【方歌】青蛇毒生腿肚下，形长三寸紫块僵，肾与膀胱湿热结，
急针蛇头血出良。
【注】此证又名青蛇便，生于小腿肚之下，形长二、三寸，结
肿、紫块、僵硬，憎寒壮热，大痛不食，由肾经素虚，
膀胱湿热下注而成。蛇头向下者，毒轻而浅，急刺蛇头
一、半寸，出紫黑血，随针孔搽拔疔散；外敷离宫锭，
内服仙方活命饮，加黄柏、牛膝、木瓜。亦有蛇头向上
者，毒深而恶，急刺蛇头一、二寸，出紫黑血，针孔用
白降丹细条插入五、六分，外贴巴膏。余肿敷太乙紫金
锭，内服麦灵丹；俟毒减退，次服仙方活命饮调和之。
若毒入腹，呕吐腹胀，神昏，脉躁，俱为逆证。
方剂：拔疔散（见齿部牙疔）
离宫锭、仙方活命饮、麦灵丹（见肿疡门）
白降丹、巴膏（俱见溃疡门）
太乙紫金锭（见胸部脾发疽）
【方歌】接骨发如核桃形，腿肚之下硬胀疼，色红漫肿宜速溃，
迟损筋脉缺踵行。
【注】此证生于腿肚之下，接骨之上，胫骨与足后跟骨相接处
，故名接骨发，属膀胱经湿热凝结而成。初如核桃，其
硬如物打磕崩之状，急胀微疼，色红漫肿，脓宜速溃，
迟则脓毒损筋，筋脉既伤，腿缺踵行。踵行者，不能全
足践地，惟恃足指着力而行也。始终内外治法，俱按痈
疽肿疡、溃疡门。
[Prescription Verse] Qing She Du (Green Snake Toxin) arises below the calf, presenting as a long, stiff purple mass measuring two to three cun in length. It is caused by the accumulation of damp-heat in the Kidney and Bladder meridians. Urgent pricking at the "snake head" (the apex of the lesion) to release blood yields good results.
[Annotation] This condition is also known as Qing She Bian. It occurs below the calf, presenting as a swelling with a purple, stiff mass measuring two to three cun. Symptoms include aversion to cold with high fever (Zeng Han Zhuang Re), severe pain leading to anorexia. The etiology involves inherent deficiency of the Kidney meridian combined with downward pouring of damp-heat from the Bladder. If the lesion points downward ("snake head down"), the toxin is mild and superficial; urgently prick the apex one to half cun deep to release dark purple-black blood, then apply Ba Ding San (Poultice for Extracting Toxins) to the puncture site; externally apply Li Gong Ding, and internally administer Xian Fang Huo Ming Yin (Immortal Formula for Preserving Life) supplemented with Huang Bo (Phellodendri Cortex), Niu Xi (Achyranthis Bidentatae Radix), and Mu Gua (Chaenomelis Fructus). If the lesion points upward ("snake head up"), the toxin is deep and malignant; urgently prick the apex one to two cun deep to release dark purple-black blood, insert a thin strip of Bai Jiang Dan (White Reduction Elixir) five to six fen into the puncture wound, and externally apply Ba Gao. Apply Tai Yi Zi Jin Ding to the remaining swelling, and internally administer Mai Ling Dan. Once the toxin subsides, subsequently administer Xian Fang Huo Ming Yin to harmonize the body. If the toxin invades the abdomen, accompanied by vomiting, abdominal distension, coma, and a restless pulse, these are all adverse signs (Ni Zheng).
Formulas: Ba Ding San (see Dental Section on Ya Ding); Li Gong Ding, Xian Fang Huo Ming Yin, Mai Ling Dan (see Swollen Ulcer Section); Bai Jiang Dan, Ba Gao (both see Ulcer Section); Tai Yi Zi Jin Ding (see Chest Section on Pi Fa Ju).
[Prescription Verse] Jie Gu Fa resembles a walnut in shape, occurring below the calf with hardness, swelling, and pain. The redness and diffuse swelling indicate it should be allowed to suppurate quickly; delay will damage the sinews and tendons, resulting in gait abnormalities resembling missing heels.
[Annotation] This condition arises below the calf, at the junction of the tibia and the calcaneus (heel bone), hence named Jie Gu Fa. It is caused by the coagulation of damp-heat in the Bladder meridian. Initially, it resembles a walnut, feeling hard as if bruised by impact, with acute swelling and slight pain. The area is red and diffusely swollen. Suppuration should be encouraged to rupture promptly; delay allows pus and toxin to damage the sinews. Once the sinews and vessels are injured, the patient suffers from Que Zhong Xing (gait without heel contact). "Que Zhong Xing" refers to the inability to place the entire sole on the ground, relying solely on the toes for weight-bearing. Both internal and external treatments throughout the course of the disease follow the protocols outlined in the sections on Carbuncles and Sores (Yong Ju), specifically the Swollen Ulcer and Ulcer categories.