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The Kidney and Bladder according to Traditional Chinese Medicine (TCM)

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Updated December 2023

This article is part of a series explaining the body’s organ systems from the perspective of Traditional Chinese Medicine (TCM) and Five Elements Theory.

TCM, The Five Elements and the Kidney

The Five Elements (Water, Fire, Wood, Metal, Earth) are qualities of nature that are foundational to the theory of TCM. The theory of the Five Elements is systematically applied to symptomatology, diagnosis, and treatment.  Some may argue that, together with the theory of Yin-Yang, it constitutes the foundation of TCM theory.

Each season is associated with an element, organ system, taste, etc. Each of these correspondences are then utilized in identifying patterns (TCM diagnosis), and treatment options. For example: Herbs that are recommended for phlegm in the sinuses are generally pungent (acrid). Example: radish

A partial list of the Five-Elements correspondences for Winter includes:

  • Season — Winter
  • Element — Water
  • Yin Organ system — Kidney
  • Yang Organ system — Bladder
  • Developments — Storage
  • Color — Black
  • Sounds — Groaning
  • Emotions — Fear
  • Taste — Salty
  • Tissue — Bones
  • Sense organ — Ears
  • Climate — Cold

The Kidney and Bladder systems

In Traditional Chinese Medicine (TCM), the Kidney and Bladder systems form a pair, one yang – the Bladder (BL) and the other yin – the Kidney (KI).

There are six yin organ systems that are paired with six yang organ systems, according to TCM

These pairs of organ systems work together. The vital substances (such as Qi, blood, yin and yang) are stored within the yin organ systems. The yang organ systems are more active; their primary function is to constantly be filled and emptied of the vital substances. One can not work without the other. 

The Bladder organ system is a perfect example of a yang organ system

In Western medicine, the bladder is a reservoir for holding urine before it is evacuated. To do this, according to TCM, the Bladder uses qi (energy) and heat from its paired yin organ, the Kidney. The Kidney is thought to be the root of life. It is the fire that heats (just like cooking). Just as one cannot cook an adequate meal without fire, one can not live without Kidney fire.

Paradoxically, even though the Kidney is the “fire,” both the Kidney and the Bladder are related to the water element. Kidney is responsible for “distilling fluids.” The Kidney regulates fluid distribution, discharges wastewater, and plays an important role in maintaining normal water metabolism in the body. This is why the Kidney governs water. The Spleen, Lung (link), Kidney, Intestines, and Bladder work together to “regulate the water pathways.”

Water element can be seen in the Bladder’s function of holding “water.” Urination is an essential component to the function of our bodies. You will not survive long without being able to evacuate the body’s toxins. As such, the bladder plays an important role through its ability to fill and empty the body of urine, and just as importantly containing it until an appropriate time. Frequently, it is the deficiency of the Kidney yang (fire) that can cause incontinence. Truly they work together. 

The Kidney has five principal functions

  • Storing essential qi, which is responsible for growth, development, and reproduction
  • Governing the bones and engenders (gives rise to) the marrow
  • Governing water
  • Opening into the ears; its “bloom” is the hair on the head
  • Kidney yin and yang are the root of the yin and yang of all the organs

Kidney as it relates to governing bone

It is the job of the Kidney qi’s function to stimulate growth and development. The Kidney stores the essence that engenders marrow, and the marrow nourishes the bones. The brain is known as the “Sea of Marrow.”  In this context, Kidney deficiency could lead to a deficiency of marrow. Common symptoms include: dizziness, dulling of mental faculties, and poor memory.

Other bone-related Kidney deficiency signs: slow development of teeth, premature loss of teeth, delayed closure of frontal bones, pain or stiffness in lumbar spine (link to article low back pain), and knee pain, tinnitus, hearing loss.

The Kidney opens into the anus and the genitals, and their functioning is associated with Kidney qi. In this context, Kidney deficiency may lead to changes in stool or urine, such as scanty urination, long voidings of clear urine, urinary or fecal incontinence, or long lasting diarrhea.

Kidney yin and yang are the root of the yin and yang of all the organs

The Kidney stores the deepest level of energy, called the jing (essence). This becomes the source of all yin and yang in the body, including Kidney yin and yang. 

Kidney yin deficiency affects other organ systems

Properties of Kidney yin include moistening and nourishing all of the organs. 

Symptoms of Kidney yin deficiency include: interior heat signs, dizziness, tinnitus (low pitch), weak aching low back pain and knee weakness, seminal emission, red tongue and dry mouth.

Kidney yin deficiency can lead to the following patterns involving other organ systems: 

  • Liver yang rising, 
  • Liver wind stirring internally, 
  • Heart fire flaring upwards, 
  • Heart and Kidney not communicating, or 
  • Kidney yin deficiency leading to Lung yin deficiency. 

As you can see, the deficiency of Kidney yin can have ramifications on almost every other organ system. 

The properties of Kidney yang are to warm and activate other organs. When Kidney yang becomes deficient it can lead to water metabolism disturbances, diminish reproductive function/ fertility, and may diminish the activity of all other organ systems.

When Kidney yang becomes deficient it can:

  • Affect the Heart yang, causing palpitations, slow pulse, sweating, shortness of breath, and cold limbs. 
  • Affect the Lungs, causing rapid breathing with little exertion.
  • Affect the Spleen, leading to urgent diarrhea first thing in the morning with undigested food.

Conversely, the Kidney organ system can be affected by the long-term dysfunction of other organ systems. 

Fear is associated with the Kidney system

Every organ/energy system in TCM affects both the physical and emotional levels. Excess fear can weaken the Kidneys over time, but irrational fear is a manifestation of a Kidney imbalance. Since the Bladder and Kidney are linked, the Bladder meridian is frequently used to treat fear. 

The Kidney Channel of Foot ShaoYin

The Primary Kidney Channel

  • Begins beneath the little toe
  • Crosses the sole of the foot to Ki 1 (Kidney 1)
  • Emerges at Ki 2 on the medial aspect of the foot
  • Travels posterior to the malleolus at the ankle to Ki 3. It then descends through the heel and ascends to below the medial malleolus to Ki 6
  • It ascends the medial aspect of the leg. Intersecting with Sp 6 (Spleen 6)
  • Continues up the leg to the medial side of the popliteal fossa (behind the knee) at Ki 10, and along the postero-medial aspect of the thigh to the tip of the coccyx where it intersects Du 1 (Governing Vessel 1). 
  • It then threads its way through the spine, enters the physical kidney and connects with the physical bladder.
  • Intersects with Ren 3, Ren 4, Ren 7 (Conception Vessel 3, Conception Vessel 4, Conception Vessel 7)
  • One branch emerges from the kidney, ascends through the liver and diaphragm, enters the lungs, and ascends along the throat to terminate at the root of the tongue.
  • Another branch separates in the lungs, joins with the heart and disperses in the chest to link with the Pericardium channel at Ren 17.
Image with the kind permission of (Deadman et al., 2005)

(Deadman et al., 2005, pp 331-332 )

The Bladder system in TCM has many other functions besides transformation and excretion 

As mentioned above, the Bladder is paired with the Kidney, and the Kidney is the root of life. Which makes it one of the most important energy systems in TCM.  

Negative emotions are associated with the Bladder system

Being consumed by emotions such as jealousy, suspicion, and the inability to let go of grudges is associated with the Bladder system being out of balance. 

Bladder system and low back or knee pain

The kidneys are located under the twelfth rib, and the Bladder meridian runs right through that area. The Bladder meridian has not one, but two pathways down the back lateral to the spine. One of the most common symptoms of Kidney deficiency is low back pain and knee pain. In TCM, the Kidney governs the low back and knees. Hence, treating the Bladder meridian would be one of the most efficient ways of treating low back or knee pain.

The Bladder Channel 

The Bladder channel is one of the longest channels in the body, which makes it efficient at treating most kinds of neck, back, sacral, hamstring, calf, and Achilles pain. 

The Bladder Channel of Foot TaiYang

Note: “cun” is a TCM form of measurement. One cun is equivalent with the width of the interphalangeal joint (the top part of your thumb). A cun is based on your client’s body measurement.

Image with the kind permission of (Deadman et al., 2005)

The Primary Bladder Channel

  • Begins at the inner canthus of the eye at BL 1 (Bladder 1). Ascends the forehead to the vertex to intersect with GB 15 (Gallbladder 15), Du24 (Governing Vessel 24), and Du 20
  • From the vertex a branch descends to the temples above the ear and intersects with the Gallbladder channel at GB 7, GB 8, GB9, GB 10, GB 11, GB12.
  • From the vertex, another branch enters the brain and meets Du 17 and then emerges to descend the nape of the neck where the channel splits into two branches. 

The First (medial) branch of the Bladder Channel

  • Descends along the back of the neck intersecting with Du 14 and Du 13. Then descends the spine 1.5 cun lateral to the midline to the low back- lumbar region.
  • It penetrates deep into the interior via the paravertebral muscles to connect with the kidneys and link with the bladder.
  • A sub- branch separates at the low back, descends along the sacrum, crosses the buttock and descends to the popliteal fossa of the knee at BL 40.

The Second (lateral) branch of the Bladder Channel

  • Separates at the nape of the neck and descends to the medial border of the scapula and then parallel to the spine, 3 cun lateral to the midline, to the gluteal region.
  • Crosses the buttock to intersect GB 30, then descends along the postero-lateral aspect of the thigh to meet with the previous branch of the channel in the popliteal fossa at BL 40
  • Descends through the gastrocnemius muscle (calf muscle), emerges posterior to the lateral malleolus at BL 60, then follows along the fifth metatarsal bone to terminate at BL 67 at the lateral side of the tip of the 5th toe, where it meets the Kidney channel.

(Deadman et al., 2005, pp 251-252)

Keeping the Bladder and Kidney systems healthy

To ensure a healthy Bladder, make sure you drink plenty of water. Not soda, not flavored carbonated water, not coffee or juice, just good old plain filtered water (ZeroWater is a great, low cost, water filtration option). Finding Kidney nourishing foods is easier than you think. In fact, they may already be part of your diet. Include foods like bone broth, beans, legumes, and walnuts in your diet. Avoid greasy and processed foods.

Stretching is also beneficial for both the Kidney and Bladder systems, as it keeps the energy moving through the meridians.  Especially beneficial are movements that focus on stretching the whole posterior portion of your body.

Other methods for helping keep Bladder and Kidney healthy are acupuncture, massage, myofascial release, cupping, gua sha, tuina, and Reiki

Additional Information


  • Deadman, P., Al-Khafaji, M., & Baker. K. (2005). A Manual of Acupuncture. East Sussex: Journal of Chinese Medicine Publications.
  • Hyunbae,K. (2007). Handbook of Oriental Medicine (3rd ed.). Harmony & Balance Press.
  • Kastner, J. (2004). Chinese Nutritional Therapy. Jeorg Thieme Verlag.
  • Maciocia, G., & Xin Ming, S. (2005). The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists. London: Churchill Livingstone.
  • Pitchford, P. (2002). Healing with Whole Foods (3rd ed.). Berkeley, CA: North Atlantic Books.
  • Wiseman, N. (ed., trans.), & Ellis, A. (trans.) (1996). Fundamentals of Chinese Medicine. (Rev. ed.) Brookline, MA: Paradigm Publications.

About the author

Teri Calandra

Teri Calandra Dipl.Acu, MSTOM, L.Ac., LMT, RMT

Teri began her studies in energy medicine as part of her own personal development journey, and continues to to learn and integrate that knowledge into her practice. Teri is the founding practitioner of Calandra Center for Health & Wellness in Schaumburg, Illinois. She is licensed by the State of Illinois in acupuncture (L.Ac.), and board certified through the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).

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