《病机》云∶破伤风者，同伤寒证治，通于表里，分别阴阳。有在表，有在里，有在半
表半
河间曰∶破伤风者从外至内，甚于内者则病也。因此，猝暴伤损，风袭之间，传播经络，
至使寒热更作，身体反强，口噤不开，甚者邪气入脏，则分汗下之治。诸疮不瘥，营卫虚，
肌肉不生，疮眼不合者，风邪亦能外入于疮，为破伤风之候，故诸疮不瘥。吁！世皆言着灸
为上，是为热疮，而不知火热客毒逐经，诸变不可胜数，微则发热，甚则生风而搐，或角弓
反张，口噤目邪，皆因疮郁结于营卫，不得宣通而生。亦有破伤不灸而病此者，疮着白痂，
疮口闭塞，气难通泄，故阳热亦为郁结，而热甚则生风也。故表脉浮而无力，太阳也；脉长
而有力者，阳明也；脉浮而弦小者，少阳也。太阳宜汗，阳明宜下，少阳宜和。若明此三法，
而治不中病者未之有也。
羌活防风汤（《拔粹》方）治破伤风，邪初传在表。
羌活 防风 川芎 本 当归 芍药 甘草（各一两） 地榆 细辛（各二两）
上咀。每服五七钱，水一盏半，同煎至七分，去渣，热服，不拘时候。量紧慢加减用
之，热则加大黄二两；大便秘则加大黄一两，缓缓令过。
白术防风汤（《拔粹》方）若服前药之过，有自汗者，宜服此药。
白术 黄 （各一两） 防风（二两）
上 咀。每服五七钱，水一盏半，煎至一盏，去渣，温服，不拘时候。
脏腑和而有自汗，可用此药。
破伤风脏腑秘、小便赤、自汗不止者，因用热药汗出不休，故知无寒也，宜速下之。先
用芎黄汤，三二服后，用大芎黄汤下之。
芎黄汤（《拔粹》方）
川芎（一两） 黄芩（六钱） 甘草（二钱）
上 咀。每服五七钱，水一盏半，同煎至七分，去滓，温服，不拘时候。三服即止，再
用下药。
大芎黄汤（《拔粹》方）
川芎 羌活 黄芩 大黄（各一两）
上 咀。依前煎服。宜利为度。
羌活汤（《拔粹》方）治半在表半在里。
羌活（去芦） 菊花（去梗） 麻黄（去根、节） 川芎 白茯苓（去皮） 防风（去
芦） 石膏（研）前胡（去芦） 黄芩 蔓荆子 细辛（去叶） 甘草（炙） 枳壳（各一
两） 薄荷 香白芷（各半
上 咀。每服一两，水二盏，生姜五片，煎至一盏，去滓，通口服，食后滓再煎服。
白术汤（《拔粹》方）治伤破风大汗不止，筋挛搐搦。
白术 葛根 芍药 升麻 黄芩（各五钱） 甘草（炙，二钱半）
上 咀。每服一两，水二盏，煎至一盏，去滓，温服，不拘时。
江鳔丸（《拔粹》方）治破伤风惊而发搐，脏腑秘涩，知病在里，可用江鳔丸下之。
江鳔（锉，炒） 野鸽粪（炒） 白僵蚕（各五钱） 雄黄（一两） 蜈蚣（一对） 天
麻（一两）
上为末，作三分，二分用烧饭丸桐子大，朱砂为衣，一分巴豆霜二钱半，亦烧饭丸桐子
大。每服朱衣丸三十丸，加巴豆霜丸一丸，第二服加二丸，加至利为度，再服朱砂丸，病愈
止。
蜈蚣全蝎散 治破伤风搐搦，角弓反张。
蜈蚣（去毒，炒，一条） 全蝎（一对，炒，去毒并头足）
上为细末。如发时用一字或二字擦牙缝内，或吹鼻中。
防风汤（《拔粹》方）治破伤风，同伤寒表证未传入里，宜急服此药。
防风 羌活 独活 川芎（各等分）
上 咀。每服五钱，水一钟半，煎至七分，去滓，温服。二三服后，宜调蜈蚣散，大效。
蜈蚣散（《拔粹》方）
蜈蚣（一对） 江鳔（三钱） 左盘龙（五钱，炒，烟尽用）
上为细末，用防风汤调下。如前药解表不已，觉转入里，当服左盘龙丸微利，看大便硬
软，加巴豆霜服之。
左龙丸（《拔粹》）方
左盘龙 白僵蚕 鳔（各五钱，炒） 雄黄（一钱）
上为细末，烧饼为丸，如桐子大。每服十五丸，温酒下。如里证不已，当于左龙丸一处
半内入巴豆霜半钱，烧饼为丸如桐子大，每服一丸，同左龙丸一处合服，每服药中一丸，如
此渐加服，至利为度。若利后更服后药。若搐 不已，亦宜服后药，羌活汤也。
羌活汤（《拔粹》方）
羌活 独活 防风 地榆（各一两）
上 咀。每服五钱，水一盏半，煎至一盏，去渣，温服。如有热加黄芩，有涎加半夏。
若病日久，气血渐虚，邪气入胃，宜养血为度。
养血当归地黄汤
当归 地黄 芍药 川芎 本 防风 白芷（各一两） 细辛（五钱）
上 咀。依前煎服。
地榆防风散 治破伤中风，半在表半在里，头微汗，身无汗。不可发汗，宜表里治之。
地榆 防风 地丁香 马牙苋（各等分）
上为细末。每服三钱，温米饮调下。
秘传止血定痛生肌散 专治跌打损伤，牙咬刀伤出血，诸般肿毒出脓后，肌肉不生，痛
不止者，并皆治之。
真龙骨（ ，三钱） 白芷（二钱五分） 黄丹（飞过，五钱） 软石膏（ 去火毒，
一两） 血竭（二钱） 乳香（三钱） 没药（三钱） 樟脑（少许）
上为细末。磁罐掺患处，血止、痛定、肌生，累用应效如神。如若肿毒顽疮收口，先用
此药掺疮口，再用白膏药贴之，肌生收口（方见肿毒门）。
秘传破伤风方
初觉有风，急取热粪堆内蛴螬虫一二个，用手捏住，待虫口中吐出水，就抹在破处，身
穿稍浓衣裳，待少时疮口觉麻，两胁微汗，风出立效。如风紧，急速取此虫三五个，剪去尾，
肚内黄水自出，涂疮口，再滴些少，入热酒饮之，汗出立效。
秘传独圣散 治破伤风五七日未愈，已至角弓反张，牙关紧急，服之立有神效。
蝉蜕（去头足、土，净，五钱）
上为末。用好酒一碗，煎滚服之，立苏为妙。
以上三方秘传，累用得效，故附于末。
如圣散（《圣惠方》）治破伤风，止血定痛。
苍术（六两） 川乌头（炮，去皮，四两） 防风 草乌头（炮，去皮） 细辛（各二
两半） 两头尖（炮去皮，四两） 天麻 川芎 白芷（各两半） 蝎梢（微炒） 雄黄（各
半两） 损骨加乳香（半两）
上为细末。每服一钱，酒调下，不拘时服。
蜈蚣散 治破伤风，搐搦，角弓反张。
蜈蚣（去毒，炒，一条） 全蝎（一对，炒，去毒）
上为细末。如发时用一字或二字擦牙缝内，或吹鼻中。
一方治破伤风欲死者
川乌 南星 半夏（并生） 天麻（去芦，等分）
上为细末。每服一钱，豆淋酒调下，稍温服。次以酒三盏投之。
According to *Bingji* (Pathogenesis): Traumatic tetanus shares similar syndrome differentiation and treatment principles with Cold Damage (Shanghan), involving both exterior and interior levels, requiring differentiation between Yin and Yang. The pathogenic factor may be in the exterior, in the interior, or at the half-exterior half-interior level.
Hejian (Liu Wansu) stated: Traumatic tetanus originates from external invasion into the interior; when it becomes severe within the interior, disease manifests. Thus, following sudden traumatic injury, wind pathogens invade and spread through the meridians, causing alternating chills and fever, generalised rigidity and opisthotonos, trismus (lockjaw), and inability to open the mouth. In severe cases, where evil qi enters the zang organs, treatments of sweating (diaphoresis) or purging are applied respectively. When various sores fail to heal due to deficiency of Ying and Wei (defensive and nutritive qi), resulting in failure of muscle regeneration and wound closure, wind pathogens can also enter externally through the sores, constituting the condition of traumatic tetanus; hence, chronic non-healing sores are associated with this. Alas! The world generally considers moxibustion as the superior method, but this applies only to heat sores. They do not realise that fire-heat toxic factors follow the meridians, producing countless variations: mild cases present with fever, while severe cases develop wind-induced convulsions, opisthotonos, trismus, and strabismus. These arise because sores cause stagnation in Ying and Wei, preventing their free circulation. There are also cases where traumatic tetanus occurs without prior moxibustion; a white scab forms over the wound, blocking the opening and preventing the smooth discharge of qi, leading to stagnation of yang-heat, which generates wind when heat is excessive. Therefore, a floating but weak pulse indicates Taiyang disease; a long and forceful pulse indicates Yangming disease; a floating, wiry, and small pulse indicates Shaoyang disease. Taiyang disease is suitable for diaphoresis (sweating); Yangming disease is suitable for purging; Shaoyang disease is suitable for harmonising. If these three methods are understood clearly, there will be no case where treatment fails to hit the mark.
Qianghuo Fangfeng Tang (Cnidium and Saposhnikovia Decoction) [from *Bacui Fang*]: Treats traumatic tetanus where the pathogen has just transmitted to the exterior.
Ingredients: Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Bencao (Ligustici Rhizoma), Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix), Gancao (Glycyrrhizae Radix et Rhizoma) (each 1 liang); Diyu (Sanguisorbae Radix), Xixin (Asari Radix et Rhizoma) (each 2 liang).
Preparation: Coarsely crush the herbs. For each dose, use 5–7 qian, add 1.5 zhong of water, decoct until 0.7 zhong remains, remove dregs, and take hot. Take at any time. Adjust dosage based on the severity of the condition; if heat signs are present, add Dahuang (Rhei Radix et Rhizoma) 2 liang; if constipation is present, add Dahuang 1 liang, allowing gradual bowel movement.
Baizhu Fangfeng Tang (Atractylodis Macrocephalae and Saposhnikovia Decoction) [from *Bacui Fang*]: If previous medication causes excessive spontaneous sweating, this formula is suitable.
Ingredients: Baizhu (Atractylodis Macrocephalae Rhizoma), Huangqi (Astragali Radix) (each 1 liang); Fangfeng (Saposhnikoviae Radix) (2 liang).
Preparation: Coarsely crush the herbs. For each dose, use 5–7 qian, add 1.5 zhong of water, decoct until 1 zhong remains, remove dregs, and take warm. Take at any time.
Indication: Suitable for cases where zang-fu harmony is restored but spontaneous sweating persists.
For traumatic tetanus presenting with internal constipation, reddish urine, and persistent spontaneous sweating caused by excessive sweating from hot medicines, indicating absence of cold pathogens, rapid purging is indicated. First administer Xionghuang Tang (Chuanxiong and Scutellaria Decoction); after 2–3 doses, administer Da Xionghuang Tang (Greater Chuanxiong and Scutellaria Decoction).
Xionghuang Tang (Chuanxiong and Scutellaria Decoction) [from *Bacui Fang*]:
Ingredients: Chuanxiong (Ligustici Chuanxiong Rhizoma) (1 liang), Huangqin (Scutellariae Radix) (6 qian), Gancao (Glycyrrhizae Radix et Rhizoma) (2 qian).
Preparation: Coarsely crush the herbs. For each dose, use 5–7 qian, add 1.5 zhong of water, decoct until 0.7 zhong remains, remove dregs, and take warm. Take at any time. Stop after 3 doses, then proceed with purging formulas.
Da Xionghuang Tang (Greater Chuanxiong and Scutellaria Decoction) [from *Bacui Fang*]:
Ingredients: Chuanxiong (Ligustici Chuanxiong Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix), Huangqin (Scutellariae Radix), Dahuang (Rhei Radix et Rhizoma) (each 1 liang).
Preparation: Coarsely crush the herbs. Decoct and take as previously described. Aim for unobstructed bowel movements.
Qianghuo Tang (Notopterygia Decoction) [from *Bacui Fang*]: Treats pathogenic factors at the half-exterior half-interior level.
Ingredients: Qianghuo (Notopterygii Rhizoma et Radix, remove rhizome head), Juhua (Chrysanthemi Flos, remove stems), Mahuang (Ephedrae Herba, remove roots and joints), Chuanxiong (Ligustici Chuanxiong Rhizoma), Baifuling (Poria cum Ligno, remove peel), Fangfeng (Saposhnikoviae Radix, remove rhizome head), Shigao (Gypsum Fibrosum, crushed), Qianhu (Peucedani Radix, remove rhizome head), Huangqin (Scutellariae Radix), Manjingzi (Viticis Semen), Xixin (Asari Radix et Rhizoma, remove leaves), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried), Zhike (Aurantii Fructus Immaturus) (each 1 liang); Bohe (Menthae Haplocalycis Herba), Xiangbaizhi (Angelicae Dahuricae Radix) (each 0.5 liang).
Preparation: Coarsely crush the herbs. For each dose, use 1 liang, add 2 zhong of water and 5 slices of Shengjiang (Zingiberis Rhizoma Recens), decoct until 1 zhong remains, remove dregs, and drink orally. After meals, decoct the dregs again and consume.
Baizhu Tang (Atractylodis Macrocephalae Decoction) [from *Bacui Fang*]: Treats traumatic tetanus with profuse sweating, muscle spasms, and convulsions.
Ingredients: Baizhu (Atractylodis Macrocephalae Rhizoma), Gegen (Puerariae Lobatae Radix), Shaoyao (Paeoniae Radix), Shengma (Cimicifugae Rhizoma), Huangqin (Scutellariae Radix) (each 5 qian); Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) (2.5 qian).
Preparation: Coarsely crush the herbs. For each dose, use 1 liang, add 2 zhong of water, decoct until 1 zhong remains, remove dregs, and take warm. Take at any time.
Jiangbiao Wan (Fish Maw Pill) [from *Bacui Fang*]: Treats traumatic tetanus with fright-induced convulsions and internal constipation, indicating interior pathology, suitable for purging with Jiangbiao Wan.
Ingredients: Jiangbiao (Ostrei Concha, cut and fried), Yegefen (Columbae Wildi Faeces, fried), Baijiangcan (Bombyx Batryticatus) (each 5 qian), Xionghuang (Realgar) (1 liang), Wugong (Centipedae Corpus) (1 pair), Tianma (Gastrodiae Rhizoma) (1 liang).
Preparation: Grind into fine powder. Divide into three parts. Use two parts mixed with steamed rice to form pills the size of wutong seeds, coated with Zhusha (Cinnabar). Use one part mixed with Badoushuang (Crotonis Seminis Oleum) 2.5 qian, also formed into pills the size of wutong seeds using steamed rice. Each dose consists of 30 Zhusha-coated pills plus 1 Badou pill. Increase by 1 pill per dose until bowel movement is achieved, then resume taking Zhusha-coated pills alone until cure.
Wugong Quanxie San (Centipede and Scorpion Powder): Treats traumatic tetanus with convulsions and opisthotonos.
Ingredients: Wugong (Centipedae Corpus, detoxified, fried, 1 piece), Quanxie (Scorpio, 1 pair, fried, detoxified, head and legs removed).
Preparation: Grind into fine powder. During an attack, apply a quantity equivalent to 1–2 zhu (approx. 0.3–0.6 g) to rub between teeth or insufflate into the nose.
Fangfeng Tang (Saposhnikovia Decoction) [from *Bacui Fang*]: Treats traumatic tetanus resembling exterior syndromes of Cold Damage that have not yet entered the interior; administer urgently.
Ingredients: Fangfeng (Saposhnikoviae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Duohuo (Angelicae Pubescentis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma) (equal proportions).
Preparation: Coarsely crush the herbs. For each dose, use 5 qian, add 1.5 zhong of water, decoct until 0.7 zhong remains, remove dregs, and take warm. After 2–3 doses, combine with Wugong San (Centipede Powder) for significant effect.
Wugong San (Centipede Powder) [from *Bacui Fang*]:
Ingredients: Wugong (Centipedae Corpus) (1 pair), Jiangbiao (Ostrei Concha) (3 qian), Zuopanlong (Scolopendrae Corpus, fried until smoke ceases) (5 qian).
Preparation: Grind into fine powder. Mix with Fangfeng Tang for administration. If exterior resolution continues without success and symptoms suggest transmission to the interior, administer Zuopanlong Wan (Left Dragon Pill) to induce mild purgation. Adjust dosage of Badoushuang (Crotonis Seminis Oleum) based on stool consistency.
Zuolong Wan (Left Dragon Pill) [from *Bacui Fang*]:
Ingredients: Zuopanlong (Scolopendrae Corpus), Baijiangcan (Bombyx Batryticatus), Jiangbiao (Ostrei Concha) (each 5 qian, fried), Xionghuang (Realgar) (1 qian).
Preparation: Grind into fine powder. Form pills the size of wutong seeds using roasted bread. Each dose is 15 pills taken with warm wine. If interior symptoms persist, add 0.5 qian of Badoushuang (Crotonis Seminis Oleum) to the Zuolong Wan mixture, form pills the size of wutong seeds using roasted bread. Take 1 pill together with Zuolong Wan. Gradually increase the number of Badou-containing pills until bowel movement is achieved. If diarrhea persists, continue with subsequent medications. If convulsions persist, administer the subsequent formula, Qianghuo Tang.
Qianghuo Tang (Notopterygia Decoction) [from *Bacui Fang*]:
Ingredients: Qianghuo (Notopterygii Rhizoma et Radix), Duohuo (Angelicae Pubescentis Radix), Fangfeng (Saposhnikoviae Radix), Diyu (Sanguisorbae Radix) (each 1 liang).
Preparation: Coarsely crush the herbs. For each dose, use 5 qian, add 1.5 zhong of water, decoct until 1 zhong remains, remove dregs, and take warm. Add Huangqin (Scutellariae Radix) if heat is present; add Banxia (Pinelliae Rhizoma) if phlegm-saliva is present.
If the disease duration is long and qi-blood gradually become deficient with evil qi entering the stomach, blood-nourishing treatment is appropriate.
Yangxue Danggui Dihuang Tang (Blood-Nourishing Angelica and Rehmannia Decoction):
Ingredients: Danggui (Angelicae Sinensis Radix), Dihuang (Rehmanniae Radix Preparata), Shaoyao (Paeoniae Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Bencao (Ligustici Rhizoma), Fangfeng (Saposhnikoviae Radix), Baizhi (Angelicae Dahuricae Radix) (each 1 liang); Xixin (Asari Radix et Rhizoma) (5 qian).
Preparation: Coarsely crush the herbs. Decoct and take as previously described.
Diyu Fangfeng San (Sanguisorba and Saposhnikovia Powder): Treats traumatic tetanus with pathogenic factors at the half-exterior half-interior level, presenting with slight sweating on the head but no sweating on the body. Sweating therapy is contraindicated; treat both exterior and interior simultaneously.
Ingredients: Diyu (Sanguisorbae Radix), Fangfeng (Saposhnikoviae Radix), Didingxiang (Artemisiae Argyi Folium? Note: Text says Di Ding Xiang, likely a specific local herb or typo for another aromatic), Mayaxian (Portulaca Oleracea) (equal proportions).
Preparation: Grind into fine powder. Each dose is 3 qian, taken with warm rice water.
Secretly Transmitted Hemostatic, Pain-Relieving, and Muscle-Regenerating Powder: Specifically treats contusions and injuries, bite wounds, knife cuts with bleeding, and various swelling/toxids after pus discharge where muscles fail to regenerate and pain persists.
Ingredients: Zhen Longgu (Fossilia Ossis Mastodi et Scapulae, calcined) (3 qian), Baizhi (Angelicae Dahuricae Radix) (2.5 qian), Huangdan (Minium) (purified) (5 qian), Ruan Shigao (Gypsum Fibrosum, calcined to remove fire toxicity) (1 liang), Xuexie (Dracaenae Sanguis) (2 qian), Ruxiang (Olibanum) (3 qian), Moyao (Myrrha) (3 qian), Zhangnao (Camphora) (small amount).
Preparation: Grind into fine powder. Apply to the affected area using a porcelain jar. Stops bleeding, relieves pain, and promotes muscle regeneration; repeated use yields miraculous results. For stubborn sores requiring closure, first apply this powder to the wound, then cover with Bai Gaoyao (White Plaster) to promote healing (see Swelling and Toxic section for plaster formula).
Secretly Transmitted Traumatic Tetanus Formula:
At the initial sensation of wind pathogen, quickly take 1–2 larvae (Qi Lao) from a hot manure pile. Hold the larva until water exudes from its mouth, then apply directly to the wound. Wear slightly thick clothing. After a short while, the wound will feel numb, and slight sweating will occur on the flanks, expelling the wind pathogen with immediate effect. If the wind pathogen is urgent, take 3–5 larvae, cut off the tails, allow the yellow fluid from the abdomen to flow out, apply to the wound, and ingest a small amount mixed with hot wine. Sweating will occur with immediate effect.
Secretly Transmitted Dusheng San (Single Sage Powder): Treats traumatic tetanus lasting 5–7 days without improvement, progressing to opisthotonos and trismus. Administer for immediate miraculous effect.
Ingredients: Chantui (Cicadae Periostracum, remove head, feet, and soil, cleaned) (5 qian).
Preparation: Grind into powder. Decoct in 1 bowl of good wine until boiling, then drink. Immediate revival is expected.
The above three formulas are secret transmissions, repeatedly proven effective, and thus appended at the end.
Rusheng San (Like-Sage Powder) [from *Shenghui Fang*]: Treats traumatic tetanus, stops bleeding, and relieves pain.
Ingredients: Cangzhu (Atractylodis Rhizoma) (6 liang), Chuan Wutou (Aconiti Radix Preparata, processed, peeled) (4 liang), Fangfeng (Saposhnikoviae Radix), Cao Wutou (Aconiti Kusnezoffii Radix, processed, peeled), Xixin (Asari Radix et Rhizoma) (each 2.5 liang), Liangtoujian (Lonicerae Japonicae Flos? Or specific root name) (processed, peeled) (4 liang), Tianma (Gastrodiae Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma), Baizhi (Angelicae Dahuricae Radix) (each 1.5 liang), Xeshao (Scorpio tail, lightly fried), Xionghuang (Realgar) (each 0.5 liang). Add Ruxiang (Olibanum) 0.5 liang for bone fractures.
Preparation: Grind into fine powder. Each dose is 1 qian, taken with wine at any time.
Wugong San (Centipede Powder): Treats traumatic tetanus with convulsions and opisthotonos.
Ingredients: Wugong (Centipedae Corpus, detoxified, fried, 1 piece), Quanxie (Scorpio, 1 pair, fried, detoxified).
Preparation: Grind into fine powder. During an attack, apply a quantity equivalent to 1–2 zhu to rub between teeth or insufflate into the nose.
Another Formula for Near-Fatal Traumatic Tetanus:
Ingredients: Chuanwu (Aconiti Radix Preparata), Nanxing (Arisaematis Rhizoma), Banxia (Pinelliae Rhizoma) (all raw), Tianma (Gastrodiae Rhizoma, remove rhizome head) (equal proportions).
Preparation: Grind into fine powder. Each dose is 1 qian, taken with Doulin Jiu (Bean-Infused Wine), slightly warm. Follow with 3 zhong of wine.