Internal Medicine - Kidney Disorders

Diabetes
Enuresis
Impotence
Lin Syndrome (Urinary Tract Infection)
Retention Of Urine
Seminal Emission
Functions of the TCM Kidneys

Important: as with all items posted here, it is very strongly recommended that you seek proper advise from your healthcare professional before administering any form of treatment to yourself.  This website is for informational purposes and does not replace the proper diagnosis of your physician.  

Overview Of Kidney Function

The kidneys are referred to as the root of Qi.  This is because the kidneys store both the post-haven Qi and pre-haven Qi.  Pre-haven Qi is derived from our parents and given to us prior to our birth.  

Post-haven Qi is received through the food we eat and the air we breath.  We can easily produce more post-haven Qi but it is extremely difficult to manipulate and strengthen our pre-haven Qi.  Kidney Yin energy is responsible for our birth, growth and reproduction while our kidney Yang energy is responsible for all of our physiological processes.  The kidneys produce marrow which fills the brain, spinal cord and controls our bones.  The kidneys also govern water by transforming and transporting different types of fluids which are found in our bodies.  The kidneys also control the bodies two lower orifices. Therefore if the kidneys are weak the possible symptoms would be frequent urination or incontinence, nocturnal emissions, diarrhea and possible prolapsed anus. The kidneys Qi is a burning energy or a fire found in the lower gates of vitality.  It is commonly called the minister fire (the heart fire is called the king fire) and it’s heat is the source of fire for all the internal organs.  This heat helps separate different fluids in the body and it also warms the stomach and spleen to aid in their digestion functions.  The warmth also keeps the bodies essence warm aiding in all sexual functions keeping fertility healthy and menstruation regular.  When the kidneys are deficient they represent disorders such as diabetes, enuresis, retention of urine, impotence, seminal emission and urinary tract infections.

3 more – 1 less (eat, drink, urinate more – lose weight/emaciation less).   

Person can eat & drink a lot but not quench thirst or gain weight.  No matter how much is the patient drinks the same amount of urine is passed.  The main pathogenesis is Yin ? w/ dry Heat.  This syndrome is closely related to Diabetes type 1 (early onset insulin dependant).

Pathogenesis

Dry Lung
Stomach Yin Deficiency
Kidney Yin Deficiency
Kidney Yin/Yang Deficiency

Lung Dryness (Upper Jiao)
• Very thirsty, drink lots of fluids but still has dry mouth & tongue, frequent large amount of urine, irritable
• T – red, thin dry coat                                        P – thin, rapid
• Treatment:        clear upper jiao heat and purge fire to promote production of body fluids
• Formula            Xiao Ke fang
Stomach Yin Deficiency (Middle Jiao)
• Hungry, will not stay full after meals, need to eat or get dizzy, extreme emaciation, constipation with dry stools
• T – red, scanty dry coat                                    P – thin, rapid
• Treatment:        Clear Stomach fire and nourish middle jiao yin
• Formula            Yu Nu Jian + Da Huang / Mang Xiao (constipation)
Kidney Yin Deficiency (Lower Jiao)
• Frequent cloudy/thick urination, urine is oily or greasy, thirsty, night sweats, dizzy, tinnitus, seminal emission, insomnia
• T – red, thin coat                                              P – thin, rapid
• Treatment:        Nourish Kidney yin and clear deficient heat.
• Formula            Liu Wei Di Huang Wan
Kidney Yin & Yang Deficiency (Lower Jiao)
• Frequent cloudy oily urination, trouble holding urine, 5-centre heat sensation, thirsty, coldness, aversion to cold, weak lower back and knees, impotence, amenorrhea, night sweat, spontaneous sweat, dry/dull complexion
• T – scanty coat                                                 P – thin, deep weak
• Treatment:        Tonify Kidney yin and yang
• Formula            Jing Gui Shen Qi Wan + Er Xian Tang

Yi Niao is the inability to control the urge to urinate especially while in bed.  Mainly caused by Kidney & Bladder disorders usually caused by Deficiency Cold. Yi Niao is common in babies, geriatrics or during post delivery in men.  Yi Niao is commonly called incontinence if urination occurs while patient is awake.

Western Medicine

Neurological dysfunction, urinary tract disorders, brain disorders, (meningitis, stroke, tumour) prostate disorders, kidney dysfunction.

All 5 Zang organs can cause Yi Niao

Lung Qi Def.  -lung regulates water passages- def qi allows lung to loose it’s governing function there fore impairing the Bladders function.
SP. Qi Def.     -spleen transports/transforms fluids which controls fluid movement –spleen qi sinking allows the spleen to loose control of these fluids.
Weak Kid.      -kidney controls the gates – when kidney is weak it looses control of the gate allowing urine to leak out.  
Kid. Yang def. –kidney looses transforming fluids function, it is unable to help bladder retail fluids
Liver Qi stag. & Damp Heat – liver will loose it’s soothing & regulating function – this causes the muscles to become flaccid allowing leakage.
Liver Yin Def.  –liver impairs DU meridian function
Heart Qi Def. -heart connects to S.I. & KD– when heart Qi is deficient it impacts the S.I. function so it will not absorb all the water and the KD will not be able to balance the water.

Causes

Deficiency cold
Accumulation of damp heat
Accumulation of blood stasis in lower Jiao (trauma ie. Post pregnancy)

Differentiation / Treatment

Kidney Yang Qi Def. (def. cold in lower Jiao)
• Large amount of clear urine, general kd def. cold sympt. Cold, tired, knee & lower back weakness/ache
• T-pale                                                              P-deep thin
• Treatment:        warm kidney, induce astringent, consolidate kidney Qi
• Formula            Tu Si Zi Wan
Lung & Spleen Qi Def.
• Prolapse feeling in Lower abdomen, urine leaks out when coughing/talking, frequent urgent urination, grey pale complexion, short of breath, over-worked / over-worry / over-thinking (sad/worried/tired)
• T-pale                                                              P-weak
• Treatment:           nourish spleen/lung Qi to control urine
• Formula    Bu Zhong Yi Qi Tang + astringent herbs Long Go, Mu Li
Heart & Kidney Qi Def.
• Dreaming with enuresis, canker sores, poor sleep, irritable, general yin def. symptoms.
• T-red tip/strawberry’s                                       P-thin/rapid/deep(kd)
• Treatment:           nourish & harmonize Heart and Kidney
• Formula    Sang Piao Xiao San + Jiao Tai Wan
Accumulation of Damp Heat in Lower Jiao
• Smelly, yellow, frequent, hot urine, (NO PAIN)
• T-red/yellow/ greasy coat                                 P-thin/slippery/rapid
• Treatment:     induce diuresis to clear heat
• Formula          Ba Zheng San
Blood Stasis
• Usually has traumatic injury, possible fever (infection=dark urine), masses in abdomen, more incontinence than enuresis.
• T-red/purple                                                     P-uneven/rapid
• Treatment:            remove blood stasis from lower jiao, clear heat
• Formula    Shao Fu Zhu Yu Tang+clear heat herbs Zhi Zi, Huang Lian, Huang Bai
Du Meridian Def. / Kidney Essence Def.
• Dizziness, blurred vision, reproductive disorders (impotence/infertility), general kidney essence def. symptoms.
• T-thin, weak                                                     P-wiry
• Treatment:           nourish Kidney & DU essence
• Formula    Shen Shi Tu Si Zi Wan

Impotence (inability to achieve full erection) & premature ejaculation during ages of regular sexual practices (16-64 +/-).  This is usually due to KI ?  but can also be caused by external factors.  Chronic illness, stress, & depression seem to be very common in these individuals.

Western Medicine

Psychological (function impotence)
Faulty Genitals (anatomic impotence)
Neuromuscular dysfunction (atonic impotence)

Pathogenesis

Ming Men Fire(Qi & essence) Deficiency
Heart and Spleen Deficiency
Kidney Qi Deficiency due to shoc
Damp Heat in L. Jiao

Ming Men Fire Deficiency
• Infertility, thin clear looking sperm, Kidney Yang deficient symptoms, lower back weakness, coldness, fatigue
• T – pale, puffy                                                  P – deep, weak
• Treatment:        Warm ming men fire to tonify Kidney essence
• Formula            You Gui Wan
Heart & Spleen Deficiency
• Insomnia, palpitations, poor appetite, fatigue, soft stools
• T – Pale                                                           P – thin
• Formula            Gui Pi Tang + Qi Fu Yin
Kidney Qi Deficiency Due To Shock
• Long term fears, sudden shock, timid person, insomnia with excess dreams, palpitations
•  T – red, greasy coat                                                      P – thin, wiry
• Treatment:        Nourish Kidney and calm spirit
• Formula            Da Yu Tang + Kidney tonics
Damp Heat In Lower Jiao
• Skin disorders around genitals (wet/soft types), dark scanty yellow hot urine, possible odor, possible constipation
• T – red, greasy yellow coat                               P – slippery, rapid
• Treatment:        induce diuresis to clear heat and transform dampness
• Formula            Long Dan Xie Gan Tang

Frequent, Urgent, Painful, dripping, dark urination caused by damp heat in the Bladder.  Urine may contain stones, blood or a milky/greasy substance.

Western Medicine

Chyluria, Prostatitis, T.B. of Kidney, Cancer

Causes

Shi Lin  - stone (heat coagulates urine into stones)
Re Lin   - heat  (toxic damp heat attacks bladder – burning pain)
Xue Lin  - blood  (heat pushes blood out of damaged vessels)
Gao Lin   - Chyluria  (heat injures meridians impairing transform/transport)
Lao Lin  -  kidney def. (kd can’t help bladder transform urine or control gate)
Qi Lin   -liver qi/blood stagnation fire travels down liver meridian impairing bladder)

Differentiate between?

Long Bi – retention of urine – not urgent, no pain, no blood
Blood Urine – blood in the urine – not urgent, no pain, mainly blood
Jing Zuo – pee with spermies during urination, usually after ejaculation.

Re Lin (excess)
• Mainly caused by damp heat.  Frequent dribbling, urgent burning urination with bitter taste, fever, aversion to cold and other general damp heat accumulation symptoms.
• Tongue – red, yellow coat         Pulse – soft, slippery, rapid
• Treatment:     induce dieresis to clear damp heat
• Formula:         Ba Zheng San
Re Lin (deficient kidney Yin)
• Deficient kidney fire.  All symptoms above but less severe – mild/dull pain, lower back/knee pain & weakness, chronic
• Tongue – red, scanty coat                                 Pulse – thin, rapid
• Treatment:     nourish kidney, clear heat
• Formula          Zhi Bai Di Huang Wan
Xue Lin (excess)
• Frequent dribbling, urgent burning urination with bitter taste, fever, aversion to cold and redness in urine (blood in urine)
• Tongue – red, yellow coat                                 Pulse – rapid
• Treatment:      clear heat, induce dieresis, cool blood to stop bleeding
• Formula          Xiao Ji Yin Zi
Xue Lin (deficient kidney yin)
• Frequent dribbling, urgent urination with mild/ dull pain, lower back/knee pain & weakness, chronic with slight red or pink colour
• Tongue – red, scanty coat                                 Pulse – thin, rapid
• Treatment:      Nourish kidney, clear heat, stop bleeding
• Formula          Zhi Bai Di Huang Wan + Gui Ban + E Jiao +Han Lian Cao
Qi Lin (excess – Liver Qi Stagnation)
• Frequent dribbling, urgent, painful urination with pain in the lower abdomen, distended pain, aggravated by stress / emotion, unfinished feeling after urination
• Tongue – red or normal                                    Pulse – Wiry, deep
• Treatment:     regulate Qi & Blood, induce dieresis
• Formula          Chen Xiang San
Qi Lin (deficient spleen Qi sinking)
• Frequent, dribbling, urgent urination, agg-when tired, pulling feeling in lower abdomen, amel-pressure, general Qi deficient symptoms.
• Tongue – pale                                                   Pulse – weak
• Treatment:     strengthen spleen Qi
• Formula          Bu Zhong Yi Qi Tang
Shi Lin (excess)
• Frequent dribbling, urgent, painful urination with pain and stones, flow suddenly stops in mid stream, over whelming urge to go with severe pain, worse for men, if stones in kidneys severe lower back pain, stones may injure vessels = blood in urine
• Tongue – red yellow coat                                  Pulse – wiry
• Treatment:     induce dieresis to eliminate stones
• Formula          Ba Zheng San + Shi Wei San (stones)
Shi Lin (complicated excess / deficient)
• Frequent dribbling, urgent, painful urination, chronic stones, fatigue, dull pain, lower back aching.
• Tongue -                                                          Pulse – weak
• Treatment:     strengthen kidney, induce dieresis to eliminate stones
• Formula          Zhi Bai Di Huang Wan + Shi Wei San (stones)
Gao Lin (excess) Chyluria
• Frequent dribbling urgent, painful urination, cloudy urine with floaters at surface, burning pain
• Tongue- red, yellow coat                                  Pulse – rapid
• Treatment:     eliminate damp heat, promote separation of waste body fluids
• Formula          Bei Xie Fen Qing Yin
Gao Lin (deficient kidney Qi)
• Chronic frequent, dribbling, urgent, painful urination with cloudy urine, emaciation
• Tongue-                                                           Pulse -
• Treatment:     nourish kidney to reinforce gate
• Formula          Liu Wei Di Huang Wan + Jin Suo Gu Jing Wan
Lao Lin (kidney deficiency)
• Chronic frequent, dribbling, urgent, painful urination induced by over strained sexual activity, general kidney deficiency symptoms.
• Tongue -                                                          Pulse – thin
• Treatment:      nourish deficiency
• Formula          Kid-yin def.       Liu Wei Di Huang Wan
                        Kid-Qi def.        Tu Si Zi Tang
                        Kid-Yang def.    Shen Qi Wan
Lao Lin (heart deficiency)
• Frequent, dribbling, urgent, painful urination accompanied by deficient heart symptoms
• Treatment:     nourish deficiency, induce dieresis
• Formula          Tu Si Zi Tang  + Qin Xin Lian Zi Yin
Lao Lin (spleen)
• Frequent, dribbling, urgent, painful urination accompanied by over work, fatigued, general heaviness
• Treatment:     Nourish deficiency
• Formula          Shen Qi Wan

Significant decrease of urine or no passing of urine at all.  Usually caused by lower jiao or bladder disorders relating back to other organs.  (no pain)

Western Medicine

Retention of urine, Anuria (unable to urinate), blockages, injury of urinary tract, enlarged prostate, bladder/sphincter spasm, neurological disorders … … …

Aetiology / Pathogenesis

Damp Heat (most common)   – accumulates in mid./lower Jiao, impairing spleen/kidney transformation/transportation functions of urine, damp heat will also block the bladder
Lung Heat      -lung is the upper source of water, lung heat will not allow descending function of water from the lung to the bladder.
Spleen Qi Def. –looses transforming/transporting function, spleen can not separate or descend clear and turbid fluids
Kidney Essence Def.  –causes ming men fire deficiency, yang Qi can’t transform to produce yin (with ought yin there is no yang)
Liver Qi Stag.   –can’t soothe or regulate san Jiao functions the san jiao looses it’s steaming transformation function
Obstruction     - stones, tumour, injury, blood stasis

Principle of Treatmen

Always induce Diuresis

Differentiation / Treatment

Excess Damp Heat in Bladder
• Dark, smelly, burning sensation with fullness in lower abdomen, thirsty with no desire to drink, bitter taste, general feeling of being sticky, possibly constipated
• T-red, greasy coat                                            P-slippery, rapid
• Treatment:     induce diresis to clear heat
• Formula          Ba Zheng San
Excess Heat in Lung
• Sore and dry throat, respiratory symptoms –dyspnea, dry cough, wheezing retention of urine symptoms
• T- red, yellow coat                                           P-rapid
• Treatment:     clear lung heat, induce diresis
• Formula          Qing Fei Yin
Stagnation of Liver Qi
• Starts with emotional anger, chest/hypochondriac pain or fullness
• T-red, thin/yellow coat                          P-wiry
• Treatment:     soothe liver Qi stagnation, induce diresis
• Formula          Chen Xiang San
Obstruction of Urinary Tract
• Possible scanty or narrow stream during urination, pain/distension of lower abdomen
• T-dark purple                                                   P-uneven
• Treatment:     promote blood circulation, remove obstruction
• Formula          Xiao Fu Jue Yu Tang (traditional)
                       Dai Di Dang Wan (more widely used)
Middle Jiao Qi Sinking- Spleen
• Prolapsed feeling in abdomen, fatigue, short of breath, bloating, other spleen Qi deficiency symptoms, over work, over worry
• T-pale                                                              P-deep thin
• Treatment:     strengthen spleen to Ascend clear Qi and Descend turbid
• Formula          Bu Zhong Yi Qi Tang + induce diresis Chun Ze Tang
Kidney Yang Deficiency (ming-men fire def.)
• No force to push urine out, pale, fatigue, lower back & knee weakness or cold
• T-pale                                                              P-deep thin
• Treatment:     warm up kidney yang to strengthen kidney Qi
• Formula          Shen Qi Wan
Kidney Yin deficiency
• General yin deficiency symptoms – 5 centre heat sensation, night sweat, zygomatic flush
• T-red                                                               P-thin, rapid
• Treatment:     nourish kidney yin & induce diresis
• Formula          Liu Wei Di Huang Wan & Zhu Ling Tang

Seminal emission (Yi Jing) is the passing of seminal fluid during ones sleep or when they are awake without sexual excitement.

Pathogenesis

Heart & Kidney Disharmony -Kidney looses control over lower gate allowing   seminal fluid to leak out.
Kidney Yin Deficiency
Liver Heat
Damp Heat in L.Jiao
Kidney Qi Deficiency
Phlegm Fire

Heart & Kidney Disharmony
• Seminal emission comes with dreams, insomnia, palpitations, yellow short urine,    KD yin deficient symptoms.
• T - red                                                                         P – rapid
• Treatment:        Clear Heart heat (king fire) and nourish Kidney.
• Formula            San Cai Feng Shui Dan + clear heat herbs
Kidney Yin Deficiency
• Seminal emission without dreams or palpitations, KD yin deficient symptoms.
• T – red, thin coat                                              P – thin, rapid
• Treatment:        Nourish Kidney yin, clear minister fire
• Formula            Zhi Bai Di Huang Wan
Liver Heat
• Seminal emission without dreams, prolonged erections during daytime, liver fire symptoms, vexation, bitter taste
• T – red                                                                         P – rapid
• Treatment:        Purge liver fire
• Formula            Long Dan Xie Gan tang
Damp Heat in Lower Jiao
• Seminal emissions at night, eruptions around genitalia, possible semen in urine, damp/heat symptoms
• T – red, thick yellow coat                                 P – rapid, slippery
• Treatment:        induce dieresis to clear heat and transform dampness
• Formula            Bi Xie Fen Qing Yin
Kidney Qi Deficiency
• Seminal emission when awake, pale puffy complexion, lassitude, KD Qi def. symptoms & possible SP Qi def. symptoms
• T - pale                                                            P – deep, weak
• Treatment:        Nourish Kidney Qi and consolidate essence
• Formula            Jing Shi Shen Qi Wan + Mi Jing Wan  (+ Gui Pi Tang if SP Def.)
Phlegm Fire
• Seminal emission, selling in lower jiao, fullness/distention in chest, dark hot scanty difficult urine, cough with phlegm, bitter taste, thirst with no desire to drink.
• T – red, yellow greasy coating                           P – red, slippery
• Treatment:        Clear fire and remove phlegm
• Formula            Zhu Ling Wan 

 Links - Kidney: Water Energy Yin  Organ (Bioenergetics)