Kidney Stones (Shi Lin)
Overview
Shi Lin (kidney stones) belongs to the category of strangury in TCM, characterized by painful, hesitant urination with sand or stones in the urine, corresponding to nephrolithiasis in Western medicine. The disease is located in the kidney and bladder. It commonly arises from damp-heat accumulating in the lower jiao, which concentrates urine over time to form sand and stones; or from qi stagnation and blood stasis obstructing the water passages; or from spleen-kidney deficiency with insufficient driving force. Clinically, there may be colicky flank and abdominal pain, hematuria, and interrupted urination. Pattern differentiation should distinguish excess from deficiency: excess patterns are mainly damp-heat, qi stagnation, and blood stasis; deficiency patterns are primarily spleen-kidney dual deficiency. Treatment follows the principles of clearing heat, draining dampness, freeing strangury, and expelling stones, combined with regulating qi, transforming stasis, and tonifying the spleen and kidney.
Pattern differentiation (clinical patterns)
Damp-Heat Accumulation
Frequent, painful, and hesitant urination with sand or stones in the urine, yellow-red or bloody urine, colicky flank and abdominal pain, bitter sticky taste in the mouth, dry bound stool, red tongue with yellow greasy coating, and a slippery rapid pulse.
Clear heat and drain dampness; free strangury and expel stones.
Qi Stagnation and Blood Stasis
Stabbing or distending pain in the flank and abdomen with a fixed location, difficult or interrupted urination, blood in the urine, dark red tongue with petechiae, and a wiry choppy pulse.
Regulate qi and transform stasis; free strangury and expel stones.
Spleen-Kidney Deficiency
Dribbling and hesitant urination that comes and goes, soreness and weakness of the lower back and knees, fatigue and lack of strength, dull complexion, episodes triggered by overexertion, pale tongue with white coating, and a deep thin weak pulse.
Tonify the spleen and kidney; free strangury and expel stones.
Connections
Daily care & prevention
Drink 2000-3000 mL of water daily to dilute urine and promote stone passage. Avoid high-oxalate foods such as spinach, strong tea, and nuts; limit high-purine foods such as organ meats and seafood. Moderate jumping exercises may help stones descend. Maintain emotional calm and avoid prolonged sitting. Regular consumption of winter melon, adzuki bean, and corn silk can promote diuresis. Periodically check urinary ultrasound to monitor stone size and location.
When to seek medical care
Seek immediate medical attention if there is severe colicky flank or abdominal pain with nausea and vomiting, high fever and chills, anuria or sudden marked decrease in urine output, worsening gross hematuria, or falling blood pressure, which may indicate obstructive stones complicated by infection or hydronephrosis.