经义
西方白色，入通于肺，开窍于鼻。○五气入鼻，藏于心、肺。心、肺有病，而鼻为之不利也。○胆移热
于脑，则辛 鼻渊。○脾热病者鼻先赤。（《素问》）
鼻者肺之官。○肺气通于鼻，肺和则鼻能知香臭矣。○肺病者，喘息鼻张。（《灵枢》）
哲言
鼻者，气之门户也。外感邪气有余，则鼻气粗，疾出疾入；
内伤正气虚败，则鼻气微，徐出徐入。鼻孔干燥，乃邪热在阳明，必衄血也。鼻干如烟煤者，阳毒热深也。鼻
黑出冷气者，阴毒冷极也。鼻鼾，风温也；鼻塞，风热也；鼻扇，肺绝也。（陈养晦）
大肠，肺之腑也；胃，五脏之所受气者也。《经》曰∶九窍不利，肠胃之所生，鼻主无形者也。《经》曰∶
天气通于肺。又曰∶喉主天气。设肠胃无痰火积热，则平常上升之气，皆清气也。若肠胃素有痰火积热，则其
平常上升之气，皆蕴而为浊矣。金职司降，喜清而恶浊。今受浊气熏蒸，壅遏郁结而为涎涕。至于痔、珠、
肉之类，皆由痰热积久，燥火内燔；风寒外束，隧道壅塞，气之升降，被其妨碍。浇培弥浓，犹积土而成敦阜
也。（孙一奎）
凡鼽渊久不愈者，非心血亏则肾水少。养血则阴生而火降，补肾则水升而金清。又鼻塞久不愈者，亦有内
伤肺、胃，清气不能上升，非尽外感也。（《医学入门》）
鼻色
鼻头色青，腹中痛，苦冷者死；鼻头色微黑者，有水气；色黄者，胸上有寒；色白者，亡血也；设微赤
非时者死。又色青为痛，色黑为劳，色赤为风，色黄者便难，色鲜明者留饮。（《金匮》）
鼻扇
病在大肠，亦能令人鼻珠扇动，迎香脉气使之然也。证实者下之愈，不得概以肺绝疑之。（《医参》）
鼻扇有虚实新久之分，不可概为肺绝。初病鼻扇，有邪热风火壅塞肺气，实热居多；久病鼻扇喘汗，是
为肺绝，不治。（林慎庵）
鼻塞
东垣曰∶《经》云∶西方白色，入通于肺，开窍于鼻，藏精于肺。夫十二经脉，三百六十五络，其气血
皆上升于面而走空
窍。其精阳气上走于目而为睛，其别气走于耳而为听，其宗气出于鼻而为嗅。夫阳气、宗气者，皆胃中生发之
气也。若因饥饱劳役，损伤脾胃，生发之气既弱，则营运之气不能上升，邪塞孔窍，故鼻不利而不闻香臭也。
宜养胃气、实营气，阳气、宗气上升，鼻管则通矣。又《难经》云∶心主五嗅，肺主诸气。鼻者肺窍，反闻香
臭者，何也？盖以窍言之，肺也；以用言之，心也。因卫气失守，寒邪客于头面，鼻受之；不能为用，是不闻
香臭矣。故《经》云∶心肺有病而鼻为之不利也。洁古云∶视听明而清凉，香臭辨而温暖是也。治宜先散寒邪，
后补卫气，使心肺之气，得以交通，则鼻利而闻香臭矣。（《赤水玄珠》）
夹鼻两傍，穴名迎香。迎香者，迎香臭也。手阳明大肠脉也。人有鼻病不闻香臭者，病在大肠，气不上行，
徒责之肺无益也。卒病治以通，久病治以表。（《医参》）
鼻塞不闻香臭，或感风寒鼻塞，俗皆以为肺寒而用解表、通利辛温之药，不效。殊不知此是肺经素有火邪，
火郁甚，故遇寒便塞。治当清肺降火，佐以通利。审其平素鼻塞，作肺热治；若素无此证，偶感风寒，而致塞
窒流涕，作风寒治。（王节斋）
近世以辛夷治鼻塞不闻香臭，无问新、久、寒、热，一概用之。不知肺胃阳气虚衰，不能上透于脑，致浊
阴上干阳位而窒塞者，固宜辛夷之辛香以通达之。若湿热上蒸，蕴酿为火而窒塞者，非山栀之轻清不能开发也。（朱丹溪）
鼻渊
《经》云∶肺和则鼻能知香臭矣。又云∶胆移热于脑，令人辛 鼻渊，传为衄蔑瞑目。是知初感风寒之
邪，久则化热，热郁则气闭而塞矣。治宜开上宣郁，如苍耳散、防风通圣散、川芎茶调散、菊花茶调散等类，
佐以荷叶边、苦丁茶、蔓荆、连翘之属，此外感宜辛散也。内热宜清凉者，用羚角、山栀、石膏、滑石、夏枯
草、青菊叶、苦丁茶等类，苦辛凉散。郁久则当用咸降滋填，
如虎潜减辛，再加镇摄之品。其有精气不足，脑髓不固，渗下无腥秽之气者，此劳怯根萌，以天真丸主之。
（《临证指南》）
鼻渊一证，总由太阳、督脉之火。甚者上连于脑，而津津不已，故又名为脑漏。多因酒醴肥甘，或火由寒
郁，以致湿热上熏，津汁溶溢而下，离经腐败而作腥臭。河间用防风通圣散，古法用苍耳散。余见炎上之火，
治以辛散有所不宜，莫若清火滋阴、高者抑之之法。○凡鼻渊脑漏，虽为热证，然流渗既久，即火邪已去，流亦
不止，以液道不能扃固也。新病者多由于热，久病者未必尽为热证。其有漏泄既多，伤其髓海，气虚于上，多
见头脑隐痛、眩晕不止等证。治非补法不可。（张景岳）
古人谓鼻渊一证，乃寒凝脑户，太阳湿热为病。皆治标而不求其本，攻邪而反耗其元，于经旨迥乎不合，
其说可足信欤？《经》曰∶胆移热于脑，则辛 鼻渊。明属内伤，与外感无涉。何医家辛夷、苍耳、防、芷杂
投，致轻者重而重者危也。夫脑属神脏，藏精髓而居高位。鼻为肺窍，司呼吸而闻香臭。清阳由此而升，浊阴
无由而上，是为平人。盖少阳生发之气，全赖肾水为之滋养。肾水虚则胆火无制而上逆于脑，脑热蒸蒸，气化
浊涕，走空窍而出于鼻，臭不堪闻。涕愈下则液愈耗，液愈耗则阴愈亏。斯时也，头为之倾矣，喉为之咳矣，
身为之热矣，食为之减矣。而医者犹曰∶风未散也，表药不可缺；寒未退也，辛味不可除。曾不知辛散伤元，
有升无降，有阳无阴。肾肝虚于下，肺气虚于上，虽有卢、扁，奈之何哉？虽然，胆之火胡为而入脑也？经谓
其脉起于目锐 ，上抵头角，下耳后，曲折布于脑后，脉络贯通，易于感召。惟其虚也，则灼脑炙髓，随液下
漏，治宜戒怒以养阳，绝欲以养阴。药进补水保肺，俾水壮火熄、木荣金肃、胆汁充满，而火自安其位矣。倘
脾胃渐亏，阳分渐弱，又宜变通∶或脾、肾双补，或阴阳两救，庶几有济。且脑为诸阳之会，髓为至精之物，
鼻属金气之路。治脑也补在髓，治鼻也清在金。脑满可以生水而
制火，金空可以化液而制木。而春升少阳之气，与厥阴相为表里，上属于脑。如此，则《经》谓胆热所关，义
亦明矣。（《会心录》）
鼻鼽
鼻渊、鼻鼽，当分寒热。若涕浓而臭者为渊，属热，清凉之药散之；若涕清而不臭者为鼽，属寒，辛温之
剂调之。（张路玉）
鼽者，鼻出清涕也。五行之理，微则当其本化，甚则兼其鬼贼。《易》曰燥万物者莫 乎火。以火炼金，
热极而反化为水。肝热甚则出泪，心热甚则出汗，脾热甚则出涎，肺热甚则出涕，肾热甚则出唾。凡痰、涎、
涕、唾稠浊者，皆火热极甚销烁致之也。或言鼽为寒者，误也，彼但见鼽嚏鼻窒，冒寒则甚，遂以为然。岂知
寒伤皮毛则腠理闭密，热气怫郁而病愈甚也。（刘河间）
鼻
鼻 肉，因上焦积热郁久而生。内服清火利膈之药，宜凉膈散加减，须断酒醴浓味。韩氏云∶一贵人鼻中
肉赘，臭不可近，痛不可忍。以白矾末加阿魏、脑、麝少许，吹其上，顷之，化水而消。内服胜湿泻肺之药。
此浓味壅热，蒸于肺门，如雨霁之地，突生芝菌也。按∶ 肉鼻痔，大同小异。痛极而不下垂者为 肉，此
血热胜也；鼻痔则有物下垂而不痛，乃湿热胜也。阿魏为血积之响导，白矾为涤垢之专药，兼脑、麝以开窍也。（张路玉）
鼻
好饮热酒，血热入肺，复被风寒外郁，则血凝于内、赤见于外，而为鼻 。有不好饮而病此者，乃肺风热
也。（朱丹溪）
选案
一人久患鼻渊，浊涕腥秽。时逢长夏，医命取艾绒四两，摊作二饼，用新瓦两片，烈日曝热，摊艾绒于凹
瓦上。先安一枕，以额抵之，冷则频易，数日病除。此日炙针锋相对，脑寒去矣。（许宣治）
黄介繁令眷，鼻中生一红珠，状如樱桃，垂挂左窍，虽无痛
苦，颇碍呼吸。予教用醋，日漱数遍，其珠自落。旬后，鼻出红毛，长一、二寸，每日数十茎，群目为怪。此
平日多食猪、羊血，蕴毒胃中，熏于肺窍，致嚏出血丝，随风成线耳。与清解药而瘥。（程华仲）
附方
砂散 治鼻生 肉。用 砂五分、白矾一钱，研末，点之即消。
附嚏
帝曰∶人之嚏者，何气使然？岐伯曰∶太阳之气，和利而满于心，出于鼻，故为嚏。（《灵枢》）
肺外证面白、善嚏。（《难经》）
夫中寒家，善欠。其人清涕出，发热色和者，善嚏。（《金匮》）
欠为气乏，嚏为气通。○腠理不密实，嚏不已。（娄全善）
嚏者，鼻中因痒而气喷作于声也。鼻为肺窍，痒为火化，心火邪热，干于阳明，发于鼻，则痒而嚏也。或
以物扰之痒而嚏者，痒属火故也。或视日而嚏者，由目为五脏之精华，太阳真火， 耀于目，心神躁乱，而热
发于上，则鼻痒而嚏也。伤寒病，再经，邪衰而嚏者，由邪热已退，虚热为痒，痒则嚏也。或风热上攻，鼻窍
壅滞，纳药鼻中，得嚏则壅滞通而愈也。或有痛处，嚏则痛甚不可忍者，因嚏气冲结，痛不得通利故也。（刘河间）
痒为火化，外风欲入而内火拒格，故发为嚏。有嚏则风邪随气而散，不能入伤于经，是以伤风有嚏为轻。
（《张氏医通》）
【经典理论】
西方对应白色，其气内通于肺，外开窍于鼻。○五种气味通过鼻腔进入，储藏于心、肺。心、肺发生病变，鼻子就会功能失常。○胆经的热邪移注于脑，就会导致鼻流浊涕的“鼻渊”病。○脾有热病的患者，鼻子先发红。（出自《素问》）
鼻子是肺的外候器官。○肺气通达于鼻，肺气调和则鼻子能辨别香臭。○患肺病的人，会出现喘息、鼻孔张大的症状。（出自《灵枢》）
【名家论述】
鼻子，是气息出入的门户。外感邪气有余（实证），则鼻息粗重，呼吸急促；内伤导致正气虚衰，则鼻息微弱，呼吸缓慢。鼻孔干燥，是邪热在阳明经，必然会导致鼻衄（鼻出血）。鼻干如烟熏煤黑者，是阳毒热邪深重。鼻色发黑且呼出冷气者，是阴寒毒邪极盛。打鼾，是风温病；鼻塞，是风热病；鼻孔扇动，是肺气将绝的危象。（陈养晦）
大肠，是肺的腑；胃，是五脏受纳水谷精气的地方。《内经》说：九窍不通利，是由肠胃病变产生的。鼻主管无形之气的感知。《内经》又说：天气通于肺。又说：喉主管天气的吸入。如果肠胃没有痰火积热，那么平常上升的气都是清气。如果肠胃素有痰火积热，那么平常上升的气都会蕴结成为浊气。金（肺）的职责是肃降，喜欢清肃而厌恶浑浊。现在受到浊气的熏蒸，壅遏郁结而形成涎液鼻涕。至于痔、珠、肉赘之类，都是由痰热积聚日久，燥火在内焚烧；风寒在外束缚，导致气道壅塞，气的升降运动受到妨碍。滋养浇灌越来越浓稠，就像堆积泥土形成高山一样。（孙一奎）
凡是鼻渊、鼻鼽长久不愈的，不是心血亏虚就是肾水不足。养血则阴液滋生而虚火下降，补肾则肾水上济而肺金清肃。另外，鼻塞长久不愈的，也有因内伤肺、胃，清气不能上升导致的，并不全是外感引起。（《医学入门》）
【鼻部色泽诊断】
鼻头颜色发青，说明腹中疼痛，若伴有畏冷症状则预后不良（死证）；鼻头颜色微黑，说明体内有水气停留；颜色发黄，说明胸上有寒饮；颜色苍白，说明失血；如果在非正常时节出现微红色，也是死证。另外，青色主痛，黑色主劳损，赤色主风邪，黄色主大便困难，颜色鲜明光亮者说明体内有留饮。（《金匮要略》）
【鼻扇】
大肠有病，也能导致鼻翼扇动，这是迎香穴经脉之气运行异常所致。如果是实证，用泻下法可以痊愈，不能一概认为是肺气将绝。（《医参》）
鼻扇有虚实、新久之分，不能一概认为是肺气将绝。初发病时的鼻扇，多由邪热风火壅塞肺气所致，属于实热的居多；久病出现的鼻扇伴喘汗，这才是肺气将绝，难以治愈。（林慎庵）
【鼻塞】
李东垣说：《内经》讲：西方白色，内通于肺，开窍于鼻，藏精于肺。十二经脉，三百六十五络，它们的气血都上升到面部并走向空窍。其中的精阳气上行到眼睛成为视觉，别气走向耳朵成为听觉，宗气出于鼻子成为嗅觉。阳气、宗气，都是从胃中生发出来的气。如果因为饥饱失调、劳累过度，损伤了脾胃，生发之气既已虚弱，那么营运之气就不能上升，邪气堵塞孔窍，所以鼻子不通利且闻不到香臭。应当养胃气、充实营气，使阳气、宗气上升，鼻管就能通畅了。又《难经》说：心主管五种嗅觉，肺主管各种气。鼻子是肺的窍，为什么反而能闻到香臭呢？从窍道来说，属于肺；从功能作用来说，属于心。因为卫气失守，寒邪客居头面，鼻子受邪而不能发挥功能，所以闻不到香臭。因此《内经》说：心肺有病，鼻子就会不通利。洁古说：视听清明是因为清凉，辨别香臭是因为温暖。治疗应当先散寒邪，后补卫气，使心肺之气得以交通，那么鼻子就通利并能闻到香臭了。（《赤水玄珠》）
鼻梁两旁，穴位名叫迎香。迎香，意思是迎接香臭。这是手阳明大肠经的脉气。人有鼻病闻不到香臭的，病在大肠，气不上行，只责怪肺是没有益处的。急性病治疗以通为主，久病治疗以宣表为主。（《医参》）
鼻塞闻不到香臭，或者感受风寒导致鼻塞，世俗都认为是肺寒而使用解表、通利的辛温药物，往往无效。殊不知这是因为肺经素有火邪，火气郁结严重，所以遇到寒冷就堵塞。治疗应当清肺降火，辅以通利药物。平时经常鼻塞的，按肺热治疗；如果平素没有这个症状，偶然感受风寒，导致堵塞流涕，按风寒治疗。（王节斋）
近代人用辛夷治疗鼻塞闻不到香臭，不分新久、寒热，一概使用。不知道如果是肺胃阳气虚衰，不能上透于脑，导致浊阴上犯阳位而窒塞的，确实适宜用辛夷的辛香来通达。如果是湿热上蒸，蕴酿成火而窒塞的，不用山栀的轻清之性不能开发。（朱丹溪）
【鼻渊】
《内经》说：肺和调则鼻子能辨别香臭。又说：胆经热邪移注于脑，导致鼻流浊涕的鼻渊，进而发展为鼻衄、目盲。由此可知，起初感受风寒邪气，久了会化热，热邪郁结则气机闭塞而堵塞。治疗应当宣通上部、发散郁结，如苍耳散、防风通圣散、川芎茶调散、菊花茶调散等类，佐以荷叶边、苦丁茶、蔓荆子、连翘等药，这是针对外感宜用辛散的方法。针对内热宜用清凉药的，可用羚羊角、山栀、石膏、滑石、夏枯草、青菊叶、苦丁茶等类，用苦辛凉散的方法。郁结久了则应当用咸味降逆、滋阴填精的方法，如虎潜丸减去辛散药，再加镇摄之品。如果有精气不足，脑髓不固，渗出无腥秽气味的清涕，这是劳损虚怯的根源，用天真丸主治。（《临证指南医案》）
鼻渊这一病症，总归是太阳经、督脉的火邪所致。严重的向上连及脑部，津液不断流出，所以又名为“脑漏”。多因饮酒吃肥甘厚味，或火邪被寒邪郁闭，导致湿热上熏，津汁溶溢而下，离经腐败而产生腥臭味。河间用防风通圣散，古法用苍耳散。我认为炎上的火邪，用辛散治疗有所不宜，不如清火滋阴、高者抑之的方法。○凡是鼻渊脑漏，虽然属于热证，但如果流渗时间已久，即使火邪已去，渗漏也不停止，因为液道不能关闭坚固。新病多由于热，久病未必全是热证。那些渗漏过多，损伤髓海，上部气虚的，多见头脑隐痛、眩晕不止等症状。治疗非用补法不可。（张景岳）
古人认为鼻渊这一病症，是寒凝脑户，太阳湿热致病。这些都是治标而不求本，攻伐邪气反而耗损元气，与经典旨意完全不合，这种说法值得相信吗？《内经》说：胆移热于脑，则辛 鼻渊。明确属于内伤，与外感无关。为什么医家乱投辛夷、苍耳、防风、白芷等药，导致轻病加重、重病转危呢？脑属于神脏，藏精髓而位居高位。鼻是肺的窍，司呼吸而闻香臭。清阳由此上升，浊阴无路可上，这是健康人的状态。少阳生发之气，全赖肾水滋养。肾水虚则胆火无制而上逆于脑，脑热蒸蒸，气化浊涕，走空窍而出于鼻，臭不堪闻。涕液越往下流，津液越耗损，津液越耗损则阴越亏。这时候，头会倾斜，喉咙会咳嗽，身体发热，食欲减退。而医生还说：风未散，解表药不可缺；寒未退，辛味药不可除。却不知道辛散伤元气，只有升没有降，只有阳没有阴。肾肝虚于下，肺气虚于上，即使是扁鹊再世，又能怎么办呢？虽然如此，胆的火为什么进入脑呢？经文说它的脉起于目锐眦，上抵头角，下耳后，曲折布于脑后，脉络贯通，易于感召邪气。正因为虚，所以灼烧脑髓，随液下漏，治疗应当戒怒以养阳，绝欲以养阴。用药进补水保肺，使水壮火熄、木荣金肃、胆汁充满，而火自然安其位。倘若脾胃渐亏，阳分渐弱，又宜变通：或脾、肾双补，或阴阳两救，或许还有希望。而且脑为诸阳之会，髓为至精之物，鼻属金气之路。治脑在于补髓，治鼻在于清金。脑满可以生水而制火，金空可以化液而制木。春升少阳之气，与厥阴相为表里，上属于脑。这样，《内经》所说的胆热相关之义也就明白了。（《会心录》）
【鼻鼽】
鼻渊、鼻鼽，应当区分寒热。如果鼻涕浓稠且有臭味的叫鼻渊，属于热证，用清凉药发散；如果鼻涕清稀且无臭味的叫鼻鼽，属于寒证，用辛温剂调理。（张路玉）
鼽，是指鼻子流出清涕。五行的道理，轻微时表现为本脏的正常化育，严重时则兼夹克制它的五行（鬼贼）之气。《易经》说：燥万物者莫乎火。用火炼金，热极反而化为水。肝热甚则流泪，心热甚则出汗，脾热甚则流涎，肺热甚则流涕，肾热甚则吐唾。凡是痰、涎、涕、唾稠浊的，都是火热极甚消烁所致。有人说鼽是寒证，是错误的，他们只是看到鼽嚏鼻塞，遇寒加重，就以为是寒证。哪里知道寒伤皮毛则腠理闭密，热气怫郁而病情更重呢？（刘河间）
【鼻息肉/鼻痔】
鼻息肉，是因为上焦积热郁久而生。内服清火利膈的药物，宜用凉膈散加减，必须戒断酒醴和浓味食物。韩氏说：一位贵人鼻中长有肉赘，臭不可近，痛不可忍。用白矾末加阿魏、冰片、麝香少许，吹在上面，一会儿化成水而消退。内服胜湿泻肺的药。这是浓味壅滞热邪，蒸腾于肺门，像雨后天晴的地面，突然生出芝菌一样。按：息肉和鼻痔，大同小异。痛极而不下垂的叫息肉，这是血热胜；鼻痔则有物下垂而不痛，这是湿热胜。阿魏是血积的向导，白矾是涤垢的专药，配合冰片、麝香以开窍。（张路玉）
【鼻齆】
喜欢喝热酒，血热入肺，又被风寒外郁，则血凝于内、赤见于外，而成为鼻齆。有不爱喝酒而得此病的，是肺风热所致。（朱丹溪）
【选案】
一人长期患鼻渊，浊涕腥秽。正值长夏，医生命令取艾绒四两，摊成两个饼，用两片新瓦，在阳光下暴晒至热，将艾绒摊在凹瓦上。先安放一个枕头，用额头抵住它，冷了频繁更换，数日后病除。这是日灸与针锋相对，脑寒去除了。（许宣治）
黄介繁大人的眷属，鼻中生出一颗红珠，形状像樱桃，垂挂在左侧鼻孔，虽然无痛楚，但颇碍呼吸。我教她用醋漱口，每天数次，那颗珠子自己脱落。十天后，鼻中长出红毛，长一两寸，每天几十根，众人视为怪异。这是因为平日多吃猪、羊血，蕴毒在胃中，熏蒸于肺窍，导致打喷嚏出血丝，随风成线罢了。给予清解药而痊愈。（程华仲）
【附方】
砂散 治疗鼻生息肉。用硇砂五分、白矾一钱，研成末，点涂患处即消。
【附嚏】
黄帝问：人打喷嚏，是什么气使之然？岐伯答：太阳之气，和利而充满于心，出于鼻，所以打喷嚏。（《灵枢》）
患有中寒症的人，容易呵欠。其人清涕流出，发热且面色平和的，容易打喷嚏。（《金匮要略》）
呵欠是气乏，打喷嚏是气通。○腠理不致密坚实，会连续打喷嚏。（娄全善）
打喷嚏，是鼻中因痒而气喷发声。鼻是肺的窍，痒是火化，心火邪热干扰阳明，发于鼻，则痒而打喷嚏。或用物体扰动鼻痒而打喷嚏的，痒属火故也。或看太阳而打喷嚏的，由目为五脏精华，太阳真火照耀于目，心神躁乱，而热发于上，则鼻痒而打喷嚏。伤寒病，经过两经传变，邪气衰退而打喷嚏的，由邪热已退，虚热作痒，痒则打喷嚏。或风热上攻，鼻窍壅滞，纳药鼻中，得喷嚏则壅滞通而痊愈。或有痛处，打喷嚏则痛甚不可忍者，因喷嚏气冲结聚，痛不得通利故也。（刘河间）
[Classic Theory]
The West corresponds to the color white; its qi internally connects with the Lung, and externally opens into the nose. ○ The five aromas enter through the nose and are stored in the Heart and Lung. When the Heart and Lung have disease, the nose becomes dysfunctional. ○ Heat from the Gallbladder transferring to the Brain causes "Bi Yuan" (Nasal Sinusitis/Rhinorrhea) characterized by acrid nasal discharge. ○ In Spleen heat diseases, the nose turns red first. (From *Su Wen*)
The nose is the external manifestation of the Lung. ○ Lung Qi communicates with the nose; when Lung Qi is harmonious, the nose can distinguish odors. ○ Patients with Lung disease exhibit panting and flaring of the nostrils. (From *Ling Shu*)
[Masters' Discourses]
The nose is the gateway for Qi. When exogenous pathogenic factors are excessive (Excess syndrome), nasal breathing is coarse, rapid in exit and entry; when internal injury leads to deficiency and collapse of Zheng Qi (Upright Qi), nasal breathing is faint, slow in exit and entry. Dryness of the nostrils indicates Pathogenic Heat in the Yangming Channel, inevitably leading to Bi Xi (Epistaxis/Nosebleed). Dryness of the nose resembling soot indicates deep-seated Yang Toxin Heat. Blackening of the nose with cold breath indicates extreme Yin Cold Toxin. Snoring indicates Wind-Warmth; nasal congestion indicates Wind-Heat; flaring of the nostrils indicates the exhaustion of Lung Qi. (Chen Yanghui)
The Large Intestine is the Interior-Exterior partner (Fu organ) of the Lung; the Stomach is where the Five Zang organs receive Qi. The Classics state: Dysfunction of the nine orifices arises from the intestines and stomach. The nose governs the perception of formless Qi. The Classics further state: Heavenly Qi communicates with the Lung. Also: The throat governs the intake of Heavenly Qi. If the intestines and stomach lack phlegm-fire and accumulated heat, the normally ascending Qi is clear Qi. If the intestines and stomach harbor chronic phlegm-fire and accumulated heat, the normally ascending Qi becomes turbid Qi. Metal (Lung) is responsible for descending; it prefers clarity and abhors turbidity. Now, subjected to the steaming of turbid Qi, it becomes obstructed and stagnant, forming saliva and nasal mucus. Conditions such as hemorrhoids, nodules, and polyps all result from long-standing accumulation of phlegm-heat and dry-fire burning internally; constrained by wind-cold externally, the meridians become blocked, hindering the ascent and descent of Qi. Nourishment accumulates like soil piling up to form a high mound. (Sun Yikui)
For cases of Bi Qiu (Allergic Rhinitis/Coryza) and Bi Yuan that do not heal for a long time, it is either due to Blood deficiency or Kidney Water insufficiency. Nourishing Blood generates Yin and descends Fire; tonifying the Kidney raises Water and clears Metal (Lung). Furthermore, chronic nasal congestion may also result from internal injury to the Lung and Stomach, where Clear Qi cannot ascend, and is not solely caused by exogenous pathogens. (*Medical Beginner*)
[Nasal Color Diagnosis]
A greenish nose tip indicates abdominal pain; if accompanied by aversion to cold, it is a fatal sign. A slightly black nose tip indicates water retention. Yellow color indicates cold-fluid in the chest. Pale/white color indicates blood loss. A slight redness appearing at an inappropriate time is also a fatal sign. Additionally, green indicates pain, black indicates consumptive disease, red indicates Wind, yellow indicates difficulty in defecation, and a bright/lustrous color indicates retained fluid. (*Jin Gui Yao Lue*)
[Nasal Flaring]
Disease in the Large Intestine can also cause flaring of the alae nasi (nose wings); this is due to abnormal Qi flow in the Yingxiang (LI20) meridian. If it is an Excess syndrome, purgation will cure it; one should not generally suspect Lung Qi exhaustion. (*Yi Can*)
Nasal flaring has distinctions between Excess/Deficiency and Acute/Chronic; it cannot be universally diagnosed as Lung Qi exhaustion. Acute nasal flaring is mostly due to Excess Heat from pathogenic Wind-Warmth and Fire obstructing Lung Qi; chronic nasal flaring with wheezing and sweating indicates Lung Qi exhaustion and is incurable. (Lin Shen'an)
[Nasal Congestion]
Li Dongyuan said: The Classics state: The West corresponds to white, internally connecting to the Lung, opening into the nose, and storing essence in the Lung. The twelve meridians and 365 collaterals all send their Qi and Blood upward to the face and into the orifices. The refined Yang Qi ascends to the eyes for vision; the branch Qi goes to the ears for hearing; the Zong Qi (Gathering Qi) emerges from the nose for olfaction. Yang Qi and Zong Qi both originate from the Qi generated in the Stomach. If dietary irregularities or overwork damage the Spleen and Stomach, the generating Qi becomes weak, and the transporting Qi cannot ascend. Pathogens block the orifices, causing nasal obstruction and loss of smell. One should nourish Stomach Qi and strengthen Ying Qi (Nutritive Qi); once Yang Qi and Zong Qi ascend, the nasal passages will clear. The *Nan Jing* states: The Heart governs the five smells; the Lung governs all Qi. The nose is the orifice of the Lung, yet why does it perceive smells? From the perspective of the orifice, it belongs to the Lung; from the perspective of function, it belongs to the Heart. Because Wei Qi (Defensive Qi) fails to guard, Cold pathogens invade the head and face, affecting the nose; unable to function, one loses the sense of smell. Thus, the Classics state: Disease in the Heart and Lung causes nasal dysfunction. Jiegu said: Clear vision and hearing stem from coolness; distinguishing smells stems from warmth. Treatment should first dispel Cold pathogens, then tonify Wei Qi, allowing Heart and Lung Qi to communicate, thereby clearing the nose and restoring smell. (*Chishui Xuanzhu*)
On both sides of the nasal bridge lies the acupoint Yingxiang (LI20). "Yingxiang" means welcoming fragrance. This is the meridian of the Hand-Yangming Large Intestine. For those with nasal disease and loss of smell, the pathology lies in the Large Intestine; if Qi does not ascend, blaming the Lung is useless. Acute diseases are treated with unblocking methods; chronic diseases are treated with exterior-releasing methods. (*Yi Can*)
Nasal congestion and loss of smell, or congestion due to Wind-Cold, are commonly treated by laypeople as Lung Cold using exterior-releasing and pungent-warm unblocking herbs, often without effect. Little do they know this is due to latent Fire in the Lung channel; severe Fire stagnation causes congestion upon exposure to cold. Treatment should clear the Lung and descend Fire, assisted by unblocking agents. Chronic congestion should be treated as Lung Heat; acute congestion with runny nose after Wind-Cold exposure should be treated as Wind-Cold. (Wang Jiezhai)
In recent times, Xin Yi (Magnolia Flower) is used for nasal congestion indiscriminately, regardless of duration or syndrome differentiation. It is unknown that if Lung and Stomach Yang Qi are deficient and cannot ascend to the Brain, causing Turbid Yin to invade the Yang position and obstruct, Xin Yi's pungent aroma is indeed suitable to open the orifice. However, if damp-heat steams upward, brewing into Fire and causing obstruction, only the light and clear nature of Shan Zhi (Gardenia Fruit) can resolve it. (Zhu Danxi)
[Bi Yuan / Nasal Sinusitis]
The Classics state: Harmonious Lung Qi allows the nose to distinguish odors. Also: Heat from the Gallbladder transferring to the Brain causes Bi Yuan, which may progress to epistaxis and blindness. This indicates that initial Wind-Cold pathogens transform into Heat over time; Heat stagnation blocks Qi and causes obstruction. Treatment should ventilate the upper jiao and disperse stagnation, using formulas such as Cang Er San (Xanthium Powder), Fang Feng Tong Sheng San, Chuan Xiong Cha Tiao San, or Ju Hua Cha Tiao San, assisted by He Ye Bian (Lotus Leaf margin), Ku Ding Cha, Man Jing Zi, and Lian Qiao. This addresses exogenous patterns requiring pungent dispersal. For internal Heat requiring cooling, use Ling Yang Jiao, Shan Zhi, Shi Gao, Hua Shi, Xia Ku Cao, Qing Ju Ye, and Ku Ding Cha, employing bitter-pungent-cool dispersal. For long-standing stagnation, use salty-descending and yin-nourishing methods, such as Hu Qian Wan with pungent herbs removed, plus calming/astringent agents. For cases with insufficient Essence-Qi, unstable Marrow, and non-foul nasal discharge, indicating the root of consumptive weakness, use Tian Zhen Wan. (*Lin Zheng Zhi Nan*)
Bi Yuan is fundamentally caused by Fire in the Taiyang and Du Meridians. Severe cases extend to the Brain, causing continuous dripping, hence the name "Nao Lou" (Brain Leakage). It is often due to alcohol and rich foods, or Fire suppressed by Cold, leading to damp-heat steaming upward, causing fluids to overflow and rot off-meridian, producing foul odors. He Jian used Fang Feng Tong Sheng San; ancient methods used Cang Er San. I believe that for ascending Fire, pungent dispersal is unsuitable; rather, clearing Fire and nourishing Yin, or suppressing what is high, is better. ○ Although Bi Yuan/Nao Lou are Heat patterns, if leakage persists long after Fire has subsided, it is because the fluid pathways are no longer secure. Acute cases are mostly Heat; chronic cases are not necessarily all Heat. Those with excessive leakage damaging the Sea of Marrow and suffering Upper Qi deficiency often present with dull headache and persistent vertigo. Such cases require tonification. (Zhang Jingyue)
Ancients claimed Bi Yuan was caused by Cold coagulating in the Brain Gate and damp-heat in Taiyang. These approaches treat symptoms but ignore the root, attacking pathogens while depleting Yuan Qi, contradicting the Classics. Is this credible? The Classics state: Heat from the Gallbladder transferring to the Brain causes Bi Yuan. This clearly belongs to internal injury, unrelated to exogenous pathogens. Why do physicians indiscriminately prescribe Xin Yi, Cang Er, Fang Feng, and Bai Zhi, worsening mild cases and endangering severe ones? The Brain is a Divine Organ storing Marrow, located at the highest position. The nose is the Lung orifice, governing respiration and smell. Clear Yang ascends here; Turbid Yin has no path upward—this is health. The Shao Yang generating Qi relies entirely on Kidney Water for nourishment. Kidney Water deficiency allows Gallbladder Fire to rebel upward to the Brain; Brain Heat steams, transforming fluids into turbid mucus that exits the nose with a foul odor. As mucus drains, fluids deplete; as fluids deplete, Yin亏损. At this point, the head tilts, the throat coughs, the body heats, and appetite decreases. Yet doctors say: Wind is not dispersed, exterior herbs are essential; Cold is not retreated, pungent flavors must remain. They fail to realize that pungent dispersal damages Yuan Qi, promoting ascent without descent, Yang without Yin. With Kidney/Liver deficiency below and Lung Qi deficiency above, even Bian Que could not help. But why does Gallbladder Fire enter the Brain? The Classics state its vessel starts at the outer canthus, ascends to the corner of the head, descends behind the ear, winds around the back of the brain, connecting via meridians, making it susceptible. Due to deficiency, it scorches Brain and Marrow, leaking with fluids. Treatment requires restraining anger to nourish Yang, abstaining from desires to nourish Yin. Medications should replenish Water and protect Lung, ensuring Water strengthens to extinguish Fire, Wood flourishes, Metal肃 (clears), and Gallbladder bile fills, stabilizing Fire. If Spleen/Stomach decline and Yang weakens, adjust: tonify Spleen/Kidney together, or rescue both Yin/Yang. The Brain is the meeting of all Yang; Marrow is supreme Essence; the nose is the pathway of Metal Qi. Treating the Brain involves tonifying Marrow; treating the nose involves clearing Metal. Full Brain generates Water to control Fire; Empty Metal transforms fluids to control Wood. Spring Shao Yang Qi is interior-exterior paired with Jue Yin, connecting to the Brain. Thus, the Classic's reference to Gallbladder Heat is clarified. (*Hui Xin Lu*)
[Bi Qiu / Allergic Rhinitis]
Bi Yuan and Bi Qiu must be distinguished by Cold/Heat. Thick, foul-smelling discharge is Bi Yuan (Heat), treated with cooling dispersants. Clear, odorless discharge is Bi Qiu (Cold), treated with pungent-warm regulators. (Zhang Luyu)
Qiu refers to clear nasal discharge. In Five Elements theory, mild manifestations follow the original transformation; severe manifestations involve the conquering element. The *I Ching* says: Nothing dries things like Fire. Using Fire to smelt metal, extreme heat converts it to water. Extreme Liver Heat causes tears; extreme Heart Heat causes sweat; extreme Spleen Heat causes saliva; extreme Lung Heat causes nasal mucus; extreme Kidney Heat causes spit. Thick/turbid phlegm, saliva, mucus, and spit are all caused by extreme Fire scorching. Some claim Qiu is Cold; this is wrong. They see congestion worsened by cold and assume Cold. They do not realize that Cold injuring skin/pores closes pores, trapping Heat and worsening the disease. (Liu Hejian)
[Nasal Polyps / Hemorrhoids]
Nasal polyps arise from long-standing accumulation and stagnation of Heat in the Upper Jiao. Internally, use cooling and diaphrag-clearing herbs like Liang Ge San with modifications, and strictly avoid alcohol and rich foods. Han Shi said: A nobleman had a foul, painful nasal polyp. Applying powder of Bai Fan (Alum), A Wei, Bing Pian (Borneol), and She Xiang (Musk) dissolved it instantly. Internally, use damp-draining and Lung-purging herbs. This results from rich foods blocking Heat, steaming the Lung gate, like fungi growing after rain. Note: Polyps and nasal hemorrhoids are similar. Extremely painful without drooping indicates Polyps (Blood Heat excess); drooping without pain indicates Nasal Hemorrhoids (Damp-Heat excess). A Wei guides Blood stasis; Bai Fan cleanses filth; combined with Borneol and Musk to open orifices. (Zhang Luyu)
[Nasi / Nasal Obstruction]
Frequent consumption of hot wine causes Blood Heat entering the Lung, compounded by external Wind-Cold constraint, leading to internal Blood coagulation and external redness, resulting in Nasi. Those who do not drink alcohol but suffer this have Lung Wind-Heat. (Zhu Danxi)
[Selected Cases]
A patient suffered chronic Bi Yuan with foul, turbid discharge. During midsummer, the doctor prescribed 4 liang of Moxa wool, formed into two cakes, placed on two new tiles heated in the sun. The patient rested their forehead on the concave tile containing moxa, replacing it when cool. After several days, the illness resolved. This method counteracts needle acupuncture, removing Brain Cold. (Xu Xuanzhi)
Madam Huang Jiefan had a red nodule in her nose, cherry-sized, hanging in the left nostril, painless but obstructing breathing. I advised rinsing with vinegar several times daily; the nodule fell off spontaneously. Ten days later, red hairs grew from the nose, 1-2 cun long, dozens per day, viewed as strange. This resulted from frequent consumption of pig/sheep blood, accumulating toxin in the Stomach, steaming the Lung orifice, causing bloody streaks in sneezes that formed threads in the wind. Cleared with resolving/clearing herbs. (Cheng Huazhong)
[Attached Formulas]
Sha San (Acid Salt Powder) Treats nasal polyps. Use 5 fen of Nao Sha (Ammonium Chloride) and 1 qian of Bai Fan (Alum), grind to powder, apply locally to dissolve.
[Attached: Sneezing]
The Yellow Emperor asked: What Qi causes sneezing? Qibo answered: Taiyang Qi, smooth and abundant, fills the Heart, emerges from the nose, thus causing sneezing. (*Ling Shu*)
External manifestations of Lung disease include pale complexion and frequent sneezing. (*Nan Jing*)
Those with Zhong Han (Internal Cold) frequently yawn. Those with clear nasal discharge, fever, and normal complexion frequently sneeze. (*Jin Gui Yao Lue*)
Yawning indicates Qi deficiency; sneezing indicates Qi unblocking. ○ Loose pores lead to incessant sneezing. (Lou Quanshan)
Sneezing is air spraying from the nose due to itching. The nose is the Lung orifice; itching is transformed by Fire. Heart Fire and pathogenic Heat interfere with Yangming, manifesting in the nose, causing itching and sneezing. Irritating the nose causes itching/sneezing because itching belongs to Fire. Looking at the sun causes sneezing because the eyes are the essence of the Five Zang; Sun True Fire shines on the eyes, agitating the Heart Spirit, sending Heat upward, causing nasal itching and sneezing. In Shang Han disease, sneezing after passing through two stages indicates declining pathogen and residual Deficiency-Heat causing itching. Wind-Heat attacking and blocking the nose can be relieved by inserting medicine, inducing sneezes to clear blockage. Painful areas may hurt severely upon sneezing because the Qi rush creates stagnation, preventing pain relief. (Liu Hejian)
Itching is Fire transformation; external Wind tries to enter but is repelled by internal Fire, causing sneezing. Sneezing disperses Wind pathogens with the Qi, preventing them from damaging the meridians; thus, sneezing in Wind-Cold indicates a mild condition. (*Zhang Shi Yi Tong*)