Stranguria

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Stranguria

Stranguria is a syndrome characterized by frequent, difficult and painful discharge of urine accompanied by abdominal pain or lumbago. Clinically it is classified as stranguria of heat-type, stranguria associated with hematuria, stranguria due to disorder of qi, stranguria due to urinary stone, stranguria associated with chyluria and stranguria induced by overstrain.

The early case of stranguria can be cured by timely and proper treatment, but it may become chronic and intractable when the treatment is delayed or erroneous. Deficiency of yin, yang, qi and blood and dysfunction of viscera in the chronic case, and occurrence of edema, dyspneic cough, palpitations, nausea, vomiting and retention of urine signify a deterioration of the disease.

Cases of urinary infection, urinary stone, tuberculosis, tumor, prostatitis and chyluria in modern medicine with stranguria as the major symptoms may be differentiated and treated with the principles mentioned in this section.
Etiology and Pathogenesis

The cause of stranguria can be summarized into three categories: (a) Retention of dampness-heat in the bladder; the affection of exogenous origin may come from the external genitals or other organs such as heat (fire) and small intestine (heat), and that of endogenous origin may be due to improper diet or alcoholic indulgence, which leads to production of dampness-heat; (b) Deficiency of the spleen and kidney; commonly seen in the chronic case whose qi is consumed or the aged, the debilitated and the overstrained; (c) Stagnation of liver-qi, occurring after a rage with formation of fire which attacks the lower-jiao.

In sum, an incipient case of stranguria usually manifests itself as a sthenic syndrome, while chronic case as an asthenic syndrome. However, both syndromes may appear simultaneously when the evil still exists, and the health qi is already impaired. The organs chiefly involved are the kidneys and bladder, but the liver and spleen are also affected.
Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

(a) Differentiation of the type of stranguria, such has heat, stone, qi blood, chyle, overstrain, etc.

b) Differentiation between asthenia-syndrome and sthenia-syndrome: Generally speaking, stranguria due to retention of dampness-heat, stagnated liver-qi or stones and marked by burning and painful urination with discharge of turbid and red urine is usually attributed to sthenia-syndrome, while that due to deficiency of spleen and kidney marked by less severe dysuria and discharge of clear and light-colored urine to asthenia-syndrome.

(c) Identification of the primary and secondary syndromes: Since different types and syndromes of stranguria may be changeable or appear at the same time, the primary type and syndrome must be identified in order to establish a correct therapeutic principle.

(d) Differentiation between stranguria and retention of urine, hematuria and chyluria: Although both stranguria and retention of urine are characterized by difficult urination, the cases with stranguria often have frequent and painful urination, and their total volume of urine discharged daily is normal, while the cases with retention of urine have a painless micturition and a decreased urine excretion or even anuria. Hematuria and chyluria differ from stranguria complicated with the corresponding disorder by the absence of painful and slow discharge of urine.

B. Therapeutic principles

For sthenia-syndrome attributive to retention dampness-heat in the bladder, the therapy of clearing away heat and dampness should be adopted; for that attributive to impairment of collaterals by heat, the therapy of cooling blood and stopping bleeding should be applied; for that due to stones, the principles is to relieve stranguria and eliminating stones; for that attributive to stagnation of Qi, the therapy of activating Qi circulation should be employed. For asthenia-syndrome involving the spleen, the therapy of invigorating spleen and benefiting Qi is available; and for that involving the kidney, the therapy of tonifying and benefiting kidney should be used.
Classification and Treatment

A. Stranguria of heat type

Manifestations: Oliguria and burning painful urination with discharge of reddish urine, distending pain of lower abdomen, lumbago, fever and chilliness, bitter taste in the mouth, nausea, vomiting, constipation, yellow greasy tongue coating and floating, soft and rapid pulse.

Therapeutic principles: Clear away heat and dampness, and relieve stranguria.

Prescription: The Modified Powder for Dispersing Heat and Promoting Urination

Herba Dianthi 10 g
Herba Polygoni Avicularis 10 g
Semen Plantaginis (wrapped with cloth) 10 g
Caulis Akebiae 9 g
Fructus Gardeniae 10 g
Radix et Rhizoma Rhei 6 g
Six-to-One Powder 10 g
Radix Achyranthis Bidentatae 10 g

Remarks: For cases with impairment of yin by dampness-heat, appearing with dryness of mouth and throat and dry red tongue, omit Rhei, and add Radix Rehmanniae and Rhizoma Anemarrhenae to nourish yin and clear away heat.

B. Stranguria due to urinary stone

Manifestations: Discharge of stone in the urine, difficult, painful and interrupted urination, colicky pain over the lower abdomen and lumbus, discharge of dark or bloody urine, thin yellow tongue coating and wiry or wiry-rapid pulse. In longstanding cases, it may be accompanied by fatigue, dull pain over the lumbus, feverish sensation over the palms, soles and the chest, red tongue with little coating or with teeth marks on it margin and thready and rapid or weak pulse.

Therapeutic principles: Clear away dampness-heat, relieve stranguria, and remove the stone.

Prescription: The Modification of Pyrrosiae Powder

Folium Pyrrosiae 30 g
Fructus Malvae Verticillatae 12 g
Herba Dianthi 10 g
Talcum 10 g
Semen Plantaginis 10 g
Endothelium Corneum Gigeriae Galli 15-30 g
Spora Lygodii 12 g
Herba Lysimachiae

Remarks: For cases with abdominal and lumbar colics, add Radix Paeoniae Rubra, Radix Glycyrrhizae, Olibanum, Myrrha and Lignum Aquilariae Resinatum to activate blood and qi circulation and relive pain. For cases with hematuria, add Herba seu Radix Cirsii Japonici, Herba Cephalonoploris, Radix Rehmanniae, Radix Sanguisorbae and Rhizoma Imperatae to cool the blood and arrest bleeding. For cases with fever, add herba Taraxaci, Fructus Forsythiae and Cortex Phellodendri to clear away heat and toxic materials. Coexistence of sthenia and asthenia syndromes is usually seen in longstanding cases of urinary stone. For those with qi and blood deficiency as the predominant syndrome, add Eight Ingredients Decoction for Tonifying Qi and Blood to the above prescription. For cases with a predominant deficiency of kidney-yin, add Bolus of Six Drugs Containing Rehmanniae Praeprata, and add the Pill for Invigorating Kidney-Qi for those with a predominant deficiency of kidney-qi.

C. Stranguria due to disorder of qi

a) Sthenia-syndrome

Manifestations: Slow and painful urination, distending pain of lower abdomen, distension over the chest and hypochondrium, thin white tongue coating and deep and wiry pulse.

Therapeutic principles: Regulate qi and blood circulation, relieve stranguria, and promote diuresis.

Prescription: The Modification of Lignum Aquilariae Resinatum Powder

Radix Paeoniae Alba 10 g
Pericarpium Citri Reticulatae Viride 10 g
Pericarpium Citri Reticulatae 10 g
Radix Angelicae Sinensis 10 g
Radix Paeoniae Rubra 12 g
Pulvis Lignum Aquilariae Resinatum (mixed
with the decoction) 2-3 g
Radix Achyranthis Bidentatae 12 g
Talcum 10 g
Folium Pyrrosiae 30 g

Remarks: Add Radix Aucklandiae, Radix Linderae and Rhizoma Cyperi for cases with severe pain over the lower abdomen.

b) Asthenia-syndrome

Manifestations: Bearing-down distention and hollow pain of lower abdomen which can be relieved by pressure, frequent and difficult urination with discharge of clear urine, pale complexion, fatigue, loose stool, pale tongue and feeble and thready pulse.

Therapeutic principles: Strengthen middle jiao and benefit qi.

Prescription: The Modified Decoction for Strengthening Middle Jiao and Benefiting Qi

Radix Astragali 12 g
Radix Codonopsis Pilosulae 10 g
Rhizoma Atractylodis Macrocephalae 10 g
Radix Glycyrrhizae Praeparata 6 g
Radix Angelicae Sinensis 10 g
Pericarpium Citri Reticulatae 10 g
Radix Linderae 10 g
Cortex Eucommiae 10 g
Lignum Aquilariae Resinatum Pulvis (mixed with the decoction) 2-3 g

Remarks: For cases with dull pain and weakness of lumbus and knees, add Radix Achyranthis Bidentatae and fructus Lycii to tonify the kidneys.

D. Stranguria complicated with hematuria

(a) Sthenia-syndrome

Manifestations: Frequent, painful and urgent urination with discharge of hot and red urine containing blood clots, distending pain of lower abdomen, restlessness, yellow tongue coating and smooth and rapid pulse.

Therapeutic principles: Clear away heat, relieve stranguria, cool the blood, and stop bleeding.

Prescription: The Modification of Cephalanoploris Decoction and Powder for Treating Dark Urine

Radix Rehmanniae 30 g
Herba seu Radix Cirsii Japonici 30 g
Herba Cephalanoploris 30 g
Fructus Gardeniae 10 g
Nodus Nelumbinis Rhizomatis 15 g
Pollen Typhae (fried) 10 g
Talcum 10 g
Caulis Akebiae 6 g
Herba Lophatheri 10 g
Pulvis Succinum (mixed with the decoction) 3 g

(b) Asthenia-syndrome

Manifestations: Difficult and painful urination not too marked, discharge of reddish urine, soreness and weakness of limbs and knees, fatigue, red tongue with little coating and thready and rapid pulse.

Therapeutic principles: Tonify kidney-yin, clear away heat, and stop bleeding.

Prescription: The Modification of Bolus of Anemarrhenae, Phellodendri and Rehmanniae

Radix Rehmanniae 30 g
Poria 10 g
Fructus Corni 10 g
Cortex Moutan Radicis 10 g
Rhizoma Dioscoreae 10 g
Herba Ecliptae 30 g
Rhizoma Anemarrhenae 10 g
Cortex Phellodendri 10 g
Caumen Biotae 15 g
Herba Agrimoniae 10 g
Colla Corii Asini (dissolved in the decoction) 10 g

E. Stranguria complicated with chyluria

(a) Sthenia-syndrome

Manifestations: Discharge of turbid urine with thready sediment and containing a floating layer of oily substance or clots of blood, difficult and painful urination, dryness of mouth and throat, red tongue with yellow greasy coating and smooth and rapid pulse.

Therapeutic principles: Clear away heat and dampness, preserve the clear substance, and discharge the turbid substance.

Prescription: The Modification of Dioscoreae Hypoglaucae Decoction for Clearing Turbid Urine

Rhizoma Dioscoreae Hypoglaucae 24 g
Rhizoma Acori Graminei 10 g
Semen Plantaginis 10 g
Poria 15 g
Cortex Phellodendri 10 g
Fructus Gardeniae 10 g
Herba Lycopi 12 g
Rhizoma Atractylodis Macrocephalae 10 g

Remarks: For cases with hematuria, add Rhizoma Imperatae, Herba seu Radix Cirsii Japonici and Herba Cephalanoploris to cool the blood and arrest bleeding.

(b) Asthenia-syndrome

Manifestations: Longstanding and recurrent discharge of milky urine, emaciation, lumbago, weakness of knees, fatigue, dizziness, pale tongue with white greasy coating and deep and weak pulse.

Therapeutic principles: Strengthen the kidneys, and preserve essence.

Prescription: The Decoction for Treating Stranguria with Chyluria

Radix Rehmanniae Praeparata 10 g
Rhizoma Dioscoreae 10 g
Semen Euryales 12 g
Radix Codonopsis Pilosulae 10 g
Os Draconis Usta 30 g
Concha Ostreae Usta 30 g
Poria 12 g
Stamen Nelumbinis 10 g
Semen Cuscutae 10 g

F. Stranguria induced by overstrain

Manifestations: Intermittent stranguria with mild dysuria (which is aggravated or induced by overstrain), soreness and weakness of lumbus and knees, fatigue, pale tongue and thready and weak pulse.

Therapeutic principles: Tonify the spleen, and benefit the kidneys.

Prescription: Wubi Bolus of Dioscoreae

Rhizoma Dioscoreae 20 g
Radix Rehmanniae Praeparata 12 g
Fructus Schisandrae 10 g
Fructus Corni 10 g
Poria 10 g
Herba Cistanchis 15 g
Semen Cuscutae 10 g
Cortex Eucommiae 10 g
Rhizoma Alismatis 10 g
Radix Achyranthis Bidentatae 10 g
Fructus Alpiniae Oxyphyllae 10 g
Pericarpium Citri Reticulatae 10 g

Remarks: For cases with spleen deficiency and qi collapse manifested by a bearing-down distension of the lower abdomen and difficult urination, add the Decoction for Strengthening Middle Jiao and Benefiting Qi containing Radix Astragali, Rhizoma Atractylodis Macrocephalae, Rhizoma Cimicifugae and Radix Bupleuri to benefit qi and relive collapse. For cases with deficiency of kidney-yin manifested by flushed face, feverish sensation over palms, soles and the chest, red tongue and thready and rapid pulse, add the Bolus of Anemarrhenae, Phellodendri and Rehmanniae containing Radix Rehmanniae, Rhizoma Anemarrhenae and Phellodendri to nourish yin and suppress fire. For cases with deficiency of kidney-yang manifested by coldness of limbs and nocturia, add Yougui Bolus containing Cortex Cinnamomi, Radix Aconiti Lateralis Praeparata, Fructus Rubi and Pulvis Cornu Cervi to warm the kidneys and preserve the essence.

Experiential Prescriptions

A. Radix et Rhizoma Rhei (prepared with wine, 10 g), Spora Lygodii (10 g), Rhizoma Alismatis (10 g) and Succinum (6 g); prepared as powder and mixed with 30 ml of yellow rice wind and 5 pieces of egg white; taken as 2-3 doses daily for 4 days; applicable to all types of stranguria.

B. Radix Astragali (10 g), Radix Codonopsis Pilosulae (30 g), Radix Rehmanniae Praeparata (24 g), Rhizoma Cimicifugae (6 g), Radix Bupleuri (10 g), Rhizoma Atractylodis Macrocephalae 912 g), Radix Angelicae Sinensis 915 g), Rhizoma Alismatis (10 g), Semen Plantaginis (10 g), Fructus Schisandrae (9 g), Rhizoma Dioscoreae (15 g), Fructus Corni (15 g) and Cortex Moutan Radicis (10 g); prepared as decoction taken daily; applicable to stranguria induced by overstrain.

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