【方歌】脱疽多生足指间，黄疱如粟黑烂延，肾竭血枯五败证，
割切仍黑定归泉。
【注】此证多生足指之间，手指生者间或有之。盖手足十指，
乃藏府枝干。未发疽之先，烦躁发热，颇类消渴，日久
始发此患。初生如粟，黄疱一点，皮色紫暗，犹如煮熟
红枣，黑气浸漫，腐烂延开，五指相传，甚则攻于脚面
，痛如汤泼火燃，其臭气虽异香难解。由膏梁药酒，及
房术丹石热药，以致阳精煽惑，淫火猖狂，蕴蓄于藏府
，消烁阴液而成。斯时血死心败，皮死肺败，筋死肝败
，肉死脾败，骨死肾败，此五败证，虽遇灵丹，亦难获
效。初起宜服解毒济生汤，外用大麦米煮饭，拌芙蓉叶
、菊花叶各五钱，贴之止痛。消之不应者，必施割法，
须患者情愿，将死生付于度外，遵古法毒在肉则割，毒
在骨则切。然割切之法，须宜早施，乘其未及延散时，
用头发十余根，紧缠患指本节尽处，绕扎十余转，毋令
毒气攻延好肉，随用蟾酥饼放于初起黄疱顶上，加艾灸
之，至肉枯疮死为度；次日病指尽黑，方用利刀，寻至
本节缝中，将患指徐顺取下。血流不止者，用如圣金刀
散止之，余肿以离宫锭涂之。次日倘有黑气未尽，单用
蟾酥饼研末撒之，用陀僧膏盖贴，黑气自退；患上生脓
，兼贴生肌玉红膏及生肌等药，肌生护骨敛口，此为吉
兆。内宜滋肾水，养气血，健脾、安神之剂，如阴阳二
气丹、清神散、金液戊土丹俱可服之。若内、外始终无
变证，十中可保三四；若割切之后，复生黑气过节，侵
漫好肉，疼痛尤甚者，属逆。此证初起不痛者，宜雌雄
霹雳火灸之，其余滋补、烫洗等法，俱按痈疽肿疡、溃
疡门。
按诸书论脱疽，单生于足大指，而别指生者，俱名敦疽
，此非确论。然脱疽偏生于属阴经之指者居多，屡经如
此，后之学者，宜详审焉可也。
方剂：解毒济生汤
组成：当归 远志（去心）
川芎 花粉
柴胡 黄芩
犀角（镑） 麦冬（去心）
知母 黄柏
茯神 金银花（各一钱）
红花 牛膝
甘草（生，五分）
水二钟，煎八分，入童便一杯，食前服。如生手指
间，去牛膝加升麻。
【方歌】解毒济生归远芎，花粉柴芩犀麦冬，知柏茯银红膝草，
脱疽初起烦热攻。
又方：如圣金刀散
组成：松香（七两） 生白矾
枯白矾（各一两五钱）
共研极细末，磁罐收贮，临用时，撒于患处。
【方歌】如圣金刀散刃伤，血流不止撒之良，白矾枯矾松香等，
共研为末罐收藏。
又方：阴阳二气丹
组成：天门冬（去心） 麦门冬（去心）
元参（汤炮去粗皮，以上三味各捣膏）
五味子（炒） 人中白（生）
黄柏（各一两） 甘草（生）
泽泻 枯白矾
青黛（各三钱） 冰片（一钱）
各研细末，同天门冬等膏，加炼蜜少许，再捣千余
下，软硬得中，丸如梧桐子大，朱砂为衣，每服六十丸
，童便、人乳各一酒钟，空心送下，安睡一时。
【方歌】阴阳二气丹脱疽，肾水枯干燥热欺，天麦元参甘泻味，
中白冰矾柏黛宜。
又方：清神散
组成：绿豆粉（一两） 牛黄（三分）
甘草节（五钱） 冰片（五分）
朱砂（三钱）
上共为极细末，每服一钱，淡竹叶、灯心煎汤调服
。
【方歌】清神散治脱疽发，闷乱心烦调服佳，豆粉牛黄甘草节，
研加冰片共朱砂。
又方：金液戊土丹
组成：茯神 胡黄连
乌梅肉 人中黄
五味子（各一两） 朱砂
雄黄 硝石
远志（去心） 石菖蒲（各三钱）
牛黄 冰片（各一钱）
各研细末，共和一处，再研千转。于端午、七夕，
或春、秋二分，冬、夏二至吉辰，在净室中，先将乌梅
肉捣膏，和入药末内，加炼蜜少许，捣千余下，软硬得
中为丸，每丸重一钱，金铂为衣。每服一丸，人乳、童
便各一酒钟，随病上下化服。修和之时，服药之际，忌
妇人、僧尼、孝服、鸡犬等见之。此药用蜡封固收藏，
不泄药味，愈久愈效。
【方歌】金液戊土茯牛黄，朱雄硝远片石菖，胡连梅肉中黄味，
专治脱疽发背疮。
又方：雌雄霹雳火
组成：雌黄雄黄丁香（各二钱）麝香（一分）
上为细末，用蕲艾茸二钱，将药末搓入艾内，作豌
豆大，丸安患上灸之，毋论痒痛，以肉焦为度。如毒已
经走散，就红晕尽处，排炷灸之，痛则至痒，痒则至痛
，以疮红活为妙。
【方歌】霹雳火治阴疽方，脱疽不疼灸更强，雌黄丁麝雄黄末，
蕲艾茸搓药末良。
又方：蟾酥饼（即蟾酥丸作饼，见疔疮门）
离宫锭（见肿疡门）
陀僧膏、生肌玉红膏（俱见溃疡门）
【方歌】脱疽多发生在足趾之间，患处出现如粟米大小的黄色水疱，随后变黑腐烂蔓延。这是肾精枯竭、血液干枯导致的“五败”证候，若进行切割手术后患处依然发黑，则必定死亡。
【注】此病证多生于足趾之间，手指生发的情况间或有之。因为手足十指是脏腑的枝干延伸。在疽毒未发作之前，患者会出现烦躁、发热等症状，颇类似于消渴病（糖尿病），经过很长时间后才引发此患。初起时像粟米一样，有一个黄色水疱，皮肤颜色紫暗，犹如煮熟的红枣，黑色之气浸润弥漫，腐烂逐渐扩大，从五指相互传染，严重时甚至蔓延至脚面，疼痛剧烈如同热水浇泼、烈火燃烧，那股臭气即使使用异香也难以消除。这是由于长期食用肥甘厚味、饮酒，以及服用房中术药物和丹石类热药，导致阳精被煽动诱惑，淫火猖狂肆虐，蕴积蓄结于脏腑之中，消耗灼烧阴液而形成的。此时心血死而心败，皮死而肺败，筋死而肝败，肉死而脾败，骨死而肾败，这“五败”证候，即使遇到灵丹妙药，也难以获得疗效。初起时适宜服用解毒济生汤，外用大麦米煮饭，拌入芙蓉叶、菊花叶各五钱，贴敷以止痛。如果消散治疗无效，必须施行切割手术，须患者心甘情愿，将生死置之度外，遵循古法：毒邪在肌肉则割，毒邪在骨骼则切。然而切割手术的方法，应当尽早施行，趁毒邪尚未蔓延扩散之时，用十余根头发，紧紧缠绕在患病脚趾的本节尽头处，绕扎十余圈，不要令毒气攻袭蔓延到健康肌肉上，随即用蟾酥饼放置在初起黄色水疱的顶端，加艾灸它，直到肌肉枯死、疮口坏死为止；第二天患病脚趾完全变黑，才用锋利的刀，沿着本节缝隙，慢慢将患病脚趾取下。如果血流不止，用如圣金刀散来止血，其余肿胀用离宫锭涂抹。第二天如果有黑色之气未尽，单独用蟾酥饼研成粉末撒在患处，用陀僧膏覆盖贴敷，黑色之气自然会消退；患处生出脓液后，兼贴生肌玉红膏及生肌类药物，肌肉生长、保护骨骼、收敛伤口，这是吉兆。内服宜用滋补肾水、调养气血、健脾、安神的药剂，如阴阳二气丹、清神散、金液戊土丹都可以服用。如果内外始终没有发生变证，十个人中可以保全三四个；如果切割之后，又生出黑色之气越过关节，侵润蔓延到健康肌肉，疼痛更加剧烈的，属于逆证。此病初起如果不痛，适宜用雌雄霹雳火灸治，其余滋补、烫洗等方法，都按照痈疽肿疡、溃疡门的规定处理。
按：各种书籍论述脱疽，说只生于足大指，而其他脚趾生发的，都称为敦疽，这不是确切的结论。然而脱疽偏生于属阴经的脚趾的情况居多，屡次经验都是如此，后来的学者，应该详细审察就可以了。
方剂：解毒济生汤
组成：当归、远志（去心）、川芎、花粉、柴胡、黄芩、犀角（镑片）、麦冬（去心）、知母、黄柏、茯神、金银花（各一钱）、红花、牛膝、甘草（生用，五分）。
用水二钟，煎至八分，加入童便一杯，饭前服用。如果生在手指之间，去掉牛膝，加入升麻。
【方歌】解毒济生归远芎，花粉柴芩犀麦冬，知柏茯银红膝草，脱疽初起烦热攻。
又方：如圣金刀散
组成：松香（七两）、生白矾、枯白矾（各一两五钱）。
共同研磨成极细粉末，用磁罐收存，临用时，撒在患处。
【方歌】如圣金刀散刃伤，血流不止撒之良，白矾枯矾松香等，共研为末罐收藏。
又方：阴阳二气丹
组成：天门冬（去心）、麦门冬（去心）、元参（汤泡去粗皮，以上三味各捣成膏）、五味子（炒）、人中白（生用）、黄柏（各一两）、甘草（生用）、泽泻、枯白矾、青黛（各三钱）、冰片（一钱）。
各自研成细末，同天门冬等膏混合，加入少许炼蜜，再捣千余下，软硬适中，丸药大小如梧桐子，朱砂为衣，每次服用六十丸，用童便、人乳各一酒钟，空腹送服，安静睡一时辰。
【方歌】阴阳二气丹脱疽，肾水枯干燥热欺，天麦元参甘泻味，中白冰矾柏黛宜。
又方：清神散
组成：绿豆粉（一两）、牛黄（三分）、甘草节（五钱）、冰片（五分）、朱砂（三钱）。
以上共同研磨成极细粉末，每次服用一钱，用淡竹叶、灯心草煎汤调服。
【方歌】清神散治脱疽发，闷乱心烦调服佳，豆粉牛黄甘草节，研加冰片共朱砂。
又方：金液戊土丹
组成：茯神、胡黄连、乌梅肉、人中黄、五味子（各一两）、朱砂、雄黄、硝石、远志（去心）、石菖蒲（各三钱）、牛黄、冰片（各一钱）。
各自研成细末，混合在一起，再研磨千转。选择在端午、七夕，或春分、秋分，冬至、夏至等吉利时辰，在洁净房间中，先将乌梅肉捣成膏，混入药末内，加入少许炼蜜，捣千余下，软硬适中制成丸药，每丸重一钱，金箔为衣。每次服用一丸，用人乳、童便各一酒钟，根据病情上下部位化开服用。制作调和之时，服药之际，忌讳妇人、僧尼、穿孝服者、鸡犬等看见。此药用蜡密封收藏，不泄露药味，存放越久效果越好。
【方歌】金液戊土茯牛黄，朱雄硝远片石菖，胡连梅肉中黄味，专治脱疽发背疮。
又方：雌雄霹雳火
组成：雌黄、雄黄、丁香（各二钱）、麝香（一分）。
以上研为细末，用蕲艾茸二钱，将药末搓入艾绒内，做成豌豆大小的丸药，放置在患处施灸，不论痒痛，以肌肉焦枯为限度。如果毒邪已经走散，就在红晕尽头处，排列艾炷施灸，痛则转为痒，痒则转为痛，以疮口红润鲜活为妙。
[Prescription Verse] Gangrene of the toes (Tuo Ju) mostly occurs between the toes; yellow blisters like millet grains appear, followed by blackening and spreading rot. This represents the "Five Failures" syndrome due to exhaustion of Kidney essence and depletion of blood; if gangrene persists after amputation, death is certain.
[Note] This condition mostly arises between the toes, with occasional occurrences on fingers. The ten digits of the hands and feet are extensions of the Zang-Fu organs. Before the onset of the abscess, patients experience irritability and fever, resembling Xiao Ke disease (Wasting-Thirst). After a long period, this affliction develops. Initially, it appears like a millet grain: a single yellow blister with purplish-dark skin color, resembling a cooked red date. Black qi infiltrates and spreads, causing rot to extend from one toe to another. In severe cases, it attacks the dorsum of the foot. The pain is intense, as if scalded by hot water or burned by fire. The foul odor cannot be resolved even with rare fragrances. This results from consuming rich foods and alcohol, and taking aphrodisiacs and mineral-based hot medicines, which stir up Yang essence and cause rampant Yin-fire. This heat accumulates in the Zang-Fu organs, consuming and burning Yin fluids. At this stage, Heart blood dies leading to Heart failure, skin dies leading to Lung failure, tendons die leading to Liver failure, flesh dies leading to Spleen failure, and bones die leading to Kidney failure. These "Five Failures" syndromes are difficult to treat effectively even with miraculous drugs. In the early stage, it is suitable to take Jiedu Jisheng Tang (Detoxification and Life-Preserving Decoction). Externally, cook barley rice, mix with 5 qian each of Hibiscus leaf (Furong Ye) and Chrysanthemum leaf (Juhua Ye), and apply to relieve pain. If resolution fails, surgical amputation must be performed. The patient must be willing and disregard life and death, following ancient methods: if the toxin is in the flesh, cut; if in the bone, chop. However, surgery should be performed early, before the toxin spreads. Tie the proximal phalanx tightly with more than ten strands of hair, winding it over ten times, to prevent toxic qi from attacking healthy tissue. Then place a Chan Su Bing (Toad Venom Cake) on top of the initial yellow blister and apply moxibustion until the tissue necroses. The next day, when the affected toe is completely black, use a sharp knife to carefully sever the toe at the joint line. If bleeding does not stop, use Rusheng Jin Dao San (Like-Sage Golden Knife Powder) to stop it, and apply Ligong Ding (Palace-Removing Paste) for residual swelling. If black qi remains the next day, sprinkle powdered Chan Su Bing alone, cover with Tuoseng Gao (Monk Tuo Paste), and the black qi will recede. When pus forms, apply Shengji Yuhong Gao (Regenerate Flesh Jade Red Ointment) and other flesh-regenerating agents. Regrowth of muscle, protection of bone, and wound closure indicate a favorable prognosis. Internally, use formulas that nourish Kidney Water, tonify Qi and Blood, strengthen the Spleen, and calm the Spirit, such as Yinyang Erqi Dan (Yin-Yang Two-Qi Pill), Qingshen San (Spirit-Clearing Powder), and Jinye Wutu Dan (Golden Fluid Earth-Earth Pill). If there are no adverse changes internally or externally, three or four out of ten may survive. If, after amputation, black qi reappears crossing joints and invading healthy tissue with intensified pain, it is an adverse sign. If the condition presents without pain initially, Ci Xiong Pili Huo (Male and Female Thunderbolt Fire) moxibustion is suitable. Other tonifying and washing methods follow the protocols for Yong Ju Swelling/Ulcer sections.
Commentary: Various texts state that Tuo Ju occurs only on the great toe, and those on other toes are called Dun Ju. This is not accurate. However, Tuo Ju predominantly affects toes belonging to Yin meridians. Based on repeated experience, future scholars should examine this carefully.
Formula: Jiedu Jisheng Tang (Detoxification and Life-Preserving Decoction)
Composition: Dang Gui (Angelicae Sinensis Radix), Yuan Zhi (Polygalae Radix, heart removed), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Fen Hua (Trichosanthis Radix), Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Xi Jiao (Rhinocerotis Cornu, sliced), Mai Dong (Ophiopogonis Radix, heart removed), Zhi Mu (Anemarrhenae Rhizoma), Huang Bo (Phellodendri Cortex), Fu Shen (Poria with Hostwood), Jin Yin Hua (Lonicerae Japonicae Flos), Hong Hua (Carthami Flos), Niu Xi (Achyranthis Bidentatae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma, raw, 5 fen). Each herb is 1 qian except Gan Cao.
Decoct 2 zhong of water to 8 fen. Add 1 cup of Tong Bian (Child's Urine). Take before meals. If occurring on fingers, remove Niu Xi and add Sheng Ma (Cimicifugae Rhizoma).
[Verse] Jiedu Jisheng uses Gui, Yuan, and Xiong; Fen Hua, Chai, Qin, Xi, and Mai Dong. Zhi, Bai, Fu, Yin, Hong, Xi, and Cao; For early Tuo Ju with irritability and heat attack.
Another Formula: Rusheng Jin Dao San (Like-Sage Golden Knife Powder)
Composition: Song Xiang (Pini Resina, 7 liang), Sheng Bai Fan (Alumen Crude), Ku Bai Fan (Alumen Ustums, 1.5 liang each).
Grind into extremely fine powder. Store in a porcelain jar. Sprinkle on the affected area when needed.
[Verse] Rusheng Jin Dao San treats blade wounds; Good for stopping unceasing bleeding. Bai Fan, Ku Bai Fan, and Song Xiang; Grind fine and store in a jar.
Another Formula: Yinyang Erqi Dan (Yin-Yang Two-Qi Pill)
Composition: Tian Men Dong (Asparagi Radix, heart removed), Mai Men Dong (Ophiopogonis Radix, heart removed), Xuan Shen (Scrophulariae Radix, boiled and coarse skin removed; these three made into paste), Wu Wei Zi (Schisandrae Fructus, fried), Ren Zhong Bai (Natrii Carbonas), Huang Bo (Phellodendri Cortex, 1 liang each), Gan Cao (Glycyrrhizae Radix et Rhizoma, raw), Ze Xie (Alismatis Rhizoma), Ku Bai Fan (Alumen Ustums), Qing Dai (Indici Folium, 3 qian each), Bing Pian (Borneolum Syntheticum, 1 qian).
Grind each into fine powder. Mix with the pastes of Tian Men Dong, etc. Add a little refined honey. Pound for over a thousand strokes until consistency is moderate. Form pills the size of Sophora seeds. Coat with Cinnabar (Zhu Sha). Take 60 pills per dose. Send down with Tong Bian (Child's Urine) and Ren Ru (Human Milk), one wine-cup each, on an empty stomach. Sleep quietly for one shichen (two hours).
[Verse] Yinyang Erqi Dan for Tuo Ju; Dryness and heat oppress withered Kidney Water. Tian, Mai, Xuan Shen, Gan, Xie, Wei; Zhong Bai, Bing, Fan, Bai, Dai are suitable.
Another Formula: Qingshen San (Spirit-Clearing Powder)
Composition: Lu Dou Fen (Vigna Radiatae Semen Pulvis, 1 liang), Niu Huang (Bovis Calculus, 3 fen), Gan Cao Jie (Glycyrrhizae Radix et Rhizoma, nodes, 5 qian), Bing Pian (Borneolum Syntheticum, 5 fen), Zhu Sha (Cinnabaris, 3 qian).
Grind all into extremely fine powder. Take 1 qian per dose. Mix with decoction of Dan Zhu Ye (Lophatheri Herba) and Deng Xin Cao (Junci Medullia) and swallow.
[Verse] Qingshen San treats Tuo Ju eruption; Good for regulating stifling and irritability. Bean powder, Niu Huang, Gan Cao nodes; Grind with Bing Pian and Zhu Sha together.
Another Formula: Jinye Wutu Dan (Golden Fluid Earth-Earth Pill)
Composition: Fu Shen (Poria with Hostwood), Hu Huang Lian (Coptidis Rhizoma alternative/Wood Betony root?), Wu Mei Rou (Mume Fructus Carnium), Ren Zhong Huang (Hominis Excrementum Purified), Wu Wei Zi (Schisandrae Fructus, 1 liang each), Zhu Sha (Cinnabaris), Xiong Huang (Realgar), Xiao Shi (Nitrums), Yuan Zhi (Polygalae Radix, heart removed), Shi Chang Pu (Acori Tatarinowii Rhizoma, 3 qian each), Niu Huang (Bovis Calculus), Bing Pian (Borneolum Syntheticum, 1 qian each).
Grind each into fine powder. Mix thoroughly and grind for a thousand turns. Prepare on auspicious days: Dragon Boat Festival, Double Seventh, Spring/Autumn Equinox, Winter/Summer Solstice. In a clean room, mash Wu Mei Rou into paste, mix with powder, add a little refined honey, and pound for over a thousand strokes until consistency is moderate. Form pills weighing 1 qian each. Coat with Gold Foil (Jin Bo). Take one pill per dose. Dissolve and take with Ren Ru (Human Milk) and Tong Bian (Child's Urine), one wine-cup each, according to the location of the disease. During preparation and administration, avoid exposure to women, monks/nuns, mourners, chickens, and dogs. Seal with wax to preserve potency. The longer it is stored, the more effective it becomes.
[Verse] Jinye Wutu contains Fu, Niu Huang; Zhu, Xiong, Xiao, Yuan, Pian, Shi Chang Pu. Hu Lian, Mei Rou, Zhong Huang, Wei; Specifically treats Tuo Ju and Back Sores.
Another Formula: Ci Xiong Pili Huo (Male and Female Thunderbolt Fire)
Composition: Ci Huang (Orpiment), Xiong Huang (Realgar), Ding Xiang (Caryophylli Flos, 2 qian each), She Xiang (Moschus, 1 fen).
Grind into fine powder. Mix with 2 qian of Qi Ai Rong (Artemisia argyi catkins). Roll into pea-sized pellets. Place on the lesion and moxa. Continue until tissue is scorched, regardless of itching or pain. If the toxin has spread, moxa at the edge of the red halo. Pain turning to itch, or itch turning to pain, indicates improvement; a bright red and active sore is ideal.
[Verse] Pili Huo treats Yin Abscess; Moxa is stronger for painless Tuo Ju. Ci Huang, Ding, She, Xiong Huang powder; Mixed with Qi Ai Rong for good effect.
Another Formula: Chan Su Bing (Toad Venom Cake - see Ding Chuang section for Toad Venom Pills)
Ligong Ding (See Yong Ju Swelling section)
Tuoseng Gao, Shengji Yuhong Gao (See Yong Ju Ulcer section)