Salt Sensitive Hypertension and Classical Chinese Medicine, Part 3
This is the final post in a three part series by Brandon Brown, blogger and student of Classical Chinese Medicine at NCNM. You can read the first two parts here and here, and can read references for the article by visiting Brandon’s site here.
Salt in the Classics
Salt is mentioned a number of times in the classics. In the Neijing Suwen, salt is considered the flavor of the Kidney. But what does this mean exactly? What follows are the most descriptive and instructive references from the Suwen followed by my translations.
Chapter 67
北方生寒，寒生水，水生鹹，鹹生腎，腎生骨髓，髓生肝。其在天為寒，在地為水，在體為骨，在氣為堅，在藏為腎，其性為凜，其德為寒，其用為，其色為黑，其化為肅，其蟲鱗，其政為靜，其令，其變凝冽，其眚冰雹，其味為鹹，其志為恐。恐傷腎，思勝恐，寒傷血，燥勝寒，鹹傷血，甘勝鹹。
“The north generates cold, cold generates water, water generates salty, salty generates kidneys, kidney generates the marrow, marrow generates the liver. In heaven it is cold, on earth it is water, in the body it is bone, its qi is hard, in the Zang it is the Kidney, its nature is cold(shivering), its virtue is cold, it is “use”, its color is black, it changes into solemn-ness(seriousness), it is worms and fish-scales, its government is stillness(jing), it causes, its pathological change is congealing coldness, its natural disaster is ice hail, its flavor is salty, it is will by fear. Fear impairs the kidney, thought defeats fear, cold damages blood, dryness defeats cold, salty damages blood, sweet defeats salty.”
Chapter 3
味過於鹹，大骨氣勞，短肌，心氣抑。
Excess salty flavor, causes great hardening of bone Qi, shortens the muscles, and restrains heart Qi.
Chapter 5
鹹勝苦。
Salty defeats bitter.
Chapter 10
是故多食鹹則脈凝泣而變色 。
Therefore, much eating of salty makes the pulse concrete and the color changing.
Chapter 22
心欲耎，急食鹹以耎之，用鹹補之，甘寫之。
The Heart desires softness, anxious people eat salty that softens it, use salty to mend it, sweet drains it.
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These excerpts from the Suwen indicate the myriad functions of salt. In Chinese Medicine, the Salty flavor is typically used to soften nodules as mentioned in Chapter 22, but we also see in Chapter 3, 10, and 67 that salt can pathologically also create hardness of Bone Qi, restrain Heart Qi, damage blood, and cause the pulse to be very firm. We can read these lines in typical Chinese Medicine fashion: that as a remedy, the salty flavor has a purpose in softening nodules, in moderation salt perhaps allows the Kidney to perform its function of storing, but pathological excess consumption of salt can lead to sclerosis.
In Chinese Medicine, the 5 flavors that go with the 5 organs typically counteract the nature of the targeted organ. For example, the energetic nature of the Liver is up and out whereas the flavor Sour astringes and contracts. The Heart, the fire organ, is up and bitter is down. For the Lung, its nature is contracting down and in, whereas pungent is the opposite: up and out. For the Kidney, as we see in Chapter 67 above, the energetic nature is definitely to store by freezing. Salt, must counteract this freezing nature, as we know that it does from our experience: salt both reduces the freezing point of water and raises the boiling point. The presence of salt liquefies ice, and thus can soften hardness (tumors, goiter, etc.). But because salt has an affinity with the Kidney it counteracts the storing nature of the organ, liquefying the Kidney energy (perhaps Jing) to be used in the body as Qi. Therefore we see again that, salt pushes out from the inside.
In their paper on the Classical Energetics of the Five Flavors (find in references section), Arnaud Versluys and Jessica Atkins describe the therapeutic actions of the five flavors in terms of tonification and purgation. In cases of excess or deficiency, the organs can be respectively purged or tonified with the appropriate flavor as shown in the figure below.
Figure 2: The actions of the 5 flavors
Organ: Excess of, purge with : Deficiency of, tonify with
Fire : Sweet : Salty
Earth : Bitter : Sweet
Metal : Pungent : Sour
Water : Salty : Bitter
Wood : Sour : Pungent
According to their interpretation, the salty flavor purges excess in the Kidneys and tonifies the Heart. In the case of SSH, chronic overexposure to dietary salt may act medicinally and impair or purge the storing function of the Kidney and thus over-tonify the Heart. Because the Kidney is also said to store pre-natal essence if there is no pathological influence to expel in the Kidneys, it is possible that what is purged is actually pre-natal essence (Jing). This essence is circulated throughout the body, transformed to Qi by the Liver function, and transformed and stored as Shen by the Heart. Shen, and thus consciousness, have as a substrate the brain, but Shen is housed in the Heart.
Therefore, the use of salt habitually may increase the Jing-Qi-Shen generation cycle, which makes us sharp and awake, but has the detrimental effect of possibly depleting pre-natal essence if the Kidneys are not constantly tonified. In the Suwen it mentions that at 8 times 7 years (56 years old), the hair (ruled by the Kidney) turns gray and the signs of aging begin to become visible. “The kidneys’ ability to excrete sodium declines gradually with age. If, with age, salt consumption is not reduced, sodium balance is maintained by raising fractional sodium excretion, which requires elevation of BP” (Khalil 2005). The 
accumulation of salt in the ocean over the years has begun to take its toll.
Because purgation of the Kidney in a non-pathological condition also tonifies the Heart, an interesting consequence of excess in the Fire element is that it easily overflows onto its child organ, the Earth. This would lead the Earth to become overwhelmed and thereby inhibiting it to control the Water element, whose function is diminishing due to the natural processes of aging. In CM, we say that the “Earth rules the muscles” and in the SSH case this clearly relates to the smooth muscle of the vasculature losing its ability to contract. Due to an excess in the Heart domain, the smooth muscle becomes dry, stiff, and brittle. The patho-mechanism of this is illustrated below.
The standard American diet is predominantly made of the flavors salty and sweet. The overwhelming absence of bitter (with the exception of Shen disturbing coffee and beer) and the overwhelming abundance of salt and sugar in the standard American diet may explain the danger of increased exposure to dietary salt.
Conclusion
It is not surprising that decreasing daily dietary salt intake will help in treatment SSH. However, what we learn from the classics and the physiology of salt in the body is that Kidney tonification is essential for SSH.
Because the Earth element has become so affected by this chronic exposure to salt, purging the Earth of excess with the bitter flavor will be important. Like a lone neuron in the brain, salt consumption is entangled in the higher social structures that predominate our times: working long hours, using the mind instead of physical labor for generating a living, exposure to a barrage of psycho-sensory information in terms of television, music, and people, along with increasing anxieties about all of it. Seen in this context it really is no wonder why SSH is a modern disease of the “developed” world.
Brandon Brown
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Tags: five phases, heart, human physiology, kidney, liver, lung, metal, nature, neijing, salt, student, translationsRelated posts
Chinese medicine, the Earth and the Center
When talking about the five elements, particularly as applied to the organ systems of Chinese medicine, it’s easy to find an angle from which to proclaim the supremacy of any of the elements. Fire gets four organs, for instance, one of those being the Emperor - surely it’s the most important. Water, on the other hand, lies at the depths - no element is more revered than water in the cultural literature of the Chinese (the Dao is often said to be like water, the supreme man is said to be like water in taking the lowest place, etc….). Surely water is “top dog,” then. But what of Wood? Wood begins the cycle of the elements from most perspectives - it is the animating principle of the whole system - Wood must be the most important.
So on and so forth. The answer to the question, “Which is most important,” is the absurdly easy and frustrating, “None.” However, Earth could have a better reason than the rest to lay claim to this elusive prize. Earth is the center - the center is the axis upon which everything else spins. Without the center, you just have a group of unassociated pieces, functioning on their own in vain. The center brings it all together, ensures that it functions.
There are two ways to think about Earth seasonally. One perspective holds that Earth is associated with a kind of “late summer,” just before the fall rains begin. Another, which I prefer, holds that the Earth occupies an interstitial space between each season - the 14 days or so around each solstice and equinox - the transitions from one season to another. I’ve heard a variety of perspectives about the actual length of time and the precise arrangement of those periods, but this seems to be a consensus. Regardless, this “in between” nature of the Earth element makes it vital, it governs our transition from one energetic state to another.
Sunday, I went on a beautiful hike in the Columbia River Gorge. I decided to try to open my senses and not impose anything in particular on my experience. The overwhelming message, again and again, spoke of the Earth element. The sweet smell of decay - cloying, almost - with the merest hint of rich wine or butter or something I can’t define. No matter what part of the trail - metallic/mineral rock faces all around sharing their sharp, clean scent - deep, watery pools of clarity lending a weedy, fresh aroma - high and dry grassy plain full of pungency and heat… behind was the deep Earthen bassnote, emanating everywhere. Now, we are not officially in the period around the autumnal equinox, though we are technically within that “late summer” period perhaps - but the working of the Earth energy was present everywhere I looked.
The overwhelming idea that came out of all of this exploration is simple. Earth is at the center, and you must always look to its health. This is why dietary therapy is the root of most successful treatment plans. It’s also why so many of my patients seem to need a simple Earth tonification formula (such as Xiao Jian Zhong Tang) after any other series of formulas. In fact, from now on, I will be carefully examining that possibility with every patient. I feel that this is, in some ways, superior to the rampant practice of throwing some heavily tonifying formula at a patient after a big illness. The idea behind it is the same, but it is actually looking at the source of weakness and not the branches.
(Photos taken by Eric and his family, August 2008)
Tags: earth, five phases, Organ systems, scent, senses, spleen, stomachRelated posts
Classical Chinese medical symbolism: Wood, Metal and Spring
Today I am featuring the first part of a two part guest post by my friend and colleague at NCNM, Michael “Delli” Dell’orfano. His article is a fine elaboration of the ideas I briefly presented in my post about Rest and Activity in the Year of Sagely Living. I will post the remainder of the article over the next few days. It will be followed up by another series that I’ve authored myself concerning treating external invasions with Classical Chinese Medicine. Before I get on with the article, a few housekeeping announcements. First, if you haven’t read through the comments on the last post, “Does Chinese Medicine Cure Disease,” I definitely recommend you do so. Second, if you have interest in following my progress in the Year of Sagely Living, be sure to visit that page and scroll down a bit where you can read my somewhat frequent updates. Third, if you haven’t already subscribed to the RSS feed or email newsletter, why don’t you take the time to do so now? Without further ado…
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As the vernal equinox approaches we find ourselves situated in the season of spring according to the Chinese calendar, yet the organ systems clock tells us that this time of year corresponds with the Lung and Large Intestine organ systems. How does one make any sense of this?
The relationship of the Wood organ systems and the Metal organ systems of Chinese Medicine can be understood through the use of Yin Yang theory. Yin Yang theory is one of the fundamental principles upon which our medicine was founded, and so I think it is worthwhile to explain a bit about the Taiji (太極) symbol (often called the Yin Yang symbol) and how it originated. It is important to keep in mind that ancient Chinese medicine is a science of movement and energy consisting of symbols. Symbols are bridges between matter and consciousness since they have the potential to resonate at the same frequency. The quality of the frequency can reveal to us similarities between the physical world and the holographic world. On one level, symbols are meant to be a simple way to convey an idea, but at the same time these symbols contain vast amounts of information that we must first comprehend in order to use them effectively.
Upon observation of the symbol we can notice the contrast in color. Light and dark are contained within it, but do not disregard the fact that a dark circle exist within the light area and vice versa. The fact that Yin always exists within Yang, and Yang within Yin, tells us that nothing is purely Yin or purely Yang, but rather that all life is a mixture of Yin and Yang. In my opinion, this clue leads us to reason that the two are mutually dependent on one another for the continuation of life. The shape of the Taiji is a circle, which tells us that it relates to infinity or completeness. We also get a sense of movement when we look at the way the dark and light shades are drawn in. These clues turn out to be very important because the Taiji is telling us that yin yang theory can be used to explain the movements of nature, because it is based on the movement of the seasons, and thus the Wu Xing (五 行, five elements, five phases, five phase movements) are closely related to it.
The Taiji symbol originated from the ancient sages who observed the cycle of the Sun using an eight foot long pole posted in the ground at a right angle to record the position of the Sun’s shadow throughout the year. They found that the length of the year was 365.25 days and then divided the year up into twenty-four segments including the solstices and the equinoxes using the sunrise and Big Dipper positions. They used six concentric circles, marked twenty-four segments points, divided the circle into twenty-four sectors, and then recorded the length of the shadow each day. After connecting the lines and dimming the portion between the solstices they created a picture that looked like the modern day Taiji symbol.
The Taiji symbol is actually a diagram charting the movement of the Sun so that the ancients could then use this information to better understand the world. This scientific breakthrough would allow the ancient sages to better understand our relationship to time and space and give them a starting point for classifying different types of energies.
The yin yang theory background is pertinent to understanding the Wu Xing (五 行, five elements, five phases, five phase movements) because they resonate on many levels. Both the wu xing and yin and yang move in cycles throughout the seasons. One interpretation/understanding of the Wu Xing I came across stated that the elements are not five distinct things, but are one cosmic force, differentiated into five appearances by time and space. Maybe this is good way to think about them because when first learning Chinese medicine many students tend to think of Jin (金, metal) and Mu (木, wood/flora) as being enemies since “Metal chops down Wood”. It is better to think of them as having a complementary relationship, because truly they balance one another out in a physiological state. When the relationship is in balance, Jin/metal works along the Ke (control) cycle to keep Mu in check since wood/flora can become relentless. If Jin over controls
Mu, then our internal “forest” would be destroyed and a pathological process would be underway.
Nature can also be described by Tian Gan Di Zhi (天幹 heavenly stems and 地支 earthly branches). Together, the ten Heavenly Stems and twelve Earthly Branches create the energy of the time and space continuum. Chinese think of the year as energy moving in a circular motion, while in the Western civilization we think of time as linear. The stems and branches were originally a counting system used to keep track of hours, days, months, and years by the ancients after they had discovered the world moves in circles or cycles as proven by the Sun diagram. In the seasons, Jin/metal represents fall and relates to the Tian Gan (heavenly stems) Geng 庚 and Xin 辛, while Mu/wood represents spring and relates to the Tian Gan Jia 甲 and Yi 乙. Jia is the first Tian Gan, and it is classified as yang wood in character, while Yi, the second Tian Gan, is considered yin wood in character. Both are associated with the springtime.
Jia 甲 is picture of a very hard tree with scales or armor around it. The traditional Chinese etymology is the idea of a helmet on a big man. It also had the meaning of a claw gripping tightly on to something, meaning very great strength and protection. Yi 乙 represents the idea of a seed of a plant which is breaking through the earth. Together Jiayi means the movement of life as it bursts open. The spring season represents the movement of Heaven and Earth coming together after being separated in the fall and winter.
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Editors note: I regret having to cut off Delli’s article here, there were really no great stopping points. However, the whole article would be too long to digest on the web in one sitting! In the next part of this article, we will learn more about metal and the interplay between the symbolism of both metal and wood.
Tags: autumn, Character, classical-chinese-medicine, etymology, fall, five phases, guest-post, Organ systems, Seasons, spring, symbolic-thinking, symbolism, taiji, yin yang symbol, yinyangRelated posts
Why does Classical Chinese Medicine seem so complicated?
This is the first part of a two part guest article by my friend and peer, Michael Givens. Michael is also a third year student of Classical Chinese Medicine at the National College of Natural Medicine in Portland, OR. He shares my fervor for the medicine and has been an inspiration to me as I seek to plumb the depths of this profession we have both chosen. I hope you will enjoy what he has to say. Please do leave your thoughts in the comments - he is a regular reader of the blog.
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When I first started to study Chinese medicine (long before I became a student at NCNM), I fell instantly in love with it because it made so much sense to me. When I read the Huangdi Neijing Suwen for the first time, it was as if all the questions I had about life, my place in relation to nature and the stars, the interplay between light and shade, warmth and cold, and how life seems to exist somewhere between them all were illuminated by Huangdi, Qibo and the other sages. The cycle of the five dynamic movements in nature and how they manifest inside and out of all things, defined for me what I felt was already true; I had found a detailed system that defined the wholeness I had been searching to understand.
As I pursued my studies as a Chinese medicine student, I began to see how my initial understanding was limited and superficial, and soon, rather than being the clearest and most elegant text I had ever read, the Neijing became the most complicated. I found myself spending hour upon hour trying to draw out the inter-lapping cycles of the six confirmations, influencing each other on the right and the left through time, in the heavens and on earth, connecting to the heavenly stems and earthly branches and the five movements…I quickly became lost in the details of such an amazingly intricate systematic understanding of the nature and movement of Qi.
When I first learned about the five organs and their relations to the five “elements”, it seemed so clear; yet, as I deepened my understanding of physiology (Chinese physiology that is), simple concepts like “Fire generates Earth, Earth generates Metal, Metal generates Water” became extremely complicated. How is it, after all, that Fire descends through the malleability of Metal, physiologically, or that Metal really descends only when Fire descends? What does it mean that Water, while it resonates with the flavor of Salty, is actually reduced by Salty and strengthened by Bitter? What is at the heart of the difference between the six atmospheric conditions and the five dynamic processes and how do they interact physiologically? Questions such as these began to plague me.
Of course, this is what happens as one deepens his or her understanding of something; and, as one narrows his or her focus from the “big picture” to the minutia, the complexities of the universe become overwhelming. Yet, the beauty of Chinese medicine lies in the central view that the Chinese sages held. Rather than lose themselves in the grand picture, focusing only on the Dao or on the stars alone, and rather than (as Western science has done) lose themselves in the smaller and smaller details of the parts, the sages of Chinese medicine maintained an open view of both through using the language of symbolism and correspondences and remaining focused on processes and dynamics, functions and movements. So, though I was swimming out in the ocean of stars, and at the same time swirling amidst the tiny fragments of manifestation, by taking on this central position of the Chinese, I found a way to begin to have clarity and understanding and to flow with the movement of nature.
This is not to say that I would advocate ignoring the details and taking for granted the whole, not at all in fact; as I said earlier, the Neijing incorporates extremely detailed understandings of the very large and the very small, though there is a much stronger emphasis on the very large. What I have found is that one’s lens is what matters, regardless of what one is looking at. The lens of the Chinese medical sages allowed them to see dynamic processes and functional qualities rather than matter or manifestation. Though much of what a Chinese doctor does is to examine the symptoms and manifestations (especially in that the pulse is so very important), the treatment comes about through understanding function and movement, quality and time.
But, this is where a new confusion arises and is really what I meant by the title of this article. Chinese medicine is complicated just because it’s complicated, to be sure. But, how we are learning about Chinese medicine is also complicated. At times we are looking from a point of view of function, and at times we are looking from a point of view of materials. At times we learn of formulas and treatments that are based on an understanding of processes, and at times we learn formulas and treatments that are based on a desire to supplement matter.
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How is a student of this medicine to behave? How are we to wade through this sea of complexity that so many years of history have created for us? That will be the topic of the second part of Michael’s article - to be released soon. Thanks for reading.
Eric
Tags: classical-chinese-medicine, five phases, focus, Learning, Michael Givens, neijing, overwhelm, Science, symbolismRelated posts
A Five Element Path to maintaining sanity amid chaos, Part II
Yesterday in the first part of this discussion of maintaining sanity, I discussed the roles of Wood, Fire and Water in creation and resolution of the problems that often plague many of us who take in, and take on - way too much. I’d like to talk now about how I’ve used the symbolism of Metal and Earth - the densest of our elemental phases - to help me see a way out of the chaotic world I sometimes live within.
Earth has taught me immensely important lessons in my quest to overcome overwhelm. Though it probably isn’t fair to lay the whole blame for this situation on Wood energetics, it is convenient in terms of looking at the Wood-Earth relationship. When we push too much, when we try to do everything and be everyone, usually the very first thing to suffer is our self-care. Right behind it is our home life. :) How many of us, when we have massive deadlines piling up on us and the pressure at work or school seems almost to intense to bear, start treating our bodies terribly and snapping at our loved ones? In my humble opinion, this is a perfect example of Wood overacting on Earth manifesting in human life. So what to do?
Earth is the province of the Spleen and Stomach, the home of nourishment and care. Importantly, this is where the transformation and transportation of what we take in takes place. In some real way, we cannot properly assimilate all of the great information we’re trying to absorb without paying close attention to our Earth-bound needs. Careful attention to nutrition, plenty of rest and relaxation and special attention to the creation of sanctuary for ourselves is essential to making great use of what we are privileged to be learning. It is the soil from which our life grows. This goes for the human element of Earth, too - our friends and family. We need to be especially careful to reach out to those who love us and those whom we love. We need to understand their essential role in our development and our responsibility to be what they need us to be. We should guard against self indulgence, of course, always remembering the vital role that the Emperor plays in reminding us of our purpose - but we MUST care for ourselves, or nothing will come of our valiant efforts.
Finally, Metal. Metal has taught me the hardest lessons, and the control cycle of the five elemental phases is a perfect analogy to use in this situation. Metal has the job of controlling the overgrowth of Wood. Where Fire gives the Wood something to reach towards, Earth gives ample nourishing space within which Wood can grow and Water ensures that everything stays supple and moving - Metal has the vital job of cutting off something gone wildly out of control. It is the pruning shear principle in our life and it *must not* be neglected if the Emperor is to maintain her appropriate place as undisputed ruler of our lives.
Sometimes you just have to say no. Even worse, sometimes you have to back out of something you erroneously said yes to at some point in the past. Metal, empowered by the animating principle of Fire and guided by the deeply connected force of water, knows when to say when. This is the hardest part to act out because there are no short cuts, and no way to make the impact less difficult. Some of us can get a little panicky when we know we are going to have to say no to something or someone. This is the edgy force of Wood wanting to grow ever more! We must have the strength to wield metal for the sake of our whole being and just cut ourselves off from overcommitment and information overload. I promise you, you will not die if you fail to read the newspaper today. You will not become a pariah if you say no to the latest committee assignment offered to you at work. You will not fail utterly in your quest to become a great practitioner if you say no to that seminar or elective class.
If you simply let the Emperor be the Emperor, pay close attention to the guiding method of Water, nourish your whole being deeply with Earth and learn when to say when with the cutting force of Metal you will flourish madly in this world and do it with your sanity intact.
What do you think? Let us know in the comments. If you’re interested in getting regular updates of content like this, be sure to subscribe to this blog via RSS feed or via email.
Eric
Tags: balance, five phases, Personal Development
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