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Bleeding from knife wounds differs from hematemesis (vomiting blood) and epistaxis (nosebleed). A knife wound is an injury to a healthy person caused by sharp objects, lacking the pathological basis of Yin or Yang deviation. Therefore, the primary treatment is simply to stop the bleeding. Stopping one unit of blood loss preserves one unit of life. The method of stopping bleeding does not distinguish between Yin and Yang: some use cold-natured herbs applied externally to stop bleeding, such as Taohua San (Peach Blossom Powder); others use hot-natured herbs applied externally, such as Hei Jiang Hui (Charred Ginger Ash). This contrasts with hematemesis and epistaxis, which arise from pathological Qi deviations of either Yin or Yang. Thus, in treating these conditions, stopping bleeding must focus on resolving the pathogenic Qi; once the pathogenic Qi recedes, the bleeding stops. This is fundamentally different from knife wounds. However, two or three days after a knife wound, the condition becomes somewhat similar to hematemesis/epistaxis. If there is swelling and pain due to blood stasis, one should resolve the stasis. Apply Huarui Shi San (Flower Rhyolite Powder) to the wound; for swollen areas, apply a paste made of crushed Xiang Ru (Frankincense), Mo Yao (Myrrh), She Xiang (Musk), San Qi (Notoginseng), and Cong Bai (Scallion White). Once the blood stasis dissipates, the pain and swelling will naturally subside. Internally administer Lidong Wan (Lidong Pill) for treatment.

If excessive blood loss from a knife wound damages the Yin aspect, presenting with restlessness, fever, and thirst, the treatment principle is to tonify Qi to generate Blood. When Blood is sufficient, Jin Ye (Body Fluids) are produced, and thirst resolves. Use Shengyu Tang (Sage Preservation Decoction), adding Suan Zao Ren (Ziziphus Seed), Hua Fen (Trichosanthes Root), Er Cha (Child's Tea), Xiang Ru (Frankincense), Mo Yao (Myrrh), and Gan Cao (Licorice). In contrast, when treating hematemesis/epistaxis, one should nourish Blood while suppressing Qi, because internal disorders involve Qi within the Blood level, and one must prevent Qi from overwhelming Blood. Knife wounds involve Blood at the Qi level; thus, tonifying Qi to generate Blood is appropriate. Qi reaching the affected area promotes tissue regeneration; abundant Qi and Blood in the skin and muscles facilitate circulation. This differs from treating internal disorders. If there is Qi deficiency failing to control Blood, or Qi cold failing to generate Blood, formulas such as Bazhen Tang (Eight Treasures Decoction), Yangrong Tang (Nourishing Prosperity Decoction), or Shenfu Tang (Ginseng and Aconite Decoction) should be used to secure Qi thereby securing Blood. Patients with hematemesis also occasionally use such medications. However, since knife wound bleeding occurs at the Qi level, and the skin is governed by Wei Qi (Defensive Qi), breaking the skin causes Qi to leak first; hence, the focus is on tonifying Qi. Internal bleeding from hematemesis belongs to the Yin level; here, Blood is injured but Qi remains intact, so the focus is on nourishing Blood. Physicians must distinguish between external and internal causes and understand the differences within similarities and similarities within differences to master this knowledge.

A guest asked why knife wounds are prone to wind invasion. The answer is: Human defense against external pathogens relies entirely on Wei Qi (Defensive Qi). Wei Qi originates in the Bladder, spreads through the San Jiao (Triple Burner), circulates externally along the muscles, and fills the skin and hair, acting like walls protecting a house, preventing external pathogens from entering. Now that the skin and flesh are broken, it is like holes in a wall or gaps in a door, inviting thieves inside. Therefore, knife wounds are more susceptible to external contraction. Symptoms include fever, headache, trismus (lockjaw), expectoration, convulsions, and opisthotonos (arched back), all indicating disease of the Wei Qi. The only difference is the presence of bleeding. Treatment methods are listed below:

In cases without sweating, Wind-Cold has closed the pores. Use Xiaochaihu Tang (Minor Bupleurum Decoction), adding Jing Jie (Schizonepeta), Fang Feng (Saposhnikovia), and Zi Su (Perilla). Xiaochaihu Tang is originally a formula for Heat entering the Blood Chamber; for any external pathogen affecting the Blood level, Xiaochaihu Tang can regulate and harmonize. Adding herbs that promote and assist Wei Qi shifts the focus to the Wei Qi level, primarily inducing sweating. This is the treatment for tetanus (Po Shang Feng). The same principles apply to deficient patients with blood loss who contract external pathogens, and to Taiyang syndrome (Exterior Syndrome) postpartum. If excessive blood loss from a knife wound precludes further sweating, use Danggui Dihuang Tang (Angelica and Rehmannia Decoction), which is Siwu Tang (Four Substances Decoction), added with wind-dispelling herbs to nourish Blood and expel pathogens. Patients with excessive hematemesis or postpartum hemorrhage who subsequently contract cold symptoms follow the same treatment: first nourish Blood to aid the source of sweat, then ventilate Qi to resolve external pathogens.

In cases with sweating, Wind-Heat is boiling between the muscles. The treatment should clear and disperse the heat. Use Danggui Xionghuang Tang (Angelica, Chuanxiong, and Huangqi Decoction), adding Jiang Can (Silkworm) and Chan Tui (Cicada Slough). If accompanied by constipation, add Da Huang (Rhubarb). This follows the principle of 《Shanghan Lun》 (Treatise on Cold Damage): using Baihu Tang (White Tiger Decoction) for fever with sweating, and Chengqi Tang (Order the Qi Decoction) for dryness and accumulation. Physicians who grasp the spirit behind these formulas can adapt them flexibly.

Generally, knife wounds represent a disorder of Blood at the Qi level. Therefore, if the pathogen is in the Exterior, release it via the Qi level; if in the Interior, drain it via the Qi level; if in the Half-Exterior/Half-Interior, harmonize it via the Qi level. Simultaneously use Blood-invigorating herbs to mediate. When Blood is regulated, Qi is also regulated; when Qi is regulated, Blood heals more easily. Conversely, in patients with chronic blood loss, the disorder is of Qi within the Blood. If they contract a cold, one should primarily regulate Blood and use Qi-level herbs to mediate. This is similar yet distinct from the treatment of knife wounds.

For any knife wound complicated by wind invasion, crush Jiang Can (Silkworm) and Chan Tui (Cicada Slough), mix with Cong Bai (Scallion White), and apply externally. This effectively extracts wind and reduces swelling.

Ulcerated knife wounds are treated similarly to sores/ulcers. This aligns with the theory that "blood stasis transforms into pus." When coagulated blood fails to dissipate and is steamed by Qi, it transforms into pus. Blood is Yin, and Qi is Yang; Yin transforms according to Yang, so pus resembles water because it is formed by Qi transformation. Yet it is not pure water, as it derives from Blood and retains its essential nature, appearing thick and turbid like water. It is actually a mixture of Water and Blood taking form. Therefore, herbs that remove pus also remove dampness/water, and herbs that elevate pus also dry dampness. Internally, administer Bazhen Tang (Eight Treasures Decoction) with Yi Yi Ren (Coix Seed) and Mu Tong (Akebia), or Liujunzi Tang (Six Gentlemen Decoction) with Dang Gui (Angelica Sinensis) and Chi Dou Ya (Red Soybean Sprout). Externally apply Huafu Shengji San (Rot-Decaying and Flesh-Generating Powder); add Long Gu (Fossilized Bone) to elevate pus, and Zhen Zhu (Pearl) to generate flesh.

This discussion compares the blood pathology of knife wounds with that of hematemesis/epistaxis, aiming to clarify blood disorders through mutual reference. While specific treatments for knife wounds are not exhaustively detailed here, the underlying principles are established for discerning practitioners to recognize.