bubble_chart Concept

Chronic shank ulcer refers to sores and ulcers that occur on the inner and outer sides of the shank bone (now known as the tibia). Those occurring on the inner side are called inner chronic shank ulcers, while those on the outer side are called sores on the lateral side of the shank. Because they are difficult to heal, they are commonly referred to as "old rotten legs."

Skirt wind and trouser cuffs (skirt edge sores, also known as trouser cuff wind sores, as mentioned in the "Complete Book of Sore and Wound Doctors") are similar to chronic shank ulcers and are often discussed together in ancient literature. However, the two differ in terms of disease cause and symptoms and signs.

bubble_chart Pattern Analysis

1. Dampness-heat︰Initially, there is local redness, swelling, and pain, followed by ulceration, spreading itching, and profuse pus discharge. In the late stage [third stage], the edges of the sore become hard and raised, and it does not heal for a long time. In severe cases, there may be aversion to cold with fever, dry mouth, yellow urine, slippery and rapid pulse, and yellow greasy tongue coating. It is mostly caused by external exposure to dampness, which enters the interior and stagnates, transforming into heat. Dampness-heat invades the Yangming Jingmai. The Yangming channel is abundant in qi and blood, and when qi and blood are steamed by heat, the skin and flesh ulcerate, forming chronic shank ulcer. Treatment should focus on clearing heat and removing toxin. The prescription used is Immortal Formula Life-Saving Decoction, supplemented with Areca Seed and other ingredients.
2. Spleen Deficiency with Dampness Retention︰The ulcer presents with pale grayish flesh, profuse and thin pus discharge, swelling that worsens in the evening, limb fatigue, loss of appetite, dizziness, and dry mouth. The pulse is slow, the tongue texture is pale, and the coating is white. This is often due to overexertion damaging the middle qi, or prolonged standing and excessive heavy lifting, which impair spleen qi, leading to lingering dampness and malnutrition of the skin, resulting in chronic shank ulcer. The key points of differentiation are: for cases caused by dampness-heat pouring down, there is local redness, swelling, ulceration, and severe itching, with a slippery and rapid pulse, and a yellow, greasy tongue coating; for cases caused by spleen deficiency with excessive dampness, the local flesh appears pale grayish, the pus is thin and clear, the pulse is slow, and the tongue coating is thin and white. Treatment should focus on invigorating the spleen and resolving dampness, using Four Gentlemen Decoction combined with Two Wonderful Herbs Pill.
3. Qi Stagnation and Blood Stasis︰The local skin appears purplish-dark with prominent veins, ulceration and erosion, accompanied by stabbing pain, heaviness and numbness in the lower limbs, which worsens when walking. The pulse is wiry and choppy, and the tongue is purple with a thin coating. This is an excess pattern caused by qi stagnation and blood stasis, external invasion of dampness, or mosquito bites leading to local ulceration, or skin trauma resulting in collateral obstruction, ultimately causing ulceration and oozing in the lower leg. The treatment should focus on promoting blood circulation and regulating qi, using the Flowering Quince Fruit and Areca Seed Powder.
4. Liver-kidney Yin Deficiency︰The area is not painful or slightly painful, with a dark red color, accompanied by low-grade fever or afternoon fever, poor appetite, insomnia and dreamfulness, rapid pulse, red tongue texture, and thin coating. It is a deficiency pattern. The common features of both are a prolonged course and a dark local color, but their disease causes and symptoms are distinctly different. It often occurs after tuberculosis, or excessive sexual activity depletes kidney essence, leading to gradual wasting of the lower limb muscles, compounded by the downward flow of yin fire. The key points for differentiation are: in cases of blood stasis and qi stagnation, the lower limbs exhibit prominent green veins, with obvious distending pain, a purple tongue, and a choppy pulse; in cases of liver-kidney yin deficiency, there is low-grade fever, emaciation, a thin and rapid pulse, and a tender red tongue texture. Treatment should focus on nourishing yin and reducing fire, using the formula Six-Ingredient Rehmannia Pill.

Chronic shank ulcers are divided into external and internal types. Generally, external ulcers are related to the three yang meridians of the foot and are often caused by dampness-heat, making them easier to treat. Internal ulcers are related to the three yin meridians of the foot and are usually caused by yin deficiency with effulgent fire, making them more difficult to treat. In terms of the appearance of the ulcer, those that are red, swollen, and painful are easier to treat, while those that are dark, dull, and diffusely swollen are harder to treat. External ulcers are often treated with clearing and draining formulas, while internal ulcers are treated with nourishing and tonifying formulas. The approaches of clearing and nourishing are distinctly different.

bubble_chart Documentation

1. 《Dong Tian Ao: Internal Sore on Lateral Side of Shank》: "Prolonged indulgence in sexual activities can lead to darkened skin, rotting flesh, and unbearable foulness. Similarly, when women experience menstrual blood stagnation, it often results in darkened flesh and muscle decay, leading to conditions that persist for years without healing. Therefore, if men or women develop an internal sore on the lateral side of the shank, it is essential to practice moderation in sexual activities and be cautious in the bedroom to facilitate recovery..."