Library

Nosebleed (Epistaxis) syndrome, various schools of thought attribute it solely to the Lung, considering the nose as the orifice of the Lung. However, they fail to realize that the nose is also traversed by the regular channels of the Hand and Foot Yangming, and both the Hand and Foot Taiyang channels reach the nose. Thus, Zhang Zhongjing stated: In Taiyang disease, with a floating and tight pulse, fever, and absence of sweating on the body, spontaneous epistaxis leads to recovery. This is epistaxis originating from the Taiyang channel. *Yuan Bing Shi* states: When yang-heat stagnates in the Foot Yangming channel and causes heat above, blood may act recklessly resulting in epistaxis; this is epistaxis originating from the Yangming channel. From my perspective, however, all epistaxis blood flows from above the Shangen point, near the Mingjing acupoint. The Mingjing acupoint is the convergence of five channels: the Hand Taiyang, Foot Taiyang, Foot Yangming, Yin Qiao, and Yang Qiao channels. Therefore, any of these channels can cause epistaxis. Among the channels running along the back, none is more significant than the Foot Taiyang. Among those running through the chest and abdomen, none is more significant than the Foot Yangming. Most importantly, however, is the Chong Mai (Penetrating Vessel), which serves as the Sea of Blood for the twelve channels. The upper shu point of the Chong Mai emerges from the Dazhu (BL11) acupoint of the Foot Taiyang, and its lower shu point converges at the Qijie area of the Foot Yangming. Thus, when the Qi of the Taiyang and Yangming channels arrives, the Chong Mai inevitably follows; when the Chong Mai arrives, all twelve channels are affected. Consequently, mild epistaxis involves only one nearby channel, whereas severe epistaxis can involve the loss of several liters or even a dou of blood, accompanied by total pallor and collapse of physical appearance. How could such severity be attributed merely to a disorder of the Hand Taiyin Lung channel alone? Clinicians must examine this carefully.

First: The cause of epistaxis due to internal heat mostly lies in the Yangming channel. Treatment should primarily focus on clearing heat and descending fire. For mild heat, Sheng Di Huang (Rehmanniae Radix), Bai Shao (Paeoniae Radix Alba), Tian Dong (Asparagi Rhizoma), Mai Dong (Ophiopogonis Radix), Xuan Shen (Scrophulariae Radix), and Dan Shen (Salviae Miltiorrhizae Radix) are suitable, or formulas such as Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) from *Ju Fang*, Sheng Di Huang Yin Zi, or Mai Men Dong San. For severe heat, Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Zhi Zi (Gardeniae Fructus), and Huang Bo (Phellodendri Cortex) are suitable, or formulas such as Qian Gen San, Chou Xin Yin, or Jia Jian Yi Yin Jian. If accompanied by headache and thirst, Yu Nu Jian or Bai Hu Tang (White Tiger Decoction) are suitable. In cases where Yangming heat is extreme, causing blockage below and fire stagnation above, *Ba Cui* Xi Jiao Di Huang Tang can be used to unblock the lower part, allowing the upper part to heal spontaneously.

Second: Epistaxis caused by external contraction mostly occurs in the Foot Taiyang channel. As Zhang Zhongjing stated: In Shanghan (Cold Damage) with a floating and tight pulse, if sweating is not induced, epistaxis may result; Ma Huang Tang (Ephedra Decoction) is indicated. He also stated: In Shanghan with constipation but clear urine, the disease is not in the interior but remains in the exterior, requiring sweating therapy. If headache is present, epistaxis will likely occur; Gui Zhi Tang (Cinnamon Twig Decoction) is indicated. Cheng Wuji stated: Epistaxis in Shanghan occurs because pathogenic factors cannot be dispersed, becoming congested in the channels and forcing blood, leading to epistaxis. Using Ma Huang Tang or Gui Zhi Tang to treat epistaxis does not directly stop bleeding but rather disperses pathogenic factors within the channels. According to this theory, if epistaxis resolves the pathogen in Shanghan, it acts as a substitute for sweating, and no specific treatment is needed. However, if epistaxis occurs but the pulse remains floating and tight and fever persists, it indicates incomplete release of the pathogen via bleeding, meaning the exterior pathogen has not yet been resolved. In such cases, Ma Huang Tang or Gui Zhi Tang should still be used. Note that these two formulas are Zhang Zhongjing's standard treatments for true Shanghan. If the disease arises from warm pathogens and these formulas are unsuitable, select appropriate powders from the Shanghan category or use various Chai Hu Yin (Bupleurum Infusions) from my new formulas as appropriate.

Third: Although epistaxis is often caused by fire, it is particularly common in individuals with Yin deficiency. Labor and overwork damage Yin, leading to an inability of Water to control Fire, which easily disturbs the blood in the Yin aspect of the Chong and Ren vessels. If the pulse is slippery, full, and forceful, and there is no history of injury, treat it as a fire condition as described above. If the pulse is flooding and weak, wiry, knotted, or thready and rapid without spirit, and there is a history of alcohol and sexual excess causing internal injury, these are signs of Yin deficiency. Treatment should focus exclusively on tonifying Yin. If slight fire is present, clear it concurrently to address the branch symptoms. If there is deficient heat but no definitive excess heat signs, use sweet and neutral agents to warmly nourish True Yin, ensuring the Yin Qi is solidified to address the root cause and prevent future issues. Formulas such as Yi Yin Jian, San Yin Jian, Zuo Gui Yin, and Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) are essential. If Qi deficiency is also present, Wu Fu Yin or Wu Yin Jian may be used as appropriate.

Fourth: Methods to stop epistaxis: For severe epistaxis that cannot be stopped, take one head of garlic, mash it into a paste, form it into a cake the size of a coin with a thickness of about one fen, and apply it to the sole of the foot. Apply to the right sole for left-sided epistaxis, to the left sole for right-sided epistaxis, and to both soles if bleeding occurs from both nostrils; this will stop the bleeding. Additionally, *Zhi Xu Ge* (Song to Stop Bleeding), *Zhi Xu Fang* (Formula to Stop Bleeding), *Bi Xu Zheng Fa* (Steaming Method for Nosebleed), and Hei Shen San (Black Divine Powder) can be selected for use.