Diabetes mellitus (diabetes) is a group of metabolic diseases characterized by chronic elevated blood glucose (referred to as blood sugar) levels. According to the World Health Organization (WHO) estimates that there are 200 million people with diabetes worldwide, and China has more than 30 million, ranking 2nd in the world. The number is expected to increase by 1 million per year in the future. Chinese medicine has a history of thousands of years in the prevention and treatment of diabetes, especially in the prevention and treatment of chronic complications, and Chinese medicine has accumulated a wealth of experience and achieved many effects that Western medicine cannot achieve, and is increasingly being highly valued by scholars at home and abroad. The following is an overview of Chinese medicine treatment of diabetes mellitus.
1, the understanding of diabetes in Chinese medicine
Diabetes mellitus belongs to the category of “thirst” or “disease” in Chinese medicine. From the original description, spleen disease is similar to the insidious stage of diabetes, thirst is similar to the clinical diabetes stage, and the disease is similar to the complication stage of diabetes. In the early Tang Dynasty, Zhen Liyan had already discovered the phenomenon of sweet urine in achalasia, and defined achalasia as “those who are thirsty and drink a lot of water, urinate a number of times, and have no fat like bran flakes sweet, are also achalasia.” This definition is still the strongest evidence for our diagnosis of diabetes mellitus. It can be seen that Chinese medicine has a long history and accumulated rich experience in understanding and documenting the causes, pathogenesis, symptoms and prevention of diabetes. This provides a reliable historical source and a solid theoretical foundation for the prevention and treatment of diabetes in Chinese medicine, and builds a good platform for prevention and treatment.
Modern research believes that Chinese medicine can lower blood sugar by regulating the endocrine metabolism of diabetic patients, improving the function of pancreatic islets, increasing insulin levels and inhibiting glucagon. At the same time has a lowering of blood lipids, improve blood rheology, microcirculation, improve kidney function, scavenging free radicals, improve the level of sex hormones, protection of nutritional nerves and regulation of trace elements, etc., to prevent and control diabetes and its complications play a positive role.
2.Diabetes mellitus in Chinese medicine
2.1 Treatments from the liver
The etiology of diabetes mellitus is closely related to the liver. The liver is the master of drainage, regulates the emotions, is the organ of the sympathetic yin, with blood as the basis, with qi as the use, emotional stimulation must first offend the liver, and mental factors are the main cause of diabetes, the successive generations of Chinese medical texts have also discussed, such as “Ling Shu – five changes” said “anger will be qi upward rebellion, chest accumulation, blood flow, hip skin full of muscle, blood vessels do not work, and turn to heat, heat is eliminated skin, so for the elimination of disease. “. Confucianism affair relatives Liu Hezhi three elimination” said: “thirst …… consume disorderly spirit, too contrary to its degree, and dryness and heat depression is also.” Qing – Ye Tianshi “clinical guide to medical cases – three elimination” cloud: “the state of mind is sad and depressed, internal fire spontaneous combustion, is the great disease of elimination”. Both point out that the onset of diabetes is closely related to the liver.
2.1.1 De-stressing the liver
The liver is the organ of wind and wood, which is the master of drainage, likes softness and smoothness, and fears depression and fries rebellion. Thirst, polyuria, polyphagia, etc. may not be obvious, but is accompanied by fatigue, dysthymia, depression, heartburn, mucous mouth, light red or reddish tongue, stringent pulse, high blood sugar. Treatment: Diversify the liver and regulate Qi. The formula: prolotherapy plus or minus: Chai Hu, Bai Shao, Angelica sinensis, Buddha’s hand, fragrant herbs and so on.
2.1.2 Clearing liver fire
The liver is a rigid organ and contains wind and fire, which is easily agitated and elevated, with unrestrained emotions, depression and anger hurting the liver or liver depression turning into fire over time, which inflames the lung gold and burns the lung yin and disturbs the middle palace, and the stomach is dry and fluid deficient, which overflows the yang and consumes the fluid and damages the kidney yin. The clinical manifestations are chest congestion, bitterness and dryness of the mouth, thirst, dizziness, insomnia, excessive dreaming, red tongue, yellow fur, and stringiness of the pulse.
2.1.3 Nourishing the liver and kidney
This method is suitable for the evidence of liver and kidney yin deficiency. Symptoms include dizziness, dizziness, soreness of the waist and knees, tinnitus and pain in the ears, dryness of the mouth and throat, irritability of the five hearts, night sweating, dry skin, itching all over the body, dry stool and frequent urination, turbidity, red tongue with little fluid, and fine pulse. The basic formula is: Consistent Decoction and Erzhi Pill with addition and subtraction: Radix Rehmanniae, Radix Salviae Miltiorrhizae, Radix et Rhizoma Macrocephalae, Radix et Rhizoma Lonicerae, etc.
2.1.4 Nourishing Blood and softening the Liver
Clinical symptoms include dry mouth, dry throat, dull pain in the ribs, irritability, insomnia, pain in the feet, dry eyes, blurred vision or sparrow blindness, dry stools, short urine, numbness in the extremities, dry skin, itching, pale tongue, thin pulse, and the following formula is used to nourish blood and soften the liver. Radix Rehmanniae Praeparata, Radix Paeoniae Alba, Radix Angelicae Sinensis, Rhizoma Chuanxiong, Ziziphi Jujube, Radix Glycyrrhiza Uralensis.
Modern research has found that liver tonics have a preventive effect on liver function damage in patients with diabetes or on liver function damage caused by certain hypoglycemic western drugs. It can promote the metabolism of sugar, protein and fat by the liver, promote the synthesis and storage of glycogen by the liver, and reduce the burden on the pancreas.
2.2 Treatment from the spleen
Most of the clinical diabetic patients with “three more and one less” symptoms are not typical, but they often have symptoms of spleen deficiency such as weakness, fatigue, laziness, and limb weakness. Following the principle of diagnosis and treatment in ancestral medicine, and based on the clinical reality, Sun Weifeng(1) believed that the traditional “three elimination” diagnosis of diabetes mellitus should be broken down, and the treatment should focus on the spleen. According to Xu Chengqun(2), the main mechanisms for treating diabetes mellitus from the spleen perspective are: heat accumulation in the spleen and stomach, spleen deficiency and dampness, spleen deficiency and fluid deficiency, spleen deficiency causing stasis, spleen qi downward movement, and spleen deficiency and kidney. The treatment of the spleen should be divided into spleen deficiency and spleen deficiency, and attention must be paid to the transportation of the spleen (3). In addition to treating the liver and kidneys, it is especially important to use the eight principles of identification, organ identification, qi, blood and fluid identification and other identification methods, a holistic understanding and comprehensive analysis. At the same time of drug treatment, abstain from eating spicy, alcoholic, fatty and sweet products, in order to protect the central state, strengthen the spleen and stomach, so that the spleen is healthy and fluids are produced, and the heat is removed from the sugar.
2.3 Treatment from the kidney
The relationship between thirst and the kidney has been discussed extensively by medical practitioners throughout the ages. Most believe that the basic pathogenesis of thirst is the deficiency of kidney water. Zhang Zhongjing created the Kidney Qi Pill to treat thirst, and Zhao Xianke advocated that the treatment of the three diseases should focus on the kidney. These doctrines have influenced and guided clinical practice until today. Due to the exhaustion of the lower yuan, the inability to restrain the bladder and the malfunction of qi and chemistry leads to excessive urination and drinking and urinating. If the kidneys are not able to seal and hold the urine, the water and grain will be injected downward and the urine will have a sweet taste.
The symptoms of kidney deficiency type diabetes mellitus are frequent urination, high volume, or drinking a urine, especially frequent urination at night, emaciation, weakness, lumbar and knee pain, five heartburn, night sweating, flushing of the face, red tongue, little or thin yellow coating, and fine pulse. This type is more common clinically, with type II older patients with a long history and poor glycemic control, and can be accompanied by a variety of complications. It can also be seen in patients with family history. The main treatment is to nourish the kidney. If the kidney is deficient in yin, it is recommended to nourish yin and tonify the kidney, mostly using Liu Wei Di Huang Wan with addition and subtraction; if the kidney is deficient in yang, it is recommended to warm yang and benefit the kidney, using Jin Kui Kidney Qi Wan with addition and subtraction; if the yin and yang are deficient, it is recommended to nourish yin and tonify yang, using Jin Kui Kidney Qi Jiu, Liu Wei Di Huang Wan with addition and subtraction of Wu Zi Yan Zong Wan.
2.4 Treatment from stasis
Since 1978, when Zhu Chen Yu(4) proposed the existence of blood stasis in diabetic patients and reported that the treatment of diabetes mellitus by activating blood circulation and resolving blood stasis had achieved satisfactory results, the study of blood stasis in diabetes mellitus and the application of the method of activating blood circulation and resolving blood stasis have been the hot spot of research on the treatment of diabetes mellitus in Chinese medicine for the past 20 years. From modern medical anatomy, diabetes mellitus is mostly characterized by hyaline and fibrous islets, arteriosclerosis, and microangiopathy. Biochemical examination shows high blood glucose, high blood lipids, and high blood viscosity. These pathological changes slow down the blood flow and affect the blood degeneration, which is similar to the stasis mechanism in Chinese medicine, “blood is not active, there is stasis”, which provides the basis for the treatment of blood stasis in Chinese medicine. In the treatment of diabetes mellitus, even if the evidence of blood stasis is not obvious, it should be prevented before it happens, and the method of activating blood and removing blood stasis should be used throughout the treatment.
Modern clinical and animal experimental research shows that herbal blood activators and blood stasis eliminators have the ability to reduce blood viscosity, change blood rheology, improve microcirculation, reduce platelet aggregation, inhibit coagulation and promote fibrinolysis, lower blood lipids, and increase venous blood oxygenation. At present, the first choice in the treatment of diabetes mellitus is rhubarb, salvia, red peony and leech.
2.5 Treatment of external infection
Modern medicine believes that viral infection can also lead to the development of diabetes mellitus, which selectively acts on susceptible individuals to induce autoimmunity and develop the disease. The onset of type 1 diabetes is often sudden, and after the onset of the disease, there is a serious insulin deficiency, so the clinical symptoms are very significant, and the onset of the disease has a certain seasonality, and is more common in autumn and winter. It is difficult to explain the cause of juvenile diabetes mellitus by diet, emotion and exertion, and so on.
As the patient is weakly endowed with kidney qi, the qi and blood are deficient, especially in children, the five organs are weak, they feel the evil of the six sexes, the positive qi is not enough to resist the invasion of the external evil, the evil first offends the lung, turning heat into dryness, depleting the lung yin, and the evil heat is contained within, further injuring the yin of the stomach and kidney, resulting in a series of pathological changes, which leads to the evidence of thirst, and the condition is serious and develops rapidly. This is precisely the pathological mechanism by which the six external influences cause thirst. Modern medicine has tried anti-infection and immunosuppressive therapy for early-onset type 1 diabetes. If Chinese and Western medicine can learn from each other, according to the basic theory of Chinese medicine, we can treat the causes of the six external sensations and carry out early diagnosis and treatment, which may open up a new way for the treatment of this external sensation-onset thirst disease.
3.Treatment of complications
For the treatment of diabetic complications, Chinese medicine has irreplaceable advantages, which have been confirmed by a large amount of clinical data and animal experiments.
(1) diabetic nephropathy: diabetic glomerulopathy, through traditional Chinese medicine treatment, can not only reduce blood sugar and blood lipids, but also change the pathological process of nephropathy, reduce glomerular thylakoid matrix proliferation, sclerosis and glomerular basement membrane thickening, inhibit collagen synthesis in the glomerular matrix, and herbal medicine also has a regulatory effect on the gene expression of TGF-B, a factor related to glomerular extracellular matrix proliferation, and play a role in protecting (2) Canker sores: Canker sores are the most common cause of kidney disease.
(2) Carbuncle: Carbuncle is a common complication of diabetes mellitus, which is mainly characterized by Yin deficiency and heat or Qi-Blood deficiency and internal stagnation of heat and toxicity in Chinese medicine.
(3) Retinopathy and cataract: This comorbidity is known as visual dimness in Chinese medicine. In the pathological process of diabetes mellitus, retinopathy and crystal disease are particularly prominent and lead to more serious consequences, even blindness.
(4) Peripheral neuropathy: Peripheral neuropathy is a frequent and difficult to treat disease, belongs to the category of paralysis in Chinese medicine, clinical numbness of limbs, sensory loss or disappearance, severe pain can affect the work and quality of life. The treatment is mostly based on comprehensive treatment with the addition of pain relieving products.
(5) Diabetic foot: diabetic foot is one of the disabling complications of diabetes mellitus, which occurs based on a combination of factors such as a general decrease in arterial pressure, microangiopathy, abnormal pressure load of neuropathy, and easy infection. The pathology is mainly based on microcirculatory disorders and is characterized by the combination of heat, toxicity and stasis in Chinese medicine. Treatment is to clear heat and detoxification, blood circulation and blood stasis as the method, can take internal and external treatment of comprehensive treatment.
4.Combination of Chinese and Western medicine treatment
Combination of Chinese and Western medicine treatment of diabetes is based on the respective advantages of Chinese and Western medicine, avoiding the shortcomings of each aspect and giving full play to their strengths. The advantages of Chinese medicine are: obvious improvement of symptoms, long-lasting effect, small side effects, and Chinese medicine can have a synergistic effect of lowering sugar with western medicine, giving full play to the advantages of Chinese medicine in regulating and treating the root, protecting the organs in the body, and reducing the side effects of western medicine. Advantages of western medicine: good effect of lowering sugar, fast onset of action, easy to control. The advantages of combining Chinese and Western medicines: it can promote insulin secretion, control hyperglycemia, inhibit the rise of glucagon, increase the content of liver glycogen, restore the function of pancreatic β-cells, improve insulin resistance, and improve clinical symptoms. It can prevent or slow down the development of complications. This is something that cannot be achieved by pure Western medicine or pure Chinese medicine, which has positive significance for improving insulin secretion dysfunction and lowering blood sugar in diabetic patients.
In specific clinical practice, patients with unsatisfactory glycemic control should be treated with insulin as early as possible, together with oral hypoglycemic drugs such as sulfonylureas and biguanides, as well as Chinese medicine evidence-based treatment. Chen Yan treated 35 cases of diabetic patients with TCM diagnosis of Qi and Yin deficiency and internal heat and fluid deficiency and blood stasis with the addition of Sugar Junkang Oral Liquid on the basis of the original diet and the dose of hypoglycemic western drugs. Fan Dongxiang treated diabetes mellitus with oral DAMAC and identification, which not only improved the symptoms quickly, but also decreased blood glucose and urine sugar significantly, and stabilized blood glucose level for a long time, and increased plasma insulin in some patients, which also had a significant improvement effect on myocardial blood supply.
5.The positioning of Chinese medicine in the treatment of diabetes mellitus
The positioning of Chinese medicine in the treatment of diabetes should be in the following aspects.
1) Overall regulation: TCM believes that the occurrence of diabetes is related to the dysfunction of several internal organs such as liver, spleen, lung and kidney. Therefore, in terms of treatment, TCM believes that emphasis must be placed on overall regulation, aiming to achieve the purpose of treating diabetes and preventing complications through systemic conditioning.
2 ) There are certain hypoglycemic effects: the hypoglycemia of Chinese medicine may have insulin-like or insulin-stimulating effects; improve insulin resistance and sensitivity; and comprehensive target effects. TCM deserves further research in this regard.
3 ) Chronic complication prevention and control: hyperglycemia is the main or only cause of diabetes, but it is not the only cause of complications. Some patients have good glycemic control while complications still do not decrease, which is attributed to the fact that type 2 diabetes is a multifactorial disease that requires comprehensive control of the four highs of blood glucose, blood pressure, blood lipids and blood viscosity to reduce the incidence of macrovascular lesions. It is in line with the multi-channel and multi-target integration role of TCM.
4) Alleviate the symptoms: the symptoms of diabetes are not proportional to the index, blood sugar control is normal, but the symptoms such as weakness and dry mouth do not disappear, Chinese medicine can achieve better results.
5 ) Prevention is the main focus, pay attention to the intervention of hypoglycemic tolerance: Chinese medicine attaches great importance to the idea of treating the disease before it happens: prevent the disease before it happens, and prevent the disease before it happens. In the stage of hypoglycemic tolerance without evidence, at this time, microscopic identification method can be used, and early intervention can be made through some traditional Chinese medicine to supplement deficiency, qigong guidance, food therapy and other health care methods, etc. For pre-diabetes —- hypoglycemic tolerance prevention treatment, on the one hand, can avoid transformation into diabetes, on the other hand, health care.
6) Scientific evaluation, reasonable treatment. Chinese medicine plays an important role in the prevention and treatment of diabetes, but it should be evaluated reasonably, treated correctly, and resisted the misguided public opinion.