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For all cases of hematuria (blood in urine), there are three sources of bleeding: two originate from the urethral orifice, and one originates from the seminal duct.

First, blood from the urethral orifice that comes from a nearby source originates from the Bladder. The symptoms include涩痛 (astringent pain) and obstruction during urination, with red and dark urine that is difficult to pass. This is mostly caused by the stirring up of Fire in the Lower Jiao due to alcohol consumption, sexual indulgence, or lustful thoughts. It is commonly seen that when Ministerial Fire (Xiang Huo, fire residing in the Liver and Kidney) moves recklessly, causing Qi mechanism to reverse and become obstructed, mild cases present as strangury (Lin syndrome) or turbid urine, while severe cases manifest as hematuria. The Classics state: "When heat transfers from the uterus/bladder to the Bladder, it causes difficulty in urination and hematuria," which refers to this condition. Treatment should focus on clearing and draining Bladder Fire, using formulas containing Sheng Di Huang (Rehmanniae Radix), Bai Shao (Paeoniae Radix Alba), Niu Xi (Achyranthis Bidentatae Radix), Shan Zhi Zi (Gardeniae Fructus), Huang Bo (Phellodendri Cortex), Zhi Mu (Anemarrhenae Rhizoma), Long Dan Cao (Gentianae Radix), Qu Mai (Dianthi Herba), Mu Tong (Akebiae Caulis), Ze Xie (Alismatis Rhizoma), etc., or formulas such as Qi Zheng San, Da Li Qing Yin, or Wu Lin San, all of which are appropriate.

Second, blood from the urethral orifice that comes from a distant source originates from the Small Intestine. The symptoms include no pain at the urethral orifice, but blood follows the urine; or pain is hidden in the umbilical/abdominal region, or heat signs appear in the Zang-Fu organs. Since the Small Intestine and Heart are exterior-interiorly related, this is the source of Bing Fire (Small Intestine Fire) for Qi transformation, where clear and turbid substances are separated. Therefore, whether due to mental anxiety and overwork, or rich flavors and alcoholic beverages, leading to Fire from the Five Emotions or dietary intake in the Upper and Middle Jiao, any heat descending through the clear pathways (digestive tract) must pass through the Small Intestine to reach the Bladder. Treatment requires examining the cause according to the symptoms and clearing the source of Fire in the Zang-Fu organs; it is suitable to select formulas from cold-natured categories.

Third, blood from the seminal duct necessarily exits from the Jing Gong (Essence Palace) and Xue Hai (Sea of Blood) via the Ming Men (Gate of Life). The Kidney governs Water and receives and stores the essence of the Five Zang and Six Fu organs. Thus, whenever the Five Zang are injured by overwork, or Fire from the Five Emotions causes movement of blood in the Chong and Ren vessels, bleeding often occurs from the seminal duct. How then to distinguish? If the disease is in the Small Intestine, blood must exit via urine; if the disease is in the Ming Men, blood must exit via semen. If there is a sensation of soreness and pain at the lower abdomen where semen is discharged, followed by bleeding, it is a disease of the Ming Men, and the treatment method differs from that of the water pathway. Generally, blood in the water pathway is suitable for diuretic treatment, whereas blood in the seminal duct is not suitable for diuretics; cases with astringent pain and obstruction are suitable for diuretics, while cases with slippery blood and no pain are not. If there is indeed excessive Fire in the Three Jiao, treatment should primarily focus on clearing Fire and cooling Blood, using Sheng Di Huang, Bai Shao, Mu Dan Pi (Moutan Cortex), Di Gu Pi (Lycii Cortex), Qian Gen (Rubiae Radix et Rhizoma), Zhi Zi, Huai Hua (Sophorae Flos), along with Huang Qin (Scutellariae Radix), Lian Zi (Coptidis Rhizoma), Zhi Mu, and Huang Bo, or formulas such as Yue Yin Wan or Yue Yin Jian can be used. If Kidney Yin is insufficient and Essence-Blood is not secure, treatment should primarily nourish Yin and Blood, using Zuo Gui Yin or Ren Shen Gu Ben Wan. If Kidney Deficiency leads to incontinence, or prolonged illness results in slipping and leaking of Essence-Blood, treatment should primarily focus on astringency, using Mi Yuan Jian, Ling Zhu Tu Si Wan, Jin Ying Gao, Yu Suo Dan, or Jin Suo Si Xian Dan. Herbs such as Xu Duan (Dipsaci Radix) and Wu Mei (Mume Fructus) are also appropriate. If Heart Qi is unstable and Spirit wanders outward, causing Water and Fire to harm each other and losing control of Essence-Blood, treatment should primarily nourish the Heart and calm the Spirit, using Ren Shen Wan, Tian Wang Bu Xin Dan, or Wang Jing Gong Miao Xiang San. If Spleen and Lung Qi are deficient and sinking, unable to hold blood and prevent it from descending, formulas such as Gui Pi Tang, Ren Shen Yang Ying Tang, Bu Zhong Yi Qi Tang, or Ju Yuan Jian should be used.

Fourth, blood exiting from the seminal duct belongs to the category of Bloody Strangury (Xue Lin), mostly caused by sexual overwork leading to Yin deficiency and Fire hyperactivity, resulting in reckless movement of Ying Blood. When blood exits from the Ming Men accompanied by astringent pain, it is called Bloody Strangury; when there is no pain, it is called Hematuria. Those who indulge in lust invariably suffer from Deficiency patterns.