大意
破伤风由伤处着邪。传播经络。荣卫不得宣通。怫郁之气。遍行身体。热盛生风而成风象。（医统）
内因
破碎小恙。视为寻常。卒遇风邪。渐变恶候。有因疮口未合。失于调理。而为风邪所乘者。有因白基易长。疮
口遽合。不得宣泄。热极生风者。或因淋洗过多。或因艾火灼灸。热毒妄行。乘虚内攻者。（汇补）
外候
凡金疮伤处。胀闷无汗者。中风也。边出黄水者。中水也。并欲作 。其在表也。振寒善欠。摇头斜视。角弓反
张。筋脉挛急。为中寒也。寒热更作。涎唾稠粘者。为入里也。舌强惊惕。口噤切牙。胸臆满塞。便浊秘涩。为入
阴也。身凉自汗。伤处反陷者。毒瓦斯内走也。（汇补）
破伤重症
初虽在表。旋即入里。非若伤寒郁热不解而传里也。但伤寒气血未耗。邪入少缓。此症气血外亡。内已空
虚。邪入甚速。比伤寒更重。（汇补）
死症
若头面青黑。须臾数发。汗雨如珠。脉散无根。为入脏者死。又痛不在伤处。而在经络者死。又服发汗药后。
前症不退。伤处不高。渐醒渐昏。时发时止。口噤不开。声音不出者。终为死候。（汇补）
脉法
浮而无力者。太阳也。长而有力者。阳明也。弦小而急者。少阳也。（医统）
治法
治分汗下和解三法。初见表症。宜辛热治风。冲开结滞。邪在半表里。宜和解兼以祛风邪。传里症。宜寒凉
下其郁热。若伤处出血过多者。又不可专执汗下。以致荣血愈亏。宜滋阴养血。仍用按摩引导。勿令口噤。（汇补）
用药
表症无汗。羌活防风汤。表虚自汗。白术防风汤。半表半里症。寒热不止者。小柴胡加蝉蜕、荆芥。里症便秘
者。大芎黄汤。里症搐搦者。江漂丸。表里盛者。防风通圣散。荣血虚者。当归地黄汤。入阴分者。其毒内走。用
万灵丹发汗。令风邪外出。次以玉真散贴患上。得脓为效。如伤处不起发。外症不退者。危。
破伤风选方
羌活防风汤 治破伤风表症无汗。脉浮数紧者。
羌活 防风 川芎 当归 芍药 本（各八分）
甘草（八分） 细辛 地榆（各四分）
热盛。加芩、连四分。便闭。加大黄一钱二分。自汗多。加白术一钱。
九味羌活汤 治表里见症。
羌活 防风 苍术（各八分） 细辛（五分） 川芎 白芷 生地 黄芩 甘草（各六分）
白术防风汤 治服药已过。脏腑已和。自汗多者。
白术 黄 （各一钱） 防风（二钱）
水煎。
小柴胡汤（方见疟症） 防风通圣散（方见火症）
大芎黄汤 治破伤风脏腑秘。小便赤。自汗不休。知无寒也。用此下之。
川芎（一钱） 黄芩（二钱半） 羌活（一钱半） 大黄（三钱）
水煎。
江漂丸 治破伤风惊而发搐。脏腑秘热在里者。
江漂（炒） 左盘龙 僵蚕（野鸭粪炒各五钱） 雄黄（水飞一钱） 蜈蚣（一对）
加巴霜五钱。烧饭为丸。朱砂为衣。丸桐子大。每服二十丸。未下再进。以利为度。
当归地黄汤
即四物汤加秦艽、钩藤、天麻、防风。
玉真丹 治破伤风牙关紧急。角弓反张。甚则切牙缩舌。
南星 防风 白芷 天麻 羌活 白附子
等分为末。每服二钱。热酒调服。更敷伤处。甚者三钱。童便调服。虽内有瘀血昏死。心腹尚温者亦效。若
为风犬所咬。便用漱口水洗净。搭伤处亦效。
万灵丹 治疮毒初起。脉沉实。及服汗药后。毒瓦斯在里不尽者。
朱砂 盐花（各一钱五分） 雄黄 明矾（生用） 枫香（各二钱） 赤石脂
黄丹 琥珀 轻粉（各一钱五分） 麝香 片脑（各一钱） 巴豆（去壳水煮十沸） 蓖麻子（另研各四十九个）
上为末。用巴豆、蓖麻子膏。和药为丸。如和不就。加炼蜜就成膏。收瓷器内。如用时。旋丸芡实大。每服一
丸。井花水下。或汤亦得。忌热物半日。
[General Principle]
Wind-stroke from injury (Po Shang Feng) occurs when pathogenic factors invade the wound site. The pathogens spread through the meridians, causing Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi) to fail in their free circulation. Stagnant Qi spreads throughout the body; excessive heat generates wind, resulting in wind-like symptoms. (From *Yi Tong*)
[Etiology]
Minor wounds are often regarded as trivial. However, sudden exposure to wind pathogens can gradually transform into severe conditions. Some cases arise because the wound has not healed and lacks proper care, allowing wind pathogens to take advantage of the deficiency. Others occur because granulation tissue grows easily, causing the wound to close rapidly, preventing the expulsion of pathogens, leading to extreme heat that generates wind. Additionally, excessive washing or moxibustion burning may cause heat toxins to act recklessly, attacking internally while taking advantage of bodily weakness. (From *Hui Bu*)
[External Manifestations]
For any metal-injury wound site: swelling, stuffiness, and absence of sweating indicate invasion by external wind. Yellow fluid oozing from the edges indicates invasion by water-dampness. Both suggest impending onset with the pathology located in the exterior. Shivering, frequent yawning, head shaking, oblique gaze, opisthotonos, and tendon spasm indicate invasion by cold. Alternating chills and fever, along with thick and sticky saliva, indicate the pathogen has entered the interior. A stiff tongue, frightfulness, locked jaw, teeth grinding, chest fullness, turbid urine, and constipation indicate the pathogen has entered the Yin level. Cool body temperature, spontaneous sweating, and a sunken wound site indicate the toxic vapors are moving inward. (From *Hui Bu*)
[Severe Cases of Wind-Stroke from Injury]
Although initially in the exterior, the pathogen quickly enters the interior. This differs from Cold Damage (*Shang Han*), where unresolved constrained heat transmits to the interior slowly. In Cold Damage, Qi and Blood are not yet depleted, so the pathogen enters slowly. In this condition, Qi and Blood are lost outwardly, leaving the interior empty, so the pathogen enters very rapidly, making it more severe than Cold Damage. (From *Hui Bu*)
[Fatal Signs]
If the face and head turn blue-black, with multiple attacks within a short time, sweating like pearls, and a scattered pulse without root, indicating the pathogen has entered the Zang organs, death ensues. Also, if pain is not at the wound site but in the meridians, death ensues. Furthermore, if after administering diaphoretic medicines the previous symptoms do not subside, the wound does not rise, consciousness fluctuates between clarity and coma, symptoms come and go intermittently, the jaw remains locked, and no voice can be produced, these are ultimately fatal signs. (From *Hui Bu*)
[Pulse Diagnosis]
A floating and weak pulse indicates the Tai Yang stage. A long and forceful pulse indicates the Yang Ming stage. A wiry, small, and rapid pulse indicates the Shao Yang stage. (From *Yi Tong*)
[Therapeutic Methods]
Treatment is divided into three methods: diaphoresis (sweating), purgation, and harmonizing. For initial exterior symptoms, acrid-warm herbs should be used to treat wind and break up stagnation. If the pathogen is in the half-exterior/half-interior, harmonizing methods combined with dispelling wind pathogens should be used. For interior symptoms, cool/cold herbs should be used to purge constrained heat. If there has been excessive bleeding from the wound, one must not rely solely on diaphoresis or purgation, lest Ying Blood become further depleted. Instead, nourish Yin and tonify Blood, while still employing massage and guidance techniques, ensuring the jaw does not lock. (From *Hui Bu*)
[Medication]
For exterior symptoms with no sweat: Qiang Huo Fang Feng Tang. For exterior deficiency with spontaneous sweating: Bai Zhu Fang Feng Tang. For half-exterior/half-interior symptoms with unceasing chills and fever: Xiao Chai Hu Tang added with Cicada Slough (*Chan Tui*) and Schizonepeta (*Jing Jie*). For interior symptoms with constipation: Da Xiong Huang Tang. For interior symptoms with spasms: Jiang Piao Wan. For excess in both exterior and interior: Fang Feng Tong Sheng San. For deficiency of Ying Blood: Dang Gui Di Huang Tang. For pathogens entering the Yin aspect, where toxicity moves inward: use Wan Ling Dan to induce sweating, expelling wind pathogens outward, followed by applying Yu Zhen San to the affected area. Suppuration indicates efficacy. If the wound fails to rise and external symptoms persist, the prognosis is critical.
[Selected Formulas for Wind-Stroke from Injury]
Qiang Huo Fang Feng Tang
Indicated for exterior symptoms of wind-stroke from injury with no sweat, and a floating, rapid, and tight pulse.
Notopterygium Rhizome (*Qiang Huo*), Saposhnikovia Root (*Fang Feng*), Ligusticum Rhizome (*Chuan Xiong*), Angelica Sinensis Root (*Dang Gui*), Peony Root (*Shao Yao*), Ligusticum Wallichii Rhizome (*Gao Ben*) (each 8 fen); Licorice Root (*Gan Cao*) (8 fen); Asarum Root (*Xi Xin*), Sanguisorba Root (*Di Yu*) (each 4 fen).
If heat is excessive, add Scutellaria Root (*Huang Qin*) and Coptis Rhizome (*Lian*) 4 fen each. If constipated, add Rheum Rhizome (*Da Huang*) 1 qian 2 fen. If spontaneous sweating is profuse, add Atractylodes Macrocephala Rhizome (*Bai Zhu*) 1 qian.
Jiu Wei Qiang Huo Tang
Indicated for simultaneous exterior and interior symptoms.
Notopterygium Rhizome (*Qiang Huo*), Saposhnikovia Root (*Fang Feng*), Atractylodes Lancea Rhizome (*Cang Zhu*) (each 8 fen); Asarum Root (*Xi Xin*) (5 fen); Ligusticum Rhizome (*Chuan Xiong*), White Peony Root (*Bai Zhi*), Rehmannia Root (*Sheng Di*), Scutellaria Root (*Huang Qin*), Licorice Root (*Gan Cao*) (each 6 fen).
Bai Zhu Fang Feng Tang
Indicated when medication has passed, the Zang-Fu are harmonized, and spontaneous sweating is profuse.
Atractylodes Macrocephala Rhizome (*Bai Zhu*), Astragalus Root (*Huang Qi*) (each 1 qian); Saposhnikovia Root (*Fang Feng*) (2 qian).
Decoct in water.
Xiao Chai Hu Tang (See Malaria section for formula)
Fang Feng Tong Sheng San (See Fire section for formula)
Da Xiong Huang Tang
Indicated for wind-stroke from injury with Zang-Fu constipation, red urine, and incessant spontaneous sweating, confirming the absence of cold. Use this formula to purge.
Ligusticum Rhizome (*Chuan Xiong*) (1 qian), Scutellaria Root (*Huang Qin*) (2.5 qian), Notopterygium Rhizome (*Qiang Huo*) (1.5 qian), Rheum Rhizome (*Da Huang*) (3 qian).
Decoct in water.
Jiang Piao Wan
Indicated for wind-stroke from injury with fright and spasms, and internal constipation with heat in the interior.
Processed Jiang Piao, Zuo Pan Long, Silkworm (*Jiang Can*) (stir-fried with wild duck feces, each 5 qian); Realgar (*Xiong Huang*) (water-ground, 1 qian); Centipede (*Wu Gong*) (1 pair).
Add 5 qian of Croton Seed Paste (*Ba Shuang*). Mix with cooked rice paste to form pills. Coat with Cinnabar (*Zhu Sha*). Size of Sophora seeds (*Tong Zi*). Take 20 pills per dose. If stool is not passed, administer again. Stop when bowel movement occurs.
Dang Gui Di Huang Tang
This is Si Wu Tang added with Gentiana Macrophylla Root (*Qin Jiao*), Uncaria Ramulus cum Uncis (*Gou Teng*), Gastrodia Rhizome (*Tian Ma*), and Saposhnikovia Root (*Fang Feng*).
Yu Zhen Dan
Indicated for wind-stroke from injury with locked jaw, opisthotonos, and even teeth grinding and tongue retraction.
Arisaema Cum Bile (*Nan Xing*), Saposhnikovia Root (*Fang Feng*), Angelica Dahurica Root (*Bai Zhi*), Gastrodia Rhizome (*Tian Ma*), Notopterygium Rhizome (*Qiang Huo*), Aconitum Carmichaelii Lateral Root Preparatum (*Bai Fu Zi*).
Grind into powder. Take 2 qian per dose, mixed with hot wine. Apply externally to the wound. For severe cases, take 3 qian, mixed with child's urine. Even if unconscious due to internal blood stasis, if the heart and abdomen remain warm, it is effective. If bitten by a mad dog, immediately wash with mouthwash and apply to the wound; also effective.
Wan Ling Dan
Indicated for early-stage sore toxicity with a deep and solid pulse, and after administering diaphoretics, when toxic vapors remain incomplete in the interior.
Cinnabar (*Zhu Sha*), Salt Flower (*Yan Hua*) (each 1.5 qian); Realgar (*Xiong Huang*), Alum (*Ming Fan*, raw use), Liquidambar Resin (*Feng Xiang*) (each 2 qian); Red Kaolin (*Chi Shi Zhi*); Lead Oxide (*Huang Dan*), Amber (*Hu Po*), Calomel (*Qing Fen*) (each 1.5 qian); Musk (*She Xiang*), Borneol (*Pian Nao*) (each 1 qian); Croton Seed (*Ba Dou*, shell removed, boiled in water for ten boils); Castor Bean (*Bi Ma Zi*, ground separately, 49 seeds).
Grind all into powder. Use Croton Seed and Castor Bean paste to mix and form pills. If unable to mix, add refined honey to form a paste. Store in porcelain. When using, roll into pills the size of Euryale Seed (*Qian Shi*). Take one pill per dose, washed down with well water. Decoction is also acceptable. Avoid hot food for half a day.