（口鼻衄 耳衄 眼衄 齿衄 舌衄 肌衄 九窍衄 血溢 心漏 脐血附）
血从清道出于鼻，为衄。症多火迫血逆，亦有因阳虚致衄者。火亢则治宜清降，生地黄饮子、茜根散。
阳虚则治宜温摄。理中汤、黑神散。既于脉之洪滑弦细别之，暴衄则治凉泻，犀角地黄汤、七汁饮。久衄则治
须滋养。止衄散、生脉散。更以血色之鲜浓暗淡辨之，且火迫致衄，有六淫之火，有五志之火。如风寒壅盛于
经，迫血妄行，表症仍在，脉浮紧用麻黄汤，缓用桂枝汤。成氏谓此非治衄，仍以散邪。仲景固言衄不可汗也。
若感温热风暑而衄者，宜辛润清凉。如杏仁、丹皮、山栀、茅花、丹参、鲜地黄、连翘、石斛、犀角、麦冬、
阿胶、蔗汁、藕汁。因火邪亢极而衄者，宜苦寒咸寒。如黄连、黄芩、山栀、枳壳、栝蒌、元参、犀角、童便。
此治衄外因也。其思伤心脾，惊悸不眠，归脾汤。劳伤元气，咳嗽发热，补中益气汤去白术，加麦冬、五味，
或当归补血汤加薄荷、杏仁。怒伤肝阴，火冒头晕，生地、丹皮、白芍、山栀、阿胶、甘菊、鲜桑叶。欲伤肾
精，阴虚失纳，上喘下遗，都气丸加杞子、菟丝饼。若火不归源，喘促烦躁，脉微肢
厥，八味地黄丸，镇阴煎。阴虚阳浮，六味饮加秋石、龟甲、白芍、五味。卫虚营损，气短色枯，养营汤。
气衰血脱，神疲昏愦，独参汤。胃火血升，犀角地黄汤加茅花。此治衄内因也。其酒升血沸，面赤汗多，四
生丸。努力负重，伤中损络，保元汤加阿胶。此治衄不内外因也。若衄多，服凉剂不止，系内虚寒而外假热，
千金当归汤。衄久不止，热在下焦血分，六味饮加五味、童便。衄久成劳，照虚损治，病后小劳屡衄，石膏
牡蛎汤。衄后屡发，或洗面即衄，并以茅花煎汤，调止衄散服。衄血未净，停瘀入胃，致面黄屎黑，加味犀角
地黄汤。大衄而头痛口渴，玉女煎。大衄不止，面目浮肿，苏子降气汤。使血随气下，得力全在肉桂。凡久衄
须加气药，如木香、黑香附之属。所以引血归经耳。
〔口鼻衄〕血退场门鼻，属肺脾二经。积劳伤脾，补中益气汤，倍 、归。如不应，归脾汤加藕节、
童便。
〔耳衄〕血出耳窍，属肝肾二经。暴衄肿痛，左关弦数，多肝经风火沸膝。柴胡清肝散。若常有点血，
不肿痛，尺中沉数，多肾经阴虚火升。生料六味丸加五味、元参。外用龙骨 研，吹入即止。
〔眼衄〕血出目 ，属肝火迫络损系。若猝视无睹，滋阴地黄丸去柴胡。常流血泪，驻景丸，外以炒黑
槐花末研敷眼角。
〔齿衄〕血出齿缝牙龈，属胃肾二经。阳明入下齿，少阴入上齿。阳明火盛必口臭，牙龈腐肿，甘露饮。
或血涌齿不摇，必酒食炙爆积热，清胃散，外敷冰玉散。甚则衄不止，大便秘，调胃承气汤。阳明风壅，齿龈
微肿，或牵引作痛，消风散加犀角、连翘，外擦青盐、 本末。少阴虚，口不臭，齿浮动不痛，牙缝中衄，
点滴而出，系肾阴不固，虚火偶动，六味饮加山栀、赤芍。若隐隐作痛，系阳虚于下，火炎于上，七味地黄丸，
或盐汤下安肾丸。外擦青盐炒香附末。龈底成块血出，盐汤下六味丸。
〔舌衄〕血出舌上如线，或有针孔，多属心包火。先以蒲黄煎汤，漱之。次以槐花炒研掺之。内服黄
六一散，合生脉散。若舌出血如泉，涂舌丹，或川文蛤研末掺。舌胀大出血不止，干姜灰、生蒲黄为末掺。
〔肌衄〕血出肤孔，属卫气不固，血乘阳分。脉洪，当归六黄汤。脉弱，保元汤。脉数，当归补血汤。
脉浮，黄 建中汤。有红汗，色红染衣，黄 建中汤，兼用妙香散，小麦煎汤调下。
〔九窍衄〕诸窍齐衄，总治侧柏散、犀角汤。有中毒者，饮生羊血。颠扑伤者，灌热童便。烦劳伤者，
补中益气汤倍参 。若五脏内崩者不治。有遍体无故血出，五花汤。
〔血溢〕血从上出，随火妄行。《原病式》以为心火销烁，用黄连泻心汤。或偶触破伤，血涌不止，内服
十全大补汤，外用百草霜掺之。
〔心漏〕胸前一孔出血水，名心漏。用嫩鹿茸去毛酥炙，附子炮去皮脐，和盐花共研末，以枣肉杵丸，
酒下。
〔脐血〕血出脐中，胃受火逼，不得运输。宜熟地、当归、白芍、丹皮、甘草、白芷、侧柏叶、茅根汁、
藕汁之属。
(Mouth and nose bleeding, ear bleeding, eye bleeding, tooth bleeding, tongue bleeding, skin bleeding, nine orifices bleeding, blood overflow, heart leakage, umbilical bleeding attached)
Blood emerging from the nasal cavity via the clear passages is termed "Nu" (epistaxis/nosebleed). The syndrome is mostly caused by fire forcing blood to rebel; there are also cases where deficiency of Yang leads to bleeding. When fire is hyperactive, treatment should focus on clearing and descending; use Shengdi Huang Yin Zi (Rehmannia Decoction) or Qian Gen San (Rubia Root Powder).
When Yang is deficient, treatment should focus on warming and astringing; use Lizhong Tang (Regulate the Middle Decoction) or Hei Shen San (Black Divine Powder). Differentiation is made based on the pulse being surging, slippery, string-taut, or fine. Sudden bleeding is treated with cooling and purging; use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) or Qizhi Yin (Seven Juices Drink). Chronic bleeding requires nourishment; use Zhinu San (Stop Bleeding Powder) or Shengmai San (Generate the Pulse Powder). Further differentiation is made based on whether the blood color is bright and thick or dull and pale. Regarding bleeding caused by fire, there is fire from the six excess pathogens and fire from the five emotions. For example, if wind-cold is congested in the meridians, forcing blood to move recklessly, while exterior symptoms remain and the pulse is floating and tight, use Mahuang Tang (Ephedra Decoction); if the pulse is slow, use Guizhi Tang (Cinnamon Twig Decoction). Cheng Wuji stated that this does not treat the bleeding directly but rather disperses the pathogenic factors. Zhang Zhongjing indeed stated that sweating is contraindicated for nosebleeds. If bleeding occurs due to contracting warm-heat, wind, or summer-heat, acrid-moistening and cooling methods are appropriate. Ingredients include Xingren (Apricot Seed), Danpi (Moutan Bark), Shanzhi (Gardenia Fruit), Maohua (Sedge Flower), Danshen (Salvia Root), Xian Dihuang (Fresh Rehmannia Root), Lianqiao (Forsythia Fruit), Shihu (Dendrobium Stem), Xijiao (Rhinoceros Horn), Maidong (Ophiopogon Tuber), Ejiao (Donkey-hide Gelatin), Zhezhijie (Sugar Cane Juice), and Ouji (Lotus Rhizome Juice). If bleeding is caused by extreme hyperactivity of fire pathogens, bitter-cold and salty-cold methods are suitable. Ingredients include Huanglian (Coptis Rhizome), Huangqin (Scutellaria Root), Shanzhi (Gardenia Fruit), Zhike (Aurantii Fructus), Gualou (Trichosanthes Fruit), Yuan Shen (Scrophularia Root), Xijiao (Rhinoceros Horn), and Tongbian (Child's Urine). This addresses the external causes of bleeding.
If excessive thinking damages the Heart and Spleen, causing palpitations and insomnia, use Guipi Tang (Restore the Spleen Decoction). If labor injures Yuan Qi (Primal Qi), causing cough and fever, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) removing Baizhu (Atractylodes Macrocephala Rhizome), adding Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Berry), or use Danggui Buxue Tang (Angelica Tonifying Blood Decoction) adding Bohe (Mint Leaf) and Xingren (Apricot Seed). Anger injures Liver Yin, causing fire to rise and dizziness, using Shengdi (Rehmannia Root), Danpi (Moutan Bark), Baishao (White Peony Root), Shanzhi (Gardenia Fruit), Ejiao (Donkey-hide Gelatin), Ganju (Chrysanthemum Flower), and Xian Sangye (Fresh Mulberry Leaf). Excessive desire injures Kidney Essence, leading to Yin deficiency and failure to grasp, with upper asthma and lower enuresis, treating with Duqi Wan (Nine-Ingredient Pill) adding Gouqi (Goji Berry) and Tusizi (Dodder Seed). If fire fails to return to its source, causing panting and irritability, with a faint pulse and cold limbs, use Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) or Zhenyin Jian (Settling Yin Decoction). For Yin deficiency with floating Yang, use Liuwei Yin (Six-Ingredient Decoction) adding Qiushi (Autumn Stone), Guijia (Tortoise Shell), Baishao (White Peony Root), and Wuweizi (Schisandra Berry). For Wei Qi (Defensive Qi) deficiency and Ying Blood (Nutritive Blood) damage, causing shortness of breath and sallow complexion, use Yangying Tang (Nourish Ying Decoction). For Qi collapse and Blood exhaustion, causing mental fatigue and confusion, use Dushen Tang (Single Ginseng Decoction). For Stomach fire causing blood to ascend, use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) adding Maohua (Sedge Flower). This addresses the internal causes of bleeding.
Alcohol consumption causing blood boiling, red face, and profuse sweating is treated with Sisheng Wan (Four Generations Pill). Straining under heavy loads damaging the middle and collaterals is treated with Baoyuan Tang (Preserve Origin Decoction) adding Ejiao (Donkey-hide Gelatin). This addresses non-internal/external causes.
If bleeding is profuse and does not stop with cooling agents, it indicates internal deficiency-cold with external false-heat; use Qianjin Danggui Tang (Thousand Gold Angelica Decoction). If chronic bleeding persists due to heat in the Lower Jiao blood level, use Liuwei Yin (Six-Ingredient Decoction) adding Wuweizi (Schisandra Berry) and Tongbian (Child's Urine). If chronic bleeding becomes a consumptive disease, treat according to deficiency damage. If bleeding recurs after minor exertion following illness, use Shigao Muli Tang (Gypsum and Oyster Shell Decoction). If bleeding recurs frequently or occurs immediately upon washing the face, decoct Maohua (Sedge Flower) and take with Zhinu San (Stop Bleeding Powder). If residual blood remains and stasis enters the stomach, causing yellow complexion and black stool, use Jiawei Xijiao Dihuang Tang (Modified Rhinoceros Horn and Rehmannia Decoction). For massive bleeding with headache and thirst, use Yuniu Jian (Jade Woman Decoction). For unceasing massive bleeding with facial and ocular edema, use Suzi Jiangqi Tang (Perilla Seed Descending Qi Decoction). To make blood follow Qi downward, reliance is entirely on Rougui (Cinnamon Bark). For chronic bleeding, Qi-moving herbs such as Muxiang (Aucklandia Root) and Heixiangfu (Cyperus Rhizoma) should be added to guide blood back to its vessels.
[Mouth and Nose Bleeding] Blood exiting the mouth and nose belongs to the Lung and Spleen meridians. Accumulated labor injuring the Spleen is treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), doubling Huangqi (Astragalus Root) and Danggui (Angelica Sinensis Root). If ineffective, use Guipi Tang (Restore the Spleen Decoction) adding Ou jie (Lotus Rhizome Node) and Tongbian (Child's Urine).
[Ear Bleeding] Blood exiting the ear orifice belongs to the Liver and Kidney meridians. Sudden bleeding with swelling and pain, with a string-taut and rapid Left Guan pulse, indicates Liver meridian wind-fire boiling. Treat with Chaihu Qinggan San (Bupleurum Clearing Liver Powder). If there is often slight bleeding without swelling or pain, with a deep and rapid Chi pulse, it indicates Kidney meridian Yin deficiency with rising fire. Treat with Shengliao Liuwei Wan (Raw Material Six-Ingredient Pill) adding Wuweizi (Schisandra Berry) and Yuanshen (Scrophularia Root). Externally, apply Longgu (Fossilized Bone) powder insufflated into the ear to stop bleeding.
[Eye Bleeding] Blood exiting the eye corners belongs to Liver fire forcing collateral damage. If sudden vision loss, use Ziyin Dihuang Wan (Nourishing Yin Rehmannia Pill) removing Chaihu (Bupleurum Root). If constant flow of bloody tears, use Zhujing Wan (Stabilizing Vision Pill), externally applying fried black Huaihua (Sophora Flower) powder to the eye corners.
[Tooth Bleeding] Blood exiting the gum crevices belongs to the Stomach and Kidney meridians. Yangming enters the lower teeth; Shaoyin enters the upper teeth. Yangming fire excess必然 causes bad breath and gum rot/swelling, treated with Ganlu Yin (Sweet Dew Decoction). If blood gushes but teeth do not loosen, it is likely accumulated heat from alcohol, food, and roasted/fried items; treat with Qingwei San (Clear Stomach Powder) and externally apply Bingyu San (Ice Jade Powder). If severe unceasing bleeding with constipation, treat with Tiaowei Chengqi Tang (Regulate the Stomach and Purge Qi Decoction). Yangming wind congestion causing slight gum swelling or radiating pain is treated with Xiaofeng San (Dispel Wind Powder) adding Xijiao (Rhinoceros Horn) and Lianqiao (Forsythia Fruit), externally rubbing with Qingyan (Green Salt) and Gaoben (Ligusticum Rhizome) powder. Shaoyin deficiency with no bad breath, loose teeth without pain, and dripping blood from gums indicates Kidney Yin insecurity with occasional virtual fire; treat with Liuwei Yin (Six-Ingredient Decoction) adding Shanzhi (Gardenia Fruit) and Chishao (Red Peony Root). If dull pain, indicating Yang deficiency below and fire flaming above, use Qiwei Dihuang Wan (Seven-Ingredient Rehmannia Pill) or Anshen Wan (Calming Spirit Pill) taken with salt water. Externally rub with Qingyan (Green Salt) and fried Xiangfu (Cyperus Rhizoma) powder. If clotted blood emerges from the gum base, take Liuwei Wan (Six-Ingredient Pill) with salt water.
[Tongue Bleeding] Blood emerging from the tongue like a thread or with needle holes mostly belongs to Pericardium fire. First, rinse with Puhuang (Lygodium Spore) decoction. Then sprinkle fried and powdered Huaihua (Sophora Flower). Internally take Huangliu Yi San (Yellow Six-One Powder) combined with Shengmai San (Generate the Pulse Powder). If tongue bleeding flows like a spring, apply Tutang Dan (Tongue Smearing Elixir) or sprinkle pulverized Chuan Wen Ge (Clam Shell). If the tongue swells and bleeding does not stop, sprinkle powdered Ganjiang Hui (Dried Ginger Ash) and Sheng Puhuang (Fresh Lygodium Spore).
[Skin Bleeding] Blood exiting skin pores belongs to insecure Wei Qi (Defensive Qi) and blood invading the Yang level. With a surging pulse, use Danggui Liuhuang Tang (Angelica and Rheum Decoction). With a weak pulse, use Baoyuan Tang (Preserve Origin Decoction). With a rapid pulse, use Danggui Buxue Tang (Angelica Tonifying Blood Decoction). With a floating pulse, use Huangqi Jianzhong Tang (Astragalus Regulating Middle Decoction). For "red sweat" staining clothes red, use Huangqi Jianzhong Tang (Astragalus Regulating Middle Decoction) combined with Miaoxiang San (Wonderful Incense Powder), taken with wheat decoction.
[Nine Orifices Bleeding] Simultaneous bleeding from all orifices is generally treated with Ce Bai San (Platycladus Powder) or Xijiao Tang (Rhinoceros Horn Decoction). For poisoning, drink raw sheep blood. For trauma from falls, pour hot child's urine. For injury from overexertion, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) doubling Renshen (Ginseng Root). If internal rupture of the five Zang organs occurs, it is untreatable. For spontaneous bleeding all over the body without cause, use Wuhua Tang (Five Flowers Decoction).
[Blood Overflow] Blood flowing upward follows reckless fire movement. The *Yuanbing Shi* attributes this to Heart fire consuming and melting; treat with Huanglian Xiexin Tang (Coptis Draining Heart Decoction). If accidental injury causes unceasing blood gushing, internally take Shiquan Dabu Tang (Perfect Great Tonification Decoction) and externally apply Baicaoshuang (Hundred Grass Soot).
[Heart Leakage] A hole on the chest leaking blood and fluid is named Heart Leakage. Use tender Lu Rong (Deer Antler) de-haired and fried in butter, Paofu Zi (Prepared Aconite Root) peeled and de-navelled, mixed with Yanhua (Salt Crystals), ground into powder, formed into pills with Jiu Rou (Jujube Flesh), and taken with wine.
[Umbilical Bleeding] Blood exiting the navel indicates the Stomach is forced by fire and cannot transport. Suitable ingredients include Shudi (Prepared Rehmannia Root), Danggui (Angelica Sinensis Root), Baishao (White Peony Root), Danpi (Moutan Bark), Gancao (Licorice Root), Baizhi (Angelica Dahurica Root), Ce Bai Ye (Platycladus Leaf), Maogen (Imperata Rhizome Juice), and Ouji (Lotus Rhizome Juice).