Traditional Chinese Medicine Chronobiological Pathogenesis of Type 2 Diabetes Mellitus and Time-Sequenced Prevention and Treatment Strategies

Abstract

Objective: To explore the central role of circadian rhythm disruption in the pathogenesis of type 2 diabetes mellitus (T2DM) from the perspective of Traditional Chinese Medicine (TCM) chronobiology, and to establish novel prevention and treatment strategies. Methods: We systematically integrated TCM theories—including “correspondence between heaven and man,” “fluctuations of yin and yang,” and “midday-midnight circulation”—with modern chronobiology research on circadian genes, gut microbiota, and the gut-brain axis to conduct interdisciplinary mechanism interpretation. Results: We propose that T2DM fundamentally stems from “desynchronization between endogenous biological rhythms and natural rhythms,” with the core pathogenesis being “disordered temporal sequencing of spleen and kidney functions.” Circadian genes (e.g., BMAL1/CLOCK) regulate insulin secretion rhythms, providing a molecular basis for the “yin-yang diurnal rhythm.” The circadian oscillations of gut microbiota reflect the microscopic manifestation of the “spleen-stomach transformation rhythm.” while the gut-brain axis provides a biological bridge for the “spleen-stomach-mind” theory. Based on this, a new temporal prevention and treatment paradigm—“timing-based, organ-differentiated, syndrome-regulated”—is refined. Conclusion: Strategies such as time-based daily routines, time-restricted eating, and meridian-based medication can restore rhythmic synchrony, offering new insights for integrated Chinese and Western medicine in preventing and treating T2DM.