Dysuria refers to a symptom characterized by scanty and difficult urination. This symptom is referred to as "difficulty in urination" in the Suwen．Jue Lun, as "small constipation disease" in the Biaoben Bingchuan Lun, and as "difficulty in urination" in the Shuirexue Lun. In the Jingui Yaolue．Water Qi Abnormal Pulse Syndrome and Treatment, it is referred to as "difficulty in urination" and "inability to relieve oneself".

This symptom is easily confused with anuria. Anuria refers to the presence of urine in the bladder but difficulty in urination, which is similar to ischuria; this symptom, however, refers to scanty or no urine.

Painful urination refers to pain in the urethra during urination, which is different from the above two symptoms, but in some patients, these three symptoms can occur simultaneously.

bubble_chart Pattern Analysis

1. Lung Qi Failing to Disperse︰Difficulty in urination, eyelid edema, followed by edema in the limbs or even the whole body, accompanied by soreness and heaviness in the limbs, fever with aversion to wind, cough and panting, or sore throat, thin white tongue coating, and floating-tight or floating-rapid pulse. This syndrome is often caused by wind evil attacking the lung, leading to impaired lung qi dispersion and failure to dredge and regulate the water passage to the bladder. The characteristic of this syndrome is edema spreading from the face and eyes to the whole body due to water-dampness overflowing the skin. This syndrome is an exterior excess pattern, accompanied by symptoms such as aversion to cold, fever, joint soreness, cough and panting, and throat discomfort. The treatment should focus on ventilating the lung and promoting water movement, and the prescription selected is Spleen-Qi Effusing plus Atractylodes Decoction.
2. Spleen Yang Deficiency︰Scanty urine, generalized edema especially in the lower body, mental fatigue, physical tiredness, complexion shallow yellow, heaviness of the head as if wrapped, heavy sensation in limbs, epigastric abdominal distension and fullness, reduced appetite, loose stool, cold extremities, pale swollen and moist tongue, white slippery tongue coating, deep slow and weak pulse. Mostly caused by cold-dampness invasion or overstrain internal damage, leading to impaired spleen yang and failure of transportation, resulting in scanty urine due to water-dampness stagnation. Treatment involves warming and activating spleen yang, warming yang qi to promote diuresis. Prescription selection: Spleen-Strengthening Decoction with modifications.
3. Kidney Yang Deficiency︰Difficulty in urination, generalized edema especially in the lower body, {|###|}complexion㿠白{|###|}, wheezing and cough with phlegm sounds, {|###|}palpitation{|###|} and shortness of breath, cold intolerance and cold limbs, soreness and heaviness in the waist and knees with cold pain, pale and swollen tongue with teeth marks, white and slippery tongue coating, deep and weak pulse at the chi position. It may be caused by prolonged illness leading to {|###|}damage to yang{|###|}, constitutional {|###|}yang deficiency{|###|}, etc., resulting in insufficient life-gate fire and the {|###|}bladder{|###|} failing to perform qi transformation, leading to difficulty in urination. The treatment should focus on {|###|}warming kidney and assisting yang{|###|}, {|###|}warming yang qi to promote diuresis{|###|}, with True Warrior Decoction as the main prescription.
4. Dampness-heat︰Short and scanty dark urine, irritability and nausea, bitter taste in the mouth with stickiness, thirst without desire to drink, anorexia, abdominal distension and fullness, severe constipation or loose sticky stools, red tongue with yellow greasy coating, soggy and rapid pulse. This is due to dampness-heat. It results from exposure to dampness-heat pathogens or internal retention of water-dampness that transforms into heat over time, leading to the binding of dampness-heat and obstruction of the triple energizer's water pathways, manifesting as dysuria. Treatment involves clearing and draining damp-heat and expelling water-dampness. The formula selected is Dredging and Channelling Decoction with modifications.
5. Qi Stagnation with Dampness Obstruction︰Difficulty in urination, bitter taste in mouth, dry throat, discomfort in the chest and hypochondrium, reduced appetite, belching acid swallow, abdominal distension and fullness after eating, or even an enlarged abdomen that feels soft upon palpation, red tongue with thin yellow coating, wiry pulse. Mostly caused by emotional distress, {|###|}liver qi depression{|###|}, qi stagnation leading to impaired water passage, hence scanty urine. Impaired liver dispersion, qi depression transforming into fire, wood overacting on earth, resulting in symptoms such as {|###|}fullness and discomfort in chest and hypochondrium{|###|}, {|###|}belching acid swallow{|###|}, wiry pulse, etc. Treatment should focus on {|###|}soothing liver and relieving depression{|###|}, moving qi to promote urination. The prescription is modified from Bupleurum Liver-Soothing Powder combined with Stomach Poria Decoction.
6. Yin Deficiency︰Due to liver-kidney yin deficiency, body fluids cannot be distributed, leading to the main symptoms of scanty and yellow urine, vertigo, tinnitus, vexation, bitter taste in the mouth, dry throat, vexing heat in the chest, palms and soles, soreness and weakness of the waist and knees, or recurrent edema, red tongue with scant coating, and thin rapid pulse. The treatment involves nourishing the liver and kidney while promoting urination, with the Kidney Qi Pill from "Ji Sheng" as the primary remedy.

Spleen yang deficiency and kidney yang deficiency: both are yang deficiency pattern, and the retention of water-dampness is particularly severe below the waist.

Internal obstruction of dampness-heat and qi stagnation with dampness obstruction: the similarity lies in the presence of heat signs in both syndromes, but the former is due to dampness-heat, while the latter is due to liver depression transforming into heat.

As for excessive sweating, or vomiting and diarrhea leading to exhaustion of yin fluids and resulting in dysuria, treatment should focus on the root cause, supplemented by nourishing yin and supplementing fluids, which will not be discussed in this section.

bubble_chart Documentation

1. Zabing Yuanliu Xizhu．"The Origin and Development of Minor Constipation Diseases" states: Gangmu said: There are three types of frequent urination without relief. If there is diarrhea and the body fluids are scanty, this is the first type, and it should be treated by promoting urination. If heat attacks the lower energizer and the body fluids cannot flow, this is the second type, and it must be treated by promoting diuresis to recover. If the spleen and stomach qi are obstructed, unable to dredge and regulate the water passage, and thus cannot transport to the bladder for transformation, this is the third type, and it can be treated by swallowing qi to promote transformation and excretion, such as Poria Amber Powder.