Chances are that you or someone you know has been affected by diabetes. It’s an increasingly common condition—one that approximately 1.3 million people in the U.S. will be diagnosed with this year alone. While it is generally a long-term condition, diabetes can be managed through self-care, nutrition, and medication. Another safe, effective approach to managing diabetes and its symptoms is acupuncture. Acupuncture and Traditional Chinese Medicine (TCM) help promote health and well-being. Both can be used safely along with your current medical treatment to provide the best results for you.
Understanding a complex condition
The body gets its energy from food through the process of digestion. Food is broken down into glucose (or sugar) which passes into the bloodstream. Then the glucose is moved into muscle, fat, and liver cells by the hormone insulin, which is produced by the pancreas. However, if you have diabetes, your body either does not produce enough insulin, or doesn’t respond to it properly, and this leads to high levels of sugar in the blood.
Uncontrolled blood-sugar levels can cause serious complications if left untreated, including blindness, heart attack, stroke, kidney failure, amputations, and nerve damage.
There are two main types of diabetes
Type I diabetes: Usually diagnosed during childhood, type I is an autoimmune disease in which the body’s immune system attacks insulin-producing cells. Symptoms usually come on suddenly, and treatment includes daily injections of insulin.
Symptoms of Type II Diabetes include:
- Increased thirst
- Increased urination
- Increased appetite
- Fatigue
- Blurred vision
- Slow-healing infections
- Impotence in men
Type II diabetes: This type accounts for 90-95% of all diabetes cases, and is usually diagnosed during adulthood. Major risk factors include family history, having high blood pressure or high cholesterol and being overweight and sedentary.
Since symptoms may be mild, many people don’t know they have diabetes, which is why it’s important to get tested regularly, especially after age 45. Testing can also detect pre-diabetes, where blood sugar is high, but not yet at diabetic levels. With early detection and treatment, it is far easier to stop the disease from progressing, control your symptoms, and prevent complications. Treatments often include regular blood-sugar monitoring and medications to control blood sugar, as well as diet and exercise.
Diabetes according to Traditional Chinese Medicine (TCM) goes beyond a simple diagnosis of Type I or Type II diabetes.
Below are some of the more common TCM diagnoses that your acupuncturist may discover and treat.
- Upper Wasting
- Middle Wasting
- Lower Wasting
- Spleen deficiency
- Liver Qi Stagnation
A natural approach that works
The good news is that certain types of diabetes respond very well to acupuncture along with other holistic health care choices and lifestyle changes—sometimes even making medications unnecessary.
Acupuncture and TCM can help put you on the path to a healthier lifestyle. Since diabetes has an impact on every part of your body, it makes sense to try a therapy that takes a holistic, or whole-body, approach to health.
According to TCM, Qi (pronounced “chee”) is the vital energy that animates the body and protects it from illness. Qi flows through pathways called meridians and provides nourishment to all of the body’s organs and glands. When there is an imbalance or blockage in the flow of Qi, symptoms associated with diabetes may appear.
According to TCM, diabetes is known as “Xiao Ke” or “wasting and thirsting disease”, caused by an imbalance of Qi and Yin. This produces heat which drains and consumes the body’s fluids. That is why symptoms related to heat appear—excessive thirst, irritability, itchy skin, dry mouth and red, swollen gums.
During treatment, fine, sterile needles will be inserted in specific acupuncture points along the meridian pathways in order to restore the flow of Qi and nourish Yin. This can ultimately relieve symptoms, improve pancreatic function and control blood sugar levels. Your acupuncturist will also work to resolve other imbalances or concerns that may be complicating your condition, and can help with common symptoms such as pain.
In addition to acupuncture care, your practitioner may offer recommendations for dietary changes, exercise plans, and herbal remedies.
Acupuncture and TCM address each patient’s individual needs in eliminating symptoms and potentially reduce the need for medication. The best approach to controlling your diabetes is to work with a team of health care providers who can address the many aspects of diabetes. Including an acupuncturist to your team—and working together to manage your diabetes—can have lasting benefits and help you live a healthy, active life.
Choate, C. Diabetes Mellitus From Western and TCM Perspectives. Accessed 2/10/2007.
Diabetes. U.S. National Library of Medicine Medical Encyclopedia. 2/8/2007.
Diabetes Overview and Facts. WebMD. Accessed 6/9/2007.
Treating Diabetes with Acupuncture and Chinese Medicine. Acufinder.com. Accessed 6/4/2007.
Traditional Chinese Medicine in the Treatment of Diabetes
Abstract
In Brief
Traditional Chinese medicine (TCM) is a system of healing that is thousands of years old. It has long been utilized in the Chinese culture to treat the complex of symptoms that Western medicine terms diabetes mellitus. This article will outline the key concepts and therapies of TCM that play a role in the evaluation and treatment of diabetic patients.
Diabetes is one of the most prevalent chronic diseases in the United States. The morbidity and mortality associated with the disease is significant and derives primarily from complications of persistent hyperglycemia. Longstanding hyperglycemia has been shown to lead to vascular complications involving large and small blood vessels, such as arteriosclerosis, glomerulosclerosis, and retinopathy. Diabetic neuropathy, characterized by pain and paresthesias, is among the most frequent complications of longstanding, poorly controlled diabetes and is often associated with a reduction in physical activity and with sleep disturbances.1,2
Western or conventional therapies for diabetes have been geared toward regulating blood glucose with a combination of diet modification, insulin and/or oral pharmacological agents, weight loss when appropriate, and exercise. Although Western medicine and Traditional Chinese medicine (TCM) share the diabetes treatment goals of reducing symptoms and preventing complications, their approaches to conceptualizing, diagnosing, and treating the disease are very different. This article will outline the key concepts and therapies of TCM that play a role in the evaluation and treatment of diabetic patients.
Traditional Chinese Medicine
TCM is a system of healing that originated thousands of years ago. It has evolved into a well-developed, coherent system of medicine that uses several modalities to treat and prevent illness. The most commonly employed therapeutic methods in TCM include acupuncture/moxibustion, Chinese herbal medicine, diet therapy, mind/body exercises (Qigong and Tai Chi), and Tui Na (Chinese massage).3
TCM views the human body and its functioning in a holistic way. From this perspective, no single body part or symptom can be understood apart from its relation to the whole. Unlike Western medicine, which seeks to uncover a distinct entity or causative factor for a particular illness, TCM looks at patterns of disharmony, which include all presenting signs and symptoms as well as patients’ emotional and psychological responses. Humans are viewed both as a reflection of and as an integral part of nature, and health results from maintaining harmony and balance within the body and between the body and nature.3
Two basic TCM theories explain and describe phenomena in nature, including human beings: Yin-Yang Theory and the Five Phases Theory or Five Element Theory.
Yin and Yang are complementary opposites used to describe how things function in relation to each other and to the universe. They are interdependent—one cannot exist without the other, and they have the ability to transform into each other.3 The traditional Yin-Yang symbol depicts the Yin (the dark side) flowing into the Yang (the light side) and vice versa. The dots within each side symbolize that there is always a bit of Yin within Yang and a bit of Yang within Yin; there are no absolutes. All physiological functions of the body, as well as the signs and symptoms of disease, can be differentiated on the basis of Yin and Yang characteristics.
The Chinese character for Yin originally meant the shady side of a slope. Qualities characteristic of Yin include cold, stillness, darkness, inwardness, passivity, decrease, and downwardness. In contrast, the Chinese character for Yang originally meant the sunny side of the slope, and qualities characteristic of Yang include heat, movement, brightness, outwardness, stimulation, excitement, increase, and upwardness.4 Illnesses that are characterized by coldness, weakness, slowness, and underactivity are considered Yin (e.g., hypothyroidism: cold limbs, fatigue, slowed metabolism). Illnesses that manifest strength, forceful movement, heat, and overactivity are Yang (e.g., acute infections with fever and sweating).
The theory of Five Phases, Wu Xing, is a means of classifying phenomena in terms of five basic processes represented by the elements wood, fire, earth, metal, and water. There exists a dynamic balance and relationship among the elements such that if the balance is interrupted or destroyed, pathological changes may occur. The clockwise movement of one element into the next (wood, fire, earth, and so forth) whereby one element generates, acts on, or promotes the following element, is referred to as the Sheng cycle. The Ke cycle represents an element acting on or controlling another element in a different order.3
Within the model of Five Phases, each element is associated with an organ. Wood is associated with the liver, fire with the heart, earth with the spleen-pancreas-stomach, metal with the lungs, and water with the kidneys. In addition, other phenomena, such as seasons, cardinal directions, weather, color, and emotions, are associated with each element. Within the TCM model, diagnostic information is gained by finding out patients’ favorite season, color, and predominant emotion(s).
Key Concepts Within TCM
Qi
Qi (pronounced “chi”) is translated into English as vital energy. It is defined in terms of function rather than as a discrete substance, and it is what animates us and allows us to move and maintain the activities of life. The origins of Qi include “congenital”’ (prenatal) Qi—that which is inherited from our parents—and “acquired” Qi—that which is incorporated from food and air.4
Two major patterns of disharmony are associated with Qi. Deficient Qi occurs when there is insufficient Qi to perform the functions of life. Deficient Qi may affect one or more organs or the entire body. If the latter occurs, then the patient may experience lethargy, fatigue, and lack of desire to move. Stagnant Qi refers to impairment of the normal movement of Qi through the meridians and may result in aches and pains in the body.4
Meridians
Meridians are the channels or pathways through which Qi is constantly flowing and circulating throughout the body. There are 12 regular meridians and 8 extra or “curious” meridians. The 12 main meridians correspond to 12 major functions or “organs” of the body (such as liver, kidney, heart).
The Chinese concept of organs corresponds only loosely to the Western concept. TCM associates specific functions, symptoms, emotions, colors, and tastes with each organ, whereas the Western view is limited primarily to function.
Qi must flow in the correct quantity and quality through the meridians and organs for health to be maintained. Acupuncture, the insertion of thin, solid metal needles, is performed on 1 or more of the 361 acupuncture points distributed along the meridians in order to regulate and promote the proper flow of Qi.5 Other techniques may be used to stimulate acupuncture points, such as moxibustion, in which the herb“moxa” (Artemesia vulgaris) is used to warm the acupuncture point either above or on the skin. Applied pressure (acupressure), lasers, and magnets also may be used to stimulate acupuncture points.
Jing
Jing, usually translated as “essence,” is the substance that is the underpinning of all organic life. Qi is responsible for the ongoing day-to-day movements and function of the body, whereas Jing can be considered an individual’s constitutional makeup. According to TCM, Jing is stored in the kidneys.4
Shen
Shen is considered to be the psyche or spirit of the individual. Shen is the vitality behind Jing and Qi in the human body. The three elements together—Qi, Jing, and Shen—are referred to collectively in TCM as the “Three Treasures” and are believed to be the essential components of life.5
Blood
According to TCM, the major activity of the blood is to circulate through the body, nourishing and moistening the various organs and tissues. Disharmonies of the blood may manifest as “deficient” blood or “congealed”blood. If deficient blood exists and affects the entire body, the patient may present with dry skin, dizziness, and a dull complexion. Congealed blood may manifest as sharp, stabbing pains accompanied by tumors, cysts, or swelling of the organs (i.e., the liver).4 The key organs associated with blood are the heart, liver, and spleen.
Fluids
Fluids are bodily liquids other than blood and include saliva, sweat, urine, tears, and semen. Fluids act to moisten both the exterior (skin and hair) and the internal organs. Disharmonies of fluids may result in dryness and excess heat. The key organs involved in the formation, distribution, and excretion of fluids are the lungs, spleen, and kidneys.3
Diagnosis in TCM
When evaluating patients with a chronic illness such as diabetes, TCM practitioners take a detailed, multi-system case history and supplement this information with observations that give information about the state of the patient’s health. These observations include the shape, color, and coating of the tongue; the color and expression of the face; the odor of the breath and body; and the strength, rhythm, and quality of the pulse. Many practitioners will palpate along meridians to detect points of tenderness that may indicate a blockage in the flow of Qi at that point.6
One of the most common ways of differentiating symptoms and syndromes in TCM is according to the Eight Principles—four pairs of polar opposites: Yin and Yang, Interior and Exterior, Cold and Heat, and Deficiency and Excess.
TCM Classification of Diabetes
The Chinese language includes two terms for diabetes. The traditional name, Xiao-ke, correlates closely with diabetes in most instances. Xiao-ke syndrome means “wasting and thirsting.” The more modern term, Tang-niao-bing, means “sugar urine illness.” Reference to diabetes by the traditional term appears in the earliest texts, including the first medical text in Chinese history, Huang Di Nei Jing, or The Yellow Emperor’s Inner Classic.
Diabetes is classically divided into three types: upper, middle, and lower Xiao-ke. Each has characteristic symptoms. The upper type is characterized by excessive thirst, the middle by excessive hunger, and the lower by excessive urination. These types are closely associated with the lungs, stomach, and kidneys, respectively, and all three are associated with Yin deficiency. At some point during the course of their illness, most people with diabetes manifest symptoms of all three types.
According to TCM, Xiao-ke is attributed to three main factors: improper diet (consuming large quantities of sweets, fatty or greasy foods, alcohol, and hot drinks such as hot coffee or tea), emotional disturbances (stress, anxiety, depression,) and a constitutional Yin deficiency (fatigue, weakness, lethargy, pale complexion).7 To the Western ear, TCM diagnoses sound esoteric, even poetic. In the case of a person with diabetes presenting with symptoms of excessive thirst, the diagnosis can be described as kidney Yin deficiency along with lung Yin deficiency and “internal heat that consumes fluids, thus bringing on wasting and thirsting.”7
TCM Therapies
Unlike Western medicine, TCM is not concerned with measuring and monitoring blood glucose levels in diabetic patients. Treatment is individualized and geared toward assessing and treating the symptoms that compose patterns of deficiency and disharmony.
Acupuncture/moxibustion
Acupuncture and moxibustion traditionally have been used in the treatment of diabetes to reduce blood glucose levels and normalize endocrine function. Clinical and experimental studies have demonstrated that acupuncture has a beneficial effect on lowering serum glucose levels.8,9
A typical acupuncture treatment involves needling 4–12 points and allowing the needles to remain in place for ∼10–30 min. Needles may be stimulated manually or by using a small electrical current. In addition, the practitioner may warm the points with moxibustion.
Auricular acupuncture (inserting needles into specific points on the ear) may be used alone or in conjunction with body acupuncture. According to TCM, the entire body is represented on the ear. Examination of the ears often reveals surface irregularities, such as superficial capillaries, scars, pitting, pimples, flaking, discoloration, or swelling. Upon probing the auricle of the ear with a rounded, blunt instrument the practitioner may discover tender areas that may correspond to the area of the patient’s pain or disturbance.10 A sample auricular treatment for diabetes might include needling a master point, for example, Shen Men (a good point for almost all disorders), along with the endocrine point, lung point (for thirst), stomach point (for hunger), kidney and bladder points (for frequent urination), and pancreas point (for increasing insulin secretion).7
Peripheral neuropathy, one of the most common complications of type 2 diabetes, occurs most often in the distal extremities and typically affects the sensory, motor, and autonomic systems. Acupuncture has been demonstrated to exert a beneficial effect on neuropathic pain.2 The effects of acupuncture, particularly on pain, are mediated in part by the release of endogenous opioids from the spinal cord, brainstem, and hypothalamus. In addition, it has been demonstrated that neurotransmitters, such as serotonin and substance P, are released during acupuncture treatments. Increases in local blood flow and vasodilation and increased levels of cortisol have also been demonstrated.10 A 300% increase in plethysmographic recordings of blood flow has been demonstrated in the digits of limbs stimulated with electroacupuncture.10
A recent study of 46 patients with painful peripheral neuropathy evaluated acupuncture analgesia to determine its short- and long-term efficacy. Using TCM acupuncture points, 34 patients (77%) experienced significant improvement in their symptoms. After a follow-up period of 18–52 weeks, 67% were able to stop or significantly reduce their pain medications. Only 8 (24%) required additional acupuncture treatment; 7 (21%) stated that their symptoms had cleared completely.11
A randomized, sham-controlled, crossover study of 50 adults with type 2 diabetes evaluated the effectiveness of Percutaneous Nerve Stimulation (PENS) therapy in the treatment of neuropathic pain. PENS is a modern adaptation of acupuncture that uses percutaneously placed acupuncture needles to stimulate peripheral sensory and motor nerves innervating the region of neuropathic pain. The results showed that active PENS treatment improved neuropathic pain symptoms in all patients. In addition to reducing pain, the treatment improved physical activity levels, sense of well-being, and quality of sleep and reduced oral non-opioid analgesic medication requirements.2
Because of poor peripheral circulation and slowed healing of skin infections and ulcerations, needling of the lower extremities in diabetic patients should be performed with extreme caution and sterile technique. In general, however, acupuncture appears to be a relatively safe form of treatment. An extensive worldwide literature search identified only 193 adverse events (including relatively minor events, such as bruising and dizziness) over a 15-year period. There have been approximately 86 reported cases of hepatitis B and 1 case of HIV transmission. In all of these cases, nondisposable needles were used.6
Herbal medicine
Herbal medicine has been an integral part of TCM for more than 2,000 years. Many herbal formulations have been developed and are used in the treatment of diabetes. The Huang Di Nei Jing (Yellow Emperor’s Inner Classic), which dates from the Han Dynasty 206 B.C.–220 A.D., listed 13 herbal formulations, 9 of which were patent medicines including pills, powders, plasters, and tinctures.12 The sources of Chinese remedies are varied and include plants, minerals, and animal parts.3
Chinese herbs have specific functions (i.e., warming, heat-clearing, eliminating dampness, and cooling) and can be classified according to those functions. They are also classified according to four natures (cool, cold, warm, and hot) and five tastes (sweet, pungent, bitter, sour, and salty).4 Herbs may be prescribed individually or as part of a formula.
Formulas promote the effective use of herbs.3 A typical formula has four components, including:
- The Chief (principal) ingredient, which treats the principal pattern of disease,
- The Deputy (associate) ingredient, which assists the Chief ingredient in treating the major syndrome or serves as the main ingredient against a coexisting syndrome,
- The Assistant (adjutant) ingredient, which enhances the effect of the Chief ingredient, moderates or eliminates the toxicity of the Chief or Deputy ingredients, or can have the opposite function of the Chief ingredient to produce supplementing effects, and
- The Envoy (guide) ingredient, which focuses the actions of the formula on a certain meridian or area of the body or harmonizes and integrates the actions of the other ingredients.3
Herbal prescriptions for diabetes are formulated or prescribed based on the patient’s predominant symptoms. For instance, a patient presenting primarily with excessive thirst (lung Yin deficiency) might be given a single herb, such as radix panacis quinquefolii; or a combination of herbs in a patent formulation such as yu chuan wan, which is used in general to treat diabetes of mild to moderate severity and specifically to treat excessive thirst due to Yin deficiency,12 and ba wei di huang tang (“eight-ingredient pill with rehmannia”), which was originally used to treat people exhibiting weakness, fatigue, and copious urine soon after drinking water.13
Some of the most commonly used herbal substances for diabetes in TCM include:
- Panax ginseng (Korean ginseng), which has a long history of use as a hypoglycemic agent. At least five constituents of this herb have been shown to exert hypoglycemic effects. In one study, treatment with ginseng lowered blood glucose levels and improved mood and psychological performance as compared with placebo. Recommended dosage is 100–200 mg/day.14
- Momodica charantia (balsam pear), which is dried, powdered, and made into pills. A dosage of 18 g/day has been shown to reduce blood glucose.15
- Lagenaria siceraria (bottle gourd), given as a decoction or pills. The recommended dose is 3 g/day. This, too, has been shown to reduce blood glucose levels.15
- Psidium gnajava, taken in the form of fresh leaves or as an infusion and drunk as a tea. The dosage is 9 g/day. It acts to reduce blood glucose levels.15
The above herbs do not appear to increase insulin levels, but rather enhance carbohydrate utilization.15.
Many Chinese herbs and formulations have been used safely for centuries in the hands of trained TCM practitioners.
Discontinuing conventional medications in favor of herbal formulations may lead to serious complications such as significant hyperglycemia, and combining conventional hypoglycemic agents with herbal preparations without proper monitoring could lead to hypoglycemia.
Diet therapy
According to TCM, diet plays an important role in maintaining health and treating disease. In the TCM paradigm, foods are valued and prescribed for their energetic and therapeutic properties rather than solely for their chemical makeup. Attention is paid to the quantity, quality, method of preparation, and time of food intake, as well as to the patient’s body type, age, vitality; geographic location; and seasonal influences.
Because TCM defines diabetes as a disease characterized by Yin deficiency and excess internal heat, an example of a dietary prescription would be to consume spinach, which is cooling, “strengthens all the organs, lubricates the intestines, and promotes urination.”7 A recommendation might be to boil tea from spinach and drink 1 cup three times/day. Other foods considered to be cooling and beneficial for diabetes include vegetables and grains, such as celery, pumpkin, soybeans (i.e., tofu, soymilk), string beans, sweet potato/yam, turnips, tomato, wheat bran, and millet. Fruit remedies, which act in specific therapeutic ways, include crab apple, guava, plum, strawberry, and mulberry.7 It is generally recommended that patients eat a wide variety of seasonal foods and avoid or minimize consumption of sweets and fruits. Meals should be smaller, eaten more frequently, and eaten at regular times each day.
Qigong
Qigong (pronounced “chi gong”) is literally translated as“function of Qi.” It emphasizes the connection between the mind and body. It is a meditative method that consists of breathing techniques that can be combined with body movements in order to regulate, harness, and enhance Qi. Qigong is used as a means of promoting health, healing, spiritual growth, and overall well-being. While Qigong is not typically used as a major treatment modality for diabetes, it has been found to be a valuable adjunctive therapy for this condition. There are specific Qigong exercises for diabetes.15
Tui Na
Tui Na is a traditional form of Chinese massage that uses hand manipulations, such as pulling, kneading, pushing, and grasping to stimulate acupuncture points and other parts of the body to create balance and harmony in the system. It can be used effectively in lieu of acupuncture in patients who have an aversion to needles, particularly pediatric patients.13
Conclusion
TCM does not offer a cure for diabetes, but instead aims to optimize the body’s ability to function normally. There is still a great need for more and better research on the efficacy and safety of both Chinese herbals, which are being used along with or in lieu of Western pharmaceuticals, and acupuncture in the care of diabetic patients. Patients, TCM practitioners, and physicians who choose to integrate the two forms of care must all recognize the importance of careful monitoring of blood glucose levels, as well as monitoring for potential side effects such as drug-herb interactions.
References
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