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Nosebleed (Rhinitis hemorrhage) in Shaoyang disease. How should this be explained? It refers to the condition where blood flows from the nasal cavity. In miscellaneous diseases, nosebleed is attributed to heat in the interior; whereas in Cold Damage (Shanghan) disease, nosebleed is attributed to heat in the exterior.

Why is this so? The *Bing Yuan* states: The Heart governs blood, the Liver stores blood, and the Lung governs Qi, with its orifice opening at the nose. When blood encounters heat, it scatters and follows the ascending Qi out through the nose, resulting in nosebleed. Thus, for nosebleed in miscellaneous diseases, the cause lies in interior heat. The Classic states: "In Cold Damage, if the pulse is floating and tight, and sweating has not been induced, leading to nosebleed, Mahuang Tang (Ephedra Decoction) is appropriate." Another passage states: "In Cold Damage, if there is no bowel movement for six or seven days, accompanied by headache and fever, Xiaochengqi Tang (Minor Order the Yang Decoction) should be given. If the urine is clear, it indicates that the pathogen is not in the interior but remains in the exterior, and sweating should be induced. If there is a headache, nosebleed will likely occur, and Guizhi Tang (Cinnamon Twig Decoction) is appropriate." From this, we see that nosebleed in Cold Damage disease is attributed to exterior heat.

The *Qianjin Yi Fang* states: There are three types of hematemesis (vomiting blood). One is lung abscess (Fei Ju), two is stomach injury, and three is internal nosebleed (Nei Nu). Since those who vomit blood are termed as having internal nosebleed, those whose blood flows from the nose can be termed external nosebleed (Wai Nu), which is caused by the reckless flow of blood in the meridians and collaterals. When heat in the meridians and collaterals is excessive, and Yang Qi is congested and heavy, it forces blood to flow recklessly; when it exits through the nose, it becomes nosebleed. The Classic states: "If the patient feels vexation and eye dimness, severe cases will inevitably result in nosebleed, after which the disease resolves. This is because Yang Qi is heavy." It also states: "When Yang is excessive, nosebleed is desired; when Yin is deficient, urination is difficult." This explains that nosebleed is a manifestation of excessive Yang in the meridians. Generally, in Cold Damage, if the pulse is floating, the nose is dry, the mouth is parched, and the patient only wishes to rinse water in the mouth without swallowing, this indicates an impending nosebleed. The Classic states: "In Yangming disease, if the mouth is dry and the nose is parched, and the patient can eat, nosebleed will occur." Furthermore, if sweating is not indicated but is forcibly induced, leading to nosebleed, the Classic states: "In Shaoyin disease, if there is only cold extremities without sweat, and sweating is forcibly induced, blood will inevitably be disturbed. It is unknown from which channel it will exit; it may come from the mouth or nose, or from the eyes. This is called 'lower cold and upper exhaustion' (Xia Jue Shang Jie), which is a difficult-to-treat condition."

Patients prone to nosebleed (Nu Jia) often have pathogenic heat in the meridians and cannot undergo sweating therapy. The Classic states: "Patients prone to nosebleed must not be sweated. If sweated, the forehead will sink, the pulse will become tight and urgent, the eyes will stare fixedly without closing, and sleep will be impossible." The previously mentioned use of Guizhi Tang and Mahuang Tang for nosebleed is not specifically to treat the nosebleed itself, but to disperse pathogenic factors in the meridians. If pathogenic factors cannot be dispersed and become congested in the meridians, forcing the blood, nosebleed occurs. Therefore, Guizhi Tang and Mahuang Tang are not exclusively for treating nosebleed. In Taiyang disease, if the pulse is floating and tight, there is fever and no sweat on the body, and spontaneous nosebleed occurs, the disease heals. This is because the pathogen in the meridians dissipates with the blood, leading to resolution. Thus, it is known that nosebleed does not wait for the dispersing action of Guizhi Tang or Mahuang Tang. However, if nosebleed is accompanied only by sweating on the head, no sweat on the body, and sweat failing to reach the feet, the prognosis is fatal. The Yellow Emperor regarded these as incurable conditions. At the time of clinical practice, careful examination and treatment will prevent errors.