Integrating the Traditional Chinese Understanding of the Kidneys into Western He

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Integrating the Traditional Chinese Understanding of the Kidneys

into Western Herbalism

 

by Michael Tierra L.Ac., O.M.D.

 

www.acupuncture.com/Herbology/Kidney.htm

 

 

 

 

That Traditional (TCM) is a complete system of

primary health care is obvious to those who have devoted years in

its study. However, for many who might appreciate a deeper

understanding of its theories and principles, especially as it

applies to the maintenance of health and the cure of disease, it

would be useful to correlate as best as possible the relationship

between the profound concepts of TCM with what is known and can be

corroborated from Western physiology. From this we may be able to

arrive at a better understanding of how certain herbs and and even

Western drug medicines exert their therapeutic effects.

 

The Chinese, famed for their pragmatic outlook, historically tended

to assume the presence of an organ by a process of induction.

Perceiving a physiological function, they then attempted to describe

or even invent, as in the case of such ubiquitous organ functions as

the so called Triple Warmer (i.e. the overall regulation of fluid

and heat throughout the entire body), appropriate organs and

corresponding meridians. Further, since most herbs tend to have

broader, more nutritive actions than chemical drugs, there was

generally little need for specificity.

 

As to the kidney, for instance, the TCM KIDNEY INVOLVES ALL

PHYSIOLOGICAL FUNCTIONS THAT INCLUDE THE KIDNEY-URINARY SYSTEM PLUS

THE ENDOCRINE SYSTEMS AND ESPECIALLY THE ADRENAL GLANDS.

 

TCM Kidney Yin and Kidney Yang involves the regulation of

electrolyte balance of sodium and potassium, necessary for the

circulation of bioelectrical energy throughout the body. Further,

the TCM concept of kidney yin very prominently involves the

secretion of glucocorticoid hormone, cortisol, from the adrenal

cortex. Kidney yang in addition to involving adrenaline secretions

of the adrenal medula, also involve other endocrine functions

including the pituitary and thyroid glands. What TCM offers is a

more holistic view of the dynamic interplay of complex physiological

phenomena. This is especially useful for clinical practice. What it

does not offer are specific physiological processes which are the

well earned domain of Western scientific medicine. Given the

difference between the two in point of view, it seems that learning

to view health and disease from both perspectives will ultimately

offer a broader, more comprehensive approach to health care in the

future.

 

The concept of `kidney' has been pivotal in Chinese medical theory

at least since the time of the writing of the Nan Ching (Classic of

Medical Difficulties) around 403-221 B.C. The other great medical

classic, the Nei Ching (The Yellow Emperor's Classic) written

somewhere around 2800 B.C., established the prior dominance of the

stomach and spleen school. With these two, we have the so called

division what some regard as the `spleen' and `kidney' doctors. The

former views disease as being caused by weak digestion and

elimination with a resultant deficiency of acquired chi from air,

food and water, while the latter considers the primary cause of

disease to be from a weak inherited constitution, lowered resistance

and lack of essence.

 

Western physiology and anatomy limits its description of the kidney

to the actual organ itself, TCM assigns such profound, broad

significance that it is obvious that the Chinese concept of

`kidney', as the home of the `ancestral chi' (inherent constitution)

and the root of yin and yang for the entire body refers to a much

vaster terrain. After studying the functions and pathologies

involved with the TCM kidney, it is obvious that at least part of

the TCM kidney encompases the urinary system, balance of mineral

electrolytes as well as the entire endocrine system including

prostaglandins and the various neuro-transmitters.

 

The Chinese had no need to extend their understanding beyond the

identification of the kidneys as both urinary organs as well as the

endocrine system. Perhaps this is because of the prominent hormone

regulating role played by the adrenals which are two endocrine

glands attached to the superior surface of the kidneys and important

in the regulation of the autonomic nervous system.

 

The fundamental principle of health and healing in TCM is the

concept of balance. In TCM, balance is expressed in broad strokes of

hot-cold, dry-wet, strong-weak, excess-deficient, chronic-acute,

etc., these concepts are applied both to the method of diagnosis as

well as to the classification of food, medicine and treatment. These

concepts are all broadly encompassed in the concept of yin and yang

which, physiologically, is controled by the kidneys.

 

In understanding the Traditional Chinese description of TCM Kidney

function we must come to the same realization that occurs with each

of the other 12 TCM organ-meridian influences, that what is implied

may in fact, represent a synthesis of dynamic life processes that

extend beyond what can be effectively grasped by current Western

physiological models. This is especially true in terms of their

being the origin of yin and yang throughout the body which involves

a complex integration of the kidneys plus all endocrine functions.

 

Because the emphasis of Chinese physiological theory is more in

terms of function rather than form, we are able to achieve a more

holistic perspective in terms of the TCM Kidneys and their effect on

the body-mind. Besides, by discovering how the TCM Kidneys are

described in terms of TCM theory we can also arrive at a deeper

understanding of how herbs, foods and lifestyle can be employed

therapeutically.

 

Kidney Yin and Yang deficiency represents a distinct category of

treatment within TCM that is not so clearly recognized or

differentiated in Western herbalism. It is useful to understand

these concepts because they involve conditions that are fundamental

to health and the Chinese have described specific treatment

protocols with herbs and other therapeutic substances emanating from

the mineral and animals kingdoms that can be used to treat these

conditions.

 

HOMEOSTASIS AND YIN YANG THEORY

According to TCM philosophy, " chi " or vital energy is a part of yang

while " blood " is a part of yin. The characteristics of yin therefore

are substantial, cool and moist, while the characteristics of yang

are ephemeral warm, mobile and dry. In terms of homeostasis, Yin

belongs to all those physiological aspects which are cooling, hypo-

metabolic, receptive, anabolic and maintaining, while yang is

warming, hypermetabolic, aggressive, catabolic, transforming and

protective.

 

Yin relates to the chalice which receives and yang relates to the

life energy with which it is filled. A deficiency of yin suggests

that the maintaining and repairing function of the body is depleted

or lacking. This is indicated by an overflowing or spilling out of

yang chi as perceived by a variety of hypermetabolic signs such as

flushed complexion, heat, nervousness, anxiety, insomnia, dryness

and chronic signs of inflammation and wasting. A deficiency of yang

is hypometabolic, with signs of coldness, paleness, tiredness,

weakness, lack of vitality, low libido, edema and puffiness.

 

In TCM, the kidneys are described as housing the essence and being

the root of yin and yang for the entire body-mind. This means that

all the inherited constitutional potential of the individual is

contained within the kidneys as well as the most essential aspects

for maintaining homeostasis.

 

One way by which the regulation of yin and yang is governed by the

kidneys is the regulation of electrolytes. Electrolytes consist of

acids, bases and salts, especially sodium, chlorine and potassium

which carry a positive and negative electrical charge as it

regulates fluid metabolism in the body's three fluid compartments,

inside the cells, in the interstitial spaces and within the blood

vessels.

 

Besides the regulation of electrolytes within the kidneys, the

endocrine system as described above plays a pivotal role in

regulating homeostasis which is described as yin and yang by the

Chinese.

 

It is through these complex physiological processes that the Chinese

assign the following spheres of influence to the TCM Kidneys:

 

 

Kidneys contain the Gate of Vitality ( " Ming men " ).

Kidneys are the Root of Yin and Yang for the Whole Body

Kidneys govern growth and maturation

Kidneys produce skill and house the will

Kidneys hold the essence (inherited constitution)

Kidneys govern the bones and teeth

Kidneys open into the ears

Kidneys manifest on the head hair

 

From the above, we arrive at the basic symptoms of TCM kidney

imbalance of which at least three prominent symptoms are required to

make a diagnosis regardless of any further specific conformations:

 

BASIC SIGNS OF TCM KIDNEY IMBALANCE

According to TCM differential diagnosis, one must have at least

three prominent symptoms from the following:

 

low back pain joint and knee pains

stiffness impotence or frigidity

libido hearing

head hair urinary problems

growth and maturation bone and marrow problems

 

Kidney Yang becomes the reactive, sympathetic nervous system

relating to the secretion of epinephrine and norepinephrine from the

adrenal medulla as well as other yangizing hormones from the

pituitary, thyroid and other endocrine glands. In contrast, Kidney

Yin is the parasympathetic nervous system relating to the secretion

of corticosteroids from the adrenal cortex as well as other

yinnizing hormones secreted by the anterior pituitary and other

endocrine glands.

 

1. THE GATE OF VITALITY (MING MEN)

The TCM kidneys are closely associated with the " the gate of

vitality " or " Ming Men " as it is called in TCM. Zhang Jie Bin (1563-

1640) said: " there are two kidneys ... (i.e. kidney yin and

yang)... the Gate of Vitality is in between them. ... it is the

organ of water and fire, the abode of yin and yang, the sea of

essence, and it determines life and death. " Energy is produced as a

result of both catabolic and anabolic reactions. The release of

energy is associated with catabolism while its use is associated

with anabolism. Ming Men is essentially concerned with the catabolic

release of energy through heat. Heat is available in two forms, one

is biologically useless since it can destroy living cells, the other

is chemical and is available in the body as adenosine triphosphate

(ATP). ATP is one of the most important compounds in the world

because it supplies energy directly to all kinds of living organisms

from one-celled plants to billion-celled humans. The energy released

from nutrients is used to form ATP. When ATP releases its energy, a

phosphoric acid radical is split away forming ADP (adenosine

diphosphate). The energy then derived from the cellular nutrients

recombine to form new ATP in a continuous cycle. As a result ATP is

called the currency of the cells, since it can be spent and remade

continuously.

 

Ming Men represents the fiery reaction which produces essential

catabolic energy or " fire " for all the internal organs. As part of

the root, Ming Men is part of the TCM Kidneys in much the same way

that the TCM Kidneys are the root of Yin and Yang for the entire

body.

 

Through the use of warming, acrid herbs such as aconitum carmichaeli

praeparatum (fu zi), cinnamomum cassia (rou gui) and other warm

spicy stimulants, the catabolic process associated with Ming Men can

be stimulated. By so doing, TCM Kidney Yang is generated.

 

2. KIDNEYS: ROOT OF YIN AND YANG THROUGHOUT THE BODY

KIDNEY YIN

According to TCM, " The vital essence or kidney yin function is the

material basis for reproduction, growth and development, formation

of the bone marrow, nourishment of the brain and bones. " (1)

Deficient kidney yin is manifested with symptoms of aching, soreness

of the lumbar region of the back, weakness of the legs and knees,

tinnitus, feverish sensation in the soles and palms, nocturnal

emission, and in women, scanty menstrual flow and amenorrhea.

Deficient liver yin has dizziness, tinnitus, dryness of the eyes,

blurred vision, irritability and irascibility. The tongue is reddish

with little or no coat. The pulse is wiry, rapid or thready.

 

The nature of all these symptoms are chronic and wasting and

reflects a tendency which we in the West commonly understand

as " burnout " neuresthenia or adrenal fatigue. There is also a

difference between the ongoing condition of " yin deficiency " which

many chronicallly have and what I call the occasional `exhausted

yin' caused by the stresses and ordeals of normal living.

 

KIDNEY YIN AND THE GLUCOCORTICOIDS

Glucocorticoids, secreted by the adrenal cortex, are used

metabolically to aid in the utilization of proteins, carbohydrates,

and fats. This partially corroborates the concept of the TCM kidney

being the root not only of constitutional or inherited chi but

acquired chi which comes from the digestion of food. Perhaps of even

greater significance, however, is that the glucocorticoids are used

by the body to counter and resist all forms of major and minor

stress be it physical or mental.

 

Chinese Five Phase Theory describes the TCM kidneys as part of the

water element with water being the mother or engendering aspect of

the wood-liver. The Five Phase Doctrine, is the second natural

philosophy of TCM (after yin-yang), and sometimes referred to as

the " system of correspondences. " Said to originate in the 3rd

century B.C., it is marvelous in its depiction of the relationship

of the individual to all physiological and psychological processes,

outer environment, food, and in fact all other natural phenomena.

The Five Phase description of the engendering relationship between

the TCM kidneys and the liver is represented at least partially

through the metabolic use of proteins, carbohydrates and fats called

gluconeogenesis.

 

EFFECTS OF CORTISOL ON CARBOHYDRATE METABOLISM

Gluconeogenesis is a process where the liver secretes enzymes

necessary to convert amino acids from proteins into glucose. The

employment of cortisol and other glucocorticoids is used to help

stimulate this process of gluconeogenesis as much as 6 to 10 times,

corroborating the Chinese five phase principle of water as

the " mother of wood, " i.e. the TCM kidneys engendering or nurturing

the liver.

 

How is this done? First, one of the metabolic effects of cortisol is

to increase the transport of amino acids from the extracellular

fluids into the liver cells. From this, gluconeogenesis is better

_facilitated. Secondly, cortisol helps all the enzymes convert these

amino acids into blood glucose. Thirdly, cortisol causes the

mobilization of amino acids from muscles and other extrahepatic

tissue. The result of this is that more amino acids become available

to enter into the liver's process of gluconeogenesis. Finally, one

of the effects of increased gluconeogenesis is a decided increase in

liver glycogen stores.

 

EFFECTS OF CORTISOL ON FAT METABOLISM

Similarly to the way it fosters amino acid mobilization from the

muscles, cortisol promotes the mobilization of fatty acids from

adipose tissue. This, despite the fact that individuals with excess

cortisol develop a type of obesity which manifests as a fatty

accumulation or edemic appearance of the chest and head regions of

the body giving a kind of bullalo-like torso.

 

In this condition, as above, we see the results of a weakening of

yang and consequent increase of fluid stagnation and yin. In

addition to treating the TCM kidneys and yang chi, Chinese medicine

may add spleen dampness removing herbs such as Poria cocos (fu

ling), spleen yang warming herbs such as Aconitum carmichaeli

praeparatum and Cinnamomum cassia, and spleen chi tonics with the

use of Atractylodes alba and Astragalus membranicus.

 

THE EFFECTS OF CORTISOL ON STRESS AND INFLAMMATION

One of the most beneficial effect of cortisol is in the relief of

stress. Besides the major physical and neurogenic stresses, there

are various minor stresses that continually occur as part of normal

living. Among many that may be cited are the movements of the joints

and especially the knees (which take the greatest structural stress)

and the initial reaction to food, especially stimulants such as

coffee and simple carbohydrates such as sugar. In addition, there is

psychological stress such as fear, paranoia and anger, and

physiological stress caused by blows and injuries and exposure to

severe cold or heat. All are buffered to some extent with the

secretion of cortisol.

 

Just as the body requires some degree of yang adrenaline hormone to

generate motivation to react both to normal as well as life

threatening stimulus, it also has a nearly continual need for

cortisol to buffer the effects of stress. In one sense, cortisol

acts like oil in a heated engine. Without it, the gears grind down

in much the same manner as for instance, in rheumatoid arthritis,

where the joints become painful, dry and twisted or in yin deficient

hypertension associated with anxiety, nervousness and irascibility.

 

In this we see that cortisol is necessary for trauma, infections,

intense heat or cold, psychological and neurological stress, and

recovery from any debilitating disease. As a result, there is a

relationship between lack of cortisol and what is diagnosed

as " kidney yin deficiency. " Cortisol is clinically used in the form

of hydrocortisone or prednisone to help control acute inflammmation,

rheumatoid arthritis, allergies and many eruptic skin diseases, to

name a few. Because cortisol mobilizes amino acids, it is effective

in helping to repair damaged tissue. Since it can suppress the

immune system by reducing leukocytes and phagocytosis, it is used to

suppress dangerously high fever, inflammation, certain poisonous

reactions, arthritic conditions and allergies. With the

administration of cortisol or other glucocorticoids, inflammation

subsides within 24 to 48 hours.

 

Herbs have healing, anti-inflammmatory actions like cortisol.

Oftentimes, it is not the cortisol stimulating properties which are

cited for their healing properties but some other biochemical agent

such as allantoin in comfrey. The effects are the same with the

exception that herbs such as unprocessed Rehmannia glutinosa and

Licorice (Glycyrrhiza sp.), tend to be milder and more indirect,

having the advantage, however, of not only suppressing but more

often enhancing the immune system. Despite its obvious life saving

advantages, cortisol type drugs do not correct the basic disease

condition. With prolonged use over weeks and months it will also

cause many of the above described side effects such as muscle

weakness, weakness of the immune system and edemic swelling of the

tissues.

 

LICORICE

Licorice root (Glycyrrhiza sp.) is noted for having cortisone-like

action. Glycyrrhizin, a derivative of glycyrrhetinic acid, is

chemically very similar to certain adrenalcortical hormones,

especially desoxycorticosterone (DOCA) and cortisone. It is not

uncommon for plants to contain hormone-like substances similar to

those found in humans and animals.

 

The anti-inflammatory properties of licorice were first recognized

quite by accident when a Dutch pharmacist, observing the use of

licorice juice by the people of Southern Italy as a cough loosening

remedy, discovered, by chance its effectiveness in the treatment of

gastric ulcers. People using licorice for their stomach symptoms

found that the effect of licorice was more reliable and enduring

than any other medication.

 

Licorice, like cortisone, though not as strong, can relieve symptoms

of peptic ulcers by inhibiting the inflammatory reactions. The

problem, according to Weiss, is that cortisone is so strong that it

can mask the symptoms of perforation and there is a danger of

peritonitis occuring, which is very dangerous. Licorice, which is

far less powerful offers no risk of perforation at normal

concentrations.

 

Also like cortisone, the regular and excess use of licorice will

produce the edemic, moon face appearance of Cushing's syndrome, a

condition which can be described as `deficient kidney yang.' As with

corticoid therapy, licorice in regular and high dosage can cause,

elevated potassium levels, resulting in edema and hypertension. It

is, therefore, contraindicated for patients past the age of 65 with

a tendency towards renal hypertension. (2) The Traditional Chinese

herbal combination that has been used for abdominal pains,

presumably ulcers, is Peony and Licorice Decoction (shao yao gan cao

tang) which combines 12 to 30 grams of paeonia alba root and 9-20

grams of honey fried licorice root.

 

According to Bensky, it " softens the liver, relieves painful spasms

and alleviates pain. " It is indicated for " irritability, slight

chills, spasms of the calf muscles with associated lack of tongue

coating. It is also useful for cramps in the hands and abdominal

pain. "

 

Bensky further describes this formula as being given for injury to

the yin. Thus, there is a lack of tongue coating (a sign of yin

deficiency), pain in the calves with blood deficiency (treated with

the paeonia) or injury to the fluids (treated with licorice). The

slight chills are caused by weakness of the yang which follows

injury to the yin.

 

Bensky further describes this formula: " spasms, cramps, and

abdominal pain are typical spasmodic, wind-like manifestations of

Liver-blood deficiency, " and that " it is very popular for a wide

variety of pain syndromes, especially spasmodic and cramping pain, "

finally " it is used for treating intercostal neuralgia, sciatica,

trigeminal neuralgia, chronic pelvic inflammatory disease and

primary dysmenorrhea. "

 

Licorice, which is classified as a chi tonic in TCM is also

recognized as moistening and therefore recognized by TCM

practitioners as having yin tonic properties. It is used by itself

to treat most metabolic poisons (including poisoning by aconite and

overuse of ephedrine and other stimulants). It is also used for

coughs, irritations, pains, allergies, colds and flus.

 

Licorice is often used to harmonize an herbal formula. This means

that it ameliorates any undesireable reaction one may have to either

a single herb or combination. In most instances this means that it

improves the flavor of the tea but since it has a soothing cortisol

action it diminishes the sympathetic stimulus and thereby softens

its therapeutic effects. Licorice is contraindicated for symptoms of

excess of yin, especially with abdominal stagnation, bloating, edema

and renal hypertension. Because of the yin nature of females, there

is an even stronger propensity towards fluid retention so that

licorice is used even more conservatively in women's formulas,

sometimes adding no more than a single slice for flavoring.

 

In high doses of up 12 grams or more, it has pseudoalderosterone

activity caused by the glycerrhetinic acid content.(4)(5) This can

cause symptoms of hypertension, hypokalemia, sodium and water

retention. Licorice, has also been found to be effective in the

management of Addison's disease or adrenal failure.(6)

 

We note that while herbs like licorice and rehmannia glutinosa have

compounds similar to cortisol, other herbs and substances that have

demulcent, emollient properties seem to have analogous, though not

identical, reactions. These are also classified as yin tonics and

include oils and fats, pork meat, marshmallow (althea off.) and

slippery elm (ulmus fulvus). Lacking the strong concentrated effects

of cortisone, these tend to be milder, with broader nutritive

actions and much less potential of harmful side effects in normal

dosage.

 

Rehmannia Glutinosa

Rehmannia glutinosa called `Di huang' is a member of the foxglove

family and in fact so resembles foxglove in appearance that it is

sometimes called Chinese Foxglove. The root is used raw as a

detoxifying herb that `cools blood' for the treatment of wasting

fevers and is known as `sheng di huang.' It is cured by soaking and

drying the compressed roots nine times in rice wine. By so doing, it

has a slightly warmer energy and is used as a nourishing blood and

yin tonic known as `shu di huang.'

 

It is in this latter category that prepared rehmannia is a primary

herb especially in formulas that nourish the blood and kidney yin

but also with other kidney yang herbs and in kidney yang formulas

such as " Rehmannia Eight. "

 

Rehmannia contains beta sitosterol, mannitol, stigmasterol,

campesterol, rehmannin, catalpol, arginine and glucose. TCM

classifies it as entering the liver, kidney and heart.

 

Prepared rehmannia, which is the form used as a blood and kidney yin

tonic, is used in the treatment of anemia usually with Dang gui and

for " yin " asthenia, dizziness, tinnitus, weakness and pain of the

lower back and legs, thirst, spermatorrhea, amenorrhea and

metrorrhagia.

 

Phamacologically, Rehmannia Six was found in mice to " antagonize the

inhibitory action of dexamethasone on the pituitary-adrenal system,

thereby increasing plasma cortisol. " (7)

 

Rehmannia helps the immune system by stimulating the formation of

red blood cells and other immune potentiating substances in the bone

marrow. The fact that rehmannia is classified in TCM as a blood

tonic while it is commonly used as a kidney yin tonic suggests that

there may be a proclivity for this herb to stimulate the secretion

of another important kidney hormone, erythropoietin. This hormone

acts on the bone marrow to stimulate the proliferation of precursor

cells and their maturation into erythrocytes. Rehmannia may also

help in the excretion of discarded red blood cells from the liver.

This is at least partially accomplished by the continuous excretion

of discarded red blood cells from the liver which are transformed

and excreted in the kidneys as urobilirubin.

 

It is the presence of this substance that gives the yellowish color

to urine. As a result of this process, chronic kidney deficiency can

cause a weakened immune system and anemia. In one study, the

protective effects of Rehmannia where found to mitigate platelet

damage caused by irradiation from an intraperitoneal injection 1 ml

daily for 6 days. It could mitigate platelet damage caused by

irradiation with 600 rad and hasten the normalization of platelet

count. (8)

 

In TCM, licorice is not customarily used for treating kidney yin or

essence deficiency. The primary formula and the root formula for

most yin tonics is Rehmannia Six, called `Liu Wei Di Wan.' It

consists of the following:

 

 

Processed Rehmannia glutinosa (shu dihuang) 20-25gms Nutritive herb

which tonifies kidney yin and blood

Dioscorea Orientalis (shan yao) 10-15gms used because it is a chi

tonic that enters the lung, spleen and kidney organ meridians, thus

it strengthens both acquired chi as well as nourishing both yin and

essence

Alisma orientalis (Zie xie) 9-12 gms diuretic, activating urinary

function

Poria cocos (fu ling) 9-12 gms diuretic, high in potassium and other

mineral salts

Cornus Off. berries (shan zhu yu) 10-15 gms astringent diuretic with

warm properties, tonifies liver and kidney essence

Moutan peony (p. suffruticosa) (mu dan pi) 6-9 gms enters the

kidney, liver and heart, eliminates deficient heat, treating

subclinical inflammatory conditions

 

The specific indications of this important classic formula is to

reinforce the Yin (vital essence) of the liver and kidney. It is

indicated for symptoms of dizziness, tinnitus, sore throat, tidal

fever, nocturnal emission, night sweats, heat sensation in the palm

and soles, toothache, dry mouth. It is given to children for

retarded growth, also for lower back pain, optic neuritis, central

retinitis, tuberculosis and all wasting diseases, diabetes,

hyperthyroidism, addison's disease, hypertension, neuresthenia,

functional anovular bleeding, chronic urinary tract infections and

deafness, the tongue is red with a thin, dry coating and the pulse

is thready and rapid.

 

While it is contraindicated for a person with deficient yang with

accompanying weak digestion, coldness and sexual impotence, the same

formula with the addition of two yang stimulating herbs, prepared

aconite and cinnamon, is given for yang deficiency. Both Rehmannia

six and Rehmannia eight, the latter with the addition of cinnamon

bark and prepared aconite are the two most frequently prescribed

formulas used for tonifying kidney yin and yang respectively.

 

Rehmannia Six is used for all symptoms of aging, burnout, and

wasting. It is specifically useful for joint pains, aching lower

back, diabetes, thirst, chronic urinary disorders. Rehmannia Eight

is used for the same conditions except with a decided tendency

towards weakness, impotence and coldness. In practice, it is

generally better to first give Rehmannia Six and if needed,

especially for impotence and cold symptoms, prescribe Rehmannia

Eight.

 

KIDNEY YANG

Kidney Yang relates especially to the adrenaline-like secretions of

the adrenal medulla as well as some androgenic hormones secreted by

the adrenal cortex, thyroid hormone, and growth hormone from the

anterior pituitary gland. Kidney yang is also effected by the

secretion of erythropoietin by cells in the kidneys and to a lesser

extent, the liver, which which stimulates the bone marrow to create

erthrocytes.

 

Before discussing the physiology of kidney yang deficiency, let's

outline the TCM characteristics which are used diagnostically.

Besides having three of the basic TCM kidney symptoms mentioned

above, kidney yang deficiency has three or more prominent

indications from the following:

 

 

coldness lack of libido

impotence, sterility frequent, clear urine

dribbling urine night urination

spermatorrhea premature ejaculation lack of spirit general

debilitation

edema of the lower limbs thin, slow, weak pulse

thin, whitish, moist tongue fur

 

Coldness refers not only to the atmospheric sensation but also to

general hypometabolic function throughout the body. Lack of

sympathetic stimulation from the adrenal medulla is one cause of

coldness and hypometabolic function. The adrenal medulla secretes

two stimulating catecholamines --- about 80% epinephrine and the

rest norepinephrine. The importance of the these secretions is in

their relationship to the sympathetic nervous system and the ability

thereby to rally visceral response to appropriate stimuli throughout

the body including most of the internal organs and glands of the

body.

 

One of the underlying causes of certain kinds of anemia is Kidney

Yang deficiency. Kidney Yang deficient anemia has the characteristic

lack of red blood cells which in this case is caused by a lack of

erythopoietin in the kidneys which in turn will give rise to many of

the previously described conditions and symptoms associated with

kidney yang deficiency. Testosterone, being a quintessential kidney

yang hormone, also stimulates the secretion of erythropoietin. It is

believed that this may account, at least in part, for higher

hemoglobin count in men (16 g/dL) than in women (14 g/dL).

 

DEFICIENT KIDNEY CHI AND YANG AND HYPOTHYROID

A diminished secretion of thyroid hormone will also account for

patterns of deficient yang associated with coldness. Other symptoms

associated with hypothyroid and TCM deficient kidney yang symptoms

include retarded growth and sexual developement, hypoglycemia, and a

particular disease syndrome called myxedema which is characterized

by a lack of mental and physical vigor, gain in weight, loss of hair

and a thickening of the skin from an accumulation of subcutaneous

fluid. One characteristic of this condition is that there is

firmness to the skin and therefore it does not pit when pressed as

in other forms of edema. Dark fluidic bags under they eyes is one

symptom associated with low thyroid as well as deficient kidney chi

and yang.

 

Many of these symptoms involve a deficiency of yang with coldness,

edema and lowered metabolism being general symptoms. Specifically,

however, kidney yang deficiency is associated with retarded growth

and sexual development, loss of hair along with coldness and fluid

retention. Seaweed in various forms, especially kelp because it is

high in trace minerals, especially iodine necessary for thyroid

malfunction, is useful to regulate both hypo and hyperactive

thyroids caused by a lack of iodine. It is, off course, especially

indicated for goitre and swollen glands of the neck. Interestingly,

Panax ginseng is also prescribed for low thyroid conditions.

However, two of the most important TCM formulas that are used to

warm and tonify kidney yang are as follows:

 

Rehmannia Eight (Ba wei wan or Jin gui shen qi wan)

 

Prepared Rhemannia Glutinosa 24 grams (sheng di huang)

Fructus Corni Officinalis 12 grams (shan zhu yu)

Radix Dioscoreae Oppositae 12 grams (shan yao)

Sclerotium Poriae Cocos (fu ling) 9 grams

Rhizoma Alismatis Orientalis (ze xie) 9 grams

Cortex Moutan Radicis (mu dan pi) 9 grams (all of the above is the

Rehmannia Six formula for yin tonification) Adding the following

warm and help tonify yang:

Ramulus Cinnamomi Cassiae (gui zhi) 3 grams

Radix Aconiti Praeparata (fu zi) 3 grams

 

Indications: lower back pain, weakness of the lower extremities,

cold sensation in the lower half of the body, either frequent or

excessive urination, possibly with incontinence, edema, impotence,

weak, frail pulse and pale, swollen tongue with thin, white and

moist coat.

 

As one can see, this formula differs from Rehmannia Six with the

addition of cinnamon bark and prepared aconite. Both of these are

strong sympathetic stimulants which in turn may increase warmth by

stimulating the secretion of adrenergic hormones such as testerone,

and consequently, erythropoietin by cells in the kidney.

 

RESTORE THE RIGHT KIDNEY PILL (you gui wan)

So named because the right kidney is considered the seat of vitality

or of kidney yang.

 

 

Rehmannia glutinosa (shu di huang) 240 grams

Radix aconiti praeparata (fu zi) 60-180 grams

Cinnamon cassia (rou gui) 60-120 grams

Cornus officinalis (shan zhu yu) 90 grams

Dioscorea oppositae (shan yao) 120 grams

Lycium chinensis (gou gi zi) 120 grams

Eucommia ulmoides (du zhong) 120 grams

Angelica sinensis (dang gui) 90 grams

Cuscuta chinensis (tu si zi) 120 grams

Colloid of cervus nippon (lu jiao jiao) 120 grams (deer antler)

 

Preparation: Grind all the ingredients to a fine powder. For this

some of the moist herbs such as Rehmannia and Lycii may have to be

baked in an open oven until dried enough to grind. Form into pills

by mixing with honey. Take 9-15 grams, 2-3 times daily with warm

water. It can also be made into a decoction with the appropriate

dose reduction of the ingredients.

 

Indications: Warms and tonifies kidney yang, replenishes essence and

blood. It is clinically used for spermatorrhea, impotence, premature

ejaculation, intolerance of cold with cold extremities, pale

complexion, weakness of the knees and aching soreness of the lower

back, dizziness, diabetes, chronic nephritis, frequent urination,

pulse is deep, slow and weak. The primary difference between this

formula and Rehmannia Six is that it does not have such a strong

diuretic effect as the former. It is therefore more useful as a pure

kidney yang tonic.

 

KIDNEY YANG AND ALDOSTERONE

That yin and yang are relative rather than absolute, applies to all

physiological and biochemical polarities including the relation of

potassium and sodium chloride to each other. From one perspective,

both are mineral salts and have a cool, yin energy. However, in

terms of their effects on the body, salt is more yang than potassium

in that it tends to attract and hold fluids in the cells while

potassium is generally excreted with the extracellular fluid and

urine. Potassium is more yin because of its discharging and

eliminative effects on extracellular fluid. (This idea of salt

holding fluid while potassium releases it may be at least part of

the rationale that George Ohsawa was considering when he reversed

some aspects of the meaning of yin and yang in Macrobiotics.)

 

The osmotic process by which salt and potassium exchange ions

between the intra and extracellular fluid also facilitates the

passage of other nutrients necessary for cellular metabolism. There

is an associated electrical charge which gives rise to the term,

`electrolyte' balance. This provides still another method wereby the

kidneys function as the `root' of chi and yin and yang for the whole

body.

 

Aldosterone, the most important mineralocorticoid is mainly

controled by the renin-angiotensin mechanism and by the

concentration of potassium in the extracellular fluid. In the first

instance a decrease of blood pressure in the glomeruli of the

kidneys triggers the secretion of an enzyme, renin into the

interstitial fluid which in turn ultimately results in the secretion

of aldosterone from the adrenal cortex.

 

In the second instance, aldosterone is triggered by high

concentrations of potassium in the extracellular fluid causing a

concommitant decrease of concentrations of sodium and chloride. With

the decrease of sodium chloride, there is a reciprical decrease of

total extracellular fluid and blood volume. In TCM this reduction of

fluid and blood is one of the conditions of wasting or yin

deficiency and is often associated with kidney hypertension.

 

An excessive loss of potassium from the extracellular fluid as a

result of aldosterone causes a serious deficiency of plasma

potassium concentration called hypokalemia. This manifests

symptomatically with episodes of severe muscular weakness or

paralysis, tetany and postural hypotension. Because this condition

is associated with greatly reduced fluid and blood volume, this

condition in TCM would be considered a condition of `Yin and Blood

deficiency' and treated with appropriate tonics.

 

A deficiency of aldosterone, on the other hand causes an abnormal

rise in extracellular fluid potassium. The result is impaired

circulatory function with associated coldness and in extreme cases,

shock. There will also be serious effects on heart function with

weakness of contraction, arrhythhmia and in extreme cases, cardiac

death.

 

This latter condition is well described in TCM as `Kidney, Spleen

and Heart Yang Deficiency.' The kidneys being the root of the body's

yang chi are unable to support the generative and transformative

functions of the other organs. With a degeneration of the " true

yang " of the kidney, both the kidney and the spleen are unable to

transform water which accumulates as edema, associated urinary

difficulty, abdominal pains and aggravation by cold. Essentially,

one might say that such a condition of kidney yang-aldosterone

deficiency results in a " dampening of spirits " on both the physical

as well as the psychological levels.

 

For this condition, one might use warm, yang stimulating herbs and

formulas such as the use of cinnamon bark (Cinnamonum cassia),

prepared aconite (Aconitum napellus praeparatus) and ginger

(Zingiberis off.). One of the most important Chinese herbal formulas

for activating the yang is called True Warrior Decoction or Vitality

Combination (zhen wu tang) and consists of the following:

 

 

Prepared aconite (Fu Zi) 9grams

Atractylodes alba (Bai Zhu) 6grams

Poria cocos (Fu Ling) 9grams

Fresh Ginger (Zingiberis off.) (Sheng Jiang) 9grams

Paeonia lateriflora (Bai Shao) 9grams

 

The indications for this formula are deficient kidney and spleen

yang with symptoms of tiredness, weakness, edema, and cold. It is

used for edema, chronic nephritis, hypothyroidism, chronic diarrhea,

rheumatic valvular heart disease, congestive heart failure, liver

cirrhosis and other chronic hepatic disorders together with other

conditions that cause edema and ascites, chronic enteritis,

rheumatoid arthritis, frequent urination and weakness of the lungs

caused by lymphatic congestion.

 

This formula, unlike the previous, does not focus so much on actual

tonification but a restoring of yang function through the use of one

of the strongest metabolic herbal stimulants, prepared aconite

(Aconitum praeparatum), together with other herbs that have diuretic

and warming properties and increase the yang fluid transforming

function. Rehmannia would be counterproductive in this formula

because it would contribute to the condition of damp stagnation. The

mushroom, Poria cocos (fu ling), however, is amphoteric in its

ability to regulate either high or low, potassium and sodium

balance.

 

When any extracellular fluid is discharged whether its from the

urine, skin pores, saliva or intestines, aldosterone is secreted to

help the body conserve sodium chloride. This is especially true, of

course, when the body tends to sweat more profusely as in hot

environments. That is why it is often recommended that one take a

little more salt in hot weather.

 

There seems good reason to believe that TCM Kidney Yang herbs are

involved with the secretion of the enzyme, renin from the kidney

which in turn stimulates aldosterone from the adrenals. Many herbs,

such as Cistanches salsa, Cynomorii songaricum, Epimedium

grandiflorum (yin yang huo), Morinda officinalis, Psoralea

coryfolia, Eucommia ulmoiodes (du zhong) and possibly North American

Gravel root (Purpureum perfoliatum) to name a few, are effective for

treating edema and frequent urination possibly caused by a lack of

aldosterone.

 

This is also associated with either constipation of diarrhea where

aldosterone being generally low, manifests with poor sodium

absorption from the intestines and consequent irregular bowel

movements. This type of constipation caused by deficiency, usually

does not respond to harsh purgatives such as rhubarb root, cascara,

senna and sodium sulphite which tend to eliminate excess.

Nevertheless, treatment to restore bowel movement with tonifying

kidney yang herbs is usually a slow process.

 

One TCM formula used for TCM Kidney Yang deficiency constipation is

called Benefit the River Decoction (ji chuan jian). It consists of

the following:

 

 

Cistanche salsa (rou cong rong) 6-9 grams primary kidney yang herb

which moistens the intestines

Angelica sinensis (dang gui) 9-15 grams tonifies blood and

lubricates the intestines

Achryanthes bidentatae (niu xi) 6 grams regulates blood circulation

downward

Alisma plantago (ze xie) 4.5 grams drains, puifies and circulates

fluid downward

Citri seu ponciri ( green citrus or zhi ke) 3 grams relaxes the

intestines and directs the chi downward

Cimicifuga foetida (sheng ma) 1.5 to 3 grams has an ascending chi

action, in combination with green citrus, which is descending, it

helps regulate kidney chi mechanism.

 

This formula is used for kidney yang, chi, yin as well as blood

deficiency. Centered around the chief herb, Cistanches, a kidney

yang herb, it focuses on warming the the kidneys as weel as

moistening the intestines to facilitate the passage of stool. It is

useful for atonic constipation, degenerative joint disease and

chronic arthritis. Appropriate modifications can be made as follows:

 

 

for deficient vital energy add Panax ginseng

for kidney yin deficiency add prepared Rehmannia glutinosa.

for internal fire add scutellaria baicalensis

for chronic constipation with dryness add crushed cannabis seed (9-

30 grams) and cynomorium songaricum (9-15 grams).

 

From the above, the importance of assigning salt to the TCM Five

Element designation for the water element is definitely underscored

because of its descending action and direct effect on kidney

function. Therefore salt is used as a conductor in TCM Kidney tonic

formulas by Chinese herbalists who recommend that a pinch of salt be

taken either with the tea or the pills taken with warm, slightly

saline, water (miso or soya sauce can be used for this).

 

The Glucocorticoids and Yin Deficiency, the effects of Cortisol on

Protein metabolism

Some of the functions of cortisol such as its gluconeogenesis

effects on carbohydrates and fats and the ability to counteract

stress, inflammation and promote healing relate to Kidney Yin

functions. Other aspects, however, actually create a wasting or yin

deficiency which manifests as a hypermetabolic condition.

 

A prolonged, high concentration of cortisol seems to reduce protein

stores in all body cells with the exception of those of the liver.

This is caused both by decreased protein synthesis and increased

catabolism or breakdown of protein in the cells. One of the many

negative effects of excess cortisol is that the muscles can become

severely weakened and immunity of the lymphoid tissue is decreased

to a fraction of normal.

 

With the increase of liver protein synthesis, the liver has a

tendency to enlarge causing ascites (abdominal swelling). There is a

tendency for cortisol to mobilize amino acids from the tissues,

increasing plasma amino acid concentration.

 

For this condition we use Rehmannia Six or Rehmannia Eight if there

is associated coldness and sexual weakness. Rehmania six formula is

selected because of its ability to drain fluid excess while at the

same time nourishing TCM kidney and liver yin. This demonstrates

that Rehmannia is amphoteric in regulating both TCM kidney yin and

yang.

 

Ma Huang (Ephedra sinensis)

Ma huang is classified as a warming exterior releasing herb usually

indicated for the treatment of cold fevers, allergies and

respiratory problems. While not a tonic because it disperses rather

than supplements, it can be used as a kidney yang stimulating herb

to `get things moving.' It helps the yang by dispersing cold,

promoting urination and reducing edema.

 

It contains a variety of well known adrenaline-like compounds

including ephedrine, pseudoephedrine, norephedrine and

norepinephrine. As such it is a powerful sympathetic nervous

stimulant which if overused can raise blood pressure, aggravate

deficiencies, heart palpitations, restlessness and tremors.

 

Interestingly, like yohimbine which contains a number of similar

alkaloids, Ma huang was combined with poria cocos (fu ling) and was

used by the Mongols as an aphrodisiac.

 

Siberian Ginseng

Siberian ginseng (Eleutherococcus senticosus) has been widely

acclaimed as an adenal tonic and adaptogen. Being in the araliaceae

family, it is related to Panax ginseng, North American Devil's Club

(Oplopanax horridum) and Spikenard (Aralia racemosa and A.

californica). All these have so called tonic adaptogen properties

meaning that they increase the body's resistance to stress.

 

Siberian ginseng is also closely related to a Chinese herb called

`Wu jia pi' or `Ci wu jia,' traditionally used for rheumatic

conditions. It has various Latin binomials including Acanthopanax

gracilistylus, A. sessiloflorus, A. senticosus and according to

Chang and But, the name given by Harms, Eleutherococcus senticosus.

 

The major chemical components of Siberian ginseng are eleuthrosides

A-G (phenylpropanoid, sterol, lignans, isofraxin, carotenoids and

coumarins) (9) Both herbs have an acrid and warm energy making them

contraindicated for Yin Deficient and inflammatory or heat signs.

This fact alone suggests that Siberian ginseng is more of a warming

TCM Kidney yang tonic with some anti-inflammatory effects associated

with cortisol.

 

Nevertheless it does have anti-inflammatory effects as demonstrated

on experimentally induced arthritis in rats. The fact that

adrenalectomized rats showed no effect demonstrates that these herbs

seem to possess adrenalcortical stimulating properties.(10) What we

have is another instance of an herb amphoterically responding

appropriately to the needs of the body, warming and stimulating or

cooling and sedating as necessary.

 

Siberian ginseng has been extensively researched by the Russians and

as a result is popular among workers and athletes in that country to

improve performance, endurance and competitive abilities as well as

preventing sickness in the workplace. All of this demonstrates the

herb's so called adaptogenic properties which is characterized by

herbalist, Steve Blake as neither stimulating the yang-sympathetic

nor the yin-parasympathetic but improving the body's ability to

appropriately switch back and forth more efficiently and at a faster

rate.

 

" Wu Jia Pi " is used for conditions of cold, damp and painful

rheumatic obstruction with liver and kidney deficiency and with weak

and soft bones. It nevertheless is especially useful for smoothing

the flow of chi and blood which tends to agree with Steve Blakes

description. " Wu Jia Pi " is made into a wine by the Chinese and is

very suitable for treating the elderly. The recommended dose of " Wu

Jia Pi " is 3 to 15 grams once or twice daily. There is no comparison

with the relatively miniscule dose, usually in tincture or alcoholic

extract recommended for Siberian Ginseng.

 

3. KIDNEYS GOVERN GROWTH, MATURATION AND PROCREATION

The TCM Kidneys are also described as being in charge of storing

essence and dominating reproduction, growth and development. The

essence of the TCM Kidney refers to two parts: Congenital chi, which

is the inherited constitutional strength and Acquired chi, which is

the body's ability to receive transformed energy from food, air and

water.

 

From a Western physiological perspective at least part of the above

TCM functions refer to the relationship between the pituitary and

the adrenals. One of the most important functions of the anterior

pituitary is the secretion of growth hormone (GH) or somatotropin.

Since the TCM Kidneys include most endocrine functions, the

secretion of growth hormone is definitely included.

 

Unlike other hormones, growth hormone does not function through a

target gland such as the ovaries, testes, thyroid, etc., but instead

exerts an effect on all or most tissues of the body. Just as TCM

designates the kidneys as governing normal growth and maturation,

growth hormone is responsible for normal growth and development of

the body down to the regulation of the size and number of individual

cells.

 

Besides the specific effects of stimulating growth, growth hormone

has many other generalized metabolic effects which relate to the TCM

description of the kidney. These include the following:

 

 

Increased rate of protein synthesis in all cells of the body --- An

increased rate of growth may be the result of an increase of protein

synthesis. One of the TCM designations of kidney deficiency is a

patient who is either excessively malformed or presents a thin

emaciated appearance, this may be caused by a deficiency of

congenital TCM Kidney chi.

 

 

Increased mobilization of fatty acids from adipose tissue, and

increased use of the fatty acids for energy --- With a loss of

kidney chi, spleen chi also becomes depleted and there may be a

tendency to gain weight more easily with difficulty reducing. This

is a common problem with aging. It is well known that fat tissue

tends to be hydrophilic, and edemic, fluid stagnation in TCM

indicates a deficiency of the yang fluid transforming powers of both

the TCM kidney and spleen. Specifically, mushrooms such as Poria

cocos (fuling), along with other chi and yang tonics are used as

special diuretics to regulate both fluid and fat metabolism.

 

 

Decreased rate of glucose utilization throughout the body --- TCM

Kidney chi deficiency can effect our energy levels dramatically with

poor utilization of carbohydrate which can cause hypo or hyper

glycemic tendencies. Diabetes is considered a disease of internal

wasting or kidney and liver yin deficiency. As such, one of the most

important formulas used in TCM is Rehmannia six.

 

This formula is also given to children who exhibit abnormal problems

of growth and developement. In adults, there may be various causes

for abnormal growth patterns and one may have to consider associated

conformational tendencies such as dietary and assimilative

malfunction associated with the TCM spleen, stagnation associated

with a tumour or other excess type causes.

 

4. KIDNEYS PRODUCE SKILL AND HOUSE THE WILL

When there is abundant TCM kidney chi or essence, there will be a

strong physical constitution as well as a strong innate sense of

purpose and will. Such strength of will is often associated with the

necessary self discipline to be able to succeed in any endeavour. As

stated in the Nei Ching (11) , " the kidneys hold essence, and the

essence holds the will. "

 

Fear, paranoia and insecurity are the negative emotions of the TCM

Kidneys. One who inappropriately exhibits these tendencies is

considered to have deficient kidney chi.

 

Here we see how the TCM Kidney, which includes the adrenals and in

fact the entire endocrine system, goes beyond its Western

physiological description as a urinary organ. The difference, as

with all the " xang fu " or TCM organ systems, lies in what Unschuld ,

describes as " a system of relations and functions derived from

conclusions by analogy " . The wide scope of influence of the kidneys

encompassing the entire range of psychological as well sympathetic

and parasympathetic reactions and functions further bears out

Unschuld's conclusion that " these analogies, cannot have originated

from within the human body. " (12)

 

Chinese medicine, taking a more functional rather than mechanical

view of the body, were able to generate psychological changes

through the treatment of diet, herbs, acupuncture and other

physiotherapies. By tonifying the kidneys, through the use of

Rehmannia Six or Rehmannia Eight formulas as well as offering

certain dietary suggestions such as the elimination of cold foods

and drinks as well as cold natured foods such as citrus for

instance, many of the physical and emotional symptoms of yang

deficiency are able to be controled and eventually eliminated. The

use of sugar, which is classified as a spleen yang, when taken in

concentrated form in white sugar and fruit juice, can, through

overstimulation of the sympathetic reflex, injure and deplete kidney

yang.

 

5. KIDNEYS HOLD THE ESSENCE

As stated, the kidneys are the location where the essence is stored.

Essence refers to the genetic potential bestowed from birth. This

forms `congenital chi' which determines the constitution of the

individual throughout life. Since this potential is also transferred

through reproduction, essence also refers to the sperm and ovum. A

strong essence manifests as abundance of spirit and energy. A lack,

corresponds to a dearth of vitality.

 

This same essence or congenital chi of the TCM kidneys is imparted

to all the internal organs and determines their form and function.

Malformed organs with impaired function, being congenital, are

attributed to TCM kidney essence deficiency. The best one can hope

to achieve in treatment is an amelioration of associated

malfunctions and to hold back further degeneration.

 

More recent scientific discoveries are revealing a plethora of neuro-

transmiting hormones that effect certain moods and attitudes. In a

sense, these powerful minute secretions are also a kind of TCM

kidney essence, the absence of which can leave us feeling depressed

and drained. This feeling can occur occasionally from an over

indulgence in sex.

 

Kidney yin and blood tonics can be used both to replenish at least

certain aspects of TCM kidney essence as well as prevent the loss

and depletion of energy. Two important herbs that might be discussed

in this context are Dendrobium nobile and Schizandra chinensis.

 

Dendrobium nobile (shi hu)

Dendrobium nobile, is the root of an orchid classified as a yin

tonic. It nourishes the yin, clears heat and refreshes the chi,

generates fluids, treats severe thirst, intractable fevers caused by

injury to fluids. It also nourishes stomach yin and is used for

stomach aches. Dendrobium is indicated for all wasting and thirsting

conditions.

 

It contains a number of alkaloids including dendrobine, dendranime,

nobilonine, dendroxine, dendrin, 5-hydroxydendroxine. The average

dose is from 6 to 9 grams in decoction or powder. Experimentally, on

animals, large doses have had an inhibitory effect on the heart and

lungs and caused convulsion.

 

Dendrobium has been indicated for feelings of being drained and

depleted generally and after sexual intercourse. The average dose is

between 9 to 20 grams and it can be either taken in decoction or

powder. It is contraindicated for individuals with an acute febrile

or inflammatory condition with no symptoms of dryness or

dehydration.

 

Schizandra chinensis (Wu wei zi)

An astringent tonic with some yin tonic properties, Schizandra

chinensis is used as an astringent protective herb against leaking

and loosing one's energy and essence.

 

Besides restraining diarrhea, nocturnal emissions, spermatorrhea,

premature ejaculation, leukorrhea and frequent urination, Schizandra

berries are also used to stop excessive sweating, control coughing

and wheezing. It is tonic to the nervous system, helping to calm the

spirit, treat insomnia and forgetfulness.

 

Schizandra is called " Wu wei zi " or " five flavor herb, " because it

possesses all five flavors considered therapeutically important in

TCM. It seems to specifically exert an effect on the central nervous

system, improving intellectual activity, concentration, fine

coordination, sensitivity and endurance as demonstrated in healthy

young males in various experiments including long distance marathon

races. The average dose given was 5 to 10 mg once or twice daily.

(13)

 

In this sense, Schizandra while classified as an astringent in the

Chinese materia medica has definite mild adaptogenic properties

which, like ginseng, help to regulate various body functions and

counteract the effects of stress. Besides supplementing, to some

extent, what has been lost, Schizandra's greatest role as stated, is

in preventing loss of energy and essence. The average dose is 3 to 9

grams. It is contraindicated for individuals with true heat,

constipation, acute inflammatory and febrile conditions.

 

An important concept related to inherited constitutional strength,

is the belief in TCM that the inherent potential or original chi

( " yuan " or " ancestral chi " ) inherited from one's parents and which

resides in the kidneys as the primal spark of life, cannot actually

be supplemented or restored by either food (including herbs), water,

air, the usual methods of supplementation. It is believed that the

only way it can be supplemented is through internal Taoist practices

using breath and meditation. This being very difficult for most (due

to a lack of will and self discipline), we are left with the

prospect of a finite amount of kidney essence which, when it is

consumed in the course of a lifetime, results in the eventual

process of aging, decline and death.

 

6. KIDNEYS GOVERN THE BONES AND THE MARROW

The Nei Ching says, " As regards the kidneys .... their fullness is

in the bones. " One of the signs of kidney deficiency is weakness of

the bones and teeth.

 

The formation and maintenance of the bones and the teeth is a

complex process which is involved with many aspects of the endocrine

system. Other more basic considerations need to be taken into

account such as nutritional factors including the presence of

sufficient protein, calcium, magnesium, vitamin C and vitamin D to

name a few. Finally, since vitamin D is at least partially absorbed

from the sun, lack of sufficient outdoor exercise and activity can

have a detrimental effect leading to osteoporosis or weakening of

the bones.

 

All of these have a complex interraction with the function of the

kidneys and adrenals. There are at least three predominant

physiological methods where the TCM kidneys have an effect on bone

growth: 1. through the parathyroids, 2. through the previously

discussed presence of growth hormone from the pituitary gland and,

3. the secretion of various sexual hormones including estrogen and

testerone.

 

THE PARATHYROIDS IN RELATION TO BONES

There are usually four to five parathyroids attached to the lateral

lobes of the thyroid gland.

 

They are mainly concerned with the regulation of the calcium-

phosphorus balance on which the bones depend for strength. A lack of

parathyroid hormone increases the excretion of phosphorus and

calcium from the bones into the urine. In addition, parathyroid

hormone is necessary for normal neuromuscular irritability, blood

clotting, cell membrane permeability and the normal function of

certain enzymes for maintaining blood concentration of calcium at

normal levels. The presence, therefore, of parathyroid hormone in

the tubules of the kidneys is necessary to increase the absorption

of calcium for the maintenance and growth of the bones as well as

strengthening and maintaining the nerves (kidney chi).

 

THE RELATION OF THE BONES TO GROWTH HORMONE

The secretion of growth hormone from the anterior pituitary

stimulates the formation of cartilage and bones. This is

accomplished through development of several small proteins, called

somatomedin which are formed in the liver, possibly the muscles as

well as the kidneys.

 

THE RELATION OF ESTROGEN AND TESTOSTERONE TO BONE MAINTENANCE

Besides being produced in the reproductive organs of the male and

female, both male and female sexual hormones are produced in the

adrenals. These hormones are necessary for the proper growth and

maintenance of many vital functions including the growth and

maintenance of the bones and muscles as well as producing primary

sex characteristics.

 

Since estrogen is known to have a bone stimulating activity, a

postmenopausal lack of estrogen secretion in women is a primary

cause of osteoporosis. Testerone has powerful anabolic or building

effect in the utilization of protein and the consequent development

of the muscles and bones.

 

In Traditional , the bones are considered part of

the yin-substance of the body. They are are treated with certain

blood and kidney yin tonic herbs which are known to strengthen and

promote the healing of broken bones. In this category, one would

definitely consider the use of various sources of organic and

inorganic calcium and other minerals for strengthening the bones.

 

Comfrey root (Symphytum officinale) is an herb traditionally used by

herbalists throughout the Western hemisphere as a yin tonic that

promotes the growth and maintenance of bones and muscles. It

contains an abundance of alantoin which is a recognized cell

proliferent. Comfrey root has all the indications of a yin tonic

have a cool, moist, nutritive energy. It is used not only to

strengthens the bones but also to counteract inflammation and

arthritic conditions. Recent findings of trace amounts of

pyrolizidine alkaloids in certain species of comfrey have made many

herbalists question its long term use. In TCM there are many yin or

blood tonic herbs that have some of the properties of comfrey and

could be substituted. One of the most important as previously

discussed, is Rehmannia glutinosa (Di huang) which, like comfrey, is

used as an anti-inflammatory yin tonic and healer of bones and

tissues.

 

Because of the increased risk of cancer in women, estrogen is not so

frequently prescribed for menopausal and post menopausal women in

China as it is in Western countries. Instead, older Chinese women

prefer to use herbs and formulas containing Rehmannnia to prevent

bone degeneration as well as other menopausal symptoms.

 

Rehmannia Six and appropriate variations is one formula that is used

and the other is as follows:

 

The Four Ingredients Decoction (Si wu tang)

 

Prepared Rehmannia (shu di huang) 10-15 grams

Dang Gui(angelica sinensis) 9-12 grams

Ligusticum Wallichi (chuan xiong) 6-9 grams

Paeonia Alba (bai shao) 9-12 grams

 

This is the most important gynecology formula. It is used for anemia

and stagnant blood circulation and is given most typically to women

with symptoms of sallow complexion, pale lips and fingernails,

dizziness, vertigo, tinnitis, irregular menstruation, decreased

blood flow, abdominal pain or ammenorhea. Tongue is pale and pulse

is thready and weak.

 

7. THE KIDNEYS OPEN INTO THE EARS WHICH ARE ITS ORIFICES

The Nei Ching says, Kidney chi goes up to the ears and when the

kidneys are harmonious, the ears can perceive the five tones. " Since

the kidneys are involved with the regulation of the autonomic

nervous system, their capacity to differentiate between pitch,

intensity and loudness is optimized. Similarly, since good kidney

chi provides a general condition of sensory alertness, they provide

the power to perceive not only sound but light, feeling, flavor and

so forth.

 

In terms of the TCM kidney we do not look so much to the

physiological structure of the ear (although, the fact that the ear

has a superficial morphological resemblance to the kidneys is

considered to have relevance). Of more importance is the complex

physiological process whereby our nervous system responds to

auditory stimulation and in turn transmits that information to the

hearing centers of the brain.

 

TCM and the Mechanism of Hearing

The relationship of the TCM kidneys to hearing specifically involve

two important physiological processes. One is the neurological

response described above which is particularly complex and sensitive

in terms of the transmission of sound wave vibrations. Impairment of

the cochlea or auditory nerve has a functional relationship not only

locally but also to the general strength of the sympathetic nervous

system. Nerve deafness can be the ultimate result of a diminishing

of nerve force and the ultimate degeneration of conducting nerves in

the ear. Of course, there can be direct injury to the nerves from

congenital defect, an accident or exposure to loud noises. This

results in nerve deafness.

 

In TCM, nerve deafness, as with all neurological degeneration, is

considered an type of yin deficiency. An appropriate yin tonic such

as Rehmannia Six is prescribed possibly with some variation to suit

the condition of the patient.

 

The second aspect of hearing that has a functional relationship to

the kidneys is the ossicular system in the middle ear which involves

three very small bones called `hammer'(malleus), `anvil'(incus) and

`stirrup' (stapes). Their names describe their shapes. Sound waves

entering the external auditory canal ultimately strike against the

tympanic membrane or eardrum, setting it in vibration. These

vibrations cause the malleus or hammer, whose head attaches to the

membrane to resound. This in turn moves the `anvil' which is

attached to the stapes.

 

Since the kidneys and the endocrine system, especially the

parathyroids, are integral to the metabolism of calcium, any

imbalance in calcium metabolism which influences the bones are

likely to have an effect on the three delicate bones which are

involved in the mechanism of hearing. These can become partially or

completely destroyed or ankylosed ( " frozen " in place by fibrosis or

calcification) and result in conduction deafness.

 

In TCM this type of deafness is caused by stagnation and blockage

and can be appropriately treated internally with herbs that

stimulate circulation, promote proper digestion so as to avoid

lymphatic congestion, promote diuresis, relieve `wind' or spasms.

 

Nerve deafness and conduction deafness can be differentiated because

in conduction deafness, the subject is still able to hear, although

weakly, by sensing vibrations directly through the skull bones. In

contrast, nerve deafness is more total since it is presumed to be

caused by damage to the cochlea or the nervous system rather than

the ossicular system.

 

The Tuning Fork Test to determine between nerve and Conduction

Deafness. The two forms of deafness are differentiated by means of

the tuning fork test. A weakly vibrating tuning fork is placed in

front of the ear, gradually it is moved away until the subject can

no longer hear it. Then the butt of the vibrating fork is placed

directly against the mastoid process. If bone conduction is better

than air conduction, the sound of the tuning fork will again be

heard and bone conduction hearing is better that air conduction.

Deafness, therefore, is caused by conduction deafness. If after

placing the fork directly against the skull, it is still not heard,

then it is nerve deafness.

 

Diseases of the ears

Nerve Deafness. This term includes damage to the cochlea (inner ear

which transmits sound vibrations to the brain), the auditory nerve,

or to the central nervous system circuits from the ear. This is

usually tested either by air or bone conduction (the transmission of

sound vibrations through the bones of the skull). Because of the

tendency toward sclerosis and weakening of neurological response,

some type of deafness, especially to high frequencies, usually

occurs as a process of aging.

 

Other patterns of deafness frequently occur as follows:

 

 

deafness for low frequency sounds caused by excessive and prolonged

exposure to very loud sounds (rock band and jet airplane engine),

and 2. deafness to all frequencies caused by drug sensitivity of the

organ of corti (in the inner ear), especially sensitivity to some

antibiotics such as streptomycin, kanamycin and chloramphenicol.

 

From this we see how both sound and drug stress has a profound

damaging effect not only on the hearing because they are such

refined receptors but most likely on kidney chi generally. To make

such a diagnosis, we would have to evaluate whether other symptoms

of kidney imbalance are present such as urinary problems, joint and

lower back pains.

 

 

Tinnitus. Here one may experience a subjective ringing, tinkling

buzzing or other sounds in the ear. Frequently this occurs as a

result of impaction of ear wax or inflammation of the eardrum or the

middle ear. Another cause is Meniere's syndrome (named after Prosper

Meniere, French physician 1799-1862). This is a disease with

progressive symptoms of deafness, ringing in the ears, dizziness,

and a sensation of fullness or pressure in the ears. The cause is

not generally known but it seems that acute symptoms tend to worsen

under stress and restis most effective. Autopsy has revealed edema

in the membraneous labyrinth so that it is always a good idea to

eliminate salt from the diet as it can aggravate conditions of edema

and fluid retention.

 

This is a condition for which TCM has effective herbal treatments.

For treatment to be effective we must differentiate between the

various syndromes.

 

 

1. If tinnitus is caused by excess dampness and wind we should use

herbs that are diuretic, antispasmodic, carminative, to prevent

fluid accumulation as a result of weak digestion.

 

Decoction of Pinellia, White Atractylodes and Gastrodia (Ban xia bai

zhu tian ma tang)

 

Pinellia tuber (ban xia) 6-9gms this herb resolves dampness in the

gastrointestinal tract

Gastrodia tuber (tian ma) 3-6gms this is one of the most powerful

antispasmodics

Atractylodes alba (bai zhu) 6-9gms this herb is used as a tonic

carminative to aid digestion and eliminate GI tract fluid stagnation

Poria cocos (FuLing) 6-9gms this herb is diuretic

Citrus reticulata peel (chen pi) 3-6gms this herb is drying and

carminative

licorice root (gan cao) 3-6gms this herb is used to harmonize the

ingredients and strengthen the digestion

fresh ginger (sheng jiang) 3-6gms this herb is circulating,

carminative

Jujube dates (da zao) 3-5 pc. this is a tonic and added to harmonize

the ingredients

 

The action of this formula is:

 

to resolve phlegm and indogenous wind (to eliminate, dry, and

prevent the accumulation of edema and to relieve internal tension

and spasm)

To strengthen the spleen and dispel dampness (to aid digestion and

assimilation, preventing lymphatic congestion and to have diuretic

action)

 

Besides its use for Meniere's disease, it is also good for symptoms

of vertigo, profuse phlegm, full and heavy feeling in the chest.

 

Tongue: white and greasy (signifying damp stagnation)

 

Pulse: soft and slippery (signifying the same with digestive

weakness)

 

The next formula is specifically for deafness caused by nerve damage

(kidney yin deficiency). It is based on the Rehmannia 6 formula

which is the basic formula for kidney yin deficiency mentioned

previously.

 

Pills for the deaf (Er long Zuo Ci wan)

 

Anemone altaica (Jiu Jie Chang Pu) 6-9 grams the rhizome is used, it

is a warming aromatic, stimulant, helping digestion and eliminating

dampness

Magnetite or feric oxide (Ci shi) 1-3 grams it has a cold energy but

enters the kidney and liver organ meridians, it has a yin effect of

calming and relaxing while at the same time because it is a mineral,

it anchors the yang or destructive rising energy

Schizandra berries (wu wei zi) 6-9 grams it has a yin tonic effect,

helping to restrain the floating yang, calms the spirit and prevents

leakage of energy

 

The remaining ingredients consist of Rehmannia 6 combination:

 

Prepared rehmannia (shu dihuang) 20-25 grams tonifies kidney essence

and yin

Cornus berries (shan zhu yu) 10-15 grams

Dioscorea batatas (shan yao) 10-15 grams

Alisma root (ze xie) 9-12 grams

Moutan peony (p. suffructicosa)(mu dan pi) 6-9 grams 9. Poria cocos

(fu ling) 9-12 grams

 

The actions of this formula are:

 

to nourish kidney yin and,

to open the hearing.

 

It is specifically indicated for an individual with hearing problems

caused by kidney deficiency with associated tinnitus, deafness and

vertigo.

 

Tongue: red

 

Pulse: thready and rapid

 

It can be used for deafness, Meniere's syndrome and diabetes.

 

From the above, we see that TCM considers neurological degeneration

(as reflected in nerve deafness) as a condition of yin deficiency,

and involves nerve deafness which would also be considered a

condition of kidney yin deficiency. A chronic remedy such as

Rehmannia Six is appropriate not only to improve the presenting

condition of deafness, but to possibly prevent further degeneration

of other vital functions. For many conditions, this may be the

greatest benefit for its use.

 

We also recognize that dampness or lymphatic stagnation caused by

poor digestion and assimilation can cause localized edema in the

inner ear that can be the cause of tinnitus. If we were to prescribe

the yin tonic, Rehmannia Six formula for this conformation it may

aggravate the condition because rehmannia is a moist herb. To give a

stimulating, drying and dampness dispelling formula is a correct

approach but would be contraindicated for the condition of yin

deficiency.

 

Now let's consider some Western herbal treatments for the ear:

 

The late Doctor Christopher had a formula which he gave both for

hearing loss, vertigo and brain damage. It was called B and B

Tincture and consisted of a combination of black and blue cohosh,

vervaine, scullcap and lobelia (all are antispasmodics and nerve

tonics), together with garlic macerated in olive oil (the garlic oil

has penetrating and regenerating properties).

 

Each night 4 to 6 drops of both the B and B tincture and the garlic

oil are inserted in each ear, plugging them afterwards with cotton

and leaving on overnight. This is done six days a week for 4 to 6

months or as needed. On the seventh day the ears are flushed out

with equal parts warm apple cider vinegar and warm water.

 

This particular combination has proven to be effective not only for

various conditions of hearing impairment but because of its

penetrating action, for the treatment of brain damage as well. It is

corroborated with the similar use of various medicated oils in

Ayurvedic medicine. This can easily be combined with the internal

treatments prescribed by TCM and will only hasten recovery, if it is

at all possible.

 

B and B Tincture combines nerve tonic herbs such as skullcap

(Scutellaria lateriflora), Black cohosh (Cimicifuga racemosa), Blue

cohosh (Caulophylum thalictroides) and Vervaine (Verbena hastata)

which besides their nerve tonic properties combine various waste

discharging benefits as well. The garlic has a penetrating and

stimulating action, helping to remove obstructions, in a base of

olive oil, there is some softening and regenerative yin tonification

as well. Altogether, the combination of herbs used externally, and

the addition of internal herbal formuli makes for a superior herbal

protocol for hearing difficulties.

 

8. KIDNEYS MANIFEST ON THE HAIR

Kidney chi is internal but it is manifested externally in the hair.

Kidney chi being the root must rise to the top of the head, when it

is strong and abundant the hair will be abundant, radiant and

lustrous. When kidney chi declines, the hair looses its

pigmentation, whithers and falls off. This is an inevitable process

of aging.

 

Hair pigmentation. Hair receives its color from different amounts of

melanin pigments in the outer layer (cortex) of the hair. Melanin is

also responsible for skin pigmentation and both skin and hair is

effected by exposure to sunlight.

 

As with other functions governed by TCM kidneys, the formation of

melanin is regulated by the endocrine system, especially the

adrenals. It is believed that the formation of melanin is regulated

by aldosterone which is the most active mineralocorticoid hormone

secreted by the adrenal cortex. This hormone is in itself stimulated

by ACTH (adrenocorticaltropic hormone) from the pituitary. With a

balanced and uniform secretion of cortisol from the adrenals,

melanocyte stimulating hormone (MSH) is secreted which regulates

hair and skin coloring.

 

Individuals with a deficiency of kidney yin and essence or a lack of

adrenalcortical hormones, will tend towards loss of hair

pigmentation or greying. As a result of this, there is a definite

relationship between the effects of a sudden shock or stress on the

adrenal glands that can deplete one's adrenalcortical reserves as

shock absorbers, so to speak, and result ultimately in either hair

loss or greying.

 

At the base of each hair follicle is a loop of capillaries enclosed

in a connective tissue covering called the hair papilla. Atop each

papilla there are clusters of epithelial cells that reproduce and

eventually form the hair shaft. In addition, to this there are small

bundles of enervated muscles which under sudden stress such as cold

or fright, causes the hair to stand on end. While the coloring is

regulated by adrenalcortical hormones, the proper nerve strength

which ennervates the arrector pili muscles attached to the base of

the hair follicle, and is, I believe, responsible at least in part,

for helping to hold the hair in place, is regulated by the

sympathetic nervous system.

 

From this we see that hair is essentially nourished by blood and

held in place and maintained by the sympathetic nervous system. A

lack of proper nutrition will effect both hair coloring and growth

while congestion and nervous exhaustion will diminish the body's

ability to conduct nutrients to the area as well as maintain

retaining power.

 

The best results for treating alopecia or hair loss is to encourage

hair growth with herbs that stimulate the scalp and hair bed.

Alcoholic extracts, tinctures and oils are made using herbs such as

echinacea root, rosemary, nettles, birch leaves, burdock root, and

seed together with a small amount of essential oils such as oils of,

rosemary, lavender and calamus. This mixture is rubbed vigorously

into the scalp. If possible, one can follow this occasionally with a

light tapping over the affected areas of the scalp with a Chinese

dermal hammer.

 

Treatment should be applied regularly and daily for anywhere from a

few weeks to months according to the severity of the condition. Many

who have been consistent in their attempts, have stimulated new hair

growth. This has been well documented by many cases both in Western

and Asian countries including China.

 

The TCM internal treatment for hair loss is tonifying for either or

both kidney yin or yang. Again, the approach is directed to

strengthen the autonomic nervous system. Evidently a similar

approach in the West is followed with the use of B Vitamins and

mineral supplements, especially Zinc.

 

Two herbs in particular are used in TCM for helping to restore hair

and skin pigmentation. These are Polygonum multiflorum (ho shou wu)

and Rehmannia glutinosa (shu dihuang). Both are classified as blood

tonics which nourish liver and kidney essence.

 

He Shou Wou (Polygonum multiflorum)

The use of He shou wuo for the hair emanates from an ancient story

of a famous Chinese military officer who was condemned to death by

confinement in a remote cell with no food or drink. He was able to

survive by consuming the leaves and roots of a common vinelike weed

(polygonum multiflorum). After one year his keepers went back to

dispose of the remains of the condemned military officer, that found

him fully rejuvenated with his lustrous black hair color fully

restored. Since that time, the herb that General He Shou Wou

consumed while incarcerated for a year has been named in his honor.

 

He shou wou, commercially misnamed in recent times, fo ti tieng,

contains lecithin, anthraquinones, chrysophanic acid, emodin, rhein,

and chrysophanic acid anthrone. Normally He shou wou has been cured

by cooking it with black beans. It is bitter, sweet, astringent and

slightly warm.

 

It is used as a tonic for the liver and kidney and also to nourish

the blood, benefit the essence, and kidney and liver yin. It is

therefore used for deficient yin and blood conformations including

dizziness, blurred vision, prematurely gray hair, weak lower back

and knees, soreness in the extremities and insomnia. All of these

are basic signs and indications for adrenal depletion included under

the signs of kidney yin deficiency. As it contains some

anthraquinones it also possesses some demulcent and detoxifying

properties making it useful for lubricating the intestines and

promoting bowel movement especially in anemic individuals.

 

One of the most remarkable effects of He shou wou is its effects on

lipid metabolism. It is believed that the lecithin in He shou wou is

responsible for preventing the accumulation of cholesterol in the

liver and the retention of lipids in the blood stream and finally

the penetration of lipids into the arterial endothelium, hence

reducing arteriosclerosis. (14)

 

The lecithin, besides being good for the hair, is found in He shou

wou as a main component of nerve tissue, particularly of the brain

and spinal cord. It is also an important raw material for the

membranes of erythrocytes and other cells, promoting their growth

and developement. (15)

 

One of the most commonly available and effective forms of He shou

wou is in a Chinese patented formula called " Shou Wou Chih " . It is a

liquid extract containing Shou wou along with Dang gui, Ligusticum,

Polygonatum, Rehmannia root and other herbs that aid circulation and

digestion. It is used as a liver tonic, tonifying, warming and

invigorating the blood, nourishing the liver and kidneys, benefiting

the eyes and tendons, strengthening the bones and tendons of the

back, relieving joint pains and depletion caused by sexual excess,

childbirth, or illness. Shou Wou Chih is suitable to take daily for

a long period of time (3 months or more). The daily dose is 2-3

tablespoons, 3 x daily.

 

Another good remedy for restoring hair color is Black sesame seeds.

Chinese medicine finds that herbs and foods that are black colored

are usually particularly good for the TCM kidneys. Black sesame is

rich in certain oils and is taken regularly, about one tablespoon

daily, to prevent greying and help restore normal hair color. Black

sesame seeds can be dry roasted and ground with a little salt to

make a delicious condiment that can be sprinkled on rice and other

foods. I have also combined about a thrid portion of ground he shou

wou with the black sesame gomasio to increase its benefits. A

delicious sweet version can be made by mixing the ground black

sesame with honey or dry powdered pure sugar cane juice extract.

 

As with the discussion of other aspects of the TCM Kidneys and

indeed herbal medicine generally, attempting to diagnose and treat a

specific symptom such as premature hair loss or greying, leads one

to use herbs and formulas that are indicated for the whole person.

By treating hair symptoms, one eventually also finds that their

energy and well being improves, joint pains disappear and perhaps is

beneficial even, to one's sex life. In this way one herb or formula

can treat 100's of symptoms while at the same time by applying TCM

diagnostic criteria we can arrive at the correct approach that will

achieve the best results for a specific symptomology.

 

9. KIDNEYS GRASP AND DESCEND LUNG CHI

Another important function of the TCM Kidneys is their ability to

grasp the chi of the lungs and pull it downward. Failure to do this

results in a kind of adrenal exhaustive asthma where the lung energy

does not properly descend.

 

What is the relationship of the kidneys to the lungs? The two end

products of carbohydrate metabolism is metabolic water and carbon

dioxide gas. While the main function of the kidneys is to eliminate

excessive water from the blood, carbon dioxide gas is eliminated

through the lungs.

 

The filtration of water through the glomeruli of the kidneys is

dependent upon high oxygen arterial blood. If the arterial blood

contains abnormal impurities from an improper diet rich in

denatured, and refined foods, the kidneys require more oxygen to

force elimination; this extra oxygen is supplied by the adrenal

glands.

 

As Dr. Henry Bieler explains, " Nature wisely placed these glands

near the kidneys, so that their internal secretion (adrenoxidase)

can supply oxygen faster, in order to overcome any strain on the

process taking place in the globule of the kidney. " (16)

 

Adrenal stimulants such as ma huang, cayenne pepper even coffee can

stimulate the adrenals to secrete adrenoxidase to supply oxygen

faster to compensate for any deficiency in the process occuring in

the glomeruli of the kidneys. By so doing the adrenals especially in

a yin deficient individual are overly taxed to facilitate the

elimination of toxins through the kidneys. This may possibly shorten

the individual's life by tending to deplete the adrenal's reserves.

 

In asthma, the adrenal potential is much below normal and because of

this kidney detoxifying function is greatly impaired. It is the

lungs which try to help the weak kidneys by secreting some of the

toxins through their mucous membranes. The lungs are not able to

function very well as accessory kidneys and the result is

inflammation and irritation of the lungs which lead to a

degeneration and atrophy of the bronchiole tubes.

 

Herbal formulas which are useful for kidney deficient asthma include

Rehmannia Six or Rehmannia Eight formulas previously described. When

there is yin deficiency with dryness one can use Rehmannia Six with

the addition of asparagus cochinchinensis (tian men dong),

Ophiopogon japonica (mai men dong) and Scrophularia ningpoensis

(xuan shen).

 

Asthma caused by asthenia or weakness of the kidney is treated with

Rehmannia Eight (jin gui shen qi wan) together with schizandra

chinensis (wu wei zi). An animal that is taken to treat kidney yang

deficient asthma is gecko lizard. The male and female lizards are

usually taken together with the head and feet removed, since these

seem to have some toxic principle. Three to six grams are taken as a

powder or nine to fifteen grams in decoction. This can be taken

alone or together with Rehmannia eight for better effect.

 

WESTERN APPROACHES TO TREATING THE ENDOCRINE SYSTEM

In the past, Western herbalism has been noticeably lacking in

treating endocrine disorders. This is primarily because endocrine

disorders occured more as a syndrome of different symptoms and

Western herbalism has tended to orient itself around more clearly

defined pathological conditions. If there was a problem with a

hypersympathetic nervous system, Western herbalists have tended use

sedatives, nervines and perhaps anti-inflammatories. There has been

little understanding of a condition of asthenic wasting. An herb

such as marshmallow (althea officinalis) occurs more for its

soothing demulcent properties rather than its ability to nourish the

parasympathetic nervous system helping it to secrete adrenalcortical

hormones such as cortisol.

 

Only recently have Western scientists and herbalists come to

recognize the effects of certain herbs, most noticeably a strong

sympathetic nervous stimulant such as Ma Huang and for the

stimulation of adrenalcortical hormones, licorice and Siberian

ginseng. As a result many of these herbs are appearing in Western

herbal formulas for the adrenals and endocrine systems.

 

Other substances that are used with good effect are protomorphogens

or glandular extracts. These include specific glands from animal

sources such as adrenal, thyroid, pituitary, thymus, ovarian, etc.

These may be prescribed alone or together with appropriate herbs,

vitamins, minerals, etc. In addition, a number of vitamin and

mineral supplements are used to nourish and stimulate the endocrine

system. These include vitamin C, all the B vitamins, Zinc, calcium

and magnesium.

 

Throughout the nineteenth century consumption or tuberculosis was

not uncommon. This condition is definitely one that would be

classified as yin deficiency in TCM. It was treated with various yin

tonic foods and medicines that often helped to stabilize and

sometimes even cure the condition at least for awhile. Because of an

epidemic occuring in China, the Chinese went to great lengths to

import wild American ginseng (panax ginseng) from Eastern North

America because of its yin tonic properties.

 

Two common substances used for T.B. where tannin leached acorns from

the oak tree which served as a powerful nutritive yin tonic; in

Russia, there were many cases of the use of large quantities of eggs

taken on a daily basis over a period of months by Russian folk

healers as described in a little book called " Russian Folk Medicine "

by Paul M. Kourennoff and George St George.

 

The use of cayenne pepper and ma huang both serve as stimulants of

the sympathetic nervous system. As such they help to raise

metabolism and thus help the lungs by stimulating the removal of

congestion and toxins from the system. This approach has worked very

well for those who have a genuine excess and are only recently

changing from a rich diet of red meat, dairy and refined sugar and

flour. The same approach, however, given to individuals with

sympathetic overload or a depletion of the parasympathetic system

(kidney yin) is further weakening and debilitating.

 

All these approaches have demonstrated considerable beneficial

clinical effects. It is in TCM, however, that the conditions

associated with kidney yin or yang deficiency is so pivotal to the

entire system. There is much that can be learned from TCM that can

be integrated into a more effective clinical model. Even more

important, we can appreciate that all the principles of TCM theory

are in perfect agreement with the most recent discoveries and

understandings of modern scientific physiology.

 

The kidneys correlates with the lower warmer and the bladder

 

The triple warmer in Chinese medicine is not an actual organ but a

functional process whereby all the organs of the upper, middle and

lower cavities of the body interract with each other. It is

therefore the process which becomes the triple warmer. Considering

the in the Nei Ching, " the triple warmer is the official in charge

of irrigation and it controls the water passages, " there must be a

direct relationship between the function of the triple warmer and

the kidneys. That relationship has to do with the regulation of

fluid within the tissues and organs of the body.

 

In the upper warmer, fluid is described in the Nei ching " opening

outwards, spreading the 5 tastes of the food essences, pervading the

skin, filling the body and moistening the skin and it is like a

mist. " The middle warmer is situated in the stomach and " receives

the chi, expels the wastes, steams the body fluids, transforms the

refined essences of food and connects upwards with the lungs. " The

lower warmer is described as a drainage ditch because of its

function of separating essences of food into the pure and impure.

 

It seems that the description of the triple warmer becomes

a " summarization of the functions of all the yang organs (including

the lungs and spleen) in their work of receiving, digesting,

transforming, absorbing, nourishing and excreting. The triple warmer

is like the great canal that was built in China in ancient times to

connect the vast distant territories. So also is it warmed and

motivated by the TCM function of the kidneys especially as it

relates to the processing of fluids. The bladder is the yang aspect

of the kidneys, making it relevant to the Gate of Vitality from

which it derives its energy. The function of the bladder is to store

and excrete urine. If kidney yang is weak, there will be frequent

but weak passage of urine.

 

The Kidneys govern water

 

Within the kidneys themselves, as with all physiological processes,

yin and yang qualities are manifested. The kidneys contribute to the

function of eliminating acid waste products and helping to maintain

proper PH throughout the body by their ability to reabsorb sodium,

calcium and other mineral salts into the plasma. The lungs also

contribute to this process by eliminating carbon dioxide which is

the waste byproduct of glucose and lactic acid metabolism. Acid

waste in the body are yang toxins because they cause inflammation

and congestion. Sodium, chloride, potassium and other mineral ions

which help to maintain homeostasis are yin. Since yin and yang are

relative to each other, sodium is yang because it causes fluid

retention while potassium would be yin.

 

Extracellular fluid in the form of blood and lymph occupies the

interstitial spaces between the cells. It must maintain a proper

amount of sodium chloride and bicarbonate with some potassium and

calcium. Intercellular fluid on the other hand must maintain a

predominance of potassium with a smaller amount of sodium. Let us

posit that the extracellular fluid is yin while the intercellular

fluid is yang.

 

Similarly, salt is a yin substance while potassium is a yang

substance. The balance and interaction of these two through the cell

walls is in the form of an electrical charge that helps in carrying

food, fluid and waste into and out of the cells.

 

Chinese medical theory maintains that the flavor of the kidneys is

salty. By this the Chinese understood the specialized relationship

the kidneys have with directly maintaining and regulating PH and by

the reabsorption of sodium and calcium into the plasma. As with the

regulation of yin and yang throughout the body, this function of the

kidneys is also regulated by hormones of the adrenal cortex and of

the posterior pituitary.

 

ANATOMY OF THE KIDNEY

The kidneys are paired reddish-brown organs situated one on each

side of the vertebral column and on the posterior wall of the

abdominal cavity. The adrenal glands are situated on the superior

portion of each kidney. Being approximately 11 cm. long, they extend

down from the level of the twelfth thoracic to the third lumbar

vertebra. The right kidney sits slightly lower than the left because

of the presence of the liver.

 

The kidney proper is composed of a cortex or outer layer; the

medulla which is located deep to the cortex and consists of up to 18

triangular renal pyramids. The renal pelvis is the papilla of each

pyramid projecting into a funnel-shaped minor calyx. The major

calyces unite to form the renal pelvis which is the expanded upper

end of the ureter. The urine passes as droplets from tiny pores in

the papillae into the renal pelvis and finally the ureter, which

carries it to the urinary bladder.

 

The nephron is the functional unit of the kidney where urine is

produced. The two kidneys together contain about 2 1/2 million

nephrons. The entire function of the kidney can be understood by the

function of a single nephron.

 

The nephron is composed of 1. a glomerulus of tiny capillary blood

vessels, and 2. a long tubule in which the filtered fluid is

converted into urine on its way to the pelvis of the kidney. Blood

enters the glomerulus through the afferent arteriole and leaves

through the efferent arteriole. Pressure of blood in the glomerulus

causes fluid to filter into Bowman's capsule. Bowman's capsule is

named after a 19th century British physician and is a visceral layer

close to the glomerulus. It functions as a filter in the formation

of urine.

 

It is within the nephrons that the major functions of the urinary

system is performed. The other parts of the system serve primarily

as passageways and storage areas. Nephrons carry out three important

processes:

 

 

1. They regulate blood concentration the volume by removing selected

amounts of water and solutes.

2. They help regulate PH

3. The remove toxic waste from the blood.

 

In the process of performing these activities, the nephrons filter

unwanted materials from the blood and return desireable ones

required by the body. The discarded material or urine together with

the entire volume of blood in the body is filtered approximately 60

times a day.

 

Urine is formed by a process of glomerular filtration caused by

forcing fluids and dissolved substances through a membrane by

pressure. In a healthy person, urine consists of all materials

normally found in the blood except for the solid elements and most

proteins which are too large to pass through the membrane.

 

Tubular reabsorption is the amount of filtrate that flows out of the

renal corpuscles of both kidneys and is reabsorbed by the blood,

which is about 99%. Thus, only about 1% actually leaves the body

which is about 1 liter a day. If filtration is too slow, there is a

reabsorption of chloride ions to increase the flow of blood which in

turn balances the rate of filtration, helping to regulate the

process.

 

Tubular secretion eliminates certain waste materials from the blood

and helps to control PH. Through a complex process, tubular

secretion releases hydrogen and ammonium ions which help to raise

the blood PH which has been lowered through the digestive process

(even though most diets provide primarily acidic foods). Ammonium

and hydrogen ion secretion normalizes urine to a PH of about 6. As a

result, urine Ph is lowered while blood PH is raised to normal.

 

Antidiuretic hormone (ADH) , called vasopressin, controls the rate

at which water is lost from the body by controlling the permiability

of the water collecting ducts. Without ADH water is expelled into

the urine, with ADH it is reabsorbed back into the blood.

 

A normal adult excretes between 1 to 2 quarts of urine daily. Blood

pressure is regulated by the secretion of renin from the

juxtaglomerular apparatus which increases reabsorption. By so doing,

blood volume and consequently blood pressure increases and urine

decreases. By raising blood pressure, the kidneys are ensured enough

oxygen (O2) and the normal volume of urine remains constant.

 

The amount of water that is consumed effects blood concentration. A

small amount of water results in a lower concentration in the blood

with the consequent release of ADH. The effect of ADH is to decrease

the volume of urine, thus conserving water reserves.

 

Exposure to high temperatures stimulates the rate of perspiration or

water loss. This also stimulates the release of ADH with an increase

in water reapsorption in the blood and a decrease of urine. A

lowering of temperature causes a dilation of the abdominal vessels

with an increase of blood to the glomeruli, with a consequent

increase of pressure and the expulsion of urine.

 

Diuretics

Diuretics are chemicals that increase urine flow. Some act on

tubular flow in the kidneys while others such as coffee, tea and

alcoholic beverages affect ADH by inhibiting its release. It is

important that the rate of sodium loss in the urine also be

increased with the loss of water.

 

Weiss points out that " it is useful to make a distinction between

diuretics in the narrower sense, which are used to treat diseases of

the urinary system, and diuretics in the wider sense, perhaps better

referred to as anti-dyscratic drugs with diuretic properties, their

actual indications being metabolic diseases, rheumatism and gout. "

(Weiss, pg. 234)

 

Weiss then goes on to define the difference between diuretics in the

narrower sense which include diuretics containing volatile oils and

those where the diuretic property is due to their saponin content.

 

Diuretics containing volatile oils

It is well understood that in general a warm or hot infusion of

herbs with volatile oils will have a diaphoretic effect and a cool

infusion will exert a diuretic effect. The following herbs are used

in either of these ways:

 

 

Parsley (petroselinum sativum)

Celery fruits (apium graveolens)

Wild carrot (Daucus carota)

Lovage (Levisticum off.)

Cinnamon bark (cinnamomum cassia)

fresh Ginger (Zingiberis off.)

Fennel (Foeniculum vulgare)

Oregano

Burdock (arctium lappa)

Buchu (Barosma betulina)

Coriander (Coriandrum sativum)

Water Plantain (Alisma plantago)

Watercress (Nasturtium off.)

Gravel root (Eupatorium purpureum)

 

Diuretics containing saponins and sterols

 

spiny restharrow (ononis spinosa)

Horsetail (equisetum arvense)

Dandelion (Taraxacum off.)

Dianthus superbus

Rehmannia glutinosa

Goldenrod (solidago virgaurea) (directly increases renal function)

Ceanothus thyrsiflorus (California lilac)

Azuki beans (Phaseolus calcaratus) which are diuretic because they

tend to

filter sodium.

Corn silk (Zea mays)

Guiacum off.

Hydrangea arborescens

 

A diuretic subcategory are herbs that have urinary antiseptic

properties and would include

 

 

Pipsissewa (Chimaphila spp.) also very useful for frequent

urination.

Uva ursi (Arctostapholos uva ursi)

Plantain (Plantago spp.)

Cleavers (Galium aparine)

 

Many herbal diuretics exert their action by directly effecting

electrolyte balance of minerals. Thus, those that are high in

potassium tend to have a cooler energy and include dandelion

(taraxacum Off.), the various mushrooms including Poria cocos,

couchgrass (Agropynum repens), probably Atractylodes alba, Some

diuretics such as Dianthus superbus promote diuretic action by

stimulating more the secretion of potassium rather than sodium.

Certain herbs of a demulcent or mucilaginous character such as

marshmallow root (Althea off.), Slippery elm (Ulmus Fulva),

Knotweed, (Polygonum aviculare), talcum, and Rehmannia glutinosa

inhibit the osmotic reabsorption of fluid by the tubules. The single

most important diuretic that inhibits antidiuretic hormone is water.

When large amounts of water are ingested, ADH is no longer secreted

from the supraoptico-posterior pituitary system. As a result large

amounts of urine are discharged.

 

In addition to the above, emotions can influence the volume of

urine. Nervousness and stress can increase blood pressure which in

turn will increase glomerular filtration.

 

Urine Characteristics

1. Color is normally yellow or amber colored. Being a breakdown

product of hemoglobin, urine is colored by urobilinogen and is more

hypertonic than plasma and more acid. It consists of urea, urin

acid, creatinine, ammonia, and hydrogen and potassium ions.

 

2. Turbidity of fresh urine is usually transparent. Slight turbidity

is a result of mucin secreted by the lining of the urinary tract. If

it is too dilute (specific gravity is low) there is not the proper

balance of fluid filtered through the tubule. Goldenrod herb and

root (Solidago virgurea) is one of the best to correct excessive

albuminaria as well as oliguria

 

3. Odor of fresh urine can vary. Asparagus will give a

characteristic smell. Of more importance, however, is a sweetish

smell which can indicate the spilling of blood sugar into the urine,

indicating diabetes. Normal urine has little odor.

 

4. PH of normal urine is slightly acidic, ranging from 4.6 to 8.0.

Variations are closely related to the diet. High protein increases

acidity while vegetables and fruit increase alkalinity. Fasting,

exercise and high altitude will also vary the PH. Standing urine

forms ammonium carbonate which is strongly alkaline.

 

5. Specific gravity is the ration of weight of solids to the weight

of equal volume of distilled water. Water has a spcific gravity of

1000. The specific gravity of urine can vary from 1.001 to 1.035 in

healthy people. This indicates health since there is a better

overall filtering capacity. Above normal readings can indicate that

the person has blood cells, casts or bacteria in the urine which is

an indication of disease.

 

 

An increase in Albumin can indicate high blood pressure, metals in

the body, bacterial toxins, disease of the glomeruli.

An increase of Glucose indicates high sugar from the diet and

emotional stress. The utilization of glucose and some amino acids by

the cells is dependent upon a process called " sodium co-transport "

whereby the osmotic diffusion of sodium into the cells carries with

it glucose and amino acids. Since the kidneys are responsible for

regulating sodium levels, there is obviously an indirect

relationship between kidney function and the absorption of

nutrients. Since the kidneys are so directly involved with the

regulation of sodium, we see the origin of adding a pinch of salt

when taking a kidney yin or yang tonic. We can also see that if the

kidneys are filtering too much salt, there can be symptoms of

overall malnourishment.

An increase of Erythrocytes can be cause by hematuria, inflammation

of the urinary organs, kidney stones, tumors, trauma and kidney

disease. In TCM, this category is in the categorized as disease

caused by heat and we look to the use of anti-inflammatory herbs

such as echinacea, barberry, gentian as well as astringent diuretics

such as pippsesewa, uva ursi and goldenrod.

An increase of Leukocytes indicates infection of the urinary organs.

This betrays the presence of pus and could come from other areas of

the body as well. Again, this is a condition of heat and requires

the use of annti-inflammatory herbs such as echinacea, chaparral,

golden seal as described above. If there is a urinary infection then

uva ursi, pippsesewa and horsetail would be very effective.

In small amounts the presence of Ketone bodies is normal. In larger

amounts it can indicate diabetes, starvation generally or overrall

too little carbohydrates in the body. Ketones can create a mild

feeling of euphoria which is the high frequently associated with

fasting. When carbohydrates are not used, almost all the energy must

come from the metabolism of fats. This can be taken from the fatty

reserves of the body resulting in tremendous amounts of fatty acids

being metabolized by the liver. This is often more than the cells

can oxidize resulting in the accumulation high concentrations of

acetoacetic acid and the other ketones in the blood.

Bilirubin is a byproduct of the hemolysis of red blood cells and

hemoglobin. The average lifespan of red blood cells is 120 days

after which they become too fragile to exist. Their cell membranes

rupture and the released hemoglobin is phagocytized by

reticuloendothelial cells throughout the body. Eventually these are

converted bilirubin. Within hours, these are absorbed by the hepatic

cells where it is combined with other substances and partially

excreted as bile where it is excreted through the gall bladder into

the small intestine where it stimulates peristalsis and is converted

by bacterial action into a more soluble substance called absorbed

through the intestinal mucosa into the blood and most of this is in

turn re-excreted by the liver back into the gut. About 5% is

excreted by the kidneys into the urine. After exposure to air in the

urine, the urobilinogen becomes oxidized to urobilin, or in the

feces it becomes altered and oxidized to form stercobilin. Herbs

that treat a congestion or excess of bilirubin are classified in TCM

as " Herbs that clear Damp Heat. " These include Oregon Grape

(Mahonia), Barberry, Golden Seal, Gentian Yellow dock root (Rumex

crispus) and Phellodendron amurense. They are important in the

treatment of most genital urinary inflammations as well as herpes

simplex and are so used with great effectiveness in both Chinese and

Western herbalism.

Casts are tiny masses of hardened material made from white blood

cells, red blood cells, epithelium that contains cells from the

tubulars, fatty or granula cells. They indicate a kind of cellular

dysfunction and are effectively treated and removed with a

combination of herbs that eliminate " damp heat " and diuretics. These

include cleavers (Galium aparine), Gentianae scabrae, Sophorae

flavescentis, Phellodendron ammurense, hydrastis canadensis.

Renal calculi are crystal salts found in the urine that can solidify

into renal calculi or kidney stones. Some of the conditions which

lead to their formation include a decrease in water intake, increase

in mineral salts and an abnormally alkaline or acidic urine. Many

diuretic herbs have anti-lithic properties but three of the most

important are as follows:

Gravel root (Eupatorium purpureum) combines both chi tonic as well

as diuretic properties. As such, it is my opinion that it is

somewhat similar in properties to the Chinese Atractylodes alba (Bai

Zhu) which is also diuretic, carminative and tonic. Gravel root, as

its name implies, is a most effective remedy for urinary calculi and

gravel, having the ability to looosen, dissolve and void gravelly

sediment in the urinary tract. Gravel root is a diuretic nervine

which means that it is able to treat frequent, ineffective or

nighttime urination due to weakness of the pelvic nerves. Since it

has the ability to increase the elimination of solids in the urine,

it is effective in cases of rheumatism and gout. Typically, as with

all remedies in this class, they should be combined with a demulcent

diuretic such as Marshmallow root (Althea off.) or talcum.

Hydrangea arborescens is another anti-lithic remedy often combined

with gravel root for the elimination of stones. It is also good for

urinary tract infections as well as infections and enlargement of

the prostate gland.

Lysimachia christinae (Jin qian cao) is the main herb used in

several Chinese patented formulas for the relief of both gallstones

as well as urinary stones. One patented formula is called Specific

Drug Passwan or " specially effective discharge stone pill. " It is

not at all uncommon that herbs that dissolve stones of the urinary

tract are also effective for the gallbladder. As such I have had

many calls of appreciation from patients around the country who have

used my Planetary formula, Stone Free (it does not contain

lysimachia). This herb is a diuretic in the category of " clearing

damp heat " . As such, it is also useful for jaundice, hepatitis,

abscess and snake-bite.

Various Microbes are also found in urine and are a way of

determining other problems in the body. Two that often cause

problems are candida albicans and trichomonas vaginalis. These are

in the category of damp heat and require diuretic herbs from this

category as well as other metabolic adjustments in diet. Herbs that

are used for these conditions include barberry root (Berberis

vulgaris.) or Oregon grape root (Mahonia aquifolium), Gentinae

scabrae and Sophorae flavescentis to name a few. Of course, these

are most effective when prepared in a balanced formulation according

to the constitution and symptoms of the patient.

 

Bibliography

 

Chinese Materia Medica by Bensky and Gamble, Publ. by Eastland Press

Formulas and Strategies by Bensky and Barolet, publ. by Eastland

press

Medical Physiology by Guyton, publ. by Saunders

Pharmacology and Applicaions of Chinese Materia Medica by Chang and

But, vols. 1 and 2 publ. by World Scientific

Textbook of Anatomy and Physiology by Anthony and Thibodeau, publ.

by Mosby

Handbook of Chinese Herbs and Formulas, vol 1 and 2 by Yeung, self

published.

The Wild Rose Scientific Herbal by Terry Willard, publ. by Wild Rose

College of Natural Healing.

Herbal Medicine by Rudolf Weiss, publ. by Beaconsfield, England

Food Is Your Best Medicine by Dr. Henry Bieler M.D., Random House.

Food Is Your Best Medicine by Dr. Henry Bieler M.D., Random House.