Library

Cough caused by heat pathogens persists without cessation, raising the fear of developing into *Lao Zhai* (consumptive disease). Use *Tuan Yu Wan* (Soft-shelled Turtle Pill) to soothe and regulate Lung Qi and nourish and benefit Liver Blood. Employing both attacking and tonifying methods simultaneously, this approach is most excellent.

One type is cough due to *Lao Chong* (tubercle bacillus/worm), characterized by a feeling of depression and slight irritability in the chest, complexion alternating between red and pale, unbearable itching in the throat, persistent cough, and loss of smell. It is appropriate to use *Yue Hua Wan* (Moonlight Pill) to regulate the Lungs and eliminate the worm for treatment. Investigating the origin of the worm, it arises from the stagnation and accumulation of Blood stasis, where heat steams dampness causing putrefaction, further agitated by Liver Wind, thus transforming into the *Lao Chong*. Once transformed into a worm, treatment should follow the method of eliminating worms, yet it is also necessary to concurrently remove Blood stasis to eradicate the root, clear damp-heat to purify the source, pacify Liver Wood/Wind to stabilize the mechanism, and gather toxic drugs to kill the species. This formula combines several methods and has grasped the general principles for treating *Lao Chong*. For details, refer to the section on *Lao Chong*; self-study will clarify.

There is also *Fei Yong* (lung abscess) with cough and expectoration of pus and blood; see the section on Expectoration of Pus for details.

There is also cough caused by fire from food retention rushing up to disturb the Lungs. This fire often manifests at dawn (5-7 AM), flowing into the Lungs to induce cough. This condition does not involve the Blood level, but it often occurs in deficient individuals. Prescribe *Xiao Chai Hu Tang* (Minor Bupleurum Decoction) combined with *Xiao Yao San* (Free and Easy Wanderer Powder), adding *Shan Zha* (Crataegi Fructus), *Shen Qu* (Massa Medicata Fermentata), *Mai Ya* (Hordei Fructus Germinatus), *Lai Fu Zi* (Raphani Semen), *Zhi Zi* (Gardeniae Fructus), and *Mai Dong* (Ophiopogonis Radix). Cough occurring at dusk indicates that Yang Qi is about to enter Yin, but floating fire cannot be contained internally, entering the Lungs to cause cough. Treat with *Wu Wei Zi* (Schisandrae Fructus), *Chuan Wen Ge* (Meretrix Shell), and *Dou Ling* (Loquat Leaf).

Other miscellaneous bloody coughs unrelated to Blood disorders have their own records in medical texts and are not discussed here.

The nose is the orifice of the Lungs. The root of the nose connects superiorly to the Taiyang (Greater Yang) meridian, while the nostrils are flanked inferiorly by the Yangming (Yang Brightness) meridians, internally connecting to the Lungs to govern respiration. It is a pathway of clarity and emptiness, a portal communicating with Heaven and Earth. It should be unobstructed rather than blocked, quiet rather than wheezing, allowing Qi out rather than bleeding. Why does nasal bleeding (*Nu Xue*) occur now? The *Jin Gui Yao Lue* states: "Heat injuring the Yang collaterals causes nasal bleeding; heat injuring the Yin collaterals causes rectal bleeding." Yin collaterals refer to the vessels within the body shell, specifically those in the fatty membranes of the Zang-Fu organs, close to the intestines and stomach, hence governing rectal bleeding. Yang collaterals refer to the vessels outside the body shell, in the muscles and skin. Blood from the Yang levels circulates upward along the meridians, invading the clear pathways, resulting in nasal bleeding. Thus, Yang collaterals are the collaterals of the Taiyang and Yangming meridians. Generally, the Taiyang and Yangming meridians traverse the exterior of the body shell. If Yang collateral blood is injured by the Taiyang meridian, it follows the back meridians upward to the nose, causing nasal bleeding; this corresponds to Zhang Zhongjing's statement that spring and summer diseases often originate from the Taiyang. If injured by the Yangming meridian, it rises from the chest upward along the meridians to the nose; this corresponds to his statement that autumn and winter diseases often originate from the Yangming. Now, let us discuss these two categories separately.

The Taiyang meridian governs opening. In spring and summer, Yang Qi should naturally expand and open. If it becomes depressed and closed, pathogenic factors accumulate, leading to nasal bleeding. Symptoms include nasal congestion, headache, aversion to cold and fever, and confusion. This may arise from pre-existing internal heat moving in response to the seasonal command of expansion, or from wind-warmth, summerheat, or epidemics attacking and triggering it. Additionally, if Cold Damage (*Shang Han*) fails to induce sweating, pathogenic factors have no exit and leak out through the Blood level as nasal bleeding. This is called "Red Sweat" (*Hong Han*), indicating the pathogen is attempting to resolve itself spontaneously; physicians must understand this. Even analyzing this as "Red Sweat," we can infer that if Taiyang Qi cannot vent through the skin and hair, it manifests as Red Sweat; similarly, if Taiyang Heat cannot disperse outward, it must force blood upward, causing nasal bleeding. Skin and hair are the exterior correspondence of the Lungs. Taiyang Qi governs the exterior skin and hair and internally correlates with the Lungs. Since the nose is the orifice of the Lungs, treating nasal bleeding from the Taiyang meridian must focus primarily on treating the Lungs. Observing the *Shang Han Lun*, treatments for Taiyang conditions use formulas like *Ma Xing Shi Gan Tang* (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) to regulate the Lungs; thus, treating the Lungs is equivalent to treating the Taiyang. The method should involve clearing and draining Lung Fire and soothing and facilitating Lung Qi. When Lung Qi is clear, Taiyang Qi naturally clears, and nasal bleeding ceases. If external Wind-Cold causes chills and anhidrosis, use *Ma Huang Ren Shen Shao Yao Tang* (Ephedra, Ginseng, and Peony Decoction). If Lung Fire is congested and abundant, causing dizziness, headache, asthma, and a slippery, large, rapid, and excess pulse, use *Ren Shen Xie Fei Tang* (Ginseng and Lung-Draining Decoction), adding *Jing Jie* (Schizonepetae Herba), *Ge Gen* (Puerariae Radix), *Pu Huang* (Typhae Pollen), *Mao Gen* (Imperatae Rhizoma), *Sheng Di Huang* (Rehmanniae Radix), and *Tong Bian* (Human Urine). For chronic nasal bleeding leading to Blood deficiency, use Danxi's *Zhi Nu San* (Hemostatic Powder), adding *Mao Hua* (Bamboo Mite/Flower), *Huang Qin* (Scutellariae Radix), *Jing Jie*, and *Xing Ren* (Armeniacae Semen Amarum). For the above formulas, if nasal congestion is present, add *She Xiang* (Musk) and *Huang Lian* (Coptidis Rhizoma). Generally, nasal congestion from Wind-Cold mixed disorders is due to external Cold closure, whereas in this condition, it is mostly due to internal Fire congestion. Using *Qiang Huo* (Notopterygii Rhizoma et Radix) would worsen the congestion. Therefore, use *Huang Lian* and *She Xiang* to open the Fire blockage. Once nasal bleeding stops, it is appropriate to take more of the original *Zhi Nu San* and *Liu Wei Di Huang Tang* (Six-Ingredient Rehmannia Pill) to consolidate recovery. There is also nasal bleeding caused by Deficient Fire of the Kidney meridian floating upward and disturbing the Du Mai (Governor Vessel). Symptoms necessarily include lower back pain, neck and spine pain, dizziness, and cold feet. This occurs because of the upward movement of Kidney Deficient Fire. Treat with *Zhi Nu San*, removing *Huang Bo* (Phellodendri Cortex), and adding *Sui Bu* (Ecliptae Herba), *Niu Xi* (Achyranthis Bidentatae Radix), *Xu Duan* (Dipsaci Radix), *Ge Gen*, *Lu Jiao Jian* (Deer Antler Glue), *Tong Bian*, and *Xuan Shen* (Scrophulariae Radix). Since the Du Mai attaches to the Taiyang meridian, treating the Taiyang also treats the Du Mai, just as treating the Yangming treats the Chong Mai (Penetrating Vessel) which attaches to it. The Taiyang meridian is one of scant blood, and the Du Mai is the master of vital essence; neither's blood should be damaged. After nasal bleeding stops, immediately use *Di Huang Tang* (Rehmannia Decoction) added with *Tian Dong* (Asparagi Radix), *E Jiao* (Colla Corii Asini), *Xue Yu* (Calamitatis Carbo), and *Wu Wei Zi* to tonify.

The Yangming meridian governs closing. In autumn and winter, Yin Qi should naturally converge. If Dryness-Fire damages its collaterals, causing floating heat and loss of the closing function, blood is forced upward and exits through the nose via the meridians. Symptoms include thirst, asthma, dry nasal passages, vertigo, and fever. This may result from alcohol-induced fire or the influence of the Six Qi. Ultimately, it is always the Dryness Qi of the Yangming combining with pathogens to cause nasal bleeding. The Yangming's intrinsic nature is Dryness; once disease enters this meridian, it invariably transforms into Dryness. Treatment generally focuses on calming Dryness Qi. Use *Xie Xin Tang* (Drain the Epigastrium Decoction) added with *Sheng Di Huang*, *Hua Fen* (Trichosanthis Radix), *Zhi Ke* (Aurantii Fructus), *Bai Shao* (Paeoniae Radix Alba), and *Gan Cao* (Glycyrrhizae Radix). Or use *Xi Jiao Di Huang Tang* (Rhinoceros Horn and Rehmannia Decoction) added with *Huang Qin* and *Sheng Ma* (Cimicifugae Rhizoma) to greatly resolve heat toxicity. After nasal bleeding stops, use *Yu Nu Jian* (Jade Woman Decoction) added with *Pu Huang* to nourish and descend. Subsequently, take *Gan Lu Yin* (Sweet Dew Drink) frequently for recuperation. Drinking pear glue, lotus root juice, radish juice, and white honey freely is beneficial for the condition.

The above two categories have different treatment methods. However, the nose is fundamentally the orifice of the Lung meridian, and blood belongs to the Liver meridian. Therefore, anyone suffering from nasal bleeding will inevitably have yellowish/dim vision. Zhang Zhongjing said: "Yellow eyes indicate nasal bleeding has not stopped; clear eyes indicate nasal bleeding has ceased." Because the Liver opens into the eyes, blood disturbance affects the Liver meridian, causing yellow eyes. Treatment should harmonize the Liver. Since the blood invades the Lung orifice and flows out, it is also necessary to harmonize the Lungs. Regardless of season, the primary strategy is to regulate the Liver and Lungs. Treat with *Sheng Di Huang Tang* (Rehmannia Decoction). After nasal bleeding stops upon administration, take *Di Gu Pi San* (Lycium Bark Powder) to nourish. Not only is nasal bleeding treated by regulating the Liver and Lungs, but all forms of hematemesis and hemoptysis should also be treated this way. The Liver governs Blood, and the Lungs govern Qi. Those treating Blood must regulate Qi; where else can one begin but with the Liver and Lungs?

Furthermore, when nasal bleeding persists for a long time without stopping, excessive blood loss occurs. Heat decreases with the blood, and Qi perishes with the blood. This is like a knife wound: if blood flows continuously, Qi perishes with it, and death ensues when blood is exhausted. Immediately use *Du Shen Tang* (Single Ginseng Decoction) to rescue. If hands and feet are cold and breathing is rapid and short, add *Fu Zi* (Aconiti Lateralis Radix Praeparata) to guide Qi back to its root. If the patient has black and dark nose and mouth, and a violet-colored face, this is a critical sign of blood overwhelming the Lungs; delay means no salvation. Treat with *Er Wei Shen Su Yin* (Two-Ingredient Ginseng and Perilla Drink). Such critical conditions are considered untreatable; using *Shen Su Yin* is merely an attempt at rescue as duty requires. Efficacy is not guaranteed.

Note: Diseases in the intestines and stomach respond quickly to medicine; diseases in the meridians respond slowly. Nasal bleeding involves the meridians; combining external therapies can yield urgent results. Stuffing the nose with *Shi Hui San* (Ten Charcoals Powder) and swallowing it is extremely safe. Alternatively, grind human fingernails into powder and insufflate into the nose to stop bleeding. Or stuff the nest of the wall spider (*Bi Qian*) into the nose, utilizing its network-like structure to maintain hemostasis. Insufflating *Long Gu* (Fossilized Bones) can dry and seal blood vessels to prevent bleeding. Insufflating *Bai Fan* (Alumen) has a penetrating nature to intercept blood. Applying vinegar-mixed earth to the scrotum works because the scrotum belongs to the Liver, which governs Blood; applying to the scrotum converges Liver Qi, thereby stopping Liver Blood. Treating upper pathology by acting on the lower is highly logical. Dipping eel blood into the nose, applying turtle blood to the nose, soaking feet in warm water to draw heat downward, binding the patient's middle finger, placing wet paper on the vertex, and ironing the paper dry with a hot iron (a method of warming and drawing fire) are other techniques. Some may work, others may not; they are recorded here for reference.

Patients with nasal bleeding must not undergo diaphoresis (sweating therapy); inducing sweat leads to sunken forehead pits, a strict prohibition established by Zhang Zhongjing. By analogy, it is known that all Blood disorders should avoid diaphoresis. Physicians must be cautious.

Although distinct from hematemesis and coughing blood, they are all Blood disorders. Refer to various sections for comprehensive understanding, ensuring accurate treatment in every case.