Essentials of Orthopaedics

Essentials of Orthopaedics is a specialized work on orthopaedics and traumatology in Chinese medicine by the Ming-dynasty physician Xue Ji, completed in the eighth year of the Jiajing reign (1529). The book is divided into two volumes. The upper volume covers the major principles of orthopaedic treatment, divided into four sections—major principles of orthopaedic treatment, treatment experiences of injury from falls and beatings, treatment experiences of falls and metal wounds, and treatment experiences of scalds and burns—containing nineteen major principles for treating internal injuries and sixty-five case records (about eighty-five cases). The lower volume contains more than seventy formulae for treating injuries, including oral decoctions, powders, pills, and elixirs as well as external remedies such as poultices, washes, and plasters. It covers classic formulae such as the Four Substances Decoction, the Decoction for Tonifying the Middle and Benefiting Qi, the Eight Treasures Decoction, and the Six-Ingredient Rehmannia Pill. The book's greatest distinction is that it was the first to systematically expound the theory of "internal treatment" in traumatology. Xue Ji advanced the holistic concept that "when the limbs are injured externally, the qi and blood are injured internally," holding that injuries from falls, blades, scalds, and burns are not merely local damage but affect the viscera and qi and blood. Diagnosis and treatment must therefore "seek the principles of the pulse, examine deficiency and excess, clearly discern the viscera, and clearly distinguish qi and blood," emphasizing pulse diagnosis and holistic pattern differentiation rather than confining attention to the site of injury. Treatment centered on gentle tonification: in treating qi, tonifying qi came first; in treating blood, tonifying qi and nourishing blood were combined with invigorating blood and dispelling stasis, with particular attention to the spleen and stomach's transportive function and to the essence of the liver and kidneys. He opposed the routine use of cold, harsh, draining remedies and did not approve of relying solely on manual techniques and external treatment. The book also records conditions such as "bastinado wounds," which carry a judicial-trauma background and possess special historical value. Essentials of Orthopaedics directly influenced the compilation of the Qing-dynasty Golden Mirror of Medicine: Essential Teachings on Bone Setting, and is a foundational work of the internal-treatment school of Chinese traumatology; to this day it remains required reading in the clinical practice and teaching of orthopaedics and traumatology.