When I was in school, whenever the topic of xiaoke (wasting-thirst) came up, the teacher would equate it with diabetes, leaving us with the first impression of yin deficiency with blazing fire. This gave many clinicians a rather rigid mindset: when you see diabetes, nourish yin, strengthen the spleen, and clear heat.

After I began working at the China Academy of Chinese Medical Sciences, I learned that Professor Tong Xiaolin at Guang’anmen Hospital specialized in treating diabetes, routinely prescribing Coptis (huánglián) at doses of 60 grams, reportedly with good results. But over time I kept hearing about cases where this approach failed, and I couldn’t help wondering: if everyone kept prescribing huanglian like this, would there even be enough of it to go around?

Diabetes is genuinely difficult to treat. Some patients do present with yin deficiency and blazing fire — a yellow, greasy tongue coating, a frighteningly red tongue body, heat radiating from every pore. In those cases, huanglian and gypsum (shígāo) may indeed work well. But such excess-pattern cases are actually in the minority. Many elderly diabetic patients are already thin and frail, with obvious deficiency of essence and qi. Nourishing yin and clearing heat in these patients is clearly inappropriate.

Later, I noticed that many diabetic patients had cold feet. Western medicine mostly attributes this to peripheral circulatory impairment, but through the lens of Chinese medicine, such a presentation points to either cold or stagnation of qi and blood. After thinking about it for some time, I wondered: shouldn’t we be using cinnamon bark (ròuguì) in these cases? Cinnamon bark plus Cyathula root (chuān niúxī), along with a careful overall assessment of the patient’s condition — prescribing whatever is truly needed — might produce quite good results.

Earlier this year, a case gave me the chance to put this into practice. A middle-aged man had elevated blood sugar for ten years, with fasting glucose of 8–9 and HbA1c of 7.4. He was thin and dry, sensitive to cold, and had pain in the soles of his feet. I prescribed Siwu Tang (Four-Substance Decoction) plus cinnamon bark, cyathula root, and sappan wood (sūmù). To my surprise, after one month of treatment, his fasting glucose stabilized around 6. Of course, he also made appropriate dietary adjustments, reducing staple intake to about three liǎng (150 g) per day. Following treatment, the coldness in his legs and the plantar pain resolved completely.

This shows that we cannot be stubborn about diabetes, or honestly analyze the patient’s qi and blood yin and yang state. We must not be preconceived, must not equate diabetes with wasting-thirst, and must not be biased by textbooks and teachers.

在上学的时候，老师讲到消渴病，一般都会说这是糖尿病，给出的第一印象就是阴虚火旺，这给许多临床大夫造成了非常死板的印象，那就是碰到糖尿病就要滋阴，就要健脾，就要清热。

来到中医科学院之后，得知广安门医院的仝小林老师擅长治疗糖尿病，黄连动辄用到60克，据说效果还不错，可是后来又陆陆续续听到了许多不成功的案例，心想要这么用下去黄连的产量真的够么？

糖尿病确实是比较难治的，有些患者确实阴虚火旺，舌苔又黄又腻，舌质红的吓人，一身热气无处安放，这时候用上黄连用上石膏可能确实好使，效果应该也不错，可是毕竟这种实证还是偏少，许多老年糖尿病患者已经是又瘦又小，精气明显不足了，这么个滋阴清热显然不合适。

后来我发现很多糖尿病患者的腿脚都比较凉，西医大多数认为这是末梢循环障碍，可是在我们中医眼里，这种表现不是寒凉，就是气血不通，我思考了半天，这种情况下难道不应该用肉桂么？用肉桂加川牛膝，再综合考虑一下整体状况，该用什么药用什么药，说不定效果不错。

年初的一个案例让我有了实践机会，一位中老年男性，血糖偏高十年，空腹血糖8-9，糖化血红蛋白7.4，干瘦，怕冷，脚底疼痛。当时我就用了四物汤加肉桂牛膝苏木，没想到吃完一个月之后空腹血糖稳定在了6左右。当然了，饮食也做了适当的控制，减少了主食的摄入，控制在一天三两主食。服药后腿脚发凉和脚底疼痛的情况已完全好转。

这说明我们对于糖尿病不能固执己见，还是要老老实实分析病人的气血阴阳状态，千万不要先入为主，不要在糖尿病和消渴之间划等号，不要被教材和老师带偏了。