（丁生手足指。或足溃而自脱。故名脱疽。有发于手指者。名蛀节。丁重者
痛者。除湿攻毒。更隔蒜灸至不痛。
痛或不痛者。隔蒜灸。更用解毒药。若色黑急割去。速服补剂。庶可救。黑延上者不
色赤 痛者。托里消毒更兼灸。
作渴者。滋阴降火。色黑者不治。
一人足指患此。 痛色赤发热。隔蒜灸之。更以人参败毒散去桔梗。加金银花、白芷、大黄
二剂痛止。又十宣散去桔梗、官桂。加天花粉、金银花。数剂而平。（此凭症也。）
一人年逾四十。左足大指赤肿 痛。此脾经积毒下注而然。名曰脱疽。喜色赤而肿。以
败毒散去人参、桔梗。加金银花、白芷、大黄二剂。更以栝蒌金银花、甘草节四剂顿退。再
以十宣散去桔梗、桂。加金银花、防己数剂愈。
一人患此。色紫赤不痛。隔蒜灸五十余壮。尚不痛。又明灸百壮方知。乃以败毒散加金
银花、白芷。数剂而愈。
一膏粱年逾五十亦患此。色紫黑。脚 痛。孙真人曰。脱疽之症。急斩之去。毒延腹必
。色黑不痛者亦不治。喜其饮食如故。动息自宁。为疮善症。遂以连翘败毒散（二六）六剂。
更以金银花、栝蒌、甘草节二十余剂。患指溃脱。更以芎、归、生、 、连翘、金银花、白
芷二十余剂而愈。
次年忽发渴。服生津等药愈盛。用八味丸而止。
大抵此症。皆由膏粱浓味。或房劳太过。丹石补药所致。其发于指。微赤而痛可治。治
愈。急斩去之。庶可保。否则不治。色紫黑。或发于脚背亦不治。或先渴而后发。或先发而
后渴。色紫赤不痛。此精气已竭。决不可治。
一刍荛左足指患一泡。麻木色赤。次日指黑。五日连足黑冷。不知疼痛。脉沉细。此脾
毒所致。进飞龙夺命丹一服。翌日令割去足上死黑肉。割后骨始痛。可救治。以十全大补汤
而愈。（此因症肉黑知为毒盛。不在于脉也。）
盖死肉乃毒瓦斯盛拒截荣气所致。况至阴之下。血气难达。经曰。风淫末疾是也。向若攻
伐之。则邪气乘虚上侵。必不救矣。
一人足指患之大痛。色赤而肿。隔蒜灸之痛止。以人参败毒散去桔梗。加金银花、白芷
。大黄而溃。更以仙方活命饮而痊。（此凭症也。）
此症情势虽小。其恶甚大。须隔蒜灸之。不痛者宜明灸之。庶得少杀其毒。此症因膏粱
浓味酒
渴者。皆肾水涸、不能制火故也。初发而色黑者不治。赤者水未涸尚可。若失解其毒。以致
肉死色黑者。急斩去之。缓则黑延上足必死。而患不问肿溃。惟隔蒜灸有效。亦有色赤作痛
溃者。元气未脱易治。夫至阴之下。血气难到。毒易腐肉。药力又不易到。况所用皆攻毒之
药。未免先干肠胃。又不能攻敌其毒。不若隔蒜灸。并割去。最为良法。孙真人云。在指则
截。在肉则割去。即此意也。
一人足指患之。色黑不痛。令明灸三十余壮而痛。喜饮食如常。予谓急割去之。速服补
剂。彼不信。果延上。遂致不救。
一人脚背患之。色黯而不肿痛。烦躁大渴。尺脉大而涩。此精气已绝。不治。后殁。
又有手指患此。色黑不痛。其指已死。予欲斩去。速服补药。恐黑上臂不治。彼不信。
另服败毒药手竟黑。遂不救。
一人足指患之。色紫不痛。隔蒜灸五十余壮。尚不知痛。又明灸百壮始痛。更投仙方活
命饮四剂。乃以托里药溃脱而愈。（此凭症也。）
一人脚背患此。赤肿作痛。隔蒜灸三十余壮痛止。以仙方活命饮四剂而溃。更以托里消
毒药而愈。（此凭症也。）
一人足指患之。色赤 痛。作渴。隔蒜灸数壮。以仙方活命饮三剂而溃。更服托里药。
及加减八味丸溃脱而愈。
一妇修伤次指。成脓不溃。 痛至手。误敷冷药。以致通溃。饮食少思。彼为毒瓦斯内攻
脉沉细。此痛伤胃气而然。遂刺之。服六君子加藿香、当归。食进。更以八珍汤加黄 。白
芷。桔梗。月余而愈。（此凭症脉也。）
一人伤拇指。色紫不痛。服托里药。及灸五十余壮。作痛。溃脓而愈。（此凭症也。）
一幼女因冻伤两足。至春发溃。指俱坏。令取之。服大补药而愈。（此凭症也。）
一女患嵌甲伤指。年余不愈。日出脓数滴。予谓足大指乃脾经发源之所。宜灸患处。使
瘀肉去。阳气至。疮口自合。否则不治。彼惑之。不早治。后变劳症而殁。
盖至阴之下。血气难到。女人患此。多因扎缚。致血脉不通。或被风邪所袭。则无血气
。遂成死肉。惟当壮脾胃。行经络。生血气则愈。有成破伤风。以致牙关紧急。口眼 邪者
。先玉真散（百二三）一二服。然后投以生血通经则可。
（病变发生于手足指部。有的足趾溃烂后自行脱落，因此称为脱疽。有的发病于手指部位，称为蛀节。如果病情严重且疼痛的，采用除湿攻毒的方法治疗，并隔蒜灸直至不再疼痛。）
（如果疼痛或不疼痛的，进行隔蒜灸，同时使用解毒药物。如果患处颜色发黑，必须紧急切除，迅速服用补益剂，才可能挽救生命。如果黑色向上蔓延，则无法治愈。）
（如果患处颜色发红、疼痛的，采用托里消毒法，并结合艾灸治疗。）
（如果感到口渴的，采用滋阴降火的方法。如果患处颜色发黑的，属于不治之症。）
（有一例患者足趾患此病，患处色红、疼痛、发热。采用隔蒜灸治疗，同时用人参败毒散去掉桔梗，加入金银花、白芷、大黄，服用两剂后疼痛停止。又用十宣散去掉桔梗、官桂，加入天花粉、金银花，服用数剂后痊愈。（这是根据症状辨证施治。））
（有一位年过四十的患者，左足大脚趾红肿疼痛。这是脾经积毒下注所致，名为脱疽。喜欢患处色红而肿，用败毒散去掉人参、桔梗，加入金银花、白芷、大黄，服用两剂。再用栝蒌、金银花、甘草节，服用四剂后症状顿退。随后用十宣散去掉桔梗、桂枝，加入金银花、防己，服用数剂后痊愈。）
（有一位患者患此病，患处色紫赤但不痛。隔蒜灸五十多壮，仍然不痛。又直接艾灸一百壮后才感到疼痛。于是用败毒散加入金银花、白芷，服用数剂后痊愈。）
（一位常年食用肥甘厚味的五十多岁患者也患此病，患处色紫黑，脚部疼痛。孙真人说：脱疽的症状，必须紧急截除，如果毒素蔓延至腹部必然死亡。患处色黑且不痛的也是不治之症。庆幸的是该患者饮食正常，动静安宁，属于疮疡中的善证。于是用连翘败毒散六剂，再用金银花、栝蒌、甘草节二十多剂，患指溃烂脱落，接着用川芎、当归、生地黄、黄芪、连翘、金银花、白芷二十多剂后痊愈。）
（次年突然发作口渴，服用生津类药物后反而加重，用八味丸才止住。）
（大抵此类病症，都是由长期食用肥甘厚味，或房劳过度，以及服用丹石类补药所导致。其发病于手指，微红而痛的可以治疗；治愈后，必须紧急截除，才可以保全性命，否则无法治愈。如果患处色紫黑，或者发病于脚背，也是不治之症。或者先口渴而后发病，或者先发病而后口渴，患处色紫赤且不痛，这是精气已经枯竭，绝对不可治愈。）
（有一位平民左足趾患了一个水泡，麻木且色红。第二天脚趾变黑，第五天整个脚都变黑冰冷，不知疼痛，脉象沉细。这是脾毒所致。服用一服飞龙夺命丹，第二天令其割去足上死黑肉，割完后骨头才开始痛，还可以救治。用十全大补汤治疗后痊愈。（这是因为看到肉黑知道是毒盛，不在于脉象。））
（大概死肉是由于毒气旺盛，拒绝荣气运行所致。况且位于至阴的下肢，气血难以到达。经书说：风邪淫溢会导致四肢末端的疾病。先前如果只靠药物攻伐，那么邪气会乘虚上侵，必然无法挽救。）
（有一位患者足趾患病，剧烈疼痛，色红而肿。隔蒜灸后疼痛停止。用人参败毒散去掉桔梗，加入金银花、白芷、大黄，使脓液溃破。再用仙方活命饮治疗而痊愈。（这是根据症状辨证施治。））
（此症情势虽然看似微小，但其凶险程度很大。必须隔蒜灸治疗，如果不痛的适宜直接艾灸，才能稍微减轻毒性。此症因食用肥甘厚味、饮酒过多引起。感到口渴的，都是肾水枯竭、不能制约火气的缘故。初发时患处色黑的无法治愈，色红的说明肾水未枯竭尚可治疗。如果失于解除毒性，以致肌肉坏死色黑的，必须紧急截除，拖延下去黑色蔓延至足部必然死亡。无论患处是否肿胀溃烂，只有隔蒜灸有效。也有色红作痛并溃烂的，元气未脱容易治疗。至于至阴的下肢，气血难以到达，毒气容易腐蚀肌肉，药力又不易到达。况且所使用的都是攻毒的药物，难免先损伤肠胃，又不能彻底攻克敌对的毒气，不如隔蒜灸并割去死肉，是最为良策。孙真人说：在手指就截断，在肌肉就割去，就是这个意思。）
（有一位患者足趾患病，色黑不痛。命令直接艾灸三十多壮后才感到疼痛。庆幸的是饮食如常，我说是急迫切除，迅速服用补益剂。他不相信，果然黑色向上蔓延，最终导致无法挽救。）
（有一位患者脚背患病，色暗而不肿痛，烦躁大渴，尺脉大而涩。这是精气已绝，无法治愈，后来死亡。）
（又有手指患此病的，色黑不痛，手指已经死亡。我想将其斩去，迅速服用补药，恐怕黑色蔓延至手臂就无法治愈了。他不相信，另外服用败毒药物，手部竟然全黑，最终无法挽救。）
（有一位患者足趾患病，色紫不痛。隔蒜灸五十多壮，仍然不知道疼痛。又直接艾灸一百壮才感到疼痛。再投以仙方活命饮四剂，然后用托里药使其溃脱而痊愈。（这是根据症状辨证施治。））
（有一位患者脚背患此病，赤肿作痛。隔蒜灸三十多壮后疼痛停止。用仙方活命饮四剂后溃脓。再用托里消毒药治疗而痊愈。（这是根据症状辨证施治。））
（有一位患者足趾患病，色红疼痛，感到口渴。隔蒜灸数壮，用仙方活命饮三剂后溃脓。再服用托里药，以及加减八味丸，待溃脱后痊愈。）
（一位妇女修治伤了指头次指，成脓但不溃破，疼痛放射至手部。误敷冷药，以致全面溃烂，饮食减少思食，脉象沉细。这是疼痛损伤了胃气所致。于是刺破排脓，服用六君子汤加藿香、当归，食欲增进，再用八珍汤加黄芪、白芷、桔梗，月余后痊愈。（这是根据症状和脉象辨证施治。））
（有一位患者伤及拇指，色紫不痛。服用托里药，并灸五十多壮，开始疼痛，溃脓后痊愈。（这是根据症状辨证施治。））
（一名幼女因冻伤双脚，到春天发作溃烂，手指全部坏死，令其去除坏死部分，服用大补药后痊愈。（这是根据症状辨证施治。））
（一名女子患嵌甲伤及手指，一年多不愈，每天流出脓液几滴。我说足大指是脾经发源的地方，适宜灸患处，使瘀肉去除，阳气到达，疮口自然愈合，否则无法治愈。她听信了迷惑之言，没有及早治疗，后来变成劳症而死。）
（大概至阴的下肢，气血难以到达。女性患此病，多因扎缚过紧，导致血脉不通，或被风邪侵袭，则无血气滋养，遂成死肉。只应当强壮脾胃，疏通经络，生发血气才能痊愈。如果有发展成破伤风的，以致牙关紧急、口眼歪斜的，先服用玉真散一二服，然后投以生血通经的药物则可以。）
(Lesion occurs on the fingers or toes of the hands and feet. Some toes ulcerate and fall off spontaneously, hence the name Tuo Ju (Falling-off Gangrene). Some occur on the fingers, called Zhu Jie (Moth-eaten Joint). If the condition is severe and painful, employ methods to dispel dampness and attack toxins, combined with Garlic-separated Moxibustion until the pain ceases.)
(Whether painful or not, perform Garlic-separated Moxibustion and use detoxifying herbs. If the tissue turns black, urgent amputation is required, followed by rapid administration of tonic formulas to potentially save life. If the blackness spreads upward, it is incurable.)
(If the lesion is red and painful, employ the method of supporting the interior and eliminating toxins, combined with moxibustion.)
(If thirst is present, employ nourishing yin and descending fire methods. If the tissue turns black, it is incurable.)
(A case: A patient suffered from this disease in the toe. The area was red, painful, and hot. Garlic-separated Moxibustion was applied. Ren Shen Bai Du San (Ginseng Decoction for Overcoming Toxicity), without Jie Geng (Platycodon Root), plus Jin Yin Hua (Honeysuckle Flower), Bai Zhi (Angelica Dahurica Root), and Da Huang (Rhubarb Root) were administered for two doses, stopping the pain. Then, Shi Xuan San (Ten Acupoints Powder), without Jie Geng and Guan Gui (Cinnamon Twig), plus Tian Hua Fen (Trichosanthes Root) and Jin Yin Hua were administered for several doses, leading to recovery. (This treatment was based on symptoms.))
(A case: A patient over forty years old had a red, swollen, and painful left big toe. This was caused by accumulated toxicity in the Spleen meridian sinking downward, named Tuo Ju. Since the area was red and swollen, Bai Du San was used, removing Ren Shen and Jie Geng, adding Jin Yin Hua, Bai Zhi, and Da Huang for two doses. Then, Gua Lou (Trichosanthes Fruit), Jin Yin Hua, and Gan Cao Jie (Licorice Knot) were used for four doses, causing sudden relief. Subsequently, Shi Xuan San, removing Jie Geng and Gui Zhi (Cinnamon Twig), adding Jin Yin Hua and Fang Ji (Stephania Root) was administered for several doses, resulting in cure.)
(A case: A patient suffered from this disease with purple-red discoloration but no pain. Fifty-plus moxa cones were applied via Garlic-separated Moxibustion, yet still no pain. Direct Moxibustion of one hundred cones was then applied before pain was felt. Bai Du San was then used, adding Jin Yin Hua and Bai Zhi, administered for several doses, leading to cure.)
(A case: A man over fifty who frequently consumed rich foods also suffered from this disease. The area was purple-black, and the foot was painful. Sun Simiao stated: For Tuo Ju, urgent amputation is necessary; if toxicity spreads to the abdomen, death is inevitable. Lesions that are black and painless are also incurable. Fortunately, the patient's diet and activity remained normal, indicating a favorable prognosis for sores. Lian Qiao Bai Du San (Forsythia Decoction for Overcoming Toxicity) was administered for six doses, followed by Jin Yin Hua, Gua Lou, and Gan Cao Jie for over twenty doses. The affected finger ulcerated and fell off. Finally, Xiong (Ligusticum Chuanxiong Rhizome), Dang Gui (Angelica Sinensis Root), Sheng Di Huang (Rehmannia Root), Huang Qi (Astragalus Root), Lian Qiao (Forsythia Fruit), Jin Yin Hua, and Bai Zhi were administered for over twenty doses, leading to recovery.)
(The following year, sudden thirst occurred. Taking fluids-generating herbs worsened it; Ba Wei Wan (Eight-Ingredient Pill) stopped it.)
(In general, this disease is caused by long-term consumption of rich and greasy foods, excessive sexual activity, or the use of cinnabar and stone tonics. Lesions on the fingers that are slightly red and painful are treatable. After healing, urgent amputation is required to preserve life; otherwise, it is incurable. Lesions that are purple-black, or those occurring on the dorsum of the foot, are incurable. Thirst preceding the onset, or onset preceding thirst, with purple-red discoloration and no pain, indicates exhaustion of essence and qi, which is absolutely incurable.)
(A case: A commoner had a blister on the left little 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. This was caused by spleen toxicity. One dose of Fei Long Duo Ming Dan (Flying Dragon Life-Snatching Pill) was administered. The next day, dead black flesh on the foot was cut off. Bone pain began after cutting, indicating salvageability. Quan Sheng Da Bu Tang (Complete Great Tonifying Decoction) led to recovery. (The diagnosis relied on the black flesh indicating severe toxicity, rather than the pulse.))
(Dead flesh is caused by abundant toxic qi rejecting the flow of Ying Qi (Nutritive Qi). Moreover, in the lower extremities, considered the "extreme yin," blood and qi are difficult to reach. The Classics state: "Wind excess leads to diseases of the extremities." Previously, if only attacking drugs were used, evil qi would invade due to deficiency, making rescue impossible.)
(A case: A patient suffered severe pain in the toe, with redness and swelling. Garlic-separated Moxibustion stopped the pain. Ren Shen Bai Du San, without Jie Geng, plus Jin Yin Hua, Bai Zhi, and Da Huang, promoted suppuration. Xian Fang Huo Ming Yin (Immortal Formula for Preserving Life) led to recovery. (This treatment was based on symptoms.))
(Although the local manifestation seems minor, the malignancy is great. Garlic-separated Moxibustion is essential. Painless lesions should undergo direct Moxibustion to slightly reduce toxicity. This disease arises from rich foods, alcohol, etc. Thirst indicates depletion of Kidney Water failing to control Fire. Initial blackness is incurable; redness indicates non-depleted water and is treatable. If toxicity is not resolved, leading to necrosis and blackness, urgent amputation is required. Delay allows blackness to spread to the foot, causing death. Regardless of swelling or suppuration, Garlic-separated Moxibustion is effective. Red, painful, suppurating lesions with intact Yuan Qi (Original Qi) are easy to treat. In the extreme yin lower limbs, blood and qi rarely reach; toxin easily corrupts flesh, and drug efficacy is hard to achieve. Attacking drugs often damage the stomach and intestines first without defeating the toxin. Therefore, Garlic-separated Moxibustion combined with excision is the best method. Sun Simiao said: Amputate if on the finger, excise if on the muscle; this is the meaning.)
(A case: A patient had a black, painless toe. Direct Moxibustion of thirty-plus cones induced pain. Diet was normal. I advised urgent excision and rapid tonic intake. He refused. Blackness spread upward, leading to death.)
(A case: A patient had a dark, non-swollen, non-painful lesion on the dorsum of the foot, with irritability and intense thirst. The Chi (Kidney) pulse was large and choppy. Essence and qi were exhausted; incurable. The patient died later.)
(Another case: A black, painless finger was already dead. I proposed amputation and rapid tonic intake, fearing blackness spreading to the arm. He refused, taking detoxifying herbs instead. The hand turned completely black, leading to death.)
(A case: A patient had a purple, painless toe. Garlic-separated Moxibustion of fifty-plus cones induced no pain. Direct Moxibustion of one hundred cones induced pain. Xian Fang Huo Ming Yin was administered for four doses, followed by interior-supporting herbs to promote suppuration and recovery. (This treatment was based on symptoms.))
(A case: A patient had a red, swollen, painful lesion on the dorsum of the foot. Garlic-separated Moxibustion of thirty-plus cones stopped the pain. Xian Fang Huo Ming Yin was administered for four doses to promote suppuration. Interior-supporting and toxin-eliminating herbs led to recovery. (This treatment was based on symptoms.))
(A case: A patient had a red, painful, thirsty toe. Garlic-separated Moxibustion of several cones was applied. Xian Fang Huo Ming Yin was administered for three doses to promote suppuration. Interior-supporting herbs and Jia Jian Ba Wei Wan (Modified Eight-Ingredient Pill) were taken until suppuration and recovery occurred.)
(A woman injured her second toe. Pus formed but did not drain. Pain radiated to the hand. Cold herbs were mistakenly applied, causing widespread suppuration. Appetite decreased. Pulse was deep and fine. Pain damaged Stomach Qi. Incision was performed. Liu Jun Zi Tang (Six-Gentlemen Decoction) with Huo Xiang (Pogostemon Herb) and Dang Gui was administered, improving appetite. Ba Zhen Tang (Eight-Treasure Decoction) with Huang Qi, Bai Zhi, and Jie Geng was administered for over a month, leading to recovery. (This treatment was based on symptoms and pulse.))
(A case: A patient injured the thumb, appearing purple and painless. Interior-supporting herbs were taken, and moxibustion was applied for fifty-plus cones. Pain ensued, pus drained, and recovery occurred. (This treatment was based on symptoms.))
(A young girl froze both feet. In spring, they ulcerated, and all toes became necrotic. Necrotic parts were removed. Large tonifying herbs led to recovery. (This treatment was based on symptoms.))
(A woman suffered from an ingrown nail injuring the toe for over a year, draining pus daily. I stated that the big toe is the source of the Spleen meridian. Moxibustion on the lesion is suitable to remove stasis, allow Yang Qi to arrive, and close the wound naturally; otherwise, it is incurable. She ignored this advice. Later, she developed Consumption Disease (Lao Zheng) and died.)
(In the extreme yin lower limbs, blood and qi rarely reach. Women suffering from this often have tight bindings obstructing blood vessels, or wind-cold invasion, leading to lack of blood and qi nourishment and subsequent necrosis. Strengthening the Spleen and Stomach, unblocking meridians, and generating blood and qi are required for cure. If complicated by Wind Trauma (Po Shang Feng) causing trismus and facial deviation, Yu Zhen San (Jade True Powder) should be taken first, followed by blood-nourishing and meridian-unblocking herbs.)