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Ke (coughing up blood from the lower respiratory tract) and Sou (coughing) belong to the same category; both arise from the desire to expel phlegm. Whether effortful or effortless, the primary aim is the expulsion of phlegm, not blood. It is only because hemorrhage occurs at that time that blood follows the phlegm out.

Tuo (spitting blood) and Tu (vomiting blood) belong to the same category, resulting from bleeding. This is due to fire-heat forcing blood upward to the throat. If the volume is large, it manifests as vomiting blood; if small, as spitting blood. Neither requires effort, and both consist of pure blood without admixture of saliva or phlegm.

Since Tu and Tuo are categorized together, does vomiting blood necessarily belong to the Stomach, and spitting blood necessarily to the Kidney? The ancients stated that spitting blood belongs to the Kidney because the *Classic* discusses the Five Fluids, stating "The Kidney governs Tuo" (referring to water flooding upwards). Thus, people held this view, but one should not adhere to it rigidly.

Since Ke and Sou are categorized together, the old distinction that Sou belongs to the Lung and Ke belongs to the Kidney is also incorrect. The Kidney meridian enters the Lung; when diseased, both organs are affected. Therefore, the Kidney can have Sou (cough), and the Lung can have Ke (spitting blood).

Then how to distinguish them? I say: Blood disorders originate from Fire. Fright causes Heart-Fire to arise; anger causes Liver-Fire to arise; sorrow causes Lung-Fire to arise; overthinking causes Spleen-Fire to arise; sexual exhaustion causes Kidney-Fire to arise. Carefully examining the etiology will reveal the truth, though words cannot exhaustively describe all cases.

Zhang Jingyue stated that in hemorrhagic syndromes: if panting, chest fullness, cough, and dull distending pain on both sides of the chest and diaphragm are seen, the disease is in the Lung. If there is pulling pain in the chest/diaphragm and Shanzhong (CV17) area, fine like threads, or unbearable mental restlessness and epigastric discomfort indescribable, the disease is in the Pericardium. If the chest and abdomen are distended, with no sense of hunger or satiety, loss of taste for food and drink, and excessive frothy saliva, the disease is in the Spleen. If there is pulling pain in the hypochondrium, irritability/depression, and alternating chills and fever, the disease is in the Liver. If there is shortness of breath resembling panting, hoarseness or aphonia, bone-steaming tidal sweating, dry throat and sore throat, and rebellious Qi rushing upward, the disease is in the Kidney. If there is severe vomiting, irritability, thirst, headache, high fever preventing sleep, the disease is in the Stomach. If there are combined symptoms, the disease involves more than one Zang organ.

For Lung diseases, clearing and descending is appropriate; ascending and dispersing is inappropriate. For Heart diseases, nourying Ying (Nutritive) Blood is appropriate; dissipating and consuming is inappropriate. For Spleen diseases, warming the Middle Jiao is appropriate; sour and cold agents are inappropriate. For Liver diseases, either soothing and draining or sweet and relaxing methods may be appropriate; astringent and stagnating agents are inappropriate. For Kidney diseases, strengthening Water (to control Fire) and nourishing Yin are appropriate; aromatic, drying, and attacking agents are inappropriate. For Stomach diseases, either drastic purging or drastic tonification may be appropriate, depending on an examination of Deficiency and Excess.