this is the classic presentation of kidney yang deficiency with insufficient fire at the gate of vitality (ming men).

the kidneys are the foundation of the prenatal essence and store the essence (jing). essence transforms into qi, and the qi which arises from the transformation of kidney essence is what is meant by the term ‘kidney qi.’ kidney qi is also known as ‘kidney yang’ or ‘source yang’ (yuan qi), as it is the basis for the yang of the entire body and the source of motivating power underlying the body’s functions of movement.

the kidneys govern the bones and reside in the lower back, and the kidney channel ascends from the foot and enters the spine to pass upward through the lower back. kidney deficiency is therefore accompanied by lower back pain and weakness of the lower limbs.

from the spine, a branch of the channel diverges and enters the abdomen. when the kidney yang is deficient, it is unable to warm the lower jiao, which causes a cold sensation in the lower half of the body and tenseness in the lower abdomen. stagnation of water and fluids produces a pale, swollen tongue with a thin, white, and moist coating.

kidney yang deficiency generally manifests as an empty or frail pulse which is submerged and faint at the proximal (kidney) position.

the yang qi of the kidneys drives the functional transformation and movement of water in the body, directing the pure upward and the turbid downward. when the kidney yang is insufficient, its ability to regulate the ascent and descent of water and fluids is impaired. various symptoms of urinary difficulty may result. if the kidneys are unable to transform qi and move water, there will be urinary difficulty and edema.

the water and qi may also rebel upward causing panting and irritability to the point that the patient will have difficulty lying down, and will lean against things for support. in those instances where the debilitated kidney qi is unable to provide stability in the governance of water, the bladder may lose its ability to restrain the water, manifested by frequent and copious urination, or in severe cases, incontinence.

(bensky & barolet)