Glossary

Wasting and Thirsting (消渴, Xiao Ke) is the Chinese medicine equivalent of metabolic disorders like diabetes. The Huang Di Nei Jing Su Wen ch. 47 attributes this to overindulgence in the five flavours, especially fatty and sweet food, leading to an overload of the Spleen which can no longer transform and transport the Essences of the food causing to Fullness in the Centre and Internal Heat. It recommends treating with orchids (蘭) but does not give any more specific information on herbs. It does state that treatment is futile without modification of diet that patients often resist. The Shang Han Lun associated this disorder particularly with Jueyin disorders and Wu Mei Wan. The Jin Gui Yao Lue further elucidated four main symptoms described as "Three Increases and One Loss":

• Increased thirst
• Increased appetite
• Increased urination
• Loss of weight

It also differentiated Xiao Ke according the three Jiao:

• Upper Jiao (associated with Lung Heat where thirst predominates) Treated primarily with Wen Ge San or Gua Lou Qu Mai San
• Middle Jiao (associated with Stomach Heat and increased appetite) Treated primarily with Fu Ling Rong Yan Tang or Hua Shi Bai Yu San
• Lower Jiao (associated with Kidneys where urination is the main symptom and is usually involved in all Xiao Ke pathologies as the body attempts to clear the Heat from this pathway) Treated primarily with Shen Qi Wan

Sun Si-Miao, in his Important Formulas Worth a Thousand Gold (Qian Jin Yao Fan, 650) dedicated a chapter to Xiao Ke where he attributes its causes to alcohol, sexual indulgence, salty and starchy food, and emotional imbalance but emphasised that the cure was dependent on the patient modifying his lifestyles habits, which could cure the disease without any intervention, but without which no cure could be effected. He also noted the presence of abscesses which could indicate severe complications of the disease. His contemporaries, the Zhen brothers, in their Records of Proven Formulas of the Past and Present (Gu Jin Yan Fang Lu, 627) also noted the sweet quality of the urine. In modern times Xiao Ke has been identified with diabetes mellitus and adopted similar classifications to those present in the modern medical literature. The symptom of weight loss is largely ignored today due to this generally being an advanced stage symptom that is usually preceded by weight gain when the disease is diagnosed diagnosed and instead the loss is seen as loss of Yin or fluids while still gaining weight. Although the essential cause of Xiao Ke as Internal Heat remains unchanged, several root causes have been identified including:

• Immodest dietary habits causing Central Stagnation and Heat (e.g. simple Type 2 diabetes)
• Kidney Yin Deficiency generating Empty Fire Blazing Upwards (e.g. inherited Type 1 or late onset diabetes during menopause)
• Counterflow in the Chong Mai leading to Heat (e.g. gestational diabetes)
• Emotional disorders causing Heat to be transferred from the Heart or Liver through its Five Phase relations to the Lung, Spleen or Kidneys (e.g. brittle diabetes, emotionally induced eating disorders leading to diabetes)
• Retained Pathogenic Factors (e.g. virally induced diabetes)

References: Huang Di Nei Jing Su Wen. Shen, X.T. (2007). The Milestones of Diabetes In Traditional Chinese Medicine. Sun Ten Journal; 8: 51-54). Sun, S.M. (650). Qian Jin Yao Fan. Zang, Z.J. (c. 200). Shang Han Lun. Zang, Z.J. (c. 200). Jin Gui Yao Lue.