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Module 5   Lesson 10   Shen zheng

The Kidneys: all patterns

The Kidneys only fall ill through deficiency: how then can water overflow or Heat blaze, and which finding shows the way between the Kidney patterns?

After this lesson you know the five deficiencies, the two deficiencies with something on top and the four combinations of ch. 37, with signs, tongue, pulse, cause and principle, and you can separate them by urine, breathing, tongue and the side where the Heat or the Cold sits. Patterns 11, 12 and 14 from module 1 stay exactly as they were.

YIN SIDE: dry and warm YANG SIDE: cold and wet Kidney-Qi: holding Qi not firm the gates leak Qi not received breath does not land Empty-Heat blazing Yin empty, fire rises Water overflowing Yang empty, water rises 11 Kidney-Yin xu the Water runs out 12 Kidney-Yang xu the Fire goes out Ming Men rooted in each other Kidney-Essence xu reserve; not warm, not cold + Heat + Water 14 with Heart with Liver-Yin with Lung-Yin with Spleen-Yang
Schematic; xu is the Chinese for deficiency. Fill: blue deficiency, white with a dotted border deficiency with something on top, grey a combination with another organ; border: blue Cold, red Heat. Arranged after ch. 37: deficiency p. 625, combined deficiency and excess p. 635, combined p. 640. Ming Men: ch. 4 p. 76.

Know by heart

  • Five deficiencies. Yang (12), Yin (11), Qi not firm, failing to receive Qi, Essence. mnemonic: cold, warm, leaks, gasps, ages.
  • 11 and 12 (module 1). 11: night sweats, weak lower back; red without coating; thin-rapid; nourish Kidney-Yin. 12: cold lower back, nocturia; pale, wet, swollen; deep and weak at Chi; warm Kidney-Yang.
  • Two Qi deficiencies. Qi not firm: dribbling, leaking, seminal loss; pale; deep, weak; tonify and consolidate Kidney-Qi. Failing to receive Qi: short of breath, the in-breath does not land; pale; deep, weak; tonify the Kidneys so that they receive Qi.
  • Essence. Early greying, loose teeth, poor memory, reduced fertility; in children slow development. No clear Heat or Cold; tongue and pulse follow the side that falls shortest; nourish Essence.
  • Deficiency with something on top (p. 635). Water overflowing: oedema with scanty urine; pale, swollen, wet; deep, weak, slow; warm Yang, resolve Water. Empty-Heat blazing: malar flush, heat in the afternoon, restlessness; red, without coating, cracked; floating-empty and rapid; nourish Yin, clear Empty-Heat. mnemonic: empty Yang, water rises; empty Yin, fire rises.
  • Four combinations. Heart (14: waking in the night, redder tip), Liver (dry eyes, dizziness), Lungs (dry cough), all three Yin; Spleen (early-morning diarrhoea, oedema), Yang. mnemonic: Yin three times upwards, Yang once to the Middle.
  • Two deciders. Urine: profuse and clear is 12, scanty with oedema is Water overflowing, dark and scanty is Yin. Tongue: wet is Yang, bare is Yin, simply pale is Qi.

The rest of this lesson is reference.

Kidneys: all patterns: The Kidneys only fall ill through deficiency: how then can water overflow or Heat blaze, and which finding shows the way between the Kidney patterns?
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Three practice questions from this lesson

Case. Man, 74: for two weeks, swollen ankles, passes little urine, cold back, feels the cold, and at night breathless when he lies flat; he now sleeps on three pillows. Tongue pale, swollen, wet. What first?
  1. Zhen Wu Tang first for the overflowing Water
  2. Warm Kidney-Yang first; the GP this week
  3. To the GP the same day: this can be heart failure

Answer: To the GP the same day: this can be heart failure. Oedema with breathlessness when lying flat is a red flag: this can be heart failure, so to the GP the same day. The TCM picture fits Kidney-Yang deficiency with Water overflowing, but that comes after the doctor; a formula first or waiting until later in the week is too late.

Case. The same man, months later: his heart failure is being treated and monitored. Still slight oedema of the ankles, scanty urine, cold back, full feeling in the abdomen. Tongue pale, swollen, wet, white coating; pulse deep, weak, slow. Which pattern?
  1. 6 Spleen-Qi deficiency
  2. 12 Kidney-Yang deficiency
  3. Water overflowing

Answer: Water overflowing. Kidney-Yang deficiency, Water overflowing: oedema with scanty urine is in the foreground. In 12 the urine is in fact profuse and clear; 6 has no cold and no Kidney signs.

Which finding best separates 12 from Water overflowing?
  1. The aching lower back
  2. The amount of urine
  3. How much someone feels the cold

Answer: The amount of urine. They share the cold and the lower back. The urine decides: profuse and clear in 12, scanty with oedema in Water overflowing. Whether the water leaves the body or stays behind makes the difference.

The rest of this lesson

In the course you get the step-by-step explanation, 15 case-based practice questions, 20 spaced-repetition flashcards, the pitfalls and the bridge to physiology with evidence grades. This lesson belongs to module 5: Patterns.

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