bubble_chart Concept

Pregnancy hematuria refers to the symptom of blood in the urine during pregnancy.

Hematuria and blood stranguria both involve blood in the urine, but they are distinguished by the presence or absence of pain. As mentioned in Zabing Yuanliu Xizhu, "The distinction lies in whether there is pain or not. If there is pain, it is blood stranguria; if there is slight pain, it is hematuria." Although hematuria may occasionally be accompanied by a slight sense of distending pain, it is not as severe as the dripping, astringent pain of blood stranguria, which is unbearable. This condition and vaginal bleeding during pregnancy are both painless bleeding, but vaginal bleeding during pregnancy involves bleeding from the vagina and occurs frequently, while hematuria involves bleeding from the urethra and is only seen during urination. In clinical diagnosis, it is important to clearly identify the source of the bleeding and whether there is astringent pain during urination to provide a basis for differentiation.

bubble_chart Pattern Analysis

1. Exuberance of Heart Fire︰During pregnancy, there is blood in the urine, which is bright red in color. Symptoms include irritability, thirst, restless sleep, mouth and tongue sores, and hot, reddish urine. The tongue tip is red, with a thin yellow coating, and the pulse is thin and rapid. This is often due to pre-existing insufficiency of heart yin, leading to hyperactivity of heart fire. After conception, yin blood gathers to nourish the fetus and cannot ascend to the heart, resulting in exuberance of heart fire, which descends to the small intestine and seeps into the bladder. The heat disturbs the blood aspect, forcing blood to overflow. The key points of diagnosis are: blood in the urine, bright red in color, accompanied by symptoms of exuberance of heart fire (such as irritability, thirst, restless sleep, red tongue tip, and thin, rapid pulse) and heat transferring to the small intestine (such as hot, reddish urine and mouth and tongue sores). Treatment should focus on clearing the heart and reducing fire, cooling the blood and stopping bleeding. The commonly used formula is Redness-Removing Powder.
2. Yin Deficiency︰Pregnancy hematuria. Dizziness, blurred vision, tinnitus, sore waist and weak legs, mental fatigue. Tongue texture tender red, no coating, pulse manifestation thin and rapid, both chi pulses weak. Mostly due to kidney yin deficiency, water failing to nourish fire, frenetic stirring of ministerial fire, heat scorching the vessels, leading to blood in urine. The diagnostic characteristics: yin deficiency with fire hyperactivity often accompanied by kidney yin depletion, ministerial fire hyperactivity, disturbing the seven orifices (such as dizziness, tinnitus, sore waist and weak legs, mental fatigue, tongue texture tender red and no coating, etc.). Treatment should focus on enriching yin, clearing heat, and stopping bleeding. The prescription is Zhi Bai Rehmannia Decoction minus moutan bark, plus lotus rhizome node and powdered amber.
3. Deficiency-heat of Liver Meridian︰Pregnancy with hematuria. Restlessness and thirst, alternating chills and fever, distending pain in the chest, flanks, and breasts, irritability and easy anger, mental depression, poor appetite, sighing. The tongue texture is normal or pale red, and the pulse is wiry, thin, and weak. This is due to constitutional blood deficiency, compounded by anger stirring fire, disturbing the blood aspect, and forcing blood to recklessly move, seeping into the bladder and causing hematuria. The key diagnostic features: there must be signs of liver depression and qi stagnation (such as distending pain in the chest, flanks, and breasts, irritability and easy anger, mental depression, sighing, poor appetite, etc.). The treatment should focus on nourishing blood and pacifying the liver, soothing stagnation to stop bleeding. The recommended formula is Peony and Gardenia Peripatetic Powder, taken in combination with Six-Ingredient Rehmannia Pill.

The condition of pregnancy hematuria is generally caused by heat disturbing the blood aspect, forcing blood to overflow and exit through the bladder. However, the heat can vary between deficiency and excess. An exuberance of heart fire is considered an excess pattern, while yin deficiency with fire agitation and deficiency heat in the liver channel are classified as deficiency pattern. The clinical presentations vary, and it is crucial to carefully differentiate based on tongue texture and pulse manifestations. In cases of exuberant heart fire, the tongue texture is often red, especially at the tip, and is frequently accompanied by oral ulcers, with a fine and rapid but forceful pulse. In cases of yin deficiency with fire agitation, the tongue is red and tender, often without coating or with a patchy coating, and the pulse is fine and rapid but weak at both chi positions. In cases of deficiency heat in the liver channel, the tongue texture is normal or pale red, and the pulse is wiry, fine, and weak, which can aid in differentiation.

bubble_chart Documentation

1. 《Annotated Furen Liangfang．Pregnancy Diseases Section》: Pregnancy hematuria, "For those caused by overwork and fire, it is appropriate to use Middle-Tonifying Qi-Replenishing Decoction. If caused by excessive consumption of rich food leading to heat accumulation, it is appropriate to use Modified Stomach-Clearing Powder."