I Pre-diabetes
1. Overview
Pre-diabetes is the development of normal glucose regulation to impaired glucose regulation, elevated blood glucose but does not meet the diagnostic criteria of diabetes. It belongs to the category of Chinese medicine “spleen disease”, “food depression” etc. Ye Minghua, Department of Endocrinology, Nanping People’s Hospital
2. Etiology
The main causes of pre-diabetes are abnormal endowment, over-eating of fat and sweet, sedentary and less active, and emotional disorders. Abnormal endowment is the internal cause and excessive consumption of fat and sweet is the external cause, and the latter is more important.
3. pathogenesis
Pre-diabetes is a disease of Qi, blood, phlegm, fire, dampness and food, and food depression is the basis of its occurrence. 4.
4. disease location and nature
Pre-diabetes is located in the five viscera, mainly in the spleen (stomach) and liver, and involves the heart, lungs and kidneys. Most of the symptoms are mainly symptoms of phlegm and spleen deficiency.
5. Clinical manifestations
Pre-diabetes usually has no clinical symptoms, mostly obese or overweight, often with hypertension and hyperlipidemia.
6. Treatment
(1) Diet
Eat less fatty, sweet and thick, fried and barbecued food, puffed food and carbonated drinks, and eat a light diet with appropriate coarse grains and more green vegetables.
(2) Exercise
Strong people can use running, hiking, swimming, playing ball and other sports of higher intensity, while weak people can use taijiquan, eight-danjin and other sports of lower intensity.
7. Symptoms
(1) Qi stagnation and phlegm obstruction evidence
Symptoms: obesity, abdominal obesity, or see distention and stuffiness in the abdomen, distress, dry stools, light red tongue, white or thick greasy moss, and slippery pulse.
Treatment: Regulating Qi and resolving phlegm.
Direction: Reduce the dosage by adding Yue Ju Wan (Dan Xi Xin Fa).
Cyperus rotundus, Rhizoma chuanxiong, Atractylodes cantonensis, Gardenia jasminoides, Sempervivum sempervicum, Pericarpium pericarpium
Add and subtract: add Huang Lian and Quan Gua Pao for bitter mouth and yellow tongue coating; add Hovenia for severe distension and stuffiness in the abdomen.
(2) Spleen deficiency with phlegm and dampness
Symptoms: obesity, enlargement of abdomen, lethargy, dullness, loose stools, tasteless or sticky mouth, pale tongue with teeth marks, thin white or greasy moss, moist and slow pulse.
Treatment: Strengthening the spleen and resolving phlegm.
Radicals: Six Junzi Tang (“The Good Formula for Women”) plus or minus.
Radix Codonopsis Pilosulae, Atractylodes Macrocephala, Poria, Licorice, Pericarpium Citri Reticulatae, Semen Parsley, Lotus Leaf, Perilla
Addition and subtraction: add Astragalus membranaceus for tiredness and fatigue; add Jiao Sanxian for loss of appetite; add Coix seed and Cardamom seed for greasy mouth.
(3) Yin deficiency and Qi stagnation
Symptoms: medium or thin body, or dry mouth and thirst, worse at night, pain in the two hypochondrium, night sweating and insomnia, red tongue, thin white fur, thin pulse.
Treatment: Nourishing Yin and regulating Qi.
Prescription: Er Zhi Wan (Collection of Medical Formulas) with Si Wei San (Treatise on Typhoid) plus or minus.
Radix et Rhizoma Polygoni, Radix Bupleurum, Radix Paeoniae Alba, Radix Glycyrrhiza Uralensis
Add and subtract: add green peel and orange leaf for painful swelling of the two hypochondria; add Sheng Di Huang and Dendrobium for dry mouth and thirst.
8. Other treatments
(1) Traditional Chinese medicine
Yueju Pill, used for chest and epigastric congestion, abdominal distention and fullness, etc.
Liu Wei Di Huang Wan, used for kidney yin deficiency, dizziness and tinnitus, soreness and weakness of the waist and knees, etc.
Tianqi descending sugar capsule, used for deficiency of both qi and yin, symptoms such as tiredness and weakness, thirst and drinking, etc.
(2) Acupuncture
Ear acupuncture and body acupuncture can be used for appetite suppression and weight loss.
(3) Massage
Performing abdominal massage is good for weight loss.
Chinese medicine prevention and treatment of diabetes
1. Overview
Diabetes belongs to the category of Chinese medicine “ thirst ”, “ obesity ” etc.
2. Etiology
Abnormal endowment, weakness of the five organs, Yin deficiency, over-eating fat and sweet, emotional and mental disorders, sedentary and long-acting, reduced exercise, etc. are the causes of diabetes. Abnormal endowment is the internal cause and diet and emotion is the external cause.
2.1 Dietary factors
Excessive consumption of sweet and fatty foods and changes in diet structure or quality are the main causes. If one eats too much fat and sweet, the stomach will be stagnant and the spleen will be hindered, the middle jiao will be stagnant, the elevation will be obstructed, the transportation and transformation will be disrupted, and the dampness will become turbid and produce phlegm.
2.2 Sedentary and less active
Sitting less, less activity, spleen stagnation, transportation and transformation; spleen is depleted, the stomach is also injured, the spleen and stomach weak; spleen does not disperse the essence, the essence of the material does not return to the correct transformation, it is wet for phlegm, for turbid for paste, heat over time.
2.3 Emotional disorders
If the liver is not drained, the qi in the middle jiao will be stagnant, resulting in stagnation of liver qi, stagnation of liver and stomach qi, abnormal transportation and transformation of the spleen and stomach, resulting in heat and phlegm due to food congestion.
3. Disease Mechanism
At the beginning of the disease, the six depressions are the main causes, and the disease is mostly located in the liver and spleen (stomach); then the depressions turn into heat for a long time, with liver heat and stomach heat as the main causes, and may be accompanied by lung heat and intestinal heat; dry heat for a long time, strong fire and eating qi, dry heat hurts yin, yin loss and yang, and finally the qi, blood, yin and yang are all deficient; the internal organs are damaged, the disease evil enters the complex, the complex is damaged and the veins are damaged, and there are many changes in the evidence.
4. Disease location
The disease is located in the five viscera, mainly in the spleen (stomach), liver and kidney, involving the heart and lung.
5. Nature of disease
Yin deficiency or qi deficiency is the main cause, phlegm and blood stasis are the symptoms, mostly mixed with deficiency and reality.
6. Clinical manifestations
6.1 Symptoms
6.1.1 Diabetic phase
Typical diabetes mellitus has polydipsia, polyphagia, polyuria and weight loss; about 50% of patients with type 2 diabetes mellitus are asymptomatic, and 80% of diabetic patients have pruritus of the skin or vulva, purulent skin infection and blurred vision as the first symptoms.
6.1.1.1 Main symptoms
Polyhydramnios, polyuria, irritable thirst, thirst for cold drinks; frequent urination, foamy, or with sweet taste.
6.1.1.2 Eating a lot and getting hungry easily
Hyper-appetite, easy to be hungry, eating more than normal.
6.1.1.3 Weight loss
Type 2 diabetes begins with obesity or overweight. When the blood glucose rises abnormally to a certain level, nutrients are lost and weight loss occurs, often accompanied by physical incompetence and lethargy.
6.1.1.4 Other symptoms
Irritability, insomnia and dreaminess, forgetfulness, weakness of the waist and knees, etc. Women with excessive amount of hypoglycemia and irregular menstruation.
6.1.2 Complication period
Acute complications of diabetes mellitus or chronic complications caused by organ dysfunction, etc. may appear corresponding manifestations, such as numbness of limbs, visual impairment, constipation or stools that are sometimes dry and sometimes thin, palpitation and panic, vertigo, edema, low libido in men, impotence, etc.
6.2 Physical signs
In the early stage, the disease is mild and most of them have no obvious signs. In severe cases, acute complications such as water loss may occur, and in prolonged cases, various complications such as macrovascular, microvascular, peripheral or visceral nerves, muscles, bones and joints may occur and the corresponding signs may appear.
7. Basic treatment
7.1 Diet
Insist on total control, structure adjustment and reversal of eating order, which means that each meal is only seven or eight minutes full, with vegetarian food as the main food and other supplements, and balanced nutrition, with soup and green vegetables at mealtime, and then some main food and meat when almost full. On the basis of balanced diet, according to the patient’s constitution of cold, heat and deficiency, choose the appropriate food: hot people choose cool food, such as bitter melon, dandelion, bitter vegetables, bitter almonds, etc.; cold people choose warm food, such as ginger, dried ginger, cinnamon, pepper as seasoning stewed lamb, beef, etc.; Yin deficiency people choose to nourish Yin food, such as cucumber, zucchini, loofah, lily, lettuce, etc.; dry stool people choose black sesame, spinach, eggplant, bean curd, etc. For those with dry stools, choose black sesame, spinach, eggplant, carrot juice, white radish juice; for those with stuffy stomachs, choose cold sorrel leaves, lotus leaves, shredded peel; for those with frequent urination, choose walnut meat, yam, lotus seeds; for the obese, use low-calorie, coarse fiber diet recipes and eat coarse grains and other foods that are good for weight loss. For different complications of diabetes often require different dietary regimen, such as diabetic neurogenic bladder patients to reduce water intake after dinner and empty the bladder before bed; combined pruritus, tinea cruris should control tobacco, alcohol, strong tea, spicy, seafood hair and other stimulating diet; combined lipid metabolism disorders can be chrysanthemum, cassia seeds, wolfberry, hawthorn and other drugs in water as a substitute for tea.
7.2 Exercise
Insist on doing exercises suitable for you, which should be done gradually, according to your ability, with quietness in movement and combining work and rest. Young and strong patients or those who are in good physical condition can choose more strenuous exercise programs; middle-aged and old patients or those who are in weak physical condition can choose milder exercise programs; those who are not suitable for outdoor exercise can practice vomiting and breathing or meditation; traditional exercise methods such as Badaanjin, Taijiquan and Wuyoujian are suitable for most patients; patients with complications should avoid strenuous exercise in principle.
7.3 Psychological adjustment
Patients should understand and treat the disease correctly, cultivate the body and temperament, keep the mood relaxed, regulate the qi, establish confidence and optimism to overcome the disease, and cooperate with the doctor for reasonable treatment and monitoring.
8. Identification and treatment
8.1 Diabetic phase
8.1.1 Phlegm (dampness) and heat interconnection evidence
Symptoms: obesity, abdominal distension, dry mouth, thirst, preference for cold drinks, excessive water intake, distention and fullness of the abdomen, easy hunger, bitterness, dry stools, yellow urine, light red tongue, yellowish greasy coating, smooth pulse.
Treatment: Clearing heat and resolving phlegm.
Formula: Xiao Shen Che Tang (Treatise on Typhoid Fever) plus or minus.
Whole Psidium guajava, Radix et Rhizoma Huanglian, Citrus aurantium.
Add and subtract: add raw gypsum and Zhi Mu for thirsty drinking; add fried lycopodium and charred betel nut for abdominal fullness; treat damp-heat trapped spleen by strengthening the spleen and stomach, clearing heat and dispelling dampness with Six Jun Zi Tang with addition and subtraction.
8.1.2 Evidence of heat injuring fluid
Symptoms: dry mouth and throat, thirst for cold drinks, easy to eat, frequent urination, irritability, bitterness in the mouth, constipation, dry tongue, yellow dry coating, and fine pulse.
Treatment: Clearing heat and generating fluid to quench thirst.
Prescription: Extinguish thirst formula (Danxi Xinfa) or Baihu plus Ginseng Tang (Treatise on Typhoid) plus or minus.
Asparagus powder, gypsum, Huang Lian, Radix Rehmanniae, Radix Panax ginseng, Kudzu root, Mai Dong, Lotus root juice, Licorice.
For heat in the liver and stomach, add or subtract Da Chai Hu Tang (Treatise on Typhoid Fever); for heat in the stomach, add or subtract San Huang Tang (Prepared Urgent Thousand Gold Essentials); for heat in the intestines, add or subtract Zengliang Cheng Qi Tang (Article of Warming Disease); for heat with strong fluid, add or subtract Lian Mei Drink (Article of Warming Disease).
8.1.3 Evidence of deficiency of both qi and yin
Symptoms: dry throat, dry mouth, thirst, fatigue, shortness of breath, lazy speech, emaciation, soreness and weakness of the waist and knees, spontaneous sweating and night sweating, feverishness of the five hearts, palpitation and insomnia, red tongue with little fluid, thin white dry moss or little moss, thin pulse string.
Treatment: Benefit Qi and nourish Yin.
Prescription: Yuquan Wan (Rhinoceros Candle on the Origin of Miscellaneous Diseases) or Yuquan Tang (Medicine Zhongzheng Ginseng Xilu) plus or minus.
Asparagus Powder, Pueraria Mirifica, Mai Dong, Radix et Rhizoma Ginseng, Poria, Umei, Astragalus, Glycyrrhiza
Add or subtract: Astragalus is used for very heavy tiredness and fatigue; Medlar and Dendrobium are added for very heavy dry mouth and throat.
8.2 Complication period
8.2.1 Liver and kidney yin deficiency evidence
Symptoms: frequent urination, cloudy like paste, blurred vision, soreness and weakness of the waist and knees, dizziness and tinnitus, irritable heat in the five hearts, low heat and red cheek, dry mouth and throat, dreamy seminal emission, dry skin, bird’s eye, or mosquitoes and flies, or blindness, itchy skin, red tongue with little coating and fine pulse.
Treatment: Nourishing the liver and kidney.
Prescription: Qiyi Ju Di Huang Wan (Medical Grade) or Mai Wei Di Huang Tang (Shou Shi Bao Yuan) plus or minus.
Fructus Lycii, Chrysanthemum, Radix Rehmanniae, Cornus Officinalis, Poria, Dampi, Zedoary, Radix et Rhizoma Polygonati, Rhizoma Drynariae
Add and subtract: blurred vision with Cyperus rotundus and Mulberry seeds; dizziness with Mulberry leaf and Tianma.
8.2.2 Evidence of deficiency of both yin and yang
Symptoms: frequent urination, increased nocturnal urination, turbidity like grease and paste, even drinking a urine, irritability of the heart, dry mouth and throat, fatigue, dry ears, sallow face, weakness of the waist and knees, coldness of the limbs, lack of warmth of the extremities, impotence, swelling of the lower limbs, or even swelling of the whole body, pale tongue, white and dry coating, sunken and weak pulse.
Treatment: Nourishing Yin and tonifying Yang.
Prescription: Jin Kui Kidney Qi Pill (Jin Kui Essentials) with addition and subtraction; for edema, Ji Sheng Kidney Qi Pill (Ji Sheng Formula) with addition and subtraction.
Prepared with Radix et Rhizoma Gui Zhi, Radix Rehmanniae, Cornu Cervi Pantotrichum, Cornu Cervi Pantotrichum, Poria Cocos, Dampi, Ze Xie
Addition and reduction: For kidney yang deficiency, choose Right Returning Drink and reduce; for kidney yin deficiency, choose Left Returning Drink and reduce.
8.3 Concurrent evidence
8.3.1 Concurrent phlegm and turbidity
Symptoms: obesity, appetite for fat and sweet, fullness of the abdomen and stomach, heavy limbs, vomiting and vertigo, nausea and mucous mouth, heavy head and drowsiness, light red tongue, white and thick greasy coating, smooth pulse.
Treatment: Regulating Qi and resolving phlegm.
Formula: Er Chen Tang (Taiping Huiming and Pharmaceutical Bureau Formula) plus or minus.
Ginger, Radix et Rhizoma, Chen Pi, Poria, Roasted Licorice, Ginger, Jujube
Add and subtract: fullness and stuffiness in the abdomen and stomach, add Guang Mu Xiang and Citrus aurantium; nausea and mucous mouth, add Sha Ren and Lotus leaf.
8.3.2 Concurrent blood stasis
Symptoms: numbness or pain in the limbs, purple and dark in the lower limbs, chest tightness and stabbing pain, hemiplegia in stroke, or bleeding at the base of the eyes, purple lips and tongue, petechiae on the tongue or bruises under the tongue, thin white fur, stringent and astringent pulse.
Treatment: Promote blood circulation and resolve blood stasis.
Treatment: Invigorate blood circulation and resolve blood stasis.
Peach kernel, red flowers, angelica, raw earth, Chuanxiong, heliotrope, red peony, orris, roasted licorice
Add and subtract: add Di Long and Quan Scorpion for stasis blocking the meridians; add Leech for stasis blocking the blood vessels.
9. Other treatments
9.1 Proprietary Chinese medicine
Sugar-free granules, capsules, concentrated pills or tablets are preferred.
Liu Wei Di Huang Wan, used for kidney yin deficiency, dizziness and tinnitus, soreness and weakness of the waist and knees, etc.
Mai Wei Di Huang Wan, for lung and kidney yin deficiency, hot flashes and night sweats, etc.
Qi Ju Di Huang Wan, used for liver and kidney yin deficiency, dizziness and tinnitus, shame and fear of light, etc.
Jin Kui Kidney Qi Pill, used for edema of kidney, lumbar soreness and leg weakness, etc.
For constipation with intestinal heat, choose Compound Aloe Vera Capsules or Xinqingning; for Yin deficiency and intestinal dryness, choose Ma Ren Run Yin Wan; for insomnia, choose An Shen Tonic Heart Pill or Tian Wang Tonic Heart Dan; for easy to catch cold, choose Yu Ping Feng Granules; for irritability, choose Dan Jia Yi Yao Wan.
Chinese and western compound preparation: Hypochondriac Pill, with the effect of nourishing kidney and nourishing yin, benefiting qi and generating body fluid, contains 2.5mg of glibenclamide (Eugenol) per 10 capsules, similar to Eugenol, and is suitable for type 2 diabetic patients with elevated blood glucose due to deficiency of both qi and yin.
9.2 Acupuncture
1.2.1 Body acupuncture
Prescription: Lung Yu, Spleen Yu, Pancreas Yu, Shouze, Quchi, Lianquan, Chengjiao, Foot Sanli, Sanyinjiao. Companion points: Jin Jin and Yu Liquid for irritable thirst and dry mouth.
Prescription: Spleen Yu, Stomach Yu, Pancreatic Yu, Foot Sanli, Sanyinjiao, Neiting, Zhonggui, Yinlingquan, Quchi, Hegu. Companion points: Tianshu and Zhigou for constipation.
Hypochondriasis (deficiency of kidney yin): Kidney Yu, Guan Yuan, Sanyinjiao, Tai Xi. Companion points: blurred vision plus Tai Chong and Guangming.
Lower elimination (Yin and Yang deficiency) prescription: Qi Hai, Guan Yuan, Kidney Yu, Life Gate, Sanyinjiao, Tai Xi, Fuyao.
1.2.2 Ear acupuncture auricular pressure
Endocrine and adrenal points are the main points. Ear acupuncture points: pancreas, endocrine, adrenal gland, marginal center, sanjiao, kidney, shenmen, heart, liver. Supporting points: lung and thirst points for upper elimination; spleen and stomach for middle elimination; bladder for lower elimination.
9.2.3 Massage
Obese or overweight diabetic patients can have abdominal massage of the middle epigastrium, moisture, Qihai, Guangyuan, Tianshu, and water channels. Point point weight loss is often taken from hegu, nei guan, foot sanli, and san yin jiao. You can also massage the face and neck, chest and back, limbs and other parts of the body with mo, snap, knead, press, pinch, take, combine, divide, tap and other techniques.