Dribbling Urination Xiao Bian Yi Li

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					Dribbling Urination (Xiao Bian Yi Li)
by Philippe Sionneau and Lü Gang

Dribbling urination refers to incessant dribbling and dripping of urine after the main stream is finished.
This is also referred to as terminal dribbling.

Disease causes, disease mechanisms:

1. Kidney vacuity & bladder cold

Kidney vacuity here mainly refers to kidney qi or possibly kidney yang vacuity. These can result from
aging, enduring disease, or excessive sexual activity. The kidneys govern the two yin and have a mutual
exterior-interior relationship with the bladder. The qi is responsible for both securing and moving water
fluids. If the kidneys become vacuous and weak, first, the bladder may fail to secure or contain the urine
firmly. Secondly, the kidney qi will not be strong enough to push the urine out of the bladder forcefully
and completely. Therefore, dribbling urination may occur.

2. Central qi vacuity

Central qi vacuity usually develops from dietary irregularity, overwork taxation, or enduring disease.
Central qi is responsible for upbearing and lifting. Therefore, if the central qi becomes vacuous and
weak, water fluids may pour downward and spill over. Since the spleen and kidneys bolster and aid each
other, the former being the former heaven root, the latter being the latter heaven root, spleen qi vacuity
may cause or contribute to kidney qi insecurity. In that case, the bladder qi will not be able to secure and
contain the fluids pouring downward. Therefore, dribbling urination may occur.

3. Damp heat in the bladder

Damp heat can arise from external contraction of evils or from dietary irregularities which engender
damp heat internally. If damp heat invades the bladder or if internally engendered damp heat pours
downward into the bladder, these evils may, first, inhibit the qi mechanism of the bladder, and secondly,
affect the bladder’s qi transformation. If either of these occurs, dribbling urination may occur. In the first
instance, the qi will not discharge the urine completely and efficiently, while in the second, excess
dampness will spill over and flood.

4. Liver depression & yang vacuity

The liver’s function of coursing and discharge is dependent on the warming and steaming of life gate fire.
Emotional stress and frustration may damage the liver and lead to qi stagnation as described in numerous
places above. As a person ages, this qi stagnation typically worsens as kidney yang begins to become
vacuous. In that case, kidney yang no longer warms and steams the liver, thus no longer promoting the
liver’s function the way it used to. Qi stagnation mixed with yang vacuity results in the accumulation of
dampness, while kidney yang vacuity must necessarily include an element of kidney qi vacuity.
Therefore, there may be an accumulation of dampness in the bladder mixed with qi stagnation, yet the
kidney qi is not able to secure and astringe properly. In that case, dampness may spill over and the kidney
qi may not close and seal the front yin firmly and decisively. Thus terminal dribbling may be seen.

Treatment based on pattern discrimination:
1. Kidney vacuity & bladder cold

Symptoms: Dribbling urination, frequent, long, clear urination, fatigue, lassitude of the spirit, upper and
lower back aching and pain, possible heavy and/or chilly sensations in the upper and lower back, lack of
warmth in the limbs, a pale tongue with white fur, and a deep, fine pulse especially in the cubit position

Therapeutic principles: Warm the kidneys and secure the bladder

Acupuncture & moxibustion:

Guan Yuan (CV 4)                         Together, these points warm yang and
Qi Hai (CV 6)                            supplement the kidneys when moxaed.

Xia Liao (Bl 34)                                Together, these points secure the bladder
Pang Guang Shu (Bl 28)                   when needled with moxibustion on the heads of the needles.

Additions & subtractions: For fear of cold, moxa Ming Men (GV 4). For loose stools, add Zu San Li (St
36). For clear, thin vaginal discharge, add Dai Mai (GB 26). For impotence, add Qu Gu (CV 2). For
dizziness, moxa Bai Hui (GV 20).

Chinese medicinal formula: Modified Jin Gui Shen Qi Wan (Golden Cabinet Kidney Qi Pills) plus Sang
Piao Xiao San (Mantis Egg Case Powder)

Ingredients: Cooked Radix Rehmanniae (Shu Di), 18g, steamed Fructus Corni Officinalis (Shan Zhu Yu),
12g, stir-fried Radix Dioscoreae Oppositae (Shan Yao), 12g, blast-fried Radix Lateralis Praeparatus
Aconiti Carmichaeli (Fu Zi), 3g, stir-fried Ramulus Cinnamomi (Gui Zhi), 6g, salt mix-fried Rhizoma
Alismatis (Ze Xie), 6g, Sclerotium Poriae Cocos (Fu Ling), 6g, Cortex Radicis Moutan (Dan Pi), 6g,
Ootheca Mantidis (Sang Piao Xiao), 9g, stir-fried Radix Codonopsitis Pilosulae (Dang Shen), 9g, stir-
fried Radix Angelicae Sinensis (Dang Gui), 6g, Fructus Rosae Laevigatae (Jin Ying Zi), 9g

Additions & subtractions: For severe, frequent, long, clear urination, enuresis, incontinence, or nocturia,
add salt stir-fried Fructus Alpiniae Oxyphyllae (Yi Zhi Ren), 9g, and Fructus Rubi Chingii (Fu Pen Zi),
9g. For scanty urination and edema in the lower limbs, replace Jin Gui Shen Qi Wan with Ji Sheng Shen
Qi Wan (Aid to the Living Kidney Qi Pills): blast-fried Radix Lateralis Praeparatus Aconiti Carmichaeli
(Fu Zi), 3g, Cortex Cinnamomi Cassiae (Rou Gui), 3g, cooked Radix Rehmanniae (Shu Di), 15g, steamed
Fructus Corni Officinalis (Shan Zhu Yu), 9g, stir-fried Radix Dioscoreae Oppositae (Shan Yao), 9g,
Sclerotium Poriae Cocos (Fu Ling), 12g, salt mix-fried Rhizoma Alismatis (Ze Xie), 12g, Cortex Radicis
Moutan (Dan Pi), 6g, salt mix-fried Semen Plantaginis (Che Qian Zi), 12g, and salt mix-fried Radix
Achyranthis Bidentatae (Huai Niu Xi), 9g. For profuse vaginal discharge, add Semen Nelumbinis
Nuciferae (Lian Zi), 9g, and Semen Euryalis Ferocis (Qian Shi), 9g.

2. Central qi vacuity

Symptoms: Dribbling urination which occurs due to overwork, fatigue, a bright white facial complexion,
lassitude of the spirit, reduced food intake, loose stools, lower abdominal sagging and distention, a pale
tongue with white fur, and a soggy, moderate, i.e., relaxed or slightly slow, or fine, weak pulse

Therapeutic principles: Supplement the center and boost the qi

Acupuncture & moxibustion:
Guan Yuan (CV 4)                Together, these points supplement the center
Qi Hai (CV 6)                   and boost the qi when needled with
Zu San Li (St 36)               supplementing method.

Bai Hui (GV 20)                 Upbears the central qi when moxaed

Additions & subtractions: For cold limbs and diarrhea, moxa Shen Que (CV 8). For prolapse of the
stomach, join Fu Ai (Sp 16) to Shen Que (CV 8). For prolapse of the rectum, add Chang Qiang (GV 1).
For prolapse of the uterus, join Zi Gong (M-CA-18) to Heng Gu (Ki 11).

Chinese medicinal formula: Modified Bu Zhong Yi Qi Tang (Supplement the Center & Boost the Qi
Decoction)

Ingredients: Honey mix-fried Radix Astragali Membranacei (Huang Qi), 15g, honey mix-fried Radix
Codonopsitis Pilosulae (Dang Shen), 9g, bran stir-fried Rhizoma Atractylodis Macrocephalae (Bai Zhu),
9g, stir-fried Pericarpium Citri Reticulatae (Chen Pi), 6g, Sclerotium Poriae Cocos (Fu Ling), 3g, honey
mix-fried Rhizoma Cimicifugae (Sheng Ma), 6g, mix-fried Radix Glycyrrhizae (Gan Cao), 6g, Ootheca
Mantidis (Sang Piao Xiao), 9g, salt stir-fried Fructus Alpiniae Oxyphyllae (Yi Zhi Ren), 9g, Radix
Linderae Strychnifoliae (Wu Yao), 9g

Additions & subtractions: For profuse white vaginal discharge, add Semen Nelumbinis Nuciferae (Lian
Zi), 9g, and Semen Euryalis Ferocis (Qian Shi), 9g. For reduced food intake and loose stools, add stir-
fried Massa Medica Fermentata (Shen Qu), 6g, stir-fried Fructus Germinatus Hordei Vulgaris (Mai Ya),
6g, and Radix Auklandiae Lappae (Mu Xiang), 9g. For spleen-stomach yang vacuity, replace Bu Zhong Yi
Qi Tang with Modified Fu Zi Li Zhong Wan (Aconite Rectify the Center Pills): honey mix-fried Radix
Codonopsitis Pilosulae (Dang Shen), 9g, dry Rhizoma Zingiberis (Gan Jiang), 6g, blasted Radix
Lateralis Praeparatus Aconiti Carmichaeli (Fu Zi), 3g, honey mix-fried Radix Glycyrrhizae (Gan Cao),
6g, uncooked Rhizoma Atractylodis Macrocephalae (Bai Zhu), 9g, Ootheca Mantidis (Sang Piao Xiao),
9g, salt stir-fried Fructus Alpiniae Oxyphyllae (Yi Zhi Ren), 9g, and Radix Linderae Strychnifoliae (Wu
Yao), 9g. For spleen vacuity with damp encumbrance, replace Bu Zhong Yi Qi Tang with Modified Shen
Ling Bai Zhu San (Ginseng, Poria & Atractylodes Powder): stir-fried Semen Dolichoris Lablab (Bai Bian
Dou), 9g, stir-fried Radix Dioscoreae Oppositae (Shan Yao), 9g, bran stir-fried Rhizoma Atractylodis
Macrocephalae (Bai Zhu), 9g, Sclerotium Poriae Cocos (Fu Ling), 6g, rice stir-fried Radix Codonopsitis
Pilosulae (Dang Shen), 9g, stir-fried till yellow Semen Nelumbinis Nuciferae (Lian Zi), 6g, Fructus
Amomi (Sha Ren), 6g, honey mix-fried Radix Glycyrrhizae (Gan Cao), 6g, Ootheca Mantidis (Sang Piao
Xiao), 9g, salt stir-fried Fructus Alpiniae Oxyphyllae (Yi Zhi Ren), 9g, and Radix Linderae Strychnifoliae
(Wu Yao), 9g.

3. Damp heat in the bladder

Symptoms: Frequent dribbling and dripping of yellow-colored or turbid urine, urgent urination, pain in
the urethra while voiding, a red tongue with slimy, yellow fur, and a slippery, rapid pulse

Therapeutic principles: Clear heat and disinhibit dampness

Acupuncture & moxibustion:

Zhong Ji (CV 3)                         Together, these points clear heat and disinhibit
Shui Dao (St 28)                        urination when needled with draining method.
Pang Guang Shu (Bl 28)

San Yin Jiao (Sp 6)              Together, these points clear heat and disinhibit
Yin Ling Quan (Sp 9)             dampness when needled with draining method.

Additions & subtractions: For lower abdominal distention and oppression, add Xiao Chang Shu (Bl 27).
For fever, prick Wei Zhong (Bl 40) to bleed. For lower back aching and pain, add Guan Yuan Shu (Bl
26).

Chinese medicinal formula: Ba Zheng San (Eight Correcting [Ingredients] Powder)

Ingredients: Caulis Akebiae (Mu Tong), 3g, Herba Dianthi (Qu Mai), 9g, cooked Radix Et Rhizoma Rhei
(Da Huang), 9g, Semen Plantaginis (Che Qian Zi), 12g, Talcum (Hua Shi), 18g, uncooked Fructus
Gardeniae Jasminoidis (Zhi Zi), 9g, Herba Polygoni Avicularis (Bian Xu), 9g, Medulla Junci Effusi
(Deng Xin Cao), 3g, Radix Tenuis Glycyrrhizae (Gan Cao Shao), 6g

Additions & subtractions: For hematuria, add Herba Cephalanoploris Segeti (Xiao Ji), 9g, and Rhizoma
Imperatae Cylindricae (Bai Mao Gen), 9g. For damp heat with sand strangury and severe, cutting,
distention and pain stretching to the low back, urethra, or perineal area which gets worse during
urination, sand in the urine, and possible hematuria, replace Ba Zheng San with Modified Shi Wei San
(Pyrrosia Powder): Folium Pyrrosiae (Shi Wei), 15g, Semen Abutilonis Seu Malvae (Dong Kui Zi), 15g,
Herba Dianthi (Qu Mai), 9g, Talcum (Hua Shi), 20g, Semen Plantaginis (Che Qian Zi), 12g, Herba
Desmodii Seu Lysimachiae (Jin Qian Cao), 15g, Spora Lygodii Japonici (Hai Jin Sha), 15g, and
Endothelium Corneum Gigeriae Galli (Ji Nei Jin), 15g. For damp heat damaging yin, subtract Rhubarb
and Gardenia and add Rhizoma Anemarrhenae Asphodeloidis (Zhi Mu), 9g, and uncooked Radix
Rehmanniae (Sheng Di), 12g. For alternating fever and chills, a bitter taste in the mouth, dry throat, and
nausea, subtract Juncus and add Xiao Chai Hu Tang (Minor Bupleurum Decoction): uncooked Radix
Bupleuri (Chai Hu), 9g, uncooked Radix Scutellariae Baicalensis (Huang Qin), 9g, ginger stir-fried
Rhizoma Pinelliae Ternatae (Ban Xia), 9g, and uncooked Radix Codonopsitis Pilosulae (Dang Shen), 6g.
For nausea and vomiting, subtract Akebia, replace uncooked with stir-fried Gardenia, and add ginger-
processed Rhizoma Pinelliae Ternatae (Ban Xia), 9g, and uncooked Rhizoma Zingiberis (Sheng Jiang),
6g.

4. Liver depression & yang vacuity

Symptoms: Dribbling urination which is clear in color, lower abdominal distention and fullness, fullness
and oppression in the umbilical region, a pale, somewhat enlarged tongue with thin, white fur, and a
deep, bowstring pulse

Therapeutic principles: Move the qi and warm the kidneys, eliminate dampness and free the flow of
urination

Acupuncture & moxibustion:

Zhong Ji (CV 3)                  Together, these points free the flow of
Pang Guang Shu (Bl 28)           the qi mechanism of the bladder when
                                 needled with draining method.

Shen Shu (Bl 23)                 When these points are moxaed together, they
Ming Men (GV 4)                 supplement the kidneys and invigorate yang.
Tai Chong (Liv 3)               Moves the qi and resolves depression

Additions & subtractions: For rib-side distention and pain, add Qi Men (Liv 14). For lower abdominal
distention and pain, add Yin Bao (Liv 9). For lower abdominal stabbing pain, add San Yin Jiao (Sp 6) and
Xue Hai (Sp 10). For shortage of qi, first drain and then supplement Qi Hai (CV 6).

Chinese medicinal formula: Modified Chen Xiang San (Aquilaria Powder)

Ingredients: Lignum Aquilariae Agallochae (Chen Xiang), 3g (powdered and taken with the strained
decoction), Pericarpium Citri Reticulatae Viride (Qing Pi), 6g, Fructus Foeniculi Vulgaris (Xiao Hui
Xiang), 6g, Radix Linderae Strychnifoliae (Wu Yao), 9g, Talcum (Hua Shi), 15g, Folium Pyrrosiae (Shi
Wei), 9g, Pericarpium Citri Reticulatae (Chen Pi), 6g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 9g,
Semen Abutilonis Seu Malvae (Dong Kui Zi), 9g, Radix Glycyrrhizae (Gan Cao), 6g

Additions & subtractions: For severe lower abdominal distention and pain, add stir-fried till scorched
Fructus Meliae Toosendan (Chuan Lian Zi), 9g, Rhizoma Corydalis Yanhusuo (Yan Hu Suo), 9g. For
dribbling urination which gets worse on emotional disturbance, such as anger, frustration, and
depression, add Semen Zizyphi Spinosae (Suan Zao Ren), 9g, Cortex Albizziae Julibrissinis (He Huan
Pi), 12g, Caulis Polygoni Multiflori (Ye Jiao Teng), 12g.


The above article is an excerpt from THE TREATMENT OF DISEASE, VOLUME 6: DISEASES OF THE
UROGENITAL SYSTEM & PROCTOLOGY by Philippe Sionneau and Lü Gang, published by Blue Poppy Press.
This book is part of seven volume series and is available from JCM.

				
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