The worldwide incidence of diabetes has doubled in the last 15 years and is projected to double again in the next 15 years. This increase in the incidence of diabetes has occurred in the People’s Republic of China as well as in the developed countries of the West, and the treatment of diabetes and its many complications is a popular topic in contemporary Chinese medical journals. The following is an abstract of an article written by Chen Gang and published in issue #11, 2001 of Si Chuan Zhong Yi (Sichuan Chinese Medicine) on page 43. Titled, “The Treatment of 48 Cases of Impaired Glucose Tolerance with Jian Pi Ni Dan Tang (Fortify the Spleen & Counter Pure Heat Decoction),” this article describes research conducted at the Diabetes Department of the Funing County Chinese Medical Hospital in Hebei in 1997-98.
All 48 patients in this study were seen as out-patients and were diagnosed as suffering from impaired glucose tolerance (IGT) according to 1985 WHO diagnostic criteria. Of these 48, 28 were men and 20 were women. The youngest was 32 and the oldest was 68 years old, with an average age of 40. Forty-two cases were 20% overweight, four cases were within 20% of normal weight, and two cases were 20% underweight. Twenty-one cases had accompanying hypertension, 38 cases had accompanying hyperlipidemia, and seven cases had a history of diabetes mellitus.
Self-composed Jian Pi Ni Dan Tang consisted of: Radix Astragali Membranacei (Huang Qi), 20g, Radix Codonopsitis Pilosulae (Dang Shen), Radix Dioscoreae Oppositae (Shan Yao), Radix Scrophulariae Ningpoensis (Xuan Shen), and Corneum Endothelium Gigeriae Galli (Ji Nei Jin), 15g each, and Rhizoma Atractylodis (Cang Zhu), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Herba Eupatorii Fortunei (Pei Lan), Herba Lycopi Lucidi (Ze Lan), Sclerotium Poriae Cocos (Fu Ling), Fructus Amomi (Sha Ren), and Pericarpium Citri Reticulatae (Chen Pi), 10g each. If there was high blood pressure, Spica Prunellae Vulgaris (Xia Ku Cao) and Flos Chrysanthemi Morifolii (Ju Hua) were added. If there was hyperlipidemia, Rhizoma Alismatis (Ze Xie), Rhizoma Polygoni Cuspidati (Hu Zhang), Radix Salviae Miltiorrhizae (Dan Shen), and Radix Ligustici Wallichii (Chuan Xiong) were added. If there was emotional agitation, Radix Bupleuri (Chai Hu), Radix Angelicae Sinensis (Dang Gui), and Herba Menthae Haplocalycis (Bo He) were added. One ji of the above medicinals were decocted in water per day down to 300ml of fluid, and a small amount was taken internally at repeated intervals. Fifteen ji equaled one course of treatment with a five day rest between courses. During this treatment, the patients were forbidden to eat oily, greasy foods, acrid, peppery foods, sugar, and alcohol.
Patients were tested initially with an oral glucose tolerance test (OGTT) and then retested after two courses of treatment. They were then tested yet again a half year later. If the OGTT after treatment was normal, this was defined as a cure. If the OGTT improved, this was labeled some effect, and if there was no change in OGTT or the patient went on to develop diabetes, this was labeled no effect. Based on these criteria, 46 cases were judged cured short-term and two got some effect. Long-term, 42 cases were cured, two got some effect, one got no effect and went on to develop diabetes, and three were unable to be re-examined after six months.
Dr. Chen equates IGT with the traditional Chinese disease category of pi dan, spleen pure heat. According to Nigel Wiseman and Feng Ye in their A Practical Dictionary of Chinese Medicine (Paradigm Publications, Brookline, MA, 1998. p. 473), pure heat refers to exuberance of heat evils or heat qi. This is what Li Dong-yuan was talking about under the rubric “center heat” in his chapter, “Heat in the Center Due to Damage by Food & Drink,” in the Pi Wei Lun (Treatise on the Spleen & Stomach), and, based on the design of his protocol, it is clear that Dr. Chen has been influenced by Li-Zhu medicine and yin fire theory. Dr. Chen quotes a number of premodern sources to support his contention that overeating sweet, greasy, fatty foods results in the internal engenderment of dampness and heat which damage the spleen. Therefore, he believes that the main treatment method for dealing with this condition is to supplement spleen vacuity while secondarily dispelling dampness and clearing heat. Thus, within this formula, Huang Qi, Dang Shen, Bai Zhu, Fu Ling, and Shan Yao greatly supplement the spleen qi. Sha Ren and Chen Pi aromatically and penetratingly arouse the spleen and also prevent supplementation from engendering stagnation. Fu Ling and Shan Yao seep dampness, Cang Zhu dries dampness, and Ze Lan and Pei Lan transform dampness. In addition, modern research has confirmed that Huang Qi, Shan Yao, Cang Zhu, and Xuan Shen are all effective medicinals for the treatment of diabetes. Ji Nei Jin fortifies the spleen and transforms food. Likewise, recent research has confirmed that this is a particularly good medicinal for treating diabetes. Xuan Shen enriches yin and clears heat.
While many Chinese doctors have traditionally emphasized yin vacuity with vacuity heat as the main disease mechanisms of diabetes, Dr. Chen recognizes that it is spleen vacuity and enduring damp heat which typically leads to the dual qi and yin vacuity so prevalent in patients who have developed symptomatic diabetes. In my experience, this evolutionary process is an important one to keep in mind when treating patients with asymptomatic or borderline diabetes. There are certain definite relationships between various disease mechanisms in Chinese medicine, and a good understanding of the evolution of these disease mechanisms over time is an important aspect of the clinical practice of Chinese medicine. As an extension of this, if one adds Chai Hu and Dang Gui from the suggested list of modifications, this formula treats the all-too-common liver-spleen disharmony and is even more obviously modeled on a typical Li-Zhu yin fire formula.