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The *Neijing* (Inner Canon) states: Ying Qi (Nutritive Qi), which is the refined essence derived from water and grain, harmonizes within the five Zang organs, spreads throughout the six Fu organs, and then enters the vessels. It originates continuously, is transformed by the Spleen, governed by the Heart, stored by the Liver, distributed by the Lungs, and excreted by the Kidneys, irrigating the entire body. Its entry, exit, ascent, and descent all follow specific regulations. Therefore, the eyes can see when nourished by it, the ears can hear when nourished by it, the hands can grasp when nourished by it, the palms can grip when nourished by it, and the feet can walk when nourished by it. If proper nourishment and regulation are insufficient, leading to internal hyperactivity of Ministerial Fire (Xiang Huo) or external invasion of cold and heat pathogens, the Qi and Blood will disrupt their normal order, giving rise to disease.

In cases where Yang is excessive and Yin blood is deficient, with only ascending and no descending movement, Blood follows Qi upward and escapes through the upper orifices, manifesting as epistaxis (nosebleed). Thus, blood flowing from the nose is called "Nu Xue" (Nasal Hemorrhage), because the nasal orifice connects to the brain; Fire Qi rushes upward to the brain. Additionally, since the Lung orifice opens at the nose, this indicates internal inflammation of Fire scorching Metal (Lung). Blood flowing from the mouth is called "Tu Xue" (Hematemesis/Vomiting Blood), which further differentiates into "Ou Xue" (Vomiting Blood with sound), "Lo Xue" (Spitting Blood), "Ke Xue" (Coughing Blood), and "Sou Xue" (Sputtering Blood).

"Tu Xue" refers to blood flowing out without sound. A single episode may yield volumes measured in sheng (a unit of volume), even reaching dou (a larger unit), causing sudden pallor and generalized flaccidity. This is caused by Fire Qi of the Stomach Meridian of Yangming reversing upward. Although the syndrome appears as extreme Yin deficiency, it is actually relatively easy to treat because the pathogen is superficial and located in the Fu organs, not yet damaging the Yin of the Zang organs. Furthermore, the Yangming meridian is rich in both Qi and Blood.

"Ou Xue" refers to blood accompanied by the sound of retching/vomiting prior to expulsion. The blood is invariably dark purple and clotted, accompanied by hypochondriac pain, internal heat, chest oppression, and irritability. This is caused by Fire Qi of the Liver Jueyin Meridian, often resulting from severe anger and disharmony of Qi. Urgent treatment should focus on descending Qi and clearing Fire. Since the Liver is a Yin organ and the "Sea of Blood," its Qi must remain quiet and stable. Any disturbance causes the Chong Mai (Penetrating Vessel) to boil, akin to waves rising in the ocean, inevitably crashing against the sky and shaking islands. If left untreated, it will lead to uncontrollable upward hemorrhage and death.

"Lo Xue" refers to blood expelled from the throat preceded by itching. When itchy, the expectorated material is purely blood, which may be bright red or purplish, sometimes mixed with phlegm. Symptoms include dry mouth, dry throat, and palpitations due to Heart emptiness. This is caused by excessive activity of the Jun Fire (Monarch Fire) of the Hand Shaoyin Meridian. It may also result from Summerheat-Heat damaging the Heart in summer months. Treatment should clear the Heart and descend Fire. If caused by emotional contemplation/stress, self-regulation is advised. If one allows such conditions to run rampant, even the finest elixirs cannot cure Heart disease.

"Ke Xue" refers to symptoms where coughing precedes the condition; persistent coughing eventually produces fresh blood. This is what the world calls "Xu Lao" (Consumptive Disease). If red threads appear in sputum, it is termed "Fei Wei" (Lung Atrophy/Fistula). Both are caused by depletion of Yin Essence and extreme hyperactivity of Yang Fire, which consumes/scorches Lung Metal. These conditions have a mortality rate of 80-90% and are extremely difficult to treat.

"Sou Xue" refers to patients who do not typically suffer from coughs nor produce coughing sounds, but blood appears specifically during productive coughing (sputtering). Symptoms include weakness in the four limbs and possibly diarrhea. This is caused by stagnation injuring the Spleen Qi or prolonged sitting/lying damaging Yuan Qi (True Qi). Treatment should tonify True Yuan. Herbs like Ren Shen (Ginseng Root) and Wei Jiang (Baked Ginger) may be selected. However, bitter and drying herbs are contraindicated, as bitterness damages Yang and dryness damages Yin.

"Tuo Xue" refers to fresh blood appearing mixed with saliva. Symptoms include bone-steaming tidal fever, internal heat, dry cough, and emaciation. This is caused by exhaustion of Kidney Water, allowing Fire to invade internally, or excessive sexual intercourse leading to Yin deficiency and Fire hyperactivity. Like pulmonary Ke Xue, this is a critical prognosis. Treating this requires exhaustive medical skill to reverse the situation; one cannot rely solely on knowledge of herbs.

Furthermore, blood flowing from the gums is called "Ya Xuan" (Gum Bleeding/Dental Caries with Bleeding), caused by Fire in the Stomach and Kidney.

Blood flowing from sweat pores is called "Ji Nu" (Cutaneous Purpura/Skin Epistaxis). Blood flowing from the tongue is called "She Nu" (Tongue Hemorrhage), caused by Heat in the Heart and Liver. These are all manifestations of blood disorders in the upper body.

Diseases manifesting in the lower body involve the stool, presenting as differences between Chang Feng (Intestinal Wind), Zang Du (Visceral Toxin), Zhi Xia (Dysentery), and Bian Hong (Bright Red Blood in Stool); and involve the urine, presenting as differences between Chi Lin (Painful Urination with Blood), Niao Xue (Hematuria), Dai Xia (Leukorrhea), and Beng Zhong (Metrorrhagia/Uterine Bleeding).

Chang Feng occurs when the intestines and stomach accumulate heat; extreme heat generates wind, or external pathogens penetrate the intestinal space. The blood color is necessarily pale/clear.

Zang Du results from a preference for rich/greasy foods, indulgence in alcohol, or excessive use of hot-natured drugs, causing toxin accumulation in the viscera. The blood color is necessarily turbid/muddy.

The cause of Zhi Xia is mostly damp-heat steaming and stasis, so pus and blood are mixed, accompanied by tenesmus (straining with little output).

Bian Hong is mostly caused by initial Spleen Qi deficiency failing to control blood, resulting in blood without pus, and defecation without sound.

Chi Lin involves painful, obstructed urination; the method should be clearing and draining.

Niao Xue is simply seeing red in the urine; the method should be cooling and resolving.

Dai Xia refers to menstrual flow dripping continuously, like an unbroken belt.

Beng Zhong refers to blood gushing downward violently and flowing uncontrollably. These two occur frequently in women and represent blood disorders manifesting in the lower body.

Diseases manifesting internally: if Heat overcomes Yin, sores and ulcers will erupt; if Dampness stagnates in the Blood, pain, itching, and urticaria will arise; if stagnation affects the skin and hair follicles, Cold Bi (painful obstruction) forms; if muscles are damaged, broken injuries occur.

Diseases manifesting externally: falls and blows leave blood stasis causing pain; confrontation with cold causes condensation forming mass lesions (Jia).

Stasis accumulating in the Upper Jiao causes mental confusion/manic behavior; stasis accumulating in the Lower Jiao causes behavior resembling madness. These are blood disorders manifesting internally and externally.

Ancients said: Blood values tranquility and dislikes dispersal/agitation; agitation risks overflow. Also: Blood favors circulation and opposes stagnation; stagnation risks fixed stasis. If one can properly regulate Ying Qi, keeping it quiet enough to avoid stagnation yet circulating enough to avoid reckless movement, then meridians will flow smoothly, skin will be moist, sinews and bones strong, and joints clear. How could diseases like those mentioned above exist?