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Leprosy, referred to as Li Feng (Leprosy) by the ancients, is also known as Evil Disease. In Guangdong, it is called Da Ma Feng (Great Leprosy), or Ge Da (Nodules). In other provinces, it may be called Da Pi Feng (Great Skin Leprosy) or Lai Pi Feng (Scaly Skin Leprosy). Those infected with this disease suffer separation from spouses, siblings, and children; relatives and friends shun them, and passersby curse them. Their plight is helpless and extreme. Physicians who do not understand the origin of the disease attribute it to contagion or wind-water factors. While there may be some basis for these views, they are not necessarily the sole cause. Generally, in the southeast where the terrain is low and near water, this disease is particularly severe. The weather is hot, and the earthy qi is damp and low. Damp-heat contends and combines, taking advantage of human deficiency to enter the Ying (Nutritive) and Wei (Defensive) levels. If the Wei Qi is affected, symptoms appear mostly on the upper body; if the Ying Blood is affected, symptoms appear mostly on the lower body; if both are affected, symptoms appear throughout. This is the general pattern. Fundamentally, regardless of location, Qi deficiency allows pathogenic factors to enter, and Blood deficiency allows pathogens to coagulate. Pathogens accumulate in the sinews and collaterals, gathering between muscles and interstices. Prolonged stagnation generates heat, so this disease is predominantly characterized by Blood Heat. Alternatively, sleeping on damp ground exposes one to steamy dampness; bathing in cold water after sweating; wearing wet clothes; or bathing in cold water and lying on damp surfaces after sexual intercourse can all lead to illness. Initially, blood stasis occurs, gradually leading to numbness. Over time, lesions enlarge, losing sensation to pain and itching, such that needle pricks are not felt. Lesions may appear on the hands one year and feet the next. They may resemble tinea, ulcers, or leprosy nodules; feel like insects crawling; or involve tendon pain and muscle twitching. Long-term damage alters physical appearance: red mounds appear on the face, ears may enlarge and ring like cicadas, the face resembles drunkenness or oil coating, hands curl into fists, legs become lame, mouth and eyes deviate, the nose collapses, and lips evert. Without early treatment, it leads to disability.

In ancient times, there was no fixed treatment for Leprosy. Zhu Danxi used only two formulas: Zui Xian San (Intoxicating Immortal Powder) and Zai Zao San (Reconstruction Powder). However, the use of Qing Fen (Calomel/Mercurous Chloride) often caused mercury poisoning, risking a new disease before the old one healed. Other prescriptions included Da Huang (Rhubarb Rhizome), Zao Ci (Gleditsia Sinensis Thorn), and Qian Niu Zi (Pharbitis Seed), which are suitable only for robust constitutions; using them in those with Qi and Blood deficiency would further deplete Yuan Qi. Li Dongyuan and Zhang Congzheng each had several formulas, often treating concurrent conditions. The formulas listed by Aryadeva (Qipo) involved difficult-to-process ingredients. Other medical texts contain few records. Xue Xinpu's "Li Yang Ji Yao" (Essentials of Leprosy Treatment) details variant and similar syndromes but omits primary treatments. Essentially, since damp-heat contends and pathogens enter via deficiency, the main strategy should be Cooling Blood and Harmonizing Blood, assisted by Expelling Wind and Dampness. One must assess the deficiency or excess of Yuan Qi and treat according to the Six Channels (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin). This is the key to treating Leprosy.

Mild cases present as scabies-like lesions on the back, waist, hands, and feet, without pain or itch. The head and face may feel like insects crawling, or joints may sting when struck, or fever may arise intermittently but vanish upon wiping. Severe cases involve ulcers on hands and feet, subcutaneous nodules, facial redness, ear swelling, and deviation of the mouth and eyes. In long-standing, deep-seated disease, deformity worsens: the nose collapses, flesh disintegrates, fingers fall off, and soles ulcerate through, making it difficult to treat. However, systemic numbness that manifests externally within months, even if severe, is easier to treat. Zhu Danxi stated that numbness is the root of Leprosy, which is correct. Additionally, the presence of Bi Rou (numb/atrophy tissue) in the hand indicates changes in the He Gu area (muscle mound at the thumb-web). Left-hand Bi Ru implies left He Gu atrophy; right-hand implies right. Mild cases show thinning; severe cases show depression. If neither hand has Bi Ru, the He Gu areas remain intact. This method only assesses hand severity, not facial, dorsal, leg, or foot conditions.

A purple complexion resembling drunkenness or an oily sheen, with slight edema, or black and emaciated, or yellow with a glossy sheen, always accompanies numbness. Symptoms may flare after months or decades. Recent onset is easier to cure; distant onset is harder, due to initial denial.

Southerners claim medication works for only 3-5 years before relapse, saying the disease can only suppress pathogens, not eradicate them. This is incorrect. Most patients are poor, unable to sustain medication costs. Relapses occur due to empty purses during partial recovery, dietary indiscretion post-recovery, incomplete treatment leaving residual numbness, or persistent skin discoloration. Sexual abstinence is strictly forbidden, as essence (Jing) transforms into marrow; ejaculation allows toxins to enter via deficiency. Without abstinence, cure is impossible. Post-cure failure to abstain guarantees relapse within a year.

Mild cases (no claw-hand, no collapsed nose, no flesh loss) are curable. If medication fails, check for unaddressed Qi/Blood deficiency or concurrent syndromes.

External/superficial diseases are easier to cure than internal/deep ones. Robust Qi/Blood responds better than deficient states. Superficial numbness is painful to pressure; toxins manifest externally as tinea or red mounds. Even widespread weeping ulcers can heal quickly. Deep/internal numbness involves sinking tissues, spreading redness/purple hues into muscles beyond the skin, lacking pain to pressure or needles. Cure requires 1-2 years.

Dead flesh/red mounds painful to shallow needling do not require cauterization. Deeply insensitive tissue (painful to deep needling, cutting, or rat bites) requires chemical cauterization, followed by plasters and tissue-regenerating herbs for easy recovery. Foul odor preceding visible disease indicates severe, contagious cases. Parasites arise from Liver Wind-Heat; absence of Liver pathology means no parasites. Denying parasites in Leprosy is wrong, as is affirming them indiscriminately. Tendon damage causes claw-hand and foot flaccidity; soft clonus is reversible with proper treatment, while rigid clonus is difficult. Foot flaccidity without atrophy recovers; atrophy does not. Bone fracture/destruction presents with ice-cold limbs, protruding joints, and withered appearance, termed Shi Zhui (Damp Drooping).

Prolonged Damp obstruction generates Heat; prolonged Heat stagnation generates Phlegm. Mild cases have nasal congestion; severe cases have hoarseness. Treatment clears and benefits the Lung Meridian, resolving Phlegm, congestion, and hoarseness.

The Lung governs Qi; the Liver stores Blood. Qi movement drives Blood flow; Blood coagulation stems from Qi stagnation. The Lung governs skin/hair; the Liver governs sinews/collaterals. Liver excess affects Spleen/Stomach, manifesting on the face (Yangming Stomach meridian). Limbs belong to the Spleen. Flaccid sinews and itchy skin are Liver signs; hoarseness and nasal congestion are Lung signs; bone destruction is Kidney pathology. Initial pathology originates in Liver and Lung. The Liver Wood generates internal Wind and parasites; Lung loses regulatory function, causing eyebrow loss and tendon flaccidity. Treatment focuses on the Liver and Lung meridians.

While everyone knows urine and feces exit through different orifices, smokers should avoid patients, and patients should avoid smokers. Patient urine contaminating tobacco causes Leprosy in smokers—a hidden transmission route. Some argue Qi and Blood stay in their meridians and cannot transmit, ignoring that Scabies/Tinea are contagious. Parental Essence and Blood form the fetus; offspring may or may not inherit the disease. Internal diseases transmit fully; external diseases transmit intermittently. Pre-conception abstinence prevents transmission. Claiming Leprosy does not affect children is false. Spouses transmit to each other; male-to-female transmission is less common than female-to-male because menstruation expels toxins, reducing female prevalence. The theory of "virgin prostitution" (buying virgins to avoid infection) suggests buying virgins prevents disease in the buyer but causes it in the seller. If true, treating virgins at menarche with Blood-Cooling and Liver-Wind-Expelling herbs could prevent manifestation. Avoid standard Leprosy remedies, which may induce the disease.

For Excess patterns (robust pulse), use diaphoretics to release from the exterior or purgatives to drain from the yin orifices, followed by alternating pills for Clearing Heat, Expelling Wind, and Nourishing Blood. Severe cases benefit from fumigation and washing. For Deficiency patterns, prioritize Nourishing and Harmonizing Blood, assisted by Cooling Blood and Expelling Wind herbs, treating slowly for efficacy. Eruptive forms are easier to treat; drug-induced eruptions also heal well.

Fumigation/washing must expose the head/face. Absence of sweat in numb areas indicates dead Blood and Damp closure. Sweating equals Blood loss; Blood-deficient patients should not sweat heavily. Nourish Blood first; then fumigate once Blood recovers. Long-term pill use inducing normal sweating makes fumigation optional.

Bi syndrome (numbness without pain) requires needling to release dead Blood, preventing ulceration and pus discharge. Black blood can be repeatedly needled; stop when bright red blood appears. Needling one area per session to avoid fatal blood loss. Cauterization acts faster but is less stable than needling.

Moxibustion: Mark numb areas with ink, apply ginger slice, and moxa cone. Stop when pain is felt. Suitable for mild numbness; extensive numbness requires pills instead.

Dead muscle/tissue with chronic Cold-Damp leads to blistering, ulceration, and pus (Wind Ulcer/Nodules). Apply medicaments to dry pus and form scabs. Some cases resolve without pus. Hard nodules resembling bean curd may be needled to release foul blood; if ineffective, use cauterization followed by plasters.

Men (Blood deficiency): Prioritize Nourishing/Harmonizing Blood, assisting with Wind-Expelling and Stagnation-Resolving herbs. Women (Blood abundance): Prioritize Invigorating/Moving Blood, assisting with Wind-Expelling and Damp-Drying herbs. Men must abstain from sex; women especially so. Pregnancy risks miscarriage if toxic drugs are given unknowingly, worsening deficiency and toxin invasion. Intercourse transmits toxins. Women’s prescriptions should include Menses-Regulating herbs.

Though Leprosy is malignant, proper treatment with mild herbs is effective. Snake/scorpion preparations are usable. Arsenic (Pi Shuang), Centipede (Wu Gong), Blister Beetle (Ban Mao), and Calomel (Qing Fen) are reserved for extreme cases only. Aconite (Chuan Wu, Cao Wu), Cinnamon Bark (Rou Gui) are for post-cure Yang deficiency consolidation, not active treatment, as acrid-hot herbs dry and consume Blood, worsening deficiency.

Toxin-aggravating foods, raw/cold foods (coagulate Blood), stagnant foods (fix toxins), and fried/spicy foods (generate Fire) must be avoided for 2-3 years. Dead meat and sow meat are lifelong prohibitions.

Contagion occurs; avoidance is key. Do not share utensils/diet; separate rooms/beds. Seek treatment diligently over time for full recovery. Provide social support (food/clothing). Do not mediate spousal abandonment.