amyjenner: May 24, 2019, 12:16am
68 yr old male. He has a gazilian interests. He is a retired art curator for big art museums. Thin, sallow, dry looking
skin, with a twinkle in the eye. Relaxed, pleasant.
Kidney Disease : “Age related chronic kidney disease”. Didn’t notice symptoms but has “advanced” kidney
disease according to blood work of GFR and Creatinine levels. He did have some unexplained wt loss 2 years ago
Thyroid and parathyroid hypo but can’t take meds dt kidney disease.
Skin : dry, sweats appropriately
Edema : sl edema around the ankles
Veins : small dark veins in feet and ankles.
Sleep : fine other than up to pee
Energy : is good. he is outdoors a lot (we live on the coast of Maine). Very active with walking, tai chi and pickle
ball.
Diet : low protein, potassium, sodium. Fish or chicken 1x per week. Sprouted grains and legumes. Mostly cooked.
No alcohol or other recreational drugs.
Thirst : not overly thirsty but likes refrigerated water, even in winter.
Bowels : tend to be a little loose
Urinary : hx of kidney stones and UTI. Has swollen prostate which he takes Tamsulosin and finasteride for. Up
once or twice at night to pee. Clear yellow, not copious.
Temp : is fine. Not too cold despite cold damp weather.
Tongue : red, thin coat, cracks all over like the dry salt lake, thin body
Abdomen : tight under the ribs, tight rectus, empty bowtie w/chopstick.
Sa’am diagnosis : LI xs. I see this as a kidney qi and yin deficiency with blood deficient, stagnant and dry. I
treated him on SP and he liked it, snoring on the table. My question is that while this is a deficient kidney disease,
I’m nervous to supplement kidney as it is liquid fire which is more kidney yang rather than yin. Is it more of a
supplement Liv situation? Cool moisture? Would appreciate any thoughts and suggestions.
KristinWisgirda: May 24, 2019, 2:27pm
26/01/2024, 11:51Kidney disease 68 yr old male – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/kidney-disease-68-yr-old-male/248/print2/4
Thanks for the case. After the LI excess, the part of the picture that stands out is lots of indications for
supplementing SI.
amyjenner:
small dark veins in feet and ankles.
Blood stasis is an indication to supplement SI. The diffusely cracked tongue is a Sa’am indication for
supplementing Taiyang water- either UB or SI. Since he isn’t hot or super loving, supplementing UB isn’t indicated
so supplement SI instead. Per a discussion with Toby on strategies for prostatitis, Toby almost always supplements
SI to help shrink it by improving tissue perfusion around this poorly vascularized organ.
Toby also talks about the common need to toggle between SI+ and K+ in the elderly since both are often indicated.
He uses the patient’s presentation at the time of treatment to help guide and then observing treatment response
closely. Do they need more consolidation with K+ or more dynamic movement with SI+? Your write up of this
patient makes him sound like a relatively vigorous 68 year old- for this reason and the reasons above, I would
supplement SI before Kidney.
I’ll ask Toby if he has other insights into kidney disease.
amyjenner: May 24, 2019, 4:48pm
Thanks for taking the time to respond. I got the blood stagnation but didnt realize that tongue would confirm SI or
UB. I have another px with a tongue like that who has Parkinsons. That is helpful. There is some heat because the
tongue is red and he prefers cold beverages despite our raw cold climate. I will work with LI xs and SI see what
happens
pattycakes: May 24, 2019, 11:13pm
Is it possible to think of K+ warming like tonifying Kidney qi, and SI+ cooling/yin nourishing? And that is why the
elderly need both?
michaelmax: May 26, 2019, 4:48am
pattycakes:
Is it possible to think of K+ warming like tonifying Kidney qi, and SI+ cooling/yin nourishing?
Hi @pattycakes, I do see +K as having warmth, as you’re tapping the heat of the shaoyin. +SI has the cold of
taiyang and the heat of being fire organ. So think of it as having dynamic movement. Like when a hot and cold26/01/2024, 11:51Kidney disease 68 yr old male – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/kidney-disease-68-yr-old-male/248/print3/4
front come together and generate storms and wind. It is very moving, and a terrific way to powerfully move blood
and qi and reduce pain.
Do keep in mind as @KristinWisgirda points out in the elderly you need to sometimes supplement KD when
working a lot with the SI. The reason for this is they are counterbalanced organ systems, so too much treatment of
the SI will in effect weaken the KD. So watch for signs of weakness in elderly or deficient patients when doing a
lot of +SI treatment.
amyjenner: May 26, 2019, 10:59am
I am still noodling about the concept of Kidney yin in Saam. I can see why Sp would cover an aspect of it with the
moisture. UB could also help if there were a lot of heat but this guy just has a little heat. It is also possible that SI
would help because the movement would relieve the stagnation that is causing the heat…Am I on the right track
with that line of thinking?
michaelmax: May 27, 2019, 1:54am
@amyjenner kidney yin is a TCM idea. We are looking more at issues of moisture/dryness,
consolidation/dispersion.
Just become someone has a western diagnosis of “kidney disease” it does not mean we would necessarily treat the
kidney. Especially as your patient sounds like a +LI, and he responded so well to treating the counterbalance of SP.
There might be a point you go more directly to the KD, but perhaps first set the fluids right and see what happens.
KristinWisgirda: May 27, 2019, 5:04pm
michaelmax:
There might be a point you go more directly to the KD, but perhaps first set the fluids right and see what
happens.
This sounds like the best strategy for managing this case. Forget about the western diagnosis and just keep
returning to viewing him through the lens of Chinese Medicine.
Taran: July 14, 2019, 6:47pm
26/01/2024, 11:51Kidney disease 68 yr old male – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/kidney-disease-68-yr-old-male/248/print4/4
One of my favorite things about Chinese medicine is that it offers us ways to meet, and treat, the whole person who
shows up in clinic. While Western medical diagnoses are an important part of our patient’s story, and consequently
something that should be attended to, they are generally not good guides for effective Chinese medical diagnosis
and treatment, in my experience.
michaelmax: July 17, 2019, 5:09pm
Taran:
While Western medical diagnoses are an important part of our patient’s story, and consequently something that
should be attended to, they are generally not good guides for effective Chinese medical diagnosis and
treatment, in my experience
My experience as well @Taran, and it seems I’m constantly having to pull myself back from the Western
perspective and keeping my focus on our Chinese medicine parameters.
Taran: July 17, 2019, 6:38pm
@michaelmax I find it is a constant study of dropping conceptual framework and relating to direct experience
while in clinic, and ceaselessly (or as close as I can manage) studying while outside of clinic. Keeps things
interesting!