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Is bleeding originating solely from the Lung, with no other conditions to discuss? The response is: The Lung not only causes hemoptysis (coughing up blood) but also hematemesis via saliva (spitting blood). This is because the Lung governs Qi; when Qi rebels upward, it causes coughing. The Kidney governs Water; water metabolism transforms into saliva. The Kidney meridian enters the Lung, follows the throat, and clamps the base of the tongue; its branch emerges from the Lung, connects with the Heart, and pours into the chest. Thus, these two organs are interconnected, and when diseased, both are affected, leading to both coughing and spitting of blood. However, distinctions can be made: if a small amount of blood is scattered diffusely in saliva, this is blood caused by the flare-up of Ministerial Fire (Xiang Huo) from the Kidney. If the blood appears like red threads within phlegm and is coughed out, this is blood resulting from heat injuring the Lung collaterals, a condition that is difficult to cure. If white blood is coughed up, death is certain. White blood is pale red, resembling flesh or lung tissue. Nevertheless, the Liver can also cause spitting of blood. The Liver stores Blood, while the Lung stores Qi. When Liver Blood fails to be stored, chaotic Qi rebels upward from both hypochondriac regions and is expelled through saliva. The *Nei Jing* (Inner Canon) describes the syndrome of Blood Depletion (Xue Ku), where spitting of blood occurs first, due to Qi exhaustion injuring the Liver. There is also expectoration of blood (Ke Xue), which differs slightly from spitting (Tuo). Spitting arises from Qi, with no obstruction above; expectoration arises from Phlegm, where Qi is stagnant below the throat and cannot exit upward, requiring forceful expulsion to come out. Investigating the organ associated with the disease, both expectoration and spitting belong to the Kidney. I once treated three patients who did not cough or spit but had blood appearing in the mouth, flowing from between the teeth and under the tongue. Each time, I used methods to nourish Kidney Water and drain Ministerial Fire, resulting in recovery within ten days. I also treated one patient who suffered from coughing and spitting blood due to worry, with a dark, sallow complexion; medication was ineffective. I said: "This must be resolved through joy." His brother found him a place sufficient for food and clothing, causing great joy. Immediately, his complexion faded, and he recovered without medication. The Classics state: "In treating diseases, one must seek the root." And again: "Do not neglect the appropriateness of Qi (climate/environment)." From this, we know that medicinal treatment must align with the Qi characteristics of the disease. If the specific circumstances of the illness are not examined, even medication will fail to cure.

This passage originates from the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), stating that heat in the Upper Jiao (Upper Burner) leads to Lung Flaccidity (Fei Wei) due to coughing. Lung Flaccidity may result from excessive sweating, vomiting, Xiao Ke (Wasting and Thirsting syndrome) with frequent urination, constipation, or overuse of harsh purgatives, all of which severely deplete Body Fluids (Jin Ye). Consequently, the Cun Kou pulse is rapid, accompanied by coughing and the presence of turbid saliva and froth in the mouth. Tracing the intent, this expands upon the flaccidity syndromes in the *Nei Jing*. It occurs when Zang Qi fails to distribute Ying and Wei (Nutritive and Defensive Qi) and circulate Jin Ye, instead becoming stagnant and transforming into heat, aggregating into frothy saliva and turbid secretions before inducing cough. Therefore, supplementary formulas include Zhi Gan Cao Tang (Honey-Fried Licorice Decoction) or Sheng Jiang Ren Shen Da Zao Tang (Fresh Ginger, Ginseng, and Jujube Decoction); the general therapeutic principle is similar. Furthermore, it states that in Lung Flaccidity, if there is spitting of saliva without coughing, and the patient is not thirsty but suffers from enuresis and frequent urination, this is due to Upper Jiao deficiency failing to control the Lower Jiao. This indicates Cold in the Lung, characterized by coughing with abundant saliva, treated with Gan Cao Sheng Jiang Tang (Licorice and Fresh Ginger Decoction) to warm the Lung. If thirst develops after taking the decoction, it belongs to Xiao Ke (Wasting and Thirsting syndrome), distinguishing this treatment from the earlier Upper Jiao Heat syndrome. Upper Jiao Heat causes stagnation, drying and obstructing the Lung's Xuan Fu (pores/ventilation openings), leading to cough due to impaired Qi movement and thirst due to lack of fluid distribution. The mention of "Cold in the Lung" does not imply external cold or cold drinks invading the interior, but rather refers to Cold due to the absence of Yang Qi in the Upper Jiao. Insufficient Yang Qi fails to generate heat; without heat, there is neither cough nor thirst, only Qi deficiency failing to regulate water pathways. The Lung and Kidney are connected organs; Lung deficiency leads to Kidney deficiency. Thus, water entering the throat reaches the Kidney directly, and the Kidney fails to distribute water essence to the five Zang organs, excreting it directly as urine.