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Chen Shigong stated: Chuanhuai Ju (Penetrating Ankle Carbuncle), also known as Jiaoguai Du (Ankle Swelling Poison), is caused by damp-heat flowing downward and stagnating in the Foot Three Yin Meridians. Initially, there is swelling and pain at the medial malleolus that penetrates to the bone, making movement difficult; in severe cases, the swelling spreads to the lateral malleolus, causing total ankle edema. If this condition is not treated early, neglect will inevitably lead to disability. (*Waike Zhengzong*)

He further stated: The general treatment principle is that for initial onset, Jingfang Baidu San (Atractylodes and Saposhnikovia Decoction) with additional Achyranthes Root should be used; if there is distension, acupuncture should be employed; after ulceration, Yuhong Gao (Jade Red Ointment) should be applied to promote healing; for deficiency patterns, tonification should be provided.

*Yizong Jinjian: Waikexinfa Yaojue* stated: Chuanhuai Ju is formed by cold-dampness descending from the Spleen Meridian, leading to sluggish blood flow and obstructed Qi. The pathology originates from the medial malleolus and spreads to the lateral malleolus, eventually eroding both inside and out, resulting in diffuse swelling without redness. The presence of a head indicates a Yang pattern, which is easy to suppurate and treat; diffuse swelling without a head indicates a Yin pattern, which is difficult to suppurate and heal. If chills and fever occur alternately at the onset with a red halo, it indicates heat accumulation, and Jingfang Baidu San is appropriate; if the skin color remains unchanged, Wanling Dan (Ten Thousand Spirits Pill) is appropriate; other treatments follow standard abscess and carbuncle protocols. (*Yizong Jinjian*)

It further stated: Neihuai Ju (Medial Malleolus Carbuncle) arises near the ankle joint on the inner side of both feet, belonging to the Foot Three Yin Meridians. It is caused by cold-dampness descending, leading to sluggish blood and obstructed Qi. The area is hard and diffusely swollen, with normal skin color, intermittent dull pain, and difficulty walking. Initially, Chuangke Liuqi Yin (Dermatological Flowing Qi Decoction) with additional Achyranthes Root, Chaenomeles Fruit, and Stephania Root should be used to promote circulation; externally, garlic moxibustion should be applied to dissipate the swelling. Once suppuration occurs, Neituo Huangqi Tang (Internal Support Astragalus Decoction) should be taken. For patients with weakness approaching suppuration or experiencing throbbing pain, Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) should be administered, with Wulong Gao (Black Dragon Ointment) applied externally.

It further stated: For Chuanhuai Ju, Neihuai Ju, and Waihuai Ju (Lateral Malleolus Carbuncle), if clear fluid oozes from the ulcer, or if prescribed formulas are ineffective and the disease lingers for a long time, it will inevitably result in disability and is difficult to cure.

Gu Shicheng stated: Neihuai Ju, also known as Xiedai Ju (Shoelace Carbuncle), belongs to the Foot Three Yin Meridians; Waihuai Ju, also known as Jiaoguai Du, belongs to the Foot Three Yang Meridians. Both arise near the ankle joints of both feet and are caused by cold-dampness descending, leading to sluggish blood and obstructed Qi. Initial treatment should involve garlic moxibustion.

Gu Shicheng stated: When damp-toxin from the Spleen Meridian stagnates in the tibia region, the skin rots like superficial ulcers, with purple-black edges, frequently discharging toxic fluid or foul pus. This is named Lvyan Chuang (Donkey Eye Ulcer), commonly known as Jiagun Chuang (Pillory Ulcer), named so because the pain is unbearable. It may also result from trauma or bites from poisonous insects, snakes, or fleas, and is extremely difficult to heal.