Abstract： The concept of "middle energizer should be treated when upper and lower energizer impairment" originates from YE Tianshi's Lin Zheng Zhi Nan Yi An（Case Records as a Guide to Clinical Practice），which suggests that when both the upper and lower energizer exhibit symptoms or lesions of deficiency，the treatment focus should be on the middle energizer（spleen and stomach）. Chinese medicine posits that dysfunction of the spleen and stomach in the middle energizer leads to insufficient kidney essence，malnourishment of the brain marrow，and obstruction of brain channels by phlegm and blood stasis， resulting in diabetic cognitive dysfunction. Modern medicine suggests that intestinal flora imbalance is closely related to diabetic cognitive dysfunction，with such imbalances inducing cognitive dysfunction and intestinal dysfunction similar to the state of "upper and lower energizer impairment". This study explores the pathogenesis of diabetic cognitive dysfunction based on the "flora-brain-gut axis"，integrating Chinese medicine classics， medication experience and related experimental research. It proposes that treating diabetic cognitive dysfunction by addressing spleen and stomach deficiency and impairment can provide new insights for the integrated treatment of this condition by combining Chinese and western medicine.