The Time of the Kidney.
Health Views from the West & the East
Tonics for Ageing in the 21C.
By Sudha Hamilton.
In our western health culture the kidneys are perhaps one of the most invisible and possibly neglected bodily organs. These two vaguely bean shaped organs are located near our spine at the small of the back, just below the liver and spleen. Responsible, in the main, for the removal of urea, mineral salts, toxins and other waste products from the blood, they are seemingly behind us and out of sight, out of mind. Perhaps their association with excreting waste has led to a lack of polite conversation about them over the years. The kidney is not, at this juncture in time, the somewhat sexy organ that the liver has been of late, with its infamous association with drugs, alcohol and partying. Traditional Chinese Medicine (TCM) however prescribes far greater influence for the kidneys upon our physical health and indeed our lives.
Western medicine focuses very much on the diseases that affect the kidney and the field is called nephrology, from the Greek "nephros" for kidney. Renal failure and dialysis are possibly terms and conditions that you have heard of and refer to in the first instance - "renal" (Latin for kidney), and their failure through disease to remove wastes from the blood; dialysis involves filtering the blood outside of the body assisted by a machine and is used as a means of keeping those with renal failure alive before and if a donor for a kidney transplant can be found. Kidney diseases can be congenital, meaning from birth, or acquired and although most of us are born with two kidneys we can function with one working kidney.
The fully functioning kidney is made up of more than a million nephrons; which are the units that actually filter the blood. Consisting of a renal corpuscle and a renal tubule, which are an intertwined blood vessel and urine collecting tube, a chemical exchange takes place between them as waste materials and water leave the blood and enter the urinary system. Your kidneys are also measuring out the minerals and chemicals like sodium, potassium and phosphorus and releasing them back into the blood as needed. They are the prime regulating organs for these vital substances, where too much or too little can be harmful and indeed fatal. In addition to this the kidneys are directly involved in the release of three important hormones: erythropoietin (EPO) which stimulates bone marrow to produce red blood cells; renin which regulates blood pressure; and calcitriol the active form of vitamin D that maintains calcium for bones and for chemical balance within the body.
The greater proportion of kidney diseases damage the nephrons and cause them to lose their filtering capacity. Diabetes is the most common cause of kidney failure and high blood pressure is a major factor in diabetics developing kidney problems. Indeed high blood pressure in non-diabetics also ranks as a leading cause of kidney disease, as it damages the small blood vessels in the kidneys. That damage reduces the filtering capacity of the kidneys. If wastes are not being removed and proteins are not being returned back into the blood then you are moving toward renal failure and a variety of health issues before death ensues without medical intervention.
So that is a very basic understanding of kidney function within the western medical framework. The TCM outlook is however a far more comprehensive and holistic view and involves more than just the organ itself. A brief definition of TCM being that it is a system of health care that encompasses acupuncture, Chinese herbal medicine, anmo tuina (remedial massage), qi gong (exercise and breathing), and diet and lifestyle. TCM has mapped an intricate series of pathways called meridians, which carry our life energy or Qi back and forth throughout our body. Disease and illness are seen to be imbalances or interruptions of Qi within our systems. TCM, through acupuncture in particular, recognises many points along these meridians that when stimulated through either the insertion of very fine needles, electrical pulses or a combination of the two can restore a balance or flow to that area of bodily influence. Massage through acupressure can also achieve similar results treating suitable conditions. Qigong is the use of focused awareness, relaxation and breathing techniques to affect the flow of Qi through the body, and can be likened to the increasingly widespread use of meditation in many medical programs- as part of treating certain terminal diseases. TCM has a rich diagnostic approach that involves detailed questioning of lifestyle and medical history, comprehensive physical observation and listening to the twelve pulses. Unlike western medicine, which only recognises the one pulse of the heart beat, TCM monitors six pulses in each wrist that connect with twelve different organ systems that pulse within us. How different this all seems from a standard visit to a GP in Australia (and illustrates how in general procedural approaches allopathic medicine doesn't usually arrive at a diagnosis until symptoms are so pronounced they are recognised by the sufferer).
TCM assigns the kidney the foundation position among the other organs, as the home of the 'ancestral Qi' and the root of the yin and yang for the entire body. The kidney stores the vital life essence, and this is produced by the Qi, as it digests food and drink in the stomach and small intestine. According to Chinese Medicine we have a post-natal Qi and a pre-natal Qi, with the former being derived from the food we eat and the air we breathe, and the latter from our parents, perhaps similar to our understanding of our hereditary genes. The kidney in TCM is much more than just renal function; it encompasses the influence of the adrenal glands as well. Kidney energy is divided into kidney yin and kidney yang. Kidney yin refers to the nutritive function of the kidney, body fluids and essential Qi. Kidney yang governs the physiological processes like warming and transforming fluids like hormones. Yin is like the earth or substance that is the body and yang is the life energy that courses through it.
I think that this is a particularly salient example of the difference between the two medical frameworks; with the western medical view only seeing the body & its functioning, but unlike TCM never seeing the life force that runs through the body because it can never measure it or define it under its current scientific rules of evidence. According to the western model early stage kidney disease is very hard to spot with few obvious symptoms and this is perhaps why most information about nephrology focuses on 'worst case' scenarios, leading to dialysis and kidney transplant. The Chinese model allows for earlier detection and indeed kidney tonics form a great part of TCM herbal remedies. A deficiency of kidney yin means that the body is being run down and not able to maintain its health with too much yang energy showing itself through a flushed complexion, overheating, hypertension, inflammation and the like. Whereas coldness, pale complexion, tiredness, low libido and fluid retention are indications of a lack of kidney yang.
Ageing in general is seen to be due to declining kidney energy in TCM and will manifest itself as low kidney yang in most cases. The slowing of our metabolism as we age contributes to many of the symptoms like coldness, fatigue, emotional withdrawal, mild depression, frequent urination, loose bowels, memory loss, weak back and legs. Kidney tonics to stimulate yang energy by increasing our metabolic rates and tightening up organ function can delay the onset of many of these conditions. Kidney yang in essence can be seen in the energy lifting secretions of the adrenal medulla, some androgenic hormones secreted by the adrenal cortex, thyroid hormone and growth hormone from the anterior pituitary gland. It is also affected by the release of EPO by cells in the kidneys and to a lesser extent the liver, which stimulates the bone marrow to make erythrocytes. Further symptoms of a kidney yang deficiency are: sensitivity to cold, lack of libido, impotence, sterility, clear urine, dribbling urine, nocturnal emissions, premature ejaculation, and oedema of the lower limbs, weak pulse, and whitish moist tongue fur. A thoroughly uncharming bunch of symptoms when considered all together, but one or two of these indicators are probably quite common in those of us now in middle age.
Morinda officinalis or Noni has a long history of use within TCM and is commonly used as a kidney yang tonic. The roots have been traditionally been employed and Morinda is known as "Bajitian." (Traditionally recognised for its adaptogenic, aphrodisiac, urogenital astringent, analgesic, hypotensive, digestive stimulant and diuretic properties). It provides a tonifying action on the reproductive (sexual), urinary, musco-skeletal and central nervous system functions.
The Morinda plant is a genus of around eighty species and they mainly come from tropical regions. There are seven species found in Australia. Plants can grow from three metre shrubs up to twelve metre trees. Morinda citrifolia has oval shaped leaves and white flowers that occur in the summer and autumn in Australia, and all year round in the more tropical climates of the Pacific Islands. These are followed by the fruit, which are edible and have a pungent aroma. The juice of the fruit is considered to have a wide range of medicinal qualities. Morinda citrifolia (a close relative of Morinda officinalis), has been used for centuries by Polynesian healers to treat the respiratory, digestive and immune systems. Likewise it has a strong healing history in India, SE Asia and in our own Northern Australia. Published information on its use by Indigenous Australians indicate that various groups regarded Morinda citrifolia as "an excellent food and a strong medicine."
In recent times, since 1997, Noni juice has become popular in western nations as a health supplement. Studies into the healing benefits of Morinda are now being undertaken by herbal research centres, like Lismore's Southern Cross University.
Morinda citrifolia is made up of polysaccharides, which include glucuronic acid, galactose, arabinose and rhamnose, coumarin, medium chain fatty acids, flavone glycosides, sterols ( betta-sistosterol), terpenoids, essential oils, amino acids, vitamin C and potassium. Plus Morindone (yellow dye), alizarin (red dye), rubiadin and a large range of anthraquinones in the roots, bark and leaves. The terpenoids help the body detoxify through their anti-bacterial qualities. The many anti-oxidants within the noni plant like the glycosides provide a defence against free radicals. Scopoletin or coumarin has anti-inflammatory properties. Limonene and anthraquinones have anti-septic value within the body.
In studies conducted recently at the Southern Cross University, the antioxidant activity of Noni juice was assessed to be in a similar range to green tea (with an oxygen radical absorbance capacity ORAC result in the 747 to 1517 level). Associate Professor Dr David Leach (Southern Cross University) says' "The in vitro findings are encouraging, and it is work we would like to repeat". Professor Wang from the Department of Pathology, UIC College of Medicine, Rockford, Illinois 61107, USA reported on studies conducted on Tahitian Noni juice, which showed the superoxide anion radicals scavenging activity of Tahitian Noni juice to be 2.8 times that of vitamin C, 1.4 times that of Pycnogenol and 1.1 times that of grape seed powder. Also the initial results of cholesterol synthesis inhibition of Noni juice are particularly promising. Results reveal that Noni juice shows a positive dose response and inhibits cholesterol synthesis. "In Noni's anti-inflammatory activity scopoletin, quercetin, and ursolic acid were identified as major anti-inflammatory constituents. Since ursolic acid was known to have anti-inflammatory activity, we characterized the mode of action of scopoletin and quercetin." H. YU, S. Li, M.-T. Huang, and C.-T. Ho. Dept. of Food Science, Rutgers, The State University of New Jersey . An antidepressant like effect was also observed in a study conducted by Zhang ZQ, Yuan L, Yang M, Luo ZP, Zhao YM. Division of Psychopharmacology, Beijing Institute of Pharmacology and Toxicology. The study observed the antidepressant-like action of the medicinal plant Morinda officinalis in a behavioural swimming test conducted on rats.
There are numerous positive anecdotal reports of Noni's effectiveness in improving vitality, libido, skin condition, hair condition and many of the symptoms related to low kidney yang levels. It is particularly useful for people who have a highly sensitive intestinal tract and who suffer easily from constipation and pain. People who exhibit sluggish metabolism associated with a hypo-thyroid condition also seem to benefit from using Noni.
Rehmannia root, or sheng di huang and/or shu di huang in Chinese, is another very effective ingredient in many kidney tonics. A member of the foxglove family, the root can be used in its raw state as a detoxifying herb that cools the blood in the treatment of wasting fevers. As shu di huang it is cured by soaking and drying the compressed root many times in rice wine, thus warming its influence as a kidney tonic. Like many TCM herbs it can be used in different preparations as both a yin and yang tonic. Rehnammia is said to be the "kidney's own leading herb." Promoting kidney function, cooling the blood and bring moisture to dryness. With kidney yin deficiency said to be very common in our modern societies because of the hectic lifestyles. Rehmannia root, taken under the supervision of a trained TCM practitioner, can be of great help in relieving many of the symptoms - like dryness in the scalp, skin, night sweats, frequent urination and dark rings under the eyes.
Lycium barbarum or matrimony vine is another herb that has been used by the Chinese for thousands of years to improve kidney health. More commonly known as Wolfberry fruit and the juice as Goji, Lycium is used to improve the flow and balance along the kidney, liver and lung meridians. The fruit in particular is utilised and the red berries are said to be sweet and plump: used traditionally to improve vision and to prevent headaches resulting from kidney deficiencies. Lycium has been shown in studies to be very high in anti-oxidant properties.
Siberian Ginseng is a warming TCM kidney yang tonic ingredient. The major chemical components of Siberian ginseng are eleuthrosides A-G (phenylpropanoid, sterol, lignans, isofraxin, carotenoids and coumarins). There is evidence of cortisol like anti-inflammatory activity.
An important basic distinction to understand in TCM, and its utilisation of active natural ingredients in the formulation of kidney tonics, is TCM's separation of people into two categories. Those who are of a hotter body type or Yang predisposition and those of the cooler Yin persuasion. As the tonic formulations can often carry the same ingredient but in differing quantities and in balance with other quite distinct active ingredients. For example Lycium, Saw Palmetto Berry and Rehmannia Root are all often included in tonics to stimulate both those deficient in kidney yin and yang.
Kidney Yang people are characterised by:
Warm to hot body temperature.
Muscular, well toned body type.
Flushed or ruddy complexion.
Diet includes animal protein.
Passionate and extroverted emotional expression.
High energy but prone to burnout.
Quick and animated physical movements.
Loud and boisterous voice.
Kidney Yin people are characterised by:
Cool to cold body temperature.
Frailness and lack of tone.
Introverted and prone to melancholy.
Sluggishness & low energy levels.
Slow and methodical movements.
Softly spoken and subdued vocal expression.
A traditional Vitalising formula for predominantly Kidney Yin types is what TCM calls an Eight Flavour Tonic. This tonic is designed to re-invigorate the vital fire in those people whose essential vitality has waned and who exhibit symptoms like feeling cold all the time; difficulty in getting up in the morning; mild depression and general low energy levels. The major ingredient in this formula is Morinda Officinalis (Noni) root. Added to this are Asian Ginseng, Saw Palmetto, Schisandra fruit, Rehmannia root, Cistanche sprout, Asian Water Plant Rhizome, Chinese Dodder seed, Dong Quai root, Psoralea seed, Chinese Yam root, Tree Peony Root bark, Cinnamon bark, Cornus Berry extract and Lycium fruit (Goji). This Kidney Vitalising tonic will rekindle feelings of warmth & vitality. Many TCM herbal tonics are devoted to the kidney and are great relievers of some of the more unfortunate effects of ageing, like incontinence and some forms of mild depression.
The Kidney Yang type formula is for those with high energy levels and who are prone to exhaustion from excessive work and play. Often they are suffering also from lack of sleep caused by an overactive mind and poor digestion due to irregular mealtimes.
Early symptoms of this condition are dryness of skin, brittle finger nails, dandruff on the scalp, cracked red tongue, lower back pain, frequent urination and pain in sole or heel of the foot. They require a tonic that fosters nourishment and a deep healing energy rather than the stimulating effect of the Vitalising formula. Ideal for business people driven to meet deadlines and athletes seeking sustained energy. Ingredients include Rehmannia root; Poria Coco Sclerotium, Tree Peony Root bark, Chinese Yam root, Asian Water Plantain Rhizome, Fo-Ti Root, Chrysanthemum Flower, Ligustrum seed, Saw Palmetto Berry, Lycium fruit extract and Cornus Berry extract.
As you can see there are a lot of similarities in the menu of ingredients that make up the two formulas and that the major differences are the Morinda officinalis and ginseng as the stimulating warming agents in the tonic for those who are Yang deficient. Most importantly is the overall recognition of the kidneys as organs that are responsible for our experience of physical ageing and that herbal supplements can offer some real help in delaying some of the debilitating effects. Another tonic ingredient that can help with strengthening the urinary muscles that are important for bladder control is Grateus nervala and this may be of particular interest to those with incontinence issues (a widespread and often silent condition within our communities). Tonics aimed at this are available from TCM practitioners and clinics.
Perhaps with the continued build up of economic power and wealth now happening in China, the coming media focus of the Beijing Olympic Games and the resultant opening up of the world's consciousness to all things Chinese, we will see a renewed focus on the wisdom of the Chinese in many things, not least health and TCM. Then as that knowledge increases here in the west and we begin to grasp certain founding principles of TCM, it may indeed be the "time of the kidney." The kidneys turn to share its profound place in the vital scheme of things as the home of our life force, our Qi.
"Acupuncture- Its Place in Western Medical Science" by Lewith. George T. Thorsons Publishing Group.
"Integrating the Traditional Chinese Understanding of the Kidneys into Western Herbalism" by Tierra. Dr Michael L.A.C, O.M.D Online Article
"Pharmacology and Applications of Chinese Materia Medica " by Chang & But Vols 1 & 2 published by World Scientific.
"Chinese Materia Medica " by Bensky & Gamble. Published by Eastland Press.
"Food is Your Best Medicine" by Bieler. Dr Henry MD Random House
"Your Kidneys & How They Work" by the National Inst of Health - National Kidney and Urological Diseases Information Clearinghouse.
"The Pharmacologically Active Ingredient of Noni." by Heinicke, R. 1985 Pacific Botanical Garden Bulletin.15:10-14
"Noni Handbook" by Jackson J, ND & Dr Wermuth PhD. Qld.
Hirazumi A, Furusawa E. Chou SC, Hokama Y. Anticancer activity of Morinda citrifolia (noni) on intraperitoneally implanted Lewis lung carcinoma in syngeneic mice. Proc West Pharmacol Soc 1994; 37: 145-6.
Hirazumi A, Furusawa E. et al., Immuno-modulation contributes to the anticancer activity of Morinda citrifolia (noni) fruit juice. Proc West Pharmacol Soc 1996; 39:7-Hirazumi A, Furusawa E. An immunomodulatory polysaccharide-rich substance from the fruit juice of Morinda citrifolia (noni) with antitumour activity. Phytotherapy Res 1999 Aug:13 (5):380-7 Liu, G., et al. Two novel glycosides from fruits of Morinda citrifolia (noni) inhibit AP-1 transactivation and cell transformation in the mouse epidermal JB6 cell line. Cancer Res 2001; 61:5749-56.
Bushnell OA et al., The antibacterial properties of some plants found in Hawaii . Pacific Science 1950; 4: 167-83
Banbury L, & Brushett D. Investigation of Noni Juice Centre for Phytochemistry & Pharmacology 2004
Wang MY et al. Morinda citrifolia (Noni): A literature review and recent advances in Noni research. Acta Pharmacol Sin 2002 Dec; 23 (12):127-41