凡手腕出骱者,医人用左手仰掌托捻被伤手臂,又用右手在下节手近处骱一把,拿定
其退缩,尽力一扯,即入故位,方服接骨丹,仍贴膏药。凡肩臂脱骱者,令患者低处坐定,
自用两手叉定抱膝上,将膝借力一扯,视其臂随手直前轻轻放两手,就入骱,方服接骨丹,
仍贴膏药。凡肩胛骨出,用椅当圈住胁,又用软衣棉被铺好,再令人捉住,两手伸却,坠下
手腕,绢布缚之。凡肩井骨在胁下有损,不可夹缚,须捺平正妥贴,以黑龙散敷绢布包好,
胁骨亦如此。凡手骨出,须看如何出,若骨向左者,须向右捺入骨,若向右则向左边捺入。
凡脑骨碎,轻轻用手捺平正。若不破,用乌龙散;若破,则用桃花散填口,以绢包之。不可
着风水,犯之则破伤风。倘在发内,宜剪去发敷药。凡跨骨从臀上出,可用人挺定援伸,方
捺入。若跨骨从裆内出,则不可治矣。凡伤重者,大概要拔伸捺正,或取开捺正,然后用桃
花散、黑龙散,再夹缚。大抵拔伸要近处,不可覆在第二节骨上。凡拔伸全要相度左右骨如
何出,或当正拔伸者,或当斜拔者,凡拔伸或用一人,或用三人,要看伤势轻重难易如何。
凡骨跌折又出肉外,折处两头必如锋刀,或长短不齐,不能复入,用麻药麻定方用锉之
用小锯锯齐,然后按入。方用敷药及膏,外加棉纸数层,再以粉板夹好,过一二日换膏药,
日进接骨丹两服。若遇热天用清茶洗净,勿令阻气。若胫骨别出在内者,难治,在外者,用
手法推入旧处,方服药。凡跌打肿处,患者不肯令人着手摸者,又肿硬难辨肉内骨之碎否,
必须以麻药服之。然后用手捻其肿处,如骨肉有声即是骨碎,以刀割开,如有血出,再用止
血散,并麻药麻住,然后取出碎骨,以别骨补好,膏药贴之,外用油纸包好,与淡盐汤一杯
服之,待醒后再服接骨丹药。凡阴子跌出有血者,先用桃仁散止血,以线缝好,再以膏贴之
,伤一月内尚可正理,久则难治。
凡是手腕关节脱位的,医生用左手掌心向上托住并捻动受伤的手臂,同时用右手在腕部下方的近端关节处握住,固定住其回缩的状态,尽力向外一拉,使关节复位,然后服用接骨丹,并贴上膏药。凡是肩臂关节脱位的,让患者坐在低处,自己用双手交叉抱住膝盖,利用膝盖作为支点借力拉扯,观察手臂是否随着手的动作向前轻轻放下而自然复位,如果复了位,就服用接骨丹,并贴上膏药。凡是肩胛骨脱出的,用椅子围住胁部,再用柔软的衣物和棉被铺垫好,另外让人抓住患者,将两手伸直下垂手腕,用绢布捆绑固定。凡是肩井穴附近的骨头在胁下有损伤的,不可夹板束缚,必须用手按压使其平整端正妥帖,用黑龙散敷在绢布上包好,胁骨的损伤也采用同样的方法。凡是手部骨骼脱位,必须查看它是如何脱出的,如果骨头向左脱出,就必须向右按压使其复位;如果向右脱出,则向左边按压复位。凡是头骨碎裂的,轻轻用手将其按平端正。如果没有破皮,用乌龙散;如果破皮了,就用桃花散填塞伤口,并用绢布包裹。不能让伤口接触风和水,否则会导致破伤风。如果伤口在头发里面,应该剪去头发再敷药。凡是胯骨从臀部上方脱出的,可以用人挺住身体进行牵引拉伸,然后再按压复位。如果胯骨从裆内脱出,那就无法治疗了。凡是伤势严重的,大体都需要拔伸矫正,或者切开复位后再矫正,然后用桃花散、黑龙散,再进行夹板固定。大抵拔伸时要靠近患处,不可压在第二节骨头上。凡是拔伸全都要观察左右骨骼是如何脱出的,有的应当正方向拔伸,有的应当斜方向拔伸。凡是用一人拔伸,还是用三人拔伸,要看伤势的轻重难易程度而定。
凡是骨折且骨头刺出肉外的,骨折处的两头必定像锋刀一样锐利,或者长短不齐,不能直接复位,先用麻药麻醉固定后,用锉刀锉平,用小锯锯齐,然后按入原位。接着敷药及贴膏药,外加棉纸数层,再用夹板固定好,过一两天更换膏药,每天服用两服接骨丹。如果遇到热天,要用清茶洗净伤口,不要让药物阻碍气机运行。如果是胫骨向内错位脱出的,难以治疗;如果在外的,用手推入旧处,然后服药。凡是跌打损伤导致肿胀的地方,患者不肯让人触摸的,又因肿胀坚硬难以分辨内部骨骼是否碎裂,必须先服用麻药。然后用手捻摸肿胀处,如果听到骨肉有声音,就是骨头碎了,用刀割开,如果有血流出,再用止血散,并用麻药麻醉,然后取出碎骨,用完整的骨头修补好,贴上膏药,外用油纸包好,给患者喝一杯淡盐汤,等患者苏醒后再服用接骨丹药。凡是阴器部位跌打损伤出血的,先用桃仁散止血,用线缝合好,再贴膏药,伤后一个月内还可以正常治疗,时间久了就难治了。
In cases of wrist joint dislocation, the physician uses the left hand with palm facing up to support and manipulate the injured arm, while the right hand grasps the proximal joint area below the wrist. The physician secures the retracted position and pulls firmly outward to reduce the joint, followed by administering Jiegu Dan (Bone-Setting Pill) and applying a plaster. In cases of shoulder or arm joint dislocation, the patient is instructed to sit on a low stool, cross their arms around their knees, and use the knees as leverage for pulling. The physician observes whether the arm reduces naturally when gently lowered forward; if reduced, Jiegu Dan is administered and a plaster applied. For scapular dislocation, a chair is used to encircle the hypochondrium, padded with soft clothing and cotton quilts. An assistant holds the patient while extending both arms downward to suspend the wrists, which are then bound with silk cloth. For injuries to the bone near Jianjing (GB21) under the hypochondrium, binding is contraindicated; instead, the area must be manually pressed flat and aligned, covered with Heilong San (Black Dragon Powder) on silk cloth. Rib injuries are treated similarly. For hand bone dislocations, the direction of displacement must be assessed: if displaced left, press right to reduce; if displaced right, press left to reduce. For comminuted skull fractures, gently press the fragments into alignment. If the skin is intact, Wulong San (Black Dragon Powder) is applied; if the skin is broken, Taohua San (Peach Blossom Powder) is packed into the wound and wrapped in silk. Exposure to wind and water must be avoided to prevent tetanus. If the wound is within hair-bearing areas, the hair should be shaved before applying medication. For hip dislocation from the upper buttock, manual traction and extension are performed by an assistant before reduction. Dislocation from the groin is considered incurable. Severe injuries generally require traction and realignment, possibly involving incision for reduction, followed by application of Taohua San and Heilong San, and splinting. Traction should be applied close to the injury site, avoiding pressure on the second phalanx. The method of traction—whether linear or angular, and whether one or three assistants are needed—depends on the severity and complexity of the injury.
When a fracture is compound with bone protruding through the skin, the fractured ends are often sharp or uneven, preventing direct reduction. After anesthesia with Ma Yao (Anesthetic Medicine), the bone ends are filed smooth with a rasp and sawed even with a small saw, then reduced. Medication and plasters are applied, covered with several layers of cotton paper, and secured with a splint. The plaster is changed after one or two days, and two doses of Jiegu Dan are taken daily. In hot weather, clear tea should be used to clean the wound to prevent stagnation of Qi. Tibial dislocation inward is difficult to treat; if outward, it can be pushed back into place manually, followed by medication. For traumatic swelling where the patient refuses palpation and hardness makes it difficult to determine if bones are shattered, anesthesia is required first. Palpation of the swollen area may reveal crepitus indicating bone fragmentation. If confirmed, the area is incised, bleeding is controlled with Zhixue San (Hemostatic Powder), and anesthesia is maintained. Shattered bone fragments are removed, replaced with healthy bone grafts if necessary, and covered with plaster, then wrapped in oiled paper. A cup of light salt water is given to the patient until they regain consciousness, after which Jiegu Dan is administered. For genital trauma with bleeding, Taoren San (Peach Seed Powder) is used to stop bleeding, the wound is sutured, and a plaster is applied. Treatment within one month is effective; delayed treatment is difficult.