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Yu Boren treated a woman. She was obese and had vigorous Qi. Because she could not conceive, she had long taken warming uterus medicines. Over time, this accumulated to cause excessive internal fire, forcing blood to move upward and causing nasal bleeding (bi xu). Each episode involved the loss of several sheng (a traditional unit of volume) of blood. Her face was red, her pulse was restless and rapid, and her spirit was恍惚 (trance-like) as if she were dazed. The physician still considered it an excess above and deficiency below, using cinnabar preparations for sedation and sinking. Yu Boren said, "The Classics state: 'Treat what is above by directing it downward.' Now that both blood and Qi are abundant, overflowing and moving upward, the method should be to guide them downward. How can one treat an excess condition with an excess-inducing approach?" He immediately administered Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Qi), inducing defecation three or four times. After the accumulated stasis was removed, he continued with Ji Ji Tang (Ji Ji Decoction). After twenty doses, she recovered.

Xiang Yanzhang treated a woman who had suffered from nasal bleeding for about three years. Physicians believed that "blood becomes fluid and overflows when heated," so they administered Xie Xin Tang (Drain the Heart Decoction) and cooling-blood agents, which only worsened her condition. When only a few drops of blood came out, she would faint. Her six pulses were weak, especially at the Cun (inch) position. Xiang said, "The Liver stores blood, and the Heart governs it. Now that the Cun pulse is weak, we know the Heart Qi is deficient. Heart deficiency fails to control the blood, causing it to reverse and act recklessly. The treatment should nourish the Heart and simultaneously tonify the Spleen, strengthening its child organ (the Spleen is the child of the Heart). Once the child is solid, the Heart will not be deficient." He then used Hu Po (Amber) and other heart-nourishing medicines, and the patient stabilized.

Scholar Xu stated: A man who favored rich foods and alcohol often suffered from nasal bleeding. The physician said, "All manifestations of blood indicate heat," and administered Qing Liang Yin Zi (Cooling Drink Formula), which stopped the bleeding immediately. A few days later, the disease recurred. The physician said, "The medicine was insufficient against the pathogen," and administered Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity). The bleeding stopped intermittently. Several physicians changed, all using bitter-cold agents, attempting to overcome the heat. However, his diet and lifestyle gradually deteriorated compared to the beginning; his muscles felt cold yet he was occasionally irritable, he spoke without voice, his breath was foul, and he disliked inhaling cold wind. The residual effects of his nasal bleeding had not ceased. Someone asked, "All blood manifestations are due to heat; nasal bleeding is also heat. Treating heat with cold is logical. Why does it fail and cause harm now?" The Inner Canon states, "The goal is balance." It also warns that inferior physicians must be cautious. Those physicians only knew that blood manifestations imply heat and attacked it with bitter-cold drugs, ignoring that bitter flavors drain Earth (Spleen/Stomach). Earth corresponds to the Spleen and Stomach, which are the root of human life. Now, because of fire pathology, they drained the Earth; the fire was not eliminated, but the Earth became diseased. Earth disease leads to Stomach deficiency; deficiency means Ying Qi (Nutritive Qi) cannot nourish the vessels, and Yuan Qi (Original Qi) cannot follow its natural course. Qi transforms with Yin, leading to silence and cold muscles. Alas! Crude physicians laughingly believe it is curable. Heat pathology has not ended, yet cold pathology arises anew. This is what is meant.

Wang Shishan treated a man who was robust, dark-skinned, and fond of drinking, aged over fifty. He suffered from profuse nasal bleeding accompanied by wheezing and coughing; the wheezing was severe enough to prevent him from resting his head on the pillow. The physician administered Si Wu Tang (Four Substance Decoction) with added Mai Dong (Ophiopogonis Radix), E Jiao (Donkey-hide Gelatin), Sang Bai Pi (Morus Bark), Huang Bo (Phellodendri Cortex), and Zhi Mu (Anemarrhenae Rhizoma), but the condition worsened. His pulse was large, as thick as a finger. The Pulse Classic states, "For nasal bleeding and blood loss, deep and fine pulses are appropriate; if floating and large pulses appear, it indicates peril." Based on this, the case seemed untreatable. Fortunately, his skin was dark. The large pulse did not indicate heat, but rather Lung Qi deficiency. This is a condition where Metal extreme resembles Fire. If the Lung Qi deficiency is tonified, the fire will naturally retreat. The physician's use of cold-cooling fire-reducing agents showed ignorance of the principle "When things reach an extreme, they cause harm; regulation follows." He therefore used Ren Shen (Ginseng Radix et Rhizoma) 3 qian, Huang Qi (Astragali Radix) 2 qian, Gan Cao (Licorice Root), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), Chen Pi (Citrus Reticulatae Pericarpium), Shen Qu (Massa Medicata Fermentata), Mai Dong, and Dang Gui Shen (Angelica Sinensis Radix tip)—all sweet-warm herbs. After one dose, symptoms decreased; after ten doses, he recovered.

Yu Zhen commented: Among the above four cases, the first is excess-heat; the second is Heart-Spleen dual deficiency; the third's etiology is heat, but excessive bitter-cold usage damaged the healthy Qi; the fourth's pulse shape suggests heat, but the reality is Qi deficiency. They differ thusly. Can clinicians not distinguish carefully?

Another person, near-obese but fragile, in his thirties, indulged in marital relations. In March, due to labor and heat contraction, he suffered prolonged nasal bleeding and unceasing runny nose. The nasal discharge was foul and unpleasant. Gradually, his vision blurred and hearing dulled; he ate little and felt body fatigue. Physicians used Si Wu Tang to cool blood or Ren Shen to tonify Qi, with no effect. His pulse was soggy and slippery, and pressing revealed weakness. Yu Zhen said, "The illness is incurable." Initially, Water failed to control Fire, disturbing the Lung, causing unceasing rhinorrhea. The Classic states, "Severe Lung heat causes discharge of mucus." Metal constitution is inherently dry; daily leakage of fluids causes dryness to wither. Over time, fluids of the Yang aspects of the head and face leak away. The Classic states, "Withered and astringent, unable to circulate, reversing into the flesh, abscesses form." More than a month later, abscesses indeed formed around his face, ears, and cheeks, leading to death. Later, several people with similar runny noses were seen, mostly incurable.

Yu Zhen commented: Runny nose with foul discharge belongs to Bi Yuan (Nasal Sinusitis). Why judge it as fatal? Primarily because the pulse is soggy, slippery, and weak. Former sages stated that slippery pulses resemble rapid pulses. Zhang Zhongjing said, "If rapid pulses persist, malignant sores arise." For weak pulses, Wang Shishan would definitely use Ren Shen and Huang Qi. Since these were ineffective, there was no path left. Moreover, unceasing rhinorrhea implies withering and astringency. Thus, "Ying Qi failing to follow its course, reversing into the flesh" serves as the conclusion of this disease. Wei's annotation says: Using herbs to nourish Water to support Liver and Lung is excellent, but for treating unceasing rhinorrhea, it may hardly be effective.

Zhu Shengqing suffered from nasal bleeding like a collapse, lasting three days without stopping. Compared to previous episodes, this was the most severe. He took Xi Jiao (Rhinoceros Horn), Di Huang (Rehmanniae Radix), Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Zhi Mu, Huang Bo, Shi Gao (Gypsum Fibrosum), and Shan Zhi Zi (Gardeniae Fructus), yet the bleeding intensified. On the fourth day, he invited Shi Wen for consultation. The pulse was wiry and urgent, like touching a blade. This indicated Yin Fire ascending, carrying blood upward. The cold-cooling medicines injured the clear Yang Qi in the Stomach, changing the pulse to wiry and tight. Shi Wen prescribed Sheng Liu Wei Di Huang Wan (Six Ingredient Pill with Rehmannia) with Wu Wei Zi (Schisandrae Fructus) as a decoction. Separately, he made three pills using Rou Gui (Cinnamon Bark) powder 3 qian and refined wheat flour paste, to be taken down with the decoction. As soon as it entered the throat, the bleeding stopped instantly. Shortly after, several clots of blood were expelled from the mouth and nose, and he recovered. For years thereafter, the affliction never recurred.

[Appendix] A man suffered from persistent nasal bleeding. Physicians all attributed it to heat. Shen Zongchang administered Ren Shen and Fu Zi (Aconiti Lateralis Radix Praeparata), and he recovered. People were shocked and asked why. He replied, "The pulse was small and declining; tonification was indispensable."

Yu Zhen commented: These two cases are similar but slightly different. One warms and tonifies Original Qi; the other guides fire back to its source.

[Appendix] Xu Degu treated a man with acute nasal bleeding. He moxa'd the point Wanyangzhong (located between the two tendons behind the nape at the hairline) with three moxa cones. The bleeding stopped immediately. Blood likely enters the brain from here and pours into the nose. Common people can sometimes stop nasal bleeding by tying a cotton band tightly around the neck; thus, this moxibustion should be effective.

Yu Zhen commented: This cuts off the source of the blood flow, similar in meaning to placing wet paper on the fontanelle. For example, Instructor Zhang of Shacun suffered nasal bleeding; a Daoist priest advised applying crushed fresh lotus root to the skull fontanelle, followed by blowing powdered Hai Ba (likely a marine product processed by calcination) into the nose two or three times, which also stopped the bleeding. Ji Qi, a commoner from Raozhou, suffered nasal bleeding; a physician used radish juice mixed with unadulterated wine, which stopped it temporarily but it recurred. Freshly scraped Ren Zhong Bai (Ureter Calculus) was dried on a tile and taken with warm water, which also stopped it. These instances coincidentally matched the pathogenesis at that specific moment and are not fixed methods for all types of nasal bleeding.