Dong’ouwa’ounu (Urinary Strangury Syndrome)
[Overview]
In Miao medicine, symptoms such as redness, swelling, and burning pain of the urethra or urinary meatus, along with sharp pain during urination, are collectively referred to as Dong’ouwa’ounu or Xiuwakaina. This condition closely resembles a urinary tract infection (UTI) in Western medicine, but in Miao medicine, it has a narrower scope, limited strictly to the lower urinary tract. It can occur in men and women, both young and old.
In Traditional Chinese Medicine (TCM), “strangury” ( lin zheng) refers to a syndrome resulting from dietary irregularities, overwork, or invasion of damp-heat pathogens. Its pathogenesis primarily involves kidney deficiency, damp-heat in the bladder, and dysfunction in the transformation of qi. Clinically, it presents with urgent, frequent urination, painful dribbling, urinary discomfort, and lower abdominal cramping radiating to the waist.
In Western medicine, diseases like urinary tract infections, urinary calculi, urinary tract tumors, and chyluria may present with symptoms resembling strangury and can be referenced in this chapter for syndrome differentiation and (used in traditional contexts).
[Huhoujipeng · Miao Medical Disease Classification]
Dong’ouwa’ou is classified as a minor syndrome and is further divided into two types: heat-type urinary pain and cold-type urinary pain.
[Aijiangduo · Etiology]
According to Miao medicine, this disorder may result from a constitutionally weak body, prolonged illness, overexertion, unclean diet, emotional disturbance, or poor personal hygiene. It may also be triggered by exposure to pathogenic wind, cold, dampness, or toxic elements from water.
[Gengduomeng · Pathogenesis]
Internally, the disease arises from imbalances in qi and water. When wind-cold-damp toxins invade the body, they lead to damp-heat in the bladder and disrupted qi transformation, resulting in urgent, frequent urination, incomplete voiding, and painful urination. In individuals with constitutional deficiency or prolonged illness, the body is more susceptible to external pathogens, weakening both qi and blood. Damp-turbid stagnation and blood stasis may obstruct the urinary tract, causing lower abdominal distension and pain during urination. Emotional stagnation and liver qi dysfunction can also result in cramping and pain in the lower abdomen. As the kidney governs the waist, damp-heat obstructing the kidney meridian can cause radiating pain from the waist to the abdomen.
[Diagnostic Key Points]
Diagnostic Criteria
(1) Primary symptoms include frequent, urgent urination, painful dribbling, urethral discomfort, lower abdominal cramps, and pain radiating to the waist. Symptoms may overlap with other forms of strangury.
(2) Chronic or recurrent cases often present with low-grade fever, lumbar pain, lower abdominal heaviness, and fatigue.
(3) Most commonly seen in married women and often triggered by fatigue, emotional disturbances, or external pathogens.
Relevant Examinations
Supporting diagnostics may include urinalysis, urine culture, abdominal X-ray, intravenous pyelogram, kidney and bladder ultrasound, and cystoscopy.
[Differential Diagnosis]
Ouwa and Aluo (Urinary Retention Syndrome)
Both syndromes may present with reduced urine volume and difficulty urinating. However, Ouwa and Aluo are characterized by severe urination difficulty and even complete urinary blockage. In contrast, Dong’ouwa’ounu is marked by frequent, urgent urination, painful dribbling, and abdominal discomfort, but total urine output typically remains normal. In Ouwa and Aluo, urination is not painful but severely limited or absent. Chronic Ouwa and Aluo can lead to Dong’ouwa’ounu, and vice versa. The former tends to be more severe and has a poorer prognosis.
[Syndrome Differentiation and Treatment]
Heat-Type Urinary Pain
Mengliduo (Clinical Manifestations): Frequent urination, urgency, yellow urine in small amounts, pain at the urinary meatus, fever, chills, bitter taste in mouth, irritability, sore waist, lower abdominal pain.
Xingleng (Classification): Heat-type syndrome.
Jiahemeng (Treatment Principle): Clear heat and drain dampness (xuga kaitunai), reduce inflammation and relieve pain (hongke dangmeng).
Ouduoxijia, Gang’ou (Prescription and Explanation):
Bangwaga (Celosia argentea flower, ji guan hua) 15g
Doulifang (Amur cork tree bark, huang bai) 10g
Woliliao (Lygodium japonicum, shi wei) 15g
Li (Eclipta prostrata, han lian cao) 10g
Pandounai (Mahonia bealei, shi da gong lao) 15g
Wobufaliu (Cirsium japonicum, da ji) 10g
Boil in water for oral consumption.
Medicinal Functions:
Bangwaga: Cold and astringent; enters heat meridians; clears heat, drains dampness, cools blood, and stops bleeding.
Doulifang: Cold and bitter; clears heat, dries dampness, purges fire, and detoxifies.
Woliliao: Cold, bitter with a hint of sweetness; promotes urination, clears heat, detoxifies, cools blood, and stops bleeding.
Li: Cooling and sour-sweet; nourishes yin, detoxifies, and cools the blood.
Pandounai: Cold and bitter; clears damp-heat and detoxifies.
Wobufaliu: Cold and bitter; cools blood, reduces swelling, stops bleeding, and detoxifies.
Cold-Type Urinary Pain
Mengliduo (Clinical Manifestations): Urethral pain, frequent urination, urgency, pale complexion, dizziness, tinnitus, lumbar soreness, bloating, night sweats, poor appetite, and limb fatigue.
Xingleng (Classification): Cold-type syndrome.
Jiahemeng (Treatment Principle): Nourish liver and kidney (hanwu shanbudiu), move qi and relieve pain (hang dangmeng).
Ouduoxijia, Feng’ou (Prescription and Explanation):
Wogale (Elsholtzia bodinieri, zhizhu xiang) 10g
Zhenbuyang (Rosa laevigata fruit, jin ying zi) 20g
Gotu kola (Centella asiatica, ji xue cao) 15g
Kai’ou (Polygonatum sibiricum, huang jing) 20g
Boil in water for oral administration.
Medicinal Functions:
Wogale: Warm, spicy, and pungent; dispels cold and damp, moves qi, and relieves pain.
Zhenbuyang: Warm and astringent; tones kidneys, reduces urination, and stops bleeding.
Gotu kola: Cold and slightly pungent-bitter; promotes urination, clears heat, detoxifies, reduces swelling, and alleviates pain.
Kai’ou: Warm and sweet; replenishes qi, nourishes yin, strengthens the spleen and kidney.
[Preventive Care]
Strengthen the body, balance rest and activity, keep warm, regulate emotions, drink plenty of water, avoid holding urine, and reduce intake of spicy and greasy foods.
Maintain good personal hygiene. Women should pay special attention during pregnancy and postpartum.
Actively treat underlying conditions like diabetes or tuberculosis and avoid unnecessary urinary catheterization.
[Commentary]
Miao medicine believes that Dong’ouwa’ounu is closely related to dysfunction of the urine outlet (nioku), governed by the brain frame and kidney frame. Urination is regulated based on the volume in the urine pouch (i.e., bladder). When kidney essence is deficient or regulation fails, urinary dysfunction occurs. Accumulation of fire in the kidney or internal heat from the Earth and Water realms causes yellow, painful, and urgent urination. Contamination from unclean sexual activity or external toxins may also trigger Dong’ouwa’ounu.
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