问。吐血多起于咳嗽。嗽血者。肺病也。方家多以止嗽药治肺兼治血而不效。何也。曰。诸书虽分咳血
嗽血出于肺。咯血唾血出于肾。余谓咳嗽咯唾皆出肾。盖肾脉入肺。循喉咙。挟舌本。其支者。从肺出络心注
胸中。故二脏相连。病则俱病。而其根在肾。肾中有火有水。水干火燃。阴火刑金。故咳。水挟相火而上化为
痰。入于肺。肺为清虚之府。一物不容。故嗽。中有痰唾带血而出者。肾水从相火炎上之血也。岂可以咳嗽独
归之肺耶。褚氏遗书津润论云。天地定位。水位乎中。人肖天地。亦有水焉。在上为痰。在下为水。伏皮为
血。从毛窍中出为汗。可见痰也水也血也。一物也。血之带痰而出者。乃肾水挟相火炎上也。又云。服寒凉百
不一生。饮溲溺百不一死。童便一味。可谓治血之要。然但暴发之际。用之以为降火消瘀之急剂则可。若多服。
亦能损胃。褚氏特甚言寒凉之不可用耳。曰若是。则黄柏知母。既所禁用。童便又不宜多服。治之当如何。曰
惟六味地黄。独补肾水。性不寒凉。不损脾胃。久服则水升火降而愈。又须用人参救肺补胃药收功。使金能
生水。盖滋其化源也。
又有一等肾水泛上。上侵于肺。水冷金寒。故咳嗽。肺气受伤。血无所附。故亦吐血。医见嗽血者火也。
以寒折之。病者危而危者毙矣。须用八味丸补命门火。以引水归原。次用理中汤
补脾胃。以补肺之母。使土能克水。则肾水归原。而血复其位矣。
以上论阴虚吐血者。用补天之法。若阳虚吐血。与夫六淫七情所致。各各不同。余另有绛雪丹书。专
论血症。逐一可考。兹不能悉。（今有一单方。只是节欲。不但节欲。直须绝欲。不绝欲。而徒恃乎药。
未有能生者也。）
问：吐血多由咳嗽引起。咳血者，是肺部的疾病。医家多用止嗽药治疗肺部兼治出血，但效果不佳，为什么呢？答：虽然各书将咳血、嗽血归为肺病，咯血、唾血归为肾病，但我认为咳嗽、咯血、唾血都源于肾。因为肾脉进入肺部，沿喉咙，夹舌根；其支脉从肺分出，联络心脏，注入胸中。所以肺肾两脏相连，有病则同时发病，而根源在肾。肾中有火有水，若水干火燃，阴火刑克肺金，故发生咳嗽；水挟带相火上炎化为痰，进入肺中。肺是清虚之府，不容纳异物，故发生嗽。其中有痰唾带血而出者，是肾水随相火上炎所致的出血。怎么能把咳嗽单独归咎于肺呢？《褚氏遗书·津润论》说：“天地定位，水居其中。人效法天地，体内也有水。在上部为痰，在下部为水，潜伏皮下为血，从毛孔排出为汗。”可见痰、水、血本质是一物。血中带痰而出，是肾水挟相火上炎所致。又说：“服用寒凉药百人中难活一人，饮用尿液百人中难死一人。”童便一味药，可以说是治疗出血的关键。然而仅在急性发作时，用它作为降火消瘀的急救剂是可以的；若长期服用，也会损伤胃气。褚氏只是极力强调不可使用寒凉药罢了。问：既然如此，那么黄柏、知母既已禁用，童便又不宜多服，治疗应当如何进行？答：唯有六味地黄丸，专门补肾水，性质不寒凉，不损伤脾胃。久服则水升火降而痊愈。还需用人参等救肺补胃的药物收功，使肺金能生肾水，这是滋生化之源的方法。
又有一种情况是肾水上泛，上侵于肺，水冷金寒，故发生咳嗽。肺气受伤，血液无所依附，因此也出现吐血。医生见咳血认为是火证，用寒凉药折损它，病人就会危险，危重者就会死亡。此时需用八味丸（金匮肾气丸）补命门之火，以引水归原；其次用理中汤补脾胃，以补肺之母（土生金），使脾土能制肾水，则肾水归位，血液恢复正常运行。
以上论述的是阴虚吐血者，采用“补天”之法。若是阳虚吐血，以及由六淫、七情所致者，各不相同，我另有《绛雪丹书》专门论述血症，可逐一考证，此处不能详尽说明。（现在有一个单方，只是节制欲望。不仅是节制，简直要断绝欲望。不断绝欲望，却单纯依赖药物，没有能存活的。）
Q: Hematemesis (vomiting blood) often originates from coughing. Coughing up blood is a disease of the Lung. Physicians often use herbs to stop coughing to treat the Lung while simultaneously treating bleeding, but with little effect. Why?
A: Although various texts distinguish that hemoptysis (coughing up blood) and sputtering blood originate from the Lung, while spitting blood and saliva originate from the Kidney, I believe that coughing, spitting blood, and spitting saliva all stem from the Kidney. This is because the Kidney meridian enters the Lung, follows the throat, and clings to the root of the tongue; its branch emerges from the Lung, connects with the Heart, and pours into the chest. Thus, these two organs are connected; when diseased, both are affected, but the root lies in the Kidney. Within the Kidney, there is Fire and Water. If Water dries up and Fire burns, Yin Fire insults Metal (the Lung), causing coughing. Water carries Ministerial Fire upward, transforming into phlegm, which enters the Lung. The Lung is a pure and empty mansion, tolerating no foreign objects, hence causing spasmodic coughing. Those who expel phlegm and saliva mixed with blood are experiencing bleeding caused by Kidney Water rising due to the flare-up of Ministerial Fire. How can coughing be solely attributed to the Lung?
*Chu Shi Yi Shu* (Remnant Book of Master Chu), chapter *Jin Run Lun*, states: "Heaven and Earth have their positions, with Water occupying the center. Humans mirror Heaven and Earth, possessing Water within. Above, it becomes phlegm; below, it becomes urine/water; hidden under the skin, it becomes blood; exiting through hair pores, it becomes sweat." This shows that phlegm, water, and blood are essentially one substance. Blood mixed with phlegm expelled outward is due to Kidney Water carrying Ministerial Fire upward. It further states: "Taking cold-cooling herbs results in survival in less than one out of a hundred cases; drinking urine results in death in less than one out of a hundred cases." *Tongbian* (Child's Urine) alone can be considered a key remedy for bleeding. However, it should only be used as an urgent agent to descend Fire and resolve stasis during acute outbreaks. Long-term consumption can damage the Stomach Qi. Master Chu merely emphasized strongly against the use of cold-cooling herbs.
Q: If so, since Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) are prohibited, and Tongbian should not be taken in large quantities, how should treatment proceed?
A: Only Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) specifically tonifies Kidney Water. Its nature is not cold or cooling, nor does it damage the Spleen and Stomach. Long-term use leads to the ascent of Water and descent of Fire, resulting in recovery. Additionally, herbs such as Renshen (Ginseng Radix et Rhizoma) to rescue the Lung and tonify the Stomach should be used to conclude treatment, allowing Metal (Lung) to generate Water (Kidney). This is nourishing the source of transformation.
There is another category where Kidney Water overflows upward, invading the Lung. Cold Water chills Metal, causing coughing. The Lung Qi is injured, and blood has no attachment, thus also leading to hematemesis/hemoptysis. Physicians see coughing blood and assume it is a Fire syndrome, using cold herbs to suppress it. Consequently, patients become critical, and the critically ill perish. In such cases, Bawei Wan (Eight-Ingredient Pill with Aconite Root) must be used to tonify the Fire of the Gate of Vitality (Mingmen), guiding Water back to its origin. Subsequently, Lizhong Tang (Regulate the Middle Decoction) is used to tonify the Spleen and Stomach, thereby tonifying the Mother of the Lung (Earth generates Metal). This allows Earth to control Water, returning Kidney Water to its proper place and restoring blood to its normal course.
The above discusses the method of "repairing Heaven" (tonifying deficiency) for hematemesis due to Yin deficiency. For hematemesis due to Yang deficiency, or those caused by the Six Exogenous Pathogens (Liu Yin) and Seven Emotions (Qi Qing), the presentations differ greatly. I have another work, *Jiangxue Dan Shu*, which specifically discusses blood diseases and can be consulted item by item. Detailed exposition here is omitted. (Currently, there is a simple prescription: merely controlling desires. Not just controlling, but absolutely abstaining from desires. Without abstinence, relying solely on medicine yields no survivors.)