Part 4 of 4 in the kidney series. Part 1 is what the TCM "kidney" governs; part 2 is what an aching back has to do with it; part 3 is the blood test and the tonic packet.

"Does this need a doctor, or can I watch it for a few more days?" That is the hardest thing to judge alone. This part lists seven see-a-doctor-first situations, each with the reason its own page gives — what the sign can indicate, and why it happens.

The short version

• If what worries you is the organ, blood and urine tests establish it; a TCM consultation does not substitute for them.
• Persistent flank pain, particularly with fever: call 999 now, or go to the nearest hospital emergency department. The relevant NHS page lists a high temperature and pain in the lower back or side among the symptoms.
• Blood in your pee must be checked out — the reason is in section I.
• If a chronic condition is under a doctor's review, keep to the checks your doctor arranges; section I has the NHS's reason.
• At a consultation the practitioner asks about routine first, then what you are taking; assessment comes after, and what follows is a direction, not a promise.

I. 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 — the NHS's acute kidney injury page states that acute kidney injury is when something suddenly causes your kidneys to stop working as well as they should, and lists "peeing a lot less than usual" among its symptoms
• Persistently foamy urine that does not settle — a urine test for protein establishes this one. The National Kidney Foundation of Malaysia states that filtered protein is normally reabsorbed and kept in the body; when the kidneys are damaged it leaks into the urine, and two positive tests over several weeks (persistent protein in the urine) is a sign of chronic kidney disease
• Swelling around the eyes or in the lower legs — the NHS's chronic kidney disease symptoms page lists swollen ankles, feet or hands among the later-stage symptoms, as the result of water retention (oedema); its acute kidney injury page lists swollen feet or legs too
• Persistent flank pain, particularly with fever — call 999 now, or go to the nearest hospital emergency department. The NHS's kidney infection page states that a kidney infection is a painful type of urinary tract infection that can affect one or both kidneys, and that urinary tract infections are caused by bacteria in the tube that carries pee out of the body; the same page states it can be serious if untreated
• Blood in the urine, or a marked change in colour — the NHS's blood-in-urine page states that blood in your pee must be checked out because it can be a sign of cancer; the blood could come from anywhere in the urinary tract — the bladder, kidneys or urethra
• Existing hypertension or diabetes — both relate to kidney function monitoring; keep to the schedule your doctor sets. The NHS's chronic kidney disease page states that high blood pressure can over time put strain on the small blood vessels in the kidneys and stop them working properly, and that in diabetes too much glucose in the blood can damage the kidneys' tiny filters
• Long-term painkiller use, or supplements of unknown origin — tell your doctor. The NHS lists long-term, regular use of certain medicines among the causes of chronic kidney disease, its examples including non-steroidal anti-inflammatory drugs (NSAIDs), the common anti-inflammatory painkillers; its acute kidney injury page also advises speaking to a doctor before taking any new medicines or supplements

Who is higher risk, and why it is checked on a schedule. The National Kidney Foundation lists diabetes, high blood pressure, a family history of kidney disease, diabetes or high blood pressure, obesity, kidney stones and being above 50 as risk factors for chronic kidney disease, and recommends an annual health screening. The NHS states that there are usually no symptoms of chronic kidney disease in the early stages — the reason its symptoms page gives is that the body is usually able to cope with a significant reduction in kidney function — and that people at high risk its diagnosis page states that because CKD often has no symptoms in the early stages, some people at a higher risk should be tested regularly; the overview page says this is so it is found at an early stage.

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.

II. Before taking any "kidney tonic" product, ask

Ask first in these situations. 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?".

One line from that 2019 NPRA press release is worth remembering: sildenafil and tadalafil may only be supplied by a doctor or from a pharmacy on a doctor's prescription, and they and their analogues are not permitted in medicines classified as traditional. How to read a packet from its registration number is in part 3.

III. What the practitioner actually does at a 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.
• What you are taking. Prescribed medication, over-the-counter products from a pharmacy, a tonic pack bought by a parent, "kidney tonic" herbs from the medicine shop, a supplement from direct sales, and anything from the gym or bought online — protein powders, amino acids, capsules of uncertain origin. Say what is in them and where they came from, especially anything long-term. Already following up a chronic condition at a Klinik Kesihatan or a private clinic: say so, with the medication. 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 kidney patterns the WHO's TCM terminology standard lists, or not a kidney pattern at all. That step comes after the consultation, not before.
• 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, you and the practitioner decide 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.

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.

The words in this part

• Acute kidney injury (AKI) — the NHS's description: when something suddenly causes your kidneys to stop working as well as they should.
• Kidney infection — the NHS's description: a painful type of urinary tract infection that can affect one or both kidneys.
• Oedema (水肿) — water retention; the NHS describes swollen ankles, feet or hands as its result.
• Persistent protein in the urine — protein found on two tests over several weeks. The Foundation says this is a sign of chronic kidney disease.
• Non-steroidal anti-inflammatory drugs (NSAIDs) — the common anti-inflammatory painkillers. The NHS lists long-term, regular use of certain medicines among the causes of chronic kidney disease, its examples including this class.

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.

The other three parts

• Part 1: What "kidney deficiency" actually means — what the TCM "kidney" governs
• Part 2: Is an aching back kidney deficiency? — the routes the theory lists, and the organ on the report
• Part 3: What a blood test measures, and how to read a "kidney tonic" packet

👉 If you are not sure "whether my situation needs a doctor first or can start with TCM", 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 anything in section I applies, see a doctor for tests first.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

Sources

• NHS, Acute kidney injury (AKI), page last reviewed 11 March 2026 — https://www.nhs.uk/conditions/acute-kidney-injury/
• NHS, Chronic kidney disease (overview), page last reviewed 22 March 2023 — https://www.nhs.uk/conditions/kidney-disease/
• NHS, Chronic kidney disease — Symptoms, page last reviewed 22 March 2023 — https://www.nhs.uk/conditions/kidney-disease/symptoms/
• NHS, Chronic kidney disease — Diagnosis, page last reviewed 22 March 2023 — https://www.nhs.uk/conditions/kidney-disease/diagnosis/
• NHS, Kidney infection, page last reviewed 13 February 2025 — https://www.nhs.uk/conditions/kidney-infection/
• NHS, Blood in urine, page last reviewed 25 September 2026 — https://www.nhs.uk/symptoms/blood-in-urine/
• National Kidney Foundation of Malaysia, Common Kidney Disease — https://nkf.org.my/facts-about-kidneys/common-kidney-disease/
• NPRA / Ministry of Health, Kenyataan Akhbar KPK 18 Mac 2019 – Produk Tradisional Nan Bao Capsule Dikesan Mengandungi Racun Berjadual Sildenafil Dan Tadalafil — https://npra.gov.my/index.php/en/component/content/article/412-english/press-release/press-release-2019/2066-kenyataan-akhbar-kpk-18-mac-2019-produk-tradisional-nan-bao-capsule-dikesan-mengandungi-racun-berjadual-sildenafil-dan-tadalafil.html
• World Health Organization, WHO international standard terminologies on traditional Chinese medicine, 2022 — https://www.who.int/publications/i/item/9789240042322

本文是「肾虚与肾脏」系列的第 4 篇，共 4 篇。第 1 篇讲中医的「肾」管什么，第 2 篇讲腰酸跟「肾」的关系，第 3 篇讲验血报告与补肾丸怎么查。

「这种情况要不要去看医生，还是再观察几天？」这是最难自己判断的一件事。这一篇把七项请先就医的情况列出来，每一项都写上对应页面给的理由——这个征兆可能是什么，为什么会出现。

一分钟看完

• 如果您担心的是肾脏本身，那需要验血与验尿才能知道，中医问诊不能取代这些检查。
• 腰部持续疼痛、尤其伴随发烧：请立刻拨打 999，或前往最近的医院急诊部。NHS 的相关页面把发烧与腰侧或下背疼痛列在症状里。
• 尿里带血一定要检查——理由见第一节。
• 慢性病正在医生跟进中的，请按医生的安排定期检查；第一节有 NHS 给的理由。
• 看诊时医师先问作息，再问您在吃什么；辨证在问诊之后，提出的是方向，不是承诺。

一、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——NHS 的急性肾损伤页写明，急性肾损伤是某件事让肾脏突然不像平常那样运作，而「小便比平常少很多」是它列出的症状之一
• 小便有大量泡沫，久久不散——这一项要靠验尿看蛋白才知道。马来西亚全国肾脏基金会写明，被过滤的蛋白正常会被重新吸收、留在体内；肾脏受损时，蛋白会漏进尿液，而几个星期内两次验出蛋白（持续性蛋白尿）是慢性肾脏病的一个征兆
• 眼睑或下肢水肿——NHS 的慢性肾脏病症状页把「脚踝、脚或手肿」列为较后期的症状，并写明那是水分滞留（水肿）的结果；它的急性肾损伤页也把「脚或腿肿」列在症状里
• 腰部持续疼痛，尤其伴随发烧——请立刻拨打 999，或前往最近的医院急诊部。NHS 的肾脏感染页写明，肾脏感染是一种会痛的泌尿道感染，可影响一侧或两侧肾脏，而泌尿道感染的成因是细菌进入把尿液带出体外的那条管道；它同一页也写，肾脏感染不治疗可能变得严重
• 小便带血，或颜色明显改变——NHS 的尿中带血页写明，尿里带血一定要检查，因为它可能是癌症的征兆；血可能来自泌尿道的任何一处——膀胱、肾脏或尿道
• 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。NHS 的慢性肾脏病页写明，高血压久了会让肾脏里的小血管承受压力，使肾脏无法正常运作；糖尿病则是血里的葡萄糖太多，会损害肾脏里那些细小的过滤结构
• 长期服用止痛药或来源不明的补品——请让医生知道。NHS 把「长期规律服用某些药物」列为慢性肾脏病的成因之一，举的例子里有非类固醇抗炎药（NSAIDs），也就是常见的消炎止痛药；它的急性肾损伤页也建议，服用任何新的药物或补充品之前先问医生

哪些人属于风险较高的一群，为什么要定期查。 全国肾脏基金会把糖尿病、高血压、肾脏病或糖尿病或高血压的家族史、肥胖、肾结石、50 岁以上列为慢性肾脏病的风险因素，并建议每年做健康筛查。NHS 写明，慢性肾脏病早期通常没有症状——它在症状那一页给的原因是：身体通常能应付肾功能相当程度的下降；它的诊断页写明，正因为早期常常没有症状，风险较高的一些人应该定期检查；总览页说这样做是为了及早发现。

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。

二、吃任何「补肾」产品之前，先问

这些情况，吃之前先问。 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〉。

NPRA 2019 年那则新闻稿还有一句值得记住：西地那非（sildenafil）与他达拉非（tadalafil）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。一包药怎么从注册编号读起，第 3 篇有步骤。

三、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、长辈买的补包、药材铺抓的「补肾」药材、直销买的保健品，还有健身房或网络买的补充品——蛋白粉、氨基酸、来路不明的胶囊。请一并说明成分与来源，长期在吃的尤其要说。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。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」，或是世界卫生组织的中医术语标准列出的其他肾证，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。

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。

这篇出现的几个词

• 急性肾损伤（AKI）——NHS 的说明：某件事让肾脏突然不像平常那样运作。
• 肾脏感染——NHS 的说明：一种会痛的泌尿道感染，可影响一侧或两侧肾脏。
• 水肿（oedema）——水分滞留。NHS 把脚踝、脚或手肿说明为水分滞留的结果。
• 持续性蛋白尿——几个星期内两次验出尿中有蛋白。全国肾脏基金会说这是慢性肾脏病的一个征兆。
• 非类固醇抗炎药（NSAIDs）——常见的消炎止痛药。NHS 把长期规律服用某些药物列为慢性肾脏病的成因之一，举的例子里有这一类。

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。

这个系列的另外三篇

• 第 1 篇：「肾虚」到底是什么——中医理论里的「肾」管什么
• 第 2 篇：腰酸就是肾虚吗——理论列的几条路，和报告上的那两颗器官
• 第 3 篇：验血报告在量什么，一包「补肾」丸怎么读

👉 如果您不确定「我这个情况要先看医生，还是可以先看中医」，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；若有本文第一节列出的情况，请先就医做检查。

无论身在何处，与持证中医师对坐。

汉方现代中医

资料来源

• NHS，Acute kidney injury (AKI)，页面最后审阅 2026 年 3 月 11 日 — https://www.nhs.uk/conditions/acute-kidney-injury/
• NHS，Chronic kidney disease（总览），页面最后审阅 2023 年 3 月 22 日 — https://www.nhs.uk/conditions/kidney-disease/
• NHS，Chronic kidney disease — Symptoms，页面最后审阅 2023 年 3 月 22 日 — https://www.nhs.uk/conditions/kidney-disease/symptoms/
• NHS，Chronic kidney disease — Diagnosis，页面最后审阅 2023 年 3 月 22 日 — https://www.nhs.uk/conditions/kidney-disease/diagnosis/
• NHS，Kidney infection，页面最后审阅 2025 年 2 月 13 日 — https://www.nhs.uk/conditions/kidney-infection/
• NHS，Blood in urine，页面最后审阅 2026 年 9 月 25 日 — https://www.nhs.uk/symptoms/blood-in-urine/
• 马来西亚全国肾脏基金会，Common Kidney Disease — https://nkf.org.my/facts-about-kidneys/common-kidney-disease/
• NPRA／卫生部，Kenyataan Akhbar KPK 18 Mac 2019 – Produk Tradisional Nan Bao Capsule Dikesan Mengandungi Racun Berjadual Sildenafil Dan Tadalafil — https://npra.gov.my/index.php/en/component/content/article/412-english/press-release/press-release-2019/2066-kenyataan-akhbar-kpk-18-mac-2019-produk-tradisional-nan-bao-capsule-dikesan-mengandungi-racun-berjadual-sildenafil-dan-tadalafil.html
• 世界卫生组织，WHO international standard terminologies on traditional Chinese medicine，2022 — https://www.who.int/publications/i/item/9789240042322