Insecurity of kidney qì

Also insecurity of the lower origin (下元不固 xià yuán bù gù)

A disease pattern chiefly characterized by limp aching lumbus and knees; enuresis or urinary incontinence; seminal emission or seminal efflux; persistent dribbling menstrual flow; vaginal discharge; miscarriage.

Description: Limp aching lumbus and knees; deafness and tinnitus; lassitude of spirit and lack of strength. Urine: Frequent voidings of clear urine; dribbling after voiding; profuse urination at night; enuresis; urinary incontinence; white turbidity. Men: premature ejaculation; seminal efflux. Women: persistent dribbling menstrual flow; clear thin vaginal discharge; fetal spotting; stirring fetus; miscarriage.

Diseases: Seminal emission; enuresis; taxation strangury; urinary turbidity; vaginal discharge; fetal spotting; stirring fetus.

Pathogenesis: Insufficiency of kidney qì taking the form of a breakdown of its function of preventing involuntary loss of urine, semen, stool, menstrual flow, vaginal discharge, and the fetus. This results from:

• poor development of kidney essential qì in childhood or debilitation of kidney qì in advancing age;
• enduring illness;
• sexual intemperance.

Analysis of signs

• General signs: When kidney qì fails to warm and nourish the bones, there is limp aching lumbus and knees. When it lacks in strength, qì and blood cannot ascend to nourish the ears, so there is deafness and tinnitus. Qì vacuity manifests in lassitude of spirit and lack of strength.
• Urine: The bladder’s ability to retain urine is dependent on the kidney’s storage function. If bladder retention fails, the signs are frequent voidings of clear urine, dribbling after voiding, enuresis, or urinary incontinence. Frequent voidings of clear urine means that urine is clear, but not necessarily more copious than normal (increased volume would indicate yáng vacuity). However, more rarely, the urine is murky and white like the water in which rice has been washed. This is called white turbidity.
• Men: If the essence gate becomes insecure, this results in premature ejaculation, seminal emission, or seminal efflux.
• Women: If the thoroughfare (chōng) and controlling (rèn) vessels become insecure, the signs are persistent dribbling menstrual flow, clear thin vaginal discharge, and, in pregnancy, stirring fetus (movement of the fetus with pain and sagging sensation in the abdomen), fetal spotting, and a tendency to miscarriage.
• Stool: Severe impairment of the kidney’s function of governing storage, there may be anal retention failure manifesting in fecal incontinence and incessant efflux diarrhea (diarrhea with incontinence and culminating in prolapse of the rectum). This is because the kidney’s storage function is partly responsible for the retention power of the anus.
• Tongue: Pale with white fur.
• Pulse: Sunken and weak.

Treatment

Medicinal therapy: Secure the kidney and astringe essence. Combine general qì-supplementing medicinals with medicinals that astringe essence and check enuresis such as Cherokee rose fruit (Rosae Laevigatae Fructus, 金樱子 jīn yīng zǐ), euryale (Euryales Semen, 芡实 qiàn shí), dragon bone (Mastodi Ossis Fossilia, 龙骨 lóng gǔ), oyster shell (Ostreae Concha, 牡蛎 mǔ lì), tribulus (Tribuli Fructus, 刺蒺藜 cì jí lí), lotus stamen (Nelumbinis Stamen, 莲须 lián xū), dioscorea (Dioscoreae Rhizoma, 山药 shān yào), and mantis egg-case (Mantidis Oötheca, 桑螵蛸 sāng piāo xiāo). Use Golden Lock Essence-Securing Pill (金锁固精丸 jīn suǒ gù jīng wán) to treat seminal emission, and Stream-Reducing Pill (缩泉丸 suō quán wán) to treat copious urine with frequent urination, and urinary incontinence in the aged. Use Mantis Egg-Case Powder (桑螵蛸散 sāng piāo xiāo sǎn) for enuresis in children.

Acumoxatherapy: Base treatment mainly on KI, CV, and back transport points. Select CV-4 (Pass Head, 关元 guān yuán), BL-23 (Kidney Transport, 肾俞 shèn shù), BL-52 (Will Chamber, 志室 zhì shì), KI-3 (Great Ravine, 太溪 tài xī), KI-7 (Recover Flow, 复溜 fù liū), GV-4 (Life Gate, 命门 mìng mén), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), and ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ); needle with supplementation and moxa.

Point selection according to signs: For enuresis, add CV-3 (Central Pole, 中极 zhōng jí) and BL-28 (Bladder Transport, 膀胱俞 páng guāng shù). For dribbling urination, add BL-20 (Spleen Transport, 脾俞 pí shù), BL-28 (Bladder Transport, 膀胱俞 páng guāng shù), CV-3 (Central Pole, 中极 zhōng jí), and SP-9 (Yīn Mound Spring, 阴陵泉 yīn líng quán). For seminal emission, add BL-15 (Heart Transport, 心俞 xīn shù), PC-6 (Inner Pass, 内关 nèi guān), and HT-7 (Spirit Gate, 神门 shén mén). For seminal efflux, add CV-3 (Central Pole, 中极 zhōng jí), CV-2 (Curved Bone, 曲骨 qū gǔ), and KI-12 (Great Manifestation, 大赫 dà hè).