经云。胃风之状。颈多汗恶风。食饮不下。鬲塞不通。腹善满。失衣则 胀。食寒则泄。诊
形瘦而腹大。
胃风者。头面肿起。右关脉弦缓带浮。多因饮食后乘凉所致。喻嘉言曰。胃风变证有五。一
曰风成为寒热。以风入于胃。必左投肝木而从其类。风气通于肝也。肝木盛则侮脾土。故生寒热。
庸医认为外感者此也。宜小柴胡汤。一曰瘅成为消中。瘅者热也。热积胃中。善食而易饥。火之
害也。宜白虎加人参。一曰厥成为巅疾。厥者逆也。谓胃气逆而上
行。成巅顶之疾。如眩晕之类是也。宜芎辛汤。一曰久风为飧泄。言胃中风炽。飧已即泄。不留
停也。若风气入血分。则下鲜血。挟湿热。则下如豆汁。人参胃风汤。有血。加防风。一曰脉风
成为疠。言胃中之风。酝酿既久。则营气热 。其气不清。故使其鼻柱坏而色败。肌肉之间。渐
至溃烂。轻则肌体麻木。目蠕动。牙关紧。面肿能食。升麻胃风汤。此五者。总为胃风之病也。
破伤风证。因击破皮肉。风邪袭入。而发热肿胀。治法与感冒不异。又诸疮溃后。风邪乘虚
内袭。其候最急。往往视为寻常。致变种种。多有不可救疗者。亦有疮热郁结。多着白痂。疮口
闭塞。气难宣通。而热甚生风者。或有用汤淋洗。湿气从疮口中入。其人昏迷沉重者。或有用艾
灸火烘。火气逼入而烦躁发热者。但须辨疮口平无汁者。破伤风也。疮口边出黄水者。破伤湿也。
疮口 肿赤色。破伤火也。其汤火之毒。亦与破伤风无异。其为证也。皆能传播经络。燔烁真气。
是以寒热间作。甚则口噤目斜。身体强直。如角弓反张之状。死在旦夕。当同伤寒处治。有在表
在里。半表半里之不同。河间曰。太阳在表者汗之。阳明在里者下之。少阳在表里之半者和解之。
但患处复加肿赤。神昏少食。不分经络者。穿山甲一钱匙。蜈蚣末半钱匙。麝香一字。浓煎葱白
香豉汤服之。患上用葱涕调炒飞面涂之。其但言三阳而不及三阴者。意谓风邪在三阳之经。便宜
按法早治而愈。若待传入三阴。其证已危。惟天灵盖 一钱匙。穿山甲半钱匙。麝香一字为散。
浓煎葱白香豉汤服之。或腹满自利。或口燥咽干。舌卷囊缩。额上汗珠不流。身上汗出如油。
眼小目瞪。肢体痛剧而不在伤处者。皆死证也。破伤风邪在表者。九味羌活汤。半表半里者。小
柴胡汤。大汗不止。筋挛搐搦。升麻汤加黄 。若服蜈蚣等风药过多。有自汗者。白术、黄 、
防风、生甘草作汤温服。大便秘结。小便赤涩。或用热药自汗不休。宜速下之。先用芎黄汤二三
服。后以大芎黄汤下之。若不愈。反作痉状。用羌独活、防风、杏仁、地榆水煎频服。名蠲痉汤。
大便闭者。用胆导蜜导法。病久衰弱。当养血。以四物加 本、防风、细辛、白芷。疮疡破伤风
邪。身体疼痛。风邪攻注挛急。皮肤搔痒。麻木不仁。头昏牙紧。以防风、 本、羌活、地骨皮、
荆芥穗为末。酒调服。疮痂壅塞。内热生风者。九味羌活汤。伤湿而疮口常有稀脓者。先服除湿
汤二三剂。后用一味白术膏。或浸酒亦可。伤火 肿赤色。时头病发热。甚则烦躁者。芎黄汤加
薄荷、荆、防。不应。加酒黄连四五分。黑山栀二钱。兼小便不利。合导赤散。牙关紧急不开。
用蜈蚣一条。焙干研细末。擦牙。吐涎立苏。或服左龙丸亦得。破伤 肿不能透脓。用朱砂、南
星、独活、穿山甲、人指甲。炒研为末。酒调服二三次。外用南星、防风为末。姜汁调敷患处。
石顽曰。破伤一证。金疮跌扑。与溃疡迥殊。金疮跌扑受伤。则寒热头痛。面目浮肿。胸膈痞闷。
六脉浮弦。或模糊不清。其传经与伤寒不异。其势较伤寒更剧。故可用疏表之法。然亦不可峻用
风药。以其经中之血。先以受伤。所谓夺血者无汗是也。若溃疡破伤。则患处忽复肿胀。按之不
知疼痛。周身肌肉不仁。缓急引痛。胸膈痞满。神思不清。六脉弦细。或虚大模糊。虽风引毒瓦斯
攻注周身。切不可用攻表药。汗之必肉 筋惕。甚则发痉。所谓疮家不可发汗。发汗必致痉也。
轻者。葱白香豉汤加鲮鲤甲、白芷、蜈蚣之属。重则葱白香豉汤加黄 、肉桂、远志、防风、鲮
鲤甲、犀角之类。甚则万灵丹。葱豉煎汤调服。呕逆不食者。此风引邪毒攻心也。急与护心散。
外用葱熨法分解其邪。如大便不通者。切
不可用芎黄汤。惟宜蜜煎导之。其势稍退。盒饭用保元。仍加远志、肉桂、犀角、鲮鲤甲等解散
余毒。兼使参、 无壅滞之患。其间泻补。各随其人所禀之偏以为权衡。贵在临证之活法耳。
〔诊〕脉浮而无力太阳也。脉长有力阳明也。浮而弦者少阳也。洪数者伤火也。沉细者伤湿也。
虚细脉涩皆不治。虞恒德治一人。因劝斗殴。眉棱骨被打破。得破伤风。头面大肿发热。以九味
羌活汤取汗。外用杏仁研烂。入白面少许。新汲水调敷疮上。肿消热退而愈。后屡试屡验。
《黄帝内经》说：胃风的症状，表现为颈部多汗且怕风，饮食难以下咽，胸膈阻塞不通畅，腹部容易胀满，受寒则腹胀，吃了冷食则腹泻。诊察时可见形体消瘦而腹部膨大。
所谓胃风，是指头面部浮肿，右关脉呈现弦缓带浮的脉象，多因饭后乘凉受凉所致。喻嘉言说：胃风的变证有五种。第一种叫“风成为寒热”，因为风邪入胃，必然向左侵犯肝木，风气与肝相通。肝木过盛会克制脾土，因此产生寒热交替的症状。庸医常误认为是外感病，适宜用小柴胡汤治疗。第二种叫“瘅成为消中”，瘅指热邪，热邪积聚在胃中，导致食欲旺盛但容易饥饿，这是火邪的危害，适宜用白虎加人参汤治疗。第三种叫“厥成为巅疾”，厥指气逆，指胃气上逆到达头部，形成头顶部的疾病，如眩晕之类的症状，适宜用芎辛汤治疗。第四种叫“久风为飧泄”，意思是胃中风邪炽盛，吃完东西随即腹泻，食物不滞留。如果风邪侵入血分，则排出鲜血；夹杂湿热，则排出像豆汁一样的粪便，用人参胃风汤治疗，若有出血加防风。第五种叫“脉风成为疠”，意思是胃中的风邪酝酿日久，导致营气发热，气血不清，致使鼻梁塌陷、面色败坏，肌肉逐渐溃烂，轻则身体麻木、眼球颤动、牙关紧闭、面部浮肿但能进食，用升麻胃风汤治疗。这五种情况，总称为胃风病。
破伤风证，是因为皮肉被击打破损，风邪乘虚侵入，导致发热肿胀。治疗方法与感冒相似。另外，各种疮疡溃烂后，风邪乘虚内侵，病情最为急迫，往往被当作普通病症忽视，导致变化多端，多有无法救治的情况。也有因疮疡热毒郁结，表面覆盖白色痂皮，疮口闭塞，气机难以宣通，从而热极生风的情况。或者有用药汤淋洗，湿气从疮口进入，导致患者昏迷沉重的情况；或者有用艾灸火烤，火气逼入体内导致烦躁发热的情况。只要辨别疮口平坦无渗出液的，是破伤风；疮口边缘流出黄水的，是破伤湿；疮口红肿的，是破伤火。这些汤火之毒引起的病症，也与破伤风没有区别。其病理都能传播至经络，灼烧真气，因此出现寒热交替发作，严重时牙关紧闭、眼睛斜视、身体强直，像角弓反张一样，死亡就在旦夕之间。应当参照伤寒的方法进行治疗，根据病邪在表、在里或半表半里的不同而区别对待。刘河间说：太阳经病在表的用发汗法，阳明经病在里的用泻下法，少阳经病在半表半里的用和解法。但如果患处再次出现红肿，伴有神志昏迷、食欲不振，不分经络归属的，可用穿山甲一钱、蜈蚣末半钱、麝香一字，用浓煎的葱白香豉汤送服。患处用葱涕调和炒过的飞面涂抹。这里只提到三阳经而未提及三阴经，意思是风邪在三阳经时，按法则及早治疗即可痊愈。若等到传入三阴经，病情已经危重，只能用天灵盖一钱、穿山甲半钱、麝香一字研成散剂，用浓煎的葱白香豉汤送服。如果出现腹部胀满自利，或口燥咽干，舌卷缩、睾丸上缩，额头出汗珠但不流动，身上汗出如油，眼睛变小且直视，肢体剧痛但不在受伤部位等情况，都是死证。
破伤风邪在表的，用九味羌活汤；在半表半里的，用小柴胡汤；大汗不止、筋脉拘挛抽搐的，用升麻汤加黄芪。如果服用蜈蚣等祛风药过多导致自汗的，用白术、黄芪、防风、生甘草煎汤温服。大便秘结、小便赤涩的，或者因用热药导致自汗不止的，应当迅速泻下。先用芎黄汤二三服，再用大芎黄汤泻下。如果无效，反而出现痉挛症状，用羌活、独活、防风、杏仁、地榆水煎频服，名为蠲痉汤。大便闭结的，用胆导或蜜导法。病程长久身体衰弱的，应当养血，用四物汤加藁本、防风、细辛、白芷。疮疡破伤风邪，身体疼痛，风邪攻注导致拘挛紧急，皮肤瘙痒，麻木不仁，头晕牙关紧闭的，以防风、藁本、羌活、地骨皮、荆芥穗研末，酒调服。疮痂壅塞，内热生风的，用九味羌活汤。伤湿且疮口常有稀脓的，先服除湿汤二三剂，后用一味白术膏，或者泡酒也可。伤火且红肿，时常头痛发热，甚至烦躁的，用芎黄汤加薄荷、荆芥、防风，无效再加酒黄连四五分、黑山栀二钱，兼有小便不利的，合用导赤散。牙关紧急打不开的，用一条蜈蚣焙干研细末，擦牙，吐出涎液后立即苏醒，或者服用左龙丸也可以。破伤肿而不能透脓的，用朱砂、南星、独活、穿山甲、人指甲，炒研为末，酒调服二三次。外用南星、防风研末，姜汁调敷患处。
王晋庵（石顽）说：破伤这一证候，金刃跌扑损伤与溃疡截然不同。金刃跌扑受伤，会出现寒热头痛、面目浮肿、胸膈痞闷，六脉浮弦，或模糊不清。其传变过程与伤寒相似，但病情比伤寒更剧烈，所以可以用疏解表邪的方法。然而也不可峻猛使用风药，因为经脉中的血液已经先因受伤而耗损，所谓“夺血者无汗”。如果是溃疡破伤，患处突然再次肿胀，按压不知疼痛，周身肌肉麻木不仁，牵引疼痛，胸膈痞满，神志不清，六脉弦细，或虚大模糊。虽然风毒瓦斯攻注全身，切不可用攻表药，发汗必致肌肉跳动筋惕，甚至发生痉挛，所谓“疮家不可发汗，发汗必致痉也”。轻症的，用葱白香豉汤加鲮鲤甲、白芷、蜈蚣之类；重症的用葱白香豉汤加黄芪、肉桂、远志、防风、鲮鲤甲、犀角之类；极重的用万灵丹，用葱豉煎汤调服。呕吐逆气不能进食的，这是风引邪毒攻心，急用护心散。外用葱熨法分解邪气。如果大便不通的，切不可用芎黄汤，只宜用蜜煎导法。病情稍退后，应当用保元汤，仍加远志、肉桂、犀角、鲮鲤甲等解散余毒，同时配合人参、黄芪，避免壅滞的隐患。其间泻补，各随患者的体质偏颇作为权衡，贵在临证时的灵活变通。
【诊法】脉浮而无力的是太阳经受邪；脉长有力的是阳明经受邪；浮而弦的是少阳经受邪；洪数的是伤火；沉细的是伤湿；虚细脉涩的都是不治之症。虞恒德治疗一个人，因劝架斗殴，眉棱骨被打破，得了破伤风，头面部大肿发热，用九味羌活汤取汗，外用杏仁研烂，加入少许白面，新汲水调匀敷在疮上，消肿退热而痊愈。后来屡次尝试都有效验。
The *Classic of Difficult Issues* (Jing Yun) states: The presentation of Wei Wind (Stomach Wind) is characterized by excessive sweating in the neck and aversion to wind, difficulty swallowing food and drink, obstruction in the chest and diaphragm, frequent abdominal distension, bloating upon exposure to cold, and diarrhea after consuming cold food. On examination, the body appears emaciated while the abdomen is distended.
Wei Wind refers to swelling of the head and face, with a wiry, moderate, and floating pulse at the right Guan position. It is often caused by being exposed to cool air after eating. Yu Jiayan stated that there are five variations of Wei Wind. The first is called "Wind transforming into Cold-Heat," meaning wind enters the Stomach and inevitably affects the Liver Wood, as wind Qi connects with the Liver. When Liver Wood is excessive, it overacts on Spleen Earth, generating alternating chills and fever. Quack doctors often mistake this for an external contraction, for which Xiao Chai Hu Tang (Minor Bupleurum Decoction) is appropriate. The second is called "Dan transforming into Xiao Zhong" (Gluttony transforming into Middle Consumption), where Dan refers to heat. Heat accumulating in the Stomach leads to voracious appetite but easy hunger, which is the harm of Fire; Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) is appropriate. The third is called "Jue transforming into Dian Ji" (Reversal transforming into Head Disease), where Jue means reversal, referring to Stomach Qi reversing upward to the head, causing diseases of the vertex, such as vertigo; Xiong Xin Tang (Ligusticum and Asarum Decoction) is appropriate. The fourth is called "Long-term Wind leading to Sun Xie" (Undigested Diarrhea), meaning wind fire in the Stomach is intense, causing immediate diarrhea after eating without retention. If wind enters the Blood level, bright red blood is passed; if complicated by damp-heat, stool resembling bean dregs is passed; Ren Shen Wei Feng Tang (Ginseng Stomach Wind Decoction) is used, adding Fang Feng (Saposhnikovia Root) if there is bleeding. The fifth is called "Pulse Wind leading to Li" (Leprosy), meaning wind in the Stomach brews for a long time, causing Ying Qi (Nutritive Qi) to become hot and turbid, resulting in the collapse of the nasal bridge and deterioration of complexion, with muscles gradually ulcerating. Mild cases present with body numbness, eye twitching, lockjaw, facial swelling, and ability to eat; Sheng Ma Wei Feng Tang (Cimicifuga Stomach Wind Decoction) is appropriate. These five conditions are collectively known as Wei Wind disease.
Po Shang Feng (Broken Injury Wind / Tetanus) occurs when skin and flesh are broken by trauma, allowing wind pathogens to invade, causing fever and swelling. The treatment method is similar to that for common cold. Furthermore, after various sores ulcerate, wind pathogens may invade due to deficiency. This condition is most acute and is often mistaken for ordinary ailments, leading to various complications and often untreatable cases. There are also cases where sore heat stagnates, forming white scabs, closing the wound, blocking Qi circulation, and generating wind from extreme heat. Or, using herbal washes allows dampness to enter through the wound, causing coma and heaviness. Or, using moxibustion or fire baking forces fire Qi inward, causing irritability and fever. One must distinguish: flat wounds without exudate indicate Po Shang Feng; wounds oozing yellow fluid indicate Po Shang Shi (Broken Injury Damp); red and swollen wounds indicate Po Shang Huo (Broken Injury Fire). The toxicity from these injuries is similar to Po Shang Feng. The pathogenesis spreads through meridians, blazing the True Qi, causing alternating chills and fever. Severe cases present with lockjaw, strabismus, rigid body, and opisthotonos, with death imminent. Treatment should follow the principles of Shang Han (Cold Damage), differentiating between exterior, interior, and half-exterior/half-interior patterns. He Jian said: For Tai Yang exterior patterns, use sweating methods; for Yang Ming interior patterns, use purgation; for Shao Yang half-exterior/half-interior patterns, use harmonization. However, if the affected area becomes red and swollen again, accompanied by coma and poor appetite, regardless of meridian involvement, use Shan Zha (Pangolin Scale) 1 qian, Wu Gong (Centipede) powder 0.5 qian, and She Xiang (Musk) one character dose, taken with strong decoction of Cong Bai (Scallion White) and Dou Chi (Fermented Soybean). Apply a paste of Cong Ti (Scallion Sap) and fried Fei Mian (Washed Flour) to the site. The text mentions only the Three Yang meridians because treating early according to the law cures wind pathogens in the Yang meridians. If it transmits to the Three Yin meridians, the condition is critical. Use Tian Ling Gai (Human Skull Cap) 1 qian, Shan Zha 0.5 qian, and She Xiang one character dose, powdered and taken with strong Cong Bai Dou Chi decoction. If abdominal fullness with spontaneous diarrhea, dry mouth and throat, curled tongue and retracted testicles, sweat beads on forehead not flowing, oily sweat on body, small eyes staring straight, and severe limb pain unrelated to the injury occur, these are death signs.
For Po Shang Feng with pathogen in the exterior, use Jiu Wei Qiang Huo Tang (Nine-Ingredient Notopterygium Decoction); for half-exterior/half-interior, use Xiao Chai Hu Tang; for profuse sweating with muscle spasms and convulsions, use Sheng Ma Tang plus Huang Qi (Astragalus Root). If excessive use of wind-dispelling herbs like Wu Gong causes spontaneous sweating, use Bai Zhu (Atractylodes Macrocephala Rhizome), Huang Qi, Fang Feng, and Sheng Gan Cao (Raw Licorice Root) decocted and taken warm. For constipation and dark scanty urine, or continuous sweating from hot medicines, rapid purgation is needed. First use Xiong Huang Tang (Ligusticum and Astragalus Decoction) two or three doses, then Da Xiong Huang Tang. If ineffective and spasms worsen, use Qiang Huo (Notopterygium Rhizome), Du Huo (Angelica Pubescens Root), Fang Feng, Xing Ren (Apricot Seed), and Di Yu (Sanguisorba Root) decocted in water frequently, named Juan Jing Tang (Spasm-Relieving Decoction). For fecal impaction, use bile suppository or honey suppository methods. For chronic weakness, nourish Blood with Si Wu Tang (Four-Substance Decoction) plus Gao Ben (Ligusticum Wallichii Rhizome), Fang Feng, Xi Xin (Asarum Root), and Bai Zhi (Angelica Dahurica Root). For sore Po Shang Feng with body pain, wind attacking causing spasms, itching, numbness, dizziness, and lockjaw, use Fang Feng, Gao Ben, Qiang Huo, Di Gu Pi (Lycium Bark), and Jing Jie Sui (Schizonepeta Flower Spike) powdered and taken with wine. For blocked scabs with internal heat generating wind, use Jiu Wei Qiang Huo Tang. For damp injury with thin pus, first use Chu Shi Tang (Dampness-Expelling Decoction) two or three doses, then Yi Wei Bai Zhu Gao (Single-Ingredient Atractylodes Paste) or wine infusion. For fire injury with redness/swelling, headache, fever, and irritability, use Xiong Huang Tang plus Bo He (Mint), Jing Jie, and Fang Feng; if ineffective, add Jiu Huang Lian (Wine-processed Coptis Rhizome) 4-5 fen, Hei Shan Zhi (Black Gardenia Fruit) 2 qian. If urination is difficult, combine with Dao Chi San (Directing Away Red Powder). For severe lockjaw, roast one Wu Gong, powder finely, rub teeth; salivation will release and consciousness return. Alternatively, use Zuo Long Wan (Left Dragon Pill). For swelling unable to drain pus, use Zhu Sha (Cinnabar), Nan Xing (Pinellia Tuber), Du Huo, Shan Zha, and Ren Zhi Jia (Human Nail) roasted and powdered, taken with wine twice or thrice. Externally, apply Nan Xing and Fang Feng powdered with Ginger Juice.
Shi Wan said: Broken injury differs significantly from ulceration. Trauma from metal or falls causes chills, fever, headache, facial swelling, chest oppression, floating-wiry pulses, or indistinct pulses. Transmission resembles Shang Han but is more severe, allowing surface-releasing methods. However, harsh wind-dispelling herbs should be avoided because blood vessels are damaged ("loss of blood precludes sweating"). Ulceration breaking open causes sudden swelling, insensitivity to pressure, generalized numbness,牵引 pain, chest fullness, confusion, wiry-thin or deficient-large indistinct pulses. Although wind-toxin attacks the body, surface-releasing drugs must not be used; sweating causes muscle twitching and spasms ("sores cannot be sweated, sweating causes spasms"). Mild cases: Cong Bai Dou Chi Tang plus Lin Qi Jia (Pangolin Scale), Bai Zhi, Wu Gong. Severe cases: Cong Bai Dou Chi Tang plus Huang Qi, Rou Gui (Cinnamon Bark), Yuan Zhi (Polygala Root), Fang Feng, Lin Qi Jia, Xi Jiao (Rhinoceros Horn). Critical cases: Wan Ling Dan (Ten-Thousand Spirit Pill) taken with Cong Chi decoction. Vomiting and inability to eat indicates wind-toxin attacking the Heart; urgently give Hu Xin San (Heart-Protecting Powder). Externally use Cong Yun (Scallion Fomentation). If constipated, do NOT use Xiong Huang Tang; use honey suppository only. As severity recedes, use Bao Yuan Tang plus Yuan Zhi, Rou Gui, Xi Jiao, Lin Qi Jia to resolve residual toxin, combined with Ren Shen (Ginseng Root) and Huang Qi to prevent stagnation. Tonification and purgation depend on individual constitution; flexibility in clinical practice is key.
[Diagnosis] Floating and weak pulse indicates Tai Yang; long and forceful pulse indicates Yang Ming; floating and wiry indicates Shao Yang; surging and rapid indicates Fire injury; deep and fine indicates Damp injury. Deficient-fine and choppy pulses are untreatable. Yu Hengde treated a man who broke his brow bone in a fight, developing Po Shang Feng with massive head/face swelling and fever. He used Jiu Wei Qiang Huo Tang to induce sweating and externally applied almond paste mixed with flour and fresh water to the wound. Swelling subsided, fever resolved, and he recovered. This method proved effective repeatedly.