凡腰骨损断,用门一片放地下,一头斜高些,令患人覆眠,以手伸上搬住其门,下
用三人拽伸,以手按损处三时久,却用定痛膏、接骨膏敷贴,病患浑身动作一宿至来日,
串处无痛,却可自便左右翻转,仍用破血药。凡臀股左右跌出骨者,右入左,左入右,用
脚踏进,撙捺平正用药,如跌入内,令患人盘脚,按其肩头,医用膝旅入,虽大痛一时
无妨,整顿平正,却用接骨膏、定痛膏敷贴,只宜仰卧,不可翻卧,大动后恐成损患。凡
腰腿伤,全用酒佐通气血药,俱要加杜仲。凡胯骨从臀上出者,用二三人捉定腿拔伸,仍
以脚捺送入,却用前等膏敷贴。如在裆内出者,则难治。凡脚骨伤甚难整,当临时相度,
难泥一说。凡两腿左右打跌骨断者,以手法整其骨,以手拽正,上拽七分于前,下拽五
分于后整定,用接骨膏、定痛膏敷贴。以夹缚缚时,先缚中正,后缚上下,外用副夹。若
上下有肿痛无虑,五日方可换药。凡辨腿胯骨出内外者,如不粘膝,便是出向内,从内
捺入平正;如粘膝不能开,便是出向外,从外捺入平正,临机应变。凡脚盘出臼,令患
人坐定,医人以脚从腿上一踏一搬,双手一撙捺,摇二三次,却用接骨膏、定痛膏,或
理伤膏敷贴。凡膝盖损断,用手按捺进平正后,用前膏敷贴,桑白皮夹缚,作四截缚之。
其膝盖骨跌锉开者,可用竹箍箍定,敷药夹定,要四截缚之,膝盖不开也。若肿痛,须
用针刀去血,却敷贴,用夹。若或内外踝骨,左右脚盘,锉跌损伤,用脚踏直拽正,按捺
平正,却敷贴前膏。若膝头骨跌出臼,牵合不可太直,不可太曲,直则不见其骨棱,曲
则亦然,只可半直半曲,以竹箍箍住膝盖骨,以绳缚之。凡骨节损折,肘臂腰膝出臼蹉跌,
须用法整顿归元,先用麻药与服,使不知痛,然后可用手法治之。
In cases of lumbar bone fracture or dislocation, place a door panel on the ground with one end slightly elevated. Have the patient lie prone on it. The physician reaches up to hold the edge of the door panel, while three assistants pull downwards to extend the spine. Simultaneously, press on the injured area for three *shichen* (six hours). Then apply *Dingtong Gao* (Pain-Relieving Paste) and *Jiegu Gao* (Bone-Setting Paste). The patient should move their whole body throughout the night until the next day. If there is no pain at the joint after reduction, they may turn over left or right, but must still take blood-invigorating and stasis-resolving herbs.
For hip dislocations to the left or right, reduce the right hip by moving it leftward, and the left hip rightward. Use foot pressure to push the femoral head back into the acetabulum until aligned, then apply medication. If the hip is dislocated posteriorly (internally), have the patient sit with legs crossed, stabilize the shoulders, and use the physician's knee to push the femoral head forward into the socket. Severe pain initially is acceptable; once reduced and aligned, apply *Jiegu Gao* and *Dingtong Gao*. The patient should only lie supine and avoid turning over, as excessive movement may cause further injury.
For waist and leg injuries, always use wine to assist blood-invigorating and qi-unblocking formulas, and always add *Eucommiae Cortex* (Duzhong, 杜仲).
For hips dislocated superiorly from the buttocks, two or three people should grasp the leg and perform traction. Use foot pressure to push it back into place, then apply the aforementioned pastes. Dislocation into the groin area is difficult to treat.
Foot bone injuries are very difficult to reduce; treatment must be adapted to the specific situation and cannot rely on a single rigid method.
For fractures of both legs caused by falls or blows, manually reduce the bones and align them. Apply traction: seven parts force upward anteriorly, five parts downward posteriorly. Once stabilized, apply *Jiegu Gao* and *Dingtong Gao*. When applying splints, bind the middle section first, then the upper and lower sections, and finally add auxiliary splints externally. Swelling and pain are not concerning; change the dressing after five days.
To determine if a hip/knee dislocation is medial or lateral: if the knee does not adhere to the opposite limb, it is a lateral dislocation; reduce it by pushing inward from the outside. If the knee adheres and cannot abduct, it is a medial dislocation; reduce it by pushing outward from the inside. Adapt to circumstances.
For ankle dislocations, have the patient sit firmly. The physician steps on the thigh to leverage and manipulate, using both hands to press and rotate the joint two or three times. Then apply *Jiegu Gao*, *Dingtong Gao*, or *Lishang Gao* (Trauma-Healing Paste).
For knee fractures or severe contusions, manually reduce and align the bones, then apply the aforementioned pastes. Use mulberry bark (*Morus Albae Cortex*) as a splint, binding it in four segments.
If the patella is fractured or separated, secure it with a bamboo hoop, apply medicine, and bind with splints in four segments, keeping the knee extended. If swelling and pain occur, use a needle-knife to bleed, then apply paste and splints.
For injuries to the medial or lateral malleoli, or bilateral ankle sprains/fractures, use foot pressure to straighten and traction to align, then press flat and apply the aforementioned pastes.
If the patella is dislocated, do not extend it completely straight nor bend it fully. Complete extension hides the bony landmarks; complete flexion is also problematic. Maintain a semi-flexed position. Secure the patella with a bamboo hoop and tie it with rope.
For any joint fractures, dislocations, or subluxations of the elbows, arms, waist, or knees, manual reduction is required to restore normal anatomy. First, administer an analgesic herb mixture (Ma Yao) to eliminate pain perception before performing manual manipulation.