下滞。其为中热可知。热结于中。上下不开。和中之法。宜反理中汤诸药。以寒凉治之。生姜泻心汤去干姜
为宜。人参白虎汤亦佳。
膀胱与血室。并域而居。热入血室。则蓄血。热结膀胱。则尿血。尿乃水分之病。而亦干动血分者。以与血室
并居。故相连累也。其致病之由。则有内外二因。
一外因。乃太阳阳明传经之热。结于下焦。其证。身有寒热。口渴腹满。小便不利。溺血疼痛。宜仲景桃仁承
气汤治之。小柴胡汤。加桃仁丹皮牛膝。亦治之。
一内因。乃心经遗热于小肠。肝经遗热于血室。其证。淋秘割痛。小便点滴不通者。呼赤淋。治宜清热。治心
经遗热。虚烦不眠。或昏睡不醒。或舌咽作痛。或怔忡懊 。宜导赤饮。加炒栀连翘丹皮牛膝。治肝经遗热。
其证少腹满。胁肋刺痛。口苦耳聋。或则寒热往来。宜龙胆泻肝汤。加桃仁丹皮牛膝郁金。
尿血治心与肝而不愈者。当兼治其肺。肺为水之上源。金清则水清。水宁则血宁。盖此证原是水病累血。
故治水即是治血。人参泻肺汤。去大黄。加苦参治之。清燥救肺汤。加藕节蒲黄亦治之。
以上结热之证。其血溺出。皆有淋滴不通之象。乃尿血之实证也。此外又有虚证。溺出鲜血。如尿长流。绝
无滞碍者。但当清热滋虚。兼用止血之药。无庸再行降利矣。盖前阴有二窍。一为水窍。一为血室之窍。血
窍在女子。则为胎孕之门。血窍在男子。则为施精之路。故女子血室之血。能由此崩漏而下。男子血室之
血。亦能由此走泄而出。是以血尿之虚证。与女子崩漏之证无异。宜用四物汤加减治之。肝如郁火者。加
丹皮炒栀子柴胡阿胶芥灰。心经血虚火旺者。加黄连阿胶血余。脾气虚寒。不能摄血者。四肢清冷。脉微
迟。面黯淡。加鱼鳔黄 人参艾叶黑姜甘草五味治之。房劳伤肾。加鹿胶海螵蛸发灰散治之。又有肺虚。
不能制节其下。以致尿后渗血者。审系肺阴虚。则兼气逆痰咳口渴等证。人参清肺汤主之。若肺阳虚。不
能治下。则必有遗溺足冷。水饮喘嗽之证。甘草干姜汤治之。
大便涩滞不通。这显然是中焦有热所致。热邪结聚在中焦，导致气机上下闭塞不通。调和中的治法，适宜使用反理中汤等药物；若用寒凉药治疗，生姜泻心汤去掉干姜较为适宜。人参白虎汤也是不错的选择。
膀胱与血室（女子胞/子宫）相邻而居。热邪侵入血室，就会导致蓄血；热邪结于膀胱，就会导致尿血。小便不利属于水分的病变，但也会波及动扰血分，因为血室与膀胱位置相邻，所以相互牵连影响。其致病的原因，分为内因和外因两种。
一是外因，是太阳病和阳明病的传经之热，结聚在下焦。症状表现为身体忽冷忽热、口渴、腹部胀满、小便不利、排尿时尿血且疼痛。适宜用张仲景的桃仁承气汤来治疗。小柴胡汤加入桃仁、丹皮、牛膝，也能治疗此证。
二是内因，是心经将余热遗留给小肠，肝经将余热遗留给血室。症状表现为淋证、小便闭塞、排尿时切割样疼痛，尿液颜色红赤如洗肉水，称为“赤淋”。治疗宜清热。针对心经遗留的热邪，症状表现为心中虚烦、失眠，或者昏睡不醒，或者咽喉作痛，或者心悸不安、心中懊恼，适宜用导赤饮，加入炒栀子、连翘、丹皮、牛膝。针对肝经遗留的热邪，症状表现为少腹胀满、胁肋刺痛、口苦、耳聋，或者寒热往来，适宜用龙胆泻肝汤，加入桃仁、丹皮、牛膝、郁金。
如果尿血经过治疗心和肝之后仍未痊愈，应当兼治肺脏。肺为水之上源，肺气清肃则水道清澈，水道安宁则血液安宁。因为这个病症原本是水病累及血分，所以治疗水病即是治疗血病。用人参泻肺汤，去掉大黄，加入苦参来治疗。清燥救肺汤加入藕节、蒲黄也能治疗。
以上这些因结热导致的病症，其血液随小便排出，都有淋漓滴沥、不通畅的现象，这是尿血的实证。除此之外还有虚证，排出鲜红的血液，像尿液一样长流不止，完全没有阻滞碍感的情况。这时只需清热滋阴，兼用止血药物，不需要再用降气通下的方法了。因为前阴有两个窍道，一个是水窍，一个是血室的窍道。女子的血窍，就是孕育胎儿的门径；男子的血窍，就是施泄精液的通道。所以女子的血室之血，能由此崩漏而下；男子的血室之血，也能由此走泄而出。因此，尿血的虚证，与女子崩漏的病症没有区别。适宜用四物汤加减来治疗。如果肝经有郁火，加入丹皮、炒栀子、柴胡、阿胶、侧柏叶炭。如果心经血虚火旺，加入黄连、阿胶、血余炭。如果脾气虚寒，不能统摄血液，症状表现为四肢清冷、脉象微迟、面色黯淡，加入鱼鳔、黄芪、人参、艾叶、炮姜、甘草、五味子来治疗。如果因房劳过度损伤肾脏，加入鹿角胶、海螵蛸、发灰散来治疗。又有因肺虚，不能制约下部，导致排尿后渗血的，如果是肺阴虚，兼见气逆、痰咳、口渴等症状，主用人参清肺汤。如果是肺阳虚，不能治理下部，则必然会有遗尿、足部寒冷、饮水喘嗽等症状，用甘草干姜汤治疗。
Stool is obstructed and difficult to pass. This clearly indicates heat accumulation in the middle jiao (Middle Burner). When heat binds in the middle, the qi mechanism is blocked from opening up or down. The method for harmonizing the middle is suitable for using herbs like those in Fan Lizhong Tang (Reverse Spleen-Harmonizing Decoction); treating it with cold-cooling herbs makes Shengjiang Xiexin Tang (Ginger Heart-Draining Decoction) with dried ginger removed more appropriate. Ren Shen Baifu Tang (Ginseng and White Tiger Decoction) is also a good choice.
The Bladder and the Blood Chamber (Uterus/Blood House) reside adjacent to each other. When heat enters the Blood Chamber, blood stasis accumulates; when heat binds in the Bladder, hematuria occurs. Disorders of urine belong to water metabolism issues, yet they can also disturb the blood level because the Blood Chamber resides alongside the Bladder, thus affecting one another. The causes of this disease are divided into external and internal factors.
One is an external factor: heat transmitted from the Taiyang (Greater Yang) and Yangming (Yang Brightness) meridians binds in the Lower Jiao (Lower Burner). Symptoms include alternating chills and fever, thirst, abdominal fullness, difficulty in urination, painful hematuria. It is suitable to treat with Tao Ren Chengqi Tang (Peach Kernel and Major Order the Qi Decoction) by Zhang Zhongjing. Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Tao Ren (Peach Kernel), Dan Pi (Moutan Cortex), and Niu Xi (Achyranthes Root) can also treat this condition.
The other is an internal factor: the Heart Meridian leaves residual heat to the Small Intestine, and the Liver Meridian leaves residual heat to the Blood Chamber. Symptoms include strangury, urinary retention, cutting pain during urination, and urine that is red like washed meat water, called "Chi Lin" (Red Strangury). Treatment should focus on clearing heat. For residual heat in the Heart Meridian, symptoms include mental restlessness due to deficiency, insomnia, or lethargy/unconsciousness, sore throat, palpitations, and mental anguish. It is suitable to use Dao Chi Yin (Guide Out Redness Decoction) added with fried Zhi Zi (Gardenia Fruit), Lian Qiao (Forsythia Fruit), Dan Pi (Moutan Cortex), and Niu Xi (Achyranthes Root). For residual heat in the Liver Meridian, symptoms include lower abdominal fullness, stabbing pain in the hypochondrium, bitter taste in the mouth, deafness, or alternating chills and fever. It is suitable to use Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction) added with Tao Ren (Peach Kernel), Dan Pi (Moutan Cortex), Niu Xi (Achyranthes Root), and Yu Jin (Curcuma Rhizome).
If hematuria does not heal after treating the Heart and Liver, the Lung should be treated concurrently. The Lung is the upper source of water; when Metal (Lung) is clear, water is clear; when water is tranquil, blood is tranquil. Since this condition originally involves water disorders affecting blood, treating water is equivalent to treating blood. Use Ren Shen Xie Fei Tang (Ginseng Lung-Draining Decoction) with Da Huang (Rhubarb Root) removed, added with Ku Shen (Sophora Root). Qing Zao Jiu Fei Tang (Clear Dryness and Rescue the Lung Decoction) added with Ou Jie (Lotus Node Joint) and Pu Huang (Typha Pollen) can also treat it.
In the above conditions caused by bound heat, the blood excreted with urine shows signs of dripping obstruction and lack of smooth flow; this is the excess type of hematuria. Besides this, there is also a deficiency type, where bright red blood flows out continuously like urine, without any obstruction. In such cases, one should only clear heat and nourish yin/deficiency, using hemostatic herbs, without needing to use descending and purgative methods again. Because the anterior orifice has two openings: one is the water opening, and the other is the opening of the Blood Chamber. In women, the Blood Chamber's opening is the gate for pregnancy; in men, it is the pathway for semen emission. Therefore, blood from the woman's Blood Chamber can descend through here as metrorrhagia; blood from the man's Blood Chamber can also leak out through here. Thus, the deficiency type of hematuria is no different from the metrorrhagia syndrome in women. It is suitable to treat with Si Wu Tang (Four Substances Decoction) with modifications. If the Liver has constrained fire, add Dan Pi (Moutan Cortex), fried Zhi Zi (Gardenia Fruit), Chai Hu (Bupleurum Root), E Jiao (Donkey-hide Gelatin), and Ce Bai Ye Tan (Charred Biota Top). If the Heart Meridian has blood deficiency with hyperactive fire, add Huang Lian (Coptis Rhizome), E Jiao (Donkey-hide Gelatin), and Xue Yu Tan (Charred Human Hair). If the Spleen Qi is deficient and cold, failing to control blood, symptoms include cold limbs, faint and slow pulse, and dull complexion. Add Yu Biao (Swim Bladder), Huang Qi (Astragalus Root), Ren Shen (Ginseng Root), Ai Ye (Mugwort Leaf), Pao Jiang (Prepared Ginger), Gan Cao (Licorice Root), and Wu Wei Zi (Schisandra Berry) to treat. If kidney injury due to sexual exhaustion occurs, add Lu Jiao Jiao (Deer Antler Gelatin), Hai Piao Xiao (Cuttlefish Bone), and Fa Hui San (Hair Ash Powder). There is also the case of Lung deficiency, failing to regulate the lower part, causing bleeding after urination. If it is confirmed as Lung Yin deficiency, accompanied by rebellious qi, phlegm-cough, and thirst, Ren Shen Qing Fei Tang (Ginseng Lung-Clearing Decoction) is the main prescription. If it is Lung Yang deficiency, failing to govern the lower part, there must be symptoms of urinary enuresis, cold feet, and wheezing cough due to fluid retention. Gan Cao Gan Jiang Tang (Licorice and Ginger Decoction) treats this.