Chinese Medical Diabetes

The Effect of Shu Gan Jian Pi Huo Xue Tang (Course the Liver, Fortify the Spleen & Quicken the Blood Decoction) on Insulin Sensitivity in Type 2 Diabetes Patients

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

Keywords: Chinese medicine, Chinese herbal medicine, type 2 diabetes mellitus, insulin sensitivity

Cohort description:

Seventy-five patients were included in a study published by Li Hong-wei in issue #5, 2002 of Xin Zhong Yi (New Chinese Medicine) on pages 28-29. All 75 patients were diagnosed with type 2 diabetes and were seen as out-patients. These patients were divided into a treatment group and a comparison group. There were 38 patients in the treatment group, 23 males and 15 females with a median age of 54.35 ± 6.24 years and a median disease duration of 4.20 ± 2.58 years. In the comparison group, there were 37 patients, 20 males and 17 females with a median age of 51.26 ± 4.36 years and a median disease duration of 4.98 ± 6.32 years. Therefore, there was no marked statistical difference between these two groups in terms of age, sex, or disease duration.

Treatment method:

The patients in the comparison group received 80-160mg of glyburide BID and 250-500mg of glycazide BID. They were also counseled on controlling their diets and getting more exercise. The patients in the treatment group received the same oral hypoglycemics. In addition, they also received Shu Gan Jian Pi Huo Xue Tang which consisted of: Radix Bupleuri (Chai Hu), Rhizoma Atractylodis Macrocephalae (Bai Zhu), and Tuber Curcumae (Yu Jin), 12g each, Radix Rubrus Paeoniae Lactiflorae (Chi Shao) and Radix Albus Paeoniae Lactiflorae (Bai Shao), 15g each, Sclerotium Poriae Cocos (Fu Ling), 18g, Fructus Citri Aurantii (Zhi Ke), Radix Angelicae Sinensis (Dang Gui), and Radix Ligustici Wallichii (Chuan Xiong), 9g each, and Herba Menthae Happocalycis (Bo He) and Radix Glycyrrhizae (Gan Cao), 6g each. If qi vacuity was pronounced, Radix Codonopsitis Pilosulae (Dang Shen) and Radix Astragali Membranacei (Huang Qi) were added. If there was accompanying dampness, uncooked Semen Lachryma-jobi (Yi Yi Ren) and Rhizoma Atractylodis (Cang Zhu) were added. If there was damp heat, Fructus Gardeniae Jasminoidis (Zhi Zi) and Stylus Zeae Maydis (Yu Mi Xu) were added. If there was accompanying dryness and binding, Radix Et Rhizome Rhei (Da Huang) was added, and, if there was accompanying yin vacuity, uncooked Radix Rehmanniae (Sheng Di) was added. One packet of these medicinals was decocted in water and administered per day. Eight weeks equaled one course of treatment for both groups.

Treatment outcomes:

Treatment outcomes were divided into three categories: marked effect, some effect, and no effect. The definitions of these three categories were based on a book published on the Chinese medical treatment of diabetes in 1993. Based on these criteria, in the treatment group, 20 patients experienced a marked effect, 11 got some effect, and seven got no effect, for a total amelioration rate of 81.57% and a marked effect rate of 52.36%. In the comparison group, 10 got a marked effect, 11 got some effect, and 16 got no effect, for a total amelioration rate of 56.76 % and marked effect rate of 27.03%. Hence there was a significant difference in effectiveness between these two protocols. Mean fasting blood glucose (FBG) prior to treatment was 11.55 ± 2.68mmol/L in the treatment group and 8.34 ± 2.47mmol/L after treatment. In the comparison group, mean FBG was 10.73 ± 2.56mmol/L before treatment and 9.04 ± 2.05mmol/L after treatment. Mean insulin in the treatment group before treatment was 9.96 ± 4.95 and after treatment was 8.68 ± 4.13. In the comparison group, mean insulin was 9.81 ± 4.59 before treatment and 9.94 ± 4.31 after treatment. Mean insulin sensitivity index (ISI) in the treatment group was -4.75 ±0.42 before treatment and -4.47 ± 0.46 after treatment. Mean ISI in the comparison group was -4.68 ± 0.41 before treatment and -4.53 ± 0.48 after treatment. Thus there was a marked improvement in insulin sensitivity in the treatment group.

Discussion:

This another of a growing body of recent Chinese medical articles discussing type 2 diabetes primarily from the point of view of the liver and spleen, not primarily from the point of view of dryness and heat and yin vacuity. This trend is the result of earlier detection of diabetes via routine blood and urine analysis. Therefore, more and more patients are being diagnosed at earlier stages of this disease, and their patterns likewise reflect this. Instead of the premodern emphasis on dryness, heat, and yin vacuity which are common patterns after a patient has manifested the three polys of polydispsia, polyphasia, and polyuria, the emphasis is on liver depression, spleen vacuity, and damp or depressive heat. This is huge conceptual shift within Chinese medicine, and is extremely important in real-life clinical practice. Unless one knows about this new trend in the Chinese medical pattern discrimination and treatment of early type 2 diabetes, one may be confused why their patients do not manifest the more traditional patterns associated with clinically symptomatic diabetes.

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.