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(See the main syndrome in the section on Major and Minor Orifices.)

Those with pain are classified as bloody strangury (Xuelin). Those without pain are classified as hematuria (Niaoxue). Bloody strangury is discussed separately later under the section on Major and Minor Orifices. For strangury obstruction syndromes and hematuria, initially administer Shengliao Wuling San (Raw Material Five-Ingredient Powder with Poria) combined with Siwu Tang (Four-Substance Decoction). If there is no effect after taking the medicine, and the patient has a history of excessive sexual activity, this belongs to deficiency syndromes. It is appropriate to use Wuling San (Five-Ingredient Powder with Poria) combined with Jiao'ai Tang (Colla Corii Asini and Moutan Decoction), swallowing Lurong Wan (Deer Antler Pill); or Fuzi Bawei Wan (Aconite Eight-Ingredient Pill); or Chensha Miaoxiang San (Cinnabar Wonderful Fragrance Powder) combined with Wuling San (Five-Ingredient Powder with Poria), while swallowing the aforementioned two types of pills. If the urine was originally clear but later shows a few drops of blood, add one qian of Chishao Yao (Red Peony Root) to Wuling San (Five-Ingredient Powder with Poria). There are also cases where the discharge resembles gravel, is red in color, yet lacks the pain characteristic of stone strangury; this also belongs to deficiency syndromes. It is appropriate to use Wuling San (Five-Ingredient Powder with Poria) combined with Jiao'ai Tang (Colla Corii Asini and Moutan Decoction), or Wuling San (Five-Ingredient Powder with Poria) combined with Chensha Miaoxiang San (Cinnabar Wonderful Fragrance Powder), swallowing Lurong Wan (Deer Antler Pill) and Bawei Wan (Eight-Ingredient Pill).

Penile swelling and pain present various syndromes. In some cases, the whole body is edematous, and the penis is also swollen; in such situations, one should seek the etiology from the sections on Qi Gates and Edema/Qi Syndromes, employing methods for treating water qi. Kidney wind causes itching; excessive scratching leads to swelling and pain; this should be sought from the Wind Syndrome section under Sores and Toxins. Once the wind pathogen is resolved, the swelling will subside naturally. There is "jealousy essence erosion sore" (Du Jing Shi Chuang): using medicines for dry sores too harshly causes toxic vapors not to dissipate, leading to accumulation and swelling. Taking mineral and metallic astringent agents causes essence and qi to stagnate and cannot be disseminated. Or trying tight-furnace prescriptions to gain momentary pleasure, unaware that heat toxins attack the body itself; all these can cause swelling. Stagnation of blood and qi blocking the orifices in the yin region causes penile swelling; colloquially known as "blowing up," or caused by holding urine. The following three categories of syndromes are all suitable for treating with Dengxin Tang (Juncus Decoction) mixed with Wuling San (Five-Ingredient Powder with Poria) to cleanse internally, and washing externally with decoctions of Jingjie (Schizonepeta), Gancao (Licorice), and Mutong (Akebia) to promote circulation externally.

Strangury pain: The five types of strangury are bloody, stone, qi, paste, and exhaustion strangury. Bloody strangury (Xuelin) involves blood in the urine. Stone strangury (Shilin) involves gravel-like substances in the urine; when urinating into a basin, there is a sound, indicating that essence and qi have formed gravel which is expelled with the urine. Qi strangury (Qilin) is caused by qi depression, presenting with a sensation of bladder qi distension in the lower abdomen. Paste strangury (Gaolin) involves urine mixed with semen; it may sink at the bottom of the vortex like paste, or float on top of the vortex like grease. Exhaustion strangury (Laolin) often occurs in those who have indulged excessively in sexual activities, resulting in deficiency and exhaustion of the lower yuan, failure to distinguish between clear and turbid, and dysfunction of kidney qi, leading to stagnation and strangury. Or due to overexertion of the mind, fire fails to receive nourishment; since the Small Intestine is the interior-exterior partner of the Heart, disease in the zang organ affects the fu organ. Or heart-kidney non-interaction, with kidney yang failing to warm, causing blockage of the fluid pathways. Or excessive sweating, or massive blood loss, causing the fluid pathways to approach depletion; all these form exhaustion strangury. These five types derive their names, excluding hot and cold strangury. Why? Because each of the five can present with either cold or heat patterns. Bloody strangury includes hot blood and stasis blood; qi strangury includes hot qi and cold qi; exhaustion strangury includes deficiency-cold and deficiency-heat. If herbal treatment is significantly erroneous, essence and qi may wander off their proper paths and be involuntarily expelled with urine; this is injury caused by hot agents, and one cannot generally assume it to be cold.

The method for treating strangury: Except for definitive deficiency-cold syndromes, for other syndromes, if medications targeting the primary pathology are ineffective, it is appropriate to administer formulas regulating qi. This is because the reversal or smooth flow of fluid pathways depends on the obstruction or patency of qi. For example, Muxiang Liuqi Yin (Costus Flowing Qi Drink) is quite appropriate, containing Mutong (Akebia), Maidong (Ophiopogon), and Fupi (Tangerine Peel), among others. If that is ineffective, it is best to administer blood-nourishing formulas. Urine is the surplus of blood. If blood is abundant, it moistens and descends, flowing naturally. Huofu Dan (Fire Mansion Pill) is quite appropriate, containing Dihuang (Rehmannia), among others. However, this applies not only to bloody and qi strangury, but to all types of strangury, except for deficiency-cold. In strangury diseases, the color of urine is mostly reddish; one must not immediately assume redness indicates heat. It is due to the accumulation and knotting of qi pathways.

For persistent rectal bleeding, take one Songyangshi (Song Yang Persimmon), burn it until carbonized (preserving its nature), grind into powder, and take with rice water to achieve cure.