[TCM understanding and classical formula treatment strategies for type 2 diabetes mellitus].

Abstract

Type 2 diabetes mellitus(T2DM) is a major metabolic disease with high prevalence in China, and its multisystem complications involving the heart, brain, kidneys, and eyes pose a serious threat to public health. According to 2023 data from the International Diabetes Federation(IDF), the prevalence of diabetes among Chinese adults has reached 12.4%, with approximately 140 million patients, over 90% of whom have T2DM. Although western hypoglycemic therapies can effectively control blood glucose, they remain limited in improving insulin resistance, regulating constitution, and preventing and treating complications. In TCM, T2DM falls under "spleen heat" and "consumptive thirst", with core pathogenesis characterized by disordered body fluid metabolism and imbalance of Qi, blood, Yin, and Yang, primarily affecting the liver, spleen(stomach), and kidneys. Based on the evolutionary pattern of pathogenesis, this study proposes six syndrome classifications, i.e., Yuke(depression-thirst), Reke(heat-thirst), Shike(dampness-thirst), Tanke(phlegm-thirst), Yuke(stasis-thirst), and Xuke(deficiency-thirst). Yuke(depression-thirst) presents with chest and hypochondriac distension and elevated blood glucose during emotional fluctuations. Reke features the typical "three excesses and one loss" with Yangming exuberant heat. Shike centers on dry mouth without desire to drink, obesity, and greasy tongue coating. Tanke exhibits dizziness, chest oppression, and excessive phlegm on the basis of Shike. Yuke(stasis-thirst) is marked by dark-purplish tongue and fixed pain. Xuke is differentiated according to the degree of Qi, Yin, Yang, or essence deficiency. Classical formulas are applied correspondingly as follows: Dachaihu Decoction for Yuke(depression-thirst), Baihu Jia Renshen Decoction for Reke, Gegen Qinlian Decoction and Wuling Powder for Shike, Banxia Xiexin Decoction for Tanke, Guizhi Fuling Pills for Yuke(stasis-thirst), and Jingui Shenqi Pills, Shengmai Powder, or Zuogui Pills for Xuke, with flexible combinations for comorbid conditions. Following the integrated TCM-western medicine approach of aligning formula with syndrome and combining pathogenesis, pathology, drug properties, and pharmacology, this study emphasizes pathogenesis-centered application of classical formulas integrated with modern pharmacology to construct a "syndrome differentiation-disease differentiation-target differentiation" trinity treatment model, providing a new TCM strategy for precise prevention and treatment of T2DM and its complications, especially in intervening in insulin resistance and regulating intestinal flora.