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The pulse at the Cun Kou (Inch Port, radial artery) is agitated and weak. Agitation indicates Jing syndrome (startle disorder), and weakness indicates Ji syndrome (palpitation).

[Annotation]
Cun Kou generally refers to the three positions: Cun, Guan, and Chi. A pulse that is both agitated and weak indicates the disease of Jing-Ji (startle and palpitation). "Agitation" corresponds to Jing, as startle causes external agitation; "weakness" corresponds to Ji, as palpitation arises internally with timidity.

[Collected Annotations]
Xu Bin stated: Jing (startle) is caused by external pathogens invading the Heart, hence the Cun Kou pulse appears agitated. "Agitated" means the pulse comes and goes in a chaotic, trembling manner. Ji (palpitation) is when the Spirit lacks autonomy, hence the Cun Kou pulse appears weak. "Weak" means the pulse is deep and forceless. The reason pathogens can invade is due to Heart deficiency, so Jing and Ji often appear together.
Li [Name obscured] stated: Here, Cun Kou refers to all three positions. Generally, Jing originates from outside; startle causes Qi chaos, hence the pulse is agitated and restless. Ji originates from internal fear; Ji is due to Middle Jiao deficiency, hence the pulse is weak and forceless.

The Master said: If the pulse is Floating (Fu), and there is yellow discoloration around the eyes, the Nosebleed (Nu) has not stopped. If the yellow discoloration disappears and the eyes become clear and bright, one knows that the Nosebleed has now stopped.

[Annotation]
A Floating pulse indicates Yang and Exterior conditions. If the eyes are clear, it indicates an Exterior Yang disease; if there is yellow discoloration around the eyes, it indicates Blood vessel disease. Since all collaterals connect to the eyes, Heat in the Blood causes redness, while Blood Stasis causes yellowing. Now, seeing yellow discoloration around the eyes indicates the Nosebleed has not stopped; if the yellow discoloration fades and the eyes become clear, it indicates the Nosebleed has stopped. Thus, it is said: "The Nosebleed has now stopped."

It is also said: Nosebleeds occurring from Spring to Summer belong to the Taiyang (Greater Yang) channel; those occurring from Autumn to Winter belong to the Yangming (Bright Yang) channel.

[Annotation]
Nosebleed results from injury to Yang collaterals; hematochezia (blood in stool) results from injury to Yin collaterals. The Taiyang channel governs the exterior; Spring and Summer govern the exterior. Therefore, nosebleeds from Spring to Summer belong to Taiyang. The Yangming channel governs the interior; Autumn and Winter govern the interior. Therefore, nosebleeds from Autumn to Winter belong to Yangming.

[Collected Annotations]
Li [Name obscured] stated: Nosebleed issues from the nose. The Hand-Taiyang channel ascends to the root of the nose and below the eye; the Foot-Taiyang channel enters from the vertex to connect with the brain, linking the nose and brain; the Hand-Yangming channel flanks the nostrils; the Foot-Yangming channel begins at the side of the nose and crosses the forehead. These four channels all traverse the nasal area, so they can all cause nosebleed. The Taiyang channel runs on the surface of the body. The Classic states: "Taiyang is the Opening." This corresponds to the generation in Spring and growth in Summer, where Yang Qi is external, having the meaning of opening. Hence, nosebleeds in Spring/Summer belong to Taiyang. The Yangming channel runs inside the body. The Classic states: "Yangming is the Closing." This corresponds to gathering in Autumn and storing in Winter, where Yang Qi is internal, having the meaning of closing. Hence, nosebleeds in Autumn/Winter belong to Yangming.
You Yi stated: The Shaoyang (Lesser Yang) channel does not enter the nose or forehead, so it does not primarily govern nosebleed.

Patients prone to nosebleed should not undergo diaphoresis (sweating therapy). If sweating occurs, there will inevitably be depression of the arteries above the forehead, an urgent and tight pulse, fixed staring gaze, inability to blink, and insomnia.

[Annotation]
"Nü" here includes vomiting blood. Patients with chronic nosebleeds or hematemesis have already lost Yin Blood. If diaphoresis is forced, sweat loss leads to fluid exhaustion, causing all vessels to lose nourishment. The arteries in the depression above the forehead will be scorched by heat, becoming tight and urgent. Fixed staring gaze means the eyes stare without moving. Inability to blink (Xuan) means the eyelids cannot close. This is also caused by heat scorching the vessels, leading to contraction and traction. Insomnia occurs because Yang Qi cannot enter Yin. All these conditions are critical signs of Excess Yang and Deficient Yin; therefore, patients with nosebleeds must strictly avoid diaphoresis.

[Collected Annotations]
Zhao Liang stated: The Foot-Taiyang channel governs the exterior, ascending to the vertex and forehead, penetrating the eyes. Nosebleed implies that blood in the upper collaterals has been depleted. Further diaphoresis would further exhaust fluids. When fluids are exhausted, vessels wither, causing the arteries in the forehead depression to become tight and urgent, pulling on the eyes and preventing closure. Lack of blood leads to Yin deficiency, hence insomnia.

If a patient's face lacks ruddy color, without chills or fever, and the pulse is Deep and Wiry, it indicates nosebleed; if the pulse is Floating and Weak, and feels absent upon heavy pressure, it indicates lower bleeding (hematochezia/melena); if accompanied by irritability and cough, hematemesis (vomiting blood) will certainly occur.

[Commentary]
The text likely contains a transcription error: "Deep" should be "Floating," and "Floating" should be "Deep," for the logic to hold.

[Annotation]
Red color represents blood. "Face lacking ruddy color" means a purely white face without redness, or a purely yellow face without pinkness. Fear causes pallor and a startled appearance; shame causes alternating pallor and flushing with a timid demeanor. Now, without cause, the face lacks color, indicating this is not due to Qi chaos and Blood scattering from fright or shame. Furthermore, without chills or fever, it is not due to deficiency failing to generate blood. Since it is neither blood scattering nor simple blood shortage, one must ask the patient about blood loss history. Pulse diagnosis reveals the cause: vomiting or nosebleeding belongs to Yang, presenting with a Floating-Wiry pulse that feels hollow (Kou) upon pressure, indicating empty Ying Blood; lower bleeding belongs to Yin, presenting with a Deep-Weak pulse that feels nearly absent upon pressure, indicating faint Ying Qi. Given the pale complexion and symptoms of irritability and cough, the disease is in the Heart and Lungs, so hematemesis is certain.

For those who vomit blood, accompanied by cough, rebellious Qi, and upward rushing Qi, if the pulse is Rapid, there is heat, and they cannot lie down, death ensues.

[Annotation]
Vomiting blood and cough/rebellious Qi indicate severe Lung damage. Upward rushing Qi indicates failure of Lung Qi to descend. A Rapid pulse with heat indicates Fire scorching Lung Metal. Inability to lie down indicates Yang cannot enter Yin; thus, it is fatal.

[Collected Annotations]
Zhao Liang stated: Rapid pulse with heat indicates Yang excess alone; inability to lie down indicates Yin extinction. If Yin is extinct, how can Yang survive alone? Thus, death. If they can lie down, Yin is not yet extinct, and death cannot be declared.
Cheng Lin stated: Vomiting blood, cough, and upward rushing Qi injure the Lung organ. A Rapid pulse indicates lingering deficient heat, with Fire punishing Metal. As Yin Blood is consumed, inability to lie down occurs, making death inevitable.

For wine drinkers who develop cough, hematemesis will inevitably result, caused by excessive drinking.

[Annotation]
Wine is intensely hot; it damages vessels and meridians. Excessive drinking inevitably leads to cough and hematemesis.

[Collected Annotations]
Xu Bin stated: This discusses hematemesis, which need not be due to Qi failing to control blood, nor necessarily due to blazing Yin fire. If a wine drinker develops cough, the Lung is extremely damaged. The act of coughing disturbs the injured vessels, inevitably causing hematemesis. Thus, it is said to be caused by excessive drinking. Treatment should focus on clearing Wine Heat.

Patients with blood loss should not undergo exterior-releasing therapy. If sweating occurs, there will be chills and tremors.

[Annotation]
After any blood loss, before Qi and Blood recover, it is termed "loss of blood"; diaphoresis is contraindicated. Initially, blood loss may involve Yang Heat, but after significant loss, Heat leaves with the Blood. Although Heat subsides, Qi follows Blood into deficiency, and Yang becomes weak. Forced diaphoresis depletes Yang Qi further, leaving insufficient strength to support the body, resulting in coldness, rigors, and trembling. Inducing sweat in Yin deficiency leads to loss of Yin (similar to sweating from hematemesis/nosebleed), causing inability to blink and insomnia (Yin loss pathology). Inducing sweat in Yang deficiency leads to loss of Yang (similar to sweating from blood loss), causing coldness and tremors (Yang loss pathology).

[Collected Annotations]
Li [Name obscured] stated: Those who suffer blood loss do not sweat, as sweat and blood both originate from Heart fluids. When blood is lost and fluids exhausted, no residual fluid remains to form sweat. Using exterior-releasing herbs now causes both Yin and Yang loss. With extreme deficiency of Wei Qi at the exterior, coldness and tremors occur.

For incessant hematemesis, Bo Ye Tang (Catalpa Twig Decoction) is the primary formula.

[Annotation]
For hematemesis caused by Heat injuring Yang collaterals, one should clear Heat; for injury due to overwork damaging Yang collaterals, one should repair the damage. However, using Bo Ye Tang, a warming and dispersing formula, to treat incessant hematemesis implies that Heat is hidden in the Yin division. This formula promotes dispersion, moving Heat to the Yang division. Once Blood is no longer forced by Heat, it will stop naturally.