Dysuria is characterized by difficult urination with discharge of scanty urine or even anuresis. Dizziness, chest oppression, dyspnea, nausea, vomiting, edema or even convulsion and coma may appear in serious cases. Retention of urine and anuria occurring in cases of nervous anuresis, vesical spincterismus, stone, tumor, injury or stenosis of the urethra, senile prostatomegaly, myelitis and uremia in modern medicine may be differentiated and treated with the principles mentioned in this section

Etiology and Pathogenesis

A fluent discharge of urine depends upon the normal functioning of triple jiao which is maintained by the lungs, spleen and kidneys and is related to the liver. hence, the etiology and pathogenesis of dysuria can be summarized as follows:

 A. Retention of dampness-heat: Dampness-heat originating from a constitutional predomination or pungent and greasy diet attacks the bladder, causing dysfunction of the bladder.

B. Accumulation of lung-heat: Heat of exogenous and endogenous origin may accumulate in the lungs and render them incapable of distributing the body fluids to the bladder. Moreover, lung-heat may attack the bladder leading to dysfunction of the bladder.

C. Failure of spleen-qi to ascend: Overstrain, Anxiety, immoderate diet and drinking and debility may weaken the spleen, so that clear qi fails to ascend and turbid yin fails to descend.

D. Exhaustion of kidney-yang: Congenital insufficiency, overstrain, again and longstanding illness may lead to deficiency of kidney-yang and disclination of life-gate fire and then to the dysfunction of the bladder. A prolonged attack by dampness-heat on the lower jiao may cause consumption of kidney-yin, which also affects the function of kidney-yang.

E. Stagnation of liver-qi: Emotional upsets leading to the stagnation of liver-qi may interfere with the function of the triple jiao and cause the obstruction of water passages.

F. Blockage of the urethra: Blood stasis, tumor or stones may obstruct or can press the urethra and impede the discharge of urine.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

(a) Differentiation between asthenia and sthenia syndromes.

(1) Asthenia-syndrome: Characterized by a a small amount or even absence of urine in the bladder, insidious onset, spiritlessness, shortness of breath, pale complexion, strengthless urination, pale tongue, keep and weak pulse, and usually caused by the failure of spleen-qi to ascend and deficiency of kidney-yuan.

(2) Sthenia-syndrome: Marked by a large amount of urine retained in the bladder, sudden onset, distending pain in the lower abdomen, burning sensation during urination, oliguria with reddish urine, yellow or yellow greasy tongue coating, wiry and rapid or uneven pulse, and usually resulting from retention of dampness-heat, accumulation of lung-heat, stagnation of liver-qi or obstruction of the urethra.

(b) Determination of the prognosis: A case initiated with difficult urination developing into anuresis indicates a deteriorated state, and the prognosis is favorable when a case of anuresis becomes dysuric. Distending pain of lower abdomen, chest oppression, dyspnea and vomiting are symptoms denoting a serious situation, and coma, convulsion and coldness of limbs are the critical signs of dysuria.

B. Therapeutic Principles

According to the principle of "an opening status is essential for the fu-organs," dredging water passages and promoting diuresis are the main therapeutic principles for dysuria.

(a) Syndrome differentiation is necessary before the therapy is adopted. For asthenia-syndrome, tonifying the spleen and kidneys are releasing inhibited bladder-qi should be applied. For sthenia-syndrome, clearing away dampness-heat, eliminating blood stasis and activating qi circulation should be employed.

(b) The etiology, location and nature of the disease should be considered in the treatment, and indiscriminate use of diuretics is inadvisable. For example, in cases due to limited fluid intake, excessive loss of body fluids or consumption of yin by heat, yin-tonifying therapy should be adopted, and diuretic therapy is unnecessary.

(c) For acute cases, symptomatic treatment should be adopted first or combined with causative treatment. For chronic cases, the causative treatment is essential, and the symptomatic treatment may be used with it if necessary.

(d) In cases of marked retention of urine which fails to respond to medication, acupuncture, massage and catheterization should be employed to induce the discharge of urine.

Classification and Treatment

A. Retention of dampness-heat in the bladder

Manifestations: Anuresis or oliguria with reddish urine, burning sensation during urination, fullness of lower abdomen, bitter taste and sticky feeling in the mouth, thirst without desire for drink, constipation, red tongue with yellow greasy coating and rapid pulse.

Therapeutic principles: Clear away heat and dampness, and promote diuresis.

Prescription: The Modified Powder for Dispersing Heat and Promoting Urination

Herba Polygoni Avicularis 10 g
Herba Dianthi 10 g
Talcum 10 g
Rhizoma Atractylodis 10 g
Cortex Phellodendri 10 g
Fructus Gardeniae 10 g
Caulis Akebiae 9 g
Semen Plantaginis (wrapped in cloth) 10 g
Pericarpium Arecae 10 g
Radix et Rhizoma Rhei (decocted later) 3-6 g

Remarks: For cases with dryness of mouth and throat, hectic fever, night sweating, feverish sensation over the palms, soles and chest and red tongue with little coating or yellow greasy coating at its root due to longstanding retention of dampness-heat leading to impairment of kidney-yin, use the Modified Pill of Tonify Kidneys and Dredging the Water Passages which contains Radix Rehmanniae, Rhizoma Anemarrhenae, Cortex Phellodendri, Semen Plantaginis, Radix Achyranthis Bidentatae and Cortex Lycii Radicis to clear away dampness-heat and support the function of qi. For cases with retention of dampness-heat, dysfunction of qi and attack of turbid-toxin, manifested as anuresis, fatigue, anorexia, chest upset, nausea, vomiting, ammonia smell in the mouth or even convulsions and coma, use the Modified Coptidis Decoction for Warming Gallbladder made from Rhizoma Coptidis, Poria, Rhizoma Pinelliae, Exocarpium Citri Grandis, Fructus Aurantii Immaturus, Caulis Bambusae in Taeniam, Semen Plantaginis and Caulis Akebiae to regulate the stomach, lower the turbid substance, clear away heat and eliminate dampness.

B. Hyperactivity of heat in the lungs

Manifestations: Dysuria, anuresis or oliguria with reddish urine, cough, dryness of throat, thirst with desire for drinking, dyspnea, thin yellow tongue coating and rapid pulse.

Therapeutic principles: Clear away lung-heat and dredge the water pathways.

Prescription: The Modification of Clearing Away Heat-Evil in the Lungs

Cortex Mori Radicis 12 g
Radix Scutellariae 10 g
Fructus Gardeniae 10 g
Caulis Akebiae 9 g
Semen Plantaginis 10 g
Poria 12 g
Radix Platycodi 10 g
Herba Lophatheri 10 g

Remarks: For cases with red and dry tongue due to impairment of yin-fluid by heat, add Radix Adenophorae Strictae and Radix Ophiopogonis to nourish lung-yin. For cases with nasal stuffiness, headache and floating pulse due to exogenous evils attacking the superficies, add Semen Armeniacae Amarum, Radix Peucedani, Herba Schizonepetae and Herba Menthae to release stagnated lung-qi and expel superficial evils.

C. Stagnation of liver-qi

Manifestations: Emotional depression or irritability, dysuria or anuresis, distension or pain over the abdomen and hypochondrium, red tongue with thin, yellow coating and wiry pulse.

Therapeutic principles: Activate qi circulation, benefit qi and promote diuresis.

Prescription: The Modification of Lignum Aquilariae Resinatum Powder

Rhizoma Cyperi 10 g
Radix Linderae 10 g
Pericarpium Citri Reticulatae 10 g
Pulvis Lignum Aquilariae Resinatum (mixed with
the decoction) 2 g
Folium Pyrrosiae 15 g
Talcum 10 g
Fructus Malvae Verticillatae 10 g
Radix Paeoniae Rubra 10 g
Radix Paeoniae Alba 10 g
Radix Glycyrrhizae (raw) 6 g
Semen Vaccariae 10 g

Remarks: For cases with stagnated qi changing into fire, manifested as irritability and red tongue with yellow coating, add Cortex Moutan Radicis, Fructus Gardeniae and Radix Gentianae to clear away liver-fire.

D. Obstruction of the urethra

Manifestations: Dysuria or anuresis, distending pain and fullness over the lower abdomen, dark purplish tongue with petechiae and uneven pulse.

Therapeutic principles: Eliminate blood stasis, disperse stagnation, and dredge water pathways.

Prescription: The Modification of Daididang Bolus

Radix Angelicae Sinensis (tail part) 10 g
Semen Persicae 10 g
Radix Achyranthis Bidentatae 12 g
Fructus Malvae Verticillatae 10 g
Herba Lysimachiae 15-30 g
Folium Pyrrosiae 5-30 g
Herba Lycopi 12 g
Radix et Rhizoma Rhei (decocted later) 30 g

Remarks: For cases with complete obstruction of the urethra and unendurable distending pain, take a small amount of Moschus, or add Lignum Aquilariae Resinatum to activate qi and blood circulation and relieve. pain. For cases with urinary stones, add Spora Lygodii, Herba Polygoni Avicularis, herba Dianthi and Endothelium Corneum Gigeriae Galli to promote diuresis and remove stones. For cases with hematuria, add Pulvis Succinum and Radix Notoginseng to activate blood circulation and stop bleeding.

E. Insufficiency of middle-jiao qi

Manifestations: Bearing-down sensation and distention over the lower abdomen, dysuria or oliguria, fatigue, shortness of breath, poor appetite, desire for defecation after bowel movement, loose stool, prolapse of rectum, pale tongue with thin coating and thready and weak pulse.

Therapeutic principles: Allow the clear substance to ascend and the turbid to descend, benefit qi, and promote diuresis.

Prescription: The Modification of Decoction for Strengthening Middle Jiao and Benefiting Qi and the Powder of Five Drugs Containing Poria

Radix Astragali 30 g
Rhizoma Atractylodis Macrocephalae 10 g
Radix Codonpsis Pilosulae 12 g
Poria 15 g
Ramulus Cinnamomi 6-10 g
Polyporus Umbellatus 10 g
Rhizoma Alismatis 12 g
Radix Angelicae Sinensis 10 g
Rhizoma Cimicifugae 3 g
Radix Bupleuri 3 g
Pericarpium Citri Reticulatae 10 g

Remarks: For cases with long-standing diarrhea and prolapse of rectum, add Fructus Aurantii to raise middle-jiao qi.

F. Exhaustion of kidney-yang

Manifestations: Dysuria or anuresis, strengthless urination, pale complexion, mental fatigue, coldness of limbs, soreness and weakness of lumbus and knees, pale tongue with white coating and deep and thready pulse with weak chi pulse.

Therapeutic principles: Warm yang, benefit qi, tonify the kidneys, and promote diuresis.

Prescription: The Modified Pill for Invigorating Kidney-Qi

Radix Rehmanniae Praeparata 12 g
Rhizoma Dioscoreae 12 g
Fructus Corni 10 g
Poria 15-30 g
Rhizoma Alismatis 12 g
Cortex Cinnamomi 3-5 g
Radix Aconiti Lateralis Praeparata 6-10 g
Radix Achyranthis Bidentatae 10 g
Semen Plantaginis 10 g

Remarks: For the aged with debility, spiritlessness and lumbago due to exhaustion of primordial-qi, add Radix Ginseng, Rhizoma Curculiginis and Herba Epimedii to invigorate primordial-qi and yang.

Experiential Prescriptions

A. Sneeze-inducing or emetic method: Sneezing and vomiting can open lung-qi, lift up middle-jiao qi and dredge lower-jiao qi and serve as a simple and effective measure for inducing diuresis. Sneezing may be induced by irritation of the nasal mucosa with a sterilized cotton stick or by nasal insufflation of 0.3-0.6 gram of Pulvis Spina Gleditsiae. Vomiting may be elicited by irritation of the throat with a cotton stick or a spatula.

B. External therapy:

(a) One piece of garlic and three pieces of Fructus Gareniae mixed with a small amount of salt; crushed to form a paste applied on umbilicus.

(b) Salt (250 g), heated by frying, wrapped with a piece of cloth; applied as a hot compress on the abdomen and umbilicus.

(c) Bulbus Allii Fistulosi (500 g), crushed and mixed with a small amount of Moschus; divided into two packages and applied as hot and cold compress alternately for 15 minutes of the umbilicus.

(d) Fructus Trichosanthis (30-60 g) prepared as decoction; applied as a sitz-bath for 20 minutes; this exerts an effect on lower lung-qi and dredges water pathways.

Copyright 1995 Hopkins Technology