There are many published studies in the contemporary Chinese medical literature on the Chinese medicinal treatment of type 2 diabetes. Below is a precis of one representative study. Titled, “The Treatment of 150 Cases of Type II Diabetes Mellitus with Yu Yin Tang (Foster Yin Decoction),” this study was authored by Ji Yun-hai and Ji Rui-yun and appeared on page 48 of issue #12, 2001, of Si Chuan Zhong Yi (Sichuan Chinese Medicine).

Cohort description:

Of the 150 out-patients seen in this study, 84 were male and 66 were female. These patients ranged in age from 31-70 years, with 18 cases being 30-40 years of age, 24 cases being 41-50 years of age, 63 cases being 51-60 years of age, and 45 cases being 61-70 years of age. The shortest course of disease was five months and the longest was six years, Twenty-seven cases had been diagnosed within one year, 30 had been diagnosed 1-2 years prior, 51 cases had been diagnosed 3-4 years before, and 42 cases had been diagnosed with type 2 diabetes for 5-6 years. There were 54 cadres, 66 workers, and 30 agricultural workers (or peasants). Thirty cases had accompanying vascular conditions, 36 cases had retinopathy, 48 cases had hypertension, 24 had cerebral vascular disease, and 18 had coronary artery disease.

In terms of clinical symptoms, these included oral thirst, polydipsia, polyphagia, frequent, copious urination, and emaciation, although the three polys were not obvious in those in the initial stages of this disease. Those whose disease had been enduring also had dizziness, chest oppression, windstroke, sparrow vision (i.e., night blindness), and ulcerous sores. Fasting blood glucose waqs greater than 7.2mmol/L, or two hour postprandial blood glucose was greater than 11.1mmol/L.

Treatment method:

The basic formula consisted of: Herba Dendrobii (Shi Hu), 20g, Tuber Ophiopogonis Japonici (Mai Men Dong), 15g, uncooked Radix Rehmanniae (Sheng Di) and Lignum Suberalatum Euonymi (Gui Jian Yu), 30g each, Radix Scrophulariae Ningpoensis (Xuan Shen), Radix Trichosanthis Kirlowii (Tian Hua Fen), and Radix Dioscoreae Oppositae (Shan Yao), 12g each, Radix Astragali Membranacei (Huang Qi), Rhizoma Anemarrhenae Aspheloidis (Zhi Mu), Rhizoma Atractylodis (Cang Zhu), and Radix Salviae Miltiorrhizae (Dan Shen), 10g each. If there was chest and/or rib-side distention and fullness, 15 grams of Radix Bupleuri (Chai Hu) and 12 grams of Fructus Citri Aurantii (Zhi Ke) were added. If there was frequent urination, 15g of Fructus Alpiniae Oxyphyllae (Yi Zhi Ren) and 12 grams of Ootheca Mantidis (Sang Piao Xiao) were added. If there was pruritus, 20 grams of Radix Sophorae Flavescentis (Ku Shen), 15 grams of Fructus Zanthoxyli Bungeani (Chuan Jiao), and 10 grams of Fructus Kochiae Scopariae (Di Fu Zi) were added. If there was cataracts, 15 grams of Flos Chrysanthemi Morifolii (Ju Hua) and 10 grams of Feces Vespertilionis (Ye Ming Sha) were added. If there was insomnia or impaired memory, 15 grams of Radix Polygalae Tenuifoliae (Yuan Zhi) and 12 grams of stir-fried Semen Zizyphi Spinosae (Suan Zao Ren) were added. If there was hypertension, 15 grams of Spica Prunellae Vulgaris (Xia Ku Cao) and 12 grams of Ramulus Uncariae Cum Uncis (Gou Teng) were added. If there was coronary artery disease and angina pain, 40 grams of Fructus Trichosanthis Kirlowii (Quan Gua Lou) and 20 grams of Radix Rubrus Paeoniae Lactiflorae (Chi Shao) were added. If there was constipation, 10 grams of Radix Et Rhizoma Rhei (Da Huang) and 15 grams of Semen Cannabis Sativae (Huo Ma Ren) were added. If there was numbness or pricking pain of the extremities, 20 grams of Caulis Milletiae Seu Spatholobi (Ji Xue Teng) and 15 grams of Fasciculus Vascularis Luffae Cylindricae (Si Gua Luo) were added. One ji of these medicinals was decocted in water and administered per day in three divided doses, with one month equaling one course of treatment. During the time these medicinals were taken, patients’ diets were regulated and they were counseled against sweet, fatty foods, bedroom (i.e., sexual) taxation, anger and worry, smoking tobacco and drinking alcohol, excessive labor and fatigue, and eating acrid, peppery foods.

Treatment outcomes:

Cure meant the disappearance of clinical symptoms with normalization of blood glucose on more than one test. Improvement meant improvement in the main clinical symptoms and improvement in blood glucose. No effect meant that there was no change in any of these parameters from before to after treatment. Based on these criteria, after 1-4 courses of treatment, 48 cases (32%) were judged cured, 90 cases (605) were judged improved, and 12 cases (8%) got no effect. Therefore, the total amelioration rate was 92%.

According to the authors, this condition is mostly due to dryness and heat damaging yin. Therefore, treatment should foster yin in order to engender fluids and clear heat in order to discharge fire. By fostering yin, the kidneys are able to be supplemented, and, by clearing heat, yin is able to be engendered. According to Liu He-jian (a.k.a. Liu Wan-su):

To treat wasting and thirsting, supplement the vacuity of kidney water yin cold and drain the repletion of heart fire yang heat. Eliminate the severity of intestinal and stomach dryness and heat, thus rescuing the whole body’s fluids and humors. Promote the scattering of the pathways and the network vessels and do not bind. Thus fluids and humors are engendered and not withered, qi and blood are disinhibited and not choppy and astringent, and the disease will be eliminated in days.

Therefore, within this formula, Shi Hu, Mai Men Dong, Sheng Di, and Shan Yao foster yin and moisten dryness and, by fostering yin, the kidneys are able to be supplemented. Tian Hua Fen engenders fluids and drains fire and, by draining fire, yin is able to be supplemented. Huang Qi supplements the qi in order to spread and control fluids and humors. Cang Zhu opens depression and scatters binding, courses and frees the flow of the qi mechanism, and promotes the spleen qi’s fortification and movement. Thus water fluids are diffused and moved so that they can moisten and sprinkle the intestines and stomach, urination is reduced, and the muscles and flesh obtain nourishment. Zhi Mu enriches yin and drain fire. Gui Jian Yu and Dan Shen quicken the blood and transform stasis. When stasis is transformed, fluids can be engendered. They also insure rectification of the qi without causing sliminess and supplementation without causing stagnation.

The incidence of liver disease, including hepatitis and hepatic cirrhosis, as a result of the administration of antidiabetic medications is approximately 0.1-0.5%. From Mar. 1996-Aug. 2000, He Yong-he et al. studied the effects of a particular Chinese medicinal formula on 72 patients with liver disease due to antidiabetic drugs. The results of this study were published in issue #12, 2001 of the Zhong Yi Za Zhi (Journal of Chinese Medicine) on pages 724-726. Because this study suggests that Chinese medicinals may eliminate such liver disease while still continuing to take the antidiabetic medications, a summary of this study appears below.

Cohort description:

Altogether, 129 patients were included in this study, all of whom met the WHO criteria for diabetes mellitus and all of whom had varying degrees of liver damage. None of these patients had had any history of liver or kidney dysfunction prior to taking antidiabetic medications, and all met 1989 criteria for medication induced liver disease, including changes in alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyltranspeptidase (GGT), bilirubin (BIL), blood urea nitrogen (BUN), total protein (TP), albumin (ALB), and prothrombin time (PT). Chinese medical diagnosis was based on criteria published in the 1995 Zhong Yi Bing Zheng Zhen Duan Zhi Xiao Biao Sun (Criteria for the Chinese Medical Diagnosis of Diseases & Patterns and Treatment Efficacy).

The total of 129 patients was divided into two groups, a treatment group of 72 patients and a comparison group of 57 patients. In the treatment group, there were 45 males and 27 females aged 23-76, with a median age of 52.9 ± 8.3 years. These patients had a disease duration of 3-28 years. In nine case, there was accompanying cerebral infarction, 26 cases had nephropathy, 22 cases had eye disease, 32 cases had peripheral neuritis, 27 cases had hypertension, 29 cases had high cholesterol, and four cases had diabetic bladder disease. Sixty-five of these patients were on oral antidiabetic medications, and seven were on insulin. In the comparison group, there were 33 males and 24 females aged 21-77 years old, with a median age of 57.4 ± 6.8 years. These patients had been ill for 5-31 years. Six of these cases had accompanying cerebral infarction, 15 had nephropathy, 12 had eye disease, 19 had peripheral neuritis, 10 had diabetic foot, and 26 had high cholesterol. Fifty-three of these patients were on oral antidiabetic medications, and four were on insulin. Therefore, in terms of sex, age, disease duration, diabetic complications, and medication, there were no marked statistical differences between these two groups.

In terms of percentages of antidiabetic medications used by members of both these two groups, 73.65% were on sulfonylurea-type medications, 51.83% were on biguanide-type medications, 19.37% were on alpha-glucosidase inhibitors, and 2.27% were on insulin.

Treatment method:

Both groups continued taking their antidiabetic medications without any changes. In addition, the treatment group was administered a Chinese medical formula named Hua Tan Yi Gan Tang (Transform Phlegm & Boost the Liver Decoction) which was composed of: Pericarpium Citri Reticulatae Viride (Qing Pi), 25g, Radix Peucedani (Qian Hu), 12g, Sclerotium Poriae Cocos (Fu Ling), 15g, Flos Inulae Racemosae (Xuan Fu Hua), 12g, Rhizoma Cyperi Rotundi (Xiang Fu), 15g, Radix Bupleuri (Chai Hu), 20g, cooked Radix Et Rhizoma Rhei (Da Huang), 10g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 15g, Radix Codonopsitis Pilosulae (Dang Shen), 10g, and Fructus Schisandrae Chinensis (Wu Wei Zi), 8g. If lack of strength was severe, 15 grams of mix-fried Radix Astragali Membranacei (Huang Qi) were added. If abdominal distention was severe, 10 grams of Pericarpium Arecae Catechu (Da Fu Pi) and 12 grams of Radix Auklandiae Lappae (Mu Xiang) were added. If torpid intake was severe, 10 grams of Herba Eupatorii Fortunei (Pei Lan), 20 grams of stir-fried Fructus Germinatus Hordei Vulgaris (Mai Ya), and 12 grams of Rhizoma Atractylodis Macrocephalae (Bai Zhu) were added. If nausea was severe, 12 grams of Rhizoma Pinelliae Ternatae (Ban Xia) and 15 grams of Caulis Bambusae In Taeniis (Zhu Ru) were added. If oral dryness and a bitter taste were severe, 12 grams of Herba Dendrobii (Shi Hu) and 15 grams of Radix Trichosanthis Kirlowii (Tian Hua Fen) were added. If fever was severe, 15 grams of Herba Oldenlandiae Diffusae Cum Radice (Bai Hua She She Cao) and 15 grams of Herba Patriniae Heterophyllae Cum Radice (Bai Jiang Cao) were added. If jaundice was severe, 20 grams of Herba Artemisiae Capillaris (Yin Chen Hao), 10 grams of Rhizoma Coptidis Chinensis (Huang Lian), and 12 grams of Fructus Gardeniae Jasminoidis (Zhi Zi) were added. If loose stools were severe, 12 grams of Rhizoma Atractylodis (Cang Zhu) and 10 grams of Cortex Magnoliae Officinalis (Hou Po) were added. One ji of these medicinals were boiled in 600ml of water down to 200ml each day and administered in two divided doses, morning and evening 15 minutes after eating.

Those patients in the comparison group received 0.1g of vitamin C, 100mg of vitamin E, and 0.2g each of of compound vitamin B₁ and glucuronolactone three times per day. Ten days equaled one course of treatment, and three courses were administered.

Treatment outcomes:

Basic cure was defined as healing of the clinical symptoms, all laboratory analyses returning to normal, liver function returning to normal, and no recurrence on follow-up after a half year. Some effect was defined as either healing or marked improvement in the clinical symptoms, normalization of all laboratory analyses, liver function returning to normal, but some abnormality in at least one of the above criteria within one half year on follow-up. No effect meant that there was no marked change in clinical symptoms, liver function was still abnormal, or the disease had actually gotten worse.

Based on the above criteria, in the treatment group, 40 cases (55.56%) were judged basically cured, 28 cases (38.89%) got some effect, and four cases (5.55%) got no effect. Thus the total amelioration rate was 94.45% in the treatment group. In the comparison group, 21 cases (36.84%) were judged basically cured, 27 cases (47.36%) got some effect, and nine cases (15.8%) got no effect, for a total amelioration rate of 84.20%.  Hence there was a marked statistical difference in cure rate (P + 0.01) and total amelioration rate (P + 0.05) between these two groups, with the Chinese medical protocol being judged more effective than the Western medical protocol. In terms of liver function and BUN, there was a marked difference between the treatment and comparison groups (P + 0.01), but there was no marked change in PT. In addition, there were no adverse reactions in the treatment group.

According to the Chinese authors of this study, liver disease as a result of antidiabetic medications should be categorized in Chinese medicine as accumulations and gatherings (ji ju), jaundice (huang dan), and liver qi depression (gan qi yu). Diabetes itself is mostly due to yin vacuity with dryness and heat. On top of this, oral antidiabetic medications enter the stomach and may make the spleen and stomach vacuous as well. In that case, the spleen may not upbear the clear and downbear the turbid. If turbidity endures, over time it gathers into dampness and transforms into phlegm. Then a combination of phlegm and stasis cause the spleen movement and transformation even further loss of fortification and the liver-gallbladder’s coursing and discharge loose their duty. Therefore, there appears spleen stagnation and liver depression. If these evils are not diffused and discharged, eventually liver woods loses its nourishment and liver blood becomes insufficient. Thus the authors believe that the main disease mechanisms of this condition are phlegm and blood stasis and stagnation and hence they also think that the treatment principles for dealing with this condition should be to move the qi and transform phlegm, boost the liver, disinhibit the gallbladder, and fortify the spleen.

Based on these theoretical considerations, within the formula used in this protocol, Qing Pi disperses phlegm, disinhibits the qi, and breaks stagnation at the same time as it harmonizes the center and courses the liver. It enters the liver where it scatters evils and it enters the spleen where it eliminates phlegm. It levels the lower burner liver qi and guides the other medicinals to enter the jue yin aspect or division. Qian Hu transforms and downbears phlegm located in the liver. Fu Ling fortifies the spleen, eliminates dampness, and disperses phlegm accumulation. Xuan Fu Hua descends the qi and disperses phlegm, scatters and frees the flow of static blood. Xiang Fu enters the liver and gallbladder channels where it resolves qi depression and dispels stasis. Chai Hu drains phlegm nodulation from the liver-gallbladder and scatters blood congelation and qi gathering in all the other channels. It assists Xiang Fu to open depression and course the liver. Cooked Da Huang flushes phlegm and cleanses static blood. Thus it regulates the center by eliminating the old so that the new can be engendered. Bai Shao both upbears and downbears. It is able to drain and it is able to scatter. However, it is also able to supplement and restrain. It is able to drain wood from center earth. When stir-fried, it disinhibits the qi of the liver-gallbladder. When combined with Xiang Fu and Chai Hu, it resolves depression. Wu Wei Zi restrains lung metal so as to level liver wood. It also protects kidney water so that it can enrich liver wood. Dang Shen fills and regulates the qi and blood of the viscera and bowels, thus aiding the function of all the other medicinals. Therefore, when all these medicinals are used together, the qi and blood are moved and regulated, phlegm is dispelled and depression is resolved, the liver is boosted, the gallbladder is disinhibited, and the spleen is fortified. Thus the viscera and bowels all become quiet.

Yu Jian published an article titled, “A Study of the Effects of Puerarin on Insulin Resistance in the Elderly with Hypertension,” in Shan Xi Zhong Yi (Shanxi Chinese Medicine), #6, 2001, p. 46-47.

Cohort description:

In this study, there were 32 men and 28 women, all of whom were seen as in-patients. The youngest patient was 61 and the oldest was 78 years of age, with a median age of 66.2 ± 5.9 years. None of these had concomitant heart, kidney, or liver disease. These 60 patients were divided into two groups: a treatment group of 35 patients and a comparison group of 25 patients. In terms of sex, age, and hypertension, there was no marked statistical difference between these two groups (P , 0.05).

Treatment method:

Members of both groups continued with their original antihypertension medicine daily life activities. In addition, the patients in the treatment group received 500mg of Ge Gen Su Zhu She Ye (Puerarin Injectible Fluid) in 250ml of saline solution intravenously one time per day. Two continuous months of treatment equaled one course, and both groups received one such course of treatment. A number of various parameters were studied before and after treatment. These included: blood pressure, fasting blood glucose (FBG), GhbA1c, insulin sensitivity index (ISI), total cholesterol, triglycerides, low density lipids (LDL), high density lipids (HDL), etc.

Treatment outcomes:

After two months, blood pressure, total cholesterol, low density lipids, triglycerides, and indeces of blood rheology all dropped remarkably in the treatment group from before to after treatment (P + 0.05-0.01) and the insulin sensitivity index increased significantly (P + 0.05). There were no significant changes in these values in the comparison group (P , 0.05). For instance, mean ISI went from -2.07 ± 0.45 before treatment to -1.76 ± 0.40 after treatment. This index was measured by multiplying the FBG (mmol/L) times fasting serum insulin (mU/L). In addition, there were significant differences in the mean changes in all measured indeces between the treatment and comparison groups (P + 0.05-0.01). Therefore, the conclusion was drawn that injectible puerarin has a good effect on reducing insulin sensitivity in elderly patients with hypertension.

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.

Cohort description:

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.

Treatment method:

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.

Treatment outcomes:

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.

Different cultures have radically different ideas about what is acceptable food and acceptable medicine. Chinese have a long history of using various species of insects as medicinal ingredients. In the last several years, ants have become a somewhat popular remedy for the treatment of diabetes and other vacuity conditions in the People’s Republic of China. In issue #1, 2002 of Si Chuan Zhong Yi (Sichuan Chinese Medicine), Liang Qi-gong et al. published an article titled, “the Treatment of 56 Cases of Diabetes Mellitus with Yi Xiao Tang Jiao Nang (Ant Disperse Sugar Gelatin Capsules).” This article appeared on pages 28-29. A precis of that article is given below.

Cohort description:

All 56 patients in this study were seen as out-patients. Among them, there were 21 males and 35 females. Nine cases were over 60 years of age, 26 cases were 45-60, and 21 cases were less than 45 years of age. The shortest course of disease was six months, and the longest was four years. All these patients had varying degrees of oral thirst, rapid hungering, polyuria, obesity or emaciation, and generalized lack of strength. Fasting blood glucose was equal to or more than 7mmol/L (126mg/dL) and glycosuria was +-++++.

Treatment method:

Yi Xiao Tang Jiao Nang consisted of: Formicida (Ma Yi, ants), 60g, Radix Pseudostellariae Heterophyllae (Tai Zi Shen), 10g, Radix Trichosanthis Kirlowii (Tian Hua Fen), 15g, Radix Puerariae (Ge Gen), 10g, Radix Dioscoreae Oppositae (Shan Yao), 10g, Endothelium Corneum Gigeriae Galli (Ji Nei Jin), 6g, Rhizoma Atractylodis Macrocephalae (Bai Zhu), 10g, Rhizoma Atractylodis (Cang Zhu), 6g, Fructus Schisandrae Chinensis (Wu Wei Zi), 10g, Fructus Corni Officinalis (Shan Zhu Yu), 10g, Radix Scrophulariae Ningpoensis (Xuan Shen), 10g, uncooked Radix Rehmanniae (Sheng Di), 20g, Cortex Radicis Lycii Chinensis (Di Gu Pi), 6g, Rhizoma Anemarrhenae Aspheloidis (Zhi Mu), 20g, Radix Salviae Miltiorrhizae (Dan Shen), 20g, uncooked Radix Glycyrrhizae (Gan Cao), 10g, Radix Astragali Membranacei (Huang Qi), 15g, Tuber Ophiopogonis Japonici (Mai Men Dong), 15g, Rhizoma Polygonati (Huang Jing), 10g, Radix Angelicae Sinensis (Dang Gui), 15g, and Herba Cistanchis Deserticolae (Rou Cong Rong), 15g. These medicinals were ground into fine powder and disinfected, after which 0.3g were put into each capsule and stored for use. Ten capsules were administered each time, three times per day, and three months equaled one course of treatment. After 2-5 such courses, outcomes were assessed. During treatment, patients were counseled not to eat acrid, peppery, stimulating foods.

Treatment outcomes:

Marked effect was defined as disappearance of clinical symptoms, FBG lower than 7mmol/L (126mg/dL), and negative glycosuria. Some effect was defined as marked improvement in clinical symptoms and marked lowering of blood sugar and urine glucose. No effect meant that, after 1-2 courses, there was no obvious improvement in any of the above parameters. Based on these criteria, there were 38 patients (67.9%) who got a marked effect, 12 patients (21.4%) who got some effects, and six patients (10.7%) who got no effect, for a total amelioration rate of 89.3%. However, these effects were most significant in those with the early stage of disease who were asymptomatic and less pronounced in those with many years’ diseases and lots of symptoms. According to the Chinese authors of this study, there were no observable side effects from this protocol.

Within this formula, Ma Yi, Shan Zhu Yu, Wu Wei Zi, and Rou Cong Rong are the sovereign medicinals for supplementing the kidneys. The ministerial medicinals in this formula are Haung Qi, Tai Zi Shen, Huang Jing, Bai Zhu, Cang Zhu, Ji Nei Jin, Shan Yao, and Ge Gen. These medicinals fortify the spleen and boost the qi. The adjunctive medicinals in this formula include Tian Hua Fen, Sheng Di, Zhi Mu, Mai Men Dong, Di Gu Pi, and Xuan Shen which clear heat, nourish yin, and engender fluids and Dang Gui and Dan Shen which quicken the blood and transform stasis. Last but not least, uncooked Gan Cao performs as the messenger medicinal. Therefore, as a whole, this formula fortifies the spleen and boosts the qi, nourishes yin, clears heat, and engenders fluids, and quickens the blood and moves stasis. By using this formula, the latter heaven root obtains fullness and nourishment and the former heaven root obtains consolidation and securing. In particular, Ma Yi are a type of kidney-supplementing medicinal which also quickens the blood and supplements the qi, boosts the qi and soothes the sinews, disperses accumulation and transforms stasis, combats debility and combats cancer. When combined with other medicinals which fortify the spleen and boost the qi, nourish yin and engender fluids, and quicken the blood and transform stasis, it achieves exceptionally satisfactory therapeutic results.

While blood stasis is not one of the main patterns associated with type 2 diabetes in the Chinese medical literature, blood stasis commonly complicates many cases of diabetes and especially if the patient has gone on to develop such complications as neuropathy, cerebral vascular disease, peripheral vascular diseases, coronary artery diseases, retinopathy, nephropathy, or a number of the common diabetic dermatological conditions.Zhou Miao-yin of the Guangzhou Municipal First People’s Hospital in Guangdong recently published a clinical audit on the treatment of 38 cases of type 2 diabetes who presented a pattern of blood stasis. Titled, “The Treatment of 38 Cases of Blood Stasis Pattern Type 2 Diabetes Mellitus with Fu Yuan Huo Xue Tang Jia Wei (Restore the Source & Quicken the Blood Decoction with Added Flavors),” this article appeared in issue #2, 2002 of Shang Hai Zhong Yi Yao Za Zhi (Shanghai Journal of Chinese Medicine & Medicinals) on page 20. A precis of this report is given below.

Cohort description:

All 38 cases in this study were diagnosed with type 2 diabetes mellitus. Among them, there were 17 males and 21 females aged 42-78 years, with an average age of 63.4 year. These patients’ fasting blood glucose was 9.2-24.4mmol/L, with a median ranged of 16.6 ± 7.3mmol/L. Fifteen cases also had high cholesterol, 12 cases also had cerebral vascular disease, and four cases had accompanying nephropathy. Twenty-six cases had taken Western oral hypoglycemic medications, such as glyburude, for a long time, however, without satisfactory results, their blood sugar still remaining higher than 11.1mmol/L. Twelve cases were trying to control their diabetes solely with diet.

Treatment method:

The basic formula consisted of: Radix Bupleuri Chai Hu), 15g, Radix Trichosanthis Kirlowii (Tian Hua Fen), 15g, Radix Angelicae Sinensis (Dang Gui), 10g, Flos Carthami Tinctorii (Hong Hua), 10g, Squama Manitis Pentadactylis (Chuan Shan Jia), 10g, Radix Et Rhizoma Rhei (Da Huang), 10g, Radix Salviae Miltiorrhizae (Dan Shen), 20g, Radix Dioscoreae Oppositae (Shan Yao), 20g, and Rhizoma Atractylodis Macrocephalae (Bai Zhu), 15g. If there was high cholesterol, 30 grams of Radix Puerariae (Ge Gen), 12 grams of Radix Albus Paeoniae Lactiflorae (Bai Shao), and 10 grams each of Tuber Curcumae (Yu Jin) and Fructus Crataegi (Shan Zha) were added. If there was accompanying cerebral vascualr disease, 10 grams each of Hirudo Seu Whitmania (Shui Zhi) and Lumbricus (Di Long) and 30 grams of Radix Astragali Membranacei (Huang Qi) were added. If there was accompanying nephropathy, 10 grams of Semen Plantaginis (Che Qian Zi), 15 grams each of Herba Ecliptae Prostratae (Han Lian Cao) and Herba Leonuri Heterophyll (Yi Mu Cao), and 30 grams of Radix Astragali Membranacei (Huang Qi) were added. One ji of these medicinals was decocted in water and administered per day.

Treatment outcomes:

Cured was defined was disappearance of clinical symptoms and fasting blood glucose of under 6.4mmol/L which remained stable for at least a half year. Marked effect meant that there was marked decrease or disappearance in clinical symptoms and fasting blood glucose of less than 7.2mmol/L which remained stable for half a year. No effect meant that the symptoms continued as before and fasting blood glucose was more than 8.5mmol/L. Based on these criteria, 24 patients (63.16%) were judged cured, 12 patients (31.58%) got a marked effect, and two patients (5.3%) got no effect, for a total amelioration rate of 94.74%.

In Chinese medicine, most Chinese doctors think of yin vacuity dryness and heat and qi and yin dual vacuity as the two main patterns of this condition. However, patients with accompanying high cholesterol, cerebral vascular, or microvascular disorders typically have arteriosclerosis, high blood viscosity, and disturbances in blood flow. In Chinese medicine, these mostly have to do with loss of regulation of the viscer and bowels and unsmooth flow of the movement of the qi and blood resulting in blood stasis obstructing the network vessels. Fu Yuan Huo Xue Tang was originally designed to treat traumatic injuries, static blood lodged under the rib-side, and unendurable pain. This formula’s functions are that it quickens the blood and dispels stasis, courses the liver and frees the flow of the network vessels. Within it, Dang Gui, Hong Hua, Tao Ren, and Chuan Shan Jia quicken the blood and dispel stasis, break the blood and free the flow of the network vessels. Da Huang sweeps and washes away static, vanquished blood which has become lodged. Tian Hua Fen enters the blood aspect where it disperses stasis and scatters nodulation. However, it is also able to engender fluids and moisten dryness. Chai Hu courses the liver and regulates the qi, thus strengthening the free and smoothly flowing movement of the qi and blood. When all these medicinals are used together, their effect is that they dispel stasis and engender the new, move the qi and free the flow of the network vessels. Thus they promote the circulation and improve endocrine dysfunction. Consequently, the blood sugar also goes down. In Dr. Zhou’s opinion, this is an example of the saying, “To treat disease, address the root.”

Diabetic foot refers to ulcers and recurrent or nonhealing sores on the feet and lower extremities of patients with diabetes mellitus. Such sores and ulcers are an important cause of morbidity in patients with diabetes. They can and often do lead to acromelic gangrene and amputation. Bai Ying-tuo published an article titled, “The Treatment of 40 Cases of Diabetic Foot with Chinese Medicinal Steaming & Washing,” in issue #2, 2002 of Ji Lin Zhong Yi Yao (Jilin Chinese Medicine & Medicinals) on page 38. A precis of that article appears below.

Cohort description:

Of the 40 patients in this study, 18 suffered from type 1 diabetes and 22 suffered from type 2. The course of disease (for diabetic foot) had lasted from 10 days to three years. No further description of these patients was given.

Treatment method:

The Chinese medicinal footbath consisted of: Herba Tougucao (Tou Gu Cao), 30g, Caulis Milletiae Seu Spatholobi (Ji Xue Teng), 30g, Herba Lycopodii (Shen Jin Cao), 30g, Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 15g, Flos Carthami Tinctorii (Hong Hua), 15g, Lignum Sappan (Su Mu), 15g, Radix Phytolaccae (Shang Lu), 15g, Radix Et Rhizoma Notopterygii (Qiang Huo), 15g, and Radix Ligustici Wallichii (Chuan Xiong), 15g. One ji of these medicinals was decocted in water per day. First it was used to steam and then it was used to wash (or soak) the affected area. This was done once each morning and night for 40 minutes each time. During this treatment, patients were forbidden to eat acrid, peppery foods or to drink alcohol.

Treatment outcomes:

Twenty cases were judged cured after 10 ji, 12 were cured after 15 ji, and three were cured after one whole month of treatment. Five cases did not persist in doing the washes and soaks resolutely.

Huang Yu and Li Le-min published an article titled, “The Treatment of 60 Cases of Type 2 Diabetes with Si Huang Xiao Ke Yin (Four Yellows Wasting & Thirsting Drink),” in issue #5, 2002 of Si Chuan Zhong Yi (Sichuan Chinese Medicine). This article appeared on pages 28-29, and a precis of this article is given below.

Cohort description:

There were 160 patients altogether in this study, 80 each a treatment and a comparison group. In the treatment group, there were46 males and 34 females aged 48-64 years with an average age of 53.6 years. These patients had had type 2 diabetes for 1-7 years, with an average disease duration of 5.4 years. In the comparison group, there were 44 males and 36 females aged 49-65, with an average age of 54 years. These patients had been diagnosed with diabetes for 2-8 years, with an average disease duration of 5.8 years. Both groups had stopped their original medication three days before the commencement of this study. There was no marked statistical difference in terms of age, sex, or disease duration between these two groups. All these patients met 1997 American diagnostic criteria for type 2 diabetes. All had a fasting blood glucose (FBG) over 7.0mmol/L and urine sugar was positive. Exclusion criteria included anyone who had had diabetic acidosis within the preciding month or any opportunistic infections. Other exclusion criteria included heart, liver, or kidney disease.

Treatment method:

The treatment group received: uncooked Radix Astragali Membranacei (Huang Qi), Radix Dioscoreae Oppositae (Shan Yao), Radix Pseudostellariae Heterophyllae (Tai Zi Shen), and cooked Radix Rehmanniae (Shu Di), 20g each, Tuber Ophiopogonis Japonici (Mai Men Dong), uncooked Radix Rehmanniae (Sheng Di), and Rhizoma Anemarrhenae Aspheloidis (Zhi Mu), 15g each, Radix Et Rhizoma Rhei (Da Huang) and Fructus Schisandrae Chinensis (Wu Wei Zi), 10g each, Rhizoma Coptidis Chinensis (Huang Lian), 6g, and Radix Trichosanthis Kirlowii (Tian Hua Fen), Radix Puerariae (Ge Gen), and Rhizoma Polygonati (Huang Jing), 30g each. One packet of these medicinals was decocted in water and divided into two daily doses. The comparison group received 8-10 pills TID of Xiao Ke Wan (Wasting & Thirsting Pills) as their only treatment. Both groups were treated for 100 days.

Treatment outcomes:

Marked effect was defined as normalization of clinical symptoms after treatment, an FBG less than 7.28mmol/L, two hour postprandial blood glucose (PPBG) of less than 8.4mmol/L, or a 30% or more lowering of these two scores. Some effect was defined as marked improvement in clinical symptoms, an FBG of less than 8.4mmol/L, an FBG of less than 10.08mmol/L, or a lessening of these two scores by 10-29%. No effect meant that none of these criteria were met. Based on these criteria, 36 cases or 45% of the treatment group were judged to have gotten a marked effect, 30 cases (37.5%) got some effect, and 14 cases (17.5%) got no effect, for a total amelioration rate of 82.5%. In the comparison group, there were 26 cases (32.5%) who got a marked effect, 26 cases (32.5%) who got some effect, and 28 cases (35%) who got no effect, for a total amelioration rate of 65%. In addition, while reductions in mean FBG were not markedly significant between the treatment and comparison groups, reductions in total cholesterol, triglycerides, blood urea nitrogen (BUN) and creatinine were markedly significant. Therefore, not only did Si Huang Xiao Ke Yin produce better overall amelioration rates, it also helped a number of other important health parameters.