Diabetes is a common metabolic and endocrine disorder. Its primary pathological change is an absolute or relative deficiency of insulin secretion, leading to imbalances in glucose, electrolyte, and acid-base levels. This disease can be classified into many types based on age of onset, clinical manifestations, and the patient’s insulin requirements. In Traditional Chinese Medicine, this disease is referred to as “xiaoke.”
I. Clinical Manifestations
1. Insulin-dependent diabetes (also known as Type I or juvenile diabetes): This type of diabetes most commonly occurs in adolescents and often has a genetic predisposition. It has an acute onset and a severe course, with pronounced symptoms such as polyphagia, polydipsia, polyuria, and weight loss, and may even include intense thirst, constant hunger, and fatigue. Patients have a tendency toward ketosis or may develop ketoacidosis, and their insulin secretion is significantly impaired. These patients depend on exogenous insulin for survival and are sensitive to insulin. Fasting blood glucose levels exceed 130 milligrams, and urine glucose tests are positive.
2. Non-insulin-dependent (also known as Type II or adult-onset) diabetes: This type of diabetes most commonly occurs in adults over 40 years of age and the elderly. Most patients are obese; the onset is gradual, and the condition is relatively mild. Some patients may even lack symptoms of metabolic disorders, with blood glucose levels that are normal or slightly elevated. Their survival does not depend on exogenous insulin, and they are insensitive to exogenous insulin. Urinary glucose may be positive.
3. Chronic Complications in Diabetic Patients: Regardless of the type of diabetes, patients often suffer from atherosclerotic cardiovascular and cerebrovascular diseases, diabetic nephropathy, neurological complications, ocular complications (particularly those affecting the fundus), and a heightened susceptibility to bacterial infections. The onset and progression of these complications are related to the age of onset, duration of the disease, severity of metabolic disturbances, and the effectiveness of treatment.
II. Treatment Based on TCM Pattern Differentiation
In recent years, an increasing number of researchers have come to view diabetes as a complex syndrome with multiple causes. According to Traditional Chinese Medicine (TCM), the internal cause of the disease lies in a constitutional deficiency of yin and an inherent insufficiency, while external factors include irregular diet, excessive consumption of sweet and sugary foods, mental stress, emotional imbalances, obesity, chemical toxins, exposure to the “Six Excesses” or pathogenic toxins, overwork and excessive indulgence, and depletion of yin essence. The pathogenesis involves the depletion of yin fluids and an excess of dry heat. Deficiency of kidney yin is the root cause, while dry heat in the lung and stomach is the manifest symptom, accompanied by spleen qi deficiency, blood stasis, and obstruction of the collaterals. Generally, it can be classified into the following types:
1. Dry Heat in the Lung and Stomach: Patients present with restlessness, thirst, and excessive fluid intake; increased appetite and frequent hunger; dry mouth and tongue; a red tongue with a yellow coating; and a slippery, rapid pulse. Treatment should focus on nourishing yin and clearing heat, using a combination of Yunu Decoction and Yiwei Decoction, modified according to the specific symptoms. The author has achieved significant therapeutic results using a formula developed from many years of clinical experience.
2. Deficiency of Kidney Yin: Patients present with frequent urination in large volumes, urine that is turbid and greasy in appearance, soreness and weakness in the lower back and knees, dry mouth and tongue, heat in the palms and soles, a red tongue with no coating, and a deep, fine, rapid pulse. Treatment should focus on nourishing yin and tonifying the kidneys, using Liuwei Dihuang Decoction with modifications based on the specific symptoms.
3. Spleen Qi Deficiency: Patients present with poor appetite, epigastric distension and fullness after eating, loose stools, shortness of breath and reluctance to speak, fatigue in the limbs and weight loss, a sallow complexion, a pale tongue with a white coating, and a slow, weak pulse. Treatment should focus on tonifying qi and strengthening the spleen, using the Decrease Blood Sugar and Nourish the Pancreas Decoction: Atractylodes lancea, Atractylodes macrocephala, Chinese yam, raw Rehmannia root, prepared Rehmannia root, Scrophularia root, Glehnia root, Polygonatum, Schisandra berry, and silkworm cocoon.
4. Blood Stasis Obstructing the Meridians: Chest tightness and stabbing pain; numbness and pain in the limbs; dark red discoloration of the extremities; ecchymoses on the skin; or symptoms such as hemiplegia, gangrene of the limbs, cloudy urine, and edema. The tongue is dark purple, and the pulse is deep and string-like. Treatment should focus on tonifying qi, nourishing yin, promoting blood circulation, and removing blood stasis. The Modified Peach Kernel Chengqi Decoction may be used. For cloudy urine and edema, treatment should focus on warming the kidneys, invigorating yang, regulating qi, and promoting diuresis; Ling Gui Zhu Gan Tang combined with Jin Gui Shen Qi Wan may be used.
III. Other Therapies for Diabetes
1. Acupuncture, qigong, and psychological counseling may be used for diabetic patients to help alleviate psychological stress, promote a sense of well-being, and stabilize emotions to facilitate recovery.
2. Dietary therapy for diabetic patients: Traditional Chinese Medicine (TCM) treatment for diabetes not only advocates limiting carbohydrate intake, avoiding spicy, greasy, and rich foods, and increasing consumption of fresh vegetables rich in dietary fiber, as well as legumes, dairy products, eggs, seafood, and lean meats, but also emphasizes diet formulation based on syndrome differentiation. For example, in cases of dry heat in the lung and stomach, one may choose spinach and white fungus soup, corn soup, rehmannia and ophiopogon stewed with tofu, radish congee, or lily bulb and raw rehmannia congee. For spleen qi deficiency, porridge made with Chinese yam and Astragalus root, or Chinese yam and Job’s tears porridge, may be used. Additionally, foods such as eel, soft-shelled turtle, kelp, celery, Chinese mustard greens, wood ear mushrooms, shiitake mushrooms, onions, bitter melon, and pumpkin may also be selected.