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[ Dai Yuanli ] When women experience hematuria (bleeding from the urinary tract), it is because the Heart governs blood. Blood circulates throughout the meridians and viscera. The nature of blood is to coagulate and become stagnant when cold, and to flow and scatter when hot. If blood loses its normal pathway, overflows, and infiltrates into the bladder (uterus/bladder area), hematuria occurs.

[ Xue Ji ] Women suffering from hematuria may be caused by long-term consumption of rich, greasy, fried, or roasted foods; sexual intercourse after drunkenness or full meals; improper diet and overwork; or invasion by the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire) and emotional disturbances (Joy, Anger, Worry, Pensiveness, Sadness, Fear, Fright). These factors deplete Yuan Qi (Original Qi), causing it to fail in controlling and retaining blood within its vessels. If caused by anger stirring up Liver Fire, use Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) taken with Fa Hui (Ashed Hair). If due to Wind-Heat in the Liver Meridian, use Zi Qin Wan (Fritillaria Pill). For chronic cases resulting in Blood Deficiency, use Ba Zhen Tang (Eight Treasure Decoction) taken with Fa Hui. For heat accumulation from rich foods, use Qing Wei San (Stomach Clearing Powder) plus Huai Hua (Sophora Flower) and Gan Cao (Licorice Root). For injury due to sexual exhaustion, use Liu Jun Zi Tang (Six Gentlemen Decoction) plus Chai Hu (Bupleurum Root) and Sheng Ma (Cimicifuga Rhizome). For injury due to Wind-Heat, use Si Jun Zi Tang (Four Gentlemen Decoction) plus Fang Feng (Saposhnikovia Root) and Zhi Ke (Aurantium Fruit). For chronic cases with depleted Yuan Qi, prioritize Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). For Spleen injury due to constraint/stagnation, prioritize Ji Sheng Gui Pi Tang (Accumulated Life Restore the Spleen Decoction).

Case 1: A woman had hematuria accompanied by alternating chills and fever due to anger, headache, or hypochondriac distension. This indicated Liver Blood Deficiency with exuberant Liver Fire. After using Jia Wei Xiao Yao San, the blood stagnation and distension ceased. Headache was cured using Bu Zhong Yi Qi Tang plus Man Jing Zi (Vernonia Seed). Later, abdominal pain and hematuria occurred due to depression and anger; the previous formula was used again, plus Long Dan Cao (Gentian Root) and Gui Pi Tang (Restore the Spleen Decoction). As she was recovering, dietary injury caused palpitations and insomnia all night; the previous decoction cured her.

Case 2: Another woman had hematuria, sallow complexion, fatigue, poor appetite, afternoon tidal fever, and thirst. This indicated Spleen and Stomach Qi Deficiency failing to control blood. Bu Zhong Yi Qi Tang was used to tonify Stomach Qi, Gui Pi Tang to resolve stagnation, and Jia Wei Xiao Yao Tang to nourish Liver Blood, leading to recovery.

Case 3: A woman with hematuria took Si Wu Tang (Four Substances Decoction) and Pu Huang (Typha Pollen), which exacerbated fever and phlegm vomiting. Taking Huang Qin (Scutellaria Root) and Huang Lian (Coptis Rhizome) led to loss of appetite and various deficiency syndromes. The Liver pulse was wiry and rapid; the Spleen pulse was wiry and moderate. This was due to Wind-Heat in the Liver Meridian, mismanaged with heavy Yin (cold/cloying) agents that injured the Spleen, causing it to lose control over blood and affecting other organs. I cured her using Bu Zhong Yi Qi Tang and Liu Wei Di Huang Wan (Six Ingredient Pill with Rehmannia).

Lurong San (Deer Horn Powder) [from *Da Quan*]: Treats hematuria in women due to consumptive weakness and debility.
Ingredients: Lurong (Deer Horn), Danggui (Angelica Sinensis), Shudihuang (Prepared Rehmannia), Kuizi (Abelmoschus Seeds), Puhuang (Typha Pollen), Xuduan (Dipsacus Root) (equal parts).
Preparation: Grind into fine powder. Take 2 qian mixed with wine, three times daily.

Fahui San (Ashed Hair Powder): Treats hematuria, whether blood appears after urine or urine after blood. It also treats "Pao Zhuan" (bladder retention/spasm) and urgent lower abdominal pain caused by holding urine or excessive sexual activity. It treats Lung abscess, heart bleeding, internal rupture, spitting up one or two mouthfuls of blood, tongue bleeding like needle pricks, and epistaxis (nosebleed); blowing the powder into the nose stops it immediately.
Ingredient: Luansha Fahui (Ashed disordered hair) [Compendium notes: treats blood stasis, opens blockages, promotes urination, breaks masses/abscesses, treats urinary retention, promotes bowel/urinary movement, cough, epistaxis].
Preparation: Single ingredient. Mix 2 qian with 2 he of rice vinegar and a little hot water. Can also be taken with Jinghua Water (first drawn well water). After taking, squat over stir-fried black soybean leaves to promote urination.

Sheng Gan Dihuang San (Raw Dried Rehmannia Powder): Treats persistent hematuria in women.
Ingredients: Sheng Gan Dihuang (Raw Dried Rehmannia, 2 liang), Baiye (Cacumen Platycladi), Huangqin (Scutellaria Root, each 0.5 liang), Ejiao (Donkey-hide Gelatin, fried until bubbling, 1 liang).
Preparation: Coarse powder. Take 3 qian per dose with 1 sheng of water and 3 slices of ginger. Decoct to 0.7 sheng, strain, and take warm.

Danggui San (Angelica Powder): Treats hematuria or intermittent blood in urine in women.
Ingredients: Danggui (Angelica Sinensis), Lingyangjiao (Antelope Horn, powdered), Chi Shaoyao (Red Peony Root, each 0.5 liang), Shengdihuang (Raw Rehmannia, 1 liang), Cijiye (Leaf of Carthamus/Saflower plant? Note: Ci Ji usually refers to Carthamus tinctorius leaf or similar thistle, here likely specific local herb), Cijiye (Thistle Leaf, 0.3 qian).
Preparation: Coarse powder. Take 3 qian per dose, decoct in water, strain, and take.

Another Formula:
Ingredients: Lingyangjiao (Antelope Horn, powdered), Longgu (Fossilized Bones), Danggui (Angelica Sinensis), Puhuang (Typha Pollen, each 1 liang), Shengdihuang (Raw Rehmannia, 2 liang).
Preparation: Fine powder. Take 2 qian mixed with millet gruel water, before meals.

Another Formula: Crush raw Rehmannia to extract juice. Take one small cup per dose, twice daily.

Another Formula: Take 2 qian of Puhuang powder mixed with wine. Water can also be used.

Another Formula: Use Lu Jiao Jiao (Deer Horn Gelatin, 2 liang, roasted yellow). Decoct in 1 large sheng of water until reduced to half a sheng. Strain and divide into three doses, before meals.

*Supplement*: For hematuria, decoct a large piece of Zhu Ru (Bamboo Shavings) in water and drink.

Another Formula: Decoct thickly Chuan Niuxi (Achyranthes Bidentata Root, de-rhizomed) and drink.

Another Formula: Make Danggui (Angelica Sinensis) and Baizhi (Angelica Dahurica) into powder. Take 2 qian with millet drink.

Another Formula: Cu Sheng Ru Shen San (Delivery-like-God Powder). Take mixed with child's urine and wine.

Treatment for sudden heat injury causing hematuria in women: Commander Chen stated: "When I was in Zhanggong at age twenty-six, I suddenly noticed a few drops of bright red blood after urination. I was terrified, though there was no pain. This persisted for a month. If I did not drink alcohol, the bleeding was less, but the fear prevented cessation. A local soldier told me of a city doctor named Zhang Kang who often treated this. I invited him. He provided a vessel of clear liquid, saying it was a herbal medicine, diluted with a little honey and water. Two doses cured me. I rewarded him heavily and asked the name. It was Jingmian Cao (Mirror-leaved Herb), also known as Luoye Cao (Snail-face Herb). It is green and grows in cracks of stone steps everywhere."