Bladder pattern identification

The process of diagnosing a morbid condition as a disease pattern of the bladder.

The bladder has the function of opening and closing, that is, the storage and voiding of urine. These functions are reliant upon the qì transformation function of the kidney.

Pathomechanical Features

Disease of the bladder takes the form of abnormalities in the storage and voiding of urine. Three patterns are recognized:

• Bladder vacuity cold, marked by frequent long voidings of clear urine, dribble after voiding, enuresis, or urinary incontinence.
• Bladder retention failure, marked by frequent urination at night, enuresis, and incontinence.
• Bladder damp-heat, characterized by urinary frequency and urgency; painful urination; damp-heat signs.

The first two are generally treated as kidney rather than bladder problems because they fall within the realm of kidney yáng vacuity and insecurity of kidney qì respectively. Modern Chinese-language texts that discuss these in the context of the bladder suggest that they are distinguishable from the two kidney conditions by the absence of kidney vacuity signs other than urinary signs.

The last pattern, bladder damp-heat, is the only bladder pattern discussed in all modern Chinese-language diagnostics textbooks. It differs from the other two and from all kidney patterns by being a repletion rather than a vacuity pattern.

The kidney and bladder stand in exterior-interior relationship with each other. They work together to store and release urine. Kidney-bladder pathologies thus relate to storage and release of urine.

When the kidney’s qì transformation is impaired, not only the production but also the discharge of urine may be compromised. Conversely, impairment of bladder function can also affect the kidney.

• Insufficiency of kidney yáng manifesting in abnormal qì transformation causes dribbling urination and urinary block.
• Insufficiency of kidney qì impairs bladder retention, causing enuresis and urinary incontinence.
• Bladder damp-heat inhibits qì transformation affecting the kidney. This manifests in the form of frequent urination, urinary urgency, rough and painful urination, and distending pain in the lumbus.

Bladder Signs

Bladder signs all relate to urine and urination.

Urinary urgency (尿急 niào jí): Frequent urgent desire to urinate. It is normally ascribed to bladder damp-heat.

Frequent urination (小便频数 xiǎo biàn pín shuò; 尿频 niào pín): Urination more frequent than normal. It occurs in kidney yáng vacuity and in bladder damp-heat.

Scorching pain in the urethra (尿道灼痛 niào dào zhuó tòng): Burning pain in the urethra on urination. It is usually associated with damp-heat and is a major sign of strangury.

Bloody urine (尿血 niào xuè): Urine colored by fresh blood or blood clots in the urine, without any pronounced discomfort. It is called hematuria in biomedicine. It is distinguished from reddish urine, which is urine darker in color than normal. The term is often used in distinction to blood strangury, in which urination is painful, to mark a condition in which pain is absent. Bloody urine is usually attributed to insufficiency of kidney yīn with effulgent heart-liver fire spreading to the small intestine or to dual depletion of the spleen and kidney preventing the blood from being contained.

Stones in the urine (尿有砂石 niào yǒu shā shí): Passing of small particles of calculus in the urine, usually associated with acute pain, and most commonly attributable to damp-heat is a sign of stone strangury (or sand strangury).

Bladder-Related Diseases

Bladder-related diseases include the following:

Strangury (淋 lìn): A disease marked by is dribbling urination (frequent, short, rough voidings) with scorching or stinging pain in the urethra and tension in the smaller abdomen (the lower abdomen). In some cases, there is pain stretching into the lumbus or abdomen. Note that the Chinese term 淋 lìn literally means to drizzle, drip, or dribble, while the English term strangury comes from Greek stranx, drop squeezed out + ouron, urine.

Distinction is made between heat strangury, stone strangury, qì strangury, blood strangury, and unctuous strangury (traditionally called the five stranguries). In most cases, these are caused by damp-heat. Damp-heat is not present in qì strangury, which is strangury caused by qì vacuity or qì stagnation. It is present in blood strangury due to blood heat, but not in blood strangury due to blood vacuity, blood stasis, or blood cold. Here, we focus on strangury caused by damp-heat. While damp-heat patterns are treated by water-disinhibiting dampness-percolating medicinals, other patterns require other categories of medicinals.

Heat strangury (热淋 rè lìn), also called damp-heat strangury (湿热淋 shī rè lìn) arises from damp-heat pouring downward, with heat more pronounced than dampness. It gives rise to scorching pain on urination, short voidings of reddish urine, and sometimes presents with aversion to cold and heat effusion, and a bitter taste in the mouth.

Stone strangury (石淋 shí lìn) arises when damp-heat pours downward and scorches the urine to produce stones. It manifests in difficult urination and the passing of stones, sometimes with complete stoppage of urine and intense pain. Sand strangury is the same condition, but the stones are smaller, like grains of sand.

Blood strangury (血淋 xuè lìn) arises when damp-heat pours downward into the bladder, scorching the network vessels of the bladder and causing frenetic movement of blood. It manifests in dribbling urination with deep-red urine that in some cases contains blood clots.

Unctuous strangury (膏淋 gāo lìn) arises when damp-heat pours downward to cause inhibited qì transformation. The urine becomes murky or like the water that rice has been washed in. When the urine is left to stand, a light sediment forms at the bottom. See white turbidity below.

Qì strangury (气淋 qì lìn) is strangury caused by either qì stagnation (depressed liver qì) or qì vacuity (spleen vacuity qì fall), and hence characterized by distinct accompanying signs.

White turbidity (白浊 bǎi zhuó): A condition in which the urine is white and murky like water in which rice has a been washed. The term white turbidity usually refers to white murky urine unassociated with inhibited urination or pain on urination and is attributable to kidney vacuity or spleen vacuity qì fall. By contrast, unctuous strangury (see above) usually refers to conditions caused by damp-heat and associated with painful inhibited urination. However, in practice, the use of the terms is not so clear-cut.

Bladder Patterns

Bladder damp-heat (膀胱湿热 páng guāng shī rè): Urinary urgency; frequent urination; inhibited urination with scorching pain in the urethra; damp-heat signs. It results from externally contracted damp-heat or from dietary irregularities giving rise to internal damp-heat that pours down into the bladder.