咯血之症生焉。中年之辈，由劳碌伤阴，阴气内虚，最易怒动肝火。火迫其血，血遂上溢。始也咯血不咳嗽；
既而胃气失降，肺脏为相火煽灼，或稍感微邪，渐增咳嗽，劳损成矣。夫咯血易
治，咳嗽难医。所以然者，咯血为火炎迫血，气逆血溢，寻其源而清之，降之，养之，和之，或不因火迫而吐
者，亦随其证而调之，无有不止者。若咳嗽则下焦阴气既虚，胃气逆而肺气亦耗，
阴火时时上炎，肺无宁静之日，愈咳愈伤，愈伤愈咳，不至水涸、金枯、土败不已。故咯血证一加咳嗽，十死
八九。亦有先咳嗽而后带血者，此先损其肺，后及其肾也。其寒热者，营卫虚而
金火相争也。盗汗者，肺气虚而卫不固，营为热迫也。咽痛者，肺阴枯而虚火上冲。便溏者，脾不守而金绝土
败，死期至矣。即越人上损下损及中不治之谓，盖后天之生生亦绝矣，此论阴虚咳血则
然。若不由阴虚者，如痰饮久咳，胃气逆而络伤，过饥过饱，疾行伤其胃络，郁热壅于肺胃，负重努力，
斗殴伤络，更有妇人肝经壅热，经不顺行，皆有咯血呕血证，未可见血即事滋阴凉降，须
求其本而治之。夫治血莫若顺气。气为血帅，气降而血自降，气顺而血自归经。即咳嗽一证，切勿沾沾治肺。
盖咳虽属肺，其致咳不在肺而在肾。夫肾，藏精者也。肾藏精虚，肾气无所根据恋，
上冲阳明，煽动肺脏，胃气逆不得降，肺欲不咳，安可得乎？古人谓肺犹钟也，钟不自鸣，有击之而后鸣。
医者不去其鸣钟之具，而日磨沙其钟，钟破而鸣如故。此言深有至理。王应震云∶
见痰休治痰，见血休治血；喘生勿耗气，遗精不渗泄，明得此中趣，方是医中杰。当三复斯言。
咯血这一病症由此产生。中年人群，因劳累过度损伤阴液，导致体内阴气虚弱，最容易引发肝火亢盛。火热之邪逼迫血液妄行，血液于是向上溢出。起初只是咯血而不咳嗽；随后胃气失去下降的功能，肺脏被相火熏灼，或者稍微感受轻微的外邪，逐渐增加咳嗽症状，劳损性疾病便形成了。咯血容易治疗，咳嗽难以医治。之所以这样，是因为咯血是由于火炎逼迫血液，气逆导致血液溢出，寻找病源进行清热、降逆、滋养、调和，或者并非因火迫而吐血者，也根据证候进行调理，没有不能止血的。如果咳嗽，则下焦阴气已经虚弱，胃气上逆且肺气也被耗伤，阴火时时上炎，肺脏没有安宁的时候，越咳嗽越受伤，越受伤越咳嗽，不到津液枯竭、肺金干枯、脾土败坏的地步是不会停止的。所以咯血证一旦加上咳嗽，十个人中有八九个死亡。也有先咳嗽而后带血的，这是先损伤肺脏，后波及肾脏。出现寒热症状的，是营卫虚弱而肺金与心火相互争斗。盗汗的，是肺气虚弱而卫气不固，营阴被热邪逼迫所致。咽痛的，是肺阴枯涸而虚火上冲。大便稀溏的，是脾土不能守持而肺金绝、脾土败，死期到了。这就是扁鹊所说的上损、下损及中损属于不治之症的说法，因为后天脾胃的生化之源也断绝了，这是针对阴虚咳血而言的。如果不是由阴虚引起的，比如痰饮久咳，胃气上逆损伤络脉，过饥或过饱，疾走损伤胃络，郁热壅塞于肺胃，负重用力，斗殴损伤络脉，更有妇女肝经壅滞有热，月经不顺行，都有咯血呕血的证候，不能一见出血就只顾滋阴凉血降逆，必须探求根本原因来治疗。治疗出血没有比顺气更重要的。气是血的统帅，气降则血自降，气顺则血自然回归经脉。即使是咳嗽一证，千万不要只专注于治肺。咳嗽虽然属于肺，但引起咳嗽的原因不在肺而在肾。肾，是藏精的脏器。肾藏精功能虚弱，肾气无所依附留恋，向上冲入阳明胃经，煽动肺脏，胃气上逆不得下降，肺想不咳嗽，怎么可能呢？古人说肺就像钟一样，钟自己不会响，有东西敲击才会响。医生不去掉敲击钟的东西，却每天磨沙清洗钟体，钟破了响声依然如故。这话很有深意和道理。王应震说：见到痰不要只治痰，见到血不要只治血；气喘发生不要耗气，遗精不要只用渗泄法，明白其中的奥妙，才是医中的豪杰。应当反复诵读这些话。
The symptom of hemoptysis (coughing up blood) arises. For individuals in middle age, excessive labor damages Yin fluids, leading to internal deficiency of Yin Qi, which makes them most susceptible to stirring up Liver Fire (Liver Fire). The fire forces the blood to move recklessly, causing it to overflow upwards. Initially, there is hemoptysis without coughing; subsequently, Stomach Qi fails to descend, and the Lung organ is scorched by Ministerial Fire (Xiang Huo), or slightly affected by minor external pathogens, gradually increasing cough symptoms, resulting in consumptive disease. Hemoptysis is easy to treat, but cough is difficult to cure. The reason is that hemoptysis is caused by fire blazing and forcing blood, with Qi rebellion leading to blood overflow. By seeking the source and clearing, descending, nourishing, and harmonizing it, or for those not vomiting blood due to fire forcing, adjusting according to the syndrome, there is no case where bleeding cannot be stopped. However, if cough occurs, the Yin Qi of the lower jiao is already deficient, Stomach Qi rebels, and Lung Qi is also exhausted. Deficient fire flares up from time to time, leaving the Lung without a day of tranquility. The more one coughs, the more damage occurs; the more damaged, the more one coughs, until fluids are dried up, Metal (Lung) is withered, and Earth (Spleen) collapses. Therefore, when hemoptysis is accompanied by cough, eight or nine out of ten cases are fatal. There are also cases where cough precedes blood-streaked sputum; this indicates prior damage to the Lung followed by involvement of the Kidney. The presence of chills and fever signifies deficiency of Ying and Wei (Nutritive and Defensive Qi) with conflict between Metal (Lung) and Fire (Heart). Night sweats indicate Lung Qi deficiency and failure of Wei Qi to secure the exterior, with Ying Yin forced by heat. Sore throat results from withered Lung Yin and upward rushing of deficient fire. Loose stools indicate Spleen Earth failing to hold, leading to the extinction of Lung Metal and collapse of Spleen Earth, signaling the approach of death. This refers to Bian Que's concept of upper, lower, and middle damage being incurable, as the generative source of the acquired post-heaven constitution is also cut off. This discussion applies specifically to Yin-deficiency hemoptysis. If not caused by Yin deficiency, such as chronic cough due to Phlegm-Fluids (Tan Yin), where Stomach Qi rebels and collaterals are damaged; over-hunger or over-eating; rapid walking damaging Stomach collaterals; stagnant heat obstructing the Lung and Stomach; bearing heavy loads and straining; fighting injuring collaterals; or women with stagnant heat in the Liver Channel and irregular menstruation, all can present with hemoptysis or hematemesis (vomiting blood). One must not immediately resort to nourishing Yin, cooling, and descending upon seeing blood; rather, one must seek the root cause to treat it. In treating bleeding, nothing is better than regulating Qi. Qi is the commander of Blood; when Qi descends, Blood naturally descends; when Qi flows smoothly, Blood naturally returns to its vessels. Even in the case of cough, one must not solely focus on treating the Lung. Although cough belongs to the Lung, the cause of cough lies not in the Lung but in the Kidney. The Kidney stores Essence (Jing). When Kidney Essence storage is deficient, Kidney Qi has no foundation or attachment, rushes upward into the Yangming Stomach channel, and stirs up the Lung. With Stomach Qi rebelling and unable to descend, how can the Lung avoid coughing? Ancients said the Lung is like a bell; a bell does not ring by itself but rings when struck. If a physician removes not the instrument striking the bell but instead polishes the sand within the bell daily, the bell will break while the ringing continues as before. This statement holds profound truth. Wang Yingzhen stated: "When seeing phlegm, do not merely treat phlegm; when seeing blood, do not merely treat blood; when wheezing arises, do not deplete Qi; when spermatorrhea occurs, do not merely use draining methods. To understand the essence of these principles is to be a hero among physicians." These words should be repeated and reflected upon frequently.