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Xue Lizhai stated: Generally, this syndrome is mostly caused by labor and fatigue damaging Qi and Blood, leading to loose Cou Li (skin texture and pores). It may also result from sexual intercourse or bathing after drunkenness, or climbing mountains and wading through water, allowing external pathogens to take advantage of the deficiency. When Wei Qi (Defensive Qi) contends with pathogens, Damp-Heat and Ministerial Fire interact, causing Blood to transform into toxic heat due to fire. Therefore, this disease is prevalent in the Huai River, Huaiyang, Fujian, and Guangdong regions. Recent sages have said that it is caused by inhaling the harsh and evil Qi of heaven and earth. If symptoms appear first or are more numerous on the upper body, the toxin is located above; if they appear first or are more numerous on the lower body, the toxin is located below. Generally, when Qi aspect is affected by pathogens, upper symptoms predominate; when Blood aspect is affected, lower symptoms predominate; when both Qi and Blood are affected, symptoms appear both above and below. If eyebrows fall out first, the toxin is in the Lung; if purple blisters appear on the face, the toxin is in the Liver; if pain or perforation occurs first on the soles of the feet, the toxin is in the Kidney; if the whole body resembles tinea, the toxin is in the Spleen; if the eyes are damaged first, the toxin is in the Heart. These are severe conditions affecting the Five Zang Organs. Another classification includes "Skin Death," characterized by numbness and insensitivity; "Flesh Death," where needle pricks cause no pain; "Blood Death," manifested as ulceration; "Tendon Death," resulting in finger detachment; and "Bone Death," marked by the collapse of the nasal bridge. These represent incurable injuries to the Five Zang Organs. Hoarseness and blindness are particularly difficult to treat. Furthermore, treatment methods must be carefully considered based on differentiation of the primary syndrome, concurrent syndromes, transformed syndromes, similar syndromes, and Yin-Yang excess-deficiency patterns. If one recklessly administers drying and hot agents, causing profuse discharge of pus and fluid, Liver Blood will become increasingly dry, Kidney Water increasingly depleted, and Ministerial Fire increasingly vigorous, ultimately leading to a fatal condition.

1. Leprosy and similar ulcers do not affect only one Zang organ. However, Qi and Blood are invariably injured, and concurrent syndromes invariably appear, especially when the disease accumulates over years and manifests externally. One must distinguish the location along the meridians (upper or lower) and the excess-deficiency nature of the pathogenic trend. One cannot indiscriminately apply detoxifying drugs. Instead, one should first strengthen the Stomach Qi and boost Yuan Qi (Primary Qi) to consolidate the root, and only then treat the sores. The Classics state: "When True Qi is depleted, it is Deficiency; when Pathogenic Qi prevails, it is Excess." Whenever a disease is described as having "excess" characteristics, one must examine whether there is a deficiency of Yuan Qi.

The *Qipo's Treatise on Malignant Diseases* states: There are four hundred types of Ji Feng (Leprosy/Malignant Wind), but generally speaking, they fall into five categories, known as the Five Winds: 1. Yellow Wind, 2. Green Wind, 3. White Wind, 4. Red Wind, 5. Black Wind. Since these winds correspond to the Five Zang Organs, they are called the Five Winds. The Five Winds generate Five Worms: Yellow Wind generates Yellow Worms, Green Wind generates Green Worms, White Wind generates White Worms, Red Wind generates Red Worms, and Black Wind generates Black Worms. These worms consume the Five Zang Organs. If they consume the Spleen, speech becomes altered and voice scattered. If they consume the Liver, eyebrows and eyelashes fall out. If they consume the Heart, sores erupt all over the body. If they consume the Lungs, the nasal bridge collapses, and polyps grow in the nose. If they consume the Kidneys, tinnitus sounds like buzzing or the rumbling of thunder from chariots. If they consume the Skin, the skin becomes hard and numb. If they consume the Tendons, limbs and joints detach. The Five Winds correspond to the Five Zang Organs; the proliferation of worms enters the Marrow, moving freely without obstruction, destroying the human body, and is named Ji Feng. Ji Feng is the root of Li Feng (Leprosy). At the onset of the disease, some feel like being pierced by needles, named Ci Feng (Needle Wind); some feel like insects crawling, named You Feng (Wandering Wind); the whole body twitches and pulls, named Che Feng (Pulling Wind); insensitivity to pain and itch is named Wan Feng (Stubborn Wind); flesh nodules rise like peach pits or jujube kernels, starting from the head and face, named Shun Feng (Smooth Wind); starting from both feet, named Ni Feng (Reverse Wind); resembling connected coins, mottled with red, white, green, and black, named KT Feng (textual variant); or sores erupt all over the body, resembling scabies or tinea, fish scales, or elm seeds, with varying degrees of itch or pain, flowing yellow juice, with limbs and joints rotting into pus and blood, or remaining painless and itchy, appearing and disappearing intermittently, changing colors among green, yellow, red, white, and black unpredictably. The causes of this disease stem from imbalance of cold and heat, flowing into the Five Zang Organs, penetrating the marrow, excessive physical exertion, impure and mixed diet, irregular sexual activity, exhaustion from labor and deficiency, and profuse sweating throughout the body. Consequently, accumulated heat arises in the Five Zang Organs, generating numerous worms that consume the Zang organs, marrow, skin, flesh, tendons, and joints. Over time, this leads to decay, named Li Feng. Cases involving only Black Worms are the most difficult to treat. Upon contracting this disease, one should quickly abandon family, property, and wealth, leave wife and extended family, retreat to the mountains for quiet recuperation and treatment, and recovery is assured.