岐天师曰∶火气郁勃于上焦，不能分散，故上冲而为吐血、衄血也。七孔流血
者，乃肾虚热也。用六味地黄汤加麦冬、五味子、骨碎补治之。（《秘录》）
冯鲁瞻曰∶鼻衄者，或心或肺或胃蕴热过极，迫血妄行，上乾清道而衄也。鼻
气通于脑，血上溢于脑，故从鼻而出，名曰鼻衄。若因风寒暑湿，流传经络，涌泄
清道而致者，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，皆内所因；饮食过多，炙 辛热，或坠车损扑而致者，皆
不内外因也。《原病式》曰∶衄者，阳热怫郁于足阳明经。丹溪曰∶衄血出于肺，言
肺者，以窍言也。言阳明者，以血海言也。又有洗面而衄，日以为常，犹风行水动，面
热而阳明之火上升，血亦随之也。（《锦囊》）
又曰∶若产后口鼻有黑气及鼻衄者，名胃绝。此证多不可治。遇有此者，急取绯
线一条，并产妇顶心发两条，紧系中指节即止。如衄不止，而头汗者死。
陈实功曰∶鼻中出血，乃肺经火旺，逼血妄行，上从鼻窍而出也。用紫土散敷囟
顶上，内服羚羊清肺汤自止。（《正宗》）
《东医宝鉴》云∶产后气血散乱，入于诸经，不得还元，故口鼻黑色起，及传变
鼻衄，名曰胃绝肺败。此证不可治，宜用犀角地黄汤救之，或急用荆芥散。
胡景周曰∶上下失血过多，气息几微，心慌神困，脉细如丝，或恶寒发热，作渴
烦躁，急用人参一两，大枣十枚去核，水煎服。盖血生于气，故血脱补气，阳生阴长之义也。
一女子因往后一跌，鼻血长流，止后一有所感，其血即出，诸医不效。后一医
以水和白面，包大附子一个在内，火煨熟，去附子，只用面烧存性，为末，每用二钱，
白汤和服。用此永不再发。
《伤寒论》曰∶衄家不可发汗。
张景岳曰∶杂病衄血，责热在里；伤寒衄血，责热在表。
又曰∶阳明病口燥，但欲漱水，不欲咽者，此必衄。盖阳明之脉络于口鼻，今
其漱水不欲咽者，以热在经，而里无热，故当鼻衄也。
又曰∶有动阴血者，又非衄血之谓。论曰∶少阴病但厥无汗，而强发之，必动其
血，未知从何道出，故或从口鼻或从目出者，是名下厥上竭，此阴血也，乃为危证。
澄曰∶书以产后口鼻黑气及见鼻衄，为不可治者，何也？盖五脏之华，皆上注于
面，凡色红赤者，阳热之生气也；青黑者，阴寒之绝气也。况口鼻为阳明多血多气之
部，而见阴寒惨杀之气，则胃中阳和之气
衰败，可知矣。复至鼻衄，则阳亡阴走也。胃绝肺败，阴阳两亡，故不可治。及产后
舌紫黑者，为血先死，不治。盖心主血，少阴气绝，则血不上荫耳。
岐天师说：火气郁结在胸膈以上部位，不能疏散，所以上冲导致吐血、鼻出血。七窍流血的情况，是由于肾阴虚生内热所致。使用六味地黄汤（由熟地黄、山茱萸、山药、泽泻、牡丹皮、茯苓组成的方剂）加入麦冬、五味子、骨碎补来治疗。（出自《秘录》）
冯鲁瞻说：鼻出血，或者是心、肺或胃中蕴积的热邪过于极盛，逼迫血液妄行，向上侵犯清阳之道而导致鼻出血。鼻气与脑相通，血液上溢至脑部，所以从鼻孔流出，称为鼻衄。如果是由于风、寒、暑、湿等外邪，流传于经络，涌泄清道而导致的，都属于外因；长期愤怒伤肝，长期忧愁伤肺，思虑过度伤脾，意志消沉伤肾，突然大喜伤心，这些都能动血并随气上溢而导致出血的，都属于内因；饮食过多，食用烤炙辛辣食物，或者坠车跌扑损伤而导致的，都属于不内外因。《原病式》说：鼻衄，是阳热郁结在足阳明经。丹溪说：鼻血出于肺，说是肺，是从孔窍的角度而言；说是阳明，是从血海的角度而言。还有洗脸时发生鼻出血，每天习以为常，就像风吹水动一样，面部发热且阳明之火上升，血液也随之上溢。（出自《锦囊》）
又说：如果在产后口鼻出现黑气并且伴有鼻出血的，称为“胃绝”。这种证候大多难以治愈。遇到这种情况，紧急取一根红线，以及产妇头顶心处的头发两束，紧紧系在中指关节处即可止血。如果鼻出血不止，且头部出汗的，预后不良，主死。
陈实功说：鼻子出血，是肺经火旺，逼迫血液妄行，向上从鼻窍流出。用紫土散敷在囟门顶上，内服羚羊清肺汤（由羚羊角、黄芩、桑白皮、知母、桔梗、甘草、石膏、生地、麦冬、地骨皮组成的方剂）自然能止住。（出自《正宗》）
《东医宝鉴》说：产后气血散乱，流入各条经脉，不能恢复元气，所以口鼻出现黑色，进而传变为鼻衄，称为“胃绝肺败”。这种证候不可治愈，宜用犀角地黄汤（由犀角、生地黄、芍药、牡丹皮组成的方剂）抢救，或者紧急使用荆芥散。
胡景周说：上下失血过多，气息微弱，心慌神疲，脉象细如丝线，或者恶寒发热，口渴烦躁，紧急用人参一两，大枣十枚去核，加水煎服。因为血生于气，所以血脱时需要补气，这是阳气生发则阴血增长的道理。
有一个女子因为向后跌倒，鼻血流个不停，止血后一旦有所触动，血就再次流出，众医治疗无效。后来一位医生用水调和白面，包入一个大附子，用火煨熟，去掉附子，只将面烧至存性，研为粉末，每次服用二钱，用温水送服。使用此法后永远不再复发。
《伤寒论》说：经常鼻出血的人（衄家）不可使用发汗法。
张景岳说：杂病中的鼻出血，责任在于里有热；伤寒中的鼻出血，责任在于表有热。
又说：阳明病出现口干舌燥，只想含水漱口而不想咽下的，这必定会发生鼻衄。因为阳明的经脉联络口鼻，现在患者只想漱口不想吞咽，是因为热在经脉之中，而脏腑内部没有热，所以应当发生鼻衄。
又说：有扰动阴血的，这并不是通常所说的鼻衄。医论说：少阴病只见四肢厥冷而无汗，如果强行发汗，必定扰动其血，不知道会从哪个通道溢出，所以有的从口鼻出，有的从眼睛出的，这叫作“下厥上竭”，这是阴血受损，属于危重证候。
我说：书中认为产后口鼻出现黑气及见鼻衄是不可治愈的，为什么呢？因为五脏的精气华彩，都上注于面部，凡是颜色红赤的，是阳热生发的表现；青黑色的，是阴寒绝灭的表现。况且口鼻是阳明经多血多气的部位，如果出现阴寒肃杀之气，那么胃中阳和之气衰败，就可以知道了。再加上鼻衄，就是阳气亡失、阴血走泄。胃绝肺败，阴阳两亡，所以不可治愈。至于产后舌头呈现紫黑色的，说明血先已死亡，无法治愈。因为心主血脉，少阴气绝，则血不能上荣滋养耳窍及面部。
Master Qi stated: When fire qi stagnates and surges in the upper jiao (upper burner), failing to disperse, it rushes upward causing hematemesis (vomiting blood) and epistaxis (nosebleed). Bleeding from the seven orifices is due to kidney yin deficiency generating internal heat. It should be treated with Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) added with Maidong (Ophiopogon Root), Wuweizi (Schisandra Fruit), and Gusuibu (Drynaria Rhizome). (From *Mi Lu*)
Feng Luzhan stated: Epistaxis may result from excessive heat accumulation in the heart, lungs, or stomach, forcing blood to move recklessly and invading the clear pathways upwards. The nose connects to the brain; when blood overflows into the brain, it exits through the nose, termed "Bi Nu" (Epistaxis). If caused by wind, cold, summerheat, or dampness circulating through the meridians and disrupting the clear pathways, these are external causes. If caused by chronic anger injuring the liver, chronic sorrow injuring the lungs, excessive worry injuring the spleen, loss of will injuring the kidneys, or sudden joy injuring the heart—thereby moving blood to overflow with qi—these are internal causes. If caused by overeating, consuming roasted/spicy/hot foods, or trauma from falls/crashes, these are neither purely internal nor external causes. *Yuan Bing Shi* states: Epistaxis results from yang heat stagnating in the Foot-Yangming Meridian. Danxi stated: Blood comes from the Lungs; referring to the Lung is from the perspective of orifices. Referring to Yangming is from the perspective of the Sea of Blood. There are cases of epistaxis occurring while washing the face, becoming a daily habit, akin to wind stirring water; with facial heat and rising Yangming fire, blood follows suit. (From *Jin Nang*)
He further stated: If black qi appears around the mouth and nose accompanied by epistaxis postpartum, it is called "Stomach Exhaustion." This condition is mostly incurable. In such cases, urgently take a red thread and two strands of hair from the vertex of the mother's head, tie them tightly around the middle joint of the middle finger to stop bleeding. If epistaxis persists accompanied by sweating on the head, death ensues.
Chen Shigong stated: Nosebleed is due to flourishing fire in the Lung Meridian forcing blood to move recklessly and exit via the nasal orifice. Apply Zitusan (Purple Earth Powder) to the fontanelle top, and internally administer Lingyang Qingfei Tang (Antelope Horn Clearing Lung Decoction) to stop it naturally. (From *Zheng Zong*)
*Dongui Bogam* states: Postpartum, qi and blood become chaotic, entering various meridians without returning to their origin, causing black discoloration at the mouth and nose, progressing to epistaxis, termed "Stomach Exhaustion and Lung Failure." This condition is incurable; one should use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) for rescue, or urgently apply Jingjie San.
Hu Jingzhou stated: With excessive bleeding from above and below, breath becomes faint, palpitations occur, spirit is fatigued, pulse is fine as a silk thread, possibly with aversion to cold and fever, thirst, and irritability. Urgently decoct 1 liang of Renshen (Ginseng) and 10 Jujubes (pitted) in water and administer. Since blood is generated by qi, replenishing qi upon blood loss follows the principle that when yang generates, yin grows.
A woman fell backward, causing continuous nosebleed. After stopping, any slight stimulus triggered bleeding again; various physicians failed. Later, a physician mixed white flour with water, wrapped a large Fuzi (Prepared Aconite Root) inside, baked it until cooked, removed the Fuzi, and only used the flour charred to retain its nature, powdered. Each dose was 2 qian, taken with warm water. This method prevented recurrence permanently.
*Shanghan Lun* states: Those prone to epistaxis (Nu Jia) must not undergo diaphoresis (sweating therapy).
Zhang Jingyue stated: For miscellaneous diseases involving epistaxis, the responsibility lies in interior heat; for Shanghan (cold damage) involving epistaxis, the responsibility lies in exterior heat.
He further stated: In Yangming disease, if there is dry mouth but only desire to rinse the mouth without swallowing, epistaxis is certain. Because the Yangming meridian connects to the mouth and nose, the desire to rinse but not swallow indicates heat in the channel but no heat in the interior, thus epistaxis will occur.
He further stated: There is disturbance of yin blood, which is distinct from ordinary epistaxis. The treatise states: In Shaoyin disease, if there is only cold extremities without sweat, and forced diaphoresis is applied, it will surely disturb the blood. Unknown from which pathway it exits, it may come out from the mouth/nose or eyes; this is termed "Lower Jue and Upper Exhaustion," involving yin blood, representing a critical condition.
I state: Why does the book consider postpartum black qi at the mouth/nose and epistaxis as incurable? The splendor of the five zang organs all ascends to the face. Redness indicates the vital qi of yang heat; cyan/black indicates the dying qi of yin cold. Moreover, the mouth and nose are areas where the Yangming Meridian has abundant blood and qi. The appearance of yin cold and desolate qi indicates the decline of the harmonious yang qi in the stomach. Coupled with epistaxis, this signifies the loss of yang and leakage of yin. Stomach exhaustion and lung failure mean both yin and yang are exhausted, hence incurable. Regarding purple-black tongue postpartum, it indicates blood death first, which is incurable. Since the Heart governs blood, when Shaoyin qi exhausts, blood cannot nourish upwards.