POST-NEUTERING URINARY INCONTINENCE IN TCM Dott. Raffarella Versari
POST-NEUTERING URINARY INCONTINENCE IN TCM For TCM, this condition involves many organs and energies: primarily, however, it affects the genitourinary apparatus.
TCM Considering that the removal of the gonads alone, or both the uterus and ovaries, is also accompanied by a dysfunction at the level of the bladder that affects both the endocrine and nervous systems,, TCM sees the condition as involving one organ in particular: the Kidney. This correlation is clear from the fact that Bladder, Kidney and Gonads all have the same embryonic derivation: from the urogenital sinus and allantois of the caudal pole of the Ancestral Muscle, Zong Jin.
KIDNEY The Kidney is connected to the Bladder in the Zang / Fu correlation. It acts together with the Bladder in metabolizing and expelling fluids in the Lower Burner. It controls the lower sphincters, in this case the urethral sphincter. It can be considered an endocrine gland, fulfilling the functions of the genital, suprarenal and parotid glands, as well as of the nervous system and hypophysis.
YANG EMPTINESS Consequently, surgical removal of the gonads causes an energy emptiness in all parts of the system, and in particular a Kidney Energy Emptiness which is expressed as Yang Emptiness resulting from Yuan Qi Deficiency and Ming Meng Fire
UNSTABLE KIDNEY QI The Yang deficiency thus causes a condition called Unstable Kidney Qi characterized by weakness of Kidney Qi and Yuan Qi in the Lower Burner, and by a condition of Interior Cold Emptiness.
SYMPTOMATOLOGY Symptoms include frequent urination, incontinence, enuresis (Yang does not control Yin during its period of greatest activity, the night), weak urine stream and dribbling after micturition because Qi is no longer able to retain fluids. As a result, the symptoms are those of leakage due to weakness of the urethra ( the lower Yin orifice ).
Other organs and meridians involved The organs that metabolize fluids in the Lower Burner, and in particular the Small Intestine (SI) connected with the Bladder (BL) in the Tai Yang energy level. The Spleen (SP),, which shows a dysfunction of its Yang root, both because it does not receive the heat needed to fulfill its functions from the Kidney, and because, in its role of keeping the organs in place, it must compensate for an alteration in the bladder s topography. The Liver (LR) in its function of presiding over the contractility of the urethral muscle, and because it is the organ that is directly involved in diseases of the Uterus; in addition, it is the Zang connected to the Gall Bladder (GB), which is the curious organ connected to the uterus. The Heart (HT),, following an alteration of the Water-Fire axis.
Nu Zi Bao In addition, all of the meridians related to the Nu Zi Bao are involved : the Uterus,, which is the central structure of the Lower Dan Tian in the female; thus, removing it interrupts the energy in the channels that pass through it and in the Qi Mai that flow in the perineal region.
BAO MAI In particular, an alteration is created in the Bao Mai (the vessel that connects the uterus to the heart), causing a change in the Water-Fire Axis which will develop starting from the formation of Gall Bladder Fire. The Nu Zi Bao, in fact, is a sort of cup where the Water boils under the direct action of the GB, and since the Curious Organs are connected, removing one will cause an excess in the other.
DAI MAI Consequently, GB and Bao Mai involvement is reflected on the Dai Mai,, a curious meridian which is often used with success in treating the condition. The Bao Mai is the extension of the Dai Mai and spreads its opening movement and communication. It is the vessel that permits the Pilgrimage of Water to the Heart, i.e., the connection between Jing (KI) and Shen (HT). This connection explains certain characteristic psycho- behavioral symptoms shown by the patients, including anxiety, agitation and restlessness.
ENERGY LEVELS Different levels are involved, depending on the severity of the condition: TAI YANG TAI YIN SHAO YIN
TAI YANG The Tai Yang is the first level involved, as it is affected by Cold cosmopathogenic energy and is closely linked to Wei energy. A Cold Syndrome based on a prior Energy Emptiness develops.
TAI YIN THE TAI YIN LEVEL IS INVOLVED BECAUSE IT IS THE OUTERMOST YIN LAYER, AND WHEN COLD PENETRATES TO THE INTERIOR, IT IS THE FIRST TO BE AFFECTED. YANG WILL BE FURTHER WEAKENED WHEN THE COLD PENETRATES IN DEPTH, DAMAGING THE TRANSPORT AND TRANSFORMATION FUNCTIONS. COLD AND DAMP WILL THUS BE IN THE INTERIOR, ALTERING THE RISING AND DESCENDING MOVEMENTS. BASICALLY, THEN, THERE IS A SPLEEN YANG EMPTINESS IN THE SYNDROME AT THIS LEVEL.
SHAO YIN SPREADING COLD CAUSES THE SHAO YIN COLD SYNDROME IN THIS CASE, THIS SYNDROME CAN RESULT WHEN THE TAI YIN SYNDROME GOES DEEPER, FROM AN EXCESSIVE LOSS OF FLUIDS THAT WEAKENS YANG, OR FROM UNBALANCED COLD/ HEAT IN THE SHAO YIN AND IN THE TAI YANG, SINCE THEY ARE COMPLEMENTARY. IN GENERAL: THERE IS A SIMULTANEOUS EMPTINESS OF HEART YANG AND KIDNEY YANG THAT ALLOWS COLD TO PENETRATE TO THE INTERIOR, AND IF YANG IS WEAKENED OR DAMAGED, YIN BECOMES COLD.
Duration of treatment Duration of treatment varies according to the individual s response to therapy, which must be assessed by monitoring how symptoms develop on a daily basis during the period of treatment and in the following months. After a diagnosis is made following the rules of TCM, a protocol appropriate for the disease s classification is selected on the basis of individual symptoms and clinical picture. In all cases, however, the starting point for selecting the protocol is a symptomatology indicating an involvement of the Lower Burner and a dysfunction in controlling urination on the part of the Bladder.
TWO TYPES The condition falls into two categories: Cases where there is a BL emptiness with invasion by Cold and/or Damp, and involvement of the Wei layer and the Tai Yang. Cases where there is a chronic Yang deficiency which was also accompanied by a significant Yin deficiency.
BL emptiness with invasion by Cold and/or Damp, and involvement of the Wei layer and the Tai Yang It is necessary to eliminate the pathogen, strengthen Wei Qi, regularize the level and tonify Yang, that of the Bladder in particular. BASIC TREATMENT: Eliminate Cold, Dispel Damp, Tonify Bladder Yang.
Basic treatment BL 28 (Pangguangshu) CV 3 (Zhongji) GV 4 (Mingmen) GV 20 (Baihui) KI 7 (Fuliu)
Additional points HAN LIN syndromes (Cold form): ST 36 (Zusanli( Zusanli), BL 27 (Xiaochangshu( Xiaochangshu) SHI LIN syndromes (Damp form): SP 6 (Sanyinjiao)( Sanyinjiao), SP 9 (Yinlingquan( Yinlingquan), BL 20 (Pishu( Pishu); Regularize the Tai Yang level through the node and root points: BL 1(Jingming Jingming), BL 67(Zhiyin Zhiyin); Use Yang Wei Mai TH 5 (Waiguan), GB 41 (Zulinqi)
For patients whose symptoms indicate an invasion of external pathogens and Kidney Yang Root Emptiness, fewer sittings are needed.
Chronic Yang deficiency accompanied by a significant Yin deficiency A more complex protocol must be adopted, which in addition to eliminating any pathogens, also tonifies the organism s Yuan Qi, and thus tonifies deficient Yin as well as Yang, and corrects the Yin/Yang unbalances that develop as the condition persists.
Basic treatment BL 23 (Shenshu) GB 25 (Jingmen) CV 4 (Guanyuan) GV 4(Mingmen4 Mingmen) KI 3(Taixi3 Taixi) GV 20 (BaiHui)
Most frequently used points CV 1 (Huiyin), SP 4 (Gongsun), KI 6 (Zahohai), PC 6 (Neiguan), TH 4 (Yangchi), GB 41(Zulinqi Zulinqi), BL 52 (Zhishi), KI 2 (Rangu), GV 1 (Changqiang), CV 5 (Shimen) Shimen), CV 6 (Qihai), CV 7 (Yinjiao), CV 15 (Jiuwei), ST 30 (Qichong), SP 6 (Sanyinjiao), ST 36 (Zusanli), LI 4 (Hegu), BL 15 (Xinshu), Acupoints outside the meridian lines alongside the vulva (symmetrical)
Additional points Cardinal points and points on the Extraordinary Meridians: Ren Mai, Dai mai, Yin Qiao Mai, Yin Wei Mai, Chong Mai. Points that regularize the Tai Yin and Shao Yin energy levels.
YANG AND YIN EMPTINESS In more complex clinical situations where the patient has a significant energy emptiness for both Yin and Yang components, a longer cycle of sittings will be needed, as these cases are more difficult: From a minimum of 10 sittings (two 5-sitting cycles spaced two weeks apart) to a maximum of 20 sittings (4 cycles: two of 5 sittings spaced two weeks apart, followed by an interval of 1 month and two further 5-sitting cycles).
CONCLUSIONS In most cases, if the animal is not affected since birth by major Jing energy deficiencies, if the condition has not been treated previously with other methods, and is dealt with soon after its first appearance, symptoms can be eliminated and the animal s energy balance restored in a small number of sittings. Even in difficult cases where patients have a major energy deficiency, have previously been subjected to other treatments, and have concomitant conditions of varying severity, acupuncture can:
CONCLUSIONS Reduce the amount of urine leakage and improve the animal s psycho-physical balance. In all cases, it should be borne in mind that if an animal has had a major Jing deficiency since birth, it should not be subjected to an ovariectomy or ovariohysterectomy, which would further weaken kidney energy and the patient will not only be more likely to develop other diseases, but will also be prone to this type of incontinence, which is both difficult to cure and will without doubt aggravate the animal s general energy situation over time.
The Spirits impregnate the Essences. Supreme Heaven and Abyssal Earth perform this living mystery. Heaven and Earth in movement: what descends from above is the image of the solar fire, what ascends from below is the image of the rising water. Life does not exist and is not perpetuated except as a result of meeting and compenetration. Animation cannot exist without form, just as there can be no form without animation. The conjunction of the essences with the Spirits is the Vital Spirit, mystery of life.