立斋曰∶脱疽，以疔患于足，或足趾，重者溃脱，故名之。亦有患于手指者，名曰蛀节
疔。重者腐去本节，轻者筋挛。此证固膏粱浓味，酒面炙爆，积毒所致，或不慎房劳，肾水
枯竭，或服丹石补药，致有先渴而后患者，有先患而后渴者，皆肾水亏涸，不能制火也。此证
情势虽小，其恶甚大，不问肿溃，皆须隔蒜灸之。不痛者，宜明灸之，庶得少杀其毒。凡初
发而色黑不溃者，不治。毒延入腹者，不治。色黑不痛者，亦不治。色赤作痛自溃者，可治
。若失解其毒，以致肉死色黑者，急斩去之。亦有因修手足口咬等伤而致者，若元气虚弱，
或犯房事，或外涂寒凉，内服克伐，损伤脾胃，以致患处不溃，或黑延上足，亦多致死。重
者须当用脚刀转解周骨，轻拽去之，使筋随骨出，而毒得泄，亦不痛。否则毒筋内断，虽去
而仍溃。且偏僻之处，气血罕到，药难导达。况攻毒之剂，必先伤脾胃，反损元气，不若灸
法为良。重者，须解去为善。故孙真人云∶在肉则割，在指则截。使不如此，则必致夭殁而
害尤甚矣。况患处已坏，虽解不痛，又何惮而不为乎。患者当知之。若女人患此，又多因札
缚，血脉不通，遂成死肉，惟当壮其脾胃，行其经络，生其血气则愈。
又《治法》曰∶色赤作痛者，元气虚而湿毒壅盛也，先用隔蒜灸，更用解毒药，如活命
饮、托里散之属。仍速用补剂，如十全大补汤、加减八味丸，则毒瓦斯不致上侵，元气不致亏
损，庶可保生。作渴者，宜滋阴降火。色黑者，不治。
崔氏方，治手足甲疽，或因修甲伤肉，或因损足成疮，溃烂上脚，用绿矾置铁板上，
沸色赤如溶金色者为真，沸定，取出研末，以盐汤洗而搽之。
一男子，足趾患之， 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。又用十宣散去桔梗、官桂，加天花粉、金银花，数剂而痊。
一男子，足趾患之，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。
一膏粱之人，先作渴足热，后足大趾赤痛，六脉洪数而无力，左尺为甚，予谓此足三阴
虚证，当滋化源为主。彼固服除湿败毒等剂，元气益虚，色黯延足。余乃朝用补中益气汤，
夕用补阴八珍汤，各三十余剂，及桑枝灸，溃而脓清，作渴不止。遂朝以前汤送加减八味丸
，夕用十全大补汤，三十余剂而痊。是时，同患此证，服败毒之药者，俱不效。
一膏粱人，年逾五十，亦患此，色紫黑，脚 痛，喜其饮食如故，动息自宁，为疮疡之
善证，尚可治。遂以连翘消毒散六剂，更以金银花、甘草节、栝蒌二十余剂，患指溃脱，再以
当归、川芎、连翘、生地、金银花、白芷，二十余剂而愈。
一刍荛，左足趾患一泡，麻木色赤，次日趾黑，五日其足黑冷，不知疼痛，脉沉细，
此脾胃受毒所致。以飞龙夺命丹一服，翌日令割去足上死肉，割后骨始痛而可救。遂以十全
大补汤治之而愈。盖死肉乃毒瓦斯盛，而拒绝营气所致。况至阴之下，气血难达。经曰风淫末
疾，即此是也。向若攻伐之，则元气愈盛，邪气愈盛，乘虚上侵，必致不救。（俱薛按）
薛己说：脱疽，是指疔疮发生在足部或足趾上，病情严重的会导致溃烂脱落，因此得名。也有发生在手指上的，称为蛀节疔。病情严重的会腐烂至指节根部，轻度的则出现筋脉拘挛。这种病症固然多因长期食用肥甘厚味、酒类面食以及煎炸烧烤食物，导致积毒所致；或者因为不慎房事过度，肾水枯竭；或者是服用丹石类补药，导致先口渴而后发病的，也有先发病而后口渴的，这些都是肾水亏虚干枯，不能制约心火所致。此证虽然局部情势看似轻微，但其危害极大，无论是否肿胀溃烂，都必须用隔蒜灸法治疗。如果不疼痛的，应当重灸，希望能稍微减轻毒性。凡是初发时颜色发黑且不溃烂的，无法治愈。毒邪蔓延入腹部的，无法治愈。颜色发黑且不痛的，也无法治愈。颜色发红且疼痛并自行溃烂的，可以治愈。如果未能及时解除毒素，导致肌肉坏死颜色发黑的，必须紧急截肢去除。也有因为修剪手足、被口咬等外伤而导致的，如果元气虚弱，或者犯忌房事，或者外涂寒凉药物，内服克伐攻邪之剂，损伤脾胃，导致患处不溃烂，或者黑色向上蔓延至足部，也大多致死。病情严重的，必须用脚刀旋转切割周围骨骼，轻轻拽出坏死的组织，使筋脉随骨骼脱出，从而让毒邪得以宣泄，这样也不会感到疼痛。否则毒邪与筋脉在内断裂，即使去除了坏死部分，伤口仍然会溃烂。况且偏僻之处，气血很少到达，药物难以引导送达。何况攻毒的药物，必定先损伤脾胃，反而损耗元气，不如灸法良好。病情严重的，必须切除去除才是好的。所以孙思邈说：在肉里的就割除，在手指的就截肢。如果不这样做，必然导致夭折死亡，而且危害更加严重。况且患处已经坏死，即使切除也不痛，又有什么害怕而不做的呢？患者应当明白这个道理。如果是女性患此病，又多是因为缠足束缚，血脉不通，遂成死肉，只应当强壮其脾胃，疏通其经络，生发其血气，就能痊愈。
又《治法》中说：颜色发红且疼痛的，是元气虚弱而湿毒壅盛，先用隔蒜灸，再用解毒药物，如仙方活命饮、托里散之类。仍要迅速使用补益药剂，如十全大补汤、加减八味丸，这样毒邪就不会向上侵袭，元气不会亏损，才可以保全生命。出现口渴的，应当滋阴降火。颜色发黑的，无法治愈。
崔氏方，治疗手足甲疽，可能是因为修剪指甲伤及肌肉，或者因为损伤足部形成疮疡，溃烂蔓延至脚部，使用绿矾放在铁板上，烧至颜色赤红像熔化的金子那样的是真品，烧定后取出研成粉末，用盐水清洗后涂抹。
一个男子，足趾患病，疼痛颜色发红，发热，用隔蒜灸治疗，再用人参败毒散去桔梗，加金银花、白芷、大黄，两剂后疼痛停止。又用十宣散去桔梗、官桂，加天花粉、金银花，数剂后痊愈。
一个男子，足趾患病，颜色紫暗不痛，用隔蒜灸五十多壮，还不知道痛，又重灸一百壮才开始痛，再投予仙方活命饮四剂，然后用托里药，溃烂脱落后痊愈。
一个饮食肥甘的人，先出现口渴足热，后来足大趾发红疼痛，六脉洪大而数但无力，左尺脉尤其明显，我认为这是足三阴经的虚证，应当以滋生化源为主。他本来服用除湿败毒等药剂，元气更加虚弱，颜色黯黑蔓延至足部。我于是早晨服用补中益气汤，晚上服用补阴八珍汤，各三十多剂，以及桑枝灸，溃烂后脓液清稀，但仍口渴不止。于是早晨以前方送服加减八味丸，晚上服用十全大补汤，三十多剂后痊愈。当时，同样患有此证，服用败毒药物的人，都无效。
一个饮食肥甘的人，年过五十，也患此病，颜色紫黑，脚部疼痛，庆幸他饮食如常，动静自若，属于疮疡中的善证，还可以治疗。于是用连翘消毒散六剂，再用金银花、甘草节、栝蒌二十多剂，患指溃烂脱落，再用当归、川芎、连翘、生地、金银花、白芷，二十多剂后痊愈。
一个樵夫，左足趾患了一个水泡，麻木颜色发红，第二天脚趾变黑，第五天整个脚变黑冰冷，不知疼痛，脉象沉细，这是脾胃受毒所致。服用一剂飞龙夺命丹，第二天让他割去脚上的死肉，割完后骨头开始痛，说明还有救。于是用十全大补汤治疗而痊愈。大概死肉是因为毒邪旺盛，拒绝营气运行所致。况且在至阴的下部，气血难以到达。经书说风邪淫溢导致末梢疾病，就是这个道理。先前如果采用攻伐之法，则元气更虚，邪气更盛，乘虚上侵，必然导致无法救治。（以上均为薛己按语）
Xue Ji stated: Tuojü (Gangrene of the toes/fingers), refers to Dingchuang (Malignant carbuncle) occurring on the foot or toes. In severe cases, it ulcerates and falls off, hence the name. There are also cases occurring on the fingers, called Zhujie Ding (Cavity-joint Malignant Carbuncle). In severe cases, rot extends to the proximal phalanx; in mild cases, there is tendon contraction. This condition is indeed caused by accumulated toxins from a diet rich in fatty foods and sweet flavors, alcohol, wheat products, and fried or roasted foods. It may also result from imprudent sexual activity leading to exhaustion of Kidney Water (Jing/Essence and Body Fluids), or from taking Dan Shi (Cinnabar and Pyrite) tonics, causing thirst before onset or onset before thirst. All these stem from the deficiency and dryness of Kidney Water, failing to control Fire. Although the local manifestation of this condition seems minor, its malignancy is great. Regardless of swelling or ulceration, Garlic-partitioned Moxibustion must be applied. If painless, strong moxibustion should be used to hopefully reduce the toxicity. Cases presenting with black color upon initial onset without ulceration are incurable. Cases where toxin spreads into the abdomen are incurable. Cases with black color and no pain are also incurable. Cases with red color, pain, and spontaneous ulceration are treatable. If the toxin is not resolved promptly, leading to necrosis and blackening of the flesh, urgent amputation is required. Some cases arise from injuries such as trimming hands/feet or animal bites. If the Original Qi (Yuan Qi) is weak, or if sexual activity is indulged, or if cold-cooling agents are applied externally and attacking/clearing herbs are taken internally, damaging the Spleen and Stomach, the affected area may fail to ulcerate, or blackness may spread upward to the foot, often resulting in death. In severe cases, a foot knife must be used to rotate and cut around the bone, gently pulling out the necrotic tissue so that tendons follow the bone out, allowing the toxin to be discharged, which will also relieve pain. Otherwise, the toxic tendons break internally, and even after removal, the wound continues to ulcerate. Moreover, in remote areas, Qi and Blood rarely reach, making it difficult for medicines to penetrate. Furthermore, detoxifying agents first damage the Spleen and Stomach, further depleting Original Qi, whereas moxibustion is superior. For severe cases, excision is best. Thus, Sun Simiao said: "If in the flesh, cut it; if in the finger, amputate." Without doing so, premature death is inevitable, and the harm is even greater. Since the affected area is already necrotic, even if excised, it causes no pain, so why hesitate? Patients should understand this. If women suffer from this, it is often due to tight binding (foot-binding), obstructing blood vessels, leading to dead flesh. Treatment should focus on strengthening the Spleen and Stomach, unblocking meridians, and generating Qi and Blood to achieve recovery.
Furthermore, "Treatment Methods" states: Red color with pain indicates Original Qi deficiency and accumulation of Damp-Toxin. First apply Garlic-partitioned Moxibustion, then use detoxifying formulas such as Xian Fang Huo Ming Yin (Immortal Life Saving Decoction) or Tuo Li San (Support Interior Powder). Quickly administer tonics such as Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) or Jia Jian Ba Wei Wan (Modified Eight-Ingredient Pill), so that toxin does not invade upward and Original Qi is not depleted, ensuring survival. Thirst should be treated by nourishing Yin and descending Fire. Black color indicates incurability.
Cui's Formula treats Shou Zu Jiu Ju (Nail Gangrene of hands and feet), whether caused by trimming nails injuring flesh or foot injury forming ulcers spreading to the leg. Use Lv Fan (Green Vitriol). Place it on an iron plate and heat until it turns red like molten gold, indicating authenticity. After cooling, grind into powder. Wash with salt water and apply topically.
A male patient suffered from toe involvement, with pain, redness, and fever. He underwent Garlic-partitioned Moxibustion, followed by Ren Shen Bai Du San (Ginseng Detoxification Powder) minus Jie Geng, added with Jin Yin Hua, Bai Zhi, and Da Huang. After two doses, pain ceased. Then, Shi Xuan San (Ten Acupoints Powder) minus Jie Geng and Guan Gui, added with Tian Hua Fen and Jin Yin Hua, was administered for several doses, resulting in recovery.
Another male patient had toe involvement with purple color and no pain. He received over fifty moxa cones via Garlic-partitioned Moxibustion but felt no pain. Strong moxibustion of one hundred cones induced pain. Subsequently, Xian Fang Huo Ming Yin was given for four doses, followed by interior-supporting medicine, leading to ulceration, detachment, and recovery.
A patient accustomed to rich diets initially presented with thirst and hot feet, followed by red painful big toe. The six pulses were surging and rapid but forceless, especially at the Left Chi position. I diagnosed this as a deficiency syndrome of the Three Yin Meridians of the Foot, primarily requiring nourishment of the source of transformation. He had previously taken damp-clearing and detoxifying agents, further depleting his Original Qi, with dark discoloration spreading to the foot. I prescribed Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) in the morning and Bu Yin Ba Zhen Tang (Nourish Yin Eight Treasure Decoction) in the evening, each for over thirty doses, along with Sang Zhi Moxibustion (Mulberry Twig Moxibustion). Ulceration occurred with clear pus, but thirst persisted. I then administered Jia Jian Ba Wei Wan (Modified Eight-Ingredient Pill) with the morning formula and Shi Quan Da Bu Tang in the evening for over thirty doses, resulting in recovery. At that time, others with similar conditions taking detoxifying agents showed no effect.
Another patient accustomed to rich diets, over fifty years old, suffered from this condition with purple-black color and foot pain. Fortunately, his appetite remained normal, and he moved/rested comfortably, indicating a favorable prognosis for a sore/ulcer, thus treatable. I prescribed Lian Qiao Xiao Du San (Forsythia Detoxification Powder) for six doses, followed by Jin Yin Hua, Gan Cao Jie, and Gua Lou for over twenty doses. The affected finger ulcerated and detached. Finally, Dang Gui, Chuan Xiong, Lian Qiao, Sheng Di, Jin Yin Hua, and Bai Zhi were administered for over twenty doses, resulting in recovery.
A woodcutter developed a blister on his left toe, numb with redness. 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 toxin affecting the Spleen and Stomach. One dose of Fei Long Duo Ming Dan (Flying Dragon Life-Snatching Pill) was given. The next day, necrotic flesh on the foot was surgically removed. Bone pain appeared post-surgery, indicating salvageability. He was then treated with Shi Quan Da Bu Tang and recovered. Necrotic flesh is caused by abundant toxin rejecting Ying Qi (Nutritive Qi) circulation. Moreover, in the lowest Yin regions, Qi and Blood struggle to reach. The Classics state: "Wind excess leads to diseases of the extremities," which applies here. Had attacking methods been used initially, Original Qi would have been further depleted while pathogenic factors intensified, invading upward through deficiency, inevitably leading to untreatable conditions. (All notes by Xue Ji)