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Wind is the beginning of all diseases. If one maintains purity and stillness, the couli (pores) close and resist, so that even severe wind and toxic pathogens cannot harm the body. When various sores fail to heal due to deficiency of Ying and Wei (nutritive and defensive qi), muscles do not regenerate, and the sore openings remain unclosed, allowing wind pathogens to enter, resulting in the condition of Po Shang Feng (tetanus). There are also cases where heat within the sores becomes stagnant, forming white scabs on the surface, causing the sore openings to close and qi circulation to be obstructed, leading to excessive heat generating internal wind.

First, distinguish the condition of the sore opening: if the sore is flat with no exudate, it is Wind invasion; if yellow fluid oozes from the edges, it is Water invasion. Both conditions tend to develop into Jing disease (spasm characterized by rigidity of the neck and back, and opisthotonos). Urgent treatment is required. Li Dongyuan stated: Po Shang Feng involves both exterior and interior levels; one must differentiate Yin and Yang, and its diagnosis and treatment are similar to Shang Han (cold damage). People know only about releasing the exterior through sweating, but do not know about purging the interior or harmonizing. A floating pulse without strength indicates Taiyang channel involvement; since the pathogen is in the exterior, sweating is indicated. A long and forceful pulse indicates Yangming channel involvement; since the pathogen is in the interior, purging is indicated. A floating, wiry, and small pulse indicates Shaoyang channel involvement; the pathogen is half-exterior and half-interior, so harmonization is indicated. Understanding these three methods ensures effective treatment. (This text mentions only the Three Yang channels, excluding the Three Yin channels, because when wind pathogens are in the Three Yang channels, early treatment according to method leads to recovery. If transmitted to the Three Yin channels, the condition becomes critical, presenting with abdominal fullness and spontaneous diarrhea, dry mouth and throat, curled tongue, and retracted testicles, which are fatal; thus, they are omitted.)

Liu Hejian stated: In Po Shang Feng, if wind-heat and dryness are severe and stagnated in the exterior while interior Qi remains peaceful, symptoms include frequent stretching and yawning, stiffness and tension of sinews and vessels, occasional aversion to cold, and occasional twitching or convulsions of sinews, with a floating, rapid, and wiry pulse. It is appropriate to use acrid-hot wind-dispelling herbs to open and scatter the stagnation. This is analogous to using Mahuang Tang (Ephedra Decoction) for acrid-hot dispersal in Shang Han with exterior heat stagnation. 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 hitting the target. For example, treating Shang Han fever with Mahuang (Ephedrae Herba) and Guizhi (Cinnamomi Ramulus) combined with Huangqin (Scutellariae Radix), Zhimu (Anemarrhenae Rhizoma), and Shigao (Gypsum Fibrosum) is such an approach. Using only cold herbs like Gancao (Glycyrrhizae Radix et Rhizoma), Huashi (Talcum), Congbai (Allii Fistulosi Bulbus), and Chishao (Fermented Soybean) for dispersal is also excellent. If the exterior syndrome persists and gradually transmits inward, while interior heat is not yet severe and the pulse is wiry and small, it is suitable to regulate with cold herbs that reduce wind-heat and open stagnation, or slightly add acrid-hot wind-treating herbs. This is like using Xiaochaihu Tang (Minor Bupleurum Decoction) to harmonize when Shang Han is at the half-exterior half-interior level. If interior heat is already severe, presenting with stiff tongue, locked jaw, opisthotonos, frightful twitching and convulsions, thick sticky saliva, chest and abdominal fullness and obstruction, constipation of urine and stool, and occasional sweating, with a deep, surging, rapid, and wiry pulse: The sweating occurs because wind-heat is severely depressed in the interior, causing slight relief of exterior heat, leading to open couli and excessive Heart fire, hence sweating. The method should involve purging with cold herbs that dispel wind and scatter stagnation, followed by regulation with cold herbs that reduce wind-heat and open stagnation, so that heat recedes, stagnation dissipates, and wind heals spontaneously.

Exterior-releasing formulas: Qianghuo Fangfeng Tang (Notopterygium and Saposhnikovia Decoction), Fangfeng Tang (Saposhnikovia Decoction), Jiuwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction), Wugong San (Centipede Powder). After releasing exterior, tonify with Baizhu Fangfeng Tang (Atractylodes Macrocephala and Saposhnikovia Decoction). Interior-purging formulas: Daxionghuang Tang (Angelica Dahurica and Rheum Decoction), Jiangbiao Wan (Fish Maw Pill), Zuolong Wan (Left Dragon Pill). Follow with Xiao Qianghuo Tang (Minor Notopterygium Decoction). Harmonizing formulas: Qianghuo Tang (Notopterygium Decoction), Diyü Fangfeng San (Sanguisorba and Saposhnikovia Powder), Xiaochaihu Tang (Minor Bupleurum Decoction). For prolonged illness with gradual deficiency of Qi and Blood, and pathogen entering the Stomach, use Siwu Tang (Four Substances Decoction) to nourish blood, adding Fangfeng (Saposhnikoviae Radix), Gaoben (Ligustici Rhizoma et Radix), and Baizhi (Angelicae Dahuricae Radix) in equal parts, with Xixin (Asari Radix et Rhizoma) halved, ground into coarse powder. Take 5 qian per dose, decocted in water. For spontaneous sweating caused by excessive wind herbs, use Baizhu Huangqi Tang (Atractylodes Macrocephala and Astragalus Decoction). For continuous profuse sweating with muscle cramps and convulsions, use Baizhu Shengma Tang (Atractylodes Macrocephala and Cimicifugae Rhizoma Decoction). For unceasing spasms and convulsions, use Juanjing Tang (Spasm-Relieving Decoction). For backward convulsions, use Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Fangfeng (Saposhnikoviae Radix), Gancao (Glycyrrhizae Radix et Rhizoma). For forward convulsions, use Shengma (Cimicifugae Rhizoma), Baizhi (Angelicae Dahuricae Radix), Duhuo (Angelicae Pubescentis Radix), Fangfeng (Saposhnikoviae Radix), Gancao (Glycyrrhizae Radix et Rhizoma). For lateral convulsions, use Chaihu (Bupleuri Radix), Fangfeng (Saposhnikoviae Radix), Gancao (Glycyrrhizae Radix et Rhizoma). Add Huashi (Talcum) for right-sided convulsions. For incessant trembling of hands and feet, use Zhusha Zhijia San (Cinnabar and Nail Powder). Four ominous signs are incurable: First, blue-black color of head and eyes; second, sweat beads on forehead that do not flow; third, small eyes staring fixedly; fourth, oily sweat on the body. Additionally, pain not at the sore site but affecting meridians and collaterals is also a death sign.

[External Treatment] At the first sign of sore swelling and white scab formation, accompanied by chills and fever, urgently apply Yuzhen San (Jade True Powder), or chew peeled Xingren (Prunus Armeniacae Semen) finely, mix with Xionghuang (Realgar) and sifted Bai mian (White Flour), and apply as a poultice. (Another method uses equal parts Xingren and Bai mian mixed evenly, blended with fresh well-water into a paste for application.) Apply until swelling gradually subsides. If opisthotonos, limb rigidity, and trismus occur, burn one mouse including its tail to ash, grind finely, and mix with pig fat from the twelfth lunar month for external application. If the jaw is tightly closed and cannot open, take one Wugong (Centipede), bake dry, grind into fine powder, rub into teeth to induce salivation and spitting, leading to immediate recovery. For tetanus caused by dog bites, use Ren Shen (Ginseng Radix et Rhizoma) in any amount, burn over mulberry wood fire until smoke ceases, cover with a bowl, grind into powder, sprinkle on the wound, and seal with dissolved Yu jiao (Fish Glue). "Ying Tong Bai Wen" states: Magistrate Zhang once said he had a miraculous formula for treating Po Shang Feng effectively. Take one Qiluo (larva of *Otiorhynchus sulcatus*) from a manure pile (also found on rotten grass roofs), pinch its spine, wait for it to spit water from its mouth, then smear this onto the sore opening. Upon feeling numbness, sweating will occur, and recovery will be immediate. This was tested and proved true. The larva should be buried back in its original place; do not kill it.