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photo montage of herbal medicine

Diabetes Mellitus: A Case History

by Heiko Lade

Diabetes was first discovered and named by the English physician Thomas Willis ( 1672 ). However the Chinese in 400 B.C. from the Yellow emperor's internal Classic, called the disease Xiao Dan. In one specific chapter "On Miraculous diseases" it describes that people who have sweet and fat food which leads to accumulated heat in the interior and middle Jiao. If this accumulation and stagnation goes upwards, Xiao Ke syndrome will occur. [ Xiao Ke literally translates as emaciation ó thirst ] In later years it was called Tang Niao Bing- sugar urine illness.

In 752 A.D. Wang Tao Published a famous book "Wai Tai Mi Yao". In it he mentioned that diabetes was indicated by sweet urine and suggested that the urine should be tested ( by tasting ! ) daily to determine the progress. As part of the treatment he recommended the consumption of pork pancreas!

From a modern biomedical perspective diabetes mellitus is a group of disorders that lead to on elevation of glucose in the blood known as hyperglycemia. As this happens there is also a loss of glucose in the urine (glucosurea). Three key symptoms arise:

    • Polyuria
    • Polydipsia
    • Polyphagia

Diabetes is divided into 2 types:

Type I: means there is an absolute dependency of insulin.( also known as juvenile ó onset diabetes )

Type II diabetes is more common than type I and usually occurs to people over the age of 40 ( hence previously called maturity ó onset diabetes.

Diagnosis of Diabetes mellitus is established by measuring blood glucose levels. A random blood glucose test which exceeds 11.0 mmd/litre ( 200 mg/dl) almost certainly indicates diabetes mellitus. Further evidence is provided by doing an oral glucose tolerance test.

Once diagnosed the common treatment is insulin either orally or by injection. Its role is to stimulate diffusion of glucose into the cells and its presence stimulates energy production within the mitochrondria. Another role of insulin is to stimulate the active transport of amino acids into cells.

The general etiological factors involving diabetes can be divided into the eastern and western viewpoint. From a western view point it is due to genetic background, viral activity and diet. It is believed that viral activity, particularly herpes-type viruses known as cytomegalovirus may initiate a diabetic syndrome. Aging and poor nutritional status trigger dormant and low activity viruses.

Diet plays a large part in the disease, particularly in managing obesity.

The western idea of genetic background correlates with the TCM view on Jing, or essence. By nurturing and supplementing the Jing, traditional treatment can increase the level of the individuals health so that stresses such as viral attack can be minimized.

According to Heiner Fruehauf whilst discussing Gu the syndrome, suggests that viruses can fall into a type of "Gu Toxin". These Gu toxins can contribute to the modern diseases such as chromic fatigue syndrome and lyme disease. With disease such as diabetes on the increase it is of importance to take into account viral infections weakening the body and hence the use of neutralizing toxin herbs. Modern medicine has realized the role of avoiding rich foods. However, they could of read from the Huang Di Nei Jing where it states that "this illness typically occurs among wealthy people, and you ask them to refrain from a rich diet, which they may resist".

An important life style modification to consider in diabetes is the importance of exercise. Exercise is able to improve the whole being and research has shown that jogging can stimulate the islets of langerhans, and Yoga can make insulin in diabetics function better.

The treatment and management of diabetes from a modern medical perspective is still difficult. As quoted from Tabers medical dictionary "Diabetes is a chromic, incurable disease but symptoms can be ameliorated and life prolonged".

It was not until 1921 when insulin was isolated and produced from pigs and beef pancreas. Historically before the treatment of diabetes was more efficient using insulin, most patients died of Ketoacidosis. However now, even though there is a longer life span, 70-80% of deaths are due to complications of the cardiovascular system.

In addition to this, the increasing life span and treatment of circulatory disorders has led to other problems. 50% of diabetes suffer diabetic retinal legions. The exact mechanism is not known but the formation of microthrombus in the retinal microcriculation can cause blindness.

This is where the intervention of TCM is of great benefit. Eye problems are contributed to deficiency of Yin with dry heat ( and sometimes complicated with Qi deficiency ) leading to stagnation of blood. The herbs that will be discussed in detail later on will be those that specifically arrest diabetes. It is beyond scope of this brief paper to mention in detail the vast range of herbs to benefit, and treat the symptoms associated with the complications of diabetes.

For academic interest though some will be mentioned.

Bleeding from optical fundus:

Xian He Cao herba agrimoniae

Bai Mao Gen herba seu radix cirsii fabonici

Da Ji herba cephalanoploris

Another complication of diabetes is a condition called acromelic necrosis ( diabetic foot ). Here we can have infection, boils, carbuncles, and if severe necrosis, and ischemia. In TCM this type of imbalance is called Tuo Ju, mainly due to stagnation of fire from Yin failing to control fire or exogenous toxic cold and dampness causing disharmony between nutritive Qi and defensive Qi.

In brief some examples for damp gangrene are

Pu gong Yin ( herba taraxci )

Lian Qiao ( fructus forsythiae )

Dry gangrene:

Shui Zhi (hirudo seu Whitmaniae)

Tao Ren ( semen persicae )

Having given a brief introduction to diabetes, it is now appropriate to discuss the differential diagnosis according to the TCM perspective. As with any other disease term or name labeled by the western medical system, there will be a number of traditional Chinese organ pathologies that fit into the western picture.

Another way of distinguishing the causes of diabetes is breaking it down into upper, middle, and lower Jiao.

In the chapter Xiao Ke syndrome from "Secret records in the stone chamber" Chen Shi Duo from the Qing dynasty said "although diabetes can be divided into the upper, the middle and the lower, it is caused by the kidney deficiency without exception. Therefore, the treatment should be mainly based on that of kidney without caring about what type it is"

Differentiation of the mild, serious and critical cases needs also to be taken into consideration. Again, if we look at quotes from the classics, it becomes evident that kidney type diabetes was more serious, Gao Gu Feng from the Qing dynasty said in a chapter of Xiao Ke syndrome in his book Treatise on the duties for medical Professionals "In the 3 types of diabetes, the upper and middle types can be cured, but the lower type is difficult to cure; urinating as much as drinking can be cured, but urinating twice as much as drinking cannot be cured".

Of interest to observe is the view outlined in the Australian Journal of Acupuncture by Ted Davis who has merged the western medical system with traditional Chinese.

Type I DM has a lack of islet cells and the beta cells canít do the job of secreting insulin. This in TCM terms is regarded as a lack of kidney energy ie. a deficiency in Yin and Yang, further complicated with Jing impairment. The 7 & 8 year growth cycles have become imbalanced by Jing insufficiency.

Type II DM is seen as an imbalance in the spleen function of transportation and transformation. It is suggested that this correlates to a lack of cell reception mechanisms ( ie. Insulin reception).

However, maintaining a traditional Chinese medicine view involving therapeutic principles and syndrome differentiation the triple heater types can be classified as follows:

Upper Jiao : lung dryness

Middle Jiao : stomach heat

Lower Jiao : kidney deficiency.

Clinical observation has shown that these three types often appear at the same time clinically with the degree of each heaters involvement varying. By analysis of the 3 key symptoms of polydipsia, polyphagia and polyuria, one can determine which of the 3 Jiao needs clinical attention. For instance, polyuria would clearly benefit from attention focused on the lower heater.

Having compiled the different literacy sources it can be established that there are 6 main types of TCM classification of diabetes.

Each one will be looked at in detail and appropriate herbs discussed that can be of clinical benefit.

One: Injury of bodily fluid by lung heat.

Key signs and symptoms are polydipsia, dry mouth and tongue, frequent and copious urination, red tongue tip with yellow coat, rapid and full pulse.

This can be explained as the excess lung heat consuming fluids causing dry mouth and tongue and as the lung dominates the regulation of water, the dry heat impairs lung function and thus leads to frequent and copious urine. Though the red tip of tongue is more associated with heart fire, here it is because the whole upper jiao is being affected.

Treatment principle is clear heat, moisten lung and promote production of body fluid.

Tian Hua Fen ( Radix Trichosanthis )

This herb has a number of functions but Bensky clearly summarizes it for us: clears heat, generates fluids when heat injures fluids causing thirst, use with wasting and thirsting syndrome. ( It is of importance to mention here that research has revealed that pairing of drugs ( herbs ) gives a better effect. Mice experiments showed that the combination of Tian Hua Fen and Zhi Mu had the fastest, strongest and longest effect in reducing blood sugar levels )

Sheng Di ( Radix Rehmannia )

Sheng Di is classically used for wasting and thirsting syndrome by nourishing Yin and blood whilst generating fluids. Signs much as low grade fever, molar flush from deficient Yin are indicated for rehmannia.

Mai Dong ( Radix Ophiopogonis )

This herb is used for nourishing Yin and clearing heat and has the special function of relieving thirst. It is of interest to note that modern research has shown that this herb can bring water into the cells because of its action effecting mitochondria and ATP synthesis.

Ge Gen ( Radix Puerariae )

Here we have a herb that nourishes fluids and alleviates thirst. Of special importance is its mention in Bensky's Materia Medica under major combinations where it is combined with Tian Hua Fen and Mai Dong for thirsting and wasting syndrome.

Addendum: It would be appropriate here to mention the contraindications of the herbs Sheng Di and Mai Dong where there is spleen deficiency with loose stools etc. Clinically I have found that in many western patients, even without loose stools, patients taking these herbs often get loose stools and abdominal bloating. Chinese culture has seen a much more concise protection of their stomach and spleen energy by avoiding cold and raw foods and omitting ice-cream and iced drinks from their diet. Hence I encounter that Ge Gen and Tian Hua Fen are more often used in clinical practice. The dosage can also be increased up to as much as 30-35 grams for a more effective result.

Two: Blazing heat in the stomach.

The Diabetic patient with this imbalance manifests symptoms of polyphagia, polydipsia, emaciation, dry stool, frequent urination ( that is sweet ! ), Tongue: dry & yellow, Pulse: slippery & solid.

An analysis of the symptoms reveals that as the stomach is in charge of receiving food, the excess fire will cause polyphagia. Consumption of the body fluid and blood due to exuberant heat in the Yang Ming and causes the inability of the muscles to be nourished thus leads to emaciation. Furthermore the insufficient stomach fluid fails to moisten the large intestine, thus ensuing dry stool.

Sheng Shi Gao ( Gypsum Fibrosum )

Here its main function is to clear blazing stomach fire but also quells excess heat in the lungs. Be sure to be careful in the cases of weak stomach as many patients may not respond favorably to the cold nature of gypsum.

Zhi Mu ( Rhizoma Amemorrhenae )

This is 2nd most important herb listed in the Materia Medica from Bensky for quelling fire. It goes to the lung, stomach and kidney channel so it can benefit all 3 heaters. The Yin is nurtured and arrests dry conditions, treats excess thirst and in particular it generates fluids. Zhi Mu is important for wasting and thirsting syndrome when used with Tian Hua Fen and Mai Dong.

Much emphasis must be put on the contraindication for patients with deficient spleen diarrhea. Personal clinical observation has revealed that in many westerners, ingestion of herbal infusion containing Zhi Mu often gives stomach ache, obviously from its bitter and cold nature.

Lu Geng ( Rhizoma Phragmitis Communis )

The cold nature of this herb quells fire and it is directed to the lung and stomach channels. In particular it generates fluids and alleviates thirst. The usual contraindications for cold and deficient stomach and spleen apply. Though personal clinical experience has revealed that this herb is not quite as harsh as Shi Gao and Zhi Mu.

Shan Zhi Zi ( Fructus Gardeniae )

This herb is not as specific in addressing blazing heat in the stomach but never the less provides good supportive measures in clearing heat and fire. It actions go to 3 meridians stomach, lung and liver. When there is any complication or signs & symptoms involving damp and heat, the use of Shan Zhi Zi is recommended.

Three : Kidney Yin Deficiency.

Here the signs and symptoms involve frequent and copious urination which is greasy ( or can be described as turbid ) and has a sweet taste. The tongue is red, and there is a rapid thready pulse. Other standard Yin deficiency features such as weak sore low back and knees, feverish sensation in the palms; and tinnitus may be present. Unconsolidation of the kidney Qi causes the food essence to flow downward.

( Huai ) Shan Yao ( Radix Dioscorea )

This herb is most useful as it no major contraindications and benefits the Yin and Yang, tonifies and benefits the lungs, spleen and kidney. It can also be used in large amounts and 30g is suggested when treating diabetes. The spleen Yin is benefited to control food essence. In Li Shi Zhen's Ben Cao it describes the herb as having virtue in treating polyuria because of its astringent nature and if taken habitually brightens the intellect and prolongs life. Bensky summaries it for us by confirming its use for wasting and thirsting syndrome in the combinations it is listed with Tian Huan Fen to arrest thirst.

Shan Yu Rou ( Fructus Corni Officinalis )

Bensky lists this herb as the first herb in the astringent category entering the liver and kidney channel. By stabilizing the kidney essence it prevents food essence from flowing downwards and this treats excessive urination. With diabetes a larger dose is suggested, even up to 60-70 grams can be used but take heed to the contraindications , as outlined by Bensky. Use with caution without kidney Yang deficiency and avoid if there is painful and difficult urination.

Gou Qi Zi ( Fructus Lycii Chinensis )

This herb is better known as blood tonic being especially beneficial to the eyes. Li Shi Zhen says that it prolongs life, improves the complexion, quenches thirst. As it nourishes and tonifies the liver and kidneys all symptoms such as impotence and sore back can be treated but it is of benefit to wasting and thirsting syndrome. Pay attention to not overlook the potential of this herb; especially when considering that diabetes often has complications with the eyes. Ted Davis in his article turns his attention to the view that the Jing ( essence ) has a correlation with diabetes type II so as this herb benefits the Jing, I have found it particularly useful.

Shu Di ( Radix Rehmanniae Glutinosae Conquitae )

This is the prepared form of Sheng Di. The process to modify the Sheng Di is quite involved and can take at least 7 days. The fresh root is steamed for many hours in a broth of Sha Ren and Chen Pi, then dried, then steamed again. Somehow this alchemical process turns it from a cooling herb to a tonic herb. Thus it becomes useful to the diabetic because it nourishes the Yin and treats wasting and thirsting syndrome. The contraindications need to be addressed as its overuse can lead to abdominal distension and loose stool. Clinically I have encountered this often, and it can take up to about 5-6 weeks of regular use to get the distension and loose stools.

In brief summary of the 4 herbs mentioned to treat kidney Yin deficiency, it is of interest to note that they are ingredients contained in Zuo Gui Wan ( Restore the left [ kidney ] decoction ). This is a variation of Six-Ingredient Pill with Rehmannia, Li Wei Di Huang Wan and has its common etiology excessive sexual activity at an early age causing the kidney weakness.

Four: depression of liver Qi and deficiency of Blood.

The symptoms of liver Qi stasis will be commonly encountered with TCM practitioners and it wonít be necessary to go into great depth discussing them. However in brief summary the symptoms include hypochondriac pain, hiccup, abdominal pain followed by diarrhea, mental depression, suffocating feeling in chest and one interesting symptom mentioned in the "Treatment of Diabetes" by Chen Jinding was difficulty in cleaning the anus after defecation which is due to unrelieved stasis in lower abdomen.

The pulse is wiry and there is a red tongue plus the patient will have thirst, emaciation and frequent turbid urine.

In the discussion on diabetes in the "Practical Traditional Chinese Medicine & Pharmacology" Xianmin provides us with clinical formula that arrest this liver condition. He uses the standard type herbs to treat wasting and thirsting such as (Huai) Shan Yao, Sheng Di, Gou Qi Zi and Shan Yu Rou and then adding common liver Qi stasis resolving herbs such as Chai Hu, Yu Jing, Bai Shao, Chuan Lian Zi and Xiang Fu. There is adequate literature discussing the clinical application of these herbs and hence I have only chosen 2 other herbs for my discussion. Both of these herbs are often overlooked in their application to treat liver Qi stasis but clinically I have found them of great benefit.

Mu Hu Die ( Semen Oroxyli Indici )

Mainly known for its use in treating cough and sore throat. It can regulate and comfort liver Qi stasis. It has no contraindiations and thus has some advantage over Chai Hu which is drying and can upset Yin deficiency conditions.

Mai Ya ( Fructus Hordei Vulgaris Germinantus )

This is barley sprout and it's main use in treating food stagnation and strengthening the stomach. The use in facilitating liver Qi provides relief from distension, constriction, belching and loss of appetite. It can be used in large amounts (up to 30g), and is commonly added to tonic formulations to minimize gas and distension. As most westerners have an underlying deficient spleen, this herb is most practical for the diabetic as it improves their digestive capacity.

Five: Blood Stasis.

Symptoms of blood stasis can be quite broad but usually include headache, throbbing or stabbing pains; stiffness in the chest, palpitation, dizziness with dry and painful eyes. The pulse and tongue are more easily observed if the stasis in strong, that is a purple tongue and rough pulse. Personal clinical observation has revealed that mild or subtle blood stasis doesnít always give clear confirming signs of pulse and tongue and it pays to especially ask about injuries and trauma and place importance on them, even if they were a long time ago and even if the accident didnít seem to be really severe.

As my case examples will confirm, clinically, blood stasis is often seen in conjunction with other pathologies.

Niu Xi ( Radix Achyranthis Bidentatae )

Predominately, it invigorates the blood and expels congealed blood. However as it goes to lover and kidney channels and has a tonic effect on these organs I have put it in first place.

Chi Shao ( Radix Paeoniae Rubra )

A common herb employed in conditions requiring invigoration of blood and treatment of traumatic injuries. It is of particular benefit to the diabetic in its action on the eye. Bensky does say that it can treat red, swollen and painful eyes from liver fire, its use is more broad depending upon which other herbs it is combined with. Gary Seifert refers to Chi Shao in the use of cataracts, glaucoma and corneal ulcers and its role in the treatment of blindness.

Dan Shen ( Radix Salviae Miltiorrhizae )

From a modern medical perspective diabetics are at high risk for circulation disorders and this is why Dan Shen is most useful. Apart from its common use of invigorating blood and breaking up congealed blood it has additional benefits in arresting the soreness of ribs from constrained liver Qi. Modern research has shown that it can benefit coronary heart disease, lower serum cholesterol levels and importantly effect glucose metabolism.

Lu Lu Tong ( Fructus Liquidamber Taiwaniana )

The final herb that I have chosen in the category of blood stasis useful in the treatment of diabetes is Lu Lu Tong. Not so commonly known, such as Tao Ren and Hong Hua, its use is applicable because of its benefit on the middle Jiao. It promotes circulation of qi and blood out is commonly combined with Chi Shao and Dan Shen to treat trauma.

Six : Deficiency of Qi and blood.

Perhaps the most common etiology that a TCM practitioner will encounter in his practice has the broad symptom of tiredness, lassitude; weakness, emaciation and a withered auricle. The king of herbs Ginseng will be placed in the first position.

Ren Shen ( Panax Ginseng )

The usefulness of this herb is seen in its multi action. It strengthens the spleen and stomach, tonifies the lungs and benefits the Qi. It has been well documented to benefit the Yin and generate fluids and this is used for wasting and thirsting syndrome. It has been specifically researched in modern China in its treatment of diabetes. In mild cases there is a decrease in glycosuria and can reduce blood glucose by as much as 40-50%. These results can last up to 2 weeks after the herb ingestion has stopped. Some patients have been able to lower their required insulin. In more moderate cases, there is no significant alteration of blood glucose levels but there was improvement in the symptoms of lassitude and thirst.

Having stated such promising hope for the diabetic may it be clear to pay heed to the contraindications as over use of this herb can lead to headache, insomnia and can increase blood pressure.

Huang Qi ( Radix Astragali )

This common tonic has a broad range clinical application including tonification of spleen and stomach, promotes discharge of pus, tonifies the blood, raises the Yang but it is the use in wasting and thirsting syndrome where it is of importance in diabetes. In particular it has a mention in Bensky in the combinations with Shan Yao and Sheng Di.

Huang Jing ( Rhizoma Polygonati )

Huang Jing generally is a tonic for spleen and stomach and moistens the lung when deficient in Qi and Yin. It is of clinical value as it can tonify the essence and treat wasting and thirsting syndrome. So great is this plant that the ancient Taoists called it the food of the immortals. In diabetes it can be combined with Shan Yao and Huang Qi.

Gan Cao ( Radix Glycyrrhizae Uralensis )

One couldnít omit Gan Cao from any herbal treatment and in this case it is appropriate to mention because of it's action on harmonizing other herbs. There has been some research into its effect on treating diabetes insipidus but results are inconsistent.

In conclusion of the 6 main diagnostic differentials it can be seen that most types of diabetic patients will full into one of these patterns. Clinically, though, a merging and mixture of patterns occurs. For instance; Yin deficiency with liver Qi stasis; Yin deficiency and Qi and blood deficiency. Some of the following case histories will exemplify this.

PLEASE NOTE ALL INGREDIANTS ARE IN QIAN ( THAT IS NOT IN GRAMS)

Diabetes Case History 1.

Male DOB 26/5/44

Occupation: Business executive

First visit :presented with stiff neck, right shoulder stiff more than 1 year sometimes with headache that goes to right eye. Previous history included ruptured 3 discs 32 years ago .and long history of excess use of beer, coffee, chocolate , fatty foods , with emaciation ,excess thirst , until diagnosis of diabetes 14 years ago.

Tongue: red, yellow furry(damp), crack central extending to tip

Pulse: thin , thready , especially liver (Yin Xu )

4 treatments of acupuncture for neck and shoulder with steady improvement.

Then started concurrent treatment with herbs to assist diabetic state.

Lu Geng ( Rhizoma Phragmitis Communis ) 9   Clears heat and generates fluids

Shi Gao ( Gypsum ) 3  Treat thirst from fire and injured fluids

Hua Fen ( Radix Trichosanthis ) 3 Generates fluid and treat wasting and thirsting syndrome

Mai Dong ( Tuber Ophiopogonis Japonici ) 2 Treat injured fluids from deficient Yin

Sheng Di ( Radix Rehmanniae Glutinosae ) 3 Nourish Yin and generate fluid

Sang Zhi ( Ramulus Mori Albae ) 4 Wind damp painful obstruction

Chuan Xiong ( Radix Ligustici Wallichii ) 2 Disperse wind ,invigorate blood

Gan Cao ( Radix Glycyrrhizae Uralensis ) 2 Harmonize

Shan Yu Rou ( Fructus Corni Officinalis ) 3 Stabilize kidneys and essence

Huai Shan Yao ( Radix Dioscoreae Oppostae ) 3 Tonify spleen and kidneys

Ze Xie ( Rhizoma Alismatis Plantago-aquaticae ) 2 Clear heat

Qian Nian Jian ( Rhizoma Homalomenae Occultae ) 4 Wind damp painful obstruction

3 Packages

The choice of herbs addresses a number of factors. Herbs have been added to help his shoulder condition by removing wind ,cold and damp. Clearing heat and moistening Yin and kidney tonics make up the rest of the formula.

The acupuncture was still giving a good improvement for his neck but the herbs caused an aggravation .Further questioning revealed a previous history of stomach ulcer at age 18.The aggravation included excess stomach bloating , bad smell with bowels, loose stools and burping .Though he was not complaining of spleen deficient type problems the reaction to the herbs confirmed that there was!

The main herbs that caused this were Shi Gao because of its cold nature and Sheng Di due to its greasy nature .This problem is commonly encountered ,that is no specific stomach /spleen signs and symptoms but then an adverse reaction if Sheng Di is prescribed.

He also did not like the taste of the herbs so I prescribed the next formulae in the form of Chinaherb (Sun Ten) granules.

Zhe Bei Mu ( Bulbus Fritillariae Thunbergii )

Shan Yao ( Radix Dioscoreae Oppostae )

Tian Hua Fen ( Radix Trichosanthis )

Ge Geng ( Radix Puerariae )

Fu Ling ( Sclerotium Poriae Cocos )

ShanYu Rou ( Fructus Corni Officinalis )

Sang Zhi ( Ramulus Mori Albae )

Lu Geng ( Rhizoma Phragmitis Communis )

Gan Cao ( Radix Glycyrrhizae Uralensis )

Mai Ya ( Fructus Hordei Vulgaris Germinantus ) ( doses equal )

I added Zhe Bei Mu to address his stomach condition and only left one herb for his shoulder, Sang Zhi. Fu Ling ,Gan Cao and Mai Ya benefit stomach and spleen. Shan Yao ,fu ling , Shan Yu Rou is part of Li Wei Di Huang wan so as to strengthen kidney .Ge Geng and Tian Hua Fen to nourish fluids.

After 4 weeks on the herbs his main comment was that he was feeling good. However by the 5th week he said his stomach was troubling him again .I didnít think it was a reaction to the herbs so I asked him to continue and added CV 12 ( Zhong Wan ) to his acupuncture treatment which fixed the problem.

I continued doing acupuncture for his aches and pains and suggested a moxa box so he could do additional kidney tonification as winter was coming and he was starting to feel the cold.

He was still on medication but his sugar levels were much more stable .As I noticed his low back condition got worse when it got cold I concluded that as a result of his previous injury there must be a component of blood stasis .As it has been previously shown blood stasis can be a major precipitating factor in the cause of diabetes ,coupled with his damage to the kidney energy via rupture of the discs and his history of damage to spleen I then prescribed in the form of Chinaherb (Sun Ten ) granules.

Ge Geng ( Radix Puerariae ) 3

Di Gu Pi ( Cortex Lycii Chinensis Radicis ) 3

Ze Xie ( Rhizoma Alismatis Plantago-aquaticae ) 2

Mai Dong ( Tuber Ophiopogonis Japonici ) 3

Shan Yao ( Radix Dioscoreae Oppostae ) 3

Lu Geng ( Rhizoma Phragmitis Communis ) 3

Fu Ling ( Sclerotium Poriae Cocos ) 3

Hong hua ( Flos Carthami Tinctorii ) 1

Dan Pi ( Cortex Moutan Radicis ) 2

Sha Shen ( Radix Glehniae Littoralis ) 3

Hua Fen ( Radix Trichosanthis ) 3

Huang Qi ( Radix Astragali ) 3

Dan Shen ( Radix Salviae Miltiorrhizae ) 3

Shan You Rou ( Fructus Corni Offcinalis ) 3

Herbs will address the kidney yin and stomach yin ,spleen Qi, and I have chosen mild herbs to promote blood circulation Dan Pi ,Hong Hua and Dan Shen .I didnít use Tao Ren as I feel it may have caused loose stools .Dan Shen was put in the formula to address the blood stagnation and to help the build up of plaque due to his smoking.

This case demonstrates the multiplicity of in depth diagnosis .His diabetes is complicated with more than 1 organ pathology. There is blood stasis , liver and kidney yin xu , stomach heat, accumulation of turbid dampness in middle jiao and spleen deficiency.

Lifestyle modifications would mainly be to give up smoking and as he plays golf I donít even have to tell him to do exercise.

His prognosis looks good though treatment will need to be long term. In particular if his stomach and spleen energy rehabilitate enough to be able to digest Sheng Di at a later date a better result can be expected.

The main herbs benefiting him at the moment are:

  • Ge Geng ( especially also as there is now evidence that it benefits the liver if damaged by alcohol)
  • Lu Geng
  • Hua Fen
  • Mai Dong ( It has been shown that a synergist action occurs with mai dong and Hua Fen as they stimulate ATP synthesis and in my view may play a role in reactivating cell tissue of the pancreas.)

DIABETES CASE 2

Boy aged 8 presented 3/9/95

Diagnosed with diabetes and on medication insulin ,actrapid and protifane.

Signs and symptoms :headache ,back of neck each few weeks ,tired in the morning ,and GREY HAIRS appearing .Further questioning revealed late in development of teeth and there was a history in the family of late development of eye teeth!

Pulse: kidney yin very deficient .Tongue : normal and slightly red.

Diagnosis: Kidney Jing and yin deficiency due to insufficient pre natal energy.

1st treatment : I prescribed Liu Wei Di Huang Wan as a testing formulae to check if his digestion can deal with the greasy nature of Shu Di.

2nd treatment :His amount of insulin needed had been reduced by 50% in a 2 week period .I then decided to make a large batch of hand made pills using vinegar as a base ( as a diabetic honey canít be used )The formulae was based on liu wei di huang wan

Shu Di ( Radix Rehmanniae Glutinosae Conquitae ) 8

Shan Yu Rou ( Fructus Corni Officinalis ) 4

Shan Yao ( Radix Dioscoreae Oppostae ) 4

Ze Xie ( Rhizoma Alismatis Plantago-aquaticae ) 3

Fu Ling ( Sclerotium Poriae Cocos ) 3

Dan Pi ( Cortex Moutan Radicis ) 2

Ji Nei Jing ( Endithelium Corneum Gigeraiae Galli ) 3

Sha Ren ( Fructus seu Semen Amomi ) 1

Mai Dong( Tuber Ophiopogonis Japonici ) 3

Tian Hua Fen ( Radix Trichosanthis ) 4

The dosage was 2-3 grams 2-3 times per day. He was on this formulae for about 1 year .His sugar levels were very good and constant at 5.2 ,5.6 and 4.3 after 6 months.

His moods had also stabilized.

3rd treatment: After 1 year his levels were at 7.5 and another formulae based on liu wei di huang wan was made into pills with vinegar.

Shu Di ( Radix Rehmanniae Glutinosae Conquitae ) 8

Shan Yu Rou ( Fructus Corni Officinalis ) 4

Shan Yao ( Radix Dioscoreae Oppostae ) 4

Fu Ling ( Sclerotium Poriae Cocos ) 3

Ze Xie ( Rhizoma Alismatis Plantago-aquaticae ) 3

San Pi ( Cortex Moutan Radicis ) 2

Ji Nei Jing ( Endithelium Corneum Gigeraiae Galli ) 3

Tian Hua Fen ( Radix Trichosanthis ) 3

Mai Dong ( Tuber Ophiopogonis Japonici ) 3

Lu Lu Tong ( Fructus Liquidambaris Taiwanianae ) 2

Lian Xu ( Stamen Nelumbinis Nuciferae ) 1

Lian Xu was added as in Li Shi Zhen's Ben Cao it states that it can blacken hair and it will also add to the astringent quality of the formulae .Lu Lu Tong was added to open the middle burner and help prevent any stagnating effects of the tonics as Lu Lu Tong can benefit abdominal bloating .

A follow up phone call 6 months later revealed that his sugar levels were 7.1 .As he was also part of a trial at the Children's hospital (pre puberty diabetic research group) it would be of interest to note that the hospital said "he's a star" .He is still on insulin 2 times per day but only takes 2 units of actrapid per week and sometimes not for 3 weeks ! And the hospital says this is very unusual .

This case is interesting as it a form of juvenile diabetes .In TCM terms this example clearly demonstrates that kidney deficiency is the cause and responds well to well known Li Wei Di Huang Wan.However patience must be exercised as this child has been taking herbal pills for nearly 3 years and is still on insulin, however much reduced !

Case History 3.

Female D.O.B 22/7/77

Diabetic since age 9, regular insulin injections.

Currently sugar levels very high, > 11 + sometimes > 15.

  • Main presenting symptom: amenorrhea.
  • Signs + symptoms

Irregular period since age 11, around age 17 cycle stopped. Last cycle 6 months ago.

Bowels each 2nd day; feels sensation to go but canít, with bloated feeling, sometimes feet cramp, red cheeks, especially after exercise, eye twitching.

Pulse: slippery rapid, tense, liver wiry.

Tongue : teethmarks, Red tip, Yin Xu crack ( central ) with a very gray coat.

Other distinguishing features: no moons on any mails ( according to Chinese medical palmistry, this indicates sever weakness ).

Differential diagnosis: Liver Qi stasis, Kidney Yin Xu, heart fire;

1st TREATMENT 18/5/77

Acupuncture Spleen 10 ( Xue Hai ) very gentle insertion and no stimulation, caused her to nearly pass out, had to withdraw needles and massage Kidney 1 & GV 26. 

Tong Cao ( Medulla Tetrapanacis Papyriferi ) 2
Shan Zhi Zi ( Fructus Gardeniae Jasminoidis ) 3 Clear heat
Lian Qiao ( Fructus Forsythiae Suspensae ) 3 from heart
Chai Hu ( Radix Bupleuri ) 2
Bai Shao ( Radix Paeoniae Lactiflorae ) 3
Gan Cao ( Radix Glycyrrhizae Uralensis ) 2 Liver Qi stasis
Lu Lu Tong ( Fructus Liquidambaris Taiwanianae ) 2
Juan Bai (Selaginella tamariscina)
Sha Shen ( Radix Glehniae Littoralis ) 3 Nourish Yin
Yu Zhu ( Rhizoma Polygonati Odorati ) 2
Bo He ( Herba Menthae ) 1
Dan Pi ( Cortex Moutan Radicis ) 2

3 Packages

This treatment resulted in her sugar levels becoming more stable at 7.1 and sometimes going up to 10 and 11. The only other change was that her bowels were a bit better.

2nd TREATMENT : Yu Zhu ( Rhizoma Polygonati Odorati ) 3

Mai Dong ( Tuber Ophiopogonis Japonici ) 2

Bai Shao ( Radix Paeoniae Lactiflorae ) 3

Dang Gui ( Radix Angelicae Sinensis ) 3

Chai Hu ( Radix Bupleuri ) 1

Chuan Lian Zi ( Fructus Meliae Toosendan ) 1

Juan Bai (Selaginella tamariscina) 2

Sha Shen ( Radix Glehniae Littoralis ) 3

Chuan Xiong ( Radix Ligustici Wallichii ) 2

Hong Hua (Fos Carhami Tinctorii ) 1

Zhi Shi ( Fructus Citri seu Ponciri Immaturus ) 3

Lu Lu Tong ( Fructus Liquidambaris Taiwanianae ) 3

Mai Ya ( Fructus Hordei Vulgaris Germinantus ) 3

Ji Nei Jing ( Endithelium Corneum Gigeraiae Galli ) 3

3 Packages

Please note the small dose of Chai Hu to prevent its drying nature aggravating the Yin deficiency.

This treatment brought on a feeling that a cycle was coming but there were mood swings with crying spells. A more positive sign was noted because the gray coat had disappeared, that is the damp and heat had cleared.

I also continued acupuncture but only using 1 point, Sp 6, with very gentle needle manipulation.

3rd TREATMENT: Chai Hu ( Radix Bupleuri ) 2

Bai Shao ( Radix Paeoniae Lactiflorae ) 4

Zhi Shi ( Fructus Citri seu Ponciri Immaturus ) 3

Chuan Xiong ( Radix Ligustici Wallichii ) 2

He Huan Hua ( Flos Albizziae Julibrissin ) 2

Mai Ya ( Fructus Hordei Vulgaris Germinantus ) 4

Mu Hu Die ( Semen Oroxyli Indici ) 1

Sha Shen ( Radix Glehniae Littoralis ) 3

Wu Yao ( Radix Linderae Strychnifoliae ) 2

Juan Bai (Selaginella tamariscina) 3

Dang Gui ( Radix Angelicae Sinensis ) 3

Mai Dong ( Tuber Ophiopogonis Japonici ) 2

3 Packages

After this her cycle came, her red cheeks had lessened, and bowels were regular.

She continued treatment for 2 months ( weekly ) by which time her sugar readings were stable as well as having a regular cycle.

She saw her specialist 3 months later who commented that she was very good but had also picked up a slight deficiency in her thyroid.

In total she continued treatment ( infrequently, sometimes only each 3 weeks ) for a total of 7 months. There was emotional stress in her life ( ie. An imbalance in her seven emotions ) influencing the healing potential.

This example demonstrates the point that even if the patient would not of told me about her diabetes; just by treating the organ pathology of Liver Qi stasis to bring on her period, it had changed her sugar levels for the better. She discontinued treatment after 7 months as I believe she mainly wanted to have a regular cycle.

In summary this case has exemplified to me that TCM treatment can stabilize sugar levels with only a minimum of treatment.

Case History 4.

Female D.O.B 16/7/69 1st Presented 9/7/93

This case is of interest because she is a long term patient who I had seen before she developed her diabetes. She presented initially with migraines, tiredness, overweight ( with a family history ) asthma and phlegm.

I treated her and in which time she married and went overseas. Whilst overseas she was involved in a near fatal car accident ( her husband as killed ) involving severe head injuries.

Upon her return to Australia I started treating her for mental and physical shock and trauma. About 1 year after the accident she started to have sore eyes; excess thirst and urination, excess appetite and weight loss.

I started treating her for dryness and heat consuming Yin upsetting the Yin of stomach and lung.

Sha Shen ( Radix Glehniae Littoralis ) 3

Mai Dong ( Tuber Ophiopogonis Japonici ) 3

Tian Hua Fen ( Radix Trichosanthis ) 3

Wu Mei ( Fructus Pruni Mume ) 2

Ren Shen Ye ( Folium Ginseng ) 2

Xia Gu Cao ( Spica Prunellae Vulgaris ) 3

Chi Shao ( Radix Paeoniae Rubra ) 2

Chuan Xiong ( Radix Ligustici Wallichii ) 1

Gan Cao ( Radix Glycyrrhizae Uralensis ) 2

Fu Shen ( Sclerotium Poriae Cocos Pararadicis ) 3

3 Packages

Shortly after this she saw a specialist who diagnosed her diabetes condition.

She has continued treatment for about 3 years ( on and off ).

Another example of the treatment given was:

Lu Geng ( Rhizoma Phragmitis Communis ) 4

Zhu Ru ( Gaulis Bambusae in Taeniis ) 3

Mai Dong ( Tuber Ophiopogonis Japonici ) 3

Shi Gao ( Gypsum ) 3

Gan Cao ( Radix Glycyrrhizae Uralensis ) 2

Yu Zhu ( Rhizoma Polygonati Odorati ) 3

Wu Mei ( Fructus Pruni Mume ) 2

Su Ye ( Folium Perillae Frutescentis ) 2

Sang Ye ( Folium Mori Albae ) 3

Xia Gu Cao ( Spica Prunellae Vulgaris ) 3

Huang Qin ( Radix Scutellariae Baicalensis ) 2

Cang Er Zi ( Fructus Xanthii ) 2

3 Packages

The herb Cang Er Zi was added because of an acute situation ( runny nose & allergy )

Recently; her headaches had been getting very severe which led me to conclude that the underlying blood stasis from the car accident was the main factor casing the complication of diabetes, in concurrence with the other organ pathologies.

One example of the treatment was as follows:

Ji Xue Teng ( Radix et Caulis Jixueteng ) 3
Tao Ren ( Semen Persicae ) 2
Hong Hua ( Flos Carthami Tinctorii ) 1
Chuan Xiong ( Radix Ligustici Wallichii ) 2
Di Long ( Lumbricus ) 3
Deng Xin Cao ( Medulla Junci Effusi ) 3
Xia Gu Cao ( Spica Prunellae Vulgaris ) 2
Huang Qin ( Radix Scutellariae Baicalensis ) 3
Lu Geng ( Rhizoma Phragmitis Communis ) 3
Tian Hua Fen ( Radix Trichosanthis ) 3
Sha Shen ( Radix Glehniae Littoralis ) 3
Dang Gui ( Radix Angelicae Sinensis ) 3

3 Packages

It is observed here that the formula addresses blood stasis, dryness and Yin deficiency simultaneously.

When she goes on a "no TCM treatment" phase her sugar levels fluctuate widely and then resumes treatment again.

In summary with the 4 cases shown: results are promising and one can conclude more stable sugar levels can be achieved, lowering of excess high levels, relief and minimization of associated symptoms are possible.

Further experience and research may be able to offer permanent cure.

SUMMARY

Research done in the United States by Institute of Traditional Chinese Medicine on diabetes says "In general , better results are obtained with acupuncture and with Chinese herbs when it is stated earlier in the chronic process rather than later ,when many complications may have developed." Results would also be much be much more impressive if there was more intensity of treatment such as daily acupuncture instead of weekly and individual herb formulae instead of prescribing one pill across the board .The fact that 1 in 4 individuals could stop all their insulin leaves quite an optimistic outlook for someone with diabetes.


References:

  • "Practical Traditional Chinese Medicine & Pharmacology Clinical Experiences" by Shang Sianmon, Junying, Huaitang, Ziyu and Yuanroong, New World Press, Beijing.
  • "Clinical Essentials of Traditional Medicine in contemporary China". Editor in chief: Hong Jiahe. Publishing house of Shanghai College of Traditional Chinese Medicine.
  • "Treatment of Diabetes with acupuncture and herbs" by Subhuti Dharmanarda, Institute for Traditional Medicine, Portland, Oregon. September 1996 ( internet article )
  • "Diabetes Mellitus : West meets East, some Reflections upon TCM Theory", by Ted Davis, Australian Journal of TCM, Vol.6, No.1, April 1991.
  • "Treatment of Diabetes with TCM", by Chen Jinding, Shandong Science and technology Press, Jinan, China.
  • "Acupuncture, a comprehensive text", Shanghai College of Traditional Medicine, by John OíConnor and Dan Bensky, Eastland Press, Chicago.
  • "Chinese herbal medicine, Materia Medica", by Dan Bensky, Randell Barolet, Eastland Press, Seattle, 1990
  • "The Journal of Chinese Medicine" Number 57, May 1998, Article: Gu syndrome by Heiner Fruehauf.
  • "Li Shi Zhen's Ben Cao ( Chinese Medicinal Herbs )" translated by F.Porter Smith & G. A. Stuart. Georgetown Press, San Francisco 1973. 5th edition: 1980
  • "Differentiation of eye diseases" by Gary Seifert, Lecture notes, Sydney College of TCM.
  • "Chinese Medical Palmistry" by Xiao-fan Zong & Gary Liscum, Blue Poppy Press, 1995.
  • "Taber's Cyclopedic Medical Dictionary" by Clayton L. Thomas, 1979.
  • "Principles Of Anatomy and Physiology" by Tortora & Grabowski, Harper Collins College Publishers, 1993.

 

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