Difficult voiding of scant urine. Inhibited urination is ascribed to nondiffusion of lung qì, devitalization of spleen yáng, debilitation of kidney yáng, internal damp-heat obstruction, or qì stagnation with damp obstruction. These patterns all involve reduced flow of urine to the bladder due to yáng qì vacuity or the presence of evil qì. In addition, there are yīn vacuity patterns, which, according to some, should not strictly be considered as inhibited urination patterns because they are essentially attributable to depletion of fluids.
Patterns
Nondiffusion of lung qì (肺气不宣 fèi qì bù xuan) inhibited urination results from invasion of wind evil (wind-cold or wind-heat) and is associated with swelling of the eyelids gradually giving way to generalized water swelling, heavy aching limbs, heat effusion, fear of wind, cough and hasty panting, sometimes sore throat, thin white tongue fur, and a tight floating or rapid floating pulse.
Medicinal therapy: Diffuse the lung and move water with formulas such as Spleen-Effusing Decoction (越婢汤yuè bì tāng).
Acumoxatherapy: Base treatment mainly on alarm and back transport points of BL, and on LU and LI. Select LU-5 (Cubit Marsh, 尺泽 chǐ zé), LI-11 (Pool at the Bend, 曲池 qū chí), LI-4 (Union Valley, 合谷 hé gǔ), CV-3 (Central Pole, 中极 zhōng jí), BL-13 (Lung Transport, 肺俞 fèi shù), BL-28 (Bladder Transport, 膀胱俞 páng guāng shù), and BL-22 (Triple Burner Transport, 三焦俞 sān jiāo shù); needle with drainage.
Point selection according to signs: For water swelling, add CV-9 (Water Divide, 水分 shuǐ fēn), CV-6 (Sea of Qì, 气海 qì hǎi), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), GV-26 (Human Center, 人中 rén zhōng), and LI-6 (Veering Passageway, 偏历 piān lì). For heat effusion and fear of wind, add GB-20 (Wind Pool, 风池 fēng chí), TB-5 (Outer Pass, 外关 wài guān), and GV-14 (Great Hammer, 大椎 dà zhuī). For cough and panting, add LU-7 (Broken Sequence, 列缺 liè quē). For sore swollen throat, prick LU-11 (Lesser Shang, 少商 shào shāng) to bleed.
Devitalization of spleen yáng (脾阳不振 pí yáng bù zhèn) can cause inhibited urination associated with water swelling that is more severe below the waist, lassitude of spirit and physical fatigue, withered-yellow facial complexion, head heavy as if swathed, heavy cumbersome limbs, distension and fullness in the stomach duct and abdomen, reduced food intake, sloppy stool, lack of warmth in the extremities, pale enlarged tongue, glossy white tongue fur, and a forceless slow sunken pulse.
Medicinal therapy: Warm and move spleen yáng; promote the qì transformation and move water. Use Spleen-Firming Beverage (实脾饮shí pí yǐn) and variations.
Acumoxatherapy: Base treatment mainly on back transport points, SP, and ST. Select BL-20 (Spleen Transport, 脾俞 pí shù), BL-23 (Kidney Transport, 肾俞 shèn shù), BL-22 (Triple Burner Transport, 三焦俞 sān jiāo shù), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), and CV-4 (Pass Head, 关元 guān yuán); needle with supplementation and add moxa.
Point selection according to signs: For generalized swelling, add CV-9 (Water Divide, 水分 shuǐ fēn), CV-6 (Sea of Qì, 气海 qì hǎi), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), and SP-9 (Yīn Mound Spring, 阴陵泉 yīn líng quán). For heavy-headedness, add ST-8 (Head Corner, 头维 tóu wéi) and Greater yáng (tài yáng) (太阳tài yáng). For distension and fullness in the stomach duct and abdomen, add PC-6 (Inner Pass, 内关 nèi guān), ST-25 (Celestial Pivot, 天枢 tiān shū), and CV-6 (Sea of Qì, 气海 qì hǎi). For sloppy stool, add CV-12 (Center Stomach Duct, 中脘 zhōng wǎn), LR-13 (Camphorwood Gate, 章门 zhāng mén), and ST-25 (Celestial Pivot, 天枢 tiān shū).
Kidney yáng vacuity (肾阳虚 shèn yáng xū) inhibited urination is associated with water swelling that is more pronounced below the waist, bright-white facial complexion, panting, cough, and phlegm rale, heart palpitation and hasty breathing, physical cold and cold limbs, cold heavy aching lumbus and knees, pale enlarged tongue with dental impressions, glossy white tongue fur, and a sunken weak cubit pulse.
Medicinal therapy: Warm the kidney and assist yáng; promote qì transformation and move water. Use True Warrior Decoction (真武汤zhēn wǔ tāng).
Acumoxatherapy: Base treatment mainly on back transport points, GV, CV, KI, and SP. Select BL-23 (Kidney Transport, 肾俞 shèn shù), GV-4 (Life Gate, 命门 mìng mén), CV-4 (Pass Head, 关元 guān yuán), CV-6 (Sea of Qì, 气海 qì hǎi), BL-20 (Spleen Transport, 脾俞 pí shù), BL-22 (Triple Burner Transport, 三焦俞 sān jiāo shù), KI-10 (Yīn Valley, 阴谷 yīn gǔ), and SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo); needle with supplementation and add moxa.
Point selection according to signs: For generalized swelling, see above. For panting, cough, and phlegm rale, add BL-13 (Lung Transport, 肺俞 fèi shù), LU-9 (Great Abyss, 太渊 tài yuān), ST-40 (Bountiful Bulge, 丰隆 fēng lóng), and LI-4 (Union Valley, 合谷 hé gǔ). For heart palpitation and hasty breathing, add BL-15 (Heart Transport, 心俞 xīn shù), CV-14 (Great Tower Gate, 巨阙 jù què), and HT-7 (Spirit Gate, 神门 shén mén). For cold heavy aching lumbus, add GV-3 (Lumbar Yáng Pass, 腰阳关 yāo yáng guān) and BL-40 (Bend Center, 委中 wěi zhōng).
Internal damp-heat obstruction (湿热内阻 shī rè nèi zǔ) causes inhibited urination associated with heart vexation, desire to vomit, bitter taste in the mouth with sticky slimy sensation, thirst without desire to drink, torpid intake and abdominal distension, constipation or sloppy and grimy stool, red tongue with yellow fur, and a soggy rapid pulse.
Medicinal therapy: Treat by clearing heat and disinhibiting dampness, and offensively expelling water-damp, with formulas such as Coursing and Piercing Drink (疏凿饮子shū záo yǐn zi).
Acumoxatherapy: Base treatment mainly on alarm and back transport points of BL, and on SP. Select CV-3 (Central Pole, 中极 zhōng jí), BL-28 (Bladder Transport, 膀胱俞 páng guāng shù), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), SP-9 (Yīn Mound Spring, 阴陵泉 yīn líng quán), and KI-7 (Recover Flow, 复溜 fù liū); needle with drainage.
Point selection according to signs: For thirst, add TB-2 (Humor Gate, 液门 yè mén), and KI-6 (Shining Sea, 照海 zhào hǎi). For torpid intake and abdominal distension, add ST-44 (Inner Court, 内庭 nèi tíng), PC-6 (Inner Pass, 内关 nèi guān), and ST-25 (Celestial Pivot, 天枢 tiān shū). For constipation, add, LI-4 (Union Valley, 合谷 hé gǔ), LI-11 (Pool at the Bend, 曲池 qū chí), TB-6 (Branch Ditch, 支沟 zhī gōu), and ST-37 (Upper Great Hollow, 上巨虚 shàng jù xū). For sloppy grimy stool, add ST-25 (Celestial Pivot, 天枢 tiān shū), and ST-37 (Upper Great Hollow, 上巨虚 shàng jù xū).
Qì stagnation with damp obstruction (气滞湿阻 qì zhì shī zǔ) causes inhibited urination accompanied by bitter taste in the mouth, dry pharynx, constrained feeling in the chest and rib-side, reduced food intake, belching, acid swallowing, and abdominal distension after eating, in severe cases with enlargement of the abdomen but with no hardness under pressure. The tongue is red with a thin yellow fur, and the pulse is stringlike.
Medicinal therapy: Course the liver and resolve depression; move qì and disinhibit water. Use Bupleurum Liver-Coursing Powder (柴胡疏肝散chái hú shū gān sǎn) combined with Stomach-Calming Poria Five Decoction (胃苓汤wèi líng tāng).
Acumoxatherapy: Base treatment mainly on alarm and back transport points of BL, and on LR, GB, PC, and SP. Select CV-3 (Central Pole, 中极 zhōng jí), BL-28 (Bladder Transport, 膀胱俞 páng guāng shù), LR-3 (Supreme Surge, 太冲 tài chōng), GB-34 (Yáng Mound Spring, 阳陵泉 yáng líng quán), PC-6 (Inner Pass, 内关 nèi guān), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), and SP-9 (Yīn Mound Spring, 阴陵泉 yīn líng quán); needle with drainage.
Point selection according to signs: For discomfort in the chest and ribs, add LR-14 (Cycle Gate, 期门 qī mén) and GB-24 (Sun and Moon, 日月 rì yuè). For belching and acid swallowing, add CV-17 (Chest Center, 膻中 shān zhōng) and CV-6 (Sea of Qì, 气海 qì hǎi). For abdominal distension after eating, add CV-12 (Center Stomach Duct, 中脘 zhōng wǎn), CV-10 (Lower Stomach Duct, 下脘 xià wǎn), ST-25 (Celestial Pivot, 天枢 tiān shū), and CV-6 (Sea of Qì, 气海 qì hǎi).
Yin vacuity (阴虚 yīn xū) can also cause inhibited urination associated with short voidings of yellow urine, dizziness, tinnitus, heart vexation, bitter taste in the mouth, dry pharynx, vexing heat in the five hearts, limp aching lumbus and knees, in some cases repeated episodes of water swelling, red tongue with scant fur, and fine rapid pulse.
Medicinal therapy: Treat by enriching the liver and kidney, and by disinhibiting urine. Use Life Saver Kidney Qì Pill (济生肾气丸jì shēng shèn qì wán).
Acumoxatherapy: Base treatment mainly on back transport points and KI. Select BL-23 (Kidney Transport, 肾俞 shèn shù), BL-22 (Triple Burner Transport, 三焦俞 sān jiāo shù), CV-4 (Pass Head, 关元 guān yuán), KI-10 (Yīn Valley, 阴谷 yīn gǔ), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), KI-3 (Great Ravine, 太溪 tài xī), and KI-7 (Recover Flow, 复溜 fù liū); needle with supplementation.
Point selection according to signs: For heart vexation, add HT-7 (Spirit Gate, 神门 shén mén) and HT-5 (Connecting Lǐ, 通里 tōng lǐ). For dry pharynx, add KI-6 (Shining Sea, 照海 zhào hǎi) and TB-2 (Humor Gate, 液门 yè mén). For limp aching lumbus and knees, GV-3 (Lumbar Yáng Pass, 腰阳关 yāo yáng guān) and BL-40 (Bend Center, 委中 wěi zhōng). Inhibited urination due to exhaustion of yīn liquid through excessive promotion of sweating, ejection, or precipitation is treated exclusively by nourishing yīn and increasing humor, and hence goes beyond the scope of inhibited urination proper. See dribbling urinary block; strangury-turbidity; shifted bladder; water swelling.