Hematuria

Hematuria

The bladder and the blood chamber coexist, and when heat enters the blood chamber, blood accumulates; when heat stagnates in the bladder, hematuria occurs. Urine is primarily a water-related disease, yet it can also affect the blood aspect due to its proximity to the blood chamber, hence the interconnectedness. The causes of this condition can be divided into internal and external factors.

External factors include heat from the Tai Yang and Yang Ming meridians accumulating in the lower jiao. Symptoms include chills and fever, thirst, abdominal distension, difficulty urinating, and painful hematuria. In such cases, Zhong Jing's Tao Ren Cheng Qi Tang is recommended, and Xiao Chai Hu Tang with peach kernels, dan pi, and niu xi can also be used.

Internal factors involve residual heat from the Heart Meridian affecting the small intestine (1) and residual heat from the Liver Meridian affecting the blood chamber (2). Symptoms include frequent urination with pain, and difficulty urinating drop by drop, known as "red dribbling." Treatment should focus on clearing heat. For residual heat from the Heart Meridian, symptoms may include restlessness, insomnia, drowsiness, sore throat, or palpitations and anxiety; in such cases, Dao Chi Yin with fried gardenia, forsythia, dan pi, and niu xi is recommended. For residual heat from the Liver Meridian, symptoms may include lower abdominal distension, stabbing pain in the ribs, bitter taste in the mouth, hearing loss, or alternating chills and fever; in such cases, Long Dan Xie Gan Tang with peach kernels, dan pi, niu xi, and yu jin is recommended.

For cases of hematuria that do not improve with treatment targeting the heart and liver, one should also treat the lungs. The lungs are the primary source of water; when the metal element is clear, the water is clear, and when the water is stable, the blood is stable. Since this condition originates from a water-related disease that affects the blood, treating the water is equivalent to treating the blood. Ren Shen Xie Fei Tang, omitting da huang and adding ku shen, can be used for treatment, as can Qing Zao Jiu Fei Tang with lotus root nodes and pu huang.

All of the above conditions involving heat accumulation result in dripping urine, which is the actual manifestation of hematuria. There are also cases of deficiency, where fresh blood flows continuously without any obstruction, but in such cases, one should clear heat and nourish deficiency, while also using hemostatic drugs, without the need for additional diuretics. This is because the anterior genital area has two openings: one for water, and one for the blood chamber. For women, the blood chamber serves as the gateway for pregnancy, while for men, it serves as the pathway for ejaculation. Therefore, blood from the female blood chamber can leak out through this route, and blood from the male blood chamber can also escape through it. Thus, cases of hematuria due to deficiency are no different from cases of uterine bleeding in women, and should be treated with modifications to Si Wu Tang. For those with liver stagnation, add dan pi, fried gardenia, bupleurum, e jiao, and mustard ash; for those with heart-blood deficiency and excess fire, add huang lian, e jiao, and xue yu; for those with spleen deficiency and cold that cannot contain blood, with cold limbs, weak pulse, and dull complexion, add fish bladder, astragalus, ginseng, mugwort, black ginger, licorice, and five flavors for treatment; for those whose kidneys are damaged by overwork, add deer glue, sea cucumber, and hair ash powder for treatment. Additionally, for those with lung deficiency who cannot control the downward flow of qi, resulting in post-urination bleeding, if it is due to lung yin deficiency, one should also address qi rebellion, phlegm cough, and thirst, and use Ren Shen Qing Fei Tang for treatment. If it is due to lung yang deficiency, one will inevitably experience cold feet and drinking-induced wheezing, and Gan Cao Gan Jiang Tang can be used for treatment.

[Note] (1) Residual heat from the Heart Meridian affecting the small intestine: refers to the pathological changes caused by heart fire affecting the small intestine. The heart and small intestine are mutually related; excessive heart fire can lead to sores in the mouth and tongue, reddish and bitter urine, and other symptoms. (2) Residual heat from the Liver Meridian affecting the blood chamber: the liver governs the Chong and Ren channels, which originate from the blood chamber, so the liver can transfer heat to the blood chamber.

[Commentary] This condition is divided into two categories: deficiency and excess. Excess cases are further divided into external and internal injuries. External injuries refer to the condition described in the Treatise on Cold Damage where heat stagnates in the bladder, treated with Tao Ren Cheng Qi Tang. Internal injuries include residual heat from the Heart Meridian affecting the small intestine and residual heat from the Liver Meridian affecting the blood chamber; the former is treated with Dao Chi San, while the latter is treated with Long Dan Xie Gan Tang. The author regards men's hematuria and women's uterine bleeding as the same phenomenon, therefore proposing the use of modified Si Wu Tang for treating deficient hematuria. For cases of deficiency accompanied by liver stagnation, Xiao Yao San is recommended; for cases of deficiency accompanied by blood deficiency and excess fire, Huang Lian E Jiao Tang is recommended. This discussion is largely based on clinical practice, and the principles, formulas, and medications proposed are all worthy of consideration, but the author's argument that "uterine bleeding and hematuria have the same origin" still requires further examination.