Nosebleeding, or epistaxis, is more common in spring due to rising yang energy. The Inner Canon states: “In spring, people are prone to rhinitis and nosebleeds.” Numerous causes lead to nosebleeds, with nasal local lesions being the most common, though systemic diseases also contribute significantly.
Nosebleeds usually occur on one side. The mucosa in the anterior inferior part of the nasal septum often shows dilated small vessels and epithelial shedding—the easy bleeding zone of the nasal septum. Nearly half of all nosebleeds originate here, especially during dry seasons like spring and autumn, or hot summer months when nasal mucosa dries out, making vessel rupture common. Another cause is trauma. Additionally, inflammation or tumors in the nasopharynx are frequent causes of nosebleeds. Systemic diseases causing epistaxis often result from infectious febrile illnesses damaging blood vessels through toxicity, causing nasal mucosal congestion and swelling, leading to capillary rupture and bleeding. Hypertension raises small artery pressure, while heart disease and bronchitis increase venous pressure, frequently triggering nosebleeds. Blood disorders (thrombocytopenia, leukemia, hemophilia, aplastic anemia), arteriosclerosis, rheumatic fever, and vitamin deficiencies (C, K), as well as chemical drugs and poisoning, can all cause nosebleeds. Moreover, nosebleeds are closely related to menstrual cycles; those occurring before menstruation are called “reverse menstruation.”
When nosebleeds occur, patients must stay calm. Since over half of cases stem from bleeding in the anterior inferior part of the nasal septum, patients can press the bleeding nostril inward toward the anterior septum with their fingers, or use vasoconstrictive agents like ephedrine solution or adrenaline-soaked cotton balls, or insert a damp cotton ball soaked in Yunnan Baiyao into the bleeding nostril and press the nostrils with fingers—most cases can be stopped this way. Cold compresses on the neck and forehead also help. If the nose bleeds repeatedly, especially from the anterior inferior bleeding zone or due to capillary hemangioma rupture, laser therapy is currently the simplest and most reliable method. For nosebleeds caused by dryness or atrophic rhinitis, oil-based medications can be used. For nosebleeds caused by systemic diseases, besides addressing the underlying condition, traditional Chinese medicine treatment is best.
Traditional Chinese medicine believes that nosebleeds are mainly due to excessive fire in the lungs, stomach, or liver, forcing blood to flow abnormally. Nosebleeds triggered by infections, febrile illnesses, hypertension, or reverse menstruation fall into this category. Treatment should primarily focus on clearing heat, purging fire, cooling blood, and stopping bleeding. I use my personal experience formula, Qinghuo Liangxue Zhibi Tang (composed of Sheng Di, Dan Pi, Chi Shao, Pu Huang, Dan Shen, Zhi Zi, Huang Qin, Zhi Da Huang, Xian Cao, Bai Mao Gen, Xian He Cao, and Sheng Gan Cao), as the base formula. For nosebleeds caused by external wind-heat, add Bo He, Jing Jie, Jin Yin Hua, and Lian Qiao; if stomach fire is excessive, add Shi Gao and Huang Lian; if liver fire is excessive, add Long Dan Cao, Bai Shao, and Dai Zhe Shi; to stop bleeding, add Oujie Tan and Ce Bai Tan; to guide the pathogen downward, add Chuan Niu Xi; for yin deficiency with blood heat, add Mai Dong and Xuan Shen. If clinical presentation indicates qi deficiency unable to hold blood, treatment should adopt methods to consolidate blood and nourish blood, using formulas like Ren Shen Gui Pi Tang with additions of E Jiao, Sheng Di, and Pao Jiang.
Patients with recurrent minor bleeding or stubborn bleeding should promptly undergo detailed local and systemic examinations at a hospital. Especially for middle-aged and elderly patients with hypertension experiencing nosebleeds, blood pressure should be checked immediately, as such episodes are often triggered by blood pressure fluctuations, increasing the risk of stroke without prevention. To reduce spring nosebleeds, one should 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 drinking strong liquor to avoid aggravating heat and fire. Additionally, emphasize preventing colds to avoid coughing and sneezing, which can trigger or worsen bleeding.
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