bubble_chart Concept

Frequent urination and dripping pain during pregnancy are referred to as pregnancy strangury, also known as strangury during pregnancy.

This condition, Zhubing Yuanhou Lun refers to it as "strangury during pregnancy", Taiping Shenghui Fang calls it "difficult urination during pregnancy", and "One Hundred Questions on Obstetrics" terms it "urinary difficulty during pregnancy".

This condition is different from bladder colic and pregnant dysuria. "Shen's Nyuke Jiyao Commentary on Strangury During Pregnancy and Bladder Colic and Pregnant Dysuria" states: "Frequent urination, discomfort, and pain are referred to as strangury... Bladder colic and pregnant dysuria also involve frequent urination and difficulty in urination, but it does not necessarily involve heat or pain, as the growing fetus presses against the side of the bladder, causing slight discomfort in the organ's function." It also says: "Strangury during pregnancy and bladder colic and pregnant dysuria must not be considered the same condition."

bubble_chart Pattern Analysis

1. Excess Heat︰During pregnancy, frequent urination with scanty, dark, burning, urgent, and painful urination, accompanied by a bitter taste in the mouth, thirst with a preference for cold drinks, mouth and tongue sores, dry stool, a red tongue with dry yellow coating, and a slippery rapid pulse. Although it is categorized as heat-induced strangury, there are differences between deficiency and excess, as well as variations in disease causes and mechanisms. The former is often due to constitutional yin deficiency, where blood gathers to nourish the fetus during pregnancy, further depleting yin. Insufficient kidney water due to yin deficiency leads to bladder scorching by fire, resulting in painful urination. There may also be yin deficiency with internal heat (such as a thin body, flushed cheeks, dry throat, dry mouth, drinking but not much, etc.).
2. Deficiency-heat︰During pregnancy, frequent urination is difficult and occurs in drops, with yellow-colored urine and a burning sensation. The body is thin with flushed cheeks, dry throat and mouth, restlessness, a red and tender tongue texture, scant or patchy coating, or no coating, and a thready, rapid pulse. This is often due to constitutional yin deficiency, where blood concentrates to nourish the fetus during pregnancy, further depleting yin. Insufficient kidney water due to yin deficiency leads to bladder scorching by fire, resulting in painful urination. It presents as yin deficiency with internal heat (such as thin body, flushed cheeks, dry throat and mouth, drinking little despite thirst, etc.).
3. Dampness-heat︰Several months of pregnancy, difficult and painful urination, frequent urination with scanty dark red urine and burning sensation, sallow complexion, fatigue, bitter taste in mouth, restlessness, thirst without much desire to drink, unsmooth bowel movements, red tongue with thick dry yellow coating, slippery and rapid pulse. $Excess-heat pregnancy dysuria and dampness-heat pregnancy dysuria! Both are excess patterns. Therefore, they share symptoms such as frequent urination, scanty dark urine with burning pain, bitter taste in mouth, red tongue with dry yellow coating, and slippery rapid pulse. However, their disease causes and pathogenesis differ: Excess-heat dysuria is mostly due to constitutional yang exuberance, with blood pooling in the lower body to nourish the fetus, failing to ascend and regulate heart fire, leading to hyperactive heart fire. Pathogenic heat transfers to the small intestine, or excessive consumption of fried, spicy, and hot foods causes internal heat to descend to the bladder, scorching and damaging fluids. Dampness-heat dysuria, on the other hand, results from improper care, allowing dampness-heat to invade and accumulate in the bladder, disrupting qi transformation. The key points for differentiation are: Excess-heat dysuria during pregnancy must exhibit clinical manifestations of intense internal fire (such as mouth ulcers, thirst with preference for cold drinks, constipation, etc.), while dampness-heat dysuria shows signs of dampness-heat (such as sallow complexion, fatigue, unsmooth bowel movements, thirst without much desire to drink, etc.). For excess-heat dysuria, treatment should focus on clearing heat and purging fire to promote urination, using Redness-Removing Powder. For dry stool accumulation, use Rhubarb Rhizoma Decoction minus Ricepaperplant Pith. For dampness-heat dysuria, treatment should focus on clearing heat and draining dampness to promote urination, using Five Ingredients with Poria Powder. If accompanied by dizziness, tinnitus, chest tightness, hypochondriac distension, irritability, and frequent anger, it indicates liver meridian stagnation-heat or dampness-heat in the liver meridian. For liver meridian stagnation-heat dysuria, treatment should focus on clearing the liver and draining heat, dispersing stagnation to promote urination, using Peony and Gardenia Peripatetic Powder plus Skullcap Root, cluster mallow fruit, and Plantain Seed. For dampness-heat in the liver meridian dysuria, if blood is mixed in the urine, it indicates blood stranguria due to heat invading the blood aspect and forcing reckless bleeding. Add blood-cooling and bleeding-stopping herbs.
4. Qi Deficiency︰During pregnancy, there is dribbling and painful urination with pale yellow urine, difficulty in urination, or incontinence, often accompanied by severe pain after urination. There is a sensation of heaviness and distension in the lower abdomen, fatigue, and lack of strength. The tongue is pale with a thin white coating, and the pulse is weak and slippery. This is often due to pre-existing deficiency of middle qi. As the fetus grows larger over the months of pregnancy, qi deficiency makes it unable to support the fetus, causing it to press on the bladder and obstruct the flow of water, leading to painful urination. The key diagnostic points are: difficult and painful urination without the symptoms of heat stranguria, such as dark urine or burning sensation. Instead, there are signs of middle qi deficiency, including a sensation of heaviness in the lower abdomen, fatigue, lack of strength, severe pain after urination, difficulty in urination, or incontinence. The treatment principle is to tonify qi and relieve stranguria, using the Tonifying Qi and Relieving Stranguria Decoction.

Painful urination during pregnancy is mostly due to heat pattern, but it can be divided into deficiency heat and excess heat. There are also cases of painful urination caused by qi deficiency. In clinical practice, careful differentiation is essential. One must not rigidly adhere to the notion that "pain indicates obstruction" and uniformly apply methods to promote urination and prescribe diuretics. Caution should also be exercised in using slippery and diuretic substances to avoid harming the fetus.

bubble_chart Documentation

1. 《Gynecological Classics: Prenatal Conditions》 quotes Wan Mi-zhai as saying: "The condition of strangury during pregnancy must be divided into two types: one is the mother's own illness, and the other is the child causing the mother's illness. However, the mother's own illness is further divided into two types: either taking medicine that is spicy and hot, leading to internal heat, or spontaneous sweating and self-induced diarrhea, causing the body fluids to dry up. The child causing the mother's illness is also divided into two types: either fetal qi disease causing heat congestion, or the fetal form causing obstruction. Since the conditions are different, the treatments also vary. Generally, heat should be cleared, dryness should be moistened, congestion should be unblocked, and obstruction should be relieved. These are the methods of treatment."
2. Fuke Yuchi．Prenatal: "Pregnancy due to excessive indulgence in alcohol and sex, internal damage to the cervical orifice, or consumption of food accumulation heat, leading to blockage of the urinary tract, dribbling urination, and pain, is called strangury during pregnancy. It is advisable to use Nutrient Aspect Stabilizing Powder."