bubble_chart Concept

Chinese medicine has records of conditions similar to diabetes as early as over two thousand years ago in the Huangdi Neijing, which described them under various names such as "Xiao Zhang," "Fei Xiao," "Gao Xiao," and "middle consumptive thirst" based on their different manifestations. Later generations of physicians generally classified diabetes under the category of "consumptive thirst" in Chinese medicine. The disease's etiology and pathogenesis are as follows: congenital insufficiency, emotional disturbances, dietary irregularities, invasion by the six excesses, and excessive labor or indulgence leading to weakness of the five zang-organs. Over time, stagnation transforms into fire, accumulated heat damages fluids, fire scorches and depletes yin, and essence is consumed, injuring the kidneys. The key pathogenesis lies in the deficiency of yin essence and the internal exuberance of dryness-heat, with yin deficiency being particularly critical. Yin deficiency is the root, while dryness-heat is the manifestation, and the two interact as both cause and effect throughout the course of consumptive thirst. This disease involves multiple zang-fu organs, but primarily the lungs, stomach, and kidneys, corresponding to upper consumptive thirst, middle consumptive thirst, and lower consumptive thirst, with the kidneys being the most affected. The lungs, stomach, and kidneys often influence each other, leading to the simultaneous occurrence of excessive drinking, eating, and urination. Prolonged consumptive thirst often results in static blood retention, and phlegm-blood can become a pathological product, blocking the zang-fu organs and causing syndromes of qi stagnation and blood stasis.

bubble_chart Modern Research

Diabetes is a common endocrine and metabolic disorder, characterized by relative or absolute insulin deficiency, leading to abnormal metabolism of carbohydrates, fats, and proteins. Its main features are hyperglycemia and glycosuria. The incidence rate is 3% to 5% in European and American countries, and 0.6% to 1% in China. The disease course is lengthy, and the lesions can affect the whole body. In critical conditions, it can lead to ketoacidosis, diabetic unconsciousness, cardiovascular and cerebrovascular diseases, chronic renal insufficiency, etc. The World Health Organization classifies diabetes into:

1. Type I diabetes, caused by absolute insulin secretion deficiency.
2. Type II diabetes, caused by relative insulin secretion deficiency.
3. Other types, namely secondary diabetes, with complex disease causes, including various diseases or drugs that induce diabetes.

Modern medicine believes that the disease causes and pathologies of Type I and Type II diabetes are different. The former is due to autoimmune deficiency, with genetic susceptibility, and the basic lesion is lymphocyte infiltration and β-cell destruction in the islets. Genetic susceptibility is closely related to the HLA-Class genes in human leukocyte antigens, which, under the influence of environmental factors, can induce an autoimmune process in β-cells, leading to Type I diabetes. Viral infections are now considered to be possible initiating factors and mediators in the onset of diabetes, selectively affecting susceptible individuals and inducing autoimmune deficiency to cause the disease; the latter mainly occurs due to insulin receptor defects. As for other types of diabetes, each has different primary disease causes, which will not be detailed here.

[Diagnosis]

Clinical presentation of typical symptoms such as polydipsia, polyphagia, polyuria, weight loss, and lack of strength makes diagnosis not difficult. For those without symptoms or with atypical symptoms and those seeking medical attention primarily for diabetic complications, laboratory confirmation is required. Diagnosis can be made if any one of the following conditions is met:

1. Blood glucose at any time of the day ≥11.1mmol/L.
2. Fasting blood glucose ≥7.8mmol/L.
3. Fasting blood glucose <7.8mmol/L, but blood glucose 2 hours after glucose load >7.8mmol/L.

Diagnosis of diabetes can also be made if any one of the following conditions is present:

1. Fasting blood glucose on two occasions ≥7.8mmol/L.
2. Blood glucose 1 hour and 2 hours after the first glucose load ≥11.1mmol/L, and blood glucose 2 hours after a repeated glucose load still ≥11.1mmol/L, or repeated fasting blood glucose ≥7.8mmol/L.

(Blood glucose conversion factor: 1mmol/L = 0.0557mg/dL)
In addition, urine glucose can be measured: both Benedict's method and test strip method show positive results; glycated hemoglobin measurement, which can be 2 to 8 times higher in diabetic patients than in normal individuals; pancreatic function tests: glucose tolerance test, insulin release test, C-peptide release test, glucagon, and insulin receptor and antibody measurements, etc., are of great significance for further classification diagnosis, disease cause, and pathological diagnosis.

bubble_chart Pattern Analysis

1. Yin Deficiency︰Excessive thirst and drinking without relief, swift digestion with rapid hungering, dry mouth and throat, irritability and anger, heat intolerance and restlessness, frequent urination with large volume, or constipation. Red tongue with yellow coating, wiry and rapid or slippery and rapid pulse. Enriching yin and clearing heat. White Tiger Decoction Plus Ginseng or Consumptive Thirst Formula combined with Jade Fluid Decoction with modifications. Gypsum Fibrosum 30–60g, Anemarrhena Rhizoma 10g, Pseudostellariae Radix 30g, Dioscoreae Rhizoma 30g, Trichosanthis Radix 10g, Schisandrae Fructus 10g, Glycyrrhizae Radix Praeparata 10g, Puerariae Radix 15g, Nelumbinis Rhizomatis Succus 30g, Coptidis Rhizoma 5g. For severe thirst, add Glehniae Radix and Dendrobii Caulis; for constipation, add Rhei Rhizoma 10g.
2. Deficiency of Both Qi and Yin︰Mental fatigue, lack of strength, shortness of breath, reluctance to speak, emaciation, dull complexion, spontaneous sweating, night sweats, thirst with preference for drinking, palpitations, insomnia, dark urine, dry stools. Red tongue with scant moisture, thin or patchy coating, wiry-thin or thin-rapid and weak pulse. Treatment: Tonify Qi and nourish Yin. Modified Six-Ingredient Rehmannia Decoction combined with Pulse-Reinforcing Powder. Ingredients: Prepared Rehmannia Root 15g, Chinese Yam 20g, Cornus Officinalis 10g, Alisma 10g, Indian Bread (Poria) 15g, Ginseng (or Heterophylly Falsestarwort Root) 10–20g, Ophiopogon Tuber 10g, Schisandra Fruit 10g. Modifications: - For tidal fever and night sweats, add Glutinous Rice Root 10g, Phellodendron Bark 10g, Anemarrhena 10g. - For insomnia, add Glossy Privet Fruit and Yerbadetajo Herb 15g each. - For soreness and weakness in the waist and knees, add Mulberry Fruit, Barbary Wolfberry Fruit, and Eucommia Bark 10g each.
3. Deficiency of Both Qi and Yin with Blood Stasis︰In addition to the symptoms of deficiency of both qi and yin, it may be accompanied by chest tightness, suffocation, precordial pain, dizziness, headache, blurred vision, limb numbness, and hemiplegia. The tongue is often purplish-dark or has ecchymosis on the edges, with varicose sublingual veins and a thready, unsmooth pulse. The treatment involves tonifying qi, nourishing yin, invigorating blood, and resolving stasis. Modified Peach Kernel Purgative Decoction combined with Pulse-Reinforcing Powder is used, including Peach Kernel 10g, Carthamus 10g, India Madder Root 10g, Sappan Wood 10g, Tianqi Powder 3g (infused), Salvia 15g, Cinnamon Twig 10g, Sichuan Lovage Rhizome 10g, Ophiopogon Tuber 10g, Ginseng 10g, and Schisandra Fruit 10g. For severe dizziness and headache, increase the dosage of Sichuan Lovage Rhizome and add Feather Cockscomb Seed. For limb numbness, add Suberect Spatholobus Stem, Chinese Clematis Root, and Polyghace Seche.
4. Deficiency of Both Yin and Yang︰Cold limbs, pale or dark complexion, tinnitus, soreness in the waist, male sexual dysfunction including impotence and premature ejaculation, loose stools, abdominal distension and fullness, poor appetite, scanty urine, edema, and cool extremities. The tongue appears pale red, swollen, tender with tooth marks on the edges, and has a thin white or white greasy coating. The pulse is deep, thin, or rapid and weak. The treatment focuses on warming yang and enriching yin to strengthen the kidneys, using a modified Golden Chamber Kidney Qi Pill. The prescription includes: Prepared Rehmannia Root 20g, Moutan Bark 10g, Poria 15g, Chinese Yam 15g, Cornus 10g, Alisma 10g, Prepared Aconite Lateral Root 10g, Cassia Bark 10g, Astragalus Root 15g, and Solomonseal Rhizome 10g. For premature ejaculation, add Dodder Seed, Glossy Privet Fruit, and Cherokee Rose Fruit. For frequent nighttime urination, add Mantis Egg-case, Sharpleaf Galangal Fruit, and Palmleaf Raspberry Fruit. For edema, add Motherwort Herb, Corn Stigma, and Plantain Seed. If accompanied by signs of phlegm and blood stasis, add Salvia, Carthamus, and Suberect Spatholobus Stem.