Gonorrhea:stranguria syndromes,an introduction about its classification,etiology and pathogenesis,syndrome differentiation.

Syndromes of Traditional Chinese Medicine. ✵Traditional Chinese medicine has been used for thousands of years. Through thousands of years of practice, it has been proved that Chinese medicine is effective and feasible in treating diseases, preventing diseases and maintaining health. The treatment of diseases with traditional Chinese medicine has saved countless lives. The treatment of diseases in traditional Chinese medicine is macro and comprehensive.

 The theoretical system of traditional Chinese medicine is derived from and guided by long-term clinical practice. Through the analysis of the phenomenon, the internal mechanism is explored. Therefore, this unique theoretical system of traditional Chinese medicine has two basic characteristics, one is the overall-concept, the other is the dialectical treatment.

Gonorrhea
Gonorrhea:stranguria syndromes 
 ✵Gonorrhea: the Gonorrhea, is also known as stranguric turbidity or Bai Zhuo(white turbidity, turbid urine is not clear, the color white as rice pulp, or at the beginning the urine is not turbid, put for a bit longer, precipitation is accumulated as a powder state.) in the TCM system, it refers to a variety of diseases or syndromes caused by improper diet and overtiredness, dampness and heat invasion, result kidney deficiency, dampness heat of urinary bladder, disturbance in functioning of QI as the main pathogenesis, and the main manifestation is frequent urination and urgent urination, dripping urination, urethral pain, contracture or spasm in lower abdomen, dragging pain radiating to low back and abdomen.

 ✵The name of Lin Zheng(Gonorrhea, or stranguric turbidity), first seen in the ancient works Nei Jing(the Yellow Emperor's Inner Canon), in the section Su Wen·Liu Yuan Zheng Ji Da Lun Pina(the Plain Question·Great Treatise on the Regular Principles of the Six Origins) it was named as "Lin Men"(stranguric depression). In the ancient works Jin Kui Yao Lue(the Synopsis of Prescriptions of the Golden Chamber). it was named as "Lin Mi"(stranguric constipation), and it pointed out that it is mainly due to heat accumulated in the Lower Energizer, and the symptoms were recorded as "the syndrome of Lin(stranguric turbidity), urine is similar to millets, spasm or contracture and pain in lower abdomen, dragging pain radiating to the abdomen."

 ✵The classification of gonorrhea(stranguria syndrome) has been explored by the herbalist experts in past Dynasties. Modern applications still use the name of five gonorrheas(five stranguria syndromes), but there is a little difference: there are two major kinds of definition, one defined the five gonorrheas as Qi Lin(Qi stranguria), Xue Lin(blood stranguria), Gao Lin(chylous stranguria), Shi Lin(urolithic stranguria), Lao Lin(strain stranguria), another defined the five gonorrheas as Re Lin(heat stranguria), Shi Lin(urolithic stranguria), Xue Lin(blood stranguria), Gao Lin(chylous stranguria), Lao Lin(strain stranguria). In practice, the Re Lin(heat stranguria) and Qi Lin(Qi stranguria) are common types, so normally gonorrheas could be understood has six major types: Re Lin(heat stranguria), Qi Lin(Qi stranguria), Xue Lin(blood stranguria), Gao Lin(chylous stranguria), Shi Lin(urolithic stranguria), Lao Lin(strain stranguria).

 ✵Etiology and Pathogenesis:(1).The heat and dampness pathogen accumulated in the urinary bladder,(2).Liver depression, Qi stagnation and angry hurt the liver, liver loss its catharsis,(3).Deficiency of spleen and kidney, a long period of gonorrhea, dampness and heat can exhaust and hurt the Positive Qi(vital energy), or overwork strain, intemperate sexual intercourse(intemperance in sexual life), or old age, prolonged illness, weak body, all could cause deficiency of spleen and kidney.

 ✵Manifestations: the gonorrhea(stranguria syndromes) observed frequent urination and urgent urination, dribbling urine, urethral pain, contracture or spasm in the lower abdomen, dragging pain radiating to the low back and abdomen as the basic characteristics. The onset of the syndrome is acute or slow, the course of the syndrome is long or short, the long term case lasting for a long time, attack irregularly, or affect in strain condition. The case of urination frequency and urgent urination, urinates up to dozens of times a day, but urine volume is small each time, or accompanied by fever, urine heat and red; Or urine discharge sand, urine flow interruption in urination, pain in abdomen and low back and unbearable; Or passing blood or blood clots in urine; Or urine turbidity as rice pulp or satiny such as grease, a variety of mixed and not the same. Long illness or repeated attack, often accompanied by low fever, low back pain, heaviness in the lower abdomen, fatigue, and other symptoms.

 ✵Diagnosis:(1).It has the basic characteristics or symptoms of frequent and urgent urination, dribbling urination, astringent pain of urethra, contracture or spasm in the lower abdomen, dragging pain radiating to the lower back and abdomen. Still, there are other specific characteristics or symptoms of various kinds of stranguria syndromes.

 (2).Long illness or repeated attack, often accompanied by symptoms low fever, low back pain, heaviness in the lower abdomen, fatigue, and other symptoms.

 (3).More common in married women, and normally induced by overwork(strain or taxation), emotional changes, exogenous pathogen affection.

 ✵Differentiations:(1).Retention of urine: the retention of urine(uroschesis) is basically with symptoms dysuria(difficulty in urination), diurnal urine volume decreased significantly, dribbling or in dripping, and in severe case urinary stoppage as characteristics. The gonorrhea(stranguria syndrome) is characterized by frequent urination and urgent urination, dribbling, astringent pain of urethra, contracture or spasm in the lower abdomen, dragging pain radiating to the waist and abdomen. Among these symptoms, urinate short and less volume astringent, dysuria(difficulty in urination) are similar to the retention of urine, but in the retention of urine there is no pain in urination, daily urine volume is much lower than normal, even without urine; And in the gonorrhea(stranguria syndrome) it is painful in urinate, daily urinate total volume is basic normal level.

 (2).Hematuria: the hematuria and blood stranguria all with symptoms urine bleeding(passing blood in urine), urine color is red, even urine out pure blood and other symptoms. The key point for its differentiation is to have urinal pain or not. There is no pain in most cases of hematuria, although there is also a slight distension pain or heat pain, but it is not similar to dribbling urine with unbearable pain in blood stranguria. In the ancient works Danxi Xinfa(Mastery of Medicine by Zhu Danxi), it recorded: "the case with pain is the syndrome of Xue Lin(blood stranguria), not pain is Niao Xue(urine blood, or hematuria)." So in general, the condition with pains is identified as blood stranguria, the condition not painful is identified as hematuria.

 (3).Turbid urine: the cloudy or turbidity of stranguria should be differentiated from turbid urine. In the condition of turbid urine, the urine is turbid and white as rice pulp, similar to chylous stranguria, but urine passes out freely in urination, without pain and stagnation sensations, which is different from stranguria. With or without pain is a point for differentiation.

Common Syndromes of Gonorrhea.
Common Syndromes of Gonorrhea. 
 ✦The common syndromes of gonorrhea or stranguria are introduced as:

 ✧Re Lin(heat stranguria): the Re Lin is also known as heat stranguria, is a stranguria ascribed to heat, marked by the discharge of reddened urine with acute onset, and accompanied by burning pain and generalized fever.

 Symptoms: the heat stranguria observed symptoms frequent urination and urgent urination, difficulty urination and short urine, urethral burning stabbing pain, urine color is yellow-red, contracture or spasm in lower abdomen and distension pain, or with cold and fever, bitterness in mouth(bitter taste), nausea and vomiting, or lumbago refuses press(low back pain and refuses press or touch), or defecation constipated(constipation), tongue coating is yellow greasy, pulse slippery and rapid.

 ✧Qi Lin(Qi stranguria): the Qi Lin is also known as Qi stranguria, is a stranguria due to Qi disorders, either stagnation or deficiency.

 Symptoms:the excess type syndrome of Qi stranguria with symptoms difficulty in urination and painful urination, dribbling urine, distension full in lower abdomen and pains, tongue coating thin and white, pulse sinking and string-like; the deficient type syndrome of Qi stranguria with symptoms stagnant and difficulty in urination, heaviness and dropping in lower abdomen, dribbling urine, pallar complexion(looks white, no glory), pale tongue, pulse feeble fine and weak.

 ✧Shi Lin(urolithic stranguria): the Shi Lin is also known as urolithic stranguria, painful and difficult urination due to the passage of urinary calculi.

 Symptoms:the urolithic stranguria with symptoms pass sand or stones in urine, urination is difficult, or urinate suddenly interrupted, urethral distress pain, tension and spasm in lower abdomen, or colic pain in waist and abdomen unbearable, dragging pain radiating to lower abdomen or even to genital regions, pass blood in urine, red tongue body, tongue coating thin and yellow. In chronic conditions and sand or stone not eliminated, with symptoms pallar complexion(looks white, no glories), spirit withering, lack in power and short of Qi, pale tongue and imprints of the teeth at the edge, pulse fine and weak; or with symptoms hidden pain in waist and abdomen, heat in palm of hands and feet, red tongue body with less tongue coating, pulse fine and rapid.

 ✧Xue Lin(blood stranguria): the Xue Lin is also known as blood stranguria, painful discharge of bloody urine.

 Symptoms: the excess type syndrome of blood stranguria with symptoms urination heat and difficulty in urination, stabbing pain, urine color deep-red, or with blood clots, pain urgent fullness aggravated, or with symptoms vexed(upset), tongue coating yellow, pulse slippery and rapid; the deficient type syndrome of blood stranguria with symptoms urine color light-red, pain and difficulty in urination not obvious, ache in waist and soft in knees, mental fatigue(spiritless and lassitude) lack in strength, tongue color light-red, pulse fine and rapid.

 ✧Gao Lin(chylous stranguria): the Gao Lin is also known as chylous stranguria, painful discharge of turbid, milky urine like rice-water.

 Symptoms: the excess type syndrome of chylous stranguria with symptoms turbid urine similar to rice water, put aside and deposit similar to cotton, floating oil similar to grease, or mixed with clots, or mixed with blood, urethral heat and difficulty painful in urination, red tongue, tongue coating yellow greasy, pulse soft and rapid; the deficient type syndrome of chylous stranguria with symptoms chronic illness and could not recover, recurrent attacks(attacks repeatedly), greasy like, difficulty and pain in micturition relieved on the contrary, but gradually thin and emaciated, dizziness and lack strength, ache in waist and soft in knees, pale tongue, tongue coating greasy, pulse fine weak.

 ✧Lao Lin(strain stranguria): the Lao Lin is also known as strain stranguria, stranguria ascribed to overstrain, marked by dripping of urine with dull pains, usually seen in chronic cases.

 Symptoms: the strain stranguria observed symptoms urination is not very difficult and red, but dribbling and unrelieved, recurrent attack or stop time and time, attacks in strain or taxation, ache and softness in waist and knees, spiritlessness(weariness) and lack in strength, pale tongue, pulse fine and weak.

Prognosis of Gonorrhea(stranguria syndromes).
Prognosis of Gonorrhea 
 ✦The prognosis of gonorrhea or stranguria syndromes is introduced as:

 ✧There is a certain relations on development of gonorrheas(stranuria syndromes). First of all, there is a mutual conversion between the deficient and excess types of different stranguria syndromes and some stranguria syndromes themselves. For example, the excess type syndrome of heat stranguria, blood stranguria, Qi stranguria, loss treatment or treated with mistakes, pathogen hurt the positive Qi, can be transformed and developed to the deficient type syndrome of strain stranguria, on the contrary, the deficient type syndrome of the strain stranguria, affected by pathogens heavily or hurt from seven emotions again, can also be transformed or developed to the excess type or excess-deficient type of heat stranguria, blood stranguria, Qi stranguria. However, when the heat and dampness are not eliminated, the positive Qi has been hurt, and is in the transition stage from excess syndrome to deficient syndrome, then it is manifested with symptoms of both deficient and excess. And the Qi stranguria, blood stranguria, chylous stranguria themselves, all could develop or transform from the excess type to deficient type, or from deficient type to excess type. And for the development of sand stranguria(urolithic stranguria) from the excess type to deficient type, because the sand and stone is not eliminated, it manifests as a syndrome of positive deficient and pathogen excess(asthenia healthy qi and sthenia pathogenic factor syndrome). Secondly, the mutual transformation between some stranguria or concurrently see at the same time, for example, heat stranguria could develop and transform to blood stranguria, blood stranguria also could induce heat stranguria. Another example, in heat stranguria condition, if heat hurt the blood collaterals, it is also blood stranguria; On the basis of sand stranguria(urolithic stranguria), if stone moves and damage blood collateral, it is also seen symptoms of blood stranguria; in the condition of sand stranguria(urolithic stranguria) affected by dampness heat pathogen again, could also observe symptoms of heat stranguria concurrently; Or chylous stranguria concurrently with heat stranguria, blood stranguria, etc. It is of practical guiding significance to understand the transformation relations of the syndrome of gonorrheas and to apply syndrome differentiation and treatment flexibly in clinic. Stranguria lasting for a long period and not treated, can develop to other syndromes, such as the uroschesis(retention of urine), obstruction and rejection.

 ✧The prognosis of stranguria syndromes, often related to its type and severity of the disease, generally speaking, stranguria syndrome is easier to cure in the initial or beginning stage, but a few heat stranguria, blood stranguria sometimes can occur heat and dampness diffuse to the Triple Energizers, heat pathogen immersed in Ying blood, show serious symptoms high fever, coma(unconsciousness), delirium and other serious symptoms.

 ✧The stranguria syndrome not cured for a long time or concurrent attack(attack repeatedly), can turn to strain stranguria, lead to asthenia or deficiency in both spleen and kidney, even spleen kidney decline, kidney deficient and liver flourishing, liver wind disturbing upward, and appear symptoms giddy and tired limbs(dizziness, tiredness in legs arms hands and feet), disgusting vomit(nausea, throw up), do not think to take food(no appetite), fidgety and restless(vexation, uneasy), even coma convulsion(unconsciousness, convulsion). As the stranguria goes long days, urine blood is continuous and unstoppable, the patient complexion is haggard, appearance and body gaunt, thin and emaciated, or lower abdomen with swelling and mass, this is due to Qi stagnation blood stasis, thereby leading to the formation of severe disease.

Prevention of Gonorrhea(stranguria syndromes).
Prevention of Gonorrhea 
 ✦Prevention tips of stranuria are introduced as:

 ✧To strengthen the body, to prevent the internal injury of emotions, to eliminate all kinds of pathogenic factors including the exogenous pathogenic invasion and endogenous factors of dampness and heat, such as tolerance of urine, excessive taking fat sweet food, excessive lust, genital region unclean, etc., is an important aspect of prevention of the onset and recurrence of the strangurias. Pay attention to pregnancy and postpartum health, is of great significance to prevent the occurrence of postpartum stranguria. Active treatment of consumptive thirst, consumption and other chronic and consumptive syndromes, to avoid unnecessary catheterization and urinary tract equipment operation, can also reduce the occurrence of stranguria. To recover from stranguria, you should drink more water, take a light diet, avoid greasy, dry, spicy food, stop sexual intercourse, pay attention to proper rest, is conducive to early recovery.

Turbid Urine.
Turbid Urine. 
 ✦The Turbid Urine is another syndrome and introduced here together with stranguria, some of its symptoms are similar to the stranguria, but they are not the same syndrome. The Turbid Urine is also known as Urine turbidity, it is a syndrome which primary symptoms are known as urine is cloudy, white as rice water, while there is no pain in urination.

 ✧The occurrence of this disease, mostly due to diet much fat and sweet, spleen loss of health transportation, generate dampness and heat, or dampness and heat pathogen not eliminated after disease, accumulate and stagnant in the Lower Energizer, clear and turbid not separated. In the condition of heat burning and hurt the collaterals, collaterals hurt and blood overflow, then urine turbidness and mixed with blood. The disease was lasting for a long time, spleen and kidney were injured, spleen deficiency and the middle Qi collapse, kidney deficiency and lost containment function, then the refined essence and lipid fluid flows downward; If the spleen not governs the blood, or kidney Yin deficient, deficient fire burns and hurts the collaterals, also can lead to turbid urine mixed with blood. If addict to fat and sweet diet, or overworked or addict to lust, it might lead to a recorrent attack.

 ✧At the beginning or initial stage of the disease, most with heat and dampness pathogens, treatment should be clear heat and eliminate dampness. In chronic cases and Long illness, spleen and kidney deficiency, appropriate to invigorate spleen and kidney, strong the lower Yuan. In the condition of both excess and deficiency, should combine them.

Common Syndromes of Turbid Urine.
Common Syndromes of Turbid Urine. 
 ✦The common syndromes of turbid urine are introduced as:

 ✧Turbid Urine of Dampness and heat accumulated internal type:

 Symptoms: urine turbidness or mixed with a condensed clot, oil floating on the surface, or with blood color, or mixed with blood silk, blood clot, or heat and difficult in the urethra, thirst, tongue coating yellow greasy, pulse soft and rapid.

 ✧Turbid Urine of Spleen deficiency and Qi collapse type:

 Symptoms: frequent or concurrent attacks of urine turbidity, not heal after long days, urine turbidity and similar to white pulp, abdominal distention and heaviness in abdomen, urine is not free or with difficulty, pallor complexion(complexion is not bright), spiritlessness(weariness) and lack in strength, emaciation, fatigue and strain or aggravated when eating greasy food, pale tongue, pulse feeble and rapid.

 ✧Turbid Urine of Kidney deficiency type:

 Symptoms: turbidness of urine lasting for a long time, urine color milk-white similar to condensed fat or frozen glue, spiritlessness(weariness, lassitude), emaciation and weakness, ache in waist and soft in knees, dizziness and tinnitus(dazzled, ringing in ears). In the condition of Yin deficiency type, see symptoms dysphoria with smothery sensation, dry mouth, tongue body red, pulse fine and rapid; In the condition of Yang deficiency type, observe symptoms white complexion without glories(looks white or pallar, no glory), cold body and cold limbs(cold body, cold in legs arms hands feet), pale white tongue, pulse sinking and fine.

References:
  • 1.Gonorrhea:stranguria syndromes,an introduction about its classification,etiology and pathogenesis,syndrome differentiation.
  • 2.Su Wen:the Plain Questions of Huangdi's Internal Classic..By 黄帝(the Yellow Emperor).
  • 3.Zhong Zang Jing:the Central Treasury Canon.By 华佗(Huà Tuó).
  • 4.Jin Kui Yao Lue Fang Lun:the Synopsis of Prescriptions of the Golden Chamber.By 张仲景(Zhāng Zhòngjǐng),王叔和(Wáng Shūhé),林亿(Lín Yì),高宝衡(Gāo Bǎohéng).
  • 5.Zhu Bing Yuan Hou Lun:the General Treatise on the Cause and Symptoms of Diseases.By 巢元方(Cháo Yuánfāng)
  • 6.Danxi Xinfa:the Mastery of Medicine.By 朱丹溪(Zhū Dānxī).

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