Chinese Medical Diabetes

Treating Type 2 Diabetes Via the Liver & Kidneys

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

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

Recently more and more emphasis has been placed within the Chinese medical journal literature on the role of the liver and spleen in type 2 diabetes mellitus. Traditionally, yin vacuity, dryness, and heat were the main factors in the disease mechanisms of this condition. However, with earlier detection through routine blood and urine examination, these traditional beliefs have had to be re-examined. In issue #3, 2002 of Shan Xi Zhong Yi (Shanxi Chinese Medicine), Zhang De-gui and He Jian-li published an article titled, “A Study of the Therapeutic Efficacy of the Methods of Regulating the Liver & Enriching the Kidneys in the Treatment of 50 Cases of Type 2 Diabetes.” This article appeared on pages 14-15 of that journal, and a precis is given below.

Cohort description:

All 50 patients in this study were diagnosed with type 2 diabetes according to WHO criteria. In terms of Chinese medicine, these patients’ basic pattern was liver-gallbladder loss of coursing and kidney yin depletion and vacuity. Six of these patients also exhibited qi vacuity and four also exhibited kidney yang vacuity. Among these 50 patients, there were 25 males and 25 females aged 38-72 years, with an average age of 50 years. These patients had been diagnosed with diabetes for from three months to 24 years.

Treatment method:

Li Gan Zi Shen Tang (Regulate the Liver & Enrich the Kidneys Decoction) consisted of: Radix Bupleuri (Chai Hu), 12g, Radix Scutellariae Baicalensis (Huang Qin), 12g, Radix Trichosanthis Kirlowii (Tian Hua Fen), 24g, Radix Pseudostellariae Heterophyllae (Tai Zi Shen), 15g, uncooked Radix Rehmanniae (Sheng Di), 24g, Fructus Corni Officinalis (Shan Zhu Yu), 20g, Radix Dioscoreae Oppositae (Shan Yao), 20g, Radix Salviae Miltiorrhizae (Dan Shen), 15g, Rhizoma Alismatis (Ze Xie), 12g, and stir-fried Rhizoma Atractylodis (Cang Zhu), 18g. If there was simultaneous qi vacuity, Radix Astragali Membranacei (Huang Qi) and Rhizoma Atractylodis Macrocephalae (Bai Zhu) were added. If there was simultaneous kidney yang vacuity, Herba Epimedii (Xian Ling Pi), Cortex Cinnamomi Cassiae (Rou Gui), and Sclerotium Poriae Cocos (Fu Ling) were added. Each day, one packet of these medicinals was decocted in water and administered in two divided doses in the morning and evening. One month equaled one course of treatment. During the course of treatment, patients gradually reduced the dosage of their original hypoglycemic drugs as far as possible and also ate a restricted diet.

Treatment outcomes:

Outcomes criteria were based on those found in the 1993 publication, Zhong Yao Xin Yao Zhi Liao Xiao Ke Bing (Chinese Medicinals & New Medicinals for the Treatment of Wasting & Thristing Disease). According to these criteria, marked effect was defined as basic disappearance of symptoms after two courses of treatment, fasting blood glucose (FBG) of less than 7.2mmol/L, two hour postprandial blood glucose (PPBG) of less than 8.3mmol/L, and a reduction in total 24 hour urine glucose of 30% or more. Some effect was defined as marked improvement in symptoms after two courses of treatment, FBG less than 8.3mmol/L, PPBG of less than 10.0mmol/L, and a reduction in total 24 hour urine glucose of 10% or more. No effect meant that, after two courses of treatment, there was no obvious improvement in symptoms and reductions in blood and urine glucose did not meet the above criteria. Based on these criteria, 36 cases were judged to have gotten a marked effect, 10 got some effect, and four got no effect, for a total amelioration rate of 92%.

Discussion:

According to Drs. Zhang and He, the basic disease mechanisms of diabetes are yin vacuity, dryness, and heat. These basic mechanisms are then complicated by phlegm turbidity and blood stasis. However, all of these may be due to the liver’s loss of coursing and discharge or the liver-gallbladder’s loss of coursing. In this case, the function of the three viscera of the lungs, spleen, and kidneys loose their regulation, leading to imbalance and dysregulation of yin and yang. If liver depression transforms fire (or liver-gallbladder depressive heat), fire heat may blaze and become exuberant, thus burning and damaging the yin fluids of the lungs. If liver wood checks earth excessively greatly, this may lead to the loss of normalcy of spleen earth’s fortification and transportation. The spleen is unable to scatter or disperse the essence via the lungs throughout the rest of the body. If liver fire becomes effulgent and liver yin is insufficient, this may lead to kidney yin insufficiency. Therefore, it is easy to see that dysregulation of the liver-gallbladder can lead to yin vacuity, dryness, and heat. This why Dr. Zhang and He believe that regulating the liver and enriching the kidneys should be the root principle of treating this condition.

Within the above formula, Chai Hu is bitter and level (or neutral). It enters the liver and gallbladder channels. It out-thrusts and discharges as well as clears and resolves evils in the shao yang. It also courses and discharges depression and stagnation of the liver-gallbladder qi mechanism. Huang Qin is bitter and cold. It clears and discharges heat from the shao yang. Sheng Di clears heat and nourishes yin, engenders fluids and also enriches the kidneys. Shan Zhu Yu and Shan Yao enrich kidney yin and secure and astringe kidney essence and qi. Tian Hua Fen clears heat and engenders fluids. Combined with Sheng Di, these two are able to disperse liver-gallbladder depressive heat burning and damaging yin fluids resulting in oral thirst. Tai Zi Shen boosts the qi and nourishes yin. If the original qi is insufficient, yin fluids are not able to ascend. This then leads to oral thirst and polydipsia. Tai Zi Shen is also able to fortify the spleen. Ze Xie and Cang Zhu fortify the spleen and dispel dampness, thus preventing enriching from causing sliminess. Dan Shen quickens the blood and transforms stasis. Therefore, when combined with medicinals which dispel phlegm dampness, these are able to simultaneously treat phlegm and stasis. Taken as a whole, this formula courses and discharges the liver and gallbladder, clears and resolves depressive heat, and enriches kidney yin at the same time as it fortifies the spleen and transforms phlegm and dispels stasis.

Looking at this formula, I believe one could say it is a combination of Xiao Chai Hu Tang (Minor Bupleurum Decoction) and Liu Wei Di Huang Wan (Six Flavors Rehmannia Pills) with additions and subtractions. While Drs. Zhang and He say nothing about supplementing spleen vacuity or dispelling phlegm and stasis in their article’s title, it is important to appreciate that this formula does all of these things as well as regulating the liver and enriching kidney yin. This makes this formula a very useful model for dealing with complex, multipattern presentations of diabetes.

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.