Outline:
Traumatic hemorrhage refers to the condition that after trauma blood flows abnormally and out of the vessels either going out of the body or staying within the body. Direct or indirect violent forces on the body cause the breaking of the vessels, resulting in bleeding. According to the origin of bleeding, it can be classified into arterial hemorrhage, venous hemorrhage and capillary hemorrhage. According the site of bleeding, it can be classified into external hemorrhage and internal hemorrhage. After a trauma, the heat in the blood forces blood to escape from the vessels, possibly leading to hemorrhage of five sense organs and nine orifices. Massive traumatic bleeding often results in a syndrome of blood deficiency.

Major points for diagnosis  
1. There is a definite traumatic history.
 
2. In external hemorrhage, the blood can be seen to come out of the wound or of the five sense organs and nine orifices. In internal hemorrhage, no bleeding can be seen. When it occurs in the limbs, there will appear symptoms of swelling, pain or obvious hematoma, ecchymoses due to blood accumulating in the spaces of fasciae. If it occurs in the viscera, there will appear symptoms of sharp pain in the chest and abdomen, pale complexion, general weakness, etc. because blood accumulates in the thoracic and abdominal cavities.
 
3. In arterial hemorrhage, the color of blood is brightly red and the bleeding is jetting. In venous hemorrhage, the color of blood is dark red and the blood is constantly flowing out. In capillary hemorrhage, the color of blood is brightly red and the bleeding is slow, gradually oozing from tissues of the wound. In visceral hemorrhage, there is tenderness in the chest and abdomen, and there is shifting dullness in percussion.
 
4. A large amount of bleeding may result in traumatic shock. At the early stage, blood pressure may be a little high, then gradually decrease, and it could not be measured in the severe cases.
 
5. If bloody fluid has been obtained through thoracic and abdominal paracenteses, a diagnosis of internal hemorrhage can be definitely established.
 
6. X-ray film and B-ultrasonic examination can confirm the site and volume of visceral hemorrhage. CT and MRI examinations can give a more accurate diagnosis.


Treatment  
For the case of heavy traumatic bleeding, a quick emergent hemostasis should be taken. For the case of general critical symptoms due to internal hemorrhage, an emergent treatment should be given for saving life.

Emergent hemostasis:    
A little bleeding in a wound of limb may be treated by covering the wound with sterile dressing and by pressure bandage for hemostasis. Then, debridement is performed. If there is rupture of small vessels, ligation should be applied. When a massive bleeding occurs in the artery and vein more than middle-sized, a provisional hemostasis with tourniquet on the proximal end of ruptured vessel of the limb should be taken, then, a neoplasty or ligation of ruptured vessel is performed as soon as possible. If a bleeding occurs because of visceral rupture or injury and can not stop naturally, an operation of ligation of ruptured vessel and neoplasty of the viscus should be conducted as soon as possible. Generally, capillary hemorrhage or hemorrhage of small vessels which can stop spontaneously, thus no emergent hemostasis is needed.


Herbal therapy  
(1) Syndrome of qi collapse following massive bleeding
 
Main symptoms and signs:
Massive bleeding after trauma, dysphoria or unconsciousness, asthma, restlessness, cold limbs, cyanosis in the lip and nail, greasy sweat, faint pulse hard to be felt. This is often seen in the cases of serious fracture of pelvis, fracture of femoral shaft and rupture of parenchymatous organ.

Therapeutic method: Invigorating qi to stem collapse.

Recipe and herbs: Shenfu Decoction. Specifically, Renshen (Radix Ginseng) 12 g and Zhifuzi (Radix Lateralis Aconiti Praeparata ) 10 g.
 
(2) Syndrome of collateral injury
Main symptoms and signs:
A little bleeding after trauma, or internal hemorrhage, or bleeding from the five sense organs and nine orifices, local pain or swelling, ecchymoses on the tongue, thin-white or thin-yellow tongue coating, stringy or thready-choppy pulse.
 
Therapeutic methods:
Stopping bleeding and removing stasis.

Recipe and herbs:
Modified Xianhecao Decoction. Specifically, Xianhecao (Herba Agrimoniae)60 g, Cebaitan (Cacumen Platycladi Carbonisatus)15 g, Danshen (Radix Salviae Miltiorrhizae )15 g, Oujietan ( Nodus Nelumbinis Rhizomatis Carbonisatus )15 g, Chaopuhuang (Pollen Typhae Praeparata)15 g, Cheqianzi ( Semen Plataginis)15 g, Jingjietan (Herba Schizonepetae Carbonisatus)15g, Fuling (Poriae)15g, Sanqi (Radix Notoginseng)6 g and Gancao (Radix Glycyrrhizae)3g.
 
(3) Syndrome of bleeding due to blood heat
Main symptoms and signs:
Bleeding from the orifices after trauma, red face and eyes, dry mouth with a desire for drink, scanty dark urine, red tongue or with ecchymoses, thin-yellow tongue coating, stringy and rapid pulse.
 
Therapeutic method:
Cooling the blood to stop bleeding.

Recipe and herbs:
Modified Sisheng Pill. Shengdihuang (Radix Rehmanniae)12g, Shengaiye (Folium Atemisiae Argyi Recens )10 g, Shengheye ( Folium Nelumbinis Nuciferae )10 g, Shengcebaiye ( Cacumen Platycladi )10 g, Oujietan ( Nodus Nelumbinis Rhizomatis Carbonisatus)15 g, Chaopuhuang (Pollen Typhae Praeparata) (to be wrapped)15g, Cheqianzi (Semen Plataginis) ( to be wrapped)15 g, Diyu ( Radix Sanguisorbae)10 g, Fuling (Poriae)15 g, Sanqi (Radix Notoginseng )6 g and Gancao (Radix Glycyrrhizae )3 g.

(4) Syndrome of blood deficiency
Main symptoms and signs:
Massive bleeding after trauma, pale complexion, dizziness, dim eyesight, palpitation, shortness of breath, reluctance to talk, pale tongue, deep and thready pulse.

Therapeutic methods:
Nourishing and replenishing blood.

Recipe and herbs:
Modified Siwu Decoction..Specifically, Danggui (Radix Angelicae Sinensis)10 g, Shudihuang ( Radix Rehmanniae Praeparata ) 12 g,Baishaoyao ( Radix Paeoniae Alba )10 g, Chuanxiong ( Rhizoma Ligustici Chuanxiong ) 10 g, Jixueteng ( Caulis Spatholobi )10 g, Ajiao ( Colla Corii Asini )10 g, Chenpi ( Pericarpium Citri Reticulatae )10 g, Gancao ( Radix Glycyrrhizae )5 g, Shengjiang ( Rhizoma Zingiberis Recens) 3 pieces and Dazao (Fructus Ziziphi Jujubae ) 2 pieces.