By Michael Tierra
That Traditional Chinese Medicine (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 encompasses 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 controlled 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
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,
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
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
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
"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
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
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 chronically have and what I call
the occasional `exhausted yin' caused by the stresses and ordeals of normal
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
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 inflammation, 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
Herbs have healing, anti-inflammatory 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
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 occurring,
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 undesirable 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
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
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 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
- 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
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
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
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 development, 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
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 goiter 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
- 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
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
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 whereby the kidneys function as the `root' of
chi and yin and yang for the whole body.
Aldosterone, the most important mineralocorticoid is mainly
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 concomitant decrease of
concentrations of sodium and chloride. With the decrease of sodium
chloride, there is a reciprocal 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
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 well 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
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
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
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 (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 development. In adults, there may be various causes for
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 tumor 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 endeavor. 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 controlled 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
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-transmitting 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
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
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
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
In Traditional Chinese Medicine, 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 rest 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.
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
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 formuls 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, withers 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
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 development. (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
third 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
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
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
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 occurred
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
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 occurring 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
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 interact 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
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
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 desirable 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 permeability 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 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)
- 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.
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 specific 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
- 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
anti-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
- 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,
- 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
loosen, 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.
- 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.
For more information, please see the web site and online forums in herbal medicine, magnet therapy, acupuncture and the EastWest School of Herbology website:
Santa Cruz, Ca. 95060