🌿 Folk Prescriptions

Nosebleed, or epistaxis, is more prevalent in spring due to rising yang energy. *The Inner Canon* states: "In spring, people are prone to nasal obstruction and nosebleeds." Numerous causes contribute to nosebleeds, with local nasal lesions being the most common, though systemic diseases also play a significant role.
Nosebleeds usually occur unilaterally. The anterior inferior part of the nasal septum often shows dilated capillaries and desquamation of epithelium—the common bleeding site, responsible for nearly half of all nosebleeds. This is especially true during dry seasons like spring and autumn, or hot summer months, when dry nasal mucosa makes vessel rupture common. Another cause is trauma. Additionally, inflammation or tumors in the nasopharynx are frequent causes of nosebleeds. Systemic diseases causing epistaxis often stem from infectious febrile illnesses leading to toxic vascular damage, causing nasal mucosal congestion and swelling, resulting in capillary rupture. Hypertension increases arterial pressure in small vessels, while heart disease and bronchitis elevate venous pressure, frequently triggering nosebleeds. Blood disorders (thrombocytopenia, leukemia, hemophilia, aplastic anemia), arteriosclerosis, rheumatic fever, vitamin deficiencies (C, K), chemical drugs, and poisoning can all induce nosebleeds. Moreover, nosebleeds are closely linked to the menstrual cycle; those occurring before menstruation are known as "reverse menstruation."
When nosebleeds occur, patients must remain calm. Since over half of cases originate from the anterior inferior septum, patients can press the bleeding side’s nostril inward against the anterior septum with fingers, or use vasoconstrictors like ephedrine or epinephrine-soaked cotton balls, or apply moist cotton balls soaked in Yunnan Baiyao into the nasal cavity and press the nostrils. Cooling the neck and forehead may also help. For recurrent or stubborn nosebleeds, especially from the anterior inferior septal bleeding zone or capillary hemangioma rupture, laser therapy is currently the simplest and most reliable method. For nosebleeds due to dryness or atrophic rhinitis, oil-based medications can be used. For systemic disease-related nosebleeds, besides addressing the underlying condition, TCM treatment is preferred.
TCM views nosebleeds primarily as due to excessive heat in the lung, stomach, or liver, forcing blood to overflow from the clear pathways. Nosebleeds triggered by infections, febrile diseases, hypertension, or reverse menstruation fall into this category. Treatment should focus on clearing heat, purging fire, cooling blood, and stopping bleeding. The author uses a personal formula, Qinghuo Liangxue Zhibi Tang (Raw Rehmannia, Moutan Bark, Red Peony Root, Ru Xiang, Salvia miltiorrhiza, Gardenia, Scutellaria baicalensis, Prepared Rhubarb, Rubia Root, White Reed Rhizome, Agrimony, Raw Licorice), as the base. For nosebleeds due to external wind-heat, add Mentha, Schizonepeta, Honeysuckle, Forsythia. For gastric fire, add gypsum, Coptis. For liver fire, add Gentiana, White Peony Root, Lodestone. For additional hemostasis, add Charred Lotus Node, Charred Cypress Twig. To guide pathogen downward, add Achyranthes bidentata. For yin deficiency with blood heat, add Ophiopogon, Scrophularia. If clinical presentation indicates qi deficiency failing to hold blood, treat with methods to consolidate blood and nourish blood, using formulas like Ren Shen Gui Pi Tang with addition of Donkey-hide Gelatin, Raw Rehmannia, and Prepared Ginger.
Patients with recurrent minor bleeding or persistent bleeding should promptly undergo detailed local and systemic examinations. Especially for middle-aged and elderly hypertensive patients experiencing nosebleeds, blood pressure should be measured immediately, as such episodes are often due to blood pressure fluctuations, increasing stroke risk without prevention. To reduce springtime nosebleeds, maintain a calm mindset and avoid anger. Spring diet should be light, drink plenty of water, eat more vegetables and fruits, avoid spicy, stimulating, and drying foods, refrain from strong liquor to avoid exacerbating heat and fire. Also, emphasize prevention of colds to avoid aggravating or triggering bleeding through coughing or sneezing.