陈无择云衄者因伤风寒暑湿流传经络涌泄于清气道中而致者皆外所因积怒伤肝积忧伤肺
烦思
伤脾失志伤肾暴喜伤心皆能动血随气上溢清气道中而致者属内因饮酒过多啖炙爆辛热或坠堕
车马伤损致者为不内外因吐血者或因四气伤于外七情动于内及饮食房劳坠闪伤损致荣血留聚
膈间满则吐溢世谓妄行或吐瘀血此名内伤 便血或清或浊或鲜或黑或在便前便后或与泄物并
下此由内外有所感伤疑停在胃随气下通亦妄行之类 尿血因心肾气结所致或忧劳房室过度此
得之虚寒不可专以血得热而淖 二者皆致尿血与淋不同
谨按衄血下血伤寒邪气壅迫于经而致者故有之杂证见者多火热所致或吐溢于空窍皆五志
所动
或阴分郁热或内外有所伤而成有寒邪者少如尿血因房劳者实由精气滑脱阴虚火动荣血妄行尔
以上论为虚寒恐未必然也若便血清者属荣虚有热浊属热与湿色鲜者属火黑者火极与泄物并下
属有积或络脉伤也并宜分治
详见积聚门
东垣曰经云怒气逆甚则呕血暴瘅内逆肝肺相搏血溢鼻口取天府穴又足少阴肾之脉从肾上
贯肝
入肺中循喉咙其病则饥不欲食面黑如地色咳唾则有血夫气者阳也血者阴也气主 之血主濡之
今血妄行上出于鼻口者皆气逆也故经言阳明厥逆怒则气逆暴瘅内逆者是也
谨按悲气劳气等皆能致血证详见气门但怒气致血证者则暴甚故经曰抑怒以全阴者是矣否
则五志之火动甚火载血上错经妄行也
陈无择说：鼻出血（衄血）是因为感受风寒暑湿，邪气流传于经络，涌泄于清阳之气通行的气道中而导致的，这属于外因；积怒伤肝、积忧伤肺、烦思伤脾、失志伤肾、暴喜伤心，这些情志因素都能扰动血液，随气上溢至清阳气道中而致病的，属于内因；饮酒过多、食用烤爆辛热食物，或因坠马、车马撞击等外伤导致损伤的，属于不内外因。
吐血，可能是因为四时气候异常伤害于外，七情内动于内，以及饮食、房劳、坠落闪挫等损伤，导致营血留滞积聚在膈间，满溢而出。世人称之为“妄行”，或者吐出瘀血，这种称为内伤。
便血，颜色或清或浊，或鲜红或黑，有的在排便前，有的在排便后，有的与排泄物混合而下。这是由于内外受邪气所伤，疑有停聚在胃中，随气下行，也属于妄行之类。
尿血，是由于心肾之气郁结所致，或因忧劳、房事过度引起。这种情况得之于虚寒，不能专门认为血得热而变得稀薄（淖）就会导致尿血。这两种情况（指尿血与淋证）是不同的。
谨按：鼻出血、便血，如果是伤寒邪气壅迫于经脉而导致的，所以会有这种情况；但在杂病中见到的，大多由火热所致。或者吐溢于空窍，都是五志（喜怒忧思恐）所动；或者是阴分郁热，或者是内外有所损伤而成，有寒邪的情况很少。至于尿血，如果是因房劳引起的，实际上是由精气滑脱、阴虚火动、营血妄行造成的。以上论述认为是虚寒，恐怕未必如此。如果便血颜色清稀的，属于营血虚而有热；浑浊的，属于热与湿；颜色鲜红的，属于火；颜色黑的，是火极；与排泄物混合而下的，属于有积滞或是络脉受伤。这些都应当分别治疗。
详见《积聚》门。
李东垣说：经云：“怒气逆乱严重则会呕血，突然发生的热病，气逆于内，肝肺相互搏结，血液从鼻口溢出。”应取天府穴。另外，足少阴肾经，从肾脏上行，贯穿肝脏，进入肺部，沿着喉咙。其病症表现为饥饿但不想进食，面色黑如泥土，咳嗽唾血。气属阳，血属阴。气主要推动（运行），血主要濡养。现在血液妄行，向上从鼻口而出的，都是气逆造成的。所以经文中说“阳明厥逆，怒则气逆，暴瘅内逆”就是这个意思。
谨按：悲气、劳气等都可能导致血证，详见《气门》篇。但怒气导致血证的，往往发作突然且严重，所以经文说“抑制怒气以保全阴精”是正确的。否则，五志之火动得非常厉害，火载着血上行，错经妄行。
Chen Wuzhe stated: Epistaxis (nosebleed) occurs when pathogenic factors such as wind, cold, summer-heat, and dampness invade and spread through the meridians, surging into the airways where clear yang qi circulates; this is classified as an external cause. Accumulated anger injuring the Liver, accumulated sorrow injuring the Lung, excessive worry injuring the Spleen, loss of will injuring the Kidney, and sudden joy injuring the Heart are all emotional disturbances that can agitate blood, causing it to overflow upwards with rebellious Qi into the clear yang airways; these are classified as internal causes. Excessive alcohol consumption, ingestion of roasted or fried spicy and hot foods, or physical trauma from falls or carriage accidents are classified as neither internal nor external causes.
Hematemesis (vomiting blood) may result from external injuries by the four climatic conditions, internal agitation by the seven emotions, or damage due to improper diet, sexual excess, falls, or sprains. These cause Ying Blood to stagnate and accumulate in the diaphragm region until it overflows. This is commonly referred to as "reckless bleeding" or expelling stasis blood, and is termed internal injury.
Hematochezia (blood in stool) may be clear or turbid, bright red or black, occurring before or after defecation, or mixed with feces. This arises from internal or external pathogenic invasion, suspected stagnation in the Stomach, descending with rebellious Qi, and also belongs to the category of reckless bleeding.
Hematuria (blood in urine) is caused by the binding of Qi between the Heart and Kidney, or results from excessive worry, labor, or sexual indulgence. This condition stems from deficiency-cold and cannot be solely attributed to blood becoming fluid due to heat. The two conditions differ from strangury (Lin syndrome).
Upon careful examination: Epistaxis and hematochezia caused by the obstruction of Shaoyang pathogenic factors in the meridians do occur. However, in miscellaneous diseases, they are mostly caused by fire and heat. Bleeding from orifices is often triggered by the movement of the five zang emotions (anger, joy, worry, thought, fear), yin-deficiency with stagnant heat, or internal/external injuries; cases involving cold pathogens are rare. Regarding hematuria caused by sexual exhaustion, it is actually due to the slipping away of essence, yin-deficiency with hyperactive fire, and reckless movement of Ying Blood. The previous assertion that these are due to deficiency-cold is likely incorrect. If the blood in stool is clear, it indicates Ying-blood deficiency with heat; if turbid, it indicates heat combined with dampness; if bright red, it indicates fire; if black, it indicates extreme fire; if mixed with feces, it indicates accumulation or meridian collateral injury. All these should be treated according to differentiation.
For details, see the section on Accumulations and Masses.
Li Dongyuan stated: The Classic says, "Severe rebellion of anger leads to vomiting blood; sudden heat disease with internal rebellion causes the Liver and Lung to clash, resulting in blood overflowing from the nose and mouth." One should select the Tianfu (LU 3) acupoint. Furthermore, the Foot-Shaoyin Kidney Meridian ascends from the Kidney, passes through the Liver, enters the Lung, and follows the throat. Its pathology manifests as hunger without desire to eat, a complexion as dark as earth, and coughing up blood. Qi is Yang, and Blood is Yin. Qi primarily drives movement, while Blood primarily nourishes. Currently, blood moving recklessly and exiting upwards from the nose and mouth is all due to rebellious Qi. Thus, the Classic states, "Yangming reversal, anger causes Qi rebellion, sudden heat with internal rebellion," which refers to this mechanism.
Upon careful examination: Sadness-Qi and Labor-Qi can both lead to blood disorders; for details, see the section on Qi. However, when anger causes blood disorders, the onset is sudden and severe. Therefore, the Classic advises, "Restrain anger to preserve Yin," which is correct. Otherwise, the fire of the five zang emotions becomes excessively active, carrying blood upwards, causing it to flow recklessly into incorrect meridians.