1

The Paradox of the Unity and Duality of the Kidneys According to Chinese
Medicine: Kidney Essence, Yin, Yang, Qi, the Mingmen-Their Origins,
Relationships, Functions and Manifestations

By Leon Hammer, MD

First published in American Journal of Acupuncture Vol. 27, No. 3&4, 1999

Abstract: This paper explores the relationship between Kidney Essence, Yang, Yin and Qi, and the
Mingmen, their origins, the variety of functions they provide to the human organism, mentally,
physically and spiritually, and the fundamental paradox they represent in terms of unity and
polarity. This exercise is part of an ongoing personal exploration in the service of a more
complete understanding of the cosmic and material functions of the Kidney in Chinese medicine
and culture, also illuminated by Chinese pulse diagnosis. It is not meant to convey a final
statement or as a repository of absolutes, but as an attempt to stimulate and ultimately share new
ideas.

This paper was originally intended to examine the enigmatic intricacies of Kidney
yang. However, considering one aspect of Kidney function separate from another is too
artificial to be entirely useful. To quote from the work of Jesuit Sinologist and co-founder
of the European School of Acupuncture, Father Claude Larre, and co-author/translator
Elisabeth Rochat de la Vallee:
"Commentators say that as the only double zang in the body, the Kidneys are the
prototype of the alliance between yin and yang."1
and,
"...analogically mingmen creates the two Kidneys (yin and yang) which in turn
create the six zang and six fu, which in turn create the four limbs and the one
hundred bones of the body and so on."2
They later continue:
"So why does the commentator speak of the Water of Heaven and the Fire of
Earth? I think it is his purpose to show the yin inside the yang and the yang inside
the yin, which is precisely the definition of the Kidneys."3

The inseparability of the yin and yang Kidneys is discussed throughout their book
The Kidney, from which these quotes are taken, and reflect my own experience and
impressions of the relationship between Kidney Essence, Yang, Yin and Qi, and the
Mingmen spelled out in the following pages in terms of origin, function and paradox.

I. KIDNEY PHYSIOLOGY ACCORDING TO CHINESE MEDICINE

Information about the Kidney according to Chinese medicine in either English or

from Chinese sources has not been readily available, nor does the material that is
available suffice to address the challenges which face the practitioner at the end of the
20th century.
While in China I made a special effort to get this information from the traditional
doctors with whom I was in contact. They seemed curiously resistant to my inquiries and
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delegated the task of studying the archives, buried in the basement of Guan An Men
Hospital, to a young female student.
What came from those archives, and what no one disagrees with, is that Kidney qi
is closely bound with the archaic substrate of all existence, the genetic code which
organizes it into form and substance, and the force which brings it into life. In order to
have a perspective on the importance of Kidney function to the basic integrity of our
being and to chronic disease, especially that associated with the separation of yin and
yang, we must examine briefly the origins and functions of Kidney qi.

A. Embryology

1. Essence, Yin and Yang

From European and mainland Chinese sources I learned that the Kidney energies
originate in utero, and that the universal cosmic energies of pure yang (Spirit) combine
with the pure yin (essence) to form the yuan qi. The yuan qi is stored in the Kidneys of
both male and female parents and is mobilized at conception. Managed by Triple Burner
(sanjiao) energies, yuan qi provides the template and force of ontology, the development
of the fetus, and brings qi to the Source points of the channels to be distributed to the rest
of the organism. According to Larre, the Triple Burner is:
"...connected with Mingmen on the right"; and from the Nan Jing in particular we
know that the Triple Heater can be considered like a messenger or servant of mingmen
for the distribution of yuan qi through the body.4
The act of birth is the final transformation of the Yuan energy of the cosmos to
the essence (jing) from which evolves the duality of yin and yang (Fire of mingmen), to
the earth or human plane. Kidney essence is often associated more with Kidney yin than
with Kidney yang; partially because on the pulse, deficiency of Kidney yin and Kidney
essence have similar qualities (Tight and Wiry). However, the functions of essence
include equally yin and yang since it is the origin of both.
I have found that a deficiency of either Kidney yin or Kidney yang can be
associated with Kidney essence deficiency. Kidney essence is, after all, the stored True qi
of the entire organism from both before and after birth and is the lifelong source of yin
and yang. Rather than just yin and yang, there is yin-essence and yang-essence, and since
Kidney qi is a combination of yin and yang, we must also have Kidney qi-essence.
Therefore, I use the terms Kidney yin-essence and Kidney yang-essence to keep
the origins and relationships clearly in focus. The essence is everywhere in Kidney
physiology and pathology as the substrate of Kidney yin, yang and qi. I shall use Kidney
qi as the term which expresses the totality of their function. (This is consistent with the
information which came from the archives of Guan An Men Hospital.)

2. Kidney Qi and the Foundation

The combined forces of Kidney yin-essence and yang-essence constitute what I
call "Kidney qi-essence," which is responsible for all growth and development
throughout life. During life, it is stored in the Kidneys as essence from which it manifests
yin-essence, yang-essence and Kidney qi, the foundation upon which rest the function of
all Organ systems. Larre and Rochat de la Vallee interpret the ideograms associated with
the Kidneys as "firm, solid and durable," "bound tightly" and "[making] a firm
 3

foundation for life so man can stand upright." It is the primitive intelligent (yin-essence)
Will (yang-essence [mingmen]) which throughout life overcomes the status quo, and
which, when balanced against the laws of entropy, create an orderly and timely evolution.
Or, as Larre and de la Vallee state, "having all the wisdom which is necessary to hold the
important things of life."5
Root (also referred to as the "trunk") is the traditional term equivalent to our term
"foundation," applied to the basic physiological role of these essences. On the pulse, Root
refers to the Kidney, or proximal (chi) positions. Because the Kidneys are associated with
this basal energy of the body, if the proximal pulse positions have strength (substance),
the body has Root. This implies a greater resistance to disease, or if a disease has
occurred, the prognosis is accordingly better.6
According to J.D. "Dick" Van Buren, pioneer of British acupuncture and founder
of the International College of Oriental Medicine in 1972:
"Root means there is strength in the deep position. This has two interpretations,
the first says that there is some pulse in the deep position; or it can mean the third
position is there, basically meaning that the Kidney has energy." 7
Townsend and De Donna note:
"If the Root is in good condition, the Deep level pulse at the Chi position should
be clean and reasonably forceful, with a feeling of intrinsic strength and slight
elasticity. Now press the pulse more deeply until it nearly vanishes. The pulse
should disappear slowly as the pressure is increased, with a hint of pulse still
present even at very deep pressure. If the pulse cuts off sharply on deepening
pressure or weakens and fades very significantly, this indicates a weakness of the
Root."8

On the other hand the proximal positions are frequently described as normally
slightly deeper than the middle (guan} positions. Wang Ping states that "It should sound
deep and strong like a stone thrown."9 The reasons for this are not explained anywhere in
the literature with which I am familiar. The fact that the Kidney represents the Root
energy at the "end" or bottom of the body does not seem sufficient explanation, since I
have noted elsewhere that the position gets Deeper with age and with abuse, either by self
(e.g., dietary, tobacco, alcohol), or by others (e.g., sexual, emotional, etc.).
Since the Kidney qi-essence, which these positions represent, is the foundation of
all of the body qi, it is constantly being used to support our use and abuse of all other
functions. The Deep quality is a sign of the depletion of qi, which for the reasons just
offered would explain the usually deeper position of the proximal pulses.
This certainly explains why the proximal positions are deeper in older people.
However, I have noticed a most disturbing development during the 28 years that I have
studied and practiced Chinese medicine; that is, the loss of the Root at younger and
younger ages. I can only attribute this to the stresses and pace of modern life, to
pollution, fast food, sex at an early age, excessive exercise at an early age and perhaps to
the artificial birthing techniques of the past 40 years. While people seem to be growing
larger and stronger on the outside, they seem to growing weaker on the inside.
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3. Left & Right Kidneys and the Mingmen

Larre and de la Vallee have reviewed this issue in an analysis of the Nan Jing3 in
terms of the double aspect of this zang as different from the others.10 They say that "It's
only this double aspect of the Kidneys which is able to make the unity of life, and we call
it Fire and Water, yin and yang."11
In another model, the left Kidney is the one we normally associate with Kidney
function, including water metabolism. Here, the right Kidney is the mingmen...
"...the door of individual destiny...Mingmen is the residence of jing-shen,
Spirits/essences; it is where the Original Breath, yuan qi, is attached. There, man
stores the essences (jing, sperm) and woman attaches the reproductive organs
(bao, uterus). Thus, the Kidneys are unique."12

In another model the mingmen is said to be on the right...

"...in order to command the ascending movement, because the right side is yin and
from yin comes the Fire of the yang which is within the yin. The Kidneys are on
the left because as the power of the Water they mark the power of the yin within
the yang. 13

Another explanation is based on the I Ching (Yi Jing), the Book of Changes. In
this explanation the mingmen is believed to be between the two Kidneys due to the
broken and solid lines of the trigrams...
"Fire (li) and Water (kan) with the unbroken lines being yang and the broken lines
being yin."
and,
"Fire comes first when a living being appears and it contains Water or yin within
in the shape of the broken line. With the trigram for Water, it's the same in that
Fire is contained within the yin power, and this is an exact image of the two
Kidneys with mingmen between them. Here mingmen is not the right Kidney, but
rather it's the Breath and Original Breath of the Fire of Life which is itself
between the Kidneys or inside the power of Water.”14

The final explanation comes to the same conclusion through a different line of
reasoning based on an analogy between the tai ji, or supreme "ridgepole," and the
mingmen. Each create two principles, the first the yin and yang which in the tradition of
the I Ching eventually leads to the 64 hexagrams and the latter,
"...[the mingmen] creates the two Kidneys which in turn create the six zang and
six fu, which in turn create the four limbs and the one hundred bones of the body,
and so on."15

The debate goes on throughout the Nan Jing, which as far as I can see comes to
no clear resolution. Larre and de la Vallee leave the impression that each of these ex-
planations were extant in different dynasties. If we read Unschuld's series Medicine in
China correctly, the preferences would be determined by some sociological aspect of that
time period in the evolution of Chinese culture and civilization.
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4. The Pulse
In the classical literature, the left proximal pulse position is associated with
Kidney yin and the right proximal position with Kidney yang/qi. However, it is my
clinical impression that deficiencies of both Kidney yin and yang can be found at either
or both proximal positions, with the former accompanied by a Tight, and the latter by a
Feeble-Absent pulse quality.
In this regard, 16th century physician and prolific author Li Shi-zhen (1518-1593
AD) stated:
"Even though the ancients say that the left chi pulse belongs to the Kidney and the
right chi belongs to the Gate of Vitality, actually the weakness or strength of the
yang Source qi can be felt at both pulses."16

These positions tell us a great deal about the origin of a disorder, since the Feeble-
Absent quality (Empty, Changing Intensity and/or Qualities, etc.), in all but the aged are
usually associated with a constitutional etiology, and a Tight quality with postpartum
etiology, often due to overwork of the mind and nervous system. This is important in
terms of how one advises the patient about self-care.
Especially if the left proximal position is Feeble-Absent in other than the elderly,
the etiology is clearly constitutional, and the patient should understand that they do not
have the innate strength to do certain things that others can do easily, without becoming
ill. I have found this to be one of the most emotionally releasing pieces of information for
people who have lived a lifetime burdened by guilt and a sense of inferiority that they
were not performing as they were expected to by parents and peers. They are relieved to
be released from the guilt and to be able to cease performing disabling activities that
enervate them and lead to symptoms and disease.
If the etiology is from a later stage of development, one can seek to delineate the
habits, which create the excesses and the symptoms about which the patient complains,
and initiate lifestyle changes that would create less stress. Changes in addictive and ego
based lifestyle patterns, such as excessive sex and/or work, are then the focus of
treatment. In such cases, there is usually more resistance to change.
In the early stages of a yin deficiency, a Tight quality will appear at first at the left
proximal position, and as the yin deficiency grows a Tight quality appears also at the
right proximal position. It has been my experience that if a Kidney qi/yang deficiency is
developing, the qualities which characterize this condition (Feeble-Absent, Empty,
Changing Intensity and/or Qualities etc.) will appear equally at both proximal positions.
In the early stages of a simultaneous Kidney yin and yang/qi deficiency, the yin
deficiency will manifest itself as a Tight quality at the left proximal position, and the
yang deficiency as a Feeble-Absent quality (Empty, Changing Intensity and/or Qualities
etc.) at the right proximal position. In the presence of both deficiencies simultaneously
the harder yin deficient quality, Tight, might overshadow the more Yielding Reduced
qualities such as Feeble-Absent, and both proximal positions would feel Tight, especially
if the yin deficiency was clearly greater than the yang/qi deficiency.
On the other hand, the Feeble-Absent (etc,) quality will dominate if the yang/qi
deficiency is significantly greater than the yin deficiency. In chronic conditions, with
either sign of deficiency manifesting, the likelihood is that both yin and yang are
deficient. For example, Dr. John Shen, CMD (with whom I have been associated for 25,
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and worked closely for eight years) states that lupus erythematosus is a condition
reflecting a severe Kidney yin and qi/yang deficiency in which external Cold has invaded
the Kidneys, which were the most vulnerable Organs when the Cold invaded the body.
(He considers it as one form of chronic fatigue syndrome.) Here the pulse picture is in a
state of flux depending upon the stage of the disease.
If an acute (or exacerbation of a chronic) colitis, pelvic inflammatory disease or
prostatitis should occur, the qualities in the proximal positions will take on an entirely
different character (Flooding Excess, Pounding, Slippery, Tight-Wiry qualities and Rapid
Rate) reflecting these processes rather than the innate condition of the Kidneys. Once the
acute condition passes, the true qualities will return.)17

5. Other
According to Chinese tradition. Mingmen is the central factor in both Kidney
function and to all of the important aspects of life. It involves the Will and Destiny which
are discussed in a following section.
It also involves Virtue and morality. According to Larre and de la Vallee:
"...but there is another ideogram [xing], which is often joined with ming-and it
means all the circumstances of life and all I must do according to my nature to
follow the right way, which is the way of authenticity. If I realize my nature I
become authentic and I become a celestial being. It's the same at the level of a
dynasty, the so-called tianming, mandate of Heaven, just the same as for an
individual. If a lineage has a virtue, a power which enables it to ensure the charge
of emperor or warrior or king, then it has to follow that way through each of it’s
members, generation after generation. [If the lineage is unworthy and loses its
authenticity, then] Heaven would withdraw its mandate because there’s no more
power and virtue in the lineage and it no longer realizes its original and primitive
nature. It's the same for man."18

On the relationship of the Kidneys to the North, Larre refers to this in terms of
"the supreme unity of each being and all beings." He states that:
"...the Pole Star was considered, in the second century BC, to be the dwelling
place of the great deity tai yi, the Supreme Unity."19

Willmont has just published an exhaustive review on the subject of mingmen,

which unfortunately arrived too late to be used for reference in this paper but which, after
a cursory reading, I can recommend.20

6. Comments
The understanding of Kidney yin as the left Kidney and Kidney yang as the right,
with the mingmen between, is the one which is most congenial to me primarily because I
have found that treating the Governor channel in the Lower Burner is more relevant to
mental-spiritual issues than treating the Kidney shu points. On the pulse, I find that right
and left side do not consistently correspond to yin or to yang. Li Shi-Zhen supports this
perspective in this 16th century excerpt:
“According to recent [!] findings, mingmen is located between the two kidneys."21
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I believe that the mingmen is the Yuan which at birth resides in the “uterus" and
issues forth the Kidney duality associated primarily with the Du Mai, Ren Mai, especially
the Chong Mai, which is associated with the other Kidney channel points 21-27, most
effective in treating emotional-spiritual issues and closely related to the Pericardium-
Heart. I was heartened to find this approach reinforced in a further discussion of the
subject by Larre and de la Vallee.22

B. Function

1.Will (Zhi)
The following are excerpted from my previous thoughts on Kidney Yang which
appeared in Dragon Rises, Red Bird Flies:26

Material Being
"Kidney yin and Kidney yang give, respectively, the 'life' and 'force' to the 'life-
force.' The 'force' induces the movement that distinguishes that which is living from that
which is not, and it is coincident with the concept of 'the qi.' If 'energy,' to which all
Organ systems contribute, is the total capability of the organism to survive, then qi is the
working agent or the power provided partly by the Lungs, Kidney, and Liver. Qi moves
that energy over a specific distance in a specific time, generating power, work,
movement, and circulation. Energy is potential; qi is kinetic. Kidney yang, the Kidney's
contribution to qi, is the kinetic component of the Water element." [For a more
exhaustive discussion of 'structive energies' and 'active energies,' I refer the reader to
Manfred Porkert's book, The Theoretical Foundations of Chinese Medicine.23]
"Kidney yang (also known as Kidney Fire or the Fire of mingmen) is, therefore,
the functional energy that provides 'drive' to all the Organ systems and circulation. The
heat energy, required for the physical and mental digestive functions of the Earth
element, comes from the mingmen. The bonding and separation of the Earth element
depend on the motivating force of Kidney Fire.Without this drive, the body will function
sluggishly. On the mental level, this drive is motivation and will power. The assertive
role of the Wood element in the 'evolution of being' requires the will power provided by
the Fire of mingmen. Kidney Fire provides the metabolic heat to transform what would
otherwise be a relatively inert organism into a dynamic, goal-oriented, aggressive being.
From the beginning, it provides the 'force' to the 'life-force' and the 'will' to the 'will to
live.'
One component of this forward motion, mediated through Kidney yang energies,
is an appropriate involvement with the future. Kidney yang energies provide the
prospective aspect of the 'through time' phenomenon, just as Kidney yin energies afford
us the retrospective, historical view. With the former energies, we become capable of
collating all of the current available information, in combinations of possibilities; these
we can test against our concept of reality in order to produce a reasonable approximation
of the future. Those in whom this talent is more highly developed are the visionaries and
prophets, almost always unsung in their own time and canonized in retrospect. Poet/artist
William Blake saw this function as belonging to the imaginative and creative faculties of
people, and Ezra Pound called poets 'the antennae of the race.' In our time the 'prophetic'
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impulse24 is strong among science fiction writers, who have fared generally better in the
scientific age than their counterparts did in other times.
"The propensity to see ahead involves a 'gift' for projection, which permits us to
move outside ourselves to other places and times, both past and future. This may be
realized in esoteric ways (such as an out-of-body experience), or, as with all natural
functions, it might become a defense, in this case a rehearsal in preparation for future
'insults,' which we call 'paranoia.' The 'clear vision' capacity of the Wood element as
expostulated by Worsley is the focused use of this gift of the Water energies for a specific
purpose.
"Kidney yin provides the 'Water of Life,'25 the medium of nutrient substances
necessary to material being. Kidney yang provides the Fire that fuels the biochemical
processes and stabilizes the balance of these substances through the control of glomerular
filtration. Between the Lungs and the Kidney yang, homeostasis of anions and cations in
the body is maintained. Electrolytes are one of three bodily systems in which there is
little tolerance for any major imbalance without a threat to life itself. Any compromise in
the performance of Kidney yang carries serious potential implications. Though Chinese
medicine itself does not make references to Western biochemical science, I feel there is
no harm in speculating on the possible correlations."26

Literature
According to Larre and de la Vallee, the Will resides in the essences (jing) which
are within the Kidneys, both left and right, yin and yang as a couple.
“When we say Will, zhi, we understand will-power, and we are just using a
shortened form....when we talk of Will in the West, it's a very intellectual
consideration of man's activity, but the Chinese character zhi has to do with what
makes life within an individual emerge from all the universe... So in zhi we must
understand the roots of life where Will is built, and the power to organize things,
not from an intellectual point of view, but in terms of the strength which arises
from the five zang, and in particular from the Kidneys which is where the essence
resides and where they are controlled from."27

2. Power
In regards to power, Larre and de la Vallee state that:
"The Kidneys have charge of arousing the power; skill and ability stem
from them...
and
"...the jing shen (the vitality) is prosperous and healthy and that makes one agile,
alert and lively but also that the muscles and bones are full of strength and power,
and movement is vigorous." 28

They also note that:

"It's the image of the double bow which is bent or stretched, and when the arrow
leaves, that is the Liver. The Kidneys are not that which makes the arrow leave,
but they are the retaining power behind it... But nothing is kept and retained if it is
not for up-thrust, or springing up. The power of the Kidneys is the ability or
possibility of producing something, an effect. Afterwards, the "skill and ability'
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are to fashion or shape something and they are the result of sharing power.
According to some old commentaries, we can see in the arousing power the
specific power of the yang in the man during sexual intercourse, and [in] the skill
and ability to give shape we see the specific power of the woman."29

3. Destiny
Again from my previous thoughts in Dragon Rises:
"Where Kidney yin transmits the genetic essence (material life) from one
generation to another, Kidney yang transmits the genetic force (the Fire of mingmen).
This inherited, surging force impels men beyond their material essence and sensory
awareness to Divine Awareness, to intuitive wisdom that transcends the obvious, to
knowledge beyond the power of our senses, and to Divine Power. In the theological
perspective, Divine Power gives man the strength to exercise his Creative Intelligence
(Heart energies), to wisely assess and exploit all of his life-enhancing Divine Will, and to
infuse Divine Love with passion, excitement, and direction. Divine Power may be said to
mandate a rational self-appreciation, a proportioned egocentricity, a stable center of
gravity, and the centered focus inherent to the meditative phrase, 'I am purpose itself.'
Only from this center can humankind enjoy its unique talent to ‘know’ God, in a
rudimentary sense, through its own creativity, and to identify with Him as the ultimate
stage in one’s becoming a 'whole person.'
"On the spiritual plane, the final step and ultimate freedom stimulated by Kidney
yang and mediated by Kidney qi energies in the 'evolution of being' is the internal search
for God’s Will and the surrender of our inherited Will to the Will of God. It is the
paradoxical function of the Kidney energies to supervise the endless transmission of the
ego from generation to generation, always directing it to its conclusive destruction, to the
Death of the Ego."30

Literature
Larre and de la Vallee discuss Destiny within the context of the meaning of the
ideogram ming. They say:
"So what is the meaning? It is that I start my life through this conjunction of two
other essences, or Spirits, or living beings -my parents representing the two
complementary forces of the universe, yin and yang and so on-these two essences
make a new composition and I exist. And I exist with my proper nature, which is
the composition of elements given at the very beginning, having the ability to
develop in the highest and best way. It is a way of expressing the power and
virtue of Heaven in me. It's the idea that heaven for me or the destiny given to me
by Heaven is nothing other than the unfolding of my proper nature in the best
way. This must also be according to the circumstance of life, but there is another
ideogram [xing] which is often joined with ming-and it means all the
circumstances of life and all I must do according to my nature to follow the right
way, which is the way of authenticity. If I realize my nature I become authentic
and I become a celestial being."31
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4. Wei Qi
The wei qi is the body's first line of defense against external, and some say even
internal, pathogenic influences. Kidney forces are involved at two levels in the process of
the formation of wei qi.
The first involves the combination in the Lung of guqi (from food) and daqi (from
the cosmos) to form zhong qi, which under the influence of yuan qi (Kidney essence)
becomes the active True qi. This in turn becomes both wei (defensive) qi, which enters
the channels, and ying (nourishing) qi, which enters the zang.
The other source comes through the Internal Duct of the Triple Burner when the
impure aspect of the Spleen's first separation of food into pure and impure in the Stomach
enters Kidney yang-essence where it is transformed into wei qi that is stored in the Liver.
Larre and de la Vallee note:
"...because you know that the defensive Breaths, wei qi, take their yang power
from the Lower heater which is the yang of the Kidneys, mingmen."32

5. Metabolism
Water Metabolism: Kidney yin-essence controls the water aspects of Kidney
function in conjunction with the Triple Burner and the Internal Duct which the latter
controls, and the Bladder which stores and excretes the impure fluids and is a part of the
system. From food, the Spleen separates the pure from the impure. The impure fluids
divide again in the Small Intestine and the impure goes to the Bladder while the pure goes
to Kidney yin where they are again divided into pure and impure {see below). The pure
Spleen qi is again divided into the pure (tastes) and the impure, which are fluids that rise
to the Lungs and then descend to Kidney yin where they are again divided into pure
(ching-dry [wei qi] and i-wet [ying qi]) and impure (saliva, mucous, sweat, tears).
"Whereas the Heat of Kidney yang controls Water by 'misting' it to other parts of
the body, Kidney yin is the Water itself. Since we are over eighty percent water and since
water is an essential part of every metabolic process, the importance of Kidney yin to
every aspect of the organism is obvious. The working of all body systems always
involves the Kidney especially when any system is overworking. As a consequence
Kidney yin energies are among the first to give way with age." And finally, "Kidney yin
and Kidney yang give, respectively, the 'life' and 'force' to the 'life-force."33

6. Triple Burner (Warmer)

The Triple Burner is, as we see above, importantly associate with the Kidneys
through its role in controlling the Internal Duct, with water metabolism, in the formation
of wei qi and ying qi and with the Fire of mingmen. Larre and de la Vallee state that:
“…the Triple Heater is connected with mingmen on the right, and we know from
the Nan Jing in particular that the Triple Heater can be considered like a
messenger or servant of mingmen for the distribution of Original Breath, yuan qi,
through the body.”34
The following excerpt from Dragon Rises presents a different view of the Triple
Burner in terms of its place in the pantheon of Fire energies.
“We subsume Pericardium, Triple Warmer, and Small Intestine energies under the
with Conception Vessel 12 (zhongwan) aegis of the Fire element, in which the Heart is
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the emperor, the supreme commander to whom all other energies are subject, to whom
they minister and are therefore known as ‘ministers.’ The Heart energy provides the
inspiration and communication of higher thought and emotion. The Pericardium provides
the communicative energies for defense and defined, focused assertion of this inspiration
as well as the ‘reason’ necessary for the achievement of enduring creation.
“The term Triple Warmer is a misleading translation of the original term sanjiao.
San means three, and jiao may be translated as level, sometimes referred to as ‘warming
spaces.’ Here, the sanjiao refers to the three ‘warming’ levels of the body, upper, middle,
and lower. The relationship of sanjiao energies to ‘heat’ or ‘warmth’ is only one aspect
of its principal functions, which more importantly are ones of distribution, integration,
balance, and homeostasis.
“During embryonic development, the Triple Warmer correctly distributes the
‘Yuan,’ or original inherited energy, from the Kidney Organ system to the source points
of each meridian, and thence to the entire being. Later, the Triple Warmer, or sanjiao, is
the ‘secretary of the interior,’ which is located in the Stomach wall. Controls for the
upper level are in the cardia, the middle level in the fundus, and the lower level in the
pyloric atrium. Triple Warmer 10 (tianjing) and Conception Vessel 17 (shanzhong) are
responsible for the Upper Warmer; Triple Warmer 7 (huizong) with Conception Vessel
12 (zhongwan) are responsible for the Middle Warmer; and Triple Warmer 2 (yemen),
Bladder 39 (weiyang) and Conception Vessel 7 (yinjiao) are responsible for the Lower
Warmer. Conception Vessel 5 (shimen) is the mu, or ‘Alarm,’ point of the Triple
Warmer.
“These three ‘energy reactors’ draw heat from the Kidney mingmen to the Spleen
for the digestion, absorption, transformation, and processing of physical as well as
intellectual food into energy usable on both planes of existence.
Through the ‘interior duct’ of the Triple Warmer, ‘impure’ energy flows to the
Kidney yang-essence to be further separated into Wei energy and the pure and impure
fluids. It is also said to be the ‘official who plans the construction of ditches, sluices and
creates waterways,’ assisting the Spleen energies to regulate Water distribution. (Yemen,
Triple Warmer 2, means ‘fluid’s door’ and is the central Water point of the body.)
“The Triple Warmer has, therefore, a unique relationship to both Kidney yin
(Water) and yang (Fire of the mingmen), and, since we are 80% water, which depends on
heat for metabolism, the Triple Warmer energies permeate the entire chemical
environment. The Triple Warmer occupies a strategic position to control the correct flow,
balance, and harmony of all energy between the upper, middle, and lower parts of the
body; as well as through the source points and Stomach, the outside and the inside.
Precise direction and movement, integration and dynamic stability characterize Triple
Warmer energies at any level of function.
The Triple Warmer’s close relationship to the digestive system and its position as
a yang Organ lend it well to important mental ego duties. These tasks are principally in
the areas of accurate flow, integration, harmony, and perception. Integration of the three
levels of the mind, the medulla, midbrain, and cortex through a free and balanced flow of
energy is fundamental to mental equilibrium. Integration of the two sides of the brain
through the corpus callosum is necessary for the effective blending of the creative (right
brain) and the logical (left brain), concomitants of innovation, invention, and original
conception.
 12

"Zhongzhu, Triple Warmer 3, also known as ‘middle islet,’ is simultaneously the

controlling acupuncture point of the ‘internal duct’ and of the sensory organs, especially
the eyes and ears. Since the Triple Warmer is an integrating force between the three
levels of the brain, as well as between the two cranial nerves that control seeing and
hearing, the suggestion is strong that it is also involved with the sensory process at
cortical levels of perception. Some say that the Triple Warmer is the ‘politician’ who can
‘sense and read the pulse of the outside world.’ It has also been characterized as a
‘receiving station and transmitter.’ All of this implies a strong investment in contact with
the outside world, with relationships, and through its involvement with perception, in the
integrity of boundaries which are so vital in human relations. As a mediator of warmth
and an orchestrator of harmony, as the integrator of the families within, these energies
would seem to be crucial to all close social bonds, especially with friends and family.
"We will confine ourselves to considerations of deficiency since it seems difficult
to imagine a person having too much of what Triple Warmer energies mediate, except
perhaps an overemphasis on form at the expense of content. . . .
"The subject will have difficulty integrating the inevitable discordances of his or
her being. . . Coldness, hardness, and arrogance fluctuate indiscreetly with softness,
humility, and flexibility. Since one part of the personality is out of touch with another,
neither can serve to ameliorate the other's more drastic qualities. The tendency is to go
rapidly and unqualifiedly to extremes. The attendant disharmony has obvious far-
reaching and fathomless consequences on the entire fabric of existence.
"This lack of integration will reveal itself in disparities between verbal and
performance skills. On psychological examinations, verbal and performance scores will
be widely divergent. Some can take apart and put back together an engine without
learning to read or write, and others who excel in many verbal faculties can barely
unwrap a package. . . The subject may have the brilliant vision of the Wood element and
the inadequate execution of the Fire element, or just the opposite, leading in either
instance to endless frustration.
"The subject may also suffer from a lack of smooth and harmonious flow of
thoughts and feelings, often becoming ‘stuck.’ An example would be ‘writer's block,’ or
the mind that ‘goes blank’; overall achievement would be uneven. If the flow between the
two sides of the brain is impeded, a full articulation of what the creative and logical sides
of this person could produce in unison will never be realized.
"In relationships there will be, at best, a lack of warmth and withdrawal, and at
worst, suspicion, estrangement, and the rupture of kinship and friendship due to
misperceptions.
"The Triple Burner deficient person… is therefore a person who seems
unbalanced, poorly integrated, and coordinated, with wide variations in performance,
problems with perception, and seriously disrupted personal relations, especially as
pertains to the exchange of warmth and the strength of bonds.35
A further link to Kidney yin, yang and qi-essence is by way of Wang Shu-He's
pulse model (The Classic of the Pulse, Jin dynasty, c. 280 AD), which places the Triple
Burner at the superficial depth at the right proximal (Kidney mingmen) position.
In the system of pulse diagnosis I espouse, there is no position for the Triple
Burner system. Its connection to water metabolism can associate it with the Bladder/
Kidney, but since, according to Dr. Shen, its function is found in all three Burners there is
 13

no single position for it. Students report associations to the right proximal position, which
makes this a reasonable area for exploration. For example, one Five element practitioner
treating a patient, whom she believed had a Triple Burner Causative Factor, was unable
to make therapeutic progress until she found extreme activity in the Gall Bladder position
and right proximal positions. At this point she resolved the pulse and clinical picture by
using the exit-entry points for Gall Bladder and Triple Burner.
In the next phase of the development of this model of pulse diagnosis, the issue of
the Triple Burner system will be explored further. For now, I discern Triple Burner issues
in the congruence of qualities in the various positions. If there is a great discrepancy in
qualities in the same burner between left and right side, or between the burners, I believe
that the Triple Burner system is deficient if the qualities are indications of deficiency or
excess if the qualities indicate stagnation. The condition in which there is a wide
discrepancy between all positions and with deficient qualities is one that I find frequently
in autoimmune diseases. This is akin to the "Qi Wild" condition.36

7. Blood
Blood is primarily a body fluid consisting largely of water and whose ultimate
physiology depends on Kidney yin-essence.
The literature is inconsistent in terms of the physiology of Blood. In The
Foundations of Chinese Medicine, author Giovanni Maciocia quotes the Spiritual Axis
and Tang Zong Hai, concluding that:
"Blood is derived mostly from the Food-qi produced by the Spleen. The Spleen
sends Food-qi upwards to the Lungs, and through the pushing action of Lung-qi,
this is sent to the Heart, where it is transformed into Blood."37

The other source of Blood is from the Marrow through Kidney yin and yang-
essence and Original qi.
On the other hand, in The Web That Has No Weaver, Kaptchuk states:
"… The Spleen qi then transports this essence upward to the Lungs. During the
upward movement, Nutritive qi begins to turn the essence into Blood. The change
is completed when the essence reaches the Lungs, where the now-transformed
food combines with the portion of air described as 'clear.' This combination
finally produces Blood."38
Unfortunately, Kaptchuk gives no source for this description.
In a personal communication, Van Buren supplied me with a very detailed
description of the Triple Burner system, which controls these transformations. He clearly
stated that Blood is made in the center of the Stomach, where "Yong (chen) qi and ching-i
[jin ye] combine to make Blood." Maciocia refers to this transformation when he says:
"Body Fluids constantly replenish the Blood and make it thinner so that it does
not coagulate or stagnate."39

Van Buren’s description of the Triple Burner system concerning the Lungs and
Heart refer only to the combination of gu qi (Spleen-Food) with chong [zong] qi from the
cosmos, (in the Lungs) with the help of yuan qi (Ancestral qi) to make chen qi (yong,
Gathering qi), which then becomes ying (Nourishing) and wei qi.
 14

From the above we see a confusing picture of Blood being made in the Heart, the
Lungs and the Stomach, as well as the "marrow." The sense I am left with is that no one
is certain.
My own reading is that the qi aspect of Blood is made in the Lungs and Heart, and
that the final product, since Blood is fluid, is when this qi aspect of Blood combines with
Fluid (jin-ye) in the Stomach. The contribution to this process by Kidney and yang-
essence are the variety of blood cells which are manufactured in the bone marrow.

8. Metabolic Heat
Kidney yang-essence is the metabolic heat which mists the water from food which
ascends to the Lungs, creates Spleen yang which cooks the food and moves the tastes to
the yin organs, and is the force for the general upward movement of Spleen qi to nourish
the brain. As indicated below under the aegis of "endocrine" function, in biomedical
terms, Kidney yang-essence controls the function of the thyroid (and parathyroid) glands.
According to Larre and de la Vallee, chapter 2 of the Su Wen states that:
"Too much sweating or sexual emission in the Winter would be worse than in
Summer because you lose essence and through them the basis for Breath. Losing
Breath, you lose warmth, and in Winter you need this inner warmth of life against
the cold and darkness or else you die."40

9. Endocrine
According to Van Buren, Kidney yin-essence controls the pituitary gland and
Kidney yang-essence controls the thyroid and parathyroid glands. The adrenal medulla is
a function of Kidney yang and the adrenal cortex is a function of Kidney yin. Kidney
yang supports Spleen qi and, therefore, is indirectly in control of the enzyme function of
the pancreas.
The endocrine function of the pancreas, insulin production, was not specifically
cited. Logic would dictate that this insulin function is associated with the yang function
due to its relationship of glucose to basal metabolism, but logic and truth are not
necessarily the same. [I have some problem with the endocrine formulation concerning
the pituitary since the same source tells us, I believe correctly, that the yang
Extraordinary meridian, yang qiao, directly affects the pituitary. This suggests that it is
the yang-essence function rather than the yin-essence function of the Kidney which
controls the pituitary.]

10. Storage
The spreading, upward and outward, moving forces of the Kidney are primarily
due to the yang-essence aspects. Storage is more closely connected with the yin-essence,
which has a downward and inward movement towards the center of gravity, or dantian,
where storage is said to occur.
According to Larre and de la Vallee, after some debate about translation and
implication, both male and female store jing which is the essence and have bao which are
essentially the organs (ovary-uterus and testes), where these are stored41 for all of the
other zang and fu.
 15

11. Sexual Function

Whereas the actual substance of essence is yin (sperm, egg, fetus), the movement
of essence is a yang function. Thus, the erection and discharge of sperm and vaginal
fluids, the movement and activity, here is Kidney yang-essence. Larre and de la Vallee
state that:
"To thesaurize the essences is the most important function of the Kidneys. It is
undeniable that the proper growth and development of the body, as well as a
healthy constitution, are related to the Kidney's role of thesaurizing the essences.
and,
"The essences, jing, are the fundamental substance of vitality (of each particular
life)...
and there are
"...essences, jing, of the sexual union between male and female, which is the trunk
and root of reproduction."42

12. Central Nervous System

Kidney yin-essence is traditionally presented as nourishing and controlling the
central nervous system (Marrow) throughout life. This concept is not in concordance with
my own clinical finding.
It is my impression that until birth the parenchymal aspects of the central nervous
system are a function of the Kidney yin-essence aspect of the Yuan force. The postnatal
development of the central nervous system (CNS), (as with all postnatal human
development), is controlled by the combined forces of yin and yang-essence, which I
refer to as Kidney qi.
However, my experience indicates that, after birth, maintenance and function of
that system are controlled by Kidney yang-essence. All of my patients with chronic
central nervous diseases, even in their early stages, were profoundly Kidney yang
deficient. It is my impression that the pure essence of prenatal development directs the
formation of the central nervous system
However, the paradigm of Kidney yin, yang, essence and qi is insufficient to
explain and more importantly therapeutically guide us in the utter complexities of the
central nervous system known to Western physiology. For example, how do we find our
clinical way using Kidney yang-essence within the context of attention deficit disorder
(ADD), which is an almost endless series of subtle defects peculiar to that individual and
no other? Even incorporating "Phlegm confusing and disturbing the orifices of the Heart"
does little to deal with these fine differences in central nervous system function.
Furthermore, in using these Chinese medical concepts, how can one explain that a
singular aspect of the central nervous system malfunctions while the rest is intact? For
example, how do we explain a Neils Bohr, one of the great quantum mechanic physicists
of the 2Oth century, who could not write!? How can the "idiot savant" who can recall the
entire dictionary be otherwise totally inept, even in remembering where they live? How
can a person born with such obvious Kidney essence deficiency as spina bifida have a
powerful will, good teeth and bones, an intact endocrine system, good fertility and sexual
function, and be a genius?
How can we explain the person who experiences profound deep chill, impotence
and an empty feeling at the top of their head, all signs of Kidney yang-essence
 16

deficiency, and yet who has an extraordinary will and drive and a great deal of courage? I
have known many of these people.
Kidney yang-essence must be as complex as the human central nervous system
with its trillions of cells; there must be an almost infinite variety of yang-essence
functions, each to its own aspect of that nervous system" However, there is no traditional
literature to guide us through this complexity. Summing it up as Kidney yang-essence
deficiency is a massive oversimplification. We have no model of Kidney yang-essence
which matches this biological complexity. There must be many Kidney yang-essences
not yet described.
(Note: Liver yin (Blood) nourishes and Liver yang is the moving aspect of the
peripheral nerves.)

13. Hemopoiesis
It is said that Kidney yin-essence (jing) controls the development of bone and
bone marrow, and therefore is an important aspect of hemopoietic function. My clinical
experience points elsewhere. Using moxa on the back shu points and yang-qi tonics, I
have successfully treated severe agranulocytosis with a count of 22,000 platelets and less
than 1,000 white blood cells. (One can argue that since the back is yang, and that we are
organized with the principle of balance, that the points on the back are primarily serving
yin. At the same time, others say that the shu points treat acute illness, which is yang in
nature.)
Again, as with the central nervous system, I believe that the prenatal development
of the Marrow is a function of the Kidney yin-essence aspect of Yuan energy; postnatal
human development is controlled by the combined forces of yin and yang-essence which
I refer to as Kidney qi.
The same conundrum occurs with Kidney yin-essence with regard to the
hemopoietic aspect of Marrow as occurs with the yang-essence and the central nervous
system. How can we differentiate Kidney yin-essence to explain and treat the
complexities of the products of the bone marrow, including white cells in their infinite
variety (polys, lymphs, mono- and basophils), red cells, platelets, etc.?

14. Spiritual, Mental, Emotional

In summary, and to again quote from Dragon Rises:
"Kidney yin provides the substance, the basic grounding material, upon which we
must all face when we go down, and the fundamental stored essence (jing) that is the
principal reserve with which to bounce back after defeat. It provides us with the capacity
for rational evaluations of our limits so that we can make strategic retreats (in conjunction
with Liver yin) in situations where advance would lead to major defeat and subsequent
grounds for depression. Kidney yin endows the spiritually evolved person with the
capacity for the Divine Love needed to 'forgive us our trespasses' when we falter. Kidney
qi endows us with the ability to live in the present, to confront issues now, to live with
our feet on the ground even when we are dreaming, all qualities which stand us well in
the face of defeat and the inclination to withdraw into depression. Kidney 'Fire' is the
functional Heat energy that 'drives' the entire physical plant to provide the force behind
the 'will to live.' Without this will, the inclination is to collapse well before retreat is
expedient."43
 17

II. KIDNEY PATHOLOGY ACCORDING TO CHINESE MEDICINE

A. Etiology

Since Kidney qi, yin, yang and jing are the foundations of the functions of all the
other Organ systems, they are quickly exhausted in a life marked by abuse. If the etiology
is not constitutional and begins at a later stage of development one can delineate the
habits which create the excesses and the symptoms about which the patient complains.
Changes in addictive- and ego-based lifestyle patterns are then the focus of the treatment.
Here, there is usually more resistance to change.
The ancient Chinese literature admonishes us to observe moderation in all things.
While too little of some things like food and warmth will damage Kidney qi, excesses are
the principal problem. For example, excessive sex during an attack by an external
pathogenic factor is a very important determinant to the outcome of that event.
(According to Dr. Shen, a woman who exposes herself to Cold during sex can become
very ill and even die, especially if she eats very "cold" foods at the same time such as
pomegranates.)
Kidney yin-essence is exhausted by excessive use of the mind and overworking of
the nervous system, and by the effect of emotional shock on the Heart and daily
frustrations and repression on the Liver and the general accelerating pace of life on all
systems including digestion (Spleen-Stomach). Chronic fear is listed in the literature as
causing the sinking of qi and weakening the Kidney's ability to store essence and control
urination. Stimulant drugs such as cocaine and amphetamines create Heart Fire which
drains Kidney yin; sedative drugs such as heroin and marijuana drain Liver and Kidney
yang. Excessive exercise beyond one's energy drains Liver and Heart qi, which must be
supported by Kidney qi. Increased exposure to parasites, due to travel and the influx of
immigrants from areas of the world where they are endemic, has lead to a new chronic
drain on our stored essence and on the Kidney.
Our "body condition" is increasingly affected by the lack of nutrients in the soil
depleted by agribusiness with its chemical fertilizers and insecticides. The disappearing
ozone layer has been seriously linked in some studies to immune deficiency. Milk has
been shown recently to destroy beta cells in the pancreas and is linked to childhood-onset
insulin-dependant diabetes. Our air, our soil and our water are polluted and we are all
threatened by the problem of waste storage, especially of radioactive wastes. So many of
the pulses I have taken over the years reveal blood toxicity (Blood Unclear). We are all
responsible because we have been too happy to accept the trade-off; the fast easy life for
the slow painful death of the planet and our soul.
It is clear from my work with pulse diagnosis that these energies are increasingly
depleted in younger and younger people.44 What are some of the abuses of this basic
energy accounting for the ever-increasing Kidney deficiencies across the spectrum and
including Kidney yang deficiency and finally the separation of Kidney yin and yang ("Qi
Wild")? What accounts for the regrettable increasing frequency of pulses deficient in
Kidney qi, especially in the very young?
Our birthing techniques, drugs and medications during pregnancy and delivery,
have a direct impact on Kidney energies and have created a generation of attention deficit
 18

disorders (minimally brain damaged children) with great learning deficits. While there
has been a growing trend of amelioration of these tragic prenatal and birthing practices,
they continue to flourish for the majority of pregnant women. The problem of learning
disorders, which I directly observed as the director of a child guidance center, is avoided
by school systems. The cost of correcting the damage would exceed the current cost of
education. Traumatic delivery, which is an automatic insult to the Kidneys, has been
statistically associated with adolescent depression and adolescent suicide.45,46 In
summary, consider the Kidneys (the foundation) (and the Liver), living as we do in a
chemical and electrical environment hostile to a healthy safe pregnancy and childbirth,
with the lack of active mental stimulation to the central nervous system due to television,
calculators and computers, and the essence crumbling with the fragmentation of family
and community: or the Spleen living in a nutrient bowl of chemically altered fast food,
contaminated water and weight loss diets; the Heart existing as we do in the cyber-world
of e-mail and the Internet where there is little warm human contact and relationships are
digitalized, and when the pace of life (again the Liver) has increased exponentially every
decade; or the Lungs living as we do in a sea of poisonous air. (In Italy I saw a young
man with testicular cancer whose brother had Kidney cancer and father had a lymphoma,
all of whom lived together for five years under the confluence of several very high
voltage electrical power lines. Previously, for generations, there had been no cancer in the
immediate or extended family.)

B. Neurological

All of the patients I have treated with central nervous system disease have been
generally severely yang deficient, especially Kidney yang-essence deficient. Primarily I
saw multiple sclerosis. They responded best to treatment of Kidney yang-essence (with
other treatments aimed at assisting with specific symptoms such as Blood stagnation in
the lower body). (I have tentatively come to associate the Doughy quality at the neuro-
psychological position of the pulse with deficiency of Kidney yang-essence. Research
concerning the relationship of this position to disease is being developed.)
As I indicated above in my discussion of the central nervous system, the concepts
of Kidney yin, yang and qi-essence does not suffice to understand or manage the infinite
possible insults to the brain and spinal cord. Perhaps rather than repair, the application of
these concepts creates or opens new lines of communication between neurons.

C. Psychological

1. Thought Disorders
Deficiency or disorder of the Yuan-essence is the genetic or in-utero origin of
thought disorders associated with the propensity to schizophrenia. Here, the critical issue
is boundaries, or the ability to distinguish between the external and internal environment.
Boundaries before birth are set by the Kidneys and after birth by the Earth element in the
making and breaking of maternal bonds.47
 19

2. Mood Disorders
Depression: It is my impression that the propensity towards all unipolar
depressions is rooted in Kidney yang, especially the "endogenous depression." In fact,
with any kind of mental stagnation, the role of Kidney yang-essence, in terms of the
"Will," should always be considered. This has been found to be the case clinically with
even a type of stagnation which I call "resignation," communicated on the pulse in the
form of the Cotton quality.48
In Dragon Rises, I discuss the relationship of various types of depression
including:
. Anaclytic and cyclothymic (Earth)
. Agitated (Wood)
. Hysterical-reactive (Fire)
. Dysphoric (Fire Triple Burner)
. Narcissistic (Earth, Metal, Fire)
. Secondary anaclytic (Metal, Earth)
. Grieving for Self (Metal, Fire)
. Involutional (Metal-Fire)
. Loneliness (Fire: Heart, Triple Burner , Small Intestine, Pericardium)
. Depression of the soul (Fire)
. Depression of the spirit (Water, Metal)49

Bipolar Disorders: I believe bipolar disease is often a constitutional defect in the

thermostatic control of the Wood-Fire-Water cycle by the Triple Warmer system.
Supporting the Triple Warmer system's ability to regulate the consumption of Wood by
Fire may avoid this psychological and physiological catastrophe. When sufficient Kidney
yin is depleted one finds oneself in the manic phase. Eventually when the yin can no
longer nourish the yang, Kidney yin deficiency transforms into a profound Kidney yang
deficiency and an almost treatment resistant depression can result. In either case it is the
effect of these deficiencies on the Heart which controls the mind that leads to the
symptoms.
The following is excerpted primarily from Dragon Rises.
"Interference with the development of creative expression on the verbal cognitive
level will also adversely affect the Fire element, primarily the Heart Organ system. The
agitated depression associated with inhibition in the 'no' and psychomotor (Wood) era
develops, with similar inhibition in the 'positive' (Fire) stage of self-expression, into the
bipolar disease that we formerly designated as manic-depressive. It is the repression of
both assertion and creativity, stagnation of the qi of both the Liver and Heart that brings
Heat and burns the Wood and builds the Fire, that Water is eventually unable to control.
Bipolar episodes may be precipitated by stress in another vulnerable energy sphere such
as abandonment on the Spleen energies or separation on the Metal energies. The
intervals, when the Fire is still being quenched by the Water, are observable periods of
quiet reasonableness, restriction and exaggerated quiescence in the areas of verbal,
intellectual, and artistic creative assertion.
"These energies are irrepressible. The manic phases are episodic breakdowns in
this inhibition when the Water is sufficiently depleted to allow the Fire to burn out of
 20

control. The Triple Warmer, one of whose functions is to regulate temperature, is pushed
beyond its capacities. The Heart 'qi is wild,' and the Heart yin cannot control the yang.
The 'mind,' which the Heart superintends, is now in a state of havoc and highly
vulnerable to other adverse pathogenic factors such as Phlegm or Damp from the Spleen.
In people with strong Wood, the manic phase may be longer and more pronounced than
the depressive phase. The person may report anxiety during the non-manic phase rather
than depression. The crash into the depths of depression occurs when the Wood is burned
past the point where it can continue to feed the Fire."50

3. Fear and Anxiety

In Western psychology, fear is defined as that “distinctively unpleasant felt
experience that occurs when a person” consciously recognizes an immediate real threat to
their being. And in the West, anxiety is that “...distinctively unpleasant felt experience
that occurs when a person unconsciously perceives a threat to his or her 'becoming' in the
process of the evolution of his or her being.”51
In Chinese medicine, fear is a term which coincides with the above definition of
anxiety, especially chronic anxiety.
The ontogenetic separations from one stage of development to another including
conception, birth and death, and all the great transitions between, concern themselves
always and inevitably with the "unknown" and are signaled by fear. Fear is that natural
atavistic emotion aroused when faced by the more fundamental cosmic unknowns of our
existence, the consciousness that we do not know who we are, where we came from,
where we are, where we are going or why.
To again excerpt from Dragon Rises, Red Bird Flies:
"The first and perhaps most ubiquitous form of anxiety is the 'fear of the
unknown.' It is the natural 'rite of passage' through each transition, from one stage to the
next in the 'evolution of being': an inherent, unavoidable condition of life that we must all
find the courage to face and pass through, either alone or with others. The alternative is to
remain behind and live what Emerson referred to as 'a life of quiet desperation.'
"This anxiety will also be experienced whenever a person is faced with a situation
that is dystonic to his personality organization. For example, the Kidney yin deficient
personality centers on the premise that the world is a hostile environment, and is thus
prepared for the ‘worst’ but unprepared for expressions of friendship, which when
pressed upon him may precipitate an acute state of anxiety.
"The Water element energies normally manage the primordial archaic fear of the
unknown and its most profound manifestations in terms of our cosmic identity and
ultimate fate beyond death. These energies are most closely associated with the
exigencies at the thin barrier between life and death, both in the beginning of life and at
the end. We denote the anxieties associated with these issues as cataclysmic in scope and
terrifying by name. People who go through life with chronic terror as a constant
companion, both night and day, but especially by night, are those who suffered damage to
the Water element through some basic insult in the intrauterine era. Many have been
documented as having survived attempted abortions.
"It is my impression that damage to the Water element predisposes people to
anxiety and fear in any and all of its manifest forms. It is the substrate, the prerequisite
 21

for the chronicity of anxiety, however it arises, and whatever its etiology in the
distortions of the natural functions of the other energy systems.
"Kidney yin, Kidney yang, and Kidney qi energies guide us respectively through
the Death of the Body, the Death of the Ego, through Divine Love, Divine Power, and
Divine Spirit, to resurrection. Thus the 'red bird' self-immolates and 'flies' again and again
until the Water energies lead us, with faith, beyond the fear of the unknown, to salvation
(Nirvana).
"The second form of anxiety I wish to discuss is Separation Anxiety, a special
form of 'the fear of the unknown' marking the several transitions from one stage of life to
another. Each of these stages is described in detail in that part of the text which deals with
the element most involved. However, just as the Kidney energies (Water element) are
involved with all chronic fear and anxiety, so in my opinion is the Metal element
involved with all separations, less obviously at the beginning of life and more so later.
The Metal element energies, for their own reasons, always lend themselves to accepting
and letting go, whenever the other elements are engaged in this process.
"Thus, while the impetus for letting go of the old and taking in the new is the
unfolding of the 'life force,' the capacity comes from Metal element energies. The
substance for the new bond is from the Earth, the passion from Fire, the direction from
Wood, and the power, as ever, from the Water. This is the basic format for, and integral
part of, all of the transitions. Within the sea of endless bonding and disengagement are
roughly ten major separations during life:"52

1. Mitosis
2. Birth
3. Assertion (the "no" stage)
4. Oedipus/electra complex
5. Transition to surrogate parent
6. Forming peer relationships
7. Investing authority in oneself
8. Love of others
9. Exploring one's self, and
10. The great departure.
Faith and hope are the antidotes to fear which have nourished and sustained the drive
to "become."53 Life is organized as a template of change by Kidney energies beginning
with conception and mitosis, the prototype of union and separation, to the separation
from life and the union with God. While I consider Metal qi as the fundamental engine of
change, Kidney qi is the source of the drive towards the realization of our destiny.

Other Sources: Larre and de la Vallee consider fear in relation to the Kidneys in three
contexts; the first is “shivering,” the second is will power, and the third is “reflective
thought prevails over fear.” With regard to “shivering” they say:

"We can shiver because of cold or fear, both are linked with the Kidneys...always
pathological because it is a reaction pathological attack on the zang...a reaction which
wakes up the yang power of the defence."
They go on to say shivering can occur when:
 22

"there is a weakness in the Breath of the Kidneys, in the Kidney yang, and
consequently the defence of all the body is weakened, because you know that the
defensive Breath, wei qi, take their yang power from the Lower heater which is the
yang of the kidneys, mingmen.... A great fear also injures the power of the Kidneys...
as a result have blockage in the circulation, particularly between Lower and Upper
heaters, the Kidneys and Heart."54
They add within their discussion of "willpower" and fear that:
"...when there is Fear, the essences withdraw and as a result the Upper Heater
completely closes, which means that the Breath returns below and there is a
swelling in the Lower heater. For this reason, Breath can no longer circulate.
What this means is that Fear realizes the separation of yin and yang, of the Upper
and Lower Heaters, of top and bottom, and so on, because all the yin goes to the
bottom and the yang is blocked in the upper part with no way for exchange or
communication between them.55
Concerning "reflective thought" they continue:
"As a result of the injury to Spirits from Fear and Fright you can lose possession
of yourself. Si, Reflective Thought, represents the movement of the Center, or
turntable, which is able to re-establish all exchanges between the upper and lower
parts, and to restart communication and permutation, and to re-center the
individual who has lost possession of himself. We can see that reflection or
thought means to see all the circumstances of the situation and the way to adapt,
and this is the best way to overcome Fear."56

Comment
The power of "reflective thought" is in my experience typically an Oriental,
perhaps Chinese, solution to all emotion, reflecting the power of aphorisms in that culture
and the preaching of Confucius. In my experience, certainly as a psychiatrist, reflective
thinking was rarely able to allay fear, and in the end I would have to reassert that "faith
and hope are the antidotes to fear," at least in the West.

D. Kidney-Heart Disharmony

Any consideration of the Kidney would include its relationship to the Heart which
is one of the critical polarities in Chinese medicine.
Dr, Shen says that the Heart is "on top" and the Kidney "on the end." If the "top"
and the "end" are balanced "the entire body is balanced." These correspond to the left
distal (cun) position and the proximal (chi) positions on the radial pulse. Larre and de la
Vallee state that:

"...the Heart masters the biao" and "the Kidneys are said to govern the li [interior,
deep-seated], the intimate structuration. Therefore the Heart and Kidneys form a
couple in this relation of biao li. In this context this is because the Heart is a yang
zang and master the Fire which flames up and goes everywhere in an expanding
movement, so the Breaths which come from the Heart can reach to the biao. In
contrast, the Kidneys govern the li and the movement which gathers together all
the elements for the internal structuring of life. The Kidneys are a Yi zang and
 23

master Water, which by nature is cold and condensed and has a downward
movement."57

However, the situation is less simple than it appears, since the Kidneys are a
double zang including both Water and Fire, "…the Fire of life. We can see how in later
centuries this idea gets transformed into this aspect of the Fire of life at the level of the
Heart, like servant of the Heart. But originally this Fire of life was at the level of the
Kidney and it was the connection of animation of life rising up until reaching the heart,
and the Heart beginning the mastering of life through Imperial Fire which is proper to the
Heart."58
The Heart and the Kidney correspondingly control the mind and the brain. If the
Water of the Kidney cannot control the Fire of the Heart, the mind will become restless.
If the Fire of the Heart cannot warm the Water (yin-essence) of the Kidney it cannot rise
and nourish the brain, and normal patterns will be disrupted. The Triple Burner mediates
this relationship and should always be considered in management. The symptoms of this
disharmony, or "shen" disturbance, are palpitations, insomnia, irritability, fatigue,
depression, being easily startled, and anxiety.
The literature of Chinese herbal medicine usually considers and treats Kidney-
Heart disharmony as a Kidney-Heart yin deficiency. However, according to Dr. Shen,
Kidney-Heart disharmony occurs as, or more, often when both the left distal and left
proximal positions are both Feeble-Absent. One confusion is that in either case, yin or
yang deficiency, one can have a Rapid Rate. The symptoms are insomnia, anxiety,
palpitations and fatigue. The Kidney-Heart disharmony with both positions Feeble-
Absent is probably more of a constitutional etiology, while the disharmony with both
positions Tight can come more from life experience.
In my own practice, which also bears out Dr. Shen’s observations, the Kidney-
Heart disharmony can also appear with other combinations of qualities on the left distal
and proximal positions. One position or the other could have a Feeble-Absent quality and
the other a Tight quality as described below.
Both the Feeble-Absent and Tight qualities are signs of deficiency. With the
Feeble-Absent qualities this is more obvious. It is important to reiterate that despite the
hard sensation of the Tight quality, it is just as much a sign of deficiency as the Feeble-
Absent quality. (The Feeble-Absent quality is a sign of qi and yang deficiency and the
Tight quality is a sign of yin deficiency.)

E. The Separation of Yin & Yang & the Kidney

As already mentioned, the Kidneys are profoundly affected by constitutional and

congenital factors. Defects which begin at conception, (at the first cell divisions, within
the frameworks of pregnancy and delivery), leave a person vulnerable to varying degrees
and an endless variety of forms for life. All of the other stages of development are
impaired to a lesser or greater extent. Congenitally induced Kidney Organ system
deficiencies are similar to but somewhat less profound and widespread as those induced
at conception or during pregnancy. Therefore, any early insult to Kidney qi-essence has a
profound effect on all physiology.
 24

We have also already said that the abuse of any organ system throughout life also
profoundly depletes Kidney qi-essence, which is the foundation and source of all the
stored essence (jing). Therefore it follows and it is my clinical experience that deficiency
of the Kidney Organ system, more than any other, is frequently present with the
separation of yin and yang in the other four yin organs. The separation of yin and yang of
the Kidney represents the most profound insult to the organism and is associated with the
most pernicious chronic illnesses, including all of the degenerative central nervous
illnesses and auto-immune diseases. The most severe separation of yin and yang is known
as the "qi is Wild."59
Larre and de la Vallee state that:
"...Kidneys are responsible for the binding together of yin and yang..."
and that...
"Fear realizes the separation of yin and yang, of the Upper and Lower Heaters, of
bottom and top and so on, because all the yin goes to the bottom and the yang is
blocked in the upper part with no way for exchange or communication between
them."60
Symptoms and signs of approaching separation of yin and yang include deep-
seated coldness, severe depression with loss of motivation along with a loss of sexual
energy, fatigue on exertion, early morning diarrhea, tinnitus, a feeling of emptiness at the
top of the head, asthma with difficulty on inspiration and on exertion, low back pain,
increasing menstrual irregularity with long and short periods alternating with each other,
and infertility. Bone degeneration in cervical and lumbar discs, and knee joint
degeneration as well as arthritis, endocrine problems such as thyroid and pituitary
deficiencies are common.
The separation of Kidney yin and yang manifests itself physically with severe
chronic nephritis, nephrosis, kidney failure, central nervous system diseases such as
multiple sclerosis, brain tumors, bone diseases including tumors, bone marrow diseases
such as agranulocytosis and leukemia, deficient erythropoiesis, thrombocytopenia, the
autoimmune diseases such as systemic lupus, and primary cancer of the Kidneys as well
as exhaustion of the adrenals such as Addison's disease, and other endocrine disorders.
The "Qi Wild" disorder, which occurs when the yin and yang of the entire
organism have lost contact with each other based on a collapse of Kidney qi-essence, will
sometimes express itself as some of the more dangerous disorders just listed, or with the
loss of the ability of the organism to clearly distinguish the outer from the inner world in
a disorder we call schizophrenia. Its most profound deterioration is found with
hebephrenia.
Kidney qi-essence is always involved with the courage to live, with the essential
challenges of life which at their most significant moments involve the "rites of passage,"
the journey into the unknown. Kidney qi-essence is the source sustaining all human
activity against the forces of entropy throughout life and the ultimate separation of yin
and yang which is death, and paradoxically the qi which restores us to final grace.61

III. SUMMARY

We have reviewed the relationships between Kidney yin, yang and qi with the
essences and with the mingmen in their various functions and manifestations. These
 25

include Will, Power, Destiny, Virtue, Polarity (Kidney-Heart disharmonies), Unity

(Centering), Fear, Water metabolism, endocrine function, embryology, storage, sex, wei
qi, the Marrow (central nervous system and hemopoiesis), neurological and psychological
disorders and the separation of yin and yang .
While the original intention was to limit the discussion to Kidney yang, it soon
became clear that this intention was not compatible with the inherent paradox of all
Chinese thinking which is rooted in the reality of a unified centering source, a potential,
manifesting as a duality in the service of the movement which is life. It is this paradox
and duality which have dictated the final form and subject matter of this paper.

Endnotes
1
Larre C, E Rochat de la Vallee: The Kidneys. The Monkey Press, Cambridge (England), 1989,
p.14.
2
Ibid. p. 15.
3
Ibid. p. 24.
4
Ibid. p. 21.
5
Ibid. p.7.
6
Porkert M: The Essentials of Chinese Diagnostics. (Zurich: Chinese Medicine Publ., 1983)
p. 244.
7
Van Buren JD. Personal communication, 1973.
8
Townsend G, Y De Donna: Pulses and Impulses. Thorsons, Wellingborough 1990, pp. 73-74.
9
Veith I: Yellow Emperor's Classic of Chinese Medicine. Univ. California Press, London, 1972.
p.209.
10
Larre C, E. Rochat de la Vallee: The Kidneys. Monkey Press, Cambridge, 1989, p 13.
11
Ibid. p. 11.
12
Ibid. p 14.
13
Ibid. p. 15.
14
Ibid. p. 15.
15
Ibid. p. 15.
16
Li Shi-Zhen: Pulse Diagnosis (Hoc KH. Seifert GM [trans]). Paradigm Publications,
Brookline, MA, 1981, p.7. Li Shi-Zhen (1518-1593 AD), a noted physician was author
of a dozen books including Bin Hu Mai Xue (Bin Hu’s Pulse Studies).
17
Hammer L: Contemporary Chinese Pulse Diagnosis. Eastland Press, Seattle,
forthcoming, ch.16.
18
Larre C, E Rochat de la Vallee: The Kidneys. Monkey Press. Cambridge. 1989, p 33.
19
Ibid. p. 49.
20
Willmont D: Fire of life in ancient acupuncture, part 1: The evolution of will, destiny and
wisdom. Oriental Med J, 1999; 7(3/4).
21
Li Shi-Zhen: Pulse Diagnosis. Paradigm Press, Brookline, MA 1981, p.7.
22
Ibid. p. 30.
26
23
Porkert M: The Theoretical Foundations of Chinese Medicine: Systems of Correspondence.
Cambridge: The MIT Press, 1974, pp.166-196.
24
This forward motion in time and space is not only a talent, but, for some, also an actual state
of mind. Those of us who are concerned about the future consequences of the impulsive, easy,
and profitable practices of the present are generally known as conservationists. What we have
 26

is too highly valued to be squandered with abandon; and the standards generally acceptable the
majority are rarely sufficient for those whose sensitivities about the future are highly devel-
oped. Modern conservationists have fared less well than modern prophets of science, with
whom they may, paradoxically, often be at odds. The misuse of science has narrowed the
time-space gap between the present and the future. Their virtual coincidence has created the
modern psychological catastrophe of Future Shock. (A. Toffler, Future Shock, (New York:
Random House, 1970.)
25
Bunyan J. The Water of Life. Swengel, Reiner, 1967.
26
Hammer L: Dragon Rises Red Bird Flies: Station Hill Press, Barry town NY, 1990,
pp.108-110.
27
Larre C, E Rochat de la Vallee: The Kidneys. Monkey Press, Cambridge, 1989, p. 26.
28
Ibid. p. 84.
29
Ibid. p. 43.
30
Hammer L: Dragon Rises Red Bird Flies: Station Hill Press, Barry town NY, 1990, p.26.
31
Larre C, E Rochat de la Vallee: The Kidneys. Monkey Press. Cambridge. 1989, p. 33.
32
Ibid. p. 70.
33
Hammer L: Dragon Rises Red Bird Flies: Station Hill Press, Barry town NY, 1990, p. 105.
34
Larre C, E Rochat de la Vallee: The Kidneys. Monkey Press. Cambridge. 1989, p.21.
35
Hammer L: Dragon Rises Red Bird Flies: Station Hill Press, Barry town NY, 1990, pp. 222-4.
36
Hammer L. The unified theory of chronic diseases. Oriental Medicine, 1998: 6(3 & 4): 42.
37
Maciocia G: The Foundations of Chinese Medicine. New York. Churchill Livingstone, 1989,
pp. 48-49.
38
Kaptchuk T: The Web That Has No Weaver. New York: Congdon & Weed, 1983, 41-42.
39
Maciocia, 48-49.
40
Larre C, E Rochat de la Vallee: The Kidneys. Monkey Press. Cambridge. 1989, p. 45.
41
Larre C, E Rochat de la Vallee: The Kidneys. Monkey Press. Cambridge. 1989, pp. 17-19.
42
Larre C, E Rochat de la Vallee: The Kidneys. Monkey Press. Cambridge. 1989, pp. 82-3.
43
Hammer L: Dragon Rises Red Bird Flies: Station Hill Press, Barry town NY, 1990, pp. 302.
44
Hammer L: Contemporary Chinese Pulse Diagnosis. Eastland Press, Seattle,
forthcoming, ch.16.
45,
Salk L, L Lipsitt, W Sturner, et al: Relationship of maternal and perinatal conditions to
eventual adolescent suicide. Lancet, March 1985m pp. 624-7.
46
Hammer : The unified theory of chronic diseases. Oriental Medicine, 1998: 6(3 & 4): 42.
47
Hammer L: Dragon Rises Red Bird Flies: Station Hill Press, Barry town NY, 1990, p. 227.
48
Hammer L: Contemporary Chinese Pulse Diagnosis. Eastland Press, Seattle,
forthcoming, ch.16.
49
Hammer L: Dragon Rises Red Bird Flies: Station Hill Press, Barry town NY, 1990,
pp.229-309.
50
Hammer L: Dragon Rises Red Bird Flies: Station Hill Press, Barry town NY, 1990, p. 304.
51
Larre C, E Rochat de la Vallee: The Kidneys. Monkey Press. Cambridge. 1989, pp. 17-19..
52
Ibid. pp. 284-285.
53
Allport G: Becoming, Yale University, New Haven, 1955.
54
Larre C, E Rochat de la Vallee: The Kidneys. Monkey Press. Cambridge. 1989, pp. 69-70.
55
Ibid. p. 73.
56
Ibid. p. 75.
57
Larre C, E Rochat de la Vallee: The Kidneys. Monkey Press. Cambridge. 1989, p.9.
58
Ibid. pp. 17-18.
59
Hammer L: The unified theory of Chinese medicine. Oriental Medicine J, 1998: 6(3 & 4).17.
 27

60
Larre C, E Rochat de la Vallee: The Kidneys. Monkey Press. Cambridge. 1989, pp. 40, 73..
61
Ibid. pp. 44-45.

Bibliography

Hammer L. Contemporary pulse diagnosis: Introduction to an evolving method for learning an

ancient art (I). Amer J Acupunc, 1993: 21(2): 123-139; (II) 1993; 21(3): 219-236
Unschuld PU: Medicine in China: A History of Ideas. University of California Press,
Berkeley, 1983.
Unschuld PU: Medicine in China: A History of Pharmaceutics. Univ. of Calif. Press,
Berkeley, 1986.

About the Author

Leon Hammer, MD, is a graduate of Cornell University Medical College and the
William A. White Institute of Psychiatry, Psychoanalysis and Psychology. Until 1971 he
practiced psychiatry. After working with Fritz Perls and Alexander Lowen over eight
years, he began a serious study of Chinese medicine in 1971, first in England, then in
Beijing and in New York, where he worked with Dr. John Shen beginning in 1974. Dr.
Hammer's articles are widely published. Now retired, his book, Contemporary Chinese
Pulse Diagnosis (Eastland Press, Seattle W A) will be released in early 2000.