篇名：上编 外治法
分类：胸背部
属性：[1]胸骨，即□骭骨，乃胸胁骨之统名也：
<1>一名膺骨，一名臆骨，俗名胸膛。
<2>其两侧自腋而下，至肋骨之尽处，统名曰胁。
<3>胁下小肋骨曰季胁，俗名软肋。
<4>肋者，单条骨之谓也，统胁肋之总，又名曰胠。
[2]凡胸骨被物从前面撞打跌仆者重，从后面撞仆者轻。
<1>轻者先按证用手法治之
<2>再内服正骨紫金丹
<3>外用面麸和定痛散灸熨之
<4>或以海桐皮汤洗之，贴万灵膏即能获效。
[3]若内血瘀聚肿痛，伛偻难仰者：
<1>早晨以清上瘀血汤、消下破血汤，分上膈、下膈以治之。
<2>晚服疏血丸。
[4]有受伤日久，胸骨高起，肌肉削瘦，内有邪热瘀血，痞气膨闷，睛蓝
体倦，痰喘咳嗽者，宜加减紫金丹，以消热化痰，理气健脾，润肌定
喘。
[5]若伤重者，内干胸中，必通心、肺两脏，其人气乱昏迷，闭目，呕吐
血水，呃逆战栗者，则危在旦夕，不可医治矣。
[6]若两侧撅肋诸骨被伤者：
<1>则相其轻重以分别治之
<2>凡胸胁诸伤轻者，如黎桐丸、三黄宝蜡丸等药，皆所必需，宜酌用
之。
按、方剂：[1]清上瘀血汤
治上膈被伤者
羌活 独活 连翘 桔梗 枳壳 赤芍 当归（酒洗） 山栀子
黄芩 甘草 川芎 桃仁 红花 苏木 川大黄 生地黄
水煎，加老酒童便和服。
[2]消下破血汤
治下膈被伤者。
柴胡 川芎 川大黄 赤芍药 当归 栀子 五灵脂 木通
枳实（炒） 红花 赤牛膝 泽兰叶 苏木 生地黄 黄芩 桃仁
水煎，加老酒童便和服。
[3]加减紫金丹
白茯苓 苍术（米泔浸，炒）各二两 当归 熟地黄 白芍药（炒）
陈皮各四两 肉苁蓉（酒洗去鳞甲）一两 丁香一钱 红花五钱
瓜儿血竭三钱 乳香（去油）三钱 没药（去油）三钱
共为细末，炼蜜为丸，弹子大，用黄酒送下。
[4]黎桐丸
治跌打损伤，瘀血奔心，昏晕不省，及一切无名肿毒，昏困欲死等证
京牛黄 冰片 麝香各二钱五 阿魏 雄黄各一两 川大黄 儿茶
天竺黄 三七 瓜儿血竭 乳香（去油） 没药（去油）各二两
藤黄（隔汤煮十数次，去浮沫，用山羊血五钱拌晒。如无山羊血，以
子羊血代之）二两
以上十三味，共为细末，将藤黄化开为丸，如芡实大，若干，稍加白
蜜，外用蜡皮封固。内服用无灰酒送下，外敷用茶卤磨涂，忌一切生
冷发物。
[5]三黄宝蜡丸
专治一切跌打损伤及破伤风，并伤力成痨，女人产后恶露不尽，致生
怪证，瘀血奔心，痰迷心窍，危在旦夕。重者一钱，轻者三分，用无
灰酒送下，立刻全生。如被鸟枪打伤，铅子在内，危在倾刻，服一钱
，吃酒数杯，睡一时，汗出即愈。如外敷，将香油热化少许，鸡翎扫
患处。服药后忌凉水、生冷、烧酒三日，如不忌此酒，则药无功。
天竺黄三两 雄黄二两 刘寄奴 红芽大戟（去骨） 骐驎竭各三两
归尾一两五钱 朱砂 儿茶各一两 净乳香（去油）三钱 琥珀
轻粉 水银（同轻粉研不见星） 麝香各三钱
以上各称足分两，各研为细末，如无真天竺黄，以真胆星三两代之，
再用好黄蜡二十四两，炼净，滚汤坐定，将药投入，不住手搅匀，取
出装磁罐内备用。
[6]正骨紫金丹：见颠顶骨伤
[7]万灵膏、定痛散：俱见囟骨伤
[8]疏血丸：见凌云骨伤
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Upper Compilation: External Treatment Methods
Classification: Chest and Back Region
Attributes: [1] The sternum, also known as the gan bone (sternal bone), is the general term for the bones of the chest and hypochondrium:
<1> Also called ying bone (anterior chest bone) or yi bone (chest region), commonly referred to as the chest.
<2> Its lateral sides extend from below the axilla down to the end of the ribs, collectively termed the hypochondrium (xi).
<3> The small ribs below the hypochondrium are called ji xie (costal margin), commonly known as soft ribs.
<4> Rib (lei) refers to a single strip of bone; the collective term for the hypochondrium and ribs is also called qu (lateral chest/axillary region).
[2] Injuries to the sternum caused by blunt force trauma from the front are severe, while those from the back are mild.
<1> For mild cases, treat first with manual manipulation techniques according to the syndrome.
<2> Then internally administer Zhenggu Zijin Dan (Bone-Setting Purple Gold Pill).
<3> Externally apply Dingtong San (Pain-Relieving Powder) mixed with wheat bran for moxibustion and warming therapy.
<4> Alternatively, wash with Haitongpi Tang (Phellodendron Bark Decoction) and apply Wanling Gao (Ten Thousand Spirits Plaster) for efficacy.
[3] If internal blood stasis accumulates causing swelling and pain, with curvature of the spine making extension difficult:
<1> In the morning, administer Qing Shang Yuxue Tang (Clear Upper Stasis-Decaying Blood Decoction) and Xiao Xia Poxue Tang (Eliminate Lower Break-Stasis Decoction) to treat upper and lower jiao injuries respectively.
<2> In the evening, administer Shuxue Wan (Blood-Dispersing Pill).
[4] For long-standing injuries where the sternum protrudes, muscles waste away, with internal pathogenic heat and blood stasis, qi stagnation causing distension, blue discoloration of the eyes, body fatigue, phlegm-induced wheezing, and cough:
Use Jiajian Zijin Dan (Modified Purple Gold Pill) to clear heat, resolve phlegm, regulate qi, strengthen the spleen, moisten the skin, and calm asthma.
[5] If the injury is severe, affecting the chest cavity and involving both the Heart and Lung organs, resulting in chaotic qi flow, coma, closed eyes, vomiting of bloody fluid, hiccups, and tremors:
The condition is critical and imminent death may occur; it is untreatable.
[6] If the ribs on both sides are fractured:
<1> Assess the severity and treat accordingly.
<2> For mild chest and hypochondrium injuries, medicines such as Litong Wan (Litong Pill) and Sanhuang Bao La Wan (Three-Yellow Precious Wax Pill) are essential and should be used as appropriate.
Notes on Formulas: [1] Qing Shang Yuxue Tang (Clear Upper Stasis-Decaying Blood Decoction)
Treats injuries to the upper jiao.
Qiang Huo (Notopterygii Rhizoma et Radix), Du Huo (Angelicae Pubescentis Radix), Lian Qiao (Forsythiae Fructus), Jie Geng (Platycodonis Radix), Zhi Ke (Aurantii Fructus), Chi Shao (Paeoniae Radix Rubra), Dang Gui (Angelicae Sinensis Radix, wine-washed), Shan Zhi Zi (Gardeniae Fructus), Huang Qin (Scutellariae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Tao Ren (Persicae Semen), Hong Hua (Carthami Flos), Su Mu (Sappan Lignum), Chuan Da Huang (Rhei Radix et Rhizoma), Sheng Di Huang (Rehmanniae Radix).
Decoct in water, mix with aged wine and child's urine before administration.
[2] Xiao Xia Poxue Tang (Eliminate Lower Break-Stasis Decoction)
Treats injuries to the lower jiao.
Chai Hu (Bupleuri Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Chuan Da Huang (Rhei Radix et Rhizoma), Chi Shao Yao (Paeoniae Radix Rubra), Dang Gui (Angelicae Sinensis Radix), Zhi Zi (Gardeniae Fructus), Wu Ling Zhi (Trogopterori Faeces), Mu Tong (Akebiae Caulis), Zhi Shi (Aurantii Fructus Immaturus, stir-fried), Hong Hua (Carthami Flos), Chi Niu Xi (Achyranthis Bidentatae Radix), Ze Lan Ye (Eupatorii Herba), Su Mu (Sappan Lignum), Sheng Di Huang (Rehmanniae Radix), Huang Qin (Scutellariae Radix), Tao Ren (Persicae Semen).
Decoct in water, mix with aged wine and child's urine before administration.
[3] Jiajian Zijin Dan (Modified Purple Gold Pill)
Bai Fu Ling (Poria), Cang Zhu (Atractylodis Rhizoma, soaked in rice water, stir-fried) each 2 liang; Dang Gui (Angelicae Sinensis Radix), Shu Di Huang (Rehmanniae Radix Preparata), Bai Shao Yao (Paeoniae Radix Alba, stir-fried), Chen Pi (Citri Reticulatae Pericarpium) each 4 liang; Rou Cong Rong (Cistanches Herba, wine-washed, scales removed) 1 liang; Ding Xiang (Caryophylli Flos) 1 qian; Hong Hua (Carthami Flos) 5 qian; Gua Er Xue Jie (Dragon's Blood); Ru Xiang (Olibanum, de-oiled) 3 qian; Mo Yao (Myrrha, de-oiled) 3 qian.
Grind into fine powder, make pills with refined honey, size of a bullet, take with yellow wine.
[4] Litong Wan (Litong Pill)
Treats contusions and fractures, blood stasis rushing to the heart, fainting and loss of consciousness, as well as all kinds of unnamed swellings and sores, drowsiness and near-death states.
Jing Niu Huang (Calculus Bovis), Bing Pian (Borneolum Syntheticum), She Xiang (Moschus) each 2.5 qian; A Wei (Ferulae Resina), Xiong Huang (Realgar) each 1 liang; Chuan Da Huang (Rhei Radix et Rhizoma), Er Cha (Catechu), Tian Zhu Huang (Bambusae Calamus Taenianus), San Qi (Notoginseng Radix et Rhizoma), Gua Er Xue Jie (Dragon's Blood), Ru Xiang (Olibanum, de-oiled), Mo Yao (Myrrha, de-oiled) each 2 liang; Teng Huang (Arcanostachys Resina) 2 liang (boiled over water several times, remove foam, mix with 5 qian of goat blood and dry; if no goat blood, use lamb blood).
Grind the above thirteen ingredients into fine powder, melt Teng Huang to form pills, size of an euryale seed. If too dry, add a little white honey. Seal externally with wax skin. Take internally with ash-free wine; for external application, grind with tea decoction and apply. Avoid all raw, cold, and stimulating foods.
[5] Sanhuang Bao La Wan (Three-Yellow Precious Wax Pill)
Specifically treats all contusions and fractures, tetanus, labor injuries leading to consumption, postpartum women with lochia不尽 (prolonged discharge) causing strange syndromes, blood stasis rushing to the heart, phlegm confusing the heart orifices, critical conditions. Severe cases: 1 qian; mild cases: 3 fen. Take with ash-free wine for immediate recovery. If shot by a bird gun with lead retained, critical condition: take 1 qian, drink several cups of wine, sleep for one hour, sweat out the toxin and recover. For external use, melt a little sesame oil, apply with a chicken feather brush. After taking medicine, avoid cold water, raw/cold foods, and distilled liquor for three days; otherwise, the medicine will be ineffective.
Tian Zhu Huang (Bambusae Calamus Taenianus) 3 liang; Xiong Huang (Realgar) 2 liang; Liu Ji Nu (Artemisiae Anomae Herba), Hong Ya Da Ji (Euphorbiae Humifusae Radix, bone removed), Qi Lin Jie (Dragon's Blood) each 3 liang; Gui Wei (Angelicae Sinensis Radix Tail) 1.5 liang; Zhu Sha (Cinnabaris), Er Cha (Catechu) each 1 liang; Jing Ru Xiang (Olibanum, de-oiled) 3 qian; Hu Po (Electrum), Qing Fen (Calomelas), Shui Yin (Hydrargyrum, ground with Qing Fen until no star points appear), She Xiang (Moschus) each 3 qian.
Weigh accurately, grind each into fine powder. If genuine Tian Zhu Huang is unavailable, substitute with 3 liang of Zhen Dan Xing (Arisaema cum Bile). Melt 24 liang of good yellow wax, place in boiling water bath, add medicine, stir constantly, pour into porcelain jars for storage.
[6] Zhenggu Zijin Dan (Bone-Setting Purple Gold Pill): See Injury to the Vertex Bone.
[7] Wanling Gao (Ten Thousand Spirits Plaster), Dingtong San (Pain-Relieving Powder): See Injury to the Fontanelle Bone.
[8] Shuxue Wan (Blood-Dispersing Pill): See Injury to the Lingyun Bone.
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