Understanding Kidney Yin and Kidney Yang.

bbsadmin

Dear Dr. King,

I read a couple of posts in Medboo Forum on the discussion of kidneys in traditional Chinese medicine. On base of this I tried to look at the real cases of chronic renal failure which I treated. I chose two cases with different etiology and pathogenesis. It is interesting that both of these patients in childhood and in youth suffer from diseases of Lung (pneumonias, psoriasis).
In first case in addition to symptoms of kidney deficiency there were signs of spleen deficiency. In second one – signs of liver pathology.
But for each of these patients I can’t neatly divide between kidney yang and kidney yin deficiency. So or there are cases of combined kidney yang and kidney yin deficiency or I incorrectly estimate theirs symptoms.
It would be very interesting and helpful to know your opinion.

Patient O.G., 51 y., male.
Most likely: yang deficiency in the kidney and spleen.

He suffers from chronic renal failure, diagnosed before 1 year. Obtain dialysis during last two weeks.
Patient complaints: lassitude, heavy sensation in the limbs.
Comorbidities: hypertension during 10 years, diabetes during 5 years, psoriasis during 30 years. Preceding diseases: in childhood – pneumonias.
Additional observations:
1) this patient have family story of chronic renal failure, his mother died after 7 years of dialysis.
2) pain in the left hypochondrium immediately after dialysis.
He has signs of kidney yang deficiency: difficulty in urination (urination only two times in a day less than 250 ml each time), general edema, the tongue is bulky, moist, and covered with white fur, the pulse is weak and deep.
On the other hand he has signs of kidney yin deficiency: weakness of the lumbar regions and knees, dizziness, a hot sensation in the soles.

Patient Sh.I., 51 y., female.
Most likely: yin deficiency in kidney and liver.

She suffers from chronic renal failure, diagnosed before 2 years.
Patient complaints: itch on the lateral side of the upper limbs during 4 years; cough in cases of physical exertion or after salty food; in blood test greatly raised liver enzymes.
Comorbidities: hypertension during 8 years; the scanty menstrual flow.
Preceding diseases: tonsillitis from childhood nearly once in a month; at the age of ten she was ill with rheumatism caused complication on mitral valve; in youth – pneumonias.
Present state was provoked by diet to lose weight (she lost 12 kg from 61 kg during 6 month).
Additional observations:
1) during 35 years (!) from age 10 she obtained antiphlogistic medicines for prophylactic (!).
2) great number of yellow spots on the iris.
She has signs of kidney yin deficiency: a dry mouth and throat, the pulse is thready and rapid,
On the other hand she has signs of kidney yang deficiency: cold limbs, tongue is pale, bulky, moist, and covered with white fur.
It is possible that in this case there are signs of insufficiency the liver blood too.

tutor

Dear Sophia,
So sorry to talk with you for so late! It's all because of my computer, I couldn't manage to come to the forum before yesterday.

In renal failure or other chronic patients, the coexistent defiiciency of kidney Yin and Yang often occurs. In course A, there is a good description on the interrelations between Yin and Yang, so when one is become deficient for a long period of time, the other must be undermined thus deficient.

As your case is concerned, the first one doesn't really have the remarkable symptoms and signs of Yang deficiency, but rather the Qi deficiency instead. There are some manifestations of Yin deficiency, but not really severe. I think the difficulty in urination (urination only two times in a day less than 250 ml each time) reveals the kidney Qi deficiency and the general edema demonstrates more the spleen Qi deficiency.
However, you didn't tell he's got cold extremeties, so it's still hard to tell it's a real Yang deficiency case.
Anyhow, the kidney, liver and spleen are closely interrelated, as they are known the three foot Yin. So the disorder of one, would affect another.

While your second case seems quite like a Yang deficiency, and I presume she's got that for quite a while, so she must have got a hard time in winter.
I agree with you on the liver blood insufficiency.
Fore sure there are also the signs and symptoms of Yin deficiency as well for the lady.

That's my rough idea, for I never saw the patients , so I cannot ensure everything

So, what do you think about it?

It's good you respond to the Tutor's invitation for the discussion of the kidney Yin and Yang and all your valuable ideas, opinions, and experience are welcome always.

tutor

Dear Dr. King,

Thank you for your explanation and ideas. Now I’m returning to examination of these two cases of renal failure in the view of your explanation.

Sophia.

tutor

Dear Sophia,
I think you have make the decision for yourelf on the renal failure patients, for you are on the first hand of their situation, and I haven't seen them personally, so I cannot make quite sure their conditions.
As we all know, to do traditional Chinese medicine, we have to see the patients, and the face-to-face personal feeling would be very important, it's a kind of awareness, not only the reasoning or deduction.
So, maybe I talked alot in terms of theory, but your personal feeling acquired from the patients proper would make you more correct.
That's the so-called a holistic medicine, the holisticness exists between the doctor and the patients. Is that right?

tutor

Dear Dr. King,
I analyzed described cases of renal failure patients and I must to say that I’m agreeing with your opinion about these cases completely.
Thanks!

tutor

Dear Sophia,
It's good to know you agree with me!