经云∶荣者，水谷之精气也，调和于五脏，洒陈于六腑，乃能入于脉也。源源而来，生
化于
脾，总统于心，藏受于肝，宣布于肺，施泄于肾，灌溉一身，出入升降，皆有所使。故目得
之而能视，耳得之能听，手得之而能摄，掌得之而能握，足得之而能步，苟调养未周，而内
动于相火，外伤于寒热，则气血乱其常度，而病生矣。凡阳盛阴虚，有升无降，血随气升，
越出上窍，则上见于鼻。故鼻中出者为衄血，以鼻窍通于脑，火上冲于脑，又肺窍通于鼻，
火内炎其金也。口中出者为吐血，又有呕血、咯血、咳血、嗽血之不同焉。吐血者，血虽出
而无声。一吐辄以升计，甚至斗许，而色顿白，举体懈惰，乃阳明胃经之火上逆。证虽极阴
，而实易治，以邪浅在腑，未动脏阴，又阳明为气血俱多之经故也。呕血者，血每出则先有
呕逆声。其血必紫黑成块，胁痛内热，气塞烦闷，乃肝厥阴经之火，或盛怒不和所致，急宜
降气清火，以肝为牝藏，为纳血之海，其气最宜静固。一有不宁，则冲脉腾沸，譬如大海生
涛，未有不拍天而撼岛者，倘迁延不治，必至上涌不止而死矣。咯血者，每血出喉中先痒，
痒则所咯皆血，其血或鲜或紫，或兼有痰，口燥嗌干，心虚惊悸，乃手少阴君火太盛。或夏
月暑热伤心所致，宜清心降火，若由于情思者，又宜于自己消息之，苟患是而一任其纵横，
虽琼浆玉醴，其如心病何哉？咳血者，其证必先病咳嗽，咳之不已，复有鲜血，即世所谓虚
劳之证。或痰内有红丝，是为肺痿，皆阴精亏损，阳火亢极，销铄肺金所致，患此必十死八
九
，最为难治。嗽血者，素未尝病咳，而又无咳逆声，但痰嗽则必有血，四肢无力，或兼泄泻
，乃郁结伤脾，或久坐卧伤气所致，宜培补真元，虽人参、煨姜，亦可选用，惟忌苦燥，以
苦伤阳而燥伤阴也。唾血者，每有鲜血必随唾而出，骨蒸内热，干咳肌瘦，乃肾水枯涸，火
反内淫，或入房太甚，阴虚火盛所致，与肺病咳血同为危候。治此者，必曲尽其术，天始
克旋，毋专恃功于知药也。
又血从齿龈出，谓之牙宣，胃与肾之火也。
血从汗孔出，谓之肌衄。从舌出，谓之舌衄，心与肝之热也。此
皆血之见于上者也。其病于下，在大便，则有肠风、脏毒、滞下、便红之殊，在小便，则有
赤
淋、溺血、带下、崩中之异。肠风者，其人本肠胃蓄热，热则生风，或邪气外入，渗透肠间
，其血来色必清淡。藏毒者，喜食膏粱，过耽醇醴，或偏服热药，蕴毒脏腑也，其血来必浑
浊，滞下之由，多由湿蒸热瘀，故必脓血相杂，里急后重。便红之病，多由脾虚先统，故但
有血而无脓， 作声，赤淋则溺管涩痛，法宜清利，溺血便是溺中见红，法当凉解。带下
者，经水淋漓，如带不断之谓。崩中者，血下崩腾，妄行不止之称。二者于妇人多有之，此
皆血病之见于下者也。其病于内，则热胜于阴，必发疮疡，湿滞于血，必发痛痒瘾疹，凝涩
皮毛，则为冷痹，损坏肌肉，则为破伤。病于外，则跌仆留瘀疼痛，寒冷相搏，必凝取成瘕
。蓄于上焦，人必喜妄；蓄于下焦，人必如狂。此又血证之见于内外者也。先哲云∶血贵宁
静，不喜疏动，疏动则有泛溢之虞。又云∶血宜流通，不当凝滞。凝滞则有瘀着之虑。人苟
能善调其营，静而不至于凝，通而不至于动，则经脉流行，皮肤润泽，筋骨强劲，关节清利
矣。又何有以上数者之病哉？
《内经》说：营气，是水谷精微化生的精气，在五脏中调和，散布于六腑，然后才能进入脉管。它源源不断地产生，由脾生化，由心统摄，由肝贮藏，由肺布散，由肾排泄，灌溉全身，其出入升降都有特定的运行规律。所以眼睛得到它就能视物，耳朵得到它就能听声，手得到它就能抓取，手掌得到它就能握持，脚得到它就能行走。如果调养不周全，导致内相火妄动，外受寒热邪气侵袭，那么气血就会扰乱正常的运行秩序，疾病由此产生。
凡是阳气盛而阴血虚，只有上升没有下降，血液随着气机上逆，越出上部的孔窍，就会从鼻子流出。所以从鼻中流出的是衄血，因为鼻窍通于脑，火气上冲至脑，且肺窍通于鼻，是火气内炎灼伤肺金所致。从口中流出的是吐血，其中又有呕血、咯血、咳血、嗽血的不同。吐血，是指血液虽然流出但没有声音。一次吐出量以升计算，甚至达到斗许，面色顿时变白，全身懈怠无力，这是阳明胃经的火气上逆所致。证候虽然表现为极度的阴虚，但实际上容易治疗，因为病邪浅表在腑，未损伤脏阴，而且阳明经是多气多血的经脉。
呕血，是指每次出血前必然有呕吐的声音。吐出的血必定紫黑成块，伴有胁痛、内热、气塞烦闷，这是肝厥阴经的火气，或因大怒导致气机不和所致，急需降气清火。因为肝为阴脏，是容纳血液的海，其气最宜安静稳固。一旦不安宁，则冲脉沸腾，就像大海掀起波涛，没有不拍打天空、撼动岛屿的，如果拖延不治，必然会导致血液上涌不止而死。
咯血，是指每次血液从喉中流出前先感到瘙痒，痒则所咯出的全是血，血色或鲜红或紫暗，有时兼有痰液，口燥咽干，心中空虚惊悸，这是手少阴君火过盛所致。或者是夏季暑热损伤心脏所致，应当清心降火。如果是由于情志思虑过度引起的，又应当自我调节疏导。如果患了这种病却任由病情发展，即使是琼浆玉液，对心病又有什么帮助呢？
咳血，其病症必然是先患咳嗽，咳嗽不止，随后出现鲜血，这就是世人所说的虚劳证。或者痰中有红丝，这称为肺痿，都是由于阴精亏损，阳火亢盛至极，销铄肺金所致，患此病十有八九死亡，最为难治。
嗽血，是指素来没有咳嗽病，也没有咳嗽的声音，但只有在痰嗽时必然带血，四肢无力，有时兼有泄泻，这是由于郁结损伤脾气，或久坐卧损伤元气所致，应当培补真元，人参、煨姜等药也可以选用，只是忌讳苦燥之品，因为苦味损伤阳气，燥性损伤阴液。
唾血，是指每次流出的鲜血必定随唾液而出，伴有骨蒸潮热、干咳、肌肉消瘦，这是肾水枯涸，火气反而内侵，或因房事过度，阴虚火盛所致，与肺病咳血一样属于危重证候。治疗此病，必须穷尽医术，才可能扭转局面，不能专门依赖懂得药物知识。
血液从汗孔流出，称为肌衄。从舌头流出，称为舌衄，是心与肝的热邪所致。这些都是血液见于身体上部的情况。
疾病见于下部，在大便方面，则有肠风、脏毒、滞下（痢疾）、便红的不同；在小便方面，则有赤淋、溺血、带下、崩中的差异。
肠风，是指患者本肠胃蓄积热邪，热极生风，或邪气从外侵入，渗透肠间，其血流出的颜色必定清淡。
脏毒，是指喜欢食用肥甘厚味，过分沉迷于美酒，或偏服热性药物，导致毒蕴结在脏腑，其血流出的颜色必定浑浊。
滞下的成因，多由湿热蒸腾瘀阻，所以必定脓血混杂，伴有里急后重感。
便红的病，多由脾气虚弱先失统摄功能，所以只有血而没有脓，排便时不作声响。
溺血就是小便中看到红色，治法应当凉血解热。
带下，是指经水淋漓不断，像带子一样连绵不绝。
崩中，是指血液下注如崩塌般汹涌，妄行不止。这两种病在妇女中多见，这都是血液病变见于下部的情况。
疾病见于体内，则是热邪胜过阴液，必定发生疮疡；湿邪停滞于血分，必定发生疼痛、瘙痒、瘾疹；凝涩于皮毛，则形成冷痹；损坏肌肉，则形成破伤。
疾病见于体外，则是跌仆导致瘀血停留疼痛，寒冷与正气相搏，必定凝结形成瘕块。
瘀血蓄积在上焦，人必定神志狂乱；瘀血蓄积在下焦，人必定如发狂状。这又是血证见于内外的情况。
先哲说：血液贵在宁静，不喜欢疏泄扰动，疏泄扰动则有泛滥溢出的忧虑。又说：血液适宜流通，不应当凝滞。凝滞则有瘀血附着留存的忧虑。人如果能够善于调理营气，使血液静而不致凝滞，通而不致妄动，那么经脉流行顺畅，皮肤润泽，筋骨强劲，关节清利了。哪里还会有上述那些疾病呢？
The *Neijing* (Inner Canon) states: Ying Qi (Nutritive Qi), which is the refined essence derived from water and grain, harmonizes within the five Zang organs, spreads throughout the six Fu organs, and then enters the vessels. It originates continuously, is transformed by the Spleen, governed by the Heart, stored by the Liver, distributed by the Lungs, and excreted by the Kidneys, irrigating the entire body. Its entry, exit, ascent, and descent all follow specific regulations. Therefore, the eyes can see when nourished by it, the ears can hear when nourished by it, the hands can grasp when nourished by it, the palms can grip when nourished by it, and the feet can walk when nourished by it. If proper nourishment and regulation are insufficient, leading to internal hyperactivity of Ministerial Fire (Xiang Huo) or external invasion of cold and heat pathogens, the Qi and Blood will disrupt their normal order, giving rise to disease.
In cases where Yang is excessive and Yin blood is deficient, with only ascending and no descending movement, Blood follows Qi upward and escapes through the upper orifices, manifesting as epistaxis (nosebleed). Thus, blood flowing from the nose is called "Nu Xue" (Nasal Hemorrhage), because the nasal orifice connects to the brain; Fire Qi rushes upward to the brain. Additionally, since the Lung orifice opens at the nose, this indicates internal inflammation of Fire scorching Metal (Lung). Blood flowing from the mouth is called "Tu Xue" (Hematemesis/Vomiting Blood), which further differentiates into "Ou Xue" (Vomiting Blood with sound), "Lo Xue" (Spitting Blood), "Ke Xue" (Coughing Blood), and "Sou Xue" (Sputtering Blood).
"Tu Xue" refers to blood flowing out without sound. A single episode may yield volumes measured in sheng (a unit of volume), even reaching dou (a larger unit), causing sudden pallor and generalized flaccidity. This is caused by Fire Qi of the Stomach Meridian of Yangming reversing upward. Although the syndrome appears as extreme Yin deficiency, it is actually relatively easy to treat because the pathogen is superficial and located in the Fu organs, not yet damaging the Yin of the Zang organs. Furthermore, the Yangming meridian is rich in both Qi and Blood.
"Ou Xue" refers to blood accompanied by the sound of retching/vomiting prior to expulsion. The blood is invariably dark purple and clotted, accompanied by hypochondriac pain, internal heat, chest oppression, and irritability. This is caused by Fire Qi of the Liver Jueyin Meridian, often resulting from severe anger and disharmony of Qi. Urgent treatment should focus on descending Qi and clearing Fire. Since the Liver is a Yin organ and the "Sea of Blood," its Qi must remain quiet and stable. Any disturbance causes the Chong Mai (Penetrating Vessel) to boil, akin to waves rising in the ocean, inevitably crashing against the sky and shaking islands. If left untreated, it will lead to uncontrollable upward hemorrhage and death.
"Lo Xue" refers to blood expelled from the throat preceded by itching. When itchy, the expectorated material is purely blood, which may be bright red or purplish, sometimes mixed with phlegm. Symptoms include dry mouth, dry throat, and palpitations due to Heart emptiness. This is caused by excessive activity of the Jun Fire (Monarch Fire) of the Hand Shaoyin Meridian. It may also result from Summerheat-Heat damaging the Heart in summer months. Treatment should clear the Heart and descend Fire. If caused by emotional contemplation/stress, self-regulation is advised. If one allows such conditions to run rampant, even the finest elixirs cannot cure Heart disease.
"Ke Xue" refers to symptoms where coughing precedes the condition; persistent coughing eventually produces fresh blood. This is what the world calls "Xu Lao" (Consumptive Disease). If red threads appear in sputum, it is termed "Fei Wei" (Lung Atrophy/Fistula). Both are caused by depletion of Yin Essence and extreme hyperactivity of Yang Fire, which consumes/scorches Lung Metal. These conditions have a mortality rate of 80-90% and are extremely difficult to treat.
"Sou Xue" refers to patients who do not typically suffer from coughs nor produce coughing sounds, but blood appears specifically during productive coughing (sputtering). Symptoms include weakness in the four limbs and possibly diarrhea. This is caused by stagnation injuring the Spleen Qi or prolonged sitting/lying damaging Yuan Qi (True Qi). Treatment should tonify True Yuan. Herbs like Ren Shen (Ginseng Root) and Wei Jiang (Baked Ginger) may be selected. However, bitter and drying herbs are contraindicated, as bitterness damages Yang and dryness damages Yin.
"Tuo Xue" refers to fresh blood appearing mixed with saliva. Symptoms include bone-steaming tidal fever, internal heat, dry cough, and emaciation. This is caused by exhaustion of Kidney Water, allowing Fire to invade internally, or excessive sexual intercourse leading to Yin deficiency and Fire hyperactivity. Like pulmonary Ke Xue, this is a critical prognosis. Treating this requires exhaustive medical skill to reverse the situation; one cannot rely solely on knowledge of herbs.
Furthermore, blood flowing from the gums is called "Ya Xuan" (Gum Bleeding/Dental Caries with Bleeding), caused by Fire in the Stomach and Kidney.
Blood flowing from sweat pores is called "Ji Nu" (Cutaneous Purpura/Skin Epistaxis). Blood flowing from the tongue is called "She Nu" (Tongue Hemorrhage), caused by Heat in the Heart and Liver. These are all manifestations of blood disorders in the upper body.
Diseases manifesting in the lower body involve the stool, presenting as differences between Chang Feng (Intestinal Wind), Zang Du (Visceral Toxin), Zhi Xia (Dysentery), and Bian Hong (Bright Red Blood in Stool); and involve the urine, presenting as differences between Chi Lin (Painful Urination with Blood), Niao Xue (Hematuria), Dai Xia (Leukorrhea), and Beng Zhong (Metrorrhagia/Uterine Bleeding).
Chang Feng occurs when the intestines and stomach accumulate heat; extreme heat generates wind, or external pathogens penetrate the intestinal space. The blood color is necessarily pale/clear.
Zang Du results from a preference for rich/greasy foods, indulgence in alcohol, or excessive use of hot-natured drugs, causing toxin accumulation in the viscera. The blood color is necessarily turbid/muddy.
The cause of Zhi Xia is mostly damp-heat steaming and stasis, so pus and blood are mixed, accompanied by tenesmus (straining with little output).
Bian Hong is mostly caused by initial Spleen Qi deficiency failing to control blood, resulting in blood without pus, and defecation without sound.
Chi Lin involves painful, obstructed urination; the method should be clearing and draining.
Niao Xue is simply seeing red in the urine; the method should be cooling and resolving.
Dai Xia refers to menstrual flow dripping continuously, like an unbroken belt.
Beng Zhong refers to blood gushing downward violently and flowing uncontrollably. These two occur frequently in women and represent blood disorders manifesting in the lower body.
Diseases manifesting internally: if Heat overcomes Yin, sores and ulcers will erupt; if Dampness stagnates in the Blood, pain, itching, and urticaria will arise; if stagnation affects the skin and hair follicles, Cold Bi (painful obstruction) forms; if muscles are damaged, broken injuries occur.
Diseases manifesting externally: falls and blows leave blood stasis causing pain; confrontation with cold causes condensation forming mass lesions (Jia).
Stasis accumulating in the Upper Jiao causes mental confusion/manic behavior; stasis accumulating in the Lower Jiao causes behavior resembling madness. These are blood disorders manifesting internally and externally.
Ancients said: Blood values tranquility and dislikes dispersal/agitation; agitation risks overflow. Also: Blood favors circulation and opposes stagnation; stagnation risks fixed stasis. If one can properly regulate Ying Qi, keeping it quiet enough to avoid stagnation yet circulating enough to avoid reckless movement, then meridians will flow smoothly, skin will be moist, sinews and bones strong, and joints clear. How could diseases like those mentioned above exist?