痛者为血淋，见淋症门。不痛者为溺血。不论何脏之血，但损伤妄行，皆得渗
入膀胱，与尿同出。盖不上行则下趋，可以渗入肠胃，亦可以渗入尿胞。此《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。
蓄血症，多嗽水不咽，（言即烦热欲饮水，但嗽不咽也，以热止在经，不在腑之故。热在经则经
血动，不衄则蓄。）小便利，（此膀胱外蓄血，以血只在小腹，未入膀胱也。）大便黑。（此肠胃蓄血。）跌打闪
撞，奔走努力，恼怒，皆能致之，伤寒等热证尤多。蓄于上，令人善忘，（血蓄则气不
通，心窍闭故善忘。）时时鼻血，犀角、生地、赤芍、丹皮。蓄于中，则心下手不可近，桃
仁、桂枝、芒硝、甘草、大黄、丹皮、枳壳。蓄于下，则脐腹肿痛，或如狂谵语，
发黄，（详《伤寒·太阳篇》。）生地四钱，犀角一钱，大黄三钱，桃仁一钱，水酒煎，
入生漆一钱再煎，服半日血不下，再一服，下即止，名生漆汤。一切瘀血，大黄四
钱，芒硝一钱，桃仁泥六个，归尾、生地、山甲各一钱，桂五分，为丸，名代抵当
丸。在上血，丸如芥子大，去枕仰卧，以津咽，令停留喉下。中、下血，丸如桐子
大，百沸水下。若血积久，此药不能下，去归、地，加莪术醋炒一钱，肉桂七分。
又破血方，（女子通经亦用之。）大黄醋煮，桃仁、益元散各一两，干漆炒，烟尽为度、
生牛膝各五钱，醋糊丸，每服七十丸。大凡跌扑损折，蓄血肿痛发热，先服折
锐汤，大黄、桃仁、红花、当归、寄奴、川芎、赤芍，大下数次；再服行血破瘀汤，
三七、当归、玄胡、乳香、没药、血竭、苏木、灵脂、赤芍、红花；然后服百和汤
收功，首乌、地黄、当归、骨碎补、白芨、鹿胶、续断、甘草、薄荷。凡血妄行瘀
蓄，必用桃仁、大黄行血破瘀之剂。盖瘀败之血，势无复反于经之理，不去则
留蓄为患，故不问人之虚实强弱，必去无疑。虚弱者加入补药可也。好酒者多阳明
蓄血，但牙齿蚀，数年不愈者是，桃仁承气汤料为丸服，屡效。
疼痛的称为血淋，详见淋症门。不疼痛的称为溺血。无论哪一脏的血，只要是受损妄行，都能渗入膀胱，与尿液一同排出。因为血液如果不向上行则向下趋流，可以渗入肠胃，也可以渗入尿胞（膀胱）。《准绳》中说：溲血、淋血、便血，这三者虽然从前阴和后阴排出不同，但致病原因是一致的。其散血、止血等药物，没有超出几十种的范围，只是引导药略有差异，这种说法确实很妥当。如果血液不与尿液一同排出，而是从精窍排出的话。清道中的血，向上可以从鼻出血，向下也可以从精窍出血，多因房事过度引起，可用牛膝四物汤治疗。服用各种药物无效，且排尿时血液成块、排不出且疼痛剧烈的，珀珠散非常有效。
蓄血症，多表现为漱水不欲咽（意思是烦热想喝水，但漱口后不咽下，这是因为热邪仅在经络，不在腑。热在经络则经络之血动，若不衄血则蓄积在内），小便通利（这是膀胱外蓄血，因为血只蓄积在小腹，未进入膀胱），大便色黑（这是肠胃蓄血）。跌打损伤、闪挫撞击、奔跑用力、恼怒，都能导致此病，伤寒等热证尤为多见。血蓄积在上部，使人健忘（血蓄积则气不通，心窍闭塞所以健忘），时常鼻出血，用犀角、生地、赤芍、丹皮治疗。血蓄积在中部，则心窝下方不可触碰，用桃仁、桂枝、芒硝、甘草、大黄、丹皮、枳壳治疗。血蓄积在下部，则脐腹肿痛，或出现如狂、谵语、发黄症状（详见《伤寒论·太阳篇》）。生地四钱，犀角一钱，大黄三钱，桃仁一钱，用水和酒煎煮，加入生漆一钱再煎，服用后半天血不下行，再服一次，下行即止，名为生漆汤。一切瘀血，用大黄四钱，芒硝一钱，桃仁泥六个，当归尾、生地、穿山甲各一钱，桂枝五分，制成丸剂，名为代抵当丸。上部瘀血，丸剂如芥子大，去掉枕头仰卧，用唾液吞咽，令药停留于喉下。中部、下部瘀血，丸剂如梧桐子大，用滚开水送服。若瘀血积聚日久，此药不能下行，去掉当归、生地，加醋炒莪术一钱，肉桂七分。又有破血方（女子通经也使用此方）：大黄醋煮，桃仁、益元散各一两，干漆炒至烟尽为度，生牛膝各五钱，醋糊为丸，每次服用七十丸。大凡跌扑损伤骨折，蓄血肿痛发热，先服用折锐汤（大黄、桃仁、红花、当归、刘寄奴、川芎、赤芍），多次强力攻下；再服用行血破瘀汤（三七、当归、玄胡索、乳香、没药、血竭、苏木、五灵脂、赤芍、红花）；然后服用百和汤收功（首乌、地黄、当归、骨碎补、白芨、鹿角胶、续断、甘草、薄荷）。凡是血液妄行瘀蓄，必须使用桃仁、大黄等行血破瘀的药剂。因为败坏的瘀血，势必要重新回归经络是不可能的，不去除则会留蓄成为祸患，所以不管人的虚实强弱，都必须去除无疑。虚弱的人加入补药即可。好喝酒的人多有阳明蓄血，表现为牙齿腐蚀，数年不愈的，用桃仁承气汤的药料制成丸剂服用，屡见疗效。
Painful hematuria is called *xuelin* (blood strangury), see the section on strangury. Painless hematuria is called *niaoxue* (bleeding from urination). Regardless of which Zang organ's blood is involved, if it is damaged and flows recklessly, it can seep into the Bladder and exit together with urine. Since blood that does not flow upward tends to descend, it can seep into the Intestines or seep into the urinary bladder (*niaopao*). As stated in *Zhunsheng*: "Hematuria (*soushui*), bloody strangury (*linxue*), and melena (*bianxue*), although they exit from the anterior and posterior yins respectively, share the same pathological origin." The herbs for dispersing blood and stopping bleeding do not exceed a few dozen types; only the guiding herbs differ slightly, so this explanation is indeed sound. If the blood does not exit with urine but instead exits from the essence orifice (*jingqiao*), this refers to blood from the clear pathways. Blood from the clear pathways may exit upwards via epistaxis or downwards via the essence orifice, often caused by excessive sexual activity; treat with *Niuxi Siwu Tang* (Dioscorea Hypoglauca and Four Substances Decoction). For cases where various medicines are ineffective, and the blood in urine forms clots, cannot be expelled, and causes severe pain, *Po Zhu San* (Pearl Powder) is very effective.
The syndrome of blood retention (*xuxue zheng*) often presents with rinsing water but not swallowing it (meaning there is irritability and heat desiring water, but one rinses without swallowing because the heat is confined to the meridians, not the fu organs. Heat in the meridions agitates the meridian blood; if no epistaxis occurs, the blood retains internally). Urination is free (this is blood retention outside the Bladder, as the blood is retained only in the lower abdomen and has not entered the Bladder). Stool is black (this is blood retention in the Intestines). Trauma, sprains, collisions, running with exertion, and anger can all cause this condition; it is particularly common in febrile diseases such as *Shanghan* (Cold Damage). When blood retains in the upper jiao, it causes forgetfulness (blood retention obstructs qi flow, closing the orifices of the Heart, thus causing forgetfulness); frequent epistaxis occurs; treat with *Xijiao*, *Shengdi*, *Chishao*, and *Danpi*. When blood retains in the middle jiao, the area below the heart is tender to touch; treat with *Taoren*, *Guizhi*, *Mangxiao*, *Gancao*, *Dahuang*, *Danpi*, and *Zhiqiao*. When blood retains in the lower jiao, there is swelling and pain around the umbilicus and abdomen, or symptoms such as manic behavior, delirious speech, and jaundice (see *Shanghan Lun · Taiyang Chapter*). Use *Shengdi* 4 qian, *Xijiao* 1 qian, *Dahuang* 3 qian, *Taoren* 1 qian; decoct with water and wine, add *Shengqi* (raw lacquer) 1 qian and decoct again. If after half a day the blood has not been purged, administer another dose; once the blood is purged, stop administration. This formula is named *Shengqi Tang* (Raw Lacquer Decoction). For all kinds of blood stasis, use *Dahuang* 4 qian, *Mangxiao* 1 qian, six *Taoren* paste, *Guiwei*, *Shengdi*, and *Shanjia* each 1 qian, *Guizhi* 0.5 fen; process into pills, named *Dai Didang Wan* (Substitute Dangdang Pill). For upper jiao blood stasis, make pills the size of mustard seeds; lie supine without a pillow, swallow with saliva, allowing the medicine to linger under the throat. For middle and lower jiao blood stasis, make pills the size of paulownia seeds; take with boiling water. If the blood stasis has accumulated for a long time and these medicines fail to purge it, remove *Guiwei* and *Shengdi*, add *Ezhu* stir-fried with vinegar 1 qian, and *Rougui* 0.7 fen. Another blood-breaking formula (also used for amenorrhea in women): decoct *Dahuang* with vinegar, use *Taoren* and *Yiyuan San* each 1 liang, *Ganqi* stir-fried until smoke ceases, and *Sheng Niuxi* each 5 qian; process into pills with vinegar paste, taking 70 pills per dose. Generally, for trauma fractures with blood retention, swelling, pain, and fever, first administer *Zherui Tang* (*Dahuang*, *Taoren*, *Honghua*, *Danggui*, *Jinu*, *Chuanxiong*, *Chishao*) to purge strongly several times; then administer *Xingxue Pouyu Tang* (*Sanqi*, *Danggui*, *Yanhusuo*, *Ruxiang*, *Moyao*, *Xuexie*, *Sumu*, *Wulingzhi*, *Chishao*, *Honghua*); finally, administer *Baihe Tang* to conclude treatment (*Shouwu*, *Dihuang*, *Danggui*, *Gusuibu*, *Baiji*, *Lujiao*, *Xuduan*, *Gancao*, *Bohe*). Whenever blood flows recklessly and accumulates as stasis, formulas containing *Taoren* and *Dahuang* for moving blood and breaking stasis must be used. Because failed/decayed blood has no possibility of returning to the meridians, if not removed, it will remain and cause harm; therefore, regardless of the patient's deficiency or excess, strength or weakness, removal is undoubtedly necessary. Tonifying herbs may be added for those who are weak. Those who enjoy alcohol often have Yangming blood retention, characterized by dental caries that persist for years without healing; treat with pills made from *Taoren Chengqi Tang* ingredients, which has proven highly effective.