URINARY DISORDERS: Lin Syndromes. Linda Boggie Eric Hartmann

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1 URINARY DISORDERS: Lin Syndromes Linda Boggie Eric Hartmann

2 Lin Syndromes Painful Urination Syndromes Painful Frequent Short Urgent Dribbling A disruption in urine flow

3 Often associated with or are an extension of Retention Syndromes Cystitis Prostatitis Cystic or renal calculi Often accompanied by abdominal pain

4 Most common disharmonies Stagnation of Qi Qi Deficiency Dampness and Damp Heat Kidney Deficiency

5 Lin Syndromes Qi Lin* Damp-Heat Lin* Stone Lin* Blood Lin* Cloudy Lin Fatigue Lin

6 CHINESE PHYSIOLOGY

7

8 LUNGS Dominate Water Passages Disperses Fluids down If passages are open no problem

9 SPLEEN Transforms and Transports The pure fluids upwards and to the Zang-Fu If poor transformation no separation of pure and impure If poor transportation fluids accumulate With long standing accumulation Phlegm

10 KIDNEY Dominates Water Metabolism Draining Ditch in lower jiao KI Yang necessary for: BL Function SP Function Separation of pure and impure in SI (LI) Control of lower orifices (all)

11 KI Yang grasps the descending LU Qi Fuel to fire (O 2 ) to continue cycle

12 BLADDER In charge of holding and excreting urine Urine is a by-product of its transformation of Qi The pure qualities in the urine as Qi via KI Yang The impure Fluid is excreted as urine

13 SMALL INTESTINE Separates pure from impure Connected with the Bladder as both are Taiyang Channels

14 SAN JIAO (Triple Heater) Connection between the three jiaos Ensure open communication Regulates drainage ditches of lower jiao and Kidney

15 LIVER Spreads Qi smoothly throughout body including lower abdomen Channel goes to genitalia and urethra Stagnation of Liver QI will affect the Bladder function of transforming Qi

16 What can happen with urine? amount amount frequency frequency Abnormal sensations can be difficult to assess in veterinary patients Painful, burning, straining Clear or cloudy

17 Lin Syndromes Qi Lin* Damp-Heat Lin* Stone Lin* Blood Lin* Cloudy Lin Fatigue Lin

18 Qi Lin Two types Symptoms Interrupted urine stream Possible pain in lower abdomen No signs of Damp-Heat Cats with mucous plug Dogs with BPH

19 Qi Stagnation 5 Element Imbalance of Wood element not moving Qi Stuckness in Wood backs up the Water Frustration or irritability

20 Qi Stagnation TCM Liver Qi Stagnation in lower jiao Feeling of distention and pain in hypogastrium Patient may resent Often emotional cause Irritable Wiry, full pulse

21 Points 5 Element KI 1, 10 LIV 2, 3, 8, CV 5, 6 LIV 4 TCM LIV 2, 3, 5 BL 18, 28 CV 3, 6

22 Qi Deficiency 5 Element Metal and Earth both extract Qi From air From food Need to strengthen the function of each

23 TCM Spleen Qi Deficiency most common Flaccid abdomen with only slight hypogastric distention Fatigue Pulse weak Tongue pale and moist

24 Points 5 Element KI 3, 7 CV 6 LU 7, 8 BL 10, 23, 28 SP 2, 3, 6, 9 TCM SP 3, 6, 9 BL 20, 21 CV 6, 17 ST 36 GV 20

25

26 Case example Patient of Sikke s Nice sweet male tabby cat, neutered 4 years? Mucous plug No anesthesia required to unplug Urine was clear, no blood Struvite crystals, no bacteria

27 Damp-Heat Lin: 5 Element 3 Elements: Water, Wood and Earth Imbalance in Earth dampness Dampness (excess) Insults Water Accumulates in Bladder

28 Heat Excess in Fire Element Small Intestine Excess Wood feeding Fire Lack of control by Water Differentiated by Pulse Tongue Symptoms

29 Damp-Heat Lin: TCM More severe presentation of DH in BL Bacterial cystitis ± crystals Because there is a disruption of flow the Liver will always be involved with TCM pattern diagnosis Case examples: cats with FLUTD, Urethral obstruction

30 Dampness EPF: damp environment IPF: affecting Spleen s function Diet affecting SP Depletion of KI Yang

31 Heat Develops secondary to Stagnation caused by Dampness Emotions Fear, Anger, Frustration, Worry, Anxiety

32 Clinical Signs Pain in urethra Turbid urine Tongue: red body with sticky yellow coat Pulse: fine and rapid, or full and rapid

33 Points 5 Element BL 60, 23, 28 KI 3 PC 3 ST 40 SP 5, 6 TCM BL 22, 28 CV 3, 12 SP 6, 9 BL 40 LIV 8 LIV 2, 5

34 Dietary considerations Cats with FLUTD have been shown to do better with moist foods

35 Blood Lin: 5 Element Excess of the Fire Element insulting Water Full syndrome Lack of Control of Water on the Fire Results in flaring of Fire Deficiency syndrome

36 Symptoms of Heat Blood Rapid pulse Symptoms of pain Crying upon urination Taut pulse

37 Blood Lin: TCM Symptoms are hematuria, painful and burning urination Heat is pushing the blood out of the vessels Full Heat Liver Fire Mental restlessness Red tongue and rapid full pulse Irritable

38 Empty Heat Kidney Yin Deficiency Depression, mental restlessness at night Not as much pain Pale blood in urine Red tongue with peeled coat Rapid but weak pulse, floating

39 Points 5 Element PC 7 BL 23 GV 3 SI 8 KI 10, 2 BL 60 TCM LIV 3, KI 2 CV 3 BL 28, 63 (pain) SP 10, 6 BL 17 CV 4 KI 6

40 Stone Lin: 5 Element Earth over controls the Water Excess Damp-Heat accumulates which turns to Phlegm As Water is over controlled unable to control Fire Metal is involved with minerals Feeding to deficient Water leads to accumulation of minerals

41 Stone Lin: TCM Chronic Damp-Heat consumes the fluid Phlegm forms as stones and sediment Sand, gravel and stones in urinary bladder and urinary tract system

42 Severe stagnation hypogastric pain May be painful over sacrum Tongue: red, thick yellow coating Root may be dry Pulse: wiry and rapid

43 Calcium oxalate stones In >60% of patients they also have renal and or urethral calculi >60% also have elevated BUN Denise Elliott, BVSc, PhD, Dipl ACVIM, Dipl ACVN,NAVC proceedings, 2003, p567-9.

44 Points 5 Element KI 7 LU 5 SP 3, 6, 9 ST 39, 40 TCM LIV 2, 3 BL 22, 63, 28 CV 3, 6 SP 9 BL 39 with KI 2 ST 28

45 Summary of Lin Syndromes Painful Obstructed urine flow 5 element Water, Earth and Wood TCM KI, LIV, SP

46 Enuresis and Incontinence

47 Enuresis Occurs without the knowledge Most common in young animals, esp. dogs Qi of Abdomen not Firm Can be result of spaying and neutering especially if other signs of KI Yang Deficiency

48 Incontinence Lack of control but occurs with knowledge Also includes feeling of urgency and difficulty holding urine Seen more in the elderly due to declining Qi

49 Other causes Chronic cough LU Qi Def and BL strain LU and KI Def over time Loss of Blood at parturition Always a Deficiency

50 End Result Urine leaking Dribbling Polyuria Frequent urging

51 Enuresis and Incontinence Both 5 Element and TCM see the involvement of Water and Earth 5 Element Lack of control by Earth on Water via K o cycle Allows disbursion of water; not contained as a ditch (Earth) would channel water flow

52 Points KI 3, 7, 14 BL 23, 27, 52 LIV 8 CV 1 GV 1 SP 3

53 TCM Always a deficiency pattern Deficiency of LU Qi Deficiency of SP Qi Deficiency of KI Qi Deficiency of KI Yang

54 Incontinence Lung Qi Def Deficient LU Qi cannot control water passages Def LU Qi can t support BL in Qi transformation 5 Element Metal not feeding Water

55 Lung Qi Def Can be result of aging (common) or chronic lung problems Other signs of Qi Def Fatigue with exercise, short breath Pale tongue, cracks, Weak pulse

56 Symptoms Frequent urges to go Dizziness, shortness of breath, no thirst, increased salivation LU cannot Disperse and Descend Fluids

57 Treatment Principle Warm and tonify Lung Qi Increase Kidney Yang/ Kidney Qi BL 13, 20, 23 LU 7, LU 8 CV 6 GV 4 KI 7

58 Kidney Yang Deficiency Most common cause There is a LACK of HEAT Polyuria and urine is CLEAR Most estrogen responsive incontinence is due to KI Yang Def 5 Element is Deficiency of Water

59 Weakened by: Spaying and neutering as it affects hormones Poor heredity Inbreeding Over vaccination Environmental toxins Stress

60 Symptoms Frequent urination, some dripping Increased frequency at night Time of Yin and when Yang is weakest Urine is pale Increased volume Wants warmth Cold in back, sore lumbar muscles Weak knees

61 Tongue: pale and wet, wide Pulse: fine, slow and deep

62 Treatment Principle Warm the KI Reinforce KI Yang Stabilize KI Qi

63 Points BL 23, 52 BL 28 BL32 stabilizes Essence with MOXA GV 4, 20 CV 6, 4, 3 KI 3, 7, 14 MOXA is great for these patients

64 Spleen Qi Deficiency Only a slight incontinence and seems to have more of a sense of urgency Other signs of Spleen involvement Poor appetite, digestion Loose stools Fatigue Pale Tongue with excess moisture Weak pulse

65 5 Element Earth not controlling the Water

66 Points BL 23 GV 20 BL 20, 21 ST 36 CV 12, 6 BL 28

67 Kidney Yin Deficiency Urine is scanty and dark yellow There is a LACK of Fluids No pain KI Yin fails to control Normal Yang which flares and pushes urine out of bladder

68 Symptoms Incontinence or frequent urination BUT with SMALL amounts of urine Dripping after urination/ never complete Enuresis

69 Dry mouth, throat Constipation Intolerance of heat Insomnia, restlessness HT Shen

70 Tongue: Red, no coating Pulse: fine, rapid or floating and empty Older Patients with renal failure End Stage Hyperthyroid cats

71 Treatment Principles Tonify KI Yin Subdue Fire Increase water Stabilize KI Qi

72 Points SP 6 KI 2, 3, 6 BL 67 CV 24 CV 4, 3 PC 6 HT 7

73 5 Element Summary Incontinence 3 major elemental interactions/ dynamics Sheng cycle Metal not feeding Water K o cycle Earth not controlling the Water Imbalance in one of the elements Water

74 Any of these dynamics can be applied to any case

75 SUMMARY Incontinence/ enuresis Deficiency pattern in animals KI YANG Retention Syndromes cystitis Heat and Damp-Heat Deficiency or Excess (Stagnation) Lin Diseases Extensions of Retention syndromes

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