Kidney essence insufficiency pattern refers to a clinical manifestation characterized by delayed development, premature aging, and weakness or paralysis of the limbs due to the depletion of kidney essence and the emptiness of the marrow sea. It is often caused by congenital deficiencies, postnatal maladjustment, or excessive strain and injury.

The main clinical manifestations include: vertigo, tinnitus, soreness and weakness of the lower back and knees, impotence, infertility; in children, delayed growth and development, delayed intelligence and motor skills, weak bones, delayed closure of the fontanel; in adults, premature aging, weakness of both legs, difficulty walking, mental dullness, slow movements, and a fine, weak pulse.

Kidney essence insufficiency pattern is commonly seen in diseases such as "ununited skull (hydrocephalus)", "five retardations, five kinds of flaccidity", "atrophy-flaccidity disease", "vertigo", "deficiency fatigue", "impotence", and "infertility".

This syndrome should usually be differentiated from "kidney-yin deficiency pattern".

bubble_chart Differentiation and Treatment

For different diseases presenting with the kidney essence insufficiency pattern, differentiation should be made.

1. For example, in children with ununited skull (hydrocephalus), the clinical features include cranial suture separation, wide anterior fontanel, prominent forehead veins, dull expression, lack of vitality in the eyes, and pale complexion. This is often caused by congenital fetal endowment deficiency, prolonged illness leading to physical weakness, kidney essence insufficiency, and insufficient marrow sea. As stated in Youyou Jicheng: "The kidney governs brain marrow. When the kidney is deficient, the brain marrow becomes insufficient, leading to the opening of the fontanel." Treatment should focus on tonifying and replenishing marrow and essence, tonifying qi, and nourishing blood. The formula used is the Kidney-Tonifying Rehmannia Pill (Zhengzhi Zhunsheng).
2. In children with five retardation and five kinds of flaccidity, characterized by weak limbs, inability to stand or walk on time, delayed teething, ununited skull (hydrocephalus), poor intelligence, dull expression, and emaciated body, the condition is often due to insufficient congenital endowment, improper postnatal nourishment, kidney essence deficiency, and qi-blood deficiency. As mentioned in Yizong Jinjian: "The five retardation syndrome in children is often caused by the parents' qi-blood deficiency, leading to congenital deficiency, resulting in weak bones and muscles, difficulty walking, delayed teething, and inability to sit steadily, all due to kidney deficiency." Treatment should focus on replenishing essence and tonifying the kidney, tonifying qi, and nourishing blood. The formula used is the Modified Six-Ingredient Rehmannia Pill (Six-Ingredient Rehmannia Pill) (Yizong Jinjian).
3. In atrophy-flaccidity disease presenting with kidney essence insufficiency pattern, characterized by gradual weakness and disuse of the lower limbs, soreness and weakness of the lower back, accompanied by vertigo, seminal emission, and enuresis, the condition is often due to excessive sexual activity or prolonged illness leading to essential qi depletion and liver-kidney depletion. Zhang Jing-yue said: "When the original qi is damaged, essence deficiency cannot nourish, and blood deficiency cannot provide nutrition, which is not uncommon." Treatment should focus on tonifying the liver and kidney. The formula used is the Hidden Tiger Pill (Hidden Tiger Pill) (Danxi Xinfa).
4. In vertigo disease presenting with kidney essence insufficiency pattern, characterized by vertigo, mental fatigue, forgetfulness, soreness and weakness of the lower back and knees, tinnitus, deafness, and thin, wiry pulse, the condition is often due to congenital deficiency, aging qi decline, or excessive indulgence leading to kidney essence insufficiency and empty marrow sea, resulting in deficiency in both upper and lower parts. As stated in Lingshu-Hai Lun: "When the marrow sea is insufficient, there is brain rotation, tinnitus, soreness of the shins, dizziness, and blurred vision, leading to fatigue and lying down." Treatment should focus on tonifying the kidney and replenishing essence. The formula used is the Left-Restoring Pill (Left-Restoring Pill) (Jingyue Quanshu).
5. In deficiency fatigue, impotence, infertility, and other diseases presenting with kidney essence insufficiency pattern, symptoms such as seminal emission, spermatorrhea, tinnitus, deafness, impotence, mental fatigue, lack of strength, scanty menstruation or amenorrhea, and infertility may occur. Treatment should focus on tonifying the kidney and replenishing essence. The formulas used include the Major Original-Qi Tonifying Decoction (Jingyue Quanshu) and the Great Life-Endowing Pill (Great Life-Endowing Pill) (Yifang Jijie, citing Wu Qiu's formula).

The presentation of kidney essence insufficiency pattern varies among individuals. In children, it manifests as delayed development, with physical strength, intelligence, and body shape lagging behind peers of the same age. In adults, it manifests as premature aging, such as lack of energy, memory decline, early loss of teeth and hair, and decreased sexual function. Differentiation should be made accordingly.

Kidney essence is the fundamental substance that maintains growth, development, reproduction, and the normal physiological activities of all zang-fu organs in the body. It also transforms into qi and generates blood. Therefore, in the disease mechanism of kidney essence insufficiency pattern, kidney essence deficiency often leads to qi-blood deficiency, presenting with symptoms such as pale and dull complexion, shortness of breath, mental fatigue, weak limbs, lack of strength, spontaneous sweating, and thin, weak pulse. In treatment, besides tonifying kidney essence, it is also necessary to tonify qi and nourish blood.

bubble_chart Differentiation of Similar Patterns

1. Kidney-yin deficiency pattern and kidney essence insufficiency pattern: Both syndromes belong to deficiency pattern. Essence belongs to yin, and kidney essence insufficiency pattern is a subset of kidney-yin deficiency pattern. The two syndromes are very similar in terms of disease cause, mechanism of disease, and clinical manifestations. However, there are still differences. Theoretically, kidney-yin deficiency pattern encompasses a broader meaning than kidney essence insufficiency pattern, with the latter being just one aspect of the former. Kidney essence insufficiency pattern only manifests as a deficiency of essential qi, while kidney-yin deficiency pattern, in addition to the manifestations of yin essence deficiency, also includes symptoms of excessive fire due to yin deficiency. From the perspective of disease cause, kidney essence insufficiency pattern is mainly formed due to congenital insufficiency, lack of postnatal nourishment, or loss of blood and fluids leading to yin essence deficiency; or due to excessive indulgence in desires, depleting the essence, as stated in Lingshu‧Pathogenic Qi Zang-Fu Organs Disease Forms: "Excessive sexual activity harms the kidneys," or due to damage from the seven emotions, such as fear damaging the kidneys, as mentioned in Suwen-Jutong Lun: "Fear causes the essence to retreat." When kidney essence is empty, it leads to tinnitus and vertigo; the kidney governs reproduction, and when the semen chamber (mingmen) is deficient, it results in male sexual dysfunction, decreased sexual function, and infertility; the kidney governs strength and skill, so kidney deficiency leads to weakness and inability to use the limbs; essence is essential for the growth and development of children, and essence deficiency causes delayed development, resulting in five retardations, five kinds of flaccidity, ununited skull (hydrocephalus), sunken fontanel, and so on. Kidney-yin deficiency pattern, in addition to the aforementioned causes, is often caused by warm diseases with heat entering the lower energizer, scorching liver and kidney yin fluids, or it may develop from lung yin deficiency. In terms of clinical manifestations, although both syndromes can exhibit deficiency symptoms, kidney essence insufficiency pattern mainly manifests as various clinical signs of essential qi deficiency and emptiness of the sea of marrow; whereas kidney-yin deficiency pattern is characterized by symptoms such as vexing heat in the chest, palms, and soles, dry mouth and throat, night sweats, red tongue texture, and thin, rapid pulse, emphasizing yin deficiency with effulgent fire. Therefore, the two syndromes are not difficult to distinguish.

bubble_chart Documentation

1. Zhubing Yuanhou Lun: "The kidney governs the bone marrow, and the brain is the sea of marrow. If the kidney qi is not abundant, the marrow and brain will be insufficient and cannot be full, hence the skull opens and separates."
2. Yizong Shuoyue: "Delayed walking, delayed teething, delayed hair growth, ununited skull (hydrocephalus), crane's knee, all belong to the kidney qi not being fully formed and the primordial essence being insufficient."