A patient asked me, "Professor Tang, isn't it said that people with diabetes eat more, drink more, and urinate more? My blood sugar is elevated in my physical exam report, but I don't feel anything unusual. Could I have diabetes?" This is a common question. Patients with such concerns often experience high work stress, frequent social engagements, and a diet high in fats. They rely on transportation and rarely walk, often stay up late, and gain weight—especially around the abdomen.Moreover, when elevated blood sugar is detected during checkups, most people show no specific symptoms. However, fluctuations or mild increases in blood pressure, blood lipids, and uric acid are common, a phenomenon increasingly seen in middle-aged and older adults.
Diabetes is defined as fasting blood glucose ≥7.0 mmol/L, 2-hour postprandial blood glucose ≥11.1 mmol/L, or random blood glucose ≥11.1 mmol/L.It is categorized into two types: Type 1 diabetes (T1DM), an autoimmune disorder accounting for only 10-20% of cases, typically managed with insulin injections. The commonly referred to "diabetes caused by diet" actually refers to Type 2 diabetes (T2DM), a metabolic disorder comprising 70-90% of cases, generally controlled with oral hypoglycemic medications.
Many individuals fall short of meeting the diagnostic criteria for diabetes but exhibit blood glucose levels above the upper limit of normal, such as fasting blood glucose between 6.1 mmol/L and 7.0 mmol/L. This condition, known as impaired fasting glucose (IFG), is often caused by reduced basal insulin secretion leading to impaired glucose metabolism.In healthy individuals, blood glucose rises after consuming carbohydrate-rich foods like rice or wheat, or after ingesting glucose. The body possesses the ability to secrete insulin to regulate blood glucose concentration and maintain it within a stable range—this is known as glucose tolerance.If the 2-hour postprandial blood glucose or oral glucose tolerance test (OGTT) result falls between 7.8 mmol/L and 11.0 mmol/L, it indicates impaired glucose tolerance (IGT). Both conditions carry a significantly increased risk of progressing to type 2 diabetes. At this stage, symptoms are often absent, but they frequently coexist with obesity and the "three highs"—hyperlipidemia, hypertension, and hyperuricemia.
Historically termed "xiao ke" (thirst disease), diabetes often reached its mid-to-late stages before detection due to the absence of advanced diagnostic tools in ancient times. When patients exhibited the "three excesses and one deficiency" symptoms—excessive thirst, hunger, urination, and weight loss—the disease had typically progressed. Modern medicine can now detect elevated blood glucose levels and identify associated metabolic abnormalities in the early stages of diabetes, facilitating timely detection of glucose metabolism disorders, diagnosis, and preventive measures.
It is believed that metabolic dysfunction in the early stages of T2DM is closely related to spleen-stomach dysfunction, damp-heat in the middle jiao, and qi stagnation transforming into heat. Therefore, regulating the spleen and stomach is advocated for the prevention and treatment of early-stage diabetes.
First, unhealthy lifestyles create fertile ground for T2DM.
The onset and progression of T2DM are relatively slow, typically taking several years to decades.Early stages often manifest as impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG)—mild elevations in pre- and postprandial blood sugar levels with subtle onset. However, if left unaddressed, IGT or IFG may progress to overt diabetes. Fundamentally, T2DM development is closely linked to modern lifestyles, particularly shifts in dietary patterns.Modern diets often prioritize palatability, featuring increased proportions of high-fat, high-sugar, and high-protein foods while reducing intake of grains and vegetables. Excessive consumption of high-calorie foods exceeds the digestive capacity of the spleen and stomach, leading to the accumulation of metabolic byproducts within the body and significantly increasing the risk of diabetes. Traditional Chinese Medicine (TCM) has long recognized how poor dietary and lifestyle habits impair spleen and stomach function, ultimately progressing to the condition known as "xiao ke" (thirst and wasting).The Huangdi Neijing (The Yellow Emperor's Inner Canon) posits that xiaoke disease predominantly affects affluent individuals. Their indulgence in rich, sweet, and fatty foods coupled with a preference for leisure over labor disrupts the spleen and stomach's transformative functions. This overburdened system fails to convert nutrients into normal energy, instead producing "waste" that manifests as abdominal distension, internal heat, phlegm-fire, and damp-heat. These pathological byproducts accumulate in the gastrointestinal tract. Over time, this depletes the vital organs, ultimately triggering "xiaoke disease."In the early stages, lifestyle modifications serve as effective therapeutic measures. Traditional Chinese Medicine emphasizes regulating spleen-stomach function through balanced diets combining coarse and refined grains, and integrating work with rest. By reducing gastrointestinal burden through labor, exercise, and dietary adjustments, spleen-stomach transformation functions can be restored, thereby slowing or halting progression to overt diabetes.
Second, detecting early signs of T2DM through "spleen-stomach symptoms"
TCM views the spleen and stomach as the "root of acquired constitution" and the "source of qi and blood generation," serving as the vital site where food transforms into vital substances. The stomach receives and digests food, while the spleen processes nutrients and distributes qi, blood, and essence throughout the body. The rhythmic functions of the spleen and stomach align with our three daily meals.In modern society, many individuals violate this rhythmic pattern due to busy work schedules. Irregular eating habits, excessive consumption of rich and sweet foods, and unrestrained alcohol intake disrupt the spleen-stomach's rhythmic transport and transformation. This leads to weakened digestive capacity, which over time causes indigestion, metabolic disorders, and elevated blood biochemical indicators such as glucose, lipids, and uric acid.During this phase, patients typically maintain good appetite and adequate energy levels, with minimal impact on daily activities. However, careful observation reveals early signs of spleen-stomach dysfunction: obesity, voracious appetite, postprandial bloating, oral malodor, constipation, fatigue, and a thick, greasy tongue coating.Persistence of these symptoms indicates accumulation of pathogenic factors like damp-heat, stagnant heat, or phlegm-dampness in the gastrointestinal tract. Patients should promptly abandon unhealthy habits, halt further damage, and nip disease progression in the bud. Third: Preventing and Treating T2DM by "Strengthening the Spleen, Aiding Digestion, and Promoting the Descending of Stomach Qi" TCM posits that the spleen functions by ascending from below.The stomach's receptive function involves descending downward. Only when these physiological characteristics of the spleen and stomach are harmonized can nutrients be properly digested and absorbed, preventing them from transforming into "turbid toxins" that harm health. First, align with the rhythms of spleen and stomach transformation: Maintain regular meal times with consistent portions; eat moderately, stopping at 70-80% fullness per meal;In food selection, reduce intake of high-fat and high-sugar foods while increasing proportions of vitamins, trace elements, and dietary fiber. Maintain appropriate temperature—avoid consuming food that is excessively cold or hot. Additionally, incorporate medicinal foods into porridge, tea, or dishes to strengthen the spleen, aid digestion, and promote smooth descent of stomach qi for preventive purposes.For symptoms of "stomach stagnation" caused by overeating, such as bloating or fullness, consume digestive and stomach-harmonizing foods like raw radish, hawthorn tea, or barley tea. For "stomach heat" symptoms like dry mouth, bitter taste, or excessive hunger, use stomach-cleansing and impurity-reducing foods: lotus leaf tea, mung bean soup, bitter melon juice, or bitter tea brewed from wild tea leaves.For "spleen deficiency" symptoms like fatigue, poor appetite, and loose stools, consume spleen-tonifying and qi-nourishing foods: porridge with poria and Chinese yam, coix seed and mung bean porridge, or American ginseng tea. For "intestinal stagnation" symptoms like dry stools and constipation, consume foods that moisten the intestines and promote bowel movements: pears, bananas, radish seed tea, or almond tea.
Appropriately selecting medicinal foods that strengthen spleen qi and clear stomach heat can enhance digestive function and nutrient utilization, reducing the retention time of waste products in the body. This not only restores gastrointestinal function and alleviates symptoms but also helps prevent and manage diabetes.
Beyond dietary adjustments, maintaining a healthy weight, cultivating a cheerful mindset, and establishing regular exercise habits are crucial. For middle-aged individuals, shedding excess weight, taking post-meal walks, and embracing a positive outlook are particularly important.