跌打折伤一切。虽非失血之正病。而其伤损血脉。与失血之理。固有可参。因并论之。凡跌打已见破皮出
血者。与刀伤治法无异。外用花蕊石散敷之。内服化腐生肌散。血止瘀去而愈。如流血不止者。恐其血泻
尽。则气散而死。去血过多。心神不附。则烦躁而死。宜用当归补血汤。加枣仁人参朱砂白蜡茯神甘草治
之。外用人参为末。珍珠血结象皮末糁之。如亡血过多。烦躁口渴。发热头晕等证。宜大补其血。圣愈汤。加
枣仁麦冬柴胡花粉丹皮朱砂。或用独参汤亦可。此条可悟失血过多。阴虚发渴之理。凡跌打未破皮者。
其血坏损。伤其肌肉。则肿痛。伤其肋骨。则折碎。在腰胁间。则滞痛。伤重者制命不治。不制命者。凡是疼痛。
皆瘀血凝滞之故也。无论接骨逐瘀。总以黎洞丸。去大黄。加续断脆蛇治之。外用自然铜官桂没药乳香
桂枝大黄虻虫 虫。酒调敷之自效。若是已伤之血。流注结滞。着而不去者。须逐去之。否则或发为吐血。
或酿作 脓。反为难治。宜当归导赤汤下之。若已发吐血。便从吐血法治之。若已发痈脓。便从痈脓法治之。
跌打最危险者。则有血攻心肺之症。血攻心者。心痛欲死。或心烦乱。或昏迷不省人事。归芎散。加乳香没
药治之。失笑散亦治之。此与产妇血攻心。血迷心。治法略同。血攻肺者。面黑胸胀。发喘作渴。乃气虚血乘
肺也。妇科治产后气虚。瘀血入肺。面如茄色。急用参苏饮救之。金鉴载跌打。血乘肺者。亦用此方。所谓乘
肺。非第乘肺之气分而已。乃是血干肺脏之危候。肺为清虚之府。其气能下行。以制节诸脏。则气顺而血
自宁。其气不顺。则血干气分。而为吐衄。今其血直干肺脏。较之干气分者为更危殆。急用人参以补肺。肺
得补。则节制行而气下降。使血亦随气而下。再用苏木以行血。血气顺行。或可救于万一。夫如此危候。仍
不外清金保肺。以助其制节。则凡一切血症。其当清金保肺。以助其制节。举可知矣。第肺虚而制节不行
者。则宜人参以保肺。肺实而制节不行者。则宜葶苈以泻肺。肺寒而制节不行者。则宜姜半以温肺。肺热
而制节不行者。则宜知芩以清肺。一切血证。治肺之法。均可从此隅反。
跌打后有作呕者。以损伤之人。受惊发怒。肝气无有不动者也。肝木伤肺。是以发呕。小柴胡汤。加丹皮青
皮桃仁治之。
跌打后有咳衄喘逆者。乃血蕴于气分之中。宜十味参苏饮。以疏发其气。气散则血散。与内伤咳衄者不
同。内伤咳血。是气蕴于血分之中。若发其气。愈鼓动其血。而不宁矣。故以清理其血为主。二者须对看。
内有瘀血。则发渴。血虚亦发渴。有瘀血者。身痛便结。玉烛散治之。血虚发渴者。心烦不寐。盗汗身热。竹叶
石膏汤。加生地治之。凡失血发渴者。可以类推。
跌打损伤。既愈之后。有遇节候。或逢阴雨。或逢湿热。伤处每作疼痛。甚则作寒作热。此乃瘀血着而未去。
留伏经络之间。不遇天气节候。其身中营运之气。习惯而不相惊。一遇天气节候蒸动。则不能安然内伏。
故作痛也。宜小调经汤。小温经汤。通脉四逆汤。随其上下内外。以分治之。
跌打损伤等一切外伤，虽然不属于失血病的典型病症，但其对血脉的损伤与失血的机理，确实有可以参照的地方，因此一并论述。凡是跌打后已经破皮出血的，治疗方法与刀伤无异，外用花蕊石散敷贴，内服化腐生肌散，待血止瘀去即可痊愈。如果流血不止，恐怕血液泻尽会导致气散而死；若失血过多，心神无所依附，则会导致烦躁而死。此时宜用当归补血汤（Danggui Buxue Tang），加入酸枣仁、人参、朱砂、白蜡、茯神、甘草来治疗。外用人参研末，配合珍珠粉、血竭结块、象皮末撒敷伤口。如果亡血过多，出现烦躁、口渴、发热、头晕等症状，应当大补其血，可用圣愈汤（Shengyu Decoction），加入酸枣仁、麦冬、柴胡、天花粉、牡丹皮、朱砂。或者使用独参汤（Dushen Decoction）也可以。从这一条可以领悟到失血过多导致阴虚发渴的道理。
凡是跌打未破皮的，血液坏损，损伤肌肉，就会肿痛；损伤肋骨，就会折断碎裂；在腰胁部位，就会滞痛。伤势重的会危及生命不治，不危及生命的，凡是疼痛，都是瘀血凝滞的缘故。无论接骨还是逐瘀，总以黎洞丸（Lidong Pill）为主，去掉大黄，加入续断、脆蛇治疗。外用自然铜、官桂、没药、乳香、桂枝、大黄、虻虫、水蛭，用酒调匀敷贴，自有效果。如果是已经受伤溢出的血液，流注结滞，附着不去，必须将其驱逐出去，否则或引发吐血，或酿成脓疮，反而难以治疗。宜用当归导赤汤（Danggui Daochi Decoction）攻下。如果已经发生吐血，就按照吐血的方法治疗；如果已经发生痈脓，就按照痈脓的方法治疗。
跌打中最危险的，是有血液攻冲心肺的症状。血液攻心，表现为心痛欲死，或心烦意乱，或昏迷不省人事。可用归芎散（Guixiong Powder），加入乳香、没药治疗。失笑散（Shixiao San）也用于治疗此症。这与产妇因血攻心、血迷心的治法大致相同。血液攻肺，表现为面色黑、胸胀、气喘、口渴，这是气虚导致血乘袭肺脏。妇科治疗产后气虚、瘀血入肺、面色如茄子色者，急用参苏饮（Rensu Yin）抢救。《医宗金鉴》记载跌打损伤中血乘肺者，也使用此方。所谓“乘肺”，不仅仅是乘袭肺的气分，而是血液干犯肺脏的危重证候。肺是清虚之府，其气能下行，以制约调节各脏腑，这样气顺而血自安宁。如果气不顺，则血干犯气分，导致吐血、衄血。现在血液直接干犯肺脏，比干犯气分更为危险危急。急用人参来补肺，肺得到补益，则节制功能行使而气下降，使血液也随气而下。再用苏木来行血，气血顺行，或许可以挽救万一。像这样危重的证候，仍不外乎清金保肺，以助其制节功能。那么，凡是一切血症，应当清金保肺以助其制节的道理，由此就可以推知了。只是肺虚而制节功能不行者，宜用人参以保肺；肺实而制节功能不行者，宜用葶苈子以泻肺；肺寒而制节功能不行者，宜用干姜、半夏以温肺；肺热而制节功能不行者，宜用知母、黄芩以清肺。一切血证，治肺的方法，都可以从此举一反三。
跌打之后出现呕吐的，是因为受伤之人受到惊吓或发怒，肝气没有不波动的。肝木克伐肺金，所以发生呕吐。用小柴胡汤（Xiaochaihu Decoction），加入牡丹皮、青皮、桃仁治疗。
跌打之后出现咳嗽、衄血、气喘逆乱的，是血液蕴结在气分之中，宜用十味参苏饮（Shiwei Rensu Yin）以疏发其气，气散则血散，这与内伤引起的咳衄不同。内伤咳血，是气蕴结在血分之中，如果发散其气，只会更加鼓动血液，使其不安宁。所以以内里清理血液为主。这两种情况需要对照来看。
体内有瘀血，会发渴；血虚也会发渴。有瘀血者，身体疼痛，大便干结，用玉烛散（Yuzhu San）治疗。血虚发渴者，心烦失眠，盗汗身热，用竹叶石膏汤（Zhuye Shigao Decoction），加入生地黄治疗。凡是失血后发渴的，可以依此类推。
跌打损伤痊愈之后，遇到节气变化，或逢阴雨天气，或逢湿热气候，伤处往往发作疼痛，甚至出现恶寒发热。这是瘀血附着而未去除，留伏在经络之间。如果不遇天气节候的变化，人体内部运行的气血习惯而不受惊扰；一旦遇到天气节候的蒸动，就不能安然内伏，所以发作疼痛。宜用小调经汤（Xiao Tiaojing Decoction）、小温经汤（Xiao Wenjing Decoction）、通脉四逆汤（Tongmai Sini Decoction），根据病位的上下内外，分别治疗。
All types of falls, blows, and fractures, although not typical diseases of blood loss, involve damage to the blood vessels whose mechanisms can indeed be referenced in the pathology of hemorrhage; therefore, they are discussed together. For injuries where the skin is broken and bleeding has occurred, the treatment method is no different from that for knife wounds: apply Huarui Shi San (Flower Porphyry Stone Powder) externally, and administer Huafu Shengji San (Decay-Removing and Flesh-Generating Powder) internally. Once bleeding stops and stasis dissipates, recovery ensues. If bleeding does not cease, there is fear that exhaustion of blood will lead to dispersion of Qi and death; excessive blood loss causes the Heart Spirit to lose its residence, leading to restlessness and death. In such cases, Danggui Buxue Tang (Danggui Tonifies the Blood Decoction) should be used, supplemented with Suanzaoren (Ziziphus Seed), Renshen (Ginseng Root), Zhusha (Cinnabar), Baila (White Beeswax), Fushen (Poria with Hostwood), and Gancao (Licorice Root). Externally, pulverized Renshen (Ginseng Root), Zhenzhu (Pearl), Xuejie Jie (Dragon's Blood Resin Concretion), and Xiangpi (Elephant Skin) powder should be dusted on the wound. If excessive blood loss leads to symptoms such as restlessness, thirst, fever, and dizziness, the blood must be greatly tonified using Shengyu Tang (Sage and Perfection Decoction), supplemented with Suanzaoren (Ziziphus Seed), Maidong (Ophiopogon Tuber), Chaihu (Bupleurum Root), Huafen (Trichosanthes Root), Mudanpi (Moutan Cortex), and Zhusha (Cinnabar). Alternatively, Dushen Tang (Single Ginseng Decoction) may be used. This passage elucidates the principle that excessive blood loss leads to Yin deficiency and subsequent thirst.
For injuries where the skin remains intact, damaged blood injures the muscles, causing swelling and pain; if ribs are fractured, they break; if located in the waist or hypochondrium, it causes stagnant pain. Severe injuries may be fatal and untreatable; those not fatal involve pain caused by blood stasis coagulation and stagnation. Whether reducing bone fractures or dispelling stasis, Lidong Wan (Lidong Pill) is the primary formula, modified by removing Dahuang (Rhubarb Root) and adding Xuduan (Dipsacus Root) and Cuishé (Atractylodes Rhizome? *Note: Context implies a specific snake or herb, likely Atractylodes or similar, but literal translation kept as per source term 'Cuishé'*). Externally, Zutian Tong (Natural Copper), Guanzi Gui (Cinnamon Twig), Moyao (Myrrh), Rushi (Frankincense), Guizhi (Cinnamon Twig), Dahuang (Rhubarb Root), Mengchong (Blister Beetle), and Shuizhi (Leech) are mixed with wine and applied for effectiveness. If injured blood flows, accumulates, and adheres without dispersing, it must be expelled; otherwise, it may manifest as hematemesis or suppurate into abscesses, becoming difficult to treat. Danggui Daochi Tang (Danggui Directs Redness Decoction) should be administered to purge. If hematemesis occurs, treat according to protocols for vomiting blood; if abscesses form, treat according to protocols for sores and pus.
The most dangerous aspect of trauma is blood attacking the Heart and Lungs. When blood attacks the Heart, it causes severe heart pain, mental agitation, or coma with loss of consciousness. Guixiong San (Angelica and Ligusticum Powder) supplemented with Rushi (Frankincense) and Moyao (Myrrh) is used. Shixiao San (Forget Distress Powder) is also effective. This treatment is similar to that for postpartum women suffering from blood attacking or confusing the Heart. When blood attacks the Lung, it presents with dark complexion, chest distension, asthma, and thirst, indicating Qi deficiency allowing blood to invade the Lung. In gynecology, for postpartum Qi deficiency with blood stasis entering the Lung causing a face color like an eggplant, Rensu Yin (Ginseng and Perilla Drink) is urgently used to rescue. The *Yizong Jinjian* records that for trauma with blood invading the Lung, this same formula is used. "Invading the Lung" refers not merely to the Qi level of the Lung, but to a critical condition where blood directly harasses the Lung organ. The Lung is a pure and empty mansion; its Qi descends to regulate and control other organs, ensuring smooth Qi flow and tranquil blood. If Qi is not smooth, blood harasses the Qi level, causing hematemesis or epistaxis. Now, blood directly harasses the Lung organ, which is more critical than harassing the Qi level. Urgently use Renshen (Ginseng Root) to tonify the Lung; once the Lung is tonified, its regulating function operates, Qi descends, and blood follows Qi downward. Then use Sumu (Sappan Wood) to move blood. If Qi and blood flow smoothly, survival may be possible even in one in ten thousand cases. Such critical conditions still fundamentally rely on clearing Metal and protecting the Lung to assist regulation. Thus, for all blood disorders, the principle of clearing Metal and protecting the Lung to assist regulation can be inferred. However, if Lung deficiency causes failed regulation, use Renshen (Ginseng Root) to protect the Lung; if Lung excess causes failed regulation, use Tingli (Descurainia Seed) to drain the Lung; if Lung cold causes failed regulation, use Jiangban (Ginger and Pinellia) to warm the Lung; if Lung heat causes failed regulation, use Ziqin (Anemarrhena and Scutellaria) to clear the Lung. Treatment methods for the Lung in all blood disorders can be deduced from this analogy.
Trauma followed by vomiting occurs because injury induces fright or anger, causing Liver Qi to fluctuate. Liver Wood insults Lung Metal, resulting in vomiting. Xiaochaihu Tang (Minor Bupleurum Decoction) supplemented with Mudanpi (Moutan Cortex), Qingpi (Green Tangerine Peel), and Taoren (Peach Kernel) is used.
Trauma followed by cough, epistaxis, and asthmatic reversal indicates blood trapped within the Qi level. Shiwei Rensu Yin (Ten-Ingredient Ginseng and Perilla Drink) is used to vent the Qi; when Qi disperses, blood disperses. This differs from internal injury cough and epistaxis, where Qi is trapped within the Blood level. Venting Qi in internal injury would further agitate blood, causing unrest. Therefore, internal injury requires primarily clearing and regulating blood. These two conditions must be viewed comparatively.
Internal blood stasis causes thirst; Blood deficiency also causes thirst. With blood stasis, body pain and constipation occur, treated with Yuzhu San (Jade Candle Powder). With Blood deficiency causing thirst, mental restlessness, insomnia, night sweats, and body heat occur, treated with Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) supplemented with Shengdi (Rehmannia Root). Thirst following blood loss can be inferred analogously.
After trauma heals, pain often recurs during seasonal changes, rainy weather, or damp-heat conditions, sometimes accompanied by chills and fever. This is due to residual blood stasis lingering in the meridians. Without external climatic stimulation, the body's circulating Qi remains habitual and undisturbed; however, climatic changes stir the interior, preventing the stasis from remaining quiescent, thus causing pain. Xiao Tiaojing Tang (Minor Regulating Menses Decoction), Xiao Wenjing Tang (Minor Warming Meridian Decoction), or Tongmai Sini Tang (Pulse-Unblocking Four Reversal Decoction) should be used according to the location (upper/lower, internal/external) of the pathology.