用手细摸所伤之处，或骨断、骨碎、骨歪、骨整、骨软、骨硬，或筋强、筋柔、筋歪、
筋正、筋断、筋走、筋粗、筋翻，或为跌扑，或为闪错，或为打撞，然后根据法治之。
接使已断之骨合拢，复归旧位，陷者复起，碎者复完，突者复平。或用手法，或用器具
，分先后而兼用之。
用两手或用一手，擒住应端之骨，或从下往上端，或从外向内端，或直端，或斜端，骨
离位者以手端之，送入其臼，不使歪斜，而骨缝方合，庶愈后无长短之患。
提出陷下骨如旧，有用两手提者，有用绳帛系高处提者，有提后用器具辅之，不使仍陷
者。倘重者轻提，则病不愈，轻者重提，反加新患。
按者以手往下抑之，摩者徐徐揉摩之。因损伤皮肤筋肉，肿硬麻木，而骨未有折断者。
以手推之，使还旧位，有用两手或一手捏定患处，缓缓以复其位。或因筋急难于转摇，
或筋纵难运动，或骨节稍有错落不合缝者，当推拿以通经络之气血。
凡人之头无骱，亦无损折，只有跌打碎伤等症，若脑浆出者不治，骨青者难治，碎骨如
大者可治，过大者不治。接骨入骱者，两手捏平其筋骨，复于旧位。或先拽之离而后合，或
推之就而复位，或正其斜，或完其缺。且骨有截断、碎断、斜断之分，骱有全脱、半脱之别
，筋有弛纵、卷挛、翻转、离合各门，在肉内者用手摸之自知。盖伤有重轻，接拿有合宜、
不合宜之法。故愈有迟有速，而得完全或遗残废者，总责乎手法也。然体质壮者易愈，元气
弱者难全，若手法再误，万难挽回。夫骨既断必使合拢一处，复归原臼。出血者敷止血散，
使血不流，再敷金疮药。用杉木板绑缚撑抵断处，方不移动矣。辨明骨有断为两截者，或折
而陷下者，或碎而散乱者，或岔而旁突者，分其情势接拿，使断者复接，陷者复起，碎者复
完，突者复平。有皮肉不破而骨断者，动则辘辘有声，或骨受伤未断者，动则无声，或碎骨
在肉内者，动则淅淅之声。后必溃烂流脓，待其烂脱离肉，箝去碎骨，掺生肌药，外贴损伤
膏，亦用绑缚，始可完全。
大凡治法，先煎代痛散熏洗，然后将断骨拿直，令其相对，平正按摩，果然照旧不歪。
痛散，铺盖艾绒，绑以杉木板，加布条扎好，取其紧直，使骨缝无绽离走脱之患。过四五日
放绑复看，如其走脱，仍根据前法扎紧。百日内换绑二十余次，内服接骨药。
凡断臂与断膊，断腿与断 ，治分上下，器具照形体变化。有筋全断者，则缩于肉里，
无用巧能接之理。若断而未全断者，外敷续筋药，内服壮筋养血药。
跌打碰伤，头颅猝死者，身虽僵直，口鼻尚有出入气，心口尚温跳动者，使患者盘坐，
发，伏我膝上。伤处先敷定痛散，随以火纸卷条点火，令烟熏其口鼻，通和脏腑血脉之气，
待口中出声，以热陈酒和灌定痛散，或炒萝卜子泡汤灌之。外用手摩其胸腋，并托其手腕，
频频揉其两手脉窠。被伤之筋脉强硬，得揉摩而心脉和运，命脉流通，即可回生。若伤重已
死者，用白布缠其头，以木棍长尺半，圆如钱大，轻轻拍其足心，再提其发，令项正直，舒
其经络。如皮未破，骨碎膜穿，血向内流，声哑不言，面青唇黑者，不治。或顶骨塌陷，七
窍出血，身僵昏迷者不治。惟皮开肉绽，血流不止者，先止其血，服补气养血药，当戒欲避
风。如染破伤风，牙关紧闭，角弓反张，即进疏风理气汤，俟身不发热，与补中益气汤。
伤囟门肉肿皮未破者，昏沉不语，扶起正坐，以葱汁和敷定痛散，次以粗纸蘸醋贴药上
小熨斗烙纸上，内觉热痛，口出声为度。去药贴损伤膏。如皮破血流不止，骨陷筋翻者不治
。凡伤头顶、两旁棱骨、额骨正中、两额角、眼眶骨、颧骨，均照囟门伤治法。
打伤眼珠落出者，先以银针蘸井水，将收珠散点红筋，次用青绢蘸温汤挪进。即服还魂
汤，再投明目生血饮。
鼻梁骨断者，先捏正断骨，掺以止血丹。如鼻已伤落下者，急趁血热，蘸发炭末粘贴
，不可歪斜，加绢条扎紧，迟则血冷不能粘。服壮筋续骨丹。如骨未碎断，只贴损伤膏，服
吉利散。骨碎内膜破者，口鼻流血者不治。
砍跌打落耳朵，或上落下粘者，或下脱上连者，急拈正用封口金疮药。若全落下者，急
余末贴原位，将两耳相对，次以竹片夹紧，加布条扎好。如耳门骨伤重而体素亏，昏沉者不
口唇豁开者，先掺麻药，急以小箝箝牢油丝线穿合其缝，不可歪斜。掺金疮药，贴损伤
外以绢条在唇上扎向脑后缚定。服活血止痛散，常饮稀粥，不可言笑，及呷食物。如血已冷
，先敷麻药，以刀尖剐破，血出时急纵合，须手快为妙。仍服前药。口含刀误割其舌，将断
未落者，急用鸡蛋壳内衣贮其舌，蜜调敷止血定痛散，频频添换。使患者仰卧，稀粥灌饮，
不动其舌，则易愈。或戮伤上 正中之孔，面肿色青，血流不止，痛连脑髓。若伤会厌，昏
沉不语，痛连心膈。急研铅粉、冰片吹患处以止其血，再用蟹黄、血竭煎汤，每日口漱三十
次，内服定痛散。
下颏一骱脱下者，遂不便言语饮食，其骱如剪刀股样。先以布包手大指入其口，余指抵
边，轻轻捺下，用力向上一推，而进骱有响声，齿能合者复位多。得于肾虚者，外加布条兜
裹于项后，常进补肾养血汤，次进补肾丸。
颈项骨难于损折，有登高倒跌，损骨外出者，重者三时死。轻者捏平其骨，相对原笋。
贴损伤膏，次以布条连肩背络之，投砂仁泡汤煎吉利散。
缺盆外锁子骨伤断者，先拿胸骨，将肩头向内合之，揉摩断骨令其复位，加带挂肩于项
，敷定痛散，不可摇动，服接骨药。
肋骨断者，骨不能对，须捏骨平正，外贴损伤膏，内服壮筋续骨丹。
肩骱与膝骱相似，肩骱落下，手不能举，将上一手擒住其肩下，一手拿住其手，轻轻转
使其筋舒。再令患者坐于低处，一人抱住其身，将手拔直，用推拿法。又两手捏其肩，抵住
其臂骨，将膝夹住其手，齐力推上。骱内有骱声，乃复旧位，手自能举动。如无响声者，骱
未能上，仍照前法而行。先以熟牛皮，长五寸、宽三寸，两头各开二孔，贯以棉绳，内贴损
伤膏，加以棉花盖之。又用棉裹如鸡卵大，夹于夹窝内，复以牛皮夹紧肩之前后，加布缠好
后，以扶手板，长二寸，宽四寸，两头穿绳，悬挂空中，令患者俯伏于上，不使其肩骨下垂
，俟全愈方可撤板。若不根据此法，后必遗残患芦节。服独活桂枝汤。
臂骱落出者，以上一手抬住其湾，下一手拿住其脉踝，令其手伸直，拔下遂曲其上，后
湾，捏平凑合其拢，内有响声，使其手曲转，搭着肩膊，骱可合缝矣。贴损伤膏，多以布每
头钉带四根，裹扎臂骨，复以竹帘照患处大小为度，围紧布外，使骨缝无参差走脱之患，以
引经药煎汤和吉利散。
手掌处腕骨被跌扑打伤，骱骨脱出者，腕缝必开，以两手先揉其腕，一手拿住其指，一
住其凹处，拔其手指，伸直手掌，曲起手骱，曲下一伸而上，骱内有响声，掌可活动，已复
旧位。但骱出不用绑。如骨断者先贴损伤膏，加布扎紧。将阔板一片，撑住患里；再以木板
四片，长三寸，加布扎紧，俟愈方去板。煎桂枝汤和吉利散。
手指有三骱，中节脱出者，拔出捏正，拈其指伸出挺直，一推即上，能屈伸则愈。不可
洗，以桂枝煎活血止痛饮。手指痛过于别处，若伤一指，痛必连心，中指尤甚。一染破伤风
，外敷金疮药，内服疏风理气汤。
被人咬伤手指者，先以童便淋洗，捏去牙根毒瓦斯。用炙龟板灰末麻油和敷，又以纸蘸麻
火熏之。如患处破伤风，进疏风理气汤。若刀斧砍斫伤者难治。臀处肉浓，骨粗，骱脱比诸
骱难于擒拿合拢（又名胯骨）。若骱脱臼者，则触在股内，须用大力人四个帮扶，使患者侧卧
，一人抱住其身，一人擒住膝上，先将臂骱拔直，上手擒住其腰，下手捧住其腿湾，将膝曲
转向上，使膝近其腹，再令伸直，骱内有响声，即归旧臼。出左臀攀向右，向右拔直而上。
出右臀攀向左，向左拔直而上。贴损伤膏，服生血补髓汤。
大腿骨骱脱者，一手擒住其膝，一手拿住其膀，上下拔直，将膝曲转，抵住臀瓣，骱内
声，始为合拢。敷定痛散，服生血补髓药。腿骨折两段者，先煎宽筋散熏洗，令患者侧卧于
床，患足拿与无患足齐，贴损伤膏。用布二条，长五寸、宽二寸、裹膏药上。外以纸包杉木
板八片，长七寸。又用布三条，与木板和扎齐紧。先进活血止痛散，次投壮筋续骨丹。大小
腿皮破骨断者，拿骨平正，贴损伤膏。用杉木板六片，长二寸半，上骨断板宽七分，下骨断
板宽五分，加布扎紧，取其担力，不致歪走。此症痛极，先以止痛丹，后投壮筋续骨丹。
膝骱处油盏骨，在膝盖之处，其骱脱出于上者，使患者仰卧，一人抬起足踝，若出于左
左而下；出于右，随右而下。医者缓缓双手挟擒，上手拿住其膝，下手擒住其足，弯使骱对
膝上，手擒膝下，手向上一抬则上。贴损伤膏，服壮筋续骨丹。膝盖离位向外侧者，则内筋
肿胀。向内侧者，则筋直起湾肿，看其骨如何斜错，根据法捏拿，复其原位，服补筋药。膝盖
骨，名护膝骨，有伤为两块者，或三块，将两脚伸直，捏其骨平伏。用薄篾片照膝盖骨之大
小，做一篾圈，套于患上，次以布四条，扣于圈上，连膝湾扎紧。先贴损伤膏，服止痛接骨丹
，不必换膏药。受伤足放床上，不可下地，半月后，用软棉放足湾处，逐日垫高，使湾曲如
旧。常煮鸭食，又恐碎骨，未长好复行损伤，将马桶垫与床一样高，以大便不可下，水洗至全
好。去篾圈如箍，月余骨仍两片者，一生跛足，不可治，服当归汤。
当归 乳香 没药 川断 陈皮 五加皮 生地 牛膝 骨碎补 红花 木瓜 如发热，
加柴胡、桔梗各一钱。发肿，加黄芩，水酒各半煎，空心服。
小腿有二骨，一大一小，断一根者易治，断两根者难治。直挺者易治，分两段者难治。
骨捏对平正，敷金疮药，贴损伤膏，不可水洗。用木板六片，长三寸五分，加布条扎好，二
日一换。此症极痛，先服接骨丹，次以壮筋续骨丹。
脚踝骨易出易入，一手抬住其脚踝，一手拿住其脚踝，将踝拔直捏正，其骨复于旧位。
出手偏于左，右踝出手偏于右，脚指曲上，脚跟曲下，一伸而上，骱有响声，活动如故。夹
以木板，加布扎紧。二日后再看，如未平直，仍拨端正。贴损伤膏，服宽筋活血散。若行走
过早，使 骨斜出。向内歪者，则内踝突出肿大；向外歪者，则外踝突出肿大。须待气血充
足，方可行动。
足背之骨缝错出，轻轻搓捏，令其骨合筋舒，贴损伤膏，服补筋药。
脚指撇伤前半截，翻下断者，或翻上断，将左手捏住其足两侧，再以右手捏平断足指
，镶接原位。贴损伤膏，以带扎紧，不可下水洗，服壮筋续骨丹。
手足之筋多在指，指伤觉痛，则筋必促，煎宽筋散熏洗，轻轻揉捏，再行摇动伸舒。如
骨与筋断者，不可熏洗。
失枕有因卧者，有一时之误者，使患者坐低处，先行揉摩，一手提起其头，一手托住其
下颏，缓缓转动伸舒使直，服吉利散。
凡伤过重，大便不通者，用牙皂末蜜丸如青果大，插入肛门内即通。
戳伤五内或大肠者，不治。伤口浅直者，易治。血出不止，服止血定痛散。伤口深斜者
，待流血止，掺金疮药，服护风托里散。
凡碰擦磕跌，并刀砍斧斫，肉开血流，或皮微破者，伤不过重，人每不甚介意。惟在春
最易侵风。在头为重，别处稍轻，渐见浮肿，速进玉真散，避风为要。若不急治，成破伤风
，甚至青肿，牙关紧闭，神昏发狂，角弓反张，四肢抽搐，多致不救。玉真散
天麻八分 羌活六分 防风 白附子 川芎 白芷各一钱煎服
刀斧砍伤硬处者，骨损先疗骨。砍伤软处者，肉损先治肉。如伤头额者，敷金疮药，以
避风为上，防身发寒热。脉沉细者，易治；脉洪大者，难医。
以刀刎喉，左手执刀者斜而深，右手执刀者直而浅。刎一刀者深而难治，刎两刀者浅而
易疗。如喉管断，有出入之气，掺药吸进必呛咳，急以鸡蛋内衣盖管上，再掺药则不呛。如
或破半边，或全断，急以油线缝合其口。若血不止，用滑石、五倍研末掺之，外封金疮药，
贴膏药。长五寸、阔三寸，加布条扎项，高枕仰卧，使项屈而不伸，刀口易合。三日后，以
葱汤洗去前药，掺生肌散，贴膏药，仍旧扎好。两月余完全，服护风散。如发寒热进补中益
气汤，若气管断或稍穿破者，不治。
伤破肚皮，而肠拖出者，医者先自剪去指甲，免碰伤其肠，将温水和麻油，浴暖外出之
肠，轻轻揉进。若未能进，用醋和冷水，勿令患者知，忽喷其面，其肠自收。以油线浅浅缝
其口，太深则伤内肉，封金疮药，贴活鸡皮，加布扎好，服通肠活血汤。五内不伤，饮食如
用手仔细触摸受伤的部位，判断是骨头断裂、碎裂、歪斜、整齐、柔软还是坚硬，或者是筋脉强直、柔韧、歪斜、端正、断裂、错位、增粗或翻转。无论是因跌倒撞击所致，还是因闪挫扭伤引起，都要根据具体情况采取相应的治疗方法。
使已断裂的骨头重新合拢，恢复到原来的位置；下陷的骨头复位隆起，碎裂的骨头修复完整，突出的骨头恢复平整。可以使用手法整复，也可以使用器具固定，或者分先后顺序结合使用。
用双手或单手抓住需要矫正的骨头，可以从下往上端提，也可以从外向内推入，可以垂直端正，也可以倾斜端正。对于脱位的骨头，用手将其端送入关节窝（臼）中，使其不歪斜，这样骨缝才能愈合，否则痊愈后可能会出现肢体长短不一的隐患。
将下陷的骨头提出至原有高度，有的用双手提拉，有的用绳索系在高处向上牵引，有的在提拉后用器具辅助固定，防止再次下陷。如果伤势重却轻提，则病不能愈；伤势轻却重提，反而会引发新的病患。
按压是用手掌向下抑制患处，揉摩是慢慢地揉动按摩。这适用于皮肤筋肉受损，出现肿胀、僵硬、麻木，但骨头没有折断的情况。
用手推按，使骨头回到原位。有的用双手或单手捏住患处，缓缓使其复位。如果是由于筋脉拘急导致难以转动摇动，或者筋脉松弛导致难以运动，或者骨节稍有错位不合缝，应当通过推拿来疏通经络的气血。
人的头部没有关节（骱），也不会发生关节脱位，只有跌打造成的粉碎性损伤等病症。如果脑浆流出则无法救治，骨头发青者难治，碎骨如豆粒大小者可治，过大者不治。所谓“接骨入骱”，是指双手捏平筋骨，使其恢复旧位。有的先牵引拉开再合拢，有的推挤使其归位，有的纠正其歪斜，有的填补其缺损。而且骨头有截断、碎断、斜断之分，关节有全脱、半脱之别，筋脉有弛纵、卷曲挛缩、翻转、离合等不同情况，位于肌肉内的损伤用手触摸即可知晓。因为伤情有轻重之分，接骨拿骨也有适宜和不适宜的方法。所以痊愈有快有慢，最终是完全康复还是遗留残疾，总归取决于手法是否得当。然而体质强壮者容易痊愈，元气虚弱者难以完全恢复，如果手法再有误，就万难挽回了。既然骨头断了，必须使其合拢一处，回归原关节窝。出血者敷上止血散，使血液不再流动，再敷金疮药。用杉木板绑缚撑抵断处，才不会移动。辨别清楚骨头是断成两截，还是折而陷入，或是碎而散乱，亦或是岔开旁突，根据情势进行接拿，使断者复接，陷者复起，碎者复完，突者复平。有皮肉未破而骨头断裂的，活动时辘辘有声；骨头受伤但未断裂的，活动时无声；碎骨在肉内的，活动时有淅淅之声。之后必然溃烂流脓，待其腐烂脱离肉体，钳去碎骨，掺入生肌药，外贴损伤膏，也用绑缚固定，才可以完全愈合。
大凡治疗法则，先煎煮代痛散熏洗，然后将断骨拿直，令其相对，平正按摩，果然照旧不歪。铺盖艾绒于止痛散上，用杉木板绑缚，加布条扎紧，取其紧直，使骨缝无绽离走脱之患。过四五日解开绑缚复查，如果发生走脱，仍按照前法扎紧。百日内更换绑带二十余次，内服接骨药。
凡是断臂与断膊，断腿与断小腿，治疗分为上部与下部，器具要根据形体变化调整。如果有筋脉完全断裂的，则会缩入肉里，没有技巧能接上的道理。如果是断裂而未全断的，外敷续筋药，内服壮筋养血药。
跌打碰伤导致头颅猝死的，身体虽然僵直，但口鼻尚有气息出入，心口尚温且跳动，让患者盘腿坐好，解开头发，伏在我的膝盖上。伤处先敷定痛散，随即用火纸卷成的条点燃，让烟熏其口鼻，以通和脏腑血脉之气，待口中出声，用热陈酒调和灌服定痛散，或者炒萝卜子泡汤灌服。外用手摩其胸腋，并托其手腕，频频揉按其两手脉窝。被伤的筋脉强硬，得到揉摩后心脉和运，命门脉流通，即可回生。如果伤重已经死亡的，用白布缠头，用长一尺半、圆如铜钱大的木棍，轻轻拍打其足心，再提起头发，令颈部正直，舒展其经络。如果皮未破，骨碎膜穿，血向内流，声音嘶哑不能说话，面青唇黑的，不治。如果顶骨塌陷，七窍出血，身体僵直昏迷的，不治。只有皮开肉绽，血流不止的，先止其血，服用补气养血药，应当戒欲避风。如果感染破伤风，牙关紧闭，角弓反张，即进疏风理气汤，等到身体不发热，给予补中益气汤。
伤囟门（头顶软处）肉肿皮未破的，昏沉不语，扶起正坐，以葱汁调和敷定痛散，然后用粗纸蘸醋贴在药上，用小熨斗烙在纸上，内部感觉热痛，口中出声为度。去掉药贴，贴损伤膏。如果皮破血流不止，骨陷筋翻的，不治。凡是伤头顶、两旁棱骨、额骨正中、两额角、眼眶骨、颧骨，均照囟门伤治法。
打伤眼珠落出的，先用银针蘸井水，将收珠散点涂红筋，次用青绢蘸温水将其挪回原位。即服还魂汤，再投明目生血饮。
鼻梁骨断裂的，先捏正断骨，掺以止血丹。如果鼻子已伤落下，急趁血热，蘸发炭末粘贴，不可歪斜，加绢条扎紧，迟则血冷不能粘。服壮筋续骨丹。如果骨未碎断，只贴损伤膏，服吉利散。骨碎内膜破的，口鼻流血的不治。
砍跌打落耳朵，或上落下粘着，或下脱上连着，急拈正用封口金疮药。如果全落下，急取余末贴原位，将两耳相对，次以竹片夹紧，加布条扎好。如果耳门骨伤重而体质素亏，昏沉的不治。
口唇豁开的，先掺麻药，急以小箝夹牢油丝线穿合其缝，不可歪斜。掺金疮药，贴损伤膏，外以绢条在唇上扎向脑后缚定。服活血止痛散，常饮稀粥，不可言笑，及呷食物。如果血已冷，先敷麻药，以刀尖剐破，血出时急纵合，须手快为妙。仍服前药。口含刀误割其舌，将断未落的，急用鸡蛋壳内衣贮其舌，蜜调敷止血定痛散，频频添换。使患者仰卧，稀粥灌饮，不动其舌，则易愈。或者戮伤上颚正中之孔，面肿色青，血流不止，痛连脑髓。如果伤会厌，昏沉不语，痛连心膈。急研铅粉、冰片吹患处以止其血，再用蟹黄、血竭煎汤，每日口漱三十次，内服定痛散。
下颏一关节脱下的，遂不便言语饮食，其关节如剪刀股样。先以布包手大指入其口，余指抵边，轻轻捺下，用力向上一推，而进关节有响声，牙齿能合者复位多。得于肾虚者，外加布条兜裹于项后，常进补肾养血汤，次进补肾丸。
颈项骨难于损折，有登高倒跌，损骨外出者，重者三时死。轻者捏平其骨，相对原笋。贴损伤膏，次以布条连肩背络之，投砂仁泡汤煎吉利散。
缺盆外锁子骨（锁骨）伤断的，先拿胸骨，将肩头向内合之，揉摩断骨令其复位，加带挂肩于项，敷定痛散，不可摇动，服接骨药。
肋骨断的，骨不能对，须捏骨平正，外贴损伤膏，内服壮筋续骨丹。
肩关节与膝关节相似，肩关节落下，手不能举，将上一手擒住其肩下，一手拿住其手，轻轻转使其筋舒。再令患者坐于低处，一人抱住其身，将手拔直，用推拿法。又两手捏其肩，抵住其臂骨，将膝夹住其手，齐力推上。关节内有响声，乃复旧位，手自能举动。如无响声者，关节未能上，仍照前法而行。先以熟牛皮，长五寸、宽三寸，两头各开二孔，贯以棉绳，内贴损伤膏，加以棉花盖之。又用棉裹如鸡卵大，夹于夹窝内，复以牛皮夹紧肩之前后，加布缠好后，以扶手板，长二寸，宽四寸，两头穿绳，悬挂空中，令患者俯伏于上，不使其肩骨下垂，俟全愈方可撤板。若不根据此法，后必遗残患芦节。服独活桂枝汤。
臂关节落出的，以上一手抬住其湾，下一手拿住其脉踝，令其手伸直，拔下遂曲其上，后湾，捏平凑合其拢，内有响声，使其手曲转，搭着肩膊，关节可合缝矣。贴损伤膏，多以布每头钉带四根，裹扎臂骨，复以竹帘照患处大小为度，围紧布外，使骨缝无参差走脱之患，以引经药煎汤和吉利散。
手掌处腕骨被跌扑打伤，关节骨脱出的，腕缝必开，以两手先揉其腕，一手拿住其指，一手住其凹处，拔其手指，伸直手掌，曲起手关节，曲下一伸而上，关节内有响声，掌可活动，已复旧位。但关节出不用绑。如骨断者先贴损伤膏，加布扎紧。将阔板一片，撑住患里；再以木板四片，长三寸，加布扎紧，俟愈方去板。煎桂枝汤和吉利散。
手指有三个关节，中节脱出的，拔出捏正，拈其指伸出挺直，一推即上，能屈伸则愈。不可洗，以桂枝煎活血止痛饮。手指痛过于别处，若伤一指，痛必连心，中指尤甚。一染破伤风，外敷金疮药，内服疏风理气汤。
被人咬伤手指的，先以童便淋洗，捏去牙根毒瓦斯。用炙龟板灰末麻油和敷，又以纸蘸麻火熏之。如患处破伤风，进疏风理气汤。若刀斧砍斫伤者难治。臀处肉浓，骨粗，关节脱比诸关节难于擒拿合拢（又名胯骨）。若关节脱臼的，则触在股内，须用大力人四个帮扶，使患者侧卧，一人抱住其身，一人擒住膝上，先将臂关节拔直，上手擒住其腰，下手捧住其腿弯，将膝曲转向上，使膝近其腹，再令伸直，关节内有响声，即归旧臼。出左臀攀向右，向右拔直而上。出右臀攀向左，向左拔直而上。贴损伤膏，服生血补髓汤。
大腿骨关节脱的，一手擒住其膝，一手拿住其膀，上下拔直，将膝曲转，抵住臀瓣，关节内有响声，始为合拢。敷定痛散，服生血补髓药。腿骨折两段者，先煎宽筋散熏洗，令患者侧卧于床，患足拿与无患足齐，贴损伤膏。用布二条，长五寸、宽二寸、裹膏药上。外以纸包杉木板八片，长七寸。又用布三条，与木板和扎齐紧。先进活血止痛散，次投壮筋续骨丹。大小腿皮破骨断者，拿骨平正，贴损伤膏。用杉木板六片，长二寸半，上骨断板宽七分，下骨断板宽五分，加布扎紧，取其担力，不致歪走。此症痛极，先以止痛丹，后投壮筋续骨丹。
膝关节处油盏骨（髌骨），在膝盖之处，其关节脱出于上者的，使患者仰卧，一人抬起足踝，若出于左随左而下；出于右，随右而下。医者缓缓双手挟擒，上手拿住其膝，下手擒住其足，弯使关节对膝上，手擒膝下，手向上一抬则上。贴损伤膏，服壮筋续骨丹。膝盖离位向外侧的，则内筋肿胀。向内侧的，则筋直起湾肿，看其骨如何斜错，根据法捏拿，复其原位，服补筋药。膝盖骨，名护膝骨，有伤为两块者，或三块，将两脚伸直，捏其骨平伏。用薄篾片照膝盖骨的大小，做一篾圈，套于患上，次以布四条，扣于圈上，连膝弯扎紧。先贴损伤膏，服止痛接骨丹，不必换膏药。受伤足放床上，不可下地，半月后，用软棉放足弯处，逐日垫高，使弯曲如旧。常煮鸭食，又恐碎骨，未长好复行损伤，将马桶垫与床一样高，以大便不可下，水洗至全好。去篾圈如箍，月余骨仍两片者，一生跛足，不可治，服当归汤。
当归 乳香 没药 川断 陈皮 五加皮 生地 牛膝 骨碎补 红花 木瓜 如发热，加柴胡、桔梗各一钱。发肿，加黄芩，水酒各半煎，空心服。
小腿有二骨，一大一小，断一根者易治，断两根者难治。直挺者易治，分两段者难治。骨捏对平正，敷金疮药，贴损伤膏，不可水洗。用木板六片，长三寸五分，加布条扎好，二日一换。此症极痛，先服接骨丹，次以壮筋续骨丹。
脚踝骨易出易入，一手抬住其脚踝，一手拿住其脚踝，将踝拔直捏正，其骨复于旧位。出手偏于左，右踝出手偏于右，脚趾曲上，脚跟曲下，一伸而上，关节有响声，活动如故。夹以木板，加布扎紧。二日后再看，如未平直，仍拨端正。贴损伤膏，服宽筋活血散。若行走过早，使胫骨斜出。向内歪的，则内踝突出肿大；向外歪的，则外踝突出肿大。须待气血充足，方可行动。
足背之骨缝错出，轻轻搓捏，令其骨合筋舒，贴损伤膏，服补筋药。
脚趾撇伤前半截，翻下断的，或翻上断，将左手捏住其足两侧，再以右手捏平断足指，镶接原位。贴损伤膏，以带扎紧，不可下水洗，服壮筋续骨丹。
手足之筋多在指，指伤觉痛，则筋必促，煎宽筋散熏洗，轻轻揉捏，再行摇动伸舒。如骨与筋断者，不可熏洗。
失枕有因卧者，有一时之误的，使患者坐低处，先行揉摩，一手提起其头，一手托住其下颏，缓缓转动伸舒使直，服吉利散。
凡伤过重，大便不通的，用牙皂末蜜丸如青果大，插入肛门内即通。
戳伤五内或大肠的，不治。伤口浅直的，易治。血出不止，服止血定痛散。伤口深斜的，待流血止，掺金疮药，服护风托里散。
凡碰擦磕跌，并刀砍斧斫，肉开血流，或皮微破的，伤不过重，人每不甚介意。惟在春季最易侵风。在头为重，别处稍轻，渐见浮肿，速进玉真散，避风为要。若不急治，成破伤风，甚至青肿，牙关紧闭，神昏发狂，角弓反张，四肢抽搐，多致不救。玉真散：天麻八分，羌活六分，防风、白附子、川芎、白芷各一钱，煎服。
刀斧砍伤硬处的，骨损先疗骨。砍伤软处的，肉损先治肉。如伤头额的，敷金疮药，以避风为上，防身发寒热。脉沉细的，易治；脉洪大的，难医。
以刀刎喉，左手执刀的斜而深，右手执刀的直而浅。刎一刀的深而难治，刎两刀的浅而易疗。如喉管断，有出入之气，掺药吸进必呛咳，急以鸡蛋内衣盖管上，再掺药则不呛。如喉或破半边，或全断，急以油线缝合其口。若血不止，用滑石、五倍研末掺之，外封金疮药，贴膏药。长五寸、阔三寸，加布条扎项，高枕仰卧，使项屈而不伸，刀口易合。三日后，以葱汤洗去前药，掺生肌散，贴膏药，仍旧扎好。两月余完全，服护风散。如发寒热进补中益气汤，若气管断或稍穿破的，不治。
伤破肚皮，而肠拖出的，医者先自剪去指甲，免碰伤其肠，将温水和麻油，浴暖外出之肠，轻轻揉进。若未能进，用醋和冷水，勿令患者知，忽喷其面，其肠自收。以油线浅浅缝其口，太深则伤内肉，封金疮药，贴活鸡皮，加布扎好，服通肠活血汤。五内不伤，饮食如
Use the hand to carefully palpate the injured area, determining whether there is a bone fracture (bone fracture), comminution (comminuted fracture), malalignment (malalignment), alignment (alignment), softness (softness), or hardness (hardness); or whether there is tendon stiffness (tendon stiffness), flexibility (flexibility), deviation (deviation), correction (correction), rupture (rupture), displacement (displacement), thickening (thickening), or flipping (flipping). Whether caused by falls and impacts (falls and impacts) or by sprains and twists (sprains and twists), treatment should be administered according to the specific condition.
Reunite the fractured bones, restoring them to their original positions; elevate sunken bones back to prominence, reconstruct comminuted bones to integrity, and flatten protruding bones to levelness. Manual reduction (manual reduction) may be used, or orthopedic devices (orthopedic devices) may be employed, either sequentially or in combination.
Using one or both hands, grasp the bone requiring reduction. The maneuver may be performed from bottom to top, outside to inside, vertically, or obliquely. For dislocated bones, use the hand to guide the bone head into the joint socket (joint socket), ensuring no deviation, so that the bone gap closes properly, preventing limb length discrepancy after healing.
To elevate sunken bones to their original height, methods include lifting with both hands, using ropes and cloth tied to a high point for traction, or supporting with devices after lifting to prevent re-sunkenness. Light traction on severe injuries will fail to heal, while heavy traction on mild injuries may cause new complications.
Pressing involves applying downward pressure with the palm; kneading involves slow rubbing and massage. These are indicated for injuries to skin and muscles presenting with swelling, induration, and numbness, where the bone remains intact.
Pushing with the hand restores bones to their original position. This may involve grasping the injury site with one or both hands and slowly returning it to place. For conditions involving tendon spasm hindering movement, tendon laxity limiting motion, or slight articular misalignment, tuina (tuina therapy) should be used to unblock the qi and blood of the meridians (meridians).
The human head lacks joints (joints) and does not suffer from dislocations, only suffering from comminuted injuries due to trauma. If brain matter leaks out, it is untreatable; if the bone turns blue, it is difficult to treat; small comminuted fragments (size of a bean) are treatable, but large ones are not. To reduce a bone into the joint: use both hands to align the tendons and bones, restoring them to their original position. This may involve traction followed by approximation, pushing to restore position, correcting deviation, or filling defects. Bones may be transversely fractured, comminuted, or obliquely fractured; joints may be fully or partially dislocated; tendons may be relaxed, contracted, flipped, or separated. Internal structures can be assessed by palpation. Injuries vary in severity, and reduction techniques must be appropriate. Healing speed and outcome (complete recovery vs. disability) depend entirely on the skill of the manipulation. However, robust constitutions heal easily, while those with weak yuan qi (vital energy) recover poorly. If the technique is erroneous, recovery is impossible. Fractured bones must be aligned and returned to the joint socket. Apply hemostatic powder (hemostatic powder) to stop bleeding, then apply jinchuang medicine (trauma medicine). Use fir wood boards for splinting and support to prevent displacement. Differentiate between transverse fractures, depressed fractures, comminuted fractures, and displaced fractures, and treat accordingly to restore continuity, elevation, integrity, and levelness. In closed fractures, movement produces a grinding sound; in non-fractured injuries, there is no sound; in intra-muscular comminution, there is a rustling sound. Later, ulceration and pus discharge occur. Once the bone fragment separates from the flesh, remove it with forceps, apply tissue-regenerating medicine (tissue-regenerating medicine), cover with trauma plaster (trauma plaster), and splint. Complete healing requires this process.
Generally, first decoct daotong san (pain-relieving powder) for fumigation and washing. Then straighten the fracture, align the ends, and perform gentle massage. Ensure alignment is correct. Cover the pain-relieving powder with moxa wool, bind with fir wood boards, and secure with cloth strips to ensure tightness and prevent gap separation. After four to five days, release the binding for inspection. If displacement occurs, re-bind as before. Change bindings over twenty times within one hundred days, and administer internal bone-setting medicines (bone-setting medicines).
For fractures of the arm and forearm, or thigh and lower leg, treatment differs by upper and lower body, and devices adapt to anatomy. Completely severed tendons retract into the muscle and cannot be surgically rejoined. Partially severed tendons require external tendon-repairing medicine (tendon-repairing medicine) and internal strengthening-tendon and nourishing-blood medicine (strengthening-tendon and nourishing-blood medicine).
For sudden death-like states from blunt trauma, where the body is stiff but breath persists at the nose/mouth, heart is warm, and pulsating: seat the patient cross-legged, drape hair over knees. Apply antidote powder (antidote powder) to the injury. Ignite rolled paper cigarettes and smoke the nose/mouth to harmonize zang-fu organs and blood vessels. When sounds emerge from the mouth, administer hot aged wine mixed with antidote powder, or roasted radish seed decoction. Massage chest and axillae, support wrists, and frequently rub pulse points. Relaxed tendons respond to massage, harmonizing heart qi and mingmen pulse, leading to revival. For deceased patients: wrap head in white cloth, gently strike sole of foot with a wooden stick (1.5 chi long, coin-sized diameter), lift hair to straighten neck and extend meridians. Untreatable signs: intact skin with shattered bone and membrane penetration, internal bleeding, hoarseness, cyanotic face/black lips; depressed skull, seven orifices bleeding, rigid coma. Treatable: open wounds with continuous bleeding—first stop bleeding, administer qi-tonifying and blood-nourishing medicine (qi-tonifying and blood-nourishing medicine), avoid wind and sexual activity. If tetanus (tetanus) occurs (lockjaw, opisthotonos): administer dispelling-wind and regulating-qi decoction (dispelling-wind and regulating-qi decoction); once fever subsides, give tonifying middle and augmenting qi decoction (tonifying middle and augmenting qi decoction).
For fontanelle injury with swelling but intact skin, causing stupor: sit patient upright, apply scallion juice mixed with antidote powder. Place vinegar-soaked coarse paper over medicine, heat with a small iron, until internal heat/pain and vocalization occur. Remove paper, apply trauma plaster. Untreatable: broken skin with continuous bleeding, depressed bone, flipped tendon. Injuries to vertex, parietal edges, frontal center, temporal angles, orbital bones, and zygomatic bones follow fontanelle protocols.
For prolapsed eyeballs: dip silver needle in well water, apply eye-recovering powder (eye-recovering powder) to red veins. Gently push back with damp green silk. Immediately administer huanhun tang (soul-returning decoction) and mingmu shengxue yin (vision-restoring and blood-generating drink).
For nasal bone fractures: realign bone, apply hemostatic cinnabar (hemostatic cinnabar). If nose detached, act quickly while blood is warm: attach with hair-charcoal powder. Secure with silk strips; delay causes cooling and failure to adhere. Administer strengthening-tendon and reconnecting-bone pill (strengthening-tendon and reconnecting-bone pill). If bone intact, apply trauma plaster and jili san (auspicious powder). Untreatable: comminuted bone with torn membrane, epistaxis.
For avulsed ears: realign and apply sealing jinchuang medicine. If completely detached, apply remaining powder to original site, align ears, clamp with bamboo splints, and bind with cloth. Untreatable: severe ear bone injury with constitutional deficiency and stupor.
For lip lacerations: apply anesthetic, suture with oil-thread using fine forceps, ensuring no deviation. Apply jinchuang medicine and trauma plaster. Bind silk strip from lip to back of head. Administer invigorating-blood and stopping-pain powder (invigorating-blood and stopping-pain powder), consume thin porridge, avoid speech/smiling/eating. If blood has cooled: apply anesthetic, incise with knife tip, squeeze blood out, then immediately approximate wound (requires speed). Continue medication. For accidental tongue cuts: hold tongue with eggshell membrane, apply honey-mixed hemostatic and pain-stopping powder (hemostatic and pain-stopping powder), replace frequently. Supine position, feed porridge, minimize tongue movement for faster healing. Untreatable: deep palatal perforation with facial swelling/cyanosis, uncontrollable bleeding, radiating pain to brainstem; or epiglottis injury causing stupor/aphagia. Emergency: insufflate lead powder and borneol to stop bleeding; rinse with crab roe and dragon’s blood (dragon’s blood) decoction 30 times daily; internally administer antidote powder.
For mandibular dislocation (affecting speech/eating): insert cloth-wrapped thumb into mouth, other fingers support border, press down gently, then thrust upward. Audible click indicates reduction. For kidney-deficiency related cases: bind neck with cloth, administer tonifying-kidney and nourishing-blood soup (tonifying-kidney and nourishing-blood soup), followed by tonifying-kidney pills.
Cervical spine fractures are rare. High falls causing vertebral extrusion: severe cases die within three hours. Mild cases: flatten bone, align with original structure. Apply trauma plaster, bind shoulder/back with cloth, administer cardamom decoction with jili san.
Clavicle fractures: manipulate sternum, adduct shoulder, massage fracture to reduce, suspend shoulder with strap, apply antidote powder, avoid movement, administer bone-setting medicine.
Rib fractures: bones cannot be perfectly opposed. Flatten bone, apply trauma plaster externally, administer strengthening-tendon and reconnecting-bone pill internally.
Shoulder dislocation resembles knee dislocation. Arm hangs limp. Grasp below shoulder with one hand, hold wrist with other, gently rotate to relax tendons. Seat patient low, assistant holds torso, physician extends arm, uses tuina. Alternatively, grasp shoulders, brace against humerus, clinch arm with knee, push upward audibly. Reduction confirmed by sound and mobility. If no sound, repeat. Prepare cowhide patch (5x3 cun, holes for cotton rope), line with trauma plaster and cotton. Pad axilla with egg-sized cotton. Secure shoulder front/back with cowhide and cloth. Suspend patient prone on support board (2x4 cun) to prevent gravity droop. Remove only when healed. Failure leads to residual deformity. Administer duhuo guzhi tang (Notopterygium and Cinnamon Twig Decoction).
Elbow dislocation: lift antecubital fossa with one hand, grasp radial styloid with other. Extend arm, flex proximal segment, align distal segment. Audible click confirms reduction. Flex arm onto shoulder. Apply trauma plaster. Bind humerus with four cloth straps per end. Wrap bamboo splint around injury. Decoct meridian-guiding medicine with jili san.
Wrist injury from fall/dislocation: wrist gap opens. Rub wrist, grasp fingers, stabilize concavity, extend fingers/palm, flex wrist joint. Audible click confirms reduction. No binding needed for pure dislocation. For fractures: apply trauma plaster, bind tightly. Support with wide board and four 3-cun wooden boards. Decoct guizhi tang (Cinnamon Twig Decoction) with jili san.
Finger joint dislocation (middle phalanx): extract, align, extend finger, push up. Flexion/extension confirms healing. Do not wash. Decoct guizhi for invigorating-blood and stopping-pain drink. Finger pain radiates to heart (especially middle finger). Tetanus risk: apply jinchuang medicine, administer dispelling-wind and regulating-qi decoction.
Dog bite to finger: wash with child’s urine, remove venom. Apply calcined turtle shell ash mixed with sesame oil, fumigate with burning paper. Tetanus risk: administer dispelling-wind and regulating-qi decoction. Axe/chopper wounds are difficult.
Hip (coxofemoral) dislocation: thick muscle, coarse bone, difficult reduction. Patient lies lateral. Four assistants: one holds torso, one holds knee. Extend hip joint, grasp waist, support popliteal fossa, flex knee toward abdomen, extend. Audible click confirms reduction. Left hip dislocates rightward (pull right); Right hip dislocates leftward (pull left). Apply trauma plaster, administer generating-blood and replenishing-marrow soup (generating-blood and replenishing-marrow soup).
Thigh (femoral) dislocation: grasp knee and hip, extend vertically, flex knee against buttock. Audible click confirms reduction. Apply antidote powder, administer generating-blood and replenishing-marrow medicine. Femur shaft fracture (two segments): decoct kuanjin san (tendon-relaxing powder) for fumigation. Lateral recumbent, align injured leg with healthy leg. Apply trauma plaster. Two 5x2 cun cloth strips over plaster. Eight 7-cun fir boards wrapped in paper. Three cloth strips bind boards and legs. First administer invigorating-blood and stopping-pain powder, then strengthening-tendon and reconnecting-bone pill. Open tibia/fibula fractures: align bone, apply trauma plaster. Six 2.5-cun fir boards (upper width 0.7 cun, lower width 0.5 cun), bound tightly to bear weight. Severe pain: first analgesic pill, then strengthening-tendon and reconnecting-bone pill.
Patellar dislocation (superior): supine patient, assistant lifts ankle. Left dislocation moves left/down; Right moves right/down. Physician grasps knee and foot, flexes knee, lifts patella up. Apply trauma plaster, administer strengthening-tendon and reconnecting-bone pill. Lateral dislocation: medial tendon swollen. Medial dislocation: lateral tendon contracted/swollen. Align bone, apply reducing-tendon medicine. Patella (protective bone) fractures (2-3 pieces): extend legs, flatten bone. Bamboo hoop sized to patella, secured with four cloth strips to popliteal fossa. Apply trauma plaster, administer pain-stopping and bone-setting pill. Keep foot off ground. After half month, elevate popliteal space with soft cotton daily to restore flexion. Eat duck meat. Fear re-injury of comminution; elevate bedpan to bed height to avoid squatting. Wash until healed. If bone remains two pieces after one month without hoop removal: permanent limp, untreatable. Administer danggui tang (Angelica Decoction).
Danggui (Angelica Root), Xuxiang (Frankincense), Moyao (Myrrh), Chuanduan (Achyranthes Root), Chenpi (Tangerine Peel), Wujia Pi (Acanthopanacis Cortex), Shengdi (Rehmannia Root), Niuxi (Achyranthes Root), Gusuibu (Drynaria Rhizome), Honghua (Safflower), Mugua (Chaenomeles Fruit). If fever: add Chaihu (Bupleurum) and Jiegeng (Platycodon) 1 qian each. If swelling: add Huangqin (Scutellaria Root), decoct half water/half wine, take fasting.
Lower leg has two bones (tibia/fibula). Single fracture easy; double fracture difficult. Straight fracture easy; segmented fracture difficult. Align bone, apply jinchuang medicine and trauma plaster, no water. Six 3.5-cun wooden boards, bound with cloth, change every two days. Severe pain: first bone-setting pill, then strengthening-tendon and reconnecting-bone pill.
Ankle dislocation: easy to reduce. Lift and grasp ankle, straighten and align. Medial malleolus displaces laterally; Lateral malleolus displaces medially. Toes flex up, heel flexes down, extend upward. Audible click confirms reduction. Splint with wood, bind with cloth. Recheck in two days; correct if misaligned. Apply trauma plaster, administer kuanjin huoxue san (tendon-relaxing and blood-invigorating powder). Early walking causes tibial obliquity. Medial deviation: medial malleolus prominent/swollen. Lateral deviation: lateral malleolus prominent/swollen. Wait for qi/blood sufficiency before ambulation.
Dorsal foot joint misalignment: gentle rubbing/kneading to align bone and relax tendon. Apply trauma plaster, administer tonifying-tendon medicine.
Toe amputation/separation: grasp foot sides, align severed toe, reattach. Apply trauma plaster, bind tightly, no water. Administer strengthening-tendon and reconnecting-bone pill.
Hand/foot tendon injuries often affect fingers. Finger pain indicates tendon tension. Decoct kuanjin san for fumigation, gentle kneading, then stretching. Do not fumigate if bone/tendon ruptured.
Stiff neck (loss of pillow): due to sleeping posture or acute strain. Seat patient low, massage, lift head, support chin, slowly rotate/stretch to straighten. Administer jili san.
Severe trauma with constipation: insert soap pod (Yazao) honey pill (size of green olive) into anus to induce bowel movement.
Puncture wound to viscera/large intestine: untreatable. Superficial/straight wounds: easy. Unstoppable bleeding: administer hemostatic and pain-stopping powder. Deep/oblique wounds: wait for bleeding to stop, apply jinchuang medicine, administer hufeng tuoli san (wind-protecting and interior-supporting powder).
Abrasion/scrape/chop wounds with bleeding or minor skin break: usually mild, often ignored. Spring season: high wind invasion risk. Head injuries most severe, others mild. Swelling appears: rapidly administer Yuzhen san (True Jade Powder), avoid wind. Untreated: tetanus (cyanosis, lockjaw, delirium, opisthotonos, convulsions), often fatal. Yuzhen San: Tianma (Gastrodia) 8 fen, Qianghuo (Notopterygium) 6 fen, Fangfeng (Saposhnikovia), Baifuzi (Typhonium), Chuanxiong (Ligusticum), Baizhi (Angelica Dahurica) 1 qian each. Decoct and take.
Chop on hard tissue: treat bone first. Chop on soft tissue: treat flesh first. Head/forehead wounds: apply jinchuang medicine, prioritize wind avoidance, prevent systemic chills/fever. Sunken/thin pulse: easy; Surging/large pulse: difficult.
Throat slash: Left-handed cut oblique/deep; Right-handed cut straight/shallow. One cut: deep/difficult; Two cuts: shallow/easy. Trachea severed but breathing present: insufflation causes coughing/choking. Cover trachea with eggshell membrane before insufflation. Half-severed or fully severed: suture with oil thread. Unstoppable bleeding: insufflate Talcum and Chinese Gall powder, seal with jinchuang medicine and plaster. 5x3 cun plaster, bind neck, sleep on high pillow with neck flexed (not extended) to aid closure. After three days: wash with scallion water, apply tissue-regenerating powder, re-plaster, re-bind. Full recovery in two months: administer hufeng san (wind-protecting powder). If chills/fever: tonifying middle and augmenting qi decoction. Tracheal severance/perforation: untreatable.
Abdominal evisceration (intestines protruding): Doctor clips nails to prevent intestinal injury. Warm intestines with warm water and sesame oil, gently push back. If unable to reduce: mix vinegar and cold water, surprise patient by spraying face, intestines retract spontaneously. Superficial suture with oil thread (deep suturing damages internal flesh). Seal with jinchuang medicine, apply live chicken skin, bind with cloth. Administer tongchang huoxue tang (intestinal-unblocking and blood-invigorating decoction). Viscera intact, diet normal...