倪（左） 小便混浊如泔，有时带出血条，却不作痛。此肾虚而湿热袭入肾与膀胱。宜泄热利湿。
海金沙（三钱） 当归炭（二钱） 川萆 （二钱） 泽泻（一钱五分） 生地（四钱） 滑石块（三钱）
丹皮炭（二钱） 赤白苓（各二钱） 鲜藕（三两煎汤代水）
二诊 尿血不止，尿管并不作痛。脉形细弱。肾虚湿热内袭，实少虚多之象也。
炙生地（四钱） 当归炭（二钱） 蒲黄（六分） 牛膝炭（三钱） 炒萸肉（一钱五分） 生甘草（三分）
丹皮炭（二钱） 山药（四钱） 藕节炭（三枚）
三诊 膀胱湿热稍化，血稍减少，小溲仍然混浊。前法再进一筹。
大生地（四钱） 当归炭（二钱） 蒲黄炭（五分） 沙苑（盐水炒三钱） 生山药（三钱） 丹皮炭（二钱）
牛膝炭（三钱） 炒萸肉（一钱五分） 淡秋石（一钱） 藕汁（一杯温冲）
四诊 尿血渐减，脉亦稍缓。痛者为火，不痛者为虚。再益肾之阴。
大生地（三钱） 粉丹皮（一钱五分） 白芍（一钱五分） 大熟地（二钱） 山药（三钱） 旱莲草（三钱）
炒萸肉（一钱五分） 泽泻（一钱五分） 潼沙苑（三钱） 藕节（二枚）
五诊 尿血降序，尚未能止。脉象微数。肾虚而虚火内迫。再育阴泄热。
大熟地（四钱） 炒五味（三分） 茯神（三钱） 旱莲草（三钱） 淡秋石（一钱） 大麦冬（二钱）
炒萸肉（二钱） 丹皮（二钱） 生山药（三钱） 白芍（一钱五分） 藕节炭（三枚）
六诊 尿血渐退。再壮水益阴。
生熟地（各三钱） 粉丹皮（二钱） 炒萸肉（二钱） 炙五味（三分） 麦冬（三钱） 杭白芍（一钱五分）
淡秋石（二钱） 生山药（三钱） 泽泻（盐水炒三钱） 藕节（三枚）
七诊 尿血之后，肾阴不复。再壮水育阴。
生熟地（各三钱） 生山药（三钱） 白芍（一钱五分） 大天冬（二钱） 党参（三钱） 生熟草（各三分）
炙五味（三钱） 泽泻（一钱五分） 大麦冬（一钱五分）
八诊 溲血之症，原由肾水内亏，虚火郁结，迫损血分。前投壮水制火，诸恙得平，调理之计，自宜扩充
前意。兹参入清养上中，以肺阴在上，而为水之上源也。
西洋参（二两） 奎党参（四两） 生山药（三两） 生于术（二两） 炒萸肉（一两） 炒扁豆（三两）
云茯苓（三两） 川石斛（四两） 粉丹皮（二两） 肥玉竹（三两） 怀牛膝（盐水炒三两） 生熟地（各二两）
天麦冬（各三两） 甘杞子（三两） 白芍（酒炒一两五钱） 生熟草（各五钱） 当归炭（一两五钱） 女贞子（酒
炒三两） 潼沙苑（盐水炒三两） 浓杜仲（盐水炒二两） 炒知母（二两） 泽泻（一两）
用清阿胶三两，龟板胶三两，鱼鳔胶二两，冰糖三两，四味溶化收膏，每日晨服一调羹。
某 尿血并不作痛。
益元散 黑山栀 龙胆草 制香附 黄柏（盐水炒） 甘草梢
川萆 赤白苓 车前子 泽泻
左 尿血而不作痛。叠投壮水益肾，诸恙渐平无如平。素多湿，水得补而渐复，湿得补而渐滞，所以目
带黄，而食不馨香也。急宜流化湿热。
制半夏（二钱） 制香附（一钱五分） 大腹皮（二钱） 生熟薏仁（各二钱） 上广皮（一钱） 建泽泻（一
钱五分） 西茵陈（二钱） 猪茯苓（各二钱）
又 小溲渐清，而面目尚带浮黄，还是气滞湿郁情形。
前方去茵陈香附，加于术砂仁玫瑰花广藿香。
左 溲血已止，而脉象尚觉弦硬。的是肝肾两亏，不能固摄，湿热乘袭其地。再从壮水之中，参以坚阴。
生地炭（四钱） 生牛膝（五分） 黑丹皮（一钱） 龟甲心（五钱） 茯苓（三钱） 黄柏炭（一钱五分）
黑山栀（三钱） 泽泻（一钱五分） 淡竹叶（一钱五分） 鲜藕（一两） 黄茧壳（二钱二味煎汤代水）
右 由牙疳而至鼻衄，兹则溲血作痛甚剧。此湿热蕴遏膀胱。
海金沙（三钱） 黑山栀（三钱） 木通（五分） 滑石（四钱） 黄柏（盐水炒二钱） 丹皮炭（二钱）
侧柏炭（三钱） 小蓟（一钱） 鲜生地（七钱） 淡竹叶（三钱）
Patient Ni (left pulse): The urine is turbid like rice washings, occasionally containing blood streaks, but without pain. This is due to Kidney deficiency with damp-heat invading the Kidneys and Bladder. Treatment should focus on clearing heat and promoting diuresis to resolve dampness.
Prescription: *Chrysosplenii Herba* (Jinsha Hai, 3 qian), *Caulis Angelicae Dahuricae Carbonized* (Danggui Tan, 2 qian), *Rhizoma Dioscoreae Hypoglaucae* (Bixie, 2 qian), *Radix Alismatis* (Zexie, 1.5 qian), *Radix Rehmanniae Recens* (Shengdi, 4 qian), *Talcum* (Huashi, 3 qian), *Radix Paeoniae Rubrae Carbonized* (Danpi Tan, 2 qian), *Poria Cocos* (Chi Fuling and Bai Fuling, 2 qian each), Fresh Lotus Root (Sanliang, decocted to replace water).
Second visit: Hematuria persists, but there is no pain in the urethra. The pulse is fine and weak. This indicates an invasion of damp-heat into the interior due to Kidney deficiency, presenting as more deficiency than excess.
Prescription: *Radix Rehmanniae Praeparata* (Zhishengdi, 4 qian), *Caulis Angelicae Dahuricae Carbonized* (Danggui Tan, 2 qian), *Spora Lygodii* (Puhuang, 6 fen), *Radix Achyranthis Bidentatae Carbonized* (Niuxi Tan, 3 qian), *Fructus Corni Stir-fried* (Yurou, 1.5 qian), *Radix Glycyrrhizae* (Shenggancao, 3 fen), *Radix Paeoniae Rubrae Carbonized* (Danpi Tan, 2 qian), *Rhizoma Dioscoreae* (Shanyao, 4 qian), *Stem Node of Lotus Carbonized* (Oujie Tan, 3 pieces).
Third visit: Damp-heat in the Bladder has slightly resolved, bleeding has decreased slightly, but the urine remains turbid. Continue the previous method for further improvement.
Prescription: *Radix Rehmanniae Recens* (Shengdi, 4 qian), *Caulis Angelicae Dahuricae Carbonized* (Danggui Tan, 2 qian), *Spore of Lygodium Japonicum Carbonized* (Puhuang Tan, 5 fen), *Semen Astragali Complanati* (Shayuanzi, stir-fried with salt water, 3 qian), *Rhizoma Dioscoreae* (Shanyao, 3 qian), *Radix Paeoniae Rubrae Carbonized* (Danpi Tan, 2 qian), *Radix Achyranthis Bidentatae Carbonized* (Niuxi Tan, 3 qian), *Fructus Corni Stir-fried* (Yurou, 1.5 qian), *Lapis Urinae* (Qianshi, 1 qian), Lotus Juice (1 cup, taken warm).
Fourth visit: Hematuria has gradually decreased, and the pulse has become slightly slower. Pain is often due to fire, while lack of pain suggests deficiency. Continue to tonify Kidney Yin.
Prescription: *Radix Rehmanniae Recens* (Shengdi, 3 qian), *Radix Paeoniae Rubrae* (Danpi, 1.5 qian), *Radix Paeoniae Alba* (Baishao, 1.5 qian), *Radix Rehmanniae Praeparata* (Shudi, 2 qian), *Rhizoma Dioscoreae* (Shanyao, 3 qian), *Herba Ecliptae* (Hanliancao, 3 qian), *Fructus Corni Stir-fried* (Yurou, 1.5 qian), *Radix Alismatis* (Zexie, 1.5 qian), *Semen Astragali Complanati* (Shayuanzi, 3 qian), Lotus Stem Node (Oujie, 2 pieces).
Fifth visit: Hematuria has reduced in severity but has not stopped. The pulse is slightly rapid. This is Kidney deficiency with internal pressing by deficient fire. Continue to nourish Yin and clear heat.
Prescription: *Radix Rehmanniae Praeparata* (Shudi, 4 qian), *Fructus Schisandrae Chinensis Stir-fried* (Wuweizi, 3 fen), *Sclerotium Poriae Cocos* (Fushen, 3 qian), *Herba Ecliptae* (Hanliancao, 3 qian), *Lapis Urinae* (Qianshi, 1 qian), *Radix Ophiopogonis* (Maidong, 2 qian), *Fructus Corni Stir-fried* (Yurou, 2 qian), *Radix Paeoniae Rubrae* (Danpi, 2 qian), *Rhizoma Dioscoreae* (Shanyao, 3 qian), *Radix Paeoniae Alba* (Baishao, 1.5 qian), *Stem Node of Lotus Carbonized* (Oujie Tan, 3 pieces).
Sixth visit: Hematuria is gradually receding. Continue to strengthen Water to control Fire and benefit Yin.
Prescription: *Radix Rehmanniae Recens* and *Radix Rehmanniae Praeparata* (Sheng Shudi, 3 qian each), *Radix Paeoniae Rubrae* (Danpi, 2 qian), *Fructus Corni Stir-fried* (Yurou, 2 qian), *Fructus Schisandrae Chinensis Roasted* (Wuweizi, 3 fen), *Radix Ophiopogonis* (Maidong, 3 qian), *Radix Paeoniae Alba* (Baishao, 1.5 qian), *Lapis Urinae* (Qianshi, 2 qian), *Rhizoma Dioscoreae* (Shanyao, 3 qian), *Radix Alismatis* (Zexie, stir-fried with salt water, 3 qian), Lotus Stem Node (Oujie, 3 pieces).
Seventh visit: After hematuria, Kidney Yin has not recovered. Continue to strengthen Water and nourish Yin.
Prescription: *Radix Rehmanniae Recens* and *Radix Rehmanniae Praeparata* (Sheng Shudi, 3 qian each), *Rhizoma Dioscoreae* (Shanyao, 3 qian), *Radix Paeoniae Alba* (Baishao, 1.5 qian), *Radix Asparagi* (Tiandong, 2 qian), *Radix Codonopsis Pilosae* (Dangshen, 3 qian), *Radix Glycyrrhizae Preparatae* and *Radix Glycyrrhizae Recens* (Sheng Shu Gancao, 3 fen each), *Fructus Schisandrae Chinensis Roasted* (Wuweizi, 3 qian), *Radix Alismatis* (Zexie, 1.5 qian), *Radix Ophiopogonis* (Maidong, 1.5 qian).
Eighth visit: The condition of hematuria originally stemmed from the internal deficiency of Kidney Water, with deficient fire stagnating and forcing damage to the Blood level. The previous administration of methods to strengthen Water and control Fire has brought various symptoms under control. The plan for regulation should naturally expand upon the previous intent. Now, incorporate methods to clear and nourish the Upper and Middle Jiao, as Lung Yin is located superiorly and serves as the upper source of Water.
Prescription: *Radix Panacis Quinquefolii* (Xiyangshen, 2 liang), *Radix Codonopsis Pilosae* (Kui Dangshen, 4 liang), *Rhizoma Dioscoreae* (Sheng Shanyao, 3 liang), *Rhizoma Atractylodis Macrocephalae* (Sheng Baizhu, 2 liang), *Fructus Corni Stir-fried* (Chao Yurou, 1 liang), *Semen Dolichoris* (Chao Bian Dou, 3 liang), *Poria Cocos* (Yun Fuling, 3 liang), *Rhizoma Dendrobii Nudae* (Chuan Shihu, 4 liang), *Radix Paeoniae Rubrae* (Fen Danpi, 2 liang), *Rhizoma Polygonati Odorati* (Fei Yuzhu, 3 liang), *Radix Achyranthis Bidentatae* (Huai Niuxi, stir-fried with salt water, 3 liang), *Radix Rehmanniae Recens* and *Radix Rehmanniae Praeparata* (Sheng Shudi, 2 liang each), *Radix Asparagi* and *Radix Ophiopogonis* (Tian Maidong, 3 liang each), *Fructus Lycii* (Gan Gouqi, 3 liang), *Radix Paeoniae Alba* (Baishao, wine-fried, 1.5 qian), *Radix Glycyrrhizae Preparatae* and *Radix Glycyrrhizae Recens* (Sheng Shu Gancao, 5 qian each), *Caulis Angelicae Dahuricae Carbonized* (Danggui Tan, 1.5 qian), *Fructus Ligustri Lucidi* (Nvzhenzi, wine-fried, 3 liang), *Semen Astragali Complanati* (Tong Shayuanzi, stir-fried with salt water, 3 liang), *Cortex Eucommiae Ulmoidis* (Nong Duzhong, stir-fried with salt water, 2 liang), *Cortex Phellodendri Amurensis Stir-fried* (Chao Zhimu, 2 liang), *Radix Alismatis* (Zexie, 1 liang).
Additionally, use *Colla Corii Asini* (Ejiao, 3 liang), *Colla Testudinis et Carapax Trionycis* (Guiban Jiao, 3 liang), *Membrana Nuclei Osseus Pisces* (Yubiao Jiao, 2 liang), and *Saccharum* (Bingtang, 3 liang). Melt these four ingredients to make a paste (gao). Take one spoonful every morning.
Another patient: Hematuria without pain.
Prescription: *Yiyuan San*, *Fructus Gardeniae Jasminoidis Charred* (Hei Shanzhi), *Radix Gentianae* (Longdancao), *Rhizoma Cyperi Rotundi Processed* (Zhi Xiangfu), *Cortex Phellodendri Amurensis* (Huangbai, stir-fried with salt water), *Radix Glycyrrhizae* (Gancao Shao), *Rhizoma Dioscoreae Hypoglaucae* (Chuan Bixie), *Poria Cocos* (Chi Bai Ling), *Semen Plantaginis* (Cheqianzi), *Radix Alismatis* (Zexie).
Left pulse patient: Hematuria without pain. Multiple administrations of methods to strengthen Water and tonify Kidney have gradually alleviated symptoms, yet they cannot be completely cured. The patient has a constitution prone to dampness. When Water is tonified, it gradually recovers, but when dampness is tonified, it gradually stagnates. Therefore, the eyes appear yellow, and appetite is poor. It is urgent to circulate and transform damp-heat.
Prescription: *Rhizoma Pinelliae Preparatae* (Zhi Banxia, 2 qian), *Rhizoma Cyperi Rotundi Processed* (Zhi Xiangfu, 1.5 qian), *Pericarpium Citri Reticulatae Viride* (Dafupi, 2 qian), *Semen Coicis Recens* and *Semen Coicis* (Sheng Shu Yiren, 2 qian each), *Pericarpium Citri Reticulatae* (Shang Guangpi, 1 qian), *Radix Alismatis* (Jian Zexie, 1.5 qian), *Herba Artemisiae Scopariae* (Xi Yinchen, 2 qian), *Poria Cocos* (Zhu Fu Ling, 2 qian each).
Again: The urine is gradually clearing, but the face and eyes still show slight yellowing. This is still a condition of Qi stagnation and dampness depression.
Remove Yinchen and Xiangfu from the previous prescription, add Baizhu, Sharen, Meiguihua, and Huoxiang.
Left pulse patient: Hematuria has stopped, but the pulse feels wiry and hard. This is indeed a deficiency of both Liver and Kidney, failing to secure and hold, allowing damp-heat to invade. From within the method of strengthening Water, incorporate methods to firm Yin.
Prescription: *Radix Rehmanniae Recens Carbonized* (Shengdi Tan, 4 qian), *Radix Achyranthis Bidentatae* (Sheng Niuxi, 5 fen), *Radix Paeoniae Rubrae* (Hei Danpi, 1 qian), *Cardia Testudinis* (Guijia Xin, 5 qian), *Poria Cocos* (Fuling, 3 qian), *Cortex Phellodendri Amurensis Carbonized* (Huangbai Tan, 1.5 qian), *Fructus Gardeniae Jasminoidis Charred* (Hei Shanzhi, 3 qian), *Radix Alismatis* (Zexie, 1.5 qian), *Herba Lophatheri* (Dan Zhuye, 1.5 qian), Fresh Lotus Root (1 liang), Yellow Cocoon Shell (Huang Jianke, 2 qian; these two decocted to replace water).
Right pulse patient: Progressing from gingival ulcer (Ya Gan) to epistaxis (Bi Nie), now presenting with severe painful hematuria. This is damp-heat accumulating and obstructing the Bladder.
Prescription: *Chrysosplenii Herba* (Jinsha Hai, 3 qian), *Fructus Gardeniae Jasminoidis Charred* (Hei Shanzhi, 3 qian), *Radix Akebiae Trifoliatae* (Mutong, 5 fen), *Talcum* (Huashi, 4 qian), *Cortex Phellodendri Amurensis* (Huangbai, stir-fried with salt water, 2 qian), *Radix Paeoniae Rubrae Carbonized* (Danpi Tan, 2 qian), *Ramulus Platycladi Carbonized* (Ce Bai Tan, 3 qian), *Herba Cirsii Japonici* (Xiaoji, 1 qian), *Radix Rehmanniae Recens* (Xian Shengdi, 7 qian), *Herba Lophatheri* (Dan Zhuye, 3 qian).