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Epistaxis in children is referred to as Nu Xue (Nasal Bleeding). Its manifestations include dryness of the nasal cavity, fever without thirst, and distressing headache, which indicates heat damaging the Yang Collaterals. In cases where epistaxis results from neglected sweating due to Cold Damage (Shang Han), heat is constrained within the Ying (Nutritive) Level; the patient has no sweat. Ancient methods prescribe Mahuang Tang (Ephedra Decoction) to induce sweating (comprising Ephedrae Herba, Armeniacae Semen Amarum, Cinnamomi Ramulus, Raw Glycyrrhizae Radix et Rhizoma, with Fresh Zingiberis Rhizoma as a guide). If the patient sweats, ancient methods prescribe Guizhi Tang (Cinnamon Twig Decoction) to resolve the exterior (comprising Cinnamomi Ramulus, Paeoniae Radix Alba, Honey-fried Glycyrrhizae Radix et Rhizoma, with Ginger and Jujube as guides). In the absence of exterior syndromes, if epistaxis is caused by internal heat, ancient methods prescribe Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) to clear heat (comprising Rhinocerotis Cornu, Rehmanniae Radix, Moutan Cortex, Paeoniae Radix Alba, etc.). If constipation is present, add Rheum Radix et Rhizoma.

[Chen Shouzhen's Note] Blood is refined from food and water, harmonized in the Five Zang Organs, and distributed to the Six Fu Organs, thereby entering the vessels. It is transformed by the Spleen, commanded by the Heart, stored by the Liver, disseminated by the Lungs, and excreted by the Kidneys. Its moistening and unblocking functions rely on this blood. Epistaxis occurs when Spleen heat transmits to the Lungs, causing blood to flow through the clear orifices, thus exiting from the nose. I have never heard of children suffering epistaxis due to neglected sweating from Cold Damage. My prescription uses half a qian of Damaidong (Ophiopogonis Tuber), five fen of Heizhiren (Gardeniae Fructus), eight fen of Pian Huangqin (Scutellariae Radix), one qian of Xi Shengdi (Rehmanniae Radix Preparata), three fen of Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma), guided by ten stalks of Dengxin (Junci Medulla) and seven slices of Xian Zhuye (Fresh Phyllostachys Folium). If heat is severe, add two fen of Xijiao Jian (Rhinoceros Horn Tip), ground into juice, and taken mixed.

When children vomit blood without coughing, it is mostly due to internal heat causing blood to move recklessly and reverse upward. Ancient methods prescribe Xijiao Dihuang Tang (see Epistaxis section for formula details). If vomiting blood results from straining, accompanied by coughing, ancient methods first prescribe Taoren Chengqi Tang (Peach Kernel and Magnolia Bark Decoction) to break up and purge stasis (comprising Persicae Semen, Rheum Radix et Rhizoma, Natrii Sulfas, Glycyrrhizae Radix et Rhizoma, Cinnamomi Ramulus, plus Angelicae Sinensis Radix, Paeoniae Radix Alba, Buteae Lignum, and Carthami Flos). Subsequently, Jiawei Siwu Tang (Modified Four Substance Decoction) is used to harmonize (comprising Angelicae Sinensis Radix, Paeoniae Radix Alba, Chuanxiong Rhizome, Rehmanniae Radix, Imperatae Rhizoma, Cyperi Rhizoma, Moutan Cortex, Gardeniae Fructus, Raw Glycyrrhizae Radix et Rhizoma, guided by Nelumbinis Plumula). The decoction is prepared with wine and water. For vomiting blood due to labor injury, also accompanied by coughing and blood in sputum, if there is heat, ancient methods prescribe Jisu San (Elsholtzia Powder) (comprising Elsholtziae Herba, Menthae Haplocalycis Folium, Fritillariae Thunbergii Bulbus, Ophiopogonis Tuber, Platycodonis Radix, Asini Corii Colla, Raw Rehmanniae Radix, Raw Glycyrrhizae Radix et Rhizoma, Honey-fried Astragali Radix, Imperatae Rhizoma, Honey-fried Cyperi Rhizoma, etc.). If there is no heat, ancient methods prescribe Jiufei Tang (Lung-Saving Decoction) (comprising Ophiopogonis Tuber, Ginseng Radix, Honey-fried Astragali Radix, Curcumae Radix, Schisandrae Fructus, Wine-washed Angelicae Sinensis Radix, Wine-fried Paeoniae Radix Alba, Fritillariae Thunbergii Bulbus, Honey-fried Glycyrrhizae Radix et Rhizoma, Aristolochiae Fructus, etc.).

[Chen Shouzhen's Note] All cases of hematemesis involve the reversal of Ying and Wei Qi. The Heart is the master of blood, and the Lungs are the master of Qi. Qi provides warmth, and blood provides nourishment, sustaining the body and irrigating sinews and vessels. With normal ascent and descent, harmony is maintained. However, external invasion by the Six Excesses or internal dietary injury can cause Qi stagnation and blood obstruction, leading to extreme heat surging and reckless movement. Since excess Qi transforms into Fire, and Fire attacks blood, causing it to move recklessly upon heating, it rushes upward resulting in hematemesis. In children, hematemesis is most often caused by food retention, as the Yangming Meridian is abundant in Qi and Blood; constrained internal heat inevitably causes reckless movement of Ying blood. Thus, 70-80% of pediatric hematemesis cases belong to the Stomach. Even infants in swaddling clothes may vomit blood due to warm living environments steaming with fire, or excessive consumption of spicy foods that pass into breast milk; after the infant suckles, accumulated warmth generates heat, which surges upward causing hematemesis. This also applies to epistaxis, hematochezia, and hematuria. If hematemesis results from chronic coughing, it is caused by Lung deficiency. The Lungs regulate the Qi of all vessels, and the Liver commands the blood of all meridians. Injury to the Spleen and Stomach leads to deficiency of Ying and Wei, causing blood to leave its normal pathway and move recklessly. If the child shows Qi deficiency, mental fatigue, and pale lips, cold-natured herbs must not be mistakenly used. A prescription of Xiyangshen (American Ginseng) 8 fen, Sheng Baizhu (Atractylodes Macrocephala) 1 qian, Baiyunling (Poria) 2 qian, Sheng Gancao (Raw Licorice) 5 fen, plus seven stalks of Dengxin and ten slices of Zhuye, is used to rescue the Spleen; when the Spleen becomes solid, bleeding stops naturally.

If vomiting is due to accumulated heat in the Stomach, one should first clear Stomach fire to return blood to its vessels. The prescription includes Jing Zhimu (Anemarrhenae Rhizoma) 1 qian, Huai Shengdi (Prepared Rehmannia) 2 qian, Fen Danpi (Moutan Cortex) 1.5 qian, Ya Chuanlian (Coptidis Rhizoma) 5 fen, Bai Guishen (Angelicae Sinensis Radix) 3 fen, Da Maidong (Ophiopogonis Tuber) 1 qian, Run Xuanshen (Scrophulariae Radix) 1 qian, and Zhi Gancao (Honey-fried Licorice) 5 fen. For infants in swaddling clothes, use only Xi Shengdi (Fine Prepared Rehmannia) 1 qian, Lianxin Maidong (Ophiopogonis Tuber with heart) 8 fen, and Sheng Gancao (Raw Licorice) 5 fen, guided by ten stalks of Dengxin and seven slices of Zhuye.

When children cough up blood, it is because the Water and Fire of the Heart and Kidneys do not ascend and descend properly, Fire flares without control, and the Lungs and Stomach become dry. This should not be treated as Tongzi Lao (Pediatric Tuberculosis). The prescription uses Da Shengdi (Large Prepared Rehmannia) 1 qian, Hang Baishao (Hangzhou White Peony Root) 1 qian, Fei Zhimu (Plump Anemarrhenae Rhizoma) 1 qian, Bailianrou (White Lotus Seed) 1 qian, Xuanshen (Scrophulariae Radix) 1 qian, Cun Maidong (Small Ophiopogonis Tuber) 1.5 qian, Zhen Ya Lian (Authentic Coptis) 8 fen, Tianhuafen (Trichosanthis Radix) 5 fen, and Zhi Gancao (Honey-fried Licorice) 5 fen.