bubble_chart Concept

Pain occurring below the ankle joint, including foot pain, heel pain, and toe pain, all fall within the scope of foot pain.

bubble_chart Pattern Analysis

1. Liver-kidney Depletion︰The main clinical manifestations are heel pain on one or both sides, or pain in the sole of the foot, with no local redness or swelling, and an inability to stand or walk for prolonged periods. Symptoms may also include dizziness, tinnitus, soreness and weakness in the lower back and knees, blurred vision, a pale or red tongue, and a deep, thin, weak or wiry, thin pulse. This condition is often caused by congenital deficiencies, overexertion damaging the tendons and bones, or excessive indulgence depleting the liver and kidneys. The liver stores blood and governs the tendons, while the kidneys store essence and govern the bones. Deficiency of the liver and kidneys leads to malnourishment of the bones and marrow, resulting in pain. It is often accompanied by symptoms of liver and kidney deficiency (dizziness, tinnitus, soreness and weakness in the lower back and knees, blurred vision, etc.). For foot pain, the treatment principle is to nourish water to moisten wood. For cases with predominant kidney yang deficiency (inability to stand for long periods, cold feet), the Right-Restoring Pill with modifications can be used. For cases with predominant kidney yin deficiency (occasional heat in the lower legs), the Left-Restoring Pill with modifications is recommended.
2. Qi Deficiency and Blood Deficiency︰Common heel pain, without redness or swelling of the skin, pain relieved during daytime activities but worsens at night, accompanied by mental fatigue, limb weariness, pale complexion, aversion to cold, spontaneous sweating, a pale and swollen tongue with tooth marks on the edges, and a thin-weak or thin-choppy pulse. This condition is often caused by prolonged illness or after a major illness, excessive loss of blood, qi deficiency leading to blood depletion, or blood deficiency failing to nourish the tissues. As stated in the "Beriberi" chapter of *Ancient and Modern Medical Records*: "For all foot pains without swelling or redness of the skin, and without muscle spasms, if the pain worsens at night, it is due to qi deficiency and blood failing to nourish." Clinically, it is often accompanied by symptoms of qi and blood deficiency (such as palpitations, shortness of breath, mental fatigue, lassitude, pale and dull complexion, etc.). The treatment method involves tonifying qi and nourishing blood, using the Ten Major Tonics Decoction with modifications.
3. Cold-dampness Stagnation︰It often occurs in the toes, with heaviness and weakness in the lower limbs while walking. Severe pain may lead to limping, accompanied by soreness, distension, and heaviness in the calves. The skin becomes cold and pale, gradually turning purplish-dark. The affected limb is sensitive to cold and experiences numbness and stabbing pain, which worsens at night. The tongue appears pale with a white coating. Prolonged cases may develop into digital gangrene. This condition is mostly caused by exposure to cold water after sweating or prolonged standing in cold-dampness environments, leading to the invasion of cold-dampness. Suwen·Taiyin Yangming Lun states: "When harmed by dampness, the lower body is the first to be affected." Suwen·Jutong Lun says: "When cold enters the collaterals, it lingers and stagnates, failing to circulate. If it lodges outside the vessels, blood becomes insufficient; if it lodges within the vessels, qi becomes obstructed, resulting in sudden pain." The combination of dampness and cold leads to stagnation of qi and blood, obstruction of the vessels, and pain. Symptoms often worsen at night, with severe cold pain in the affected foot, even causing limping. Treatment should focus on warming the meridians and dissipating cold, resolving dampness, supplemented by promoting blood circulation and unblocking the vessels. The recommended formula is Angelica Cold-Extremities Decoction combined with Aconite Decoction, modified as needed. For cases of wind-dampness obstruction, the treatment should emphasize resolving dampness and relieving obstruction in the collaterals, using Ma Xing Yi Gan Tang or Juan Bi Tang with modifications.
4. Wind-dampness Obstruction︰Foot pain worsens in cold and rainy weather, often accompanied by pain and swelling in the joints of the limbs, difficulty in flexion and extension, heaviness in the lower limbs, thin white tongue coating, and floating or soggy and slow pulse. This is caused by the combination of wind and dampness invading the skin and lingering in the meridians, leading to bi syndrome, often accompanied by pain in the joints throughout the body, or swelling and deformation.

Cold-dampness stagnation and wind-dampness obstruction over time can both lead to blood stasis due to the blockage of qi and blood, or transform into heat due to prolonged stagnation. For cases with blood stasis, local cyanosis may be observed, and treatment should include invigorating blood and resolving stasis, with formulas such as Taohong Siwu Decoction. For cases where prolonged stagnation transforms into heat, symptoms include local redness, burning swelling and pain, and a dry mouth with a bitter taste. Treatment should focus on clearing heat and draining dampness, as well as promoting the flow of meridians, with modified Simiao Powder.

Foot pain is often caused by liver-kidney depletion and qi deficiency with blood deficiency, mostly due to internal damage. The former is due to the deficiency of the liver and kidney, while the latter is due to the insufficiency of qi and blood. Treatment should focus on nourishing and tonifying. Cold-dampness stagnation and wind-dampness obstruction are caused by the six excesses. The former is due to the combination of cold and dampness, and treatment should focus on warming and promoting circulation. The latter is due to the combination of wind and dampness, and treatment should focus on dispelling wind and draining dampness.

bubble_chart Documentation

1. "Luo's Compendium of Medical Mirrors: On Dampness Pattern" states: "The classics say, all dampness swelling and fullness belong to the spleen earth. It also says, those harmed by dampness are first affected below. As the feet are located below and often receive dampness, when dampness stagnates and turns into heat, the struggle between dampness and heat causes pain to arise."