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
Salt-sensitive hypertension and Classical Chinese Medicine, Part 2
This is the second part in a three part guest article series by Brandon Brown, student at National College of Natural Medicine and Chinese medicine blogger. You can access the first part of the article which covers salt in the macrocosm - nature. I should note that he has posted references for the entire series on his blog, you can access those references by clicking on this link. -Eric
Salt in the Microcosm
By preserving meat with salt, mankind was unknowingly creating a vicious cycle that would change the health of all people up to the present day. It is estimated that before the advent of this preservation technique people consumed no more than 0.5 grams of naturally occurring salt per day (g/d). After brining was put to use, daily consumption jumped to an estimated 10 g/d (because even though the meat is soaked in water to reconstitute it, no amount of soaking can remove a large amount of salt). This continued to climb throughout the centuries, upwards to nearly 18g/d (some estimates in Scandinavia indicate consumption near 100g/d) until the advent of refrigeration techniques which brought estimated consumption back down to its present day levels of 10 g/d. It is hypothesized that one reason for the stabilization at 10g/d instead of 0.5g/d is the addictive nature of salt: in the presence of continued salt loads the taste receptors on the tongue down-regulate their sensitivity to the salty flavor. However, as we will see, salt plays a crucial role in the nervous system, and it could be this current cultural bias for all things cerebral that creates our hunger for the briny crystal.
One of the most prolific cellular mechanisms in the body is the sodium-potassium pump. These pumps are found in a number of cells throughout the body, but most importantly in the nerve cells of the Central Nervous System. This mechanism, called Na+/K+-ATPase, regulates cellular chemistry and polarity by using ATP to remove 3 Na+ intracellular ions and replace them with 2 K+ ions. Na+/K+-ATPase is the mechanism that is responsible for the nerve’s ability to achieve the resting potential of approximately -70 mV by removing a net positive charge from the intracellular fluid with each pumping action. The creation of this potential primes the neuron to do work, in this case to release its charge as a rush of electrochemical ions, creating a signal that releases neurotransmitters at the terminal end of the neuron. The charging of this battery comes at a cost of a single phosphate group from ATP (converted to ADP). Because the pump is operating against the normal flow of the concentration gradient, energy is required to create this potential difference. This process is such that a large differential between sodium and potassium is created:
Table 1: Concentration of fluids by ion type (mmol/L)
| Ion | Extracellular | Intracellular |
| Na+ | 150 | 15 |
| Cl- | 110 | 7 |
| K+ | 5 | 150 |
Therefore the exterior of the cell is essentially salt water (NaCl), and the interior of the cell is largely dissolved potassium ions.
This is striking for a couple of reasons. First, in the resting state we see that salt water is kept on the outside of the membrane and only when an action or graded potential occurs is it allowed to rush into the cell. To reach the resting potential the cell must actively store potassium, and excrete sodium. In other words, the movement of salt (in this case sodium) into the cell causes the transmission of an electrochemical action potential. It is this action potential that is thought to give rise to all cognition and movement in the body. The axon, the long transmitting portion of the neuron, propagates the signal through voltage controlled sodium channels. The inward movement of salt is giving birth to movement and thought, whereas the expulsion of salt promotes stillness and thusly, stores great potential.
Secondly, the regular and crystalline lattice structure is perhaps more than metaphorical. In cognitive neuroscience, most theories of the mind involve describing the geometrical structure of the neural lattice as an explanation of functional capabilities. For example, the visual cortex is organized in columnar functional groups that serve to detect edges in the visual field. The creation of memory involves creating a new pathway on an already established lattice. Therefore, as sodium enters the cell it gives its organizational properties over to the cell to provide for the creation of new synaptic connections and lattice-like structures. The lattice-like structure of the salt is reflected in the lattice-like structure of the brain.
Figure 2: Columnar structure of neurons in the visual cortex and the octahedral geometry of sodium chloride
In terms of SSH research, it seems that excess dietary salt may not only change the sodium levels in the plasma but also in the cerebrospinal fluid, inhibiting Na+-K+-ATPase in both locations, perhaps giving rise to cognitive changes (Khalil 2005).
—
In the next and last installment of this series, Brandon discusses salt from the perspective of Classical Chinese texts and brings the various ideas together. Please look forward to it tomorrow. -Eric
Tags: crystal, human physiology, microcosm, nature, organization, salt, Science, waterRelated posts
Chinese medicine and physical exercise
Lately, I’ve been considering any holes I can find in my Classical Chinese Medicine education here at NCNM. Amazingly, there aren’t many. It’s hard to put together a top notch program in any topic, much less one as complicated as Chinese medicine. One place I have found myself without much to go on is in understanding the role of physical exercise in health according to this medicine. I’ve learned things here and there, both in class and in my own study, but the information is confusing and definitely conflicts with my own experience in places. In this article, I’d like to briefly discuss what I feel I have learned and the problems I’ve found therein. I hope that you will add your input in the comments. Some of what I write below will be in explicit TCM terms, as most of the docs I’ve talked to about this subject know that system best.
What I’ve learned about physical exercise since starting school in Chinese Medicine:
- In general, vigorous exercise is not recommended. This is particularly the case when the exercise is productive of lots of sweat. The thought is that the discharge of so much sweat inevitably damages Heart Yang, given that Heart Yang is used to expel sweat from the pores. Instead, gentler forms such as Qigong, Taiji and sometimes Yoga are recommended. These are said to build the body from the inside in a way that does not damage any vital substance of the body.
- Many of our doctors mention of how overwork can be very bad for the muscles and tendons and deplete both the Blood and the Qi. This is often mentioned mostly with relation to labor, but also non-working exercise. We are frequently asked to consider the lot of laboring people worldwide. They are often physically strong, but become ill easily and have shortened life.
- Much of the negative information we get about exercise concerns specific habits. For instance, showering or soaking in water directly after being very sweaty (with open pores). It is said that this (common) practice pulls dampness into the body and creates conditions of damp and hot damp in the middle jiao. Lifting very heavy weights over long periods of time are widely regarded (by most medicine) to be difficult for the joints, tendons and even bones. Another commonly mentioned problem is the tendency for many weight lifters to be building a sort of “muscle shell” that only conceals a hollow interior. Their muscles are very strong, very impressive, but the person is ultimately weak on a number of levels.
- There are often discussions about the importance of protecting the Heart. We often hear worry about making the Heart work so hard and wasting its precious Qi and Yang. Sometimes we will discuss various spiritual theories about the length of a person’s life being determined by a pre-determined number of heartbeats or breaths. I don’t think this information is regarded very seriously, we simply discuss it as something intriguing to consider.
I can understand much of this. For instance, it is certainly important that we don’t overwork ourselves. I see many people exercising in the name of health who seem to be making gains (losing weight, gaining muscle) but possibly at the expense of their longevity because of heavy wear on the joints and Heart. Further, the practice of being hot and sweaty and immediately going into the sauna or hot shower has always made me cringe a little.
On the other hand, we need to be mindful of the current state of most Americans. Another thing that we hear railed about at school is the danger of being overweight - leading a sedentary lifestyle. So, while exercising too much is certainly a bad thing and we can advise our patients to avoid it, we do need to help our overweight and out of shape patients! It seems that most Chinese medicine doctors would have us just eat a moderate diet, sleep well and do gentle movement in order to stay healthy. This sounds fantastic, but it doesn’t seem to work for everyone. It also makes one wonder what to do with a person who comes in already suffering from an overweight condition. Often overweight conditions are helped with dampness draining formulas and SP rectification, but again, this doesn’t seem to work for everyone. Some of the work seems to need to come from the person themselves.
Anciently, of course, most people were doing hard labor. In many of the Qigong forms we use, we visualize doing various kinds of labor (grinding the millstone, for instance). So, there is obviously some kind of recognition of the physical benefit of hard work. But, again, as explained above - it’s clear to anyone that too much hard physical labor is not great for a person.
I’m interested in this topic for two reasons. First, I expect to have plenty of fitness-challenged patients walking through my door in just over a year’s time. I want to know how to talk to them in a way that makes sense, will help them understand a course of action and yet also be rooted in Classical Chinese Medical principles. Second, as part of my revised Year of Sagely Living goal, I plan to engage in a program of focused physical exercise to help achieve a more optimal physique. Why do this? Well, by anyone’s measure I do need it and also I find that the process (exercise, focusing on what’s going on with my body) is very pleasurable and gives me lots of energy in a way that doesn’t feel at all jittery or strange.
I’m interested to hear others’ thoughts and experiences with this topic. What have you learned? What have you rejected? Please comment!
Note: For the record, my current plan is to balance my physical cultivation through a combination of walking/bike-riding, weight lifting, gardening, Qigong and yoga. I am also doing some work with diet, but mostly just watching portion sizes and eating until I am about 3/4 full. This seems to work the best for me. I’ll probably track my progress on the YSL page, if you’re interested. I will be watching, particularly, my experience of some of this information listed above and monitoring my energy levels very carefully.
Eric
Tags: exercise, human physiology, Year of Sagely LivingRelated posts
Rest and activity in the Year of Sagely Living
You might wonder why you haven’t yet seen a post from me about March’s Year of Sagely Living goal. Fittingly enough, I was at a Qigong retreat all weekend in one of the most beautiful places I have ever been with some of the greatest people I know. It was a good way to start off my contemplation of the rhythm of relaxation and focused work in my life! It reminds me that my program, while rigorous and sometimes quite difficult, does try to build in time for rejuvenation - we have a retreat every term! A luxury, no doubt about it.
When conceiving the Year of Sagely Living we decided to focus March, the time of first real visible manifestation of spring, on the balance between activity and rest. This is such a wide topic, there are a variety of possibilities within it. Originally, I explained:
Lung, Yin 寅 (Tiger)- Activity/Rest: This category will contain practices having to do with appropriate cycles of rest and activity in daily life - for instance, appropriate waking times throughout the seasons.
I am reminded to consider the Lung and everything we learned about that organ system in our classes with Heiner Fruehauf . When I read back through all the symbols associated with Lung I see a lot of contrasting elements. This makes sense given the “tension between opposites” that the actual physical Lung deals with. It interfaces between liquid and gas, it is part of what oversees the interchange between carbon dioxide and oxygen… One of the interesting contradictions we’re asked to ponder as we study the Lung organ system is the fact that while the Lung is most often referred to in terms of metal - as per the Neijing Suwen (and many other places) on the organ clock it is solidly placed in the spring! What can this mean?
I have thought of it in many ways over the last couple of years. First, the Lung/metal is in charge of descending the Qi of the body and the wood is responsible for ascending movement. This vital pillar of human physiology serves as the mechanism by which rhythm is maintained in the body. The Lung is readily associated with rhythm - along with the heartbeat our breathing rate is one of those regular things that happen all day, every day, without our even thinking about it.
Another way to look at it is simply by assuming there is something about the Lung which is Fall and something which is Spring. What parts of Lung function are similar to Fall? The Fall is crisp and cool, it is a time when the Yin energy begins to dominate strongly over the Yang. The Lung, too, is a Yin-like environment as an organ and as one of the six conformations. The Taiyin damp aspect of the Lung creates an organ that likes to be relatively cool (though not cold) and wet (though not filled!). There are other similarities, but I will move on. What parts of Lung function are in resonance with Spring energy? I think the best way to understand this is to take a few minutes and do some really deep breathing. See how the light returns to your eyes? See how your energy rebounds?
I will be thinking about the tension and similarity between Fall and Spring as I enter March and this phase of the Year of Sagely Living. I have a few ideas of what one might consider as practices to learn about rest and activity.
1. Chinese organ clock and its application: I have spoken many times on the blog about the Chinese organ clock. One of the pieces of information associated with the clock that most everyone has heard about is the two hour periods associated with each organ system. Here’s a quick rundown of the associations:
- Lung - Fèi 肺 : 3-5 am
- Large Intestine - Dà Cháng 大腸 : 5-7am
- Stomach - Wèi 胃 : 7-9am
- Spleen - Pí 脾 : 9-11am
- Heart - Xīn 心 : 11-1pm
- Small Intestine - Xiǎo Cháng 小腸 : 1-3pm
- Bladder - Páng Guāng 膀胱 : 3-5pm
- Kidney - Shèn 腎 : 5-7pm
- Pericardium - Xīn Bāo 心包 : 7-9pm
- Triple Burner - Sān jiāo 三膲 : 9-11pm
- Gall Bladder - Dǎn 膽 : 11-1am
- Liver - Gān 肝 : 1-3am
While the organ clock is vitally important and often eerily accurate, it is still something we must look at through the lens of individual experience, cultural application and the normal seasonal changes. Regarding individual experience - this is simply recognizing the changing terrain of the human body. While I believe the human body is essentially the same as it was thousands of years ago, certainly the introduction of many human created chemicals and conditions have altered our bodies in some way. Perhaps some are more resistant to these changes than others. Regarding seasonal changes - in most parts of the world the Yang or light parts of the day are longer in the summer and shorter in the winter. This means that the organ systems located on the “Yang” or daytime side of the clock will have, comparitively, more time in those months.
As an aside - if you have a Mac running OSX (anything before Leopard) you might want to go over to the site of my colleague, Brandon Brown. He has skillfully and artistically created a widget that takes into account these seasonal changes. At this point, it is somewhat limited in that it is focused on the West coast of the United States. He says he’ll work on a more robust version someday. :) Regardless - the main lesson of the organ clock is to remember that all energy isn’t in all places at all times naturally. Everything in its time, in its season. Regarding all this organ clock business, one possible March practice would be to pay close attention to the flow of energy through my organ systems and consider how I might best organize my time to take advantage of the flow.
2. Appropriate amounts of sleep. In the Neijing Suwen, there are some important discussions about the importance of sleep - in particular, the optimal seasonal variations for sleeping and waking. In general, we understand that sleeping is important to bring the Shen back to be housed in the Heart and to allow the Wei Qi to descend into the organs to begin the process of rejuvenation. Sleep is vital! So, when should I wake? How long should I sleep at night? A natural goal here would be to try to achieve my mythical optimum and see how it affects my life. Another would be to try some kind of artificial sleep schedule, something outside of my optimum, and see how that affects my life.
3. Regulating relaxation. We are all told that we need to take time to relax. But, this means many different things to different people. In Chinese medicine school, we learn a lot about the taxing effect that continuous work has on both the Spleen and the Heart organ systems. Depletion of the Qi and Blood leads to what is often jokingly called “Exhausted Student Syndrome.” On my Qigong retreat, I found myself contemplating whether it is better to work very hard with little time for “relaxation” and then take a stretch of time COMPLETELY off or whether it’s more advantageous to work continuously, but with small regular breaks. Further, what is true relaxation? Watching television? Hiking? Playing a sport? Meditating? It’s a variety of things, to be certain, but what is it for me?
A subset of the relaxation question concerns the importance of taking microbreaks while doing sit down work, especially at the computer. Repetitive strain injury is something all Chinese Medicine students and bloggers should think about. One quick note - some recent software programs help you avoid long stretches at the computer with no break. One simple practice I could incorporate into my daily life is simply to use a program like that and to review my ergonomics at my desk.
I’d be interested to hear how other people think about rest, relaxation and work in their own lives. Please leave your thoughts in the comments. In my next article, released shortly, I will declare my March Year of Sagely Living goal.
Eric
Tags: Acupuncture, autumn, fall, focus, human physiology, lung, organ-clock, Seasons, spring, symbolic-thinking, symbolism, Year of Sagely LivingRelated posts
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