Urinary calculus is a common disease in the urinary system, including calculus of the kidneys, urethral calculus, vesical calculus and urethral calculus. This disease incidence appears obviously in certain areas. The disease belongs to the categories of "sha lin" (strangury form urolithiasis), "shi lin"  (strangury caused by urinary calculus) and  "xue lin" (strangury complicated by hematuria) in TCM.  

Main Points of Diagnosis

1.Symptoms

1) Calculus of the Kidneys: There is a dull pain in the lower loins of the affected side, when the stones in the kidney radiates along the ureter to the lower abdomen and the perineal region which is associated with different degrees of hematuria. If the case turns into a complicated infection, the patient may have fever and pus cells in the urine.

2) Ureteral Calculus: In the lumbar region there is an acute pain which is often associated with hematuria. When the stones happen to be in the upper 1/3 part of the ureter, the pain will be in the costovertebral angle region and radiate to the part above iliac crest and external side of the abdomen. When the stones descend, the region of pain will also come down with the pain radiating to the thigh, testicle or vulva region.

3) Vesical Calculus: There is a pain in urination and the pain is often severest at the end of urination. This pain mainly occurs in the lower abdomen and may radiate to the perineum and balanus. Other symptoms are often difficulty of interruption in micturation and hematuria at the end of urination, urgent and frequent micturation.

4) Urethral Calculus: Pain in urination, thready urination, dribbling urination , or even retention of urine may appear.

2. Signs: The patients who have kidney calculus will have a percussion pain or a tenderness on the kidney area of the affected side. When there is an obstruction caused by kidney calculus and urethral calculus, sometimes, a swollen kidney will be felt. In vesical calculus and posterior urethral calculus, stones can be felt in rectal examination. In the case of anterior urethral calculus, a hard lump with tenderness may be felt in the local region.

3. Laboratory Examination: Through urine test the number of red blood cells is often found increased. When the function of kidney is suspected of being impaired, urea nitrogen and creatinine tests will be necessary.

4. X-ray Examination: The urogram will show the majority of the stones. Use excretion urography or retrograde urography to help you find out the positions of the stones and the functions of both kidneys.

5. Cystoscopy: "B" type ultrasonograpny and isotope renogram will be helpful for clinical diagnosis.

Differentiation and Treatment of Common Syndromes

The following therapies are good for those cases in which the transverse diameter of the stones in the kidney and ureter is less than 1 cm; the transverse diameter of the stones the urinary bladder is less than 2 cm and there is no serious obstruction and infection, and the function of kidney is in a good condition.

1. Internal Treatment

1) Qi-Stagnation Type

Main Symptoms and Signs: In the waist and the lower abdomen there is distending pain, full ache or even paroxysmal colicky pain accompanied with nausea, vomiting and hematuria, tongue with white and greasy fur and tight and taut pulse.

Therapeutic Principle: Promoting the circulation of qi, inducing diuresis, relieving strangury and removing the stones.

Recipe: Modified Pyrrosia Decoction

lysimachia

pyrrosia leaf

plantago seed (piece of cloth before it is decocted with other herbs )

cluster mallow fruit

oriental water plantain rhizome

citron fruit

vaccaria seed

radish seed

rhubarb

all the above herbs are to be decocted in water for oral administration.

2) Damp-Heat Type

Main Symptoms and Signs: There is a continuous pain in the waist or the lower abdomen accompanied with fever, frequent micturation, urgent urination, urodynia, cloudy or bloody urine, and pyuria, tongue with yellow and greasy fur and slippery rapid or taut rapid pulse.

Therapeutic Principle: Clearing away pathogenic heat and dampness, relieving strangury and removing the stones.

Recipe: Modified Eight Health Restoring Powder

lysimachia

prostrate knotweed

Chinese pink herb

talc

phellodendron bark

capejasmine fruit

plantago seed (piece of cloth before it is decocted in water with other herbs )

rhubarb

licorice root tip

All the above herbs are to be decocted in water for oral administration.

3) Kidney-deficiency Type

Main Symptoms and signs: The whole course of the illness lasts for a long period. Its symptoms are weakness and ache of the waist and limbs, fullness of abdomen, unsmoothness and feebleness of urination, pale tongue with thin and whitish fur, and deep and thready pulse.

Therapeutic Principle: Supplementing qi, reinforcing the kidney, relieving stranguria and removing the stones.

Recipe: Modified Kidney-Reinforcing Decoction

prepared rehmannia root

wolfberry fruit

dogwood fruit

achyranthes root

bighead atractylodes rhizome

eucommia bark

cinnamon bark

pilose asiabell root

lysimachia

climbing fern spore

All the above herbs are to be decocted in water for oral administration.

For those who are marked by acraturesis, add of 6 grams of ginseng instead of pilose asiabell root 30 grams of congongrass rhizome and 15 grams of milkvetch root, For those who have hematuria, add 20 grams each of Japanese thistle and field thistle and 12 grams of sanguisorba root.

2. Acupuncture Therapy

1. Body Acupuncture

Acupuncture Points: Shenshu (UB 23), Pangguangshu (UB 28), Zusanli (St 36), Guangyuan (Ren 4).

Adjunct Acupuncture Points: Zhongji (Ren 3), Sanyingjiao(Sp 6), Yinlingquan (Sp 9), Shuidao (St 28).

Manipulation: Choose 2 or 3 acupoints each time and use strong stimulation. Do this twice a day , retaining the needle for 20-30 minutes.

2) Electrotherapy

Acupuncture Points: The therapeutic electrode (-)is connected with Shenshu (UB 23) or Pangguangshu (UB 28), while the (+) with Guanyuan (Ren 4) or Shuidao (St 28).

Manipulation: Select the upper and the lower points of the affected side for needling. The intensity of the needling should be form weak to strong and it must be as strong as the patient could bear. Then, sustain the needling for 20-30 minutes, 1or 2 times a day.

3) Ear Needling

Auricular Points: In the kidney and ureter's area or the tenderness area.

Manipulation: Use strong stimulation, retaining the needle for 15-40 minutes.  

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