一两） 乱发（壮年无病男子者，一块） 干蟾（一只，即风鸡） 凤凰胎（一只，即壳中不转头鸡黄也。阴干用） 桃
柳桑枝（各五茎）
上各细切，用香油六斤重，浸药三五日，入锅内熬黑色，去渣入黄丹三斤，别用槐柳枝不住手搅，膏成候温，入后
药末。
乳香 没药 龙骨（各一两） 轻粉（五钱） 血竭（一两） 麝香（二钱）
上搅匀，瓷器收贮，临期看疮大小摊贴。
没药散（录验） 治刀箭伤，止血住痛。
定粉 风化锻石（各一两） 枯白矾（二钱，另研） 乳香（五分，另研） 没药（另研，一字）
上各研为细末，同和匀再研，干掺之。
论
《内经》曰∶风者百病之始也，清净则腠理闭拒，虽有大风苛毒，而弗能为害也。若夫破伤风证，因事击破皮肉，
往往视为寻常，殊不知风邪乘虚而客袭之，渐至变为恶候。又诸疮久不合口，风邪亦能内袭，或用汤淋洗，或着艾焚灸，
其汤火之毒瓦斯，亦与破伤风邪无异。其为证也，皆能传播经络，烧烁真气，是以寒热间作，甚则口噤目斜，身体强直，
如角弓反张之状，死在旦夕，诚可哀悯！治之之法，当同伤寒处治，因其有在表、在里、半表半里三者之不同，故不
离乎汗、下、和三法也。是故在表汗之，在里者下之，在表里之间者宜和解之，又不可过其法也。闾阎野人，多不识此
证杀人之易，早不求医治疗，而袖手待毙，哀哉！
脉法
表脉浮而无力，太阳也。脉长有力，阳明也。脉浮而弦小者，少阳也。
河间曰∶太阳宜汗，阳明宜下，少阳宜和解，若能明此三法而治，不中病者未之有也。
愚按∶河间先生论破伤风脉证，详明甚矣，何其但云三阳，而不及于三阴？盖风邪在于三阳之经，便宜按法早治而
愈。若待传入三阴，其证已危，或腹满自利，口燥咽干，舌卷卵缩，皆无可生之证，故置而弗论也。
方法
丹溪曰∶破伤风同伤寒坏证治，看在何经而用本经药驱逐之，误则杀人。刘河间有法有方，宜选而用之。
（以上丹溪方法凡一条）
羌活防风汤（河间） 治破伤风邪，初传在表。
羌活 防风 川芎 本 当归 芍药（各一钱） 甘草 地榆 细辛（各五分）
上细切，作一服，水一盏半，煎至一盏，去渣热服，不拘时候。量紧慢加减用之，热则加大黄一钱，大便秘只加大
黄五分，缓缓令通。
白术防风汤（河间） 若服前药太过，令自汗者，宜服此药。
白术（一钱） 防风（二钱） 黄 （一钱五分）
上细切，作一服，水一盏半，煎至一盏，温服不拘时。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，因服热药汗出不休者，故知无寒也，宜速下之，先用小芎黄汤，二三服后，用大芎黄汤下之。
小芎黄汤（河间）
川芎（二钱） 黄芩（一钱五分） 甘草（五分）
上细切，作一服，水一盏半，煎至一盏，温服，不拘时候，三服即止，再用后药。
大芎黄汤（河间）
川芎（一钱） 羌活 黄芩 大黄（各一钱五分）
上细切，作一服，水一盏，温服，宜和为度。
发表雄黄散（河间）
雄黄（一钱） 防风（二钱） 草乌（一钱，泡裂）
上为细末，每服一字，温酒调下。里和，至愈可服；里未和，不可服。
大蜈蚣散（河间）
蜈蚣（黄赤足各一条） 江鳔（五钱，即鱼胶，炒） 左蟠龙（五钱，炒烟尽为度，即野鸽粪）
上为细末，每服一钱，清酒调下。治法根据前用，里和，至愈可服；但有里证，不可服。次当下之，用蜈蚣散四钱，
巴豆霜五分，饭丸如绿豆大，每服一丸，渐加至六七丸，清酒调蜈蚣散少许送下，宣利为度。内外风去，可服羌活汤缓
缓而治，不拘时候服之。羌活汤者，治半在表半在里之药也。
大羌活汤
羌活 菊花 麻黄 川芎 石膏（ ，另研） 防风 前胡 黄芩 细辛 甘草 枳壳 白茯苓 蔓荆子（各四分）
薄荷 白芷（各二分）
上细切，作一服，入生姜五片，水一盏半，煎至一盏，稍热服，不拘时，日进二服。
防风汤（河间） 治破伤风，同伤寒表证，未传入里，宜服此药。
防风 羌活 独活 川芎（各一钱二分）
上细切，作一服，水一盏半，煎至一盏，温服。
小蜈蚣散
蜈蚣（黄赤足各一条） 江鳔（三钱）
上为细末，用防风汤调下。如前药解表不已，觉传入里，当服左龙丸，渐渐看大便软硬，加巴豆霜服之。
左龙丸（河间）
左蟠龙（五钱，炒） 白僵蚕（五钱，炒） 江鳔（五钱，炒） 雄黄（一钱）
上同为细末，饭丸如梧桐子大，每服十五丸，温酒下。如里证不已，当于左龙丸末一半内，入巴豆霜半钱，饭丸如
梧桐子大，每服一丸，渐加至以利为度。若利后，更服后药。若搐痉不已，亦宜服后药羌活汤也。
小羌活汤（河间） 治搐痉不止。
羌活 独活 防风 地榆（各一钱二分）
上细切，作一服，水一盏半，煎至一盏，温服。如有热，加黄芩。有痰，加半夏。若病日久，气血渐虚，邪气入胃，
全在养血为度。
养血当归地黄汤（河间）
当归 地黄 芍药 川芎 本 防风 白芷（各一钱） 细辛（五分）
上细切，作一服，水一盏半，煎至一盏服。
雄黄散（河间） 治表药。
南星（三钱，泡） 半夏（五钱，泡七次，去脐） 天麻（五钱） 雄黄（二钱五分）
上为细末，每服一钱，温酒调下。如有涎，于此药中加大黄，为下药。
地榆防风散（河间） 治破伤风、中风，半在表，半在里，头微汗，身无汗，不可发汗，宜以表里治之。
地榆 防风 地丁草 马齿苋（各等分）
上为细末，每服三钱，温米饮调下。
白术汤 治破伤风，大汗不止，筋挛，手足搐搦。
白术 葛根（各二钱） 升麻 黄芩（酒炒，各一钱） 芍药（四钱） 甘草（五分）
上细切，作一服，水一盏半，煎至一盏，温服，不拘时候。
江鳔丸（河间） 治破伤风，惊而发搐，脏腑秘涩，知病在里，宜以此药下之。
江鳔（锉炒，五钱） 野鸽粪（炒，五钱） 雄黄（一钱） 白僵蚕（五钱，炒） 蜈蚣（黄赤足，一对） 天麻
（五钱）
上为细末，分作三分，用二分以烧饭为丸，如梧桐子大，朱砂为衣。用一分入巴豆霜一钱同和，亦以烧饭为丸，如
梧桐子大，不用朱砂为衣。每服以前朱砂衣丸子二十丸，巴豆霜丸一丸，第二服二丸，加至利为度，再单服朱砂衣丸子，
病愈止药。
（祖传方）
治初破伤风，发热红肿，风邪将欲传播经络而未入深者，屡验。
杏仁（去皮，研细） 罗白面（各等分）
上以二味和匀，用新汲水调和如膏，敷伤处，肿消热退。
一方 治破伤风发热。
用蝉蜕略炒研细，酒调一钱七服效。
（医案）
安文陈珍四兄，因劝斗殴，眉棱骨被打破，得破伤风，头面大肿发热。予适在彼家，以九味羌活汤服取汗，外用杏
仁捣烂，入白面少许，新汲水调敷疮上，肿消热退而愈。后以此法治若干人，皆验。
附∶翻花疮（一名绵花疮，一名广东疮。）
川芎 天花粉（各五钱） 轻粉（二钱五分） 雄黄（一钱一分半） 辰砂（一钱一分半） 麝香（五分）
上为细末，蒸饼丸如绿豆大，每服八分，温酒下，日三服。一方无川芎、天花粉二味，亦效。
(Previous prescription ingredients) One qian. Luankun (Hair from a healthy young man, one piece), Ganchan (One Bufo bufo gargarizans, also known as Fengji), Fenghuangtai (One unfertilized chicken egg yolk still in the shell, dried in shade). Tao Zhi (Peach twig), Liu Zhi (Willow twig), Sang Zhi (Mulberry twig) (five stems each).
Cut the above herbs finely separately, soak them in six jin of Xiangyou (Sesame oil) for three to five days, boil in a pot until black, filter out the dregs, add Sanjin Huangdan (Lead monoxide), and stir constantly with Huai Zhi (Locust twig) and Liu Zhi (Willow twig). When the plaster is ready and slightly cool, add the following powdered herbs: Ruxiang (Frankincense), Moyao (Myrrh), Longgu (Fossilized mammal bones) (one qian each), Qingfen (Calomel) (five qian), Xuexie (Dragon's blood) (one qian), Shexiang (Musk) (two qian).
Mix the above powders evenly, store in a porcelain vessel, and apply externally according to the size of the wound when needed.
Moyao San (Myrrh Powder) [Recorded in Verified Prescriptions]: Treats knife and arrow wounds, stops bleeding and pain.
Dingfen (Minium powder), Fenghua Duanshi (Weathered calcined alum) (one qian each), Kubai Fan (Calcined white alum) (two qian, ground separately), Ruxiang (Frankincense) (five fen, ground separately), Moyao (Myrrh) (ground separately, one zi dose).
Grind each herb into fine powder, mix thoroughly, and grind again. Apply dry powder directly to the wound.
Discussion
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "Wind is the beginning of all diseases. If one remains pure and quiet, the Couli (pores and interstices) will close and resist, so that even strong wind and severe toxins cannot cause harm." Regarding the syndrome of Po Shang Feng (Lockjaw/Tetanus caused by trauma), skin and flesh are broken by external force, often treated casually. However, one must not ignore that Wind pathogen invades through the deficiency, gradually evolving into a critical condition. Furthermore, if various sores do not heal for a long time, Wind pathogen can also invade internally. Using hot water washing or moxibustion burning, the toxic heat from water and fire is no different from the Wind pathogen of Po Shang Feng. These conditions allow pathogens to spread through the meridians, scorching the True Qi. Thus, alternating chills and fever occur; severely, there is trismus (lockjaw), deviation of eyes, body stiffness, and opisthotonos (arched back like a bow), leading to death soon. This is truly pitiable! The treatment method should follow the principles for treating Shang Han (Cold Damage Syndrome). Since the pathogen may be in the Exterior, Interior, or Half-Exterior Half-Interior, the treatment relies on Sweating (Han), Purging (Xia), and Harmonizing (He) methods. Therefore, if in the Exterior, use sweating; if in the Interior, use purging; if in the Half-Exterior Half-Interior, use harmonizing. However, these methods must not be overused. Common people often do not realize how quickly this disease kills, failing to seek medical help early, and waiting passively for death. How sorrowful!
Pulse Diagnosis
Exterior pulse is floating and weak, indicating Tai Yang (Greater Yang) channel involvement. A long and forceful pulse indicates Yang Ming (Yang Brightness) channel involvement. A floating, wiry, and small pulse indicates Shao Yang (Lesser Yang) channel involvement.
He Jian (Liu Wansu) stated: Tai Yang is suitable for sweating, Yang Ming for purging, and Shao Yang for harmonizing. If one understands these three methods, there is no case of failure to cure.
Commentary: Mr. He Jian’s discussion on the pulses and syndromes of Po Shang Feng is very detailed. Why does he only mention the Three Yang channels and not the Three Yin channels? Probably because when the Wind pathogen is in the Three Yang channels, it is appropriate to treat early according to the rules and achieve recovery. If one waits for the pathogen to transmit to the Three Yin channels, the syndrome becomes critical, presenting with abdominal fullness, spontaneous diarrhea, dry mouth and throat, curled tongue, and retracted testicles—all signs of incurability. Therefore, they are omitted from discussion.
Treatment Methods
Dan Xi (Zhu Danxi) said: Treat Po Shang Feng similarly to the complicated syndromes of Shang Han. Determine which meridian is affected and use herbs from that meridian to expel the pathogen; misdiagnosis leads to death. Liu He Jian has methods and prescriptions, which should be selected and used.
(Above: One method from Dan Xi)
Qiang Huo Fang Feng Tang (Decoction of Notopterygium and Saposhnikovia) [Liu He Jian]: Treats Po Shang Feng where the pathogen initially transmits to the Exterior.
Qiang Huo (Notopterygium root), Fang Feng (Saposhnikovia root), Chuan Xiong (Ligusticum rhizome), Ben Cao (Ligusticum sinense rhizome), Dang Gui (Angelica sinensis root), Shao Yao (Peony root) (one qian each); Gan Cao (Licorice root), Di Yu (Sanguisorba root), Xi Xin (Asarum root) (five fen each).
Cut finely, take as one dose. Add one and a half cups of water, decoct to one cup, filter, and drink hot. Take at any time. Adjust dosage based on urgency. If there is heat, add Da Huang (Rhubarb root) one qian; if constipation, add Da Huang five fen, allowing gradual bowel movement.
Bai Zhu Fang Feng Tang (Decoction of Atractylodes and Saposhnikovia) [Liu He Jian]: If previous medications cause excessive spontaneous sweating, this prescription is suitable.
Bai Zhu (Atractylodes macrocephala rhizome) (one qian), Fang Feng (Saposhnikovia root) (two qian), Huang Qi (Astragalus root) (one qian five fen).
Cut finely, take as one dose. Add one and a half cups of water, decoct to one cup, drink warm. Take at any time. Suitable for patients with harmonized internal organs and spontaneous sweating. For Po Shang Feng patients with constipation, red urine, and incessant spontaneous sweating due to overheating from previous hot medicines, knowing there is no cold, rapid purging is indicated. First use Xiao Xiong Huang Tang, then after two or three doses, use Da Xiong Huang Tang to purge.
Xiao Xiong Huang Tang (Minor Decoction of Ligusticum and Scutellaria) [Liu He Jian]
Chuan Xiong (Ligusticum rhizome) (two qian), Huang Qin (Scutellaria root) (one qian five fen), Gan Cao (Licorice root) (five fen).
Cut finely, take as one dose. Add one and a half cups of water, decoct to one cup, drink warm. Take at any time. Stop after three doses, then proceed to subsequent prescriptions.
Da Xiong Huang Tang (Major Decoction of Ligusticum and Scutellaria) [Liu He Jian]
Chuan Xiong (Ligusticum rhizome) (one qian), Qiang Huo (Notopterygium root), Huang Qin (Scutellaria root), Da Huang (Rhubarb root) (one qian five fen each).
Cut finely, take as one dose. Add one cup of water, decoct, drink warm. Aim for a balanced effect.
Fa Biao Xiong Huang San (Exterior-Releasing Realgar Powder) [Liu He Jian]
Xiong Huang (Realgar) (one qian), Fang Feng (Saposhnikovia root) (two qian), Cao Wu (Aconitum carmichaelii root) (one qian, soaked until cracked).
Grind into fine powder. Take one zi dose per serving, mixed with warm wine. Can be taken until recovery if the interior is harmonious; do not take if the interior is not harmonious.
Da Wu Gong San (Major Centipede Powder) [Liu He Jian]
Wu Gong (Centipede) (one yellow-footed and one red-footed), Jiang Bi (Fish maw/collagen) (five qian, fried), Zuo Pan Long (Wild pigeon droppings) (five qian, fried until smoke ceases).
Grind into fine powder. Take one qian per serving, mixed with clear wine. Treatment follows previous methods; can be taken until recovery if the interior is harmonious; do not take if there are interior syndromes. Next, purging is required. Use four qian of Wu Gong San and five fen of Ba Dou Shuang (Croton seed paste), made into pills the size of mung beans. Take one pill initially, gradually increasing to six or seven pills, delivered with a little Wu Gong San mixed in clear wine. Stop when bowel movement occurs. Once internal and external wind pathogens are expelled, treat slowly with Qiang Huo Tang. Qiang Huo Tang treats syndromes half in the exterior and half in the interior.
Da Qiang Huo Tang (Major Notopterygium Decoction)
Qiang Huo (Notopterygium root), Ju Hua (Chrysanthemum flower), Ma Huang (Ephedra stem), Chuan Xiong (Ligusticum rhizome), Shi Gao (Gypsum fibrosum, calcined, ground separately), Fang Feng (Saposhnikovia root), Qian Hu (Peucedanum root), Huang Qin (Scutellaria root), Xi Xin (Asarum root), Gan Cao (Licorice root), Zhi Ke (Aurantium fruit), Bai Fu Ling (Poria sclerotium), Man Jing Zi (Vittex fruit) (four fen each), Bo He (Mentha haplocalyx), Bai Zhi (Angelica dahurica root) (two fen each).
Cut finely, take as one dose. Add five slices of Sheng Jiang (Fresh ginger), one and a half cups of water, decoct to one cup. Drink slightly warm. Take at any time, twice daily.
Fang Feng Tang (Saposhnikovia Decoction) [Liu He Jian]: Treats Po Shang Feng similar to Shang Han exterior syndrome, before transmitting to the interior. Suitable for this prescription.
Fang Feng (Saposhnikovia root), Qiang Huo (Notopterygium root), Du Huo (Angelica pubescens root), Chuan Xiong (Ligusticum rhizome) (one qian two fen each).
Cut finely, take as one dose. Add one and a half cups of water, decoct to one cup, drink warm.
Xiao Wu Gong San (Minor Centipede Powder)
Wu Gong (Centipede) (one yellow-footed and one red-footed), Jiang Bi (Fish maw/collagen) (three qian).
Grind into fine powder, take with Fang Feng Tang. If previous exterior-releasing drugs fail and the pathogen seems to transmit inward, take Zuo Long Wan. Gradually observe stool consistency and add Ba Dou Shuang.
Zuo Long Wan (Left Dragon Pill) [Liu He Jian]
Zuo Pan Long (Wild pigeon droppings) (five qian, fried), Bai Jiang Can (Bombyx batryticatus) (five qian, fried), Jiang Bi (Fish maw/collagen) (five qian, fried), Xiong Huang (Realgar) (one qian).
Grind together into fine powder, make pills with rice flour the size of Sophora seeds. Take fifteen pills per serving, with warm wine. If interior syndromes persist, add half a qian of Ba Dou Shuang to half of the Zuo Long Wan powder, make pills the size of Sophora seeds with rice flour. Take one pill initially, gradually increasing until bowel movement occurs. After purging, take subsequent prescriptions. If spasms persist, also take the subsequent Qiang Huo Tang.
Xiao Qiang Huo Tang (Minor Notopterygium Decoction) [Liu He Jian]: Treats persistent spasms.
Qiang Huo (Notopterygium root), Du Huo (Angelica pubescens root), Fang Feng (Saposhnikovia root), Di Yu (Sanguisorba root) (one qian two fen each).
Cut finely, take as one dose. Add one and a half cups of water, decoct to one cup, drink warm. Add Huang Qin if there is heat; add Ban Xia (Pinellia tuber) if there is phlegm. If the disease is chronic and Qi and Blood are deficient, with pathogen entering the Stomach, focus on nourishing Blood.
Yang Xue Dang Gui Di Huang Tang (Blood-Nourishing Angelica and Rehmannia Decoction) [Liu He Jian]
Dang Gui (Angelica sinensis root), Di Huang (Rehmannia root), Shao Yao (Peony root), Chuan Xiong (Ligusticum rhizome), Ben Cao (Ligusticum sinense rhizome), Fang Feng (Saposhnikovia root), Bai Zhi (Angelica dahurica root) (one qian each), Xi Xin (Asarum root) (five fen).
Cut finely, take as one dose. Add one and a half cups of water, decoct to one cup, drink.
Xiong Huang San (Realgar Powder) [Liu He Jian]: Treats exterior syndromes.
Nan Xing (Arisaema cum Bile) (three qian, soaked), Ban Xia (Pinellia tuber) (five qian, soaked seven times, navel removed), Tian Ma (Gastrodia rhizome) (five qian), Xiong Huang (Realgar) (two qian five fen).
Grind into fine powder. Take one qian per serving, mixed with warm wine. If there is phlegm-saliva, add Da Huang to this powder as a purgative.
Di Yu Fang Feng San (Sanguisorba and Saposhnikovia Powder) [Liu He Jian]: Treats Po Shang Feng and Zhong Feng (Wind Stroke) with syndromes half in the exterior and half in the interior, slight head sweating, no body sweating. Sweating method is contraindicated; treat both exterior and interior.
Di Yu (Sanguisorba root), Fang Feng (Saposhnikovia root), Di Ding Cao (Prunella vulgaris), Ma Chi Xian (Portulaca oleracea) (equal parts).
Grind into fine powder. Take three qian per serving, mixed with warm rice water.
Bai Zhu Tang (Atractylodes Decoction): Treats Po Shang Feng with incessant profuse sweating, muscle cramps, and hand/foot convulsions.
Bai Zhu (Atractylodes macrocephala rhizome), Ge Gen (Pueraria lobata root) (two qian each), Sheng Ma (Cimicifuga rhizome), Huang Qin (Scutellaria root, wine-fried) (one qian each), Shao Yao (Peony root) (four qian), Gan Cao (Licorice root) (five fen).
Cut finely, take as one dose. Add one and a half cups of water, decoct to one cup, drink warm. Take at any time.
Jiang Bi Wan (Fish Maw Pill) [Liu He Jian]: Treats Po Shang Feng with fright-induced convulsions, constipation, knowing the pathogen is in the interior. Suitable for purging.
Jiang Bi (Fish maw/collagen, cut and fried) (five qian), Ye Ge Fen (Wild pigeon droppings, fried) (five qian), Xiong Huang (Realgar) (one qian), Bai Jiang Can (Bombyx batryticatus, fried) (five qian), Wu Gong (Centipede, yellow and red feet, a pair), Tian Ma (Gastrodia rhizome) (five qian).
Grind into fine powder. Divide into three parts. Use two parts to make pills with cooked rice, size of Sophora seeds, coated with Cinnabar. Use one part mixed with one qian of Ba Dou Shuang, make pills with cooked rice, size of Sophora seeds, without Cinnabar coating. Take twenty Cinnabar-coated pills and one Ba Dou Shuang pill per serving initially, increase Ba Dou Shuang pills to two in the second serving, increasing until bowel movement occurs. Then take only Cinnabar-coated pills alone. Stop medication when cured.
(Ancestral Prescription)
Treats initial Po Shang Feng with fever, redness, and swelling, where Wind pathogen is about to spread through meridians but has not penetrated deeply. Proven effective repeatedly.
Xing Ren (Apricot seed, peeled and finely ground), Luo Bai Mian (Fine white wheat flour) (equal parts).
Mix the two ingredients evenly, blend with fresh well water to form a paste, and apply to the wound site. Reduces swelling and clears heat.
Another Prescription: Treats Po Shang Feng fever.
Lightly fry Chan Tui (Cicada slough), grind finely. Mix one qian with wine. Effective after seven doses.
(Medical Case)
Mr. Chen Zhen Si, fourth brother of An Wen, suffered a broken brow bone during a brawl while mediating. He developed Po Shang Feng with severe head and facial swelling and fever. I happened to be at his home and administered Jiu Wei Qiang Huo Tang to induce sweating. Externally, I applied a paste of crushed Xing Ren mixed with a little Bai Mian and fresh well water to the wound. Swelling subsided, heat cleared, and he recovered. I later treated many others with this method, all successfully.
Appendix: Fan Hua Chuang (Flower-Turning Sore, also known as Mian Hua Chuang or Guangdong Chuang.)
Chuan Xiong (Ligusticum rhizome), Tian Hua Fen (Trichosanthes root) (five qian each), Qing Fen (Calomel) (two qian five fen), Xiong Huang (Realgar) (one qian one fen half), Chen Sha (Cinnabar) (one qian one fen half), She Xiang (Musk) (five fen).
Grind into fine powder, make pills with steamed bread dough the size of mung beans. Take eight fen per serving, with warm wine, three times daily. Another version omits Chuan Xiong and Tian Hua Fen, which is also effective.