经云。胞移热于膀胱。则癃溺血。可知溺血之由。无不本诸热者。多欲之人。肾阴亏损。下
焦结热。血随溺出。脉必洪数无力。治当壮水以制阳光。六味加生牛膝。溺血不止。牛膝一味煎
膏。不时服之。有气虚不能摄血者。玉屑膏最妙。方用人参、黄 等分为末。以白莱菔切片蜜炙。
不时蘸末食之。岂非虚火宜补宜缓之意欤。然痛属火盛。则谓之血淋。不痛属虚。谓之溲血。二
者不可不辨。溲血。先与导赤散加桂、苓作汤。若服药不效。此属阴虚。五苓散加胶、艾。下四
味鹿茸丸。小便自利后有血数点者。五苓散加桃仁、赤芍。暴病脉滑实者。加大黄、滑石、甘草、
延胡索下之。溲血日久。元神大虚而挟虚热。所下如砂石而色红。有如石淋之痛。神砂妙香散加
泽泻、肉桂。病久滑脱者。去黄 、山药、桔梗、木香。加 飞龙骨、益智仁。即王荆公妙香散。
虚寒。以此汤吞四味鹿茸丸。老人溲血。多是阴虚。亦有过服助阳药而致者。多难治。惟大剂六
味丸加紫菀茸作汤服之。咳而溲血脱形。脉小劲而搏。逆也。溲血日久。形枯
六味加五味子作汤。另用肉桂末三钱。飞罗面糊。分三丸。用煎药调下。甫入喉。其血顿止。少
顷。口鼻去血块数枚而愈。自此数年之患。绝不再发。
《黄帝内经》中说：胞宫的热邪转移至膀胱，就会导致小便不通或尿血。由此可知，尿血的成因，没有不是由于热邪引起的。纵欲过度的人，肾阴亏损，下焦积聚热邪，血液随着尿液排出。脉象必定洪大、数急但按之无力。治疗应当滋补肾水以制约亢盛的阳火，用六味地黄丸加生牛膝。如果尿血不止，单用牛膝一味煎煮成膏剂，随时服用。有因气虚不能统摄血液的，玉屑膏最为巧妙。方用人参、黄芪等分为末，将白莱菔（萝卜）切片后用蜜炙烤，随时蘸取药粉食用。这难道不是体现对虚火宜补益宜缓和的意思吗？然而疼痛属于火盛，称为血淋；不疼痛属于虚证，称为溲血。这两者不可不加以辨别。对于溲血，先给予导赤散加肉桂、茯苓煎汤服用。如果服药无效，这属于阴虚，用五苓散加阿胶、艾叶，或者服用下四味鹿茸丸。小便通畅后排出几点血液的，用五苓散加桃仁、赤芍。突发疾病且脉象滑实有力的，加大黄、滑石、甘草、延胡索攻下。尿血日久，元神极度虚弱且夹杂虚热，排出的血液像砂石一样颜色红，伴有像石淋那样的疼痛，用神砂妙香散加泽泻、肉桂。病程长久导致滑脱不禁的，去掉黄芪、山药、桔梗、木香，加入飞龙骨、益智仁。这就是王荆公的妙香散。如果是虚寒证，以此汤送服下四味鹿茸丸。老年人尿血，多是阴虚，也有因为过服助阳药物导致的，大多难以治疗。只有用大剂量六味地黄丸加紫菀茸煎汤服用。咳嗽并尿血导致形体消瘦，脉象细小强劲而搏指，这是逆证。尿血日久，形体枯槁，用六味地黄丸加五味子煎汤。另外用肉桂末三钱，飞罗面糊制成三丸，用煎好的药液调服。刚入口，出血立刻停止。过了一会儿，口鼻排出几枚血块而痊愈。从此几年的病患，绝不再发作。
The *Classic of Medicine* (Huangdi Neijing) states: "When heat from the bladder organ (Baopao) shifts to the urinary bladder, it results in strangury or hematuria." From this, it can be inferred that the etiology of hematuria is invariably rooted in heat. Individuals with excessive sexual desire often suffer from kidney yin deficiency, leading to heat accumulation in the lower jiao, causing blood to exit with urine. The pulse will necessarily be large (Hong), rapid (Shu), yet powerless upon pressure. Treatment should focus on nourishing water (kidney yin) to control hyperactive yang fire, using Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) added with raw Achyranthis Bidentatae Radix (Niuxi). If hematuria persists, a decoction paste made solely from Achyranthis Bidentatae Radix (Niuxi) should be taken intermittently. In cases where qi deficiency fails to contain the blood, Yuexie Gao (Jade Dust Paste) is most effective. This formula consists of Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi) ground into equal parts of powder. Slices of white Raphanus sativus (Laifu) are honey-roasted and dipped into the powder for consumption. Does this not reflect the principle that deficient fire requires tonification and gentle treatment? However, pain indicates excessive fire, termed blood strangury (Xuelin); absence of pain indicates deficiency, termed hematuria (Souxue). These two must be distinguished. For hematuria, initially administer Daochi San (Guide Out the Red Powder) with Cinnamomi Ramulus (Gui) and Poria (Ling) as a decoction. If ineffective, this belongs to yin deficiency; use Wuling San (Five-Ingredient Powder for Water Metabolism) plus Cornu Asini Colla (Ejiao) and Folium Artemisiae Argyi (Aiyi), or take Xi Siwei Lurong Wan (Four-Ingredient Deer Antler Pill). If only a few drops of blood appear after urination flows freely, use Wuling San plus Persicae Semen (Taoren) and Paeoniae Rubra Radix (Chishao). In acute onset with slippery and excess pulses, use Rheum Radix et Rhizoma (Dahuang), Talcum (Huashi), Glycyrrhizae Radix et Rhizoma (Gancao), and Corydalis Rhizoma (Yanhusuo) to purge. For chronic hematuria with severe depletion of primordial spirit accompanied by deficient heat, where excreted blood resembles red sandstones and causes pain similar to calculus strangury, use Shensha Miaoxiang San plus Alisma Rhizoma (Zexie) and Cinnamomi Cortex (Rougui). For long-standing cases with slipping and incontinence, remove Astragali Radix (Huangqi), Dioscoreae Rhizoma (Shanyao), Platycodonis Radix (Jiegeng), and Aucklandiae Radix (Muxiang); add Calcitrum (Fei Longgu) and Alpiniae Oxyphyllae Fructus (Yizhiren). This is Wang Jinggong's Miaoxiang San. For deficiency-cold patterns, swallow Xi Siwei Lurong Wan with this decoction. Elderly patients with hematuria mostly suffer from yin deficiency, or sometimes from overconsumption of yang-tonifying drugs; these are difficult to treat. Only large doses of Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) with Asteli Herba (Ziwanrong) as a decoction are suitable. Coughing with hematuria leading to emaciation, with a small, forceful, and pounding pulse, is an adverse sign. For chronic hematuria with withered physique, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) plus Schisandrae Fructus (Wuweizi) as a decoction. Separately, prepare three pills using 3 qian of Cinnamomi Cortex (Rougui) powder bound with fine wheat flour paste. Take these pills down with the decoction. Upon entering the throat, bleeding stops immediately. Shortly after, several blood clots are expelled from the mouth and nose, resulting in cure. Thus, a condition lasting several years never recurs.