TCM Acupuncture and Massage

Chapter 54 Endocrine and Metabolic Diseases (1)
Diabetes mellitus

An overview of the disease

([-]) Relevant knowledge

Diabetes mellitus (abbreviated as DM in English, meaning sweet polyuria) is a common chronic metabolic disease characterized by persistent high blood sugar as its basic biochemical feature.It is customary to call it "three excesses and one deficiency", accompanied by fatigue, weakness, and lack of energy. If ideal treatment is not obtained, chronic diseases and various infections of the cardiovascular and cerebrovascular systems, kidneys, retina, and nervous system are likely to occur, and serious Ketoacidosis can occur, and even lead to disability or death.Diabetes is called diabetes in traditional Chinese medicine, and it is believed that the onset of diabetes is most closely related to the "lung", "stomach" and "kidney". Its main pathogenesis is kidney yin deficiency and lung and stomach dryness. Excessive drinking, overeating sweets and fats, and unrestrained life.According to the severity of its "three excesses" symptoms, traditional Chinese medicine divides it into "three eliminations", that is, excessive drinking is the upper elimination, excessive eating is the middle elimination, and polyuria is the lower elimination.Diabetes is a common disease. With the improvement of living standards, the incidence of diabetes is increasing year by year.The prevalence of diabetes in developed countries has reached 5% to 10%, and the prevalence in my country has reached 3%.The disease is more common in middle-aged and elderly people, and the prevalence rate increases with age. It rises obviously after the age of 45 and reaches a peak at the age of 60.In terms of gender, the proportion of men and women is equal.In terms of occupation, cadres, intellectuals, retired workers and housewives are higher, and farmers are the lowest; mental workers are higher than manual workers, cities are higher than rural ones, and the prevalence rate of obese people is three times that of normal weight people.In terms of ethnicity, the Hui nationality is the highest, followed by the Han nationality.The vast majority of diabetes in my country is type Ⅱ.

([-]) Etiology and pathogenesis

The etiology and pathogenesis of diabetes are very complex and have not been fully elucidated yet, mainly related to the following factors.

1. Genetic factors Diabetes is a genetic disease.Genetic studies have shown that the incidence of diabetes is significantly different between blood relatives and non-blood relatives, and the former is 5 times higher than the latter.

2. Mental factors Mental stress, emotional agitation and various stress states will cause a large amount of blood sugar-raising hormones to be secreted, such as growth hormone, norepinephrine, glucagon and adrenal cortex hormones.

3. Obesity factors At present, obesity is considered to be an important cause of diabetes.About 60% to 80% of adult diabetic patients were obese before the onset of the disease, and the degree of obesity is directly proportional to the incidence of diabetes, especially in the elderly who are obese and fat.

4. Long-term overeating, eating too much without restraint, and overnutrition will overburden the insulin β cells that have potential low function, and induce diabetes.Therefore, there is a saying that "the richer the life, the fuller the body, the more diabetes will increase".

5. Infection Infection itself will not induce diabetes, it can only make invisible diabetes manifest.

6. Pregnancy-related experts have found that the number of pregnancies is related to the onset of diabetes, and multiple pregnancies can induce diabetes.

7. Genetic factors Regardless of the type of diabetes, whether it is caused by genetic susceptibility, environmental factors, or viral infection, it is ultimately caused by genetic damage.In other words, diabetes is a genetic disease.

([-]) Clinical manifestations and classification
Typical symptoms are "three excesses and one deficiency": polyuria, polydipsia, polyphagia, and weight loss.In addition to three more and one less, the following situations should be checked and diagnosed in time.

1. Symptoms such as palpitation, fatigue, sweating, dizziness, and hunger often occur 2 to 3 hours after a meal or before lunch and dinner.

2. Skin purulent infection often occurs.

3. Women of childbearing age have multiple miscarriages, fetal malformation, polyhydramnios and other medical history.

4. Women with recurrent urinary system infection and frequent genital itching.

5. Men with impotence.

6. Unexplained heaviness, numbness, calf pain or cramps in the extremities.

7. Sudden loss of vision for unknown reasons.

8. The elderly have unexplained coma, high blood pressure, coronary heart disease, etc.

9. Unexplained necrosis of extremities.

10. Premature arteriosclerosis and hypertension.

11. Physical weakness, emaciation, unexplained growth retardation, etc.

According to different causes and clinical manifestations, diabetes is divided into four types: insulin-dependent (type I), non-insulin-dependent (type II), malnutrition-related, and secondary. The former two types are the most common, as follows:

Insulin-dependent diabetes mellitus (type Ⅰ diabetes mellitus): the most frequent onset is under the age of 30, but it can also occur in adults or even old people. This type of patients has a late onset and severe condition, prone to ketoacidosis and coma in severe cases.After some patients are treated with insulin, the function of pancreatic β-cells has been improved to varying degrees.Individual patients can even be treated without insulin for a period of time.

Non-insulin-dependent diabetes mellitus (ie, type 90 diabetes): it occurs more frequently in adults or the elderly.The onset of the disease is slow, the condition is mild, and the body is mostly obese. The plasma insulin level can be slightly low, normal or high. The incidence of type Ⅱ diabetes is very high, accounting for about [-]% of the number of diabetic patients.

([-]) Diagnosis

The diagnosis of diabetes is based on blood sugar and clinical symptoms. The World Health Organization formulated the diagnostic criteria for diabetes in 1985, which are still in use now. The details are as follows:
One of the following can be diagnosed as diabetes:

1. With typical symptoms of diabetes, blood sugar higher than 11.1 mmol/L (200 mg/dL) at any time.

2. When checking fasting blood sugar, it was higher than 7.8 mmol/L (140 mg/dL) twice or more.

3. If the fasting blood sugar does not exceed 7.8 mmol/L, if you suspect diabetes, you can do an oral glucose tolerance test, and the blood sugar exceeds 2 mmol/L 11.1 hours after taking the sugar.If there are no symptoms of diabetes, another blood sugar exceeding 11.1 mmol/L is required.The above blood glucose values ​​are venous plasma glucose concentrations.

([-]) The hazards and complications of diabetes

The incidence of diabetes in the world is increasing year by year, and it has been listed as the third largest disease after cardiovascular diseases and tumors in developed countries.There are more than 80 acute and chronic complications caused by diabetes in the heart, brain, liver, lung, kidney, eyes, limbs, skin, and nerves.Common chronic complications that cause great physical and mental pain to patients mainly include the following:

1. Diabetic cardiovascular and cerebrovascular disease refers to diabetic patients with concurrent or concomitant coronary atherosclerotic heart disease, diabetic cardiomyopathy, as well as cardiac rhythm and cardiac dysfunction caused by microvascular disease and autonomic dysfunction.

2. Diabetic nephropathy is a very serious disease for diabetic patients.Lesions can involve renal vessels, glomeruli, tubules, and interstitium.Common kidney damage is diabetic glomerulosclerosis, arteriolar nephrosclerosis, pyelonephritis, renal papillary necrosis, and urinary protein.Among them, diabetic glomerulosclerosis is a unique renal complication of diabetes.Diabetic nephropathy is an important cause of death in diabetic patients.

3. Diabetic eye disease There are 7 common eye diseases complicated by diabetes, diabetic retinopathy, diabetic uveopathy, diabetic cataract, diabetic optic nerve changes, diabetic retinal lipemia, diabetic glaucoma, diabetic Sexual refractive changes.The most common of these is diabetic retinopathy, an important cause of diabetic blindness, followed by diabetic cataract.

4. Diabetic neuropathy is a general term for various diseases of the nervous system caused by diabetes.It covers both the central and peripheral nervous systems, with diabetic peripheral neuropathy being the most common.Lesions can be unilateral, bilateral, symmetrical, or asymmetrical.The prominent manifestations are numbness and distending pain in both lower limbs, accompanied by acupuncture-like and burning-like abnormal sensations, which are unbearable.Some patients may have spontaneous lightning-like pain or knife-like pain.

5. Diabetic sexual dysfunction Most diabetic patients have sexual dysfunction such as impotence, premature ejaculation, low libido, and menstrual disorders, which can appear at the same time as diabetes symptoms, but most of them appear after diabetes symptoms.Medicine believes that the impact of diabetes on sexual function may be related to vascular disease and pelvic autonomic neuropathy.

6. Diabetic gangrenous lesions of the lower extremities are due to long-term uncontrolled diabetes, arteriosclerosis, and pathological changes in the large vessels and microvessels of the lower extremities, resulting in gangrene.Its mechanism of occurrence is: when arteriosclerosis occurs in the lower limbs of diabetic patients, the vascular endothelial cells are damaged, and the aggregation function of red blood cells and platelets in the blood is enhanced, which makes the blood hypercoagulable, promotes thrombus formation, causes luminal stenosis and vascular obstruction, Cause lower extremity or central ischemia, hypoxia so that gangrene occurs.

In short, diabetes and its chronic complications are very serious hazards to human health, and have attracted great attention from the medical community all over the world.

([-]) Treatment

Since the etiology of primary diabetes has not been fully elucidated so far, there is no radical cure for diabetes.Many treatments can only effectively control the disease, so the so-called panacea that can cure diabetes is not credible.Even if some patients undergo appropriate treatment, their clinical symptoms disappear, their blood sugar and urine sugar return to normal, and they participate in work and labor like normal people. If they do a glucose tolerance test, they are still abnormal and show a diabetic curve.If you do not pay attention to recuperation at this time, do not control your diet or treat according to the doctor's requirements, high blood sugar and urine sugar will also appear.Therefore, it can be said that diabetes is a lifelong disease, and it needs long-term adherence to treatment. Even if the condition is ideally controlled, it is necessary to adhere to diet therapy and go to the hospital for regular checkups.

Comprehensive treatment measures should be taken for diabetes. The current treatment methods for diabetes mainly include: ① diabetes education; ② diet therapy; ③ exercise therapy;Due to the different conditions, living environment, and age of each diabetic patient, the treatment plan is also different, but no matter what type of diabetes, regardless of the severity of the disease, diet therapy must be carried out.

Insulin-dependent diabetes should be mainly treated with insulin, combined with diet therapy and psychological adjustment.Those with mild non-insulin-dependent diabetes mellitus should focus on diet therapy and exercise (those with severe comorbidities should limit their activities).Especially non-insulin-dependent obese people should focus on exercise therapy and diet therapy. Appropriate exercise can enhance the physical fitness of diabetic patients, eliminate the tension in the cerebral cortex, improve the sensitivity of target cells to insulin, and make insulin and oral hypoglycemic drugs The dosage is reduced, and it has the effects of losing weight, lowering blood sugar and blood fat, and has a certain effect on preventing or delaying various complications.Non-insulin-dependent diabetes mellitus can be treated with oral hypoglycemic drugs and Chinese herbal medicine or acupuncture if the blood sugar control is not satisfactory under diet therapy and exercise therapy. Insulin therapy or the combination of insulin and oral hypoglycemic drugs.Gestational diabetes should be treated with insulin combined with diet, and elderly diabetes should be treated with diet therapy, exercise therapy, oral hypoglycemic drugs (choose second-generation sulfonylureas), or comprehensive treatment with Chinese herbal medicine and qigong therapy.Integrative traditional Chinese and Western medicine should be used for chronic diseases of diabetes.

Diabetic patients should not worry and be pessimistic and disappointed because diabetes cannot be cured at present. They should establish confidence and determination to overcome the disease, and correctly understand diabetes, because diabetes itself is not terrible, nor is it an incurable disease. What is terrible is life-threatening complications. .Therefore, as long as diabetics insist on long-term treatment, cooperate closely with doctors, and control diabetes stably for a long time, the occurrence and development of diabetic complications can be prevented or delayed.

([-]) Prevention and recuperation
Diabetes is a lifelong disease, and there is no cure for it, so prevention and care are particularly important.details as follows:
1. Control diet The key to treating diabetes is to control diet.Through diet control, it can promote the disappearance of urine sugar, reduce fasting blood sugar to normal, correct metabolic disorders, and prevent various complications.

2. Combination of work and rest. Generally, patients can participate in normal work, but they should not be overworked, and they should be restrained in sexual intercourse.Stay mentally optimistic and avoid trauma.

Exercise can enhance tolerance to sugar and reduce dependence on insulin, reduce insulin requirements, lower blood sugar, and improve abnormal blood lipid metabolism.Appropriate exercise can control obesity. Choose jogging, walking, practicing [-] methods, aerobics, Tai Chi and other items. Start with a short period of time and a small amount of exercise, and persevere.However, people with severe diabetes should not exercise on an empty stomach to prevent hypoglycemic shock and other diseases.

3. Blood sugar self-test Diabetics should be equipped with a blood sugar self-test at home to monitor blood sugar at any time.

4. Prenatal and postnatal care According to statistics, about 25-30% of diabetics have a family history.Young men and women with a family history of diabetes should avoid marrying each other.The incidence of congenital abnormalities in fetuses of diabetic women is three times that of fetuses of normal women.Multiple pregnancies can induce diabetes.Female patients can only conceive and give birth after their condition has been basically controlled.

[-]. Point massage

([-]) Acupuncture therapy

1. Take acupuncture points
(1) Feishu, Yuji, Lianquan, Hegu, Ganshu, and Tianshu were eliminated from the top.

(2) Quchi, Neiguan, Zusanli, Pishu, Yishu, Zhongwan, and Qihai are eliminated in the middle.

(3) Shenshu, Fuliu, Taixi, Sanyinjiao, Taichong, and Yongquan are eliminated.

2. Positioning
Feishu—below the spinous process of the third thoracic vertebra, 1.5 cun laterally.

Thenar—the midpoint of the radial side of the first metacarpal bone, at the junction of the red and white flesh.

Lianquan—tilt the head slightly, above the Adam's apple, at the midpoint of the upper edge of the hyoid body.

Hegu—radial border of the midpoint of the second metacarpal bone.

Ganshu—below the spinous process of the ninth thoracic vertebra, 1.5 cun laterally.

Tianshu—2 cun lateral to the middle of the navel.

Quchi—the elbow, at the midpoint of the line connecting the lateral end of the cubital crease and the lateral epicondyle of the humerus.

Neiguan—2 cun above the transverse crease of the wrist, between the flexor carpi radialis tendon and the palmaris longus tendon.

Zusanli - 3 inches below the calf's nose, one transverse finger (middle finger) outside the anterior crest of the tibia.

Pishu—Below the spinous process of No.11 thoracic vertebrae, 1.5 cun laterally.

Yishu—below the spinous process of the eighth thoracic vertebra, 1.5 cun laterally.

Zhongwan—4 cun straight above the middle of the navel.

Sea of ​​Qi—1.5 inches straight down from the middle of the navel.

Shenshu—below the spinous process of the second lumbar vertebra, 1.5 cun laterally.

Fu Liu - Taixi straight up 2 inches.

Taixi—the depression at the midpoint of the line connecting the highest point of the medial malleolus and the Achilles tendon.

Sanyinjiao—3 cun above the tip of the medial malleolus, on the posterior border of the tibia.

Taichong—in the depression before the junction of the first and second metatarsal bones.

涌泉—当第2、3趾趾缝纹头端与足跟连线的前1/3与后2/3交点上。卷足时足前部凹陷处。

([-]) Self-massage
1. Knead Yishu and take the prone position. Others rub the Yishu point with the thumb for 5 minutes.

2. Knead the Ganshu, take the prone position, make a fist, and use the middle finger to knead the Ganshu and Shenshu for 2 minutes each.

3. Take the prone position for chiropractic, pinch the skin on both sides of the spine until Dazhui point, repeat the operation 27 times.

4. Point and knead Zhongwan, Tianshu, and Qihai Take the supine position, and use the middle finger to rub Zhongwan, Tianshu, and Qihai for 2 minutes each.

5. Press Taichong and Yongquan to take the seat, and use your thumb to press on Taichong acupoint on both sides for 2 minutes; then use the thenar muscle of your palm to rotate and press Yongquan for about 1 minute.

Obesity

An overview of the disease

([-]) Relevant knowledge

1. What is obesity? Obesity means that the intake of calories in the human body is greater than the consumption, resulting in excessive calories stored in the body in the form of fat, making the body weight more than 20% of the standard body weight.

2. Commonly used standard weight (Kg)

（1）国际常用标准体重（Kg）身高（cm）－100（身高在165cm 以下）身高（cm）－110（身高在165cm 以上）

(2) Commonly used domestic standard weight (Kg) [height (cm) -100] × 0.9
(End of this chapter)