Diabetes and Chinese Medicine
By: Elizabeth H. Trattner, A.P., D.O.M.
This article is designed to help readers, especially diabetics, understand how diabetes is uniquely classified in Traditional Chinese Medicine and the role Chinese Medicine and its sub-braches of acupuncture and tai chi, can play as an ancillary treatment for diabetic patients.
Traditional Chinese medicine is a whole system of medicine that originated in China over 2,000 years ago for the treatment of disease and pain. This system can also be traced back to other countries such as Japan, Tibet and Korea. It is important for readers to understand the philosophy and theories of Chinese Medicine and the different types of modalities that make up the system of Traditional Chinese Medicine. Later in the article we will discuss acupuncture and tai chi and how it relates and can possibly assist with the management of diabetes.
The Yellow Emperor’s Classic Text of Internal Medicine is one of the earliest books of Traditional Chinese Medicine, laying out the theories of TCM (Traditional Chinese Medicine). These theories are Yin/Yang, Qi (pronounced Chee), Spirit, Blood, the Five Elements, the meridian pathways, etiology of disease, pathology, diagnosis, and acupuncture points. It is unknown how, in such early times, practitioners of this medicine were able to figure out this complex system, but there is hard empirical evidence that TCM works. In fact, the NIH grants a tremendous amount of money to research of many sub-branches.
For basic purposes there are 12 main meridians in the body that correspond to an organ system in the body. The meridians are located between the skin and muscles. There are 6 yin meridians and 6 yang meridians. These are symmetrical as well. Although there are over 2,000 acupuncture points on the body there is about 360 regular points commonly used. There have been studies that demonstrate that distal points can stimulate activity in the brain. This study used both sham points and points corresponding to ocular points, both located on the feet. While the sham points showed no activity in ocular center in an MRI, the points corresponding to the eye on the foot showed activity in the ocular centers of the brain.1 Neurosci Lett. 2009 Jul 10;458(1):6-10. doi: 10.1016/j.neulet.2009.04.027. Epub 2009 Apr 15. Comparison of visual cortical activations induced by electro-acupuncture at vision and nonvision-related acupoints. Zhang Y1, Liang J, Qin W, Liu P, von Deneen KM, Chen P, Bai L, Tian J, Liu Y.
Diagnosis is made by taking the pulse, looking at the tongue and a detailed history of the patient. Tongue and pulse diagnosis are very important tools in assessing a patient along with a detailed health history and keen observation of the patient such as looking at qualities of the skin, eyes and hair. Pulses are taken on both sides of the body and in three positions. These positions correspond to organ systems within the body and also have specific qualities that help describe what is happening internally with a patient. Tongue diagnosis is another diagnostic tool that reflects the interior landscape of the body. Different parts of the tongue correspond to various areas in the body. Tongue diagnosis is especially important when diagnosing and treating patients with diabetes as it reflects the digestive process in the body. TCM practitioners can make astute observations regarding digestion and moreover creating a treatment plan that includes acupuncture, herbs and dietary recommendations that can easily be woven into a diabetic’s current dietary program to control blood sugar.
Traditional Chinese Medicine is a whole system that encompasses different modalities of treatment, including acupuncture, moxibustion, herbal medicine, body therapies including tai chi and chi gong, and dietary therapy. Although the exact number of people who use TCM in the United States is unknown, it was estimated in 1997 that some 10,000 practitioners served more than 1 million patients each year. According to the 2007 National Health Interview Survey (NHIS), which included a comprehensive survey on the use of complementary health approaches by Americans, an estimated 3.1 million U.S. adults had used acupuncture in the previous year. The number of visits to acupuncturists tripled between 1997 and 2007. According to the 2007 NHIS, about 2.3 million Americans practiced tai chi and 600,000 practiced qi gong in the previous year. (http://nccam.nih.gov/health/whatiscam/chinesemed.htm)
Acupuncture is one of the facets of Traditional Chinese Medicine. It is performed by inserting very fine, disposable, sterile needles into the skin in specific energetic points. Acupuncture is used to reinforce, reduce or harmonize Chi energy in the body by applying various needles in specific places in the body with the goal of restoring balance to the body. Acupuncture treats many different conditions however the most treated condition is pain. The NIH is currently funding more than 40 clinical trials that involve acupuncture and focus on a variety of medical conditions including diabetes. (http://search.nih.gov/search?affiliate=nih&query=%2Bacupucture) (http://nccam.nih.gov/health/whatiscam/chinesemed.htm) Acupuncture is safe when performed by a qualified practitioner.
Tai chi is a graceful, dance like form of body movement therapy that coordinates a flow of body movements that focus on the cultivation of energy in the body. An ancient form of exercise, Tai chi also helps balance the body, mind and spirit as well to promote the well-being when practiced. Today in China you can find many people young and old practicing tai chi in parks and outdoor spaces just like they did thousands of years ago. Tai chi isn’t just a form of body movement therapy, but a system for health. It has been compared to yoga as it increases strength, flexibility and range of motion. It also helps with balance and coordination. Tai chi is considered a safe practice by the NIH. (http://nccam.nih.gov/health/whatiscam/chinesemed.htm). In 2011 a study was done that demonstrated the efficacy in mind body modalities including Tai chi and the management of metabolic syndrome. (J Nutr Metab. 2011;2011:276419. doi: 10.1155/2011/276419. Epub 2011 May 18. The metabolic syndrome and mind-body therapies: a systematic review. Anderson JG1, Taylor AG.)
Traditional Chinese Medicine and Diabetes
Diabetes has been reference in Chinese Literature for over 2,000 years. In the Yellow Emperor’s Classic of Medicine, Diabetes was known as xiao ke and has been translated to diabetes or diabetic exhaustion, or thirst and wasting disorder. (Maoshing Ni, The Yellow Emperor’s Classic of Medicine: A New Translation of the Neijing Suwen with Commentary, 1995 Shambhala, Boston, MA.) According to this ancient text this disease arises from eating too much sweet, fatty and rich food that we see traditionally with metabolic syndrome or type 2 diabetes. This disease was associated with wealthy people. Xiao-ke is also attributed emotional disturbances (stress, anxiety, depression,) and a constitutional Yin deficiency (fatigue, weakness, lethargy, pale complexion). (Choate C: http://www.acupuncture.com/Acup/Diabetes2.htm (accessed March 2001)
“Diabetes mellitus from Western and TCM perspectives.”
A yin deficiency is the absence or deficiency of the cooling mechanism in the body. With diabetics this presents as thirst. The two organ systems correlated with a yin deficiency in diabetes are the kidney and lung. When patients experience too much heat they become thirsty and there body becomes wasted or depleted. Diabetes in TCM is divided into three categories. Upper, middle and lower xiao ke. These three categories correspond to the lungs which have excess thirst, the stomach which has excess hunger and lastly the kidneys that have excess urination. All of these three patterns correlate to a yin deficiency. Most diabetics display all three types of xiao ke during the course of their disease.
Traditional Chinese medicine is a whole system that approaches diabetes in a manner westerners are not accustomed to. Instead of monitoring blood sugar, HA1C and other blood biomarkers, TCM treats the patients as a whole and treats not only symptoms, but the underlying cause as well. It can address issues of sleep, fatigue and even neuropathy in the same treatment. Good practitioners not only administer acupuncture, but provide other lifestyle recommendations as well as herbal preparations.
Lifestyle modification is one area that has a great impact in diabetics’ lives. Chinese dietary therapy addresses the issue of increasing yin which is often depleted in diabetics by specific food choices. Interestingly enough these foods are low glycemic and generally have a low glycemic load such as vegetables, berries and soy products. Other lifestyle modifications are movement therapy such as Tai chi and Chi gong for management of the disease. Like any exercise program we know that this helps with the management of blood sugar, however Tai chi and Chi gong are movement therapies like yoga that focus on the whole system.
There are numerous studies documenting the benefits of many herbal formulas for the treatment of diabetes demonstrating reduced blood sugar, side effects and secondary complications such as peripheral neuropathy. (http://nccam.nih.gov/health/whatiscam/chinesemed.htm) While acupuncture has been used for thousands of years to treat the symptoms of diabetes or xioa ke, clinical trials for acupuncture in China began just over twenty years ago, prior to acupuncture needles being classified as safe class two medical devices. After 1996 acupuncture needles went from experimental class three devices to class two by the Food and Drug Administration. (http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=880.5580).
Most of the studies that have been conducted for diabetes have focused on Type 2 diabetes or the symptoms of peripheral neuropathy, as a complication of diabetes. Many studies have been conducted by the use of electro-acupuncture, a modality of acupuncture that uses a specific level electro frequency in HZ. One specific study in China showed that electro acupuncture on specific points can reduce HbA1c and 2 h PBG levels patients, suggesting a helpful effect in controlling the development of diabetes. (Zhen Ci Yan Jiu. 2011 Jun;36(3):220-3. Chinese) [Effects of different frequencies of electro-acupuncture on blood glucose level in impaired glucose tolerance patients]. Meng H1, Hao JD, Wang HC, Zhao JY, Zhao CL, Zhai X.)
One study has shown some promise that acupuncture can improve negative mental state, glucose metabolism and blood glucose in type 2 diabetes patients. Two groups of 50 people were given Diaformin , and one group received acupuncture as well. After treatment, the mood disorder improved in the two groups, with the observation group being better than the control group (P < 0.05).(Zhongguo Zhen Jiu. 2007 Oct;27(10):741-3. [Effects of acupuncture on mood and glucose metabolism in the patient of type 2 diabetes]. [Article in Chinese] Shen PF1, Kong L.).
Early this year another study in China showed a correlation that acupuncture therapy is effective in lowering serum leptin, which may contribute to its clinical effect in improving type two diabetes. (Zhen Ci Yan Jiu. 2011 Aug;36(4):288-91. [Effect of acupuncture on serum leptin level in patients with type II diabetes mellitus]. [Article in Chinese]Cai H1, Zhao LJ, Zhao ZM, Guo JH, Yuan AH.)
Although there are very promising studies that have been done on diabetes for many years, these studies have been small. The most conclusive data is for pain especially neuropathic pain associated with diabetes. This is no surprise as the National Institute for Health concludes that acupuncture has the most positive clinical outcomes for pain. (http://nccam.nih.gov/health/whatiscam/chinesemed.htm)
Tai chi is an ancient Chinese movement therapy practiced as a graceful, dance like form of exercise. It involves a series of movements performed in a slow, focused manner. This mind body therapy involves deep breathing as well and is designed not only as a form of exercise, but also helps reduce stress. This martial art is gently practiced by young and old alike and has significant benefits for balance, flexibility, strength and endurance. There are studies that have demonstrated this especially amongst the elderly population. (Tai chi, Altern Ther Health Med. 2006 Mar-Apr; 12(2):50-8.) Improvement in balance, strength, and flexibility after 12 weeks of Tai chi exercise in ethnic Chinese adults with cardiovascular disease risk factors.
Studies have been shown to help with balance and plantar sensory ability as well in the elderly with diabetes (Diabetes Technol Ther. 2007 Jun;9(3):276-86. Does Tai Chi improve plantar sensory ability? A pilot study. (Richerson S1, Rosendale K. Taylor-Piliae RE1, Haskell WL, Stotts NA, Froelicher ES).
Tai chi invovles many different styles and poses like yoga has and is noncompetitive. Tai chi studies have demonstrated that it improves quality of life, and reduces inflammation. (Sleep. 2014 Sep 1;37(9):1543-52. doi: 10.5665/sleep.4008). Cognitive Behavioral Therapy vs. Tai Chi for Late Life Insomnia and Inflammatory Risk: A Randomized Controlled Comparative Efficacy Trial. (Irwin MR, Olmstead R, Carrillo C, Sadeghi N, Breen EC, Witarama T, Yokomizo M, Lavretsky H, Carroll JE, Motivala SJ,Bootzin R, Nicassio P.)
There have been some small studies that suggest Tai chi may help patients with diabetes but larger meta-analysis and double blind studies claim that tai chi lacks evidence to support the benefits. However, Tai chi was shown to dramatically improve triglycerides in patients with Type 2 diabetes. Further large-scale studies are needed to investigate the long-term efficacy of Tai chi. (Exp Clin Endocrinol Diabetes. 2013 May;121(5):266-71. doi: 10.1055/s-0033-1334932. Epub 2013 Feb 28.) Lack of evidence on Tai Chi-related effects in patients with type 2 diabetes mellitus: a meta-analysis. Yan JH1, Gu WJ, Pan L.) Although Tai chi is beneficial on reducing inflammation and improving lifestyle it still needs more testing to see if it can help diabetics reduce blood sugar. Tai chi can still help with balance and sensory issues in diabetic patients and improve quality of life.
Traditional Chinese Medicine is a rich medical system offering many modalities of healing. All of these modalities have demonstrated efficacy in many areas of health and well-being. For patients with type two diabetes, TCM has much to offer for lifestyle and pain management. Acupuncture is promising for assisting in reducing blood sugar and pain management for peripheral neuropathy associated with type two diabetes. Chinese dietary therapy also can enhance a low sugar diet by building depleted yin associated with diabetes and enhance the effects of eating a diabetic meal. Chinese herbal medicine has many documented studies for not only reducing blood sugar, but assisting with secondary issues such as peripheral neuropathy. Movement therapy also shows promise despite the lack of sufficient data directly on blood sugar. Tai chi assists in helping patients have better quality of life overall; improving balance in elderly diabetics means reducing the risk of falls. It is important for diabetic patients to seek out a qualified practitioner of Traditional Chinese Medicine preferably with more than five years of practice. Never stop taking your diabetic medication and make sure your primary care provider or endocrinologist communicates with your practitioner of Chinese medicine for more effective and managed treatment of your disease. Chinese medicine is an excellent adjunctive treatment in the management of diabetes.