破伤风者，因疮热甚郁结而荣卫不得宣通，怫热因之遍体，故多白痂。是时疮口闭塞，气难宣通，故热甚
而生风也。先辨疮口平无汁者，中风也；边自出黄水者，中水也，并欲作 ，急治之。又痛不在疮处者，伤经
络，亦死症也。初觉疮肿起白痂，身寒热，急用玉真散贴之。伤在头面，急嚼杏仁和雄黄、白面敷疮上，肿渐
消为度。若腰脊反张，四肢强直，牙关口噤，通身冷不知人，急用蜈蚣研细末擦牙，吐出涎沫立苏，亦宜按摩
导引。
〔河〕破伤风，风热躁甚，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、石膏、知母
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，涎吐稠粘，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。
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；两傍搐者，柴胡、防
风、甘草；右搐加滑石。
〔河〕玉真散
南星 防风（各等分）
上为末，生姜汁、酒调服，伤处以此贴之。
羌活防风汤 治破伤风，初邪传在表。
羌活 防风 川芎 本 当归 芍药 甘草 地榆 细辛（各一两）
上 咀，每服五钱，水二盏，煎八分，热服。热则加黄芩一两，大便秘加大黄一两。
防风汤。（见前风条。）
蜈蚣散
蜈蚣（一对） 鱼鳔（五钱，炒） 左蟠龙（半两，炒烟尽）
上为细末，用防风汤调服。
白术防风汤 若服前药已过，脏腑和，有自汗者，宜服此药。
白术 防风 黄 （各一两）
上 咀，每服七钱，水二盏，煎至一盏，去滓温服。
大芎黄汤 脏腑秘，小便赤，自汗不止者，宜速下之。
川芎（一两） 黄芩（六钱） 甘草（半两） 大黄（一两）
上 咀，每服五钱，水一盏半，煎至一盏，去滓温服，以利为度。
江鳔丸 治破伤风，惊而发搐，脏腑秘涩，知病在里。
江鳔（半两，炒） 野鸽粪（半两，炒） 雄黄（一钱） 蜈蚣（一对） 天麻（一两） 白僵蚕（半两）
上为细末，分作三分，先用二分，烧饭为丸，如桐子大，朱砂为衣。又用一分，入巴豆霜一钱，同和，亦
以烧饭为丸，不用朱砂为衣。每服朱砂为衣丸药二十丸，入巴豆霜丸药一丸，次服二丸，渐加至利为度。再
服朱砂为衣丸药，病愈止。
羌活汤 利后宜服，搐 不已亦宜服。
羌活 独活 地榆（各一两）
每服五钱，水一盏半，煎至一盏，去滓温服。如有热加黄芩，有痰加半夏。
地榆防风散 治半表半里，头微汗，身无汗。
地榆 防风 地丁香 马齿苋（各一两）
上为细末，每服三钱，温米饮调下。
养血当归地黄散 日久气血渐虚，邪气入胃，宜养血。四物汤加防风、 本、白芷、细辛各等分，为细末，每
用五钱，水一盏半，煎至一盏，温服。
破伤风病，是由于疮口热邪郁结，导致营卫之气不能宣通，郁热遍布全身，所以常出现白痱（一种细小的白色疱疹）。此时疮口闭塞，气机难以宣通，因此热盛而生风。首先应辨别：若疮口平坦且无渗出液，属于中风；若疮口边缘流出黄水，属于中水，这两种情况都容易发展为痉挛抽搐，需紧急治疗。另外，如果疼痛不在疮口局部，而是损伤了经络，也属于死症。初起时感觉疮口肿胀并出现白痱，身体忽冷忽热，应立即用玉真散外贴患处。若伤口在头面部，应紧急嚼碎杏仁，混合雄黄、白面敷在疮口上，直到肿胀逐渐消退为止。如果出现腰脊向后反张，四肢强直，牙关紧闭，全身发冷且神志昏迷，应立即将蜈蚣研成细末擦牙，吐出涎沫后即可苏醒，同时也适宜进行按摩和导引疗法。
〔李东垣〕破伤风，若风热躁动剧烈，郁结在体表，而体内脏腑之气尚平和的，表现为喜欢伸展身体、频繁打哈欠，筋脉拘急，有时怕冷，有时肌肉跳动或抽搐，脉象浮数而弦。适宜使用辛热性质的祛风药物，以开通冲散郁结阻滞而痊愈。这就像伤寒表热郁结，使用麻黄汤辛温发散一样。凡是使用辛热药物开通冲散风热结滞时，宜配合寒性药物作为佐使，这样效果较好，可避免药力虽中病但风热反而加重的情况。例如治疗伤寒发热，在使用麻黄、桂枝的同时，加入黄芩、石膏、知母等寒凉药物即是此理。如果仅使用甘草、滑石、葱、豆豉等寒凉药物发散，效果也非常好。如果表证未解，病邪逐渐传入体内，里证尚未严重，且脉象弦小的，适宜用退风热、开结滞的寒性药物调理，或者稍微加入一些治风的辛热药物也可以。这就像伤寒病在半表半里之间，用小柴胡汤和解的方法一样。如果里证已经非常严重，出现舌体僵硬、牙关紧闭、项背向后反张、惊恐惕动、抽搐掣动，吐出粘稠涎沫，胸腹部胀满堵塞，大小便秘结，有时出汗，脉象沉洪数而弦。然而出汗的原因，是因为风热在体内郁结严重，导致体表热势稍减，腠理疏松泄越，加上心火极旺，所以出汗。治疗方法应当除风散结，用寒性药物攻下，之后再用退风热、开结滞的寒性药物调理，那么热退结散，风证自然痊愈。
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；向两侧抽搐的，用柴胡、防风、甘草；右侧抽搐的加滑石。
〔李东垣〕玉真散
天南星、防风（各等分）
以上药物研为细末，用生姜汁、酒调服，并将药粉贴在受伤处。
羌活防风汤 治疗破伤风，初期邪气传变在体表。
羌活、防风、川芎、藁本、当归、芍药、甘草、地榆、细辛（各一两）
以上药物切碎，每次服用五钱，加水两盏，煎至八分，热服。若有热象加黄芩一两，大便秘结加大黄一两。
防风汤。（见前文风条。）
蜈蚣散
蜈蚣（一对）、鱼鳔（五钱，炒制）、左蟠龙（即蛇蜕，半两，炒至烟尽）
以上研为细末，用防风汤调服。
白术防风汤 如果服用前面的药物后，脏腑功能调和，有自汗症状的，适宜服用此药。
白术、防风、黄芪（各一两）
以上药物切碎，每次服用七钱，加水两盏，煎至一盏，去渣温服。
大芎黄汤 脏腑秘结，小便赤红，自汗不止的，适宜迅速攻下。
川芎（一两）、黄芩（六钱）、甘草（半两）、大黄（一两）
以上药物切碎，每次服用五钱，加水一盏半，煎至一盏，去渣温服，以大便通畅为度。
江鳔丸 治疗破伤风，因惊恐而引发抽搐，脏腑秘涩，知道病邪在体内的。
江鳔（即鱼鳔，半两，炒制）、野鸽粪（半两，炒制）、雄黄（一钱）、蜈蚣（一对）、天麻（一两）、白僵蚕（半两）
以上研为细末，分为三份。先用两份，用米饭制成丸药，如梧桐子大小，用朱砂做外衣。再用一份，加入巴豆霜一钱，一同混合，也用米饭制成丸药，不用朱砂做外衣。每次服用朱砂外衣丸药二十丸，搭配巴豆霜丸药一丸，第二次服用二丸，逐渐增加剂量，以大便通畅为度。再服用朱砂外衣丸药，病愈即止。
羌活汤 攻下之后适宜服用，抽搐不止也适宜服用。
羌活、独活、地榆（各一两）
每次服用五钱，加水一盏半，煎至一盏，去渣温服。如果有热象加黄芩，有痰饮加半夏。
地榆防风散 治疗半表半里证，头部微汗，身体无汗。
地榆、防风、地丁香、马齿苋（各一两）
以上研为细末，每次服用三钱，用温米汤调下。
养血当归地黄散 病程日久气血逐渐虚弱，邪气入胃，适宜养血。四物汤加防风、藁本、白芷、细辛各等分，研为细末，每次用五钱，加水一盏半，煎至一盏，温服。
Wind-stiffness (Pòshāngfēng) is caused by the severe heat of a wound being constrained and accumulated, preventing the smooth circulation of Ying (Nutritive Qi) and Wei (Defensive Qi). The constrained heat spreads throughout the body, often resulting in white crusts. At this time, the wound opening is closed, making it difficult for Qi to circulate freely, so excessive heat generates wind. First, distinguish the condition: if the wound is flat with no exudate, it is due to Wind invasion; if yellow fluid oozes from the edges, it is due to Water-Dampness invasion. Both conditions may develop into spasms and clonic jerks (Chìzòng), requiring urgent treatment. Furthermore, if the pain is not localized at the wound but involves the meridians and collaterals, it is also a critical condition. Initially, when swelling appears with white crusts accompanied by chills and fever, apply Yuzhen San (Jade True Powder) externally to the affected area immediately. If the injury is on the head or face, chew fresh almonds and mix them with Realgar (Xionghuang) and wheat flour to apply as a poultice over the wound until the swelling gradually subsides. If opisthotonos (retraction of the back), rigidity of the limbs, trismus (lockjaw), coldness of the whole body, and loss of consciousness occur, grind Centipede (Wugong) into fine powder and rub it on the teeth; expelling salivary foam will lead to immediate recovery. Massage and Dao Yin (guiding and pulling exercises) are also appropriate.
[Li Dongyuan] In Wind-stiffness, if wind-heat is agitated and severe, constrained in the exterior while interior Qi remains relatively peaceful, symptoms include frequent stretching and yawning, tendon and vessel constriction, occasional aversion to cold, muscle twitching, or convulsions, with a floating, rapid, and wiry pulse. It is suitable to use acrid-hot herbs that dispel wind to open up and scatter the constraint, leading to recovery. This is similar to exterior heat constraint in Cold Damage (Shanghan), treated with Mahuang Tang (Ephedra Decoction) to disperse via acrid-hot properties. Whenever using acrid-hot medicines to open and scatter wind-heat constraints, it is advisable to assist with cold-natured herbs to prevent the medicine from hitting the pathogen but causing the wind-heat to intensify. For example, treating fever in Cold Damage by adding Scutellariae Radix (Huangqin), Gypsum Fibrosum (Shigao), and Anemarrhenae Rhizoma (Zhimu) alongside Ephedrae Herba (Mahuang) and Cinnamon Twig (Guizhi). Using only Licorice Root (Gancao), Talcum (Huashi), Scallion Stem (Congbai), and Fermented Soybean (Douchi) as cold-natured dispersants is also excellent. If the exterior syndrome persists and the pathogen gradually transmits inward, but the interior is not yet severely affected and the pulse is wiry and small, regulate with cold-natured herbs that clear wind-heat and open constraints, or slightly add acrid-hot wind-dispelling herbs. This is analogous to treating Cold Damage at the half-exterior half-interior level with Xiaochaihu Tang (Minor Bupleurum Decoction) for harmonization. If the interior syndrome becomes severe, presenting with a stiff tongue, lockjaw, opisthotonos, frightfulness, twitching, viscous saliva, chest and abdominal fullness, constipation of urine and stool, occasional sweating, and a deep, surging, rapid, and wiry pulse: the sweating occurs because wind-heat is severely constrained internally, causing exterior heat to subside slightly, leading to loose pores and excessive Heart Fire, thus inducing sweat. The method should be to dispel wind and scatter constraints, purge with cold-natured herbs, and subsequently regulate with cold-natured herbs that clear wind-heat and open constraints. Then heat recedes, constraints dissipate, and wind heals naturally.
For spasms pulling backward, use Notopterygii Rhizoma et Radix (Qianghuo), Angelicae Pubescentis Radix (Duohuo), Saposhnikoviae Radix (Fangfeng), and Glycyrrhizae Radix et Rhizoma (Gancao); for spasms pulling forward, use Cimicifugae Rhizoma (Shengma), Angelicae Dahuricae Radix (Baizhi), Angelicae Pubescentis Radix (Duohuo), Saposhnikoviae Radix (Fangfeng), and Glycyrrhizae Radix et Rhizoma (Gancao); for spasms pulling to both sides, use Bupleuri Radix (Chaihu), Saposhnikoviae Radix (Fangfeng), and Glycyrrhizae Radix et Rhizoma (Gancao); add Talcum (Huashi) for spasms on the right side.
[Li Dongyuan] Yuzhen San (Jade True Powder)
Arisaema Cum Bile (Nanxing) and Saposhnikoviae Radix (Fangfeng) in equal parts.
Grind into powder. Mix with ginger juice and wine for oral administration, and apply the powder to the injured site.
Qianghuo Fangfeng Tang (Notopterygium and Saposhnikovia Decoction) Treats Wind-stiffness where the initial pathogen has transmitted to the exterior.
Notopterygii Rhizoma et Radix (Qianghuo), Saposhnikoviae Radix (Fangfeng), Chuanxiong Rhizoma (Chuanxiong), Ligustici Rhizoma et Radix (Guben), Angelicae Sinensis Radix (Danggui), Paeoniae Radix Alba (Shaoyao), Glycyrrhizae Radix et Rhizoma (Gancao), Sanguisorbae Radix (Diyu), Asari Radix et Rhizoma (Xixin) (each 1 liang).
Cut into pieces. Take 5 qian per dose, boil in 2 zhan of water until reduced to 0.8 zhan, and take hot. Add Scutellariae Radix (Huangqin) 1 liang if there is heat; add Rheum Palmatum Radix (Dahuang) 1 liang if constipated.
Fangfeng Tang (Saposhnikovia Decoction). (See previous section on Wind.)
Wugong San (Centipede Powder)
Centipede (Scolopendra Subspinipes mutilans) (1 pair), Fish Swim Bladder (Yubiao) (5 qian, stir-fried), Left-coiling Dragon (Zuo Panlong - likely referring to a specific insect or part, traditionally interpreted as dried centipede or similar arthropod, here kept as Zuo Panlong) (0.5 liang, stir-fried until smoke ceases).
Grind into fine powder. Take with Fangfeng Tang (Saposhnikovia Decoction).
Baizhu Fangfeng Tang (Atractylodes Macrocephala and Saposhnikovia Decoction) If previous medications have harmonized the Zang-Fu organs and spontaneous sweating occurs, this formula is suitable.
Atractylodis Macrocephalae Rhizoma (Baizhu), Saposhnikoviae Radix (Fangfeng), Astragali Radix (Huangqi) (each 1 liang).
Cut into pieces. Take 7 qian per dose, boil in 2 zhan of water until reduced to 1 zhan, remove dregs, and take warm.
Da Xionghuang Tang (Major Chuanxiong and Rhubarb Decoction) Suitable for rapid purgation if Zang-Fu organs are constipated, urine is red, and spontaneous sweating persists.
Chuanxiong Rhizoma (Chuanxiong) (1 liang), Scutellariae Radix (Huangqin) (6 qian), Glycyrrhizae Radix et Rhizoma (Gancao) (0.5 liang), Rheum Palmatum Radix (Dahuang) (1 liang).
Cut into pieces. Take 5 qian per dose, boil in 1.5 zhan of water until reduced to 1 zhan, remove dregs, and take warm. Stop when bowel movement is achieved.
Jiangtiao Wan (Fish Bladder Pill) Treats Wind-stiffness with fright-induced convulsions, constipation of Zang-Fu organs, indicating the pathogen is in the interior.
Fish Swim Bladder (Jiangtiao) (0.5 liang, stir-fried), Wild Pigeon Droppings (Yegefen) (0.5 liang, stir-fried), Realgar (Xionghuang) (1 qian), Centipede (Wugong) (1 pair), Gastrodiae Rhizoma (Tianma) (1 liang), Bombyx Batryticatus (Bai Jiangcan) (0.5 liang).
Grind into fine powder and divide into three parts. Use two parts first, make pills with steamed rice, size of paulownia seeds, coated with Cinnabar (Zhusha). Use the remaining one part, mix with 1 qian of Semen Crotonis (Badou) frost, make pills with steamed rice without Cinnabar coating. Take 20 pills of the Cinnabar-coated variety and 1 pill of the Badou-frost variety together. Increase the Badou-frost pills gradually until purgation occurs. Resume taking the Cinnabar-coated pills until the disease resolves.
Qianghuo Tang (Notopterygium Decoction) Suitable after purgation; also suitable if spasms persist.
Notopterygii Rhizoma et Radix (Qianghuo), Angelicae Pubescentis Radix (Duohuo), Sanguisorbae Radix (Diyu) (each 1 liang).
Take 5 qian per dose, boil in 1.5 zhan of water until reduced to 1 zhan, remove dregs, and take warm. Add Scutellariae Radix (Huangqin) if heat is present; add Pinelliae Rhizoma (Banxia) if phlegm is present.
Diyu Fangfeng San (Sanguisorba and Saposhnikovia Powder) Treats pathogen at the half-exterior half-interior level, with slight sweating on the head and no sweating on the body.
Sanguisorbae Radix (Diyu), Saposhnikoviae Radix (Fangfeng), Illicium Difengengi Fructus (Didingxiang), Portulacae Herba (Machixian) (each 1 liang).
Grind into powder. Take 3 qian per dose, mix with warm rice water.
Yangxue Danggui Dihuang San (Blood-Nourishing Angelica and Rehmannia Powder) Suitable for long-standing cases where Qi and Blood are gradually deficient and the pathogen enters the Stomach, requiring blood nourishment. Siwu Tang (Four Substances Decoction) plus Saposhnikoviae Radix (Fangfeng), Ligustici Rhizoma et Radix (Guben), Angelicae Dahuricae Radix (Baizhi), and Asari Radix et Rhizoma (Xixin) in equal parts. Grind into fine powder. Take 5 qian per dose, boil in 1.5 zhan of water until reduced to 1 zhan, and take warm.