足跟疽，生于足跟骨下。由脏腑积热，或汗足涉水，远行伤筋而成。初起赤肿疼痛，脓
成有头可刺，出黄白色脓者易治；若初起便破，黑色而烂者难治。此处属足太阳膀胱经申脉
穴，乃阳跷发源之所，肾经所过之地；疮口久溃不合，阳跷脉气不能冲发，肾气由此而泄，
以致患者益虚，恐遂成终身之疾。初宜用隔蒜灸法；内服仙方活命饮加肉桂、牛膝；溃后宜
补中益气汤、人参养营汤、桂附地黄丸，随证滋补治之。又名兔啮疮者，盖猎人被兔咬脚跟
成疮，久而不敛，必气血沥尽而死；若人脚跟患此，亦非易愈，故名兔啮也。
厉痈，发于足旁小指之侧，由足三阴经亏损为疽者重，若兼足三阳经湿热下注而成痈者
轻。如红肿疼痛，溃后有脓腐脱，无黑气侵漫，属湿热偏胜易治；若微红微肿，溃出脓水，
属阴气凝结，不能化脓，险证难治；若黑暗漫肿，痛甚而不溃脓，烦热作渴，小水淋漓，为
阴败恶证。治宜隔蒜灸之；投以十全大补汤，或补中益气汤、八味丸之属，或可收功。若妄
用苦寒克伐之剂，多致不救。
脚发背，一名足跗发。经云∶三背不宜生疮。惟足背多筋少骨，肉少皮薄，又在至阴之
下，发疮疽者升发迟慢，所以为险候也。其证或由于足三阴精血亏损，或由于足三阳湿热下
注而生。若初起寒热作呕，坚硬红肿，疼痛作脓者，属湿热，为可治；又或有因物搐伤，初
起一粒，渐渐加大，寒热交作，日重一日，而成斯证者；亦因湿火之盛而然。必俟热退，肿
势方收止而渐消，此与烂皮乳痈相似。掺以珍珠散，贴以白玉膏可愈。若色微赤微肿而脓清
者，属精血亏损，为难治；若黑暗不肿痛，不溃脓，烦热作渴，小便淋漓者，阴败未传，恶
证也，为不治。治法∶湿热下注者，先用隔蒜灸；内服活命饮，以解壅毒；次用托里消毒散
；溃后服益气汤、六味丸，以补精气。若色暗不痛者，着肉用桑枝灸，以行壅滞、助阳气，
更用十全大补汤、八味丸，以壮脾土、滋化源，多有复生者。若专治其疮，复伤生气，吾未
见其生者。
脱疽者，足指生疔，重者溃而紫黑，不疼不痒，久则脱去其节，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。此由膏粱浓味，醇酒炙 ，积毒所致；或
因房术涩精，丹石补药，销烁肾水，房劳过度，气竭精枯而成。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。初起如粟，黄泡一点，皮色
紫暗，如煮熟红枣，黑气漫延，腐烂渐开，五指相染，甚至脚面疼如汤泼火燃，秽臭难闻，
遂成五败之证（血死心败，皮死肺败，筋死肝败，肉死脾败，骨死肾败），而不可救。凡遇此
证，乘其未及延散，须用隔蒜灸之，不痛者宜明灸之，庶得少杀其毒。盖用药攻，则患在偏
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，不若灸法为良也。孙
真人云∶在肉则割，在指则截。毒之重者，古人原有割截之法，然每为病家之所忌，未可轻
言；况证之首尾，吉凶变驳难定，岂可罔顾前虑后，而妄施之乎。至于用药之法，若色赤肿
痛者，元气虚而湿热壅甚也，即用活命饮、托里散之属，以解其毒；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。如作渴者，宜滋阴降火；
若色黑，不疼痛，不溃脓者，则不可救。
诸方书论脱疽，单生于足大指；而别指生者，则名敦疽。谓敦疽易治，脱疽难治，以脱
疽之指属阴经也。学人宜详审之。（足大指属足太阴）
足跟疽，生长在足跟骨下方。这是由于脏腑积热，或者脚出汗后涉水、长途行走损伤筋脉所致。初起时局部红肿疼痛，脓液形成后有头可刺破，流出黄白色脓液的容易治疗；如果初起就破溃，疮面发黑且腐烂的则难治。此处属于足太阳膀胱经的申脉穴，是阳跷脉的发源之地，也是肾经经过的地方；如果疮口长期溃烂不愈合，阳跷脉的气血不能冲发，肾气由此而泄，导致患者身体更加虚弱，恐怕最终会形成终身的疾病。初期适宜使用隔蒜灸法；内服仙方活命饮加入肉桂、牛膝；溃烂后期适宜服用补中益气汤、人参养营汤、桂附地黄丸，根据证候进行滋补治疗。又名兔啮疮，大概是因为猎人被兔子咬伤脚跟形成疮口，久久不收敛，必然导致气血耗尽而死；如果人脚跟患此病，也非轻易能愈，所以名叫兔啮。
厉痈，发生在足旁小脚趾的一侧，如果是由于足三阴经亏损导致的疽则病情重，如果是兼有足三阳经湿热下注形成的痈则病情轻。如出现红肿疼痛，溃烂后有脓腐脱落，没有黑色毒气蔓延，属于湿热偏盛，容易治疗；如果微红微肿，溃烂流出脓水，属于阴气凝结，不能化脓，属于险证难治；如果黑暗漫肿，疼痛剧烈但不溃脓，伴有烦热口渴，小便淋漓不尽，这是阴气败坏的恶证。治疗适宜用隔蒜灸；给予十全大补汤，或者补中益气汤、八味丸之类的药物，或许可以取得疗效。如果妄用苦寒克伐的药物，大多会导致无法救治。
脚发背，一名足跗发。医经说：三个背部不宜生疮。只有足背多筋少骨，肉少皮薄，又在至阴之下，发生疮疽时升发迟缓缓慢，所以属于险候。其证候有的由于足三阴精血亏损，有的由于足三阳湿热下注而生。如果初起时寒热发作伴呕吐，坚硬红肿，疼痛化脓的，属于湿热，是可以治疗的；又或者有因为异物刺伤，初起一粒，渐渐变大，寒热交替发作，一天比一天加重，从而形成此证的；也是因为湿火旺盛所致。必须等到热退，肿势才停止并逐渐消退，这与烂皮乳痈相似。掺敷珍珠散，贴敷白玉膏可以痊愈。如果颜色微赤微肿且脓液清稀的，属于精血亏损，难以治疗；如果黑暗不肿痛，不溃脓，烦热口渴，小便淋漓的，是阴气败坏尚未传变，属于恶证，不可治愈。治疗方法：湿热下注者，先用隔蒜灸；内服活命饮，以解除壅滞之毒；接着用托里消毒散；溃烂后服用益气汤、六味丸，以补益精气。如果颜色暗且不痛的，直接在患处用桑枝灸，以疏通壅滞、助长阳气，再用十全大补汤、八味丸，以壮脾土、滋养化源，多有复生的可能。如果只专注于治疗疮口，反而伤害生气，我没见过能活的。
脱疽，足趾生疔，严重的溃烂后呈紫黑色，不疼不痒，时间久了关节脱落，所以叫这个名字。也有发生在手指上的，名叫蛀节疔，严重的腐蚀掉近端指节，轻微的筋脉拘挛。这是由于饮食肥甘厚味、醇酒炙烤食物，积毒所致；或者因为房中术涩精、丹石补药，销烁肾水，房劳过度，气竭精枯而成。有先口渴而后发病的，有先发病而后口渴的，都是肾水亏涸，不能制约心火。此证情势虽然看似小，但其凶险程度很大。初起像粟米大小，有一个黄泡，皮色紫暗，像煮熟的红枣，黑气蔓延，腐烂逐渐扩大，五指相互传染，甚至脚面疼痛如火烧汤泼，气味秽臭难闻，遂成五败之证（血死心败，皮死肺败，筋死肝败，肉死脾败，骨死肾败），而不可救。凡遇到此证，趁它还未蔓延扩散，必须用隔蒜灸之，不痛的宜用明灸，希望能稍微减轻毒性。因为用药攻伐，患处偏僻，气血罕至，药物难以到达；况且攻毒的药物，必先损伤脾胃，反而损害元气，不如灸法好。孙思邈说：在肌肉则割除，在手指则截肢。毒邪严重的，古人原有割截之法，但常被病人所忌讳，不可轻易言及；何况病症的首尾吉凶变化驳杂难定，岂可不顾前因后果而妄加施行呢？至于用药的方法，如果色赤肿胀疼痛的，是元气虚而湿热壅盛，即用活命饮、托里散之类的药物，以解除其毒；仍迅速使用补剂，如十全大补汤、加减八味丸，则毒瓦斯不至于向上侵扰，元气不至于亏损，或许可以保全生命。如作渴的，宜滋阴降火；如果颜色黑，不疼痛，不溃脓的，则不可救。
各种方书论述脱疽，单生于足大脚趾；而其他脚趾生长的，则名叫敦疽。说敦疽容易治疗，脱疽难治，因为脱疽所在的脚趾属于阴经。（足大脚趾属足太阴脾经）
Heel Abscess (Zu Gen Ju) arises below the bone of the heel. It is caused by accumulated heat in the Zang-Fu organs, or by wading in water after sweating, or by damaging the sinews through long-distance walking. Initially, there is redness, swelling, and pain. When pus forms, a head appears that can be pricked; discharging yellowish-white pus indicates an easy-to-treat condition. If it breaks open immediately upon onset with black, rotting tissue, it is difficult to treat. This area belongs to Shenmai (BL62), an acupoint of the Foot-Taiyang Bladder Channel, which is the source of the Yang Qiao vessel and the pathway of the Kidney Channel. If the ulcer remains unhealed for a long time, the Qi of the Yang Qiao vessel cannot surge forth, causing Kidney Qi to leak out, leading to further deficiency in the patient, potentially resulting in a lifelong disease. Initially, Garlic-Separated Moxibustion (Ge Suan Jiu) should be used; internally, Xian Fang Huo Ming Yin (Immortal Life Elixir Decoction) added with Rou Gui (Cortex Cinnamomi) and Niu Xi (Radix Achyranthis Bidentatae) is indicated. After ulceration, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), Ren Shen Yang Ying Tang (Ginseng Nourishing the Nutritive Decoction), and Gui Fu Di Huang Wan (Cinnamon Twig and Aconite Pill of the Six Ingredients) should be used according to the syndrome for tonification and treatment. Also known as Rabbit-Bite Sore (Tu Ni Chuang), this name likely originates from hunters bitten on the heel by rabbits, whose sores fail to heal over time, eventually leading to death due to exhaustion of Qi and Blood. Similarly, if humans suffer from this on the heel, it is not easily cured, hence the name.
Li Yong (Severe Carbuncle) occurs on the side of the little toe of the foot. If it arises from deficiency of the Foot-Yin channels manifesting as a deep abscess (Ju), the condition is severe; if it results from damp-heat pouring downward involving the Foot-Yang channels manifesting as a superficial carbuncle (Yong), the condition is mild. If there is redness, swelling, and pain, with necrotic pus shedding after ulceration and no spreading black gas, it belongs to excess damp-heat and is easy to treat. If there is slight redness and swelling, with watery pus discharge indicating congealed Yin Qi unable to transform into pus, it is a critical and difficult condition. If the area is dark, diffusely swollen, severely painful without suppuration, accompanied by irritability, fever, thirst, and dribbling urination, it is a malignant syndrome of Yin collapse. Treatment should involve Garlic-Separated Moxibustion; administering Shi Quan Da Bu Tang (Great Tonifying Ten Substance Decoction), or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), or Ba Wei Wan (Eight-Ingredient Pill), may yield results. Prescribing bitter-cold purgatives recklessly often leads to untreatable outcomes.
Foot-Dorsal Carbuncle (Jiao Fa Bei), also known as Foot-Dorsum Fa, states in the classics: "Sores should not arise on the three backs." The dorsum of the foot has many tendons but few bones, with thin flesh and skin, located below the extreme Yin. Sores and abscesses here develop slowly and sluggishly, making them dangerous conditions. Etiology includes either deficiency of essence and blood in the Foot-Yin channels or damp-heat pouring downward from the Foot-Yang channels. Initial symptoms of chills, fever, vomiting, hardness, redness, swelling, and pain with suppuration indicate damp-heat and are treatable. Alternatively, injury from foreign objects starting as a single nodule that gradually enlarges, with alternating chills and fever worsening daily, is also due to excessive damp-fire. One must wait for the fever to subside before the swelling recedes and gradually dissipates; this resembles Rotting-Skin Breast Carbuncle. Applying Zhen Zhu San (Pearl Powder) and pasting Bai Yu Gao (White Jade Ointment) can lead to cure. If slightly red/swollen with clear pus, it indicates deficiency of essence and blood and is difficult to treat. If dark, non-painful, non-suppurating, with irritability, fever, thirst, and dribbling urination, it is a malignant sign of Yin collapse not yet transmitted, which is incurable. Treatment for damp-heat pouring downward: first use Garlic-Separated Moxibustion; internally administer Huo Ming Yin (Life-Saving Decoction) to resolve stagnation and toxicity; subsequently use Tuo Li Xiao Du San (Interior-Supporting and Toxin-Resolving Powder); after ulceration, take Yi Qi Tang (Qi-Tonifying Decoction) and Liu Wei Wan (Six-Ingredient Pill) to tonify essence and Qi. For dark, non-painful lesions, apply Mulberry Branch Moxibustion directly to the flesh to move stagnation and assist Yang Qi, followed by Shi Quan Da Bu Tang (Great Tonifying Ten Substance Decoction) and Ba Wei Wan (Eight-Ingredient Pill) to strengthen Spleen Earth and nourish the source of transformation; many patients recover. Focusing solely on treating the sore while damaging vital Qi rarely results in survival.
Tuo Ju (Falling Off Gangrene) involves Ding (malignant furuncles) arising on the toes. Severe cases become purple-black after ulceration, with no pain or itching; eventually, the joints fall off, hence the name. It can also occur on fingers, called Zhu Jie Ding (Bone-Eating Joint Furuncle), where severe cases corrode the proximal phalanx and mild cases cause tendon contraction. Etiology includes accumulation of toxins from rich foods, alcohol, and roasted/grilled items; or kidney Yin depletion from sexual techniques, cinnabar/stone tonics, and excessive sexual activity leading to exhaustion of Qi and Jing. Thirst preceding illness or illness preceding thirst both indicate Kidney Water deficiency failing to control Fire. Although the presentation seems minor, the malignancy is great. Initially resembling millet grains with a yellow blister, the skin becomes purple-dark like cooked red dates, with spreading black gas, gradual rotting, contagion among toes, and even severe pain on the dorsum of the foot feeling like boiling water or fire burning, with foul odor, leading to the Five Collapses syndrome (Blood death/Heart failure, Skin death/Lung failure, Tendon death/Liver failure, Flesh death/Spleen failure, Bone death/Kidney failure), which is incurable. Upon encountering this, before it spreads, one must use Garlic-Separated Moxibustion; for painless areas, use Bright Moxibustion (Ming Jiu) to reduce toxicity. Medicinal attacks are ineffective because the affected area is peripheral with scarce Qi and Blood, making drug delivery difficult; moreover, toxic-clearing herbs damage the Spleen and Stomach and deplete Yuan Qi, whereas moxibustion is superior. Sun Simiao stated: "If in the flesh, cut it; if on the finger, amputate it." Ancients had amputation methods for severe toxins, but these are often feared by patients and should not be suggested lightly; given the unpredictable nature of the disease's progression and prognosis, reckless application is unjustified. Regarding medication: for red, swollen, painful lesions indicating Yuan Qi deficiency and severe damp-heat stagnation, use Huo Ming Yin (Life-Saving Decoction) and Tuo Li San (Interior-Supporting Powder) to resolve toxicity; promptly follow with tonics like Shi Quan Da Bu Tang (Great Tonifying Ten Substance Decoction) or Jia Jian Ba Wei Wan (Modified Eight-Ingredient Pill) to prevent toxin ascent and Yuan Qi depletion, thereby preserving life. For thirst, employ Yin-nourishing and Fire-descending methods. For black, painless, non-suppurating lesions, it is incurable.
Various medical texts discuss Tuo Ju as occurring only on the great toe; lesions on other toes are named Dun Ju (Dun Abscess). It is said that Dun Ju is easier to treat than Tuo Ju because the toe involved in Tuo Ju belongs to a Yin channel. (The great toe belongs to the Foot-Taiyin Spleen Channel.)