《医宗金鉴》云∶青腿牙疳,此证自古方书罕载,其名仅传。雍正年间北路随营
医官陶麟起颇得其详,略云∶军中凡病腿肿色青者,其上必发牙疳;凡病牙疳腐血
者,其下必发青腿。二者相因而至,推其原皆因上为阳火炎炽,下为阴寒闭郁,以
至阴阳上下不交,各自为寒为热,各为凝结而生此证也。相近内地间亦有之,边外
虽亦有,不甚多,惟内地民众初赴边外,得此证者十之八九。盖中国之人,本不耐边
外苦寒风冷,况坐卧湿地,故寒湿之痰生于下,致腿膝青肿,其病形如云片,色似
乌茄,肉体顽硬,所以步履艰难也。又缘边外缺少五谷,多食牛羊等肉,其肥腻腥
膻,瘀滞于胃,毒火上熏,致生牙疳,牙龈腐烂出血。若穿腮破唇,腐烂色黑,即
为危候。边外相传有令服马乳之法,麟初到军营诊视青腿牙疳之证,亦仅以马乳。阅
历既久,因悟其马脑之温,不如易之马乳,为效倍速,令患者服之,是夜即能发出,诸
证减矣。盖脑为诸阳之首,其性温暖,且能流通故耳,兼服活络流气饮,加味二妙
汤,宣其气血,通其经络,使毒不得凝结,外用砭法,令恶血流出以杀毒势,更以牛
肉片贴敷以拔积毒,不数日而愈。盖黑血出则阴气外泄,阳气即随阴气而下降,两
相交济,上下自安矣。由是习为成法,其中活者颇多。因不敢自私,着之于书,以公于世。
又曰∶形气衰败,饮食不思者,不治。牙齿俱落,紫黑血流,腐溃秽臭者,不治。
腿大肿腐烂,或细而干枯者,不治。
*Yi Zong Jin Jian* (Golden Mirror of Medicine) states: Qing Tui Ya Gan (Green Leg and Gum Gangrene), this syndrome is rarely recorded in ancient medical texts, with its name merely passed down. During the Yongzheng reign, Tao Linqi, a military physician attached to the northern route camp, understood its details quite well. He briefly stated: In the army, whenever patients suffer from leg swelling with a bluish color, they must simultaneously develop Ya Gan (Gum Gangrene) above; whenever patients suffer from Ya Gan with rotting blood, they must simultaneously develop Qing Tui (Green Leg) below. These two conditions arise mutually and concurrently. Tracing their origin, it is all due to Yang Fire blazing excessively above and Yin Cold closing and stagnating below, leading to a failure of Yin and Yang Qi to interact between upper and lower parts. Each generates cold or heat independently, condensing to produce this syndrome. It also occurs in areas near the interior regions. Although it exists outside the borderlands, it is not very common. However, among the populace from the interior who first go to the borderlands, eight or nine out of ten contract this syndrome. This is because people from China are inherently不耐 (not resistant to) the bitter wind and cold of the borderlands. Moreover, sitting and sleeping on damp ground causes Phlegm of Cold-Dampness to generate in the lower part, resulting in bluish swelling of the legs and knees. The lesion resembles cloud patches, the color resembles that of an eggplant, the flesh becomes hard and stubborn, making walking difficult. Furthermore, due to the scarcity of grains outside the borders, people consume much beef and mutton. The greasy, fishy, and muttony nature of these foods causes stasis in the Stomach, with Toxic Fire steaming upward, leading to Ya Gan (Gum Gangrene), where gums rot and bleed. If it progresses to perforating the cheeks and lips, with blackish rotting tissue, it indicates a critical prognosis. Outside the borders, there is a tradition of administering Horse Milk (Equus caballus milk). When Tao Linqi first arrived at the military camp to treat Qing Tui Ya Gan, he initially used only Horse Milk. After extensive experience, he realized that the warming property of Horse Brain was inferior to Horse Milk, which yielded twice as fast results. Upon instructing patients to take it, the toxins were expelled that very night, and various symptoms subsided. This is likely because the brain is the head of all Yang meridians, possessing a warm nature and facilitating circulation. Subsequently, Huoluo Liuqi Yin (Circulating-Activating Decoction for Unblocking Collaterals) and Jia Wei Er Miao Tang (Modified Two-Awesome Decoction) were added to promote Qi and Blood circulation, unblock meridians, and prevent toxin condensation. Externally, Bian Fa (Scarification Therapy) was used to let evil blood flow out to kill the toxic pathogen, followed by applying slices of beef to draw out accumulated toxins. Within a few days, recovery occurred. Essentially, when black blood is discharged, Yin Qi leaks outward, and Yang Qi descends following Yin Qi. The two interact harmoniously, bringing peace to both upper and lower parts. Thus, it became a standard method, saving many lives. Not daring to keep it private, he recorded it in a book to share with the world. He further stated: Cases where physical constitution and Zheng Qi (Upright Qi) are exhausted, and there is no desire for food, are incurable. Cases where all teeth fall out, purple-black blood flows, and the tissue rots with a foul odor are incurable. Cases where the legs are massively swollen and rotting, or thin and dry/withered, are incurable.