bubble_chart Concept

Postpartum frequent urination refers to an increased frequency of urination after childbirth, which can occur dozens of times a day and night. Postpartum incontinence of urine refers to dribbling urination after childbirth, which cannot be controlled voluntarily, or involuntary leakage of urine. Although the symptoms of the two conditions differ, their underlying causes are essentially the same, hence they are discussed together.

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1. Qi Deficiency︰Postpartum frequent urination or incontinence, lower abdominal distension, chest tightness and shortness of breath, weak voice, pale complexion, lack of strength in limbs, pale tongue with scant coating, thin and weak pulse. This is often due to the woman's inherent weakness, insufficient lung qi, and postpartum depletion of qi and blood, further weakening lung qi and impairing its ability to regulate water pathways, leading to this condition. Jingui Yaolue states in the chapter "Lung Abscess Lung Atrophy": "Lung atrophy...enuresis, frequent urination, all due to upper deficiency failing to control the lower," indicating that lung qi deficiency results in insufficient control over the lower body, causing bladder incontinence. The diagnostic features include: frequent urination or incontinence, worsening symptoms after overstrain, pale complexion, lack of strength in limbs, chest tightness and shortness of breath, and weak voice. The treatment focuses on tonifying qi for astringing and constraining, using Middle-Tonifying Qi-Replenishing Decoction with Asiatic Cornelian Cherry Fruit and Sharpleaf Galangal Fruit.
2. Kidney Yin Deficiency︰Frequent urination with scanty urine, emaciated physique, soreness and weakness of the waist and knees, feverish sensation in the palms and soles, afternoon tidal fever, flushed cheeks, red and bare tongue, thready and rapid pulse. This condition is often caused by constitutional deficiency of yin essence, compounded by damage to yin and blood during childbirth, leading to further depletion of yin fluids. Alternatively, it may result from prolonged dampness-heat accumulation in the lower energizer, which damages kidney yin and causes heat accumulation in the bladder. The symptoms include frequent urination with scanty urine, accompanied by feverish sensation in the palms and soles, afternoon tidal fever, flushed cheeks, red tongue tip, and thready rapid pulse—all signs of yin deficiency with internal heat. Treatment should focus on nourishing the kidney and reducing fire, using formulas such as Anemarrhena, Phelloendron and Rehmannia Pill or Left-Restoring Decoction. If yin deficiency affects yang, Left-Restoring Pill can be used to enrich yin and support yang, replenishing essence and marrow.
3. Kidney Yang Deficiency︰Frequent urination with incontinence, increased urine volume, especially at night, accompanied by {|###|}dusky complexion{|###|}, mental fatigue, cold limbs, or lower limb edema, pale tongue with white coating, and weak pulse. This is often due to congenital deficiency of {|###|}kidney yang{|###|}, decline of {|###|}life gate fire{|###|}, and postpartum damage to qi and blood, leading to {|###|}insecurity of kidney qi{|###|} and bladder incontinence. The key diagnostic features include frequent urination with incontinence, increased urine volume, particularly worse at night, along with {|###|}dusky complexion{|###|}, cold limbs, pale tongue, and thin weak pulse. For treatment, it is advisable to tonify the kidney and secure the bladder. The recommended formulas are Right-Restoring Pill or Kidney Qi Pill from the Golden Cabinet with the addition of {|###|}mantis egg-case{|###|}, {|###|}palmleaf raspberry fruit{|###|}, and {|###|}Psoralea{|###|}. For severe deficiency with spontaneous urine leakage, Mantis Egg-Case Powder may be used instead.
4. External Injury︰Injury to the bladder during childbirth, continuous dribbling urination, occasionally mixed with blood, normal tongue coating, slow pulse. It is caused by trauma to the bladder during childbirth. The clinical features include: a history of trauma, continuous dribbling urination, or urine mixed with blood. Treatment should focus on tonifying qi to consolidate the bladder, using Astragalus RootAngelica Powder.

Postpartum frequent urination and incontinence, whether due to internal damage or external injury, are always caused by the bladder's loss of control, with the location of the disease being the bladder. However, the bladder and kidneys are interconnected, and the lungs are the source of water emetic therapy, so the condition is also closely related to the lungs and kidneys. In the lungs, it is often due to qi deficiency, while in the kidneys, it is often due to yin deficiency or yang deficiency. Grasping this key point makes differentiation naturally straightforward.

bubble_chart Documentation

1. Zhangshi Yitong．Postpartum: "Frequent urination after childbirth is due to qi deficiency and inability to control water. Tonify the middle and replenish qi, adding Plantago and Poria. If bladder yin deficiency causes dribbling urination, use raw Six-Ingredient Decoction combined with Pulse-Reinforcing Powder to nourish the source of transformation. It must be decocted in large doses, heated in a double boiler, and taken continuously. Postpartum incontinence of urine is due to qi deficiency and inability to control blood. Use Middle-Tonifying Qi-Replenishing Decoction. If the urethral orifice has not closed after childbirth, causing involuntary urination, this is common and will stop on its own by the sixth or seventh day, and does not require treatment."