Urinary tract infections are diseases caused by the invasion of various pathogens into the urinary system. Depending on the site of infection, they can be divided into upper urinary tract infections (pyelonephritis, ureteritis) and lower urinary tract infections (cystitis, urethritis). Urinary tract infections are a common clinical condition that can occur in all populations, mostly in women, especially in women of childbearing age. About 20-30% of women have had urinary tract infections in their lifetime, and according to the results of a domestic survey of more than 30,000 women, the incidence rate is 2.05%. Men are less likely to develop the disease, with infants, the elderly, kidney transplant patients, and those with structural or functional abnormalities of the urethra.
According to its clinical manifestations, it mainly belongs to the category of “gonorrhea” and “lumbago” in Chinese medicine.
1.Diagnosis
1.1 Clinical manifestations
1.1.1 Symptoms: Most urinary tract infections have obvious local symptoms, often manifesting as bladder irritation symptoms such as urinary frequency, urinary urgency, urinary pain and lower abdominal discomfort. If combined with upper urinary tract infection can be accompanied by systemic symptoms, manifested as fever, chills, lumbago (a few patients can manifest renal colic) and gastrointestinal symptoms such as nausea and vomiting.
1.1.2 Signs: There may be pressure pain in the suprapubic bladder area and percussion pain in the kidney area if there is upper urinary tract infection.
1.2 Auxiliary examination
1.2.1 Routine: microscopic examination shows more than 5 white blood cells per high magnification field (400x).
1.2.2 Routine blood: with upper urinary tract infection, there is often an increase in total leukocyte count and neutrophil ratio.
1.2.3 Middle urine culture: urine culture can clarify the pathogenic bacteria and drug sensitivity.
1.3 Diagnostic criteria Based on the typical clinical symptoms combined with abnormal results of urine examination, the diagnosis of this disease is not difficult.
1.4 Clinical typing based on the site of infection can be divided into upper urinary tract infection (pyelonephritis, ureteritis) and lower urinary tract infection (cystitis, urethritis). The difference between the two is that upper urinary tract infections are mostly accompanied by systemic symptoms and signs, while lower urinary tract infections are mainly local symptoms.
1.5 Differential diagnosis
1.5.1 Adenoid cystitis: clinical manifestations include urinary frequency, urgency, painful urination, dysuria and hematuria similar to those of lower urinary tract infection, but it is a rare bladder epithelial proliferative lesion. Ultrasonography may show non-specific signs such as intravesical occupying lesions or bladder wall thickening, and cystoscopy and mucosal biopsy may be useful for differentiation.
1.5.2 Interstitial cystitis: The clinical presentation has significant urinary frequency and is similar to the symptoms of lower urinary tract infection, but it is a painful bladder disease. There is a giant pain when the bladder is full, significant pain and pressure in the suprapubic bladder area, and a full bladder can be palpated. Clear urine, mostly normal urine routine examination, very few pus cells and no bacterial growth in urine culture can be distinguished.
1.5.3 Renal cortical abscess and perinephritis: there are manifestations of systemic infection and pain or swelling in the kidney area, but no urinary tract irritation symptoms, and no pus cells in urine examination.
2. Identification of evidence
2.1 Damp-heat infusion: frequent urination, dripping, yellowish red urine, burning and stinging pain, urgency, pain leading to the umbilicus, or with lumbar pain and refusal to press; or see cold, heat, bitterness in the mouth, nausea and vomiting; or with constipation in the stool. The tongue is red with a yellowish coating and the pulse is moist.
2.2 Liver Qi stagnation: stagnant urine, dripping and draining, remaining dripping is difficult to finish, fullness and stuffiness in the umbilicus and abdomen, or even distension and pain. The tongue is red, the fur is thin and white, and the pulse is sunken and stringent.
2.3 Kidney Qi deficiency: The disease is long, lingering, sometimes mild, sometimes severe, aggravated or induced by desire for labor. Urine is not very red and astringent, drowning pain does not appear, dripping, remaining dripping is difficult to finish, intolerant of exertion. Pale tongue with thin white coating and thin pulse.
3.Treatment
3.1 Traditional Chinese medicine treatment
3.1.1 Identification treatment
3.1.1.1 Damp-heat downward injection evidence Treatment: Dampness and laxative.
Formula: Bazheng San plus or minus. q Cun 12 g, Qu Mai 12 g, Da Huang 6 g, Slippery Rock 10 g (pack), Tong Cao 10 g, Gardenia 10 g, Plantago 15 g, Licorice 6 g.
Addition and subtraction: for abdominal distension and constipation, add Citrus aurantium; for abdominal fullness and loose stools, remove Rhubarb; for small abdominal cramps, add Neem and Ocimum sanctum.
Chinese patent medicine: Sanjin tablets 4 capsules tid
3.1.1.2 Treatment for liver qi stagnation: Regulating qi and blood, relieving dampness and promoting drenching.
Prescription: Shen Xiang San. Shiwei 12g, Dongkuizi 15g, Slippery Rock 10g (packet), Licorice 10g, Shen Xiang 10g, Chen Pi 10g, Wang Bu Liu Xing 10g, Angelica Sinensis 12g, Bai Shao 15g.
Addition and subtraction: For intolerable distension of the abdomen, add Mu Xiang, Qing Pi and Wu Yao; for obvious stabbing pain, add Chuan Niu Kne, Hong Hua and Red Shao.
3.1.1.3 Treatment for kidney qi deficiency: tonify the kidney and promote lymphatic flow.
Remedy: Liu Wei Di Huang Wan. Dihuang 15 grams, shamrock 10 grams, yam 10 grams, dampi 10 grams, poria 15 grams, zedoary 10 grams.
Addition and subtraction: for those with yin deficiency and fire, five hearts are troubled and hot, add Zhi Mu and Huang Bai; for those with obvious lumbar pain, add Sequoia, Dogwood and Sang Sang Sang; for those with damp-heat not yet exhausted and yellow and hot painful urination, add Che Qian Cao and Yin Hua Vine.
3.2 Western medicine treatment
3.2.1 General treatment: For patients with urinary tract infection, patients should be advised to drink more water and pay attention to rest.
3.2.2 Use of antibiotics: For lower urinary tract infection, single dose or 1~3 days of antibiotic treatment is advocated. Single dose such as SMZ2g, TMP0.4g, SMZ-TMP2 tablets, hydroxyaminobianicillin 3g in a single dose or choose quinolone antibiotics. For upper urinary tract infections, a course of 7-14 days is advocated, with SMZ-TMP2 tablets twice daily or norfloxacin 0.2g three times daily. For severe infection with sepsis, intravenous administration is recommended, and it is best to choose sensitive drugs based on urine culture results. Before the drug sensitivity test, antibiotics should be applied empirically, and antibiotics with a broad antibacterial spectrum should be chosen as much as possible. Quinolones or cephalosporin III antibiotics in combination with clindamycin can be used.