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Diabetes in TCM: 5 Syndrome Differentiations & Treatment Protocols

Diabetes in TCM: 5 Syndrome Differentiations & Treatment Protocols
In the fifth class of the Clinical Pearls from Top TCM Experts series, Dr. Lan Zhang explored the complex understanding of diabetes in Traditional Chinese Medicine. While diabetes is an elaborate disease that can present in a variety of symptoms, Dr. Zhang outlined five unique syndrome differentiations of diabetes in TCM and suggested different treatment protocols for each.

1. Syndrome of fluid consumption due to lung heat
  • Symptoms:
    • Thirst and excessive drinking of water, dry mouth and tongue, frequent urination, irritability, and sweating
    • Red tongue tip, thin and yellow tongue coating, surging and rapid pulse
  • Pathogenesis: Fluid consumption due to lung heat
  • Therapeutic methods:
    • Clearing heat and moistening the lungs, producing fluid and quenching thirst
    • Formula: Xiao Ke Fang
      • Tian Hua Fen, Sheng Di Huang, Huang Lian, lotus root juice, human milk, ginger juice
    • Modification:
      • For patients eating more, easy hunger, dry stool, yellow and dry tongue - Bai Hu Jia Ren Shen Decoction
      • Heat damages the lung yin, and thready pulse, less tongue coating - Yu Quan Wang or Er Dong Tang
2. Syndrome of stomach heat exuberance
  • Symptoms:
    • Eating more, easy hunger, thirst, frequent urination, emaciation, dry stool
    • Yellow tongue coating, smooth and strong pulse
  • Pathogenesis: Stomach heat damaging fluid
  • Therapeutic methods:
    • Clearing the stomach and purging fire, nourishing yin, and increasing fluid
    • Formula: Yu Nu Jian
      • Zhi Mu, Shi Gao, Mai Dong, Shu Di Huang, Niu Xi
    • Modification:
      • For bitter mouth, constipation - add Shi Gao, Huang Lian, Zhi Zi
      • For thirst, less tongue coating - add Wu Mei
      • For fire exuberance injures yin, red and dry tongue, thin and rapid pulse - Zhu Ye Shi Gao Tang
3. Syndrome of deficiency of both qi and yin
  • Symptoms:
    • Thirst with preference for drinking, excessive food intake, loose stools, or reduced diet, lack of energy, weakness of limbs, emaciation
    • Pale tongue, white and dry tongue coating, weak pulse
  • Pathogenesis: Long-term illness causes lung, stomach, and kidney yin loss, yin injury involves qi
  • Therapeutic methods:
    • Invigorating qi and spleen, producing body fluid, and quenching thirst
    • Formula: Modified Qi Wei Bai Zhu San
      • Ren Shen, Fu Ling, Bai Zhu, Gan Cao, Huo Xiang Ye, Mu Xiang, Ge Gen
    • Modification:
      • For those with dryness and heat in the lung - add Di Gu Pi, Zhi Mu, Huang Qin
      • For obvious thirst - add Hua Fen, Sheng Di Huang, Wu Mei
      • For shortness of breath and profuse sweating- add Sheng Mai San
      • For less eating and bloating - add Sha Ren, Ji Nei Jin
4. Syndrome of kidney yin deficiency
  • Symptoms:
    • Frequent and profuse urination, cloudy like grease, soreness of waist and knees, fatigue, dizziness and tinnitus, dry mouth and lips, dry skin, itching
    • Red tongue with little tongue coating, thin and rapid pulse
  • Pathogenesis: Deficiency of kidney yin
  • Therapeutic methods:
    • Nourishing yin and strengthening kidney
    • Formula: Liu Wei Di Huang Wan
      • Shu Di Huang, Shan Yu Rou, Shan Yao, Dan Pi, Fu Ling, Ze Xie
    • Modification:
      • For hyperactivity of fire due to yin deficiency - add Zhi Bo Di Huang Wan
      • For deficiency of both yin and yang, limbs with lack of warmth, pale tongue, white and dry tongue coating, weak pulse - add Jin Gui Shen Qi Wan
      • For yin exhaustion and yang depletion, loss of consciousness, cold limbs, fine and thready pulse - add Shen Fu Long Mu Tang
5. Syndrome of dampness-heat disturbing spleen or phlegm-turbidity obstructing middle-jiao
  • Symptoms:
    • Distension in the chest and abdomen, or fullness after eating, heavy head and body, obesity, distress in the heart and chest, fatigue in the limbs, yellow and dark urine, dry stool
    • Red tongue with yellow greasy tongue coating, slippery and rapid pulse
  • Pathogenesis: Internal accumulation of dampness and heat, disharmony of the spleen and stomach
  • Therapeutic methods:
    • Invigorating the spleen and harmonizing the stomach, clearing heat and removing dampness
    • Formula:
      • Er Miao San (Cang Zhu, Huang Bai)
      • Or modified Er Chen Tang (Hou Po, Chen Pi, Cang Zhu, Zhi Gan Cao)
    • Modification:
      • For obvious chest tightness - add Dan Shen, Chi Shao, Chuan Xiong

In addition to these syndrome differentiations, Dr. Zhang also introduced the classical TCM reference of diabetes “Xiaoke”, explored several routes of etiology and pathogenesis, shared strategies for diabetes prevention and regulation, and presented multiple successful case studies from her clinical experience.

Many of the herbal formulas and/or single herb ingredients suggested by Dr. Zhang are available through Treasure of the East. The full video recording of this session is available HERE for those who are logged in and registered through the World Chinese Medicine Forum.

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