咯血者。痰带血丝也。昔人谓咯血出于心。谓心主血脉。咯出血丝。象血脉之形故也。又谓咯血出于肾。盖
肾主五液。虚火上升。则水液泛上。凝而为痰。然第吐痰已也。而何以又带血丝哉。盖肾气下行。则水出膀
胱。今肾经之气不化于膀胱。而反载膀胱之水上行为痰。膀胱者。胞之室。膀胱之水。随火上沸。引动胞血
随之而上。是水病兼病血也。观女人先发水肿。然后断经者。名曰水分。是水病而连累胞血之一证。又观
伤寒论。热结膀胱。其血自下。夫热结膀胱。是水病也。而即能惹动胞中之血。从小便而下。又水病兼动胞
血之一证也。据此。可知水泛为痰。而亦能牵引胞血矣。古法但谓咯血出于肾。而未能发明。致庸劣者竟
谓其血出于肾脏。非也。所谓咯血出于肾者。乃肾气不化于膀胱。水沸为痰。而惹动胞血之谓也。此论从
古未经道及。而予从伤寒悟出。千虑一得。不容自秘。医者知此。则可知治咯之法。并可知治痰之原矣。仲
景猪苓汤。化膀胱之水。而兼滋其血。最为合法。再加丹皮蒲黄。以清血分。凡痰之原血之本。此方兼到。或
用地黄汤。加旋复花五味天冬寸冬蒲黄。火甚者。用大补阴丸。加海粉牛膝云苓丹皮蛤蚧。凡此数方。皆
主利痰立法。是就肾主咯血之说。以出治也。肾水化于膀胱。故泻膀胱。即是泻肾。膀胱与血室同居一地。
膀胱之水不泛。则自不动血室之血矣。数方皆治膀胱。兼治血室。故效。
夫痰为肾之所主。血实心之所主也。况水火互根。肾病及心。心病亦及肾。其有心经火旺。血脉不得安静。
因而带出血丝。咳逆咽痛者。导赤饮。加黄连丹皮血余蒲黄天冬寸冬尖贝茯苓治之。地骨皮散。加茯苓
射干旋复花牛膝。太平丸亦治之。以上数方。皆就咯血出于心之说以立法。心主血脉。部居胸中。与肺为
近。肺气咳逆。犹易牵动心部之血。故痰咳者。往往带出血丝。治血丝以心为主。肺为水之上源。水不清而
凝为痰。痰不降而牵动血。治肺之痰。又是治咯血捷法。盖痰血之来。虽由心肾。而无不关于肺者也。太平
丸为治肺通剂。紫菀散。保和汤。皆善能涤除肺痰。补泻兼到。另参咳血唾血门。可尽其治。
咯血，是指痰中带有血丝。古人认为咯血源于心，是因为心主司血脉，咯出的血丝形状类似血脉的形态。又有人认为咯血源于肾，因为肾主管五液（津液），若虚火上升，则水液泛溢上行，凝结而成痰。但这仅仅是吐痰罢了，为何又会带有血丝呢？这是因为肾气本应下行，使水液排出至膀胱；如今肾经之气不能在膀胱正常气化，反而携带膀胱的水液向上运行化为痰。膀胱是胞宫（子宫）所在的室域，膀胱中的水液随着虚火上沸，引动胞宫之血随之上行，这是水病兼及血病。观察女性患者，先出现水肿，随后月经停止，这种病症称为“水分”，这就是水病连累胞血的例证。再观察《伤寒论》中的记载，热邪结聚于膀胱，血液会自行下行。热结膀胱属于水病，却能引动胞中之血从小便排出，这也是水病兼动胞血的例证。据此可知，水液泛滥化为痰，也能牵引胞血上行。古法只说咯血出于肾，却未能阐明其机理，导致平庸低劣的医生竟认为出血直接来自肾脏，这是错误的。所谓咯血出于肾，是指肾气不能在膀胱气化，水液沸腾化为痰，进而引动胞血而言。这一论述自古未曾提及，是我从《伤寒论》中领悟出来的，虽属千虑一得，但不敢私藏。医者知晓此理，就能明白治疗咯血的方法，也能了解治痰的根本。张仲景的猪苓汤，能化除膀胱之水，同时滋养阴血，最为合乎法度。再加牡丹皮、蒲黄，以清解血分之热。凡是痰的来源和血的根本，此方都能兼顾。或者使用地黄汤，加入旋覆花、五味子、天冬、麦冬、蒲黄。火势旺盛者，使用大补阴丸，加入海粉、牛膝、云茯苓、牡丹皮、蛤蚧。以上几个方剂，都是主要采用利痰的方法来立法，这是基于“肾主咯血”的说法而制定的治疗方案。肾水在膀胱气化，所以泻膀胱即是泻肾。膀胱与血室（胞宫）同居一处，如果膀胱的水液不泛滥，自然就不会扰动血室的血液了。这几个方剂都治疗膀胱，兼治血室，所以有效。
痰是由肾所主，而血实际上是心所主。况且水火互根互用，肾病可波及心，心病也可波及肾。如果有手少阴心经火旺，导致血脉不能安宁，因而带出血丝，伴有咳嗽气逆、咽喉疼痛的，可用导赤饮，加入黄连、牡丹皮、血余炭、蒲黄、天冬、麦冬、川贝母来治疗。地骨皮散，加入茯苓、射干、旋覆花、牛膝。太平丸也可以治疗。以上几个方剂，都是基于“咯血出于心”的说法来立法的。心主司血脉，部位居于胸中，与肺脏相近。肺气咳嗽气逆，容易牵动心部区域的血液，所以患痰咳的人，往往痰中带血丝。治疗血丝以心为主，肺为水之上源，水液不清澈而凝结成痰，痰液不下降而牵动血液，治疗肺部的痰，又是治疗咯血的捷径。大概痰和血的来源，虽然由心和肾引起，但没有不关系到肺脏的。太平丸是治疗肺气的通剂，紫菀散、保和汤，都善于涤除肺部的痰浊，补益与泻实兼顾。另外参考咳血、唾血门的内容，可以穷尽治疗方法。
Hemoptysis refers to sputum containing blood streaks. Ancient practitioners believed that hemoptysis originates from the Heart, because the Heart governs the blood vessels (Xue Mai), and the shape of the expelled blood streaks resembles the form of blood vessels. It is also held that hemoptysis originates from the Kidney, as the Kidney governs the five fluids (Wu Ye). When deficient fire rises, body fluids overflow and ascend, condensing into phlegm. However, this merely involves expectorating phlegm; why does it contain blood streaks? This is because Kidney Qi should descend, allowing fluids to be excreted into the Bladder. Currently, Qi of the Kidney meridian fails to undergo qi transformation in the Bladder, instead carrying bladder fluids upward to transform into phlegm. The Bladder is the chamber of the Bao (Uterus/Womb); when water in the Bladder boils up with fire, it draws the blood of the Bao upward along with it. This constitutes a water disease complicating a blood disease. Observing women who first develop edema and then cease menstruation—a condition named "Water Division" (Shui Fen)—provides evidence that water disease can implicate Bao blood. Furthermore, observing the *Treatise on Cold Damage* (*Shanghan Lun*), where heat accumulation in the Bladder causes blood to descend spontaneously: heat accumulation in the Bladder is a water disease, yet it provokes blood within the Bao to exit via urination. This is another instance of water disease moving Bao blood. Based on this, it is evident that overflowing water transforming into phlegm can also draw Bao blood upward. Ancient methods only stated that hemoptysis originates from the Kidney but failed to elucidate the mechanism, leading mediocre physicians to erroneously claim that the bleeding comes directly from the Kidney organ itself. What is meant by "hemoptysis originating from the Kidney" is that Kidney Qi fails to transform in the Bladder, water boils into phlegm, and thereby provokes Bao blood. This theory has not been mentioned since ancient times; I deduced it from the *Shanghan Lun*. Though it may be but one insight from a thousand deliberations, I dare not keep it secret. If physicians understand this, they will know the methods for treating hemoptysis and the root cause of phlegm. Zhang Zhongjing's Zhu Ling Tang (Polyporus Decoction) resolves water in the Bladder while simultaneously nourishing blood, which is most appropriate. Adding Mu Dan Pi (Moutan Cortex) and Pu Huang (Pollen Typhae) clears the blood level. For both the source of phlegm and the root of blood, this formula covers both aspects. Alternatively, use Di Huang Tang (Rehmannia Decoction) added with Xuan Fu Hua (Inulae Flos), Wu Wei Zi (Schisandrae Fructus), Tian Dong (Asparagi Radix), Cun Dong (Ophiopogonis Radix), and Pu Huang. If fire is severe, use Da Bu Yin Wan (Great Supplement the Yin Pill) added with Hai Fen (Calamari Glarea), Niu Xi (Achyranthis Bidentatae Radix), Yun Ling Shen (Poria), Mu Dan Pi, and Ge Jie (Gecko). All these formulas primarily establish legislation based on resolving phlegm, deriving treatment from the theory that "the Kidney governs hemoptysis." Since Kidney water transforms in the Bladder, draining the Bladder is equivalent to draining the Kidney. The Bladder and the Blood Chamber (Bao Luo) share the same location. If water in the Bladder does not overflow, it will naturally not disturb the blood of the Blood Chamber. These formulas treat the Bladder and concurrently treat the Blood Chamber, hence their efficacy.
Phlegm is governed by the Kidney, while blood is actually governed by the Heart. Moreover, Water and Fire are mutually rooted; Kidney disease affects the Heart, and Heart disease affects the Kidney. If there is hyperactivity of fire in the Heart Meridian, causing the blood vessels to lose tranquility, resulting in blood streaks accompanied by coughing, counterflow of Qi, and sore throat, Dao Chi Yin (Guide Out Redness Decoction) added with Huang Lian (Coptidis Rhizoma), Mu Dan Pi, Xue Yu Tan (Carbonized Human Hair), Pu Huang, Tian Dong, Cun Dong, and Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) should be used. Di Gu Pi San (Lycii Cortex Powder) added with Fu Ling (Poria), She Gan (Belamcandae Rhizoma), Xuan Fu Hua, and Niu Xi is also applicable. Tai Ping Wan (Peaceful Empire Pill) can also treat this condition. The aforementioned formulas all establish legislation based on the theory that "hemoptysis originates from the Heart." The Heart governs blood vessels and resides in the chest, close to the Lung. Lung Qi coughing and counterflow easily perturb the blood in the Heart region; thus, those with phlegm-cough often have blood streaks in sputum. Treating blood streaks focuses on the Heart. The Lung is the upper source of water; if water is not clear, it condenses into phlegm; if phlegm does not descend, it perturbs blood. Treating Lung phlegm is therefore a swift method for treating hemoptysis. Although the origin of phlegm and blood lies in the Heart and Kidney, none do not involve the Lung. Tai Ping Wan is a general agent for treating Lung Qi. Zi Wan San (Asteris Radix Powder) and Bao He Tang (Preserve Harmony Decoction) are excellent at cleansing Lung phlegm, combining tonification and purgation. Refer additionally to the sections on Hemoptysis and Spitting Blood for comprehensive treatment methods.