The Relationship between the Kidney and the Heart in Chinese Medicine - Part Two
Kidney-Heart Disharmony and Sleep
If both the Heart and Kidney are yin deficient [left distal and proximal positions are Tight, sleep is very restless. One will easily wake at the smallest sound or disturbance.
If the Heart is yin deficient [left distal Tight] and Kidney Qi-Yang is deficient [left proximal position Feeble-Absent], sleep resembles the Heart Blood deficient pattern. One wakes after approximately five hours sleep and then can return to sleep after a short while. This may be due to the Kidney Essence’s control of the bone marrow that is not making sufficient blood and blood is yin.
Increasingly common, if both the Heart and Kidneys are qi-yang deficient, [left distal and proximal Feeble-Absent], we have a restless sleep pattern similar to the Heart –Kidney Yin deficiency. However, there is no restless agitation and more depression. The individual is physically very uncomfortable in the reclining position.
If the Heart Yin is deficient [Left Distal Tight] and Kidney Qi-Yang deficient [Left Proximal Position Feeble-Absent], circulation is impaired making the person sluggish. The Heart Yin deficient condition is associated with agitation that in this instance manifests as a strong tendency to worry that can interfere with sleep at any step along the way, especially at the beginning.
Dragon Rises Red Bird Flies[i]
Kidney is the potential, the primordial soup out of which the unconscious is manifested and realized through the Heart-Mind as` Heart Yin’. The inspiration and passion ensconced in `Heart Yin’ is unconscious and as original as the individual from whom it is springs. Yet once brought to a reality by `Heart Yang’
it is familiar to all. `Heart Yang’ fashions the imagination and inspiration of `Heart Yin’ into a recognizable object that we recognize and appreciate as a work of art or a discovery of science. It is what Thomas Edison called `perspiration’. The ultimate source is Kidney Essence. `Pericardium Yin’ protects creation and `Pericardium Yang’ projects it, enhanced harmoniously by the Triple Burner.
All of the functions of the Water from Divine Love and Divine Spirit and Divine Power, awe and faith, will and courage in the face of the unknown, all are potential becoming a reality through the expressive power of the Heart, the great communicator that reaches out to the world with the `Word’. Will power, zhi, a prime function associated with the Kidney, has been described as the ability to put one’s Heart into what one is doing.
Some expressions that come from the Heart is unfamiliar to the culture into which it is introduced. The unfamiliar inspires the inherent `fear of the unknown’ that responds to eliminate the perceived danger and the creator is threatened at which point they can withdraw or persist. That persistence requires courage, courage that man the creator draws from God the creator [Kidney Qi-Yang], from the Water of our existence, the spirit of the `Kidney Qi’ in man, the `essence.’
The inspiration and passion ensconced in `Heart Yin’ [DRRBF], that longing comes from our `gut' and cannot be denied except at a much greater price than all the `mistakes' along the way that are not mistakes at all, only ruts in the road that make us turn to a different direction. We have a mind [heart] and an ego [`Kidney Qi’] and hopefully they have at least a tenuous connection to keep us from making fatal mistakes.
In passing it should be noted that following the disruptions in Kidney-Essence that make us psychologically vulnerable, all psychological disturbances are maladaptive maneuvers [usually misconstrued as `defensive’] that are employed as a way for an individual to stay in `contact’ in order to survive and stay `intact’[ii]. They are functions of Pericardium yin, the protector of the Heart, as described in Dragon Rises, Red Bird Flies.[iii]
Literature and Shen-Hun-Po
With regard to the Shen, Hun, Po etc., during our material life on this planet, Fire and Water meet in the Earth phase, the other source of Heart Blood. Ultimately all are expressed by the Shen-Heart that houses Awareness through which all reaches consciousness.
`Water is of heaven cascading down into the heart where it is life on earth.' Another version is that the Fire of heaven entered the Heart and was taken by the Triple Burner to be stored in the Mingmen, the source of Kidney Yang. Li Shi-Zhen supports this perspective in this 16th century excerpt: "According to recent findings, mingmen is located between the two kidneys."21 This Fire of the Mingmen is carried to the Heart by the Triple Burner and resides there to the degree that the Heart is free of longings and addictions. Triple Burner is a servant of ming men for the distribution of Original Breaths, yuan qi, through the body.*
Case study
Patient: Female Age 60 5’1 125lb
Chief Complaints [only those relevant to presentation]
1. Physical
a. Breathing difficulties
Sx:
Emphysema, 60%
SOB severe
Worse
On mild exertion- walking up hills
Hx:
Child
Delicate; multiple illnesses and asthma.
Adult
Smoke for 40 yrs- one pack/day
Bronchitis every winter
b. Back Problems
Sx:
Low back & dull
Hx:
Severe trauma going back 35 years without healing
c. Bowel Problems
Constipation since very young; every few days
Currently sometimes loose
No appetite since childhood
d. Fatigue
Fatigue after eating
e. ROS
Child
Youngest child [Paradise Gained]
Overprotected: Fragile child
Considered perfect- could do no wrong
[Message is: To get love must be perfect]
Adult [paradise Lost]
Avoid judgment of finished product by "never finishing”
Avoid criticism
Generally cold, even to the bone
Addictions
Alcoholic for 30 years recovering for 15 years
Cocaine
8 months age 30 yrs
Pot irregularly for 17 years
Nicotine
31 years ages 14 to 45
Mental-Emotional
a. What else would you want to be different about yourself or your life apart from not being involved with cigarettes and alcohol?
To not be afraid to fail.
To charm less and listen more.
To believe that I am as smart as I pretend that I am.
To have not smoked
To have not given up potential by drinking
b. How are you a problem to yourself or others now or in the past apart from alcohol?
Identifiable Problems
· Avoid judgment of finished product by "never finishing”
· " not as directed”
· Agitated- Scattered- multitasking rather than focusing on one thing
· Avoid reflection
· Never sat down long enough to think
· Avoid directly expressing anger: hold it until situation intolerable and move on
· Impulsive and Impatient
· Opportunist
· Move through life according to what comes along that seems convenient for the moment-
· No goals or direction of own
· Problem to Self
· Impatient. judgmental. procrastinator. disorganized
Identifiable Strengths
· Survived
· Stopped smoking
· Stopped drinking
· Honest
· Empathetic: Good friend; helper [except self]
· Ended addictions
· Daughter graduated high school
· Understands herself re:
· Would change about self if did it over again
· To not be afraid to fail
Signs
1. Pulse
All the findings are summarized here with only the ones important to our conversation in the Heart and Kidneys in italics [in the interests of space].
a. HEART
i. Qi deficiency [Mild to Moderate]
Mitral Valve: ~ Choppy; ~Rough Vibration; Amplitude Change [3]
Rate slightly Slow
ii. Phlegm-Misting the Orifices [Severe]
LDP: Slippery [3]
iii. Heart Qi Agitation [Moderate]
LDP: Smooth Vibration [3]
68]
iv. Yin deficiency [Moderate]
LDP: Tight
b. KIDNEY-BLADDER
i. Separation of Yin-Yang [Severe]
1). LPP: Changing Qualities: ÖFeeble
2). RPP: Intensity Changing [3]
ii. Qi deficiency
LPP: Feeble; Qi Depth Diminished; Ö Reduced Pounding
iii. Neo-plastic Activity (Stagnation of All Substances) [?]
RPP: Muffled [?]
iv. Excess Heat
LPP: Tense; Robust Pounding
v. Blood Stagnation in Lower Burner [Moderate]
vi. LPP: ~choppy [3]
vii. Blood Deficiency [Severe]
RPP: Thin [4]
2. Tongue
Swollen [3+]; shallow teeth indentations:
Thick yellow Coat- thicker at root
Wide crack down middle with yellow coat
Sides red- pale underneath
Tip indented
3. Eyes
Pale: Blood deficiency
Loss of discreet lines
Right- horizontal line
4. Sound
Groan
5. Color:
Green around mouth
Inner cheeks: red
Outer cheeks: Yellow –Green
Summary
A. DRRBF: [Five Phases]
1. PRIMARY [Water]
Psycho-energetic era that is undeveloped is the Water Phase
Kidney Yang-Essence deficiency
Hx:
Youngest child [Paradise Gained]
Overprotected: Fragile child
Considered perfect- could do no wrong
Consequence
Adult [paradise Lost]
Avoid judgment of finished product by "never finishing”
Avoid criticism
Comment
There is the issue of her being born `fragile’ with many signs and symptoms of Kidney Yang-Jing deficiency complicated by overprotection that deprived her of a sense of self that she could recover from failure. [Fear of Unknown and diminished courage to overcome it] [blue color around mouth]
Message is:
To get love must be perfect
2. SECONDARY [Fire]
a. Compensatory adaptations to `defend’ her fragile ego [from failure]
· Always to avoid judgment of a finished product by never finishing.
· Called `defenses’;
· I call them `adaptations’-usually `mal-adaptations’ as with this patient.
i. Pericardium Yin Excess
1). Acting Out
a). Whenever she was faced with a life decision she grasped at the nearest escape such as an impulsive injudicious marriage or signing on to a equally impulsive sailing adventure
b). Describes herself as an `opportunist’
2). Denial
a). An ego defense mechanism that operates unconsciously to resolve emotional conflict, and to reduce anxiety by refusing to perceive the more unpleasant aspects of external reality
b). Describes self as "non-reflective”
3). Displacement
From awareness of anxiety about wasting her life to cigarettes and ultimately to emphysema, to alcohol and drugs and thereby Liver Yin/Yang deficiency and Separation of Yin and Yang
Passive-Aggressive [Wood `No’ Phase]
a}. "not as directed”
This passive-resistance is gives her a false sense of power to compensate for her surrendering her real power to avoid failure.
In DRRBF terms this is Liver Yang deficiency adaptation.
b). Drained Liver Yang Qi-Yang that would be otherwise used to move her forward
B. KIDNEY-HEART DISHARMONY
The core of the existential problem for this woman is her `fear of the unknown’ as an extension of her Kidney Yang-Essence deficiency that occurred at least at birth and considering her fragility as a child, probably in-utero.
This sense of vulnerability and inadequacy was exacerbated by exaggerated overprotection as the `perfect child’ that rendered her feeling that to be loved one must be perfect. For the rest of her life she could not take a chance on being anything less and so she never `tried’. Her life is a cameo of Thoreau assertion that "most men lead lives of quiet desperation and go to the grave with the song still in them.’
While her original attempts to live with this desperation were through mind-awareness numbing maneuvers such as alcohol, cigarettes and drugs, even marriage, her Heart was strong enough to assist the Kidneys make a life and function through more sophisticated mal-adaptations. These were drawn from other aspects of the Fire Phase Pericardium energies that permitted to protect her fragile ego by `not trying’ so she could not fail, and through the Triple Burner that maintained a connection with her Water. Otherwise without the latter she would have lost the vital connection of the brain and mind and probably become psychotic.
Treatment
Acupuncture
1. Channel Kidney Points
Kidney 4
Allows the Kidney to communicate with the Heart, P-3, 6, 8
Kidney 9
· Phlegm disturbing the Heart
· Communicates between Kidney and Heart
· Cry and laugh for no reason
Kidney 12 with Ren 17
Kidney 16
Calms the mind by bringing Yin to the Heart thru Bl-43
Kidney 21
Profound old terror
2. Upper-Lower: Kidney and Heart
a. Chong Mai [Ancestral Channel] + Yin Qiao Mai and Upper Kidney Points
Self-reflection
Cope with self [literally `stand up to self’-
Starts at inner ankle, Ki- 6]
b. Chong Mai [Ancestral Channel] + Yang Qiao Mai and Upper Kidney Points
Self-reflection
Cope with self [literally `stand up to others’-
c. Exit-entry Points
KI- 22 – P- 1.2
d. Sometimes H/W imbalance comes from this level and you must use upper Kidney points to break it.
KI-22 Walking on Veranda [Corridor] Bulong; Exit point
· Probable name for location on ribcage
· Energy transition from Middle to Appendix Upper Heater
· Exit point from Kidney to Pericardium
· Relation between fear and intimacy
· Transition to spirit
· Despondency - isolation
· Combined with Entry Points [WOS] [PC-1-Tianchi in man & PC-2Tianguan in woman]
· Feel free
KI-23 - Spirit Seal – Shengfeng
· Seal as in Emperors jade stamp, giving mandate of heaven
· IDENTITY -like energy of metal (VIII-4 middle seal).
· Relation of breathing (in heaven) and Will
· Kidney 23 and 25 strong together!
· Storehouse - to add power, but less powerful than Kid27; can use them together; to keep what was hers in her
Ki23 - Physically strong - no will to live
· Spiritual Seal -if Spirit is with me
· Are one with God in relation to terror
KI-24 - Spirit Burial Ground – Lingxu
· Located over Heart.
· Resurrect dead spirit, no will, no ambition.
· Shark Eyes - too much ambition.
· No spirit behind it.
· People totally involved in grief and can't let go of the corpse; "They're dead and you have to revive them"
· Resurrects spirit if part of us dies
· God is with me- terrors
KI-25 - Spirit Storehouse [Ling]-Shencang
· Identity and sense of purpose is emergent but it hasn't crystallized for them yet
· Identity – to get through a difficult time bring Spirit up
· To seal a treatment- 3 moxa[A1]
· Give spirit strength.
· As opposed to: KI-27 – KI 25 Storehouse is more generalized
IV Energy at level of IX-1,2 - breathing and IV.
· Acquired spirit-ling; Spirit Storehouse
· Reservoir
· Fluid flowing across our spirit- refreshes us
KI26 - Amidst Elegance - Yuzhong
· Ambition; anxiety with anger (bad temper)
· More like an induction compared to a command (relative to others); gentler: "Yes, you can have this" instead of "Get moving" (kid 27) or "HAVE an identity" - A little push; artful quality to embracing aspect of Kidney
· Riches of the inherited constitution
· In touch with elegance but flow of life stopped; illusions are shattered
· Flow changes; helps restore harmony
· The Essence- `Clever Official’, a bright person whom we can imagine squandering their inheritance. Old clothes -- we can see them as elegant.[A2]
· Related to BL-10 [Heavenly Pillar]- pillar of spirit. BL-10 is "Holding one's head high"
· Like GV-12 [Great shuttle], the pillar of the body (spine) weaving together fabric of life
KI-27- Storehouse of Spirit Shu Mansion Shufu
· Overall energy - add power
· Physically weak - no will to live . Use with Ki23
· Storehouse - for all-mind, body, spirit together
· Strengthen the adrenals.
· Impotence, frigidity - sexual energy is stuck and they don't have access to it.
· Asthma
3. Other Points
Yin Deficiency
HT-7 and BL-40: regulates the Lower Burner and calms the Fire
For nervous and slightly hyperactive children w/ nocturnal enuresis.
P- 5
Creates communication between Heart and Kidney
Clears phlegm from heart that must interfere with Kidney-Heart connection
SP-4, w/ CV 3, 4,; Hua Tuo at GV- 4, 6; BL- 23
Outer Shu Points [Moxa on needle]
Especially Bl- 43
Upper and Lower Burner
Lu- 9, Ht 5-7, Anmien, Yin Tang; DU 24
Ren 17
Shu point for the Pericardium
Triple Burner
TB2- controls water metabolism
TB-3-controls thermostat
Herbs
1. HEART QI AND BLOOD AND KIDNEY YANG-ESSENCE
Note: In lieu of Cinnebar use Magnetite that is specific for K-H Disharmony
Yi Yang Shen 4.5 gm American Ginseng
Korean Ginseng 4.5 gm
Zi He Che 4.5 gm Placenta
Bai Zi Ren 4.5 gm Biota Seed
Long Yan Rou 6.0 gm Longan
Suan Zao Ren 6.0 gm Zizyphus
Yue Jin 6.0 gm Curcumae [Tuber]
Shu Di Huang 9.0 gm Rehmannia [Cooked in wine]
Ye Jiao Teng 9.0 gm Polygalae Multifloriae
Sha Ren 1.5 gm Fr. Seu Se. Amomi
Fo Shou 3.0 gm Fr. Citri Sarcodactylis
Dan Shen 9.0 gm Salvia
Mai Men Dong 6.0 gm Ophiopogon
Chang Pu 6 .0 gm Acorus
Gan Cao 3.0 gm Licorice
Fu Zi 0.25 gm Aconite
Huang qi 10.0gm Astragalus
Shan Yu Ru 6.0gm Cornus
Gou Qi Zi 6.0gm Lycium Berry
Du Zhong 6.0gm Eucommia
Dong Chong 2.0gm Cordyceps
Fu Xiao Mai 3gm Tritici Levis Semen
Ge Jie 3.0gm Gecko
Yin Yang Huo 8gm Epidmedii
Rou Cong rong 10gm Cistanches
Ci Shi 20gm Magnetite
Note: For `Phlegm Misting the Orifices’ the most effective combination is Niu Huang Qing Xin Wan especially with serious mental disturbance
Conclusion
Stated at the beginning of this paper and once again at the end, the practical significance of harmony between the Heart and the Kidney is the relationship of the mind-spirit [controlled by the Heart] and the brain-marrow [created and sustained by the Kidney]. Together they determine mental stability and function. More than any other measure, mental acuity and constancy determines the quality of life and the freedom to live it outside the constraints that society proscribes and excludes people with significant mental dysfunction.
The integrity of Kidney Essence is determined by the in-utero and birth experience. The integrity of the Heart is particularly a function of that in-utero Kidney Essence that establishes the onset of the Kidney-Heart, brain-mind-spirit connection [Kidney-Heart Harmony].
Kidney is the potential, the primordial soup out of which the unconscious is manifest in reality through the creative inspiration of Heart-Mind. While `fear of the unknown’, the root ineluctable and ongoing existential dilemma, assuaged by faith, love and hope, is a Water-Kidney issue, making this conscious and manageable is a Fire-Heart issue.
The Heart [mind] is home to the spirit (shén), which is received from above, while the ‘nervous system’ is derived from the more material basis of Kidney Essence. Balance between these two poles is necessary and mediated by the Triple Burner’s regulating function.
The significance of the Heart in all disruptions of Awareness [iv] is paramount. The tendency to associate emotions solely according to the conventional correspondences fails to recognize that Kidney Essence ‘nervous system’ is the ineluctable source of mental-emotional integrity and that Heart-Mind-Spirit mediates the expression of this integrity. This is true primarily because of the Heart’s preeminence in all aspects of awareness. The manifestation of almost all psychological disorders can and must be understood in terms of awareness and communication. When there are issues with communication, the associated Fire energies of the Heart, Pericardium, Triple Burner, and Small Intestine are likewise involved.
Without the Awareness that is characterized by a Heart whose orifices are open, all of the above would operate outside of consciousness, raising the question that has come down through the ages, if a tree falls deep in the forest and no one is there to observe it, did it really happen?
[i] Yin and Yang
In Chinese medicine the terms Yin and Yang are used variously depending upon the context
I. Complementary-Dynamically Interdependent Opposites-Inter-consuming
When one gains the other diminishes to maintain equilibrium
The principle issue is the dynamic balance and harmony that we call homeostasis
In our study of Chinese medicine we are introduced initially to the cosmic use of Yin/Yang as interdependent-inter-consuming states in which each defines a state of the environment. When one increases the other diminishes. Yang is essentially the state of increased activity, of heat, dryness and brightness while Yin is a state of diminished activity, heat and light and a damp environment. A healthy condition of the natural world as well as an individual depends upon approximately equal amounts of each in a dynamic stability called homeostasis.
II. Substances
i. Measured separately
Kidney Yin and Yang deficiency at same time
ii. Measured quantitatively [1-5]
In another framework Yin and Yang are substances. In represents substance, the body fluids including water, blood and tissue, while the Yang represents the metabolic heat of the body or a particular organ, activity, function and movement closely allied with the warming, nourishing and moving aspects of Qi. This use of the terms is most common clinically and rather than being balanced in which more of one means less of another, we can a deficiency or superabundance of both Yin and Yang at the same time.
III. Strong – Weak
Yin – Weak
Yang – Strong
Though he used the substance aspect of Yin and Yang just described, during my apprenticeship with Dr. Shen , often he used the terms as meaning deficient [Yin] or excess [Yang]. Therefore rather than describe a deficient patient as such the patient was referred to as a Yin person. Likewise a patient with a strong terrain was referred to as a Yang person. This was initially confusing.
IV. Stabilizing Functional Relationship
Yin is substance [parenchyma-80% Water]
Yang is function
`Contact’ is necessary to stability [vs. chaos]
Significant deficiency of either causes Separation of Yin and Yang
v. DRRBF
The final use of which I am aware of the concept Yin/Yang is that employed in Dragon Rises Red Bird Flies in which Yin refers to the passive aspects of phase activity and the Yang refers to the active aspects of the phase.
Example:
Yin the passive function; Yang is the active function
Wood
Yin – retreat
Yang- advance
Heart
Yin- chaos- creative inspiration
Yang- form – the perspiration
[ii] Hammer, Leon I., M.D.; Dragon Rises Red Bird Flies; Eastland Press, 2005, Pgs. xxxiii, 77, 392
[iii] Hammer, Leon I., M.D.; Dragon Rises Red Bird Flies; Eastland Press, 2005, Pg. 77, 79
21 Li Shi-Zhen: Pulse Diagnosis. Paradigm Press, Brookline, MA 1981, p.7.
[iv] Hammer, Leon I. M.D.; Awareness in Chinese Medicine, The American Acupuncturist, Fall 2007, Volume 41
