〔大〕产后小便出血者，因血气虚而热乘之，血得热则流散，渗于胞内，故血随小
便出。
〔薛〕一产妇尿血，面黄，胁胀少食，此肝木乘脾土也。用加味逍遥、补中益气兼
服而愈。后为怀抱不乐，食少体倦，惊悸无寐，血仍作，用加味归脾汤二十余剂，将愈。
惑于众论，服犀角地黄汤，诸证复作，仍服前汤而愈。
治小便利血方。
乱发（汤洗垢腻净）
上烧研为末，米饮调服方寸匕。
又方 用滑石（研） 发灰（等分） 每服一钱，地黄汁调下。
崔氏方 疗产后血渗入大小肠。
蜜（一大合） 车前草（捣汁，一升）
上相和煎沸，分两服。
《补遗》方 治产后小便出血。
川牛膝（去芦） 水煎服。
又方
生地黄汁（半升） 生姜自然汁（半合）
上相和服之。
〔薛〕产后便血，或饮食起居，或六淫七情，以致元气亏损，阳络外伤。治法∶若
因膏粱积热，用加味清胃散。若因醇酒湿毒，葛花解酲汤。若因怒动肝火，六君加芍药、柴
胡、芎、归。若因郁结伤脾，加味归脾汤。若因思虑伤心，妙香散。若因大肠风热，四物
加侧柏、荆、防、枳壳、槐花。若因大肠血热，四物加芩、连。若因肠胃虚弱，六君加
升麻、柴胡。若因肠胃虚寒，六君加肉蔻、木香。若因元气下陷，补中益气加茯苓、半夏。
若因气虚，用六君、升麻。若因血虚，用四物。气血俱虚，用八珍，俱加柴胡、升麻。大
凡病久或元气虚弱，见病百端，皆因脾胃亏损，内真寒而外假热，但用六君子或补中益
气加炮姜，温补脾气，诸证悉退。若四肢畏冷，属阳气虚寒，急加附子。病因多端，当
临证制宜，庶无误矣。一产妇粪后下血，诸药不应，饮食少思，肢体倦怠，此中气虚弱，
用补中益气加吴茱、炒黄连五分，四剂顿止。但怔忡、少寐，盗汗未止，用归脾汤治之而
痊。一妇人但怒便血，寒热口苦，或胸胁胀痛，或小腹痞闷，此木乘土。用六君加山
栀、柴胡而愈。又用补中益气、加味逍遥二药而不复作。一妇人久下血，在粪前，属
脾胃虚寒，元气下陷。用补中益气汤加连、炒吴茱一钱，数剂稍缓。乃加生吴茱五分，数
剂而愈。 一妇人产后便血，口干饮汤，胸胁膨满，小腹闷坠，内热晡热，饮食不甘，体
倦面黄，日晡则赤，洒淅恶寒，此脾肺气虚。先用六君加炮姜、木香，诸证渐愈。用补中
益气，将愈。用归脾汤全愈。后饮食失节，劳役兼怒气，发热血崩，夜间热甚，谵语不绝，
此热入血室。用加味小柴胡二剂而热退，用补中益气而血止，用逍遥散、归脾汤调理而
康。
[Da Lun] Postpartum hematuria (blood in urine) occurs due to deficiency of Qi and Blood, allowing Heat pathogens to invade. When Blood is affected by Heat, it flows and scatters, seeping into the interior of the Baogong (uterus/bladder area), thus causing blood to be discharged with urine.
[Xue Ji's Case] A postpartum woman presented with hematuria, sallow complexion, distension in the hypochondrium, and poor appetite. This indicates Liver Wood overacting on Spleen Earth. She was cured by alternating administration of Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Later, due to emotional depression, she developed poor appetite, fatigue, palpitations, insomnia, and recurrent bleeding. After taking Jia Wei Gui Pi Tang (Modified Restore the Spleen Decoction) for more than twenty doses, her condition was nearly resolved. However, misled by public opinion, she took Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction), which caused all symptoms to recur. She was subsequently cured by resuming the previous prescription (Jia Wei Gui Pi Tang).
Prescription for treating hematuria:
Fa Luan (Human Hair) (Washed clean with hot water to remove grease and dirt)
Burn the above material, grind into powder, and take one Fang Cun Bi (a square-inch measure) mixed with rice water.
Another prescription: Use Hua Shi (Talcum) (ground) and Fa Hui (Hair Ash) in equal parts. Take one Qian per dose, administered with Sheng Di Huang Zhi (Juice of Fresh Rehmannia Root).
Cui Shi's Prescription: Treats postpartum blood seeping into the large and small intestines.
Mi (Honey) (One Da He)
Che Qian Cao (Plantago Leaf/Herb) (Crushed to extract juice, One Sheng)
Mix and boil until bubbling, divide into two doses.
Bu Yi Prescription: Treats postpartum hematuria.
Chuan Niu Xi (Cyathulae Radix) (Remove the radicle)
Decoct in water and take.
Another prescription:
Sheng Di Huang Zhi (Juice of Fresh Rehmannia Root) (Half a Sheng)
Sheng Jiang Zi Ran Zhi (Fresh Ginger Juice) (Half a He)
Mix and take.
[Xue Ji's Commentary] Postpartum hematochezia (blood in stool) may result from improper diet or lifestyle, or from the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire) and Seven Emotions, leading to depletion of Yuan Qi (Original Qi) and external injury to Yang Collaterals. Treatment methods: If caused by accumulation of heat from rich food, use Jia Wei Qing Wei San (Modified Stomach-Clearing Powder). If caused by damp-toxin from alcohol, use Ge Hua Jie Cheng Tang (Ardisia Flower Decoction to Resolve Intoxication). If caused by anger stirring up Liver Fire, use Liu Jun Zi Tang (Six Gentlemen Decoction) added with Shao Yao (Peony), Chai Hu (Bupleurum), Xiong (Ligusticum), and Dang Gui (Angelica). If caused by constraint injuring the Spleen, use Jia Wei Gui Pi Tang (Modified Restore the Spleen Decoction). If caused by excessive thinking injuring the Heart, use Miao Xiang San (Wonderful Incense Powder). If caused by Wind-Heat in the Large Intestine, use Si Wu Tang (Four Substances Decoction) added with Ce Bai Ye (Biota Tip), Jing Jie (Schizonepeta), Fang Feng (Saposhnikovia), Zhi Ke (Aurantii Fructus), and Huai Hua (Sophora Flower). If caused by Blood-Heat in the Large Intestine, use Si Wu Tang added with Huang Qin (Scutellaria) and Lian Lian (Coptis). If caused by Spleen-Stomach weakness, use Liu Jun Zi Tang added with Sheng Ma (Cimicifuga) and Chai Hu (Bupleurum). If caused by Spleen-Stomach deficiency-cold, use Liu Jun Zi Tang added with Rou Dou Kou (Nutmeg) and Mu Xiang (Aucklandia). If caused by sinking of Yuan Qi, use Bu Zhong Yi Qi Tang added with Fu Ling (Poria) and Ban Xia (Pinellia). If caused by Qi deficiency, use Liu Jun Zi Tang and Sheng Ma. If caused by Blood deficiency, use Si Wu Tang. If both Qi and Blood are deficient, use Ba Zhen Tang (Eight Treasures Decoction), adding Chai Hu and Sheng Ma. Generally, in prolonged illness or weak Yuan Qi, presenting with various symptoms, the root cause is often Spleen-Stomach damage, manifesting as true cold internally and false heat externally. In such cases, only use Liu Jun Zi Tang or Bu Zhong Yi Qi Tang added with Pao Jiang (Prepared Ginger) to warm and tonify Spleen Qi, after which all symptoms will recede. If there is aversion to cold in the four limbs, indicating Yang deficiency-cold, urgently add Fu Zi (Aconite). Etiologies are diverse; clinical judgment must be applied flexibly to avoid errors.
Case 1: A postpartum woman passed blood after defecation; various medicines failed. She had poor appetite and limb fatigue, indicating Spleen Qi deficiency. She was treated with Bu Zhong Yi Qi Tang added with Wu Zhu Yu (Evodia) and Chao Huang Lian (Stir-fried Coptis, 5 fen). After four doses, bleeding stopped abruptly. However, palpitations, insomnia, and night sweats persisted. She was cured using Gui Pi Tang (Restore the Spleen Decoction).
Case 2: A woman experienced hematochezia whenever angry, accompanied by alternating chills and fever, bitter taste, sometimes chest/hypochondriac distension/pain, or abdominal fullness. This indicates Liver Wood overacting on Spleen Earth. She was cured using Liu Jun Zi Tang added with Shan Zhi (Gardenia) and Chai Hu (Bupleurum). Subsequent maintenance with Bu Zhong Yi Qi Tang and Jia Wei Xiao Yao San prevented recurrence.
Case 3: A woman suffered from chronic hematochezia, with blood appearing before stool. This belongs to Spleen-Stomach deficiency-cold and sinking of Yuan Qi. She was treated with Bu Zhong Yi Qi Tang added with Lian Lian (Coptis) and Chao Wu Zhu Yu (Stir-fried Evodia, 1 qian). Symptoms eased slightly after several doses. Then, raw Wu Zhu Yu (5 fen) was added, and she was cured after several more doses.
Case 4: A postpartum woman presented with hematochezia, dry mouth desiring soup, chest/hypochondriac distension, abdominal heaviness/dragging sensation, internal heat worsening at dusk, poor appetite, fatigue, sallow complexion, afternoon facial redness, and aversion to cold/shivering. This indicates Spleen and Lung Qi deficiency. Initially, Liu Jun Zi Tang added with Pao Jiang (Prepared Ginger) and Mu Xiang (Aucklandia) gradually improved symptoms. Bu Zhong Yi Qi Tang brought her near recovery. Finally, Gui Pi Tang (Restore the Spleen Decoction) led to complete cure. Later, due to irregular diet, overwork, and anger, she developed fever and metrorrhagia (flooding), severe night fever, and continuous delirium. This indicates Heat entering the Blood Chamber (Xue Shi). She was treated with Jia Wei Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction) for two doses to resolve the fever, then Bu Zhong Yi Qi Tang to stop bleeding, and finally Xiao Yao San (Free and Easy Wanderer Powder) and Gui Pi Tang for regulation, resulting in recovery.