Oliguria+and+Anuria+(Long+Bi)

Oliguria, Anuria (Long Bi)
Characterized by a measurable decrease in the amount of urine output in relation to fluid intake

Long and Bi denote two separate but related conditions and are condiered one disorder in TCM. They represent a continuum from difficult urination to complete urinary retention

Relevant Biomedical Diseases
-UTI -BPH -Obstruction by renal calculi -Renal Failure -Neoplasms of the bladder, prostate or kidney

Main Organs Involved
-Urinary Bladder -Liver -Lung -Spleen -Kidney

Identification of Repletion vs. Vacuity
Damp-Heat, Lung Heat, Liver Qi Stagnation Pain and distention in the lower abdomen, yellow greasy and thin yellow tongue coat, wiry/choppy or rapid pulse || Chronic Spleen Qi sinking, Kidney vacuity Lack of strength to void, dribbling urine or anuria Fatigue, shortness of breath, weak voice, pale complexion, deep, weak and thready pulse ||
 * Repletion || Vacuity ||
 * Acute

Differential Diagnosis of Similar Disorders
-Urinary Strangury: Often presents w/ increased frequency and significant pain when voiding. Although the amount of urine with each voiding is often less than normal, the daily volume of urine output is adequate -Edema: Edema is fluid accumulation in subcutaneous tissues. When edema is significant, there is a decrease in fluids being processed by the kidney and smaller volumes are excreted. However, there is usually no difficulty urinating -Drum-like abdominal distention: This is a fluid accumulation in the abdominal cavity with a decrease in urinary output. It occurs in such conditions as hepatic cirrhosis, abdominal and liver cancer, chronic malaria schistosomiasis, and tuberculous peritonitis

Damp-Heat in the Bladder
[Mu tong stem (mu tong) 9g, Plantago seed (che qian zi) 12g - wrapped, Knotgrass (bian xu) 9g, Dianthis herb (qu mai) 9g, Talcum (hua shi) 15g - wrapped, Juncus pith (deng xin cao) 3g, Steamed Rhubarb (shu da huang) 9g, Gardenia fruit (shan zhi zi) 9g, Honey-fried Licorice (zhi gan cao) 6g]
 * Signs:** anuria, dribbling, dark scanty urine, burning sensation during micturition, distention in the lower abdomen
 * Symptoms:** Bitter & stick taste in the mouth, thirst w/ little desire to drink, constipation with incomplete defecation in some cases
 * Tongue:** red with yellow, greasy coat
 * Pulse:** rapid and slippery
 * Treatment Principle:** Clear Heat, drain Dampness, free and promote urination
 * Herbal Treatment:** Ba Zheng San (Eight Corrections Powder)

Lung-Heat Congestion
[Huang Qin (12g., Sang Bai Pi (9g.), Mai Men Dong (9g.), Che Qian Zi (12g.), Mu Tong (9g.), Zhi Zi (9g.), Fu Ling (12g.)]
 * Signs:** difficult, sluggish urination or anuria; rapid, shallow respiration
 * Symptoms:** dry throat, excessive thirst, cough, sensation of heat in the chest
 * Tongue:** thin, yellow coat
 * Pulse:** rapid
 * Treatment Principle:** Clear Lung Heat, free and promote urination
 * Herbal Treatment:** Qing Fei Yin (Lung CLearing Beverage)

Liver Qi Stagnation
[Aquilaria wood (chen xiang) 1.5g - powdered, Tangerine peel (chen pi) 9g, Tankuei (dang gui) 6g, White Peony root (bai shao yao) 9g, Licorice root (gan cao) 6g, Pyrrosia leaf (shi wei) 9g, Talcum (hua shi) 12g, Mallow seed (dong kui zi) 9g, Vaccaria seed (wang bu liu xing) 9g]
 * Signs:** difficult urination or anuresis accompanied by emotional stress, anger/irritability, or depression
 * Symptoms:** distention and pain in the chest and hypochondriac regions
 * Tongue:** red body with thin, yellow coating
 * Pulse:** wiry
 * Treatment Principle:** Soothe the Liver, regulate Qi, free and promote urination
 * Herbal Treatment:** Chen Xiang San (Aquilaria Powder)

Obstruction by Blood Stasis
[Shu Da Huang (9g.), Mang Xiao (9g.), Dang Gui Wei (9g.), Chuan Shan Jia (9g.), Tao Ren (9g.), Sheng Di Huang (6g.), Rou Gui (3g.)] + Qu Mai (9g.), Wang Bu Liu Xing (9g.)
 * Signs:** dribbling or thin urine stream, interrupted urination, or anuria often resulting from traumatic injury, injury or kidney stones
 * Symptoms:** distention and pain in the lower abdomen
 * Tongue:** dark purple with petechiae
 * Pulse:** choppy or wiry
 * Treatment Principle:** Quicken the Blood, dispel stasis, free and promote urination
 * Herbal Treatment:** Dai Di Dang Wan (Substitute Dead-On Pill) or Shao Fu Zhu Yu Tang

Spleen Qi Sinking
[Huang Qi (15g,) Ren Shen (9g.), Bai Zhu (9g.), Dang Gui (9g.), Chen Pi (6g.), Chai Hu (3g.), Sheng Ma (3g.), Zhi Gan Cao (6g.)]
 * Signs:** distention and heaviness in the lower abdomen, urinary urgency with inability to urinate, or scanty and hesitant urination
 * Symptoms:** Fatigue, weakness, shortness of breath, weak voice, poor appetite, chronic loose stools or diarrhea, rectal prolapse with a sense of incomplete defecation
 * Tongue:** pale with thin white coat
 * Pulse:** weak and thready
 * Treatment Principle:** Supplement the Spleen, Boost Qi, ascend clear Yang Qi, free and promote urination
 * Herbal Treatment:** Bu Zhong Yi Qi Tang (Supplement the Center Decoction)

Kidney Yang Vacuity

 * Signs:** anuria or urinary dribbling, weak urine stream
 * Symptoms:** Sore, weak low back and knees, cold limbs and body, pale complexion, fatigue
 * Tongue:** pale with white coating
 * Pulse:** deep, weak and thready, particularly in the chi position
 * Treatment Principle:** Warm and supplement the Kidney Yang, free and promote urination
 * Herbal Treatment:** Jin Gui Shen Qi Wan (Life Saver Kidney Qi Pill)

Acupucnture for Oliguria, Anuria CV 3, SP-6, SP 9, BL 28
 * Supplementary Points:**
 * Damp Heat:** ST-28, TW-5, BL-39
 * Lung Heat:** LI-4, LU-5, TW-5, LI-11, LU-11, LU-1
 * Liver Qi Stagnation:** LI-4, LR-3, LR-14
 * Blood Stasis:** CV-6, CV-5, SP-10
 * Spleen Qi Sinking:** SP-3, BL-20, LR-13, ST-36, GV-20
 * Kidney Yang Vacuity:** GV-4, BL-23, GV-20, CV-4, TW-4

Clinical Tips for Treating Oliguria, Anuria
1. In oliguria, urine is produced and stored in the bladder. This is a relatively more manageable condition than anuria, in which urine is not formed and the bladder is empty. Therefore, accurate differentiation between these two related conditions are essential for proper treatment.Physical examination including observation, palpation and percussion is necessary to detect urine formation.

Distention, discomfort on palpation, and solid resonance to percussion in the lower abdomen indicates formation of urine and a full bladder. The patient may express a desire to urinate but be unable to do so. Decreased urine output, lack of desire to urinate, a flat lower abdomen, and hollow resonance to percussion in the lower abdomen indicate lack of urine formatio in the bladder. This essentially corresponds to the Chinese term/disease Bi and is a medical emergency that needs to be treated in a hospital.

2. For anuria, auto-intoxication from metabolized waste can cause nausea, vomiting, dyspnea, tightness in the chest, systemic edema, constipation, irritability, delirium, convulsions, and loss of consciousness. This is an urgent condition requiring medical intervention.

3. Caution should be exercised when needling in the vacinity of the bladder if it is full and distended. Deep, vertical needling is contraindicated in such cases.