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Chen Wuzhe stated: Epistaxis (nosebleed) occurs when pathogenic factors such as wind, cold, summer-heat, and dampness invade and spread through the meridians, surging into the airways where clear yang qi circulates; this is classified as an external cause. Accumulated anger injuring the Liver, accumulated sorrow injuring the Lung, excessive worry injuring the Spleen, loss of will injuring the Kidney, and sudden joy injuring the Heart are all emotional disturbances that can agitate blood, causing it to overflow upwards with rebellious Qi into the clear yang airways; these are classified as internal causes. Excessive alcohol consumption, ingestion of roasted or fried spicy and hot foods, or physical trauma from falls or carriage accidents are classified as neither internal nor external causes.

Hematemesis (vomiting blood) may result from external injuries by the four climatic conditions, internal agitation by the seven emotions, or damage due to improper diet, sexual excess, falls, or sprains. These cause Ying Blood to stagnate and accumulate in the diaphragm region until it overflows. This is commonly referred to as "reckless bleeding" or expelling stasis blood, and is termed internal injury.

Hematochezia (blood in stool) may be clear or turbid, bright red or black, occurring before or after defecation, or mixed with feces. This arises from internal or external pathogenic invasion, suspected stagnation in the Stomach, descending with rebellious Qi, and also belongs to the category of reckless bleeding.

Hematuria (blood in urine) is caused by the binding of Qi between the Heart and Kidney, or results from excessive worry, labor, or sexual indulgence. This condition stems from deficiency-cold and cannot be solely attributed to blood becoming fluid due to heat. The two conditions differ from strangury (Lin syndrome).

Upon careful examination: Epistaxis and hematochezia caused by the obstruction of Shaoyang pathogenic factors in the meridians do occur. However, in miscellaneous diseases, they are mostly caused by fire and heat. Bleeding from orifices is often triggered by the movement of the five zang emotions (anger, joy, worry, thought, fear), yin-deficiency with stagnant heat, or internal/external injuries; cases involving cold pathogens are rare. Regarding hematuria caused by sexual exhaustion, it is actually due to the slipping away of essence, yin-deficiency with hyperactive fire, and reckless movement of Ying Blood. The previous assertion that these are due to deficiency-cold is likely incorrect. If the blood in stool is clear, it indicates Ying-blood deficiency with heat; if turbid, it indicates heat combined with dampness; if bright red, it indicates fire; if black, it indicates extreme fire; if mixed with feces, it indicates accumulation or meridian collateral injury. All these should be treated according to differentiation.

For details, see the section on Accumulations and Masses.

Li Dongyuan stated: The Classic says, "Severe rebellion of anger leads to vomiting blood; sudden heat disease with internal rebellion causes the Liver and Lung to clash, resulting in blood overflowing from the nose and mouth." One should select the Tianfu (LU 3) acupoint. Furthermore, the Foot-Shaoyin Kidney Meridian ascends from the Kidney, passes through the Liver, enters the Lung, and follows the throat. Its pathology manifests as hunger without desire to eat, a complexion as dark as earth, and coughing up blood. Qi is Yang, and Blood is Yin. Qi primarily drives movement, while Blood primarily nourishes. Currently, blood moving recklessly and exiting upwards from the nose and mouth is all due to rebellious Qi. Thus, the Classic states, "Yangming reversal, anger causes Qi rebellion, sudden heat with internal rebellion," which refers to this mechanism.

Upon careful examination: Sadness-Qi and Labor-Qi can both lead to blood disorders; for details, see the section on Qi. However, when anger causes blood disorders, the onset is sudden and severe. Therefore, the Classic advises, "Restrain anger to preserve Yin," which is correct. Otherwise, the fire of the five zang emotions becomes excessively active, carrying blood upwards, causing it to flow recklessly into incorrect meridians.