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Zhengti Leyao (Standard Treatise on Orthopedics) states: If bleeding occurs at the injured site or in various orifices, it is due to blazing Liver Fire (Liver Huo Chi Sheng), where heat in the blood causes it to deviate from its normal pathways and flow recklessly. Use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) to clear heat and nourish blood. If Spleen Qi (Zhong Qi) is deficient, causing blood to lose its attachment and flow recklessly, use Jiawei Sijunzi Tang (Modified Four Gentlemen Decoction) to tonify middle Qi and promote Qi to control blood. If Yuan Qi (Primal Qi) has collapsed internally and cannot hold blood, use Dushen Tang (Single Ginseng Decoction) with Pao Jiang (Prepared Ginger) to restore Yang; if ineffective, urgently add Fuzi (Prepared Aconite Root). If blood stagnates internally leading to hematemesis, use Siwu Tang (Four Substances Decoction) added with Chaihu (Bupleurum Root) and Huangqin (Scutellaria Root). Generally, injuries, overwork, anger, abdominal distension, or the mistaken use of drugs like Dahuang (Rhubarb Rhizome) can damage the Yang Collaterals (Yang Luo), resulting in hematemesis, epistaxis, hematochezia, or hematuria; damaging the Yin Collaterals (Yin Luo) results in blood stasis and clots, with muscles appearing cyanotic and dark. This indicates deficiency of Zang-Fu organs and dysfunction of the meridians; urgently tonifying the Spleen and Lung may lead to survival.

Jiujifang (Emergency Formulas) states: For those severely injured by falling or crushing, with bleeding from the mouth and ears and sudden fainting, if the complexion still shows vitality and the body remains soft, they can be saved. However, do not allow many people to crowd around, creating noise and panic, which could prevent the recovery of the frightened soul. Quickly have relatives call out to and support the patient, having them sit on the ground. Firmly grasp their hands and feet and hold them tightly. After a moment, gently move them into the arms of a relative, using a knee to press against their anus to prevent the leakage of Qi. If there is any sign of consciousness, move them to their usual sleeping place, darken the room by covering windows, continue to grasp hands and feet tightly, and do not let them lie down. Urgently take urine from a healthy boy and administer it while hot; horse urine is even better. If unavailable, human urine may be used, but discard the beginning and end portions, ensuring it is clear and free from dietary influences like garlic and scallions. Force-feed one or two cups; once it enters the throat, improvement will follow. Simultaneously, prepare Siwu Tang (Four Substances Decoction) at three to four times the usual dose, adding Taoren (Peach Seed), Honghua (Safflower), Shanzha (Hawthorn Fruit), and Sheng Dahuang (Raw Rhubarb Rhizome), each 2 liang, along with a large cup of boy's urine. In summer, add Huanglian (Coptis Rhizome) 4-5 fen. Boil rapidly with flowing water until half-cooked, pour into a bowl, and place it under the patient's nose so that the medicinal vapor is inhaled, preventing nausea. Administer warm liquid in small cups; if rejected, try again later. Do not let the patient lie down after taking the medicine. The anus must be held tight to prevent gas leakage. Do not induce defecation immediately while the medicine is acting, as this may cause Qi to escape, leading to death. Wait until there is movement and sound in the abdomen, moving up and down several times, before allowing defecation. The excrement will be entirely purple-black blood stasis; once half the toxin is cleared, sleep may be permitted. Continue until only feces are passed, then stop the medication. Otherwise, one or two more doses are acceptable. Then proceed with gradual conditioning; do not lightly use tonic medicines.

Wang Kentang stated: Regarding hemorrhage, leakage, and various forms of blood stasis and reckless flow, I initially treated them with blood-moving and stasis-breaking agents like Taoren (Peach Seed) and Dahuang (Rhubarb Rhizome) to curb their aggressive nature, treating them differently based on differentiation. Although often effective, I did not fully understand the underlying principles. Later, in Siming, I met an old friend, Su Yifangju, and we discussed various medical techniques. Yifangju said: "In my hometown, skilled physicians always use strong purgatives first when treating loss of blood and reckless flow." Someone asked, "If blood is lost and purgatives are used again, how can the deficiency withstand it?" He replied, "Since the blood is flowing recklessly and has lost its proper path, if we do not remove the accumulated stasis, reckless flow will become the norm, and how can we control it? What leaves is gone, what remains is new; where is the deficiency?" I heard this and exclaimed, "These are profound words!" My previous doubts were now resolved.

He also stated: For bleeding from the nine orifices, use Nantianzhu (Nandina Stemwood) or Xueyu Hui (Burnt Hair Ash). Self-shed hair is best, followed by hair from father and son (sharing the same origin), then male fetal hair, and finally loose hair. Wash the hair with Gengjiao (Gleditsia Sinensis fruit juice), dry it, burn it to ash, and make it into powder. Take 2 qian each time, mixed with decoction of Maogen (Imperata Rhizome). Alternatively, crush Jingye (Perilla Leaf) to extract juice and mix with wine for ingestion. Or take a handful of Ciji (Thistle), squeeze out the juice, and mix with half a cup of wine; if fresh material is unavailable, use dried powder mixed with water (3 qian). All are effective.

A formula states: Moss from walls can be used to plug wounds; juice from Cheqiancao (Plantago Herb) can be dripped; lotus pods burned and mixed with water can be applied; coal dust from pot bottoms can be ingested. Pomegranate flower petals can plug wounds; raw Radish juice can be dripped; burned Longgu (Fossilized Bones) can be insufflated; decoction of Maohua (Millet Flower) can be ingested.

Note in Jiujifang: To treat fatal cases of falls and blows, use Renzhongbai (Calculus Ureteralis) from urine pots of men and women. Refine it seven times with red vinegar, grind into powder, and send down with wine (2 qian). Vomiting black blood indicates rescue is possible. Strictly avoid moving the patient; movement renders it untreatable.

General Notes:
Kefa Lianggui (Good Rules for Practice) states: Injuries caused by solid objects affect bones and tendons and should be treated from the perspective of blood. Blood boils when heated, causing rapid harm. First, clear Liver Fire and resolve fire toxins, bleed the affected area, and harmonize the meridians so that blood stasis does not spread and muscles do not ulcerate extensively. Next, strengthen the Spleen and Stomach, improve diet, generate Qi and blood, and subdue Yin fire so that stasis decomposes easily and new flesh regenerates. This is a crucial method. Using harsh purgative drugs will worsen deficiency and stagnation, bringing immediate disaster.

Binhu Jifang (Simple Formulas from Binhu) states: To treat rolling blood stasis from falls or tidal fever, apply Dahuang (Rhubarb Rhizome) powder mixed with Ginger Juice. It turns black-purple after one night and white after two nights.

Fever:
Li Dongyuan stated: Fever during the day and quietness at night indicates Yang Qi flourishing in the Yang divisions. Quietness during the day and fever/restlessness at night indicates Yang sinking into Yin, termed Re Ru Xue Shi (Heat Entering the Blood Chamber). Fever and restlessness both day and night indicate excessive Yang without Yin; urgently drain Yang and tonify Yin.
For Heat Entering the Blood Chamber, occurring when a woman's menses arrive or due to injury, with delirium as if seeing ghosts, use Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Sheng Di Huang (Rehmannia Root) as the principal treatment. Wang Taipou stated: Intermittent fever that comes and goes unpredictably is rootless deficient fire; use Liujunzi Tang (Six Gentlemen Decoction) added with Sheng Jiang (Fresh Ginger) and Rou Gui (Cinnamon Bark); if ineffective, urgently add Fuzi (Prepared Aconite Root), or Bajie Wan (Eight-Ingredient Pill) is best.

Kefa Lianggui states: For injuries with sweating, determine Yin/Yang and Deficiency/Excess to treat. If Yin is deficient and Yang invades, spontaneous sweating occurs; use sweet-cold formulas to tonify Qi, such as Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If Yang is deficient and Yin invades, cold limbs and spontaneous sweating occur; use sweet-warm formulas to assist Yang, such as Shenfu Tang (Ginseng and Aconite Decoction). Spontaneous sweating may also result from severe pain, primarily requiring clearing Liver Fire. Spontaneous and night sweats due to Yin-Yang injury require tonifying Qi and generating Blood. Sweating specifically from the heart region stops by nourishing Heart Blood.

External Pathogens:
Chen Wenzhi stated: Injuries in all seasons with floating-tight pulse, fever, aversion to cold, and body pain indicate external pathogens. Disperse to expel pathogens: Spring uses Wuji San (Five Accumulations Powder) or Suyin Yin; Summer uses Xiangru Yin (Elsholtzia Decoction) or Wuling San (Five Ling Powder); Autumn uses Huoxiang Zhengqi San (Agaricus Rectifying Qi Powder); Winter uses Shuangjie San (Double Resolution Powder). Add Chaihu (Bupleurum Root), Qianhu (Peucedanum Root), Huangqin (Scutellaria Root) for chills and fever; Chuanxiong (Ligusticum Rhizome), Baizhi (Angelica Dahurica Root) for headache; Baizhi (Angelica Dahurica Root), Binglang (Areca Seed), Muxiang (Aucklandia Root) for gout; Banxia (Pinellia Tuber), Chenpi (Tangerine Peel) in equal parts for phlegm, decocted with Congbai (Green Onion White).

Kefa Lianggui states: In injuries with excessive bleeding or ulceration, after healing, if chills, fever, headache, night sweats, irritability, thirst, generalized pain, fatigue, trismus, or phlegm obstruction occur, these are complications due to extreme Qi and Blood deficiency. Urgently tonify Yuan Qi. External pathogens enter through deficiency in injuries; tonification is necessary, treating as external pathogens, otherwise disaster follows.

Yaoshan stated: Injuries mostly involve internal stasis, occasionally accompanied by external pathogens. Chen's discussion covers all seasons and upper/lower modifications, which is steady, but should be cross-referenced with chapters on fever for safer treatment. Students must study carefully.

Coma:
Zhengti Leyao states: For severe injury coma, urgently administer Dushen Tang (Single Ginseng Decoction). Even with internal stasis, do not purge; urgently use Huaruishi San (Flower Rhyolite Powder) to transform stasis, fearing that purging will cause Yin collapse via diarrhea. If Yuan Qi is extremely deficient, do not purge; use the aforementioned powder to transform. For internal stasis causing constipation, use Dahuang (Rhubarb Rhizome) and Poxiao (Mirabilite). For congealed blood not passing, urgently use Muxiang (Aucklandia Root) and Rougui (Cinnamon Bark) powder (2-3 qian) mixed with hot wine and administered; life returns when blood passes. For weak patients using Mirabilite and Rhubarb, add Cinnamon and Aucklandia to borrow warmth to move the cold.

Xuanhui states: For fainting from falls, administer Suhexiang Wan (Styrax Pill) mixed with wine. For traumatic injury, expel evil blood using Su Mu (Sappan Wood) decocted in wine mixed with Suhexiang Wan or Jiming San; or Huoxue Heqi Yin (Invigorate Blood and Harmonize Qi Decoction) with Dahuang and vinegar; or Boy's Urine or Su Mu wine mixed with Heishen San (Black Divine Pill) or Wuyao Shunqi San (Mayapple Regulating Qi Powder).

Chen Yuangong stated: Falling from heights causing unconsciousness is often attributed to evil blood rushing to the heart, but it is actually Qi blocked by blood. Trauma involves blood stasis attacking the heart, but sudden trauma may not disturb the heart. Falling from heights causes shock and fear of death, disturbing the heart beforehand, unlike simple trips. Thus, Qi and Blood become chaotic, leading to coma. Treatment involves expelling stasis and assisting Spleen awakening herbs to disperse blood and open Qi. Merely attacking stasis closes Qi further. Use Suqi Tang (Regulate Qi Decoction): one dose opens Qi, three doses activate blood and cure.

Gulan stated: Before falling, the heart is still; during falling, the body vibrates, so the heart cannot remain still. Since the Heart governs Blood, if the Heart is undisturbed, no stasis occurs. This view is kept for reference.

Kefa Lianggui states: In injuries with broken skin and excessive bleeding causing coma, Qi and Blood are extremely deficient; strongly tonify. If ineffective, urgently add Fuzi (Prepared Aconite Root). If falling heavily without broken skin or bleeding, causing coma, it is internal stasis; focus on dispersing. If ineffective, quickly add Wine-fried Dahuang (Rhubarb Rhizome). If complications arise after purging, it is extreme Qi/Blood deficiency; use Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction). If coma and sweating result from severe pain, it is blazing Wind-Liver; use cooling Liver and Blood herbs to stop pain and sweat. Treating as external wind accelerates danger.
Also: For head/fatal injuries with prolonged coma, finely chop Congbai (Green Onion White), mash, fry, and apply to the wound. Replace with warm applications as it cools; usually restores consciousness.

Xuanhui states: Blood confusing the Heart orifice causes coma; use Huaruishi San (Flower Rhyolite Powder) with Boy's Urine. Loss of spirit causing temporary unconsciousness requires judgment. Generally, trauma treatment focuses on tonifying Qi and moving Blood. Herbs like Ziran Tong (Natural Copper Pyrite) aid bone setting but are drying and dispersing, potentially harmful like swords, as Danxi noted.

Gulan stated: Falls injure the Liver; if stasis remains, tonifying Qi/Blood may fail to disperse stasis and worsen the condition. Only for weak patients should tonification accompany stasis expulsion.

Jiujifang: For sudden death from blows, if the chest is warm, rescue is possible even after days. Position the deceased squatting on the ground. Have someone pull the hair to press against the anus. Blow Sheng Banxia (Raw Pinellia Tuber) powder into the nose with a bamboo/paper tube. If alive, administer fresh Ginger Juice to detoxify Pinellia.

Yaoshan stated: Human urine is salty, cold, non-toxic, also called Laihui Jiu (Wheel Return Wine) or Huanyuan Tang (Restore Origin Decoction). For trauma with internal stasis and absent pulse, add wine and drink; it promotes elimination of old and generation of new, with great efficacy. Qianjin Fang uses urine for metal wounds, beating injuries, burns, etc. It also treats embedded thorns, bites, snake/scorpion stings when washed. It is a miraculous herb in orthopedics. Fan Ju survived being beaten to death and urinated upon by Wei Qi's guests, later becoming Qin Chancellor. A corrupt Ming official survived being beaten to death and urinated upon by victims' sons. These cases prove urine's efficacy, often ignored due to disgust. Life hangs in the balance; use this cheap, effective remedy on unconscious patients. If oral administration fails, urinate on the head/face to enter the orifices; revival is certain.

Jiujifang Note: For fatal falls/hanging/drowning with warm chest, drip fresh Rooster Comb Blood (male right, female left) into throat/nose; immediate revival. For breathlessness from trauma, use Xianrenchai (Nine-Mile Fragrance Leaf) juice (1 cup) orally; revival occurs if chest is warm. Named Jiuming Dan (Life-Saving Pill).

Dizziness:
Yaoshan stated: Blood deficiency leads to Yin deficiency, causing fever/thirst. Abdominal distension/vomiting implies Spleen Qi deficiency, hence tonification. Falling dizziness is Qi reversal and Blood dizziness. Jiujifang supplement: Use Cunxing (Preserved Nature) Goose Quill Feather (1 qian) mixed with old wine for revival. True Yuan deficiency failing to gather Qi causes dizziness; use tonics. Excessive bleeding dizziness responds to Xionggui Tang (Cyathula and Angelica Decoction).

Irritability:
Li Dongyuan stated: Fever, aversion to cold, extreme thirst, large but forceless pulse is not Baihu Tang syndrome; it is Blood deficiency irritability. Use Danggui Tang (Angelica Decoction). Mr. Pei stated: Muscle heat, irritability, red eyes/face, large-empty pulse indicates Blood deficiency. Mistaking this for Baihu Tang syndrome causes danger or wheezing.

Wheezing:
Yaoshan stated: Wheezing often relates to the Lung, but Neijing states: Fear/falls cause Liver wheezing; water accidents/falls cause Kidney/Bone wheezing. Differentiate treatments.

Vomiting:
Yaoshan stated: Per Xue, stomach injury from cold meds causes fine-slow pulse vomiting; urgently use Liujunzi Tang (Six Gentlemen Decoction) with Shaoyao (Peony Root) and Fuzi (Prepared Aconite Root). Stomach Fire vomiting presents with thirst/brown lips, history of heat, aggravated by spicy/warm meds; use Qingwei San (Clear Stomach Powder) with Zhizi (Gardenia Fruit), Huangqin (Scutellaria Root), Gancao (Licorice Root) for instant relief. Post-ulcer vomiting follows excessive bleeding protocols. Wrong medication harms rather than helps.

Thirst:
Li Dongyuan stated: Fever, aversion to cold, extreme thirst, large-forceless pulse is not Baihu Tang syndrome; it is Blood deficiency irritability and thirst. Use Danggui Buzhong Tang (Angelica Tonify Middle Decoction).

Anorexia:
Zhong Jun stated: A Jiangxi thief with broken ribs refused food. Used 4 liang lean pork, 1 bowl glutinous rice, 4 liang sugar mixed and eaten; healed completely with intact bones. Likely a secret recipe. I note: Blood closure with lethargy/anorexia: Deficiency uses Bajie Tang (Four Substances plus Morinda/Rhubarb); Excess uses Chengqi/Tidang formulas. Qi stagnation anorexia needs Zhishi (Bitter Orange), Baizhu (Atractylodes), Xiangfu (Cyperus), Sharen (Amomum).

Constipation:
Yaoshan stated: Zhengti Leyao: Chest/abdominal pain, constipation, coughing blood indicates stasis; use Danggui Daochi Tang (Angelica Guiding Out Decoction). Abdominal pain, constipation, severe tenderness indicates internal stasis; use Jiawei Chengqi Tang (Modified Chengqi Decoction) to purge. Abdominal stasis unresponsive to Dahuang (Rhubarb) worsening chest pain/shortness of breath: Use Rougui (Cinnamon Bark) and Muxiang (Aucklandia Root) powder (2 qian each) in hot wine to expel stasis. Cold meds cause stagnation; warm herbs move blood. Observe those using only bitter-cold agents!

Kefa Lianggui states: Injury-related dysuria due to bleeding or Yin deficiency/fire requires nourishing Bladder Yin. Due to pain or Lung Qi deficiency failing to generate Kidney Water (short urine), tonify Spleen/Lung Qi to nourish the source. Misusing diuretics damages Yin, bringing disaster. Classics state: Qi transformation produces urine; without Yang, Yin cannot generate; without Yin, Yang cannot transform. Profuse sweating with short urine resolves when sweating stops; avoid diuretics.

Stagnation:
Kefa Lianggui states: Severe blunt trauma causes muscle death even without skin break, resembling a bag of paste. Mild cases have deep stasis; urgently bleed and tonify. Otherwise, high fever, irritability, head pain, trismus resemble Tetanus (Po Shang Feng); this is internal toxic stasis; urgent bleeding resolves symptoms.
Not bleeding releases toxicity; ignore heavy injury/stasis at peril. Remove stasis urgently, then tonify to secure foundation. Ancients said stasis is worse than wolves/tigers, more toxic than snakes/scorpions; delay kills. Physicians must reflect on this!
Yaoshan stated: Per Xue, persistent swelling/pain from stasis requires bleeding; otherwise, pain recurs on cloudy days years later. Blood is Yin, following its kind.

Blood Deficiency:
Kefa Lianggui states: Severe injury with rotting flesh/pus/blood loss leads to Yang following Yin, collapsing Yuan Qi. Rarely is Qi/Blood not deficient. Wise practitioners judge this!
Itching or scratching to sores indicates Blood failing to nourish skin; treat as Blood deficiency; if ineffective, tonify Qi. Post-healing white scales or fabric-like skin separation indicates Qi/Blood deficiency failing to nourish pores; strongly tonify Qi/Blood. Treating as Wind is error.
Numbness with normal face/back indicates Qi deficiency. Blood deficiency causes numbness; this is Yin deficiency with Fire agitation, not Wind. Use raising Yang/nourishing Yin formulas. Treating as Wind is dangerous.
Injuries benefit from strong Qi/Blood tonification to facilitate sloughing and granulation. Practitioners often misuse Shixuan San (Ten Acupoints Powder), limiting Ginseng/Astragalus/Chuanxiong/Angelica due to fear of fullness, using less than 1 qian;