Kidney-yin deficiency pattern refers to a series of symptoms caused by the deficiency of kidney yin fluid and the upward flaring of deficient fire. This syndrome is often caused by internal damage due to overstrain, prolonged illness affecting the kidneys, or extreme heat damaging yin in the late stage [third stage] of warm disease.

The main clinical manifestations include: vexing heat in the chest, palms, and soles; insomnia; night sweats; dry mouth and throat; heel pain; soreness and weakness in the lower back and knees; seminal emission; menorrhagia and metrostaxis in women; red tongue texture; and a thin, rapid pulse.

Kidney-yin deficiency pattern is commonly seen in diseases such as "seminal emission," "insomnia," "deficiency fatigue," "chylous stranguria," "hematuria," "menorrhagia and metrostaxis," "consumptive thirst," and warm febrile diseases.

This syndrome should be differentiated from "kidney essence insufficiency pattern," "pattern of dual deficiency of kidney yin and yang," "liver-kidney yin deficiency pattern," and "lung-kidney yin deficiency pattern."

bubble_chart Differentiation and Treatment

The kidney-yin deficiency pattern manifests differently in various diseases, and the treatment methods also vary.

1. For example, when it appears in seminal emission, symptoms such as easily aroused male sexuality, nocturnal emission, and premature ejaculation are observed. Dizziness, blurred vision, and lack of energy are often caused by excessive indulgence, depletion of kidney yin, and disturbance of the semen chamber by deficient fire. The treatment should focus on nourishing kidney yin and purging deficient fire, using the Anemarrhena, Phellodendron, and Rehmannia Pill (Yifangkao).
2. If it appears in insomnia, symptoms such as irritability, insomnia, chaotic dreams, vexing heat in the chest, palms, and soles, dizziness, and tinnitus may occur. These are often caused by overthinking, unfulfilled desires, and depletion of kidney yin, leading to excessive heart fire. Xu Dong'ao said, "Some cases are due to insufficient kidney water, where true yin does not rise, and fire becomes hyperactive, causing sleeplessness." The treatment should focus on nourishing the kidney, strengthening water to control fire, and tranquilizing the spirit, using the Six-Ingredient Rehmannia Pill (Xiao'er Yaozheng Zhijue) combined with Coptis and Ass Hide Glue Decoction (Shanghan Lun).
3. If it appears in chylous stranguria, symptoms such as turbid urine resembling rice water, painful urination, or discharge of fatty substances, emaciation, weakness, soreness in the lower back and knees, and a red, greasy tongue coating may occur. These are often caused by overexertion in sexual activities or emotional stress, leading to kidney yin deficiency and leakage of fatty substances. The treatment should focus on tonifying the kidney and securing the lower body, using Rhizoma Dioscoreae Decoction for Clearing Turbid Urine (Danxi Xinfa) combined with Six-Ingredient Rehmannia Pill with modifications.
4. If it appears in deficiency fatigue, symptoms such as emaciation, feverish sensations, dizziness, tinnitus, deafness, weakness in the legs, and a withered spirit may occur. These are often caused by congenital deficiency, excessive labor, or prolonged illness without proper care, leading to kidney yin deficiency and chronic deficiency fatigue. The treatment should focus on nourishing the kidney and replenishing yin, using Major Yin-Tonifying Pill (Danxi Xinfa) and Major Original-Qi Tonifying Decoction (Jingyue Quanshu).
5. If it appears in hematuria, symptoms such as reddish urine, soreness in the lower back and knees, mental fatigue, weakness, a red tongue, and a thin, rapid pulse may occur. These are often caused by excessive indulgence in sexual activities, stirring of ministerial fire, and kidney yin deficiency, leading to internal heat and bleeding. Zhang Jing-yue said, "This is often due to excessive indulgence in wine and lust, stirring the fire of the lower energizer." The treatment should focus on nourishing yin, clearing fire, and stopping bleeding, using Major Yin-Tonifying Pill combined with Small Thistle Decoction (Jisheng Fang).
6. If it appears in consumptive thirst, known as "lower consumptive thirst," symptoms such as frequent urination, urine resembling fat, dry mouth, red tongue, emaciation, and a deep, thin, rapid pulse may occur. These are often caused by excessive sexual activity, overconsumption of rich foods and medicinal wine, and kidney yin deficiency, leading to exhaustion of the lower energizer. Jingyue Quanshu states, "Lower consumptive thirst is a disease of the lower energizer, characterized by dark urine, turbid discharge, emaciation, and a blackened face. It is a kidney disease, hence also called lower consumptive thirst." The treatment should focus on enriching yin and securing the kidney, using Six-Ingredient Rehmannia Pill with increased doses of Chinese Yam and Cornus.
7. In warm febrile diseases, if pathogenic heat lingers in the lower energizer and scorches true yin, causing kidney yin deficiency, the condition tends to be acute. Clinical symptoms include mild but persistent fever, feverish palms and soles, dry mouth, a dry, crimson tongue, or even a purple, withered tongue, fatigue, deafness, and a large, weak pulse. The treatment should focus on enriching yin, nourishing yin, and clearing heat, using Modified Pulse-Restoring Decoction (Wenbing Tiaobian).
8. If it appears in gynecological menorrhagia and metrostaxis, symptoms such as early menstruation, continuous bleeding, red and heavy menstrual flow, or sticky leukorrhea, a red tongue, and a deep, thin, rapid pulse may occur. The treatment should focus on enriching yin, cooling blood, and stopping bleeding, using Qinghai Pill (Fuqingzhu Gynecology) and Ophicalcite Powder (Shiyao Shenshu).

The manifestations of kidney-yin deficiency pattern often vary depending on the individual and the timing. For example, in elderly individuals with kidney-yin deficiency pattern, the main symptoms include premature tooth loss and hair shedding, constipation, difficulty and dribbling urination, deafness, tinnitus, and vertigo. In young and middle-aged males with kidney-yin deficiency pattern, the primary symptoms are nocturnal emission, premature ejaculation, and insomnia. In female patients, the main symptoms include early menstruation, or menorrhagia and metrostaxis, and infertility. In terms of timing, the phenomenon of yin deficiency with effulgent fire in kidney-yin deficiency pattern is more severe in the evening or at night and improves in the morning.

According to the theory related to zang-fu organs, when one organ is diseased, it will inevitably affect other organs. The kidney-yin deficiency pattern often presents with some accompanying symptoms and signs during its disease mechanism evolution. For example, the mutual nourishment between water and fire in the heart and kidney ensures that kidney yin nourishes the heart, preventing excessive heart fire. If kidney yin is insufficient, water cannot control fire, leading to excessive heart fire and resulting in the syndrome of non-interaction between heart and kidney. Symptoms include irritability, insomnia, dreamfulness, seminal emission, palpitation, forgetfulness, vertigo, tinnitus, dry mouth and throat, soreness and weakness of the waist and knees, tidal fever, night sweat, red tongue without coating, and thready rapid pulse.

bubble_chart Differentiation of Similar Patterns

1. Kidney essence insufficiency pattern and kidney-yin deficiency pattern: Essence belongs to yin, and kidney essence insufficiency pattern falls within the category of yin deficiency pattern. The disease cause, mechanism of disease, and clinical manifestations of the two syndromes are very similar, but there are still some differences. The concept of kidney yin is broader than that of kidney essence. Kidney essence insufficiency pattern is one manifestation of kidney-yin deficiency pattern, but not the entirety. In terms of disease cause, kidney-yin deficiency pattern often arises from excessive sexual activity leading to depletion of kidney yin; or from prolonged dampness-heat in the lower energizer, which consumes and damages kidney yin; or during the late stage of warm febrile disease [third stage], where heat scorches the body fluids, damaging kidney yin; or from emotional internal damage, where qi-fire damages yin; or in chronic sexually transmitted diseases, where the yin of other zang-fu organs is first damaged, and over time, it affects the kidney, leading to kidney yin damage and excessive virtual fire, resulting in this syndrome. Kidney yin deficiency generates internal heat, hence symptoms such as vexing heat in the chest, palms, and soles, insomnia, night sweats, dry mouth, and throat; yin deficiency leads to excessive yang, resulting in seminal emission; virtual fire disturbs the Chong and Ren meridians, leading to menorrhagia and metrostaxis, infertility; insufficient kidney yin also leads to deficiency of essential qi, hence symptoms like soreness and weakness of the lower back and knees, and a fine and rapid pulse. The disease cause of kidney essence insufficiency pattern is often due to congenital insufficiency, excessive sexual activity leading to depletion of yin essence; or from fatigue and exhaustion, leading to deficiency of essential qi. Clinically, the main symptoms of kidney essence insufficiency pattern include vertigo, tinnitus, cerebral tinnitus, deafness, loose teeth, hair loss, premature graying of hair, mental fatigue, lack of strength, forgetfulness, memory decline, male infertility, female infertility, and a deep and fine pulse at the chi position. Unlike kidney-yin deficiency pattern, it generally does not include symptoms of yin deficiency with effulgent fire such as vexing heat in the chest, palms, and soles, night sweats, dry throat, red tongue, and a fine and rapid pulse, which distinguishes it.
2. Pattern of dual deficiency of kidney yin and yang and kidney-yin deficiency pattern: The so-called pattern of dual deficiency of kidney yin and yang includes both kidney-yin deficiency pattern and kidney-yang deficiency pattern. From the mechanism of disease analysis, prolonged kidney yin deficiency leads to yin impairment affecting yang, resulting in dual deficiency of kidney yin and yang. Therefore, the pattern of dual deficiency of kidney yin and yang can be a further development of kidney-yin deficiency pattern. Clinical manifestations include fear of cold, feverish feeling in the palms and soles, dry mouth and throat, but a preference for hot drinks, tinnitus, night sweats, impotence, seminal emission, soreness and weakness of the lower back and knees, clear and long urination or dribbling, white coating at the root of the tongue, slightly red tongue texture, and a fine and weak or slightly rapid pulse at the chi position. This is clearly different from the series of symptoms of yin-blood deficiency and excessive virtual fire that appear in simple kidney yin deficiency.
3. Liver-kidney yin deficiency pattern and kidney-yin deficiency pattern: The liver stores blood, and the kidney stores essence. The liver and kidney share a common source, with essence and blood mutually generating each other, making the physiological relationship between the liver and kidney very close. The formation of liver-kidney yin deficiency pattern is often due to excessive loss of blood, prolonged illness leading to depletion of yin, or excessive sexual activity, causing deficiency of liver and kidney yin; it can also be due to initial kidney yin deficiency, where essence does not transform into blood, and blood does not nourish the liver, leading to deficiency of both liver and kidney. Clinically, symptoms include dizziness, blurred vision, sallow complexion, tinnitus, deafness, pain in the hypochondriac region, soreness and weakness of the lower back and knees, numbness of limbs, flushed cheeks and lips, feverish feeling in the palms and soles, night sweats, seminal emission, and menstrual irregularities in women. Unlike simple kidney-yin deficiency pattern, due to the involvement of different zang-fu organs, the latter often does not include symptoms of liver blood deficiency such as vertigo, blurred vision, pain in the hypochondriac region, and numbness and spasms of limbs, which can be used for differentiation.
4. Lung-kidney yin deficiency pattern and kidney-yin deficiency pattern: The lung belongs to metal, and the kidney belongs to water. The lung and kidney have a mutual generation relationship between metal and water. Lung-kidney yin deficiency pattern and kidney-yin deficiency pattern are quite similar in terms of disease mechanism and clinical manifestations. However, the formation of lung-kidney yin deficiency pattern may be due to chronic cough disease consuming lung yin, prolonged lung yin deficiency leading to metal not generating water, further consuming kidney yin, resulting in deficiency of both lung and kidney; or due to insufficient kidney yin, unable to enrich and tonify lung yin, forming lung-kidney yin deficiency pattern. Clinical manifestations include cough with difficulty expectorating phlegm, shortness of breath upon exertion, occasional hemoptysis, dry mouth and throat, or hoarseness, soreness and weakness of the lower back and knees, steaming bone fever, tidal fever, night sweats, seminal emission, flushed cheeks, red tongue with little coating, and a fine and rapid pulse. In contrast, kidney-yin deficiency pattern is often caused by sexual overstrain, prolonged illness affecting the kidney, or late stage [third stage] of Rebing with heat entering the lower energizer. The pathological changes are limited to the kidney and have not yet affected the lung, hence symptoms of lung yin injury such as cough, hemoptysis, and hoarseness do not appear.

bubble_chart Documentation

1. "Supplement to the Formulas of the Viscera, Middle Volume": "When the yin fluids of the kidneys are insufficient, there is often an external floating of qi and fire, which follows the meridians and manifests as muscle heat. Sometimes, there may be no heat signs on the skin, but the patient feels a sensation of steaming and burning. This condition should be treated by vigorously nourishing kidney water to control the yang light."
2. Zhengyin Maizhi ‧ Kidney Deficiency and Strain: "The pulse of kidney deficiency and strain is thin and rapid at both chi positions, indicating a deficiency of true yin; if the pulse is rapid and large, it indicates fire in the kidneys; if the pulse is deep and slow, it indicates a deficiency of true yang. For the treatment of kidney deficiency and strain: for true yin deficiency, use Ginseng Root-Consolidating Pill and the family secret liver-kidney pill; for excessive fire in the kidneys, use Anemarrhena, Phellodendron, Asparagus, and Rehmannia Decoction; for true yang deficiency, use Golden Chamber Kidney Qi Pill."
3. "The Mirror of Flower-like Medical Skills, Kidney Section": "Heat in the kidneys indicates that the water is nearly exhausted. This is seen in cold-damage diseases but is rare in miscellaneous diseases. The left and right chi positions are deep and rapid, or floating and empty, with a black tongue lacking moisture. Symptoms include dry mouth and throat, blurred vision, difficulty in urination, turbid urine, bloody urine, and severe constipation."