溺血与血淋异，痛为血淋，出精窍；不痛为溺血，出溺窍。痛属火盛，不痛属虚。然经云∶胞移热于膀
胱，则癃溺血。膀胱者胞之室。惟房欲损肾，热注膀胱，肾与膀胱相表里。故血随溺出，亦火所迫也。其脉洪
数，法当滋化源。六味饮加生牛膝。如肺肾阴虚，口干腰酸，六味丸合生脉散。小肠火盛，血渗膀胱，导赤散。
肝火脉洪，不能藏血，龙胆草汤加法。胆火溺血，头痛眩晕，当归饮。溺血日久，肾液虚涸，六味阿胶饮。
阴虚火炎，一切溺血血淋，保阴煎。小溲自利，后沥血点，痛如血淋，小蓟饮子。小水不利，赤浊淋闭，大分
清饮。通治溺血，益母草捣汁
一升，服效。槐花炒、郁金煨各一两，研。每用三钱，豆豉煎汤下效。治血淋，琥珀研细，以灯心、薄荷煎
汤下二钱。脾虚不能摄血，久而滑脱，妙香散去桔梗、麝，加 龙骨、益智仁。
〔化源〕六味汤 见一卷中风。
〔阴虚〕生脉散 见一卷暑。
〔小肠〕导赤散 见一卷温。
〔肝火〕龙胆草汤 一味龙胆草煎服。
〔胆火〕当归饮 当归 羚羊角 赤芍（各二钱） 生地 刺蓟叶（各一钱）
〔液涸〕六味阿胶饮 六味汤加阿胶、童便。
〔虚火〕保阴煎 见五卷痉。
〔血淋〕小蓟饮子 蓟 栀 归（各一钱） 地 藕节（各钱半） 滑石 蒲黄（炒。各钱二分） 通草
甘草 竹叶（各八分）
〔淋闭〕大厘清饮 见四卷泄泻。
〔脾虚〕妙香散 见二卷衄。
溺血与血淋是不同的，排尿时疼痛的是血淋，血液从精窍排出；不疼痛的是溺血，血液从尿窍排出。疼痛属于火邪亢盛，不疼痛属于虚证。然而《内经》记载：胞宫的热邪转移至膀胱，就会导致小便不通或尿血。膀胱是胞宫的室舍。只有因房事过度损伤肾气，热邪下注于膀胱，因为肾与膀胱互为表里，所以血液随尿液排出，这也是被火邪逼迫所致。其脉象洪大而数，治法应当滋养化源（指滋补肾阴以生元气）。可用六味地黄丸加生牛膝。如果是肺肾阴虚，出现口干、腰酸症状，用六味地黄丸合生脉散。小肠火邪亢盛，血液渗入膀胱，用导赤散。肝火旺盛脉象洪大，导致肝不能藏血，用龙胆草汤加减。胆火引起的溺血，伴有头痛眩晕，用当归饮。溺血日久，肾液枯竭，用六味阿胶饮。阴虚火旺上炎，引起的一切溺血和血淋，用保阴煎。小便自利通畅，但后段滴出血点，疼痛如同血淋，用小蓟饮子。小便不利，尿液浑浊色红且淋沥闭塞，用大分清饮。通治溺血，可将益母草捣取汁一升，服用有效。槐花炒制、郁金煨制各一两，研成细末。每次服用三钱，用豆豉煎汤送服有效。治疗血淋，将琥珀研细，用灯心草、薄荷煎汤送服二钱。脾虚不能统摄血液，日久导致滑脱不禁，用妙香散去掉桔梗、麝香，加入龙骨、益智仁。
〔化源〕六味汤 见于一卷中风篇。
〔阴虚〕生脉散 见于一卷暑病篇。
〔小肠〕导赤散 见于一卷温病篇。
〔肝火〕龙胆草汤 单味龙胆草煎服。
〔胆火〕当归饮 当归、羚羊角、赤芍（各二钱）、生地、刺蓟叶（各一钱）
〔液涸〕六味阿胶饮 六味汤加阿胶、童便（儿童尿液）。
〔虚火〕保阴煎 见于五卷痉病篇。
〔血淋〕小蓟饮子 小蓟、栀子、当归（各一钱）、生地、藕节（各钱半）、滑石、蒲黄（炒，各钱二分）、通草、甘草、竹叶（各八分）
〔淋闭〕大分清饮 见于四卷泄泻篇。
〔脾虚〕妙香散 见于二卷鼻衄篇。
Hematuria (blood in urine) differs from strangury with blood (xuelin). Strangury with blood is characterized by pain, and the blood exits from the essence orifice; hematuria is painless, and the blood exits from the urinary orifice. Pain indicates excessive fire, while painlessness indicates deficiency. However, the Classics state: "When heat shifts from the uterus to the bladder, it results in difficulty in urination or hematuria." The bladder is the chamber of the uterus. Only when sexual excess damages the Kidney, allowing heat to sink into the Bladder, and because the Kidney and Bladder are exterior-interiorly related, does blood follow the urine out. This is also forced by fire. The pulse is surging and rapid; the method should be to nourish the source of transformation (referring to nourishing Kidney Yin to generate Yuan Qi). Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) added with raw Achyranthes Root (Sheng Niuxi) is indicated. If there is Lung-Kidney Yin deficiency with dry mouth and soreness of the waist, Liuwei Dihuang Wan combined with Shengmai San (Generate the Pulse Powder) is used. Excessive fire in the Small Intestine causing blood to seep into the Bladder is treated with Daochi San (Guide Out Red Powder). Liver fire with a surging pulse, leading to the Liver's inability to store blood, is treated with Longdan Cao Tang (Gentian Decoction) with modifications. Hematuria caused by Gallbladder fire, accompanied by headache and dizziness, is treated with Danggui Yin (Angelica Decoction). For chronic hematuria where Kidney fluids are exhausted, Liuwei Ejiao Yin (Six-Ingredient Donkey-Hide Gelatin Decoction) is used. For Yin deficiency with flaming fire causing all types of hematuria and strangury with blood, Baoyin Jian (Preserve the Yin Decoction) is indicated. If urination is free but drops of blood appear at the end, with pain resembling strangury with blood, Xiaojiao Yinzi (Little Thistle Infusion) is used. If urination is obstructed, with red turbid urine and strangury/retention, Da Fenqing Yin (Great Separation of Clearness Decoction) is used. To generally treat hematuria, fresh Motherwort Juice (Yimucao juice), one sheng, taken orally, is effective. Stir-fried Sophora Flower (Huaihua) and calcined Curcuma Aromatic Tuber (Yujin), each one liang, ground into powder. Take three qian per dose, washed down with fermented Soybean Decoction (Douchi decoction), which is effective. For treating strangury with blood, finely ground Amber (Hupo), two qian, taken with a decoction of Nymphoides Peltata Stem (Dengxincao) and Mint (Bohe), is effective. Spleen deficiency failing to control blood, leading to chronic slipping and incontinence, is treated with Miaoxiang San (Wonderful Fragrance Powder) without Platycodon Root (Jiegeng) and Musk (Shexiang), adding Dragon Bone (Longgu) and Bitter Apricot Seed (Yizhiren).
[Source of Transformation] Liuwei Tang (Six-Ingredient Decoction) - See Volume I, Stroke Chapter.
[Yin Deficiency] Shengmai San (Generate the Pulse Powder) - See Volume I, Summerheat Chapter.
[Small Intestine] Daochi San (Guide Out Red Powder) - See Volume I, Warm Disease Chapter.
[Liver Fire] Longdan Cao Tang (Gentian Decoction) - Single herb Gentiana Scabra Root and Rhizome (Longdancao) decocted and taken.
[Gallbladder Fire] Danggui Yin (Angelica Decoction) - Angelica Sinensis Root (Danggui), Saiga Antelope Horn (Lingyangjiao), Red Peony Root (Chishao) (each 2 qian), Rehmannia Root (Shengdi), Chinese Thistle Leaf (Cijiye) (each 1 qian).
[Fluid Exhaustion] Liuwei Ejiao Yin (Six-Ingredient Donkey-Hide Gelatin Decoction) - Liuwei Tang plus Donkey-Hide Gelatin (Ejiao) and Child's Urine (Tongbian).
[Deficient Fire] Baoyin Jian (Preserve the Yin Decoction) - See Volume V, Spasm Chapter.
[Strangury with Blood] Xiaojiao Yinzi (Little Thistle Infusion) - Little Thistle (Ji), Gardenia Fruit (Zhi), Angelica Sinensis Root (Gui) (each 1 qian); Rehmannia Root (Di), Lotus Rhizome Node (Oujie) (each 1.5 qian); Talcum (Huashi), Polygonum Multiflorum Rootlet (Puhuang) (stir-fried, each 0.2 qian); Tetrapanax Pith (Tongcao), Licorice Root (Gancao), Bamboo Leaf (Zhuye) (each 0.8 fen).
[Strangury and Retention] Da Fenqing Yin (Great Separation of Clearness Decoction) - See Volume IV, Diarrhea Chapter.
[Spleen Deficiency] Miaoxiang San (Wonderful Fragrance Powder) - See Volume II, Epistaxis Chapter.