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(Tuoju, also known as gangrene of the toes, refers to ding sores (hard, deep-rooted boils) occurring on the toes, or where the foot wastes away and naturally falls off, hence the name. There are also cases occurring on the fingers, called Zhujie Ding (nodular joint ding), where severe cases corrode the finger joints, and mild cases cause tendon curvature.)

A man suffered from Tuoju in his toe; it was painful, red, accompanied by fever. He was treated with garlic-partitioned moxibustion. Additionally, he took Renshen Baidu San (Ginseng Detoxification Powder) with Jiegeng (Platycodon Root) removed, and added Yinjinhua (Honeysuckle Flower), Baizhi (Angelica Dahurica Root), and Dahuang (Rhubarb Root). The pain ceased. Subsequently, he took Shixuan San (Ten Acupoints Powder) with Jiegeng and Guigui (Cinnamon Twig) removed, and added Huafen (Trichosanthes Root). After several doses, he recovered.

Another man suffered from Tuoju in his toe; the color was purple and there was no pain. He underwent garlic-partitioned moxibustion for over fifty moxa cones but still felt no pain. Direct moxibustion was then applied for one hundred cones before he felt pain. He was then administered Xianfang Huoming Yin (Immortal Recipe for Saving Lives Decoction) for four doses, followed by Tuoli medicines (tonifying interior remedies) to promote suppuration and healing. (In *Xinfa*, the case of Magistrate Han presented identical symptoms and treatment; he recovered after taking Baidu San with added Yinjinhua and Baizhi.)

A third man suffered from Tuoju in his toe; the pain was slight, but the area was red and swollen. Garlic-partitioned moxibustion was applied until the pain stopped. He took Renshen Baidu San with Jiegeng removed, adding Yinjinhua, Baizhi, and Dahuang to induce suppuration. This was followed by Xianfang Huoming Yin, leading to recovery. Although the clinical presentation appeared mild, the malignancy was severe. Garlic-partitioned moxibustion is essential; for non-painful cases, moxibustion should be used to mitigate toxicity. This condition is often caused by the accumulation of toxins from a diet rich in fatty, sweet, strong-flavored foods, alcohol, wheat products, and roasted/fried items. It may also result from sexual indiscretion depleting Kidney Water, or from taking Dan-Shi tonics, leading to thirst preceding or following the onset of disease. In all these cases, the depletion of Kidney Water fails to control Fire. Initial black discoloration indicates an untreatable condition, whereas redness suggests Kidney Water is not yet exhausted and treatment is possible. If detoxification is neglected, leading to necrosis and blackening, immediate amputation is required; delay allows the blackness to spread up the foot, resulting in death. Unlike ordinary swelling and suppuration, only garlic-partitioned moxibustion is effective here. Cases presenting with redness, pain, and spontaneous suppuration indicate intact Yuan Qi and are easier to treat. Since the lesion occurs at the "Extreme Yin" lower extremities, Qi and Blood struggle to reach the site, making toxin resolution difficult and medicinal efficacy limited. Moreover, systemic medications primarily affect the intestines and stomach rather than directly attacking the local toxin. Therefore, garlic-partitioned moxibustion combined with surgical excision is the optimal method. As Sun Simiao stated: "Amputate if on the digit; excise if on the flesh."

A man suffered from this condition on the dorsum of his foot; it was red, swollen, and painful. Garlic-partitioned moxibustion was applied for over thirty cones, stopping the pain. He took Xianfang Huoming Yin for four doses, inducing suppuration, and recovered after taking Tuoli Xiaodu medicines (interior-tonifying and detoxifying remedies).

A man suffered from this condition in his toe; it was red, painful, and accompanied by thirst. Garlic-partitioned moxibustion was applied for several cones, followed by Xianfang Huoming Yin for three doses, inducing suppuration. He then took Tuoli medicines and Jiajian Bawei Wan (Modified Eight-Ingredient Pill), recovering after the necrotic tissue sloughed off.

A man suffered from this condition in his toe; it was black and painless. Direct moxibustion was applied for thirty cones, inducing pain. Fortunately, his appetite remained normal. Urgent excision and rapid administration of tonic preparations were advised. He refused, allowing the toxin to ascend, leading to an incurable state.

A man suffered from this condition on the dorsum of his foot; it was dark, non-swollen, and painless, accompanied by irritability, intense thirst, and a large, choppy Chi pulse (Kidney position). This indicated exhaustion of Essence and Qi, rendering it untreatable. The outcome proved correct.

Grand Steward Yang, over forty years old, suffered from red, swollen, and painful left big toe, caused by accumulated heat-toxin in the Spleen channel sinking downward—this is Tuoju. Fortunately, the redness and pain indicated viable Qi. He took Renshen Baidu San with Renshen and Jiegeng removed, adding Yinjinhua, Baizhi, and Dahuang for two doses. Then, using Gualou (Trichosanthes Fruit), Yinjinhua, and Gancao Jie (Licorice Joint), symptoms subsided rapidly after four doses. Finally, Shixuan San with Jiegeng removed, adding Yinjinhua and Fangji (Stephania Root), cured him after several doses.

A person accustomed to rich foods, over fifty years old, suffered from this condition; the toe was purple-black and painful. Sun Simiao stated: "For Tuoju, urgent amputation is required. If the toxin spreads to the heart and abdomen, it is untreatable; black, painless lesions are also untreatable." Fortunately, his diet and rest were normal, indicating a favorable prognosis for a sore. He took Linqiao Xiaodu San (Forsythia Detoxification Powder) for six doses, followed by Yinjinhua, Gancao Jie, and Gualou for over twenty doses, causing the affected toe to suppurate and slough off. Recovery was achieved after another twenty doses of Xiong (Ligusticum Rhizome), Gui (Angelica Sinensis Root), Di (Rehmannia Root), Linqiao, Yinjinhua, and Baizhi.

A humble practitioner developed a blister on his left big toe, numb and red. The next day, the toe turned black; by the fifth day, the entire foot was black and cold, with no sensation of pain. The pulse was deep and fine, indicating toxin affecting the Spleen and Stomach. One dose of Feilong Duoming Dan (Flying Dragon Life-Taking Pill) was administered. The next day, the dead black flesh was surgically removed. Bone pain upon cutting indicated salvageability. He was treated with Shiquan Dabu Tang (Complete Great Tonifying Decoction) and recovered. The black flesh resulted from excessive toxic qi rejecting Ying and Wei Qi circulation. Given the location at the Extreme Yin, Qi and Blood cannot easily reach, consistent with the Classic's statement: "Wind excess causes diseases in the extremities." Had aggressive purgatives been used initially, the pathogenic factor would have intensified, invading the deficiency upward, leading to certain death.

Haishan was arrogant, licentious, and unbridled, forcibly annexing lands, houses, and women of commoners, controlling half of Shandong Province. Lu Xuanzi was a renowned physician in Shandong. A wealthy woman’s mother-in-law had a sore on her little toe, resembling a grain of millet, with a white head and a root like a ripe date. She felt visceral emptiness and a sense of falling. Hearing of Haishan’s fame, she summoned him. He diagnosed: "This is Sumi Chuang (Millet Sore), equivalent to Renmian Chuang (Human Face Sore). In seven days, the toxin will ascend, causing whole-body rotting into black water death. To survive, you must urgently amputate the toe." Haishan himself developed this sore and consulted Lu Xuanzi. Lu gave the same advice. Haishan was furious and wanted to kill him. Ding Weizhang, a Chu native famous for surgery and frequenting the palace, was invited by Haishan. Haishan relayed Lu’s words and said, "If you say my sore is harmless, I will kill you." Ding examined it closely and said, "You may kill me, but why blame Lu? Three days have passed; the toxin has ascended. If you wish to live, amputation at the knee is the only option." Haishan stared and asked three questions, receiving immediate answers. Haishan sighed, "My life is in your hands." He ordered his attendants to bring an amputation knife, extended his leg, and said, "Cut." The attendants trembled. Haishan cursed them to cut, and a leg was severed. Ding held Haishan’s hair, leaning against a pillar. Haishan’s face was yellow, and his breath seemed to cease. Ding said, "Summon the previous doctor immediately." Lu arrived and saw the severed leg still twitching, with black blood dripping. Lu ordered one jin (approx. 500g) of Renshen decocted strongly and forced down Haishan’s throat. Soon, Haishan revived. Looking at his remaining limb, Haishan said, "Alas, foot amputation is already a heavy punishment; what sin warranted knee amputation? Thanks to your treatment, I may avoid future complications." Forty-nine days later, toxin erupted at the right knee, growing a Human Face Sore again. The doctor declared, "He cannot be saved." Haishan died within a few days. All property seized from the people was dispersed; his brother returned to begging as before.