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[Prescription Verse] Gangrene of the toes (Tuo Ju) mostly occurs between the toes; yellow blisters like millet grains appear, followed by blackening and spreading rot. This represents the "Five Failures" syndrome due to exhaustion of Kidney essence and depletion of blood; if gangrene persists after amputation, death is certain.

[Note] This condition mostly arises between the toes, with occasional occurrences on fingers. The ten digits of the hands and feet are extensions of the Zang-Fu organs. Before the onset of the abscess, patients experience irritability and fever, resembling Xiao Ke disease (Wasting-Thirst). After a long period, this affliction develops. Initially, it appears like a millet grain: a single yellow blister with purplish-dark skin color, resembling a cooked red date. Black qi infiltrates and spreads, causing rot to extend from one toe to another. In severe cases, it attacks the dorsum of the foot. The pain is intense, as if scalded by hot water or burned by fire. The foul odor cannot be resolved even with rare fragrances. This results from consuming rich foods and alcohol, and taking aphrodisiacs and mineral-based hot medicines, which stir up Yang essence and cause rampant Yin-fire. This heat accumulates in the Zang-Fu organs, consuming and burning Yin fluids. At this stage, Heart blood dies leading to Heart failure, skin dies leading to Lung failure, tendons die leading to Liver failure, flesh dies leading to Spleen failure, and bones die leading to Kidney failure. These "Five Failures" syndromes are difficult to treat effectively even with miraculous drugs. In the early stage, it is suitable to take Jiedu Jisheng Tang (Detoxification and Life-Preserving Decoction). Externally, cook barley rice, mix with 5 qian each of Hibiscus leaf (Furong Ye) and Chrysanthemum leaf (Juhua Ye), and apply to relieve pain. If resolution fails, surgical amputation must be performed. The patient must be willing and disregard life and death, following ancient methods: if the toxin is in the flesh, cut; if in the bone, chop. However, surgery should be performed early, before the toxin spreads. Tie the proximal phalanx tightly with more than ten strands of hair, winding it over ten times, to prevent toxic qi from attacking healthy tissue. Then place a Chan Su Bing (Toad Venom Cake) on top of the initial yellow blister and apply moxibustion until the tissue necroses. The next day, when the affected toe is completely black, use a sharp knife to carefully sever the toe at the joint line. If bleeding does not stop, use Rusheng Jin Dao San (Like-Sage Golden Knife Powder) to stop it, and apply Ligong Ding (Palace-Removing Paste) for residual swelling. If black qi remains the next day, sprinkle powdered Chan Su Bing alone, cover with Tuoseng Gao (Monk Tuo Paste), and the black qi will recede. When pus forms, apply Shengji Yuhong Gao (Regenerate Flesh Jade Red Ointment) and other flesh-regenerating agents. Regrowth of muscle, protection of bone, and wound closure indicate a favorable prognosis. Internally, use formulas that nourish Kidney Water, tonify Qi and Blood, strengthen the Spleen, and calm the Spirit, such as Yinyang Erqi Dan (Yin-Yang Two-Qi Pill), Qingshen San (Spirit-Clearing Powder), and Jinye Wutu Dan (Golden Fluid Earth-Earth Pill). If there are no adverse changes internally or externally, three or four out of ten may survive. If, after amputation, black qi reappears crossing joints and invading healthy tissue with intensified pain, it is an adverse sign. If the condition presents without pain initially, Ci Xiong Pili Huo (Male and Female Thunderbolt Fire) moxibustion is suitable. Other tonifying and washing methods follow the protocols for Yong Ju Swelling/Ulcer sections.

Commentary: Various texts state that Tuo Ju occurs only on the great toe, and those on other toes are called Dun Ju. This is not accurate. However, Tuo Ju predominantly affects toes belonging to Yin meridians. Based on repeated experience, future scholars should examine this carefully.

Formula: Jiedu Jisheng Tang (Detoxification and Life-Preserving Decoction)
Composition: Dang Gui (Angelicae Sinensis Radix), Yuan Zhi (Polygalae Radix, heart removed), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Fen Hua (Trichosanthis Radix), Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Xi Jiao (Rhinocerotis Cornu, sliced), Mai Dong (Ophiopogonis Radix, heart removed), Zhi Mu (Anemarrhenae Rhizoma), Huang Bo (Phellodendri Cortex), Fu Shen (Poria with Hostwood), Jin Yin Hua (Lonicerae Japonicae Flos), Hong Hua (Carthami Flos), Niu Xi (Achyranthis Bidentatae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma, raw, 5 fen). Each herb is 1 qian except Gan Cao.
Decoct 2 zhong of water to 8 fen. Add 1 cup of Tong Bian (Child's Urine). Take before meals. If occurring on fingers, remove Niu Xi and add Sheng Ma (Cimicifugae Rhizoma).

[Verse] Jiedu Jisheng uses Gui, Yuan, and Xiong; Fen Hua, Chai, Qin, Xi, and Mai Dong. Zhi, Bai, Fu, Yin, Hong, Xi, and Cao; For early Tuo Ju with irritability and heat attack.

Another Formula: Rusheng Jin Dao San (Like-Sage Golden Knife Powder)
Composition: Song Xiang (Pini Resina, 7 liang), Sheng Bai Fan (Alumen Crude), Ku Bai Fan (Alumen Ustums, 1.5 liang each).
Grind into extremely fine powder. Store in a porcelain jar. Sprinkle on the affected area when needed.

[Verse] Rusheng Jin Dao San treats blade wounds; Good for stopping unceasing bleeding. Bai Fan, Ku Bai Fan, and Song Xiang; Grind fine and store in a jar.

Another Formula: Yinyang Erqi Dan (Yin-Yang Two-Qi Pill)
Composition: Tian Men Dong (Asparagi Radix, heart removed), Mai Men Dong (Ophiopogonis Radix, heart removed), Xuan Shen (Scrophulariae Radix, boiled and coarse skin removed; these three made into paste), Wu Wei Zi (Schisandrae Fructus, fried), Ren Zhong Bai (Natrii Carbonas), Huang Bo (Phellodendri Cortex, 1 liang each), Gan Cao (Glycyrrhizae Radix et Rhizoma, raw), Ze Xie (Alismatis Rhizoma), Ku Bai Fan (Alumen Ustums), Qing Dai (Indici Folium, 3 qian each), Bing Pian (Borneolum Syntheticum, 1 qian).
Grind each into fine powder. Mix with the pastes of Tian Men Dong, etc. Add a little refined honey. Pound for over a thousand strokes until consistency is moderate. Form pills the size of Sophora seeds. Coat with Cinnabar (Zhu Sha). Take 60 pills per dose. Send down with Tong Bian (Child's Urine) and Ren Ru (Human Milk), one wine-cup each, on an empty stomach. Sleep quietly for one shichen (two hours).

[Verse] Yinyang Erqi Dan for Tuo Ju; Dryness and heat oppress withered Kidney Water. Tian, Mai, Xuan Shen, Gan, Xie, Wei; Zhong Bai, Bing, Fan, Bai, Dai are suitable.

Another Formula: Qingshen San (Spirit-Clearing Powder)
Composition: Lu Dou Fen (Vigna Radiatae Semen Pulvis, 1 liang), Niu Huang (Bovis Calculus, 3 fen), Gan Cao Jie (Glycyrrhizae Radix et Rhizoma, nodes, 5 qian), Bing Pian (Borneolum Syntheticum, 5 fen), Zhu Sha (Cinnabaris, 3 qian).
Grind all into extremely fine powder. Take 1 qian per dose. Mix with decoction of Dan Zhu Ye (Lophatheri Herba) and Deng Xin Cao (Junci Medullia) and swallow.

[Verse] Qingshen San treats Tuo Ju eruption; Good for regulating stifling and irritability. Bean powder, Niu Huang, Gan Cao nodes; Grind with Bing Pian and Zhu Sha together.

Another Formula: Jinye Wutu Dan (Golden Fluid Earth-Earth Pill)
Composition: Fu Shen (Poria with Hostwood), Hu Huang Lian (Coptidis Rhizoma alternative/Wood Betony root?), Wu Mei Rou (Mume Fructus Carnium), Ren Zhong Huang (Hominis Excrementum Purified), Wu Wei Zi (Schisandrae Fructus, 1 liang each), Zhu Sha (Cinnabaris), Xiong Huang (Realgar), Xiao Shi (Nitrums), Yuan Zhi (Polygalae Radix, heart removed), Shi Chang Pu (Acori Tatarinowii Rhizoma, 3 qian each), Niu Huang (Bovis Calculus), Bing Pian (Borneolum Syntheticum, 1 qian each).
Grind each into fine powder. Mix thoroughly and grind for a thousand turns. Prepare on auspicious days: Dragon Boat Festival, Double Seventh, Spring/Autumn Equinox, Winter/Summer Solstice. In a clean room, mash Wu Mei Rou into paste, mix with powder, add a little refined honey, and pound for over a thousand strokes until consistency is moderate. Form pills weighing 1 qian each. Coat with Gold Foil (Jin Bo). Take one pill per dose. Dissolve and take with Ren Ru (Human Milk) and Tong Bian (Child's Urine), one wine-cup each, according to the location of the disease. During preparation and administration, avoid exposure to women, monks/nuns, mourners, chickens, and dogs. Seal with wax to preserve potency. The longer it is stored, the more effective it becomes.

[Verse] Jinye Wutu contains Fu, Niu Huang; Zhu, Xiong, Xiao, Yuan, Pian, Shi Chang Pu. Hu Lian, Mei Rou, Zhong Huang, Wei; Specifically treats Tuo Ju and Back Sores.

Another Formula: Ci Xiong Pili Huo (Male and Female Thunderbolt Fire)
Composition: Ci Huang (Orpiment), Xiong Huang (Realgar), Ding Xiang (Caryophylli Flos, 2 qian each), She Xiang (Moschus, 1 fen).
Grind into fine powder. Mix with 2 qian of Qi Ai Rong (Artemisia argyi catkins). Roll into pea-sized pellets. Place on the lesion and moxa. Continue until tissue is scorched, regardless of itching or pain. If the toxin has spread, moxa at the edge of the red halo. Pain turning to itch, or itch turning to pain, indicates improvement; a bright red and active sore is ideal.

[Verse] Pili Huo treats Yin Abscess; Moxa is stronger for painless Tuo Ju. Ci Huang, Ding, She, Xiong Huang powder; Mixed with Qi Ai Rong for good effect.

Another Formula: Chan Su Bing (Toad Venom Cake - see Ding Chuang section for Toad Venom Pills)
Ligong Ding (See Yong Ju Swelling section)
Tuoseng Gao, Shengji Yuhong Gao (See Yong Ju Ulcer section)