Carlos Durana Ph.D., M.Ac. practices acupuncture in Washington D.C., Reston, Virginia, and in Bethesda, Maryland.
The Kidneys and the Bladder
From the point of view of traditional Chinese medicine, each of the four seasons is a concentration of a particular type of energy. The passage of time marked by the seasons involves the succession of one type of energy to another (Larre, Schatz & Rochat de la Vallee, 1986). This same succession, this movement, occurs inside human beings as an organizing principle of life. The energy of winter is similar to the energy and functions of the kidneys and the bladder. Through these organs and their energies we find winter brought within ourselves.
In this section we will explore the functions and activities associated with the kidneys and the bladder. The metaphor of water is traditionally used to encompass the functions and activities influenced by these organs their energy pathways.
These functions, activities and their corresponding body parts include:
Physically—kidneys, bladder, anus, urethra, reproductive organs and sexuality, sense of hearing, saliva and body fluids, the teeth, the bones and bone marrow, head hair, several hormones, the spinal cord and the brain, and the nervous system.
Psychospiritually—interiorization, storing, regeneration and gestation; resources and reserves; genetic imheritance, link of past to present and future; awareness of limits and limitations; vitality, potency, adaptation/coping and flow/fluidity, will, power and ambition for carrying out our life purpose; faith, courage and fear; wisdom, awe, grace and surrender; depth and clarity of vision; and potential unconscious intelligence and its use.
The kidneys are vital to our health. From Western physiology, we know they play a role in the regulation of blood and fluid volume and red blood cell production, in the maintenance of electrolyte balance, in the regulation of blood glucose level, in regulating the acid/base balance, in detoxification or removal of substances such as excess ions, urea and urine not needed by the cells in protein regulation and in bone formation.
When blood volume increases, the stretch receptors in the walls of the atrial chambers of the heart, and large veins are excited; these receptors send messages to the vasomotor center in the brain which in turn transmits signals to the kidneys to increase output of fluid. Signals are also sent to the hypothalamus in the brain to decrease secretion of anti-diuretic hormone, in turn having an effect on increasing fluid output by the kidneys. The net result is a mechanism which helps control blood volume and body fluid. Failure of the kidneys to release sufficient fluids can result in edema and high blood pressure.
When the arterial blood pressure falls very low, the kidneys also produce a substance called renin. Renin acts on a plasma protein (renin substrate) to split away from the hormone angiotensin; this substance is the most powerful constrictor of vessels, and it constricts the vessels in the kidneys, causing the kidneys to retain water and salt, thereby increasing body fluid volume and raising blood pressure. Angiotensin also stimulates the adrenal cortex to release aldosterone, a hormone that causes the kidneys to decrease excretion of salt and water, thus elevating fluid or blood volume. The renin-angiotensin system is a powerful and life-saving device which can help arterial pressure return to normal especially during emergencies like circulatory shock, for example, or hemorrhaging.
These mechanisms form the short-term arterial blood pressure control systems. The long-term pressure control system involves a feedback mechanism between the kidneys and the heart. An increase in arterial pressure causes the kidneys to increase their output of fluid (urine). This loss of fluid reduces blood volume and the return of blood to the heart which in turn reduces the output of the heart, thus bringing arterial pressure back to normal (Guyton, 1979). If the arterial pressure drops too low, on the other hand, the kidneys retain fluid, the blood volume increases, the heart output increases and arterial pressure returns to normal. This is a necessary mechanism in the long run because when it is not in balance it can cause hypertension (high blood pressure), a disease which can increase the work load of the heart and cause danger to the arteries from excessive pressure, in turn leading to arteriosclerosis or rupturing of vessels (i.e. hemorrhaging of brain or kidney vessels). Hypertension can be caused by excess salt intake, by frustration and pain, and by other unknown factors (essential hypertension).
The kidneys control the concentration of most of the constituents of the body fluids, and they help detoxify the body through excretion of metabolic end-products such as uric acid and urea. Each kidney filters the fluid flow through its tubules so that unwanted substances are passed in the urine and wanted substances are reabsorbed; the latter include include water, proteins, amino acids, vitamins, glucose, electrolytes (hydrogen, sodium, potassium ions etc.). Reabsorption of substances of nutritional value such as proteins and glucose is essential for maintaining our health and vitality. As much as 30 grams of protein, for example, filter throughout the kidneys each day to be reabsorbed into the body; a loss of this protein would be a big drain on the body. Thus, the kidneys play a role in protein and glucose regulation.
Through the regulation of excretion of metabolic end-products, the kidneys play an essential role in the regulation of the acid-base balance in the body. Concentrations of hydrogen ions and carbon dioxide in body tissues (acid-base balance) influence the rate of chemical reactions in the body, our metabolism. Too low a hydrogen ion concentration, called alkalosis, causes over-excitability of the nervous system, for example, nervousness and muscle spasms. Acidosis, on the other hand, is the state created from too many hydrogen ions in the system, causing a depression in the central nervous system resulting in emotional depression, disorientation or coma. A very high concentration of hydrogen ions caused by kidney failure can eventually result in a clouding of consciousness and eventually coma. The kidneys along with the lungs and the large intestine are involved in rectifying the acid-base balance in our system so that our body, mind and emotions can regain equilibrium.
The kidneys also play a vital role it the manufacturing of the blood, the red blood cell production called hematopoesis. Red blood cell production is influenced by the degree of physical activity, the increased need for oxygen such as in high attitudes or in conditions such as anemia or hemorrhaging. Low oxygen levels, however, do not have a direct effect on the bone marrow where red blood cells are produced. Instead, low levels of oxygen cause the formation of erythropoietin, a hormone that stimulates the bone marrow to produce more red blood cells. Low oxygen levels cause the release in the kidneys of an enzyme, called the renal erythropoetic factor, which acts on a plasma protein to produce erythropoietin which in turn acts on the bone marrow to produce red blood cells. Only minute quantities of this hormone can be produced if the kidneys have failed.
The kidneys influence bone formations by acting on vitamin D. Vitamin D plays an important role in the formation and absorption of bone. However, Vitamin D must be converted to 1.25–dihydroxy-cholecalciferol by the kidneys in order to have its effect on the bones. In the absence of kidney function, vitamin D is ineffective.
Another connection between the kidneys and bone growth is exemplified by the growth hormone which stimulates the growth of a substance, somatomedin (formed in the liver and the kidneys) which in turn promotes the growth of bone and cartilage.
Hormones, brain, nervous system and bones
From the point of view of traditional Chinese medicine the kidneys and the bladder pathways of energy and their corresponding organs influence the function of several hormones, the brain, the nervous system and the bones. In this section we will focus primarily on the hormonal system.
The hormonal and nervous systems are the two major control systems of the body. The hormonal system controls metabolic functions, the rates of chemical reactions in the cells and the transport of substances through cell membranes. A hormone is a chemical substance that exerts physiologic control on cells of the body. Some hormones have local effects and other have distant effects. The major hormones influenced by the kidney/bladder energy and organ systems are: (1) the anterior pituitary gland hormones (the growth hormone corticotropin), thyroid-stimulating and melanocyte-stimulating hormones; and hormones affecting reproduction and lactation such as follicle-stimulating hormone, luteinizing hormone and prolactin; (2) posterior pituitary hormones (antidiuretic hormone and oxytocin); (3) thyroid hormones (thyroxin, triiodothyronine, and calcitonin) which control the rate of reactions in cells; (4) adrenal hormones (cortisol and aldosterone) which affect the metabolism of glucose, protein, fats, and play a role in modulating stress and controlling ions which affect cellular fluid, blood volume and hypertension; epinephrine (adrenaline) and norepinephrine hormones that are similar in function to the sympathetic nervous systems; (5) ovarian hormones (estrogen and progesterone); testicular hormones; parathyroid hormones which affect calcium, phosphate, vitamin D functions and the formation of bones and teeth; and (6) placental hormones.
Many of our behavioral responses are influenced by parts of the brain such as the hypothalamus which affects the production of hormones, the reticular formation and part of the nervous system called autonomic (sympathetic and parasympathetic). Although these responses take place automatically, higher areas of the brain can alter their function by inhibiting them or moderating them. Emotions can also influence these functions. For example, rage stimulates the hypothalamus which in turn signals the reticular formation and spinal cord to cause massive sympathetic nervous system discharge (activating an alarm reaction or a fight or flight reaction), or sympathetic stress reaction. These changes include: increases in blood pressure and blood flow to muscles for activation, increased cell metabolism and blood glucose and fat for energy consumption as well as increased mental activity and blood coagulation. The extra activation of the body in states of stress permits us to perform more vigorous physical activity (Guyton, 1979).
During stress the hypothalamus and pituitary glands release hormones which in turn release adrenal hormones; this results in the repression of immune function. The way we cope with stressors influences immune function. Good coping skills and a positive attitude increase the activity of natural killer cells whereas negative emotional states and poor coping skills suppress immune function, decreasing killer cell activity. High levels of stress and tension resulting from over activating the sympathetic nervous system also can cause depression and anxiety, helplessness and hopelessness. Herein lies the importance of techniques and methods such as imagery, meditation, relaxation and qigong that reduce the overactivity of the nervous and hormonal systems.
Kidneys: a Chinese traditional view
The Chinese character for the kidneys suggests the notion of firmness and bounding tightly, in the sense of holding firmly or standing upright and holding on to the important things in life, like someone who is wise and experienced (Larre & Rochat de la Vallee, 1992). From this perspective, in the human body the kidneys provide a firm foundation for life so that a person can stand upright. As with winter, the kidneys are said to govern a centripetal and downward movement that gathers and helps give the power and structure to life. From a Western perspective, this is akin to the genetic inheritance which gives a foundation and structure for the recreation of life in the body. Part of the influence or power of the kidneys would also include the reproductive organs and sexuality, hearing, the bone marrow, the spinal cord, brain and “essences” which today we might think of as hormones and our vitality. The power of the kidneys is also central to the ability to hold and treasure our vitality and strength for the possibility of producing something. For that reason the kidneys and associated functions or energies are seen as a deep root; the bones and marrow are the structural aspect of this rooted firmness with suppleness within (marrow). From this foundation and potency (a contained force or strength), the power of will, the intensity or intent of a direction, can emerge, taking our inheritance and vitality, our potency, in certain directions—at its best—in the service of our life purpose, our inner nature and our authenticity.
This power of will, of retaining and holding firm, can also insure the sealing and storing of what is essential for vitality, particularly when the kidneys are weakened. Thus, wisdom is the ability to conduct our life with know-how, strong will, purpose and clarity at the highest level possible. All of this strength is kindled and activated by our heart and spirit (Larre & Rochat de la Vallee, 1987).
The primary role of the bladder is the storage and elimination of fluids in the urine. The bladder is a smooth muscle vesicle. Fluid enters the bladder from the kidneys through the ureter, and it exits through the urethra. The external sphincter of the bladder, a skeletal muscle under voluntary control, remains constricted to prevent the dribbling of urine until it is relaxed during urination. Nerves emanating from the second lumbar vertebral areas and sacral regions of the spinal cord cause the bladder to contract or relax.
In Chinese medicine, some of the functions of the bladder differ from those ascribed to the bladder in Western medicine, yet the two hold complementery functions. Many of its functions are similar to those ascribed to the kidneys, such as storing, power, will, drive, etc. In addition, the bladder controls the quantity and quality of the liquid in the body through its elimination function or by its injecting back into the body, with the help of the kidneys, the necessary liquids for the cells (Larre & Rochat de la Vallee, 1992).
The ideogram for the bladder denotes brilliance (Larre, Schatz & Rochat de la Vallee, 1986); Chinese medical texts also qualify it as “clear,” as influencing along with the kidneys clarity and depth of vision and thought. The bladder pathway is the longest and has the most points; its points connect with all the major organs along the back of the body thus influencing the entire physiology of the organism as well as the nervous system. Larre, Schatz & Rochat de la Vallee (1986) have suggested that traditional Chinese medicine’s placement of inherited energy (what we today might refer to as DNA and genetic structures) within the realm of kidney functions—and through extension, to the spinal cord and brain—might be analogous to what we now call the nervous system and might foreshadow the modern understanding of genetic information that carries the past to the future of the organism. The kidney and bladder pathways along with the heart, governing and conception pathways all have major influences on the entire nervous system.
Shivering, whether from cold or fear, is linked with the kidneys and bladder in Chinese medicine. Shivering is a reaction to a “pathological attack” on the body. If the body is influenced by excess cold or fear, the kidney and bladder functions and energies are weakened and injured. Fear can also come from a weakness in the kidneys and bladder.
The trembling or startling quality of fear is depicted by the Chinese character jing which stands for fright. Part of the character depicts a horse, a symbol of power, but also the quality of a horse that is not quiet and is sensitive to noise. Symbolizing fear, the Chinese character depicts a heart and another symbol that stands for working hard, as when the heart pounds in fear. Also often associated with this character is another character, a little bird. This image expresses the vigilance of the little bird, a quality that is necessary for preserving life and noticing danger (Larre & Rochat de laVallee, 1996).
An absence of fear is detrimental, for we are then not able to see real dangers, and we may lack clarity and distort our perception. Normal fear, as with the little bird, is a healthy emotion, a form of will that can help us be watchful, cautious and duly vigilant. It also gives us the necessary vigilance for attending to the unfolding of our important thoughts and feelings, our emotional and psychological life; our inner life quest is a process of interiorization, going inside and paying attention to our inner shiftings. This inner attention and movement are similar to what happens with winter. In winter, we are moved to pay greater attention to ourselves; our energy draws inside; we are forced to be more self-focused. Attending to storing and self-preservation is vitally important for our survival as well as for our psychospiritual development.
In fear as in fright, energetically, experientially and physically, there is a disruption in the communication between the chest and lower abdomen, the kidneys and the heart. A blockage or split occurs at the level of the upper abdomen and diaphragm. The heart beats faster (as if its energy lacks a lower foundation) and the lower abdomen swells as if fluids have moved down.
If gone unattended, the splitting between chest (heart) and lower abdomen (kidneys), alluded to earlier, produces imbalances and pathology in our body, mind and emotions. The experience of fear is sometimes described in Chinese texts as the feeling of always being on the lookout, the feeling of someone “on the edge of being arrested…a sensation of a suspended heart…a kind of panic, like a man in quicksand” (Larre & Rochat de la Vallee, 1996).
Other sensations can include panting, shock (a scattering of our spirit), throat tightness and dryness, agitation and unease around the heart, apprehension, worry, flacidity (as with diarrhea); in more advanced stage, one may be shaken to one’s foundation, losing the solidity of life and becoming unable to recover as would be the case with insanity.
To reestablish balance after we have experienced a separation and absence of circulation between the heart and kidneys and the chest and lower abdomen, will and courage will assist us in overcoming our fears. In choosing to attend to our breath, for example, rather than to our fear, we can often regain some balance. Essential to reestablishing the communication is the centering/grounding function influenced by the stomach and spleen/pancreas functions and energies. As these energies feed the middle abdomen and influence reflective thought, our centering and reflecting on our fear can take us to the source of the problem. Through deep breathing, centering/grounding and reflecting as well as by consciously aiding the energetic integration of heart and lower belly, we can learn from the fear and transform it into courage and faith.
“Courage is resistance to fear, mastery of fear, not absence of fear.”
The idea of water is a useful metaphor in Chinese medicine to describe the multitude of functions and activities associated with winter, the kidneys, the bladder and their associated energetic pathways at different levels within us. When we think of water we recognize its adaptability as it takes the shape of any container. By its very essence, water adapts; it is flexible. When we are adaptable—in the flow—there is no struggling, no effort. The water image can help us conduct our life in a difficult situation; sometimes we need to accept the situation, flow with it and act appropriately rather than with fear, anger or avoidance.
In the Chinese tradition this is called Wu-Wei, the action of non-action. When we are not in the flow, life becomes a torment, a struggle to go upstream resulting in a depletion of our reserves and a loss of will—“I can’t go on.” We forget that there may be a challenge and a lesson in the situation or in the problem that needs to be uncovered. By proceeding with caution, centered and open to discovery, we can move through the seeming difficulty and gain wisdom. We need to remember there is only one Creator and we are participants in that creation. When our actions (will, spirit) are in tune with that of the Tao (natural movement of life, Spirit, God, etc.), life is effortless and there is no dissipation of our vital energy but rather replenishing of these reservoirs. Then the “waters” of the mind and spirit are abundant, quiet and clear.
We must also look at the contrasting side of water and not let water’s
softness and adaptability be deceiving. Water has its hard, destructive side too. Think of the power of water to wear down rocks over the years or the uncontrollable power of tidal waves as they destroy entire communities. We can hear the power of water if we listen to the surf of the ocean, yet the emotion associated with the idea of water is fear, and appropriately so. Imagine the fear of too much water, the fear of drowning or of being overwhelmed; or the fear of too little water, being lost in the desert without any water; or the fear of dying, the fear of being depleted.
As we become more in tune with ourselves, more conscious of the quantity and quality of our life force, of our limits and our reserves, we grow healthier. The quality of life as we addressed it in the autumn seminar is essential not only for our survival but for thriving and having a deeper and richer life and sense of meaning. The proper quantity of water or fluids in our body is essential for our health. Just as important, or maybe more important, is the quality of those fluids in our cells in our every organ. Likewise, the quality of these “fluids” in our emotion, mind and spirit. The purity and quality evoked by water is well known in many religions as an idea and symbol to represent cleaning and purifying our spirits. This is recognized in traditional Acupuncture: points with names such as Bubbling Spring in the ball of the foot, Illuminated Sea in the inner ankle, and Spirit Storehouse in the chest can be used to enhance the quality of these physical, mental and spiritual “waters.”
A poem by Chuang Tzu conveys this meaning of water as a symbol and quality of our inner life:
Fishes are born in water
Man is born in Tao.
If fishes, born in water,
Seek the deep shadow
Of Pond and Pool,
All their needs
If man, born in Tao,
Sinks into the deep shadow
To forget aggression and concern,
He lacks nothing,
His life is secure.
All the fish need
Is to get lost in the water.
All man needs
Is to get lost in the Tao.