“Uroschesis” – hepatogenic prostatic hypertrophy and inflammation causing “retention of urine”
If “retention of urine” occurs in the form of acute urinary stoppage, “catheterization” is the usual management and the following step is to investigate the cause of the retention. Modern surgical treatment can often relieve the cause of urinary retention (such as stones, tumor). But the clinical symptoms of lower-jiao wetness-heat in hepatophilic virus infection patients characterized by the TCM “stranguria”, “turbid urine” “uroschasis” manifestations (in cases with history of chronic hepatitis or abnormal margin of liver dulness in physical examination) should lead one to be scrupulous about the necessity of operative treatment.
Old people are weak and deficient in blood and energy. There are more uroschesis cases of the deficiency type and less of the excess type in old patients. The incidence of uroschesis is higher in the elderly class in which most of the cases are senile prostatic hypertrophy. The cause of the latter is chiefly disorder of the gasification function; other causes are wetness-heat, stagnation of qi and blood stasis. Gasification function defends mainly on the three jiao. The lung is the chief organ in the upper-jiao; if it loses the purifying and lowering functions, water cannot be transported to the bladder. The middle-jiao depends chiefly on the spleen which controls elevation and descent. If the spleen is weak, the function of elevating the clear and lowering the turbid is impaired. In the lower-jiao, the kidney and bladder are in an even more critical position. If the kidney yang is deficient, solid substances can not be gasified and if the kidney yin is deficient, yin can not use water to supply yang and these may all lead to abnormality of gasification function and finally form the presently disease.
According to the TCM pathogenic analysis, the viscera demonstrate the location of illness and the character of illness is guided by the eight principles. The present disease is divided into many forms, namely, excess of lung heat, stagnation of lung qi, heat of kidney and bladder, retention of bladder heat, formation of bladder mass, deficiency of middle-jiao qi, deficiency of kidney yang, exhaustion of kidney yin. In fact, in chronic hepatitis following hepatophilic virus infection, the above forms are caused by prolonged excess of fire in the heart, liver and lung and large intestinal heat. These conditions induce exhaustion of kidney water and the forms classified above are no more than different stages of development of the disease. If effective systemic TCM therapy is given in time, chronic hepatitis may be cured clinically and the symptoms oflower-jiao wetness-heat and uroschesis can be relieved and in some patients, operation may be avoided. These patients, although operated but not treated by effective systemic TCM drugs, would not have an ideal postoperative course and clinical symptoms of lower-jiao wetness-heat may relapse frequently.
Introduction of cases
| Case 7
Tong (code number 473) male, age 66 years. His two sons were confirmed to have type B hepatitis 20 years ago, but he had a negative result on blood examination. His first visit was on October, 1996 with the chief complaint of receiving prostatic operation due to acute anuria five months ago; but after operation there was repeated narrowing of the urethra and also dysuria and anuria which required another two operative episodes of urethral dilatation to improve urination. Not long after the dilatation operation, he again experienced pricking pain in urination and the stream of urine was thready. Especially in the morning, he had to urinate twice for complete excretion and so another urethral dilatation operation seemed unavoidable.
Physical examination revealed a moist and enlarged tongue with teeth prints and yellowish coating. The lower extremities showed (++) edema; hepatomegaly was 1.5 cm. Urine routine examination and bacterial culture showed normal results. The diagnosis was chronic hepatitis and hepatogenic edema; lower-jiao wetness-heat with uroschesis. He received TCM treatment.
After TCM therapy, he felt improvement in dysuria and painful urination. Following administration of 13 parcels of TCM drugs, the liver was normal and urination was smooth. He could do the voiding only once in the morning. The amount of urine is large and there was no pain during urination. Edema of the lower extremities subsided and pitting edema over the pretibial region was (+). TCM therapy was given in a course of 8 weeks. There was pain at the right heel during the medication, but it disappeared during the course of the treatment.
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| Case 8
Chan (code number 0261) male, age 64 years. He had a long history of hepatitis and his first visit was on July 1986. His chief complaint was prolonged nausea, acid regurgitation, upper abdominal pain and insomnia of eight years duration. He was diagnosed to have peptic ulcer and neurosis and was uninterruptedly given gastric drugs and sedatives. He had ultrasonography of the liver and spleen; the result was chronic hepatitis, decrease of liver size but no splenomegaly. Liver function test: C.C.F.T (++). Barium meal examination of the gastrointestinal tract showed ulcer of the lesser curvature. Gastroscopy and biopsy proved the existence of benign gastric lesser curvature large ulcer. Physical examination: decrease of area of liver dullness, lower margin of liver 3 cm above costal margin. After taking 33 parcels of TCM drugs, the liver returned to normal. Ultrasonic examination four months after cessation of medication showed mild persistent hepatitis, liver shrinkage about 0-1 cm and X-ray examination revealed marked decrease of size of peptic ulcer. Medication was stopped after 6 weeks of TCM therapy. In the following years, he received TCM treatment from time to time and during this period, he suffered from myocardial ischemia, urinary system infection, post-operative hemorrhage after bladder stone surgery and hypertension, but all these successfully treated by TCM and modern medical methods. He is now eight more years of age, in good health and has no relapse of hepatomegaly.
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By WONG Kwok Hung
published on 21st August 2001
(translated by Professor ZHENG Hua En in 2003)