（谓疔生于足趾，或足消而自脱，故名。亦有发于手指者，名炷节疔，重者腐指节，轻者筋弯。）
一男子足趾患脱疽， 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，痛止。又十宣散去桔梗、官桂，加花粉，数剂而痊。
一男子足趾患脱疽，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，乃以托里药溃而愈。（《心法》中韩判官症同，灸同，乃以败毒散加银花、白芷而愈矣。）
一男子足趾不大痛，色赤而肿，令隔蒜灸至痛止。以人参败毒散去桔梗，加金银花、白芷、大黄
而溃。更加以仙方活命饮而痊。此症情势虽小，其恶甚大，须隔蒜灸之，不痛者宜用灸之，庶得少杀
其毒。盖因膏粱浓味，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。此患不同肿溃，惟隔蒜灸有效。亦有色作痛而自溃
者，元气未脱易治。夫至阴之下，血气难到，毒不易腐，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，故隔蒜灸，并割去，最为良法。故孙真人云∶在指则截，在肉则割，即此
意也。
一男子脚背患此症，赤肿作痛，令隔蒜灸三十余壮，痛止。以仙方活命饮，四剂而溃。以托里消
毒药而愈。
一男子足趾患此症，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。
一男子足趾患此症，色黑不痛，令明灸三十余壮而痛。喜饮食如常，谓急割去，速服补剂。彼不
信，延上遂致不救。
一男子脚背患此症，色黯而不肿痛，烦躁大渴，尺脉大而涩。此精气已绝，不治。后果然。
杨太仆年逾四十，左足大趾赤肿 痛，此脾经积毒下注而然，乃脱疽也。喜色赤而痛，以人参败
毒散去人参、桔梗，加银花、白芷、大黄，二剂。更以栝蒌、银花、甘草节，四剂顿退。再以十宣散
去桔梗，加银花、防己，数剂而愈。
一膏粱人年逾五十，患此症，色紫黑，脚 痛。孙真人云∶脱疽之症，急斩去之。毒延心腹必不
治，色黑不痛者亦不治。喜其饮食如故，动息自宁，为疮疡善症也，尚可治。遂以连翘消毒散六剂，
更以银花、甘草节、栝蒌，二十余剂，患趾溃脱。再以芎、归、地、连翘、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，翌日令割去足上死黑肉。割后骨始痛，可救，遂以十全大补汤治之而愈。盖黑肉
乃毒瓦斯之盛，而拒截荣气所致。况至阴之下，气血难达，经云风淫末疾，即此是也。向若攻伐之，则
邪气愈盛，乘虚上侵必不救。
海山骄淫益无度，强并民居田宅妇女，竟占山东之半。陆宣子者，山东名医也。有富室外家，足小
趾生疮，状类细米，疮头早白，根如熟枣，脏腑挈挈欲坠。闻平湖名，延之视曰∶此粟米疮也，与人
面疮等，七日毒上升，遍体腐烂成黑水死矣。君欲生之，当急断其趾，断之愈。海山亦生是疮，嘱宣
子视。宣子仍前言，海山大怒，欲杀之。楚人丁维章，以外科有名，出入禁内，海山邀之至，告以宣
子语。且曰∶公视我疮无恙，吾必杀之。维章熟视曰∶杀我可也，何尤宣子？今已过三日，毒上升矣。
公欲活耶？断膝尚可。海山 目曰∶其然，
三问应声如响。海山喟然曰∶我命在公矣。顾左右取截刀，伸足曰∶斩。左右战栗，海怒骂使斩，遂
断一腿。维章手提海山发，倚柱坐，海山面黄气绝。维章曰∶可速召前医者。宣子至，视其地一腿尚
自起跳跃，黑血淋漓，命取人参一斤，浓煎灌其口，少顷海山苏。顾其足曰∶嗟乎，刖足刑已重矣，
何辜而刖膝，幸公治我，我自今后庶几可以无后患。阅四十九日，而右膝毒发，复生人面疮。医曰∶
不可再活矣。海山不数日死。凡所夺民家产，皆散去，其兄乃乞食如初。
（脱疽，是指疔疮生于足趾，或者足部消瘦而自然脱落，因此得名。也有发生在手指的，称为炷节疔，病情重的会腐蚀指节，轻的则导致筋脉弯曲。）
有一个男子足趾患脱疽，疼痛且颜色赤红，伴有发热，采用隔蒜灸治疗，同时服用人参败毒散去掉桔梗，加入金银花、白芷、大黄，疼痛停止。又服用十宣散去掉桔梗、官桂，加入天花粉，服用几剂后痊愈。
另一个男子足趾患脱疽，颜色紫暗且不痛，隔蒜灸了五十多壮，仍然不知道疼痛，又直接艾灸一百壮后才感到疼痛。再投用仙方活命饮四剂，然后用托里药促使脓溃排出而痊愈。（《心法》中韩判官的症状相同，灸法也相同，后来用败毒散加金银花、白芷而痊愈。）
还有一个男子足趾疼痛不明显，颜色赤红且肿胀，让他隔蒜灸直到疼痛停止。用人参败毒散去桔梗，加金银花、白芷、大黄使疮疡溃破。再加用仙方活命饮而痊愈。这种病症情势虽然看似轻微，但危害极大，必须用隔蒜灸，不痛的应该用灸法，希望能稍微减轻其毒性。这大多是因为长期食用肥甘厚味、酒面炙烤爆炒食物，积毒所致。或者不慎房事劳损，肾水枯竭；或者服用丹石补药，导致先口渴而后发病，也有先发病而后口渴的，这都是因为肾水干涸不能制约虚火的原因。初发时颜色发黑的属于不治之症，颜色赤红的说明肾水未干，还可以治疗。如果失于解毒，导致肌肉坏死颜色变黑，必须紧急截除，拖延则黑色蔓延至足部必然死亡。此病不同于一般的肿痛溃烂，只有隔蒜灸有效。也有颜色发红作痛而自行溃破的，元气未脱，容易治疗。由于病位在至阴之下（下肢末端），气血难以到达，毒素不易腐化，药力也不易达到，况且所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，所以隔蒜灸并配合割除坏死组织，是最为良策。所以孙思邈说：“在指头就截肢，在肉上就割除”，就是这个意思。
有一个男子脚背患此病，赤肿疼痛，令其隔蒜灸三十多壮，疼痛停止。服用仙方活命饮，四剂后溃破。再用托里消毒药而痊愈。
有一个男子足趾患此病，颜色赤红疼痛，口渴，隔蒜灸数壮，服用仙方活命饮，三剂后溃破。再服用托里药，以及加减八味丸，溃破脱落后痊愈。
有一个男子足趾患此病，颜色黑且不痛，令其直接艾灸三十多壮后感到疼痛。庆幸他饮食如常，嘱咐紧急割除，速服补益药剂。他不相信，延误病情导致毒气上行，最终无法救治。
有一个男子脚背患此病，颜色黯黑而不肿痛，烦躁大渴，尺脉大而涩。这是精气已经衰竭，属于不治之症。后果果然如此。
杨太仆年过四十，左足大趾赤肿疼痛，这是脾经积毒下注所致，就是脱疽。庆幸颜色赤红且疼痛，用人参败毒散去人参、桔梗，加金银花、白芷、大黄，服用两剂。再用栝蒌、金银花、甘草节，四剂后症状顿退。再用十宣散去桔梗，加金银花、防己，服用几剂后痊愈。
一个吃肥甘厚味的人年过五十，患此病，颜色紫黑，脚部疼痛。孙思邈说：脱疽之症，应紧急截除。毒气蔓延至心腹必不治，颜色黑且不痛的也不治。庆幸他饮食如故，动静安宁，属于疮疡中的善症，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，患趾溃脱。再用川芎、当归、地黄、连翘、金银花、白芷，二十多剂后痊愈。
一个底层医者左足趾患一水泡，麻木色赤，次日脚趾变黑，五日足部变黑冷，不知疼痛，脉象沉细，这是脾胃受毒所致。服用飞龙夺命丹一剂，第二天令其割去足上死黑肉。割后骨头才感到疼痛，说明还有救，于是用十全大补汤治疗而痊愈。黑色的肉乃是毒气旺盛，拒绝荣气运行所致。何况病在至阴之下，气血难达，经书说“风淫末疾”，就是这个道理。先前若用攻伐之法，则邪气更盛，乘虚上侵必然无法救治。
海山骄奢淫逸无度，强行兼并民居田宅妇女，竟然占据了山东的一半土地。陆宣子是山东名医。有一富商的岳母，足小趾生疮，形状像细米，疮头早白，根部像熟枣，脏腑感觉空虚欲坠。听说海山的名声，延请他诊治，他说：“这是粟米疮，与人面疮等同，七日毒气上升，遍体腐烂成黑水而死。您想活命，应当紧急切断脚趾，切断就能好。”海山自己也长了这种疮，嘱托陆宣子诊治。陆宣子仍说前面的话，海山大怒，想杀了他。楚国人丁维章，以外科闻名，出入宫廷禁地，海山邀请他到家中，告诉了他陆宣子的话。并且说：“你看了我的疮没事，我就杀了你。”丁维章仔细看了看说：“杀我可以，为什么要怪罪陆宣子？现在已经过了三天，毒气已经上升了。您想活吗？切断膝盖还可以。”海山瞪眼说：“既然如此，”连续问了三个问题，回答都如回声般迅速。海山感叹道：“我的命在您手里了。”回头让左右拿截刀，伸出脚说：“斩。”左右侍从颤抖，海山怒骂让他们斩，于是切断了一条腿。丁维章提着海山的头发，靠柱子坐下，海山面色黄，气息断绝。丁维章说：“可以迅速召请之前的医生。”陆宣子到了，看到那条被截掉的腿还在跳跃，黑血淋漓，命令取人参一斤，浓煎灌入他口中，一会儿海山苏醒。看着他的脚说：“唉，砍脚刑罚已经很重了，何辜而要砍膝盖，幸亏您治疗我，我自今以后或许可以没有后患。”过了四十九天，右膝毒气发作，又长出人面疮。医生说：“不能再活了。”海山几天后死了。凡是他掠夺的民家财产，都散尽了，他的哥哥又回到最初乞讨的生活。
(Tuoju, also known as gangrene of the toes, refers to ding sores (hard, deep-rooted boils) occurring on the toes, or where the foot wastes away and naturally falls off, hence the name. There are also cases occurring on the fingers, called Zhujie Ding (nodular joint ding), where severe cases corrode the finger joints, and mild cases cause tendon curvature.)
A man suffered from Tuoju in his toe; it was painful, red, accompanied by fever. He was treated with garlic-partitioned moxibustion. Additionally, he took Renshen Baidu San (Ginseng Detoxification Powder) with Jiegeng (Platycodon Root) removed, and added Yinjinhua (Honeysuckle Flower), Baizhi (Angelica Dahurica Root), and Dahuang (Rhubarb Root). The pain ceased. Subsequently, he took Shixuan San (Ten Acupoints Powder) with Jiegeng and Guigui (Cinnamon Twig) removed, and added Huafen (Trichosanthes Root). After several doses, he recovered.
Another man suffered from Tuoju in his toe; the color was purple and there was no pain. He underwent garlic-partitioned moxibustion for over fifty moxa cones but still felt no pain. Direct moxibustion was then applied for one hundred cones before he felt pain. He was then administered Xianfang Huoming Yin (Immortal Recipe for Saving Lives Decoction) for four doses, followed by Tuoli medicines (tonifying interior remedies) to promote suppuration and healing. (In *Xinfa*, the case of Magistrate Han presented identical symptoms and treatment; he recovered after taking Baidu San with added Yinjinhua and Baizhi.)
A third man suffered from Tuoju in his toe; the pain was slight, but the area was red and swollen. Garlic-partitioned moxibustion was applied until the pain stopped. He took Renshen Baidu San with Jiegeng removed, adding Yinjinhua, Baizhi, and Dahuang to induce suppuration. This was followed by Xianfang Huoming Yin, leading to recovery. Although the clinical presentation appeared mild, the malignancy was severe. Garlic-partitioned moxibustion is essential; for non-painful cases, moxibustion should be used to mitigate toxicity. This condition is often caused by the accumulation of toxins from a diet rich in fatty, sweet, strong-flavored foods, alcohol, wheat products, and roasted/fried items. It may also result from sexual indiscretion depleting Kidney Water, or from taking Dan-Shi tonics, leading to thirst preceding or following the onset of disease. In all these cases, the depletion of Kidney Water fails to control Fire. Initial black discoloration indicates an untreatable condition, whereas redness suggests Kidney Water is not yet exhausted and treatment is possible. If detoxification is neglected, leading to necrosis and blackening, immediate amputation is required; delay allows the blackness to spread up the foot, resulting in death. Unlike ordinary swelling and suppuration, only garlic-partitioned moxibustion is effective here. Cases presenting with redness, pain, and spontaneous suppuration indicate intact Yuan Qi and are easier to treat. Since the lesion occurs at the "Extreme Yin" lower extremities, Qi and Blood struggle to reach the site, making toxin resolution difficult and medicinal efficacy limited. Moreover, systemic medications primarily affect the intestines and stomach rather than directly attacking the local toxin. Therefore, garlic-partitioned moxibustion combined with surgical excision is the optimal method. As Sun Simiao stated: "Amputate if on the digit; excise if on the flesh."
A man suffered from this condition on the dorsum of his foot; it was red, swollen, and painful. Garlic-partitioned moxibustion was applied for over thirty cones, stopping the pain. He took Xianfang Huoming Yin for four doses, inducing suppuration, and recovered after taking Tuoli Xiaodu medicines (interior-tonifying and detoxifying remedies).
A man suffered from this condition in his toe; it was red, painful, and accompanied by thirst. Garlic-partitioned moxibustion was applied for several cones, followed by Xianfang Huoming Yin for three doses, inducing suppuration. He then took Tuoli medicines and Jiajian Bawei Wan (Modified Eight-Ingredient Pill), recovering after the necrotic tissue sloughed off.
A man suffered from this condition in his toe; it was black and painless. Direct moxibustion was applied for thirty cones, inducing pain. Fortunately, his appetite remained normal. Urgent excision and rapid administration of tonic preparations were advised. He refused, allowing the toxin to ascend, leading to an incurable state.
A man suffered from this condition on the dorsum of his foot; it was dark, non-swollen, and painless, accompanied by irritability, intense thirst, and a large, choppy Chi pulse (Kidney position). This indicated exhaustion of Essence and Qi, rendering it untreatable. The outcome proved correct.
Grand Steward Yang, over forty years old, suffered from red, swollen, and painful left big toe, caused by accumulated heat-toxin in the Spleen channel sinking downward—this is Tuoju. Fortunately, the redness and pain indicated viable Qi. He took Renshen Baidu San with Renshen and Jiegeng removed, adding Yinjinhua, Baizhi, and Dahuang for two doses. Then, using Gualou (Trichosanthes Fruit), Yinjinhua, and Gancao Jie (Licorice Joint), symptoms subsided rapidly after four doses. Finally, Shixuan San with Jiegeng removed, adding Yinjinhua and Fangji (Stephania Root), cured him after several doses.
A person accustomed to rich foods, over fifty years old, suffered from this condition; the toe was purple-black and painful. Sun Simiao stated: "For Tuoju, urgent amputation is required. If the toxin spreads to the heart and abdomen, it is untreatable; black, painless lesions are also untreatable." Fortunately, his diet and rest were normal, indicating a favorable prognosis for a sore. He took Linqiao Xiaodu San (Forsythia Detoxification Powder) for six doses, followed by Yinjinhua, Gancao Jie, and Gualou for over twenty doses, causing the affected toe to suppurate and slough off. Recovery was achieved after another twenty doses of Xiong (Ligusticum Rhizome), Gui (Angelica Sinensis Root), Di (Rehmannia Root), Linqiao, Yinjinhua, and Baizhi.
A humble practitioner developed a blister on his left big toe, numb and red. 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, indicating toxin affecting the Spleen and Stomach. One dose of Feilong Duoming Dan (Flying Dragon Life-Taking Pill) was administered. The next day, the dead black flesh was surgically removed. Bone pain upon cutting indicated salvageability. He was treated with Shiquan Dabu Tang (Complete Great Tonifying Decoction) and recovered. The black flesh resulted from excessive toxic qi rejecting Ying and Wei Qi circulation. Given the location at the Extreme Yin, Qi and Blood cannot easily reach, consistent with the Classic's statement: "Wind excess causes diseases in the extremities." Had aggressive purgatives been used initially, the pathogenic factor would have intensified, invading the deficiency upward, leading to certain death.
Haishan was arrogant, licentious, and unbridled, forcibly annexing lands, houses, and women of commoners, controlling half of Shandong Province. Lu Xuanzi was a renowned physician in Shandong. A wealthy woman’s mother-in-law had a sore on her little toe, resembling a grain of millet, with a white head and a root like a ripe date. She felt visceral emptiness and a sense of falling. Hearing of Haishan’s fame, she summoned him. He diagnosed: "This is Sumi Chuang (Millet Sore), equivalent to Renmian Chuang (Human Face Sore). In seven days, the toxin will ascend, causing whole-body rotting into black water death. To survive, you must urgently amputate the toe." Haishan himself developed this sore and consulted Lu Xuanzi. Lu gave the same advice. Haishan was furious and wanted to kill him. Ding Weizhang, a Chu native famous for surgery and frequenting the palace, was invited by Haishan. Haishan relayed Lu’s words and said, "If you say my sore is harmless, I will kill you." Ding examined it closely and said, "You may kill me, but why blame Lu? Three days have passed; the toxin has ascended. If you wish to live, amputation at the knee is the only option." Haishan stared and asked three questions, receiving immediate answers. Haishan sighed, "My life is in your hands." He ordered his attendants to bring an amputation knife, extended his leg, and said, "Cut." The attendants trembled. Haishan cursed them to cut, and a leg was severed. Ding held Haishan’s hair, leaning against a pillar. Haishan’s face was yellow, and his breath seemed to cease. Ding said, "Summon the previous doctor immediately." Lu arrived and saw the severed leg still twitching, with black blood dripping. Lu ordered one jin (approx. 500g) of Renshen decocted strongly and forced down Haishan’s throat. Soon, Haishan revived. Looking at his remaining limb, Haishan said, "Alas, foot amputation is already a heavy punishment; what sin warranted knee amputation? Thanks to your treatment, I may avoid future complications." Forty-nine days later, toxin erupted at the right knee, growing a Human Face Sore again. The doctor declared, "He cannot be saved." Haishan died within a few days. All property seized from the people was dispersed; his brother returned to begging as before.