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The *Ling Shu Jing (Spiritual Pivot)*, Chapter "Pathogenic Factors, Zang-Fu Organs, and Disease Manifestations," states: If one suffers a fall, causing evil blood (blood outside the vessels) to remain inside, or if accompanied by great anger leading to qi ascending without descending, accumulating under the hypochondrium, the Liver will be injured.

The *Yi Zong Jin Jian (Golden Mirror of Medicine)* annotates: Due to a fall, blood has already remained inside. If further aggravated by great anger injuring the Liver, with qi ascending without descending, the retained blood and ascending qi stagnate together, accumulating under the hypochondrium, thereby injuring the Liver.

The *Nan Jing (Classic of Difficult Issues)* states: Anger causes qi to reverse, ascending without descending, thus injuring the Liver.

The *Lei Zuan Yue* annotates: The Liver stores blood, and the hypochondrium is the region traversed by the Liver meridian; therefore, blood tends to accumulate in both hypochondriac regions.

The *Yi Xue Ru Men (Introduction to Medicine)* states: In all injuries, the primary focus is on blood disorders. The Liver governs blood; regardless of which meridian is injured, evil blood inevitably returns to the Liver, flows into the hypochondrium, and stagnates in the abdomen causing distension and pain. For excess patterns, purgation is used; for deficiency patterns, regulation and tonification are employed.

The *Ling Shu Jing*, Chapter "Pathogenic Factors, Zang-Fu Organs, and Disease Manifestations," states: If one suffers blows or falls, or engages in sexual intercourse while drunk, or exposes sweating body to wind, the Spleen will be injured.

The *Yi Zong Jin Jian* annotates: Blows and falls injure the exterior body. Sexual intercourse after drunkenness, or failing to avoid wind when sweating, allows pathogenic factors to lodge in the skin and muscles, injuring the interior organs. These are all causes of Spleen injury.

The *Ling Shu Jing*, Chapter "Pathogenic Factors, Zang-Fu Organs, and Disease Manifestations," states: If one exerts force to lift heavy objects, or engages in excessive sexual activity, or takes a cold bath while sweating, the Kidney will be injured.

Yaoshan states: Lifting heavy weights damages the bones. The classics state: The Kidney governs the bones; it also states: The Kidney corresponds to the bones; hence, the Kidney is injured. Unrestrained sexual intercourse inevitably damages Kidney essence and Yuan Qi; therefore, in trauma cases, sexual intercourse is strictly contraindicated. Furthermore, the classics state: Carrying heavy loads over long distances produces sweat from the Kidney; the *Nan Jing* states: Sitting long on damp ground or forcing entry into water injures the Kidney. Water and dampness belong to Yin pathogens; Yin damaging Yin exhausts the Kidney further.

The *Su Wen (Basic Questions)*, Chapter "Essential Meaning of Pulse Diagnosis," states: When the Liver pulse is firm and long, yet the complexion is not green, it indicates disease due to falling or beating, caused by blood accumulating in the hypochondrium, leading to panting.

The *Yi Zong Jin Jian* annotates: Liver pulses vary in rigidity and flexibility, corresponding to different diseases. A Liver pulse that beats firmly and long against the fingers, with an inappropriate complexion, suggests injury from falling or beating. Blood accumulates in the hypochondrium, causing incessant panting. This is because the Jueyin Liver meridian spreads through the hypochondrium and ribs, follows behind the throat, and its branch penetrates the Liver, crosses the diaphragm, and ascends to connect with the Lung. Now, with blood accumulating in the hypochondrium, the stagnant qi of the blood steams upward to the Lung, causing panting. Additionally, the *Jing Mai Bie Lun (Treatise on Differences in Meridians)* states: Falling and fear cause panting originating from the Liver. Wading through water and falling cause panting originating from the Kidney and bones. At such times, those with robust constitution recover as qi circulates freely, while those with weak constitution develop disease. Thus, the method of diagnosis involves observing courage versus timidity, and the condition of bones, flesh, and skin to understand the pathology.

The *Ling Shu Jing*, Chapter "Pathogenic Factors, Zang-Fu Organs, and Disease Manifestations," states: An excessively large Spleen pulse indicates injury from blows or falls.

Yaoshan states: The Spleen governs muscles. In strikes and falls, muscles are injured first. Muscle injury leads to stagnation and obstruction of qi and blood, resulting in an excessively large Spleen pulse.

The *Jin Gui Yao Lue (Essential Prescriptions of the Golden Cabinet)* states: If the Cun Kou (radial artery at the wrist) pulse is floating, faint, and choppy, it typically indicates blood loss or excessive sweating. If there is no sweating, but there are sores on the body injured by knives or axes, it is due to blood loss.

Yaoshan states: According to the *Yi Zong Jin Jian* annotation: Those who lose blood do not sweat, and those who lose sweat do not lose blood. Both conditions should present with a floating, faint, and choppy pulse. Since the pulse is observed thus, indicating exhaustion without sweating, it must be blood loss. Therefore, one can infer metal wounds (lacerations from sharp instruments) or trauma-induced hemorrhage.

Cui Zixu's *Mai Jue (Pulse Mantra)* states: In various diseases involving blood loss, the pulse must appear Kou (hollow like a scallion stem). A slow and small pulse is auspicious; a rapid and large pulse is concerning. With internal accumulation of stasis, a firm and large pulse is appropriate; a deep, small, choppy, or faint pulse is detrimental.

Yaoshan states: The Kou pulse feels hollow under the finger, having edges but no center. Dai Tongfu states: Ying Qi circulates within the vessels, and the vessel relies on blood for its form. The Kou pulse is a sign of blood depletion. As blood declines and depletes, the pulse should be harmonious, slow, and small. If it becomes rapid and large, the body will be irritable, causing concern and alarm. Regarding internal accumulation of stasis causing obstruction, the pulse should be firm and large. Firm means solid; large means surging. The pulse matching the pathology requires promoting stasis resolution and guiding stagnation out, posing no harm to the condition. However, if a deep, small, choppy, or faint pulse appears, harm ensues immediately. Deep indicates interior disease; if forceful, attack methods may still be used. Small and faint pulses do not correspond to the illness. Choppy indicates blood deficiency. In stasis accumulation, presenting a choppy pulse implies essential essence damage, with ruined blood causing harm internally.

The *Mai Jing (Pulse Classic)* states: After falling from height or being beaten, with internal stasis and abdominal fullness, a firm and strong pulse indicates survival, while a small and weak pulse indicates death.

Yaoshan states: Even with severe injury, if the life pulse is harmonious and relaxed, safety can be assured. Even with mild injury, if the life pulse is deficient and hurried, caution is warranted. If internal organ injury occurs alongside external fatal trauma, and the pulse is deficient and hurried, life is in danger. Hurried pulse refers to a rapid pulse with intermittent pauses.

The *Shi Ji (Records of the Grand Historian)* records: The Qi State Mid-Lang Jiang, Po Shi, fell ill. Chunyu Yi diagnosed his pulse and stated, "Lung injury is incurable; you will die from hematuria ten days later." Indeed, he died from hematuria on the tenth day. Po Shi’s illness resulted from falling off a horse onto a stone. The reason for diagnosing lung injury from the fall was that palpating the pulse revealed Lung Yin Qi, coming in a scattered manner, irregular across multiple channels, and the complexion showed overcoming signs. The specific indication of a fall was found in the Fan Yin pulse (entering interior Yin pulse) invading the Xu Li (empty chamber/heart area) and overcoming the Lung pulse. The Lung pulse was scattered, consistent with the complexion changes. He did not die exactly on schedule because the teacher said: "If the patient can eat, they will exceed the predicted time; if they cannot eat, they will not reach it." This person liked eating millet (Shu), which governs the Lung, hence the delay. Regarding hematuria, the *Zhen Mai Fa (Pulse Diagnosis Method)* states: Patients who prefer cool, quiet places die in accordance with the pattern (Shun); those who prefer warm, active places die contrary to the pattern (Ni). This person preferred solitude and quiet, avoiding agitation, and often sat resting on a table or slept propped up, causing blood to leak downward. Yaoshan comments: Any trauma from falling entering the Lung is an incurable condition; additionally, a pulse lacking substance is also an incurable sign. This case is recorded in *Yi Shuo (Medical Stories)*. Although it lacks treatment methods and prescriptions, its detailed discussion of subtle pulse principles can enlighten future students, so it is appended here.

The *Mai Jing* states: In metal wounds with excessive bleeding, a deficient and thin pulse indicates survival, while a rapid, excess, and large pulse indicates death.

Yaoshan states: In severe hemorrhage, a surging and large pulse is most contraindicated; only a balanced and quiet pulse is suitable.

The *Mai Jing* states: In metal wounds with bleeding, a deep and small pulse indicates survival, while a floating and large pulse indicates death.

Yaoshan states: Whether the pulse corresponds to the disease determines auspiciousness or inauspiciousness via floating and deep positions, and life or death is decided by small and large qualities.

The *Mai Jing* states: In cutting or stabbing wounds with unceasing bleeding, a large pulse indicates death in seven days, while a slippery and fine pulse indicates survival.

Yaoshan states: Pulses can predict outcomes; how can one neglect studying them? Thus, I have summarized the essentials in detail.

Wang Shuhe's *Mai Jue* states: In metal wounds with abundant blood loss, a deficient, thin, and free-flowing pulse is favorable; a rapid, urgent, large, and frequent pulse endangers the body.

Zhang Shixian annotates: Metal wounds are lacerations caused by blades. Abundant blood means significant hemorrhage. Since much blood has been lost, the pulse should be deficient and thin. If instead it is rapid, urgent, large, and frequent, wind-heat will inevitably exploit the deficiency, and survival will be rare.