手指头生疮，俗名天蛇毒。然五指各有经络，拇指属手太阴肺经，食指属手阳明大肠经，中指属手厥阴心包络经，
无名指属手少阳三焦经，少指属手少阴心经。亦有患于足者，足趺属肝胆胃三经，大指属肝脾二经，次指属胆经，小指
属膀胱经，各当随经而治。其致患之由，或因胃中积热所发，或因乳母膏粱浓味所致，或因湿热下流，或因风毒外中，
大率多由所禀足三阴之经虚，故邪得以入之也。其初患肿痛者，先用仙方活命饮，次用托里消毒散。元气下陷，重坠作
痛，久而不溃者，用补中益气汤，若服败毒散，及敷寒凉之剂，则疮口变黑，或 肉突出，或指皆黑。大抵手足为气血
难到之处，手属于胃，足属于脾，不可损其真气。丹溪以臀居僻位，尚言气血罕到，况肢末乎。故寒凉克伐之药，所宜
深戒者也。
一小儿十四岁，手大指患之，色赤肿痛，用夺命丹二粒，活命饮一剂，将愈；因饮酒沐浴，而疮复作，发热咳嗽。
余谓∶此毒原属肺经，今肺为湿热所攻，疮毒乘势妄行，故复作耳。先用泻白散二剂，而痰嗽除；又用托里消毒散而疮
愈。
一小儿食指患之，迸出血水，疮口凸肿，上连手背，久而不愈。余曰∶此元气虚弱，风邪袭于患处，血气不能运及
而然。用托里散及葱熨之法，诸症悉退；又用豆豉饼、异功散加升麻、柴胡而愈。
一小儿患之，作痛发热，内外皆用寒凉之药，手背出脓，三月不愈，面色痿黄，此脾气复伤也，先用异功散加升麻、
柴胡、桔梗，渐愈，又佐以托里散、豆豉饼而痊。
一小儿十三岁，素食膏粱，足大指患之，肿连脚面，喜饮冷水，右关脉洪大，此脾气复伤，而积热下注也。先用清
胃散四剂，次用活命饮二剂，肿痛渐消，又用托里消毒散数剂，脓溃而愈。
一小儿足大指漫肿，上连趺阳，色赤肿甚，右关脉数而有力，此胃经湿热下注也，用活命饮一剂，大指本节后，始
发疮头，痛亦稍止，再剂而漫肿悉退，又用消毒散出脓，托里散收敛而愈。
一小儿足次指患之，色赤肿痛，上连于腿，外涂寒凉之药，反致麻木重陷，方知此气血难到之所，又因寒凉遏绝而
然。急以活命饮加黄 五钱煎服，外以姜葱汤洗去敷药，用隔蒜灸法，半晌知痛，其肿顿退，再用托里散加人参三钱数
剂，脓溃而愈。
一小儿足大指患之，内服外敷，皆寒药也，腹痛恶心，手足并冷，此脾胃之气复伤而作，非疮毒也，先用异功散加
柴胡、升麻、白芷，及神方活命饮各一剂，诸症顿退，又用托里消毒散，脓溃而愈。
一小儿足大指患之，变脓窠之状良久，干硬痛甚，小便频数，此禀父肾经虚热所致，用六味地黄丸而愈。
一小儿足中指患之，耳中肿痛，小便频数，此禀父肝肾虚热为患，用六味地黄丸为主，佐以柴胡栀子散而愈。
一小儿不时生疮，HT 在手足之表，年余不愈，审其乳母善怒，用加味逍遥散，母子服而愈。
一小儿足大指患之，肿痛连脚，用活命饮及隔蒜灸，其痛不止，着肉艾灸数壮方止，用活命饮及托里消毒散而愈。
一女子十五岁，足拇指痒痛，敷败毒之药，势益甚而色黯，余谓脾经郁结所致。彼人略不经意，后朝寒暮热，饮食
顿减，患处微肿，足胫渐细而殁。
钱氏泻白散（方见臂痈）
夺命丹（方见疔疮）
消毒散（方见胎毒发丹）
葱熨法
托里散（二方见流注）
仙方活命饮
托里消毒散（二方见热毒疮疡）
东垣清胃散（方见腹痈）
五味异功散（方见败毒之药）
补中益气汤（方见肌肉不生）
Sores on the fingertips, commonly known as "Heavenly Snake Poison" (Tianshe Du), occur. However, each of the five fingers is governed by specific meridians: the thumb belongs to the Hand-Taiyin Lung Meridian (Shǒu Tàiyīn Fèi Jīng), the index finger to the Hand-Yangming Large Intestine Meridian (Shǒu Yángmíng Dàcháng Jīng), the middle finger to the Hand-Jueyin Pericardium Meridian (Shǒu Juéyīn Xīnbāo Jīng), the ring finger to the Hand-Shaoyang Sanjiao Meridian (Shǒu Shàoyáng Sānjiāo Jīng), and the little finger to the Hand-Shaoyin Heart Meridian (Shǒu Shàoyīn Xīn Jīng). There are also cases affecting the feet; the dorsum of the foot involves the Liver, Gallbladder, and Stomach meridians, the great toe involves the Liver and Spleen meridians, the second toe involves the Gallbladder meridian, and the little toe involves the Bladder meridian. Treatment should be conducted according to the affected meridian. The causes of this condition include accumulation of heat in the Stomach, dietary factors such as the wet nurse consuming rich and greasy foods, downward flow of damp-heat, or external invasion of wind-toxin. Generally, it arises from a congenital deficiency of the Foot-Taiyin meridians, allowing pathogens to enter. For initial swelling and pain, Xianfang Huoming Yin (Immortal Life Elixir Decoction) is used first, followed by Tuoli Xiaodu San (Supporting Interior and Detoxifying Powder). If Qi sinks, causing heavy dragging pain and failure to suppurate over time, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is indicated. If Baidu San (Detoxification Powder) is taken or cold-natured agents are applied externally, the sore may turn black, flesh may protrude, or the entire finger may become necrotic. Broadly speaking, the hands and feet are areas where Qi and Blood rarely reach. The hands relate to the Stomach, and the feet relate to the Spleen; one must not damage the True Qi. Danxi stated that even the buttocks, being in a remote location, have scarce Qi and Blood, let alone the extremities. Therefore, cold and purgative medicines should be strictly avoided.
A fourteen-year-old boy suffered from this on his left thumb, presenting with redness, swelling, and pain. He took two pills of Xueming Dan (Life-Rescuing Pill) and one dose of Huoming Yin, and was nearly cured. However, after drinking alcohol and bathing, the sore recurred with fever and cough. I reasoned: This toxin originally belongs to the Lung Meridian; now the Lung is attacked by damp-heat, and the sore toxin acts recklessly due to the momentum, hence the recurrence. First, Xiebai San (Draining White Powder) was administered for two doses to resolve the phlegm and cough; then, Tuoli Xiaodu San was used to heal the sore.
A boy suffered from this on his index finger, exuding blood and serum, with the sore opening protruding and swollen, extending upward to the dorsum of the hand, failing to heal for a long time. I said: This is due to deficient Yuan Qi, with Wind pathogen invading the affected area, preventing Qi and Blood from reaching it. Tuoli San (Supporting Interior Powder) and Congyun method (Scallion Moxibustion/Warming Therapy) were used, resolving all symptoms; subsequently, Douchi Bing (Fermented Soybean Cake) and Yigong San (Five-Ingredient Extraordinary Power Powder) with Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) led to recovery.
A boy suffered from this, experiencing pain and fever. Both internal and external treatments involved cold-natured medicines. Pus appeared on the dorsum of the hand, and the condition persisted for three months without healing. His complexion was sallow, indicating further injury to Spleen Qi. First, Yigong San with Shengma, Chaihu, and Jiegeng (Platycodonis Radix) was used, leading to gradual improvement; then, supplemented with Tuoli San and Douchi Bing resulted in full recovery.
A thirteen-year-old boy, accustomed to a diet rich in fats and sweets, suffered from this on his right great toe. Swelling extended to the foot surface, he preferred drinking cold water, and his Right Guan pulse was surging and large. This indicated injured Spleen Qi with accumulated heat sinking downward. Qingwei San (Clearing Stomach Powder) was administered for four doses, followed by two doses of Huoming Yin, gradually reducing swelling and pain. Several doses of Tuoli Xiaodu San were then used, leading to suppuration and recovery.
A boy presented with diffuse swelling of the right great toe, extending to the dorsum, with severe redness and swelling. His Right Guan pulse was rapid and forceful, indicating damp-heat sinking from the Stomach Meridian. One dose of Huoming Yin was given. A sore head began to form behind the proximal interphalangeal joint of the great toe, and pain subsided slightly. After another dose, the diffuse swelling completely receded. Xiaodu San was used to expel pus, and Tuoli San to promote healing and contraction.
A boy suffered from this on his right second toe, presenting with redness, swelling, and pain, extending up the leg. External application of cold medicines caused numbness and heaviness with sinking sensation. Realizing this was an area where Qi and Blood rarely reach, exacerbated by cold constriction, immediate treatment involved Huoming Yin with Huangqi (Astragali Radix) 5 qian decocted and taken internally. Externally, ginger and scallion water was used to wash off the applied medicine, followed by Gexuanjiu (Garlic-Separated Moxibustion). After half a day, pain returned, and swelling suddenly subsided. Tuoli San with Renshen (Ginseng Radix) 3 qian was administered for several doses, leading to suppuration and recovery.
A boy suffered from this on his right great toe. Internal and external applications were all cold medicines. He experienced abdominal pain, nausea, and cold hands and feet. This was caused by further injury to Spleen and Stomach Qi, not by the toxin itself. First, Yigong San with Chaihu, Shengma, and Baizhi (Angelicae Dahuricae Radix), along with Shenfang Huoming Yin (Miraculous Formula Huoming Decoction), each one dose, rapidly resolved all symptoms. Tuoli Xiaodu San was then used, leading to suppuration and recovery.
A boy suffered from this on his right great toe. It remained in a pustular cavity state for a long time, dry, hard, and severely painful, with frequent urination. This was attributed to inherited Kidney Meridian deficiency-heat from the father. Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) was used for recovery.
A boy suffered from this on his right middle toe, accompanied by ear swelling and pain, and frequent urination. This was attributed to inherited Liver-Kidney deficiency-heat. Liuwei Dihuang Wan was used as the primary formula, supplemented with Chaihu Zhizi San (Bupleurum and Gardenia Powder) for recovery.
A boy frequently developed sores on the surface of his hands and feet, persisting for over a year. Upon inquiry, it was found that his wet nurse had a tendency toward anger. Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) was prescribed for both mother and child, resulting in recovery.
A boy suffered from this on his right great toe, with swelling and pain extending to the foot. Huoming Yin and Gexuanjiu were used, but pain persisted. Direct moxibustion on the flesh for several moxa cones stopped the pain. Huoming Yin and Tuoli Xiaodu San were then used for recovery.
A fifteen-year-old girl suffered from itching and pain in her right great toe. She applied detoxifying (cold/purgative) medicines, which worsened the condition and turned the color dark. I diagnosed this as constraint in the Spleen Meridian. She paid little attention to it. Later, she developed aversion to cold in the morning and fever in the evening, sudden reduction in appetite, slight swelling at the site, and thinning of the lower legs, eventually dying.
Qian's Xiebai San (Formula see Arm Carbuncle chapter)
Xueming Dan (Formula see Ding Chuang chapter)
Xiaodu San (Formula see Tai Du Fa Dan chapter)
Congyun Method
Tuoli San (Two formulas see Liuzhu chapter)
Xianfang Huoming Yin
Tuoli Xiaodu San (Two formulas see Re Du Chuang Yang chapter)
Dongyuan Qingwei San (Formula see Abdominal Carbuncle chapter)
Wuwei Yigong San (Formula see Bai Du Zhi Yao chapter)
Buzhong Yiqi Tang (Formula see Ji Rou Bu Sheng chapter)