Lesson 4: Zangfu Theory – Kidney and Bladder

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Kidney . Bladder

General Information

In TCM the Kidneys are considered to be the Root of Life, the Root of Pre-heaven Qi and the Root of the Twelve Internal Organs. Pre-heaven Essence is stored in the Kidneys – they are related to lifespan and longevity.

The Kidneys are located in the lower abdomen on both sides of the spine. In an undamaged person there are two. According to some schools of thought the organ on the Left is the Kidney proper. The organ on the Right is the “Gate of Vitality” or the Mingmen, where the fire of the Kidney originates.

Kidney channel diagram for FoundationsThe Channel
The Kidney is properly called “The Kidney Channel of the Foot Shaoyin.” The Kidney connects to all other organs through its channel. It originates under the little toe, and passes through the sole of the foot obliquely to the navicular bone. It goes past the medial malleolus and along the posterior/medial line of the leg through the knee, entering the sacrum. It then enters the spine and travels through it until it reaches L2 (Du 4 point). At this point it goes out to the abdomen and connects to the Kidneys, then to the Urinary Bladder and to the Liver. It passes through the diaphragm, entering the Lungs, flowing up through the throat and ends at the root of the tongue. On its path it connects to all organs except the Spleen.
Know the landmarks outlined on the graphic above, including the branch going from Lung to Heart part in the center. 

Energetic Motion
By nature, Kidney Qi ascends, also going out and down. The upward motion is the most important to know, however.

Kidney Channel Dysfunction
Because the Kidney channel connects with the spine, the channel can treat problems of the sciatica as well as the bones. The lower back is the residence of the Kidneys. Kidney problems can express as persistent pain in the lower back. If both the Kidneys and the lower back have pain in addition to burning urgent urination, you must refer a patient to an MD to test for Kidney infection. You will learn more about testing for this in some of the coming Physical Assessment classes, but this need for referral is especially true if there is pain upon percussion of the Kidneys. (To test for this, you cup your hand over the kidney area and use your fist to hit your cupped hand. Pain upon percussion may well indicate Kidney infection.)

Why doesn’t the Kidney connect to the Spleen? We’ll get to that later. But good for you for noticing.

Respiration is controlled by both the Lungs and Kidneys. Lung draws fresh air in and down to the Kidneys. The Kidneys control reception and retention of the breath. This is kind of a suction function, grabbing the inhale so that the qi can be extracted from the air. When the Kidney is weak there can be shortness of breath and more difficulty inhaling than exhaling.

Functions of the Kidney

Yuan Qi to Kidney Qi diagramThe functions of the Kidney derive from the Kidney Qi (actually, this is true of all organs, but double down on that business with the Kidney). The Essence of the Kidney comes from your parents. Think of it as a starter pack, a trust fund, your very first birthday gift. This Essence is converted into Yuan or Primary Qi and then into Kidney Qi.

This is really a process of refinement, sort of like refining tomatoes growing in your garden into diced tomatoes and then into salsa. Still tomatoes, just in a different format. Qi does this too, but on a grander scale.

When you talk about the Kidney, you might be talking about one of several aspects of the Kidney: Kidney Essence, Kidney Qi, Kidney Yin, and/or Kidney Yang. Here are some things you need to know:

The Kidney stores essence, governs birth, growth, reproduction, and development

The Kidney stores essence

When an egg is fertilized the essence within the sperm is held by the woman who adds her own essence to it to create new life. The combined essence of both parents leads to new life.

There are two definitions of the Kidney in TCM. The narrow definition is just what it sounds like: a literal pair of organs. The broader definition, however includes the external kidneys (the penis, scrotum, and testes) and the internal kidneys which include the kidney organ plus the prostate or the uterus. (The ovaries in a female are actually part of the Liver system in TCM.)

Congenital essence is the Prenatal or Pre-Heaven Essence which one gets from the parents as described above.

Acquired essence is Postnatal or Post-Heaven Essence of Da Qi (air) and Gu Qi (food/drink)

The Kidney stores both of these essences. The quality and quantity of prenatal essence depends upon the parents’ health and state of being at the time of conception. You don’t always get enough essence from your parents. Diabetes, hypertension and such which are passed from the parents to the child through the genes reflects this. If a patient comes to you with inherited or genetic problems, treat the Kidney. The prognosis for an inherited disease is not as good as for an acquired infectious disease.

Parents who are party animals can pass along bad genetic material to the next generation. Chronically depressed patients (with this as the chief complaint) may have alcoholic parents.

The Kidneys store most of their energy in the winter. This is the best time for conception and is the time when one can pass on the most and best energy/essence to the child.

The Kidney governs birth, growth, and development

One’s whole life span is controlled by the Kidney Essence. For women, life is marked in 7 year cycles. For men, it’s 8 year cycles. The diagram below shows age ranges and life stages for women. Note the seven-year cycles. Kidney ages

This is a very old theory and life spans have changed since then, but the basics are still true.

For best longevity, health care should be well established by age 28, which is when your energy drops. Qigong, dietary therapy, herbal therapy can all help to build good Acquired Essence so that you don’t have to tap into the Pre-Heaven Essence mom and dad gave you. It is never too late to expand, strengthen, and conserve that Pre-Heaven Essence! You only get one dose of that, so treat it well and make it last. (Hint: do a bunch of Qigong if you’ve already spent that particular bank account!)

My teacher, Dr. Qianzhi Wu, recommends Bone Soup to help with this preservation and build up the Kidneys. Want the recipe?

Kidney governs Reproduction

The Kidney has lots more functions in TCM than in western medicine. How does it govern reproduction? It stores Essence or Tian Kui. This is similar to the concepts of estrogen and testosterone hormones. Tian Kui controls maturation of the reproductive organs as well as menstruation.

If hormones are in excess, the Liver is affected. The result is often emotion swings and PMS. If the hormones are deficient, the Kidney is affected. This can result in irregular cycles, amennhorea, and scanty periods. Always care for the Kidney during menstruation and menopause, but especially in menopause.

Age 49-51 is the common age range for onset of menopause. Menopausal women typically suffer from poor sleep, hot flashes, emotional swings, and vaginal dryness/atrophy. All of these are symptoms of Kidney Yin Deficiency.

The Kidneys produce Marrow, fill up the Brain, and govern the Bones

Bone MarrowMarrow has a broader definition in TCM than it does in western medicine. In TCM marrrow includes the literal bone marrow, but also refers to the spine and the brain. Marrow is Yin in nature and fluid-like. There are 3 types in TCM:

Bone Marrow
Because Kidney governs the bones it also governs the marrow. Poor kidney essence can result in weak knees and cartilage degradation as well. Depleted Kidney essence can result in joint pain, articular degeneration, herniation of discs, bone spurs, and sciatica.

Spinal Marrow
When the Kidney qi not in balance or the Essence is depleted, herniation of discs, sciatic pain, back pain and back weakness can result.

Brain Marrow
The brain is also called the “Sea of Marrow” in TCM. One branch of the Kidney channel enters the spine at the tip of the coccyx, travels up the spine and into the brain. The Du channel, an extraordinary channel with its’ own points along the vertebrae and on the head, also enters the spine and the brain, connecting with the Kidney channel. Because of this interaction between the Kidney and Du channels and their interaction with the brain, they have a strong effect upon brain function. Alzheimer’s, dementia, and bone loss can all be attributed to the exhaustion of Kidney essence which results in insufficient marrow to fill the brain or bones.

Look back at the Heart notes and you will see reference to the Kidneys controlling long term memory and the heart controlling short term memory. For best intelligence, harmonize the Heart and Kidney.

During infancy the forehead fontanelles are open, there are no teeth and no knee caps. If you can strengthen the Kidneys you strengthen these areas. It is said that the Tibetan form of ritual prayer in which they pray, kneel on the knees, and touch the forehead to the ground strengthens the Kidneys.

For bone fractures, tonify the Kidneys to speed healing – use acupuncture and herbal therapies as well as bone soup.

Kidney governs water

Body Fluids are stored in the Bladder, but are not considered urine until they are excreted. While they are in the Bladder they are steamed by the Kidney Yang and can be recycled back to the Lung. The Lung can then disperse them further to the skin for skin moisture.

A nugget of wisdom from the aforementioned Dr. Wu: If you exercise in the morning before you urinate you won’t have to pee afterwards (or not as much) because the liquid will have been reclaimed by the body! And yes, I know biomed denies that this can happen. Whatevs. I’ve tried it and it worked just like Dr. Wu said it would.

The Kidney governs the water of the body – the Kidney Qi governs the opening and closing of the Urine Bladder. While the Bladder opening is closed, the fluids remain. All urination problems are due to Kidney dysfunction. Difficult urination, retention of urine, incontinence, and dribbling all fall under this umbrella. Treat the Kidney and you will treat the root of the problem, thus fixing it.

Kidney controls reception of Qi
Kidney controls reception of Qi and breath

Qigong exercise to strengthen Kidneys and breath

There are 3 sources of Qi. Air, also called Da Qi or Big Qi is sourced from the Lungs and the Upper Jiao. Qi from food and drink is called Gu Qi. The source of Gu Qi is the Spleen and Middle Jiao. The Kidney in the Lower Jiao holds the Primary Qi.

Though breathing seems to us to happen in the Lungs, breath is rooted in the Kidney. Think of the Kidney as a kind of catcher waiting to receive the Qi.This is the root of the body, the Sea of Qi. When you inhale the Kidney grasps the breath long enough for the body to extract oxygen. Without good Kidney Qi there is shortness of breath. When a patient has asthma, bronchitis, or emphysema, tonify the Kidney Qi and the breath will deepen.

Respiration should be rooted deep enough through the Kidney’s holding function. Ren 4 and 6 is the lower abdomen are in the area of the Dantian and should never be sedated as they are the seat of this holding function.

For chronic cases of respiratory problems and when asthma is in remission, you treat the Kidney; for acute cases such as an active active asthma attack, treat the Lung.

The Lungs govern the Breath
The Kidneys root the Breath.

Kidney opens to the ears

Kidney Essence can be monitored by the teeth, hair, and ears. Problems with teeth can be due to weakened Kidney Essence. Early hair loss, early graying of the hair, fragile of thin hair can all be the result of poor Kidney essence.

The ears are also a reflection of Kidney. Asian cultures often view long earlobes as a sign of a good constitution that suggests longevity. This is why you often see Buddhas with very long earlobes. Ringing in the ears can be a sign of Kidney Essence deficiency. For deafness and tinnitus, tonify the Kidney.

Kidney manifests on the hair

Hair is a surplus of Blood while teeth are a surplus of Bone. Hair loss and alopecia are due to Kidney Essence Deficiency. Dryness and weakness of the hair can be due to Liver Blood deficiency or Kidney weakness.

Kidney opens the two lower orifices (anus, urethra/vagina)

The anal opening is controlled by the Kidney. Chronic constipation, diarrhea, and bowel incontinence are often Kidney-related problems. Kidney yang deficiency expresses as early morning diarrhea, between 5am and 7am. It is sometimes called “Cocks Crow Diarrhea” in Chinese literature. This can also express as vaginal discharge in women.

Kidney yin deficiency can manifest as nocturnal emissions in men, with or without accompanying dreams and Kidney qi deficiency can result in incontinence of either urine or stool.

Kidney houses willpower

If one lacks motivation, has feelings of hopelessness, tonify the Kidney. Use moxa at L2 (Du 4) to encourage Kidney Qi to move upward.


If one dreams of swimming after a shipwreck it reflects a desire for water and swimming in general – and reflects Kidney deficiency.

The Kidneys are the Gate of Vitality or Ming Men

Chinese culture has been around a looooong time. And as with all cultures, philosophies and concepts shift and are rewritten over time. Please bear that in mind as you read on.

So what is the Ming Men?
The Ming Men has the following functions (Wu says don’t need to memorize this). But you might want to remember it. When you gets to herbs you’ll hear about a few that ‘return the fire to its source.’ This refers to tonifying the Ming Men.

  • Root of Primary Qi
  • Source of Fire for all internal organs
  • Warms the Lower Jiao and Urinary Bladder
  • Warms the Spleen and Stomach, assisting in digestion. Food will not ripen/rot without it!
  • Harmonizes sexual function, warming semen and uterus.
  • Assists Kidney function of the reception of Qi
  • Assists the Heart’s function of housing the Shen/Mind.

About 1800 years ago the Difficult Questions work was published. These consisted of eighty one questions and answers. This work stated that the Kidney is actually two organs. The left Kidney is the organ itself while the right was described as the Ming Men, or the Gate of Vitality.

In the 13th Century, however, Dr. Zhao Xian Ke said no, both are organs and the Ming Men is between the Kidneys. Primary Qi is in this area. Within the Kidney is a fluid-like essence. Dr. Zhong Jingyue said the left Kidney is the home of the Kidney yin while the right Kidney is the home of the Kidney yang. If a Kidney is removed, one will have deficiency accordingly.

At this point, we stick with the Ming Men residing in between the two Kidneys.

Sayings from various TCM literature

The Kidneys have no excess
Never sedate them. Urinary Bladder, yes, but not the Kidney.

A seeming contradiction:
TCM says never sedate or reduce the Kidney, yet you will soon study Four Needle Technique, which includes reducing or sedating (same thing) the Kidney.

If you study classical acupuncture you will learn that there can be an excess in the Kidney channel, which would need to be reduced. Here’s an example: The Kidney channel flows up the trunk of the body on the anterior side. Someone who is wearing a seatbelt and is in a car accident might be pushed forcefully against that seatbelt causing bruising on the chest and along the Kidney channel. This bruising is a build-up of stagnant blood and would be considered an excess in the Kidney channel. You would then reduce (which is also called “sedate”) this excess.

So why the contradiction? Because when medicine in China was modernized in the last half of the 20th Century it was the herbal medicine practitioners that were calling the shots (see the end of Lesson 1 for more) and superimposed herbal diagnostic and treatment rules onto the system of acupuncture. This is a reflection of the modernization and synthesis of internal herbal medicine and acupuncture. The system were separate in the past.

Women have Liver as the most important organ while men have Kidney as the most important organ. Practice celibacy – about 100 days per year – in order to preserve Kidney essence.

The Kidney does not like Dryness.
It stores fluid-like Essence and needs moisture.

Urinary Bladder

Pathway of the Bladder channelReceive and store Body Fluids
(not urine! Urine isn’t urine until it’s exiting from the body. Until then it’s still “body fluid” and TCM says the body can reabsorb the moisture when it’s still in the Bladder.)

Discharge urine with the help of the Kidney
Kidney Qi/Yang governs the transformation. Normal fluids become turbid until the Kidney transforms them. The Kidney controls the opening and closing of the Bladder. When closed the Kidney Yang steams the fluid upward to the Lung. When open, the Bladder discharges, producing urine. This controls the water metabolism of the body.

Body Fluids plus accumulated Dampness and Heat in the Bladder can produce stones. Drain away the damp and clear the heat to treat bladder stones.

While the Kidney never suffers from excess, the Urinary Bladder is prone to excessive conditions.