真痨病之吐血，南齐褚澄曰∶“饮溲溺，百不一死。”夫溲溺能清脏腑虚热，兼降浮火
。痨
病吐血，实由于此，最为切要。然有法焉，俗谓之还元汤。乃服自便之溺，宜不食腥秽之物
食，味略淡，晚餐白粥，如是数日后，五更或清晨，解时去头末，取中一碗服之，更能散心
远色戒性，虽沉 宿疾，不数日可痊。海盐县村寺
有一僧，能疗一切劳伤，虚损吐血，干痨无血可吐之症。此僧绝不知《神农本草》、《黄帝
内经》。惟善于起居得宜，饮食消息，患者住彼寺中，三月半年，十愈八九。此虽勿药，记
之名医可也。予举斯，亦愿病者，知起居得宜，饮食消息之法，莫单仗草根木皮，久归不起
。夫血，心主之，脾统之，肝藏之，用心过度，心阳不摄。吐血者，药用人参、枣仁、茯神
、
柏子仁、麦冬、丹皮、犀角、生地、茅根、藕节之类。须加橘红、通草、牛膝炭以松之；劳
倦伤脾，药用人参、白术、茯神、炙草、广皮、归身、炙侧柏叶、藕节之类；怒气伤肝，药
用丹皮、桑叶、生地炭、归身炭、炒白芍、钩藤、白蒺藜、甘草之类。以上药味，并非成方
，惟与脏相合，在圆机之士，采而施之可也。吐血有数种，呕血属阳明胃，与厥阴肝为多，
故盈盆满碗；咯血唾血，俱从肺肾出，咳血心肺胃三经俱有；痰中带血，肝肾为多，吐红痰
脾虚肺热也。心肝肾先伤，继及脾胃肺。吐血者为真痨病难治，余当辨其何脏何腑何因，随
其症而治之。每有因外感吐血，观予医案可得也。
关于真痨病（肺痨重症）引起的吐血，南齐时期的褚澄曾说：“饮用尿液，一百人中也不会有一个人死亡。”因为尿液能够清除脏腑的虚热，同时降低上浮的虚火。痨病导致的吐血，确实可以通过这种方法治疗，这是非常关键的方法。然而其中也有具体的方法，俗称“还元汤”。即服用自己刚排出的小便，期间应避免食用腥膻污秽的食物，饮食口味要略淡，晚餐只喝白粥。这样坚持数日后，在五更天或清晨排尿时，弃去开头和结尾的部分，只取中间的一段尿液约一碗服用。如果能进一步做到清心寡欲、戒除色欲、节制性情，即使是陈年旧疾，不需几天也可以痊愈。海盐县乡村寺庙中有一位僧人，擅长治疗各种劳伤、虚损及吐血，以及干痨（无血可吐的严重阴虚症状）。这位僧人完全不懂《神农本草经》和《黄帝内经》，但他善于指导患者起居作息得当，并懂得饮食调养。患者在寺中居住三个月到半年，十人能治愈八九个。这虽然不用药物治疗，但记录在名医事迹中也完全可以。我举这个例子，也是希望病患者知道起居得当、饮食调养的方法，不要仅仅依赖草根树皮类的药物，导致病情迁延不愈。血液由心所主，脾所统摄，肝所贮藏。如果用心过度，导致心阳不能固摄血液而吐血，用药可选用人参、酸枣仁、茯神、柏子仁、麦冬、牡丹皮、犀角、生地黄、白茅根、藕节等。必须加入橘红、通草、炭制牛膝以疏通气机；如果是劳累疲倦损伤脾气，用药可选用人参、白术、茯神、炙甘草、陈皮、当归身、炙侧柏叶、藕节等；如果是怒气损伤肝脏，用药可选用牡丹皮、桑叶、炭制生地黄、炭制当归身、炒白芍、钩藤、白蒺藜、甘草等。以上药味并非固定的成方，只要与受损的脏腑相契合，具有灵活变通能力的医生，可以采集这些药材进行施治。吐血有几种不同类型：呕血属于阳明胃经，常与厥阴肝经有关，所以出血量大盈盆满碗；咯血和唾血都从肺肾而出，咳血则心肺胃三经都可能出现；痰中带血多与肝肾有关，吐出红色痰液则是脾虚肺热的表现。心、肝、肾先受伤，随后波及脾胃肺。因吐血而被诊断为真痨病的难以治疗，其余情况应当辨别是哪一脏哪一腑、何种原因所致，根据症状进行治疗。常有因外感邪气导致吐血的，可以参考我的医案。
Regarding hemoptysis (coughing up blood) caused by true Lao disease (severe pulmonary tuberculosis), Chu Cheng of the Southern Qi dynasty stated, "Drinking urine ensures that not one in a hundred will die." This is because urine can clear deficiency heat from the Zang and Fu organs and subdue floating fire. Hemoptysis due to Lao disease can indeed be treated by this method, which is most crucial. However, there is a specific protocol, commonly known as "Huan Yuan Tang" (Returning to Origin Decoction). This involves drinking one's own fresh urine. During this period, one should avoid eating fishy or foul-smelling foods; the diet should be slightly bland, with white rice porridge for dinner. After persisting in this for several days, during the Wugeng time (3-5 AM) or early morning, discard the initial and final portions of the urine, taking only the middle portion (approximately one bowl) to drink. If one can further practice mental clarity, abstain from sexual desires, and regulate emotions, even chronic ailments can be cured within a few days. In a village temple in Haiyan County, there was a monk skilled in treating all types of overstrain injuries, deficiency damage, and hemoptysis, including dry Lao conditions where no blood remains to be coughed up. This monk knew nothing of the *Shennong Bencao Jing* (Divine Farmer's Materia Medica) or the *Huangdi Neijing* (Yellow Emperor's Inner Canon). He was merely adept at guiding proper daily routines and dietary adjustments. Patients who stayed in his temple for three to six months saw eight or nine out of ten recover. Although this involved no medicinal treatment, it deserves recording among the deeds of renowned physicians. I cite this example to hope that patients understand the methods of proper living and dietary regulation, rather than relying solely on herbal roots and barks, leading to prolonged illness without recovery. Blood is governed by the Heart, controlled by the Spleen, and stored by the Liver. If excessive mental exertion causes Heart Yang to fail in controlling the blood, resulting in hematemesis (vomiting blood), herbs such as *Ren Shen* (Ginseng Radix et Rhizoma), *Zao Ren* (Ziziphi Spinosae Semen), *Fu Shen* (Poria with Hostwood), *Bai Zi Ren* (Biota Seed), *Mai Dong* (Ophiopogonis Radix), *Mu Dan Pi* (Moutan Cortex), *Xi Jiao* (Rhinoceros Horn - note: substitute with Buffalo Horn in modern practice), *Sheng Di Huang* (Rehmanniae Radix), *Mao Gen* (Imperatae Rhizoma), and *Ou Jie* (Nelumbinis Node) may be used. It is necessary to add *Ju Hong* (Citri Reticulatae Pericarpium Rubrum), *Tong Cao* (Tetrapanacis Medulla), and *Niu Xi Tan* (Achyranthis Bidentatae Radix Carbonized) to soothe and unblock the qi. If fatigue and overwork injure the Spleen, herbs such as *Ren Shen*, *Bai Zhu* (Atractylodis Macrocephalae Rhizoma), *Fu Shen*, *Zhi Gan Cao* (Glycyrrhizae Radix et Rhizoma Preparata), *Guang Pi* (Citri Reticulatae Pericarpium), *Gui Shen* (Angelicae Sinensis Radix), *Zhi Ce Bai Ye* (Platycladi Cacumen Preparatum), and *Ou Jie* may be used. If anger injures the Liver, herbs such as *Mu Dan Pi*, *Sang Ye* (Mori Folium), *Sheng Di Huang Tan* (Rehmanniae Radix Carbonized), *Gui Shen Tan* (Angelicae Sinensis Radix Carbonized), *Chao Bai Shao* (Paeoniae Radix Alba Preparata), *Gou Teng* (Uncariae Ramulus cum Uncis), *Bai Ji Li* (Tribuli Fructus), and *Gan Cao* (Glycyrrhizae Radix et Rhizoma) may be used. The above herbs do not constitute a fixed formula; they are selected based on their compatibility with the affected Zang organs. Physicians with flexible clinical reasoning may select and apply them appropriately. There are several types of hemoptysis: Hematemesis belongs to the Yangming Stomach channel and is often associated with the Jueyin Liver channel, hence the large volume filling basins and bowls. Hemoptysis (coughing up blood) and spitting saliva with blood originate from the Lung and Kidney. Coughing up blood may involve the Heart, Lung, and Stomach channels. Blood in sputum is mostly related to the Liver and Kidney; vomiting red phlegm indicates Spleen deficiency and Lung heat. Injury to the Heart, Liver, and Kidney occurs first, subsequently affecting the Spleen, Stomach, and Lung. True Lao disease presenting with hemoptysis is difficult to treat. For other cases, one must differentiate the affected Zang and Fu organs and the etiology, treating according to the symptoms. There are cases of hemoptysis caused by external pathogenic factors; these can be observed in my medical records.