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Insulin Resistance Syndrome & Treatment Based on Pattern Discrimination abstracted & translated by Keywords: Chinese medicine, Chinese herbal medicine, insulin resistance, Syndrome X, treatment based on pattern discrimination In the last year, I have noticed a definite up-surge in the number of articles being published on diabetes and insulin resistance in Chinese medical journals. Syndrome X, also referred to as insulin resistance syndrome, refers to a constellation of hypertension, dyslipidemia, and elevated blood glucose which predisposes patients suffering from this trio to coronary heart disease. Recently, Yang Yu-tian from the Shanghai Da Hua Hospital published an article titled, “The Treatment of 52 Cases of Insulin Resistance Syndrome Based on Pattern Discrimination,” in issue 1, 2002, of Shan Xi Zhong Yi (Shanxi Chinese Medicine) on pages9 and 10. Because so many Westerners are at risk for syndrome X and the subsequent morbidity and mortality with which it is related, a precis of that article appears below. Cohort description: Fifty-two patients were orally administered 75g of glucose. Afterwards, their fasting blood glucose, fasting serum insulin, triglycerides, and blood pressure were taken. Fasting blood glucose (FBG) was 6.2mmol/L or higher, serum fasting insulin was 15mu/L or higher, triglycerides were 1.7mmol/L or higher, and blood pressure was 18.7/12kPa or higher. Thus all 52 patients met the criteria for insulin resistance syndrome. Among these 52, 23 were male and 29 were female, with a median age of 53.4 ± 8.6 years and a median disease duration of 2.32 ± 1.46 years. Treatment method: All 52 patients in this study were administered the following basic Chinese medicinal formula: Radix Glehniae Littoralis (Sha Shen), 15g, Tuber Asparagi Cochinensis (Tian Men Dong), 9g, Tuber Ophiopogonis Japonici (Mai Men Dong), 9g, Radix Trichosanthis Kirlowii (Tian Hua Fen), 15g, Rhizoma Gastrodiae Elatae (Tian Ma), 9g, Ramulus Uncariae Cum Uncis (Gou Teng), 9g, Fructus Lycii Chinensis (Gou Qi Zi), 9g, Flos Chrysanthemi Morifolii (Ju Hua), 9g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 9g, Radix Achyranthis Bidentatae (Niu Xi), 9g, Radix Scutellariae Baicalensis (Huang Qin), 9g, Rhizoma Coptidis Chinensis (Huang Lian), 9g, Semen Arecae Catechu (Bin Lan), 9g, processed Radix Et Rhizoma Rhei (Da Huang), 9g, Semen Cassiae Torae (Jue Ming Zi), 15g, and Semen Raphani Sativi (Lai Fu Zi), 15g. If there was accompanying dry mouth and parched throat with polydispsia and rapid hungering, dry stools, yellow urination, a red tongue with scanty or peeled fur, and a fine, rapid pulse suggesting stomach yin insufficiency, nine grams each of Herba Dendrobii (Shi Hu), Rhizoma Anemarrhenae Aspheloidis (Zhi Mu), Radix Puerariae (Ge Gen), and Rhizoma Polygonati Odorati (Yu Zhu) and 30 grams of uncooked Gypsum Fibrosum (Shi Gao) were added. If there was dizziness, tinnitus, tidal fever, red cheeks, dry, scratchy eyes, a red tongue with white fur, and a bowstring pulse suggesting ascendant liver yang hyperactivity, 30 grams each of uncooked Os Draconis (Long Gu), uncooked Concha Ostreae (Mu Li), and Magnetitum (Ci Shi) and 0.6g of powdered Cornu Antelopis Saiga-tatarici (Ling Yang Jiao) were added. If there was a red facial complexion, red eyes, heart vexation, easy anger, a dry mouth, and a bitter taste in the mouth suggesting liver fire flaming upward, 12 grams of Spica Prunellae Vulgaris (Xia Ku Cao) and nine grams each of Radix Gentianae Scabrae (Long Dan Cao) and Fructus Gardeniae Jasminoidis (Zhi Zi) were added. If there was constipation, a liking fro chilled things and aversion to heat, a red tongue with yellow fur, and a bowstring, rapid pulse suggesting stomach and intestinal dryness and heat, 10 grams of uncooked Radix Et Rhizoma Rhei (Da Huang) were added. If the body was overweight, the head was clouded and unclear, and there was addiction to sleep suggesting phlegm heat, 15 grams each of Herba Sargassii (Hai Zao) and Thallus Algae (Kun Bu) were added. If the mouth was dry and bitter but there was no desire to drink, the tongue fur was yellow and slimy, and the pulse was slippery, suggesting gallbladder heat, nine grams each of Radix Bupleuri (Chai Hu), Rhizoma Pinelliae Ternatae (Ban Xia), Herba Lysimachiae Seu Desmodii (Jin Qian Cao), and Herba Artemesiae Capillaris (Yin Chen Hao) were added. If there were heart palpitations, insomnia, and profuse dreams due to heart yin insufficiency with ascendant heart yang hyperactivity, 12 grams of Radix Salviae Miltiorrhizae (Dan Shen) and nine grams of Radix Scrophulariae Ningpoensis (Xuan Shen) were added. These medicinals were decocted in water and administered orally, one ji per day, with one month equaling one course of treatment. During the term of this treatment, patients were not supposed to take any other hypoglycemic or hypocholestrolemic medications nor any orally administered hyportensive medications. Treatment outcomes: Median FBG went from 6.6 ±1.4mmol/L before treatment to 4.3 ± 1.2mmol/L after treatment. Median fasting serum insulin went from 24.3 ± 3.9mu/L before treatment to 15.4 ± 2.6mu/L after treatment. Median triglycerides went from 3.9 ± 1.7mmol/L before treatment to 1.2 ± 0.9mmol/L after treatment. Median insulin sensitivity went from 6.24 ± 2.5 x 10-3 before treatment to 15.10 ± 0.6 x 10-3 after treatment, and median blood pressure went from 20.8 ± 1.6kPa before treatment to 16.7 ± 1.5kPa after treatment. Therefore, there was significant difference in all measured indices from before to after treatment. Discussion: According to Dr. Yang, insulin resistance syndrome is commonly characterized by dizziness, tinnitus, a dry mouth, polydipsia, constipation, yellow urination, an overweight body, a red tongue, and a bowstring pulse. In terms of Chinese medical disease diagnosis, it corresponds to dizziness and vertigo (xuan yun), wasting and thirsting (xiao ke), and phlegm condition (tan zheng). Further according to Dr. Yang, its viscera and bowel disease mechanisms are mostly closely associated with the liver-gallbladder and spleen-stomach. The liver rules coursing and discharging, the stomach rules accepting and absorbing, and the spleen rules movement and transformation. If there is emotional anxiety, depression, and tension, the qi mechanism may become depressed and stagnant. If this endures, it may transform fire. It is also possible for addiction to eating acrid, peppery, fatty, sweet, fried or grilled foods to cause accumulation of heat in the spleen and stomach. In either case, this evil heat will burn and damage yin and the constructive which, in turn, may lead to liver yin insufficiency. In that case, liver yang may become hyperactive and ascend and stomach yin may become insufficient. Ascendant liver yang hyperactivity may then lead to dizziness and tinnitus, a red tongue, and bowstring pulse. Stomach yin insufficiency may then lead to a dry mouth, polydipsia, constipation, and yellow urination. If the spleen and stomach accumulate heat, there will be a tendency to rapid hungering and polyphagia. If this endures for some time, it may engender phlegm heat which then results in obesity. Based on these theories, within this formula, Tian Ma and Gou Teng are the sovereigns which level the liver and subdue yang. Tian Hua Fen, Tian Men Dong, Sha Shen, and Mai Men Dong enrich and nourish stomach yin. Gou Qi Zi, Ju Hua, Bai Shao, and Niu Xi enrich yin and emolliate the liver. Bin Lan, processed Da Huang, Jue Ming Zi, and Lai Fu Zi disperse and abduct as well as transform phlegm. These are the ministerial medicinals in this formula. Huang Qin and Huang Lian clear and drain spleen-stomach heat. They are also able to clear and drain liver-gallbladder fire. These are the assistant medicinals. Niu Xi also leads fire to move downward. So it is also a messenger or guiding medicinal. When all these medicinals are used together, they level the liver and subdue yang, enrich yin and clear heat, disperse and abduct and transform phlegm. In terms of modifications, when yang has a surplus, it tends to produce fire. Therefore, in this disease, one commonly sees dry mouth, parched throat, polydipsia, easy hunger, and red tongue with scanty or peeled fur, and a fine, rapid pulse. These are signs and symptoms of stomach yin insufficiency, for which Shi Hu, Yu Zhu, uncooked Shi Gao, Zhi Mu, and/or Ge Gen may be added. If fire heat damages yin and liver-kidney yin becomes vacuous, this may give rise to ascendant liver yang hyperactivity with dizziness, vertigo, tinnjitus, insomnia, and profuse dreams. In that case, uncooked Long Gu, Mu Li, Ci Shi, and/or Ling Yang Jiaomay be added to settle and subdue yang, clear heat, and extinguish wind. If there is heart vexation, easy anger, a red face and eyes, this is due to liver fire flaming upward. In that case, Long Dan Cao, Zhi Zi, and Xia Ku Cao are added to clear and drain liver fire. If there is spleen-stomach accumulation of heat or stomach yin insufficiency, stomach heat may be shifted to the large intestine. In that case, there will be a dry mouth with a bitter taste, constipation, and yellow tongue fur, for which uncooked Da Huang can be added to free the flow of the bowels and drain heat. If the patient is markedly overweight, this is due to phlegm fire being more severe. Therefore, Hai Zao and Kun Bu may be added to transform phlegm. Because the liver-gallbladder and spleen-stomach are so closely related, the liver-gallbladder can shift heat to the spleen-stomach and the spleen-stomach can shift heat to the liver-gallbladder. Dry mouth with a bitter taste in the mouth but no desire to drink, yellow, slimy tongue fur, and a slippery pulse are due to liver heat being shifted to the gallbladder. In that case, one can add Chai Hu, Huang Qin, Jin Qian Cao, and/or Yin Chen Hao to clear gallbladder heat. My one criticism of this article is that it does not take into consideration spleen qi vacuity, and, in my experience with Western patients with this condition, spleen vacuity often plays a significant part. This is because, when the liver becomes exuberant and replete, the spleen commonly becomes vacuous and weak. This tendency is so great that there are sayings in Chinese medicine that, “If the liver is disease, first treat the spleen,” and, “Liver disease is spleen disease.” Dr. Yang’s protocol appears to be a good one for those whose only vacuity is a yin fluid vacuity and insufficiency. However, if there is a concomitant spleen qi vacuity, the above protocol would need to be modified for that as well as the other modifications Dr. Yang does suggest. Copyright © Blue Poppy Press, 2002. All rights reserved. For more information on the Chinese medical treatment of diabetes, see Bob Flaws, Lynn Kuchinski & Robert Casañas’s The Treatment of Diabetes Mellitus with Chinese Medicine available from Blue Poppy Press in late Spring 2002. |
