病机云破伤风者有因卒暴伤损风袭之间传搐经络至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
言着灸为上是谓热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
按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
谨按破伤风证古方药论甚少岂非以此疾与中风同论故不另立条目也唯河间论伤寒表里中
三法
同治用药甚详其言病因有因外伤于风有因灸及内热所作者然与中风相似也但中风之人尚可淹
延岁月而破伤风者犯之多致不救盖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坦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
破伤风治法
病机羌活防风汤治邪初在表
羌活 防风 甘草 川芎 本 当归 芍药(各四两) 地榆 细辛(各二两)
上 咀每五钱水煎热服无时热则加大黄黄芩(各二两)
防风汤治破伤风同伤寒表证未传入里急宜服之
防风 羌活 独活 川芎(等分)
上 咀每五钱水煎服宜调蜈蚣散大效
按以上二方并三阳经药也
蜈蚣散
蜈蚣(一对) 鳔(三钱)
上为细末用防风汤调下如表解不已觉转入里常服左龙丸(即后江鳔丸四味是也)
蜈蚣散治里和至愈可服
蜈蚣(一对) 鳔(五钱) 左盘龙(五钱炒烟尽野鸽粪是也)
上为细末每服一钱清酒调下治里至愈可服但有里证不可服次当下之用蜈蚣散四钱巴豆霜
半钱烧饭为丸如绿豆大每服一丸加至六七丸清酒调蜈蚣散少许送下宣利为度
发表雄黄散里和至愈可服
雄黄(一钱) 防风(二钱) 草乌(一钱)
上为细末每服一字温酒调下
天麻雄黄散治表
天南星(三钱) 半夏 天麻(各五钱) 雄黄(二钱半)
上为细末每服一钱温酒调下如有涎加大黄为下药
三因防风散治风入疮口项强牙关紧急欲死又名玉真散
防风 天南星(炮各等分)
上为末每服三钱童子小便一大盏煎七分热服
香胶散治破伤风口噤直强
鱼胶(烧七分存性)
上研细入麝香少许每服二钱酒调下不饮米汤下一方以苏木煎汤下
元戎治破伤风欲死者
川乌 南星 半夏(并生) 天麻(去芦各等分)
上为细末每服一钱豆淋酒调下稍温服次以酒一二盏投之
治破伤风
蝎梢七条为细末热酒调下
按此以上八方并厥阴例药也
The *Bingji* (Pathogenesis) discusses that wind-stroke due to trauma (Po Shang Feng, a condition characterized by spasms following injury) may arise from sudden trauma where wind-pathogen invades and transmits through the meridians, causing convulsions and alternating chills and fever. The body may arch backward, and the mouth may remain clenched shut. In severe cases, the pathogenic qi enters the Zang organs. Alternatively, it arises when various sores fail to heal; deficiency of Ying and Wei (Defensive and Nutritive Qi) prevents muscle regeneration, leaving the sore open for external wind-pathogens to enter, resulting in wind-stroke due to trauma. Regarding unhealed sores, the world generally attributes this to heat-toxin from moxibustion, calling it "heat-sores," unaware that fire-heat pathogens lingering in the body can cause countless variations along the meridians. Mildly, it presents as fever; severely, it generates wind leading to convulsions, opisthotonos (arched back), trismus (lockjaw), and deviation of the eyes. There are also cases where trauma occurs without moxibustion, yet the disease develops because a white scab forms over the wound, closing the orifice and blocking the free flow of Qi, causing Yang-heat to easily stagnate. Excessive heat then generates wind.
According to this discussion, there are four causes: two involve wind entering through open sores, resembling external causes; one involves heat accumulation from moxibustion, resembling neither-internal-nor-external causes; and one involves internal heat generating wind due to closed sores, resembling internal causes.
I respectfully note: Ancient formulas and discussions on wind-stroke due to trauma are scarce. Is it not because this disease was discussed alongside Zhong Feng (Wind Stroke, typically referring to apoplexy or facial paralysis)? Thus, no separate category was established. Only Liu Hejian, in his treatise on the exterior, interior, and middle methods of Shang Han (Cold Damage), provided detailed treatments. He stated that etiologies include external wind invasion or internal heat/moxibustion effects, which resemble Zhong Feng. However, while Zhong Feng patients may survive for years, those with wind-stroke due to trauma often die quickly. This is because Zhong Feng has distinctions between involvement of meridians, Fu organs, and Zang organs, with Zang involvement being hardest to treat. In contrast, wind-stroke due to trauma often begins with excessive bleeding or early closure of wounds leading to blood stasis. Since blood belongs to Yin and is governed by the Five Zang organs, once affected by wind, although initially at the exterior, it rapidly transmits to the Zang organs, leading to high mortality. Furthermore, some open sores exposed to cold and wind suffer no harm, while sealed wounds avoiding wind still become diseased; some seemingly safe patients suddenly develop severe symptoms. Generally, this affects those with deficient internal Qi and stagnant heat. Those with robust internal Qi and no stagnant heat remain unaffected even if injured.
Treatment Methods for Wind-Stroke Due to Trauma:
Qiang Huo Fang Feng Tang (Notopterygium and Saposhnikovia Decoction): Treats pathogenic factors initially at the exterior.
Ingredients: Qiang Huo (Notopterygii Rhizoma et Radix), Fang Feng (Saposhnikoviae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Ben Cao (Ligustici Rhizoma), Dang Gui (Angelicae Sinensis Radix), Shao Yao (Paeoniae Radix Alba) (each 4 liang); Di Yu (Sanguisorbae Radix), Xi Xin (Asari Radix et Rhizoma) (each 2 liang).
Preparation: Coarsely crush the herbs. Take 5 qian per dose, decoct in water, and take hot at any time. If fever is severe, add Da Huang (Rhei Radix et Rhizoma) and Huang Qin (Scutellariae Radix) (each 2 liang).
Fang Feng Tang (Saposhnikovia Decoction): Treats wind-stroke due to trauma presenting like exterior syndrome of Shang Han, not yet transmitted to the interior; urgent administration required.
Ingredients: Fang Feng (Saposhnikoviae Radix), Qiang Huo (Notopterygii Rhizoma et Radix), Du Huo (Angelicae Pubescentis Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma) (equal parts).
Preparation: Coarsely crush. Take 5 qian per dose, decoct in water. Best taken with adjustment of Wu Gong San (Centipede Powder) for significant effect.
Note: Both above formulas utilize herbs belonging to the Three Yang meridians.
Wu Gong San (Centipede Powder):
Ingredients: Wu Gong (Scolopendra), Biao (Fish Maw/Collagen).
Preparation: Grind into fine powder. Mix with Fang Feng Tang. If exterior symptoms resolve but signs suggest transmission to the interior, regularly use Zuo Long Wan (Left Dragon Pill, composed of the four ingredients in Jiang Biao Wan mentioned later).
Wu Gong San (for Interior Harmony until Cure):
Ingredients: Wu Gong (Scolopendra) (1 pair), Biao (Fish Maw/Collagen) (5 qian), Zuo Pan Long (5 qian, stir-fried until smoke ceases; also known as wild pigeon feces).
Preparation: Grind into fine powder. Take 1 qian per dose, mix with clear wine. For treating interior conditions until cure. Contraindicated if excess interior syndrome exists. Next, use purgative method: Mix 4 qian of Wu Gong San with half a qian of Ba Dou Shuang (Croton Seed Frost), form pills using cooked rice dough, size of mung beans. Take 1 pill, increasing to 6-7 pills, delivered with clear wine mixed with a little Wu Gong San. Stop when bowel movement is achieved.
Fa Biao Xiong Huang San (Exterior-Releasing Realgar Powder): For use when interior is harmonized until cure.
Ingredients: Xiong Huang (Realgar) (1 qian), Fang Feng (Saposhnikoviae Radix) (2 qian), Cao Wu (Aconiti Radix Preparata) (1 qian).
Preparation: Grind into fine powder. Take one "zi" (a small unit of weight) per dose, mix with warm wine.
Tian Ma Xiong Huang San (Gastrodia and Realgar Powder): Treats exterior syndrome.
Ingredients: Tian Nan Xing (Arisaematis Rhizoma) (3 qian), Ban Xia (Pinelliae Rhizoma), Tian Ma (Gastrodiae Rhizoma) (each 5 qian), Xiong Huang (Realgar) (2.5 qian).
Preparation: Grind into fine powder. Take 1 qian per dose, mix with warm wine. If phlegm-saliva is present, add Da Huang (Rhei Radix et Rhizoma) as a purgative.
San Yin Fang Feng San (Three Causes Saposhnikovia Powder): Treats wind invading the sore orifice, neck stiffness, tight jaw, impending death. Also known as Yu Zhen San.
Ingredients: Fang Feng (Saposhnikoviae Radix), Tian Nan Xing (Arisaematis Rhizoma) (processed, equal parts).
Preparation: Grind into powder. Take 3 qian per dose, decoct in one large cup of urine from an uncircumcised boy until reduced to 70%, drink hot.
Xiang Jiao San (Gelatin Powder): Treats wind-stroke due to trauma with trismus and rigid straightening of the body.
Ingredients: Yu Jiao (Fish Glue/Collagen) (burned until 70% carbonized but retaining nature).
Preparation: Grind finely, add a small amount of She Xiang (Moschus). Take 2 qian per dose, mix with wine. If unable to drink wine, decoct Su Mu (Sappan Wood) in water and take.
Yuan Rong Formula: Treats critical wind-stroke due to trauma.
Ingredients: Chuan Wu (Aconiti Radix), Nan Xing (Arisaematis Rhizoma), Ban Xia (Pinelliae Rhizoma) (all raw), Tian Ma (Gastrodiae Rhizoma) (deprived of stem, equal parts).
Preparation: Grind into fine powder. Take 1 qian per dose, mix with Dou Lin Jiu (Soybean-infused Wine), take slightly warm. Follow with 1-2 cups of wine.
Formula for Treating Wind-Stroke Due to Trauma:
Take 7 Scorpion tails (Xie Shao), grind into fine powder, mix with hot wine, and take.
Note: The above eight formulas all belong to the treatment principles of the Jue Yin meridian.