《医宗金鉴》总论曰∶跌扑损伤,虽用手法调治,恐未尽得其宜,以致有治如未治之苦
未可云医理之周详也。爰因身体上下正侧之象,制器以正之,用辅手法之不逮,以冀分者
复合,欹者复正,高者就其下,陷者升其位。则危症可转于安,重伤可就于轻,再施以药饵
之功,更示以调养之善,则正骨之道全矣。
裹帘
《医宗金鉴》曰∶裹帘以白布为之,因患处不宜他器,只宜布缠,始为得法,故名裹帘
,其长短阔狭,量病势用之。
振梃
释义云∶凡头被伤而骨未碎、筋未断,虽瘀聚肿痛者,皆为可治。先以手法端提颈项筋
再用布缠头二、三层令紧,再以振挺轻轻拍击足心,令五脏之气,上下宣通,瘀血开散,则
奔心,亦不呕呃,而心神安矣。若已缠头,拍击足心,竟不觉疼,昏不知人,痰响如拽据,
身体僵硬,口溢涎沫,乃气血垂绝也,不治。
披肩
释义云∶凡两肩仆坠闪伤,其骨或断碎,或傍突,或斜努,或骨缝开错筋翻,法当令病
卧凳上,安合骨缝,揉按筋结,先以棉花贴身垫好,复以披肩夹住,肩之前后缚紧,再用
布在外缠裹毕,更用扶手板,长二尺余,宽三、四寸,两头穿绳,悬空挂起,令病者俯伏于
上,不使其肩骨下垂,过七日后开视之,如俱痊,可撤板不用,如尚未愈,则仍用之。若不
根据此治法,后必遗残患芦节。
耀山云∶用水竹半边,长短阔狭,以患处为则,削去棱角,嵌入肩内,其肩下腋肢,再
团一个,实其腋内,外以布带缚定系住,此治肩骨断碎之具,虽比板物较硬,然用之得法,
缚之妥贴,则无动移之患矣。
攀索
《医宗金鉴》曰∶攀索者,用绳挂于高处,以病患两手攀之也。
迭砖
释义云∶凡胸腹腋胁,跌打蹦撞垫努,以致胸陷而不直者,先令病患以两手攀绳,足踏
,将后腰拿住,各抽去砖一块,令病患直身挺胸,少倾,又各抽去砖一块,仍令直身挺胸,
如此者三,其足着地,使气舒瘀散,则陷者能起,曲者可直也。再将其胸以竹帘围裹,用宽
带八条紧紧缚之,勿令窒碍。但宜仰卧,不可俯卧侧卧,腰下以枕垫之,勿令左右移动。
通木
释义云∶凡脊背跌打损伤,膂骨开裂高起者,其人必伛偻难仰。法当令病者俯卧,再着
以两足踏其两肩。医者相其开裂高起之处,宜轻宜重,或端或拿,或按或揉,令其缝合,然
后用木根据前法逼之。
腰柱
释义云∶凡腰间闪挫岔气者,以常法治之。若腰节骨被伤错笋,膂肉破裂,筋斜伛偻者
醋调定痛散,敷于腰柱上,视患处将柱排列于脊骨两傍,务令端正,再用蕲艾做薄褥,复于
柱上,以御风寒,用宽长布带,绕向腹前,紧紧扎裹,内服药饵,调治自愈。
耀山曰∶医者,意也。尝考古人创论立方,虽有根据,以已意参之,总不出情理之中。
骨一道,用手法外,复用器具,盖有意会之处。阅《明史》内载,有谏臣某,因事迭奏忤上
,致延讯时,上令武士,用金瓜锤责其遍体,甚至肋骨击断其二;复令下狱,身加挺棍脚
,手铐刑具,严行监固。挺棍者,较人之长短,以木为之,上锁于颈,下链于踝,中系于手
而及于腰,使囚不能弯曲转侧活动。后上悟,怜其苦谏释之,肋骨俱已接续,未始非挺棍铐
之益也。挺棍与通木相似,械系与扎缚相同,击断者复接续,是以不医医之。今之用器具,
殆即此遗意欤。
竹帘
释义云∶凡肢体有断处,先用手法安置讫,然后用布缠之,复以竹帘围于布外,紧扎之
,使骨缝无参差走作之患,盖通用之物也。
杉篱
释义云∶凡用以围裹于竹帘之外,将所穿之绳结住,再于篱上加绳以缠之,取其坚劲挺
使骨缝无离绽脱走之患也。盖骨节转动之处与骨筋甚长之所,易于摇动,若仅用竹帘,恐挺
劲之力不足,故必加此以环抱之,则骨缝吻合坚牢矣。
陈远公曰∶有跌打骨折,必用杉木或杉板,将折骨凑合端正,以绳缚定,勿偏斜曲,再
扎,不可因疼痛心软,少致轻松,反为害事。后用内服药,如皮破血出,须用外治药,但骨
折而外边之皮不破,即不用外治之药,然内外夹攻,未尝不更佳耳。内治法宜活血去瘀为先
,血不活则瘀不去,瘀不去则骨不能接也。内治用接骨神丹煎服,外治贴全体神膏,再加末
药胜金丹,掺伤处为妙。每膏一张用末药三钱,掺膏上贴之。凡接骨不须二个,至重则用二
个。此绝奇绝异之方,倘未损伤,只贴膏药,不必用胜金丹掺药。内外治法三方,有不可形
容之妙,医者患者得以旦夕奏功,故特为表出,方出《冰鉴》。
谷兰云∶损伤固痛,因痛而以板木缚之则愈痛,愈痛而手软、心软,转致轻松,是痛其
反增其痛,迨至不可医药,悔何及哉!学人务熟习手法,临症时得自然之妙,自无手软、心
软之弊矣。
耀山云∶凡臂骨及小儿颈骨、腿骨、大手膊骨,截断折断、碎断斜断者,不必用大杉篱
用杉木皮尽可。将杉木皮削去粗皮,或三片或二片,如指面大,长短以患处为则。况杉木皮
似竹样阁漏式,合于骨处极为妥贴。又杉木皮挖空,用纸粘裹,可缚手肘手腕,使其能转能
伸,能屈能曲,此夹扎中之活法也。又有竹蔑大片,再以纸包,或用三片、四片,看患处之
宽狭长短,定为法则。又有松木薄板,象今做糕匣者,用纸包裹,安于骨断之处,以棉带紧
扎甚妙。此皆常用验过之器具也。
抱膝
释义云∶膝盖骨复于楗 二骨之端,本活动物也。若有所伤,非骨体破碎,即离位而突
左右。虽用手法推入原位,但步履行止,必牵动于彼,故用抱膝以固之,庶免复离原位,而
遗跛足之患也。其法将抱膝四足插于膝盖两傍,以竹圈辖住膝盖,令其稳妥,不得移动,再
用白布宽带,紧紧缚之。
耀山云∶膝盖骨脆碎或跌碎者,常用纸竹毛篾缠绕一KT ,与膝盖大小相等,再加四绳缚
于KT 上,贴膏药后,即将篾KT 安上,四绳分前后缚之,较之竹圈,稍觉柔软矣。
又云∶以上器具,皆伤科必用之物,又增补试验各具,然未备也。有肩胛出臼,用布带
手上,系于柱间,在带上 者;有腿骨出 ,用阔带缚定腿足,将人抱住,以大 头吓者;
有用硬挺者;有用软骗者,种种器具,总不出缚缠夹扎挺托之法,复其原位,使勿游移活动
为得耳,要在人之活法变动也。
《选粹》云∶凡损伤平处,骨断骨碎,皮不破者,用接骨定痛等膏敷贴。若伤在手足曲
缩之处,要用包裹,可令时时转动。指骨碎者,只用麻片夹缚。腿上用麻绳扎缚。冬月热缚
,夏月凉缚,余月温缚。又云∶骨断皮破者,不可用酒煎药。或损在内而皮破者,可加童便
于破血药内和服。若骨断、皮不破者,可全用酒煎药。若只伤而骨不折、肉不破者,用消肿
膏或定痛膏。又云∶皮里有碎骨,只用定痛膏敷贴夹缚,如十分伤重,自然烂开其肉,碎骨
自出,然后用补肌散,外以补肉膏敷贴。又云∶夹缚处,须药水以时泡洗,春秋三日,夏二
日,冬四日,洗去旧药,须仔细勿惊动伤处,洗讫,仍用前药前膏敷缚。凡换药不可生换,
须用手巾打湿拓润,逐片取脱,随手荡洗换上,又不可停留一时刻,药膏必须预为摊就,随
手换上,此乃敷药之诀,如换膏药亦然。
General Discussion in *Yizong Jinjian* states: For falls and blows causing injury, although manual manipulation is used for treatment, it is feared that the appropriateness may not be fully achieved, leading to the suffering of being treated as if untreated. This cannot be said to reflect a thorough understanding of medical principles. Therefore, based on the morphology of the body's upper and lower parts and its anterior and posterior aspects, devices are manufactured to correct deformities, assisting where manual manipulation falls short, with the hope that separated parts will rejoin, crooked parts will become straight, high parts will be lowered to match low ones, and depressed parts will be elevated to their proper position. In this way, critical conditions can turn into safety, severe injuries can become mild. Furthermore, by applying the efficacy of medicinal herbs and demonstrating proper recuperation methods, the art of bone setting becomes complete.
Wrapping Curtain (Guolian)
*Yizong Jinjian* states: The Wrapping Curtain is made of white cloth. Because other devices are unsuitable for the injured area, only wrapping with cloth is appropriate, hence the name "Wrapping Curtain." Its length, width, and narrowness are determined according to the severity of the condition.
Vibrating Mallet (Zhenting)
The Explanation states: Whenever the head suffers trauma but the bone is not shattered and the tendons are not severed, even if there is blood stasis accumulation with swelling and pain, it is considered treatable. First, use manual manipulation to align and lift the tendons of the neck. Then, wrap the head tightly with two or three layers of cloth. Next, gently tap the soles of the feet with the Vibrating Mallet to promote the free flow of Qi among the Five Viscera (Zang-organs), disperse the blood stasis, prevent Qi from rushing to the Heart (Benxin), avoid vomiting or hiccups, and calm the Spirit (Shen). However, if after wrapping the head and tapping the soles, the patient feels no pain, falls into unconsciousness, produces rattling phlegm sounds like sawing wood, exhibits body rigidity, and foams at the mouth, this indicates that Qi and Blood are on the verge of exhaustion; such cases are untreatable.
Shoulder Cape (Pijian)
The Explanation states: Whenever both shoulders suffer sprain or fall injuries, where bones may be fractured, displaced laterally, protruding obliquely, or where bone joints are misaligned and tendons are flipped, the method requires the patient to lie on a bench. First, realign the bone joints and massage the tendon knots. Place cotton padding close to the skin, then secure the shoulder with the Shoulder Cape, binding it tightly front and back. Finally, wrap the outside with cloth. Use an armrest board, slightly over two chi long and three to four cun wide, with ropes threaded through both ends, suspended in the air. Have the patient lie prone on it to prevent the shoulder bones from sagging. After seven days, inspect the area. If healed, remove the board; if not, continue using it. Failure to follow this treatment will inevitably lead to permanent disability.
Yaoshan states: Use half-split water bamboo, sized to the injured area, with sharp edges removed, and insert it into the shoulder. Under the shoulder and armpit, place another padded object to fill the axilla. Secure externally with cloth bands. This device treats shattered shoulder bones. Although harder than wooden boards, if used correctly and bound securely, there is no risk of displacement.
Climbing Rope (Pansuo)
*Yizong Jinjian* states: The Climbing Rope involves hanging a rope from a high place for the patient to grasp with both hands.
Stacked Bricks (Diezhuan)
The Explanation states: For chest, abdomen, axilla, and hypochondriac injuries caused by falls, blows, or compression resulting in a depressed and straightened chest, first have the patient grasp a rope with both hands and stand on bricks. The physician holds the patient's lower back. Remove one brick from each side, instructing the patient to straighten their body and extend their chest. After a moment, remove another brick from each side, again instructing the patient to straighten and extend. Repeat this three times until the feet touch the ground. This allows Qi to flow freely and stasis to dissipate, raising the depression and straightening the curvature. Afterwards, wrap the chest with a bamboo curtain and bind tightly with eight wide belts to ensure breathing is not obstructed. The patient should only lie supine, not prone or lateral. Place a pillow under the waist to prevent left-right movement.
Through Wood (Tongmu)
The Explanation states: For spinal injuries from falls and blows where the dorsal bone is cracked and elevated, the patient will likely suffer from kyphosis and difficulty extending backward. The method requires the patient to lie prone. The physician places their shoulders under the patient's feet. Observing the cracked and elevated area, the physician determines whether to apply light or heavy pressure, lifting, grasping, pressing, or kneading to realign the fracture. Then, use a wooden device to force alignment according to previous methods.
Waist Pillar (Yaozhu)
The Explanation states: For lumbar sprains and Qi stagnation, use standard treatments. If the lumbar vertebrae are injured and misaligned, muscles are ruptured, and tendons are slanted causing kyphosis, mix Dingtong San (Pain-Relieving Powder) with vinegar, apply it to the Waist Pillar. Arrange the pillars alongside the spine according to the injury site, ensuring they are upright. Cover the pillars with a thin mat made of Qiai (Ai Ye, Mugwort Herb) to protect against wind and cold. Bind tightly with a long wide belt around the abdomen. Administer internal medicine for self-healing.
Yaoshan states: Medicine relies on intent. Examining how ancient masters established theories and formulas, although based on evidence, incorporating personal insight always remains within reason. Bone setting, besides manual therapy, utilizes devices, implying a conceptual connection. Reading the *History of Ming*, it records an censor who offended the Emperor through repeated memorials. During interrogation, the Emperor ordered warriors to beat him with golden melon hammers, breaking two ribs. He was then imprisoned, subjected to the "Tinggun" (a wooden torture device), shackles, and strict confinement. The Tinggun was made of wood, sized to the person, locked at the neck, chained at the ankles, and tied at the hands and waist, preventing bending or turning. Later, the Emperor realized his error, released the censor out of pity for his loyal remonstrance, and found his broken ribs had already united. This was not without benefit from the Tinggun and shackles. The Tinggun resembles Tongmu; shackling resembles binding. Broken bones reunited implies "healing without medicine." The current use of devices likely stems from this legacy.
Bamboo Curtain (Zhulian)
The Explanation states: For limb fractures, after manual reduction, wrap with cloth, then encircle with a bamboo curtain outside the cloth and bind tightly. This prevents bone fragments from shifting or displacing. It is a general-purpose item.
Fir Fence (Shali)
The Explanation states: Used to wrap around the bamboo curtain, securing the ropes, and adding more ropes around the fence to provide firmness and strength, preventing bone joints from separating or sliding. Areas of joint movement or long tendons are prone to shaking. Using only a bamboo curtain may lack sufficient rigidity, so adding this fence to encircle the area ensures firm union of the bone joints.
Chen Yuan Gong states: For fractures from falls and blows, use fir wood or fir boards to align the broken bones properly, bind them with ropes to prevent tilting or bending, and tighten securely. Do not loosen due to sympathy for pain, as this causes harm. Subsequently, use internal medicines. If the skin is broken and bleeding, external treatments are necessary. If the skin is intact despite the fracture, external treatment may be omitted, but combining internal and external treatments is superior. Internal treatment prioritizes invigorating blood and removing stasis; if blood does not circulate, stasis remains, and bones cannot unite. Internally, administer Jiegu Shendan (Bone-Connecting Divine Elixir) decoction. Externally, apply Quantisheng Gao (Whole-Body Divine Plaster), supplemented with Shengjindan (Gold-Surpassing Golden Pill) powder sprinkled on the wound. Use three qian of powder per plaster sheet. Usually, one application suffices; for severe cases, use two. This is an extraordinary formula. If there is no injury, simply applying the plaster without the powder is unnecessary. These three methods of internal and external treatment possess indescribable efficacy, allowing rapid results for both doctor and patient. Hence, they are highlighted here. The formula originates from *Bingjian*.
Gulan states: Injury causes pain. Binding with boards and wood due to pain increases pain. Increased pain leads to laxity in hands and heart, resulting in loosening. This exacerbates the pain. When treatment becomes impossible, regret comes too late. Students must master manual techniques to achieve natural efficacy during clinical practice, avoiding laxity.
Yaoshan states: For fractures of the arm, child's neck, leg, or upper arm, whether cut, broken, shattered, or oblique, large fir fences are not necessary; fir bark suffices. Remove the rough bark from the fir bark, using two or three pieces, sized like a finger nail, with length determined by the injury site. Fir bark has a hollow structure similar to bamboo, fitting the bone perfectly. Hollowed fir bark wrapped in paper can be used for elbows and wrists, allowing rotation, extension, flexion, and bending—this is the flexible method of splinting. Large bamboo strips wrapped in paper, or three to four pieces sized to the injury, are also effective. Thin pine boards, like those used for cake boxes, wrapped in paper and placed at the fracture site, tightly bound with cotton bands, are also excellent. These are all commonly used and verified devices.
Knee Hug (Baoxi)
The Explanation states: The patella covers the ends of the femur and tibia and is naturally mobile. If injured, the bone may shatter or dislocate laterally. Even after manual reduction to the original position, walking or stopping will pull on it. Therefore, use the Knee Hug to stabilize it, preventing re-dislocation and subsequent lameness. Insert the four legs of the Knee Hug beside the knee, secure the knee with a bamboo hoop to ensure stability, and bind tightly with a wide white cloth belt.
Yaoshan states: For brittle or shattered patellae, wrap paper, bamboo, and hair strips into a frame equal in size to the knee. Attach four ropes to the frame. After applying plaster, place the strip frame over the knee and bind with the four ropes front and back. This is softer than a bamboo hoop.
Furthermore, the above devices are essential for orthopedics, yet additional experimental devices exist, though still incomplete. For shoulder dislocations, use cloth bands around the arms tied between pillars. For leg dislocations, bind the leg and foot with wide belts, hold the person, and use a large hammer head to intimidate/reduce. Some use hard supports; some use soft padding. All devices essentially rely on binding, wrapping, splinting, supporting, and holding to restore position and prevent movement. The key lies in the practitioner's flexibility.
*Xuanhui* states: For flat-surface injuries with fractures or comminution but intact skin, apply Jiegu Dingtong Gao (Bone-Setting and Pain-Relieving Plaster). For injuries in flexor areas of hands and feet, use wrapping that allows frequent movement. For crushed finger bones, use hemp片 (hemp slices) for splinting. For legs, use hemp rope binding. Apply hot bindings in winter, cool in summer, and warm in other months. If the bone is broken and skin is lacerated, do not decoct medicine with alcohol. If internal damage exists with skin laceration, add fresh urine (Tongbian, Child's Urine) to blood-breaking medicines for oral administration. If the bone is broken but skin is intact, decoct medicine entirely with alcohol. For soft tissue injuries without bone fracture or muscle rupture, use Xiaozhong Gao (Swelling-Reducing Plaster) or Dingtong Gao. If small bone fragments remain under the skin, apply Dingtong Gao and splint. If the injury is severe enough to cause necrosis and spontaneous expulsion of fragments, apply Bujisan (Muscle-Nourishing Powder) and cover with Burou Gao (Flesh-Replenishing Plaster). Soak splints in medicinal water regularly: every three days in spring/autumn, two days in summer, four days in winter. Wash off old medication carefully without disturbing the injury site, then reapply the same medicine and plaster. When changing dressings, do not peel dry gauze directly. Moisten with a wet towel, peel off layer by layer, wash immediately, and reapply. Do not delay; prepare plasters in advance for immediate application. This is the secret of dressing changes, applicable to plaster replacement as well.