A 67-year-old woman with a four-month history of a persistent fungal urinary tract infection, complicated by a 20-year history of diabetes, was managed using a Qi-moving and blood-invigorating herbal strategy.

Case ID: CHC-0047

Case Summary

This case describes a 67-year-old woman who presented with a four-month history of frequent, urgent, and painful urination. Despite testing negative for common bacterial infections, a urine culture revealed a fungal infection. She had a 20-year history of diabetes. The original report documented a conventional diagnosis of fungal infectious urethritis and a TCM assessment of Stranguria (Lin Syndrome) driven by Qi Stagnation and Blood Stasis. She was managed through a dynamic herbal approach designed to move stagnant Qi, resolve emotional depression, clear localized heat, and unblock the urinary passages.

Patient Presentation

• Patient: 67-year-old female (Surname: Chen).
• Main Complaint: Frequent urination, urgency, and painful urination for 4 months, accompanied by a burning sensation at the urethral opening.
• History: The patient sought initial consultation on April 11, 2022. She had reached menopause at age 51 and had a 20-year history of diabetes, for which she was currently taking medication. Four months prior, she developed severe urinary symptoms without hematuria or urethral discharge. Initial testing in December 2021 was negative for Chlamydia, Mycoplasma, and bacterial cultures, though her urine routine showed white blood cells (3+) and occult blood (1+). On February 25, 2022, a urine culture confirmed a fungal infection. She had sought treatment at other hospitals, but her symptoms kept recurring. Associated symptoms included lower back pain, chest tightness, shortness of breath, gastric discomfort (嘈杂), and poor sleep with many dreams.

Examination and Diagnosis

• Conventional Diagnosis: Fungal infectious urethritis.
• TCM Tongue and Pulse: The tongue body was dark red with a thin, white coating. The pulse was fine and choppy (脉细涩).

TCM Assessment

The original practitioner interpreted the presentation as Stranguria (Lin Syndrome) driven by Qi Stagnation and Blood Stasis (淋证 – 气滞血瘀).

According to the holistic principles of yin and yang Chinese Medicine this elderly patient had an underlying deficiency of Liver and Kidney Yin and blood (evidenced by her lower back ache and poor sleep). The original report noted that her symptoms consistently worsened when she experienced emotional frustration or anger.

The practitioner assessed that Heart fire had triggered Liver stagnation fire. This trapped emotional and physical energy disrupted her body’s internal water metabolism. Over time, the stagnant fluids transformed into internal heat, which scorched her bodily fluids and created physical blood stasis. This combination of dampness and stasis physically blocked the urinary tract (San Jiao waterways), leading to the painful, urgent urination. Furthermore, the stagnant Qi generated internal phlegm, which blocked her chest and caused the shortness of breath. The dark red tongue and choppy pulse provided definitive objective confirmation of this deep blood stasis.

Treatment Approach

The primary treatment principle was to move Qi and invigorate blood, unblock stranguria, and stop pain (行气活血，通淋止痛). The strategy avoided purely attacking the fungus with heavy bitter-cold herbs, focusing instead on restoring the micro-circulation of the pelvic region and resolving the emotional/Qi blockage that was keeping the urinary tract closed.

Herbal Formulas and Modifications

• Initial Formula (April 11, 2022): An 11-herb decoction combining strong Qi-moving and blood-invigorating botanicals.
  • Moving Qi and Relieving Depression: Bei Chai Hu (Bupleurum, 10g), Zhi Shi (Immature Bitter Orange, 20g), Mu Xiang (Aucklandia, 10g), and Zi Su Ye (Perilla Leaf, 10g) formed a powerful matrix to aggressively soothe Liver constraint, unblock the chest, and restore the downward flow of Qi.
  • Invigorating Blood and Stopping Pain: San Qi Fen (Notoginseng powder, 3g – taken with the decoction) and Cu Ru Xiang (Vinegar-prepared Frankincense, 10g) forcefully broke up the localized blood stasis to stop the sharp urinary pain.
  • Clearing Damp-Toxicity: Tu Fu Ling (Smilax, 20g) is a crucial herb for clearing damp-heat and resolving toxicity, particularly suited for lower warmer infections (including fungal and spirochete infections).
  • Strengthening Spleen and Harmonizing: Bai Zhu (Atractylodes, 20g) and Sha Ren (Amomum, 5g) protected the digestive system from the strong moving herbs, while Hai Piao Xiao (Cuttlefish Bone, 10g) settled the gastric discomfort. Gan Cao (10g) harmonized the decoction.
• Second Visit (April 18, 2022): The urinary frequency, urgency, and pain were slightly reduced, but the burning sensation remained. The tongue showed visible petechiae (瘀点 – dark stasis spots). The practitioner intensified the blood-moving and pain-stopping strategy by adding Cu Yan Hu Suo (Corydalis, 10g) and Wu Ling Zhi (Trogopterus Dung, 10g).
• Third Visit (April 25, 2022): The urinary symptoms and burning sensation were both significantly reduced. To clear the residual heat in the blood and further promote urination, the practitioner added Bai Mao Gen (Imperata Root, 10g), Chi Shao (Red Peony, 10g), Dan Pi (Moutan Cortex, 10g), and Huo Xiang (Agastache, 10g).

Follow-Up

• The patient continued this treatment protocol for a total of two months. At the conclusion of the treatment, her urinary frequency, urgency, and pain completely disappeared, and the burning sensation at the urethral meatus was successfully resolved.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is treating a confirmed fungal urinary tract infection primarily through moving Qi and breaking up Blood Stasis.

Diabetic patients are highly susceptible to stubborn fungal infections. In conventional medicine, anti-fungals are the sole approach. However, this patient’s infection was recurrent and refractory. The original practitioner recognized that the fungus was thriving because the local “environment” was stagnant—blocked by trapped Liver Qi and Blood Stasis. By utilizing herbs like Chai Hu, Zhi Shi, and San Qi alongside the damp-clearing Tu Fu Ling, the treatment successfully altered the internal environment of the urinary tract, draining the stagnant heat and stasis so the fungus could no longer survive.

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Source Original source: Qingyuan Maternal and Child Health Hospital / Guangdong Provincial Administration of Traditional Chinese Medicine Original title: 【以案说医】曾宪进：行气活血，通淋止痛法治疗真菌感染性尿道炎案 Practitioner: Professor Zeng Xianjin (曾宪进) Publication date: September 16, 2024 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation