咯血之症生焉。中年之辈，由劳碌伤阴，阴气内虚，最易怒动肝火。火迫其血，血遂上溢。始也咯血不咳嗽；
既而胃气失降，肺脏为相火煽灼，或稍感微邪，渐增咳嗽，劳损成矣。夫咯血易
治，咳嗽难医。所以然者，咯血为火炎迫血，气逆血溢，寻其源而清之，降之，养之，和之，或不因火迫而吐
者，亦随其证而调之，无有不止者。若咳嗽则下焦阴气既虚，胃气逆而肺气亦耗，
阴火时时上炎，肺无宁静之日，愈咳愈伤，愈伤愈咳，不至水涸、金枯、土败不已。故咯血证一加咳嗽，十死
八九。亦有先咳嗽而后带血者，此先损其肺，后及其肾也。其寒热者，营卫虚而
金火相争也。盗汗者，肺气虚而卫不固，营为热迫也。咽痛者，肺阴枯而虚火上冲。便溏者，脾不守而金绝土
败，死期至矣。即越人上损下损及中不治之谓，盖后天之生生亦绝矣，此论阴虚咳血则
然。若不由阴虚者，如痰饮久咳，胃气逆而络伤，过饥过饱，疾行伤其胃络，郁热壅于肺胃，负重努力，
斗殴伤络，更有妇人肝经壅热，经不顺行，皆有咯血呕血证，未可见血即事滋阴凉降，须
求其本而治之。夫治血莫若顺气。气为血帅，气降而血自降，气顺而血自归经。即咳嗽一证，切勿沾沾治肺。
盖咳虽属肺，其致咳不在肺而在肾。夫肾，藏精者也。肾藏精虚，肾气无所根据恋，
上冲阳明，煽动肺脏，胃气逆不得降，肺欲不咳，安可得乎？古人谓肺犹钟也，钟不自鸣，有击之而后鸣。
医者不去其鸣钟之具，而日磨沙其钟，钟破而鸣如故。此言深有至理。王应震云∶
见痰休治痰，见血休治血；喘生勿耗气，遗精不渗泄，明得此中趣，方是医中杰。当三复斯言。
The symptom of hemoptysis (coughing up blood) arises. For individuals in middle age, excessive labor damages Yin fluids, leading to internal deficiency of Yin Qi, which makes them most susceptible to stirring up Liver Fire (Liver Fire). The fire forces the blood to move recklessly, causing it to overflow upwards. Initially, there is hemoptysis without coughing; subsequently, Stomach Qi fails to descend, and the Lung organ is scorched by Ministerial Fire (Xiang Huo), or slightly affected by minor external pathogens, gradually increasing cough symptoms, resulting in consumptive disease. Hemoptysis is easy to treat, but cough is difficult to cure. The reason is that hemoptysis is caused by fire blazing and forcing blood, with Qi rebellion leading to blood overflow. By seeking the source and clearing, descending, nourishing, and harmonizing it, or for those not vomiting blood due to fire forcing, adjusting according to the syndrome, there is no case where bleeding cannot be stopped. However, if cough occurs, the Yin Qi of the lower jiao is already deficient, Stomach Qi rebels, and Lung Qi is also exhausted. Deficient fire flares up from time to time, leaving the Lung without a day of tranquility. The more one coughs, the more damage occurs; the more damaged, the more one coughs, until fluids are dried up, Metal (Lung) is withered, and Earth (Spleen) collapses. Therefore, when hemoptysis is accompanied by cough, eight or nine out of ten cases are fatal. There are also cases where cough precedes blood-streaked sputum; this indicates prior damage to the Lung followed by involvement of the Kidney. The presence of chills and fever signifies deficiency of Ying and Wei (Nutritive and Defensive Qi) with conflict between Metal (Lung) and Fire (Heart). Night sweats indicate Lung Qi deficiency and failure of Wei Qi to secure the exterior, with Ying Yin forced by heat. Sore throat results from withered Lung Yin and upward rushing of deficient fire. Loose stools indicate Spleen Earth failing to hold, leading to the extinction of Lung Metal and collapse of Spleen Earth, signaling the approach of death. This refers to Bian Que's concept of upper, lower, and middle damage being incurable, as the generative source of the acquired post-heaven constitution is also cut off. This discussion applies specifically to Yin-deficiency hemoptysis. If not caused by Yin deficiency, such as chronic cough due to Phlegm-Fluids (Tan Yin), where Stomach Qi rebels and collaterals are damaged; over-hunger or over-eating; rapid walking damaging Stomach collaterals; stagnant heat obstructing the Lung and Stomach; bearing heavy loads and straining; fighting injuring collaterals; or women with stagnant heat in the Liver Channel and irregular menstruation, all can present with hemoptysis or hematemesis (vomiting blood). One must not immediately resort to nourishing Yin, cooling, and descending upon seeing blood; rather, one must seek the root cause to treat it. In treating bleeding, nothing is better than regulating Qi. Qi is the commander of Blood; when Qi descends, Blood naturally descends; when Qi flows smoothly, Blood naturally returns to its vessels. Even in the case of cough, one must not solely focus on treating the Lung. Although cough belongs to the Lung, the cause of cough lies not in the Lung but in the Kidney. The Kidney stores Essence (Jing). When Kidney Essence storage is deficient, Kidney Qi has no foundation or attachment, rushes upward into the Yangming Stomach channel, and stirs up the Lung. With Stomach Qi rebelling and unable to descend, how can the Lung avoid coughing? Ancients said the Lung is like a bell; a bell does not ring by itself but rings when struck. If a physician removes not the instrument striking the bell but instead polishes the sand within the bell daily, the bell will break while the ringing continues as before. This statement holds profound truth. Wang Yingzhen stated: "When seeing phlegm, do not merely treat phlegm; when seeing blood, do not merely treat blood; when wheezing arises, do not deplete Qi; when spermatorrhea occurs, do not merely use draining methods. To understand the essence of these principles is to be a hero among physicians." These words should be repeated and reflected upon frequently.