Urinary Calculi. (Kidney Stones) Presented by Jetsken van Os, Januari 2016

Transcription

1 Urinary Calculi (Kidney Stones) Presented by Jetsken van Os, Januari

2 What are Urinary Calculi? Western Medical perspective: Urinary Calculi are formed in the Kidneys by the precipitation in crystalline (stones) or granular (sand) form of acids present in the urine. They travel down the Urinary tract, causing colic painful obstructions and infection. TCM perspective: from Classic of the Secret Transmission by Hua Tuo (AD 200): Stones are caused by Qi deficiency and Heat. Their formation is similar to the evaporation of sea water by fire to produce Salt 2

3 Sizes and forms Sizes range from just a speck to as large as a pingpong ball (some mm to 1 to 2 cm) Forms are rounded or irregulary shaped About 5% to 10% of the people develop Kidney Stones during their lifetime. 3

4 Symptoms and Signs: Severe pain in the back, side or abdomen Blood and/or pus in the urine Fever & Chills Vomiting Urine that smells bad or looks cloudy Burning feeling while urinating 4

5 Ahhh!! 5

6 Pain/ No pain Many Renal Calculi are painless (no symptoms) until they travel from the Kidneys down the Ureter and into the Bladder. Depending on the size of the stone, movement of the stone through the Urinary tract can cause severe pain with sudden onset. 6

7 Western diagnosis: Physical examination Information obtained by the Medical History Urine analysis (urine may be normal despite multiple calculi or it can contain white bloodcells/pus = Pyuria) Imaging tests KUB view ( Kidney, Ureter, Bladder) by X-ray or CT-scan Determination of calculus composition (if a calculus is confirmed) 7

8 Types and Causes: 1. Calcium Stones (most common; 85%) Caused by too much Calcium in urine. 2. Struvite Stones (more common in women) Often caused by infections (UTI that lasted a long time) 3.Uric Acid Stones (high amount of acid in urine) May caused by high proteine diet (meat!), gout, chemotherapy and a inherited condition. 4. Cystine Stones (rarest form of stones) Caused by inherited condition called cystinuria. 8

9 Western treatment: A. No intervention/treatment: Stones pass on their own: by drinking a lot of water (the smaller the stone, the more likely it is to pass without intervention) Size 5 mm and more? Then 20% chance of passing on their own (with or without painkillers) Size 4 mm and less? Then 80% chance of passing on their own 9

10 Western treatment: B Treatment if stones do not pass on their own: (depending on the size and location of the calculi) 1. Lithrotripsy: shock waves therapy to break a stone into smaller pieces that can more easily be expelled from the body. 2. Surgical removal by incision in the skin 3. Removal with a ureteroscope; an instrument that is advanced up through the urethra and bladder to the ureter and kidney. 10

11 Lithrotripsy 11

12 TCM Syndrome Differentiation In TCM, symptoms associated with urinary stones and urinary infections, fall in the category of Painful Urinary Syndrome. This syndrom is attributed to the accumulation of Damp-Heat in the lower Jiao which affects the normal Bladder functions of water circulation and urination. There are 3 common types of painful urinary syndrome: 1. Accumulation of Damp Heat 2. Liver Qi stagnation 3. Deficiency of Spleen and Kidney Qi 12

13 Treatment Principle Clear Heat Drain Dampness Open the Water Passages Expell the Stones 13

14 TCM Causes/ Aetiology Excessive Sexual Activity This may weaken Kidney-Yin and lead to a concentration of urine which, after years, may give rise to stones. Diet Excessive consumption of cheese, milk, spinach, rhubarb, liver, kidney, fish-roe and sardines may all contribute to the formation of stones. Loss of Fluids Persistent and long-standing loss of fluids from sweating in certain occupations Lack of Exercise This can lead to stagnation in the Lower Jiao which may contribute to the formation of stones 14

15 Acute Stage Combined Patterns: 1. Deficiency of Spleen and Kidney 2. Heat in the Lower Jiao Symptoms: Pain!! (Main symptom; Colicky nature, very intense, coming in waves) Restlessnes, sweating, patient may look under shock, burning pain on micturation, interrupted flow of micturation, dark urine. Shivering, fever, thirst lassitude, lumbago. Tongue: Pulse: Thick yellow tongue coating with red spots on the root Rapid and wiry pulse. 15

16 Points: Acupuncture Points Acute Stage BL-23 Shenshu (Back Shu point of the Kidneys) REN-6 Qihai ( moves Qi in the Lower Burner. Moving Qi helps to transform fluids and drain Dampness) SP-9 Yinlingquan (drains Damp-Heat from the Lower Burner) LIV-3 Taichong (regulates the lower jiao and free flow of qi) KID-3 Taixi (nourishes Kidney Yin) ST 25 Tianshu (resolves Dampness and Damp-Heat) Moxa may be used to tonify Yang and facilitate the movement of the stone, even if there is Kidney-Yin deficiency. 16

17 Other points According to location of pain which follows the movement of the stones allong the Urinary tract: Stones in the Kidney (lumbar loin pain): BL-23, BL-22, GB-25 and BL-52 Stones in Upper Urether (Loin and upper-abdomen pain): ST-25, SP-15, BL-23 and BL-24 Stones in the Middle-lower Ureter (pain in lower-abdomen): St-27, ST-28, ST-29 and BL-26 Stones in the Bladder (hypogastric pain): REN-3, REN-2, BL-32 and BL

18 Chronic Stage- 1. Damp-Heat: Symptoms: Burning urination, difficulty in micturation, dark urine, Tongue: Pulse: Points: Yellow-sticky tongue coating on the root Rapid and Slippery pulse. BL-22 Sanjiaoshu (drains Dampness from the Lower Burner) ST-28 Shuidao (promotes the transformation of fluids in the Lower Burner) SP-9 Yinlingquan (drains Damp-Heat from the Lower Burner) ST-36 Zusanli (tonifies Qi and is used mostly for the Empty type) REN-6 Qihai (moves Qi in the Lower Burner. Moving Qi helps to transform fluids and drain Dampness) 18

19 2. Kidney-Yin Deficiency Chronic Stage Symptoms: Repeated attacks of urinary-stones pain, dull ache in the back, dark urine, prickly pain in the urethra on micturition, insomnia, dry mouth, night sweating Tongue: Red tongue without coating Pulse: Floating and Empty pulse 3. Kidney-Yang Deficiency (from long-standing Kidney-Yin deficiency) Symptoms: Long history of repeated colicky attacks, a sore back, chilliness, depression, exhaustion Tongue: Pale tongue Pulse: Weak and Deep pulse 19

20 Chronic Stage Points Kidney Deficiency: BL-23 Shenshu (Back Shu point of the Kidneys) REN-4 Guanyuan (tonifies and nourishes the Kidneys) Sp-6 Sanyinjiao (Meeting point of Spleen, Liver and Kidney channels) KID-3 Taixi (nourishes Kidney Yin) Reinforcing Method Moxa for Kidney-Yang deficiency, no Moxa for Kidney-Yin deficiency. 20

21 Herbal treatment Formulae: Zhi Bo Ba Wei Wan (suitable for both Damp Heat and Kidney deficiency)- -> nourishes Kidney-Yin and resolves Damp-Heat. Jin Gui Shen Qi Wan (tonify and warm Kidney-Yang and resolve Dampness) Wu Ling San (tonify and warm Kidney-Yang and resolve Dampness) Te Xiao Pai Shi Wan (drain Damp-Heat and either expell or dissolve urinary calculi) 21

22 Prognosis Location: Stone in upper Ureter? -->difficult to expell Stone in Middle-lower Ureter or Bladder? --> Easier to expell Size/Shape: Stone is rounded? --> Easier to expell (even when it is big) (but less than 1cm) Stone is irregularly shaped --> difficult to expell, even when it is small Time of Treatment Best result if treatment is given at the time of pain. If there is pain after treatment-->expulsion of the stone is imminent 22

23 Prevention/ Advice Drink more water and take exercise Avoid excessive consumption of spicy and very hot foods (including Alcohol) Avoid sexual activity soon after a period of heavy physical work (especially lifting and carrying weights) Avoid excessive consumption of greasy foods and dairy products 23

24 Sources Acupuncture case studies from China by Chen Jirui and Nissi Wang The Practice of Chinese Medecin by Maciocia 24