by Bob Flaws

In Old China, diabetes mellitus was only diagnosed (under the rubric of xiao ke, wasting thirst) once a person displayed the three polys: polyuria, polyphagia, and polydipsia. Wang Ken-tang, in his Wai Tai Mi Yao (Secrets Essentials from the Outer Posting), said, “Thirst with excessive drinking of water [along] with frequent urination… which is sweet is wasting thirst disease.” In that case, such frankly symptomatic patients mainly exhibit the patterns of dryness, heat, and yin vacuity. Therefore, our classic formulas for wasting thirst clear heat, moisten dryness, and enrich yin. However, in the West, our patients are commonly diagnosed with diabetes 10-15 years earlier during a routine physical exam. These patients do not have the three polys and, therefore, also do not necessarily exhibit the patterns of heat, dryness, and yin vacuity. Thus, we modern practitioners of Chinese medicine need to simply identify our diabetes patient’s presenting pattern(s) based on the signs and symptoms that are present and then treat what we see without undue influence from the classical Chinese medical literature.

Follow up:

In fact, in the last five years or so in China, more and more Chinese doctors are realizing that the classical literature on wasting thirst does not reflect the clinical realities of diabetes diagnosed by serum glucose analysis in otherwise asymptomatic patients (i.e., asymptomatic for the three polys). As an example of this, on pages 118-119 of issue #6, 2008 of Shi Yong Zhong Yi Nei Ke Za Zhi (Journal of Practical Chinese Medicine Internal Medicine), Xue Xue and Gong Jie-ning, both from the Nanjing University of TCM, published an article titled “Research on the Relationship between Wasting Thirst and the Liver’s Coursing & Discharging Function.” In this article, Xue and Gong discuss the liver’s governance of coursing and discharging in terms of the spleen and stomach’s upbearing and downbearing and thence the development of diabetes mellitus. Although classical texts say nothing about the liver’s coursing and discharging in terms of the disease causes and mechanisms of wasting thirst, Xue and Gong say that Chinese medical practitioners need to pay attention to this function of the liver in the case of this disease. This is an example of how Chinese medical theory and practice is constantly evolving in the light of clinical practice and why it is important to a) stay abreast of the contemporary literature and b) not be blinded by Golden-Age-ism.

For more information on the contemporary Chinese medical treatment of diabetes mellitus, search that term on our Blue Poppy TCMinfoline and you will find a number of articles discussing the treatment of early-stage diabetes by mainly treating the liver, spleen, and stomach.