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Hezi stated: For injuries resulting from falling from horses, plunging into wells, beating, or striking; as well as sprains, fractures, and whip wounds with swelling and pain that does not cease, a drastic purgative method may be employed to induce defecation twenty to thirty times. Once the pain ceases and the swelling subsides, one should then administer herbs such as Tongjing San (Unblocking Meridian Powder) or Daoshui Wan (Water-Guiding Pill), or combine them with decoctions for purgation. Subsequently, herbs that harmonize blood, reduce swelling, and detoxify should be taken.

My commentary: Hezi applied drastic purgatives to cases of carriage falls, horse falls, whip wounds, and sprains. For those presenting with mental agitation and lockjaw, he attributed this to "startle phlegm" blocking the upper jiao, and prescribed Sansheng San (Three Sages Powder) to induce vomiting first, followed by purgation. Although this method is drastic, if there is indeed startle phlegm and blood stasis retained internally, with pain and swelling manifesting externally, it can achieve swift results. However, for patients with excessive bleeding, the elderly, the weak, or those with a large and deficient pulse, one must investigate the root cause carefully.

Respectfully noting: Injuries from beating/striking or metal blades are caused by external有形 (tangible) objects injuring the body, rather than diseases arising internally from qi dynamics. These injuries affect flesh, blood, tendons, and bones, differing from diseases caused by the Six Evils (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) or Seven Emotions (Joy, Anger, Worry, Overthinking, Sadness, Fear, Fright), which have distinctions between affecting the Qi level or Blood level. Therefore, injury syndromes are specifically analyzed from the perspective of Blood. However, one must distinguish between syndromes of blood stasis retention and those of excessive blood loss. Generally, those beaten or fallen who have intact skin but internal damage inevitably have blood stasis. Conversely, those injured by metal blades with broken skin and bleeding, or those suffering from excessive blood loss, require different treatments. For blood stasis, purgative methods to expel stasis are appropriate; for excessive blood loss, tonification should be combined. One must also observe differences in the location (upper/lower), severity (light/heavy), and depth (superficial/deep) of the injury, as well as variations in the abundance of Qi and Blood in different meridians. The treatment should primarily focus on expelling blood stasis, unblocking meridians, harmonizing blood to stop pain, and subsequently regulating Qi, nourishing Blood, and tonifying Stomach Qi. This approach is invariably effective. Recently, I observed soldiers within a besieged city being treated regardless of whether the injury was on the head, face, hands, feet, chest, or back, and regardless of severity. Physicians uniformly used Rhubarb (Dahuang) and similar drugs for purgation. When Rhubarb became scarce, they substituted it with Croton Seed (Badou), believing that failing to purge the "toxic qi" early would lead to critical conditions. Even minor finger injuries were subjected to purgation. They failed to realize that Rhubarb is suitable only for those with blood stasis; it is contraindicated for those with excessive blood loss and deficient Yuan Qi and Stomach Qi. Furthermore, Croton Seed is hot and toxic, capable only of breaking down hard accumulations, making its use for these injuries particularly inappropriate. Consequently, some patients experienced pulses becoming harder and larger after taking purgatives. Physicians, failing to examine this correctly, assumed the blood stasis was not yet cleared and administered further purgation, leading to premature death. Human life is at stake; how can one not be cautious?