Chinese Medical Diabetes

Wu Mei Wan & The Treatment of Slight Diabetic Gastroparesis

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

Keywords: Chinese medicine, Chinese herbal medicine, diabetes, diabetic gastroparesis, Wu Mei Wan

Neuropathy is one of the complications of diabetes mellitus. Although peripheral neuropathy due to diabetes is more widely known, paralysis of the stomach (gastroparesis) is also common. For a number of years, the Western drug Propulsid was effective in treating this condition. However, this drug was taken off the market in the U.S. in 2000 due to its association with heart arrhythmias and a number of deaths due to such arrhythmias. This has left Western medical practitioners and their patients without an effective therapy for this condition. Recently, Zou Shi-chang published an article in issue #12, 2001 of Xin Zhong Yi (New Chinese Medicine) describing his treatment of this condition with Wu Mei Wan (Mume Pills). Titled, “A Clinical Audit of the Treatment of 42 Cases of Slight Diabetic Gastroparesis with Wu Mei Wan),” this article appeared on pages 34-35 of that journal. This article suggests that a very old, very famous Chinese medicinal formula may be effective for the treatment of this condition. Since the incidence of diabetes mellitus has doubled in the last 15 years and is projected to double again in the next 15 years, the incidence of diabetic gastric paresis will also be likely to rise substantially in the near and intermediate future. I also am interested in this article because I have long been interested in this specific formula which originated in Zhang Zhong-jing’s late Han dynasty Shang Han Lun (Treatise on Damage [Due to] Cold). Although this formula is the prototypical worm-eliminating formula of Chinese medicine, its scope of application is much greater than that fact might indicate to many.

Cohort description:

Altogether, there were 84 patients in this study who were divided into two groups of 42 patients each. All these patients met the 1985 WHO criteria for diabetes. In addition, all had been diagnosed with diabetes for five years or more and all experienced postprandial abdominal distention, nausea, indigestion, and upper abdominal discomfort. X-ray examination showed that gastric peristalsis was weak and that emptying time was slow. None of the patients had gastric ulcers or Heliobacter pylori infections. In the so-called treatment group, there were 22 men and 20 women with a median age of 53.7 ± 6.3 years and median fasting blood glucose (FBG) of 9.8 ± 4.3mmol/L. A median numerical rating was given to their symptoms of 59.6 ± 12.8. In the comparison group, there were 21 men and 21 women with a median age of 53.7 ± 6.4 years, a median FBG of 9.9 ± 4.0mmol/L, and a median rating of symptoms of 59.4 ± 12.2. Therefore, in terms of age, sex, and degree of disease severity, there was no marked statistical difference between these two groups (P , 0.05).

Treatment method:

The treatment group received the following version of Wu Mei Wan: Radix Codonopsitis Pilosulae (Dang Shen), 18g, Radix Angelicae Sinensis (Dang Gui), Ramulus Cinnamomi Cassiae (Gui Zhi), Fructus Pruni Mume (Wu Mei), and Cortex Phellodendri (Huang Bai), 10g each, Fructus Zanthoxyli Bingeani (Chuan Jiao) and Rhizoma Coptidis Chinensis (Huang Lian), 4g each, dry Rhizoma Zingiberis (Gan Jiang) and Herba Asari Cum Radice (Xi Xin), 6g each, and Radix Lateralis Praeparatus Aconiti Carmichaeli (Fu Zi), decocted first, 12 g. One ji of these medicinals was decocted in water two times down to 400ml of liquid and administered in two doses per day. The comparison group received 20mg of domperidone (Motilium) each time, three times per day, 30 minutes before meals. Four weeks equaled one course of treatment. After one such course, treatment efficacy and adverse reactions were assessed and the patients were followed for six months. During this study, both groups continued on their hypoglycemic and antidiabetic medications and adhered to the diabetic diet.

Treatment outcomes:

In the treatment group, 12 cases were judged cured, 13 were thought to have experienced a marked effect, nine got some effect, and eight got no effect, for a total amelioration rate of 81.0%. In the comparison group, there were 10 cures, 12 marked effects, 11 some effects, and nine no effects, for a total amelioration rate of 78.6%. Therefore, there was no marked difference in treatment efficacy between these two groups (P , 0.05). Subjective sensations of postprandial distention, nausea, vomiting, indigestion, and upper abdominal discomfort all decreased with treatment in both groups. However, only 11.9% of those in the treatment group experienced any adverse reactions, while 33.3% in the comparison group had side effects. In addition, on follow-up after six months, the recurrence rate was only 8.3% in the treatment group compared to 30.0% in the comparison group. Hence there was a marked difference in outcomes between these two groups in terms of adverse reactions and recurrence. In the treatment group, median gastric evacuation time before treatment was 88.3 ± 34.6 minutes. This decreased to 54.3 ± 23.3 minutes after treatment (P + 0.05). Thus is can be said that Wu Mei Wan does promote stomach emptying, its effect is relatively lasting, and its side effects are few.

Discussion:

The author’s choice of Wu Mei Wan implies that, in their experience, most diabetes patients with slight gastroparesis present a combination of hot and cold, repletion and vacuity symptoms. Within this formula, Xi Xin, Gan Jiang, Fu Zi, Chuan Jiao, and Gui Zhi are all acrid and warm ingredients which warm the center and scatter cold. Huang Lian and Huang Bai are bitter, cold ingredients which clear heat and dry dampness. When used together, acridity opens and bitterness downbears, thus promoting the restoration of the spleen and stomach’s mechanism of upbearing and downbearing. Dang Shen and Dang Gui supplement the qi and nourish the blood, thus supporting the righteous. Dr. Zou considers spleen vacuity the root of this condition. According to Dr. Zou, Wu Mei has the action of fortifying the spleen and stomach. However, according to Ye Tian-shi, it may also be said to restrain the liver. Thus this formula treats the liver-spleen/spleen-stomach disharmony so common in patients with diabetes. In this case, the liver is depressed and replete and the spleen is vacuous, cold, and damp, while the stomach, liver, gallbladder, and/or heart are hot. Over time, these heat evils may damage and consume yin fluids. However, typically, such yin vacuity dryness does not manifest in the early stages of this disease. Therefore, I believe Dr. Zou’s choice of this formula is an insightful one. For those cases where this formula is too hot, practitioners may want to consider some combination of Ban Xia Xie Xin Tang (Pinellia Drain the Heart Decoction) and Xiao Chai Hu Tang (Minor Bupleurum Decoction). If stomach yin vacuity symptoms, such as thirst and dry mouth, are present, Tuber Ophiopogonis Japonici (Mai Men Dong) may be added. In addition, due to concern over aristolochic acid, Xi Xin should no longer be prescribed internally. It is important that practitioners not assume that every patient with diabetes should be treated primarily with yin-enriching medicinals.

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