Class 1: Kidney disorder: edema, nocturnal enuresis,

1. Class 1: Kidney disorder: edema, nocturnal enuresis, Xianhui Li

2. Edema • Subcutaneous retention of fluid which leads to puffiness of the head, face, eyelids, limbs, abdomen and even the whole body is called edema.

3. Etiology • Exterior wind and dampness • Diet • Overwork • Excessive sexual activity • Fire-poison from sores or carbuncles

4. Pathogenesis • Yang edema • Yin edema

5. The main points that promote the transformation, transportation and excretion of fluids • Du26 shui gou: this point promotes the transformation of fluids in the upper burner, for edema of face and hands • Ren9 shui fen: this point can be used as a general point to promote the transformation of fluids anywhere in the body • Ren5 shi men: this is the front mu point of triple energizer and it promotes the transformation and excretion of fluids in the lower burner, essential in edema of the lower burner • ST28 shui dao: this is an essential point to promote the transformation and excretion of fluids in the lower burner • Ren17 shan zhong: it stimulates the diffusing and transformation of fluids in the upper burner • Ren6 qi hai: it promotes the transformation of fluids in the lower burner by activating qi • UB22 san jiao shu: back shu point of the san jiao. It promotes the transformation and excretion of fluids in the lower burner

6. The main points that promote the transformation, transportation and excretion of fluids (continued) • LU7 lie que: it makes lung qi descend and diffuse and it promotes the diffusing and transformation of fluids in the upper burner in lung pathology, for edema of face and hands • SP6 and SP9: both these points stimulate the transformation and excretion of fluids in the middle and lower burner, essential in spleen pathology • KI7 fu liu: promotes the transformation and excretion of fluids in the lower burner, essential in kidney pathology • UB13, UB20 and UB23: these are the back shu point of the lung, spleen and kidneys. They are used to tonify the lungs, spleen or kidneys in chronic yin edema

7. Pattern identification • Yang edema • Wind water invading the defensive qi portion • Fire poison affecting the Lung and Spleen • Accumulation of dampness • Accumulation of damp-heat • Yin edema • Spleen Yang deficiency • Kidney Yang deficiency

8. Wind water invading the defensive qi portion • Clinical manifestations: • edema of eyes and face with sudden onset, aversion to cold, fever, aches in muscles, retention of urine. Light red tongue, thin white or thin yellow coat. Floating pulse. • Treatment principle: • Release the exterior, expel wind, open water passage, stimulate the lung’s dispersing of fluids • Acupuncture LI4, TB5 wai guan, LU7 lie que, BL12 feng men, BL13 fei shu, DU26 ren zhong, ST36, LI6 pian li • LI4 yuan point of LI, LU7 luo point of LU, TB5 luo point of TB, BL12 and BL13 release the exterior, expel wind and restore the lung’s dispersing and descending function. • Du26 promotes the transformation of fluids in the upper burner, for edema of face and hands • ST36 tonify the spleen and harmonizes nutritive and defensive qi and removes fluids from the space between skin and muscles • LI6, luo point of LI, opens the water passages and resolves acute edema of the upper limbs and face • Herbal treatment: yue bi jia zhu tang

9. Fire poison affecting the Lung and Spleen • Clinical manifestations: • edema of any part of the body, sores, carbuncles or furuncles, red tongue, thick yellow coating. Rapid pulse • Treatment principle: • Clear fire poison and drain dampness • Acupuncture Ren12 zhong wan, BL20, BL22, Ren9 shui fen, ST28 shui dao, LI11, LU7, BL13, SP9, local points • Ren12 and BL20 tonify the spleen to resolve dampness and edema • Ren9, ST28 and BL22 promote the transformation of fluids and resolve edema • SP9 resolves dampness • LU7 stimulates the lung’s diffusing of fluids • BL13 tonifies lung qi • LI11 resolves toxic heat • Herbal treatment: ma huang lian qiao chi xiao dou tang and wu wei xiao du yin

10. Accumulation of dampness • Clinical manifestations: • edema, scanty urination, heavy body, poor appetite, oppression of the chest, sticky white tongue coating, slippery pulse • Treatment principle: • resolve dampness and strengthen spleen • Acupuncture Ren12, BL20, BL21, ST36, Ren9, ST28, Ren6, SP6, SP9, BL22, BL39 wei yang • Ren12, BL20, BL21 and ST36 tonify stomach and spleen • Ren9 and ST28 resolves edema • Ren6 with moxa, tonifies and moves yang qi, which will help to move and transform fluids and resolve edema • SP6 and SP9 resolves dampness • BL22 stimulates the transformation and excretion of fluids in the lower burner • BL39 lower he sea point of san jiao, opens the water passages in the lower burner, stimulates the transformation and excretion of fluids in the lower burner • Herbal treatment: wu ling san and wei ling tang

11. Accumulation of damp-heat • Clinical manifestations: • edema, scanty dark urination, heavy body, oppression of the chest, sticky yellow tongue coating, slippery rapid pulse • Treatment principle: • Clear heat and resolve dampness • Acupuncture Ren12, Ren9, ST28, SP6, SP9, BL22, LI11, BL39 • LI11 solves damp heat • SP6 and SP9 resolves damp heat from the lower burner • Ren9 promotes the transformation of fluids and the separation of clear from turbid. It resolves edema • ST28 promotes the transformation of fluids in the lower burner and resolves edema • BL22 promotes the transformation and excretion of fluids in the lower burner • BL39 lower he sea point of san jiao, opens the water passages in the lower burner, stimulates the transformation and excretion of fluids in the lower burner • Herbal treatment: shu zao yin zi, ting li da zao xie fei tang

12. Spleen Yang deficiency • Clinical manifestations: • edema of the abdomen and/or legs, feeling of oppression of the chest and abdomen, loose stools, poor appetite, fatigue. Pale swollen tongue with teeth-marks, weak fine pulse. • Treatment principle: • tonify spleen and resolve dampness • Acupuncture Ren12, BL20, BL21, ST36, Ren9, ST28, Ren6, SP6, SP9, BL22 • Ren12, BL20, BL21 and ST36 tonify stomach and spleen • Ren9 and ST28 resolves edema • Ren6 with moxa, tonifies and moves yang qi, which will help to move and transform fluids and resolve edema • SP6 and SP9 resolves dampness • BL22 stimulates the transformation and excretion of fluids in the lower burner • Herbal treatment: shi pi yin

13. Kidney Yang deficiency • Clinical manifestations: • edema of the whole body or legs, sore back and knees, feeling cold especially in the back and legs, scanty or profuse urination, fatigue, pale or bright-white complexion, pale swollen tongue with teeth marks. Deep weak pulse. • Treatment principle: • tonify kidney and resolve dampness • Acupuncture Ren 4, BL23, BL20, ST36, KI7, BL22, ST28 • Ren4 with moxa, tonifies kidney yang • BL23 and KI7 tonifies kidney yang • BL20 and ST36 tonify the spleen, in edema form kidney yang deficiency. In edema from kidney-yang deficiency it is essentila to tonify the spleen as well • BL22 and ST28 resolve edema • Herbal treatment: ji sheng shen qi wan and zhen wu tang

14. Nocturnal Enuresis • Nocturnal enuresis is referred to involuntary discharge of the urine occurring at night and during sleep. As a morbid condition, it is mostly seen in children over the age of three years and occasionally in adults.

15. Etiology • Kidney Qi deficiency

16. Kidney Qi deficiency • Main Manifestations • Involuntary micturition during sleep, once in several nights in mild cases, or several times a night in severe cases. Sallow complexion, loss of appetite, pale tongue, thin white coat, thin pulse weak at the chi region. • Treatment principle: • Strengthen kidney and reinforce Qi • Acupuncture Treatment: BL23 shen shu, BL28 pang guang shu, Ren3 zhong ji, SP6 san yin jiao • BL23, BL28 and Ren3, back shu points of the kidney and bladder, front mu point of the bladder, this three points contribute to reinforce the kidney qi and the restrain function • SP6 is added to adjust the qi of the three yin meridians • Herbal treatment: suo quan wan