Geriatric kidney deficiency urinary frequency is equivalent to modern medicine’s geriatric urethral syndrome, which refers to elderly patients who only have symptoms such as frequent urination, urinary urgency and or (painful urination), dyspareunia and abdominal cramping, while 2 negative mid-stage urine bacterial cultures and excluding tuberculosis, fungal and anaerobic urinary tract infections. The evidence is lingering and prone to recurrent episodes.
I. Diagnosis
This disease is diagnosed with reference to Modern Chinese Medicine Nephrology.
Chinese medicine treatment
(A) Identification and treatment
1.Spleen and Yang do not rise, dampness and heat are injected
Symptoms: urinary frequency and urgency, prolonged illness, recurrent episodes, residual draining of urine, burning in the urethra, abdominal cramps, pain on the pubic bone, soreness and weakness of the waist and knees, shortness of breath, tiredness and weakness, poor appetite, pale tongue, greasy coating, slippery pulse.
Treatment: Tonifying the middle and benefiting the qi, clearing heat and relieving dampness.
Formulation: Tonifying the middle and benefiting the qi with addition and subtraction.
Herbs: Astragalus membranaceus 30g, Radix et Rhizoma Ginseng 15g, Radix Angelicae Sinensis 10g, Atractylodes Macrocephala 15g, Radix et Rhizoma Glycyrrhiza Uralensis 5g, Radix Bupleurum Chinense 10g, Radix et Rhizoma Sagittatum 10g, Pericarpium Citri Reticulatae 10g, Poria 20g, Semen Coix Coix Seed 20g, Phellodendron Bark 10g.
Addition and subtraction: soreness and weakness of the waist and knees, the lower yuan is not solid obvious, heavy use of Ren Ren to participate in the puzzle nut, Wu Yao, yam to warm the kidneys and shrink urine. For frequent urination and burning in the urethra, use Ermiao San in combination. If the urine is astringent or even dripping with stabbing pain, the tongue is dark, and the veins under the tongue are obvious, on top of this add peach kernel, safflower, zelen and other products that activate the blood and eliminate stasis.
2.Liver stagnation, bladder dampness and heat
Symptoms: urinary frequency and urgency, residual draining of urine, burning of the urethra, obvious pain in the lower abdomen, pain on the pubic bone, dysthymia, qi stagnation, pale tongue, yellow greasy moss, thin string pulse.
Treatment: Diversify the liver and Qi, clear heat and dampness.
Formula: Prosperity San and Pigling Tang with addition and reduction.
Herbs: Chai Hu 15g, Bai Shao 15g, Angelica Sinensis 15g, Fu Ling 20g, Atractylodes Macrocephala 15g, Pig Ling 20g, Ze Di 15g, Slippery Rock 15g, Agaricus blazei 15g, Licorice 15g.
Addition and subtraction: If the liver stagnation is heavy and the two ribs are full, add green peel and aromatic herb to clear the liver and regulate the qi; if the pain is heavy, add yujin and yanhu to regulate the qi and relieve pain; if the appetite is poor, add shamrock, hawthorn and malt to eliminate food and appetite; if the damp-heat is heavy, add q cunningham and stone wormwood to clear the heat and relieve dampness. In cases of coldness below the waist, lack of warmth in the extremities, dripping after urination, white face, pale tongue, sunken and thin pulse, due to deficiency of the spleen and sagging, use Huang Qi and Atractylodes macrocephala 20g each; in cases of deficiency of the lower element, prolonged dripping, residual dripping of urine, distension and pain in the abdomen, soreness and weakness of the waist and knees, pale tongue, greasy coating, thin pulse, due to deficiency of the spleen and kidney, use Dang Shen 20g, Sheng Ma 5g, add Shan Yao 20g, Jin Zhen Zi 15g.
3, Qi and Yin deficiency, dampness and heat in the bladder
Symptoms: urinary frequency and urgency, residual draining of urine, burning in the urethra, less abdominal swelling, recurrent episodes, pain on the pubic bone is not obvious, shortness of breath, tiredness and weakness, light tongue, little coating, thin pulse.
Treatment: Benefit Qi and nourish Yin, clear dampness and heat
Recipe: Qingxinlianzi Drink plus reduction
Herbs: Astragalus membranaceus 30g, Radix Codonopsis pilosulae 20g, Radix Rehmanniae 15g, Rhizoma Dioscoreae 15g, Radix bupleurum 15g, Poria cocos 15g, Radix et Rhizoma maitake 15g, Plantago ovata 20g, Radix Scutellaria baicalensis 10g, Rhizoma ciliatica 20g, Dandelion 30g, Rhizoma alba 20g, Glycyrrhiza glabra 15g.
Addition and subtraction: for Qi deficiency, increase the dosage of Astragalus membranaceus, change Radix Codonopsis to Ginseng to replenish Qi; for Yin deficiency, add Zhi Mu and Tian Dong to nourish Yin; for Damp-Heat, add Bai Mao Root, Q Cunningham, Qu Mai to clear heat and relieve Dampness. For prolonged gonorrhea, with residual draining of urine, distension and pain in the abdomen, soreness and weakness of the waist and knees, add 20g each of gorgonian, yam and gold cherry.
4.Spleen and kidney Yang deficiency, bladder failure.
Symptoms: frequent urination, urgent urination, dripping urination, or abdominal cramps, long urination, the condition is intermittent, and it occurs in case of exertion, accompanied by lumbar soreness and weakness, cold in the extremities, mental weakness, light tongue, thin white or white greasy coating, sunken and thin pulse.
Treatment: Tonifying the kidneys, warming the Yang, resolving Qi and inducing diuresis.
Formula: Jin Kui Kidney Qi Pill with addition and reduction
Medicine: 10g of Radix Aconiti, 10g of Osmanthus, 15g of Cornu Cervi Pantotrichum, 15g of Yam, 15g of Poria, 10g of Mudanpi, 10g of Zedoary, 10g of Hyssop, 20g of Radix Rehmanniae, 20g of Semen Cuscutae.
If you have astringent pain when urinating, add Chuan Cao Xue, Gao Mai Xian Mao, Epimedium and Ba Ji Tian to warm the kidney yang, fill the essence and regulate the bladder’s qi and chemistry.
(B) Chinese medicine treatment
1.Prosperity Pill: Radix Angelicae Sinensis, Radix Paeoniae Alba, Radix Bupleurum, Poria, Rhizoma Atractylodis Macrocephala, Radix Ginger, Radix Glycyrrhiza Uralensis. Take 9g per dose, 2 times daily. It has the effect of draining the liver and strengthening the spleen, and is used for the type of liver depression and qi stagnation.
2.Zhi Kidney Tongguan Pill: Zhi Mu, Huang Bai, Cinnamon. 6g per dose, 3 times a day. This product has the effect of clearing the heat contained in the lower jiao and helping the bladder to transform Qi, and is suitable for patients with obvious dampness and heat in the lower jiao.
3.Gong Di Wan: 60g of Radix Rehmanniae, 60g of Semen Cuscutae (boiled in wine), 60g of Atractylodes Macrocephala (fried), 30g of each of Bei Wu Wei, Fructus Puzzlee (fried in wine), Fructus Papyri (fried in wine), Radix Aconiti (made), Poria Cocos, and Lonicerae (fried). It can warm the kidney yang, consolidate the essence and reduce urine, strengthen the spleen and relieve dampness, and is used for “treating the bladder that does not hide, the water spring does not stop, the vital gate fire fails, and the small water cannot be suppressed” and other kidney deficiency cannot be sealed.
(C) Acupuncture treatment
1.Body acupuncture
Main acupuncture points: Guan Yuan, San Yin Jiao, Kidney Yu, Subs, Hui Yang.
Matching points: for deficiency of kidney yang, with vital gate; for deficiency of kidney yin, with tai xi and fu qi; for deficiency of middle energy, with spleen yu and foot san li; for damp-heat injection, with hui yin and yinling quan; for soreness and weakness of the waist and knees, with vital gate and yangling quan.
Operation: apply tonic method to the main point and use moxibustion; for damp-heat infusion, apply laxative method to the supporting points. Guan Yuan and other abdominal points are stabbed slightly downward and obliquely, so that the needle sensation is released to the front yin. Subs, downward oblique stabbing into the 2nd posterior sacral foramen 75-85 mm; Huiyang: straight stabbing 60 mm.
2.Auricular acupuncture
Selected points: bladder, urethra, kidney, Shen Men, occipital and cerebral points. Add allergy zone if you have vulvar allergy; add subcortical, heart, mouth, and Shen decay points for insomnia and dreaminess; add heart, liver, gallbladder, and endocrine for heartburn and irritability; add spleen and stomach for atrophy and dullness; add spleen, stomach, liver, and adrenal gland for deficiency of both qi and yin.
Operation: After local disinfection of both sides of the auricle with 75% alcohol, probe the sensitive points of each acupuncture point with a probe, then take medical tape cut into 0.6cm×0.6cm, embed 1 Wang Bu Liuxing seed in the center of the tape, stick it on the selected acupuncture point sensitive points, and ask the patient to press it 5-6 times a day for 2-3 minutes each time, to the extent that the auricle is warm or the sensitive points appear slightly painful.
C. Analysis of the difficulties in Chinese medicine treatment
1. This disease is a non-infectious geriatric urethral syndrome with frequent urination and discomfort in urination as the main manifestation, which is often misdiagnosed as urinary tract infection and used with antibiotics for a longer period of time. Therefore, the diagnosis can be made in elderly patients with urinary frequency and discomfort, no clinical evidence of bacterial or microbial infection, multiple negative urine cultures, normal routine urine examination, and positive exclusion of urinary tract tuberculosis, fungi, anaerobic bacteria, gonococci, mycoplasma, and chlamydia infection.
2, elderly urethral syndrome although only urinary tract irritation symptoms, no bacterial infection, but easy to relapse. The disease is deficient and the evil is easy to feel, the more deficient the righteousness, and the more complicated the evidence is, the more prolonged it is. This makes prevention and treatment the focus of the disease. Treatment should be long-term support to make up for the deficiency of the need, “positive energy within, the evil can not dry”, the disease is difficult to get back, and finally cured.
The onset of urethral syndrome in old age is related to mental and emotional factors, some patients have mental symptoms before the disease, after the disease due to long-term use of antibacterial drugs and not effective, so that the psychosomatic symptoms are more obvious, and manifested as irritability, good rest, memory loss, inattention, insomnia and other symptoms. At this time, psychological treatment is very important, to eliminate the adverse psychological factors affecting the disease, has an important role in the improvement of the disease.