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It is said that the Kidneys contain the essence (肾藏精) and that the Kidneys govern water (肾主水). There are many other descriptions of the Kidneys, which to me are either of lesser importance or can be derived from the two assertions mentioned above.

Kidneys contain the essence (肾藏精)

Here, essence can be seen as sperm and the testosterone that goes with it. That is why the ancients believed in not letting out your sperm because it takes away your manhood. In fact, testosterone – which is needed to create sperm – is what gives men their male characteristics.

That said, the Kidney is likely not just Testosterone but alot of other sexual hormones, for example DHEA, estrogen and progesterone. The Kidney in Chinese Medicine does a great balancing act with all the sexual hormones in our body.

But that’s not all it is. Androgens are created in the zona reticularis of the adrenals. So adrenals create testosterone. But the Kidneys do not just govern reproduction, they also govern growth and development (生长发育). For this, other hormones like Growth Hormone (GH) are vital. Growth hormone – also called somatotropin – is produced in the pituitary gland. Production of somatotropin as with other sexual hormones decreases with age. In some people, the pituitary secretes insufficient GH from a young age, and so we have dwarfism (呆小症).

The TCM solution here is to pump up on Yin and Yang boosters. Examples include dihuang yinzi (地黄饮子) and baiwei shenqi wan (八味肾气丸).

Kidneys govern water (肾主水)

We can understand this as saying that the Kidney regulates water metabolism within the body. The first place we can see this happening is with the bladder (膀胱). The bladder has an interior-exterior relationship with the Kidneys – it is because of the Kidneys ability to transform qi (气化) that the bladder is able to open and close up in a proper fashion.

When the bladder does not open when it should, we have longbi (癃闭), oliguria (尿少)，edema (水肿) etc, we say that the Kidney isn’t qi-transforming enough (气化不主). In this situation, insufficient qi-transformation means not enough pushing power (推动无力), and so urine doesn’t come pumping out like it should.  When does this happen?

1. In acute nephritis, when the glomeruli are inflammed, GFR falls and there is a fall in urine production.
2. When a guy has benign prostate hyperplasia (BPH), the growth may create a mechanical obstruction that impedes the passing of urine.

In another case, once again the Kidney is blamed for insufficent transformation of qi. But this time, while its is accorded the same reason, the lack of qi transformation means lack of power to hold in/contain (固摄无力，制约无权). Possible consequences include polyuria (尿多)，urinary incontinence (遗尿 and 尿失禁). When does this happen?

1. Stress Urinary Incontinence: due to weak pelvic floor muscles
2. Reflex Urinary Incontinence: This is often due to non-ideal functioning of the nerves that give signals. Often, people with overactive nerves will have reflex urinary incontinence
3. Overflow Incontinence: This happens when the bladder is too full, the result of which bladder pressure exceeds urethral pressure. Such a bladder “leaks” urine because the muscles are weak and it can’t close, dysfunction of the nerves that send messages (seen in diabetes or MS) or mechanical obstruction from a tumor or stones or enlarged prostate gland.

Not Water but Sperm

In addition to urinary incontinence, the Kidneys are blamed for 遗精，滑精，早泄. These are diseases where not urine but spermatozoa exits the body when it shouldn’t. Once again, we talk about Kidneys not holding in (肾不能固摄). But we skip the bladder, since this is not about urine.

How to treat? We can consider the following methods, of which only one is related to holding in (固摄).

1. Clear Liver Channel Damp-Heat using 龙胆泻肝汤.
2. Regulate the constitution of a Kidney-Yin deficient person. Tonifying Kidney Yin using 知柏地黄丸 or 大补阴丸 or 二至丸.
3. Regulate the constitution of a Cinnamon Twig person using 桂枝汤 and add 龙骨 and 牡蛎
4. Regulate the constitution of a Bupleurum person using 柴胡疏肝散. He’s of a stronger constitution with more fire than the Cinnamon Twig person.

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