bubble_chart Concept

Post-micturition dribbling refers to the symptom of having residual drops of urine after urination.

Neijing only records "bladder dysfunction leading to retention, and lack of restraint leading to enuresis." Zhubing Yuanhou Lun first listed "deficiency fatigue with residual urine" as a specific condition, and later generations continued to use this name, though not entirely the same, such as Yixue Rumen calling it "post-micturition dribbling," and Maijue referring to it as "urinary dribbling."

Post-micturition dribbling and incontinence of urine have often been confused as the same condition in historical medical texts. However, post-micturition dribbling refers to residual drops of urine after urination, while incontinence of urine is the constant involuntary leakage of urine, which is more voluminous. Clinically, they should be distinguished.

If white mucus is discharged along with urine after urination, it is a symptom of semen mixed with urine and is not within the scope of this discussion.

bubble_chart Pattern Analysis

1. Kidney Deficiency and Uterine Cold︰Frequent and clear urination, dribbling after voiding, mental fatigue, physical exhaustion, soreness and weakness in the lower back, cold limbs, pale tongue with white coating, deep and thin pulse especially at the chi position. Often caused by prolonged illness or excessive sexual activity, injuring kidney qi, kidney deficiency leading to deficient qi transformation, and the bladder's inability to restrain, resulting in post-void dribbling.
2. Spleen Qi Deficiency︰Post-void dribbling, intermittent and triggered by fatigue, with a pale complexion, mental exhaustion, reduced appetite, loose stools, lower abdominal distension and sagging sensation, pale tongue with white coating, and soggy-slow or thin-weak pulse. Mostly caused by dietary overstrain and weakness of middle qi, leading to failure of lifting and resulting in post-void dribbling. Key points for differentiation: Kidney deficiency with uterine cold is characterized by frequent urination with clear and copious urine, soreness and weakness of the lower back and legs, cold extremities, and aggravation by cold, commonly seen in the elderly. Treatment should focus on warming the kidney and reinforcing astringency, using modified Kidney Qi Pill combined with Mantis Egg-Case Powder. Middle qi deficiency is characterized by mental exhaustion, reduced appetite, loose stools, and lower abdominal distension and sagging sensation, commonly seen in middle-aged adults. Treatment should focus on tonifying the middle and replenishing qi, using modified Middle-Tonifying Qi-Replenishing Decoction.
3. Bladder Dampness-heat︰Frequent urination, yellow or turbid urine, dribbling after urination, accompanied by burning pain in the urethra, red tongue with yellow greasy coating, soggy and rapid pulse. Mostly caused by dampness-heat accumulation in the lower energizer, dysfunction of qi transformation, and failure of the bladder to restrain, leading to dribbling after urination. The syndrome is characterized by frequent urination, urgency, dysuria, and yellow or turbid urine. Treatment should focus on {|###|}clearing heat and draining dampness{|###|}, and the prescription used is Eight-Ingredient Rectification Powder with modifications.

The symptom of post-urination dribbling should be differentiated into deficiency and excess patterns. Deficiency syndromes are more common and often present with clear and copious urine, frequent nighttime urination, and frequent urination. The treatment generally involves warming and tonifying to consolidate and astringe. Excess syndromes often present with frequent, urgent, and painful urination, and the treatment should focus on clearing heat and draining dampness. As for stranguria presenting with post-urination dribbling, as mentioned in "Luo's Medical Mirror on Strangury and Retention": "Qi stranguria causes difficulty in urination, often with residual dribbling, leading to incomplete voiding." Alternatively, if trauma damages the bladder, causing residual dribbling, the treatment should target the root cause. Once the primary condition is resolved, the residual dribbling will naturally cease.

bubble_chart Documentation

1. Zhubing Yuanhou Lun．Deficiency Fatigue and Dribbling Urine: "The kidney governs water. In people who are overworked and injured, the kidney qi is deficient and weak, unable to store water. The bladder is internally deficient and cold, hence after urination, the water does not stop and there is dribbling. A slow and thin pulse at the chi position indicates dribbling urine."
2. Yixue Rumen．Incontinence of Urine: "Deficiency and internal damage below lead to the bladder not being restrained, resulting in involuntary urination or dribbling after urination, all due to excessive fire causing water to be unsettled. Treatment should focus on nourishing the yin blood of the bladder and purging fire pathogens, supplemented with Asiatic Cornelian Cherry Fruit, oyster shell, Schisandra Fruit, etc. Warm medicines should not be used."
3. Zhangshi Yitong．Incontinence of Urine: "There are also cases where after urination, one thinks it is finished, but after a short while, a little more comes out. This is mostly due to holding urine and engaging in sexual activity. It is advisable to use raw Five Ingredients with Poria Powder with Donkey-hide Gelatin, and take modified Eight Flavor Pills."