秦子曰∶血从鼻孔而出者，衄也。鼻为清道，肺之开窍，阳明主司，以手太阴肺，与手
阳明大肠，相为表里者也。阳明有热，肺受火制，阳明之脉，入目络鼻，交 中，旁纳太
阳之脉，故仲景伤寒条，以太阳有邪，侵入阳明则衄血。又以足太阳膀胱之脉，与足少阴肾
，相为表里，故《金匮》内伤条，以肝肾有火，上冲太阳巅顶，传入阳明，亦为衄血。内伤
门衄血，为热在里，宜凉血；外感门衄血，为热在表，宜解表。
【外感衄血之症】恶寒身热，头疼身痛，鼻孔出血，此寒伤太阳经，侵入阳明，而成
衄血之症也。若目痛鼻干不眠，身热口渴，脉长而洪，此阳明本经郁热衄血之症也。
【外感衄血之因】其人内有积热，外冒风寒，伤于太阳之经，郁而发热，经络热甚，
热侵
汗，两阳相搏，此皆外感衄血之因也。
【外感衄血之脉】浮大而紧，太阳衄血；脉若弦长，热在阳明；脉沉洪数，里有热结
【外感衄血之治】恶寒脉浮紧无汗，冬月仲景用麻黄汤；有汗脉浮缓，桂枝汤，三时
节庵
麻黄汤
麻黄 桂枝 甘草 杏仁
桂枝汤
桂枝 芍药 甘草 生姜 大枣
桢按∶以上二方，辛温太过，仲景冬月用之，治衄血皆表症，不比吐血咳血，里热症耳。
羌活冲和汤
羌活 黄芩 防风 苍术 川芎 生地 细辛 白芷 甘草
干葛解肌汤
葛根 桂枝 芍药 甘草 麻黄
犀角地黄汤
犀角 地黄 白芍 丹皮 山栀 升麻 干葛
加茅根同煎。热甚加黄芩。
黄芩芍药汤
黄芩 白芍药 生地 丹皮 甘草
加茅根同煎。磨京墨冲服。
Qin Zi said: Blood flowing from the nostrils is called "Nü" (epistaxis). The nose is a clear orifice and the opening of the Lung, governed by the Yangming channel, because the Hand-Taiyin Lung channel and the Hand-Yangming Large Intestine channel are exteriorly-interiorly related. If there is heat in the Yangming channel, the Lung is constrained by fire. The Yangming channel enters the eyes, connects with the nose, intersects at the fontanelle, and laterally receives the Taiyang channel. Therefore, Zhang Zhongjing, in the clauses of *Shanghan Lun* (Treatise on Cold Damage), states that when the Taiyang channel is invaded by pathogens which then penetrate into the Yangming channel, epistaxis occurs. Furthermore, since the Foot-Taiyang Bladder channel and the Foot-Shaoyin Kidney channel are exteriorly-interiorly related, *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) in its internal injury clauses states that if there is fire in the Liver and Kidneys, rushing upward to the vertex of the Taiyang channel and transmitting into the Yangming channel, it also causes epistaxis. Epistaxis in the category of internal injuries is due to heat in the interior, suitable for cooling blood therapy; epistaxis in the category of external contraction is due to heat in the exterior, suitable for releasing the exterior therapy.
[Symptoms of External Contraction Epistaxis] Aversion to cold, fever, headache, and body pain, with bleeding from the nostrils, indicate that cold has injured the Taiyang channel, invading the Yangming channel, thereby forming the syndrome of epistaxis. If there is eye pain, dry nose, insomnia, body fever, thirst, and a pulse that is long and surging, this indicates epistaxis caused by stagnant heat in the Yangming channel itself.
[Etiology of External Contraction Epistaxis] The person has accumulated heat within and is exposed to wind-cold externally. This injures the Taiyang channel, causing stagnation and fever. The heat in the channels and collaterals becomes severe, invading the sweat pores. The interaction of two Yang channels constitutes the etiology of external contraction epistaxis.
[Pulse of External Contraction Epistaxis] A floating, large, and tight pulse indicates Taiyang epistaxis; a string-like and long pulse indicates heat in the Yangming channel; a deep, surging, and rapid pulse indicates heat accumulation in the interior.
[Treatment of External Contraction Epistaxis] With aversion to cold, floating-tight pulse, and no sweating, Zhang Zhongjing used Mahuang Tang (Ephedra Decoction) in winter; with sweating and a floating-slow pulse, Guizhi Tang (Cinnamon Twig Decoction) was used, while other seasons [referencing Jie'an]...
Mahuang Tang (Ephedra Decoction)
Herbs: Ephedrae Herba (Mahuang, 麻黄), Cinnamomi Ramulus (Guizhi, 桂枝), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草), Armeniacae Semen Amarum (Xingren, 杏仁)
Guizhi Tang (Cinnamon Twig Decoction)
Herbs: Cinnamomi Ramulus (Guizhi, 桂枝), Paeoniae Radix Alba (Shaoyao, 芍药), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草), Zingiberis Recens Rhizoma (Shengjiang, 生姜), Jujubae Fructus (Dazao, 大枣)
Commentary by Zhen: The above two formulas are excessively acrid-warm. Zhang Zhongjing used them in winter to treat epistaxis as exterior syndromes, which differs from hematemesis and hemoptysis, which are interior heat syndromes.
Qianghuo Chonghe Tang (Notopterygii Root and Harmonizing Decoction)
Herbs: Notopterygii Rhizoma et Radix (Qianghuo, 羌活), Scutellariae Radix (Huangqin, 黄芩), Saposhnikoviae Radix (Fangfeng, 防风), Atractylodis Rhizoma (Cangzhu, 苍术), Chuanxiong Rhizoma (Chuanxiong, 川芎), Rehmanniae Radix Preparata (Shengdi, 生地), Asari Radix et Rhizoma (Xixin, 细辛), Angelicae Dahuricae Radix (Baizhi, 白芷), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草)
Gegen Jiemi Tang (Puerariae Root Muscle-Relieving Decoction)
Herbs: Puerariae Lobatae Radix (Gegen, 葛根), Cinnamomi Ramulus (Guizhi, 桂枝), Paeoniae Radix Alba (Shaoyao, 芍药), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草), Ephedrae Herba (Mahuang, 麻黄)
Xiaojiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction)
Herbs: Rhinocerotis Cornu (Xijiao, 犀角), Rehmanniae Radix Preparata (Dihuang, 地黄), Paeoniae Radix Alba (Baishao, 白芍), Moutan Cortex (Danpi, 丹皮), Gardeniae Fructus (Shanzhi, 山栀), Cimicifugae Rhizoma (Shengma, 升麻), Puerariae Lobatae Radix (Gegen, 干葛)
Usage: Decoct together with Imperatae Rhizoma (Maogen, 茅根). If heat is severe, add Scutellariae Radix (Huangqin, 黄芩).
Huangqin Shaoyao Tang (Scutellaria and Peony Decoction)
Herbs: Scutellariae Radix (Huangqin, 黄芩), Paeoniae Radix Alba (Baishaoyao, 白芍药), Rehmanniae Radix Preparata (Shengdi, 生地), Moutan Cortex (Danpi, 丹皮), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草)
Usage: Decoct together with Imperatae Rhizoma (Maogen, 茅根). Take with suspended ink made from Jingmo (京墨).