《医宗金鉴》曰∶摸者,用手细细摸其所伤之处,或骨断骨碎,骨歪骨整,骨软骨硬,
筋柔,筋歪筋整,筋断筋走,筋粗筋翻,筋寒筋热,以及表里虚实,并所患之新旧也。先摸
其或为跌仆,或为错闪,或为打撞,然后根据法治之。
接法
《医宗金鉴》曰∶接者,谓使已断之骨,合拢一处,复归于旧也。凡骨之跌伤错落,或
两分,或折而陷下,或碎而散乱,或岐而傍突,相其情势,徐徐接之,使断者复续,陷者复
起,碎者复完,突者复平。或用手法,或用器具,或手法器具分先后而兼用之,是在医者之
通达也。
端法
《医宗金鉴》曰∶端者,或用两手一手,擒定应端之处,酌其轻重,或从下往上端,或
向上托,或直端、斜端也。盖骨离其位,必以手法端之,则不待旷日持久,而骨缝即合,仍
须不偏不倚,庶愈后无长短不齐之患。
提法
《医宗金鉴》曰∶提者,谓陷下之骨,提出如旧也。其法非一,有用两手提者,有用绳
高处提者,有提后用器具辅之不致仍陷者,必量所伤之轻重浅深,然后施治。倘重者轻提,
则病莫能愈;轻者重提,则旧患虽去,而又增新患矣。
按摩法
《医宗金鉴》曰∶按者,谓以手往下抑之也。摩者,谓徐徐揉摩之也。此法盖为皮肤筋
伤,但肿硬麻木,而骨未断折者设也。或因跌仆闪失,以致骨缝开错,气血郁滞,为肿为痛
,宜用按摩法,按其经络,以通郁闭之气,摩其壅聚,以散瘀结之肿,其患可愈。
推拿法
《医宗金鉴》曰∶推者,谓以手推之,使还旧处也。拿者,谓两手一手,捏定患处,酌
轻宜重,缓缓焉以复其位也。若肿痛已除,伤痕已愈,其中或有筋急而转摇不甚便利,或有
筋纵而运用不甚自如,又或有骨节间微有错落不合缝者,是伤虽平,而气血之流行未畅,不
宜按整端提等法,惟宜推拿以通经络气血也。盖人身之经穴,有大经细络之分,一推一拿,
视其虚实,酌而用之,则有宣通补泻之法,所以患者无不愈也。
注云∶以上诸条乃八法之大略如此。至于临症之权衡,一时之巧妙,神而明之,存乎其
耀山云∶八法之外,又有推骨入 秘法,或用肩头掮,或用足腿牮。掮者,如挑负然,
人掮起,骨入 矣,较之用手拉手拽,更觉有力多矣。牮者,或坐其上,或卧于地,两手将
患人擒住,随用足跟牮去,比之用手推托,便捷甚矣。此秘法也,故附八法之后,以补手法
之未备也。
《医宗金鉴》说:摸法,是用手指细细触摸受伤的部位,判断是否有骨折或骨碎、骨骼位置歪斜或端正、骨头松动或坚硬,筋腱柔软、歪斜或端正、断裂或移位、增粗或翻转、受寒或受热,以及病位的表里虚实和病程的新旧。先确定是跌打损伤、扭闪错位还是撞击所致,然后根据具体情况制定治疗方案。
接法
《医宗金鉴》说:接法,是指使已经断裂的骨头重新合拢一处,恢复原来的状态。凡是因跌打导致的骨骼错位,有的分为两截,有的折断并陷入皮下,有的碎裂散乱,有的畸形旁突。要观察伤势情况,慢慢地进行接续,使断裂的重新连接,陷入的重新抬起,碎裂的重新完整,畸形的重新平整。可以使用手法,也可以使用器具,或者手法与器具分先后联合使用,这取决于医生的通达变通能力。
端法
《医宗金鉴》说:端法,可以用双手或单手,固定住需要端整的部位,斟酌力量的轻重,有的是从下往上端托,有的是向上托举,有的是直端,有的是斜端。因为骨头脱离了正常位置,必须用手法来端整,这样就不必花费很长时间,骨缝就能愈合。操作时仍须不偏不倚,以免痊愈后出现肢体长短不一的隐患。
提法
《医宗金鉴》说:提法,是指将陷入皮下的骨头提拉出来,恢复原状。这种方法不止一种,有用双手提拉的,有用绳子在高处吊拉的,有提拉后用器具辅助防止再次陷入的。必须衡量受伤的轻重深浅,然后施治。如果重伤轻提,病就不能痊愈;轻伤重提,虽然旧患去除,却又增加了新的病患。
按摩法
《医宗金鉴》说:按法,是指用手向下按压。摩法,是指慢慢地揉搓抚摸。这种方法是为皮肤和筋腱受伤,仅表现为肿胀、僵硬、麻木,而骨头没有折断的情况设立的。也有因跌打闪失,导致骨缝开错,气血郁滞,形成肿胀疼痛,适宜使用按摩法,按压经络以疏通郁闭之气,揉摩壅聚之处以消散瘀结之肿,这样病患即可痊愈。
推拿法
《医宗金鉴》说:推法,是指用手推动,使患处回到原来的位置。拿法,是指用双手或单手捏定患处,斟酌力量轻重,缓缓地进行复位。如果肿痛已经消除,伤痕已经愈合,但其中可能有筋腱拘急导致转动不便,或者有筋腱松弛导致运用不灵活,又或者骨节间有微小的错位不合缝。这时虽然外伤已平复,但气血运行尚不畅通,不宜再用按、整、端、提等法,只宜用推拿法来疏通经络气血。因为人体穴位有大经和小络之分,一推一拿,根据虚实证候斟酌使用,就有宣通补泻的方法,所以患者没有不能痊愈的。
注释说:以上各条是八法的大致内容。至于临症时的权衡利弊,一时的巧妙运用,神妙明达,全在于医生的悟性。
耀山说:在八法之外,还有推骨入臼的秘法,有的用肩膀扛,有的用腿顶。扛法,就像挑担子一样,人扛起来,骨头就进入臼窝了,比用手拉拽更有力量。顶法,有的坐在上面,有的躺在地上,双手抓住病人,随即用脚跟顶去,比起用手推托,便捷多了。这是秘法,所以附在八法之后,以补充手法的不足。
The *Yizong Jinjian* (Golden Mirror of Medical Tradition) states: Touching (Mo Fa) involves using the fingers to carefully palpate the injured area to determine if there is a bone fracture or comminution, bone displacement or alignment, bone looseness or hardness; tendon softness, displacement, or alignment; tendon rupture or migration; thickening or eversion; cold or heat sensations; as well as the exterior-interior, deficiency-excess nature of the pathology, and whether the condition is new or old. First, determine whether the injury resulted from a fall, twist, or blow, and then formulate a treatment plan based on this assessment.
Repositioning (Jie Fa)
The *Yizong Jinjian* states: Repositioning refers to bringing broken bones back together into one place to restore their original state. For bones dislocated by trauma, they may be separated into two parts, fractured and depressed, shattered and scattered, or deformed with protrusions. One must observe the specific circumstances and slowly perform the repositioning, so that the broken are connected, the depressed are elevated, the shattered are restored, and the protruding are flattened. This can be done manually, with instruments, or by combining both methods sequentially, depending on the physician's adaptability.
Lifting/Supporting (Duan Fa)
The *Yizong Jinjian* states: Lifting involves using one or both hands to secure the area requiring adjustment, judging the appropriate force. It may involve lifting from below upwards, supporting upwards, straight lifting, or oblique lifting. Since the bone has deviated from its position, manual manipulation is necessary to ensure the bone joints heal quickly without prolonged delay. The operation must be balanced and precise to avoid complications such as limb length discrepancy after healing.
Traction (Ti Fa)
The *Yizong Jinjian* states: Traction refers to pulling out depressed bones to restore their original position. There are various methods: some use two hands to pull, some use ropes for high suspension traction, and some use instruments after traction to prevent recurrence of depression. One must assess the severity and depth of the injury before applying treatment. If severe injuries are treated with light traction, the disease will not heal; if mild injuries are treated with heavy traction, although the old injury may resolve, it could cause new problems.
Massage (An Mo Fa)
The *Yizong Jinjian* states: Pressing (An) refers to pushing down with the hand. Rubbing (Mo) refers to gently kneading and stroking. This method is designed for skin and tendon injuries characterized only by swelling, stiffness, and numbness, without bone fractures. It is also suitable for cases where falls or twists cause joint misalignment, leading to Qi and blood stagnation, resulting in swelling and pain. In such cases, massage should be used to press the meridians to unblock stagnant Qi, and rub the congested areas to dissipate swelling caused by blood stasis, thereby curing the condition.
Pushing and Grasping (Tui Na Fa)
The *Yizong Jinjian* states: Pushing (Tui) refers to using the hand to push the affected part back to its original position. Grasping (Na) refers to using one or both hands to pinch the injured area, adjusting the force appropriately, and slowly restoring its position. If swelling and pain have subsided and wounds have healed, but there is still tendon spasm causing limited mobility, or tendon laxity causing poor function, or slight misalignment of the bone joints, although the external injury has settled, the circulation of Qi and blood is not yet smooth. At this stage, methods like pressing, aligning, lifting, and pulling are inappropriate; instead, Tui Na should be used to unblock the meridians and promote Qi and blood flow. Since human acupoints are divided into major meridians and collateral vessels, pushing and grasping, applied according to deficiency or excess patterns, employ methods of dispersing, tonifying, draining, and supplementing, ensuring that patients recover.
Note: The above items outline the general principles of the Eight Methods. However, the judgment during clinical practice and the skillful application at any given moment depend on the physician's insight and understanding.
Yaoshan stated: Beyond the Eight Methods, there is a secret technique for reducing dislocated joints into the socket. This may involve using the shoulder to bear the weight or the leg to prop up the limb. Bearing (Qian) is like carrying a load on a pole; when the person bears the weight, the bone enters the socket, which is more powerful than pulling with hands. Propping (Jian) involves sitting on top or lying on the ground, holding the patient with both hands, and then pushing with the heel. This is much more convenient than pushing with hands. This is a secret technique, so it is appended after the Eight Methods to supplement the inadequacies of manual techniques.