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UROLITHIASIS,BLADDER STONES, KIDNEY STONES,URETER STONES, RENAL CALCULI, NEPHROLITHIASIS

GENERAL

Clinical Manifestations	Often asymptomatic Flank pain and colic Nausea Vomiting Abdominal distention Hematuria Chills Fever Bladder irritability
Treatment Principle
Herb Formulas
Points

WEI STAGE: SUMMERHEAT WITH DAMPNESS

Clinical Manifestations	Fever and chills, fever more pronounced or Tidal fever Cold extremities Abdominal distention Thirst Sweat Anxiety Stifling sensation of Heat in the chest Restlessness Disturbed speech Gastric disturbances: Heaviness Nausea Severe diarrhea Dark, scanty urine Maybe loss of consciousness Maybe convulsions T: Red tip and edges or Dark red and dry C: Greasy white or yellow P: Rapid and soft or Flooding and rapid or Thready and rapid or Slippery and rapid
Treatment Principle	Disperse Wind Clear Heat Resolve Damp Open the Orifices
Herb Formulas	Gui Ling Gan Lu Yin Yi Yuan San For Summerheat with Liver and Gall Bladder Heat: Bi Yu San
Points

SMALL INTESTINE QI PAIN

Clinical Manifestations	Vague pain in the lower abdomen involving the low back Pain radiates down into the testicle Abdominal distention Borborygmus Relief after passing wind Hernia pain in the scrotum T: Pale C: Thin and white P: Deep and wiry or Wiry and tight
Treatment Principle	Move Qi Expel knotting
Herb Formulas	Nuan Gan Jian
Points	LIV-1, LIV-4, LIV-5, LIV-8, REN-4, SP-6, ST-39

SPLEEN AND KIDNEY QI DEFICIENCY

Clinical Manifestations	Somewhat red, choppy urination Dribbling and dripping that does not stop Soreness or pain and weakness of the waist, low back and knees Dizziness Tinnitus Frequent, clear urination Recurrent attacks which tend to be brought on by over-taxation Maybe fine sand or stones in the urine Maybe slightly painful urination with a hollow, empty sensation of pain Pain is better with pressure Pain is worse with exertion or taxation Fatigue Lassitude Weakness Abdominal distention Loose stools T: Pale C: Thin and white P: Submerged and frail or Thready and weak
Treatment Principle	Strengthen the Spleen Boost the Kidneys Tonify Qi Disperse stones
Herb Formulas	Wu Bi Shan Yao Wan modified
Points	GB-25, ST-36, UB-23 For occasional low back pain radiating to the lower abdomen and/or genitalia: + REN-4 With sand or small stones: + electro acupuncture UB-25 - UB-28 For severe Spleen Qi Deficiency: + SP-3 For severe Kidney Qi Deficiency: + KI-3 With Stomach and abdominal distention, flatulence, a poor appetite and nausea: + PC-6, SP-4

LIVER AND KIDNEY YIN DEFICIENCY

Clinical Manifestations	Low back and knees weak, sore and painful Dripping and dribbling, unsmooth urination Maybe sand or stones in the urine Facial complexion pale and sallow Both cheeks slightly red Red lips Dizziness Dry mouth Parched throat Dry eyes Blurred vision Spots before the eyes Numbness of limbs Flaccid paralysis (Wei syndrome), weakness Tinnitus Deafness Forgetfulness Throat dry and painful Five Sole Heat Low-grade tidal fever Night sweats Irritability Insomnia Stools difficult to pass Constipation Men: Spermatorrhea Women: Irregular menses or Scanty menses or Amenorrhea Vaginal discharge T: Red C: None P: Thready and rapid or Deep, thready and rapid
Treatment Principle	Nourish and reinforce the Liver and Kidneys Clear Heat Disperse stones
Herb Formulas	Yi Shen Pai Shi Tang Jia Jian With Damp-Heat: San Jin Hu Tao Tong
Points	GB-25, KI-3, UB-23 For occasional low back pain radiating to the lower abdomen and/or genitalia: + KI-5 For frequent, urgent, difficult urination: + REN-4 With sand or small stones: + electro acupuncture UB-24 - UB-28 With Spleen Qi Deficiency: + ST-36 With severe Kidney Yin Deficiency: + KI-7 KI-3, LIV-3, SP-6, UB-18, UB-23

KIDNEY YANG DEFICIENCY

Clinical Manifestations	Lumbago: low back feels cold, weak and aching Feeling chilled Aversion to Cold Cold limbs General debility Fatigue Weakness Pale face Urinary frequency with abundant, clear or turbid urine or Oliguria with edema Possible terminal dribbling and/or slight pain Maybe occasional discharge of sand or stones Maybe nocturia Lassitude Withdrawn, subdued behavior Knees feel cold and aching Dizziness Tinnitus Impotence Spermatorrhea Premature ejaculation Low libido Female infertility ("uterus cold and infertile") Maybe anorexia Maybe loose stools Maybe chronic diarrhea or "cock crow" diarrhea T: Pale and swollen C: Thin and white P: Deep and thready - maybe slow
Treatment Principle	Warm and Reinforce Kidney Yang Unblock the channels Disperse stones
Herb Formulas	Ba Wei Di Huang Wan augmented Niu Che Shen Qi Wan With Damp-Heat: Tong Lin Yi Shen Pei Shi Tang
Points	Moxa or moxa needle GB-25, KI-3, REN-4, UB-23 For occasional low back pain radiating to the lower abdomen and/or genitalia: + KI-5 For frequent, urgent, difficult urination: + SP-6 With sand or small stones: + electro acupuncture UB-24 - UB-28 With Spleen Qi Deficiency: + ST-36 With severe Kidney Yin Deficiency: + KI-7 Moxa or moxa needle DU-4, KI-3, REN-4, UB-23

DAMP-HEAT IN THE URINARY BLADDER (STONE LIN)

Clinical Manifestations	Urinary frequency Urinary urgency Painful urination or Continuous dripping of urine or Sudden interruption to the urinary stream Turbid urine or Bladder: Hematuria Obstruction of the flow Kidney: Slightly bloody urine Enlarged Kidney Ureter: Slightly bloody urine Urethra: Pain in the penis Sand and stones in the urine In Damp-Heat Pouring Downward there may also be: Fever Thirst Dry mouth Low back pain In Damp-Heat Crystallizes in Urinary Bladder there may also be: Colicky pain in the low back, possibly radiating to the groin T: Red or Normal C: Yellow or Yellow and sticky P: Slippery and rapid or Deep and wiry or Rolling
Treatment Principle	Clear Heat Eliminate Dampness by diuresis Eliminate stones
Herb Formulas	Shi Wei San Urolithiasis #1 Urolithiasis #2 Wu Lin San Ba Zheng San Liu Yi San San Jin Tang Zhi Zhuo Gui Ben Wan Niao Lu Pai Shi Tang Er Hao Inflammatory stage: Zi Shen Tong Guan Wan With Heart Fire and Qi and Yin Deficiency: Qing Xin Lian Zi Yin With Large Intestine Excess Heat: Da Cheng Qi Tang modified For Blood Lin: Xiao Ji Yin Zi For Milky Lin: Bei Xie Fen Qing Yin If there are no contractions: Zhu Ling Tang For lower abdominal Blood Stagnation with pain on palpation: Gui Zhi Fu Ling Wan modified For lower abdominal Blood Stagnation with pain and constipation: Da Huang Mu Dan Tang For lower abdominal Blood Stagnation with pain, cramps and constipation: Tao He Cheng Qi Tang For extreme lower abdominal Blood Stagnation with pain when the above formulas are too harsh: Da Jian Zhong Tang For extreme abdominal muscle contractions: Shao Yao Gan Cao Tang(use once to relieve spasm) With Kidney Yang Deficiency: Jin Gui Shen Qi Wan With Spleen Deficiency edema: Wu Ling San Si Ling San With Internal Cold: Da Huang Fu Zi Tang With External Wind invasion: Dang Gui Nian Tong Tang With Blood Stagnation: Shao Fu Zhu Yu Tang With Liver Qi Stagnation Attacking the Spleen: Dang Gui Shao Yao San With Liver Qi Stagnation Attacking the Stomach: Si Ni San
Points	KI-7, LIV-2, REN-3, SP-6, SP-9, UB-23, UB-28, UB-39 KI-2, KI-3, LIV-2, REN-3, SP-9, UB-28, UB-39 KI-1, REN-4, UB-28, UB-40, moxa LIV-1, UB-23, KI-1, REN-3, KI-4, ST-28, UB-22, UB-23, UB-28, UB-40 KI-1, KI-3, LIV-1, LIV-2, SP-6, SP-9, moxa REN-8 KI-3, SP-6, UB-23, UB-52 KI-3, SP-6, UB-22, UB-23, UB-24, UB-25, UB-26, UB-27, UB-51, UB-52 LIV-4, REN-6, UB-17, UB-18, UB-20, UB-23, moxa LU-7 REN-3, SP-6, SP-9, UB-39 Moxa LIV-1, UB-23 LIV-1 or LIV-14 + moxa (30 cones) REN-4 For stones in the Kidney: GB-34, UB-23, UB-28, moxa DU-4 REN-3, SP-6, SP-9, UB-23, UB-28 For stones in the Kidney or ureter: KI-3, KI-4, SP-6, UB-23, UB-52 Ahshi points to relieve spasm For stones in the Bladder: KI-3, REN-2, REN-3, SP-6, SP-9 REN-3, REN-4, REN-5, SP-6, SP-9, UB-23, UB-28 REN-3, REN-4, ST-36, UB-23, UB-28 Electro-acupuncture SP-6 - UB-23 For stones in the Ureter: SP-6, ST-28, UB-23 REN-6, SP-9, ST-27, ST-28 or ST-25 For hematuria: 1. KI-3, LIV-2, REN-3, SP-6, SP-9, SP-10, UB-28 2. KI-1, KI-7, LIV-3, REN-3, SP-10, UB-17, UB-23, UB-27

BLOOD STAGNATION IN THE URINARY BLADDER

Clinical Manifestations	Sharp, stabbing rough pain during urination without burning Decreased urination or Interrupted urination or Constant urination or Anuria Lower abdominal fullness Fixed, stabbing lower abdominal pain which may radiate to the genitals Maybe hematuria Palpable masses which may or may not be painful Purple urine with blood clots Dark or purplish spider naevi or broken vessels on the trunk , around the inner ankle and inner knee Dark, ashen, sallow or purplish facial complexion Dark or purplish lips and conjunctiva Dark rings under the eyes T: Dark purple or with brown or purplish echymosis spots and/or dark and distended sublingual veins C: Thin P: Slow and choppy or Thin or Deep and choppy or Thready and choppy
Treatment Principle	Relieve Stasis Shrink the tumor Promote urination Warm Yang
Herb Formulas	Shao Fu Zhu Yu Tang modified With Blood Deficiency: + Dang Gui Jian Zhong Tang Chinese Patent Medicines: Yun Nan Bai Yao to be taken along with Qi Li San Sheng Tian Qi Pian Yan Hu Suo Zhi Tong Pian Fu Ke Wan Jin Wan
Points	REN-3, REN-4, SP-1, SP-6, SP-10, ST-29, UB-17, UB-28 LIV-3, SP-6, SP-10

COLD-DAMPNESS IN THE LOWER JIAO

Clinical Manifestations	Cold pain in the lower back and body Sciatica Copious urination Extreme heavy sensation in the lower back Absence of thirst T: Pale C: White P: Deep, thready and moderate
Treatment Principle	Warm Yang Strengthen the Spleen Dispel Cold Eliminate Dampness
Herb Formulas	Gan Cao Gan Jiang Fu Ling Bai Zhu Tang
Points

QI AND BLOOD STAGNATION

Clinical Manifestations	Choppy, stagnant urination which dribbles and drips uneasily Blood clots or dark red Blood in the urine Lower abdominal distention and pain or Lancinating pain Possible excruciatingly severe low back pain T: Normal or Dark purplish with dark macules or spots C: Normal P: Deep, wiry and maybe choppy
Treatment Principle	Move Qi Invigorate the Blood Unblock the channels Expel stones
Herb Formulas	Xue Fu Zhu Yu Tang modified
Points	GB-25, KI-2, UB-23, UB-39 With extreme low back pain, radiating to the lower abdomen and/or genitalia: + strongly manipulate KI-5 for 30 minutes, then replace it with Yaotong #2 With marked urinary tract infection due to Damp-Heat: + REN-3 With less pain and more urinary symptoms: - KI-2, UB-39 + REN-3, UB-28 After the crisis, if small stones or sand remain: - KI-2, UB-39 + ST-36

DAMP-HEAT IN THE LOWER JIAO

Clinical Manifestations	Frequent, urgent, painful urination The lower back feels hot either to the patient or practitioner Extreme pain in the low back possibly radiating to the lower abdomen and genitalia Pain in the knees The pain is aggravated by Heat, humid or rainy weather and is not improved by rest Aches and pains in the bones and sinews Weakness or atrophy of lower extremities Scanty yellow or yellow-red or turbid urine Choppy, stagnant unsmooth urination or Dribbling urination with stops and starts or Urination with pus, blood and sand or stones Red, hot, swollen and painful feet or knees Edema in lower legs Leukorrhea (thick, yellow, foul-smelling) Sores on lower extremities due to Damp Redness, swelling and pain of the knees with burning sensations Oliguria Eczema Irritability Feverishness Thirst Fever and chills A bitter taste in the mouth Nausea and vomiting Possible constipation T: Normal C: Yellow and greasy P: Soft and rapid or Slippery and rapid
Treatment Principle	Clear Damp-Heat from the Lower Jiao Ease the tendons Stop pain
Herb Formulas	Ba Zheng San modified Er Miao San modified With yellow, turbid, foul-smelling urine, a bitter taste in the mouth, Heart vexation, a quick temper and a wiry, slippery, rapid pulse: Long Dan Xie Gan Tang modified With Heat toxins entering the Blood and spreading throughout the San Jiao (emergency): Huang Lian Jie Du Tang + Wu Wei Xiao Du Yin modified Chinese Patent Medicines: Qian Jin Zhi Dai Wan Yu Dai Wan Shi Lin Tong Pian
Points	GB-25, KI-2, UB-23, UB-39 With extreme low back pain, radiating to the lower abdomen and/or genitalia: + strongly manipulate KI-5 for 30 minutes, then replace it with Yaotong #2 With marked urinary tract infection due to Damp-Heat: + REN-3 With less pain and more urinary symptoms: - KI-2, UB-39 + REN-3, UB-28 After the crisis, if small stones or sand remain: - KI-2, UB-39 + ST-36 LI-11, SP-6, SP-9, ST-25, UB-25 General points + GB-34, KI-7, SP-9

TAN YIN

Clinical Manifestations	Anorexia Edema Abdominal distention Chest and hypochondriac distention Dizziness Nausea Vomiting Vertigo Thirst with no desire to drink Maybe no thirst Palpitations Shortness of Breath T: Normal C: Thick and slippery P: Slippery, full and maybe wiry
Treatment Principle	Warm and Dissolve Tan Yin
Herb Formulas	Ling Gui Zhu Gan Tang
Points	PC-6, SJ-6, SP-6, SP-9, ST-40, UB-13, UB-20, UB-23