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The *Neijing* (Inner Canon) states: Leprosy (*Li*) is characterized by heat in the Ying (Nutrient) Qi, causing its nature to be impure. Consequently, it leads to the collapse of the nasal bridge and a deteriorated complexion, with ulcers and sores on the skin. When Wind-Cold pathogens invade the meridians and remain, it is called Leprous Wind (*Li Feng*). The pathogenic wind enters together with the Taiyang (Greater Yang) channel, circulates through the Shu (Transport) points of various meridians, and scatters between the muscle layers, interfering with the Wei (Defensive) Qi. This obstruction hinders the smooth flow of pathways, resulting in ulcers in the muscles. Since the Wei Qi is hindered and cannot circulate freely, numbness and insensitivity occur in the flesh. If the condition progresses to heavy joints and loss of eyebrows and beard, it is called Great Wind (*Da Feng*). A pulse indicating wind signifies leprosy. To treat leprosy, one should repeatedly puncture the swollen areas to reduce swelling; use a sharp needle to prick the affected site, press to expel foul qi, and stop only when the swelling completely subsides. One should consume only regular food and avoid other foods. Observing the discussions in the *Neijing*, treatment should distinguish between the Ying (Nutrient) and Wei (Defensive) levels for regulation. Although ancient formulas are numerous, they often indiscriminately drain wind-heat from both Ying and Wei without distinguishing sequence. It was not until Li Dongyuan and Zhu Danxi that a distinction was made. *Huofa Jiyao* records: First, administer Huapi San (Birch Bark Powder), starting from a small dose and gradually increasing to the maximum, taken continuously for five to seven days. Then moxa the Chengjiang (CV24) acupoint with seven moxibustion cones. After the moxibustion wound heals, moxa again. After three rounds of moxibustion, administer Zaizao San (Reconstruction Powder) to dispel wind-heat from the Blood level, and abstain from sexual intercourse for three years for recovery. This is a method of treating the Wei level first, then the Ying level.

Zhu Danxi stated: Treating leprosy requires distinguishing whether the pathology is upper or lower. Observe the nodules on the body; if they appear predominantly on the upper half, the Qi level is affected. Use Zuixian San (Intoxicating Immortal Powder) to extract foul blood through the gum margins. If they appear predominantly on the lower half, the Blood level is affected. Use Zaizao San to extract foul matter and parasites via the anus. Although the routes differ, all pertain to the Yangming (Yang Brightness) channel. If both upper and lower parts are affected simultaneously, both Qi and Blood are involved. Use Bisheng San (Invincible Powder) to treat both upper and lower. This is because the Yangming channel governs the Stomach and Large Intestine, accepting everything. Qi belongs to Yang, which is Wei; Blood belongs to Yin, which is Ying. The upper half of the body is affected by Yang pathogens first, and the lower half by Yin pathogens first. Therefore, Zaizao San treats pathology in the Yin level by using Gaojiao Ci (Gleditsia Spine) to draw out wind-toxin from the Ying-Blood. The Liver governs Blood; stasis of foul blood indicates Liver involvement. Parasites are also generated from the Jueyin (Terminal Yin) Wind-Wood transformation. Thus, this method must be used to regulate the Zang organs, focusing on killing parasites. Chi Binglang (Areca Seed) expels toxin from the Ying level; Bai Qianniu (Morning Glory Seed) expels toxin from the Wei level; Dahuang (Rhubarb Root) guides the medicine into the intestines and stomach to promote the discharge of stasis and foul matter. Zuixian San treats pathology in the Yang level by using Niuzi (Burdock Fruit) to draw out wind-toxin from widespread sores; Yama (Flaxseed) dispels wind and moistens the Lungs and skin; Jili (Tribulus Fruit) treats foul blood-induced pruritus and opens the nasal passages; Fangfeng (Saposhnikovia Root) acts as a guide for various winds; Gualougen (Trichosanthes Root) treats blood stasis and reduces heat-swelling; Gouqi (Goji Berry) harmonizes blood, dispels wind-heat, and dissipates sores; Manjingzi (Vitality Fruit) treats thief-wind; Kushen (Sophora Root) treats heat-toxic wind, relieving restlessness, sores, red leprosy, and eyebrow loss. These eight herbs are indeed effective, but Yin Fen (Calomel) must be used as an assistant drug. Yin Fen is a crucial agent for descending through the diaphragm and unblocking the Large Intestine, used to drive other medicines into the Yangming channel, open the stagnation of wind-heat, expel foul wind and odorous toxins, and kill parasites. The medicinal power ascends along the meridian to the soft teeth, expelling foul saliva. If this medication damages the teeth, wipe them with Huanglian (Coptis Rhizome) powder. Zhu Danxi selected these two formulas as vanguard troops. Bisheng San combines their efficacies but requires strict dietary control and abstinence from sex; it will surely be effective.

There are five methods for treating leprosy:
1. Sweating Method: Use Ephedrae Herba (Mahuang), Schizonepetae Spica (Jingjie), Saposhnikoviae Radix (Fangfeng), Notopterygii Rhizoma et Radix (Qianghuo), Saussureae Radix (Duhuo), Gleditsiae Fructus (Zaogao), Sophorae Flavescentis Radix (Kushen), and Scorpio (Quanxie). Take hot and cover to induce sweating.
2. Fumigation and Bathing Method: First, mix Phellodendri Cortex (Huangbai), Coptidis Rhizoma (Huanglian), and Menthae Haplocalycis Herba (Bohe) into powder, apply with water around the eyes. Then decoct Schizonepetae Spica (Jingjie), Sophorae Flavescentis Radix (Kushen), Pteridis Massae (Fengteng), Aurantii Fructus (Zhike), Xanthii Fructus (Cangerzi), Notopterygii Rhizoma et Radix (Qianghuo), branches of Morus alba (Sangzhi), Sophora japonica (Huai zhi), Persicae Semen (Tao zhi), Salix matsudana (Liuzhi), and green onions with roots. Fumigate and bathe. After bathing, apply powder of Akebiae Caulis (Mutong), Acori Tatarinowii Rhizoma (Shichangpu), and Rhei Radix et Rhizoma (Dahuang) with a little Moschus (Shexiang) to the affected area.
3. Application and Rubbing Method: Use Alum (Baifan), Hibiscus mutabilis root bark (Chuanjinpi), Myrobalan (Wubeizi), and Scorpio (Quanxie) as powder, add a little Mylabris (Banzhe), and mix with sesame oil for application. Wolf fat is excellent. For dry itching, use Semend Acanthopanacis Senticosi (Dafengzi), Strychni Semen (Fanmubie), Paviae Semen (Wubairen), Sesami Nigris Semen (Heizhima), Sojae Semen Nigrum (Heidou), Armeniacae Semen Amarum (Xingren), and Gossypii Semen (Mumianzi). Crush together, place in a heated jar, cover with an iron lid, secure with iron wire and nails, and simmer in chaff fire overnight. Extract the medicinal oil to mix with subsequent drugs. Prepare Piperis Longi Fructus (Hujiao) and Zanthoxyli Pericarpium (Chuanjiao), 2 liang each; Calcined Alum (Kufan) and Calomel (Qingfen), 6 qian each. Grind to fine powder, mix with the aforementioned oil, and rub on the lesion. After several days, the skin may shed like snake skin; rub twice more for effect. For obese patients, use Aconiti Lateralis Radix Praeparata (Chuanwu), Aconiti Kusnezoffii Radix (Caowu), Asari Radix (Xixin), Armeniacae Semen Amarum (Xingren), Typhonii Rhizoma (Baifuizi), Realgar (Xionghuang), and Sinapis Albae Semen (Baijiezi) as powder, add a little Moschus (Shexiang), and rub with fresh ginger. For stubborn pus, add Mylabris (Banzhe) and Orpiment (Baipi). Rub occasionally. Find an empty room, seal with paper, avoid wind. After seven days, move to another quiet room due to foul odor. After seven days, rub once daily until cured. If any area lacks sensation, it is the root cause; rub that area specifically, 3-5 times daily.
4. Decoction Method: Use Liangge San (Cool the Chest Powder), Shuangjie San (Double Resolution Powder), Xiaofeng San (Dispel Wind Powder), etc.
5. Pill and Powder Method: Select Jiulong Wan (Nine Dragons Pill), Qihuang Wan (Lacquer Yellow Pill), [Missing Name] Wan, Bungarus Parvus Pill (Baihuashe Wan), Eling San (Goose Feather Powder), or Wugong San (Centipede Powder). If all leprosy medicines fail, use Qianjin Qipo Wanbings Wan (Thousand Gold Qibo All-Disease Pill), which is extremely effective. For facial twitching in leprosy, use Shengma Weifeng Tang (Ephedra and Stomach Wind Decoction), fumigating and washing with peach, willow, sophora, and mulberry branch decoctions. For facial swelling, take Xiaofeng San or Liangge San. Externally, apply powder of Sulphur (Huangshan), Realgar (Xionghuang), Boswelliae Resina (Ruxiang), Myrrhae Resina (Moyao), Draconis Sanguis (Xuexie), Calomel (Qingfen), Calcined Alum (Kufan), Moschus (Shexiang), and Sepiae Endoconcha (Wuzeigu) mixed with sesame oil to the swollen area. Do not wash the face for seven days for effect. For perforated soles in leprosy, use Strychni Semen (Fanmubie) prepared with butter, 3 qian, and Boehmeriae Niveae Fibre (Zhuma) 1 jin, burned to ash. Take 1 qian with wine on an empty stomach. Severe cases resolve within a month. If excessive medication causes aversion to cold and vomiting, stop with Piper Longum (Hujiao) decoction. For eyebrow loss in leprosy, use Cervi Cornu Colla (Lu jiao) processed to ash, 6 qian, and Gleditsiae Fructus (Zaogao) ash, 1 liang. Rub with ginger on eyebrows, 3-5 times daily. Another method: use Drynariae Rhizoma (Gusuibu) dried and Pinelliae Rhizoma (Banxia) raw, equal parts, rubbed with ginger, 5-7 times daily. Internally, take roasted Gleditsiae Spine (Zaogao ci) powder, 2 qian, after meals with rice wine or tea infusion.

Vitiligo (*Baiban Feng*) is caused by Blood deficiency failing to moisten meridians and toxic pathogens injuring the Qi level of the Lung channel. *Shenghui Fang* uses Mulberry Branch (Sangzhi) 10 jin and Leonuri Fructus (Chongweicao) 3 jin, decocted into paste, taken with warm wine. Externally, apply Realgar (Xionghuang), Sulphur (Huangshan), Minium (Huandan), Arisaema Cum Bile (Nanxing), Calcined Alum (Kufan), and Litharge (Mituoseng) equally, rubbed with ginger. It turns black upon rubbing, then heals. Another formula uses white eggplant cut at one end for rubbing.

Purple Cloud Wind (*Ziyun Feng*) is caused by Qi stagnation failing to govern blood circulation and toxic pathogens accumulating in the Blood level of the Liver channel. Take [Missing Name] leaf 1 jin and Lacquer Tree Leaf (Qiyè) 0.5 jin, honey-processed nine times, made into pills the size of marbles, taken with plain water. Another formula: decoct Kushen (Sophora Root), He Shou Wu (Polygonum Multiflorum), Da Hu Ma (Sesamum Indicum), Bai Ji Li (Tribulus), Shi Chang Pu (Acorus), Chi Jing [Missing], Bohe (Mint), and Qi Ye (Lacquer Leaf). Externally, apply Sulphur (Huangshan) and Official Powder (Guanfen) mixed with egg white.

Goose Palm Wind (*Ezhang Feng*): Wash frequently with decoction of Walnut Shell (Hetao Qiao) and Pigeon Droppings (Ge Fen). Another method: Apply raw Tung Oil (Tongyou) to fingers and fumigate with Qiai (Artemisia argyi) smoke. Avoid water for seven days for effect.

Leprous Ulcer Bleeding/Cupping Method: Zhang Zihe said one sweating session equals a thousand needles, as bleeding is less comprehensive than sweating. However, "those who lose sweat have no blood; those who lose blood have no sweat." They are consistent principles. If foul blood stagnates in the skin and meridians, puncture or sweating is suitable. For sweating, use only Marrubium Vulgare (Fuping), dried and powdered, 3 qian per dose, taken with black bean steeped wine before bed, covered to sweat. Avoid wind-aggravating and toxin-releasing foods. Strong constitutions take it daily; weak constitutions take it one day, skip two-three days, alternating with Dihuang Wan (Rehmannia Pill), stopping when symptoms improve by 70-80%. Early leprosy with numbness uses Wanling Dan (Ten Thousand Spirit Pill) to sweat and disperse stagnant wind-toxin, similar to using Doulin Jiu (Bean-Infused Wine) with Fuping.

If foul blood accumulates in the Zang organs, internal purging is necessary for cure. If toxins are external, puncturing lesions on the body, arms, waist, buttocks, finger webs, and Weizhong (BL40) to bleed is required to disperse toxins. If both exterior and interior are affected, external cupping/puncturing and internal purging are needed to reduce toxins. If accompanied by chills, fever, headache, strongly tonify Qi and Blood and take Calomel (Qingfen) preparations. If abdominal pain follows with pus/feces, do not stop diarrhea with medication. If mouth/tongue swell, foul water flows, thirst, fever, preference for cold, this is Upper Jiao Heat-Toxin; use Xiehuang San (Drain Yellow Powder). If alternating chills and fever, use Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Zhimu (Anemarrhena Rhizome). If mouth fissures bleed, fever, constipation, this is internal Heat-Toxin invasion; use Huanglian Jiedu Tang (Coptis Detoxification Decoction) plus Xijiao (Rhinoceros Horn - substitute with Water Buffalo Horn) and Lianqiao (Forsythia). If stool is normal, use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). If leprosy Qi causes lower Jiao leg weakness or profuse sweating due to open pores, use Yebip Jia Zhu Tang (Yebip Plus Atractylodes Decoction). If foul fluids cease but mouth/tongue persist, or fever/thirst prevents drinking cold, this is Deficiency Heat; use Qiwei Baizhu San (Six-Atractylodes Macrocephala Powder).

Prescription: For red swelling in leprosy due to Blood pathology, use Pangolin Scale (Linglijia). Apply raw lacquer to the inner side of the scale according to the onset site, bake in sand until crisp, powder, and take 7-8 fen with aged wine in the morning. Effective in three doses, cured in seven days. Use scales found locally.

Xue Lizhai stated: Leprosy mostly results from labor damaging Qi and Blood, loose pores, or sexual activity/bathing after drunkenness, or climbing mountains/wading through water, allowing external pathogens to attack. Wei Qi struggles against pathogens, damp-heat merges, and Blood transforms with Fire. Eyebrow loss indicates toxin in Lung; purple blisters on face indicate toxin in Liver; painful/perforated soles indicate toxin in Kidney; body-wide eczema-like rash indicates toxin in Spleen; eye damage indicates toxin in Heart. These are severe Zang organ diseases. Five types of death: 1. Skin death (numbness); 2. Flesh death (no pain on puncture); 3. Blood death (ulceration); 4. Tendon death (finger loss); 5. Bone death (nasal collapse). These are incurable Zang injuries. Generally, wind starting from head/face is favorable; from soles is unfavorable. Hoarseness and blindness are very difficult to treat. Treatment must distinguish primary, concurrent, altered, and similar syndromes, adjusting for Yin/Yang and Deficiency/Excess. Misusing drying-hot agents causes dripping pus, dries Liver Blood, intensifies wind-heat, depletes Kidney Water, and excites Ministerial Fire, leading to bad outcomes. Facial paralysis, limb spasms, brow itching, purple blisters, or lumps indicate Liver Blood deficiency with Wind-Heat; use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to generate Liver Blood and nourish Kidney Water. Alternating chills/fever, deafness, hypochondriac pain indicate Liver Wood excess; use Chaihu Siwu Tang (Bupleurum Four Substances Decoction) to clear Liver Fire and generate Liver Blood. Tendon cramps, bone pain, immobility indicate need for Liuwei Wan and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to nourish the source. Body itch due to Blood failing to nourish pores: Siwu Tang plus Jiu Qin (Wine-fried Scutellaria), mixed with Zibei Fuping (Purple-backed Floating Fern) powder. Severe itch adds Jingjie (Schizonepeta) and Chantui (Cicada Slough). In summer/autumn damp-heat, if poor appetite, dizziness, body soreness, leg numbness, dry mouth, spontaneous sweating, shortness of breath, fever, yellow frequent urine, loose stools, this is damp-heat damaging Yuan Qi; use Qingzao Tang (Clear Dryness Decoction). Body nodules, bursting with pus, alternating chills/fever indicate Liver Qi/Blood deficiency with Fire; use Jiawei Xiaoyao San. Itching feeling like fabric rubbing indicates Qi/Blood failing to nourish exterior; use Renshen Yangwei Tang (Ginseng Stomach-Nourishing Decoction). Face itching/numbness indicates Qi/Blood failing to nourish upper; use Buzhong Yiqi Tang. Mouth/tongue sores, sore throat, preference for cold, constipation indicate Excess Heat; use Sishun Qingliang Yin (Four-Obedient Cooling Drink). Muscle heat, aversion to heat, thirst, desire to drink indicates Blood deficiency; use Danggui Buxue Tang (Angelica Tonifying Blood Decoction). Toothache, gum ulceration, preference for cold/aversion to heat indicates Stomach Fire; use Qingwei San (Clear Stomach Powder). Red cracked tongue, thirst, frequent urination, irregular fever, hot soles indicate Kidney Water dryness and Heart Fire excess; use Jiajian Bawei Wan (Modified Eight-Ingredient Pill). Misusing cold-cool agents leads to deficiency-cold death.

[Pulse Diagnosis] Pulses at both Cun positions floating and tight, or floating and surging; Yang pulses floating and wiry, Yin pulses solid and large; floating and slow are easy to treat. Surging-large-rapid or deep-solid are difficult to cure. Deep pulse with upper disease, floating pulse with lower disease, and absence of sweating are signs of incurability.