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In cases of minor severe trauma, after four or five days, if there is colicky abdominal pain, chest tightness with nausea and vomiting, numbness in the four limbs, or pain in the bone joints, and the pulse is either floating (Fu) or hidden (Fu), which does not match the symptoms. The fingernails turn purple, and blue veins appear in the popliteal fossae of both legs; this must be due to Sha (sand-heat toxin) and filth poison. It is appropriate to use scraping (Gua Sha), bloodletting (Fang Sha), and first administer herbs to dissipate Sha. One must not administer trauma-healing medicines, nor ginger-wine hot soups or other warm substances. If these contraindications are violated, disaster will follow immediately. The treatment method involves insufflating Renma Ping'an San into the nose, taking Chansu Wan internally, and further administering Zaizao Zijin Dan. After the Sha syndrome subsides, then administer drugs that remove blood stasis and generate new blood, so that no harm will result. There are also cases where trauma syndromes are complicated by epidemic diseases; one should first treat the epidemic disease, and then treat the trauma, so that both may recover. I frequently encounter such cases in clinical practice, so I have specially added this section.

Song on Acupoints for Bloodletting Sha (Lost)

In injury syndromes, if bleeding occurs at the injured site or from various orifices, this is due to blazing Liver Fire causing Heat in the Blood to flow recklessly outside the meridians. Use Jiawei Xiaoyao San. If Middle Qi is deficient, and Blood has no root and flows recklessly, use Jiawei Sijunzi Tang. If Middle Qi sinks, use Buzhong Yiqi Tang. If Yuan Qi (Original Qi) collapses internally, use Dushen Tang added with Pao Jiang (Prepared Ginger) and Fuzi (Prepared Aconite). If Blood stagnates internally causing hematemesis, use Siwu Tang added with Chai Hu (Bupleuri Radix) and Huang Qin (Scutellariae Radix). Excessive fatigue, or anger leading to rebellious Qi, or excessive intake of cold and toxic drugs, may damage the Yang Collaterals, resulting in hematemesis, epistaxis, or hematochezia; damaging the Yin Collaterals results in blood accumulation and clots, muscles turning dark blue/black, loss of Zang-Fu function, and failure of the meridians to perform their duties; urgently tonifying the Spleen and Lung Zang-Fu organs will lead to self-healing. If black blood is vomited, it is because beating or falling caused injury, allowing ruined blood to flow into the stomach cavity, resembling bean curd dregs, and being vomited out. For those with a robust constitution, use Baihe San; for those with a deficient constitution, use Jiawei Xionggui Tang. If bleeding is excessive, and the pulse is large and forceful but empty upon pressing, and completely absent upon heavy pressure, this is Fever due to Blood Deficiency; use Danggui Buxue Tang. If the pulse is fine, deep, and faint, feeling weak upon light pressure, this is Fever due to Yin Excess; use Sijunzi Tang added with Jiang (Ginger) and Fuzi (Aconite). If muscle twitching occurs, this is Loss of Blood; use Shengyu Tang. Fever with incessant sweating indicates Blood Collapse; use Dushen Tang. In all cases of Blood Collapse, if the pulse is solid/excess, it is difficult to treat; if the pulse is deficient/weak, it can be treated.