衄行清道，经藏之血也，多由督脉而上出。经藏之气通于鼻，故其血之溢者，
亦出于鼻。张景岳曰凡鼻衄，必自山根以上，睛明之次而来。而睛明一穴，乃小肠、
膀胱、胃、阴跷、阳跷五经之会，皆能为衄。又冲脉为十二经之血海，其上俞出膀
胱经之大杼，下俞出胃经之气街，膀胱、胃二经血至，则冲脉之血亦至，而十二经
之血无不至矣。所以血衄之微者，不过一经之近，甚者通身之血尽出。旧谓衄出于
肺，岂其然哉？《准绳》云鼻通于脑，血上溢于脑，所以从鼻而出，宜茅花汤调止
衄散。嵩 云∶不甚者，以水纸搭鼻衡，或以凉水拊项后即止。甚者犀角地黄汤，
对症之药。又黄芩、白芨各二两，水丸，治久衄，神效。（犀角下入肾，由肾脉上通鼻脑故也。
胃衄者亦可用，以胃脉亦上入鼻也。故火郁阳明致衄者，无犀角以升麻代之，以升麻阳明药也。）
此胃、大肠、肾三经之病。盖大肠脉入下齿中，胃脉入上齿中，而肾主骨，齿
为骨之余也。胃火盛则血出如涌，而齿不动摇，或见口臭，牙龈腐烂肿痛，此浓酒
浓味所致，宜清胃火，便结可下之。若口不臭，牙不痛，但齿动不坚，或微痛不甚，
而牙缝时多出血者，此肾阴虚，火动而然，宜滋肾水，六味丸（见虚损）主之。若肾火虚
而上浮者，八味丸（见虚损）主之。《医旨绪余》述所治三人齿衄，出血甚多，皆以三制大
黄末二钱，枳壳汤少加童便调下，去黑粪而愈。缘阳明热盛，冲任二脉皆附阳明，
故血如潮涌。若肾虚，血必点滴而出，齿亦悠悠而疼，必不如此暴且甚也。
鼻衄（鼻腔出血）运行于清阳之道，是经络脏腑中的血液，大多由督脉向上溢出。经络脏腑之气通达于鼻，所以溢出的血液也从鼻而出。张景岳说：凡是鼻衄，必定从山根以上、睛明穴附近开始流出。而睛明穴，是小肠经、膀胱经、胃经、阴跷脉、阳跷脉五条经脉的交会处，这五条经都能导致鼻衄。另外，冲脉是十二经脉的血海，其上部的腧穴出于膀胱经的大杼穴，下部的腧穴出于胃经的气街穴，当膀胱经和胃经的血液到达时，冲脉的血液也随之到达，那么十二经脉的血液没有不到达的。所以，轻微的鼻衄，不过是一经附近的血液溢出；严重的则全身之血尽出。旧时说鼻衄出于肺，难道真是这样吗？《准绳》说鼻与脑相通，血液上溢至脑，所以从鼻而出，适宜用茅花汤调服止衄散。嵩云说：病情不重的，用水纸搭在鼻梁上，或用凉水敷在后颈部即可停止。病情严重的，用犀角地黄汤，这是对症的药物。又方：黄芩、白及各二两，制成水丸，治疗久治不愈的鼻衄，效果神奇。（犀角入肾经，因为肾脉上行通达鼻和脑的缘故。胃衄也可以使用此法，因为胃脉也上行进入鼻部。所以因火郁于阳明经导致鼻衄的，若无犀角，可用升麻代替，因为升麻是阳明经的药物。）
这是胃、大肠、肾三经的疾病。大概大肠经脉进入下齿中，胃经脉进入上齿中，而肾主骨，牙齿是骨的余气所生。胃火旺盛则血液涌出如喷泉，但牙齿不松动，或者出现口臭、牙龈腐烂肿痛，这是由浓酒和厚味引起的，适宜清泻胃火，若大便干结可以攻下。如果口不臭，牙不痛，只是牙齿松动不坚固，或微痛但不严重，且牙缝时常多出血，这是肾阴虚，虚火妄动所致，适宜滋补肾水，以六味丸为主治。若是肾阳虚火上浮者，以八味丸为主治。《医旨绪余》记载了所治疗的三个齿衄患者，出血量很大，都是用三次炮制的大黄末二钱，加少量枳壳汤和童便调服，排出黑色粪便后痊愈。原因是阳明热盛，冲脉和任脉都依附于阳明经，所以血液如潮水般涌出。如果是肾虚，血液必定点滴而出，牙齿也会悠悠作痛，绝不会像这样突然且严重。
Nasal bleeding (epistaxis) travels through the clear pathways and involves blood from the meridians and zang-fu organs, mostly emerging upwards via the Du Meridian. The qi of the meridians and zang-fu organs connects to the nose; therefore, overflowing blood also exits through the nose. Zhang Jingyue stated: "All cases of epistaxis must originate above the Shangen point, near the Jingming acupoint." The Jingming acupoint is the intersection of five meridians: the Small Intestine Meridian, Bladder Meridian, Stomach Meridian, Yin Qiao Mai, and Yang Qiao Mai, any of which can cause epistaxis. Furthermore, the Chong Mai serves as the Sea of Blood for the twelve meridians. Its upper shu points emerge from the Dazhu acupoint of the Bladder Meridian, and its lower shu points emerge from the Qijie area of the Stomach Meridian. When blood from the Bladder and Stomach meridians arrives, the blood of the Chong Mai also arrives, thereby reaching all twelve meridians. Thus, mild epistaxis involves only blood from a nearby single meridian, while severe cases may result in the expulsion of blood from the entire body. The old theory claims that epistaxis originates from the Lung; is this really true? *Zhunsheng* states that the nose connects to the brain, and when blood overflows upward into the brain, it exits through the nose. It is appropriate to use Maohua Decoction to administer Zhinu San. Song Yun said: For mild cases, applying water-soaked paper to the nasal bridge or splashing cold water on the back of the neck will stop the bleeding. For severe cases, Xijiao Dihuang Tang is used, which is a symptomatic treatment. Another prescription consists of Huangqin and Baiji, each two liang, processed into water pills, which is highly effective for chronic epistaxis. (Xijiao enters the Kidney channel because the Kidney meridian ascends to connect with the nose and brain. This method can also be used for gastric epistaxis, as the Stomach meridian also ascends into the nose. Therefore, in cases of epistaxis caused by fire stagnation in the Yangming channel, if Xijiao is unavailable, Shengma can be substituted, as Shengma is a herb of the Yangming channel.)
This condition pertains to the diseases of the Stomach, Large Intestine, and Kidney channels. Generally, the Large Intestine meridian enters the lower teeth, and the Stomach meridian enters the upper teeth. The Kidney governs the bones, and teeth are considered the surplus of bone. When Stomach fire is excessive, blood gushes out like a fountain, yet the teeth remain firm. Symptoms may include bad breath and rotting, swollen, and painful gums, typically caused by heavy consumption of alcohol and rich flavors. The treatment should focus on clearing Stomach fire; if constipation is present, purgatives may be used. If there is no bad breath or toothache, but the teeth feel loose and unstable, or suffer slight pain without severity, accompanied by frequent bleeding from the gum spaces, this indicates Kidney yin deficiency with hyperactive fire. The treatment should nourish Kidney water, primarily using Liuwei Wan (see Xu Sun). In cases where Kidney fire floats upward due to deficiency, Bawei Wan (see Xu Sun) is indicated. *Yizhi Xuyu* records three cases of dental bleeding treated by the author, involving significant blood loss. All were cured by administering two qian of Sanzhi Dahuang powder, mixed with a small amount of Zhike decoction and child's urine. Recovery occurred after the passage of black stools. The reason is that Yangming heat is excessive, and both the Chong Mai and Ren Mai attach to the Yangming channel, causing blood to surge like a tide. In contrast, if the cause is Kidney deficiency, blood will drip out slowly, and the teeth will ache intermittently; such cases would never present with such sudden and severe hemorrhage.