Recurrent bladder symptoms with cold signs: a case note

A single case from the clinic, shared for professional interest. It is not evidence of effectiveness, and individual results vary. Shared with the client’s written consent and anonymised.

Presenting complaint

A woman in her thirties contacted me about bladder pain and was seen the same day. She has had urinary tract infections over many years, usually kept manageable with D-mannose and Zhu Ling (Polyporus). Recently, a very demanding job, poor sleep and marked exhaustion, on a background of chronic fatigue, caused a flare. Her symptoms were:

• Sharp, stabbing lower abdominal pain, with pain all around the waist
• Strong urgency, but sometimes difficulty passing urine
• Stinging (not burning) on urination
• Smelly urine that was neither cloudy nor yellow
• A desire for warmth in the lower abdomen, and feeling cold all over, especially hands and feet
• Difficulty falling asleep and frequent waking, for 4 to 5½ hours a night
• Headaches with a pressing-down quality
• Tongue pale and swollen with no thick coat; pulses weak, especially at the Kidney positions

These symptoms were consistent with a UTI, without the red flags of fever, rigours, vomiting, blood in urine, or kidney-area pain.

Assessment

UTIs are often understood as damp-heat: yellow, cloudy, smelly urine, a burning sensation, a rapid pulse and a yellow tongue coat. None of the heat signs were present; the preference for warmth, the cold limbs, stinging rather than burning, the sharp pain, and the pale, swollen tongue with weak Kidney pulses pointed instead to cold obstructing the bladder on a background of Kidney yang deficiency, with exhaustion and poor sleep as the likely drivers for the flare.

Treatment

Acupuncture

• Dai Mai opened with GB-41 (right) and SJ-5 (left), to move fluids in the lower abdomen, coupled with LI-4 (right) and LR-3 (right); a combination that promotes movement throughout the body
• REN-3, REN-5 and ST-28 to move fluids locally, with LR-5 and SP-6 to move qi in the groin and drain dampness
• Moxibustion and tonification at ST-36 and KID-3
• Even technique (15 mins), except for the tonification above

Her symptoms eased noticeably during the session.

Herbs

A modified Wu Bi Shan Yao Tang, a traditional kidney-yang tonic, was adapted for this patient:

(He Zi is a substitute for Chi Shi Zhi)

Dose: two sachets of 60g raw herb equivalent FCG a day (from Balance Dispensary).

Outcome

All signs of infection had resolved after three days of taking the herbs. Bladder function was normal with better sleep, no headaches, and improved energy. She took Zhu Ling for four days and then stopped.

Reflection

UTI-type presentations can be caused by a wide range of factors, particularly stress, exhaustion, damp clothes, poor diet or excessive sex.

In Chinese medicine, UTIs were first described in the Su Wen (100 BC) as ‘Lin (urinary dysfunction) syndrome’. Understanding the root cause is crucial to successfully treat the problem and prevent recurrence.

Recurrent or worsening urinary symptoms, fever, back pain or blood in the urine need prompt medical assessment.