一、咯血唾血，古皆云出于肾；痰涎之血，云出于于脾。此亦未必然也。凡咯血者，于
喉中微咯即出，非若咳血、嗽血之费力而甚也。大都咳嗽而出者出于脏，出于脏者其来远；
一咯而出者出于喉，出于喉者其来近，其来远者，内伤已甚，其来近者，不过在经络之间，
所以凡见咯血、唾血及痰涎中带血者，多无咳嗽发热，气喘骨蒸等证，此其轻重为可知矣。
治此之法，凡因火者，亦不过微清脾肺之火；或因劳倦而致者，但为养营补阴，则自无不愈
。
一、劳损之渐者，必初因酒色劳伤过度，以致痰中或见血丝，此则本于肝脾肾经。当于
未咳未嗽之先，速为调理，宜生地、熟地、天冬、麦冬、枣仁、茯神、茜根、贝母、甘草之
属主之。或有火者，宜加黄柏、知母，仍须加意谨慎，庶无后患，否则必渐甚也。
一、清晨初起时，每于痰中有淡紫凝血，或块或片，常见数口者，此多以操心动火，或
多思郁，或由过饮，但无咳嗽发热等证，即不足虑，此不过致动络血而然，惟天王补心丹，
或二阴煎之类最所宜也。
薛立斋曰∶若脾经气滞而痰中有血者，宜加味归脾汤。若肝经血热而痰中有血，宜加味
逍遥散。若肝肾阴虚而痰中有血，宜六味地黄丸。若过服寒凉而唾痰有血者，宜四君子类。
1. Hemoptysis (coughing up blood from the throat) and spitting of blood are traditionally said by ancient texts to originate from the Kidney; blood in phlegm and saliva is said to originate from the Spleen. This is not necessarily true. In cases of hemoptysis, the blood is expectorated with slight effort from the throat, unlike ke-xue (coughing up blood from the lungs) or sou-xue (spitting blood), which require significant effort and are more severe. Generally speaking, blood expelled through coughing originates from the Zang organs; since it comes from the Zang organs, its source is distant (deep). Blood that appears simply by spitting/hawking originates from the throat; since it comes from the throat, its source is proximate (superficial). A distant source indicates severe internal injury, whereas a proximate source implies the pathology is merely within the meridians and collaterals. Therefore, patients presenting with hemoptysis, spitting of blood, or blood in saliva/phlegm usually lack symptoms such as cough, fever, panting, or bone-steaming fever (yin deficiency heat). The severity can thus be determined. The treatment for this condition: if caused by fire, one need only mildly clear the fire of the Spleen and Lung; if caused by fatigue and overexertion, one should nourish Ying (nutritive Qi) and tonify Yin, and recovery will naturally follow.
2. The gradual onset of Lao Sun (consumptive disease due to overstrain) invariably begins with excessive indulgence in alcohol and sexual activity, or physical overexertion, leading to blood streaks in the phlegm. This pathology roots in the Liver, Spleen, and Kidney meridians. One must intervene promptly to regulate the body before coughing or spitting occurs. The primary prescription should include Sheng Di Huang (Rehmanniae Radix), Shu Di Huang (Rehmanniae Radix Preparata), Tian Dong (Asparagi Radix), Mai Dong (Ophiopogonis Radix), Zao Ren (Ziziphi Spinosae Semen), Fu Shen (Poria with Hostwood), Qian Cao Gen (Rubiae Cordifoliae Radix), Bei Mu (Fritillariae Cirrhosae Bulbus), and Gan Cao (Glycyrrhizae Radix et Rhizoma). If fire signs are present, add Huang Bo (Phellodendri Cortex) and Zhi Mu (Anemarrhenae Rhizoma). Caution must still be exercised to prevent future complications; otherwise, the condition will inevitably worsen gradually.
3. Upon waking in the early morning, pale purple coagulated blood clots or flakes are often found in the phlegm, typically appearing in small amounts (a few mouthfuls). This is mostly caused by mental exertion generating fire, excessive thinking and depression, or overindulgence in alcohol. As long as there are no symptoms of cough or fever, there is no cause for concern. This is merely due to the disturbance of collateral vessels causing bleeding. The most suitable treatments are Tian Wang Bu Xin Dan (Emperor of Heaven’s Special Pill to Tonify the Heart) or Er Yin Jian (Two Yin Decoction).
Xue Lizhai stated: If blood in the phlegm is due to Qi stagnation in the Spleen meridian, Jia Wei Gui Pi Tang (Modified Restore the Spleen Decoction) is indicated. If blood in the phlegm is due to blood heat in the Liver meridian, Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) is indicated. If blood in the phlegm is due to Yin deficiency of the Liver and Kidney, Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) is indicated. If blood in saliva/phlegm results from the excessive use of cold-natured drugs, Si Jun Zi Tang class formulas (Four Gentlemen Decoction variants) are indicated.