Journal of Acuherb in Medicine

All about TCM Kidney

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An Overview of TCM Kidney

The TCM understanding of the kidney is more extensive than the Western understanding of the anatomical kidney, regarding it as the root of life and the origin of our individuality as human beings. It is no wonder that the kidneys are considered to be one of the most important organs in the body in TCM. They perform genital, urinary, endocrine, skeletal, blood, and central nervous system functions as well as store primordial yin and primordial yang (known as inherited or kidney yin and yang) which are attributive to the water and fire elements of the body respectively.

The major physiological functions of the TCM kidneys include:
1. Storing essence for reproduction, blood production, growth and development, and preventing evils or pathogens from invading the body.

2. Controlling water/fluid balance in the body.

3. Helping to control respiration through the grasping of qi.

4. Producing strong healthy bones and bone marrow.

5. Producing healthy hair.

6. Connecting with the ears to control hearing.

7. Opening into the urethra and anus.

Kidney Properties

The Huang Ti Nei Ching (The Yellow Emperor’s Medicine Classic) states: “Kidneys control the storage of essence, so they are also the root for sealing up substances and storing them.” The kidneys possess sealing and astringent (consolidating) properties. These properties allow them to gather and hold on to substances such as essence. If the essence leaked out freely, there would not be sufficient amounts for all the bodily functions that rely on it. Inherent fire (part of inherited or primordial kidney yang) that is kept in the kidney should also be hidden and not be over exposed. The simultaneous storing of the primordial fire and primordial water (part of primordial or inherited kidney yin) means the kidneys provide a place for the essence (yin) to motivate the power of our human vitality (yang). Only the kidneys’ sealing and astringent properties can prevent them form escaping and extinguishing their existence. Therefore, the kidneys are not suitable to carry out dispersing and expelling functions.

Clinically, most kidney diseases are due to a deficiency of some sort and present as an asthenia syndrome. Tonification is the usual method of treatment for deficiencies because it tries to replace the missing elements in the body. However this is not absolute, sometimes a sthenia syndrome can be the cause of a kidney problem. Sthenia syndrome, which is the opposite of asthenia syndrome, occurs when there is a strong body resistance to fight off exogenous evils. Fever is a common symptom with a sthenia syndrome. In this case, a reducing method is applied to help decrease the body’s resistance. It is not uncommon to have sthenia symptoms in a deficiency state. Remedies for replenishing vital energy (qi) and expelling the pathogens or evils are generally used in these instances. It is important to weigh the predominant symptoms carefully when generating a diagnosis and apply the correct treatment method to avoid further deterioration.


Since the kidneys affect so many vital bodily functions, maintaining their health is an essential part of disease prevention in Chinese medicine. Retaining youth and vitality is also closely linked with good kidney functioning. This is why the kidneys’ importance in health maintenance cannot be overlooked.

Understanding Kidney Yin and Kidney Yang
The theory of yin-yang is a conceptual framework used for observing and analyzing the material world in ancient China. The theory permeates all aspects of traditional Chinese medicine. It serves to explain the organic structure, physiological functions and pathological changes of the human body, and in addition guides clinical diagnosis and treatment and prevention.

When The theory of yin and yang is used to explain the organic structure of the human body; the physical form pertains to yin, while activities or functions pertain to yang. The physical forms are the material basis for functions, while functions are the motivating power for physical forms. They are mutually complementary. TCM views the kidneys as the center of the body’s yin and yang, the “congenital foundation,” or the origin of life. In other words, the kidneys store the primordial yin and primordial yang (also called kidney yin and yang), which is the place where nutrients are stored and physiological functions take place.

Kidney yin, also called primordial yin, true yin or true water, is the foundation of theyin fluid of the whole body; it moistens and nourishes the organs and tissues.
Kidney yang, also called primordial yang, true yang or true fire, is the foundation of the yang qi of the whole body; it warms and promotes the functions of the organs and tissues.
Kidney yin provides energy for physiological functions while kidney yang promotes storage of kidney yin. Kidney yin and yang are mutually dependent, promoting and restraining each other, leading to an internal harmony of yin and yang, and healthy functioning of the body’s organs. It is the dynamic interaction between the two that maintains the normal life activities. The third chapter of Suwen (The Book of Plain Questions) confirms this by saying, “When yin is stabilized and yang well-conserved, the spirit will be in harmony; separation of yin and yang will cause exhaustion of essence and Qi.” This statement implies the mutual relationship of yin and yang.

When imbalance Occurs

When the balance of kidney yin and kidney yang is disrupted, pathological changes take place and illness occurs.

Presentations of kidney yin deficiency include: soreness and weakness of the lumbar regions and knees, dizziness, ringing in the ears, hearing problems, a dry mouth and throat, a hot sensation in the palms, soles and chest, spontaneous sweating, constipation, and seminal emission. The pulse is weak or fine and rapid; the tongue is red and covered with a light coating of fur. Kidney yin deficiency syndrome always produces signs of yin vacuity internal heat.

Presentations of kidney yang deficiency include: soreness or cold sensation in the knees and lumbar regions, aversion to cold, cold limbs, spiritual fatigue, difficulty in urination, enuresis, incontinence, declining libido, or impotence in severe cases; female sterility, and general edema may also appear. The pulse is fine or fine and deep; the tongue is bulky, moist, and covered with white fur. Kidney yang deficiency syndrome always produces signs of yang vacuity internal cold.
Kidney yin and kidney yang always influence each other, since they are mutually dependent. Therefore if kidney yin suffers long-term damage, kidney yang will be affected and result in depletion of both yin and yang. This is called “impairment of yin affecting yang” and vice versa.
This is why in routine TCM therapies, tonifying yin will also support yang and tonifying yang will also support yin, or tonify both yin and yang at the same time, by this means the state of equilibrium are restored. According to the clinical diagnosis, yang and yin are invigorated to different degrees. In the Ming dynasty (1368-1644), a notable physician, Zhang Jiebin (1563-1640) had the celebrated idea that “The body is prone to deficiency rather than excess. It is necessary to warm and tonify kidney yin and kidney yang from time to time, and to use cold-cool and potent drugs with caution. Therefore the kidney, which is the root of all the organs, can be consolidated.” He also claimed that “when tonifying the yin, yang should be protected, not suppressed, and vice versa.” This concept is generally accepted today, and many of his formulas relating to kidney tonification are still popular.
In respect to deficiency in kidney qi and kidney yang
Kidney yang deficiency and kidney qi deficiency have similar presentations; however they can still be differentiated clinically. Manifestation of kidney yang deficiency follows the rules of yang vacuity internal cold; therefore it usually presents cold symptoms, e.g. cold and pain in the lumbar area and cold limbs. Kidney qi deficiency is a common clinical diagnosis and does not usually present with cold symptoms. When the kidney’s astringent or storage functions are poor with a kidney qi deficiency, associated symptoms appear, e.g. frequent urination, copious amounts of clear urine, incontinence, enuresis, seminal emission, abortion, or miscarriage.

Kidney yang deficiency and kidney qi deficiency represent different stages of a process; improper management of kidney qi deficiency leads to kidney yang deficiency; in contrast, proper management of kidney yang deficiency leads to less severe symptoms of a kidney qi deficiency and then gradual recovery to the normal state.

In respect to kidney qi and kidney essence
In ancient times, Qi belonged to yang and was called yang-qi. Therefore, kidney qi belongs to yang, and represents all the functions of the kidney. On the other hand, the body’s essence, blood, and fluid are generally called yin essence in TCM. Yin essence is material basis for the body’s physiological functions as well as the kidneys as a whole. Manifestation of kidney yin deficiency follows the rules of yin vacuity internal heat; therefore it usually presents heat symptoms, e.g. a dry mouth and throat, a hot sensation in the palms, soles and chest. However deficiency in kidney essence does not usually present with the heat symptoms.

Simply speaking, citing the analogy of yin and yang, kidney essence is the material basis, kidney qi is the functional force. Kidney essence and kidney qi are complementary and closely associated.


Imbalance of kidney yin and kidney yang leads to many diseases, and affects all organs of the body. For accurate diagnosis of a condition, it must be first ascertained whether there is a deficiency of yin or yang, before identifying the organs involved. For example in chronic nephritis, chronic renal failure, or senile kidney deficiency diseases, the usual TCM syndromes are kidney qi deficiency, kidney yang deficiency, qi deficiency in the kidney and spleen, yang deficiency in the kidney and spleen, kidney yin deficiency, yin deficiency in kidney and lung, yin deficiency in kidney and liver. Careful diagnosis can increase the effectives of treatment.

1. Kidneys store essence (jing)

Essence, which is also called “essential qi” or jing is considered to be the underpinning of all aspects of organic life. Stored in the kidneys, it is the material basis for all kinds of functional activities and is responsible for human growth and development. In effect, kidney essence is what makes up our human vitality. The stored essence is comprised of congenital jing (also called congenital essence) and acquired jing (also called acquired essence).
Congenital jing:
Congenital jing originates from the kidney itself and is made from the sexual energies of the parents when they procreate. Thus, “congenital jing” forms the basis for prenatal growth in the womb and nourishes the developing embryo and fetus. It also determines the constitution and characteristics a person will have throughout their life. After birth, congenital jing is stored in the kidneys and is nourished by acquired jing. It gradually becomes the material for our development and reproduction. Thus it also sometimes referred to as “reproductive jing.”

Acquired jing:
Acquired jing is often called the “jing of the organs” because this jing originates from them. It is obtained from ingested foods and fluids through the action of the stomach and spleen. The digested food and fluids are first transformed into nutrient substances in the stomach, and then further transformed into nutrient essence by the spleen. This nutrient essence or acquired jing is mainly responsible for irrigating and nourishing the organs so they can maintain their daily functions. Extra-acquired jing that is not being used is stored in the kidneys and can be used for nourishing the organs on demand. This process results in acquired jing being repeatedly replaced in the kidney; the extra jing is stored, sent out as required, and then replaced by new jing.
Although the above two jings are from different sources, both are mutually dependent on the other in order to function properly. Because congenital jing forms the essence of us as humans it is needed initially to produce acquired jing. This is sometimes referred to as “congenital jing creating acquired jing.” At the same time, acquired jing is needed to nourish and support the congenital jing, which is referred to as “acquired jing providing congenital jing”. Often these two types of jing are collectively referred to as “kidney essence” since their functions and origins depend on one another and cannot exist independently.
2. Kidneys rule water
The kidneys play an important role in water movement and balance of the whole body. They do this through a kidney yang process called vaporization. Vaporization is the process by which fluids are separated into clean and turbid (unclean) portions. Clean fluid is “vaporized” by the kidneys and sent back to the lungs for redistribution throughout the body while turbid fluid is sent to the bladder by the kidneys for excretion as urine. This type of regulation of body fluids is also called the “opening and closing of the water gate.”

Having a balance between kidney yin and yang functions are necessary for normal functioning of the opening and closing of the water gate and the regulation of fluid movement which both control urination. However, when kidney-yin and kidney-yang are unbalanced, the opening and closing of the water gate is abnormal, disturbing normal fluid movement. For example, in the case of a yang-deficiency and yin-excess, there is more closing than opening of the water gate, which leads to problems of urine production and excretion. This gives rise to symptoms of scanty urine and edema (generalized swelling). In the case of a yin-deficiency and yang-excess, there are many more incidences of opening the water gate, and problems like polyuria (excess urine production) will appear. Other organs, like as the lungs, Spleen and bladder, are also dependent on the vaporization function of the kidney to regulate fluid movement. Therefore, the kidneys’ vaporization control on the opening and closing of the water gate is crucial in balancing the fluid movement throughout the body.

3. Kidneys rule the grasping of qi

One way that Qi enters and leaves the body is through normal respiration. The kidneys grasp the qi that is inhaled through the lungs to help regulate respiration. Although respiratory functions mainly depend on the lungs, inhaled qi must flow down and be grasped by kidneys for smooth respiratory movements to occur. Since normal respiration depends on mutual regulation by the kidneys and lungs, sayings such as “the lungs are the master of qi, the kidneys are the root of qi, the lungs exhale qi and the kidneys inhale qi” are commonly used to describe this relationship.
In order for the kidneys to be able to grasp the qi, they must have an abundance of stored kidney essence and their astringent or grasping and holding functions must be intact. When a kidney deficiency develops and there is a failure to grasp the qi, the qi does not flow down to the kidney and leads to symptoms such as difficulty inhaling with longer exhalation times, shortness of breath, wheezing, spontaneous perspiration, and fatigue.

4. Kidneys rule the bones

Kidney essence is needed for healthy bones. Essence stored in the kidneys is transformed into bone marrow, which provides the nutrients for bone development and blood formation. When kidney essence is abundant, the bone cavities can be fully occupied with marrow and the bones become strong. Through this process the kidneys contribute to bone growth and reconstruction.
When depletion of kidney essence occurs, the bone cavity empties, as marrow is no longer able to fully occupy the space. This results in bone weakness or growth retardation. Clinical presentations include delayed closing of the fontanels (delayed fusing of the skull bones) in babies, difficulty walking, osteoporosis, and fractures related to bone weakness or brittleness.

Teeth are considered to be remnants of bone in TCM and therefore are also dependent on kidney essence for their health. One particular TCM saying that illustrates this concept is: “Teeth are the manifestation of the kidneys, but their root is the bones.” Teeth problems associated with a kidney deficiency include delayed growth of teeth in children or teeth falling out in early adulthood.

5. Kidneys manifest in the hair

Head hair depends on blood for its nourishment and TCM believes hair is the remnant of blood. Since the kidneys play a role in transforming stored essence into blood, they are thought to be the origin of hair. If the stored kidney essence and blood are abundant, hair will appear bright, shiny, and healthy. On the other hand, hair loss or other hair disorders can indicate a kidney or blood deficiency. For example the elderly or those with chronic diseases, who have a depletion of kidney essence, may have hair that appears withered and falls out easily. In these cases, the TCM physician will replenish the kidney essence and nourish the blood to amend the problem.

6. Kidneys open into the ears

In TCM, the ears are conside red to be an opening to the kidneys. It is no surprise then that hearing relies on nourishment from essence stored in the kidneys. A famous TCM classic Yilin Gaicuo (Errors Corrected from the Forest of Physicians)published in 1830 said, “The two ears communicate with the brain, and all the sound they perceive comes from the brain too.” When kidney essence is transformed into the marrow, part of the marrow collects to form the “sea of marrow” which makes up the brain and spinal column, which are responsible for neurological functions as well as intelligence. If the kidney essence is abundant then so will be the sea of marrow resulting in acute hearing. However, if the sea of marrow is unable to be nourished by kidney essence then hearing disorders like tinnitus (ringing in the ears) or deafness appear. In the elderly, increasing deafness coincides with the age-related depletion of kidney essence.

7. Kidneys dominate anterior and posterior orifices

“Anterior orifice” refers to the urethra (the tube that urine passes through from the bladder to the outside of the body) and male/female genitalia, which provide urination and reproduction functions. Although the storage and excretion of urine is related to the bladder, it is dependent on the kidney’s vaporization function for the production of urine. Therefore, disorders in urination such as enuresis (involuntary leakage of urine), incontinence, frequent urination, scanty urine and inability to make urine, are the result of the kidney’s inability to carry out the vaporization function properly.

“Posterior orifice” refers to the anus, which excretes stool or feces. Although stool is mainly transmitted by the large intestine to the anus for excretion, the spleen plays an important part in digestion and stool production through its transformation and transportation functions. These functions need the support of the kidney to perform normally. Kidney yang provides a warm force while kidney yin provides nourishment for the spleen. In this way, the kidneys indirectly affect stool excretion. When a kidney yang deficiency is present, the spleen loses warmth and the large intestine becomes cold and under performs, leading to problems such as diarrhea. On the other hand, when kidney yin is deficient, the large intestine does not have adequate fluid for nourishment and constipation results.

One Comment

  1. yungcin / 2011/11/14 9:24 am

    ok, I may contact you for some questions.

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