Diabetes mellitus is a
heterogeneous primary disorder affecting the processing of
carbohydrates with multiple etiologic factors that generally
involve absolute or relative insulin deficiency, insulin
resistance or both. All causes of diabetes ultimately lead to
hyperglycemia, which is the hallmark of this disease.
Diabetes is typically classified into Type I, or insulin
dependent diabetes mellitus, in which patients have little or no
endogenous insulin secretory capacity, and Type II, or
non-insulin dependent diabetes mellitus, in which patients
retain significant endogenous insulin secretory capacity.
Diabetes mellitus is known in traditional Chinese medicine as
depletion-thirst disease, characterized by polydipsia,
polyphagia, polyuria, and emaciation.
Pathomechanism and Pathogenesis
Diabetes occurs in association with
the following etiologic factors:
1.
The spleen
and stomach are damaged by overeating greasy food or by
over-consuming alcohol, causing failure of the spleen in
transporting and transforming which, in turn, causes
interior-heat to accumulate and consume food and body fluids,
finally resulting in diabetes.
2. Anxiety, anger, mental
depression, etc. injure the liver, causing the liver qi to
stagnate. Protractedly stagnated liver qi turns into evil heat
which consumes body fluids body fluids and eventually leads to
diabetes.
3. Deficiency in
the kidneys caused by intemperance in sexual life or congenital
essence defect causes the kidney qi to wane; as a result, the
kidney qi fails to maintain the functioning of the bladder in
restraining urine discharge, thus polyuria occurs.
Differential Diagnosis of Syndromes
Traditional Chinese medicine
identifies three types of diabetes: the upper depletion-thirst,
the middle depletion-thirst, and the lower depletion-thirst.
Differential diagnosis of syndromes is based upon these three
types
1. Upper-warmer depletion-thirst
diseases
Pathogenic heat consumes the lung
yin, thus affecting the upper-warmer.
Primary manifestations: Severe thirst accompanied by dryness of
the mouth and tongue, polyguria, reddened tip and margin of the
tongue with thin, yellow coating, and full and rapid pulse.
2.
Middle-warmer depletion-thirst disease
Excessive fire of the stomach consumes the stomach yin fluids.
Primary manifestations: Polyphagia, emaciation, constipation,
reddened tongue with dry, yellow coating, and slippery and
strong pulse.
3.
Lower-warmer depletion-thirst disease
a).
Yin deficiency: A morbid state due to a defect in the kidney
essence and consumption of the kidney yin.
Primary manifestations: Polyguria, turbid urine, dry mouth,
reddened tongue with little coating, and weak and rapid pulse.
b).
Deficiency of both yin and yang: A morbid state due to
deficiency of the kidney yin and yang.
Primary manifestations: Severe polyguria, turbid urine,
lassitude, spontaneous sweating, shortness of breath, impotence,
dark complexion, pale tongue with white coating, and deep and
weak pulse.
Treatment
1.
Upper-warmer depletion-thirst disease
Principle of treatment: Expel heat, purge fire, increase the
production of the body fluids and relive thirst.
Formula of choice: Asparagus and Ophiopogon Decoction with
modifications; in this prescription, asparagus root (tian dong)
and ophiopogon root (mai dong) nourish the yin of the lungs and
stomach, and promote the production of the body fluids;
scutellaria root (huang qin) and anemarrhena root (zhi mu) clear
away heat from the lungs and stomach; ginseng (ren shen)
strengthens the qi and produces the body fluids; for patients
with extreme thirst accompanied by a dry and yellow tongue
coating, gypsum (shi gao) can be prescribed to clear away the
stomach fire.
2.Middle-warmer depletion-thirst disease
Principle of treatment: Clear away stomach heat and nourish the
yin.
Formula of choice: Jade Dew Decoction, in which gypsum and
anemarrhena root (zhi mu) clear the stomach fire; fresh
rehmannia root (sheng di) and ophiopogon root (mai dong) nourish
the yin of the lungs and kidneys; and achyranthes root (niu xi)
brings fire downward; for cases with yellow, greasy tongue
coating, add coptis root (huang lian) and scutellaria root
(huang qin) to expel dmap-heat from the stomach; for cases with
constipation, add rhubarb (da huang), magnolia bark (hou po),
and unripe bitter orange (zhi shi) to purge heat.
3.Lower-warmer depletion-thirst disease
a).
Yin deficiency:
Principle of treatment: Nourish the kidney yin.
Formula of choice: Six-Ingredient Rehmannia Pill; when this
prescription is used to treat diabetes, use large dosages of
cornus fruit (shan zhu yu), cooked rehmannia root (shou di),
dioscorea root (shan yao) to nourish and retain the yin fluids
of the liver and kidneys and to replenish the spleen yin in
order to relive polyuria.
b).
Deficiency of the yin and yang:
Principle of treatment: Replenish the qi and nourish the yin.
Formula of choice: Six-Ingredient Rehmannia Pill and
Pulse-Activating Powder; for patients with aversion to cold and
clod limbs, add Kidney Qi Pill to invigorate the kidney yin and
yang.
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