夫风者，百病之始也，清净则腠理闭拒，虽有大风苛毒，莫之能害。诸疮不瘥，荣卫虚肌肉不生，
疮眼不合而风邪入之，为破伤风之候。亦有因疮热郁结，多着白痂，疮口闭塞，气难宣通，故热甚而
生风者。先辨疮口，平无汁者，中风也；边自出黄水者，中水也，并欲作痉。急治之。东垣云∶破伤
风者，通于表里，分别阴阳，同伤寒证治。人知有发表，不知有攻里、和解。夫脉浮而无力太阳也，
在表宜汗。脉长而有力阳明也，在里宜下。脉浮而弦小者少阳也，半在表半在里，宜和解。明此三法，
而治不中病者，未之有也。（此但云三阳，不及三阴者，盖风邪在三阳经，便宜按法早治而愈。若
得传入三阴，其证已危，或腹满自利，口燥嗌干，舌卷卵缩，皆无生理，故置而勿论也。）河间云∶
破伤风，风热燥甚，怫郁在表，而里气尚平者，善伸数欠，筋脉拘急，或时恶寒，或筋惕而搐，脉浮
数而弦也。宜以辛热治风之药，开冲结滞而愈。犹伤寒表热怫郁，而以麻黄汤辛热发散也。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、知母、石膏之类是也。若止以甘草、滑石、葱、豉寒药发散甚妙。若表不已，渐传入里，里又未
太甚，而脉弦小者，宜以退风热开结滞之寒药调之，或微加治风辛热药亦得，犹伤寒在半表半里而以
小柴胡和解之也。若里势已甚，而舌强口噤，项背反张，惊惕搐搦，涎唾稠粘，胸腹满塞，便溺秘结，
或时汗出，脉沉洪数而弦也。然汗出者，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、开结滞之寒药调之，则热退结散而风自愈矣。解表，
羌活防风汤、防风汤、九味羌活汤、蜈蚣散。解后实之白术防风汤。攻里，大芎黄汤、江鳔丸、左龙
丸。后服小羌活汤。和解，羌活汤、地榆防风散、小柴胡汤。日久气血渐虚，邪气入胃，宜养血四物
汤，加防风、 本、白芷各等分，细辛减半，为粗末。每服五钱水煎。服风药过多自汗
出者，白术黄 汤。大汗不止，筋挛搐搦，白术升麻汤。搐痉不已，蠲痉汤。背后搐者，羌活、独活、
防风、甘草。向前搐者，升麻、白芷、独活、防风、甘草。两旁搐者，柴胡、防风、甘草。右搐加滑
石。手足颤掉不已，朱砂指甲散。四般恶证不可治。第一头目青黑色，第二额上汗珠不流，第三眼小
目瞪，第四身上汗出如油。又痛不在疮处者，伤经络亦死证也。
【外治】初觉疮肿起白痂，身寒热，
急用玉真散敷之，或用杏仁去皮细嚼，和雄黄飞罗白面敷之。（一方只用杏仁白面等分和匀，新汲水
调和如膏敷。）肿渐消为度。若腰脊反张，四肢强直，牙关口噤，用鼠一头和尾烧作灰细研，以腊月
猪脂和敷。牙关紧不能开，用蜈蚣一条，焙干研细末，擦牙吐涎立苏。狗咬破伤风，人参不拘多少，
桑柴火上烧令烟绝，用盏子合研为末掺疮上，仍以鱼胶煮烊封固。《婴童百问》云∶县尹张公尝言吾
有一妙方，治破伤风如神，用人家粪堆内蛴螬虫一枚，烂草房上亦有之，捏住其脊，待其虫口中吐水，
就抹在疮口上，觉麻即汗出，立愈。后试之，果然。其虫仍埋故处，勿伤其命。
风，是各种疾病的起始因素。如果人体保持清净（指正气充足、腠理致密），则腠理闭合抵御外邪，即使有大风苛毒，也不能伤害人体。各种疮疡久不愈合，因营卫虚弱导致肌肉不生，疮口不能闭合，风邪乘虚而入，便形成破伤风的证候。也有因为疮疡内部热邪郁结，表面多结成白色痂皮，导致疮口闭塞，气机难以宣通，从而热盛而生风的。
首先要辨别疮口的情况：疮口平坦且无分泌物的，属于中风邪；疮口边缘流出黄水的，属于中水邪，这两种情况都容易发展为痉病（以项背强直、角弓反张为特征的疾病）。必须紧急治疗。李东垣说：破伤风，病位涉及表里，需要分辨阴阳，其诊治原则与伤寒相似。人们只知道用发汗解表的方法，却不知道还有攻下里实和解半表半里的方法。脉象浮而无力，属太阳经病，病在表，宜用发汗法；脉象长而有力，属阳明经病，病在里，宜用攻下法；脉象浮而弦小，属少阳经病，病在半表半里，宜用和解法。明了这三种治法，治疗没有不中病的。（这里只提到三阳经，没提三阴经，是因为风邪在三阳经时，按法早治即可痊愈。如果传入三阴经，病情已经危重，如出现腹满自利、口燥咽干、舌卷缩、睾丸上缩等症状，都没有生机了，所以不予讨论。）
刘河间说：破伤风，风热燥邪甚盛，郁结在体表，而里气尚平和的，表现为喜欢伸懒腰、频繁打哈欠，筋脉拘急，有时怕冷，有时筋肉跳动抽搐，脉象浮数而弦。适宜用辛热的祛风药，开散冲决郁结滞气而治愈。这就像伤寒表热郁结，用麻黄汤辛热发散一样。凡是使用辛热药物开散风热结滞，应当佐以寒凉药物，这样才好，以免药力虽中病但风热反而加重。比如治疗伤寒发热，用麻黄、桂枝，加上黄芩、知母、石膏等寒凉药就是这种用法。如果只用甘草、滑石、葱、豆豉等寒凉药发散，效果也很好。如果表证未解，逐渐传入里，里热又不太严重，且脉象弦小的，适宜用退风热、开结滞的寒凉药调理，或者稍微加一点治风的辛热药也可以，这就像伤寒病在半表半里用小柴胡汤和解一样。如果里热势已很盛，出现舌强、牙关紧闭、项背反张、惊恐惕动抽搐、痰涎稠粘、胸腹满塞、大小便秘结，有时出汗，脉象沉洪数而弦。至于出汗，是因为风热郁结于里，表热稍减，导致腠理疏泄，心火亢盛，所以出汗。治法适宜用除风散结的寒凉药攻下，之后再用退风热、开结滞的寒凉药调理，那么热退结散，风邪自然痊愈。
解表方剂：羌活防风汤、防风汤、九味羌活汤、蜈蚣散。解表后补益脾胃：白术防风汤。攻下方剂：大芎黄汤、江鳔丸、左龙丸。攻下后服用：小羌活汤。和解方剂：羌活汤、地榆防风散、小柴胡汤。病程日久气血渐虚，邪气入胃，适宜用养血的四物汤，加防风、藁本、白芷各等分，细辛减半，研成粗末。每次服五钱，水煎服。服用风药过多导致自汗出的，用白术黄芪汤。大汗不止，筋挛抽搐的，用白术升麻汤。抽搐痉挛不已的，用蠲痉汤。背部抽搐的，用羌活、独活、防风、甘草。向前抽搐的，用升麻、白芷、独活、防风、甘草。两侧抽搐的，用柴胡、防风、甘草。右侧抽搐加滑石。手足颤抖不停，用朱砂指甲散。有四种恶证不可治：第一头目呈现青黑色，第二额头出汗珠但不流动，第三眼睛变小且直视，第四身上出汗如油。另外，疼痛不在疮处而是伤及经络的，也是死证。
【外治法】初觉疮肿起白痂，身体寒热，急用玉真散敷贴，或者用杏仁去皮细嚼，和雄黄、过筛的白面一起敷贴。（另一方法只用杏仁和白面等分混合均匀，用新汲水调和成膏状敷贴。）直到肿胀逐渐消退为止。如果出现腰脊反张，四肢强直，牙关紧闭，用一只老鼠连同尾巴烧成灰，细细研磨，用腊月猪脂调和敷贴。牙关紧不能张开，用一条蜈蚣，焙干研成细末，擦牙吐涎，立刻苏醒。被狗咬伤导致的破伤风，用人参不拘多少，在桑柴火上烧至烟尽，用碗盖住研磨成末，撒在疮口上，仍用鱼胶煮化封固。《婴童百问》说：县尹张公曾说我有一个妙方，治疗破伤风如神，取人家粪堆内的蛴螬虫一枚（烂草房上也有），捏住它的脊背，等它口中吐出水分，就抹在疮口上，感觉麻木就会出汗，立刻痊愈。后来试了，果然有效。这只虫子仍埋回原处，不要伤害它的性命。
Wind is the beginning of all diseases. If one maintains purity and stillness, the couli (pores) close and resist, so that even severe wind and toxic pathogens cannot harm the body. When various sores fail to heal due to deficiency of Ying and Wei (nutritive and defensive qi), muscles do not regenerate, and the sore openings remain unclosed, allowing wind pathogens to enter, resulting in the condition of Po Shang Feng (tetanus). There are also cases where heat within the sores becomes stagnant, forming white scabs on the surface, causing the sore openings to close and qi circulation to be obstructed, leading to excessive heat generating internal wind.
First, distinguish the condition of the sore opening: if the sore is flat with no exudate, it is Wind invasion; if yellow fluid oozes from the edges, it is Water invasion. Both conditions tend to develop into Jing disease (spasm characterized by rigidity of the neck and back, and opisthotonos). Urgent treatment is required. Li Dongyuan stated: Po Shang Feng involves both exterior and interior levels; one must differentiate Yin and Yang, and its diagnosis and treatment are similar to Shang Han (cold damage). People know only about releasing the exterior through sweating, but do not know about purging the interior or harmonizing. A floating pulse without strength indicates Taiyang channel involvement; since the pathogen is in the exterior, sweating is indicated. A long and forceful pulse indicates Yangming channel involvement; since the pathogen is in the interior, purging is indicated. A floating, wiry, and small pulse indicates Shaoyang channel involvement; the pathogen is half-exterior and half-interior, so harmonization is indicated. Understanding these three methods ensures effective treatment. (This text mentions only the Three Yang channels, excluding the Three Yin channels, because when wind pathogens are in the Three Yang channels, early treatment according to method leads to recovery. If transmitted to the Three Yin channels, the condition becomes critical, presenting with abdominal fullness and spontaneous diarrhea, dry mouth and throat, curled tongue, and retracted testicles, which are fatal; thus, they are omitted.)
Liu Hejian stated: In Po Shang Feng, if wind-heat and dryness are severe and stagnated in the exterior while interior Qi remains peaceful, symptoms include frequent stretching and yawning, stiffness and tension of sinews and vessels, occasional aversion to cold, and occasional twitching or convulsions of sinews, with a floating, rapid, and wiry pulse. It is appropriate to use acrid-hot wind-dispelling herbs to open and scatter the stagnation. This is analogous to using Mahuang Tang (Ephedra Decoction) for acrid-hot dispersal in Shang Han with exterior heat stagnation. 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 hitting the target. For example, treating Shang Han fever with Mahuang (Ephedrae Herba) and Guizhi (Cinnamomi Ramulus) combined with Huangqin (Scutellariae Radix), Zhimu (Anemarrhenae Rhizoma), and Shigao (Gypsum Fibrosum) is such an approach. Using only cold herbs like Gancao (Glycyrrhizae Radix et Rhizoma), Huashi (Talcum), Congbai (Allii Fistulosi Bulbus), and Chishao (Fermented Soybean) for dispersal is also excellent. If the exterior syndrome persists and gradually transmits inward, while interior heat is not yet severe and the pulse is wiry and small, it is suitable to regulate with cold herbs that reduce wind-heat and open stagnation, or slightly add acrid-hot wind-treating herbs. This is like using Xiaochaihu Tang (Minor Bupleurum Decoction) to harmonize when Shang Han is at the half-exterior half-interior level. If interior heat is already severe, presenting with stiff tongue, locked jaw, opisthotonos, frightful twitching and convulsions, thick sticky saliva, chest and abdominal fullness and obstruction, constipation of urine and stool, and occasional sweating, with a deep, surging, rapid, and wiry pulse: The sweating occurs because wind-heat is severely depressed in the interior, causing slight relief of exterior heat, leading to open couli and excessive Heart fire, hence sweating. The method should involve purging with cold herbs that dispel wind and scatter stagnation, followed by regulation with cold herbs that reduce wind-heat and open stagnation, so that heat recedes, stagnation dissipates, and wind heals spontaneously.
Exterior-releasing formulas: Qianghuo Fangfeng Tang (Notopterygium and Saposhnikovia Decoction), Fangfeng Tang (Saposhnikovia Decoction), Jiuwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction), Wugong San (Centipede Powder). After releasing exterior, tonify with Baizhu Fangfeng Tang (Atractylodes Macrocephala and Saposhnikovia Decoction). Interior-purging formulas: Daxionghuang Tang (Angelica Dahurica and Rheum Decoction), Jiangbiao Wan (Fish Maw Pill), Zuolong Wan (Left Dragon Pill). Follow with Xiao Qianghuo Tang (Minor Notopterygium Decoction). Harmonizing formulas: Qianghuo Tang (Notopterygium Decoction), Diyü Fangfeng San (Sanguisorba and Saposhnikovia Powder), Xiaochaihu Tang (Minor Bupleurum Decoction). For prolonged illness with gradual deficiency of Qi and Blood, and pathogen entering the Stomach, use Siwu Tang (Four Substances Decoction) to nourish blood, adding Fangfeng (Saposhnikoviae Radix), Gaoben (Ligustici Rhizoma et Radix), and Baizhi (Angelicae Dahuricae Radix) in equal parts, with Xixin (Asari Radix et Rhizoma) halved, ground into coarse powder. Take 5 qian per dose, decocted in water. For spontaneous sweating caused by excessive wind herbs, use Baizhu Huangqi Tang (Atractylodes Macrocephala and Astragalus Decoction). For continuous profuse sweating with muscle cramps and convulsions, use Baizhu Shengma Tang (Atractylodes Macrocephala and Cimicifugae Rhizoma Decoction). For unceasing spasms and convulsions, use Juanjing Tang (Spasm-Relieving Decoction). For backward convulsions, use Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Fangfeng (Saposhnikoviae Radix), Gancao (Glycyrrhizae Radix et Rhizoma). For forward convulsions, use Shengma (Cimicifugae Rhizoma), Baizhi (Angelicae Dahuricae Radix), Duhuo (Angelicae Pubescentis Radix), Fangfeng (Saposhnikoviae Radix), Gancao (Glycyrrhizae Radix et Rhizoma). For lateral convulsions, use Chaihu (Bupleuri Radix), Fangfeng (Saposhnikoviae Radix), Gancao (Glycyrrhizae Radix et Rhizoma). Add Huashi (Talcum) for right-sided convulsions. For incessant trembling of hands and feet, use Zhusha Zhijia San (Cinnabar and Nail Powder). Four ominous signs are incurable: First, blue-black color of head and eyes; second, sweat beads on forehead that do not flow; third, small eyes staring fixedly; fourth, oily sweat on the body. Additionally, pain not at the sore site but affecting meridians and collaterals is also a death sign.
[External Treatment] At the first sign of sore swelling and white scab formation, accompanied by chills and fever, urgently apply Yuzhen San (Jade True Powder), or chew peeled Xingren (Prunus Armeniacae Semen) finely, mix with Xionghuang (Realgar) and sifted Bai mian (White Flour), and apply as a poultice. (Another method uses equal parts Xingren and Bai mian mixed evenly, blended with fresh well-water into a paste for application.) Apply until swelling gradually subsides. If opisthotonos, limb rigidity, and trismus occur, burn one mouse including its tail to ash, grind finely, and mix with pig fat from the twelfth lunar month for external application. If the jaw is tightly closed and cannot open, take one Wugong (Centipede), bake dry, grind into fine powder, rub into teeth to induce salivation and spitting, leading to immediate recovery. For tetanus caused by dog bites, use Ren Shen (Ginseng Radix et Rhizoma) in any amount, burn over mulberry wood fire until smoke ceases, cover with a bowl, grind into powder, sprinkle on the wound, and seal with dissolved Yu jiao (Fish Glue). "Ying Tong Bai Wen" states: Magistrate Zhang once said he had a miraculous formula for treating Po Shang Feng effectively. Take one Qiluo (larva of *Otiorhynchus sulcatus*) from a manure pile (also found on rotten grass roofs), pinch its spine, wait for it to spit water from its mouth, then smear this onto the sore opening. Upon feeling numbness, sweating will occur, and recovery will be immediate. This was tested and proved true. The larva should be buried back in its original place; do not kill it.