Library

4. Traumatic tetanus caused by excessive blood loss leads to malnourishment of the sinews; slight injuries allow wind pathogen to enter and transform into fire pathogen. If presenting as dryness, white scabs form around the wound without significant swelling; if presenting as dampness, turbid black fluid drains. The jaw becomes tight.

[Note] Excessive bleeding from trauma causes the sinews to lose nourishment, leaving the meridians empty, allowing wind pathogen to invade due to deficiency, as stated in the classics: "Wind pathogen enters when there is deficiency." For this condition where wind pathogen combines with deficiency, Guizhi Tang (Cinnamon Twig Decoction) combined with Danggui Buxue Tang (Angelica Sinensis Blood-Nourishing Decoction) is indicated. Generally, contracting wind disease after severe injury and excessive bleeding is common. However, sometimes slight superficial injuries with minimal blood loss lead to wind disease because the patient has a constitutive heat tendency, triggered by wind, as Liu Wansu stated: "Excessive heat combats with wind and merges into the meridians." This constitutes wind-fire pathogen, for which Fangfeng Tongsheng San (Saposhnikovia Universal Relief Powder) added with Scorpion Tail is indicated. In all such cases, regardless of excess or deficiency, if wind-toxin is internally retained and fails to manifest externally, characterized by dry white scabs forming around the wound, minimal swelling, drainage of turbid black fluid, and slight stiffness of the jaw that does not move normally, these are all prodromal signs of traumatic tetanus.

Fangfeng Tongsheng San with Scorpion Tail Formula, Quanxie San (Whole Scorpion Powder), Banmao Dahuang Formula (Mustard Beetle and Rhubarb Formula)

5. When fire pathogen is predominant, use Fangfeng Tongsheng San with Scorpion Tail; when wind pathogen is predominant, use Quanxie San or Zuolong Wan (Left Dragon Pill). External treatment involves using burning wine with cupping therapy; for dog bite wounds ("dog wind"), use Banmao (Mustard Beetle) and Dahuang (Rhubarb) decocted together.

[Note] Traumatic tetanus with predominant fire pathogen often presents as Yangming meridian syndrome, treated with Fangfeng Tongsheng San (Sapothikovia Universal Relief Powder) added with Scorpion Tail. Predominant wind pathogen often presents as Taiyang meridian syndrome, treated with Quanxie San (Whole Scorpion Powder), consisting of seven raw scorpion tails ground into powder, taken with hot wine. If symptoms persist after administration and the pathogen gradually penetrates deeper internally, use Zuolong Wan (Left Dragon Pill), composed of Columbae Faeces (wild pigeon droppings), Ichthyocol (fish swim bladder), Bombyx Batryticatus (stiff silkworm), Realgar, Scolopendra (centipede), Gastrodia Elata (Tianma), Cinnabar, and Crotonis Fructus Pulveratum (Croton seed frost) made into pills. The detailed formula is found in the chapter on various traumatic tetanus cases in *Danxi Xinfa* (New Methods of Danxi). For all these conditions, external treatment should employ two clay wine pots: fill each slightly more than half with burning wine. Heat one pot until boiling silently, pour out the wine, and immediately press the opening onto the traumatic wound to extract turbid black blood and fluid; it will fall off automatically when full. Repeat with the second pot, alternating suction until thoroughly drained, at which point the wind pathogen will be instantly resolved. For those bitten by mad dogs where toxin enters the abdomen causing spasms (tetanic convulsions), use seven Banmao (Mylabris/Blister Beetles), stir-fried with glutinous rice until the rice turns yellow, remove the rice, grind the beetles into powder, mix evenly with one qian of raw Dahuang (Rhubarb Root) powder, decoct in one sheng of yellow wine until reduced to half a sheng, take warm on an empty stomach to expel toxins. Those with weak constitutions should take half the dose.