伤寒脉浮紧，不发汗，因致衄者，麻黄汤主之。（《活人》云∶衄后脉浮者，宜麻黄汤。衄后脉已微者，
不可行麻黄汤，宜黄芩芍药汤。）太阳病，脉浮紧，无汗发热，身疼痛，八九日不解，表症仍在，此当发其汗。
服药已，微除，其人发烦目瞑，剧者必衄乃解。所以然者，阳气重故也，麻黄汤主之。不大便，头痛有热，
若小便赤者，承气汤也。若小便清而衄者，桂枝汤也。（论见发汗。）太阳病，脉浮紧，发热无汗而
衄者，愈也。（论见发热。）
太阳病，以火劫发汗，血气流溢，失其常度，阳盛则欲衄，阴虚则小便难。（论见头汗。）少阴病，
但厥无汗，而强发之，必动其血，或从口鼻出，或从目中出者，难治。（论见欲寐。）动气发汗，则衄而
渴，饮水就吐。（论见动气。）
脉浮发热，口干鼻燥，能食者则衄。阳明胃实口燥，但欲漱水不咽者，必衄也。衄家不可发汗，汗
出必额上陷，脉急紧，直视不能瞬，不得眠。（衄忌发汗者，为无脉。若浮紧身疼发热恶寒之症，宜发之。）
〔海〕仲景言衄不可发汗者，盖为脉微也。若浮紧者，麻黄汤；浮缓者，桂枝汤；脉已微，二药不可用，
犀角地黄汤主之。（仲景云∶衄家不可发汗，汗出必额上陷，脉紧，直视不能瞬，不得眠。又云∶亡血不可发
其表，汗出即寒栗而振。此二说，皆为脉微不可汗也。若脉浮紧及得缓者，皆当发之是也。）
〔《活》〕伤寒衄血，脉已微者，黄芩芍药汤、犀角地黄汤主之。
犀角地黄汤 治伤寒应发汗而不发汗，内有瘀血，鼻衄吐血，面黄，大便黑，此方主消化瘀血。
芍药（一两） 生地（一两半） 牡丹皮（二钱半） 犀角（二钱半）
上 咀，每服五钱，水一盏半，煎取一盏。有热如狂者，加黄芩一两。其人脉大来迟，腹不满，自言满者，
为无热，不用黄芩。
茅花汤 治鼻衄不止。
用茅花尖一把，以水三盏，浓煎汁一盏，分二服，即瘥。无花以根代之。
若衄而渴者，心烦，饮则吐水，先服五苓散，次服竹叶汤。
〔《本》〕治伤寒衄血，滑石丸。
滑石末不以多少，饭丸，如桐子大。每服十丸，微嚼破，新水咽下立止。用药末一钱，饭少许，同嚼下，
亦得。老幼皆可服。汤晦叔云∶鼻衄者，当汗不汗所致。其血青黑时，不以多少，乃止，宜服温和药以调其卫。
才见鲜血，急以此药治之。
伤寒病脉象浮紧，若未及时发汗，导致鼻出血的，用麻黄汤主治。（《活人书》说：鼻出血后脉象仍浮的，适宜用麻黄汤。鼻出血后脉象已微弱的，不可使用麻黄汤，适宜用黄芩芍药汤。）太阳病，脉象浮紧，无汗、发热、身体疼痛，经过八九日病情未解，表证仍在，这应当采用发汗法。服药后，症状轻微缓解，病人出现心烦、眼睛闭合不想睁开，严重的必然通过鼻出血才能解除。之所以这样，是因为阳气郁闭过重的缘故，用麻黄汤主治。大便不通，头痛且有热感，如果小便颜色赤红，属于承气汤证。如果小便清亮而鼻出血的，属于桂枝汤证。（相关论述见“发汗”篇。）太阳病，脉象浮紧，发热无汗且发生鼻出血的，病会自愈。（相关论述见“发热”篇。）
太阳病，用火法强行发汗，导致气血运行溢出常态，失去正常节度，阳热亢盛则想要鼻出血，阴液亏虚则小便困难。（相关论述见“头汗”篇。）少阴病，仅有四肢厥冷而无汗，若强行发汗，必定扰动血液，血液或从口鼻流出，或从眼中流出，难以治疗。（相关论述见“欲寐”篇。）有动气（腹部悸动）时发汗，会导致鼻出血且口渴，喝水即吐。（相关论述见“动气”篇。）
脉象浮、发热、口干鼻燥，能进食的人会发生鼻出血。阳明胃实导致口燥，只想含水漱口而不愿咽下的，必然会发生鼻出血。经常鼻出血的人（衄家）不可发汗，若发汗出汗，必然导致额部凹陷，脉象急紧，两眼直视不能眨眼，无法入睡。（禁止对鼻出血者发汗的原因，通常是因为无脉。如果是脉浮紧、身疼、发热恶寒的症状，适宜发汗。）
〔海〕张仲景说鼻出血不可发汗，大概是指脉象微弱的情况。如果是脉浮紧的，用麻黄汤；脉浮缓的，用桂枝汤；脉象已微弱，这两种药都不可用，用犀角地黄汤主治。（张仲景说：经常鼻出血的人不可发汗，发汗出汗必然导致额部凹陷，脉紧，两眼直视不能眨眼，无法入睡。又说：亡血之人不可发其表，发汗出汗就会导致寒战颤抖。这两种说法，都是指脉微弱不可发汗的情况。如果是脉浮紧及脉缓的，都应当发汗，这是正确的。）
〔《活人书》〕伤寒鼻出血，脉象已微弱的，用黄芩芍药汤、犀角地黄汤主治。
犀角地黄汤 治疗伤寒应当发汗而未发汗，体内有瘀血，鼻出血吐血，面色黄，大便黑色，此方主治消化瘀血。
芍药（一两） 生地黄（一两半） 牡丹皮（二钱半） 犀角（二钱半）
以上药物切碎，每次服用五钱，用水一盏半，煎取一盏药液。如果有热象如狂躁的，加黄芩一两。如果病人脉象来势大但至数迟，腹部不胀满，却自称胀满的，为无热邪，不用黄芩。
茅花汤 治疗鼻出血不止。
用茅花尖一把，用水三盏，浓煎取汁一盏，分两次服用，即可痊愈。没有花就用根代替。
如果鼻出血且口渴，心烦，喝水即吐水，先服用五苓散，再服用竹叶汤。
〔《本草》〕治疗伤寒鼻出血，用滑石丸。
滑石末不限多少，做成饭丸，大小如梧桐子。每次服用十丸，稍微嚼碎，用新汲水送下，立止。用药末一钱，少许米饭，同嚼服下，也可以。老人小孩都可以服用。汤晦叔说：鼻出血，是应当发汗而未发汗所致。如果血色青黑，无论多少，都能止血，适宜服用温和的药物以调和卫气。刚见到鲜血，应立即以此药治疗。
Taiyang disease characterized by a floating and tight pulse, if sweating is not induced initially leading to epistaxis (nosebleed), Ma Huang Tang (Ephedra Decoction) is the primary treatment. (The *Liu Ren Shu* states: If the pulse remains floating after epistaxis, Ma Huang Tang is suitable. If the pulse has become thready/weak after epistaxis, Ma Huang Tang must not be used; Huang Qin Shao Yao Tang (Scutellaria and Peony Decoction) is suitable.) In Taiyang disease, with a floating and tight pulse, absence of sweat, fever, and body pain, persisting for eight or nine days without resolution, while the exterior syndrome remains, sweating should be induced. After taking medicine, symptoms may slightly alleviate; the patient may experience irritability and desire to keep eyes closed. In severe cases, relief comes only through epistaxis. This occurs because of excessive accumulation of Yang Qi; Ma Huang Tang is the primary treatment. If there is constipation, headache with heat sensation, and red urine, this indicates Cheng Qi Tang (Purgative Decoction) syndrome. If urine is clear but epistaxis occurs, Gui Zhi Tang (Cinnamon Twig Decoction) is indicated. (See discussion under "Inducing Sweating".) In Taiyang disease, with a floating and tight pulse, fever, absence of sweat, and subsequent epistaxis, the disease will resolve spontaneously. (See discussion under "Fever".)
In Taiyang disease, if fire therapy is forcibly applied to induce sweating, causing blood and Qi to overflow and lose their normal rhythm, excess Yang leads to impending epistaxis, while Yin deficiency leads to difficulty in urination. (See discussion under "Head Sweat".) In Shaoyin disease, presenting only with cold extremities and no sweat, if sweating is forcibly induced, it will surely disturb the blood, causing bleeding from the mouth and nose or from the eyes; this is difficult to treat. (See discussion under "Desire to Sleep".) If sweating is induced in cases of moving Qi (abdominal palpitations), it results in epistaxis, thirst, and vomiting upon drinking. (See discussion under "Moving Qi".)
A floating pulse, fever, dry mouth and nose, and ability to eat indicate that epistaxis will occur. In Yangming stomach excess causing dry mouth, where the patient desires to rinse water in the mouth but does not swallow, epistaxis is certain. Patients prone to epistaxis (Nü Jia) must not undergo sweating therapy; if sweating occurs, it leads to depression of the forehead, a tense and tight pulse, staring gaze without blinking, and insomnia. (The prohibition against sweating for epistaxis generally applies when the pulse is absent. However, for symptoms of floating-tight pulse, body pain, fever, and aversion to cold, sweating is appropriate.)
[Hai] Zhang Zhongjing stated that epistaxis precludes sweating therapy, referring specifically to cases with a thready/weak pulse. If the pulse is floating and tight, use Ma Huang Tang; if floating and slow, use Gui Zhi Tang. If the pulse is already thready/weak, neither drug is applicable; Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) is the primary treatment. (Zhang Zhongjing said: Patients prone to epistaxis must not undergo sweating; if sweating occurs, it leads to depression of the forehead, tight pulse, staring gaze without blinking, and insomnia. He also said: Those who have lost blood must not have their exterior released; sweating leads to chills and tremors. These two statements both refer to cases with weak pulses where sweating is contraindicated. Conversely, if the pulse is floating-tight or slow, sweating is indeed indicated.)
[From *Liu Ren Shu*] For epistaxis due to cold damage with a thready/weak pulse, Huang Qin Shao Yao Tang (Scutellaria and Peony Decoction) and Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) are the primary treatments.
Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction): Treats cold damage where sweating was indicated but not performed, resulting in internal blood stasis, epistaxis, hematemesis, yellowish complexion, and black stools. This formula primarily resolves blood stasis.
Shao Yao (Peony Root, 1 liang)
Sheng Di Huang (Rehmanniae Radix Recens, 1.5 liang)
Mu Dan Pi (Moutan Cortex, 2.5 qian)
Xi Jiao (Rhinocerotis Cornu, 2.5 qian) [Note: Modern substitutes like Water Buffalo Horn are often used.]
Crush the herbs. Take 5 qian per dose, decoct in 1.5 cups of water until 1 cup remains. If there is heat manifesting as mania-like agitation, add Huang Qin (Scutellariae Radix, 1 liang). If the pulse appears large but beats slowly, and the abdomen feels full though it is not distended, this indicates absence of heat; do not use Huang Qin.
Mao Hua Tang (Thrush Flower Decoction): Treats persistent epistaxis.
Take a handful of the tips of Thrush flowers (Mao Hua), decoct strongly in 3 cups of water until 1 cup remains. Divide into two doses for administration; recovery follows. If flowers are unavailable, use the roots instead.
If epistaxis is accompanied by thirst, irritability, and vomiting of ingested water, first administer Wu Ling San (Five-Ingredient Powder with Poria), followed by Zhu Ye Tang (Bamboo Leaf Decoction).
[From *Ben Cao*] For treating epistaxis due to cold damage, use Shi Hu Wan (Talcum Pills).
Grind Talcum (Hua Shi) into powder, form pills with rice paste, sized like wattle seeds. Take 10 pills per dose, chew slightly, and swallow with fresh well-water; bleeding stops immediately. Alternatively, take 1 qian of the powder with a small amount of rice, chew together, and swallow. Suitable for both elderly and young. Tang Hui Shu stated: Epistaxis is caused by failure to induce sweating when indicated. When the blood is dark/black, regardless of quantity, it can stop bleeding; mild-warm natured medicines should be taken to harmonize the Wei Qi. Upon seeing fresh bright red blood, treat urgently with this medicine.