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Xue Lizhai stated: In the treatment of li yang (leprosy and severe skin ulcers), one must understand that there are differences between variations and similar presentations, and treatment methods vary among diaphoresis (sweating method), purgation, bloodletting with stone needles, attacking pathogens, and tonification. For concurrent syndromes, one must assess their severity; for transformed syndromes, one must observe their sequence; for similar syndromes, one must carefully distinguish truth from falsehood. Furthermore, the methods of diaphoresis, purgation, bloodletting, attacking, and tonifying must be applied according to the patient's deficiency or excess, investigating the root cause of the disease. "Deficiency" refers to weakness in form and Qi; "excess" refers to an abundance of pathogenic Qi, though the form and Qi may not necessarily be robust.

1. Regarding the use of bloodletting with stone needles for li yang, Zhang Hezi stated: One instance of diaphoresis is equivalent to a thousand needle pricks. This is because releasing blood is less comprehensive than inducing sweating. However, diaphoresis is akin to bleeding, and bleeding is akin to diaphoresis; they are essentially the same principle. If evil blood stagnates in the muscle layers and meridians, both needling and diaphoresis are suitable; taking blood from Weizhong (BL40) yields effective results. If toxic heat accumulates within the Zang-Fu organs, internal purification is required for recovery. If toxins reside on the exterior, blood must be released from all affected areas on the body, as well as the wrists of both arms, ankles of both legs, and the spaces between fingers and toes; otherwise, the toxin will not dissipate. If both interior and exterior are affected by toxins, external bloodletting combined with internal purgation is necessary to eliminate the toxin. If symptoms predominate in the upper body, Zuixian San (Intoxicating Immortal Powder) should be used to allow accumulated evil blood to exit through the gum margins, while simultaneously pricking the finger webs and arm wrists to remove superficial toxic blood. If symptoms predominate in the lower body, Zaizao San (Reconstruction Powder) should be used to expel evil blood and old worms via the anus, while still pricking the finger/toe webs and leg/ankle wrists; repeat pricking every one to two days until the blood turns bright red. If accompanied by aversion to cold, fever, headache, etc., primary treatment should focus on greatly tonifying Qi and Blood.

2. After administering medicines containing calomel (light powder) for li yang, if abdominal pain occurs followed by the discharge of pus and foul matter, do not use medication to stop the diarrhea. If there is swelling and pain in the mouth and tongue, continuous flow of foul saliva, thirst, fever, and a preference for cold drinks, this indicates toxic heat in the Upper Jiao; Xiehuang San (Drain Yellow Powder) is appropriate. If there is alternating chills and fever, Xiaochaihu Tang (Minor Bupleurum Decoction) added with Zhimu (Anemarrhena Rhizome) is appropriate. If bleeding occurs from the gum margins, accompanied by fever and constipation, this indicates internal invasion of toxic heat; Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity) is appropriate. If bowel movements are normal, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) from the *Ju Fang* is appropriate. If the foul discharge has ceased but the mouth and tongue remain unhealed, or if there is fever and thirst without a desire for cold drinks, this is deficient heat; Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder) is appropriate.

3. When li yang patients experience spasms and curling of the hands, feet, legs, arms, or individual fingers, it is due to blazing Yin fire damaging Qi and Blood. Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) added with Shengdihuang (Rehmanniae Radix Recens) should be taken, along with Huanji San (Muscle-Replacing Powder).

4. The emergence of worms in li yang results from the convergence of wind pathogens from the five directions, where Ministerial Fire suppresses Lung Metal. As Metal becomes deficient, it fails to control Liver Wood, leading to the generation of worms. These worms internally damage the Zang organs, while manifestations appear externally. Shengma Tang (Cimicifuga Decoction) should be used to administer Xieqing Wan (Clearing Down Pills), or Huapi San (Birch Bark Powder) should be used to clear pathogens from the Lungs and Liver. External moxibustion at Chengjiang (CV24) helps unblock the Yangming and Ren Mai meridians, causing wind-heat to subside and worms to cease growing. For Liver channel deficient heat, add Jiawei Xiaoyao San and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia).

Xu Donggao stated: The classics say, "Diaphoresis cures sores." Moreover, leprosy is caused by wind and is the most malignant of sores. Thus, it is said: Long-standing heat in leprosy sores generates wind, and leprosy is particularly formed by inhaling killing autumnal qi. Without the diaphoretic method, how can toxic wind be expelled? Therefore, diaphoresis is the most crucial method for treating leprosy. Other formulas should be used sequentially. Severe itching on the body of patients is due to wind pathogen stagnation and blood failing to nourish the skin. Siwu Tang (Four Substances Decoction) added with Huangqin (Scutellaria Root) and Baizhi (Angelica Dahurica) should be taken with Fuping (Duckweed) powder to induce sweating and achieve cure.

1. For moxibustion therapy in leprosy, first take Huapi San, gradually increasing the dose over five to seven days. Then apply moxibustion to Chengjiang (CV24) with seven moxa cones. After the moxa blisters heal, repeat the moxibustion. After three rounds of moxibustion, take Ersheng San (Two Sages Powder) to drain heat and expel wind pathogens from the blood; during this time, it is best to take Xieqing Wan using Shengma Tang as a vehicle. If the disease has persisted for many years, detailed use of Yufeng Dan (Wind-Dispelling Pill) and Huangu Dan (Bone-Changing Pill) is recommended.

1. When Da Feng (Great Wind/Leprosy) first begins, with itching on the head and face and the appearance of red-purple rash patches, Fangfeng Tongsheng San (Saposhnikovia Decoction for Unblocking and Generating) added with Kushen (Sophora Root), Tianma (Gastrodia Rhizome), and Chantui (Cicada Slough) should be taken for dozens of doses. Externally, wash with Qizhen Tang (Seven Treasures Decoction). Inducing sweating facilitates easier recovery. Strictly avoid pungent spices, meat, fish, and strong flavors for half a year to prevent recurrence.