The
Wandering Kidney
- Keisetsu Ōtsuka (大塚敬節)
A while
back, a male presented at the clinic looking to improve his overall
health. He complained that he would be
easily fatigued following exercise, and afterwards would experience lower back
and abdominal pain. He had been diagnosed with various conditions such as
gallstones, kidney stones, and chronic appendicitis. Most recently following
thorough examination, he was diagnosed with a wandering or floating kidney[1]
on the right side. During abdominal diagnosis his kidney was easily palpated
below his ribs on the right side when sitting up, however, when laying down the
kidney was difficult to palpate. His appetite was normal as were his bowel
movements and urination.
Shèn Qì Wán was administered, in accordance with the Jīn Guì
Yào Lüè line that states,
“For deficiency taxation
manifesting with lumbar pain, lesser abdominal hypertonicity, and inhibited
urination, Bā Wèi Shèn Qì Wán (Eight-Ingredient Kidney Qi Pill) is
indicated”.
After one month his fatigue had markedly improved and he no
longer felt the lower back and abdominal pain.
Not long after this case, I saw a woman with a floating
kidney, for which I reluctantly administered Shèn Qì Wán. Although the previous
patient had excellent results with the formula, after giving this patient Shèn
Qì Wán, she suffered from vomiting and poor appetite. The formula was discontinued
after two days. This patients’ entire abdomen was soft and weak, with water
sounds in the abdomen on percussion. In addition, her pulse was weak, appetite
poor, and she experienced abdominal, back and lumbar pain, which were affecting
her work. If Shèn Qì Wán is used in gastroptosia[2] or in patterns associated
with sluggish stomach function manifesting with poor appetite, diarrhea, or
vomiting there will frequently be side effects and great difficulty in
resolution of the patients’ condition. There is also a line related to the
formula in the Jīn Guì Yào Lüè, which states, “Eating and drinking as normal”, which
clearly specifies that Shèn Qì Wán is not indicated in cases involving
obstruction of the gastrointestinal tract. Although the line is very clear, I
still administered the formula, ignoring the pattern identification and therefore
failed to control the disease. I
changed the formula to Liáng Zhǐ Tāng, which was able to
control the symptoms, and reduce the abdominal, back and lumbar pain.
In addition, this patient also had obvious umbilical pulsations.
The famous
Japanese doctor Wada Tōkaku (和田東郭- 1744-1803), said that umbilical pulsations are a typical Dì
Huáng formula sign, but should be combined with lóng gǔ (Fossilia Ossis Mastodi), mǔ lì (Ostreae Concha), guì
zhī (Cinnamomi Ramulus) and gān cǎo (Glycyrrhizae Radix) formulas, which also
present with umbilical pulsations. Therefore one must be cautious in using Shèn Qì
Wán based on umbilical pulsations alone.
Liáng Zhǐ Tāng is líng guì cǎo zǎo
tāng (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) with the addition
of zhǐ shí (Aurantii Fructus immaturus), bàn xià (Pinelliae Rhizoma preparatum),
and liáng jiāng (Alpiniae Officinarum Rhizoma). When I find umbilical
pulsations with hardness in the abdomen, I will typically use this formula to attack and move the pain.
[1] Floating kidney is a condition that
is also termed as hypermobile kidney or the wandering kidney. The medical name
of such a condition is nephroptosis. In such a condition the kidney is seen to
drop downwards when a person stands up or is transiting from a lying down to an
upright position. It is also known as the kidney prolapse condition. The kidney
moving downward suggests that it is not fixed fully by the tissues that
surround it. Such a condition is not uncommon and has been noted over a century
by physicians in many cases.
[2] Downward displacement of the stomach.
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