《三因方》云∶衄者，因伤风寒暑湿，流传经络，涌泄于清气道中而致者，皆外
所因。积怒伤肝，积忧伤肺，烦思伤脾，失志伤肾，暴喜伤心，皆能动血，随气上
溢而致者，属内所因。饮酒过多，啖炙爆辛热，或坠堕车马伤损致者，皆非内非外
因也。鼻通于脑，血上溢于脑，所以从鼻而出。宜茅花汤调止衄散，时进折二泔，
仍令其以麻油滴入鼻，或以莱菔汁滴入亦可。茅花、白芍药对半尤稳。糯米炒微黄为
末，新水下二钱。乱发烧灰存性，细研，水服方寸匕，并吹鼻中。萱草根捣汁，每
一盏入生姜汁半盏相和，时时细呷。竹蛀屑，水饮调。百药煎，半烧半生，水酒调
服。白芨末，新汲水调下神效。治鼻衄久不止，或素有热而暴作者，诸药不效，
神法以大白纸一张，作十数揲，于冷水内浸湿，置顶中，以热熨斗熨之，至一重或
二重纸干立止。又方，用线扎中指中节，如左鼻孔出血扎左指，右鼻孔出血扎右指，
两鼻孔齐出，则左右俱扎之。血衄不愈，以三棱针于气街穴出血，更用五味子十粒，
麦门冬、当归、黄 、生地、人参各一钱，水煎，空心热服。六脉细弦而涩，按之
空虚，其色必白而夭不泽者，脱血也。此大寒证，以辛温补血养血，以甘温、甘热
滑润之剂佐之即愈，理中汤，小建中汤。六脉俱大，按之空虚，心动面赤，善惊上
热，乃手少阴心脉也，此气盛多而亡血。以甘寒镇坠之剂，大泻其气以坠气浮，以
甘辛温微苦，峻补其血，三黄补血汤。实热衄血，先服朱砂、蛤粉，次服木香、黄
连。大便结者下之，用大黄、芒硝、甘草、生地。溏 者，栀子、黄芩、黄连、犀
角地黄汤，可选用之。有头风自衄，头风才发则衄不止，宜芎附饮，间进一字散。
下虚上盛而衄，不宜过用凉剂，宜四物汤加参、 、麦门、五味，磨沉香下养正丹，
八味地黄丸。伤湿而衄，肾着汤加川芎，名除湿汤。伏暑而衄，茅花汤调五苓散。
上膈极热而衄，金沸草散去麻黄、半夏、加茅花如荆芥数，或用黄芩芍药汤加茅花
一撮。虚者茯苓补心汤，生料鸡苏散。饮酒过多而衄，茅花汤加干葛、鸡矩子，或
理中汤去干姜，用干葛加茅花。 而衄不止，苏合香丸一丸，或以小乌沉汤一钱，
白汤调下。或煎浓紫苏汤，独调小乌沉汤，或添入黑神散一钱，盐汤调下亦得。仍
蓦然以水 其面，使惊则血止。非特 而衄，凡五窍出血皆治。曾病衄，后血因旧
路，一月或三四衄，又有洗面而衄，日以为常，此即水不通借路之意，并宜止衄散，
茅花煎汤调下。或四物汤加石菖蒲、阿胶、蒲黄各半钱，煎熟，调火 石膏末一匙
头许，兼进养正丹。前诸证服药不效，大衄不止者，养正丹多服，仍佐以苏子降气
汤，使血随气下。衄后头晕，四物汤、十全大补汤。有先因衄血，衄止而变生诸
证，或寒热间作，或喘急无寐，病状不一，渐成劳惫，当于虚损诸证详之。
《三因方》记载：鼻出血，是因为感受风寒暑湿邪气，邪气流传于经络，涌泄于清阳之气通行的气道中而导致，这都属于外因。积怒伤肝，积忧伤肺，烦思伤脾，失志伤肾，暴喜伤心，这些都能扰动血液，随气上逆溢出而致，属于内因。饮酒过多，食用烤爆辛热食物，或因坠车马跌打损伤所致，既不属于内因也不属于外因。鼻子与脑相通，血液上溢至脑部，所以从鼻孔流出。适宜用茅花汤调服止衄散，不时饮用折二泔（淘米水），并令患者滴入麻油，或滴入莱菔汁也可以。茅花、白芍药各半尤稳妥。糯米炒至微黄研为末，新汲水送服二钱。乱发烧灰存性，细研，用水送服一方寸匕的量，并吹入鼻中。萱草根捣汁，每盏加入生姜汁半盏调和，时时细细呷饮。竹蛀屑，用水调服。百药煎，一半烧一半生，用水酒调服。白芨末，用新汲水调下神效。治疗鼻出血久不止，或素有热邪而突然发作的，诸药无效，神法是用大白纸一张，折叠成十几层，在冷水中浸湿，敷贴于印堂穴，用热熨斗熨烫，直到一层或两层纸变干，血立止。又一方，用线扎住中指中节，如左鼻孔出血扎左手手指，右鼻孔出血扎右手手指，两鼻孔齐出，则左右都扎。血衄不愈，用三棱针在气街穴刺络出血，再用五味子十粒，麦门冬、当归、黄芪、生地、人参各一钱，水煎，空腹热服。六脉细弦而涩，按之空虚，面色必白且枯槁无光泽，这是脱血证。此为大寒证，用辛温补血养血的药物，佐以甘温、甘热滑润的剂型即可痊愈，可用理中汤、小建中汤。六脉俱大，按之空虚，心动面赤，易惊上部发热，这是手少阴心经的脉象，这是气盛多而亡血。用甘寒镇坠的剂型，大泻其气以平抑气浮，用甘辛温微苦的药物，峻补其血，可用三黄补血汤。实热衄血，先服朱砂、蛤粉，次服木香、黄连。大便结者攻下，用大黄、芒硝、甘草、生地。大便溏者，栀子、黄芩、黄连、犀角地黄汤，可选用。有头风自衄，头风刚发则衄不止，宜用芎附饮，间进一字散。下虚上盛而衄，不宜过用凉剂，宜用四物汤加人参、黄芪、麦门冬、五味子，磨沉香送服养正丹，八味地黄丸。伤湿而衄，肾着汤加川芎，名为除湿汤。伏暑而衄，茅花汤调五苓散。上膈极热而衄，金沸草散去麻黄、半夏，加茅花如荆芥数量，或用黄芩芍药汤加茅花一撮。虚者用茯苓补心汤，生料鸡苏散。饮酒过多而衄，茅花汤加干葛、鸡矩子，或理中汤去干姜，用干葛加茅花。呃逆而衄不止，苏合香丸一丸，或小乌沉汤一钱，白开水调下。或煎浓紫苏汤，单独调服小乌沉汤，或添入黑神散一钱，盐汤调下也可。仍突然用水泼其面部，使其受惊则血止。不仅呃逆而衄，凡五窍出血皆治。曾患鼻衄，后血沿旧路而出，一月或三四次鼻衄，又有洗脸时鼻衄，日以为常，这就是水不通借路的意思，都适宜用止衄散，茅花煎汤调下。或四物汤加石菖蒲、阿胶、蒲黄各半钱，煎熟，调火煅石膏末一匙头许，兼进养正丹。前诸证服药无效，大衄不止者，多服养正丹，仍佐以苏子降气汤，使血随气下行。鼻衄后头晕，用四物汤、十全大补汤。有先因鼻衄，衄止后变生诸证，或寒热间作，或喘急无寐，病状不一，渐成劳惫，应当参考虚损诸证详细诊治。
The *San Yin Fang* (Treatise on Three Causes) states: Epistaxis (nosebleed) occurs when pathogenic factors such as wind, cold, summer-heat, and dampness invade the meridians, surging into the clear orifices of the head. This is classified as an external cause. Accumulated anger injures the Liver; accumulated sorrow injures the Lung; excessive thinking injures the Spleen; loss of will injures the Kidney; sudden joy injures the Heart. All these can disturb blood, causing it to overflow upward with Qi, which belongs to internal causes. Excessive alcohol consumption, ingestion of roasted, fried, or pungent-hot foods, or injuries from falls and carriage accidents are neither internal nor external causes. The nose connects to the brain; when blood overflows upward to the brain, it exits through the nostrils. It is advisable to use Maohua Tang (Flower of Hemp Decoction) to administer Zhini San (Stop Nosebleed Powder), frequently drink Zhe Er Jiang (second rice-washing water), and instill Sesame Oil or Radish Juice into the nostrils. A combination of Maohua (Flower of Hemp) and Baishao Yao (White Peony Root) in equal parts is particularly stable. Stir-fried Glutinous Rice until slightly yellow, grind into powder, and take two qian with fresh well-water. Burn disordered hair to ash while preserving its nature, grind finely, and take one fangcun bi (a measure roughly equivalent to a teaspoon) with water, also insufflating into the nose. Crush Rhizoma Dayliliis (Daylily Root) for juice, mix half a cup of Ginger Juice with one cup of this juice, and sip slowly. Bamboo borings can be taken mixed with water. Baiyao Jian (Fermented Medicinal Brick), half burnt and half raw, is taken with water and wine. Baidi Mo (Bletilla Striata Powder) taken with fresh well-water is miraculous. For chronic epistaxis or sudden onset due to latent heat where other remedies fail, a divine method involves folding a large white paper into more than ten layers, soaking it in cold water, placing it on Yintang (Ex-HN3), and applying heat with a hot ironing tool until one or two layers dry, stopping the bleeding immediately. Another prescription ties the middle phalanx of the middle finger with thread; tie the left finger for left-sided bleeding, the right for right-sided, and both if bilateral. If bleeding persists, pricking Qijie (ST30) with a three-edged needle to bleed, followed by a decoction of Wuweizi (Schisandra Berry), Maimendong (Ophiopogon Tuber), Danggui (Angelica Sinensis), Huangqi (Astragalus Root), Shengdi (Rehmannia Root), and Renshen (Ginseng Root) each at one qian, taken warm on an empty stomach, is indicated. If the six pulses are fine, wiry, and choppy, feeling empty upon pressure, and the complexion is pale and dull, this indicates Blood depletion. This is a severe Cold syndrome; treat with acrid-warm herbs to tonify and nourish Blood, assisted by sweet-warm and sweet-hot lubricating agents. Lizhong Tang (Regulate the Middle Decoction) or Xiaojianzhong Tang (Minor Construct the Middle Decoction) may be used. If all six pulses are large but empty upon pressure, accompanied by palpitations, facial redness, fright, and upper body heat, this reflects the pulse of the Hand Shaoyin Heart Meridian, indicating excess Qi and Blood loss. Use sweet-cold heavy-settling agents to drain excess Qi and anchor floating Qi, combined with sweet-acrid-warm and slightly bitter herbs to vigorously tonify Blood. Sanhuang Buxue Tang (Three Yellow Blood Tonifying Decoction) is appropriate. For excess heat epistaxis, first take Cinnabar and Gypsum Pulvis, then Magnolia Bark and Coptis Rhizome. If constipation exists, purge using Rhubarb, Mirabilite, Licorice Root, and Rehmannia Root. If diarrhea exists, use Gardenia, Scutellaria Root, Coptis Rhizome, or Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). For cephalalgia-induced spontaneous epistaxis, where bleeding continues as long as the headache persists, use Xiongfu Yin (Ligusticum and Aconite Drink), interspersed with Yizi San (One Character Powder). For deficiency below and excess above causing epistaxis, avoid excessive cooling agents; use Siwu Tang (Four Substances Decoction) plus Renshen, Huangqi, Maimendong, and Wuweizi, taken with ground Agarwood and Yangzheng Dan (Nourish Righteousness Pill) or Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill). For dampness-induced epistaxis, Shen Zhuo Tang (Kidney Fixation Decoction) plus Chuanxiong, named Chushi Tang (Remove Dampness Decoction). For latent summer-heat epistaxis, use Maohua Tang to regulate Wuling San (Five-Ingredient Poria Decoction). For extreme heat in the upper jiao causing epistaxis, use Jifeicao San (Boiling Herb Powder) removing Mahuang and Banxia, adding Maohua equivalent to Jingjie, or Huangqin Shaoyao Tang (Scutellaria and Peony Decoction) with a pinch of Maohua. For deficiency, use Fuling Buxin Tang (Poria Nourishing Heart Decoction) or Shengliao Jisu San (Raw Material Mint Powder). For alcohol-induced epistaxis, Maohua Tang plus Gegen (Kudzu Root) and Jimuzi (Chicken Knees Fruit), or Lizhong Tang removing Ganjiang, adding Gegen and Maohua. For hiccups with persistent epistaxis, take Suhexiang Wan (Styrax Pill) or Xiaowuchen Tang (Minor Black Stagnation Decoction) dissolved in plain water. Alternatively, brew strong Perilla Decoction to take Xiaowuchen Tang alone, or add Heishen San (Black Divine Powder) taken with salt water. Suddenly splashing water on the face to startle the patient can stop the bleeding. This applies not only to hiccups but to bleeding from any of the five orifices. For recurrent epistaxis along old pathways occurring monthly or several times a month, or daily washing-induced epistaxis, reflecting the principle of "water finding another path," use Zhini San regulated by Maohua Decoction. Or use Siwu Tang plus Shichangpu (Acorus Rhizome), Ejiao (Donkey-hide Gelatin), and Puhuang (Pollen Typhae) each at half a qian, decocted, mixed with calcined Gypsum powder, and taken alongside Yangzheng Dan. If previous prescriptions fail for massive epistaxis, take more Yangzheng Dan, assisted by Suzi Jiangqi Tang (Perilla Seed Descending Qi Decoction) to guide blood downward following Qi. For dizziness after epistaxis, use Siwu Tang or Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction). If various symptoms arise after epistaxis ceases, such as alternating chills and fever, panting, insomnia, leading gradually to exhaustion, refer to the treatment of deficiency syndromes.