蜣螂蛀由痰气凝，指节坚肿蝉肚形，初起不疼久方痛，溃久脓清痨病成。
【注】此证多生于体虚人手指骨节，由湿痰、寒气凝滞而成。初起不红不热不痛，渐
次肿坚，形如蝉肚，屈伸艰难，日久方知木痛。初肿时，宜先服六君子汤，益气、除湿、
化痰；外以离宫锭姜汁磨敷，或兼阳燧锭于坚痛处灸之自消。若失于调治，肿处渐渐腐
烂，脓如清水，淋沥不已，肿仍不消。然在骨节之处，溃久大泄气血，每成疮痨之证，宜
预服人参养荣汤补之，外贴蟾酥饼子，陀僧
膏益之。遇壮年人，如法治之可愈；若年老及虚羸之人，不能收功。
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六君子汤（即香砂六君子汤减去藿香、砂仁。见肿疡门）
离宫锭（见肿疡门）
阳燧锭（见首卷烙法）
人参养荣汤 陀僧膏（俱见溃疡门）
蟾酥饼（见疔疮门）
疮每发指掌中，两手对生茱萸形，风湿痒痛津汁水，时好时发久生虫。
【注】此证生于指掌之中，形如茱萸，两手相对而生。亦有成攒者，起黄白脓庖，痒
痛无时，破津黄汁水，时好时发，极其疲顽，由风湿客于肤腠而成，以润肌膏擦之。若日
久不愈，其痒倍增，内必生虫，治以杀虫为主，用藜芦膏擦之甚效。忌动风、鸡鹅、鱼
腥等物。
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藜芦膏
藜芦 苦参（各一两）
猪脂油八两，将二味炸枯，滤去渣；入松香一两，溶化开，离火，再加枯矾末、雄
黄末各一两，搅匀，候温涂之，以痊为度。
【方歌】藜芦膏用苦参良，脂油炸滤入松香，再加枯矾雄黄搅，杀虫止痒抹 疮。
润肌膏（见头部白屑风）
【蜣螂蛀】此病由痰湿与气机郁结所致，表现为指节部位坚硬肿胀，形状如同蝉的腹部。初期不疼痛，日久才出现疼痛；溃破后流出清稀脓液，久治不愈则形成“疮痨”（慢性消耗性溃疡）。
【注】这种病症多发生于体质虚弱者的手指骨节处，是由湿痰和寒气凝滞阻塞经络而形成的。初起时局部不红、不热、不痛，逐渐变得肿胀坚硬，形状像蝉肚一样，导致手指屈伸困难，过了很久才知道有麻木疼痛感。在刚开始肿胀时，适宜先服用六君子汤（Six Junzi Decoction），以益气健脾、祛除湿邪、化解痰浊；外用离宫锭（Ligong Ding）用姜汁磨开后敷贴，或者配合使用阳燧锭（Yangsui Ding）在坚硬疼痛的部位进行灸疗，可使肿块自行消散。如果延误治疗，肿胀部位逐渐腐烂，流出的脓液像清水一样，淋漓不尽，肿胀依然不消退。然而由于病变位于骨节之处，溃烂日久会大量耗伤气血，往往演变成“疮痨”之证，此时宜预先服用人参养荣汤（Renshen Yangrong Tang）进行补益，外贴蟾酥饼（Chansu Bing），并辅以陀僧膏（Tuoseng Gao）增强疗效。若是青壮年患者，按上述方法治疗可以痊愈；若是年老体弱或极度消瘦的人，则难以治愈。
【方剂说明】
六君子汤：即香砂六君子汤减去藿香、砂仁。（详见肿疡门章节）
离宫锭：（详见肿疡门章节）
阳燧锭：（详见首卷烙法章节）
人参养荣汤、陀僧膏：（均详见溃疡门章节）
蟾酥饼：（详见疔疮门章节）
【疮】此病常发于手指和手掌中，双手对称生长，形状如同茱萸果实。伴有风湿引起的瘙痒疼痛，渗出黄白色津液，病情时好时坏，日久会在患处生出虫蚀感。
【注】这种病症生于手指和手掌之中，形状像茱萸，双手相对而生。也有聚集成簇的情况，起初出现黄白色的脓疱，瘙痒疼痛无定时，破溃后流出黄色汁水，病情反复发作，极其顽固难愈。这是由风湿之邪侵袭皮肤腠理所致，可用润肌膏（Runji Gao）涂抹擦拭。如果日久不愈，瘙痒感加倍增加，内部必然滋生“虫”（此处指代微生物感染或寄生虫引起的病理变化），治疗应以杀虫为主，使用藜芦膏（Lilu Gao）涂抹效果显著。忌食动风食物以及鸡肉、鹅肉、鱼类等腥膻之物。
【方剂制作】
藜芦膏配方：
藜芦、苦参（各一两）
猪脂油八两，将上述两味药材炸至枯焦，滤去药渣；加入松香一两，加热溶化，离火后，再加入枯矾末、雄黄末各一两，搅拌均匀，待温度适宜时涂抹患处，直至痊愈为止。
[Qianglang Zhu (Dung Beetle Bore)] This condition arises from the accumulation of phlegm-dampness and qi stagnation. It manifests as hard swelling of the finger joints, resembling the abdomen of a cicada. Initially painless, it becomes painful after a long duration; if ulcerated, it discharges clear pus, and prolonged non-healing leads to "chuang lao" (chronic consumptive ulcer).
[Note] This syndrome typically occurs in the finger joints of individuals with weak constitutions, caused by the stagnation of damp-phlegm and cold qi. At the onset, there is no redness, heat, or pain. Gradually, it becomes swollen and hard, shaped like a cicada's abdomen, making flexion and extension difficult. Only after a long time does numbness and pain become apparent. During the initial swelling phase, it is appropriate to first administer Liujunzi Tang (Six Gentlemen Decoction) to tonify qi, eliminate dampness, and resolve phlegm. Externally, Ligong Ding (Palace Separation Plaster) should be ground with ginger juice and applied, or combined with the use of Yangsui Ding (Sun Warming Plaster) for moxibustion on the hard and painful areas, which can cause the swelling to dissipate spontaneously. If treatment is neglected, the swollen area gradually becomes necrotic, discharging clear fluid continuously, while the swelling persists. Since the lesion is located at the joint, prolonged ulceration severely depletes qi and blood, often evolving into "chuang lao" (chronic consumptive ulcer). In this stage, Renshen Yangrong Tang (Ginseng Nourishing Harmony Decoction) should be taken prophylactically to tonify the body, and Chansu Bing (Toad Venom Cake) should be applied externally, supplemented with Tuoseng Gao (Monk Plaster). Young adults can be cured using this method; however, elderly patients or those who are emaciated and weak may not achieve recovery.
[Formula Notes]
Liujunzi Tang: Refers to Xiangsha Liujunzi Tang minus Huoxiang and Sharen. (See Chapter on Ulcerative Diseases)
Ligong Ding: (See Chapter on Ulcerative Diseases)
Yangsui Ding: (See First Volume, Moxibustion Methods)
Renshen Yangrong Tang, Tuoseng Gao: (Both see Chapter on Ulcerated Diseases)
Chansu Bing: (See Chapter on Carbuncles)
[Chuang (Ulcer/Eczema)] This condition frequently occurs in the fingers and palms, appearing symmetrically on both hands, resembling the fruit of the cornel tree. It is accompanied by wind-damp induced itching and pain, discharge of yellowish-white fluids, recurrent episodes, and over time, a sensation of insect infestation.
[Note] This syndrome arises in the fingers and palms, shaped like cornel fruits, growing symmetrically on both hands. Sometimes they cluster together. Initially, yellow-white pustules appear, causing intermittent itching and pain. Upon rupture, yellow fluid drains out. The condition is recurrent and extremely stubborn. It is caused by wind-damp pathogens invading the skin and interstices. It should be treated by applying Runji Gao (Nourishing Muscle Ointment). If it persists without healing, the itching intensifies significantly, implying internal "worm" generation (referring to microbial infection or parasitic pathology). Treatment should focus on eliminating parasites/germs; applying Lilu Gao (Veratrum Ointment) is highly effective. Avoid foods that trigger wind, as well as chicken, goose, and fish, which are considered pungent/fishy foods.
[Preparation of Lilu Gao]
Ingredients:
Lilu (Veratri Radix), Kushen (Sophorae Flavescentis Radix) (each 1 liang)
Zhu Zhiyou (Porcine Lard) 8 liang. Fry the two herbs until scorched, filter out the dregs. Add Songxiang (Pini Resin) 1 liang, melt it, remove from fire, then add Kufan (Alumen) powder and Xionghuang (Realgar) powder, each 1 liang. Stir evenly. Apply when warm, continue until healed.
[Prescription Verse]
Lilu Gao uses Kushen effectively,
Fried in lard, filtered, mixed with Pini Resin.
Add Alumen and Realgar powder, stir well,
Eliminate parasites, stop itching, apply to ulcers.
Runji Gao: (See Chapter on Seborrheic Dermatitis of the Head)