《病机》云∶破伤风者，有因卒暴伤损，风寒袭之，传播经络，致使寒热更作，身体反
张，口噤不开，甚者邪气入脏。有因诸疮不瘥，营卫俱虚，肌肉不生，疮眼不合，邪亦能外
入于疮，为破伤风之候。有诸疮不瘥，举世皆言，着灸为上，是为热疮而不知火热客毒，逐
经为变，不可胜数，微则发热，甚则生风而搐，或角弓反张，口噤目斜。亦有破伤不灸而病
此者，因疮着白痂，疮口闭塞，气难通泄，故阳热易为郁结，热甚则生风也。
徐用城曰∶此论所因有四，二者因疮口入风，似属外因。一者因灸生热，似属不内外
因。一者因疮口闭塞，内热生风，似属内因也。又云∶破伤风证，古方药论甚少，岂非以此
疾与中风同论，故不另立条目也。惟河间论与伤寒表里中三法同治，其言病因，有因外伤于
风者，有因灸者，有因内热所作者，然与中风相似也。但中风之人，尚可淹延岁月，而破伤
风者，犯之多至不救。盖中风有在经、在腑、在脏之异，独入脏者最难治。破伤风，或始而
出血过多，或疮早闭合，瘀血停滞，俱是阴虚受病，乃五脏之所主。故此风所伤，始虽在表
，即随必传入脏，故多死也。此病或因疮口坦露，或因疮口闭密，皆能为之。若病已十分安
全，而忽有此，大抵皆由内气虚而有郁热者，乃得之。若内气壮实而无郁热者，虽害而无所
害也。
立斋曰∶大法；破伤中风，风热燥甚，怫郁在表，而里气尚平者，必善伸数欠，筋脉拘
急，时或恶寒，或筋惕而播，脉浮数而弦，皆表证也。宜以辛热治风之药，开散结滞，是与
伤寒表热怫郁，而以升麻汤辛热发散者同也。然凡用辛热开其风热结滞者，宜用寒药佐之，
则免其药虽中病，而风热转甚也。如治伤寒发热，用麻黄、桂枝，而加黄芩、知母、石膏之
类是也。若近世以甘草、滑石、葱、豉寒药，发散甚妙。若表病不已，渐伤入里，里又未太
甚，而脉在肌肉者，宜以退风热，开结滞之寒药调之，或微加治风辛热亦得，犹伤寒在半表
半里，而以小柴胡和解之意也。若里热已甚，而舌强口噤，项背反张，惊搐惕搦，涎唾稠粘
，胸腹满塞，或便溺闭结，或时汗出，脉洪数而弦。然汗出者，由风热甚于里，而表邪已罢
，腠理疏泄，心火内盛，故汗出也。法宜除风散结，以寒药下之，后用退风热，开郁滞之
寒药调之，热退结散则风自愈矣。凡治此者，亦宜用按摩导引之法，及以药干开牙关，勿令
口噤，使粥药得下也。
一妇人，臀痈将愈，患破伤风，发热搐搦，脉浮数。予以当归地黄汤治之，彼不信。
乃服发散败毒药，果甚，始信而服之。数剂而痊。
一男子，背疮未痊敛，以膏药剪孔贴之，患破伤风证而殁。此先失于内补，外邪袭其
虚耳。余见此证贴膏药剪孔，欲其通气，而反患破伤风；搽敛药生肌，欲其收口，而反助余
毒，以致殁者多矣，可不慎哉。（薛按）
《病机》中说：破伤风，有的是因为突然遭受创伤，风寒之邪侵袭，传入经络，导致寒热交替发作，身体向后反张，牙关紧闭不能张开，严重的则邪气侵入内脏。有的是因为各种疮疡久不愈合，营气和卫气都虚弱，肌肉不生，疮口不合，邪气也能从外部进入疮口，形成破伤风的证候。有的疮疡久不愈合，世人皆说用艾灸治疗是最好的，这是对于热性疮疡却不知火热之毒客留体内，沿着经络产生变化，这种情况不可胜数，轻微的表现为发热，严重的则生风而抽搐，或者角弓反张，牙关紧闭、眼睛斜视。也有的是受了外伤但没有进行艾灸却得了这种病的，是因为疮口结上了白色痂皮，疮口闭塞，气息难以通畅宣泄，所以阳热容易郁结，热势严重就会生风。
徐用城说：这段论述提到的病因有四种情况，其中两种是因为疮口进风，似乎属于外因。一种是因为艾灸产生热邪，似乎属于不内外因。一种是因为疮口闭塞，内部热气生风，似乎属于内因。又说：破伤风的证候，古代方书和药论中记载很少，难道不是因为此病与中风（卒中等）放在一起讨论，所以没有单独设立条目吗？只有刘河间在论述伤寒表里三法时一同治疗，他所说的病因，有因外伤于风的，有因艾灸引起的，有因内部热气产生的，然而这与中风相似。但是患中风的人，还可以拖延岁月，而患破伤风的人，一旦发病大多无法救治。大概中风有在经络、在腑、在脏的区别，唯独入脏的最难治疗。破伤风，或者是开始出血过多，或者是疮口过早闭合，瘀血停滞，这些都是阴虚受病，由五脏所主。所以这种风邪伤害人体，开始时虽然在体表，但随即必定传入内脏，所以死亡率很高。这个病要么是因为疮口坦露在外，要么是因为疮口闭密，都能导致此病。如果病情已经十分安稳，却突然发生这种情况，大抵都是因为内部元气虚弱而有郁热的缘故，才会得病。如果内部元气壮实而没有郁热的，即使受到危害也没什么大碍。
薛立斋说：一般的治疗原则是：破伤中风，风热燥盛，郁结在体表，而里气尚且平和的，必然会出现频繁伸懒腰打哈欠，筋脉拘急，有时怕冷，或者筋肉跳动，脉象浮数而弦，这都是表证的特征。适宜用辛热性质的治风药物，来开散结滞，这与治疗伤寒表热郁结，使用升麻汤辛热发散的道理相同。然而凡是使用辛热药物来开通风热结滞的，应该配合寒性药物作为辅助，这样可以避免虽然药力对症，但风热反而加重的情况。比如治疗伤寒发热，使用麻黄、桂枝，而加入黄芩、知母、石膏之类就是这种用法。如果近世使用甘草、滑石、葱、豆豉等寒性药物来发散，效果非常好。如果表证未愈，逐渐损伤到内部，内部又不太严重，且脉象在肌肉层显现的，适宜用退除风热、开散结滞的寒性药物来调理，或者稍微加入一些治风的辛热药物也可以，这就像伤寒在半表半里之间，使用小柴胡汤和解的意思一样。如果内部热势已经很严重，出现舌头僵硬、牙关紧闭、项背向后反张、惊厥抽搐、唾液稠粘、胸腹部胀满堵塞，或者大小便闭塞不通，或者偶尔出汗，脉象洪数而弦。至于出汗，是因为风热在内部很盛，而表邪已经解除，腠理疏松泄越，心火内部旺盛，所以出汗。治疗方法适宜祛除风邪、解散结滞，用寒性药物攻下，之后再用退除风热、开散郁滞的寒性药物来调理，热退结散则风邪自然痊愈。凡是治疗此病，也适宜采用按摩导引的方法，以及用药粉吹开牙关，不要让牙关紧闭，使粥和药物能够服下。
有一个妇人，臀部痈疽即将痊愈时，患了破伤风，发热抽搐，脉象浮数。我给她用当归地黄汤治疗，她不相信。于是服用了发散败毒的药物，果然病情加重，才开始相信并服用我的药。几剂药后痊愈。
有一个男子，背部疮疡尚未痊愈收敛，用膏药剪个孔贴在上面，结果患了破伤风证而死。这是因为先前失于内部补益，外邪乘虚侵袭所致。我看到这种证候贴膏药剪孔，本意是想通气，反而导致患破伤风；涂抹生肌敛口的药物，本意是想收口，反而助长余毒，导致死亡的例子很多，能不谨慎吗？（薛己按语）
The *Pathogenesis* states: Broken-wind (Po Shang Feng, tetanus-like syndrome resulting from trauma) may arise from sudden injury where wind-cold pathogens invade and spread through the meridians, causing alternating chills and fever, opisthotonos (body arching backward), trismus (lockjaw), and in severe cases, pathogenic factors entering the Zang organs. It may also arise from chronic ulcers that fail to heal, where both Ying (Nutrient) and Wei (Defensive) Qi are deficient, muscles do not regenerate, and wound edges remain open, allowing external pathogens to enter the ulcer, resulting in broken-wind. In cases of non-healing ulcers, it is universally believed that moxibustion is the superior treatment; however, for heat-type ulcers, one must be unaware that fire-heat toxic pathogens lodging internally can cause transformations along the meridians, a phenomenon too numerous to recount. Mild cases present with fever, while severe cases develop wind-stirring convulsions, opisthotonos, trismus, and strabismus. There are also cases where trauma occurs without moxibustion yet the disease develops; this is because a white scab forms over the wound, closing the orifice and preventing the free flow and discharge of Qi, leading to the stagnation of Yang-heat. When heat becomes excessive, it generates wind.
Xu Yongcheng stated: This discussion outlines four etiologies. Two involve wind entering through the wound, resembling external causes. One involves heat generated by moxibustion, resembling neither-internal-nor-external causes. One involves internal heat generating wind due to wound closure, resembling internal causes. He further noted: Ancient formularies and materia medica contain few records of broken-wind syndromes. Could it be because this disease was discussed alongside Zhong Feng (Wind Stroke)? Thus, no separate entry was established. Only Liu Wansu treated it concurrently with the three methods for exterior-interior conditions in Cold Damage. His discussion on etiology includes external wind invasion, effects of moxibustion, and internal heat generation, all resembling Wind Stroke. However, patients with Wind Stroke may survive for years, whereas those with broken-wind often die upon onset. Generally, Wind Stroke varies by location—meridians, Fu organs, or Zang organs—with Zang involvement being the most difficult to treat. Broken-wind, whether due to initial excessive bleeding or early wound closure causing blood stasis, represents Yin deficiency diseases governed by the Five Zang organs. Therefore, once this wind pathogen invades, although initially at the exterior, it quickly transmits to the interior, leading to high mortality. This condition can occur whether the wound is exposed or tightly closed. If a patient who seemed stable suddenly develops these symptoms, it is largely due to internal Qi deficiency with stagnant heat. If internal Qi is robust without stagnant heat, even if harmed, the outcome is less severe.
Xue Li-zhai stated: The general principle is: In broken-wind, if wind-heat and dryness are excessive and stagnant at the exterior while interior Qi remains peaceful, symptoms such as frequent yawning/stretching, tendon and vessel tension, occasional aversion to cold, or muscle twitching will occur, accompanied by a floating, rapid, and wiry pulse—all indicating exterior syndromes. It is appropriate to use acrid-hot herbs to disperse wind and resolve stagnation, similar to using Shengma Tang (Cimicifugae Decoction) for acrid-hot dispersion in Cold Damage with exterior heat stagnation. However, when using acrid-hot herbs to resolve wind-heat stagnation, they should be assisted by cold herbs to prevent the worsening of wind-heat despite correct diagnosis. For example, treating Cold Damage fever with Mahuang Tang (Ephedra Decoction) or Guizhi Tang (Cinnamon Twig Decoction) supplemented with Huangqin (Scutellariae Radix), Zhimu (Anemarrhenae Rhizoma), or Shigao (Gypsum Fibrosum). In recent times, using cold herbs like Gancao (Licorice Root), Huashi (Talcum), Congbai (Allii Fistulosi Bulbus), and Chijiao (Fermented Soybean) for dispersion yields excellent results. If exterior pathology persists and gradually affects the interior, but the interior is not severely affected and the pulse is felt at the muscle level, it is suitable to regulate with cold herbs that clear wind-heat and resolve stagnation, or slightly add acrid-hot wind-resolving herbs. This parallels the harmonizing approach of Xiaochaihu Tang (Minor Bupleurum Decoction) for half-exterior half-interior Cold Damage. If interior heat is severe, presenting with tongue stiffness, trismus, opisthotonos,惊厥 (convulsions/tetany), viscous saliva, chest/abdominal fullness, constipation or urinary retention, or occasional sweating with a surging, rapid, and wiry pulse: sweating occurs because wind-heat is intense internally while exterior pathogens have resolved, pores are open, and Heart Fire is flourishing internally. The method should involve dispelling wind and resolving stagnation using cold herbs to purge, followed by regulation with cold herbs that clear wind-heat and resolve depression. Once heat subsides and stagnation resolves, the wind self-cures. Treatment should also include massage and Daoyin (guiding and pulling) techniques, and applying medicinal powder to open the jaw to prevent trismus, allowing porridge and medicine to be ingested.
A woman suffering from a buttock abscess nearing healing developed broken-wind with fever and convulsions, and a floating, rapid pulse. I prescribed Danggui Dihuang Tang (Angelica and Rehmannia Decoction), but she did not believe in it. She instead took dispersing and detoxifying herbs, which indeed worsened her condition, after which she finally accepted my prescription. After several doses, she recovered.
A man with an unhealed back ulcer applied a plaster with a hole cut in it. He subsequently died from a broken-wind syndrome. This was due to prior failure to tonify internally, allowing external pathogens to attack the deficiency. I have observed many cases where cutting holes in plasters to allow ventilation resulted in broken-wind, and applying hemostatic/astringent herbs to promote tissue regeneration instead aided residual toxins, leading to death. How can one not be cautious? (Commentary by Xue Ji)