Question 29 on Lower Leg Qi
The following is another excerpt from my ongoing translation project, the “Hundred Questions of Gynecology” 女科百問 by Qí Zhòngfǔ from 1220 CE, the first volume of which I recently published as “Channeling the Moon" and which you can read more about here…
Question Twenty-Nine: What is the Reason for Women Suffering from Pain in the Ten Toes as If They Were Being Fried in Oil, and Experiencing Heat Pain When Covered up and Cold Pain When Exposed to Blowing Wind?
Answer: According to the words of the Realized Master Sūn, people who have Lower-Leg Qì [have the following characteristics: The condition] first rises from the lower legs, possibly with slackening and weakness first, suddenly falling over when getting up or walking, or swelling and fullness in the shins, or withered and delicate knees, or palpitations in the heart, or numbness in the lower abdomen, or cramping sinews when moving, or retching counterflow when seeing food and aversion to the smell of food, or fullness in the chest and urgent breathing, or soreness and pain all over the body. All of these are the signs of Lower-Leg Qì.
What the Yellow Emperor refers to as “slackened Qì damp bì Impediment” is precisely this. Unresponsive softness is called “slackening wind”; the pain constitutes damp bì Impediment. In the winter, it strikes the three Yáng [channels], and the ailment must be cold, while in the summer it strikes the three Yīn [channels] and the ailment must be heat.
When women [suffer from pain] in the ten toes as if they were being fried in hot oil, this is caused by Qì vacuity in yíng Provisioning and wèi Defense and by the retention of the toxic Qì of dampness in the channels and network vessels. When this [damp Qì] attacks the heart above, heart pain results; when it attacks the lower legs below, pain in the lower legs results. The feeling as if the ten toes were being fried in hot oil also falls into the category of Qì [disorder]. What the Classic refers to as “heat Reversal” is precisely this.
As the first line in the answer makes clear, Question Twenty-Nine is concerned with a condition called Lower-Leg Qì (腳氣 jiǎo qì). In spite of Qí Zhòngfǔ’s apparent claims that the first part of his answer is a quotation from Sūn Sīmiǎo, I have been unable to confirm that. It should be noted that Sūn’s Bèijí qiānjīn yàofāng 備急千金要方 devotes an entire volume to the topic of “Wind Toxin Lower-Leg Qì,” so it must have been a medical category of great diagnostic and therapeutic significance in the early Táng period. Supporting this, the slightly earlier Zhūbìng yuánhòu lùn 諸病源候論 by Cháo Yuánfāng 巢元方 also contains abundant information in Volume Thirteen on “The Various Signs of Lower-Leg Qì Disease.” Reviewing the historical information on this condition and explaining the quite tenuous relationship to the biomedical condition Beriberi, as which it is quite inaccurately translated in most contemporary TCM literature, is beyond the scope of this book. For more information, the reader is referred to Hilary Smith’s outstanding book on the topic, Forgotten Disease: Illnesses Transformed in Chinese Medicine.
The key points to take away from earlier medical literature on the disease of Lower-Leg Qì are as follows: It is a condition that can express itself in numerous ways and does not have a single cause or even key symptoms. Nevertheless, it is, at least was originally, associated with pathological wind that invades the body through the feet. As such, texts warned against prolonged standing, sitting, or lying on damp, wet, and cold or hot ground. From the feet, this evil Qì is seen as rising up in the body, often without the patient noticing. Expressing itself primarily in weakness and slackening, pain and soreness, swelling, or numbness as it traveled upward, it eventually affects the heart, at which point it has reached a critical point and become difficult to treat. In addition to the patient’s carelessness in protecting him- or herself from an invasion of pathological Qì through the feet, and the dangers of wet or damp locations, diet and emotion are also mentioned as contributing factors.
Concerning the affected channels, Sūn Sīmiǎo mentions that while wind toxin can strike a person anywhere in the body, the fact that the three channels of the liver, kidney, and spleen start in the feet means that these are the most likely vectors for wind toxin Qì rising up from the ground. In contrast to this etiology, the middle section of the answer above offers an alternative explanation related to the seasons, namely that the three Yīn and Yáng channels are the place where damp bì Impediment strikes in summer and winter, respectively. This is a much simpler concept than the explanation on seasonal variations of bì Impediment found in Sùwèn 素問Chapter Forty-three, the “Treatise on Bì Impediment:”
The Yellow Emperor asked: “How is it that bì Impediment is created?”
Qí Bó replied: “When a medley of the three Qì of wind, cold, and dampness reaches the body and blends together, it forms bì Impediment. In this condition, if the wind Qì prevails, the patient develops moving bì; if the cold Qì prevails, the patient develops painful bì; if the dampness Qì prevails, the patient develops adhesive bì.”
The Emperor said: “How is it that there are five types of this bì?”
Qí Bó said: “Encountering this condition in the winter causes bone bì. Encountering this condition in the spring causes sinew bì. Encountering this condition in the summer causes vessel bì. Encountering this condition at the time of “reaching/apex yīn” causes muscle bì. Encountering this condition in autumn causes skin bì.
In the following paragraph, these physiological features are related to the associated zàng organs in accordance with standard Chinese medicine theory, “when the condition becomes chronic and fails to leave”: As such, chronic bone bì is related to the kidney, sinew bì to the liver, vessel bì to the heart, muscle bì to the spleen, and skin bì to the lung. The section concludes, “what we refer to as bì is this multi-layered contraction of the Qì of wind, cold, and/or dampness, each in its respective season.”
To complicate matters further, the last paragraph mentions a third etiology, namely “heat Reversal.” This condition is explained in the “Treatise on Reversal,” which is Sùwèn Chapter Forty-Five:
The Yellow Emperor asked: ‘What is reason for the cold and heat forms of Reversal?’
Qí Bó replied: ‘Debilitation of Yáng Qì below results in cold Reversal. Debilitation of Yīn Qì below results in heat Reversal.’
The Yellow Emperor said: ‘Why is it that when heat Reversal causes heat, it must rise up from the underside of the feet?’
Qí Bó said: ‘Yáng Qì arises from the exterior of the five toes, while the Yīn vessels come together on the underside of the foot and gather in the center of the foot. Thus the soaring of Yáng Qì results in heat on the underside of the feet.’
To conclude this discussion and bring it back to the topic of Lower-Leg Qì, let me mention an interesting side note on this condition from a much later text from Japan, Zábìng guǎngyào 《雜病廣要》 (Comprehensive Essentials about the Various Diseases) by Tanba no Genken 丹波元堅 from 1853. The volume on “External Causes” includes the following short paragraph on women’s particular association with this disease. Admittedly, this text is obviously much later and originated in Japan, was thus most likely influenced by localized understandings of the disease, and must be treated with caution in its proper historical context. I have included it here solely because it may be of clinical interest to my readers. This text does identify the statement below as a quotation from a text called Jìshēng 《濟生》(Rescuing Life), which presumably refers to the Sòng dynasty text Yán shì jìshēng fāng 《嚴氏濟生方》 (Life-Saving Formulas by Master Yán), which was completed in 1253. That text in turn contains a whole section on formulas for Lower-Leg Qì and mentions briefly that this disease also affects women and must be due to blood, but the following is by no means a literal quotation and thus must be seen as an expression of a nineteenth-century Japanese understanding of the disease.
Women’s Lower-Leg Qì is caused by blood vacuity. Looking at Lower-Leg Qì, it is always engendered as the result of kidney vacuity. This being so, there are also women who fall ill with Lower-Leg Qì, and this is invariably caused by vacuity in the Sea of Blood and a habit of harboring anger and worry, which is further complicated by contracting sorrow and subsequently forms this disease. Because there are currently great multitudes of women suffering from this condition, we know that women contract it from a vacuity of the Sea of Blood, which falls into the same category as kidney vacuity in men. The treatment method for women is certainly no different from the medicinals used for men. Nevertheless, you will most definitely see results if you concurrently use medicinals that treat [the female patients’] worry and rage.