Diabetes, Biomedical and TCM Perspectives and

Treatments (Part 1)
By Clinton J. Choate L.Ac.
Part One of this article covers the biomedical treatment of diabetes, including clinical
observations, symptoms, laboratory diagnosis, complications or sequelae of
diabetes, nutritional therapy, botanical medicines, status of diabetes research and the
future of diabetes.
Part Two of this article covers the traditional Chinese medicine treatment of diabetes,
including differentiation, needling prescriptions, dietary medicine.
Part Three of this article covers the traditional Chinese medicine treatment of diabetes, using individual
herbs and herbal prescriptions.
CLINICAL OBSERVATIONS
1. Background
There is nothing new about diabetes; it has been a medical problem since antiquity. The name which
was originated by Aretaeus (30-90 CE) came from the Greek words meaning 'siphon' and 'to run
through', signifying the chronic excretion of an excessive volume of urine.
Diabetes mellitus, because of its frequency, is probably the single most important metabolic disease and
is widely recognized as one of the leading causes of death and disability in the United States. It affects
every cell in the body and the essential biochemical processes that go on there.
Diabetes has been linked to the western lifestyle, as it is uncommon in cultures consuming a more
primitive diet. As cultures switch from their native diets to more commercial foods, their rate of diabetes
increases, eventually reaching the same proportions seen in western societies.
A great deal of research has been conducted into the possible aetiology of diabetes. Most of the
prevalent ideas can be classified under one of the following categories: heredity, endocrine imbalance,
dietary indiscretion and obesity, sequelae of infection, and severe and continued psychic stress.
Although genetic factors appear important in determining susceptibility to diabetes, environmental and
dietary factors are also important in its development and many have been identified. A diet high in
refined fibre-depleted carbohydrate is believed to be the causative factor in many individuals, while a
high intake of high-fibre complex carbohydrate foods is protective against diabetes.
Obesity appears to be a significant factor, particularly considering the fact that 90% of Type 2 (see
below) sufferers are obese. Even in normal individuals, significant weight gain results in carbohydrate
intolerance, higher insulin levels and insulin insensitivity in the fat and muscle tissue. The progressive
development of insulin insensitivity is believed to be the main underlying factor in Type 2 diabetes.
Weight loss can correct all of these abnormalities in many instances and significantly improves the

metabolic disturbance of diabetes in most cases.

What has become apparent through years of research is that the diabetic condition is not simply a
matter of one or two things having gone wrong. It is a complex condition with a multitude of metabolic
imbalances. Consequently, the conventional medical approach of simply using insulin or oral drugs to
treat diabetes is incomplete and the person relying on them to prevent long-term complications remains
at risk.
About Blood Sugar
Carbohydrate is the active fuel of the body and is ordinarily the main source of energy of the tissue cell.
In the normal digestive process, food sugars and starches (carbohydrates) are changed into sugar
glucose. This is stored in the form of glycogen (animal starch) in the liver and muscles for later use as a
body fuel, at which time it is reconverted into glucose. Blood sugar rises somewhat after eating, and in
healthy individuals returns to normal levels in about an hour or two. The amount of glucose in the blood
is controlled mainly by the hormones insulin and glucagon. Too much or too little of these hormones (or
if they are somehow ineffective) can cause blood sugar levels to fall too low (hypoglycemia) or rise too
high (hyperglycemia). Other hormones that influence blood sugar levels are cortisol, growth hormone
and catecholamines (epinephrine and norepinephrine).
The pancreas, a gland in the upper abdomen is responsible for producing insulin and glucagon. The
pancreas is dotted with hormone-producing tissue called the islets of Langerhans, which contain alpha
and beta cells. When blood sugar rises after a meal, the beta cells release insulin. The insulin helps
glucose enter body cells, lowering blood glucose levels to the normal range. When blood sugar drops
too low however, the alpha cells secrete glucagon. This signals the liver to release stored glycogen and
change it back to glucose, raising blood sugar levels to the normal range. The result of the disturbed
metabolism of glucose causes an abnormal accumulation of sugar in the blood stream and the diabetic
condition.
Blood Sugar Ranges
The quantity of glucose in the blood seldom exceeds 160 milligrams/decilitre (mg/dl) of blood shortly
after food sugar has been absorbed, nor seldom falls below 60 mg/dl during fasting. This increases
about 2 mg/dl per decade after age 30. Some mild diabetics will have normal fasting blood sugar values
and values in the diabetic range only after meals. Occasionally very mild cases will have values within
normal at both times and the diabetic tendency will be evident only when these persons are required to
handle more than an ordinary amount of carbohydrate.
In the fasting state, blood sugar can occasionally fall below 60 mg/dl and even to below 50 mg/dl and
not indicate a serious abnormality or disease. This can be seen in healthy women, particularly after
prolonged fasting. Blood sugar levels below 45 mg/dl in a woman or 55 mg/dl or less in a man indicate a
strong possibility of hypoglycaemia.
Higher-than-normal blood sugar levels, for example 140 mg/dl or higher after an overnight fast, can
indicate diabetes mellitus. In moderately severe diabetes, after-meal values of 250-350 mg/dl are not
unusual. If a person with diabetes develops hyperglycaemia and it is left untreated, the result can lead

to coma or death.
Diabetes is characterised by three well-known syndromes, polydipsia (excessive thirst), polyphagia
(excessive hunger) and polyuria (excessive urination). Laboratory findings reveal high blood sugar and
glucose in the urine and as the metabolic derangement worsens, excessive ketone bodies in the blood
and urine. The accumulation of these produces acidosis which, if not counteracted, can result in coma
and death.
There are three main types of diabetes:
Type 1 or 'Insulin-Dependent Diabetes Mellitus' (IDDM) also known as 'Juvenile Onset Diabetes'.
Type 2 or 'Noninsulin-Dependent Diabetes Mellitus' (NIDDM) also known as 'Adult Onset Diabetes'.
Gestational diabetes.
Type 1 Diabetes (Insulin-Dependent Diabetes Mellitus/IDDM)
Insulin-dependent diabetes is considered an autoimmune disease in which the immune system attacks
the insulin-producing beta cells in the pancreas and destroys them. The pancreas produces little or no
insulin and it is then almost certain that life-long insulin replacement will be necessary. The exact
mechanism for the body's immune system attack to the beta cells is unknown but the most likely causes
are viral infection, genetic factors and free radicals.
Interest has been generated lately in the strong evidence linking exposure to a protein in cow's milk
(bovine albumin peptide) in infancy to the autoimmune response and subsequent Type 1 diabetes. In
detailed studies1 it was shown that patients with Type 1 diabetes were more likely to have been breastfed for less than three months and to have been exposed to cow's milk or solid foods before the age of
four months. Since the cow's milk protein can enter the mother's breast milk, in cases of family history of
diabetes it is recommended that the mother avoid cow's milk while breast-feeding.
IDDM accounts for about 5 to 10 percent of diagnosed diabetes in the USA and develops most often in
children and young adults, but the disorder can appear at any age. Symptoms usually develop over a
short period, although beta cell destruction can begin months, even years, earlier.
Over time both Type 1 and Type 2 diabetes are accompanied by many severe complications, such as
blindness, renal failure, lower- limb amputations, cardiovascular disease and stroke. For those with Type
1 diabetes the object is not to find a way to get off insulin but rather to prevent the long-term
complications. It is encouraging to note that modern research has demonstrated the amount of insulin
required could be reduced through appropriate life style modifications and the likelihood of consequent
complications significantly lowered.
Type 2 Diabetes (Noninsulin-Dependent Diabetes Mellitus/NIDDM)
The most common form of diabetes is noninsulin-dependent diabetes. About 90 to 95 percent of people

with diabetes have Type 2. In the USA more than 16 million people, over 7% of the adult population,
have Type 2 with 600,000 new cases diagnosed each year. In many patients, the initial diagnosis of
Type 2 diabetes is delayed perhaps by as much as 10 years because symptoms are often absent or
very mild during its early stages.
Type 2 diabetes usually develops in adults over the age of 40 and is most common among adults over
age 55. It is particularly common among the elderly and in many minority populations, including African
Americans, Hispanic Americans, American Indians and Asian and Pacific Islander Americans, in whom it
may occur in 1050% of adults.
Type 2 diabetics typically have elevated levels of insulin, often producing two to three times the normal
amount. Rather than an insulin deficiency condition it is an "insulin resistance" condition whereby the
body loses its ability to properly respond to the signals given by insulin. We now know that excess
insulin brought on by insulin resistance is not only associated with elevated blood sugar levels, but also
with high blood pressure and increased rates of atherosclerosis.
In the treatment of Type 2 diabetes, dietary modification has been found to be of primary importance
and should be diligently followed before using drug intervention since most cases can be controlled by
diet alone. For all Type 2 diabetics an effective treatment approach should employ a broad-based
therapeutic regimen. Such a regimen would incorporate appropriate diet, prescribed exercise, stress
reduction techniques and a substantial amount of specific nutritional supplements. If adequate control of
blood sugar levels remains problematic, conventional treatment with insulin and oral agents can be
initiated.
Gestational Diabetes
Gestational diabetes develops or is discovered during pregnancy. This type usually disappears when
the pregnancy is over, but women who have had gestational diabetes have a greater risk of developing
NIDDM later in their lives.
2. Presenting Symptoms
The clinical manifestations of diabetes in the order in which they usually appear are:
frequent, copious urination
excessive thirst
rapid weight loss
excessive hunger
drowsiness, fatigue
itching of the genitals and skin
visual disturbances
skin infections
slow healing
paraesthesia in the hands or feet
Other signs of diabetes include lingering influenza-like symptoms, loss of hair on the legs, increased
facial hair, small yellow bumps anywhere on the body (known as xanthomas-cholesterol) and

inflammation of the penile skin.

In most juvenile cases the earliest symptoms noted are increased urination, thirst and hunger. Other
symptoms include irritability, nausea or vomiting, weakness and fatigue. Physical findings in the adult
are mostly attributable to complications, and the first sign of the disease may be some dermatological,
circulatory, neurological or visual complications.
3. Laboratory diagnosis
The laboratory diagnosis of diabetes depends on finding glucose in the urine together with an elevated
blood sugar. The newest routine diagnostic test for diabetes is a fasting plasma glucose test rather than
the previously preferred oral glucose tolerance test. A confirmed fasting plasma glucose value of greater
than or equal to 126 mg/dl indicates a diagnosis of diabetes.
In certain clinical circumstances physicians may still choose to perform the more difficult and costly oral
glucose tolerance test. When a doctor chooses to perform this test a confirmed glucose value of greater
than or equal to 200 mg/dl indicates a diagnosis of diabetes. According to World Health Organisation
standards an oral glucose tolerance test is performed by administering 75 grams of anhydrous glucose
dissolved in water and then measuring the plasma glucose concentration 2 hours later.
Monitoring the Diabetic Patient
There appears to be a strong relationship between blood sugar levels and the development of the
complications of diabetes. Specifically, when blood sugar levels are chronically elevated, the risk of
complications is very high. To reduce the risk of developing complications it is important to control
elevations in blood sugar by careful monitoring. The availability of home glucose monitoring kits makes
this easier now than in the past.
4. Complications or Sequelae of Diabetes
Sometimes a complication of diabetes may give a clue to the presence of the disease. The principle
complications or sequelae associated with diabetes are retinopathy, neuropathy, nephropathy and
arteriosclerosis. Whether these are the unavoidable consequences of the diabetic state over time or
whether they may be influenced by controlling the diabetes through aggressive monitoring, treatment
and life-style management, including diet and supplements, remains a central topic.
One of the largest, most comprehensive diabetes studies conducted to date2 showed that keeping
blood sugar levels as close to normal as possible through aggressive management slows the onset and
progression of eye, kidney and nerve diseases caused by diabetes. In fact it demonstrated that any
sustained lowering of blood sugar helps, even if the person has a history of poor control.
Specifically it found that lowering and maintaining more constant blood sugar levels reduced the risk of
eye disease by 76%, kidney disease by 50%, nerve disease by 60% and cardiovascular disease by
35%.
Since the discovery of insulin nearly 70 years ago, the patterns of morbidity from diabetes have
changed. Where the major causes of death were ketoacidosis and infection, they are now the
microvascular and cardiovascular complications of diabetes (renal failure and myocardial infarction).

These complications are responsible for a reduction in the life expectancy of a newly diagnosed insulin
dependent diabetic by about one-third. The basis of managing diabetes in the 90's is an improvement in
the life-style of the diabetic and prevention of complications responsible for morbidity and mortality in
diabetes.
Neuropathy (nerve disease)
Diabetic neuropathies are among the most frequent complication of long-term diabetes. It is estimated
that 60% to 70% of diabetics have mild to severe forms of nervous system damage. The femoral nerve
is commonly involved giving rise to symptoms in the legs and feet. Pain is the chief symptom and tends
to worsen at night when the person is at rest. It is usually relieved by activity and aggravated by cold.
Paraesthesias are a common accompaniment of the pain. Cramping, tenderness and muscle weakness
also occur but atrophy is rare. Advanced femoral nerve disease is a major contributing cause of lower
extremity amputations.
Nerves in the arms, abdomen and back may also be affected. Symptoms may include impaired heart
function, slowed digestion, reduced or absent perspiration, severe oedema, carpal tunnel syndrome,
alternating bouts of diarrhoea and constipation, bladder atony, urinary and faecal incontinence and
impotence.
With respect to sexual impotence, diabetes is probably the single most common disease associated
with erectile failure (termed neurogenic impotence in the diabetic). Since diabetes is a metabolic
disease with vascular and nervous system complications and an erection involves all levels of the
nervous system from the brain to the peripheral nerves, lesions anywhere along the path may be
responsible for erectile failure. It has been estimated that close to 50% of diabetic males have some
degree of erectile dysfunction.
Neuropathies usually improve with the control of the diabetes. Severe or chronic changes may require
several weeks or months to show maximum improvement.
Retinopathy (eye disease)
Changes occurring in the eye which are distinctive of diabetes involve the narrowing, hardening,
bulging, haemorrhaging or severing of the veins and capillaries of the retina. This is a serious
complication known as retinopathy and may lead to loss of vision. Visual changes in the earlier stages
may include diminished vision, contraction of the visual field, changes in the size of objects or
photophobia. In the more advanced stage, termed 'proliferative retinopathy', haemorrhages, retinal
detachment and other serious forms of deterioration are observed. When the disease progresses to this
late stage total blindness may occur.
It usually takes between 10-13 years for diabetic retinopathy to develop and it is present in some degree
in most diabetics who have had the disease for 20 years. In only about half of the diabetics who develop
it however, is vision markedly impaired and blindness occurs in only about 6%. Still, diabetes is the
leading cause of blindness in adults 20 to 74 years old and is estimated to cause from 12,000 to 24,000
new cases each year. Two other complications of diabetes, cataracts and glaucoma, can also lead to

loss of vision
The development of laser therapy will probably reduce the prevalence of diabetes-induced blindness,
however this therapy is not without occasional side effects (haemorrhage, retinal detachment and loss
of visual field) and is therefore indicated only for the more serious conditions.
Arteriosclerosis (vessel disease)
The diabetic state is associated with earlier and more severe vascular changes than normally occur at a
given age. Cardiovascular-renal disease is the leading cause of death among diabetics. Atherosclerosis
can be accurately described as the end stage of Type 1 and Type 2 diabetes, since the vast majority of
diabetes patients will die from an atherosclerotic event. Most commonly these events are cardiovascular
in nature (an estimated 60% to 65% of diabetics have high blood pressure) although 20-25% of
atherosclerotic events may be cerebrovascular or microvascular. The incidence of coronary occlusion in
persons with clinical diabetes has been estimated at from 8-17% with diabetic adults having heart
disease death rates about 2 to 4 times as high as the general population. The risk of stroke is also found
to be 2 to 4 times higher in people with diabetes.
Arteriosclerosis obliterans in the lower extremities, a form of peripheral vascular disease, may produce
disturbances in sensation, decrease in muscular endurance, intermittent claudication on effort, absence
of peripheral pulses in the lower legs and feet and gangrene, and ultimately lead to amputation of the
extremity. Diabetic gangrene usually involves the toes, heels or other prominent parts of the feet and is
precipitated by trauma, infection or extremes in temperature. Needless to say, careful attention to proper
foot care, avoidance of injury and consistent use of methods to improve peripheral circulation, including
withdrawal from tobacco use in any form, are critical for the diabetic.
The aetiology of large vessel disease is multi-factorial in the diabetic as well as the non-diabetic
population with lipoprotein metabolism, hypertension, physical activity, obesity, cigarette smoking,
stress, personality and genetic and racial factors all playing a part.
Nephropathy (kidney disease)
Nephropathy is a common and important accompaniment of diabetes and one that in young diabetics
takes prece-dence over heart disease as a cause of illness and death. As with eye changes, there is a
wide variation in the type and degree of renal damage. Nephropathy is less frequent than retinopathy
and where it occurs is also a development of long standing diabetes. Nevertheless, diabetes is the
leading cause of end-stage renal disease in the US, accounting for about 40% of new cases. In 1995, a
total of 98,872 people with diabetes underwent dialysis or kidney transplantation and 27,851 developed
end-stage renal disease.
One study3 reported that among 200 juvenile diabetics who survived 20 years after onset, one half had
evidence of renal disease. Another study found that the majority of these patients have hypertension
and two thirds show significant albuminuria, but the fully developed nephrotic syndrome of hypertension,
proteinuria and oedema occurs in less than 10% and renal function is impaired in only one half to three
quarters of those patients.

Like other long-term complications, good blood glucose control goes a long way towards reducing the
risk of diabetic nephropathy. In addition to monitoring the blood sugar levels, periodic monitoring of a
diabetic patient's kidney function (blood urea nitrogen, uric acid, creatinine and creatinine clearance) is
important.
Hypoglycaemia
If there is too much insulin in the body compared to the amount of blood sugar, and the blood sugar falls
below normal levels, a condition known as hypoglycaemia occurs. This problem of hypoglycaemia due
to insulin or oral hypoglycaemic drugs is much more common in Type 1 than Type 2 diabetes since the
Type 1 diabetic is directly injecting insulin. If too much insulin is administered, or the person misses a
meal or over-exercises, hypoglycaemia may result. In this condition, commonly referred to as insulin
shock, the brain is deprived of an essential energy source. The first sign is mild hunger, quickly followed
by dizziness, sweating, palpitations, mental confusion and eventual loss of consciousness. Before the
condition reaches emergency proportions, most diabetics learn to counteract the symptoms by eating a
sweet or drinking a glass of orange juice. In some cases, the only effective measure is an intravenous
injection of glucose.
Digestive Disorders
Based on the 1989 US National Health Interview Survey, diabetics are more likely than the general
population to report a number of digestive conditions, including ulcers, diverticulitis, symptoms of
irritable bowel syndrome, abdominal pain, constipation, diarrhoea and gallstones.
Oral Complications
Periodontal disease, which can lead to tooth loss, occurs with greater frequency and severity among
diabetics. Periodontal disease has been reported to occur among 30% of people aged 19 years or older
with Type1 diabetes.
Infections
Studies in clinic, community and hospital populations indicate that diabetic subjects have a higher risk of
some infections, including asymptomatic bacteriuria, lower extremity infections, re-activation
tuberculosis, infections in surgical wounds and group B streptococcal infection. Population-based data
suggest a probable higher mortality from influenza and pneumonia.
Complications of Pregnancy
The rate of major congenital malformations in babies born to women with pre-existing diabetes varies
from 0% to 5% among women who receive preconception care, to 10% among women who do not
receive preconception care. Between 3% to 5% of pregnancies among women with diabetes result in
death of the new-born; the rate for women who do not have diabetes is 1.5%4.

Ketoacidosis
Another acute complication more likely to occur in the IDDM is ketoacidosis, a condition caused by a
lack of insulin leading to a build-up of ketoacids. Chemical compounds called ketones are one of the
natural by-products of fat metabolism. Excessive ketone bodies are formed by the biochemical
imbalance in uncontrolled or poorly managed diabetes. The condition known as diabetic ketoacidosis
can directly cause an acute life-threatening event, a diabetic coma.
The possibility of ketoacidosis is suggested by:
Confusion or coma, the patient almost always appearing extremely ill.
Air hunger - an attempt to compensate for metabolic acidosis.
Acetone odour (fruity) invariably on the breath.
Nausea and vomiting almost always present.
Abdominal tenderness which may mimic viral gastro-enteritis.
Extreme thirst and dry mucous membranes.
Diabetic history (present in about 90% of cases).
Weight loss.
Before the discovery of proper treatment by insulin and other intravenous injections, acidosis was the
chief cause of death among diabetics. Today diabetics can use a simple urine dipstick at home to
measure the level of ketones (excreted ketoacids) in the urine.
5. Conventional Medical Treatment
Insulin was the first, and remains the primary means of treatment for Type 1 diabetes and is
administered by subcutaneous injection. This method is necessary since insulin is destroyed by gastric
stomach secretions when it is taken by mouth. Insulin injections must be balanced with meals and daily
activities, and glucose levels must be closely monitored through frequent blood sugar testing. Many
diabetics need inject insulin only once a day; others require two or more injections. The usual time for a
dose of insulin is before breakfast. The dosage is initially established according to the severity of the
condition, but it often has to be reassessed as one or another of the variables in the person's condition
changes.
During the past several years a large number of different classes of drug therapies for patients with both
Type 1 and Type 2 diabetes have been developed. The concept of genetic re-engineering of insulins to
produce insulin analogs (synthetic insulin) with improved properties has enhanced the ability to affect
glycaemic control with fewer adverse reactions. For Type 2 patients, the number of orally active
antidiabetic agents has increased from one class of agents (the sulfonylureas - sulfa drugs) to the
current total of four classes of agents. The three new classes include agents of potentially even greater
glycaemic efficacy, such as Biguanide 'Metformin'; agents directly improving the underlying insulin
resistance of Type 2 diabetes, specifically thiazolidinediones such as 'Troglitazone'; and finally agents
that alter the rate of hydrolysis and absorption of oligosaccharides, such as the alpha-glucosidase
inhibitor 'Acarbose'.
The sulfonylureas as a group have proven to be not very effective. After three months of continual
treatment at an adequate dosage, only about sixty percent of Type 2 diabetics are able to control blood

sugar levels using these drugs. Furthermore these agents generally lose their effectiveness over time.
After an initial period of success they fail to produce a positive effect in about thirty- percent of the cases
at best.
In addition to being of limited value, there is evidence that the sulfonylureas actually produce harmful
long-term effects. Tolbutamide has been reported to be associated with increased cardiovascular
mortality. Other major side effects of the sulfonylureas are hypoglycaemia, allergic skin reactions,
headache, fatigue, nausea, vomiting and liver damage. Common examples of sulfonylureas include
Chlor-propamide (Diabinese), Glipizide (Glucotrol), Tolazamide (Tolinase) and Tolbutamide (Orinase).
Metformin has been used in the management of Type 2 diabetes in more than 90 countries for over 30
years. It was approved for use in diabetes patients in the United States in 1995. Metformin reduces the
excessive hepatic glucose production that characterizes Type 2 diabetes. With reduced hyperglycaemia,
glucose uptake by peripheral tissues is enhanced while insulin levels remain stable or decline.
Metformin also lowers elevated cholesterol and lipids, particularly the serum levels of triglycerides.
Frequency of adverse effects is low at the doses needed to obtain the desired metabolic effect.
Troglitazone is a member of a new class of drugs that are 'insulin sensitizers'. It was selected on the
basis of its effect to lower glycaemia without increasing insulin levels, its ability to improve lipid levels
and absence of significant side effects or adverse events in short-term human studies.
The new generation oral drugs do have a specific and beneficial place particularly for patients who are
on an appropriate diet and exercise program, have attained an optimal weight and are still unable to
adequately control blood sugar levels. However with the increased number of oral antidiabetic agents
soon to increase even further, the medical emphasis upon management of hyperglycaemia in Type 2
diabetes with these agents will likely increase. Realistically this is the easiest and least time-consuming
response that can be made by practitioners to the impact of managed care plans. However to prescribe
these agents alone and in combination for even minimal degrees of hyperglycaemia without an
adequate trial of diet and exercise will only serve to accentuate the problem. For the non-insulin
dependent diabetic, dietary and life style changes can often provide adequate remediation.
Medical Cost Attributed To Diabetes
Medical cost for persons with diabetes are higher because they visit physician's offices, hospital
outpatient departments and emergency rooms more frequently than their non-diabetic counterparts and
are more likely to be admitted to hospitals and nursing homes. One estimate of the total health-care
expenditures for diabetes in the USA is approximately $100 billion per year in both direct and indirect
costs, or about 12% of all health-care expenditures.
6. Nutritional Therapy
Meal Planning
A non-diabetic produces the constantly varying amounts of insulin necessary for obtaining energy from
glucose. A diabetic cannot achieve this balance. Beyond the basic requirements to provide adequate
calories and necessary nutrients, there are marked differences in diet strategy for the two major groups
of diabetic patients: Type 1 insulin-dependent non-obese patients and Type 2 obese patients who do not

require insulin. Patients who are on insulin therapy must schedule their meals to provide regular caloric
intake. In overweight patients, special attention must be given to total caloric consumption.
There is no need to disproportionately restrict the intake of carbohydrates in the diet of most diabetic
patients. In fact, Dr. H.P. Himsworth demonstrated in 1930 that if carbohydrates were taken out of the
diet and replaced by either protein or fats, a person would quickly develop insulin resistance and
diabetes5. The key here is in the choice of high-fibre complex carbohydrates.
One of the first dietary rules for all diabetics is to avoid all sugar and foods containing sugar, such as
pastry, candy and soft drinks. While these refined sugars and other simple carbohydrates like white flour
must be carefully watched, most diabetics are actually encouraged to eat more complex carbohydrates the same bulky, fibre-rich unprocessed foods that are now recommended for everyone. Vegetables are
ideal. For example, a diabetic can eat a large plate of spinach that contains as much carbohydrate as a
tablespoonful of sugar, without suffering any ill effects.
Spinach, asparagus, broccoli, cabbage, string beans and celery are among the so-called "Food
Exchange Group A" vegetables that the American Diabetes Association (ADA) says can be generously
included in the diabetic diet. What makes these complex carbohydrates special is their ability to slow
down the body's absorption of carbohydrates by helping to delay the emptying of the stomach and
thereby smoothing out the absorption of sugars into the blood. Whole grain cereals also have this ability.
Fully one third of diabetic patients in clinical surveys have hyper-lipidemia, clearly indicating the need for
dietary management. The most sensible approach is to limit the amount of fat in their diet and to
substitute polyunsaturated fats for the saturated type when possible. Fish and poultry are especially
recommended instead of fatty cuts of meat. Greasy, fried foods are strongly discouraged.
Obesity is much more likely in people who eat a high-fat diet, which is often a high calorie diet, since
each gram of fat contains nine calories instead of the four calories in each gram of protein or
carbohydrate. With obesity comes an increased risk of a variety of problems, not the least of which is
adult-onset diabetes.
Overweight diabetics, by carefully calculating the proper daily calorie intake for their body weight and
activity level, and never exceeding it, can usually bring their weight down to an optimal level - a level
which is actually 10% less than the standard height and weight charts recommend. "The overweight
diabetic who successfully brings their weight back to normal usually experiences a dramatic
improvement in their condition. Indeed the symptoms often virtually disappear," says Charles Weller
M.D. in his book The New Way to Live with Diabetes6. He goes on to state "Weight reduction and
control can bring this incurable disease closer to complete remission than any medication."
The need to reduce fat is reflected in the standard diet and food exchange lists prepared by the ADA
that restricts the intake of fat to 35% of calories. The reduction of saturated fats to one-third of the fat
intake by substituting poultry, veal and fish for red meats, and the reduction of cholesterol to less than
300 mg/day are stressed. The carbohydrate content is 40-50 per cent of total calories, with unrefined
carbohydrates recommended to the exclusion of refined and simple carbohydrates.
Currently another diet, known as the 'HCF (high-carbohydrate high plant-fibre) diet' popularised by

James Anderson7 has substantial support and validation in the scientific literature as the diet of choice
in the treatment of diabetes. It is high in cereal grains, legumes and root vegetables and restricts simple
sugar and fats. The calorie intake consists of 70-75 per cent complex carbohydrates, 15-20 per cent
protein and only 5-10 per cent fat, and the total fibre content is almost 100 grams/day. The positive
metabolic effects of the HCF diet are many: reduced after-mealtime hyperglycaemia and delayed
hypoglycaemia; increased tissue sensitivity to insulin; reduced cholesterol and triglyceride levels with
increased HDL-cholesterol levels; and progressive weight reduction.
In general the HCF diet is adequate for the treatment of diabetes. However improvements can be made,
primarily by substituting more natural (primitive) foods wherever possible. The Modified HCF or MHCF
diet recommends a higher intake of legumes, along with restrictions of several foods allowed on the
HCF diet, namely processed grains, and excludes fruit juices, low fibre fruits, skimmed milk and
margarine. It is noteworthy that if patients resume a conventional ADA diet, their insulin requirements
return to prior levels.
Many diabetics have found it beneficial to eat smaller, more frequent meals, rather than the two or three
big meals most people consume daily. Researchers have found that multiple frequent feedings tend to
keep blood cholesterol levels lower, for the diabetic and non-diabetic alike.
Vitamins and Minerals
Generally a well-balanced diet rich in vitamins and minerals is one of the most important factors in the
control of diabetes and prevention of diabetic complications. One reason for stressing the need for
proper levels of nutrients is the excessive urination experienced by the diabetic.
Normally the body reabsorbs glucose and other water-soluble nutrients. When glucose rises to levels
above 160-170mg/dl, as it does quite frequently in even well controlled diabetic patients, it acts as an
osmotic diuretic. This process overwhelms the kidney's ability to reabsorb glucose and other watersoluble nutrients, thus the increased urination, and substantial losses of nutrients such as vitamins B-1,
B-6 and B-12 and the minerals magnesium, zinc and chromium pass out along with the urine.
Consequently diabetes and its complications are as much a result of nutritional wasting as of elevated
blood sugar.
In an article in the American Journal of Clinical Nutrition where 247 studies were reviewed8, it was
found that Type 1 (IDDM) diabetics generally had deficiencies in zinc, calcium, magnesium and the
more active form of vitamin D. Those with Type 2 diabetes (NIDDM) generally were found to be low in
zinc and magnesium and often low in vitamins B6 and C.
The physical body needs all these water-soluble nutrients to maintain the integrity of its organ system.
Perhaps one of the most important nutrients is magnesium. The medical literature is full of studies
showing that diabetic patients invariably have lower blood levels of magnesium than normal, also with
higher urinary losses. In a landmark study conducted in 1978 by Dr. P. McNair and titled
Hypomagnesemia, a Risk Factor in Diabetic Retinopathy9, it was demonstrated that diabetics with the
lowest magnesium levels had the most severe retinopathy, and that low magnesium levels were linked
significantly to retinopathy more than any other factor. The article argued that simply elevating the

magnesium concentration with supplements would protect the eyes.

Other nutrients are also attracting serious attention. Researchers in London recently reported that
vitamin D is essential for the islet cells in the pancreas to be able to secrete insulin properly10. Their
studies have shown that individuals with the lowest vitamin D levels experienced the worst blood sugarhandling problems and had a greater risk of developing diabetes. They found that those with greatest
risk of developing vitamin D deficiency included the elderly who were either institutionalised or stayed
indoors, those living in climates where sunlight is scarce several months a year, and those with indoor
sedentary jobs. In an effort to eliminate the widespread vitamin D deficiencies in the institutionalised
elderly, over 80% of those individuals are now being given 800 IU/day vitamin D3 supplements.
Other researchers have found that the diabetic is unable to convert carotene into vitamin A. It is
advisable therefore for the diabetic to ingest at least the recommended dietary allowance of vitamin A
from a non-carotene source such as fish-liver oil. Diabetics and others on low-fat diets often need
supplemental amounts of this fat-soluble nutrient. Also recommended is a vitamin E supplement,
ranging from 400-1200 IU per day and a vitamin C supplement ranging from 1000-4000 mg per day to
help prevent small-vessel disease of the extremities.
Brewer's yeast is another food supplement that is recommended for the diabetic patient. The yeast is a
rich source of chromium-containing GTF (glucose tolerance factor) which is able to potentiate the insulin
in our bodies. GTF also contains amino acids such as glutamic acid, glycine, and cysteine. Both
brewer's yeast (9 gm/day) and trivalent chromium (150-1000 mcg/day) have been shown to significantly
improve blood sugar metabolism when taken for several weeks to months. As a side benefit it has also
been found that brewer's yeast and chromium supplementation lower elevated total cholesterol and total
lipids, and significantly raise the levels of HDL-cholesterol, the beneficial or protective fraction of
cholesterol.
Chromium is found in foods as both inorganic and organic salts. Brewer's yeast contains a form of
chromium with high bioavailability, chromiumdinicotinic acidglutathione complex. The bioavailability
of chromium in liver, American cheese and wheat germ is also relatively high. Chromium is also
available from a variety of sources including whole grains, potatoes and apples with skins, spinach,
oysters, carrots, and chicken breast. Recent research has identified certain varieties of barley grown in
Mesopotamia to be some of the richest sources of chromium.
A 1996 study of 180 Type 2 diabetics, carried out in China under the guidance of Dr. Richard A.
Anderson11, found that 500 mcg of chromium picolinate taken twice daily for four months lowered the
fasting glucose level to an average of 129, compared to 160 in those taking a placebo. In addition,
glycosylated haemoglobin (a test of longer-term glucose tolerance) averaged an almost normal level of
7.5% in those taking chromium - significantly lower than those on placebo. All of the effects of chromium
appear to be due to increased insulin sensitivity.
Another exceptionally useful trace mineral to combat diabetes is vanadium, which lowers blood sugar by
mimicking insulin and improving the cells' sensitivity to insulin. A growing body of human research
shows that vanadium compounds, most notably vanadyl sulfate, consistently improve fasting glucose
and other measures of diabetes. These benefits were often extended for weeks after the mineral

supplementation was discontinued.

In addition to taking supplements, diabetics are encouraged to eat the widest possible variety of
permitted foods to ensure getting the full range of trace elements and other nutrients. It is interesting to
note that certain nutrients like vitamins B1, B2, B12, pantothenic acid, vitamin C, protein and potassium
- along with small frequent meals containing some carbohydrate - can actually stimulate production of
insulin within the body.
Cautions
1. Fish oil capsules or supplements containing large amounts of para-aminobenzoic acid (PABA) can
elevate blood sugar.
2. Supplements containing cysteine interfere with absorption of insulin by cells.
3. Extremely large dosages of vitamins B1 or C may inactivate insulin. Dosages listed above are within
normal ranges.
7. Botanical medicines
Since antiquity, diabetes has been treated with plant medicines. The following herbs appear to be the
most effective, are relatively non-toxic and have substantial scientific documentation to attest to their
efficacy.
European Blueberry (Vaccinium myrtillus)
Traditional herbalism places great value on European Blueberry leaves, a.k.a. Bilberry, as a natural
method of controlling or lowering blood sugar levels when they are slightly elevated. Results have
shown the leaves have an active ingredient with a remarkable ability to reduce excess sugar in the
blood. To use, steep two to three handfuls of leaves in 4 cups hot water for half an hour. Drink three
cups a day. Modern research has demonstrated the berries or extract of the berries offer even greater
benefit. The standard dose of the extract is 80-160 mg three times per day.
Gymnema sylvestre
Native to the tropical forests of India. Used to lower blood sugar and help repair damage to pancreatic
cells. Therapeutic dosage is 400 mg/day. A good source is a preparation by Natrol as a single herb 5:1
extract containing 300 mg.
Bitter melon (Momordica Charantia)
Composed of several compounds with confirmed anti-diabetic properties. 50-60 ml (about 2 oz) of fresh
juice per day has shown good results in clinical trials. Charantin, the key ingredient extracted by alcohol,
is a hypoglycaemic agent composed of mixed steroids more potent than the drug Tolbutamide that is
often used to treat diabetes.

Onion and Garlic

The common bulbs, onion and garlic, have significant blood sugar-lowering action as well as lowering
lipids, inhibiting platelet aggregation, and reducing blood pressure.
Fenugreek
Fenugreek seeds have demonstrated anti-diabetic effects in experimental and clinical studies.
Administration of the defatted seed (in daily doses of 1.5-2g/kg) reduces fasting and after-meal glucose,
glucagon, somatostatin, insulin, total cholesterol and triglycerides, while increasing HDL-cholesterol
levels.
Salt Bush (Atriplex halimu)
Rich in fibre, protein, and numerous trace minerals, including chromium. Human studies in Israel have
demonstrated improved blood glucose regulation and glucose tolerance in Type 2 diabetes. Dosage
used in this study was 3g per day.
Ginkgo biloba
Gingko biloba extract improves blood flow in the peripheral tissues of the arms, legs, fingers and toes
and is therefore an important medicine in the treatment of peripheral vascular disease. It has also been
shown to prevent diabetic retinopathy. Dosage of the extract standardised to contain 24% ginkgo
flavoglycosides is 40-80 mg three times per day.
Ginseng (Panax ginseng)
Ginseng, besides reducing fasting blood sugar levels and body weight, can elevate mood and improve
psycho-physiological performance. Therapeutic dosage is 100-200 mg daily.
8. Status of diabetes research
In recent years, advances in diabetes research have led to better ways to manage diabetes and treat its
complications. Major advances include:
New forms of purified insulin, such as human insulin produced through genetic engineering.
Better ways for doctors to monitor blood glucose levels and for people with diabetes to test their own
blood glucose levels at home.
< Development of external and implantable insulin pumps that deliver appropriate amounts of insulin,
replacing daily injections.
Laser treatment for diabetic eye disease, reducing the risk of blindness.
Successful transplantation of kidneys in people whose own kidneys fail because of diabetes.
Better ways of managing diabetic pregnancies, improving chances of successful outcomes.
New drugs to treat NIDDM and better ways to manage this form of diabetes through weight control.
Evidence that intensive management of blood glucose reduces and may prevent development of
microvascular complications of diabetes.

Demonstration that anti-hypertensive drugs called ACE-inhibitors prevent or delay kidney failure in
people with diabetes.
9. Diabetes in the year 2010 - what will the future bring?
Although there are no definitive preventative measures that can be taken against diabetes at this time,
except for identifying persons at high risk and encouraging appropriate dietary and exercise guidelines,
research into the causes and control of this disease continues to provide the possibility of new cures.
With the discovery of insulin in the 1920's and the development of oral hypoglycaemic drugs in the
1950's, a person who has diabetes can live an active and productive life. The importance of early
detection and proper management of this chronic disease cannot, however, be emphasised too strongly.
The therapy of insulin-dependent diabetes will surely be altered dramatically over the next few decades.
One can project that there will be improved strategies for glucose control in established IDDM. This will
include the widespread use of mechanical devices, which will involve both implantable glucose sensors
and implantable insulin infusion systems; and successful pancreas, islet or beta cell transplantation, in
the absence of the need of immunosuppressive therapy to prevent rejection.
An inhaled form of insulin, under development for several years, appears to be ready for wide scale
application by the year 2000. Recent studies conducted at the Universities of Miami and Vermont
involving Type I and Type II patients demonstrated that inhaled insulin is at least as effective as injected
insulin in controlling the symptoms of diabetes and has no side effects. The delivery system, whereby a
finely powdered form of insulin is inhaled directly into the lungs, promises to greatly simplify
management of both forms of diabetes. Powdered insulin requires no refrigeration and since it is
absorbed into the bloodstream though the lungs, there will generally be no need for hypodermic
needles. Type I patients will still require an injection of slow-acting insulin at bedtime12.In the future it
may also be possible to administer insulin in the form of a pill or patch. All of these advances will change
the face of diabetes, as we know it.
Moreover, we will see the application of immune intervention strategies at the time of onset of IDDM,
with the reversal of the disease process. Ultimately, these strategies will be applied earlier in the
sequence during a stage that we do not yet recognise as clinical diabetes. In these individuals otherwise
destined to develop IDDM, the disease will be prevented.
Part Two of this article to covers the traditional Chinese medicine treatment of diabetes, including
differentiation, needling prescriptions, dietary medicine, individual herbs and herbal prescriptions.
References
1 Encyclopedia of Natural Medicine, M. Murray and J. Pizzorno, Revised 2nd Edition 1998, p.407
2 New England Journal of Medicine, 329(14), Sept. 30, 1993.
3 National Diabetes Data Group, National Institutes of Health, Diabetes in America, 2nd Edition.
Bethesda, MD: National Institutes of Health ("NIH") Publication No. 95-1468. Ch.1 p.13
4 U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,

November 1997, National Diabetes Fact Sheet: National estimates and general information on diabetes
in the United States. Atlanta, GA: NIH Publication No. 98-3926
5 Julian Whittaker, Health & Healing, Sept. 1995, Vol. 5, No. 9, p.2
6 Charles Weller, M.D., The New Way to Live with Diabetes.
7 Encyclopedia of Natural Medicine, M. Murray and J. Pizzorno, Revised 2nd Edition 1998, p.414
8 Elson Haas, Staying Healthy with Nutrition, 1992, Ch. 5, p.100
9 P. McNair, Hypomagnesemia- A Risk Factor in Diabetic Retinopathy, Diabetes, Nov. 1978, 27 (II):
1075-77
10 Diabetologia; 97; 40:344-347
11 Clinical Diabetes, Vol. 15, No. 1, Jan/Feb 1997
12 Researchers will begin their final six-month trial on 1000 patients in the fall of 1998 and if successful,
expect the product to be on the market within two years. US volunteers interested in participating in the
study can call 1-800-438-1985.
The following websites offer further information on diabetes:
American Association of Diabetes Educators
American Diabetes Association
National Center for Nutrition and Dietetics, Consumer Nutrition Hotline (a part of The American Dietetic
Association)
The International Diabetes Federation (IDF)
National Institute of Diabetes and Digestive and Kidney Disease of the National Institutes of Health
Centers for Disease Control and Prevention
Department of Veterans Affairs
Health Resources and Services Administration
Clinton J. Choate, L.Ac. graduated from from Emperor's College in 1989 and spent 6 months in a postgraduate internship program for foreign students he helped develop at Shu Guang Hospital in Shanghai.
He has a Masters of Oriental Medicine degree (M.O.M.) and practices acupuncture and Chinese herbal

medicine in Santa Monica, California.

Diabetes, Biomedical and TCM Perspectives and Treatments
Part One of this article covers the biomedical treatment of diabetes, including clinical observations,
symptoms, Laboratory diagnosis, Complications or Sequelae of Diabetes, Nutritional Therapy, Botanical
medicines, Status of diabetes research, and the future of diabetes.
Part Two of this article covers the traditional Chinese medicine treatment of diabetes, including
differentiation, needling prescriptions, dietary medicine.
Part Three of this article covers the traditional Chinese medicine treatment of diabetes, using individual
herbs and herbal prescriptions.
The following websites offer further information on diabetes:
American Association of Diabetes Educators
American Diabetes Association
National Center for Nutrition and Dietetics, Consumer Nutrition Hotline (a part of The American Dietetic
Association)
The International Diabetes Federation (IDF)
National Institute of Diabetes and Digestive and Kidney Disease of the National Institutes of Health
Centers for Disease Control and Prevention
Department of Veterans Affairs
Health Resources and Services Administration

Diabetes Mellitus From Western and TCM

Perspectives - Part 2
By Clinton J. Choate L.Ac.
TRADITIONAL CHINESE MEDICINE
There are two words in the Chinese language for diabetes: the traditional medical name 'xiao-ke' which
means "wasting and thirsting", and the modern term 'tang-niao-bing' which means "sugar urine illness".

Discussion of diabetes by its traditional name appears in all the earliest texts, including the Yellow
Emperor's Inner Classic (Neijing). Traditionally, it is divided into three types: upper, middle and lower.
Each type reflects the predominance of one of the three main symptoms (thirst, hunger, and excessive
urination) and is intimately related to the Lung, Spleen and Kidneys respectively. Yin deficiency is
usually associated with all three types. A traditional diagnosis of wasting and thirsting may include
illnesses besides the modern entity of diabetes and vice-versa i.e. someone with tang-niao-bing would
not necessarily have xiao-ke.
For the purposes of this discussion, diabetes mellitus will be analyzed according to the traditional
category of xiao-ke or wasting and thirsting disease. It is believed to be related to eating fatty or sweet
foods in excess, to emotional disturbances and to a constitution that is yin deficient.
According to TCM, irregular food intake in the form of over-consumption of fatty, greasy, pungent and
sweet food, hot drinks and alcohol impairs the transportive and transformative functions of the Spleen
and Stomach, which in turn generates internal heat. The accumulated food turns into heat that
consumes fluids thereby creating thirst and hunger. In the Simple Questions (Su Wen) it is explained
that " ... fat causes interior heat while sweetness causes fullness in the middle burner. The qi therefore
rises and overflows and the condition changes into that of thirsting and wasting"1.
Long-term internal heat injures yin and consumes body fluids. When body fluids are consumed, they fail
to nourish the Lung and Kidneys. The pathological changes seen in diabetes therefore always include
yin deficiency and dry heat. These factors mutually influence each other: yin deficiency leads to dry
heat, dry heat to yin deficiency.
Prolonged emotional disturbance may contribute to wasting and thirsting by hindering the flow of qi.
Over-thinking damages the Spleen whilst anger, resentment and frustration lead to constrained Liver qi.
Stagnant Liver qi transforms into fire, which then consumes the yin of the Lung and Stomach. A
passage from the Spiritual Axis (Ling Shu) elaborates "The five inner [yin] organs are soft and weak and
prone to symptoms of wasting heat. When there is something soft and weak there must be something
hard and strong. Frequent anger is hard and strong and the soft and weak are thereby easily injured"2.
When dry heat consumes Lung fluid, the 'Lung fire' gives rise to great thirst, with the consumption of
large quantities of water and a dry mouth. The tongue is red with a yellow coating and the pulse floating
and rapid.
When heat is retained in the Stomach and Spleen there is excessive appetite and constant hunger.
Large appetite and excessive eating, thinness and constipation characterize 'Stomach fire'. The tongue
is red with a yellow coating and the pulse rapid.

When a person is constitutionally yin deficient, overwork, prolonged stress or illness, excessive sexual
activity and pregnancy can consume the essence. The result is deficiency of Kidney yin which can in
turn lead to blazing of Kidney fire. 'Kidney fire' is characterized by frequent, copious urination, cloudy
urine (as if containing grease), progressive weight loss, dizziness, blurred vision, sore back, ulceration
or itching of the skin, and vaginal itching. The tongue is red with scanty or no coating and the pulse is
fine and rapid.
All three patho-mechanisms involve the mutual exacerbation of yin deficiency and dry heat scorching
Kidney yin essence and the fluids of the Lung and Stomach. Yin deficiency is primarily associated with

the Kidneys, and according to the principle that detriment to yin affects yang, Kidney yang deficiency is
also invariably observed in prolonged cases. Therefore xiao-ke syndrome may also occur when there is
deficiency of Kidney yang.
DIFFERENTIATION AND TREATMENT ACCORDING TO THE THREE BURNERS
By analysis of the patient's overall symptoms it should become apparent which organ, whether the
Lung, Spleen or Kidneys, is the most yin deficient. The focus of the treatment can then be established
as concentrating upon relieving deficiency heat in the upper, middle or lower burners. Although there are
usually combinations of patterns seen in the diabetic, such as Lung qi and yin deficiency with phlegm
and heat, for simplicity the focus will remain with the classical differentiation of yin deficiency in the three
burners
UPPER BURNER
For upper wasting (injury of body fluids by Lung heat) the treatment principal is to strengthen the
function of the Lung, tonify yin and clear heat.
Principal clinical manifestations
excessive thirst or desire for liquids is predominant.
Other possible manifestations are
dry throat and mouth
dry cough
hoarse voice
night sweats
emaciation
flushed cheeks
tidal fevers
red tongue with a thin, dry, yellow coating or no coating
thready or wiry and rapid pulse
Typical points
Feishu BL-13
Chize LU -5
Gaohuangshu BL-43
Yuji LU-10
Lianquan REN-23
Zusanli ST-36
Taixi KID-3
Explanation
Feishu BL-13 clears heat, whether excess or deficient, from the Lung and upper warmer and tonifies
Lung yin. Chize LU -5 clears heat from the Lung, alleviates cough and regulates the water passages.
Yuji LU-10 clears Lung heat and benefits the throat. Gaohuangshu BL-43 nourishes blood and yin,
tonifies deficiency, cools heat and treats night sweating. It is said to tonify the Lung, Spleen, Stomach
and Kidneys and can thus be used in any of the three patterns of disharmony, but due to its location in
the upper warmer is most recommended for this pattern, especially when there is great deficiency
accompanied by deficiency heat. Lianquan REN-23 stimulates the production of body fluids*.
(Footnote*: Prof. Qu Maolian who specialized in the acupuncture treatment of diabetes before his
retirement advised applying the chicken-claw method of needling to this point. The needle is first

inserted perpendicularly until deqi is obtained then partially withdrawn and redirected laterally, first in
one direction and then the other. In this way the needle will stimulate the two extra points Jinjin 'Golden
Liquid' and Yuye 'Jade Fluid' (both M-HN-20), located on the veins either side of the frenulum of the
tongue3.
Zusanli ST-36 assists Feishu BL-13 in strengthening the Lung according to the principle of tonifying the
mother (i.e. a point from the earth Stomach channel) to strengthen the child (the Lung corresponding to
the metal phase). Taixi KID-3 tonifies the Kidneys, nourishes yin and helps support the Lung.
MIDDLE BURNER
For middle wasting (injury of yin by Stomach dryness) the treatment principle is to clear Stomach
dryness and heat and tonify yin.
Clinical manifestations
excessive appetite or propensity to hunger predominates.
Other possible manifestations include
halitosis
dry lips
painful swelling or bleeding of the gums
burning sensation in the epigastrium
preference for cold drinks
constipation
red tongue with a thick yellow coating and red ulcerous tip
rapid, full pulse
Typical points
Zusanli ST-36
Neiting ST-44
Sanyinjiao SP-6
Neiguan P-6
Zhongwan REN-12
Pishu BL-20
Weishu BL-21
Weiguanxiashu (M-BW-12)
Taixi KID-3
Explanation
Zusanli ST-36 clears Stomach dryness and benefits Stomach yin and is classically indicated for "heat in
the middle warmer with propensity to hunger"4. Neiting ST-44 clears Stomach heat. Sanyinjiao SP-6
benefits the Stomach and tonifies yin and body fluids. Neiguan P-6 regulates the middle burner and
clears heat. Zhongwan REN-12 harmonises the middle burner and tonifies the Stomach. Pishu BL-20
and Weishu BL-21 benefit the Spleen and Stomach and both were classically indicated for remaining
thin despite large food intake5. Weiguanxiashu (M-BW-12) nowadays known as Yishu (Pancreas Shu)
was first mentioned in the Thousand Ducat Formulas by the great 7th century physician Sun Si-miao for
wasting and thirsting disorder. It is able to clear heat and generate fluid6. Taixi KID-3 tonifies the
Kidneys and nourishes yin, and due to the central role of the Kidneys in housing the original yin is able
to support the yin of the whole body.
LOWER BURNER

For lower wasting (exhaustion of Kidney essence and Kidney yin) the treatment principle is to
strengthen the function of Kidneys and nourish essence.
Clinical manifestations
Excessive urination predominates.
Other possible manifestations include
lower lumbar pain
weakness of the legs
constipation
blurred vision
dizziness
malar flush
poor memory
afternoon fever
nocturnal emission
red tongue with scanty coating
thin and rapid pulse
Typical points
Guanyuan REN-4
Qihai REN-6
Taixi KID-3
Rangu KID-2
Sanyinjiao SP-6
Shenshu BL-23
Jingmen GB-25
Explanation
Guanyuan REN-4 benefits essence, tonifies and nourishes the Kidneys and benefits the Bladder. Qihai
REN-6 tonifies the Kidney qi. Taixi KID-3 tonifies the Kidneys and nourishes yin. Rangu KID-2 clears
deficiency heat and regulates the Kidneys. Sanyinjiao SP-6 benefits the Kidneys and nourishes yin.
Shenshu BL-23 tonifies the Kidneys, nourishes yin and essence and treats excessive urination.
Jingmen GB-25 (the front-mu point of the Kidney) combines with its back-shu point Shenshu BL-23 to
tonify the Kidneys, benefit the water passages and control urination.
Method (for all three patterns)
If possible treat as frequently as daily or every other day. Needles are retained for 30 minutes. Apply
reinforcing method mainly. In cases of severe heat, apply reducing method.
Discussion
Patients commonly present with mixed patterns (i.e. symptoms of more than one burner). Treatment
should be given according to the predominant clinical manifestations. Where there are clear signs of two
of the excesses, e.g. thirst and excessive appetite, treat both. Furthermore additional points may be
added according to clinical presentation. Flexibility in treatment is therefore necessary, for example:
If there is thirst, a yellow dry tongue coating and an overflowing pulse, select points from yangming
channel such as Quchi L.I.-11, Jiexi ST-41, Hegu L.I.-4 etc.
If there is yin deficiency and uprising of yang, with symptoms such as low-grade fever, night sweats,
malar flush, deep-red tongue body and a fine and rapid pulse, select Dazhui DU-14 and Yinxi HE-6 to
clear deficiency heat.

 If night sweating is severe, add Houxi SI-3.

Kidney deficiency can lead to qi deficiency. Alternatively heat can consume Stomach yin leading to qi
deficiency. In the case of qi deficiency symptoms such as shortness of breath after exertion,
spontaneous sweating, and a deep, thready pulse, apply moxibustion to Qihai REN-6 and Guanyuan
REN-4.
In the case of Kidney yang deficiency with cold limbs, lower limb edema, copious urination, a pale
tongue with white coating, and a thready, deep, and weak pulse, apply moxibustion Mingmen DU-4, and
Guanyuan REN-4.
For increased appetite accompanied by muscle atrophy, add Pirexue (N-BW-10) [0.5 cun lateral to the
lower border of the spinous process of the sixth thoracic vertebra, corresponding to one of the
Huatuojiaji (M-BW-35) points], Weishu BL-21 and Zhongwan REN-12.
The following points are indicated for wasting and thirsting disorder in a variety of classical Chinese
texts7.
Yinshi ST-33, Feishu BL-13, Guanyuanshu BL-26, Xiaochangshu BL-27, Pangguangshu BL-28, Yishe
BL-49, Rangu KID-2, Taixi KID-3, Yangchi SJ-4, Renzhong DU-26, Qimen LIV-14, Guanyuan REN-4,
Jinjin/Yuye (M-HN-20), Weiguanxiashu (M-BW-12), Xingjian LIV-2, Duiduan DU-27, Chengqiang REN24, Shenshu BL-23.
The following combinations are indicated for wasting and thirsting disorder in a variety of classical and
modern texts.
Severe thirst of wasting and thirsting disorder: Yongquan KID-1 and Xingjian LIV-2 (Ode of One
Hundred Symptoms)8.
Wasting and thirsting disorder with great desire to drink: Rangu KID-2, Yishe BL-49 and Guanchong
SJ-1 (Classic of Supplementing Life with Acupuncture and Moxibustion)9.
Wasting and thirsting disorder with great desire to drink: Rangu KID-2, Yishe BL-49, Chengjiang REN24 and Guanchong SJ-1 (Thousand Ducat Formulas)10.
Wasting and thirsting disorder: Ranggu KID-2, Chengjiang REN-24, Jinjin (M-HN-20), Yuye (M-HN-20),
Renzhong DU-26, Lianquan REN-23, Quchi L.I-11, Laogong P-8, Taichong LIV-3, Xingjian LIV-2,
Shangqiu SP-5 and Yinbai SP-1 (Great Compendium of Acupuncture and Moxibustion)11.
Kidney deficiency wasting and thirsting disorder, absence of sweating, difficulty in moving the lumbar
spine, distension of the abdomen and pain of the lateral costal region: Yishe BL-49 and Zhonglushu BL29 (Classic of Supplementing Life with Acupuncture and Moxibustion)12.
Thirst and emaciation: Chengqiang REN-24, Shentang BL-44, Guanchong SJ-1 and Rangu KID-2
(Prescriptions for Universal Benefit)13.
Thirst and emaciation: use up to 100 cones of moxa at Guanyuan REN-4 (Book of Bian Ques
Secrets)14.
Weiguanxiashu (M-BW-12), Feishu BL-13, Pishu BL-20, Shenshu BL-23, Zusanli ST-36 and Taixi KID3. For excessive thirst add Shaoshang LU-11, Yuji LU-10 and Geshu BL-17. For increased appetite
accompanied by emaciation of the muscles add Pirexue (N-BW-10), Weishu BL-21 and Zhongwan
REN-12. For frequent urination add Guanyuan REN-4, Fuliu KID-7 and Shuiquan KID-515.
EAR ACUPUNCTURE
In auricular diagnosis one can identify subtle problems of the body by detecting areas of the ear which
are discolored, flaky, or have tenderness or high skin conductance. Unilateral pathology is generally
represented by ear points on the same side.
The practitioner should first stimulate the appropriate local points corresponding to specific body
symptoms, for example pain of the foot is treated by selecting the ear region corresponding to the foot,
on the ear of the affected side if unilateral and on both ear if bilateral.
If a point is not reactive, exhibiting increased skin conductance and/or heightened tenderness, it is

usually omitted from the treatment plan. The master points are then stimulated, followed by the
functional points indicated by specific treatment plans. Treat ipsilaterally or bilaterally, 5-10 points per
ear, using as few needles as possible. Retain needles for 20-30 minutes, and treat once to three times a
week.
Specific Treatment Plan for Diabetes Mellitus16:
Master Points: Point Zero*, Shen Men, Endocrine Hormone (Internal Secretion).
Functional Points: Pancreas, Pancreatitis, Liver.
The following points may be added according to predominant symptoms17:
Thirst: Endocrine, Lung, Thirst.
Hunger: Endocrine, Stomach.
Frequent urination: Endocrine, Kidney, Bladder.
Increasing insulin: Pancreas.
MOXIBUSTION
dryness in the mouth: burn 100 cones at Xiaochangshu BL-2718.
frequent urination: moxa can be burned at the tips of the little finger and toe, as well as at points along
the cervical vertebrae (e.g. Dazhui DU-14)19.
DIABETIC COMPLICATIONS
The following passage on diabetic complications is derived from a valuable article on Diabetes by
Nicholas Haines published in The Journal of Chinese Medicine, issue 43, September 1993, page 5.
Cataracts, night blindness, blindness
Patterns involved: Kidney yin deficiency, Liver blood deficiency, Liver yin deficiency and Liver yang
rising.
Cataracts
Usually require surgical intervention. One can, however, slow the progression of cataract formation by
selecting points according to the above differentiations.
Night-blindness
A progressive disorder with underlying Kidney yin deficiency and Liver yin/blood deficiency. It is unlikely
complete night-vision can be restored, however, there should be improvement and/or a slower amount
of deterioration with treatment.
Tonify Kidney and Liver yin with the following points:
Shenshu BL-23, Ganshu BL-18, Danshu BL-19, Qihai REN-6, Zusanli ST-36, Taixi KID-3, Taichong LIV3.
Blindness
Often due to hemorrhage caused by a combination of Spleen qi deficiency and Liver yang rising. Loss
of vision may be temporary or permanent depending where the bleeding occurs. Even in the case of
irreversible loss of vision, it is important to subdue the Liver yang and tonify the Spleen to prevent
further bleeding.

 Subdue ascendant Liver yang and wind by using reducing or neutral technique at the following points:
Taichong LIV-3, Xingjian LIV-2, Fengchi GB-20, Baihui DU-20, Hegu L.I.-4.
Support the Spleen and Liver and Kidney yin using reinforcing technique at the following points:
Ququan LIV-8, Taixi KID-3, Sanyinjiao SP-6, Shenshu BL-23, Ganshu BL-18.
Deafness
Patterns involved: Kidney yin deficiency. This is a progressive development and most likely irreversible.
To prevent further deterioration select points with the action of tonifying the Kidneys and nourishing yin.
Edema
Patterns involved: Spleen yang deficiency, Kidney yang deficiency. Edema usually starts with the feet
and gradually affects other parts of the body. The edema tends to be recurrent.
Tonify the Spleen and Kidneys using a reinforcing method and/or moxa at the following points: Pishu
BL-20, Shenshu BL-23, Shuifen REN-9, Qihai REN-6, Zusanli ST-36, Taixi KID-3.
Skin infections, ulcerations and decay
Patterns involved: deficiency heat (from yin deficiency) and ying qi deficiency failing to move blood
which blocks the collaterals, causing decay through stagnation and lack of nourishment. Failure of body
fluids to circulate causes dampness and heat to arise by virtue of stagnation.
This is usually seen on the extremities or an area with reduced blood supply, like the hips or buttocks,
and is due to poor circulation and/or an elevated level of blood sugar. Both conditions promote an
environment for infections. The areas will usually appear red and purple with yellow pus or clear yellow
liquid on the surface. The "yellow pus type" is normally seen on the extremities, and the "clear yellow
fluid type" occurring as sores at pressure areas like the elbows and buttocks. A small cut, abrasion or
localized pressure usually initiates diabetic infections. A "yellow pus type" would be classified as a
damp-heat type with poisons (du), and a "clear yellow liquid type" as a yin-deficiency ulcer.
Local needling is to be avoided. Distal points to remove stagnation in the affected channels should be
employed. In addition a topical, dilute solution may be applied, made of a tincture of 100ml Huang Bai
(Cortex Phellodendri) and 50 ml Pu Gong Ying (Herba Taraxaci Mongolici cum Radice) to which 2gms of
Yunnan Bai Yao (Yunnan Province White Medicine) Powder is added.
Reduced peripheral circulation and neuropathy
Patterns involved: blood stagnation, blood deficiency, qi deficiency, yin deficiency, yang deficiency or
cold stagnation. Treat according to differentiation.
Impairment of blood circulation and blockage of the collaterals by blood stasis creates poor peripheral
circulation that manifests as purple or dark limbs with markedly decreased sensitivity. This complication
will often be combined with skin infections and decay.
Strokes and hemiplegia
Patterns involved: long term yin deficiency and deficiency heat which condenses body fluids and leads
to the formation of phlegm, or prolonged dampness condenses into phlegm, or prolonged yin deficiency
leads to interior wind that carries the phlegm upwards. Phlegm blocks the channels and obstructs the
Heart orifices.
Onset can present as any one or a combination of the following: severe headache; dizziness; loss of
consciousness; aphasia; convulsions; facial paralysis; hemiplegia; or numbness of the face and limbs; a

wiry and slippery pulse and a red tongue with a greasy yellow coating.
Clear fire and phlegm, and subdue Liver wind with the following points: Baihui DU-20, Renzhong DU26, Fenglong ST-40, Taichong LIV-3, Yongquan KID-1, hand jing-well points.
Concluding Remarks
Acupuncture, although proven to be clinically effective in reducing blood sugar and normalizing
endocrine function, is most effective when used as part of a comprehensive treatment program.
Among diabetic patients, the body's resistance to disease is usually low, rendering it more susceptible
to infection. Therefore careful attention must be placed on sterilization of the needles and the puncture
site.
APPENDIX ONE
The following is an acupuncture protocol for diabetes developed by Master Dong and related by Miriam
Lee20. Three points are used:
Sanyinjiao SP-6 is said to regulate the original (yuan) qi which is stored in Kidneys.
Lougu SP-7
Shenguan (Extra) i.e. Kidney Gate, located 1.5 cun distal to Yinlingquan SP-9
According to Master Dong, these three points are so potent in normalizing internal secretion imbalances
they are known as the "Three Emperors". Since wasting and thirsting disorder is characterized by
excess of yang and deficiency of yin, the yin earth channel (Spleen) is favored over its yang partner
(Stomach).
Discussion: When the body is out of balance it craves sweets, and excess of the sweet taste drains the
Spleen. Sweet cravings are usually satisfied by candies, cookies, pastries, and soft drinks made from
sugar, a refined, super-concentrated extract. Such refined sugar, with far different characteristics from
more complex carbohydrates, is a potent yang substance that generates excessive heat of a false kind
which leads to deficiency of yin.
These authors also recommend an ear acupuncture protocol using the following points:
Hunger Point (near SI-19 *needs precise location), Internal Secretion, Heart/Thyroid, Kidneys, Shen
Men and Sympathetic.
Many people, both over- and under- weight, have uncontrollable cravings for sweets or salt. This is an
internal secretion problem. The "Hunger Points" are very effective to control these cravings when used
3-5 days in a row. This formula also addresses insomnia, poor appetite, upper and lower extremity
edema (via Kidneys, Shen Men and Sympathetic points).
According to Western medical understanding excessive or scanty appetite, obesity or emaciation,
lethargy or hyper-excitability may all be related to either hyper or hypothyroidism. Ear points are
particularly useful in addressing these problems since they can affect hormonal and enzymatic activity
throughout the body.
APPENDIX TWO: THREE PRESCRIPTIONS ACCORDING TO DR. RICHARD TAN'S BALANCE
METHOD
The 'Balance Method' was developed by Dr. Tan through his extensive clinical research on the
application of "I-Jing/Bagua" theory to acupuncture. It incorporates universal concepts and applies

fundamental acupuncture theory that is often overlooked in Western acupuncture training.

This method basically relies on balancing the point prescription according to the fundamental
relationships between the channels as found in the I-Jing/Bagua, and upon the "image" of the
symptomatic body area. Traditional point functions combined with ahshi qualities are used to guide point
selection, however clearing the channels remains the primary focus. Dr. Tan advocates that the way to
address an imbalance of any kind, including the symptoms of the diabetic condition, lies on achieving a
"global balance". An example would be to use yang channel points (+) on the Upper Left and Lower
Right Extremities (ULE/LRE) with yin channel points (-) on the Upper Right and Lower Left Extremities
(URE/LLE); i.e. ULE (+); LLE (-); URE (-); LRE (+). One to four extremities can be used in a given
treatment. Body and head points may also be incorporated, for example balancing the upper front torso
with the lower back torso. The method is most effective when fewer than 6-8 needles are used and they
are placed remote to the site of pain or imbalance. Local ahshi points are used to identify the principal
site and channels affected and are not directly needled. For example, pain at Yangxi L.I.-5 on the left
wrist could be addressed by needling Taiyuan LU-9 on the right wrist, or pain at Jiexi ST-41 on the right
ankle by needling Shangqiu SP-5 on the left ankle.

Diabetic with a tight, wiry pulse

URE: Tongli HE-5; ULE: Waiguan SJ-5, Hegu L.I.-4; LLE: Sanyinjiao SP-6, Lougu SP-7, Yinlingquan
SP-9; LRE: Zusanli ST-36.
Diabetic Impotence
ULE: Waiguan SJ-5; LLE: Sanyinjiao SP-6, Lougu SP-7, Yinlingquan SP-9;
URE: Ling Ku (proximal to Hegu L.I.-4 and just distal to the intersection of the first and second
metacarpal bones); LRE: Yinbao LIV-9, plus three extra points located 1, 2 and 3 cun proximal to Yinbao
LIV-9 and known as the "Upper San Huang" points by Master Dong.
Note: This prescription is designed to move energy up and down through the genital region.
ULE: SJ-5; LLE: SP 6, 7, 9;
URE: Ling Ku; LRE: LV-9 a1 a2 a3 (3 pts. called "Upper San Huang" by Master
Dong)
Diabetic bilateral symmetrical peripheral neuropathy in the feet
1.5 cun insertion into bilateral Baxie (M-UE-22) and bilateral Ling Ku (see above) penetrating towards
Houxi SI-3. Note: If the patient has a burning sensation in the feet that are cold to the touch, the
prognosis is poor.
CHINESE SYSTEM OF FOOD CURES
"Proper diet is the foundation for life-long good health"
Introduction
Chinese nutrition uniquely differs from modern Western nutrition in that it determines the energetic and
therapeutic properties of foods rather than analyzing them solely according to their chemical
constituents. For example Spinach is cooling, strengthens all the organs, lubricates the intestines,
quenches thirst and promotes urination. One application for diabetes to strengthen the digestive organs
and assist in clearing heat would be to boil tea from spinach and chicken gizzards and drink 1 cup three
times a day. Another application is to eat spinach cooked with seaweed to help clean the blood and

reduce swellings. This is beneficial when a diabetic develops itchy skin, rashes or hot skin eruptions.
Furthermore, Chinese nutrition takes into consideration such factors as the person's body type, age
and Vitality level, the geographical location, yearly seasonal influences and the method of preparation
in determining the appropriate diet. Used both as a healing and disease prevention system, the distinct
advantage of Chinese nutrition lies in its ability to adapt to the changing needs of an individual. In case
of illness, rather than solely focusing on treating the particular disease, the whole person and their
interrelated bio-chemical and bio-energetic systems can be addressed.
Sugar in the urine, as one of the most important symptoms of diabetes, was included in the Chinese
medical classic, A Collection of Diseases, by Wang Shou, published in 752. For the first time in Chinese
medical history diabetes was listed among the eleven hundred diseases. The author recommended pork
pancreas as treatment for the disease, and also recommended a special method of testing sugar in the
urine: the patient was asked to pass urine on a wide, flat brick to see if ants gathered to collect the
sugar.
This method of testing urine was more than ten centuries ahead of Richard Thomas Williamson (18621937), who invented a test for the same purpose. The Chinese author's treatment using pork pancreas
was similar to modern treatment by insulin. In Chinese medicine however, thirst, weight loss, fatigue,
and sugar in the urine are considered the key symptoms of diabetes. When a patient recovers from any
of these symptoms, the diabetes treatment is considered successful.
Food Remedies for Diabetes
Clinical Report: A Food Treatment of Diabetes21.
Steam 60% wheat bran and 40% all-purpose whole wheat flour; add an adequate amount of vegetable
oil, eggs and vegetables. Eat at meals to relieve diabetes.
The proportion of wheat bran was decreased as the condition improved. No drugs or nutritional
supplements were given in this treatment. Among the 13 diabetes cases treated, blood sugar dropped
to below 140 mg/dl in 3 cases and to 180 mg/dl in 7 cases; after treatment (lasting from 5 to 90 days),
sugar in the urine changed from ++++ or +++ to negative in 10 cases; but in general, sugar in the urine
changed to negative within one month along with the disappearance of neuritis associated with
diabetes.
Vegetable and Grain Remedies
Bamboo Shoots: Cooling. Strengthens the Stomach, resolves mucous, promotes diuresis. Add
generously to stir-fry vegetable dishes or blend bamboo shoots and celery juice, warm and drink 1-2
cups a day.
Bok Choy: Cooling. Clears heat, lubricates the intestines, quenches thirst. Steam or lightly stir-fry as a
side dish or blend with cucumber as a juice.
Celery: Cooling. Tonifies the Kidneys, strengthens the Spleen and Stomach, clears heat, promotes
diuresis, lowers blood pressure. Combine celery, yam and pumpkin and bake to make vegetable pie or
lightly boil celery juice and drink 1-3 cups daily. Can also blend daikon radish, celery, carrot, and
spinach as a juice and drink one or two cups a day.

Corn Silk: Neutral, sweet. Promotes urination, affects the Liver and Gall Bladder, lowers blood sugar.
Boil corn silk with watermelon peel and small red beans in water. Drink as soup for the relief of chronic
nephritis with edema and ascites.
Millet: Cooling. Benefits the Stomach and intestines, promotes urination. Steam millet with yams and a
few dates.
Mung Bean: Cold, sweet. Clears heat, quenches thirst, resolves edema in the lower limbs. Make soup
from mung beans, barley and rice. Or soak 100mg. mung beans overnight; boil in 3 cups water over low
heat; drink twice a day. Or grind mung beans into powder and take 15g powder dissolved in warm water
twice a day.
Mushroom (Chinese Black or Shitake): Neutral, sweet. Strengthens the Stomach, promotes healing,
lowers blood pressure, counteracts cholesterol, lowers blood fat levels. Eat fresh or soak, blending with
the soaking water; heat like soup and take on an empty stomach to clear toxins from the intestines. Or
bake until it appears burned on the surface; eat 10g twice a day.
Pearl Barley: Cooling. Promotes diuresis, strengthen the Spleen, clears heat. Blend barley and water,
boil and drink the liquid. Or cook soupy barley and eat as a porridge.
Pumpkin: Cooling. Dispels dampness, reduces fever, particularly beneficial for diabetes. Eat a slice of
pumpkin everyday it is in season. For a main dish bake a pie with pumpkin, yam and potato.
Snow Peas: Cold. Strengthens the middle warmer, detoxifies, promotes diuresis, quenches thirst. Cook
snow peas, blend and drink as a juice half a cup twice a day.
Soybeans: Cooling. Clears heat, detoxifies, eases urination, lubricates the Lung and intestines. Drink
plain soymilk or eat tofu to relieve heat conditions. Steam tofu, cool, add sesame oil and thin julienne
slices of raw squash.
Soybean Sprouts: Cooling. Promotes diuresis, clears heat, especially in the Stomach. Boil for four
hours; drink tea lukewarm. Continue over a period of one month to relieve hypertension.
Spinach: Cooling. Strengthens all the organs, lubricates the intestines, quenches thirst, promotes
urination. Boil tea from spinach (including the roots) and chicken gizzard; drink 1-3 cups a day.
String Bean (Green Bean): Neutral, sweet. Kidney and Spleen tonic. Boil 50g dried string beans (with
the shells) in water. Drink as a soup once a day to relieve thirst, and frequent urination. Or blend string
beans, cucumber and celery as juice and drink 1 cup daily.
Sweet Potato (Yam): Neutral, sweet. Strengthens the Spleen and Stomach, tonifies qi, clears heat,
detoxifies. Steam millet with yams and a few dates or cook soup with winter melon. Or mix 50g yam
powder with 10g American Ginseng powder. Dissolve 15g in warm water each time; drink 3 cups a day
as a therapeutic dose.
Sweet Rice (Glutinous): Warm, sweet. Used as an energy tonic. Benefits the Spleen, Stomach, and
Lung. Relieves excessive urination, perspiration, and diarrhea. Cook 50g sweet rice with 60g Job's tears
and 8 red dates. Eat as a side dish at meals to provide general support.

Tomato: Slightly cooling. Promotes body fluids, quenches thirst, strengthens the Stomach, cools blood,
clears heat, calms the Liver. Eat one raw tomato daily on an empty stomach.
Turnip: Cooling. Clears heat, removes dampness. Boil with tops as a side dish.
Water Chestnut: Cold, sweet. Relieves fever and indigestion; promotes urination; benefits the Lung and
Stomach. Boil 5 water chestnuts in water with 1 fresh mandarin orange peel. Drink as a tea to relieve
hypertension. Or peel 100g water chestnuts and chew them slowly in the morning and evening.
Winter Melon: Cooling. Clears heat, detoxifies, quenches thirst, relieves irritability, dispels dampness.
Particularly effective in regulating blood sugar. Make soup from cabbage, yam, winter melon and lentils.
Or drink three cups of fresh winter melon juice a day. Oral administration of 50-60 ml of the juice per
dose has shown good results in clinical trials21.
Wheat Bran: Cool, sweet. Benefits the Stomach22.
Recipes
Winter Melon Soup
6 pints (3.5 liters) vegetable broth, 3 cups chopped and peeled winter melon, 2 carrots, 2 celery stalks,
1 onion, 12 Mushrooms (Chinese Black or Shitake), stems removed, 6oz (170g) tofu noodles or finely
sliced baked tofu. Cook until tender (about 25 minutes) Season with 1tsp chives, 1Tbs tamari, and 1tsp
peanut oil. Serves 4.
Stuffed Pumpkin
Cut the top off a small pumpkin; clean out the seeds and strings; save the lid. Fill with the following
mixture:
3 cups cooked rice or barley, 1Tbs crushed, toasted sesame seeds, 2-3 sliced celery stalks, 1Tbs
parsley, 1tsp thyme, 1tsp sage, half tsp. rosemary, and 1Tbs tamari
Cover with pumpkin lid and bake at 350 degrees for 1 to 1.5 hrs. A fork will easily go into the pumpkin
when cooked. Serves 4-6.
Azuki Bean and Squash Casserole
1cup azuki beans soaked overnight, two 6-inch pieces of kombu seaweed, 1 small butternut squash,
kabuchi or other winter squash.
Cover beans and kombu with water and simmer for about 1 hour, adding water as needed. Then add
the cubed and peeled squash. Cook until tender (about half an hour). Stir in a pinch of sea salt or 1-2
tsp. tamari. Serves 4
Case report
Twenty-five diabetes patients were treated at the Canton College of Traditional Chinese Medicine with
dried bitter melon slices; 250g dried bitter melon slices boiled in water each day. The changed levels of
their blood sugar taken 2.5 hours after meals, and of their urine sugar taken 24 hours after meals, were
both statistically significant. The same method has subsequently been applied to diabetic rats, and also
resulted in a significant decrease in the level of blood sugar. The same report concludes that the effects
of dried bitter melon are remarkably similar to those of insulin. It was also suggested that when 100g

fresh clams are boiled in water with the dried bitter melon slices, the results should be better.
Animal Product Remedies
Abalone: Neutral, sweet, salty. Detoxifies; sharpens vision. Contraindicated for persons with a weak
digestion. Boil 20-25g abalone with 250-300g fresh radish in water. Drink as a soup once every other
day. Repeat 6-7 times as a treatment program. This is a time-honored recipe in Chinese folk medicine
for diabetes.
Beef: Neutral, sweet. Used as a Spleen, Stomach, qi and blood tonic. Boil lean beef with yam to make
soup.
Clam (freshwater): Cold, sweet, salty. Detoxifies, sharpens vision; acts on the Liver and Kidneys.
Freshwater clam saliva is especially beneficial for diabetes. Boil 150g chives with 200g clams and
suitable seasoning.
Milk: Cow's milk is neutral and sweet with a descending action. Used as a Lung and Stomach tonic,
produces fluids and lubricates the intestines, benefits the Heart, Lung and Stomach. Contraindicated
with diarrhea or mucous discharge. Mix equal amounts of cow's and goat's milk. Drink the milk as a
substitute for tea or juice to improve physical condition and help reduce frequency of urination.
Pork: Neutral, sweet, salty. Used to lubricate dryness; benefits the Spleen, Stomach and Kidneys. Cut
up 100g lean pork and boil in water with 100g Job's tears over low heat for 2 hours. Eat as a side or
main dish.
In the 1846 Chinese diet classic New Collected Works of Proven Dietary Recipes, pork pancreas was
used as an ingredient in several dietary formulas to treat diabetes. One recipe called for boiling a pork,
beef, or lamb pancreas in water with 200g yam; season with salt and divide into 4 parts. One part is to
be eaten every day for 4 days. Another instructed to cut up a pork pancreas and bake it over a low heat
until dry and then to grind into powder. 3-5g to be taken in warm water at each meal. And another called
to wash the pork pancreas and remove all white fat. Then cut into thin pieces; boil over low heat in water
with 20g corn silk, and season with salt. One portion is to be eaten daily.
Fruit Remedies
Crab Apple: Neutral, sweet and sour. Quenches thirst; astringes, benefits the Heart, Liver, and Lung.
Boil 10 partially ripe fresh crab apples in an adequate amount of water until the water is reduced by half.
Drink the soup and eat the fruit to quench thirst and relieve diarrhea.
Guava: Warm, sweet. Astringent and constrictive, relieves frequent urination and diarrhea. Crush 90g
fresh guavas; squeeze out the juice and drink before meals.
Plum: Neutral, sweet, sour. Produces fluids, promotes urination and digestion, benefits the function of
the Liver and Kidneys.
Strawberry: Cooling. Lubricates the Lung, promotes body fluids, strengthens the Spleen. Drink 1 small
glass of fresh juice daily during the summer.
Mulberry: Slightly cold. Quenches thirst, detoxifies, tonifies the Kidneys, lubricates the Lung, relieves

constipation, calms the spirit, promotes diuresis. Boil mulberries as a tea and drink half a cup at a time.

Eating Guidelines to Promote Healthy Digestion

The dining area should be clean and nicely arranged, free of foul odors, and with plentiful fresh air.
During meals and for a least one hour afterwards an upright posture of the torso should be
maintained.
Liquids should be consumed sparingly at meals. Sipping green tea during or after meals is beneficial.
A wide variety of seasonal foods should be included in the diet, however fruit and sweet foods should
be minimized.
Three to four light meals should be eaten at regular times each day. The largest meal should be taken
at mid-day and the evening meal should be consumed at least 2 hours before bedtime. When mental or
physical demands are high, natural, complex carbohydrate snacks are encouraged.
After meals some light movement, such as a stroll in the fresh air, is highly recommended. A Chinese
proverb says "100 paces after each meal will allow one to live a healthy 100 years".
Notes
1. Simple Questions (Su Wen) chapter 47.
2. Spiritual Axis (Ling Shu) chapter 46.
3. Nanjing Seminars Trancript, Qiu Mao-lian and Su Xin-ming. Journal of Chinese Medicine, 1984.
4. A Manual of Acupuncture, Peter Deadman, Mazin Al-Khafaji and Kevin Baker, Journal of Chinese
Medicine Publications, 1998, p.158.
5. Ibid. p.279.
6. Ibid. p.571.
7. Ibid.
8. Ibid. p. 338.
9. Ibid. p339.
10. Ibid. p339.
11. Ibid. p339.
12. Ibid. p309.
13. Acupuncture A Comprehensive Text, OConnor, J. and Bensky, D., Eastland Press.
14. Ibid.
15. Ibid.
16. Oleson, Terrence, D., Ph.D., Auriculotherapy Manual Chinese and Western Systems of Ear
Acupuncture, 1990, Published by Health Care Alternatives.
17. Acupuncture A Comprehensive Text, OConnor, J. and Bensky, D., Eastland Press.
18. Ibid.
19. Ibid.
20. Lee, Miriam, O.M.D., Insights of a Senior Acupuncturist, Blue Poppy Press, 1992
21. A Food Treatment of Diabetes (8) Ch.7, p.112.
22. Bever, B. O. and Zahand, G. R.,