March 19, 2014

Kidney Fixity Disease (腎著病)


What is Kidney Fixity disease?

Kidney fixity or as it is sometimes translated Kidney stickiness, is basically cold pain and heaviness in the lumbar region that prevents (one) from normal turning and is exacerbated by yīn-type (dull-wet) weather, attributed to kidney vacuity cold-damp becoming “fixed” in the inner body. 1

The typical formula used to treat this condition is Gān Cǎo Gān Jiāng Fú Líng Bái Zhú Tāng. I'd like to present a section from my upcoming translation of the Jīn Guì Fāng Gē Kuò (金匱方歌括)- Prescriptions from the Golden Cabinet with Songs and a couple case studies illustrating its use. 



甘薑苓白
Gān Jiāng Líng Bái Zhú Tāng
Licorice, Dried Ginger, Poria, and Ovate Atractylodes Decoction


一名腎著湯                                                                                                                                                         Also called Kidney Fixity Decoction

治腎著之病, 其人身體重, 腰中冷, 如坐水中, 形如水狀, 反不渴, 小便自利, 飲食如故, 病屬下焦, 身勞汗出, 衣裡冷濕, 久久得之, 腰以下冷痛, 腹重如帶五千錢者,此主之。
A treatment for kidney fixity disease; where the patient experiences generalized heaviness and lumbar coldness, as if they are sitting in water.  Symptoms resemble those of water disease, yet there is no thirst, urination is uninhibited, and eating and drinking are normal. This means that the disease is in the lower burner.  Physical taxation with sweating leads to cold and dampness in the clothes, and over an extended period of time manifests with cold pain below the waist, and abdominal heaviness as if carrying five thousand coins.  This formula rules it.  

甘草    (各二兩)乾薑 茯苓(各四兩)
gān cǎo
甘草

6g
bái zhú

6g
gān jiāng
乾薑

12g
fú líng
茯苓

12g

上四味, 以水五升, 煮取三升, 分溫三服, 腰即溫。
Simmer the four ingredients above in 1000ml of water until reduced to 600ml.  Divide and take warm in three doses, until the lumbus feels warm. 

Song 歌曰:
腰冷溶溶坐水泉, 帶脈束於腰間, 腎著則腰帶病, 故溶溶如坐水中狀。  腹中如帶五千錢, 朮甘二兩薑苓四, 寒濕同驅豈偶然?
Lumbar coldness as if sitting in gently flowing water springs.
The girdling vessel binds around the lumbus.
With kidney fixity there is disease in the waist, which therefore brings the feeling as if one is sitting in water.
The abdomen feels as if it is carrying five thousand coins,
(With) six grams each of bái zhú and gān cǎo, and twelve of gān jiāng and fú ling,
is it by chance that both cold and dampness are expelled?


Quotation by Yóu Zàijīng 2 尤在涇雲:
寒濕之邪, 不在腎之中臟, 而在腎之外府, 故其治不在溫腎以散寒, 而在燠土以勝水。  若用桂、 , 則反傷腎之陰矣。
Cold-damp evils are not located in the kidney viscera but in the external dwelling of the kidneys.  Therefore, treatment need not involve warming the kidneys in order to dissipate cold, but to warm earth to prevail over water.  If guì zhī, or fù zǐ were used, then kidney yīn would be damaged!



Case #1

A fifty-four year-old male patient presented at the clinic with cold lumbar pain, which felt as if he were immersed and sitting in water. In addition, he had little desire to eat or drink, and his bowel movements were thin and loose.  Tongue coating was white and his pulse was soggy and moderate. This is a pattern of cold dampness fixed in the musculature of the lower back. The lumbus is the house of the kidney, and (this condition) is what is referred to in the jīn guì yào lüè as kidney fixity disease. It is suitable here to treat by warming the center, dissipating cold, strengthening the spleen and drying dampness with the formula gān cǎo gān jiāng fú líng bái zhú tāng (Licorice, Ginger, Poria and Atractrylodes Macrocephala Decoction).

gān jiāng (Zingiberis Rhizoma) 6g
gān cǎo (Glycyrrhizae Radix) 3g
fú líng (Poria) 10g
bái zhú (Atractylodis macrocephalae Rhizoma) 10g

Five packages were administered.  This patient also received local treatment with moxibustion.

Afterwards his appetite had increased and his bowel movements were now formed.

He was given another five packages of the formula above with 12g of dǎng shēn (Codonopsis Radix) added.

After finishing the formula his back pain had completely resolved.

Taken from page 193 of the ‘Simple Commentary on the Jīn Guì Yào Lüè’ (金匮要略浅述) by Tán Rì-Qiáng (谭日强)


Case #2

A fifty-year old male patient presented with aching pain in his lower back and legs.  In addition, he experienced a fear of cold, and heaviness of both legs after walking. His pulse was deep, moderate and lacking strength, and his tongue was slightly enlarged with a slippery-white coating. A yīn pulse is typically deep, and therefore this is a pattern of shào yīn yáng qì vacuity. A moderate pulse is typically associated with dampness, and therefore this is also a tài yīn spleen yáng weakness pattern. This pattern is what is referred to in the jīn guì yào lüè as kidney fixity disease. He was administered:

fú líng (Poria) 30g
bái zhú (Atractylodis macrocephalae Rhizoma) 15g
gān jiāng (Zingiberis Rhizoma) 14g
zhì gān cǎo (Glycyrrhizae Radix preparata) 10g

After taking twelve packages of the formula his legs started feeling warmer and his fear of cold, leg heaviness after walking, and pain had completely resolved.

Taken from page 145 from the Selected Clinical Case Studies of Liú Dù-Zhōu’ (劉渡舟臨証驗案)



1. (Practical Dictionary of Chinese Medicine, Wiseman et al. pg.326)
 
2. Yóu Zàijīng (尤在涇) (?-1749), was a well known Qíng dynasty scholar-physician from cháng zhōu (modern day wú county in jiāngsū province), who had written several commentaries on hàn dynasty medical literature, including the Jīn Guì Yì (金匮翼), Appendices to the Golden Cabinet.