|
Diabetes, Depression & Heat abstracted & translated by Keywords: Chinese medicine, Chinese herbal medicine, diabetes mellitus, liver depression, depressive heat
While faulty diet is, perhaps, the single most important disease cause of diabetes mellitus, depressive heat is also a main mechanisms of this disease, and depressive heat has as much to do with psychological factors as it does with diet. On pages 76-77 in issue #2, 2002 of Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine), Wu Yun and Ran Bin published two case histories by Liang Li-jing, a professor at the Yunnan College of Chinese Medicine, one of which clearly underscores the importance of liver depression transforming heat as a disease mechanism of diabetes. The article in which this case appears is titled, “Liang Li-jing’s Experiences in the Treatment of Diabetes Mellitus.” A precis of this case and Dr. Liang’s teachings on this disease mechanism are given below.
Liu Wan-su, in his Ru Men Shi Qin (A Confucian’s Duty to [His] Parents), “Treatise on the Three Wastings,” says that, “Excessive consumption and chaos of the essence spirit may result in wasting and thirsting;” while the author of the Lin Zheng Zhi Nan Yi An (A Clinical Reference & Cases Histories), “The Three Wastings,” says, “Heart predicament, worry, and depression may cause internal heat spontaneously combusting [and thus] resulting in wasting condition and great disease.” These two sayings underscore that excessiveness and extremity of the five minds causing depressive heat which, in turn, damages the fluids and humors is a main disease mechanism of this condition. According to Prof. Liang, if liver depression and spleen depression endure for days and transform heat, this heat may burn and damage stomach fluids. This then results in oral dryness and polydipsia as well as rapid hungering after eating. When liver and stomach heat occur together, the symptoms that may be seen include a bitter taste in the mouth and dry throat, putrid belching, and dry stools. In this case, the treatment principles are to mainly clear heat assisted by boosting the qi, nourishing yin, and engendering fluids combined with soothing the liver and resolving depression.
Case history:
The patient was a 58 year old male who was initially examined on Feb. 12, 1990. The man had been diagnosed three years before with type 2 diabetes mellitus. However, various oral hypoglycemic medications had not gotten a good effect. When examined, this man’s affect was poor and he appeared depressed. There was generalized lack of strength, a bitter taste in his mouth, and a dry throat and tongue as well as vexatious thirst and polydipsia, polyphagia and easy hungering, and polyuria. His stools were dry, and his pulse was bowstring and rapid. The patient’s fasting blood glucose was 12.9mmol/L, his two hour postprandial blood glucose was 19.7mmol/L, urine sugar was +++, and urine ketones were negative.
Based on the above, Dr. Liang categorized this patient’s Chinese medical pattern was liver-stomach depressive heat with qi and yin dual vacuity. Therefore, the treatment principles were to clear heat and enrich yin, boost the qi and nourish yin, and soothe the liver and resolve depression. For these purposes, the following Chinese medicinals were prescribed: uncooked Radix Rehmanniae (Sheng Di), 60g, cooked Radix Rehmanniae (Shu Di), Gypsum Fibrosum (Shi Gao), Radix Astragali Membranacei (Huang Qi), and Radix Trichosanthis Kirlowii (Tian Hua Fen), 30g each, Herba Dendrobii (Shi Hu), Rhizoma Anemarrhenae Aspheloidis (Zhi Mu), Radix Puerariae (Ge Gen), Cortex Phellodendri (Huang Bai), Radix Glehniae Littoralis (Sha Shen), Fructus Alpiniae Oxyphyllae (Yi Zhi Ren), Flos Chrysanthemi Morifolii (Ju Hua), and Radix Albus Paeoniae Lactiflorae (Bai Shao), 15g each, Rhizoma Coptidis Chinensis (Huang Lian), Fructus Schisandrae Chinensis (Wu Wei Zi), uncooked Radix Et Rhizoma Rhei (Da Huang), and mix-fried Radix Glycyrrhizae (Gan Cao), 6g each, and Radix Bupleuri (Chai Hu), 12g. One ji of these medicinals was supposed to be decocted in water per day and taken orally, with seven days’ worth prescribed.
On Feb. 20, the patient was seen for the second time, after taking the above medicinals, the patient’s lack of strength, oral dryness, vexatious thirst, polyphagia, polyuria, and dry stools were all significantly decreased, his fasting blood glucose was 9mmol/L, his two hour postprandial blood glucose was 11.6mmol/L, and his urine glucose was +. The patient’s tongue had thin, yellow fur, and his pulse was deep. Therefore, Chai Hu and Bai Shao were removed from the original formula and Sheng Di was lowered to 30 grams. In addition, 15 grams of Radix Scrophulariae Ningpoensis (Xuan Shen) were added to strengthen the clearing of heat and engenderment of fluids.
On Mar. 2, the patient was seen for the third time, at which time his lack of strength, dry mouth, vexatious thirst, polyphagia, polyuria, and dry stools had all basically disappeared. The man’s affect had improved as had his mood. Fasting blood glucose was now 5.8mmol/L, two hour postprandial blood glucose was 7.6mmol/L, and urine glucose was negative. The patient was administered five more packets of the above medicinals, after which he was advised to take Xiao Ke Wan (Thirsting & Wasting Pills) in order to maintain his blood glucose at normal levels.
Discussion:
Based on this case history and Prof. Liang’s teachings, it is important not to overlook psychological factors leading to liver depression/depressive heat in the causation and aggravation of diabetes. While acrid, windy qi-rectifying medicinals are typically contraindicated in cases of yin vacuity with vacuity heat and most diabetes patients exhibit symptoms of yin vacuity, dryness, and heat, it is, nevertheless, important to course or soothe the liver, rectify the qi and resolve depression when liver depression is the source of the heat which is consuming and damaging yin fluids. As long as this is done carefully as part of a formula which contains yin-enriching, fluid-engendering, and heat-clearing medicinals, it is possible and even necessary to use such otherwise contraindicated medicinals as Radix Bupleuri (Chai Hu).
Copyright © Blue Poppy Press, 2002. All rights reserved.
For more information on the Chinese medical treatment of diabetes and its complications, see Bob Flaws, Lynn Kuchinski & Robert Casañas’s The Treatment of Diabetes Mellitus with Chinese Medicine available from Blue Poppy Press in late Spring-early Summer, 2002. |
