（雄按∶史 臣云∶冒风者曰破伤风，染湿者曰破伤湿。今但列伤风，而不及伤湿，犹有缺漏也。）
官使明光祖，向任统制官，被重伤，患破伤风，牙关紧急，口噤不开，口面 斜，肢体弛缓。用
土虺蛇一
条，去头、尾、肠、皮、骨，醋炙；地龙五条，去泥醋炙；天南星八钱重一枚，炮。上为末，醋炙，
面糊为丸绿豆大。每服三丸、五七丸，生姜酒下，仍食稀葱白粥取汗，即瘥。（《普济方》、《本草
纲目》）
万密斋治一妇人，年四十余，形黑而瘠，性躁急，先患左腿发内痈，溃后起坐。万曰∶疮口未合
当禁风。其妇自恃强健，不听。忽一日眩仆，目贬口 ，身反张，手足挛曲，亟求治。曰∶此破伤风，
病也。用桂枝汤加熟附子、黄 、防风，一剂而病减。再服十全大补汤，三剂而安。
胡念庵曰∶一人因拔髭一茎，忽然肿起不食。有友人询余，余曰∶此破伤风也，速灸为妙。医乃
认作髭疔，治以寒凉，不数日发痉而死。（《医林指月》）
有男子年六十一，脚肿生疮，忽食猪肉不安。医以药利之，稍愈。时出外，中风汗出，头面暴肿
起紫黑色，多唾，耳叶上有浮泡小疮，黄汁出，乃与小续命汤加羌、活一倍，服之遂愈。（《医说续
篇》）
薛立斋云∶一男子背疮未敛，以膏药剪孔贴之，患破伤风症而殁。此先失于内补，外邪集其虚耳。
余见此症，贴膏药剪孔，欲其通气，而反患破伤风；搽敛药生肌，欲其收口而助其余毒，以致殁者多
矣。可不慎哉？
一男子风袭疮口，牙关紧急，腰背反张，以玉真散，一服而愈。仍以托里药而敛。
薛立斋治一妇人，臀痈将愈，患破伤风，发热搐搦，脉浮数，以当归地黄汤治之。不信，乃服发
散败毒药，果甚。始信，服数剂而痊。是症须分表里，别虚实，不可概治。《原病式》云∶破伤风，
因疮热甚，郁结荣卫，不得宣通，怫热遍身，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，但有风热微甚兼化，故殊异矣。大法，风热躁甚，怫屈在表，而里气尚平者，善
伸数欠，筋脉拘急，时或恶寒，或筋惕而搐，脉浮数而弦者，宜以辛热治风之药，开卫结滞，是与怫
屈而以麻黄汤辛热发者同也。凡用辛热，宜以寒药佐之，免至药中病，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。或以甘草、滑石、葱、豉寒药，发散之妙。若表不
已，渐入里，里又未甚，而脉在肌内者，宜以退风热，开结滞之寒药调之，或微加治风，辛热亦得，
犹风寒半表半里，以小柴胡和解之意也。若里热已甚，舌强口噤，项背反张，惊
惕搐搦，涎唾稠粘，胸腹满塞，或便溺闭结，或时汗出，脉洪数而弦，此由风热屈甚于里，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，开屈滞之寒药调
之。热除结散，则风自愈矣。凡治此，宜按摩导引，及以药斡开牙关，勿令口噤，使粥药不得下也。
治破伤风及金刃伤，打扑伤损，方名玉真散，《本事》、《必用》两方皆有，但人不知。张叔潜
知府云∶此方极奇，居官不可阙，是斋宰清流日，以授直厅医，救欲死者数人，奇甚。用天南星、防
风，二味等分为末。破伤风以药敷贴疮口，然后以温酒调下一钱。如牙关紧急，角弓反张，用药二钱，
童子小便调下。或因斗殴相打，内有伤损，以药二钱，温酒下。打伤至死，但心头微温，以童小便灌
下二钱，并进三服。天南星为防风所制，服下不麻。（《是斋方》）
（按∶《卫生宝鉴》以此方兼治狂犬所伤，并诸犬咬，神效。）
（徐灵胎按语：史官说，受风邪侵袭的称为破伤风，受湿邪侵袭的称为破伤湿。现在只列举了伤风，而没有提及伤湿，这还是有缺漏的。）
官员明光祖，曾任统制官，遭受严重外伤，患上了破伤风，牙关紧闭，口噤不能张开，口眼歪斜，肢体弛缓无力。使用土虺蛇一条，去掉头、尾、肠、皮、骨，用醋炙烤；地龙五条，去泥后用醋炙烤；天南星一枚重八钱，炮制。以上药物研为细末，用醋拌炒，面粉糊制成如绿豆大小的丸药。每次服用三丸或五到七丸，用生姜酒送服，同时喝稀葱白粥以取汗，病即可痊愈。（出自《普济方》、《本草纲目》）
万密斋治疗一位四十多岁的妇人，形体黑瘦，性情急躁暴躁，先前左腿患有内痈，溃破后起身活动。万密斋说：“疮口未愈合时应当避风。”这位妇人自恃身体强健，没有听从。忽然有一天眩晕跌倒，眼球上翻，口角歪斜，身体向后反张，手足拘挛弯曲，急忙求治。万密斋说：“这是破伤风病。”使用桂枝汤加入熟附子、黄芪、防风，一剂药后病情减轻。再服用十全大补汤，三剂后病情安定。
胡念庵说：有一人因为拔掉一根胡须，突然肿胀起来且无法进食。有朋友询问我，我说：“这是破伤风，赶快艾灸是妙法。”医生却误认为是髭疔，用寒凉药物治疗，没过几天患者因发痉而死。（出自《医林指月》）
有一名六十一岁的男子，脚部肿胀生疮，忽然吃了猪肉后感到不适。医生用药通便泻下，稍微好转。后来外出，中风出汗，头面突然肿胀呈紫黑色，多唾液，耳叶上有浮泡状小疮，流出黄色汁液，于是给予小续命汤并加倍羌活、独活，服用后遂痊愈。（出自《医说续篇》）
薛立斋说：一名男子背部疮疡未收敛，用膏药剪孔贴敷，患上破伤风症而死亡。这是因为先前失于内补，外邪聚集于其虚弱之处。我见到这类病症，贴膏药剪孔是为了通气，反而导致患破伤风；涂抹敛疮生肌药，本意是想让伤口愈合，却助长了余毒，以致死亡的很多。能不谨慎吗？
另一名男子风邪侵袭疮口，牙关紧急，腰背反张，使用玉真散，一服药即愈。随后仍用托里药使疮口收敛。
薛立斋治疗一名妇人，臀部痈肿即将痊愈时，患破伤风，发热抽搐，脉象浮数，用当归地黄汤治疗。患者不信，反而服用发散败毒药，病情果然加重。始信从，服用数剂后痊愈。这种病症必须分辨表里，辨别虚实，不可一概而论。《原病式》说：破伤风，是因为疮热严重，郁结营卫之气，不得宣通，热气遍布全身，所以多有白痂。此时疮口闭塞，气难以通泄，热盛则生风。如果不加控制，病邪由表传里，只有风热的轻重兼夹变化不同，所以症状殊异。大法则是：如果风热躁动严重，郁结在体表，而里气尚且平和，表现为善伸懒腰、频繁打哈欠，筋脉拘急，时而恶寒，或者筋惕肉瞤而抽搐，脉象浮数而弦，适宜用辛热祛风的药物，开通卫气的结滞，这与用麻黄汤辛热发汗治疗伤寒郁结的原理相同。凡是使用辛热药物，宜用寒性药物佐助，以免药力正中病所，而风热反而更盛。比如治疗伤寒发热用麻黄、桂枝，加入黄芩、石膏、知母之类就是如此。或者用甘草、滑石、葱、豉等寒性药物发散，也是妙法。如果表证未解，逐渐入里，里证又未严重，而脉象在肌内者，适宜用退风热、开结滞的寒性药物调理，或者微微加入治风的辛热药物也可以，犹如风寒在半表半里之间，用小柴胡汤和解的意思。如果里热已经严重，舌强口噤，项背反张，惊惕抽搐，涎唾稠粘，胸腹满塞，或者大小便闭结，或者时常出汗，脉象洪数而弦，这是由于风热郁结严重在里，而表热稍退，则腠理疏泄，心火极盛，所以出汗。治法适宜除风散结，用寒性药物攻下。之后用退风热、开郁滞的寒性药物调理。热除结散，风邪自然痊愈。凡治疗此症，适宜按摩导引，以及用药斡开牙关，不要让口噤，致使粥药无法进入。
治疗破伤风及金刃伤、打扑伤损，方名玉真散，《本事方》、《必用方》两书中都有记载，只是人们不知道。张叔潜知府说：这个方子极其奇妙，做官的人不可缺少，是在担任清流县宰时，传授给直厅医，救活了几个垂死之人，非常神奇。使用天南星、防风，两味药等分为末。破伤风将药粉敷贴在疮口，然后用温酒调服一钱。如果牙关紧急，角弓反张，用药二钱，用童子小便调服。或者因为斗殴打架，体内有伤损，用药二钱，温酒送下。被打至假死，只要心头微温，用童子小便灌服二钱，并进服三剂。天南星被防风所制约，服用后不会麻木。（出自《是斋方》）
(Comment by Xu Lingtai: Historians state that contracting wind pathogen is termed "Po Shang Feng" (Broken Injury Wind / Tetanus), while contracting dampness pathogen is termed "Po Shang Shi" (Broken Injury Dampness). Currently, only wind injury is listed, omitting dampness injury, which remains an omission.)
Official Ming Guangzu, formerly serving as a Commander-in-Chief, suffered severe trauma and contracted Po Shang Feng. He presented with trismus (lockjaw), inability to open the mouth, facial deviation, and flaccidity of the limbs. One Tu Hui She (local viper) was used; the head, tail, intestines, skin, and bones were removed, and it was stir-fried with vinegar. Five Di Long (Earthworms) were used; mud was removed, and they were stir-fried with vinegar. One Tian Nan Xing (Arisaema Rhizome) weighing eight qian was processed (pao). The above ingredients were ground into powder, mixed with vinegar during processing, and formed into pills the size of mung beans using wheat flour paste. Each dose consisted of three pills, or five to seven pills, taken down with ginger wine. Simultaneously, consuming thin congee made with white parts of green onions induced sweating, leading to recovery. (From *Pu Ji Fang* and *Ben Cao Gang Mu*)
Wan Mizhai treated a woman in her forties, who was dark-skinned and emaciated, with an irritable temperament. Previously, she had developed an internal abscess in her left leg. After it ulcerated, she sat up and moved around. Wan stated, "When the wound has not healed, exposure to wind must be avoided." Relying on her robust constitution, she did not listen. Suddenly, one day she fainted due to vertigo, her eyes rolled upward, her mouth deviated, her body arched backward (opisthotonos), and her hands and feet became spasmodic. She urgently sought treatment. Wan diagnosed this as Po Shang Feng disease. He prescribed Gui Zhi Tang (Cinnamon Twig Decoction) supplemented with Shu Fu Zi (Prepared Aconite Root), Huang Qi (Astragalus Root), and Fang Feng (Saposhnikovia Root). After one dose, the condition improved. Subsequently, she took Shi Quan Da Bu Tang (Ten Significant Tonifying Decoction) for three doses, after which she stabilized.
Hu Nian'an stated: A person plucked a single whisker hair, which suddenly swelled up, preventing eating. When asked by a friend, I said, "This is Po Shang Feng; immediate moxibustion is the best approach." However, the physician misdiagnosed it as a whisker carbuncle and treated it with cold-natured herbs. Within a few days, the patient died from convulsions. (From *Yi Lin Zhi Yue*)
A sixty-one-year-old man had swollen legs with sores. After eating pork, he felt uncomfortable. The physician administered purgative medicine, providing slight relief. Later, upon going outside, he suffered from wind-stroke with sweating. His face and head suddenly swelled, turning purple-black. He produced excessive saliva, and small blister-like sores appeared on his earlobes, oozing yellow fluid. Xiao Xu Ming Tang (Minor Continuation of Life Decoction) was prescribed with doubled amounts of Qiang Huo (Notopterygium Root) and Huo Xiong (Ligusticum Wallichii Rhizome). He recovered after taking it. (From *Yi Shuo Xu Pian*)
Xue Lizhai stated: A man with an unhealed back sore applied a plaster with a hole cut out. He subsequently contracted Po Shang Feng and died. This was because he had previously neglected internal tonification, allowing external pathogens to gather in his deficiency. In cases I have seen where patients applied plasters with holes to allow ventilation, they ironically contracted Po Shang Feng; similarly, applying astringent medicines to promote tissue regeneration often exacerbated residual toxins, leading to death. How can one not be cautious?
Another man had wind pathogen invading a wound, presenting with trismus and opisthotonos. Yu Zhen San (Jade True Powder) cured him in one dose. Thereafter, he was treated with formulas to support the interior to facilitate healing.
Xue Lizhai treated a woman whose buttock abscess was nearly healed but who then contracted Po Shang Feng, presenting with fever and spasms, and a floating, rapid pulse. She was treated with Dang Gui Di Huang Tang (Angelica and Rehmannia Decoction). Distrusting this, she took dispersing and detoxifying herbs, which indeed worsened her condition. Upon believing the correct diagnosis, she took several doses and recovered. For this syndrome, one must distinguish between exterior and interior, and excess and deficiency; it cannot be treated uniformly. *Yuan Bing Shi* states: Po Shang Feng occurs when intense heat from a wound stagnates the Ying and Wei mechanisms, preventing their free circulation, causing heat to pervade the body, resulting in white scabs. At this time, the wound closes, qi cannot vent, and extreme heat generates wind. If unchecked, the pathogen transmits from the exterior to the interior. The variations depend on the severity of wind-heat transformation. The general principle is: if wind-heat is agitated and severe, stagnating at the exterior while the interior qi is relatively calm, symptoms include frequent stretching and yawning, tendon constraint, occasional aversion to cold, muscle twitching and spasms, and a floating, rapid, and wiry pulse. It is appropriate to use acrid-warm wind-dispelling herbs to open Wei qi stagnation, similar to using Ma Huang Tang (Ephedra Decoction) to release exterior constraint via acrid-warm sweating in cold damage. Whenever acrid-warm herbs are used, they should be assisted by cold herbs to prevent the medicine from hitting the pathogen too directly and exacerbating wind-heat. For example, treating cold damage fever with Ma Huang and Gui Zhi, supplemented with Huang Qin (Scutellaria Root), Shi Gao (Gypsum Fibrosum), and Zhi Mu (Anemarrhena Rhizome). Alternatively, using cold herbs like Gan Cao (Licorice Root), Hua Shi (Talcum), Cong Bai (Green Onion White), and Chi Dou (Fermented Soybean) for dispersion is also effective. If the exterior pattern persists and gradually moves inward, but the interior is not yet severe, and the pulse is located within the muscles, it is appropriate to regulate with cold herbs that clear wind-heat and resolve stagnation, or slightly add acrid-wind herbs. This resembles the harmonizing intent of Xiao Chai Hu Tang (Minor Bupleurum Decoction) for half-exterior, half-interior wind-cold. If interior heat is already severe, presenting with stiff tongue, trismus, opisthotonos, fright and spasms, thick sticky phlegm/saliva, chest and abdominal fullness, constipation or urinary retention, or intermittent sweating, with a surging, rapid, and wiry pulse, this indicates severe wind-heat constraint in the interior while exterior heat has subsided. Consequently, pores are open, heart fire is extreme, causing sweating. The method should involve dispelling wind and resolving stagnation, using cold herbs to purge downward. Afterwards, regulate with cold herbs that clear wind-heat and open constraint. Once heat is cleared and stagnation resolved, the wind will heal itself. In treating this, massage and guided exercises are suitable, along using medicine to pry open the jaw to prevent trismus, ensuring food and medicine can enter.
Yu Zhen San, used for treating Po Shang Feng, knife wounds, and blunt trauma, appears in both *Ben Shi Fang* and *Bi Yong Fang*, though unknown to many. Prefect Zhang Shuqian said: This formula is extremely miraculous; officials should always keep it on hand. While serving as magistrate of Qingliu County, I taught it to the medical officer, saving several near-death patients; it is very remarkable. Use Tian Nan Xing and Fang Feng, ground equally into powder. For Po Shang Feng, apply the powder to the wound, then take one qian mixed with warm wine. If trismus or opisthotonos occurs, take two qian mixed with urine from a young boy. For internal injuries from fighting, take two qian with warm wine. If beaten to apparent death but the heart remains slightly warm,灌 (irrigate/pour) two qian mixed with urine from a young boy, followed by three doses. Tian Nan Xing is restrained by Fang Feng, so ingestion does not cause numbness. (From *Shi Zhai Fang*)
(Note: *Wei Sheng Bao Jian* uses this formula to treat rabies bites and various dog bites, with miraculous effects.)