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It is also said: In cases of traumatic injury, if there is fever, treatment should be differentiated according to the yin and yang of day and night. Li Dongyuan said: Fever during the day and quietness at night indicates that Yang Qi is flourishing in the Yang aspect; quietness during the day and fever with irritability at night indicates that Yang Qi has sunk into the Yin aspect, a condition named *Re Ru Xue Shi* (Heat Entering the Blood Chamber). If there is fever and irritability both day and night, this represents Extreme Yang without Yin (Yin deficiency), and one should urgently drain the Yang and vigorously tonify the Yin. Regarding the condition of Heat Entering the Blood Chamber, it often occurs when a woman's menstruation has just begun, or due to trauma, excessive labor, or severe anger causing fever and the aforementioned symptoms, or presenting with delirious speech as if seeing spirits; in such cases, *Xiao Chai Hu Tang* (Minor Bupleurum Decoction) added with *Sheng Di Huang* (Rehmanniae Radix Recens) is appropriate. For those with Extreme Yang without Yin and blood deficiency, *Xiao Chai Hu Tang* combined with *Si Wu Tang* (Four Substance Decoction) is used. (Discussion on differentiating fever by day and night.)

It is also said: In cases of traumatic injury, if there is thirst, if thirst arises after bleeding, this is Blood depletion; treat with *Si Wu Tang* (Four Substance Decoction) added with *Bai Zhu* (Atractylodis Macrocephalae Rhizoma) to tonify. If ineffective, add *Ren Shen* (Ginseng Radix et Rhizoma) and *Huang Qi* (Astragali Radix) to tonify Qi, and double the dosage of *Dang Gui* (Angelicae Sinensis Radix) and *Shu Di Huang* (Rehmanniae Radix Preparata) to nourish Blood. If thirst arises after ulceration, the main treatment is vigorous tonification of Qi and Blood. If thirst is caused by Stomach heat consuming body fluids, use *Zhu Ye Huang Qi Tang* (Bamboo Leaf and Astragalus Decoction). If thirst is caused by internal retention of Blood stasis and fever, use *Zhu Ye Shi Gao Tang* (Bamboo Leaf and Gypsum Decoction). If thirst arises after massive discharge of pus and blood, or accompanied by red and scanty urination, or painful and obstructed urination, death may occur swiftly; this condition often follows the ulceration of carbuncles and sores, and only *Liu Wei Di Huang Wan* (Six-Ingredient Pill with Rehmannia) can save the patient. (Discussion on thirst.)

It is also said: In cases of traumatic injury, if there is vomiting, whether due to unceasing pain or due to purgative drugs, this indicates injury to Stomach Qi. Treat with *Si Jun Zi Tang* (Four Gentlemen Decoction) added with *Xiong* (Chuanxiong Rhizome), *Gui* (Dang Gui), *Ban Xia* (Pinelliae Tuber), *Huo Xiang* (Pogostemonis Herba), *Jiang* (Zingiberis Rhizoma), and *Zao* (Jujubae Fructus). If vomiting is caused by anger-induced injury, this is rebellious Qi; treat with *Xiao Chai Hu Tang* (Minor Bupleurum Decoction) added with *Shan Zhi* (Gardeniae Fructus), *Zhi Ke* (Aurantii Fructus), *Fu Ling* (Poria), and *Jie Geng* (Platycodonis Radix). If vomiting is caused by abundant Phlegm-Fire in the Stomach, treat with *Er Chen Tang* (Two-Aged Decoction) added with *Huang Lian* (Coptidis Rhizoma), *Shan Zhi*, and *Sheng Jiang* (Zingiberis Rhizoma Recens). If vomiting is caused by Stomach Qi deficiency and cold, treat with *Bu Zhong Yi Qi Tang* (Tonify the Middle and Augment the Qi Decoction) added with *Jiang* and *Zao*; or if vomiting occurs due to excessive bleeding or post-ulceration, the main treatment should be vigorous tonification of Qi and Blood. (Discussion on vomiting.)

It is also said: In cases of traumatic injury with excessive bleeding, if the face turns black and the chest is distended, or if there is pain in the diaphragm and panting, this indicates Lung Qi deficiency with Blood stasis entering the Lung. Urgently rescue with *Ren Shen Su Mu Yin* (Ginseng and Sappanwood Drink). If there is hemoptysis or epistaxis, this is due to excessive Fire and rebellious Qi with blood accumulating in the Lung; rescue with *Shi Wei Ren Shen Yin* (Ten-Ingredient Ginseng Drink) added with *Shan Zhi*, *Huang Qin* (Scutellariae Radix), and *Su Mu* (Sappanwood). The condition of a black face with panting is not discussed in other texts; if physicians do not understand it, the patient will surely die. Only in *Chan Bao Bai Wen* (Hundred Questions on Obstetrics) is it stated: For postpartum women with Blood stasis entering the Lung, causing a black face and panting, rescue with *Ren Shen Yin* (Ginseng Drink); the formula uses one liang of *Ren Shen* and two liang of *Su Mu* as one dose for decoction and administration. (Discussion on black face with panting.)

It is also said: In cases of traumatic injury, if urination is difficult, if it is due to bleeding or chronic Yin deficiency with hyperactive Fire impairing excretion, one should nourish the Yin of the Bladder. If it is due to pain or chronic Qi deficiency of the Lung Meridian failing to generate Kidney Water leading to short urination, one should tonify the Qi of the Spleen and Lung; nourishing the source of transformation will naturally restore urination. If one mistakenly uses diuretic agents, it will further damage Yin, bringing disaster swiftly. The Classics state: "When Qi transforms, urine is excreted." It also states: "Without Yang, Yin cannot be generated; without Yin, Yang cannot transform." There are also cases where incessant sweating leads to short urination; once sweating stops, urination naturally becomes adequate, and one must still avoid diuretic and draining agents. (Discussion on difficult urination.)

It is also said: In cases of traumatic injury with excessive bleeding, or during ulceration and subsequent healing, if there are alternating chills and fever with pain, spontaneous or nocturnal sweating, irritability and thirst, generalized body pain, limb fatigue, lockjaw, and phlegm-fluids surging upward, these are changes resulting from extreme deficiency of Qi and Blood. The primary treatment should be vigorous tonification of Yuan Qi (Original Qi). Generally, if external pathogens invade traumatic injuries, they enter through deficiency, and one should still support the righteous Qi. Treating it merely as an external pathogen will bring swift disaster. (Discussion on internal injury of Qi and Blood.)

It is also said: In cases of traumatic injury where tendons are macerated and flesh rots, with massive discharge of pus and blood, Yang Qi follows the loss of Yin Blood, and Yuan Qi is exhausted; this is inevitable. It is rare for Qi and Blood to remain non-deficient. Wise practitioners should exercise caution. (Discussion on the inevitability of Qi and Blood deficiency.)

It is also said: In cases of traumatic injury with massive discharge of pus and blood and excessive bleeding, accompanied by aversion to cold, fever, body pain, and dry mouth, Liver Blood is naturally insufficient. Since the Liver governs the sinews, loss of Blood means sinews lack nourishment; without Blood nourishment, sinews become dry and cannot bind bones for free flexion and extension, leading to spasms. Treat with *Sheng Yu Tang* (Holy Rescue Decoction) added with *Chai Hu* (Bupleuri Radix), *Mu Gua* (Chaenomelis Fructus), *Shan Zhi*, *Mai Dong* (Ophiopogonis Radix), and *Wu Wei Zi* (Schisandrae Fructus). If treated as a Wind syndrome, sinews will become drier and Blood more depleted, making extension impossible! (Discussion on Blood deficiency causing tendon spasms.)

It is also said: In cases of traumatic injury, bone Qi deficiency and exhaustion are most taboo. The Kidneys govern bones; sufficient Kidney Water fills Liver Qi and strengthens meridians. Even with injury, if Qi and Blood are not deficient and healing occurs on time, Qi pathways will not rebel upward, and how can phlegm-fluids surge? If Kidney Qi becomes deficient, Water fails to generate Wood, causing Liver Qi to surge downward uncontrollably, and Phlegm-Qi rises with it. This is not Wind-Phlegm, but Phlegm generated by Water overflowing (Kidney deficiency leading to water flooding transforming into phlegm). Treat with *Liu Wei Di Huang Wan* (Six-Ingredient Pill with Rehmannia) or *Liu Wei Di Huang Tang* (Decoction) added with Liver-clearing herbs. (Discussion on Kidney deficiency causing Qi rebellion.)

It is also said: In cases of traumatic injury, if the lesion has healed but the leg hurts, it is because the injury was severe, pus and blood were excessive, and although the sore has healed, Liver Meridian Qi and Blood have not yet replenished. Thus, Damp-Heat takes advantage of the deficiency to invade, causing pain; this is not a Wind syndrome. Use *Ba Zhen Tang* (Eight-Treasure Decoction) added with *Niu Xi* (Achyranthis Bidentatae Radix), *Mu Gua*, *Cang Zhu* (Atractylodis Rhizoma), *Huang Bo* (Phellodendri Cortex), *Fang Ji* (Stephaniae Tetrandrae Radix), and *Zhi Gan Cao* (Prepared Licorice Root) to dispel Damp-Heat and nourish Yin Blood. After pain subsides, remove *Fang Ji* and *Huang Bo* and continue taking the formula until cured. (Discussion on Damp-Heat invading the Liver.)

It is also said: In cases of traumatic injury, generalized itching or scratching until resembling sores indicates that Blood fails to nourish the muscle and interstices; treat as Blood deficiency. If ineffective, tonify Qi concurrently. Some patients develop white scales after healing, falling off and recurring, or feeling like a layer of cloth separates the skin; this indicates dual deficiency of Qi and Blood failing to nourish the interstices. The main treatment should be vigorous tonification of Qi and Blood. Treating it as Wind-Evil is a mistake. (Discussion on generalized itching.)

It is also said: In cases of traumatic injury, numbness of limbs with normal mouth/eyes and back/waist indicates Qi deficiency. Since Blood deficiency leads to Qi deficiency, those with Blood deficiency often experience limb numbness; this is a change due to Yin deficiency and Fire movement, truly not Wind. Use ascending-Yang and nourishing-Yin formulas. Treating it as Wind brings swift danger. (Discussion on limb numbness.)

It is also said: In cases of traumatic injury, if the injury is minor and purgatives were not used, but there is limb fatigue, reduced spirit, reluctance to move, chest fullness, shortness of breath, heavy limbs, rapid breathing, fever with irritability, epigastric fullness, loss of appetite, spontaneous sweating, heavy body, and a large headache with a洪大 (Surging-Large) pulse, this is an internal injury of Yuan Qi. Treat with *Bu Zhong Yi Qi Tang* (Tonify the Middle and Augment the Qi Decoction). If in summer, it is Summer-Heat internally injuring Yuan Qi; treat with *Qing Shu Yi Qi Tang* (Clear Summer-Heat and Augment Qi Decoction). If in autumn, it is Damp-Heat internally injuring Yuan Qi; treat with *Qing Zao Tang* (Clear Dryness Decoction). (Discussion on limb fatigue.)

It is also said: In cases of traumatic injury, if the person usually has much Damp-Phlegm, or has taken acrid-hot blood-breaking drugs, Damp-Heat assists Phlegm to block pathways, causing generalized pain. Danxi said: People in the Southeast often have Phlegm generated by damp earth; Phlegm generates Heat, Heat generates Wind, resembling stroke. Only *Qing Zao Tang* or *Er Chen Tang* (Two-Aged Decoction) added with *Qiang Huo* (Notopterygii Rhizoma et Radix), *Fang Feng* (Saposhnikoviae Radix), *Dang Gui*, *Bai Shao* (Paeoniae Radix Alba), *Jie Geng*, fried *Huang Qin*, and *Cang Zhu* is suitable. (Discussion on pain from Damp-Phlegm.)

It is also said: In cases of traumatic injury, if sores appear on hands or feet in areas rarely reached by Qi and Blood, never use drugs that damage Yuan Qi. If Yuan Qi is weak and Evil Qi flourishes, spreading ulceration leads to death; non-spreading dark color also leads to death. Black color on palms/soles/dorsum of hands/feet often indicates death; loss of joints/thighs does not necessarily mean death. Therefore, if bone fracture with tendon/skin connection exists, cut it off urgently; if flesh is damaged but still connected, cut it off. Otherwise, ulceration spreads to healthy flesh, and weak patients often die. Loss of one segment of fingers/toes is treatable; loss of half a segment or bone fracture with tendon/skin connection is most difficult to treat. (Discussion on Qi obstruction causing flesh death.)

It is also said: In cases of traumatic injury, do not lightly administer Wu Tou (Aconiti Lateralis Radix Preparata) or Fu Zi (Aconiti Radix Preparata) due to their acrid-hot nature, which may assist Fire and worsen the condition. Those with chronic blood loss or Blood deficiency should absolutely avoid them, even in winter, because Blood stasis worsens with Fire, Yin Blood depletes with Fire, circulating Blood runs recklessly with Fire, injured flesh deteriorates with Fire, new flesh ulcerates with Fire, and pain intensifies with Fire. However, if the person is constitutionally deficient-cold or has Yang collapse due to illness, this rule does not apply. (Discussion on the impropriety of acrid-hot drugs.)

It is also said: In cases of traumatic injury, do not apply Xiao (Natrii Sulfas) or Huang Bo (Phellodendri Cortex) etc., as their salty-cold nature may aggravate cold and injury. If the person is constitutionally weak and painful, avoid them even in summer. Cold prevents Stomach Qi generation, impairs circulation, stagnates Blood stasis, prevents rotting flesh from discharging, and hinders new flesh growth. However, if there is internal Blood stasis, using draining drugs is acceptable. (Discussion on the impropriety of salty-cold drugs.)

It is also said: Recently, hot black sheepskin patches have been used. Mutton is hot and tonifies Qi; for severe injuries where internal flesh is damaged and suppuration is desired, this accelerates pus formation. However, without internal tonic drugs to strengthen the root, toxins invade internally; without external scarification to drain filth, healthy flesh is damaged. For mild injuries with broken skin, apply *Shen Xiao Dang Gui Gao* (Miraculous Efficacy Angelica Ointment) externally; scabs will not form, injured flesh will gradually suppurate, dead flesh will decay, swelling will subside, and dark color will fade. Internally, use *Si Wu Tang* (Four Substance Decoction) added with *Huang Lian*, *Chai Hu*, *Shan Zhi*, *Bai Zhu*, and *Fu Ling* to clear Liver Wood and strengthen Spleen Earth for self-healing. Using only black sheepskin patches instead assists toxin, deepens ulceration, and hinders healing; wise practitioners should be cautious. (Discussion on the impropriety of black sheepskin patches.)

It is also said: In cases of traumatic injury, if Blood stasis is gone but flesh erodes and refuses to heal, it belongs to dual deficiency of Qi and Blood; vigorous tonification may still be insufficient. How can one use Qi-moving and Blood-breaking drugs, thereby stealing Yuan Qi! Many doctors at the time fell into this error, causing weak patients to die. (Discussion on the impropriety of Qi-moving drugs.)

It is also said: In cases of traumatic injury from beating or falling, if there is Blood stasis at the site, only scarification should be used to release it, followed by drugs strengthening Yuan Qi. Since Qi and Blood are already damaged, reckless purging is forbidden. These are extremities where Qi and Blood are hard to reach; using Qi-moving and Blood-draining drugs further damages Spleen-Stomach Yuan Qi, making circulation to the lower parts even harder, leading to defeat syndromes. Weak patients often die prematurely. (Discussion on the impropriety of blood-draining methods.)

It is also asked: Cold-cooling drugs reduce swelling and relieve pain; why do they cause internal ulceration, prevent flesh regeneration, and even cause death? Answer: When cold-cooling agents are applied to muscles without pain sensation, upon exposure to cold, Blood coagulates and Qi stagnates. With stagnant Qi and Blood, muscles become dead Yin, losing pain perception. Thus, toxins do not exit but attack inward, often leading to death. One must know that Qi and Blood flow with warmth and coagulate with cold; extreme cold generates Heat, transforming into pus, deepening ulceration. Once Qi and Blood are defeated, muscles cannot regenerate; hoping for safety is slim! (Discussion on the impropriety of cold drugs.)

It is also said: In cases of traumatic injury from severe beating, if the skin is intact but internal flesh is eroded and mixed with blood,严重时 buttocks and thighs resemble bags filled with paste. If not scarified to vent, the harm is significant. Many officials in the Dali Temple prisons died because they failed to scarify, not realizing severe injury with internal filth. Filth must be urgently removed, followed by tonic drugs to secure the root, ensuring safety. Ancients said filth is worse than tigers and wolves, more toxic than snakes and scorpions; delaying removal kills life. This is not empty talk; physicians must reflect repeatedly. (Discussion on the impropriety of not scarifying.)

It is also said: In cases of traumatic injury, vigorous tonification of Qi and Blood is crucial; this facilitates rotting flesh discharge and promotes flesh regeneration. Often, physicians ignore Qi and Blood deficiency, overusing *Shi Xuan San* (Ten-Venations Powder) and considering *Ren Shen*, *Huang Qi*, *Xiong*, and *Gui* within it as tonics. Disliking its cloying nature, they use less than one qian, adding *Hou Po* (Magnoliae Officinalis Cortex) and *Fang Ji* as detoxifying drugs. Due to their dispersing action, doses are doubled. How does this benefit Qi and Blood, while expecting rapid suppuration, healing, and regeneration? No wonder patients suffer irritability, thirst, reduced intake, and many die. (Discussion on the impropriety of lacking tonification.)

*De Xiao Fang* says: For those crushed or pressed to death, place them comfortably, cover mouth and nose with a sleeve for the duration of a meal, wait for eyes to open, then give hot urine to drink. If initially found breathless, forcibly open mouth and灌 (pour) hot urine to drain Blood stasis. (Recorded below in *Dongui Bogam*)

It is also said: For falls or crushing injuries, shock affects four limbs and five Zang organs, inevitably leaving Evil Blood inside. Nausea is particularly feared. First, use drugs promoting bowel/bladder opening mixed with Child's Urine (*Tong Bian*). Effect is immediate; if Large and Small Intestines are unobstructed, there is no worry of distress attacking the Heart.

It is also said: For head wounds, fractures, or knife cuts, apply medicinal paste, bind tightly with horn, prevent Wind invasion, and be cautious.

It is also said: If vital organs are injured, observe the pulse; if weak and hurried, it is critical.

*Ben Cao Gang Mu* says: Sudden falls, crushing, or beating to death can be saved if the heart remains warm. Place the person in a meditative sitting posture, have someone hold the hair low, blow powder of *Ban Xia* (Pinelliae Tuber) or *Zao Jiao* (Gleditsiae Sinensis Spina) into the nose. If revived, mix Ginger Juice and Sesame Oil evenly and pour in.

*Yi Men Ru Men* says: If medicine is unavailable, urgently open mouth and pour much hot urine.

It is also said: Traumatic injuries focus on Blood. The Liver governs Blood; regardless of meridian injured, Evil Blood returns to the Liver, flows to the hypochondrium, stagnates in the abdomen causing abdominal pain. Excess patterns require purging.

It is also said: If bleeding is excessive and hematemesis continues, it is difficult to treat. Use *Su Mu* (Sappanwood) decoction to mix and take *Bang Shuang San* (Clam Frost Powder).

It is also said: External fractures damaging sinews and bones are treatable. Internal injury to organ membranes and rupture of genitalia/ears are untreatable.

*Yi Jian* says: Wounds from knives/axes, falls from heights, or impacts damaging sinews/bones/flesh cause continuous bleeding or Blood stasis accumulation. If not removed early, toxins enter the abdomen and attack the Heart.

It is also said: After beating/falling with excessive blood loss, the pulse should be weak and fine. If rapid, large, and frequent, death ensues.

*Dan Xin* says: For falls/injuries, use *Su Mu* to invigorate Blood, *Huang Lian* to descend Fire, *Bai Zhu* to harmonize the Middle, decocted with Child's Urine. If injury is upper body, drink Leek Juice.

*Hui Chun* says: For beatings with internal Blood stasis, if the pulse is strong and firm, survival; if small and weak, death. (*Mai Jing*)

*De Xiao Fang* says: Hands and feet each have six joint dislocations and four fractures. Each hand has three dislocation points, feet three, and palm base one. Bones lock together; dislocation means slipping out of the clavicle/socket. Must manipulate bone back under clavicle into socket. If outwards, push in; if inwards, push out. Simply pulling the hand makes reduction difficult; 80-90% become chronic disabilities.

It is also said: For joint dislocations/fractures of elbows, arms, waist, knees, manipulation must restore origin. First administer麻醉药 (Anesthetic Drugs) to eliminate pain, then use manual techniques.

It is also said: For bone reduction, use a piece of bamboo; fresh willow wood board is better. Clamp one side, leave the other unclamped to allow flexion/extension. Manipulate bending and straightening frequently. Otherwise, mobility is lost after healing.

It is also said: For comminuted fractures, administer麻醉药 (Anesthetic Drugs, i.e., *Ca Wu San*) or incise with a knife. For severe cases, cut bone spurs with scissors to prevent piercing flesh. For粉碎 (comminuted) fractures, remove fine bone fragments to avoid pus/blood disasters. Wash with medicinal water daily to prevent foul odor.

It is also said: For comminuted fractures, melt bone-setting medicine over fire, paste on bone, clamp firmly. Externally apply bone-clamping methods, *Huo Xue San* (Invigorate Blood Powder), *Jie Gu Dan* (Bone-Setting Pill), *Er Sheng Gao* (Two-Life Ointment), *Nuomi Gao* (Glutinous Rice Ointment).

It is also said: For washing/rinsing, use *Man Jing San*.