Xiao Ke: Wasting and Thirsting

Modern TCM (Traditional Chinese Medicine) has a useful system of integrating with Western germ-based biomedicine. In our textbooks, diseases are categorized in two ways: by Chinese disease name and Western disease name. Under the Western disease name, it breaks down all the different Chinese diseases it could be, and then further divides it into Chinese medicine pattern, which we'll come back to.

This is most revealing when looking at something like hypertension. "Hypertension" is a Western disease term defined by a relatively arbitrary number system. Systolic pressure under 140 used to be considered normal, but now the definition is under 125, meaning anyone with systolic pressure between 126 and 139 is all of a sudden considered to have high blood pressure.

Classical Chinese medicine (and most other systems of medicine up to a few hundred years ago, from Roman and Greek to Ayurveda and Umami) uses the doctor's powers of observation as the tools of diagnosis. Modern TCM takes full advantage of advances in equipment, while still taking as primary the doctor's observation, including subjective pulse-quality readings and observations of the patient's tongue color, shape and coating.

This means that "hypertension" can fall under a few different TCM disease names, including such terms translated from the Chinese as "dizziness" "headaches" and so on.

In the case of diabetes, there is a fairly direct correlation between the Chinese term xiao ke, which translates as "wasting and thirsting" and the modern disease name "diabetes." However, the test for diabetes is based on two fasting blood sugars of 126 or more on consecutive days. This means that people who do not test with those numbers aren't considered to have diabetes, even if they have all the other clinical signs of diabetes (although there is a newer category called "pre-diabetic" which may be useful, if not a little depressing). This addiction to numbers-based medicine ties the hands of many good Western doctors, or at the very least may make them hesitant to prescribe treatment for someone who doesn't actually "have diabetes."

TCM diagnosis has a big advantage in this area, because the blood sugar level becomes just another useful tool with which to assess a patient's condition, rather than the be-all end-all of treatment.

To summarize: most diabetics have some sort of xiao ke, but not everyone diagnosed with xiao ke has diabetes as defined by the blood sugar level test. Tomorrow we'll go over the different kinds of xiao ke.