痛者为血淋。不痛者为溺血。血淋别见淋门。经云∶悲哀太甚则胞络绝，胞络
绝则阳气内动，发则心下崩，数溲血也。又云∶胞移热于膀胱则癃、溺血，是溺血
未有不本于热者。陈无择以为心肾气结所致，曾不思圣人之言简意博，举一而可十
者也。血虽主于心，其四脏孰无血以为养，所尿之血，岂拘于心肾气结者哉。若此
类推之，则五脏凡有损伤妄行之血，皆得如心下崩者渗于胞中，五脏之热，皆得如
膀胱之移热传于下焦。何以言之？肺金者，肾水之母，谓之连脏，况恃之通调水道
下输膀胱者也。肺有损伤妄行之血，若气逆上者，既为呕血矣。气不逆者如之何？
不从水道下降入于胞中耶，其热亦直抵肾与膀胱可知也。脾土者，胜水之贼邪
也，水精不布则壅成湿热，湿热必陷下，伤于水道，肾与膀胱俱受其害，害则阴络伤，
伤则血散入胞中矣。肝属阳，主生化，主疏泄，主纳血。肾属阴血，闭脏而不固，
必渗入胞中。正与《内经》所谓伤肝血枯症，时时前后血者类也。大抵溲血、淋血、
便血三者，虽以前后阴所出之窍血有不同，然于受病则一也。故治分标本亦一也。
其散血止血之药，无越于数十品之间，惟引导佐使、各走其乡者少异耳。先与生料
五苓散和四物汤，若服药不效，其人素病于色者，此属虚证。宜五苓散和胶艾汤，
吞鹿茸丸。或八味地黄丸，或鹿角胶丸，或辰砂妙香散和五苓散，吞二项丸子。若
小便自清，后有数点血者，五苓散加赤芍药一钱。亦有如砂石而色红，却无石淋之痛，
亦属虚证。宜五苓散和胶艾汤，或五苓散和辰砂妙香散，吞鹿茸丸、八味丸、鹿角
胶丸。干胶炙捣末，酒和服。鹿角胶尤妙。每服一二两。发灰二钱，茅根、车前草
煎汤调下。当归四两，酒三升，煮取一升，顿服。镜面草自然汁，加生蜜一匙服之。
以八正散加麦门冬、葱煎服。小便涩痛，药内调海金砂末。夏枯草烧灰存性为末，
米饮或凉水调下。车前草自然汁数合，空心服。实者，可以调胃承气汤加当归下之。
《脉经》云∶尺脉滑，气血实，妇人经脉不利，男子尿血，宜服朴硝煎、大黄汤，下
去经血，针关元泻之。
咳而且溲血，脱形，其脉小劲，是逆也。咳，溲血，形肉脱，脉搏，是逆也。
疼痛的为血淋。不疼痛的称为溺血（尿血）。血淋在淋证门类中另有论述。医经记载：悲哀过度会导致胞络阻滞，胞络阻滞则阳气在内妄动，发作时会出现心下出血，并频繁出现尿血的症状。又说：胞中的热邪转移至膀胱，会导致小便不通或尿血，由此可见，尿血没有不是以热邪为根本原因的。陈无择认为是心肾之气郁结所致，却未曾思考圣人的言语简练而意蕴深远，举一例可推知十例的道理。血液虽然由心所主，但其他四脏哪一脏没有血液来滋养呢？排出的血液，难道仅仅局限于心肾气结的情况吗？以此类推，五脏凡是因损伤导致血液妄行的情况，都会像心下出血那样渗入胞中；五脏的热邪，也都会像膀胱移热那样传导至下焦。为什么这样说呢？肺属金，是肾水之母，被称为“连脏”，况且肺还负责通调水道，将津液向下输送到膀胱。如果肺有损伤导致血液妄行，若气机上逆，就会表现为呕血。若气机不逆，那会怎样呢？难道不会顺着水道下降进入胞中吗？其热邪也会直接抵达肾脏和膀胱，这是显而易见的。脾属土，是克制水的邪气，若水精不能布散，则会壅滞形成湿热，湿热必然下陷，损伤水道，肾脏和膀胱都会受到损害，受损后阴络受伤，血液便会散入胞中。肝属阳，主管生化、疏泄和收纳血液。肾属阴血，若闭藏功能不固，血液必会渗入胞中。这与《内经》所说的伤肝血枯症，时常大小便出血的情况类似。大抵来说，尿血、淋血、便血这三种病，虽然从前阴和后阴排出的途径不同，但它们致病的原因是一致的。因此，治疗时区分标本的原则也是一致的。那些散血止血的药物，不过几十种而已，只是引导药、佐使药各走其经络略有差异罢了。先用生料五苓散配合四物汤，如果服药无效，且此人平素房事过度，这属于虚证。适宜用五苓散配合胶艾汤，吞服鹿茸丸。或者使用八味地黄丸，或者鹿角胶丸，或者辰砂妙香散配合五苓散，吞服上述两种丸剂。如果小便原本清澈，后来有几滴血，可在五苓散中加入一钱赤芍药。也有排出物如砂石般红色，却没有石淋的疼痛，这也属于虚证。适宜用五苓散配合胶艾汤，或者五苓散配合辰砂妙香散，吞服鹿茸丸、八味丸、鹿角胶丸。阿胶干炙烤捣成粉末，用酒调和服用。鹿角胶尤其好。每次服用一两到二两。发灰二钱，茅根、车前草煎汤送服。当归四两，酒三升，煮取一升，一次性服下。镜面草的自然汁，加一勺生蜜服用。用八正散加入麦门冬、葱白煎服。如果小便涩痛，在药内调入海金沙粉末。夏枯草烧灰存性研末，用米饮或凉水调服。车前草自然汁数合，空腹服用。实证者，可以用调胃承气汤加入当归攻下。《脉经》记载：尺脉滑，气血实盛，妇女月经不畅，男子尿血，适宜服用朴硝煎、大黄汤，攻下瘀血，针刺关元穴泻之。咳嗽且尿血，形体消瘦，脉象小而强劲，这是逆证（预后不良）。咳嗽，尿血，肌肉消瘦，脉搏盛大，这也是逆证。
Those with pain are classified as *xuelin* (blood strangury). Those without pain are termed *niaoxue* (hematuria). *Xuelin* is discussed separately in the section on strangury. The classics state: "Excessive sorrow causes the pericardium collaterals to be obstructed; obstruction of the pericardium collaterals leads to internal movement of yang qi, resulting in bleeding from below the heart and frequent hematuria." It also states: "Heat transferring from the uterus/bladder to the bladder causes urinary retention or hematuria." Thus, hematuria invariably originates from heat. Chen Wuyue attributed it to the stagnation of heart and kidney qi, failing to realize that the words of the sages are concise yet profound, where one example can illustrate ten. Although blood is primarily governed by the Heart, which of the other four Zang organs does not rely on blood for nourishment? Is the blood expelled in urine restricted only to cases of heart-kidney qi stagnation? By analogy, any blood from the five Zang organs that flows recklessly due to injury will seep into the bladder like bleeding from below the heart; similarly, heat from the five Zang organs will transmit to the Lower Jiao like heat transferring to the bladder. Why is this so? Lung Metal is the mother of Kidney Water, referred to as the "connected organ," and furthermore, the Lung regulates water passages, directing fluids downward to the Bladder. If lung injury causes reckless blood flow, upward rebellious Qi results in hematemesis. What if Qi does not rebel? Would it not descend via the water passages into the bladder? Its heat would undoubtedly reach the Kidneys and Bladder directly. Spleen Earth is the controlling element over Water; if water essence fails to distribute, damp-heat accumulates. Damp-heat sinks downward, damaging the water passages, harming both the Kidneys and Bladder. Damage to the Yin collaterals causes blood to scatter into the bladder. The Liver belongs to Yang, governing metabolism, free flow, and storing blood. The Kidney belongs to Yin Blood; if its closing function is insecure, blood inevitably seeps into the bladder. This aligns with the *Neijing*'s description of liver-injury blood depletion, where bleeding occurs frequently from both anterior and posterior orifices. Generally, hematuria, bloody strangury, and bloody stool differ only in the exit orifice (anterior vs. posterior), but their pathological origins are identical. Therefore, the treatment principle of distinguishing root and branch remains the same. Hemostatic and blood-resolving herbs number no more than a few dozen; the difference lies merely in the guiding and assistant herbs targeting specific meridians. Initially, use raw *Wuling San* combined with *Sini Tang*. If ineffective, and the patient has a history of sexual excess, this indicates deficiency. Use *Wuling San* combined with *Jiao'ai Tang*, swallowing *Lurong Wan*. Alternatively, use *Bawei Dihuang Wan*, *Luji Jiao Wan*, or *Chensha Miaoxiang San* combined with *Wuling San*, swallowing two types of pills. If urine is clear initially followed by a few drops of blood, add one qian of *Chishao Yao* to *Wuling San*. Discharge resembling red gravel without the pain of stone strangury also indicates deficiency. Use *Wuling San* combined with *Jiaoai Tang*, or *Wuling San* combined with *Chensha Miaoxiang San*, swallowing *Lurong Wan*, *Bawei Wan*, or *Luji Jiao Wan*. Dry gelatin roasted and powdered, taken with wine. *Luji Jiao* is particularly effective; take 1–2 liang per dose. Two qian of hair ash, administered with decoction of *Maogen* and *Cheqian Cao*. Four liang of *Danggui* boiled in three sheng of wine to yield one sheng, taken at once. Natural juice of *Jingmiancao* with one spoonful of raw honey. Decoct *Bazheng San* with *Mendong* and scallion. For painful, difficult urination, mix in powder of *Haijinsha*. Powder of calcined *Xiakucao* mixed with rice drink or cold water. Several he of natural *Cheqiancao* juice taken on an empty stomach. In excess patterns, purge using *Tiaowei Chengqi Tang* added with *Danggui*. The *Maijing* states: "Slippery pulse at the Chi position indicates excess Qi and Blood; irregular menstruation in women and hematuria in men should be treated with *Piaoxiao Jian* or *Dahuang Tang* to purge menstrual blood, followed by needle therapy at *Guanyuan* with reducing method." Cough with hematuria, emaciation, and a small, forceful pulse indicate adverse prognosis. Cough, hematuria, muscle wasting, and a surging pulse also indicate adverse prognosis.