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王肯堂曰∶天蛇毒，即天蛇头，不拘何指， 赤结毒，肿痛有脓，裂开有口唇
如蛇头状，是以名焉。又名发指，属手厥阴
心包络经积热所致，虽黑色顽麻，溃烂脱指者，亦不死。（《准绳》）
陈实功曰∶天蛇毒即蛇头疔，乃心火妄动，攻注而成。其指头肿若蛇头，赤肿
痛，疼极连心；甚者寒热交作，肿痛炎上。初起宜灸，蟾酥饼膏盖。（《正宗》）
冯鲁瞻曰∶天蛇头者，手指毒疮，各随经络而生。疼痛殊甚，宜审其经络，投
以解毒和血，加以引经之药治之。（《锦囊》）
窦汉卿曰∶此证如脓未熟，不可刀开针拨，不然则 肉起发难医。
胡公弼曰∶天蛇头患久有出骨者，如初起紫黑者，必死。须割去其指，方可医
治。治同脱疽。（《青囊》）
汪省之曰∶手三阴、三阳经，亦有气血多少不同，生于手之十指，名敦疽。四
五日溃脓，可刺者生；如不溃无脓，黑色过节者，死不可治也。（《理例》）
王肯堂曰∶五指头生疽，名曰敦疽，系脏腑积热。治不可缓。（《准绳》）
又曰∶手大指疽发指头，小点如粟，渐大如豆，或如桃李，或青或紫，乍黄乍白
乍黑，或痒，或麻木不痛，或大痛澈心，此名调疽，属手太阴肺经积毒。毒盛者，宜
截去了，四日刺得血脓者生，得黑白者死。毒瓦斯攻心，呕吐不食，膨胀者死，齿缝出
血者死。（《准绳》）
朱丹溪曰∶蛇头疔在手指顶，坚硬有头，十指同，自筋骨发出，根深毒重。初
起小泡，色紫疼痛，坚硬如疔者是。
王肯堂曰∶天蛇毒，在手指顶，闷肿无头，十指同自肌肉发出，其毒稍轻。夫
手指虽各有专经，然俱兼脾经火发而成。但手指系皮肉浇薄之处，不宜艾灸，亦不宜
开早。若误灸开早，以致皮裂肉 翻出，疼痛倍增，不能速愈，慎之。
又曰∶调疽生于手大指，由肺经积热而成。初如粟豆，渐肿如李，青紫麻木，痛
痒澈心。六日刺破，出稠脓鲜血者吉；出黑血者险。若黑腐延蔓不痛者，名断指，属
逆。当如足部脱疽治法。
澄曰∶凡手指患天蛇毒，如内脓已成胀痛者，用针挑放，务须从下往上挑破，切
不可从上向下挑，否则毒传下节溃烂，俗谓戳了蛇头，蛇头往下缩也。
又曰∶凡指头溃后，切忌用力拿重，如操作用力，则 肉必出，难以速愈。足指
溃后，俱忌行走，否则亦然。
又曰∶凡慵工操作之人，指皮粗浓，每每脓已胀急，不能穿溃，常见通手化脓。凡
遇此等人，须用针向指尖上挑砭出脓，不可向下砭，如误向下砭，每每毒流下节，遂
有脱指之患，不可不知。
又曰∶凡溃后须将老皮剪去，免藏毒水，浸伤良肉。
又曰∶每见当砭不砭，脓已胀过，以致甲脱肉无，惟存筋骨，用玉红膏搽上生
肌。只有指尖难以长皮，撤消如旧，须以生肌散内加珍珠末掺上，其皮即长合矣。脚
尖不长皮，亦照此法。
澄治手指足指，溃后形如蝉蜕者，须用利剪剪去死皮，方可上药。不然，皮中
蓄有脓水难干，虽用珍珠散冀其收功，何异隔靴抓痒，决难速愈。
王肯堂说：天蛇毒，也就是天蛇头，不论发生在哪根手指上，都是赤结毒，表现为肿痛且有脓液，溃破后裂开，口唇状如蛇头，因此得名。又名发指，属于手厥阴心包络经积热所致，即使出现黑色、顽固麻木、溃烂脱指的情况，也不会致死。（《医学准绳六要》）
陈实功说：天蛇毒即蛇头疔，是心火妄动，攻注而成。其指头肿胀若蛇头状，红肿疼痛，痛极牵连心脏；严重的会出现寒热交替发作，肿痛向上炎蒸。初起时适宜艾灸，并用蟾酥饼膏覆盖。（《外科正宗》）
冯鲁瞻说：天蛇头是指手指上的毒疮，各随所属经络而生。疼痛非常剧烈，应当审查其所属经络，投以解毒和血的药物，并加入引经药进行治疗。（《外科锦囊》）
窦汉卿说：此证如果脓未成熟，不可用刀切开或用针拨动，否则会导致肌肉突起翻出，难以医治。
胡公弼说：天蛇头患病日久会有骨头排出的情况，如果初起时呈紫黑色，必定死亡。必须割去该手指，方可治疗。治疗方法同脱疽。（《青囊秘传》）
汪省之说：手三阴、手三阳经的气血多少各不相同，生于手之十指的称为敦疽。四五天溃脓，可以刺破的能生还；如果不溃破无脓，黑色蔓延过节的，死症不可治。（《外科理例》）
王肯堂说：五指头生疽，名为敦疽，系脏腑积热所致。治疗不可迟缓。（《医学准绳六要》）
又说：手大拇指疽发于指头，初起小点如粟米，逐渐增大如豆，或如桃李，颜色或青或紫，忽黄忽白忽黑，或痒，或麻木不痛，或大痛彻心，这名叫调疽，属于手太阴肺经积毒。毒盛者，宜截除手指，四天内刺出带血的脓液的能生还，刺出黑白颜色的会死亡。毒瓦斯攻心，呕吐不能进食，腹部膨胀的会死亡，齿缝出血的也会死亡。（《医学准绳六要》）
朱丹溪说：蛇头疔在手指顶端，坚硬有头，十指皆同，自筋骨发出，根深毒重。初起为小泡，色紫疼痛，坚硬如疔疮的是此类。
王肯堂说：天蛇毒，在手指顶端，闷肿无头，十指皆同，自肌肉发出，其毒稍轻。虽然手指各有专属经络，但都兼有脾经之火引发而成。只是手指是皮肉较薄的地方，不宜艾灸，也不宜过早切开。如果误灸或过早切开，导致皮肤破裂、肌肉翻出，疼痛倍增，不能迅速痊愈，务必谨慎。
又说：调疽生于手大拇指，由肺经积热而成。初起如粟豆，逐渐肿胀如李子，青紫麻木，痛痒彻心。第六天刺破，流出稠脓鲜血的为吉兆；流出黑血的为险症。如果黑腐蔓延且不痛的，名叫断指，属于逆证。应当参照足部脱疽的治疗方法。
顾世澄说：凡是手指患天蛇毒，如果内部脓已成且胀痛，用针挑放时，务必从下往上挑破，切不可从上向下挑，否则毒气会传导至下节导致溃烂，俗话叫“戳了蛇头，蛇头往下缩”。
又说：凡是手指头溃烂后，切忌用力拿重物，如果操作用力，则肌肉必会翻出，难以迅速痊愈。脚趾溃烂后，也都忌讳行走，否则也会如此。
又说：凡是做工操作的人，手指皮厚粗糙，常常脓已胀急，但不能穿溃，常见整个手化脓。凡是遇到这种人，必须用针向指尖上挑砭出脓，不可向下砭，如果误向下砭，常常导致毒气流窜下节，于是有脱指的祸患，不可不知道。
又说：常见到应当砭刺却不砭刺，脓已胀溢过多，以致指甲脱落、肌肉腐烂无存，只存筋骨，用玉红膏涂抹以生肌。只有指尖难以长皮，消退如旧，必须在生肌散内加入珍珠末掺敷，皮肤就能生长愈合了。脚尖不长皮，也照此法处理。
顾世澄治疗手指脚趾，溃烂后形状如蝉蜕的，必须用利剪剪去死皮，方可上药。不然，皮中蓄积脓水难干，虽然使用珍珠散希望其收功，何异于隔靴抓痒，决难迅速痊愈。
Heavenly Snake Poison (Tianshe Du)
Wang Kentang stated: Heavenly Snake Poison, also known as Heavenly Snake Head, can occur on any finger. It is a type of red knot toxin characterized by swelling, pain, and pus formation. Upon ulceration, it splits open with lips resembling a snake's head, hence the name. It is also called "Fa Zhi" (Finger Eruption), caused by accumulated heat in the Pericardium Meridian of Hand-Jueyin. Even if it presents with blackness, stubborn numbness, or ulceration leading to finger loss, it is not fatal. (*Zhunsheng*)
Chen Shigong stated: Heavenly Snake Poison is equivalent to Snake-Head Ding (Snake-Head Carbuncle). It arises from reckless movement of Heart Fire attacking and injecting into the area. The fingertip swells like a snake's head, becoming red, swollen, and painful, with extreme pain radiating to the heart. In severe cases, alternating chills and fever occur, with swelling and pain flaring upwards. At the initial stage, moxibustion is suitable, covered with Chan Su Bing Gao (Toad Venom Cake Plaster). (*Zhengzong*)
Feng Luzhan stated: Heavenly Snake Head refers to toxic sores on the fingers, arising according to their respective meridians. The pain is extremely severe. One must examine the affected meridian and administer detoxifying and blood-nourishing herbs, supplemented by guide drugs to direct the action to the specific meridian. (*Jinnang*)
Dou Hanqing stated: If pus has not yet matured in this condition, one must not cut it open with a knife or probe it with a needle; otherwise, the flesh will protrude and become difficult to treat.
Hu Gongbi stated: In prolonged cases of Heavenly Snake Head, bone may be expelled. If the lesion appears purple-black at the onset, it is invariably fatal. The finger must be amputated for treatment to proceed. The treatment method is the same as that for Tuo Ju (Gangrene of the Extremities). (*Qingnang*)
Wang Shengzhi stated: The three Yin and three Yang meridians of the hand have varying amounts of Qi and Blood. Lesions occurring on the ten fingers are named Dun Ju. If they ulcerate and discharge pus after four to five days and can be punctured, the patient will survive. If they do not ulcerate, lack pus, or show blackness spreading past the joint, it is an incurable fatal condition. (*Lili*)
Wang Kentang stated: Gangrene arising on the tips of the five fingers is named Dun Ju, resulting from accumulated heat in the Zang-Fu organs. Treatment must not be delayed. (*Zhunsheng*)
He further stated: When gangrene erupts on the tip of the thumb, it begins as a small point like millet, gradually enlarging to the size of a bean, plum, or peach. The color may be green, purple, yellow, white, or black intermittently. Symptoms may include itching, numbness without pain, or excruciating pain penetrating the heart. This is called Diao Ju, belonging to accumulated toxins in the Lung Meridian of Hand-Taiyin. If the toxin is excessive, amputation of the finger is advisable. If bloody pus is obtained upon puncturing within four days, the patient survives; if black or white discharge occurs, death ensues. If toxins attack the heart causing vomiting, anorexia, and abdominal distension, or if bleeding occurs from the gum margins, death is inevitable. (*Zhunsheng*)
Zhu Danxi stated: Snake-Head Ding located at the tip of the finger is hard with a distinct head, common to all ten fingers. It originates from the tendons and bones, with deep roots and heavy toxicity. Initially presenting as small blisters, it is characterized by purple discoloration, pain, and hardness resembling a Ding carbuncle.
Wang Kentang stated: Heavenly Snake Poison, located at the tip of the finger, presents as stifling swelling without a distinct head, common to all ten fingers. It originates from the muscles, and its toxicity is slightly milder. Although each finger has its dedicated meridian, these lesions often arise from the fire of the Spleen Meridian combined with other factors. Since the fingers are areas where skin and flesh are thin, moxibustion is contraindicated, as is early incision. Mistaken moxibustion or premature incision can cause skin rupture and muscle eversion, doubling the pain and preventing rapid healing. Caution is essential.
He further stated: Diao Ju arises on the thumb due to accumulated heat in the Lung Meridian. It starts like a millet grain or bean, gradually swelling to the size of a plum, with green-purple discoloration, numbness, and pain/itching penetrating the heart. Puncturing on the sixth day yielding thick pus and fresh blood is auspicious; yielding black blood is dangerous. If black necrosis spreads without pain, it is named Duan Zhi (Severed Finger) and is considered a adverse prognosis. It should be treated according to the methods for foot gangrene.
Gu Shicheng stated: For any finger suffering from Heavenly Snake Poison, if internal pus has formed causing distending pain, use a needle to drain it. One must always prick from below upwards. Never prick from top to bottom, otherwise the toxin will transmit to the lower segment causing ulceration. This is colloquially referred to as "poking the snake's head, causing the snake to shrink downwards."
He further stated: After a fingertip ulcerates, one must strictly avoid lifting heavy objects. If force is applied during work, the flesh will evert, making rapid healing difficult. Similarly, after toe ulcers form, walking must be avoided, or similar complications will arise.
He further stated: Workers whose finger skin is thick and rough often experience situations where pus becomes distended and urgent but cannot penetrate naturally, leading to suppuration of the entire hand. For such individuals, one must use a needle to pricking/draining pus from the fingertip upwards. Do not prick downwards. Mistaken downward pricking often causes toxin flow to the lower segment, leading to finger loss. This must be known.
He further stated: After ulceration, old skin must be trimmed away to prevent it from harboring toxic fluids that could damage healthy flesh.
He further stated: I often see cases where pricking was neglected until pus over-distended, resulting in nail loss and flesh rot leaving only tendons and bones. Applying Yu Hong Gao (Jade Red Ointment) promotes tissue regeneration. However, fingertips often fail to regenerate skin, remaining receded as before. Adding Pearl Powder (Zhenzhu Mo) to Sheng Ji San (Generate Flesh Powder) allows the skin to grow and heal. The same method applies to toes.
When treating fingers or toes where the ulcerated appearance resembles a cicada slough, Gu Shicheng advised using sharp scissors to remove dead skin before applying medication. Otherwise, pus fluid trapped under the skin will remain un-dried. Even with the use of Zhenzhu San (Pearl Powder), hoping for resolution, it is akin to scratching an itch through a boot—rapid healing is impossible.