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Diabetes is a disease characterized by polydipsia, polyphagia, polyuria, emaciation and turbidness and sweetness of the urine. Clinically, diabetes is classified as that involving upper jiao, middle jiao and lower jiao, which manifests predominantly polydipsia, polyphagia and polyuria, respectively. Longstanding cases may be complicated by pulmonary tuberculosis, cataract, skin infection, deafness, night blindness, apoplexy and edema. Moreover, critical conditions such as difficulty in defecation and urination, coma, etc., may appear in the late stage of the disease.

Etiology and Pathogenesis

A constitution with a yin-deficiency, immoderate eating and drinking, emotional upset, overstrain and sexual indulgence are the major causes of diabetes.

A. Yin-deficiency acts as the primary cause and dryness-heat as the secondary. The more deficient in yin, the more severe dryness-heat will be and vice versa. In this case, lungs, stomach and kidneys are the organs involved, predominantly the kidneys. Physiologically, the lungs are responsible for the coordination of visceral activities and serve as a source of body fluids. Dryness of the lung results in consumption of body fluid and disturbs the coordinative function and fluid distribution, leading to polyuria and thirst. The stomach is the sea of water and cereals; hence, hyperactivity of stomach-fire causes polyphagia and constipation. The kidneys control water and store essence and primary yin and yang, so dysfunction of the kidneys may lead to polyuria and discharge of sweet urine.

B. Consumption of qi and yin or deficiency of yin and yang may occur in longstanding cases.

C. On the basis of yin-deficiency and dryness-heat, various complications may develop. For example, prolonged undernourishment of the lungs may lead to pulmonary tuberculosis; consumption of kidney-yin failing to nourish the liver may result in the malnutrition of eyes and ears, causing cataract, night blindness and deafness; dryness-heat consuming ying-yin may block the collaterals and induce suppuration, resulting in skin infection; retention of dryness-heat may produce phlegm which blocks the meridians and the heart orifice, inducing apoplexy and hemiplegia; impairment of yin may involve spleen-yang and kidney-yang and then retention of dampness, leading to edema; retention of water and exhaustion of yin and body fluids cause depletion of yang, resulting in coma or syncope.

D. Impediment of blood circulation and blockage of collaterals by blood stasis. The formation of blood stasis may be due to deficiency or stagnation of blood, deficiency of qi and yin or deficiency of yang and predomination of cold

Syndrome Differentiation and Therapeutic Principles

A. Differentiation of the involvement of triple-jiao: Although diabetes may be differentiated into that involving upper-jiao (lung dryness), middle-jiao (stomach-heat) and lower-jiao (kidney-deficiency), the three syndromes often appear at the same time clinically despite the fact that the degree of involvement is different. Hence, the severity of polydipsia, polyphagia and polyuria may serve as the diagnostic criterion for diabetes involving upper-jiao, middle-jiao and lower-jiao.

B. Identification of the extent of yin-deficiency and dryness-heat: Although yin-deficiency and dryness-heat are two principal pathogeneses of the disease, one may predominate over the other in its different stages. In general, dryness-heat is the predominant syndrome in the early stage, and both dryness-heat and yin-deficiency coexist later. In the late stage, yin-deficiency syndrome predominates, and even yang is involve, resulting in both yin and yang.

C. Identification of critical conditions: A lengthy course of the disease, improper treatment, complications, pregnancy or childbirth may aggravate the condition. Flushed face, dryness of mouth, irritability, nausea, vomiting, hyperpnea with a smell of retted apples, somnolence, syncope or signify a critical condition of yin exhaustion, yang depletion and obstruction of upper orifices by phlegm-fire.

D. Prediction of prognosis: Generally speaking, in young patients or cases with a sudden onset, rapid progress, serious conditions, multiple symptoms and a prolonged course, the prognosis may be unfavorable, while in the cases affecting those after middle age, with an insidious onset, slow progress, mild condition, atypical symptoms and short course, the prognosis is favorable.

Classification and Treatment

A. Diabetes involving upper-jiao (consumption of body fluids by lung-heat)

Manifestations: Thirst, polydipsia, dryness of mouth and tongue, polyuria, emaciation, redness of tongue tip with thin yellow coating and full and rapid pulse.

Therapeutic principles: Clear away heat, moisturize the lungs, promote the production of body fluids and arrest thirst.

Prescription: The Modification of Diabetes Decoction

Radix Adenophorae Strictae 10-20 g
Radix Ophiopogonis 10 g
Radix Trichosanthis 20-30 g
Rhizoma Atractylodis 10 g
Radix Rehmanniae 10-30 g
Rhizoma Coptidis 6 g
Radix Puerariae 10 g
Radix Scrophulariae 15-30 g

Remarks: For cases with qi and yin deficiency of lungs and kidneys manifested by severe thirst, polyuria and full, rapid and weak pulse, add Radix Ginseng or increase the dose of Radix Codonopsis Pilosulae, Rhizoma Anemarrhenae and Radix Scutellariae to benefit qi, promote the production of body fluids, clear away heat and relieve thirst. For cases with accumulation of heat in the lungs and stomach and impairment of qi and yin manifested by thirst, polydipsia, dry and yellow tongue coating and full pulse, add Radix Ginseng (or increase the dose of Radix Codonopsis Pilosulae), Rhizoma Anemarrhenae and Gypsum Fibrosum to benefit qi, promote the production of body fluids and clear away heat from the lungs and stomach

B. Diabetes involving middle-jiao (hyperactivity of stomach-heat)

Manifestations: Polyphagia, emaciation, dry stool, dry, yellow tongue coating and smooth and forceful pulse.

Therapeutic principles: Clear away stomach-heat, nourish yin and increase body fluids.

Prescription: The Modification of Jade Screen Decoction

Gypsum Fibrosum (decocted first) 30 g
Rhizoma Anemarrhenae 12 g
Radix Ophiopogonis 12 g
Radix Rehmanniae 10-20 g
Radix Achyranthis Bidentatae 10 g
Rhizoma Coptidis 6 g
Radix Scrophulariae 30 g
Fructus Gardeniae 5-10 g

Remarks: For cases with constipation, add Radix et Rhizoma Rhei and increase the doses of Rehmanniae and Scrophulariae to increase body fluids, moisten dryness and dredge fu-organs.

C. Diabetes involving lower-jiao

(a) Deficiency of kidney-yin

Manifestations: Polyuria, turbid urine with sweet taste, dryness of mouth and lips, feverish sensation over palms, soles and the chest, red tongue and deep, thready and rapid pulse.

Therapeutic principles: Tonify yin and strengthen the kidneys.

Prescription: The Modified Bolus of Six Drugs Containing Rehmanniae Praeparata

Radix Rehmanniae 10-20 g
Radix Rehmanniae Praeparata 10-20 g
Fructus Corni 10 g
Rhizoma Dioscoreae 12 g
Radix Ophiopogonis 10 g
Cortex Moutan Radicis 10 g
Cortex Lycii Radicis 10 g
Radix Scrophulariae 15 g
Fructus Schisandrae 9 g
Rhizoma Alismatis 10 g
Poria 10 g

Remarks: For cases with yin-deficiency resulting in hyperactivity of fire manifested with irritability, insomnia and seminal emissions, add Rhizoma Anemarrhenae, Cortex Phellodendri, Os Draconis, Concha Ostreae and Plastrum Testudinis to nourish yin, clear away heat, preserve essence and suppress yang. For cases with chyluria, add Ootheca Mantidis, Fructus Alpiniae Oxyphyllae and Fructus Schisandrae to benefit the kidneys and reduce urination. For cases with fatigue, shortness of breath and reddish tongue, add Radix Codonopsis Pilosulae, Rhizoma Polygonati and Radix Astragali to benefit qi.

(b) Deficiency of both yin and yang

Manifestations: Frequent urination of turbid urine, soreness and weakness of lumbus and knees, aversion to cold, dimmish blank complexion, dryness of helix, impotence, pale tongue with white coating and deep, thready and unforceful pulse.

Therapeutic principles: Warm yang, tonify the kidneys and preserved fluids.

Prescription: The Modified Pill for Invigorating Kidney-Qi

Radix Rehmanniae Praeparata 15 g
Fructus Corni 10 g
Rhizoma Dioscorae 12 g
Poria 15 g
Rhizoma Atractylodis 10 g
Radix Trichosanthis 15-30 g
Radix Astragali 12 g
Radix Aconiti Lateralis Praeparata 5-10 g
Cortex Cinnamomi 3-5 g
Radix Puerariae 15 g
Radix Salviae Miltiorrhizae 15-30 g
Rhizoma Alismatis 10 g

Remarks: For cases with profound polyuria, add Ootheca Mantidis, Fructus Rosae Laevigatae and Fructus Rubi to invigorate the kidneys and preserved fluids. Furthermore, in all above kinds of diabetes whenever blood stasis occurs Radix Salviae Miltiorrhizae, Flor Carthami, Fructus Crataegi and Semen Persicae should be employed to activate blood circulation and eliminate blood stasis.

D. Complications

(a) Cataract, deafness and night blindness due to deficiency of the liver and kidneys and insufficiency of blood and essence, which results in malnutrition of eyes and ears. The therapy of tonifying the liver and kidneys should be given as the prescription of Bolus of Lycii and Chrysanthemi and Rehmanniae Praeparata and the Pill of Goat's Liver, containing Radix Rehmanniae Praeparata, Rhizoma Dioscoreae, Fructus Lycii, Periostracum Cicadae, Radix Angelicae Sinensis, Faeces Vespertilionis and Goat's Liver.

(b) Skin infections due to heat-toxin impairing yingfen in the early stage. The therapy of eliminating toxic materials and cooling blood should be applied with the prescription of Antiphlogistic Decoction of Five Ingredients, containing Flos Lonicerae, Flos Chrysanthemi Indici, Herba Taraxaci, Herba Violae, Concha Mauritiae, etc. In the late stage when qi and ying are deficient, the meridians are blocked by blood stasis and suppuration occurs, the therapy of benefiting qi and eliminating toxic materials should be employed, and the prescription of Six-to-One Decoction with Radix Astragali and Pill of Cornu Rhinocerotis and Radix Rehmanniae applied, which contain Cornu Rhinocerotis, Myrrha, Olibanum, Flos Lonicerae, Fructus Forsythiae, Radix Codonopsis Pilosulae, Radix Astragali and Radix Rehmanniae, etc.

(c) Pulmonary tuberculosis, edema, apoplexy, syncope, etc., refer to the corresponding section. Aside from prescribing medications, dietary and mental care is also important for the treatment of diabetes. Emotional upsets, mental stress and sexual indulgence should be avoided. Foods should be digestible and taken in moderate amount, and a pungent and irritating diet is inadvisable.

Experiential Prescriptions

A. Radix Rehmanniae (30 g), Radix Astragali (30 g) and Rhizoma Dioscoreae (30 g) prepared as decoction; one dose daily; applicable to diabetes due to deficiency of both qi and yin

B. One piece of pig's pancreas, dried at a low temperature, powdered and prepared as honeyed boluses, each weighing 9 grams; one bolus is taken 2 to 3 times daily for long-term treatment; applicable to any kind of diabetes.

Copyright 1995 Hopkins Technology

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