Differential Diagnosis of Common Symptoms — Difficult Urination and Edema

Difficult Urination

Difficult urination refers to symptoms such as difficulty in voiding urine, reduced urine volume, and obstructed, blocked urination. It is also called “retention of urine” (long bi). Clinically, it is essential to differentiate the zang-fu organ involved and whether the condition belongs to cold, heat, deficiency, or excess.

• Difficult urination, or dribbling discharge of urine, yellow and reddish in color, with fullness and distention in the lower abdomen, thirst without a desire to drink, difficult bowel movements, red tongue with yellow slimy coating, and a thin, rapid pulse: this is difficult urination due to damp-heat accumulation. It is caused by damp-heat binding and accumulating, leading to impaired bladder qi transformation.
• Difficult urination, or complete urinary obstruction, with rapid, hurried breathing, dry throat, vexation and thirst with a desire to drink, red tongue with yellow coating, and a rapid pulse: this is difficult urination due to heat pathogen congesting the lung. It is caused by pathogenic heat congesting the lung, leading to lung failing to depurate and descend, and bladder qi transformation losing its normal function, resulting in difficult urination.
• Difficult urination with reduced urine volume, fullness in the lower abdomen, fever and aversion to cold, thirst but with no ability to drink much water, thin white tongue coating, and a floating pulse: this is Taiyang water retention pattern. It is caused by Taiyang pathogens entering the interior, leading to impaired bladder qi transformation.
• Difficult urination with reduced volume, accompanied by fever and aversion to cold, cough, facial and eyelid edema in the morning that progresses to generalized edema which pits on pressure, white tongue coating, and a floating, rapid pulse: this is wind-water edema pattern. It is caused by external pathogens invading, leading to lung failing to diffuse and depurate, and bladder qi transformation losing its function.
• Difficult urination with reduced volume, edema of the face and limbs, primarily pitting edema of the lower limbs, mental fatigue and lack of strength, cold extremities and loose stools, heavy body sensation and soreness of the lower back, aversion to cold with a preference for warmth, pale, swollen tongue with white coating, and a deep pulse: this is difficult urination due to yang deficiency with water flooding. It is caused by yang qi deficiency, with bladder qi transformation losing its function.
• Difficult urination, or stabbing pain on urination, or frequent, short, rough urination, or spasmodic cramping in the lower abdomen with pain radiating to the lower back, or blood in the urine, or gravel and stones in the urine, thin tongue coating, and a rapid pulse: this is difficult urination due to strangury (lin bing). It is caused by damp-heat or stones binding in the bladder, leading to impaired qi transformation.
• Difficult urination with reduced volume, accompanied by high fever, profuse sweating, dry mouth and vexation, obstructed defecation, red tongue with dry yellow coating, and a flooding, large pulse: this is difficult urination due to heat disease damaging yin. It is caused by exuberant pathogenic heat blazing fiercely, resulting in depletion of body fluids and insufficiency of the source of transformation.

Edema

Edema refers to the retention of water and fluids within the body that flood the skin and flesh, causing swelling of the head and face, eyelids, limbs, abdomen, back, or even the entire body. Clinically, in addition to distinguishing between yang edema and yin edema, one must also identify the zang-fu organ involved.

• Edema first appearing in the face and eyes, then spreading to the entire body, with difficult urination and reduced volume; prior to or during the onset of edema, there is an exterior pattern of external contraction, such as fever and aversion to cold, headache, aching joints and limbs, cough, sore throat, thin white tongue coating, and a floating, rapid pulse: this is edema due to wind and water struggling (feng shui xiang bo). It is caused by external wind-cold invading, leading to lung failing to diffuse and depurate and unable to regulate the waterways, with impaired bladder qi transformation.
• Generalized edema, primarily in the abdomen and lower limbs, pitting on pressure, scanty urine, heavy body sensation and fatigue, chest oppression, nausea, slimy tongue coating, and a soggy pulse: this is edema due to dampness trapping the spleen. The spleen is trapped by dampness, its transportation and transformation function is impaired, and water-dampness soaks into the skin and flesh, resulting in edema.
• Pronounced edema of the lower limbs, pitting that is not easily restored, epigastric stuffiness and abdominal distention, poor appetite and loose stools, sallow complexion, mental fatigue and cold extremities, scanty urine, pale tongue with white, slippery coating, and a deep pulse: this is edema due to spleen yang deficiency. It is caused by spleen yang deficiency and debilitation, failing to warm and transport water-dampness.
• Generalized edema, more pronounced below the waist, soreness and heaviness of the lower back, reduced urination, cold extremities, mental fatigue and lack of strength, a dull gray or pale white complexion, pale, swollen tongue with white coating, and a deep, thin pulse: this is edema due to kidney yang deficiency. Kidney yang deficiency leads to impaired bladder qi transformation, and water-dampness accumulates internally, resulting in edema.
• Generalized edema, accompanied by palpitations, dyspnea, inability to lie flat, cold extremities, aversion to cold, reduced urination, pale white or bluish-purple complexion, pale white tongue coating, and a deep, thin or knotted, intermittent pulse: this is edema due to heart-kidney yang deficiency. It is caused by heart-kidney yang deficiency, failing to warm and transport water-qi.
• Generalized edema with extremely severe palpitations and dyspnea, inability to lie flat, restlessness and agitation, profuse sweating, cold extremities, scanty urine, white, moist tongue coating, and a deep, thin pulse verging on extinction: this is edema due to yang deficiency nearing collapse, a critical and severe pattern. It is caused by yang deficiency with yin excess, resulting in the unchecked flooding of water-qi.
• A dull, lusterless, puffy complexion, mental listlessness, chest oppression and abdominal distention, poor appetite, nausea and vomiting, reduced urination, palpitations and shortness of breath, in severe cases progressing to restlessness and agitation, loss of consciousness and coma, convulsions and seizures, pale, swollen tongue with white slimy coating, and a deep, thin pulse: this is edema due to dual yin-yang deficiency with damp-toxin internal accumulation. It is caused by dual yin-yang deficiency with damp-toxin accumulating internally, resulting in the flooding of water-qi.
• Generalized edema with slow onset, more pronounced in the head and face in the morning and in the lower limbs in the afternoon, mental fatigue and lack of strength, poor appetite, pale, swollen tongue with thin slimy coating, and a soggy pulse: this is edema due to spleen deficiency, also called nutritional deficiency edema. It is caused by dietary irregularities leading to damage of the spleen and stomach, impaired transportation and transformation, and internal accumulation of water-dampness.