凡丁肿生于手足指，或足溃而自脱，故名脱疽。有发于手指者，名曰蛀节丁，重者腐去本
节，轻者筋挛。
痛或不痛者，急用隔蒜灸，更用解毒药。若色黑，急刮去，速服补剂，庶可灸。黑延上
者，不治。
痛者，除湿攻毒，隔蒜灸至不痛。
色赤 痛者，托里消毒，更兼灸。作渴者，滋阴降火。色黑者，不治。
一人足指患毒， 痛色赤发热，隔蒜灸之，更以人参败毒散，去桔梗，加金银花、白芷、
大黄，二剂痛止。又十宣散，去桔梗、官桂，加天花粉、金银花，数剂愈。
一人年四十，左足大指赤肿 痛，此脾经积毒下注而然，名曰脱疽，喜色赤而肿。以人参
败毒散去人参、桔梗，加金银花、白芷、大黄，二剂，更以栝蒌、金银花、甘草节，四剂顿退。
再以十宣散去桔梗，加金银花、防己，数剂愈。
一膏粱之人年五十，患足疽，色紫黑，脚 痛。孙真人云∶脱疽之证，急斩之，若毒延入
腹必不治，色黑不痛亦不治。喜其饮食如故，动息自宁，为疮善证。遂以连翘败毒六剂，更以
金银花、栝蒌、甘草节，二十余
剂，患指溃脱。更以川芎、当归、生地、连翘、金银花、白芷二十剂而愈。次年忽发渴，服
生津药愈甚，用八味丸而止。
一 荛左足指患一泡，麻木色赤，次日指黑，五日连足黑冷，不知疼痛，脉沉细。此脾胃
受毒所致。与飞龙夺命丹一服，翌日令割去死黑肉，割后始痛，可救，治以十全大补汤而愈。
Whenever a Ding swelling (a carbuncle occurring at the tips of fingers or toes) arises on the fingers or toes, and if the foot ulcerates leading to the spontaneous detachment of the toe segment, it is named Tuojue (Gangrene of the Toes). Some cases occur on the fingers, known as Zhujie Ding (Segment-Eroding Ding), where severe cases result in necrosis extending to the proximal joint, while mild cases present with tendon contraction.
For those presenting with pain or without pain, immediate application of Garlic-Separated Moxibustion is required, along with the administration of detoxifying herbs. If the tissue turns black, rapid debridement of necrotic tissue should be performed, followed by the prompt intake of tonic formulas; only then is moxibustion appropriate. If the blackness spreads upward, the condition is incurable.
In cases with prominent pain, dampness-draining and toxin-attacking methods are employed, using Garlic-Separated Moxibustion until the pain subsides.
For cases presenting with redness and pain, interior-supporting and detoxification methods are used, combined with moxibustion. If accompanied by thirst, yin-nourishing and fire-descending methods are applied. Cases turning black are incurable.
One patient suffered from toxicity in the toe, presenting with pain, redness, and fever. He was treated with Garlic-Separated Moxibustion and Ren Shen Bai Du San (Ginseng Decoction to Overcome Toxicity), with Jiegeng (Platycodon Root) removed, and Jinyinhua (Honeysuckle Flower), Baizhi (Angelica Dahurica Root), and Dahuang (Rhubarb Root) added. After two doses, the pain ceased. Subsequently, Shixuan San (Ten Acupoints Powder) was administered, with Jiegeng (Platycodon Root) and Guigui (Cinnamon Twig) removed, and Tianguafen (Trichosanthes Root) and Jinyinhua (Honeysuckle Flower) added. After several doses, he recovered.
A forty-year-old patient presented with redness, swelling, and pain in the left big toe. This was caused by accumulated toxicity in the Spleen meridian sinking downward, diagnosed as Tuojue (Gangrene of the Toes), characterized by a preference for redness and swelling. Ren Shen Bai Du San (Ginseng Decoction to Overcome Toxicity) was prescribed, removing Renshen (Ginseng Root) and Jiegeng (Platycodon Root), adding Jinyinhua (Honeysuckle Flower), Baizhi (Angelica Dahurica Root), and Dahuang (Rhubarb Root). After two doses, Guanlou (Trichosanthes Fruit), Jinyinhua (Honeysuckle Flower), and Gancao Jie (Licorice Knots) were given for four doses, resulting in rapid symptom resolution. Finally, Shixuan San (Ten Acupoints Powder) was used, removing Jiegeng (Platycodon Root) and adding Jinyinhua (Honeysuckle Flower) and Fangji (Stephania Tetrandra Root), curing him after several doses.
A fifty-year-old individual accustomed to rich and greasy foods suffered from foot gangrene, presenting with purple-black discoloration and foot pain. Sun Simiao stated: "For Tuojue (Gangrene of the Toes), amputation should be performed urgently; if the toxin spreads into the abdomen, it is incurable. Black coloration without pain is also incurable." Fortunately, the patient’s diet remained normal, and his movements and rest were undisturbed, indicating a favorable prognosis for the sore. Thus, Lianqiao Bai Du San (Forsythia Decoction to Overcome Toxicity) was given for six doses, followed by Jinyinhua (Honeysuckle Flower), Guanlou (Trichosanthes Fruit), and Gancao Jie (Licorice Knots) for over twenty doses, leading to the suppuration and detachment of the affected toe. Subsequently, Chuanxiong (Szechwan Lovage Rhizome), Danggui (Chinese Angelica Root), Shengdi (Rehmannia Root), Lianqiao (Forsythia Fruit), Jinyinhua (Honeysuckle Flower), and Baizhi (Angelica Dahurica Root) were administered for twenty doses, resulting in recovery. The following year, he suddenly developed thirst; taking fluids-generating herbs worsened the condition, but it was resolved using Ba Wei Wan (Eight-Ingredient Pill with Rehmannia).
A patient surnamed Rao had a blister on his left big toe, which was numb and red. The next day, the toe turned black. By the fifth day, the entire foot became black and cold, with loss of pain sensation, and the pulse was deep and fine. This was caused by toxicity affecting the Spleen and Stomach. One dose of Feilong Duoming Dan (Flying Dragon Life-Seizing Pill) was given. The next day, the necrotic black flesh was surgically excised. Pain commenced only after the excision, indicating that rescue was possible. He was treated with Shiquan Dabu Tang (Perfect Golden Great Tonic Decoction) and recovered.