3: DIABETES MODERN MEDICINE AND TRADITIONAL CHINESE MEDICINE - PART THREE

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>DIABETES: MODERN MEDICINE AND TRADITIONAL CHINESE MEDICINE - PART THREE

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> DIABETES: MODERN MEDICINE AND TRADITIONAL CHINESE

>MEDICINE - PART THREE

> By Clinton J. Choate L.Ac.

>

> According to TCM, diabetes mellitus is classified as

>upper, middle or lower xiao-ke (wasting and thirsting syndrome) and is

>generally characterised by thirst, hunger, frequent urination and wasting

>(footnote). Cloudy urine and sugar in the urine may also accompany these

>symptoms, each of which is said to have a predominant symptom - excessive

>thirst in the upper jiao (Lung), excessive appetite in the middle jiao

>(Stomach) and excessive urination in the lower jiao (Kidney).

>

> a.. Upper xiao-ke syndrome is characterised by Lung

>heat drying up body fluids leading to great thirst, restlessness, dry

>cough, dry skin, hoarseness, dry red tongue with or without cracks, a thin

>yellow tongue coating, and a forceful rapid pulse especially at the cun

>(distal) position.

> b.. Middle xiao-ke syndrome is characterised by

>Stomach fire leading to excessive appetite and constant hunger, desire to

>drink cold liquids, burning sensation in the epigastrium, constipation, a

>red tongue with a thick yellow coating, and a slippery-forceful-rapid

>pulse.

> c.. Lower xiao-ke syndrome is characterised by Kidney

>yin deficiency where there is excessive urination (clear or turbid), dry

>mouth at night, night sweating, sore back and aching bones, red-peeled

>tongue, and a deep-thready-rapid pulse.

> d.. Lower xiao-ke syndrome with deficiency of both

>Kidney yin and yang (with the latter more pronounced) is characterised by

>frequent urination of turbid urine especially at night, soreness and

>weakness of the lower back and knees, aversion to cold, lassitude,

>impotence, a pale red tongue with teethmarks and a white tongue coating,

>and a deep-thready-weak pulse.

> Xiao-ke is attributed to three main factors: improper

>diet, emotional disturbance, and a constitution that is yin deficient1.

>

> a.. Improper diet refers to irregular eating and

>drinking habits which damage the transporting and transforming functions of

>the Spleen and Stomach. The accumulated food in turn generates internal

>heat that consumes the fluids, thus bringing on wasting and thirsting.

> b.. Prolonged emotional disturbance contributes to

>wasting and thirsting by hindering the flow of qi. Over-thinking damages

>the Spleen. Anger, resentment and frustration lead to constrained Liver qi

>which transforms into heat and fire and consumes the yin of the Lung and

>Stomach. Excessive worry damages the Kidneys and weakens the qi.

> c.. When an individual is constitutionally yin

>deficient, factors such as prolonged stress or illness, overwork or

>excessive sexual activity can consume the essence. The result is Kidney yin

>deficiency that can be mixed with Lung and Stomach yin deficiency symptoms

>as well as with Kidney yang deficiency.

> Similarities

>

> a.. Polyuria (excessive urination), polydipsia

>(excessive thirst), polyphagia (excessive hunger), weight loss.

> Differences

>

> a.. Increase in blood glucose level in diabetes

>mellitus, which is not necessarily seen in xiao-ke.

> b.. Various complications associated with diabetes

>mellitus such as visual disturbances, impotence, infection and neuropathies

>are not necessarily seen in xiao-ke.

> c.. Many conditions can cause polyuria or polydipsia

>in xiao-ke such as fever, dehydration and Kidney disease that are not

>necessarily seen in diabetes mellitus.

> In reality there is usually a mixture of all the

>symptoms, although one often predominates slightly. By analysis of the

>symptoms, one should be able to determine which organ, whether the Lung,

>Stomach or Kidney is most yin deficient and therefore have a focus for

>treatment.

>

> HERBAL MEDICINE TREATMENT

>

> While acupuncture is a distinctive feature of

>traditional Chinese medicine, China's herbal medicine has many parallels

>to, and is a part of the general quest for effective medicines to treat

>illness. Our ancestors recognised their dependence upon nature in both

>health and sickness. Led by instinct, taste and experience, they used

>plants, animal parts and minerals that did not belong to their usual diet.

>Until well into the 20th century, much of the pharmacopoeia of scientific

>medicine was derived from just this type of herbal lore. Today in the

>United States, about one quarter of the prescriptions dispensed by

>pharmacies contain at least one active ingredient derived from plant

>material.

>

> The 20th century has also seen a revival of more natural

>medicine as an outcome of increasing disenchantment with conventional

>medicine. By utilising natural substances together in their whole form in

>accurate formulations, effectiveness will be maximised and side effects

>minimised. This is contrary to conventional medicine that extracts or

>synthesises active chemicals that often, over time, produce drastic side

>effects due to their partiality.

>

> The following section lists the herbs and herbal

>formulations that, through time-tested usage and modern pharmacological

>research have demonstrated their effectiveness in treating xiao-ke. Two of

>the more frequent formulas used for this purpose in China and Japan today

>were first described in the book Jin Gui Yao Lue, written around 200 CE.

>One is Ba Wei Di Huang Tang (Eight-Ingredient Pill with Rehmannia) which

>was originally prescribed for persons showing weakness, fatigue and copious

>urination soon after drinking water. In some cases, this may have been

>diabetes as we know it today. The other is Bai Hu Jia Ren Shen Tang (White

>Tiger Plus Ginseng Decoction), which was prescribed for severe thirst and

>fatigue. This formula, considered ideal for diabetes of recent onset, is

>used more frequently for this today in Japan than in China2.

>

> 1. Representative herbs and formulas for treating

>according to the three jiao differentiation

>

> Upper jiao: excessive thirst predominant (Lung yin

>deficiency)

>

> Treatment Principle: clear heat and moisten the Lung.

>

> Single Herbs

> Xi Yang Shen (Radix Panacis Quinquefolii)

> Zhi Mu (Radix Anemarrhenae Asphodeloidis)

> Bai He (Bulbus Lilii)

> Sha Shen (Radix Glehniae Littoralis)

> Wu Mei (Fructus Pruni Mume)

> Mai Men Dong (Tuber Ophiopogonis Japonici)

> Ge Gen (Radix Puerariae)

> Sheng Di Huang (Radix Rehmanniae Glutinosae)

> Huang Qin (Radix Scutellariae Baicalensis)

> Tian Hua Fen (Radix Trichosanthis)

>

> Formulas

>

> 1. Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng

>Decoction): Shi Gao (Gypsum), Zhi Mu (Radix Anemarrhenae Asphodeloidis),

>Zhi Gan Cao (Radix Glycyrrhizae Uralensis), Geng Mi (Semen Oryzae). Action:

>Tonifies qi, clears qi-level heat, drains Stomach fire, generates fluids,

>and alleviates thirst.

>

> Modifications

>

> a.. substitute Xi Yang Shen (Radix Panacis

>Quinquefolii) for Ren Shen (Radix Ginseng), and omit Geng Mi (Semen

>Oryzae).

> b.. combine with Tian Hua Fen (Radix Trichosanthis),

>Lu Gen (Rhizoma Phragmitis Communis) and Mai Men Dong (Tuber Ophiopogonis

>Japonici).

> 2. Er Dong Tang (Asparagus & Ophiopogon Combination):

>Tian Men Dong (Tuber Asparagi Cochinchinensis), Mai Men Dong (Tuber

>Ophiopogonis Japonici), Tian Hua Fen (Radix Trichosanthis), Zhe Bei Mu

>(Bulbus Fritillariae Thunbergii), Huang Qin (Radix Scutellariae

>Baicalensis), Gan Cao (Radix Glycyrrhizae Uralensis), Ren Shen (Radix

>Ginseng) and He Ye (Folium Nelumbinis Nuciferae)3. Action: Nourishes yin,

>generates fluids, clears deficient heat.

>

> 3. Mai Men Dong Yin Zu (Ophiopogon and Trichosanthis

>Combination): Mai Men Dong (Tuber Ophiopogonis Japonici), Zhi Mu (Radix

>Anemarrhenae Asphodeloidis), Fu Ling (Sclerotium Poriae Cocos), Zhu Ru

>(Caulis Bambusae in Taeniis), Xi Yang Shen (Radix Panacis Quinquefolii), Ge

>Gen (Radix Puerariae), Wu Wei Zi (Fructus Schisandrae Chinensis), Tian Hua

>Fen (Radix Trichosanthis), Sheng Di Huang (Radix Rehmanniae Glutinosae),

>Gan Cao (Radix Glycyrrhizae Uralensis)4. Action: Nourishes yin, clears Lung

>heat, relieves coughing.

>

> Middle jiao: excessive hunger predominant (Stomach yin

>deficiency)

>

> Treatment Principle: clear Stomach heat and promote

>fluids.

>

> Single Herbs

> Zhi Mu (Radix Anemarrhenae Asphodeloidis)

> Huang Lian (Rhizoma Coptidis)

> Shan Zhi Zi (Fructus Gardeniae Jasminoidis)

> Sheng Shi Gao (Gypsum)

> Huang Jing (Rhizoma Polygonati)

> Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae)

> Mai Men Dong (Tuber Ophiopogonis Japonici)

>

>

> Formulas

>

> 1. Yu Nu Jian (Jade Woman Decoction): Shi Gao (Gypsum),

>Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae), Zhi Mu (Radix

>Anemarrhenae Asphodeloidis), Mai Men Dong (Tuber Ophiopogonis Japonici),

>Niu Xi (Radix Achyranthis Bidentatae). Actions: Eliminates intense heat or

>fire from the Stomach; to replenish the yin.

>

> 2. Zheng Yi Cheng Qi Tang (Increase the Fluid and Order

>the Qi Decoction): Da Huang (Rhizoma Rhei), Mang Xiao (Mirabilitum), Xuan

>Shen (Radix Scrophulariae Ningpoensis), Mai Men Dong (Tuber Ophiopogonis

>Japonici) and Sheng Di Huang (Radix Rehmanniae Glutinosae)5. Actions:

>Enriches yin, generates fluids, drains heat and unblocks the bowels

>

> Lower jiao: excessive urination predominant

>

> 1. Kidney yin deficiency

>

> Treatment principle: Nourish and reinforce Kidney yin,

>eliminate deficiency heat.

>

> Single Herbs

> Ze Xie (Rhizoma Alismatis Plantago-aquaticae)

> Fu Ling (Sclerotium Poriae Cocos)

> Shan Zhu Yu (Fructus Corni Officinalis)

> Shan Yao (Radix Dioscoreae Oppositae)

> Huang Bai (Cortex Phellodendri)

> Bie Jia (Carapax Amydae Sinensis)

> Huang Jing (Rhizoma Polygonati)

> Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae)

>

> Representative Formulas

>

> 1. Liu Wei Di Huang Wan (Six-Ingredient Pill with

>Rehmannia).

> 2. Zuo Gui Wan (Restore the

Kidney Pill).

> 3. Da Bu Yin Wan (Great Tonify the Yin Pill)6.

> 4. Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and

>Rehmannia Pill). Quells ascending yang in the mingmen with such symptoms as

>frequent small amounts of concentrated dark urine.

>

> 2. Kidney yang deficiency

>

> Treatment principle: Tonify Kidney yang; astringe urine.

>Single Herbs

>

> Fu Zi (Radix Aconiti Carmichaeli Praeparatae)

> Ze Xie (Rhizoma Alismatis Plantago-aquaticae)

> Rou Gui (Cortex Cinnamomi Cassiae)

> Fu Ling (Sclerotium Poriae Cocos)

> Shan Zhu Yu (Fructus Corni Officinalis)

> Shan Yao (Radix Dioscoreae Oppositae)

> Mu Dan Pi (Cortex Moutan Radicis)

> Lian Xu (Stamen Nelumbinis Nuciferae)

> Lian Zi (Semen Nelumbinis Nuciferae)

> Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae)

>

> Representative Formulas

>

> 1. You Gui Wan (Restore the

Kidney Pill).

> 2. Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden

>Cabinet).

> 3. Qi Wei Du Qi Wan (Seven Herbs to Guide the Qi Pills)7

>: Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae), Shan Zhu Yu

>(Fructus Corni Officinalis), Shan Yao (Radix Dioscoreae Oppositae), Wu Wei

>Zi (Fructus Schisandrae Chinensis), Mu Dan Pi (Cortex Moutan Radicis), Fu

>Ling (Sclerotium Poriae Cocos), Ze Xie (Rhizoma Alismatis

>Plantago-aquaticae) plus

> 4. Suo Quan Wan (Shut the Sluice Pill).

>

> All replenish the yang [vital function] of the Kidney to

>warm the lower part of the body and curb excessive urination. Formula 4

>should be combined with either 1, 2 or 3 to further help the Kidney

>reassert its control over the functions of the Bladder to reduce frequency

>of urination.

>

> 2. General Treatment with Modifications8

>

> The clinical presentation of patients with diabetes can

>be summarised as yin deficiency with dryness and heat. As an empirical

>treatment Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia)

>together with Yu Nu Jian (Jade Woman Decoction) can be used.

>

> Modifications

>

> a.. To address high cholesterol add Shan Zha (Fructus

>Crataegi), He Shou Wu (Radix Polygoni Multiflori) and Sang Ji Sheng (Ramus

>Loranthi seu Visci).

> b.. To address coronary artery disease add Gua Lou Pi

>(Pericarpium Trichosanthis), Dan Shen (Radix Salviae Miltiorrhizae) and

>Jiang Xiang (Lignum Dalbergiae Odoriferae).

> 3. Modern Research Formula: " EquilibriumTM " 9

>

> EquilibriumTM is an herbal formula developed jointly by

>professor Xiao-Ping Zhang of Anhui Hospital of Traditional

>and Lotus Herbs Inc. It is an empirical formula designed to treat patients

>with diabetes mellitus. It has been used successfully for over 30 years in

>China and has helped several thousands of patients with diabetes mellitus.

>

> Western Therapeutic Action

>

> a.. Lowers blood glucose

> b.. Lowers blood cholesterol

> c.. Improves blood circulation to the coronary

>arteries and peripheral parts of the body

> Ingredients

>

> Xi Yang Shen (Radix Panacis Quinquefolii)

> Shi Gao (Gypsum)

> Zhi Mu (Radix Anemarrhenae Asphodeloidis)

> Xuan Shen (Radix Scrophulariae Ningpoensis)

> Huang Qi (Radix Astragali)

> Shan Yao (Radix Dioscoreae Oppositae)

> Cang Zhu (Rhizoma Atractylodis)

> Bai Zhu (Rhizoma Atractylodis Macrocephalae)

> Dan Shen (Radix Salviae Miltiorrhizae)

> Hong Hua (Flos Carthami Tinctorii)

> Lian Zi Xin (Plumula Nelumbinis Nuciferae)

> Lian Xu (Nelumbinis Nuciferae Stamen)

> This formula addresses both the cause of, and the

>symptoms that arise from, yin deficiency with dryness and heat.

>

> Explanation

>

> Xi Yang Shen greatly replenishes the vital essence of

>the body and promotes the secretion of body fluids. Shi Gao and Zhi Mu are

>a commonly used pair to treat heat in the middle jiao. Together they sedate

>Stomach fire and relieve thirst by generating fluids. Xuan Shen enters the

>Lung, Stomach and Kidneys to replenish the vital essence and simultaneously

>clear heat. Huang Qi and Fu Ling strengthen the Spleen and enhance its

>function of transportation and transformation. Bai Zhu and Cang Zhu

>strengthen the Spleen and dry up dampness. Dan Shen and Hong Hua activate

>blood circulation and enhance the overall effectiveness of the herbs.

>Activation of blood circulation will also reduce the risk of

>atherosclerosis by preventing build-up of cholesterol on the inner walls of

>the blood vessels. Lastly Lian Zi Xin and Lian Xu tonify the Kidneys and

>control frequent urination.

>

> Formula explanation according to modern research

>Diabetes mellitus is defined simply as a rise in blood glucose level. Its

>clinical manifestations, however, are much more complicated than its

>definition. Patients with diabetes mellitus are frequently plagued by

>various complications such as visual disturbance, and increase in blood

>cholesterol and lipid levels.

>

> Treatment of diabetes mellitus therefore, must focus on

>treating the cause and the symptoms simultaneously. Xi Yang Shen is most

>commonly used for its effect to tonify qi. In terms of western physiology,

>tonification of qi enhances the ability of the cells to utilise glucose as

>energy and prevent synthesis of glucose. Clinically, Xi Yang Shen has

>demonstrated its effectiveness in lowering blood glucose and cholesterol

>levels10. Shi Gao and Zhi Mu also lower blood glucose levels and relieve

>indigestion, whilst Xuan Shen and Cang Zhu lower blood glucose levels and

>reduce build-up of cholesterol within the blood vessels. The combination of

>these herbs has excellent hypoglycaemic effects and reduces the risk of

>long-term atherosclerosis11. Dan Shen and Hong Hua are used to improve the

>blood circulation and minimise long-term complications. Studies have

>demonstrated that Dan Shen improves micro-circulation to the peripheral

>parts of the body, increases blood flow to coronary arteries, and lowers

>both blood cholesterol and blood sugar.

>

> 4. Individual Herb Properties

>

> Ze Xie (Rhizoma Alismatis Plantago-aquaticae)

> Sweet, bland, cold. Enters the Kidneys and Bladder.

>Promotes urination, leaches out dampness without injuring yin, and lowers

>blood pressure and blood glucose. In classical texts Ze Xie is recommended

>as an adjunctive herb for wasting and thirsting syndrome.

>

> Zhi Mu (Radix Anemarrhenae Asphodeloidis)

> Bitter, cold. Enters the Lung, Kidneys and Stomach.

>Clears heat, quells fire and generates fluids. Combine with Tian Hua Fen

>(Radix Trichosanthis).

>

> Tian Men Dong (Tuber Asparagi Cochinchinensis)

> Sweet, bitter, cold. Enters the Lung and Kidneys.

>Moistens the Lung and nourishes the Kidneys; used for patterns of

>deficiency of Lung and Kidney yin.

>

> Huang Qi (Radix Astragali)

> Sweet, neutral. Enters the Spleen, Lung and Heart.

>Strengthens the Spleen and benefits qi. Used for deficient Spleen and

>Stomach with fatigue and lack of appetite. Tonifies the Lung and stabilises

>the exterior. Combine with Shan Yao and Sheng Di Huang (Radix Rehmanniae

>Glutinosae) for wasting and thirsting.

>

> Cang Zhu (Rhizoma Atractylodis)

> Acrid, bitter, warm, aromatic. Enters the Spleen and

>Stomach. Dries dampness and strengthens the Spleen. Initially raises blood

>glucose then significantly lowers it.

>

> Bai Zhu (Rhizoma Atractylodis Macrocephalae)

> Bitter, sweet, warm. Enters the Spleen and Stomach.

>Tonifies the Spleen and benefits qi, dries dampness. Used for such symptoms

>as fatigue, poor appetite, nausea. Increases assimilation of glucose and

>lowers plasma glucose levels.

>

> Dang Shen (Radix Codonopsis Pilosulae)

> Sweet, neutral. Enters the Spleen and Lung. Strengthens

>qi, nourishes fluids, tonifies the middle jiao. In general the functions of

>this herb are analogous to Ren Shen (Radix Ginseng) although not as strong.

>Clinically used to tonify the qi of the Spleen and Lung. Dang Shen has a

>vasodilatory effect on terminal blood vessels.

>

> Shi Hu (Herba Dendrobii)

> Sweet, slightly salty, bland, cold. Enters the Stomach,

>Lung and Kidneys. Nourishes deficient Stomach yin. Combine with Mai Men

>Dong (Tuber Ophiopogonis Japonici) and Tian Hua Fen (Radix Trichosanthis)

>for abdominal discomfort associated with Stomach yin deficiency.

>

> Shan Yao (Radix Dioscoreae Oppositae)

> Sweet, neutral. Enters the Spleen, Lung and Kidneys.

>Benefits the Lung and nourishes the Kidneys (yin and yang). Combine with

>Tian Hua Fen (Radix Trichosanthis) for irritability and thirst associated

>with injured fluids.

>

> Ren Shen (Radix Ginseng)

> Sweet, slightly bitter, slightly warm. Benefits yin and

>generates fluids. Tonifies the Lung and benefits qi; strengthens the Spleen

>and Stomach; benefits the Heart and calms the spirit. Some patients can

>lower their insulin requirement by taking this herb.

>

> Gan Cao (Radix Glycyrrhizae Uralensis)

> Sweet, neutral (raw); sweet, warm (honey-baked). Enters

>all twelve primary channels (principally the Stomach and Spleen). Tonifies

>the Spleen and benefits qi: commonly used for Spleen deficiency patterns.

>

> Gou Qi Zi (Fructus Lycii Chinensis)

> Sweet, neutral. Enters the Liver and Kidneys. Nourishes

>and tonifies the Liver and Kidneys; used for yin and blood deficiency.

>

> Di Gu Pi (Cortex Lycii Chinensis Radicis)

> Sweet, cold. Enters the Lung, Kidneys and Liver; quells

>fire from yin deficiency, alleviates cough from Lung heat, lowers blood

>pressure. First slightly raises serum glucose then steadily lowers it; does

>not counteract the hyperglycaemic effect of adrenaline.

>

> Sang Shen Zi (Fructus Mori Albae)

> Sweet, cool. Enters the Liver and Kidneys. Nourishes yin

>and blood. Combine with Ji Xue Teng (Radix et Caulis Jixueteng) for yin

>deficiency.

>

> Mai Men Dong (Tuber Ophiopogonis Japonici)

> Sweet, slightly bitter, slightly cold. Enters the Lung,

>Stomach and Heart. Nourishes yin and clears heat. Experimentally has

>lowered serum glucose, speeded recovery of Islets of Langerhans, and

>increased glycogen storage levels in rabbits with artificially induced

>diabetes mellitus.

>

> Huang Bai (Cortex Phellodendri)

> Bitter, cold. Enters the Kidneys, Bladder and Large

>Intestine. Eliminates heat and dampness, sedates fire and detoxifies,

>reduces deficiency heat. Increases pancreatic secretions, lowers blood

>pressure and blood sugar.

>

> Huang Jing (Rhizoma Polygonati)

> Sweet, neutral. Enters the Spleen and Lung. Tonifies the

>Spleen; used for deficiency of Spleen or Stomach and debility after

>prolonged illness. Tonifies essence after a chronic wasting disease.

>Combine with Shan Yao (Radix Dioscoreae Oppositae) and Huang Qi (Radix

>Astragali).

>

> Yu Zhu (Rhizoma Polygonati Odorati)

> Sweet, slightly cold. Enters the Lung and Stomach.

>Nourishes yin and moistens dryness. Used for Lung and Stomach dry heat or

>deficient yin patterns with cough, dry throat, irritability, thirst and

>intense hunger, and constipation.

>

> He Shou Wu (Radix Polygoni Multiflori)

> Bitter, sweet, astringent, slightly warm. Enters the

>Liver and Kidneys. Tonifies the Liver and Kidneys, nourishes blood,

>benefits the essence; used for deficient yin or blood patterns. Decreases

>absorption of cholesterol; initially increases serum glucose, then lowers

>it.

>

> Fu Ling (Sclerotium Poriae Cocos)

> Sweet, bland, neutral. Enters the Heart, Spleen and

>Lung. Strengthens the Spleen and harmonises the middle jiao; transforms

>phlegm and eliminates dampness.

>

> Wu Mei (Fructus Pruni Mume)

> Sour, warm. Enters the Liver, Spleen, Lung and Large

>Intestine. Generates fluids, alleviates thirst: used for thirst from

>deficiency heat or deficient qi and yin. Combine with Tian Hua Fen (Radix

>Trichosanthis) for thirst and irritability from injured fluids.

>

> Ge Gen (Radix Puerariae)

> Sweet, acrid, cool. Enters the Spleen and Stomach.

>Nourishes fluids and alleviates thirst, especially from Stomach heat.

>Combine with Tian Hua Fen (Radix Trichosanthis) and Mai Men Dong (Tuber

>Ophiopogonis Japonici) for thirst.

>

> Xi Yang Shen (Radix Panacis Quinquefolii)

> Sweet, bitter, cool. Enters the Lung, Stomach and

>Kidneys. Benefits qi, generates fluids and nourishes yin; especially good

>for deficient yin with heat signs such as weakness, irritability and

>thirst. Combine with Shi Gao (Gypsum) and Zhi Mu (Radix Anemarrhenae

>Asphodeloidis) for thirst where fluids are injured.

>

> Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae)

> Sweet, slightly warm. Enters the Liver, Kidneys and

>Heart. Nourishes the yin especially of the Kidneys. Lowers blood pressure

>and serum cholesterol.

>

> Sheng Di Huang (Radix Rehmanniae Glutinosae)

> Sweet, bitter, cold. Enters the Liver, Kidneys and

>Heart. Clears heat, cools blood, nourishes yin and blood and generates

>fluids. Used for deficient yin patterns with heat signs and injury to body

>fluids. Lowers serum glucose levels. Combine with Xuan Shen (Radix

>Scrophulariae Ningpoensis) for excessive thirst, irritability and a scarlet

>tongue.

>

> Wu Wei Zi (Fructus Schisandrae Chinensis)

> Sour, warm. Enters the Lung and Kidneys. Restrains

>essence. Used for deficient Lung and Kidney patterns. Calms the spirit.

>Recent reports state this herb increases usage of both liver glycogen

>stores and serum glucose. Combine with Dang Shen (Radix Codonopsis

>Pilosulae) and Mai Men Dong (Tuber Ophiopogonis Japonici) for symptoms

>associated with exhaustion from qi and yin.

>

> Xuan Shen (Radix Scrophulariae Ningpoensis)

> Salty, slightly bitter, cold. Enters the Lung, Stomach

>and Kidneys. Nourishes yin, clears heat. Lowers blood sugar, dilates blood

>vessels.

>

> Tian Hua Fen (Radix Trichosanthis)

> Bitter, slightly sweet, sour, cool. Enters the Lung and

>Stomach. Quells heat, promotes fluids. Combine with Sha Shen (Radix

>Glehniae Littoralis), Mai Men Dong (Tuber Ophiopogonis Japonici) and Sheng

>Di Huang (Radix Rehmanniae Glutinosae) for injury to yin from Stomach heat.

>

> 5. Review of herbs with hypoglycaemic effects12

>

> Wu Jia Pi (Cortex Acanthopanacis Radicis)

> Cang Zhu (Rhizoma Atractylodis)

> Bai Zhu (Rhizoma Atractylodis Macrocephalae)

> Ze Xie (Rhizoma Alismatis Plantago-aquaticae)

> Ren Shen (Radix Ginseng)

> Di Gu Pi (Cortex Lycii Chinensis Radicis)

> Mai Men Dong (Tuber Ophiopogonis Japonici)

> Huang Bai (Cortex Phellodendri)

> He Shou Wu (Radix Polygoni Multiflori)

> Huang Jing (Rhizoma Polygonati)

> Sheng Di Huang (Radix Rehmanniae Glutinosae)

> Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae)

> Xuan Shen (Radix Scrophulariae Ningpoensis)

>

>

> Herb pairs with hypoglycaemic effects13

>

> a.. Zhi Mu (Radix Anemarrhenae Asphodeloidis) and Shi

>Gao (Gypsum): best used when there is Stomach heat present.

> b.. Xuan Shen (Radix Scrophulariae Ningpoensis) and

>Cang Zhu (Rhizoma Atractylodis): best used when there is yin deficiency

>with excessive damp present.

> c.. Shan Yao (Radix Dioscoreae Oppositae) and Huang Qi

>(Radix Astragali): best used when Spleen deficiency symptoms are present.

>Do not use the honey-processed Mi Huang Qi.

> 7. Example of a herbal prescription14

>

> Basic formula

>

> Ren Shen (Radix Ginseng) 6-10g

> Dang Shen (Radix Codonopsis Pilosulae) 30g

> Sheng Shi Gao (Gypsum) 30g

> Zhi Mu (Radix Anemarrhenae Asphodeloidis) 10g

> Huang Lian (Rhizoma Coptidis) 10g E Jiao (Gelatinum

>Asini) 10g Bai

> Shao (Radix Paeoniae Lactiflorae) 18g

> Tian Hua Fen (Radix Trichosanthis) 15-30g

> Ge Gen (Radix Puerariae) 30g

> Shan Yao (Radix Dioscoreae Oppositae) 15g

> He Shou Wu (Radix Polygoni Multiflori) 30g

> Dan Shen (Radix Salviae Miltiorrhizae) 15g

> Chuan Xiong (Radix Ligustici Wallichii) 12g

> Huang Jing (Rhizoma Polygonati) 15-30g

> Mai Men Dong (Tuber Ophiopogonis Japonici) 15-30g

> Tian Men Dong (Tuber Asparagi Cochinchinensis) 15g

> Sheng Di Huang (Radix Rehmanniae Glutinosae) 15g

>

> Modifications

>

> a.. Upper jiao symptoms predominant: add Bai He

>(Bulbus Lilii) 10g, Wu Mei (Fructus Pruni Mume) 10g, Tian Hua Fen (Radix

>Trichosanthis) 30g, Sha Shen (Radix Glehniae Littoralis) 30g.

> b.. Middle jiao symptoms predominant: add Shu Di Huang

>(Radix Rehmanniae Glutinosae Conquitae) 30g, Shi Gao (Gypsum) 30g, Huang

>Jing (Rhizoma Polygonati) 15g.

> c.. Lower jiao symptoms predominant: add Rou Gui

>(Cortex Cinnamomi Cassiae) 6g, Fu Zi (Radix Aconiti Carmichaeli

>Praeparatae) 6-10g, Hong Shen (Radix Ginseng) 15g.

> d.. If thick greasy yellow tongue coating: add Cang

>Zhu (Rhizoma Atractylodis) 15g, Bai Zhu (Rhizoma Atractylodis

>Macrocephalae) 20g, Jin Qian Cao (Herba Jinqiancao) 30g.

> e.. If loose stools or diarrhoea: add Yi Yi Ren (Semen

>Coicis Lachryma-jobi) 30g, Mu Xiang (Radix Saussureae seu Vladimirae) 15g.

>Subtract: Sheng Di Huang (Radix Rehmanniae Glutinosae).

> f.. If blood stagnation and pain: add Tao Ren (Semen

>Persicae) 10g, Hong Hua (Flos Carthami Tinctorii) 6g.

> The above formula, with additions and subtractions, is

>provided only as a general guide since each patient¹s signs and symptoms

>must be considered when prescribing their own individualised formula. The

>formula represents a one-day¹s dose. Herbs are combined in a non-reactive,

>glass or ceramic cooking pot covered with water and brought to a boil.

>Reduce to simmer for 20-30 minutes with lid slightly ajar. Strain off

>liquid and repeat process a second time, simmering the herbs 30-40 minutes.

>Combined brewing should result in 3-4 cups of liquid. Drink warm or hot.

>

> 8. General patent formulas for diabetes

>

> The traditional method of preparing Chinese medicine is

>to boil and simmer raw herbs in an earthenware pot in accordance with

>strict instructions. Preparation and actual consumption of the medicine can

>take one to three hours. To make it more convenient, and to help insure

>patient compliance, medicinal formulations are now prepared for use in more

>than 30 different intake forms. These include pills, powders, granules,

>tablets, capsules, gelatins, medicinal wines and waters, medicinal teas,

>oral liquids, syrups, sprays, concentrates, injections and plasters.

>

> Following is a partial listing of Chinese patent

>formulations currently used for the treatment of diabetes and its

>complications. Inclusion does not imply endorsement by the author, rather

>they are offered for the reader's further investigation and study.

>

> Ci Wu Jia Pian

> A single herb (Acanthopanax senticosus) patent used to

>support endocrine gland functions in general and particularly in order to

>increase insulin production and to decrease blood sugar. A member of the

>Araliaceae family, and analogous to Siberian Ginseng (Eleutherococcus

>senticosus), this herb has been used for over 2000 years for its

>adaptogenic (normalising) and energising properties.

>

> Specific Juk Tsyn Wan

> Produces saliva, quenches thirst; relieves fever,

>alleviates mental uneasiness; vitalises blood activity, nourishes the

>Kidney; invigorates the nervous system and improves appetite. Kwangchow

>United Manufactory of , PRC

>

> Yuechung Pills, a.k.a. Yu Quan Wan [Jade Spring Pills]

> Nourishes yin, strengthens the Kidneys, Lung, and

>Spleen; dispels phlegm-heat; relieves thirst; circulates fluid; regulates

>the appetite; calms the spirit. A classical formula for " sugar urine

>disease " , used for both juvenile and insipid diabetes in mainland China.

>The United Pharmaceutical Manufactory, Sichuan, PRC

>

> Xiaoke Wan, a.k.a. " Diabetes Pill " 15

> Widely prescribed in Chinese hospitals and clinics today

>for reducing glucose levels and alleviating symptoms of diabetes and other

>related diseases. Xiaoke Wan has proven to be especially effective for

>treating mild and moderate cases of diabetes in which the pancreas is still

>partially functioning. The herbal components are Shu Di Huang (Radix

>Rehmanniae Glutinosae Conquitae), Huang Qi (Radix Astragali) and Tian Hua

>Fen (Radix Trichosanthis) which have the action of nourishing the Kidneys

>and yin, benefiting qi and promoting the production of fluids. In addition

>it also includes a small amount of the oral antidiabetic drug

>Glibenclamide. Zhong Yi Brand, Guangzhou Pharmaceutical Company Ltd., PRC.

>(see Appendix-Clinical Research).

>

> Yu Xiao San 880516 (*16 is a note)

> Designed to restore pancreatic function and to

>proliferate insulin beta cells, Yu Xiao San has been shown to gradually and

>effectively lower blood-sugar levels and increase insulin secretion. In

>addition it has been shown to regulate carbohydrate metabolism, improve

>blood circulation, lower blood cholesterol and increase immune response.

>The main herb components are Ramulus Euonymi Alatae, Niu Bang Zi (Fructus

>Arctii Lappae), Wei Ling Xian (Radix Clemetidis Chinensis), Di Gu Pi

>(Cortex Lycii Chinensis Radicis), E Zhu (Rhizoma Curcumae Zedoariae), Jie

>Geng (Radix Platycodi Grandiflori), Li Zhi He (Semen Litchi Chinensis) and

>Ren Shen (Radix Ginseng). This patent is currently also being produced in

>the US and marketed as a health food. (see Appendix-Clinical Research).

>

> Sugar-Reducing and Pulse-Invigorating Capsule17

> Effective in replenishing qi, nourishing yin, activating

>blood, and resolving stagnation. It has been proven clinically effective in

>correcting abnormalities in blood rheology, improving fat metabolism,

>enhancing the function of the islets of Langerhans, lowering blood sugar

>and alleviating clinical symptoms of diabetes. The formulation, which

>includes such herbs as Huang Qi (Radix Astragali) and Sheng Di Huang (Radix

>Rehmanniae Glutinosae), is noted for its effectiveness against the chief

>vascular complications of diabetes by reducing myocardial anoxia, (oxygen

>deprivation of heart tissue), improving left heart function, stimulating

>blood circulation to the brain, resisting coagulation, resolving

>thrombosis, and dilating the arteries of the legs. It is also has some

>proven benefit in early diabetic retinopathy and renal disease. (see

>Appendix-Clinical Research).

>

> Ji Wei Ling capsules, Zhong Ji Ling powders and others18

> A group of herbal preparations produced by the Special

>Department of Diabetes Medical Research, Xi Yuan Hospital to treat diabetic

>cardio-cerebral vascular disease and diabetic neuropathy. Statistics

>include 3,690 cases with complete medical records that demonstrate an

>overall effective rate of 95.2%. Many patients were noted to have regained

>their health to a degree where they were able to discontinue western

>medicine and insulin, thereby greatly decreasing their chances of diabetic

>complications. (see Appendix-Clinical Research).

>

> Appendix - Clinical Research

>

> Testing for Effectiveness of Commercially Available

>Patent Medicines

>

> Xiaoke Wan

> Indicated in cases of polydypsia, polyuria, polyphagia,

>emaciation, fatigue, sleeplessness, lumbago, and elevated sugar levels in

>blood and urine, Xiaoke Wan as a combination herbal and western drug*

>treatment for diabetes, has been the subject of many studies to establish

>its level of effectiveness. In one recent study (1994) a control group of

>22 patients were selected to take Xiaoke Wan as part of a one month

>clinical study in the treatment of diabetes by acupuncture. At the end of

>the trial period among the 22 control group participants, 12 cases were

>rated as effectively treated, 8 cases as markedly effective and 2 cases as

>ineffective. All but two of the patients showed decline in blood sugar and

>urinary sugar excretion and improvement in symptoms. More than one-third of

>the patients had marked improvement. Clearly none of these patients could

>be considered " cured " of diabetes, which would suggest sustained fasting

>blood-sugar levels below 100mg/dl, but as previous studies confirmed,

>Xiaoke Wan was demonstrated to be quite effective. " Markedly effective " was

>defined as having initial symptoms essentially disappear and their fasting

>blood-sugar levels drop to below 130mg/dl, and the 24-hour urine-sugar

>content was reduced by 30% or more compared to the beginning of treatment.

>For those deemed " effectively treated " symptoms were improved but not

>resolved, and fasting blood-sugar levels dropped to below 150mg/dl and the

>24-hour urinary excretion declined by at least 10% from initial values. If

>these standards were not met the treatment was deemed ineffective.

>

> * Contains glibenclamide, a.k.a., glipizide and

>glyburide. One of the more efficient oral antidiabetic drugs of the " second

>generation " of sulphonylureas, however certain precautions exist for

>pregnant women or persons with renal or hepatic insufficiency. More

>information on glibenclamide can be found at the Informed Drug Guide web

>site at: http://www.infomed.org/frames/glibfram-s.html

>

> Yu Xiao San 8805.

> From Feb. 1992 to Oct. 1992, 10,618 cases were selected

>based upon the diagnostic criteria established for diabetes mellitus by the

>World Health Organization. The patients were drawn for clinical assessment

>from the China Beijing Chao Yang District Red Cross Hospital and from 48

>comparable hospitals nationwide.

>

> Treatment Criteria and Result

>

> a.. Clinical Recovery: The preferred criterion: FPG

>(Fasting Plasma Glucose) <6.1 mmol/L (110 mg/dl), HbA1c <6.8%; symptoms and

>complications recovery; discontinuing medication after 3 months or more.

> b.. Prominent Effect: FPG <7.8 mmol/L (140 mg/dl),

>HbA1c <8%; symptoms improved and complications reduced.

> c.. Effective: FPG reduced 3.33 mmol/L (60 mg/dl),

>HbA1c <9%.

> d.. Ineffective: No evidence of symptom improvement

>and reduction of criteria established for diabetes mellitus.

> Results

>

> After 4 months of treatment and monitoring, of patients

>with Type 1 diabetes, 84 (6.80%) demonstrated clinical recovery, 106

>(8.58%) prominent effect, 144 (11.65%) some effect, and 902 (72.98%) no

>effect. Over the same period, 1794 (19.12%) patients with Type 2 diabetes

>demonstrated clinical recovery, 2346 (25.01%) prominent effect, 3835

>(40.88%) some effect, and 1407 (15.00%) no effect. Overall totals were

>1,878 (17.69%), 2,452 (23.09%), 3,979 (37.47%) and 2,309 (21.75%)

>respectively.

>

> Two Case Reports

>

> a.. Mrs. W.

> Age: 56; height: 5'6 " ; weight: 150 lbs.

> 1990.5: Tested blood glucose at 200mg/dl, diagnosed as

>Diabetes II, took oral hypoglycaemics two tablets twice a day.

> 1994.9.10: Began treatment with Yu Xiao San 8805 two

>tablets four times a day, and continued oral hypoglycaemics.

> 1994.9.25: FPG level at 140-160mg/dl.

> 1994.10.12: FPG was 112-140/dl. Reduced oral

>hypoglycaemics to one tablet.

> 1994.11.12: Stopped oral hypoglycaemics. Fasting blood

>glucose was 93-136mg/dl.

> 1994.12.12: FPG was 90-128mg/dl. Continued Yu Xiao San

>for three months for consolidation.

> Up to 1995.8: Monthly monitored blood glucose level

>100-110mg/dl.

> b.. Mr. G.

> Age: 44; height: 5'7 " ; weight: 152 lbs.

> 1990.6: Rapid weight loss, tested blood glucose at

>405mg/dl, diagnosed as Diabetes I, hospitalised on insulin injection, 20

>units once a day.

> 1992.8.20: FPG was 117mg/dl. Started Yu Xiao San 8805

>two tablets four times a day and continued injection.

> 1992.9.5: FPG 115-120mg/dl.

> 1992.10.5: FPG 105-109mg/dl, lower blood sugar

>reaction. Reduced insulin 4 units.

> 1992.10.29: FPG 90-111mg/dl. Reduced insulin 4 units

> . 1992.11.20: FPG 95-115mg/dl. Reduced insulin 2

>units.

> 1993.1.15: FPG 90-120mg/dl. Stopped injection and

>continued Yu Xiao San 8805 two tablets four times a day for three month

>consolidation.

> Up to 1995.8: Maintained blood glucose level

>90-140mg/dl after discontinuance of any medication.

> Yu Xiao San 8805 was developed by Dr. Chong Lianjin,

>Director of The Red Cross Hospital in Beijing, as a herbal product to

>restore pancreatic function and to increase insulin beta cells. It has

>undergone experimental tests both in China and the United States with good

>results and has been used by diabetics in over fifty countries worldwide.

>No adverse or allergic reactions have been reported from its use nor has

>damage to the liver, kidney or any other organs. It is currently used by

>the Asian Diabetes Association, Red Cross Hospital in Beijing and several

>State Hospitals in China as a medical treatment for Type II Diabetes. For a

>more complete description of Yu Xiao San together with numerous other case

>reports refer to the China Guide website at:

>http://www.china-guide.com/health/diabetes.html

>

> Sugar-Reducing and Pulse-Invigorating Capsule ( " Jiang

>Tang Tong Mai Yin Jiao Nang " )

> The following is excerpted from a study appearing in

>1994 on the effectiveness of " Sugar-Reducing and Pulse-Invigorating

>Capsule " in treating vascular complications of diabetes. It was conducted

>at the Guang An Men Hospital, China Academy of Traditional Chinese

>Medicine, Beijing. The effect of the formula on the signs and symptoms,

>biochemistry, haemodynamics, and the fibrinolytic system were observed and

>the results compared with those in a 159 patient control group who did not

>receive the capsule. All patients under observation were non-insulin

>dependent diabetics with fasting blood sugar of between 150-240mg/dl, and

>had one of the following complications: vascular hypertension, coronary

>heart disease, cerebrovascular disease, vascular disease of the

>extremities, retinopathy, or renal disease. Blood stasis was diagnosed when

>there were two of the following symptoms and signs, or there was one

>symptom or sign along with one abnormal laboratory finding, or there were

>two or more abnormal laboratory findings. Symptoms and signs included

>cyanosis or ecchymosis over the face, lips or tongue, sublingual engorged

>veins, precordial (heart) pain, numbness or cold aching in the extremities

>with cyanosis of the toes, blurring of vision, dizziness and headache,

>amnesia or dementia, dysarthria (imperfect speech articulation due to

>damage to the peripheral nervous system) and hemiplegia, and a hesitant,

>slow pulse with missing beats, or a deep or very slow pulse. The abnormal

>laboratory findings included increased blood coagulability, abnormal blood

>rheology, decrease in fibrinolytic activity, increased platelet

>aggregation, and impediment to the microcirculation. The study group

>consisted of 625 diabetic patients most of which had been diagnosed as

>having both deficiency of qi and yin with concurrent blood stasis. Two

>control groups were used with the first taking dimicron 80mg 2-3 times a

>day and the other a tablet prepared by the Academy plus a Western oral

>hypoglycaemic agent. For purposes of the study a 3 month duration of

>treatment was established.

>

> Results Criteria

>

> a.. Marked Improvement: after 3 months of treatment,

>the signs and symptoms basically subsided, 5 items of the blood rheology

>and 2 items of the fibrinolytic system were improved, fasting blood sugar <

>110mg/dl, urine sugar in 24 hrs < 5g, or blood sugar and urine sugar were

>lowered by 50% or more as compared with pre-treatment values.

> b.. Effective: after 3 months of treatment, signs and

>symptoms were distinctly reduced, 4 or more items of the blood rheology and

>fibrinolytic system improved, fasting blood sugar <150mg/dl, urine sugar

>dropped by 30% or more as compared with pre-treatment values.

> c.. Ineffective: after 3 months of treatment, the

>above criteria of effectiveness were not met.

> Results

>

> After 3 months of treatment and monitoring, of 625

>patients who took the Sugar-Reducing and Pulse-Invigorating Capsule, 95

>(15.2%) experienced marked improvement, 388 (62.08%) experienced effective

>results, and 142 (22.72%) were ineffective. In the two control groups,

>results were: 1. of 57 cases, 6 (10.52%), 31 (54.39%) and 20 (35.09%); 2.

>of 102 cases, 10 (9.81%), 57 (55.88%) and 35 (34.31%).

>

> An analysis of the difference in therapeutic efficacy

>among the various TCM diagnostic types showed that cases with deficiency of

>both qi and yin had a general efficacy of 81.89%, while those with i.

>predominance of yin deficiency and heat, and ii. deficiency of both yin and

>yang, were 63.38% and 63.03% respectively, indicating that the capsule was

>best suited for cases with deficiency of both qi and yin. As for the

>relationship between the course of treatment and its efficacy, it was

>observed that when the capsule was administered for 1-3 years or longer,

>there was a gradual increase in its effectiveness, showing the lasting and

>steady action of the capsule.

>

> Summary

>

> The authors report that vascular disease in diabetes and

>the symptom-complex of blood stasis in traditional Chinese medicine share

>the same pathological basis, namely impediment to circulation causing blood

>stagnation. The proportion of cases with vascular disease and blood

>stagnation within the diabetic population varies, with its distribution

>increasing in the order of i. yin deficiency with heat preponderance, ii.

>deficiency of both qi and yin, and iii. deficiency of both yin and yang. It

>was observed that the severity of the complications also increase in that

>order, indicating that both the modern medical classification of vascular

>disease and the TCM symptom complex of blood stasis followed rules of

>distribution common to both and had a common trend toward development.

>

> Vascular disease and the symptom-complex of blood stasis

>are considered to be two different expressions of the same pathological

>change, the latter being the clinical manifestation of the former, and the

>former the pathologic basis of the latter, the two being reciprocally

>causative. Diagnosis of signs and symptoms indicate that deficiency of yin

>is the basis for diabetes, deficiency of both qi and yin is the basic

>diagnostic type of the disease, and blood stasis is its chief accompanying

>symptom complex. Therefore, replenishing qi, nourishing yin, and

>invigorating the blood are the main treatment principles for vascular

>disease in diabetes. Replenishing qi plays the leading role, nourishing yin

>the supportive role, and invigoration of blood the required role, the three

>working together to counteract the pathogenic factors and reinforce the

>body resistance at the same time.

>

> In the 625 cases of diabetes the capsule was shown to

>correct abnormalities in the blood rheology, haematocrit, erythrocyte

>sedimentation rate, platelet aggregation, fibrinogen and fibrin

>decomposition products, improve lipid metabolism, increase the function of

>the islets of Langerhans cells, lower blood sugar and alleviate clinical

>symptoms. The total effectiveness reached 77.28%.

>

> Clinical observation of the effect of the capsule on the

>chief vascular complications showed that it had the actions of nourishing

>yin and replenishing qi of the Heart, reducing myocardial ischaemia and

>anoxia, eliminating abnormalities in the ECG and improving functioning of

>the left heart. Brain CT proved that the drug had the actions of

>invigorating the blood, resisting blood coagulation and dissolving

>thrombosis, thereby improving blood circulation to the brain tissue and

>playing a beneficial role in cerebral infarction. Ultrasonic Doppler

>testing showed that the formulation could dilate the arteries of the lower

>extremities and increase their blood flow. Fluorescein angiography of the

>ocular fundus (concave interior of the eye) and ophthalmoscopic examination

>showed that the formula was effective in the prevention and treatment of

>early diabetic retinopathy. It also somewhat improved the relevant

>biochemical indices and clinical symptoms of renal complications of

>diabetes.

>

> Administering the formula did not harm the heart, liver,

>kidney or any other internal organs and is considered to be a safe and

>effective traditional Chinese medical preparation for prevention and

>treatment of vascular complication of diabetes.

>

> Ji Wei Ling capsules, Zhong Ji Ling powders, Jin Li Da

>oral liquids, Jin Li Da powders, and Tong Xin Luo capsules

> Under the leadership of Wu Yi Ling, Medical Director of

>the Diabetes Research Institute in Xi Yuan Hospital, another approach to

>the pathology and treatment of diabetes with TCM has been developed, namely

>that the pathology of diabetes lies in the abnormal function of the Spleen.

>This leads to imbalance and disorder of fluid transportation and

>utilisation, thereby hampering normal absorption of nutrients even though

>the diet may be more than adequate. Great thirst, despite drinking copious

>amounts of water, is caused by the Spleen's inability to transport fluid to

>the Lung. Emaciation is caused by the Spleen's inability to move fluid

>(food essence) from the Stomach. This gradually leads to i. Spleen and

>Kidney deficiency, ii. deficiency of yin and yang, and iii. blood

>stagnation. Blood stagnation alone may lead to such serious complications

>as stroke, hemiplegia and heart disease. It was noted that the treatment

>approach developed for diabetes at the Diabetes Research Institute

>therefore encompassed more than the traditional idea of " invigorating yin

>and clearing away heat " . On the basis of the above observations a series of

>herbal preparations have been formulated. A complete description of these

>products can be found at the Window on China web site:

>[http://china-window.com/zhongy/zyxxzx/yl/eylyjs.html]. Address of the

>Medical Research Institute: Special Department of Diabetes, Xi Yuan

>Hospital, Xin Shi Bei Road No 385, Shi Jia Zhuang City, He Bei, China

>050091

>

> 9. Clinical notes

>

> a.. Non-insulin dependent diabetes mellitus:

>Prescribed herbs in therapeutic dosages, in combination with a sound diet

>and exercise program, provide clinically effective results often within 3

>to 4 weeks. Clinical effectiveness is defined as a significant reduction in

>blood glucose level with less fluctuation throughout the day.

> b.. Herbal medical treatment should always overlap

>with western medical treatment for at least 1 to 2 weeks before the dosage

>of any conventional diabetic drugs can be reduced.

> c.. Patients should never discontinue taking

>conventional diabetic drugs abruptly, as there is risk of developing

>hyperglycaemia or diabetic ketoacidosis.

> d.. Insulin dependent diabetes mellitus: Prescribed

>herbs in therapeutic dosages can help reduce the dosage and frequency of

>insulin injections, however it can never totally replace the need for

>supplemental insulin in insulin dependent patients.

> Notes

>

> 1. A detailed discussion of the patho-mechanisms

>involved in Xiao-Ke can be found in Part II of this article (published in

>the Journal of Traditional issue 59, January1999

> 2. Dharmananda, Subhuti, Institute for Traditional

>Medicine (itm Online), Rev. Sept. 1996.

>http://www.europa.com/~itm/index.html

> 3. Chen, John K., Treatment of Diabetes Mellitus with

>Chinese Herbs, Lecture Notes presented in conjunction with CAAOM and Lotus

>Herbs, Inc., 1998. Contact Lotus Herbs at US telephone (626) 916-1070.

> 4. Hsu, Hong-Yen, and Hsu, Chau-Shin, Commonly Used

>Chinese Herb Formulas with Illustrations, Oriental Healing Arts Institute,

>1980

> 5. Chen, J. K., Treatment of Diabetes Mellitus with

>Chinese Herbs

> 6. Li Cheng-Yu, Fundamentals of , East

>Asian Medical Society, Paradigm Pub. 1985

> 7. Chen, J., Treatment of Diabetes Mellitus with Chinese

>Herbs

> 8. Ibid.

> 9. Ibid.

> 10. Yen, Zheng Hua et al. American Ginseng, Chinese

>Herbology, Zhiyin Publishing Company, 1998, p 738,

> 11. Zhang, Xiao Ping, Treatment of Endocrine Disorders

>with Herbs, Presentation given by Professor Zhang at seminar hosted by

>California Association of Acupuncture and Oriental Medicine, July 1998

> 12. Hsu, Hong-Yen, and Kuwaki, Takahide, Diabetes

>Mellitus and Chinese Herb Formulas, Bulletin of the Oriental Healing Arts

>Institute, Vol 3, No.1, p.13, 1978.

> 13. Chen, J., Treatment of Diabetes Mellitus with

>Chinese Herbs

> 14. Herb Formula provided by Heming Gu, Acupuncturist

>and Herbalist, Los Angeles, CA

> 15. Chen DC, Gong DQ, and Zhai Y., Journal of

>Traditional 14(3): 163-166, 1994

> 16. China Guide Web site at

>http://www.china-guide.com/health/diabetes.html

> 17. Lin L, et al., A Clinical Study on Treatment of

>Vascular Complications of Diabetes with the Sugar-Reducing and

>Pulse-Invigorating Capsule, Journal of 14(1): 3-9, 1994 .

> 18. Window on China Web site at

>http://china-window.com/zhongy/zyxxzx/yl/eylyjs.html

>

> Additional bibliography

>

> 1. Yeung, Him-Che, Handbook of Chinese Herbs and

>Formulas Vol. II, Institute of , 1996.

> 2. Fratkin, Jake, Chinese Herbal Patent Formulas-A

>Practical Guide, Institute for Traditional Medicine, 1986.

> 3. Bensky, D. et al., Chinese Herbal Medicine-Materia

>Medica, Eastland Press, 1986.

> 4. Bensky, D. et al, Chinese Herbal Medicine-Formulas

>and Strategies, Eastland Press, 1990.

>

> Footnote

>

> Xiao-ke syndrome correlates closely with diabetes

>mellitus in most but not all cases.

>

> Clinton J. Choate, L.Ac., MTOM, Dip.NBAO, received his

>traditional oriental medical training in both the US and China. He has been

>in private practice in Santa Monica, California for the last 10 years.

>

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