Dear Colleagues! I decided to write a few words about diabetes mellitus in TCM after reading the article, which was published in 2018 and share with you for discussion. «Five Types of Diabetes: Will New Classification Make Management Easier? Jay H. Shubrook, DO; Sumera Ahmed, MD» (https://www.medscape.com/viewarticle/897960 ). This article talks about the practicability of changing the classification of diabetes mellitus (both type 1 and type 2) with more types of diabetes in order to improve clinical practice and make treatment more accurate. The article immediately caused heated discussions in the comments, which clearly indicates the relevance of this topic. After all, the problem of diabetes is a very acute topic, this is not surprising. As you know, the number of people suffering from diabetes is growing from year to year – just look at the statistics according to WHO https://www.who.int/news-room/fact-sheets/detail/diabetes). We see that medicine is now developing at an enormous pace, many researchers say that exponential growth is characteristic of Western science. Indeed, as we can see, almost every month all the new recommendations for people with diabetes are published in terms of lifestyle, diet and physical activity. But these recommendations are still not unambiguous, they are fully suitable for some patients, but for others they do not always bring the expected benefits. Perhaps an integrative approach would be appropriate here, as Chinese medicine is also developing, it has its own classification of diabetes, and this classification of syndromes has undergone changes and has expanded significantly in recent years. As is known, the main difference in approaches is that in Chinese medicine an increase in blood glucose is considered as part of a single set of symptoms, which is a single syndrome. And each such syndrome is a separate pathogenic mechanism of a certain “breaking down” of metabolic processes. And it is well known to the respected reader. The importance of this classification seems to me in that the causes and starting factors for increasing sugar in each case are clearly visible. They can be completely different. According to TCM, for example, for a group of syndromes of “heat” (re zheng) overeating and stagnation of food, hot weather, inflammation in the intestines, excessive alcohol consumption, and so on provokes an increasing of glucose level. For syndromes associated with the stagnation of qi, the trigger factor for hyperglycemia is often stress, anger, disturbed cyclical sleep and wakefulness, and frustration. On the contrary, for patients with syndromes of “cold” and “emptiness” (exhaustion), as you know, danger of overworking, hypothermia, catarrhal diseases, eating cold raw food exchange metabolic indicates worsen. In a nutshell, according to current publications, a total of about 12 syndromes, including all conditions accompanied by hyperglycemia, are currently isolated in the TCM. This classification appeared relatively recently, when specialists in the field of TCM began to apply an integrative approach to the study of the metabolic syndrome in general and type 2 diabetes in particular. Yes, and when the metabolic syndrome was formed itself as a nosological unit in Western medicine. As is known, 10 or 15 years ago diabetes was considered in the TCM as “thirst and exhaustion syndrome” – “Xiao Ke”, divided into three types (upper, middle and lower thirst – according to the pathogenesis mechanism in upper, middle or lower jiao). Type 1 diabetes is more correlated with upper and middle “thirst”, and type 2 diabetes with “lower thirst” syndrome and partly middle one. Currently, this classification has not lost its significance for those syndromes that are described in it. But, moreover, today’s detailed classification of syndromes includes type 2 diabetes, insulin resistance disorders, and changes in carbohydrate metabolism associated with it, allows us to very accurately determine the trigger factors in terms of increasing glucose levels and, accordingly, preventive measures, diet and lifestyle recommendations. And experts widely use this approach. The TCM approach helps in combination with the methods of Western medicine, although there are still questions. Separately, it must be said that in the TCM, hereditary predisposition to diabetes, as is known, is considered as one of the reasons and is called the “weakness of the first palate” – xiang tian bu zu. Therefore, great hopes are placed on the diagnosis of the genome in terms of susceptibility to diabetes, when even moderately powerful trigger factors can play a decisive role. I would like to bring to your attention the classification of diabetes mellitus already familiar to many in the TCM and invite distinguished colleagues to discuss, since nobody has canceled the epidemic nature of this pathology. I deal in detail with the problems of metabolic syndrome, and your additions and comments will be very interesting to me.
Without pretending to be scientific, since all this information is borrowed from modern editions and lectures of colleagues dealing with diabetes in the TCM, and my own practice, I would like to express my thoughts on the importance of starting factors for increasing glucose levels, the causes of illness in each syndrome, to attempt to workout some recommendations. In my opinion, the subjective symptoms of the patient are undeservedly not given importance. I think that this information will be useful in practice. Too quickly some recommendations in classical Western medicine are replaced by others that deny the previous ones, which means that, in my opinion, the problem is far from being solved.
The first line of syndromes. More relevant to conditions of insulin resistance, type 2 diabetes, prediabetes, metabolic syndrome, NAFLD, combined endocrine pathology, including dysfunction of the thyroid gland, adrenal glands with a simultaneous increase in blood glucose and a violation of other indicators, in particular, mainly insulin and glucagon.