The traditional view is that the pathogenesis of diabetes mellitus (achalasia) is Yin deficiency and dry heat, with Yin deficiency as the basis and dry heat as the target, involving the lung, stomach, kidney and other internal organs. Although the treatment of diabetes mellitus from the spleen and stomach has been discussed for a long time, it has either been discussed from stomach fire and dry heat, or generalized to the dysfunction of the spleen and stomach. The respective roles of the spleen and stomach in diabetes and the role of the spleen and stomach in each period of diabetes have not been clearly described. In this article, we will try to discuss the respective roles of the spleen and stomach in each stage of diabetes from the spleen-stomach syndrome. The relationship between the spleen and the stomach and diabetes mellitus has been discussed in various medical treatises. As early as in the “Treatise on Strange Diseases”, there is a statement: “The five tastes are hidden in the stomach, and the spleen carries out its essence for it. This person must eat a number of sweet and more fat. Fat people make internal heat, sweet people make full, so its gas overflow, turn into thirst.” He proposed that fatty, sweet and thick flavors make the spleen unable to move the essence for the stomach, and the mechanism of internal heat causes extinction. Zhao Xian can “medical Guan thirst theory” said: “the spleen and stomach are both deficient, it can not spread fluid so thirst.” In recent times, Zhang Xichun also pointed out that diabetes is due to “the failure of the vital energy to rise, the sinking of the atmosphere, and the failure of the spleen to disperse essence.” Modern epidemiological surveys have found that a large proportion of diabetic patients have symptoms such as fatigue, dry mouth and poor stool, suggesting the important role of spleen deficiency and stomach heat in the formation of diabetes. Modern studies have also recognized the relationship between the spleen and stomach and diabetes, such as Xiong Manqi et al. earlier proposed that spleen deficiency is an important pathogenic mechanism of diabetes and analyzed it in terms of physical, dietary, emotional and mismanagement damage to the spleen and resulting in abdominal thirst. Pan Shanyu believed that spleen qi deficiency is the key to the pathogenesis of diabetes mellitus. Liu Chengqin believes that spleen deficiency and dampness are the pathological basis of insulin resistance, and phlegm and stagnant blood are the pathological products of insulin resistance. In summary, the relationship between the spleen and the stomach and diabetes has been recognized, but the main cause is the weakness of the spleen and stomach. This understanding highlights the role of spleen deficiency in the development of diabetes mellitus, but it is still not completely free from the traditional theory of Yin deficiency and dry heat. In particular, the respective roles of the spleen and stomach organs in the development of diabetes are blurred, and the different functions of the spleen and stomach organs are generally regarded as spleen and stomach weakness. The functions of the spleen and stomach differ in both physiology and pathology. In the physiological condition, the stomach is the main receiver; the spleen is the main transporter and transports its fluids for the stomach, and together they complete the digestion and absorption of food and its essence. As stated in “The Twenty-first Treatise on the Meridians and Veins of the Neijing”, “Drinking into the stomach overflows the essence and is transferred upward to the spleen; the spleen disperses the essence and returns it to the lungs; the water channels are regulated and transferred downward to the bladder; the water essence is distributed in all directions and the five meridians are in parallel.” Under pathological conditions, spleen deficiency is mainly manifested by the weakness of spleen qi and spleen yang, which is reflected in the malfunction of spleen transportation and clearing, so it cannot move qi and disperse essence for the stomach, and the water and grain essence cannot be distributed to all the limbs and bones; the dysfunction of the stomach is manifested by abnormal intake, and there is a distinction between deficiency and reality, where reality is more food and hunger, and even fire and heat; deficiency is poor appetite and tasteless diet. Therefore, dysfunction of the spleen and stomach cannot be simply summarized as weakness of the spleen and stomach. In the pathological state, both spleen deficiency and stomach deficiency may exist in the same body. From the perspective of the evolution of diabetes mellitus, there are several seemingly contradictory symptomatic features, one being obesity followed by gradual wasting. In the early stage of diabetes (especially the IGT stage), there is mostly obesity, but as the disease progresses patients tend to lose weight and become thin; then there is good appetite, eating more and becoming thin instead. If the spleen and stomach are weak, they should have poor appetite and loose stools, but the opposite is true: easy to eat, hard stools and other signs of heat in the stomach. Moreover, it is difficult to explain the dynamic process of obesity followed by weight loss in diabetes mellitus by spleen and stomach deficiency alone. We believe that there is a paradoxical pathological mechanism of diabetes mellitus with both spleen deficiency and stomach solidity (heat). The seemingly contradictory symptoms of diabetes mellitus are the result of the contradictory pathology of spleen deficiency and stomach solidity (heat). In the early stage of diabetes (including IGT), there is spleen deficiency and stomach solidity (heat). The stomach is strong and eager to eat, but not yet to the extent that food accumulates and turns into fire, so there is no obvious symptoms of excessive food and hunger and excessive thirst and drinking; the spleen is weak, but still able to “disperse essence and move fluids” for the stomach, so there is a lot of food and obesity. At this stage, the balance between spleen and stomach functions has not yet been broken, but is characterized by weak spleen qi, and the actual stomach has not yet turned into fire. Obesity is the clinical manifestation of this period. For the relationship between obesity and diabetes, modern medical progress suggests that abnormal fat metabolism is the driving factor of glucose metabolism disorder. Regarding the relationship between thirst and obesity in Chinese medicine, the “Nei Jing” has “fat makes internal heat, and sweet makes the middle full, so its qi overflows and turns into thirst”. And recognize that spleen deficiency is the common pathological mechanism of thirst and obesity, and obesity is the early manifestation of diabetes mellitus. During the period of diabetes, food accumulates in the stomach, heat accumulates in the stomach and turns into fire, and the strong stomach has turned into real fire in the stomach. If the stomach fire is strong, it is good at eliminating grain and hunger, dry mouth and more drinking; the thief fire consumes gas, the spleen is overloaded, the spleen deficiency is even, it can’t “disperse essence and fluids” for the stomach, the spleen and stomach function is out of order, so although receiving more but the spleen deficiency water and grain essence can’t be distributed, the limbs and bones and organs can’t be nourished, so gradually wasting, the patient is fat and thin, there is the typical The patient is fat but thin, with the typical “three more and one less syndrome”. This period is characterized by a strong stomach fire, spleen deficiency and spleen-stomach function disorder. If no treatment is given and the disease develops, the stomach fire becomes more intense, depleting the fluid, the spleen qi is weak, the fluid cannot be distributed, the five organs are not nourished, the yin deficiency and dryness and heat arise from this, the fluid injury and heat and dryness intermingle with silt, blood, phlegm and turbidity and turn into a hundred symptoms. This period is characterized by spleen deficiency and dryness and heat, and many internal organs are involved, and all the symptoms are caused by the birth of the disease. In summary, spleen deficiency and gastric heat play an important role in the development of diabetes mellitus throughout all periods of the disease. Based on this theoretical hypothesis, we propose that the main treatment of diabetes is to support the spleen and suppress the stomach, with Bai Hu Ren Shen Tang plus or minus, according to the priority of the contradiction between spleen deficiency and stomach strength, taking into account the stages of the disease, either to strengthen the spleen or to diarrhea the stomach. In the early stage of the disease, strengthening the spleen is the mainstay, and diarrhea of the stomach is supplementary. In the middle stage, the main objective is to clear the fire in the stomach, supplemented by strengthening the spleen, and in the later stage, we take into account the spleen and stomach, nourish the Yin and moisten the dryness, and administer the treatment in a dialectical manner, achieving better results.