Diabetes mellitus is a common metabolic endocrine disease, the incidence of which is increasing rapidly with the improvement of human living standards, lifestyle changes and the aging of the population, and is reported by WHO to be the third most lethal disease after cardiovascular disease and malignant tumors. At present, modern medicine has not fully elucidated the causes and pathogenesis of diabetes, therefore, there is a lack of fundamental measures to prevent and treat it. Treatment is often carried out through diabetes education, diet, exercise and medication to achieve weight loss, control blood sugar, prevent complications, improve quality of life and prolong survival time.
Glucose-lowering drugs and insulin therapy can control blood glucose quickly and effectively, and the mortality rate of acute complications of diabetes has been basically controlled clinically, but the efficacy of its chronic complications is lacking, especially because chronic complications can damage all systems of the body, which brings great pain to diabetic patients and a heavy burden to their families and society, and the prevention and treatment of its chronic complications is also receiving increasing attention. It has been reported that diabetic complications are the main cause of disability and death in diabetes, for example, the incidence of cardiovascular disease is four times higher in diabetic patients compared with non-diabetic patients, the risk factors for stroke are three to four times higher, and diabetic nephropathy is a common cause of end-stage renal disease. Therefore, actively seeking ways and means to effectively prevent and treat diabetes and its complications has become a major issue facing the medical profession, and is one of the important strategic tasks of global health care in the 21st century, which is of great significance.
Type 2 diabetes mellitus belongs to the category of thirst disease in Chinese medicine, “thirst” has been discussed by many medical scholars for many generations. Since the Suwen-Yin-Yang Bu Bu Lun proposed “the knot of two yang is called elimination”, expounding the viewpoint of the pathogenesis of elimination caused by heat and fluid injury in the stomach and dryness and heat in Yangming, although there has been a certain development in the treatment of thirst disease in successive generations, it is always inseparable from the theory of Yin deficiency causing dryness. It is believed that the pathogenesis of this disease is based on yin deficiency and dryness and heat as the symptoms, and that the treatment is based on the upper, middle and lower extinction, and the principle of nourishing yin and generating fluid, clearing heat and moistening dryness, mostly starting from moistening the lung, clearing the stomach and nourishing the kidney.
The “Diagnostic and Efficacy Standards for Chinese Medicine Evidence” promulgated by the State Administration of Traditional Chinese Medicine also emphasizes the concept, diagnostic basis, and classification of the disease of thirst, and the “Internal Medicine of Traditional Chinese Medicine”, a seven-year planning textbook for higher Chinese medicine schools in the new century, also advocates the basic pathological view that yin deficiency is the basis and dry heat is the standard, and the two are mutually causal, with different emphasis depending on the length of the disease and the degree of the disease. However, with the in-depth understanding of diabetes mellitus, especially because many clinical patients with type 2 diabetes mellitus do not have typical symptoms of “three more and one less”, or even no clinical manifestations, this has challenged the traditional theory of Yin deficiency causing elimination. Therefore, in recent years, there are scholars who disagree with this and put forward different propositions, or believe that the pathogenesis of diabetes is mainly qi-yin deficiency, and advocate benefitting qi and nourishing yin; or believe that damp-heat is the cause of the disease, and emphasize that treatment should be to clear heat and damp; or believe that blood stasis is blocking, and therefore emphasize that treatment should be based on activating blood circulation and removing blood stasis; or believe that the key to the pathogenesis is kidney deficiency, and treat it from the kidney; or believe that liver stagnation is the cause, and treat it from the liver; or believe that Many views have revealed the essence of the pathogenesis of diabetes from different angles and at different levels, and have certain clinical guidance significance, but the most prevalent views are those on the pathogenesis of yin deficiency, dry heat, blood stasis, and kidney deficiency. Through years of clinical observation and research on the evidence of type 2 diabetes mellitus, we found that most patients with type 2 diabetes mellitus are characterized by advanced age, obesity and body deficiency, inconspicuous “three more”, and dark tongue with greasy coating. Therefore, we believe that spleen deficiency and dampness is a predisposing factor for type 2 diabetes, and that derangement of the elevation of the spleen and stomach is the main pathogenesis of type 2 diabetes, and it is always present in the development of type 2 diabetes, and we have created the “Spleen and Stomach Acupuncture Method” and the “Tone in the Middle and Lower Sugar Formula” to treat thirst and its complications from the spleen and stomach.
Spleen deficiency and dampness are the factors that predispose to type 2 diabetes mellitus, and the key to its pathogenesis is the derangement of the elevation of the spleen and stomach.
Through literature analysis and years of clinical practice observation and flow regulation research, we believe that spleen deficiency and dampness is a predisposing factor for type 2 diabetes mellitus, and under the action of provoking factors, it leads to malfunction of spleen and stomach elevation. The Spleen is unable to transfer water and grain essence, and the water and grain essence flow down to the bladder, resulting in excessive and sweet urination, forming type 2 diabetes.
In type 2 diabetes, if the spleen and stomach are malfunctioning, the kidney damage will occur if the patient is not cured for a long time. If the spleen is deficient, the spleen will not be able to ascend and descend the turbidity, the turbidity will not be separated, and the turbidity will stay in the clear stream; if the spleen is deficient, the kidney will not be able to nourish the innate, the essence will gradually decline, and the gas will not turn into fluid, so that the clear will be transformed from the turbidity, “because of deficiency to stasis”. As a result of spleen deficiency and kidney deficiency, the body’s qi is not conducive to metabolism, and metabolites such as phlegm, dampness and toxicity cannot be discharged from the body in time, resulting in a series of pathological changes due to phlegm and stasis, leading to the occurrence and development of diabetic nephropathy. The main features of diabetic nephropathy as described by modern medicine: hyperlipidemia, proteinuria, elevated blood creatinine, urea nitrogen, etc., belong to the category of “phlegm-dampness”, “turbid toxicity” and “blood stasis” in Chinese medicine.
Lipids and ointments are produced by water and grain, and spread around the body with fluid. Their normal physiology depends on the role of the kidney’s qi, the spleen’s transportation, the liver’s drainage, and the lung’s propagation. We believe that although lipid, cream and blood involve several internal organs, the main organ of the disease is the spleen, which is responsible for transportation and transformation, and plays a leading role in the transportation, storage and distribution of fluid and the transformation between fluid, essence and blood. The formation of large amounts of proteinuria is the most important feature of the early stage of diabetic nephropathy. The spleen deficiency is the root cause of diabetic nephropathy, and the spleen deficiency is not rising, but sinking, and the bladder is flowing down, so that a lot of essence is lost, and the kidneys lose their nourishment. The spleen deficiency and the kidney, the kidney can not steam and gasification, “the kidney is the gateway to the stomach” incompetent, fluid and fat loss outside the body, and the evil of turbidity and toxicity in the body, the development of diabetic nephropathy.
The spleen and stomach function is not regulated for a long time, the spleen is weak and cannot transport water and grain, so the Qi, blood and fluids cannot be properly biochemical and distributed. One is blood deficiency can not moisten the heart veins; the other is qi deficiency and fluid stopping blood obstruction, “because of deficiency to stasis”. The fluid gathered into dampness, dampness gathered into phlegm, phlegm and dampness paralyze the meridians, so that the blood flow is not smooth, the vein is stagnant, then the chest Yang paralysis, qi is not smooth, the heart vein contracture or paralysis, leading to the occurrence and development of diabetic coronary heart disease.
If the spleen and stomach have malfunctioned in lifting and lowering for a long time, the dampness will become phlegm and cause stasis due to phlegm, and the phlegm and stagnant blood will block the cerebral veins and lead to cerebral infarction; block the eye veins and lead to glucose reticulopathy; block the foot meridians and veins and lead to diabetic gangrene; block the ligaments and veins and lead to diabetic neuropathy; block the tendons and tendons and lead to diabetic sexual dysfunction and so on. Therefore, the malfunction of the spleen and stomach is the root cause of type 2 diabetes, and over time, dampness and phlegm become phlegm, and phlegm leads to stasis, and phlegm and stasis intertwine and block the vascular complications of type 2 diabetes.
According to Chinese medicine, the spleen and stomach are the main organs of the body that digest, absorb and transmit the essence of food, water and grain. In the Suwen (Su Wen) and Linglan (Ling Lan) Secret Discourse, it is said that “the spleen and stomach are the officials of the granary, from which the five tastes come.” The Suwen – meridians and veins also said: “Drinking into the stomach, overflowing essence, upward transmission in the spleen, the spleen temperature dispersed essence, up to the lungs, through the water channel, down to the bladder, water and fluids four cloth, five parallel meridians, combined in the four seasons five organs of yin and Yang, consider the degree as normal.” These arguments summarize the whole process of the transformation of water and grain into essence and its distribution after entering the stomach, as well as the main role of the spleen and stomach in this process. Because all human physiological activities depend on the nourishment of water and grain essence, and the stomach is the first gateway for people to absorb water and grain essence, whether people can absorb enough nutrients from water and grain essence depends on the normal physiological function of the spleen and stomach, the spleen and stomach is located in the middle jiao, is the pivot of lifting and lowering.
The stomach is the main descending, food and meal to get down; spleen qi is the main ascending, the essence can be transported cloth. If the stomach and lift is not normal, then vomiting, dull; spleen transportation and clearing obstacles, then abdominal distension, diarrhea; spleen and stomach lift is not normal, nano-transformation is not in order, then water gathered for wet, grain stagnation for accumulation, the essence does not return to the correct transformation, the gas overflow for diabetes. As “Su Wen – Yin and Yang should be like the great theory of the chapter” said: “clear gas in the lower, it will produce food and drainage; turbid gas in the upper, it will produce? The swelling.” Su Wen – strange disease on the chapter of cloud: “the entrance of the five flavors, hidden in the stomach, the spleen for the movement of its essence, fluid in the spleen, so that the population is also sweet, this fatty hair. This person must eat a number of sweet and more fat. Fat people make internal heat, sweet people make full, so its gas overflow turned into thirst.” In the process of digestion, absorption and distribution of water and grain, “spleen qi disperses essence” plays a leading role, is the “water and fluid four cloth, five parallel” key link, if spleen qi can not rise clear, water and fluid can not be four cloth, human nutrition and metabolic process will be disrupted. It is true that the “Spiritual Pivot – this organ” said: “Spleen disease, good disease and disease.” This indicates that the inability of spleen qi to rise and clear plays an extremely important role in the pathogenesis of type 2 diabetes.
Modern medicine believes that under normal conditions, when blood glucose rises, it will stimulate pancreatic islet cells to secrete insulin, which binds to insulin receptors on the cell membrane and transmits the glucose lowering signal to the cells, and glucose tolerance factor (GTF) receives the glucose lowering signal on the inner side of the cell membrane, initiating a series of phosphorylation reactions and opening the glucose utilization channel gate. Glucose from blood enters the cell through the sugar channel and is converted to cellular energy or stored as glycogen, thus achieving the dual purpose of lowering blood glucose and replenishing cellular energy. In this process, insulin is the transmitter of glucose-lowering signal, insulin receptor is the receiver of insulin, and GTF is the one who opens the gate of cellular glucose channel, and insulin, insulin receptor and GTF work together in order for the gate of glucose channel to be opened and glucose to enter the cell through the glucose channel. Regardless of which part of this link has a problem, the end result is that glucose is not fully utilized by the cells, causing a malfunction in glucose metabolism and leading to the development of type 2 diabetes. Combined with the metabolic theory of diet water and grain in Chinese medicine, the glucose in the blood is the fine and microscopic substances needed by the body. The link of glucose entering the cells formed by insulin, insulin receptors and GTF is the process of temperament ascending and clearing and distributing the fine and microscopic substances. If this link is not realized, it will eventually lead to the development of type 2 diabetes. Therefore, it is said that the malfunction of the spleen and stomach elevation is the key to the pathogenesis of type 2 diabetes.
According to clinical observation, most type 2 diabetic patients do not have obvious three more or less symptoms, but are often found to have diabetes only during physical examination or when complications arise. These patients mostly have.
1.Onset at an advanced age ;
2, obesity and weakness;
3, like to eat fat and sweet;
4, “three more” is not obvious;
5, tiredness and fatigue;
6, dark tongue with greasy coating. This kind of patient’s physique belongs to the TCM “form and qi decay physique”. The spleen and stomach are the source of Qi and blood biochemistry, and the basis of the latter day, mastering the muscles and limbs. The food enters the stomach, after the stomach and spleen digestion, the water and grain essence must be transported and dispersed through the spleen and transported to the whole body, in order to nourish the five organs and six bowels, to nourish the limbs and muscles. If the spleen and stomach are sick, the biochemical source is lacking, the transportation and transformation is out of order, and the water becomes damp, then the qi decreases inside and the form is strong outside, so the “form is strong and the qi decreases in the body” is born, so it is said that spleen deficiency and dampness is the basis for the development of type 2 diabetes.
It is reported that with the improvement of people’s living standard and working condition, the prevalence of type 2 diabetes is increasing year by year. The prevalence of type 2 diabetes has been reported to be increasing with the improvement of people’s living standard and working condition. The predisposing factors include the consumption of fatty and sweet foods, the reduction of physical activities, the increase of mental work, the fierce social competition and the excessive psychological pressure. Long-term over-eating of fatty, sweet and greasy food or alcoholic wine and thick taste will cause dampness and heat, depleting the spleen’s qi and causing the spleen to lose its ability to transport and clear the body, resulting in thirst. When explaining the cause of diabetes, the Su Wen – The Book of Strange Diseases says: “The fat and beauty of this disease is also the cause, this person must eat a lot of sweet and fat. The fat makes people hot inside, and the sweet makes people full in the middle, and their Qi overflows and turns into thirst.” The “Suwen・Tong evaluation of the virtual reality” also pointed out that “the disease, fat people, is also the disease of sorghum.” “Jing Yue Quan Shu” more clearly pointed out: “thirst disease, the origin of the disease, are sorghum fat and sweet changes …… are rich and noble people sick and the poor are few.”
This coincides with the modern medical belief that abnormal lipid metabolism, causing insulin resistance, leading to the occurrence of type 2 diabetes, is coincidental. Long-term emotional and mental disorders, qi stagnation, affect the elevation and transportation of the spleen and stomach, spleen transport failure, water and grain essence is not distributed, the development of diabetes. Modern medicine also believes that mental factors are important factors leading to blood sugar fluctuations and deterioration of the condition of diabetic patients. In short, or due to poor diet damage to the spleen and stomach, the spleen and stomach elevation is not normal, transport and transformation failure; or due to reduced physical activity, long lying hurt qi, long sitting hurt meat, too comfortable, spleen spleen stagnation, ascending and transportation is not healthy; or brain work increased, thinking about the spleen, spleen loss of healthy transportation; or because of increased competition, psychological stress so that the liver does not regulate, wood depression, earth congestion. Even though the beginning is different, the end is the same, which eventually leads to abnormal elevation of the spleen and stomach, the failure of nourishment and transformation, water gathering as dampness, grain stagnation as accumulation, essence not returning to the right transformation, spleen deficiency and dampness, body weakness and obesity, accumulation of fat in the blood, abnormal lipid metabolism, increased insulin resistance, abnormal glucose metabolism, leading to type 2 diabetes. According to this, the main pathogenesis of type 2 diabetes is the failure of the spleen and stomach to elevate and transform, and it is a major factor in the development of type 2 diabetes.
This shows that the spleen and stomach are the central organs in the development and occurrence of type 2 diabetes. Therefore, we propose that spleen deficiency and dampness are the predisposing factors for type 2 diabetes, that spleen-stomach syndromes are the pathological basis of type 2 diabetes, that spleen-stomach malfunction is the main pathogenesis of type 2 diabetes, and that spleen-stomach malfunction is the main pathogenesis of type 2 diabetes.
Regulating the elevation of the spleen and stomach is the basic method of treating type 2 diabetes
Since the spleen and stomach play an important role in the pathogenesis of diabetes, and the malfunction of the spleen and stomach is the basic pathogenesis of type 2 diabetes and its complications, and it runs throughout type 2 diabetes, we believe that regulating the spleen and stomach and restoring its function of elevation and transportation is the basic method of treating type 2 diabetes. The main objective is to strengthen the spleen, resolve dampness, harmonize the stomach and lower turbidity, and regulate the elevation pivot mechanism. In the treatment process, we should always pay attention to the protection of spleen yang, obey the characteristics of spleen like dryness but hate dampness, stomach like moistening but hate dryness, and spleen ascending and stomach descending, follow its nature as tonic, and reverse its nature as diarrhea, seize the link of spleen and stomach ascending and descending malfunction, target and “take a peaceful period”. The basic method of treating type 2 diabetes – “the method of regulating the spleen and stomach with acupuncture and the formula for regulating the middle and lowering sugar” – has been summarized, and on this basis, additions and subtractions are made according to different diseases.