Main Signs and Symptoms
After surgical removal of his right Kidney due to a malignant tumour, one year ago he began to experience urinary frequency with difficulty and disrupted flow. Urinary frequency (day time every 1-2 hours; night time every 2-3 hours) with difficulty and disrupted flow for the past year. Pain in the perineal area. During operation it was found that he had an enlarged prostate. Nocturia is disrupting his sleep.
Other signs and symptoms: Low back pain; fatigue and lethargy; dull complexion; low spirit (looks unwell and has the appearance of a person with a chronic illness); poor appetite.
Tongue: Pale with a thin white coat
Pulse: Deep, thready and rapid
Diagnosis and Treatment
Urinary retention (long bi syndrome): Lower Jiao stagnation and blockage (i.e. urethral obstruction) due to Damp-Heat in the Urinary Bladder with Spleen and Kidney Yang deficiency.
Nei Xiao Luo Li Wan (Prunella & Scrophularia) for 7 days.
Second consultation (after one week): The perineal pain has stopped. Urination less difficult, flow not as disrupted. Treatment Principle: Activate the Blood and unblock urination, tonify the Kidney and disperse the bound pathogens using Qian Lie Xie Wan (Rubus, Rosa & Rehmannia) for 7 days.
Third consultation (after another 7 days): The flow of urine improved further, frequency still the same during the day, a little less during the night time. Treatment Principle: Tonify the Qi to activate the Blood and dispel stasis to promote the flow of urine using Bu Yang Huan Wu Wan (Astragalus & Lumbricus) for 7 days.
Fourth consultation (after a further 7 days): Frequency of urination is now normal, only needs to urinate once at night time. Energy level has improved.
Follow up: Continued with Bu Yang Huan Wu Wan (Astragalus & Lumbricus) for several more weeks. The symptoms have not returned.
Blood stasis is a common pathodynamic underlying insomnia, especially in middle aged and elderly patients. Generally, such patients are readily subject to Blood stasis due to declining Yang Qi, and deficiency of the Qi and Blood due to declining Stomach Qi. Lack of normal movement of the Blood, together with deficiency of the Blood affects the Spirit in the Heart, dIn this case there were several pathogens binding in the lower Jiao causing urinary obstruction. The treatment protocol that was used illustrates the principle that the bound pathogens (including the static Blood) may best be dispersed by tonifying the Qi. Once the Damp-Heat had been resolved, the stagnation of combined pathogens, which directly gave rise to the urinary blockage, was primarily addressed through the tonification method. In chronic conditions, such as this case, with stagnation due to accumulated pathogens the key to resolving the condition is to tonify the Qi. This principle achieves much better and more lasting results compared with treatments that focus solely on dispelling the pathogens.