Case Report
Patient: Female, 56 years old
Consultation Date: December 17, 2023
Main Complaint: Urinary incontinence and frequent urination for 3 years, worsened in the last 3 weeks, with fever for 1 day.
Present Illness: The patient has experienced urinary incontinence and frequent urination for three years, particularly after catching a cold or coughing, with significant volume and frequency. Occasional leakage occurs when sneezing. Despite multiple visits to hospitals and clinics, there was no significant improvement. Three weeks ago, she developed cold symptoms, fever, and cough, and was diagnosed with pneumonia at a hospital, where she was hospitalized for a week and discharged after improvement. However, after being exposed to cold last night, her urination frequency and volume increased. She requested TCM treatment.
Current Condition: Fever at 39.2°C, chills, headache, generalized body aches, neck and back pain, bitter and dry mouth, chest and hypochondriac discomfort, cold back, normal appetite, one bowel movement, small in shape, clear and frequent urination, needing to urinate approximately every half hour. Tongue: pale red with thin, slightly yellow greasy coating; Pulse: floating, wiry, thin, and strong.
Past Medical History: History of “gastric polyps”.
Prescription: Chai Hu (Bupleurum) 25g, Huang Qin (Scutellaria) 12g, Ban Xia (Pinellia) 9g, Zhi Gan Cao (Honey-fried Licorice) 5g, Da Zao (Jujube) 10g, Sheng Jiang (Fresh Ginger) 5g, Gui Zhi (Cinnamon Twig) 10g, Bai Shao (White Peony) 12g, Ge Gen (Kudzu Root) 30g, Ma Huang (Ephedra) 10g, Xing Ren (Apricot Kernel) 10g, Hou Po (Magnolia Bark) 10g, Dang Shen (Codonopsis) 10g, Chan Tui (Cicada Slough) 10g, two doses, decocted in water for oral administration.
Advised that if no sweating occurs two hours after the first dose, she may take another dose.
Diagnostic Approach
1. If there is no fever, consider bladder cough, Taiyang (Greater Yang) water retention, and use Wu Ling San (Five-Ingredient Powder with Poria) combined with Zhen Wu Tang (True Warrior Decoction). Chronic illness must lead to deficiency.
2. The patient has a cold back and currently has a fever, so Aconite-based formulas are temporarily not used.
3. In urgent cases, treat the symptoms; currently, the patient has a fever, so we address that first.
4. The patient has fever, chills, headache, generalized body aches, neck and back pain, and a floating pulse, indicating a Taiyang exterior syndrome, suggesting the use of Ge Gen Tang (Kudzu Decoction); with bitter and dry mouth, chest and hypochondriac discomfort, pale red tongue, and wiry pulse, indicating a half exterior, half interior Shaoyang syndrome.
5. For fever, should we use gypsum? The patient has frequent urination, and gypsum is a cold and cooling substance, so it is temporarily not used.
6. Advised the patient to return for treatment of frequent urination after the fever subsides.
Results
The patient consulted around 5 PM and called around 10 PM to report sweating.
The next day, the patient called to inform me that the fever had completely subsided.
Most surprisingly, the frequency and volume of urination had returned to normal!
She did not use any Western medicine for fever reduction. I will continue to follow up.
Comments
1. In urgent cases, treat the symptoms; based on the current symptoms, the diagnosis is a cold, and the differentiation of the six meridians indicates that Taiyang and Shaoyang are accurate, making the use of Ge Gen Tang combined with Xiao Chai Hu Tang (Minor Bupleurum Decoction) appropriate.
2. Chai Hu and Ge Gen also form the basis for Chai Ge Jie Ji Tang (Bupleurum and Kudzu Decoction), which releases the exterior and resolves muscle tension.
3. Chan Tui has the effect of dispersing wind-heat, and modern pharmacological studies indicate it has antipyretic effects; some journals suggest it has hormone-like effects, which are beneficial for reducing fever.
4. Ma Huang releases the exterior, induces sweating, and opens the lungs.
5. The patient has had frequent urination for three years, and after taking the medicine, the symptoms improved significantly. It is possible that a certain point in the lung’s movement was blocked, and after taking the medicine, it was unblocked. The lung governs the qi of the whole body, regulates water, and controls the passage.
6. For the long-term effects on frequent urination, I will continue to follow up. During the follow-up visit on December 20, the patient reported normal urination.
Author Introduction
Chen Quanji, attending physician of Traditional Chinese Medicine, licensed Chinese herbalist. Graduated from Guangxi University of Traditional Chinese Medicine (now Guangxi University of Chinese Medicine) in 1996 and has been engaged in clinical practice ever since. He has studied under renowned TCM masters Wei Guikang and Huang Jinming, and has furthered his studies at several top-tier hospitals including the Affiliated Hospital of Guangxi University of Chinese Medicine.
He is a disciple of Lin Jiaming, the deputy director of the Qinzhou Traditional Chinese Medicine Hospital, a deputy chief physician, a renowned TCM practitioner in Qinzhou, and a mentor for undergraduate students in TCM at Beijing University of Chinese Medicine. He is also the head of the Qinjian TCM inheritance base for Hu Xishu’s classical formulas.
In clinical practice, he employs a combination of TCM and Western medicine, using organ differentiation and six meridian differentiation methods, integrating current and classical formulas to treat common and frequently occurring diseases such as colds, coughs, gastrointestinal diseases, angina, dizziness, headaches, neonatal jaundice, malnutrition, menstrual disorders, leukorrhea, scabies, rhinitis, otitis media, etc. He also treats certain chronic and difficult diseases such as liver cirrhosis with ascites, gallbladder and kidney stones, lung nodules, cardiovascular and cerebrovascular diseases, nephrotic syndrome, insomnia, anxiety, postherpetic neuralgia, various pain syndromes, infertility, and certain visceral tumors and nodules.
Written by: Chen Quanji
Edited by: Huang Huaizhen
Proofread by: Ma Yuwen, Zeng Jingyi