2 Dietary remedies with qi-tonifying and yin-nourishing effects, suitable for patients with Qi and Yin deficiency: ① Yellow

Jiang; 3g of Wu Zhu Yu; and 5g of Gancao. Modifications: For those with impotence, add 3g of Rougui, 10g each of Suoyang and Yangqishi to warm the kidneys and boost yang; for those with frequent nocturnal urination, add 10g each of Sangpiaoshuo, Fubanzi, and Yizhiren to astringe and reduce urination; for those with deafness and hearing loss, add 15g each of Lingcishi and Sangjisheng to tranquilize the kidneys and open the orifices. 3. Spleen-Stomach Yang Deficiency Type: Presents with the main syndrome of Yin and Yang deficiency, characterized by cold pain in the epigastric region, postprandial regurgitation of clear water, upper abdominal fullness, decreased appetite, cold extremities, a pale and swollen tongue with white, slippery coating, and a deep, fine pulse. Treatment principle: Warmly disperse cold in the middle jiao. Formula: Lizhong Tang combined with Houpu Wenzhong Tang, with modifications. Ingredients: 15g each of Dangshen, Baizhu, and Yunling; 9g each of Houpu and Chenpi; 6g each of Caodoukou and Ganjiang; 5g each of Muxiang and Gancao. Modifications: For those with spleen-stomach deficiency and cold qi causing obvious epigastric pain, add 6g each of Tanxiang and Sharen, plus 15g of Danshen to warm the middle jiao, harmonize the stomach, and relieve pain; for those with reversed stomach qi causing severe nausea and vomiting, add 12g of Jiang Banxia, 9g each of Chenpi, Zhuru, and Zhishi to harmonize the middle jiao and reverse the qi. 4. Heart-Kidney Yang Deficiency Type: Presents with the main syndrome of Yin and Yang deficiency, characterized by aversion to cold and fatigue, palpitations and anxiety, chest tightness and shortness of breath, cyanosis of lips and nails, reduced urine output and body swelling, a dark blue-purple tongue with white, slippery coating, and a deep, faint pulse. Treatment principle: Warmly tonify the heart and kidneys, warm yang and dispel dampness. Formula: Zhenwu Tang combined with Baoyuan Tang, with modifications. Ingredients: 20g of Huangqi, 15g of Dangshen, 12g of Yunling, 10g of Baizhu, 6g each of Rougui and Zhi Fupian, plus 5g of Sheng Gancao. Modifications: For those with obvious edema and reduced urine output, add 10g each of Cheqianzi, Dafupi, Ginger Peel, Winter Melon Peel, and Sangbai Pi to enhance diuretic and anti-edema effects; for those with severe chest tightness and shortness of breath, add 12g of Quan Gualou and 10g of Zhishi to broaden the middle jiao and regulate qi. 5. Heart-Yang Deficiency Type: Presents with the main syndrome of Yin and Yang deficiency, characterized by palpitations and shortness of breath, chest pain and discomfort, a dull complexion, fatigue, a pale and purplish tongue that is soft and plump, and a deep, fine pulse or alternating pulse. Treatment principle: Warmly tonify yang and unblock stagnation. Formula: Baoyuan Tang combined with Gualou Xiebai Gui Zhi Tang, with modifications. Ingredients: 20g of Huangqi, 15g of Taizishen, 10g each of Gui Zhi, Xiebai, Fahuanxia, Yujin, Jiang Huang, Zhishi, and Quan Gualou, plus 5g of Gancao. Modifications: For those with more pronounced chest pain and discomfort, add 15g of Foshou, 10g each of Houpu and Tanxiang, plus 3g of Muxiang to move qi and relieve pain; for those with severe insomnia and frequent dreams, add 15g each of Suanzaoren and Baiziren to nourish blood and calm the spirit. II. Traditional Chinese Medicine dietary therapy is part of TCM treatment and, when used in conjunction with other therapies, helps diabetic patients effectively control their blood sugar. (1) Dietary remedies with clearing heat, nourishing yin, generating fluids, and quenching thirst, suitable for patients with Yin deficiency and excessive heat: ① Corn silk, persimmon leaves, and pancreatic powder mixture: Dry one pig, cow, or sheep pancreas, mix with 60g of persimmon leaves and 30g of corn silk, grind into fine powder, and take 10g three times a day, half an hour before meals. ② Yam, Shengdi, and pollen porridge: Use 20g of yam, 15g each of Shengdi and Tianhuafen, plus 100g of millet, cook into porridge, and eat three times a day, taking 1-2 servings each time. ③ Asparagus, bamboo shoots, and rice porridge: Use 15g each of asparagus and bamboo shoots, plus 100g of rice, first boil the asparagus and bamboo shoots for 20 minutes, strain out the residue, then add the rice and cook into porridge, eating three times a day, taking 1-2 servings each time. ④ Bitter melon powder: Slice and dry bitter melon, grind into powder, and take 15g three times a day, half an hour before meals. (2) Dietary remedies with qi-tonifying and yin-nourishing effects, suitable for patients with Qi and Yin deficiency: ① Yellow **Eel and pig pancreas soup: Use one eel and half a pig pancreas (or sheep pancreas), simmer to make soup, eat the meat and drink the broth. Eat twice or three times a week, one serving each time, before meals. ② Pumpkin, yam, coix seed, and bamboo shoot soup: Use 300g of fresh pumpkin, 100g of fresh yam, plus 30g each of coix seed and pressed bamboo shoots. Cook into porridge and eat three times a day, one serving each time, half an hour before meals. One course lasts 10 days, and while taking this dietary remedy, you should correspondingly reduce your food intake. ③ Rabbit yam soup: Use one rabbit and 100g of yam, first cook the rabbit, then add the yam and cook together, eating one serving every three days, three times a day before meals. While taking this dietary remedy, you should also correspondingly reduce your food intake. (3) Dietary remedies with warming yang and tonifying kidney effects, suitable for patients with Yin and Yang deficiency: ① Walnuts and ginger: Every night before bed, peel 2-3 walnuts and slice a piece of ginger, chew slowly and swallow. ② Jin Yingzi, yam, white beans, and coix seed porridge: Use 50g each of these ingredients, cook into porridge and eat three times a day, one serving each time before meals. While taking this dietary remedy, you should also correspondingly reduce your food intake. ③ Stir-fried chives with walnut meat and millet porridge: Use 150g of chives and 50g of walnut meat, stir-fry with sesame oil and seasonings, then cook millet into porridge and eat together, three times a day, one serving each time, replacing three meals a day. One course lasts 10 days. ④ Silkworm cocoon soup: Use 60g of silkworm cocoons, boil water to make tea, drink the soup and eat the pupae, dividing it into three doses, taken three times a day, half an hour before meals. One course lasts 10 days. III. Acupuncture Treatment Acupuncture treatment uses needle insertion and moxibustion to help patients "obtain qi" (i.e., achieve effective therapeutic stimulation), and transmits treatment information along the meridians to the corresponding internal organs, thereby regulating their functions, eliminating disease, strengthening the body, and helping to control diabetes.

1. Needling Method ① Yin Deficiency and Excessive Heat Type: Treatment principle: Clear the lungs and moisten dryness. Main acupoints: Taiyuan (lung meridian), Shenmen (heart meridian), Lianquan (Ren meridian), Neiting (stomach meridian), Feiyu (bladder meridian), Xinyu (bladder meridian), Yinyu (bladder meridian), and Shenyu (bladder meridian). Auxiliary acupoints: For those with obvious dry mouth, add Geyu (bladder meridian) and Yiji (lung meridian); for those who eat a lot, are hungry, and lose weight, add Weiyu (bladder meridian) and Zhongwan (Ren meridian); for those with significant polyuria, add Guanyuan (Ren meridian) and Shuidao (stomach meridian). Method: Needle insertion should aim for "obtaining qi," and can also use the method of gentle, balanced needling with slow twisting. Take 3-4 acupoints each time, once a day, alternating between main and auxiliary acupoints, with 30 sessions constituting one course. ② Qi and Yin Deficiency Type: Treatment principle: Tonify qi and nourish yin. Main acupoints: Zhongwan (Ren meridian), Zusanli (stomach meridian), Sanyinjiao (spleen meridian), Piyu (bladder meridian), Weiyu (bladder meridian), and Yinyu (bladder meridian). Auxiliary acupoints: For those with heart restlessness and irritability, add Feiyu (bladder meridian) and Chengjiang (Ren meridian); for those with obvious fatigue and abdominal distension, add Yanglingquan (gallbladder meridian). Method: During needling, insert and twist alternately on both sides, aiming for "obtaining qi," taking 3-4 acupoints each time, alternating between main and auxiliary acupoints, once a day, with 30 sessions making up one course. ③ Yin and Yang Deficiency Type: Treatment principle: Tonify the kidneys and warm the yang. Main acupoints: Taixi (kidney meridian), Taichong (liver meridian), Guanyuan (Ren meridian), Hanyu (bladder meridian), Yinyu (bladder meridian), and Shenyu (bladder meridian). Auxiliary acupoints: For those with obvious abdominal distension, loose stools, and limb swelling, add Fuliu (kidney meridian), Chengjiang (Ren meridian), Hegu (large intestine meridian), and Qihai (Ren meridian). Method: Gently twist, aiming for "obtaining qi," taking 4-5 acupoints each time, alternating between main and auxiliary acupoints, once a day, with 30 sessions constituting one course.
2. Moxibustion Method Treatment principle: Regulate internal organs, tonify qi and blood. Main acupoints: Taixi (kidney meridian), Guanyuan (Ren meridian), Zusanli (stomach meridian), Yinyu (bladder meridian), Shenyu (bladder meridian), and Feiyu (bladder meridian). Auxiliary acupoints: For those with fever, dry throat, and cough, add moxibustion to Yiji (lung meridian); for those with upper abdominal fullness and nausea, add moxibustion to Zhongwan (Ren meridian); for those with frequent urination and spermatorrhea, add moxibustion to Guanyuan (Ren meridian). Moxibustion method: Do it once a day, targeting 4-5 acupoints each time, alternating between main and auxiliary acupoints. Can use suspended moxa sticks, but be careful not to get burned.
3. Ear Acupuncture Main acupoints: Pancreas, endocrine system, kidneys, lungs, and stomach. Auxiliary acupoints: For those with dry mouth and tongue and obvious thirst, add lungs; for those with dizziness, tinnitus, and obvious emaciation and fatigue, add stomach; for those with aversion to cold, loose stools, and body swelling, add bladder. Needling method: Moderate stimulation, taking 3-4 acupoints each time, alternating between main and auxiliary acupoints, leaving the needles in for 15 minutes each time, with 7 days constituting one course.

Section 5 Oral Hypoglycemic Drug Treatment

Oral hypoglycemic drugs refer to medications that can lower blood sugar after being taken orally. Since the discovery in 1956 that sulfonylurea drug methsulfonilurea could lower blood sugar, the variety of oral hypoglycemic drugs has continued to increase, and their application has become increasingly widespread. In addition to the early discovered sulfonylureas and biguanides, α-glucosidase inhibitors and insulin sensitizers have now been developed. In recent years, extensive research has also been conducted on the hypoglycemic effects of single herbal medicines. Clinically, the commonly used first-generation sulfonylurea drugs include methsulfonilurea (D860); second-generation drugs include Youjiangtang (domestic), Damai Kang (France), Da’an Liao (Germany), Ketaoli (Switzerland), Meipida (Italy), Dishapian (domestic), and Tangshiping (domestic), among others. Commonly used biguanide hypoglycemic drugs include phenformin (Jiangtangling), metformin (Jiangtangpian), as well as various manufacturers' products containing metformin, such as Dihua Tangding, Medikang, and Chan Ketang.

I. Sulfonylureas

These are medium-strength oral hypoglycemic drugs. As the preferred choice for early and mid-stage type 2 diabetes patients with thin bodies, they are widely used clinically. The main mechanisms by which these drugs lower blood sugar are as follows: ① They stimulate pancreatic β-cells to release insulin, but do not promote increased insulin synthesis by the β-cells. Therefore, for type 2 diabetes patients in the early and mid-stages who still have some β-cell function, they have a clear hypoglycemic effect; however, for type 1 diabetes patients whose β-cell function has completely disappeared, as well as for late-stage type 2 diabetes patients, they have no hypoglycemic effect. ② They enhance the action of insulin receptors in peripheral tissues, increasing the number of receptors and their affinity for insulin, making the body's tissue cells more sensitive to insulin and increasing glucose consumption and utilization. ③ They promote hepatic glycogen synthesis, reduce hepatic glucose output, inhibit the conversion of fructose to glucose, and thus lower blood sugar.

Once we understand the mechanism by which sulfonylurea drugs lower blood sugar, we also understand their indications. In other words, they are mainly used for type 2 diabetes patients whose pancreatic β-cells still retain some function. Specifically, the following patients can take these drugs: ① Type 2 diabetes patients who developed the disease in middle age and whose blood sugar control is unsatisfactory despite diet and exercise therapy; ② Type 2 diabetes patients with a disease duration of less than 5 years and normal or slightly underweight body weight; ③ Type 2 diabetes patients without stressors such as infection, trauma, surgery, or pregnancy, and without complications such as ketoacidosis or lactic acidosis, who use less than 40 units of insulin per day, can take oral sulfonylurea drugs. (i) Dosage and Usage of Commonly Used Sulfonylurea Drugs

1. First-generation sulfonylurea hypoglycemic drugs ① Methsulfonilurea (D₈60): Take 0.5–1.0g daily, divided into three doses half an hour before meals. Side effects include loss of appetite and abdominal distension, and may cause cardiovascular complications. It is now rarely used. ② Chlorpropamide: Take 100–300mg daily, only once a day. Side effects are significant, easily causing hypoglycemia and damaging liver and kidney function. It is currently not used clinically.
2. Second-generation sulfonylurea hypoglycemic drugs ① Glibenclamide (Youjiangtang): Take 2.5–15mg daily, divided into one or two doses half an hour before meals. Its effect is 100–500 times that of D860, and its efficacy can last for 24 hours. It is relatively easy to cause hypoglycemia, even leading to hypoglycemic coma, so it should be used with caution by the elderly, people with liver or kidney dysfunction, or those with cardiovascular complications. ② Gliclazide (Meipida, Dishapian): Take 5–30mg daily, divided into two or three doses half an hour before meals. It takes effect 30 minutes after ingestion, with an intensity second only to Youjiangtang, 100 times that of D860, and is less likely to cause hypoglycemia. Side effects may include nausea, vomiting, and upper abdominal discomfort; drinkers may sometimes experience hypoglycemia. ③ Gliclazide (Damai Kang): Take 80–160mg daily, divided into two doses half an hour before meals. Its hypoglycemic effect is mild, 10–20 times that of D860, with fewer side effects, making it suitable for the elderly. ④ Gliclazide (Tangshiping): Take 30–180mg daily, divided into three doses half an hour before meals. Its metabolites are 95% excreted through the bile duct into the intestines, so patients with reduced kidney function can also take it. It has few side effects, and even large doses are unlikely to cause hypoglycemia, making it suitable for elderly diabetic patients. ⑤ Gliclazide (Ketaoli): Take 25–75mg daily, divided into two or three doses half an hour before meals. Its hypoglycemic effect is moderate, 40 times that of D860, with fewer side effects, possibly including mild abdominal distension and decreased appetite. This product is well-tolerated and unlikely to cause hypoglycemia, making it suitable for

elderly diabetic patients.

(ii) Factors Affecting the Efficacy of Sulfonylurea Hypoglycemic Drugs

1. Heavy drinking Because alcohol can deplete hepatic glycogen stores and inhibit gluconeogenesis, it can lower blood sugar, thereby exacerbating the hypoglycemic reactions caused by sulfonylureas.

2. Antipyretic analgesics Aspirin can inhibit the synthesis of endogenous prostaglandins (PGE) in the body, thereby increasing glucose utilization in peripheral tissues and lowering blood sugar.

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While aminopyrine (found in antipyretic tablets) and butadione can slow down the metabolism of sulfonylureas in the human body, thereby prolonging their hypoglycemic effects.

3. Antibacterial drugs: Sulfonamide antibiotics, as well as chloramphenicol, penicillin, oxytetracycline, tetracycline, and probenecid, can all extend the action of sulfonylureas, making them more likely to cause hypoglycemic reactions.

4. β-Adrenergic blockers: Propranolol can inhibit glucagon release and reduce gluconeogenesis; while antihypertensive drugs such as guanethidine, reserpine, and clonidine can also decrease gluconeogenesis and deplete catecholamines in the body, both of which can lower blood glucose levels and trigger hypoglycemia.