"Li Qi San" (Qi-Moving Powder) for Urinary Retention in the Elderly

Elderly people often experience difficulty urinating. The causes are complex. Prostate problems in male patients, hypertension and cerebrovascular accidents in both sexes, and some problems of the urinary system can all cause urinary retention in the elderly. Ascites caused by diseases such as cancer can also cause urinary retention, and some urinary system diseases may also lead to it. Ancient TCM has a formula called "Li Qi San" (Qi-Moving Powder) that can treat urinary retention in the elderly.

Both Lei Bian Zhu Shi Ji Yan Yi Fang (Collected Proven Prescriptions from the Zhu Family, Classified) and Yi Liu Liu Shu (Six Books on Medical Strategy) contain a formula called "Li Qi San," also for treating difficulty urinating, but the compositions differ and the indications are not entirely the same.

The Li Qi San in Lei Bian Zhu Shi Ji Yan Yi Fang is composed of: Mian Huang Qi (Astragali Radix), Chen Pi (Citri Reticulatae Pericarpium), and Gan Cao (Glycyrrhizae Radix), each in equal amounts. Grind the above into a fine powder. Take an appropriate amount each time (6–10 g), decoct in water, remove the dregs, and take warm, three times daily.

This formula supplements qi and promotes urination. It is indicated for qi deficiency in old age with hesitant, difficult urination. I have not used this formula myself, but I once treated an elderly stroke patient who had difficulty passing both urine and stool; the patient said she felt too weak to defecate. After I used a large dose of Sheng Huang Qi (raw Astragalus, 120 g), her urinary and bowel problems were unexpectedly resolved. Raw Astragalus is a qi-supplementing Chinese herb; TCM holds that difficult urination in the elderly is due to qi deficiency, and this has some basis. So this formula uses raw Astragalus, tangerine peel, and licorice for the same principle.

The Li Qi San in Yi Liu Liu Shu is composed of: Mu Tong (Akebiae Caulis) 3 liang (90 g), Zhi Qiao (Aurantii Fructus, stir-fried) 1.5 liang (45 g), Chen Pi (Citri Reticulatae Pericarpium) 1.5 liang (45 g), and Gan Cao Shao (Glycyrrhizae Radix Tenuis) 1.5 liang (45 g). Make the herbs into a powder. Take 3 qian (9 g) each time, washed down with sha-ren (Amomi Fructus) decoction, three times daily.

This formula moves qi and promotes urination. The Mu Tong and Gan Cao Shao used are diuretic herbs; Zhi Qiao, Chen Pi, and Sha Ren are all qi-moving herbs. So this formula is indicated for qi stagnation in the bladder causing urinary retention, fullness of the lower abdomen, and a deep, choppy pulse. Its indication differs from the qi-deficiency urinary retention above; this formula can be used to treat difficult urination caused by prostatic enlargement, ascites, and pelvic effusion.

For the Mu Tong in this formula, Chuan Mu Tong (Sichuan Akebia) must be used; Guan Mu Tong (Aristolochia manshuriensis) must not be used. Guan Mu Tong belongs to the birthwort family and has strong nephrotoxicity and is unsafe.

Besides the above two formulas, I also often use Jin Kui Shen Qi Wan (Kidney-Qi Pill from the Golden Cabinet) or Ji Sheng Shen Qi Wan for urinary retention in the elderly, with good results. In addition, folk practice often uses white radish stewed with fish soup to treat urinary retention in the elderly, which has some effect. All these experiences may be referred to.