bubble_chart Concept

The semen appears red when mixed with blood. Zhubing Yuanhou Lun It is said that "the kidney stores essence, and essence is formed from blood. Deficiency fatigue leads to the seven damages and six extremes, both qi and blood are impaired, the kidney is particularly deficient, unable to store essence, hence both essence and blood are discharged."

bubble_chart Pattern Analysis

1. Yin Deficiency︰The semen appears bright red, with a sensation of heaviness and distension in the genital area, or pain in the penis, emaciation, soreness in the waist and weakness in the knees, physical fatigue and mental fatigue, or dry mouth, irritability and heat, a red tongue with scant coating, and a thin, rapid, and weak pulse. The clinical manifestation of hematospermia is often caused by excessive sexual activity, prolonged consumption of pungent and drying tonifying yang substances that stir fire, or withholding ejaculation, leading to excessive ministerial fire. This excessive heat disturbs the semen chamber (mingmen), damaging essence and consuming blood. Therefore, in addition to the symptoms of hematospermia, the condition is also accompanied by soreness in the waist, mental fatigue, irritability and heat, dry mouth, a red tongue, and a thin, rapid pulse—symptoms indicative of yin deficiency with effulgent fire. Treatment should focus on nourishing yin and reducing fire, supplemented with blood-regulating and hemostatic herbs such as Sanqi, charred human hair, Typha, amber, and Donkey-hide Gelatin. For mild cases, Anemarrhena, Phelloendron and Rehmannia Pill or Angelica Six Yellows Decoction with modifications can be used. For severe cases, Major Yin-Tonifying Pill with modifications is recommended.
2. Dampness-heat in Lower Energizer︰The semen appears red or dark, accompanied by lumbago, frequent urination, itching or pain in the penis, or pulling pain in the genital area, dark urine, constipation, a yellow tongue coating, and a slippery or wiry-rapid pulse. This condition is caused by dampness-heat accumulating in the lower energizer, disturbing the semen chamber (mingmen), leading to the discharge of both semen and blood. Clinically, it must present with dampness-heat symptoms such as a distending and pulling pain in the perineum, frequent and dark urine, pain and itching in the urethra, a yellow tongue coating, and a wiry-rapid pulse. The treatment should focus on clearing heat and draining dampness, supplemented with blood-regulating herbs. The prescription used is the Prostatitis Decoction with modifications.
3. Traumatic Blood Stasis︰The pain in the genital area is severe, and the semen appears dark red or contains blood clots. It should be treated as an excess pattern, primarily focusing on invigorating blood and resolving stasis. The prescription used is Peach Kernel, Carthamus and Four-Ingredient Decoction with modifications.

Hemospermia often occurs concurrently with symptoms such as seminal emission and hematuria, mostly presenting as a deficiency pattern, with yin deficiency with effulgent fire being the most common. In cases of hemospermia due to dampness-heat accumulation in the lower energizer, prolonged illness often manifests with signs of yin deficiency, hence yin-enriching medications are frequently used. Prolonged illness can also lead to static blood, so blood-regulating and hemostatic drugs should be adjusted according to the syndrome.

bubble_chart Documentation

1. "Shicai Sanshu: Chi Bai Zhuo": "It has been observed that when the reproduction-stimulating essence has not arrived, and one forcefully engages in excessive sexual activity, the semen that is ejaculated is followed by blood."
2. "Zabing Xinfa Yaojue": "If semen continues to be discharged without stopping, and priapism does not subside, it is called priapism. This condition is caused by excessive consumption of aphrodisiacs or excessive indulgence in lust. If not treated urgently, over time the essence will be exhausted, priapism will not resolve, and blood will be forced out, leading to continuous pain, emaciation, and death. If death does not occur immediately, it will inevitably lead to consumptive thirst and large abscesses."