Epistaxis

Etiology and Pathogenesis

The lung qi flows up to the nose. The Foot - Yangming Meridian starts at the side of the nose. If there is accumulated wind heat in the lung or pathogenic fire in the stomach, they would rush upward to the nose. If there is yin deficiency leading to up flaring of the asthenic fire, the blood would flow up together with the fire. All of these cause blood to rush out of the vessels, resulting in epistaxis.

Differentiation

a) Extreme heat in lung and stomach: Main manifestations: Epistaxis accompanied by fever, cough, reddened tongue, superficial and rapid pulse ; or dire thirst with preference for cold drink, constipation, foul breath, reddened tongue with yellow coating, forceful and rapid pulse.

Analysis: Extreme heat in the lung goes up to the nose, forcing blood to rush out of the vessels. The heat also causes dysfunction of the lung in spreading and descending of qi. The reverse flow of qi results in cough. Reddened tongue and rapid pulse are signs of heat in the lung. Sometimes epistaxis occurs when the stomach fire flares up along the meridians to the nose, and injures the blood vessels. Thirst and preference for cold drinking are caused by the stomach heat consuming the fluid. Exhaustion of fluid causes constipation. The stomach heat makes foul breath. Irritability and restlessness are due to extreme heat in the Yangming Meridians disturbing the heart mind. Reddened tongue with yellow coating and forceful rapid pulse are signs of the stomach heat.

b) Deficiency of yin with preponderance of fire

Main manifestations: Epistaxis accompanied by malar flush, dryness of the mouth, feverish sensation of the palms and soles, afternoon fever, night sweating, thready and rapid pulse.

Analysis: When deficiency of the kidney yin causes the asthenic fire to flare up to the nose, blood vessels are injured, resulting in epistaxis. Malar flush, dryness of the mouth, feverish sensation of the palms and soles, and afternoon fever are manifestations of the asthenic fire associated with yin deficiency. Night sweating is also due to the asthenic fire that forces the moisture to be given off. Thready and rapid pulse is a sign of yin deficiency.

Treatment

Method: Points of the Hand - Yangming and Du Meridians are selected as the principal points. The reducing method is applied to clear off the heat and stop bleeding for extreme heat in the lung and stomach. The even movement is used to nourish yin and descend the fire for deficiency of yin with preponderance of fire.

Prescription: [LI20 - LI4 - DU23].

Supplementary points:

Heat in the lung: LU11.
Heat in the stomach: ST44.
Deficiency of yin with preponderance of fire ; KI6.

Explanation: The Hand - Yangming Meridian and Hand - Taiyin Meridian are exteriorly and interiorly related. The Hand - Yangming Meridian connects with the Foot - Yangming Meridian. So LI20 and LI4 are seclected to clear offbeat and stop bleeding. The Du Meridian is the sea of all the yang meridians. Extreme yang forces blood to rush out. So LI20 is used to reduce heat of the Du Meridian. The lung has its specific body opening in the nose. LU11, the jing-well point of the Lung Meridian, is used to reduce heat of the lung. ST44, the ying-spring point of the Stomach Meridian, is good for eliminating the stomach fire. KI6, one of the Confluential Points of the Eight Extra Meridians, has the action of nourishing yin and reducing fire.

Remarks

Epistaxis may be caused by trauma, nasal disorders and acute febrile diseases. In addition to acupuncture treatment, other therapeutic measures should be adopted according to its primary cause.