Library

Wang Shengzhi stated: Laoju (Tuberculous Ulcer) occurs in the Foot-Taiyang Bladder Meridian, which is rich in Qi but deficient in Blood. It arises on the dorsum of the little toe, at the Jinggu (BL64) and Jinmen (BL63) acupoints. If pus forms sparingly after five to seven days, the prognosis is auspicious; if the tissue turns black and fails to ulcerate, accompanied by severe itching, the prognosis is ominous. (From *Li Li*)

Feng Luzhan stated: When women's ten toes feel as if fried in hot oil, this is due to deficiency of Ying and Wei Qi, with damp-toxic qi stagnating in the meridians. If it attacks upward to the Heart, it causes heart pain; if it attacks downward to the feet, it causes foot pain. The toes burn intensely, resembling Hongxiangjiao (Hong Kong Foot / Tinea Pedis). The classics refer to this as Re Jue (Heat Jue).

Tuojie (Gangrene of the Toes)
The *Ling Shu* states: Eruptions on the toes are named Tuoyong (Sloughing Abscess). If the lesion appears red and black, death ensues; it is incurable. If it does not appear red and black, death does not ensue. If treatment fails to alleviate the condition, urgent amputation is required; otherwise, death will follow.
The *Gui Yi Fang* states: Dunju (Dun Ulcer) erupts on two toes. If not punctured within five days, death ensues; it can be pricked on the fourth day. If the color turns black and the abscess is unbearable, but has not crossed the joint, it is treatable.
Wang Kentang stated: When a Ding (carbuncle) grows on a toe, severe cases ulcerate and slough off spontaneously, hence the name Tuojie. Some say that only when the great toe is affected is it called Tuojie, while other toes are called Dunju and are easier to treat. Only Tuojie is difficult to treat. (From *Zhun Sheng*)

Chen Yuangong stated: Sometimes the tip of a toe suddenly itches first, followed by pain, and the nail turns black. On the second day, the entire toe turns black; on the third day, the dorsum of the foot turns black. If the blackness reaches the sinews and bones, death ensues. This is caused by Wuming Zhongdu (Nameless Swelling and Poison), often resulting from excessive consumption of aphrodisiacs, leading to accumulation of fire-toxin. This differs from ordinary foot gangrene. In ordinary foot gangrene, usually only the left little toe turns black. However, foot gangrene is extremely fierce. Although not as rapid and violent as nameless swelling poison, its lethality is the same. Generally, the feet are the extremities of the four limbs, where toxins should not reach. Why is it so fierce? Precisely because where toxins should not gather, they accumulate and disperse not, instead emerging between the nails. This indicates extreme toxin intensity, so treatment must not be taken lightly. Can one use drugs to drain toxins? Who would know that this is incorrect? When human Qi is vigorous, it circulates freely up and down, and toxins do not gather in one place. Only when Qi and Blood are severely deficient, unable to circulate through the meridians, do fire-toxins and evil pathogens solidify at the joints. The generation of foot gangrene is due to Qi and Blood deficiency failing to nourish the area. Therefore, how can one solely use draining-toxin drugs to further injure Qi and Blood! One must greatly tonify Qi and Blood, adding ingredients to drain toxins; this is the path to complete victory. Gubu Tang: Niuxi (Radix Achyranthis Bidentatae) 1 liang, Jinchai Shihu (Dendrobii Nobile Caulis) 1 liang, Renshen (Radix Ginseng) 3 qian, Huangqi (Radix Astragali Membranacei) 1 liang, Danggui (Radix Angelicae Sinensis) 1 liang, Jinyinhua (Flos Lonicerae Japonicae) 3 liang. Decoct in water and take orally. After one dose, blackness resolves; after two doses, pain stops; after three doses, recovery is achieved. If already ulcerated, taking several more doses ensures cure. This formula uses Jinyinhua to resolve toxins, but without Niuxi and Shihu, it cannot reach the toes directly; without Renshen, Danggui, and Huangqi, it cannot circulate Qi and Blood, allowing Qi flow and Blood activation to scatter toxins. Even for nameless swelling poison, this formula is effective, not just for foot gangrene. Physicians of the world sometimes cut off toes with knives, which is also a method, but it is inferior to this formula which tonifies the center, defeats toxins, revives the dying, causes no painful injury, and offers the miracle of preserving life. (From *Bing Jian*)

Chen Shigong stated: Tuojie is external rotting and internal necrosis. This results from using seminal retention techniques during intercourse, consuming Dan-Shi (cinnabar and sulfur) tonics that consume Kidney Water, and excessive sexual activity, leading to exhaustion of Qi and injury to Essence. The hands and feet are the branches and trunks of the Five Zang Organs; thus, those suffering from this disease mostly have it on their feet. Initially, it appears like a millet grain, a single yellow blister, with skin resembling a cooked red date. Blackness spreads progressively, passing through all five toes, ascending to the dorsum of the foot. Pain is like boiling water pouring or fire burning. The form becomes emaciated with flaccid sinews. The foul odor is an exotic fragrance that is hard to resolve. Life is hard to save. Blood death leads to Heart failure; Sinew death leads to Liver failure; Flesh death leads to Spleen failure; Skin death leads to Lung failure; Bone death leads to Kidney failure. Life and death are left to fate. Sun Simiao said: If in the flesh, cut it; if in the finger, amputate it. This refers to this disease. While it has not yet spread, urgently tie about ten strands of hair tightly around the proximal interphalangeal joint of the affected finger, winding it ten times, tightening gradually to prevent toxin invasion into healthy flesh. Then place a Chan Su (Toad Venom) cake on the original millet-sized spot, apply moxibustion until the flesh dries and the sore dies. The next day, if the entire finger is black, use a sharp knife to locate the proximal joint seam, and slowly remove the affected finger. If bleeding does not stop, use Jin Dao Ru Sheng San (Golden Knife Like Holy Powder) to stop it. Apply Zhen Jun Miao Tie San (True Lord's Miraculous Paste Powder) to the remaining swelling. If blackness remains the next day, use Chan Su Ding (Toad Venom Tablet) ground into powder, sprinkled on plaster, and covered; the blackness will naturally recede, pus will generate, and following standard methods, use Yu Gao (Jade Ointment) to regenerate flesh, protect bone, and close the wound. This is an auspicious sign. Internally administer formulas to nourish Kidney Water, tonify Qi and Blood, strengthen the Spleen, and calm the Spirit. If there are no internal complications and no mixed external infections, three or four out of ten can be saved. For treating this syndrome, one must not decide alone; consult with eminent physicians and listen to the patient's family's willingness to amputate before proceeding. Because the prognosis of this syndrome fluctuates unpredictably from start to finish, do not act lightly. There are also cases that look similar but originate differently, or seem to be acupoints but suffer from different pathogens; treatment requires flexibility, and one must not blindly cut. Careful clinical judgment is necessary. (From *Zheng Zong*)

He also said: Tuojie mostly occurs on hands and feet. Initially like millet, it gradually enlarges, turning brown or like date skin, then black, cracking, and enlarging further, black like crow feathers. There is no sensation of pain or itch, and the heat and stench are unbearable. Children often suffer from accumulated heat and toxins; adults often suffer from mistakenly ingesting Dan-Shi yang-tonifying drugs or using sexual techniques that block the essence pathway. Although ancients had amputation methods, I saw three people who died within seven or eight days.

Feng Luzhan stated: Tuojie is mostly due to sexual techniques damaging Kidney Water, and depression/anger injuring the Liver and Spleen. The location is remote, drug efficacy rarely reaches it, and Qi and Blood struggle to arrive, easily leading to sinew ulceration and bone detachment. Thus, it is still appropriate to primarily tonify and support Qi and Blood, observing the pulse for prognosis. If the tissue turns black, it is untreatable. (From *Jin Nang*)

Dou Hanqing stated: Tuojie is caused by Heat in the Lung Meridian, erupting on the tips of the ten fingers of both hands. If toxins are not drained within seven or eight days, death ensues; it can be pricked on the fourth day. If it turns black, and the abscess is not severe enough to cross the joint, it is treatable. If blackness is severe and crosses the joint, death ensues. Although crossing the joint, it may still be treatable if medicine reaches the lesion. The symptoms begin with slight darkening, small spots arising in the flesh. Small ones are like millet beans; large ones are like plums. They may be red or black, alternating green and white. A solid core exists, which is the root. There is no edema, but severe pain radiates to the heart and bones. The body may have fever. If not treated urgently, toxins rush upward, causing the face to swell with purple-black blisters. Rotting enters the Heart, killing the person. People in the South call this Ta Zhuo Du (Bed-Attaching Poison). Even if the finger is amputated, fearing upward toxin attack, few survive. Sudden stabbing pain in the ten fingertips entering the heart is unbearable. Looking towards the light, the color is bright yellow-red, or dark cyan-black, indicating Ju (gangrene). If foul-smelling bloody water flows from the teeth, death occurs in seven days. Cut away the fleshy part immediately, cauterize with a branding iron until charred like charcoal, similar to treating Ju. Moxibustion of one hundred moxa cones is best. Must drink Kui Gen Juice (Malva Root Juice), Qing Dian Hua (Indigo Flower), Zhu Li (Bamboo Sap), Xi Jiao Juice (Rhinoceros Horn Juice - *Note: Use substitute*), Zhi Ke Tang (Aurantium Decoction), and Xiao Du Yin (Detoxification Decoction). If vomiting pus and blood occurs, it is untreatable. Cover the pus and blood with ash; otherwise, toxic vapors will harm people and infect others. Ju harms people swiftly; evil wind enters muscle and vessels, initially unnoticed. Once toxins郁 (stagnate) and erupt, it is fierce like fire. The upper part is hidden, small, and deep, with solid black points that are unclear. The disease corresponds to the Heart; if delayed slightly, it enters the Zang organs.

The *Xin Fa* states: Tuojie mostly occurs between toes; occasionally on fingers. The ten fingers of hands and feet are the branches of the Zang-Fu organs. Before the eruption of Ju, there is irritability and fever, resembling Xiao Ke (Wasting-Thirst Disease). After long duration, this affliction develops. Initially like millet, a yellow spot, skin color purple-dark, like a cooked red date. Blackness spreads, rotting expands, passing through five toes, even attacking the dorsum of the foot. Pain is like boiling water poured or fire burning. The odor is an exotic fragrance hard to resolve. All result from rich foods, alcohol, sexual techniques, and Dan-Shi hot drugs, causing Yang Essence to stir, lascivious fire to rage, accumulating in the Zang-Fu, consuming fluids and juices. At this time, Blood death leads to Heart failure, Skin death to Lung failure, Sinew death to Liver failure, Flesh death to Spleen failure, Bone death to Kidney failure. These five failures are difficult to treat even with miraculous pills. Initially, administer Jiedu Jisheng Tang (Detoxification and Life-Saving Decoction). Externally, boil barley rice, mix with Furong Ye (Hibiscus Leaf) and Juhua Ye (Chrysanthemum Leaf), each 5 qian, apply to relieve pain. If resolution fails, amputation must be performed. The patient must consent, regarding life and death with indifference, and action must not be taken lightly. (From *Jin Jian*)

He also said: Various medical texts discuss Tuojie, stating it occurs only on the great toe, and eruptions on other fingers are Dunju. This is not an accurate theory. However, Tuojie predominantly occurs on toes belonging to the Foot-Yin Meridians. Students should examine this carefully.