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 these conditions.

HOMEOSTASIS AND YIN YANG THEORY

According to TCM philosophy, "chi" or vital energy is a part of yang while "blood" is a part of yin. The characteristics of yin therefore are substantial, cool and moist, while the characteristics of yang are ephemeral warm, mobile and dry. In terms of homeostasis, Yin belongs to all those physiological aspects which are cooling, hypo-metabolic, receptive, anabolic and maintaining, while yang is warming, hypermetabolic, aggressive, catabolic, transforming and protective.

Yin relates to the chalice which receives and yang relates to the life energy with which it is filled. A deficiency of yin suggests that the maintaining and repairing function of the body is depleted or lacking. This is indicated by an overflowing or spilling out of yang chi as perceived by a variety of hypermetabolic signs such as flushed complexion, heat, nervousness, Anxiety, insomnia, dryness and chronic signs of inflammation and wasting. A deficiency of yang is hypometabolic, with signs of coldness, paleness, tiredness, weakness, lack of Vitality, low libido, edema and puffiness.

In TCM, the kidneys are described as housing the essence and being the root of yin and yang for the entire body-mind. This means that all the inherited constitutional potential of the individual is contained within the kidneys as well as the most essential aspects for maintaining homeostasis.

One way by which the regulation of yin and yang is governed by the kidneys is the regulation of electrolytes. Electrolytes consist of acids, bases and salts, especially sodium, chlorine and potassium which carry a positive and negative electrical charge as it regulates fluid metabolism in the body's three fluid compartments, inside the cells, in the interstitial spaces and within the blood vessels.

Besides the regulation of electrolytes within the kidneys, the endocrine system as described above plays a pivotal role in regulating homeostasis which is described as yin and yang by the Chinese.

It is through these complex physiological processes that the Chinese assign the following spheres of influence to the TCM Kidneys:

1. Kidneys contain the Gate of Vitality ("Ming men").
2. Kidneys are the Root of Yin and Yang for the Whole Body
3. Kidneys govern growth and maturation
4. Kidneys produce skill and house the will
5. Kidneys hold the essence (inherited constitution)
6. Kidneys govern the bones and teeth
7. Kidneys open into the ears
8. Kidneys manifest on the head hair

From the above, we arrive at the basic symptoms of TCM kidney imbalance of which at least three prominent symptoms are required to make a diagnosis regardless of any further specific conformations:

BASIC SIGNS OF TCM KIDNEY IMBALANCE

According to TCM differential diagnosis, one must have at least three prominent symptoms from the following:

• low back pain joint and knee pains
• stiffness impotence or frigidity
• libido hearing
• head hair urinary problems
• growth and maturation bone and marrow problems

Kidney Yang becomes the reactive, sympathetic nervous system relating to the secretion of epinephrine and norepinephrine from the adrenal medulla as well as other yangizing hormones from the pituitary, thyroid and other endocrine glands. In contrast, Kidney Yin is the parasympathetic nervous system relating to the secretion of corticosteroids from the adrenal cortex as well as other yinnizing hormones secreted by the anterior pituitary and other endocrine glands.

1. THE GATE OF Vitality (MING MEN)

The TCM kidneys are closely associated with the "the gate of Vitality" or "Ming Men" as it is called in TCM. Zhang Jie Bin (1563-1640) said: " there are two kidneys ... (i.e. kidney yin and yang)... the Gate of Vitality is in between them. ... it is the organ of water and fire, the abode of yin and yang, the sea of essence, and it determines life and death." Energy is produced as a result of both catabolic and anabolic reactions. The release of energy is associated with catabolism while its use is associated with anabolism. Ming Men is essentially concerned with the catabolic release of energy through heat. Heat is available in two forms, one is biologically useless since it can destroy living cells, the other is chemical and is available in the body as adenosine triphosphate (ATP). ATP is one of the most important compounds in the world because it supplies energy directly to all kinds of living organisms from one-celled plants to billion-celled humans. The energy released from nutrients is used to form ATP. When ATP releases its energy, a phosphoric acid radical is split away forming ADP (adenosine diphosphate). The energy then derived from the cellular nutrients recombine to form new ATP in a continuous cycle. As a result ATP is called the currency of the cells, since it can be spent and remade continuously.

Ming Men represents the fiery reaction which produces essential catabolic energy or "fire" for all the internal organs. As part of the root, Ming Men is part of the TCM Kidneys in much the same way that the TCM Kidneys are the root of Yin and Yang for the entire body.

Through the use of warming, acrid herbs such as aconitum carmichaeli praeparatum (fu zi), cinnamomum cassia (rou gui) and other warm spicy stimulants, the catabolic process associated with Ming Men can be stimulated. By so doing, TCM Kidney Yang is generated.

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

KIDNEY YIN

According to TCM, "The vital essence or kidney yin function is the material basis for reproduction, growth and development, formation of the bone marrow, nourishment of the brain and bones." (1) Deficient kidney yin is manifested with symptoms of aching, soreness of the lumbar region of the back, weakness of the legs and knees, tinnitus, feverish sensation in the soles and palms, nocturnal emission, and in women, scanty menstrual flow and amenorrhea. Deficient liver yin has dizziness, tinnitus, dryness of the eyes, blurred vision, irritability and irascibility. The tongue is reddish with little or no coat. The pulse is wiry, rapid or thready.

The nature of all these symptoms are chronic and wasting and reflects a tendency which we in the West commonly understand as "burnout" neuresthenia or adrenal fatigue. There is also a difference between the ongoing condition of "yin deficiency" which many chronically have and what I call the occasional `exhausted yin' caused by the stresses and ordeals of normal living.

KIDNEY YIN AND THE GLUCOCORTICOIDS

Glucocorticoids, secreted by the adrenal cortex, are used metabolically to aid in the utilization of proteins, carbohydrates, and fats. This partially corroborates the concept of the TCM kidney being the root not only of constitutional or inherited chi but acquired chi which comes from the digestion of food. Perhaps of even greater significance, however, is that the glucocorticoids are used by the body to counter and resist all forms of major and minor stress be it physical or mental.

Chinese Five Phase Theory describes the TCM kidneys as part of the water element with water being the mother or engendering aspect of the wood-liver. The Five Phase Doctrine, is the second natural philosophy of TCM (after yin-yang), and sometimes referred to as the "system of correspondences." Said to originate in the 3rd century B.C., it is marvelous in its depiction of the relationship of the individual to all physiological and psychological processes, outer environment, food, and in fact all other natural phenomena. The Five Phase description of the engendering relationship between the TCM kidneys and the liver is represented at least partially through the metabolic use of proteins, carbohydrates and fats called gluconeogenesis.

EFFECTS OF CORTISOL ON CARBOHYDRATE METABOLISM

Gluconeogenesis is a process where the liver secretes enzymes necessary to convert amino acids from proteins into glucose. The employment of cortisol and other glucocorticoids is used to help stimulate this process of gluconeogenesis as much as 6 to 10 times, corroborating the Chinese five phase principle of water as the "mother of wood," i.e. the TCM kidneys engendering or nurturing the liver.

How is this done? First, one of the metabolic effects of cortisol is to increase the transport of amino acids from the extracellular fluids into the liver cells. From this, gluconeogenesis is better _facilitated. Secondly, cortisol helps all the enzymes convert these amino acids into blood glucose. Thirdly, cortisol causes the mobilization of amino acids from muscles and other extrahepatic tissue. The result of this is that more amino acids become available to enter into the liver's process of gluconeogenesis. Finally, one of the effects of increased gluconeogenesis is a decided increase in liver glycogen stores.

EFFECTS OF CORTISOL ON FAT METABOLISM

Similarly to the way it fosters amino acid mobilization from the muscles, cortisol promotes the mobilization of fatty acids from adipose tissue. This, despite the fact that individuals with excess cortisol develop a type of obesity which manifests as a fatty accumulation or edemic appearance of the chest and head regions of the body giving a kind of bullalo-like torso.

In this condition, as above, we see the results of a weakening of yang and consequent increase of fluid stagnation and yin. In addition to treating the TCM kidneys and yang chi, Chinese medicine may add spleen dampness removing herbs such as Poria cocos (fu ling), spleen yang warming herbs such as Aconitum carmichaeli praeparatum and Cinnamomum cassia, and spleen chi tonics with the use of Atractylodes alba and Astragalus membranicus.

THE EFFECTS OF CORTISOL ON STRESS AND INFLAMMATION

One of the most beneficial effect of cortisol is in the relief of stress. Besides the major physical and neurogenic stresses, there are various minor stresses that continually occur as part of normal living. Among many that may be cited are the movements of the joints and especially the knees (which take the greatest structural stress) and the initial reaction to food, especially stimulants such as coffee and simple carbohydrates such as sugar. In addition, there is psychological stress such as fear, paranoia and anger, and physiological stress caused by blows and injuries and exposure to severe cold or heat. All are buffered to some extent with the secretion of cortisol.

Just as the body requires some degree of yang adrenaline hormone to generate motivation to react both to normal as well as life threatening stimulus, it also has a nearly continual need for cortisol to buffer the effects of stress. In one sense, cortisol acts like oil in a heated engine. Without it, the gears grind down in much the same manner as for instance, in rheumatoid arthritis, where the joints become painful, dry and twisted or in yin deficient hypertension associated with Anxiety, nervousness and irascibility.

In this we see that cortisol is necessary for trauma, infections, intense heat or cold, psychological and neurological stress, and recovery from any debilitating disease. As a result, there is a relationship between lack of cortisol and what is diagnosed as "kidney yin deficiency." Cortisol is clinically used in the form of hydrocortisone or prednisone to help control acute 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 hours.

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 tissues.

LICORICE

Licorice root (Glycyrrhiza sp.) is noted for having cortisone-like action. Glycyrrhizin, a derivative of glycyrrhetinic acid, is chemically very similar to certain adrenalcortical hormones, especially desoxycorticosterone (DOCA) and cortisone. It is not uncommon for plants to contain hormone-like substances similar to those found in humans and animals.

The anti-inflammatory properties of licorice were first recognized quite by accident when a Dutch pharmacist, observing the use of licorice juice by the people of Southern Italy as a cough loosening remedy, discovered, by chance its effectiveness in the treatment of gastric ulcers. People using licorice for their stomach symptoms found that the effect of licorice was more reliable and enduring than any other medication.

Licorice, like cortisone, though not as strong, can relieve symptoms of peptic ulcers by inhibiting the inflammatory reactions. The problem, according to Weiss, is that cortisone is so strong that it can mask the symptoms of perforation and there is a danger of peritonitis 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 flavoring.

In high doses of up 12 grams or more, it has pseudoalderosterone activity caused by the glycerrhetinic acid content.(4)(5) This can cause symptoms of hypertension, hypokalemia, sodium and water retention. Licorice, has also been found to be effective in the management of Addison's disease or adrenal failure.(6)

We note that while herbs like licorice and rehmannia glutinosa have compounds similar to cortisol, other herbs and substances that have demulcent, emollient properties seem to have analogous, though not identical, reactions. These are also classified as yin tonics and include oils and fats, pork meat, marshmallow (althea off.) and slippery elm (ulmus fulvus). Lacking the strong concentrated effects of cortisone, these tend to be milder, with broader nutritive actions and much less potential of harmful side effects in normal dosage.

Rehmannia Glutinosa

Rehmannia glutinosa called `Di huang' is a member of the foxglove family and in fact so resembles foxglove in appearance that it is sometimes called Chinese Foxglove. The root is used raw as a detoxifying herb that `cools blood' for the treatment of wasting fevers and is known as `sheng di huang.' It is cured by soaking and drying the compressed roots nine times in rice wine. By so doing, it has a slightly warmer energy and is used as a nourishing blood and yin tonic known as `shu di huang.'

It is in this latter category that prepared rehmannia is a primary herb especially in formulas that nourish the blood and kidney yin but also with other kidney yang herbs and in kidney yang formulas such as "Rehmannia Eight."

Rehmannia contains beta sitosterol, mannitol, stigmasterol, campesterol, rehmannin, catalpol, arginine and glucose. TCM classifies it as entering the liver, kidney and heart.

Prepared rehmannia, which is the form used as a blood and kidney yin tonic, is used in the treatment of anemia usually with Dang gui and for "yin" asthenia, dizziness, tinnitus, weakness and pain of the lower back and legs, thirst, spermatorrhea, amenorrhea and metrorrhagia.

Phamacologically, Rehmannia Six was found in mice to "antagonize the inhibitory action of dexamethasone on the pituitary-adrenal system, thereby increasing plasma cortisol." (7)

Rehmannia helps the immune system by stimulating the formation of red blood cells and other immune potentiating substances in the bone marrow. The fact that rehmannia is classified in TCM as a blood tonic while it is commonly used as a kidney yin tonic suggests that there may be a proclivity for this herb to stimulate the secretion of another important kidney hormone, erythropoietin. This hormone acts on the bone marrow to stimulate the proliferation of precursor cells and their maturation into erythrocytes. Rehmannia may also help in the excretion of discarded red blood cells from the liver. This is at least partially accomplished by the continuous excretion of discarded red blood cells from the liver which are transformed and excreted in the kidneys as urobilirubin.

It is the presence of this substance that gives the yellowish color to urine. As a result of this process, chronic kidney deficiency can cause a weakened immune system and anemia. In one study, the protective effects of Rehmannia where found to mitigate platelet damage caused by irradiation from an intraperitoneal injection 1 ml daily for 6 days. It could mitigate platelet damage caused by irradiation with 600 rad and hasten the normalization of platelet count. (8)

In TCM, licorice is not customarily used for treating kidney yin or essence deficiency. The primary formula and the root formula for most yin tonics is Rehmannia Six, called `Liu Wei Di Wan.' It consists of the following:

• Processed Rehmannia glutinosa (shu dihuang) 20-25gms Nutritive herb which tonifies kidney yin and blood
• Dioscorea Orientalis (shan yao) 10-15gms used because it is a chi tonic that enters the lung, spleen and kidney organ meridians, thus it strengthens both acquired chi as well as nourishing both yin and essence
• Alisma orientalis (Zie xie) 9-12 gms diuretic, activating urinary function
• Poria cocos (fu ling) 9-12 gms diuretic, high in potassium and other mineral salts
• Cornus Off. berries (shan zhu yu) 10-15 gms astringent diuretic with warm properties, tonifies liver and kidney essence
• Moutan peony (p. suffruticosa) (mu dan pi) 6-9 gms enters the kidney, liver and heart, eliminates deficient heat, treating subclinical inflammatory conditions

The specific indications of this important classic formula is to reinforce the Yin (vital essence) of the liver and kidney. It is indicated for symptoms of dizziness, tinnitus, sore throat, tidal fever, nocturnal emission, night sweats, heat sensation in the palm and soles, toothache, dry mouth. It is given to children for retarded growth, also for lower back pain, optic neuritis, central retinitis, tuberculosis and all wasting diseases, diabetes, hyperthyroidism, addison's disease, hypertension, neuresthenia, functional anovular bleeding, chronic urinary tract infections and deafness, the tongue is red with a thin, dry coating and the pulse is thready and rapid.

While it is contraindicated for a person with deficient yang with accompanying weak digestion, coldness and sexual impotence, the same formula with the addition of two yang stimulating herbs, prepared aconite and cinnamon, is given for yang deficiency. Both Rehmannia six and Rehmannia eight, the latter with the addition of cinnamon bark and prepared aconite are the two most frequently prescribed formulas used for tonifying kidney yin and yang respectively.

Rehmannia Six is used for all symptoms of aging, burnout, and wasting. It is specifically useful for joint pains, aching lower back, diabetes, thirst, chronic urinary disorders. Rehmannia Eight is used for the same conditions except with a decided tendency towards weakness, impotence and coldness. In practice, it is generally better to first give Rehmannia Six and if needed, especially for impotence and cold symptoms, prescribe Rehmannia Eight.

KIDNEY YANG

Kidney Yang relates especially to the adrenaline-like secretions of the adrenal medulla as well as some androgenic hormones secreted by the adrenal cortex, thyroid hormone, and growth hormone from the anterior pituitary gland. Kidney yang is also effected by the secretion of erythropoietin by cells in the kidneys and to a lesser extent, the liver, which which stimulates the bone marrow to create erthrocytes.

Before discussing the physiology of kidney yang deficiency, let's outline the TCM characteristics which are used diagnostically. Besides having three of the basic TCM kidney symptoms mentioned above, kidney yang deficiency has three or more prominent indications from the following:

• coldness lack of libido
• impotence, sterility frequent, clear urine
• dribbling urine night urination
• spermatorrhea premature ejaculation lack of spirit general debilitation
• edema of the lower limbs thin, slow, weak pulse
• thin, whitish, moist tongue fur

Coldness refers not only to the atmospheric sensation but also to general hypometabolic function throughout the body. Lack of sympathetic stimulation from the adrenal medulla is one cause of coldness and hypometabolic function. The adrenal medulla secretes two stimulating catecholamines --- about 80% epinephrine and the rest norepinephrine. The importance of the these secretions is in their relationship to the sympathetic nervous system and the ability thereby to rally visceral response to appropriate stimuli throughout the body including most of the internal organs and glands of the body.

One of the underlying causes of certain kinds of anemia is Kidney Yang deficiency. Kidney Yang deficient anemia has the characteristic lack of red blood cells which in this case is caused by a lack of erythopoietin in the kidneys which in turn will give rise to many of the previously described conditions and symptoms associated with kidney yang deficiency. Testosterone, being a quintessential kidney yang hormone, also stimulates the secretion of erythropoietin. It is believed that this may account, at least in part, for higher hemoglobin count in men (16 g/dL) than in women (14 g/dL).

DEFICIENT KIDNEY CHI AND YANG AND HYPOTHYROID

A diminished secretion of thyroid hormone will also account for patterns of deficient yang associated with coldness. Other symptoms associated with hypothyroid and TCM deficient kidney yang symptoms include retarded growth and sexual 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 yang.

Many of these symptoms involve a deficiency of yang with coldness, edema and lowered metabolism being general symptoms. Specifically, however, kidney yang deficiency is associated with retarded growth and sexual development, loss of hair along with coldness and fluid retention. Seaweed in various forms, especially kelp because it is high in trace minerals, especially iodine necessary for thyroid malfunction, is useful to regulate both hypo and hyperactive thyroids caused by a lack of iodine. It is, off course, especially indicated for 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)

1. Prepared Rhemannia Glutinosa 24 grams (sheng di huang)
2. Fructus Corni Officinalis 12 grams (shan zhu yu)
3. Radix Dioscoreae Oppositae 12 grams (shan yao)
4. Sclerotium Poriae Cocos (fu ling) 9 grams
5. Rhizoma Alismatis Orientalis (ze xie) 9 grams
6. 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:
7. Ramulus Cinnamomi Cassiae (gui zhi) 3 grams
8. Radix Aconiti Praeparata (fu zi) 3 grams

Indications: lower back pain, weakness of the lower extremities, cold sensation in the lower half of the body, either frequent or excessive urination, possibly with incontinence, edema, impotence, weak, frail pulse and pale, swollen tongue with thin, white and moist coat.

As one can see, this formula differs from Rehmannia Six with the addition of cinnamon bark and prepared aconite. Both of these are strong sympathetic stimulants which in turn may increase warmth by stimulating the secretion of adrenergic hormones such as testerone, and consequently, erythropoietin by cells in the kidney.

RESTORE THE RIGHT KIDNEY PILL (you gui wan)

So named because the right kidney is considered the seat of Vitality or of kidney yang.

1. Rehmannia glutinosa (shu di huang) 240 grams
2. Radix aconiti praeparata (fu zi) 60-180 grams
3. Cinnamon cassia (rou gui) 60-120 grams
4. Cornus officinalis (shan zhu yu) 90 grams
5. Dioscorea oppositae (shan yao) 120 grams
6. Lycium chinensis (gou gi zi) 120 grams
7. Eucommia ulmoides (du zhong) 120 grams
8. Angelica sinensis (dang gui) 90 grams
9. Cuscuta chinensis (tu si zi) 120 grams
10. Colloid of cervus nippon (lu jiao jiao) 120 grams (deer antler)

Preparation: Grind all the ingredients to a fine powder. For this some of the moist herbs such as Rehmannia and Lycii may have to be baked in an open oven until dried enough to grind. Form into pills by mixing with honey. Take 9-15 grams, 2-3 times daily with warm water. It can also be made into a decoction with the appropriate dose reduction of the ingredients.

Indications: Warms and tonifies kidney yang, replenishes essence and blood. It is clinically used for spermatorrhea, impotence, premature ejaculation, intolerance of cold with cold extremities, pale complexion, weakness of the knees and aching soreness of the lower back, dizziness, diabetes, chronic nephritis, frequent urination, pulse is deep, slow and weak. The primary difference between this formula and Rehmannia Six is that it does not have such a strong diuretic effect as the former. It is therefore more useful as a pure kidney yang tonic.

KIDNEY YANG AND ALDOSTERONE

That yin and yang are relative rather than absolute, applies to all physiological and biochemical polarities including the relation of potassium and sodium chloride to each other. From one perspective, both are mineral salts and have a cool, yin energy. However, in terms of their effects on the body, salt is more yang than potassium in that it tends to attract and hold fluids in the cells while potassium is generally excreted with the extracellular fluid and urine. Potassium is more yin because of its discharging and eliminative effects on extracellular fluid. (This idea of salt holding fluid while potassium releases it may be at least part of the rationale that George Ohsawa was considering when he reversed some aspects of the meaning of yin and yang in Macrobiotics.)

The osmotic process by which salt and potassium exchange ions between the intra and extracellular fluid also facilitates the passage of other nutrients necessary for cellular metabolism. There is an associated electrical charge which gives rise to the term, `electrolyte' balance. This provides still another method whereby the kidneys function as the `root' of chi and yin and yang for the whole body.

Aldosterone, the most important mineralocorticoid is mainly controlled by the renin-angiotensin mechanism and by the concentration of potassium in the extracellular fluid. In the first instance a decrease of blood pressure in the glomeruli of the kidneys triggers the secretion of an enzyme, renin into the interstitial fluid which in turn ultimately results in the secretion of aldosterone from the adrenal cortex.

In the second instance, aldosterone is triggered by high concentrations of potassium in the extracellular fluid causing a 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 hypertension.

An excessive loss of potassium from the extracellular fluid as a result of aldosterone causes a serious deficiency of plasma potassium concentration called hypokalemia. This manifests symptomatically with episodes of severe muscular weakness or paralysis, tetany and postural hypotension. Because this condition is associated with greatly reduced fluid and blood volume, this condition in TCM would be considered a condition of `Yin and Blood deficiency' and treated with appropriate tonics.

A deficiency of aldosterone, on the other hand causes an abnormal rise in extracellular fluid potassium. The result is impaired circulatory function with associated coldness and in extreme cases, shock. There will also be serious effects on heart function with weakness of contraction, arrhythhmia and in extreme cases, cardiac death.

This latter condition is well described in TCM as `Kidney, Spleen and Heart Yang Deficiency.' The kidneys being the root of the body's yang chi are unable to support the generative and transformative functions of the other organs. With a degeneration of the "true yang" of the kidney, both the kidney and the spleen are unable to transform water which accumulates as edema, associated urinary difficulty, abdominal pains and aggravation by cold. Essentially, one might say that such a condition of kidney yang-aldosterone deficiency results in a "dampening of spirits" on both the physical as well as the psychological levels.

For this condition, one might use warm, yang stimulating herbs and formulas such as the use of cinnamon bark (Cinnamonum cassia), prepared aconite (Aconitum napellus praeparatus) and ginger (Zingiberis off.). One of the most important Chinese herbal formulas for activating the yang is called True Warrior Decoction or Vitality Combination (zhen wu tang) and consists of the following:

1. Prepared aconite (Fu Zi) 9grams
2. Atractylodes alba (Bai Zhu) 6grams
3. Poria cocos (Fu Ling) 9grams
4. Fresh Ginger (Zingiberis off.) (Sheng Jiang) 9grams
5. 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:

1. Cistanche salsa (rou cong rong) 6-9 grams primary kidney yang herb which moistens the intestines
2. Angelica sinensis (dang gui) 9-15 grams tonifies blood and lubricates the intestines
3. Achryanthes bidentatae (niu xi) 6 grams regulates blood circulation downward
4. Alisma plantago (ze xie) 4.5 grams drains, puifies and circulates fluid downward
5. Citri seu ponciri ( green citrus or zhi ke) 3 grams relaxes the intestines and directs the chi downward
6. 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:

1. for deficient vital energy add Panax ginseng
2. for kidney yin deficiency add prepared Rehmannia glutinosa.
3. for internal fire add scutellaria baicalensis
4. for chronic constipation with dryness add crushed cannabis seed (9-30 grams) and cynomorium songaricum (9-15 grams).

From the above, the importance of assigning salt to the TCM Five Element designation for the water element is definitely underscored because of its descending action and direct effect on kidney function. Therefore salt is used as a conductor in TCM Kidney tonic formulas by Chinese herbalists who recommend that a pinch of salt be taken either with the tea or the pills taken with warm, slightly saline, water (miso or soya sauce can be used for this).

The Glucocorticoids and Yin Deficiency, the effects of Cortisol on Protein metabolism

Some of the functions of cortisol such as its gluconeogenesis effects on carbohydrates and fats and the ability to counteract stress, inflammation and promote healing relate to Kidney Yin functions. Other aspects, however, actually create a wasting or yin deficiency which manifests as a hypermetabolic condition.

A prolonged, high concentration of cortisol seems to reduce protein stores in all body cells with the exception of those of the liver. This is caused both by decreased protein synthesis and increased catabolism or breakdown of protein in the cells. One of the many negative effects of excess cortisol is that the muscles can become severely weakened and immunity of the lymphoid tissue is decreased to a fraction of normal.

With the increase of liver protein synthesis, the liver has a tendency to enlarge causing ascites (abdominal swelling). There is a tendency for cortisol to mobilize amino acids from the tissues, increasing plasma amino acid concentration.

For this condition we use Rehmannia Six or Rehmannia Eight if there is associated coldness and sexual weakness. Rehmania six formula is selected because of its ability to drain fluid excess while at the same time nourishing TCM kidney and liver yin. This demonstrates that Rehmannia is amphoteric in regulating both TCM kidney yin and yang.

Ma Huang (Ephedra sinensis)

Ma huang is classified as a warming exterior releasing herb usually indicated for the treatment of cold fevers, allergies and respiratory problems. While not a tonic because it disperses rather than supplements, it can be used as a kidney yang stimulating herb to `get things moving.' It helps the yang by dispersing cold, promoting urination and reducing edema.

It contains a variety of well known adrenaline-like compounds including ephedrine, pseudoephedrine, norephedrine and norepinephrine. As such it is a powerful sympathetic nervous stimulant which if overused can raise blood pressure, aggravate deficiencies, heart palpitations, restlessness and tremors.

Interestingly, like yohimbine which contains a number of similar alkaloids, Ma huang was combined with poria cocos (fu ling) and was used by the Mongols as an aphrodisiac.

Siberian Ginseng

Siberian ginseng (Eleutherococcus senticosus) has been widely acclaimed as an adenal tonic and adaptogen. Being in the araliaceae family, it is related to Panax ginseng, North American Devil's Club (Oplopanax horridum) and Spikenard (Aralia racemosa and A. californica). All these have so called tonic adaptogen properties meaning that they increase the body's resistance to stress.

Siberian ginseng is also closely related to a Chinese herb called `Wu jia pi' or `Ci wu jia,' traditionally used for rheumatic conditions. It has various Latin binomials including Acanthopanax gracilistylus, A. sessiloflorus, A. senticosus and according to Chang and But, the name given by Harms, Eleutherococcus senticosus.

The major chemical components of Siberian ginseng are eleuthrosides A-G (phenylpropanoid, sterol, lignans, isofraxin, carotenoids and coumarins) (9) Both herbs have an acrid and warm energy making them contraindicated for Yin Deficient and inflammatory or heat signs. This fact alone suggests that Siberian ginseng is more of a warming TCM Kidney yang tonic with some anti-inflammatory effects associated with cortisol.

Nevertheless it does have anti-inflammatory effects as demonstrated on experimentally induced arthritis in rats. The fact that adrenalectomized rats showed no effect demonstrates that these herbs seem to possess adrenalcortical stimulating properties.(10) What we have is another instance of an herb amphoterically responding appropriately to the needs of the body, warming and stimulating or cooling and sedating as necessary.

Siberian ginseng has been extensively researched by the Russians and as a result is popular among workers and athletes in that country to improve performance, endurance and competitive abilities as well as preventing sickness in the workplace. All of this demonstrates the herb's so called adaptogenic properties which is characterized by herbalist, Steve Blake as neither stimulating the yang-sympathetic nor the yin-parasympathetic but improving the body's ability to appropriately switch back and forth more efficiently and at a faster rate.

"Wu Jia Pi" is used for conditions of cold, damp and painful rheumatic obstruction with liver and kidney deficiency and with weak and soft bones. It nevertheless is especially useful for smoothing the flow of chi and blood which tends to agree with Steve Blakes description. "Wu Jia Pi" is made into a wine by the Chinese and is very suitable for treating the elderly. The recommended dose of "Wu Jia Pi" is 3 to 15 grams once or twice daily. There is no comparison with the relatively miniscule dose, usually in tincture or alcoholic extract recommended for Siberian Ginseng.

3. KIDNEYS GOVERN GROWTH, MATURATION AND PROCREATION

The TCM Kidneys are also described as being in charge of storing essence and dominating reproduction, growth and development. The essence of the TCM Kidney refers to two parts: Congenital chi, which is the inherited constitutional strength and Acquired chi, which is the body's ability to receive transformed energy from food, air and water.

From a Western physiological perspective at least part of the above TCM functions refer to the relationship between the pituitary and the adrenals. One of the most important functions of the anterior pituitary is the secretion of growth hormone (GH) or somatotropin. Since the TCM Kidneys include most endocrine functions, the secretion of growth hormone is definitely included.

Unlike other hormones, growth hormone does not function through a target gland such as the ovaries, testes, thyroid, etc., but instead exerts an effect on all or most tissues of the body. Just as TCM designates the kidneys as governing normal growth and maturation, growth hormone is responsible for normal growth and development of the body down to the regulation of the size and number of individual cells.

Besides the specific effects of stimulating growth, growth hormone has many other generalized metabolic effects which relate to the TCM description of the kidney. These include the following:

1. 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.

2. 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.

3. 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 abnormal growth patterns and one may have to consider associated conformational tendencies such as dietary and assimilative malfunction associated with the TCM spleen, stagnation associated with a 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 Vitality.

This same essence or congenital chi of the TCM kidneys is imparted to all the internal organs and determines their form and function. Malformed organs with impaired function, being congenital, are attributed to TCM kidney essence deficiency. The best one can hope to achieve in treatment is an amelioration of associated malfunctions and to hold back further degeneration.

More recent scientific discoveries are revealing a plethora of neuro-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 convulsion.

Dendrobium has been indicated for feelings of being drained and depleted generally and after sexual intercourse. The average dose is between 9 to 20 grams and it can be either taken in decoction or powder. It is contraindicated for individuals with an acute febrile or inflammatory condition with no symptoms of dryness or dehydration.

Schizandra chinensis (Wu wei zi)

An astringent tonic with some yin tonic properties, Schizandra chinensis is used as an astringent protective herb against leaking and loosing one's energy and essence.

Besides restraining diarrhea, nocturnal emissions, spermatorrhea, premature ejaculation, leukorrhea and frequent urination, Schizandra berries are also used to stop excessive sweating, control coughing and wheezing. It is tonic to the nervous system, helping to calm the spirit, treat insomnia and forgetfulness.

Schizandra is called "Wu wei zi" or "five flavor herb," because it possesses all five flavors considered therapeutically important in TCM. It seems to specifically exert an effect on the central nervous system, improving intellectual activity, concentration, fine coordination, sensitivity and endurance as demonstrated in healthy young males in various experiments including long distance marathon races. The average dose given was 5 to 10 mg once or twice daily. (13)

In this sense, Schizandra while classified as an astringent in the Chinese materia medica has definite mild adaptogenic properties which, like ginseng, help to regulate various body functions and counteract the effects of stress. Besides supplementing, to some extent, what has been lost, Schizandra's greatest role as stated, is in preventing loss of energy and essence. The average dose is 3 to 9 grams. It is contraindicated for individuals with true heat, constipation, acute inflammatory and febrile conditions.

An important concept related to inherited constitutional strength, is the belief in TCM that the inherent potential or original chi ("yuan" or "ancestral chi") inherited from one's parents and which resides in the kidneys as the primal spark of life, cannot actually be supplemented or restored by either food (including herbs), water, air, the usual methods of supplementation. It is believed that the only way it can be supplemented is through internal Taoist practices using breath and meditation. This being very difficult for most (due to a lack of will and self discipline), we are left with the prospect of a finite amount of kidney essence which, when it is consumed in the course of a lifetime, results in the eventual process of aging, decline and death.

6. KIDNEYS GOVERN THE BONES AND THE MARROW

The Nei Ching says, "As regards the kidneys .... their fullness is in the bones." One of the signs of kidney deficiency is weakness of the bones and teeth.

The formation and maintenance of the bones and the teeth is a complex process which is involved with many aspects of the endocrine system. Other more basic considerations need to be taken into account such as nutritional factors including the presence of sufficient protein, calcium, magnesium, vitamin C and vitamin D to name a few. Finally, since vitamin D is at least partially absorbed from the sun, lack of sufficient outdoor exercise and activity can have a detrimental effect leading to osteoporosis or weakening of the bones.

All of these have a complex interraction with the function of the kidneys and adrenals. There are at least three predominant physiological methods where the TCM kidneys have an effect on bone growth: 1. through the parathyroids, 2. through the previously discussed presence of growth hormone from the pituitary gland and, 3. the secretion of various sexual hormones including estrogen and testerone.

THE PARATHYROIDS IN RELATION TO BONES

There are usually four to five parathyroids attached to the lateral lobes of the thyroid gland.

They are mainly concerned with the regulation of the calcium-phosphorus balance on which the bones depend for strength. A lack of parathyroid hormone increases the excretion of phosphorus and calcium from the bones into the urine. In addition, parathyroid hormone is necessary for normal neuromuscular irritability, blood clotting, cell membrane permeability and the normal function of certain enzymes for maintaining blood concentration of calcium at normal levels. The presence, therefore, of parathyroid hormone in the tubules of the kidneys is necessary to increase the absorption of calcium for the maintenance and growth of the bones as well as strengthening and maintaining the nerves (kidney chi).

THE RELATION OF THE BONES TO GROWTH HORMONE

The secretion of growth hormone from the anterior pituitary stimulates the formation of cartilage and bones. This is accomplished through development of several small proteins, called somatomedin which are formed in the liver, possibly the muscles as well as the kidneys.

THE RELATION OF ESTROGEN AND TESTOSTERONE TO BONE MAINTENANCE

Besides being produced in the reproductive organs of the male and female, both male and female sexual hormones are produced in the adrenals. These hormones are necessary for the proper growth and maintenance of many vital functions including the growth and maintenance of the bones and muscles as well as producing primary sex characteristics.

Since estrogen is known to have a bone stimulating activity, a postmenopausal lack of estrogen secretion in women is a primary cause of osteoporosis. Testerone has powerful anabolic or building effect in the utilization of protein and the consequent development of the muscles and bones.

In Traditional 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)

1. Prepared Rehmannia (shu di huang) 10-15 grams
2. Dang Gui(angelica sinensis) 9-12 grams
3. Ligusticum Wallichi (chuan xiong) 6-9 grams
4. 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:

1. 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.

2. 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)

1. Pinellia tuber (ban xia) 6-9gms this herb resolves dampness in the gastrointestinal tract
2. Gastrodia tuber (tian ma) 3-6gms this is one of the most powerful antispasmodics
3. Atractylodes alba (bai zhu) 6-9gms this herb is used as a tonic carminative to aid digestion and eliminate GI tract fluid stagnation
4. Poria cocos (FuLing) 6-9gms this herb is diuretic
5. Citrus reticulata peel (chen pi) 3-6gms this herb is drying and carminative
6. licorice root (gan cao) 3-6gms this herb is used to harmonize the ingredients and strengthen the digestion
7. fresh ginger (sheng jiang) 3-6gms this herb is circulating, carminative
8. Jujube dates (da zao) 3-5 pc. this is a tonic and added to harmonize the ingredients

The action of this formula is:

1. to resolve phlegm and indogenous wind (to eliminate, dry, and prevent the accumulation of edema and to relieve internal tension and spasm)
2. 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)

1. Anemone altaica (Jiu Jie Chang Pu) 6-9 grams the rhizome is used, it is a warming aromatic, stimulant, helping digestion and eliminating dampness
2. 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
3. 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:

4. Prepared rehmannia (shu dihuang) 20-25 grams tonifies kidney essence and yin
5. Cornus berries (shan zhu yu) 10-15 grams
6. Dioscorea batatas (shan yao) 10-15 grams
7. Alisma root (ze xie) 9-12 grams
8. Moutan peony (p. suffructicosa)(mu dan pi) 6-9 grams 9. Poria cocos (fu ling) 9-12 grams

The actions of this formula are:

1. to nourish kidney yin and,
2. to open the hearing.

It is specifically indicated for an individual with hearing problems caused by kidney deficiency with associated tinnitus, deafness and vertigo.

Tongue: red

Pulse: thready and rapid

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

From the above, we see that TCM considers neurological degeneration (as reflected in nerve deafness) as a condition of yin deficiency, and involves nerve deafness which would also be considered a condition of kidney yin deficiency. A chronic remedy such as Rehmannia Six is appropriate not only to improve the presenting condition of deafness, but to possibly prevent further degeneration of other vital functions. For many conditions, this may be the greatest benefit for its use.

We also recognize that dampness or lymphatic stagnation caused by poor digestion and assimilation can cause localized edema in the inner ear that can be the cause of tinnitus. If we were to prescribe the yin tonic, Rehmannia Six formula for this conformation it may aggravate the condition because rehmannia is a moist herb. To give a stimulating, drying and dampness dispelling formula is a correct approach but would be contraindicated for the condition of yin deficiency.

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

The late Doctor Christopher had a formula which he gave both for hearing loss, vertigo and brain damage. It was called B and B Tincture and consisted of a combination of black and blue cohosh, vervaine, scullcap and lobelia (all are antispasmodics and nerve tonics), together with garlic macerated in olive oil (the garlic oil has penetrating and regenerating properties).

Each night 4 to 6 drops of both the B and B tincture and the garlic oil are inserted in each ear, plugging them afterwards with cotton and leaving on overnight. This is done six days a week for 4 to 6 months or as needed. On the seventh day the ears are flushed out with equal parts warm apple cider vinegar and warm water.

This particular combination has proven to be effective not only for various conditions of hearing impairment but because of its penetrating action, for the treatment of brain damage as well. It is corroborated with the similar use of various medicated oils in Ayurvedic medicine. This can easily be combined with the internal treatments prescribed by TCM and will only hasten recovery, if it is at all possible.

B and B Tincture combines nerve tonic herbs such as skullcap (Scutellaria lateriflora), Black cohosh (Cimicifuga racemosa), Blue cohosh (Caulophylum thalictroides) and Vervaine (Verbena hastata) which besides their nerve tonic properties combine various waste discharging benefits as well. The garlic has a penetrating and stimulating action, helping to remove obstructions, in a base of olive oil, there is some softening and regenerative yin tonification as well. Altogether, the combination of herbs used externally, and the addition of internal herbal 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 including China.

The TCM internal treatment for hair loss is tonifying for either or both kidney yin or yang. Again, the approach is directed to strengthen the autonomic nervous system. Evidently a similar approach in the West is followed with the use of B Vitamins and mineral supplements, especially Zinc.

Two herbs in particular are used in TCM for helping to restore hair and skin pigmentation. These are Polygonum multiflorum (ho shou wu) and Rehmannia glutinosa (shu dihuang). Both are classified as blood tonics which nourish liver and kidney essence.

He Shou Wou (Polygonum multiflorum)

The use of He shou wuo for the hair emanates from an ancient story of a famous Chinese military officer who was condemned to death by confinement in a remote cell with no food or drink. He was able to survive by consuming the leaves and roots of a common vinelike weed (polygonum multiflorum). After one year his keepers went back to dispose of the remains of the condemned military officer, that found him fully rejuvenated with his lustrous black hair color fully restored. Since that time, the herb that General He Shou Wou consumed while incarcerated for a year has been named in his honor.

He shou wou, commercially misnamed in recent times, fo ti tieng, contains lecithin, anthraquinones, chrysophanic acid, emodin, rhein, and chrysophanic acid anthrone. Normally He shou wou has been cured by cooking it with black beans. It is bitter, sweet, astringent and slightly warm.

It is used as a tonic for the liver and kidney and also to nourish the blood, benefit the essence, and kidney and liver yin. It is therefore used for deficient yin and blood conformations including dizziness, blurred vision, prematurely gray hair, weak lower back and knees, soreness in the extremities and insomnia. All of these are basic signs and indications for adrenal depletion included under the signs of kidney yin deficiency. As it contains some anthraquinones it also possesses some demulcent and detoxifying properties making it useful for lubricating the intestines and promoting bowel movement especially in anemic individuals.

One of the most remarkable effects of He shou wou is its effects on lipid metabolism. It is believed that the lecithin in He shou wou is responsible for preventing the accumulation of cholesterol in the liver and the retention of lipids in the blood stream and finally the penetration of lipids into the arterial endothelium, hence reducing arteriosclerosis. (14)

The lecithin, besides being good for the hair, is found in He shou wou as a main component of nerve tissue, particularly of the brain and spinal cord. It is also an important raw material for the membranes of erythrocytes and other cells, promoting their growth and 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 extract.

As with the discussion of other aspects of the TCM Kidneys and indeed herbal medicine generally, attempting to diagnose and treat a specific symptom such as premature hair loss or greying, leads one to use herbs and formulas that are indicated for the whole person. By treating hair symptoms, one eventually also finds that their energy and well being improves, joint pains disappear and perhaps is beneficial even, to one's sex life. In this way one herb or formula can treat 100's of symptoms while at the same time by applying TCM diagnostic criteria we can arrive at the correct approach that will achieve the best results for a specific symptomology.

9. KIDNEYS GRASP AND DESCEND LUNG CHI

Another important function of the TCM Kidneys is their ability to grasp the chi of the lungs and pull it downward. Failure to do this results in a kind of adrenal exhaustive asthma where the lung energy does not properly descend.

What is the relationship of the kidneys to the lungs? The two end products of carbohydrate metabolism is metabolic water and carbon dioxide gas. While the main function of the kidneys is to eliminate excessive water from the blood, carbon dioxide gas is eliminated through the lungs.

The filtration of water through the glomeruli of the kidneys is dependent upon high oxygen arterial blood. If the arterial blood contains abnormal impurities from an improper diet rich in denatured, and refined foods, the kidneys require more oxygen to force elimination; this extra oxygen is supplied by the adrenal glands.

As Dr. Henry Bieler explains," Nature wisely placed these glands near the kidneys, so that their internal secretion (adrenoxidase) can supply oxygen faster, in order to overcome any strain on the process taking place in the globule of the kidney."(16)

Adrenal stimulants such as ma huang, cayenne pepper even coffee can stimulate the adrenals to secrete adrenoxidase to supply oxygen faster to compensate for any deficiency in the process occuring in the glomeruli of the kidneys. By so doing the adrenals especially in a yin deficient individual are overly taxed to facilitate the elimination of toxins through the kidneys. This may possibly shorten the individual's life by tending to deplete the adrenal's reserves.

In asthma, the adrenal potential is much below normal and because of this kidney detoxifying function is greatly impaired. It is the lungs which try to help the weak kidneys by secreting some of the toxins through their mucous membranes. The lungs are not able to function very well as accessory kidneys and the result is inflammation and irritation of the lungs which lead to a degeneration and atrophy of the bronchiole tubes.

Herbal formulas which are useful for kidney deficient asthma include Rehmannia Six or Rehmannia Eight formulas previously described. When there is yin deficiency with dryness one can use Rehmannia Six with the addition of asparagus cochinchinensis (tian men dong), Ophiopogon japonica (mai men dong) and Scrophularia ningpoensis (xuan shen).

Asthma caused by asthenia or weakness of the kidney is treated with Rehmannia Eight (jin gui shen qi wan) together with schizandra chinensis (wu wei zi). An animal that is taken to treat kidney yang deficient asthma is gecko lizard. The male and female lizards are usually taken together with the head and feet removed, since these seem to have some toxic principle. Three to six grams are taken as a powder or nine to fifteen grams in decoction. This can be taken alone or together with Rehmannia eight for better effect.

WESTERN APPROACHES TO TREATING THE ENDOCRINE SYSTEM

In the past, Western herbalism has been noticeably lacking in treating endocrine disorders. This is primarily because endocrine disorders 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 systems.

Other substances that are used with good effect are protomorphogens or glandular extracts. These include specific glands from animal sources such as adrenal, thyroid, pituitary, thymus, ovarian, etc. These may be prescribed alone or together with appropriate herbs, vitamins, minerals, etc. In addition, a number of vitamin and mineral supplements are used to nourish and stimulate the endocrine system. These include vitamin C, all the B vitamins, Zinc, calcium and magnesium.

Throughout the nineteenth century consumption or tuberculosis was not uncommon. This condition is definitely one that would be classified as yin deficiency in TCM. It was treated with various yin tonic foods and medicines that often helped to stabilize and sometimes even cure the condition at least for awhile. Because of an epidemic 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 St George.

The use of cayenne pepper and ma huang both serve as stimulants of the sympathetic nervous system. As such they help to raise metabolism and thus help the lungs by stimulating the removal of congestion and toxins from the system. This approach has worked very well for those who have a genuine excess and are only recently changing from a rich diet of red meat, dairy and refined sugar and flour. The same approach, however, given to individuals with sympathetic overload or a depletion of the parasympathetic system (kidney yin) is further weakening and debilitating.

All these approaches have demonstrated considerable beneficial clinical effects. It is in TCM, however, that the conditions associated with kidney yin or yang deficiency is so pivotal to the entire system. There is much that can be learned from TCM that can be integrated into a more effective clinical model. Even more important, we can appreciate that all the principles of TCM theory are in perfect agreement with the most recent discoveries and understandings of modern scientific physiology.

The kidneys correlates with the lower warmer and the bladder

The triple warmer in Chinese medicine is not an actual organ but a functional process whereby all the organs of the upper, middle and lower cavities of the body 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 body.

In the upper warmer, fluid is described in the Nei ching "opening outwards, spreading the 5 tastes of the food essences, pervading the skin, filling the body and moistening the skin and it is like a mist." The middle warmer is situated in the stomach and "receives the chi, expels the wastes, steams the body fluids, transforms the refined essences of food and connects upwards with the lungs." The lower warmer is described as a drainage ditch because of its function of separating essences of food into the pure and impure.

It seems that the description of the triple warmer becomes a "summarization of the functions of all the yang organs (including the lungs and spleen) in their work of receiving, digesting, transforming, absorbing, nourishing and excreting. The triple warmer is like the great canal that was built in China in ancient times to connect the vast distant territories. So also is it warmed and motivated by the TCM function of the kidneys especially as it relates to the processing of fluids. The bladder is the yang aspect of the kidneys, making it relevant to the Gate of Vitality from which it derives its energy. The function of the bladder is to store and excrete urine. If kidney yang is weak, there will be frequent but weak passage of urine.

The Kidneys govern water

Within the kidneys themselves, as with all physiological processes, yin and yang qualities are manifested. The kidneys contribute to the function of eliminating acid waste products and helping to maintain proper PH throughout the body by their ability to reabsorb sodium, calcium and other mineral salts into the plasma. The lungs also contribute to this process by eliminating carbon dioxide which is the waste byproduct of glucose and lactic acid metabolism. Acid waste in the body are yang toxins because they cause inflammation and congestion. Sodium, chloride, potassium and other mineral ions which help to maintain homeostasis are yin. Since yin and yang are relative to each other, sodium is yang because it causes fluid retention while potassium would be yin.

Extracellular fluid in the form of blood and lymph occupies the interstitial spaces between the cells. It must maintain a proper amount of sodium chloride and bicarbonate with some potassium and calcium. Intercellular fluid on the other hand must maintain a predominance of potassium with a smaller amount of sodium. Let us posit that the extracellular fluid is yin while the intercellular fluid is yang.

Similarly, salt is a yin substance while potassium is a yang substance. The balance and interaction of these two through the cell walls is in the form of an electrical charge that helps in carrying food, fluid and waste into and out of the cells.

Chinese medical theory maintains that the flavor of the kidneys is salty. By this the Chinese understood the specialized relationship the kidneys have with directly maintaining and regulating PH and by the reabsorption of sodium and calcium into the plasma. As with the regulation of yin and yang throughout the body, this function of the kidneys is also regulated by hormones of the adrenal cortex and of the posterior pituitary.

ANATOMY OF THE KIDNEY

The kidneys are paired reddish-brown organs situated one on each side of the vertebral column and on the posterior wall of the abdominal cavity. The adrenal glands are situated on the superior portion of each kidney. Being approximately 11 cm. long, they extend down from the level of the twelfth thoracic to the third lumbar vertebra. The right kidney sits slightly lower than the left because of the presence of the liver.

The kidney proper is composed of a cortex or outer layer; the medulla which is located deep to the cortex and consists of up to 18 triangular renal pyramids. The renal pelvis is the papilla of each pyramid projecting into a funnel-shaped minor calyx. The major calyces unite to form the renal pelvis which is the expanded upper end of the ureter. The urine passes as droplets from tiny pores in the papillae into the renal pelvis and finally the ureter, which carries it to the urinary bladder.

The nephron is the functional unit of the kidney where urine is produced. The two kidneys together contain about 2 1/2 million nephrons. The entire function of the kidney can be understood by the function of a single nephron.

The nephron is composed of 1. a glomerulus of tiny capillary blood vessels, and 2. a long tubule in which the filtered fluid is converted into urine on its way to the pelvis of the kidney. Blood enters the glomerulus through the afferent arteriole and leaves through the efferent arteriole. Pressure of blood in the glomerulus causes fluid to filter into Bowman's capsule. Bowman's capsule is named after a 19th century British physician and is a visceral layer close to the glomerulus. It functions as a filter in the formation of urine.

It is within the nephrons that the major functions of the urinary system is performed. The other parts of the system serve primarily as passageways and storage areas. Nephrons carry out three important processes:

1. 1. They regulate blood concentration the volume by removing selected amounts of water and solutes.
2. 2. They help regulate PH
3. 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

Diuretics are chemicals that increase urine flow. Some act on tubular flow in the kidneys while others such as coffee, tea and alcoholic beverages affect ADH by inhibiting its release. It is important that the rate of sodium loss in the urine also be increased with the loss of water.

Weiss points out that "it is useful to make a distinction between diuretics in the narrower sense, which are used to treat diseases of the urinary system, and diuretics in the wider sense, perhaps better referred to as anti-dyscratic drugs with diuretic properties, their actual indications being metabolic diseases, rheumatism and gout." (Weiss, pg. 234)

Weiss then goes on to define the difference between diuretics in the narrower sense which include diuretics containing volatile oils and those where the diuretic property is due to their saponin content.

Diuretics containing volatile oils

It is well understood that in general a warm or hot infusion of herbs with volatile oils will have a diaphoretic effect and a cool infusion will exert a diuretic effect. The following herbs are used in either of these ways:

• Parsley (petroselinum sativum)
• Celery fruits (apium graveolens)
• Wild carrot (Daucus carota)
• Lovage (Levisticum off.)
• Cinnamon bark (cinnamomum cassia)
• fresh Ginger (Zingiberis off.)
• Fennel (Foeniculum vulgare)
• Oregano
• Burdock (arctium lappa)
• Buchu (Barosma betulina)
• Coriander (Coriandrum sativum)
• Water Plantain (Alisma plantago)
• Watercress (Nasturtium off.)
• Gravel root (Eupatorium purpureum)

Diuretics containing saponins and sterols

• spiny restharrow (ononis spinosa)
• Horsetail (equisetum arvense)
• Dandelion (Taraxacum off.)
• Dianthus superbus
• Rehmannia glutinosa
• Goldenrod (solidago virgaurea) (directly increases renal function)
• Ceanothus thyrsiflorus (California lilac)
• Azuki beans (Phaseolus calcaratus) which are diuretic because they tend to
• filter sodium.
• Corn silk (Zea mays)
• Guiacum off.
• Hydrangea arborescens

A diuretic subcategory are herbs that have urinary antiseptic properties and would include

• Pipsissewa (Chimaphila spp.) also very useful for frequent urination.
• Uva ursi (Arctostapholos uva ursi)
• Plantain (Plantago spp.)
• Cleavers (Galium aparine)

Many herbal diuretics exert their action by directly effecting electrolyte balance of minerals. Thus, those that are high in potassium tend to have a cooler energy and include dandelion (taraxacum Off.), the various mushrooms including Poria cocos, couchgrass (Agropynum repens), probably Atractylodes alba, Some diuretics such as Dianthus superbus promote diuretic action by stimulating more the secretion of potassium rather than sodium. Certain herbs of a demulcent or mucilaginous character such as marshmallow root (Althea off.), Slippery elm (Ulmus Fulva), Knotweed, (Polygonum aviculare), talcum, and Rehmannia glutinosa inhibit the osmotic reabsorption of fluid by the tubules. The single most important diuretic that inhibits antidiuretic hormone is water. When large amounts of water are ingested, ADH is no longer secreted from the supraoptico-posterior pituitary system. As a result large amounts of urine are discharged.

In addition to the above, emotions can influence the volume of urine. Nervousness and stress can increase blood pressure which in turn will increase glomerular filtration.

Urine Characteristics

1. Color is normally yellow or amber colored. Being a breakdown product of hemoglobin, urine is colored by urobilinogen and is more hypertonic than plasma and more acid. It consists of urea, urin acid, creatinine, ammonia, and hydrogen and potassium ions.

2. Turbidity of fresh urine is usually transparent. Slight turbidity is a result of mucin secreted by the lining of the urinary tract. If it is too dilute (specific gravity is low) there is not the proper balance of fluid filtered through the tubule. Goldenrod herb and root (Solidago virgurea) is one of the best to correct excessive albuminaria as well as oliguria

3. Odor of fresh urine can vary. Asparagus will give a characteristic smell. Of more importance, however, is a sweetish smell which can indicate the spilling of blood sugar into the urine, indicating diabetes. Normal urine has little odor.

4. PH of normal urine is slightly acidic, ranging from 4.6 to 8.0. Variations are closely related to the diet. High protein increases acidity while vegetables and fruit increase alkalinity. Fasting, exercise and high altitude will also vary the PH. Standing urine forms ammonium carbonate which is strongly alkaline.

5. Specific gravity is the ration of weight of solids to the weight of equal volume of distilled water. Water has a 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.

1. An increase in Albumin can indicate high blood pressure, metals in the body, bacterial toxins, disease of the glomeruli.
2. 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.
3. An increase of Erythrocytes can be cause by hematuria, inflammation of the urinary organs, kidney stones, tumors, trauma and kidney disease. In TCM, this category is in the categorized as disease caused by heat and we look to the use of anti-inflammatory herbs such as echinacea, barberry, gentian as well as astringent diuretics such as pippsesewa, uva ursi and goldenrod.
4. 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.
5. 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.
6. Bilirubin is a byproduct of the hemolysis of red blood cells and hemoglobin. The average lifespan of red blood cells is 120 days after which they become too fragile to exist. Their cell membranes rupture and the released hemoglobin is phagocytized by reticuloendothelial cells throughout the body. Eventually these are converted bilirubin. Within hours, these are absorbed by the hepatic cells where it is combined with other substances and partially excreted as bile where it is excreted through the gall bladder into the small intestine where it stimulates peristalsis and is converted by bacterial action into a more soluble substance called absorbed through the intestinal mucosa into the blood and most of this is in turn re-excreted by the liver back into the gut. About 5% is excreted by the kidneys into the urine. After exposure to air in the urine, the urobilinogen becomes oxidized to urobilin, or in the feces it becomes altered and oxidized to form stercobilin. Herbs that treat a congestion or excess of bilirubin are classified in TCM as "Herbs that clear Damp Heat." These include Oregon Grape (Mahonia), Barberry, Golden Seal, Gentian Yellow dock root (Rumex crispus) and Phellodendron amurense. They are important in the treatment of most genital urinary inflammations as well as herpes simplex and are so used with great effectiveness in both Chinese and Western herbalism.
7. Casts are tiny masses of hardened material made from white blood cells, red blood cells, epithelium that contains cells from the tubulars, fatty or granula cells. They indicate a kind of cellular dysfunction and are effectively treated and removed with a combination of herbs that eliminate "damp heat" and diuretics. These include cleavers (Galium aparine), Gentianae scabrae, Sophorae flavescentis, Phellodendron ammurense, hydrastis canadensis.
8. 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:
   1. 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.
   2. 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.
   3. 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.
9. Various Microbes are also found in urine and are a way of determining other problems in the body. Two that often cause problems are candida albicans and trichomonas vaginalis. These are in the category of damp heat and require diuretic herbs from this category as well as other metabolic adjustments in diet. Herbs that are used for these conditions include barberry root (Berberis vulgaris.) or Oregon grape root (Mahonia aquifolium), Gentinae scabrae and Sophorae flavescentis to name a few. Of course, these are most effective when prepared in a balanced formulation according to the constitution and symptoms of the patient.

Bibliography

• Chinese Materia Medica by Bensky and Gamble, Publ. by Eastland Press
• Formulas and Strategies by Bensky and Barolet, publ. by Eastland press
• Medical Physiology by Guyton, publ. by Saunders
• Pharmacology and Applicaions of Chinese Materia Medica by Chang and But, vols. 1 and 2 publ. by World Scientific
• Textbook of Anatomy and Physiology by Anthony and Thibodeau, publ. by Mosby
• Handbook of Chinese Herbs and Formulas, vol 1 and 2 by Yeung, self published.
• The Wild Rose Scientific Herbal by Terry Willard, publ. by Wild Rose
• College of Natural Healing.
• Herbal Medicine by Rudolf Weiss, publ. by Beaconsfield, England
• Food Is Your Best Medicine by Dr. Henry Bieler M.D., Random House.
• Food Is Your Best Medicine by Dr. Henry Bieler M.D., Random House.

For more information, please see the web site and online forums in herbal medicine, magnet therapy, acupuncture and the EastWest School of Herbology website: http://www.Planetherbs.com

Michael Tierra

mTierra@cruzio.com