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Painful hematuria is called *xuelin* (blood strangury), see the section on strangury. Painless hematuria is called *niaoxue* (bleeding from urination). Regardless of which Zang organ's blood is involved, if it is damaged and flows recklessly, it can seep into the Bladder and exit together with urine. Since blood that does not flow upward tends to descend, it can seep into the Intestines or seep into the urinary bladder (*niaopao*). As stated in *Zhunsheng*: "Hematuria (*soushui*), bloody strangury (*linxue*), and melena (*bianxue*), although they exit from the anterior and posterior yins respectively, share the same pathological origin." The herbs for dispersing blood and stopping bleeding do not exceed a few dozen types; only the guiding herbs differ slightly, so this explanation is indeed sound. If the blood does not exit with urine but instead exits from the essence orifice (*jingqiao*), this refers to blood from the clear pathways. Blood from the clear pathways may exit upwards via epistaxis or downwards via the essence orifice, often caused by excessive sexual activity; treat with *Niuxi Siwu Tang* (Dioscorea Hypoglauca and Four Substances Decoction). For cases where various medicines are ineffective, and the blood in urine forms clots, cannot be expelled, and causes severe pain, *Po Zhu San* (Pearl Powder) is very effective.

The syndrome of blood retention (*xuxue zheng*) often presents with rinsing water but not swallowing it (meaning there is irritability and heat desiring water, but one rinses without swallowing because the heat is confined to the meridians, not the fu organs. Heat in the meridions agitates the meridian blood; if no epistaxis occurs, the blood retains internally). Urination is free (this is blood retention outside the Bladder, as the blood is retained only in the lower abdomen and has not entered the Bladder). Stool is black (this is blood retention in the Intestines). Trauma, sprains, collisions, running with exertion, and anger can all cause this condition; it is particularly common in febrile diseases such as *Shanghan* (Cold Damage). When blood retains in the upper jiao, it causes forgetfulness (blood retention obstructs qi flow, closing the orifices of the Heart, thus causing forgetfulness); frequent epistaxis occurs; treat with *Xijiao*, *Shengdi*, *Chishao*, and *Danpi*. When blood retains in the middle jiao, the area below the heart is tender to touch; treat with *Taoren*, *Guizhi*, *Mangxiao*, *Gancao*, *Dahuang*, *Danpi*, and *Zhiqiao*. When blood retains in the lower jiao, there is swelling and pain around the umbilicus and abdomen, or symptoms such as manic behavior, delirious speech, and jaundice (see *Shanghan Lun · Taiyang Chapter*). Use *Shengdi* 4 qian, *Xijiao* 1 qian, *Dahuang* 3 qian, *Taoren* 1 qian; decoct with water and wine, add *Shengqi* (raw lacquer) 1 qian and decoct again. If after half a day the blood has not been purged, administer another dose; once the blood is purged, stop administration. This formula is named *Shengqi Tang* (Raw Lacquer Decoction). For all kinds of blood stasis, use *Dahuang* 4 qian, *Mangxiao* 1 qian, six *Taoren* paste, *Guiwei*, *Shengdi*, and *Shanjia* each 1 qian, *Guizhi* 0.5 fen; process into pills, named *Dai Didang Wan* (Substitute Dangdang Pill). For upper jiao blood stasis, make pills the size of mustard seeds; lie supine without a pillow, swallow with saliva, allowing the medicine to linger under the throat. For middle and lower jiao blood stasis, make pills the size of paulownia seeds; take with boiling water. If the blood stasis has accumulated for a long time and these medicines fail to purge it, remove *Guiwei* and *Shengdi*, add *Ezhu* stir-fried with vinegar 1 qian, and *Rougui* 0.7 fen. Another blood-breaking formula (also used for amenorrhea in women): decoct *Dahuang* with vinegar, use *Taoren* and *Yiyuan San* each 1 liang, *Ganqi* stir-fried until smoke ceases, and *Sheng Niuxi* each 5 qian; process into pills with vinegar paste, taking 70 pills per dose. Generally, for trauma fractures with blood retention, swelling, pain, and fever, first administer *Zherui Tang* (*Dahuang*, *Taoren*, *Honghua*, *Danggui*, *Jinu*, *Chuanxiong*, *Chishao*) to purge strongly several times; then administer *Xingxue Pouyu Tang* (*Sanqi*, *Danggui*, *Yanhusuo*, *Ruxiang*, *Moyao*, *Xuexie*, *Sumu*, *Wulingzhi*, *Chishao*, *Honghua*); finally, administer *Baihe Tang* to conclude treatment (*Shouwu*, *Dihuang*, *Danggui*, *Gusuibu*, *Baiji*, *Lujiao*, *Xuduan*, *Gancao*, *Bohe*). Whenever blood flows recklessly and accumulates as stasis, formulas containing *Taoren* and *Dahuang* for moving blood and breaking stasis must be used. Because failed/decayed blood has no possibility of returning to the meridians, if not removed, it will remain and cause harm; therefore, regardless of the patient's deficiency or excess, strength or weakness, removal is undoubtedly necessary. Tonifying herbs may be added for those who are weak. Those who enjoy alcohol often have Yangming blood retention, characterized by dental caries that persist for years without healing; treat with pills made from *Taoren Chengqi Tang* ingredients, which has proven highly effective.