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The pulse in trauma surgery must be diagnosed with absolute precision. In cases of blood stasis (accumulation of stagnant blood), the pulse should be surging (Hong); in cases of blood loss, a surging pulse is difficult to grasp and indicates poor prognosis. If blood stasis is located in the middle of the body, a firm and large pulse (Lao Da) is appropriate. If the pulse is deep, choppy, and faint, few will recover. Various symptoms of blood loss invariably present with a knifelike pulse (Kou Mai - floating, large, and empty in the center, like pressing on a scallion). A slow and small pulse is auspicious, while a rapid and large pulse causes great concern. A floating-knifelike or slow-choppy pulse is suitable for patients with blood loss. However, if the pulse is both rapid and large, it indicates that pathogenic factors are prevailing and the condition is difficult to treat. If the pulse in blood stasis is faint, the primordial qi (Yuan Qi) must be deficient. When the pulse contradicts the symptoms, harsh and potent treatments cannot be applied. On the left hand, if the three positions (Cun, Guan, Chi) show a floating, tight, and wiry pulse, it indicates external contraction of wind-cold. On the right hand, if the three positions show a surging and excess pulse, it indicates internal injury with blood stasis. The pulse may be either deep or floating, indicating cold coagulation and qi binding. The pulse may suddenly become sparse or rapid, indicating unpredictable transmission and transformation. A deep, slippery, and tight pulse suggests the formation of phlegm and blood stasis. A floating, slippery, and rapid pulse indicates the malignancy of wind-phlegm. If all six pulses are indistinct, fortune and misfortune are hard to discern. A harmonious and spirited pulse indicates survival even in critical conditions. In cases of severe trauma and extreme pain, the intermittent pulse (Dai Mai - pulse with regular pauses) may appear; this can still be treated, so there is no need for alarm. To master these essentials, one must study carefully.

"Jin Chuang" (Metal Wounds) refers to injuries caused by blades such as knives, axes, swords, and edges, hence the name. Wood corresponds to the authority of spring, and metal corresponds to the decree of autumn. In spring, all things begin to grow, so spring belongs to the Zhen trigram, representing the qi of Jia Wood in the East; in autumn, all things wither, so metal belongs to the Dui trigram, representing the qi of Geng Metal in the West. Regarding the color of Jin Chuang wounds, pale red is most desirable, indicating more good than bad omens; purple-black is most ominous, indicating more bad than good omens. Since metal corresponds to the Lung organ, patients with Jin Chuang should avoid coughing, vomiting, and hiccups, and it is advisable to strictly avoid wind. Wind belongs to the Xun trigram and is the qi of the Liver. The wound belongs to Geng Metal and is a manifestation of the Lung. If the wound is invaded by wind pathogens, wood becomes excessive and generates fire, which counter-attacks Lung Metal, resulting in tetanus (Po Shang Feng). This leads to swelling of the wound, ulceration with pus discharge, and the emergence of various symptoms. Severe cases involve aversion to cold with high fever, lockjaw, strabismus, body rigidity, opisthotonos (arched back), imminent death, and untreatable fatality. Diagnosis requires distinguishing the depth of the wound, the deficiency or excess of the pulse, the age of the patient, and the strength or weakness of their constitution. If stomach qi is robust and diet is normal, this is the best scenario. Because Spleen and Stomach belong to Earth, and Earth generates all things, they are the origin of yang qi. When yang qi is strong, yin blood is easily generated. One must especially abstain from anger and desire; anger causes the wound to burst and polyps to form, while desire causes the wound to rot and damages new muscle tissue. Treatment relies on regulating the meridians and channels to turn danger into safety.

For initial treatment of Jin Chuang: For mild cases, when bleeding occurs, use hemostatic cotton wool to seal the wound, stopping the blood quickly. If no other infection occurs, healing will occur naturally upon scabbing. For severe cases where tendons are severed and blood flows profusely, apply Rusheng Jindao San (Sage Golden Knife Powder), bind with hemostatic cotton wool. After bleeding stops, if swelling and ulceration occur, remove the previous medicine, apply Yuhong Gao (Jade Red Ointment), and cover with Tuoseng Gao (Monk's Paste) to relieve pain and generate flesh. Initially administer Sanhuang Baola Wan (Three Yellows Precious Wax Pill); if swelling and pain persist, administer Lidong Wan. If excessive blood loss occurs, manifesting as yellowish complexion and blackened vision, do not attack blood stasis; instead, administer Bazhen Tang (Eight Treasures Decoction). In severe cases, administer Danshen Tang (Single Ginseng Decoction) to first consolidate the root. At the time of initial injury, hot water washing is strictly forbidden to avoid the toxicity of heat and fire. If the wound swells, ulcerates, and discharges pus, wash clean with Gancong Jian (Sweet Onion Decoction), then apply Jinqiang Tieshan San (Golden Spear Iron Fan Powder) to absorb dampness and draw out pus, cover with Yuhong Gao to relieve pain and generate flesh, and protect against wind pathogens to prevent future complications. All herbal decoctions should primarily focus on harmonizing and nourishing the defensive qi (Wei Qi). If symptoms of wind injury, fever, swelling, and pain appear, and the pulse is floating and weak, the disease is in the Taiyang (Greater Yang) channel, and Qianghuo Tang (Notopterygium Decoction) should be used to induce sweating. If the pulse is long and forceful, the disease is in the Yangming (Yang Brightness) channel, and Chengqi Tang (Stomach-Purging Decoction) should be used to purge downward. If the pulse is tight and wiry, the disease is in the Shaoyang (Lesser Yang) channel, and Chaihu Tang (Bupleurum Decoction) should be used to harmonize. If the pathogen transmits inward, it becomes untreatable. Jin Chuang varies in changes, each requiring specific treatments. If injured by weapons in border regions, without effective medicines, how can one cure it? The "Huling Jing" states: When a person is injured by weapons and bleeds, they will be extremely thirsty. Do not recklessly give hot water or hot wine. Instead, provide dry food and fatty substances to quench thirst, which causes no harm. Even hot porridge should not be drunk in large quantities, as excessive drinking causes blood to boil and flow uncontrollably. There are eight taboos: 1. Avoid cursing and anger; 2. Avoid joyful laughter; 3. Avoid loud shouting; 4. Avoid physical labor; 5. Avoid reckless movement; 6. Avoid hot soups and porridges; 7. Avoid excessive alcohol; 8. Avoid sour and salty foods. Violating these eight rarely results in survival. There are also nine untreatable conditions: injury to the brain, injury to Tiancang (a specific head point), injury to the pulsing artery in the arm, injury to the large and small intestines, and injury to the five zang organs. These nine are fatal. There are four difficult-to-treat conditions: broken brain with marrow leakage, boiling sounds in the throat, fixed staring eyes, and pain in uninjured areas. The classics state: Unstoppable bleeding, red front and black rear, or rotting muscles and solid cold coagulation, make the wound difficult to heal. These four conditions are untreatable. Further palpation of the pulse shows that deficiency, fine, deep, small, harmonious, and slow pulses indicate life, while floating, surging, rapid, large, urgent, and swift pulses indicate death. If excessive blood loss occurs, urgently administer Ginseng to tonify qi, which embodies the principle of "yang generation leading to yin growth."