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According to *Chao Shi Bing Yuan* (Source of Diseases by Chao) regarding the syndrome of pediatric cold damage with epistaxis: Cold damage is caused by cold pathogenic qi invading the skin, struggling with blood and qi, causing the couli (skin pores and interstices) to close tightly. The qi cannot be vented, leading to accumulation and generation of heat; thus, headache, body pain, and high fever occur. The epistaxis in this context arises because heat struggles with qi and then invades the blood. The Lung governs the body's skin and hair and controls qi, opening into the nose. Cold damage pathogens first invade the skin, struggle with qi, and generate heat. Heat then invades the blood; when blood is affected by heat, it flows and scatters, emerging from the nose, which is termed epistaxis. In general, for febrile diseases where epistaxis is anticipated, the patient presents with high fever, frequent sweating but no actual sweat excretion, or no sweating yet, accompanied by dry nose, panting, and noisy nasal breathing, at which point epistaxis occurs. Generally, if a child's epistaxis amounts to half a sheng or several he (ancient volume units), the heat will subside due to the bleeding. If the bleeding reaches one to two sheng, death ensues.

*Huo Ren Shu* (Book that Saves Lives) discusses the treatment methods for cold damage in both children and adults: Essentially, the dosage is smaller, and the medicinal properties are slightly cooler. Question: Why does epistaxis occur? This is a Taiyang syndrome of cold damage; epistaxis leads to resolution because yang qi is excessive. As Zhang Zhongjing stated, "Excess yang leads to epistaxis." If the pulse is floating and tight, with no sweating, Ma Huang Tang (Ephedra Decoction) is administered. If the medication does not address the condition, and the patient becomes irritable, experiences visual disturbances, and symptoms worsen, epistaxis will definitely occur. If there is slight epistaxis but the pulse remains floating and tight, it is appropriate to administer Ma Huang Tang again. After epistaxis, if the pulse has become faint, Ma Huang Tang should not be used. If the pulse is floating with spontaneous sweating, Gui Zhi Tang (Cinnamon Twig Decoction) is administered. If the medication fails to resolve the condition and the Gui Zhi Tang syndrome persists, severe headache leading to epistaxis will occur. If there is slight epistaxis but the pulse remains floating, it is appropriate to administer Gui Zhi Tang again. After epistaxis, if the pulse has become faint, Gui Zhi Tang should not be used. Broadly speaking, epistaxis in cold damage precludes diaphoresis (sweating therapy) because the pulse is faint (Treatment principle: Those prone to epistaxis must not undergo diaphoresis; if sweating causes depression of the forehead, urgent pulse, fixed gaze without blinking, and insomnia. However, if there is no sweating and epistaxis occurs, but the pulse remains floating and tight, Ma Huang Tang must be given again. If there is sweating and epistaxis, but the pulse remains floating and slow, Gui Zhi Tang must be given again.) For those with a faint pulse, Huang Qin Shao Yao Tang (Scutellaria and Peony Decoction) or Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) are used. For unceasing epistaxis, Mao Hua Tang (Thatch Flower Decoction) is used. If epistaxis is accompanied by thirst, mental restlessness, and vomiting after drinking water, Wu Ling San (Five-Ingredient Powder with Poria) is administered first, followed by Zhu Ye Tang (Bamboo Leaf Decoction). Another question: Is there epistaxis in Yin syndromes? Yin syndromes inherently lack heat, so how can epistaxis arise? If Shaoyin disease presents only with cold extremities and no sweating, forcing diaphoresis will inevitably disturb the blood. It is unknown through which orifice the blood will exit; it may come from the mouth or nose, or from the ears and eyes. This is called "Jue at the lower part and exhaustion at the upper part," which is difficult to treat.

The song from *Ying Tong Bao Jian* (Precious Mirror for Infants and Children) on pediatric cold damage with epistaxis:
Heat blood coagulates, blood flow scatters,
Emerging from the nose, startling all who watch.
All because sweat could not escape,
Nose dry and noisy, the sign appears first.

*Qian Jin Fang* (Essential Prescriptions Worth a Thousand Gold) treats infants under one hundred days old with cold damage epistaxis, fever, and vomiting/reversal using Mai Men Dong Tang (Ophiopogon Decoction):
Mai Men Dong (Ophiopogonis Radix) (18 zhu) Shi Gao (Gypsum Fibrosum) Han Shui Shi (Halloysitum Rubrum) Gan Cao (Licorice Root, honey-fried) (each 0.5 liang) Gui Xin (Cinnamomi Cortex) (8 zhu)
Crush these five ingredients. Boil in 2.5 sheng of water to obtain 1 sheng. Divide into doses of 1 he, taken three times daily.

*Sheng Hui Fang* (Holy Grace Formulas) treats pediatric cold damage epistaxis with irritability, heat, and headache using Zhu Ru San (Bamboo Sheath Powder):
Ku Zhu Ru (Bambusae Caulis in Taenia) Gan Cao (Licorice Root, fried until slightly red and crushed) Huang Qin (Scutellariae Radix) (each 0.5 liang) Mai Men Dong (Ophiopogonis Radix, heart removed, baked) Fu Long Gan (Dragon's House Earth) Shi Gao (Gypsum Fibrosum) (each 1 liang)
Pound the above ingredients and sieve coarsely. Take 1 qian per dose, decoct in a small cup of water until reduced to 0.5 cup, remove dregs, and take warm at any time. Adjust dosage according to the child's size.

*Sheng Hui Fang* treats pediatric cold damage with high fever and unceasing epistaxis:
Sheng Gan Di Huang (Rehmanniae Radix Preparata) (2 liang)
Finely crush, place in a silver vessel, add one cup of wine, decoct until 0.7 portion remains, remove dregs. Take warm in three divided doses at any time.

*Sheng Hui Fang*, another formula:
Sheng Ge Gen (Puerariae Lobatae Radix) (extract juice)
Take one small cup, divide into two doses, and bleeding will stop.

*Sheng Hui Fang* treats pediatric cold damage epistaxis lasting several days:
Sheng Di Huang (Rehmanniae Radix) (juice) Bai Mi (Apis Mellifera Cera Alba / Honey) (each one small cup) Pu Huang (Typhae Pollen) (1 liang)
Mix the above ingredients, warm slightly. Take half a small cup per dose, reduce frequency/amount according to the child's size.

*Sheng Hui Fang* treats pediatric cold damage epistaxis recurring over a day:
Pu Huang (Typhae Pollen) (1 liang) Shi Liu Hua (Punica Granatum Flos) (powder, 0.5 liang)
Mix evenly. At any time, mix with fresh well-water and take 0.5 qian, adjusting dosage based on the child's size.

*Sheng Hui Fang* treats pediatric cold damage epistaxis lasting several days:
Take disordered hair, burn to ash, grind finely. Frequently blow a small amount into the nostrils; this is effective.

Zhang Huan's Li Ying San (Instant Response Powder) treats cold damage with reckless blood movement due to blood heat and unceasing epistaxis:
Shi Liu Hua (Punica Granatum Flos) (take powder, bake dry) Gan Ge Gen (Puerariae Lobatae Radix) (powder) Pu Huang (Typhae Pollen) (powdered, each 0.5 liang)
Grind into fine powder. Take 0.5 qian per dose, mixed with Sheng Di Huang juice.

*Huo Ren Shu*: Zhang Zhongjing's Ma Huang Tang (Ephedra Decoction), see section on Cold Damage with Asthma.
*Huo Ren Shu*: Zhang Zhongjing's Gui Zhi Tang (Cinnamon Twig Decoction), see section on Cold Damage with Spontaneous Sweating.
*Huo Ren Shu* Huang Qin Shao Yao Tang (Scutellaria and Peony Decoction):
Huang Qin (Scutellariae Radix) (3 liang) Shao Yao (Paeoniae Radix) Gan Cao (Licorice Root, fried) (each 0.5 liang)
Make into coarse powder. Take 3 qian per dose, decoct in one cup of water until 0.6 cup remains, remove dregs and take warm.

*Huo Ren Shu* Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction):
Xi Jiao Xiao (Rhinocerotis Cornu) (if unavailable, substitute with Sheng Ma) Mu Dan Pi (Moutan Cortex) (heart removed, each 1 liang) Shao Yao (Paeoniae Radix) (0.3 fen) Sheng Di Huang (Rehmanniae Radix) (0.5 jin)
Cut like hemp seeds. Take 5 qian bi per dose, decoct in 1.5 cups of water until 1 cup remains. If heat manifests as mania-like behavior, add Huang Qin (Scutellariae Radix) 2 liang. If the pulse is large but slow, and the abdomen feels full despite not being distended, this indicates absence of heat; do not use Huang Qin.

*Huo Ren Shu* Mao Hua Tang (Thatch Flower Decoction):
A large handful of Mao Hua (Thatch Flowers), 3 cups of water, decoct to obtain 1 cup of concentrated juice. Divide into two doses for recovery. If flowers are unavailable, use roots.

*Huo Ren Shu*: Zhang Zhongjing's Wu Ling San (Five-Ingredient Powder with Poria), see section on Spontaneous Sweating.
*Huo Ren Shu*: Zhang Zhongjing's Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction):
Dan Zhu Ye (Lophatheri Herba) (half a bunch) Shi Gao (Gypsum Fibrosum) (4 liang, pounded) Ban Xia (Pinelliae Rhizoma) (0.25 fen) Ren Shen (Ginseng Radix et Rhizoma) Gan Cao (Licorice Root) (each 0.5 liang) Mai Men Dong (Ophiopogonis Radix) (1.5 liang)
For vomiting, add Sheng Jiang (Zingiberis Rhizoma Recens) 1 liang.
Cut like hemp seeds. Take 5 qian bi per dose, add over 100 grains of Jing Mi (Oryza Sativa Japonica Group), decoct in 1.5 cups of water until 0.8 cup remains. When rice is cooked and liquid formed, remove dregs and take warm.

Zhang Huan's *Ji Feng Fang* (Chicken Peak Formulas) treats cold damage and seasonal miasma with unceasing epistaxis:
Hao Song Yan Mo (High-quality Pine Soot Ink)
Grind into fine powder. Mix with egg white to form pills the size of Toosie seeds. Take 10 pills per dose with plain hot water, at any time.
Another formula:
Fresh Luo Bo (Raphani Semen) mashed to extract juice.
Take half a cup per dose, add a little salt, mix well, and take frequently at any time.