Interstitial Cystitis and Neurogenic Bladder have a long history of treatment with Classical Chinese Acupuncture and Herbal Medicine’
Neurogenic bladder is a general term for a condition that can be the result of different diseases involving damage, by illness or injury, to the nervous system’s ability to adequately control the muscular control of bladder emptying. Bladder emptying is the result of complicated feedback mechanisms between the nerves and muscles, and when this is damaged, by disease, injury, or nervous system dysfunction it effects the critical muscles ability to tighten or relax the sphincter at the base of the urinary bladder.
Neurogenic bladder includes hyperactive or overactive bladder, in which the person has to urinate too often in small amounts, has problems voiding completely, or has complete loss of bladder control.
Underactive bladder, on the other hand, involves the Bladder becoming too full with a consequent leakage of smaller amounts of urine. In underactive bladder the person often suffers from the inability to tell when the bladder is full, from difficulties with the the beginning of urination, from diffulties emptying all the urine from the bladder, and with wholescale urinary retention.
Classical Chinese medicine is especially effective in the cases of neurogenic bladder that are functional disorders, that is, in which there is no known nervous system deficit. When there has been full scale damage to the nervous system treatment is more difficult, but not impossible. But when the neurogenic bladder is due to little understood nervous dysfunction, such as ADDH, or Anxiety and OCD disorders,
then treatment is very promising, using a combination of dietary, nutrtional, acupuncture, and Chinese herbal medicine therapies.
In the case of hyperactive bladder, treatment is directed at tonification, at unblocking depressed liver qi, at clearing dampness and depressive heat, at strengthening the nervous system signals to the bladder, and building what Chinese medicine calls the “upright” or Zhong Qi, the Qi responsible for holding things in place.
In underactive bladder treatment is directed at retraining the sphincter at the base of the bladder how to relax on command. These cases will inovlve a greater degree of treatment along the Liver/Gb and Dai Channels, as well as the Dai and Ren Mo.
One of the ways in which Chinese Acupuncture may help neurogenic bladder may be similar to the usage in western medicine of electrical stimulators to stimulate the bladder nerves. Acupuncture needles in the Hua To and Bai Liao points, along the depression ½ lateral to the spinous processes of the vertebrae and in the ‘eyes” of the sacrum, may do just that. We also know from functional MRI that acupuncture on specific points in the body, such as bladder points, effect the part fot he cerebral cortex that influences bladder function.
Acupuncture may also just strengthen, through he sensory nervous system, the connections between brain-nerve-muscle by a sort of sensory repatterning, in which new feedback loops are introducted thought the fine nerves in the skin that serve as our outermost external sensors.
In my San Diego Chinese Herbal Medicine and acupuncture practice, over the last 22 years, I have found acupuncture and moxabustion very valuable in the treatment of interstitial cystits and neurogenic bladder , using such points as Yin Bai and Tai Bai on the foot, as well as the Chong and Dai channel points. Point Bai Hui at the crown of the head is also very useful. It is also typically necessary to choose points like San Yin Jiao and points on the Liver channel that will harmonize the relationship between the Liver and Spleen Qi while draining dampness.
Often in neurogenic bladder we see evidence of a disquietude of the Shen/spirit, Hun/ethereal soul and Po/corporeal soul caused by the fundamental aspect of Spleen Qi Vacuity that has failed to construct or nourish, and at the same to failed to upbear the clear. This failure in the upbearing of the clear Qi is why we perform moxabustion on Yin Bai and Bau Hui. This failure of the upright Qi can be due to a fundamental weakness, or it can be the effect of depressive heat from liver depression/qi stagnation. In my experience with American patients, this latter case is much more common, and reflects also the effects of emotional states on the body. Depressive heat has as its primary cause emotional states that are caused by our inelegant ways of dealing with our emotions through both overindulgence as well as repression. Its this failure, too, that creates the vacuum by which dampness, pushed by the depressed Liver Qi pours downward.
This also explains why neurogenic bladder symptoms (and those of intersitital cystitis, to be discussed in a moment) are often aggravated by adverse reactions to stress or emotional upset. Here we see the complex relationship between the fight or flight nervous system response as mediated by the hypothalamus and other aspects of the endocrine system, which themselves mediate the emotional states. This is why it is so vital to have a meditative practice such as Mindfulness Meditation in place when treating diseases involving the nervous system. Even a disease such as Multiple Sclerosis, with its concrete organic lesions in the brain has been demonstrated to worsen with stress. The key with stress are as much how we react to it, as the stressors themselves.
Interstitial cystitis (IC) is a condition that causes discomfort or pain in the bladder with a need to urinate frequently and urgently. It is often misdiagnosed as a bladder infection or U.T.I., when in fact there is no infectious agent operative in the IC.
While IC is far more common in women than in men I have seen more than a few male patients here in San Diego. Interestingly, and suggestive of the emotional/nervous system element to this syndrome that one of my MD friends, a pain specialist, describes as a “migraine in your bladder” (remember, as syndrome is a set of symptoms without a specific cause or diseased tissue or infectious process), each one of these male patients has been tender hearted and emotional, rather than stoic or macho.
On the other hand, a large percent of my female cases here in San Diego have seemed emotionally reactive in the direction of irritability and brittleness, with signs of nervous exhaustion, what corresponds in Chinese Medicine to a weakness in the Yin/Blood, whose job it is to keep things appropriately soft and cool.
The symptoms of Interstitial Cystitis vary from person to person. Some people may have pain without urgency or frequency. Others have urgency and frequency without pain. Women’s symptoms often get worse during their periods which is when Liver Depression exacerbates naturally. They may also have pain with sexual intercourse.
The cause of IC isn’t known. There is no one test to tell if you have it. But it is clearly a dysfunction of the nervous system, involving inflammation and irritation and in Chinese medicine both are associated with heat and the chief cause of pathological internal heat is what we call Affect Damage, which is the effect on the body when any one of the emotions—sadness, grief, anger, worry, or fear is excessive, left to fester, unadressed, or repressed, and my provisional theory is that IC is a sort of somaticisation of anxiety, which is a fancy word for what we do and feel when we have too much fear, and frustration, which is hard wired close to anger; let’s put it this way, I have not met an IC patient who is happy-go-lucky, care free, lazy, or over-relaxed. I think its more complicated than that, and none of this is to ever ever ever blame the victim, its just that I think western medicine does a poor job of addressing the nervous system and emotional elements to syndromes. Relaxation therapies and stress management are vital in the treatment of all pain syndromes, and interstitial cystitis is no exception. This is why I prescribe Mindfulness Meditation to all of my pain patients.
Classical Chinese Herbal formulas that can be used to treat neurogenic bladder disorders and Interstitial Cystitis include Bu Zhong Yi Qi Tang, Xiao Chai Hu Tang, and Blue Poppy Originals CystiQuell, which is based on a modification of Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Bu Zhong Yi Qi Tang/Raise the Central Qi Decoction.
Xiao Chai Hu Tang, from the late Han dynasty text the Shang Han Lun or Treatise on Damage Due to Cold was created by the greatest herbalist in Chinese medical history, Dr. Zhang Zhong Jing. It has one of the widest usages in all of Chinese medicine and can be modified to treat hundreds of diseases. In essence, you could almost say this formula treats the human condition. In Blue Poppy’s version, credited to a modern Chinese doctors modifications, there are added herbal medicinals to further calm the spirit, nourish the body, clear heat, move the blood, and reduce irritability.
In addition to the actual bladder symptoms that we look for when using treating Interstitial Cystitis and Neurogenic Bladder with Classical Chinese Medicine Herbal Prescriptions and Acupuncture, we also look for various symptoms that fit the overall pattern of disharmony that is to the Neurogenic Bladder and/or Interstitial Cystitis, what bad soil is to a diseased plant.
These can include various combinations of any of the following. It may be only 1-2 of these symptoms and signs, or it could be an array. As follows:
LIVER DEPRESSION with QI STAGNATION
- A pulse that feels like a bow or vibrating wire
- Pre Menstural Symptoms or Painful Periods
- Anger issues, moodiness, or irritability
- A tongue that is dark or dusky colored
- Constant hunger
- A tongue with swollen and/or dark sides
- A tongue with redness at the tip and/or sides
- A yellow coating on the tongue
- Restlessness, a sense of agitation, profuse dreams, poor quality sleep, insomnia
SPLEEN EMPTYNESS WITH DAMP
- Fatigue and/or lack of strength
- A tendency to soft or loos stools, but without burning
- A swollen tongue with toothmarks at the edges
HEART SPIRIT/SHEN LACK OF CONSTRUCTION
- Anxiety or Obsessive thinking
- Insomnia and Light Sleeping
- Restlessness and Nervousness
- Poor memory or Absentmindedness
Another herbal prescription I have used with great success in the treatment of Interstitial Cystits, WHEN THE PATTERN OF DISHARMONY MATCHES THE PRESCRIPTION, which is how Classical Chinese Medicine works, not by treating a disease, but by treating the underlying pattern that caused it, is Si Ni San/Frigid Extremitis Powder. This is a formula that treats heat trapped in the body that makes the patient feel hot and with various symptoms of Liver Depression, but whose stasis is so bad that the heat, being trapped, fails to nourish the extremities, resulting in ice cold hands and feet.
This pattern is especially common in young females, who all to often have been trained to repress their feelings and not be direct with them, resulting in impatience, frustration, and cold hands and feet. This is very different though from people with cold hands and feet who are cold all the time in their whole bodies, and who can get warm by drinking hot beverages, eating food, and dressing in warm clothes.
Our Si Ni San pattern involves a warm body with cold hands and feet. These people complain of cold hands and feet but wear flip flops and shorts with a tank top. In these patients, the trapped internal heat combined with anxiety and worry and the wrong diet creat a climate of dampness and moisture that pours downward, along with heat and qi stagnation, resulting in pain