一、衄血有格阳证者，以阴亏于下，而阳浮于上，但察其六脉细微，全无热证，或脉见
浮虚豁大，上热下寒而血衄不止，皆其证也。治宜益火之源，古有八味地黄汤，乃其对证之
剂，余复有镇阴煎之制，其效尤捷。盖此证不惟内伤者有之，即伤寒者亦有之，然必其素多
斫丧，损及真阴者，乃见此证。余尝治一多欲少年，以伤寒七日之后，忽尔鼻衄，以为将解
之兆，及自辰至申，所衄者一斗余，鼻息脉息俱已将脱，身凉如冰，目视俱直，而犹涓涓不
绝，呼吸垂危。其父母号呼求救，余急投镇阴煎一剂，衄乃止，身乃温。次加调理而愈。自
后凡治此证，无不附应，亦神矣哉。
一、血从齿缝牙龈中出者，名为齿衄。此手足阳明二经及足少阴肾家之病。盖手阳明入
下齿中，足阳明入上齿中。又肾主骨，齿者骨之所终也。此虽皆能为齿病，然血出于经，则
惟阳明为最。故凡阳明火盛，则为口臭，为牙根腐烂肿痛，或血出如涌而齿不动摇。必其人
素好肥甘辛热之物，或善饮胃强者，多有阳明实热之证，宜内服抽薪饮、清胃散等剂，外以
冰玉散敷之。
一、阳明实热之甚，大便闭结不通，而齿衄不止者，宜调胃承气汤下之。
一、肾水不足，口不臭，牙不痛，但齿摇不坚，或微痛不甚，而牙缝时多出血者，此肾
阴不固，虚火偶动而然。但宜壮肾，以六味地黄丸、左归丸之类主之。或其阳虚于下而虚火
上浮者，宜八味丸、小安肾丸之类主之。
一、阴虚有火而病为齿衄者，其证或多燥渴，或见消瘦，或神气困倦，或小水短涩而热
，或六脉浮大而豁。此虽阳明有余，而亦少阴不足，宜玉女煎主之。凡属阴虚有火者，则惟
此煎为最妙，然必大便多实者，乃可用之。若大便滑泄，或脉细恶寒，下元无火等证，则亦
有格阳而然者，当以前吐血条中格阳法治之。
舌上无故出血如缕者，以心脾肾之脉皆及于舌。若此诸经有火，则皆能令舌出血。用蒲
黄炒焦为末敷之。或炒槐花为末掺之。或冰玉散敷之亦可。若火之甚者，仍须用汤饮等剂，
以清三阴之火。
一、对于衄血（鼻出血）属于格阳证的患者，是由于下焦阴液亏损，导致阳气浮越于上。只要诊察发现六脉细微，完全没有热象；或者脉象呈现浮虚、豁大，伴有上热下寒且鼻出血不止的情况，都属于这种证候。治疗应当补益命门之火以引火归元，古代有八味地黄汤，是对证的方剂；我又制定了镇阴煎，疗效更加迅速。这种证候不仅在内伤杂病中出现，在伤寒病中也会出现，但必定是患者平时多有房劳过度或耗损，损伤了真阴，才会出现这种证候。我曾经治疗过一个纵欲过度的少年，他在患伤寒七天之后，突然发生鼻衄，我起初以为是病情将要解除的征兆，但从早晨到傍晚，出血量超过一斗，鼻息和脉搏都几乎要脱绝，身体冷得像冰一样，眼睛直视不动，但血液仍然涓涓不断，呼吸处于危急状态。他的父母大声呼救，我急忙给他服用一剂镇阴煎，鼻衄才停止，身体才回暖。随后加以调理而痊愈。从此以后，凡是治疗这种证候，没有不灵验的，真是神奇啊。
二、血液从齿缝和牙龈中流出的，称为齿衄。这是手阳明大肠经、足阳明胃经以及足少阴肾经的病变。因为手阳明大肠经进入下齿中，足阳明胃经进入上齿中。另外，肾主骨，牙齿是骨骼的终末表现。虽然这三条经络都能引起牙齿疾病，但血液从经脉溢出，主要责之于阳明经。所以凡是阳明火盛，就会出现口臭、牙根腐烂肿痛，或者出血如涌出而牙齿不松动。必定是那些平素喜好肥甘厚味、辛辣温热食物，或者善于饮酒、胃气强盛的人，多有阳明实热的证候，适宜内服抽薪饮、清胃散等方剂，外用冰玉散敷贴。
三、如果是阳明实热非常严重，大便闭结不通，且齿衄不止的，适宜用调胃承气汤攻下泄热。
四、如果是肾水不足，口不臭，牙不痛，只是牙齿摇动不坚固，或者微痛但不严重，且牙缝时常多出血的，这是肾阴不固，虚火偶尔扰动所致。只宜补肾壮骨，以六味地黄丸、左归丸之类为主治方剂。或者是由于下焦阳虚，导致虚火上炎的，适宜用八味丸、小安肾丸之类为主治方剂。
五、如果是阴虚有火而导致齿衄的，其症状可能有多燥渴，或者见形体消瘦，或者神气困倦，或者小便短涩且有热感，或者六脉浮大而豁。这虽然是阳明有余（实），但也兼有少阴不足（虚），适宜用玉女煎主治。凡是属于阴虚有火的，这个方子最为巧妙，但必须是大便经常干结的，才可以应用。如果大便滑泄，或者脉细恶寒，下元无火等证候，则也有可能是格阳证所致，应当参照前文吐血条中关于格阳证的治疗方法进行处理。
舌头上无故出血像丝线一样的，是因为心、脾、肾的经脉都联系到舌头。如果这几条经络有火，都能导致舌头出血。可以用蒲黄炒焦后研成粉末敷贴。或者用炒槐花研成粉末掺撒。或者用冰玉散敷贴也可以。如果火势严重的，仍然需要使用汤剂或饮品等方药，来清除三阴经的火邪。
1. For epistaxis (nosebleed) presenting as the Ge Yang syndrome (floating yang due to yin deficiency), it is caused by yin deficiency in the lower jiao leading to floating of yang qi upwards. If examination reveals six pulses that are fine and minute, with no signs of heat; or if the pulse appears floating, deficient, and large/hollow, accompanied by upper heat and lower cold with continuous nosebleed, these all constitute this syndrome. Treatment should focus on tonifying the source of fire (mingmen fire) to guide fire back to its origin. The ancient formula Ba Wei Di Huang Tang (Eight-Ingredient Rehmannia Pill) is an appropriate prescription for this condition. I have also formulated Zhen Yin Jian (Yin-Securing Decoction), which yields even more rapid results. This syndrome occurs not only in internal injury diseases but also in Shang Han (Cold Damage) diseases, provided the patient has a history of excessive sexual activity or consumption that damages true yin. I once treated a young man who indulged excessively in sexual desires. Seven days after contracting Shang Han, he suddenly experienced severe epistaxis. Initially, I thought it was a sign of impending resolution. However, from morning until evening, he lost over one dou of blood. His nasal respiration and pulse were nearly imperceptible, his body was cold as ice, his eyes were fixed and staring, yet the bleeding continued incessantly, and his breathing was critical. His parents cried out for help. I urgently administered one dose of Zhen Yin Jian, after which the bleeding stopped and his body warmed up. Subsequent regulation led to his recovery. Since then, every case of this syndrome I treated responded effectively, which is truly miraculous.
2. Bleeding from the gum margins and interdental spaces is termed Chi Nu (gingival bleeding). This pathology involves the Hand-Yangming Large Intestine meridian, Foot-Yangming Stomach meridian, and Foot-Shaoyin Kidney meridian. The Hand-Yangming meridian enters the lower teeth, while the Foot-Yangming meridian enters the upper teeth. Furthermore, the Kidney governs the bones, and teeth are considered the culmination of bone tissue. Although these meridians can all cause dental diseases, bleeding originating from the vessels primarily relates to the Yangming meridians. Therefore, when Yangming fire is exuberant, symptoms such as halitosis, rotting/swollen/painful gums, or gushing bleeding without tooth mobility occur. This typically affects individuals who habitually consume rich, sweet, spicy, and hot foods, or those who drink alcohol heavily and have strong stomach qi, presenting with excess heat in the Yangming. Internal administration of Chou Xin Yin (Fire-Withdrawing Decoction) or Qing Wei San (Stomach-Clearing Powder) is indicated, along with external application of Bing Yu San (Ice-Jade Powder).
3. In cases where Yangming excess heat is severe, accompanied by constipation and impaction, and gingival bleeding persists, Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Magnolia Bark Decoction) should be used to purge the accumulation downward.
4. When kidney water is insufficient, manifesting as no bad breath, no toothache, but rather loose/unstable teeth or mild pain, with frequent bleeding from the gum margins, this indicates insecure kidney yin with occasional stirring of deficient fire. Treatment should focus on strengthening the kidney, primarily using Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) or Zuo Gui Wan (Left Restoring Pill). If there is deficiency of yang in the lower jiao causing deficient fire to float upward, Ba Wei Wan (Eight-Ingredient Pill) or Xiao An Shen Wan (Small Calming Kidney Pill) should be used.
5. For gingival bleeding caused by yin deficiency with fire, symptoms may include excessive dryness and thirst, emaciation, mental fatigue, scanty and turbid urine with a sensation of heat, or six pulses that are floating, large, and hollow. Although this presents with Yangming excess, it also involves Shaoyin insufficiency. Yu Nu Jian (Jade Woman Decoction) is the primary treatment. This decoction is most effective for yin deficiency with fire, but it is strictly indicated only for patients with frequent solid stools. If there is loose stool/diarrhea, fine pulse with aversion to cold, or absence of fire in the lower origin, the condition may be due to Ge Yang syndrome. In such cases, refer to the treatment principles for Ge Yang syndrome described in the preceding section on hematemesis.
Spontaneous bleeding from the tongue resembling threads occurs because the meridians of the Heart, Spleen, and Kidney all connect to the tongue. If fire exists in these meridians, it can cause tongue bleeding. Puhuang (Pollen Typhae) can be charred, powdered, and applied topically. Alternatively, fried Huaihua (Flos Sophorae) powder can be sprinkled. Bing Yu San (Ice-Jade Powder) is also applicable. If the fire is severe, herbal decoctions or drinks must still be used to clear the fire of the three yin meridians.