Kidney yáng vacuity

Also:

• Debilitation of the life gate fire (命门火衰 mìng mén huǒ shuāi), usually referring to severe conditions.
• Insufficiency of the life fire (命火不足 mìng huǒ bù zú), usually not referring to severe conditions
• Exhaustion of the lower origin (下元虚惫 xià yuán xū bèi )

A disease pattern chiefly characterized by cold aching lumbus and knees; reduced sexual function; profuse urination at night; vacuity cold signs.

Description: Dizzy head and vision; bright-white or soot black facial complexion; cold aching lumbus and knees; fear of cold and cold limbs (especially the legs); lassitude of spirit and lack of strength; poor libido; in men, impotence, premature ejaculation, seminal cold, and male infertility; in women, infertility attributable to uterine cold; and copious clear thin vaginal discharge; enduring incessant diarrhea, grain failing to transform, fifth watch diarrhea or, in some cases, cold constipation; frequent urination, long voidings of clear urine, frequent urination, profuse urination at night; pale tongue with white fur; a pulse that is sunken, fine, and forceless. A variant pattern is kidney vacuity water flood.

Diseases: Vacuity taxation; impotence; seminal cold; dribbling urinary block, water swelling; diarrhea; vaginal discharge; lumbar pain.

Pathogenesis: Insufficiency of kidney yáng making it incapable of performing its warming and qì transformation functions. Factors include:

• constitutional weakness or general debilitation attributable to advancing age;
• damage to kidney yáng by sexual intemperance or enduring illness;
• spleen or heart yáng vacuity affecting the kidney.

Analysis of signs

• Cold: When kidney yáng is insufficient, it cannot restrain yīn, and so cold arises internally. Cold signs include cold aching lumbus and knees, physical cold, and cold limbs. In some cases, congealing cold can cause the stool to bind, giving rise to cold constipation.
• Men: Poor libido, impotence, and seminal cold causing male infertility all due to vacuity cold; premature ejaculation due to reduced retentive function of yáng qì.
• Women: Poor libido, uterine cold causing female infertility, and copious clear thin vaginal discharge. These signs are all attributed to vacuity cold.
• Fire failing to engender earth: When kidney yáng vacuity deprives the spleen of warmth, there is enduring incessant diarrhea, grain failing to transform, fifth watch diarrhea. Less commonly, spleen-kidney yáng vacuity reduces large intestine conveyance and transformation to cause constipation.
• Qì transformation: When insufficiency of yáng qì affects production and storage of urine (a function often referred to by the term qì transformation), there may be long voidings of clear urine and profuse urination at night.
• Spirit: Lassitude of spirit and lack of strength reflect the insufficiency of yáng qì.
• Complexion: Weak qì and blood flow shows in the face as a bright-white complexion. In more severe cases, exuberant internal yīn cold is reflected in a soot-black complexion. Remember, black is the color associated with the water phase.
• Tongue: Pale and enlarged with white fur.
• Pulse: Sunken and weak, reflecting the reduced power of yáng qì.

Variant: Kidney vacuity water flood, also called yáng vacuity water flood, is a variant pattern caused by impairment of the kidney’s qì transformation function. It manifests as puffy swelling (yīn water) most pronounced below the waist and sometimes spreading to the whole body. The swelling engulfs the fingers when pressed and does not rebound immediately when pressure is released, indicating that the swelling forms a vacuity pattern. This is accompanied by short voidings of scant urine and in some cases abdominal distension and fullness.

Kidney vacuity water flood can also manifest as water-cold shooting into the lung marked cough, panting, and phlegm rale or as water qì intimidating the heart marked by heart palpitation. See heart-kidney yáng vacuity.

Treatment

Medicinal therapy: Boosting the source of fire to eliminate the shroud of yīn is the method used to treat kidney yáng vacuity. Commonly used are medicinals that warm and supplement kidney yáng, such as aconite (Aconiti Radix Lateralis Praeparata, 附子 fù zǐ), cinnamon bark (Cinnamomi Cortex, 肉桂 ròu guì), fenugreek (Trigonellae Semen, 胡芦巴 hú lú bā), psoralea (Psoraleae Fructus, 补骨脂 bǔ gǔ zhī), alpinia (Alpiniae Oxyphyllae Fructus, 益智仁 yì zhì rén), curculigo (Curculiginis Rhizoma, 仙茅 xiān máo), and epimedium (Epimedii Herba, 淫羊藿 yín yáng huò). Formulas include Cinnamon Bark and Aconite Eight-Ingredient Pill (桂附八味丸 guì fù bā wèi wán), which warms the lower burner and is used for general kidney yáng vacuity. Spleen-kidney yáng vacuity presenting with enduring, clear-grain, or early morning diarrhea may be treated with Four Spirits Pill (四神丸 sì shén wán) and variations, which warm and supplement the spleen and kidney.

• Where water swelling is pronounced, True Warrior Decoction (真武汤 zhēn wǔ tāng) or Life Saver Kidney Qì Pill (济生肾气丸 jì shēng shèn qì wán) may be used to warm yáng and disinhibit water. Qì absorption failure may be treated with combinations including such formulas as Ginseng with Gecko Powder (参蚧散 shēn jiè sǎn) or Galenite Elixir (黑锡丹 hēi xí dān), which warm the kidney and promote qì absorption.
• Impending desertion due to heart-kidney yáng debilitation should be treated with such yáng-returning desertion-stemming formulas as Ginseng and Aconite Decoction (参附汤 shēn fù tāng).
• Kidney yáng vacuity occurring in combination with insufficiency of essence-blood may be treated according to the principle that the essence promotes qì formation; use formulas that replenish essence and supplement the kidney, such as Right-Restoring [Life Gate] Pill (右归丸 yòu guī wán).

Acumoxatherapy: Moxibustion at GV-4 (Life Gate, 命门 mìng mén), BL-23 (Kidney Transport, 肾俞 shèn shù), CV-4 (Pass Head, 关元 guān yuán), KI-3 (Great Ravine, 太溪 tài xī), and ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ) helps supplement kidney yáng. At SP-9 (Yīn Mound Spring, 阴陵泉 yīn líng quán) and CV-9 (Water Divide, 水分 shuǐ fēn) it will disinhibit water, where severe water swelling is present.

• Spleen-kidney yáng vacuity with cold diarrhea calls for the addition of points such as BL-20 (Spleen Transport, 脾俞 pí shù)^mx, SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo)^mx, BL-25 (Large Intestine Transport, 大肠俞 dà cháng shù)^mx, and ST-25 (Celestial Pivot, 天枢 tiān shū)^mx to supplement the spleen and large intestine.
• Heart-kidney yáng vacuity may be treated with the back transport point of the heart, BL-15 (Heart Transport, 心俞 xīn shù)^mx, which will supplement the heart, and points such as HT-7 (Spirit Gate, 神门 shén mén) and PC-6 (Inner Pass, 内关 nèi guān), which quiet the spirit and heart respectively.

Combined patterns

• Heart-kidney yáng vacuity, characterized by heart palpitation or fearful throbbing, puffy swelling and scant urine, with vacuity cold signs. Heart yáng vacuity is often attributable to kidney yáng vacuity.
• Spleen-kidney yáng vacuity, characterized by cold pain in the lumbus and abdomen, clear-grain diarrhea (diarrhea with stool containing undigested food), fifth-watch diarrhea (diarrhea heralded by pain just before dawn), and puffy swelling, with vacuity cold signs. Spleen yáng vacuity is often attributable to kidney yáng vacuity (kidney yáng depriving the spleen of warmth).

Further developments: Dual vacuity of yīn and yáng with inner body vacuity heat and outer body vacuity cold.