源由 经云∶脾移热于肝，则为惊衄。脾，土也。肝，木也。木本克土。今脾热为土气翻盛，逆往乘木，
是木之虚，不能制土，故受脾之移热也。肝之神为魂，而藏于血。虚热则魂神不定，故惊也。凡血与气，内荣腑
脏，外循经络，相随而行于身，周而复始。血性得寒则凝涩，热则流散，而气肺之所生也，肺开窍于鼻。热乘于
血，则气亦热也，血气俱热，血随气发出于鼻，为鼻衄。（《病源论》）
诸气皆属于阳，诸血皆属于阴，阴盛则阳亏，阳盛则阴亏，经所谓阳胜则阴病，阴胜则阳病。诸血衄血，由
阳气侵阴，阴气被伤，血失常道，或从口出，或从鼻出。若暴出而色鲜，心烦燥闷，时欲引出，至一二斗，此阳
邪暴入于阴分，血得热则流散。盖人之经血，譬如天地之经水，天暑地热，则经水沸溢而涌起，故有衄血、肺疽，
其证大同而小异。（《鸡峰》）
鼻通于脑，血上溢于脑，所以从鼻而出。（《要诀》）
病有三因 外因衄血病者，因伤风寒暑湿，流传经络，阴阳相胜，故血得寒则凝泣，得热则淖溢，各随
脏腑经络，涌泄于清气道中，衄出一升一斗者，皆外所因，治之各有方。内因衄血病者，积怒伤肝，积忧伤肺，
烦思伤脾，失志伤肾，暴喜伤心，皆能动血，蓄聚不已，停留胸间，随气上溢，入清气道中，发为鼻衄，名五脏
衄。不内外因病者，饮酒过多，及啖炙 五辛热食，动于血，血随气溢，发为鼻
衄，名酒食衄，或堕车马，打扑伤损，致血淖溢，发为鼻衄，名曰折伤衄。（《三因》）
有感冒汗后不解，郁干经络，随气涌泄而成衄血。思虑伤心，心伤则吐衄。（《济生》）
脉候 寸口脉微，苦寒，为衄。汗出若衄，其脉小滑者生，大躁者死。寸口脉微弱，尺脉涩，弱则发热，
涩为无血，其人必厥，微呕。夫厥当眩，不眩而反头痛，痛为实，下虚上实，必衄也。太阳脉大而浮，必衄吐
血。（《脉经》）
诊其寸口微芤者，衄血。肝脉大，喜为衄。脉阴阳错而浮，必衄血。脉细而数，数反在上，法当吐而不吐，
其面颧上小赤，眼中白肤上，自有细赤脉如发，其趣至黑童子上者，当衄。鼻衄，脉沉细者生，浮大而牢者死。
（《病源论》）
其脉洪数者为逆，微少者为顺。（《鸡峰》）（按∶少当作小。）
脉沉小留连或微者易治，浮大洪数者难治。宜滑不宜弦。（《丹溪》）（《纂要》曰∶此论诸血见脉之大
概也，与诸书论吐血脉大意相合。）
衄血脉浮大数者，为邪伏于经，宜发汗。大而虚者，为脾虚不能统摄，宜补气。小而数者，为阴虚火乘，
宜摄火。弦涩为有瘀积，宜行滞。凡衄血之脉，数实或坚劲，或急疾不调，皆难治。久衄脉虚大，头额痛甚，鼻
流淡黄水者死。（《医通》）
证治例 衄血，凉血行血为主，犀角地黄汤入郁金同用。（《丹溪》）
有因虚致衄，此为下虚上盛，不宜过用凉剂，宜养正丹及紫霞丹（紫霞丹用硫黄、针砂、五倍子），仍佐以
四物汤、芎归汤，磨沉香服。颠而衄不止，苏合香丸一丸，或以小
乌沉汤一钱，白汤调下，或煎浓苏汤独调小乌沉汤，或添入黑神散（即妇人中八味方是）一钱，盐汤调下亦得。
仍蓦然以水喷其面，使载惊则止。小乌沉浓苏汤调，非特颠而衄，而五窍出血皆治，不因颠而衄者亦治。诸窍
血，皆可以水沃 ，惊则血止（按∶水 是古方，见后。）曾病衄愈后，血因旧路，一月或三四衄，又有洗面而
衄，日以为常，此即水不通借路之意，并宜止衄散（此用 、苓、归、芍、生地、阿胶。），茅花煎汤调下；或
四物汤加石菖蒲、阿胶、蒲黄各半钱，煎熟调火 石膏末一匙头许，兼进养正丹。前诸证服药不效，大衄不止
者，养正丹多服，仍佐以苏子降气汤，使血随气下（《直指》苏子降气汤，治虚壅鼻血）。衄后头晕，四物汤或
芎归汤、十全大补汤。有先因衄血，衄止而变生诸证，或寒热间作，或喘急无寐，病状不一，渐成劳惫，当于虚
损诸证详之。（《要诀》）
夫衄血之病，虽属平常，若出而不止，阴阳离脱，亦有死者。临病施治，常须识此，不可忽也。（《医学真
传》）
治宜加气药 风行水动，气行血流，治衄者则知血药以治衄，而不知气降则血归经。古人所以血药中必加
气药一、二味，如上所谓苏子降气汤是也。（《统旨》）
治有宜补阴 衄血虽多由火，而惟于阴虚者为尤多。正以劳损伤阴，则水不制火，最能动冲任阴分之血。
但察其脉之滑实有力，及素无伤损者，当作火治。若脉来洪大无力，或弦或芤，或细数无神，而素多酒色内伤者，
此皆阴虚之证，当专以补阴为主。若有微火者，自当兼而清之，以治其标。若虽见虚热，而无真确阳证，则但当
以甘平之剂，温养真阴，务令阴气完固，乃可拔本塞源，永无后患。（《景岳》）
石顽治朱圣卿，鼻衄如崩，三日不止，较之向来所发之势最剧，服犀角、地黄、芩、连、知、柏、石膏、
山栀之属转盛。第四日邀余诊之，脉弦急如循刀刃，此阴火上乘，载血于上，得寒凉之药，转伤胃中清阳之气，
所以脉变弦紧。与生料六味加五味子作汤，另用肉桂末三钱，飞罗面糊，分三丸，用煎药调下。甫入喉，其血顿
止，少顷口鼻去血块数枚而愈。自此数年之患，绝不再发。（《医通》）
心虚证治验 鄞董允谦妻，患衄三年许。医以血得热则淖溢，服泻心凉血之剂益困，衄才数点辄昏。
翁诊之，六脉微弱，寸为甚。曰∶肝藏血而心主之。今寸口脉微，知心虚也。心虚则不能司其血，故逆而妄行。
法当养心，仍补脾实其子，子实则心不虚矣。服琥珀诸补心之剂愈。（《医史·抱一翁传》）
泻下方法 崔氏疗鼻衄，苦参汤方。
苦参（三分） 黄连（二两） 栀子（二七枚劈） 大黄（一两） 地黄（一两生干者）
上五味切，以水五升，煮取一升半，去滓分再服。（一方更用石榴花半两。）（《外台》）《圣惠》刺蓟散，
治鼻衄血出，经日不止，于本方加刺蓟、侧柏叶、青竹茹。又治大衄，口耳皆血出不止，苦参散，于本方加柏叶、
桑耳，水煎去滓，入生地黄汁，搅令匀。
治衄血无时，三黄散。
大黄（一两湿纸裹甑上蒸） 黄连（半两去须） 黄芩（去皮半两）
上细末，每服二钱，新水调下，蜜水亦得。（《本事》）《直指》川芎三黄散，治实热衄血，于本方加川芎。
马万户妻，体肥而气盛，自以无子，尝多服暖子宫药，积久火甚，迫血上行为衄，衄必数升余，面赤脉躁疾，神
如痴。医者犹以治上盛下虚丹剂镇坠之。寿曰∶经云上者下之，今血气俱盛，溢而上行，法当下导，奈何实实
邪。即与桃仁承气汤三、四服下之，积瘀既去，继服既济汤二十剂而愈。杨子县吏陈某，当腊月鼻衄，至正月，
凡十三日始定，其脉实而数，治法与前证同。盖马妇过服刚剂，陈过食煎炙，饮醇酒，皆积热所致也。（《医史·
撄宁生传》）
止遏诸方《短剧方》治鼻衄，血出数斗，眩冒，剧者不知人方。
取乱发五两，烧之治末，取如枣核，着筒头，吹着鼻孔中，不止益末吹之，并（《千金》此有水字）服方寸匕，日
三，甚者夜二。（《医心》）《千金》已困不识人者，亦佳。
《葛氏方》治鼻卒衄方。
苦酒渍绵，塞鼻孔。又方，釜底墨、末以吹纳鼻中。（《医心》）
治鼻衄方。
以冷水净漱口，含水以芦管吹二孔中，即止。（《千金》）
《广济方》治鼻衄，出血不止方。
新汲水淋头顶上六七斗，并将浸脚，立效。（《医心》）治卒鼻衄方。上用水罐一枚，钻底作小窍子，盛新
汲水，淋项后宛宛中，淋不过一两罐，即瘥。（《圣惠》）（《医方考》曰∶治衄血者，以凉水拊其颈后，此责
其火于太阳经也。）
又方，童子小便三四灌入鼻中，立效。（《医心》）
治鼻衄久不止方。
乱发灰（一钱） 人中白（半钱） 麝香（半钱）
上件药相和细研，如小豆大，吹入鼻中，立效。（《圣
惠》）又治鼻衄终日不止，心神烦闷，于本方去乱发。
饶州市民李七，常苦鼻衄，垂至危困。医授以方，取萝卜自然汁，和无灰酒，饮之财止。医云∶血随气运转，
气有滞逆，所以妄行。萝卜最下气，而酒导之，是以一服效。经五日复如前，仅存喘息，而张思顺以明州刊《王
氏单方》，刮人中白，置新瓦上，火逼干，以温汤调服，实时血止，至今十年不作。（《医说》）
吐衄太甚，卒不能止，防其血 （《金匮翼》血晕），用茅根放炭火中，以醋洒，于鼻边嗅之，以遏其势。
（《原病集》）
一方，蒲黄、血竭为末，吹鼻中效。（《医林集要》）
《经验方》治鼻衄不止，甚者，白芨为末，津调涂山根上，立止。（《本草》）
治鼻衄不止，诸药不验，大蒜贴足方。
蒜（一枚去皮研细）
上一味摊作饼子，如钱大，浓一豆许。若左窍出血，贴于左脚心下，帛系定，右窍即贴右脚心，两窍俱出即
俱贴之。血止，急以温水洗脚心，令去蒜气。（《圣济》）
清凉诸方 生地黄汤，主衄方。
生地黄（八两） 黄芩（一两） 阿胶（二两） 柏叶（一把） 甘草（二两）
上五味 咀，以水七升，煮取三升，去滓纳胶，煎取二升半，分三服。（《千金》）又治小便血方，于本方
去甘草。
柏皮汤，衄至一二斗，闷绝者，宜此。
柏皮 栀子（各一两） 甘草（半两）
上为粗末，每服五钱，水二盏，煎至一盏，去滓温服。
（《鸡峰》）
沈氏子十岁，鼻衄不止。召二三医，或以茅花煎汤，或
以犀角地黄汤，并龙骨末吹鼻，数法皆不效。其血注下，召愚视。曰∶急以浓盐水，下龙胆丸（此用黄连、龙胆
等分糊丸）。一服减半，再进全除。主人曰∶盐水有何效？愚曰∶夫血得热而流溢。盐水咸冷，能凝其血。譬之
屠猪，就血得盐水而凝结。黄连、龙胆味苦寒，能坚其血。所以知其咸苦入口，即立效也。（《全婴方论》）
治衄血汗血，郁金散方。
郁金 甘草（炙） 青黛（各半两）
上三味捣罗为散，每服二钱匕，用鸡子白调下。（《圣济》）
治鼻衄日夜不止，头痛心烦，宜服此方。
石膏（一两细研） 牡蛎（一两烧为粉）
上件药都细研为散，以新汲水调如稀面糊，候血滴间断时，便点三、五滴于鼻中，仍以新汲水调两钱服之。
（《圣惠》）《圣济》名玉粉散。（此方既举于《伤寒》中，然用法不同，仍再列于此。）
山栀子散。
山栀子不拘多少，烧存性末之，搐入鼻中立愈。（《本事》）
温中诸方 《极要方》疗鼻衄，血出数升，令人眩冒，剧者不知人方。
桂心（三两） 干姜（一两） 乱发灰（一两）
上为散，先食浆水粥，服方寸匕，日二。（《医心》）
加味理中汤，治饮酒过多及啖炙 热食动血，发为鼻衄。
人参 白术 甘草（炙） 干姜（炮） 干葛 川芎（各等分）
上锉散，每服四钱，水一盏，煎七分，去滓温服。（《三因》）
《和剂》金液丹，固其气，治衄血。（《直指》）
利气镇逆诸方 鼻衄终日不止者，以冷水嚼苏合丸。
（《琐碎录》）
芎附散，冶头风才发，则衄不止。用童便浸川芎一两，童便制香附二两，炙甘草半两，共为末，每服三钱，
清茶调下，间用搐鼻法。（《医通》）（按∶此方原出《六要》，彼无甘草，并不用童便。又《医通》无方名，
据《六要》补。）
鼻衄，用黑锡丹，以枣汤任下。面青身冷虚弱人方可服，须子细用之。（《魏氏》）
鼻衄之病，久不得已，但服凉药亦不止者，可用《局方》养正丹、黑锡丹，根据法服，更兼灸三里二十一壮。
（《助道方》）
刺法 大衄不止，刺少商出血，良。（《六要》）
[Origin of Etiology]
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "When heat from the Spleen transfers to the Liver, it results in fright and epistaxis." The Spleen belongs to Earth, and the Liver belongs to Wood. Normally, Wood controls Earth. Now, spleen-heat causes Earth Qi to become excessive and inversely attacks Wood. This is because Wood Qi is deficient and cannot control Earth, thus receiving the transferred heat from the Spleen. The spirit of the Liver is called Hun (Ethereal Soul), which resides in Blood. Deficient heat causes the Hun and Shen (Spirit) to be unsettled, resulting in fright. Generally, Blood and Qi nourish the Zang-Fu organs internally and circulate along the meridians externally, moving together throughout the body in a continuous cycle. The nature of Blood is to coagulate and stagnate when cold, and to flow and scatter when hot. Qi is generated by the Lungs, and the Lungs open into the nose. When heat invades the Blood, Qi also becomes hot. With both Blood and Qi being hot, Blood follows Qi upward and exits through the nose, which is defined as epistaxis. (*Zhuzhu Bingyuan Hulun*, Treatise on the Origins and Manifestations of Various Diseases)
All "Qi" belongs to Yang, and all "Blood" belongs to Yin. When Yin is excessive, Yang is deficient; when Yang is excessive, Yin is deficient. As the classics state, "Excess Yang leads to Yin pathology, excess Yin leads to Yang pathology." Various forms of bleeding and epistaxis occur because Yang Qi invades the Yin aspect, damaging Yin Qi, causing Blood to lose its normal pathway. It may exit from the mouth or the nose. If blood flows out suddenly and profusely with a bright red color, accompanied by mental restlessness and irritability, and one frequently desires to vomit, reaching volumes of one or two dou, this indicates that pathogenic Yang has suddenly invaded the Yin aspect. Heat causes Blood to flow and scatter. The blood in human meridians is like the rivers and waters of heaven and earth; when the weather is hot and the earth is warm, the river water boils over and surges. Therefore, conditions such as epistaxis and lung abscesses occur. Their manifestations are largely similar with minor differences. (*Jifeng Puji Fang*, General Relief Formulas)
The nose connects to the brain. When blood overflows upwards to the brain, it exits through the nostrils. (*Renzhai Zhizhi Fang*, Direct Instructions from Renzhai)
[Etiological Classification: Three Causes]
Epistaxis caused by external factors arises from contracting wind, cold, summer-heat, or dampness, which spread through the meridians, leading to an imbalance of Yin and Yang. Thus, Blood coagulates when cold and overflows when hot, surging and draining into the clear orifices according to the affected Zang-Fu organs and meridians. Epistaxis involving the loss of one to two sheng or dou per episode belongs to external causes, each having specific treatments. Epistaxis caused by internal factors results from chronic anger injuring the Liver, chronic sorrow injuring the Lungs, excessive thinking injuring the Spleen, loss of will injuring the Kidneys, or sudden joy injuring the Heart. All these can disturb Blood, causing it to accumulate and remain in the chest, overflowing upwards with Qi into the clear orifices, manifesting as epistaxis, known as "Five Zang Epistaxis." Epistaxis caused by neither internal nor external factors arises from excessive alcohol consumption or eating roasted, grilled, and pungent foods, which disturb Blood, causing it to overflow with Qi, manifesting as epistaxis, known as "Wine and Food Epistaxis." Alternatively, falling from horses or carriages, or being beaten and bruised, causes Blood to overflow, manifesting as epistaxis, known as "Traumatic Epistaxis." (*Sanyin Jiyi Bingzheng Fanglun*, Formulas for Diseases Categorized by Three Causes)
There are cases where, after sweating for a cold, the pathogen remains unresolved, stagnating in the meridians, and surging with Qi to cause epistaxis. Excessive worry injures the Heart; Heart injury leads to hematemesis or epistaxis. (*Jisheng Fang*, Formulas for Medical Practice)
[Pulse Diagnosis]
A faint and weak pulse at the Cun (inch) position, accompanied by aversion to cold, is a sign of epistaxis. After sweating or epistaxis, if the pulse is small and slippery, the prognosis is good (survival); if the pulse is large and restless, the prognosis is poor (death). A faint and weak pulse at the Cun position and a choppy pulse at the Chi (cubit) position indicate fever (weak pulse) and blood deficiency (choppy pulse). The patient will likely experience cold limbs (Jue) and slight vomiting. In cases of Jue, dizziness is expected; if there is no dizziness but rather headache, the pain indicates excess. Lower deficiency and upper excess inevitably lead to epistaxis. A Sun Taiyang meridian pulse that is large and floating indicates inevitable epistaxis and hematemesis. (*Maijing*, Pulse Classic)
Palpating a faint and hollow (Kou) pulse at the Cun position indicates epistaxis. A large Liver pulse predisposes to epistaxis. A pulse that is disordered in its Yin-Yang balance and floating indicates inevitable epistaxis. A fine and rapid pulse, with rapidity predominant in the upper positions, suggests vomiting should occur but does not. Small red patches on the cheekbones, fine red vessels like hair on the whites of the eyes extending to the pupils, indicate impending epistaxis. For epistaxis, a deep and fine pulse indicates a good prognosis, while a floating, large, and firm pulse indicates a poor prognosis. (*Zhuzhu Bingyuan Hulun*)
A洪 (Surging) and rapid pulse is a counter-indication (adverse), while a small pulse is a favorable indication. (*Jifeng Puji Fang*) [Note: 'Shao' (few) should be read as 'Xiao' (small).]
A deep, small, lingering, or faint pulse is easy to treat; a floating, large, surging, and rapid pulse is difficult to treat. A slippery pulse is preferred over a wiry pulse. (*Danxi Xinfa*, New Methods of Danxi) [Yi Fang Zuanyao states: This discusses the general characteristics of pulses for various bleedings, consistent with discussions on hematemesis pulses in other texts.]
For epistaxis, a floating, large, and rapid pulse indicates pathogen latent in the meridians; diaphoresis (sweating method) is appropriate. A large and empty pulse indicates Spleen deficiency failing to control Blood; tonifying Qi is appropriate. A small and rapid pulse indicates Yin deficiency with Fire encroaching; subduing Fire is appropriate. A wiry and choppy pulse indicates blood stasis accumulation; promoting stagnation resolution is appropriate. Generally, for epistaxis, pulses that are rapid and excess, hard and tough, or rapid and irregular are difficult to treat. Chronic epistaxis with a void and large pulse, severe forehead pain, and dripping pale yellow fluid from the nose indicates death. (*Yixue Rumen*, Introduction to Medicine)
[Examples of Syndrome Differentiation and Treatment]
The treatment of epistaxis focuses primarily on cooling Blood and promoting Blood circulation. Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) combined with Yujin (Curcuma aromatica Rhizome) is used. (*Danxi Xinfa*)
Epistaxis caused by deficiency, characterized by lower deficiency and upper excess, should not be treated excessively with cold medicines. Instead, Yangzheng Dan (Nourishing Upright Pellets) and Zixia Dan (Purple Cloud Pellets, composed of Sulfur, Iron Sand, and Chinese Gallnut) should be used, assisted by Siwu Tang (Four Substances Decoction) and Xionggui Tang (Ligusticum and Angelica Decoction), taken with ground Agarwood. For epistaxis accompanying mania, one pill of Suhexiang Wan (Styrax Pill) or one qian of Xiao Wuchen Tang (Minor Black Stagnation Decoction) mixed with plain water can be administered. Alternatively, decoct strong Suhexiang soup to mix with Xiao Wuchen Tang, or add one qian of Heishen San (Black Divine Powder, i.e., Eight Ingredients Formula for Women) mixed with salt water. Suddenly spraying water on the face to startle the patient can stop the bleeding. Using Xiao Wuchen Tang mixed with strong Suhexiang soup treats not only epistaxis with mania but also bleeding from all five orifices, regardless of whether mania is present. Bleeding from various orifices can be stopped by startling the patient with water pouring on the head. [Note: Pouring water on the head is an ancient formula, see later.] For those who had cured epistaxis but relapse along the old pathway, occurring three or four times a month, or daily during washing, indicating blocked water pathways forcing blood to take alternative routes, Zhinu San (Stop Bleeding Powder, containing Astragalus, Poria, Angelica, Peony, Rehmannia, and Donkey-hide Gelatin) mixed with Thalia flower decoction is suitable. Or, Siwu Tang added with Shichangpu (Acorus), Ejiao (Donkey-hide Gelatin), and Puhuang (Pollen Typhae), each half qian, decocted and mixed with one spoonful of calcined Gypsum powder, alongside Yangzheng Dan. If previous treatments fail and massive epistaxis persists, administer more Yangzheng Dan, assisted by Suzi Jiangqi Tang (Perilla Fruit Descending Qi Decoction) to guide Blood downward with Qi. (*Zhizhi Fang* notes Suzi Jiangqi Tang treats epistaxis due to deficiency and congestion). For dizziness after epistaxis, use Siwu Tang, Xionggui Tang, or Shiquan Dabu Tang (Ten Significant Tonification Decoction). If epistaxis stops but transforms into other syndromes, such as alternating chills and fever, or panting and insomnia, gradually leading to consumptive fatigue, detailed differentiation within consumptive syndromes is required. (*Renzhai Zhizhi Fang*)
Although epistaxis is a common disease, if bleeding continues without stopping, leading to separation and collapse of Yin and Yang, death may occur. Clinicians must recognize this and not neglect it. (*Yixue Zhenchuan*, True Transmission of Medicine)
[Principle: Adding Qi-Moving Herbs]
Wind moves water; Qi moves Blood. Those treating epistaxis know to use Blood-cooling herbs but often ignore that descending Qi guides Blood back to its vessels. This is why ancients always added one or two Qi-moving herbs to Blood herbs, such as the aforementioned Suzi Jiangqi Tang. (*Yizong Tongzhi*, Comprehensive Guide to Medical Works)
[Principle: Benefiting from Yin-Tonification]
Although epistaxis is mostly caused by Fire, it occurs most frequently in cases of Yin deficiency. Labor damages Yin, causing Water to fail to control Fire, easily disturbing Blood in the Chong and Ren vessels. If the pulse is slippery, full, and forceful, and there is no history of damage, treat as a Fire syndrome. If the pulse is surging and large but weak, wiry, hollow, or fine and rapid without spirit, and there is a history of alcohol and sexual excess, these are Yin deficiency syndromes requiring primary Yin tonification. If there is slight Fire, clear it concurrently to treat the branch. If deficiency-heat is seen without definitive Yang-excess signs, use sweet and neutral formulas to warmly nourish True Yin, ensuring Yin Qi is solidified to eradicate the root and prevent future recurrence. (*Jingyue Quanshu*, Complete Works of Jingyue)
Shiweng treated Zhu Shengqing, who suffered from epistaxis like a waterfall for three days, worse than previous episodes. After taking Rhinoceros Horn, Rehmannia, Scutellaria, Coptis, Anemarrhena, Phellodendron, Gypsum, and Gardenia, the condition worsened. On the fourth day, I examined him; the pulse was wiry and urgent like touching a blade. This indicated Yin Fire attacking upwards, carrying Blood up. Cold herbs had damaged the Clear Yang Qi in the Stomach, changing the pulse to wiry and tight. I prescribed Shengli Liuwei Dihuang Tang (Raw Six-Ingredient Rehmannia Decoction) with Schisandra, and separately prepared three pills of Cinnamon Bark powder mixed with flour paste, taken with the decoction. Upon entering the throat, bleeding stopped immediately. Shortly after, several blood clots were expelled, and he recovered. The chronic ailment did not recur for years. (*Yixue Rumen*)
[Case of Heart Deficiency]
The wife of Dong Yunqian from Yin County suffered from epistaxis for about three years. Physicians believed "Blood overflows when heated" and administered Heart-draining and Blood-cooling agents, worsening her condition; she fainted after just a few drops of blood. Master Weng diagnosed a faint pulse in all six positions, especially at the Cun. He said: "The Liver stores Blood, but the Heart governs it. The faint Cun pulse indicates Heart deficiency. Heart deficiency fails to govern Blood, causing it to rebel and flow recklessly. The treatment should nourish the Heart and strengthen the Spleen to support the Son (Fire generates Earth; Heart is Mother, Spleen is Son). When the Son is solid, the Mother is not deficient." She recovered after taking Ambre (Amber) and other Heart-nourishing agents. (*History of Medicine · Biography of Baoyi Weng*)
[Downward Purging Methods]
Cui Shi's Kushen Tang (Sophora Root Decoction) for epistaxis:
Sophora Root (3 fen), Coptis Rhizome (2 liang), Gardenia Fruit (14 pieces, split), Rhubarb (1 liang), Rehmannia Root (1 liang, dried raw).
Chop the five ingredients, boil in 5 sheng of water to obtain 1.5 sheng, strain, and divide into two doses. (Another prescription adds 0.5 liang of Pomegranate Flower.) (*Waitai Miyao*, Essential Prescriptions from the Outer Cabinet)
*Taiping Shenghui Fang*'s Ciji San (Cactus Thorn Powder) treats persistent epistaxis by adding Cactus Thorn, Platycladi Leaf, and Green Bamboo Sap to the base formula. For massive epistaxis with bleeding from mouth and ears, Kushen San (Sophora Root Powder) adds Platycladi Leaf and Auricularia to the base formula, decocted with fresh Rehmannia juice.
Sanhuang San (Three Yellow Powder) for intermittent epistaxis:
Rhubarb (1 liang, steamed in wet paper), Coptis Rhizome (0.5 liang, de-stamened), Scutellaria Root (0.5 liang, peeled).
Grind to fine powder. Take 2 qian mixed with fresh well-water or honey water. (*Benshi Fang*, Formulas of Authentic Value)
*Zhizhi Fang*'s Chuanxiong Sanhuang San (Ligusticum and Three Yellow Powder) for excess-heat epistaxis adds Ligusticum to the base formula.
The wife of Marshal Ma was obese with vigorous Qi. Infertile, she long took uterine-warming drugs, accumulating intense Fire that forced Blood upward into epistaxis, losing several sheng each time. Her face was red, pulse rapid and restless, and she appeared delirious. Physicians used heavy sedative pills for upper excess and lower deficiency. Shou said: "The classic says 'Treat what is above by purging downwards.' Now Blood and Qi are both excessive and flowing upward; the method should be downward guidance. Why reinforce excess?" He immediately administered Taoren Chengqi Tang (Peach Kernel and Magnolia Bark Decoction) three to four times to purge. After stasis was removed, Ji Ji Tang (Decoction of Mutual Achievement) was taken for twenty doses, resulting in recovery. Chen, a clerk in Yangzi County, suffered epistaxis in December lasting until January (13 days). His pulse was excess and rapid; treatment was identical. Ma's wife overdosed on acrid-hot drugs; Chen overconsumed fried/grilled foods and strong wine, both causing accumulated heat. (*History of Medicine · Biography of Yingning Sheng*)
[Methods to Stop Bleeding]
*Duanju Fang* (Short Drama Formulas) for epistaxis with massive bleeding, dizziness, and unconsciousness:
Burn 5 liang of tangled hair to ash. Form into dates-sized pellets, insert into a tube, and blow into the nostril. If bleeding continues, add more powder. Also ingest 1 cun-bi (measure) orally, three times daily, twice at night for severe cases. (*Yixin Fang*, Mirror of Medicine). *Qianjin Fang* notes this is also effective for unconscious patients.
*Ge Shi Fang* for sudden epistaxis:
Soak cotton in vinegar and plug the nostril. Another method: Blow soot from the bottom of a pot into the nose. (*Yixin Fang*)
Epistaxis treatment:
Rinse mouth with clean cold water, hold water, and blow through a reed tube into both nostrils to stop bleeding. (*Qianjin Fang*)
*Guangji Fang* for persistent epistaxis:
Pour 6-7 dou of freshly drawn cold water over the head, and soak feet simultaneously for immediate effect. (*Yixin Fang*)
Another method for sudden epistaxis: Use a water jar with a small hole in the bottom, filled with fresh cold water, pour over the depression at the back of the neck (Wanwan point). One or two jars suffice for cure. (*Taiping Shenghui Fang*) [Yi Fang Kao states: Cooling the back of the neck addresses Fire in the Taiyang meridian.]
Another method:灌 (pour) 3-4 measures of urine from an uncircumcised boy into the nostrils for immediate effect. (*Yixin Fang*)
Treatment for chronic persistent epistaxis:
Hair Ash (1 qian), Renzhongbai (Human Urine Deposit, 0.5 qian), Musk (0.5 qian).
Mix and grind finely, form bean-sized pellets, and blow into the nostrils for immediate effect. (*Taiping Shenghui Fang*). To treat all-day epistaxis with mental restlessness, omit Hair Ash.
Li Qi, a citizen of Raozhou, suffered frequent epistaxis nearing critical condition. A doctor prescribed radish juice mixed with unfermented wine, stopping bleeding quickly. The doctor explained: "Blood follows Qi movement; Qi stagnation causes reckless flow. Radish descends Qi best, and wine guides it, hence one dose works." Relapse occurred after five days. Zhang Sishun used *Wang Shi Dan Fang* (Single Formulas of Wang), heating Renzhongbai on a tile, mixing with warm water, stopping bleeding instantly. No recurrence for ten years. (*Yi Shuo*, Medical Narratives)
For massive hematemesis/epistaxis that suddenly cannot stop, preventing blood晕 (syncope): Roast Mugwort Root in charcoal, sprinkle with vinegar, and have the patient inhale the vapor near the nose to curb the momentum. (*Yuanbing Ji*, Collection of Original Pathologies)
Another formula: Powdered Lygodium Spore and Dragon's Blood blown into the nose is effective. (*Yilin Jiyao*, Collected Essentials of the Medical Forest)
*Jingyan Fang* (Experience Formulas) for persistent epistaxis: Bletilla Rhizome powder mixed with saliva applied to the Shan Gen (root of the nose) stops bleeding immediately. (*Bencao Gangmu*, Compendium of Materia Medica)
For persistent epistaxis unresponsive to other drugs, Garlic Foot-Paste Formula:
Garlic (one clove, peeled and minced).
Spread into a cake size of a coin, thickness of a bean. Apply to the left sole for left nostril bleeding, right sole for right, or both for bilateral. Wash feet with warm water immediately after bleeding stops to remove garlic odor. (*Shengji Zonglu*, General Records of Holy Emergency)
[Cooling Formulas]
Shengdihuang Tang (Rehmannia Decoction) for epistaxis:
Rehmannia Root (8 liang), Scutellaria Root (1 liang), Donkey-hide Gelatin (2 liang), Platycladi Leaf (one handful), Licorice Root (2 liang).
Crush the five ingredients, boil in 7 sheng of water to obtain 3 sheng, strain, add gelatin, simmer to 2.5 sheng, divide into three doses. (*Qianjin Fang*). For hematuria, omit Licorice.
Bapi Tang (Platyclami Bark Decoction) for epistaxis of 1-2 dou with fainting:
Platyclami Bark, Gardenia Fruit (1 liang each), Licorice Root (0.5 liang).
Coarse powder. Take 5 qian with 2 cups of water, simmer to 1 cup, strain, and take warm. (*Jifeng Puji Fang*)
Shi's son, age 10, had persistent epistaxis. Multiple doctors tried Thalia flower tea, Xijiao Dihuang Tang, and blown Dragon Bone powder, all ineffective. Blood flowed downwards. I advised: Immediately administer Longdan Wan (Gentian Pills, equal parts Coptis and Gentian) with strong salt water. One dose reduced bleeding by half; a second dose cleared it completely. The owner asked: What is the effect of salt water? I replied: "Blood flows when hot. Salt water is salty and cold, coagulating blood. Like pig blood coagulating with salt water. Coptis and Gentian are bitter and cold, strengthening blood coagulation. Hence, salty and bitter tastes induce immediate effect." (*Quanying Fanglun*, Formulas for Infant Care)
Yujin San (Curcuma Powder) for epistaxis and hematohidrosis:
Curcuma, Roasted Licorice, Indigo Naturalis (0.5 liang each).
Grind to powder. Take 2 qian-bi mixed with egg white. (*Shengji Zonglu*)
For day-and-night epistaxis with headache and restlessness:
Calcined Gypsum (1 liang, finely ground), Calcined Oyster Shell (1 liang, powdered).
Grind finely. Mix with fresh cold water to a thin paste. When bleeding drips intermittently, instill 3-5 drops into the nose. Also take 2 qian mixed with fresh cold water orally. (*Taiping Shenghui Fang*). Named Yufen San (Jade Powder) in *Shengji Zonglu*. (Listed again here as usage differs from Shanghan discussions.)
Shanzhizi San (Gardenia Powder):
Gardenia Fruit (any amount), charred to retain properties, powdered, insufflated into the nose for immediate cure. (*Benshi Fang*)
[Warming Middle Formulas]
*Jiyao Fang* (Essential Formulas) for epistaxis with massive bleeding, dizziness, and unconsciousness:
Cinnamon Twig (3 liang), Dried Ginger (1 liang), Hair Ash (1 liang).
Powder. Take 1 cun-bi with grain porridge before meals, twice daily. (*Yixin Fang*)
Jiawei Lizhong Tang (Modified Gastro-Regulating Decoction) for epistaxis caused by excessive alcohol or roasted/hot foods:
Codonopsis, Atractylodes, Roasted Licorice, Fried Dried Ginger, Kudzu Root, Ligusticum (equal parts).
Cut into pieces. Take 4 qian with 1 cup of water, simmer to 0.7 cup, strain, and take warm. (*Sanyin Jiyi Bingzheng Fanglun*)
Heji Ju Fang*'s Jinye Dan (Golden Liquid Pellets) stabilizes Qi and treats epistaxis. (*Zhizhi Fang*)
[Qi-Regulating and Counter-Flow Suppressing Formulas]
For all-day epistaxis: Chew Suhexiang Wan (Styrax Pill) with cold water. (*Suosuilu*, Trivial Records)
Xiongfu San (Ligusticum and Aconite Powder) for epistaxis starting with Head Wind: Soak 1 liang Ligusticum in child's urine; process 2 liang Cyperus with child's urine; add 0.5 liang Roasted Licorice. Grind to powder. Take 3 qian with clear tea. Occasionally use nasal insufflation. (*Yixue Rumen*) [Note: Originally from *Liuyao*, lacking Licorice and urine processing. Name added from *Liuyao*.]
For epistaxis: Use Heixi Dan (Black Tin Pellets) with jujube soup. Only for patients with blue complexion, cold body, and weakness. Use with caution. (*Wei Shi Jiacang Fang*, Wei Family Collection*)
For chronic epistaxis unresponsive to cold herbs alone: Use *Ju Fang*'s Yangzheng Dan and Heixi Dan according to method, plus moxa on Zusanli (ST36) for 21 cones. (*Zudao Fang*, Aid to the Dao*)
[Acupuncture Methods]
For massive persistent epistaxis: Prick Shaoshang (LU11) to bleed. Effective. (*Liuyao*, Six Essentials)