male urinary obstruction from blood stasis and without damp heat

October 16, 2009

Dear Colleagues,

I have a very athletic patient in his 50s, who 5 years ago came down with a

severe case of Guillain-Barre syndrome. Though he has difficulty walking, he

has built himself back up by swimming an hour daily. When I started treating

him about a month ago, both proximal pulses were empty, and slow but as would be

expected, the distal pulses on the right wrist are robust. I have been treating

him with a combination of You Gui wan and Xiao Huo Luo Dan, along with

acupuncture and heat (a combination of infrared heat and moxa, alternatingly) .

The first condition that I treated him for was ulcerated sores or his feet and

toes with numbness, similar to diabetics with neuropathy. The sores have now

healed completely, and the extremities though still cold are less so. His

proximal pulses are now thready and a little slow and weak. None of his pulses

give any indication of a slippery or rapid quality. All the above

is background to my actual question:

His chief complaint is urinary obstruction and unrelenting pain upon urination.

In order to urinate he has to gently massage his penis, and even then only a few

drop come out. It is very painful, and he is afflicted by it day and night,

every half hour or so. But wait, before you jump on the prostatitis and damp

heat bandwagon, first, as I mentioned above neither his pulses nor tongue

reflect that at all. Second, he saw his urologist yesterday, who upon

examination and testing said that there is no evidence of infection, and though,

his prostate is marginally enlarged, it is consistant with someone his age, and

certainly contributes little to his current condition. Also, there is no

urinary retention, and so a catheter would not be helpful at all. The current

condition, he said, was clearly the result of scar tissue and stricture, the

result of the GBS from 5 years ago in the penis and urethra. He is open

to herbs

and clearly, what I need to prepare is a formula that will invigorate blood

stasis, while continuing to warm and open the channels, boost Kidney Yang and

nourish Kidney Jing. One other unpleasant side effect: When he bears down too

hard trying to urinate, he involuntarily defecates.

The benefit of your experience would be appreciated.

October 18, 2009

Hi

I hope to give a small contribution to your case, but understand this is quite

complicated from the Western perspective (I am also an MD), and really quite

interesting. From a Western perspective, having discounted prostate and bladder

causes, we are left with a Urethritis, irritated urethra of unclear etiology.

Does he have arthritis or other joint problems? Any eye problems?. At any rate

other Western causes are likely difficult to treat.

From the TCM perspective, the symptoms certainly seem to point to DH in the

Bladder, which you have appropriately challenged by your exam, or Heat in the

SI/?heart channels. Any other SI symptoms?. Any trouble sleeping/etc?. I'm

not an A + herbs practitioner, but from the acupuncture aspect, would certainly

include SI points such as SI 3 and ST 37, along w the usual (REN 3,4, possibly

even REN 1 if you are feeling brave, Ht 7 or even 8, LI 11 for heat).

Hope I've added something.

Chicoliv

Chinese Medicine , yehuda frischman

< wrote:

>

> Dear Colleagues,

>

> I have a very athletic patient in his 50s, who 5 years ago came down with a