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Qin Zi said: Hemoptysis (coughing up blood) is the same as sou-xue (coughing with blood). The symptoms of exogenous hemoptysis are caused by pathogenic factors obstructing the lungs; treatment should be administered based on the specific pathogen, and the disease will heal. Therefore, Dan Xi stated: Obstruction in the lungs is easy to treat, requiring only dispersal and clearing; it is not as difficult to treat as damage to the stomach in internal injury cases.

[Symptoms of Exogenous Sou-Xue] The body presents with aversion to cold and fever, panting and急促 qi rebellion, incessant coughing, sputum mixed with blood, and in severe cases, disturbance of stomach qi leading to vomiting of phlegm and saliva, with food and phlegm expelled together. These are the symptoms of exogenous sou-xue.

[Etiology of Exogenous Sou-Xue] There may be latent fire in the lungs and stomach that has not been cleared, combined with external wind-cold binding the exterior, causing lung heat to stagnate internally. Since the lungs govern the skin and hair, the pathogens cannot be vented and rush upward to the throat. Alternatively, seasonal dry-heat damages lung qi, impairing the clear-descending function, causing rebellion in the "Minister Official" (lungs). Both conditions lead to coughing and spitting blood.

[Pulse of Exogenous Sou-Xue] A floating and large left pulse indicates unresolved exterior pathogens; a rapid and large right cun pulse indicates fire damaging the lungs; or a deep and rapid pulse indicates latent fire in the lungs.

[Treatment of Exogenous Sou-Xue] If exterior pathogens bind the surface, presenting with aversion to cold and fever, coughing with blood, use Xie Bai San (Drain White Powder) plus Jingjie (Schizonepetae Herba), Fangfeng (Saposhnikoviae Radix), Chaihu (Bupleuri Radix), and Gegen (Puerariae Lobatae Radix). If heat pathogens are latent internally, use Xie Bai San plus Gegen (Puerariae Lobatae Radix) and Shigao (Gypsum Fibrosum). If dry-fire damages the lungs, Qing Zao Jiu Fei Tang (Clear Dryness Rescue the Lungs Decoction) is the primary formula.

Xie Bai San (Drain White Powder)
Sangbaidi (Mori Cortex), Digupi (Lycii Cortex), Gancao (Glycyrrhizae Radix et Rhizoma), Jingjiesui (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix)

Another Xie Bai San
Sangbaipi (Mori Cortex), Digupi (Lycii Cortex), Gancao (Glycyrrhizae Radix et Rhizoma), Gegen (Puerariae Lobatae Radix), Shigao (Gypsum Fibrosum)

Qing Zao Jiu Fei Tang (Clear Dryness Rescue the Lungs Decoction)
Sangye (Mori Folium), Shigao (Gypsum Fibrosum), Gancao (Glycyrrhizae Radix et Rhizoma), Renshen (Panacis Ginseng Radix), Sangbaipi (Mori Cortex), Ejiao (Asini Corii Colla), Maidong (Ophiopogonis Radix), Xingren (Armeniacae Semen Amarum), Pipaye (Eriobotryae Folium), Zhimu (Anemarrhenae Rhizoma), Digupi (Lycii Cortex)

[Symptoms of Internal Injury Sou-Xue] The body lacks exterior signs, yet there is coughing and spitting of blood. The *Jin Gui Yao Lue* outlines three major approaches: If one first coughs up phlegm and later coughs up blood, this is a condition of accumulated heat in the lungs and stomach with phlegm-fire rushing upward. If one first coughs up pure blood and later coughs up phlegm, this is a condition of yin deficiency with yang hyperactivity, characterized by consumptive fever (lao zhai) and bone-steaming. If the complexion is pale, the pulse is deep and slow, and there is no internal heat, this is a condition where earth fails to generate metal, due to yang deficiency failing to contain blood.

[Etiology of Internal Injury Sou-Xue] Accumulated heat from rich foods and phlegm-fire latent between the lungs and stomach, if chronic cough is untreated, leads to spleen fire attacking lung metal, as mentioned in the *Jin Gui*: drinkers who develop cough will inevitably spit blood. Exhaustion of essence from sexual excess causes kidney fire to attack lung metal. Overthinking damages spleen qi, and spleen fire consumes yin. Anger and depression damage the liver, causing liver fire stagnation. Excessive mental exertion causes heart fire to move recklessly, corresponding to the *Jin Gui* description of cough with qi rebellion, rapid pulse, and heat. Yang insufficiency and blood/qi weakness lead to earth failing to generate metal, corresponding to the *Jin Gui* description of pale complexion, no internal heat, and deep-slow pulse.

[Pulse of Internal Injury Sou-Xue] A surging and rapid right hand pulse indicates accumulated heat from rich foods; a slippery and large pulse indicates internal phlegm-fire binding; a restless and rapid left chi pulse indicates essence exhaustion from sexual excess; a fine and rapid right guan pulse indicates spleen yin exhaustion; a wiry and rapid left guan pulse indicates liver stagnation; a restless and rapid left cun pulse indicates reckless heart fire; deep and slow pulses across all positions indicate yang deficiency.

[Treatment of Internal Injury Sou-Xue] For accumulated heat damaging lung qi, use Xie Bai San combined with Gegen Shigao Tang. For heat damaging lung blood, use Huang Qin Yi Wu Tang (Single Herb Decoction of Scutellaria). For stomach fire rushing upward, use Qing Wei Tang (Clear Stomach Decoction) and Hua Tan Wan (Phlegm Resolving Pill). For essence exhaustion and kidney fire attacking lung metal, first use Xi Jiao Di Huang Tang (Rhinoceros Horn Rehmannia Decoction), followed by Gui Shao Tian Di Jian and San Cai Dan. For insufficient spleen yang and earth failing to generate metal, use Jia Wei Gui Pi Tang. For insufficient spleen yin and spleen fire attacking lung metal, use Jia Wei Wu Ji Tang. For anger stirring liver fire and wood fire attacking lung metal, use Chai Hu Yin Zi. For liver blood deficiency, use Jia Wei Bu Gan San. For reckless heart fire, use Dao Chi Ge Ban Tang. For heart blood deficiency, use Tian Wang Bu Xin Dan. For insufficient kidney fire and yang deficiency failing to control blood, use Ba Wei Shen Qi Wan.

Xie Bai San treats fire damaging lung qi, causing cough with sputum and blood.
Sangbaipi (Mori Cortex), Digupi (Lycii Cortex), Gancao (Glycyrrhizae Radix et Rhizoma)

Huang Qin Yi Wu Tang treats fire damaging lung blood, causing cough with sputum and blood.
Huangqin (Scutellariae Radix)

Qing Wei Tang treats stomach fire rushing upward.
Shengma (Cimicifugae Rhizoma), Huanglian (Coptidis Rhizoma), Shengdi (Rehmanniae Radix), Shanzhi (Gardeniae Fructus), Gancao (Glycyrrhizae Radix et Rhizoma), Gegen (Puerariae Lobatae Radix), Shigao (Gypsum Fibrosum)

Hua Tan Wan
Tianmendong (Asparagi Radix), Gualou Shuang (Trichosanthis Fructus Frost), Lianqiao (Forsythiae Fructus), Xiangfu (Cyperi Rhizoma), Huangqin (Scutellariae Radix), Haishi (Magnitio Concha), Qingdai (Indigo Naturalis), Jiegeng (Platycodonis Radix)

Xi Jiao Di Huang Tang is a formula for cooling blood and stopping bleeding.
Xijiao (Rhinocerotis Cornu - note: typically substituted with Shuiniu Jiaojang or other substitutes in modern practice), Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), Baishao (Paeoniae Radix Alba), Huangqin (Scutellariae Radix), Jingjie (Schizonepetae Herba), Shanzhi (Gardeniae Fructus)

Gui Shao Tian Di Jian
Tianmendong (Asparagi Radix), Shengdi (Rehmanniae Radix), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Danpi (Moutan Cortex), Shanzhi (Gardeniae Fructus)
Take with Xuanwu Jiao (turtle shell glue) concentrated paste.

San Cai Dan
Tianmendong (Asparagi Radix), Shengdi (Rehmanniae Radix), Renshen (Panacis Ginseng Radix)

Jia Mi Gan Shen Wan (Secret Family Liver-Kidney Pill)
Tianmendong (Asparagi Radix), Dihuang (Rehmanniae Radix), Baishao (Paeoniae Radix Alba), Danggui (Angelicae Sinensis Radix), Huangbai (Phellodendri Cortex), Zhimu (Anemarrhenae Rhizoma)
Grind into fine powder, form pills with Xuanwu Jiao.

Jia Wei Gui Pi Tang
Danggui (Angelicae Sinensis Radix), Baifushen (Poria cum Radix), Huangqi (Astragali Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Muxiang (Aucklandiae Radix), Renshen (Panacis Ginseng Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Longyanrou (Longan Arillus), Yuanzhi (Polygalae Radix), Suanzaoren (Ziziphi Spinosae Semen)

Jia Wei Wu Ji Tang
Baishao (Paeoniae Radix Alba), Gancao (Glycyrrhizae Radix et Rhizoma), Huangbai (Phellodendri Cortex), Zhimu (Anemarrhenae Rhizoma)

Chai Hu Yin Zi treats anger stirring liver fire and wood fire rushing upward.
Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Guangpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Renshen (Panacis Ginseng Radix), Danggui (Angelicae Sinensis Radix), Dahuang (Rhei Radix et Rhizoma), Baishao (Paeoniae Radix Alba)

Jia Wei Bu Gan San treats liver blood deficiency and hyperactive fire.
Danggui (Angelicae Sinensis Radix), Shengdi (Rehmanniae Radix), Baishao (Paeoniae Radix Alba), Chuanxiong (Ligustici Chuanxiong Rhizoma), Guangpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Chaihu (Bupleuri Radix), Shanzhi (Gardeniae Fructus), Huangqin (Scutellariae Radix)

Dao Chi Ge Ban Tang treats reckless heart fire attacking lung metal.
Shengdi (Rehmanniae Radix), Mutong (Akebiae Caulis), Gancao (Glycyrrhizae Radix et Rhizoma), Chuanhuanglian (Coptidis Rhizoma), Maidong (Ophiopogonis Radix), Xijiao (Rhinocerotis Cornu)

Tian Wang Bu Xin Dan
Renshen (Panacis Ginseng Radix), Xuanshen (Scrophulariae Radix), Danshen (Salviae Miltiorrhizae Radix), Wuweizi (Schisandrae Fructus), Baiziren (Biotae Semen), Danggui (Angelicae Sinensis Radix), Yuanzhi (Polygalae Radix), Jiegeng (Platycodonis Radix), Shengdi (Rehmanniae Radix), Tianmendong (Asparagi Radix), Maidong (Ophiopogonis Radix), Gancao (Glycyrrhizae Radix et Rhizoma)

Shen Qi Wan treats kidney yang insufficiency and decline of true fire.
Shengdi (Rehmanniae Radix), Shanyao (Dioscoreae Rhizoma), Zexie (Alismatis Rhizoma), Danpi (Moutan Cortex), Shanzhuyu (Corni Fructus), Bai Fuling (Poria), Fuzi (Aconiti Lateralis Radix Praeparata), Rougui (Cinnamomi Cortex)

Qin Zi said: Coughing phlegm first, then seeing blood, indicates excessive phlegm in the chest and diaphragm, caused by accumulated heat from rich foods and excess fire attacking. This first damages lung qi, refining fluids into white phlegm; if prolonged, it damages lung blood, forcing hemoptysis. Treatment should use Xie Bai San plus Shigao and Zhimu to clear lung qi-level fire first (treating the root), then use Xi Jiao Di Huang Tang and Huang Qin Yi Wu Tang to clear lung blood-level fire (treating the branch). This corresponds to the *Jin Gui* principle that drinkers with cough and rapid-large pulses should clear lung and stomach fire.

If coughing blood first, then coughing phlegm, this indicates yin deficiency with fire movement, exhaustion of fluids and dryness of blood, with fire arising from water. This first damages lung blood, causing pure hemoptysis; if prolonged, it damages lung qi, leading to white phlegm. Treatment should use Xi Jiao Di Huang Tang plus Jingjie and Huangqin to cool lung blood-level fire first (treating the root), then use Tian Di Jian and Xuanwu Jiao combined with Xie Bai San to clear lung qi-level fire (treating the branch). This corresponds to the *Jin Gui* principle of yin-deficient consumptive disease with fine-rapid pulses, where tonifying qi is contraindicated, and one should follow the principle of strengthening water to suppress fire.

If there is true yang insufficiency, spleen-kidney cold, sallow complexion, occasional hemoptysis, and empty-large-weak pulses, this is earth failing to generate metal, lung deficiency, and lung qi failing to control blood. Warm tonification is highly suitable, while bitter-cold herbs are strictly contraindicated. This corresponds to the *Jin Gui* description of pale complexion and deep-slow pulse, and Yuèrén's principle: "Damage to the lung requires benefiting its qi."

Hematemesis (vomiting blood) differs from hemoptysis. Hemoptysis is entirely due to latent fire in the lungs; therefore, warm tonics and astringents are all contraindicated. Jiezhai's warning that taking ginseng leads to death applies specifically to cases of accumulated heat and phlegm causing hemoptysis. However, patients with long-term hematemesis may also develop yang deficiency. Although hematemesis is often due to hyperactive yang, if it persists, true yang becomes deficient. Thus, Zhang Zhongjing advocated benefiting qi when blood is depleted, and used Bo Ye Tang (Persimmon Leaf Decoction) for persistent hematemesis. Bo Ye (Kaki Leaf) is drying; although *Ben Cao Gang Mu* notes its benefit to the spleen, Zhang Zhongjing used its drying and acrid-aromatic nature to guide blood back to the spleen channel when cold-hemostatic herbs failed due to yang loss following yin loss. Therefore, the original text only treats long-term hematemesis and does not list it under hemoptysis/sou-xue categories. Modern practitioners misunderstand the ancients' intent and mis-treat hemoptysis. I have clarified these points here.