Home › Forums › Diplomate Discussion › Difficult Urination Case
- This topic has 44 replies, 1 voice, and was last updated 7 years, 3 months ago by
eraneven.
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October 16, 2017 at 3:49 am #7171
eraneven
ParticipantI’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!
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October 16, 2017 at 3:50 am #7759
timothyross
ParticipantIf the right cun was still floating and tight? I could see a Fu Zi Ma Huang Combo, so maybe MHFZXXT? How is the abdomen?
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October 16, 2017 at 3:51 am #7758
laurieayres
ParticipantOne 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.
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October 16, 2017 at 3:51 am #8054
timothyross
ParticipantExcept at ICEAM conferences, we put everything on Facebook! 😂
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October 16, 2017 at 3:52 am #7762
Chun-Kai
ParticipantHas this person checked his prostate and PSA? These are prostate symptoms by his age
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October 16, 2017 at 3:53 am #8055
john braide
ParticipantThanks. Is this a pre SHZBL formula?
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October 16, 2017 at 3:53 am #8056
timothyross
ParticipantThrow some buffers in like Dang Gui and Chi Xiao Dou?
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October 16, 2017 at 3:53 am #8057
eraneven
ParticipantYes, of course. All normal.
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October 16, 2017 at 3:54 am #8058
laurieayres
ParticipantNo, it’s post SHZBL – SQW -FZ&GZ +ZM&HB
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October 16, 2017 at 3:54 am #8059
eraneven
ParticipantTim 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…..
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October 16, 2017 at 3:55 am #8060
john braide
ParticipantIts 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…
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October 16, 2017 at 3:55 am #8061
timothyross
ParticipantI’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.
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October 16, 2017 at 3:56 am #8062
laurieayres
ParticipantNope! There is no other name! 🙂
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October 16, 2017 at 3:56 am #8063
eraneven
ParticipantTim 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.
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October 16, 2017 at 3:57 am #8064
john braide
ParticipantRight? As soon as I tried typing it, I felt Darth Vader’s grip around my throat.
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October 16, 2017 at 3:57 am #8065
Christoph Ludwig Beer
GuestZWT can also have a right tight cun. Have you tried that?
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October 16, 2017 at 3:58 am #8066
laurieayres
ParticipantThat wasn’t Darth Vader it was ZZJ
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October 16, 2017 at 3:58 am #8067
timothyross
ParticipantZWT would appear to be a much more reasonable choice.
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October 16, 2017 at 3:59 am #8068
john braide
ParticipantFine. But you know Darth is in our lineage somewhere.
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October 16, 2017 at 3:59 am #8069
eraneven
ParticipantChristoph Ludwig Beer: Yes, when I used LGZGT with GLQMW I added SJ to incorporate it in as well. Haven’t used it alone though.
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October 16, 2017 at 4:00 am #8070
Chun-Kai
ParticipantSqw – fzgz +zmhb isn’t that zhibaidihuangwan?
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October 16, 2017 at 4:00 am #8071
Christoph Ludwig Beer
GuestTry it alone, it seems to work different if used solo in some cases. Also considering adding PHS, or CQC.
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October 16, 2017 at 4:01 am #8072
eraneven
ParticipantI forgot to mention that he occasionally has bleeding haemorrhoids and given the random bleeding in the urine, I was apprehensive to use ma Huang.
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October 16, 2017 at 4:02 am #8073
eraneven
ParticipantSounds good, thank you sir. I’ll keep things simple and give it a whirl. Much appreciated.
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October 16, 2017 at 4:03 am #8074
john braide
ParticipantYBWW?
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October 17, 2017 at 4:01 am #8079
laurieayres
ParticipantChunkai Jason Wang we don’t approve of that kind of dirty language in these here parts!
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October 25, 2017 at 3:53 am #7760
eraneven
ParticipantUpdate 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?!?
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October 25, 2017 at 3:54 am #7755
Christoph Ludwig Beer
GuestOkay. That’s the thing that really isn’t DGSNJWZYSJT. Maybe JZT/ZWT combo. Can do ZS at 18.
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October 26, 2017 at 3:55 am #7761
eraneven
ParticipantLaurie 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.
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October 26, 2017 at 3:56 am #7757
Arnaud Versluys
KeymasterEngert
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October 26, 2017 at 3:56 am #8114
Christoph Ludwig Beer
GuestI know the type….
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October 26, 2017 at 3:57 am #8115
eraneven
ParticipantI’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.
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October 26, 2017 at 3:58 am #8116
Arnaud Versluys
KeymasterHuang Qin? Especially since FZ made him worse, there might be trapped heat.
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October 26, 2017 at 3:59 am #8117
Christoph Ludwig Beer
GuestAs 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 😉
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October 26, 2017 at 4:00 am #8118
Arnaud Versluys
KeymasterPeter
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October 26, 2017 at 4:01 am #8119
eraneven
ParticipantThanks boys. Hopefully that’s the missing link. I’ll give it a whirl and report back.
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October 29, 2017 at 3:57 am #7756
Christoph Ludwig Beer
GuestHey 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…
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October 29, 2017 at 3:58 am #8130
eraneven
ParticipantTXS+FL maybe
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