Epistaxis (Ru’af)

Epistaxis (Ru’af)


Epistaxis (Ru’af) also called acute haemorrhage or nose bleed is a medical condition in which bleeding occurs from nasal cavity of the nostril. It is usually noticed when the blood drains out through the nostrils. It occurs due to an accident, trauma to the nose or injury to the interior of the nose from nasal pricking.

Epistaxis (Ru’af) incidence has been reported to occur in up to 60 percent of the general population. The condition has a bimodal distribution, with incidence peaks at ages younger than 10 years and older than 50 years. Epistaxis appears to occur more often in males than in females.

Nosebleed/ Bleeding from nose is a common complaint which is rarely life threatening but may cause significant concern due to the loss of blood.

It is mainly caused by nasal polyp, nasal pustules (Busoor-e- Anf), rupture of vessels due to shiddat-e- imtela (Excessive congestion), increased heat of sanguine (Hiddate- Dam) due to predominance of yellow bile (Ghalba-e- safra) and trauma (chot). It may also occur as a result of crisis of acute disease (Buhran-e- Amraz-e- Hadda).

In case of Excessive congestion (Shiddat-e- imtila) it is preceded by headache and redness of face and eyes. Other clinical features will be according to causative factors.

Common Causes of Nosebleeds/ Epistaxis (Ru’af)

  • Excessive nose-blowing from a cold or allergies
  • Injury to the nose or near the nose
  • Exposure to dry or cold air
  • High blood pressure (Zaght-ud- Dam Qawi)

Types of Epistaxis (Ru’af): It can be classified according to their site of origination as:

  • Anterior Nosebleed
  • Posterior Nosebleed

Anterior Nosebleed is common and does not require medical attention, while posterior nosebleed is rare and requires immediate medical care.

Principles of treatment (Usool-e- Ilaj)

  • To produce cold (Tabreed)
  • Neutralization of causative humour (Taskeen)
  • To make the consistency of sanguine thicker (Takseef-e- Dam)
  • To stop bleeding (Habs-e Dam), but not in case of crisis (Buhran) until the patient’s condition deteriorates
  • To reduce the quantity of food (Taqleel-e- Ghiza)

Pharmacotherapy (Ilaj Bil Dawa)

  • Oral administration of seed of Portulaca oleracea Linn. (Sheera-e- Tukhm-e- Khurfa) and seed of Lactuca sativa Linn. (Sheera-e- Tukhm-e- Kahu) with gum of Sterculia urens Roxb. (Kateera).
  • Oral administration of seed of Lactuca sativa Linn. (Sheera-e- Tukhm-e- Kahu), Zizyphus vulgaris Lamk. (Sheera-e- Unnab) and mucilage of seed of Cydonia oblonga Mill. (Luaab-e- Behidana) alongwith Sharbat-e- Nilofar.
  • Local application of paste prepared with Armanian earth (Gil-e- Armani) mixed with vinegar on scalp
  • Instillation of nasal drop prepared with camphor (Kafur) boiled in vinegar Snuff
  • (Sa’oot) with camphor (Kafoor) 32 mg mixed with 21 gm. Of juice of fresh coriander.
  • Local application of paste prepared with starch (Nashashta) mixed with vinegar on scalp

Compound Drugs

  • Sharbat-e- Anjabaar
  • Sharbat-e- Unnab
  • Sharbat-e- Nilofar
  • Sharbat-e- Khashkhas

Ilaj Bil Tadbeer (Regimenat Therapy)

  • Hijama (Cupping) on nape of the neck
  • Bloodletting through cephalic vein (Fasd-e- Qifal)
  • Sprinkling of cold water on scalp and extremities

Dietary Recommendations

  • Ma-ul- Sha’ir
  • Ma-ul- Jubn
  • Aghziya Mughalliz-e- Dam
  • Aghziya Hamiza wa Qabiza

Dietary Restrictions

  • Aghziya Muraqqiq-e- Dam

Tahaffuz (Prevention/ Precaution)

  • Avoid illegal drugs, smoking and alcohol consumption
  • Rigorous physical activities should be avoided
  • Don’t strain during defecation
  • Control high blood pressure (Zaght-ud- Dam Qawi)
  • Eat cold food items and beverages
  • Sneeze with open mouth
  • Trim fingernails regularly
  • Avoid caffeinated beverages

Steps to Treat a Nosebleed (Ru’af)

  • Remain calm/ Relax
  • Sit or stand upright and lean slightly forward. By remaining upright, you reduce blood pressure in the veins of your nose. This will prevent blood from going down the back of your throat.
  • Breathe through mouth
  • Pinch the nose with your thumb and index finger, just below the bony ridge of the nose.
  • Once the bleeding stops, DO NOT bend over; strain and/or lift anything heavy; and DO NOT blow, rub, or pick your nose for several days.
  • If bleeding has not stopped, apply pressure for 5 to 10 minutes.
  • If bleeding has not stopped after pinching the nose for 10 minutes, apply pressure again for 5 more minutes.
  • If the bleeding has not stopped after 15 minutes, apply an ice pack wrapped in a sterile towel to the bridge of the nose, upper lip, or back of the neck. This may help to constrict the blood vessels and reduce the bleeding
  • If the bleeding has not stopped in 30 minutes, seek medical attention


  • Complete Blood Count (CBC)
  • Bleeding time (BT)
  • Clotting time (CT)
  • Platelet count
  • Peripheral blood film
  • Prothrombin time test
  • X-ray Paranasal Sinuses (Water’s view)

Note: Unani drugs should be taken under the advice of the qualified Unani physician. The patients are required to follow strict Unani regimen for optimum results.


  • PUBLISHED DATE : Jun 03, 2019
  • CREATED / VALIDATED BY : Dr. Mahtab Alam Khan
  • LAST UPDATED ON : Jun 03, 2019


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