Class 2: Kidney disorder: Urinary disturbance (Lin), Retention of

Urine

Xianhui Li

Edema

• Subcutaneous retention of fluid which leads to puffiness of the head, face, eyelids, limbs, abdomen and even the whole body is called edema.

Etiology

• Exterior wind and dampness

• Diet

• Overwork

• Excessive sexual activity

• Fire-poison from sores or carbuncles

Pathogenesis

• Yang edema

• Yin edema

The main points that promote the transformation, transportation and

excretion of fluids• Du26 shui gou: this point promotes the transformation of fluids in

the upper burner, for edema of face and hands• Ren9 shui fen: this point can be used as a general point to promote

the transformation of fluids anywhere in the body• Ren5 shi men: this is the front mu point of triple energizer and it

promotes the transformation and excretion of fluids in the lower burner, essential in edema of the lower burner

• ST28 shui dao: this is an essential point to promote the transformation and excretion of fluids in the lower burner

• Ren17 shan zhong: it stimulates the diffusing and transformation of fluids in the upper burner

• Ren6 qi hai: it promotes the transformation of fluids in the lower burner by activating qi

• UB22 san jiao shu: back shu point of the san jiao. It promotes the transformation and excretion of fluids in the lower burner

The main points that promote the transformation, transportation and

excretion of fluids (continued)• LU7 lie que: it makes lung qi descend and diffuse and it

promotes the diffusing and transformation of fluids in the upper burner in lung pathology, for edema of face and hands

• SP6 and SP9: both these points stimulate the transformation and excretion of fluids in the middle and lower burner, essential in spleen pathology

• KI7 fu liu: promotes the transformation and excretion of fluids in the lower burner, essential in kidney pathology

• UB13, UB20 and UB23: these are the back shu point of the lung, spleen and kidneys. They are used to tonify the lungs, spleen or kidneys in chronic yin edema

Pattern identification

• Yang edema– Wind water invading the defensive qi portion– Fire poison affecting the Lung and Spleen– Accumulation of dampness– Accumulation of damp-heat

• Yin edema– Spleen Yang deficiency– Kidney Yang deficiency

Wind water invading the defensive qi portion

• Clinical manifestations: – edema of eyes and face with sudden onset, aversion to cold, fever, aches in

muscles, retention of urine. Light red tongue, thin white or thin yellow coat. Floating pulse.

• Treatment principle: – Release the exterior, expel wind, open water passage, stimulate the lung’s

dispersing of fluids• Acupuncture LI4, TB5 wai guan, LU7 lie que, BL12 feng men, BL13 fei

shu, DU26 ren zhong, ST36, LI6 pian li– LI4 yuan point of LI, LU7 luo point of LU, TB5 luo point of TB, BL12 and BL13

release the exterior, expel wind and restore the lung’s dispersing and descending function.

– Du26 promotes the transformation of fluids in the upper burner, for edema of face and hands

– ST36 tonify the spleen and harmonizes nutritive and defensive qi and removes fluids from the space between skin and muscles

– LI6, luo point of LI, opens the water passages and resolves acute edema of the upper limbs and face

• Herbal treatment: yue bi jia zhu tang

Fire poison affecting the Lung and Spleen

• Clinical manifestations: – edema of any part of the body, sores, carbuncles or furuncles, red

tongue, thick yellow coating. Rapid pulse• Treatment principle:

– Clear fire poison and drain dampness• Acupuncture Ren12 zhong wan, BL20, BL22, Ren9 shui fen,

ST28 shui dao, LI11, LU7, BL13, SP9, local points– Ren12 and BL20 tonify the spleen to resolve dampness and edema– Ren9, ST28 and BL22 promote the transformation of fluids and

resolve edema– SP9 resolves dampness– LU7 stimulates the lung’s diffusing of fluids– BL13 tonifies lung qi– LI11 resolves toxic heat

• Herbal treatment: ma huang lian qiao chi xiao dou tang and wu wei xiao du yin

Accumulation of dampness• Clinical manifestations:

– edema, scanty urination, heavy body, poor appetite, oppression of the chest, sticky white tongue coating, slippery pulse

• Treatment principle: – resolve dampness and strengthen spleen

• Acupuncture Ren12, BL20, BL21, ST36, Ren9, ST28, Ren6, SP6, SP9, BL22, BL39 wei yang

– Ren12, BL20, BL21 and ST36 tonify stomach and spleen– Ren9 and ST28 resolves edema– Ren6 with moxa, tonifies and moves yang qi, which will help to move

and transform fluids and resolve edema– SP6 and SP9 resolves dampness– BL22 stimulates the transformation and excretion of fluids in the

lower burner– BL39 lower he sea point of san jiao, opens the water passages in the

lower burner, stimulates the transformation and excretion of fluids in the lower burner

• Herbal treatment: wu ling san and wei ling tang

Accumulation of damp-heat• Clinical manifestations:

– edema, scanty dark urination, heavy body, oppression of the chest, sticky yellow tongue coating, slippery rapid pulse

• Treatment principle: – Clear heat and resolve dampness

• Acupuncture Ren12, Ren9, ST28, SP6, SP9, BL22, LI11, BL39– LI11 solves damp heat– SP6 and SP9 resolves damp heat from the lower burner– Ren9 promotes the transformation of fluids and the separation of

clear from turbid. It resolves edema– ST28 promotes the transformation of fluids in the lower burner and

resolves edema– BL22 promotes the transformation and excretion of fluids in the lower

burner– BL39 lower he sea point of san jiao, opens the water passages in the

lower burner, stimulates the transformation and excretion of fluids in the lower burner

• Herbal treatment: shu zao yin zi, ting li da zao xie fei tang

Spleen Yang deficiency• Clinical manifestations:

– edema of the abdomen and/or legs, feeling of oppression of the chest and abdomen, loose stools, poor appetite, fatigue. Pale swollen tongue with teeth-marks, weak fine pulse.

• Treatment principle: – tonify spleen and resolve dampness

• Acupuncture Ren12, BL20, BL21, ST36, Ren9, ST28, Ren6, SP6, SP9, BL22

– Ren12, BL20, BL21 and ST36 tonify stomach and spleen– Ren9 and ST28 resolves edema– Ren6 with moxa, tonifies and moves yang qi, which will help to move

and transform fluids and resolve edema– SP6 and SP9 resolves dampness– BL22 stimulates the transformation and excretion of fluids in the

lower burner• Herbal treatment: shi pi yin

Kidney Yang deficiency

• Clinical manifestations: – edema of the whole body or legs, sore back and knees, feeling cold

especially in the back and legs, scanty or profuse urination, fatigue, pale or bright-white complexion, pale swollen tongue with teeth marks. Deep weak pulse.

• Treatment principle: – tonify kidney and resolve dampness

• Acupuncture Ren 4, BL23, BL20, ST36, KI7, BL22, ST28– Ren4 with moxa, tonifies kidney yang– BL23 and KI7 tonifies kidney yang– BL20 and ST36 tonify the spleen, in edema form kidney yang

deficiency. In edema from kidney-yang deficiency it is essentila to tonify the spleen as well

– BL22 and ST28 resolve edema• Herbal treatment: ji sheng shen qi wan and zhen wu tang

Nocturnal Enuresis

• Nocturnal enuresis is referred to involuntary discharge of the urine occurring at night and during sleep. As a morbid condition, it is mostly seen in children over the age of three years and occasionally in adults.

Etiology

• Kidney Qi deficiency

Kidney Qi deficiency

• Main Manifestations– Involuntary micturition during sleep, once in several nights in

mild cases, or several times a night in severe cases. Sallow complexion, loss of appetite, pale tongue, thin white coat, thin pulse weak at the chi region.

• Treatment principle:– Strengthen kidney and reinforce Qi

• Acupuncture Treatment: BL23 shen shu, BL28 pang guang shu, Ren3 zhong ji, SP6 san yin jiao– BL23, BL28 and Ren3, back shu points of the kidney and

bladder, front mu point of the bladder, this three points contribute to reinforce the kidney qi and the restrain function

– SP6 is added to adjust the qi of the three yin meridians• Herbal treatment: suo quan wan

Urinary Disturbance

• Painful-urination syndrome, called Lin in Chinese, refers to a condition of urinary dysfunction characterized by frequency of urination, pain, scanty urine, urgency and difficulty.

• Includes the western medical conditions of acute and chronic urinary infection, bladder or kidney stones, acute and chronic prostatitis and chyluria

Etiology

• Invasion of exterior damp heat

• Improper diet

• Emotional stress

• Indulgent sexual activities

Pathogenesis• Heat Lin

– Full type: full heat– Empty type: empty heat

• Stone Lin– Full type

• Qi Lin– Full type: stagnation of qi– Empty type: qi deficiency or qi sinking

• Blood Lin– Full type: blood heat– Empty type: blood or qi deficiency

• Sticky (Cloudy) Lin – Full type: dampness– Empty type: dampness with qi deficiency

Heat Lin• Clinical manifestations:

– frequent, scanty and difficult urination, burning pain on urination, dark urine with a strong smell, bitter taste in the mouth, pain on the sacrum, constipation, thirst. Red tongue, yellow sticky coating, rapid slippery pulse.

• Treatment principle: – Clear heat, drain dampness, and open the water passages

• Acupuncture Treatment: Ren3 zhong ji, BL28 pang guang shu, BL22 sanjiaoshu, BL39 weiyang, ST28 shuidao, SP9 yinlingquan, SP6 sanyinjiao, Du14 dazhui, LI11 qu chi

– Ren3 and BL28 clear heat and drain dampness from the bladder– BL22 drain dampness from the lower burner– ST28 and SP9 drain dampness from the lower burner– SP6 clears heat and cools blood, drains dampness from the lower burner and

calms the spirit– DU14 and LI11 clear heat– BL39 lower he sea point of san jiao, opens the water passages in the lower

burner, stimulates the transformation and excretion of fluids in the lower burner• Herbal treatment: ba zheng san

Stone Lin• Clinical manifestations:

– stone or sand in the urine, difficult urination which may stop suddenly, sacral pain, blood in urine, red tongue with thick-sticky coating. Rapid, wiry pulse.

• Treatment principle: – Open the water passages and expel the stones

• Acupuncture Treatment: Ren3, BL28, BL22, BL39, SP9, ST28, Ren6– Ren3 and BL28 clear heat and drain dampness from the bladder– BL22 drain dampness from the lower burner– ST28 and SP9 drain dampness from the lower burner– BL39 lower he sea point of san jiao, opens the water passages in the

lower burner, stimulates the transformation and excretion of fluids in the lower burner

– Ren6 moves qi in the lower burner, moving qi helps to transform fluids and drain dampness

• Herbal treatment: shi wei san

Qi Lin• Clinical manifestations:

– Full type: difficult and painful urination, hypochondrium pain and distension, irritability, wiry and deep pulse.

– Empty type: difficult urination, weak constitution, tiredness, pale tongue, week pulse

• Treatment principle:– Full type: move qi, eliminate stagnation, open the water passage– Empty type: tonify and raise qi, open the water passage

• Acupuncture Treatment Ren3, BL28, BL22, BL39, SP9, ST28, SP6– Ren3 and BL28 clear heat and drain dampness from the bladder– BL22 drain dampness from the lower burner– ST28 and SP9 drain dampness from the lower burner– SP6 drains dampness from the middle and lower burner and calms the spirit– BL39 lower he sea point of san jiao, opens the water passages in the lower

burner, stimulates the transformation and excretion of fluids in the lower burner– For liver qi stagnation: LIV3, LIV5– For Qi deficiency: ST36, Ren6

• Herbal treatment: chen xiang san or bu zhong yi qi tang

Blood Lin• Clinical manifestations:

– Full type: difficult urination, burning pain on urination, blood in the urine which could take the form of small clots, mental restlessness, red tongue and rapid pulse.

– Empty type: blood in urine, slight pain on urination, low back pain, 5-palms heat, hot flushes. Red tongue without coating, thin rapid pulse.

• Treatment principle:– Full type: Clear heat, cool blood, stop bleeding and open the water passage– Empty type: nourish yin, clear heat, stop bleeding and open the water passage

• Acupuncture Treatment: Ren3, BL28, BL22, BL39, ST28, SP9, SP6, SP10, BL17,

– Ren3 and BL28 clear heat and drain dampness from the bladder– BL22 drain dampness from the lower burner– ST28 and SP9 drain dampness from the lower burner– SP6 clears heat and cools blood, drains dampness from the middle and lower

burner and calms the spirit– BL39 lower he sea point of san jiao, opens the water passages in the lower

burner, stimulates the transformation and excretion of fluids in the lower burner – SP10 and BL17 tonify the blood and cool the blood– Full type: DU14, LI11– Empty type: KID2, Ren4, KI6, KID3

• Herbal treatment: xiao ji yin zi or zhi bai di huang tang

Cloudy Lin• Clinical manifestations:

– Full type: turbid or cloudy urine like rice soup, difficult urination, a sticky tongue coating and a slippery pulse

– Empty type: turbid or cloudy urine like rice soup, slight difficult urination, tiredness, dizziness, lower back pain, pale tongue with sticky tongue coating and a weak pulse

• Treatment principle:– Full type: drain dampness, separate the clear from the turbid, open the water

passages– Empty type: tonify qi, strengthen kidneys, separate the clear from the turbid,

open the water passages• Acupuncture Treatment: Ren3, BL28, BL22, BL39, ST28, SP9, SP6

– Ren3 and BL28 clear heat and drain dampness from the bladder– BL22 drain dampness from the lower burner– ST28 and SP9 drain dampness from the lower burner– SP6 drains dampness from the middle and lower burner and calms the spirit– BL39 lower he sea point of san jiao, opens the water passages in the lower

burner, stimulates the transformation and excretion of fluids in the lower burner– For kidney Qi deficiency: ST36, Ren 6, KI3, KI6

• Herbal treatment: cheng shi bi xie fen qing yin or gao lin tang

Retention of Urine

• Retention of urine is a disease manifested by difficult urination, distending pain in the lower abdomen and even blockage of urine.

• The mild case refers to difficulty in urination and dripping of urine

• The severe case refers to failure in urination with distension and feeling of urgency.

Etiology and pathogenesis

• Exterior or interior heat

• Kidney deficiency

• Traumatic injury or surgical operation

Pattern identification

• Accumulation of heat in the bladder

• Decline of Mingmen fire

• Damage of the qi of the meridian

Accumulation of heat in the bladder

• Clinical manifestations: – Scanty hot urine or retention of urine, distension and fullness of the

lower abdomen, thirst but with no desire to drink, constipation, red tongue with yellow coating, rapid pulse.

• Treatment principle: – clear heat and promote urination

• Acupuncture: BL28, Ren3, BL39, BL22, SP6, LI11, DU14– BL28 and Ren3, back shu point and front mu point of the bladder, both

can reduce heat from the bladder and adjust its function– SP6 can dispel heat from the lower jiao and drain dampness from the

middle and lower burner– BL22, back shu point of sanjiao, drain dampness from the lower burner– BL39: lower he sea point of san jiao, opens the water passages in the

lower burner, stimulates the transformation and excretion of fluids in the lower burner

– LI11 and Du14 clear heat• Herbal treatment: ba zheng san or dao chi san

Decline of Mingmen fire• Clinical manifestations:

– Dribbling urination, weakness of the loins and knees, cold limbs, listlessness, pale tongue with teeth marks, deep thin weak pulse.

• Treatment principle: – Warm kidney yang and facilitate urination

• Acupuncture: BL28, Ren3, BL39, BL22, SP6, DU20, Ren4, BL23, Ren6, DU4, KI 3, KI6, KI7

– BL28 and Ren3, back shu point and front mu point of the bladder, both can reduce heat from the bladder and adjust its function

– SP6 can dispel heat from the lower jiao and drain dampness from the middle and lower burner

– BL22, back shu point of sanjiao, drain dampness from the lower burner– BL39: lower he sea point of san jiao, opens the water passages in the lower

burner, stimulates the transformation and excretion of fluids in the lower burner– BL23, Ren6, BL23, DU4 tonify kidney yang – Moxa to Ren4 and Du20 can ingorate kidney qi, – KI 3, KI6, KI7 tonify kidney

• Herbal treatment: ji sheng shen qi wan

Damage of the qi of the meridian

• Clinical manifestations: – Dribbling urination or retention of urine, distension and pain in the lower

abdomen, purple tongue with spots, wiry pulse.• Treatment principle:

– Promote the circulation of qi and facilitate urination• Acupuncture: BL28, Ren3, BL39, BL22, SP6, ST28 shui dao, KI5 shui

quan– BL28 and Ren3, back shu point and front mu point of the bladder, both can

reduce heat from the bladder and adjust its function– SP6 can dispel heat from the lower jiao and drain dampness from the middle and

lower burner– BL22, back shu point of sanjiao, drain dampness from the lower burner– BL39: lower he sea point of san jiao, opens the water passages in the lower

burner, stimulates the transformation and excretion of fluids in the lower burner– KI5 xi cleft point of the kidney combine with ST28 may promote urination and

relieve distension and pain• Herbal treatment: chen xiang san