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 44 :Hepatophilic virus disease - TCM classification as “Wetness-heat vaporization form”
 Common symptoms (10):Wetness-heat of lower-jiao (II) 
  Stranguria, turbid urine, leukorrhea
infection of urinary system, acute and chronic cystitis, urethritis, gonorrhea

(下焦濕熱)

　

     “Stranguria” is mostly caused by weakness of kidney energy and excessive sexual activity combined with enclosure of heat in the small intestines and urinary bladder leading to the development of an unclear water passage in the lower-jiao and an intermixing of the clear and turbid gases.  “Stranguria disease” in TCM is not entirely synonymous with modern medical diagnosis; the latter refers to sexually transmitted disease caused by bacterial infection which is only considered as a part of “stranguria disease” in TCM.  (It is not surprise to find that these patients have had chronic hepatitis with a wetness-heat vaporization form of body constitution which is susceptible to “gonorrhea”) 

Actually, “five stranguria” in TCM should include: “overstrain stranguria”, “hematostranguria”, “heat stranguria”, “gi-stagnant stranguria” “stone stranguria”.  Their presenting symptoms are mostly unsmooth and dribbling urination, spasmodic pain in urethra, paste-like urinary discharge or urine excretion associated with blood or stones, darkish or reddish urine, hard feces, and craving for water because of thirst.

 Although the formation and therapy of stranguria are not the same in every case, their common pathology and pathogenesis is the pestilential evil of hepatophilic virus infection causing wetness-heat vaporization which further develops into lower-jiao wetness-heat.  If the illness runs a prolonged course, it will pass into the stage of yin deficiency of liver and kidney and finally, it produces various symptoms of “stranguria”.  In TCM syndrome differentiation and treatment, it bases on clinical manifestations and signs that can be classified into the following types:


Overstrain stranguria: It is due to overloading of the heart, deficiency of spleen and kidney, instability of gi and downflow of wetness-heat to the bladder causing dribbling urination, frequent nocturnal urination with or without pain, and in severe cases post-urination bleeding.

Hematostranguria: It is caused by excessive sexual activities or lower-jiao wetness-heat which runs into the blood portion leading to formation of abnormal blood pathways and urinary excretion of a mixture of turbid and clear urine.  The urine may therefore carry out blood which may be large in amount or sometimes scanty, purplish dark or bright red in color.

Gi-stagnant stranguria: It is formed because wetness-heat is accumulated in the urinary bladder and gi is weak and dropped down.  There is distention and dull pain in the lower abdomen below the navel.
Sand or stone stranguria: This is due to mental depression causing exhaustion of the heart and kidney so that the kidney loses its strengthening power.  Another cause is heat retention in the bladder and depletion of water leading to congregation of salts which cannot be disintegrated by the kidney and therefore they are excreted in the form of sand or stones with urine.  Pain may be experienced in the urethra, navel and abdomen and also during urination, which may be difficult.  Small sand like particles are excreted with urine, but the larger ones obstruct the urinary passage and cause unbearable pain.

Heat stranguria: Because of increasing heat in the heart and lung, the origin of body fluid cannot be effectively supplemented.  If heat is accumulated in the bladder, stranguria is produced.  The urine is reddish and voiding is difficult and there is pain in the shaft of penis.  In severe cases, there is bloody urine and the patient becomes anxious and craves for water.

　

The above commonly seen “five stranguria” originate from downflow of wetness-heat; if chromic hepatitis is confirmed clinically and if physical examination reveals abnormal margin of liver dulness, effective systemic TCM therapy should be given to obtain clinical cure of chronic hepatitis.  This is fundamental treatment of the disease.

 

Introduction of cases (continued)

Case 2

Wong (code number 1203), female, 30 years of age. 

She first visited the clinic on June 1990 with the chief complaint of a history of acute icteric hepatitis of her husband two more years ago.  She was married for 6 years and had a history of abortion of nine weeks pregnancy, after which she had no more pregnancy.  She often had sorethroat, plenty of sputum, fatigue, yellowish urine and recurrent uringry system infection with fever.  She had cystitic irritable symptoms such as lower abdomen distensive pain, frequent urination and dysuria, and although treated for many times but still susceptible to attacks. 

Physical examination revealed hepatomegaly of 1.5 cm.  The tentative diagnosis was chronic hepatitis complicated with lower-jiao wetness-heat “stranguria”; infertility.  The irritable symptoms of bladder disappeared after taking 3 parcels of TCM drugs and after 13 parcels, the liver was normal.  Urine examination showed no abnormality.  Systemic therapy was totally given for 6 weeks, by which time clinical cure was attained and therapy was stopped.

She made a return visit four years later and the liver was found normal.  She said that the year after systemic therapy she gave birth to a male infant and they were all in good health.

Case 3

Shui (code number 2106), female, age 41 years. 

Her first visit was on April 2000.  Her urine examination showed hematuria and albuminuria and was suspected to have nephritis.  She was hospitalized for urinary system examinations but no abnormality was found.  She resisted the advice of biopsy examination in a certain hospital.  Presently, there were still red blood cells in the urine.  She experienced frequency of urination, lower abdominal discomfort during urination and also had repeated insomnia, long periods of common cold, sorethroat, cough, itching of throat, abundant yellowish white leukorrheal discharge, loin pain and difficult to sleep again after waking up. 

Physical examination: abdomen distended, soft and tympani tic, anomaly of hypochondria, percussion tenderness of liver, hepatomegaly of 3 cm, (+) pitting edema of lower extremities.  The tentative diagnosis was chronic hepatitis, liver stagnation and lung dryness and wetness-heat vaporization form complicated with lower-jiao wetness-heat “leukorrheal disease” and “hematostranguria”

After taking 3 parcels of TCM drugs, the margin of liver dullness returned to normal.  Coughing decreased but these was still some pain over the loins.  During the administration of TCM drugs, she had nasal discharge, hoarseness of voice, violent coughing, abdominal distention, nausea, flatulence, and wetness-heat stools.  After nearly two weeks of TCM treatment, coughing began to subside, sleeping was good, loin pain disappeared and the urine was normal.  She occasionally had tenesmus and loose stools. 

After 4 weeks of TCM treatment, routine urine examination was normal and bacterial culture was negative.  After 6 weeks of systemic TCM treatment, clinical symptoms disappeared and drugs were discontinued for observation. 　

　

By WONG  Kwok Hung

published on  31st  July 2001

(translated by Professor ZHENG Hua En in March 2003)

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