寶鑑Bogam

Formulas · Text · Donguibogam 東醫寶鑑

The Foot

Jok

한글 족문  ·  Pinyin Zu

Leg qi, wilting and crane's-knee wind — the three great illnesses of everything below the hip

足門

The Foot chapter covers everything from the hip down, and it is organized around three great illnesses rather than around anatomy: leg qi (脚氣), the swelling and pain that rises from the feet; wilting (痿), the weakness in which the legs will no longer bear the body; and crane's-knee wind (鶴膝風), where the knees swell while the thighs and shins waste to skin and bone. Between them sit the reversal patterns — hands and feet gone cold, or gone hot — and a closing section of remedies for ingrown nails and corns that is as practical as anything in the book.

Measurements of the foot 足部度數

靈樞曰, 橫骨上廉以下至內輔之上廉, 長一尺八寸. 內輔之上廉以下至下廉, 長三寸半. 內輔下廉下至內踝, 長一尺三寸. 內踝以下至地, 長三寸. 膝膕以下至跗屬, 長一尺六寸. 跗屬以下至地, 長三寸. ○髀樞以下至膝中, 長一尺九寸. 膝以下至外踝, 長一尺六寸. 外踝以下至京骨, 長三寸. 京骨以下至地, 長一寸. ○兩髀之間, 廣六寸半. 足長一尺二寸, 廣四寸半. 《靈樞》

The Numinous Pivot says: from the upper border of the pubic bone down to the upper border of the inner condyle is one cheok eight chon. From the upper border of the inner condyle down to its lower border is three and a half chon. From the lower border of the inner condyle down to the inner ankle is one cheok three chon. From the inner ankle down to the ground is three chon. From the popliteal crease down to where the instep joins is one cheok six chon; from there to the ground, three chon. — From the hip joint down to mid-knee is one cheok nine chon. From the knee down to the outer ankle is one cheok six chon. From the outer ankle down to the tuberosity of the fifth metatarsal is three chon; from there to the ground, one chon. — Between the two hips is six and a half chon across. The foot is one cheok two chon long and four and a half chon wide.
Clinical note Proportional measurements, not absolute ones — the cheok and chon here are the patient's own body-inches, which is how classical acupuncture locates points on any size of person. Reading them as a set gives a workable skeleton of the leg, and every one of the landmarks named is still palpable at the bedside.

Yeongchu 靈樞

The parts of the leg named 足領髀股膝臏腨脛腕

膝上曰髀, 膝上骨曰髀骨. 髀骨與髖骨接處曰髀樞 穴名也. 髀內曰股, 髀外曰腿. 腿下脛上接處曰膝, 膝之盖骨曰臏. 膝下曰脛, 一名曰骭. 膝下之骨曰䯒骨, 䯒骨之外骨曰輔骨. 脛之後魚腹曰腨, 一云足肚曰腨. 脛下跗上接處曰腕, 腕骨曰踝. 《銅人》 ○足通謂之脚. 脚者, 却也, 以其坐時却在後也. 《回春》

Above the knee is called the thigh; the bone above the knee is the thigh bone. Where the thigh bone meets the hip bone is called the hip pivot — this is a point name —. The inner thigh is called the *go*, the outer the *toe*. Where the lower thigh meets the upper shin is the knee; the covering bone of the knee is the patella. Below the knee is the shin. The bone below the knee is the shin bone, and the bone outside it the fibula. The fish-belly behind the shin is the calf — one text says the belly of the foot is the calf. Where the lower shin meets the upper instep is the ankle joint, and the ankle bone is the malleolus (Donginn 銅人). — The whole lower limb is called *gak*. *Gak* means to withdraw — because when one sits, it withdraws behind. (Hoechun 回春)
Clinical note A glossary, and a useful one: the classical anatomical vocabulary for the leg is more finely divided than the English, distinguishing inner thigh from outer, shin bone from fibula, and the calf by its resemblance to a fish's belly. The closing etymology is characteristic of this book — a pun offered as explanation, and preserved here because it tells you how the word was heard.

Donginn 銅人 · Hoechun 回春

Pulse patterns 脉法

脚氣之脉其狀有四. 浮弦爲風, 濡弱濕氣, 遲濇因寒, 洪數熱鬱. 《脉訣》 ○微滑者虛, 牢堅者實. 《正傳》 ○脚氣之脉, 浮爲風, 緊爲寒, 緩細爲濕, 洪數爲熱. 又曰, 沈而弦者爲風, 沈而緊者爲寒, 沈細爲濕, 沈數爲熱. 《三因》 ○脾脉緩甚痿厥. 《內經》 ○尺脉虛弱, 緩濇而緊, 病爲足痛, 或是痿病. 《脉訣》 ○痿脉多浮而大. 《子和》 ○診人痿躄, 其脉虛者生, 緊急疾者死. 《脉經》

The pulse in leg qi has four forms: floating and wiry is wind; soggy and weak is damp Qi; slow and rough comes of cold; surging and rapid is constrained heat (Maekgyeol 脉訣). — Faintly slippery is vacuity; firm and hard is repletion (Jeongjeon 正傳). — In leg qi, floating is wind, tight is cold, moderate and fine is damp, surging and rapid is heat. And again: sunken with wiry is wind, sunken with tight is cold, sunken and fine is damp, sunken and rapid is heat (Samin 三因). — When the Spleen pulse is very moderate, there is wilting and reversal (Naegyeong 內經). — Where the cubit pulse is vacuous and weak, moderate and rough with tightness, the illness is foot pain, or else it is wilting (Maekgyeol 脉訣). — The wilting pulse is mostly floating and large (Jahwa 子和). — Examining a person with wilting and lameness: where the pulse is vacuous they live; tight, urgent, and racing, they die.
Clinical note Two tables in one section. The first sorts leg qi by cause — wind, damp, cold, heat — and the two sources give overlapping but not identical readings, which the chapter prints side by side without reconciling. The second is prognostic and belongs to wilting: a vacuous pulse in a person whose legs have failed is survivable; a tight and racing one is not.

Maekgyeol 脉訣 · Jeongjeon 正傳 · Samin 三因 · Naegyeong 內經 · Jahwa 子和 · Maekgyeong 脉經

Reversal has cold and heat kinds 厥有寒熱

王太僕云, 厥者, 氣逆上也. 世謬傳爲脚氣. 內經曰, 寒厥者, 手足寒也, 熱厥者, 手足熱也. 盖陽衰於下則爲寒厥, 陰衰於下則爲熱厥, 陰陽之氣不相接續則爲厥. 《綱目》 ○厥證, 多以不勝乘其所勝. 如腎移寒於脾則爲寒厥, 心移熱於腎則爲熱厥. 《入門》 ○厥論寒熱, 皆由腎之精氣內竭而成也. 《綱目》

Wang Taipu says: reversal is Qi counterflowing upward. The world has mistakenly transmitted it as leg qi. The Inner Classic says: in cold reversal the hands and feet are cold; in heat reversal the hands and feet are hot. Where the Yang has waned below there is cold reversal; where the Yin has waned below there is heat reversal; and where the Qi of Yin and Yang do not join in succession, there is reversal (Gangmok 綱目). — In reversal patterns, mostly what cannot overcome mounts what it should be overcome by: as when the Kidney shifts cold onto the Spleen there is cold reversal, and when the Heart shifts heat onto the Kidney there is heat reversal (Immun 入門). — The reversals, cold and heat alike, all arise from the Kidney's essence-Qi being inwardly exhausted.
Clinical note The chapter opens its clinical material by correcting a confusion: reversal — cold or hot extremities — is not leg qi, though the two had been conflated. The distinction is worth keeping because the treatments differ entirely. And the closing line ties both to the same root, which is the same argument the Lumbus chapter makes about the back: whatever the presentation, the Kidney was empty first.

Gangmok 綱目 · Immun 入門

黃帝曰, 寒厥之爲寒也, 必從五指而上於膝者何也. 岐伯對曰, 陰氣起於五指之裏, 集於膝下而聚於膝上, 故陰氣勝則從五指至膝上寒. 其寒也不從外, 皆從內也. ○帝曰, 寒厥何爲而然也. 岐伯曰, 前陰者, 宗筋之所聚, 太陰陽明之所合也. 春夏則陽氣多而陰氣少, 秋冬則陰氣盛而陽氣衰. 此人者, 以秋冬奪於所用, 下氣上爭不能復, 精氣溢下, 邪氣因從而上之也. 氣因於中, 陽氣衰, 不能滲營其經絡, 陽氣日損, 陰氣獨作, 故手足爲之寒也. 《內經》 ○內經曰, 腎虛則淸厥, 意不樂. 又曰, 下虛則厥. ○寒厥脉沈數實爲熱. 東垣治一人, 脚膝尻臀皆冷, 脉沈數有力, 用滋腎丸 方見小便, 再服而愈. 又治一人, 上熱下寒, 用旣濟解毒湯, 良愈. 則寒厥用藥, 不可不審. 《綱目》 ○寒厥, 宜十全大補湯 方見虛勞, 加附子, 或當歸四逆湯 方見寒門. 《入門》

The Yellow Emperor said: in cold reversal, why must the cold rise from the five toes up to the knee? Qibo answered: the Yin Qi arises within the five toes, gathers below the knee and collects above it; so when the Yin Qi prevails, there is cold from the five toes up to above the knee. And that cold does not come from outside — it comes wholly from within. — The Emperor said: how does cold reversal come about? Qibo said: the front Yin is where the ancestral sinew gathers and where greater-Yin and Yang-brightness meet. In spring and summer the Yang Qi is abundant and the Yin scant; in autumn and winter the Yin is exuberant and the Yang wanes. Such a person, having in autumn and winter been robbed by what they put to use, cannot recover as the lower Qi contends upward; the essence Qi spills downward and the evil Qi follows it up. The Qi being taken from the center, the Yang wanes and cannot percolate through and nourish the channels; the Yang diminishes by the day, the Yin acts alone — and so the hands and feet grow cold. — The Inner Classic says: Kidney vacuity brings clear reversal, and the intent is not glad. And: vacuity below brings reversal. — **In cold reversal, a pulse sunken, rapid, and replete indicates heat.** Dongyuan treated a man whose legs, knees, and buttocks were all cold, with a pulse sunken and rapid and forceful, using Jasin-hwan — formula in the Urination chapter —; on the second dose he recovered. He also treated a man with heat above and cold below using Gijehaedok-tang, with good result. So in treating cold reversal with medicines, one must not fail to examine carefully. — For cold reversal, Sipjeondaebo-tang — formula in the Taxation chapter — with aconite added, or Danggwisayeok-tang — formula in the Cold Damage chapter —.
Clinical note The line that matters clinically is Dongyuan's warning: a patient whose legs are frankly cold may still have heat, and the pulse is what tells you. He treated cold buttocks and cold knees with a Kidney-cooling formula because the pulse was sunken, rapid, and forceful — and it worked on the second dose. This is the same trap the Fire chapter sets out at length: the patient's sensation and the pattern are not always the same thing.

Naegyeong 內經 · Gangmok 綱目 · Immun 入門

黃帝曰, 熱厥之爲熱也, 必起於足下者何也. 岐伯曰, 陽氣起於足五指之表, 陰脉者集於足下而聚於足心, 故陽氣勝則足下熱也. ○帝曰, 熱厥何如而然也. 岐伯曰, 酒入於胃則絡脉滿而經脉虛. 脾主爲胃行其津液者也. 陰氣虛則陽氣入, 陽氣入則胃不和, 胃不和則精氣竭, 精氣竭則不營其四肢也. 此人必數醉若飽以入房, 氣聚於脾中不得散, 酒氣與穀氣相搏, 熱盛於中, 故熱遍於身, 內熱而尿赤也. 夫酒氣盛而慓悍, 腎氣日衰, 陽氣獨勝, 故手足爲之熱也. 《內經》 ○熱厥, 宜升陽散火湯ㆍ火鬱湯 方幷見火門.

The Yellow Emperor said: in heat reversal, why must the heat begin from the soles? Qibo said: the Yang Qi arises on the surface of the five toes, and the Yin vessels gather at the sole and collect at the heart of the foot; so when the Yang prevails, the soles are hot. — The Emperor said: how does heat reversal come about? Qibo said: when wine enters the stomach, the network vessels fill and the channel vessels empty. The Spleen governs moving the fluids on the Stomach's behalf. The Yin being vacuous, the Yang enters; the Yang entering, the Stomach is not harmonized; the Stomach unharmonized, the essence Qi is exhausted; the essence Qi exhausted, it does not nourish the four limbs. Such a person has surely gone repeatedly to the bedchamber drunk or full, so that Qi collects in the Spleen and cannot disperse; the wine Qi and the grain Qi strike against one another, heat becomes exuberant within, and so heat spreads through the body, the interior is hot and the urine red. The wine Qi being exuberant and fierce, the Kidney Qi wanes by the day and the Yang alone prevails — and so the hands and feet are hot. — For heat reversal, Seungyangsanhwa-tang and Hwaul-tang — both formulas in the Fire chapter —.
Clinical note Burning soles traced to a specific history: drinking heavily, eating heavily, and going to bed on both. The mechanism proposed — wine Qi colliding with grain Qi in a Spleen that cannot disperse it, heat building inward while the Kidney wanes — is the classical account of what would now be described in terms of alcohol, metabolic load, and neuropathy. The presenting sign is the same either way: heat that starts at the soles.

Naegyeong 內經

Other names for leg qi 脚氣異名

脚氣, 古謂之緩風, 又謂之厥者, 是古今之異名也. 有乾濕之分, 其脚腫者名濕脚氣, 不腫者名乾脚氣. 漸而至於足脛腫大如瓜瓠者有之. 《醫鑑》

Leg qi was anciently called slack wind, and was also called reversal — these are the differing names of ancient and modern times. It divides into dry and damp: where the leg swells it is called damp leg qi, and where it does not swell, dry leg qi. There are cases that come by degrees to where the foot and shin swell as large as a gourd.
Clinical note The first and most useful division: swollen or not. Damp leg qi and dry leg qi are treated differently throughout the chapter, and the sign costs nothing to check. The gourd comparison marks the far end of the disease — what would now be recognized as the gross edema of wet beriberi or of cardiac failure.

Uigam 醫鑑

The causes of leg qi 脚氣病因

脚氣之疾, 實水濕之所爲也. 其爲病有證無名. 脚氣之稱, 自蘇敬始, 關中河朔無有也. 惟南方地下水寒, 其淸濕之氣中於人, 必自足始. 故經曰, 淸濕襲虛則病起於下, 是也. 《綱目》 ○南方者, 其地下, 水土弱, 霧露之所聚也. 江東嶺南, 春夏之交, 山林蒸鬱, 風濕毒氣爲甚, 足或感之, 遂成瘴毒脚氣. 《東垣》 ○水性潤下, 氣不能呴, 故下疰於足脛, 積久而作腫痛, 此飮食下流之所致也. 內經曰, 太陰之勝, 火氣內鬱, 流散於外, 足脛胕腫, 飮發於中, 胕腫於下. 加之房事不節, 陰盛陽虛, 遂成痼疾. 孫眞人云, 古人少有此疾, 自永嘉南渡, 衣冠士人多有之, 亦此意也. 《東垣》

The illness of leg qi is in truth the doing of water and damp. As an illness it had signs but no name; the term leg qi began with Su Jing, and in Guanzhong and Hesuo it did not exist. Only in the south, where the land is low and the water cold, does its clear damp Qi strike people — and it must begin from the feet. Hence the Classic says: where clear damp assails vacuity, the illness arises from below (Gangmok 綱目). — The south is low-lying, its soil and water weak, and a place where mist and dew collect. In Jiangdong and Lingnan, at the turn of spring and summer, the mountain forests steam and stifle and the wind-damp toxic Qi is severe; should the feet take it in, poison-miasma leg qi results (Dongwon 東垣). — Water's nature is to moisten downward, and where the Qi cannot breathe it upward it pours down into the foot and shin; accumulating long, it makes swelling and pain — this is brought about by food and drink flowing downward. The Inner Classic says: when greater-Yin prevails, the fire Qi is constrained within and spreads outward, and the foot and shin swell at the instep; rheum breaks out in the center and swelling appears below. Add to this immoderate bedroom affairs, so that Yin is exuberant and Yang vacuous, and it becomes an entrenched disease. Master Sun said that the ancients rarely had this illness, and that from the southward crossing at Yongjia the gentry and officials had much of it — which is the same point.
Clinical note An epidemiology, and a fairly good one. The disease is southern, associated with low wet ground, and — Sun Simiao's observation — it appeared among the gentry after a mass migration south. Modern reading would add that beriberi follows a diet of polished rice, which is exactly what a displaced southern gentry would have eaten. The classical framework got the geography and the population right while attributing it to damp.

Gangmok 綱目 · Dongwon 東垣

The signs of leg qi 脚氣病證

凡脚氣之病, 始起甚微, 多不令人識也. 食飮嬉戱, 氣力如故, 惟卒起脚屈伸不能動爲異耳. 《千金》 ○內經曰, 傷於濕者, 下先受之. 盖足居于下而多受其濕, 濕鬱生熱, 濕熱相搏, 其病乃作. 東南卑濕之地比比皆是, 西北高燥之地鮮有之. 古方名爲緩風, 宋元以來呼爲脚氣, 雖有外感內傷之殊, 其濕熱之患則一也. 《正傳》 ○脚氣外證全類傷寒, 但初起脚膝軟弱ㆍ頑痺ㆍ轉筋ㆍ赤腫爲異耳. 《入門》

In all illness of leg qi, the beginning is very slight and mostly does not let a person recognize it. Eating, drinking, and amusement go on, the Qi and strength are as before — only that on rising suddenly the leg cannot bend or stretch or move, and this alone is different (Cheongeum 千金). — The Inner Classic says: where there is damage from damp, the lower parts receive it first. The feet dwell below and take much of the damp; damp constrained engenders heat, damp and heat strike against one another, and the illness comes about. In the low damp lands of the southeast it is everywhere; in the high dry lands of the northwest it is rare (Jeongjeon 正傳). — The outward signs of leg qi entirely resemble cold damage; only that at the outset the legs and knees are soft and weak, numb and insensate, with cramping and red swelling — this alone is different. (Immun 入門)
Clinical note Two diagnostic warnings worth keeping. The first is about onset: it begins so mildly that the patient notices nothing except that on standing up suddenly the leg will not work. The second is about mimicry: leg qi looks like a febrile illness from the outside, and the way to tell is to check the legs — soft, numb, cramping, red. Both are the kind of observation that only comes from seeing the disease often.

Cheongeum 千金 · Jeongjeon 正傳 · Immun 入門

脚氣爲病, 雖起於足, 實周乎身. 或壯熱頭痛, 或百節拘攣, 或十指走注, 或轉筋急痛, 或小腹不仁, 以至胸滿喘息, 煩悶怔忪, 昏憒羞明, 腹痛下利, 嘔噦痰涎, 惡聞食氣, 大便小便多是秘澁, 自腿至膝, 自脛及踝, 屈弱頑痺, 攣急痠疼, 或焮不焮, 或腫不腫, 皆其候也. 其傳足六經, 外證與傷寒頗類, 但卒然脚痛爲異耳. 《直指》 ○人黑瘦者易治, 肥大肉厚赤白者難愈. 黑人耐風濕, 赤白者不耐風濕. 瘦人肉硬, 肥人肉軟, 肉軟則受病難愈. 《千金》

Though leg qi as an illness begins from the feet, in truth it goes round the whole body. There may be vigorous fever and headache; or all the joints drawn into cramp; or the ten toes running with shifting pain; or cramping with urgent pain; or the lower abdomen gone insensate — and so on to fullness of the chest with panting, vexed oppression and fearful throbbing, clouded confusion and aversion to light, abdominal pain with diarrhea, retching and phlegmy drool, aversion to the smell of food, and stool and urine mostly bound and rough; from thigh to knee, from shin to ankle, bent and weak, numb and insensate, cramping and aching. It may be inflamed or not inflamed, swollen or not swollen — all are its signs. It transmits through the six foot channels, and its outward signs closely resemble cold damage; only that the leg pain comes on suddenly, and this alone is different (Jikji 直指). — The dark and lean are easy to treat; the stout, large, thick-fleshed, and pale are hard to cure. Dark people endure wind and damp; the pale do not. Lean people have firm flesh, stout people soft flesh — and where the flesh is soft, illness taken in is hard to cure. (Cheongeum 千金)
Clinical note The long list in the first passage is a description of systemic beriberi — cardiac involvement (chest fullness, panting, palpitations), neurological (numbness, cramping, confusion), and gastrointestinal — all correctly gathered under one illness that begins in the feet. The second passage's prognosis by constitution belongs to its era and should be read as such, though the underlying claim that body habitus affects recovery is not in itself unreasonable.

Jikji 直指 · Cheongeum 千金

Treatment methods for leg qi 脚氣治法

脚氣是爲壅疾, 治以宣通之劑, 使氣不能成壅. 壅旣成而盛者, 砭惡血而去其重勢. 經曰, 蓄則腫熱, 砭射之後, 以藥治之. 《綱目》 ○脚氣之疾, 自古皆尙疏下, 爲疾壅故也. 然不可太過, 太過則損傷脾胃, 又不可不及, 不及則使壅氣不能消散. 《東垣》 ○脚氣之疾, 皆由氣實而死, 終無一人以服藥致虛而殂. 故其病皆不得大補, 亦不可大瀉. 縱甚虛羸, 亦須微微通泄, 亦宜時取汗也. 《千金》 ○治法大要, 疏導大便, 使毒氣得泄而後愈. **其補湯淋洗, 皆醫家之大戒也.** 《直指》

Leg qi is an illness of damming, and is treated with preparations that diffuse and free, so that the Qi cannot form a dam. Where the dam has already formed and is exuberant, lance the malign blood and take away its weight. The Classic says: where it accumulates there is swelling and heat; after lancing and letting it out, treat with medicines (Gangmok 綱目). — In the illness of leg qi, from antiquity all have favored dispersing and draining downward, because the illness is a damming. Yet it must not be overdone — overdone, it damages the Spleen and Stomach; nor may it fall short, for falling short leaves the dammed Qi unable to disperse (Dongwon 東垣). — In the illness of leg qi, all who die do so from Qi repletion; not one has ever perished from being made vacuous by medicine. Therefore in this illness one may neither greatly supplement nor greatly drain. Even in the very vacuous and emaciated, one must still free and drain a little at a time, and it is also right to take sweat from time to time (Cheongeum 千金). — The great essential of the method is to disperse and conduct the stool, so that the toxic Qi is drained and afterward there is recovery. **Supplementing decoctions and hot soaks are both great prohibitions among physicians.** (Jikji 直指)
Clinical note The strategic core of the chapter, and it is unusually emphatic. Leg qi is a damming, so the treatment is to open — and the two things one must *not* do are named outright: do not give tonic decoctions, and do not soak the legs in hot medicated water. Both are the obvious instinct when a leg is swollen and weak, and both are forbidden here. The reasoning follows from the etiology: adding to a dammed system and driving the evil deeper with heat both make it worse.

Gangmok 綱目 · Dongwon 東垣 · Cheongeum 千金

脚痛患在風濕, 風則用烏藥順氣散 方見風門, 濕則不換金正氣散 方見寒門, 加赤茯苓ㆍ生乾薑. 《直指》 ○治法, 用蒼朮ㆍ白朮以治濕, 黃芩ㆍ黃柏ㆍ知母以治熱, 當歸ㆍ芍藥ㆍ地黃以調血, 木瓜ㆍ檳榔以調氣, 羌活ㆍ獨活以利關節而散風濕, 兼用木通ㆍ防己ㆍ牛膝引諸藥下行, 此爲治之大法. 淸熱瀉濕湯亦可. 《醫鑑》 ○濕熱在三陽, 則宜神秘左經湯; 在太陽則宜麻黃左經湯; 在少陽則宜半夏左經湯; 在陽明則宜大黃左經湯, 或加味敗毒散. 通宜檳蘇散. 《入門》 ○濕熱在三陰, 則宜羌活導滯湯ㆍ除濕丹ㆍ三花神祐丸ㆍ搜風丸ㆍ枳實大黃湯ㆍ開結導引丸ㆍ當歸拈痛湯. 《入門》 ○氣血虛者, 宜獨活寄生湯ㆍ羌活續斷湯. 《入門》 ○寒濕盛, 則宜勝駿丸ㆍ捉虎丹. ○病久者, 宜卷柏散. 熱甚者, 宜二炒蒼柏散ㆍ加味蒼柏散. 腫甚, 宜勝濕餠子ㆍ桑白皮散.

Where the leg pain lies in wind and damp: for wind use Oyaksungi-san — formula in the Wind chapter —; for damp, Bulhwangeumjeonggi-san — formula in the Cold Damage chapter — with red poria and dried fresh ginger added (Jikji 直指). — As to method: use atractylodes and white atractylodes to treat the damp; scutellaria, phellodendron, and anemarrhena to treat the heat; angelica, peony, and rehmannia to regulate the Blood; chaenomeles and areca to regulate the Qi; notopterygium and pubescent angelica to free the joints and disperse wind-damp; and together with these, akebia, stephania, and achyranthes to lead all the medicines downward. This is the great method of treatment. Cheongyeolsaseup-tang 淸熱瀉濕湯 also serves (Uigam 醫鑑). — Where damp heat is in the three Yang: Sinbijwagyeong-tang 神秘左經湯; in greater-Yang, Mahwangjwagyeong-tang 麻黃左經湯; in lesser-Yang, Banhajwagyeong-tang 半夏左經湯; in Yang-brightness, Daehwangjwagyeong-tang 大黃左經湯, or Gamipaedok-san 加味敗毒散. For all alike, Binso-san 檳蘇散. — Where damp heat is in the three Yin: Ganghwaldoche-tang 羌活導滯湯, Jeseup-dan, Samhwasinu-hwan, Supung-hwan 搜風丸, Jisildaehwang-tang 枳實大黃湯, Gaegyeoldoin-hwan 開結導引丸, Danggwiyeomtong-tang 當歸拈痛湯. — Where Qi and Blood are vacuous: Dokhwalgisaeng-tang 獨活寄生湯, Ganghwalsokdan-tang 羌活續斷湯. — Where cold damp is exuberant: Seungjun-hwan 勝駿丸, Chakho-dan 捉虎丹. — Where the illness is long-standing: Gwonbaek-san 卷柏散. Where heat is severe: Ichochangbaek-san 二炒蒼柏散, Gamichangbaek-san 加味蒼柏散. Where swelling is severe: Seungseupbyeong-ja 勝濕餠子, Sangbaekpi-san 桑白皮散.
Clinical note The Uigam's paragraph is the single most useful page in the chapter — a treatment recipe stated as roles rather than as a formula: these herbs for damp, these for heat, these for Blood, these for Qi, these to open the joints, and these three to lead everything downward. A practitioner who knows nothing else about leg qi can build a workable prescription from it. The channel-by-channel 'left channel' formulas that follow are unusual and appear almost nowhere else.

Jikji 直指 · Uigam 醫鑑 · Immun 入門

Critical signs in leg qi 脚氣危證

凡脚氣, 覺病候有異, 卽須急治之. 稍緩則氣上肩息, 胸脇逆滿, 急者死不旋踵, 寬者數日必死, 不可不急治也. 但見心下急, 氣喘不停, 或自汗出, 或乍熱乍寒, 其脉促短而數, 嘔吐不止者死. 《千金》 ○上氣脉數, 不得臥者亦死. ○脚氣之病, 其小腹頑痺不仁者多不腫. 小腹頑, 後不過三五日, 卽令人嘔吐, 名曰脚氣入心, 死在朝夕. ○脚氣脉浮大而緊駃, 此最惡脉也. 若細而駃, 同是惡脉. 《千金》

In all leg qi, the moment one perceives that the signs are unusual, it must be treated urgently. Delay even a little and the Qi rises so that one breathes at the shoulders, with counterflow fullness of chest and flanks; in the urgent cases death comes before one can turn on one's heel, and in the slower ones death is certain within a few days — it cannot but be treated urgently. Should one see urgency below the heart, panting that does not stop, spontaneous sweating, or alternating heat and cold, with a pulse hurried, short, and rapid, and retching that will not stop — death (Cheongeum 千金). — Where the Qi rises, the pulse is rapid, and the patient cannot lie down — also death. — In the illness of leg qi, those whose lower abdomen is numb and insensate mostly do not swell. Once the lower abdomen is numb, within three to five days it brings on retching; this is called leg qi entering the Heart, and death is a matter of morning or evening. — Where the leg qi pulse is floating, large, tight, and racing, this is the worst of pulses; and fine and racing is equally a bad pulse.
Clinical note This is the chapter at its most urgent, and what it describes is recognizable: swelling that has moved upward, breathlessness, inability to lie flat, and a racing pulse. In modern terms, wet beriberi progressing to high-output cardiac failure — and the classical text is right that it kills quickly. **Note on modern practice: breathlessness with leg swelling, or inability to lie flat, is a cardiac emergency and requires immediate medical care.**

Cheongeum 千金

脚氣入心則恍惚譫妄, 嘔吐不食, 左寸脉乍大乍小乍有乍無者死. 宜杉節湯ㆍ三脘散, 或三和散 方見氣門, 加烏藥救之. 《綱目》 ○入腎則腰脚腫, 小便不通, 氣上喘急, 目與額皆黑, 左尺脉絶者死. 宜八味元去山藥救之. 盖少陰腎經, 脚氣入腹, 上氣喘急, 此證最急, 以腎乘心, 水剋火, 死不旋踵, 此藥救之. 又四物湯加炒黃柏煎服, 外以附子末, 津唾調, 付涌泉穴, 以艾灸之, 引熱下行. 《丹心》 ○脚氣入腹, 喘急欲死, 宜木萸湯ㆍ杉節湯ㆍ三將軍元ㆍ烏藥平氣湯救之. 《入門》

When leg qi enters the Heart there is abstraction and delirium, retching and no eating; and where the left inch pulse is now large now small, now present now absent — death. Samjeol-tang 杉節湯 and Samwan-san 三脘散, or Samhwa-san — formula in the Qi chapter — with lindera added, to rescue them (Gangmok 綱目). — When it enters the Kidney, the lumbus and legs swell, the urine does not pass, the Qi rises with hurried panting, the eyes and forehead are both black, and where the left cubit pulse is cut off — death. Palmi-won with the dioscorea removed, to rescue them. For in the lesser-Yin Kidney channel, leg qi entering the abdomen with Qi rising and panting hurried is the most urgent of patterns: the Kidney mounts the Heart, water overcomes fire, and death comes before one can turn on one's heel — this medicine rescues them. Also Samul-tang with dry-fried phellodendron, decocted and taken; and externally, powdered aconite mixed with saliva applied to KI1 Yongcheon and moxaed, to lead the heat downward (Dansim 丹心). — Where leg qi has entered the abdomen with hurried panting and one is at the point of death: Mogyu-tang 木萸湯, Samjeol-tang, Samjanggun-won 三將軍元, Oyakpyeonggi-tang 烏藥平氣湯.
Clinical note Leg qi 'entering the Heart' and 'entering the Kidney' are the chapter's names for the two terminal courses, and both are described precisely — the first with confusion and vomiting and an irregular pulse, the second with anuria, rising breathlessness, and a face gone dark. The external measure at the end is worth noting: aconite paste on the sole at Yongcheon with moxa over it, to draw the heat down. Applying medicine to the foot to pull a rising illness back down is a strategy that appears throughout Korean practice.

Gangmok 綱目 · Dansim 丹心 · Immun 入門

Prohibitions in leg qi 脚氣禁忌法

第一忌嗔. 嗔則心煩, 脚氣發. 第二禁大語. 大語則傷肺, 亦發動. 又不得露足當風, 入水以冷水洗脚. 雖夏月, 常須着綿裩, 至冬寒, 倍令兩脛溫煖, 得微汗爲佳. 常令按摩, 數勞動關節, 令氣血通暢, 此養生之要, 拒風濕之法也. 《外臺》 ○每至丑寅日, 割手足甲, 割小侵肉, 去氣. 《外臺》 ○凡飮食之後, 宜緩行二三百步, 疲倦卽止. 如此則不能成壅也. 《東垣》 ○每朝早飯任意飽食, 午飯少食, 晚飯不食彌佳. 夜食則血氣壅滯而愈增腫痛矣. 《寶鑑》 ○凡飮食酒麪潼酪, 勿使過度, 過度則脚氣發. 慾不可縱, 嗜慾多則脚氣亦發. 《東垣》 ○脚氣之病, 極忌房室. 勿食牛ㆍ羊ㆍ魚肉ㆍ葱ㆍ蒜ㆍ韭ㆍ菘菜ㆍ酒ㆍ麪ㆍ酥ㆍ油ㆍ猪ㆍ雞ㆍ鵝ㆍ鴨. 惟食粳粟醬豉薑椒及生果子. 犯禁者病不差. 《千金》 ○最忌熱藥蒸泡, 恐逼邪入經絡也. 《入門》

The first prohibition is anger: anger vexes the Heart and leg qi breaks out. The second is loud speech: loud speech damages the Lung and likewise stirs it. Further, one must not bare the feet to the wind, nor enter water or wash the feet in cold water. Even in summer one should always wear padded trousers, and in the cold of winter keep both shins doubly warm; to get a slight sweat is best. Have oneself massaged regularly and work the joints often, so that Qi and Blood pass freely — this is the essential of nurturing life and the method of warding off wind and damp (Oedae 外臺). — On every ox and tiger day, cut the finger and toe nails, cutting a little into the flesh, to let the Qi out. — After eating, walk slowly two or three hundred paces and stop when tired; in this way the damming cannot form (Dongwon 東垣). — Each morning eat the early meal to the full as you please, eat little at midday, and eat nothing at the evening meal — that is best of all. Eating at night dams and stagnates the Blood and Qi, and increases the swelling and pain (Bogam 寶鑑). — In food and drink, in wine, wheat, and dairy, do not exceed measure; exceeding it, leg qi breaks out. Desire must not be given free rein; where cravings are many, leg qi likewise breaks out (Dongwon 東垣). — In the illness of leg qi, bedroom affairs are absolutely forbidden. Do not eat beef, mutton, fish, scallion, garlic, chives, cabbage, wine, wheat, butter, oil, pork, chicken, goose, or duck. Eat only rice, millet, bean paste, fermented beans, ginger, pepper, and fresh fruit. Those who break the prohibitions do not recover (Cheongeum 千金). — Most forbidden of all is steaming and soaking with hot medicines, for fear of forcing the evil into the channels.
Clinical note A long list, and much of it has aged well: keep the legs warm, don't wash the feet in cold water, walk a few hundred paces after eating, make breakfast the large meal and skip dinner. The dietary prohibitions are severe and the permitted list — rice, millet, bean paste, ginger, fruit — is close to a whole-grain diet, which is a curious near-miss given that beriberi is a thiamine deficiency of polished-rice eaters. The repeated ban on hot soaks is the chapter's most insistent instruction.

Oedae 外臺 · Dongwon 東垣 · Bogam 寶鑑 · Cheongeum 千金 · Immun 入門

Self-massage for leg qi 脚氣按摩法

涌泉穴在足心, 濕氣皆從此入. 日夕之間, 常以兩足赤肉, 更次用一手握指, 一手摩擦, 數目多時, 覺足心熱. 卽將脚指略略動轉, 倦則少歇, 或令人擦之亦得, 終不若自擦爲佳. 脚力强健, 無痿弱痠痛之疾矣. 《養老》

KI1 Yongcheon lies at the heart of the foot, and the damp Qi all enters by way of it. Between day and evening, taking the bare flesh of both feet in turn, hold the toes with one hand and rub with the other, many times and for a good while, until the sole is felt to grow warm. Then move and turn the toes a little; rest briefly when tired. Having someone else rub them will also serve, but it is never so good as rubbing them oneself. The strength of the legs becomes firm and vigorous, and there is no illness of wilting, weakness, or aching.
Clinical note The most practical entry in the chapter, and free. Hold the toes with one hand, rub the sole with the other until it warms, then work the toes. The instruction that self-massage beats having it done for you is not sentiment — it involves the patient's own hands, arms, and attention, which is a small amount of exercise and a large amount of engagement. This is a prescription any clinician could hand a patient today.

Yangno 養老

The causes of wilting illness 痿病之因

內經曰, 肺者藏之長也, 爲心之盖也. 有所失亡, 所求不得, 則發肺鳴, 鳴則肺熱葉焦. 故曰, 五藏因肺熱, 肺焦發爲痿躄, 此之謂也. ○陽明者, 五藏六府之海, 主潤宗筋, 宗筋主束骨而利機關也. 陽明虛則宗筋縱, 帶脉不引, 故足痿不用也. ○心氣熱爲脉痿, 則脛縱而不任地. 肝氣熱爲筋痿, 則筋急而攣. 脾氣熱爲肉痿, 則胃乾而渴, 肌肉不仁. 腎氣熱爲骨痿, 則腰脊不擧, 骨枯而髓減. 《內經》

The Inner Classic says: the Lung is the eldest of the viscera and the canopy of the Heart. **Where there has been loss, or what was sought was not attained, the Lung sounds; sounding, the Lung is hot and its lobes are scorched.** Hence it is said: the five viscera, by reason of Lung heat and the Lung scorched, give rise to wilting and lameness. — Yang-brightness is the sea of the five viscera and six bowels, and governs moistening the ancestral sinew; the ancestral sinew governs binding the bones and freeing the joints. Where Yang-brightness is vacuous, the ancestral sinew slackens and the girdling vessel does not draw — hence the feet wilt and cannot be used. — Heart Qi heat makes vessel wilting: the shins slacken and will not bear on the ground. Liver Qi heat makes sinew wilting: the sinews are urgent and cramp. Spleen Qi heat makes flesh wilting: the stomach is dry and thirsty, the flesh insensate. Kidney Qi heat makes bone wilting: the lumbus and spine cannot be lifted, the bones wither and the marrow diminishes.
Clinical note The first passage is the striking one, and it belongs with the etiologies the Spirit and Womb chapters give: **loss, and what was sought and not attained** — and from that, heat in the Lung, and from that, legs that will not work. A musculoskeletal failure traced to a thwarted life. The five-viscera table that follows is a genuine differential, sorting wilting by which tissue has failed: vessel, sinew, flesh, or bone, each with its own presentation.

Naegyeong 內經

痿謂手足痿弱, 無力以運動也. 由肺金本燥, 燥之爲病, 血衰不能榮養百骸, 故手足痿弱不能運動, 猶秋金旺則草木萎落, 病之象也. 痿猶萎也. 《河間》 ○痿之作也, 皆五月六月七月之時. 午者, 少陰君火之位; 未者, 濕土庚金伏火之地; 申者, 少陽相火之分. 故病痿之人, 其脉浮大. 《子和》

Wilting means the hands and feet grown weak and wilted, without strength to move. It arises because Lung metal is dry by nature; dryness as an illness means the Blood wanes and cannot nourish the hundred bones, and so the hands and feet wilt and weaken and cannot move — just as when autumn metal flourishes, grasses and trees wither and fall. This is the image of the illness: **to wilt is to wither** (Hagan 河間). — Wilting arises always in the fifth, sixth, and seventh months. The horse month is the seat of lesser-Yin sovereign fire; the goat month is the ground where damp earth and metal harbor fire; the monkey month is the division of lesser-Yang ministerial fire. Hence in those ill with wilting the pulse is floating and large. (Jahwa 子和)
Clinical note Hejian's image is the whole doctrine in a phrase: 痿 is 萎 — the wilting of a person is the withering of a plant, and the cause in both is drying. It gives the illness a shape that patients understand immediately. Zihe's seasonal observation is harder to assess, but the underlying claim — that these presentations cluster in high summer — is at least an empirical one.

Hagan 河間 · Jahwa 子和

Treatment methods for wilting 痿病治法

肺金體燥而居上, 主氣畏火者也. 脾土性濕而居中, 主四肢畏木者也. 火性炎上, 若嗜慾無節則水失所養, 火寡于畏而侮所勝, 肺得火邪而熱矣. 木性剛急, 肺受熱則金失所養, 木寡于畏而侮所勝, 脾得木邪而傷矣. 肺熱則不能管攝一身, 脾傷則四肢不能爲用, 而諸痿之病作矣. 瀉南方則肺金淸而東方不實, 何脾傷之有. 補北方則心火降而西方不虛, 何肺熱之有. 故陽明實則宗筋潤, 能束骨而利機關矣. **治痿之法, 無出於此.** 《丹心》 ○東垣取黃柏爲君, 黃芪等輔佐以治諸痿, 無一定之方. 有兼痰積者, 有濕多者, 有熱多者, 有濕熱相半者, 有挾氣者, 臨病製方, 其善於治痿者乎. 雖然, 若將理失宜, 醫所不治. 天産作陽, 厚味發熱, 患痿之人若不淡薄食味, 吾知其必不能安全也. 《丹心》 ○**痿病切不可作風治, 用風藥.** 《丹心》 ○蒼朮ㆍ黃柏, 治痿之要藥也. 《正傳》

Lung metal is dry in body and dwells above, governs Qi, and fears fire. Spleen earth is damp in nature and dwells in the center, governs the four limbs, and fears wood. Fire's nature is to blaze upward; where cravings know no measure, water loses what nourishes it, fire has little to fear and insults what it overcomes, and the Lung takes the fire evil and grows hot. Wood's nature is hard and urgent; the Lung being heated, metal loses what nourishes it, wood has little to fear and insults what it overcomes, and the Spleen takes the wood evil and is damaged. The Lung hot, it cannot govern the whole body; the Spleen damaged, the four limbs cannot be put to use — and the various wilting illnesses arise. Drain the southern quarter and the Lung metal is clear and the eastern quarter not replete — what damage to the Spleen can there be? Supplement the northern quarter and the Heart fire descends and the western quarter is not vacuous — what Lung heat can there be? Therefore when Yang-brightness is replete, the ancestral sinew is moistened and can bind the bones and free the joints. **In the method of treating wilting, there is nothing beyond this** (Dansim 丹心). — Dongyuan took phellodendron as sovereign with astragalus and others assisting to treat the various wiltings, having no fixed formula. Some have phlegm accumulation besides; some have much damp; some much heat; some damp and heat in equal halves; some have Qi involved. To compose the formula at the bedside — is this not being skilled at treating wilting? Yet if the regimen is mismanaged, the physician cannot treat it. Heaven's produce makes Yang and rich flavors engender heat: for one suffering wilting, if they do not make their diet bland and light, I know they cannot come through safely. — **In wilting illness one must absolutely not treat it as wind, nor use wind medicines.** — Atractylodes and phellodendron are the essential medicines for treating wilting.
Clinical note Two rules, and the second is a prohibition worth the whole section: **do not treat wilting as wind.** Weak, useless legs invite the wind-dispelling formulas used for stroke and paralysis, and Danxi says flatly not to — wind medicines are drying and dispersing, and this illness is already dryness. The positive rule is the five-phase argument above it, which reduces to draining fire and supplementing water rather than attacking the legs at all. And the dietary instruction has teeth: rich food engenders heat, and a patient who will not eat plainly cannot be brought through.

Dansim 丹心 · Jeongjeon 正傳

肝腎俱虛, 筋骨痿弱, 宜加味四斤元ㆍ五獸三匱丸ㆍ鹿角膠丸ㆍ養血壯筋健步丸. ○濕熱痿弱, 宜神龜滋陰丸ㆍ三妙丸ㆍ加味二妙丸ㆍ加味四物湯ㆍ滋血養筋湯. ○長夏濕熱成痿, 宜健步丸ㆍ四製蒼柏丸ㆍ二炒蒼柏散ㆍ淸燥湯. ○兼濕痰, 二陳湯 方見痰門, 加蒼朮ㆍ黃柏ㆍ黃芩ㆍ白朮ㆍ竹瀝ㆍ薑汁. 血虛, 四物湯加蒼柏; 氣虛, 四君子湯加蒼柏.

Where Liver and Kidney are both vacuous and the sinews and bones wilt and weaken: Gamisageun-won 加味四斤元, Osusamgwe-hwan 五獸三匱丸, Nokgakgyo-hwan 鹿角膠丸, Yanghyeoljanggeungeonbo-hwan 養血壯筋健步丸. — For damp heat wilting and weakness: Singwijaeum-hwan 神龜滋陰丸, Sammyo-hwan 三妙丸, Gamiimyo-hwan 加味二妙丸, Gamisamul-tang 加味四物湯, Jahyeolyanggeun-tang 滋血養筋湯. — Where damp heat in late summer has made wilting: Geonbo-hwan 健步丸, Sajechangbaek-hwan 四製蒼柏丸, Ichochangbaek-san 二炒蒼柏散, Cheongjo-tang 淸燥湯. — With damp phlegm besides: Ijin-tang — formula in the Phlegm chapter — with atractylodes, phellodendron, scutellaria, white atractylodes, bamboo sap, and ginger juice added. For Blood vacuity, Samul-tang with atractylodes and phellodendron; for Qi vacuity, Sagunja-tang with the same.
Clinical note The dispensing shelf, sorted by which of the three grounds is present — dual Liver-Kidney depletion, damp heat, or late-summer damp heat. Note that atractylodes and phellodendron are added to whatever base formula is chosen, which follows from the rule stated above that they are the essential pair for this illness.

Dansim 丹心

Heat reversal becoming wilting 熱厥成痿

一人自踝以下常覺熱, 冬不可加綿於上. 常自言曰, 我稟質壯, 不怕冷. 予曰, 足三陰虛, 宜斷慾事以補養陰血, 庶乎可免. 彼笑而不答. 年近五十, 患痿半年而死. 《丹心》 ○一相公, 兩脚痿弱, 臍下尻陰皆冷, 精滑不固, 服鹿茸丸不減. 東垣診其脉, 沈數而有力, 告曰, 飮醇酒食膏粱, 滋火于內, 逼陰於外. 醫不知此, 投以熱劑, 反瀉其陰而補其陽, 眞所謂實實虛虛也. 遂處以滋腎丸, 再服而愈. 或問其故, 答曰, 是病相火熾盛, 以乘陰位, 故用此大寒之劑以瀉相火而復眞陰; 陰旣復其位, 則皮裏之寒自消矣. 《東垣》

A man constantly felt heat from the ankles down, and in winter could not put padding over them. He would often say: I am strongly endowed by nature and do not fear cold. I said to him: the three foot Yin are vacuous; you should break off desire in order to supplement and nourish the Yin Blood, and then you might be spared. He laughed and did not answer. Approaching fifty, he fell ill with wilting and died within half a year (Dansim 丹心). — A certain official had both legs wilted and weak, with everything below the navel — buttocks and genitals — cold, and seminal emission slipping and unsecured; he took Nokyong-hwan without improvement. Dongyuan examined his pulse: sunken, rapid, and forceful. He said: drinking strong wine and eating rich food has fed fire within and driven the Yin outward. The physicians, not knowing this, gave hot preparations, thereby draining his Yin and supplementing his Yang — truly what is called repleting the replete and depleting the depleted. He then prescribed Jasin-hwan, and on the second dose the man recovered. Someone asked the reason. He answered: in this illness the ministerial fire blazes and mounts the position of Yin, so one uses this greatly cold preparation to drain the ministerial fire and restore the true Yin; the Yin having recovered its place, the cold beneath the skin dissolves of itself.
Clinical note Two case histories making one point, and it is the chapter's sharpest: **cold legs can be a heat illness.** The second case is the more instructive — a man with cold buttocks, cold genitals, and weak legs who had been given warming medicines and got worse, because the pulse said the cold was Yin being driven outward by fire within. Dongyuan's explanation of why a cold-feeling patient improves on a cold formula is as clear a piece of reasoning as the classical literature offers. The first case is a warning of a different kind, and the physician records that his advice was laughed at.

Dansim 丹心 · Dongwon 東垣

Crane's-knee wind 鶴膝風

患痢後, 脚痛瘓弱, 不能行履, 名曰痢風. 或兩膝腫大痛, 髀脛枯腊, 但存皮骨, **如鶴膝之節**, 拘攣跧臥, 不能屈伸, 大防風湯主之. 《局方》 ○鶴膝風, 乃足三陰虛損, 風邪乘之痛者. 五積散 方見寒門, 加松節. 久痢後, 或手足腫者, 或歷節痛者, 乃餘瘀不散, 宜大防風湯, 或獨活寄生湯. 脚細者, 蒼龜丸. 《入門》 ○鶴膝風腫痛, 宜經驗二防飮. 《正傳》 ○又四物湯加人參ㆍ黃芪ㆍ白朮ㆍ附子ㆍ牛膝ㆍ杜沖ㆍ防風ㆍ羌活ㆍ甘草服. 《醫鑑》

After suffering dysentery, the legs pain and are palsied and weak and one cannot walk — this is called dysentery wind. Or both knees swell large and painful while the thighs and shins wither and dry until only skin and bone remain, **like the joint of a crane's knee**, and one lies drawn up and cramped, unable to bend or stretch: Daebangpung-tang 大防風湯 governs it (Gukbang 局方). — Crane's-knee wind is where the three foot Yin are vacuously damaged and a wind evil mounts them and pains. Ojeok-san — formula in the Cold Damage chapter — with pine node added. After long dysentery, where the hands and feet swell, or where there is joint-running pain, this is remaining stasis undispersed: Daebangpung-tang, or Dokhwalgisaeng-tang 獨活寄生湯. Where the legs are thin, Changgwi-hwan 蒼龜丸 (Immun 入門). — For crane's-knee wind with swelling and pain, Gyeongheomibang-eum 經驗二防飮. — Also Samul-tang with ginseng, astragalus, white atractylodes, aconite, achyranthes, eucommia, saposhnikovia, notopterygium, and licorice.
Clinical note The name is the description: knees swollen large while thigh and shin waste to skin and bone, so that the leg takes the shape of a crane's. It is a picture a clinician recognizes at a glance — joint swelling with profound muscle wasting around it, which today would raise tuberculous arthritis, septic arthritis, or inflammatory arthropathy. Note the association the chapter makes: it follows dysentery. **Note on modern practice: a hot, swollen knee with wasting and inability to walk requires urgent medical assessment — septic arthritis is an emergency, and joint tuberculosis is treatable when identified.**

Gukbang 局方 · Immun 入門 · Jeongjeon 正傳 · Uigam 醫鑑

Inauspicious signs in leg illness 脚病凶證

脚氣衝心, 恍惚氣急, 脉乍大乍小者, 死. 《入門》 ○骨痿不能起於床者, 死. 《入門》 ○病人足跗上腫, 膝大如斗者, 十日死. 《扁鵲》

Where leg qi surges into the Heart, with abstraction and hurried breath, and the pulse is now large now small — death (Immun 入門). — Where bone wilting has gone so far that one cannot rise from the bed — death. — Where the sick person's instep is swollen and the knee is as large as a peck measure — ten days and death.
Clinical note Three signs marking where the chapter's art ends. The first is cardiac failure, the second is a wilting that has become complete, and the third is a swelling so gross it was taken as terminal. **Note on modern practice: what this section calls fatal is in several cases now treatable — beriberi responds to thiamine, and joint infection to antibiotics.**

Immun 入門 · Pyeonjak 扁鵲

Nail-bed sores 甲疽瘡

一名嵌甲. 或因割甲傷肌, 遂成瘡腫, 復緣窄靴硏損, 四邊腫焮, 黃水出, 浸淫相染, 五指俱爛, 漸漸引上脚趺. 綠礬五錢火煅, 候冷硏爲末, 先以鹽湯洗瘡, 拭乾付礬末, 軟帛裹定, 一日一易, 自然差矣. 《本草》 ○一方, 枯礬五錢ㆍ蘆薈一錢半ㆍ麝香少許和用, 如上法尤妙. 《入門》 ○又方, 陳皮濃煎湯浸良久, 甲肉自相離開. 輕手剪去肉中爪甲, 外用蛇退燒灰ㆍ雄黃一錢爲末, 乾摻或香油調付. 《入門》

Also called ingrown nail. It may come from cutting the nail and injuring the flesh, so that a sore and swelling forms, and then be worsened by a narrow boot chafing it: the four sides swell and inflame, yellow water issues, it steeps and spreads and infects, all five toes suppurate, and it draws gradually up onto the instep. Green vitriol 5 don, calcined in fire and ground to powder when cool: first wash the sore with salt water, wipe it dry, apply the powder, and bind with soft cloth, changing it once a day — and it heals of itself (Bonchō 本草). — Another method: calcined alum 5 don, aloe 1.5 don, and a little musk used together as above, which is even better. — Another: soak a good while in a strong tangerine peel decoction, and the nail and flesh separate of themselves. With a light hand cut away the nail from within the flesh; externally use burnt snake slough and 1 don of realgar powdered, sprinkled dry or mixed with sesame oil and applied.
Clinical note A complete account of an infected ingrown toenail — cause, aggravation by tight boots, spread up the foot — and three treatments. The third is the one that survives: soak the toe until the nail separates from the flesh, then cut the offending spur away with a light hand. That is essentially the modern procedure. **Note on modern practice: realgar is an arsenic sulfide and green vitriol an iron salt; neither is used topically today. An infected toenail with spreading redness needs antibiotics, and in diabetes any foot infection requires prompt medical care.**

Bonchō 本草 · Immun 入門

Corns 肉刺

生指間, 碍痛不得着履靴, 此因穿窄靴而生. 黑虱多取, 擣付之, 卽根出. 《本草》 ○又法, 取莨菪根, 繫裩帶上, 感應永不痛. 《本草》 ○又法, 撑黨實爛擣貼之, 卽脫去. 《俗方》 ○又大棗去核付貼, 候爛剔去. 《俗方》

They grow between the toes, obstructing and paining so that one cannot wear a shoe or boot; they come from wearing narrow boots. Take a quantity of lice, pound them and apply, and the root comes out (Bonchō 本草). — Another method: take henbane root and tie it to the waistband, and by sympathy it will never pain again. — Another: pound ripe fruit soft and paste it on, and it falls away. — Another: pit a jujube and paste it on; when it has softened, pick it out.
Clinical note Folk remedies preserved as such, and the etiology is correct and unchanged: corns come from narrow shoes. The jujube method — a moist poultice left on until the callus softens, then lifted out — is the same principle as a modern salicylic acid pad. The henbane amulet is included for completeness; the chapter offers it without comment, as it does the other charms scattered through the book.

Bonchō 本草 · Sokbang 俗方

Simple medicinals 單方

凡二十三種. ○牛膝, 治脚膝痛痿弱, 不可屈伸. 煎服丸服, 或浸酒服幷佳. **腰腿之疾, 必用藥也.** ○石斛, 治脚膝疼冷弱. ○薏苡仁, 去乾濕脚氣, 大驗. 和郁李仁作粥常服良. ○威靈仙, 一人足病不能行數十年, 一僧敎服此藥, 爲末每二錢酒調服, 數日能步履. ○何首烏, 治骨軟風腰膝痛. 何首烏一斤ㆍ牛膝半斤ㆍ黑豆三升煮取汁, 拌蒸三次, 共擣成泥曬乾爲末, 棗肉和丸梧子大, 酒下五七十丸. ○萆麻葉, 主脚氣腫痛. 取葉蒸裹, 日三易卽差. ○牽牛子, 治脚氣腫滿. ○松節, 主脚弱痺痛. 煮取汁釀酒取淸, 飮之良. ○五加皮, 療痿躄脚弱. 釀酒服, 或水煎如茶飮之. ○桑枝茶, 治脚氣, 久服之佳. ○川椒, 治寒濕脚氣. 川椒盛疏布袋中, 置微火上, 跣足踏椒囊, 寒濕散去卽效. 《本草》 《入門》

Twenty-three kinds in all. — Achyranthes treats pain, wilting, and weakness of leg and knee that cannot bend or stretch: decocted, taken as pills, or steeped in wine, all are good. **For illnesses of the lumbus and thigh it must be used.** — Dendrobium treats aching, cold, and weakness of leg and knee. — Job's tears removes dry and damp leg qi, greatly proven; made into gruel with bush cherry kernel and taken regularly, it is good. — Clematis: a man had leg illness and could not walk for some decades; a monk taught him to take this medicine, powdered, 2 don stirred into wine, and within days he could walk. — Fleeceflower root treats bone-softening wind with pain of lumbus and knee: one geun of it with half a geun of achyranthes, boiled with three doe of black soybean for the liquid, steamed with it three times, pounded together to a paste, sun-dried and powdered, bound with jujube flesh into pills; 50–70 with wine. — Castor leaf governs leg qi swelling and pain: steam the leaves and wrap them on, changing three times a day. — Morning glory seed treats leg qi swollen and full. — Pine node governs leg weakness with numb pain: boil for the liquid, ferment it into wine and take the clear part. — Acanthopanax heals wilting and lameness with weak legs. — Mulberry twig tea treats leg qi; taken long, it is excellent. — Sichuan pepper treats cold damp leg qi: put the pepper in a loose cloth bag, set it over a low fire, and tread on the bag barefoot; when the cold damp disperses, it takes effect.
Clinical note The botanical half of the list, and two entries are worth keeping. Achyranthes is given the strongest endorsement in the section — *for illnesses of the lumbus and thigh it must be used* — which matches its role in the Lumbus chapter as the herb that leads a formula downward. And the Sichuan pepper method is the chapter's most appealing: warm a bag of peppercorns over a low fire and stand on it barefoot. A heated foot pad, four centuries early.

Bonchō 本草 · Immun 入門

檳榔, 治脚氣衝心氣急. 雞心檳榔末二錢, 以童便ㆍ薑汁ㆍ溫酒各半盞調服. ○蠡魚及鰻鱺魚, 幷主脚氣, 作膾常食. ○田螺, 主脚氣上衝, 取螺煮食之. ○生栗, 治脚氣及脚弱無力. 袋盛風乾, 每日空心食十餘枚. ○木瓜, 治脚氣及脚氣上衝, 取一顆濃煎湯飮之. ○黑豆, 治脚氣衝心. 取豆濃煎汁飮之, 和甘草煎服尤佳. ○赤小豆, 甚治脚氣水腫. 和鯉魚煮食甚佳. ○紫蘇, 治脚氣. 取葉煮湯如茶飮之. ○鹿蹄肉, 治脚膝痠痛不得踐地. 取蹄四隻, 治如食法, 着五味煮熟食之. ○烏牛尿, 治脚氣水腫. ○人尿, 治脚氣痛不可忍. 取自己尿或童子尿, 令煖盛桶, 浸兩脚, 以物盖覆勿泄氣. 《本草》 《澹寮》

Areca treats leg qi surging into the Heart with hurried breath: 2 don of chicken-heart areca powder stirred into half a cup each of child's urine, ginger juice, and warm wine. — Snakehead and eel both govern leg qi; eat them regularly as sliced raw fish. — River snail governs leg qi surging upward: boil the snails and eat them. — Fresh chestnut treats leg qi and weak, strengthless legs: keep them in a bag and wind-dry, and eat a dozen or so on an empty stomach daily. — Chaenomeles treats leg qi and leg qi surging upward: take one fruit and drink it as a strong decoction. — Black soybean treats leg qi surging into the Heart: boil the beans strongly and drink the liquid; decocted with licorice it is better still. — Adzuki bean treats leg qi with water swelling very well: boil and eat with carp. — Perilla treats leg qi: boil the leaves and drink as tea. — Deer's trotter treats aching pain of leg and knee that cannot tread the ground: take four trotters, dress them as for eating, season with the five flavors, boil through and eat. — Black ox urine treats leg qi with water swelling. — Human urine treats leg qi pain that cannot be borne: take one's own urine or a child's, warm it in a tub, soak both legs in it, and cover so the vapor does not escape.
Clinical note Foods, mostly, and several are more interesting than they look: chestnuts eaten daily, adzuki beans with carp, black soybean broth — these are the diet of a household treating swollen legs with what it had. Chaenomeles appears here as a single-herb decoction and throughout the chapter's formulas, and it remains the standing herb for cramping and leg qi in East Asian practice. **Note on modern practice: the urine soaks and animal preparations are recorded as text; neither is used today.**

Bonchō 本草 · Damryo 澹寮

Acupuncture and moxibustion 鍼灸法

環跳穴, 係兩足之安否. 《資生》 ○腿膝攣痛或枯黑, 取風市ㆍ陽陵泉ㆍ曲泉ㆍ崑崙. ○髀脛痛急, 取風市ㆍ中瀆ㆍ陽關ㆍ懸鍾. ○腰脚痛, 取委中ㆍ崑崙ㆍ人中ㆍ陰市. ○膝痛足蹶, 取環跳ㆍ懸鍾ㆍ居髎ㆍ委中. ○髀痛脛痠, 取陽陵泉ㆍ絶骨ㆍ中封ㆍ臨泣ㆍ足三里ㆍ陽輔. ○膝內廉痛, 取膝關ㆍ大衝ㆍ中封. ○膝外廉痛, 取俠谿ㆍ陽關ㆍ陽陵泉. ○足腕痛, 取崑崙ㆍ大谿ㆍ申脉ㆍ丘墟ㆍ商丘ㆍ照海ㆍ大衝ㆍ解谿. ○足五指盡痛, 取湧泉ㆍ然谷. 《綱目》

GB30 Hwando governs whether the two legs are sound or not (Jasaeng 資生). — For cramping pain of thigh and knee, or where they are withered and dark: GB31 Pungsi, GB34 Yangneungcheon, LR8 Gokcheon, BL60 Gonryun. — For urgent pain of thigh and shin: GB31 Pungsi, GB32 Jungdok, GB33 Yanggwan, GB39 Hyeonjong. — **For lumbar and leg pain: BL40 Wijung, BL60 Gonryun, GV26 Insu, ST33 Eumsi.** — For knee pain with the foot stumbling: GB30 Hwando, GB39 Hyeonjong, GB29 Georyo, BL40 Wijung. — For thigh pain with aching shins: GB34 Yangneungcheon, GB39 Jeolgol, LR4 Jungbong, GB41 Imgeup, ST36 Joksamni, GB38 Yangbo. — For pain on the inner edge of the knee: Seulgwan, LR3 Daechung, LR4 Jungbong. — For pain on the outer edge: GB43 Hyeopgye, GB33 Yanggwan, GB34 Yangneungcheon. — For ankle pain: BL60 Gonryun, KI3 Daegye, BL62 Sinmaek, GB40 Guheo, SP5 Sanggu, KI6 Johae, LR3 Daechung, ST41 Haegye. — For pain in all five toes: KI1 Yongcheon, KI2 Yeongok.
Clinical note A point map for the whole leg, region by region, and it is directly usable. **The entry for lumbar and leg pain — 腰脚痛 — is the one to note here: BL40 Wijung, BL60 Gonryun, GV26 Insu, ST33 Eumsi.** That combination is the classical prescription for what would now be called sciatica: pain that begins in the low back and runs down the leg. It is the same Wijung the Lumbus chapter reaches for, extended down the bladder channel to the ankle.

Jasaeng 資生 · Gangmok 綱目

脚氣一病, 最宜鍼, 有熱者不可灸. 《資生》 ○脚氣初發, 先灸風市, 次伏兎, 次犢鼻, 次三里, 次上廉, 次下廉, 次絶骨, 日日報灸, 以百壯爲率. ○濕熱脚氣, 紅腫生瘡, 取中封ㆍ陽輔ㆍ風市ㆍ絶骨. ○脚氣, 取足十指端, 名曰氣端, 去指奇一分, 日灸三壯, 神效. ○膝中痛, 鍼犢鼻. 《綱目》 ○膝腫, 以火鍼刺三里, 其腫如失. 又取行間. ○脚氣, 速灸風市ㆍ三里, 以瀉毒氣. ○脚弱瘦削, 取三里ㆍ絶骨. **絶骨治脚疾, 神效.** 《資生》

In the illness of leg qi, needling is most appropriate; **where there is heat, moxa must not be used** (Jasaeng 資生). — At the first outbreak of leg qi, moxa first GB31 Pungsi, then ST32 Bokto, then ST35 Dokbi, then ST36 Samni, then ST37 Sangnyeom, then ST39 Hanyeom, then GB39 Jeolgol, repeating the moxa day after day, taking a hundred cones as the measure. — For damp heat leg qi with red swelling and sores: LR4 Jungbong, GB38 Yangbo, GB31 Pungsi, GB39 Jeolgol. — For leg qi, take the tips of the ten toes, called the Qi Ends, one fun back from the nail, and moxa three cones daily — divinely effective. — For pain within the knee, needle ST35 Dokbi. — For a swollen knee, needle ST36 Samni with a fire needle and the swelling vanishes; also LR2 Haenggan. — For leg qi, moxa GB31 Pungsi and ST36 Samni quickly, to drain the toxic Qi. — For weak, wasted legs: ST36 Samni and GB39 Jeolgol. **Jeolgol treats leg illness with divine effect.**
Clinical note The contraindication comes first and is absolute: needle leg qi, but where there is heat do not moxa. The sequence for a first outbreak runs down the leg in order — Pungsi, Bokto, Dokbi, Samni, and so on to Jeolgol — a hundred cones repeated daily, which is a serious course. GB39 Jeolgol gets the section's strongest endorsement and appears in four of the eight entries; it remains a principal point for the legs in Korean practice.

Jasaeng 資生 · Gangmok 綱目