溃疡发痉类破伤，有汗为柔无汗刚，脓血出多成此证，补正驱邪要审详。
【注】此证势类破伤风，牙紧体强，肢搐背反，有汗曰柔痉，无汗曰刚痉，由溃疡亡
血过多所致。治宜大补气血，以十全大补汤加钩藤钩、栀子、天麻。服之不应者，服独
参汤；手足逆冷加桂、附，误作风痉，汗之则危。
十全大补汤 独参汤（俱见溃疡门）
汤烫火烧皮烂疼， 起挑破使毒轻，烦躁作呕防毒陷，便秘神昏气喘凶。
【注】此证系好肉暴伤，汤烫火烧，皮肤疼痛，外起燎 。即将 挑破，放出毒水，使
毒轻也。其证虽属外因，然情势必分轻重。轻者施治应手而愈，重者防火毒热气攻里，令
人烦躁，作呕，便秘，甚则神昏闷绝，初伤用冷烧酒一盅，于无意中望患者胸前一泼，被
吃一惊，其气必一吸一呵，则内之热毒，随呵而出矣。仍作烦闷者，以新童便灌之。外
初用清凉膏涂之，解毒止痛，不致臭烂；次以罂粟膏涂之。痛止生脓时，换黄连膏贴之
收敛。火毒攻里者，宜四顺清凉饮服之，务令二便通利，则毒热必解。初终禁用冷水、井泥浸 伤处，恐热毒伏于内，
寒滞束于外，致令皮肉臭烂，神昏便秘，端肩气喘，多致不救。外花炮火药烘燎者，治法同前。
罂粟膏
罂粟花（十五朵，无花以壳代之）
香油四两，将罂粟炸枯，滤净，入白蜡三钱溶化尽，倾入碗内，待将凝之时，下轻
粉二钱，搅匀炖水中，令冷取出。临用时，抿脚挑膏，手心中捺化，搽于伤处，绵纸盖之，
日换二次，其痛自止。次日用软帛挹净腐皮，再搽之。
【方歌】罂粟膏医汤火烧，香油罂粟共煎熬，白蜡更兼真轻粉，患上搽涂痛即消。
清凉膏
水泼开锻石末一升，加水四碗，搅浑澄清；取清汁一碗，加香油一碗，以筷顺搅数
百转，其稠粘如糊，用鸡翎蘸扫伤处。
黄连膏（见鼻部鼻疮）
四顺清凉饮（见面部 腮）
The syndrome of spasms occurring after ulceration is similar to tetanus. Those with sweating are termed "soft spasm" (Rou Jing), while those without sweating are termed "hard spasm" (Gang Jing). This condition arises from excessive loss of pus and blood in ulcers; treatment requires careful examination to tonify the healthy qi and expel pathogenic factors.
[Note] The progression of this syndrome resembles tetanus, characterized by lockjaw, body rigidity, limb convulsions, and opisthotonos. Sweating indicates soft spasm, while absence of sweating indicates hard spasm. It is caused by excessive blood loss during the course of ulceration. Treatment should focus on greatly tonifying qi and blood, using Shiquan Dabu Tang (Complete Ten Tonification Decoction) added with Uncariae Ramulus cum Uncis (Gouteng), Gardeniae Fructus (Zhizi), and Gastrodiae Rhizoma (Tianma). If there is no response to this prescription, administer Dushen Tang (Single Ginseng Decoction); if coldness extends to the hands and feet, add Cinnamomi Ramulus (Guizhi) and Aconiti Lateralis Radix Praeparata (Fuzi). Misdiagnosing this as wind-induced spasm and applying diaphoretic methods will be dangerous.
Shiquan Dabu Tang (Complete Ten Tonification Decoction) and Dushen Tang (Single Ginseng Decoction) are both described in the Ulcer Section.
Scalds from boiling water or burns from fire cause skin damage and pain; rupturing blisters can help reduce toxicity. Restlessness and vomiting indicate a risk of toxin penetration inward; constipation, coma, and panting indicate a critical prognosis.
[Note] This syndrome results from sudden injury to healthy skin by boiling water or fire, causing pain and external blistering ("liao"). The blisters should be promptly punctured to drain toxic fluids, thereby reducing toxicity. Although caused by external factors, the severity must be distinguished. Mild cases respond quickly to treatment; severe cases require prevention of fire-toxic heat attacking the interior, which causes restlessness, vomiting, constipation, and even coma or suffocation. Upon initial injury, one cup of cold rice wine may be splashed unexpectedly onto the patient's chest to startle them. This startle induces a reflexive inhalation and exhalation, allowing internal heat-toxin to exit with the breath. If restlessness persists, fresh child's urine should be administered orally. Externally, apply Qingliang Gao (Cooling Ointment) initially to detoxify and relieve pain, preventing foul rot; subsequently apply Ying Su Gao (Poppy Ointment). When pain ceases and suppuration begins, switch to Huanglian Gao (Coptis Ointment) for astringency. If fire-toxin attacks the interior, administer Sishun Qingliang Yin (Four-Obedience Cooling Decoction), ensuring free passage of urine and stool to resolve toxic heat. From onset to resolution, strictly forbid soaking the injured area in cold water or well mud, lest heat-toxin become trapped internally while cold stagnation binds externally, leading to putrefaction of skin and flesh, coma, constipation, shoulder shrugging, panting, and often death. Injuries from fireworks or gunpowder heat follow the same treatment.
Ying Su Gao (Poppy Ointment)
Papaveris Somniferi Flos (Poppy Flower) (15 flowers; use pods if flowers are unavailable)
Sesame Oil (Xiangyou) 4 liang. Fry the poppies until withered, filter cleanly, add Mel (Beeswax) 3 qian until fully dissolved, pour into a bowl. When it is about to solidify, add Calomelas (Qingfen) 2 qian, stir evenly, place in hot water to cool, then remove. For use, take a small amount with fingers, melt in the palm, and apply to the wound. Cover with cotton paper, change twice daily; pain will subside naturally. The next day, gently wipe away necrotic skin with soft cloth and reapply.
[Prescription Verse] Poppy Ointment treats scalds and burns, Sesame Oil and Poppy are boiled together, Beeswax and pure Calomelas are added, Application to the wound instantly eliminates pain.
Qingliang Gao (Cooling Ointment)
Take one sheng of Calcined Alumen (Duan Shi) powder, sprinkle with water, add four bowls of water, stir until turbid, then allow to settle and clarify. Take one bowl of the clear liquid, add one bowl of Sesame Oil (Xiangyou), stir vigorously with chopsticks in one direction for hundreds of turns until thick and paste-like. Apply to the injured area using a chicken feather.
Huanglian Gao (Coptis Ointment) (See Nasal Ulcers in the Nose Section)
Sishun Qingliang Yin (Four-Obedience Cooling Decoction) (See Facial Parotitis in the Face Section)