Home Forums Diplomate Discussion Difficult Urination Case

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    • #7171
      eraneven
      Participant

      I’d love some help with a stubborn case I’m having trouble shifting. I’ll try and keep it short. Male 62 years old presented with obstructive and painful urination (strangury) for 8 years. Dribbling and hesitant urination with strong pain in the lower abdomen. He has frequent urination (>15x/day), with no burning sensation. Very occasional blood in the urine, as well as semen (only a couple times). No testicle pain, no perineal pain. In addition, he has some bloating after meals, is sensitive to temperature changes, has left subcostal tenderness, is thirsty, has SOB on exertion and feels anxious. Pulses were mid-thin-wiry on left cun and guan, and deep-thin on chi; floating-tight on right cun and mid-wiry on guan. I gave him Si Ni San + Gui Zhi Fu Ling Wan + mu li, tian hua fen. Follow up: strangury episodes reduced, subcostal tenderness was less, bloating went down, and no thirst, but overall urinary symptoms were still the same. Pulses now are deep-wiry-thin on left cun and guan and deep-thin-sl. weak chi. The right cun is still floating and less tight, and deep-wiry right guan. Prescribed Shen Qi Wan + Gui Zhi Fu Ling Wan + Gua Lou Qu Mai Wan. The strangury reduced, but frequency and pelvic pain remained the same. Some post voiding urination. Essentially I’ve seen him a couple times since and depending on some pulse signs I’ve gone between Ling Gui Zhu Gan Tang, Gua Lou Qu Mai Wan and even Da Huang Zhe Chong Wan with varying results, but nothing solid. The pain, frequency and flow are the targets and they’re being stubborn. Last visit, his pulses were all deep-wiry across the board, which to me suggests water encumbering yang, but none of these water formulas have done much. This guy has seen tons of practitioners and has been given the most insane formulas (one with 72 herbs) and nothing has helped!

    • #7759
      timothyross
      Participant

      If the right cun was still floating and tight? I could see a Fu Zi Ma Huang Combo, so maybe MHFZXXT? How is the abdomen?

    • #7758
      laurieayres
      Participant

      One possibility is YBWW, but that’s similar to what you’ve done thus far, so with all pulses deep and wiry, I’d agree with Christoph Ludwig Beer on ZWT, as everything else you’ve tried so far. Though having FZ has also had an element of cooling the lower too, SD, QM, MDP etc. and though you would typically need an element of that when the urination is dribbling, it hasn’t fully worked. I’d just go with straight warming and then you get a clear answer either way. From what you’ve done so far you can conclude that warming is not wrong, as urine isn’t dark, and the warming you’ve done (though combined with some cooling) hasn’t led to an exacerbation, but to a slight improvement. If there is bleeding at the time, then you could also do ZWT –BS +GJ, just to keep the message clear, otherwise start unmodified.

    • #8054
      timothyross
      Participant

      Except at ICEAM conferences, we put everything on Facebook! 😂

    • #7762
      Chun-Kai
      Participant

      Has this person checked his prostate and PSA? These are prostate symptoms by his age

    • #8055
      john braide
      Participant

      Thanks. Is this a pre SHZBL formula?

    • #8056
      timothyross
      Participant

      Throw some buffers in like Dang Gui and Chi Xiao Dou?

    • #8057
      eraneven
      Participant

      Yes, of course. All normal.

    • #8058
      laurieayres
      Participant

      No, it’s post SHZBL – SQW -FZ&GZ +ZM&HB

    • #8059
      eraneven
      Participant

      Tim Ross you think it’s enough to open the bladder? I’m thinking if there’s very little yang in the interior, would MHFZXXT open the surface too much? There’s fever and closure of the lung with this formula, so I’m having a hard time seeing the correlation aside from the right cun. Hmmm…..

    • #8060
      john braide
      Participant

      Its only anticlockwise to us, when seem from the heavens its clockwise!I have always felt the same on anticlockwise seemingly ‘counter to nature’s order’ but I am starting to wonder if it’s our bias and perhaps a western one at that, brought on by our term ‘clockwise’ amongst other things.For instance driving on the wrong side of the road like you guys do seems anticlockwise and unnatural 😋Hmmm nice one on the å character…

    • #8061
      timothyross
      Participant

      I’m just throwing ideas out. I think there is something in the right cun and the relationship of lung and bladder, like maybe the lungs needs to open a little more to open the bladder a little more.

    • #8062
      laurieayres
      Participant

      Nope! There is no other name! 🙂

    • #8063
      eraneven
      Participant

      Tim Ross absolutely. I appreciate the discussion. Yes, that right cun could hold the secret, and there must be something to it as clearly something’s not working with my current approach.

    • #8064
      john braide
      Participant

      Right? As soon as I tried typing it, I felt Darth Vader’s grip around my throat.

    • #8065
      Christoph Ludwig Beer
      Guest

      ZWT can also have a right tight cun. Have you tried that?

    • #8066
      laurieayres
      Participant

      That wasn’t Darth Vader it was ZZJ

    • #8067
      timothyross
      Participant

      ZWT would appear to be a much more reasonable choice.

    • #8068
      john braide
      Participant

      Fine. But you know Darth is in our lineage somewhere.

    • #8069
      eraneven
      Participant

      Christoph Ludwig Beer: Yes, when I used LGZGT with GLQMW I added SJ to incorporate it in as well. Haven’t used it alone though.

    • #8070
      Chun-Kai
      Participant

      Sqw – fzgz +zmhb isn’t that zhibaidihuangwan?

    • #8071
      Christoph Ludwig Beer
      Guest

      Try it alone, it seems to work different if used solo in some cases. Also considering adding PHS, or CQC.

    • #8072
      eraneven
      Participant

      I forgot to mention that he occasionally has bleeding haemorrhoids and given the random bleeding in the urine, I was apprehensive to use ma Huang.

    • #8073
      eraneven
      Participant

      Sounds good, thank you sir. I’ll keep things simple and give it a whirl. Much appreciated.

    • #8074
      john braide
      Participant

      YBWW?

    • #8079
      laurieayres
      Participant

      Chunkai Jason Wang we don’t approve of that kind of dirty language in these here parts!

    • #7760
      eraneven
      Participant

      Update on case: gave patient straight up Zhen Wu Tang, and he just sent me an email saying the urinary pain/discomfort has increased!!! Argh!! Thoughts?!?

    • #7755
      Christoph Ludwig Beer
      Guest

      Okay. That’s the thing that really isn’t DGSNJWZYSJT. Maybe JZT/ZWT combo. Can do ZS at 18.

    • #7761
      eraneven
      Participant

      Laurie Ayres, I wanted to update you and ask for your input. I saw her on 8/10/17 and she reported that her sinus pressure is 90% gone, but there is still some behind her eyes in the afternoon. She’s still having clear nasal dripping in the morning, which is what she originally came in for earlier this year. Her BMs have been formed, and there hasn’t been any rib pain, nausea, etc. L: all thin wiry, 2 big, dong 1-2, roll up; R: 1 slightly tight, 2 wiry slightly weak, 3 thin wiry, slight roll up. I gave her CHGZGJT again, + LGZGT + XB and GG.

    • #7757
      Arnaud Versluys
      Keymaster

      Engert

    • #8114
      Christoph Ludwig Beer
      Guest

      I know the type….

    • #8115
      eraneven
      Participant

      I’m waffling: DGSYS + CXDDGS, or DGJZT + CXDDGS. Should I address that big R Guan at the same time, since the eczema flare is slightly calmed down now that she stopped herbs? Also to be clear, there’s no blood. It’s just oozing fluids and is red with pustules. After it’s done oozing, it gets dry and itchy. Her main complaint though is the shoulder/neck pain.

    • #8116
      Arnaud Versluys
      Keymaster

      Huang Qin? Especially since FZ made him worse, there might be trapped heat.

    • #8117
      Christoph Ludwig Beer
      Guest

      As I mentioned, since ZWT made it worse, you need to harmonise MF, and the only way to do that is using Huangqin. (kinda repeating what Arnaud Versluys just spelled out 😉

    • #8118
      Arnaud Versluys
      Keymaster

      Peter

    • #8119
      eraneven
      Participant

      Thanks boys. Hopefully that’s the missing link. I’ll give it a whirl and report back.

    • #7756
      Christoph Ludwig Beer
      Guest

      Hey Eran Even,I’ve been thinking about your case again. Maybe a wild guess, but MLZXT came to my mind–closure of the lower jiao with water qi. Since it combines warming approach like FZ and some cooling herbs and salty opening. Should have deep and tight pulses. Since using THF and ML helped initially, I though of other salty cooling methods. Just keep it on the radar…

    • #8130
      eraneven
      Participant

      TXS+FL maybe

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