Symptom family: Nasal Disorders and Symptoms

Sub-symptom(s): Frequent Nosebleeds

What is Nosebleeds?

Nosebleeds, medically known as epistaxis, are a common condition where bleeding occurs from the nostrils, nasal cavity, or nasopharynx. This symptom can be spontaneous or caused by trauma, and while often benign, can sometimes indicate more serious health issues. Frequent nosebleeds may be particularly concerning and require medical evaluation. Managing nosebleeds involves understanding both the immediate triggers—such as dry air or nasal congestion—and any underlying disorders that may predispose someone to bleed more easily.

How Does TCM View Nosebleeds?

Traditional Chinese Medicine (TCM) perceives nosebleeds as a manifestation of disharmony within the body. Unlike Western medicine, which often focuses on local factors like dry mucosa or external injuries, TCM explores underlying imbalances that lead to a predisposition for such symptoms.

It emphasizes the importance of identifying distinct patterns of disharmony—be it from Heat, Wind, or Blood Stagnation—to tailor treatment effectively. This holistic approach seeks not only to stop the bleeding but also to address the root causes preventing future occurrences.

Root Causes of Nosebleeds in TCM

In TCM, nosebleeds are most commonly associated with Heat in the Blood and Liver Fire, both of which lead to the overheating of Blood which then "jumps" the vessels. Heat in the Blood can manifest as spontaneous bleeding, a feeling of heat, red skin eruptions, and a rapid pulse.

Alternatively, Liver Wind agitating Internally due to Liver Fire might present with symptoms such as severe headaches, irritability, red eyes, and a bitter taste in the mouth, reflecting an internal excess that needs cooling and calming. Treatments focus on nourishing Yin and subduing Yang to restore balance between the body's energetic forces.

Explore below more details about what might cause Nosebleeds according to TCM.

  • By Syndrome
  • By Organ
  • Heat
  • Wind
  • Mind Disturbance
  • Blood Stasis
  • Blood Deficiency
  • Cold
  • Liver
Detailed description of the cause

Heat

In TCM "Heat" signifies an excess of Yang energy, leading to an imbalance where heat predominates over the body's cool Yin aspects. This condition is metaphorically akin to an internal over-heating. Symptoms indicative of Heat can include feelings of warmth, fever, sweating, irritability, red face, thirst with a preference for cold drinks, and a rapid pulse. The tongue may appear red with a yellow coating. Unlike the common interpretation of heat in terms of temperature, in TCM, it represents a state of hyperactivity or inflammation in the body.... see more

Heat Patterns That Can Lead to Nosebleeds

Common Symptoms: Thirst Vomiting Blood Cough Of Blood Irritability Flushed Face Dark Urine Dry Stools Bitter Taste In The Mouth

Pattern Name Relevant Symptoms Relevant Formulas
Heat in the Blood Bloody nose, Feeling of heat, Red skin eruptions, Thirst, Frequent bleeding, Bloody sputum, Hematochezia, Hematuria, Vomiting blood, Cough of blood, Nosebleeds, Excessive menstruation... see more Xi Jiao Di Huang Tang | Gu Jing Wan | Shi Hui San | Bai He Di Huang Tang | Hua Ban Tang | Qing Ying Tang | Qing Re Gu Jing Tang
Heat victorious agitating Blood Epistaxis, Restlessness, High fever, Mania, Macules, Vomiting blood, Nosebleeds, Hematochezia, Hematuria... see more Xi Jiao Di Huang Tang
Liver Fire Blazing Epistaxis, Irritability, Anger, Tinnitus, Deafness, Temporal headache, Dizziness, Flushed face, Eye hyperemia, Thirst, Bitter taste in the mouth, Vivid dreaming, Constipation, Dry stools, Dark urine, Nosebleeds, Cough of blood, Vomiting blood... see more Long Dan Xie Gan Tang | Dang Gui Long Hui Wan | Xie Qing Wan
Liver Wind agitating Internally due to Liver Fire Epistaxis, Tremors, Irritability, Anger, Tinnitus, Deafness, Temporal headache, Dizziness, Flushed face, Eye hyperemia, Thirst, Bitter taste in the mouth, Vivid dreaming, Constipation, Dry stools, Dark urine, Nosebleeds, Vomiting blood, Cough of blood... see more Ling Jiao Gou Teng Tang | Zi Xue Dan | Feng Yin Tang
Wind Cold with Internal Heat Nosebleeds, High fever, Severe chills, Lack of sweating, Headaches, Feeling of heaviness, General sensation of tightness, Flushed face, Eye hyperemia, Dry nose, Thirst, Irritability, Insomnia, Cough of blood, Mottled skin... see more Shi Gao Tang
Detailed description of the cause

Wind

In TCM "Wind" is a concept that represents a pattern of disharmony, often characterized by its sudden and unpredictable nature, much like a gusty wind changing direction without warning. This pattern is associated with symptoms that come and go quickly or move around the body, such as itching, tremors, or even certain types of pain. Wind is considered to be a primary cause of illnesses that have these rapidly changing characteristics. In TCM, external Wind often refers to illnesses that start suddenly, like the common cold, believed to be caused by external pathogenic factors like climatic changes. On the other hand, internal Wind can be linked to internal imbalances and can manifest in conditions like dizziness or spasms. ... see more

Wind Patterns That Can Lead to Nosebleeds

Common Symptoms: Irritability Flushed Face Eye Hyperemia Thirst Cough Of Blood Tremors Anger Tinnitus

Pattern Name Relevant Symptoms Relevant Formulas
Liver Wind agitating Internally due to Liver Fire Epistaxis, Tremors, Irritability, Anger, Tinnitus, Deafness, Temporal headache, Dizziness, Flushed face, Eye hyperemia, Thirst, Bitter taste in the mouth, Vivid dreaming, Constipation, Dry stools, Dark urine, Nosebleeds, Vomiting blood, Cough of blood... see more Ling Jiao Gou Teng Tang | Zi Xue Dan | Feng Yin Tang
Wind Cold with Internal Heat Nosebleeds, High fever, Severe chills, Lack of sweating, Headaches, Feeling of heaviness, General sensation of tightness, Flushed face, Eye hyperemia, Dry nose, Thirst, Irritability, Insomnia, Cough of blood, Mottled skin... see more Shi Gao Tang
Detailed description of the cause

Mind Disturbance

In TCM "Shen" refers to the mind or spirit, and a Shen disturbance is a pattern of disharmony that affects the mental and emotional state. This concept reflects the TCM belief in the deep interconnectedness of mind and body. Symptoms of Shen disturbance can vary widely but often include anxiety, insomnia, restlessness, confusion, or in severe cases, hallucinations or delirium. These symptoms indicate an imbalance in the body's energies affecting the heart, which in TCM is not only the center of blood circulation but also the seat of the mind and consciousness. The root of Shen disturbance can be traced to various factors, including emotional stress, physical illness, or an imbalance in fundamental substances like Qi, Yin, or Yang.... see more

Mind Disturbance Patterns That Can Lead to Nosebleeds

Pattern Name Relevant Symptoms Relevant Formulas
Heat victorious agitating Blood Epistaxis, Restlessness, High fever, Mania, Macules, Vomiting blood, Nosebleeds, Hematochezia, Hematuria... see more Xi Jiao Di Huang Tang
Detailed description of the cause

Blood Stasis

Blood Stasis in TCM is a concept where the blood flow in the body is not as smooth or efficient as it should be. Imagine a river that's supposed to flow freely, but instead, it's getting blocked or moving too slowly in some parts. This can lead to various health issues, like pain that feels sharp or stabbing, dark bruises, and a complexion that looks purplish. TCM believes that good health relies on the smooth and vibrant flow of Qi and blood throughout the body, so when blood gets stuck, it's like a traffic jam in your body, leading to discomfort or health problems.... see more

Blood Stasis Patterns That Can Lead to Nosebleeds

Pattern Name Relevant Symptoms Relevant Formulas
Liver Blood Stagnation Epistaxis, Hypochondriac pain, Abdominal pain, Vomiting blood, Nosebleeds, Menstrual cramps, Irregular periods, Dark menstrual clots, Infertility, Abdominal masses, Purple nails, Purple lips, Purple face, Skin dryness, Petechiae... see more Xiao Yao San | Chai Hu Shu Gan San | Ge Xia Zhu Yu Tang | Shi Xiao San
Detailed description of the cause

Blood Deficiency

Blood Deficiency in TCM is like when your body's tank runs low on the vital energy that blood provides. It's not exactly the same as anemia in modern medicine, which is about having too few red blood cells. Instead, Blood Deficiency in TCM is about your body not having enough of the life-giving qualities that blood brings, like nourishment and moisture. This can make you feel tired, look pale, and even feel dizzy or have blurry vision. It's like a garden not getting enough water to stay lush and vibrant. TCM sees this as an imbalance where the body isn't being nourished as it should be, impacting overall health and well-being.... see more

Blood Deficiency Patterns That Can Lead to Nosebleeds

Pattern Name Relevant Symptoms Relevant Formulas
Loss of Blood Epistaxis, Nosebleeds, Uterine hemorrhage, Hematuria, Hematochezia, Cough of blood, Vomiting blood, Dark menstrual clots, Excessive menstruation, Bloody sputum... see more Xi Jiao Di Huang Tang
Detailed description of the cause

Cold

In TCM "Cold" as a pattern of disharmony refers to a specific type of imbalance within the body's systems, often linked to a deficiency or weakness. It's not about feeling physically cold or having a common cold, but rather a metaphorical description of certain symptoms and underlying conditions. When a TCM practitioner says someone suffers from "Cold," it usually implies that the body's Yang energy, which is warm and active, is insufficient or overpowered by Yin energy, which is cool and passive. Symptoms of Cold in TCM can include a general feeling of coldness, cold limbs, pale complexion, low energy, slow metabolism, and a preference for warmth. ... see more

Cold Patterns That Can Lead to Nosebleeds

Pattern Name Relevant Symptoms Relevant Formulas
Wind Cold with Internal Heat Nosebleeds, High fever, Severe chills, Lack of sweating, Headaches, Feeling of heaviness, General sensation of tightness, Flushed face, Eye hyperemia, Dry nose, Thirst, Irritability, Insomnia, Cough of blood, Mottled skin... see more Shi Gao Tang
Detailed description of the cause

Liver

In TCM the Liver is viewed as the organ responsible for the smooth flow of Qi, Blood, and emotions throughout the body. It plays a key role in regulating mood, storing blood, supporting digestion, and ensuring the health of tendons and eyes. When the Liver malfunctions or is imbalanced in TCM, it can lead to a range of issues such as irritability, mood swings, menstrual irregularities, eye problems, and muscular stiffness or pain. A malfunctioning Liver in TCM reflects not only physical disturbances but also emotional and mental disharmony, emphasizing the holistic approach of TCM in addressing health and wellness.... see more

Liver Patterns That Can Lead to Nosebleeds

Common Symptoms: Vomiting Blood Irritability Anger Tinnitus Deafness Temporal Headache Dizziness Flushed Face

Pattern Name Relevant Symptoms Relevant Formulas
Liver Blood Stagnation Epistaxis, Hypochondriac pain, Abdominal pain, Vomiting blood, Nosebleeds, Menstrual cramps, Irregular periods, Dark menstrual clots, Infertility, Abdominal masses, Purple nails, Purple lips, Purple face, Skin dryness, Petechiae... see more Xiao Yao San | Chai Hu Shu Gan San | Ge Xia Zhu Yu Tang | Shi Xiao San
Liver Fire Blazing Epistaxis, Irritability, Anger, Tinnitus, Deafness, Temporal headache, Dizziness, Flushed face, Eye hyperemia, Thirst, Bitter taste in the mouth, Vivid dreaming, Constipation, Dry stools, Dark urine, Nosebleeds, Cough of blood, Vomiting blood... see more Long Dan Xie Gan Tang | Dang Gui Long Hui Wan | Xie Qing Wan
Liver Wind agitating Internally due to Liver Fire Epistaxis, Tremors, Irritability, Anger, Tinnitus, Deafness, Temporal headache, Dizziness, Flushed face, Eye hyperemia, Thirst, Bitter taste in the mouth, Vivid dreaming, Constipation, Dry stools, Dark urine, Nosebleeds, Vomiting blood, Cough of blood... see more Ling Jiao Gou Teng Tang | Zi Xue Dan | Feng Yin Tang

TCM Herbal Formulas for Nosebleeds

To treat nosebleeds, TCM recommends formulas that address the underlying patterns. For Heat in the Blood, Xi Jiao Di Huang Tang, which includes ingredients like Water Buffalo Horns (Shui Niu Jiao), is used to cool the Blood and stop bleeding. This formula is ideal for cases where there is also restlessness, fever, or skin eruptions.

In situations involving Liver Fire or Wind Heat, practitioners might choose formulas that pacify the Liver and clear Heat, such as Ling Jiao Gou Teng Tang or Shi Gao Tang. These formulas help regulate the energy flow and cool the blood, providing relief from symptoms.

Explore below some TCM herbal formulas used to address nosebleeds, organized by cause and by formula type.

  • By Cause
  • By Formula Type
  • Heat
  • Wind
  • Mind Disturbance
  • Blood Stasis
  • Blood Deficiency
  • Cold
  • Formulas that clear heat from the organs
  • Formulas that clear nutritive-level heat
  • Formulas that clear heat from deficiency
  • Formulas that invigorate blood and dispel blood stagnation
  • Formulas that secure irregular uterine bleeding and stop vaginal discharge
  • Formulas that stop bleeding
  • Formulas that clear heat from qi and blood
  • Formulas that warm interior cold
  • Formulas that harmonize liver-Spleen
  • Formulas that promote qi movement
  • Formulas that pacify and extinguish internal wind
  • Formulas that clear heat and open sensory orifices
  • Formulas that dredge and disperse external wind
  • Formulas that tonify qi
  • Formulas that clear qi-level heat
  • Formulas that release the exterior and clear the interior
  • Formulas that tonify blood

All Formulas Recommended for Nosebleeds Caused by Heat

Formula Patterns Suitable For
Xi Jiao Di Huang Tang Heat in the Blood, Heat victorious agitating Blood
Gu Jing Wan Heat in the Blood
Shi Hui San Heat in the Blood
Bai He Di Huang Tang Heat in the Blood
Hua Ban Tang Heat in the Blood
Qing Ying Tang Heat in the Blood
Qing Re Gu Jing Tang Heat in the Blood
Long Dan Xie Gan Tang Liver Fire Blazing
Dang Gui Long Hui Wan Liver Fire Blazing
Xie Qing Wan Liver Fire Blazing
Ling Jiao Gou Teng Tang Liver Wind agitating Internally due to Liver Fire
Zi Xue Dan Liver Wind agitating Internally due to Liver Fire
Feng Yin Tang Liver Wind agitating Internally due to Liver Fire
Shi Gao Tang Wind Cold with Internal Heat

All Formulas Recommended for Nosebleeds Caused by Wind

Formula Patterns Suitable For
Ling Jiao Gou Teng Tang Liver Wind agitating Internally due to Liver Fire
Zi Xue Dan Liver Wind agitating Internally due to Liver Fire
Feng Yin Tang Liver Wind agitating Internally due to Liver Fire
Shi Gao Tang Wind Cold with Internal Heat

All Formulas Recommended for Nosebleeds Caused by Blood Stasis

Formula Patterns Suitable For
Xiao Yao San Liver Blood Stagnation
Chai Hu Shu Gan San Liver Blood Stagnation
Ge Xia Zhu Yu Tang Liver Blood Stagnation
Shi Xiao San Liver Blood Stagnation

All "formulas that clear nutritive-level heat" recommended for nosebleeds

Formula Patterns Suitable For (if applicable)
Xi Jiao Di Huang Tang Heat in the Blood, Heat victorious agitating Blood, Loss of Blood
Qing Ying Tang Heat in the Blood

All "formulas that clear heat from the organs" recommended for nosebleeds

Formula Patterns Suitable For (if applicable)
Long Dan Xie Gan Tang Liver Fire Blazing
Dang Gui Long Hui Wan Liver Fire Blazing
Xie Qing Wan Liver Fire Blazing

All "formulas that clear heat from deficiency" recommended for nosebleeds

Formula Patterns Suitable For (if applicable)
Bai He Di Huang Tang Heat in the Blood
Qing Re Gu Jing Tang Heat in the Blood

All "formulas that invigorate blood and dispel blood stagnation" recommended for nosebleeds

Formula Patterns Suitable For (if applicable)
Ge Xia Zhu Yu Tang Liver Blood Stagnation
Shi Xiao San Liver Blood Stagnation

Acupoints for Nosebleeds

TCM also incorporates acupuncture as a treatment for nosebleeds, targeting specific points that can help control acute symptoms and correct underlying imbalances. For example, Chengjin BL-56 and Feiyang BL-58 are points on the Bladder meridian that can relax sinews and strengthen Kidney Qi, respectively, both of which are beneficial for managing blood flow and systemic Heat.

Other points like Fengmen BL-12 and Ganshu BL-18 are used to expel Wind and nourish Liver Blood, directly influencing factors that contribute to nasal bleeding. These targeted interventions are part of a broader strategy to harmonize the body’s energies and prevent the recurrence of nosebleeds.

Explore below some acupoints used to address nosebleeds, organized by meridian.

  • By Meridian
  • Bladder Channel
  • Governing Vessel
  • Large Intestine Channel
  • Small Intestine Channel
  • Gall Bladder Channel
  • Stomach Channel
  • Triple Burner Channel
  • Extra Points: Head and Neck (EX-HN)
  • Lung Channel
  • Pericardium Channel
  • Spleen Channel
  • Heart Channel
Zanzhu BL-2

Zanzhu BL-2

On the medial extremity of the eyebrow, or on the supraorbital notch.

Qucha BL-4

Qucha BL-4

0.5 cun superior to the anterior hairline and 1.5 cun lateral to the anterior midline, at the junction of the medial third and lateral two-thirds of the distance from anterior midline to Touwei ST-8.

Tongtian BL-7

Tongtian BL-7

1.5 cun lateral to the anterior midline and 4 cun within the anterior hairline.

Fengmen BL-12

Fengmen BL-12

1.5 cun lateral to the lower border of the spinous process of the 2nd thoracic vertebra (T2).

Geshu BL-17

Geshu BL-17

1.5 cun lateral to the lower border of the spinous process of the 7th thoracic vertebra (T7).

Ganshu BL-18

Ganshu BL-18

1.5 cun lateral to the lower border of the spinous process of the 9th thoracic vertebra (T9).

Shangliao BL-31

Shangliao BL-31

In the 1st posterior sacral foramen, about midway between the posterior superior iliac spine (PSIS) and the midline.

Yixi BL-45

Yixi BL-45

3 cun (about 4 finger-breadths) lateral to the lower border of the spinous process of the 6th thoracic vertebra (T6).

Chengjin BL-56

Chengjin BL-56

5 cun inferior to Weizhong BL-40 which is the midpoint of the popliteal crease. In the center of the belly of gastrocnemius muscle, midway between Heyang BL-55 and Chengshan BL-57.

Feiyang BL-58

Feiyang BL-58

On the posterior border of fibula, about 1 cun inferior and lateral to Chengshan BL-57, 7 cun directly above Kunlun BL-60.

Kunlun BL-60

Kunlun BL-60

In the depression between the tip of the lateral malleolus and the Achilles tendon.

Zutonggu BL-66

Zutonggu BL-66

In the depression distal and inferior to the 5th metatarsophalangeal joint, at the lateral border of the foot.

Baihui DU-20

Baihui DU-20

At the vertex, at the junction of a line connecting the apex of the ears and the midline, in the depression 7 cun above the posterior hairline and 5 cun behind the anterior hairline.

Xinhui DU-22

Xinhui DU-22

On the head midline, 3 cun anterior to Baihui DU-20, 2 cun posterior to the front hairline.

Shangxing DU-23

Shangxing DU-23

On the head midline, 1 cun within anterior to the front hairline, 4 cun anterior to Baihui DU-20.

Shenting DU-24

Shenting DU-24

On the head midline, 0.5 cun above the anterior hairline.

Suliao DU-25

Suliao DU-25

In a depression on the tip of the nose.

Renzhong DU-26

Renzhong DU-26

Below the nose, a little above the midpoint of the philtrum.

Duiduan DU-27

Duiduan DU-27

On the midline, at the junction of the philtrum and the upper lip.

Hegu LI-4

Hegu LI-4

Between the 1st and 2nd metacarpal bones, approximately in the middle of the 2nd metacarpal bone on the radial side.

Yangxi LI-5

Yangxi LI-5

On the radial side of the wrist. When the thumb is tilted upward, it is in the depression on the wrist joint space (wrist crease) between the tendons of extensor pollicis longus and brevis muscles.

Pianli LI-6

Pianli LI-6

3 cun above Yangxi LI-5, on the line joining Yangxi LI-5 and Quchi LI-11.

Kouheliao LI-19

Kouheliao LI-19

Directly below the lateral margin of the nostril, level with Renzhong DU-26.

Yingxiang LI-20

Yingxiang LI-20

In the nasolabrial groove, at the level of the midpoint of the lateral border of ala nasi.

Shaoze SI-1

Shaoze SI-1

On the ulnar side of the little finger, about 0.1 cun posterior to the corner of the nail.

Qiangu SI-2

Qiangu SI-2

On the ulnar aspect of the little finger, distal to the metacarpophalangeal joint, at the junction of the shaft and the base of the proximal phalanx.

Houxi SI-3

Houxi SI-3

Proximal to the head of the 5th metacarpal bone on the ulnar side, in the depression at the junction of the red and white skin.

Chengling  GB-18

Chengling GB-18

1.5 cun posterior to Zhengying GB-17 or 4 cun posterior to the anterior hairline. Or 1 cun anterior and 2.25 cun lateral to Baihui DU-20, which is at the vertex of the head.

Naokong GB-19

Naokong GB-19

Directly above Fengchi GB-20, level with Naohu DU-17, on the lateral side of the external occipital protuberance.

Juliao ST-3

Juliao ST-3

Directly below Sibai ST-2, at the level of the lower border of ala nasi.

Lidui ST-45

Lidui ST-45

On the lateral side of the 2nd toe, about 0.1 cun posterior to the corner of nail.

Waiguan TB-5

Waiguan TB-5

2 cun above Yangchi TB-4 at the dorsal wrist joint space, between the radius and ulna.

Tianyou TB-16

Tianyou TB-16

Posterior and inferior to the mastoid process, on the posterior border of sternocleidomastoid muscle, level with Tianrong SI-17 and Tianzhu BL-10.

Shangyingxiang EX-HN-8

Shangyingxiang EX-HN-8

At the upper end of the nasiolabial groove, at the junction of the maxilla and the nasal cavity.

Tianfu LU-3

Tianfu LU-3

On the medial aspect of the upper arm, 3 cun below the end of the axillary fold and 6 cun above Chize LU-5, in the depression on the lateral border of biceps muscle.

Ximen P-4

Ximen P-4

5 cun above the transverse crease of the wrist, on the line connecting Quze P-3 and Daling P-7, between the tendons of palmaris longus and flexor carpi radialis muscles.

Yinbai SP-1

Yinbai SP-1

On the medial side of the big toe, about 0.1 cun posterior to the corner of the nail.

Yinxi HE-6

Yinxi HE-6

On the radial side of the tendon of flexor carpi ulnaris muscle, 0.5 cun above the transverse crease of the wrist when the palm faces upward.