谓疔生于足趾，或足溃而自脱，故名脱疽。
亦有发于手指者，名曰蛀节疔，重者腐去本节，轻者筋挛。
痛者，除湿攻毒，更以隔蒜灸至不痛。 痛，或不痛者，隔蒜灸之，更用解毒药。若
色黑
者，滋阴降火，色黑者不治。
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。
一男子足趾患之，大痛，色赤而肿，令隔蒜灸至痛止。以人参败毒散去桔梗，加金银
花、白
明灸之，庶得少杀其毒。此证因膏粱浓味，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。此患不问肿溃，惟隔蒜灸有效，亦有色赤作痛而自溃者，元气未脱易治。夫至阴之
下，血气难到，毒易腐肉，药力又不易达。况所用皆攻痛之药，未免先于肠胃，又不能攻敌
其毒。不若隔蒜灸，并割去，最为良法。故孙真人云∶在指则截，在内则割。即此意也。
一男子脚背患此，赤肿作痛，令隔蒜灸三十余壮，痛止。以仙方活命饮，四剂而溃。更
以托里消毒药而愈。
一男子足趾患之，色赤 痛作渴。隔蒜灸数壮，服仙方活命饮，三剂而溃。更服托里药
，及加减八味丸，溃脱而愈。
一男子足趾患之，色黑不痛，令明灸三十余壮而痛，喜饮食如常。余谓∶“急割去之，
速服补剂。”彼不信。果延上，遂致不救。
一男子脚背患之，色黯而不肿痛，烦躁大渴，尺脉大而涩。此精已绝，不治，后果然。
附方
人参败毒散（方见溃疡发热门）
隔蒜灸法
仙方活命饮（二方见发背门）
加减八味丸（方见作渴门）
十宣散（方见肿疡门）
所谓脱疽，是指疔疮生于足趾，或者足部溃烂后自行脱落，因此得名。
也有发生在手指的，称为蛀节疔，病情重的会导致本节指骨腐烂脱落，轻的则出现筋脉拘挛。
如果伴有疼痛，治疗应除湿攻毒，并配合隔蒜灸法，直到疼痛消失。无论疼痛还是不痛，都使用隔蒜灸，并服用解毒药物。如果患处颜色发黑，需滋阴降火；若颜色发黑且无其他变化者，属于不治之症。
有一个男子足趾患病，疼痛、肤色赤红、发热，采用隔蒜灸法，同时服用去掉了桔梗的人参败毒散，加入金银花、白芷、大黄，服用两剂后疼痛停止。接着又服用去掉了桔梗、官桂的十宣散，加入天花粉、金银花，经过数剂服药后痊愈。
另一个男子足趾患病，肤色紫暗且不痛，隔蒜灸了五十多壮，仍然感觉不到疼痛。后来又直接艾灸一百壮，才开始感到疼痛，随后投用仙方活命饮四剂，再用托里药（补益气血以托毒外出），待脓溃脱落后痊愈。
还有一个男子足趾患病，剧烈疼痛，肤色赤红且肿胀，令其隔蒜灸至疼痛停止。服用去掉了桔梗的人参败毒散，加入金银花……（此处原文有缺漏或排版错误，结合下文语境及常见医案逻辑，通常后续为继续用药或描述疗效，但根据提供的文本片段，仅能翻译现有内容）……直接艾灸，希望能稍微减轻毒性。此病是因为长期食用膏粱厚味、酒面炙爆食物，积聚毒素所致；或者不慎房劳过度，导致肾水枯竭；或者服用丹石类补药。导致有的先口渴而后发病，有的先发病而后口渴，这都是因为肾水枯竭，不能制约心火所致。初发时颜色就发黑的，属于不治之症。颜色赤红的说明肾水尚未枯竭，还可以治疗。如果未能及时解毒，导致肌肉坏死颜色变黑，必须紧急截肢切除，拖延下去黑色会向上蔓延，足部必然死亡。此病不论是否肿胀溃破，只有隔蒜灸有效，也有肤色赤红作痛而自行溃破的，元气未完全耗脱，容易治疗。由于病变部位位于人体最阴之下（足部），气血难以到达，毒素容易腐蚀肌肉，药力也不容易送达。况且所使用的多是攻伐止痛的药物，难免先作用于肠胃，又不能直接攻击体内的毒素。不如隔蒜灸，并结合手术切除，才是最好的方法。所以孙思邈说：“在手指则截断，在内侧则割除。”就是这个意思。
又一个男子脚背患此病，红肿疼痛，令其隔蒜灸三十多壮，疼痛停止。服用仙方活命饮，四剂后溃脓。再用托里消毒药而痊愈。
又一个男子足趾患病，肤色赤红、疼痛并伴有口渴。隔蒜灸了几壮，服用仙方活命饮，三剂后溃脓。再服用托里药，以及加减八味丸，待溃脱后痊愈。
又一个男子足趾患病，肤色发黑且不痛，令其直接艾灸三十多壮后开始疼痛，庆幸的是饮食如常。我说：“必须紧急切除，迅速服用补剂。”他不相信。果然病情向上蔓延，最终导致无法救治。
Tuojü (Gangrene of the toes/fingers) is so named because ding sores (hard, painful nodules resembling thorns) occur on the toes, or the foot ulcerates and falls off spontaneously.
There are also cases occurring on the fingers, called Zhujie Ding (Cavity-joint Ding), where severe cases result in the rotting and loss of the proximal phalanx, while mild cases present with tendon contraction.
If pain is present, treatment involves eliminating dampness and attacking toxicity, combined with Garlic-Separated Moxibustion until the pain ceases. Whether painful or painless, Garlic-Separated Moxibustion should be applied, along with detoxifying herbs. If the color turns black, nourish Yin and descend fire; if the color remains black without other changes, it is incurable.
A male patient suffered from this condition on his toe, presenting with pain, redness, and fever. He underwent Garlic-Separated Moxibustion and took Renshen Baidu San (Ginseng and Detoxification Powder) with Jiegeng removed, plus Jinyinhua (Lonicerae Japonicae Flos), Baizhi (Angelicae Dahuricae Radix), and Dahuang (Rhei Radix et Rhizoma). After two doses, the pain ceased. Subsequently, he took Shixuan San (Ten-Acupoints Powder) with Jiegeng and Guangui removed, plus Tianhuafen (Trichosanthis Radix) and Jinyinhua, recovering after several doses.
Another male patient suffered from this on his toe, with a purplish color and no pain. He received over fifty moxa cones via Garlic-Separated Moxibustion but felt no pain. Later, direct moxibustion was applied for one hundred cones, at which point pain began. He was then administered Xianfang Huoming Yin (Immortal Formula for Life-Invigorating Decoction) for four doses, followed by Tuoli medicines (tonifying and promoting suppuration), leading to recovery after the necrotic tissue sloughed off.
Yet another male patient suffered from this on his toe, experiencing severe pain, redness, and swelling. He was instructed to undergo Garlic-Separated Moxibustion until the pain stopped. He took Renshen Baidu San with Jiegeng removed, adding Jinyinhua... [Text fragment] ...direct moxibustion was used to hopefully reduce the toxicity somewhat. This condition is caused by the accumulation of toxins from a diet rich in fatty meats, refined grains, alcohol, and fried foods; or by imprudent sexual activity leading to the depletion of Kidney Water; or by taking Dan-Shi tonics. It may manifest as thirst preceding the disease, or disease preceding thirst, all due to the depletion of Kidney Water failing to control Fire. If the lesion is black upon initial onset, it is incurable. Redness indicates that Kidney Water has not yet dried up, and treatment is possible. If toxicity is not resolved promptly, leading to muscle death and blackening, amputation is urgently required; otherwise, the blackness will spread upward, resulting in certain death regarding the limb. Regardless of swelling or suppuration, Garlic-Separated Moxibustation is effective. Some cases with redness and pain may suppurate spontaneously; if Yuanqi (Original Qi) is not exhausted, they are easy to treat. Because the affected area is at the lowest Yin part of the body, Qi and Blood have difficulty reaching it, making it prone to toxin-induced tissue decay and resistant to herbal efficacy. Moreover, oral medications primarily affect the intestines and stomach and cannot directly attack the deep-seated toxin. Therefore, combining Garlic-Separated Moxibustion with surgical excision is the best method. As Sun Simiao stated: "For lesions on fingers, amputate; for those internally, excise." This illustrates the principle.
Another male patient suffered from this on the dorsum of his foot, presenting with redness, swelling, and pain. He underwent Garlic-Separated Moxibustion for over thirty cones, and the pain ceased. He took Xianfang Huoming Yin for four doses until suppuration occurred, and recovered after taking Tuoli Xiaodu medicines (tonifying and detoxifying).
Another male patient suffered from this on his toe, with redness, pain, and thirst. He received several cones of Garlic-Separated Moxibustion and took Xianfang Huoming Yin, suppurating after three doses. He then took Tuoli medicines and Jiaban Bawei Wan (Modified Eight-Ingredient Pill), recovering after the necrotic tissue sloughed off.
Another male patient suffered from this on his toe, with black discoloration and no pain. Direct moxibustion for thirty cones induced pain, and fortunately, his appetite remained normal. I advised: "Amputate immediately and take tonic preparations quickly." He did not believe me. The condition indeed spread upward, leading to an untreatable state.
Another male patient suffered from this on the dorsum of his foot, with dark discoloration but no swelling or pain, accompanied by irritability and intense thirst. His Chi pulse was large and choppy. This indicates the exhaustion of Essence, which is incurable; the outcome proved correct.
Attached Formulas:
Renshen Baidu San (See Fever Section with Ulceration)
Garlic-Separated Moxibustion Method
Xianfang Huoming Yin (See Back Carbuncle Section)
Jiaban Bawei Wan (See Thirst Section)
Shixuan San (See Swollen Tumor Section)