Diabetes mellitus is a heterogeneous primary disorder affecting the processing of carbohydrates with multiple etiologic factors that generally involve absolute or relative insulin deficiency, insulin resistance or both. All causes of diabetes ultimately lead to hyperglycemia, which is the hallmark of this disease.

Diabetes is typically classified into Type I, or insulin dependent diabetes mellitus, in which patients have little or no endogenous insulin secretory capacity, and Type II, or non-insulin dependent diabetes mellitus, in which patients retain significant endogenous insulin secretory capacity.

Diabetes mellitus is known in traditional Chinese medicine as depletion-thirst disease, characterized by polydipsia, polyphagia, polyuria, and emaciation.

Pathomechanism and Pathogenesis

Diabetes occurs in association with the following etiologic factors:

1. The spleen and stomach are damaged by overeating greasy food or by over-consuming alcohol, causing failure of the spleen in transporting and transforming which, in turn, causes interior-heat to accumulate and consume food and body fluids, finally resulting in diabetes.

2. Anxiety, anger, mental depression, etc. injure the liver, causing the liver qi to stagnate. Protractedly stagnated liver qi turns into evil heat which consumes body fluids body fluids and eventually leads to diabetes.

3. Deficiency in the kidneys caused by intemperance in sexual life or congenital essence defect causes the kidney qi to wane; as a result, the kidney qi fails to maintain the functioning of the bladder in restraining urine discharge, thus polyuria occurs.                                  

Differential Diagnosis of Syndromes

Traditional Chinese medicine identifies three types of diabetes: the upper depletion-thirst, the middle depletion-thirst, and the lower depletion-thirst. Differential diagnosis of syndromes is based upon these three types

1. Upper-warmer depletion-thirst diseases

Pathogenic heat consumes the lung yin, thus affecting the upper-warmer.

Primary manifestations: Severe thirst accompanied by dryness of the mouth and tongue, polyguria, reddened tip and margin of the tongue with thin, yellow coating, and full and rapid pulse.

2. Middle-warmer depletion-thirst disease

Excessive fire of the stomach consumes the stomach yin fluids.

Primary manifestations: Polyphagia, emaciation, constipation, reddened tongue with dry, yellow coating, and slippery and strong pulse.

3. Lower-warmer depletion-thirst disease

a). Yin deficiency: A morbid state due to a defect in the kidney essence and consumption of the kidney yin.

Primary manifestations: Polyguria, turbid urine, dry mouth, reddened tongue with little coating, and weak and rapid pulse.

b). Deficiency of both yin and yang: A morbid state due to deficiency of the kidney yin and yang.

Primary manifestations: Severe polyguria, turbid urine, lassitude, spontaneous sweating, shortness of breath, impotence, dark complexion, pale tongue with white coating, and deep and weak pulse.

Treatment                                                         

1. Upper-warmer depletion-thirst disease

Principle of treatment: Expel heat, purge fire, increase the production of the body fluids and relive thirst.

Formula of choice: Asparagus and Ophiopogon Decoction with modifications; in this prescription, asparagus root (tian dong) and ophiopogon root (mai dong) nourish the yin of the lungs and stomach, and promote the production of the body fluids; scutellaria root (huang qin) and anemarrhena root (zhi mu) clear away heat from the lungs and stomach; ginseng (ren shen) strengthens the qi and produces the body fluids; for patients with extreme thirst accompanied by a dry and yellow tongue coating, gypsum (shi gao) can be prescribed to clear away the stomach fire.

2.Middle-warmer depletion-thirst disease

Principle of treatment: Clear away stomach heat and nourish the yin.

Formula of choice: Jade Dew Decoction, in which gypsum and anemarrhena root (zhi mu) clear the stomach fire; fresh rehmannia root (sheng di) and ophiopogon root (mai dong) nourish the yin of the lungs and kidneys; and achyranthes root (niu xi) brings fire downward; for cases with yellow, greasy tongue coating, add coptis root (huang lian) and scutellaria root (huang qin) to expel dmap-heat from the stomach; for cases with constipation, add rhubarb (da huang), magnolia bark (hou po), and unripe bitter orange (zhi shi) to purge heat.

3.Lower-warmer depletion-thirst disease

a). Yin deficiency:

Principle of treatment: Nourish the kidney yin.

Formula of choice: Six-Ingredient Rehmannia Pill; when this prescription is used to treat diabetes, use large dosages of cornus fruit (shan zhu yu), cooked rehmannia root (shou di), dioscorea root (shan yao) to nourish and retain the yin fluids of the liver and kidneys and to replenish the spleen yin in order to relive polyuria.

b). Deficiency of the yin and yang:

Principle of treatment: Replenish the qi and nourish the yin.

Formula of choice: Six-Ingredient Rehmannia Pill and Pulse-Activating Powder; for patients with aversion to cold and clod limbs, add Kidney Qi Pill to invigorate the kidney yin and yang.  

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