2: DIABETES MODERN MEDICINE AND TRADITIONAL CHINESE MEDICINE - PART TWO

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>DIABETES: MODERN MEDICINE AND TRADITIONAL CHINESE MEDICINE - PART TWO

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> DIABETES: MODERN MEDICINE AND TRADITIONAL CHINESE

>MEDICINE - PART TWO

> 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 analysed 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.

>

> a.. 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.

> b.. When heat is retained in the Stomach and Spleen

>there is excessive appetite and constant hunger. Large appetite and

>excessive eating, thinness and constipation characterise 'Stomach fire'.

>The tongue is red with a yellow coating and the pulse rapid.

> c.. 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

>

> a.. excessive thirst or desire for liquids is

>predominant.

> Other possible manifestations are

>

> a.. dry throat and mouth

> b.. dry cough

> c.. hoarse voice

> d.. night sweats

> e.. emaciation

> f.. flushed cheeks

> g.. tidal fevers

> h.. red tongue with a thin, dry, yellow coating or no

>coating

> i.. 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 specialised 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

>

> a.. excessive appetite or propensity to hunger

>predominates.

> Other possible manifestations include

>

> a.. halitosis

> b.. dry lips

> c.. painful swelling or bleeding of the gums

> d.. burning sensation in the epigastrium

> e.. preference for cold drinks

> f.. constipation

> g.. red tongue with a thick yellow coating and red

>ulcerous tip

> h.. 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

>

> a.. Excessive urination predominates.

> Other possible manifestations include

>

> a.. lower lumbar pain

> b.. weakness of the legs

> c.. constipation

> d.. blurred vision

> e.. dizziness

> f.. malar flush

> g.. poor memory

> h.. afternoon fever

> i.. nocturnal emission

> j.. red tongue with scanty coating

> k.. 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:

>

> a.. 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.

> b.. 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.

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

> d.. 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.

> e.. In the case of Kidney yang deficiency with cold

>limbs, lower limb oedema, copious urination, a pale tongue with white

>coating, and a thready, deep, and weak pulse, apply moxibustion Mingmen

>DU-4, and Guanyuan REN-4.

> f.. 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 REN-24, Shenshu BL-23.

>

> The following combinations are indicated for wasting and

>thirsting disorder in a variety of classical and modern texts.

>

> a.. Severe thirst of wasting and thirsting disorder:

>Yongquan KID-1 and Xingjian LIV-2 (Ode of One Hundred Symptoms)8.

> b.. 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.

> c.. Wasting and thirsting disorder with great desire

>to drink: Rangu KID-2, Yishe BL-49, Chengjiang REN-24 and Guanchong SJ-1

>(Thousand Ducat Formulas)10.

> d.. 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.

> e.. 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 BL-29 (Classic of Supplementing Life with Acupuncture and

>Moxibustion)12.

> f.. Thirst and emaciation: Chengqiang REN-24, Shentang

>BL-44, Guanchong SJ-1 and Rangu KID-2 (Prescriptions for Universal

>Benefit)13.

> g.. Thirst and emaciation: use up to 100 cones of moxa

>at Guanyuan REN-4 (Book of Bian Que¹s Secrets)14.

> h.. Weiguanxiashu (M-BW-12), Feishu BL-13, Pishu

>BL-20, Shenshu BL-23, Zusanli ST-36 and Taixi KID-3. 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 discoloured, 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

>

> a.. dryness in the mouth: burn 100 cones at

>Xiaochangshu BL-2718.

> b.. 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 , 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 LIV-3.

>

> 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.

>

> a.. 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.

> b.. 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.

>

> Oedema

>

> Patterns involved: Spleen yang deficiency, Kidney yang

>deficiency. Oedema usually starts with the feet and gradually affects other

>parts of the body. The oedema tends to be recurrent.

>

> a.. 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.<./li>

> 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.

>

> a.. Clear fire and phlegm, and subdue Liver wind with

>the following points: Baihui DU-20, Renzhong DU-26, Fenglong ST-40,

>Taichong LIV-3, Yongquan KID-1, hand jing-well points.

> Concluding Remarks

>

> a.. 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 programme.

> b.. 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 sterilisation 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:

>

> a.. Sanyinjiao SP-6 is said to regulate the original

>(yuan) qi which is stored in Kidneys.

> b.. Lougu SP-7

> c.. 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 normalising internal secretion imbalances they are known as the

> " Three Emperors " . Since wasting and thirsting disorder is characterised by

>excess of yang and deficiency of yin, the yin earth channel (Spleen) is

>favoured 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 oedema (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 analysing 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 (1862-1937), 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: ³A Food Treatment of Diabetes²,21.

>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 oedema 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 oedema 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

>stringbeans, 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 diarrhoea. 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 litres) 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 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

>diarrhoea 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

>diarrhoea.

>

> Guava: Warm, sweet. Astringent and constrictive,

>relieves frequent urination and diarrhoea. 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

>

> a.. The dining area should be clean and nicely

>arranged, free of foul odors, and with plentiful fresh air.

> b.. During meals and for a least one hour afterwards

>an upright posture of the torso should be maintained.

> c.. Liquids should be consumed sparingly at meals.

>Sipping green tea during or after meals is beneficial.

> d.. A wide variety of seasonal foods should be

>included in the diet, however fruit and sweet foods should be minimised.

> e.. 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 , 1984.

> 4. A Manual of Acupuncture, Peter Deadman, Mazin

>Al-Khafaji and Kevin Baker, Journal of 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, O¹Connor, 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, O¹Connor, 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., Plants with Oral

>Hypoglycemic Action, Quarterly Journal: Crude Drug Research, 1979, 17, pp.

>139-96.

> 23. A Food Treatment of Diabetes (8) Ch.7, p.112.

>

>

> ADDITIONAL BIBLIOGRAPHY

>

> a.. Kaptchuk, Ted, J., The Web That Has No Weaver,

>Conydon & Weed, 1983

> b.. Jianfei, Chen, A Hemorrheological Study on the

>Effect of Acupuncture in Treating Diabetes Mellitus, Journal of TCM 7(2):

>95-100, 1987 3.

> c.. Li Cheng-Yu, Fundamentals of ,

>East Asian Medical Society, Paradigm Pub. 1985

> d.. Tan, Richard, O.M.D., L.Ac., & Rush, Stephen,

>L.Ac., Twelve and Twelve in Acupuncture, 1991; Twenty-Four More in

>Acupuncture, 1994. Published by R. Tan, San Diego, CA.

> Part Three

>

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