源由（尿血、血淋之辨）心主于血，与小肠合。若心家有热，结于小肠，故小便血也。（《病源论》）
夫尿血者，是膀胱有客热，血渗于脬故也。血得热而妄行，故因热流散，渗于脬内而尿血也。（《圣惠》）
《内经》谓悲哀太甚，则胞络绝，阳气动中，数溲血。又曰∶胞移热于膀胱，为癃溺血。二者皆虚热妄溢，
故溲血不止也。治宜去邪热，调心气。（《圣济》）
病者小便出血，多因心肾气结所致，或因忧劳房室过度，此乃得之虚寒，故《养生》云∶不可专以血得热
为淖溢为说。二者皆致尿血，与淋不同，以其不痛，故属尿血，痛则当在血淋门。（《三因》）
溺孔精道之别 凡溺血证，其所出之血有三，盖从溺孔出者二，从精孔出者一也。溺孔之血，其来近
者，出自膀胱。其来远者，出自小肠。精道之血，必自精宫血海而出。多因房劳，以致阴虚火动，营血妄行而
然。（《景岳》）（按∶原文稍繁，今撮其要。）
脉候 尺脉滑，血气实，妇人经脉不利，男子尿血，宜服朴消煎大黄汤，下去经血，针关元泻之。尺脉
芤，下焦虚，小便去血，宜服竹皮生地黄汤，灸丹田、关元，亦针补之。（《脉经》）（按∶此所谓方，固不可
知。然二条对看，足以知尿血自有虚实二因，其治亦有泻下清凉及刺灸补泻之别矣。）
下部脉急而弦者，风邪入于少阴，则尿血。尺脉微而芤，亦尿血。（《病源论》）
咳而尿血形羸瘦，其病脉大命难任。（咳而尿血，乃形体羸瘦，其脉洪大，是病与脉不相应，故知死。）
（《脉诀》并注）
证治例 溺血属热实者，用当归承气汤下之（按∶此系大承气汤加当归），后以四物加山栀。（《丹溪》）
尿血，先与生料五苓散和四物汤。若服药不效，其人素病于色者，此属虚证，宜五苓散和胶艾汤，吞鹿茸丸
（按∶见《济生》）或附子八味丸（按∶此即肾气丸）；或辰砂妙香散（按见和剂）和五苓散，吞二项丸子。
若小便自清，后有数点血者，五苓散加赤芍药一钱。亦有如砂石而色红，却无石淋之痛，亦属虚证，宜五苓散和
胶艾汤，或五苓散和辰砂妙香散，并吞鹿茸丸、八味丸。（《要诀》）
小便自利，后有血数点者，五苓散加桃仁（赤芍。暴病脉滑实者，加大黄、滑石、甘草、延胡索下之。溲血
日久，元神大虚而挟虚热，所下如砂石而色红，有如石淋之痛，辰砂妙香散加泽泻、肉桂。病久滑脱者，去黄 、
山药、桔梗、木香，加 飞龙骨、益智仁，即王荆公妙香散。虚寒，以此汤吞四味鹿茸丸。老人溲血，多是阴虚，
亦有过服助阳药而致者，多难治，惟大剂六味丸加紫菀茸作汤服之。溲血日久，形枯色痿，癃闭如淋，二便引痛，
喘急虚眩，行步不能者，与死为邻矣。（《医通》）
《准绳》谓溲血、淋血、便血三者，虽前后阴不同，而受病则一。其散血、止血等药，无越数十品之间，惟
向导少异，其说固甚允也。若不与尿同出，乃从精窍出也。盖清道之血，上可从鼻出，下亦可从精窍出，多因色
欲而成，牛膝四物汤。服诸药不效者，所溺之血成块不得出而痛甚者，珀珠散甚效。（《医碥》）（按∶珀珠散用
琥珀、珍珠、朱砂、滑石、甘草、五味。）
清凉诸方 治小便血方。（《千金》）（即《衄血》生地黄汤，去甘草。）
治肾客热连心，小便出血疼痛，阿胶汤方。
阿胶（炒燥） 黄芩（去黑心各三分） 甘草（炙半两） 生地黄（绞取汁）
车前叶（生者绞取汁） 藕节（绞取汁各四合） 生蜜（一盏）
上七味，将前三味粗捣筛，同后四味搅匀，每服一大匙，水一盏，煎至七分，去滓温服，不拘时候。（《圣
济》）
治妇人小便出血，心神烦闷，茜根散方。
茜根 当归（锉微炒） 甘草（炙微赤锉） 贝母（煨微黄） 牡丹 瓜蒂（按∶此方不宜用瓜蒂，疑是栝蒌。）
羚羊角屑 柏叶（微炙各一两） 红蓝花（二两） 生干地黄（三两）
上件药捣，粗罗为散，每服三钱，以水一中盏，煎至五分，去滓食前温服。（《圣惠》）
治虚损，膀胱有热，尿血不止方。
蒲黄 郁金（各一两）
上件药捣，细罗为散，每于食前，以粥饮调下二钱。（同上）《养生主论》引《箧中秘宝方》，金黄散，治
尿血，用槐花、郁金各一两，淡豉汤调下。
泻下方 崔氏疗卒伤热行来尿血方。
大黄（末） 芒硝（末各半匕）
上二味，冷水和，顿服之，立止。三日内禁如药法。（《外台》、《圣惠》治妇人卒伤热尿血，大黄散，于
本方加蒲黄。
止遏诸方 治溺血方。
戎盐（六分） 甘草 蒲黄 鹿角胶 芍药（各二两） 矾石（三两） 大枣（十枚）
上七味 咀，以水九升，煮取二升，分三服。（《千金》）
发灰散，治小便尿血，或先尿而后血，或先血而后尿，亦远近之谓也。
发灰（《本草》云∶能消瘀血，通关格，利水道，破 瘕、痈肿、狐
尿刺、尸疰、杂疮，疗转胞，通大小便，止咳嗽、鼻衄。）
上一味，每用二钱，以米醋二合、汤少许调服，井花水调亦可。（《三因》）（按∶此方本出《千金》，酒
服。注曰苏澄用水服。）
鹿角胶丸，治房损伤中，小便尿血。
鹿角胶（半两） 油头发灰 没药（别研各三钱）
上为末，用茆根汁打糊为丸，如梧桐子大，每服五十丸，空心盐汤下。（《济生》）
补养诸方《古今录验》疗尿血，鹿茸散方。
鹿茸（炙） 当归 干地黄（各二两） 葵子（五合） 蒲黄（五合）
上五味捣筛为散，酒服方寸匕，日三服。（《外台》）《圣惠》治下元虚惫尿血，鹿茸丸，本方炼蜜和捣三
二百杵，丸如梧桐子大，每于食前，以炒盐汤下二十丸。又治虚劳内伤，小便出血，水道中痛，于本方加阿胶。
治因劳损，尿血不止方。
地黄汁 车前叶汁（各五合） 鹿角胶（三两捣碎炒令黄燥为末）
上件药，将二味汁相和，每服食前，暖一小盏，调下胶末二钱。（《圣惠》）
苁蓉丸，若小便纯血，血下则凝，亦无痛处， 短气，日就羸瘦，不食。此由阳不固，阴无所守，五液
注下。诊其脉散涩欲绝而身冷者，死。治属虚损，宜。（《指迷方》）
菟丝子 肉苁蓉 干地黄 鹿茸（各一两）
上为末，酒糊丸如桐子，饮下三十丸。（《十便》）
发灰煎，治五劳七伤，溺血淋露，胸腹撑闷（《鸡峰方》）。
菟丝子（四两） 鹿茸 山药（各一两） 发灰（一分）
上为细末，酒煮面糊和丸，如梧桐子大，每服五十丸，空心白汤下。（同上）（按∶此方系今本《鸡峰方》佚
卷所载。）
玉屑膏，治尿血，并五淋砂石，疼痛不可忍受者。
黄 人参（各等分）
上为末，用萝卜大者，切一指浓，三指大，四五片，蜜淹少时，蘸蜜炙干复蘸，尽蜜二两为度，勿令焦，
炙熟，点黄 、人参末吃，不以时，仍以盐汤送下。（《三因》）
[Pathogenesis Analysis (Differentiation between Hematuria and Bloody Lin)] The Heart governs blood and is internally-externally related to the Small Intestine. If there is heat in the Heart, stagnating in the Small Intestine, it leads to bleeding from urination. (*Zhubing Yuanhou Lun*)
Hematuria refers to external heat residing in the Bladder, causing blood to渗 into the bladder (paopao). Blood tends to flow recklessly when exposed to heat; thus, due to heat, it scatters and渗es into the bladder, resulting in hematuria. (*Taiping Shenghui Fang*)
The *Huangdi Neijing* states: Excessive grief causes the pericardium collaterals to sever, leading to internal movement of Yang Qi, frequent urination with blood. It also says: Heat transferring from the uterus (Baogong) to the Bladder results in difficulty in urination and bloody urine. Both conditions belong to reckless overflow caused by deficiency-heat, hence continuous hematuria. Treatment should focus on clearing pathogenic heat and regulating Heart Qi. (*Shengji Zonglu*, cited in *Jisheng Fang*)
Patient's hematuria is often caused by stagnation of Qi in the Heart and Kidney, or due to excessive worry, fatigue, and sexual indulgence. This constitutes a deficiency-cold syndrome. Therefore, *Yangsheng Zhulun* states: One cannot solely explain it as "blood overflowing when heated." Both causes lead to hematuria, which differs from Lin syndrome because hematuria is painless; if painful, it belongs to the category of Bloody Lin. (*Sanyin Jiyi Bingzheng Fanglun*)
[Differentiation between Urethral Orifice and Seminal Duct] In cases of hematuria, the source of blood can be traced to three locations: two from the urethral orifice (niaokong) and one from the seminal duct orifice (jingkong). Blood from the urethral orifice that originates proximally comes from the Bladder; that originating distally comes from the Small Intestine. Blood from the seminal duct must originate from the Essence Palace (Jinggong) and Sea of Blood (Xuehai). This is mostly due to sexual exhaustion leading to Yin deficiency with fire hyperactivity, causing reckless movement of Ying blood. (Zhang Jingyue) [Note: The original text is verbose; only key points are extracted here.]
[Pulse Diagnosis] A slippery pulse at the Chi position indicates excess of blood and Qi. Women may experience irregular menstruation, while men may suffer from hematuria. They should take Puxiao Decoction with Dahuang to purge menstrual blood, and puncture Guanyuan acupoint using the reducing method. A hollow (Kou) pulse at the Chi position indicates deficiency in the Lower Jiao with urinary bleeding. They should take Zhupi Shengdihuang Tang, moxa Dantian and Guanyuan acupoints, and apply tonification via acupuncture. (*Maijing*) [Note: The specific formulas mentioned are unknown. However, comparing these two pulse patterns reveals that hematuria has both excess and deficiency etiologies, and treatments vary between purging/cooling and tonifying/reducing via needling and moxibustion.]
A tense and wiry pulse in the lower abdomen indicates Wind pathogen invading the Shaoyin meridian, leading to hematuria. A faint and hollow pulse at the Chi position also indicates hematuria. (*Zhubing Yuanhou Lun*)
Coughing with hematuria and emaciation, accompanied by a large pulse, indicates a critical condition difficult to treat. (Coughing with hematuria and physical emaciation, yet presenting with a surging pulse, indicates a mismatch between disease and pulse, suggesting impending death.) (*Maijue* and its commentary)
[Examples of Syndrome Differentiation and Treatment] For hematuria belonging to Heat-Excess syndrome, use Danggui Chengqi Tang to purge (Note: This is Dachengqi Tang added with Danggui), followed by Siwu Tang plus Zhizi. (Zhu Danxi)
For hematuria, initially administer Shengliao Wuling San combined with Siwu Tang. If ineffective, and the patient has a history of sexual indulgence, this indicates a Deficiency syndrome. Use Wuling San combined with Jiao'ai Tang, swallowing Lurong Wan (see *Jisheng Fang*) or Fuzi Bawei Wan (Note: This is Shenqi Wan); or Chen Sha Miaoxiang San (see *Heji Jufang*) combined with Wuling San, swallowing the aforementioned pills. If urine is clear but followed by a few drops of blood, add Chishao to Wuling San. Some discharge red, gravel-like material without the pain of Stone Lin; this also belongs to Deficiency syndrome. Use Wuling San combined with Jiao'ai Tang, or Wuling San combined with Chen Sha Miaoxiang San, along with Lurong Wan and Bawei Wan. (*Shiyi De Xiao Fang*)
If urination is free-flowing but followed by a few drops of blood, use Wuling San plus Taoren (or Chishao). For acute onset with slippery and excess pulse, add Dahuang, Huashi, Gancao, and Yanhusuo to purge. For chronic hematuria with severe depletion of Yuan Shen and mixed deficiency-heat, where discharged blood resembles red gravel with pain similar to Stone Lin, use Chen Sha Miaoxiang San plus Zexie and Rougui. For long-standing cases with slipping and incontinence, remove Huangqi, Shanyao, Jiegeng, and Muxiang, and add Fei Longgu and Yizhiren, forming Wang Jinggong's Miaoxiang San. For deficiency-cold, swallow Simei Lurong Wan with this decoction. Elderly patients with hematuria mostly suffer from Yin deficiency, or sometimes from overuse of Yang-tonifying herbs; these are difficult to treat. Only large doses of Liuwei Wan added with Ziwan Rong decoction are effective. For chronic hematuria with withered form, sallow complexion, obstructed urination like Lin, pain radiating from both bowels and bladder, panting, dizziness, and inability to walk, death is imminent. (*Yixue Rumen*)
*Yixue Zhunsheng Liuyao* states: Although Sourhematuria (hematuria), Lin-blood, and Rectal bleeding differ in exit orifices, their pathogenesis is identical. The herbs for dispersing blood and stopping bleeding do not exceed dozens of types; only the guiding herbs differ slightly. This view is sound. If blood does not exit with urine but from the seminal orifice, it is considered blood from the Clear Pathways. Such blood can exit upwards from the nose or downwards from the seminal orifice, mostly caused by sexual excess. Use Niuxi Siwu Tang. If various medicines fail, and clotted blood cannot exit causing severe pain, Po Zhu San is very effective. (*Yique*) [Note: Po Zhu San consists of Hupo, Zhenzhu, Zhusha, Huashi, Gancao, and Wuweizi.]
[Cooling Formulas] Formula for treating urinary bleeding. (*Qianjin Fang*) (This is Shengdihuang Tang from the Epistaxis chapter, minus Gancao.)
Formula for E'jiao Tang treating Kidney guest-heat affecting the Heart, with urinary bleeding and pain.
E'jiao (stir-fried until dry) Huangqin (remove black heart, each 3 fen) Gancao (honey-fried, 0.5 liang) Shengdihuang (juiced)
Cheqianye (fresh, juiced) Oujie (juiced, each 4 he) Raw Honey (1 zhan)
Crush and sieve the first three ingredients, mix evenly with the latter four. Take one large spoonful, boil in one zhan of water until reduced to 70%, strain, and take warm. No fixed time. (*Shengji Zonglu*)
Formula for Qianggen San treating women's urinary bleeding with mental restlessness.
Qianggen Danggui (chopped, lightly stir-fried) Gancao (honey-fried, slightly reddened, chopped) Beimu (baked, slightly yellow) Mudanpi Gouti (Note: Gouti is inappropriate here; likely Gualou.)
Lingyangjiaoxie Baiye (lightly baked, each 1 liang) Honglanhua (2 liang) Shenggan Dihuang (3 liang)
Pound the ingredients, sieve coarsely. Take 3 qian, boil in one zhongzhan of water until reduced to 50%, strain, and take warm before meals. (*Taiping Shenghui Fang*)
Formula for treating deficiency damage, Bladder heat, and continuous hematuria.
Puhuang Yujin (each 1 liang)
Pound and sieve finely. Take 2 qian before meals, mixed with rice water. (Same source) *Yangsheng Zhulun* cites *Qiezhong Mibao Fang*: Jinhuang San for hematuria, using Huaihua and Yujin (1 liang each), taken with Danshi decoction.
[Purgative Formulas] Cui Shi's formula for sudden hematuria after walking in heat.
Dahuang (powder) Mangxiao (powder, each half bi)
Mix with cold water and take in one dose. Stops immediately. Abstinence for three days. (*Waitai Miyao*, *Taiping Shenghui Fang* treats sudden female heat-hematuria with Dahuang San, adding Puhuang to this base.)
[Astringent Formulas] Formula for treating hematuria.
Rongyan (6 fen) Gancao Puhuang Lujiao Jiao Shaoyao (each 2 liang) Fanshi (3 liang) Dazao (10 pieces)
Chop the seven ingredients, boil in 9 sheng of water until 2 sheng remains. Divide into three doses. (*Qianjin Fang*)
Fahui San treats urinary hematuria, whether blood appears before or after urine, indicating proximal or distal sources.
Fahui (Bencao states: Eliminates blood stasis, opens blockages, promotes urination, breaks masses/abscesses, treats fox urine刺, corpse infection, miscellaneous sores, treats inverted bladder, unblocks bowel/bladder, stops cough/epistaxis.)
Take 2 qian, mix with 2 he of rice vinegar and a little hot water. Well water is also acceptable. (*Sanyin Fang*) [Note: Originally from *Qianjin Fang*, taken with wine. Commentary notes Su Cheng used water.]
Lujiao Jiao Wan treats injury from sexual activity causing hematuria.
Lujiao Jiao (0.5 liang) You Toufa Hui Moyao (separately ground, each 3 qian)
Grind to powder, make pills with Maogen juice paste, size of wutong seeds. Take 50 pills on an empty stomach with salt water. (*Jisheng Fang*)
[Nourishing Formulas] *Gujin Luyan* treats hematuria with Lurong San.
Lurong (roasted) Danggui Gandi Huang (each 2 liang) Kuizi (5 he) Puhuang (5 he)
Pound and sieve. Take one cunbi with wine, three times daily. (*Waitai Miyao*) *Taiping Shenghui Fang* treats lower yuan deficiency hematuria with Lurong Wan. Mix honey and pound 200-300 times, make pills size of wutong seeds. Take 20 pills before meals with roasted salt water. Also treats deficiency consumption/internal injury with urinary bleeding and pain in the urinary tract, adding E'jiao to this formula.
Formula for hematuria due to labor damage.
Dihuangzhi Cheqianyezhi (each 5 he) Lujiao Jiao (3 liang, pounded, fried until yellow/dry, ground)
Mix the two juices. Warm a small cup before meals, mix with 2 qian of powder. (*Taiping Shenghui Fang*)
Congrong Wan: If urine contains pure blood that coagulates upon exiting, with no pain, shortness of breath, progressive emaciation, and anorexia. This is due to insecure Yang and unprotected Yin, with five fluids leaking down. Pulse is scattered and choppy, nearly absent, with cold body—this is a death sign. Treatment addresses deficiency damage. (*Zhimi Fang*)
Tusizi Rongcongrou Gadi Huang Lurong (each 1 liang)
Grind to powder, make pills with wine paste, size of tung seeds. Take 30 pills with water. (*Shibian Liangfang*)
Fahui Jian treats five labors and seven injuries, hematuria with dripping lin, chest/abdominal fullness (*Jifeng Fang*).
Tusizi (4 liang) Lurong Shanyao (each 1 liang) Fahui (1 fen)
Grind to fine powder, make pills with wine-boiled flour paste, size of wutong seeds. Take 50 pills on an empty stomach with plain water. (Same source) [Note: This formula is from a lost volume of the current *Jifeng Fang*.]
Yuxue Gao treats hematuria and five lins with gravel, unbearable pain.
Huangqi Ren Shen (equal parts)
Grind to powder. Slice large radish 1 finger thick, 3 fingers wide, 4-5 slices. Soak in honey briefly, dip in honey, roast dry, repeat until 2 liang of honey is consumed. Do not burn. Roast thoroughly, sprinkle Huangqi and Ren Shen powder on top. Eat anytime, washed down with salt water. (*Sanyin Fang*)