Chinese medicine never recommends single rules for everyone to follow. The idea of general advice to drink 8 cups of water—or any set amount—is too simplistic. Fluid needs are constantly changing. Often, more water simply increases uri- nation, which can be good at times but at other times can be taxing, particularly for the elderly. The key to understanding water and health is:
• becoming more aware of our fluid status, and
• how to eat and drink for best absorption and utilization of water.
Many people, young or old, are chronically under-hydrated, and dehydration underlies a great many chronic degenera- tive conditions. To have a basic idea whether you are dehydrated, assess your first urine after getting up in the morning. Healthy urine is lightly straw colored and without a strong smell. Morning urine that is dark, scanty or strong smelling is a sign of dehydration (and internal heat), while morning urine that is watery, pale, odorless and abundant signifies sufficient hydration (but also indicates internal cold). Inability to sleep through the night without waking to urinate often indicates deficient qi or vital energy. is may seem counterintuitive, but the qi of the lower arena is needed for the action of holding the bladder until morning.
Very commonly, elderly men and women will deliberately avoid hydrating sufficiently because of urinary difficulties. If urinary difficulties are present, they can be classified into five types (the five lin in Chinese medicine): painful (burning), cloudy, bloody, stone, and qi taxation (fatigue after urina- tion). Healing strategies include restoring hydration while also aiding diuresis, through increasing hydrating drink and food (grains, congee, porridge, soups, stews) along with foods known to be mildly diuretic, then addressing the presence of internal heat (inflammation) or cold (stagnation). Foods with diuretic quality include bland foods (e.g., zucchini, bean sprouts, mushrooms, sea vegetables, melons, fruit eaten with their peels, or, within animal food, single shell mollusks) and green beans eaten complete with their pods (e.g., string beans, snow peas and sugar snap peas, or a broth made from just the pods themselves). From this beginning more precise
treatment strategies are developed, based on the type of difficulty present.
In our family, we drink one or two glasses of room temperature water shortly after waking, ideally 15-20 minutes before breakfast. This water is not primarily for hydration, rather, it passes quickly through an empty stomach and irrigates the in- testines. In a healthy person, peristalsis is stimulated, there is morning elimination, and after about 20 minutes, nearly the entire amount of water is reabsorbed for use. The Large Intestine is very important for regulating hydration in the body, including reabsorbing and redirecting water from digestive waste. Drinking plain water first thing in the morning is a very strong health practice centered on the Large Intestine. This water—neither cold nor hot—is the only drinking that is beneficial to do quickly.
The best breakfasts for hydration are wet, cooked breakfasts: porridge, congee, or even soup (essential in a traditional Japanese breakfast, for example). Wet
breakfasts nourish stomach yin and provide time-released hydration to the body. (See “Congee and the Importance of Wet, Cooked Breakfasts,” Golden Flower Newsletter, Fall, 2015.) Soups were once part of nearly every meal, a prac- tice that can be revived for noticeable improvements in health through nourishing stomach yin.
DRINK WATER BETWEEN MEALS, NOT WITH FOOD
For best digestion, drink water between meals, because water (or other drinks) can dilute the digestive secretions necessary for efficient and timely digestion (including stomach acid and pancreatic enzymes). The sensation that you can’t eat or swallow without drinking something “to wash it down” could be a sign of chronic dryness due to an internal heat condition (low-level inflammation). Drink in sips during meals to satisfy that urge (or the culinary urge of matching drinks with food). Once better hydrated through morning water, wet breakfasts and ample (but not measured) water between meals, the sensation some have that food is too dry to swallow will disappear.
The primary step in digestion is breaking down solid foods through physical and chemical means into the semi-liquid mass known as chyme. This is achieved in the stomach, after which the chyme is slowly released into the duodenum, the upper portion of the small intestine. Drinking fluids during a meal can dilute the acids and other secretions, causing the stomach to slow its pace or sending the chyme forward without sufficient processing.
Foods not sufficiently broken down in the stomach must un- dergo this first step of digestion in the small intestine. The small intestine is capable of providing another attempt at this primary phase of digestion, but whereas the stomach is a decidedly acidic environment, the alkaline environment of the duodenum is better suited for the secondary steps.
Digestion is further inhibited by drinking cold beverages, since digestion works best at body temperature. Having ice in drinks is not a health-supportive practice as it dramatically slows digestion. Further, since all metabolic functions are hindered by cold, it is sensible to avoid introducing cold to the digestion if interested in restoring metabolism or avoiding weight gain. It is best to wait 20-30 minutes after eating before drinking water, tea, or other drinks, at room-temperature or above.
HOW CAN I BE DEHYDRATED WHEN I STILL HAVE SALIVA, BLOOD, SWEAT, ETCETERA?
Our bodies have a complex hierarchy of fluid distribution. For example, since eating is essential for survival, fluid is provided to create saliva even if relatively dehydrated; saliva is prioritized above other hydration needs. It is for this reason that by the time you feel thirsty in the mouth you are long past due for water. Other areas have been deprived of fluids to insure sufficient saliva to facilitate swallowing food. Sweating when hot is also necessary for survival. Inability to sweat when overheated or during a fever is a serious sign needing attention, but fluid sufficiency and mobility has usually been compromised long before symptoms can be noticed. The joints, for example, are low in the fluid priority hierarchy. In this sensible and interesting model, most chronic degenerative illnesses—including inflammation in the joints and resultant arthritis—result directly from chronic dehydration, hidden from view.
Drinking more water has a double benefit: first, more hydration is simply available and second, frequent, ample water intake signals the body that it doesn’t need to ration internal hydration. Fluids are released and allowed to circulate to the areas of relatively low hierarchy. The very fact that the body prioritizes fluids is a way of understanding why degenerative illnesses usually arise later in life: the aspects most critical for personal and species survival are prioritized, the other aspects become a catalog of common degenerative illness. Drinking water becomes a longevity practice if it not only provides fluids but signals within the body that the fluid supply is not and will not be stressed. Drinking sodas, carbonated water, tea, coffee, beer, juice, or anything but still water is less effective (or harmful) for protecting or restoring healthy fluid metabolism.
Beyond drinking water, wet-cooked foods are very important for hydrating the body. Chinese medicine has extensively explored the differing hydration benefits of drinking water and eating various foods. Plain room temperature water upon waking, between meals, and especially before and after exercise is very important. Hydration absorbed through wet-cooked grains, soups or stews functions differently and is perhaps equally important (though not interchangeable). The very gentle sweetness of rice congee or summer squashes nourishes the yin aspect of stomach and digestion and is particularly beneficial for nourishing fluids. By including water in these dishes along with some oil or fats, the aspects of internal fluids that are rely on lipids are also nourished.
HOW YOU DRINK WATER MATTERS
When drinking water, sip rather than gulp. Sipping water brings the calming influence of water gently into the stomach. Gulping to quench an urgent thirst
can be a sign of having neglected hydration, eating overly salty or spicy foods, or a condition of internal heat.
At least occasionally in our lives we might raise water to the level of a healing herb. To do this, sip water as if it is an elixir to harmonize and restore our physical, mental, and emotion- al beings. If you like, imagine where it’s been, how old it is, how it continually gets renewed through its cycle of evaporation and rain. This is a simple and powerful spiritual practice available to everyone without any fuss or formal structure.
Observing the Tongue to Assess Hydration
Observing the appearance of the tongue is a valuable method for assessing internal conditions. Although training is needed to match what is seen with medical theory, anyone can easily learn to interpret basic information from the appearance of their tongue in the mirror, particularly about hydration and diet.
The tongue’s coat reveals information about current hydration and uid transport status. If the coat is absent, some degree of dehydration and yin deficiency is occurring. On the other hand, if the coat is overly shiny, thick, or saliva is sticky, some degree of dampness or yin stagnation is present. (The first step is to reduce or eliminate sugar, gluten and dairy; in many cases that is sufficient to restore balance.) This relates to the coating of the tongue.
The body of the tongue itself should be neither too thin (not assimilating nutrition well enough) nor too thick (indicating stagnation of digestion and building up of unhealthy yin). The surface of most tongues has various crack lines. Small, horizontal cracks emanating from the middle area of the tongue are the ones that interest us here: this crack pattern (if present) represents a history of dehydration.
WHAT WATER TO DRINK
Plain water is the best drink for our bodies’ necessary hydration. Carbonated water is highly stimulating, and, being water, stimulates our Water Element (Kidney, Bladder). Carbonated water can be pleasant but it effectively becomes a diuretic, potentially causing the loss of more water than it contributes. Many find this counterintuitive, but consider that athletes do not drink carbonated water or sodas to hydrate before, during, or after games.
Juices are concentrates of their fruit (or vegetable) and should be used judiciously for their energetic effects. Coffee, tea, and alcohol are drying. Cold (iced or refrigerated) drinks (including water) can be shocking to the internal organs (which like to be at a well-regulated temperature). Cold drinks even when we are overheated (in Summer or after exercise) are best avoided. The insistent practice in American restaurants of automatically providing water with ice even during very cold weather is ill-advised. Ice cubes are a historically recent thing, and can be understood as representing a conspicuous expression of affluence: only the affluent can have ice cubes all year or be heated enough in the winter to desire them. A better offering from restaurants would be nicely filtered water at room temperature. For those strongly desiring ice, it is not hard to find, but if the desire persists it is prudent to look for issues of chronic dehydration, use of non-hydrating drinks, and particularly conditions of internal heat. Looking honestly and being open to changing personal hydration habits could strongly help prevent serious problems as varied as acid reflux, heart disease, auto-immune diseases, joint pain, depression, kidney stones, influenza, and common cold.
SELECTING WATER TYPES
Spring water contains natural minerals; distilled water does not. Distilled water will absorb minerals out of our bodies and is useful only for purposes of detoxification (use with caution if at all, not long-term).
Bottled mineral water does contain minerals, of course. Brands are differentiated by the types of minerals that predominate, usually salty (e.g., Evian, Vichy, Apollinaris) or “sulfury” (e.g., Saratoga Spring). Salty tasting mineral water is more calming (more alkaline) while the “sulfury” tasting mineral waters are more stimulating (sulfur is traditionally used to foster transformations in the self-cultivation work known as Internal Alchemy). Other common minerals include calcium, magnesium, and potassium; these can be considered as less extreme than salty or “sulfury” and slightly calming (due to their slightly higher alkalinity). Certain brands specifically market high pH of their bottled water; more alkaline waters can be considered as slightly more calming, but major health claims may be overstated. Generally, water should be neutral or slightly alkaline (higher in pH). Tap water running through plumbing should certainly not be acidic (it can dissolve metals into the water), and overly acidic internal body conditions can underlie many health problems, but purchasing bottled waters with special pH levels is not necessary. The most natural and effective methods to resolve internal acidity are to eat far more green vegetables and to regularly breathe more openly and fully (built up carbon dioxide in the blood from shallow breathing increases blood acidity).
Filtered water can be excellent, depending on the source of the tap water and the type of filter. Avoid filters that remove all impurities (or use like distilled water, only for detoxification purposes). Some people add small unpolished stones to the water tank after filtration with the intention of adding back minerals and alkalinity. Find your own comfort zone; we prefer filters in the middle of the spectrum.
Tap water does include minerals, but drinking unfiltered tap water should be considered carefully according to location and water treatment. Much of the world never uses tap water for drinking. Safe, drinkable tap water has provided an inestimable boon to public health, nonetheless the additives used in the process need to be considered. Choices can be (and should be) personal; for example, we filter New York City water for drinking, making tea, and cooking (but not for showering) and drink our Connecticut well water as it comes from the ground (after testing and carefully reading the report).
Overall, spring or filtered water are the best choices, sipped slowly and often, with ample use of wet-cooked foods in the diet. And don’t forget to have plenty of room temperature water shortly after waking.
Hydration is never just about drinking water. Many factors are significant. Our diets can include drying foods or drinks, or we can regularly include dishes that have specific influences on our fluid metabolism. Two recipes follow, one for
a porridge that helps maintain good hydration, and one for a soup that helps drain stagnant fluids (water retention and related problems). A skilled home cook should know both strategies.
Millet is perhaps the most hydrating of all grains. Water absorbed by the millet during cooking is released by the body during digestion.
4 cups water
2 cups cooked millet (leftover is fine)
8 unsulfured dried apricots, sliced
2 tablespoons kuzu powder (mixed rst into a slurry with 2 tbls cool water)
2 tablespoons maple syrup, honey or barley malt syrup
1 teaspoon tamari
1/2 cup pine nuts
Options: Peaches are another fruit traditionally paired with millet. Dried peaches (or dried apples) can be substituted for apricot in this dish if dryness is in the lungs. Apricots will focus the dish to the middle area of digestion (and the organs of stomach, pancreas, spleen, liver, and gall bladder). Peaches and apples would shift the focus to the area of the chest. Peaches, pears, and apples moisten the lungs and are good to help a dry, hacking cough.
Although seeds are not classically included with wet-cooked grains, sprinkling a tablespoon of black sesame seeds just before serving is an option (and will help spread the benefits to the lower arena of the torso, including intestines, kidney, and bladder).
Snow Pea and Mung Sprout Soup
Hydration health is not just about providing enough water, it is also about clearing stagnant fluids through a healthy kidney and bladder system. If fluid stagnation (dampness) or any of the five lin (urinary symptoms) are a problem, a diuretic soup is a good addition to the diet. Fresh broth renews hydration while diuretic vegetables helps flush out heat and dampness.
For a cleansing snow pea (or string bean) soup, use a vegetarian stock made from dried mushroom and kombu. (Chicken, meat or bone stock are fortifying and warming; here we want to focus on clearing.) Place 1 piece dried kombu and about 5 dried black mushrooms in a pot of cool water. Bring to a boil, reduce to simmer. Remove mushrooms and kombu after 10-15 minutes. Reserve the mushrooms, discard the kombu. Add some salt if desired. Throw in a good handful of clean, trimmed snow peas per person to the stock, cut in half or thirds if you wish. Add 1/2 handful mung bean sprouts per person to the pot. When the snow peas are bright green and the sprouts just wilted, ladle into bowls. In the bowl, add the cooked mushrooms (sliced thinly without their stems), a splash of good tamari, a dash of toasted sesame oil and a generous pinch of cilantro or parsley. This soup is a template; add root vegetables such as daikon, carrots or parsnips, rutabaga, sliced scallions, slivered fresh ginger, and so forth. For something more hardy yet still cleansing, add cellophane noodles, lentils, or use a fish stock. Options are open. Select foods with cooling and clearing energetics. Snow peas or string beans are mildly diuretic, as are mung bean sprouts. Mushrooms also help clear dampness; more importantly, they strengthen the kidneys to handle increased clearing, particularly the dried black mushrooms. For a stronger effect, add bitter vegetables such as broccoli rabe, chicory, or dandelion greens.
©Andrew Sterman, 2017. First published in Herbal Medicine Press, Santa Fe, New Mexico
ANDREW STERMAN teaches food energetics and sees clients for private dietary therapy and qigong practice in New York City. He has studied broadly in holistic cooking, and since 2001 has been a student of Daoist Master Jeffrey Yuen in herbal medicine, qigong, tai chi, meditation and of course, dietary therapy from the classical Chinese Medicine tradition. In addition to an active musical career in New York City, Andrew is currently completing a multi-volume book on food energetics and previews material on his blog, andrewsterman.com/#!blog/c5kf or at facebook.com/UnderstandingFood.