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The *Bingji* states: The pathogenesis and treatment of tetanus (Po Shang Feng) are consistent with those of cold damage diseases, requiring differentiation into exterior, interior, and half-exterior half-interior stages. For pathogens in the exterior, sweating methods should be used; for pathogens in the interior, purgative methods should be used; for pathogens in the half-exterior half-interior stage, harmonizing methods should be used. Treatment must not be excessive. Therefore, a floating but weak pulse indicates Taiyang disease (disease of the Taiyang channel); a long and forceful pulse indicates Yangming disease (disease of the Yangming channel); a floating, wiry, and small pulse indicates Shaoyang disease (disease of the Shaoyang channel). If these three methods are understood and applied correctly, cases of ineffective treatment will be rare.

The *Yuanbing Shi* states: The cause of tetanus following trauma is due to intense heat and toxin accumulation at the wound site, obstructing the circulation of Ying (Nutrient) and Wei (Defensive) Qi. This stagnation generates internal heat spreading throughout the body, often resulting in white scabs. At this time, the wound closes, preventing the smooth flow and discharge of Qi. Excessive heat generates wind. If unchecked, the pathogen transmits from the exterior to the interior. This is similar to contracting cold damage, where severe stagnation and heat fail to resolve, leading to transmission from the exterior to the interior. However, differences arise due to variations in the severity of wind-heat and their transformations.

Generally, for treating tetanus, if wind-heat and dryness are severe and stagnant in the exterior while the interior Qi remains peaceful, symptoms may include frequent stretching and yawning, tendon and vessel stiffness, occasional aversion to cold, or muscle twitching and convulsions, with a floating, rapid, and wiry pulse. In such cases, acrid-hot herbs that dispel wind should be used to open and disperse the stagnation, leading to recovery. This is analogous to using Mahuang Tang (Ephedra Decoction) for acrid-warm diaphoresis in cold damage with exterior heat stagnation. When using acrid-hot herbs to disperse wind-heat stagnation, it is advisable to combine them with cold-natured herbs as adjuncts to prevent the wind-heat from intensifying despite the medication targeting the pathology. For example, when treating fever from cold damage, adding cold herbs like Huangqin (Scutellaria Root), Shigao (Gypsum Fibrosum), and Zhimu (Anemarrhenae Rhizoma) to Mahuang (Ephedrae Herba) and Guizhi (Cinnamomi Ramulus) exemplifies this approach. Alternatively, using cold herbs for dispersal such as Gancao (Licorice Root), Huashi (Talcum), Congbai (Allii Fistulosi Bulbus), and Chidouchi (Fermented Soybean) is also highly effective.

If the exterior syndrome persists and gradually penetrates inward, but the interior condition is not yet severe, and the pulse is felt at the muscle level (indicating a deeper location but not yet involving the zang-fu organs), cold-natured herbs that clear wind-heat and resolve stagnation should be used for regulation. Slightly adding acrid-hot herbs for wind disorders is also acceptable. This corresponds to the use of Xiaochaihu Tang (Minor Bupleurum Decoction) for harmonization in cold damage located in the half-exterior half-interior stage.

If interior heat is already severe, presenting with a stiff tongue, locked jaw, opisthotonos (backward arching of the neck and back),惊搐 (startle and convulsions), thick and sticky saliva, chest and abdominal fullness and obstruction, constipation or urinary retention, and occasional sweating, with a surging, rapid, and wiry pulse, the sweating occurs because wind-heat is severely stagnant in the interior while exterior heat has slightly subsided, causing the pores to open and leak, combined with excessive heart fire. The treatment method should first employ cold-natured herbs to dispel wind and resolve stagnation via purgation, followed by regulation with cold-natured herbs that clear wind-heat and open stagnation. Once the heat recedes and stagnation dissipates, the wind disorder will naturally heal.

In all treatments for this condition, massage and Dao Yin (guiding and pulling exercises) are appropriate. Medications should also be used to pry open the jaw to prevent lockjaw, ensuring that gruel and medicine can be administered.

Commentary: This discussion on the pulses, pathologies, and treatments concerning the exterior, interior, and middle aspects is extremely comprehensive and detailed, representing insights not previously discussed by earlier authorities.