bubble_chart Concept

Painful urination, abbreviated as dysuria, refers to stabbing pain, burning pain, astringent pain, colicky pain, etc., occurring in the urethra during urination, accompanied by dribbling urination and difficulty.

Suwen refers to painful urination as "lin" or "lin bi". Jingui Yaolue．five zang-organs wind-cold abdominal mass pulse syndrome and treatment》 refers to it as "dysuric stranguria". Zhongcang Jing．On dribbling and difficult urination divides "lin" into eight types: "cold, heat, qi, fatigue, paste, sand, deficiency, and excess". Zhubing Yuanhou Lun．Various syndromes of lin disease also list "urolithic stranguria", "qi stranguria", "chylous stranguria", "overstrain stranguria", "heat stranguria", "blood stranguria", and "cold lin". Suwen Xuanji Yuanbingshi refers to it as "difficult and painful urination". Jingyue Quanshu．Treatment of ischuria》 records "pain in the urinary tract".

This symptom is different from difficult urination and anuria. Difficult urination refers to reduced or absent urine, not necessarily painful; anuria refers to obstructed urine output, without pain or only grade I pain; this symptom emphasizes the sensation of pain in the urethra during urination, and some cases may coexist with difficult urination or anuria.

Painful urination with hematuria generally classifies cases with pain during hematuria as this symptom, and those without pain as hematuria. Similarly, urine like rice water with painful urination belongs to this symptom (as "chylous stranguria"), while painless cases belong to turbid urine.

bubble_chart Modern Research

Heat stranguria often refers to acute or chronic urinary tract infections, including pyelonephritis, cystitis, and urethritis, among which acute pyelonephritis is the most clinically significant. It has a sudden onset, with symptoms such as shivering, high fever, lumbago, frequent and urgent urination, and percussion pain and tenderness in the kidney area. For first-time urinary tract infections, compound formula sulfamethoxazole or norfloxacin can be used. For those with severe systemic and urinary symptoms, intravenous medication can be administered based on urine culture and drug sensitivity test results. In cases of acute severe pyelonephritis, a combination of semi-synthetic broad-spectrum penicillins, aminoglycoside antibiotics, and third-generation cephalosporins may be used.

Blood stranguria is named based on its clinical characteristics, corresponding to various Western medical conditions such as chronic pyelonephritis, urethral syndrome, and bladder cancer, which present with bladder irritation symptoms accompanied by hematuria, all falling under the category of "blood stranguria." In treatment, Western medicine advocates for the use of antibiotics based on urine culture and drug sensitivity tests for chronic pyelonephritis; urethral syndrome can be treated with antibiotics, estrogen, prednisone, and surgical methods such as urethral dilation and release; bladder cancer can be treated with a combination of surgery and chemotherapy.

Chylous stranguria corresponds to chyluria in Western medicine, with its disease causes divided into two major categories: those caused by Chinese Taxillus Herb parasites and those not caused by them. The vast majority are due to the blockage of abdominal lymphatic vessels or the thoracic duct, preventing chyle from entering the chyle cistern and instead flowing back into the urinary system's lymphatic vessels, leading to increased pressure and rupture, resulting in chylous stranguria; additionally, changes in the dynamics of the lymphatic system can also lead to chylous stranguria. Depending on the severity of symptoms, non-surgical or surgical treatments can be adopted.

Overstrain stranguria corresponds to chronic urinary tract infections in Western medicine, such as pyelonephritis, chronic cystitis, urethral syndrome, and subcutaneous nodules of the kidney or bladder presenting with persistent dribbling urination.

bubble_chart Pattern Analysis

1. Dampness-heat in Lower Energizer︰It is commonly seen in excess patterns such as "urolithic stranguria," "blood stranguria," and "chylous stranguria." The clinical manifestations include hot, astringent, and painful urination, purplish-red urine, or turbid urine resembling rice water; or urine mixed with sand-like stones, accompanied by unbearable colicky pain, often with lower abdominal tension or colicky pain in the waist and abdomen. Other symptoms include bitter taste in the mouth, thirst, reduced appetite, unsmooth bowel movements, a red tongue with yellow or greasy yellow coating, and a slippery, rapid pulse. The condition arises from excessive consumption of rich and sweet foods or alcohol, leading to the formation of dampness-heat that pours into the lower energizer; it can also result from exposure to external dampness-heat pathogens. Symptoms include bitter taste in the mouth, thirst, chest tightness, gastric stuffiness, reduced appetite, and unsmooth bowel movements. The painful urination primarily manifests in three forms:
   1. blood stranguria: dampness-heat pouring into the bladder, causing reckless movement of blood-heat, resulting in hot, astringent, painful urination and hematuria;
   2. chylous stranguria: dampness-heat pouring down, impairing bladder qi transformation and disrupting the separation of clear and turbid fluids, leading to hot, astringent, painful urination with turbid, rice-water-like urine;
   3. urolithic stranguria: dampness-heat pouring down, condensing urine into stones, causing difficult, stabbing pain during urination with sand-like stones.
   Treatment should be based on clearing heat and draining dampness, combined with pattern identification for specific cases. For blood stranguria, the approach involves clearing heat and draining dampness, cooling blood, and stopping bleeding, using Small Thistle Decoction; for chylous stranguria, clearing heat and draining dampness, separating the clear and turbid, using Rhizoma Dioscoreae Decoction for Clearing Turbid Urine; for urolithic stranguria, clearing heat and draining dampness, relieving stranguria, and expelling stones, using Sanjin Decoction.
2. Exuberance of Heart Fire︰It manifests as hot and painful urination, scanty and yellow urine, a flushed face and dry throat, thirst with a preference for cold drinks, mouth and tongue sores, vexing heat in the heart, restless sleep at night, a reddened tongue tip, yellow and dry tongue coating, and a rapid pulse. This is due to heart fire transferring heat to the small intestine, resulting in hot and painful urination with scanty yellow urine, often accompanied by mouth and tongue sores, heart vexation and insomnia, a reddened tongue tip, and other symptoms. The urinary pain is generally mild. Treatment should focus on clearing the heart and reducing fire, and the recommended formulas are Heart-Draining Decoction combined with Redness-Removing Powder.
3. Lower Jiao Blood Stasis︰It belongs to the category of "blood stranguria." The clinical manifestations include stabbing pain or astringent pain during urination, accompanied by turbid urine, hematuria, urine that appears dark purple or contains blood clots, lower abdominal pain, scaly skin, purplish lips, a dark tongue with ecchymosis, and a deep, thin, and astringent pulse. It is often caused by traumatic injury, qi deficiency leading to blood stagnation, or invasion of cold pathogens resulting in static blood accumulation in the lower abdomen. When blood fails to follow its normal pathways, hematuria occurs, and impaired bladder qi transformation leads to painful urination. The characteristic symptoms are stabbing or astringent pain during urination without a burning sensation in the urethra, accompanied by lower abdominal distension and fullness, scaly skin, purplish-dark lips, ecchymosis on the tongue, and a deep, thin, and astringent pulse. The treatment principle involves warming yang and invigorating blood to promote urination. The recommended formula is Lesser Abdomen Stasis-Expelling Decoction, with modifications such as adding Akebia Stem and Christina Loosestrife.
4. Liver Qi Depression︰The clinical manifestations include difficult and painful urination, stabbing pain, dizziness, dizzy vision, bitter taste in the mouth, chest and hypochondriac distension and fullness, lower abdominal distension and fullness, and pain. Women may experience menstrual irregularities. The tongue appears bluish with thin yellow coating, and the pulse is wiry. This condition arises from anger damaging the liver, leading to liver qi stagnation that transforms into fire. The stagnation of qi and fire in the lower energizer affects bladder qi transformation, resulting in difficult and painful urination, characterized mainly by astringent pain. It is commonly seen in robust middle-aged individuals and is often triggered by anger, accompanied by symptoms such as headache, dizzy vision, bitter taste in the mouth, and epigastric distension and fullness. Treatment involves soothing the liver and regulating qi to relieve stranguria, using Aquilaria Powder. If liver fire is excessive, the approach should focus on soothing the liver and regulating qi, clearing heat, and relieving stranguria, using Peony and Gardenia Peripatetic Powder with additions such as cluster mallow fruit and Lygodium Spore as appropriate.
5. Kidney Yin Deficiency︰Ke Bei is seen in deficiency patterns such as "blood stranguria" and "chylous stranguria." The clinical manifestations include painful and burning urination, accompanied by hematuria or turbid urine, dizziness, tinnitus, dry throat, flushed cheeks, tidal fever, night sweats, soreness in the lower back and weak legs, a red tongue with scant coating, and a thin, rapid pulse. It is often caused by excessive sexual activity or Rebing damaging yin, leading to internal heat that affects the bladder's qi transformation, resulting in the inability to separate the clear from the turbid and thus causing "chylous stranguria." Alternatively, it may arise from yin deficiency with effulgent fire, forcing blood to move recklessly and causing "blood stranguria." Both conditions belong to deficiency patterns, with urinary pain generally being mild. In cases of excessive deficiency fire, there may be a burning sensation during urination, along with symptoms such as dry throat, flushed cheeks, tidal fever, night sweats, dizziness, and tinnitus. The treatment should focus on nourishing yin and reducing fire, and the recommended formula is Modified Anemarrhena, Phelloendron and Rehmannia Pill.

This condition is often more excess than deficiency, hence the emphasis on excess pattern and the neglect of deficiency pattern. Jingyue Quanshu states: "However, at the onset of stranguria, it is invariably due to intense heat, which is indisputable. Yet, there are cases where prolonged use of cold and cooling agents does not cure, and there are also cases where stranguria persists without cessation, with pain and astringency disappearing but the discharge of turbid fluid continuing, resembling white turbidity. This is solely due to the sinking of middle qi and the insecurity of the life gate," which is the deficiency pattern of "qi stranguria." It should be attributed to the insufficiency of middle qi, characterized by difficult and painful urination with a sense of urgency, accompanied by signs of spleen deficiency qi sinking. Treatment should focus on tonifying the middle and replenishing qi, with the prescription Middle-Tonifying Qi-Replenishing Decoction being selected. This condition is an internal syndrome. According to "Internal Medicine: Stranguria" (Trial Textbook for Higher Medical Institutions at Various Levels): "In clinical practice, stranguria with fear of cold and fever often coexists with difficult and painful urination, caused by the steaming of dampness-heat and the struggle between pathogenic and righteous qi. It differs from the fever of general exterior pattern. It is not necessary to use acrid dispersing agents at the first sign of fever and chills, as stranguria is mostly due to heat in the bladder, often with a deficiency of yin fluids. Improper use of acrid dispersing and exterior-releasing agents not only fails to reduce fever but also depletes the nutrient aspect, exacerbating hematuria. If stranguria is indeed triggered by external contraction, presenting with fever, aversion to cold, cough, and runny nose, it is appropriate to combine with agents that disperse wind and release the exterior for simultaneous treatment of the exterior and interior."

bubble_chart Documentation

1. Jingui Yaolue·Consumptive Thirst, Dysuria, Stranguria, Abnormal Pulse, Syndrome and Treatment: "The disease of stranguria is characterized by urine resembling foxtail millet, tightness and urgency in the lower abdomen, and pain radiating to the navel."
2. Yizong Bidu·Stranguria: "Cold stranguria is caused by cold invading the lower energizer, leading to sluggish water passage, initially presenting with chills, followed by the development of stranguria."
3. 《Chinese Medicine Clinical Essentials·Urinary Stabbing Pain》: "In general external-contraction fever and pattern of yin deficiency and internal heat, there may also be a sensation of burning heat and slight pain during urination, with scanty and yellow urine, which is not considered as stranguria. If it occurs during high fever, Talc and Ricepaperplant Pith can be added to the prescription as appropriate; for dampness warm disease syndrome, Virgate Wormwood and Plantain Seed can be added; for yin deficiency pattern, Unprocessed Rehmannia Root and Anemarrhena can be added."