For a long time, yin deficiency and heat has been considered as the basic pathogenesis of diabetes, and has been guiding and influencing the clinical practice of past doctors. With the changes of the times and lifestyle changes, the prevalence of obesity type 2 diabetes (T2DM) in China has increased significantly. The epidemiological study from 2007 to 2008 found that the proportion of overweight in T2DM patients in China exceeds 40%, and the proportion of obesity About 25%, this ratio is still rising. Clinical practice has found that the symptoms of "three more and one less" based on clinical syndrome are not obvious. Therefore, the traditional theory of yin deficiency and heat cannot adapt to the syndrome differentiation and treatment of obese T2DM patients, thus restricting the improvement of clinical efficacy. In recent years, the author has obtained some experience and experience from the treatment of obesity T2DM in the liver and spleen theory, as described below.

1.                  Etiology and Pathogenesis

Chinese medicine on the etiology of obesity T2DM, the responsibility is congenital endowment, eating disorders, emotional uneasiness, old and physical, sedentary and less moving.

1.1.              Congenital endowment: "Shishi secret record · fat treatment law" cloud: "Fat people are more sturdy, but qi is also imaginary, imaginary gas cannot run, so it is born." Fat people are more damp, more qi. Qi deficiency promotes weakness, then the water is not wet, the blood is stagnant, and it is easier to phlegm, dampness, and phlegm, leading to obesity. The key cause of phlegm physique is responsible for the lack of congenital endowment or the loss of the day after tomorrow. "Medical Reality" says: "The prosperity of Su Shi is due to innateness. It is a great success in the prime, and there is no shortage of wetness." This is in line with the genetic predisposition of this disease pointed out by modern medicine. Consistently, people with obesity in the family have a significantly higher risk of their close relatives, and the phlegm-dampness is the main constitution type of obese people [1].

1.2.              Diet is not the same: "Su Wen · Tong Ping Xuan Shi" on the: "disappearing fat and fat is the disease of the cream." It is pointed out that obesity is one of the main factors in the formation of diabetes, and diet is not good, addicted to fat Flavor is the main factor in the formation of obese T2DM. "Su Wen and Odd Diseases" also pointed out that fat people have eaten "paste", and "Zhong Man" and "internal heat" have become a thirst. "Jing Yue Quan Shu" also said: "Thies who are thirsty, they are the end of the disease, all of which are succulent and fat, and the food and drink are overworked. They are all fat and ill." Overeating, or long-term diet, on the one hand can cause the water valley to accumulate in the human body into a cream, forming obesity; on the other hand, it can also damage the spleen and stomach, the spleen cannot be transported, cannot spread the water valley and the transport water is wet, the ups and downs, resulting in wet turbidity, brewing into sputum, phlegm and intrinsic, heat for a long time, burning and oysters, and become a thirst.

1.3.              Emotional Disorders: liver qi stagnation, poor air, long-term stagnation of fire, on the lungs and lungs, in the stomach burning stomach, under the kidney yin, hair as a thirst. "Lingshu·Five Change" Cloud: "Angry is angry on the air, heat is accumulated in the chest, blood is not good, turn to heat, heat is to eliminate the skin, so it is to eliminate." "Three Dissipation" 曰: "This Five ambitions, all from cremation, resulting in thirst. "Excessive thinking, long-term mental stress, can lead to air-conditioning disorders, blood and fine materials transport lost, eventually leading to diabetes, so-called Liver depression caused elimination.Air-conditioning disorders are also an important factor in obesity. The evacuation of the liver and the adjustment of the gas of the three coke are closely related to the operation and gasification of the water and the fluid. Loss of liver and stagnation not only makes the bodies air-condition disorder, the fluid infusion is abnormal, the water is wet and stagnant, and it can also cause the liver to stagnate, which affects the function of the spleen and stomach.

1.4.              Old and Young: obese T2DM is more common in middle-aged and elderly patients. After middle age, the physiology of the human body changes from stagnation to decay, lipid metabolism is imbalanced, so sit and move, so that the body is gradually obese. For example, "Yu Wen·Yin Yang should be like a big theory": "Year 40, and yin is half, life is weak. Fifty years, weight, eyes and ears are not clear." Modern medicine believes that the metabolic process is subject to the regulation of nerve and body fluid system, when people reach middle age, with the decline of neurohormones and enzymes in the regulation of metabolic processes, especially the reduction of sex hormone secretion, the incidence of obesity is significantly improved.

1.5.              The Important Role of Spleen and Liver Dysfunction in the Pathogenesis: Obesity T2DM belongs to the category of Chinese medicine, such as thirst, phlegm and dampness. Its incidence is related to dysfunction of viscera and dysfunction of qi and blood, and it is especially important to dysfunction of liver and spleen. As mentioned above, whether it is the patient's physical factors, or the loss of diet by diet, or emotional loss of relief, or the increase of age, or by the attack too much, can make the spleen yin deficiency, liver gas machine the operation is not smooth, and the water-salt and fat-stricken things are not refined, and the blood is fine, and it is transformed into a phlegm-dampening lipid accumulation body, which eventually becomes a thirst.

The spleen is the foundation of the day after tomorrow. The theory of "spleen, good disease and elimination of sputum" is elaborated and played by the doctors of the past dynasties; the theory of "spleen deficiency and elimination" and "liver depression" has been recognized by the industry, and it is a common cause of diabetes. Important pathogenesis. However, the obesity T2DM pathogenesis is not limited to simple spleen deficiency and liver depression. Dampness and qi deficiency are both important features of obesity and an internal cause of liver and spleen dysfunction, and various external causes induce and aggravate the development of this disease. The liver and spleen are closely related in physiology, and pathologically affect each other. The liver and the spleen are spleen, and the spleen loses health and spleen; the spleen is qi and blood, and the source of spleen deficiency affects the liver's blood storage and diarrhea function. In addition, obesity T2DM has both temper (yang) deficiency and yin deficiency in the characteristics of pathogenesis, as well as signs of phlegm, stagnation, qi stagnation, blood stasis, etc. The physical basis of T2DM [2], liver qi stagnation is a common sign of its symptoms.

1.6.              FushenLigan Method for the Treatment of Obesity T2DM: Through literature data mining and retrospective clinical statistical analysis, the author found that spleen deficiency, liver depression, qi stagnation and phlegm dampness are high-frequency TCM syndromes of obesity T2DM, and proposed spleen-reinforcing liver therapy for this disease [2-4]. Supporting the spleen and solidifying, that is, starting from the day after tomorrow, stressing the leading role of Zhengqi deficiency in the pathogenesis of obesity T2DM, focusing on strengthening the spleen and transporting the spleen to protect the root.

The purpose of strengthening the spleen is to treat diabetes and to treat obesity. Factors, the spleen and soil are transported to be healthy, then the wet turbidity can be paralyzed. Supporting the spleen includes the methods of strengthening the spleen, transporting the spleen, and waking the spleen; the spleen has the points of replenishing the temper, raising the spleen and spleen, and warming the spleen and yang. The clinical needs to be used flexibly. In addition, pay attention to the nature of the day after the treatment, to prevent the attack from being too bad.

The fundamental of the liver method is to adjust the air machine. The liver has the characteristics of easy depression, easy fire and easy deficiency. Therefore, it is better to use the method of soothing the liver, clearing the liver and nourishing the liver to make the liver smooth and restore its physiological function. The liver gas is up, the air machine is smooth, the spleen rises to the stomach, the kidneys are lungs descending, the lifting is orderly, the blood and body fluids are normal, the blood sugar is naturally reduced, and the lesions are controlled.

When the air machine is smooth, the evil has a way to go, and various pathological products such as dampness, water drink, and blood stasis can also follow. For example, Li Mingqi, et al [5] used Xiaochaihu Tang and Jiexiaoyang method to treat diabetes, Wang Qiaoyun, et al [6] used Jiawei Sini San to treat diabetic gastroparesis, so that the cardinal operation, air machine opening and lowering freely, and the symptoms were removed. The author's previous clinical research also showed that the traditional Chinese medicine compound based on FushenLigan method has been used to treat obese T2DM and achieved good clinical results [7,8].

Chen, male, 50 years old, first diagnosed: October 24, 2013. Current medical history: 14 years ago, the blood test was found to be elevated during the physical examination. The external hospital was diagnosed as T2DM. He took a variety of oral hypoglycemic drugs to control blood sugar. Eight years ago, he began to control insulin with blood glucose, and blood sugar control was not ideal. Pre-hospital hypoglycemic regimen: Insulin aspart 18u Subcutaneous injection before meals, insulin glargine 14u subcutaneous injection before bedtime; Metformin hydrochloride 0.5g orally, 3 times a day, Baitang 50mg oral, 3 times a day, DameiKangshu Release tablets 30 mg orally, once a day. The fasting blood glucose fluctuation was 8-12 mmol/L, and the blood glucose fluctuation was 15~20 mmol/L 2 hours after meal. Past history: 10 years of history of hypertension, oral betaloc sustained-release tablets, Ambovir control of blood pressure, blood pressure control is acceptable; history of hyperlipidemia for 7 years, oral administration of Lipitor to control blood lipids; history of hyperuricemia 5 year. Personal history: superior living conditions, bad habits of smoke-free wine; married and uncultivated; denied family history of genetic diseases. See the symptoms: dry mouth, bitter mouth, no obvious polydipsia, a little fatigue, numbness of the fingers and fingers.

The stool is rotted, the tongue is dark red, the moss is yellow, and the pulse is slippery. Physical examination: height 181 cm, weight 114 Kg, BMI 34.79 Kg/m², BP145/90 mmHg, obesity, no abnormalities in cardiopulmonary examination. Laboratory examination: glycosylated hemoglobin 8.6%, blood uric acid 521 μmol / L, liver function, renal function, normal blood lipids; OGTT test: glucose: fasting 13.25 mmol / L, 1 hour 21.85 mmol / L, 2 hours 22.42 mmol / L, 3 hours 19.13 mmol / L; C peptide: 3.36 ng / mL (normal 0.60 - 1.28 ng / mL), 1 hour 4.74 ng / mL, 2 hours 5.60 ng / mL, 3 hours 6.06 ng / mL.

2.                  Diagnosis

TCM diagnosis: diabetes, obesity, blood turbidity (spleen deficiency and dampness, qi and yin deficiency syndrome). Western medicine diagnosis: type 2 diabetes, obesity, hyperuricemia, hypertension (grade 3, extremely high risk group). Treatment plan: 1 diet: do not eat breakfast, drink tea mainly, a small amount of staple food at noon, dinner with tomato or cucumber. 2 Sports: 8-10 Km after dinner, about an hour and a half. 3 drugs: adjustment to reduce hypoglycemic western medicine: insulin aspart 6u subcutaneous injection before lunch, insulin glargine 8u subcutaneous injection before bed; metformin sustained-release tablets 0.5 g orally, 2 times a day (after lunch and dinner), antihypertensive drugs, Stop the fat medicine. TCM treatment: to strengthen the spleen and qi, clear liver and dampness and blood circulation, with the method of nourishing Yin. Prescription: Astragalus, Mian Yin Chen, plantain, Chinese wolfberry, Pueraria, Salvia, Radix Rehmanniae, Dioscorea, Zeeland 30g, Atractylodes, Cork 15g, Atractylodes, Lotus leaf 10g, Licorice 5g. 1 dose per day, decoction divided into two servings. On November 12, 2013, the second diagnosis: the symptoms of dry mouth and mouth were relieved, the stool was still rotted, the tongue was slightly dark, the yellow coating of the tongue was relieved, and the pulse string was slippery. Reduce the amount of yellow cedar to 10g above, add yam 20g to strengthen the spleen. Add 1-2 lean meat or fish for dinner.

On December 8, 2013, three clinics: no symptoms of dry mouth and polydipsia, stools in a row, slightly dark tongue, yellow greasy tongue coating, slippery pulse, stable symptoms. The fasting blood glucose was 5.10 mmol/L, the blood glucose was 7.60 mmol/L 2 hours after the meal, and the body weight was 102 Kg. Stop insulin and oral hypoglycemic and antihypertensive drugs. Traditional Chinese medicine and lifestyle intervention treatment, Chinese medicine Shouyuan side.

Four clinics on February 21, 2014: check fasting blood glucose 5.3 mmol/L, blood glucose 7.4 mmol/L 2 hours after meal, glycosylated hemoglobin 4.8%, body weight 84 Kg (weight loss 30 Kg), no other discomfort, qi and yin deficiency The image has disappeared, mainly with wet heat and internal resistance, dark red tongue, yellow greasy moss and slippery pulse string. Above, go to Huangqi, Rehmannia, and Earth's bone skin. Chinese medicine was changed to one dose every other day. Follow-up on December 5, 2015: fasting blood glucose 5.10 mmol / L, blood glucose 7.60 mmol / L 2 hours after a meal, weight 81 Kg. Follow-up on January 2, 2016: Normal blood glucose.

3.                  According to

This patient has a long history of diabetes, but the islet function is better, and no acute or chronic complications are combined. The blood glucose of the various oral hypoglycemic agents is not up to standard after high-dose insulin combination. Due to the strong willingness of patients to treat, the compliance is better, the strict diet and exercise intervention, and the treatment of TCM syndrome differentiation, in the short-term reduction, stop the hypoglycemic western medicine, and successfully achieved good blood sugar and weight control, long-term follow-up The blood sugar is normal, and the patient has no obvious hunger and hypoglycemia during the treatment, and the curative effect is remarkable.

1.       See R, Abdullah SM, McGuire DK (2007) Relationship between different indicators of overweight and obesity and atherosclerosis: Dallas heart study. World Core Medical Journal Abstracts, Cardiology 22: 1032-1036.

2.       Xianyu T, Guanjie F, Xiaohua Z (2013) Frequency Analysis of TCM Syndrome Types of Obesity Type 2 Diabetes. Clinical Research of Chinese Medicine 5: 115-116.

3.       Xianyu T, Wenwen X, Liu H (2015) Therapeutic theory of FupiLigan therapy for obesity type 2 diabetes mellitus. Chinese Journal of Basic Medicine in Traditional Chinese Medicine 21: 1365-1395.

4.       Wei S, Xianyu T, Peng Z (2014) Analysis of the law of medicinal drugs in the treatment of overweight and Obesity Type 2 Diabetes patients. New Chinese Medicine 46:146-148.

5.       Mingwei L (2003) Application of Xiaochaihu Decoction in the treatment of diabetes. Chinese Journal of Practical Traditional Chinese and Western Medicine 16: 54-55.

6.       Qiaoyun W, Zhonghong G, Jing Q (2004) Treatment of 56 cases of diabetic gastroparesis with Jiawei Sini San. Journal of General Armaments 6: 104.

7.       Xianyu T, Wei S, GuanjieF (2012) Study on the effect of WenshenJianpi, ShuganTiaoqi method on inflammatory markers of Obesity Type 2 Diabetes. New Chinese Medicine 44:15-17.

8.       Xueping P (2011) Effect of Guben Changshu on inflammatory markers of obesity type 2 diabetes. Guangzhou: Guangzhou University of Traditional Chinese Medicine 2011.