《巢氏病源》小儿伤寒鼻衄候∶伤寒是寒气客于皮肤，搏于血气，腠理闭密，气不得宣泄，蕴积生热，故
头痛、体疼而壮热也。其鼻衄是热搏于气，而乘于血也。肺候身之皮毛而主气，开窍于鼻。伤寒先客皮肤，搏
于气而成热。热乘于血，血得热则流散，发从鼻出者，为鼻衄也。凡候热病知应衄者，其人壮热，频发汗，汗
不出或未及发汗，而鼻燥喘息，鼻气鸣，即衄。凡衄，小儿止半升数合，则热因之得歇。若一升二升者死。
《活人书》论伤寒小儿、大人治法∶一般但小分剂，药性差凉耳。问∶鼻衄者，何也？伤寒太阳证，衄血者乃解，
盖阳气重故也。仲景所谓阳盛则衄。若脉浮紧，无汗，服麻黄汤。不中病，其人发烦目瞑剧者，必衄，小衄而脉尚浮紧
者，宜再与麻黄汤也。衄后脉已微者，不可行麻黄汤也。苦脉浮自汗，服桂枝汤不中病，桂枝证尚在，必头疼甚而致衄。
小衄而脉尚浮者，宜再与桂枝也。衄后脉已微者，不可行桂枝汤也。大抵伤寒衄血不可发汗者，为脉微故也（治法∶衄
家
不可发汗，汗出额上陷，脉紧急，直视不能瞬，不得眠。然而无汗而衄，脉尚浮紧者，须再与麻黄汤。有汗而衄，
脉尚浮缓者，须再与桂枝汤。）脉已微者，黄芩芍药汤、犀角地黄汤。衄血不止者，茅花汤。若衄而渴，心烦，饮水则吐
水，先服五苓散，次服竹叶汤。又问∶阴证有衄血者乎？阴证自无热何缘有衄。若少阴病但厥无汗，强发之必
动血。未知从何道出，或从口鼻，或从耳目，是谓下厥上竭，为难治。
《婴童宝鉴》小儿伤寒鼻衄歌∶
结热血兮血流散，从鼻出兮人可惊。皆因汗兮不得汗，鼻干燥兮先有声。
《千金》治小儿未满百日，伤寒鼻衄，身热呕逆。麦门冬汤方
麦门冬（十八铢） 石膏 寒水石 甘草（炙。各半两） 桂心（八铢）
上五味 咀，以水二升半，煮取一升。分服一合，日三。
《圣惠》治小儿伤寒鼻衄，烦热头痛。竹茹散方
苦竹茹 甘草（炙微赤，锉） 黄芩（各半两） 麦门冬（去心，焙） 伏龙肝 石膏（各一两）
上件药捣，粗罗为散。每服一钱，以水一小盏，煎至五分，去滓，不计时候温服。更量儿大小加减服之。
《圣惠》治小儿伤寒壮热，鼻衄不止方。
生干地黄（二两）
上细锉，于银器中，以酒一中盏，煎至七分，去滓。不计时，分温三服。
《圣惠》又方
生葛根（汁）
上用一小盏，分二服，即止。
《圣惠》治小儿伤寒鼻衄，已经数日不止方。
生地黄（汁） 白蜜（各一小盏） 蒲黄（一两）
上件药相和，微暖过。每服半小盏，量儿大小分减频服。
《圣惠》治小儿伤寒鼻衄，经日发歇不止方。
蒲黄（一两） 石榴花（末，半两）
上件药，相和令匀。不计时候，以新汲水调下半钱，更量儿大小加减服之。
《圣惠》治小儿伤寒鼻衄，经数日不止方。
上取乱发烧灰细研，频频吹少许于鼻中良。
张涣立应散方 治伤寒血热妄行，鼻衄不止。
石榴花（取末，焙干） 干葛根（为末） 蒲黄（研。各半两）
上件为细末。每服半钱，取生地黄汁调下并服。
《活人书》仲景麻黄汤，方见伤寒发喘门中。
《活人书》仲景桂枝汤，方见伤寒自汗门中。
《活人书》黄芩芍药汤
黄芩（三两） 芍药 甘草（炙。各半两）
上为粗末。每服三钱，水一盏，煎至六分，去滓温服。
《活人书》犀角地黄汤
犀角屑（如无，以升麻代之） 牡丹（去心。各一两） 芍药（三分） 生地黄（半斤）
上锉如麻豆大。每服五钱匕，水一盏半，煮取一盏。有热如狂者，加黄芩二两；其人脉大来迟，腹不满自
言满者，为无热，不用黄芩。
《活人书》茅花汤
茅花一大把，水三盏，煎浓汁一盏，分二服即瘥。无花以根代之。
《活人书》仲景五苓散，方见自汗门中。
《活人书》仲景竹叶石膏汤
淡竹叶（半把） 石膏（四两，杵碎） 半夏（二分半） 人参 甘草（各半两） 麦门冬（一两半）
呕者加生姜一两。
上锉如麻豆大。每服抄五钱匕，水一盏半，入粳米百余粒，煮取八分，米熟汤成，去滓温服。
张涣《鸡峰方》 治伤寒时气，衄血不止。
好松烟墨
上为细末，鸡子清和如桐子大。每服十粒，白汤下，不以时。
又方
生萝卜捣取汁。
上每服半盏，入盐少许，搅匀频服之，不以时。
《巢氏病源》中关于小儿伤寒鼻衄的论述：伤寒是由于寒气侵袭皮肤，与血气相搏结，导致腠理（皮肤纹理及汗孔）闭塞紧密，气机无法宣泄，郁积而生热，因此出现头痛、身体疼痛和高烧。其中的鼻衄（鼻出血），是因为热邪搏结于气分，进而波及血分。肺主司体表的皮毛并主管气机，其开窍于鼻。伤寒之邪先侵犯皮肤，与气相搏而化热。热邪波及血分，血液受热则流动散乱，从鼻腔流出，这就称为鼻衄。凡是诊察热病，判断应当发生鼻衄的情况，患者表现为高烧，频繁出汗但汗不出，或者尚未发汗，而出现鼻干燥、喘息、鼻孔呼吸有声，这时就会发生鼻衄。一般来讲，小儿鼻衄血量在半升到数合之间，热邪就会随之消退。如果出血量达到一升到二升，则会导致死亡。
《活人书》论述伤寒小儿和成人的治法：大体上只是剂量较小，药性稍微偏凉罢了。问：为什么会有鼻衄？这是伤寒太阳经证，通过鼻衄出血后病情得以解除，这是因为阳气亢盛所致。正如张仲景所说，阳盛则导致鼻衄。如果脉象浮紧，无汗，服用麻黄汤。若服药后病症未解，患者出现烦躁、眼睛昏花且症状加剧的，必然会发生鼻衄；如果是少量鼻衄而脉象仍然浮紧的，适宜再次给予麻黄汤。鼻衄之后脉象已经微弱的，不可再使用麻黄汤。如果脉象浮且自汗，服用桂枝汤后病症未解，桂枝汤证依然存在，必然会出现剧烈头痛而导致鼻衄。如果是少量鼻衄而脉象仍然浮的，适宜再次给予桂枝汤。鼻衄之后脉象已经微弱的，不可再使用桂枝汤。大抵而言，伤寒鼻衄不可发汗的原因，是因为脉象微弱（治法：经常鼻衄的人不可发汗，若发汗导致额头凹陷、脉象紧急、两眼直视不能眨眼、无法入睡。然而若无汗且鼻衄，脉象仍浮紧的，须再次给予麻黄汤。若有汗且鼻衄，脉象仍浮缓的，须再次给予桂枝汤。）脉象已经微弱的，用黄芩芍药汤、犀角地黄汤治疗。鼻衄不止的，用茅花汤治疗。如果鼻衄且口渴、心烦，喝水即吐，先服用五苓散，随后服用竹叶汤。又问：阴证有鼻衄吗？阴证本身没有热，怎么会引起鼻衄呢？如果是少阴病，只有四肢厥冷而无汗，强行发汗必然扰动血分。不知道血液会从哪个通道流出，有的从口鼻出，有的从耳目出，这被称为“下厥上竭”，属于难治之症。
《婴童宝鉴》中小儿伤寒鼻衄的歌诀：
热血凝结血流散，从鼻而出令人惊。皆因汗出不畅故，鼻干有声先兆明。
《千金方》治疗未满百日的小儿伤寒鼻衄，身热呕吐逆气的麦门冬汤方：
麦门冬（十八铢） 石膏 寒水石 甘草（炙。各半两） 桂心（八铢）
以上五味药切碎，用水二升半，煮取一升。分次服用一合，每日三次。
《圣惠方》治疗小儿伤寒鼻衄，烦热头痛的竹茹散方：
苦竹茹 甘草（炙至微赤，锉碎） 黄芩（各半两） 麦门冬（去心，焙干） 伏龙肝 石膏（各一两）
将上述药物捣碎，粗筛为散剂。每次服用一钱，用水一小盏，煎至五分，去渣，不限时候温服。更根据患儿大小调整剂量服用。
《圣惠方》治疗小儿伤寒高烧，鼻衄不止的方子。
生干地黄（二两）
将其细切，在银器中，用酒一中盏，煎至七分，去渣。不限时候，分三次温服。
《圣惠方》又一方
生葛根（取汁）
以上取一小盏，分两次服用，即可止血。
《圣惠方》治疗小儿伤寒鼻衄，已经数日不止的方子。
生地黄（取汁） 白蜜（各一小盏） 蒲黄（一两）
将上述药物混合，微微加热。每次服用半小盏，根据患儿大小减量频繁服用。
《圣惠方》治疗小儿伤寒鼻衄，经过一天发作停止不止的方子。
蒲黄（一两） 石榴花（研末，半两）
将上述药物混合均匀。不限时候，用新汲水调服半钱，更根据患儿大小调整剂量服用。
《圣惠方》治疗小儿伤寒鼻衄，经过数日不止的方子。
以上取乱发烧制成细灰，频频吹少许入鼻中，效果良好。
张涣立应散方，治疗伤寒血热妄行，鼻衄不止。
石榴花（取末，焙干） 干葛根（研末） 蒲黄（研。各半两）
将上述药物研为细末。每次服用半钱，取生地黄汁调服并同服。
《活人书》中张仲景的麻黄汤，方子见伤寒发喘门中。
《活人书》中张仲景的桂枝汤，方子见伤寒自汗门中。
《活人书》黄芩芍药汤
黄芩（三两） 芍药 甘草（炙。各半两）
以上为粗末。每次服用三钱，水一盏，煎至六分，去渣温服。
《活人书》犀角地黄汤
犀角屑（如无，以升麻代之） 牡丹（去心。各一两） 芍药（三分） 生地黄（半斤）
切碎如麻豆大小。每次服用五钱匕，水一盏半，煮取一盏。如果有热象如狂躁者，加黄芩二两；如果脉象大而来迟，腹部不胀满却自称胀满的，为无热，不用黄芩。
《活人书》茅花汤
茅花一大把，水三盏，煎浓汁一盏，分两次服用即痊愈。无花可用根代替。
《活人书》中张仲景的五苓散，方子见自汗门中。
《活人书》中张仲景的竹叶石膏汤
淡竹叶（半把） 石膏（四两，杵碎） 半夏（二分半） 人参 甘草（各半两） 麦门冬（一两半）
呕吐者加生姜一两。
切碎如麻豆大小。每次取五钱匕，水一盏半，加入粳米百余粒，煮取八分，米熟汤成，去渣温服。
张涣《鸡峰方》，治疗伤寒时气，衄血不止。
好松烟墨
以上研为细末，用鸡蛋清调和如桐子大小。每次服用十粒，白开水送下，不限时候。
又一方
生萝卜捣取汁。
以上每次服用半盏，加入少许盐，搅匀频繁服用，不限时候。
According to *Chao Shi Bing Yuan* (Source of Diseases by Chao) regarding the syndrome of pediatric cold damage with epistaxis: Cold damage is caused by cold pathogenic qi invading the skin, struggling with blood and qi, causing the couli (skin pores and interstices) to close tightly. The qi cannot be vented, leading to accumulation and generation of heat; thus, headache, body pain, and high fever occur. The epistaxis in this context arises because heat struggles with qi and then invades the blood. The Lung governs the body's skin and hair and controls qi, opening into the nose. Cold damage pathogens first invade the skin, struggle with qi, and generate heat. Heat then invades the blood; when blood is affected by heat, it flows and scatters, emerging from the nose, which is termed epistaxis. In general, for febrile diseases where epistaxis is anticipated, the patient presents with high fever, frequent sweating but no actual sweat excretion, or no sweating yet, accompanied by dry nose, panting, and noisy nasal breathing, at which point epistaxis occurs. Generally, if a child's epistaxis amounts to half a sheng or several he (ancient volume units), the heat will subside due to the bleeding. If the bleeding reaches one to two sheng, death ensues.
*Huo Ren Shu* (Book that Saves Lives) discusses the treatment methods for cold damage in both children and adults: Essentially, the dosage is smaller, and the medicinal properties are slightly cooler. Question: Why does epistaxis occur? This is a Taiyang syndrome of cold damage; epistaxis leads to resolution because yang qi is excessive. As Zhang Zhongjing stated, "Excess yang leads to epistaxis." If the pulse is floating and tight, with no sweating, Ma Huang Tang (Ephedra Decoction) is administered. If the medication does not address the condition, and the patient becomes irritable, experiences visual disturbances, and symptoms worsen, epistaxis will definitely occur. If there is slight epistaxis but the pulse remains floating and tight, it is appropriate to administer Ma Huang Tang again. After epistaxis, if the pulse has become faint, Ma Huang Tang should not be used. If the pulse is floating with spontaneous sweating, Gui Zhi Tang (Cinnamon Twig Decoction) is administered. If the medication fails to resolve the condition and the Gui Zhi Tang syndrome persists, severe headache leading to epistaxis will occur. If there is slight epistaxis but the pulse remains floating, it is appropriate to administer Gui Zhi Tang again. After epistaxis, if the pulse has become faint, Gui Zhi Tang should not be used. Broadly speaking, epistaxis in cold damage precludes diaphoresis (sweating therapy) because the pulse is faint (Treatment principle: Those prone to epistaxis must not undergo diaphoresis; if sweating causes depression of the forehead, urgent pulse, fixed gaze without blinking, and insomnia. However, if there is no sweating and epistaxis occurs, but the pulse remains floating and tight, Ma Huang Tang must be given again. If there is sweating and epistaxis, but the pulse remains floating and slow, Gui Zhi Tang must be given again.) For those with a faint pulse, Huang Qin Shao Yao Tang (Scutellaria and Peony Decoction) or Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) are used. For unceasing epistaxis, Mao Hua Tang (Thatch Flower Decoction) is used. If epistaxis is accompanied by thirst, mental restlessness, and vomiting after drinking water, Wu Ling San (Five-Ingredient Powder with Poria) is administered first, followed by Zhu Ye Tang (Bamboo Leaf Decoction). Another question: Is there epistaxis in Yin syndromes? Yin syndromes inherently lack heat, so how can epistaxis arise? If Shaoyin disease presents only with cold extremities and no sweating, forcing diaphoresis will inevitably disturb the blood. It is unknown through which orifice the blood will exit; it may come from the mouth or nose, or from the ears and eyes. This is called "Jue at the lower part and exhaustion at the upper part," which is difficult to treat.
The song from *Ying Tong Bao Jian* (Precious Mirror for Infants and Children) on pediatric cold damage with epistaxis:
Heat blood coagulates, blood flow scatters,
Emerging from the nose, startling all who watch.
All because sweat could not escape,
Nose dry and noisy, the sign appears first.
*Qian Jin Fang* (Essential Prescriptions Worth a Thousand Gold) treats infants under one hundred days old with cold damage epistaxis, fever, and vomiting/reversal using Mai Men Dong Tang (Ophiopogon Decoction):
Mai Men Dong (Ophiopogonis Radix) (18 zhu) Shi Gao (Gypsum Fibrosum) Han Shui Shi (Halloysitum Rubrum) Gan Cao (Licorice Root, honey-fried) (each 0.5 liang) Gui Xin (Cinnamomi Cortex) (8 zhu)
Crush these five ingredients. Boil in 2.5 sheng of water to obtain 1 sheng. Divide into doses of 1 he, taken three times daily.
*Sheng Hui Fang* (Holy Grace Formulas) treats pediatric cold damage epistaxis with irritability, heat, and headache using Zhu Ru San (Bamboo Sheath Powder):
Ku Zhu Ru (Bambusae Caulis in Taenia) Gan Cao (Licorice Root, fried until slightly red and crushed) Huang Qin (Scutellariae Radix) (each 0.5 liang) Mai Men Dong (Ophiopogonis Radix, heart removed, baked) Fu Long Gan (Dragon's House Earth) Shi Gao (Gypsum Fibrosum) (each 1 liang)
Pound the above ingredients and sieve coarsely. Take 1 qian per dose, decoct in a small cup of water until reduced to 0.5 cup, remove dregs, and take warm at any time. Adjust dosage according to the child's size.
*Sheng Hui Fang* treats pediatric cold damage with high fever and unceasing epistaxis:
Sheng Gan Di Huang (Rehmanniae Radix Preparata) (2 liang)
Finely crush, place in a silver vessel, add one cup of wine, decoct until 0.7 portion remains, remove dregs. Take warm in three divided doses at any time.
*Sheng Hui Fang*, another formula:
Sheng Ge Gen (Puerariae Lobatae Radix) (extract juice)
Take one small cup, divide into two doses, and bleeding will stop.
*Sheng Hui Fang* treats pediatric cold damage epistaxis lasting several days:
Sheng Di Huang (Rehmanniae Radix) (juice) Bai Mi (Apis Mellifera Cera Alba / Honey) (each one small cup) Pu Huang (Typhae Pollen) (1 liang)
Mix the above ingredients, warm slightly. Take half a small cup per dose, reduce frequency/amount according to the child's size.
*Sheng Hui Fang* treats pediatric cold damage epistaxis recurring over a day:
Pu Huang (Typhae Pollen) (1 liang) Shi Liu Hua (Punica Granatum Flos) (powder, 0.5 liang)
Mix evenly. At any time, mix with fresh well-water and take 0.5 qian, adjusting dosage based on the child's size.
*Sheng Hui Fang* treats pediatric cold damage epistaxis lasting several days:
Take disordered hair, burn to ash, grind finely. Frequently blow a small amount into the nostrils; this is effective.
Zhang Huan's Li Ying San (Instant Response Powder) treats cold damage with reckless blood movement due to blood heat and unceasing epistaxis:
Shi Liu Hua (Punica Granatum Flos) (take powder, bake dry) Gan Ge Gen (Puerariae Lobatae Radix) (powder) Pu Huang (Typhae Pollen) (powdered, each 0.5 liang)
Grind into fine powder. Take 0.5 qian per dose, mixed with Sheng Di Huang juice.
*Huo Ren Shu*: Zhang Zhongjing's Ma Huang Tang (Ephedra Decoction), see section on Cold Damage with Asthma.
*Huo Ren Shu*: Zhang Zhongjing's Gui Zhi Tang (Cinnamon Twig Decoction), see section on Cold Damage with Spontaneous Sweating.
*Huo Ren Shu* Huang Qin Shao Yao Tang (Scutellaria and Peony Decoction):
Huang Qin (Scutellariae Radix) (3 liang) Shao Yao (Paeoniae Radix) Gan Cao (Licorice Root, fried) (each 0.5 liang)
Make into coarse powder. Take 3 qian per dose, decoct in one cup of water until 0.6 cup remains, remove dregs and take warm.
*Huo Ren Shu* Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction):
Xi Jiao Xiao (Rhinocerotis Cornu) (if unavailable, substitute with Sheng Ma) Mu Dan Pi (Moutan Cortex) (heart removed, each 1 liang) Shao Yao (Paeoniae Radix) (0.3 fen) Sheng Di Huang (Rehmanniae Radix) (0.5 jin)
Cut like hemp seeds. Take 5 qian bi per dose, decoct in 1.5 cups of water until 1 cup remains. If heat manifests as mania-like behavior, add Huang Qin (Scutellariae Radix) 2 liang. If the pulse is large but slow, and the abdomen feels full despite not being distended, this indicates absence of heat; do not use Huang Qin.
*Huo Ren Shu* Mao Hua Tang (Thatch Flower Decoction):
A large handful of Mao Hua (Thatch Flowers), 3 cups of water, decoct to obtain 1 cup of concentrated juice. Divide into two doses for recovery. If flowers are unavailable, use roots.
*Huo Ren Shu*: Zhang Zhongjing's Wu Ling San (Five-Ingredient Powder with Poria), see section on Spontaneous Sweating.
*Huo Ren Shu*: Zhang Zhongjing's Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction):
Dan Zhu Ye (Lophatheri Herba) (half a bunch) Shi Gao (Gypsum Fibrosum) (4 liang, pounded) Ban Xia (Pinelliae Rhizoma) (0.25 fen) Ren Shen (Ginseng Radix et Rhizoma) Gan Cao (Licorice Root) (each 0.5 liang) Mai Men Dong (Ophiopogonis Radix) (1.5 liang)
For vomiting, add Sheng Jiang (Zingiberis Rhizoma Recens) 1 liang.
Cut like hemp seeds. Take 5 qian bi per dose, add over 100 grains of Jing Mi (Oryza Sativa Japonica Group), decoct in 1.5 cups of water until 0.8 cup remains. When rice is cooked and liquid formed, remove dregs and take warm.
Zhang Huan's *Ji Feng Fang* (Chicken Peak Formulas) treats cold damage and seasonal miasma with unceasing epistaxis:
Hao Song Yan Mo (High-quality Pine Soot Ink)
Grind into fine powder. Mix with egg white to form pills the size of Toosie seeds. Take 10 pills per dose with plain hot water, at any time.
Another formula:
Fresh Luo Bo (Raphani Semen) mashed to extract juice.
Take half a cup per dose, add a little salt, mix well, and take frequently at any time.