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.
—-
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
Book Review: Bob Flaws, Statements of Fact in Traditional Chinese Medicine
I am pleased to review Bob Flaws‘ latest book, an updated and revised version of his Statements of Fact in Traditional Chinese Medicine
This book is, essentially, a highly organized collection of statements culled from various texts of Chinese medicine thematically represented with English, Chinese and pinyin included. It contains statements about a number of essential topics, from basic theory to individual Zang-Fu organs to pathological processes to treatment principles. So, for instance, in the section on physiology we find a subsection about the Zang and Fu organs. Within that section, under the subheading Lung, we find 49 Chinese statements and their translation from a variety of source texts. There are statements about the Lung’s function in the body, the things that easily harm it, some of its pathological states as well as some more symbolic information pertaining to it. Additionally, Flaws provides a brief yet rich interpretation of each statement and its relevance.
Statements of Fact is intended to be a companion to beginning theory classes in Chinese medicine. In the preface of the book, Flaws discusses the challenges faced by Western students of Chinese Medicine. I have to agree with him on his basic assessment of the situation. We are not commonly asked to memorize pieces of texts or the many poems that Chinese speaking students do. We tend not to have basic theoretical information imprinted on our minds and so when we are in clinic or in conversation with a Chinese-trained practitioner, we may be at a disadvantage. Having the basics of theory at hand make it easier to understand inferences, make connections between treatments and their patterns and generally make us more effective students and practitioners. In the introduction, Flaws states:
“Therefore, I recommend that students study this book along with whatever basic theory text their school has chosen. Then, along with understanding the theory contained in that text, they should try to memorize as many of the corresponding statements of fact as possible. That way, one will have remembered the words and the understood their meaning.”
Further, in many schools of CM doctors make many statements in lecture and clinic that have their roots in the voluminous Chinese medicine literature. Only rarely do they have time to verbally source every statement! The ability for an English speaking student to quickly and easily locate that statement as part of the literature is invaluable. Yet this is also where the book finds its primary weakness. While an extensive bibliography is provided, Flaws was unable to follow each statement with a listing of its source text. He explains in the book that this was impractical. Those statements that did not come directly from a Classical text came mostly from Chinese language compendiums of classical statements and knowledge. He explains that the Chinese sources he utilized did not always list their original source for each statement. However, I feel that it would have been wonderful if he could have at least told us which Chinese source each statement came from, regardless of whether that was likely to have referenced the original source. Additionally, for those statements that he was able to trace back to their original source he could easily have listed them. This would have increased the book’s value immeasurably. However, this omission does not significantly alter my overall positive rating.
Overall, the book is a fine effort. As I’ve already mentioned, the organization is first rate and the inclusion of characters, English and pinyin is most appreciated. All of these elements are improvements over the previous edition. Flaws’ explanations of each statement or group of statements is very nice for beginners, but it will be important for students to be careful of taking these as absolute truth. They are Flaws’ interpretation, and while he is a very experienced practitioner and worthy of great respect, he of course interprets these statements through his own point of view. Using his interpretation as a guide will help new students to get a grasp of the basic idea and they can do further investigation to come to a fuller understanding for themselves.
The book is a great value for the price and I believe it will make a good addition to your Chinese medicine library. You can visit Blue Poppy Press’ website for more information and to purchase yourself a copy. You can also simply click on the picture of the book at the beginning of this article. When you do and have had a chance to use it for a while, please do come and let us know how you enjoyed it.
Eric
Tags: blue-poppy-press, bob-flaws, book-review, books, Character, Classical Texts (general), textual-analysis, Theory, translationsRelated posts
What symptoms can emotions cause in the view of ancient Chinese medicine?
In my previous article, How the Emotions impact the body’s basic energy, Huang Di has some insightful information to share even as he has some questions about his understanding of the emotions and the basic health of the body. QiBo, however, shows his prowess as the Master by revealing some fascinating details about the full impact of emotions on the body - even discussing particular symptoms. I’ll list the text first in Chinese and then in translation to English, using Maoshing Ni’s translation as a guide. I’ll follow that with discussion about what QiBo has to say.
Tags: Character, Classical Texts (general), emotions, neijing, textual-analysis, Theory, translation-problems, translations岐 伯 曰 ：
怒 則 氣 逆/ 甚 則 嘔 血/ 及 飧 泄/ 故 氣 上 矣。
喜 則 氣 和 志 達/ 營 衛 通 利/ 故 氣 緩 矣 。
悲 則 心 系 急/ 肺 布 葉 舉 而 上 焦 不 通/ 營 衛 不 散/ 熱 氣 在 中/ 故 氣 消 矣 。
恐 則 精 卻/ 卻 則 上 焦 閉 /閉 則 氣 還/ 還 則 下 焦 脹 /故 氣 不 行 矣 。
思 則 心 有 所 存/ 神 有 所 歸/ 正 氣 留 而 不 行/ 故 氣結 矣 。
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Keys to a deeper understanding of the emotions in Chinese medicine
To come into a deep understanding of the emotional aspects of Chinese medicine, you have to start with the basics. In this article, I would like to demonstrate my understanding of the emotions as they are described in Chinese medical theory to provide some basis for further discussions on the topic.
There are a few preliminary things to understand before we dive into investigating the emotional states themselves. First, the emotions are associated with the five elemental phases, and thus the organs. There is some literature that lists seven emotions, but I have not investigated that yet. Second, each of the states listed below are like nodes. The physicians of Chinese antiquity were not so naive as to think that there were only five emotions! Each “emotion” is a keystone representative of a group of emotional states. This is the template used by most concepts in Chinese medicine. A concept like Qi, though often explained using a discreet definition, is a placeholder for a much larger and more complex group of phenomena.
One final preliminary note. Much literature about the emotions contains the following standard list: joy, anger, grief, worry and fear. You can find ample information about this list in a variety of books and websites. There are a variety of problems with this list, not least of which is the fact that it doesn’t make much sense to folks that joy could be a negative emotion as all the rest seem to be. In my first year, I learned an alternative way of looking at the emotions that shapes how I see them today. This alternative view sees both Yin and Yang sides to each of the five emotional states. The Yang emotional states are functional and an expression of balance, and the Yin sides are not. Below, I will describe each of these, beginning with the Yin as those are the most commonly discussed. Note that while the Yang “emotions” are natural responses to encounters with the world, the Yin “emotions” seem to be maladaptations.
The fire emotional state: Mania - kuáng 狂
I am not sure if this is the best character to use in this situation. In most lists of correspondences, the Yang emotion of Joy is listed, which I will discuss shortly. Kuáng has a range of meanings from manic, deranged, crazy to unrestrained and wild. The character consists of the dog radical on the left and the character for the Emperor on the right. Many times in class we have heard the Yin state of the fire organ systems associated with the image of the Emperor running around at night barking like a dog. I know I feel sort of this way when I’m fully in the grip of insomnia. It is worth noting that the Pericardium is associated with the dog - which connects it well with the Fire phase, and the Heart in particular.
More often you will see fire, and specifically the Heart, associated with Joy. Joy, the Yang emotion of fire, is represented in Chinese by two characters, lè 樂 and xǐ 喜. Le is variously translated as pleasure, happiness and enjoyment. The pictogram represents a musical instrument made of wood. Xi is translated as like, fondness and happiness and is created from a radical meaning mouth on the bottom and a radical representing a drum on the top. So both of these characters relate to music - a pleasurable activity that often brings people together. This is the kind of joy one gets from being around great friends, it is time in the summer sun filled with laughter and the building of beautiful memories. It is sharing of stories around the fire, playing group games, and the unabashed smile of a toddler.
As the Fire emotional state, it is associated with the Heart, Small Intestine, Pericardium and Triple Burner. Thus these organs are most buoyed when the Yang side of the fire emotional state is cultivated just as they are most harmed when the Yin emotional state takes hold.
As a nexus of emotional states, with the spectrum starting at Pure joy on the Yang side and going further and further off balance finally reaching Mania on the far Yin side this emotional state seems to speak to the outward and inward facing parts of ourselves. It concerns our ability to relate properly with other people, to let them into our world and to revel in the exchange of intimacy that takes place between people. A failure in this regard causes us to display behavior that tells other people to “keep away.”
Tags: Acupuncture, Character, emotions, etymology, five phases, textual-analysis, translationsRelated posts
What are the classical texts of Chinese medicine?
Because I mention the classics of Chinese medicine often, I think it makes sense to list them. The list below is short, and rightly so. These are the works that have been recommended to me most often, and they are also available in English. There are doubtless other books that one could consider under the category “Chinese Medical Classics” (for instance, the Pi Wei Lun) but they have either not been recommended to me by my CCM teachers or are not available in suitable English translations.
Each name will lead you to a link where you can purchase a recommended translation of each book. Future posts will discuss the texts at length and provide reviews of different translations where available. The best of all worlds is achieved when you have at least two different translations of the text as well as the original Chinese and either a command of the language or an excellent Chinese-English dictionary and the ability to use it. This way you can use prior translations as a guide and fallback while checking the translation for accuracy and gaining a broader understanding of the information.
Shang Han Lun
Huangdi Neijing - The Yellow Emperor’s Internal Classic. The Huangdi Neijing is composed of the Suwen
Shennong Ben Cao Jing
Mai Jing
Nan Jing
Huangdi Zhen Jui Jia Yi Jing, aka Jia Yi Jing
Zhong Zang Jing
There are several other texts that one might consider foundational in the field of Chinese medicine, but they are not medical books. They serve as a foundation insofar that CM grows out of the soil of Chinese culture and philosophy. Thus, if a person wants to have a deep relationship with the medicine they must feel comfortable operating within the context of ancient Chinese culture and philosophy.
Yi Jing (I Ching) - Th
Dao De Jing (Tao Te Ching) - The Classic of the Way
The Analects
* I have provided some Wade-Giles spelling for texts that people recognize best that way.
Eric
Tags: Acupuncture, books, Classical Texts (general), education, Learning, lists, students, study-methods, translations
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