Chinese Medical Diabetes

Diabetes & Aorto-arteritis: A Case History

abstracted & translated by
Bob Flaws, Dipl. Ac. & C.H., Lic. Ac., FNAAOM, FRCHM

Keywords: Chinese medicine, Chinese herbal medicine, diabetes, aorta-arteritis, Takayasu’s arteritis, aortic arch syndrome

The following case history comes from Zhu Chen Zi Jing Yan Ji (A Collection of Zhu Chen-zi’s Case Histories) anthologized by Dong Zhen-hua et al. and published by the Peoples’ Health & Hygiene Press in Beijing in 2000. The patient was a 44 year old female worker who was initially seen by Dr. Zhu on Apr. 10, 1995. The patient had had hypertension for 20 years, and there was no pulse in her left upper extremity. In addition, she had had lack of strength, dry mouth, and easy hunger for two years. The pulselessness in her left upper extremity had been going on for three months. Other symptoms included continuous heart palpitations, shortness of breath, precordial and left shoulder and upper back aching and pain, insomnia, bilateral lower extremity soreness and chill, borborygmus, and loose stools, with two bowel movements per day. Her fasting blood glucose (FBG) was 10.2mmol/L, her two hour postprandial blood glucose was 15.9mmol/L, and urine glucose was 100mg/dL. The patient had previously been diagnosed with diabetes and Takayasu’s arteritis and was currently taking 2.5mg of glyburide three times per day. Her tongue was pale and dark with white fur, and her pulse was deep, fine, and forceless.

Based on the above signs and symptoms, Dr. Zhu’s pattern discrimination for this patient was qi and yin dual vacuity with heart blood insufficiency and static blood obstructing the network vessels. Therefore, his treatment principles were to boost the qi and nourish yin, supplement the heart and quiet the spirit, and quicken the blood and transform stasis. The formula he prescribed was Sheng Mai San (Engender the Pulse Powder) plus Bu Yang Huan Wu Tang (Supplement Yang & Restore Five [Tenths] Decoction) with added flavors: uncooked Radix Astragali Membranacei (Huang Qi), 50g, uncooked Radix Rehmanniae (Sheng Di) and cooked Radix Rehmanniae (Shu Di), 15g each, Rhizoma Atractylodis (Cang Zhu) and Rhizoma Atractylodis Macrocephalae (Bai Zhu), 10g each, Radix Scrophulariae Ningpoensis (Xuan Shen), 20g, Radix Salviae Miltiorrhizae (Dan Shen), 30g, Radix Ligustici Wallichii (Chuan Xiong), 10g, Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 15g, Lumbricus (Di Long), 10g, Caulis Milletiae Seu Spatholobi (Ji Xue Teng), 30g, Tuber Ophiopogonis Japonici (Mai Men Dong), 10g, Fructus Schisandrae Chinensis (Wu Wei Zi), 10g, Semen Zizyphi Spinosae (Suan Zao Ren), 15g, Caulis Polygoni Multiflori (Ye Jiao Teng), 15g, and Fructus Ligustri Lucidi (Nu Zhen Zi), 10g.

The patient’s second visit occurred on Apr. 24. After taking the above medicinals, her dry mouth and excessive hunger had improved. Her sleep was somewhat better, and her stools now had form. Fasting blood glucose was 8.0mmol/L. However, she still had precordial, shoulder, and upper back pain as well as soreness and heaviness of her lower extremities. Her tongue and pulse were the same as before. Therefore, Dr. Zhu changed the formula to read: uncooked Radix Astragali Membranacei (Huang Qi), 50g, uncooked Radix Rehmanniae (Sheng Di) and cooked Radix Rehmanniae (Shu Di), 15g each, Rhizoma Atractylodis (Cang Zhu) and Rhizoma Atractylodis Macrocephalae (Bai Zhu), 10g each, Radix Scrophulariae Ningpoensis (Xuan Shen), 20g, Radix Salviae Miltiorrhizae (Dan Shen), 30g, Radix Puerariae (Ge Gen), 15g, Radix Codonopsitis Pilosulae (Dang Shen), 10g, Tuber Ophiopogonis Japonici (Mai Men Dong), 10g, Fructus Schisandrae Chinensis (Wu Wei Zi), 10g, Rhizoma Acori Graminei (Shi Chang Pu), 10g, Tuber Curcumae (Yu Jin), 10g, Radix Et Rhizoma Notopterygii (Qiang Huo), 10g, Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 10g, Fructus Lycii Chinensis (Gou Qi Zi), 10g, Radix Dipsaci (Xu Duan), 15g, Ramulus Loranthi Seu Visci (Sang Ji Sheng), 20g, and Rhizoma Cibotii Barometsis (Gou Ji), 15g.

On May 5, Dr. Zhu saw the woman for the third time. After taking this new prescription, all her symptoms had diminished. Her FBG was now 6.5mmol/L and she had reduced her glyburide to 2.5mg two times per day. Dr. Zhu told the woman to keep taking basically the same formula which the woman did until Aug. 28 when she was seen for the fourth time. The patient had taken these medicinals for three months and there were no markedly apprarent symptoms, although her stools still tended to be loose. Her FBG was 8.8mmol/L and her two hour postprandial blood glucose (PPBG) was 12.8mmol/L. Therefore, the patient was prescribed the following medicinals in order to consolidate the treatment effects: uncooked Radix Astragali Membranacei (Huang Qi), 120g, uncooked Radix Rehmanniae (Sheng Di) and cooked Radix Rehmanniae (Shu Di), 50g each, Rhizoma Atractylodis (Cang Zhu) and Rhizoma Atractylodis Macrocephalae (Bai Zhu), 30g each, Radix Scrophulariae Ningpoensis (Xuan Shen), 50g, Radix Salviae Miltiorrhizae (Dan Shen), 90g, Radix Puerariae (Ge Gen), 50g, Radix Codonopsitis Pilosulae (Dang Shen), 30g, Tuber Ophiopogonis Japonici (Mai Men Dong), 30g, Fructus Schisandrae Chinensis (Wu Wei Zi), 30g, Caulis Perillae Frutescentis (Su Geng) and Caulis Agastachis Seu Pogostemi (Huo Geng), 30g each, Radix Angelicae Dahuricae (Bai Zhi), 30g, uncooked Semen Coicis Lachyrma-jobi (Yi Yi Ren), 60g, Radix Dipsaci (Xu Duan), 60g, and Caulis Milletiae Seu Spatholobi (Ji Xue Teng), 90g. These medicinals were ground into fine powder and made into pills. The patient was instructed to take 10 grams of these pills each time, three times per day. On follow-up on Oct. 26, 1998, the patient’s symptoms were stabile, her FBG was 8.4mmol/L, and her two hour PPBG was 9.7mmol/L.

This is an interesting case history because the patient suffered from two conditions concomitantly: diabetes mellitus and Takayasu’s arteritis. Takayasu’s arteritis is an inflammatory disease of unknown etiology that affects the aorta and its branches. It is most commonly seen in young Asian women. This condition causes occlusion of the affected vessels which results in loss of pulse. The diabetes was responsible for her lack of strength, thirst, and easy hunger, while the arteritis was responsible for the palpitations, precordial, shoulder, and upper back pain, and the lack of pulse in her left upper extremity. According to Dr. Zhu, the diabetes was due to qi and yin vacuity, whereas Takaysau’s arteritis was associated with heart vessel stasis and obstruction. Therefore, treatment was designed to lower blood glucose by boosting the qi and nourishing yin. Sheng Mai San plus Bu Yang Huan Wu Tang was meant to strengthen the heart and restore the pulse, boost the qi and quicken the blood. In addition, the patient also had loose stools and borborygmus due to spleen vacuity leading to dampness. Therefore, Cang Zhu, Bai Zhu, Su Geng, Huo Geng, Bai Zhi, and uncooked Yi Yi Ren were meant to dry dampness, fortify the spleen, and stop diarrhea. This is based on the saying, “[If one] has a pattern, use medicinals for [that pattern].” This case shows how is able to treat even complex, multi-pattern presentations with a single, well crafted formula.

For more information of the Chinese medical treatment of diabetes and all its complications, see Bob Flaws, Lynn Kuchinski & Dr. Robert Casañas’s The Treatment of Diabetes Mellitus with Chinese Medicine available from Blue Poppy Press in Spring 2002.