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Diabetes : Xiāo Kě (消渴)

References

  1. Internal medicine in Traditional Chinese medicine (TCM), Shanghai technical press, ISBN 7-5323-4105-4. 王永炎.
  2. Acupuncture treatment study, Shanghai technical press, ISBN 7-5323-4564-5. 石学敏 .
  3. Diabetes seminar from Prof Wu Xue Zhang, 8.10.2006, Aarau, Complemedis AG.
  4. Private communication with Dr. Xu Min, Wu Han University of TCM.

General Introduction

Diabetes in western medicine is named Xiāo Kě (消渴) in TCM1. This paper discuss Xiāo Kě (消渴) within the TCM framework.

The clinical symptoms of Xiāo Kě (消渴) could be of the following:

  • excessive urination
  • excessive thirst
  • excessive hunger

The patients could have thin body appearance, the urine could have sweat taste.

TCM has good results in improving the symptoms of the patients. Diabetes is mentioned in Nei Jing already. Nei Jing said that the weakness of the five Zhang organs, over eating fatty food, unbalanced emotional life are the main causes of Xiāo Kě (消渴). 金匮要略 (Jīn Kuì Yào Luè) is the first book to mention about treatment for Xiāo Kě (消渴).

Today, diabetes is a common disease, it seriously injures the health of the patients, and there is an increase of patients who are diagnosed as diabetes.

Characteristics

The three excessive: urination, thirst and hunger are the main characteristics of for Xiāo Kě (消渴).

Though over eating, the patients often feel tire, no energy, and could even with thin body appearance.

Too frequent urination in the night is common among the Xiāo Kě (消渴)patients.

Aetiology

The following are causes known for Xiāo Kě (消渴):

  1. Weakness in the pre-natal energy, especially with Yin deficient constitution.
  2. Food: too much fatty and spicy food for a long period of time. The dysfunction of the stomach and the spleen due to the inappropriate food intake and the accumulated internal heat from the food themselves could injure the body fluid, and thus lead to dryness and thirst.
  3. Emotion: anger, worry are two known enemies for the liver and the spleen. If they are long standing, they could lead to internal fire, injure the yin of the stomach and the lung.
  4. Over tiredness: over work and too much sex are two causes for kidney yin deficiency and empty fire, this could lead to dryness in the lung and heat in the stomach.

Pathology

The yin deficiency is the cause (Ben) and the dryness and heat are the symptoms (Biao). It is to note that yin deficiency could lead to dryness and heat and vice versa.

Yin deficiency  dryness and heat the patients

The Zhang Fu organs involved in Xiāo Kě (消渴) are Lung, Stomach, and Kidney, among them, Kidneys are the most often involved.

Lung

Lung directs the Qi, is also the upper source of water, it is responsible for the distribution of the body fluid. When the Lung is injured with dryness and heat, the distribution of the body fluid is not assured, the body fluid goes straight down to the lower part of the body, eliminated as urine. This explains why the patients have frequent urination, excessive thirst.

Stomach

Stomach is the sea of food. Stomach digests the food so that the Spleen could perform its function of transportation. When the Stomach and the Spleen are injured by the dryness and the heat, the patients might have stomach fire and spleen yin deficient, they could lead to thirst, over drinking and over eating. Spleen Qi deficiency blocks the function of the transportation, the food essence instead of nourishing the muscle, they go to the lower part of the body, eliminated as urine, thus sweet urine and in some cases, the body become thin after a period of time.

Kidneys

Kidneys are the source of the yin and the yang energy. Yin deficiency in Kidneys leads to empty internal heat. This internal heat flares up to the heart and the lung, thus thirst results and excessive drinking. When the internal heat affects the stomach and the spleen, this deprives even more the kidneys from nourishment. All these could lead to the food essence to go down straight as urine eliminates.

Though Xiāo Kě (消渴) could be classified as Lung pathology, the stomach / Spleen pathology and the kidneys pathology, these pathologies are often inter-related.

When the lung is attacked by dryness, this injures the body fluid, the lung could then not be able to distribute the body fluid, the spleen/Stomach and the kidneys are then deprived of nourishment.

When the stomach / spleen are attacked by the heat and dryness, this instead injures the lung fluid and the kidney yin.

When Kidney yin is deficiency, this could injure the stomach / Spleen and the Lung as well.

When the patients suffer from the disease for a long time, the following two scenarios are common:

  • Yin injures the yang, this leads to yin and the yang both deficient. Spleen yang and Kidney yang deficiency are seen commonly for patients who suffer from the disease for a long time.
  • With very chronic disease, it goes into the Luo system, the blood vessel are blocked.

Xiāo Kě (消渴) is a disease that involved multiple organs, it influences the normal circulation of the Qi and blood. Yin deficiency and internal heat consume the body fluids, the circulation of the blood are not working on its normal condition, often lead to blood stagnation.

Diagnosis

  1. Excessive thirst or excessive hunger lead to over drinking and eating, frequent urination, thin body appearance, urine has sweet taste, any of these clinical manifestations could be diagnosed as Xiāo Kě (消渴). The patients are mostly in their middle age, often with eating spicy and oily food habit, consumption of alcohol is another characteristics. If the patients are from the younger age group, they are mostly more serious cases.
  2. The symptoms could develop into dizziness, tuberculosis, heart pain, strokes, eye diseases (què mù 雀目), skin disease (chuāng yōng 疮痈). Headache, vomiting, pain in the abdominal area, breathing difficulties, even to the point of losing the consciousness could belong to more serious cases. As the disease is strongly linked with the pre-natal energy, it is worth looking into the family medical records.
  3. Perform necessary urine tests might help in identifying the disease.

Differential diagnosis

The following two diseases are to be distinguished:

  1. Kǒu Kě Zhèng 口渴症, thirst is a clinical manifestation when the patients drink excessively due to thirst, this could be an accompanying symptoms in many diseases, especially in external heat induced diseases. This type of patients does not have excessive hunger for food, neither do they have excessive urination, and they do not have the typical thin physical body as many diabetes patients appear.
  2. Yǐng Bìng 瘿病, goitre, patients normally have fire due to Qi stagnation or empty fire due to Yin deficient. Emotional imbalance, excessive food intake, easily get hunger, thin body type, palpitation, eye dashed forward, one side or both sides of the neck are swollen, it differentiates from Xiao Ke by having no excessive thirst, excessive urination and no sweet taste in the urine.

Treatment based on the differentiation

Importance Differentiation

1. The three types of Xiāo Kě

When dryness in the lung is the main cause, excessive thirst the main symptom, the disease is called Shàng Xiāo (上消).

When heat in the stomach is the main cause, excessive hunger is the main symptom, the disease is called Zhōng Xiāo (中消).

When kidney deficiency is the main cause, excessive urination is the main symptom, the disease is called Xià Xiāo (下消).

2. Biao and Ben

Yin deficiency is the Ben (cause) of this disease, dryness and heat are the Biao (symptoms) of this disease.

Generally speaking, at the beginning stage, the Biao (dryness and heat) predominates, at the later stage, the Ben (Yin deficient) predominates the disease.

However, the Biao and the Ben manifestation co-exist in both stages.

3. Xiao Ke and other diseases

With Xiāo Kě as primary complaint, patients could also suffer from diseases such as eye problems, tuberculosis, disease of the heart and the brain, oedema, carbuncle, numbness of the four limbs as secondary complaints.

However, there are older patients who suffer first from these other diseases mentioned above as primary complaint(s), and Xiāo Kě as secondary complaint.

Treatment Principle

The main root cause of Xiāo Kě is Yin deficient and the main symptoms are dryness and heat. Clear heat and lubricate the dryness, nourish the Yin and the body fluid are the main treatment principles.

医学心悟, an old TCM book said: “To treat Shàng Xiāo (上消), it is required to lubricate the lung, clear the stomach heat. To treat Zhōng Xiāo (中消), it is required to clear the stomach heat and nourish the kidney. To treat Xià Xiāo (下消), it is required to nourish the kidney and tonify the lung.”

As most patients have long disease history, patients might also suffer from severe yin deficient and blood stagnation, diseases affecting the eyes, tuberculosis. It is thus required to take the stage of the patient into account, often one need to invigorate blood, clear heat and detoxifying, tonify spleen, nourish kidney yin.

Treatment based on differentiation:

1. Shàng Xiāo (上消), Lung Heat

Symptoms: Big thirst, excessive drinking, dry mouth and tongue, frequent and lot of urination, the edge and the tip of the tongue are red, yellow tongue coating, pulse is full and fast.

Method of treatment: clear heat, lubricate the lung, nourish the body fluid and stop the thirst.

Herbal prescription:

  • Xiāo Kě Fāng 消渴方 (Tiān Huā Fěn 天花粉, Huáng Lián 黄连, Shēng Dì Huáng, 生地黄, Gé Gēn 葛根, Mài Dōng 麦冬)

Acupuncture points:

  • Shǎo Fǔ 少府 Ht 8, Xīn Yú 心俞 Bl 15, Tài Yuān 太渊 Ki 3, Fèi Yú 肺俞 Bl 13, Yú Jì 鱼际 Lu 10

2. Zhōng Xiāo (中消), Stomach heat

Symptoms: Big hunger, excessive food intake, thirst, frequent urination, thin body shape, dry stool, yellow tongue coating, pulse is slippery and forceful.

Method of treatment: clear stomach heat, drain fire, nourish the yin and increase the body fluid.

Herbal prescription:

  • Yù Nǚ Jiān 玉女煎 (Shí Gāo 石膏, Shóu Dì Huáng 熟地黄, Mài Dōng 麦冬, Zhī Mǔ 知母, Niú Xī 牛膝)

Acupuncture points:

  • Pí Yú 脾俞 Bl 20, Wèi Yú 胃俞 Bl 21,Sān Yīn Jiāo 三阴交 Sp 6, Nèi Tíng 内庭 St 44, Zú Sān lǐ 足三里 St 36, Yí Yú 胰俞2

Xià Xiāo (下消)

2.1. Kidney Yin deficient

Symptoms: Frequent urination, cloudy urination or sweet urine, back pain and / or soar in the knees, lack of force, dizziness, tinnitus, dry mouth and dry lips, dry and itchy skin, red tongue body and little coating, pulse is thin and quick.

Method of treatment: nourish the yin and tonify the kidney. Lubricate the dryness and stop the thirst.

Herbal prescription:

  • Liù Wèi Dì Huáng Wán 六味地黄丸 (Shóu Dì Huáng 熟地黄, Shān Yào 山药, Fú Líng 苻苓, Dān Pí 丹皮, Zé Xiè 泽泻, Shān Zhū Yú 山茱萸)

Acupuncture points:

  • Shèn Yú 肾俞 Bl 23, Tài Xī 太溪 Ki 3, Gān Yú 肝俞 Bl 18, Tài Chōng 太冲 Liv 3, Yí Yú 胰俞2

2.2. Yin and Yang deficient

Symptoms: Frequent urination, cloudy urination. In worse case, urination follows immediately after drinking. Tireness, dry ear, soar in the back and in the knee, cold in the four limps. Sensitive to cold, heavy or irregular menstruation. Pale tongue body and white and dry coating, pulse is deep and forceless.

Method of treatment: Warm the yang and nourish the yin, nourish the kidney.

Herbal prescription:

  • Jīn Kuì Shèn Qì Wán 金匮肾气丸 (Guì Zhī 桂枝, Fù Zi 附子, Shóu Dì Huáng 熟地黄, Shān Yú Ròu 山萸肉, Shān Yào 山药, Fú Líng 苻苓, Dān Pí 丹皮, Zé Xiè 泽泻)

Acupuncture points:

  • Tài Xī 太溪 Ki 3, Shèn Yú 肾俞 BL 23, Zú Sān Lǐ 足三里 St 36, Qì Hǎi 气海 Ren 6, Mìng Mén 命门 Du 4, Yí Yú 胰俞2

Often Xiāo Kě patients suffer as well from blood stasis, in such case, the patient has purple tongue and other symptoms of blood stasis. Herbs from the invigorate blood category could be used; such as Dān Shēn 丹参, Yù Jīn 郁金, Hóng Huā 红花, Shān Zhā 山楂. Or one can use herbs that lower the sugar level and invigorate blood; such as Dān Shēn 丹参, Chuān Qiōng 川芎, Yì Mǔ Cǎo 益母草, these herbs invigorate blood and remove stasis, or Dāng Guī 当归, Chì Bái Sháo 赤白芍, these herbs invigorate blood and nourish blood. Mù Xiāng 木香 can also be used to move Qi and remove Qi stagnation. Gé Gēn 葛根 could be used to stop thirst.

Other Treatment

Xiāo Kě patients could suffer as well from other diseases simultaneously, especially chronic patients, such as Bái Nèi Zhàng 白内障, Què Máng 雀盲, and deafness. The main cause being liver blood and kidney essence deficiency, it is to note that nourish the ear and the eye is not sufficient. The main strategy recommended here is to: tonify the liver blood and kidney essence, commonly use formula are: Qǐ Jú Dì Huáng Wán 杞菊地黄丸 or Míng Mù Dì Huáng Wán 明目地黄丸. For patients who suffer from oedema, strokes, tuberculosis, they should also be treated for the diseases based on TCM differentiation.

Prevention and life style adjustment

Apart from the TCM treatment, patients are to note that some food intake adjustment is important, avoid oily and sweet food, cigarettes, alcohol, strong tea and coffee. Regular meals, lead an emotionally balance life style are advisable.

Conclusion

Xiāo Kě is a disease that identified by the three excessive: thirst, hunger and urination, with thin body appearance. The three excessive are used also to classify the diseases into Shàng Xiāo (上消), Zhōng Xiāo (中消) and Xxià Xiāo (下消). The liver, the stomach (Spleen) and the kidneys are the main organs affected by the disease.

TCM treatment is based on the principles: clear heat, lubricate the dryness, and nourish the yin and body fluid. For Shàng Xiāo (上消), it is required to lubricate the lung, for Zhōng Xiāo (中消), it is required to treat the stomach and for Xià Xiāo (下消), it is required to nourish the kidneys.

Xiāo Kě can lead to blood stasis, injures the yin and the yang, thus the patients could suffer from many other diseases simultaneously.

It is not clear how Insulin could be replaced by the TCM treatment, however, with TCM treatment, the patients have better chance to achieve a good balance of Yin, Yang, Qi and Blood, it is thus advisable to use TCM treatment for Xiāo Kě patients to reduce at least the risk of leading simultaneously to other diseases, if not eliminating completely the Xiāo Kě itself.

1: TCM: Traditional Chinese medicine

2: 胰俞 : is a point that is situated between Bl 17 and Bl 18, at the level of the lower border of spinous process of the 8th thoracic vertebra, 1.5 cun lateral to the Du meridian, 胃脘下俞（膵俞、胰俞、八俞, 背部穴  (EX-B3), [定位] 在背部，当第8胸椎棘突下，旁开1.5寸。[主治] 胃痛、腹痛、胸胁病、消渴。