脑衄者。口鼻俱出血也。乃鼻血多。溢从口出。非别有一道来血也。亦非真从脑髓中来。此不过甚言鼻衄
之重。而因名之曰脑衄耳。盖吐血多者。血每呛入鼻中。故衄血多者。血亦溢入口中。治法用白纸折十余
叠。打湿贴脑顶。用熨斗熨令热气蒸腾。其衄自止。此乃因脑衄之名。望文生义而出。熨脑止衄之法。非探
本之治。故有效有不效。其实脑衄。只鼻衄之甚者耳。宜照鼻衄分经用药。乃不致循名失实。
脑衄治法。与鼻衄同。但脑衄出血既多。易成虚证。宜参苏饮。用人参以补之。用苏木以行之。如衄甚不止。
身热脉浮。喘促足厥者。乃气随血泄。阴脱阳亡。急危之候也。宜独参汤。加附子稠煎。服后得睡。汗不出。热
稍退。气稍息。则命根乃定。此等虚脱之证。血家最少而最危。勿因其少。而误用凉泻。
白珠黑珠。均无出血之窍。目下眼皮。只有泪窍。乃阳明经脉所贯注。春秋传。称蔡哀侯之泪尽。继之以血。
则是血自泪窍出也。阳明脉起于承泣穴。泪窍出血。乃阳明燥热所攻发。犀角地黄汤。加归尾赤芍银花
白芷粉葛牛膝石膏草梢治之。如风热重。大便闭者。通脾泻胃汤治之。阳明之脉。绕络于目。故凡治目。多
治阳明。吾尝观审视瑶函。外障目翳诸方。共一百零。而用大黄者七十余方。可知泻阳明胃经之热。是治
目疾一大法门。治目衄者。可以类椎。凡白虎汤。甘露饮。玉女煎。均治阳明方。医者审虚实先后而用之。罔
不奏效。
夫目虽阳明经所属。而实肝所开之窍也。血又肝之所主。故治目衄。肝经又为要务。地骨皮散。加柴胡炒
栀益母草。及丹栀逍遥散治之。谨按病发于肝者。多是怒逆之气火。耳鸣口苦。胸胁刺痛。宜从肝治之。可
用上二方。及当归芦荟丸。龙胆泻肝汤治之。病发阳明者。发热口渴。目干鼻干。大便燥结。宜从阳明法治之。
小眼角。乃少阳经脉所络。原无出血之窍。少阳相火。随经脉而出。冲动肝经血分。则生血筋。窜入瞳珠。及
肉长出。亦见流血。但不多耳。宜小柴胡。加青皮当归红花胆草丹皮。外用杏仁白矾铜绿点之。
大眼角。乃太阳经脉所络。名睛明穴。太阳气血充足。眼角内结赤肉如珠。有大眼角内不起肉珠者。乃太
阳之气不足故也。太阳经有风热。则大眼角生血筋 肉。或微渗血点。外治总以血筋 肉之法治之。内
服防风通圣散。去麻黄大黄芒硝。再服防风归芎汤调之。点药如上。
以上两条。均非目衄正病。以其起血筋。亦系血分为病。故兼及之。此书为血说法。其有目疾膜翳等项。均
有眼科专书。尽多可采。兹不具论。
脑衄，是指口和鼻同时出血。实际上是鼻血较多，溢出而从口中流出，并非另有一条通道让血液流出，也并不是真正从脑髓中流出来的。这不过是夸张地形容鼻衄（鼻出血）的严重程度，因此给它命名为“脑衄”罢了。一般来说，吐血多的人，血液常常呛入鼻中；所以鼻衄多的人，血液也会溢入口中。治疗方法是用白纸折叠十余层，打湿后贴在头顶，用熨斗熨烫使其热气蒸腾，鼻衄自然就会停止。这是根据“脑衄”这个名字，望文生义而提出的方法。熨头止鼻衄的方法，不是探究根本的治疗，所以有时有效有时无效。实际上，“脑衄”只是严重的鼻衄而已。应当按照鼻衄分经用药的原则进行治疗，才不会因名失实。
脑衄的治疗方法，与鼻衄相同。但脑衄出血量既多，容易形成虚证，宜使用参苏饮，用人参来补益正气，用苏木来活血行瘀。如果鼻衄严重不止，身体发热、脉象浮大、气喘急促、足部发凉，这是气随血泄，阴脱阳亡的急危征候。宜使用独参汤，加入附子浓煎服用。服药后若能入睡，无汗出，热势稍退，气息稍平，则性命得以安定。这类虚脱之证，在血证患者中最少出现却最为危险，不要因为出血量少，就误用寒凉泻下的药物。
眼白（白珠）和黑眼珠（黑珠），都没有出血的孔窍。眼下眼皮只有泪窍，是阳明经脉所贯穿注的地方。《春秋左传》记载蔡哀侯眼泪流尽后，继之以血，说明血液是从泪窍流出的。阳明经脉起始于承泣穴，泪窍出血，是由阳明燥热攻发所致。可用犀角地黄汤，加入当归尾、赤芍、银花、白芷、粉葛、牛膝、石膏、甘草梢来治疗。如果风热较重，大便闭塞者，用通脾泻胃汤治疗。阳明经脉环绕联络于眼部，所以凡是治疗眼病，多从治阳明入手。我曾观看《审视瑶函》，其中关于外障目翳的各种方剂共一百零一方，而使用大黄的就七十多方，可知清泻阳明胃经的热邪，是治疗眼疾的一大法门。治疗目衄（眼出血）者，可以由此类推。凡是白虎汤、甘露饮、玉女煎，都是治疗阳明的方剂，医生审察虚实先后而使用它们，没有不奏效的。
虽然眼睛属于阳明经所属，但实际上是肝所开之窍。血液又由肝所主，所以治疗目衄，调理肝经又是重要任务。可用地骨皮散，加入柴胡、炒栀子、益母草，以及丹栀逍遥散来治疗。谨按：发病源于肝的，多是愤怒逆乱之气火，伴有耳鸣、口苦、胸胁刺痛，应从肝论治，可使用上述两个方剂，以及当归芦荟丸、龙胆泻肝汤来治疗。发病源于阳明的，表现为发热口渴、眼睛干涩、鼻子干、大便燥结，应从阳明法治之。
小眼角，是少阳经脉所络属的地方，原本没有出血的孔窍。少阳相火随着经脉而出，冲动肝经血分，则产生血筋，窜入黑眼球，以及长出息肉，也能看见流血，但不多。宜用小柴胡汤，加入青皮、当归、红花、胆草、丹皮。外用杏仁、白矾、铜绿点眼。
大眼角，是太阳经脉所络属的地方，名为睛明穴。太阳气血充足，大眼角内会结成红色的肉珠；有大眼角内不起肉珠的，是太阳之气不足的缘故。太阳经如果有风热，则大眼角会长出血筋或息肉，或者微微渗出血点。外治总以治疗血筋息肉的方法处理。内服防风通圣散，去掉麻黄、大黄、芒硝，再服用防风归芎汤调理。点眼药如上所述。
以上两条，都不是目衄的正病，因为它们起因于血筋，也属于血分病变，所以一并提及。这本书是为血证说法，其中如有眼疾膜翳等项，均有眼科专书，内容非常丰富，此处不再详细论述。
Nao Nu (Brain Epistaxis) refers to bleeding from both the mouth and nose. In fact, it is excessive epistaxis (nosebleed) that overflows and exits through the mouth; there is no separate channel for blood flow, nor does it truly originate from the brain marrow. This is merely an exaggerated description of severe epistaxis, hence the name "Nao Nu." Generally, those with severe hematemesis (vomiting blood) often have blood splashed into the nasal cavity; thus, those with severe epistaxis may also have blood overflow into the mouth. The treatment method involves folding white paper more than ten times, wetting it, and applying it to the vertex of the head, then using a clothes iron to generate steam heat, which naturally stops the epistaxis. This approach is derived literally from the name "Nao Nu" without probing the root cause. Therefore, its efficacy is inconsistent. In reality, "Nao Nu" is simply severe epistaxis. Treatment should follow the principle of prescribing herbs according to meridian differentiation for epistaxis to avoid being misled by the name.
The treatment for Nao Nu is the same as for epistaxis. However, since Nao Nu involves significant blood loss, it easily leads to deficiency syndromes. Shen Su Yin (Ginseng and Tallowwood Decoction) is indicated, using Ren Shen (Ginseng Root) to tonify and Su Mu (Sappan Wood) to invigorate blood circulation. If the epistaxis is severe and unceasing, accompanied by fever, floating pulse, panting, and cold feet, this indicates Qi escaping with blood, leading to Yin collapse and Yang extinction—a critical emergency. Du Shen Tang (Single Ginseng Decoction) with Fu Zi (Aconite Lateral Root) added and decocted thickly is indicated. After ingestion, if the patient falls asleep, sweats not, fever subsides slightly, and breathing stabilizes, life is preserved. Such deficiency-collapse syndromes are rare but most dangerous among blood disorders; do not mistakenly use cooling purgatives due to the perception of minor bleeding.
The sclera (white part) and cornea/iris (black part) have no orifices for bleeding. The lower eyelid has only the lacrimal punctum, through which the Stomach Meridian passes. The *Zuo Zhuan* records that Duke Ai of Cai wept until his tears were exhausted, followed by blood, indicating that blood can exit from the lacrimal punctum. The Stomach Meridian originates at Chengqi (ST1), so bleeding from the lacrimal punctum is caused by Stomach Dryness-Heat attacking. Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) with Dang Gui Wei (Angelica Sinensis Tail), Chi Shao (Red Peony Root), Jin Yin Hua (Honeysuckle Flower), Bai Zhi (Angelica Dahurica), Ge Gen (Kudzu Root), Niu Xi (Achyranthes Root), Shi Gao (Gypsum), and Cao Gao (Licorice Tip) is used for treatment. If Wind-Heat is heavy and constipation exists, Tong Pi Xie Wei Tang (Decoction to Purge the Spleen and Stomach) is used. Since the Stomach Meridian loops around the eyes, treating eye diseases often involves addressing the Stomach. I once reviewed *Shen Shi Yao Han*, which contains 101 formulas for external eye opacities; over 70 contain Da Huang (Rhubarb). This shows that clearing Heat from the Stomach Meridian is a major method for treating eye diseases. Those treating Mu Nu (Eye Epistaxis) can infer from this. Bai Hu Tang (White Tiger Decoction), Gan Lu Yin (Sweet Dew Drink), and Yu Nu Jian (Jade Woman Decoction) are all formulas for the Stomach; physicians who assess deficiency/excess and sequence of onset will find them effective.
Although the eyes belong to the Stomach Meridian, they are actually the orifice opened by the Liver. Blood is governed by the Liver, so regulating the Liver Meridian is crucial in treating Mu Nu. Di Gu Pi San (Lycium Bark Powder) with Chai Hu (Bupleurum Root), Chao Zhi Zi (Fried Gardenia Fruit), Yi Mu Cao (Motherwort Herb), and Dan Zhi Xiao Yao San (Moutan and Gardenia Free and Easy Wanderer Powder) are used. Note: Pathologies originating in the Liver are often due to angry, rebellious Qi and Fire, accompanied by tinnitus, bitter taste, and stabbing pain in the chest and hypochondrium. These should be treated via the Liver using the aforementioned formulas, plus Dang Gui Lu Hui Wan (Angelica and Aloe Pill) or Long Dan Xie Gan Tang (Gentian Decoction to Drain the Liver). Pathologies originating in the Stomach present with fever, thirst, dry eyes, dry nose, and dry stool; these should be treated via the Stomach method.
The inner canthus (small corner of the eye) is connected by the Gallbladder Meridian and originally has no bleeding orifice. Shaoyang Ministerial Fire follows the meridian outward, stirring the Blood level of the Liver Meridian, generating blood vessels, invading the eyeball, and causing fleshy growths, sometimes with slight bleeding. Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Qing Pi (Green Tangerine Peel), Dang Gui (Angelica Sinensis), Hong Hua (Safflower), Long Dan Cao (Gentian Root), and Mu Dan Pi (Tree Peony Bark) is indicated. Externally, Xing Ren (Apricot Seed), Bai Fan (Alum), and Tong Lv (Malachite) are applied to the eye.
The outer canthus (large corner of the eye) is connected by the Bladder Meridian, named Jingming (BL1). When Bladder Qi and Blood are sufficient, red fleshy nodules form inside the outer canthus; absence of such nodules indicates insufficiency of Bladder Qi. If Wind-Heat affects the Bladder Meridian, blood vessels or fleshy growths appear in the outer canthus, or slight bleeding points渗 out. External treatment follows methods for blood vessels and growths. Internally, Fang Feng Tong Sheng San (Saposhnikovia Universal Relief Powder) is used, removing Ma Huang (Ephedra), Da Huang (Rhubarb), and Mang Xiao (Mirabilite), followed by adjustment with Fang Feng Gui Xiong Tang (Saposhnikovia, Angelica, and Ligusticum Decoction). Eye drops are as described above.
These two conditions are not true Mu Nu, but involve blood vessels, belonging to Blood-level pathology, hence mentioned together. This book discusses blood disorders; other eye diseases like membrane opacities are covered in specialized ophthalmology texts, which are abundant and not detailed here.