Creating Blood

Creating Blood

Bleeding from knife wounds differs from hematemesis and epistaxis. Knife wounds result from injuries sustained by healthy individuals, without any inherent imbalance between yin and yang. Therefore, the primary goal is to stop the bleeding; every unit of blood stopped means saving a corresponding unit of life. The method of stopping bleeding is also independent of yin or yang—some rely on cooling agents applied topically to halt the bleeding, such as Taohua San; others use warming agents, like black ginger ash. Unlike hematemesis and epistaxis, which stem from imbalances between yin and yang, those treating hematemesis and epistaxis must prioritize addressing the underlying pathogenic qi. Only when the pathogenic qi subsides will the hematemesis and epistaxis resolve, making them fundamentally different from knife wounds. However, two to three days after a knife wound, the situation begins to resemble that of hematemesis and epistaxis: if bruising and swelling occur, it is advisable to dispel blood stasis. Apply Huairui Shi San to the wound site, and apply a mixture of frankincense, myrrh, musk, sanqi, and scallions to the swollen areas. Once the blood stasis is dispersed, the pain and swelling will naturally subside, and oral administration of Lidong Wan can further aid recovery.

If a knife wound results in excessive blood loss, it damages the yin aspect of the body, manifesting as irritability, fever, and thirst. In such cases, it is advisable to tonify qi to generate blood; once blood levels are sufficient and bodily fluids are adequately replenished, thirst will naturally dissipate. Shengyu Tang, supplemented with jujube seeds, pollen, catechu, frankincense, myrrh, and licorice, is suitable for this purpose. Conversely, in cases of hematemesis, it is preferable to tonify the blood while suppressing the qi, since the internal manifestation pertains to the blood aspect of qi, and one must prevent qi from overpowering the blood. Knife wounds, on the other hand, involve blood in the qi aspect, so tonifying qi to generate blood is crucial. Only when qi reaches the affected area can muscle regeneration occur, and only when qi nourishes the skin can blood circulation be maintained—this differs from treating internal conditions. If qi deficiency prevents the body from controlling blood, or if cold qi hinders blood generation, formulas such as Bazhen Tang, Yangrong Tang, and Shenfu Tang can be used to strengthen qi and thereby stabilize blood. Patients experiencing hematemesis sometimes also utilize these medications. Nevertheless, in knife wounds, blood resides in the qi aspect, and the skin is particularly governed by defensive qi. When the skin is breached, qi leaks out first, making qi tonification the primary focus. In contrast, if the internal manifestation of hematemesis pertains to the yin aspect, where blood is injured but qi remains intact, then blood tonification takes precedence. Physicians must distinguish between internal and external factors, recognizing both their similarities and differences, in order to arrive at an accurate diagnosis.

A visitor asked why knife wounds are more susceptible to wind exposure (1). The response was: "The reason people are protected from external influences is entirely due to defensive qi, which originates in the bladder, extends to the triple burner, circulates through the muscles, and permeates the skin and hair—much like walls in a room or partitions in a house, preventing external pathogens from entering. However, once the skin and flesh are breached, it is akin to having holes in the walls or gaps in the partitions, effectively inviting intruders in. Consequently, knife wounds make individuals more prone to external infections, presenting symptoms such as fever, headache, clenched jaw, phlegm production, convulsions, and opisthotonus—all of which are manifestations of defensive qi dysfunction. The only difference is that there is also bleeding, which is treated separately later."

For those who do not sweat, it indicates that wind carries cold, closing off the skin and hair; in such cases, Xiao Chaihu Tang supplemented with Jingjie, Fangfeng, and Zisu is recommended. Xiao Chaihu Tang is primarily used to treat heat invading the blood chamber, and whenever external pathogens affect the blood aspect, Xiao Chaihu Tang can always help clear and harmonize the situation. Adding ingredients that assist defensive qi further emphasizes the treatment of defensive qi, while also promoting sweating. The treatment for tetanus follows this principle: whether it involves patients with blood loss and weakness or postpartum febrile illnesses, the same principles apply. If a knife wound results in excessive blood loss and further sweating is no longer feasible, Danggui Dihuang Tang—four substances plus wind-dispelling herbs—is recommended to tonify the blood and expel pathogens. Patients with excessive blood loss and subsequent colds after childbirth face similar challenges, and this treatment approach applies equally to them: first nourish the blood to stimulate sweat production, then clear the qi to dispel external pathogens.

For those who do sweat, it indicates that wind carries heat, causing the body to overheat between the muscles; in such cases, it is advisable to clear the heat, using Danggui Xiong Huang Tang supplemented with Jiangcan and Chan Tui. If constipation is also present, add Dahuang to address it. This echoes the principles outlined in the "Shanghan Lun": for fever and sweating, use Baihu Tang; for dryness and constipation, use Chengqi Tang. Physicians can adapt these principles according to individual circumstances, resulting in numerous variations.

In essence, knife wounds are diseases of blood in the qi aspect. Therefore, when pathogens reside on the surface, they should be expelled via the qi aspect; when they reside internally, they should be eliminated via the qi aspect; and when they occupy both the surface and interior, they should be harmonized via the qi aspect, with blood-based medications used to mediate the process (2). Through this mediation, both blood and qi are regulated, and the better the regulation of qi, the more effectively blood is managed. Conversely, if the disease stems from blood in the qi aspect, then when catching a cold, one should focus solely on regulating the blood, while also using qi-based medications to mediate the situation—this is similar yet different.

Whenever a knife wound results in wind exposure, it is advisable to apply a mixture of Jiangcan, Chan Tui, and scallions, which can effectively dispel wind and reduce swelling—a highly effective remedy.

Knife wounds and sores share the same treatment approach, as discussed in the section on pus drainage, specifically regarding the transformation of blood stasis into pus. When blood does not disperse and is instead evaporated by qi, it transforms into pus. Blood is yin, qi is yang; yin transforms into yang, so pus resembles water. Since qi is responsible for this transformation, it is indeed water—but if it is not purely water, it is because it is transformed by blood, retaining its fundamental nature as blood. Thus, pus appears thick and turbid, resembling water, yet in reality, it is formed through the interplay of water and blood. Consequently, any medication aimed at eliminating pus is essentially a drug designed to remove water, while medications intended to draw out pus are, in fact, drugs meant to dry up water. Internally, Bazhen Tang supplemented with Yiren and Mutong, along with Liu Junzi Tang supplemented with Danggui and Red Bean Sprouts, are used to treat this condition. Externally, Huafu Shengji San is applied to dissolve decay and promote tissue regeneration, while Longgu is used to draw out pus and Pearl is used to foster tissue growth.

This discussion compares the nature of blood associated with knife wounds to that of hematemesis and epistaxis, aiming to clarify the mutual relationship between these two types of blood-related conditions. Although the specific treatment methods for knife wounds are not detailed here, the underlying principles are already established, and those familiar with them can readily appreciate the distinctions.

---

[Note]

(1) Mao Feng: Refers to the sensation of being exposed to wind pathogens.

(2) Wo Xuan: Means "to mediate" or "to balance."

[Commentary] This syndrome refers to external injuries accompanied by bleeding, which is quite different from conditions such as hematemesis and epistaxis. Hematemesis and epistaxis occur when qi is excessively strong and forces blood, requiring treatment focused on tonifying blood and calming qi. In contrast, creating blood involves qi leakage and bleeding, necessitating treatment centered on tonifying qi to stop the bleeding. Treatment for creating blood typically involves modifying formulas such as Shengyu Tang, Bazhen Tang, and Yangrong Tang, all of which emphasize qi tonification while supplementing with blood-stopping and blood-tonifying agents. Due to the breach of the skin and hair, defensive qi is weakened, allowing wind pathogens to take advantage of the situation and cause symptoms of wind exposure. For those experiencing this condition, if there is no sweating, it indicates that wind carries cold, and Xiao Chaihu Tang supplemented with Jingjie, Fangfeng, and Zisu is recommended. If there is sweating, it indicates that wind carries heat, and Danggui Dihuang Tang supplemented with Jiangcan and Chan Tui is advised to clear the heat. In short, external injuries accompanied by bleeding involve qi acting upon blood first, making it a disease of qi; internal injuries accompanied by bleeding involve blood acting upon qi first, making it a disease of blood. For the former, treatment should prioritize the qi aspect, expelling pathogens from the surface via the qi aspect, eliminating them from the interior via the qi aspect, and harmonizing them in the semi-surface/semi-interior region, while also incorporating blood-based medications to achieve the desired effect. For the latter, treatment should focus on the blood aspect, with additional qi-based medications used to mediate the situation.

---

It is advisable to use ginger and ban to warm the lungs; if the lungs are overheated and unable to regulate the flow of qi, then Zhizi and Qin can be used to cool the lungs. In general, any treatment targeting blood-related conditions can be approached from this angle (1).

After falls and blows, some individuals experience nausea, likely due to shock and anger following the injury, which inevitably affects the liver qi. Since the liver wood harms the lungs, this leads to vomiting; Xiao Chaihu Tang supplemented with Danpi, Qingpi, and Taoren is recommended to address this issue.

After falls and blows, some individuals also experience coughing, nosebleeds, and wheezing, indicating that blood is trapped within the qi aspect. In such cases, Shiwai Sansu Yin is recommended to disperse the qi; once the qi is dispersed, the blood is also dispersed, differing from internal injuries accompanied by coughing and nosebleeds. Internal injuries accompanied by coughing and nosebleeds involve qi trapped within the blood aspect, which struggles to release the qi and further agitates the blood, leading to unrest. Therefore, the primary focus should be on clearing the blood. These two conditions must be compared carefully.

If there is blood stasis, one will feel thirsty; blood deficiency also leads to thirst. Those with blood stasis often experience body pain and constipation, which can be alleviated with Yucu San. Individuals with blood deficiency who feel thirsty often experience restlessness, insomnia, night sweats, and fever, which can be addressed with Zhuye Shigao Tang supplemented with Shengdi. Anyone experiencing thirst due to blood loss can follow this pattern.

After falls and blows have healed, some individuals encounter changes in weather—whether it's rainy or humid—and the injured area often experiences pain, sometimes feeling cold or hot. This is due to residual blood stasis that has not yet been completely eliminated, remaining lodged in the meridians and collaterals. When the body encounters changes in weather, the qi circulating within the body, accustomed to stable conditions, is suddenly disturbed, leading to discomfort. In such cases, Xiaodiao Jing Tang, Xiaowen Jing Tang, and Tongmai Si Ni Tang can be used to address the issue, providing targeted treatment based on the specific circumstances.

---

[Note]

(1) Yu Fan: Refers to "corner" or "angle." Yu Fan implies drawing broader conclusions from specific examples.

[Commentary] Falls and blows accompanied by open wounds and bleeding share the same treatment approach as creating blood. However, when there is no open wound, blood stasis accumulates in the internal organs, muscles, and bones, often causing swelling and pain; in severe cases, fractures may even occur. In extremely severe cases, similar to creating blood, the body may suffer from complete exhaustion of qi and blood, leading to mental confusion, agitation, and even death. Treatment typically involves activating blood circulation and removing blood stasis, commonly using Li Dong Wan supplemented with Danggui and Cuiduan, along with natural copper, cinnamon, myrrh, frankincense, Dahuang, and horsefly wine for external application. When there is a risk of qi deficiency and blood dispersion, Danggui Buxue Tang is recommended. This syndrome also has two particularly dangerous manifestations: blood rushing to the heart and blood rushing to the lungs. When blood rushes to the heart, the person experiences excruciating chest pain, restlessness, or even coma; in such cases, Gui Xiong San supplemented with frankincense and myrrh is recommended. When blood rushes to the lungs, the face turns purplish, and urgent measures such as ginseng supplementation are required to support the lungs; alternatively, Sansu Yin can be used for emergency relief. From a modern medical perspective, the described scenarios of blood rushing to the heart are typically associated with gastric perforation or liver rupture, while blood rushing to the lungs is usually linked to lung contusion, pneumothorax, or lung rupture. Given the severity of these conditions, the suggested remedies are only for clinical reference and should not be regarded as definitive cures.

---