"Do I have kidney deficiency?" It is a question that comes up often — and the term circulates locally through advertising, short videos and word of mouth, not through TCM texts.

The answer first. In TCM theory, the kidney stores essence: 「肾」 stores and secures the essence of the body, the foundation of growth and reproduction; it also governs water metabolism, governs the bones and generates marrow, opens into the ears, and governs the reception of qi. [WHO-2022]

「肾虚证」 in the same standard is the name of a pattern, and its description mentions: this pattern often results from congenital deficiency, postnatal over-exertion or chronic diseases. [WHO-2022]

So 「肾虚」 is about that whole set of functions in TCM theory being insufficient — not about the figures for the two organs on a blood test. When to see a doctor first is section V. Set out in 5 points.

I. First: the TCM "kidney" is not your kidneys

This is the source of every other misunderstanding, and the first thing to get clear.

In TCM theory, 「肾」 is the name of a functional system. The WHO's standard terminology for TCM defines the kidney system as a functional system composed of the kidney, urinary bladder, bones, hair, ears, urethra, anus, and kidney meridian. [WHO-2022]

The kidney of modern anatomy is a different order of thing — one is a functional category inside a theoretical model, the other is an organ you can see on a scan and assess with a blood test.

The two do not translate into each other. TCM 「肾虚」 and the kidney-function figures on a blood test measure two different things — one being normal does not mean the other is, and one being abnormal does not mean the other must be. Testing the organ, likewise, does not go through the TCM concept.

• The creatinine and GFR on a blood test measure the kidney as an organ. What they measure is in section VI.
• The TCM 「肾」 counts bones, hair and ears as part of itself — because it is a functional category, not anatomy.

II. What 「肾」 and 「肾虚」 actually are

Everything below is TCM theory, defined from the WHO's 2022 standard terminology.

① The kidney stores essence (肾藏精). The standard's description is: the kidney stores and secures the essence of the human body. [WHO-2022]

Kidney essence, in the same standard, is: the essence stored in the kidney, inherited from one's parents and nourished by water and food, known as the foundation of the physiological activities of the kidney. [WHO-2022]

TCM theory therefore calls the kidney the "congenital foundation": the kidney essence inherited from parents is fundamental to growth and reproduction. [WHO-2022]

② The kidney governs reproduction (肾主生殖). The standard's description is: the function of kidney essence and qi in boosting the maturity of reproductive organs and maintaining reproductive ability. [WHO-2022] The standard's entry does not distinguish between men and women.

③ The kidney governs water and fluids (肾主水液). The standard's description is: the kidney governs and regulates water metabolism. [WHO-2022]

④ The kidney governs the bones, generates marrow, and its lustre shows in the hair. Kidney essence generates marrow to nourish bones; the colour and lustre of hair manifest the functioning of the kidney. [WHO-2022]

⑤ The kidney opens into the ears, and into the urethra and anus. The ears are nourished by kidney essence and qi and are the opening orifice of the kidney; the kidney secures essence and dominates the urethra and anus. [WHO-2022]

⑥ The kidney governs the reception of qi (肾主纳气). The kidney receives and holds the clear qi inhaled by the lung to maintain the depth of breathing. [WHO-2022] And the emotion of the kidney is fear: fear is associated with the kidney. [WHO-2022]

That is the scope of 「肾」 in TCM theory: essence, reproduction, water, bones and hair, the ears, the depth of breathing. Far wider than the "one particular use" it is narrowed to in local advertising.

And 「肾虚」? 「肾虚证」 in the same standard is the name of a pattern, and its description mentions: this pattern often results from congenital deficiency, postnatal over-exertion or chronic diseases. [WHO-2022]

The standard lists it under "patterns of the kidney system", and the kidney deficiency pattern is only one of them — the same section also lists kidney qi deficiency, kidney yin deficiency, kidney yang deficiency and kidney essence deficiency patterns, among others. [WHO-2022]

That is exactly why "just tonify" does not follow: which pattern applies is the practitioner's judgement after seeing the whole picture, and the method of tonifying follows that judgement — not the other way round.

With the definitions in place, one more thing needs saying: these words belong after a consultation. The same set of presentations can point to different patterns in TCM theory, so the term is a practitioner's word after assessment — not a label for a reader to match against themselves.

III. What 「肾」 models in the theory: one chain, several routes

Section II gave the definitions. This section answers two questions: why bones, the lower back and body fluids sit under 「肾」 in TCM theory; and what that 「肾」 and the kidneys on a screening report are each talking about.

① Essence comes first. The WHO standard describes kidney essence as: the essence stored in the kidney, inherited from one's parents and nourished by water and food, the foundation of the physiological activities of the kidney. [WHO-2022]

"The kidney stores essence" — the kidney stores and secures the essence of the human body [WHO-2022] — is, in the theory, where this functional system starts.

② Essence, marrow, bone: one chain. The standard records "the kidney generates marrow": kidney essence transforms into and generates bone marrow [WHO-2022]; and "the kidney governs the bones": kidney essence generates marrow to nourish bones. [WHO-2022]

The direction is: essence → marrow → bone. Bones sit under 「肾」 in the theory not because the anatomical kidney is attached to the skeleton, but because the theory assigns the essence that nourishes bone to the kidney.

This sentence is the article's integration of the two definitions above, not the standard's own words.

③ The water route. "The kidney governs water and fluids": the kidney governs and regulates water metabolism. [WHO-2022] The standard's kidney system also includes the urinary bladder and the urethra. [WHO-2022]

So in the theory's model, urine and body fluids fall under this same set of functions.

④ So why does an aching back get pinned on 「肾」? The often-heard phrase 「腰为肾之府」 ("the lower back is the house of the kidney") is quoted, in a column from the School of Chinese Medicine at The Chinese University of Hong Kong, from the Huangdi Neijing (《黄帝内经》) as 「腰者肾之府」. [CUHK-SCM]

It comes from a classical text; it is not an entry in the WHO standard, and this article does not use it as a definition. What connects the lower back to the kidney in the standard is its symptom entries themselves.

"Lower back pain" (腰痛) is described in the standard as: pain on one or both sides of the lumbar vertebrae, which often results from kidney problems, low back trauma or strain, or cold damp or damp heat affecting the lumbar region [WHO-2022] — and "kidney" here is still the theory's functional system.

The "low back soreness" (腰酸) entry says it often results from ageing, chronic diseases, over-exertion, emotions and the like; alternatively, it may also occur when external pathogens or traumatic injuries damage the flow of meridian qi and blood. [WHO-2022]

In other words, even inside the theory, lower back pain has several routes and 「肾」 is one of three; the low back soreness entry's routes do not name 「肾」 at all. A friend's "an aching back means kidney deficiency" skips the other routes the theory itself lists.

Which route applies is the practitioner's judgement after seeing the whole picture.

⑤ The organ on the report, set beside it. The National Kidney Foundation of Malaysia describes the kidneys as organs this way.

They filter 180 litres of fluid a day to produce 2 litres of urine; remove harmful wastes from the body via urine; and keep the body's internal environment constant. [NKF-MY-Facts]

The same page says the kidneys produce certain hormones: erythropoietin, which stimulates the bone marrow to produce red blood cells, and renin, which regulates blood pressure; and they activate vitamin D, which helps maintain calcium balance in the bones. [NKF-MY-Facts]

Both descriptions use the words "bone" and "marrow". That is not evidence: one is a functional category inside a theory, the other is a physiological description of an organ. This article does not use either to prove the other, and does not translate between them.

⑥ So 「肾虚」 and kidney disease are two different claims. 「肾虚证」 is a pattern name in TCM theory [WHO-2022], reached by a TCM practitioner after seeing the whole picture.

Whether the kidney as an organ is diseased is established by a urine test for protein and a blood test for creatinine [NKF-MY], and judged by a doctor.

One claim holding in the theory does not mean the other holds in the laboratory, and the reverse is equally true. Section VI covers what the blood test measures.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

IV. One table: common situations, what TCM theory says, what is usually done

Definitions done, this section sets a few common situations side by side. The "what TCM theory says" column is theory, not a judgement about you; the "usual practice" column comes from public patient information.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

V. See a doctor first in these situations

If what actually worries you is the organ, that needs testing to establish. See a doctor first if there is:

• A marked increase or decrease in how much you pass
• Persistently foamy urine that does not settle
• Swelling around the eyes or in the lower legs
• Persistent flank pain, particularly with fever — call 999 now, or go to the nearest emergency department
• Blood in the urine, or a marked change in colour
• Existing hypertension or diabetes — both relate to kidney function monitoring; keep to the schedule your doctor sets
• Long-term painkiller use, or supplements of unknown origin — tell your doctor

Kidney function is assessed by blood and urine tests, and a TCM consultation does not substitute for them.

⚠️ A safety note: TCM and Western medicine complement each other; it is not a choice between them. If you are under medical treatment, never stop a prescription on your own. There are many products marketed for "kidney tonifying" — anything of unclear origin or composition is not something to take on your own, and whatever you are taking should be mentioned to both your doctor and your practitioner.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

VI. What the blood test measures, how to read a tonic packet, and what the consultation does

Once the situations in section V are ruled out, this section covers three things: what those figures on the report measure, how to read a tonic packet from the packaging up, and what a TCM consultation actually does.

① What the blood test measures. The National Kidney Foundation of Malaysia recommends an annual health screening that includes: a urine test for protein, blood pressure, a blood test for glucose, and a blood test for creatinine. [NKF-MY]

Creatinine is a waste product that comes from muscle activity; the kidneys normally remove it from the blood, and when the kidneys are damaged, blood creatinine may build to a high level. [NKF-MY]

The doctor uses the creatinine result, together with your age, race and gender, to estimate the glomerular filtration rate (GFR) — GFR tells how much kidney function you have. [NKF-MY]

The NHS puts the calculation more concretely: a doctor uses the blood test result to calculate how many millilitres of waste the kidneys should be able to filter in a minute — this calculation is known as the estimated glomerular filtration rate (eGFR). [NHS-CKD]

Why creatinine is the figure looked at: the National Kidney Foundation writes that a build-up of creatinine in the blood indicates kidney function and the level of kidney impairment. [NKF-MY-Facts] In other words, that number is a yardstick for "how much filtering capacity is left", not a yardstick for 「肾虚」.

Protein in the urine: when the kidneys are damaged, protein leaks into the urine; two positive tests over several weeks is called persistent protein in the urine, and is a sign of chronic kidney disease. [NKF-MY]

The NHS urine test also checks the levels of albumin and creatinine in the urine — the albumin:creatinine ratio, or ACR — and checks for blood or protein in the urine; alongside the eGFR, urine tests can help give a more accurate picture of how well the kidneys are working. [NHS-CKD]

So it is two tests, not one.

Why it is done on a schedule rather than when something feels wrong: the NHS position is that because chronic kidney disease often has no symptoms in the early stages, some people at higher risk should be tested regularly. [NHS-CKD]

At what point the creatinine figure starts to move noticeably, none of these pages explains, and this article does not fill that in.

All of this is the doctor's work. A TCM consultation does not run these tests and does not read these figures; keep the report and show it at the consultation.

② How to read a tonic packet: one example. Suppose there is a packet of pills in your hand with 「补肾」 on the front. Using this article's own logic, read it from the packaging up, one step at a time.

• Find the number. In Malaysia, registered medicines, traditional and proprietary Chinese medicines included, carry a registration number beginning with MAL and a Meditag hologram on the packaging [MOH-PSP]; products and remedies of unknown origin, or with no registration number, sit outside that review. The format is "MAL" followed by 8 digits and a final letter; the example number on the Ministry of Health's page is MAL20125467T. [MOH-PSP]
• Read the last letter. It indicates the registration category: T for natural products and traditional medicines, N for health supplements. [MOH-PSP] Two packets both labelled 「补肾」 may be registered one as a traditional medicine and the other as a health supplement — the letter tells you which category it was submitted under.
• Check the current status. Go to Product Search on npra.gov.my and search by product name or registration number; for a registered product, the registration status is displayed [MOH-PSP]; the "NPRA Product Status" app does the same. [NPRA-2019] Why check when there is already a number: in a 2019 press release, the NPRA reported a traditional product found to contain sildenafil and tadalafil, and its registration was cancelled [NPRA-2019] — it had a registration, and lost it. The number printed on the packet speaks for the day it was printed; the search result speaks for today.
• Verify the Meditag label. After checking the registration number, the Ministry of Health advises checking the validity of the hologram label through a pharmacist at a nearby hospital, clinic or pharmacy. [MOH-PSP]
• Ask "tonify which pattern". Registration answers "has this product been through review"; it does not answer "which pattern is it for". The word 「补肾」 on the packet does not say which of the kidney patterns listed in the standard it corresponds to [WHO-2022]; whether to tonify, and what, is the practitioner's call after seeing the whole picture.
• If you take prescribed medication, tell your doctor and your practitioner first, and never stop a prescription on your own.

These steps read a packet, not a person. What you have at the end is "what this is, what review it has been through, and who to ask" — not "what happens if I take it".

One more line from that press release: sildenafil and tadalafil may only be supplied by a doctor or from a pharmacy on a doctor's prescription; they and their analogues are not permitted in medicines classified as traditional. [NPRA-2019]

③ In these situations, ask before taking any "kidney tonic" product. On long-term prescribed medication · pregnant or trying to conceive · breastfeeding · under 12 · older adults · before surgery · a chronic condition under a doctor's review.

Each of these is a tell-your-doctor-and-practitioner-first situation; if you are under medical treatment, never stop a prescription on your own. On taking Chinese herbs alongside Western medication, see "Can you take Chinese herbs with Western medication?" (/chinese-herbs-with-western-medicine/).

④ What the practitioner actually does at the consultation.

• Routine first, pattern later. The practitioner asks about your sleep, your workload, whether this is crunch season, your diet and movement, and why the word 「肾虚」 came to mind in the first place.
• What you are taking. Prescribed medication, over-the-counter products from a pharmacy, a tonic pill from a parent, a supplement from direct sales. Doing this safely depends on both sides knowing.
• Assessment. Only after seeing the whole picture does the practitioner say whether this is 「肾虚证」, another of the patterns listed in section II, or not a kidney pattern at all. That step comes after the consultation, not before it.
• Then a direction, not a promise. The options a practitioner may raise include acupuncture, herbal medicine, and a direction on routine and diet. Which suits you, and whether to use any, is decided between you and the practitioner at the consultation.
• This article does not say "what the effect will be", because that belongs to an individual assessment, not to an article.

On how assessment works: what pattern differentiation is. The term often comes up alongside tiredness and low energy in men: how TCM looks at tiredness and low energy in men.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

Fitting it into life in Malaysia

• What the ads and short videos say. Section II's definition is a yardstick. Does the "kidney" in the ad match those six things — essence, reproduction, water, bones and hair, ears, breathing — or is only "one particular use" left.
• The self-test your friend forwarded. Useful as a starting point for a question, not as a conclusion. Bring the screenshot to the consultation and discuss it; that is more useful than matching yourself against it.
• Tonic packets bought by family, "kidney tonic" herbs from the medicine shop. Mention the contents and where they came from. If it has packaging, look for the MAL number and the Meditag label first [MOH-PSP], then walk through the steps in section VI ②.
• A "kidney tonic" supplement a direct-sales friend recommends. Check the registration status the same way [NPRA-2019], then bring it to the consultation as a question.
• Your annual company health screening. The kidney items are usually a urine test for protein and a blood test for creatinine. [NKF-MY] What the eGFR on the report measures is in section VI ①. Keep the report and mention it.
• Crunch season. The kidney deficiency pattern's description contains the words "postnatal over-exertion" [WHO-2022] — but that is theory. Whether it is that pattern is known only after the whole picture is seen.
• Supplements from the gym or bought online. Protein powders, amino acids, capsules of uncertain origin — say so, especially anything long-term.
• Already following up a chronic condition at a Klinik Kesihatan or a private clinic. Say so, including any medication.

Frequently asked

Will kidney deficiency turn into kidney disease? They are two different languages, and one does not "turn into" the other. 「肾虚证」 is a pattern name in TCM theory, whose description mentions that it often results from congenital deficiency, postnatal over-exertion or chronic diseases [WHO-2022]; whether the kidney as an organ has a problem is established by a urine test for protein and a blood test for creatinine with a GFR estimate, and judged by a doctor [NKF-MY]. If the organ is what worries you, get tested; do not use the TCM term to guess. Why these are two different claims is set out in section III ⑥.

Do all middle-aged men have kidney deficiency? No. 「肾虚证」 is a pattern name; the standard's description mentions congenital deficiency, over-exertion or chronic diseases, and says nothing about age or sex. [WHO-2022] It is a practitioner's judgement after assessment, not a label for an age group. Tying it to middle-aged men is local advertising's usage; the standard's own definition carries no such restriction.

Can women be told they have kidney deficiency too? Yes. The TCM 「肾」 governs essence, reproduction, water, bones and hair, the ears and the depth of breathing, and the standard's entries do not distinguish between men and women. [WHO-2022] Whether it is that pattern is, again, the practitioner's assessment. If you are pregnant, trying to conceive or breastfeeding, tell your doctor and your practitioner before any "kidney tonic" product.

Is back pain the same as kidney deficiency? No. TCM theory holds that the kidney governs the bones [WHO-2022], but back pain is a presentation, not a pattern name; the standard's own "lower back pain" entry lists three routes — kidney problems, trauma or strain, cold damp or damp heat [WHO-2022] — and 「肾」 is only one of them (section III). The NHS position is that back pain often improves on its own within a few weeks — stay active, do not stay in bed for long periods. [NHS-背痛] With fever: call 999 now (section V). Pain, tingling, weakness or numbness in both legs; loss of feeling around the genitals or anus; changes in bladder or bowels, such as difficulty peeing or incontinence; chest pain; or pain that started after a serious accident: call 999 now, or go to the nearest hospital emergency department. [NHS-背痛] Severe pain that starts suddenly or is getting worse quickly: see a doctor urgently, the same day. [NHS-背痛]

Can I take kidney tonic pills? Check the registration first: registered medicines carry a registration number beginning with MAL and a Meditag hologram [MOH-PSP], and registration status can be checked at npra.gov.my or on the "NPRA Product Status" app. [NPRA-2019] Then ask "tonify which pattern": the standard lists more than one kidney pattern [WHO-2022], and the method follows the assessment. If you take prescribed medication, tell your doctor and your practitioner first, and never stop a prescription on your own. Section VI ② reads one packet from its number through to "who to ask".

My blood test is normal — can I still have "kidney deficiency"? Possibly, because the two measure different things. The blood test looks at the kidney as an organ [NKF-MY]; 「肾虚证」 is a pattern name for the functional system called 「肾」 in TCM theory [WHO-2022], reached by a practitioner's assessment. A normal report does not mean the practitioner will say 「肾虚」, and an abnormal one does not either. Bring the report all the same, because it decides the section V half. What the eGFR on it measures is in section VI ①.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

In closing

✅ Worth remembering:

1. In TCM theory the kidney stores essence and governs reproduction, water, bones and hair, the ears and the reception of qi [WHO-2022] — 「肾」 is a functional system, not the two organs. Bones sit under 「肾」 because of the theory's essence → marrow → bone chain [WHO-2022].
2. 「肾虚证」 is a pattern name, often resulting from congenital deficiency, over-exertion or chronic diseases; the standard lists more than one kidney pattern [WHO-2022], so "just tonify" does not follow.
3. The kidney items in an annual screening measure urine protein and creatinine, from which the doctor estimates GFR [NKF-MY] — the eGFR is a calculation of how many millilitres of waste the kidneys should be able to filter in a minute. [NHS-CKD] A TCM consultation does not substitute for those tests.
4. For a tonic pill, look for the MAL number and the Meditag label first [MOH-PSP], then check its current registration status [NPRA-2019], then ask which pattern it is meant to tonify.
5. Swelling, foamy urine, changes in output, back pain with fever — see a doctor first.

❌ Better not to:

1. Take an advertisement's "kidney deficiency" as your own diagnosis.
2. Buy tonifying products of unclear origin or composition on your own.
3. Stop prescribed medication on your own because you have started TCM care.

👉 If you are not sure whether the "kidney deficiency" in the advertisement has anything to do with you, you are welcome to book an online consultation with HansMed, where a practitioner registered under the T&CM Act 2016 can assess it with you; if what worries you is the organ itself, or if anything in section V applies, see a doctor for tests first.

Reviewed by Mr. Lim Gao Hong, a TCM practitioner registered with Malaysia's Traditional and Complementary Medicine Council under the T&CM Act 2016, practising in general TCM, pain management and internal medicine.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

「医师，我是不是肾虚？」不少读者常问这句话——而这个词在本地主要透过广告、短视频与朋友之间流传，不是透过中医文献。

先说结论。 中医理论认为「肾藏精」：「肾」贮藏并固摄人体的精，是生长与生殖的根本；它同时主水液代谢、主骨生髓、开窍于耳、主纳气。[WHO-2022]

「肾虚证」在同一份标准里是一个证的名称，说明提到：此证常由先天不足、后天过劳或慢性疾病所致。[WHO-2022]

所以，「肾虚」讲的是中医理论里这一整组功能不足——不是验血报告上那两颗肾脏的数值。哪些情况请先看医生，在第五节。整理成 5 个重点。

一、先分清楚：中医的「肾」不是您的肾脏

这是所有误会的源头，也是要先分清楚的一点。

在中医理论中，「肾」指的是一个功能系统。世界卫生组织的中医术语标准把「肾系统」定义为由肾、膀胱、骨、发、耳、尿道、肛门与肾经组成的功能系统。[WHO-2022]

它与现代解剖学里的肾脏（kidney）是两个不同层次的东西——一个是理论模型里的功能分类，一个是可以在影像上看见、可以验血评估的器官。

两者不能互相翻译。 中医说的「肾虚」和验血报告上的肾功能，量的是两件事——一个正常，不代表另一个也正常；一个异常，也不代表另一个一定异常。肾脏这个器官的检查，也不靠中医的「肾」这个概念。

• 验血报告上的肌酸酐、GFR，量的是肾脏这个器官。它们量什么，第六节说明。
• 中医说的「肾」，把骨、发、耳都算在内——因为它是功能分类，不是解剖。

二、「肾」与「肾虚」到底是什么

以下全部是中医理论的说法，用世界卫生组织 2022 年的中医术语标准来定义。

① 肾藏精。 标准的说明是：肾贮藏并固摄人体的精。[WHO-2022]

「肾精」在同一份标准里的说明是：藏于肾的精，禀受于父母、由饮食水谷所养，是肾生理活动的基础。[WHO-2022]

中医理论因此称肾为「先天之本」：禀受于父母的肾精，是生长与生殖的根本。[WHO-2022]

② 肾主生殖。 标准的说明是：肾精与肾气促使生殖器官成熟、维持生殖能力的功能。[WHO-2022] 标准的这一条没有区分男女。

③ 肾主水液。 标准的说明是：肾主管并调节水液代谢。[WHO-2022]

④ 肾主骨、生髓，其华在发。 肾精生髓以养骨；头发的色泽反映肾的功能。[WHO-2022]

⑤ 肾开窍于耳与二阴。 耳受肾精肾气濡养，是肾的窍；肾固摄精，主管尿道与肛门。[WHO-2022]

⑥ 肾主纳气。 肾接纳并保持肺吸入的清气，以维持呼吸的深度。[WHO-2022] 「肾在志为恐」：恐与肾相配。[WHO-2022]

这就是「肾」在中医理论里管的范围：精、生殖、水液、骨与发、耳、呼吸的深度。比本地广告里那「某一方面的用途」宽得多。

那「肾虚」呢？ 「肾虚证」在同一份标准里是一个证的名称，说明提到：此证常由先天不足、后天过劳或慢性疾病所致。[WHO-2022]

标准把它列在「肾系证类」之下，而「肾虚证」只是其中之一——同一节还列有肾气虚证、肾阴虚证、肾阳虚证、肾精亏虚证等。[WHO-2022]

这正是「补就对了」不成立的原因：哪一个证成立，是医师看过整体之后的判断，补法跟着判断走，不是反过来。

有了定义，还有一件事要说清楚：这些词属于问诊之后。 同一组表现在中医理论中可能指向不同的证，所以它是医师辨证后的用语，不是读者拿来对照自己的标签。

三、「肾」在理论里是怎么一回事：一条链，几条路

第二节给了定义。这一节回答两个问题：为什么在中医理论里，骨头、腰和水液会被放在「肾」底下；以及这个「肾」和体检报告上的肾脏，各自在说什么。

① 先有「精」。 世界卫生组织的标准把「肾精」说明为：藏于肾的精，禀受于父母、由饮食水谷所养，是肾生理活动的基础。[WHO-2022]

「肾藏精」——肾贮藏并固摄人体的精 [WHO-2022]——在理论里，就是这个功能系统的起点。

② 精、髓、骨，一条链。 标准记录「肾生髓」：肾精化生并生成骨髓 [WHO-2022]；「肾主骨」：肾精生髓以养骨。[WHO-2022]

方向是这样的：精 → 髓 → 骨。骨头在理论里挂在「肾」底下，不是因为解剖上肾脏连着骨头，而是因为理论把养骨的那份「精」归给了肾。

这一句是本文对上面两条定义的整理，不是标准的原句。

③ 水液这条路。 「肾主水液」：肾主管并调节水液代谢。[WHO-2022] 标准定义的「肾系统」也把膀胱与尿道算在内。[WHO-2022]

所以在理论的模型里，小便和水液的事，也归在这一组功能名下。

④ 那「腰酸」为什么会被扯到「肾」？ 常听到的「腰为肾之府」，香港中文大学中医学院的一篇专栏引为《黄帝内经》的「腰者肾之府」。[CUHK-SCM]

它出自古籍，不在世界卫生组织标准的词条里，本文不用它作定义；标准里把腰和肾接起来的，是症状词条本身。

「腰痛」在标准里的说明是：腰椎一侧或两侧疼痛，常由肾的问题、腰部外伤或劳损、或寒湿／湿热侵袭腰部所致 [WHO-2022]——这里的「肾」仍是理论里的那个功能系统。

「腰酸」词条则说它常由年老、慢性疾病、过劳、情志等所致；另外也可因外邪或外伤损伤经络气血而起。[WHO-2022]

换句话说，就算只看理论，腰痛也有好几条路，「肾」只是三条之一；「腰酸」词条列的那几条，更没有一条写着「肾」。朋友那句「腰酸就是肾虚」，跳过了理论自己列出的其他几条路。

哪一条路成立，是医师看过整体之后的判断。

⑤ 报告上的肾脏，放在旁边看。 马来西亚全国肾脏基金会对肾脏这个器官的说明是这样的。

它每天过滤 180 公升的液体、产生 2 公升的尿液；把有害的废物经尿液排出体外；维持体内环境的稳定。[NKF-MY-Facts]

同一页也写，肾脏分泌几种激素：刺激骨髓制造红血球的促红细胞生成素、调节血压的肾素；并活化维生素 D，帮助维持骨骼中的钙平衡。[NKF-MY-Facts]

两边都用到「骨」「髓」这些字。但这不是证据：一边是理论里的功能分类，一边是器官的生理说明。本文不用其中一边去证明另一边，也不把它们互译。

⑥ 所以「肾虚」和「肾病」是两个不同的说法。 「肾虚证」是中医理论里的一个证名 [WHO-2022]，由中医师看过整体之后判断。

肾脏这个器官有没有病，靠验尿看蛋白、验血看肌酸酐 [NKF-MY]，由医生判断。

一句话在理论里成立，不代表另一句在化验室里成立；反过来也一样。第六节说验血在量什么。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

四、一张表看懂：常见的情况，中医理论怎么说，一般怎么做

定义说完，这一节把几个常见的情况并排放在一起。「中医理论的说法」一栏是理论，不是对您的判断；「一般做法」一栏来自公开的患者资讯。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

五、这些情况请先看西医

如果您担心的其实是肾脏本身，那需要检验才能知道。以下情况请先就医：

• 小便量明显变多或变少
• 小便有大量泡沫，久久不散
• 眼睑或下肢水肿
• 腰部持续疼痛，尤其伴随发烧——请立刻拨打 999，或前往最近的急诊部
• 小便带血，或颜色明显改变
• 已有高血压或糖尿病——这两者与肾脏功能的追踪有关，请按医生的安排定期检查
• 长期服用止痛药或来源不明的补品——请让医生知道

肾脏功能需要验血与验尿才能评估，中医问诊不能取代这些检查。

⚠️ 安全提醒：中医与西医是互相补位的关系，不是二选一。若您正在西医治疗中，切勿自行停药。市面上有不少标示「补肾」功能的产品，来源与成分不明的一律不建议自行服用，并请把您正在吃的东西告诉医生与医师。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

六、验血在量什么、一包补肾丸怎么读、看诊时又会做什么

第五节的情况排除之后，这一节说清楚三件事：报告上那几个数字量的是什么、一包补肾丸怎么从包装读起，以及中医问诊实际会做什么。

① 验血在量什么。 马来西亚全国肾脏基金会建议每年做健康筛查，项目包括：验尿看蛋白、量血压、验血看血糖、验血看肌酸酐。[NKF-MY]

肌酸酐是肌肉活动产生的废物，正常由肾脏从血液中清除；肾脏受损时，血液中的肌酸酐可能升高。[NKF-MY]

医生会用肌酸酐的数值，加上年龄、种族与性别，估算肾小球过滤率（GFR）——GFR 说明的是肾功能还有多少。[NKF-MY]

英国 NHS 把这个计算说得更具体：医生用验血的结果，计算肾脏每分钟应能过滤多少毫升的废物——这个计算结果就是 eGFR（估算肾小球过滤率）。[NHS-CKD]

为什么看的是肌酸酐：全国肾脏基金会写道，血液中肌酸酐的堆积，可以指示肾功能与受损的程度。[NKF-MY-Facts] 换句话说，那个数字是一把量「还剩多少过滤能力」的尺，不是量「肾虚」的尺。

尿液里的蛋白：肾脏受损时，蛋白会漏进尿液；几个星期内两次验出蛋白，称为持续性蛋白尿，是慢性肾脏病的一个征兆。[NKF-MY]

NHS 的验尿项目还包括尿液中白蛋白与肌酸酐的比值（ACR），以及尿中有没有血或蛋白；配合 eGFR，验尿能让「肾脏运作得怎么样」这幅图更准确。[NHS-CKD]

所以是两项检验，不是一项。

为什么要定期查、而不是等有感觉才查：NHS 的说法是，慢性肾脏病早期常常没有症状，所以风险较高的一些人应该定期检查。[NHS-CKD]

至于肌酸酐的数字要到什么程度才会明显变化，这几页都没有说明，本文也不替它们补。

这些都是医生的工作。中医问诊不做这些检验，也不解读这些数字；报告请留着，看诊时一并出示。

② 一包补肾丸，怎么读：一个例子。 假设手上有一包写着「补肾」的丸药。用这篇的逻辑，从包装读起，一步一步。

• 找编号。 在马来西亚，注册药品（包括传统药与中成药）的包装上有以 MAL 开头的注册编号与 Meditag 防伪标签 [MOH-PSP]；来源不明、没有注册编号的产品与偏方，不在这个审查范围内。编号的格式是「MAL」加 8 位数字、再加一个字母；卫生部页面上的示例编号是 MAL20125467T。[MOH-PSP]
• 看最后那个字母。 它说明注册类别：T 是天然产品／传统药，N 是保健品。[MOH-PSP] 两包同样写着「补肾」的东西，可能一包以传统药注册、另一包以保健品注册——字母告诉您它是以哪一类送审的。
• 查现在的状态。 到 npra.gov.my 的 Product Search，用产品名或注册编号查询，注册产品会显示注册状态 [MOH-PSP]；也可用「NPRA Product Status」应用程式。[NPRA-2019] 有编号为什么还要查：NPRA 在 2019 年的一则新闻稿中，一款传统产品被检出含有西地那非（sildenafil）与他达拉非（tadalafil），注册被取消 [NPRA-2019]——它曾经有注册，后来被撤销。印在包装上的编号说的是印刷时的状态，查询结果说的是现在的状态。
• 核对 Meditag 标签。 查完编号后，卫生部建议到附近的医院、诊所或药剂行，请药剂师核对防伪标签的真伪。[MOH-PSP]
• 问「补哪一个证」。 注册回答的是「这个产品有没有经过审查」，不回答「它对应哪一个证」。包装上的「补肾」两个字，没有说它对应标准里列出的哪一个肾证 [WHO-2022]；要不要补、补什么，是医师看过整体之后的事。
• 正在吃医生开的药的，先告诉医生与医师，切勿自行停药。

这几步读的是一包药，不是读某个人。走完之后得到的是「这包东西是什么、经过什么审查、该问谁」，不是「吃了会怎样」。

那则新闻稿还有一句：西地那非与他达拉非只能由医生或凭医生处方在药剂行供应；它们及其类似物，不允许出现在归类为传统药的产品中。[NPRA-2019]

③ 这些情况，吃任何「补肾」产品之前先问。 正在长期服用医生开的药 · 怀孕或备孕 · 哺乳 · 12 岁以下 · 乐龄人士 · 手术前 · 慢性病正在医生跟进中。

这些都是先告诉医生与医师、再决定的情况；正在西医治疗中的，切勿自行停药。中药与西药同用的问题，见〈中药和西药可以一起吃吗〉（/chinese-herbs-with-western-medicine/）。

④ 看诊时医师实际会做什么。

• 先问作息，再谈证。 医师会问您的睡眠、工作强度、最近是不是加班季、饮食与运动，以及您为什么会想到「肾虚」这个词。
• 问正在服用的东西。 医生开的药、药剂行买的非处方药、长辈给的补肾丸、直销买的保健品。两边都知道，才安全。
• 辨证。 医师看过整体之后，才会说这是不是「肾虚证」，或是第二节列出的其他证，或根本不是肾的证。这一步在问诊之后，不在之前。
• 然后是方向，不是承诺。 医师可能提出的选项包括针灸、中药，以及作息与饮食的方向。哪一种适合您、要不要用，由医师与您在看诊时决定。
• 本文不写「会有什么效果」，因为那属于个人评估，不属于文章。

想了解辨证是怎么做的，可参考：辨证是什么。男性的疲劳与精神不济常和这个词一起被提起，可参考：中医怎么看男性的疲劳与精神不济。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

大马生活里怎么安排

• 广告与短视频里的说法：第二节的定义是一把尺。广告说的「肾」，对得上精、生殖、水液、骨与发、耳、呼吸这六项吗，还是只剩「某一方面」。
• 朋友转发的「自测表」：可以当作提问的起点，不要当成结论。截图带来看诊时讨论，比自己对号入座有用。
• 长辈买的补包、药材铺抓的「补肾」药材：请一并说明成分与来源。有包装的，先看 MAL 编号与 Meditag 标签 [MOH-PSP]，再照第六节②那几步读一遍。
• 直销朋友推荐的「补肾」保健品：同样先查注册状态 [NPRA-2019]，再带来看诊时问。
• 公司年度体检：肾脏项目通常是验尿看蛋白、验血看肌酸酐。[NKF-MY] 报告上的 eGFR 量的是什么，第六节①有说明。报告留着，看诊时一并说明。
• 加班季：肾虚证的说明里有「后天过劳」这个词 [WHO-2022]——但那是理论的说法。是不是这个证，要看过整体才知道。
• 健身房或网络买的补充品：蛋白粉、氨基酸、来路不明的胶囊——请说明，尤其是长期在吃的。
• 已在 Klinik Kesihatan 或私人诊所跟进慢性病的：请一并说明，包括正在服用的药物。

常见问题

肾虚会不会变成肾病？ 两套不同的语言，一方不会「变成」另一方。「肾虚证」是中医理论里的证名，说明提到它常由先天不足、后天过劳或慢性疾病所致 [WHO-2022]；肾脏这个器官有没有问题，靠验尿看蛋白、验血看肌酸酐并估算 GFR，由医生判断 [NKF-MY]。担心肾脏本身，请做检验，不要用中医的词来推测。为什么这是两个不同的说法，第三节⑥有说明。

中年男人都肾虚吗？ 不是。「肾虚证」是一个证名，标准的说明提到先天不足、后天过劳或慢性疾病，没有提到年龄或性别。[WHO-2022] 它是医师辨证后的判断，不是某个年龄层的标签。把它和中年男性绑在一起的，是本地广告的用法；标准的定义本身没有这个限定。

女性也会被说肾虚吗？ 会。中医理论里的「肾」管精、生殖、水液、骨与发、耳、呼吸的深度，标准的说明没有区分男女。[WHO-2022] 是不是这个证，同样由医师辨证。怀孕、备孕或哺乳中的，任何「补肾」产品都先告诉医生与医师。

腰痛就是肾虚吗？ 不是。中医理论认为「肾主骨」[WHO-2022]，但腰痛是一个表现，不是证名；标准自己的「腰痛」词条就列了三条路——肾的问题、外伤或劳损、寒湿／湿热 [WHO-2022]，「肾」只是其中一条（第三节）。 NHS 的说法是：腰背痛多在几个星期内自行好转，保持活动、不要长时间卧床。[NHS-背痛] 伴随发烧：请立刻拨打 999（第五节）。双腿疼痛、刺痛、麻木或无力，生殖器或肛门周围失去知觉，大小便的改变（例如排尿困难，或大小便失禁），胸痛，或在严重意外之后开始：请立刻拨打 999，或前往最近的医院急诊部。[NHS-背痛] 突然剧痛或迅速加重：请当天求医。[NHS-背痛]

补肾丸可以吃吗？ 先查注册：注册药品有以 MAL 开头的注册编号与 Meditag 防伪标签 [MOH-PSP]，注册状态可在 npra.gov.my 或「NPRA Product Status」应用程式查询。[NPRA-2019] 再问一句「补哪一个证」：标准列出的肾证不止一个 [WHO-2022]，补法跟着辨证走。正在服用医生开的药的，先告诉医生与医师，切勿自行停药。一包丸药从编号读到「问谁」，第六节②有一个例子。

验血正常，还会「肾虚」吗？ 可能会，因为两者量的不是同一件事。验血看的是肾脏这个器官 [NKF-MY]；「肾虚证」是中医理论中「肾」这个功能系统的一个证名 [WHO-2022]，由医师辨证。报告正常，不等于医师会说「肾虚」；报告异常，也不等于医师会说「肾虚」。报告仍然要带来，因为它决定的是第五节那一半。报告上的 eGFR 量的是什么，第六节①有说明。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

结语

✅ 记住这几点：

1. 中医理论认为「肾藏精」，肾主生殖、水液、骨与发、耳、纳气 [WHO-2022]——「肾」是功能系统，不是那两颗器官。骨头挂在「肾」底下，是因为理论里精 → 髓 → 骨这条链 [WHO-2022]。
2. 「肾虚证」是一个证名，常由先天不足、后天过劳或慢性疾病所致；标准列出的肾证不止一个 [WHO-2022]，所以「补就对了」不成立。
3. 年度体检的肾脏项目量的是尿蛋白与肌酸酐，医生据此估算 GFR [NKF-MY]——eGFR 算的是肾脏每分钟应能过滤多少毫升的废物。[NHS-CKD] 中医问诊不取代这些检验。
4. 补肾丸先看 MAL 编号与 Meditag 标签 [MOH-PSP]，再查现在的注册状态 [NPRA-2019]，再问补哪一个证。
5. 水肿、泡沫尿、尿量改变、腰痛伴发烧——先就医。

❌ 不要这样做：

1. 不要把广告里的「肾虚」当成自己的诊断。
2. 不要自行购买来源与成分不明的「补肾」产品。
3. 不要因为开始中医调理就自行停掉医生开的药。

👉 如果您不确定「广告说的肾虚，跟我有没有关系」，欢迎透过汉方中医的线上问诊，由依 2016 年 T&CM 法令注册的医师为您评估；若您担心的是肾脏本身，或有第五节列出的情况，请先就医做检查。

本文由 林高鸿 医师 撰稿审阅。林高鸿 医师依 2016 年 T&CM 法令于马来西亚传统与辅助医药理事会注册执业，专长为中医全科、疼痛管理与内科。

无论身在何处，与持证中医师对坐。

汉方现代中医