bubble_chart Concept

Lockjaw refers to the symptom of tightly clenched teeth and inability to open the mouth. Because its main manifestation is the difficulty in opening the jaw due to clenched teeth, it is also called "urgent lockjaw."

In ancient literature, lockjaw is also referred to as "wind lockjaw," "apoplexy lockjaw," "lockjaw," "urgent lockjaw," "urgent jaw lockjaw," and "locked mouth."

Additionally, lockjaw should be distinguished from "tight lips" and "lockjaw." "Tight lips," also known as "tight mouth" or "tightened lips," refers to the condition where the muscles of the lips are tense, making it difficult to open or close the mouth, and thus unable to eat, which is different from lockjaw, where the main symptom is tightly clenched teeth. "Lockjaw" specifically refers to a condition in infants caused by heat in the womb and exposure to wind during bathing, characterized by "mouth puckering like a bag," inability to suckle, and accompanied by symptoms such as a stiff tongue, blue lips, and a yellow-red complexion. Its diagnosis and treatment are different from those of lockjaw.

bubble_chart Pattern Analysis

1. External Contractionwind-cold︰fever and chills, headache, lockjaw, stiff neck and back, without sweating or sweating, white tongue coating, floating and tight or floating and rapid pulse. Mostly caused by invasion of wind-cold-damp pathogens into the three yang meridians, leading to tendon tension and lockjaw, belonging to the taiyang convulsive disease. The taiyang convulsive disease must be accompanied by aversion to cold, headache, floating pulse, white tongue coating, and other exterior patterns, and the degree of lockjaw and neck stiffness is also milder than that of interior heat, manifesting as tightness of the mouth and teeth, and stiffness of the neck and back. It is advisable to disperse the external pathogens, and Pueraria Decoction with modifications can be used.
2. Exuberant Internal Heat︰Lockjaw, stiff neck, opisthotonos, and spasticity of the limbs, fever or high fever, flushed face, red eyes, dry and cracked lips, constipation, scanty and dark urine, a red tongue with yellow and dry coating, and a wiry-rapid or deep-rapid and forceful pulse. This is caused by wind-cold transforming into heat upon entering the interior or by warm-heat invading the interior, leading to excessive accumulation in the qi aspect or stirring liver wind, resulting in lockjaw or grinding of teeth with audible sounds. Not only is there stiffness of the neck and back, but in severe cases, opisthotonos may occur, making it impossible to lie flat, along with spasticity of the limbs. There may also be high fever, flushed face, red eyes, dry and cracked lips, constipation, and dark urine—all signs of excessive heat. In severe cases, unconsciousness may accompany these symptoms. A red tongue with a yellow coating and a rapid pulse are all due to interior heat. Treatment should focus on clearing and draining interior heat, with different formulas selected based on the severity of heat toxin and its location in the zang-fu organs. If interior heat is excessive in the yangming qi aspect or accumulates in the stomach and intestines, leading to fu-organ excess, the approach is to clear heat, purge fire, and promote bowel movement, using modified White Tiger Decoction or Major Purgative Decoction. If heat toxin scorches qi and blood or accumulates intensely in the throat, formulas that clear heat, remove toxins, cool blood, and clear heat, such as modified Plague-Clear Toxin-Vanquishing Decoction, can be used. For cases of liver channel excessive heat generating wind, often accompanied by convulsions and opisthotonos, the treatment should clear the liver, drain fire, and extinguish wind, using modified Gentian Liver-Draining Decoction or Antelope Horn and Uncaria Decoction. If unconsciousness is present, the approach should include clearing the heart and opening the orifices, with formulas like Peaceful Palace Bovine Bezoar Pill as the primary treatment.
3. Yin Deficiency with Blood Deficiency︰Dizziness and blurred vision, lockjaw with clenched teeth, convulsions or spasms in the limbs, or stiffness and collapse, restlessness, possible fever, emaciation, a red tongue without coating, and a deep, thin, and rapid pulse. This often occurs in the late stage (third stage) of warm disease, due to pathogenic heat consuming and damaging yin fluids, or sweating and purging damaging yin, where the pathogenic influence has receded but yin-blood is also deficient. Alternatively, Zabing may result from blood loss or postpartum conditions, where yin deficiency and blood deficiency lead to malnutrition of the tendons and vessels, causing spasms and lockjaw. The severity of wind stirring in lockjaw is not as intense as in cases of interior heat congestion. Wriggling of limbs or convulsions in the limbs may manifest as slight movements, or there may be residual stiffness, collapse, or spasms. Fever often occurs in the afternoon or evening, accompanied by dizziness, restlessness, emaciation, a red tongue with little coating, and a thin, rapid pulse—signs of yin-blood deficiency. Treatment should focus on nourishing yin and blood to extinguish wind, using Major Wind-Stabilizing Pearl with modifications.
4. Cold Pathogen Directly Attacking︰Lockjaw and muteness, trembling limbs, rigid body, reversal cold of hands and feet, abdominal pain and diarrhea, bluish-purple complexion, dark tongue with white coating, deep, wiry, and rough pulse. The symptoms present a series of signs of interior cold. Apart from lockjaw and muteness, there are also cold breath from the mouth and nose, abdominal pain and diarrhea, reversal cold of hands and feet, bluish-purple complexion, and deep, wiry pulse manifestations. Sometimes, due to yang qi failing to reach the exterior, the skin, muscles, and tendons lose their warmth, leading to symptoms such as a rigid and stiff body, though this differs from the neck stiffness and body pain seen in exterior patterns. In treatment, formulas that warm the middle and dispel cold should be used, such as Cold-Extremities Decoction or Great Smoothing Powder with modifications.
5. Qi Depression with Phlegm Congestion︰Lockjaw, or accompanied by syncope, limb convulsions, or generalized rigidity, with phlegm congestion in the throat, panting respiration, thin white or white greasy tongue coating, and deep-stringy or stringy-slippery pulse. It is commonly seen in Zabing, caused by phlegm-qi depression and obstruction of the seven orifices or wind invading the meridians. It is often triggered by emotional agitation, worry, or anger. Apart from lockjaw, it is usually accompanied by temporary syncope, convulsions, or rigidity, so it should be distinguished from lockjaw with unconsciousness due to interior heat congestion. The latter mostly occurs in warm febrile diseases, with severe unconsciousness and manifestations of interior excess heat pattern, making it generally easy to differentiate. Moreover, this syndrome often has a history of recurrent episodes, with relatively short durations, and is accompanied by phlegm congestion in the throat, panting respiration, and white greasy tongue coating—signs of internal phlegm-qi obstruction. Treatment should focus on regulating qi, orifice-opening, and resolving phlegm, using Aucklandia Root Qi-Regulating Powder or Phlegm-Guiding Decoction with modifications. For cases with unconsciousness, administer Styrax Pill first to open the orifices and revive consciousness.
6. External Injury with Wind Toxin︰The jaw is slightly tight, with lockjaw and neck stiffness, convulsions in the limbs, and a sardonic smile-like facial expression. In severe cases, opisthotonos may occur, accompanied by alternating chills and fever, a white and greasy tongue coating, and a wiry pulse. Although the above symptoms share the manifestations of neck stiffness, opisthotonos, and convulsions, their disease causes differ. It is often due to trauma or falls that damage the skin and muscles, or sores and ulcers that fester and are invaded by external wind-toxins, leading to constriction of the Yangming collaterals and resulting in lockjaw. When caused by wind, it is called "tetanus"; when caused by dampness, it is termed "dampness injury." Although alternating chills and fever may also occur, the overall condition differs from external contraction. There is facial muscle spasm, presenting a typical sardonic smile. In severe cases, when the toxins attack the heart, it may lead to unconsciousness. Compared to other lockjaw and unconsciousness conditions, it can be distinguished by medical history, disease cause, and clinical manifestations. Treatment should focus on calming convulsions and dispelling wind, particularly using insect-based formulas to dispel wind and relieve convulsions. Select Jade-like Vitality Powder combined with Five Tigers Wind-Chasing Powder with modifications.

External contraction wind-cold and interior heat exuberance are both caused by exposure to external pathogens, and share symptoms such as fever, lockjaw, and neck stiffness. However, the disease causes differ in terms of cold and heat, and the location of the disease varies between the exterior and interior.

The symptom of lockjaw often appears simultaneously with neck stiffness, unconsciousness, muteness, spasms, and convulsions. It can be caused by both internal damage and external contraction, and there are differences in cold, heat, deficiency, and excess. Therefore, treatment must be based on a holistic pattern differentiation. However, due to the urgency of the condition, the first priority is to open the jaw, so local treatment can be applied. This includes grinding Smoked Plum, borneol, and raw Arisaema into powder to rub on the teeth, or using false hellebore and Curcuma Root powder to induce sneezing through the nose, or combining with acupuncture. In mild cases, the lockjaw will open; in severe cases, further treatment based on the above pattern differentiation is required.

bubble_chart Documentation

1. "Secret Transmission of Essential Treatments for Lockjaw": "Due to exposure to improper qi, there is a sudden reversal cold of hands and feet, skin foxtail millet-like eruptions, a greenish-black complexion on the face and head, unsettled spirit or incoherent speech, tight teeth lockjaw, or dizziness and fainting, unconsciousness, this is sudden syncope. ... Storax pills should be administered, and once slightly awake, regulate qi powder and Stomach-Calming Powder should be taken."
2. "Chapter on Dampness-Heat Diseases": "In the pattern of dampness and heat, within three to four days there is lockjaw, limbs pulling and contracting, and in severe cases, opisthotonos. This is due to dampness-heat invading the meridians and collaterals. Fresh Earthworm, Gentiana macrophylla, Chinese Clematis Root, Talc, Cocklebur Fruit, towel gourd stem, kadsura pepper stem, and wine-stir-fried Coptis should be used."