如机针之转环。一丝不续。乃回则不转。而霄壤判矣。是以有吐数口而即死者。非有伤
于血。乃神气不续也。）然高士宗以络血经血。分此证之轻重死生。可谓简括。第有从
血海而流溢于中。冲脉与少阴之大络。起于肾。上循背里。心下夹脊多血。虽不可与精
专者。行于经隧。以奉生身之血并重。而视散于脉外。充于肤腠皮毛之血。贵贱不同。
如留积于心下。胸中必胀。所吐亦多。而或有成块者。此因焦劳所致。若屡吐不止。或
咳嗽而成劳怯。或伤肾脏之原。而后成虚脱。所谓下厥上竭。为难治也。（喻嘉言寓意
草。以阿胶煮汤。送下黑锡丹。）其有身体不劳。内无所损。卒然咯血数口。或紫或红。一
咯便出者。为脾络之血。脾之大络。络于周身。络脉不与经脉和谐。则有此血。下不伤
阴。内不伤经。此至轻至浅之血。不药亦愈。若不分轻重。概以吐血之法治之。（如六
味地黄汤三才汤。加藕节白芨阿胶黑栀子之类。）致络血寒凝。变生怯弱咳嗽等病。医
之过也。总而言之。治络之血。当调其营卫。和其三焦。使三焦之气和于荣卫。荣卫之
气下合胞中。气归血附。即引血归经之法也。其经脉之血。心包主之。内包心。外通脉。
下合肝。合肝者。肝与心包皆为厥阴。同一气也。若房劳过度。思虑伤脾。则吐心包之
血也。吐此血者。十无一生。惟药不妄投。大补心肾。重服人参。（十药神书
用人参一两。顿服。）可于十中全其一二。若从血海流溢于心包而大吐。与心包之自
伤而吐者有别。以由病络而涉于经。宜从治络血之法。引其归经可也。又五脏有血。六
腑无血。（试观剖诸兽腹中。心下夹脊包络中多血。肝内多血。心中有血。脾中有血。
肺中有血。肾中有血。六腑无血。）吐心脏之血者。一二口即死。吐肺脏之血者。形如
血丝。吐肾脏之血者。形如赤豆。五七日必死。若吐肝脏之血。有生有死。贵乎病者能
自养。医者善调治尔。脾脏之血若罗络。即前咯血是也。（按。此脾络血。非脾脏血也。
有因腹满而使血唾者。为脾虚不能统摄也。）凡吐血多者。乃胞中血海之血。医者学不
明经。指称胃家之血。夫胃为仓廪之官。受承水谷。并未有血。谓包中血海之血。为六
淫七情所逼。上冲于胃脘而出。则可。若谓胃中有血。则不可也。
（出血如机针之转环，一丝不续。）这就好比织布机的梭子快速转动，中间没有任何停顿。如果气血回环往复的机制停止运转，那么生与死的差别就如同天壤之别了。因此，有的人吐出几口血就立即死亡，这并不是因为血液本身受到了损伤，而是神气断绝、无法接续的缘故。（然而，高士宗认为可以通过区分络脉出血和经脉出血来判断此证的轻重和生死，这种说法可谓简明扼要。只是，有的出血是从血海流溢而出，冲脉与足少阴肾经的大络，起始于肾脏，向上沿着脊柱内部行走，在心下夹脊处血液丰富。虽然这些血液不能与专门行于经脉隧道中、奉养全身生命的血液相提并论，但比起散布在脉外、充盈于皮肤腠理皮毛的血液来说，其价值贵贱是不同的。如果血液留积在心下、胸中，必然导致胸部胀满，吐出的血量也会较多，甚至可能有血块形成。这是由于过度劳累所致。如果反复吐血不止，或者因咳嗽而发展为虚劳怯弱之证，或者损伤了肾脏的根本，从而形成虚脱，这就是所谓的“下厥上竭”，属于难治之症。（喻嘉言在《寓意草》中建议，用阿胶煮汤，送服黑锡丹。））
另外，有的人身体并未劳累，体内也没有损耗，突然咯出几口血，颜色或紫或红，一咯便出，这是脾络的出血。脾的大络分布联络周身，如果络脉与经脉不和谐，就会出现这种出血。这种情况下部不伤阴，内部不伤经脉，是最轻微浅表的出血，即使不吃药也能痊愈。如果不分辨病情的轻重，一概按照治疗吐血的方法来对待（例如使用六味地黄汤、三才汤，加入藕节、白芨、阿胶、黑栀子等药物），会导致络脉中的血液寒凝，变生出怯弱、咳嗽等疾病，这是医生的过错。总而言之，治疗络脉的出血，应当调和营卫，疏通三焦，使三焦之气与营卫之气和谐，营卫之气向下汇合于胞中，气归附于血，这就是所谓“引血归经”的方法。至于经脉中的血液，由心包所主，心包内护心脏，外通血脉，下合肝脏。之所以说下合肝脏，是因为肝与心包同属厥阴经，具有相同的气机。如果是房事过度，或者思虑伤脾，就会导致心包之血外溢而吐血。吐出心包之血的人，十人中没有一人能存活。只有不乱用药，大补心肾，重用人参（《十药神书》中使用人参一两，一次性顿服），才有可能在十人中保全一二。如果是从血海流溢到心包而导致大量吐血，这与心包自身受伤而吐血是有区别的。因为这是由病在络脉波及到经脉，应当采用治疗络脉出血的方法，引导血液回归经脉。
又有人说五脏有血，六腑无血。（试着观察剖开各种野兽的腹部，心下夹脊的心包络中血液多，肝脏内部血液多，心脏中有血，脾脏中有血，肺脏中有血，肾脏中有血，而六腑中没有血。）吐出心脏之血的，吐一两口就会死亡；吐出肺脏之血的，形状像血丝；吐出肾脏之血的，形状像赤豆，五到七天内必定死亡。如果吐出肝脏之血，则有生有死，关键在于病人能否自我调养，医生能否善于调治。脾脏之血若像罗网一样散乱，就是前面所说的咯血。（按：这里的脾络血，并非脾脏本身的血。有因为腹部胀满而使血液随唾液吐出的，这是因为脾虚不能统摄血液的缘故。）凡是吐血多的，都是胞中血海的血液。医生如果学习经典不明晰，将其指称为胃家的血。胃是仓廪之官，接受和容纳水谷，并没有血。如果说胞中血海的血液，被六淫七情所逼迫，向上冲逆至胃脘而出，这还可以理解；如果说胃中有血，那就是错误的了。
(As if the shuttle of a loom turns in a ring, without a single thread breaking.) This is like the rapid rotation of the shuttle on a weaving loom, with no pause in between. If the mechanism of the return and circulation of Qi and blood ceases to operate, the distinction between life and death becomes as vast as the difference between heaven and earth. Therefore, some individuals die immediately after spitting out a few mouthfuls of blood; this is not due to damage to the blood itself, but rather to the discontinuation of Shen (Spirit) and Qi. (However, Gao Shizong distinguished the severity and prognosis of this condition by differentiating between bleeding from the collaterals [Luo vessels] and the meridians [Jing vessels], a view that can be considered concise and comprehensive. Nevertheless, some bleeding flows溢出 from the Blood Sea [Xue Hai]. The Chong Mai (Penetrating Vessel) and the large collateral of the Foot-Shaoyin Kidney Meridian originate in the kidney, ascend along the interior of the spine, and have abundant blood at the region below the heart flanking the spine. Although this blood cannot be equated with the specialized blood flowing through the meridian tunnels to nourish the body, its value differs significantly from the blood scattered outside the vessels and filling the skin, muscles, and hair follicles. If blood stagnates below the heart and in the chest, it must cause distension, and the amount vomited will be large, possibly forming clots. This is caused by excessive mental or physical exertion. If vomiting blood persists repeatedly, or develops into consumptive weakness due to coughing, or damages the root of the Kidney leading to collapse, this is termed "Rebellion of Yin below and Exhaustion of Yang above" [Xia Jue Shang Jie], which is difficult to treat. (Yu Jiayan, in *Yi Yi Cao*, suggested decocting Ejiao [Donkey-hide Gelatin] in water to administer Heixi Dan [Black Tin Pill].))
Furthermore, for those whose bodies are not fatigued and who have no internal depletion, suddenly coughing up a few mouthfuls of blood, either purple or red, which comes out easily upon coughing, is bleeding from the Spleen collaterals. The great collateral of the Spleen connects throughout the body. If the collaterals are not harmonious with the meridians, such bleeding occurs. This condition does not injure Yin below nor the meridians internally; it is the mildest and most superficial type of bleeding, which may heal even without medication. If one fails to distinguish the severity and treats all cases generally as stomach bleeding (such as using Liuwei Dihuang Wan [Six-Ingredient Rehmannia Pill], Sancai Tang [Three Essentials Decoction], adding Oujie [Lotus Node], Baiji [Bletilla Rhizome], Ejiao, and Heizhizi [Gardenia Fruit charred]), it may cause cold coagulation of the collateral blood, giving rise to diseases such as weakness and coughing. This is the fault of the physician. In summary, treating collateral bleeding requires regulating Ying (Nutritive) and Wei (Defensive) Qi, and harmonizing the Sanjiao (Triple Burner), so that Sanjiao Qi harmonizes with Ying and Wei Qi, and Ying and Wei Qi descend to merge in the Baozhong (Uterus/Pelvic Cavity). When Qi returns and attaches to Blood, this is the method of "guiding blood back to the vessels." As for blood in the meridians, it is governed by the Pericardium [Xinbao]. The Pericardium protects the Heart internally, connects externally with the vessels, and merges with the Liver below. It merges with the Liver because both the Liver and the Pericardium belong to the Jueyin [Greater Yin] category and share the same Qi. If sexual excess or overthinking injures the Spleen, it leads to vomiting of Pericardium blood. Those who vomit Pericardium blood rarely survive (ten out of ten die). Only by avoiding reckless medication, strongly tonifying the Heart and Kidney, and administering large doses of Renshen [Ginseng] (as per *Shi Yao Shen Shu* [Divine Book of Ten Medicines], using 1 liang of Ginseng taken in one dose) might one or two out of ten survive. If bleeding flows from the Blood Sea into the Pericardium causing massive vomiting, it differs from self-injury of the Pericardium. Since the disease spreads from collaterals to meridians, one should use methods for treating collateral bleeding to guide the blood back to the vessels.
It is also said that the Zang organs [Solid Organs] have blood, while the Fu organs [Hollow Organs] do not. (Observe the abdomens of dissected animals: the Xinbao Luo [Pericardium Collaterals] below the heart flanking the spine have much blood; the Liver has much blood internally; the Heart, Spleen, Lungs, and Kidneys contain blood; but the Six Fu organs do not.) Vomiting blood from the Heart results in death after one or two mouthfuls; blood from the Lung appears like silk threads; blood from the Kidney resembles red beans, leading to death within five to seven days. Vomiting blood from the Liver may result in survival or death, depending on whether the patient can self-nourish and the physician can treat skillfully. Blood from the Spleen organ dispersing like a net refers to the hemoptysis mentioned earlier. (Note: This Spleen collateral blood is not Spleen organ blood. Some spit blood accompanied by abdominal fullness due to Spleen deficiency failing to control blood.) Generally, profuse hematemesis originates from the Blood Sea in the Baozhong. Physicians who do not understand the classics mistakenly attribute it to the Stomach. The Stomach is the official of the granary, receiving and storing food and drink, and contains no blood. It is acceptable to say that blood from the Blood Sea, forced upward by the Six Evils [Pathogenic Factors] and Seven Emotions, rushes to the epigastrium and is vomited; however, claiming there is blood inside the Stomach itself is incorrect.