Yin Edema SP and KI deficiency, chronic situation Pale & puffy face, but: LU Yang def pale, white

e SP Yang def dull, yellowish not jaundice like KI Yang def darker HR Yang pale, purple LIN Zheng Stranguria, frequent, purgent, painful urination, pain can radiate to lower abdomen as well as lower back, -more common in married women Characteristic: Frequent, difficult, painful discharge of urine, accompanied by abdominal and lumbar pain Hot (Re): feverish feeling, or real fever along with hot burning urine base pathological factor Stone: has discharge of stones, discontinuation of the stream of urine half way through urination, severe cramping in lower abdominal or lumbar area; heat coagulation of dampness Qi stagnation Lin: onset is often linked to stress, distending pain; L Jiao Qi loses soothing function Bleeding Lin: blood in urine; heat, deficiency (SP) or excess Chyluria Lin (Gao Lin): cloudy and white urine, like water after washing rice, big chunks of white, greasy clots, pain; impaired fatty transportation, dampness; deficiency type as well as excess Strain Lin (Lao): chronic, induced by exhaustion; only deficiency type -old days bleeding lin wasnt a separate category, 5 standard, but some have 8 these 6 plus excess and deficiency. -they can all transform into eachother Etiology Excess 1. Retention of damp-heat in the bladder the main one, can cause all Lins; the affection of exogenous origin may come from external genitals or either organs such as heat (fire), and small intestine heat and that of endogenous origin may be due to improper diet or alcoholic indulgence which leads to production of dampness (HR fire transforming into SI heat mouth sores) Deficiency 2. Deficiency of SP and KI commonly seen in the chronic case whose Qi is consumed or the aged, debilitated, overstrained, congenital, sickness, exhaustion 3. Stagnation of LV qi occurring after a rage with formation of fire which attacks the Lower Jiao Diagnosis

1. clinical manifestation: frequency, urgency, pain 2. urine tests Differentiation 1. with retention of urine: both have difficult urination, but Lin has pain Syndrome Differentiation 1. type of different Lin 2. under different type identify excess and deficiency 3. often complicated so differentiate the branch and root attack treat branch, remission treat root Treatment In excessive clear and since damp-heat is the most common cause we induce diuresis to clear damp-heat, cool blood if there is heat, stop beeding, soothe, ease LV if Qi X, stone removing, tonify for deficiency either SP or KI -according to the classics, lin syndrome contra indicating treatments are a) avoid inducing sweat b) avoid tonifying Qi because it can easily cause blockage (Fu Ping, Zi Su ?) Dysuria Retention of urine, urination difficulty -the total amount of urine passed every day is less than normal or even no urine at all. Long: milder, still might pass a few drops Bi: more severe, no urine at all Etiology due to urine transformation irregularity 1. excess: heat obstruction; 2. organs that deal with fluid transportation: LU, SP and KI. In urine problems its more LU and KI. SP ia also related: more the diet, pungent, greasy dmaging the KI; or overstrain and exhaustion weakens SP Qi so once Sp loses its ascending function, the turbidness cant descend retention of dampness. 3. LV soothing, easing L Jiao Qi to help the SJ function. If LV loses its soothing Qi function, SJ also might lose transformation function, Water might be retained. LV meridian also circulating in external genitalia region which esp for men is closely related to urinary tract there might be blockage Diagnosis 1. retention of urine, possible abdominal fullness, but no pain, dscharge of scanty urine, anuresis 2. history, age, gender (more common in male than female esp in older age male 3. tests bladder, kidney function, prosate to determine where the condition is in western point of view Differential diagnosis 1. LIN urgency, frequency, and pain; also the amount of urine in one day is

significantly reduced in dysurea. In Lin the amount over the entire day is normal 2. Guan Ge: dysurea and vomiting together, similar to dysurea but more severe Syndrome Differentiation 1. Excess: blockage; stone, tumor, blood stasis 2. deficiency: more sever, organ deficiency 3. prognosis: if from Long to BI not very good, if from Bi to Long its better. Treatment This is a Fu organ disorder; blockage in the bladder or urethra. We need to open the water passage to promote urination. For deficiency we need to combine with tonifying to open. Open upper Qi to go up so turbidness would go down in emergency situations; acupuncture much more effective to open uo everything in emergency Tx. Guan Ge Retention of urine, scanty urine, anuresis, nausea and vomiting. Normally under KI, but it could also relate to constipation (no urine, no BM along with vomiting). Late stage of KI failur that leads to uremia long term SP Yang qi not functioning, cant transform fluids, turbidness accumulates, toxins in the body = vomiting Characteristics 1. preonset stage: chronic nephritis before KI failur, fatuge, dark complexion, poor sleep, headaches, nausea in the morning when Yang qi starts rising, ocasioanl vomiting 2. full onset: frequent vomiting, urine taste in the mouth, rotten apple, sour taste, diarrhea or constipation, other toxic symptoms like skin itchiness, salt like pore discharge, breathing is affected slow and deep, LV wind, HR symp, bleeding Etiology & Pathogenesis This is a consequence of severe Ki disorder edema, LIN, urine retention, Ki Yang loses its function to transform fluids and toxins accumulate in the body.can mix with heat or cold 1. organs; KI, SP, LV 2. Yin, Yang collapse Diagnosis 1. Main symptom: retention of urine with vomiting 2. History: Long history of KI disorders, lin, edema, retention of urine 3. Western heck KI function, CT scan Differentiation 1. vomiting 2. retention of urine: less severe, no vomiting

Syndrome differentiation Complicated deficiency with excess during Tx distinguish which is more 1. excess: distinguish if turbid-toxic-damo mixed with cold or heat 2. deficiency Treatment Emergency condition we treat branch more, get rid of toxins; If there is lots of def we will have to tonify the organs Getting rid of turbid dampness: 1. Descending, purge from BM (in Ki failure this is very important since KI cant make urine, BM is the only way to get rid of toxins, as long as the ptn can handle it. BM has to be regular) 2. Turbid dampness turning into toxins so there is some phlegm involved so we have to transform phlegm