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Taiyang disease characterized by a floating and tight pulse, if sweating is not induced initially leading to epistaxis (nosebleed), Ma Huang Tang (Ephedra Decoction) is the primary treatment. (The *Liu Ren Shu* states: If the pulse remains floating after epistaxis, Ma Huang Tang is suitable. If the pulse has become thready/weak after epistaxis, Ma Huang Tang must not be used; Huang Qin Shao Yao Tang (Scutellaria and Peony Decoction) is suitable.) In Taiyang disease, with a floating and tight pulse, absence of sweat, fever, and body pain, persisting for eight or nine days without resolution, while the exterior syndrome remains, sweating should be induced. After taking medicine, symptoms may slightly alleviate; the patient may experience irritability and desire to keep eyes closed. In severe cases, relief comes only through epistaxis. This occurs because of excessive accumulation of Yang Qi; Ma Huang Tang is the primary treatment. If there is constipation, headache with heat sensation, and red urine, this indicates Cheng Qi Tang (Purgative Decoction) syndrome. If urine is clear but epistaxis occurs, Gui Zhi Tang (Cinnamon Twig Decoction) is indicated. (See discussion under "Inducing Sweating".) In Taiyang disease, with a floating and tight pulse, fever, absence of sweat, and subsequent epistaxis, the disease will resolve spontaneously. (See discussion under "Fever".)

In Taiyang disease, if fire therapy is forcibly applied to induce sweating, causing blood and Qi to overflow and lose their normal rhythm, excess Yang leads to impending epistaxis, while Yin deficiency leads to difficulty in urination. (See discussion under "Head Sweat".) In Shaoyin disease, presenting only with cold extremities and no sweat, if sweating is forcibly induced, it will surely disturb the blood, causing bleeding from the mouth and nose or from the eyes; this is difficult to treat. (See discussion under "Desire to Sleep".) If sweating is induced in cases of moving Qi (abdominal palpitations), it results in epistaxis, thirst, and vomiting upon drinking. (See discussion under "Moving Qi".)

A floating pulse, fever, dry mouth and nose, and ability to eat indicate that epistaxis will occur. In Yangming stomach excess causing dry mouth, where the patient desires to rinse water in the mouth but does not swallow, epistaxis is certain. Patients prone to epistaxis (Nü Jia) must not undergo sweating therapy; if sweating occurs, it leads to depression of the forehead, a tense and tight pulse, staring gaze without blinking, and insomnia. (The prohibition against sweating for epistaxis generally applies when the pulse is absent. However, for symptoms of floating-tight pulse, body pain, fever, and aversion to cold, sweating is appropriate.)

[Hai] Zhang Zhongjing stated that epistaxis precludes sweating therapy, referring specifically to cases with a thready/weak pulse. If the pulse is floating and tight, use Ma Huang Tang; if floating and slow, use Gui Zhi Tang. If the pulse is already thready/weak, neither drug is applicable; Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) is the primary treatment. (Zhang Zhongjing said: Patients prone to epistaxis must not undergo sweating; if sweating occurs, it leads to depression of the forehead, tight pulse, staring gaze without blinking, and insomnia. He also said: Those who have lost blood must not have their exterior released; sweating leads to chills and tremors. These two statements both refer to cases with weak pulses where sweating is contraindicated. Conversely, if the pulse is floating-tight or slow, sweating is indeed indicated.)

[From *Liu Ren Shu*] For epistaxis due to cold damage with a thready/weak pulse, Huang Qin Shao Yao Tang (Scutellaria and Peony Decoction) and Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) are the primary treatments.

Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction): Treats cold damage where sweating was indicated but not performed, resulting in internal blood stasis, epistaxis, hematemesis, yellowish complexion, and black stools. This formula primarily resolves blood stasis.
Shao Yao (Peony Root, 1 liang)
Sheng Di Huang (Rehmanniae Radix Recens, 1.5 liang)
Mu Dan Pi (Moutan Cortex, 2.5 qian)
Xi Jiao (Rhinocerotis Cornu, 2.5 qian) [Note: Modern substitutes like Water Buffalo Horn are often used.]
Crush the herbs. Take 5 qian per dose, decoct in 1.5 cups of water until 1 cup remains. If there is heat manifesting as mania-like agitation, add Huang Qin (Scutellariae Radix, 1 liang). If the pulse appears large but beats slowly, and the abdomen feels full though it is not distended, this indicates absence of heat; do not use Huang Qin.

Mao Hua Tang (Thrush Flower Decoction): Treats persistent epistaxis.
Take a handful of the tips of Thrush flowers (Mao Hua), decoct strongly in 3 cups of water until 1 cup remains. Divide into two doses for administration; recovery follows. If flowers are unavailable, use the roots instead.

If epistaxis is accompanied by thirst, irritability, and vomiting of ingested water, first administer Wu Ling San (Five-Ingredient Powder with Poria), followed by Zhu Ye Tang (Bamboo Leaf Decoction).

[From *Ben Cao*] For treating epistaxis due to cold damage, use Shi Hu Wan (Talcum Pills).
Grind Talcum (Hua Shi) into powder, form pills with rice paste, sized like wattle seeds. Take 10 pills per dose, chew slightly, and swallow with fresh well-water; bleeding stops immediately. Alternatively, take 1 qian of the powder with a small amount of rice, chew together, and swallow. Suitable for both elderly and young. Tang Hui Shu stated: Epistaxis is caused by failure to induce sweating when indicated. When the blood is dark/black, regardless of quantity, it can stop bleeding; mild-warm natured medicines should be taken to harmonize the Wei Qi. Upon seeing fresh bright red blood, treat urgently with this medicine.