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Journal of Chinese Medicine Number 78 June 2005 29An Outline of Diabetes Mellitus and its Treatment by TCM & Acupuncture

Introduction

Adiabetes mellitus (DM) epidemic is

underway. An estimated 30 million peopleworldwide had diabetes in 1985, but by

1995 this number had shot up to 135 million1. In the

year 2000 the World Health Organisation (WHO)

estimated that the number of people worldwide with

diabetes amounted to 177 million, with the expectation

that this will reach 300 million by 2025. The top 10

countries, in terms of numbers of sufferers, are India,

China, USA, Indonesia, Russia, Japan, UAE, Pakistan,

Brazil and Italy respectively. By 2025, in developed

countries most people with diabetes will be aged 65

years or more, while in developing countries most

will be between 45-64 years old, thereby affecting theirmost economically productive years2. Much of the

increase in DM is occurring in developing countries

as a result of population growth, ageing, unhealthy

diets, obesity and sedentary lifestyles. According to

a recent report by the WHO in December 2004, 3.2

million deaths are attributable to diabetes every year:

one in 20 of all deaths3. Many of these diabetes related

deaths are from cardiovascular complications. Most of

them are premature deaths, occurring at an age when

the people concerned should still be contributing to

society economically. This situation is increasingly

stretching health-care resources1.

In recent years, thanks to the rapid development

of molecular biological technologies including

genomics and proteomics, western medicine has had

a more thorough understanding of the genetic factors

involved in DM. The identification of the human

genome and the genes responsible for diabetes could

contribute to the introduction of gene therapy inDM4 and potential application of proteomics and

metabomics has also been adapted5.

In traditional Chinese medicine (TCM), DM is most

closely related to xiao ke (wasting and thirsting)

syndrome, which was first mentioned in the Su Wen

(Essential Questions) of the Huang Di Nei Jing (Canon

of Medicine, 200BCE to 100CE). Chinese and western

medical researchers have conducted extensive

investigation into DM and its treatment, and this is

briefly reviewed in the following article.

Differences and similarities betweenwasting & thirsting syndrome anddiabetes mellitusXiao (wasting) indicates excessive hunger, frequent

urination and wasting. Ke (thirsting) refers to

excessive thirst, and drinking much without being able

to quench the thirst. Xiao ke (wasting and thirsting)

syndrome has the symptoms of san duo yi shao (3

excess, 1 less), i.e. polydipsia, polyphagia, polyuria

and emaciation. Actually glycosuria (elevated urine

glucose levels) is also very common.

Diabetes was first discovered and named by an

English physician Thomas Willis in 1672. It is a group of

metabolic disorders with one common manifestation:

hyperglycaemia, with or without the presence of san

duo yi shao. If these symptoms are less than obvious,

then diagnosis will be based on laboratory tests.

An Outline of Diabetes Mellitus andits Treatment by Traditional ChineseMedicine and Acupuncture

By: William

Chi-Shing Cho,

Kevin Kin-Man

Yue & Albert

Wing-NangLeung

Keywords:

Diabetes

mellitus, xiao

ke (wasting

and thirsting),

traditional

Chinese

medicine,

acupuncture

AbstractDiabetes Mellitus (DM), with its rapid growth rate, is becoming an alarming threat to human health, especially in

developing countries such as China, India, Indonesia and Russia. Even though western medicine can contribute to

the control and treatment of DM, it is generally unable to cure it.Traditional Chinese Medicine (TCM) can buildup the diabetic patients resistance to disease, strengthen immunity and promote metabolism. Therefore there areadvantages in combining TCM with western medicine in the treatment of DM.

This article reviews the history of DM diagnosis by TCM, as well as the pathogenesis of DM from the viewpoints

of both western and Chinese medicine. TCM treatment (both herbal medicine and acupuncture) is also reviewed,

and treatment methods and formulas are suggested for different patterns of disharmony.

TCM diagnoses and treats disease based on an integrative analysis and differentiation of signs and symptoms,

including the cause and nature of the illness, as well as the patients physical and emotional condition. It can

therefore act as a well-tried protocol for the long-term recuperation of diabetic patients.

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Journal of Chinese Medicine Number 78 June 200530 An Outline of Diabetes Mellitus and its Treatment by TCM & Acupuncture

According to the Expert Committee on the Diagnosis

and Classification of Diabetes Mellitus6, the disease is

classified into four types:

1. Type I diabetes mellitus (formerly known as

insulin-dependent diabetes mellitus or IDDM).

2. Type II diabetes mellitus (formerly known as non-

insulin-dependent diabetes mellitus or NIDDM).3. Gestational diabetes mellitus (GDM).

4. Other specific types.

In addition, DM may have many complications

that are not present in xiao ke (wasting and thirsting)

syndrome, such as visual disturbance, impotence,

amenorrhoea and frequent infections. Conversely, xiao

ke (wasting and thirsting) syndrome is diagnosed by

the presence of san duo yi shao. These symptoms

may be caused by factors other than DM, such as

fever, dehydration or kidney diseases. Obviously

xiao ke (wasting and thirsting) syndrome and DM

are not identical, yet they have some similar clinicalsymptoms.

Research into the pathogenesis ofdiabetes by western medicineFrom the western viewpoint, general aetiological

factors for DM include genetic background, viral

activity and diet. It is believed that viral activity,

particularly herpes-type viruses known as

cytomegalovirus may initiate the diabetic syndrome.

Aging and poor nutritional status may trigger

dormant and low activity viruses.

1. Type I Diabetes MellitusType I DM may account for 5-10% of all diagnosed

cases of diabetes and usually affects children.

Although the exact cause is not known, autoimmune,

genetic and environmental factors are thought to be

involved. Pancreatic cells destruction leads to insulin

deficiency, which subsequently triggers DM. On theother hand, it has become a recognised fact that the

susceptibility genes of type I DM are located at the

Major Histocompatibility Complex (MHC). Genetic

research has shown that DR3 and DR4, as well as

DQ alleles, especially the non-aspartic acid (Asp)-

57 of DQ1 alleles and arginine (Arg)-52 of DQ1

alleles, are strongly associated with the development

of DM7,8.

2. Type II Diabetes MellitusThe prevalence of DM is increasing in many countries all

over the world, of which around 90-95% are type II DM.Most patients have symptoms appearing around

or after age 40. Type II DM is often associated with

a strong genetic predisposition; the likelihood of

normal diabetic patients family members also being

becoming diabetic is 4 to 10 times higher than for

normal individuals9. On the other hand, oxidative

stress has been implicated in the pathogenesis of

DM10. Aging, obesity, unhealthy diet11 and sedentary

lifestyles such as prolonged TV watching12 are

all associated with type II DM. In addition, the

American Diabetes Association (ADA) reported that

hypertension was also a risk factor for type II DM13.

3. Gestational Diabetes MellitusGestational DM is a form of glucose intolerance that

is diagnosed in some women during pregnancy, more

commonly among obese women and women with

a family history of diabetes. It develops in 2 to 5%

of all pregnancies but usually disappears when the

pregnancy is over. Women who have had gestational

diabetes are at increased risk for later developing type

II diabetes. In some studies, nearly 40% of women

with a history of GDM developed diabetes in the

future14.

4. Other specific typesOther specific types of DM result from specific genetic

conditions, surgery, drugs, malnutrition, infections

and other illnesses. Such types of DM may account

for 1 to 2% of all diagnosed cases of diabetes15.

Pathogenesis of diabetes mellitusaccording to traditional ChinesemedicineThe pathogenesis for DM is complicated: there

are many causes. According to TCM analysis and

differentiation of diseases, based on pathological

changes of the zangfu organs and their interrelations,

all organs are mutually affected. They have reciprocal

causation and mutual interference. Traditionally, the

Figure 1:

Pathogenesis

of Diabetes

Mellitus by

Traditional

Chinese

Medicine.

Congenital factors; strain,endowment...

Acquired factors;diet, emotion...

Spleen & qideficiency

Lungdryness

Kidneydeficiency

Liver qistagnancy

Blood stasis Qi deficiencyBlocking of qi flow

DiabetesMellitus

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disease can be caused by constitutional factors, disorder of

the zangfu, improper diet, emotional stress, intemperance

in sexual life, etc. Moreover, diabetic patients are normallyattracted to greasy and pungent foods which tend to

hinder digestion and finally lead to qi obstruction and

blood stasis. (Figure 1).

Recent research has demonstrated that emotional

factors may stimulate the ventromedial hypothalamus

(VMH), subsequently affecting the sympathetic nerve

and impairing insulin secretion, finally leading to

hyperglycaemia. The relatively recent discovery by

western medicine that emotional stress is one of the main

causes for DM is comparable to the TCM understanding

nearly two thousand years earlier that emotional factors

involving stagnation of Liver qi might trigger xiao ke.

ZangfuThe pathological changes in DM are focused in the Lung,

Spleen (and Stomach), Kidney and Liver, with the Kidney

as the key organ. Although the four organs have their own

functions, they often mutually influence one another.

1 Lung

Qian Qiu Hai16 propounded that the Lung was the organ

in charge of purification and descending of Lung qi and

regulating qi, blood and body fluids. Dryness and heat

injure the Lung and consume yin fluids, leading to thirst,restlessness and a dry-hot tongue. Furthermore, when

dryness and heat injure the Lung, it may fail to regulate

the water passages giving rise to polyuria.

2 Spleen

Xiong Man Qi17 thought that Spleen qi deficiency was

associated with DM. Throughout the entire disease course,

most patients have some degree of Spleen qi deficiency.

Shao et al.18 thought that the dryness and heat deriving

from yin deficiency, the qi deficiency due to yang failure,

and the blood stasis that are all seen in DM, were actually

secondary patterns. The primary cause was sinking ofSpleen qi, and this underlay the entire course of the disease.

Pan Chao Xi19 proposed that as the Spleen failed to spread

food essence, water and fluid could not be distributed

upward which then led to thirst. Also because water and

food essence were unable to be distributed upward and

thus spread elsewhere, this led to polyuria and glycosuria.

This approach sees the Spleen failing to free food essence

as being the root cause in the pathogenesis of DM.

3 Kidney

Another school of thought argues that the Kidney is

central to the pathogenesis of the disease (yi shen wei ben:

Kidney is the primary onset) arguing that DM is caused

either by Kidney yin deficiency or by Kidney (both yin and

yang) deficiency. The Kidney governs water metabolism

and stores jing (essence). Kidney deficiency leads to water

diffusion (shui fan) and therefore causes polyuria. When

Kidney deficiency fails to cause contraction and arrest

discharges, essence (jing) subtly exits with the urine andtherefore the urine is greasy. Since body fluid exits

excessively, dryness leads to restlessness and polydipsia.

Kidney deficiency also fails to nourish the bones, causing

lumbago and knee pain. Chronic Kidney yin deficiency

can lead to the impairment of yin which then impedes the

generation of yang. Combined yin and yang deficiency

can lead to Kidney qi failure which is then even less able

to arrest body fluids. Polyuria will thus become more

serious, such that patients may even need to urinate after

each drink.

4 LiverZou Ru Zheng20 pointed out that the pathological

characteristics of the Liver are that it is easily depressed,

easily heated, and easily made deficient. Liver qi

depression, heat and deficiency, caused by the failure to

smooth and regulate qi, affects jin ye (body fluids) and

therefore insulin secretion. As the occurrence of DM is

mainly due to the absolute or relative insufficiency of

insulin secretion, Liver qi stagnation is fundamental to

the pathogenesis of DM. In addition, the emotional factors

related to Liver qi stagnation can directly induce DM.

Qi and bloodZhou Shu Ping21 noted that diabetic patients have qi

deficiency symptoms at the non-symptomatic stage.

Because of this underlying deficiency, there is an inability

to create and hold jing (essence), leading to its loss. As a

result, yin deficiency develops until it obscures the root

cause of qi deficiency.

According to clinical manifestations, most diabetic

patients have symptoms of blood stasis. This may be

caused by qi obstruction, injury to jin ye (body fluid) by

evil fire, qi deficiency, accumulated cold due to yang

deficiency, or blocking of the collaterals by phlegm-

dampness. Symptoms of blood stasis may be presentthrough the entire course of the disease22.

Diabetes mellitus treatment by traditionalChinese medicineThe incidence of DM is high and it has many complications,

some of which Western medicine is unable to completely

cure. However, TCM has had more success in the treatment

of some complications, with a direct effect on the

improvement of insulin levels and receptor binding

sensitivity.

Zangfu treatments1 Lung dryness

Clinical manifestations

polydipsia

dry mouth and tongue

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polyuria

reddened tongue borders, thin yellow tongue coating

full (hong) and rapid (shuo) pulse or wiry (xian) andsmooth (hua) pulse

Treatment principles

clear evil heat

moisten dryness

improve secretions and quench thirst

Acupuncture treatment

Yishu M-BW-12, Feishu BL-13, Taiyuan LU-9, Hegu

L.I.-4, Yuji LU-10, Shaofu HE-8. The back-shu points

are punctured obliquely medially 0.5-0.8 cun. The other

points are punctured perpendicularly 0.5-l.0 cun, usingeven needling technique. Needles are retained for 10-20

minutes.

Herbal treatment

Gan Lu Xiao Ke Tang Jia Jian (Modified Application of Sweet

Dew Diabetes Decoction), which comprises: Sheng Di

Huang (Rehmanniae Radix), Mai Men Dong (Ophiopogonis

Radix), Dang Shen (Codonopsitis Radix), Tian Men Dong

(Asparagi Radix), Tu Si Zi (Cuscutae Semen), Shan Zhu Yu

(Corni Fructus), Xuan Shen (Scrophulariae Radix), Huang

Qi (Astragali Radix), Dang Gui (Angelicae sinensis Radix),

Fu Ling (Poria). The herbs were ground and filled intocapsules. Each capsule contained 1.8g powder, which was

taken 3 times a day with 3 months as a therapeutic course.

Research

An Bang Yu23 applied this formula to treat 102 diabetic

patients. Of these 30 showed marked improvement, 57

improved, but 15 failed to respond to the treatment. The

total effective rate was 85%.

2 Spleen yin waning and deficiency


fatigue lassitude

poor appetite or fullness felt over the epigastric

region

thirst but no desire to drink

feverish sensations in the palms, or night sweats

flushed cheeks

dry hard or unsolid stool

scanty yellow urine

frequent urination

pale lips and tongue with scanty or peeled coating

fine (xi) and rapid (shuo) pulse

Treatment principle

Invigorate the Spleen and replenish yin.


Yishu M-BW-12, Weishu BL-21, Zhongwan REN-12,

Zusanli ST-36, Sanyinjiao SP-6. The back-shu points are

punctured obliquely medially 0.5-0.8 cun, the other points

are punctured perpendicularly 0.5-l.5 cun, using evenneedling manipulation. Needles are retained for 10-20

minutes.

Herbal treatment

Zi Zao Jiang Tang Tang Jia Wei (Moistening to Reduce

Blood Glucose Decoction with Added Flavours), which

comprises: Ge Gen (Radix Puerariae) 30g, Shan Yao (Radix

Dioscoreae Oppositae) 30g, Cang Zhu (fried Rhizoma

Atractylodis) 6g, Huang Qi (Radix Astragali) 30g, Xuan

Shen (Radix Scrophulariae Ningpoensis) 15g, Fu Ling

(Sclerotium Poriae Cocos) 20g.

Research

Wu Xiao Ling24 applied this formula to treat 15 diabetic

patients. Of these 12 showed marked improvement, 2



3 Spleen and Stomach (yang) deficiency


cold limbs

facial oedema

pale complexion

fatigue and lassitude abdominal fullness

poor appetite

lack of thirst

loose stools

clear profuse urine

body oedema

whitish moist tongue with tooth prints at the

borders with either a thin white coating or a white

smooth greasy coating

deep (chen), slow (chi) and moderate (huan) pulse

Treatment principle

Warm the Spleen and invigorate qi.


Taibai SP-3, Gongsun SP-4, Sanyinjiao SP-6, Zusanli

ST-36, Neiting ST-44. The back-shu points are punctured

obliquely medially 0.5-0.8 cun, the other points are

punctured perpendicularly 0.5-l.5 cun, using even needling

manipulation. Needles are retained for 10-20 minutes.

Herbal treatment

Shen Ling Bai Zhu San Jia Jian (Modified Ginseng, Poria and

Atractylodis Macrocephala Powder), which comprises:

Dang Shen (Codonopsitis Radix) 15g, Bai Zhu (Atractylodis

macrocephalae Rhizoma) 10g, Huang Qi (Astragali Radix)

15g, Chen Pi (Citri reticulatae Pericarpium) 10g, Cang Zhu

(Atractylodis Rhizoma) 10g, Fu Ling (Poria) 20g, Jiao Shan

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Zha (charred Fructus Crataegi) 15g, Ban Xia (Pinelliae

ternatae Rhizoma) 10g, Ze Xie (Alismatis Rhizoma) 10g,

Hou Po (Magnoliae officinalis Cortex) 10g, Shan Yao(Dioscoreae Rhizoma) 20g.

Research

Zhang Song Ming25 applied this formula to treat 15 diabetic

patients. Of these, 6 achieved notable curative effects, 8



4 Disturbance of the Spleen owing to dampness


poor appetite and reduced food intake

abdominal fullness loose thin stool

lassitude

white greasy tongue coating

soft (ru wu li) pulse

Treatment principle

Invigorate the Spleen and dispel dampness.


Danshu BL-19, Yanggang BL-48, Pishu BL-20, Sanyinjiao

SP-6, Yanglingquan SP-9. The back-shu points are

punctured obliquely medially 0.5-0.8 cun, the otherpoints are punctured perpendicularly 0.5-l.5 cun, using

even needling manipulation. Needles are retained for

10-20 minutes.

Herbal treatment

Jian Pi Tang Jia Jian (Modified Strengthen the Spleen

Decoction), which comprises: Chen Pi (Citri reticulatae

Pericarpium) 9g, Huang Qi (Astragali Radix), 30g Shan

Yao (Dioscoreae Rhizoma) 30g, Fu Ling (Poria) 30g, Bai

Zhu (Atractylodis macrocephalae Rhizoma) 15g, Gan Cao

(Glycyrrhizae Radix) 12g, Ren Shen (Ginseng Radix) 9g.

Research

Liu Yong26 applied this formula to treat 54 diabetic

patients. Of these, 51 achieved notable curative effects or

improved, while 3 failed to respond to the treatment. The


5 Kidney yin deficiency


polyuria

greasy urine

excessive thirst

emaciation

lumbago

aching knees

dry red tongue with a thin coating

deep (chen), fine (xi) and rapid (shuo) pulse

Treatment principle

Nourish yin and strengthen the Kidney.


Yishu M-BW-12, Shenshu BL-23, Sanyinjiao SP-6, Taixi

KID-3, Zhaohai KID-6. The back-shu points are punctured

obliquely medially 0.5-1.0 cun. The other points are

punctured perpendicularly 1.0 cun using reinforcing

needling manipulation. Needles are retained for 10-20

minutes.

Herbal treatment

Zi Shen Qing Gan Tang Jia Jian (Modified Nourish the

Kidney and Quench Fire in the Liver Decoction), which

comprises: Sheng Di Huang (Rehmanniae Radix) 30g,Shan Zhu Yu (Corni Fructus) 12g, Shan Yao (Dioscoreae

Rhizoma) 30g, Fu Ling (Poria) 12g, Ze Xie (Alismatis

Rhizoma) 12g, Huang Qi (Astragali Radix) 30g, Shan Zhi

Zi (Gardeniae Fructus) 12g, Dang Gui (Angelicae sinensis

Radix) 12g, Bai Shao (Paeoniae Radix alba) 12g, Xuan

Shen (Scrophulariae Radix) 12g, Yin Yang Huo (Epimedii

Herba) 12g, Mu Dan Pi (Moutan Cortex) 9g, Cang Zhu

(Atractylodis Rhizoma) 9g, Chai Hu (Bupleuri Radix) 9g.

Research

Yang Shan Dong27 applied this formula to treat 70 diabetic

patients. Of these, 24 achieved notable curative effects, 41improved, but 5 failed to respond to treatment. The total

effective rate was 93%.

6 Kidney yin and yang deficiency


frequent urination

greasy urine

dark complexion

lumbago

cold limbs

impotence

dry, pale tongue with a white smooth coating deep (chen), fine (xi) and soft (wu li) pulse

Treatment principle

Nourish yin, promote yang and tonify the Kidney.


Sanyinjiao SP-6, Zusanli ST-36, Guanyuan REN-4, Ganshu

BL-18, Shenshu BL-23. The back-shu points are punctured

obliquely medially 0.5-0.8 cun, the other points are

punctured perpendicularly 0.5-l.5 cun, using even needling


Herbal treatment

Gu Yin Jian Jia Wei (Arresting Yin Decoction with Added

Flavours), which includes: Shu Di Huang (Rehmanniae

Radix preparata) 15g, Shan Zhu Yu (Corni Fructus) 10g,

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Xu Duan (Dipsaci Radix) 10g, Dang Shen (Codonopsitis

Radix) 15g, Fu Ling (Poria) 15g, Mai Men Dong

(Ophiopogonis Radix), 15g, Huang Jing (PolygonatiRhizoma) 15g, Gan Cao (Glycyrrhizae Radix) 10g, Tu Si Zi

(Cuscutae Semen) 15g, Wu Wei Zi (Schisandrae Fructus)

10g, Shan Yao (Dioscoreae Rhizoma) 30g.

Research

Shao Sheng Kuan28 applied this formula to treat 34 diabetic

patients. Of these, 26 achieved notable curative effects or

improved, while 8 failed to respond to treatment. The total


7 Liver disharmony

Clinical manifestations irritability

proneness to anger

excessive thirst

yellow urine

red face and eyes

dizziness

bitter taste in the mouth

dry throat

dry hard stool

red tongue with a yellow coating

wiry (xian) and rapid (shuo) pulse

Treatment principle

Disperse stagnant Liver qi.


Fengchi GB-20, Taichong LIV-3, Sanyinjiao SP-6, Fuliu

KID-7. The back-shu points are punctured obliquely

medially 0.5-0.8 cun, the other points are punctured

perpendicularly 0.5-l.5 cun, using even needling


Herbal treatment

Xiao San Duo Tang Jia Jian (Modified Application of ResolveThree Poly Decoction), which comprises: Tian Hua Fen

(Trichosanthis Radix) 9g, Zhi Mu (Anemarrhenae Radix)

10g, Huang Lian (Coptidis Rhizoma) 9g, E Jiao (Asini Corii

Colla) 9g, Huang Jing (Polygonati Rhizoma) 15g, Shi Gao

(Gypsum fibrosum) 30g, Shan Yao (Dioscoreae Rhizoma)

15g, Ren Shen (Ginseng Radix) 5g, Bai Shao (Paeoniae

Radix alba) 15g, Zheng He Shou Wu (steamed Polygoni

multiflori Radix) 15g, Mai Men Dong (Ophiopogonis

Radix) 15g, Di Gu Pi (Cortex Lycii Chinensis Radicis) 9g, Ji

Zi Huang (egg yolk) 2 pieces.

Research

Qiao Bao Jun29 applied this formula to treat 50

diabetic patients. Of these, 23 achieved notable

curative effects, 21 improved, but 6 failed to respond

to treatment. The total effective rate was 88%.

Ni et al.30 explored the clinical effect ofDan Zhi Xiao Yao

San (Cortex Moutan Radicis and Fructus Gardeniae Ease

Powder) in treating DM, concluding that the formulacould soothe the Liver to relieve qi depression, which is

effective in treating DM and could improve the symptoms

of DM patients.

Qi and blood treatments1 Qi and yin deficiency with blood stasisClinical manifestations

emaciation

thirst

dry throat

lassitude

dizziness and headache numb aching body, or oppressed feeling and aching in

the chest

dry stool

deep red tongue with purple spots on edges

fine (xi) and hesitant (se) pulse

Treatment principle

Reinforce qi and replenish yin, activate qi and stimulate

the collaterals.

Herbal treatment

Bu Yang Huan Wu Tang Jia Wei (Tonify Yang to RestoreFive Tenths Decoction with Added Flavours), which

comprises: Huang Qi (Astragali Radix) 60g, Chuan Xiong

(Chuanxiong Rhizoma) 15g, Di Long (Pheretima) 15g,

Dang Gui (Angelicae sinensis Radix) 12g, Tao Ren (Persicae

Semen) 10g, Hong Hua (Carthami Flos) 10g, Chi Shao

(Paeoniae Radix rubra) 20g. The following herbs maybe

added as appropriate: Quan Xie (Scorpio) 6g, Wu Gong

(Scolopendra) 1 piece, Dan Shen (Salviae miltiorrhizae

Radix) 15g, Sheng Di Huang (Rehmanniae Radix) 12g, Yu

Zhu (Polygonati odorati Rhizoma) 12g.

Research

Wei Jiang Lei31 applied this formula to treat 30 diabetic

patients. Of these, 12 achieved notable curative effects, 14



2 Accumulated cold due to yang deficiency withblood stasisClinical manifestations

fatigue

lassitude

intolerance of cold

numb, aching body

cold limbs

symptoms worse with the cold

cardiac pain

oedema

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dull pale tongue

enlarged veins under the tongue

white smooth tongue coating deep (chen), fine (xi) and soft empty (wu li) pulse

Treatment principle

Reinforce qi and warm yang, invigorate qi to relieve pain.

Herbal treatment

Shen Qi Jiang Tang Tang Jia Jian (Modified Application

of Radix Scrophulariae and Membranous Asparagus

Blood Glucose Reducing Decoction), which includes:

Huang Qi (Radix Astragali) 30-45g, Gui Zhi (Ramulus

Cinnamomi Cassiae) 6-12g, Da Huang (Rhizoma

Rhei) 6-12g, Xuan Ming Fen (Natrii Sulfas Exsiccatus)3-6g, Xuan Shen (Radix Scrophulariae Ningpoensis)

12-15g, Gan Cao (Radix Glycyrrhizae Uralensis) 3g,

Sheng Di Huang (Radix Rehmanniae Glutinosae)

12-15g, Mai Men Dong (Tuber Ophiopogonis

Japonici) 12g, Tao Ren (Semen Persicae) 9-12g.

Research

Qian Qiu Hai32 applied this formula to treat 20 diabetic

patients. Of these 11 achieved notable curative effects, 7

improved, but 2 failed to respond to treatment. The total


3 Phlegm obstruction and blood stasisClinical manifestations

obesity

heavy, regular aching at affected parts of the body

dull purple lips

aching limbs, or cardiac pain

sticky dry mouth

thick tongue coating

dull purple tongue with purple spots

slippery (hua) or choppy (se) pulse

Treatment principle

Resolve phlegm, invigorate blood circulation, remove

blood stasis and stimulate the collaterals.

Herbal treatment

Shen Qi Tao Ren Tang Jia Jian (Modified Codonopsis Pilosula

and Semen Persicae Decoction), which comprises: Huang

Qi (Astragali Radix) 30g, Dang Shen (Codonopsitis Radix)

30g, Shi Gao (Gypsum fibrosum) 30g, Dan Shen (Salviae

miltiorrhizae Radix) 30g, Cang Zhu (Atractylodis

Rhizoma) 15g, Tao Ren (Persicae Semen) 6g, Hong Hua

(Carthami Flos) 6g, Dang Gui (Angelicae sinensis Radix)

12g, Zhi Mu (Anemarrhenae Radix) 20g, Chuan Xiong

(Chuanxiong Rhizoma) 6g, Sheng Di Huang (Rehmanniae

Radix) 30g.

Research

Gao Xiu Zhen33 applied this formula to treat 20 diabetic

patients. Of these 1 achieved notable curative effects, 19improved, and none failed to respond to the treatment.

The total effective rate was 100%.

4 Liver qi stagnation leading to qi obstruction andblood stasisClinical manifestations

thirst

fatigue

lassitude

loss of appetite

abdominal distension

depression irritability

vexation

insomnia

excessive dreaming

hypochondrial aches

hypomenorrhoea with blood clots

deep red tongue, or with purple spots

wiry (xian) and fine (xi) pulse

Treatment principle

Adjust qi flow and invigorate blood circulation, remove

blood stasis and stimulate the collaterals.

Herbal treatment

Xiao Yao Jiang Tang San Jia Jian (Modified Application

of Blood Glucose Reducing and Ease Powder), which

comprises: Chai Hu (Bupleuri Radix) 9g, Bai Zhu

(Atractylodis macrocephalae Rhizoma) 12g, Bai Shao

(Paeoniae Radix alba) 10g, Chuan Xiong (Chuanxiong

Rhizoma) 9g, Dang Gui (Angelicae sinensis Radix)

10g, Sheng Di Huang (Rehmanniae Radix) 10g, Gou

Qi Zi (Lycii Fructus) 10g, Fu Ling (Poria) 9g, Zhi

Mu (Anemarrhenae Radix) 30g, Xiang Fu (Cyperi

Rhizoma) 9g.

Research

Guo Xi Jun34 applied this formula to treat 60 diabetic

patients. Of these 42 achieved notable curative effects, 15

improved, but 3 failed to respond to treatment. The total


AuriculotherapyAlternatively, ear acupuncture therapy may also be tried.

Selected auriculopoints include: Pancreas, Endocrine,

Kidney, Triple Heater, Vagus, Ear Shenmen, Heart and

Liver. Three to five points are selected each time. Moderate

needling stimulation is given, and the needles are retained

for 20 minutes. The treatment is conducted once every other

day with 10 sessions forming a therapeutic course35.

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16. Qian, Q.H. Combining Chinese andWestern medicine for diagnoses and

treatments. Shanxi Science andTechnology Publishing House,Shanxi, pp. 50-51 and 79-83, 1999.

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is the important pathogenesis ofhectic thirst. Guangzhou TraditionalChinese Medical College Journal. 7:3-14, 1991.

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20. Zou, R.Z. The Liver diagnosis indiabetes. China Medicine Journal.

13(1): 17-23, 1998.21. Zhou, S.P. A discussion of vital

energy deficiency as the key todiabetes mellitus. New TraditionalChinese Medicine. 31(2): 5-6, 1999.

22. Zhan, R.W. The Fourth NationalDiabetes Mellitus (Hectic Thirst).Academic Conference PapersCollection. p. 284, 1995.

23. An, B.Y. Clinical investigation ofSweet Dew Diabetes Decoctiontreating 102 non-insulin dependentdiabetes cases Chinese MedicineJournal. 12(6):31, 1985.

24. Wu, X.L. Fujian Chinese Medicine.2:23, 1983.

25. Zhang, S.M. Anhui Chinese MedicalCollege Journal. 4:21, 1988.

26. Liu, Y. Sichuan Chinese Medicine.7(11):9, 1989.

27. Yang, S.D. Shanxi Chinese Medicine.6:241, 1992.

28. Shao, S.K. Shanxi Chinese MedicalCollege Journal. 2:21, 1989.29. Qiao, B.J. Henan Chinese Medicine.

4:21, 1988.30. Ni, H., G. Liu and S. Luo. Clinical

study in treating type 2 diabetesmellitus according to Liver inTCM. Chinese Journal of IntegratedTraditional and Western Medicine.20(8):577-579, 2000.

31. Wei, J.L. The analysis of reinforcingYang and restoring the five visceradecoction treating 30 diabetes cases.Zhejiang Chinese Medical Journal.4:178, 1989.

32. Qian, Q.H. Practical diabetestreatment and health care. Jinan

Shandong University PublishingHouse, 1993.

33. Gao, X.Z. Zhejiang Chinese MedicalCollege Journal. 1:15, 1989.

34. Guo, X.J. Beijing Chinese MedicalCollege Journal. 14(3):36, 1991.

35. Meng, H., Wang, S.R. and Wang, W.Lectures on acupuncture. World J.Acup-Mox. 10(4):70, 2000.

36. Cho, C.S. Chinese medicine to viewmodern life. Vitality. 1:48-49, 2004.

37. Cho, C.S. Personalized medicine.Popular Medicine. 10:74-75, 2004.

38. Cho, C.S. Strengthen our immunity:nutrition, exercise, health andpsychology. Vitality. 8:30-33, 1997.

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