26 Feb TCM Explanation of Diabetes Mellitus
Modern Medicine and Traditional Chinese Medicine: Diabetes Mellitus (Part Two)
by Clinton J. Choate
Published in the Journal of Chinese Medicine, No. 59, January 1999
There are two words in the Chinese language for diabetes: the traditional medical name ‘xiao-ke’ which means “wasting and thirsting”, and the modern term ‘tang-niao-bing’ which means “sugar urine illness”. Discussion of diabetes by its traditional name appears in all the earliest texts, including the Yellow Emperor’s Inner Classic (Neijing).
Traditionally, it is divided into three types: upper, middle and lower. Each type reflects the predominance of one of the three main symptoms (thirst, hunger, and excessive urination) and is intimately related to the Lung, Spleen and Kidneys respectively. Yin deficiency is usually associated with all three types. A traditional diagnosis of wasting and thirsting may include illnesses besides the modern entity of diabetes and vice-versa i.e. someone with tang-niao-bing would not necessarily have xiao-ke.
For the purposes of this discussion, diabetes mellitus will be analysed according to the traditional category of xiao-ke or wasting and thirsting disease. It is believed to be related to eating fatty or sweet foods in excess, to emotional disturbances and to a constitution that is yin deficient. According to TCM, irregular food intake in the form of over-consumption of fatty, greasy, pungent and sweet food, hot drinks and alcohol impairs the transportive and transformative functions of the Spleen and Stomach, which in turn generates internal heat.
The accumulated food turns into heat that consumes fluids thereby creating thirst and hunger. In the Simple Questions (Su Wen), it is explained that ” … fat causes interior heat while sweetness causes fullness in the middle burner. The qi therefore rises and overflows and the condition changes into that of wasting and thirsting”.
Long-term internal heat injures yin and consumes body fluids. When body fluids are consumed, they fail to nourish the Lung and Kidneys. The pathological changes seen in diabetes therefore always include yin deficiency and dry heat. These factors mutually influence each other: yin deficiency leads to dry heat, dry heat to yin deficiency.
Prolonged emotional disturbance may contribute to wasting and thirsting by hindering the flow of qi. Over-thinking damages the Spleen whilst anger, resentment and frustration lead to constrained Liver qi. Stagnant Liver qi transforms into fire, which then consumes the yin of the Lung and Stomach. A passage from the Spiritual Axis (Ling Shu) elaborates “The five inner [yin] organs are soft and weak, and prone to symptoms of wasting heat. When there is something soft and weak there must be something hard and strong. Frequent anger is hard and strong and the soft and weak are thereby easily injured”.
1. When dry heat consumes Lung fluid, the ‘Lung fire’ gives rise to great thirst, with the consumption of large quantities of water and a dry mouth. The tongue is red with a yellow coating and the pulse floating and rapid.
2. When heat is retained in the Stomach and Spleen there is excessive appetite and constant hunger. Large appetite and excessive eating, thinness and constipation characterise ‘Stomach fire’. The tongue is red with a yellow coating and the pulse rapid.
3. When a person is constitutionally yin deficient, overwork, prolonged stress or illness, excessive sexual activity and pregnancy can consume the essence. The result is deficiency of Kidney yin which can in turn lead to blazing of Kidney fire. ‘Kidney fire’ is characterized by frequent, copious urination, cloudy urine (as if containing grease), progressive weight loss, dizziness, blurred vision, sore back, ulceration or itching of the skin, and vaginal itching. The tongue is red with scanty or no coating and the pulse is fine and rapid.
All three patho-mechanisms involve the mutual exacerbation of yin deficiency and dry heat scorching Kidney yin essence and the fluids of the Lung and Stomach. Yin deficiency is primarily associated with the Kidneys, and according to the principle that detriment to yin affects yang, Kidney yang deficiency is also invariably observed in prolonged cases. Therefore xiao-ke syndrome may also occur when there is deficiency of Kidney yang.