CHAPTER 41 Retention of Urine During Pregnancy

This condition is characterized by difficult urination, slight retention of urine, an uncomfortable feeling in the lower abdomen and a feeling of irritability.

Aetiology

Excessive physical exercise

Excessive physical exercise injures the muscles and the Spleen and may lead to Spleen-Qi deficiency. When Spleen-Qi is deficient, it may also sink leading to a slight prolapse of the internal organs. In pregnancy, this is aggravated by the pressure of the growing fetus on the bladder which, together with Spleen-Qi deficiency, may lead to a slight retention of urine.

The Medical Collection of Four Families from Meng He says:

Urinary problems in pregnancy are due to the fetus weighing down, pressing on the bladder, leading to urinary problems (which could be retention or incontinence). To treat it, one must raise Qi and lift the fetus.¹

Excessive sexual activity, excessive standing or lifting

Excessive sexual activity during the last trimester of pregnancy or excessive lifting and standing may injure the Kidneys and lead to the sinking of Kidney-Qi. In pregnancy, the pressure of the growing fetus on the bladder, together with the sinking of Kidney-Qi, may cause retention of urine.

External Dampness

External Dampness may invade the channels of the legs: in women, it easily settles in the urinary passages. Here, Dampness obstructs the transformation and transportation of urine and may cause retention.

Irregular diet

Excessive consumption of dairy foods and greasy foods easily leads to Dampness. This often settles in the urinary passages and obstructs them in the same way as described above.

Pathology

The pathology of retention of urine in pregnancy is characterized by a combination of interacting physical and energetic components. The sinking of Spleen-Qi and/or Kidney-Qi may lead to the fetus dropping down slightly and pressing on the bladder; vice versa, the downward pressure of the growing fetus may lead to the sinking of Spleen- and/or Kidney-Qi. Although normally retention of urine may be due to either Full or Empty causes, in pregnancy it is always due to Empty causes; these may be deficiency and sinking of Spleen-Qi or Kidney-Qi. Thus, the treatment consists in tonifying and raising Spleen- or Kidney-Qi and stimulating the Bladder’s function of Qi transformation.

Identification of patterns and treatment

The patterns discussed are:

• Spleen-Qi deficient and sinking

• Kidney-Qi deficient and sinking

• Damp-Heat in the Bladder.

Spleen-Qi deficient and sinking

Clinical manifestations

Frequent but scanty urination, discomfort in the lower abdomen, a bearing-down sensation, restlessness with inability to sit or lie down, pale complexion, tiredness, shortness of breath. Tongue: Pale. Pulse: Weak.

Treatment principle

Tonify Spleen-Qi, raise Yang, lift the fetus.

Herbal treatment

b Prescription

– YI QI LI SHUI TANG

– Benefiting Qi and Transforming Water Decoction

Explanation

– Huang Qi, Dang Shen and Bai Zhu tonify and raise Qi.

– Sheng Ma, in combination with Huang Qi, raises Qi.

– Tong Cao opens the Water passages and removes obstructions from the Connecting channels.

– Gui Zhi, in combination with Tong Cao, opens the Water passages by tonifying the Minister Fire and warming the channels; Heat is necessary to transform Water.

– Che Qian Cao and Ze Xie drain Dampness from the Lower Burner.

– Yi Mu Cao and Dang Gui invigorate and nourish Blood.

– Wu Yao moves Qi, which helps to open the Water passages in the Lower Burner.

– Gu Ya promotes digestion.

Compared with the previous formula, this formula has a more complex action and might actually be more suitable after childbirth. In fact, besides tonifying and raising Qi, it drains Dampness from the urinary system and it nourishes and invigorates Blood. Strictly speaking, Tong Cao and Che Qian Cao are forbidden in pregnancy, so they should be either removed or used in a very small dose.

Three Treasures remedies

– TONIFY QI AND EASE THE MUSCLES

This remedy is a variation of the formula Bu Zhong Yi Qi Tang Tonifying the Centre and Benefiting Qi Decoction which tonifies and raises Spleen-Qi. It has been modified with the addition of herbs which resolve Dampness: it is therefore particularly indicated if there is Dampness. The tongue presentation appropriate to this remedy is a Pale body with a sticky, white coating.

– SEPARATE CLEAR AND TURBID

This remedy promotes the transformation and separation of fluids in the Bladder and also tonifies and lifts Spleen- and Kidney-Qi: it is specific to treat urinary difficulty deriving from Qi deficiency and Dampness in the urinary passages. The tongue presentation appropriate to this remedy is a Pale body. Strictly speaking, Qu Mai and Che Qian Zi are forbidden in pregnancy, so this remedy should be used in a very small dose (e.g. one or two tablets a day).

Kidney-Qi deficient and sinking

Clinical manifestations

Frequent but scanty urination, pale urine, flow of micturition interrupted, uncomfortable sensation in hypogastrium which is worse when sitting, feeling cold, backache, tiredness. Tongue: Pale and wet. Pulse: Deep, Weak.

Treatment principle

Tonify and warm Kidney-Yang, promote the transformation of Water, warm the Bladder, calm the fetus.

Herbal treatment

Three Treasures remedy

– STRENGTHEN THE ROOT

This remedy is a variation of the formula You Gui Wan Restoring the Right [Kidney] Pill which tonifies and warms Kidney-Yang and strengthens the Governing Vessel. The tongue presentation appropriate to this remedy is a Pale and wet body.

I have not recommended the prepared remedy Jin Gui Shen Qi Wan Golden Chest Kidney-Qi Pill because it contains Fu Zi Radix Aconiti lateralis preparata which is contraindicated in pregnancy. However, there are on the market variations of Jin Gui Shen Qi Wan without Fu Zi: if these can be obtained, then this remedy would be suitable.

Damp-Heat in the Bladder

Clinical manifestations

Difficult urination, dark and turbid urine, irritability, a feeling of heaviness in the lower abdomen, poor appetite, a sticky taste. Tongue: thick, sticky, yellow coating on the root with Red spots. Pulse: Slippery and slightly Wiry on the left Rear position.

Treatment principle

Resolve Dampness, clear Heat, promote the transformation of Water, calm the Mind, calm the fetus.

Herbal treatment

a Prescription

– DONG KUI ZI SAN Variation

– Fructus Malvae Powder Variation

Explanation

The first four herbs constitute the formula Dong Kui Zi San which is specific for urinary retention during pregnancy according to the Great Dictionary of Chinese Formulae.² Dong Kui Zi and Fu Ling, in combination, also constitute a formula of the same name, Dong Kui Zi San. The dosages of the first four herbs are those from the original formula: I would personally at least halve them and not use Mu Tong. Although Mu Tong and Dong Kui Zi are contraindicated in pregnancy, this formula is considered specific for retention of urine in pregnancy. I would replace Mu Tong with Tong Cao Medulla Tetrapanacis.

– Dong Kui Zi, Hua Shi, Mu Tong and Fu Ling resolve Damp-Heat from the Bladder.

– Shan Zhi Zi clears Heat and resolves Dampness.

Note: Dong Kui Zi, Shan Zhi Zi and Hua Shi can also be used externally as a wash.

b Prescription

– ZI SHEN TANG³

– Nourishing the Kidneys Decoction

Explanation

– Zhu Ling and Fu Ling drain Dampness.

– Che Qian Zi, Mu Tong, Huang Bo and Hua Shi drain Damp-Heat.

– Zhi Mu clears Heat.

– Rou Gui is used here to tonify the Minister Fire to promote the transformation of Water.

– Jie Geng is used here to vent the Upper Burner which promotes the excretion of fluids in the Lower Burner. This use is comparable to the hole in a teapot lid which facilitates the pouring of tea. Strictly speaking, Che Qian Zi and Mu Tong are contraindicated in pregnancy, so they should either be removed or used in a very small dose.

Prognosis and prevention

Difficulty in urination responds well to treatment with both acupuncture and/or herbs. In my experience, the three patterns described above often occur in combination, e.g. Spleen-Qi deficiency with Dampness or Kidney-Qi deficiency with Dampness. When selecting a formula, one must therefore decide whether the deficiency or the Dampness is predominant. The pattern from Damp-Heat is the most difficult to treat. Generally speaking, with a combination of acupuncture and herbs, good results should be obtained within days.

There is no Western view of this condition.