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Master Qi stated: When fire qi stagnates and surges in the upper jiao (upper burner), failing to disperse, it rushes upward causing hematemesis (vomiting blood) and epistaxis (nosebleed). Bleeding from the seven orifices is due to kidney yin deficiency generating internal heat. It should be treated with Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) added with Maidong (Ophiopogon Root), Wuweizi (Schisandra Fruit), and Gusuibu (Drynaria Rhizome). (From *Mi Lu*)

Feng Luzhan stated: Epistaxis may result from excessive heat accumulation in the heart, lungs, or stomach, forcing blood to move recklessly and invading the clear pathways upwards. The nose connects to the brain; when blood overflows into the brain, it exits through the nose, termed "Bi Nu" (Epistaxis). If caused by wind, cold, summerheat, or dampness circulating through the meridians and disrupting the clear pathways, these are external causes. If caused by chronic anger injuring the liver, chronic sorrow injuring the lungs, excessive worry injuring the spleen, loss of will injuring the kidneys, or sudden joy injuring the heart—thereby moving blood to overflow with qi—these are internal causes. If caused by overeating, consuming roasted/spicy/hot foods, or trauma from falls/crashes, these are neither purely internal nor external causes. *Yuan Bing Shi* states: Epistaxis results from yang heat stagnating in the Foot-Yangming Meridian. Danxi stated: Blood comes from the Lungs; referring to the Lung is from the perspective of orifices. Referring to Yangming is from the perspective of the Sea of Blood. There are cases of epistaxis occurring while washing the face, becoming a daily habit, akin to wind stirring water; with facial heat and rising Yangming fire, blood follows suit. (From *Jin Nang*)

He further stated: If black qi appears around the mouth and nose accompanied by epistaxis postpartum, it is called "Stomach Exhaustion." This condition is mostly incurable. In such cases, urgently take a red thread and two strands of hair from the vertex of the mother's head, tie them tightly around the middle joint of the middle finger to stop bleeding. If epistaxis persists accompanied by sweating on the head, death ensues.

Chen Shigong stated: Nosebleed is due to flourishing fire in the Lung Meridian forcing blood to move recklessly and exit via the nasal orifice. Apply Zitusan (Purple Earth Powder) to the fontanelle top, and internally administer Lingyang Qingfei Tang (Antelope Horn Clearing Lung Decoction) to stop it naturally. (From *Zheng Zong*)

*Dongui Bogam* states: Postpartum, qi and blood become chaotic, entering various meridians without returning to their origin, causing black discoloration at the mouth and nose, progressing to epistaxis, termed "Stomach Exhaustion and Lung Failure." This condition is incurable; one should use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) for rescue, or urgently apply Jingjie San.

Hu Jingzhou stated: With excessive bleeding from above and below, breath becomes faint, palpitations occur, spirit is fatigued, pulse is fine as a silk thread, possibly with aversion to cold and fever, thirst, and irritability. Urgently decoct 1 liang of Renshen (Ginseng) and 10 Jujubes (pitted) in water and administer. Since blood is generated by qi, replenishing qi upon blood loss follows the principle that when yang generates, yin grows.

A woman fell backward, causing continuous nosebleed. After stopping, any slight stimulus triggered bleeding again; various physicians failed. Later, a physician mixed white flour with water, wrapped a large Fuzi (Prepared Aconite Root) inside, baked it until cooked, removed the Fuzi, and only used the flour charred to retain its nature, powdered. Each dose was 2 qian, taken with warm water. This method prevented recurrence permanently.

*Shanghan Lun* states: Those prone to epistaxis (Nu Jia) must not undergo diaphoresis (sweating therapy).

Zhang Jingyue stated: For miscellaneous diseases involving epistaxis, the responsibility lies in interior heat; for Shanghan (cold damage) involving epistaxis, the responsibility lies in exterior heat.

He further stated: In Yangming disease, if there is dry mouth but only desire to rinse the mouth without swallowing, epistaxis is certain. Because the Yangming meridian connects to the mouth and nose, the desire to rinse but not swallow indicates heat in the channel but no heat in the interior, thus epistaxis will occur.

He further stated: There is disturbance of yin blood, which is distinct from ordinary epistaxis. The treatise states: In Shaoyin disease, if there is only cold extremities without sweat, and forced diaphoresis is applied, it will surely disturb the blood. Unknown from which pathway it exits, it may come out from the mouth/nose or eyes; this is termed "Lower Jue and Upper Exhaustion," involving yin blood, representing a critical condition.

I state: Why does the book consider postpartum black qi at the mouth/nose and epistaxis as incurable? The splendor of the five zang organs all ascends to the face. Redness indicates the vital qi of yang heat; cyan/black indicates the dying qi of yin cold. Moreover, the mouth and nose are areas where the Yangming Meridian has abundant blood and qi. The appearance of yin cold and desolate qi indicates the decline of the harmonious yang qi in the stomach. Coupled with epistaxis, this signifies the loss of yang and leakage of yin. Stomach exhaustion and lung failure mean both yin and yang are exhausted, hence incurable. Regarding purple-black tongue postpartum, it indicates blood death first, which is incurable. Since the Heart governs blood, when Shaoyin qi exhausts, blood cannot nourish upwards.