Type 2 diabetes — a Chinese medicine perspective

Name: Dr (TCM) Attilio D'Alberto
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By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham, Berkshire

Type 2 diabetes is one of the most common chronic conditions of modern life — affecting roughly 1 in 11 adults globally and rising sharply every year. It is also, unlike many conditions, largely a disease of diet and lifestyle rather than fate or genetics. The same factors that drive it can also be used to reverse it, particularly in the early stages. Traditional Chinese medicine has recognised and treated this pattern for over 2,000 years — describing it as Xiao Ke, the Wasting and Thirsting disorder — and its insights into the role of food, the digestive organs and the Kidneys remain remarkably relevant today.

On this page

Why type 2 diabetes is largely a diet problem
What is type 2 diabetes?
The TCM view: Xiao Ke (Wasting and Thirsting)
The three patterns — Upper, Middle and Lower Xiao
Foods to avoid
Foods that help
Chinese herbal medicine
Acupuncture
Lifestyle and exercise
Combining TCM with conventional treatment
When to seek help
Frequently asked questions

1. Why type 2 diabetes is largely a diet problem

Genetics load the gun but diet pulls the trigger. The vast majority of type 2 diabetes cases are driven by decades of dietary patterns that overload the body’s ability to handle sugar and refined carbohydrate: the modern diet of bread, pasta, breakfast cereals, biscuits, sugary drinks, fruit juice, takeaways and snack foods. Visceral fat accumulates, the liver becomes fatty, the pancreas struggles, and over years the cells stop responding to insulin properly. By the time a fasting glucose test returns "diabetic" results, the underlying process has usually been in motion for 10–15 years.

The evidence that diet is the primary driver is now overwhelming:

The DiRECT trial (Lancet 2018) — a low-calorie, structured diet put 46% of participants into full remission of type 2 diabetes within 12 months. Diet alone, no new drugs.
Bariatric surgery reverses type 2 diabetes in 60–80% of patients — not because of the surgery itself but because of the dramatic post-operative change in food intake.
Migration studies show that South Asian, Caribbean and East Asian populations have very low rates of type 2 diabetes in their home countries but develop it at high rates after adopting a Western diet.
Twin studies show genetic predisposition accounts for ~30–40% of risk; environmental factors (overwhelmingly diet) account for the rest.

This is not a condition you have to live with forever. It is, in most cases, a condition created by what you eat — which means it can usually be reversed by changing what you eat.

2. What is type 2 diabetes?

Type 2 diabetes is a condition in which the body becomes resistant to insulin — the hormone that allows cells to take glucose out of the bloodstream and use it for energy. As insulin resistance worsens, the pancreas produces more and more insulin to compensate, until eventually the pancreatic cells become exhausted and insulin output falls. The result: blood glucose rises above the normal range and stays there.

Diagnostic thresholds (UK):

HbA1c < 42 mmol/mol (< 6.0%) — normal
HbA1c 42–47 mmol/mol (6.0–6.4%) — prediabetes
HbA1c ≥ 48 mmol/mol (≥ 6.5%) — type 2 diabetes
Fasting glucose ≥ 7.0 mmol/L — diabetes (on two separate measurements)

Common symptoms include excessive thirst, frequent urination (especially at night), constant hunger, unexplained weight loss in advanced cases, blurred vision, slow wound healing, recurrent thrush, dark velvety skin patches (acanthosis nigricans, often on the neck or armpits), and persistent fatigue. Many people have type 2 diabetes for years before they notice any symptoms at all.

3. The TCM view: Xiao Ke (Wasting and Thirsting)

Chinese medicine has described diabetes-like syndromes since the Huang Di Nei Jing (Yellow Emperor’s Inner Canon, c. 100 BCE). The classical name is Xiao Ke (消渴) — literally "wasting and thirsting" — capturing the three cardinal symptoms recognised even then: excessive thirst, excessive hunger, and excessive urination, often accompanied by weight loss.

The TCM mechanism is built around three concepts:

Spleen Qi deficiency — the Spleen in Chinese medicine governs digestion and the transformation of food into usable Qi. When overwhelmed by years of unsuitable food (sweet, rich, greasy, cold), it fails to transform glucose properly. Sugar accumulates in the blood rather than being converted into energy.
Damp-Heat in the Stomach — the by-product of a Spleen that can’t cope. This creates the "excessive hunger" sensation: the appetite is constantly stimulated even when the body has more than enough fuel.
Kidney Yin deficiency — the deeper pattern that develops as Xiao Ke progresses. The Kidneys in TCM control fluid metabolism and store the body’s essence (jing). Damaged Kidney Yin produces the classic thirst and frequent urination, and in advanced stages, the wasting away of body tissue.

Notice that this is fundamentally a model of digestive dysfunction caused by what we eat. The Spleen is damaged first, by food. The Kidneys are damaged later, by the metabolic consequences. The TCM framework was essentially saying "this is a diet problem" two thousand years before modern epidemiology arrived at the same conclusion.

4. The three patterns — Upper, Middle and Lower Xiao

Classical Chinese medicine subdivides Xiao Ke into three patterns based on which symptom dominates and which Jiao (body region) is most affected. Most people show a mix, but one usually predominates.

Upper Xiao — Lung Heat pattern

Dominant symptom: thirst. The mouth is constantly dry, the person drinks vast amounts of water but is never quite satisfied. Heat in the Lungs (which connect to the throat and mouth) consumes fluids. Tongue: red tip, thin yellow coat.

Classical formula: Xiao Ke Fang (a Lung-Yin nourishing, Heat-clearing formula).

Middle Xiao — Stomach Heat pattern

Dominant symptom: hunger. The person feels constantly ravenous, may overeat without putting on weight, and often has constipation. Stomach Heat is driving the appetite while damaging digestion. This is the most common pattern in early-stage type 2 diabetes in overweight patients. Tongue: red, yellow coat.

Classical formula: Yu Nu Jian or Bai Hu Jia Ren Shen Tang (both clear Stomach Heat and nourish Yin).

Lower Xiao — Kidney Yin deficiency pattern

Dominant symptom: frequent urination. Urine output is high — the body is essentially flushing excess glucose out through the kidneys. Low back ache, weakness in the knees, dizziness and night sweats are common. This is the more advanced stage and is often where modern type 2 diabetes patients are by the time they seek help. Tongue: red, no coat.

Classical formula: Liu Wei Di Huang Wan or its variant Qi Ju Di Huang Wan, both nourishing Kidney Yin.

5. Foods to avoid

The single biggest intervention in type 2 diabetes is taking the foods that caused it off the plate. From a TCM perspective these are the foods that overburden the Spleen and generate Damp-Heat:

Refined carbohydrates — white bread, pasta, rice, pastries, biscuits, crackers, breakfast cereals. These spike blood glucose fastest and hardest.
Sugary drinks — fizzy drinks, fruit juice (including "100% pure"), energy drinks, sweetened tea/coffee. Liquid sugar bypasses satiety signals entirely.
Sweets, chocolate, desserts and ice cream — obvious but worth stating.
Hidden sugar — in sauces (ketchup, BBQ, sweet chilli), salad dressings, flavoured yoghurts, "low fat" products (often high in sugar to compensate), ready meals, breakfast cereals marketed as "healthy".
Greasy and fried foods — chips, deep-fried foods, takeaways. These generate Damp.
Cold, raw foods in excess — particularly raw salads and smoothies. TCM views these as weakening to the Spleen.
Alcohol — particularly beer (sugar) and sweet wines/spirits. Alcohol also damages the Liver, which compounds blood sugar regulation problems.
Ultra-processed foods generally — if it has more than 5 ingredients or ingredients you don’t recognise, treat it with caution.

6. Foods that help

Foods that strengthen the Spleen, clear Damp-Heat and nourish Kidney Yin without spiking blood glucose:

Bitter leafy greens — rocket, watercress, dandelion, chicory, kale, spinach. The bitter flavour clears Heat in TCM and supports liver function.
Cruciferous vegetables — broccoli, cauliflower, brussels sprouts, cabbage. Particularly good for insulin sensitivity.
Mushrooms — shiitake, maitake, reishi. Strengthen the Spleen and support immune function.
Bitter melon (karela) — a traditional Chinese and Indian remedy with strong evidence for lowering blood glucose. Can be eaten as a vegetable or taken as a supplement.
Cinnamon — warming spice that improves insulin sensitivity. Add to porridge, coffee or savoury cooking.
Beans and pulses — lentils, chickpeas, black beans, kidney beans. Complex carbs with fibre.
Whole grains (in moderation) — oats, quinoa, brown rice, buckwheat. Better than refined but still need portion control.
Nuts and seeds — almonds, walnuts, flaxseed, chia. Healthy fats stabilise blood glucose.
Oily fish — salmon, mackerel, sardines. Reduce inflammation and improve insulin sensitivity.
Apple cider vinegar — a tablespoon before meals can reduce post-meal glucose spikes.
Green tea — clears Heat in TCM, contains EGCG which supports glucose metabolism.
Eggs — good protein, satiating, don’t spike blood glucose.

7. Chinese herbal medicine

Several Chinese herbs and formulas have a long traditional use for Xiao Ke and increasingly strong research support for blood-glucose-lowering action.

Key single herbs

Huang Lian (Coptis chinensis) — one of the most-studied herbs for diabetes. Contains berberine, which has been shown in multiple clinical trials to reduce HbA1c, fasting glucose and insulin resistance comparably to metformin. Clears Damp-Heat in the Stomach.
Tian Hua Fen (Trichosanthes root) — nourishes Stomach Yin and generates fluids. The classical herb for thirst in Xiao Ke.
Sheng Di Huang (Rehmannia glutinosa) — nourishes Kidney Yin and cools Blood. Used in many Xiao Ke formulas.
Mai Men Dong (Ophiopogon japonicus) — moistens dryness, useful for Upper Xiao thirst.
Shan Yao (Chinese yam) — tonifies the Spleen, Lung and Kidney. Often included for the long-term constitutional weakness.

Classical formulas

The formula prescribed depends on the predominant pattern:

Stomach Heat (Middle Xiao): Yu Nu Jian or Bai Hu Jia Ren Shen Tang
Kidney Yin deficiency (Lower Xiao): Liu Wei Di Huang Wan or Qi Ju Di Huang Wan
Lung Heat (Upper Xiao): Xiao Ke Fang
Damp-Heat with insulin resistance: often custom formulas combining Huang Lian, Tian Hua Fen and Spleen-tonifying herbs

Important: Chinese herbal formulas for blood glucose can interact with diabetes medications (especially metformin, sulfonylureas and insulin) and may cause hypoglycaemia if combined without monitoring. Always tell your GP/diabetes team if you are using Chinese herbs and book treatment only with a registered Chinese herbalist (the Register of Chinese Herbal Medicine).

8. Acupuncture

Acupuncture on its own does not cure diabetes, but it is a useful adjunct. Research suggests it can:

Improve insulin sensitivity (especially with electroacupuncture)
Reduce stress and cortisol, which contributes to blood glucose dysregulation
Improve sleep, another major factor in glucose metabolism
Reduce cravings for sugar and refined carbohydrates
Help manage diabetic neuropathy (numbness, tingling, pain in feet and hands)

Typical treatment points include ST36 (Zusanli — Spleen/Stomach tonification), SP6 (Sanyinjiao — nourishing Yin), KI3 (Taixi — Kidney Yin), CV12 (Zhongwan — Middle Jiao), and ear points particularly the Pancreas point.

9. Lifestyle and exercise

Walk after meals — even 10–15 minutes after eating significantly blunts blood glucose spikes. The single most-effective free intervention.
Resistance training 2–3 times a week — building muscle dramatically improves insulin sensitivity. Muscle is the body’s main glucose sink.
Sleep 7–9 hours — one night of poor sleep produces insulin resistance equivalent to several weeks of bad diet. Acupuncture for insomnia can help.
Manage stress — chronic cortisol elevation drives blood glucose up. See cortisol and stress.
Eat your largest meal at midday — aligning with the Spleen’s peak energy time in Chinese medicine (and with modern circadian-rhythm research).
Intermittent fasting can help some patients, though it’s not suitable for everyone — see intermittent fasting in TCM.

10. Combining TCM with conventional treatment

TCM is not a replacement for conventional diabetes care. If you have been diagnosed with type 2 diabetes, you should:

Keep working with your GP and diabetes nurse
Continue prescribed medications (metformin, etc.) unless your doctor reduces them based on improving HbA1c
Monitor your HbA1c regularly (typically every 3–6 months) — this is the objective measure of whether interventions are working
Tell your acupuncturist/herbalist what medications you are on
Tell your GP that you are using Chinese herbs — some interact with diabetes medication

Patients who combine careful dietary change, targeted Chinese herbs, regular acupuncture and prescribed metformin often see HbA1c drop significantly over 6–12 months — sometimes enough that medication can be reduced or discontinued (always with the diabetes team’s agreement). Putting type 2 diabetes into remission is a realistic goal for many newly-diagnosed patients.

11. When to seek help

If you have any of the following, see your GP for a fasting glucose or HbA1c test:

Excessive thirst that doesn’t go away
Frequent urination, especially at night
Constant hunger despite eating normally
Unexplained weight loss
Recurrent thrush or skin infections
Dark velvety patches of skin (neck, armpits, groin)
Slow-healing cuts
Family history of type 2 diabetes plus central weight gain

If you have been told you have prediabetes or "borderline" diabetes — act now. This is the most reversible stage. Most cases of prediabetes can be reversed with dietary change alone within 3–6 months. The earlier you intervene the better the outcome.

To discuss your individual situation, the role of Chinese medicine in diabetes management, or to book an appointment in Wokingham (or an online herbal consultation for elsewhere in the UK), contact me.

Frequently asked questions

Can type 2 diabetes really be reversed by diet?

Yes — particularly in the prediabetic and early-diabetic stages. The DiRECT trial (Lancet 2018) showed 46% remission at 12 months on a structured low-calorie diet, and 64% at 6 years in those who maintained the weight loss. Bariatric surgery achieves 60–80% remission for the same reason (dramatic dietary change). The longer diabetes has been present, and the more pancreatic function has been lost, the harder reversal becomes — but improvement is almost always possible.

Is type 2 diabetes hereditary?

There is a genetic component — particularly in South Asian, African-Caribbean and East Asian populations — but genes account for only 30–40% of risk. Environment (overwhelmingly diet) accounts for the rest. A family history means you should be more vigilant about diet, not that you are doomed to develop diabetes.

What’s the difference between type 1 and type 2 diabetes?

Type 1 is an autoimmune condition where the body destroys its own insulin-producing cells, usually diagnosed in childhood or young adulthood. It is not diet-related, not reversible, and requires lifelong insulin. Type 2 is insulin resistance plus eventual pancreatic exhaustion, usually develops slowly in adulthood from dietary and lifestyle factors, and is largely reversible. This article is about type 2.

Should I take berberine instead of metformin?

Berberine (the active compound in Huang Lian) has similar effects to metformin in clinical trials. However, you should never replace a prescribed medication without your GP’s agreement. Berberine can be used alongside metformin, often allowing the metformin dose to be reduced over time as HbA1c improves — but this should be done with monitoring. Berberine also has some side effects (mainly digestive) and interactions with other drugs.

Can acupuncture lower my HbA1c?

Acupuncture alone produces modest improvements in HbA1c — typically a few mmol/mol. The bigger effect is via the indirect benefits: better sleep, lower stress, reduced cravings, improved insulin sensitivity. Acupuncture as part of a broader programme of dietary change, exercise and Chinese herbs is much more effective than acupuncture in isolation.

Are sweet fruits like bananas and grapes off-limits?

Not entirely, but they should be eaten in moderation and ideally with protein or fat to slow absorption. Berries (blueberries, raspberries, strawberries), apples and pears are lower glycaemic options. Tropical fruits (mango, pineapple, banana) and dried fruits (dates, raisins) should be limited. Fruit juice should be avoided altogether.

How long until I see results?

Blood glucose responds quickly to dietary change — you can see improvements in fasting glucose within 2–4 weeks. HbA1c reflects the average over 3 months, so meaningful changes show up at the 3-month re-test. Most patients who commit to dietary change see significant HbA1c reduction by 6 months. Sustained reversal requires sustained change.

What about GLP-1 drugs like Ozempic?

GLP-1 receptor agonists (Ozempic, Wegovy, Mounjaro) work and are appropriate for many patients. They are not, however, a substitute for dietary change — people who come off them often regain weight and glucose dysregulation returns. They are best thought of as a tool to support a deeper lifestyle change, not a permanent solution. See GLP-1 / Ozempic and TCM support.