浪费渴 XIAO KE ─ WASTING THIRSTING ─ TYPE II DIABETES

Chinese physicians appear to have had a reasonably good understanding of diabetes since ancient times. One of the oldest books about Chinese medical theory, the Huang Di Neijing, compiled around 100 BC, mentions XIAO KE as a condition. This is translated today as diabetes or wasting-thirsting pattern. The literal translation of the term is emaciation-thirst, referring to the disease manifestation when it has gone untreated: namely, one loses body weight despite eating normally, and thirst is persistent. According to this ancient text, the syndrome arises from consuming too much fatty, sweet, or rich foods. The description fits that of non-insulin-dependent diabetes mellitus.

For Type II Diabetes or Metabolic Syndrome, the dietary needs and sensible protocols are much different, and restoring a healthy metabolism, improving insulin sensitivity, and reversing fatty accumulation in and around organs are keys to success. Diets most studied and proven to help with insulin resistance include the Mediterranean Diet ─plant-based whole food diet with a variety of healthy fats, a diet to restore balance of essential fatty acids, a low carbohydrate and high protein diet, a diet that avoids simple and processed carbohydrates and emphasizes healthier complex carbohydrates, a high fiber diet, and sensible use of specific nutrient supplements, i.e. magnesium, zinc-monomethione, methylselenocysteine, green coffee extract, green tea epicatechins, and krill oil. In all types of diabetes, avoidance of trans-fats and high fructose corn syrup, as well as processed fats and sugars, in general, is very important. ^[1]

In Western medicine, the clinical manifestations of diabetes mellitus and diabetes insipidus are in many ways similar to those of wasting-thirst patterns. Differential diagnosis and treatment of diabetes can be made according to the descriptions below.

Wasting-thirsting patterns manifest as excessive thirst, hunger, and urination. They are often accompanied by emaciation and sweet or turbid urine. They may be divided into Upper, middle and LowerJiao patterns based on the relative severity of the three excessive symptoms.^[2][3]

UpperJiao wasting-thirst is characterized by prominence of excessive thirst.
MiddleJiao wasting-thirst is characterized by the prominence of excessive hunger.
LowerJiao wasting-thirst is characterized by excessive urination.

A theory has arisen as to how diabetes progresses. The disease begins with a deficiency of Yin, which seems contradictory to the appearance of the patient, who often shows obese constitution and low metabolism ─signs that would correspond to excess of Yin and deficiency of Yang. However, these patients with early stage of diabetes actually have a hyperactive metabolism that does not make efficient use of energy. Hence, the food nutrients are not successfully utilized; hunger persists, sugar pours out in the urine, thirst develops, and there may be easy sweating. Subsequently, this deficiency of Yin generates Heat that becomes pathological, and then parches the Yin. The imbalance of Yin and Yang eventually degrades and inhibits the Qi, so that Qi and Yin deficiency co-exist.

At this point, secondary effects, such as blood stasis and damp-heat, manifest, causing many serious symptoms. Without proper nourishment of Qi and Yin, Yang eventually becomes impaired, and the patient, now with advanced disease, has a combined deficiency of Qi, Yin, and Yang.^[4][5][6]

Etiology and Pathogenesis

Wasting-thirst patterns are related to a constitutional deficiency of Yin, improper diet and eating habits, emotional disturbance and overindulgent sexual activity. The pathogenesis of wasting-thirst is attributed to Yin deficiency and dryness heat, with Yin insufficiency as the root and heat-dryness as the branch. Very often, these 2 give rise to one another, with severe heat-dryness depleting Yin and the depletion of Yin allowing exuberant heat-dryness. Pathological changes occur mainly in the LU, ST and particularly the KD.

During the initial stages of the disease, dryness heat is generally prominent. Heat-dryness existing with Yin deficiency results in a more prolonged illness, with the deficiency of Yin becoming more prominent as the illness progresses. Injury to both Qi and Yin or insufficiency of both Yin and Yang are possible developments. Yin deficiency coupled with heat-dryness can lead to blood stasis, producing secondary conditions such as pulmonary tuberculosis, cataracts, night blindness, ulcers, stroke and edema. If the Yin fluids are severely depleted, insufficient Yang may rise to the surface and escape, producing symptoms of headache, agitation, nausea, vomiting, dry red tongue and lips, and rapid breathing. In severe cases cold limbs, faint pulse, coma and collapse can occur.^[7]

TCM Patterns

Lung-Heat with Injury to Fluids
Profusion of ST-Fire
Depletion of KD Yin

LU-Heat with Injury to Fluids

Symptoms: Excessive thirst, high fluid intake and dry mouth, accompanied by frequent urination and excessive hunger.
Tongue: Dry red tip; thin yellow coat.
Pulse: Rapid.
Treatment: Clear heat, moisten the LU, generate liquid, and relieve thirst.

Profusion of ST-Fire

Symptoms: Excessive hunger, high food intake, emaciation, dry stools or constipation, thirst.
Tongue: Yellow coating.
Pulse: Forceful, slippery.
Treatment: Clear ST fire, nourish SP Yin, generate liquid.

Depletion of KD Yin

Symptoms: Frequent urination, copious turbid milky urine, dry mouth and lips, thirst, high fluid intake, weak aching lower back and knees, dizziness and vertigo, blurred vision, red cheeks.
Tongue: Red with little coating.
Pulse: Deep, rapid, thready.
Treatment: Nourish KD Yin, secure the KD.

COMMENTARY

Pre-Diabetes and Diabetes
Identifying prediabetes early can help you head off diabetes and other long-term health problems. Prediabetes is a common condition, and often goes undetected. People with this condition have a number of health risks, including a greater chance of suffering a heart attack or stroke. In addition, they are more likely to develop diabetes, which can lead to additional health problems, such as kidney disease and a higher rate of infection.

Testing for prediabetes can find the condition early and potentially prevent it from progressing to diabetes. Many women and men are living with an unseen health risk — prediabetes, a condition where blood sugar is elevated, but not high enough to meet the threshold for diabetes. While prediabetes affects one in every three adults, nine out every 10 people with prediabetes don’t know they have it.

Diabetes occurs when the body has trouble using the sugar it gets from food for energy. Sugar builds up in the bloodstream. High blood sugar can have immediate effects, like blurry vision. It can also cause problems over time, like heart disease and blindness.

There are two main types of diabetes: type 1 diabetes (once called juvenile-onset diabetes) and type 2 diabetes (once called adult-onset diabetes). Both are caused by problems making or using insulin, a hormone that makes it possible for cells to use glucose, also known as blood sugar, for energy.

When you eat, your body breaks down carbohydrates into a simple sugar called glucose. It also produces a hormone called insulin that signals the body’s cells to absorb glucose from the bloodstream. Type 1 diabetes occurs when the body doesn’t make enough insulin, or stops making it altogether. Type 2 diabetes occurs when the body’s cells don’t respond to insulin. Either way, since sugar can’t get into cells, it builds up in the bloodstream.

Too much sugar in the blood can cause a range of uncomfortable symptoms. These include:

Blurry vision

Intense thirst

Need to urinate often

Fatigue

Numbness or tingling in the hands or feet

Type 1 diabetes often comes on suddenly. It usually strikes children and teenagers but can appear later in life. It is an autoimmune disease, meaning it happens because the body’s immune system mistakenly attacks and destroys the body’s insulin-making cells. Type 1 diabetes can’t be cured, but it can be managed by taking insulin before eating.

Type 2 diabetes takes longer to develop. It can begin any time from childhood onward. Type 2 diabetes is usually triggered by being overweight or obese and not getting much physical activity. Treatment for type 2 diabetes includes weight loss if needed, daily exercise, a healthy diet, and medications.

HYPERTENSION

OBESITY

METABOLIC SYNDROME

LONGEVITY

 

__________________________________________________________________________________________________________________________________________________________________REFERENCES
^[1]http://www.ncbi.nlm.nih.gov/pubmed/27159643 . Of course, this is a big subject, and a dizzying amount of information and advice, mostly geared to sales rather than health, is now available on the web. Hopefully, this small offering will help create a guideline for a healthy individualized approach.
^[2] Maoshing Ni, The Yellow Emperor’s Classic of Medicine: A New Translation of the Neijing Suwen with Commentary, 1995 Shambhala, Boston, MA.
^[3]Personal classroom notes. 2009-2011.
^[4] Chen DC, et al., Clinical and experimental studies in treating diabetes mellitus by acupuncture, 1994 Journal of Traditional Chinese Medicine; 14(3): 163-166.
^[5] Lu Renhe, Treatment of diabetes in the elderly-an analysis of 885 cases, Journal of Traditional Chinese Medicine, 1993; 13(2): 83-91.
^[6] Lin L, et al., A clinical study on treatment of vascular complications of diabetes with the sugar-reducing and pulse-invigorating capsule, Journal of Traditional Chinese Medicine (English) 1994; 14(1): 3-9.
^[7]Yan Wu. Practical Therapeutics of Traditional Chinese Medicine. Paradigm Publications. Taos, New Mexico. 2017.

-Above Article Written by Dr. Osorio, Gloria DAOM, L.Ac. 2017.