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Abbreviation: KI. Either of the two organs located in the small of the back, on either side of the spine; the two kidneys as a single functional unit. The kidney belongs to the water phase. It governs water, stores essence, governs storage (in a wider sense), absorbs qì, is the root of the yīn and yáng of the entire body, governs the bones and engenders marrow. It has its bloom in the hair of the head, opens at the ears and at the two yīn. It stores mind/memory and its mind is fear. It stands in internal-external relationship with the bladder. It holds the office of Forceful Action.

For additional details about the functions, attributes, and associations of the kidney further to the description below, analogy in Chinese medicine: kidney, water, Office of Forceful Action.

Kidney Functions

The Kidney Governs Water (肾主水 shèn zhǔ shuǐ)

The kidney belongs to water in the five phases; it is the chief organ of fluid metabolism. It has the function of removing turbid fluids in the form of urine and returning clean fluids back into circulation. It controls the opening and closing action of the bladder that allows urine to be retained or discharged. Hence, Sù Wèn (Chapter 34) states, the kidney is the water viscus; it governs fluids (肾者水脏, 主津液 shèn zhě shuǐ zàng, zhǔ jīn yè).

Overview of the Kidney
Functions Governs water Stores essence Governs qì absorption Governs storage The root of the yīn and yáng of the entire body Associations Phase: Water Bowel: Bladder Channel: Foot lesser yīn (shào yīn) kidney channel Orifice: Ears (and two yīn) Body constituent: Bone Bloom: Hair Humor: Spittle Spiritual entity: Mind/memory Mind: Fear Aversion: Dryness Office: Forceful Action

The water phase is traditionally described as moistening and descending. As water in the environment naturally flows down to the ocean, so the surplus fluids of the body flow down to the kidney in the lower burner. Here, by the action of kidney yáng, they are heated so that the clear part of them steams upward to be reused by the body. The kidney’s action is thus conceived in terms of a pot of water heated by a fire. The steaming action leaves a turbid part, which is drained off and conducted down to the bladder, where it is temporarily stored before finally being discharged.

The term qì transformation loosely refers to all processes of change in the body. However, it is also used to refer specifically to the action of the kidney in governing water. The warming effect of kidney yáng not only steams the fluids; it also enables the other bowels and viscera involved in fluid metabolism (spleen, stomach, large intestine, small intestine, and lung) to perform their functions. Hence, it plays a general regulatory role in the management of the body’s fluids. Furthermore, kidney qì controls the release of urine from the bladder. Hence, it is said that the kidney governs opening and closing.

When kidney yáng is weak and the steaming function fails, there may be long voidings of clear urine, frequent urination, or profuse urination at night. Alternatively, insufficient urine is produced, and surplus fluid retained in the body gives rise to puffy swelling (water swelling). When kidney qì weakens and fails to control opening and closing, there may be urinary incontinence.

The kidney is gate of the stomach (肾为胃之关 shèn wéi wèi zhī guān): The kidney is also said to be the gate of the stomach. The kidney governs water, and the stomach is the first collecting place of water in the body. Normally, fluids entering the body first collect in the stomach, and from there are transported to the lung, which, by the depurative downbearing action of its qì, carries them down to the kidney and bladder. When the kidney fails to perform qì transformation properly and urination becomes inhibited, there is often glomus and fullness in the center burner. For this reason, the kidney is said to be the gate of the stomach.

The Kidney Stores Essence (肾藏精 shèn cáng jīng)

Essence, also called essential qì, is a substance that has a nourishing action required for the production of qì and blood and that is specifically responsible for reproduction, for growth and development, as well as for aging. The reproductive essences of males and females (semen in males) unite after coitus to produce offspring. In the newborn, essence gradually strengthens to power physical growth and mental development. In middle age, essence begins to weaken so that the physical strength and mental faculties decline. Slow growth and development, infertility, and premature aging are all related to insufficiency of the essential qì of the kidney.

Associated with essence is the notion that the kidney is the root of earlier heaven (肾为先天之本 shèn wéi xiān tiān zhī běn). Earlier heaven refers to the congenital constitution, that is, the physical and mental characteristics that children receive from their parents. Earlier heaven is contrasted with later haven, the acquired constitution, which is associated with the spleen.

Draining the Kidney?

Because essence is a vital substance for the human body, it should be carefully preserved. Kidney essence should be stored and not discharged. By extension, the life gate fire (kidney yáng) should remain hidden and not be conspicuous. From this developed the notion that the kidney has no repletion and cannot be drained. This is not an absolute rule because there are some instances where it is affected by evil qì and can therefore be drained. Nevertheless, it is true that the kidney is mostly treated by supplementing.

The Kidney Governs Qì Absorption (肾主纳气 shèn zhǔ nà qì)

As explained above in the discussion of the lung, the lung governs qì and is in charge of respiration. The kidney is said to be the root of qì, because it helps the lung to draw in qì and absorb it into the body and because kidney essential qì helps to produce original qì. When kidney qì is weak and its function of qì absorption is impaired, the patient may experience panting characterized by difficult inhalation. This condition is called the kidney failing to absorb qì. For this reason, it is said that the kidney is the root of qì (肾为气之根 shèn wéi qì zhī gēn), while the lung is the governor of qì (肺为气之主 fèi wéi qì zhī zhǔ).

The Kidney Governs Storage (肾主封藏 shèn zhǔ fēng cáng)

The kidney’s function of storing essence is part of a wider kidney function of governing storage in general. The kidney governs opening and closing, that is, the retention and release of both urine and semen. A breakdown of this function is called insecurity of kidney qì. Furthermore, the kidney’s storage affects menstruation and stool.

• Semen: By its storage function, the kidney controls the essence gate, the mechanism by which semen is discharged. When this function fails, there is premature ejaculation or seminal loss.
• Urine: The kidney governs the opening and closing of the bladder, controlling the discharge of urine from the body. When this function fails, enuresis (loss of urine in sleep) and urinary incontinence (loss of urine when asleep or awake) may result.
• Women: The kidney exerts influence over the thoroughfare (chōng) and controlling (rèn) vessels, regulating menstrual flow and vaginal discharge, as well as retaining the fetus. When it fails to do so, flooding and spotting (heavy and light bleeding via the vagina) and miscarriage may result.
• Stool: The kidney helps to prevent involuntary loss of stool. Diarrhea may be a sign of kidney vacuity.

The kidney’s function of qì absorption is sometimes considered as one of the kidney’s storage functions.

The Kidney is the Root of the Yīn and Yáng of the Entire Body (肾为一身阴阳之根本 shèn wéi yī shēn yīn yáng zhī gēn běn)

In keeping with the notion of storing essence, the kidney is said to store the original yīn and original yáng (元阴元阳 yuán yīn yuán yáng), also called true yīn and true yáng (真阴真阳 zhēn yīn zhēn yáng) of the body, and is described as the viscus of fire and water (水火之脏 shuǐ huǒ zhī zàng) or residence of fire and water (水火之宅 shuǐ huǒ zhī zhái).

The terms yīn vacuity and yáng vacuity are essentially kidney yīn vacuity and kidney yáng vacuity. Yīn vacuity and yáng vacuity in other viscera are always related to kidney yīn vacuity and kidney yáng vacuity. For example, when kidney yīn is depleted, liver-yīn may be affected. When kidney yáng is weak, the heart or spleen may also be affected. Conversely, yīn vacuity and yáng vacuity of other viscera can affect the kidney. Hence, it is said that enduring illness affects the kidney (久病及肾 jiǔ bìng jí shèn).

In the context of kidney yáng, the life gate (命门 mìng mén) should also be mentioned. Like the triple burner, the life gate is now usually regarded as a functional entity without an anatomical structure of its own. This was not always so. There is a centuries-old debate about its correspondence to physical substrata and about the nature of its function.

The term life gate first appears in the Nèi Jīng, where it refers to the eyes. As a name of an internal organ, it is mentioned for the first time in the Nàn Jīng (a text from the late Hàn period), where it is identified with the right kidney. The two kidneys are not both kidneys; the left one is the kidney; and the right one is the life gate. The explanation dominated for centuries and was not questioned until the Míng and Qīng dynasties, when various different theories were advanced.

Today, it is widely agreed among Chinese medical scholars that the life gate fire, or true fire of the life gate, is kidney yáng.

Life Gate

In the term life gate (命门 mìng mén). The character 命 first meant a command or order. It then came to mean fate or destiny, since a person’s destiny is like a mandate issued by Heaven. From this, it was extended to mean a person’s life. In the human body, the life gate has variously been defined as follows: The eyes; An entity inhabiting the kidneys; The space between the kidneys; The stirring qì between the kidneys; The root of original qì and the house of fire and water; The fire of earlier heaven or the true yáng of the whole body; The gate of birth, that is, in women the birth gate (cervix uteri) and in men the essence gate (not ascribed to any anatomical locus).

The Relationship Between The Qì, Essence, Yīn, and Yáng of the Kidney

The functions of the kidney are understood in terms of kidney essence, kidney qì, kidney yīn, and kidney yáng. Essence is yīn, while qì is yáng, so kidney essence is part of kidney yīn, and kidney qì is part of kidney yáng.

Kidney essence is a yīn substance responsible for reproduction, growth, and development. It finds its active expression in these functions through original qì, which it nourishes. Kidney qì is the retentive power of the kidney’s general function of storage, i.e., retaining urine, stool, semen, menstrual blood, vaginal fluids, and fetuses, as well as the function of absorbing qì.

Kidney yīn and kidney yáng are the kidney’s yīn humor and yáng qì. Kidney yáng is responsible, on the one hand, for the warming action that steams the fluids and produces urine and, on the other, for the libido and, in males, the ability to obtain and maintain an erection and control ejaculation. Note the during erections the penis becomes hot and red, which are yáng qualities. Kidney yáng also warms the other viscera, especially the spleen. Kidney yīn provides the natural counterbalance to these actions.

Kidney yáng vacuity can manifest in poor libido, impotence, and premature ejaculation, as well as the urinary signs previously discussed. Kidney yīn vacuity tends to manifest in general yīn vacuity signs (vacuity heat).

The Kidney’s Associations

The Kidney and Bladder Stand in Exterior-Interior Relationship (肾与膀胱相为表里 shèn yǔ páng guāng xiāng wéi biǎo lǐ)

The kidney and bladder are interconnected by channels. As a result, the bladder’s action of storing and releasing urine is considered part of the kidney’s function of qì transformation. Hence it is said that the kidney governs opening and closing (肾主开阖 shèn zhǔ kāi hé).

The Kidney Channel (肾经 shèn jīng)

The kidney is associated with the foot lesser yīn (shào yīn) kidney channel (KI).

The Kidney Opens at the Ears (肾开窍于耳 shèn kāi qiào yú ěr)

The ears are the orifices of the kidney; hearing problems such as tinnitus (ringing in the ears) and deafness are therefore attributed to an insufficiency of the essential qì of the kidney.

The Kidney Opens at the Two Yīn (肾开窍于二阴 shèn kāi qiào yú èr yīn)

In addition to opening at the ears, it is also said to open at the two yīn, which are the anus (posterior yīn) and the urethra (anterior yīn), respectively. Impairment of the kidney’s role in qì transformation is impaired may cause urinary disturbances, such as long voidings of clear urine or frequent urination on the one hand or scant urine or dribbling urinary block (anuria) on the other. When the kidney’s storage function breaks down, urinary or fecal incontinence may appear. When kidney yáng fails to warm the spleen, diarrhea occurs. Furthermore, constipation is sometimes seen in kidney yīn vacuity.

The Kidney Governs the Bones and Engenders Marrow (肾主骨生髓 shèn zhǔ gǔ shēng suǐ)

The Nèi Jīng states that the kidney has its fullness in the bones (肾，其充在骨 shèn, qí chōng zài gǔ), which means that the state of the bones reflects the condition of essential qì in the kidney. Delayed closure of the fontanels and weak bones in infants, as well as brittleness of the bones in old age are therefore attributed to an insufficiency of the kidney’s essential qì. In addition, since the teeth are the surplus of the bone (齿为骨之余 chǐ wéi gǔ zhī yú), it can also manifest in the loosening or loss of teeth.

The kidney engenders marrow reflects the relationship of the kidney to the brain. In Chinese medicine, marrow is derived by a transformation of kidney essence. The brain is considered a form of marrow and hence is called the sea of marrow (髓海 suǐ hǎi). The mental development in childhood on the one hand and the degeneration of mental faculties in old age on the other are explained in terms of the strengthening and weakening of the essential qì of the kidney. Conditions marked by dizziness, slowness of thought, and forgetfulness are sometimes referred to as emptiness of the sea of marrow (髓海空虚 suǐ hǎi kōng xū).

Marrow reflects the storage function of the kidney. It is contained within the bone. The sea of marrow (brain) is contained within the skull.

The Kidney has its Bloom in the Hair (肾, 其华在发 shèn, qí huá zài fà)

The kidney has its bloom in the hair means that the hair of the head reflects the state of the kidney. The hair is also said to be the surplus of the blood. Thus, hair loss in advancing years is attributed to depletion of essence and blood.

Spittle is the Humor of the Kidney (唾为肾液 tuò wéi shèn yè)

Spittle is the thicker form of saliva, by contrast to the thinner kind, drool, which belongs to the spleen. Spittle tends to be foamy. It provides moisture for the mouth when not eating. It mixes with food to facilitate swallowing. A traditional explanation of the connection between the kidney and spittle is that the foot lesser yīn (shào yīn) kidney channel carries the humor of the kidney upward through the liver, diaphragm, lung, trachea, and reaches the acupoints Golden Liquid (jīn jīn) and Jade Humor (yù yè) under the tongue, where it is secreted as spittle.

Dǎo-yǐn (导引 dǎo yǐn) practitioners traditionally press their tongue against the palate to encourage the secretion of spittle; when it filled the mouth, they swallow it in order to nourish the kidney.

The Kidney Stores Mind/Memory (肾藏志 shèn cáng zhì)

Mental faculties, especially the memory, are closely associated with the state of the essential qì in the kidney. When the kidney’s essential qì is exuberant, the brain marrow is full. This manifests in strong mental powers and a good memory. Forgetfulness and lack of mental agility are principal signs of kidney vacuity. In classical Chinese, the term 志 zhì has several meanings: will, emotion, and memory.

Mind, Memory, and Will

In English interpretations of Chinese medical literature, the term志 zhì is often translated as will and has therefore somewhat mistakenly been associated exclusively with will power. In the phrase the kidney stores mind, the word mind means memory as well as will. Chinese texts often point out that 志 in this context represents 誌, memory. In any event, will and memory are closely related. Memory is not merely recollection of the past; it is required in order to carry through voluntary decisions.

Fear is the Mind of the Kidney (肾, 在志为恐 shèn zài zhì wéi kǒng)

Fear is the mental state associated with the kidney. Excessive fear damages the kidney. Fear causes qì to descend. Excessive or prolonged fear can cause qì to descend and lead to insecurity of kidney qì. Fecal incontinence and urinary incontinence as a result of sudden fear and fright is understood as descent of qì combined with failure of the kidney’s storage function.

The Kidney Belongs to Water (肾属水 shèn shǔ shuǐ)

The kidney is associated with water’s qualities of moistening and descending (润下 rùn xià). It is associated with winter, cold, north, saltiness, and black.

Why the kidney is ascribed to water: The kidney’s association with the water phase is seen not only in its governing water, but also in its essence-storing and general storage functions.

Moistening and descending: In the body, surplus fluid flows down to the kidney, the clear part is removed by kidney yáng’s steaming action, while the turbid part flows out via the bladder.

Winter and essence: The water phase is associated with winter, the time when nature reaches its lowest ebb and becomes dormant. During winter, many plants survive only in root or seed form and many animals hibernate. Water thus signifies life in its minimal and inert form. In the body, the kidney stores the essence that is human life in its potential form. As essence strengthens in early life, the body grows and develops, while as it weakens in advancing years, it allows the body to decline. The exhaustion of essence is the ultimate cause of death. However, since male and female essences unite to create a new individual, kidney essence ensures progeny and hence the continuation of human life. Essence ensures survival against all odds.

The notion of storing essence is reflected in many associations of the kidney, notably the bones, teeth, hair, and reproductive function, which all develop as essence waxes in early life and decline as essence wanes in advancing years. It is also reflected in the notion that the kidney is the root of the yīn and yáng of the whole body. All these theories of kidney function were inspired by five-phases associations of water.

Winter: Kidney qì resonates with the qì of winter. Kidney qì is most exuberant and its storage function is strongest in the winter. Winter provided the model for the development of the theory of essence.

Saltiness: Water becomes salty after its descent into the ocean. Semen (male essence) has a salty taste. Salt is used to preserve food through the winter. Many medicinals that are salty in flavor and cold in nature enrich the kidney. Examples are guī jiǎ (Testudinis Carapax et Plastrum), lù róng (Cervi Cornu Parvum), and zǐ hé chē (Placenta Hominis)..

Black: Black is associated with water because winter is the time of least light. A black complexion is often seen in kidney yáng vacuity and when kidney essence is depleted in enduring illness.

Cyclical relationships: In its cyclical relations, kidney-water is engendered by lung-metal and engenders liver-wood. Kidney-water is restrained by spleen-earth and restrains heart-fire.

The Kidney Holds the Office of Forceful Action (肾者, 作强之官 shèn zhě, zuò qiáng zhī guān)

The Sù Wèn (Chapter 8) states, the kidney holds the office of Forceful Action; dexterity and ingenuity arise from it (肾者, 作强之官, 伎巧出焉 shèn zhě, zuò qiáng zhī guān, jì qiǎo chū yān). Because the kidney governs the bones and engenders marrow, and because the brain is the sea of marrow, so the strength of the bones and clarity of mental faculties are related to the kidney. The relationship between the kidney and physical dexterity is reflected in the facts that physical agility declines with the waning of kidney essence in old age and that kidney vacuity often manifests in limp wilting legs or limp aching knees. Its relationship to mental ingenuity is seen in the gradual loss of mental faculties in old age.

It is said that lumbus is the house of the kidney (腰为肾之府 yāo wéi shèn zhī fǔ): This is because aching pain and weakness in the lumbus are explained by kidney vacuity. Kidney yīn vacuity manifests in aching lumbus, while kidney yáng vacuity manifests in aching lumbus with cold sensations in the lumbar region or the back in general. The knees are also considered to fall within the sphere of influence of the kidney. Limp aching lumbus and knees are often observed in kidney vacuity. Since strong lumbus and knees are important for physical activity, these kidney-related parts reflect the association of agility with the kidney.

The kidney holds the office of Forceful Action; dexterity and ingenuity arise from it. The interpretation of this phrase from the Nèi Jīng the has been the subject of debate. Zuò qiáng zhī guān 作强之官 can be most literally translated as official for Forceful Action. Taken to refer to a government position, it would correspond to the modern notion of ministry of labor (office of labor in Practical Dictionary of Chinese Medicine). However, the term does not appear to have been used other than in the Nèi Jīng. Jì qiǎo 技巧, here translated dexterity and ingenuity, can refer to physical agility and dexterity or to mental skill and ingenuity (agility in Practical Dictionary of Chinese Medicine). Early Nèi Jīng commentator Wáng Bīng suggests that the whole phrase refers to skills (jì qiǎo) in women and to forceful action (zuò qiáng), i.e., physical strength, in men. Others do not follow the division between the sexes, pointing rather to the connection between physical strength and the condition of the bones and marrow or to the connection between physical strength and reproductive capacity.

The disagreements are arguably of little consequence. The notion of the kidney’s storage function in its widest sense concerns the preservation of the life force in decline. In old age, people lose their physical strength, their agility, and their mental faculties (remember, the kidney stores mind), making them unable to do physical or mental work. Maintaining the ability for physical and mental activity in advancing years is a sign of an abundance of kidney essence. The relationship of the kidney to mental agility and to bone, marrow, and the brain (the sea of marrow) is reflected in the head being described as the house of bright essence (精明之府 jīng míng zhī fǔ).

The Kidney Is Averse to Dryness (肾恶燥 shèn wù zào)

This statement from the Nèi Jīng appears to refer not to a susceptibility to externally contracted dryness but to the waning of essence that gives rise to dryness of the hair, brittleness of the bones, cessation of menstruation, and decrease in semen, which naturally occur in later life. The kidney itself is not vulnerable to any external evils. Note that external dryness, common in autumn in China, affects the lung. It damages lung liquid causing dry cough, dry mouth, and dry nose.

The Psyche in Chinese Medicine

The traditional Chinese conception is somewhat different. Its main feature is that there is no single mind. A connection between the mind and the brain is observed, since mental development in childhood and degeneration of mental faculties in old age on the other are explained in terms of the strengthening and weakening of the essential qì of the kidney. Nevertheless, different functions of the mind are considered separately and are associated with different viscera. The heart stores the spirit; the lung stores the ethereal soul; the spleen stores ideation (ability to form ideas: thoughts, opinions, intentions); the liver stores the corporeal soul; and the kidney stores mind (mental faculties and memory). Joy, worry, thought, anger, and fear, collectively known as the the five minds, are each associated with one of the viscera. Excesses of the five minds can cause damage to the associated viscus. In modern Chinese medicine, spirit, affect, mind, essence-spirit, spirit-mind, and affect-mind are important basic terms used in describing the psychic aspects of the body. Spirit (神 shén) is the principle of consciousness associated with the heart. Affect (情 qíng) is emotional or mental state. The seven affects are anger, joy, worry, sorrow, thought, fear, and fright. These include the five minds (anger, joy, thought, worry, and fear). Mind (志 zhì). The Chinese term has three distinct meanings: emotion or mental state (same as affect) memory will, volition The Chinese character 志 in its original form means orientation of the heart. Volition, memory, and mental states are different aspects or orientations of the heart (or psyche). The English word mind, has been chosen to represent this concept, because it not only has the general meaning of psyche, but also denotes (1) emotion or mental state (e.g., mind-frame), (2) memory (e.g., to bear in mind, remind), and (3) will, intention (e.g., have a mind to do something). In the phrase, the kidney stores mind, senses 2 and 3 are implied. In the phrase, the five minds (a fivefold division of mental states), sense 1 is meant. Essence-spirit (精神 jīng shén) spirit (as stored by the heart); mental vigor. Essence-spirit is essentially the same as spirit, which denotes the entity stored by the heart, the principle of consciousness. In practice, it often refers to mental vigor, as in the terms devitalized essence-spirit, torpor of essence-spirit, and dullness of essence-spirit. The term essence-spirit also hints at the understanding that the spirit is dependent on all the essential substances of the body, in particular qì and blood, as well as essence in the narrower sense as the entity stored by the kidney. Because of this, it reflects the health of the whole body. Note that 精神 jīng shén is also the term adopted in contemporary China to represent the Western concept of psyche. In modern Chinese medical texts, it is sometimes used in that sense, e.g., 精神病 jīng shén bìng, psychosis, mental illness. Spirit-mind (神志 shén zhì), like spirit, refers to consciousness. It is often used in description of states of mind, e.g., unclear spirit-mind and abstraction of spirit-mind. In this term, mind has all the connotations described above. Affect-mind (情志 qíng zhì) means any or all the seven affects and five minds, referring to the emotional or mental states of the individual. For example, frustration of affect-mind means emotional frustration. Spirit qì (神气 shén qì) is mental vitality. Spirit-affect (神情 shén qíng) refers to the appearance or facial expression that reflects the state of their spirit and affect mind. For example, indifference of spirit-affect is a mentally and emotionally unreactive state of patient. It describes someone who is completely out of it.

Kidney Disease Signs

Signs of kidney disease fall within several categories:

• Urine: Urinary disturbances in kidney disease, which involve too much urine or too frequent urination, include long voidings of copious urine, frequent urination at night, enuresis, and urinary incontinence. These are mostly attributable to kidney yáng vacuity or insecurity of kidney qì. Urinary disturbances characterized by dark or scant urine are attributed not to the kidney, but to heat or damp-heat affecting the bladder or the body as a whole.
• Sex and reproduction: Seminal emission can result from kidney yīn vacuity (yīn failing to counterbalance yáng) or insecurity of kidney qì (qì failing in its retention function); poor libido and impotence are most commonly associated with kidney yáng vacuity. Male and female infertility are often associated with insufficiency of kidney essence, although other causes exist.
• Development: Signs of retarded development in infants and children and premature signs of aging in advancing years.
• Cold and heat: Slight heat effusion, tidal heat effusion, and vexing heat in the five hearts are signs of kidney yīn vacuity; fear of cold and cold limbs, cold aching lumbus and knees are signs of kidney yáng vacuity.
• Head, ears, lumbus, and knees: Dizziness, tinnitus (ringing in the ears), deafness, and limp aching lumbus and knees can appear in any disease pattern of the kidney.

Enuresis (遗尿 yí niào); urinary incontinence (小便失禁 xiǎo biàn shī jìn): Enuresis is involuntary loss of urine during sleep (bed-wetting); urinary incontinence is involuntary urine asleep or awake. Both are attributed to insecurity of kidney qì, incontinence being the more severe condition.

Seminal emission (遗精 yí jīng); seminal efflux (滑精 huá jīng): Seminal emission is involuntary loss of semen during sleep; seminal efflux, a more severe condition, is involuntary loss of semen night or day, asleep or awake. Seminal emission, when associated with dreaming, mostly results from frenetic stirring of the ministerial fire (which means liver-kidney yīn vacuity with vacuity fire flaming upward) harassing the heart spirit. Seminal emission unassociated with dreaming is usually attributed to insufficiency of kidney qì causing storage failure (insecurity of kidney qì). Seminal efflux is mostly ascribed to insecurity of kidney qì. However, in adolescents or older males who do not engage in sexual activity (sex or masturbation), seminal loss especially when associated with dreaming (wet dreams) may be normal.

Efflux diarrhea (滑泄 huá xiè): Diarrhea with loss of voluntary continence. A sign of insecurity of kidney qì or qì fall.

Limp aching lumbus and knees (腰膝酸软 yāo xī suān ruǎn): The lumbus is the house of the kidney, and aching lumbus reflects kidney yīn or yáng vacuity. The knees are also closely associated with the kidney. In China, people with limp knees will report, for example, difficulty from rising from a crouching posture, as from a squatting toilet.

Vexing heat in the five hearts (五心烦热 wǔ xī fán rè): An annoying sensation of the heat in the palms of the hands, soles of the feet, and center of the chest indicating yīn vacuity. This has the same significance as vexing heat in the palms and soles.

Kidney Patterns

For fuller information than is given below, follow the pattern links. See kidney and bladder pattern identification.

Kidney disease patterns include kidney yīn vacuity, kidney yáng vacuity, insufficiency of kidney essence, and insecurity of kidney qì. No repletion patterns are associated with the kidney.

Because the kidney is the root of the yīn and yáng of the whole body, yīn vacuity and yáng vacuity essentially mean kidney yīn vacuity and kidney yáng vacuity, because they either develop in the kidney as a result of kidney depletion in advancing years, enduring illness, constitutional insufficiencies, or sexual intemperance. Even when yīn and yáng vacuity arise in other viscera, they invariably affect the kidney.

Insufficiency of Kidney Yīn and Kidney Yáng

Kidney yīn vacuity (肾阴虚 shèn yīn xū) is marked by depletion of yīn humor, vacuity heat signs and other yáng exuberance signs.

• Depletion of yīn humor: Dry mouth; emaciation.
• Vacuity heat (from yīn failing to restrain yáng): Slight heat effusion, vexing heat in the five hearts (palms, soles, and center of the chest), and postmeridian tidal heat effusion (heat effusion in the afternoon, evening, or night) with night sweating.
• Hyperactivity of yáng qì attributable to yīn failing to restrain yáng (hyperactivity of the ministerial fire): Insomnia; and seminal emission.

A red tongue with scant liquid and little or no fur and a pulse that is fine and rapid reflect all three aspects.

Kidney yáng vacuity (肾阳虚 shèn yáng xū) manifests in vacuity cold signs, qì vacuity signs, disturbances of urine and sexual functions, and often spleen signs.

• Vacuity cold: Fear of cold, cold limbs, and cold pain in the lumbus and knees.
• Qì vacuity: Lassitude of spirit and lack of strength, and dizzy head and vision.
• Urinary disturbances: These often take the form of impairment of the retentive function of yáng qì, as reflected in long voidings of clear urine, frequent urination, and profuse urination at night. Alternatively, they take the form of distributional disturbances, as reflected in scant urine with puffy swelling most pronounced from the waist downward that does not spring back when pressed.
• Disturbances in sexual functions: Poor libido, impotence, premature ejaculation, seminal efflux, and female infertility.
• Diarrhea: When the spleen is deprived of the warming effect of kidney yáng, there is enduring incessant diarrhea or fifth-watch diarrhea (diarrhea before dawn heralded by pain and rumbling intestines).

The facial complexion is bright-white or soot black. The tongue is pale with a white fur. The pulse is sunken, fine, and forceless, and these qualities are most pronounced at the cubit position.

Insufficiency of kidney essence (肾精不足 shèn jīng bù zú) is a pattern of retarded development or premature degeneration. It affects children, male and female adults, and people in advancing years in different ways.

• Retarded development problems in infants and children: delayed closure of the fontanels, slowness to walk, short stature, retarded mental development, weak bones.
• In adult males, there may be scant semen and sterility; in women, amenorrhea, and infertility. In both, there may be poor libido.
• Premature senility in advancing years: hair loss, loss of teeth, weak bones, torpor of essence-spirit.

Unless kidney yīn vacuity or kidney yáng vacuity is also present, no heat or cold signs present.

Insufficiency of Kidney qì and Kidney Essence

Insecurity of kidney qì (肾气不固 shèn qì bù gù) is a breakdown of the retentive function of kidney qì. It results in:

• Bladder retention failure: dribble after voiding, enuresis, or urinary incontinence.
• Insecurity of the essence gate (in men): seminal loss, premature ejaculation.
• Insecurity of the thoroughfare e (chōng) and controlling (rèn) vessels (in women): persistent menstrual periods; flooding and spotting; vaginal discharge; miscarriage.
• Anal retention failure: efflux diarrhea, fecal incontinence.

Secondary signs include aching lumbus and weak knees. Unless kidney yīn vacuity or kidney yáng vacuity is also present, there are no heat or cold signs.

Kidney failing to absorb qì (肾不纳气 shèn bù na4 qì) manifests in hasty panting exacerbated or brought on by the slightest exertion and with exhalation more pronounced than inhalation. This is combined with dizziness, tinnitus, bright-white facial complexion, lassitude of spirit, low timid voice, and limp aching lumbus and knees. The tongue is pale with white fur. The pulse is sunken and weak. When panting is severe, there may be dripping cold sweat, cold limbs, and green-blue complexion, and a pulse that is floating, large and without root. Conversely, there may be shortness of breath and rapid breathing, with red face, heart vexation, and dry throat and mouth, and red tongue with a pulse that is fine and rapid.

The Kidney’s Relationships

Kidney and Heart

The physiological relationship between the heart and kidney concerns (a) the interdependence between heart fire and kidney water and (b) the interdependence between heart blood and kidney essence.

Spirit and Essence in the Relationship Between the Heart and Kidney

The relationship of fire and water helping each other also manifests in a relationship between spirit and essence. The heart stores the spirit; the kidney stores essence. A powerful spirit boosts essence; accumulated essence nourishes the spirit. Essence can transform into qì and engender spirit; it is the root of spirit and qì; the spirit controls essence and manipulates qì; it is the governor of essence and qì.

Interaction of the heart and kidney (心肾相交 xīn shen2 xiang1 jiāo): The heart belongs to fire in the five phases and is located in the upper burner; the kidney belongs to water and is located in the lower burner. In the five phases, water restrains fire. In yīn-yáng theory, fire and water and upper and lower are yīn-yáng pairs; they are rooted in each other and mutually restraining. What is in the lower body should ascend, while what is in the upper body should descend. Therefore, heart fire, that is, heart yáng, is expected to descend to the kidney, while kidney water, that is, kidney yīn, is expected to ascend to the heart. If the kidney is deprived of heart fire, water becomes cold; when the heart is deprived of kidney yīn, fire becomes intense. The heart needs the moistening and enriching influences of kidney yīn, and the kidney needs the warmth of heart fire. Therefore, it is said that the heart and kidney interact. This is also expressed in five-phase terms as fire and water interact (水火相交 shui3 huo3 xiang1 jiāo) or the heart and kidney help each other (水火相济 shui3 huo3 xiang1 jì).

A breakdown of this relationship, called noninteraction of the heart and kidney, most commonly arises when kidney yīn is insufficient and fails to nourish heart yīn, allowing heart fire to grow intense. For this reason, it is also called water failing to help fire. It can also arise when heart fire stirs and saps, that is, damages kidney yīn. In either case, noninteraction of the heart and kidney manifests in kidney signs such as tinnitus and limp aching lumbus and knees, together with heart signs such as heart vexation and insomnia.

Water qì intimidating the heart: When kidney yáng is depleted, it can fail to perform its function of governing water. This most commonly takes the form of weakness of the steaming function that manifests in long voidings of clear urine. However, in some cases, the kidney’s qì transformation function and opening and closing action is impaired, so that waste fluid is not properly discharged in the form of urine but tends to accumulate and seep out into the skin to cause puffy swelling most pronounced in the lower body, together with short voidings of scant urine. This is called yáng vacuity water flood or kidney vacuity water flood. In this event, water accumulating within the body can affect the heart, overburdening heart yáng, causing heart palpitation and shortness of breath. This is called water qì intimidating the heart.

Blood and essence: The heart governs blood; the kidney stores essence. Blood and essence are mutually convertible.

Insufficiency of heart blood can cause insufficiency of kidney essence; insufficiency of kidney essence can cause insufficiency of heart blood. In both cases there are heart signs such as lusterless complexion and heart palpitation, together with kidney signs such as tinnitus and limp aching lumbus and knees.

Kidney and Lung

The relationship between the lung and the kidney is mainly observed in water metabolism and respiration.

Water metabolism: The lung governs regulation of the waterways; the kidney is the water viscus. When coordinated, the lung and kidney ensure normal distribution and discharge of fluids. The lung’s function of governing regulation of the waterways is reliant upon the kidney’s steaming and qì transformation action, while the kidney’s function of governing water is also reliant on the diffusion and depurative downbearing action of the lung.

Impaired depurative downbearing and impaired kidney qì transformation are mutually conducive, giving rise to water swelling, scant urine, with cough, panting, aching lumbus and limp knees.

Respiration: The lung governs respiration; the kidney governs qì absorption. Inhaled clear qì is carried downward by the depurative downbearing action of lung qì. However, the lung also requires the complementary action of kidney qì to perform deep breathing and carry the inhaled qì downward. Thus, the lung’s depurative downbearing function and the kidney’s action of absorbing qì are mutually complementary. For this reason, it is said that the lung is the governor of qì and the kidney is the root of qì.

Lung qì vacuity with impaired depurative downbearing and insufficiency of kidney qì with qì absorption failure (kidney failing to absorb qì) are also mutually conducive, causing qì counterflow with panting at the slightest exertion, oppression in the chest, together with cough, aching lumbus and limp knees.

When kidney yáng vacuity manifests in yáng vacuity water flood (described above), accumulation of water within the body can affect the lung, giving rise to panting. This is called water-cold shooting into the lung.

Yīn qì: The yīn qì of the lung and kidney are mutually nurturing. Kidney yīn is the root of the yīn qì of the whole body. It nurtures the yīn of the other viscera and is also dependent upon them for nourishment.

Lung yīn vacuity can damage kidney yīn, and kidney yīn vacuity can spread to the lung. In either case, the result is lung-kidney yīn vacuity, which is characterized by tidal reddening of the cheeks, tidal heat effusion, night sweating, dry cough, hoarse voice, and limp aching lumbus and knees.

Kidney and Liver

The relationship between the liver and kidney is extremely close. The kidney stores essence, while the liver stores blood. The relationship between the two is threefold: (a) the relationship between blood and essence; (b) the complementarity of storage and free coursing; and (c) the yīn and yáng of the liver and kidney.

Liver and kidney are of the same source: The production of blood is dependent upon the qì transformation action of the essential qì in the kidney. The exuberance of kidney essential qì is dependent upon the nourishing action of the blood. Hence, it is said that essence can engender blood, and blood can engender essence. This is often also expressed as essence and blood are of the same source. For this reason, it is also said that liver and kidney are of the same source (肝肾同源 gān shèn tong2 yuán).

Pathologies of essence and blood can give rise to each other:

• When kidney essence is damaged, this can cause insufficiency of liver blood.
• Conversely, when liver blood is insufficient, this can damage kidney essence.

In both cases, signs include dizzy head and vision, deafness, tinnitus, limp aching lumbus and knees.

Mutual complementarity of storage and free coursing: A mutually opposing and complementary relationship exists between the kidney’s storage function and the liver’s free coursing function, which primarily pertains to female menstruation and male ejaculation. The liver governs free coursing (encouraging flow of blood and semen), while the kidney governs storage (preventing loss of blood or semen). Imbalance between the two functions is often referred to as disharmony of storage and free coursing.

• In women, menstrual problems such as profuse menstruation or amenorrhea.
• In men, seminal emission (loss of semen during sleep) or seminal efflux (loss of semen when asleep or awake), or frequent and persistent erections without ejaculation.

Yīn and yáng of the liver and kidney: Because the liver and kidney are of the same source, the yīn and yáng of the liver and kidney are intimately related. Several imbalances are possible:

• Insufficiency of kidney yīn can cause insufficiency of liver yīn. This is called water failing to moisten wood.
• When liver yīn is insufficient and fails to counterbalance liver yáng, ascendant hyperactivity of liver yáng can develop.
• Insufficiency of liver yīn can give rise to depletion of kidney yīn and cause the ministerial fire to become hyperactive.
• Excessively exuberant liver fire can damage kidney yīn, causing insufficiency of kidney yīn.

Kidney and Spleen

The kidney is the root of earlier heaven, while te spleen is the root of later heaven. Herein lies the most important aspect of the relationship between the spleen and kidney. The complementarity of the spleen’s movement and transformation function and the kidney’s governing of water constitutes a secondary aspect of the relationship.

Earlier and later heaven: The spleen moves and transforms the essence of grain and water and is the source of qì and blood formation; it is the root of later heaven (acquired constitution). The kidney stores essence and houses the true fire of the life gate; it is the root of earlier heaven (congenital constitution).

Splenic movement and transformation rely on the warming and steaming action of kidney yáng. Hence, it is said, spleen yáng is rooted in kidney yáng (脾阳根于肾阳 pí yáng gen1 yú shèn yáng). The essential qì in the kidney is reliant on the spleen for constant replenishment from the essence of grain and water. Hence, the root of earlier heaven and the root of later heaven are entirely interdependent.

In pathology, earlier and later heaven often affect each other:

• Vacuity of spleen qì with impaired movement and transformation can cause insufficiency of kidney essence. The resulting dual condition manifests in spleen signs such as abdominal distension, sloppy stool, and emaciation, together with kidney signs such as aching lumbus and tinnitus.
• Insufficiency of kidney yáng depriving the spleen of warmth or enduring spleen yáng vacuity affecting kidney yáng gives rise to spleen-kidney yáng vacuity, which is marked by cold pain in the abdomen, clear-grain diarrhea (diarrhea with undigested food in the stool) or fifth-watch diarrhea (diarrhea just before dawn, heralded by pain and rumbling intestines), and water swelling.

Water metabolism: The spleen is responsible for moving and transforming ingested fluids. The kidney governs water: by its steaming action, it returns clear fluids into the system and drains off the waste in the form of urine; it also controls the opening and closing of the bladder. Normal water metabolism thus requires the coordinated action of the spleen and kidney. Furthermore, the spleen can only perform its functions when it benefits from the warming of kidney yáng. Less importantly, the warming action of kidney yáng can only be maintained if spleen yáng is exuberant.

In pathology, the spleen and kidney influence each other greatly in the realm of water metabolism in the following ways:

• Kidney yang vacuity with impaired qì transformation can also cause water-damp to brew internally and affect splenic movement and transformation, ultimately causing dual vacuity of the spleen and kidney with water-damp collecting internally. This is called kidney vacuity water flood, which is characterized by scant urine and puffy swelling, abdominal distension and sloppy stool, with fear of cold, cold limbs, and limp aching lumbus and knees.
• Spleen vacuity with impaired movement and transformation causes water-damp to arise internally. When this condition endures and kidney yáng becomes insufficient, the condition may turn into one of kidney vacuity water flood.

Etymology

Chin The lower part of the character 肾 shèn is flesh signifier 肉 roù in its abbreviated form 月. The upper part is said to be an abbreviated form of 坚 jiān, meaning firm, and in this context denoting the firmness of the flesh in the lumbar region.

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