典藏书目

Tuojue (Gangrene of the toes) mostly occurs between the toes. The skin turns yellow like millet grains, then blackens and rots, spreading continuously. If the "Five Failures" syndrome (Kidney exhaustion and blood depletion) appears, even if cutting is performed, if the area remains black, death is certain.

[Note] This condition mostly occurs between the toes; cases occurring in the fingers are rare. The ten fingers of the hands and feet are the branches of the Zang-Fu organs. Before the abscess erupts, patients often experience irritability and fever, resembling Xiao Ke (Wasting and Thirsting Syndrome). After a long time, this disease develops. Initially, it appears like a millet grain with a single yellow spot, the skin color is purple and dark, resembling a cooked red date. Then, black Qi invades and spreads, causing rotting to expand from toe to toe. In severe cases, it attacks the instep. The pain is intense, as if scalded by hot water or burned by fire. The foul odor cannot be masked even by fragrant incense. This is caused by consuming rich foods, alcohol, medicinal wines, and sexual enhancement drugs or mineral-based heat-inducing pills. These lead to the stirring of Yang essence and rampant Yin fire, accumulating in the Zang-Fu organs and consuming Yin fluids. At this stage, Heart blood dies and Heart function fails; Skin dies and Lung function fails; Tendons die and Liver function fails; Flesh dies and Spleen function fails; Bones die and Kidney function fails. This is the "Five Failures" syndrome. Even with miraculous medicines, efficacy is difficult to achieve. In the early stage, Jiedu Jisheng Tang (Detoxification and Life-Sustaining Decoction) should be taken internally. Externally, cook barley rice, mix with 5 qian each of Hibiscus leaf (Furong Ye) and Chrysanthemum leaf (Juhua Ye), and apply to the lesion to relieve pain. If medication fails to resolve it, surgical excision is necessary. The patient must be willing and disregard life and death. Follow 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 more than ten strands of hair tightly around the proximal interphalangeal joint of the affected toe, winding it more than ten times, to prevent toxic vapors from invading healthy tissue. Place a Chan Su Bing (Toad Venom Cake) on top of the initial yellow spot and apply moxibustion until the tissue dries and necrotizes. The next day, when the toe is completely black, use a sharp knife to locate the joint line and gently remove the affected toe. If bleeding does not stop, use Rusheng Jindao San (Sage-like Golden Knife Powder) to stop it. Apply Ligong Ding (Palace-Lixing Plaster) for residual swelling. If black Qi persists the next day, sprinkle powdered Chan Su Bing alone, cover with Tuoseng Gao (Tathagata Paste), and the black Qi will recede. Once pus forms, apply Shengji Yuhong Gao (Muscle-Regenerating Jade Red Ointment) and other muscle-regenerating agents. Muscle growth, bone protection, and wound closure indicate a favorable prognosis. Internally, administer 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 Jinlie Wutu Dan (Golden Fluid Earth-Pentagon Pill). If there are no adverse changes throughout internal and external treatment, three or four out of ten cases may be saved. If after surgery, black Qi reappears crossing joints and invading healthy tissue with intensified pain, it is an adverse sign. If the disease presents without pain initially, Cixiong Pili Huo (Female-Male Thunderbolt Fire) moxibustion is suitable. Other tonifying and hot-washing methods follow the protocols for Yong Ju Swelling/Ulcer sections.

Commentary: Various texts state that Tuojue occurs only on the big toe, and cases on other digits are named Dun Ju. This is not an accurate conclusion. However, Tuojue predominantly affects digits belonging to Yin meridians. Repeated observations confirm this. Future practitioners should examine this carefully.

Jiedu Jisheng Tang (Detoxification and Life-Sustaining Decoction)
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, shaved), Mai Dong (Ophiopogonis Radix, heart removed), Zhi Mu (Anemarrhenae Rhizoma), Huang Bai (Phellodendri Cortex), Fu Shen (Poria with Hostwood), Jin Yin Hua (Lonicerae Japonicae Flos) (each 1 qian), Hong Hua (Carthami Flos), Niu Xi (Achyranthis Bidentatae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma, raw) (each 0.5 qian).
Decoct 2 zhong of water to 0.8 zhong. Add 1 cup of Tong Bian (Child's Urine). Take before meals. If located in the fingers, remove Niu Xi and add Sheng Ma (Cimicifugae Rhizoma).
[Fang Ge]: Jiedu Jisheng Gui Yuan Xiong, Fen Hua Chai Qin Xi Mai Dong, Zhi Bai Fu Yin Hong Xi Cao, Tuojue Chuqi Fanre Gong.

Rusheng Jindao San (Sage-like Golden Knife Powder)
Song Xiang (Pini Resina) (7 liang), Sheng Bai Fan (Alumen Crude) (1.5 liang), Ku Bai Fan (Alumen Ustums) (1.5 liang).
Grind into extremely fine powder. Store in a porcelain jar. Sprinkle on the lesion when needed.
[Fang Ge]: Rusheng Jindao San Ren Shang, Xueliu Bizhi Sa Zhi Liang, Bai Fan Ku Fan Song Xiang Deng, Gong Yan Wei Mo Guan Shou Cang.

Yinyang Erqi Dan (Yin-Yang Two-Qi Pill)
Tian Men Dong (Asparagi Radix, heart removed), Mai Men Dong (Ophiopogonis Radix, heart removed), Yuan Shen (Scrophulariae Radix, soaked in water, coarse skin removed; these three are pounded into paste) (each amount specified for paste), Wu Wei Zi (Schisandrae Fructus, stir-fried), Ren Zhong Bai (Nitrinum) (raw), Huang Bai (Phellodendri Cortex) (each 1 liang), Gan Cao (Glycyrrhizae Radix et Rhizoma, raw), Ze Xie (Alismatis Rhizoma), Ku Bai Fan (Alumen Ustums), Qing Dai (Indici Folium) (each 3 qian), Bing Pian (Borneolum Syntheticum) (1 qian).
Grind each into fine powder. Mix with the Tian Men Dong paste. Add a little refined honey. Pound over a thousand times until consistency is appropriate. Form pills the size of Sophora seeds. Coat with Zhu Sha (Cinnabaris). Take 60 pills per dose. Send down with 1 wine cup of Tong Bian (Child's Urine) and 1 wine cup of Ren Ru (Human Milk) on an empty stomach. Sleep quietly for one shichen (two hours).
[Fang Ge]: Yinyang Erqi Dan Tuojue, Shen Shui Ku Gan Re Re Qi, Tian Mai Yuan Shen Gan Xie Wei, Zhong Bai Bing Fan Bai Dai Yi.

Qingshen San (Spirit-Clearing Powder)
Lu Dou Fen (Phaseoli Volgaris Semen Pulvis) (1 liang), Niu Huang (Bovis Calculus) (3 fen), Gan Cao Jie (Glycyrrhizae Radix et Rhizoma, node section) (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 take orally.
[Fang Ge]: Qingshen San Zhi Tuojue Fa, Men Luan Xin Fan Tiao Fu Jia, Dou Fen Niu Huang Gan Cao Jie, Yan Bing Bing Pian Gong Zhu Sha.

Jinli Wutu Dan (Golden Fluid Earth-Pentagon Pill)
Fu Shen (Poria with Hostwood), Hu Huang Lian (Coptidis Rhizoma var. chinensis), Wu Mei Rou (Mume Fructus pulp), Ren Zhong Huang (Hominis Siccus Stercus), Wu Wei Zi (Schisandrae Fructus) (each 1 liang), Zhu Sha (Cinnabaris), Xiong Huang (Realgar), Xiao Shi (Natrii Sulfas), Yuan Zhi (Polygalae Radix, heart removed), Shi Chang Pu (Acori Tatarinowii Rhizoma) (each 3 qian), Niu Huang (Bovis Calculus), Bing Pian (Borneolum Syntheticum) (each 1 qian).
Grind each into fine powder. Mix thoroughly and grind another thousand times. On auspicious days such as Dragon Boat Festival, Double Seventh Festival, Spring/Autumn Equinoxes, Winter/Summer Solstices, in a clean room, first pound Wu Mei Rou into paste. Mix with the powder. Add a little refined honey. Pound over a thousand times until consistency is appropriate. Form pills weighing 1 qian each. Coat with Jin Bo (Gold Foil). Take 1 pill per dose. Dissolve in 1 wine cup of Ren Ru (Human Milk) and 1 wine cup of Tong Bian (Child's Urine) according to the location of the disease. During preparation and administration, avoid exposure to women, monks/nuns, mourners, chickens, and dogs. Seal with wax for storage to preserve potency. The longer it is stored, the better the effect.
[Fang Ge]: Jinli Wutu Fu Niu Huang, Zhu Xiong Xiao Yuan Pian Shi Chang, Hu Lian Mei Rou Zhong Huang Wei, Zhuan Zhi Tuojue Fa Bei Chuang.

Cixiong Pili Huo (Female-Male Thunderbolt Fire Moxa)
Ci Huang (Orpiment), Xiong Huang (Realgar), Ding Xiang (Caryophylli Flos) (each 2 qian), She Xiang (Moschus) (1 fen).
Grind into fine powder. Use 2 qian of Qi Ai Rong (Artemisia argyi pappus). Rub the powder into the mugwort. Form pills the size of soybeans. Place on the lesion and moxibust. Continue until the tissue is scorched, regardless of itching or pain. If the toxin has already spread, place moxa cones at the edge of the redness. Pain turns to itch, itch turns to pain. Aim for a vibrant red appearance of the sore.
[Fang Ge]: Pili Huo Zhi Yin Ju Fang, Tuojue Bu Teng Jiu Geng Qiang, Ci Huang Ding She Xiong Huang Mo, Qi Ai Rong Cuo Yao Mo Liang.

Chan Su Bing (Toad Venom Cake) (See Ding Chuang Section)
Ligong Ding (Palace-Lixing Plaster) (See Zhongyang Section)
Tuoseng Gao (Tathagata Paste), Shengji Yuhong Gao (Muscle-Regenerating Jade Red Ointment) (Both See Youyang Section)