Liver-kidney yin deficiency pattern is caused by insufficient kidney yin leading to insufficient liver yin, or insufficient liver yin causing kidney yin deficiency, clinically manifesting as yin deficiency in both the liver and kidney. It is often caused by prolonged illness, overexertion, or warm febrile diseases depleting liver yin and kidney yin.

The main clinical manifestations include: blurred vision or nyctalopia, muscle cramps, numbness, convulsions, brittle nails, hypochondriac pain, vertigo, tinnitus, soreness and weakness in the lower back and knees, loose teeth, hair loss, seminal emission, emaciation, dry throat and mouth, vexing heat in the chest, palms, and soles, afternoon tidal fever, flushed cheeks, night sweats, restlessness, insomnia, dark urine, dry stools, a red tongue with little or no coating, and a deep, wiry, thin, and rapid pulse.

Liver-kidney yin deficiency pattern is commonly seen in diseases such as "hypochondriac pain," "lumbago," "deficiency fatigue," "blood pattern," "vertigo," "advanced menstruation," "amenorrhea," and "dysmenorrhea."

This syndrome should be differentiated from "heart-kidney non-interaction pattern," "lung-kidney yin deficiency pattern," and "kidney essence insufficiency pattern."

bubble_chart Differentiation and Treatment

Liver-kidney yin deficiency pattern can be seen in various diseases.

1. In hypochondriac pain, the liver-kidney yin deficiency pattern is characterized by dull pain in the hypochondriac region, continuous and unrelenting, accompanied by soreness and weakness in the lower back and knees, dizziness, blurred vision, tidal fever, night sweats, and other symptoms of liver-kidney yin deficiency. This is due to internal damage from the seven emotions, transforming into fire and damaging yin; prolonged illness leading to depletion of essence and blood, and malnutrition of the meridians. Jingyue Quanshu·Hypochondriac Pain states: "Those with internal damage and deficiency causing hypochondriac pain, especially those who overindulge in sexual activity and are emaciated due to kidney deficiency, often experience a dull, lingering pain in the hypochondriac region. This is because the liver and kidney essence is deficient and cannot transform qi, and qi deficiency cannot generate blood." Treatment should focus on nourishing water to moisten wood. The formula used is All-Along Decoction (from "Liuzhou Medical Talks").
2. In lumbago, the liver-kidney yin deficiency pattern is characterized by soreness and dull pain in the lower back, weakness in the lower back and knees, worsening with exertion, relief when lying down, and blurred vision. This is often due to congenital deficiency, prolonged illness leading to physical weakness, overindulgence in sexual activity, or aging leading to depletion of essence and blood, resulting in malnutrition of the tendons and meridians. Treatment should focus on nourishing water to moisten wood. The formula used is Left-Restoring Pill (from Jingyue Quanshu).
3. Deficiency fatigue can also present with this pattern, where patients exhibit soreness and weakness in the lower back and knees, vertigo, tinnitus, blurred vision, and other symptoms of liver-kidney yin deficiency, along with symptoms of qi and blood deficiency in multiple zang-fu organs. The disease cause is as described in Yixue Gangmu·Deficiency Fatigue: "Deficiency refers to insufficiency of the skin, hair, muscles, tendons, bones, marrow, qi, blood, and body fluids. If a man labors all day, depleting his spirit and strength, eating irregularly, experiencing excessive emotions, and indulging in desires... the root of his vitality will be exhausted." Suwen-Shanggu Tianzhen Lun states: "People today are not like this; they treat wine as water, take recklessness as normal, enter the bedroom while drunk, exhaust their essence with desires, dissipate their true qi, do not know how to maintain fullness, do not regulate their spirit, seek only to satisfy their heart, go against the joys of life, and have no regularity in their daily routines, thus aging by fifty." Treatment should focus on nourishing water to moisten wood. The formula used is Major Yin-Tonifying Pill (from Danxi Xinfa).
4. Blood pattern such as gingival hemorrhage can also present with liver-kidney yin deficiency, due to internal damage from emotions, indulgence in desires, liver-kidney yin deficiency, yin deficiency with internal heat, scorching the meridians, and causing blood to overflow. The bleeding is characterized by light red blood, loose teeth, and mild pain. As Jingyue Quanshu·Blood Gate states: "Bleeding from the gums and between the teeth is called gingival hemorrhage. This is a disease of the Yangming meridians of the hands and feet and the Kidney meridian of the foot Shaoyin. When kidney water is insufficient, the mouth is not foul, the teeth do not hurt, but the teeth are loose and not firm, or there is mild pain, and bleeding often occurs between the teeth. This is due to kidney yin not being firm, and occasional movement of deficient fire." Treatment should focus on nourishing yin and reducing fire, cooling blood and stopping bleeding. The formula used is Water-Nourishing Liver-Clearing Decoction (from "Yizong Jiren Bian") combined with Qian Gen San (from Jingyue Quanshu).
5. In vertigo, the liver-kidney yin deficiency pattern has a slow onset and a long course. The vertigo is mild, often deficiency-type dizziness, relieved by closing the eyes and lying down, and accompanied by other symptoms of liver-kidney yin deficiency. This is often due to kidney water deficiency, water failing to nourish wood, and wind-yang rising; or liver-kidney yin and essence deficiency, inability to generate marrow, and insufficiency of the sea of marrow. Lingshu-Hai Lun states: "When the sea of marrow is abundant, one is light and strong, exceeding one's limits; when the sea of marrow is insufficient, there is dizziness, tinnitus, soreness in the legs, blurred vision, and a tendency to lie down." Treatment should focus on nourishing water to moisten wood. The formula used is Wolfberry and Chrysanthemum Rehmannia Pill (from "Medical Levels").
6. In women with advanced menstruation, the pattern of yin deficiency in the liver and stomach is characterized by early menstruation, scanty and red flow, sticky texture, and signs of yin deficiency with internal heat, such as flushed cheeks and feverish sensation in the palms and soles. This is due to liver-kidney yin deficiency, yin deficiency with internal heat, forcing blood to move recklessly, and instability of the Chong and Ren meridians. Fuqingzhu Gynecology·Regulating Menstruation states: "When menstruation comes early with only a small amount, people think it is extreme blood heat, but who knows it is due to kidney fire excess and kidney water deficiency... Early menstruation with scanty flow is due to fire heat and water insufficiency." Treatment should focus on nourishing yin and clearing heat. The formula used is Rehmannia and Lycium Root-Bark Decoction (from Fuqingzhu Gynecology).
7. In women with amenorrhea, the liver-kidney yin deficiency pattern manifests as: delayed onset of menstruation, scanty flow with red or pale color, gradually leading to amenorrhea. This is often caused by congenital insufficiency, underdeveloped reproduction-stimulating essence, or prolonged illness leading to deficiency damage, resulting in liver-kidney essence deficiency and blood deficiency, leading to malnourishment of the Chong and Ren meridians. Treatment should focus on nourishing water to moisten wood, nourishing blood, and regulating menstruation. The prescription used is Returning To Kidney Pill (Jingyue Quanshu).
8. Another example is the occurrence of this syndrome in women with dysmenorrhea, clinically characterized by dull pain in the lower abdomen after menstruation, continuous and unceasing, with pale and scanty menstrual flow. It is mostly caused by liver-kidney yin deficiency, essence and blood deficiency, emptiness of the chong and ren meridians, and lack of nourishment to the uterine collaterals. Treatment should focus on regulating and tonifying the liver and kidneys, nourishing blood to stop pain. The prescription used is Tiaogan San (Fuqingzhu Gynecology).

Liver-kidney yin deficiency pattern often occurs in individuals who are physically thin or have insufficient innate endowment. Due to the physiological characteristics of women such as menstruation, pregnancy, delivery, and infant feeding, they are prone to yin and blood deficiency, hence this syndrome is more common in women. As stated in the Lingshu-Wuyin Wuwei chapter: "In the life of a woman, there is an excess of qi and a deficiency of blood, because she frequently loses blood."

The liver stores blood and governs dispersion, while the kidney stores essence and governs development and reproduction. Physiologically, liver blood and kidney essence mutually support each other; sufficient liver blood can transform into essence, and abundant kidney essence can transform into blood. Therefore, in pathology, liver yin deficiency and kidney yin deficiency often occur simultaneously. In the evolution of the liver-kidney yin deficiency pattern mechanism of disease, the following situations often occur:

1. Liver and kidney yin deficiency cannot restrain liver yang, leading to excessive rising of liver yang, resulting in symptoms such as distending headache, red face, irritability, and other manifestations of ascendant hyperactivity of liver yang.
2. Liver and kidney yin deficiency can also lead to lung yin deficiency, resulting in loss of its clear and moistening descending function, yin deficiency with effulgent fire, scorching the lung collaterals, and symptoms such as dry cough, shortness of breath, scanty and sticky phlegm, dry mouth and throat, hoarseness, coughing up blood or hemoptysis.
3. Liver and kidney yin deficiency cannot nourish the heart, leading to heart yin deficiency, yin deficiency with internal heat, disturbing the heart spirit, resulting in symptoms such as heart vexation, insomnia, dreamfulness, forgetfulness, fright, and vigilance.
4. The kidney is the residence of water and fire, and the original yin and yang stored in the kidney depend on and restrain each other. In the course of disease, they also influence each other. Liver-kidney yin deficiency, yin impairment affecting yang, leading to kidney yang deficiency, loss of warming function, and qi transformation dysfunction, can result in symptoms such as cold body and limbs, pale complexion, cold and sore waist and knees, clear and long urination or enuresis, severe swelling below the waist, forming a condition of both kidney yin and yang deficiency.

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bubble_chart Differentiation of Similar Patterns

1. Heart-kidney non-interaction pattern and liver-kidney yin deficiency pattern: The heart belongs to fire and stores the spirit, located in the upper energizer; the kidney belongs to water and stores essence, located in the lower energizer. Physiologically, heart yang descends to the kidney to warm kidney water, and kidney yin ascends to nourish heart yin. If the heart and kidney lose their mutual interaction, kidney water is insufficient and cannot enrich and tonify heart yin, yin fails to control yang, heart yang becomes hyperactive above and cannot descend to the kidney, resulting in heart-kidney non-interaction pattern. This syndrome, in addition to symptoms of heart and kidney yin deficiency such as soreness and weakness of the waist and knees, vertigo, tinnitus, tidal fever, night sweats, and vexing heat in the chest, palms, and soles, also includes manifestations of hyperactive heart yang such as virtual vexation, insomnia, and palpitations, without signs of liver yin deficiency. Liver-kidney yin deficiency pattern not only exhibits symptoms of kidney yin deficiency but also includes symptoms of liver yin deficiency such as dry eyes, blurred vision, muscle tension, numbness, convulsions, brittle nails, and hypochondriac pain, without manifestations of hyperactive heart yang. The clinical manifestations of these two syndromes have distinct characteristics and are not difficult to differentiate.
2. Lung-kidney yin deficiency pattern and liver-kidney yin deficiency pattern: Both belong to yin deficiency, and their clinical manifestations can include vertigo, tinnitus, decreased vision, forgetfulness, less sleep, soreness and weakness of the waist and knees, emaciation, dry mouth and throat, vexing heat in the chest, palms, and soles, afternoon tidal fever, night sweats, flushed cheeks, seminal emission in men, and scanty menstruation, amenorrhea, or menorrhagia and metrostaxis in women, which are symptoms of kidney yin deficiency and can easily be confused, thus requiring differentiation. Lung-kidney yin deficiency pattern is often caused by kidney yin deficiency failing to ascend, or virtual fire scorching the lung, chronic cough disease damaging the lung. Clinically, it also includes manifestations of lung yin deficiency such as cough with little or no phlegm or blood in phlegm, dry mouth and throat, and hoarseness. Liver-kidney yin deficiency pattern is often due to kidney yin deficiency failing to enrich and tonify liver yin, or liver yin deficiency leading to kidney yin deficiency. Patients also have symptoms such as blurred vision or nyctalopia, muscle tension, numbness, convulsions, brittle nails, and hypochondriac pain. The location of disease in these two syndromes is in the lung and kidney versus the liver and kidney, respectively, and they are not difficult to distinguish.
3. Kidney essence insufficiency pattern and liver-kidney yin deficiency pattern: The kidney stores essence and governs development and reproduction. Kidney essence insufficiency mainly refers to the deficiency of innate essence, affecting human growth, development, and reproduction, leading to symptoms such as scanty sperm and infertility in men, amenorrhea and infertility in women; delayed development, short stature, delayed intelligence and motor skills, weak bones, delayed closure of the fontanel in children; and premature aging, hair loss, loose teeth, forgetfulness, mental confusion, weak feet, mental dullness, and slow movements in adults. Clinically, there is only a deficiency of yin essence without obvious signs of virtual heat. Liver-kidney yin deficiency pattern not only shows symptoms of essence and blood deficiency such as loose teeth, hair loss, soreness and weakness of the waist and knees, forgetfulness, and insomnia, but also includes symptoms of virtual heat such as vexing heat in the chest, palms, and soles, tidal fever, night sweats, dry mouth and throat, and flushed cheeks, as well as manifestations of liver yin deficiency such as blurred vision, muscle tension, and hypochondriac pain, which are clearly different from the clinical manifestations of simple kidney essence insufficiency pattern.

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bubble_chart Documentation

1. Suwen-Fuzhong Lun: "In youth, if there is a significant loss of blood, or if one enters the chamber while drunk, the qi is exhausted and the liver is injured, hence menstruation diminishes and ceases."
2. Yixue Rumen‧Various Deficiencies: "Five kinds of strain, six extremes, seven damages, accumulated deficiency leading to impairment, accumulated impairment leading to injury, if not cured over the years, it is called chronic deficiency. Liver strain, exerting oneself in planning and worrying, then the sinews and bones become cramped, in extreme cases, the head becomes blurred and dizzy; kidney strain, maintaining one's will and integrity, then the lumbar bone aches, seminal emission and white turbidity, in extreme cases, the face becomes dirty and the spine aches."
3. Bencao Jingshu‧Volume 2: "Ten symptoms of liver deficiency: chest and hypochondriac pain, belonging to liver blood deficiency; spasm, belonging to blood deficiency; short-sightedness, belonging to liver blood deficiency and insufficient kidney water and true yin; blurred vision, belonging to liver blood deficiency with heat and insufficient kidney water and true yin; eye nebula, belonging to liver heat and insufficient kidney water; excessive loss of blood, opisthotonos, belonging to blood deficiency with heat; pain in the lower abdomen connected to the yin, stopping upon pressure, belonging to blood deficiency of the Jueyin meridian; migraine, belonging to blood deficiency, heat in the liver, if not treated promptly, will eventually damage the eyes; dark eyes and vertigo, belonging to blood deficiency and insufficient kidney water and true yin."
4. Zhangshi Yitong‧Pain in the Waist, Spine, Legs, and Feet: "All continuous aching pain in the waist and spine, and weakness in the legs and feet, is due to kidney deficiency.…Kidney-deficiency lumbago, mostly caused by sexual desire, but observe that there is neither external contraction nor dampness-heat. Or due to old age and decline, or emotional depression, or inability to support exertion, and slight relief from sitting or lying down, or fatigue and weakness, and worsening with labor, or a sallow complexion, weak and faint pulse, all indicate insufficiency of the kidney meridian."