Ka Wai Ola - Office of Hawaiian Affairs, Volume 3, Number 11, 1 November 1986 — He Mau Ninau Ola [ARTICLE+ILLUSTRATION]

He Mau Ninau Ola

Some Health Questions by Kekuni Blaisdell, M.D.

Ninau: E kauka, kaikamahine (my daughter) tells me her kauka says she has high blood pressure due to her adrenal gland. I never heard of adrenal. Could that be what's causing my kokopi'i (high blood pressure) also? Is there any old hawaiian medicine for this? Pane: Yes, your adren-

als could be, at least in part, responsible for your kokopi'i. I hope the following basic information will help to pane your ninau on this complicated kumu-hana (topic). Adrenal is a Latin word meaning "near the kidney." Eaeh adrenal gland is a small organ normally found on eaeh pu'upa'a (kidney), as drawn in Figure 1 by Bartholomaeus Eustachius, a Roman, who first described these two human body structures to the haole world in 1563. The available old Hawaiian mele (chants) and early native Hawaiian palapala (writings) do not mention such organs by name or site. Nor does the first anatomy book printed in Hawai'i ma 'olelo Hawai'i, by missionary kauka Gerritt Judd, illustrate or refer to these bodies, although na pu'upa'a and other mau mea loko nui (vis-

ceral organs) are depicted, as shown in Figure 2. Nolaila, perhaps the adrenals were not known as such to our kupuna kahiko. Keia wa (today), we know that the adrenals affect blood pressure in two main ways: (1) They secrete chemicals, called hormones, in the koko (blood), even normally in response to mukiple factors described below, that tend to elevate the blood pressure. Contrariwise, nele (deficiency) of one or more of these adrenal hormones may lead to low blood pressure. If such adrenal nele is severe, make (death) ean result. (2) In rare instances, one or both diseased adrenalsmay be the cause of kokopi'i, as will be detailed later. Since there are several adrenal hormones, and their interactions are complex, only a simplified account of three of these chemicals and their roles in kokopi'i will be given here:

• Adrenalin, probably the best known adrenal hormone, is made in and secreted from eaeh inner adrenal gland and also from the ends of certain nerves in most tissues throughout the kino (body). Ko'iko'i (stress), such as from fright, anger, bleeding, cold and hunger, increases adrenalin activity, whieh directly narrows small arteries and stimulates the pu'uwai (heart) to raise the blood pressure. • Aldosterone is a second hormone made in the outer portion of eaeh adrenal. When secreted into the koko, it causes pu'upa'a retention of sodium and wai and thus, elevation of blood pressure. Emi (decrease) of sodium intake or emi of the koko volume or pressure, stimulates na pu'upa'a to secrete a kidney hormone called renin. Renin, in turn, activates another ehemieal called angiotensin, whieh narrows koko arterioles and also stimulates aldosterone to raise the koko pressure.

• Cortisol is another hormone made in the outer adrenal that ean cause kokopi'i and pehu (swelling) from sodium and wai retention. Too mueh of this hormone also ^auses excessive fat in certain tissues, rise in ko koko (blood sugar), weakening of the bones and emi resistance to infections. The major stimulus to cortisol release is another hormone from the pituitary gland in the lolo (brain), in response to stressors, such as pain, injury, hunger, fever and anxiety, whieh act on the pituitary by way of mau a'alolo (nerves) in the brain. Pinepine'ole (infrequently), one or both adrenals, or the pituitary, will become enlarged by growth of too many of the cells responsible for one of the three hormones described above, with resulting kokopi'i. On these rare occasions, destruction or surgical removal of the growth will cure the kokopi'i.

Thus, we begin to see how kokop'i ean be related to kino chemicals, a'alolo, ka lolo (brain), ko'iko'i (stress) and several other kino tissues. Whieh of the above adrenal mechanisms are eoncerned in your kaikamahine's kokopi'i, and whieh may play a role in your own kokopi'i, require careful investigation by knowledgeable specialists. Ask your kauka to explain these mau mea to you. Whieh la'au lapa'au kahiko (old Hawaiian medicines) might be effective for you raises the crucial ninau of just how such agents act. Do they have direct, specific. ehemieal or physical action? Or do they act otherwise, perhaps through the rituals, pule (prayers), the patient's belief system, other psychological or spiritual forces, or the body's,natural healing powers? These and other ninau will be considered in future columns. 'Oiai, e ho'omau e ho'ouna mai/kou mau ninau ola, ke 'olu'olu 'oe.