**5. Kidney Essence, Qigong, and diabetes**

Diabetes mellitus is a common degenerative disease and one of the leading causes of morbidity and mortality in developed countries. Diabetes has become a worldwide epidemic with a substantial social and economic burden [6]. The prevalence of this disorder is rising dramatically; an estimated 370 million people worldwide will be suffering from diabetes in 2030 [7]. Type 2 diabetes mellitus (T2DM) is a complex, chronic, metabolic disease with hyperglycemia and is the most common form of diabetes. The exact cause of T2DM is unknown in Western medicine. The modern studies show that bioenergetic dysfunction is emerging as a cornerstone for understanding T2DM. The mitochondria, whose main function is the production of the energy substance adenosine triphosphate (ATP), all the life activities depend on ATP, mitochondrial dysfunction is at the centre of understanding many metabolic disorders, such as obesity and T2DM [8, 9]. Imbalanced energy homeostasis is characteristic of obese and T2DM patients [10]. This suggests that mitochondrial dysfunction might contribute to metabolic inflexibility and insulin resistance [11]. The ability of pancreatic β-cells to regulate blood glucose levels relies on mitochondrial ATP generation. Adenylate energy charge was decreased in prediabetic rats, as were ATP and adenosine diphosphate (ADP) levels. Conversely, adenosine monophosphate (AMP) levels were increased, evidencing a decreased ATP/AMP ratio [12].

Qigong is one of the major Chinese medical therapies used to strengthen Qi through self-practice and to manage the state of Qi to prevent and cure disease. Qigong therapies are popular in China as Qi therapies are in Asia. Medical Qigong is defined as the system of authentic Qi (vital energy) practice, which empowers the body to heal itself and to facilitate the healing process of others. Qigong exercises that focus on boosting Kidney and Spleen Qi can be particularly beneficial in managing T2DM [13–15].

Genetic, dietary, lifestyle, and environmental factors play a role in T2DM. Improper diet, overeating of certain foods, and overtaxing the body can weaken the Qi energy and disrupt the balance of the Zang (organs). Likewise, a sedentary lifestyle can weaken the Qi because not enough Qi is generated to invest in the strengthening of the body. Medical Qigong involves appropriate management and regulation of all energetic and informational communications. Receiving acupuncture treatments from an experienced Chinese medical practitioner supports the management of T2DM by improving the energetic function of the internal organs.

The kidney is central to the understanding of the pathogenesis of T2DM in Chinese medicine. Kidney is the root of Qi and the foundation of Yin and Yang in the body. The Kidney stores the Essence or one's inherited original reserves of vital energy. If one has constitutional kidney deficiency, one may already be deficient in Yin and may be predisposed to other organ imbalances. In the view of TCM, the etiology of diabetes can originate with pre-heaven Kidney Essence or Kidney Yin deficiency and weakness of the five Zang organs that predispose a person to further imbalances such as Spleen Qi deficiency. Congenital Kidney Essence and vital Qi deficiency are the intrinsic factors to diabetes. In addition, chronic Kidney Yin deficiency can diminish the generation of Kidney Yang. Combined Kidney Yin and Yang deficiency can in the long run lead to Kidney Qi failure, making the kidney unable to regulate the exiting of body fluids and manifesting as the need to urinate directly after drinking [16]. In Chapter 3, Guan-Cheng Sun et al. look at how TCM views diabetes as well as new understandings of how Qigong can support the management of T2DM and discuss the changes of mitochondrial energy metabolism and bioenergetics in the process of T2DM onset.

### **6. Kidney Essence and reproduction**

Infertility is a worldwide problem affecting people of all communities; infertility has a wide range of causes stemming from three general sources: physiological dysfunctions, preventable causes, and unexplained issues [17]. It is an important medical and social problem in the world as regards 15% of couples are infertile and 40% are infertile because of male factor infertility [18]. The ancient Chinese physicians think that the main pathogenesis of infertility is kidney deficiency; kidney-nourishing therapy is an effective method to the treatment of infertility. Kidney deficiency syndrome was positively correlated with Yin deficiency and Yang deficiency constitution. The Kidney stores Essence to control the reproductive activity. Kidney Essence is the basis of the conception; the Kidney Essence-, Kidney Qi-, Kidney Yin-, and Kidney Yang-tonifying therapies were often used according to treatment based on syndrome differentiation. Acupuncture and moxibustion work by regulating Qi flow over the meridians. According to the Yin and Yang theory, Kidney Essence pertains to Yin, while the Kidney Qi pertains to Yang. Kidney Essence is the most vital substance both constituting the human body and supporting its functional activities; it is the foundation of Kidney Yin and Kidney Yang. Kidney Yin provides material basis for the activities of human body, while Kidney Yang promotes the functions of the organs. In Chapter 4, Yen-Nung Liao et al. reviewed the scientific evidence that kidney-nourishing Chinese herbal formulas, single Chinese herbs, acupuncture, and moxibustion are used for female and male infertility.

TCM, with its long history of clinical practice, occupies an important place among the "alternative medicine" that has been gaining attention in recent years. Because of the general mildness in nature and the emphasis on relief, balance, and harmonization rather than forceful suppression, many good Chinese medicines are particularly suited for pregnancy. Lu Li et al. summarize in details the Chinese medicines classified as contraindicated, not recommended and cautiously used for pregnancy in Chinese *Pharmacopeia*. The authors obtained the most specific safety information for pregnancy. They gathered information about the adverse effects and potential toxicity of the Chinese medicines for pregnancy.
