Lin syndrome is a common condition associated with the kidney system, characterized by its unique pathogenesis and treatment methods in addition to the general characteristics of kidney diseases. Generally, Lin syndrome is often caused by damp-heat, leading to Qi stagnation, blood stasis, stones, hematuria, and turbid urine. Over time, this can deplete Qi and injure Yin, resulting in a deficiency of the root with excess symptoms. Treatment should focus on clearing heat and unblocking Lin, while also considering nourishing and transforming Qi, with specific treatments tailored to various types.
1. Gao Lin—Emphasizing Differentiation and Focusing on Single Formulas
Traditional differentiation and treatment of Gao Lin often categorize it into deficiency and excess patterns. The excess pattern is due to damp-heat obstructing the lower jiao, causing fluids to lose their normal pathway, leading to accumulation in the bladder, impaired transformation, and inability to separate clear from turbid. The deficiency pattern is associated with other diseases harming the kidneys, resulting in instability in the lower jiao, unable to control the fluids. Formulas such as Cheng’s Pi Fen Qing Yin, Di Huang Wan, and Jin Suo Gu Jing Wan can be selected.
Clinically, Gao Lin is often seen in patients with chyluria. Due to the mixed nature of chyluria, which often involves multiple organs and is difficult to treat, simply applying the aforementioned formulas is insufficient. A more effective approach is to combine differentiation of symptoms with targeted herbal selection based on detailed differentiation.
Differentiation is based on the deficiency and excess of the organs. For patients with heart Yin deficiency and heat in the heart, use Qing Xin Lian Zi Yin (Huang Qi, Huang Qin, Shi Lian Rou, Fu Ling, Dang Shen, Mai Dong, Gan Cao, Di Gu Pi, Che Qian Zi), which clears virtual heat from the heart and drains dampness from the bladder, clarifying the source and purifying the flow, and can harmonize the functions of multiple organs in the upper, middle, and lower jiao through appropriate combinations. Shi Lian Rou, or lotus seed flesh, nourishes the heart and benefits the kidneys. According to the “Ben Cao Bei Yao,” it is said to “clear the heart, relieve irritability, stimulate appetite, and specifically treat dysentery and turbid urine symptoms.” Modern reports indicate good effects for chyluria, such as Shi Lian Zi Tang (Shi Lian Zi, Fu Ling, Che Qian Zi, Ze Xie, Pi Xian, Shu Di Huang, Dang Gui, E Jiao Zhu, Pu Huang Tan, Gan Cao).
For those with liver channel stagnation and damp-heat descending, use Long Dan Xie Gan Wan to clear the liver and drain dampness. I once treated a patient surnamed Min, who had suffered from chyluria for many years with ineffective treatments. After administering this formula for over ten doses, his urine became clear.
For those with insufficient kidney Qi, use Tu Si Zi Tang (Tu Si Zi, Fu Ling, Shan Yao, Lian Rou, Gou Qi Zi), which nourishes and gently consolidates while assisting Qi transformation;
For those with kidney Yin deficiency, use Da Bu Yin Wan, which nourishes kidney Yin and clears damp-heat;
For those with unstable kidney essence, use Zhen Ling Dan (Yu Yu Liang, Dai Zhe Shi, Zi Shi Ying, Chi Shi Zhi, Ru Xiang, Mo Yao, Wu Ling Zhi, Zhu Sha), which warms the kidneys, astringes essence, and unblocks the meridians;
For those with chronic Lin syndrome and deficiency, use Wu Bi Shan Yao Wan (Shan Yao, Rou Cong Rong, Shu Di, Shan Yao Rou, Fu Shen, Tu Si Zi, Wu Wei Zi, Chi Shi Zhi, Ba Jiao Tian, Ze Xie, Du Zhong, Niu Xi), which assists Yang, transforms Qi, and consolidates essence, or add Shui Lu Er Xian Dan to strengthen kidney essence on the basis of nourishing the spleen and kidneys.
Differentiation in treatment involves combining differentiation with single effective formulas. Commonly used herbs in clinical practice include Shui Wu Gu, Fei Lian, and Kui Hua Geng Xin. Shui Wu Gu is pungent and neutral, functions to detoxify, promote blood circulation, reduce swelling and pain, and facilitate urination. Using 60g of the dried product for decoction or 20-30g in combination with other formulas has shown good effects for treating chyluria; Fei Lian dispels wind, clears heat, drains dampness, reduces swelling, cools the blood, and disperses stasis, and has been used in the past for treating chyluria; Kui Hua Geng Xin is a folk remedy that has been used in recent decades to treat hematuria, chyluria, and urinary stones. Its light white color and light texture, similar to Tong Cao, suggest its function of promoting urination.
Case Study:
Mr. Pan, male, 50 years old, worker. Initial diagnosis in April 1986. Suffered from chyluria for several years, diagnosed with filariasis through pathogen examination. Previously treated with no significant effect. Current examination shows turbid, dark red urine, burning sensation during urination, lower back pain, weakness in the legs, mild swelling in the lower limbs, pale yellow complexion, red tongue with thin coating, and thin, rapid pulse. Urinalysis: protein (++++), red blood cells (++), white blood cells (++).
The diagnosis is Yin deficiency with fire scorching, damaging blood vessels, and the kidneys losing their ability to store. Treatment involves Da Bu Yin Wan combined with Xi Jiao Di Huang Tang, adjusted as needed.
Prescription: Salt-fried Zhi Mu, Huang Bai each 10g, Sheng Di 15g, Water Buffalo Horn 12g (first decocted), Dan Pi 10g, Chi Shao 10g, Gui Ban 12g (first decocted), Ming E Jiao 10g (melted and mixed), Da Xiao Ji each 12g, Pi 10g, Shui Wu Gu 30g, Fei Lian 10g, Mo Zao Lian 10g, Liu Yi San 15g (wrapped for decoction).
After taking 14 doses, Gao Lin significantly reduced, with urine occasionally slightly turbid. Urinalysis shows protein (++), red blood cells (+), and a few white blood cells, with other symptoms also improving. The original formula was continued. After taking 30 doses of the above formula, all symptoms alleviated, urine became clear, and urinalysis showed protein (+), with red and white blood cells negative. The above formula was adjusted by removing Da Xiao Ji and adding Tu Si Zi and Jin Ying Zi each 10g. After two months of continued treatment, he gradually recovered and returned to normal work.
2. Shi Lin—Addressing Both Symptoms and Root Causes, Combining Clearing and Nourishing
Stone accumulation in the urinary tract leads to obstruction and difficulty in urination, resulting in Shi Lin. The basic pathogenesis involves damp-heat descending, transforming into fire that scorches the Yin, boiling the urine, and forming stones, leading to stagnation in the water pathways. Treatment should focus on clearing damp-heat, expelling stones, and unblocking Lin.
Due to damp-heat accumulation in the lower jiao, obstructing the Qi transformation function, leading to Qi stagnation, blood stasis, and water retention, it is essential to combine clearing damp-heat with Qi transformation and promoting urination to eliminate the stagnation in the lower jiao.
Shi Lin, if prolonged, can easily harm the kidneys, so treatment must address both symptoms and root causes. The symptomatic treatment should primarily focus on clearing damp-heat, with options such as Ba Zheng San and Shi Wei San.
For Qi transformation, use Wu Yao and Chen Xiang, the former “breaks stasis, relieves fullness, stops pain, and reduces swelling” (according to “Yu Qu Yao Jie”), and is effective in moving Qi in the lower jiao; the latter “warms without drying, moves without leaking, supports the spleen without tiring, reaches the kidneys to guide fire back to the source, has the function of descending Qi without harming Qi” (according to “Ben Cao Tong Xuan”). Together, they assist Qi transformation, eliminate dampness, and expel stones.
For promoting urination, use Shi Wei and Hua Shi, with Shi Wei primarily for “five types of Lin, unblocking and facilitating urination” (according to “Shang Jing”), and Hua Shi for “treating five Lin” (according to “Yao Xing Lun”). Together, they form Shi Wei San (according to “Gu Jin Lu Yan”), which excels in promoting urination, dissolving stones, and unblocking kidney pathways. For invigorating blood, use Wang Bu Liu Xing and Chuan Shan Jia, the former “facilitates urination” (according to “Gang Mu”), promotes blood circulation, and is good for downward movement; the latter “moves Qi and blood” (according to “Dian Nan Ben Cao”), disperses stasis and alleviates pain.
For those with significant Qi stagnation and blood stasis, commonly used are amber and Chen Xiang, ground into powder and mixed for oral administration, 2g each time, taken twice daily, showing good effects in regulating Qi, invigorating blood, unblocking Lin, and relieving pain.
For prolonged Shi Lin, with damp-heat accumulation harming Yin and depleting Qi, it is advisable to combine clearing and nourishing, starting with kidney tonification, aiming to strengthen the root and stabilize the essence, thereby enhancing the kidney’s ability to expel stones and promote urination.
For those with Yin deficiency, often use Zhi Bie Jia, which nourishes Yin, softens hardness, and dissolves stones. The “Zhou Hou Fang” uses this as a single formula for treating Shi Lin. For Yang deficiency, use Lu Jiao Pian, which warms and stimulates kidney Qi to promote stone expulsion.
For those with Qi deficiency, combine with walnut meat, which warms Qi and tonifies the kidneys. Zhang Xi Chun states it “dissolves hardness, opens stasis, treats abdominal pain, and is effective for sand Lin and stone Lin causing pain, and kidney failure unable to filter water, leading to difficulty in urination.” It is also used as a single formula for treating Shi Lin with certain effects. Additionally, use Wei Yu Nao Shi, ground into powder and taken orally, 3-6g each time, showing good effects, as stated in “Kai Bao Ben Cao,” which claims it is “mainly for treating stone Lin.”
Case Study:
Ms. Xu, female, 42 years old, worker. Diagnosed in October 1989. The patient experienced recurrent lower back cramping pain accompanied by visible hematuria for two months. An abdominal X-ray revealed several right kidney stones (approximately 0.4cm x 0.6cm), with a small amount of hydronephrosis.
Current symptoms include lower back pain, frequent episodes, discomfort in the lower abdomen, reddish and painful urination, wiry pulse, red tongue with thin yellow greasy coating. The diagnosis is lower jiao damp-heat, accumulating into stones, obstructing the urinary tract, and impairing Qi transformation. Treatment is proposed to clear damp-heat and expel stones, unblocking Lin.
Prescription: Cang Zhu 10g, Chuan Bai 10g, Chuan Niu Xi 10g, Shi Wei 10g, Dong Kui Zi 10g, Qu Mai 12g, Chen Xiang 6g, Wu Yao 6g, Amber 3g (ground into powder for oral administration), Wang Bu Liu Xing 10g, Hua Shi 15g (wrapped for decoction), Ze Lan 15g, Ze Xie 15g, Che Qian Zi 12g (wrapped for decoction).
After taking 14 doses, the episodes of lower back pain gradually decreased, and hematuria improved, with only occasional microscopic examination showing red blood cells (+), urine yellow, and slight burning sensation during urination. The tongue and pulse remained the same, and the original formula was continued. After taking 20 doses of the above formula, the lower back pain disappeared, and routine urinalysis showed no abnormalities. Follow-up abdominal X-ray revealed no stone shadows.
In summary, regardless of the type of Lin syndrome, treatment should always address both symptoms and root causes, combining clearing and nourishing approaches. On the basis of regulating and unblocking, incorporate methods for Qi transformation, promoting urination, invigorating blood, and dissolving stones to achieve better therapeutic effects.
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Thisarticle is sourced from: Ming Yi Open Class, excerpted from “Learning Clinical Practice from Famous Teachers: Zhou Zhongying”.
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