The kidneys reside in the lumbar region — one on the left and the other on the right. The urinary bladder is located at the center of the lower abdo- men. They kidneys are internally–externally connected with the urinary bladder through meridians. They store essence, govern reproduction, con- trols bone and produce marrow to supplement the brain. As a result, the kidneys are also known as the congenital base. They also govern water and absorb qi. They open into the ears, their tissue shows in the bone and luster manifests in the hair.
The physiological function of the urinary bladder is to store and dis- charge urine. A normal function of the urinary bladder depends on the qi transformation of the kidneys.
The main pathologies of the kidneys manifest abnormal functions of the kidneys, often causing deficiency patterns. Common signs and symp- toms of the kidney conditions include soreness and weakness of the low back and knee joints, tinnitus, deafness, prematurely graying hair, loos- ened teeth, impotence, nocturnal emissions, sterility due to a low sperm count, scanty menstruation or amenorrhea, edema, and abnormal urination and bowel movements.
The main pathologies of the urinary bladder mainly manifest as abnor- mal micturition, such as dysuria, frequent urgent painful urination, enure- sis and urinary incontinence.
QUESTIONS
1. Describe the clinical manifestations of liver qi stagnation, ascending of liver fire, liver blood deficiency, liver yin deficiency and hyperactivity of liver yang.
2. Analyze the etiology and pathogenesis of the above five patterns.
3. How can you distinguish liver qi stagnation from ascending of liver fire, liver yin deficiency, hyperactivity of liver yang and internal stirring of liver wind? Try to analyze the interactions between their etiology and pathogenesis. 4. Describe the clinical manifestations of cold retention in the liver meridian,
damp–heat in the liver and gallbladder, and gallbladder stagnation with phlegm retention.
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Kidney yang deficiency
Overview
Kidney yang deficiency manifests a condition due to yang–qi deficiency of the kidneys. The main contributing factors include constitutional yang defi- ciency, sex indulgence, aging, chronic conditions, contraction of external pathogens and conditions of other organs.
Clinical manifestations
Soreness, weakness or pain of the low back and knee joints, cold intoler- ance, cold limbs, dizziness, a low spirit, a bright pale or dark complexion, impotence, sterility, diarrhea mixed with undigested food, diarrhea before dawn, a pale tongue with a white coating and a deep thready weak pulse.
Analysis
Since the lumbus houses the kidneys and the kidneys dominate bones, fail- ure of kidney yang to warm and nourish the lumbus and bones may cause soreness, weakness or pain of the low back and knee joints. Failure of yang–
qi to warm the body may cause cold intolerance and cold limbs. Failure of
clean yang to ascend may cause dizziness and a low spirit. Failure of yang–
qi to circulate blood may cause a bright pale or dark complexion. Kidney
yang deficiency may cause fire declining of the vital gate, resulting in impotence and sterility. Kidney yang deficiency may further cause spleen yang deficiency and subsequent diarrhea mixed with undigested food or diarrhea before dawn. A pale tongue with a white coating and a deep thready weak pulse are typical signs of kidney yang deficiency.
Differentiation
This pattern should be distinguished from a general yang deficiency syn- drome. General yang deficiency is marked by deficiency and cold of the body, while kidney yang deficiency also includes kidney-related symptoms.
Distinctive notes
This pattern is distinctively marked by hypofunction of the kidneys and deficiency cold symptoms.
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Kidney yin deficiency
Overview
Kidney yin deficiency manifests a condition due to insufficiency of kidney yin fluid. The main contributing factors include chronic conditions, febrile diseases, congenital deficiency, sex indulgence, loss of blood or fluids, and overingestion of dry and warm-property food or medications.
Clinical manifestations
Soreness, weakness or pain of the low back and knee joints, vertigo, tin- nitus, insomnia or dream-disturbed sleep, weight loss, tidal fever, night sweats, feverish sensations on the palms, soles and chest, a dry mouth and throat, nocturnal emissions, premature ejaculations, scanty menstruation, amenorrhea or uterine bleeding, a red tongue with a scanty coating and a thready rapid pulse.
Analysis
Failure of kidney yin to nourish the lumbus and bones may cause sore- ness, weakness or pain of the low back and knee joints. Failure of kidney yin to fill up the brain marrow may cause vertigo and tinnitus. Failure of kidney water to constrain heart fire may cause insomnia or dream- disturbed sleep. Kidney yin deficiency may cause internal heat, resulting in weight loss, tidal fever, night sweats, feverish sensations on the palms, soles and chest, a dry mouth and throat, a red tongue with a scanty coating and a thready rapid pulse. Internal deficient heat due to kidney yin defi- ciency may cause nocturnal emissions and premature ejaculations. Kidney yin deficiency may affect essence blood, leading to scanty menstruation or amenorrhea. Internal deficient fire may also accelerate the flow of blood, resulting in uterine bleeding.
Differentiation
This pattern should be distinguished from a general yin deficiency syn- drome. General yin deficiency syndrome is marked by yin deficiency with internal heat, while this pattern also includes the kidney-related symptoms.
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Distinctive notes
This pattern is distinctively marked by kidney deficiency symptoms and clinical manifestations due to internal deficient heat.
Insufficiency of kidney essence
Overview
Insufficiency of kidney essence manifests delayed growth and develop- ment due to deficiency of kidney essence. The main contributing factors include congenital maldevelopment, constitutional weakness, hypofunc- tion of the spleen and stomach, sexual indulgence and severe chronic conditions.
Clinical manifestations
Delayed growth and development, delayed closure of the fontanelle, short stature, mental retardation, skeletal flaccidity, slow movements, sterility, scanty menstruation or amenorrhea, premature aging, loss of hair with loosened teeth, tinnitus, deafness, soreness and weakness of the low back and knee joints, a dull spirit, a poor memory, a small tongue and a thready weak pulse.
Analysis
Since the kidneys store essence and dominate growth and reproduction, failure of kidney essence may cause delayed growth in children, delayed closure of the fontanelle and short stature. Failure of kidney essence to sup- plement the brain marrow may cause mental retardation, skeletal flaccidity, slow movements, a dull spirit and a poor memory. Deficiency of kidney essence may also cause sterility and scanty menstruation or amenorrhea. Since the kidneys open into the ears and their tissue shows in bone, kidney essence deficiency may cause loss of hair (hair is known as the extension of blood, and blood and essence share the same source), loosened teeth, tinnitus, deafness, and soreness and weakness of the low back and knee joints. Premature aging, a small tongue and a thready weak pulse are typi- cal signs of deficiency.
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Differentiation
This pattern should be distinguished from kidney yang deficiency and kid- ney yin deficiency. All three patterns have kidney deficiency. Both kidney yang deficiency and kidney yin deficiency have obvious cold and heat symptoms. However, this pattern has no visible cold or heat symptoms.
Distinctive notes
This pattern is distinctively characterized by severe delayed growth and development or severe reproductive hypofunction.
Weakness of kidney qi
Overview
Weakness of kidney qi manifests a condition due to infirmness of kidney
qi. The main contributing factors include congenital deficiency, sex indul-
gence, aging and chronic conditions.
Clinical manifestations
Clear profuse urine, frequent urination, urine dribbling, urinary inconti- nence, enuresis, increased urination at night, spermatorrhea, premature ejaculations, thin clear leukorrhea, susceptibility to miscarriage, mental fatigue, lassitude, soreness and weakness of the low back and knee joints, hearing impairment, pallor, a pale tongue with a white coating and a thready weak deep pulse.
Analysis
Failure of kidney qi to constrain the urinary bladder may cause clear pro- fuse urine, frequent urination, urine dribbling, urinary incontinence, enu- resis, and increased urination at night. Failure of kidney qi to constrain the essence chamber may cause spermatorrhea, premature ejaculations, thin clear leukorrhea and susceptibility to miscarriage. Kidney qi deficiency may also cause hypofunction of the other organs and meridians, leading to mental fatigue, lassitude, soreness and weakness of the low back and
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knee joints, hearing impairment, pallor, a pale tongue with a white coating and a thready weak deep pulse.
Differentiation
Abnormal urination in this pattern should be distinguished from damp– heat in the urinary bladder. Damp–heat in the urinary bladder is character- ized by frequent urgent painful urination, scanty dark-yellow urine, a yellow greasy tongue coating and a rapid pulse. This pattern has no damp–heat symptoms. Also, it has no obvious cold or heat symptoms, unlike kidney yang deficiency and kidney yin deficiency.
Distinctive notes
This pattern is distinctively marked by an uncontrollable urinary bladder, insecurity of the essence chamber or dai meridian and kidney qi deficiency.
The kidneys failing to receive qi
Overview
The kidneys failing to receive qi manifests a condition due to kidney-qi deficiency. It is often caused by chronic lung conditions.
Clinical manifestations
Panting and shortness of breath that can be aggravated by physical exer- tion, an inability to lie flat, breathing with an open mouth and raised shoulders, more exhalation than inhalation, a low voice, soreness and weakness of the low back and knee joints; in severe cases, chest tightness, cold limbs, a bluish complexion, cold sweats and a deficient floating root- less pulse may also be present. Alternatively, a red face, restlessness, a dry mouth and throat, a red tongue and a thready rapid pulse may be present.
Analysis
The lungs govern respiration and the kidneys dominate the receiving of qi. Lung qi deficiency may cause panting and shortness of breath that
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can be aggravated by physical exertion. Kidney qi deficiency causes an inability to lie flat, breathing with an open mouth and raised shoulders, more exhalation than inhalation and a low voice, as well as soreness and weakness of the low back and knee joints. The kidneys failing to receive
qi may affect chest yang, resulting in chest tightness, cold limbs, pallor
and cold sweats. A deficient floating rootless pulse is a critical sign of yang–qi failure. Those with a yin deficiency constitution may have inter- nal deficient fire–heat and thus present with a red face, restlessness, a dry mouth and throat, a red tongue and a thready rapid pulse.
Differentiation
Panting with shortness of breath in this pattern should be distinguished from lung qi deficiency. Lung qi deficiency alone often causes weak coughing and lack of qi without more exhalation than inhalation. Also, this pattern should be distinguished from kidney yang deficiency and kidney yin defi- ciency, in that they do not involve lung-related symptoms.
Distinctive notes
This pattern is distinctively marked by more exhalation than inhalation (due to the kidneys failing to receive qi) and panting with shortness of breath (due to lung qi deficiency).
Damp–heat in the urinary bladder
Overview
Damp–heat in the urinary bladder manifests a condition of pathogenic damp-heat accumulating in the urinary bladder. The main contributing factors include external contraction of damp–heat, an improper diet, and internal damp–heat due to spleen deficiency.
Clinical manifestations
Frequent urgent painful urination, scanty dark-yellow urine, urine drib- bling, lower abdominal distension, a red tongue with a yellow greasy coating and a rapid pulse; fever, low back pain, bloody urine, urine con- taining stones and turbid urine may also be present.
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Analysis
Damp–heat in the urinary bladder may impair its qi transformation, lead- ing to frequent urgent painful urination, urine dribbling and lower abdom- inal distension. Exuberant heat causes scanty dark-yellow urine. More dampness causes turbid urine. Damp–heat damaging the collaterals may cause bloody urine. Over time, buildup of damp–heat may cause urine containing stones. Accumulated damp–heat may affect the kidneys, result- ing in low back pain. A red tongue with a yellow greasy coating and a rapid pulse are typical signs of internal accumulation of damp–heat.
Differentiation
This pattern should be distinguished from an uncontrollable urinary blad- der, which is mainly characterized by frequent and dribbling urination but with no urgency and pain during urination.
Distinctive notes
The distinctive points of this pattern include irritation signs of the urinary bladder (frequent urgent painful urination) and internal accumulation of damp–heat.
Summary
The patterns of the kidneys and urinary bladder:
Patterns Distinctive diagnosis points
Kidney yang deficiency Yang deficiency + kidney-related symptoms
Kidney yin deficiency Yin deficiency + kidney-related symptoms
Kidney essence insufficiency Severe delayed growth and development + reproductive hypofunction
Weakness of kidney qi Uncontrollable urinary bladder + insecurity of the essence chamber or uncontrollable dai meridian Kidneys failing to receive qi Lung qi deficiency + more exhalation than inhalation Damp–heat in the urinary bladder Irritation signs of the bladder + internal buildup
of damp–heat
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