鼻为肺窍，又曰天牝，乃宗气之道，而实心肺之门户，故经曰∶心肺有病而鼻为之不利
也。然其经络所至，专属阳明，自山根以上，则连太阳、督脉，以通于脑，故此数经之病，
皆能及之。若其为病，易窒塞者谓之鼽，时流浊涕而或多臭气者，谓之鼻渊，又曰脑漏；或
生肉而阻塞气道者，谓之鼻 ，及有喷嚏、鼻衄、酒 、赤鼻之类，各
当辨而治之。然总之鼻病无他也，非风寒外感，则内火上炎耳。外感者，治宜辛散，内热者
，治宜清凉，知斯二者，则治鼻大纲尽乎是矣。
一、鼻塞证有二∶凡由风寒而鼻塞者，以寒闭腠理，则经络壅塞而多鼽嚏，此证多在太
阳经，宜用辛散解表自愈，如川芎散、神愈散，及麻黄、紫苏、荆芥、葱白之类皆可择用。
若由火邪上炎而鼻塞者，单宜清火。火之微者，多近上焦，出自心肺，宜清化饮、黄芩知母
汤之类主之。火之甚者，多出阳明，或微兼头痛，宜竹叶石膏汤、凉膈散之类主之。若风寒
兼火者，即防风通圣散之类亦可用。大都常塞者多火，暴塞者多风寒，当以此辨之。
一、鼻涕多者，多由于火，故曰∶肺热甚则鼻涕出。由此观之，则凡无故多泪及多口涎
者，亦多属肝脾之火，皆其类耳。
一、鼻渊证，总由太阳、督脉之火，甚者上连于脑，而津津不已，故又名为脑漏。此证
多因酒醴肥甘，或久用热物，或火由寒郁，以致湿热上熏，津汁溶溢而下，离经腐败，有作
臭者，有大臭不堪闻者，河间用防风通圣散一两，加薄荷、黄连各二钱以治之。古法有用苍
耳散治之者。然以余之见，谓此炎上之火，而治兼辛散，有所不宜，故多不见效，莫若但清
阴火而兼以滋阴，久之自宁，此即高者抑之之法，故常以清化饮加白蒺藜五钱或一两，苍耳
子二三钱。若火之甚者，再以清凉等剂加减用之，每获全愈，或用《宣明》防风汤之意亦可
。但此证一见，即宜节戒早治，久则甚难为力也。凡鼻渊脑漏，虽为热证，然流渗既久者，
即火邪已去，流亦不止，以液道不能扃固也。故新病者，多由于热，久病者，未必尽为热
证，此当审察治之，若执用寒凉，未免别生他病。其有漏泄既多，伤其髓海，则气虚于上，
多见头脑隐痛及眩运不宁等证，此非补阳不可，宜十全大补汤、补中益气汤之类主之。又《
医学正传》有脑漏秘方，亦可检用。
一、鼻 肉，阻塞清道，虽鼻为肺窍，而其壅塞为患者，乃经络肌肉之病，此
实阳明热滞留结而然。故内治之法，宜以清火、清气为主；外治之法，宜以黄白散，及《千
金》 肉方雄黄散，或《简易》 肉方之类主之。
一、酒 赤鼻，多以好酒之人，湿热乘肺，熏蒸面鼻，血热而然；或以肺经素多风
热，色为红黑而生 疖者亦有之。内宜凉血清火，外宜硫磺散、白矾散之类主之。
一、鼻衄证，详见血证门。
鼻子是肺的窍道，又被称为天牝，是宗气运行的通道，实际上是心和肺的门户，所以医经说：心和肺有病时，鼻子就会不通利。然而鼻子的经络所经过的地方，主要归属于阳明经，从山根以上，则连接太阳经和督脉，与脑相通，因此这几条经脉的病变，都能影响到鼻子。如果鼻子发生病变，容易堵塞的称为“鼽”（鼻塞流清涕），时常流出浊涕且气味多臭的，称为“鼻渊”，又叫“脑漏”；或者长出息肉阻塞气道，称为“鼻息肉”；以及有打喷嚏、鼻出血、酒渣鼻、红鼻头等情况，都应当辨别后进行治疗。总之，鼻病没有其他的，不是风寒外感，就是内火上炎罢了。外感引起的，治疗适宜用辛散的方法；内热引起的，治疗适宜用清凉的方法，懂得这两点，那么治疗鼻病的总纲就完备了。
一、鼻塞证有两种：凡是因风寒导致的鼻塞，是因为寒气闭塞腠理，导致经络壅塞而多出现鼻塞喷嚏，这种证候多在太阳经，适宜用辛散解表的方法自愈，如川芎散、神愈散，以及麻黄、紫苏、荆芥、葱白等药物都可以选择使用。如果是因火邪上炎导致的鼻塞，则单纯适宜清火。火邪轻微的，多靠近上焦，出自心肺，适宜用清化饮、黄芩知母汤等方剂主治。火邪严重的，多出于阳明经，或者轻微兼有头痛，适宜用竹叶石膏汤、凉膈散等方剂主治。如果是风寒兼有火邪，即防风通圣散等方剂也可以使用。大抵经常鼻塞的多属火邪，突然鼻塞的多属风寒，应当以此进行辨别。
一、鼻涕多的人，多由于火邪，所以说：肺热严重就会鼻涕流出。由此看来，那么凡是没有缘故地多流泪及多口涎的，也多属于肝脾的火邪，都是同一类情况。
一、鼻渊证，总由太阳经和督脉的火邪引起，严重的向上连及于脑，津液不断流出，所以又名为脑漏。此证多因饮酒嗜食肥甘厚味，或长期食用热性食物，或火邪被寒邪郁遏，导致湿热上熏，津液溶溢而下，离开经脉腐败，有的发出臭味，有的恶臭不堪闻。刘河间用防风通圣散一两，加薄荷、黄连各二钱来治疗它。古法有用苍耳散治疗它的。然而依我的见解，认为这是炎上的火邪，而治疗兼用辛散的方法，有所不宜，所以大多不见效，不如只清阴火并兼以滋阴，时间久了自然安宁，这就是“高者抑之”的方法，所以常用清化饮加白蒺藜五钱或一两，苍耳子二三钱。如果火邪严重的，再用清凉等方剂加减使用，每每获得痊愈，或者采用《宣明论方》中防风汤的意思也可以。但是此证一旦见到，就应当节制戒除并尽早治疗，时间久了就很难施力了。凡是鼻渊脑漏，虽然属于热证，但如果流渗时间既久，即使火邪已去，流涕也不停止，因为液道不能关闭坚固。所以新得的病，多由于热，久病的人，未必全是热证，这应当审慎考察治疗，如果固执地使用寒凉药物，未免会另外生出其他疾病。如果有漏泄过多，损伤髓海，则气虚于上部，多见头脑隐痛及眩晕不安等症状，这不是补阳不可，适宜用十全大补汤、补中益气汤等方剂主治。另外《医学正传》中有治疗脑漏的秘方，也可以查阅使用。
一、鼻息肉，阻塞清道，虽然鼻子是肺的窍道，但其壅塞为害的，乃是经络肌肉的病，这实际上是阳明经热邪滞留结聚而造成的。所以内治的方法，适宜以清火、清气为主；外治的方法，适宜用黄白散，以及《千金方》中的去肉方雄黄散，或《简易方》中的去肉方等主治。
一、酒渣赤鼻，多因喜好饮酒之人，湿热乘袭肺脏，熏蒸面部和鼻子，血热而造成的；也有因肺经素来多有风热，面色红黑而生疖子的情况。内治适宜凉血清火，外治适宜用硫磺散、白矾散等主治。
一、鼻衄证，详见血证门。
The nose is the orifice of the Lung, also called Tianping (Heavenly Nostril), and is the pathway of Zongqi (Gathering Qi), serving as the gateway for the Heart and Lung. Therefore, the classics state: "When the Heart and Lung are diseased, the nose becomes obstructed." However, the meridians passing through the nose primarily belong to the Yangming channel. From the Shangen point (Mountain Root) upwards, it connects with the Taiyang channel and the Du vessel, communicating with the brain. Thus, diseases of these meridians can all affect the nose. If pathological changes occur in the nose, obstruction is called Qiu (rhinorrhea with nasal congestion); frequent discharge of turbid mucus with a foul odor is called Biyuan (nasal sinusitis), also known as Naolou (brain leakage); growths obstructing the airway are called Nasal Polyps; and conditions such as sneezing, epistaxis, rhinophyma, and erythema of the nose should each be differentiated and treated accordingly. In summary, nasal diseases are none other than either external contraction of Wind-Cold or internal flaming-up of Fire. For external contractions, treatment should employ Acrid-Dispersing methods; for internal heat, Cooling methods are appropriate. Understanding these two principles encompasses the general outline for treating nasal diseases.
1. There are two types of nasal congestion: When caused by Wind-Cold, cold closes the interstices (Couli), causing meridian obstruction leading to frequent nasal congestion and sneezing. This pattern mostly involves the Taiyang channel and should resolve spontaneously with Acrid-Dispersing and Exterior-Releasing methods. Formulas such as Chuanxiong San, Shenyu San, and herbs like Ephedrae Herba (Mahuang), Perillae Folium (Zisu), Schizonepetae Spica (Jingjie), and Allii Fistulosi Bulbus (Congbai) may be selected. If caused by Fire pathogen flaming upward, only Clearing Fire is suitable. Mild fire, often located in the Upper Jiao originating from the Heart and Lung, is treated with Qinghua Yin or Huangqin Zhimu Tang. Severe fire, often arising from the Yangming channel, possibly accompanied by mild headache, is treated with Zhuye Shigao Tang or Liangge San. If Wind-Cold is combined with Fire, Fangfeng Tongsheng San may also be used. Generally, chronic congestion is mostly due to Fire, while sudden congestion is mostly due to Wind-Cold; differentiation should be based on this.
2. Excessive nasal discharge is mostly due to Fire, hence it is said: "Severe Lung Heat causes nasal discharge." By analogy, excessive tearing and salivation without cause also mostly belong to Fire of the Liver and Spleen, being of the same category.
3. The Biyuan (Nasal Sinusitis) pattern is generally caused by Fire of the Taiyang channel and Du vessel. Severe cases extend upward to the brain, causing continuous dripping, hence the name Naolou (Brain Leakage). This condition often results from indulgence in alcohol and rich/greasy foods, long-term consumption of hot-natured substances, or Fire constrained by Cold, leading to Damp-Heat steaming upward. Body fluids overflow and drip down, leaving the vessels and becoming putrefied, resulting in odors ranging from slight to unbearable. Liu Hejian treated this with Fangfeng Tongsheng San (1 liang) plus Bohe (2 qian) and Huanglian (2 qian). Ancient methods used Can'er San. However, in my view, since this is Fire flaming upward, using Acrid-Dispersing methods in treatment is inappropriate, which is why efficacy is often poor. It is better to solely clear Deficient Fire while simultaneously nourishing Yin, allowing natural recovery over time. This follows the principle of "Suppressing what is high." I commonly use Qinghua Yin added with Tribuli Fructus (Baijili, 5 qian or 1 liang) and Xanthii Fructus (Cangerzi, 2-3 qian). If the Fire is severe, Cooling formulas are modified and used, often achieving full recovery. Alternatively, the intent of Fangfeng Tang from *Xuanming Lun* may be adopted. Once this condition appears, one must immediately observe dietary restrictions and treat early; if prolonged, it becomes difficult to manage. Although Biyuan/Naolou is a Heat pattern, if discharge persists for a long time, even after the Fire pathogen is eliminated, discharge may continue because the fluid pathways fail to close securely. Thus, new-onset cases are mostly due to Heat, but chronic cases are not necessarily entirely Heat patterns; careful examination is required. Adhering rigidly to Cold/Cooling drugs may induce other diseases. If leakage is excessive, damaging the Sea of Marrow, Qi deficiency occurs in the upper body, manifesting as dull headache and dizziness/restlessness. This requires tonifying Yang, treated with Shiquan Dabu Tang or Buzhong Yiqi Tang. Additionally, a secret formula for Brain Leakage in *Yixue Zhengzhuan* can be consulted.
4. Nasal Polyps block the clear passages. Although the nose is the orifice of the Lung, the obstruction and harm are diseases of the meridians and muscles, actually caused by stagnation and accumulation of Yangming Heat. Internal treatment should focus on Clearing Fire and Qi; external treatment should utilize Huangbai San, or the Xionghuang San from the *Qianjin* Polyp Removal Formula, or similar formulas from the *Jianyi* text.
5. Rhinophyma (Alcoholic Red Nose) is mostly caused by individuals fond of alcohol, where Damp-Heat attacks the Lung, steaming the face and nose, resulting from Blood Heat. Alternatively, it may arise from pre-existing Wind-Heat in the Lung channel, leading to red-black complexion and boils. Internal treatment should Cool the Blood and Clear Fire; external treatment should use Liuhuang San or Baifan San.
6. Epistaxis (Nosebleed) is detailed in the Chapter on Blood Disorders.