薛立斋治一妇人。小便血。因怒气寒热。或头痛。或胁胀。用加味逍遥散。诸证稍愈。
惟头痛。此阳气虚。用补中益气加蔓荆子而痊。后郁怒。小腹内 痛。次日尿痛热甚。仍用
加味逍遥散加龙胆草。并归脾汤。将愈。因饮食所伤。血仍作。彻夜不寐。怔忡不宁。此胆
血尚虚。用前汤而愈。
一妇人尿血。久用寒凉止血药。面色萎黄。肢体倦怠。饮食不甘。晡热作渴。三年矣。
此前药复伤脾胃。元气下陷而不能摄血也。盖病久郁结伤脾。用补中益气以补元气。用归脾
汤以解脾郁。使血归经。更用加味逍遥以调养肝血。不月。诸证渐愈。三月而痊。
震按内经谓胞移热于膀胱则溺血。故溺血证属热者多。实热则脉洪数有力。宜导赤散加
栀、芩、淡竹叶、鲜小蓟。调滑石末。冲生藕汁。虚热则脉洪数无力。宜生地、归、芍、栀
芩、牛膝、麦冬、黄连等。调发灰。或茅根汁。若夏月有感暑热者。六一散加黄连、生地
若少年有血虚挟瘀者。阿胶、三七二味多服。若阻塞不通。并可加冬葵子、生蒲黄以化之
若多怒人有肝家郁火者。龙胆泻肝汤。甚则当归龙荟丸。惟久而不止则为虚。归脾、补中
益气酌用。或老年及久病患。始虽热证。久变虚寒。并可用八味地黄丸、四味鹿茸丸等方。
然用至此种药小愈仍复发者。多不救。予选二案。又恐人止狃于属热治法。故取立斋以疗庸
浅之通病。
薛立斋治疗一位妇人，出现小便出血的症状。起因是愤怒导致寒热交替，有时头痛，有时胁肋胀满。使用加味逍遥散后，各种症状稍有好转。
唯独头痛未愈，这是因为阳气虚弱，于是使用补中益气汤加入蔓荆子，最终痊愈。后来因郁怒，小腹内部疼痛，第二天排尿时疼痛剧烈且发热严重。仍然使用加味逍遥散加入龙胆草，并配合归脾汤服用，病情即将好转。又因饮食不当受损，出血再次发作，整夜无法入睡，心悸不安。这是胆血依然虚弱，使用前方的汤剂而痊愈。
另一位妇人尿血，长期服用寒凉止血药物，面色萎黄，肢体倦怠，饮食无味，下午发热口渴，病程已达三年。
这是由于之前的药物反复损伤脾胃，元气下陷而不能统摄血液所致。因为病程长久，郁结伤及脾脏，使用补中益气汤来补益元气，使用归脾汤来疏解脾郁，使血液回归经脉。再使用加味逍遥散来调养肝血，不到一个月，各种症状逐渐好转，三个月后痊愈。
俞震按语：《内经》说胞宫的热邪转移至膀胱就会导致溺血（小便出血）。所以溺血证属于热证的居多。实热证则脉象洪大、数且有力，适宜用导赤散加入栀子、黄芩、淡竹叶、鲜小蓟，调服滑石末，冲入生藕汁。虚热证则脉象洪大、数但无力，适宜用地黄、当归、白芍、栀子、黄芩、牛膝、麦冬、黄连等药，调服血余炭粉，或者茅根汁。如果是夏季感受暑热者，可用六一散加入黄连、地黄。如果是少年有血虚兼挟瘀血者，可多服阿胶、三七两味药。如果阻塞不通畅，还可以加入冬葵子、生蒲黄以化瘀。如果是易怒之人有肝脏郁火者，用龙胆泻肝汤；严重时用当归龙荟丸。只有病程长久不止的才属于虚证，酌情选用归脾汤、补中益气汤。或者是老年人及久病患者，起初虽是热证，日久变为虚寒，也可使用八味地黄丸、四味鹿茸丸等方剂。
然而，用到这类药物后稍微好转又复发的，大多难以救治。我选取了这两个医案，又是担心人们只拘泥于属热证的治疗方法，所以选取薛立斋的案例来疗治庸医浅见形成的通病。
Xue Lizhai treated a woman presenting with hematuria (blood in urine). The condition arose from anger causing alternating chills and fever, accompanied by occasional headache or distension of the hypochondrium. After administering Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder), her symptoms improved slightly.
However, the headache persisted, which was attributed to deficiency of Yang Qi. She was then prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Manjingzi (Bupleuri Radix or similar herb for head/eye issues), resulting in a cure. Later, due to pent-up anger, she experienced pain inside the lower abdomen. The next day, urination was painful with intense heat. He again used Jiawei Xiaoyao San with added Longdancao (Gentianae Radix), combined with Guipi Tang (Restore the Spleen Decoction). As the condition was nearing resolution, dietary injury caused the bleeding to recur, leading to insomnia all night and palpitations with restlessness. This indicated that Gallbladder Blood was still deficient; using the aforementioned decoction led to recovery.
Another woman suffered from hematuria. Having long used cold-natured hemostatic drugs, she presented with sallow complexion, limb fatigue, poor appetite, afternoon tidal fever with thirst, a condition persisting for three years.
This was because previous medications repeatedly damaged the Spleen and Stomach, causing Yuan Qi (Primary Qi) to sink and fail to control the blood. Since prolonged illness and stagnation had injured the Spleen, he used Buzhong Yiqi Tang to tonify Primary Qi, and Guipi Tang to resolve Spleen stagnation, guiding the blood back into its vessels. Additionally, Jiawei Xiaoyao San was used to nourish Liver Blood. Within less than a month, her symptoms gradually improved, and she recovered after three months.
Yu Zhen commented: The *Neijing* states that if heat transfers from the Bao (uterus/bladder area) to the Bladder, it results in hematuria. Therefore, most cases of hematuria belong to Heat patterns. For Excess Heat, the pulse is surging, rapid, and forceful; Daichi San (Child's Guide Powder) is appropriate, added with Zhizi (Gardeniae Fructus), Huangqin (Scutellariae Radix), Danzhuye (Lophatheri Herba), and Xian Xiaoji (Cirsii Herba), mixed with Huashi powder (Talcum), and flushed with fresh Oujiang juice (Lotus Root Juice). For Deficient Heat, the pulse is surging and rapid but weak; Shengdi (Rehmanniae Radix), Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix), Zhizi, Huangqin, Niuxi (Achyranthis Bidentatae Radix), Maidong (Ophiopogonis Radix), and Huanglian (Coptidis Rhizoma) are suitable, mixed with Faxie (Hair Charcoal) or Maogen juice (Imperatae Rhizoma Juice). If contracted during summer due to Summer-Heat, Liuyi San (Six-to-One Powder) with Huanglian and Shengdi can be used. For youths with Blood deficiency complicated by stasis, Ejiao (Donkey-hide Gelatin) and Sanqi (Notoginseng Radix) should be taken frequently. If there is obstruction and blockage, Dongkuizi (Malvae Semen) and Sheng Puhuang (Typhae Pollen) can be added to transform the stasis. For individuals prone to anger with Liver Fire stagnation, Longdan Xiegan Tang (Gentian Liver-Draining Decoction) is indicated; in severe cases, Danggui Longhui Wan (Angelica Dragon-Gall Tablet) may be used. Only when the condition persists for a long time does it become a Deficiency pattern, where Guipi Tang or Buzhong Yiqi Tang should be selected according to circumstances. For elderly patients or those with chronic illnesses, although initially presenting as Heat, it may transform into Cold-Deficiency over time; Bajwei Dihuang Wan (Eight-Ingredient Rehmannia Pill) or Siwei Lurong Wan (Four-Ingredient Deer Antler Pill) can be used.
However, if such medicines provide only slight improvement followed by recurrence, the prognosis is generally poor. I selected these two cases to caution against the common tendency to exclusively treat based on Heat patterns, thereby illustrating how Xue Lizhai addressed the superficial errors often made by mediocre practitioners.