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Treating Diabetes Via the Spleen abstracted & translated by Keywords: Chinese medicine, Chinese herbal medicine, diabetes, spleen, Li Dong-yuan, yin fire In modern Chinese medicine, most Chinese doctors think that diabetes is predominantly a yin vacuity-dryness and heat condition that should be treated by clearing the lungs and stomach, engendering fluids and humors, and enriching kidney yin. However, patients with diabetes present many signs and symptoms which are associated with spleen vacuity, such as devitalized essence spirit, shortness of breath, lack of strength, spontaneous perspiration, bodily fatigue, dizziness and vertigo, no thought for food or drink, a somber white or sallow yellow facial complexion, loose stools or irregular defecation, facial and/or lower extremity edema, and a slippery, moderate (i.e., relaxed or slightly slow) or deep, fine, and forceless pulse. In patients with diabetes with these kinds of symptoms, the treatment principles should include supplementing the center and boosting the qi, upbearing yang and eliminating dampness, and Wang Hong-zhen published two such case histories in issue #12, 2001 of the Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine) under the title, “Two Cases of Wasting & Thirsting Treated Via Spleen Vacuity,” on page 535. A summary of these two cases appears below. Case 1: The patient was a 52 year old male who was initially examined in Oct. 1995. The man had been diabetic for three years, and his blood sugar sometimes reached 18.2mmol/L. Glycosuria was (+++-++++). He had been previously treated with insulin and the Chinese medicine, Yu Quan Wan (Jade Spring Pills), without any apparent effect. Because the insulin had made him dizzy, the patient had stopped his medication. At the time of examination, the man’s body was not fat, his facial complexion was sallow yellow, and he had oral thirst and polydipsia. In addition, there was shortness of breath, disinclination to speak and a weak voice, bodily fatigue, lack of strength, torpid intake, glomus and distention, scanty urination, and loose stools, with 2-3 bowel movements per day. There was lower extremity superficial edema, his tongue was pale and fat with teeth-marks on its edges and thin, white fur which was slimy at the root, and a deep, fine, forceless pulse. Blood glucose was 13.4mmol/L, and glycosuria was (+++). Based on the above, Dr. Wang concluded that the patient’s pattern should be categorized as spleen vacuity with qi fall, cold and dampness stagnating internally, and upbearing and downbearing loss of duty. Therefore, the treatment principles were to boost the qi and lift the fallen, upbear yang and eliminate dampness using Li Dong-yuan’s Sheng Yang Yi Wei Tang (Upbear Yang & Boost the Stomach Decoction) with additions and subtractions: Radix Astragali Membranacei (Huang Qi), Radix Panacis Ginseng (Ren Shen), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Sclerotium Poriae Cocos (Fu Ling), lime-processed Rhizoma Pinelliae Ternatae (Ban Xia), and Radix Albus Paeoniae Lactiflorae (Bai Shao), 10g each, dry Rhizoma Zingiberis (Gan Jiang), Radix Et Rhizoma Notopterygii (Qiang Huo), Radix Angelicae Pubescentis (Du Huo), Radix Ledebouriellae Divaricatae (Fang Feng), and Rhizoma Coptidis Chinensis (Huang Lian), 4.5g each, Radix Bupleuri (Chai Hu) and Pericarpium Citri Reticulatae (Chen Pi), 6g each, and mix-fried Radix Glycyrrhizae (Gan Cao), 3g. After administering six ji of these medicinals, the oral thirst had greatly decreased and the lower extremity edema had dispersed. Urination was normal and the stools had formed up and were only 1-2 times per day. Therefore, Dr. Wang added 10 grams of Rhizoma Atractylodis (Cang Zhu) to the formula and increased Qiang Huo, Du Huo, and Fang Feng to six grams each. After another 10 ji of this formula, the oral thirst had disappeared, the man’s abdomen was comfortable, his intake had increased, and his affect was clear and crisp. In addition, his bowel movements had returned to normal. Now Dr. Wang deleted Huang Qi and increased the Chai Hu to 10 grams. Yet another 10 ji were administered and the man’s strength gradually increased and all his symptoms were eliminated. His blood glucose was now 6.7mmol/L and his urine glucose was (-). Case 2: The patient was a 48 year old man who was first examined in Jul. 1997. This patient had been diabetic for seven years and had been treated with such formuals as Er Dong Tang (Two Dongs Decoction), Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction), and Liu Wei Di Huang Tang (Six Flavors Rehmannia Decoction), but his blood glucose was still 15.68mmol/L and glycosuria was (++++). At the time of examination, the man’s body was exuberant and his facial complexion was yellow. There was vexatious heat in the center of his heart, spontaneous perspiration, lack of strength, torpid intake, indigestion, low back and lower limb soreness and limpness, short, scanty urination, and loose stools 2-4 times per day. The man’s tongue was fat and enlarged, pale red in color, and had thin, white fur. His pulse was fine, moderate (i.e., relaxed or slightly slow), and forceless, and both inch positions were deep and weak. Based on the above signs and symptoms, Dr. Wang categorized this patient’s Chinese medical pattern as spleen-stomach qi vacuity with dampness obstructing the middle burner and loss of command of the qi transformation. Therefore, the treatment principles were to boost the spleen and harmonize the center, upbear yang and eliminate dampness using Li Dong-yuan’s Sheng Yang Chu Shi Tang (Upbear Yang & Eliminate Dampness Decoction) with additions and subtractions: Radix Codonopsitis Pilosulae (Dang Shen), Rhizoma Atractylodis (Cang Zhu), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Radix Albus Paeoniae Lactiflorae (Bai Shao), lime-processed Rhizoma Pinelliae Ternatae (Ban Xia), Sclerotium Poriae Cocos (Fu Ling), and Radix Bupleuri (Chai Hu), 10g each, Radix Et Rhizoma Notopterygii (Qiang Huo), Radix Angelicae Pubescentis (Du Huo), Radix Ledebouriellae Divaricatae (Fang Feng), Ramulus Cinnamomi Cassiae (Gui Zhi), and Pericarpium Citri Reticulatae (Chen Pi), 6g each, Rhizoma Coptidis Chinensis (Huang Lian) and Rhizoma Alismatis (Ze Xie), 4.5g each, and mix-fried Radix Glycyrrhizae (Gan Cao), 3g. After administering six ji of the above formula, the man’s thirst was cut in half, his urination was freely flowing and easy, and his stools had formed up. After 10 ji, the thirst had disappeared, the bowel movements were normal, and the spontaneous perspiration and vexatious heat were greatly decreased. Therefore, Dr. Wang took Ze Xie out of the formula and added 10 grams of Radix Ligustici Wallichii (Chuan Xiong) and 4.5 grams of Fructus Alpiniae Oxyphyllae (Yi Zhi Ren). After taking 15 ji of this formula, all the patient’s symptoms had disappeared and his body was strong and healthy. Now the man’s blood glucose was 6.1mmol/L and urine glucose was (-). Discussion: Although most contemporary textbooks emphasize the disease mechanisms of yin vacuity and dryness and heat in the etiology and treatment of diabetes mellitus, spleen vacuity commonly plays a role was well and yin vacuity symptoms may not be very apparent or even nonexistent. In that case, it is Dr. Wang’s opinion that one should emphasize treating the spleen via Li Dong-yuan’s yin fire theory and formulas. This means supplementing the center and boosting the qi, upbearing yang and eliminating dampness. As evidenced by the two preceding case histories, when the treatment corresponds to the individual patient’s personal pattern, the effects will be there. Conversely, as the second case presented above shows, when patients are treated in a pro forma way using primarily yin supplementation when qi vacuity is predominant, not only does this not eliminate the patient’s signs and symptoms but also does not lower their blood sugar. This is an extremely important lesson in standard professional Chinese medicine and one which needs to be continually restated. 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. |
