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Nasal bleeding (epistaxis) indicates that pathogenic heat is at the exterior. When pathogens are at the exterior, they should be resolved through sweating (diaphoresis). If sweating fails to resolve the condition and instead leads to epistaxis, the Classics state: "In cold damage diseases, if the pulse is floating and tight, and epistaxis occurs due to failure to induce sweating, Ma Huang Tang (Ephedra Decoction) is the primary formula." This does not imply that Ma Huang Tang treats epistaxis; rather, it means that while Ma Huang Tang should be used to induce sweating, failure to follow the correct protocol results in epistaxis.

It is also stated: "In cold damage diseases, if there is constipation for six or seven days accompanied by headache and fever, Cheng Qi Tang (Order the Qi Decoction) may be given. However, if the urine is clear, it indicates the pathogen is not in the interior but remains at the exterior, and sweating should be induced. If headache persists, epistaxis will likely occur, and Gui Zhi Tang (Cinnamon Twig Decoction) is appropriate." This again does not imply that Gui Zhi Tang treats epistaxis; it means that while Gui Zhi Tang should be used, failure to follow the correct protocol for inducing sweating with this formula leads to epistaxis.

Epistaxis shares the same function as sweating in resolving the exterior; however, individuals prone to nasal bleeding (those with a history of frequent epistaxis) must not be subjected to diaphoresis. Inducing sweating in such cases causes depression in the forehead, tension and urgency of the vessels, fixed staring of the eyes, inability to close them, and insomnia. This demonstrates that after epistaxis has occurred, there is no rationale for further induction of sweating. Generally, wind-cold pathogens at the exterior first invade the Taiyang (Greater Yang) channel, transform into heat from Yang, and force blood to move recklessly. Thus, the Classics state: "Excess Yang leads to a desire for epistaxis," and "In Taiyang disease, with a floating-tight pulse and fever, if spontaneous epistaxis occurs, the disease resolves." This indicates that pathogens in the channels are resolved along with the epistaxis, confirming that epistaxis is a sign of righteous qi expelling pathogens and recovery.

Regarding Yangming disease, if the patient experiences dryness in the mouth, desiring only to rinse water in the mouth without swallowing, epistaxis is certain. Yangming heat excess causes dryness in the mouth, but since the heat remains in the channels and has not entered the interior, the patient desires only to rinse without swallowing. This serves as a precursor sign of impending epistaxis, again because the heat is located at the exterior.

Taiyang disease should be resolved through sweating; if not, it may resolve through epistaxis. Conversely, errors involving inappropriate sweating are most severe when sweating is incorrectly induced for Shaoyin (Lesser Yin) disease. This disturbs Yin blood, leading to violent complications. The Classics state: "In Shaoyin disease, if there is only cold extremities without sweat, forcing sweating will inevitably disturb the blood. It is unknown from which pathway it will exit—either from the mouth and nose, or from the eyes. This is termed 'Lower Cold and Upper Exhaustion,' a difficult-to-treat condition." In such cases, one cannot blame the condition on exterior heat. These two scenarios differ: one error lies in failing to sweat when one should have, resulting in minor complications; the other error lies in sweating when one should not have, resulting in major complications. Practitioners using medicinal formulas must exercise utmost caution.