枳壳、桔梗以开肺，咳嗽即止，但日间劳动则复发。病者问善后之图，黄曰∶是病诸经虚损，先宜息气凝神，
节劳欲以立其基，次宜节饮食以保其脾，终宜调寒温以补其肺，然后随病症之虚实寒热，用药饵以调其偏。大
约症见肝燥咳红，脉见左关独数，非用首乌、阿胶不能润；肝气上逆，非用龙骨不能镇；肺气随湿上涌，非用
苡仁不能泻；肝气燥而不收，非用牛膝、车前不能使气归阴，下朝于左；火衰气浮，非用附子、五味不能使阳
阴下行于右。至或脾湿痰涌，不思饮食，则当重陈皮、浓朴以疏之，或加半夏以降之。肺有感冒而见胸痹，微
用枳壳、桔梗以开之，盖重用则恐其肾气上浮也。若更见哮喘，则又当用麻黄、杏仁，使血归经而不上溢。但
总不宜过润过清致伤脾胃，俾流为呕吐泄泻之症。又不宜碍肝碍气，使血随气涌，而致不可救也。
窦材治一人患衄血，日夜有数升，诸药不效，窦为针关元穴，入二寸，留二刻。呼问病患曰∶针下觉热否？
曰∶热矣。乃令吸气出针，其血立止。
一法，治鼻衄与脑衄神方∶用赤金打成一戒指，带左手无名指上，如发作时，将戒指捏紧箍住，则衄止矣。
（《医林指月》。）
赵汝隆治一官病齿衄，日流血数升，诸医束手，隆摘苦蒿令细嚼立愈。（《云南通志》。）
李嗣立治赵季修，赴龙泉知县，单骑速行，时值盛暑，未几患鼻衄，日出血升许，李教服藕汁、生地黄膏
方。赵云∶某往年因赴铨曹听选，省前急走数回，心绪不宁，感热骤得鼻衄之症，寻扣临安一名医，服药遂痊，
谢以五万钱。临别时，医再三嘱云∶恐后时疾作，万勿轻信医者，服生地黄、藕汁之药，冰冷脾胃，无服可生。
半月易医无效。李乃就此方，隐其药味俾服之，三日疾愈。赵问曰∶此药如是灵验，得非与临安医之药同乎？
李笑曰∶即前所献之方也。赵叹曰∶前医设为谲谋，几误性命，微君调治，吾其鬼矣。（《续医说》。）
龚子才治一人，年近五旬，素禀弱怯，患衄血，长流五昼夜，百药不止，脉洪数无力。此去血过多，虚损
之极，以八物汤加熟附子等分，又加真茜草五钱，水煎频服，连进二剂，其血遂止。又根据前方去茜草，调理十数剂而愈。
李时珍治一妇人，衄血一昼夜不止，诸治不效，令捣蒜敷足心，实时遂愈。
汪石山治陈锐，面黑形瘦，年三十余，患鼻衄，发热恶寒，消谷善饥，疲倦，或自汗呕血。汪诊之，脉细
且数，约有六至，曰∶丹溪论瘦黑者，鼻衄者，脉数者，参、 皆所当禁，固也，然不可执为定论。《脉经》
云∶数脉所主，其邪为热，其症为虚。宜人参三钱，生甘草、陈皮、黄柏、白术、归身、生地、山栀、生白芍，
递为佐使，服之果安。
张路玉治朱圣卿，鼻衄如崩，三日不止，较往时所发最剧。服犀角地黄汤，柏叶、石膏、丹、栀之属转盛。
第四日邀诊，脉迫急如循刀刃，此阴火上乘，载血于上，得寒凉之药，伤其胃中清阳之气，所以脉变弦紧。与
生料六味加五味子作汤，另加肉桂三钱，飞罗面糊，分三丸，用煎药调下。甫入咽，其血顿止。少顷，口鼻去
血块数枚，全愈。自此数年之后，永不再发。
杨乘六治施鸣玉，衄血如注，三日半不止，凡止衄方法，并无一应，气息欲绝。脉之，虚大而缓，面色萎
黄，舌嫩黄而胖，知其四肢疲软，浑身倦怠，懒于言语，动辄嗜卧者，匪朝伊芳夕也。询之果然。而衄起之故，
缘自钟溪归家，一路逆风，操舟尽力，不及达岸即衄，至今第四日矣。曰∶病患中气大亏，本不足以摄血，复
因劳力太甚，重伤胃络。胃络，阳络也，阳络伤则血出上窍，胃脉络鼻，所以血出鼻孔也。乃用补中益气汤加
炒黑干姜，一剂而衄止。去干姜，加白芍、五味子，数剂而从前诸症渐除。
吕东庄治一张姓者，好学深思士也，年十八，冬杪得齿衄，及手足心热，恍惚不宁，合目愈甚，盗汗胸前
出如油，间或梦遗，或不梦而遗。伊芳叔录脉症求方，吕曰∶脉不敢凭，据所示症，乃三焦胞络火游行也。试用
后方∶连翘、黄芩、麦冬、生地、丹皮、丹参、茯苓、石斛、滑石、辰砂、甘草、白豆蔻等，二剂而愈。及明
年，用功急迫，至夏其症复作。或云∶皆不足症，用温补肾经及涩精等剂，服之日剧。又进温补肾经丸料斤许
愈剧，至不能立，立则足底刺痛。或谓为虐症矣。乃求诊，吕曰∶体虽 羸，而面色憔悴之中，精神犹在。问
所服药，出示方。曰∶生药铺矣，何得不凶？且少年朴实人，何必用温补？曰∶手足心热奈何？曰∶劳心之人，
大抵如是。曰∶梦泄奈何？曰∶梦泄人人各殊，此乃心肾不交所致，与夫盗汗恍惚症，皆三焦胞络之火行游而
然。药宜清凉，遂仍前方去滑石、豆仁、辰砂，加升麻五钱，灯草十余茎，又用麦冬、生地、滑石、石斛、茯
苓、白芍、丹参、神曲、辰砂作丸，守服而愈。（真通人之论，可为执方治病者作顶门针。）
王执中母氏，忽患鼻衄，急取药服，凡昔与人服有甚效者，皆不效。因阅《集效方》云∶口鼻出血不止，
名脑衄，灸上星五十壮。尚疑头上不宜多灸，只灸七壮而止。次日复作，再灸十一灸而愈。有人鼻常出
脓血，执中教灸囟会亦愈。则知囟会、上星皆治鼻衄之上法也，医者不可不知。（《资生经》。）
一妇人郁结而患前症，用加味归脾汤，其血渐止，饮食渐进。用加味逍遥散，元气渐复，寒热渐止。后因
怒仍衄，寒热往来，用小柴胡汤加芎、归、丹皮而愈。
一妇人因劳衄血，服凉药之剂，更致便血。或以血下为顺，仍用治血。薛曰∶此因脾气下陷而从，当升补
脾气，庶使血归其经。不信，果血益甚，乃朝用补中益气汤，夕用加味归脾汤而愈。此症用寒凉止血，不补脾
肺而死者多矣。
马元仪治陆太史母，患衄血不已，两脉浮大而数，重按无神，面赤烦躁，口干发热，心悸恍惚。群作阳明
火热阴虚内动之症治，旬日转盛。此因忧思悒郁，致伤阳气，阳气既伤，阴血无主，上逆则衄，下夺则便。当
作中虚挟寒治，用附子理中汤，内益人参至三两，众阻之。明日复诊，脉象散失，较之浮数为更天渊。乃谓众
曰∶症既非实，以补养为主。然气血俱要，而补气则在补血之先，阴阳并需，养阳在滋阴之后，是以非助火而
益水，不如是不得其平也。令进前方，不得已减去人参二两，服至第九日，衄血便血俱止。后以归脾汤调理而愈。
谯知阁熙载，壬子年病衄血，用灯草数枚，以百沸汤煮，逐枚漉出，乘热安顶上，冷即易之，遂愈。（《百乙
方》。此即灸上星、囟会之意。）
苏滔光云∶其母夫人，常衄血盈盆，百药不效，用好麻油纸捻 鼻中，顷之打嚏即愈。此方甚奇。（同上。）
杨子县吏陈某，当腊月鼻衄至正月，凡十三日始定。其脉实而数，治当下导，与桃仁承气汤去积瘀，次服
既济汤而愈。盖此人过食煎炙，饮醇酒，皆积热所致也。（《白云集》。）
《医旨绪余》曰∶有侄女十岁，因伤齿动摇，以苎麻摘之，血出不止，一日夜积十一盆，用末药止之，少
顷，复从口出。诊其脉，皆洪大有力。以三制大黄末二钱，枳壳汤少加童便调下，去黑粪数枚，其血顿止。（未入选。）
一男子每齿根出血盈盆，一月一发，百药不效。知其饮酒，投前药一服而安，是知此疾多阳明热甚所致。
缘冲任二脉，皆附阳明，而阳明一经气血俱多，故一发如潮涌，急则治其标也。投以釜底抽薪之法，应手而愈。
窦汉卿曰∶一人齿根边，津津血不止，苦竹茹四两，醋煮含漱，吐之而愈。
一人舌上忽出血，有穴如簪孔大，赤小豆一升杵碎，水三碗，和捣取汁，每服一盏，不拘时服，用槐花末
糁上而愈。（《良方》但用槐花末糁，名曰舌衄。）
沈明生治给谏姜如农长君勉中，患衄不已，去血盈斗，一月后衄止，复患囊痈，六脉如丝，精神困惫，始
犹健饮，渐至 粥不入。先后医友但云虚而当补，莫测病根所在，于是，参、 不效，桂、附随之，愈补而形
愈虚，愈温而气愈弱。最后沈至，时居冬至矣，据脉与症，亦谓当温无疑，独念桂、附太热，姑用补中益气，
尝之毫无进退。忽悟吾亦踵其误矣，夫食虽不入，而大便秘结，症类虚寒，而口渴喜饮。盖衄血之来，本因邪
火上炽，乃遽用血脱益气之法，衄虽止而热不下，发为囊痈。既溃，疡科又泥寒药不能收口之戒，亦务温补。
周旋左右者，目击病患 羸，又闻众口称虚，强令进食，以久卧床蓐之体，恣啖肥甘，不为运化，是以药
食并壅，内热外寒，此病中之病，初非衄与痈所致，宜其愈补而愈不灵也。先哲云∶脉浮者谷不化。又云∶大
实有羸状，误补益疾，其斯之谓与。遂力主清润疏解，以硝、黄为前茅，而大便立通，以芩、芍为后劲，而饮
食渐进，如丝之脉，一钱添长，久冷之躯，一阳来复，不惟衄血不作，且令疮口易收。孰谓从脉可以舍症，不思
而得病情哉。向非翻然易辙，转败为功，人惟知补之不效而已，又安知效之不在补也？此事难知如此。
吴桥治文学于学易，举孝廉，病衄，其衄 然，七昼夜不止，甚则急如涌泉，众医济以寒凉不效，急以
大承气汤下之，亦不行。桥曰∶孝廉故以酒豪，积热在胃，投以石膏半剂愈之。众医请曰∶积热宜寒，则吾剂
寒之者至矣，公何独得之石膏？桥曰∶治病必须合经，病在是经，乃宜是药，石膏则阳明胃经药也，安得以杂
投取效哉？（《太函集》。）
聂久吾治叶氏子，年十五，患衄血，治不效。询其症，自九岁起，其初每年不过五七次，每次流数茶匙。
至十一岁，则每月一次，每次流半酒盏。十二岁，则两月三次，每次流一酒杯。十三岁，则每月两次，流半茶
钟。十四岁，则每月或两次，流大半碗。今十五岁，则八九日一次，每次流盈碗矣。瘦削骨立，夜间身热，危
困极矣。诸医所用，皆清热凉血之剂。十剂衄减四五，三十剂减七八，四十剂则两月一次，每次不过数点，五
十剂全安，而肌肉丰矣。后或有时少作，以前方一剂立愈。地、芍、芎、归、二冬、知、柏、芩、连、首乌、
花粉、丹皮、香附、甘草、龙眼肉，水煮，调好发灰五分，食远服。（聂方轻极，每品不过五七分。）
魏玉横曰∶杨氏子年二十余岁，病鼻衄如涌，有令以黑山栀末吹者，有令以湿草纸熨脑门者，有令以热酒
浸脚者，憧憧扰扰，一日夜不得止。令觅有乳妇人，以乳对鼻孔挤乳，乳入必止。止后，候鼻血干燥，宜 去
之，如法立愈。
郭氏儿七岁，病咳嗽夜热，时时鼻衄，衄之盛，常在半夜。儿医端与疏散凉解，食减则又与香燥消运，日
益就惫。延诊，见其面目略肿，年寿环口隐起青气，按其乳旁期门、虚里之间，突突跳筑，谓此禀赋薄弱，顽
耍过劳，伤其肝肾，木上侮金，故其衄多出于左鼻孔。乃内伤，非外感也，与养青汤数帖少减。再加熟地、地
骨皮、蒌仁，四帖全愈。
枳壳、桔梗用来宣通肺气，咳嗽随即停止，但白天劳累就会复发。病人询问后续调理方案，黄氏说：这个病是各经虚损所致，首先应当平息气息、凝聚精神，节制劳力和欲望以奠定身体基础；其次应当节制饮食以保护脾胃；最后应当调节寒温以补益肺气，然后根据病症的虚实寒热，用药饵来纠正身体的偏颇。大抵症状表现为肝燥咳血，脉象左关独数，非用何首乌、阿胶不能滋润；肝气上逆，非用龙骨不能镇潜；肺气随湿邪上涌，非用薏苡仁不能渗利；肝气燥而不能收敛，非用牛膝、车前子不能引导气机归于阴分，下行至左侧；火衰而气浮，非用附子、五味子不能使阳气与阴液下行于右侧。至于如果脾湿痰涌，不思饮食，则应当重用陈皮、厚朴来疏理，或者加入半夏以降逆。肺有外感而出现胸痹，轻微使用枳壳、桔梗来开宣，因为重用恐怕会导致肾气上浮。如果更见哮喘，则又当用麻黄、杏仁，使血液回归经脉而不向上溢出。但是总不宜过度滋润或过度清泻以致损伤脾胃，从而演变为呕吐泄泻的症状。也不宜阻碍肝气、阻滞气机，使血液随气机上涌，而导致不可救治。
窦材治疗一个人患鼻衄，日夜出血数升，各种药物无效，窦材针刺关元穴，进针二寸，留针两刻钟。问病患说：针下有感觉发热吗？回答说：热了。于是令患者吸气时出针，其血立即停止。
另一种方法，治疗鼻衄和脑衄的神方：用赤金打成一枚戒指，戴在左手无名指上，如发作时，将戒指捏紧箍住，则衄血即止。（《医林指月》。）
赵汝隆治疗一位官员患齿衄，每天流血数升，众医生束手无策，赵汝隆摘取苦蒿让患者细细咀嚼，立刻痊愈。（《云南通志》。）
李嗣立治疗赵季修，赴任龙泉知县，单骑疾行，当时正值盛夏，不久后患鼻衄，每日出血约一升，李嗣立教导服用藕汁、生地黄膏方。赵某说：我往年因赴吏部听选，在省城前急走数次，心绪不宁，感受热邪突然患上鼻衄症，随即寻访临安一名名医，服药后痊愈，赠送五万钱酬谢。临别时，医生再三嘱咐说：恐怕日后时疫发作，千万不要轻信医者，服用生地黄、藕汁等药会冰冷脾胃，不服这些药才能生存。半个月后换医生无效。李嗣立便采用此方，隐瞒药味让患者服用，三天疾病痊愈。赵某问：这药如此灵验，难道不是和临安医生的药一样吗？李嗣立笑着说：就是之前所献的方子。赵某感叹道：前医设下诡计，几乎误我性命，若非先生调治，我早已成为鬼魂了。（《续医说》。）
龚子才治疗一个人，年近五十，平素体质弱怯，患衄血，长流五昼夜，百药不止，脉象洪数无力。这是失血过多，虚损到了极点，用八物汤加熟附子等量，又加真茜草五钱，水煎频服，连进两剂，其血遂止。又根据前方去掉茜草，调理十余剂而愈。
李时珍治疗一个妇人，衄血一昼夜不止，各种治疗无效，令捣蒜敷贴足心，实时痊愈。
汪石山治疗陈锐，面色黑形体瘦，三十多岁，患鼻衄，发热恶寒，消谷善饥，疲倦，有时自汗呕血。汪诊察其脉，脉细且数，约有六至，说：丹溪论述面色黑者、鼻衄者、脉数者，人参、黄芪都是应当禁忌的，固然正确，然而不可固执为定论。《脉经》说：数脉所主，邪气为热，症状为虚。宜用人参三钱，生甘草、陈皮、黄柏、白术、当归身、生地、山栀、生白芍，依次作为佐使，服用后果然安宁。
张路玉治疗朱圣卿，鼻衄如崩，三日不止，比往年发作最剧烈。服用犀角地黄汤，以及柏叶、石膏、丹皮、栀子之类，病情反而加重。第四日邀请诊治，脉迫急如循刀刃，这是阴火上乘，载血上行，得到寒凉药物，损伤了胃中清阳之气，所以脉变弦紧。给予生料六味地黄丸加五味子作汤，另加肉桂三钱，飞罗面糊，分成三丸，用煎药送下。刚咽下，其血顿时停止。片刻后，口鼻排出血块数枚，完全痊愈。从此数年之后，永不再发。
杨乘六治疗施鸣玉，衄血如注，三日半不止，凡是止衄的方法，没有一应验的，气息欲绝。诊其脉，虚大而缓，面色萎黄，舌嫩黄而胖，知道其四肢疲软，浑身倦怠，懒于言语，动辄嗜卧，不过是早晚的事。询问果然如此。而衄血起因，是因为从钟溪回家，一路逆风，划船尽力，来不及到达岸边即发生衄血，至今第四天了。说：病患中气大亏，本来不足以摄血，又因劳力太甚，重伤胃络。胃络，属于阳络，阳络伤则血出上窍，胃脉络鼻，所以血出鼻孔。于是用补中益气汤加炒黑干姜，一剂而衄止。去掉干姜，加白芍、五味子，数剂而从前诸症渐除。
吕东庄治疗一个姓张的人，是好学深思的读书人，十八岁，冬末得齿衄，以及手足心热，恍惚不宁，合目更甚，盗汗胸前出如油，间或梦遗，或不梦而遗。他的叔叔记录脉症求方，吕说：脉不敢凭信，据所示症状，是三焦胞络之火游行所致。试用后方：连翘、黄芩、麦冬、生地、丹皮、丹参、茯苓、石斛、滑石、辰砂、甘草、白豆蔻等，两剂而愈。及明年，用功急迫，到夏天其症复发。有人说：都是不足之症，用温补肾经及涩精等剂，服用后日渐加剧。又进温补肾经丸料一斤多，更加剧，以至不能站立，站立则足底刺痛。有人说为疟疾了。于是求诊，吕说：体虽羸弱，而面色憔悴之中，精神犹在。问所服药，出示方子。说：生药铺的药，怎么会不凶险？况且少年朴实人，何必用温补？说：手足心热怎么办？说：劳心之人，大抵如此。说：梦泄怎么办？说：梦泄人人各殊，这是心肾不交所致，与夫盗汗恍惚症，都是三焦胞络之火游行所致。药宜清凉，于是仍用前方去掉滑石、豆仁、辰砂，加升麻五钱，灯草十余茎，又用麦冬、生地、滑石、石斛、茯苓、白芍、丹参、神曲、辰砂作丸，守服而愈。（真是通达之人的言论，可为执方治病者作顶门针。）
王执中的母亲，忽然患鼻衄，急忙取药服用，凡是以前给人服用很有效的，都不见效。因而阅读《集效方》说：口鼻出血不止，名叫脑衄，灸上星穴五十壮。还怀疑头上不宜多灸，只灸七壮而止。次日复发，再灸十一壮而愈。有人鼻常出脓血，王执中教灸囟会穴也痊愈。则知囟会、上星都是治疗鼻衄的上法，医者不可不知。（《资生经》。）
一个妇人因郁结而患前症，用加味归脾汤，其血渐止，饮食渐进。用加味逍遥散，元气渐复，寒热渐止。后因怒仍衄，寒热往来，用小柴胡汤加川芎、当归、丹皮而愈。
一个妇人因劳衄血，服凉药之剂，更致便血。有人认为血下行为顺，仍用治血之法。薛己说：这是因为脾气下陷而从，应当升补脾气，庶使血归其经。不信，果然血更严重，于是早晨用补中益气汤，晚上用加味归脾汤而愈。此症用寒凉止血，不补脾肺而死者很多了。
马元仪治疗陆太史之母，患衄血不已，两脉浮大而数，重按无神，面赤烦躁，口干发热，心悸恍惚。众人当作阳明火热阴虚内动之症治疗，旬日病情转盛。这是因为忧思悒郁，导致损伤阳气，阳气既伤，阴血无主，上逆则衄，下夺则便。应当当作中虚挟寒治疗，用附子理中汤，内益人参至三两，众人阻止。明日复诊，脉象散失，较之浮数为更天渊之别。于是对众人说：症既非实，以补养为主。然而气血俱要，而补气则在补血之先，阴阳并需，养阳在滋阴之后，因此如果不是助火而益水，不如是这样不得其平也。令进前方，不得已减去人参二两，服至第九日，衄血便血俱止。后以归脾汤调理而愈。
谯知阁熙载，壬子年病衄血，用灯草数枚，以百沸汤煮，逐枚漉出，乘热安顶上，冷即易之，遂愈。（《百乙方》。此即灸上星、囟会之意。）
苏滔光说：其母夫人，常衄血盈盆，百药不效，用好麻油纸捻塞入鼻中，顷刻打喷嚏即愈。此方甚奇。（同上。）
杨子县吏陈某，当腊月鼻衄至正月，凡十三日始定。其脉实而数，治当下导，给予桃仁承气汤去积瘀，次服既济汤而愈。盖此人过食煎炙，饮醇酒，皆积热所致也。（《白云集》。）
《医旨绪余》说：有个侄女十岁，因伤齿动摇，用苎麻摘之，血出不止，一日夜积十一盆，用末药止之，少顷，复从口出。诊其脉，皆洪大有力。以三制大黄末二钱，枳壳汤少加童便调下，去黑粪数枚，其血顿止。（未入选。）
一个男子每齿根出血盈盆，一月一发，百药不效。知道他饮酒，投前药一服而安，是知此疾多阳明热甚所致。缘冲任二脉，皆附阳明，而阳明一经气血俱多，故一发如潮涌，急则治其标也。投以釜底抽薪之法，应手而愈。
窦汉卿说：一人齿根边，津津血不止，苦竹茹四两，醋煮含漱，吐之而愈。
一人舌上忽出血，有穴如簪孔大，赤小豆一升杵碎，水三碗，和捣取汁，每服一盏，不拘时服，用槐花末糁上而愈。（《良方》但用槐花末糁，名曰舌衄。）
沈明生治疗给谏姜如农长子姜勉中，患衄不已，去血盈斗，一月后衄止，复患囊痈，六脉如丝，精神困惫，开始还能健饮，渐渐至粥不入。先后医友只说虚而当补，莫测病根所在，于是，人参、黄芪不效，肉桂、附子随之，愈补而形愈虚，愈温而气愈弱。最后沈明生至，时居冬至矣，据脉与症，亦谓当温无疑，独念肉桂、附子太热，姑用补中益气，尝之毫无进退。忽悟我也跟随其错误了，食物虽不入，而大便秘结，症类虚寒，而口渴喜饮。盖衄血之来，本因邪火上炽，乃遽用血脱益气之法，衄虽止而热不下，发为囊痈。既溃，疡科又泥于寒药不能收口之戒，亦务温补。周旋左右者，目击病患羸弱，又闻众口称虚，强令进食，以久卧床蓐之体，恣啖肥甘，不为运化，是以药食并壅，内热外寒，此病中之病，初非衄与痈所致，宜其愈补而愈不灵也。先哲说：脉浮者谷不化。又说：大实有羸状，误补益疾，其斯之谓与。遂力主清润疏解，以硝、黄为前茅，而大便立通，以芩、芍为后劲，而饮食渐进，如丝之脉，一钱添长，久冷之躯，一阳来复，不惟衄血不作，且令疮口易收。谁说从脉可以舍症，不思而得病情哉。向非翻然易辙，转败为功，人惟知补之不效而已，又安知效之不在补也？此事难知如此。
吴桥治疗文学于学易，举孝廉，病衄，其衄滔滔，七昼夜不止，甚则急如涌泉，众医济以寒凉不效，急以大承气汤下之，亦不行。吴桥说：孝廉故以酒豪，积热在胃，投以石膏半剂愈之。众医请曰：积热宜寒，则吾剂寒之者至矣，公何独得之石膏？吴桥说：治病必须合经，病在是经，乃宜是药，石膏则阳明胃经药也，安得以杂投取效哉？（《太函集》。）
聂久吾治疗叶氏之子，年十五，患衄血，治不效。询其症，自九岁起，其初每年不过五七次，每次流数茶匙。至十一岁，则每月一次，每次流半酒盏。十二岁，则两月三次，每次流一酒杯。十三岁，则每月两次，流半茶钟。十四岁，则每月或两次，流大半碗。今十五岁，则八九日一次，每次流盈碗矣。瘦削骨立，夜间身热，危困极矣。诸医所用，皆清热凉血之剂。十剂衄减四五，三十剂减七八，四十剂则两月一次，每次不过数点，五十剂全安，而肌肉丰矣。后或有时少作，以前方一剂立愈。地、芍、芎、归、二冬、知、柏、芩、连、首乌、花粉、丹皮、香附、甘草、龙眼肉，水煮，调好发灰五分，食远服。（聂方轻极，每品不过五七分。）
魏玉横说：杨氏之子年二十余岁，病鼻衄如涌，有人令以黑山栀末吹者，有人令以湿草纸熨脑门者，有人令以热酒浸脚者，憧憧扰扰，一日夜不得止。令觅有乳妇人，以乳对鼻孔挤乳，乳入必止。止后，候鼻血干燥，宜去除之，如法立愈。
郭氏儿七岁，病咳嗽夜热，时时鼻衄，衄之盛，常在半夜。儿医端与疏散凉解，食减则又与香燥消运，日益就惫。延诊，见其面目略肿，年寿环口隐起青气，按其乳旁期门、虚里之间，突突跳筑，谓此禀赋薄弱，顽耍过劳，伤其肝肾，木上侮金，故其衄多出于左鼻孔。乃内伤，非外感也，与养青汤数帖少减。再加熟地、地骨皮、蒌仁，四帖全愈。
Zhiqiao (Fructus Aurantii) and Jiegeng (Radix Platycodonis) are used to open the Lung Qi, after which coughing stops immediately; however, it recurs upon daytime exertion. When the patient asked for a follow-up regimen, Huang said: This disease involves deficiency and damage of all meridians. First, one should calm the Qi and concentrate the spirit, moderating labor and desires to establish a foundation. Second, diet must be regulated to protect the Spleen. Finally, cold and warmth should be adjusted to tonify the Lung. Then, based on the excess or deficiency, cold or heat of the symptoms, medicinal herbs should be used to correct the imbalance. Generally, if symptoms show Liver dryness with hemoptysis and the pulse at the left Guan position is exclusively rapid, only Shouwu (Polygoni Multiflori Radix Praeparata) and Ejiao (Colla Corii Asini) can moisten [the Liver]. If Liver Qi rebels upward, only Longgu (Os Draconis et Ossis Fossilia) can anchor it. If Lung Qi surges upward with dampness, only Yiren (Semen Coicis) can drain it. If Liver Qi is dry and fails to consolidate, only Niuxi (Radix Achyranthis Bidentatae) and Cheqianzi (Semen Plantaginis) can guide the Qi back to Yin, descending to the left. If Fire is deficient and Qi floats, only Fuzi (Radix Aconiti Lateralis Preparata) and Wuweizi (Fructus Schisandrae Chinensis) can cause Yang and Yin to descend to the right. Furthermore, if Spleen dampness generates phlegm surging upward and appetite is lost, heavy doses of Chenpi (Pericarpium Citri Reticulatae) and Houpo (Cortex Magnoliae Officinalis) should be used to diffuse, or Banxia (Rhizoma Pinelliae Preparata) added to direct downward. If the Lung has an external contraction presenting as chest bi (obstruction), mild use of Zhiqiao and Jiegeng can open it; heavy use is feared to cause Kidney Qi to float upward. If asthma is also present, Mahuang (Herba Ephedrae) and Xingren (Semen Armeniacae Amarum) should be used to make blood return to the vessels without overflowing upward. However, one must never over-moisten or over-clear, causing damage to the Spleen and Stomach, leading to vomiting and diarrhea. Nor should one obstruct the Liver or Qi, causing blood to surge with Qi, resulting in incurable conditions.
Dou Cai treated a patient suffering from epistaxis, bleeding several sheng day and night, with no effect from various medicines. Dou acupunctured the Guanyuan (CV4) point, inserting two cun deep, and retained the needles for two ke (approx. 30-60 mins). He asked the patient: "Do you feel heat under the needle?" The patient replied: "Yes, it is hot." Dou then instructed the patient to inhale while withdrawing the needle, and the bleeding stopped immediately.
Another method, a divine prescription for treating epistaxis and nasopharyngeal hemorrhage: Forge a ring from pure gold, wear it on the ring finger of the left hand. When an attack occurs, squeeze the ring tightly around the finger, and the bleeding will stop. (From *Yilin Zhiyue*.)
Zhao Rulong treated an official suffering from gingival bleeding, losing several sheng of blood daily. All physicians were helpless. Zhao picked bitter mugwort leaves (Ku Hao), had the patient chew them thoroughly, and the condition was cured immediately. (From *Yunnan Tongzhi*.)
Li Sili treated Zhao Jixiu, who was traveling alone to assume office as Magistrate of Longquan. It was midsummer, and shortly after, he suffered from epistaxis, bleeding about one sheng per day. Li advised taking lotus root juice and Rehmannia paste. Zhao said: "In previous years, when I went to the Ministry of Personnel for selection, I ran hurriedly several times before the provincial gate. My mind was unsettled, and I contracted heat, suddenly developing epistaxis. I sought a famous doctor in Lin'an, took medicine, and recovered. I rewarded him with 50,000 cash. Before parting, the doctor repeatedly warned: 'If seasonal diseases arise later, do not trust doctors easily. Do not take Rehmannia or lotus root juice, as they will chill the Spleen and Stomach. Only by avoiding these can you survive.' Half a month later, changing doctors yielded no effect. Li then used this prescription but concealed the ingredients, administering it to the patient. The illness was cured in three days. Zhao asked: 'This medicine is so effective; is it not the same as the Lin'an doctor's prescription?' Li smiled and said: 'It is exactly the formula previously presented.' Zhao sighed: 'The former doctor devised a deceitful scheme, nearly costing me my life. Had it not been for your treatment, I would have become a ghost.'" (From *Xu Yishuo*.)
Gong Zicai treated a man near fifty years old, whose constitution was inherently weak and timid. He suffered from bleeding, flowing continuously for five days and nights, resisting all medicines. His pulse was large, rapid, and powerless. This was due to excessive blood loss, reaching extreme deficiency. Gong prescribed Babu Tang (Eight-Tonifying Decoction) with equal parts of Shufu Zi (Prepared Aconite Root), plus five qian of genuine Qiancao (Radix Rubiae Cordifoliae), decocted in water and taken frequently. After two doses, the bleeding stopped. Following the same formula minus Qiancao, he administered more than ten doses for regulation, resulting in recovery.
Li Shizhen treated a woman suffering from continuous epistaxis for a day and night, unresponsive to various treatments. He ordered crushed garlic applied to the Yongquan (KI1) point on the sole of the foot, resulting in immediate cure.
Wang Shishan treated Chen Rui, a man in his thirties, dark-complexioned and emaciated, suffering from epistaxis, fever with aversion to cold, rapid digestion with easy hunger, fatigue, spontaneous sweating, and occasional hematemesis. Wang diagnosed a fine and rapid pulse, approximately six beats per breath cycle. He stated: "Danyu argued that for those with dark complexions, epistaxis, and rapid pulses, Ginseng and Astragalus are contraindicated. This is true, yet one cannot adhere rigidly to this as a fixed rule. The *Mai Jing* states: 'Rapid pulses indicate Heat pathogenic factors and Deficiency symptoms.' Therefore, use three qian of Renshen (Radix Ginseng), along with Sheng Gancao (Raw Licorice Root), Chenpi, Huangbai (Cortex Phellodendri), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui Shen (Radix Angelicae Sinensis Root Body), Shengdi Huang (Rehmanniae Radix), Zhizi (Fructus Gardeniae), and Sheng Baishao (Raw Peony Root), arranged as assistants and envoys. The patient recovered after taking it."
Zhang Luyu treated Zhu Shengqing, who suffered from severe epistaxis like a burst vessel, lasting three days, worse than previous episodes. He had taken Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), as well as Cebai Ye (Cacumen Biota Orientalis), Shigao (Gypsum Fibrosum), Danpi (Cortex Moutan), and Zhizi, but the condition worsened. On the fourth day, Zhang examined him and found the pulse urgent and sharp like touching a blade. This indicated Yin Fire ascending, carrying blood upward. The cold-natured medicines had damaged the clear Yang Qi in the Stomach, causing the pulse to become wiry and tight. Zhang prescribed Shengli Liuwei Wan (Six-Ingredient Pill with Added Ingredients) with Wuweizi (Schisandra Fruit) made into a decoction, plus three qian of Rougui (Cortex Cinnamomi), formed into three pills with refined wheat flour paste, taken with the decoction. Upon swallowing, the bleeding stopped instantly. Shortly after, several blood clots were expelled from the mouth and nose, and full recovery ensued. Thereafter, for several years, the condition never recurred.
Yang Chengliu treated Shi Mingyu, who suffered from gushing epistaxis for three and a half days. None of the usual methods for stopping epistaxis worked; his breath was nearly exhausted. His pulse was empty, large, and slow. His complexion was sallow, tongue tender yellow and swollen. Yang knew that his limbs were flaccid, body fatigued, reluctance to speak, and tendency to sleep were imminent signs of death. Inquiry confirmed this. The cause of the epistaxis was returning home from Zhongxi against the wind, rowing hard, and bleeding before reaching shore. It was now the fourth day. Yang said: "The patient's Middle Qi is severely depleted, insufficient to control blood. Additionally, excessive physical labor severely injured the Stomach collaterals. The Stomach collateral belongs to the Yang collaterals; injury to Yang collaterals causes bleeding from upper orifices. The Stomach meridian connects to the nose, hence nasal bleeding." He prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with stir-fried black Ganjiang (Dried Ginger), stopping the epistaxis in one dose. Removing Ganjiang and adding Baishao and Wuweizi, several doses eliminated previous symptoms.
Lv Dongzhuang treated a scholar named Zhang, eighteen years old, who developed gingival bleeding at the end of winter, along with heat in the palms and soles, mental restlessness worsening with closed eyes, nocturnal sweating on the chest like oil, occasional seminal emission during dreams, and emission without dreams. His uncle recorded the pulse and symptoms seeking a prescription. Lv said: "I dare not rely solely on the pulse. Based on the symptoms, this is Fire wandering in the Sanjiao and Pericardium collaterals." He tried the following prescription: Lianqiao (Forsythiae Fructus), Huangqin (Scutellariae Radix), Maidong (Ophiopogonis Tuber), Shengdi Huang, Danpi, Danshen (Salviae Miltiorrhizae Radix), Fuling (Poria), Shihu (Dendrobii Caulis), Huashi (Hualshi), Zhusha (Cinnabar), Gancao, and Baiddoukou (Amomi Fructus Rotundus). Two doses resulted in cure. The following year, due to intense study, the symptoms recurred in summer. Some said it was a deficiency syndrome and prescribed warming tonics for the Kidney and astringents for essence, but the condition worsened daily. Another jin (approx. 500g) of Kidney-warming pills made it worse, to the point of inability to stand, with stabbing pain in the soles upon standing. Others suspected malaria. Seeking consultation, Lv said: "Though the body is emaciated, spirit remains amidst the haggard face." Asking about the medicines taken and seeing the prescriptions, Lv said: "Medicine shop drugs, how could they not be harsh? Moreover, why use warming tonics for a simple young man?" Asked about heat in palms/soles, Lv said: "Those who labor with their minds usually have this." Asked about dream emissions, Lv said: "Dream emissions vary among individuals; this is caused by failure of Heart-Kidney interaction. Along with nocturnal sweating and mental confusion, it is due to Fire wandering in the Sanjiao and Pericardium collaterals. Medicines should be cooling." Thus, he kept the previous formula, removing Huashi, Baiddoukou, and Zhusha, adding Shengma (Cimicifugae Rhizoma) five qian and Dengcao (Junci Medulla) over ten stems. He also prepared pills with Maidong, Shengdi Huang, Huashi, Shihu, Fuling, Baishao, Danshen, Shenqu, and Zhusha, taken continuously until cured. (A truly enlightened opinion, serving as a wake-up call for physicians who treat rigidly with formulas.)
Wang Zhizhong's mother suddenly suffered from epistaxis. Urgent medication failed, including remedies previously effective on others. Reading *Jixiao Fang*, he found: "Unstoppable bleeding from mouth and nose is called Brain Epistaxis; moxa the Shangxing (GV23) point fifty cones." Still doubting that the head should not receive excessive moxibustion, he applied only seven cones. The next day, bleeding recurred. He applied eleven more cones, and she was cured. Someone else with chronic purulent bloody discharge from the nose was cured by Wang teaching them to moxa the Xinhui (GV16) point. Thus, Xinhui and Shangxing are superior methods for treating epistaxis; physicians must know this. (From *Zisheng Jing*.)
A woman suffering from epistaxis due to emotional stagnation was treated with Jiawei Guipi Tang (Modified Restore the Spleen Decoction); her bleeding gradually stopped, and appetite improved. She then took Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder); her Yuan Qi gradually recovered, and chills/fever subsided. Later, anger triggered another episode with alternating chills and fever. She was cured using Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Chuanxiong (Ligustici Rhizoma), Danggui, and Danpi.
A woman suffered epistaxis due to labor. Taking cooling medicines led to hematochezia. Some believed downward bleeding was favorable and continued blood-stopping treatments. Xue Ji said: "This is due to sinking of Spleen Qi. One must raise and tonify Spleen Qi so blood returns to its vessels." Disbelieving this, the bleeding worsened. She was then cured by taking Buzhong Yiqi Tang in the morning and Jiawei Guipi Tang in the evening. Many died from such cases because physicians used cold-cooling hemostatics without tonifying Spleen and Lung.
Ma Yuanyi treated the mother of Grand Secretary Lu, who suffered from persistent epistaxis. Both pulses were floating, large, and rapid, but powerless upon heavy pressure. Her face was red, irritable, mouth dry, feverish, with palpitations and mental confusion. The group treated it as Yangming Fire-Heat and Yin Deficiency with internal stirring. After ten days, the condition worsened. This was due to worry and depression injuring Yang Qi. Once Yang Qi is injured, Yin Blood has no master; rebelling upward causes epistaxis, collapsing downward causes bowel bleeding. It should be treated as Middle Deficiency with Cold. Ma prescribed Fuzi Lizhong Tang (Aconite and Poria Decoction to Warm the Middle), increasing Renshen to three liang. Others opposed this. On the second day, the pulse became scattered, far worse than before. Ma told the others: "The syndrome is not Excess; tonification is primary. While both Qi and Blood are needed, tonifying Qi precedes tonifying Blood; both Yin and Yang are required, but nourishing Yang follows nourishing Yin. Therefore, unless one aids Fire to benefit Water, balance cannot be achieved." He ordered the formula. Reluctantly, Renshen was reduced by two liang. By the ninth day, both epistaxis and bowel bleeding stopped. She was later regulated with Guipi Tang and recovered.
Qiao Zhige Xizai suffered from epistaxis in the Renzi year. He boiled several stalks of Juncus (Dengcao) in boiling water, removed them one by one, and placed them hot on the top of the head, replacing them when cool. He was cured. (From *Baiyi Fang*. This implies the intent of moxa Shangxing and Xinhui.)
Su Taoguang said: His mother often bled enough to fill basins from epistaxis, resisting all medicines. Using good hemp oil-soaked paper twists inserted into the nostrils, she sneezed shortly after and was cured. This prescription is very strange. (Same source.)
Chen, a county clerk in Yangzi, suffered from epistaxis from December to January, lasting thirteen days before settling. His pulse was solid and rapid. Treatment required downward guiding. He was given Tao Ren Chengqi Tang (Peach Kernel and Da Huang Decoction) to remove accumulated stasis, followed by Jiji Tang (Decoction for Mutual Completion), resulting in recovery. This was caused by excessive consumption of fried foods and strong wine, leading to accumulated Heat. (From *Baiyun Ji*.)
*Yizhi Xuyu* states: A ten-year-old niece suffered loose teeth due to injury. Using Ramie root to pull them caused unstoppable bleeding, accumulating eleven basins in a day and night. Powdered medicines failed, and bleeding resumed from the mouth. Her pulse was large, forceful, and powerful. Two qian of Sanzhi Dahuang (Three-Processed Rhubarb) powder was mixed with Zhiqiao decoction and child's urine, taken orally. Several pieces of black stool were passed, and bleeding stopped instantly. (Not selected.)
A man suffered from gingival bleeding filling basins once a month, resisting all medicines. Knowing he drank alcohol, one dose of the previous formula brought relief. This disease is mostly caused by severe Yangming Heat. Since the Chong and Ren meridians attach to Yangming, and the Yangming meridian has abundant Qi and Blood, attacks surge like tides. In emergencies, treat the branch. Using the method of "removing firewood from under the pot," he was cured promptly.
Dou Hanqing said: A person had continuous oozing bleeding from the gum margin. Four liang of Kuzhuru (Bamboo Shavings) were boiled in vinegar, swished in the mouth, and spat out. He was cured.
A person suddenly bled from a hole on the tongue like an awn pore. One sheng of Xiaochidou (Adzuki Beans) was crushed, mixed with three bowls of water, pounded to extract juice. One cup was taken at any time, sprinkled with Huaihua (Sophorae Flos) powder. He was cured. (*Liangfang*: Using only Huaihua powder is called Lingnie/Tongue Epistaxis.)
Shen Mingsheng treated Jiang Runong's eldest son, Jiang Mianzhong, who suffered from persistent epistaxis, losing a dou of blood. After a month, bleeding stopped, but he developed a scrotal abscess. His six pulses were thread-like, spirit exhausted. Initially able to drink, he gradually reached a state where he could not even consume congee. Previous physicians only claimed deficiency requiring tonification, failing to identify the root cause. Thus, Renshen and Huangqi were ineffective, followed by Guizhi and Fuzi. The more he was tonified, the weaker his form became; the more warmed, the weaker his Qi. Finally, Shen arrived during Winter Solstice. Based on pulse and symptoms, he also deemed warming necessary, but noted Guizhi and Fuzi were too hot. He tentatively used Buzhong Yiqi Tang, observing no improvement or deterioration. Suddenly realizing he had followed the error: although food intake was poor, there was constipation. The symptoms resembled Cold-Deficiency, yet he thirsted and desired drinks. The epistaxis originated from blazing Evil Fire. Suddenly using the method of "benefiting Qi for blood loss" stopped the epistaxis but did not clear the Heat, leading to the scrotal abscess. Once ulcerated, surgeons adhered to the taboo that cold medicines prevent wound healing, insisting on warming tonics. Observers saw the patient's emaciation and heard claims of deficiency, forcing food intake. For a body long bedridden, indulging in rich/greasy foods without transformation led to obstruction of both medicine and food, internal Heat and external Cold. This was the disease within the disease, not caused by epistaxis or abscess itself, explaining why tonification failed. Ancients said: "Floating pulse indicates undigested grain." Also: "Great Excess presents with Emaciation signs; mistaken tonification worsens the disease." Shen firmly advocated clearing, moistening, and resolving. Using Xiaoshi (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma) as vanguard, bowel movements cleared immediately. Using Huangqin and Baishao as rear guard, diet gradually improved. Thread-like pulses lengthened with just one qian of medicine. The long-cold body experienced the return of Yang. Not only did epistaxis cease, but the wound healed easily. Who says one can abandon symptoms for the pulse? Without thinking, how can one grasp the pathology? If not for changing course, turning defeat into victory, people would only know that tonification failed, never knowing that efficacy might lie in non-tonification. Such matters are difficult to understand.
Wu Qiao treated Yu Xueyi, a literary scholar and successful candidate, who suffered from epistaxis. The flow was torrential, lasting seven days and nights, sometimes rushing like a spring. Physicians used cold-natured medicines without effect. Urgently giving Dachengqi Tang (Major Order the Qi Decoction) for purgation also failed. Wu Qiao said: "The scholar was formerly a heavy drinker; accumulated Heat is in the Stomach." He prescribed Ban ji (half dose) of Shigao (Gypsum), resulting in cure. Other physicians asked: "Accumulated Heat requires cold; our prescriptions were cold. Why did you specifically choose Gypsum?" Wu Qiao said: "Treating disease must accord with the Meridians. If the disease is in this Meridian, this herb is appropriate. Gypsum is a herb for the Yangming Stomach Meridian. How can one achieve effect by indiscriminate mixing?" (From *Taihan Ji*.)
Nie Jiuwu treated the son of the Ye family, fifteen years old, suffering from epistaxis unresponsive to treatment. Inquiring about symptoms: Starting at age nine, initially occurring 5-7 times yearly, each time a few tea spoons. At eleven, monthly, half a wine cup. At twelve, three times every two months, one wine glass. At thirteen, twice monthly, half a tea bowl. At fourteen, monthly or twice, most of a bowl. Now at fifteen, every 8-9 days, filling a bowl each time. He was emaciated, skeletal, with nightly fever, extremely critical. All physicians used heat-clearing and blood-cooling agents. Ten doses reduced bleeding by 40-50%; thirty doses by 70-80%; forty doses reduced frequency to once every two months, a few drops each time. Fifty doses brought complete peace and flesh gain. Later, occasional minor occurrences were cured immediately with one dose of the previous formula. Ingredients: Shengdi, Baishao, Chuanxiong, Danggui, Dongqu/Dongchongxiaoca (Winterworm Summergrass - likely Ophiopogon/Asparagus context here referring to herbs), Zhimu, Huangbai, Huangqin, Lianqiao, Shouwu, Huafen, Danpi, Xiangfu, Gancao, Longyanrou. Decocted in water, mixed with 5 fen of burnt hair ash, taken well after meals. (Nie's formulas are extremely light, each ingredient not exceeding 5-7 fen.)
Wei Yuheng said: A son of the Yang family, over twenty, suffered from gushing epistaxis. Some advised blowing Black Zhizi (Gardenia) powder; some advised applying wet grass paper to the forehead; some advised soaking feet in hot wine. Chaos reigned, unable to stop for a day and night. He was ordered to find a lactating woman, press her breast against the nostril to express milk. Once milk entered, bleeding stopped. After stopping, waiting for nasal blood to dry, it should be removed according to method, resulting in immediate cure.
A seven-year-old son of the Guo family suffered from cough and nighttime fever, with frequent epistaxis, peaking at midnight. Pediatricians used dispersing and cooling-resolving methods. When appetite decreased, they used aromatic-dry digestive methods. Day by day, he grew weaker. Upon consultation, his face and eyes were slightly swollen, blue qi hidden around the nose and mouth. Pressing between Qimen (LR14) and Xuli (extra point) beside the breasts revealed throbbing pulsations. He stated: "This is weak constitution, overexertion from play, injuring Liver and Kidney. Wood insults Metal, hence epistaxis often comes from the left nostril. This is Internal Injury, not External Contraction." He prescribed Yangqing Tang (Nourish Green Decoction) for several doses, reducing symptoms slightly. Adding Shudi, Digupi (Cortex Lycii), and Louren (Trichosanthis Semen), four doses resulted in full recovery.