立斋曰∶脚发之证，属足三阴精血亏损，或足三阳湿热下注。若色赤肿痛而溃脓者，属湿热
下注，为可治。若色微赤微肿而脓清者，属精血亏损，为难治。若黑黯不肿痛，不溃脓，烦
热作渴，小便淋漓者，阴败末传恶证也，为不治。治法∶湿热下注者，先用隔蒜灸、活命饮
，以解壅毒，次服益气汤、六味丸，以补精气。若色黯不痛者，着肉灸、桑枝灸，以行壅滞
，助阳气；更用十全大补汤，八味丸，以壮脾土，滋化源，多有生者。若专治其疮，复伤生
气，吾未见其生者。
阁老靳介庵，脚趾缝作痒，出水肿 ，脚面敷止痒之药不应，服除湿之药益甚。余
以为阴虚湿热下注，用六味地黄丸、补中益气汤而愈。
大参李北溪，左足赤肿作痛，此足三阳经湿热下注。先用隔蒜灸，与活命饮一剂，其
痛顿止，灸患处出水，赤肿顿消。次用托里消毒散四剂，灸患处，出脓而愈。
一儒者患此，肿硬色白，两月余矣。此足三阴亏损，为外寒所侵也，用大防风汤，及
十全大补汤，兼服而消。后场屋不利，饮食劳倦，前证复作，盗汗内热，饮食不化，便滑肌
瘦，此脾土虚寒，而命门火不能相生。用八味丸、益气汤，百余剂，喜其年壮得愈。
一男子，脚心发热，作渴引饮，或用四物芩连知柏之类，腹痛作呕，烦热大渴，此足三
阴亏损，前药复伤脾胃也。先用六君加炮姜，数剂而脾胃醒，再用补中益气加茯苓、半夏
，而脾胃健，乃以加减八味丸，兼服半载而愈。
一儒者，脚心发热作痒，以滚汤浸渍而出水，肌体骨立，作渴吐痰，此脾肾虚而水泛为痰
也。服益气汤、六味丸年余，元气复而诸证愈。（俱薛按）
Xue Lizhai stated: The condition of Jiao Fa (foot carbuncle) belongs to the deficiency of essence and blood in the three foot-Yin meridians, or the downward pouring of damp-heat in the three foot-Yang meridians. If the affected area is red, swollen, painful, and suppurates, it belongs to downward-pouring damp-heat and is treatable. If the color is slightly red, swelling is mild, and the pus is clear, it belongs to deficiency of essence and blood and is difficult to treat. If the color is dark black, without swelling or pain, without suppuration, accompanied by irritability, heat sensation, thirst, and dribbling urination, this is a malignant syndrome transmitted at the terminal stage of Yin collapse, which is incurable. Treatment methods: For downward-pouring damp-heat, first apply Garlic-partitioned Moxibustion and Xianfang Huoming Yin (Immortal Life Elixir), to resolve the obstructed toxicity; subsequently administer Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Liuwei Wan (Six-Ingredient Pill with Rehmannia), to tonify essence and qi. If the color is dark purple and painless, apply Flesh-adhering Moxibustion and Mulberry Branch Moxibustion to unblock stagnation and assist Yang qi; further use Shiquan Dabu Tang (Ten-Agent Great Tonifying Decoction) and Bawei Wan (Eight-Ingredient Pill), to strengthen Spleen Earth and nourish the source of transformation and generation; many will recover. If one focuses solely on treating the sore while damaging the vital Qi, I have not seen such patients survive.
The Grand Secretary Jin Jian'an had itching between his toes with edema. Applying anti-itch medicine on the dorsum of the foot was ineffective, and taking damp-draining medicines worsened the condition. I considered this to be Yin deficiency with downward-pouring damp-heat, and used Liuhuang Dihuang Wan (Six-Ingredient Rehmannia Pill) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), resulting in recovery.
Grand Censor Li Beixi had redness, swelling, and pain in the left foot, indicating downward-pouring damp-heat in the three foot-Yang meridians. First, Garlic-partitioned Moxibustion was applied, along with one dose of Xianfang Huoming Yin (Immortal Life Elixir); the pain ceased immediately. After moxibustion on the affected area exuded fluid, the redness and swelling subsided instantly. Subsequently, four doses of Tuoli Xiaodu San (Interior-Supporting and Toxin-Expelling Powder) were administered, followed by moxibustion on the affected area to discharge pus, leading to recovery.
A scholar suffered from this condition; the swelling was hard and white, persisting for over two months. This was due to deficiency of the three foot-Yin meridians invaded by external cold. Da Fengguang Tang (Great Wind-Dispersing Decoction) and Shiquan Dabu Tang (Ten-Agent Great Tonifying Decoction) were used concurrently, resulting in resolution. Later, due to failure in the imperial examinations, combined with dietary irregularities and fatigue, the previous symptoms recurred with night sweats, internal heat, indigestion, loose stools, and emaciation. This indicated deficiency-cold of Spleen Earth and inability of the Mingmen Fire (Gate of Vitality) to generate support. Bawei Wan (Eight-Ingredient Pill) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) were administered for over a hundred doses. Fortunately, being young and strong, he recovered.
A male patient experienced heat in the soles of his feet and thirst with desire to drink. Others prescribed Siwu Tang (Four-Substance Decoction) modified with Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhimu (Anemarrhenae Rhizoma), and Huangbai (Phellodendri Cortex). This led to abdominal pain, vomiting, aggravated irritability, heat, and severe thirst. This indicated deficiency of the three foot-Yin meridians, where the previous medicines further damaged the Spleen and Stomach. First, Liujunzi Tang (Six-Gentlemen Decoction) with Paojiang (Roasted Ginger) was given for several doses to restore Spleen function. Then, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Fuling (Poria) and Banxia (Pinelliae Rhizoma) was used to strengthen the Spleen. Finally, Jiaban Bawei Wan (Modified Eight-Ingredient Pill) was taken concurrently for half a year, resulting in recovery.
Another scholar had heat and itching in the soles of his feet. Soaking the affected area in boiling water caused exudation, leading to extreme emaciation ("skeleton-like body"), thirst, and expectoration of phlegm. This indicated Spleen and Kidney deficiency causing water flooding to form phlegm. After taking Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Liuhuang Dihuang Wan (Six-Ingredient Rehmannia Pill) for over a year, Yuanqi (Primordial Qi) was restored, and all symptoms resolved. (All notes by Xue Ji)