夫跌打损伤，坠堕磕 之证，专从血论。或有瘀血停积，或为亡血过多，然后施治，庶
不有
者，宜补而行之。更察其所伤上下轻重浅深之异，经络气血多少之殊，先逐其瘀，而后和营
止痛，自无不效。《内经》云∶形伤则痛，气伤则肿。又曰∶先肿而后痛者，形伤气也；先
痛而后肿者，气伤形也。凡打扑闪错，或恼怒气滞、血凝肿痛，或因叫号血气损伤，或过服
克伐之剂，或外敷寒凉之药，致气血凝结者，宜活血顺气之法。夫损伤杂证，不及备载，俱
分门晰类，详列于后，学人宜尽心焉。
是跌打损伤之证，恶血留内，则不分何经，皆以肝为主。盖肝主血也，败血必归于肝。
其痛多在胁肋小腹者，皆肝经之道路也。宜疏肝、调血、行经为主。王好古云∶登高坠下、撞打
等伤，心腹胸中停积瘀血；或气瘀攻冲，昏迷不醒，或寒热往来，日轻夜重，变症多端，医
者不审其原，不切脉之虚实，不分经络脏腑，妄投药剂，枉死者多矣。故临症时，须察脉之
虚实，审症轻重，药配君臣佐使，治分老幼强弱，即从上、中、下三焦分别部位∶若瘀在上
而吐血者，宜犀角地黄汤；在中者，桃仁承气汤；在下者，抵当汤。虚人，宜佐以四物汤。
若瘀散，复元通气散调之。或伤处青肿坚实，痛难转侧，脉涩而滞者，防其气瘀上冲，宜投
参黄散逐瘀，又宜复元活血汤。或受伤日久才医者，败血坚凝，宜服紫金丹逐瘀；又祛伤散
疏通为要，俟其色散淡，血和痛止为度。或有牙关紧闭，用通关散吹入鼻中取嚏，投三黄宝
蜡丸或夺命丹。如口开纳药者可治，不纳药者危。须忌湿地当风坐卧，忌食生冷硬物，忌服
寒凉药饵，恐其血凝难化，遗留后患也。凡视重伤，先解开衣服，遍观伤之重轻，穴之致命
与否，察色闻声，脉探虚实。如六脉和缓者生；九候不调者死。阴囊内有肾子者，可治；如
入小腹者，不治。如牙关闭，急用开牙散搽之，若能苏醒，再投黎洞丸，或可挽回。医者须
细心审察，不可草率误人。
跌打损伤、坠落磕碰等病症，专门从血的角度进行辨证论治。如果有瘀血停滞积聚，或者因为失血过多，然后才实施治疗，这样就不会有错误了。对于虚证，应当采用补益兼通行的方法。更要观察受伤部位在上在下的区别、伤势轻重以及深浅的不同，以及经络中气血多少的差异，先祛除瘀血，然后调和营血、止痛，自然没有不有效的。《内经》说：形体受伤则疼痛，气机受伤则肿胀。又说：先肿胀后疼痛的，是形体受伤影响了气；先疼痛后肿胀的，是气机受伤影响了形体。凡是跌打闪挫，或者因恼怒导致气滞、血液凝结出现肿痛，或者因大声呼号导致气血损伤，或者过服攻伐性质的药物，或者外敷寒凉的药物，导致气血凝结的，适宜使用活血顺气的方法。至于损伤的杂症，来不及全部记载，都分门别类详细列在后面，学习的人应该尽心研究。
跌打损伤这类病症，恶血留存在体内，就不分属于哪条经络，都以肝脏为主要调理对象。因为肝主藏血，败坏的血液必然归于肝脏。其疼痛多在胁肋和小腹部位的，都是肝经循行的道路。适宜以疏肝、调血、行经为主要治法。王好古说：登高坠落、撞击打击等伤害，会导致心腹胸中停积瘀血；或者气与瘀血相互攻冲，导致昏迷不醒，或者寒热往来，白天轻晚上重，变症多种多样，医生如果不审察病因根源，不切脉判断虚实，不分清经络脏腑，妄自投药，枉死的人很多了。所以在临症时，必须诊察脉象的虚实，审察症状的轻重，药物配伍要遵循君臣佐使的原则，治疗要区分患者是老幼强弱，并且从上、中、下三焦分别确定病变部位：如果瘀血在上部且伴有吐血的，适宜用犀角地黄汤；在中部的，用桃仁承气汤；在下部的，用抵当汤。体质虚弱的人，适宜配合四物汤。如果瘀血消散后，用复元通气散来调理。或者伤处青紫肿胀坚实，疼痛难以转侧，脉象涩而滞的，要防止气瘀上冲，适宜投用参黄散逐瘀，又适宜用复元活血汤。或者受伤日久才就医的，败血坚凝，适宜服用紫金丹逐瘀；又以祛伤散疏通为关键，等到患处颜色消散变淡，血液调和疼痛停止为止。或者有牙关紧闭的，用通关散吹入鼻中取嚏，再投用三黄宝蜡丸或夺命丹。如果口张开能纳药的可以治疗，不能纳药的危重。必须忌讳在湿地当风处坐卧，忌讳食用生冷硬物，忌讳服用寒凉药物，恐怕导致血液凝结难以化解，遗留后患。凡是诊治重伤，先解开衣服，遍观伤势的轻重，穴位是否致命，观察面色、听声音，诊脉探察虚实。如果六脉和缓的预后良好；九候不调的预后不良。阴囊内有睾丸的，可治；如睾丸缩入小腹的，不治。如果牙关紧闭，急用开牙散搽之，如果能苏醒，再投用黎洞丸，或许可以挽回。医生必须细心审察，不可草率误人。
In cases of traumatic injury, falls, or bumps, the syndrome is specifically differentiated based on blood. If there is stagnant blood accumulation or excessive blood loss, treatment should be administered accordingly to avoid errors. For deficiency syndromes, tonification combined with promoting circulation is appropriate. One must also observe the differences in location (upper vs. lower), severity, and depth of the injury, as well as the variations in the quantity of Qi and Blood within the meridians. First, eliminate the stasis; then harmonize the Ying (Nutritive) level and relieve pain. This approach will invariably be effective. The *Neijing* states: "Injury to the form causes pain; injury to Qi causes swelling." It further says: "Swelling preceding pain indicates form injuring Qi; pain preceding swelling indicates Qi injuring form." In cases of contusions, sprains, or injuries caused by anger leading to Qi stagnation and blood coagulation resulting in swelling and pain, or injuries from shouting causing Qi and Blood damage, or overuse of purgative agents, or external application of cold-natured medicines leading to Qi and Blood coagulation, methods for invigorating blood and smoothing Qi are suitable. Miscellaneous trauma syndromes are not exhaustively listed here but are categorized and detailed subsequently for students to study diligently.
For traumatic injuries where evil blood remains internally, regardless of the meridian involved, the Liver is primarily addressed because the Liver stores blood, and damaged blood inevitably returns to the Liver. Pain located mainly in the hypochondrium and lower abdomen follows the pathway of the Liver Meridian. Treatment should focus on soothing the Liver, regulating blood, and unblocking the meridians. Wang Haogu stated: Injuries such as falling from heights, collisions, or blows cause stagnant blood in the heart, abdomen, and chest; or Qi and blood stasis attack each other, causing coma, alternating chills and fever, worse at night than during the day, with numerous variable symptoms. If physicians do not examine the root cause, palpate the pulse for deficiency or excess, distinguish between meridians and Zang-Fu organs, and prescribe medications recklessly, many will die unnecessarily. Therefore, in clinical practice, one must assess the pulse for deficiency/excess, evaluate the severity of symptoms, arrange herbs according to the principles of Sovereign, Minister, Assistant, and Courier, tailor treatment to the age and constitution (old/young, strong/weak), and differentiate lesion locations among the Upper, Middle, and Lower Jiao. If stasis is in the upper jiao accompanied by hematemesis, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) is indicated; if in the middle jiao, Tao Ren Chengqi Tang (Peach Kernel and Rhubarb Decoction); if in the lower jiao, Didang Tang (Attack the Accumulation Decoction). For deficient patients, Sini Tang (Four Substances Decoction) should be added. Once the stasis dissipates, Fuyuan Tongqi San (Restore Origin and Unblock Qi Powder) can be used for regulation. If the injured area is cyanotic, swollen, firm, with severe pain limiting movement, and the pulse is choppy and sluggish, preventing Qi and stasis from rushing upward is crucial; Shenhua San (Ginseng and Astragalus Powder? Note: Text says Shen Huang San, likely a typo for Shen Mai San or similar, but translating literally as Ginseng and Astragalus Powder or keeping Pinyin) should be used to dispel stasis, along with Fuyuan Huoxue Tang (Restore Origin and Invigorate Blood Decoction). For injuries treated late, where damaged blood has hardened, Zijin Dan (Purple Gold Pill) should be taken to dispel stasis, followed by Qushang San (Remove Trauma Powder) for unblocking, until the discoloration fades, blood harmonizes, and pain ceases. In cases of trismus (lockjaw), Tongguan San (Open the Pass Powder) should be insufflated into the nose to induce sneezing, followed by Sanhuang Bao La Wan (Three Yellows Precious Wax Pill) or Duoming Dan (Life-Rescuing Pill). If the mouth is open and medication can be swallowed, the prognosis is treatable; if not, it is critical. Patients must avoid sitting or lying in damp, windy places, consuming raw/cold/hard foods, and taking cold-natured medicines, lest blood coagulate and remain difficult to resolve, causing lingering complications. When examining severe trauma, first loosen clothing, inspect the severity of the injury and whether vital points are affected, observe complexion, listen to voice, and palpate the pulse for deficiency/excess. A harmonious pulse across six positions indicates survival; discordant nine-pulse readings indicate death. If the testes are within the scrotum, the case is treatable; if they retract into the lower abdomen, it is untreatable. In cases of lockjaw, apply Kaiya San (Open Teeth Powder) urgently; if consciousness returns, Li Dong Wan (Li's Cave Pill) may be administered to potentially reverse the condition. Physicians must examine carefully and avoid negligence that could harm patients.