咯与嗽为一类，皆因有痰而欲出之，或费力，或不费力，总以出痰为主，非欲
出其血也。因值其失血，故血随痰出耳。唾与吐为一类，此则因血而然。缘血为火
所涌，上升出至咽喉，多则吐，少则唾，并不费力，皆系纯血，无痰涎夹杂。
吐唾既为一类，吐不定属胃，唾独必属肾乎？古谓唾血属肾者，因《经》论五液，
谓肾主唾（水泛于上也。）故耳，不可泥。咯既与嗽为一类，旧分嗽属肺，咯属肾，亦非。
肾脉上入肺中，病则俱病，肾亦有嗽，肺亦有咯也。然则何以别之？曰∶血证由于
火，惊则火起于心，怒则火起于肝，悲伤火起于肺，思虑火起于脾，房劳火起于肾，
审察病因自见，言不能尽也。张景岳谓失血证，凡见喘满咳嗽，及胸膈左右皆隐隐
胀痛者，此病在肺也。若胸膈、膻中间觉有牵痛，如缕如丝，或懊 嘈杂不可名状
者，此病在心包络也。若胸腹膨胀，不知饥饱，食饮无味，多涎沫者，此
病在脾也。若雨胁肋牵痛，或多怒郁，往来寒热者，此病在肝也。若气短似喘，
声哑不出，骨蒸盗汗，咽干喉痛，动气上冲者，此病在肾也。若大呕大吐，烦渴头
痛，大热不卧者，此病在胃也。若有兼证，则病不止在一脏。肺病宜清降，不宜升
浮。心主病宜养营，不宜耗散。脾病宜温中，不宜酸寒。肝病或宜疏利，或宜甘缓，
不宜秘滞。肾病宜壮水，宜滋阴，不宜香燥克伐。胃病或宜大泻，或宜大补，当察虚实。
咯血与咳嗽属于同一类病证，都是因为体内有痰液想要排出。有的费力，有的不费力，但总以排出痰液为主要目的，并非为了排出血液。只是因为此时发生了失血，所以血液随着痰液一起出来罢了。
唾血与吐血属于同一类病证，这是因为出血导致的。由于火热之邪逼迫血液上涌，上升至咽喉部位，血量多则表现为吐血，血量少则表现为唾血。这个过程并不费力，且都是纯血，没有痰涎夹杂其中。
既然吐和唾归为一类，那么吐血不一定归属于胃，唾血就一定归属于肾吗？古人说唾血归属于肾，是因为《内经》论述五液时，提到“肾主唾”（指水湿泛滥于上），所以人们便这样认为，但这不可拘泥固执。
既然咯血与咳嗽归为一类，旧说将咳嗽归属于肺、咯血归属于肾，这也是错误的。肾的经脉上行进入肺部，生病时两脏都会受累，所以肾也会有咳嗽，肺也会有咯血。
那么如何区分它们呢？回答说：各种血证都源于火邪。惊恐导致心火起，愤怒导致肝火起，悲伤导致肺火起，思虑过度导致脾火起，房劳过度导致肾火起。仔细审察病因自然就能看清，言语无法穷尽所有情况。
张景岳说，在失血证中，凡是出现气喘、胸闷、咳嗽，以及胸膈左右都有隐隐胀痛感的，这是病在肺。如果胸膈、膻中穴中间感觉有牵引性疼痛，像丝线一样细微，或者心中烦闷懊恼、嘈杂不适难以名状的，这是病在心包络。如果胸腹部胀满膨胀，不知道饥饿或饱足，饮食无味，口水多且有泡沫的，这是病在脾。如果胁肋部牵引作痛，或多怒抑郁，忽冷忽热的，这是病在肝。如果气短似喘，声音嘶哑发不出声，骨蒸潮热、盗汗，咽喉干燥疼痛，气机上冲的，这是病在肾。如果剧烈呕吐，烦躁口渴，头痛，高热不能安卧的，这是病在胃。如果有兼夹症状，那么病就不止在一脏。
肺部的疾病适宜用清降法，不宜用升浮法。心脏的主病适宜滋养营血，不宜耗散正气。脾部的疾病适宜温补中焦，不宜用酸寒药物。肝脏的疾病有时适宜疏泄通利，有时适宜甘缓柔肝，不宜使用收敛滞涩的药物。肾脏的疾病适宜壮水制火，适宜滋阴，不宜使用香燥克伐的药物。胃部的疾病有时适宜大泻，有时适宜大补，应当审察虚实情况。
Ke (coughing up blood from the lower respiratory tract) and Sou (coughing) belong to the same category; both arise from the desire to expel phlegm. Whether effortful or effortless, the primary aim is the expulsion of phlegm, not blood. It is only because hemorrhage occurs at that time that blood follows the phlegm out.
Tuo (spitting blood) and Tu (vomiting blood) belong to the same category, resulting from bleeding. This is due to fire-heat forcing blood upward to the throat. If the volume is large, it manifests as vomiting blood; if small, as spitting blood. Neither requires effort, and both consist of pure blood without admixture of saliva or phlegm.
Since Tu and Tuo are categorized together, does vomiting blood necessarily belong to the Stomach, and spitting blood necessarily to the Kidney? The ancients stated that spitting blood belongs to the Kidney because the *Classic* discusses the Five Fluids, stating "The Kidney governs Tuo" (referring to water flooding upwards). Thus, people held this view, but one should not adhere to it rigidly.
Since Ke and Sou are categorized together, the old distinction that Sou belongs to the Lung and Ke belongs to the Kidney is also incorrect. The Kidney meridian enters the Lung; when diseased, both organs are affected. Therefore, the Kidney can have Sou (cough), and the Lung can have Ke (spitting blood).
Then how to distinguish them? I say: Blood disorders originate from Fire. Fright causes Heart-Fire to arise; anger causes Liver-Fire to arise; sorrow causes Lung-Fire to arise; overthinking causes Spleen-Fire to arise; sexual exhaustion causes Kidney-Fire to arise. Carefully examining the etiology will reveal the truth, though words cannot exhaustively describe all cases.
Zhang Jingyue stated that in hemorrhagic syndromes: if panting, chest fullness, cough, and dull distending pain on both sides of the chest and diaphragm are seen, the disease is in the Lung. If there is pulling pain in the chest/diaphragm and Shanzhong (CV17) area, fine like threads, or unbearable mental restlessness and epigastric discomfort indescribable, the disease is in the Pericardium. If the chest and abdomen are distended, with no sense of hunger or satiety, loss of taste for food and drink, and excessive frothy saliva, the disease is in the Spleen. If there is pulling pain in the hypochondrium, irritability/depression, and alternating chills and fever, the disease is in the Liver. If there is shortness of breath resembling panting, hoarseness or aphonia, bone-steaming tidal sweating, dry throat and sore throat, and rebellious Qi rushing upward, the disease is in the Kidney. If there is severe vomiting, irritability, thirst, headache, high fever preventing sleep, the disease is in the Stomach. If there are combined symptoms, the disease involves more than one Zang organ.
For Lung diseases, clearing and descending is appropriate; ascending and dispersing is inappropriate. For Heart diseases, nourying Ying (Nutritive) Blood is appropriate; dissipating and consuming is inappropriate. For Spleen diseases, warming the Middle Jiao is appropriate; sour and cold agents are inappropriate. For Liver diseases, either soothing and draining or sweet and relaxing methods may be appropriate; astringent and stagnating agents are inappropriate. For Kidney diseases, strengthening Water (to control Fire) and nourishing Yin are appropriate; aromatic, drying, and attacking agents are inappropriate. For Stomach diseases, either drastic purging or drastic tonification may be appropriate, depending on an examination of Deficiency and Excess.