某 温邪衄血。（温邪）
连翘 元参 淡黄芩 黑山栀皮 杏仁 郁金
某 风温衄血。（风温）
丹皮 元参 连翘 赤芍 茅花 黑栀皮
某（三四） 此热蒸于水谷之湿。龈血鼽衄。纳谷如昔。治在阳明。（湿热胃火上蒸）
熟地 知母 石膏 元参 牛膝
陈（女） 常有衄血。今夏忽起神识如呆。诊脉直上鱼际。大忌惊恐恼怒。天癸得通可愈。
（胆火上升心营热）
犀角 丹参 元参 生地 连翘 知母
林（二六） 阳升。鼻衄不止。
细生地 乌犀角 炒知母 牛膝 黑山栀 川斛 丹皮 炒黑侧柏叶
某 努力伤。阳逆鼻衄。
犀角（二钱镑） 细生地（三钱） 炒丹皮（一钱） 元参（一钱） 炒牛膝（一钱半） 黑
山栀（一钱） 炒黑侧柏叶（五钱）
临服冲鲜荷叶汁一小杯。
赵（二十） 脉左数。衄血火升。（阴虚阳冒）
生地 阿胶 天冬 麦冬 淡菜 生白芍 茯神 炒山药
程 从前衄血。都以养阴益气而愈。知非实热。皆劳役阳冒。以致阴血之动也。今壮年肌肉不
充。身动气促如喘。口中腻涎浊沫。竟是肾精带伤。收纳失职之象。急急保养。远戒酒色。犹可
向安。
熟地 人参 萸肉 湖莲 芡实 补骨脂 山药粉丸
朱（十七） 脉数。阴亏阳升。头晕。心中烦杂。鼻衄。
生地 元参 金银花 川斛 丹皮 石决明
某 咳逆失音。衄血。
生地 龟板 丹皮 牛膝 山药 茯苓
某（十岁） 鼻衄时发。
生地 元参 丹皮 山药 茯苓 泽泻 黄柏 人中白
某 食烧酒辛热。及青梅酸泄。遂衄血咳嗽。心腹极热。五味偏胜。腑阳脏阴为伤。此病以养胃
阴和法。（酒热伤胃）
生白扁豆 北沙参 麦冬 白粳米
血行清道。从鼻而出。古名曰衄。与浊道之吐咯者不同。清道即指至高之分。由山根以上
睛明之次而来也。其穴乃手足太阳足阳明。阴阳跷五脉之会。及冲脉交会其间。可见诸
经皆能为衄。不独肺胃而然。诸书虽已详明。惟景岳辨之尤切。但衄之为患。总由乎火。外
为六淫之变化。内因五志之掀腾。气血日为错乱。阴阳为之相乘。天人交感之处。虚实攸
分矣。若风寒壅盛于经。阳气郁而迫营者。宜参麻黄桂枝症之大意。若温风暑热怫郁。而
动血外溢者。用辛凉清润等剂。认定经络之高下。若火邪极甚。而载血上泛者。有苦寒咸
寒之法。审其原委之浅深。此外因主治法也。至于烦冗曲运。耗及木火之营。肝脏厥阳化
火风上灼者。甘咸柔婉。理所必需。多劳过欲。病及天一之真。阳浮引阴血以冒上窍者。滋
潜浓味。法从峻补血脱则挽回元气。格阳则导火归源。因酒用和阳消毒之剂。因努力用
培中益下之方。此内因主治法也。学人惟审内外两因。庶乎施治无误矣。（邵新甫）
徐评 治衄诸方。为案中最稳当。
某患者，温邪导致鼻出血。（病因：温邪）
处方：连翘、玄参、淡黄芩、黑山栀皮、杏仁、郁金。
某患者，风温导致鼻出血。（病因：风温）
处方：丹皮、玄参、连翘、赤芍、茅花、黑栀皮。
某患者（三十多岁），这是热邪蒸腾水谷之湿所致。牙龈出血、鼻塞流涕或鼻出血。饮食如常。治疗重点在阳明经。（病机：湿热胃火上蒸）
处方：熟地黄、知母、石膏、玄参、牛膝。
陈某（女性），经常鼻出血。今年夏天突然神志呆滞。诊脉象直上鱼际穴部位。大忌惊恐和恼怒。待天癸（月经）通畅即可痊愈。
（病机：胆火上升，心营热盛）
处方：犀角、丹参、玄参、生地黄、连翘、知母。
林某（二十六岁），阳气升发太过。鼻出血不止。
处方：细生地黄、乌犀角、炒知母、牛膝、黑山栀、川石斛、丹皮、炒黑侧柏叶。
某患者，因用力过度损伤身体。阳气逆乱导致鼻出血。
处方：犀角（二钱，镑片）、细生地黄（三钱）、炒丹皮（一钱）、玄参（一钱）、炒牛膝（一钱半）、黑山栀（一钱）、炒黑侧柏叶（五钱）。
服药时冲服鲜荷叶汁一小杯。
赵某（二十岁），左脉数。鼻出血，火气上升。（病机：阴虚阳冒）
处方：生地黄、阿胶、天冬、麦冬、淡菜、生白芍、茯神、炒山药。
程某，以前的鼻出血，都是通过养阴益气而痊愈的。知道不是实热证，都是由于劳役导致阳气上冒，致使阴血妄动。现在正值壮年，肌肉不充实，身体活动后气短急促像喘一样，口中有多余的粘稠涎沫浊液。这完全是肾精受损，收纳功能失职的表现。急需保养，远离酒色，还可以趋向安宁。
处方：熟地黄、人参、山茱萸、湖莲子、芡实、补骨脂、山药粉丸。
朱某（十七岁），脉数。阴亏阳升。头晕。心中烦乱杂扰。鼻出血。
处方：生地黄、玄参、金银花、川石斛、丹皮、石决明。
某患者，咳嗽气逆失音。鼻出血。
处方：生地黄、龟板、丹皮、牛膝、山药、茯苓。
某患者（十岁），鼻出血时常发作。
处方：生地黄、玄参、丹皮、山药、茯苓、泽泻、黄柏、人中白。
某患者，食用烧酒辛热之物，以及青梅酸泄之物，于是出现鼻出血、咳嗽。心腹极度发热。五味偏胜，损伤了腑阳和脏阴。此病以养胃阴调和的方法治疗。（病因：酒热伤胃）
处方：生白扁豆、北沙参、麦冬、白粳米。
血液运行于清道，从鼻子流出，古时候称为衄。这与浊道的吐血、咯血不同。清道指的是人体最高处的部位，由山根以上睛明穴附近而来。这里的穴位是手足太阳经、足阳明经、阴阳跷脉五条经脉的交会处，以及冲脉也在其间交会。可见各条经络都能导致衄血，不仅仅是肺和胃。各种医书虽然已经详细说明，只有张景岳辨析得尤其透彻。但是衄血的祸患，总归是由火引起。外在是六淫邪气的变化，内在是五志情绪的激荡，气血每天错乱，阴阳相互乘袭。在天人交感的地方，虚实就区分开了。如果风寒壅盛于经络，阳气郁结而逼迫营血，应该参考麻黄汤、桂枝汤证的大意。如果温风暑热怫郁，而动血外溢，使用辛凉清润等方剂。认定经络的高下位置。如果火邪极甚，而载着血液上泛，有苦寒、咸寒的治疗方法。审察其原委的深浅。这是外因的主要治疗方法。至于烦冗曲折的用脑思虑，耗损木火之营，肝脏厥阳化火生风上灼者，甘咸柔婉的药物，是理所必需的。多劳过欲，病及天一之真阴，阳气浮越牵引阴血向上冲犯清窍者，滋补潜镇浓味的方法，法度从峻补。血脱则挽回元气，格阳则导火归源。因为饮酒，用和阳消毒的方剂。因为用力过度，用培中益下的方子。这是内因的主要治疗方法。学习的人只要审察内外两个原因，施治就不会有误了。（邵新甫评注）
A certain patient, Nasal bleeding caused by warm pathogen. (Etiology: Warm Pathogen)
Prescription: Lonicerae Japonicae Flos (Qianqiao), Scrophulariae Radix (Yuanshen), Scutellariae Radix Dan (Dan Huangqin), Gardeniae Fructus Pericarpium Nigrum (Hei Shanzhi Pi), Armeniacae Semen Amarum (Xingren), Curcumae Zedoariae Rhizoma (Yujin).
A certain patient, Nasal bleeding caused by wind-warmth. (Etiology: Wind-Warmth)
Prescription: Moutan Cortex (Danpi), Scrophulariae Radix (Yuanshen), Lonicerae Japonicae Flos (Qianqiao), Paeoniae Radix Rubra (Chishao), Imperatae Rhizoma Spiculum (Maohua), Gardeniae Fructus Pericarpium Nigrum (Hei Zhipi).
A certain patient (30s), This is heat steaming the dampness of water and grain. Gingival bleeding and nasal discharge or epistaxis. Appetite remains normal. Treatment focuses on the Yangming channel. (Pathogenesis: Damp-heat and Stomach fire steaming upward)
Prescription: Rehmanniae Radix Preparata (Shudi), Anemarrhenae Rhizoma (Zhimu), Gypsum Fibrosum (Shigao), Scrophulariae Radix (Yuanshen), Achyranthis Bidentatae Radix (Niuxi).
Patient Chen (Female), Frequently suffers from epistaxis. This summer, suddenly developed mental dullness/stupor. Pulse diagnosis shows the pulse rising straight to the Yuji area. Greatly avoid fright and anger. Recovery is possible once Tian Gui (menstruation) flows freely.
(Pathogenesis: Gallbladder fire ascending, Heart Ying-level heat)
Prescription: Rhinocerotis Cornu (Xijiao), Salviae Miltiorrhizae Radix et Rhizoma (Danshen), Scrophulariae Radix (Yuanshen), Rehmanniae Radix Recens (Shengdi), Lonicerae Japonicae Flos (Qianqiao), Anemarrhenae Rhizoma (Zhimu).
Patient Lin (26 years old), Yang qi rises excessively. Epistaxis does not stop.
Prescription: Rehmanniae Radix Recens Xi (Xi Shengdi), Rhinocerotis Cornu Wu (Wu Xijiao), Anemarrhenae Rhizema Chao (Chao Zhimu), Achyranthis Bidentatae Radix (Niuxi), Gardeniae Fructus Hei (Hei Shanzhi), Dendrobii Caulis Chuan (Chuan Hu), Moutan Cortex (Danpi), Platycladi Cacumen Carbonized Chaohei (Chaohei Cebeiyè).
A certain patient, Injury due to excessive effort. Rebellious Yang causes epistaxis.
Prescription: Rhinocerotis Cornu (2 qian, sliced), Rehmanniae Radix Recens Xi (3 qian), Moutan Cortex Chao (1 qian), Scrophulariae Radix (1 qian), Achyranthis Bidentatae Radix Chao (1.5 qian), Gardeniae Fructus Hei (1 qian), Platycladi Cacumen Carbonized Chaohei (5 qian).
Take with a small cup of fresh Nelumbinis Nelumbinis Leaf汁 (Fresh Lotus Leaf Juice) mixed in before administration.
Patient Zhao (20 years old), Left pulse is rapid. Epistaxis with fire rising. (Pathogenesis: Yin deficiency with Yang floating)
Prescription: Rehmanniae Radix Recens (Shengdi), Asini Corii Colla (Ejiao), Asparagi Radix (Tiantong), Ophiopogonis Radix (Maidong), Mytilus Edulis (Dancai), Paeoniae Radix Alba Sheng (Sheng Baishao), Poria (Fushen), Dioscoreae Rhizoma Chao (Chao Shanyao).
Patient Cheng, Previous episodes of epistaxis were cured by nourishing Yin and benefiting Qi. It is known that this was not excess heat, but rather labor-induced rebellious Yang causing movement of Yin blood. Now in prime adulthood, muscles are not full, physical activity leads to shortness of breath resembling asthma, and there is excessive sticky turbid saliva/phlegm in the mouth. This is clearly a sign of Kidney Essence damage and failure of reception/storage. Urgent conservation is needed; abstain from alcohol and sexual indulgence, then recovery is possible.
Prescription: Rehmanniae Radix Preparata (Shudi), Ginseng Radix et Rhizoma (Renshen), Corni Fructus (Yurou), Nelumbinis Semen Hugu (Hulian), Euryales Semen (Qianshi), Psoraleae Fructus (Buguzhi), Dioscoreae Rhizoma powder pills (Shanyao Fen Wan).
Patient Zhu (17 years old), Pulse is rapid. Yin deficiency with Yang rising. Dizziness. Mental restlessness/irritability. Epistaxis.
Prescription: Rehmanniae Radix Recens (Shengdi), Scrophulariae Radix (Yuanshen), Lonicerae Japonicae Flos (Jinyinhua), Dendrobii Caulis Chuan (Chuan Hu), Moutan Cortex (Danpi), Arconis Concha (Shijueming).
A certain patient, Cough with rebellious Qi and loss of voice. Epistaxis.
Prescription: Rehmanniae Radix Recens (Shengdi), Testudinis Carapax et Plastrum (Guiban), Moutan Cortex (Danpi), Achyranthis Bidentatae Radix (Niuxi), Dioscoreae Rhizoma (Shanyao), Poria (Fuling).
A certain patient (10 years old), Intermittent epistaxis.
Prescription: Rehmanniae Radix Recens (Shengdi), Scrophulariae Radix (Yuanshen), Moutan Cortex (Danpi), Dioscoreae Rhizoma (Shanyao), Poria (Fuling), Alismatis Rhizoma (Zexie), Phellodendri Cortex (Huangbai), Humanis Dentifricium Residuum (Renzhongbai).
A certain patient, Consumed spicy-hot liquor and sour/astringent green plums, resulting in epistaxis and cough. Extreme heat in heart and abdomen. Excess of five flavors injured Fu-Yang and Zang-Yin. This disease is treated by nourishing Stomach Yin and harmonizing methods. (Etiology: Liquor heat injuring Stomach)
Prescription: Phaseoli Radiatus Semen Album Sheng (Sheng Baibian Dou), Glehniae Radix (Beishashen), Ophiopogonis Radix (Maidong), Oryza Sativa Var. Glutinosa Baijingmi (Bai Jingmi).
Blood travels through the Clear Passages and exits from the nose, anciently termed "Nu" (epistaxis). This differs from vomiting or hemoptysis from the Turbid Passages. The Clear Passage refers to the highest part of the body, originating from above the Shan Gen (root of nose) near the Jingming acupoint. These areas are the convergence points of the Hand and Foot Taiyang, Foot Yangming, Yin and Yang Qiao meridians, and the Chong Mai also intersects here. Thus, all meridians can cause epistaxis, not just Lung and Stomach. Although various texts explain this in detail, Zhang Jingyue's analysis is particularly precise. However, the affliction of epistaxis is always due to Fire. Externally, it arises from changes of the Six Evils; internally, from the agitation of the Five Emotions. Qi and Blood are daily disordered, and Yin and Yang attack each other. At the point of Heaven-Human interaction, Deficiency and Excess are distinguished. If Wind-Cold is abundant in the channels, and Yang qi is constrained forcing Ying blood out, one should refer to the general principles of Mahuang Tang and Guizhi Tang patterns. If Warm Wind and Summer Heat are constrained, causing blood to move and overflow externally, use pungent-cool clearing and moistening formulas. Identify the high and low positions of the meridians. If Fire pathogen is extreme, carrying blood upward, bitter-cold and salty-cold methods apply. Examine the depth of the origin and course. These are the main treatment methods for external causes. Regarding complex mental exertion consuming Wood-Fire Ying, where Liver Jue-Yang transforms into Fire and Wind scorching upward, sweet-salty soft and gentle medicines are necessary. Excessive labor and desire injure the True Yin of Tian Yi; when Yang floats drawing Yin blood to rush to the upper orifices, nourishing and subduing heavy/tasty methods apply. In cases of severe method from tonifying heavily. For blood loss, rescue Yuan Qi; for floating Yang, guide fire back to its source. Due to alcohol, use formulas to harmonize Yang and detoxify. Due to excessive effort, use formulas to cultivate the middle and benefit the lower. These are the main treatment methods for internal causes. Students must examine both internal and external causes to ensure accurate treatment. (Commentary by Shao Xinpu)
Xu Lingtai's Commentary: The various formulas for treating epistaxis are the most stable and appropriate among the cases.