凡咳血嗽血者，诸家皆言其出于肺；咯血唾血者，皆言其出于肾。是岂足以尽之？而不
知咳、嗽、咯、唾等血，无不有关于肾也。何也？盖肾脉从肾上贯肝膈，入肺中，循喉咙，
挟舌本，其支者从肺出络心，注胸中，此肺肾相联而病则俱病矣。且血本精类，而肾主五液
。故凡病血者，虽有五脏之辨，然无不由于水亏。水亏则火盛，火盛则刑金，金病则肺燥，
肺燥则络伤而嗽血，液涸而成痰。此其病标固在肺，而病本则在肾也。苟欲舍肾而治血，终
非治之善者。第肾中自有水火，水虚本不能滋养，火虚尤不能化生，有善窥水火之微者，则
洞垣之目无过是矣。
一、咳血、嗽血，皆从肺窍中出，虽若同类，而实有不同也。盖咳血者少痰，其出较难
；嗽血者多痰，其出较易。咳而少痰者，水竭于下，液涸于上也，亦名干嗽。嗽而多痰者，
水泛于上，血化为痰也，亦谓之白血。此二者之治，虽皆宜壮水补阴，凡一阴煎、四阴煎、
六味地黄汤、麦门冬汤、天门冬丸、贝母丸之类，皆必用之药也。然干咳者，宜加滋润为佐
，如天冬、麦冬、百合、柏子仁、茜根之属，或当归亦可酌用；多痰者宜加清降为佐，如贝
母、海石、阿胶、竹沥之属，而当归则非所宜也。
王节斋曰∶大抵咳嗽见血，多是肺受热邪，气得热而变为火，火盛而阴血不宁，从火上
升，故治宜泻火滋阴，忌用人参等甘温之药。然亦有气虚而咳血者，则宜用人参黄 、款冬
花等药，但此等证不多耳。
愚意王氏之说，乃多以火证为言。故凡治血因火动而为咳嗽者，则不得不于滋阴药中加
清火等剂。如黄芩、桑皮清肺火，黄连清心火，石膏清胃火，栀子、龙胆草清肝火，黄柏、
知母清肾火，贝母、栝蒌、竹叶、枇杷叶润肺化痰。此等治法，非不可用，然惟火之偶盛而
根本未亏者，则但去其火，自无不愈。若用此法概治劳损，总不过暂解燃眉，终非救本之道
。盖凡阴虚生火等证，多以真阴受伤，水亏而然。此其所重在阴，不当在火。若治火太过，
则未免脾肾俱败，必致不救，此所以虚火宜补也。且常有过服天冬、生地之类，致伤胃气，
不能生金而不愈者；又有妄用黄柏、知母之属，愈损真阴，遏绝生气而不复者。此又伤而复
伤，则尤为脾肺肾三阴亏损之害。故凡欲壮水补阴者，无如一阴煎、左归饮，或五阴煎、五
福饮、大补元煎、六味地黄丸等方，斯为最妥。其有火本无根，化元失守，或误用寒凉而病
及脾肺，则有以寒在上焦而为呕恶，为短气，为眩运者；有以寒在中焦而为膨满，为痰涎，
为饮食不运者；有以寒在下焦而为溏泄，为腹痛，为小水不化，为足寒膝冷等证，则理中汤
、理阴煎，或右归饮、右归丸、八味地黄丸之类，皆当随证随脏择而用之。勿谓见血者多是
肺受热邪，而但知滋阴降火，则必多为人害矣。
For those with hemoptysis (coughing up blood) and sputtering of blood, various schools state that the origin lies in the Lung; for those with spitting of blood and saliva, it is stated that the origin lies in the Kidney. How can this be sufficient to cover all cases? They fail to realize that bleeding from coughing, sputtering, spitting, and salivating are all related to the Kidney. Why? Because the Kidney Meridian ascends from the Kidney, passes through the Liver and Diaphragm, enters the Lung, follows the throat, and flanks the root of the tongue. Its branch emerges from the Lung, connects with the Heart, and pours into the chest. This indicates the connection between the Lung and Kidney; when disease occurs, both organs are affected. Moreover, blood belongs to the category of Essence (Jing), and the Kidney governs the Five Fluids. Therefore, for any disease involving blood, although differentiation by the Five Zang Organs is possible, it invariably stems from a deficiency of Water (Kidney Yin). When Water is deficient, Fire becomes excessive. Excessive Fire damages Metal (the Lung element), causing Lung Dryness. Lung Dryness injures the collaterals, leading to coughing up blood, while fluid depletion results in phlegm. Thus, the manifestation of the disease is in the Lung, but the root lies in the Kidney. To treat blood disorders by neglecting the Kidney is ultimately not a good therapeutic approach. However, the Kidney contains both Water and Fire. If Water is deficient, it cannot nourish; if Fire is deficient, it cannot transform. One who skillfully observes the subtle balance of Water and Fire can see through the internal organs clearly.
1. Hemoptysis and sputtering of blood both originate from the Lung orifice. Although they appear similar, there are differences. In hemoptysis, there is little phlegm, and expulsion is difficult; in sputtering of blood, there is much phlegm, and expulsion is easier. Coughing with little phlegm indicates exhaustion of Water below and drying of fluids above, also known as dry cough. Coughing with much phlegm indicates water flooding upwards, where blood transforms into phlegm, also called white blood. For the treatment of both, strengthening Water and tonifying Yin is appropriate. Formulas such as Yi Yin Decoction (One-Yin Decoction), Si Yin Decoction (Four-Yin Decoction), Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Pill), Mai Men Dong Tang (Ophiopogon Decoction), Tian Men Dong Wan (Asparagus Pill), and Bei Mu Wan (Fritillaria Pill) are essential. For dry cough, moistening herbs should be added as auxiliaries, such as Tian Dong (Asparagi Radix), Mai Dong (Ophiopogonis Radix), Bai He (Lilii Bulbus), Bai Zi Ren (Biota Seed), Qian Gen (Rubiae Radix), or Dang Gui (Angelicae Sinensis Radix) may be used酌情ly. For excessive phlegm, clearing and descending herbs should be added as auxiliaries, such as Bei Mu (Fritillariae Bulbus), Hai Shi (Silex Siliceus), E Jiao (Colla Corii Asini), Zhu Li (Bambusa Textilis Sap), whereas Dang Gui is unsuitable.
Wang Jiezhai stated: Generally, cough with blood is mostly due to Heat-Evil affecting the Lung. Qi transforms into Fire under the influence of Heat. When Fire is excessive, Yin Blood becomes unsettled and rises with the Fire. Therefore, treatment should focus on purging Fire and nourishing Yin, avoiding sweet-warm herbs like Ren Shen (Ginseng Radix). However, there are cases of coughing up blood due to Qi Deficiency, which should be treated with Ren Shen, Huang Qi (Astragali Radix), and Kuan Dong Hua (Farflos Flos), though such cases are rare.
In my opinion, Wang’s theory focuses mainly on Fire syndromes. Thus, for treating cough caused by Fire stirring blood, one must add fire-clearing agents to Yin-nourishing formulas. For example, Huang Qin (Scutellariae Radix) and Sang Bai Pi (Mori Cortex) clear Lung Fire; Huang Lian (Coptidis Rhizoma) clears Heart Fire; Shi Gao (Gypsum Fibrosum) clears Stomach Fire; Zhi Zi (Gardeniae Fructus) and Long Dan Cao (Gentianae Radix) clear Liver Fire; Huang Bo (Phellodendri Cortex) and Zhi Mu (Anemarrhenae Rhizoma) clear Kidney Fire; Bei Mu, Gua Lou (Trichosanthis Fructus), Zhu Ye (Bambusa Leaf), and Pi Pa Ye (Loquat Leaf) moisten the Lung and resolve phlegm. These methods are usable, but only when Fire is occasionally excessive and the root is not yet depleted will removing the Fire lead to recovery. Using these methods universally for consumptive diseases (Lao Sun) merely provides temporary relief and is not a fundamental cure. Most Yin-deficiency generating Fire syndromes result from injury to True Yin and Water deficiency. The emphasis here should be on Yin, not on Fire. Over-treating Fire may damage both Spleen and Kidney, leading to untreatable conditions. This is why deficient Fire requires tonification. Furthermore, overuse of Tian Dong and Sheng Di Huang (Rehmanniae Radix) may damage Stomach Qi, preventing the generation of Lung Metal and hindering recovery. Reckless use of Huang Bo and Zhi Mu may further deplete True Yin, suppressing vital energy and preventing restoration. This double injury causes severe deficiency of the Yin of the Spleen, Lung, and Kidney. Therefore, for strengthening Water and tonifying Yin, formulas such as Yi Yin Decoction, Zuo Gui Yin (Left Restoring Drink), Wu Yin Decoction (Five-Yin Decoction), Wu Fu Yin (Five-Fortune Drink), Da Bu Yuan Jian (Great Tonification Decoction), and Liu Wei Di Huang Wan are most appropriate. If Fire has no root, transformation Yuan is lost, or cold-cooling herbs were mistakenly used damaging Spleen and Lung, symptoms may include vomiting, nausea, shortness of breath, and dizziness due to Cold in the Upper Jiao; abdominal distension, phlegm-saliva, and poor digestion due to Cold in the Middle Jiao; loose stools, abdominal pain, difficulty urinating, cold feet, and cold knees due to Cold in the Lower Jiao. In such cases, Li Zhong Tang (Regulate the Middle Decoction), Li Yin Jian (Regulate Yin Decoction), You Gui Yin (Right Restoring Drink), You Gui Wan (Right Restoring Pill), or Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill) should be selected according to the syndrome and affected organ. Do not assume that bleeding is always due to Lung Heat and rely solely on nourishing Yin and descending Fire, or you will inevitably harm patients.