TCM and Disorders of Urination and Defecation
By Dr. Hong-Yen Hsu
Urinary incontinence, the uncontrollable, involuntary discharge of urine, is much more common in the elderly than in the young. This is because the efficiency of muscular sphincters and the tone of ligaments associated with urination diminish with age.
In traditional Chinese medicine (TCM), the kidneys are in charge of water metabolism and are responsible for the excretion of urine; while the urinary bladder is responsible for the storage of urine. Dysfunction of the kidneys and bladder may cause frequent or incontinent urination.
Based on the patient's symptoms and the associated conformation, the following formulas are commonly used to treat urinary incontinence.
1. Unconsolidation of the kidney qi, a condition due to kidney-qi deficiency, manifests as urinary incontinence, frequent urination, soreness and weakness in the lower back and knees, lassitude, spermatorrhea, premature ejaculation, nocturia, pale tongue with white coating, and deep, thready pulse. This condition is commonly treated by Lotus Stamen Formula and Alpinia & Lindera Formula.
2 Kidney-yang deficiency, which is very common in the elderly, is marked by urinary incontinence, pale complexion, cold extremities, dizziness, tinnitus, fatigue, soreness and weakness in the lower back and knees, decreased libido or impotence, pale tongue with white coating, and deep, slow, and forceless pulse. Rehmannia Eight Formula is commonly used. Deer antler and mantis can be added.
3. Kidney-yin deficiency marked by urinary incontinence or frequent but scanty urination, feverish sensation in the palms and soles, dry mouth and throat, irritability, dry stools or constipation, red tongue with little coating, and thready, rapid pulse can be treated with Rehmannia and Schizandra Formula in conjunction with Mantis Formula. In case of
dampness-heat characterized by yellow tongue coating and frequent micturition of small amounts of dark yellow urine or dribbling urination, Anemarrhena, Phellodendron & Rehmannia Formula can be used.
4. Spleen deficiency manifested as urinary incontinence, frequent urination, lassitude, low energy, lack of strength in speaking, loose stools, slightly pale tongue with teeth marks, and thready, forceless pulse can be treated with Ginseng & Astragalus Combination in conjunction with Hoelen & Cuscuta Formula.
Surveys have shown that nocturnal frequency is the number one urinary problem in the elderly. It occurs in 70% of men and 61 % of women over 65, and increases in prevalence beyond that age. There are a number of possible reasons for this. Elderly people's sleep is lighter and they waken during the night. Additionally, the nyctohemeral pattern of micturition alters with aging, and a comparatively greater volume of urine is excreted during the night in old people than in young people. Additionally, old people may develop uninhibited bladder contractions, either due to aging or due to cerebral pathology.
As mentioned above, in traditional Chinese medicine, the kidneys are responsible for normal excretion of urine and nocturnal frequency is one of the symptoms of kidney deficiency.
1. Kidney-yang deficiency manifested as nocturnal frequency, dripping urination or urinary incontinence, tinnitus, soreness and weakness in the lower back and knees, pale and flappy tongue, and deep, thready, and weak pulse is commonly treated with Rehmannia Eight Formula or Eucommia & Rehmannia Formula to warm and tonify kidney yang. Alpinia fruit and lindera or Alpinia & Lindera Formula can be added to warm the kidneys and astringe urine.
2. Both spleen and kidney deficiencies marked by intolerance of cold, cold limbs, lassitude, fatigue, dizziness, tinnitus, soreness and weakness in the lower back and knees, diarrhea or loose stools, frequent urination, pale and swollen tongue with teeth marks, thin, white tongue coating, and deep, thready pulse can be treated with Ginseng & Astragalus Combination plus cooked rehmannia and cinnamon bark, or Rehmannia Eight Formula plus ginseng, astragalus, and atractylodis. Alpinia & Lindera Formula may be added.
It is a generally held impression that people tend to become more constipated as they get older. Studies have shown a decrease in both basal pressure and squeeze pressure of the bowels in both sexes with aging. A survey of the bowel habits of 1,455 people showed between 3 defecations a day and 3 defecations a week for 99% of the subjects. This held good for the 125 who were over the age of 60; however, the elderly group consumed twice as many laxatives their under-60 counterparts. Among the elderly, 30% take laxatives at least once a week.
In Chinese medicine, constipation is usually divided into two types: excess type and deficiency type. The latter is more common in the elderly. The commonly used Chinese herbal formulas used to treat elderly patients with habitual constipation are as follows.
1. Apricot Seed & Linum Formula, a mild laxative which moistens the large intestine, drains heat, and promotes bowel movement, is recommended for elderly patients with dry stools.
2. Linum & Rhubarb Combination, which clears heat and moistens the large intestine, is commonly used in the treatment of habitual constipation, especially in the elderly, since even frequent use will not produce side effects.
3. Cistanche & Tang-kuei Combination, which warms the kidneys, tonifies essence, and moistens the large intestine, is suitable for elderly patients with kidney deficiency marked by dizziness, lassitude, cold limbs, soreness and weakness in the lions and knees, frequent urination, and constipation.
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