Diabetes - Acupuncture can help
 

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糖尿病的中医治疗

Treatment of type II diabetes by Traditional Chinese Medicine (TCM)

                                                  Diabetes

我们这里要讨论的是II 型糖尿病的中医治疗。糖尿病是西医概念,其目前的发病原因是胰岛素和细胞膜上的胰岛素受体的结合发生了障碍,而胰岛素是促进血糖进入细胞内氧化供能的激素。胰岛素不能和它的受体结合,那么血糖就不能进入细胞进行氧化和提供能量,如此细胞处于饥饿状态。

Here we are discussing about the treatment of type II diabetes, not the type I diabetes. Diabetes is the concept of conventional medicine, not one in TCM. The conventional medicine believes that the reason for the type II diabetes is the blockage of Insulin to its receptor on cell membrane. The insulin works to improve the transport of blood sugar into the cell and for further metabolism into energy allowing the cells to use. Due to the slow down or block of the insulin to its receptor, the blood sugar becomes accumulated in the blood to cause high blood sugar level, and also cause the cells being hungry for energy.

所以糖尿病的病情就是这两个基本的病理改变,一方面,血糖进入不了细胞而在血液中蓄积,造成高血糖症;另外一方面,细胞缺能量而造成糖尿病细胞性疾病。

Therefore, the pathological background for type II diabetes are: the increased high level of blood sugar in blood, and the hungry of cells for energy.

由于血糖高,人体就会激活降低血糖的机制,如分泌胰岛素,使血液中胰岛素含量增加,进而使肝脏内脂肪合成和糖原合成增加,造成脂肪肝。血糖过分增高,尿中排出增加,而出现尿糖。皮肤中糖分增加,皮肤就容易感染及感染后伤口也不容易愈合。

Due to the high level of blood sugar, the body starts its own way to reduce it, such as to secrete more insulin, to speed up synthesize of sugar into glucogen and fat, to secrete extra sugar into the urine, etc. Accumulation of too much sugar in tissue under skin stimulates end of nerves to cause itch and slow down wound healing.  

细胞饥饿,细胞能量不足,就会导致视网膜病变,末梢神经炎,肾病,心肌炎,脑血管病,胃炎,肠炎等等。

The insufficient energy in cells causes retina disease, peripheral neuritis, nephropathy, myocarditis, cerebrovascular diseases, gastritis, enteritis, etc. 

如此,我们就知道,治疗糖尿病的根本在于解除干扰胰岛素和胰岛素受体结合的因素。而现代医学能作到的是使用药物让血糖转化为脂肪或糖原储存起来,而根本就没有办法解决细胞饥饿的问题,所以,血糖是降下来了,让人好欢喜,但是,细胞经饿造成的糖尿病并发症却并没有根本性的减少。另外,血糖被降低,就很容易导致低血糖,频繁的低血糖造成细胞损害,特别是心肌和神经细胞损害,因为心肌和神经细胞主要靠糖分解来提供能量。在低血糖情况下,机体动员储存的脂肪分解,容易造成酮症酸中毒而危及生命。这就是目前医学治疗糖尿病的现状,就是说,西医治疗糖尿病并没有治到点子上。

So, we know that the main target to cure the diabetes is to improve the binding of insulin to its receptors on cell membrane. What the conventional medicine can do it to reduce the blood sugar level rather than to improve the binding of insulin to its receptors, so it is not sufficient to solve the hungry of cells for energy (the breakdown of sugar into energy).  Therefore, the blood sugar can be reduced into so called “normal” level, but the cells are still in a hungry status. The rate of complications of diabetes might be reduced, but not eliminated completely.

When the blood sugar level is brought into “normal” but the cells are still hungry, it would be easy to have low blood sugar syndrome due to irregular diet, sudden emotional stress, heavy labor, extreme cold, etc. Upon the low blood sugar level, body cells are to be damaged more, especially for the heart cells and nerve cells, since they need the metabolism of sugar to supply energy. Also, upon the low blood sugar syndrome, the body activate the breakdown of fat, but the fatty acids so largely created cannot be utilized completely and sufficiently by the cells, so as to cause ketoacidosis to risk life.

那么,中医是如何理解和治疗这所谓的糖尿病的呢?在这里,我们首先要声明,中医有不同的体系,也就是说,都是用草药治病,但是,不同的中医体系对于疾病的认识是不同的,那么对于疾病的治疗手段和草药的立法处方也就很不一样,自然疗效也就很不同了。我们在这里所介绍的中医体系,不是现行中医学院采用的教材中介绍的那种中医体系 (即脏腑辩证,五行辩证体系),而主要是现代中医教育体系中所忽略的和不甚重视的经方体系,即六经辩证体系, 以及另外一种被称之为时方的中医体系(这种体系也是以脏腑辩证和五行辩证为主,但是比教材体系更系统和实用)。

Then, how TCM understand the type II diabetes? Here we should tell you that there are different styles of TCM actually. It means that different TCM styles recognize the diabetes in a different view too, so as to make different diagnosis and use different herbal formula to treat the diabetes. This is true for any diseases.  The TCM style that we introduce here is the one we called classical TCM or Jing Fang TCM, which is different from the textbook TCM that is taught in TCM school, nor from the so called Shi Fang TCM style, both of which make TCM diagnosis based on the Organ and Five Element theory.  

首先糖尿病不是一个单独的疾病,各式各样的原因都会导致血糖持续性升高而被西医诊断为糖尿病。而在经方中医看来,糖尿病的早中期,病情会有各式各样的表现。到晚期才会出现所谓的三多一少现象,即多饮,多食,多尿,体重下降。而这多饮,多食多尿和消瘦也并不见得就只是糖尿病才会有。进一步,会出现糖尿病的并发症,病人会有手脚麻痹或疼痛,视力下降,极度疲乏,血压升高,皮肤感染难愈,小便减少,下肢水肿,心悸等等。

No matter it is classical TCM or textbook TCM, both believe the type II diabetes is not an individual disease condition, but pretty much a syndrome or a symptom. Its meaning is similar to a fever,  or diarrhea. Many reasons can cause a fever and a diarrhea, so does type II diabetes. A conventional medicine defined “type II diabetes” can be seen in many TCM defined diseases. Therefore, for the treatment of type II diabetes, there are many herbal formula that can be used for the treatment with good results.

In the early stage of diabetes, the clinic manifestations are largely variable. Only in the later stage, the patients have typical frequent drink, frequent eat, frequent urination and loss body weight. In the middle to later stages, the patients can have diabetes complications, such as numbness in hands and feet, poor vision, extreme fatigue, hard-to-heal ulcer on skin, leg swelling, palpitation, etc.  

在经方中,糖尿病早期基本上表现在少阳和阳明阶段,中期期处于太阴,而晚期则为太阴,少阴和厥阴阶段。

In the Jing Fang TCM, the early stage of diabetes belongs to the TCM Shao Yang and Yang Ming stages. The later stage of the diabetes belongs to the TCM Tai Yin, Shao Yin and Jue Yin stages. 

早期少阳阶段,病人口苦咽干目眩,或耳朵内堵塞感,听力下降,眼睛发红干滞感,或寒热往来,焦躁烦躁,两肋下胀满不适等,用柴胡类方剂,或柴胡桂枝,或柴胡葛根类汤剂治疗。

In the early Shao Yang stage, the patient may feel dry mouth and throat, bitter taste in mouth, or blocked feeling in the ears, dry eye and red eye, or hot-cold shift feeling, anxiety and easy to get upset, bloating or pain feeling in the upper-side abdomen. We use herbal formula that contains herb Chai Hu, such as Chai Hu Gui Zhi Tang, or Chai Hu Ge Gen Tang.

当病人表现为身热为主的阳明病阶段,常用的草药为白虎汤,栀子豉汤,小陷胸汤,凉膈散,葛根芩连汤,三黄泻心汤,附子泻心汤,甘草泻心汤,干姜泻心汤,或选用如黄连解毒汤,黄连上清丸,宣明神芎丸,大青龙汤或大柴胡汤等。医生会根据病人的更具体的病情决定所需要采用的方剂。

When  the diabetes is in the TCM Yang Ming stage, we use herbal formula Bai Hu Tang, Zhi Zi Chi Tang, Xiao Xiang Xiong Tang, Liang Ge San, Ge Gen Qin Liang Tang, San Huang Xie Xin Tang, Fu Zi Xie Xin Tang, Gan Cao Xie Xin Tang, Gan Jiang Xie Xin Tang, or use Huang Lian Jie Du Tang, Huang Lian Shang Qin Wan, Xuan Ming Sheng Xiong Wan, even Da Qing Long Tang or Da Chai Hu Tang. TCM doctor would have detailed assessment for the patient to decide the exact herbal formula to use.   

阳明阶段而身热伤津,病患口渴多饮为主时,用白虎加人参汤,竹叶石膏汤。身热不甚而口干口渴尿少尿不利为主时,考虑用五苓散治疗。

In the Yang Ming stage, if the patient feels very thirst and dry mouth, we use Bai Hu Ren Shen Tang, or Zhu Ye Shi Gao Tang. If the body is hot, the patient feels dry mouth and thirsty but also difficult in urination, we may consider the use of Wu Ling San.

病情进入太阴阶段时,病人畏寒,腹部胀满时痛,或吐或泻溏便,用理中汤,附子理中汤,或小建中汤,或黄芪建中汤等。

When the disease comes into the Tai Yin stage, the patient feels cold, bloating in abdomen and pain in the abdomen from time to time, and has vomit or diarrhea. We use Li Zhong Tang, Fu Zi Li Zhong Tang, or Xiao Jiang Zhong Tang, or Huang Qi Jiang Zhong Tang.

病情进一步发展进入阴盛阳虚的少阴病阶段,此阶段中,病人生活精力下降,疲倦倦卧,脉沉微细。其中分肾阴阳虚和心阴阳虚。肾阳虚而导致小便频数或不利者,用金匮肾气丸。典型的肾阴虚,患者口干咽燥皮肤干燥,手脚心发热,舌瘦干而红,脉细数,则用六味地黄丸。心阴虚者,心悸气短,口干烦渴,夜寐不宁,舌红少苔脉虚数,用黄连阿胶汤。心阳虚者,心悸气短,怕冷浮肿,用炙甘草汤。小便淋漓涩痛,口干口渴,心烦失眠者用猪苓汤。频繁腹泻水样便者用白通汤。

When the disease comes into the TCM Shao Yin stage, the patient feels very tired, likes to lie down and the pulse is deep, thin and weak. There are two major subgroups in the Shao Yin stage: the Heart Yin deficiency and the Kidney Yang deficiency. In typical Kidney Yang deficiency, the patient feels frequent urination or difficulty in the urination. We use Jin Kui Shen Qi Wan for the treatment. In typical Kidney Yin deficiency,  the person feels dry in mouth, skin, hot in hands and feel at night, the tongue is slim and dry, and the pulse is thin and fast. We use Liu Wei Di Huang Wan. People with Heart Yin deficiency fells palpitation, short of breath, dry mouth and thirsty, poor sleep; the tongue is red with little or no covering; and the pulse is fast and week. We use Huang Lian A Jiao Tang. People with Heart Yang deficiency feels also palpitation and short of breath, feel cold and fear cold. We use Zhi Gan Cao Tang. If the person feels difficult or pain in the urine tract, dry mouth and thirsty, annoyed and poor sleep, we consider the use of Zhu Ling Tang. If the person is with frequent diarrhea, we need to think about Bai Tong Tang. The Shao Yin Stage is a critical stage. Many people die in this stage, especially for the Type II diabetes.

到厥阴阶段,表现为寒热错杂,气阴两虚(气也为阳,所以气阴两虚也是阴阳错杂),或手足厥冷等。治疗厥阴病的基本方剂是乌梅丸。如果病人常恶心呕吐,胃痛,手脚冰冷却喜欢冷饮,用干姜芩连汤。

Another later stage is called Jue Yin stage. It is characterized of the Cold-Hot co-exist and cold hands and feet. The most commonly used herbal formula is Wu Mei Wan. If the person feels nausea and vomit, pain in stomach, cold hands and feet, but likes to drink cold water, use Gan Jiang Qin Lian Tang.

厥阴病的另外一个特点是阴盛阳浮,虚阳上浮而口渴(即所谓的上消症),虚阳浮游于中而多食(即中消症),虚阳滞留下焦而导致多尿(下消症)。治疗上,上消中消都可以用理中汤,锡纯玉液丹治疗,下消用肾气丸治疗。也可以用大剂封髓丹、潜阳丹,使浮游之阳气回归命门。

Another characteristics of the Jue Yin stage is the Yang floating due to Yin overwhelming. If the floating Yang Qi is in the upper part of the body, the person feels very thirsty (we call it upper exhausting syndrome). If it is in the middle part of the body, it causes very hungry (Middle exhausting syndrome). If it is located in lower part of the body, it causes frequent urination (Lower exhausting syndrome). For the treatment of the upper exhausting syndrome, use Li Zhong Tang; for middle exhausting syndrome, use Li Zhong Tang or Xi Chun Yu Ye Dan; for the lower exhausting syndrome, use Shen Qi Wan. For all of these syndromes, we can also try large dose of Feng Sui Dan, Qian Yang Dan, to bring back the floating Yang Qi into the Ming Men, where the Yang Qi is originally stored and saved.   

在中医看来所谓的糖尿病就如同发热一样是一个体征,而不是一个独立的疾病。许多原因都可以导致发热,我们可以单独降热,但更需要治疗造成发热的原因,如感染,过敏等等。同样,许多原因都可以造成糖尿病,我们可以用药将血糖本身降低,但更需要治疗造成血糖升高的原因。不同的人,其血糖升高的原因不同,临床表现也不同,但是临床表现出来的症状(也就是中医疾病的证型)就提示出身体正气不足的部位和程度。以这些证型为目标,而不是以所谓的血糖本身为目标来治疗糖尿病,糖尿病的真正痊愈才有可能。

In the view of the TCM, the type II diabetes has to be regarded as a symptom, not a single disease, similar to fever. Many reasons can cause a fever, so can type II diabetes. We need to reduce the fever, but also need to stop the reason that causes the fever, so for the treatment of type II diabetes. Different patients have different reasons for the increased blood sugar level and the clinic manifestations are also different. However, the symptoms indicate where the body defense system and life energy is insufficient. Working to solve the symptoms (the TCM syndromes) would be able to improve the life energy flow in that part of the body. Therefore, targeting to the TCM syndromes, but not the increased blood sugar per se, allows the cure of the conventional medicine defined ‘type II diabetes”.

这里要指出的是,就算是用以上这些方剂治疗糖尿病,用教科书上的剂量,是能达到消除这些症状本身,但是对于彻底消除升高的血糖,必须考虑用大剂量才行。草药用量偏小也许是许多中医医生治不了糖尿病的一个非常重要的原因。

It should be pointed out that, even if we use the herbal formula above, but if we use the herb dose as most current TCM used (we call it small dose), it is not hard to solve symptoms, but hard to cure the type II diabetes. Low dose use of herbs might one of the most important reasons why most TCM doctor have no confidence to treat diabetes.

中医治疗后血糖可以降至正常,病人精力旺盛,饮食起居皆正常,而且不再需要服任何药物,更不需要终身服药。就此,我们很难说中医治疗是否就解决了细胞内缺少能量的问题。但是从中医能够治疗糖尿病本身和糖尿病诸多并发症的临床现实来看,细胞内糖代谢在中医治疗后转为正常是极有可能的。这一点,需要作科研的人们去证实了。

After TCM treatment, the blood sugar level can turn to normal. The person becomes energized with normal diet and ability to work. No need for any continuous herbs for a maintenance, neither need for a life-long herbal therapy. We cannot tell if the TCM treatment solves the disorder of sugar metabolism inside the cells, but based on the clinic reality that the TCM treatment can stop diabetes and its various complications, it is possible that the TCM treatment has normalized the cell sugar metabolism and the cells are no longer in an hungry status. This is the job for medical researchers to confirm. It should be a very interesting topic for them.

 

中草药治疗糖尿病需要每天服药,连续2 5个月。血糖通过以上治疗降到正常后,减少每天的剂量维持12个月。如果开始草药治疗时病人已经在服用降糖药,可开始逐渐减少降糖药剂量,这样才有可能判断草药是否有效。

To take the TCM herbal therapy, the herbs extract (herb decoction) needs to be drink every day, for 2 to 5 months. After the blood sugar level returns to normal, start to reduce the dose of the herbal therapy for 1 to 2 months. If the patient has already taken blood sugar drugs in the beginning of the herbal therapy, the dose of the drugs can be reduced gradually, so as to be able to see the effect of the herbs and eventually quit the conventional drugs.

草药的疗效受西药的影响。我们发现如果病人已经使用了胰岛素,那么草药的疗效就差。使用胰岛素的时间越长,草药治疗的难度就越大。可能是因为外源性胰岛素的应用促使了体内胰岛细胞的萎缩,要激活或促使萎缩的胰岛细胞再生就很困难了。这也就是为什么使用了胰岛素后,以后胰岛素的用量会愈来愈大,根本就不再可能停止的原因吧。

The healing effect of TCM herbal therapy is affected by the conventional drugs. It was experienced that the healing effect is not as satisfied if the patient has been using insulin products. The longer the insulin use, the poorer the healing effect. Possibly the use of external insulin makes the beta cells in the pancreas shrink or even die (since the body sensed enough insulin in the blood, so stops to send signal to the pancreas asking the beta cells to secrete boy its own insulin). It would be more difficult to activate or to regenerate the beta cells by the herbs. This is why the patient has to keep using the insulin and use higher and higher dose of insulin for the treatment, after the external insulin product has been used for a longer time.

所以,如果被诊断为糖尿病,在开始降糖药治疗之前,不妨先看一看中医,看中医治疗能否彻底消除持续性的血糖升高。我们不建议在疾病的初期就将中药和西药同时使用。这时候的中医学结合未必是好事,也未必有必要。

Therefore, we recommend our clients, once you are diagnosed as type II diabetes and if your doctor remind you to take medicine for ever, you may had better come to consult TCM, to see if we can help you with TCM (herbal therapy or acupuncture) first. We do not recommend to use the conventional medicine and TCM the same time from the beginning. Sometime, such combination may not be a good thing, especially if the conventional medicine is to use hormones.

泛泛而言,经方中医治疗糖尿病不要求病人限制饮食中的糖含量。实际上,有些方剂中糖分的含量是很高的,但却能治疗糖尿病,比如小建中汤, 黄芪建中汤,炙甘草汤,或甘麦大枣汤等。它们都含有饴糖,或甘草,或大枣,却丝毫不影响它们治疗糖尿病的效果。

Generally speaking, in the classical TCM, we do not ask the patient to restrict their diet to low carbohydrate and high protein (the textbook or the Shi style TCM do). In fact, some herbal formula contains high amount of sugar in it, but they can be used to solve the diabetes, such as Xiao Jian Zhong Tang, or Huang Qi Jian Zhong Tang, or Zhi Gan Cao Tang, or Gan Mai Da Zao Tang. They contain either sugar, or Gancao, or Chinese daze, but we cannot eliminate them from the formula.

中医治疗糖尿病的现实经验是,不要特意限制饮食的同时,草药效果比限制饮食时要好得多。病人在限制饮食的时候往往感到非常疲倦,也就是正气极度不足,草药疗效也就要大大减低。这一点应该很好理解,同样的病,体质健壮的人必定会比体弱的人好的快。

It was found that the healing effect of the herbal therapy is much better if we do not restrict the diet of patients than to restrict it. Upon taking restricted diet, the patients feel very tired. In TCM, it means that the body defense energy or healing energy is very low. This should be easy to understand: a disease should be easier to recover in a strong person than in a very weak person.

用了中医治疗后,有些病人的血糖不降,甚至会更高。但是,这些病人的精神面貌,精力却反而会比治疗前好很多,提示着病情本身在好转。血糖的这种升高一般是一过性的。随着治疗的进行,血糖会随后降低,一般需要一到两周时间。对于这种一过性血糖升高的一种解释是,草药动员了人体的清除功能,使得原先积沉在组织中的糖分脱离组织而进入血液。 这是人体的排毒和清除机制,而不表示病情的加重。这就象打扫房间一样, 刚开始的时候房间反而会很乱, 但最终会变得真正的干净.

In the early stage of the herbal therapy, the blood sugar level in some patients might not reduce, but even higher. The overall conditions of the body of these patients however become better, indicating that the disease is getting better. Such increase in the blood sugar level is usually a short time. It will go down eventually along with the treatment. It may take about one to two weeks. The explanation for such  temporary increase in the blood sugar is that the herbs activates the cleansing mechanism of the body to move the sugar that previous accumulated in the tissue into the blood.  This is as to clean a room. Once you start to clean it, the room would become more mass or dirty, but it would become real clean after you finish the cleaning.

理解和认识这一点非常重要。这种一过性化验和检查指标的变差现象会出现在治疗许多疾病的早期阶段,比如说治疗高血压,血压会一过性增高;治疗坐骨神经痛,其疼痛有可能会反而一过性增剧;治疗皮疹皮炎,皮肤也许会更痒,等等。好处是,一旦这种一过性反应消失,病情会比那些没有出现这种一过性反应的病人好转的更快。

It is important to understand this phenomenon. Such temporary “worse” of lab test or symptoms can be seen in many diseases. For example in the treatment of hypertension, the blood pressure may be even higher in some persons. Also in the treatment of sciatic pain, some person may feel more pain after the first acupuncture session. In the treatment of psoriasis, some person may feel more itch, etc. The goodness for this phenomenon is that the person who experienced such temporary “healing crisis” would usually get better mush sooner than those who do not have.

这种一过性反应并不是所有人都会出现。大约只有5% 左右的人会出现。这种情况比较容易出现在那些属于中医辩证中的虚寒性病人用了温阳药物后。

Surely not everyone will have such temporary worse experience. It may happen in about 5% of the people. Those persons usually are those who suffer from TCM Yin syndromes (Yai Yin, Shao Yin and Jue Yin stages) and after the use of Warm herbs for the treatment.

 

无症状病人的治疗

The treatment of no-symptom patient

经过中医以上的治疗,症状已经完全消失,病人没有任何不舒服,但是血糖仍然处于较高水平;或者是来诊之人只是血糖持续性高,却没有任何症状, 我们就按照体质辩证治疗。

If the patients have no any symptoms after the TCM treatment but still have high blood sugar, or if the patients have only the higher level of blood sugar but no any symptoms the first time they visit us, we will use body constitution therapy.

常见的糖尿病病人的体质为大柴胡汤体质,其人肥胖,上腹部饱满,压之或有不适感,时时便秘,口臭。

The commonly seen body constitution for a person with type II diabetes is the Da Chai Hu Tang constitution. The person is overweight, fullness in upper abdomen, which feels discomfort or pain upon press, constipation from time to time, and bad mouth odor or odor in the feet.

如果其它身热,怕热,喜欢冷饮,可以用白虎汤。这种人,西方人非常多见。属于火热体质。

If the person feels hot, dislikes hot, likes cold drink, we try the use of Bai Hu Tang. Such body constitution can be seen more among western people. They are the Fire body constitution.

如果其人常怕冷,手脚易冰,易胀满不适或体重很容易增加,面色不佳, 用当归芍药散(重用芍药)。 东方人常见。属于寒性体质。

If the person usually fears cold, dislikes to stay in cold room, likes to drink or eat hot or warm food, the person is Cold body constitution. The hands and feet are also commonly cold and frozen in winter. Such body constitution is more seen in Asia people. They need warm herbal formula, such as Gui Zhi Tang, or Dang Gui Shao Yao San. 

还有其它许多不同类型的体质,需要医生加以辨别,采用相应的治疗。这种按照体质的治疗需要坚持一到二个月,血糖多可下降,如果血糖还不能下降,就得考虑是否为家族性,基因性血糖高,也就是说,对于这个家族来说,这样数值的血糖当为正常,不必过度治疗,注意观察就可。如果病人以后出现别的疾病,通过将别的疾病按照中医草药疗法治愈后,看血糖是否还高,如果仍然较高,就的接受这个血糖的相对于这个家族的所谓的正常值,毕竟血糖的所谓正常值是一个大范围人群中得出的统计学上的相对数值,会有5% 的正常人,其血糖比另外95% 的人的血糖低,但是他们仍然属于正常人;也会有另外5% 的人,他们的血糖数值高于另外95% 的人群,但是也属于正常人范畴。我们不应该将这些 5% 的本来属于正常人的人们作为可疑和潜在的病人而给予降糖治疗,使得对他们来说本来属于正常的血糖,由于医生的强迫而变成了对于他们来说是低的低血糖而导致一系列疾病。如果真是这样,该是医生的罪过。

There are some other types of body constitutions which need TCM doctor to verify and to use corresponding herbal formula for the treatment. Such body constitution treatment needs about one to two months. The high blood pressure can usually come down to normal or basically normal. If not, we need to consider if the “high” level of the blood pressure is a genetic. It means that, for this family, such level of blood pressure should be regarded as “normal”. The so called “normal” level of the blood pressure is deduced from a statistic data of a large group of healthy people, among which 90% of their blood pressure values are regarded as “normal”, a 5% of them are lower than the “normal” but they are healthy; another 5% is with their blood pressure is higher than the “normal” but they are also healthy. We should not regard this 5% of healthy people as “sick” people just because their blood pressure is higher than the “normal”. If we do so and force them to take blood pressure drugs, we would make their blood pressure lower than what they should be and to cause extra, doctor-origin diseases. If indeed it is so, we are bad doctor.

如果其人仅仅是情感异常,常觉得焦虑,焦躁不安,容易生气,或情绪低落,担忧过多,或有恐惧感,有受惊史等等,同时血糖高,参考我们治疗情感障碍的方法治疗即可。 其中最主要的方剂有黄连解毒汤,三黄泻心汤,附子泻心汤,黄连上清丸,栀子豉汤系列方剂的应用。

If the hypertension person has only and mostly emotional disorders, such as stress, anxiety, depression, frustrated, annoyed, worry, fear, phobia, we also use herbal formula for the treatment. If interested, please refer to our brochure for “the treatment of stress by TCM way”. The most commonly used herbal formula is the Huang Lian Jie Du Tang, San Huang Xie Xin Tang, Fu Zi Xie Xin Tang, Huang Lian Shng Qing Wan, or Zhi Zi Chi Tang, etc.  

如果血糖高而连体质辩证都很难,可以按照中医的升降沉浮理论,旋转中焦,以利气在体内之上升和下降,疏通气道运行而降血压,可用平胃散加减。

If it is difficult to even make a body constitution diagnosis, we will apply the Rising-falling theory of the TCM. Based on this theory, we use herbal therapy to activate or to motivate the function of middle stomach area, by which the body Qi can move more easily to go up and fall down to form a complete Qi circulation circle, so as to reduce the increased blood pressure. The most commonly used herbal formula in such situation is the Ping Wei San.

糖尿病并发症的治疗

Treatment of diabetes complications

正如我们前面所说的,糖尿病本身就是多种原因造成的,不同的人在不同的疾病阶段所需要的治疗方法很不同,也就是说草药方剂必须因人而异,不能类同。这也就是为什么我们能指望中医治疗糖尿病而不能指望现在的西医西药。当糖尿病出现了并发症,病情就更复杂,治疗措施就更的因人而异了。我们在这里介绍的治疗糖尿病并发症的方法只是一个提示,只是提示那些临床证型比较多见和那些方剂使用的比较多,以便临床医生参考。

As we mentioned before, the type II diabetes is caused by various reasons in the view of Chinese medicine. Different patient, in different stage of the disease, needs different herbal formula for the treatment. The herbal formula must match the body condition of each individual. Only keeping this way, is it possible to cure the type II diabetes. Once the diabetic complications happen, the clinic manifestations become much more complex and the herbal formula need more personalized. The herbal formula we introduced here for the treatment of diabetic complications is only for an introduction to tell which kinds of clinic types/syndromes are commonly seen and which herbal formula are mostly used in clinic. It is for a reference for TCM doctor. 

泛泛而言,治疗糖尿病多用草药疗法,针灸用的比较少。但是治疗糖尿病并发症草药和针灸都可以单独使用,当然二者结合,效果会更好。

Generally speaking, to treat type II diabetes, the herbal therapy is used mostly, and the acupuncture, less. In the treatment of diabetic complications, either the Chinese herbal therapy or acupuncture can be used separately or in combination. Surely the combination of them would work much better.

1)糖尿病性末梢神经炎

Diabetic peripheral neuritis

糖尿病最常见的并发症是末梢神经炎。病人手脚麻木疼痛或烁热或寒冷。严重者会出现手脚皮肤溃烂难愈而需要截肢。中医治疗这种并发症效果很好。我们常用的方剂是,麻木为主而体质虚胖皮肤白者(多为年长,经济条件较好的妇女),用黄芪桂枝五物汤. 体质厚敦,肌肉结实而皮肤较黑者(多为体力劳动者),用乌药顺气散。如果为手脚冰冷为主者,或用四逆散,或用当归四逆汤。若为手脚或指趾疼痛为主者,多用乌头汤(寒证),甘草附子汤(寒证),或当归拈痛汤(热证),或白虎加桂枝汤(热证)。

Diabetic peripheral neuritis is very common in type II diabetic patients. The patients feel numbness of pain, or cold or hot, in the fingers and/or toes, hands and/or feet. In severe cases, the hands or feet may become ulcer and need amputation.

Chinese medicine works very well in the treatment of diabetic peripheral neuritis. We also have a lot of such clients in our clinic. The commonly used herbal formula is Huang Qi Gui Zhi Wu Wo Tang (the patients are usually overweight, have good social or life, and have white skin color and the age is more than 40). If the person is strong, shorter, skin is tight (mostly a labor worker), we use Wu Yao Sun Qi San. If the patient mostly feels cold hands and feet, we either use Si Ni San, or Dang Gui Si Ni Tang (they need to be further more distinguished). If the most problem is the severe pain in the fingers or toes, we consider the use of either Wu Tou Tang (for cold syndrome), Gan Cao Fu Zi Tang (cold syndrome), Dang Gui Nian Tong Tang (hot syndrome), or Bai Hu Jia Gui Zhi Tang (hot syndrome).

 

2)糖尿病性视网膜病变

Diabetic retinopathy

糖尿病性视网膜病变是一种眼科的血证。早期毛细血管渗出增加,周围组织水肿,出血继而毛细血管闭塞、循环障碍引起视网膜缺血,导致组织坏死及新生血管的产生,从而引起视网膜大量出血与玻璃体的大量积血,产生增殖性玻璃体视网膜病变。

中医对于本并发症,不同的医院和医生有不同的分型和治则。但是基本上都承认本症的基本机理是气郁化火,气阴两虚,后至阴阳两虚而夹杂出血,痰淤,血瘀。所以治疗原则是补气补阴,活血化瘀祛痰等。 经方治疗本症经验不多。

Diabetic retinopathy is a kind of bleeding syndrome in the eyes. The ways to treat this complication is largely various among TCM hospitals and individual TCM doctors. Most of TCM doctors agree that the mechanism for this complication is the Qi stagnation, which turns Fire, and further causes the Qi-Yin both deficiency and later both Yin-Yang deficiency. The Qi-Yin and Yin-Yang deficiency is mixed with bleeding, phlegm accumulation and blood stagnation. Therefore, the principle for the treatment is to nourish the Qi and Yin, activate blood circulation, and to clear Phlegm and stagnated blood clots.

具体的分型有:肝郁气滞型,脾虚络阻型,肝肾不足型,气血两虚型;或分为肺胃燥热,脾虚湿因,痰浊阻络,阴虚内热,气阴两虚,脾肾两虚,瘀血内阻, 或按期分为单纯期,增殖前期,增殖期。

In practice, the diabetic peripheral retinopathy is classified into Liver stagnation with Qi stagnation; Spleen deficiency with meridian blocks; Liver-Kidney deficiency. Some doctor classifies it into Lung-stomach dry-hotness; Spleen deficiency with wetness; Phlegm block in meridians; Yin deficiency with inner hotness; Qi-Yin deficiency; Spleen-Kidney deficiency; Blood stagnation. Some separate it into non-hyperplasia, pre-hyperplasia, and hyperplasia stages.

由于对本症的理解,分型不同,临床用药也非常多样。基本上是按照分型而分别采用补气,补阴,清热,活血,化瘀,祛痰等。 总的来讲,中医治疗本症的有效率多在70% 以上。结合针灸治疗的,效果更好。

To treat this complication, the herbal formula are largely variable. The herbs work either to nourish the Qi, the Yin, the Yang, or to clear the Fire, the phlegm, or the stagnated blood. In most clinic reports, the effective rate is more than 70%. For the clinic report with acupuncture, the effective rate is much higher.

糖尿病皮肤瘙痒

Diabetic skin itch

不少糖尿病患者伴有顽固的皮肤瘙痒。单纯使用降糖药不能使瘙痒减轻,而抗组胺药、钙剂、维生素C等对病情亦多无效。这是由于糖尿病皮肤内葡萄糖含量增高,刺激皮肤瘙痒,或皮肤含糖量增高,乳酸增加,致使皮肤处于脱水状态,皮肤过度干燥而瘙痒。

Many diabetes patients have obstacle skin itch. The use of blood sugar reducing drugs do not work to eliminate the itch. The use of antihistamine, calcium, Vitamin C, etc, in most cases, does not work either. The reason for the skin itch in diabetes might be due to accumulation of extra sugar in skin tissue, that stimulate the sense nerves, or due to the breakdown the sugar in skin to cause accumulation of lactate, which also stimulate the sense nerve, or cause dry skin to cause itch.

一般按照皮肤风热,血虚,湿热,寒凝而分别治疗。风热者,多用消风散治疗;血虚者,用当归饮子;湿热用萆薢渗湿汤;寒凝者,用荆防败毒散。如果诸药不效,可选用李可乌蛇荣皮汤,或大黄蛰虫丸。

The itch is treated according to Wind-Fire, Blood deficiency, Dampness-Hotness, or Cold coagulation of the body. For Wind-Fire syndrome, we use Xiao Fang San; for Blood deficiency, use Dang Gui Yin Zi; for Dampness-Hotness, use Bi Xie Shen Shi Tang and for Cold coagulation, use Jing Fang Bai Du San. If none of the work, consider to use Li Ke Wu She Rong Pi Tang, or Da Huang Zhe Chong Wang. Generally speaking, the treatment of skin itch in diabetes is not a big challenge to TCM doctors. 

 

糖尿病肾病

 Diabetic nephropathy

糖尿病肾病是糖尿病特有的严重的微血管并发症,也是糖尿病病人死亡的主要原因。糖尿病一旦发生肾脏损害,出现持续性蛋白尿,则肾功能持续减退直至终末期肾功能衰竭。

Diabetic nephropathy is the most severe complication for diabetes. It is the most common reason for the death of people with diabetes. Once the patient has evidence of kidney damage, the kidney function would go down continuously and quickly until kidney failure.

 中医治疗糖尿病肾病也已经积累了大量的临床经验。和糖尿病出现其它并发症一样,糖尿病肾病在中医方面也是证型多端,需要中医辩证施治方可,不能说那几个方剂就主要用来治疗糖尿病肾病。但是基本上讲,在经方中医,常用的经方是肾气丸,真武汤,瓜蒌瞿麦丸,桃核承气汤,大黄蛰虫丸等。这些基本方剂几乎都需要参考是否有血瘀,痰淤,湿滞等而加味。

Chinese medicine has built up lots of clinic experience in the treatment of diabetic nephropathy. As the same as other diabetic complications, the clinic manifestations are largely variable. Therefore, the herbal formula used for the treatment of this complication is also largely different from patient to patient. It is hardly to say which formula works better than others, though we can say that in classical TCM, the mostly used herbal formula are Shen Qi Wan, Zhen Wu Tang, Guo Lu Ju Mai Wan, Tao He Cheng Qi Tang, and Da Huang Zhe Chong Wan. Even for these basic formula, we need to modify them by addition of more other herbal ingredients with the aim to clear Blood stagnation, Phlegm accumulation, or Wetness coagulation.

总的来讲,中医(经方或时方)治疗糖尿病肾病的有效率都在 70% 90% 左右。中医无疑是糖尿病肾病治疗的较好的选择。

Overall, the effective rate for the diabetic nephropathy is between 70% and 90%. TCM is no doubt the most promising alternative for the treatment of diabetic nephropathy, though it takes longer time for the treatment than that for any other diabetic complications.

 

 

 

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