诸骨哽。用象牙末吹患处。或取犬涎。徐徐咽下。立效。用苎根捣烂。丸如弹子大。
就将所鲠物煎汤化下。
又方。食橄榄。用核为末。含之亦效。
谷麦芒在咽不出。取鸡鹅延含之。立消。
误吞金银等物。多食诸般肥肉膏滑。自从大便出。
误吞铜钱。用炭末白汤调服。多食蜜食饴糖。自从大便出。或多食荸荠。或胡桃肉。钱
误吞针。用磁石如枣核大。磨令光。钻一孔。用线穿。含之。针自口出。
（附破伤风）
经云。肝脉转坚而长。色不青。当病坠若转。因血在胁下。令人呕逆。
金匮云。寸口脉浮。微而涩。当亡血。若汗出者。当身有疮。被刀斧所伤。亡血故也。
脉经云。金疮出血太多。脉虚细者生。数实大者死。金疮出血。脉沉小者生。浮大者死
。斫刺出血不止者。脉来大者。七日死。滑细者生。
从高颠仆。内有瘀血。腹胀脉坚强者生。小弱者死。
破伤有瘀血在内。脉坚强实则生。虚小弱者死。皆为脉病不相应故也。
一妇臀痈。疮将愈。患破伤风。发热搐搦。脉浮数。治以当归地黄汤。不信。乃服发散
败毒药。果甚。始信而服之。至数剂而痊。
脉浮数而发表。今用发表而病重。可见脉之浮数。亦有主阴虚者、必兼症参之为稳。认
作阴虚。由臀痈后也。
夫破伤风症。须分表里。别虚实。不可一概治之。原病式云。破伤中风之由。因疮热甚
结而荣卫不得宣通。怫热因之遍体。故多白痂。是时疮口闭塞。气难通泄。热甚则生风也。
不已。则表传于里矣。但有风热微甚兼化。故殊异耳。
大法。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
筋畅而播。脉浮数而弦者。宜辛热治风之药。开冲结滞而犹伤寒。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。免致药虽中病。而风热转甚
也。如治伤寒发热。用麻黄、桂皮、加黄芩、知母、石膏之类足也。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。以小柴胡和解之意也。若里热已甚
。而舌强口噤。项背反张。惊搐惕搦。涎唾涸枯。胸腹满塞。而或便溺秘结。或时汗出。脉
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。后以退风热开郁滞之寒药调之。而热退结散。则风自愈矣。凡
治此。亦宜按摩导引。及以箸斡开牙关。勿令口噤。使粥药得下也。
病机云。破伤风者。有因卒暴损伤。风袭之间。传播经络。致使寒热更作。身体反张。
不开。甚者邪气入脏。有因诸疮不瘥荣卫俱虚。肌肉不生。疮眼不合。邪亦能外入于疮。为
破伤风之疾。有诸疮不瘥。举世皆言着灸为上。是为熟疮。而不知火热客毒。逐经传变。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。一者因疮口入风。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。破伤风症。古方药论甚少。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。尚可淹涎岁月。而破伤风者。犯之多致不救。盖中
风有在经、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。属阴五脏之所主。故此风所伤。始虽在表。随则必传入里脏。故多死也
。此病或疮口袒露。不避风寒。而有所伤。或疮口闭合。密被风邪而及。病已十分安全而忽
有此。大抵皆由内气虚而有郁热者得之。若内气不虚而无郁热者。虽伤而无所害也。
各种骨刺卡喉。用象牙末吹入患处。或者取狗唾液，慢慢咽下，立即见效。用苎麻根捣烂，做成如弹丸大小的药丸。
就用卡住骨头的那个东西煎汤送服该药丸。
又一方。吃橄榄，将核研成粉末，含在口中也有效。
谷壳麦芒卡在咽喉出不来，取鸡或鹅的唾液含在口中，立即消除。
误吞金银等物，多吃各种肥腻滑润的肉膏，让它们自然随大便排出。
误吞铜钱，用炭末加白开水调服。多吃蜂蜜和饴糖，让它们自然随大便排出。或者多吃荸荠，或者胡桃肉。
误吞针，用磁石如枣核大小，磨得光滑，钻一个孔，用线穿起来，含在口中，针自然会从口里出来。
（附：破伤风）
《内经》说。肝脉变得坚硬而长，面色不青，应当是遭受坠落或扭伤所致，因为瘀血在胁下，导致人呕吐逆气。
《金匮要略》说。寸口脉浮，微而涩，应当是失血。如果是汗出过多，身上有疮，被刀斧所伤，是因为失血的原因。
《脉经》说。金创出血太多，脉象虚细的能生，数实大的会死。金创出血，脉象沉小的能生，浮大的会死。
砍刺出血不止，脉象来的大的，七天死。滑细的能生。
从高处置身跌落，体内有瘀血，腹胀且脉象坚强有力的能生，脉象小弱无力的会死。
破伤后有瘀血在内，脉象坚强实大的能生，虚小无力的会死。这都是因为脉象与病情不相适应的缘故。
有一位妇女患臀痈，疮将要痊愈时，患了破伤风，发热抽搐，脉象浮数。治疗用当归地黄汤。她不信，反而服用发散败毒的药物，果然病情加重，这才相信并服用当归地黄汤。服了几剂后痊愈。
脉象浮数本当解表，现在用了发汗解表的方法反而病重，可见脉象浮数，也有主阴虚的情况，必须结合症状参详判断才稳妥。认定为阴虚，是因为臀痈之后导致的。
大凡破伤风症，必须分清表里，辨别虚实，不可一概而论治疗。《原病式》说。破伤中风的原因，是因为疮热甚结，导致营卫不得宣通，郁热因此遍布全身，所以多有白痂。这时疮口闭塞，气难以通泄，热甚则生风。
如果不愈，就会由表传于里。但因为有风热微甚兼化，所以表现殊异。
大法。破伤中风，风热燥甚，郁结在表而里气尚平和的，表现为善伸数欠（喜欢打哈欠伸懒腰），筋脉拘急，时而恶寒，筋脉舒畅而动摇，脉象浮数而弦的，宜用辛热治风的药物，开冲结滞，这与伤寒表热郁结，用麻黄汤辛热发散是一样的。凡是使用辛热药物开冲风热结滞，宜以寒药佐助才好，以免药虽中病，而风热转甚。比如治疗伤寒发热，用麻黄、桂皮，加黄芩、知母、石膏之类就够了。如果世医认为甘草、滑石、葱、豉等寒药发散非常妙。如果表证不愈，逐渐伤入里，里证又未大盛，而脉在肌肉层的，宜用退风热开结滞的寒药调理。或者微加治风的辛热药也可以。这就像伤寒在半表半里，用小柴胡汤和解的意思一样。如果里热已甚，而舌强口噤，项背反张，惊搐惕搦，涎唾干枯，胸腹满塞，或者二便秘结，或者时时汗出，脉象洪数而弦的。然而汗出的原因，是由于风热郁结在里，而表热稍罢，腠理疏泄，心火热甚，所以汗出。法宜用除风散结的寒药攻下。后用退风热开郁滞的寒药调理，热退结散，风邪自然痊愈。大凡治疗此病，也宜按摩导引，以及用筷子撬开牙关，不要令口噤，使粥药得以进入。
《病机》说。破伤风，有因突然严重损伤，风邪侵袭之间，传播经络，致使寒热交替发作，身体反张，不能弯曲。严重的邪气入脏。有因诸疮不愈，营卫俱虚，肌肉不生，疮口不合，邪气也能从外侵入疮口，成为破伤风的疾病。有诸疮不愈，举世都说艾灸为上策，这叫熟疮，却不知道火热客毒，逐经传变，不可胜数。轻则发热，重则生风抽搐，或者角弓反张，口噤目斜。也有破伤不灸，而患此病的，因为疮着白痂，疮口闭塞，气难通泄，故阳热易为郁结，热甚则生风。徐用诚说。这个论述提到的病因有四条。一是因疮口入风，似属外因。一是因灸逐热，似属不内外因。一是因疮口闭塞，内热生风，似属内因。又说。破伤风症，古方药论很少，难道不是因为这个疾与中风同论，所以不另立条目吗？只有河间刘完素的论述，与伤寒表里中三法同治，用药很详细。他说的病因，有因外伤于风，有因灸及内热所致的。然而与中风相似。但是中风的人，尚可拖延岁月，而破伤风者，犯之大多致死。大概中风有在经、在脏、在腑的区别，唯独入脏的最难治。破伤风或者是开始出血过多，或者是疮早闭合，瘀血停滞，都是血受病，属阴五脏所主。故此风所伤，开始虽然在表，随即必传入里脏，所以多死。此病或者是疮口袒露，不避风寒，而有所伤。或者是疮口闭合，密被风邪而及。病已十分安全而忽然有此。大抵皆由内气虚而有郁热者得之。若内气不虚而无郁热者，虽然受伤也无害处。
Various bone obstructions in the throat. Use powdered ivory (Bos taurus horn) blown into the affected area. Or take dog saliva (Canis lupus familiaris saliva), swallow it slowly, and immediate effect will be achieved. Use root of Boehmeria nivea (Ramie Root), mash it thoroughly, and form pills the size of a bullet.
Swallow these pills using the decoction made from the object that caused the obstruction.
Another prescription. Eat olive fruits, grind the pits into powder, and hold them in the mouth; this is also effective.
Rice husks or wheat awns stuck in the throat cannot come out. Take chicken or goose saliva, hold it in the mouth, and they will disappear immediately.
If gold, silver, or other objects are accidentally swallowed, eat plenty of various fatty, greasy, and slippery meats to facilitate their natural passage through the large intestine with feces.
If copper coins are accidentally swallowed, mix charcoal powder with warm water for oral administration. Eat plenty of honey (Apis mellifera product) and maltose syrup to facilitate their natural passage through the large intestine with feces. Alternatively, eat plenty of Eleocharis dulcis (Chinese Water Chestnut) or walnut kernels.
If needles are accidentally swallowed, use magnetite (Magnetitum) the size of a jujube pit, grind it until smooth, drill a hole, thread it with a string, and hold it in the mouth; the needle will naturally exit from the mouth.
(Attached: Tetanus / Wind Stroke after Injury)
The *Neijing* states: If the Liver pulse becomes hard and long, but the complexion is not green, one should suffer from falling or twisting injuries due to blood stasis under the hypochondrium, causing vomiting and reverse qi flow.
The *Jingui Yaolue* states: If the Cun-kou pulse is floating, faint, and choppy, it indicates blood loss. If there is excessive sweating and sores on the body caused by knife or axe wounds, it is due to blood loss.
The *Maijing* states: In traumatic bleeding, if the pulse is deficient and fine, the patient survives; if rapid, excess, and large, the patient dies. In traumatic bleeding, if the pulse is sunken and small, the patient survives; if floating and large, the patient dies.
For cutting or stabbing wounds with continuous bleeding, if the pulse is large, death occurs within seven days; if slippery and fine, the patient survives.
After falling from a height, if there is internal blood stasis, abdominal distension, and a strong, firm pulse, the patient survives; if the pulse is small and weak, the patient dies.
In traumatic injuries with internal blood stasis, if the pulse is strong, firm, and excess, the patient survives; if deficient, small, and weak, the patient dies. This is because the pulse does not correspond to the disease condition.
A woman suffering from a carbuncle on the buttock developed tetanus as the sore was about to heal. She had fever and convulsions, with a floating and rapid pulse. The treatment prescribed was Danggui Dihuang Tang (Angelica Sinensis and Rehmannia Decoction). She did not believe in it and instead took dispersing and detoxifying drugs. Her condition indeed worsened. Only then did she believe and take the prescribed medicine. After several doses, she recovered.
A floating and rapid pulse usually indicates the need to release the exterior. However, using dispersing methods here worsened the illness. This shows that a floating and rapid pulse can also indicate Yin deficiency. One must combine pulse diagnosis with symptoms for a stable judgment. The diagnosis of Yin deficiency was based on the aftermath of the buttock carbuncle.
Generally, tetanus must be differentiated by exterior/interior and deficiency/excess; it cannot be treated uniformly. The *Yuanbing Shi* states: The cause of wind stroke after injury is that intense heat in the sore causes constriction, preventing the circulation of Ying and Wei (Nutritive and Defensive Qi). Depressed heat spreads throughout the body, resulting in white scabs. At this time, the wound closes, making it difficult for Qi to vent. Intense heat generates wind.
If untreated, the pathogen transmits from the exterior to the interior. However, due to variations in the severity of wind-heat and transformation, manifestations differ.
General principle: For tetanus where wind-heat is dry and severe, depressed at the exterior while interior Qi is peaceful, presenting with frequent stretching and yawning, tendon and vessel stiffness, occasional aversion to cold, relaxed tendons with tremors, and a floating, rapid, and wiry pulse, one should use acrid-hot herbs to treat wind, opening and flushing out stagnation. This is similar to treating exterior heat depression in Cold Damage using Mahuang 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 hitting the target. For example, treating fever in Cold Damage, using Ephedrae Herba (Mahuang), Cinnamomi Ramulus (Guizhi), plus Scutellariae Radix (Huangqin), Anemarrhenae Rhizoma (Zhimu), and Gypsum Fibrosum (Shigao) is sufficient. Some physicians consider dispersing with cold herbs like Glycyrrhizae Radix (Gancao), Talcum (Huashi), Allii Fistulosi Bulbus (Congbai), and Sojae Semen Praeparatum (Douchi) to be excellent. If the exterior syndrome persists and gradually invades the interior, but the interior is not yet severely affected, and the pulse is felt at the muscle layer, one should regulate with cold herbs that reduce wind-heat and open stagnation. A slight addition of acrid-hot wind-treating herbs is also acceptable. This resembles the harmonizing method of Xiaochaihu Tang (Minor Bupleurum Decoction) for Cold Damage at the half-exterior/half-interior level. If interior heat is already severe, presenting with stiff tongue, locked jaw, opisthotonos,惊搐 (startle convulsions), dry saliva, chest and abdominal fullness, constipation of urine and feces, or intermittent sweating, with a surging, rapid, and wiry pulse: The sweating occurs because wind-heat is severely depressed in the interior, while exterior heat has slightly subsided, causing pores to open and Heart fire to become intense. The method should involve purging with cold herbs that dispel wind and resolve stagnation. Afterwards, regulate with cold herbs that reduce wind-heat and open depression. Once heat recedes and stagnation dissipates, the wind will heal itself. In treating this, massage and guidance exercises are also appropriate, and using chopsticks to pry open the jaw is necessary to prevent lockjaw, allowing porridge and medicine to enter.
The *Bingji* states: Tetanus arises from sudden severe trauma where wind pathogens invade and spread through meridians, causing alternating chills and fever, opisthotonos, and inability to bend. Severe cases involve pathogens entering the Zang organs. It can also arise from non-healing sores where both Ying and Wei are deficient, muscles do not regenerate, and wound edges do not close, allowing external pathogens to enter the sore, causing tetanus. When sores do not heal, everyone advocates moxibustion as the best method, creating "cooked sores." However, they fail to realize that fire-heat and toxic pathogens transmit through meridians in countless ways. Mildly, it causes fever; severely, it generates wind and convulsions, opisthotonos, lockjaw, and deviated eyes. There are also cases of tetanus without moxibustion, where white scabs form, closing the wound, blocking Qi venting, causing Yang heat to easily stagnate, and intense heat generating wind. Xu Yongcheng stated that this discussion identifies four causes: 1. Wind entering through the wound, resembling an external cause. 2. Heat driven by moxibustion, resembling a neither-internal-nor-external cause. 3. Internal heat generating wind due to wound closure, resembling an internal cause. He further stated that ancient formulas rarely discuss tetanus, likely because it is discussed alongside wind stroke, hence no separate category. Only Liu Wansu (Hejian) discussed it similarly to the three methods of exterior/interior in Cold Damage, with detailed prescriptions. His etiology includes external wind invasion and internal heat from moxibustion. It resembles wind stroke. However, wind stroke patients may survive for years, whereas tetanus patients often die upon contraction. Wind stroke differs by location in meridians, Zang, or Fu organs, with Zang involvement being hardest to treat. Tetanus, whether due to initial excessive bleeding or early wound closure with blood stasis, involves blood pathology governed by the Yin Zang organs. Thus, although the wind initially affects the exterior, it quickly transmits to the interior Zang organs, leading to high mortality. This disease occurs either when wounds are exposed to wind-cold or when closed wounds are invaded by wind pathogens. Even if the patient seems safe, this can suddenly occur. Generally, it results from internal Qi deficiency combined with depressed heat. If internal Qi is not deficient and there is no depressed heat, injury causes no harm.