(1) etiology
1. Physical factors
Congenital deficiency, acquired malnutrition and biased constitution are the important internal causes of diabetes. The Five Changes of Lingshu once pointed out that "those who are weak but not dirty should be good at eliminating malnutrition", and systematically discussed the role of physique in the occurrence and development of diseases. Clinical observation shows that Yangming's stomach-heat constitution, Shaoyin deficiency constitution, Shaoyang deficiency of liver, Jueyin deficiency of liver and Taiyin deficiency of spleen can all cause diseases, especially Yangming's stomach-heat constitution and Shaoyin deficiency of yin.
2. Improper diet
Long-term gluttony of fat and mellow wine, spicy and fragrant, deep-fried barbecue, can lead to endogenous damp heat, phlegm fire, or gastrointestinal heat, injury of yin and production of body fluids, and thirst quenching. As Su Wen's "On Strange Diseases" said: "The beauty of this fat makes people eat sweet fat, and the fat makes people feel hot inside, and the sweet makes people full, so they overflow and turn to quench their thirst."
3. Emotional disorder
Long-term excessive mental stimulation, such as depression and anger hurting the liver, stagnation of liver qi, stagnation of liver fire for a long time, or overexertion and competitiveness. If the yang is too strong, the five meetings will turn into a fire, and the internal combustion will be fiery, burning yin and generating body fluid and quenching thirst. The so-called "Three Cases of Clinical Guidelines" says: "Emotional depression, internal fire spontaneous combustion, and serious illness due to symptoms".
4. Old age, fatigue, physical weakness, or overwork, dark consumption of yin and blood, fornication, and injury to kidney essence, "fire is strong because water is exhausted, and water is strong because fire is dry", all of which can quench thirst.
5. Exogenous pathogens
Exogenous wind and heat attack, or exogenous warm and toxic evil can directly hurt yin and become the basis of quenching thirst. "Five Changes of Lingshu" once said that "all diseases are born in the wind", and Zhu's "Hygiene Jiabao" in the Song Dynasty also pointed out that quenching thirst is "the gas of wind and poison"
Hurt.
6. Medical stone injury
If the medical stone is too dry, it will hurt yin and body fluid, leading to diabetes. It was mentioned in Su Wenbei's Theory.
In fact, ancient "Wushi powder", aphrodisiac and modern steroid hormones can all lead to abnormal increase of blood sugar.
(2) Pathogenesis
Internal heat impairing yin is the basic pathogenesis of diabetes. Internal heat is a "strong fire", which not only hurts yin, but also consumes gas, which can lead to deficiency of both qi and yin, and yin can damage yang, which can lead to deficiency of both yin and yang over time. Yin deficiency leads to exhaustion of body fluid, loss of yang, or transformation of dryness and heat into turbid toxin, which can lead to syncope and vomiting. Long-term illness and blood stasis, blood stasis blocking collaterals, can cause chest pain, stroke dementia, edema, numbness and pain of limbs, blurred vision and other complications.
1. Pathogenesis of Yin Injury Caused by Internal Heat
The pathogenesis of yin injury caused by internal heat originates from Neijing. Liu Jicheng, a famous doctor in Jin and Yuan Dynasties, has made a profound discussion on the pathogenesis of diabetes with yin deficiency and dry heat. Zhang has the same understanding of Confucianism as Hejian. Later, many doctors in Ming and Qing Dynasties said that Ye's Clinical Guide to Medical Records pointed out that the symptoms of diabetes were "yin deficiency as the foundation and dryness and heat as the standard", and Chen Tuduo's Secret Book of Stone Chambers even said: "Although the symptoms of diabetes are divided into upper, middle and lower levels, they are no different from kidney deficiency." Emphasize the importance of kidney yin deficiency. Modern scholars have observed that diabetes is related to spleen, stomach and kidney, and yin deficiency can be manifested as lung yin deficiency, stomach yin deficiency and kidney yin deficiency, among which kidney yin deficiency is the most critical; Internal heat can be manifested as lung heat, stomach heat and kidney deficiency fire, but gastrointestinal heat seems to be more common. Clinically, damp-heat, phlegm-fire and stagnation of heat are also common, which are the basis of diabetes. It should be pointed out that the pathogenesis of internal heat damaging yin is the basic pathogenesis of diabetes, and the pathological mechanism of internal heat damaging yin runs through the whole process of diabetes and its subsequent development. What we emphasize is the pathogenesis of internal heat injuring yin, not the most common syndrome of yin deficiency and internal heat in diabetes.
2. Deficiency of both Qi and Yin
The pathogenesis of deficiency of both qi and yin originates from synopsis of golden chamber, and is based on the viewpoint of "strengthening fire and eating qi" in Neijing. Qianjin Yaofang, Waitai Secret Recipe, Tang and Song Fangshu contain a large number of prescriptions for invigorating qi and nourishing yin. Zhang Xichun, a famous doctor in modern times, created Yu Ye Decoction and Cui Zi Decoction in Medical Heat Record, all of which emphasized the pathogenesis of deficiency of both qi and yin in diabetes. Shi Jinmo, a famous doctor in Beijing, also thinks that strengthening the spleen, tonifying the kidney and nourishing yin should be placed in the same important position, making good use of hypoglycemic drugs such as Astragalus membranaceus, Dioscorea opposita, Radix Scrophulariae and Rhizoma Atractylodis, and attaching importance to the mechanism of deficiency of both qi and yin in diabetes. Modern scholars have found that deficiency of both qi and yin is the most common clinical syndrome of diabetes, which can be manifested as deficiency of both qi and yin in heart and kidney, lung and kidney, liver and kidney, spleen and kidney or multiple organs, which is the result of internal heat due to yin deficiency in diabetes. Yin and yang are mutually rooted, and yin damages yang, which can become a syndrome of yin and yang deficiency for a long time. Deficiency of healthy qi is easy to be invaded by external evils, which leads to exogenous wind-heat or lingering damp-heat, or endogenous heat toxicity, which can lead to asthma, tuberculosis, stranguria, tinea, furuncle, carbuncle and so on. Excessive yin injury, qi escaping with body fluid, yin failing and yang failing, or dryness and heat turning into turbid toxin, which blocks the ascending and descending of qi-flow, can lead to syncope, vomiting and anti-acute syndrome.
3. Pathogenesis of blood stasis block
The pathogenesis of blood stasis comes from Neijing. Modern Tang Rongchuan's Theory of Blood Syndrome also discusses the theory of blood stasis and fluid production. Professor Zhu Chenyu, a contemporary scholar, has a deeper understanding of the pathogenesis of blood stasis in diabetes. His compatibility of Radix Puerariae and Radix Salviae Miltiorrhizae and his prescription for lowering blood sugar and promoting blood circulation are known as medical forests. In recent years, many scholars used modern scientific means, combined with hemorheology, nail fold microcirculation and platelet function measurement, to deeply study the pathogenesis of blood stasis in diabetes mellitus, and found that blood stasis in diabetes mellitus was related to patients' high viscosity, high aggregation, high coagulation and microcirculation disorder. The formation of blood stasis is often related to qi deficiency and blood deficiency, yang deficiency and cold coagulation, yin deficiency and fluid exhaustion, phlegm-dampness, phlegm-fire, damp-heat blocking qi and blood, qi stagnation and blood stasis, and long-term illness entering the collaterals. The pathogenesis of blood stasis, especially collateral stasis, can be said to be the basis of the formation of various vascular and neurological complications of diabetes. Professor Lu Renhe believes that the microvascular complications of diabetes mellitus are the result of long-term treatment of diabetes mellitus and the disease entering the collaterals. On the basis of deficiency of both qi and yin or deficiency of both yin and yang, internal heat, phlegm-dampness, qi stagnation and blood stasis are mutually cemented, forming a "miniature syndrome". Collaterals are distributed all over the body, with internal collaterals connecting the five zang-organs and six fu-organs, and external collaterals connecting the limbs, so complications can occur in multiple organs and parts of the whole body.
4. Pathogenesis of spleen deficiency
Diabetes has spleen deficiency syndrome. Zhang Jiegu, a famous doctor in Jin and Yuan Dynasties, once said that Dai Sigong and Yu, doctors in Ming and Qing Dynasties, all belonged to it, but it was never universally recognized by the ancient medical community. Zhang Xichun, a modern physician, re-expounded that "there is a syndrome of quenching thirst, and there are upper, middle and lower points in ancient times, all of which started from the middle jiao and reached the upper and lower points". Contemporary scholars put spleen deficiency at the key position in the pathogenesis of diabetes mellitus. They think that spleen deficiency and body fluid cannot be normally distributed, and they are used to quench thirst. For example, Professor Xiong Manqi and Professor Chen Jing attach great importance to the pathogenesis of spleen deficiency in diabetes mellitus. "Eliminating spleen deficiency" has become the theoretical basis of "treating diabetes from spleen".
5. Pathogenesis of liver depression and qi stagnation
The pathogenesis of diabetic liver depression and qi stagnation can also be considered as originating from Neijing. The so-called saying that "the rigid person is angry, and anger leads to the upward movement of qi, so it is to eliminate miliaria" suggests that the occurrence of miliaria is related to emotional fluctuations, and the liver controls emotions, so the occurrence of diabetes is closely related to Jueyin liver meridian. "synopsis of the golden chamber" begins with a clear meaning: "Jue yin is a disease, quenching thirst, qi hits the heart directly, and heartache is hot." Later generations, such as Huang, Huang, Huang and Huang, gave full play to this point and systematically discussed it. Li Liang, a contemporary physician, clearly put forward that diabetes should be treated from the liver, and thought that emotional depression and liver depression turning fire into yin played an important role in the occurrence and development of diabetes.
To sum up, although there are differences in the understanding of the etiology and pathogenesis of diabetes between ancient and modern doctors, they all come from practice and are influenced by classic works such as Neijing and synopsis of golden chamber, which reflect the pathogenesis evolution of diabetes from different aspects. It is not comprehensive to simply regard diabetes as "yin deficiency and dryness-heat", "deficiency of both qi and yin", "spleen deficiency" and "liver depression". A large number of clinical syndrome studies have found that the occurrence of diabetes is closely related to environmental factors such as physical factors, emotional internal injuries, emotional tension, dietary factors, medicinal stone injuries, exogenous pathogens, etc. All kinds of environmental factors, whether it is heat depression, damp heat, phlegm fire, accumulated heat, dry heat, wind heat, can hurt yin and produce the syndrome of "yin deficiency and internal heat"; Internal heat can damage yin and even consume qi, resulting in deficiency of both qi and yin and accumulation of heat. Deficiency of both qi and yin, lack of positive energy is easily influenced by pathogenic factors, or endogenous toxic factors, which can be combined with furuncle, tinea, asthma, tuberculosis and stranguria; Yin deficiency and dryness-heat, dryness-heat transforming turbid toxin, yin exhausting body fluid and qi exhausting yang can lead to nausea, unconsciousness and syncope. Deficiency of both qi and yin, deficiency of qi and handsome blood, exhaustion of body fluids due to yin deficiency, deficiency of both yin and yang, and poor circulation of qi and blood can all lead to blood stasis, heat depression, qi stagnation and phlegm-dampness, which can also lead to blood stasis, so blood stasis syndrome is more common. Long-term illness entering collaterals, phlegm-heat stagnation, blood stasis, and the formation of "micro-clusters" in collaterals will lead to various diseases, or chest pain, or stroke paralysis, or edema, or cataract blindness.