活海桐皮八风等汤以徐风及宜淋炸蒸煨足
膝以利关节导引按跷以舒壅滞针石以开发邪气三月四月天气正方地气
正定发人气在脾宜食薤以散结气利病人又取栋花和粉粉身以固阳气除
邪亦宜前治风药以除邪气大抵春三月天地俱生万物以荣夜卧早起广步
于庭被发缓形以便志生生而勿杀予而弗夺赏而勿罚此春气之应养生之
道也及宜进温食尤移丸煎以除风热之疾五月六月天气正盛地气高人气
在头宜服独活寄生汤以凑风湿气宜木瓜浆以解渴利腰脚大抵夏三月此
谓蕃秀天地气交万物华实早卧早起无厌于日使智无怒使华英成秀使气
得泄此夏气之应养长之道也七月八月阴气始杀人气在肺宜温下频易袜
履以防湿气宜独活寄生汤海桐皮散薏苡汤以温下除湿毒之气大抵秋三
月此谓容平无外其志使肺气清此秋气之应养成之道也九月十月阴气始
冰地气闭人气在心脚气正是小歇当饮金牙侧子酒肾沥汤牛膝石南木瓜
八味等丸小小补之不可导引按跷十一月十二月冰冻地气合人气在肾宜
前诸补药以益元真及诸灸腰肾御寒邪气也亦不宜导引动气大抵冬三月
此谓闭藏水冰地圻无扰乎阳早卧晚起必待日光使志若伏若匿若有私意
若已有得去寒就温使气涵养此冬气之应养藏之道也
治验嘉佑二年正月二十六日殿直郭中立来求孙殿丞兆诊脉久患脚气疼
痛身发寒热胀满气上服热药及甚兆与九味延年茯苓饮子以下其气每用
六物麻仁丸以泄其热后又上气呕逆烦热遂令服局方紫雪大效（延年茯
苓饮麻仁丸方见本门）
熙宁年间崔郎中直病脚气肿弱枯瘦不能行汲作千金方天门冬大煎服之
即差永不发方见后董文思中行为汶上驻泊日忽觉两脚赤肿疼足下隐痛
汲与食前丸食后丸即差即冬月令作金牙酒并淋炸遂不复作
梁承议子谅病膝痛不能跪翰林医官杨文蔚处海桐皮散服之遂愈吴宣义
管在汶上病脚气中满宣义郎席公延赏处顺气丸麻仁丸神仙丸遂愈冯侍
郎宅十五小娘子病脚弱不能步翰林尚药奉御孔元处千金方独活寄生汤
遂愈
汲熙宁年间因冬月行大雪中至春两脚忽然赤肿疼痛痿弱不能行走遂服
犀角饮及韶脑汤蜀椒汤淋炸得差经月再作自脚及通身肿气渐上入腹心
烦腹满气促面如土色大小便不通遂以?榔一枚为未诃子炮去复选末一
钱生牵牛取末二钱以童子小便二盏生姜一钱切煎一沸去姜调前药末分
二服小便大利肿遂消尽后两脚作疮久久不愈以天麻丸鸟蛇丸摩以陈元
膏疮遂愈但觉脚弱无力冬月进以木瓜丸食前丸金牙酒脚遂有力
脚气治法总要卷上终
我曾考证各种经典中关于脚气病的记载，其历史由来已久。在黄帝时代称为“厥”，两汉之间多称为“缓风”，宋齐之后称为“脚弱”，到了大唐时期，才正式称为“脚气”。虽然名称不同，但实质是一样的。厥病的原因，都是风寒湿毒侵袭肝肾脾经，脉气起于足十趾。而且风毒之气源于大地，寒暑风湿都化作蒸气，脚经常踩踏地面，所以邪气内传经络，形成肿痛、挛急、软弱，这才称为脚气。然而感生病痛的原因，如果在夏季长时间坐或站在潮湿的地方，湿热之气蒸腾进入经络，发病时会出现发热、四肢疼痛闷胀；如果在冬季长时间坐或站在潮湿的地方，冷湿之气上行进入经络，发病时会出现转筋（肌肉痉挛）、全身极度寒冷；如果迎风取凉，得病后皮肤内部麻木不仁，各处有蠕动感，逐渐向上蔓延至头面部。这三种情况尤其需要辨别清楚。只是后来的学者不能深入考察，就胡乱进行治疗，轻症变成重症，重症难以治愈，能不谨慎吗？
患病之后，病情或虚或实，或冷或热，都由患者原本的体质决定。所以脚气的证候，有轻有重，有干有湿，有阴有阳，有实有虚。
干证：风毒在络脉，膝盖和小腿导致身体消瘦或疼痛，或拘挛或松弛无力，气喘口渴，头痛，大小便闭塞，或皮肤麻木不仁。
湿证：湿毒在经脉，小腿肿胀，皮肤肌肉紫白相间裂破成疮，内部化脓溃烂，大便或泄泻或秘结，或成为便痈，烦躁不想饮食。
阴证：风毒在脏，怕光喜静，身体寒冷，足部厥冷，筋脉拘挛，或小腹麻木不仁。
阳证：风毒在腑，发病时小腿发热，筋脉抽掣疼痛，松弛不收，恶寒发热，头痛，喜欢发怒，喜欢明亮的环境，气息短促，精神昏沉。这是因为长期服用补暖药物，导致气机壅滞便秘而产生的。
虚证：嗜欲没有节制，营卫空虚，骨髓枯竭，又不服用补药，身体极度寒冷，两小腿酸痛，膝盖寒冷，转筋，不能行动，气喘急促。这是证候的不同之处。
若论及脉象，唐代苏恭曾说有三种脉象：缓脉为轻症，沉脉为次症，洪数为下症。大沉紧的脉象为难治，洪数的脉象易治，缓脉的不治疗自己也会痊愈。如果治疗违背法则，即使是轻症也会变重；如果治疗合乎道理，即使是重症也会变轻。大体上，脉象顺应四时变化的能生存，违背四时变化的难治。因为脉象沉紧是邪气入里损伤痹阻，所以重；脉象沉洪数是阳气有余，与风厥相应，所以易治；缓脉是邪气微弱，所以自己会痊愈。另外孙思邈的论述也说脉分三品，内外证候相似，但脉象不同。如果脉象浮大而缓，宜服用续命汤；如果素来风盛，用越婢汤；如果脉象浮而紧，转动剧烈则作竹沥汤；如果脉象微而弱，宜用风引汤。这些脉象多是阴虚所致。如果非常虚弱、气短，适宜间歇服用补汤，根据病情的冷热来使用。
然而古人治疗此病有门道，大体上风多湿少，以及服用风引汤、续命汤、越婢汤之类的方剂；湿多风少，即宜服用独活寄生汤、薏苡汤之类的方剂。如果一概用药，很难取得奇效，全在于斟酌权衡。至于江淮、岭南、秦川四个地区，四季气候各不相同。这样的人长期居住在江淮及岭南，作为宦游之客，如果风毒在脏腑，或者回到秦中引发脚气，也应当根据江淮、岭南的方法治疗。大概秦川地势高亢干燥，春夏即使经过连绵阴雨，也少有蒸腾湿气，所以禾黍五谷受的气不同，水菜鱼肉饮食完全不同。地势低洼潮湿的地方，则蒸热相继，利于使用燥药；土地高亢的地方，则时常适宜发汗利水。又如各方认为脚气本因肾虚，有的人用药补益，十个人中没有一两个能完全治愈的。大概虽然由肾虚引起，但因感受风湿，所以邪气更加旺盛。旺盛时，虽然是虚证却表现为实证，反而不能用峻猛补药，否则会导致气机壅滞产生喘满。《千金方》说腹胀非泻不愈，正是这个意思。又《素问》说脚气之人，只在秋冬季节良好，是因为阳气在内而阴气在外，没有蒸疾之气。所以有风毒的人必须按照四季来服药饮食，就不会发作。因此春夏宜发汗利水，秋冬趁疾病小歇时，宜用诸药稍微滋补，这样气机平和而不发作。现在的医生只凭家传之学，不能深究其理，只是一味补益，或者只用攻下药，这不得其中道。如果在冬季，必须根据人的盛衰稍微滋补，不然就会导致血气日渐衰弱，必然使每年遇到蒸热时发作，这是理所当然的道理。
过去有人说脚气由肾虚而生，有的人因为妇女不以肾为主，便说妇女没有此病，这是不对的。大概妇女虽然不专主于肾，但必定因为血海空虚，乘着宿块（瘀血积块），或因嗔恚感激悲伤，遂成此疾。况且现在患此病的妇人很多，就知道妇人是因血海空虚而得病，与男子肾虚类似。凡是治疗妇人的方法，与男子用药没有不同，只要兼以治疗忧愤的药物，没有不有效的。
我曾在熙宁年间，因为在大雪中行走，被寒湿冷气相乘，于是得了这个病。十年之间，凡发作七八次，每次发作都很严重，且证候各异，十天之内变化不等。因此深思其根源，广泛求取古方，采摘要法，屡次尝试神方，不敢私藏，传录如下。脚气发作大体相同，但三分之中有一分差异，应当根据法则，循证治疗，才能痊愈。其相同的部分，手足厥冷、迟缓、软弱、麻木不仁、肿痛或疮疡，小愈之后，仍应依照四季法则服药饮食，无不有效。至于痿厥不能动的，比此稍轻，只需以各种脚气法治之，指定期限即可见效。谨根据四时的适宜，方药的法度，名录于后。
论曰：古代的太医往往因为自己生病或亲属有病，所以用心积虑，遂成为高明的医生。大概是因为日日见到变化之候，斟酌冷热虚实，全都经历过。所以唐代的孙真人、甄权、苏恭、深师道人等，都属于这类人。谚语说“千闻不如一见”，就是这个意思。现在列出确实经过脚气病人尝试、用得有效的方子，另列一门，所贵的是临时有可以根据的。
论曰：人有久蓄积气，因感受风毒成疾之后，如果一味补益，不经发汗利水，即使风毒成实，导致便秘积聚、壮热、喘满、脚肿赤痛、大小便闭、喜欢胡言乱语，这是其证候。宜用紫气红雪防风汤、神功圆、角犀饮。如果小便涩滞，即服绛宫圆、白皮小豆散治疗。
论曰：阳气衰于下则为寒厥。其人足胫寒冷，筋脉拘挛急迫，小腿酸软，膝盖冷痛，或皮肤麻木不仁，怕光喜静。这是其证候。宜用石南圆、金牙酒、侧子酒、八味圆、海桐皮散、木香饮子、松节散，以及灸风市穴，即可痊愈。
论曰：人有禀赋气虚，以及起居不节制，或者说脚气不可滋补，冬季略微不补，只服用泻药过度，使脏气虚弱，两脚削瘦，身体极度寒冷，少力，膝盖冷，转筋挛紧而重，这是其证候。宜用风引汤、八味木瓜圆、石南圆、金牙酒、侧子酒，以及灸绝骨穴，在冬季服用，即可避免毒气入腹，疾病不再发作。
论曰：凡是针灸孔穴主治对应，穴名在上，病状在下。脚气这一病，最宜针灸。只灸不针，是不对的；只针灸而不吃药，更是错误。脚气初得，便迅速针灸。如果专用药物而不针灸，则可以减半疗效。然而人的尺寸长短，皮肤肥瘦，都必须精心思考，准确衡量，不得一概而论，以致有差错。尺寸的准则，以铜人模型随中指中间纹路为准。如果坐着点穴，就坐着灸；躺着点穴，就躺着灸；站着点穴，就站着灸。不根据这些，只是徒然破坏肌肉罢了。苏恭曾说：“脚气始发，通常跟随疼痛处灸，不必拘泥于穴位。”这也如同《素问》缪刺之法，也可以根据使用。
初灸风市穴（主治两膝挛痛牵引，拘急跛行，或青或黄，干枯黧黑如腐木，松弛痿痹）。
次灸伏兔穴（主治中寒。按《甲乙经》说，足阳明经针刺可五分，不可超过）。
次灸犊鼻穴（主治膝中痛、麻木不仁、难跪。此穴肿胀不可灸，也不可刺）。
次灸膝眼穴（主治膝冷痹痛）。
次灸三里穴（主治腰痛不能久立，膝痿，腹胀满，内侧痛，足痿失履不收）。
次灸上廉穴（主治小便难、赤黄、狂言非常）。
次灸下廉穴（主治小便难、赤黄）。
次灸绝骨穴（主治风劳身肿，髀枢痛，膝骨酸，血痹不仁，筋缩，诸节酸折，四肢懈怠不收，风劳身重）。
论曰：风湿毒气中于足胫，遂为脚气。如果久而不治，或治疗时一味用攻下药，脏气虚弱，毒势内攻入腹，闷乱烦喘，气不得息。如果不迅速用凑毒之药，必致恶气内薰五脏，使三焦营卫不通，则治疗为难。譬如浸淫疮，从四指流向心腹者，难治；从心腹流向四肢者，易治。这种疮毒不由经络，外自皮肤尚且如此，又何况风毒因经络受邪而内达五脏呢？像这样势极内攻入腹的，没有比木瓜茱萸汤更能救困急的了。服用之后，即使恶毒邪湿盛来，也无从进入了。
论曰：凡脚气治法，大体上每日须进食前服丸药，食后服汤药。在春夏当服防风续命汤、越婢汤、竹沥汤、风缓汤、八风汤、独活寄生汤、海桐皮散等。如果大便秘结，则服神功丸、麻仁丸、三脘散、三仁丸、橘香丸、润肠丸。如果小便不通，即服白皮小豆散、绛宫丸、木通散，尤其适宜针石之类，取证最亲近者服用。秋冬脚气正是小歇之时，当服金牙酒、侧子酒、肾沥汤、石南丸、八味丸、木瓜丸、牛膝丸，以及灸法，也是取证亲近者使用。四季之中，皆适宜淋炸、蒸熨。寅日去除手甲理发，丑日洗足去脚甲，令深取大，去风气。有力之人当作天门冬大煎，四季不缺服用。这是最紧要的脚气方，只是难得药材罢了。病者应当知道。此方天门冬大煎，治男子五劳七伤、八风十三痹、伤中六极。一气极则多寒痹腹痛、喘息、惊恐、头痛；二肺极则寒痹腰痛、心下坚、有积聚、小便不利、手足不仁；三脉极则颜色苦青、逆噫嘻、恍惚失气、状似悲泣之后、苦舌强、咽喉干、寒热恶风、不可动、不嗜食、苦眩、喜怒妄言；四筋极则拘挛、少腹坚胀、心痛、膝寒冷、四肢骨节皆疼痛；五骨极则肢节厥逆、黄疸、消渴、痈疽妄发、重病浮肿如水病状；六肉极则发疰、如鬼击、不复言、甚者至死复生、众医所不治。此皆六极七伤所致，非独房室之为也。忧恚积思、喜怒悲欢，复随风湿结气、咳时呕吐食物、为便、大小便不利、时泄利重下、溺血、气上吐、下乍寒乍热、卧不安席、小便赤黄、时时恶梦与死人共食、饮入家神室、魂飞魄散。筋极则伤肝，伤肝则腰背相引、难作俯仰；气极则伤肺，伤肺则小便有血；目不名髓极则阴痿不起、住而不交；骨极则伤肾，伤肾则短气、不可久立、阴疼、恶寒、甚者卵缩、阴下生疮、湿痒瘙之不欲住、汗出神昏，为肾病。甚者多遭风毒，四肢顽痹，手足浮肿，名曰脚弱，肾所不治，此悉主之。
熙宁年间，有济南崔公，即中直先，自己从川中病风得安时，其子生须城簿，迎侍于此。经夏涉履蒸湿，脚为之肿弱挛痛。于沂州取得骨汁，川中得真酥，遂合成半剂，服之即应。细详此方，通四时，括众虚实寒热，率皆主对，乃孙真人之用心处。疗有如此者。世之人或有药品繁多，求索难得，遂于受疾而惮于修治，良可叹也。
论曰：风属阳物，性上腾。脚气厥之人气多上行不顺，薄而生热，内枯津液，遂为秘滞。如肥泽壮实、热风盛者，当以神功丸、麻仁丸、大黄汤之类。如老人津液少及素虚遇秘者，当服三仁丸、五柔丸、润肠丸、橘皮丸、三脘散之类。此二候不同，切宜斟酌而用也。
论曰：足经受卑湿之气，及膀胱宿有停水，甚者攻注肿破皮肉，顽紫。世所谓下注肾风者，乃其候也。亦有成疮，但肿痛痹弱者，宜独活寄生汤、薏苡汤。其已攻注者，宜茴香丸、天麻丸、乌蛇丸及陈元膏摩之。
论曰：凡脚气人，足经留滞，淋炸蒸熨最为要。然当先煎成诸汤。玉琳炸时，自膝下至踝，以故衣裹数重，随将温汤徐徐沃汤在膝下。慎不可先炸两足，须自膝炸至足，益风气从足甲出。若先炸足，及风毒上行入腹，切宜慎之。炸讫后，去足甲为良。当用丑日或十二日一去之。
论曰：夫人法天地之形，禀阴阳而生。四时寒暑推移，人气不定。脚气发动，必由天之五气、地之五行。治之虽其间变易小有不同，而大法不过如此。故谨序月令条法于其下。
凡正月二月，天气正方，地气始发，人气在肝。宜导和气，加厚袜以暖足。宜进地黄粥补虚，防风粥以去四肢风，紫苏粥以去壅气，及桑皮煎、竹沥、防风、风引、续命、风缓、越婢、独活、海桐皮、八风等汤以徐风。及宜淋炸蒸煨足膝，以利关节，导引按跷以舒壅滞，针石以开发邪气。
三月四月，天气正方，地气正定，发人气在脾。宜食薤以散结气，利病人。又取栋花和粉，粉身以固阳气，除邪。亦宜前治风药以除邪气。大抵春三月，天地俱生，万物以荣。夜卧早起，广步于庭，被发缓形，以便志。生生而勿杀，予而弗夺，赏而勿罚。此春气之应，养生之道也。及宜进温食，尤移丸煎以除风热之疾。
五月六月，天气正盛，地气高，人气在头。宜服独活寄生汤以凑风湿气，宜木瓜浆以解渴，利腰脚。大抵夏三月，此谓蕃秀，天地气交，万物华实。早卧早起，无厌于日，使智无怒，使华英成秀，使气得泄。此夏气之应，养长之道也。
七月八月，阴气始杀，人气在肺。宜温下，频易袜履，以防湿气。宜独活寄生汤、海桐皮散、薏苡汤以温下除湿毒之气。大抵秋三月，此谓容平，无外其志，使肺气清。此秋气之应，养成之道也。
九月十月，阴气始冰，地气闭，人气在心。脚气正是小歇，当饮金牙侧子酒、肾沥汤、牛膝、石南、木瓜、八味等丸，小小补之。不可导引按跷。
十一月十二月，冰冻，地气合，人气在肾。宜前诸补药以益元真，及诸灸腰肾御寒邪气也。亦不宜导引动气。大抵冬三月，此谓闭藏，水冰地圻，无扰乎阳。早卧晚起，必待日光，使志若伏若匿，若有私意，若已有得，去寒就温，使气涵养。此冬气之应，养藏之道也。
治验：嘉佑二年正月二十六日，殿直郭中立来求孙殿丞兆诊脉。久患脚气，疼痛，身发寒热，胀满，气上。服热药及甚。兆与九味延年茯苓饮子以下其气，每用六物麻仁丸以泄其热。后又上气呕逆烦热，遂令服局方紫雪，大效。（延年茯苓饮、麻仁丸方见本门）
熙宁年间，崔郎中直病脚气，肿弱枯瘦，不能行。汲作千金方天门冬大煎，服之即差，永不发。方见后。董文思中行为汶上驻泊日，忽觉两脚赤肿疼，足下隐痛。汲与食前丸、食后丸，即差。即冬月令作金牙酒并淋炸，遂不复作。
梁承议子谅病膝痛，不能跪。翰林医官杨文蔚处海桐皮散，服之遂愈。吴宣义管在汶上病脚气中满，宣义郎席公延赏处顺气丸、麻仁丸、神仙丸，遂愈。冯侍郎宅十五小娘子病脚弱，不能步。翰林尚药奉御孔元处千金方独活寄生汤，遂愈。
汲熙宁年间，因冬月行大雪中，至春两脚忽然赤肿疼痛，痿弱不能行走。遂服犀角饮及韶脑汤、蜀椒汤，淋炸得差。经月再作，自脚及通身肿，气渐上入腹，心烦腹满，气促，面如土色，大小便不通。遂以槟榔一枚为末，诃子炮去复选末一钱，生牵牛取末二钱，以童子小便二盏，生姜一钱切，煎一沸，去姜，调前药末，分二服。小便大利，肿遂消尽。后两脚作疮，久久不愈。以天麻丸、鸟蛇丸，摩以陈元膏，疮遂愈。但觉脚弱无力。冬月进以木瓜丸、食前丸、金牙酒，脚遂有力。
脚气治法总要卷上终
San San Yi Shu (Medical Books of the San San Collection), Second Series, Nineteenth Volume
Written by Dong Ji of the Song Dynasty, published by Qiu Jisheng
I have examined various classics regarding the disease of "Jiaoqi" (Foot Qi / Beriberi). Its origins are ancient. During the time of the Yellow Emperor, it was called "Jue" (Reversal/Cold Extremities); between the Two Han Dynasties, it was mostly referred to as "Huan Feng" (Sluggish Wind); after the Song and Qi dynasties, it was called "Jiao Ruo" (Weakness of the Legs); only in the Great Tang Dynasty did it come to be named "Jiaoqi". Although the names differ, the essence is the same. The cause of Jue disease lies in the coagulation of wind-toxin and dampness invading the Liver, Kidney, and Spleen meridians. The pulse originates from the ten toes of the feet. Moreover, wind-toxin arises from the earth; cold, heat, wind, and dampness all transform into steam. Since the feet constantly tread upon the ground, the pathogen transmits internally into the meridians, resulting in swelling, pain, spasms, and weakness, thus named Jiaoqi.
However, the causes of contracting the disease vary. If one sits or stands for long periods on wet ground in summer, damp-heat steams into the meridians; upon onset, fever occurs, accompanied by painful stuffiness in the four limbs. If one sits or stands on wet ground in winter, cold-dampness ascends into the meridians; upon onset, muscle spasms occur, and the whole body becomes extremely cold. If one exposes oneself to wind to cool down, the disease manifests as internal skin numbness and insensitivity, with a creeping sensation in various areas that gradually spreads toward the head and face. These three scenarios must be distinguished carefully. Unfortunately, later scholars fail to investigate deeply and prescribe treatments arbitrarily, turning mild cases into severe ones and making severe cases difficult to cure. Can one not be cautious?
After contracting the disease, conditions may be deficient or excess, cold or hot, depending on the patient's constitution. Thus, Jiaoqi presentations include mild and severe, dry and damp, yin and yang, excess and deficiency types.
Dry type: Wind-toxin resides in the collaterals, affecting the knees and calves, leading to emaciation or pain, spasms or flaccidity/weakness, panting and thirst, headache, constipation of both stool and urine, or skin numbness and insensitivity.
Damp type: Damp-toxin resides in the main meridians, causing swelling of the lower legs, with skin and flesh cracking into purple-white sores, internal suppuration and necrosis, diarrhea or constipation, or anal abscesses, irritability, and loss of appetite.
Yin type: Wind-toxin affects the Zang organs; patients fear light and prefer stillness, suffer from cold body and cold extremities, tendon spasms, or numbness of the lower abdomen.
Yang type: Wind-toxin affects the Fu organs; upon onset, the calves feel hot, tendons and vessels spasm and hurt, muscles relax and cannot hold posture, accompanied by alternating chills and fever, headache, irritability, preference for bright environments, shortness of breath, and mental confusion. This often arises from long-term use of warming and tonifying medicines, causing qi stagnation and constipation.
Deficient type: Unrestrained desires lead to emptiness of Ying and Wei (Nutritive and Defensive Qi), depletion of bone marrow, and failure to take tonics. The body becomes extremely cold, calves ache, knees are cold, spasms occur, mobility is lost, and breathing is rapid and panting. These are the differences in presentation.
Regarding pulses, Su Gong of the Tang Dynasty stated there are three types: a slow pulse indicates a mild case; a deep pulse indicates an intermediate case; a surging and rapid pulse indicates a severe case. A large, deep, and tight pulse is difficult to treat; a surging and rapid pulse is easy to treat; a slow pulse may resolve spontaneously without treatment. If treatment violates principles, even mild cases become severe; if treatment follows principles, even severe cases become mild. Generally, pulses conforming to the Four Seasons indicate survival, while those violating them indicate difficulty. A deep and tight pulse signifies pathogenic invasion into the interior causing bi-syndrome, hence severity. A deep, surging, and rapid pulse indicates excess Yang corresponding to Wind-Jue, hence ease of treatment. A slow pulse indicates weak pathogens, hence spontaneous recovery. Sun Simiao also discussed three grades of pulses where external and internal symptoms are similar but pulses differ. A floating, large, and slow pulse suggests using Xuming Tang (Continuing Life Decoction). If wind is prevalent, use Yebip Tang (Diaphoretic Decoction). If the pulse is floating and tight with severe movement, prepare Zhuli Tang (Bamboo Juice Decoction). If the pulse is faint and weak, use Fengyin Tang (Wind-Quelling Decoction). These pulses often stem from Yin deficiency. For extreme deficiency and shortness of breath, intermittent use of Tonifying Decoctions is appropriate, adjusted for cold or heat.
Ancient methods for treating this disease emphasized distinguishing wind and damp ratios. For wind-dominant and damp-minor cases, formulas like Fengyin Tang, Xuming Tang, and Yebip Tang were used. For damp-dominant and wind-minor cases, Duhuo Jisheng Tang (Notopterygium and Ligusticum Decoction) and Yiyi Tang (Coix Seed Decoction) were preferred. Uniform medication rarely yields miraculous results; careful consideration is key. In regions like Jianghuai, Lingnan, and Qinchuan, climates vary by season. Travelers from Jianghuai/Lingnan returning to Qinchuan with Jiaoqi should follow Jianghuai/Lingnan treatment protocols. Qinchuan is high and dry; even with spring rains, steam-dampness is rare, affecting crops and diet differently. Low, damp areas favor drying herbs; high, dry areas favor diaphoresis and diuresis. Many attribute Jiaoqi to Kidney deficiency and use tonics, yet few succeed. Although rooted in Kidney deficiency, wind-damp pathogens exacerbate the condition. When pathogens are strong, the condition presents as excess despite underlying deficiency; harsh tonics cause qi stagnation and distension. As *Qianjin Fang* states, abdominal distension requires purgation. *Suwen* notes Jiaoqi improves in autumn/winter because Yang is internal and Yin external, lacking steam-dampness. Thus, patients should adjust medication by season: diaphoresis/diuresis in spring/summer; mild tonification during remission in autumn/winter to calm Qi. Modern doctors often blindly tonify or purge, missing the middle way. In winter, mild tonification based on strength is necessary; otherwise, blood and Qi decline, leading to annual recurrences during humid seasons.
Some claim Jiaoqi stems solely from Kidney deficiency, asserting women are immune since they do not primarily govern the Kidneys. This is incorrect. Women suffer from blood-sea deficiency, compounded by stasis, anger, or grief. Many women suffer from this, confirming blood-sea deficiency parallels male Kidney deficiency. Treatment for women mirrors men's, supplemented by herbs for emotional distress.
In the Xining era, I walked in heavy snow and contracted cold-dampness, suffering recurrent attacks for ten years. Varying symptoms prompted me to study sources, compile ancient prescriptions, and test efficacious formulas, which I now record. While Jiaoqi shares common features, one-third varies; treatment must follow evidence. Common symptoms include cold extremities, weakness, numbness, pain, swelling, or sores. Post-recovery, seasonal dietary and medicinal regimens ensure efficacy. Paralysis is milder; standard Jiaoqi treatments work within a set timeframe. The following lists seasonal prescriptions.
Discussion: Ancient imperial physicians often became experts due to personal or familial illness, meticulously observing symptom variations and adjusting for cold, heat, and deficiency/excess. Figures like Sun Simiao, Zhen Quan, Su Gong, and Daoren exemplify this. "Seeing is better than hearing." I present proven effective formulas for clinical reference.
Discussion: Chronic qi accumulation combined with wind-toxin, treated only with tonics without diaphoresis/diuresis, can solidify toxins, causing constipation, high fever, panting, leg swelling/pain, urinary/fecal retention, and delirium. Treat with Zi Qi Hong Xue Fangfeng Tang, Shengong Wan, Jiaoxi Yin. For dysuria, use Jianggong Wan or Baipi Xiaodou San.
Discussion: Yang deficiency below causes Cold Jue: cold calves, spasms, soreness, knee pain, numbness, photophobia, and preference for stillness. Treat with Shinan Wan, Jinya Jiu, Cizi Jiu, Bawei Wan, Haitongpi San, Muxiang Yinzi, Songjie San, and moxibustion at Fengshi (GB31).
Discussion: Congenital qi deficiency and irregular lifestyle, or excessive purgation in winter leading to organ weakness, emaciated legs, extreme cold, fatigue, cold knees, and heavy spasms, require Fengyin Tang, Bawei Mugua Wan, Shinan Wan, Jinya Jiu, Cizi Jiu, and moxibustion at Jiexu (GB39) in winter to prevent abdominal toxin invasion.
Discussion: Acupuncture and moxibustion are crucial for Jiaoqi. Treating only with herbs without acupuncture/moxibustion reduces efficacy by half. Adjust needle depth based on body size. Use bronze mannequin standards. Position patient (sitting/standing/lying) according to point location. Su Gong advised moxibustion at painful spots rather than fixed points, akin to *Miaoci* techniques.
Initial moxibustion: Fengshi (GB31) for knee spasms, limp, discoloration, flaccidity.
Next: Fubu (ST32) for cold; per *Jiayi Jing*, ST meridian needling max 5 fen.
Next: Dubi (ST35) for knee pain/numbness; avoid if swollen.
Next: Xiyan (EX-LE7) for cold bi-pain.
Next: Zusanli (ST36) for back pain, knee weakness, abdominal distension, foot drop.
Next: Shanglian (EX-LE8) for difficult urination, yellow urine, delirium.
Next: Xialian (EX-LE9) for difficult urination, yellow urine.
Next: Jiexu (GB39) for wind-lao, edema, hip/knee pain, hemibi numbness, tendon contraction, limb inertia.
Discussion: Wind-damp-toxin in calves causes Jiaoqi. Untreated or mistreated with purgatives, toxins attack the abdomen, causing confusion, panting, and suffocation. Rapid detoxification is vital to prevent five-zang damage and Sanjiao/Ying-Wei blockage. Like impetigo spreading from fingers to heart (hard to treat) vs. heart to limbs (easy to treat), internal toxin invasion is severe. Mugua Zhuyu Tang (Papaya and Cornus Decoction) is best for critical abdominal invasion, preventing further toxin entry.
Discussion: Daily regimen: pills before meals, decoctions after. Spring/Summer: Fangfeng Xuming Tang, Yebip Tang, Zhuli Tang, Fenghuan Tang, Bafeng Tang, Duhuo Jisheng Tang, Haitongpi San. Constipation: Shengong Wan, Maren Wan, Sanwan San, Sanren Wan, Juxiang Wan, Runchang Wan. Dysuria: Baipi Xiaodou San, Jianggong Wan, Mutong San. Acupuncture/stones for close-symptom matches. Autumn/Winter (remission): Jinya Jiu, Cizi Jiu, Shenli Tang, Shinan Wan, Bawei Wan, Mugua Wan, Niuxi Wan, plus moxibustion. Year-round: Steam baths/moxibustion. Remove nails on Chou days. Strong individuals take Tianmendong Dajian (Asparagus Large Decoction) year-round. This formula treats Five Labors, Seven Injuries, Eight Winds, Thirteen Bi, Six Extremes. Qi Extreme: cold bi, abdominal pain, panting, fright, headache. Lung Extreme: cold bi, back pain, epigastric hardness, masses, dysuria, numbness. Pulse Extreme: blue complexion, belching,恍惚, gas, tongue stiffness, dry throat, aversion to wind, dizziness, delirium. Tendon Extreme: spasms, lower abdominal distension, heart pain, cold knees/joints. Bone Extreme: cold extremities, jaundice, wasting-thirst, abscesses, edema. Flesh Extreme: Zhu diseases, ghost-strikes, death/rebirth. All stem from Six Extremes/Seven Injuries, not just sexual excess. Emotional stress, wind-damp, cough, vomiting, bowel/bladder issues, nightmares, etc., are also addressed. Liver/Tendon injury: back pain, limited movement. Lung/Qi injury: hematuria. Marrow/Bone injury: impotence, shortness of breath, genital pain/cold, ulcers, sweating, confusion. This formula covers these.
Case: Cui Gong (Xining era) had wind-damp from Sichuan travel, worsened by summer humidity in Shoucheng. Swollen, weak, painful legs. Combined Yi Zhou Gu Zhi (Bone Juice) and Zhen Su (True Butter) from Sichuan. Half dose cured him. This formula suits all seasons/types, reflecting Sun Simiao’s wisdom. Rare ingredients make it hard to prepare; lamentable.
Discussion: Wind is Yang, ascending. Jiaoqi Qi rebels upward, generating heat, drying fluids, causing constipation. Robust/heat-excess types: Shengong Wan, Maren Wan, Dahuang Tang. Elderly/deficient/constipated types: Sanren Wan, Wuro Wan, Runchang Wan, Ju Pi Wan, Sanwan San. Choose wisely.
Discussion: Foot meridians receiving dampness and Bladder water retention cause swelling, rupture, purple skin ("Lower Pouring Kidney Wind"). Sores with pain/numbness: Duhuo Jisheng Tang, Yiyi Tang. Advanced infiltration: Huixiang Wan, Tianma Wan, Wushe Wan, rubbed with Chen Yuan Gao.
Discussion: Steam baths/moxibustion are vital for stagnant Jiaoqi. Boil decoctions first. Wrap clothes around lower legs/ankles. Pour warm soup slowly from knee down. Do NOT start at feet; ascend from knee to foot to expel wind via toenails. Starting at feet risks ascending toxin. Remove toenails afterward, preferably on Chou days or every 12 days.
Discussion: Humans follow Heaven/Earth, Yin/Yang. Seasonal changes affect Qi. Jiaoqi stems from Heavenly Five Qi and Earthly Five Elements. Treatment varies slightly but follows general rules.
Jan-Feb: Qi in Liver. Warm feet, thick socks. Di Huang Zhou (Rehmannia Porridge), Fangfeng Zhou, Zisu Zhou. Decoctions: Sangpi Jian, Zhuli, Fangfeng, Fengyin, Xuming, Fenghuan, Yebip, Duhuo, Haitongpi, Bafeng. Moxibustion/steam on knees/feet. Guided exercises/acupressure.
Mar-Apr: Qi in Spleen. Eat Scallions (Xie) to dissipate knots. Donghua powder for body. Prevailing wind herbs. Spring: Rise early, walk freely, loosen hair/form. Nourish life, do not kill. Warm food, remove wind-heat.
May-Jun: Qi in Head. Duhuo Jisheng Tang, Mugua Jiang (Papaya Drink). Summer: Early rise, no fear of sun. Calm mind, let Qi vent. Nourish growth.
Jul-Aug: Qi in Lungs. Keep lower body warm, change socks/shoes. Duhuo Jisheng Tang, Haitongpi San, Yiyi Tang. Autumn: Calm will, clear Lung Qi. Nourish completion.
Sep-Oct: Qi in Heart. Remission period. Mild tonification: Jinya Jiu, Cizi Jiu, Niuxi, Shinan, Mugua, Bawei Wan. No vigorous exercise.
Nov-Dec: Qi in Kidneys. Tonify Yuan Zhen. Moxibustion on waist/kidneys. Avoid moving Qi. Winter: Hide, wait for sun. Calm will. Nourish storage.
Clinical Cases:
Jiayou Era, Jan 26: Guo Zhongli (Dianzhi) sought Sun Zhao’s diagnosis. Long-term Jiaoqi, pain, fever/chills, distension, rebellious Qi. Hot meds worsened it. Sun prescribed Jiwei Yannian Fuling Yinzi to descend Qi, Liuwu Maren Wan to clear heat. Later, vomiting/irritability treated with Jufang Zixue (Purple Snow), highly effective. (Formulas see respective sections).
Xining Era: Cui Langzhong Zhi suffered Jiaoqi, swollen/weak/emaciated, unable to walk. Dong Ji prescribed Qianjin Fang Tianmendong Dajian. Cured permanently. (Formula see below).
Dong Wensi Zhongxing, stationed in Wenshang, suddenly had red/swollen/painful legs and hidden sole pain. Dong Ji gave pre/post-meal pills. Cured. Winter: Jinya Jiu and steam baths prevented recurrence.
Liang Chengyi’s son Liang: Knee pain, unable to kneel. Treated with Haitongpi San by Imperial Physician Yang Wenwei. Cured.
Wu Xuanyi Guan: Abdominal fullness/Jiaoqi in Wenshang. Treated with Shunqi Wan, Maren Wan, Shenxian Wan by Xi Yanshang. Cured.
Feng Shilang’s 15th Daughter: Leg weakness, unable to walk. Treated with Qianjin Fang Duhuo Jisheng Tang by Kong Yuan. Cured.
Dong Ji (Xining Era): Walked in snow, developed red/swollen/painful/weak legs in spring. Treated with Xijiao Yin, Shaonao Tang, Shujiao Tang, steam baths. Improved, then relapsed with全身 swelling, abdominal distension, shortness of breath, pale face, urinary/fecal retention. Treated with Binglang (Areca Nut) powder, Hezi (Chebula) powder, Sheng Qianniu (Morning Glory) powder, child’s urine, ginger. Profuse urination reduced swelling. Later leg sores treated with Tianma Wan, Wushe Wan, Chen Yuan Gao. Winter: Mugua Wan, pre-meal pills, Jinya Jiu restored strength.
End of Volume One of Essential Methods for Treating Jiaoqi.