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The Heart governs the blood; the Liver stores the blood. Excessive worry and overthinking damage the Heart, while anger causing Qi rebellion to ascend without descending damages the Liver. When both the Liver and Heart are damaged, the blood flows and scatters uncontrollably; Qi rebellion leads to vomiting accompanied by bleeding.

Hemoptysis (spitting up blood mixed with saliva) results from damage to the Lung. The Lung is the uppermost cover among the five Zang organs and is easily damaged. If affected by pathogenic heat, hemoptysis occurs. Spitting blood resembling red threads indicates Lung injury. Pain in the hypochondrium accompanied by spitting fresh red blood indicates Liver injury.

The Heart governs the blood vessels and its manifestations are reflected on the tongue. If there is heat in the Heart, blood will bleed from the tongue as if gushing from a spring.

These conditions are caused by damage to the five Zang organs. Once the Qi of the Zang organs is injured, Wind pathogens easily invade, and internal heat can also cause fresh red blood to appear in the stool accompanied by vomiting. Internal cold can also cause blood in the stool, with a color resembling bean juice; it is painful upon discharge but not severely so. Blood appearing after defecation indicates the lesion is distant (in the Upper Jiao); blood appearing before defecation indicates the lesion is near (in the Lower Jiao). "Distant" and "near" refer to lesions in the Upper or Lower Jiao respectively. These symptoms cause a pale complexion, alternating chills and fever, a floating and weak pulse that disappears upon deep pressure, characteristic of lower gastrointestinal bleeding.

The Heart governs blood and pairs with the Small Intestine. If heat accumulates in the Heart and binds to the Small Intestine, it causes hematuria (blood in urine). A rapid and wiry pulse at the lower position indicates Wind pathogen invading the Shaoyin channel, leading to hematuria; a faint and hollow (Kou) pulse at the Chi position also leads to hematuria.

When Ying (Nutritive) and Wei (Defensive) Qi are severely deficient, the Fu and Zang organs become easily damaged, and the blood vessels are emptied. This state, combined with uncontrolled anger, excessive fright and resentment, and violent rebellious Qi overflowing, causes the Couli (skin pores) to open and the blood vessels to scatter uncontrollably. If bleeding occurs from the nine orifices, accompanied by asthma, coughing, Qi rebellion, a rapid pulse with heat, and inability to lie down, the prognosis is fatal.

The Liver stores blood, and the fluid of the Heart manifests as sweat. This means that when both the Liver and Heart are injured by pathogens, blood exudes from the skin and Couli.

The *Yuan Bing Shi* states: "Blood overflow" refers to blood flowing upward. The Heart nourishes itself with blood; thus, when heat is extreme, blood becomes excessive and flows recklessly. Some claim that vomiting purple, coagulated blood indicates cold; this is an error. It is not due to cold condensation, but rather because extreme heat consumes and scorches the blood, making it thick and turbid. Furthermore, extreme heat controls Water (Kidney), so the blood appears red mixed with black, becoming purple. "Nuxue" (epistaxis/nosebleed) occurs when Yang heat stagnates in the Foot-Yangming Stomach channel, causing upper heat and reckless blood flow.

"Nuxue" refers to bloody discharge. "Wu" means turbid. When Heart fire is extreme, blood is excessive; excessive rising heat causes blood overflow. When heat reaches its peak, it dries and turbidifies the blood; when the condition reaches extremity and is controlled, the blood mixes with black to become purple.

"Xixie" (blood leakage) refers to heat lodging in the Lower Jiao, causing blood in both stool and urine.