Etiology and Pathogenesis of Kidney Diseases in TCM
Weak constitution from birth, congenital insufficiency; overwork and excessive sexual activity; excessive childbirth and chronic illness affecting the kidneys; and external pathogenic invasion or internal injury to the kidneys are major causes of kidney diseases.
The pathology of kidney diseases primarily stems from intrinsic kidney deficiency. For example, kidney yang deficiency leads to failure of the gate to seal properly, impaired qi movement, retention of water, or overflow onto the skin, resulting in edema or fluid retention. If the lower burner is damaged and life gate fire declines, it may lead to impotence or early-morning diarrhea. Depletion of kidney qi impairs its sealing and retention functions, causing spermatorrhea, premature ejaculation, or urinary incontinence. Kidney failure to contain qi leads to dyspnea and shortness of breath. Kidney yin deficiency fails to nourish wood (liver), causing dizziness and tinnitus. Depletion of kidney yin prevents it from ascending to nourish the heart, leading to rising false fire, heart-kidney disharmony, and symptoms such as restlessness, insomnia, palpitations, tidal fever, and night sweats. Kidney yang deficiency impairs qi transformation in the bladder, leading to urinary retention. Meanwhile, external pathogens invading the kidney, such as damp-heat accumulation or blood stasis obstruction, can also cause edema, dysuria, and lumbago.
Traditional TCM holds that “the kidney has no real syndromes” or “the kidney is mostly deficient.” Clinical observation confirms that most kidney diseases arise from kidney deficiency. However, real syndromes do exist—for example, edema, dysuria, and lumbago caused by wind invading the kidney, damp-heat accumulation, or blood stasis obstruction—these may be considered real syndromes or mixed deficiency-excess conditions.