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Fractures and sprains, although treated with manual manipulation, may not be fully addressed appropriately, leading to the suffering of "treatment as if no treatment had occurred." In such cases, one cannot claim that the medical principles are thorough. Therefore, based on the anatomical positions (upper/lower, anterior/posterior) of the body, instruments are fabricated to correct deformities, assisting where manual manipulation falls short. This aims to reunite separated parts, straighten tilted ones, level elevated areas, and restore depressed regions to their proper positions. Consequently, critical conditions can be stabilized, and severe injuries can be mitigated. Furthermore, by applying herbal medicine and instructing on proper recuperation, the art of bone-setting becomes complete.

Guolian (Instrument 1, no illustration): Guolian is made of white cloth. Since other instruments are unsuitable for the injured area, wrapping with cloth is the only appropriate method, hence the name. Its length and width are determined according to the severity of the condition.

Zhen Ting (Instrument 2, no illustration): Zhen Ting refers to a wooden rod, approximately one chi five cun long and round like a coin; a rolling pin may also be used. Where injury has caused qi and blood stagnation, resulting in pain, swelling, and hardness, gently vibrating and tapping the surrounding areas with this rod promotes the circulation and dispersion of qi and blood, thereby gradually reducing pain and subsiding swelling and hardness.

Explanation of Usage: For head injuries where bones are not shattered and tendons are not severed, even with blood stasis causing swelling and pain, the condition is treatable. First, use manual manipulation to align the neck and upper back structures. Then, wrap the head tightly with two or three layers of cloth. Next, gently tap the soles of the feet with the Zhen Ting to promote the free flow of qi among the Five Viscera, dispersing blood stasis. This prevents the stasis from rushing to the Heart or causing vomiting and hiccups, thus calming the Shen (Spirit). However, if after wrapping the head and tapping the feet, the patient feels no pain, falls into unconsciousness, exhibits rattling phlegm sounds resembling sawing, rigid body posture, and foaming at the mouth, it indicates impending exhaustion of qi and blood; this is incurable.

Pijian (Instrument 3, no illustration): Pijian consists of a piece of tanned cowhide, five cun long and three cun wide, with two holes opened at each end. It is placed over the injury site, threaded with cotton rope, and tied tightly. It offers slightly more flexibility than wooden boards.

Explanation of Usage: For shoulder dislocations or fractures caused by falling or twisting, where bones may be shattered, displaced laterally, angulated, or joint spaces misaligned with tendon displacement, the patient should lie supine on a bench. The bone joints should be realigned, and tendon knots massaged. Cotton padding is placed against the skin first. Then, the Pijian is used to clamp the front and back of the shoulder, secured tightly, and wrapped externally with white cloth. A support board (Fu Shou Ban), over two chi long and three to four cun wide, with ropes at both ends, is suspended overhead. The patient lies prone on this setup to prevent the shoulder bones from drooping. After seven days, inspect the area. If healed, remove the board; otherwise, continue its use. Failure to follow this protocol will likely result in residual deformity resembling a reed node.

Pan Suo (Instrument 4): Pan Suo involves hanging a rope from a high place for the patient to grasp with both hands.

Die Zhuan (Instrument 5): Die Zhuan involves stacking six bricks, three on each side, for the patient to stand upon.

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Explanation of Usage: For chest, abdomen, viscera, or hypochondriac injuries caused by falling, striking, jumping, colliding, cushioning, or straining, resulting in chest depression and deformity, have the patient grasp the rope with both hands and stand on the bricks. An assistant holds the lower back. Remove one brick from each side, instructing the patient to straighten the torso and protrude the chest. Repeat this process twice more (removing one brick each time). When the feet touch the ground, qi flows freely, stasis dissipates, depressed areas rise, and curvature straightens. Subsequently, wrap the chest with a bamboo mat (Zhulian) and secure it tightly with eight broad belts. Ensure breathing is not obstructed. The patient must sleep supine, avoiding prone or lateral positions. Place a pillow under the waist to prevent left-right movement.

Tong Mu (Instrument 6): Made of fir wood, three cun wide and two cun thick, extending from the waist up past the shoulders by about one cun. The outer surface is flat, while the inner surface facing the spine is carved concavely to fit the spinal muscles perfectly. It is divided into five sections (fen, pronounced qù shēng). At the first section, drill two diagonal holes on the left side and two on the right. From the second through fifth sections, drill one diagonal hole on each side. Thread a broad belt through the upper-left hole of the first section, over the right shoulder, across the chest, diagonally under the left axilla, around the back, and into the next-right hole of the first section. Thread another belt through the upper-right hole of the first section, over the left shoulder, across the chest, diagonally under the right axilla, around the back, and into the next-left hole of the first section. Tie both ends tightly to the wood. Pass belts through the third and fourth sections, wrapping horizontally across the soft ribs and abdomen, then back through the original holes, tying tightly. Pass a belt through the fifth section, wrapping horizontally across the anterior abdomen, then back to tie tightly. The instrument must remain stable without shifting to be effective. Before application, pad the skin with cotton wadding and soft fabric to prevent pain.

Explanation of Usage: For spinal injuries from falls or blows where the vertebral processes are fractured and elevated, the patient typically suffers from kyphosis and difficulty extending backward. Have the patient lie prone. An assistant stands on the patient's shoulders. The practitioner assesses the fracture site, applying appropriate pressure—lifting, pressing, or massaging—to realign the fragments. Then, apply the Tong Mu according to the described method to stabilize the spine.

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Yao Zhu (Instrument 7): Yao Zhu consists of four fir wood strips shaped like a carrying pole, one cun wide and half a cun thick, sized according to the injury site. Holes are drilled on the sides, and they are linked by ropes.

Explanation of Usage: For lumbar sprains or qi stagnation, standard treatments apply. However, if the lumbar vertebrae are misaligned, muscle tissue is torn, or tendons are displaced causing kyphosis, mix Ding Tong San (Pain-Relieving Powder) with vinegar and apply it to the Yao Zhu. Arrange the columns alongside the spine, ensuring alignment. Cover the columns with a thin mattress made of Qiai (Ai Ye, Artemisia argyi) to protect against wind and cold. Secure tightly with a long broad belt around the abdomen. Administer internal herbal medicine for self-healing.

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Zhulian (Instrument 8): Zhulian is simply a summer bamboo cooling mat, cut to the size and length of the injury site.

Explanation of Usage: For limb fractures, after manual reduction, wrap the area with cloth, then encase it in the Zhulian and tie tightly. This prevents bone fragments from shifting or displacing. It is a general-purpose instrument.

Shan Li (Instrument 9): Shan Li is an additional stabilizing instrument. It is made of fir wood, tailored to the length, width, and contour (concave/convex) of the injury. The number of slats is determined, and their order is noted to avoid confusion. Holes are drilled at both ends of each slat, which are then linked by ropes. Resembling a fence, it is named accordingly. It is spaced more sparsely than the Zhulian.

Explanation of Usage: Used outside the Zhulian, the ropes are knotted, and additional ropes are wound around the Shan Li for extra rigidity. This prevents bone fragments from separating or displacing. Areas involving joint movement, especially long bone segments, are prone to instability. Relying solely on Zhulian may lack sufficient tensile strength; therefore, adding Shan Li provides circumferential support, ensuring firm union of the bone fragments.

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Bao Xi (Instrument 10): Bao Xi is a circular bamboo frame with four legs. A bamboo hoop, slightly larger than the knee, is constructed. Four bamboo pieces are tightly bound to the hoop with hemp thread to form four legs. White cloth strips are wrapped around the hoop and legs. When applied to the knee, it immobilizes the joint without causing excessive discomfort.

Explanation of Usage: The patella sits atop the distal ends of the femur and tibia/fibula and is naturally mobile. Injury may cause comminution or lateral displacement. Even if manually reduced, walking inevitably stresses the joint. The Bao Xi device stabilizes the area to prevent redisplacement and subsequent claudication. Place the four legs beside the knee, securing the patella within the hoop to ensure stability. Tighten with a broad white cloth belt.

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