脱疽谓疔患于足或足趾，重者溃脱，故名之。亦有患于手，患于指者。因醇酒炙爆，膏
粱伤脾，或房劳损肾，故有先渴而后患者；有先患而后渴者。若色赤作痛自溃者，可治。色黑不
溃者，不治。色赤作痛者，元气虚而湿毒壅盛也。先用隔蒜灸、活命饮、托里散，再用十全
大补汤、加减八味丸。色黯不痛者，肾气败而虚火盛也，隔蒜灸、桑枝灸，亦用十全大补
汤、加减八味丸，则毒瓦斯不致上侵，元气不致亏损，庶可保生。亦有因修手足口咬等伤而致
者。若元气虚弱，或犯房事，外涂寒凉，内服克伐，损伤脾胃，患处不溃，若黑黯上延，亦
多致
虽
者须解去为善。故孙真人云∶在肉则割，在指则截。盖亲之遗体，虽不忍伤，而遂至夭殁，
则尤伤矣。况解法无痛，患者知之。
治验
一男子足趾患之，肿 痛赤，此三阳经虚，而外邪所乘也。用隔蒜灸，人参败毒散加银
花、
。又有足趾患之者，色紫不痛，此三阳经热毒壅滞，隔蒜灸五十余壮，又明灸百壮，始痛，
投活命饮四剂，更以托里药，溃脱而愈。
一男子患前症，赤痛作渴，此足三阴虚，而火内动。用隔蒜灸、活命饮，三剂而溃；更
服托里药，及加减八味丸，溃脱而愈。若早用前法，不至于此。
一男子肿痛，色赤发热作渴，大小便秘结，其脉浮数，按之沉实，此足三阳经积热，内
外俱受患也。先用隔蒜灸，及人参败毒散加银花、白芷、大黄而溃，更以活命饮而痊。
一膏粱之人，先作渴足热，后足大趾赤痛，六脉洪数而无力，左尺为甚。余以为此足三
阴虚
阴八珍汤，各三十余剂，及桑枝灸，溃而脓清，作渴不止。遂朝以前汤，送加减八味丸，夕
用十余大补汤，三十余剂而痊。是时同患此症，服败毒之药者，俱不救。
Tuoju (Gangrene of the toes) refers to Ding sores (hard, deep-rooted boils) occurring on the foot or toes. In severe cases, it leads to ulceration and shedding of tissue, hence the name. It can also occur on the hands and fingers. It is caused by excessive consumption of rich wine and roasted/fried foods, which damage the Spleen; or by sexual excess, which damages the Kidney. Therefore, some patients experience thirst before the onset of the disease, while others develop the disease first and then experience thirst. If the affected area is red, painful, and spontaneously ulcerates, it is treatable. If it is black and does not ulcerate, it is untreatable. Redness with pain indicates deficiency of Yuan Qi (Original Qi) and abundance of damp-toxin stagnation. Initially, use Garlic-partitioned Moxibustion, Huoming Yin (Life-Saving Decoction), and Tuoli San (Supporting Interior Powder), followed by Shiquan Dabu Tang (Ten-Ingredient Great Tonifying Decoction) and Jiaban Bawei Wan (Modified Eight-Ingredient Pill). Dark discoloration without pain indicates failure of Kidney Qi and flourishing of deficient fire. Use Garlic-partitioned Moxibustion and Mulberry Branch Moxibustion, along with Shiquan Dabu Tang and Jiaban Bawei Wan, so that toxic factors do not invade upward and Yuan Qi is not depleted, thereby preserving life. It may also be caused by injuries such as trimming hands/feet or animal bites. If Yuan Qi is weak, or if one engages in sexual activity, applies cold-cooling external medicines, or takes internal purgatives, the Spleen and Stomach are damaged. If the lesion does not ulcerate and the blackness spreads upward, death often results. In such cases, it is best to excise the necrotic tissue. Thus, Sun Simiao said: "If in the flesh, cut it; if on the finger, amputate it." Although this body is a gift from parents and one is reluctant to harm it, dying from it would be a greater unfilial act. Moreover, the excision method is painless, and patients know this.
Clinical Cases:
A man suffered from the condition in his toe, with swelling, pain, and redness. This was due to deficiency of the Three Yang meridians and invasion of external pathogens. He received Garlic-partitioned Moxibustion and Renshen Baidu San (Ginseng Detoxification Powder) added with Jinyinhua (Honeysuckle Flower) and Baizhi (Angelica Dahurica). Another man had a toe lesion that was purple and painless, indicating heat-toxin stagnation in the Three Yang meridians. He underwent more than fifty moxa cones via Garlic-partitioned Moxibustion, followed by direct moxibustion for over one hundred cones, after which pain began. He was administered four doses of Huoming Yin (Life-Saving Decoction), followed by interior-supporting medicines, leading to ulceration, shedding of tissue, and recovery.
A man suffered from the aforementioned symptoms, with redness, pain, and thirst. This indicated deficiency of the Three Yin meridians of the Foot and internal movement of fire. He received Garlic-partitioned Moxibustion and Huoming Yin (Life-Saving Decoction), which led to ulceration after three doses. He then took interior-supporting medicines and Jiaban Bawei Wan (Modified Eight-Ingredient Pill), resulting in ulceration, shedding of tissue, and recovery. Had the previous methods been used earlier, he would not have reached this state.
A man presented with swelling, pain, redness, fever, and thirst, accompanied by constipation of both stool and urine. His pulse was floating and rapid, but deep and solid upon pressure. This indicated accumulated heat in the Three Yang meridians of the Foot, affecting both interior and exterior. He initially received Garlic-partitioned Moxibustion and Renshen Baidu San (Ginseng Detoxification Powder) added with Jinyinhua (Honeysuckle Flower), Baizhi (Angelica Dahurica), and Dahuang (Rhubarb Root), which led to ulceration. He was then cured with Huoming Yin (Life-Saving Decoction).
A man accustomed to rich foods first experienced thirst and hot feet, followed by redness and pain in the big toe. His six pulses were surging and rapid but forceless, especially the left Chi position. I diagnosed this as deficiency of the Three Yin meridians of the Foot. He took Ziyin Bazhen Tang (Yin-Nourishing Eight-Treasure Decoction) and Jiaban Bawei Wan (Modified Eight-Ingredient Pill), each for over thirty doses, along with Mulberry Branch Moxibustion. After ulceration, the pus became clear, but thirst persisted. Consequently, he took the former decoction in the morning to deliver Jiaban Bawei Wan (Modified Eight-Ingredient Pill), and Shiquan Dabu Tang (Ten-Ingredient Great Tonifying Decoction) in the evening. After over thirty doses, he recovered. At that time, others suffering from the same condition who took detoxification medicines all died.