衄血者，是五脏热结所为也。血随气行，通流脏腑，冷热调和，不失常度，无
有壅滞，亦不流溢。血得寒而凝结，得热而流散，热乘于血，血随气发，溢于鼻窍
也。又有因伤寒瘟疫，诸阳受病，不得其汗，热无所泄，故从鼻而出也。春冬
衄者，用生地黄研取汁，加生蒲黄少许，沙糖、井花水、浸服之，愈。秋夏衄者，
用车前草一握洗净，同生姜一处研取汁，入生蜜一匙；先拌渣塞鼻，次用新汲水和
蜜，并车前草、生姜汁饮之，即愈。又方，生萝卜取根捣自然汁，仰头滴入鼻管
中即止，次以新汲水和蜜、萝卜汁饮之良。〔薛〕因惊作气散，血无所羁而鼻衄
者，用异功散加柴胡、山栀。左脸青而兼赤者，先用柴胡清肝散，后用地黄丸。右
脸赤，乃肺大肠实热也，用泻白散。鼻色赤，乃脾胃实热也，用泻黄散。微赤，乃
脾经虚热也，用异功散加升麻、柴胡。色深黄用《济生》犀角地黄汤，后用杨氏地
黄散。淡白色，用六君子汤。颏间色赤，用四物汤加山栀。赤甚，用五淋散。小便
赤色，用六味丸、补中益气汤。唇色白，用六君子汤。久不愈，用麦门冬饮子。若
初病元气未亏，乳食如常，发热壮热，二便秘结，作渴饮水，卧不露睛者，悉属形
病俱实，当治邪气。若病久元气已亏，食少发热，口干饮汤，呕吐泄泻，肢体畏寒，
卧而露睛者，悉属形病俱虚，当补正气为要。
汤氏地黄汤 治荣中热，及肺壅，鼻血生疮，一切丹毒。
生地黄 赤芍药 当归 川芎（各等分）
上 咀。水煎，去滓，量大小加减服。如鼻衄，临熟入生蒲黄少许。生疮加黄
等分。丹毒加防风等分同煎，累验。
柴胡清肝散（肝热） 地黄丸（肾） 泻白散（脾） 泻黄散（脾） 异功散（吐泻）
六君子汤（脾） 五淋散（淋） 六味丸（即地黄丸肾）
麦门冬饮子 治吐血久不愈者。
五味子（十粒） 麦门冬（去心） 黄 （各一钱） 当归身 人参 生地黄（各五分）
上，水煎服。
龙胆丸 治小儿衄不止。
黄连 龙胆草（各等分）
上为末，糊丸，如小豆大。三岁三十丸。或作散子，以浓盐水送下。
柏皮汤 治小儿衄血。
柏皮 山栀子（各一两） 甘草（炙，半两）
上 咀。三岁一钱，水一小盏，煎三分，去滓服。
槐花散 治衄血。
槐花（炒，一两） 蒲黄（半两） 川面姜（一分）
上捣罗为细末。每服半钱，新水调下。
胶黄散 治小儿大衄，口鼻耳出血不止，十五六岁儿、阳盛多此病。
阿胶（一两） 蒲黄（半两）
上为末。三岁半钱，生地黄汁，微煎调下，食前服。
Epistaxis is caused by the accumulation of heat in the five zang organs. Blood follows the movement of Qi and circulates through the zang-fu organs. When cold and heat are harmonious and within normal limits, there is no stagnation, nor does blood overflow. Blood coagulates when exposed to cold and scatters when exposed to heat; when heat attacks the blood, the blood follows the upward movement of Qi and overflows from the nasal orifice. Additionally, epistaxis may occur due to cold damage or epidemics, where the yang meridians are affected, sweat cannot be released, and heat has no outlet, thus exiting through the nose.
For epistaxis occurring in spring and winter, use fresh Rehmanniae Radix (Sheng Di Huang), crushed to extract juice, adding a small amount of fresh Polygoni Multiflori Caulis et Radix (Sheng Pu Huang), rock sugar, and well water. Soak and take orally for recovery. For epistaxis occurring in autumn and summer, take a handful of Plantaginis Herba (Che Qian Cao), wash it clean, crush it together with Zingiberis Rhizoma Recens (Sheng Jiang) to extract juice, add one spoonful of raw honey. First, plug the nose with the residue mixed with the juice. Then, drink a mixture of fresh water, honey, Plantaginis Herba, and Zingiberis Rhizoma Recens juice for immediate recovery. Another method: crush the root of Raphani Fructus (Sheng Luo Bo) to obtain natural juice, tilt the head back, and drip the juice into the nasal cavity to stop bleeding. Subsequently, drinking a mixture of fresh water, honey, and Raphani Fructus juice is beneficial. [Xue Ji] stated that epistaxis caused by fright leading to the dispersion of Qi, leaving blood without restraint, should be treated with Yigong San (Isolated Efficacy Powder) added with Bupleuri Radix (Chai Hu) and Gardeniae Fructus (Shan Zhi). If the left cheek is blue-green and reddish, first use Chaihu Qinggan San (Bupleurum Liver-Clearing Powder), followed by Dihuang Wan (Rehmannia Pill). Redness on the right cheek indicates excess heat in the Lung and Large Intestine; treat with Xiebai San (Drain White Powder). Redness of the nose indicates excess heat in the Spleen and Stomach; treat with Xiehuang San (Drain Yellow Powder). Slight redness indicates deficiency heat in the Spleen meridian; treat with Yigong San added with Cimicifugae Rhizoma (Sheng Ma) and Bupleuri Radix (Chai Hu). Deep yellow color indicates the use of Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) from *Jisheng Fang*, followed by Yangshi Dihuang San (Yang's Rehmannia Powder). Pale white color indicates the use of Liujunzi Tang (Six Gentlemen Decoction). Redness between the chin indicates the use of Siwu Tang (Four Substance Decoction) added with Gardeniae Fructus (Shan Zhi). Severe redness indicates the use of Wulin San (Five Damp-Heat Powder). Red urine indicates the use of Liuwei Wan (Six-Ingredient Pill with Rehmannia) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). White lips indicate the use of Liujunzi Tang (Six Gentlemen Decoction). If chronic and unhealed, use Maimendong Yinzi (Ophiopogon Drink).
If the disease is recent and Yuan Qi (Original Qi) is not depleted, with normal milk/food intake, fever or high fever, constipation of both stool and urine, thirst with desire to drink, and eyes closed during sleep, these are signs of both form and disease being excess; treat by eliminating pathogenic factors. If the disease has been long-standing and Yuan Qi is depleted, with poor appetite, fever, dry mouth desiring warm drinks, vomiting, diarrhea, aversion to cold in the limbs, and eyes open during sleep, these are signs of both form and disease being deficiency; the priority is to tonify healthy Qi.
Tangshi Dihuang Tang (Tang's Rehmannia Decoction): Treats heat in the Ying (Nutritive) level, Lung congestion, nasal sores from bleeding, and all types of erysipelas.
Ingredients: Sheng Dihuang (Fresh Rehmanniae Radix), Chishao Yao (Red Peony Root), Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma) (equal parts).
Preparation: Coarsely crush. Decoct in water, remove dregs, and adjust dosage according to age. For epistaxis, add a small amount of Sheng Pu Huang near the end of decoction. For sores, add equal parts of Huanglian (Coptidis Rhizoma). For erysipelas, add equal parts of Fangfeng (Saposhnikoviae Radix). This formula has proven effective repeatedly.
Chaihu Qinggan San (Liver Heat) | Dihuang Wan (Kidney) | Xiebai San (Spleen*) | Xiehuang San (Spleen) | Yigong San (Vomiting/Diarrhea) | Liujunzi Tang (Spleen) | Wulin San (Damp-Heat Dysuria) | Liuwei Wan (Same as Dihuang Wan, Kidney)
*(Note: In the source text, Xiebai San is listed under Spleen, though traditionally associated with Lung heat. Translated literally as per source.)*
Maimendong Yinzi (Ophiopogon Drink): Treats hematemesis that persists for a long time.
Ingredients: Wuweizi (Schisandrae Fructus, 10 grains), Maimendong (Ophiopogonis Tuber, heart removed), Huang [Qi] (Astragali Radix, 1 qian), Danggui Shen (Angelicae Sinensis Radix body), Renshen (Ginseng Radix), Sheng Dihuang (Fresh Rehmanniae Radix) (each 5 fen).
Preparation: Decoct in water and take orally.
Longdan Wan (Gentian Pill): Treats persistent epistaxis in children.
Ingredients: Huanglian (Coptidis Rhizoma), Longdancao (Gentianae Radix) (equal parts).
Preparation: Grind into powder, make pills with paste, size of adzuki beans. For 3-year-olds, 30 pills per dose. Alternatively, make into powder and take with strong salt water.
Bapi Tang (Cypress Bark Decoction): Treats epistaxis in children.
Ingredients: Bapi (Cupressi Cacumen), Shanzhizi (Gardeniae Fructus) (each 1 liang), Gancao (Licorice Root, roasted, 0.5 liang).
Preparation: Coarsely crush. For 3-year-olds, take 1 qian, decoct in 1 small cup of water until reduced to one-third, remove dregs, and take.
Huaihua San (Sophora Flower Powder): Treats epistaxis.
Ingredients: Huaihua (Sophorae Flos, stir-baked, 1 liang), Puhuang (Typhae Pollen, 0.5 liang), Chuanmianjiang (River Wheat Ginger? Likely a typo for specific ginger type or flour, translated as River Wheat Ginger, 1 fen).
Preparation: Pound and sieve into fine powder. Take 0.5 qian per dose, mixed with fresh water.
Jiaohuang San (Ejiao and Coptis Powder): Treats severe epistaxis in children, with continuous bleeding from mouth, nose, and ears. Common in adolescents aged 15-16 due to excess Yang.
Ingredients: Ejiao (Donkey-Hide Gelatin, 1 liang), Puhuang (Typhae Pollen, 0.5 liang).
Preparation: Grind into powder. For 3-year-olds, take 0.5 qian, mix with Sheng Dihuang juice, gently heat and stir, take before meals.