刀伤出血。与吐衄不同。刀伤乃平人被伤出血。既无偏阴偏阳之病。故一味止血为要。止得一分血。则保
得一分命。其止血亦不分阴阳。有以凉药敷上而血止者。桃花散是也。有以热药敷上而血止者。黑姜灰
是也。不似吐衄。出于偏阴偏阳之病气。故吐衄家止血。必以治病气为主。病气退。斯吐衄亦退。与刀伤迥
不同也。然刀伤二三日后。则亦与吐衄略同。有瘀血肿痛者。宜消瘀血。刀口敷花蕊石散。肿处用乳香没
药麝香三七葱白捣敷。瘀血消散。则痛肿自除。内服黎洞丸治之。
刀伤去血过多。伤其阴分。证见心烦发热口渴。法宜补气以生血。血足津生。则不渴矣。圣愈汤。加枣仁花
粉儿茶乳香没药甘草。此在吐衄。则宜补血而抑气。以内证系血分之气。不可使气乘血也。刀伤乃是气
分之血。故宜补气以生血。气达患处。乃能生肌。气充肌肤。乃能行血。与治内证者不同。其有气虚不能统
血。气寒不能生血者。则宜八珍养荣参附等汤。以固气者固血。吐血家亦间用此等药物。然刀伤之血。在
气分。皮肤尤卫气所统。破其皮肤。气先漏泄。故以补气为主。若内证吐血属阴分。血伤而气未伤。故以补
血为主。医者须分别内外。而知其同中之异。异中之同。则得之矣。
客问刀伤何以善于冒风。答曰。人之所以卫外者。全赖卫气。卫气生于膀胱。达于三焦。外循肌肉。充于皮
毛。如室之有壁。宅之有墙。外邪不得而入也。今既破其皮肉。是犹壁之有穴。墙之有窦。揖盗而招之入也。
是以刀伤更易外感。病见发热头痛。牙关紧闭。吐痰抽掣。角弓反张。皆是卫气为病。所不同者。多一出血
证而已。治法列后。
无汗者为风中挟寒。闭其皮毛。宜用小柴胡汤。加荆芥防风紫苏。盖小柴胡。乃治热入血室之方。凡外邪
干血分者。小柴胡汤。皆能疏理而和解之。加宣助卫气之药。则偏治卫气。而主发汗矣。破伤风治法如是。
即失血家虚人感伤。以及产后伤寒治法。皆可参知。若刀伤去血过多。不可再发汗者。宜当归地黄汤。即
四物汤。加去风之药。以补血而驱邪也。失血家吐血过多。与产后去血过多。而复得感冒之症者。与此治
法无异。皆宜先滋其血。以助汗源。后宣其气。以解外邪。
有汗者为风中挟热。沸出肌肉之间。法宜清散其热。当归芎黄汤。加僵蚕蝉蜕。若兼便结者。加大黄治之。
此即伤寒论。发热汗出用白虎汤。燥结者用承气汤之意。医者得其意而变化之。自有许多法门。
夫刀伤。气分之血病也。故邪在表者。从气分以发之。邪在里者。从气分以夺之。邪在半表半里者。从气分
以和之。兼用血药斡旋其间。血调而气亦调。气调而血愈治矣。若失血家。乃血中之气病也。故有感冒。则
但取调血。而兼用气分之药。以斡旋之。与此同而不同。
凡是刀伤冒风。宜僵蚕蝉蜕捣和葱白敷之。力能拔风消肿。神效。
刀伤溃烂。与疮同治。此即吐脓条内。所谓瘀血变化成脓之说也。血凝不散。为气所蒸。则化而成脓。血者
阴也。气者阳也。阴从阳化。故脓似水。以气之所化。即为水也。而又非水者。则以其为血所化。仍不失血之
本质。故稠浊似水。实则水与血交并。而成形者也。故凡去脓之药。即是去水之药。而提脓之药。又即是干
水之药。内服八珍汤。加苡仁木通。六君子汤。加当归赤豆芽治之。外敷化腐生肌散。提脓加龙骨。生肌加珍珠。
此举刀伤之血。与吐衄之血。较论其义。务期血证。互勘而明。其于刀伤治法。固未详也。然其理已具。识者鉴之。
刀伤出血，与吐血、鼻衄不同。刀伤是普通人被利器所伤而出血，既没有偏阴或偏阳的病理基础，因此治疗上以单纯止血为关键。止住一分血，就能保住一分性命。其止血方法也不分阴阳属性：有用凉性药物外敷而止血的，如桃花散；有用热性药物外敷而止血的，如黑姜灰。这与吐血、鼻衄不同，后者是由于偏阴或偏阳的病气所致，所以治疗吐衄患者时，止血必须以祛除病气为主，病气消退，吐衄自然停止，这与刀伤截然不同。然而，刀伤两三天后，情况则与吐衄略有相似之处。若有瘀血导致肿痛者，应当消散瘀血。刀口处可外敷花蕊石散，肿胀处可用乳香、没药、麝香、三七、葱白捣烂后外敷。待瘀血消散，疼痛和肿胀自然消除。内服黎洞丸进行治疗。
若刀伤失血过多，损伤了阴分，出现心烦、发热、口渴等症状，治法宜补气以生血。血液充足，津液生成，口渴自解。方用圣愈汤，加酸枣仁、天花粉、儿茶、乳香、没药、甘草。而在治疗吐衄时，则宜补血而抑制气机，因为内伤杂病属于血分之气的问题，不可让气乘袭血分。刀伤则是气分之血受损，故宜补气以生血。气能到达患处，才能生肌长肉；气血充盈肌肤，才能运行血液。这与治疗内伤杂病不同。如果有气虚不能统摄血液，或气寒不能化生血液的情况，则宜使用八珍汤、养荣汤、参附汤等，通过固护气来固护血。吐血患者也偶尔使用这类药物。但是，刀伤之血在气分，皮肤尤其由卫气所统摄，皮肤破损，气先漏泄，所以以补气为主。若内伤吐血属于阴分，血受伤而气未伤，所以以补血为主。医生必须区分内外，并知晓其同中之异、异中之同，才算掌握了要领。
有人问：为什么刀伤容易感受风邪？回答说：人体之所以能防御外邪，全赖卫气。卫气生于膀胱，通达于三焦，外行于肌肉，充盛于皮毛，就像房屋有墙壁一样，外邪无法侵入。如今皮肉已破，犹如墙壁有了孔穴，门户大开，等于邀请盗贼进入。因此，刀伤更容易发生外感。病症表现为发热、头痛、牙关紧闭、吐痰、抽搐、角弓反张等，这些都是卫气受病的表现。所不同的只是多了一个出血证而已。治疗方法列述如下：
无汗者，是风邪夹寒，闭塞皮毛，宜用小柴胡汤，加荆芥、防风、紫苏。小柴胡汤本是治疗热入血室的方剂，凡是外邪侵犯血分的，小柴胡汤都能疏理并和解。加入宣发助卫气的药物，则侧重于治疗卫气，主要起到发汗的作用。破伤风的治法如此。即使是失血体虚之人感受外邪，以及产后伤寒的治法，都可以参考此法。若刀伤失血过多，不可再发汗者，宜用当归地黄汤，即四物汤，加祛风药物，以补血而驱除邪气。失血患者吐血过多，与产后失血过多而复感感冒症状者，与此治法无异，都宜先滋养血液以资助汗源，后宣通气机以解除外邪。
有汗者，是风邪夹热，沸腾于肌肉之间，治法宜清散其热。方用当归芎黄汤，加僵蚕、蝉蜕。若兼有大便干结者，加大黄治疗。这即是《伤寒论》中发热汗出用白虎汤、燥结者用承气汤之意。医生领会其精神而变化运用，自有许多法门。
大凡刀伤，是气分之血病。所以邪气在表，从气分发散；邪气在里，从气分攻夺；邪气在半表半里，从气分调和。同时兼用血药在其中斡旋。血调则气亦调，气调则血更易治愈。若是失血患者，乃是血中之气病。所以若有感冒，只取调血之法，兼用气分之药来斡旋。这与刀伤的治法相同而又不相同。
凡是刀伤感受风邪，宜将僵蚕、蝉蜕捣碎，混合葱白外敷。力能拔除风邪、消肿，效果神奇。
刀伤溃烂，与疮疡同样治疗。这就是吐脓条文中所说的“瘀血变化成脓”的理论。血液凝结不散，被气所蒸腾，则化为脓。血属阴，气属阳，阴随阳化，所以脓像水，是因为气化而为水。但又不是纯粹的水，是因为它由血转化而来，仍不失血的本质，所以稠浊似水，实际上是水与血交并而成形的物质。因此，凡是去脓的药物，就是去水的药物；提脓的药物，又是燥湿（干水）的药物。内服八珍汤，加薏苡仁、木通；或六君子汤，加当归、赤豆芽治疗。外敷化腐生肌散，提脓加龙骨，生肌加珍珠。
以上列举了刀伤之血与吐衄之血的比较论述，务必使血证的治疗互相参照而明晰。对于刀伤的具体治法，固然未详尽列出，但其原理已经具备，明眼人自当鉴别。
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.