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Kidney pattern identification

肾病辨证 〔腎病辨證〕shèn bìng biàn zhèng

The process of diagnosing a morbid condition as a disease pattern of the kidney.

Physiological Recap

Kidney governs water: The kidney produces urine and controls its discharge via the bladder.

Kidney stores essence: The essence stored by the kidney responsible for reproduction, growth, and development. Essence is a yīn substance that produces its effects by nourishing original qì.

Kidney governs storage: Kidney qì has four storage functions.

Kidney governs qì absorption: Kidney essential qì helps the downbearing action of the lung that draws air into the body. This is sometimes considered as one of the kidney’s storage functions.

Essence, Qì, Yīn, and Yáng

Kidney essence and qì: The essence stored by the kidney is often called essential qì, because it possesses a relatively substantial aspect (essence) and relatively active aspect (qì). Essence is yīn, while qì is yáng. However, kidney essence and qì do not possess the normal mutually counterbalancing actions of yīn and yáng, because failure to perform their functions does not entail heat or cold; hence they are understood to be distinct from yīn and yáng. Nevertheless, Chinese-language texts do not provide a clear single description of the relationships between the essence, qì, and yīn and yáng of the kidney.

In theory, kidney qì is the qì responsible for all kidney functions. In modern practice, the term refers to the retentive power of the kidney’s general function of storage, that is, retaining urine, semen, and stool, as well as the function of absorbing qì.

Kidney yīn and yáng: Kidney yīn and kidney yáng are the kidney’s yīn humor and yáng qì. Because they are the root of yīn and yáng of the entire body, they are sometimes called true or original yīn and yáng or the life gate fire and life gate water respectively.

Pathomechanical Features

Insufficiency Only

Kidney pathologies only take the form of insufficiency and hence manifest in vacuity patterns only, which are generically referred to as kidney vacuity (肾虚 shèn xū). Although the kidney channel may be affected by cold evil, the kidney itself is susceptible only to insufficiencies.

All forms of kidney vacuity can be caused by congenital insufficiency, acquired nutritional deficiency, enduring illness, sexual intemperance, and natural decline of health in advancing years. Sexual intemperance can damage the yīn, yáng, essence, and qì of the kidney.

Insufficiency of Kidney Essence and Kidney Qì

Kidney essence is understood as the physical basis of reproduction and development. It includes the male and female reproductive essences, which combine to create a new individual. Essence in its active aspect is called essential qì, the force that activates development. From conception, it grows gradually stronger to drive development. When it begins to decline in mid-life, so the aging process sets in.

The term kidney qì is used in two basic senses:

Insufficiency of kidney essence: Kidney essence includes reproductive essence used in procreation. It is closely related to the kidney’s function of governing the bones and engendering marrow in its relationship to the brain (is the sea of marrow), the teeth (surplus of the bone) and the hair (the bloom of the kidney). Furthermore, it is involved in the production of qì and blood. Insufficiency of kidney essence therefore manifests in the following ways:

Insufficiency of kidney qì: When kidney qì is insufficient, its storage or qì absorption function may be affected.

Impaired storage: Impairment of the storage function is called insecurity of kidney qì, which manifests in five possible ways:

Insufficiency of Yīn and Yáng

Kidney yáng is the warming and active aspect of the kidney, which is key to its contribution to water metabolism and to sexual functions. Hence, insufficiency of kidney yáng manifests in urinary signs, poor libido, impotence, and infertility. Kidney yīn is the substantial, nurturing aspect of the kidney, which counterbalances kidney yáng. When it weakens there are signs of heat and hyperactivity of kidney yáng. Since the kidney is the root of the yīn and yáng and the essential qì of the whole body, kidney disease invariably affects other bowels and viscera, and diseases of the other bowels and viscera inevitably take their toll on the kidney.

Insufficiency of kidney yáng manifests in the following signs:

Depletion of kidney yīn manifests in the following signs:

Frenetic Stirring of the Ministerial Fire

A fire in the body inhabiting the life gate, liver, gallbladder, and triple burner, and thought to come from the life gate fire. It stands in complementary opposition to the sovereign fire, which is the heart fire. The sovereign fire and ministerial fire together warm the bowels and viscera and power activity in the body.

Insufficiency of liver-kidney yīn can cause frenetic stirring of ministerial fire (相火妄动 xiàng huǒ wàng dòng), which manifests in dizziness, headache, unclear vision, tinnitus, deafness, irascibility, profuse dreaming, vexing heat in the five hearts, excessive libido, seminal emission with dreaming (dream emission), premature ejaculation, and frequent and persistent erections.

Frenetic stirring of the ministerial fire is effectively liver-kidney yīn vacuity with vacuity fire flaming upward and harassing the heart spirit. Conventionally, the term is used when a sexual component is present.

Note that excessive libido, seminal emission, premature ejaculation, and frequent and persistent erections are also explained in terms of excessive free coursing.

Relationship to Other Bowels and Viscera

Yīn-Yáng, Essence-Blood, Qì Absorption

The kidney stores essence. It is the root of the yīn and yáng of the entire body. It also governs qì absorption. These aspects of kidney function are interrelated with functions of all the other viscera.

Yīn: Insufficiency of kidney yīn can cause, or be caused by, depletion of yīn in other bowels and viscera, especially lung yīn vacuity, heart yīn vacuity, and liver yīn vacuity.

Yáng: Insufficiency of kidney yáng can cause, or be caused by, depletion of yáng qì in the other bowels or viscera, especially spleen yáng vacuity and heart yáng vacuity.

Essence-blood: Essence and blood are of the same source. Hence, insufficiency of kidney essence can cause depletion of liver blood, giving rise to liver-kidney essence-blood vacuity.

Qì absorption: The essential qì of the kidney helps the downbearing action of lung qì to draw air into the lungs. Hence, it is said that the lung governs qì, while the kidney is the root of qì. Insufficiency of kidney essence manifesting in qì absorption failure can cause or be caused by insufficiency of lung qì, the two invariably existing together.

Spleen and Kidney

The spleen and kidney, in their physiological roles, are the root of later and earlier heaven, respectively. Pathological influences between the two manifest in the form of spleen-kidney yáng vacuity.

Spleen kidney yáng vacuity arises when persistent insufficiency of kidney yáng and debilitation of the life gate fire deprives the spleen of warmth or, less commonly, when enduring spleen yáng vacuity affects kidney yáng. It primarily manifests in two ways:

Heart and Kidney

The pathologies involving the heart and kidney are non-interaction of the heart and kidney water qì intimidating the heart.

Noninteraction of the heart and kidney (心神不交 xīn shén bù jiāo): The heart is in the upper burner, belongs to fire, and is yáng in nature. The kidney is in the lower burner, belongs to water, and is yīn in nature. Heart fire descends to the kidney, while kidney yīn ascends to the heart so that the yīn and yáng of the heart and kidney stay in balance. This mechanism is called heart and kidney helping each other. When it breaks down, the pathomechanism is described as fire and water failing to help each other, and the resulting disease pattern is called noninteraction of the heart and kidney.

Noninteraction of the heart and kidney can arise either when kidney yīn is depleted and fails to help the heart or when heart yīn is insufficient and saps kidney yīn (下汲肾阴 xià xī shèn yīn). In either event, heart yīn and kidney yīn are both insufficient and unable to restrain yáng. This manifests in heart palpitation, heart vexation, insomnia, profuse dreaming, limp aching lumbus and knees, dream emission in men, and dreaming of sexual intercourse in women. See noninteraction of the heart and kidney. Compare also the relationship between the liver and kidney below.

Water qì intimidating the heart (水气凌心 shuǐ qì níng xīn): When kidney yáng is insufficient and qì transformation is impaired, this causes yáng vacuity water flood (also called kidney vacuity water flood), which causes water swelling or phlegm-rheum. In some cases, the condition affects the heart so that in addition, heart palpitation is also seen. This is called water qì intimidating the heart. Water qì refers to pervasive surplus fluid in the body.

Lung and Kidney

The lung and kidney both have important functions regarding qì and water. The lung is the governor of qì, while the kidney is the root of qì. The kidney governs water, while the lung is the upper source of water. Pathologies affect both qì and breathing on the one hand and water metabolism on the other. In addition, lung yīn and kidney yīn are both prone to insufficiency and are mutually conducive.

Qì absorption: The lung is in charge of breathing, while the kidney governs qì absorption.

Water metabolism: The lung regulates the waterways, carrying fluid down to the kidney, while the kidney, by its qì transformation action, distills the fluids, draining the turbid fluid off in the form of urine and sending the clear fluid upward back into circulation.

Impairment of either function often affects the other. The resulting condition is usually either water swelling with scant urine or phlegm-rheum. Severe kidney yáng vacuity can result in water-cold shooting into the lung, characterized not only by generalized water swelling but also by panting that prevents the patient from lying down.

Yīn humor: Lung and kidney yīn are mutually dependent. Insufficiency of the one can cause insufficiency of the other.

In either case, the resulting condition is lung-kidney yīn vacuity, characterized by cough, hoarse voice, reddening of the cheeks, steaming bone tidal heat, night sweating, and limp aching lumbus and knees.

Liver and Kidney

Central to pathologies that involve both the liver and kidney are yīn-yáng disharmony, depletion of essence-blood, and disorders of storage and free coursing.

Yīn-yáng disharmony: Insufficiency of kidney yīn can cause insufficiency of liver yīn, creating liver-kidney yīn vacuity. In five-phase parlance, this is called water failing to moisten wood. When insufficiency of kidney yīn leaves liver yáng unrestrained, it gives rise to ascendant hyperactivity of liver yáng. Conversely, insufficiency of liver yīn can sap kidney yīn, thereby also causing liver-kidney yīn vacuity with hyperactive yáng.

Insufficiency of liver-kidney yīn can also cause frenetic stirring of ministerial fire (相火妄动 xiàng huǒ wàng dòng), which manifests in dizziness, headache, unclear vision, tinnitus, deafness, irascibility, profuse dreaming, vexing heat in the five hearts, excessive libido, seminal emission with dreaming (dream emission), premature ejaculation, and frequent and persistent erections. Although the ministerial fire is explained as being the fire of the life gate, liver, gallbladder, and triple burner, frenetic stirring of the ministerial fire in practice refers to liver-kidney yīn vacuity with vacuity fire flaming upward and harassing the heart spirit. However, the term is conventionally used when a sexual component is present.

Depletion of essence-blood: The liver stores blood, while the kidney stores essence. Essence can engender blood, while blood can also engender essence. For this reason, it is said that essence and blood are of the same source. Insufficiency of liver blood can cause depletion of kidney essence and vice versa. In either case, the signs that may appear include deafness, tinnitus, dizzy vision, amenorrhea in women, and scant semen in men.

Storage and free coursing: The liver governs free coursing and the kidney governs storage. The two functions are mutually opposing and complementary. Both affect the thoroughfare (chōng) and controlling (rèn) vessels, which control menstruation, and the essence gate, which controls ejaculation. When free coursing and storage are compromised, there can be menstrual irregularities and abnormalities in the discharge of semen.

Kidney Signs

Kidney signs relate to urine (governance of water), development, reproduction, lumbus and knees, and breathing.

Governance of Water

Disturbances of urination are mostly attributable to insufficiency of kidney yáng’s steaming function causing too much or too little urine to pass to the bladder or to a weakening of the retentive function of kidney qì that results in inability to control discharge of urine. Note that urinary disturbances are also prominent in bladder patterns.

Inhibited urination (小便不利 xiǎo biàn bù lì): Inability to achieve a full stream of urine. It is caused by disturbances in the movement of fluids or urine productionowing to insufficiency of yáng qì of the kidney, lung, and/or spleen. It may also be attributable to damp-heat or to qì stagnation with damp obstruction.

Puffy swelling (浮肿 fú zhǒng): Diffuse swelling of the flesh, most commonly affecting the lower limbs, but sometimes the face and upper limbs. Puffy swelling usually indicates water swelling, described further ahead under Kidney Related Diseases. It may also indicate qì swelling, which is attributable to qì stagnation and water-damp. Puffy swelling is a symptom name. Water swelling and qì swelling are disease names.

Profuse urination at night (夜间多尿 yè jiān duō nail): Called nocturia in biomedicine. Getting up frequently in the night to urinate. It is usually a sign of kidney yáng vacuity.

Frequent urination (小便频数 xiǎo biàn pín shuò): Urination more frequent than normal. It occurs in kidney yáng vacuity and in bladder damp-heat.

Dribble after voiding (尿后余沥 niào hòu yú lì): Failure of voluntary urination to terminate cleanly. It is attributed to insecurity of kidney qì.

Enuresis (遗尿 yí niào): Involuntary loss of urine during sleep; bed-wetting. It is usually attributable to insecurity of kidney qì.

Urinary incontinence (小便失禁 xiǎo biàn shī jìn): Involuntary loss of urine during the day or night. Like enuresis, it is a sign of insecurity of kidney qì but indicates a more severe condition.

Short voidings of reddish urine (小便短赤 xiǎo biàn duǎn chì); short voidings of yellow urine (小便短黄 xiǎo biàn duǎn huáng): Scant urine darker in color than normal. It is attributable to heat causing reduction of the fluids. Mild heat (e.g., vacuity heat) causes the urine to become yellower than normal, while severe heat (repletion heat) causes the urine to assume a deep tea-colored appearance, which is traditionally called reddish. Note that we say reddish rather than red, to avoid confusion with the bright-red coloration observed in bloody urine.

Long voidings of clear urine (小便清长 xiǎo biàn qīng cháng): Urination longer than normal with copious colorless urine. It results from yáng vacuity. This conforms with the maxim that all disease with watery humors that are clear, pure, and cold is ascribed to cold (诸病水液澄澈清冷, 皆属于寒 zhū bìng shuǐ yè chéng chè qīng lěng, jiē shǔ yú hán).

Development

The kidney governs essence; it governs the bones and engenders marrow. The development of the body and the brain in infancy is closely related to the kidney.

Retarded closure of the fontanel gates (囟门迟闭 xìn mén chí bì): Delayed closure of the spaces between the bones of the head in infants. It is attributed to insufficiency of kidney essence.

Retarded development (发育迟缓 fā yù chí huǎn): Delay in growth and development of functions in infants. It results from insufficiency of kidney essence. See five slownesses under Kidney-Related Diseases below.

Reproduction

Problems relating to reproductive functions (impotence, infertility) are most commonly attributable to the kidney. Problems specific to males are associated with insufficiency of kidney essence and kidney yáng vacuity.

Impotence (阳痿 yáng wěi): The inability to achieve or maintain an erection for the complete duration of sexual intercourse. It is mostly associated with kidney yáng vacuity (debilitation of the life gate fire). Impotence is traditionally called yáng wilt; it is now often referred to in modern biomedicine as erectile dysfunction.

Seminal emission (遗精 yí jīng): Loss of semen during the night. When associated with dreaming, it mostly results from frenetic stirring of the ministerial fire (liver-kidney yīn vacuity with vacuity fire flaming upward) with vacuity fire harassing the essence chamber. When unassociated with dreaming, it is usually attributable to insufficiency of kidney qì causing storage failure (insecurity of kidney qì).

Seminal efflux (滑精 huá jīng): Involuntary loss of semen night or day. It is mostly attributed to insecurity of kidney qì.

Premature ejaculation (早泄 zǎo xiè): Inability to withhold ejaculation for long. It is mostly attributable to insufficiency of kidney qì manifesting in storage failure (insecurity of kidney qì). It can also result from kidney yīn vacuity, liver channel damp-heat, dual vacuity of the heart and spleen, or depressed liver qì.

Excessive libido (性欲过强 xìng yù guò qiáng): A greater desire for sex than normal. It results from kidney yīn vacuity with frenetic stirring of the ministerial fire (liver-kidney yīn vacuity with vacuity fire flaming upward).

Poor libido (性欲减退 xìng yù jiǎn tuì): Less desire for sex than normal. It results from kidney yáng vacuity or insufficiency of kidney essence.

Frequent and persistent erections (阳强易举 yáng qiáng yì jǔ): Erections that are more frequent and persistent than usual. They are the result of kidney yīn vacuity with frenetic stirring of the ministerial fire (liver-kidney yīn vacuity with vacuity fire flaming upward).

Scant semen and infertility (精少不育 jīng shǎo bù yǔ): Scant ejaculate resulting inability to produce offspring. It is mostly a sign of insufficiency of kidney essence.

Seminal cold (精冷 jīng lěng): Ejaculate that is cold, scant, and thin. It is mostly attributed to kidney yáng vacuity.

Head, Eyes, and Ears

The kidney opens at the ears and governs the bones and engenders marrow. The brain is the sea of marrow. Hence, depletion of kidney yīn and kidney essence causes hearing problems.

Gradual deafness (渐聋 jiàn lóng) is of slow onset, usually in advancing yearsand can affect one or both ears. It is caused by insufficiency of kidney essence or insecurity of kidney qì. It is contrasted with fulminant deafness, which is mostly attributed to liver-gallbladder fire or other evils in the lesser yáng (shào yáng) channel, which passes around the ear.

Forgetfulness (健忘 jiàn wàng): Poor memory. It arises when kidney essence fails to nourish the sea of marrow or when yīn blood fails to nourish the heart. It occurs in insufficiency of kidney essence and kidney yīn vacuity, as well as in heart blood vacuity.

Loosening of the teeth (齿松 chǐ sōng, 牙齿松动 yá chǐ sōng dòng): Occurs in insufficiency of kidney essence and in kidney yīn vacuity.

Hair loss (发脱 fǎ tuō): Occurs in insufficiency of kidney essence and in liver yīn vacuity.

Breathing

The kidney’s functions of governing qì absorption and governing water can both affect the lung’s action of depurative downbearing.

Vacuity panting (虚喘 xū chuǎn): Inhalation greater than exhalation. It is attributed to the kidney failing to absorb qì (which also involves lung qì vacuity) or to kidney vacuity water flood with water-cold shooting into the lung.

Digestion:

The spleen relies on the warming action of kidney yáng.

Fifth-watch diarrhea (五更泄 wǔ jīng xiè): Also called early morning diarrhea and daybreak diarrhea. Diarrhea during the 5th watch (4–6 a. m.), heralded by pain. It is a sign of spleen-kidney yáng vacuity and accumulation and stagnation of cold-damp.

Lumbus and Knees

The lumbus is the house of the kidney; the kidney governs the bones. The lumbus and the legs are easily affected by kidney vacuity.

Limp aching lumbus and knees (腰膝酸软 yaō xī suān ruǎn); limp aching lumbus and legs (腰腿酸软 yaō tuǐ suān ruǎn): Aching pain and lack of strength in the lower back and in the legs and knees can appear in any kidney pattern. Limpness of the legs and knees can easily be determined by ascertaining whether the patient has difficulty rising from a crouching posture by the strength of the legs alone.

Cold painful lumbus and knees (腰膝冷痛 yaō xī lěng tòng): Cold pain in the lumbus, legs, and knees is a sign of kidney yáng vacuity.

General signs

General signs are mostly related to imbalances of yīn and yáng.

Night sweating (盗汗 dào hàn): Sweating during sleep that ceases upon waking. It is a sign of kidney yīn vacuity.

Vexing heat in the five hearts (五心烦热 wǔ xīn fán rè): Palpable heat in the palms and soles with vexation and heat felt in the center of the chest. It is a sign of kidney yīn vacuity.

Postmeridian tidal heat (午后潮热 gǔ zheng4 chao2 rè): Tidal heat that occurs any time after midday. It is most commonly associated with yīn vacuity, although a heightening of fever from 3–5 p.m., called late afternoon tidal heat is associated with yáng ming2 (yáng ming2) disease. See next.

Steaming bone tidal heat (骨蒸潮热 gǔ zheng4 chao2 rè): Tidal heat that can only be felt on palpation and appears to emanate from the bones; hence the name. It is a sign of kidney yīn vacuity.

Fear of cold and cold limbs (畏寒肢冷 weì hán zhī lěng); physical cold and cold limbs (形寒肢冷 xing2 hán zhī lěng): A chronic subjective feeling of cold with a palpable lack of warmth in the extremities. It is caused by yáng vacuity. Fear of cold should be distinguished from the more severe aversion to cold experienced in external contractions.

Kidney-Related Diseases

Steaming bone, dribbling urinary block, lumbar pain, seminal emission, tinnitus, and deafness, which are traditionally regarded as diseases as well as symptoms, are described under Kidney Signs above. Other kidney-related diseases include the following:

Dribbling urinary block (癃闭 long bì): The reduction of urine to a mere dribble or no urine at all. It corresponds to anuria in biomedicine. In kidney disease, these conditions are usually attributable to insufficiency of kidney yáng and impairment of the opening and closing of the bladder. It may also be attributable to bladder damp-heat, depressed liver qì, or blood stasis.

Water swelling (水肿 shuǐ zhǒng): Puffy swelling of the face, limbs, or whole body without heat, redness, or pain. It results from impairment of the lung’s governance of the waterways, the spleen’s action of warming and transforming water-damp, and the kidney’s function of steaming the fluids. Distinction is made between yīn water and yáng water. Yīn water the more common form and the form mostly commonly involving the kidney.

Water swelling is distinguished from qì swelling, attributed to qì stagnation and water-damp, in which the flesh rebounds immediately after release of pressure. It is also distinguished from toxin swelling, which is localized red, hot, and tender swelling.

Dispersion-thirst (消渴 xiaō ke3): A disease characterized by thirst, increased fluid intake, and copious urine; attributed to disturbances mainly of the spleen-stomach and kidney. Dispersion-thirst is categorized as upper, center, and lower dispersion depending on the focus among the three burners. It corresponds to diabetes mellitus, diabetes insipidus, and hypoadrenocorticism in biomedicine. A traditional threefold distinction is made, although modern internal medicine textbooks make finer differentiations.

Vacuity taxation (虚劳 xū lao2): Any condition of enduring severe vacuity.

Stirring fetus (胎动不安 taī dòng bù ān): Movement of the fetus with pain and sagging sensation in the abdomen and with bleeding via the vagina, which may threaten miscarriage. Stirring fetus is attributed to insecurity of kidney qì, general qì and/or blood vacuity, blood heat, depressed liver qì, or external injury.

Miscarriage (流产 liú chǎn, 小产 xiǎo chǎn, 半产 bàn chǎn, 堕胎 duò taī): Expulsion of a fetus before term after the third month of pregnancy. Miscarriage is attributed to damage to the thoroughfare (chōng) and controlling (ren4) vessels and inability to contain blood and nourish the fetus stemming from dual vacuity of qì and blood, kidney vacuity, blood heat, or external injury. Miscarriage occurring three times or more in a succession is called habitual miscarriage (滑胎 huá taī), which is attributed to depletion of kidney qì or to dual vacuity of qì and blood.

Five slownesses (五迟 wǔ chí): Five kinds of retardation in the development of infants: slowness to stand; slowness to talk; slowness to grow hair; slowness to teethe; and slowness to speak. They are all signs of insufficiency of kidney essence.

Five limpnesses (五软 wǔ ruǎn): Five conditions of softness or of body parts indicating poor development in infants: softness of the skull, limpness of the neck, limpness of the hands and feet, limpness of the flesh, and limpness of the mouth.

Ununited skull (解颅 jie3 lú): Failure of the bones of the head to join together in infants at the normal time. The bones of the skull harden at around the age of sixth months. The anterior fontanel closes at the age of 12–18 months, whereas the posterior fontanel closes at the age of 1–3 months. Delay in these developments is traditionally referred to as ununited skull. It is attributable to insufficiency of kidney essence.

Male infertility (男性不育 nán xìng bù yù): Inability of men to produce offspring. It is mostly attributed to insufficiency of kidney essence or to seminal cold stemming from kidney yáng vacuity.

Female infertility (女性不孕 nu93 xìng bù yun4): Inability of women of childbearing age to become pregnant. It is mostly attributed to uterine cold due to kidney yáng vacuity, kidney yīn vacuity, insufficiency of kidney essence, blood vacuity, qì stagnation and blood stasis, or to phlegm-damp obstruction.

Kidney Patterns

Below is a brief description of the major kidney disease patterns, with links to entries that provide more detail.

Simple Patterns

Kidney yīn vacuity (肾阴虚 shen4 yīn xū): Aching lumbus and knees; seminal emission; scant menstruation; dizziness; tinnitus; yīn vacuity (vacuity heat) signs. It results from enduring illness affecting the kidney; damage to yīn in the advanced states of warm-heat disease; excessive consumption of warm and dry medicinals; sexual intemperance (excessive sexual activity).

Kidney yáng vacuity (肾阳虚 shen4 yáng xū): Cold aching lumbus and knees; poor reproductive functions (impotence, infertility, low libido); profuse urination at night; yáng vacuity (vacuity cold) signs. It results from constitutional yáng vacuity; general debilitation attributable to advancing age; enduring illness damaging yáng (as spleen or heart yáng vacuity affecting the kidney); sexual intemperance (excessive sexual activity).

Kidney vacuity water flood (肾虚水泛 shen4 xū shuǐ fàn): Also called yáng vacuity water flood (阳虚水泛 yáng xū shuǐ fàn). A form of kidney yáng vacuity in which, instead of long voidings of clear urine, there is scant urine and generalized water swelling. In this pattern, water qì accumulates and rises counterflow to affect the heart or lung. When it affects the heart, it is called water qì intimidating the heart (水气凌心 shuǐ qì ling2 xīn), which is marked by heart palpitation, rapid breathing, and a skipping pulse. When it affects the lung, it is called water-cold shooting into the lung (水寒射肺 shuǐ hán shè feì), which is marked by cough, panting, and copious thin white phlegm-rheum.

Insufficiency of kidney essence (肾精不足 shen4 jīng bù zú): Slow development; reduced reproductive capacity; premature aging. Attributed to constitutional insufficiency or debilitation in advancing age, to enduring illness, or to sexual intemperance (excessive sexual activity).

Insecurity of kidney qì (肾气不固 shen4 qì bù gù): Limp aching lumbus and knees; enuresis or urinary incontinence; seminal emission or seminal efflux; vaginal discharge; persistent dribbling menstruation, a tendency toward miscarriage. It results from poor development of kidney essential qì in childhood or debilitation of kidney qì in advancing age; sexual intemperance (excessive sexual activity); or enduring illness.

Kidney failing to absorb qì (肾不纳气 shen4 bù na4 qì): Also called lung-kidney qì vacuity. Panting with exhalation greater than inhalation; limp aching lumbus and knees; and signs of insufficiency of yáng qì. It results from damage to lung qì by cough and panting that eventually affects the kidney; from taxation damage or weak health in advancing years causing depletion of kidney qì that affects the qì absorption function; or from earlier heaven insufficiency or original qì.

Combined Patterns

Noninteraction of the heart and kidney (心肾不交 xīn shen4 bù jiaō): Heart vexation; heart palpitation; insomnia; limp aching lumbus and knees; seminal emission; profuse dreaming; and yīn vacuity signs. It is caused by excessive thought and preoccupation, by damage to yīn through enduring illness, or by sexual intemperance (excessive sexual activity).

Heart-kidney yáng vacuity (心肾阳虚 xīn shen4 yáng xū): Heart palpitation or fearful throbbing; puffy swelling; scant urine; vacuity cold signs. It develops when heart yáng vacuity affects the kidney or when kidney yáng vacuity water flood intimidates the heart. Compare water qì intimidating the heart.

Water qì intimidating the heart (水气凌心 shuǐ qì ling2 xīn): A heart-kidney yáng vacuity pattern (See preceding item), in which the heart is affected by water qì resulting from kidney yáng vacuity. This is a vacuity-repletion complex and is marked by heart palpitation, rapid breathing, and a skipping pulse.

Water-cold shooting into the lung (水寒射肺 shuǐ hán shè feì): A vacuity-repletion complex in which the lung is affected by water qì resulting from kidney yáng vacuity. It is marked by cough, panting, and copious thin white phlegm-rheum.

Lung-kidney yīn vacuity (肺肾阴虚 feì shen4 yīn xū): Dry cough with scant phlegm; hoarse voice; seminal emission; menstrual irregularities; vacuity heat signs. It develops when enduring cough damages the lung and lung vacuity affects the kidney or when, in vacuity taxation, kidney disease affects the lung.

Spleen-kidney yáng vacuity (脾肾阳虚 pí shen4 yáng xū): Cold pain in the lumbus and abdomen; clear-grain diarrhea; fifth-watch diarrhea; puffy swelling; vacuity cold signs. It arises when, in enduring diarrhea or dysentery, disease of the spleen affects the kidney or when, in kidney vacuity water flood, disease of the kidney affects the spleen.

Liver-kidney yīn vacuity (肝肾阴虚 gān shen4 yīn xū): Dizziness; tinnitus; limp aching lumbus and knees; rib-side pain; insomnia; vacuity heat signs. It is caused by enduring illness damaging yīn humor; affect-mind causing internal damage and formation of fire that damages yīn; sexual intemperance (excessive sexual activity) damaging kidney yīn; advanced-stage warm-heat disease that damages the fluids. Kidney yīn depletion affecting liver yīn is described as water failing to moisten wood.

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