Library

After the ulceration of sores and carbuncles, there are occasional cases of bleeding. By distinguishing their color and form, and tracing their etiology and pathogenesis, patterns can be identified and discussed. At the initial moment when the knife or needle is applied, pus overflows with blood; the blood is bright red, originating from the puncture wound in the skin and flesh, rather than being inherently mixed within the pus (This occurs mainly in the early stage, as vessels are prone to leakage at this time. Crying causes fire to rise and qi to ascend, compounded by the anger-induced fire of the Heart and Liver meridians, leading to more profuse bleeding. For furuncles occurring in summer heat, which are most common in children, needling should only be performed when the skin is thin and pus is abundant. Early needling results in excessive blood and insufficient pus, which is not ideal.) In sores caused by labor injuring the collaterals, blood from the collaterals may overflow, resulting in a larger volume of blood; in such cases, the puncture site should be covered to stop the bleeding. This is because it is merely circulating blood within the collaterals that should not be allowed to spill recklessly. In cases where the ulcer is excessively large, causing the major collaterals to undergo putrefaction, any movement may trigger a continuous flow of fresh blood. It is difficult to treat by purging or to stop easily. The patient should be kept calm and still, and surgical intervention on the damaged major collateral is required to arrest the hemorrhage. If the post-ulceration discharge is impure, mixed with blood, appearing neither white nor red but resembling peach blossom color, it indicates deficiency of Yuan Qi (Original Qi), with blood overflowing along with putrid matter; this condition requires clearing and nourishing therapies. If Yuan Qi has already collapsed, the post-ulceration discharge fails to form proper pus or blood, becoming turbid and greasy; this represents "bai jiang" (decayed plasma), a hopeless condition. Hemangiomas (blood tumors) should not be pricked indiscriminately. If mistakenly punctured due to lack of knowledge, bleeding will not cease, potentially leading to disastrous consequences. There are also cases where an ulcer initially shows no bleeding but suddenly spurts fresh blood. This may result from excessive physical activity damaging major collaterals; if rest and care are observed, injury may be avoided. Alternatively, severe anger injuring the Liver may cause blood to surge with qi; cooling the blood and soothing the Liver is often effective. Additionally, conditions such as "xue jian" (blood arrow), "xue zhi" (blood mole), "ji nu" (muscle petechiae), and "da nu" (severe hemorrhage) involve spontaneous bleeding without obvious cause. Although these do not belong to the category of carbuncles and ulcers, they are external manifestations, and practitioners of surgery must be familiar with them. In summary, spontaneous bleeding without apparent cause is due to surging qi and fire, causing blood collaterals to rupture. Large doses of herbs to clear Heart and Liver fire and suppress it with sedating agents are indicated, allowing the Dragon Fire and Ministerial Fire to settle, thereby calming the turbulent waves. Such severe hemorrhage cannot be remedied by meager efforts like pouring a cup of water on a burning cartload of straw.