破伤风方论，已载杂病第五，此其似是而非者尔。
〔薛〕 大凡痈疽溃后筋縻肉烂，脓血大泄，阳随阴散，或筋脉拘急，恶寒惕搐，甚
者舌强口噤，项背反张，痰涎壅盛，便闭汗出，不时发热，此气血俱虚而传变。虽与破
伤风相类，而主治之法当大补气血。若果系风症，亦须以大补气血为本，而兼以治风之
药。设若不审是非而妄药之，则误矣。 司徒边华泉，肩患痈，溃而发热，目直或 ，殊
类中风，日晡热甚，脉益数，此足三阴气血亏损，虚火妄动。用参、 、归、术、炙草，
加酒炒黑黄柏、五味、麦门、肉桂，四剂而愈，又数剂而敛。 陆大行，背疮内溃，出
脓二碗许，用托里之剂痛止肿消，停药忽寒热作渴，头痛自汗，此元气虚而未能复也。用
十全大补加麦门、五味、肉桂二剂，益甚。诊其脉如故，此药力未及，仍用前药加附子一
钱，三剂诸症悉愈，乃去附子，加肉桂，数剂而敛。 一儒者患腿痈，深蓄于内，肉色
不变，久不穿溃，针出脓瘀五碗许，恶症骈臻，全类中风，此脾胃虚而变症也。用六君
子加当归、炮姜，及圣愈汤各四剂而安；又劳心不寐，用归脾汤而愈。 一儒者，伤寒
后患流注，肿痛潮热，用十宣散，败毒等剂，出稀脓五六碗许，发热、恶寒、烦躁、作渴，
殊类破伤风症而殁。 一男子背疮未痊，敛以膏药，剪孔贴之。患破伤风症而殁。此先
失于内补，外邪袭其虚耳。予见了此症，贴膏药剪孔，欲其通气而反患破作风；搽敛药
生肌，欲其收口而反助其余毒，以致殁者多矣，可不慎哉。
The discussion on formulas for treating tetanus (Pòshāngfēng) has already been recorded in Volume 5 of Miscellaneous Diseases; this section describes cases that appear similar but are fundamentally different.
[Xue Ji] Generally, after the ulceration of carbuncles and sores (Yongju), the sinews become lax and the flesh rots, with a massive discharge of pus and blood. Yang Qi dissipates along with the loss of Yin fluids. This may present as spasms and stiffness of the sinews and vessels, aversion to cold, and fearful tremors or convulsions. In severe cases, it manifests as a stiff tongue, locked jaw, opisthotonos (hyperextension of the neck and back), excessive phlegm and saliva, constipation, sweating, and intermittent fever. These are transformations resulting from deficiency of both Qi and Blood. Although these symptoms resemble tetanus, the primary treatment method should be to greatly tonify Qi and Blood. If it is indeed a wind-pathogen condition, one must still take tonifying Qi and Blood as the root, while simultaneously using herbs that treat wind. If one fails to discern the truth and falsehood and prescribes medication recklessly, it will be an error.
Bian Huaquan, a Grand Secretary, suffered from a carbuncle on his shoulder. After it ulcerated, he developed fever, fixed gaze, or strabismus, closely resembling stroke (Zhongfeng). His fever was severe during the Shen hour (3-5 PM), and his pulse became increasingly rapid. This indicated a deficiency of Qi and Blood in the three Yin meridians of the foot, with deficient fire moving recklessly. He was treated with Ginseng Radix (Renshen), [missing character in source], Angelicae Sinensis Radix (Danggui), Atractylodis Macrocephalae Rhizoma (Baizhu), and Glycyrrhizae Radix et Rhizoma Preparata (Zhi Cao), added with alcohol-fried and charred Phellodendri Cortex (Huangbai), Schisandrae Fructus (Wuweizi), Ophiopogonis Radix (Maimendong), and Cinnamomi Ramulus (Rougui). After four doses, he recovered; after several more doses, the wound healed.
Lu Daxing suffered from an internal ulceration of a back sore, discharging approximately two bowls of pus. After using a formula to support the interior and expel toxins, the pain stopped and swelling subsided. Upon stopping the medication, chills, fever, thirst, headache, and spontaneous sweating suddenly appeared. This indicated that Yuan Qi (Original Qi) was deficient and unable to recover. He was treated with Shiquan Dabu Decoction (Ten Significant Tonification Decoction) added with Ophiopogonis Radix (Maimendong), Schisandrae Fructus (Wuweizi), and Cinnamomi Ramulus (Rougui). After two doses, his condition worsened. Palpating his pulse remained unchanged; this indicated the medicinal force had not yet reached the disease site. The previous prescription was used again with one qian of Aconiti Lateralis Radix Praeparata (Fuzi) added. After three doses, all symptoms resolved. Fuzi was then removed, and Cinnamomi Ramulus (Rougui) was added. After several doses, the wound healed.
A scholar suffered from a leg carbuncle, which accumulated deeply internally without changing the skin color, failing to ulcerate for a long time. Needling released approximately five bowls of pus and blood stasis. Malignant symptoms followed closely, completely resembling stroke. This was a transformation due to Spleen and Stomach deficiency. He was treated with Liujunzi Decoction (Six Gentlemen Decoction) added with Angelicae Sinensis Radix (Danggui) and Zingiberis Rhizoma Preparatum (Paojiang), as well as Shengyu Decoction (Holy to Save Life Decoction), each for four doses, leading to stabilization. Later, due to mental exertion and insomnia, he was treated with Guipi Decoction (Restore the Spleen Decoction) and recovered.
Another scholar, after suffering from Cold Damage (Shanghan), developed liuzhu (a type of wandering abscess), presenting with swelling, pain, and tidal fever. He was treated with Shixuan San (Ten Acupoints Powder) and Baidu San (Defeat Toxin Powder) and other formulas, discharging about five to six bowls of thin pus. He subsequently developed fever, aversion to cold, irritability, and thirst. His condition closely resembled tetanus, and he died.
A man’s back sore had not fully healed. It was covered with a plaster, with a hole cut out for application. He subsequently contracted tetanus and died. This was because internal tonification was neglected initially, allowing external pathogens to attack the deficiency. I have seen such cases where cutting holes in plasters was intended to allow ventilation but instead led to tetanus; applying healing ointments intended to close the wound instead aided the residual toxin, leading to death in many instances. Can one not be cautious?