Epistaxis

WESTERN MEDICINE: Epistaxis hemorrhage from the nose. Nosebleed is a common emergency that usually results from a local disturbance but may be associated with a serious systemic disorder. Trauma from direct injury, nose picking, fracture, or intranasal foreign body are the most frequent causes. Other local causes are local infections in the area. Nasal hemorrhage is seen in many systemic disorders and may be the foremost symptom of hemorrhagic disorders such as telangiectasia (hereditary), scurvy, leukemia, thrombocytopenia, agranulocytosis, and hemophilia.

ETIOLOGY AND PATHOLOGY: Epistaxis in this chapter mostly means nasal hemorrhage due to infections (or interior heat of lung, stomach, liver or kidney organs in Chinese medicine). Nosebleeds due to trauma or other systemic disorders are excluded in this chapter. In Chinese medicine, the etiology and pathology of epistaxis are mostly due to the following:

  1. Exogenous wind heat factors attacks the lung channel through the nose, and damages the nasal Luo channels causing bleeding. 
  2. Accumulated interior heat from stomach due to hot and spicy food intake flames upward to attack the nose or gum causing bleeding. 
  3. Liver fire due to strong prolonged emotions goes up easily to disturb the upper orifices, and damages the Luo channel causing bleeding.The nose is the orifice that is mostly affected by the liver fire.
  4. The deficient Qi and blood lose their control of blood circulation causing bleeding. 

DIFFERENTIATIONS: 

1. Epistaxis due to Exogenous Wind - Heat:

Indications: Nasal bleeding, dry nose, throat and mouth, or accompanied with fever, cough, scanty sputum, red tongue, thin coating, rapid and floating pulse. 

Treatment & Formulas: Clear the lung heat, dispel the exogenous wind factor and cool the blood heat.

Products:

    • Sang Ju Yin (Marus and Chrysanthemum Combination, Item No. 2146): This is a typical formula for wind heat symptoms. 
    • Xie Bai San (Morus and Lycium Formula, Item No. 2268): This clears the lung heat.
    • Bai He Gu Jin Tang (Lily Combination, Item No. 2092): This moistures lung & clears the lung heat. 

2. Epistaxis due to the Stomach Heat:

Indications: Nasal bleeding, or gum bleeding with bright color, thirsty, likes cold drinks in large amounts, bad breath, constipation, yellow coating, rapid pulse.

Treatment & Formulas: Clear the interior stomach fire and cool the blood. 

Products:

    • Ching Wei San (Coptis and Rehmannia Formula, Item No. 2182): This is a very good formula for epistaxis or gum bleeding due to the stomach fire. 
    • Huang Lian Jie Du Tang (Coptis and Scute Formula, Item No. 2212): This is a strong formula to cool the interior heat from lung, stomach and lower burner. 
    • Shan Huang Xie Xin Tang (Coptis and Rhubarb Combination, Item No. 2026): This is also a strong formula to clear the interior heat by its cooling and laxative functions. 

3. Epistaxis due to the Liver Fire:

Indications: Nasal bleeding with bright color, headache, dizziness, red irritated eyes, easily angered, restlessness, thirsty, burning sensation during urinating, red tongue, yellow coating, wiry and rapid pulse. 

Treatment & Formulas: Dispel the liver fire and cool the blood heat. 

Products:

    • Long Dan Xie Gan Tang (Gentiana Combination, Item No. 2267): This is a strong formula to cool the liver fire so as to stop the bleeding.
    • Jia Wei Xiao Yao San (Bupleurum and Paeonia Formula, Item No. 2068): It regulates the stagnated liver and cools the interior heat stopping bleeding. 

4. Epistaxis due to the Qi and Blood Deficiency:

Indications: Chronic nosebleed, or bleeding of other parts of the body, pale complexion, fatigue, dizziness, tinnitus, palpitation, insomnia, pale tongue, thready and weak pulse. 

Treatment & Formulas: Tonify the Qi and blood by promoting the functions of spleen and heart or liver.

Products:


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