Chinese Medical Diabetes

Diabetes, Fatty Liver & Chinese Medicine

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

Keywords: Chinese medicine, Chinese herbal medicine, diabetes, fatty liver

Fatty liver (hepatic steatosis) refers to excessive accumulation of lipids in the hepatocytes. Fatty liver occurs when lipid accumulation exceeds the normal 5% of liver weight. Alcoholism, obesity, and diabetes are the most common causes of macrovesicular fatty liver in developed countries. Therefore, this is a commonly seen complication of diabetes. Approximately 45% of patients with diabetes over 60 years of age have a fatty liver. It is believed that fatty liver is due to loss of balance between triglycerides. Fifty to 80% of patients with type 2 diabetes are obese, and a fatty liver and obesity are closely related. Diabetic fatty liver is most often found on physical examination as nontender, smooth, diffuse hepatomegaly in a diabetic patient. While there may be accompanying right upper quadrant pain, tenderness, and/or jaundice, fatty liver may be asymptomatic. Ultrasonography and CT scan may reveal excess fat, but fatty liver is diagnosed with certainty only by liver biopsy. Macrovesicular fatty liver is usually not harmful in itself, and no specific Western medical treatment exists for it other than to treat the underlying disorder. Management includes weight loss for obese patients, and glycemic control for those with diabetes.

According to Li Sai-mei et al. in Tang Niao Bing Zhong Xi Yi Zhen Liao Yu Tiao Yang (Diabetes, Its Western & Chinese Medical Diagnosis, Treatment & Care, Guangdong Tourism Publishing Co., Guangzhou, 2000), diabetic fatty liver is divided into four stages and its Chinese medical treatment based pattern discrimination is related to these four stages.

Treatment based on pattern discrimination:

Stages I & II

1. Liver qi depression & binding

Main symptoms: Right rib-side distention, fullness, and discomfort mostly caused and/or aggravated by emotional stress or psychological stimulation accompanied by a dry mouth with a bitter taste, a red tongue with thin, white fur, and a bowstring, fine pulse

Treatment principles: Course the liver and resolve depression

Rx: Si Ni San Jia Jian (Four Counterflows Powder with Additions & Subtractions)

Radix Bupleuri (Chai Hu), 6g, Fructus Immaturus Citri Aurantii (Zhi Shi), 6g, Fructus Citri Aurantii (Zhi Ke), 6g, Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 10g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 10g, uncooked Radix Glycyrrhizae (Gan Cao), 6g, Rhizoma Cyperi Rotundi (Xiang Fu), 10g, Rhizoma Alismatis (Ze Xie), 10g, Radix Salviae Miltiorrhizae (Dan Shen), 20g, Folium Nelumbinis Nuciferae (He Ye), 6g, Fructus Citri Sacrodactylis (Fo Shou), 10g, Radix Scrophulariae Ningpoensis (Xuan Shen), 10g, Radix Trichosanthis Kirlowii (TianHua Fen), 20g, Cortex Magnoliae Officinalis (Hou Po), 6g

2. Yin vacuity-yang effulgence

Main symptoms: Dry mouth, polydipsia, polyuria colored yellow, constipation, tenseness, agiation, easy anger, dizziness and vertigo, if severe, abdominal distention, right upper abdominal discomfort, bleching, decreased appetite, a red tongue with yellow fur, and a weak pulse

Treatment principles: Nourish yin and emolliate the liver

Rx: Zeng Ye Tang Jia Wei (Increase Fluids Decoctions with Added Flavors)

Radix Scrophulariae Ningpoensis (Xuan Shen), 20g, uncooked Radix Rehmanniae (Sheng Di), 20g, Tuber Ophiopogonis Japonici (Mai Men Dong), 10g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 20g, uncooked Radix Polygoni Multiflori (He Shou Wu), 15g, Radix Puerariae (Ge Gen), 10g, Radix Trichosanthis Kirlowii (Tian Hua Fen), 20g, uncooked Radix Glycyrrhizae (Gan Cao), 3g

Stage III

1. Phlegm turbidity congestion & exuberance

Main symptoms: Ductal and abdominal distention and fullness, torpid intake, loose stools, heavy, encumbered body and limbs, scanty qi, lack of strength, a dry mouth and thirst, a fat body, a pale but dark tongue with thick, slimy, white fur, and a bowstring, slippery pulse

Treatment principles: Fortify the spleen and harmonize the stomach, dispel phlegm and transform turbidity

Rx: Wen Dan Tang Jia Wei (Warm the Gallbladder Decoction with Added Flavors)

Rhizoma Pinelliae Ternatae (Ban Xia), 10g, Sclerotium Poriae Cocos (Fu Ling), 12g, Rhizoma Atractylodis Macrocephalae (Bai Zhu), 10g, Caulis Bambusae In Taeniis (Zhu Ru), 10g, Tuber Curcumae (Yu Jin), 10g, Rhizoma Alismatis (ZE Xie), 15g, Radix Puerariae (Ge Gen), 12g, Pericarpium Citri Reticulatae (Chen Pi), 10g, Rhizoma Atractylodis (Cang Zhu), 10g, Cortex Magnoliae Officinalis (Hou Po), 10g, Semen Pruni Persicae (Tao Ren), 10g, Fructus Crataegi (Shan Zha), 15g, Radix Salviae Miltiorrhizae (Dan Shen), 20g

2. Damp heat depression & binding

Main symptoms: Chest, ductal, and abdominal distention, bloating and distention after meals, thirst but no polydipsia, muscular soreness and distention, a heavy feeling in the four limbs, a bitter taste in the mouth, nausea, if severe, jaundice, yellow urine, a pale, fat, slightly red tongue with thick, slimy, yellow fur, and a slippery, bowstring, rapid pulse

Treatment principles: Fortify the spleen and transform dampness, clear heat and disinhibit water

Rx: Yin Chen Hao Tang (Artemisia Capillaris Decoction) plus San Miao San (three Wonders Powder) with additions and subtractions

Rhizoma Atractylodis (Cang Zhu), 10g, Radix Puerariae (Ge Gen), 10g, Semen Coicis Lachryma-jobi (Yi Yi Ren), 30g, Sclerotium Polypori Umbellati (Zhu Ling), 20g, Sclerotium Poriae Cocos (Fu Ling), 20g, Cortex Phellodendri (Huang Bai), 10g, Radix Achyranthis Bidentatae (Niu Xi), 12g, Cortex Magnoliae Officinalis (Hou Po), 6g, Herba Artemisiae Capillaris (Yin Chen Hao), 20g, Pericarpium Citri Reticulatae (Chen Pi), 10g, Radix Trichisanthis Kirlowii (Tian Hua Fen), 20g, Rhizoma Coptidis Chinensis (Huang Lian), 10g

3. Liver depression & blood stasis

Main symptoms: Dry mouth, parched throat, rib-side and abdominal distention and fullness, a fat body, lower and upper back soreness and pain, dark red lips and tongue, and a bowstring, slippery pulse

Treatment principles: Course the liver and rectify the qi, quicken the blood and transform stasis

Rx: Chai Hu Shu Gan San Jia Wei (Bupleurum Course the Liver Powder with Added Flavors)

Rhizoma Polygonati (Huang Jing), 30g, Radix Bupleuri (Chai Hu), 10g, Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 30g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 20g, Fructus Citri Aurantii (Zhi Ke), 6g, Fructus Immaturus Citri Aurantii (Zhi Shi), 6g, Radix Salviae Miltiorrhizae (Dan Shen), 30g, Semen Pruni Persicae (Tao Ren), 20g, Radix Angelicae Sinensis (Dang Gui), 10g, Fructus Schisandrae Chinensis (Wu Wei Zi), 10g, Herba Artemisiae Capillaris (Yin Chen Hao), 20g, uncooked Radix Rehmanniae (Sheng Di), 15g, Semen Polygoni Orientalis (Shui Hong Yao Zi), 10g

Stage IV

1. Spleen-kidney yang vacuity, phlegm & stasis collecting internally

Main symptoms: Fear of cold, chilled limbs, lower extremity superficial edema, diarrhea, hypochondral piercing pain, distention, and fullness, lack of strength, a dry mouth and tongue, no thirst but profuse drinking, lower and upper back soreness and aching, impotence, a fat, dark red tongue with white fur, and a deep, fine, forceless pulse

Treatment principles: Warm and supplement the spleen and kidneys, free the flow of the network vessels and quicken the blood

Rx: [Unnamed formula]

uncooked Radix Astragali Membranacei (Huang Qi), 20g, Radix Angelicae Sinensis (Dang Gui), 10g, Radix Rubrus Panacis Ginseng (Ren Shen), 5g, Radix Lateralis Praeparatus Aconiti Carmichaeli (Fu Zi), 5g, Sclerotium Polypori Umbellati (Zhu Ling), 20g, Rhizoma Atractylodis (Cang Zhu), 10g, cooked Radix Rehmanniae (Shu Di), 10g, Fructus Amomi (Sha Ren), 6g, Rhizoma Cibotii Barometsis (Gou Ji), 15g, Fructus Chaenomelis Lagenariae (Mu Gua), 15g, Radix Dipsaci (Xu Duan), 10g, Radix Puerariae (Ge Gen), 10g, Radix Salviae Miltiorrhizae (Dan Shen), 20g, Scolopendra Subspinipes (Wu Gong), 2 strips, Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 30g, Pericarpium Citrti Reticulatae (Chen Pi), 10g

2. Liver-kidney yin vacuity, static blood obstructing the network vessels

Main symptoms: Lassitude of the spirit, lack of strength, a sallow yellow facial complexion, dizziness and vertigo, low back soreness and low limb limpness, if severe, epistaxis, bleeding gums, liver palms, spider nevi, a dry mouth and parched tongue, a dark red tongue with scanty fur, and a fine, rapid pulse

Treatment principles: Enrich yin and nourish the blood, boost the qi and quicken the blood

Rx: [Unnamed formula]

Radix Pseudostellariae Heterophyllae (Tai Zi Shen), 20g, Sclerotium Polypori Umbellati (Zhu Ling), 20g, Rhizoma Atractylodis Macrocephalae (Bai Zhu), 10g, mix-fried Radix Glycyrrhizae (Gan Cao), 6g, Radix Angelicae Sinensis (Dang Gui), 10g, Radix Ligustici Wallichii (Chuan Xiong), 10g, Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 20g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 20g, Radix Achyranthis Bidentatae (Niu Xi), 15g, uncooked Radix Rehmanniae (Sheng Di), 20g, uncooked Radix Astragali Membranacei (Huang Qi), 20g, Radix Salviae Miltiorrhizae (Dan Shen), 20g, Gelatinum Plastri Testudinis (Gui Ban Jiao), 10g, cooked Radix Rehmanniae (Shu Di), 15g, Fructus Corni Officinalis (Shan Zhu Yu), 10g, Cortex Eucommiae Ulmoidis (Du Zhong), 10g, Fructus Lycii Chinensis (Gou Qi Zi), 10g

Body acupuncture:

Main points: Qi Men (Liv 14), Zu San Li (St 36), Zhong Wan (CV 12), Nei Guan (Per 6), Yang Ling Quan (GB 34)

Auxiliary points: Zhang Men (Liv 13), Zhi Gou (TB 6), Pi Shu (Bl 20), San Yin Jiao (Sp 6), Guan Yuan (CV 4)

Needling hand technique: Even supplementing-even draining. After obtaining the qi, retain the needles for 30 minutes. Treat once per day, with 15 days equaling one course of treatment.

Ear acupuncture:

Main points: Liver, Gallbladder, Endocrine, Sympathetic, Kidney

Auxiliary points: Pancreas, Spleen, Subcortex, Shen Men

Needling hand technique: Choose 2-3 points each time, using medium stimulation, and retain the needles for 20-30 minutes. Treat once per day, with 10 days equaling one course of treatment. One can also use ear point bean treatment, [i.e., pellets taped over acupuncture points in the ear].

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