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(As if the shuttle of a loom turns in a ring, without a single thread breaking.) This is like the rapid rotation of the shuttle on a weaving loom, with no pause in between. If the mechanism of the return and circulation of Qi and blood ceases to operate, the distinction between life and death becomes as vast as the difference between heaven and earth. Therefore, some individuals die immediately after spitting out a few mouthfuls of blood; this is not due to damage to the blood itself, but rather to the discontinuation of Shen (Spirit) and Qi. (However, Gao Shizong distinguished the severity and prognosis of this condition by differentiating between bleeding from the collaterals [Luo vessels] and the meridians [Jing vessels], a view that can be considered concise and comprehensive. Nevertheless, some bleeding flows溢出 from the Blood Sea [Xue Hai]. The Chong Mai (Penetrating Vessel) and the large collateral of the Foot-Shaoyin Kidney Meridian originate in the kidney, ascend along the interior of the spine, and have abundant blood at the region below the heart flanking the spine. Although this blood cannot be equated with the specialized blood flowing through the meridian tunnels to nourish the body, its value differs significantly from the blood scattered outside the vessels and filling the skin, muscles, and hair follicles. If blood stagnates below the heart and in the chest, it must cause distension, and the amount vomited will be large, possibly forming clots. This is caused by excessive mental or physical exertion. If vomiting blood persists repeatedly, or develops into consumptive weakness due to coughing, or damages the root of the Kidney leading to collapse, this is termed "Rebellion of Yin below and Exhaustion of Yang above" [Xia Jue Shang Jie], which is difficult to treat. (Yu Jiayan, in *Yi Yi Cao*, suggested decocting Ejiao [Donkey-hide Gelatin] in water to administer Heixi Dan [Black Tin Pill].))

Furthermore, for those whose bodies are not fatigued and who have no internal depletion, suddenly coughing up a few mouthfuls of blood, either purple or red, which comes out easily upon coughing, is bleeding from the Spleen collaterals. The great collateral of the Spleen connects throughout the body. If the collaterals are not harmonious with the meridians, such bleeding occurs. This condition does not injure Yin below nor the meridians internally; it is the mildest and most superficial type of bleeding, which may heal even without medication. If one fails to distinguish the severity and treats all cases generally as stomach bleeding (such as using Liuwei Dihuang Wan [Six-Ingredient Rehmannia Pill], Sancai Tang [Three Essentials Decoction], adding Oujie [Lotus Node], Baiji [Bletilla Rhizome], Ejiao, and Heizhizi [Gardenia Fruit charred]), it may cause cold coagulation of the collateral blood, giving rise to diseases such as weakness and coughing. This is the fault of the physician. In summary, treating collateral bleeding requires regulating Ying (Nutritive) and Wei (Defensive) Qi, and harmonizing the Sanjiao (Triple Burner), so that Sanjiao Qi harmonizes with Ying and Wei Qi, and Ying and Wei Qi descend to merge in the Baozhong (Uterus/Pelvic Cavity). When Qi returns and attaches to Blood, this is the method of "guiding blood back to the vessels." As for blood in the meridians, it is governed by the Pericardium [Xinbao]. The Pericardium protects the Heart internally, connects externally with the vessels, and merges with the Liver below. It merges with the Liver because both the Liver and the Pericardium belong to the Jueyin [Greater Yin] category and share the same Qi. If sexual excess or overthinking injures the Spleen, it leads to vomiting of Pericardium blood. Those who vomit Pericardium blood rarely survive (ten out of ten die). Only by avoiding reckless medication, strongly tonifying the Heart and Kidney, and administering large doses of Renshen [Ginseng] (as per *Shi Yao Shen Shu* [Divine Book of Ten Medicines], using 1 liang of Ginseng taken in one dose) might one or two out of ten survive. If bleeding flows from the Blood Sea into the Pericardium causing massive vomiting, it differs from self-injury of the Pericardium. Since the disease spreads from collaterals to meridians, one should use methods for treating collateral bleeding to guide the blood back to the vessels.

It is also said that the Zang organs [Solid Organs] have blood, while the Fu organs [Hollow Organs] do not. (Observe the abdomens of dissected animals: the Xinbao Luo [Pericardium Collaterals] below the heart flanking the spine have much blood; the Liver has much blood internally; the Heart, Spleen, Lungs, and Kidneys contain blood; but the Six Fu organs do not.) Vomiting blood from the Heart results in death after one or two mouthfuls; blood from the Lung appears like silk threads; blood from the Kidney resembles red beans, leading to death within five to seven days. Vomiting blood from the Liver may result in survival or death, depending on whether the patient can self-nourish and the physician can treat skillfully. Blood from the Spleen organ dispersing like a net refers to the hemoptysis mentioned earlier. (Note: This Spleen collateral blood is not Spleen organ blood. Some spit blood accompanied by abdominal fullness due to Spleen deficiency failing to control blood.) Generally, profuse hematemesis originates from the Blood Sea in the Baozhong. Physicians who do not understand the classics mistakenly attribute it to the Stomach. The Stomach is the official of the granary, receiving and storing food and drink, and contains no blood. It is acceptable to say that blood from the Blood Sea, forced upward by the Six Evils [Pathogenic Factors] and Seven Emotions, rushes to the epigastrium and is vomited; however, claiming there is blood inside the Stomach itself is incorrect.