During pregnancy, symptoms such as frequent urination, urgency, and painful urination are referred to as “painful urination during pregnancy” (妊娠小便淋痛, rènshēn xiǎobiàn lín tòng), also known as “zi lin” (子淋).
This condition corresponds to urinary tract infections in Western medicine, such as pregnancy-related urethritis, cystitis, and pyelonephritis. Painful urination during pregnancy is a common complication in clinical practice.
[Etiology and Pathogenesis]
The main mechanism involves bladder heat accumulation and dysfunction of qi transformation. Common patterns include Yin deficiency with fluid depletion, excessive heart fire, and damp-heat in the lower jiao.
1. Yin Deficiency with Fluid Depletion
Individuals with a constitution of Yin deficiency experience further depletion of Yin and blood during pregnancy. The excess heat from Yin deficiency descends to the bladder, scorching the fluids, resulting in painful urination.
2. Excessive Heart Fire
Individuals with a Yang excess constitution may indulge in spicy foods during pregnancy, leading to internal heat accumulation that stirs heart fire. This fire then moves to the small intestine and transmits to the bladder, scorching the fluids, resulting in painful urination.
3. Damp-Heat in the Lower Jiao
Improper dietary habits during pregnancy may lead to the invasion of damp-heat pathogens, which accumulate and scorch the bladder fluids, causing painful urination.
[Differentiation and Treatment]
In differentiation, it is crucial to understand the frequency and pain of urination, the duration of the condition, and the recurrence of symptoms, which can serve as indicators of deficiency or excess. This must be combined with other accompanying symptoms and a comprehensive analysis of tongue and pulse to determine the syndrome type and specific treatment methods. The main treatment principle is to clear and moisten, avoiding excessive purgation to prevent harm to the fetus. If purgation is necessary, it should be accompanied by tonifying kidney and stabilizing pregnancy herbs.
1. Yin Deficiency with Fluid Depletion Type
Main symptoms: During pregnancy, frequent urination, painful and scanty urination with yellow color, afternoon tidal fever, heat in the palms and soles, constipation, red cheeks and lips, red tongue with little or no coating, and thin, rapid pulse.
Symptom analysis: Yin deficiency leads to internal heat and fluid depletion, causing frequent urination and painful, scanty urination with yellow color; internal heat causes heat in the palms and soles and afternoon tidal fever; deficiency heat rises, leading to red cheeks and lips; insufficient Yin fluids result in constipation. A red tongue with little or no coating and a thin, rapid pulse indicate Yin deficiency with fluid depletion.
Treatment principle: Nourish Yin, clear heat, moisten dryness, and promote urination.
Example formula: Zhi Bai Di Huang Wan (知柏地黄丸, Anemarrhena and Rehmannia Pill).
If there are significant tidal fever and night sweats, add Mai Dong (麦冬, Ophiopogon), Wu Wei Zi (五味子, Schisandra), Di Gu Pi (地骨皮, Lycium), and Mu Li Fen (牡蛎粉, Oyster Shell Powder) to nourish Yin, clear heat, and restrain sweating; if there is blood in the urine, add Nu Zhen Zi (女贞子, Ligustrum), Han Lian Cao (旱莲草, Eclipta), and Xiao Ji (小蓟, Cirsium) to nourish Yin, clear heat, and cool the blood to stop bleeding.
2. Excessive Heart Fire Type
Main symptoms: During pregnancy, frequent urination, difficult and painful urination, scanty dark yellow urine, flushed face, irritability, and in severe cases, sores on the tongue and mouth, red tongue, thin yellow coating, and thin, rapid pulse.
Symptom analysis: Excessive heart fire moves heat to the small intestine and transmits to the bladder, causing frequent urination, difficult and painful urination with scanty yellow urine; heart fire rising scorches the mouth and tongue, leading to flushed face and irritability. A red tongue with thin coating and thin, rapid pulse indicate excessive heart fire.
Treatment principle: Clear heart fire, moisten dryness, and promote urination.
Example formula: Dao Chi Qing Xin Tang (导赤清心汤, Guide Red to Clear Heart Decoction) from the “Tong Su Shang Han Lun” (通俗伤寒论).
Ingredients: Fresh Sheng Di (鲜生地, Rehmannia), Fu Shen (茯神, Poria), Xi Mu Tong (细木通, Clematis), Yuan Mai Dong (原麦冬, Ophiopogon), Fen Dan Pi (粉丹皮, Moutan), Yi Yuan San (益元散, Beneficial Source Powder), Dan Zhu Ye (淡竹叶, Lophatherum), Chen Deng Xin (辰灯心, Juncus), Lian Zi Xin (莲子心, Lotus Seed Heart), Tong Bian (童便, Child’s Urine).
This formula cools the blood and moistens dryness to clear heart heat; Mu Tong, Zhu Ye, Deng Xin, Yi Yuan San, and Tong Bian promote urination to drain heart fire; Mai Dong, Lian Xin, and Fu Shen nourish heart Yin, clear heart fire, and calm the spirit. The entire formula works to clear heart fire, moisten dryness, and promote urination.
If there is severe heat and pain during urination, add Zhi Zi (栀子, Gardenia) and Huang Qin (黄芩, Scutellaria) to clear heat and detoxify; if heat injures the Yin and there is blood in the urine, add Chao Di Yu (炒地榆, Sanguisorba) and Ou Jie (藕节, Lotus Root Node) to cool the blood and stop bleeding.
3. Damp-Heat in the Lower Jiao Type
Main symptoms: During pregnancy, sudden onset of frequent and urgent urination, yellow-red urine, difficult urination with burning pain, and possibly low back pain, bitter mouth, dry throat, thirst with preference for cold drinks, chest fullness with reduced appetite, yellowish complexion, red tongue, yellow greasy coating, and slippery rapid pulse.
Symptom analysis: Dampness and heat combine to accumulate in the bladder, obstructing qi transformation and causing frequent and urgent urination, yellow-red urine, and burning pain; damp-heat injures the kidneys, leading to low back pain; damp-heat steaming upward causes bitter mouth and dry throat, and a yellowish complexion; dampness obstructs the spleen and stomach, leading to chest fullness and reduced appetite; heat injures fluids, causing thirst with preference for cold drinks. A red tongue with yellow greasy coating and slippery rapid pulse indicate internal damp-heat excess.
Treatment principle: Clear heat, drain dampness, moisten dryness, and promote urination.
Example formula: Jia Wei Wu Lin San (加味五淋散, Modified Five Lin Powder) from the “Yi Zong Jin Jian” (医宗金鉴).
Ingredients: Black Zhi Zi (黑栀子, Gardenia), Chi Fu Ling (赤茯苓, Poria), Dang Gui (当归, Angelica), Bai Shao (白芍, White Peony), Huang Qin (黄芩, Scutellaria), Gan Cao Shao (甘草梢, Licorice), Sheng Di (生地, Rehmannia), Ze Xie (泽泻, Alisma), Che Qian Zi (车前子, Plantago), Mu Tong (木通, Akebia), and Hua Shi (滑石, Talcum).
This formula uses Black Zhi Zi and Huang Qin to clear heat and drain fire; Ze Xie, Mu Tong, Hua Shi, Chi Fu Ling, and Che Qian Zi drain damp-heat and promote urination; Bai Shao and Gan Cao nourish Yin and alleviate urgency to stop painful urination; Sheng Di and Dang Gui cool the blood, nourish blood, moisten dryness, and support the fetus. The entire formula works to clear heat, drain dampness, moisten dryness, and promote urination. However, Hua Shi is very slippery, and Dang Gui is rich in flavor, which may easily disturb the fetus, so caution is advised.
If there is severe heat and toxicity, add Jin Yin Hua (金银花, Honeysuckle), Lian Qiao (连翘, Forsythia), and Pu Gong Ying (蒲公英, Dandelion) to clear heat and detoxify; if damp-heat injures the Yin and there is blood in the urine, add Da Xiao Ji (大小蓟, Cirsium) and Ce Bai Ye (侧柏叶, Platycladus) and Chao Di Yu to cool the blood and stop bleeding.
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