this is kidney yang deficiency accompanied by an increase of internal cold. cold is a yin pathogenic influence that readily injures the yang qi. the kidney yang, which is the foundation of the body’s yang qi, is responsible for transmitting warmth to all the yang organs.

when cold invades the interior it injures the kidney yang, its warming function is inhibited, which is manifested in various signs of deficiency and cold such as extreme cold in the extremities, aversion to cold, sleeping with the knees drawn up, and lethargic state with a constant desire to sleep.

the spleen, which transforms food and fluids into refined essence, is dependent upon the warmth from the kidney yang to carry out this function. when the kidney yang is deficient, it cannot provide adequate warmth to the spleen yang, which reduces the spleen to a “cauldron without a fire under it”.

when the spleen yang is deficient, it cannot digest, assimilate, transform, and transport the essence of food and fluids. as a result, the clear yang cannot ascend, nor can the turbid yin properly descend. vomiting, diarrhea with undigested food particles, and an abscence of thirst ensues. because cold contracts, congeals, and stagnates, congealed cold and qi stagnation causes pain and cold in the abdomen.

the yang qi also nourishes the spirit. when the yang qi is sufficient the spirit will be vigorous, but when the spirit is deprived of nourishment it will weaken, which is manifested in a lethargic state and a desire to sleep. a pale tongue with a white, slippery coating and a submerged, thin or submerged, faint pulse is also indicative of yang deficiency.

(bensky & barolet)

a) the first presentation is kidney yang deficiency, or spleen and kidney yang deficiency, with retention of pathogenic water. the kidneys are the yin organ associated with water and fire. they control the process of water meetabolism and urination. when the true yang is deficient, the kidney qi loses its ability to transform water, which thereupon accumulates as pathogenic water in the lower jiao where it causes urinary difficulty a well as abdominal pain that is aggravated by cold.

the kidneys are the root of the body’s yang qi and support the generative and transformative processes in the other organs. for this rason, kindey yang deficiency is often accompanied by spleen yang deficiency.

the spleen governs the transformation and transportation of water and dampness. the inability of the spleen yang to transport water leads to various problems associated with the retention of pathogenic water and dampness. they may flood of spill over into the flesh and skin, producing generalized edema with deep aching and heaviness in the extremities. in the intestines this may cause loose stoools.

water and dampnesss prevent clear yang from ascending and the turbid yin from descending. this veils the sensory orifices and produces dizziness and a heavy sensation in the head. internal accumulation of damp-cold obstructs the flow of water and qi and causes abdominal pain.

when papthogenic water ascends and affects the heart, it causes epigastric palpitations; when it attacks the lungs, it disrupts the lung qi and produces coughing; and when it attacks the middle jiao it disturbs the spleen and stomach and causes vomiting and diarrhea.

the pale or dark swollen tongue with toothmarks, the white, slippery tongue coating, and the submerged, thin, and forceless pulse are signs of yang deficiency with internal retention of pathogenic water and dampness.

b) the second presentation is externally-contracted wind-cold at the greater/tai yang stage. when sweating does not alleviate the fever, the continuous loss of fluids causes the body to wither and severly depletes the yang qi. this deprives the sinews and flesh of nourishment, and the channels and extermities of warmth, which is manifested as shivering and trembling and an unsteady appearance.

(bensky & barolet)