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(Great Nuxue, Tongue Nuxue, Tooth Nuxue, Ear Nuxue, Eye Nuxue, Muscle Nuxue)

Nuxue (epistaxis/nosebleed) refers to blood seeping from the meridians and flowing through the clear orifices. In Shanghan (Cold Damage) disease, nuxue is attributed to heat in the exterior; methods such as Mahuang Tang (Ephedra Decoction) and Yuespi Tang are applicable. In miscellaneous diseases, nuxue is attributed to heat in the interior, where extreme heat in the meridians causes yang qi to become congested and heavy, forcing blood to move recklessly and exit from the nose. There is no rationale for using dispersing methods. If caused by emotional disturbances (seven emotions), anger, or excessive labor injury, regardless of which meridian is involved, it is appropriate to decoct Maohua (Carpobambus Flower) and take it with Zhi Nü San (Stop Epistaxis Powder), or use Siwu Tang (Four Substances Decoction) added with Xijiao (Rhinoceros Horn, now substituted with water buffalo horn), Mudan Pi (Tree Peony Bark), and Chenxiang (Agarwood). If the six pulses are wiry, fine, and choppy, feeling empty upon deep pressure, and the complexion is pale and lusterless, this is Blood Loss Syndrome (Tuoxue), representing a severe cold syndrome. Lizhong Tang (Regulate the Middle Decoction) added with Huangqi (Astragalus Root) should be used. If all six pulses are large but feel empty upon deep pressure, accompanied by palpitations, flushed face, susceptibility to fright, and upper body heat, this indicates hyperactivity of Heart Fire in the Hand Shaoyin meridian, steaming upwards into the Lung meridian. Sanhuang Buxue Tang (Three-Yellow Blood-Nourishing Decoction) should be used. For true heat nuxue with solid, large pulses and constipation, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) added with Muxiang (Aucklandia Root) and Dahuang (Rhubarb Root) is indicated. If nuxue is excessive and persists despite repeated doses of Xijiao Dihuang Tang, this indicates internal deficiency-cold with external false-heat; Qianjin Danggui Tang (Dangui Decoction from Essential Prescriptions Worth a Thousand Gold) should be used to treat both root and branch. If onset occurs at night, it is due to profuse sweating causing significant deficiency of Wei Qi (Defensive Qi), failing to secure Ying Blood (Nutritive Blood); Danggui Buxue Tang (Dangui Blood-Nourishing Decoction) is indicated. If ineffective, add Muxiang; if still ineffective, it must be Blood Deficiency with Fire Hyperactivity, requiring a large dose of Baoyuan Tang (Preserve Origin Decoction). If cooling-blood herbs are mistakenly used, causing stasis-heat to knot internally and chest pain, grinding Muxiang in wine and taking it in one dose (approx. 1 qian) yields immediate effect. In cases of internal injury and labor fatigue, presenting with wheezing, cough, flushed face, fever, headache, and nuxue, this is Lung Qi deficiency failing to perform its guarding function, leading to inflammation of Pericardium Fire and extreme heat in the meridians, causing blood to flow through the clear orifices. Danggui Buxue Tang added with Bohe (Mint) and Jingjie (Schizonepeta Spike) is indicated. If ineffective, switch to Buzhong Yiqi Tang (Center-Supplementing Qi-Boosting Decoction) with doubled Huangqi.辛热 (Acrid-Warm) herbs must strictly be avoided. If complicated by wind-cold, Xiaojianzhong Tang (Minor Construct the Middle Decoction) added with Congbai (Green Onion White) and Chidou Chi (Fermented Soybean) is used. If the clear orifices are blocked and blood flows into the stomach, vomiting clear blood, or incomplete nuxue leaves stasis that causes sallow complexion and black stool, Xijiao Dihuang Tang is indicated. If nuxue persists after trauma, Xiaowuchen Tang (Minor Black Sink Decoction) mixed with Heishen San (Black Divine Powder) is used. For nuxue due to latent summerheat, Wuling San (Five-Ingredient Powder with Poria) added with Maohua is used. For chronic persistent nuxue with heat in the Lower Jiao Blood level, Liuwei Wan (Six-Ingredient Pill) added with Wuweizi (Schisandra Berry) decocted as soup is used; if ineffective, add Tongbian (Child's Urine). If nuxue stops but various syndromes arise subsequently, such as alternating chills and fever, or wheezing urgency with insomnia, with varying symptoms gradually leading to consumptive fatigue, one should consult detailed treatments for deficiency-consumption syndromes. For those who have previously suffered nuxue, where blood recurs along the old path, occurring three or four times a month, or bleeding upon washing the face becoming a daily routine, Zhi Nü San (Stop Epistaxis Powder) decocted with Maohua is appropriate. For great nuxue uncontrolled with facial edema, Suzi Jiangqi Tang (Perilla Seed Descending Qi Decoction) is used to make blood follow the qi downward; the efficacy relies entirely on Rougui (Cinnamon Bark). For chronic nuxue, qi-moving herbs such as Muxiang and Xiangfu (Cyperus Rhizome) must be added, because without qi guidance, blood does not return to the vessels. In cases where Toufeng (Head Wind/Migraine) just starts, causing persistent nuxue, soak 1 liang of Chuanxiong (Sichuan Lovage Rhizome) in Tongbian, and process 2 liang of Xiangfu with Tongbian, plus 0.5 liang of Zhi Gancao (Honey-fried Licorice Root), grind into powder, take 3 qian per dose with clear tea. Intermittently use the nasal insufflation method.

[Diagnosis] If the pulse in nuxue is floating, large, and rapid, it indicates pathogenic factors lurking in the meridians, and sweating is indicated. If large and deficient, it indicates Spleen deficiency failing to control blood, and tonifying qi is indicated. If small and rapid, it indicates yin deficiency with fire encroaching, and subduing fire is indicated. Wiry and choppy pulses indicate stasis accumulation, and moving stagnation is indicated. Generally, if the pulse in nuxue is rapid and solid, hard and stiff, or hurried and irregular, it is difficult to treat. In chronic nuxue, if the pulse is deficient and large, accompanied by severe forehead/head pain and dripping of pale yellow fluid from the nose, the prognosis is fatal.

Great Nuxue: Great nuxue involves simultaneous bleeding from the mouth and nose. This is caused by accumulated fatigue injuring the Spleen. Buzhong Yiqi Tang with doubled Huangqi and Danggui (Angelica Sinensis) is indicated; if ineffective, Guipi Tang (Restore the Spleen Decoction) added with Tongbian and Ou Jie (Lotus Node) is used.

Tongue Nuxue: Sudden thread-like bleeding from the tongue should first be rinsed with decocted Puhuang (Pollen Typhae), then dusted with fried and ground Huaihua (Sophora Flower). Take Huangqi Liuyi Tang (Astragalus Six-to-One Decoction) combined with Shengmai San (Generate the Pulse Powder). If heat congestion causes fountain-like bleeding from the tongue, use only Wen Ge (Clam Shell) ground into powder for dusting. For tongue swelling and continuous bleeding due to deficient heat, apply raw dried Ginger powder and Puhuang powder.

Tooth Nuxue: Bleeding from between teeth or gums is called Tooth Nuxue, also known as Ya Xuan (Gum Recession/Disease). Causes include Wind Congestion, Kidney Deficiency, and Stomach Fire. In Wind Congestion, gums may be slightly swollen or painful upon traction; Xiaofeng San (Extinguish Wind Powder) added with Xijiao and Lianqiao (Forsythia Fruit) is used. Externally rub Qingyan (Green Salt) and Gaoben (Ligusticum Root) powder. In Kidney Deficiency, there is no foul odor, teeth are loose, and bleeding drips from gum gaps. If dull pain exists, it is deficient wind invading the Kidney meridian. The Kidney governs bones, and teeth are the surplus of bones; take Xiao An Shen Wan (Small Calming Kidney Pill) with salt water. If painless, it is Kidney Deficiency with Fire; Liuwei Wan (Six-Ingredient Pill) added with Gusuibu (Drynaria Rhizome) is used. Externally rub Qingyan with fried Xiangfu powder. In Stomach Heat, teeth ache and gums bleed like a surge, teeth do not loosen, and the patient likely enjoys alcohol or fried foods. Foul breath makes others avoid them; Qingwei San (Clear Stomach Powder) is indicated. In severe cases, Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction) is taken.

Ear Nuxue: Bleeding from the ear is Ear Nuxue. Wiry and rapid pulses at both Guan positions in drinkers prone to anger indicate Liver Fire; Chaihu Qinggan San (Bupleurum Clearing Liver Powder) is used. Weak or restless Chi pulses indicate Yin Deficiency; Shengliao Liuwei Wan (Raw Material Six-Ingredient Pill) added with Wuweizi is used. Additionally, burn Longgu (Fossilized Bone) to ash and insufflate into the ear to stop bleeding.

Eye Nuxue: Blood exiting the eye is caused by accumulated heat injuring the Liver, or by mistaken medication disturbing Yin Blood. It appears in acute febrile diseases. Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) added with Xijiao, Qinpi (Ash Bark), Mudan Pi, and Chishao (Red Peony Root) is used. If seen in complex diseases caused by mistaken medication, even with Dushen Tang (Single Ginseng Decoction), Baoyuan Tang, or Shengliao Liuwei Wan, it is incurable.

Muscle Nuxue: Blood exiting pores is Muscle Nuxue. With rapid pulses, use Danggui Buxue Tang. With floating pulses, use Huangqi Jianzhong Tang (Astragalus Construct the Middle Decoction). With weak pulses, use Baoyuan Tang. With full/exuberant pulses, use Danggui Liuhuang Tang (Danggui Six-Yellow Decoction). Hua Borén treated a woman who was obese with vigorous qi. Due to infertility, she frequently took uterine-warming medicines, causing long-term fire hyperactivity forcing blood upward into nuxue, accompanied by residual blood rising. Physicians still considered it Upper Excess and Lower Deficiency, using cinnabar preparations to suppress. The Classic states: "What is above, direct below." Now, with both blood and qi exuberant, overflowing and rising, the method should be to guide downward. Why exacerbate excess? He immediately administered Taohe Chengqi Tang (Peach Kernel and Magnolia Bark Decoction) to purge three or four times. After stasis was removed, Ji Ji Tang (Ji Ji Decoction) was taken for over twenty doses, resulting in recovery.

Another case involved nuxue caused by excessive rich diet. The physician said: "All blood manifestations are heat," and administered Qingliang Yinzi (Cooling Drink), which stopped the bleeding. Days later, it recurred. The physician said: "The medicine could not overcome the disease," and administered Huanglian Jiedu Tang (Coptis Detoxification Decoction). It stopped intermittently. Several physicians changed, all using bitter-cold agents. Gradually, diet and lifestyle deteriorated compared to before; muscles became cold and irritable, speech became silent, and breath smelled foul. The residual wave of nuxue had not ceased. Someone said: "All blood manifestations are heat; treating heat with cold is correct logic. Why does it fail and cause harm?" The reason is that physicians only know blood manifestation implies heat and attack with bitter-cold, unaware that bitter-cold specifically drains Spleen Earth. Spleen Earth is the root of humanity. In fire disease, draining earth harms the earth before the fire is eliminated. Earth disease leads to Stomach deficiency; deficiency prevents Ying Qi from nourishing the hundred vessels; Yuan Qi fails to follow natural laws; qi transforms with yin, hence voice is suppressed and muscles are cold. Only by using sweet-warm herbs to greatly tonify Spleen Earth can peace be restored.

Shiwan treated Zhu Shengqing, whose epistaxis was torrential, lasting three days without stopping, more severe than previous episodes. Taking Xijiao, Dihuang, Huangqin, Huanglian, Zhimu, Huangbai, Shigao (Gypsum), and Shanzhi (Gardenia) aggravated the condition. On the fourth day, I examined him. The pulse was wiry and urgent like touching a knife edge, indicating Min Fire surcharging upward, carrying blood up. Cold-cool medicines injured the clear Yang qi in the Stomach, changing the pulse to wiry and tight. I prescribed Shengliao Liuwei Wan added with Wuweizi decocted as soup, separately preparing three pills from 3 qian of Rougui (Cinnamon Bark) powder and Feiluo Mian (Fine Wheat Flour) paste, taken down with the decoction. Upon entering the throat, bleeding stopped instantly. Shortly after, several blood clots were expelled from the mouth and nose, and he recovered. Since then, this multi-year affliction never recurred.