《内经》云∶肝脉搏坚而长，色不青，当病堕。若搏因血在胁下，令人呕逆。
《金匮》云∶寸口脉浮微而涩，然当亡血，若汗出。设不汗出者，当身有疮被刀斧所伤
，亡血故也。
《脉经》云∶金疮出血太多，其脉虚细者生，数实者死。金疮出血，脉沉小者生，浮大
者死
，小弱者死。破伤有瘀血在内，脉坚强实则生，虚小弱者死。若亡血过多，脉细小者生，浮
大数实者死，皆为脉病不相应故也。
一妇人臀痈将愈，患破伤风，发热搐搦，脉浮数，余以当归地黄汤治之。彼不信，乃服
发散败毒药，果甚，始信而服之，至数剂而痊。夫破伤风之症，须分表里别虚实，不可一概治之
。《原病式》云∶夫破伤中风之由者，因疮热甚郁结，而荣卫不得宣通，怫热因之遍身，故
多白痂，是时疮口闭塞，气难通泄，热甚则生风，不已则表传于里者也。但有风热微甚，兼
化，故殊异矣。大凡破伤中风，风热燥甚，怫郁在表，而里气尚平者，善伸数欠，筋脉拘
急，时或恶寒，或筋惕而播，脉浮数而弦者，宜以辛热治风之药，开冲结滞；是与伤寒表热
怫郁，而以麻黄汤辛热发散者同也。凡用辛热开冲风热结滞，宜以寒药佐之则良，免致药中
病而风热转甚也。如治伤寒发热，用麻黄、桂枝，加黄芩、石膏、知母之类是也。若世以甘
草、滑石、葱、豉寒药，发散甚妙。若表不已，渐伤入里，里又未大甚，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，而或便溺闭
结，或时汗出，脉洪数而弦也。然出汗者，由风热郁甚于里，而表热稍罢，则腠理疏泄，而
心火热甚，故汗出也，法宜除风散结，寒药下之，后以退风热开郁结之寒药调之，而热退结
散，则风自愈矣。凡治此，亦宜按摩导引及以药干开牙关，勿令口噤，使粥药得下也。
《病机》云∶破伤风者，有因卒暴伤损风袭之间，传播经络，致使寒热更作，身体反张
，口
，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，遂经诸变
，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。徐用诚云∶此论所
因有四∶二者，因疮口入风，似属外因；一者因灸逐热，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，古方药甚论少，岂非以此疾，与中风同论，故不
另立条目也。唯河间论与伤寒表里中三法同治，用药甚详。其言病因，有因外伤于风；有因
灸及内热所作者，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，多致不
救。盖中风在经在脏在腑之异，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，俱是血，受病属五脏之所主，故此风所伤，始虽在表，随即必传入脏，故多死也
。此病或疮口坦露，不避风寒而有所伤，或疮口闭合，密避风邪而及，病已十分安全，而忽
有此，大抵皆由内气虚，而有郁热者得之。若内气壮实，而无郁热者，虽伤而无所害也。
附方
八珍汤（方见溃疡发热门）
六君子汤（方见作呕门）
复元活血汤 治坠堕，或打扑瘀血，流于胁下作痛，或小腹作痛，或痞闷，及便
毒，初起肿痛。
柴胡（一钱五分） 天花粉 当归（酒拌，各一钱） 红花 甘草（各七分） 穿山甲（一钱
，炮）
前服。
小柴胡汤
四物汤（二方见瘰 门）
复元通气散（方见乳痈门）
桃仁承气汤 治伤损瘀血停滞，腹作痛，发热，或发狂，或便毒壅肿，疼痛便秘
发热，并宜用此通之。
桃仁（五十粒，去皮尖，研） 桂枝 芒硝 甘草（炙，各一钱） 大黄（一钱） 作一剂，
水二钟，煎一钟，空心服。
玉真散（一名定风散） 治破伤风重者，牙关紧急，腰背反张，并蛇犬所伤。
天南星 防风（各等分） 为末。每服二钱，温酒调下，更搽患处。若牙关紧急，腰背反
张者
。若治风犬咬伤，更用漱口水，洗净搽之，神效。
隔蒜灸法（方见发背门）
太乙膏（方见肠痈门）
托里散（方见肿疡门）
解毒散 治一切毒蛇恶虫并兽所伤，重者毒入腹，则眼黑口噤，手足强直。此药
平易，不伤气血，大有神效，不可以为易而忽之。
白矾（一两） 甘草末（一两） 为细末。每服二钱，不拘时，冷水调下，更敷患处。
苏合香丸（方见方脉科气门）
圣愈汤 治疮疡，脓水出多，或疮出血，心烦不安，眠睡不宁，或五心烦热。
地黄（酒拌，蒸半日） 生地黄（酒拌） 川芎 人参（各五钱） 当归（酒拌） 黄 （盐水
浸炒，各一钱） 作一剂，水二钟，煎八分，食远服。
独参汤 治溃疡气血虚极，恶寒或发热，或失血之证，葛可久血脱用补气，即此
方也。
人参（二两） 作一剂，水二钟，枣十枚，煎一钟，徐徐服。若煎至稠浓，即为膏矣。
当归地黄汤 治破伤风，气血俱虚，发热头痛，此养气血祛风邪，不拘新旧，并
治之。
当归（酒拌） 地黄（酒拌） 芍药 川芎 本 防风 白芷（各一钱） 细辛（五分） 作
一剂，水二钟，煎一钟服。
《黄帝内经》说：肝脉搏动坚实而长，面色却不发青，应当是坠落伤所致。如果是因为血瘀在胁下，会导致人呕吐气逆。
《金匮要略》说：寸口脉浮微而涩，这通常是失血或汗出过多的表现。如果不曾出汗，则应当是有疮疡或被刀斧等利器所伤，这是因失血造成的。
《脉经》说：金创（金属利器造成的创伤）出血过多，脉象虚细的能生，脉象数实的会死。金创出血，脉象沉小的能生，脉象浮大的会死，脉象小弱的也会死。破伤风体内有瘀血，脉象坚强实大的能生，脉象虚小弱的会死。如果失血过多，脉象细小的能生，脉象浮大数实的会死，这都是因为脉象与病情不相适应的缘故。
有一位妇女臀痈即将痊愈时，患上了破伤风，出现发热、抽搐的症状，脉象浮数。我用当归地黄汤治疗。她不相信，反而服用了发散和败毒的药物，结果病情加重，这才相信并服用我的药，经过几剂治疗后痊愈。破伤风这种病症，必须区分表里、辨别虚实，不能一概而论地治疗。《原病式》说：破伤中风的原因，是因为疮疡热邪郁结严重，导致营卫之气不能宣通，怫热（郁积的热邪）因此遍布全身，所以多形成白痂。这时疮口闭塞，气机难以通畅宣泄，热邪极盛则生风，若不停止，就会由表传里。但由于风热的轻重不同，兼夹变化各异，所以症状表现也不同。大凡破伤中风，风热燥邪极盛，怫郁在体表，而里气尚且平和的，表现为喜欢伸展、频繁打哈欠，筋脉拘急，时而怕冷，或者筋肉跳动，脉象浮数而弦，适宜用辛热的祛风药物，来开冲结滞；这与伤寒表热怫郁，使用麻黄汤辛热发散的治法相同。凡是使用辛热药物开冲风热结滞，宜以寒性药物佐助，这样才好，以免药虽中病但风热反而更甚。比如治疗伤寒发热，用麻黄、桂枝，加上黄芩、石膏、知母之类就是这种情况。如果用甘草、滑石、葱、豆豉等寒性药物发散，也非常巧妙。如果表证未解，逐渐传入里部，里热又不是很严重，脉象在肌肉层的，适宜用退风热、开结滞的寒性药物调理，或者稍微加一点治风的辛热药物也可以，这就像伤寒在半表半里之间，用小柴胡汤和解的意思一样。如果里热已经很严重，出现舌强、口噤、项背反张、惊搐惕搦、涎唾稠粘、胸腹满塞，或者大小便闭结，或者偶尔出汗，脉象洪数而弦。然而出汗的原因，是由于风热郁结在里很深，而表热稍减，腠理疏泄，心火极盛，所以出汗。治法适宜除风散结，用寒性药物攻下，之后再用退风热、开郁结的寒性药物调理，热退结散，风邪自然痊愈。治疗此病，也适宜按摩导引，并用药物干姜等开通牙关，不要让口噤，使粥药能够服下。
《病机》说：破伤风，有的是因为突然遭受损伤，风邪乘袭其间，传播经络，致使寒热交替发作，身体反张，口噤，这是破伤风的征候。有的诸疮不愈，世人都说艾灸是最好的，这属于热疮，却不知道火热客毒，遂引发各种变化，不可胜数。轻微的发热，严重的生风抽搐，或者角弓反张，口噤目斜。也有破伤后，没有艾灸却患病，这是因为疮上结了白痂，疮口闭塞，气难通畅宣泄，所以阳热容易郁结，热极则生风。徐用诚说：这个论述提到的病因有四方面：两个方面，是因疮口进风，似乎属于外因；一个方面是因艾灸逐热，似乎属于不内外因；一个方面是因疮口闭塞，内热生风，似乎属于内因。又说：破伤风证，古方药论很少提及，难道不是因为这个疾病与中风同论，所以没有另立条目吗？只有河间（刘完素）的论述与伤寒表里中的三法同治，用药非常详细。他说的病因，有因外伤于风的；有因艾灸及内热引起的，然而与中风相似。但是中风的人，还可以拖延岁月，而破伤风患者染上此病，大多导致无法救治。大概中风有在经、在脏、在腑的区别，唯独入脏的最难治。破伤风，或者开始出血过多，或者疮口过早闭合，瘀血停滞，都是血分受病，属于五脏所主，所以此风所伤，开始虽然在表，随即必然传入脏，所以大多死亡。此病或者疮口坦露，不避风寒而有所伤，或者疮口闭合，严密避风邪却仍被侵袭，病已十分安全，却忽然发生此病，大抵都是由内气虚弱，而有郁热的人得之。如果内气壮实，而没有郁热的，虽然受伤也无害。
附方
六君子汤（方剂见作呕门）
复元活血汤 治疗坠堕，或打扑导致的瘀血，流注于胁下引起疼痛，或小腹疼痛，或痞闷，以及便毒初起肿痛。
柴胡（一钱五分） 天花粉 当归（酒拌，各一钱） 红花 甘草（各七分） 穿山甲（一钱，炮制）
前服。
四物汤（两个方剂见瘰疬门）
复元通气散（方剂见乳痈门）
桃仁承气汤 治疗伤损瘀血停滞，腹部疼痛，发热，或者发狂，或者便毒壅肿，疼痛便秘发热，都适宜用此方通下。
桃仁（五十粒，去皮尖，研碎） 桂枝 芒硝 甘草（炙，各一钱） 大黄（一钱） 作一剂，水二钟，煎至一钟，空腹服用。
玉真散（又名定风散） 治疗破伤风重症，牙关紧急，腰背反张，以及蛇犬咬伤。
天南星 防风（各等分） 研为末。每次服用二钱，温酒调下，另外涂抹患处。如果是牙关紧急，腰背反张的情况。如果是治疗疯狗咬伤，还要用漱口水洗净后涂抹，神效。
隔蒜灸法（方剂见发背门）
太乙膏（方剂见肠痈门）
托里散（方剂见肿疡门）
解毒散 治疗一切毒蛇恶虫以及野兽所伤，重的毒入腹，则眼黑口噤，手足强直。此药平易，不伤气血，大有神效，不可以因为药易而忽视它。
白矾（一两） 甘草末（一两） 研为细末。每次服用二钱，不拘时间，冷水调下，另外敷于患处。
苏合香丸（方剂见方脉科气门）
圣愈汤 治疗疮疡，脓水流出多，或者疮出血，心烦不安，睡眠不宁，或者五心烦热。
地黄（酒拌，蒸半天） 生地黄（酒拌） 川芎 人参（各五钱） 当归（酒拌） 黄芪（盐水浸炒，各一钱） 作一剂，水二钟，煎至八分，饭后服用。
独参汤 治疗溃疡气血极度虚弱，恶寒或发热，或者失血的证候，葛可久治疗血脱时用补气法，就是这个方子。
人参（二两） 作一剂，水二钟，枣十枚，煎至一钟，慢慢服用。如果煎至稠浓，就成为膏了。
当归地黄汤 治疗破伤风，气血俱虚，发热头痛，此方养气血祛风邪，不拘新旧，一并治疗。
当归（酒拌） 地黄（酒拌） 芍药 川芎 藁本 防风 白芷（各一钱） 细辛（五分） 作一剂，水二钟，煎至一钟服用。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When the Liver pulse is firm and long, yet the complexion is not green, it indicates a fall injury. If the pulsation is due to blood stasis under the hypochondrium, it causes vomiting and reflux.
The *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) states: A floating, faint, and choppy pulse at the Cun position typically indicates blood loss or excessive sweating. If there has been no sweating, it suggests the presence of sores or injuries caused by knives or axes, resulting from blood loss.
The *Maijing* (Pulse Classic) states: In metal weapon wounds with excessive bleeding, a deficient and fine pulse indicates survival, while a rapid and excess pulse indicates death. For bleeding from metal wounds, a deep and small pulse indicates survival, whereas a floating and large pulse indicates death; a small and weak pulse also indicates death. In broken wound injuries with internal blood stasis, a firm, strong, and excess pulse indicates survival, while a deficient, small, and weak pulse indicates death. If there is excessive blood loss, a fine and small pulse indicates survival, while a floating, large, rapid, and excess pulse indicates death. These cases all occur because the pulse does not correspond to the disease condition.
A woman whose buttock abscess was nearly healed contracted tetanus (broken wind), presenting with fever and convulsions, and a floating, rapid pulse. I treated her with Danggui Dihuang Tang (Angelica and Rehmannia Decoction). She did not believe in this treatment and instead took dispersing and detoxifying drugs that damaged healthy qi, causing her condition to worsen. Only then did she trust my prescription and take it, recovering after several doses. Tetanus must be differentiated by exterior/interior and deficiency/excess; it cannot be treated uniformly. The *Yuanbing Shi* (Original Causes of Disease) states: The cause of tetanus is severe heat accumulation in the sore, preventing the smooth circulation of Ying and Wei qi. This stifling heat spreads throughout the body, often forming white scabs. At this time, the wound closes, making it difficult for qi to circulate and vent. Extreme heat generates wind; if unchecked, it transmits from the exterior to the interior. Due to variations in the severity of wind-heat and accompanying transformations, symptoms differ. Generally, in tetanus where wind-heat dryness is severe and stifled in the exterior, while interior qi remains peaceful, symptoms include frequent stretching and yawning, tendon and vessel stiffness, occasional aversion to cold, or muscle twitching. The pulse is floating, rapid, and wiry. It is appropriate to use acrid-hot wind-dispelling herbs to open and flush out stagnation; this is similar to treating exterior heat stiflement in Cold Damage using Ma Huang Tang (Ephedra Decoction) for acrid-hot dispersion. Whenever using acrid-hot herbs to open wind-heat stagnation, it is advisable to assist with cold herbs to prevent the wind-heat from intensifying despite the medication targeting the pathogen. For example, when treating fever from Cold Damage, one might combine Ma Huang (Ephedra Herb) and Gui Zhi (Cinnamon Twig) with Huang Qin (Scutellaria Root), Shi Gao (Gypsum Fibrosum), and Zhi Mu (Anemarrhenae Rhizoma). Using cold herbs like Gan Cao (Licorice Root), Hua Shi (Talcum), Cong Bai (Scallion White), and Chi Dou (Fermented Soybean) for dispersion is also excellent. If the exterior syndrome persists and gradually enters the interior, but the interior heat is not yet severe, 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-treating herbs. This resembles the principle of harmonizing Shaoyang in Cold Damage using Xiao Chai Hu Tang (Minor Bupleurum Decoction). If interior heat is already severe, presenting with stiff tongue, locked jaw, opisthotonos,惊搐 (startle convulsions), thick sticky saliva, chest and abdominal fullness, constipation or urinary retention, or occasional sweating, with a surging, rapid, and wiry pulse, the sweating occurs because wind-heat is deeply stifled in the interior while exterior heat subsides, causing pores to open and Heart fire to become extreme. The treatment should focus on dispelling wind and resolving stagnation, using cold herbs to purge downwards, followed by regulation with cold herbs that clear wind-heat and open depression. Once heat recedes and stagnation dissipates, the wind will heal itself. Treatment should also include massage and guidance techniques, and using medicinal substances to open the jaw to prevent locking, allowing porridge and medicine to be ingested.
The *Bingji Lun* (Treatise on Pathogenesis) states: Tetanus arises when sudden trauma allows wind pathogens to invade and spread through the meridians, causing alternating chills and fever, opisthotonos, and locked jaw. Alternatively, chronic sores that do not heal are often treated with moxibustion, considered superior for "heat sores." However, practitioners fail to realize that fire-heat pathogenic toxins can trigger numerous complications. Mild cases present with fever; severe cases develop wind and convulsions, opisthotonos, locked jaw, and deviated eyes. Some suffer broken wounds without moxibustion yet still contract the disease because white scabs form, closing the wound and trapping qi, leading to yang-heat accumulation and subsequent wind generation. Xu Yongcheng stated that the causes mentioned above fall into four categories: two aspects involve wind entering through the wound, resembling external causes; one aspect involves heat expulsion via moxibustion, resembling neither-internal-nor-external causes; and one aspect involves internal heat generating wind due to wound closure, resembling internal causes. He further noted that ancient texts rarely discuss tetanus separately, likely because it is discussed alongside Zhong Feng (Wind Stroke). Only Liu Wansu (Hejian) discusses it similarly to the three methods of exterior/interior Cold Damage, with detailed prescriptions. His etiology includes external wind invasion and internal heat/moxibustion factors, resembling Wind Stroke. However, while Wind Stroke patients may survive for years, tetanus patients often die. Wind Stroke varies by location (meridians, zang, fu organs), with zang involvement being hardest to treat. Tetanus, whether starting with excessive bleeding or early wound closure with blood stasis, involves blood pathology governed by the five zang organs. Thus, although the pathogen starts in the exterior, it quickly transmits to the zang organs, leading to high mortality. This disease may occur if an exposed wound is exposed to wind-cold, or if a closed wound is penetrated by wind despite precautions. Even if the patient seems safe, sudden onset usually stems from deficient interior qi and stifled heat. Those with strong interior qi and no stifled heat remain unaffected even if injured.
Attached Formulas
Bazhen Tang (Eight Treasures Decoction) (See section on Ulcer Fever)
Liujunzi Tang (Six Gentlemen Decoction) (See section on Vomiting)
Fuyuan Huoxue Tang (Restoring Flow Blood-Invigorating Decoction) Treats pain in the hypochondrium or lower abdomen due to blood stasis from falls or blows, distension, and initial swelling/pain of groin abscesses.
Chai Hu (1.5 qian) Tianhuafen Angelicae Sinensis Radix (soaked in wine, 1 qian each) Honghua Carthami Flos Gancao (0.7 qian each) Manis Squama (1 qian, processed)
Take as directed.
Xiao Chai Hu Tang (Minor Bupleurum Decoction)
Siwu Tang (Four Substances Decoction) (Two formulas see section on Scrofula)
Fuyuan Tongqi San (Restoring Flow Qi-Unblocking Powder) (See section on Breast Abscess)
Taoren Chengqi Tang (Persimmon Seed Bowel-Purging Decoction) Treats abdominal pain, fever, mania, or swollen painful groin abscess with constipation due to stagnant blood from trauma. Use this to unblock.
Taoren (50 seeds, peeled and crushed) Guizhi Mangxiao Glycyrrhizae Radix et Rhizoma Preparata (roasted, 1 qian each) Dahuang (1 qian) Make one dose, decoct in two zhong of water to yield one zhong, take on an empty stomach.
Yuzhen San (Jade Truth Powder) (Also called Dingfeng San / Wind-Calming Powder) Treats severe tetanus with locked jaw and opisthotonos, and snake/dog bites.
Tian Nan Xing Fangfeng (equal parts) Grind into powder. Take 2 qian per dose, mixed with warm wine, and apply to the affected area. For locked jaw/opisthotonos. For dog bites, rinse with mouthwash before applying; highly effective.
Ge Suan Jiu Fa (Garlic-Separator Moxibustion Method) (See section on Back Carbuncle)
Taiyi Gao (Great One Ointment) (See section on Intestinal Abscess)
Tuoli San (Support Interior Powder) (See section on Swollen Ulcer)
Jiedu San (Detoxification Powder) Treats injuries from venomous snakes, insects, and beasts. Severe cases involve toxin entering the abdomen, causing blackened eyes, locked jaw, and limb rigidity. This mild formula does not damage qi and blood and is highly effective; do not neglect it due to its simplicity.
Bai Fan (1 liang) Gancao Endospermum (1 liang) Grind into fine powder. Take 2 qian per dose, mixed with cold water at any time, and apply topically.
Suhe Xiang Wan (Styrax Pill) (See section on Pulse Diagnosis)
Shengyu Tang (Sage Replenishing Decoction) Treats sores with excessive pus or bleeding, restlessness, insomnia, or five-palm heat.
Dihuang (wine-soaked, steamed for half a day) Sheng Dihuang (wine-soaked) Chuanxiong Renshen (5 qian each) Danggui (wine-soaked) Huangqi (salt-water soaked and stir-fried, 1 qian each) Make one dose, decoct in two zhong of water to yield eight fen, take after meals.
Dushen Tang (Single Ginseng Decoction) Treats extreme qi and blood deficiency in ulcers, aversion to cold, fever, or blood loss. Ge Kejiu used this for qi tonification in blood depletion.
Renshen (2 liang) Make one dose, decoct in two zhong of water with ten jujubes to yield one zhong, take slowly. If boiled to a thick consistency, it becomes a paste.
Danggui Dihuang Tang (Angelica and Rehmannia Decoction) Treats tetanus with combined qi and blood deficiency, fever, and headache. Nourishes qi and blood and dispels wind, applicable to both acute and chronic cases.
Danggui (wine-soaked) Dihuang (wine-soaked) Shaoyao Chuanxiong Gaoben Fangfeng Baizhi (1 qian each) Xixin (0.5 qian) Make one dose, decoct in two zhong of water to yield one zhong, take.