 |
Differential Treatment of Frequent Urination in Elderly Patients
by
Wei Zixiao
Xiyuan Hospital of China Academy of TCM Institute (100091)
|
Appearing originally in The Journal of Traditional Chinese Medicine
Frequent urination is a commonly seen symptom in our clinical
practice. The degrees of severity may be different as to the
various chief complaints presented by patients such as frequent
urination, oliguria, emergent urination, dysuria and vesicle
tenesmus etc. Among the young and middle-aged patients, it is
mostly seen in female urinary tract infection, which is generally
easily and quickly treated. Treatment often seems
comparatively more difficult for those patients with repeated
attacks. For elderly patients, this syndrome often appears to be
more intractable with a higher incidence of relapses. These recurrences are
due to the weak body resistance and greater number of inducing factors in elderly patients. These factors include inflammation of the urinary tract and around the urethra (including gynecological inflammation,
prostatitis), diabetes, kidney diseases and urinary obstruction
induced by various factors. Besides, cystoparalysis resulted from
prostatic hyperplasia, diabetes and diseases of the nervous
system, although without bacterial infection, may also have these
symptoms, or even retention of urine. Meanwhile, the above
diseases may also be the inducing factors of infection of the
urinary tract. Therefore, in our treatment a clear distinction
must be made between the infectious causative factors and the
non-infectious ones; and some probable chronic diseases should be
controlled.
In Chinese medicine, this group of symptoms are characteristic of
stranguria which is treated according to the differentiation of
zangfu and the eight principle syndromes, supplemented with
special herbs for the five types of stranguria (i.e. hematuria,
urinary incontinence, galacturia, uropsammus and pollakuria), the
effect of which is usually superior to western medicines. Here
are several points which should be paid attention to in the treatment of
this syndrome so as to raise the therapeutic effect.
- Since the aged people often have the body constitution with
deficiency of and insufficiency of yang, problems
of deficiency complicated with excess and simultaneous occurrence
of cold and heat should be taken into consideration in the making
of differential diagnosis, even if there exists downward flow of
damp-heat. Pure cold-cooling prescriptions must be avoided, for
they may prolong the duration of the illness and result in
recurrences.
- There are two circumstances under which the superficiality
must be urgently treated, one being retention of urine, the other
excessive pathogenic heat with cold-heat symptoms. Treatment retention of urine should be based on the principle of promoting diuresis
combined with external treatments such as acupuncture,
moxibustion, medicinal hot compress or fomentation; while the treatment for pathogenic heat with cold-heat symptoms should include a large dosage of heat-clearing and detoxifying herbs to promote diuresis. For those with dry stool or
constipation, purgation is adopted to clear away heat and promote
bowel movement.
- Doctors must know fairly well about the above-mentioned
chronic diseases and take notice of the changes in the related
indexes, which matters much in the control of the illness,
and in the prevention of recurrences.
- In medication, herbs, regardless of if you know them through your clinical experience or through your education,
must be prescribed according to their nature and taste, channel
tropism and their compatibilities in ancient recipes. This
medication not only makes a flexible selection of herbs, enhances
therapeutic effect but also ensures the continuity of
differential treatment.
Here are the commonly used recipes in
differential treatment:
- Bu Zhong Yi Qi Tang (Decoction for
Reinforcing Middle-jiao and Replenishing Qi) for deficiency of
qi.
- Wu Ling San (Powder of Five Drugs with Poria) for
disturbance in qi transportation of the bladder.
- Ji Sheng Shen Qi Wan (Life Preserving Pill for Replenishing the Kidney Qi)
for insufficiency of Kidney Yang.
- Gui Zhi Fu Ling Wan (Cinnamon Twig
and Poria Pill) for retention and stagnation.
- Ba Zhen San (Eight
Health Restoring Powder) for downward flow of damp-heat.
- Wu Wei
Xiao Du Yin (Antiphlogistic Decoction of Five Drugs) for excessive
toxic heat.
Commonly used herbs for various symptoms:
- Xiao Ji
(Herba Cirsii), Bai Mao Gen (Rhizoma Imperatae) for
hematuria.
- Bi Xie (Rhizoma Dioscoreae Septemlobae), Tu Fu Ling
(Rhizoma Smilacis Glabrae) for turbid urine.
- Hai Jin Sha (Spora Lygodii), Dong Kui Zi (Semen Abutili) for hesitant
painful urination.
- Pu Huang (Pollen Typhae), Wu Yao (Radix
Linderae) for lower abdominal pain.
- Rou Gui (Cortex Cinnamomi),
Fu Pen Zi (Fructus Rubi) for enuresis
- Hei Bai Chou (Semen
Pharbitidis), powder of Hu Po (Succinum) for retention of urine
-
Da Huang (Radix et Rhizoma Rhei), Mang Xiao (Natrii Sulphas) for
dry stool and constipation
- Chai Hu (Radix Bupleuri), Ge Gen
(Radix Puerariae) for cold-heat.