Library

Blood flowing from the nose is termed *Bi Xue* (Nosebleed). The occurrence of *Bi Xue* arises because the Qi of the Yangming Meridian does not follow the Stomach collaterals but instead spreads horizontally throughout the body, causing the fierce-heat Qi to damage the Ying Blood (Nutritive Blood), thereby forcing the blood to move recklessly and resulting in nosebleed. In cases of Cold Damage (*Shanghan*) where Yang-heat is excessive, leading to cold coagulation in the collaterals and disharmony of Ying and Wei (Defensive and Nutritive) levels, if the body is feverish, the occurrence of nosebleed allows Yin and Yang to harmonize and heat to subside, thus curing the disease; hence, it is commonly called "red sweat." For those who do not suffer from Cold Damage but experience frequent nosebleeds, it is due to excess heat in the Yangming channel that fails to descend along the meridian and instead reverses upward, damaging the collateral vessels; once the bleeding stops, the hyperactive heat of Yangming also subsides, so recovery occurs without medication, representing the mildest form of nosebleed. Conversely, individuals with deficiency-cold of the Yangming meridian, whose constitutions are inherently weak, having internally depleted their Essence and Blood and externally overtaxed their physical form, may suffer from profuse, unceasing nosebleed. If cooling-blood and yin-nourishing herbs are used, the bleeding worsens; this indicates failure of Yang Qi in the Yangming channel, requiring Ren Shen (Ginseng Root) and Fu Zi (Aconite Lateral Root) to tonify Qi to control blood and assist Yang to rescue Yin, after which the bleeding ceases—this represents the most severe form of nosebleed. To distinguish the severity of nosebleed, one must observe whether the blood feels hot or cold upon exit. Nosebleed accompanied by a sensation of heat involves blood from the Yangming collaterals and is mild, treated by cooling blood and nourishing Yin. Nosebleed accompanied by a sensation of cold involves blood from the Yangming meridian and is severe, treated by warming the meridians and assisting Yang. Although nosebleed is a common ailment, if bleeding continues uncontrollably leading to the separation and collapse of Yin and Yang, death may occur. Clinicians must be aware of this when prescribing treatment and must not neglect it.

Hematochezia (blood in stool), commonly known as "Intestinal Red," refers to blood expelled during defecation. It may appear before or after the feces, but while feces originate from within the intestines, blood originates from outside the intestinal lumen. This external blood flows from the rectal ampulla (Zong Yan) at the anus. It results from blood in the Sea of Blood (located in the uterus/lower abdomen) failing to ascend via the Chong Mai (Penetrating Vessel) and reach the exterior, instead leaking downward; upon straining during defecation, the blood is expelled. Initially, patients often do not notice this condition; when they do, their physical constitution may seem normal, leading them to ignore it. Even if treated, remedies typically consist only of cooling-blood and clearing-fire prescriptions that provide temporary relief followed by recurrence. Years later, fatigue sets in, and indiscriminate use of medications fails to eradicate the root cause, resulting in a lifelong chronic illness. Although chronic, this condition is not immediately fatal. The general treatment principle should be warming and tonifying, rather than cooling and purging; warmth ensures blood follows the meridians, and tonification enables Qi to control blood. If treated appropriately at the onset, complete recovery is possible; however, if time is allowed to pass, cure becomes difficult.