凡溺血证，其所出之由有三，盖从溺孔出者二，从精孔出者一也。
一、溺孔之血，其来近者，出自膀胱。其证溺时必孔道涩痛，小水红赤不利，此多以酒
色欲念致动下焦之火而然。常见相火妄动，逆而不通者，微则淋浊，甚则见血。经曰∶胞移
热于膀胱，则癃而溺血，即此证也。治宜清利膀胱之火，以生地、芍药、牛膝、山栀、黄柏
、知母、龙胆草、瞿麦、木通、泽泻等剂，或七正散、大厘清饮、五淋散之属，皆所宜也。
一、溺孔之血，其来远者，出自小肠。其证则溺孔不痛而血随溺出，或痛隐于脐腹，或
热见于脏腑。盖小肠与心为表里，此丙火气化之源，清浊所由以分也。故无论焦心劳力，或
浓味酒浆，而上中二焦五志口腹之火，凡从清道以降者，必皆由小肠以达膀胱也。治须随证
察因，以清脏腑致火之源，宜于寒阵中择方用之。
一、精道之血，必自精宫血海而出于命门。盖肾者主水，受五脏六腑之精而藏之，故凡
劳伤五脏，或五志之火致令冲任动血者，多从精道而出。然何以辨之？但病在小肠者，必从
溺出；病在命门者，必从精出。凡于小腹下精泄处觉有酸痛而出者，即是命门之病，而
治之之法亦与水道者不同。盖水道之血宜利，精道之血不宜利；涩痛不通者亦宜利，血滑不
痛者不宜利也。若果三焦火盛者，惟宜清火凉血为主，以生地、芍药、丹皮、地骨、茜根、
栀子、槐花及芩、连、知、柏之类主之，或约阴丸、约阴煎俱可用。若肾阴不足而精血不固
者，宜养阴养血为主，以左归饮，或人参固本丸之类主之。若肾虚不禁，或病久精血滑泄者
，宜固涩为主，以秘元煎、苓术菟丝丸、金樱膏、玉锁丹、金锁思仙丹之类主之。或续断乌
梅之属，亦所宜用。若心气不定，精神外驰，以致水火相残，精血失守者，宜养心安神为主
，以人参丸、天王补心丹、王荆公妙香散之类主之。若脾肺气虚下陷，不能摄血而下者，宜
归脾汤、人参养营汤、补中益气汤、举元煎之类主之。
一、血从精道出者，是即血淋之属，多因房劳以致阴虚火动，营血妄行而然。凡血出命
门而涩痛者为血淋；不痛者为溺血。好色者，必属虚也。
凡溺血证，其所出之由有三，盖从溺孔出者二，从精孔出者一也。
凡是溺血（尿中带血）的病症，其出血的来源有三种，大概是从尿道口出来的有两种，从精道出来的有一种。
一、溺孔之血，其来近者，出自膀胱。其证溺时必孔道涩痛，小水红赤不利，此多以酒色欲念致动下焦之火而然。常见相火妄动，逆而不通者，微则淋浊，甚则见血。经曰∶胞移热于膀胱，则癃而溺血，即此证也。治宜清利膀胱之火，以生地、芍药、牛膝、山栀、黄柏、知母、龙胆草、瞿麦、木通、泽泻等剂，或七正散、大厘清饮、五淋散之属，皆所宜也。
第一种，从尿道口出的血，来源较近的，出自膀胱。其症状是排尿时尿道涩痛，小便红赤且不通畅，这多是因为饮酒、房事或欲望念头导致下焦之火妄动而引起的。常见的情况是相火（寄居于肝肾之火）妄动，气机逆乱而不通畅，轻微的表现是淋证、尿浊，严重的则出现尿血。《内经》说：热邪传入膀胱，就会导致小便淋漓不畅甚至尿血，就是这种病症。治疗应当清利膀胱之火，使用生地黄、白芍、怀牛膝、山栀子、黄柏、知母、龙胆草、瞿麦、木通、泽泻等药物组成的方剂，或者七正散、大厘清饮、五淋散这类方子，都是适宜的。
一、溺孔之血，其来远者，出自小肠。其证则溺孔不痛而血随溺出，或痛隐于脐腹，或热见于脏腑。盖小肠与心为表里，此丙火气化之源，清浊所由以分也。故无论焦心劳力，或浓味酒浆，而上中二焦五志口腹之火，凡从清道以降者，必皆由小肠以达膀胱也。治须随证察因，以清脏腑致火之源，宜于寒阵中择方用之。
第二种，从尿道口出的血，来源较远的，出自小肠。其症状是尿道口不疼痛，但血液随着尿液排出，或者疼痛隐蔽在肚脐腹部，或者热象表现在脏腑。因为小肠与心互为表里，这是丙火（小肠之火）气化的源头，也是清浊分离的地方。所以无论是思虑过度劳累，还是食用浓厚滋味和酒类，导致上焦和中焦的五志之火及饮食之火，凡是沿着清道（消化道）下降的，必定都会经过小肠到达膀胱。治疗必须根据症状考察病因，清除导致脏腑生火的根源，适宜在寒凉性质的方剂中选择使用。
一、精道之血，必自精宫血海而出于命门。盖肾者主水，受五脏六腑之精而藏之，故凡劳伤五脏，或五志之火致令冲任动血者，多从精道而出。然何以辨之？但病在小肠者，必从溺出；病在命门者，必从精出。凡于小腹下精泄处觉有酸痛而出者，即是命门之病，而治之之法亦与水道者不同。盖水道之血宜利，精道之血不宜利；涩痛不通者亦宜利，血滑不痛者不宜利也。若果三焦火盛者，惟宜清火凉血为主，以生地、芍药、丹皮、地骨、茜根、栀子、槐花及芩、连、知、柏之类主之，或约阴丸、约阴煎俱可用。若肾阴不足而精血不固者，宜养阴养血为主，以左归饮，或人参固本丸之类主之。若肾虚不禁，或病久精血滑泄者，宜固涩为主，以秘元煎、苓术菟丝丸、金樱膏、玉锁丹、金锁思仙丹之类主之。或续断乌梅之属，亦所宜用。若心气不定，精神外驰，以致水火相残，精血失守者，宜养心安神为主，以人参丸、天王补心丹、王荆公妙香散之类主之。若脾肺气虚下陷，不能摄血而下者，宜归脾汤、人参养营汤、补中益气汤、举元煎之类主之。
第三种，从精道出的血，必然从精宫、血海出于命门。因为肾主水，接受并贮藏五脏六腑的精气，所以凡是劳损伤及五脏，或者五志之火导致冲脉、任脉动血的，大多从精道而出。那么如何辨别呢？如果病在小肠，必定从尿道排出；如果病在命门，必定从精道排出。凡是感到小腹下方精液排泄处有酸痛感而后出血的，就是命门的病，治疗方法也与水道（尿道）的不同。大概来说，水道中的血适宜用利尿法，精道中的血不适宜用利尿法；尿道涩痛不通畅的适宜利尿，血液滑利不痛的就不适宜利尿。如果确实是三焦火盛，只适宜以清火凉血为主，使用生地黄、白芍、牡丹皮、地骨皮、茜草根、栀子、槐花以及黄芩、黄连、知母、黄柏之类的药物为主，或者约阴丸、约阴煎都可以使用。如果是肾阴不足导致精血不稳固的，适宜以滋养阴血为主，使用左归饮，或者人参固本丸之类的方子。如果是肾虚不能固摄，或者病程长久导致精血滑脱泄出的，适宜以固涩为主，使用秘元煎、苓术菟丝丸、金樱膏、玉锁丹、金锁思仙丹之类的方子。或者续断、乌梅这类药物，也适宜使用。如果是心气不安，精神外越，导致水火相争，精血失守的，适宜以养心安神为主，使用人参丸、天王补心丹、王荆公妙香散之类的方子。如果是脾肺气虚下陷，不能统摄血液而导致下行的，适宜使用归脾汤、人参养营汤、补中益气汤、举元煎之类的方子。
一、血从精道出者，是即血淋之属，多因房劳以致阴虚火动，营血妄行而然。凡血出命门而涩痛者为血淋；不痛者为溺血。好色者，必属虚也。
第四种，血液从精道排出的，属于血淋（排尿涩痛且有血）的范畴，多因为房事过度导致阴虚火旺，营血妄行所致。凡是血液从命门出来且伴有尿道涩痛的称为血淋；不疼痛的称为溺血。喜好色欲的人，必定属于虚证。
For all cases of hematuria (blood in urine), there are three sources of bleeding: two originate from the urethral orifice, and one originates from the seminal duct.
First, blood from the urethral orifice that comes from a nearby source originates from the Bladder. The symptoms include涩痛 (astringent pain) and obstruction during urination, with red and dark urine that is difficult to pass. This is mostly caused by the stirring up of Fire in the Lower Jiao due to alcohol consumption, sexual indulgence, or lustful thoughts. It is commonly seen that when Ministerial Fire (Xiang Huo, fire residing in the Liver and Kidney) moves recklessly, causing Qi mechanism to reverse and become obstructed, mild cases present as strangury (Lin syndrome) or turbid urine, while severe cases manifest as hematuria. The Classics state: "When heat transfers from the uterus/bladder to the Bladder, it causes difficulty in urination and hematuria," which refers to this condition. Treatment should focus on clearing and draining Bladder Fire, using formulas containing Sheng Di Huang (Rehmanniae Radix), Bai Shao (Paeoniae Radix Alba), Niu Xi (Achyranthis Bidentatae Radix), Shan Zhi Zi (Gardeniae Fructus), Huang Bo (Phellodendri Cortex), Zhi Mu (Anemarrhenae Rhizoma), Long Dan Cao (Gentianae Radix), Qu Mai (Dianthi Herba), Mu Tong (Akebiae Caulis), Ze Xie (Alismatis Rhizoma), etc., or formulas such as Qi Zheng San, Da Li Qing Yin, or Wu Lin San, all of which are appropriate.
Second, blood from the urethral orifice that comes from a distant source originates from the Small Intestine. The symptoms include no pain at the urethral orifice, but blood follows the urine; or pain is hidden in the umbilical/abdominal region, or heat signs appear in the Zang-Fu organs. Since the Small Intestine and Heart are exterior-interiorly related, this is the source of Bing Fire (Small Intestine Fire) for Qi transformation, where clear and turbid substances are separated. Therefore, whether due to mental anxiety and overwork, or rich flavors and alcoholic beverages, leading to Fire from the Five Emotions or dietary intake in the Upper and Middle Jiao, any heat descending through the clear pathways (digestive tract) must pass through the Small Intestine to reach the Bladder. Treatment requires examining the cause according to the symptoms and clearing the source of Fire in the Zang-Fu organs; it is suitable to select formulas from cold-natured categories.
Third, blood from the seminal duct necessarily exits from the Jing Gong (Essence Palace) and Xue Hai (Sea of Blood) via the Ming Men (Gate of Life). The Kidney governs Water and receives and stores the essence of the Five Zang and Six Fu organs. Thus, whenever the Five Zang are injured by overwork, or Fire from the Five Emotions causes movement of blood in the Chong and Ren vessels, bleeding often occurs from the seminal duct. How then to distinguish? If the disease is in the Small Intestine, blood must exit via urine; if the disease is in the Ming Men, blood must exit via semen. If there is a sensation of soreness and pain at the lower abdomen where semen is discharged, followed by bleeding, it is a disease of the Ming Men, and the treatment method differs from that of the water pathway. Generally, blood in the water pathway is suitable for diuretic treatment, whereas blood in the seminal duct is not suitable for diuretics; cases with astringent pain and obstruction are suitable for diuretics, while cases with slippery blood and no pain are not. If there is indeed excessive Fire in the Three Jiao, treatment should primarily focus on clearing Fire and cooling Blood, using Sheng Di Huang, Bai Shao, Mu Dan Pi (Moutan Cortex), Di Gu Pi (Lycii Cortex), Qian Gen (Rubiae Radix et Rhizoma), Zhi Zi, Huai Hua (Sophorae Flos), along with Huang Qin (Scutellariae Radix), Lian Zi (Coptidis Rhizoma), Zhi Mu, and Huang Bo, or formulas such as Yue Yin Wan or Yue Yin Jian can be used. If Kidney Yin is insufficient and Essence-Blood is not secure, treatment should primarily nourish Yin and Blood, using Zuo Gui Yin or Ren Shen Gu Ben Wan. If Kidney Deficiency leads to incontinence, or prolonged illness results in slipping and leaking of Essence-Blood, treatment should primarily focus on astringency, using Mi Yuan Jian, Ling Zhu Tu Si Wan, Jin Ying Gao, Yu Suo Dan, or Jin Suo Si Xian Dan. Herbs such as Xu Duan (Dipsaci Radix) and Wu Mei (Mume Fructus) are also appropriate. If Heart Qi is unstable and Spirit wanders outward, causing Water and Fire to harm each other and losing control of Essence-Blood, treatment should primarily nourish the Heart and calm the Spirit, using Ren Shen Wan, Tian Wang Bu Xin Dan, or Wang Jing Gong Miao Xiang San. If Spleen and Lung Qi are deficient and sinking, unable to hold blood and prevent it from descending, formulas such as Gui Pi Tang, Ren Shen Yang Ying Tang, Bu Zhong Yi Qi Tang, or Ju Yuan Jian should be used.
Fourth, blood exiting from the seminal duct belongs to the category of Bloody Strangury (Xue Lin), mostly caused by sexual overwork leading to Yin deficiency and Fire hyperactivity, resulting in reckless movement of Ying Blood. When blood exits from the Ming Men accompanied by astringent pain, it is called Bloody Strangury; when there is no pain, it is called Hematuria. Those who indulge in lust invariably suffer from Deficiency patterns.