Urolithiasis is a common disease in urology, which is a manifestation of abnormal mineralization in the urinary system. According to the different parts of the urinary system where the stones stay, it is clinically divided into upper urinary tract stones including kidney and ureter and lower urinary tract stones including bladder and urethra. The prevention and treatment of urolithiasis is aimed at protecting renal function, removing stones as much as possible, treating complications, identifying the cause of the disease, and preventing recurrence. Chinese medicine will be urolithiasis belongs to the stone shower”, “lumbago” category, the etiology of its pathogenesis is kidney deficiency, bladder qi unfavorable, dampness and heat in the lower jiao. In order to better improve the diagnosis and treatment level of urolithiasis, based on the “Wu Jieping Urology”, the State Administration of Traditional Chinese Medicine, “Diagnostic and therapeutic efficacy standards of Chinese medicine”, and with reference to the urolithiasis diagnostic and treatment guidelines formulated by the Chinese Urological Association, the combined diagnosis and treatment of urolithiasis of Chinese and Western medicine is sorted out. Kidney and ureteral stones Kidney and ureteral stones are commonly known as upper urinary tract stones. Ureteral stones usually come from the kidney, and they tend to stay in the physiological narrowing of the ureter, such as the renal pelvic-ureteral junction, ureteral cross-iliac vessels and ureteral bladder wall. 1.1 Diagnostic criteria 1.1.1 Pain and hematuria Large stones in the renal pelvis and calyceal stones may have no obvious symptoms. Huge stones or secondary obstruction and hydronephrosis may have dull pain and distension in the lower back. Smaller stones may cause colic and hematuria if they move in the renal pelvis, embedded in the ureteral junction of the renal pelvis, or stimulate the ureteral wall to cause strong peristalsis or spasm. 1.1.2 Renal percussion pain and pressure pain In the attack of colic, there may be pressure pain and percussion pain in the angle of the spine and ribs on the sick side. During the resting period of renal colic, there may be no positive signs or mild percussion pain in the renal region on physical examination. 1.1.3 Complicated infections may have symptoms such as frequent urination, painful urination and pus; when secondary to acute pyelonephritis or pus accumulation in the kidney, there may be systemic symptoms such as fever, chills and shivering. 1.1.4 Anuria is often caused by bilateral ureteral stones resulting in complete obstructive hydronephrosis, or one side of the ureteral stone obstruction, the opposite side of the kidney is absent or non-functional due to the bladder is in a state of emptiness, and complicated by acute renal failure. 1.1.5 Urine routine Most patients can see red blood cells, and pus cells can be seen when accompanied by infection. 1.1.6 Urine bacterial culture Urine bacterial culture should be done when associated with infection. 1.1.7 24 h urine quantitative analysis Measurement of calcium, phosphorus, uric acid, oxalic acid, etc. can help to analyze the cause of stones. 1.1.8 Blood test: Serum calcium, phosphorus, uric acid, urea nitrogen, creatinine, etc. If necessary, measure parathyroid hormone (PTH). 1.1.9 Urological X-ray film (Kidney ureter bladder, KUB) More than 90% of patients show stone shadow on X-ray film, pure uric acid stones do not appear. 1.1.10 Intravenous urography(IVU) Knowing the location of stone, morphology of renal calyx and pelvis, the presence or absence of hydronephrosis and the functional status of the opposite side of the kidney is an important basis for determining the method of treatment.A negative stone on the X-ray radiograph may be shown as a filling defect in the renal pelvis of the developed renal pelvis. In case of poor visualization, double or high dose contrast and delayed contrast may be used. It should not be performed if the creatinine is more than double the normal value. 1.1.11 Retrograde pyelogram (RPG) Retrograde pyelogram is not a routine examination, but if the diagnosis cannot be confirmed by KUB or IVU, and ureteral stone is highly suspected, ureteral catheter can be inserted to do X-ray abdominal plain film, and it can be used to find out whether there is any narrowing of the ureter below the stone and the degree of patency. 1.1.12 Ultrasound can be used as a screening test for kidney stones. It can show the X-ray positive and negative stones over 2 mm, and understand the renal parenchyma and the morphology of the collecting system, and the status of fluid accumulation. If a “strong echogenic mass” without acoustic shadow cannot be confirmed by X-ray, it cannot be recognized as a stone. 1.1.13 CT is generally not suitable as the first choice of stone examination, but the sensitivity of detecting stones is higher than that of KUB and IVU, especially for the diagnosis of patients with renal colic, it can be used as an important supplement, and thus it has important diagnostic value for those who are negative for stones in X-ray examination or suspected of having combined renal tumors. 1.1.14 Nephrogram can understand the degree of renal function impairment, suggesting the presence or absence of obstruction. 1.1.15 Qualitative analysis of chemical composition of stones can be used as the basis for the formulation of preventive and curative measures. Above (1), (2) positive can be proposed to diagnose the disease, (9) + (10), (11) or (12) positive can confirm the diagnosis of the disease, (13) for the diagnosis of negative stones used. 1.2 Differential diagnosis: It should be differentiated from chronic appendicitis, cholecystitis, cholelithiasis with biliary colic, renal tuberculosis, renal tumor, mesenteric lymphatic gland calcification, and so on. 1.3 Classification of symptoms in Chinese medicine 1.3.1 Damp-heat downstream injection: lumbar and abdominal cramps, frequent and painful urination, blood in urine or interruption of urination, unbearable stabbing pain when relieving oneself, and dry stools. Yellow and greasy tongue coating, stringy or numbered pulse. 1.3.2 Qi stagnation and blood stasis, lumbago and distension, stabbing pain in the abdomen, blood clots in the urine or dark red urine, dyspareunia, dark red tongue, scanty or yellowish greasy moss, and a fine, astringent pulse. 1.3.3 Kidney qi deficiency: vague pain in the lumbar and abdominal region, weakness in urination, abdominal distension, fatigue, or even facial weakness, fear of cold and cold limbs, pale and fat tongue, white moss, and sunken and weak pulse. 1.3.4 Kidney yin deficiency: hidden pain in the waist and abdomen, dry stool and urine, dizziness, tinnitus, heartburn and dry throat, soreness and weakness of the waist and knees, red tongue with little fur, and fine pulse. 1.4 Treatment program The main purpose is to remove stones, relieve inflammation and obstruction, protect renal function, and find and relieve the cause of the disease as far as possible. According to each patient’s general condition, stone size, stone composition, obstruction, infection, fluid retention, renal function damage and stone recurrence trend, etc., the program is formulated. 1.4.1 Treatment of renal colic (1) intravenous rehydration: maintain water, electrolyte acid-base balance, general rehydration volume should be more than 2,000 mL per day, of which saline fluid should be more than 1,000 mL, and a small amount of 5% sodium bicarbonate can be added. (2) Acupuncture pain relief method: commonly used acupuncture points are kidney Yu, bladder Yu, Sanyinjiao, A Yes point, the pain is very good, plus the foot Sanli, Jingmen strong stimulation, each time to stay in the needle for 20-30 min. (3) Renal area of localized hot compresses. (4) The application of antispasmodic and analgesic drugs, such as atropine, scopolamine, dulcolax, morphine, ipecac, etc.. (5) Emergency ESWL treatment: can be used for renal colic can not be controlled by drugs. (6)Ureteroscopic lithotripsy, stone removal or placement of double J tube drainage. (7) Percutaneous nephrolithotomy. 1.4.2 Lithotripsy treatment Applicable to those with diameter less than 0.6 cm, smooth appearance without urinary tract obstruction and infection and with good renal function. According to the combination of traditional Chinese medicine and western medicine, it is divided into four types of treatment, aiming at promoting stone removal, controlling infection, improving symptoms and protecting renal function. (1) clearing heat and dampness, lymphatic drainage: used for damp-heat injection type, equivalent to the movement of stones, or lower ureteral stones and lower urinary tract stones with infection. The drugs used in the formula are: Qu Mai 10 g, Bian Zhi 10 g, Psyllium 15 g, Shi Wei 15 g, Bai Mao Gen 10 g, Bamboo Leaves 6 g, Di Ding 15 g, Huang Bai 12 g, Dong Kwai Zi 12 g, Guang Qin Cao 30 g, Talcum 10 g, Hai Jin Sha 10 g. (2) Resolving stagnation of blood stasis to move qi and seepage of dampness to remove stones: used for the type of qi stagnation and blood stasis, equivalent to the long-stagnation of stones, with frequent renal colic or with hydronephrosis. The drugs used in the formula are: trigonelline 6 g, curcuma 6 g, andrographis paniculata 10 g, saponaria 10 g, hyssop 10 g, Salvia miltiorrhiza 15 g, aconite 15 g, Radix et Rhizoma Ginseng 30 g, talcum officinale 10 g, citrus aurantium tenuifolia 10 g, thick pimpinella 10 g, radix paeoniae alba 10 g, peach kernel mud 10 g, psyllium carneatum 15 g. (3) tonifying the kidney and benefiting the vital energy to relieve the lymphatic drainage and eliminate the stones: it is used to treat the type of kidney vital energy deficiency, which is associated with renal hydronephrosis in long term disease. The drugs used in the formula: 10 g of ripened earth, 15 g of yam, 10 g of cornelian cherry, 10 g of poria, 10 g of zedoary, 6 g of cinnamon stick, 4 g of baked epimedium, 10 g of wolfberry, 20 g of astragali, 20 g of broad golden cohosh, 10 g of sea gold sand, 10 g of talcum. (4) nourishing yin and tonifying the kidneys to pass the lymphatic drainage stone: used in the kidney yin deficiency type, most of them with a longer duration of the disease. The drugs used in the formula: 15 g of ripened earth, 15 g of yam, 12 g of poria, 10 g of zedoary, 15 g of huang jing (yellow essence), 15 g of chasteberry, 12 g of dandelion, 10 g of hyssop, 20 g of Radix et Rhizoma Gynostemma, 15 g of Psyllium Hederariae. In the course of the treatment, the patient’s different situations, with the addition and subtraction of the symptoms, follow the principle of “elimination of the evil does not injure the right and correctness of the right not to leave the evil, elimination of the stone in the first place, correctness and correctness of the good, and the symptomatic and the fundamental”. The principle of TCM diagnosis and treatment of “taking care of both the symptoms and the root cause” is followed. 1.4.3 Extracorporeal shock-wave lithotripsy (ESWL) (1) Indications: for kidney stones with a diameter of ≤2 cm, and ureteral stones with a diameter of ≤1 cm, with no urinary obstruction at the distal end of the stone, and with good renal function. The method is not suitable for those who have no urinary tract obstruction at the distal end of the stone, pregnancy, bleeding disorders, severe cardiovascular and cerebrovascular diseases, pacemakers, serious damage to renal function, acute urinary tract infections, etc., and those who are too obese and cannot focus, or whose positions are affected by severe bone and joint deformities. The stone stays in the ureter for a long time, the stone is large, and the ipsilateral renal function is seriously impaired should not be used.ESWL treatment should emphasize the postural lithotripsy method, and at the same time, the patient should be asked to drink more water, or intravenous fluids to dilute the urine, to prevent the formation of the stone street caused by obstruction. There is no standardized time interval for resuscitation of kidney stones, and the repair time after kidney injury is 2 weeks, so it is recommended that resuscitation interval should be more than 2 weeks. (2) Complications of ESWL: hematuria, colic, “stone street” formation, fever, skin injury, perinephric hematoma. After the operation, KUB flat film should be taken regularly to know whether the stone is crushed and discharged, whether there is any residual stone after lithotripsy treatment, whether the stone site changes, and whether “stone street” is formed, etc. Once “stone street” is formed, the patient should be informed that the stone has been discharged. If a “stone street” is formed, prompt treatment is needed. The larger stone particles in the “faucet” can be crushed by resuscitation to facilitate discharge and prevent damage to renal function. For patients with isolated kidney or stones >2 cm, it is recommended to keep double J tube before lithotripsy in order to prevent “stone street”. If it is ineffective, the obstruction should be relieved promptly, and percutaneous transluminal nephrostomy or combined treatment with percutaneous nephrolithotomy (PCNL), transureteroscopic lithotripsy or lithotripsy (URL) is feasible. 1.4.4 Ureterorenoscopic lithotripsy (URL) is indicated for lower and middle ureteral stones, and can be used to treat some upper ureteral stones in the skilled population. It can also be used for those who have difficulty in localizing the stone by extracorporeal shock wave lithotripsy or for those who have adhesions or stones embedded in the stone, and for those who have formed a stone street after extracorporeal shock wave lithotripsy. 1.4.5 Percutaneous nephrolithotomy (PCNL) and percutaneous nephrolithotomy MPCNL are suitable for pyelolithiasis stones >2 cm, complete dehiscence stones, large kidney stones, and large kidney stones. It is suitable for >2 cm pyeloliths, complete staghorn stones, large renal stones, lower calyceal stones >1 cm in diameter, or stones left behind or not crushed after ESWL; upper ureteral stones located above the third lumbar vertebra. MPCNL has the advantages of less trauma and repeatability, and has fewer complications than PCNL. 1.4.6 Open surgery At present, the commonly used treatment methods are extracorporeal shock wave lithotripsy and endoluminal urology, but open surgery is still of great clinical value. It is suitable for those who have contraindications to ESWL, URL, PCNL or those who need open surgery because of complications arising from the failure of the above treatments, and those who have diseases that need open surgery at the same time. 1.4.6.1 Common surgical methods (1) Pyelotomy and lithotripsy, especially for extra-renal pelvic stones. (2) Intrarenal sinus pyelolithotomy is suitable for intrarenal type, or large stones that are easy to cause renal pelvis tear by pyelolithotomy. It is difficult to remove large stones by pyelotomy, but the combination of pneumatic ballistic lithotripsy can help to remove the stones during the operation. (3) Parenchyma incision lithotomy is suitable for those who can not take out the calyceal stone by pyelotomy, or most of the calyceal stones and staghorn-shaped stones. (4) Partial nephrectomy, applicable to the renal pole or calyx with obvious dilatation, parenchymal atrophy and obvious recurrence factors. (5) Nephrectomy, if the stone causes severe destruction of the kidney, loss of function, or combined with renal pus, and the opposite side of the kidney has good function. (6) Ureterotomy and lithotripsy, applicable to the stone embedded for a long time, serious obstruction of the ureter and upper urinary tract infection, ureteral diverticulum stone and endoluminal surgery is ineffective or complications occur. 1.4.6.2 Principles of surgical treatment for bilateral upper urinary tract stones (1) For bilateral ureteral stones, if the total renal function is normal or in the compensatory stage of renal insufficiency, and the blood creatinine value is <178 μmol/L, the severe side of the obstruction should be treated first. If the total renal function is poor, in the stage of azotemia or uremia, the side with better renal function should be treated first. If conditions permit, both sides of the stone can be treated at the same time. (2) One side of the ureteral stones, the opposite side of the kidney stones, first deal with ureteral stones. (3) Bilateral kidney stones, according to the stones and renal function decision. In principle, the kidneys should be preserved as much as possible. Generally, the side that is easy to take out and safe is treated first. If the renal function is poor, obstruction is serious, the systemic condition is poor, it is advisable to first through the cystoscope or ureteroscopy retrograde tube drainage or percutaneous nephrostomy. When the situation improves, then deal with the stone. (4) bilateral urinary tract stones or isolated upper renal urolithiasis caused by acute obstruction of anuria, after a clear diagnosis, if the systemic condition permits, surgery should be carried out in a timely manner. If the systemic condition is poor and cannot tolerate surgery, ureteral intubation can be tried, and if the stone can be passed, catheter drainage can be retained. Can also be performed percutaneous nephrostomy, until the condition improves after treatment. 1.4.7 Precautions for stone treatment (1) infection. All stone treatment patients must be bacteriologic urine examination, clinically diagnosed infection and obstruction of patients need to carry out the necessary treatment before treatment: anti-infection and drainage. (2) Bleeding. Patients with bleeding disorders or taking anticoagulant drugs need to be assisted by an internist before treatment. Coagulation disorders are a contraindication to stone treatment. (3) Pregnancy. In pregnant patients with stones, keeping the urine flow is the main purpose of treatment, fistula and double J-tube drainage are optional treatments, ESWL, PCNL and URL treatment are relative contraindications. (4) Installation of cardiac pacemaker. In principle, ESWL can be performed, and cardiology consultation is recommended before treatment. 1.5 Criteria for determining the efficacy of treatment 1.5.1 Cure No residual stones, no urinary tract obstruction, recovery of renal function, or crushed stones after extracorporeal shock wave lithotripsy, most of which are discharged. (Residue ≤ 0.4 cm is defined as residual fragments without clinical significance, and ≥ 0.5 cm is defined as residual stone). 1.5.2 Improvement (1) Reduction of hydronephrosis, improvement of renal function, with residual small stones (≥12.5px). (2) After ESWL or URL, the stone is crushed and still to be discharged. 2.Bladder stone 2.1 Diagnostic criteria (1)Sudden interruption of urination: pain radiating to the head of the penis and the distal urethra. (2) Bladder irritation: often combined with urinary tract infection, with urinary frequency, urinary urgency, urinary pain symptoms. (3) X-ray examination: plain film can show most of the stones. Larger stones can be seen under fluoroscopy. (4) Ultrasound: it can show the sound shadow of stones and can detect prostate hyperplasia at the same time. (5) cystoscopy: can directly see the stone, and may find the cause of the stone, such as bladder outlet obstruction, bladder diverticulum, inflammatory changes. The diagnosis can be confirmed by (1), (3), (4) and (5)1. 2.2 Treatment program The treatment of bladder stones follows two principles, one is to remove the stones, and the other is to correct the cause of stone formation. 2.2.1 General treatment Control infection, improve symptoms, and promote the discharge of small stones. Clearing heat, diuresis and drenching treatment: add and subtract with Bazheng San. Add and subtract according to the symptoms: if accompanied by hematuria, add leucocephala, artichoke, pohuang; accompanied by fever, add septoria, diclofenac sodium, and so on. 2.2.2 Extracorporeal shock wave lithotripsy (ESWL) can be used for primary stones and stones <2 cm in diameter, but it is not preferred. 2.2.3 Endoluminal urological surgery Bladder stones can be crushed by cystoscopic lithotripters, or ultrasound, electro-hydraulic, laser, and pneumatic ballistic lithotripters, and then sucked out by flusher. 2.2.4 Surgery: suprapubic cystotomy: it is suitable for large or multiple bladder stones, and the method is simple and easy to implement. However, the cause of the disease must be identified before surgery, and secondary stones should be solved at the same time in order to prevent the recurrence of stones. 2.3 Criteria for determining the efficacy of treatment (1) Cure: the stone is discharged or removed, urination is smooth, urinary tract irritation disappears, and the urine routine is normal. (2) improved: ① stone disappears, but there are still signs of urinary tract infection; ② residual small stones. 3, urethral calculi 3.1 diagnostic criteria (1) the main symptoms of dysuria, urinary effort, can be dripping, sometimes interrupted urine flow and acute urinary retention. There is obvious urinary pain during urination, which may radiate to the head of the penis. Posterior urethral calculi have pain in the perineum and scrotum. (2) In men, anterior urethral calculi can be palpated in the penis or perineum, posterior urethral calculi can be palpated in the rectum, and female urethral calculi can be palpated in the anterior wall of the vagina. (3) X-ray examination: urethra X-ray film can show positive stone shadow. (4) Urethroscopy can show stones. (5)Metal urethral probe can touch the stone. (6) Urethrography may be performed in rare cases. 3.2 Treatment program (1) anterior urethral stones can be injected into the urethra after anesthetic, paraffin oil extrusion, or pliers, forceps will be pinched out of the stone, or through the urethroscope out. Be careful not to damage the urethra, otherwise the incidence of urethral stricture is very high. (2) The stone embedded in the posterior urethra soon, can be used to urethral metal probe or cystoscopy, urethroscopy will be pushed to the bladder and then according to the bladder stone treatment. (3) Open surgery for stone extraction: it is suitable for those with large stones, or long time of embeddedness and failure of the above treatments, or with urethral stenosis and diverticulum, which need to be treated together with surgery. 3.3 Criteria for determining the efficacy of treatment (1) Cure: the stone is discharged or removed, urination is smooth, urinary tract irritation disappears, and the urine routine is normal. (2) Improvement: disappearance of urethral calculi, but there are still signs of urinary tract irritation.