bubble_chart Concept

Hematuria refers to the presence of blood in the urine, causing the urine color to appear light red, bright red, or dark red, and sometimes even mixed with blood clots.

This condition is referred to as "nì xuè" (溺血) or "sōu xuè" (溲血) in Suwen, while Jingui Yaolue calls it "hematuria."

The concept of hematuria is different from that of blood stranguria. Hematuria is often painless or may only involve grade I distending pain and a burning sensation; blood stranguria, on the other hand, is characterized by dripping, astringent, and unbearable pain during urination. In Danxi Xinfa{|108|}, it is stated: "Painful cases are referred to as strangury, while painless cases are referred to as hematuria," which is a key point in distinguishing the two conditions.

bubble_chart Pattern Analysis

1. Bladder Dampness-heat︰Short and hesitant urination with blood, bright red or dark red in color, sometimes mixed with blood clots, accompanied by urethral stabbing pain or a burning sensation, lower abdominal distension and fullness with discomfort, occasional fever, bitter taste in the mouth, dry throat, red tongue with thin yellow or thin greasy coating, rapid pulse. This is often caused by exposure to external dampness-heat pathogens or excessive consumption of rich and greasy foods, leading to the production of dampness-heat. The dampness pathogen combined with heat accumulates in the bladder, disrupting qi transformation, resulting in lower abdominal distension and fullness with a burning sensation in the urethra, while systemic accompanying symptoms are relatively mild. Treatment involves clearing heat and promoting diuresis, cooling blood and stopping bleeding, using the formula Small Thistle Decoction.
2. Liver-gallbladder Dampness-heat︰Short reddish urine with leukorrhea, accompanied by fever, bitter taste in the mouth, thirst without desire to drink, reduced appetite, abdominal distension and fullness, nausea with a tendency to vomit, pain in the hypochondriac region, or yellowing of the body and eyes, red edges of the tongue, yellow and greasy coating, and wiry rapid pulse. This is often due to excessive liver-gallbladder dampness-heat, which descends to the bladder, resulting in fever, bitter taste in the mouth, nausea with a tendency to vomit, pain in the hypochondriac region, and more severe systemic symptoms. The treatment involves draining the liver and clearing the gallbladder, {|###|}cooling blood and stopping bleeding{|###|}, using Gentian Liver-Draining Decoction with appropriate additions of hemostatic agents.
3. Exuberance of Heart Fire︰Blood in urine, deep red with a burning sensation, flushed face, dry throat, mouth and tongue sores, thirst with preference for cold drinks, internal heat and restlessness, insomnia, tongue texture {|###|}red and crimson{|###|}, yellow coating, pulse {|###|}full and rapid{|###|}. Often caused by excessive mental strain, leading to hyperactivity of heart fire, which transfers heat to the small intestine, scorching the vessels and resulting in red urine. Commonly accompanied by irritability, insomnia, and mouth sores. Treatment should focus on {|###|}clearing the heart and reducing fire{|###|}, cooling the nutritive level, and stopping bleeding. The recommended formula is Redness-Removing Powder with modifications.
4. Kidney Yin Deficiency︰Blood in urine is bright red, accompanied by dizziness, tinnitus, dry throat, flushed cheeks, night sweats, steaming bone fever (tidal fever), listlessness, restlessness, insomnia, dry stool, a red tongue with scant coating, and a thin, rapid pulse. This is mostly due to yin deficiency and frenetic stirring of ministerial fire, which scorches the vessels, resulting in bright or pale red urine. The distinguishing features include frequent dizziness, tinnitus, and steaming bone fever (tidal fever). Treatment should focus on enriching yin, benefiting the kidneys, and calming collaterals to stop bleeding. The recommended formula is Anemarrhena, Phellodendron, and Rehmannia Pill with modifications.
5. Spleen-kidney Qi Deficiency︰Hematuria with pale red color, complexion shallow yellow, mental fatigue, limb weariness, shortness of breath, lack of strength, dizziness, tinnitus, reduced appetite, loose stool, soreness and weakness of the waist and legs, pale tongue with thin white coating, soggy and slow pulse. This belongs to the syndrome of yang qi deficiency and decline, mostly caused by the spleen failing to control blood and the kidney failing to store essence, hence manifesting as frequent urination with clear and profuse urine, and the blood color often appearing pale red. Clinically, it can be differentiated by combining the accompanying symptoms of spleen and kidney deficiency. The treatment should focus on strengthening the spleen and tonifying the kidney, tonifying qi and securing astringency. The recommended formulas are Middle-Tonifying Qi-Replenishing Decoction combined with Incomparable Chinese Yam Pill, with the addition of hemostatic agents as appropriate.

Additionally, there is static blood obstructing the bladder, where blood does not follow its normal pathways, leading to hematuria. The characteristics include dark purple blood, often accompanied by blood clots, difficulty in urination, grade I stabbing pain, turbid urine, and symptoms of static blood. Treatment should differentiate between blood stasis caused by injury, qi deficiency and blood stasis, or cold-induced blood stasis, and employ methods such as invigorating blood and resolving stasis. Clinically, the color of hematuria is quite helpful in differential diagnosis. For example, dark red or bright red urine often indicates excess heat, pale red urine usually suggests qi deficiency, bright red urine accompanied by steaming bone fever and fatigue often points to deficiency heat, and dark purple urine indicates blood stasis.

bubble_chart Documentation

1. Leizheng Zhicai．Hematuria: "If lung-kidney yin deficiency, dry mouth and sore waist, Six-Ingredient Pill combined with Pulse-Reinforcing Powder. If small intestine fire is excessive, blood seeps into the bladder, Redness-Removing Powder. If liver fire pulse is surging, unable to store blood, Gentian Decoction with modifications. If gallbladder fire causes hematuria, headache and vertigo, Angelica Powder. If hematuria persists for a long time, kidney fluid is depleted, Six-Ingredient Donkey-hide Gelatin Drink..."
2. Xiezheng Lun．Hematuria: "One internal cause is heart channel heat transferring to the small intestine, liver channel heat transferring to the blood chamber... To treat liver channel heat transfer, symptoms include slight abdominal distension and fullness, hypochondriac region stabbing pain, bitter taste in mouth, deafness, or alternating chills and fever, Gentian Liver-Draining Decoction with Peach Kernel, Moutan Bark, Achyranthes Root, and Curcuma Root is appropriate."
3. "Therefore, the deficiency pattern of hematuria is no different from that of menorrhagia and metrostaxis in women, and should be treated with Four Ingredients Decoction with modifications... There is also lung deficiency, unable to control the lower part, leading to blood seeping after urination. If it is lung yin deficiency, then it is accompanied by qi counterflow, phlegm cough, thirst, etc., Ginseng Lung-Clearing Decoction is the main treatment. If lung yin deficiency cannot control the lower part, there must be symptoms of enuresis, cold feet, water-drinking, wheezing, and cough, Liquorice and Dried Ginger Decoction is used to treat it."