bubble_chart Concept

Difficulty in urination refers to the difficulty in passing urine, and in severe cases, urine may only drip out.

This condition has various names in ancient texts. Suwen.Xuanming Wuqi refers to it as "retention," Suwen.Zhizhenyao Da Lun calls it "inability to urinate," Suwen.Wuchangzheng Da Lun refers to it as "ischuria," Suwen.Bi Lun calls it "bladder impediment." Lingshu.Jingmai refers to it as "urinary retention," Lingshu.Benshu chapter calls it "urinary retention," "urinary blockage," and "urinary retention," Lingshu.pathogenic qi zang-fu organs discusses it as "urinary retention" and "retention of urine." Jingyue Quanshu.ischuria discussion calls it "blockage of small water." Shoushi Baoyuan refers to it as "inability to pass urine."

This condition should be distinguished from difficulty in urination and painful urination. Difficulty in urination refers to a small amount of urine with difficulty in passing; painful urination refers to pain in the urethra during urination.

bubble_chart Modern Research

Western medicine considers that the urine output of a healthy adult in 24 hours is between 1000~2000ml. Urine output less than 400ml in 24 hours is called oliguria, and urine output less than 100ml or complete absence of urine in 24 hours is called anuria (or urinary retention). Urinary retention and anuria caused by various reasons such as neurogenic urinary retention, bladder sphincter spasm, urinary tract stones, urinary tract tumors, urethral stricture, prostatic hyperplasia, and uremia all fall under the category of "ischuria".

An important cause of urinary retention is that the bladder neck, prostatic capsule membrane and glands, and urethra all have adrenal α-receptors. Sudden excitation of these receptors causes a sharp increase in the tension of smooth muscle tissue in the prostatic capsule membrane, thereby obstructing the urethra. Therefore, clinical use of phentolamine and other "receptor blockers" has certain efficacy in treating urinary retention. In addition, 5-fluorouracil, candicidin, etc. are used to treat urinary retention caused by prostatic hyperplasia and hypertrophy, and securinine has significant efficacy for neurogenic urinary retention.

For urinary retention caused by prostatic hypertrophy, catheterization is often used to relieve the urgency.

bubble_chart Pattern Analysis

1. Dampness-heat in Lower Energizer︰Difficulty in urination is often accompanied by painful urination, frequent urination, and urgency, with a possible burning sensation. It may also present with {|###|}bitter taste in the mouth{|###|}, thirst without the desire to drink, and difficulty in bowel movements. The tongue appears {|###|}red with a yellow, greasy coating{|###|}, and the pulse is deep and rapid or soggy and rapid. The disease is located in the {|###|}lower energizer{|###|}, Zhubing Yuanhou Lun. "Various Conditions of Urinary Disorders: Difficulty in urination is caused by heat in both the {|###|}bladder{|###|} and kidneys." {|###|}Dampness-heat{|###|} obstructs the bladder or transfers heat to the {|###|}bladder{|###|}, leading to the binding of {|###|}dampness-heat{|###|} and dysfunction of {|###|}bladder qi transformation{|###|}, resulting in difficulty in urination. Treatment focuses on the {|###|}lower energizer{|###|}, aiming to {|###|}clear and drain damp-heat{|###|} and {|###|}promote urination{|###|}. The recommended formula is Eight-Ingredient Rectification Powder.
2. External Contractionwind-cold︰Difficulty in urination, chest tightness, cough with rapid breathing, dyspnea, severe constipation, red or pale red tongue texture, white or thin yellow coating, soggy and rapid pulse. The root cause lies in the upper energizer, but symptoms manifest in the lower energizer. The lung, being the upper source of water, fails to perform its descending function, leading to impaired regulation of water pathways and affecting the lower energizer, resulting in difficulty in urination. The distinguishing points are: for dampness-heat in the lower energizer, the urine is scanty and yellow with a burning sensation during urination; for lung qi stagnation, the urine is not very yellow and generally lacks a burning sensation. Dampness-heat in the lower energizer primarily presents with lower energizer symptoms, while lung qi stagnation exhibits symptoms in both upper and lower energizers. Dampness-heat in the lower energizer shows signs of internal dampness-heat accumulation, whereas lung qi stagnation displays manifestations of qi stagnation. In treatment, it is appropriate to address the lower disease by treating the upper, using the method of lifting the pot and removing the lid. For example, inducing sneezing or vomiting to open lung qi, and for prolonged cases with heat formation, Lung-Clearing Decoction can be used with appropriate additions of urination-promoting agents.
3. Spleen Qi Deficiency︰Difficulty in urination, fatigue and shortness of breath, reduced appetite, epigastric {|###|}abdominal distension and fullness{|###|} and stuffiness, lower abdominal distension and sagging, loose stools, pale tongue with thin white coating, deep and weak pulse. Due to congenital {|###|}spleen qi{|###|} deficiency, or {|###|}overstrain{|###|} damaging the spleen, or dietary irregularities depleting {|###|}middle qi{|###|}, {|###|}qi deficiency lack of strength{|###|} leads to weak urination; treatment involves {|###|}tonifying middle and replenishing qi{|###|}, {|###|}promoting urination{|###|}, with the formula selection of {|###|}Middle-Tonifying Qi-Replenishing Decoction{|###|} with modifications.
4. Kidney Qi Deficiency︰Weak urine flow, frequent urination with difficulty in voiding, aching pain in the lower back and knees, cold extremities, pale tongue with tooth marks and thin white coating, deep and thin pulse with weak chi (尺) pulse. The disease is rooted in the kidneys, which may be caused by prolonged illness injuring kidney yang, or aging and physical decline leading to insufficient yang qi, or excessive indulgence damaging the kidneys, resulting in kidney qi failing to transform and causing weak urine flow. Key points for differentiation: insufficiency of middle qi (中氣) often manifests as impaired spleen function and sinking of middle qi, with intermittent and fluctuating difficulty in urination, often aggravated or triggered by excessive qi depletion; insufficiency of kidney qi mostly presents with signs of kidney yang deficiency, where kidney deficiency leads to frequent urination and weak urine flow or even inability to void. Treatment should focus on warming yang and replenishing qi, tonifying the kidneys and promoting diuresis. The prescription can be modified from the Kidney Qi Pill from "Ji Sheng" (《濟生》).
5. Liver Qi Depression︰Difficulty in urination or incomplete urination, emotional depression, frequent irritability and anger, discomfort in both flanks, restless sleep at night, dreamfulness, bitter taste in mouth and acid regurgitation, red tongue with thin yellow coating, wiry pulse. This syndrome arises from emotional imbalance, liver failing to regulate and disperse, leading to impaired urination, presenting symptoms of liver qi depression. Treatment should focus on soothing the liver and regulating qi, promoting urination. Prescriptions may include Aquilaria Powder or a modified Bupleurum Liver-Soothing Powder.
6. Static Blood︰The inability to urinate, or intermittent obstruction, accompanied by lower abdominal distension and fullness, pain, a purplish-dark tongue texture with ecchymosis, a white or slightly yellow tongue coating, and a choppy pulse. This belongs to an excess pattern caused by static blood forming clots and causing obstruction. Static blood can result from various causes such as traumatic injuries, qi stagnation and blood stasis, or blood heat congealing into stasis. The main manifestations of urinary obstruction include lower abdominal distension and fullness, retention, fixed pain, or the presence of abdominal masses, a purplish-dark tongue with ecchymosis, and a choppy pulse. The treatment principle is to promote blood circulation, resolve stasis, and unblock the water passages. The recommended formula is Substitute Resistant and Withstanding Pill with modifications.

Chinese medicine has a long history of using external treatments to treat ischuria, as early as the Tang Dynasty in the Beiji Qianjin Yaofang "Bladder" section, which records: "The bladder is associated with the kidneys, storing body fluids and urine. If there is Rebing in the organs, the bladder becomes obstructed, leading to difficulty in urination... causing the bladder to twist and body fluids to be blocked. Using a scallion stalk with the tip removed, insert it three inches deep into the urethral opening, gently blow into it, the bladder will expand, body fluids will flow freely, and the condition will be cured." This is the earliest record of using catheterization to treat urinary retention. Medical texts from the Ming Dynasty also document many external methods to promote urination, such as in the Jingyue Quanshu "Ischuria" section, which introduces three methods to promote urination.

Zhu Dan-xi pioneered the use of emetic therapy to treat urinary retention, comparing the application of emetic therapy to a dripping water vessel: if the upper opening is closed, the lower opening will not flow; if the upper opening is opened, the lower opening will flow freely. This is the method of "lifting up the pot and removing the lid."

bubble_chart Documentation

1. Danxi Xinfa．Difficulty in urination: "Difficulty in urination can be due to qi deficiency, blood deficiency, phlegm, wind blockage, or excess heat. For qi deficiency, use ginseng, astragalus, Cimicifuga Rhizome, etc., take first and then induce vomiting, or induce vomiting within ginseng and astragalus medicine. For blood deficiencyFour Ingredients Decoctiontake first and then induce vomiting, or induce vomiting within Chuanxiong and Angelica decoction is also acceptable. For excessive phlegmTwo Old Ingredients Decoctiontake first and then induce vomiting. All the above methods use induced vomiting. If there is qi blockage and obstruction, add Akebia Stem and Cyperus to Two Old Ingredients Decoction and induce vomiting to lift the qi, as the rise of qi will naturally lower the water, because qi carries the water. For those with excess heat, it should be purged, use Granulated Sugar soup to mix with lobedleaf pharbitis seed powder two to three parts, or gardenia and the like. For those with heat, dampness, and qi stagnation below, it is appropriate to clear, dry, and lift."
2. Bianzheng Lu．Difficulty in urination section: "People with difficulty in urination, unable to pass even a drop, anxious and feeling like dying, restless and irritable, thirsty and seeking to drink, but drinking only makes it worse, people think it is extreme heat in the small intestine, who would have thought it is extreme hyperactivity of heart fire. The heart and small intestine are interior-exteriorly related, extreme heat in the small intestine leading to ischuria, is actually heat in the heart causing ischuria. The ability of the small intestine to open and close is entirely dependent on the communication of heart and kidney qi. Now with hyperactive heart fire, the clearing qi aspect does not communicate with the small intestine, only the intense fire is pressing, the small intestine has yang without yin, how can it perform transmission and transformation? If the small intestine cannot perform transmission and transformation, how can the bladder substitute for the small intestine to perform transmission and transformation? Moreover, if the heart and kidney qi cannot enter the small intestine, how can it enter the bladder to perform the transmission and transformation of water? The treatment method is to purge the fire in the heart and also benefit the bladder, thus when the heart and kidney qi are connected, urination will also be facilitated."