名义 破伤风者，巢元方所谓金疮痉者，正此证也。（《明医指掌》）
源候诸说 夫金疮痉者，此由血脉虚竭，饮食未复，未盈月日，荣卫伤穿，风气得入，五脏受寒则
痉。其状口急背直，摇头马鸣，腰为反折，须臾十发，气息如绝，汗出如雨，不及时救者皆死。凡金疮卒无汗
者，中风也，边自出黄汁者，中水也，并欲作痉，急治之。又痛不在疮处者，伤经络亦死。（《病源论》）（
按∶《医碥》曰∶先须辨疮口，平而无水者，止于郁热而已；若肿而出水，则热郁而蒸成湿矣。）
夫腕折伤皮肉作疮者，慎不可当风及自扇。若风入疮
内，犯诸经络即致痉。痉者，脊背强直，口噤不能言也。（同上）
凡诸疮生之初，因风湿搏血气，发于皮肤，故生也。若久不瘥，多中风冷水气。若中风则噤痉，中冷则难
瘥，中水则肿也。（同上）
夫刀箭所伤，针疮灸烙， 折筋骨，痈肿疮痍，或新有损伤，或久患疮口未合，不能畏慎，触冒风寒，毒
气风邪从外所中，始则伤于血脉，又则攻于脏腑，致身体强直，口噤不开，筋脉拘挛，四肢颤掉，骨髓疼痛，
面目 斜，如此之间，便致难救，此皆损伤之处，中于风邪，故名破伤风也。（《圣惠》）
疮疡未合，风入为破伤风，湿入为破伤湿（按∶此盖巢氏所谓中水之类），二者害人最急，仓卒不知其因，
甚难忍。痈疽瘰 ，脓溃之后，尤宜谨之。（《三因》）
破伤风者，有因卒暴伤损，风袭其间，传播经络，致使寒热更作，身体反张，口噤不开，甚者邪气入脏。
有因诸疮不瘥，荣卫虚，肌肉不生，疮眼不合，风邪亦能外入于疮，为破伤风之候。有诸疮不瘥，举世皆言着
灸为上，是谓熟疮，而不知火热客毒，逐经诸变，不可胜数，微则发热，甚则生风而搐，或角弓反张，口噤目
斜。亦有破伤不灸而病此者，因疮着白痂，疮口闭塞，气难通泄，故阳热易为郁结，热甚则生风也。（《保命
集》）（按∶原文稍冗，今从《微义》引录。又《微义》曰∶此论所因有四∶二者因疮口入风，似属外因；一
者因灸逐热，似属不内外因，一者因疮口闭塞，内热生风，似属内因也。）
中风有在经在腑在脏之异，独入脏者最难治。破伤风，或始而出血过多，或疮早闭合，瘀血停滞，俱是血
受病，血
属阴，五脏之所主，故此风所伤，始虽在表，随即必传入脏，故多死也。又此病，或疮口袒露，不避风寒而无
所伤，或疮口闭合，密避风邪而反病此，或病已十分安全而忽有此，大抵皆由内气虚而有郁热者得之。若内气
壮实而无郁热者，虽伤而无所害也。（《微义》）
破碎小恙，视为寻常（《简明医彀》曰∶伤处或如豆粒，此也），卒遇风邪，渐变恶候。有因疮口未合，
失于调理而为风邪所乘者；有因白痂易长，疮口遽合，不得宣泄，热极生风者；或因淋洗过多，或因艾火灼灸，
热毒妄行，乘虚内攻者。（《汇补》）
破伤一证，金疮跌扑与溃疡迥殊。金疮跌扑受伤，则寒热头痛，面目浮肿，胸膈痞闷，六脉浮弦，或模糊
不清，其传经与伤寒不异，其势较伤寒更剧，故可用疏表之法。然亦不可峻用风药，以其经中之血先已受伤，
所谓夺血者无汗是也。若溃疡破伤，则患处忽复肿胀，按之不知疼痛，周身肌肉不仁，缓急引痛，胸膈痞满，
神思不清，六脉弦细，或虚大模糊，虽风引毒瓦斯攻注周身，切不可用攻表药汗之，必肉 筋惕，甚则发痉。
（《医通》）
凡此证，不论虚实，风毒内蕴，不发于外，疮口周遭，燥起白痂，疮不甚肿，湿流污黑之水，牙关微紧，
不似寻常活动，皆破伤风之先兆也。（《金鉴》）
证治诸说 大法破伤中风，风热燥甚，怫郁在表，而里气尚平者，善伸数欠，筋脉拘急，或时恶寒，
或筋惕而搐，脉浮数而弦也。宜以辛热治风之药，开冲结滞，荣卫宣通而愈。由伤寒表热怫郁，则以麻黄汤辛
热发散者也。若破伤中风，表不已而渐入于里，则病势渐甚。若里未太甚，而热在肌肉者，宜以退风热开郁滞
之寒药调之。或以微加治风辛热
之药亦得，以意消息，不可忘也。此犹伤寒半在表半在里，而以小柴胡汤和解之也。若里势已甚，而舌强口噤，
项背反张，惊搐惕搦，涎唾稠粘，胸腹满塞，而或便溺闷结，或时汗出，脉洪数而弦也云云。犹阳明证热甚于
里，而日晡潮热，大汗虽出，热不退而不能解也，故当大承气汤下之，其里热也云云。呜呼！俗医所治破伤中
风，不明浅深，但以辛热燥药，任其天命而已。若始觉风热郁结于表，而里尚和平者，未传也，或以寒物佐之
亦佳云云。凡治风热结滞，宜戒热药过甚。（《原病式》）
破伤风者，通于表里，分别阴阳，同伤寒证治。闾阎往往有不知者，只知有发表者，不知有攻里者、和解
者。此汗下和三法也，亦同伤寒证，然汗下亦不可过其法也。（《保命集》）
防风、全蝎之类，皆是要药。（《丹溪》）
初觉疮肿起白痂，身寒热，急用玉真散贴之。伤在头面，急嚼杏仁和雄黄白面敷疮上，肿渐消为度。若腰
脊反张，四肢强直，牙关口噤，通身冷，不知人，急用蜈蚣研细末，擦牙，吐出涎沫立苏。（《纲目》）
破伤风，因皮肉损破，复被外风袭入经络，渐传入里。其患寒热交作，口噤切牙，角弓反张，口吐涎沫。
入阴则身凉自汗，伤处反为平陷如故，其毒内收矣。当用万灵丹（按∶用茅术、全蝎等二十六味，今不录）发
汗，令风邪反出，次以玉真散，患上贴之，得脓为效。（《外科正宗》）
死证 （巢氏有说，宜参源候条。）病疮，腰脊强急 者，皆不可治。（《脉经》）（按∶疮，盖金
疮之谓。）
汗出如珠颗，眼黄，饮得水者，可治。若汗出如油，直视吐涎水，心烦热闷，头发乱，身不转者，难治。
（《圣
济》）
四般恶证不可治∶第一，头目青黑色；第二，额上汗珠不流；第三，眼小目瞪；第四，身上汗出如油。
（《宝鉴》）
如汗后，前症（上所引是）不退，伤处不高，渐醒渐昏，时发时止，口噤不开，语声不出者，终为死候。
（《外科正宗》）
或腹满自利，或口燥咽干，舌卷囊缩，皆死证也。（《医通》）
类证 大凡痈疽溃后，筋糜肉烂，脓血大泄，阳随阴散，或筋脉拘急，恶寒惕搦，甚者舌强口噤，项
背反张，痰涎壅甚，便闭汗出，不时发热。此气血俱虚而传变，虽与破伤风相类，而主治之法，当大补气血。
若果系风症，亦须以大补气血为本，而兼以治风之药。设若不审是非而妄药之，则误矣。（《外科枢要》）
汤酒诸方 （按∶此证治诸方，多为驱风之剂，其他则不过仅仅数首，今不敢区其类，一以汤酒丸散概
之，从变例也。）
治破伤风入，四体角弓反张，口噤不能言，或产妇堕胎，凡得此者用紫汤，大重者不过五剂。（《千金》）
治金疮中风痉方。
生葛根（一斤锉）
上以水五升，煮取三升去滓，每热服一小盏，日三四服。（《圣惠》）
羌活防风汤，治破伤风，邪初传在表。
羌活 防风 川芎 本 当归 芍药 甘草（各一两） 地榆 华细辛（各三两）
上 咀，每服五七钱，水一盏半，同煎至七分，去滓热
服，不拘时候，量紧慢加减用之。热则加大黄二两，大便秘则加大黄一两，缓缓令过。（《保命集》）
羌活汤，治半在表半在里也。
羌活 菊花 麻黄 川芎 防风 石膏 前胡 黄芩 细辛 甘草 枳壳 白茯苓 蔓荆子（各一两）
薄荷（半两） 吴白芷（半两）
上 咀，每服五钱，水一盏半，入生姜五片，同煎至一盏，去渣稍热服，不拘时候，日进二服。（同上）
防风汤，治破伤风同伤寒，表证未解入里，宜急服此药。
防风 羌活 独活 川芎（各等分）
上 咀，每服五钱，水一盏半，煎至七分，去滓温服。二三服后，宜调蜈蚣散，大效。（同上）又若搐
不已，宜服羌活汤，于本方去川芎，加地榆，各一两。如有热，加黄芩。
大芎黄汤，破伤风，脏腑秘，小便赤，自汗不止者，因用热药汗出不休，故知无寒也，宜速下之，先用芎
黄汤（用川芎一两，黄芩六钱，甘草二钱），三二服后，用大芎黄汤下之。
川芎（二两） 羌活 黄芩 大黄（各一两）
上 咀，根据前煎服，以利为度。（同上）
白术汤，治破伤风，大汗不止，筋变搐搦。
白术 葛根（各一两） 升麻 黄芩（各半两） 芍药（二两） 甘草（二钱半）
上 咀，每服一两，水一盏半，煎至一盏，去滓温服，不拘时候。（同上）
一妇人年四十余，形黑而瘠，性躁急。嘉靖庚申五月。
左腿发内痈，溃后起坐。予曰∶疮口未合，当禁风。其妇自恃强健不听，忽一日眩仆，目札口 ，身反张，手
足挛曲，其家人请予治之。予曰∶此破伤风， 病也。乃用桂枝汤加熟附子、黄 、防风，一剂而症减，再服
十全大补汤，三剂而安。（《保命歌括》）
《必效》疗金疮中风，角弓反张者方。取蒜一大升，破去心，以无灰酒四升，煮蒜令极烂，并滓服一大升
以来，须臾汗如雨出则瘥。（《外台》）
治金疮或打击破疮等风入，口闭牙噤，身强欲死，宜浸酒方。
雀屎（炒研半合）
上一味，以酒七合，煮至五合，滤去滓，令温服，腹中转动，当时愈。若不能开口，拨开灌之。（《圣济》）
破伤风能死人，用桑条如箸长者，十数茎阁起，中用火烧，接两头滴下树汁，以热酒和而饮之，可愈。
（《山居新话》）
破伤风病，用蟾二两半，切剁如泥，入花椒一两，同酒炒熟，再入酒二盏半，温热服之，少顷通身汗出，
神效。（《本草纲目》）
刑曹案牍多被殴后以伤风死者，在保辜限内，于律不能不拟抵。吕太常含晖常刊秘方，以荆芥、黄蜡、鱼
鳔三味《鱼鳔炒黄色）各五钱，艾叶三片，入无灰酒一碗，重汤煮一炷香，热饮之，汗出立愈。惟百日以内，
不得食鸡肉。（《槐西杂志》）
丸散诸方 治破伤风，干蝎丸方。
干蝎（酒炒） 天麻（各半两） 蟾酥（二钱汤浸化如稀糊）
上三味，将二味捣罗为末，用蟾酥糊丸，如绿豆大，每服一丸至二丸，豆淋酒下，甚者加三丸至五丸。
（《圣济》）
治破伤风打扑内损，银花散方。
天南星（大者半生半炮） 白附子（半生半炮） 防风（去叉等分）
上三味，为细散，每服二钱匕，重者童子小便调下，稍轻熟酒调下。如外伤，用此药贴疮口，仍根据法服之。
如破伤风，先以小便温洗疮口，次用药干贴，追出风毒立愈。势稍恶、口噤者，以童子小便调，斡开口灌之。
如斗打至死，但心头微暖者，并灌三服即活。常须合下，以备急用。（同上）（按∶《本草》引初虞世治破伤
风入疮强直，防风、天南星等分为末，以醋调作靥粘贴。又《圣济》夺命散，亦用二味，先用童子小便洗疮口，
后以此药末酒调贴之。《叶氏》举其方曰∶先以热小便洗疮贴之，有紫汁出是效。）《本事》玉真散，于本方
去白附子。（用方稍与本方同。《是斋》曰∶玉真散，《本事》、《必用》两方皆有，但人不知。张叔潜知府
云∶此方极奇，居官不可阙。予宰清流，且以授直厅医，救欲死者数人，奇甚。又曰∶天南星为防风所制，服
之不麻。）《三因》防风散，亦去白附子，每服三钱，童子小便一大盏，煎至七分热服。《保命集》雄黄散，
于本方去白附子，南星三钱，半夏五钱，加天麻五钱，雄黄二钱半，每服一钱，温酒调下。如有涎，加大黄。
《外科正宗》玉真散，于本方加白芷、天麻、羌活。（六味各等分，用法与《本事》同。）
治破伤风、洗头风，金花散。
草乌头（研破，用里面白腻，如黑者不可用。） 防风（用实而粗大者。） 雄黄（别研如粉，各等分。）
上件为末，每服一字，温酒调下。如是噤了口，以物斡开，热酒调半钱灌之。如人行二三里，更进一字，
神效。些小伤风，一两日安。（《传家秘宝》）《保命集》发表雄黄散，即本方（防风二钱，余一钱）。里和，至愈
可服；里不和，不可服。
治破防风，腰脊反折，项强直，牙关紧急，急风散方。
草乌头（不拘多少，用酽醋煮十余沸，漉出曝干，如此十遍为度。）
上一味捣罗为细散，每服一字，温酒调下。（《圣济》）
治破伤风，身项强硬，不知人事，必效散方。
鳔胶（白色者，不拘多少，炙令焦黄。）
上一味，捣罗为细散，每服三钱匕，热酒调下。如不省，灌之。（同上）（按∶《千金》治风角弓反张方。
酒一斗，胶二斤，煮令烊，得六升，每服一升，稍服得愈。岂此方所本欤。）《杨氏》海神散，鳔胶，木匠用
者，于瓦上用炭火烧成灰，研细。《叶氏》鳔不以多少，于一仰一合瓦内，炭火烧，烟尽研细，热酒调下，汗
出即愈。
香胶散，治破伤风，口噤强直。
鱼胶（烧七分留性）
[Definition]
Po-shang-feng (Broken-wind disease / Tetanus), as referred to by Chao Yuan-fang, is Jin-chuang-jing (Metal wound spasm); it is precisely this syndrome. (*Ming Yi Zhi Zhang*)
[Source and Syndrome Discussions]
Regarding Jin-chuang-jing (Metal wound spasm): This arises from the exhaustion of blood vessels and depletion of essence, with diet not yet restored. Within less than a month, Ying-Wei (Nutritive and Defensive Qi) are damaged and perforated, allowing Wind pathogen to enter. When the Five Zang organs receive Cold, spasms occur. The manifestations include tightness of the mouth, rigidity of the back, shaking of the head accompanied by sounds like a neighing horse, opisthotonos (arching of the back), attacks occurring ten times in a short while, breath seeming to cease, sweating profusely like rain; if not rescued promptly, death ensues. Generally, if a metal wound suddenly presents without sweating, it indicates Wind strike; if yellow fluid spontaneously exudes from the edges, it indicates Water toxicity. Both tend to develop into spasms and require urgent treatment. Furthermore, pain located away from the wound site indicates meridian damage, which is also fatal. (*Zhu Bing Yuan Hou Lun*) [Note: *Yi Que* states: One must first examine the wound. If flat and dry, it is merely stagnant heat; if swollen and weeping, heat stagnation steams into dampness.]
For wrist fractures damaging skin and flesh forming wounds, one must strictly avoid wind exposure or self-fanning. If Wind enters the wound and invades various meridians, it causes spasms. Spasms manifest as rigidity of the spine and back, and trismus (lockjaw) preventing speech. (Ibid.)
When various sores initially arise, Wind-Damp combats with Qi and Blood, emerging on the skin, thus generating the lesion. If prolonged without healing, it often involves invasion of Cold-Wind and Cold-Water Qi. Invasion by Wind leads to trismus and spasms; invasion by Cold makes healing difficult; invasion by Water causes swelling. (Ibid.)
Injuries from knives or arrows, acupuncture, moxibustion, cauterization, bone fractures, carbuncles, sores, or recent injuries, or long-standing open wounds that have not closed, if carelessness leads to exposure to Wind-Cold, toxic Qi and Wind pathogen attack from outside. Initially damaging blood vessels, subsequently attacking the Zang organs, it results in body rigidity, inability to open the mouth, tendon and vessel contraction, trembling of limbs, bone marrow pain, and facial deviation. In such cases, rescue becomes difficult. These are all instances where the injury site is struck by Wind pathogen, hence named Po-shang-feng (Broken-wind disease). (*Tai Ping Sheng Hui Fang*)
If an ulcer has not closed and Wind enters, it becomes Po-shang-feng; if Dampness enters, it becomes Po-shang-shi (Broken-wind-dampness) [Note: This likely corresponds to Chao's concept of "Water strike"]. Both are most dangerous and acute; sudden onset with unknown cause is extremely distressing. After abscesses, carbuncles, or scrofula rupture pus, extra caution is required. (*San Yin Ji Yi Bing Zheng Fang Lun*)
Po-shang-feng may result from sudden severe trauma, where Wind strikes the area, spreads through meridians, causing alternating chills and fever, opisthotonos, and trismus. Severe cases involve pathogen entering the Zang organs. It may also arise from non-healing sores where Ying-Wei are deficient, muscles do not regenerate, and wound pores remain open, allowing Wind to enter externally. Some claim moxibustion is best for non-healing sores ("cooked sores"), unaware that fire-heat and guest toxins cause countless variations along meridians: mild cases present with fever, severe cases with Wind-stroke and convulsions, opisthotonos, or trismus with eye deviation. Even without moxibustion, if a white scab forms over the wound closing the pore, Qi cannot vent, leading to Yang-heat stagnation; excessive heat generates Wind. (*Bao Ming Ji*) [Note: Original text is verbose; excerpted from *Wei Yi*. *Wei Yi* adds four causes: two due to Wind entering wounds (external); one due to moxibustion driving out heat (neither internal nor external); one due to wound closure causing internal heat generating Wind (internal).]
Wind-strike differs by location in Meridians, Fu organs, or Zang organs; invasion of Zang is hardest to treat. Po-shang-feng, whether due to initial excessive bleeding or premature wound closure causing blood stasis, involves pathology in Blood. Blood belongs to Yin, governed by the Five Zang. Thus, although Wind injury starts at the Exterior, it rapidly transmits to the Zang, leading to high mortality. Additionally, some exposed wounds resist Wind-Cold without harm, while sealed wounds protected from Wind still contract this disease, or patients seemingly recovered suddenly relapse. Generally, this affects those with internal Qi deficiency and stagnant heat. Those with robust internal Qi and no stagnant heat suffer little harm even if injured. (*Wei Yi*)
Minor broken injuries are often treated casually [as noted in *Jian Ming Yi Gou*: even small injuries like bean-sized wounds], but sudden Wind exposure gradually transforms into malignant conditions. Causes include: unclosed wounds neglected and invaded by Wind; rapid scab formation closing wounds preventing venting, leading to extreme heat generating Wind; excessive washing; or moxibustion causing wild heat-toxicity to attack internally via deficiency. (*Hui Bu*)
Po-shang-feng differs significantly between metal wounds/falls and ulcers. Metal wounds/falls present with chills, fever, headache, facial swelling, chest oppression, floating-stringy pulses, or indistinct pulses. Transmission resembles Taiyang disease but is more severe, allowing for exterior-releasing methods. However, harsh Wind-dispelling drugs must be avoided because blood in the meridians is already injured ("those who lose blood do not sweat"). Ulcer-related Po-shang-feng presents with sudden swelling at the site, insensitivity to pressure, general muscle numbness, pulling pain, chest fullness, confusion, string-thin or large/vague pulses. Although Wind-toxin attacks the whole body, exterior-releasing diaphoretics must never be used, as this will cause muscle twitching and spasms. (*Yi Tong*)
Regardless of deficiency or excess, if Wind-toxin is internally retained without expressing outward, with dry white scabs around the wound, minimal swelling, blackish discharge, slight jaw tightness, and limited mobility, these are prodromal signs of Po-shang-feng. (*Yi Zong Jin Jian*)
[Treatment Principles]
The general principle for treating Po-shang-feng with Wind-Heat dryness and stagnation at the Exterior, while Interior Qi is peaceful, includes frequent stretching/yawning, tendon stiffness, occasional chills, or muscle twitching/convulsions, with floating-rapid-stringy pulses. Use acrid-hot Wind-dispelling drugs to open stagnation, restoring Ying-Wei circulation for cure. Similar to Taiyang exterior Heat stagnation treated with Ma Huang Tang (Ephedra Decoction) for acrid-hot dispersion: if Po-shang-feng remains at the Exterior and moves inward, severity increases. If Interior is not severely affected but Heat is in the Muscles, use cold drugs to clear Wind-Heat and open stagnation, possibly adding mild acrid-hot Wind drugs. This resembles Shaoyang half-exterior/half-interior patterns treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction). If Interior pathology is severe, presenting with tongue stiffness, trismus, opisthotonos,惊厥 (convulsions), thick saliva, chest/abdominal fullness, constipation/dysuria, or intermittent sweating, with flooding-rapid-stringy pulses: this resembles Yangming interior Heat with afternoon tidal fever, where massive sweating fails to resolve heat. Da Cheng Qi Tang (Major Order the Qi Decoction) should be used to purge interior Heat. Alas! Quack doctors treat Po-shang-feng without distinguishing depth, relying solely on acrid-hot drying drugs and leaving fate to chance. If Wind-Heat stagnates at the Exterior with peaceful Interior, adding cold herbs is beneficial. Caution against excessive use of hot drugs for Wind-Heat stagnation. (*Yuan Bing Shi*)
Po-shang-feng involves both Exterior and Interior, distinguished by Yin/Yang, similar to Taiyang disease treatment. Laypeople often know only of exterior-releasing methods, ignoring purgative or harmonizing methods. These are Sweating, Purging, and Harmonizing techniques, applicable to Taiyang-like patterns, but sweating and purging must not exceed proper limits. (*Bao Ming Ji*)
Fang Feng (Saposhnikovia Root) and Quan Xie (Scorpion) are essential drugs. (*Dan Xi Xin Fa*)
At the first sign of wound swelling and white scabs with chills/fever, urgently apply Yu Zhen San (Jade True Powder). For head/face injuries, chew Almond mixed with Xiong Huang (Realgar) and flour, apply to wound until swelling subsides. For opisthotonos, limb rigidity, trismus, whole-body coldness, and unconsciousness, urgently grind Centipede (Wu Gong) into fine powder, rub on teeth; expulsion of saliva restores consciousness immediately. (*Ben Cao Gang Mu*)
Po-shang-feng arises from skin/flesh breach allowing external Wind to invade meridians, gradually transmitting inward. Symptoms include alternating chills/fever, trismus, opisthotonos, salivation. Invasion of Yin channels causes cool body and spontaneous sweating, with the wound flattening as toxin retreats inward. Use Wan Ling Dan (Ten Thousand Spirit Pill) to induce sweating, expelling Wind pathogen outward, followed by Yu Zhen San applied topically; suppuration indicates efficacy. (*Wai Ke Zheng Zong*)
[Death Signs]
(Wang Hun-yuan's views should be consulted in Source/Syndrome sections.) Wounds with stiff/opisthotonic back/spine are incurable. (*Mai Jing*) [Note: "Wound" here refers to metal wounds.]
Sweating like beads, yellow eyes, ability to drink water: curable. Sweating like oil, fixed gaze, vomiting saliva, irritability/heat/fullness, disheveled hair, immobility: difficult to treat. (*Sheng Ji Zong Lu*)
Four ominous signs are incurable: 1. Blue-black color of head/eyes; 2. Sweat beads on forehead not flowing; 3. Small pupils with staring eyes; 4. Sweating like oil. (*Shi Yi De Xiao Fang*)
If after sweating, previous symptoms persist, wound does not elevate, consciousness fluctuates between alert and comatose, spasms come and go, trismus prevents speech: terminal prognosis. (*Wai Ke Zheng Zong*)
Abdominal fullness with spontaneous diarrhea, dry mouth/throat, curled tongue, retracted testicles: death signs. (*Yi Tong*)
[Differential Diagnosis]
Generally, after carbuncles/ulcers rupture, tendons rot, flesh decays, pus/blood drains heavily, Yang dissipates with Yin. Manifestations include tendon stiffness, aversion to cold, twitching/convulsions, severe tongue stiffness/trismus, opisthotonos, phlegm-saliva obstruction, constipation/sweating, intermittent fever. This is transmission due to dual Qi/Blood deficiency. Though resembling Po-shang-feng, primary treatment must strongly tonify Qi and Blood. Even if truly Wind-pathogen, tonifying Qi/Blood is fundamental, supplemented by Wind-treating drugs. Failure to distinguish correctly leads to error. (*Wai Ke Shu Yao*)
[Decoctions, Wines, and Other Formulas]
(Note: Most formulas for this condition are Wind-dispelling agents; others are few. Classified generally as Decoctions, Wines, Pills, Powders following variable examples.)
Treat Po-shang-feng with opisthotonos, trismus, or postpartum abortion complications using Zi Tang (Purple Decoction). Severe cases require no more than five doses. (*Qian Jin Fang*)
Formula for Metal Wound Wind-Spasm:
Sheng Ge Gen (Fresh Pueraria Root, 1 jin, chopped)
Boil in 5 sheng water to obtain 3 sheng, strain. Take one small cup hot, 3-4 times daily. (*Sheng Hui Fang*)
Qiang Huo Fang Feng Tang (Notopterygium and Saposhnikovia Decoction), for Po-shang-feng with pathogen newly transmitted to Exterior.
Qiang Huo, Fang Feng, Chuan Xiong, Ben Cao, Dang Gui, Shao Yao, Gan Cao (each 1 liang); Di Yu, Hua Xi Xin (each 3 liang).
Chop. Take 5-7 qian, boil in 1.5 sheng water to 0.7 sheng, strain, take hot. Dosage adjusted by urgency. Add Da Huang (Rhubarb) 2 liang for heat; add 1 liang for constipation, slowly inducing bowel movement. (*Bao Ming Ji*)
Qiang Huo Tang (Notopterygium Decoction), for half-exterior/half-interior patterns.
Qiang Huo, Ju Hua, Ma Huang, Chuan Xiong, Fang Feng, Shi Gao, Qian Hu, Huang Qin, Xi Xin, Gan Cao, Zhi Ke, Bai Fu Ling, Man Jing Zi (each 1 liang); Bo He (Half liang); Wu Bai Zhi (Half liang).
Chop. Take 5 qian, boil with 5 slices of Sheng Jiang (Fresh Ginger) in 1.5 sheng water to 1 sheng, strain, take slightly warm. Twice daily. (Ibid.)
Fang Feng Tang (Saposhnikovia Decoction), for Po-shang-feng resembling Taiyang disease, exterior unresolved transmitting inward; take urgently.
Fang Feng, Qiang Huo, Du Huo, Chuan Xiong (equal parts).
Chop. Take 5 qian, boil in 1.5 sheng water to 0.7 sheng, strain, take warm. After 2-3 doses, adjust with Wu Gong San (Centipede Powder) for great effect. (Ibid.) If convulsions persist, use Qiang Huo Tang, removing Chuan Xiong, adding Di Yu (each 1 liang). Add Huang Qin if heat is present.
Da Xiong Huang Tang (Major Ligusticum and Scutellaria Decoction), for Po-shang-feng with organ constipation, red urine, continuous spontaneous sweating due to excessive hot-diaphoretic use (indicating no Cold); purge quickly. First use Xiong Huang Tang (Chuan Xiong 1 liang, Huang Qin 6 qian, Gan Cao 2 qian). After 2-3 doses, use Da Xiong Huang Tang to purge.
Chuan Xiong (2 liang), Qiang Huo, Huang Qin, Da Huang (each 1 liang).
Chop, decoct as before, stop when bowels move. (Ibid.)
Bai Zhu Tang (Atractylodes Macrocephala Decoction), for Po-shang-feng with profuse sweating and tendon convulsions.
Bai Zhu, Ge Gen (each 1 liang); Sheng Ma, Huang Qin (each half liang); Shao Yao (2 liang); Gan Cao (2.5 qian).
Chop. Take 1 liang, boil in 1.5 sheng water to 1 sheng, strain, take warm. Anytime. (Ibid.)
Case: A woman, 40+, dark and emaciated, irritable. In May of Jia-Shen year (Jiajing era), developed an internal carbuncle on left leg. After rupture, she sat up. I said: "Wound unhealed, must avoid wind." She ignored advice due to perceived strength. Suddenly fainted, blinking eyes, twitching mouth, opisthotonos, limb curling. Family summoned me. I diagnosed: "Po-shang-feng, critical illness." Prescribed Gui Zhi Tang (Cinnamon Twig Decoction) plus Shu Fu Zi (Prepared Aconite), Huang Qi (Astragalus), Fang Feng. One dose reduced symptoms; subsequent Shiquan Dabu Tang (Complete Great Tonifying Decoction) for three doses brought recovery. (*Bao Ming Ge Kuo*)
*Bi Xiao Fang* for Metal Wound Wind-Stroke with Opisthotonos: Take 1 sheng Garlic, remove heart, boil in 4 sheng Wine without ash until very soft. Consume entire amount including dregs. Profuse sweating like rain indicates cure. (*Wai Tai Mi Yao*)
Soaking Wine for Metal Wounds/Blunt Trauma with Wind invasion, trismus, rigidity nearing death:
Que Shi (Sparrow Droppings, stir-fried and ground, half he)
Boil in 7 he wine to 5 he, strain, take warm. Abdominal movement indicates immediate cure. If unable to open mouth, force feed. (*Sheng Ji Zong Lu*)
Po-shang-feng can be fatal. Use Mulberry branches chopstick-length, bundle, burn middle, catch dripping sap at ends. Mix with hot wine and drink. Cure. (*Shan Ju Xin Hua*)
Po-shang-feng: Chop 2.5 liang Toad (Chan Su), mix with 1 liang Sichuan Pepper, stir-fry in wine until cooked. Add 2.5 cups wine, take warm. General sweating shortly after indicates miraculous effect. (*Ben Cao Gang Mu*)
Judicial clerks often died of Wind-strike after beatings within Bao Gu period, requiring capital punishment. Grand Secretary Lv Hanhui published secret formula: Jing Jie (Schizonepeta), Huang La (Yellow Beeswax), Yu Biao (Fish Maw, stir-fried yellow) each 5 qian; Ai Ye (Mugwort Leaf) 3 pieces. Simmer in 1 bowl wine without ash over double boiler for incense time. Drink hot; sweating cures immediately. Avoid chicken meat for 100 days. (*Huai Xi Za Zhi*)
[Pills and Powders]
Gan Xie Wan (Dried Scorpion Pill) for Po-shang-feng:
Gan Xie (Stir-fried in wine), Tian Ma (each half liang); Chan Su (Toad Venom, 2 qian, dissolved in hot water to paste).
Grind first two ingredients to powder. Use Chan Su paste to make pills size of mung beans. Take 1-2 pills, washed down with Dou Lin Jiu (Bean-soaked wine). Severe cases: 3-5 pills. (*Sheng Ji Zong Lu*)
Yin Hua San (Silver Flower Powder) for Po-shang-feng/blunt trauma internal injury:
Tian Nan Xing (Large, half raw half processed), Bai Fu Zi (half raw half processed), Fang Feng (de-veined, equal parts).
Grind to fine powder. Take 2 qian bi, heavy cases with child's urine, lighter with cooked wine. For external wounds, apply powder to wound, continue oral dosage. For Po-shang-feng, wash wound with warm urine first, then apply dry powder to draw out Wind-toxin. For severe cases/trismus, use child's urine to administer. For beaten to death but heart still warm, give 3 doses to revive. Keep prepared for emergencies. (Ibid.) [Note: *Ben Cao* cites Chu Yu Shi treating Po-shang-feng rigidity with Fang Feng/Tian Nan Xing powder mixed with vinegar as patch. *Sheng Ji* Duo Ming San uses same two ingredients, washed with urine then applied with wine. *Ye Shi* notes: Wash with hot urine, apply; purple juice indicates efficacy. *Ben Shi Fang* Yu Zhen San removes Bai Fu Zi from this base. *Shi Zhai* notes Yu Zhen San exists in *Ben Shi* and *Bi Yong*, rarely known. Prefect Zhang Shuqian praised it highly. Added note: Tian Nan Xing is controlled by Fang Feng, causing no numbness. *San Yin* Fang Feng San also removes Bai Fu Zi, take 3 qian with large cup child's urine boiled to 0.7, take hot. *Bao Ming Ji* Xiong Huang San removes Bai Fu Zi, reduces Nan Xing to 3 qian, Ban Xia 5 qian, adds Tian Ma 5 qian, Xiong Huang 2.5 qian. Take 1 qian with warm wine. Add Da Huang if phlegm. *Wai Ke Zheng Zong* Yu Zhen San adds Bai Zhi, Tian Ma, Qiang Huo (six ingredients equal parts, usage same as *Ben Shi*).]
Jin Hua San (Golden Flower Powder) for Po-shang-feng/Head-washing Wind:
Cao Wu Tou (Crushed, use inner white part, not black), Fang Feng (solid and coarse), Xiong Huang (separately ground to powder, equal parts).
Powder. Take 1 zi, mixed with warm wine. If locked jaw, pry open,灌 half qian with hot wine. Walk 2-3 li, take another zi. Miraculous. Minor wind-colds resolve in 1-2 days. (*Chuan Jia Mi Bao*) *Bao Ming Ji* Biao Fa Xiong Huang San is this formula (Fang Feng 2 qian, others 1 qian). Take only if Interior is harmonious; contraindicated if Interior disharmonious.
Ji Feng San (Urgent Wind Powder) for Po-shang-feng with opisthotonos, neck rigidity, emergency trismus:
Cao Wu Tou (Any amount, boil in strong vinegar 10+ boils, drain, dry, repeat 10 times).
Grind to fine powder. Take 1 zi, mixed with warm wine. (*Sheng Ji Zong Lu*)
Bi Xiao San (Miraculously Effective Powder) for Po-shang-feng with body/neck rigidity and unconsciousness:
Biao Jiao (White type, any amount, roast until scorched yellow).
Grind to fine powder. Take 3 qian bi, mixed with hot wine. Force-feed if unconscious. (Ibid.) [Note: *Qian Jin* treats opisthotonos with 1 dou wine and 2 jin gelatin, boiled down to 6 sheng, take 1 sheng per dose. Is this formula derived from there? *Yang Shi* Hai Shen San uses carpenter's gelatin, burned to ash on tile, ground fine. *Ye Shi* burns gelatin in inverted tiles until smoke ceases, grinds, takes with hot wine, sweating cures.]
Xiang Jiao San (Fragrant Gelatin Powder) for Po-shang-feng with trismus and rigidity:
Yu Jiao (Fish Maw/Gelatin, roasted 70% retaining nature)