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Better Diabetes Management with TCM

Better Diabetes Management with TCM

For five months, Richard*, who had a 20-year history of diabetes, experienced numbing, burning, and tingling sensations in his lower limbs. By the time the sixty-four-year-old sought help from a Traditional Chinese Medicine (TCM) practitioner, his lower calves were hyper-pigmented, his tongue was dark red with a thick coating, and his pulse was tense and “slippery”.

With herbal medications, however, his symptoms improved noticeably. He continues to take the prescribed herbs and returns to his TCM physician for fortnightly reviews.

Traditional Chinese Medicine has a long and successful history of managing diabetes and its complications. References to xiao-ke, a disease characterised by persistent thirst and hunger, copious urination and weight loss, can be found as early as the 1st century BCE, in the medical text Huang Di Nei Jing (The Yellow Emperor’s Inner Classic). Translated literally as “wasting thirst”, it was believed to be the result of consuming too much fatty, sweet, or rich food.

Today, TCM practitioners see poor diet as just one of four major contributing factors to the root cause of diabetes, believed to be a depletion of yin energy – a cool, dark and earthy energy – combined with excessive asthenic fire in the body.

Beyond greasy, sweet and spicy food, and alcohol, all of which exhaust the spleen and result in the production of damp heat, three other factors commonly cause yin depletion and excessive fire in the body:

  • an unstable emotional life, which disrupts the flow of energy in the body and causes qi stagnation, leading to an excess of internal fire;

  • imbalances and disruptions in energy that are present at birth;

  • excessive sexual intercourse, which depletes kidney essence, impairing its ability to provide yin to the whole body.

Symptom-led treatment

Unlike conventional medicine, TCM is not concerned with blood glucose levels but instead, the actual symptoms displayed by the individual patient. These symptoms can be distilled into three main categories: upper, middle, and lower wasting.

Upper wasting is primarily characterised by excessive thirst. Other typical symptoms may include a dry mouth, irritability, a red tongue with a thin yellow coating, and rapid pulse. A TCM practitioner may diagnose someone with these symptoms as having Lung Heat with Depletion of Jin syndrome – a rise in internal heat, primarily in the lungs, due to a deficiency in yin jin (body fluids). This can be managed with a concoction made with Coptis Chinesis (Huang Lian), Ophiopogon Japonicas (Mai Dong), and Radix Rehmannia (Sheng Di Huang).

The most apparent symptom of Middle wasting is excessive hunger. Patients will also likely suffer from bad breath, weight loss, frequent oral ulcers, excessive thirst and urine output, constipation with dry stools, a red tongue with yellow coating, and a strong rapid pulse. Also known as Stomach Fire syndrome, it is commonly managed with a remedy known as Jade Maiden Decoction, made with Gypsum Fibrosum (Shi Gao), Rhizoma Anemarrhenae (Zhi Mu), and Gardenia Jasminoides (Zhi Zi).

Finally, lower wasting can be recognised by excessive turbid urination, often accompanied by lower lumbar pain and weakness in the knees, fatigue, dizziness, tinnitus (ringing in the ears), dry lips, dry and itchy skin, a red tongue with little or no coating, and a thin and rapid pulse. These symptoms point to a deficiency of yin in the kidney syndrome, which is commonly managed with Six-flavour Rehmannia Pills, made with Schisandra (Wu Wei Zi), Chinese Yam (Shan Yao), and Wolfberries or Goji berries (Gou Qi Zi).

Broadly speaking, “the main goal in TCM treatment of diabetes is to invigorate the spleen (pancreas) and revitalise the kidneys,” explains Eu Yan Sang Senior Physician Tang Yue.

Using TCM to better outcomes

Particularly over the last decade, scientific studies have backed the use of TCM to complement or augment conventional medicine in the treatment of diabetes, and to mitigate the risks associated with certain medications.

In a study conducted in 2013, 800 patients were managed with either the ‘Xiaoke Pill’, a compound of Chinese herbs combined with glibenclamide, or glibenclamide alone. Glibenclamide, an antidiabetic drug commonly used to manage type-2 diabetes, is associated with drug-induced hypoglycemia. At the end of 48 weeks, those taking the Xiaoke Pill showed a significantly reduced risk of hypoglycemia and similar improvements in glycemic control compared to those who took glibenclamide. The controlled, double-blind trial was conducted in China and edited by US-based Pennington Biomedical Research Center.

It is important to remember however, that when TCM is used in conjunction with western medication, it should always be done with the knowledge and advice of both a qualified TCM practitioner and a western medical professional.

Eat your way to better health

As important as herbal medication is, it is only part of the solution.

“Even with medication, diet control is just as important,” says Senior Physician Tang. He advises patients to avoid foods high in sugar, such as candy, chocolate, pastries, and sweetened drinks, and to reduce their intake of starch and fat.

Instead, they should fill up on foods with a low glycaemic index (GI), which can help reduce spikes in their blood glucose levels. These foods include oats, wholemeal bread, brown rice, lentils, soy and walnuts. Other beneficial foods, like black fungus, Chinese yam, barley, American ginseng and wolfberries can be consumed in soups.

Lifestyle changes must also be made, which means adopting a diet that is low in fat, sugar and salt, and making time for aerobic exercise. This makes the body more receptive to insulin, says Senior Physician Tang.

“In Mandarin we say 管住嘴、迈开腿 (Guǎn zhù zuǐ mài kāi tuǐ), or watch what you eat and exercise since neglect of both is the most common cause of type-2 diabetes. Focus on maintaining a healthy Body Mass Index of between 18 and 23, and try and get active for at least 150 minutes a week. It will help you control your blood glucose levels and find your way to better health,” she says.

*Not his real name

Related Articles

All About Cholesterol

Dr Tan Hong Chang, Associate Consultant in the Department of Endocrinology, Singapore General Hospital, explains that the human body is a cholesterol factory as it needs cholesterol to function. “Cholesterol is used by the body to make cell membranes, hormones and vitamin D,” he explains. “It’s also part of the outer covering of nerves, and is a component of bile. As the body is able to make cholesterol in the liver and other organs, there is no minimum requirement for cholesterol intake.”

Good cholesterol (HDL) helps transport cholesterol from the blood to the liver, before excretion in the bile. Bad cholesterol (LDL) is deposited in the blood vessels, forming plaques in the arteries. The relative level of HDL and LDL in your blood is dependent on genetics and diet. When we refer to high cholesterol levels, we predominantly refer to the bad cholesterol, ie high LDL-cholesterol. “High cholesterol increases cardiovascular risk because cholesterol can get deposited in the arterial wall, causing narrowing and hardening of the artery, which leads to atherosclerosis,” reminds Dr Tan. The total cholesterol-to-HDL ratio is an indication of the proportion of good and bad cholesterol, and is a better indicator of cardiovascular risk than total cholesterol.

Dr Peter Eng, Consultant Endocrinologist at Peter Eng Endocrine Clinic in Mount Elizabeth Medical Centre, advises that our body needs to maintain a desirable cholesterol level of no more than 5.2mmol/L (200mg/dl). Total cholesterol levels above 6.2mmol/L (240mg/dl) or LDL-cholesterol levels above 4.1mmol/L (160mg/dl) are considered high for a person without other risks of heart disease. A person with other risk factors for heart disease—such as smoking, hypertension or diabetes—requires a lower target level.

Risk Factors

Li Guang Jun, a registered TCM physician with the Eu Yan Sang TCM Clinic at Seragoon Nex and Eastpoint Mall, comments, “In TCM, high cholesterol is thought to result from chronic mental stress or excessive emotional upheavals, which cause the liver qi to stagnate, producing “fire” that depletes yin in the liver. Consuming too much alcohol and a high-calorie diet can also damage the spleen and stomach, resulting in the build-up of toxins, phlegm and “dampness. Risk factors include a family history of high cholesterol, menopause, heavy smoking and drinking, obesity, and/or chronic conditions such as diabetes, high blood pressure and a fatty liver. Chronic mental stress is also a risk factor.”

According to Physician Li, symptoms of high cholesterol include:

  • phlegm stagnation

  • qi stagnation

  • blood stasis

  • deficient yin in liver and kidney

In TCM, a person’s inability to digest efficiently may affect how cholesterol is processed and stored in the body. Similarly, with blood and fluid circulation, slower fluid circulation will encourage more or larger deposits of cholesterol, while poor blood circulation is seen in many types of arthritic disorders as well as some types of cardiovascular diseases. Excretory system dysfunction is also a huge indicator, as “the relationship between the liver and bile production is critical to ensure cholesterol is eliminated efficiently when bile is released.”

Bridging East & West: Holistic Diabetes Management

In the first installment of our “Bridging East & West” series, we’re diving into how to manage diabetes from both Eastern and Western medicine perspectives. It’s not just about treatments but finding a balance that gives you a full picture of how to manage diabetes.

Article reviewed by:
Dr. Chuah Hui En – Western Family physician at One Wellness Medical @ Sengkang Grand Mall
Physician Kean Chan – TCM Physician at Eu Yan Sang Premier TCM Centre @ Woodleigh Mall and Eu Yan Sang TCM Clinic @ Sembawang

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The rising incidence of diabetes mellitus is an issue of global concern. What exactly is diabetes, and how is it different in Western medicine versus TCM?

Understanding Diabetes in Western Medicine:

Diabetes is a chronic metabolic disorder due to poor insulin production or insulin resistance, leading to high blood sugar levels.

Diabetes can cause complications in your body, such as nerve damage (neuropathy), eye disease (retinopathy), and reduced kidney function (nephropathy) and you may not know of the damage until you develop symptoms or screen for these complications.[1] 



Type 1 Diabetes

  • An autoimmune condition whereby the body's immune system attacks and destroys the beta cells of the pancreas, making it unable to produce insulin.

  • Not caused by diet or lifestyle.

  • Typically develops in children or early adulthood but can occur at any age.

Type 2 Diabetes

  • Most common form.

  • Occurs when the body's cells do not respond well or are resistant to the body's own insulin.

  • Often associated with overweight and excessive body fat.

  • Develops in older adults, with increased risk above 40 years.

How does TCM view Diabetes?

Traditional Chinese Medicine (TCM) does not use the term “diabetes.” Instead, a group of symptoms characterised by excessive thirst, hunger, frequent urination, gradual weight loss, or sweet-tasting urine is referred to as “Xiao Ke” (消渴).

Diabetes falls within the scope of “Xiao Ke” (消渴) in TCM.

TCM identifies 3 primary factors contributing to "Xiao Ke" (消渴):

  • Congenital deficiencies (先天禀赋不足) lead to weak organ systems.

  • Dietary imbalances (饮食不节), especially overeating and a preference for specific foods, with obesity being a significant trigger.

  • Emotional disturbances (情志失调) cause damage to vital fluids (郁火伤津), with prolonged emotional imbalances as a contributing factor to the development and worsening of diabetes.

Treatment of Diabetes

Western Medical Approach:


  • Stomach enzymes disrupt insulin activity, so insulin needs to be injected or pumped into the blood.

Other Medications:

  • Individualised selection based on patients’ conditions, response to medications, and blood sugar control.

  • To stimulate pancreatic insulin production.

  • Prevent the liver from producing and releasing glucose into the blood.

  • Inhibit carbohydrate breakdown to slow absorption.

  • Increase tissue sensitivity to insulin.

  • Prevent kidneys from reabsorbing sugar into the blood.

Traditional Chinese Medical Approach:

Focuses on restoring the balance between ‘Yin’ and ‘Yang’ of the body:

  • TCM diagnosis considers the progression of the disease, tailoring treatment based on specific patterns observed.

  • Focuses on cleansing heat, moistening dryness, generating fluids and replenishing ‘Yin’.

  • Multiple organs including the lungs, spleen (stomach), and kidneys, are implicated.

  • Acupuncture is used to regulate the flow of ‘Qi’ along the lungs, spleen and kidney meridians, helps our organs maintain balance, and reduces dependence on external insulin.

TCM focuses on cleansing heat, moistening dryness, generating fluids and replenishing ‘Yin’.

Chinese herbs can complement insulin treatment to reduce blood glucose, here are some herbal medications for common symptoms:

Abnormally Thirsty

  • Honeysuckle flower (金银花)

  • Ophiopogon root (麦门冬)

Large Appetite yet Loses Weight

  • Gypsum (石膏)

  • Anemarrhena rhizome (知母)

  • Chinese foxglove root (生地黃)

Excessive Urination

  • Processed Chinese foxglove root (熟地黄)

  • Cornelian cherries (山茱萸)

  • Chinese magnolia berries (五味子)

Lifestyle Tips for Diabetic Patients:

  • Regular exercise and a healthy diet are important.

  • Closely monitor blood glucose and carbohydrate intake.

  • Avoid sugar, oil, caffeine and alcohol.

  • Diabetics heal poorly from wounds. Avoid injuries and keep limbs clean to prevent infection.

  • Maintain emotional balance to minimise disrupting the flow of Qi.

TCM Health Report

Early Detection Saves Lives

Get an analysis of your dominant body constitution and lifestyle tips to help improve it. Available in both English and Chinese at all general and One Wellness Medical clinics.

Diabetes is a ‘silent’ disease in its early stages, individuals may feel completely healthy until complications arise. Detect and address potential health concerns early on to stay ahead in your wellness journey.

One Wellness Medical GP x Eu Yan Sang TCM

Explore our holistic diabetes management at Eu Yan Sang One Wellness Medical clinics. Equipped with both TCM and Western family medicine services under one roof – let our integrated expertise provide you with personalized solutions for diabetes management.

Source: [1]  https://www.healthhub.sg/programmes/diabetes-hub/types-of-diabetes

Cholesterol and TCM

Many people have misconceptions about cholesterol, thinking it is detrimental to the body however this is not exactly true. Cholesterol can be either a friend or an enemy, depending on their levels in blood stream. Cholesterol is an essential substance for the body’s normal physiological functions such as precursors for cellular membrane, certain hormones and vitamin D.

Hypercholesterolaemia, or commonly known as high cholesterol occurs when the total cholesterol (TC) exceeds 240mg/dL, or when low-density lipoprotein cholesterol (LDL-C) exceeds 130mg/dL. Cholesterol plaques build up in the arteries, a condition called atherosclerosis which may partially or totally obstructs blood flow to organs such as the brain, heart, kidneys and extremities. A small portion of the plaque may break off, or the formation of blood clot on the plaque’s surfaces may result in a heart attack or stroke.

Cholesterol is classified into LDL-C and high-density lipoprotein cholesterol (HDL-C). LDL-C is harmful to the body – it attaches to the arterial walls and hardens the arteries (reduced flexibility). In contrast, HDL-C helps to carry cholesterol to the liver for removal and storage which therefore prevents formation of cholesterol plaques.

TCM Cause

Li Guang Jun, a registered TCM physician physician with Eu Yan Sang TCM Clinic at Serangoon and Simei shares the following causes:

  • Yin deficiency with the production of asthenic Fire: Chronic mental stress or excessive emotional activities may cause Liver Qi stagnation and the production of Liver Fire when exhaust the Yin. The depletion of the Liver Yin may then complicate the Kidney.

  • Heat-phlegm syndrome: Alcoholism or a diet high in calories (fats and sugars) can damage the Spleen and Stomach, resulting in build up for phlegm-dampness and toxins.

  • Phlegm-Blood stasis syndrome: the formation of heat-phlegm (unwanted wastes) obstructs normal blood flow, causing stagnation of Blood. When heat, phlegm and Blood stasis mix with one another, they can result in the yin exhaustion of the Liver and Kidney with obstruction to proper circulation.


People with slightly elevated blood cholesterol often do not experience any symptoms However, the absence of symptoms does not indicate normal level of blood cholesterol. Therefore, regular medical check up is important in detecting the condition. Other symptoms may include giddiness, fatigue, weakness, insomnia, forgetfulness, chest discomfort and fast heart rate. High cholesterol is often seen in overweight or obese individuals. The chronic elevation of blood cholesterol without medical treatment can result in coronary heart disease, peripheral arterial disease which exhibit as chest pain (angina), heart attack, stroke and intermittent claudication (limping due to obstruction in arteries)

TCM categorises high cholesterol into various syndromes, namely Phlegm obstruction type, Excessive Dampness with Kidney deficiency type, Stagnation of Qi with Blood Stasis type, Yin deficiency of the Liver and Kidney type, Yang deficiency of the Spleen and Kidney type and lastly simple type based on individual’s clinical presentation, tongue, pulse. A treatment plan is then formulated based on the different syndromes and according to individual’s physique.

Susceptible group of people

Family history of high cholesterol, individuals who are overweight or obese, middle aged and above, post-menopausal women, heavy smoker and drinker, people with sedentary lifestyle, people with medical conditions such as diabetes, high blood pressure, fatty liver. Irregular lifestyle, people who are easily tensed, agitated and under chronic mental stress.

Cholesterol-lowering herbs

There are various herbs or food that exhibit cholesterol lowering properties. Some examples are hawthorn (shan zha), red sage (dan shen), oriental water-plantain (ze xie), tuber fleeceflower (he shou wu), cassia seeds (jue ming zi), solomon’s seal (huang jing), kudzu root (ge gen), cattail pollen (pu huang), lotus leaves (he ye), gynostemma tea (jiao gu lan) and lastly ginkgo leaves (yin xing ye). They may be boiled or simmered with hot water and consume as tea. However, it is advisable to consult a physician as individual’s physique and symptoms may differ or when your condition persists or does not improve.

Food Remedy

Hawthorn congee

Ingredients: Hawthorn fruit 30-45g (or fresh product 60g), white rice 100g, sugar

Properties: Strengthen Spleen, Stomach and lower cholesterol. Suitable for individuals with high cholesterol, high blood pressure, coronary heart disease and those who experience indigestion (especially for those who consume plenty meat)

Method: Boil hawthorn to obtain concentrated juice, cook rice with juice till desired consistency and sweeten as desired. Consume warm, once daily for 10 days.

Caution: Not to be taken cold or on an empty stomach.

Chrysanthemum and Cassia seed congee

Ingredients: chrysanthemum 10g, cassia seeds 10-15g, white rice 50g, rock sugar

Properties: Clear Liver and brighten eyes, lower blood pressure and soothe bowels

Method: Place cassia seeds in clay-pot and roast till fragrant. When cooled, boil with chrysanthemum, filter and drain. Cook rice with filtrate till desired consistency, sweeten with rock sugar. Consume once daily, 5-7 days as a course of treatment.

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