Teresa’s Case Study  | Nocturia Five or Six Times a Night — Why Didn’t Kidney-Tonifying Treatment Help?

By Teresa Shen, BHSc (Acupuncture), ACC Registered Treatment Provider, Registered Chinese Medicine Practitioner (NZ)

1. The Patient’s Story

This was a young woman who worked as a nail technician.

Her job required her to sit at a workbench for long periods, often leaning forward with her head down. Sometimes she remained in almost the same position for several hours without getting up to move.

Her main problem was urinary frequency.

During the day, she sometimes needed to use the toilet every hour. But the most disruptive problem was at night.

She was waking to urinate five or six times almost every night.

Her sleep was repeatedly interrupted, and over time she became very tired.

The main issue was frequent urination rather than passing a particularly large volume each time. She had mild urgency but no pain with urination.

She had previously seen her GP. Urine testing did not show clear evidence of infection, and an ultrasound did not identify an obvious abnormality.

She had also been given approximately five or six days of antibiotics, without significant improvement.

Later, she received Chinese herbal medicine and acupuncture mainly based on a Kidney deficiency treatment approach, but the symptoms still did not improve much.

2. What I Found on Examination

When I examined her abdomen, I found several clearly tense, cord-like areas.

One was around four centimetres lateral to the umbilicus. Another was around the outer third of the line between the anterior superior iliac spine and the umbilicus.

Along these areas, I could palpate firm, tight and nodular tissue.

In our clinical language, we sometimes describe this type of palpable tight band as “Diao Jin” (吊筋) — a distinctly tense, cord-like structure found on palpation.

These areas were very tender. At times, pressure also reproduced discomfort towards the groin.

Anatomically, I considered that the tension could involve the psoas region, other muscles of the posterior abdominal wall, and related fascial tissues.

This finding made me reconsider the case.

From a TCM perspective, Kidney function is closely related to Bladder transformation and urinary control, and Kidney deficiency can certainly present with frequent urination.

But:

Urinary frequency does not automatically mean Kidney deficiency.

This patient had already received treatment based mainly on tonifying the Kidney, without much improvement.

Her occupation also caught my attention.

She spent many hours sitting in a fixed, flexed posture, and examination showed significant tension and tenderness through the abdominal and lower trunk tissues.

I therefore began to ask a different question:

Could there also be constrained soft tissues and impaired Qi movement in the lower abdomen, rather than this being simply a Kidney deficiency pattern?

Based on her symptoms, work posture and what I actually found on palpation, I decided not to simply repeat the previous treatment direction.

3. Treatment

I focused treatment on the abnormal areas identified during the abdominal examination.

Along the palpable tight bands, I looked for the most significant tender points, particularly areas where pressure reproduced familiar lower abdominal or groin discomfort.

I then used targeted acupuncture in these regions.

The aim was not simply to “treat the bladder” or continue tonifying the Kidney.

Instead, I wanted to reduce the marked muscular and fascial tension that I had found and then observe something clinically important:

If these abnormal physical findings changed, would her urinary frequency and urgency change as well?

For me, the treatment was also a way of testing the clinical reasoning.

4. Her Response After the First Treatment

When she returned after the first treatment, she was very pleased.

Before treatment, she had been waking to urinate five or six times every night.

After the first treatment, this had reduced to approximately two times per night.

For her, this was a meaningful change.

Previously, she was repeatedly woken throughout the night and rarely had a sustained period of sleep. She still needed to get up at night, but the interruption to her sleep had reduced considerably.

She was very happy simply to be sleeping for longer periods again.

Of course, one significant response after one treatment does not prove that the problem has been resolved.

Nor does it prove that the abdominal tight bands were directly causing her urinary frequency.

But a long-standing symptom that had responded poorly to previous treatment changed noticeably after treatment was redirected towards the abnormal findings identified on examination.

That made me think:

This clinical direction was worth continuing to investigate.

5. What This Case Made Me Think About

What interests me most about this case is not simply that nocturia reduced from five or six times to around two after one treatment.

The more important question is:

Why had Kidney-tonifying treatment not helped, and why did the treatment direction change after a new examination?

In TCM, failure of Kidney Qi to consolidate can certainly contribute to urinary frequency.

But if every case of frequent urination is immediately labelled “Kidney deficiency”, it becomes very easy to turn a symptom directly into a pattern diagnosis.

This patient reminded me that:

The symptom is the starting point of pattern differentiation — not the end of it.

She spent many hours working in a fixed seated posture, and examination revealed marked tightness, palpable bands and tenderness through the abdominal region.

Those physical findings made me reconsider the case in terms of constrained tissues, impaired Qi movement and possible disturbance of lower abdominal function.

Modern research has also drawn attention to the relationship between lower urinary tract symptoms and pelvic floor myofascial dysfunction. Some patients with urinary frequency and urgency demonstrate increased muscle tone, tenderness and myofascial trigger points, even when primary bladder pathology is not clearly identified.

That does not mean the abdominal “Diao Jin” found in this patient was proven to be the cause of her urinary frequency.

The response after the first treatment is better understood as a clinical clue that deserves further observation.

For me, the most useful lesson from this case is simple:

When a treatment approach has repeatedly failed to produce the expected change, sometimes we need to return to the patient — take another history, examine again, and look for something that may previously have been overlooked.

Clinical reasoning should not depend on the symptom alone. It should also consider how the patient works, how she lives, and what we can actually find through examination.

That is why I felt this case was worth sharing.