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The *Daquan* (Complete Good Prescriptions for Women) states: When a pregnant woman suffers from exertion and injury to the meridians, with heat residing internally, the heat attacks the blood. Blood, when subjected to heat, flows and overflows, seeping into the bladder (Pangguang), thus causing hematuria (blood in urine).

Li states: Fetal leakage (Tailou) involves bleeding from the vagina, whereas hematuria involves bleeding from the urethra. In pregnancy, hematuria is mostly due to heat in the uterus (Baogong); Siwu Tang (Four Substances Decoction) added with Zhizi (Gardeniae Fructus) and Fahui (Carbonized Hair) is used. Another prescription uses Ejiao (Donkey-hide Gelatin) and Shudihuang (Prepared Rehmanniae Radix).

Shen Zhai notes: The above two passages describe the syndrome of antepartum hematuria. Hematuria can be easily confused with fetal leakage; Li’s differentiation has clarified this distinction. However, while fetal leakage may bleed intermittently or frequently, hematuria results from heat entering the bladder. Originally, there is fire in the Heart Meridian, which transfers to the Small Intestine, then seeps into the bladder. Blood is discharged during urination but not when voiding does not occur. This is essentially hematuria in the urine, differing only in that it occurs during pregnancy.

The *Chanbao Baiwen* (Hundred Questions on Childbirth Treasures) states: The Kidney (Shen) is the official of strength and vigor, where skills originate; it forms an interior-exterior relationship with the Bladder. In men, it stores essence; in women, it anchors the fetus (Bao). During pregnancy, dysuria (Linzheng) is caused by Kidney deficiency and heat in the Bladder. Kidney deficiency fails to control water, leading to frequent urination. Exogenous heat in the Bladder causes the water pathway to become obstructed and frequent, resulting in dribbling and incomplete emptying, named Zilin (pregnancy dysuria), treated primarily with Difuzi Tang (Kochia Seed Decoction).

Chen Liangfu states: Scanty and difficult urination in pregnant women occurs because Qi and Blood gather to nourish the Fetus Yuan, leaving insufficient resources to moisten the urinary pathways, thereby causing stagnant heat in the Bladder. The method should be to nourish Blood to moisten the pathways and promote urination to guide out stagnant heat. Use Danggui (Angelicae Sinensis Radix) and Shaoyao (Paeoniae Radix) to regulate Blood, Renshen (Ginseng Radix) to tonify Qi, Maidong (Ophiopogonis Tuber) to clear the Lung and nourish the source of Kidney Water, Huashi (Talcum) and Tongcao (Tetrapanacis Medulla) to promote urination and clear stagnation. This is named Anrong San (Anrong Powder). Since Huashi is a heavy/cold agent, it might induce abortion; it is excellent near term. If before the seventh or eighth month, remove this herb and add Shihu (Dendrobii Caulis) and Zhizi (Gardeniae Fructus) for greater safety.

Wan Muzhai states: Zilin must be differentiated into two syndromes. One is the mother being ill herself; the other is the fetus being affected by the mother. Regarding the mother being ill herself, it divides into two syndromes: either consuming pungent and hot foods, generating internal heat; or having spontaneous sweating and diarrhea, leading to dryness of body fluids. Regarding the fetus being affected by the mother, it also divides into two syndromes: either heat congestion in the fetal Qi, or physical obstruction by the fetus. Since the syndromes differ, the treatments also differ. Generally, heat is cleared, dryness is moistened, congestion is unblocked, and obstruction is moved. This is the method of treatment.