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The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When the Liver pulse is firm and long, yet the complexion is not green, it indicates a fall injury. If the pulsation is due to blood stasis under the hypochondrium, it causes vomiting and reflux.

The *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) states: A floating, faint, and choppy pulse at the Cun position typically indicates blood loss or excessive sweating. If there has been no sweating, it suggests the presence of sores or injuries caused by knives or axes, resulting from blood loss.

The *Maijing* (Pulse Classic) states: In metal weapon wounds with excessive bleeding, a deficient and fine pulse indicates survival, while a rapid and excess pulse indicates death. For bleeding from metal wounds, a deep and small pulse indicates survival, whereas a floating and large pulse indicates death; a small and weak pulse also indicates death. In broken wound injuries with internal blood stasis, a firm, strong, and excess pulse indicates survival, while a deficient, small, and weak pulse indicates death. If there is excessive blood loss, a fine and small pulse indicates survival, while a floating, large, rapid, and excess pulse indicates death. These cases all occur because the pulse does not correspond to the disease condition.

A woman whose buttock abscess was nearly healed contracted tetanus (broken wind), presenting with fever and convulsions, and a floating, rapid pulse. I treated her with Danggui Dihuang Tang (Angelica and Rehmannia Decoction). She did not believe in this treatment and instead took dispersing and detoxifying drugs that damaged healthy qi, causing her condition to worsen. Only then did she trust my prescription and take it, recovering after several doses. Tetanus must be differentiated by exterior/interior and deficiency/excess; it cannot be treated uniformly. The *Yuanbing Shi* (Original Causes of Disease) states: The cause of tetanus is severe heat accumulation in the sore, preventing the smooth circulation of Ying and Wei qi. This stifling heat spreads throughout the body, often forming white scabs. At this time, the wound closes, making it difficult for qi to circulate and vent. Extreme heat generates wind; if unchecked, it transmits from the exterior to the interior. Due to variations in the severity of wind-heat and accompanying transformations, symptoms differ. Generally, in tetanus where wind-heat dryness is severe and stifled in the exterior, while interior qi remains peaceful, symptoms include frequent stretching and yawning, tendon and vessel stiffness, occasional aversion to cold, or muscle twitching. The pulse is floating, rapid, and wiry. It is appropriate to use acrid-hot wind-dispelling herbs to open and flush out stagnation; this is similar to treating exterior heat stiflement in Cold Damage using Ma Huang Tang (Ephedra Decoction) for acrid-hot dispersion. Whenever using acrid-hot herbs to open wind-heat stagnation, it is advisable to assist with cold herbs to prevent the wind-heat from intensifying despite the medication targeting the pathogen. For example, when treating fever from Cold Damage, one might combine Ma Huang (Ephedra Herb) and Gui Zhi (Cinnamon Twig) with Huang Qin (Scutellaria Root), Shi Gao (Gypsum Fibrosum), and Zhi Mu (Anemarrhenae Rhizoma). Using cold herbs like Gan Cao (Licorice Root), Hua Shi (Talcum), Cong Bai (Scallion White), and Chi Dou (Fermented Soybean) for dispersion is also excellent. If the exterior syndrome persists and gradually enters the interior, but the interior heat is not yet severe, 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-treating herbs. This resembles the principle of harmonizing Shaoyang in Cold Damage using Xiao Chai Hu Tang (Minor Bupleurum Decoction). If interior heat is already severe, presenting with stiff tongue, locked jaw, opisthotonos,惊搐 (startle convulsions), thick sticky saliva, chest and abdominal fullness, constipation or urinary retention, or occasional sweating, with a surging, rapid, and wiry pulse, the sweating occurs because wind-heat is deeply stifled in the interior while exterior heat subsides, causing pores to open and Heart fire to become extreme. The treatment should focus on dispelling wind and resolving stagnation, using cold herbs to purge downwards, followed by regulation with cold herbs that clear wind-heat and open depression. Once heat recedes and stagnation dissipates, the wind will heal itself. Treatment should also include massage and guidance techniques, and using medicinal substances to open the jaw to prevent locking, allowing porridge and medicine to be ingested.

The *Bingji Lun* (Treatise on Pathogenesis) states: Tetanus arises when sudden trauma allows wind pathogens to invade and spread through the meridians, causing alternating chills and fever, opisthotonos, and locked jaw. Alternatively, chronic sores that do not heal are often treated with moxibustion, considered superior for "heat sores." However, practitioners fail to realize that fire-heat pathogenic toxins can trigger numerous complications. Mild cases present with fever; severe cases develop wind and convulsions, opisthotonos, locked jaw, and deviated eyes. Some suffer broken wounds without moxibustion yet still contract the disease because white scabs form, closing the wound and trapping qi, leading to yang-heat accumulation and subsequent wind generation. Xu Yongcheng stated that the causes mentioned above fall into four categories: two aspects involve wind entering through the wound, resembling external causes; one aspect involves heat expulsion via moxibustion, resembling neither-internal-nor-external causes; and one aspect involves internal heat generating wind due to wound closure, resembling internal causes. He further noted that ancient texts rarely discuss tetanus separately, likely because it is discussed alongside Zhong Feng (Wind Stroke). Only Liu Wansu (Hejian) discusses it similarly to the three methods of exterior/interior Cold Damage, with detailed prescriptions. His etiology includes external wind invasion and internal heat/moxibustion factors, resembling Wind Stroke. However, while Wind Stroke patients may survive for years, tetanus patients often die. Wind Stroke varies by location (meridians, zang, fu organs), with zang involvement being hardest to treat. Tetanus, whether starting with excessive bleeding or early wound closure with blood stasis, involves blood pathology governed by the five zang organs. Thus, although the pathogen starts in the exterior, it quickly transmits to the zang organs, leading to high mortality. This disease may occur if an exposed wound is exposed to wind-cold, or if a closed wound is penetrated by wind despite precautions. Even if the patient seems safe, sudden onset usually stems from deficient interior qi and stifled heat. Those with strong interior qi and no stifled heat remain unaffected even if injured.

Attached Formulas

Bazhen Tang (Eight Treasures Decoction) (See section on Ulcer Fever)

Liujunzi Tang (Six Gentlemen Decoction) (See section on Vomiting)

Fuyuan Huoxue Tang (Restoring Flow Blood-Invigorating Decoction) Treats pain in the hypochondrium or lower abdomen due to blood stasis from falls or blows, distension, and initial swelling/pain of groin abscesses.
Chai Hu (1.5 qian) Tianhuafen Angelicae Sinensis Radix (soaked in wine, 1 qian each) Honghua Carthami Flos Gancao (0.7 qian each) Manis Squama (1 qian, processed)
Take as directed.

Xiao Chai Hu Tang (Minor Bupleurum Decoction)

Siwu Tang (Four Substances Decoction) (Two formulas see section on Scrofula)

Fuyuan Tongqi San (Restoring Flow Qi-Unblocking Powder) (See section on Breast Abscess)

Taoren Chengqi Tang (Persimmon Seed Bowel-Purging Decoction) Treats abdominal pain, fever, mania, or swollen painful groin abscess with constipation due to stagnant blood from trauma. Use this to unblock.
Taoren (50 seeds, peeled and crushed) Guizhi Mangxiao Glycyrrhizae Radix et Rhizoma Preparata (roasted, 1 qian each) Dahuang (1 qian) Make one dose, decoct in two zhong of water to yield one zhong, take on an empty stomach.

Yuzhen San (Jade Truth Powder) (Also called Dingfeng San / Wind-Calming Powder) Treats severe tetanus with locked jaw and opisthotonos, and snake/dog bites.
Tian Nan Xing Fangfeng (equal parts) Grind into powder. Take 2 qian per dose, mixed with warm wine, and apply to the affected area. For locked jaw/opisthotonos. For dog bites, rinse with mouthwash before applying; highly effective.

Ge Suan Jiu Fa (Garlic-Separator Moxibustion Method) (See section on Back Carbuncle)

Taiyi Gao (Great One Ointment) (See section on Intestinal Abscess)

Tuoli San (Support Interior Powder) (See section on Swollen Ulcer)

Jiedu San (Detoxification Powder) Treats injuries from venomous snakes, insects, and beasts. Severe cases involve toxin entering the abdomen, causing blackened eyes, locked jaw, and limb rigidity. This mild formula does not damage qi and blood and is highly effective; do not neglect it due to its simplicity.
Bai Fan (1 liang) Gancao Endospermum (1 liang) Grind into fine powder. Take 2 qian per dose, mixed with cold water at any time, and apply topically.

Suhe Xiang Wan (Styrax Pill) (See section on Pulse Diagnosis)

Shengyu Tang (Sage Replenishing Decoction) Treats sores with excessive pus or bleeding, restlessness, insomnia, or five-palm heat.
Dihuang (wine-soaked, steamed for half a day) Sheng Dihuang (wine-soaked) Chuanxiong Renshen (5 qian each) Danggui (wine-soaked) Huangqi (salt-water soaked and stir-fried, 1 qian each) Make one dose, decoct in two zhong of water to yield eight fen, take after meals.

Dushen Tang (Single Ginseng Decoction) Treats extreme qi and blood deficiency in ulcers, aversion to cold, fever, or blood loss. Ge Kejiu used this for qi tonification in blood depletion.
Renshen (2 liang) Make one dose, decoct in two zhong of water with ten jujubes to yield one zhong, take slowly. If boiled to a thick consistency, it becomes a paste.

Danggui Dihuang Tang (Angelica and Rehmannia Decoction) Treats tetanus with combined qi and blood deficiency, fever, and headache. Nourishes qi and blood and dispels wind, applicable to both acute and chronic cases.
Danggui (wine-soaked) Dihuang (wine-soaked) Shaoyao Chuanxiong Gaoben Fangfeng Baizhi (1 qian each) Xixin (0.5 qian) Make one dose, decoct in two zhong of water to yield one zhong, take.