【方歌】足跟疽生脚挛根，状如兔咬紫红焮，阳跷积热溃难敛，
初宜隔蒜艾灸勤。
【注】此证生足跟，俗名脚挛根，由脏腑积热，汗出涉水，远
行伤筋而成。初肿红紫疼痛，溃破脓水淋沥，状如兔咬
。经云兔啮状如赤豆，至骨急治，迟则害人。盖谓毒之
深恶也，属足太阳膀胱经，穴名申脉，即阳跷脉发源之
所，又系肾经所过之路。疮口久溃不合，阳跷脉气不能
冲发，肾气由此漏泄，以致患者益虚。初起宜隔蒜片灸
之，服仙方活命饮加肉桂、牛膝；溃后宜补中益气汤、
人参养荣汤、桂附地黄丸随证滋补治之。余按痈疽溃疡
门。《海藏》云：免囓久不收敛，用盐汤洗之，白术研
末撒之，两日一易，谨戒一切劳碌即效。
方剂：隔蒜灸法（见首卷灸法）
仙方活命饮（见肿疡门）
补中益气汤、人参养荣汤（见溃疡门）
桂附地黄丸（见面部颊疡）
【方歌】厉痈势小足旁生，四淫在足上下凝，三阴亏损为疽重，
三阳湿热发痈轻。
【注】《灵枢》云：发于足上下，名曰四淫，其状大痈，急治
之，百日死；发于足旁，名曰厉痈，其状不大，急治之
，去其黑者，不消辄益，不治，百日死。此二证俱由足
三阴经亏损，为疽者重；若兼足三阳经湿热下注而成痈
者轻。若红肿疼痛，溃破有脓，腐脱无黑气浸漫，属湿
热偏盛，顺证易治；若微红微肿，溃出脓水，属阴气凝
结不能化脓，险证难治；若黑暗漫肿，痛不溃脓，烦热
作渴，小水淋漓，为阴败，恶证属逆。四淫无边沿，厉
痈类敦疽。初俱宜仙方活命饮，外宜隔蒜灸，以宣壅毒
。将溃宜服人参养荣汤，兼六味地黄丸以滋补之。若色
黯不痛，即用桑柴烘法，以行壅滞助阳气，更宜十全大
补汤，兼桂附地黄丸，壮脾滋水治之，或可成功。若妄
用苦寒克伐之药，多致不救。外治法同敦疽。
方剂：仙方活命饮（见肿疡门）
隔蒜灸法（见首卷灸法）
人参养荣汤、十全大补汤（见溃疡门）
六味地黄丸（见面部雀斑）
桑柴烘法（见首卷）
桂附地黄丸（见面部颊疡）
[Prescription Verse] Heel abscess (Zugenju) arises at the heel, resembling a rabbit bite with purple-red swelling and heat. Accumulated heat in the Yangqiao vessel leads to difficult healing after ulceration; initially, frequent moxibustion with garlic partition (Gesanjiu) is suitable.
[Annotation] This condition occurs at the heel, commonly known as "Jiaoluan Gen" (foot cramp root). It results from accumulated heat in the zang-fu organs, wading in water while sweating, or damaging tendons through long-distance walking. Initially, there is red-purple swelling and pain; upon ulceration, pus drains continuously, resembling a rabbit bite. The classics state: "Rabbit bite resembles a red bean; if it reaches the bone, urgent treatment is required, otherwise it harms the patient." This refers to the deep and malignant nature of the toxin. It belongs to the Foot-Taiyang Bladder Meridian, specifically the Shenmai point (BL62), which is the source of the Yangqiao vessel and also a pathway for the Kidney Meridian. If the wound remains unhealed for a long time, the Qi of the Yangqiao vessel cannot surge forth, causing Kidney Qi to leak, thereby making the patient increasingly deficient. At the onset, moxibustion with garlic slices is suitable, accompanied by internal administration of Xianfang Huoming Yin (Immortal Life Elixir) augmented with Rougui (Cinnamon Bark) and Niuxi (Achyranthes Root); after ulceration, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), Renshen Yangrong Tang (Ginseng Nourishing the Nutritive Decoction), and Guifu Dihuang Wan (Cinnamon and Aconite Rehmannia Pill) should be administered according to the syndrome to tonify and nourish. I note: In the section on carbuncles and ulcers, Haizang states: For rabbit bites that fail to heal over time, wash with salt water, sprinkle powdered Baizhu (Atractylodes Macrocephala Rhizome) on the lesion, change every two days, and strictly avoid all exertion for efficacy.
Formulas: Gesanjiu Method (see Moxibustion Methods in Volume 1)
Xianfang Huoming Yin (see Swelling Ulcer Section)
Buzhong Yiqi Tang, Renshen Yangrong Tang (see Ulcer Section)
Guifu Dihuang Wan (see Facial Cheek Ulcer)
[Prescription Verse] Liyong (Malignant Carbuncle) is small in scale and arises beside the foot; Siyin (Four Pervasions) condenses above and below the foot. Gangrene resulting from deficiency of the Three Yin meridians is severe; carbuncles arising from damp-heat in the Three Yang meridians are mild.
[Annotation] The Ling Shu states: Arising above and below the foot, it is named Siyin (Four Pervasions); its presentation is a large carbuncle, requiring urgent treatment, or death will occur within one hundred days. Arising beside the foot, it is named Liyong (Malignant Carbuncle); its presentation is not large, requiring urgent treatment to remove black necrotic tissue; if it does not subside but worsens, and is untreated, death will occur within one hundred days. Both conditions result from deficiency of the Foot-Sanyin meridians; those presenting as gangrene are severe. If complicated by damp-heat pouring downward from the Foot-Sanyang meridians forming a carbuncle, the condition is mild. If there is redness, swelling, pain, ulceration with pus, and sloughing without black gas infiltration, it indicates predominant damp-heat, representing a favorable syndrome that is easy to treat. If there is slight redness and swelling, with pus drainage indicating yin qi condensation failing to transform into pus, it is a dangerous syndrome difficult to treat. If there is dark discoloration with diffuse swelling, pain without ulceration/pus, irritability, heat, thirst, and dribbling urination, it indicates collapse of yin, representing an malignant syndrome and adverse prognosis. Siyin lacks distinct borders, while Liyong resembles Dunju (Dun Abscess). Initially, both are suitable for Xianfang Huoming Yin (Immortal Life Elixir) internally and garlic-partitioned moxibustion externally to disseminate stagnant toxins. As ulceration approaches, Renshen Yangrong Tang (Ginseng Nourishing the Nutritive Decoction) should be taken, combined with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) for tonification. If the color is dull and painless, immediately employ the Sangchai Hong method (Mulberry wood roasting technique) to resolve stagnation and assist yang qi, preferably combined with Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction) and Guifu Dihuang Wan (Cinnamon and Aconite Rehmannia Pill) to strengthen the spleen and nourish water, which may succeed. If bitter-cold draining medicines are recklessly used, rescue is often impossible. External treatment methods are identical to those for Dunju.
Formulas: Xianfang Huoming Yin (see Swelling Ulcer Section)
Gesanjiu Method (see Moxibustion Methods in Volume 1)
Renshen Yangrong Tang, Shiquan Dabu Tang (see Ulcer Section)
Liuwei Dihuang Wan (see Facial Freckles)
Sangchai Hong Method (see Volume 1)
Guifu Dihuang Wan (see Facial Cheek Ulcer)