Library

The *Pathogenesis* states: Broken-wind (Po Shang Feng, tetanus-like syndrome resulting from trauma) may arise from sudden injury where wind-cold pathogens invade and spread through the meridians, causing alternating chills and fever, opisthotonos (body arching backward), trismus (lockjaw), and in severe cases, pathogenic factors entering the Zang organs. It may also arise from chronic ulcers that fail to heal, where both Ying (Nutrient) and Wei (Defensive) Qi are deficient, muscles do not regenerate, and wound edges remain open, allowing external pathogens to enter the ulcer, resulting in broken-wind. In cases of non-healing ulcers, it is universally believed that moxibustion is the superior treatment; however, for heat-type ulcers, one must be unaware that fire-heat toxic pathogens lodging internally can cause transformations along the meridians, a phenomenon too numerous to recount. Mild cases present with fever, while severe cases develop wind-stirring convulsions, opisthotonos, trismus, and strabismus. There are also cases where trauma occurs without moxibustion yet the disease develops; this is because a white scab forms over the wound, closing the orifice and preventing the free flow and discharge of Qi, leading to the stagnation of Yang-heat. When heat becomes excessive, it generates wind.

Xu Yongcheng stated: This discussion outlines four etiologies. Two involve wind entering through the wound, resembling external causes. One involves heat generated by moxibustion, resembling neither-internal-nor-external causes. One involves internal heat generating wind due to wound closure, resembling internal causes. He further noted: Ancient formularies and materia medica contain few records of broken-wind syndromes. Could it be because this disease was discussed alongside Zhong Feng (Wind Stroke)? Thus, no separate entry was established. Only Liu Wansu treated it concurrently with the three methods for exterior-interior conditions in Cold Damage. His discussion on etiology includes external wind invasion, effects of moxibustion, and internal heat generation, all resembling Wind Stroke. However, patients with Wind Stroke may survive for years, whereas those with broken-wind often die upon onset. Generally, Wind Stroke varies by location—meridians, Fu organs, or Zang organs—with Zang involvement being the most difficult to treat. Broken-wind, whether due to initial excessive bleeding or early wound closure causing blood stasis, represents Yin deficiency diseases governed by the Five Zang organs. Therefore, once this wind pathogen invades, although initially at the exterior, it quickly transmits to the interior, leading to high mortality. This condition can occur whether the wound is exposed or tightly closed. If a patient who seemed stable suddenly develops these symptoms, it is largely due to internal Qi deficiency with stagnant heat. If internal Qi is robust without stagnant heat, even if harmed, the outcome is less severe.

Xue Li-zhai stated: The general principle is: In broken-wind, if wind-heat and dryness are excessive and stagnant at the exterior while interior Qi remains peaceful, symptoms such as frequent yawning/stretching, tendon and vessel tension, occasional aversion to cold, or muscle twitching will occur, accompanied by a floating, rapid, and wiry pulse—all indicating exterior syndromes. It is appropriate to use acrid-hot herbs to disperse wind and resolve stagnation, similar to using Shengma Tang (Cimicifugae Decoction) for acrid-hot dispersion in Cold Damage with exterior heat stagnation. However, when using acrid-hot herbs to resolve wind-heat stagnation, they should be assisted by cold herbs to prevent the worsening of wind-heat despite correct diagnosis. For example, treating Cold Damage fever with Mahuang Tang (Ephedra Decoction) or Guizhi Tang (Cinnamon Twig Decoction) supplemented with Huangqin (Scutellariae Radix), Zhimu (Anemarrhenae Rhizoma), or Shigao (Gypsum Fibrosum). In recent times, using cold herbs like Gancao (Licorice Root), Huashi (Talcum), Congbai (Allii Fistulosi Bulbus), and Chijiao (Fermented Soybean) for dispersion yields excellent results. If exterior pathology persists and gradually affects the interior, but the interior is not severely affected and the pulse is felt at the muscle level, it is suitable to regulate with cold herbs that clear wind-heat and resolve stagnation, or slightly add acrid-hot wind-resolving herbs. This parallels the harmonizing approach of Xiaochaihu Tang (Minor Bupleurum Decoction) for half-exterior half-interior Cold Damage. If interior heat is severe, presenting with tongue stiffness, trismus, opisthotonos,惊厥 (convulsions/tetany), viscous saliva, chest/abdominal fullness, constipation or urinary retention, or occasional sweating with a surging, rapid, and wiry pulse: sweating occurs because wind-heat is intense internally while exterior pathogens have resolved, pores are open, and Heart Fire is flourishing internally. The method should involve dispelling wind and resolving stagnation using cold herbs to purge, followed by regulation with cold herbs that clear wind-heat and resolve depression. Once heat subsides and stagnation resolves, the wind self-cures. Treatment should also include massage and Daoyin (guiding and pulling) techniques, and applying medicinal powder to open the jaw to prevent trismus, allowing porridge and medicine to be ingested.

A woman suffering from a buttock abscess nearing healing developed broken-wind with fever and convulsions, and a floating, rapid pulse. I prescribed Danggui Dihuang Tang (Angelica and Rehmannia Decoction), but she did not believe in it. She instead took dispersing and detoxifying herbs, which indeed worsened her condition, after which she finally accepted my prescription. After several doses, she recovered.

A man with an unhealed back ulcer applied a plaster with a hole cut in it. He subsequently died from a broken-wind syndrome. This was due to prior failure to tonify internally, allowing external pathogens to attack the deficiency. I have observed many cases where cutting holes in plasters to allow ventilation resulted in broken-wind, and applying hemostatic/astringent herbs to promote tissue regeneration instead aided residual toxins, leading to death. How can one not be cautious? (Commentary by Xue Ji)