Lin Lan, a famous doctor in the capital, discussed the ideas and methods of treating diabetes (1) | grasp the disease opportunity from the "five causes" as a whole

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Lin Lan, Professor, Chief Physician, Doctoral Supervisor, Famous Doctor of the Capital State, Guidance Teacher of academic Experience Inheritance of the Fourth Batch of Old Chinese Medicine Experts in China, Chief Researcher of China Academy of Chinese Medical Sciences, And National Famous Diabetes Expert. He is currently the academic leader of the Key Clinical Specialty (Department of Endocrinology of Traditional Chinese Medicine) of the National Health and Family Planning Commission and the Key Discipline of Endocrinology of Traditional Chinese Medicine of the State Administration of Traditional Chinese Medicine. He has been practicing medicine for 60 years and teaching for 55 years, has rich clinical experience, pioneered the dialectical theory of type 3 diabetes and the principles of beneficial qi and yin, invigorating blood and dissolving stasis, developed and marketed 4 kinds of proprietary Chinese medicines for the treatment of diabetes mellitus and its complications, and obtained 4 invention patents.

Diabetes belongs to the category of "quenching thirst" in Traditional Chinese medicine. The Inner Classics say: "All the five internal organs are weak, and the good and the sick are eliminated." Emphasizing the significance of the weakness of the five viscera in the thirst-quenching disease, the cause of the thirst-quenching disease is attributed to the "dirty and brittle" of the five viscera. According to the theory of "Neijing" and combined with his long-term clinical experience, Professor Lin Lan summarized the causes of diabetes into the following five aspects.

Intrinsic factors: the five internal organs are weak

"The memory of righteous qi, evil cannot be done" "Where evil is gathered, its qi will be empty." Traditional Chinese medicine attaches great importance to the role of factors in the body. Deeply realize that the occurrence of diabetes mainly lies in the internal factors of the weakness of the five internal organs. Kidney yin deficiency, lonely yang, can not control the fluid, direct infusion of the bladder and cause frequent urination, more volume, turbid and sticky like grease paste, urine has a sweet taste. Mizutani is delicate and cannot nourish the skin, and the body is emaciated and weak. Kidney yang deficiency and kidney qi deficiency, it is a thirst-quenching disease. Diabetic kidney yin deficiency, yin disease and yang and kidney qi deficiency, indicating the development of thirst-quenching disease worsening trend. Kidney yang deficiency, Jin does not dissolve gas, gasification disorders, drink one or two. Diabetic blood glucose is not controlled, resulting in hypertonic dehydration and symptoms such as thirst, drinking, frequent urination, and high urine output. The kidney yin has been lost for a long time, the yin essence is consumed, and the fire of the thunder dragon is inflamed, and it is unstoppable at one time. Fire swims in the lungs and thirsty, fire swims in the stomach and hunger, fire burns yin essence and yang is strong, yin is not guarded, then the urine is cloudy like an ointment, and the true yin is discharged into the next dissipation.

The typical "three-plus" symptoms of diabetes mellitus are seen in diabetic hyperglycemia, which leads to diabetic ketosis or ketoacidosis. The five organs are lost in the kidneys and are weak, and the qi and yin are all weak. Compound due to poor diet, damage to the spleen and stomach, the day after tomorrow water valley subtle biochemical deficiency; or internal injuries of the seven emotions, anger liver fire wound yin; or room fatigue loss, depletion of kidney essence and kidney qi; or external evil six adulterous into the void, long-term stagnation of heat, consumption of yin and injury qi leads to yin more deficiency and hotter, the more hot the vicious circle of yin callus, and finally becomes the pathogenesis of thirst quenching disease.

In summary, the onset of thirst-quenching disease plays a leading role, which is consistent with the understanding that modern medical research confirms that the incidence of diabetes is related to genetic factors, immunodeficiency, insulin deficiency or insulin resistance.

Emotional factors: hepatic depression stagnation

Thirst quenching disease can be caused by long-term emotional discomfort, mental depression, liver disorders, poor gas machine, liver depression stagnation, long-term depression fire, liver fire burning, consumption of yin fluid and other symptoms, clinically common lung yin burns, kidney water consumption, heat injuries stomach yin and other symptoms. Successive generations of physicians have paid great attention to the causes of thirst-quenching, and believe that the injuries of the seven emotions, the depression of liver qi, the long-term depression of fire and yin, the consumption of lung jin, the trauma of gastric juice, and the damage to kidney water are the main causes and pathogenesis of thirst. This is quite similar to the modern medical view that diabetes can be induced or aggravated in psychological stress states. American physiologist Cannon found that nervous stimulation can cause endocrine disorders, prompting an increase in the secretion of hormones such as epinephrine, norepinephrine, and thyroxine. These hormones are antagonistic with insulin. Recent studies have further confirmed that when in a state of anxiety, the plasma insulin content is significantly reduced, and glucagon is increased, which increases blood sugar. It can be seen that psychological factors can promote the occurrence of diabetes and make the symptoms worse. Some researchers have found that in the case of stress, people can cause psychological disorders, disrupt normal psychological and living conditions, and then induce diabetes. Diabetes is a lifelong disease, the complication rate is very high, the incidence of psychological disorders in patients is as high as 30% to 50%, mainly manifested as anxiety, depression, compulsion, terror and other diseases, the quality of life is significantly reduced, which is quite consistent with the theory of the seven emotions of Chinese medicine.

Life Factors: Poor diet

Diet therapy is the basis of all diabetes treatment and is an indispensable and important treatment measure in the natural course of diabetes. Healthy diet, through the spleen and stomach transport subtle, chemical qi and blood, nourish the five organs, sprinkle the six intestines, maintain the metabolism of the human body. Diet is not moderate, vegetarian alcohol is fat and sweet, eating spicy, or hungry and full, stagnation of food, damage to the spleen and stomach, all diseases arise from birth, and thirst is quenched.

The spleen is the foundation of the day after tomorrow, the source of mizutani biochemistry, and the main transport. Poor diet, damage to the spleen and stomach, spleen loss of good luck, wet turbidity, permanence heat, stomach fire, hot burning yin injury, insufficient stomach yin, jin can not inherit the lungs, and cause lung dryness. Poor diet, spleen loss of good luck, spleen wet connotation, heat consumption can also lead to thirst-quenching disease. This is in line with modern medicine advocating controlled diet, reduced caloric intake, and maintenance of a standard body weight to prevent or improve insulin resistance, delaying or stopping the body's transfer to prediabetes or diabetes. The appetite for ointment is thick and tasteful, and the wine is spicy, and it is easy to contain heat and hurt the stomach. The stomach is hot and dry, the liquid is depleted, and the desire to eat and drink is filled with funds, and the food is cremated to eliminate the hunger of the valley. Mizutani is slightly depleted, can not nourish the skin, then the body is getting thinner and thinner. Poor diet, heavy appetite and depletion of stomach yin, stomach burning can cause thirst-quenching disease. Exacerbation due to poor diet is similar to the poor diet of diabetics, which causes hyperglycemia. Poor diet can cause hot and dry knots in the large intestine of diabetic patients. In the face of the stomach and the large intestine, the stomach is hot and dry, the large intestine is not moist, then the large intestine is hot knot, the hot knot is steamed in the stomach, and the dry heat in the stomach is aggravated, which eventually leads to the hot knot of the hands and feet, the constipation knot is not clear, and the Yang Ming intestine is solid and causes thirst-quenching disease. Constipation is one of the common clinical symptoms in patients with diabetes mellitus, mainly caused by diabetes mellitus complicated by autonomic gastrointestinal dysfunction, or hyperglycemic dehydration.

Modern medicine believes that excessive intake of carbohydrates, fats, proteins and other diets is the main cause of obesity. Obese people are often accompanied by hyperinsulinemia, which presents with insulin resistance. Type 2 diabetes occurs when insulin does not compensate for insulin resistance. Controlling diet and preventing obesity are currently the main measures to prevent the development of type 2 diabetes. Alcohol abuse can reduce the liver's ability to store glucose, promote glycogen breakdown, aggravate liver cell damage, and even accelerate cirrhosis and make diabetes worse. This is the same as the understanding of Chinese medicine.

Precipitating factors: external sensations of sexual immorality

"Where evil is gathered, its qi will be empty", the body endowment is vain, the guard is not solid, the heart is sparse, the kidney qi is not full, the qi and blood are both lost, and the external evil takes advantage of the void. Children are the body of the immature yang, the five organs are weak, and they are susceptible to external evils. Wei Qi is weak, the heart and lungs are weak, and they are susceptible to external evil. External evil and inner connotation, containing long-lasting heat, heat consumption lung yin hair into thirst-quenching disease. Six obscene attacks on the lungs, lung qi is not declared, contains heat, heat consumes lung yin and causes thirst quenching disease. Dry fire burns the lungs, lung loss joints, can not be infused with water valley fine in the body, straight to the bladder, and there are clinical manifestations such as thirst and drinking, more and sweet urine, and emaciation. The evil of the six external sensations, the dryness and injury of the yin, the heat is diffuse, the thirst for drinking water and cannot help itself, indicating that the heat evil is still scorched, and it can be seen that the mouth is dry and dry, shortness of breath and sweat, fatigue and other symptoms of the lungs and stomach. The disease is aggravated on the basis of dry fire wounding the lungs, and the disease is entered from the surface, and the health point enters the qi point, which is equivalent to the diabetic patient's aggravation due to infection. Modern medical research on the causes of diabetes has confirmed that some patients with type 1 diabetes mellitus are caused by autoimmune lesions caused by viral infections, causing isletitis, and islet β cells are damaged. Patients with type 2 diabetes can cause blood glucose to rise after external sensation, aggravate the condition, and even develop diabetic ketoacidosis. From the perspective of two different medical systems, the theory of the six sexual diseases in Traditional Chinese medicine and the theory of diabetes caused by viral infections in modern medicine have a lot in common.

Physical factors: loss of work and leisure

Moderate activity or labor, rest and orderly rest, help the body to the subtle transport and transfusion of the water valley, to achieve the effect of dredging qi and blood, strengthening muscles and bones, and enhancing physical fitness. Overwork, delusion is common, temper loss, stomach weakness, kidney deficiency and lung dryness can cause diabetes. If overwork, labor sad spleen, spleen does not for the stomach to do its fluid, the stomach fire is hyperactive, fire burning, and stomach heat; or overthinking, overwork, sad spleen, yin blood dark consumption, mental unregulated, hyperactive heart, heart fire inflammation, burning lung gold; or overwork hurts the kidneys, kidney yin is insufficient, water is not superior, lung yin is insufficient, qi deficiency and yin deficiency and dry mouth, gradually become thirst quenching. Therefore, it is advocated that the activities should be moderate, and should not be overworked and nervous. This is consistent with modern medicine's view that excessive activity can easily lead to ketosis due to lactate accumulation; or excessive thinking and excessive nervousness can cause sympathetic excitement and the secretion of anti-insulin hormones such as catecholamines, inducing or aggravating diabetes.

Excessively injured qi covets comfort, lying down for a long time and moving less, then the temper is injured, can not be infused with water valley subtlety, the operation of jin liquid is blocked, the qi and blood are stasis, and the fire is depressed for a long time, which can also lead to thirst-quenching disease. Strengthening exercise is not only an important measure to improve physical fitness, but also a basic treatment measure for diabetic patients, especially obese patients. Activity can improve insulin resistance and lower blood sugar. Insufficient activity, the conversion of calories into fat caused by obesity, increased insulin resistance leads to abnormal glucose tolerance, and even the development or aggravation of diabetes mellitus.

Fang lao injuries the kidneys and kidneys as the innate foundation, the yin of the kidney master, the atrioventricular degree, damage to the kidneys, the exhaustion of kidney essence, dry heat endogenous, kidney yin deficiency, then the heart, liver, lungs, spleen, stomach and other organs yin fluid are weak, yin deficiency and dry heat and thirst quenching diseases. Yin and yang are mutually rooted, kidney yin is insufficient, yin damage and yang, and kidney yin and yang are both weak. In the "Outline of the Golden Plateau", it is recorded: "Men quench their thirst, urinate more, drink a bucket, urinate a bucket, kidney qi pills are the main." "Advocate the method of warm tonic kidney yang in the later stage of thirst quenching disease." The Eighteen Volumes of the Jingyue Quanshu says: "If the yang does not dissolve the qi, the water is not refined, and if the water is not fire, it does not rise, so it goes straight into the bladder and drinks one or two." "It further clarified the deficiency of kidney yang, insufficient kidney qi, and the occurrence of three symptoms of thirst quenching disease." It is consistent with modern medicine's view that excessive indulgence and sympathetic excitement can promote the secretion of glycosteroids, especially glucagon, causing increased blood sugar, hypertonic dehydration, and aggravation of diabetes.

Author: Ni Qing Guang'anmen Hospital, China Academy of Chinese Medical Sciences