人有脚趾上，忽然发痒，而后作痛，指甲现黑色，第二日连脚趾俱黑，第三日连脚面俱黑，黑至腿上，过
膝即死，亦无名肿毒之一种也。因人贪欢，过服春药，是火热之毒，非脚疽可比。若脚疽止黑在脚趾，而不至
脚面也。然脚疽最凶，虽不如无名肿毒之横，而杀人则一也。盖脚为四余之末，宜毒之所不到者也，何以凶恶
至此？正以谓毒所不到之处而毒聚不散，反出于脚趾之间，则毒盛非常，而治之不可轻视也。然则用泄毒之药
治之可乎？而孰知不然。凡人身气血，周流上下，则毒瓦斯不能聚结于一处，惟气血亏损，不能遍走经络，而火
毒恶邪，乃固结于骨节之际。脚疽之生，正因气血之亏，不能周流之故，安可单泄其毒，以再伤其气血乎？治
之法，必须大补气血，而佐以泄毒之品，则安全之道也。方用顾步汤∶
牛膝（一两） 黄 （一两） 石斛（一两） 当归（一两） 金银花（三两） 人参（三钱）
水煎服，一剂而黑色解，二剂而疼痛止，三剂愈。若已溃烂，多服数剂，无不愈也。此方用金银花以解毒，
非用牛膝、石斛，则不能直达于脚趾；非用人参、归、 ，亦不能使气血流通以散毒也。故用此方治脚疽多效，
即是无名肿毒用此方治之，亦可得生。世医用刀割去脚趾，亦是治法，不若此方于补中散毒。起死为生，既无痛楚之
伤，又有全活之效也。
秘诀∶
顾步汤药治脚疽，牛 石斛一两归，
三两银花参三钱，未溃三剂溃四奇。
本症用地丁饮亦效∶
紫花地丁（一两） 甘菊花（一两） 牛膝（一两） 甘草（五钱） 天花粉（三钱）
水煎服，未溃二剂，已溃再服二剂收功，多服为妙。
秘诀∶
又有脚疽紫地丁，甘菊牛膝一两同，
甘草五钱粉三钱，未溃二剂溃再功。
人有脚腿之上，忽然肿起一块，皮色如常又不痛，人以为痈疽也，谁知是气血大虚之故乎？夫痈疽而皮色
不变，乃气血之虚，而曰非生痈也，其谁信之？嗟乎！气所以行血者也。气行则血行，气止则血止，若气血相
活，纵有邪气亦难成肿。邪气之盛，由于气血之衰，其肿为痈，每每作痛，而色必变为红赤也。然是痈也，肿而
不痛不赤，皮色不变，有肿名而无肿实，纯是气虚而血无以养，邪盛而气不能制也。治之法，宜补气以养血，
何必化毒以祛邪哉？方用补中益气汤∶
白术（一两） 黄 （一两） 升麻（五分） 柴胡（一钱） 陈皮（一钱） 茯苓（三钱） 甘草（二钱）
制半夏（二钱） 人参（五钱） 当归（五钱）
水煎服，十剂而肿自消矣。此方乃益气之圣药，非消肿之神剂，何以用之而肿即消也？差真气夺则虚，
邪气盛则实，真气愈虚，邪气愈盛，不能补气之药，而气何以能行，肿何以能消哉？盖补中益气汤善能补气，
故能消肿，何况又益以消肿去湿之品，所以易于建功耳。
秘诀∶
补中益气两术 ，升麻五分钱柴陈，
苓三甘草制夏二，参归五钱十剂神。
又用下方亦效∶
当归（五钱） 人参（五钱） 黄 （一两） 牛膝（五分） 荆芥（三钱） 茯苓（三钱） 天花粉（三钱）
附子（三钱） 甘草（一钱）
水煎服。
秘诀∶
还有五钱当归参，一两黄 牛五分，
荆芥苓粉俱三钱，附子三钱草钱存。
A person experiences sudden itching on the toes, followed by pain, with the fingernails/toenails turning black. By the second day, the entire toe turns black; by the third day, the dorsum of the foot also turns black. If the blackness spreads up the leg past the knee, death ensues. This is also a type of nameless carbuncle and swelling (Wuming Zhongdu). It arises from excessive indulgence in sexual activity and the overconsumption of aphrodisiacs, resulting in toxic heat-fire, which differs from gangrene of the foot (Jiao Ju). In true Jiao Ju, the blackness remains confined to the toes and does not spread to the dorsum of the foot. However, Jiao Ju is extremely fierce; although it may not be as aggressive as nameless carbuncles, its lethality is the same. The feet are the extremities of the four limbs, areas where pathogens should ideally not reach. Why is it so malignant? Precisely because when pathogens accumulate and fail to disperse in places they cannot normally reach, their concentration becomes exceptionally high. Therefore, treatment must not be taken lightly. Can one treat this with purgative drugs to drain toxicity? No. When Qi and Blood circulate freely throughout the body, pathogenic factors cannot congregate in one location. Only when Qi and Blood are deficient and fail to nourish the meridians can fire-toxicity and evil pathogens become firmly fixed at the joints. The onset of Jiao Ju is precisely due to Qi and Blood deficiency failing to circulate. How can one simply purge toxicity and further injure Qi and Blood? The treatment method must involve significantly tonifying Qi and Blood, assisted by herbs that drain toxicity; this is the safe approach. Use Gu Bu Tang:
* *Eucommiae Cortex* (Du Zhong) [Note: Text says Huang, likely Huangqi based on context and formula composition, but literal translation follows text "Huang" usually implying Huangqi in this context or Du Zhong if typo. Given standard Gu Bu Tang often contains Du Zhong or Huangqi. The text lists "Huang". I will use Astragali Radix (Huangqi) as it fits the "tonify Qi" theme better than Eucommia, though Du Zhong is common in some variations. Let's stick to the character provided: Huang -> Astragali Radix (Huangqi)] (1 liang), *Dendrobii Caulis* (Shihu) (1 liang), *Angelicae Sinensis Radix* (Danggui) (1 liang), *Lonicerae Japonicae Flos* (Jinyinhua) (3 liang), *Ginseng Radix* (Renshen) (3 qian).
Decoct in water and take orally. After one dose, the blackness resolves; after two doses, the pain stops; after three doses, recovery occurs. If ulceration has already occurred, taking several more doses will ensure healing. This formula uses *Lonicerae Japonicae Flos* to resolve toxicity; without *Eucommiae Cortex* (or Achyranthis Bidentatae Radix - Niuxi) and *Dendrobii Caulis*, the medicine cannot reach the toes directly; without *Ginseng Radix*, *Angelicae Sinensis Radix*, and *Astragali Radix*, Qi and Blood cannot flow freely to dissipate the toxin. Thus, this formula is highly effective for Jiao Ju, and even for nameless carbuncles, it can save lives. Surgeons who cut off the toes are employing a valid method, but this formula is superior as it disperses toxins while tonifying, bringing the dead back to life without causing painful injury, achieving full preservation of life.
Secret Formula:
Gu Bu Tang treats foot gangrene,
Niuxi and Shihu one liang, Danggui one liang,
Three liang Yinhua, three qian Renshen,
Three doses if un-ulcerated, four if ulcerated, miraculous.
The Di Ding Yin is also effective for this condition:
* *Viola Herba* (Zihua Diding) (1 liang), *Chrysanthemi Flos* (Ganjuhua) (1 liang), *Achyranthis Bidentatae Radix* (Niuxi) (1 liang), *Glycyrrhizae Radix et Rhizoma* (Gancao) (5 qian), *Trichosanthis Radix* (Tianhuafen) (3 qian).
Decoct in water and take orally. Two doses if un-ulcerated; if already ulcerated, take two more doses to complete the cure. Taking more is advisable.
Secret Formula:
For foot gangrene, Zihua Diding,
Ganjuhua and Niuxi one liang each,
Five qian Gancao, three qian Tianhuafen,
Two doses if un-ulcerated, two more if ulcerated to achieve success.
If a lump suddenly swells up on the leg or foot, with normal skin color and no pain, people assume it is a carbuncle or gangrene. Who would know it is actually due to severe deficiency of Qi and Blood? If a carbuncle or gangrene presents with unchanged skin color, it indicates Qi and Blood deficiency, yet some deny it is a carbuncle—would anyone believe them? Alas! Qi moves Blood. When Qi moves, Blood moves; when Qi stops, Blood stops. If Qi and Blood are harmonious and flowing, even if pathogenic factors exist, swelling is difficult to form. The excess of pathogenic factors stems from the decline of Qi and Blood. Swelling that forms a carbuncle is typically painful and turns red. However, this specific swelling is painless, non-red, with unchanged skin color. It has the name of swelling but lacks the substance of true swelling; it is purely Qi deficiency with insufficient Blood nourishment, and pathogenic excess with Qi unable to control it. The treatment should tonify Qi to nourish Blood; why bother resolving toxicity to expel pathogens? Use Bu Zhong Yi Qi Tang:
* *Atractylodis Macrocephalae Rhizoma* (Baizhu) (1 liang), *Astragali Radix* (Huangqi) (1 liang), *Bupleuri Radix* (Chaihu) (1 qian), *Citrini Pericarpium* (Chenpi) (1 qian), *Poria* (Fuling) (3 qian), *Glycyrrhizae Radix et Rhizoma* (Gancao) (2 qian), *Pinelliae Rhizoma Praeparatum* (Zhibanxia) (2 qian), *Ginseng Radix* (Renshen) (5 qian), *Angelicae Sinensis Radix* (Danggui) (5 qian).
Decoct in water and take orally. After ten doses, the swelling will naturally subside. This formula is the supreme medicine for tonifying Qi, not merely a divine agent for reducing swelling. Why does it reduce swelling? Generally, loss of True Qi leads to deficiency, while excess of pathogenic Qi leads to excess. The more deficient the True Qi, the stronger the pathogenic Qi. Without tonifying Qi, how can Qi move and swelling disappear? Bu Zhong Yi Qi Tang excels at tonifying Qi, thus it can reduce swelling. Moreover, it includes herbs that reduce swelling and drain dampness, making it easy to achieve results.
Secret Formula:
Bu Zhong Yi Qi with Baizhu and Huangqi,
Chaihu one qian, Chenpi one qian,
Fuling three qian, Gancao two qian, Zhibanxia two qian,
Renshen and Danggui five qian each, ten doses work miracles.
Another formula below is also effective:
* *Angelicae Sinensis Radix* (Danggui) (5 qian), *Ginseng Radix* (Renshen) (5 qian), *Astragali Radix* (Huangqi) (1 liang), *Achyranthis Bidentatae Radix* (Niuxi) (5 fen), *Schizonepetae Spica* (Jingjie) (3 qian), *Poria* (Fuling) (3 qian), *Trichosanthis Radix* (Tianhuafen) (3 qian), *Aconiti Lateralis Radix Praeparata* (Fuzi) (3 qian), *Glycyrrhizae Radix et Rhizoma* (Gancao) (1 qian).
Decoct in water and take orally.
Secret Formula:
Danggui and Renshen five qian each,
Huangqi one liang, Niuxi five fen,
Jingjie, Fuling, and Tianhuafen all three qian,
Fuzi three qian, Gancao one qian remains.