Toe ulceration refers to the condition of ulceration of the toes.

This condition is referred to in ancient medical texts as digital gangrene, Dun Ju, and toe nail gangrene. Ulceration of the big toe is called digital gangrene, while ulceration of the other toes is called Dun Ju, both caused by internal factors. Toe nail gangrene, commonly known as ingrown toenail, is mostly caused by external injuries.

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1. Accumulation of Fire Toxin︰The toes appear purplish-dark or black, with skin ulceration, wounds that intermittently discharge bloody fluid, necrotic flesh that lacks vitality, and pain as intense as a scorching fire, worsening at night to the point of sleeplessness, often forcing the patient to sit clutching their knees. In severe cases, the necrosis spreads, potentially affecting all five toes and even ascending to the dorsum of the foot, gradually leading to gangrene, autoamputation, and prolonged non-healing. The primary causes are: (1) prolonged exposure to cold-dampness, or wading through frigid water, allowing cold-dampness to invade the lower body, resulting in congealing cold and meridian obstruction, impeded blood flow, and failure of yang qi to descend. Over time, cold-dampness stagnates and transforms into heat, leading to excessive heat causing flesh to rot. (2) Excessive consumption of rich, greasy foods, spicy or fried dishes, disrupting gastrointestinal function and generating internal fire-toxin. (3) Overuse of warming and tonifying kidney yang medications, or excessive sexual activity, leading to pathogenic fire scorching yin, with kidney water deficiency failing to control fire. Although these three causes differ, they all result in the accumulation of fire-toxin, Jingmai obstruction, and stagnation of qi and blood, thereby triggering the disease. Key diagnostic points: wounds intermittently discharging pus, necrotic flesh lacking vitality, pain like scorching fire, worsening at night, or even spreading necrosis affecting all five toes; or gangrenous limbs autoamputating. Treatment should promote blood circulation, remove toxin, and unblock collaterals, using Digital Gangrene Formula No. 3, externally applying Granulation-Promoting Jade and Red Paste; if the wound is purplish-black with watery discharge but no pus, tonify and replenish qi and blood, expel toxin, and reduce swelling, using Detoxifying and Supporting Powder plus Unprocessed Rehmannia Root and Achyranthes Root; if prolonged ulceration fails to heal due to dual deficiency of qi and blood, regulate and tonify qi and blood, using Ginseng Nourishing Decoction.
2. External Contraction of Pathogenic Toxin︰It is often seen on the inner side of the big toe. The nail grows inward, the nail bed becomes swollen and ulcerated, with exuberant granulation tissue protruding, pain, and immersion in water. This is followed by suppuration and ulceration, or pus infiltrating beneath the toenail. It is mostly caused by trimming the toenail and injuring the flesh, or by excessively long toenails penetrating the muscle, or by prolonged compression from tight shoes, all of which disrupt the local circulation of qi and blood and lead to infection by toxic qi. Key diagnostic points: often seen on the inner side of the big toe, with swelling and ulceration around the nail, exuberant granulation tissue protruding, and suppuration with ulceration. Treatment should focus on {|###|}clearing heat and removing toxin{|###|}, and Five-Ingredient Toxin-Eliminating Decoction can be used. For external treatment, Ping Ru Dan can be applied to corrode and flatten the granulation tissue, or surgical intervention may be performed.

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1. Waike Dacheng．Digital Gangrene: "It occurs on the big toe, and also on the thumb... caused by the transformation of rich food and the effects of hot medicinal stones. This poison accumulates in the bone marrow; if it does not turn purple-black, the patient may survive, and if it has not passed the joint, it can be treated. If it blackens and spreads to all five toes, ascending to the instep, with withered form, hardened tendons, severe pain, and foul odor, it is fatal. For this condition, if it is in the flesh, it should be cut; if it is in the finger, it should be amputated, to let the tendon follow the bone out, to drain the poison, and also to avoid pain. If one waits until the poisoned tendon breaks internally, even if the bone is removed, it will still be incurable."
2. Waike Dacheng．Toenail Gangrene: "Due to cutting the nail and injuring the flesh, or the nail growing into the flesh, causing the blockage of qi and blood, leading to long-term decay and the formation of sores and blisters; or if the flesh grows over the nail, with swelling and pain of the nail, this is a disease of the muscles, not following the meridians, and also not manifesting in diagnosis."