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Yaoshan stated: For blood-related injuries in orthopedics, Siwu Tang (Four Substances Decoction) serves as the principal formula, used for tonification after hemorrhage and for resolving stasis. Generally, internal accumulation of unresolved stasis is treated according to three locations: for stasis in the middle jiao (Middle Burner), Taoren Chengqi Tang (Peach Kernel and Rhubarb Decoction) is essential; for stasis in the lower jiao (Lower Burner), Didang Tang (Definitely Break Through Decoction) is used to promote unblocking and purgation. If external pathogens are involved, physicians should adjust prescriptions according to the four seasons: in spring, Wuji San (Five Accumulations Powder) or Xiangsu Yin (Fragrant Perilla Drink); in summer, Wuling San (Five Ling Powder) or Xiangru Yin (Mosla Drink); in autumn, Huoxiang Zhengqi San (Agastache Powder to Rectify Qi); in winter, Shuangjie San (Double Resolution Powder).

Furthermore, regarding fever following trauma, one must distinguish between yin and yang deficiency: for yin deficiency, Danggui Buxue Tang (Angelica Tonifying Blood Decoction) is used; for yang collapse, Sijunzi Tang (Four Gentlemen Decoction) with added Fuzi (Aconite Lateral Root) and Shengjiang (Fresh Ginger) is indicated. When accompanied by exterior symptoms and body pain, deficiency and excess must be carefully distinguished: for those with robust constitution, Shufeng Baidu San (Wind-Dispersing and Toxin-Vanquishing Powder) is used; for those with weak qi, Qianghuo Ruxiang Tang (Notopterygium and Frankincense Decoction) is prescribed. At the initial stage of injury, select formulas based on symptoms: for unconsciousness due to coagulated stasis, Huaruishi San (Flower Porphyry Stone Powder) is used; for chest tightness due to phlegm confusing the heart, Suhexiang Wan (Styrax Pill) is administered; for diffuse stasis infiltration, Congxi Fa (Scallion Moxibustion Method) is applied; for excessive blood loss, Shengyu Tang (Savior's Life Decoction) is used; for restlessness and insomnia, Jiawei Guipi Tang (Modified Heart-Spleen Tonifying Decoction) is indicated; for dizziness, vomiting, and abdominal distension, Liujunzi Tang (Six Gentlemen Decoction) is prescribed.

Between the third and fifth days, complications may arise: for wheezing and coughing, Shenru Erwei Tang (Ginseng and Perilla Two-Ingredient Decoction) or Shiwei Shenru Tang (Ten-Ingredient Ginseng and Perilla Decoction) are used; for thirst, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) or Zhuye Huangqin Tang (Bamboo Leaf and Scutellaria Decoction) are indicated; for heat in the blood causing agitation, Danggui Buxue Tang is still used; for sinking of qi deficiency, Buzhong Yiqi Tang (Center-Boosting and Qi-Generating Decoction) is used to raise; for stomach fire causing vomiting, Jiawei Zhiqin Qingwei San (Modified Gardenia and Scutellaria Stomach-Clearing Powder) is used; for spleen deficiency caused by cold-collapsing medicines, Liujunzi Tang is used to tonify the spleen. After this period, regulation is more important: for vomiting black fluid, Jiawei Baihe San (Modified Lily Bulb Powder) or Xionggui Tang (Ligusticum and Angelica Decoction) are used; for blazing liver fire, Jiawei Xiaoyao San (Modified Free Wanderer Powder) is added to; for internal blood stasis causing vomiting, Siwu Tang with Chaihu (Bupleurum Root) and Huangqin (Scutellaria Root) is used; for collapse of yuan qi (Original Qi), Renshen Dushen Tang (Single Ginseng Decoction) is used.

Alternatively, for bone and tendon pain due to liver and kidney injury, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) is used; for muscle pain due to nutritive and defensive stagnation, Fuyuan Tongqi San (Restoring Origin and Promoting Qi Circulation Powder) is used. For pain due to excessive fire, Xiao Chaihu Tang (Minor Bupleurum Decoction) with Zhizi (Gardenia Fruit) and Huanglian (Coptis Rhizome) is used; for malice caused by damp-phlegm, Erchen Tang (Two-Aged Decoction) with modifications is used. For headache, Danggui Buxue Tang, Anshen Tang (Calming Spirit Decoction), and Buzhong Yiqi Tang are used; for chest pain, Sijunzi Tang, Siwu Tang, and Guipi Tang are used. However, for lower back pain due to lingering blood stasis, PoXue San (Blood-Breaking Powder) and Shujin San (Tendon-Relaxing Powder) are used for excess patterns, while Siwu Tang is used for deficiency patterns; for excess patterns, Taoren Chengqi Tang may also be used. For yin pain with white turbid urine, Xiao Chaihu Tang is appropriate; for liver meridian stagnant fire, Shanzhizi (Gardenia Fruit), Huangqin, Huanglian, and Shengjun (Raw Rhubarb) are added.

Similarly, for distending pain in the hypochondrium, distinguish between obstruction and patency: if obstructed due to stasis aggregation, Chexiao Huoxue Tang (Remove Stasis and Invigorate Blood Decoction) is used; if patent, indicating liver fire, Xiao Chaihu Tang with Zhizi and Qingpi (Aged Tangerine Peel) is used. For abdominal pain after purgation, observe yin and yang: for yang injury with aversion to cold, Shiquan Dabu Tang (Complete Great Tonifying Decoction) is employed; for yin injury with fever, Siwu Tang with Baizhu (Atractylodes Macrocephala Rhizome) and Renshen (Ginseng Radix) is used. For constipation, Runchang Wan (Intestine-Moistening Pill) or Daozhi Tang (Guide Out Stagnation Decoction) are used; for blood-deficiency constipation, Yuzhu San (Jade Candle Powder) harmonizes; for diarrhea, Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction) or Qingzao Tang (Clear Dryness Decoction) are used; for kidney failure and spleen diarrhea, Pogu Zhi (Psoralea Fruit) and Rouguou (Myristica Seed) are used.

For cyanosis without ulceration, which indicates weakness, use external warming and internal supporting methods; for failure of new flesh growth due to deficiency, strongly add warming and tonifying agents. Regarding wind from broken skin, differentiate exterior and interior; for spasms, distinguish between flexible and rigid types: drink Baizhu Tang (Atractylodes Macrocephala Decoction) for flexible spasms, and Gegen Tang (Kudzu Decoction) for rigid spasms; take Qianghuo Fangfeng Tang (Notopterygium and Saposhnikovia Decoction) for exterior conditions, and Xiaoxiong Huang Tang (Minor Ligusticum and Astragalus Decoction) for interior conditions; Qiangma Tang (Notopterygium and Ephedra Decoction) is a harmonizing agent for both exterior and interior, while Yuzhen San (Jade Truth Powder) is the general formula for this condition. The ultimate secret lies in nourishing blood and managing trauma. Short phrases cannot exhaustively explain these principles; detailed study of longer texts is required.

*Shangsun Lun* (Treatise on Trauma) states: Treating trauma requires seeking its source, observing the severity of the disease, and assessing the depth of the injury. From head to toe, any part of the body can suffer cuts, blows, falls, or blade wounds. Each of these conditions has specific treatments; some require resolving the exterior and interior before administering trauma-specific medicines. Physicians must follow these principles. However, medical practice relies on intuitive understanding; those lacking this insight are not good physicians. Some, being dull-witted, fail to observe the severity of symptoms or the depth of injury, administering trauma medicines before addressing the exterior-interior dynamics, leading to many errors. This may cause phlegm-saliva to rush upward or blockages in the zang-fu organs. A slight deviation leads to great error. As the saying goes, "If a physician does not practice for three generations, do not take their medicine," this is indeed true.

Liu Zongnong stated: Injuries from blows, falls, or metal blades are external diseases not caused by internal qi movement but by tangible external objects damaging flesh, blood, tendons, and bones. Unlike diseases caused by the six excesses (pathogenic factors) or seven emotions, which have distinctions between qi and blood levels, trauma specifically concerns blood. One must distinguish between stasis accumulation and excessive blood loss. Blows and falls where the skin remains intact but internal damage occurs inevitably involve stasis; whereas blade wounds causing bleeding or excessive blood loss represent different pathologies requiring different treatments. For stasis, purgative and resolving methods are suitable; for blood loss, tonification combined with resolution is necessary. Furthermore, injuries vary in location (upper/lower), severity, and depth, and differ in the abundance of qi and blood in various meridians. The priority is to first eliminate stasis, unblock meridians, harmonize blood, and stop pain, followed by regulating qi, nourishing blood, and tonifying stomach qi, ensuring efficacy.

*Zhengzhi Zhunsheng* (Standard for Diagnosis and Treatment) medication aphorism states: For injuries from tree crushing or falling from heights, these injuries disturb the four limbs and five zang organs, inevitably involving evil blood (stasis). Nausea is particularly feared. First administer heart-clearing medicines, blood-resolving medicines, and medicines to unblock the intestines and bladder in sequence. Add child's urine to the decoction just before administration for immediate effect. Using only intestinal/bladder-unblocking medicines may cause blockage, which is very harmful. Clear the heart first, then unblock, naturally avoiding drowsiness, irritability, and evil blood contaminating the heart. Then administer pain-relieving medicines to stop pain, or use modifications of the Twenty-Five Ingredient Medicine.

For severe falls, knife/stone injuries, or other heavy traumas, first take heart-clearing medicine, then child's urine, then blood-removing medicine. If the injury is not yet clotted and blood flows from the wound; or if clots are inside and expelled via the large intestine after medication; or if clots are outside and dispersed by medication; or if clots rise to the upper burner and are vomited out; then mix the Twenty-Five Ingredient Medicine with ginger water or Jiedixin (Centella Decoction), mint water is also acceptable.

For sprains and fractures/dislocations, Hetoushao San (Polygonum Multiflorum Powder) is conveniently used. For those with fever and robust constitution, Shufeng Baixue San (Wind-Dispersing and Blood-Resolving Powder) is used. For those with cold constitution and weakness, Wuji Jiaojia San (Five Accumulations Combined Powder) is used. Later, regulate with yellow, white, red, and black powders, Huoxue Dan (Invigorate Blood Pellet), and Busun Dan (Tonify Trauma Pellet).

For fractures and dislocations, avoid purgative stasis-resolving medicines and bowel-unblocking medicines; instead, use wind-dispersing and qi-smoothing agents to harmonize blood, stabilize pain, and tonify trauma.

For blows, cuts, or falls from height causing stasis attacking the heart and inability to speak, use Dusheng San (Single Miracle Powder) and blood-breaking medicines to expel stasis, restoring speech, followed by detailed clinical treatment.

For falls injuring the hypochondrium with unbearable stasis pain, first use blood-breaking medicines and Dusheng San, then regulate with Fuyuan Huoxue Tang (Restoring Origin and Invigorating Blood Decoction).

For falls damaging skin and flesh turning purple-black, first use blood-breaking medicines, then Dusheng San, followed by Qing Shang Yuxue Tang (Clear Upper Stasis-Decaying Blood Decoction) and Xiao Xia PoXue Tang (Eliminate Lower Blood-Breaking Decoction).

For trauma with vomiting of foul blood, first use Dusheng San, then Baihe San (Lily Bulb Powder), then Shengliao Siwu Tang (Raw Material Four Substances Decoction) with Yinggu Niurugen (Hard Bone Cow Milk Root), adjusted as needed.

For cuts/axe wounds with extensive bleeding and dizziness, first take Chuan Danggui (Angelica Sinensis) and Da Chuanxiong (Ligusticum Chuanxiong) decoction. Separately decoct Baishao (White Peony Root), Shudi (Prepared Rehmannia Root), Xuanduan (Drynaria Rhizome), Fangfeng (Saposhnikovia Root), Jingjie (Schizonepeta Spike), Qianghuo (Notopterygium Rhizome), Duhuo (Angelica Pubescens Root), and Nanxing (Arisaema Rhizome), mix with child's urine for drinking; do not use alcohol. If bleeding is minimal with internal stasis, mix half Shengliao Siwu Tang and half Dusheng San, decoct and drink. For intact skin, add alcohol.

For traumatic wind (tetanus) from cuts/axes with unbearable pain, locked jaw, and opisthotonos, mix equal parts Sheng Nanxing (Raw Arisaema) and Fangfeng into powder, apply with rice wash water. Also mix hot wine and child's urine equally, take three doses to revive, then treat with Shufeng Baidu San.

For scrotal skin wounds from axes/cuts, first take Dusheng San, then pain-relieving medicine. For internal stasis, use blood-breaking medicine.

For abdominal wall rupture with evisceration, first take heart-clearing medicine mixed with child's urine, and Dusheng San, then pain-relieving medicine. For excessive bleeding, first decoct Danggui and Chuanxiong in water; then add Baishao, Shudi, Qianghuo, Duhuo, Fangfeng, Jingjie, Baizhi (Angelica Dahurica Root), and Xuanduan, decoct, and mix with Rumxiang (Frankincense) and Moyao (Myrrh) powder.

In all trauma medicines, Rumxiang and Moyao are indispensable as they effectively resolve blood and stop pain.

For dislocations, avoid Ziran Tong (Pyritum) initially; it can be used later. It is suitable for fractures but not for non-fractured dislocations; remove it when compounding trauma medicines. When using Ziran Tong, it must be calcined. Freshly calcined stone contains fire toxicity and metal toxicity, which, combined with aromatic-hot drugs, causes dryness and dispersion worse than swords/knives despite its bone-setting benefits. Beware!

For internal stasis from falls causing abdominal distension/pain or chest/hypochondriac fullness, use blood-breaking and heart-clearing medicines to unblock, leading to natural recovery. If pain persists, Dusheng San is effective. If still persistent, pain-relieving medicines are highly effective.

For blade wounds or falls with skin/flesh damage and excessive bleeding, prioritize pain relief and tonification with Danggui Buxue Tang. For intact skin, treat as stasis accumulation: first Dusheng San, then blood-breaking medicines, adjusted by syndrome. If pain persists later, use pain-relieving medicines.

The essence of trauma treatment lies in tonifying qi and blood. Quacks seek quick effects using much Ziran Tong, risking chronic illness. Initial trauma uses Musong (Sappan Wood), Huanglian (Scutellaria) to clear fire, Baizhu to harmonize the middle, decocted with child's urine. For lower injuries, purge stasis but first support tonically. For upper injuries, drink leek juice or eat with porridge. Never drink cold water; blood congeals in cold, and even a drop entering the heart causes death.

For elderly people falling from horses with immobile lower back pain, first decoct Musong, Renshen, Huangqi (Astragalus Root), Chuanxiong, Danggui, Chenpi (Aged Tangerine Peel), and Gancao (Licorice Root). Later, mix with the four colored powders, Huoxue Dan, and Busun Dan.

For stick strikes and sprains causing pain, these are stagnant blood syndromes; use blood-breaking medicines. Unbearable pain indicates blood injury; use heart-clearing medicines. If persistent, use Dusheng San.

For trauma with urinary/fecal retention, do not immediately take trauma medicines as they are hot and often taken with wine, worsening constipation. For excess patterns, add Mutong (Akebia Stem) to blood-breaking medicines; if no effect, add Mangxiao (Mirabilite). For deficiency patterns, use Siwu Tang with Zhike (Aurantii Fructus), Maren (Hemp Seed), and Taoren (Peach Kernel) to lubricate intestines. For frail patients who cannot tolerate purgation, use Siwu Tang with Chuanshanjia (Pangolin Scale).

When taking trauma medicines, avoid cold foods, fish, and beef. Beef makes pain untreatable; diseased pork and sow's meat are especially forbidden. Avoid ash wine regardless of type. Severe trauma should not use wine as it may aggravate qi or cause abdominal/chest distension. Remember this!

Trauma medicines are inherently hot to generate qi/blood for bone setting; avoid roasting. If topical application fails, oral medication will also fail.

Do not use wild herbs for trauma; they cause excessive bone growth preventing joint reduction. Combine with sovereign-minister herbs; adding warming/tonifying qi-blood herbs for decoction is better.

For injuries to hypochondrium, chest, abdomen, or ribs, use qi-unblocking, blood-harmonizing, and heart-clearing medicines. Adjust for deficiency/excess: for deficiency, combine unblocking with tonifying slowly, applying topicals first, then oral unblocking agents.

If unblocking medicines fail, use qi-smoothing agents. If abdomen is not distended and patient feels safe, it is qi closure, not blood stasis. If blood stasis is present, unblocking works, but combine with qi-smoothing to prevent chest/abdominal tightness. After qi smooths, use trauma medicines.

For drunk falls causing shoulder/back pain unable to bend/extend, if trauma medicines fail, drink black bean wine for several days; beans descend qi.

For children falling on feet, decoct Luobozhong (Radish Seed) to cure; this also smooths qi.

For trauma reduction, first take Caowu (Aconitum Carmichaelii Lateral Root) ground in hot wine, 1-2 cups. If unconscious during reduction, use Suhexiang Wan to revive; if not revived, decoct Black Bean, Fangfeng, Gancao, and Huanglian in water, cool and drink, or grind Yicao (Plantago Seed) with water. Do not use salt to dissolve. If vomiting, add Shengjiang (Fresh Ginger) juice.

These are specialized methods; patients vary in deficiency/excess, so uniform application is wrong. As in the last case, using Caowu wine for reduction, Suhexiang Wan for unconsciousness, and cold medicine if not revived, could be fatal for qi-deficient patients. Only Xue's method, treating based on syndrome and focusing on internal tonification, is advisable. Students should examine this carefully.

Yaoshan stated: Once internal treatment is clear, external applications should be distinct. For split skin and flesh, use Fengkou Yao (Sealing Wound Medicine); for continuous bleeding, use Zhixue Yao (Stop Bleeding Medicine). For severed vessels/tendons, use Xiang San (Fragrant Powder); for dislocated bones, apply Dieda Gao (Trauma Plaster). Wanling Gao (Myriad Spirits Plaster) and Jiegu Gao (Bone-Setting Plaster) treat shattered joints; Xiaozhong Gao (Swelling-Reducing Plaster) and Yiyang San (Yang-Inhibiting Powder) treat body swelling/protrusions. For induration not resolving, use Huyang Gao (Restore Yang Plaster); for lack of muscle growth, use Taiyi Gao (Supreme One Plaster). For skull fractures, use Hunyuan Gao (Primordial Unity Plaster) and Dingtong Gao (Pain-Stabilizing Plaster); for eye bruising, use Shengdihuang San (Raw Rehmannia Powder). For cheek injuries, hold Biba San (Piper Longum Powder); for lip tears, apply Jiexue Gao (Blood-Stopping Plaster). Jili Guchi San (Tribulus Tooth-Strengthening Powder) treats knocked-out teeth; Ji Zi Pi (Chicken Egg Skin) protects bitten/severed tongues. For nasal injuries, use Sibi Dan (Nasal Stuffing Elixir); for ear amputation, use Erzui Fa (Ear Attachment Method). For self-inflicted throat cuts, suture quickly; mix chicken down feathers externally with Huashi Shi San (Orpiment Powder). For abdominal rupture with evisceration, suture with hemp thread/mulberry bark; for scrotal opening/testicle prolapse, apply Bizhi Qian (Wall Spider Web) and Jinmao Gouji (Golden-haired Dog Spine Fur). For arrow splinters, use Mouse Brain and Elephant Ivory Dust; for tetanus, hot Congxi Fa (Scallion Moxibustion) is required. For whip marks on buttocks, strictly avoid cold compresses; for crush injuries to heels, use blood-breaking and invigorating methods. Hundreds of symptoms and thousands of formulas are hard to list; these colloquial phrases serve as basic guidelines for beginners.

*Zhengzhi Zhunsheng* states: For skull bone injuries with intact skin, apply Tuizhong Gao (Swelling-Reducing Plaster). For broken skin/flesh, first dust Fengkou Yao (Sealing Wound Medicine), then apply Sanxue Gao (Blood-Resolving Plaster). For broken skin with bleeding, dust Zhixue Yao (Stop Bleeding Medicine).

For blue/black facial injuries, apply Yizi San (One Purple Powder) or Zijin Gao (Purple Gold Plaster). For severe injuries, apply Burou Gao (Flesh-Tonifying Plaster).

For nose injuries from falls breaking nostrils, dust Fengkou Yao on the wound, apply Sanxue Gao externally to reduce swelling.

For ears cut or beaten off, whether detached upwards/downwards or attached downwards/upwards, internally dust Fengkou Yao, externally apply Tuizhong Gao.

For lip/mouth injuries from cuts/falls breaking skin/flesh, first suture with Sangbaipi (Mulberry Bark), apply Fengkou Yao; then apply powder, securing the sealed medicine to prevent opening. Alternatively, apply Ji Zi You Huang (Chicken Egg Yolk Oil), dust Jinmao Gouji Mao (Golden-haired Dog Spine Fur) thinly externally, reapply Fengkou Yao. Next day, clean with tea, dust powder, change once daily. On the eighth day, cut threads, dust powder again.

For cheek/jaw injuries from cuts/falls breaking skin/flesh, fill wound with Fengkou Yao, apply Sanxue Gao externally. For contusions without broken skin, apply Burou Gao.

For accidental tongue severance (not complete), apply Fengkou Yao, change 2-3 times daily; fully healed in 7-8 days.

For teeth knocked out by blows/cuts, dust Buchi San (Muscle-Replenishing Powder).

For broken teeth not loose, dust Furong Gao Mo (Hibiscus Plaster Powder). For loose teeth, burn Jili Gen (Tribulus Root) to char, powder, and rub frequently to secure.

For throat cutting, suture inner trachea first with silk thread, then outer neck skin, apply Fengkou Yao, cover with Sanxue Gao.

For crushed fingers, moisten with Chicken Egg Yolk Oil, dust Fengkou Yao powder, cover with Sanxue Gao. For bites, apply Zelan San (Eupatorium Powder).

For chest bone bruises with external swelling and internal pain, apply Dingtong Gao externally, take blood-breaking/diuretic medicines internally.

For abdominal splits, use hemp thread or pounded mulberry bark as suture, dust Huaruishi San on thread. Suture from inside; do not suture outside skin, leave space to dust medicine. Apply Fengkou Yao or Buchi San mixed with egg white.

For torn scrotum, apply Chicken Egg Yolk Oil, spread Jinmao Gouji Mao thinly on top, dust Fengkou Yao, then apply Sanxue Gao.

For scrotal bruising/swelling, apply Burou Gao, or mix Dingtong Gao with Chi Shao (Red Peony Root), Caowu, Liangjiang (Galangal), and Rougui (Cinnamon Bark), mash with Leek Juice, apply. If no leek juice, scallion juice works. Also take diuretic medicines.

For shattered or broken bones with skin/flesh damage, first fill wound with Buchi San, apply Sanxue Gao. For fractures, apply Jiegu Gao and bandage. For broken skin with bone fracture, apply Burou Gao.

For severed tendons, mix Fengxiang (Benzoin) with Jinfei Cao (Boil-down Grass) juice, apply, then cover with Lishang Gao (Injury-Healing Plaster).

When applying splints, spread medicine evenly on paper, ensure thin overlaps at ends that do not press too thickly on flesh. Flat application prevents uneven pressure blisters. If edges are uneven, gaps occur causing blisters. Remember this!

For bone-setting plasters causing persistent pain, add Rumxiang, Moyao, Fengxiang, Baizhi, Rougui, Nanxing, Duhuo in measured amounts. Warmth stops pain. For axe/cut wounds, remove Rougui, Nanxing, Duhuo.

For axe/cut wounds, dose by severity. Mild: dust Buchi San. Severe: dust Fengkou Yao, bind tightly. Very severe: apply Sanxue Gao externally.