治血淋及溺血、大便下血，证之由于热者。
生山药（一两） 生龙骨（六钱，捣细） 生牡蛎（六钱，捣细） 海螵蛸（四钱，捣细） 茜草（二钱）
生杭芍（三钱） 白头翁（三钱） 真阿胶（三钱，不用炒）
溺血者，加龙胆草三钱。大便下血者，去阿胶，加龙眼肉五钱。
血淋之症，大抵出之精道也。其人或纵欲太过而失于调摄，则肾脏因虚生热。或欲盛强制而妄言采补，则
相火动无所泄，亦能生热。以致血室（男女皆有，男以化精女以系胞）中血热妄动，与败精混合化为腐浊之物，
或红、或白、成丝、成块，溺时杜塞牵引作疼。故用山药、阿胶以补肾脏之虚，白头翁其性寒凉，其味苦而兼
涩，凉血之中大有固脱之力，故以清肾脏之热，茜草、螵蛸以化其凝滞而兼能固其滑脱，龙骨、牡蛎以固其滑
脱而兼能化其凝滞，芍药
以利小便而兼能滋阴清热，所以投之无不效也。此证，间有因劳思过度而心热下降，忿怒过甚而肝火下移以成
者，其血必不成块，惟溺时牵引作疼。此或出之溺道，不必出自精道也。投以此汤亦效。
溺血之证，不觉疼痛，其证多出溺道，间有出之精道者。大抵心移热于小肠，则出之溺道。肝移热于血室，
则出之精道。方中加生地黄者，泻心经之热也。若系肝移热于血室者，加龙胆草亦可。
一人，年三十许，患血淋。溲时血块杜塞，努力始能溲出，疼楚异常。且所溲者上多浮油，胶粘结于器底，
是血淋而兼膏淋也。从前延医调治，经三十五人，服药年余，分毫无效， 羸已甚。后愚诊视，其脉弦细，至
数略数，周身肌肤甲错，足骨凸处，其肉皮皆成旋螺高寸余，触之甚疼。盖卧床不起者，已半载矣。细询病因，
谓得之忿怒之余误坠水中，时当秋夜觉凉甚，遂成斯证。知其忿怒之火，为外寒所束，郁于下焦而不散，而从
前居室之间，又有失保养处也。拟投以此汤，为脉弦，遂以柏子仁（炒捣）八钱，代方中山药，以其善于养肝
也。疏方甫定，其父出所服之方数十纸，欲以质其同异。愚曰∶无须细观，诸方与吾方同者，惟阿胶白芍耳，
阅之果然。其父问何以知之？愚曰∶吾所用之方，皆苦心自经营者，故与他方不同。服三剂血淋遂愈，而膏淋
亦少减。改用拙拟膏淋汤，连服二十余剂，膏淋亦愈，而小便仍然频数作疼。细询其疼之实状，谓少腹常觉疼
而且坠，时有欲便之意，故有尿即不能强忍，知其又兼气淋也。又投以拙拟气淋汤，十剂全愈。周身甲错，足
上旋螺尽脱。
溺血之证，热者居多，而间有因寒者，则此方不可用矣。曾治一人，年三十余，陡然溺血，其脉微弱而迟，
自觉下焦凉甚。知其中气虚弱，不能摄血，又兼命门相火衰微，乏吸摄之力，以
致肾脏不能封固，血随小便而脱出也。投以四君子汤，加熟地、乌附子，连服二十余剂始愈。又有非凉非热，
但因脾虚不能统血而溺血者。方书所谓失于便溺者，太阴之不升也。仍宜用四君子汤，以龙骨、牡蛎佐之。
大便下血者，大抵由于肠中回血管或血脉管破裂。方中龙骨、牡蛎之收涩，原可补其破裂之处。而又去阿
胶者，防其滑大肠也。加龙眼肉者，因此证间有因脾虚不能统血而然者，故加龙眼肉以补脾。若虚甚者，又当
重用白术，或更以参、 佐之。若虚而且陷者，当兼佐以柴胡、升麻。若虚而且凉者，当兼佐以干姜、附子，
减去芍药、白头翁。一少妇，大便下血月余，屡次服药不效。愚为诊视，用理血汤，去阿胶，加龙眼肉五钱治
之。而僻处药坊无白头翁，权服一剂，病稍见愈。翌日至他处药坊，按方取药服之，病遂全愈。则白头翁之功
效，何其伟哉！
附录∶
直隶唐山张××来函∶
张××，年二十八岁，于冬月初，得膏淋，继之血淋。所便者，或血条，或血块，后则继以鲜血，溺频茎疼。
屡经医者调治，病转加剧。其气色青黑，六脉坚数，肝脉尤甚。与以理血汤，俾连服三剂，血止，脉稍平，他
证仍旧。继按治淋浊方诸方加减治之，十余剂全愈。
生山药（一两） 生龙骨（六钱，捣碎成细粉） 生牡蛎（六钱，捣碎成细粉） 海螵蛸（四钱，捣碎成细粉） 茜草（二钱）
生杭芍（三钱） 白头翁（三钱） 真阿胶（三钱，不需要炒制）
若是尿血患者，加龙胆草三钱。若是大便下血患者，去掉阿胶，加龙眼肉五钱。
血淋这一病症，大抵是从精道排出的。这类病人或许是因为纵欲过度而缺乏调养，导致肾脏因虚而生热；或者是欲望旺盛却强行克制，又妄信所谓的“采补”之法，导致相火（寄居于肝肾之火，主生殖发育）躁动无处宣泄，也能产生热邪。致使血室（男女皆有，男性用于化生精液，女性用于系胞宫）中的血液受热妄动，与败精混合化为腐浊之物，颜色或红或白，形态成丝或成块，排尿时堵塞牵引疼痛。因此使用山药、阿胶来滋补肾脏之虚，白头翁性寒凉，味苦兼涩，在凉血之中具有强大的固脱止涩之力，所以用来清泻肾脏之热，茜草、海螵蛸用来化解凝滞并兼顾固摄滑脱，龙骨、牡蛎用来固摄滑脱并兼顾化解凝滞，芍药用来通利小便并兼顾滋阴清热，所以投用此方没有不有效的。这种证候，间或有因为思虑劳倦过度导致心热下降，或者愤怒过甚导致肝火下移而形成的，其血液必然不成块，仅在排尿时牵引作痛。这或许是从溺道（尿道）排出，不一定出自精道。投用此汤同样有效。
尿血的证候，不觉疼痛，其证多出於溺道，间有从精道排出的。大抵是心将热邪移于小肠，则从溺道排出；肝将热邪移于血室，则从精道排出。方中加入生地黄，是为了泻除心经的热邪。如果是肝将热邪移于血室的情况，加入龙胆草也可以。
有一人，三十岁左右，患血淋。排尿时血块堵塞，用力才能排出，疼痛异常。而且所排出的尿液上面漂浮着油脂，胶结粘附在容器底部，这是血淋兼膏淋（以尿液浑浊如米泔水或脂膏为特征的病证）。此前延请医生调治，经过三十五位医生，服药一年多，分毫无效，身体已经极度消瘦虚弱。后来我诊治，脉象弦细，至数略微偏快，周身肌肤干燥粗糙如鳞甲，足骨凸起处，皮肉都形成旋螺状隆起一寸多，触碰非常疼痛。大概卧床不起已经有半年了。仔细询问病因，说是发怒之后误坠入水中，当时正值秋夜觉得寒冷刺骨，于是形成此证。我知道他是愤怒之火被外寒束缚，郁结在下焦而不能发散，加上从前房事方面失于保养。打算投以此汤，但因为脉象弦，所以用柏子仁（炒后捣碎）八钱，代替方中的山药，因为柏子仁善于养肝。处方刚定，他的父亲拿出所服过的几十张药方，想要比较其中的异同。我说：不必细看，各方与我方相同的，只有阿胶和白芍罢了，查看果然如此。他父亲问怎么知道？我说：我所用的方剂，都是苦心独自经营的，所以与其他方不同。服用三剂后血淋痊愈，膏淋也减少。改用我拟定的膏淋汤，连续服用二十余剂，膏淋也痊愈，但小便仍然频数且疼痛。仔细询问疼痛的真实情况，说小腹部常觉疼痛且下坠，时常有想排便的感觉，所以一有尿意就不能强忍，知道他又兼气淋（以小便涩痛、少腹拘急胀痛为主症的病证）。又投用我拟定的气淋汤，十剂后完全痊愈。周身肌肤甲错现象消失，足上旋螺状隆起全部脱落。
尿血的证候，热证居多，间或有因寒邪所致者，那么此方就不可使用了。曾治疗一人，三十多岁，突然尿血，脉象微弱而迟，自觉下焦非常寒冷。知道是中气虚弱，不能统摄血液，又兼命门相火衰微，缺乏吸摄之力，导致肾脏不能封固，血液随小便而脱出。投用四君子汤，加熟地黄、乌头、附子，连续服用二十余剂才痊愈。又有既非凉也非热，只是因为脾虚不能统摄血液而导致尿血的。医书所谓“失于便溺”，是指太阴脾土不升。仍宜用四君子汤，以龙骨、牡蛎辅助。
大便下血，大抵是由于肠道中的回血管或血脉管破裂。方中龙骨、牡蛎的收涩作用，原本可以修补破裂之处。而又去掉阿胶，是防止其润滑大肠。加入龙眼肉，是因为此证间有因脾虚不能统摄血液而导致的，所以加龙眼肉以补脾。如果虚损严重，应当重用白术，或者再加人参、黄芪辅助。如果虚而且伴有气陷者，应当兼佐柴胡、升麻。如果虚而且伴有寒凉者，应当兼佐干姜、附子，减去芍药、白头翁。有一位少妇，大便下血一个多月，屡次服药无效。我为她诊治，用理血汤，去掉阿胶，加龙眼肉五钱治疗。而偏僻处的药坊没有白头翁，暂且服用一剂，病情稍见好转。第二天到另一处药坊，按方取药服用，病遂完全痊愈。可见白头翁的功效，是多么伟大啊！
附录：
直隶唐山张××来信：
张××，二十八岁，在冬月初，得膏淋，继之出现血淋。所排出的，有时是血条，有时是血块，随后继之以鲜血，尿频且阴茎疼痛。屡次经过医生调治，病情反而加剧。其气色青黑，六脉坚硬而数，肝脉尤其明显。给予理血汤，令其连续服用三剂，血止住，脉象稍平，其他症状依旧。接着按照治疗淋浊的各种方剂加减治疗，十余剂后完全痊愈。
Treats hematuria (blood in urine) and bloody stool, where the syndrome is due to heat.
Raw Dioscoreae Rhizoma (30g) Raw Longgu (Fossilized Bones, 18g, finely crushed) Raw Muli (Oyster Shell, 18g, finely crushed) Hai Piao Xiao (Cuttlefish Bone, 12g, finely crushed) Qian Cao (Rubiae Radix et Rhizoma, 6g)
Raw Shaoyao (Paeoniae Radix Alba, 9g) Baitouweng (Pulsatillae Radix, 9g) Zhen Ejiao (Donkey-hide Gelatin, 9g, not stir-fried)
For cases of hematuria, add Longdancao (Gentianae Radix, 9g). For cases of bloody stool, remove Ejiao, add Longyanrou (Longan Aril, 15g).
The condition of blood lin (dysuria with blood) generally originates from the essence channel (jing dao). The patient may have indulged excessively in sexual activity without proper regulation, causing the Kidney to generate heat due to deficiency. Or, due to strong desires but forced suppression, coupled with false claims of "harvesting tonification," the Ministerial Fire (Xiang Huo, fire associated with reproduction and development residing in the Liver and Kidney) moves restlessly without an outlet, also generating heat. This causes the blood in the Blood Chamber (Xue Shi, present in both sexes; in males it transforms essence, in females it anchors the uterus) to move recklessly due to heat, mixing with degenerated essence to form turbid matter. It may be red or white, forming threads or clots. During urination, blockage causes pulling pain. Therefore, Dioscoreae Rhizoma and Ejiao are used to tonify Kidney deficiency; Baitouweng is cold in nature and bitter with astringent properties, possessing great power to consolidate collapse while cooling blood, thus clearing Kidney heat; Qian Cao and Hai Piao Xiao resolve stagnation while consolidating leakage; Longgu and Muli consolidate leakage while resolving stagnation; Shaoyao promotes diuresis while nourishing Yin and clearing heat. Thus, administering this formula yields effective results. In some cases, this syndrome arises from excessive mental labor causing Heart heat to descend, or extreme anger causing Liver Fire to shift downward. In such cases, the blood does not form clots, only causing pulling pain during urination. This may originate from the urinary tract (ni dao) rather than the essence channel. Administering this decoction is also effective.
In cases of hematuria, there is no pain; these cases mostly originate from the urinary tract, occasionally from the essence channel. Generally, if Heart transfers heat to the Small Intestine, it exits via the urinary tract. If Liver transfers heat to the Blood Chamber, it exits via the essence channel. Adding Sheng Dihuang (Rehmanniae Radix Preparata) in the formula clears Heat from the Heart Meridian. If the case involves Liver transferring heat to the Blood Chamber, adding Longdancao is also suitable.
A man, around thirty years old, suffered from blood lin. Blood clots blocked urination, requiring effort to pass, accompanied by severe pain. The urine floated with oil on top, sticking viscously to the bottom of the container, indicating blood lin combined with gao lin (a type of dysuria characterized by cloudy urine resembling rice water or fat). Previously treated by 35 physicians over a year with no effect, he was extremely emaciated. Upon my examination, his pulse was wiry and thin, slightly rapid. His skin was rough like fish scales all over, and the protruding parts of his foot bones had flesh and skin forming spiral ridges over one inch high, very painful to touch. He had been bedridden for half a year. Detailed inquiry revealed the cause: after a fit of anger, he fell into water on a cold autumn night. I determined that his anger-induced Fire was constrained by external Cold, stagnating in the Lower Jiao without dispersing, compounded by prior lack of conservation in sexual activity. I intended to prescribe this formula, but due to the wiry pulse, I replaced the Dioscoreae Rhizoma with Baiziren (Biota Seed, 24g, stir-fried and crushed), as it benefits the Liver well. Just as the prescription was finalized, his father presented dozens of previous prescriptions for comparison. I said, "No need to examine closely; the only herbs common to other formulas and mine are Ejiao and Shaoyao." He confirmed this. When asked how I knew, I replied, "My formulas are carefully crafted independently, hence different from others." After three doses, blood lin resolved, and gao lin decreased. Switching to my Gao Lin Tang (Decoction for Gao Lin), taken for over twenty doses, gao lin also resolved, but frequent and painful urination persisted. Inquiry revealed constant lower abdominal pain and bearing-down sensation, with urgency preventing retention, indicating concurrent qi lin (dysuria with Qi stagnation symptoms). Prescribing my Qi Lin Tang, ten doses resulted in complete recovery. The ichthyosis-like skin condition disappeared, and the spiral ridges on the feet vanished.
Most cases of hematuria are due to heat; however, those due to Cold cannot use this formula. I once treated a man in his thirties who suddenly developed hematuria. His pulse was weak and slow, and he felt intense cold in the Lower Jiao. I diagnosed Spleen Qi deficiency failing to control blood, combined with deficient Mingmen Fire lacking suction power, leading to Kidney failure to secure, causing blood to escape with urine. I prescribed Si Jun Zi Tang (Four Gentlemen Decoction) with Shu Di Huang (Prepared Rehmannia Root), Wu Tou (Aconite Lateral Root), and Fu Zi (Prepared Aconite Root). After over twenty doses, he recovered. There are also cases neither hot nor cold, but due to Spleen deficiency failing to control blood, resulting in hematuria. Medical texts refer to this as "failure in urination," caused by Taiyin Spleen failing to ascend. Si Jun Zi Tang should still be used, assisted by Longgu and Muli.
Bloody stool is generally due to rupture of intestinal capillaries or blood vessels. The astringent properties of Longgu and Muli in the formula can originally help repair ruptures. Ejiao is removed to prevent lubricating the Large Intestine. Longyanrou is added because some cases involve Spleen deficiency failing to control blood, so Longyanrou tonifies the Spleen. If deficiency is severe, heavy doses of Bai Zhu (Atractylodis Macrocephalae Rhizoma) should be used, or supplemented with Ren Shen (Ginseng Radix) and Huang Qi (Astragali Radix). If deficiency is accompanied by sinking Qi, Chai Hu (Bupleuri Radix) and Sheng Ma (Cimicifugae Rhizoma) should be added. If deficiency is accompanied by Cold, Gan Jiang (Zingiberis Rhizoma) and Fu Zi should be added, while reducing Shaoyao and Baitouweng. A young woman suffered from bloody stool for over a month with no response to previous treatments. I prescribed Li Xue Tang (Blood-Regulating Decoction), removing Ejiao and adding Longyanrou (15g). The local pharmacy lacked Baitouweng, so she took one dose temporarily, showing slight improvement. The next day, she obtained the full prescription elsewhere and took it, resulting in complete cure. This demonstrates the magnificent efficacy of Baitouweng!
Appendix:
Letter from Zhang XX of Tangshan, Zhili:
Zhang XX, aged 28, developed gao lin in early winter, followed by blood lin. Excretions included blood strips and clots, later fresh blood, with frequent urination and penile pain. Treated repeatedly by doctors, the condition worsened. His complexion was dark blue-black, six pulses were firm and rapid, especially the Liver pulse. Given Li Xue Tang, taken for three consecutive doses, bleeding stopped, pulse normalized slightly, but other symptoms remained. Subsequently treated with modified formulas for lin turbidity, fully recovered after over ten doses.