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[Background Information]
Book: Zhengzhi Zhunsheng · Yangyi (Standardized Diagnosis and Treatment for Surgeons)
Author: Wang Kentang
Dynasty: Ming
Chapter: Feifa Chu (Calf Ulcer)
Category: Medical Theory

[Translation]
A question was asked: "What should be done if a carbuncle (ju, 疽) arises on the calf, accompanied by chills, fever, irritability, and restlessness?" The answer was: "This is named Feifa Ju (carbuncle arising on the calf), belonging to the Foot Shaoyin Kidney Meridian. It is caused by insufficiency of Kidney Water and accumulation of heat. Ancient formulas consider this disease incurable. Huoming Yin (Life-Saving Decoction) with added Niuxi (Achyranthis Bidentatae Radix), Mugua (Chaenomelis Fructus), and Huangbai (Phellodendri Cortex) is suitable. For the elderly and weak, Bazhen Tang (Eight-Treasure Decoction) with added Niuxi is used. For those who are robust, Yili Jindan (One-Grain Golden Pill) is used to purge. Cases involving deficiency are difficult to treat; Shensui Wan (Kidney Qi Pill) and Shiquan Dabu Tang (Ten-Increment Great Tonifying Decoction) are the main treatments. If it ulcerates and discharges blood and pus, there is hope for survival; if it ulcerates and discharges clear water, death ensues."

The *Gui Yi* (Ghost's Legacy) states: "Below the two calves, in front of the inner and outer malleoli, there are sharp edges on both sides, referred to as the inner Lian and outer Lian. If a carbuncle forms here, because it is close to the bone, it is difficult to heal. It is suitable to apply Shou Du San (Poison-Gathering Powder) externally around the periphery, and apply Huoxue Rou Yao (Blood-Invigorating Flesh-Replenishing Medicine) directly to the center; this does no harm."

A question was asked: "What should be done if ulcers arise on the medial and lateral aspects of the foot and persist for years without healing?" The answer was: "This is due to damp-heat sinking downward and blood stasis stagnating in the collaterals, leading to purple-black discoloration within the muscles, and intermittent itching and pain. In women, it is called Qunfeng Kukou Chuang (Skirt-Wind Crotch-Ulcer), which is also Fei Chuang (calf ulcer), and is the most difficult to cure effectively. This is likely because skirts drag on the ground, allowing wind-dampness to flourish. It is suitable to take Duhuo Jisheng Tang (Angelica Pubescens and Drynaria Decoction) or Fangfeng Tongsheng San (Saposhnikovia Releasing and Unblocking Powder) with added Niuxi, Mugua, and Fangji. Externally, Gezhi Gao (Paper-Interposed Plaster) or prepared Luzhen Ye (Glossy Privet Leaf) can be applied."

[Xue Ji] Fei Chuang (calf ulcer) arises on the two calves. Initially, there is redness and swelling; over time, it rots and ulcerates, or oozes and itches, discharging dripping pus after rupture. This is generally due to improper diet and lifestyle damaging the Liver and Kidneys, or Yin Fire flowing downward and combing with external pathogens. The lateral aspect belongs to damp-heat of the Three Yang meridians of the foot and is treatable; the medial aspect belongs to yin-deficiency heat of the Three Yin meridians of the foot and is difficult to treat. If initially there are chills and high fever with swollen, painful areas, it belongs to damp-heat; use Bingsu Baidu San (Areca Seed and Perilla Detoxifying Powder). If there is diffuse swelling with pain, or no swelling and no pain, it belongs to yin-deficiency; use Buyin Bazhen Tang (Yin-Nourishing Eight-Treasure Decoction). If there is dripping pus, fatigue, poor appetite, internal heat, and dry mouth, it belongs to Spleen deficiency; use Buzhong Yiqi Tang (Middle-Boosting Qi-Enriching Decoction) with added Fuling (Poria) and Jiuchao Baishaoyao (Wine-fried White Peony Root). If there is afternoon fever, or pain, and unclear head/eyes, it belongs to Yin Fire; add Jiuchao Hei Huangbai (Wine-fried Black Phellodendron Bark) to the previous formula, along with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). If there is afternoon fever that stops only at Zi hour (11 PM - 1 AM), it is Blood deficiency; add Xiong (Ligustici Chuanxiong Rhizoma), Gui (Angelicae Sinensis Radix), and Shudi (Prepared Rehmannia Root) to the previous formula. If depression injures the Spleen severely, use Guipi Tang (Spleen-Restoring Decoction) with added Chaihu (Bupleuri Radix) and Shanzhi (Gardeniae Fructus). If anger moves Liver Fire severely, use Buzhong Yiqi Tang with added Chuanxiong, Shanzhi, and Huangqin (Scutellariae Radix). Internal heat, dry mouth, limb fatigue, rising phlegm-saliva, or sores in the mouth and tongue belong to Spleen-Kidney deficiency heat; use Liuwei Dihuang Wan and Buzhong Yiqi Tang. If the affected area is dark black, limbs fear cold, and there is little desire for food, or Spleen-Kidney deficiency and collapse, use Bawei Wan (Eight-Ingredient Pill). If attacking/purging medicines are mistakenly used, further damaging Stomach Qi and cutting off the source of transformation, treatment becomes difficult. Zhai Shaoxi, an official of the Honglu Temple, had ulcers on both calves that gradually spread over the whole body, with fever, expectoration, dry mouth and throat, night sweats, irritability, red urine, hot feet, worsening in the late afternoon, and emaciation. This was Deficient Fire of the Kidney Meridian. Using Liuwei Wan (Six-Ingredient Pill), all symptoms receded within a month, and Yuanqi (Primal Qi) recovered in three months.

A man had swelling in his left calf, with normal skin color, chills, fever, nausea, and poor appetite. This was insufficient Spleen Qi affected by external pathogens. Using Liujun Zi Tang (Six-Gentlemen Decoction) with added Huoxiang (Pogostemonis Herba), Jiegeng (Platycodonis Radix), and Chuanxiong, the chills and fever stopped. Then using Buzhong Yiqi Tang, the swelling and pain subsided. Lu Maocheng, constitutionally deficient in Yin, drank excessively and engaged in sexual activity, resulting in fever and leg pain resembling an ulcer. Using exterior-releasing agents, both legs became swollen and dark, with heat like fog, impending spasms, and pulse that was surging and rapid, especially at the Chi positions. I said: "This belongs to deficiency of the Three Yin meridians of the foot, exacerbated by alcohol-dampness, where Yuanqi is damaged and pathogens become more severe." Using Shiquan Dabu Tang with added Shanyao (Dioscoreae Rhizoma), Shanzhuyu (Corni Fructus), and Fuzi (Aconiti Lateralis Radix Praeparata), the pulse and symptoms retreated after one dose. Fuzi was removed, and after two more doses, full recovery occurred.

A man first suffered from ulcers on both calves, which later spread to the whole body. The sores resembled scabies but were not scabies, sometimes discharging dripping pus, especially in the legs. There was limb fatigue, itching, irritability, and heat, lasting over a year without healing. I considered it Deficient Fire of the Kidney Meridian and used Jiajian Bawei Wan (Modified Eight-Ingredient Pill) for recovery.

Ermiao Wan (Two-Exquisite Pill) treats lower-jiao damp ulcers. (Any ulcer in the lower jiao may take this.) Qianxing San powder and Cangzhu powder (Atractylodis Rhizoma) in equal parts, formed into pills with refined honey, size of Sophora seeds.

[Hai Zang] Huangbo Wan (Huangbo Pill, from *Ju Fang*) treats ulcers on both calves, knees, and feet. Taking this brings immediate relief.
Chuan Wutou (Prepared Aconitum Carmichaelii Lateralis Radix, peeled and de-seeded), Chuanlianzi (Meliae Toosendan Fructus), Dilong (Pheretima, earthworm, cleaned and stir-fried), Xiangfu (Cyperi Rhizoma, stir-fried), Du Jili (Tribuli Fructus, stir-fried and thorns removed), Chixiaodou (Vigna umbellata Seed), Fangfeng (Saposhnikoviae Radix, de-rhizome), Huangbo (Phellodendri Cortex, sliced, each 1 liang), Wuyao (Linderae Radix).
All ground into fine powder. Made into pills with wine-boiled wheat paste, size of Sophora seeds. Take 15 pills each time, washed down with warm wine; salt water is also acceptable. Women should wash down with vinegar water. Take on an empty stomach.

An excellent method for treating calf ulcers: Digupi (Lycii Cortex), 1 jin; Huangbo (Phellodendri Cortex), 2 liang. Coarsely chopped. Fry in 1.5 jin of sesame oil, filter, obtaining 6-7 liang of medicinal oil. Add 20 liang of pure pine resin and 2 liang of Huangdan (Lead Tetroxide). Simmer together until Huangdan turns slightly black. Then add 7 jiao of Qingfen (Calomel) and 2 jiao of Guangfen (White Lead). The simmering method is the same as making plasters. Drag through long strips of paper and hang to dry. If the ulcer is purple-black, first use a three-edged needle to remove bad blood, wash clean with cold water, cut plaster to fit the ulcer size, cover it, and tie tightly with silk gauze. After one week, change the plaster. When changing, must wash the ulcer with cold water. After a few changes, whether new or old, it will heal. Must avoid sun air, fire air, and yang air. If upon changing the plaster, black swelling remains, bleed again until purple-black blood is exhausted.

To treat calf ulcers, rinse the ulcer with rice-washing water (after rinsing mouth with it), wipe dry, then apply Digupi powder mixed with honey to the ulcer, and bind with oiled paper.

[Danxi] Treating calf ulcers:
Baijiaoxiang (Elemi Resin), Huangbo (Phellodendri Cortex), Ruangao (Soft Gypsum, separately ground, each 1 liang), Qingdai (Indigo Naturalis), Longgu (Fossilized Bones, each 0.5 liang).
All ground into fine powder. Mix with sesame oil and apply to the affected area.

Another prescription: Use male sheep dung (2 fen), Gypsum (1 fen), Chishizhi (Halloysit Rubrum, 0.5 fen). Grind into fine powder. Mix with sesame oil. Use old black oil umbrella paper as a barrier plaster and bind to eradicate the root.

[Luo Qianfu] Cuiyu Gao (Jade Green Plaster) treats calf ulcers.
Qingli (Bitumen), 1 liang; Huangla (Yellow Beeswax), Tonglv (Malachite, each 2 qian); Moyao (Myrrha), Ruxiang (Olibanum, each 1 qian).
First grind Tonglv into fine powder and mix with sesame oil. Melt Huangla and Qingli over fire. Add the oil-Tonglv mixture and stir well over fire. Gradually add Moyao and Ruxiang and stir evenly. Pour into a bowl of river water, pull and mix by hand until uniform. Wrap in oiled paper. Depending on ulcer size, divide into pieces, chew into cakes, and apply to the ulcer. Seal with paper for three days, then change.

[Danxi] For calf ulcers, boil Ligustrum lucidum leaves (Dongqing Ye) in sugar water for 3-5 boils, remove, press dry with stone. Apply leaves to the ulcer opening, changing twice a day. For foot pain forming ulcers, decoct Polygonum hydropiper (Shuiliao) in water, wash the ulcer, and let dry for natural comfort.

[Shanzhai] For calf ulcers, wash with leek juice, wipe dry, and apply finely chopped tiger bone.

Ruxiang San (Guoshi's Incense Powder) treats various gan erosions that do not heal for a long time, sinking-down gan ulcers, ulcers on inner and outer malleoli, stubborn ulcers, etc.
Kufan (Alum), Baijiaoxiang (Elemi Resin), Chishizhi (Halloysit Rubrum, each 0.5 liang); Huangdan (Lead Tetroxide), Ruxiang (Olibanum), Moyao (Myrrha, each 3 qian); Qingfen (Calomel, 2 qian).
All ground into fine powder. Add a small amount of Shexiang (Musk). If the ulcer is wet, sprinkle dry powder; if dry, mix with sesame oil and apply.

Qingfen San (Guoshi's Calomel Powder) treats sinking-down gan ulcers with foul erosion, rotting, pain unbearable.
Huangbai (Phellodendri Cortex, honey-fried), Miduoseng (Litharge), Huangdan (Lead Tetroxide), Gaomo Cha (Fine Tea Leaves), Ruxiang (Olibanum, each 3 qian); Qingfen (Calomel, 1.5 qian); Shexiang (Musk, a little).
All ground into powder. Wash ulcer with scallion soup, then apply this medicine. Also treats pediatric gan ulcers.

Prescription for treating calf ulcers:
Shufen (Mouse feces), Kushen (Sophorae Flavescentis Radix), Tao Zhi (Peach Twig), Shanshu Ci (Chinese Fir Thorn), Liuzhi (Willow Twig), Songzhi (Pine Twig), Fujiang (Wheat Bran Paste), Jizi Qiao (Chicken Eggshell), Zaojiao (Gleditsiae Fructus), Quefen (Sparrow feces), Shaoyao (Peony Root), Mianzi (Cottonseed), Zhima (Sesame), Sangzhi (Mulberry Twig), Sheke (Snake Shell), Didimei (Pot Bottom Coal), Du Danggui Xu (Wild Angelica Tail, each 4 qian); Songming (Pine Knot, any amount).
All ground into fine powder. First crush Songming, mix with other medicines in a clay pot. Dig a pit, place the pot in the pit, surround with fire to melt. Remove, grind again to make uniform, and apply to ulcer for natural recovery. Avoid all stimulating and hot foods.

Gezhi Gao (Paper-Interposed Plaster) treats internal and external calf ulcers.
Danggui (Angelicae Sinensis Radix), Baizhi (Angelicae Dahuricae Radix), Huanglian (Coptidis Rhizoma), Wubeizi (Chinese Gall), Xionghuang (Realgar), Moyao (Myrrha), Xuexie (Dragon's Blood), Haipiaoxiao (Sepiae Endoconcha), Baiji (Bletillae Rhizoma), Bailian (Smilacis Glabrae Rhizoma), Huangbai (Phellodendri Cortex), Houpo (Magnoliae Officinalis Cortex, each 0.5 liang); Huangdan (Lead Tetroxide, 6 qian); Ruxiang (Olibanum, ground, 2.5 qian); Qingfen (Calomel, 1 qian).
All ground into fine powder and mixed evenly. Make into a plaster with clear oil. Apply medicated oiled paper to the ulcer and bind with silk gauze. If there is pus, untie, scrape away impurities, and reapply. Repeat several times until healed. Must first wash with boiled salt water, wipe dry with cloth, wait until moisture evaporates, then apply medicine.

Treating chronic non-healing ulcers:
Longgu (Fossilized Bones, 2.5 qian), Qingfen (Calomel, a little), Binglang (Arecae Semen, 0.5 liang), Ruxiang (Olibanum), Moyao (Myrrha, each 1 qian); Gan Zhufen (Dry Pig Feces, 0.5 liang, burned to retain nature).
All ground into fine powder. First wash ulcer with boiled salt water, wipe dry with soft silk gauze, mix with clear oil and apply; if wet, sprinkle dry powder.

Treating sinking-down calf ulcers:
Baishizhi (Halloysit Albus), Longgu (Fossilized Bones, each 0.5 liang); Baifan (Alum, 1 liang, calcined); Wubeizi (Chinese Gall, 2 liang, burned to retain nature); Huangdan (Lead Tetroxide, 3 qian, purified); Xionghuang (Realgar, a little).
All ground into fine powder. First wash ulcer with scallion-salt water until red flesh appears. Then apply the above medicine. For thick applications, bind with cloth and do not move until dry, then the crust falls off naturally.

Treating calf ulcers:
Huangdan (Lead Tetroxide), Qingfen (Calomel), Baiji (Bletillae Rhizoma), Zhangnao (Camphora), Baichuanhui (Old Boat Ash, equal parts).
All ground into fine powder, made into a plaster with tung oil, spread on oiled paper bags. First wash with warm scallion soup, wipe dry with cloth, place medicine on ulcer, and tie. Use one side, then flip and wash/apply as before. Another formula: without Qingfen, using ash from dung-carrying boats is also excellent.

Prescription for calf ulcers: Zhan Wuzi suffered from this at age thirty and found it frequently effective.
Baiji (Bletillae Rhizoma), Bailian (Smilacis Glabrae Rhizoma), Huangbai (Phellodendri Cortex), Huangdan (Lead Tetroxide, separately ground, equal parts).
All ground into extremely fine powder. Add a little Qingfen, mix evenly, form into cakes with refined honey, apply to ulcer. Fill deep ones completely, wrap with cloth strips, change once a day. Later, as the ulcer dries or cracks, just sprinkle dry powder until healed.

Treating 'Xiezhu Jiao' (Blood-Stagnant Leg):
Sangshu Gu (Mulberry Tree Puff), Niushi Gu (Cow Dung Puff, also known as Duanshi Gu, grows on ground, breaks if stone-like, contains ash), Feizhu Shu Gu (Fat Tree Puff), Taifa (Embryonic Hair: male hair for males, female hair for females, three strands).
First bake the three puffs until dry, 5 qian each; burn embryonic hair to ash retaining nature, 3 qian. All ground into fine powder and mixed evenly. If wet, sprinkle dry powder; if dry, mix with pure hemp seed oil and apply.

Prescription for calf ulcers:
Dongqing Ye (Ligustrum Lucidum Leaf), Lazhu Dan (Winter Pig Gallbladder), Baicaoshuang (Soot, mix these two evenly).
Chew Dongqing Ye thoroughly with the patient. First wash ulcer with scallion and pepper. Apply gallbladder frost, then apply the chewed leaf on top. 3-4 times is sufficient.

Wonderful Gardenia Powder treats long-standing internal and external calf ulcers.
Shanzhizi (Gardeniae Fructus, any amount, burned to ash and ground fine); Ruxiang (Olibanum, separately ground, each 0.5 qian); Qingfen (Calomel, a little).
Mix evenly, store in porcelain. Each time use, first decoct scallion white and Sichuan peppercorn, wash ulcer and let rest; then wash again with warm sour rice water. Wait until foul fluid is gone, then boil plain water vigorously, cool to warmth, and wash again. Only when no pus or blood streaks remain, and clear water is gone, wipe dry with powder cloth, then apply medicine. If dry, mix with sesame oil; if wet, sprinkle dry powder. Fill the ulcer opening completely, protect with soft silk gauze. Do not use if hard and not suppurating. If swollen and soft indicating pus, follow the previous method: wash again, then apply. 2-3 times leads to healing. This is the effect of one medicine and two washes.

Prescription for calf ulcers: First decoct scallion white and sour rice water, wash ulcer, wipe dry. Slowly sprinkle Qingfen powder onto the ulcer opening. Then use Wulingzhi (Trogopteri Dung) and Huangbai (Phellodendri Cortex) in equal parts, grind fine, mix with cold water, apply to ulcer, cover with paper. 3-5 times leads to recovery.