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Qin Zi said: Ya Nu (gingival bleeding) refers to the symptom of bleeding from the gums. It is primarily governed by two meridians: one belongs to the Yangming Stomach and Intestines, and the other to the Shaoyin Kidney meridian. If blood gushes out with a violent onset and in large quantities, this is Yangming gingival bleeding, which can be caused by either external pathogens or internal injury. If blood drips out slowly in small amounts, this is bleeding from the Shaoyin Kidney meridian, which is caused only by internal injury and not by external pathogens. From the perspective of meridians, there are distinctions between Zang-Fu organs and Yin-Yang; from the perspective of etiology, all cases belong to "fire" within the blood, requiring differentiation between deficiency and excess, but they do not belong to Yin-cold patterns.

[Symptoms of External Pathogen Gingival Bleeding] The body presents with aversion to cold and fever, restlessness and discomfort, eye pain, headache in the forehead, dry nose, and insomnia, accompanied by sudden profuse bleeding from the gums. This belongs to Yangming [Stomach Meridian] external pathogen gingival bleeding.

[Etiology of External Pathogen Gingival Bleeding] This may occur when exterior pathogens from the Taiyang meridian invade the Yangming meridian, or when the Yangming meridian itself contracts wind-heat, leading to intense heat within the meridian. The Yangming meridian is abundant in both Qi and Blood. When both Qi and Blood are affected by heat, they attack upwards along the pathways traversed by the Yangming meridian, exiting directly through the gaps in the gums.

[Pulse Diagnosis for External Pathogen Gingival Bleeding] The pulse is typically Floating-Rapid (Fu Shu); a Floating pulse indicates exterior pathogens, while a Rapid pulse indicates heat in the blood. A Floating-Rapid pulse on the left position indicates invasion by Taiyang pathogens; a Floating-Rapid pulse on the right position indicates heat in the Yangming meridian. For Floating-Rapid pulses, the treatment principle is to release the exterior; for Deep-Rapid pulses, the principle is to cool the blood.

[Treatment for External Pathogen Gingival Bleeding] For a Floating-Rapid pulse on the left, with fever, absence of sweating, and presence of exterior pathogens, use Gegen Qianghuo Tang (Pueraria and Notopterygium Decoction). For a Floating-Rapid pulse on the right, with fever, absence of sweating, and presence of exterior pathogens, use Gange Fangfeng Tang (Pueraria and Saposhnikovia Decoction); for a Floating-Rapid pulse on the right, with fever, presence of sweating, and absence of exterior pathogens, use Gange Qingwei Tang (Pueraria and Stomach-Clearing Decoction). If the exterior pathogens have been resolved and the pulse becomes Deep and Rapid, use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). If ineffective, add Jiuzheng Dahuang (Wine-processed Rheum officinale), and the bleeding will stop.

Gegen Qianghuo Tang is Qianghuo Tang added with Gegen (Puerariae Radix).

Gange Fangfeng Tang
Gegen (Puerariae Radix)
Fangfeng (Saposhnikoviae Radix)
Jingjie (Schizonepetae Spica)
Shigao (Gypsum Fibrosum)
Zhimu (Anemarrhenae Rhizoma)

Gange Qingwei Tang
Shengma (Cimicifugae Rhizoma)
Shengdi (Rehmanniae Radix Preparata)
Danpi (Moutan Cortex)
Chuanlian (Coptidis Rhizoma)
Gancao (Glycyrrhizae Radix et Rhizoma)
Gegen (Puerariae Radix)
Shigao (Gypsum Fibrosum)

Xijiao Dihuang Tang See previous section on Hemoptysis and Coughing Blood.

If interior heat is severe, add Jiuzheng Dahuang (Wine-processed Rheum officinale).