Notes by Dr. Michael Tierra O.M.D., L.A.C., A.H.G.
Diabetes is a condition where the body cannot use and store blood sugar (glucose) correctly. This is because the body either stops producing or doesn’t produce enough insulin (a hormone that helps your body use glucose). The amount of sugar in the blood then rises to unhealthy levels. If left untreated, diabetes can cause many health problems including impotence, amputation, kidney failure, blindness, and heart disease. Heart disease is the leading cause of diabetes-related deaths with death rates being about 2 to 4 times as high as that of adults without diabetes.
Diabetes is the leading cause of blindness in adults 20 to 74 years of age with about 12 to 24 thousand new cases of blindness caused by diabetic retinopathy.
In 1995, about 27,851 people with diabetes develop end-stage renal disease.
About 60 to 70% of people with diabetes have mild to severe forms of nervous system damage, which can include peripheral neuropathy, digestive problems, carpal tunnel and other nerve related problems. Diabetic nerve damage is the main cause for lower extremity amputations.
Diabetes also causes lower immunity with higher susceptibility to contagious diseases, birth defects, periodontal disease.
From the above, we understand with the wide range of conditions caused or aggravated by diabetes, an herbalist and must be prepared to treat not only the disease, which in the case of Type 1 diabetes is incurable but to prevent and address all the possible complications that are commonly associated with the disease which if addressed early enough, one can accomplish a great deal.
According to the Center for Disease control diabetes is becoming more common in the United States. In 1999, about 11.1 million persons in the United States reported that they had diabetes. This constitutes about 6% of the population with approximately 798,000 new cases diagnosed each year. It is considered to be the 7th leading cause of death. As a cause of death, diabetes is is considered to be under reported.
Its prevalence is about equal according to gender
Type 1 diabetes is known as Insulin-dependent-diabetes mellitus (IDDM). In this type, patients are dependent on the exogenous use of insulin by pill or injection to prevent ketoacidosis and death. About 75% of type 1 diabetics have antibodies to their own pancreatic cells. This condition can be caused by viral infections triggering an autoimmune response. Some viruses that have been implicated in this reaction include pertussis, hepatitis, rubella, coxackie, Epstein-Barr, cytomegalovirus, and herpes virus 6. Type 1 diabetes can also be genetically predetermined.
Type 11 diabetes known as non-insulin-dependent diabetes mellitus (NIDDM) because patients with this type may or may not rely on the use of exogenous insulin for survival. Diet, obesity, allergies to certain foods, viral infections, and stress are all factors that can contribute to the onset or aggravate Type 11 diabetes. An estimated 85% of Type 11 diabetics are overweight when diagnosed. Professor Ernest Pfeiffer of UlM University in Germany said that ‘It’s almost a law that any person 30% overweight for 30 years will become a Type 11 diabetic.
A third type of diabetes is called gestational diabetes. This is where some women develop a glucose intolerance during pregnancy. It is characterized by excessive hunger, thirst and frequent urge to urinate. Because it is mild, it often goes unnoticed. However, it is important to treat because high blood sugar can have an adverse reaction on the developing fetus. Usually this type of diabetes can be controlled with diet and resolves after childbirth.
Symptoms of diabetes and diagnostic criteria
The typical symptoms of Type 1 diabetes include:
- Increased thirst
- Dry mouth
- Frequent urination
- Unexplained weight loss (even though you are eating and feel hungry)
- Fatigue (weak, tired feeling)
- Blurred vision
- Numbness or tingling of the hands or feet
- Loss of consciousness (rare)
Symptoms of Type 2 diabetes include:
- The same as those listed above
- Slow-healing sores or cuts
- Itching skin (especially the groin or vaginal area)
- Yeast infections
- Recent weight gain.
In general one’s risk of contracting diabetes increases with age.
The major diagnostic test for diabetes is the glucose tolerance test. This can be either fasting or non-fasting.
Traditional Chinese Medicine (TCM) categorizes diabetes as xiao ke, sometimes translated as ‘˜inner wasting,’ or ‘˜wasting thirst disease.’ The common symptoms include profuse eating, profuse drinking, profuse urination as well as obesity, impotence, tingling numbness, sores and clear-eyed blindness.
Causes: Juvenile onset diabetes is considered an inherited condition and is categorized as yuan qi deficiency. It usually begins with long-standing stomach heat together with TCM Spleen deficiency. It can be caused by over-eating hot, spicy, greasy, fatty, thick flavored foods or alcohol or by liver and stomach heat causing an abnormal rise in appetite. Spleen deficiency can be caused by over-eating too much sugar, sweets and carbohydrates, fatty foods, worry, insufficient exercise, fatigue.
TCM Spleen deficiency results in obesity, fatigue initially as well as the opposite, anorexia, emaciation, muscular atrophy as the disease progresses.
If internal heat continues, it eventually damages the yin fluids of the stomach, lungs and gives rise to abnormal thirst.
TCM Spleen deficiency also gives rise to TCM Kidney yang and/or yin deficiency. Kidney Yin and/or Yang deficiency is the cause of urinary problems as well as impotence.
Adult diabetics also exhibit signs of Liver Qi Stagnation with Qi and Blood deficiency that can cause Blood stagnation.
Spleen deficiency can also be complicated by Damp Heat in the Lower Warmer (pelvic area), causes sores, urinary problems, impotence, restless leg syndrome, and/or vaginitis.
TCM also categorizes diabetes according to the Triple Warmer location:
1. Upper Warmer diabetes involving the lungs and stomach
2. Middle Warmer diabetes involving Stomach heat and Stomach Yin deficiency.
3. Lower Warmer diabetes involving the TCM Kidneys.
A TCM practitioner must clinically evaluate each diabetic patient according to the above symptomatic criteria and prescribe herbs accordingly.
TCM Treatment based on Pattern Discrimination
UPPER WARMER DIABETES
Lung and Stomach Heat Pattern
Symptoms: Thirst, dry mouth and tongue, frequent urination with excess amount
Tongue: red tongue on the tip and sides, possible yellow tongue fur
Pulse: forceful and rapid
Representative Formula:
WHITE TIGER DECOCTION WITH GINSENG (Bai hu ren shen tang)
Panax Ginseng (Ren Shen) — 10-15 g
Gypsum (Shi Gao) — 20-30 g
Anemarrhena (Zhi Mu) ‘“ 9-12 g
Rice (Jing Mi) ‘“ 15-30g
- Eliminates heat at the qi (secondary defensive level) and the Yang Ming channel.
- Promotes the secretion of body fluids to replenish vital energy
Other TCM herbs that can be added or made into a separate formula include:
Ophiopogon japonicus (Mai men dong)
Asparagus root (Tian men dong)
Scutellariae baicalensis (Huang qin)
Coptis sinensis (Huang Lian)
Possible Non-TCM formula
Panax quinquefolium (American ginseng) 20-30g
Althea officinalis (Marshmallow root) 20-30g
Hydrastis Canadensis (Golden seal) 9-15 g
Taraxacum officinalis (Dandelion root) 15-30 g
MIDDLE WARMER DIABETES
Fair Maiden Decoction (Yu Nu Chien)
Gypsum Fibrosum (Shi Gao) 10-15 g
Prepared Rehmannia glutinosa 10-15 g
Ophiopogon japonicus (Mai Men Dong) 3-6g
Achryanthes bidentata (Huai Niu Xi) 3-6 g
Action:
- clears heat and fire from the stomach (febrifugal)
- Nourishes Yin essence
Indications:
Deficient yin essence, with stomach heat. Symptoms may include headache, toothache, loose teeth, gingivitis, thirst, dry mouth and throat, easy nose-bleeding.
Medical conditions for which it may be useful:
Toothache, gingivitis, periodontitis, glossitis, inflammation of the oral cavity, diabetes mellitus
Contraindicated for someone with diarrhea
For increased dryness and thirst add Schisandra Chinensis (Wu wei zi)
Difficult urination: Alisma plantago (Ze xie)
Excessive Heat and fire: gardenia fruit (Zhi Zi) and lycii bark (Di Gu Pi)
With pronounced Yin Deficiency: Glehnia (Sha shen) and Dendrobium stem (Sh Hu)
Possible Non-TCM formula
Althea officinalis (Marshmallow root) 20-30 g
Symphytum officinalis (Comfrey root) 10 -15 g (Ideally with Pyrilizidine alkaloids removed)
Ulmus fulva (Slippery Elm bark) 10-15 g
Chondrus crispus (Irish Moss) 10-15 g
Iceland moss (Iceland moss) 10-15 g
Polygonatum officinale (Solomon’s seal root) 9-15 g
For difficult urination add: juniper berries
For heat and inflammation add: dandelion root and Oregon grape root
For Yin Deficiency and thirst add: American ginseng
LOWER WARMER DIABETES
Rehmannia Six Combination (Liu We Di Huang)
Prepared Rehmannia glutinosa (Shu di huang) ‘“ 20-30g
Cornus officinalis (Shan zhu yu) — 10-15 g
Dioscorea batata (Shan yao) ‘“ 9-12 g
Alisma plantago (Ze xie) ‘“ 6-9g
Poria cocos (Fu ling) ‘“ 9-12 g
Paeonia suffructicosa (Mu dan pi) ‘“ 6-9 g
Action: reinforces Yin Essence of the Kidney and liver
Indications: for kidney or liver yin deficiency with dizziness, tinnitus, sore throat, tidal fever, nocturnal emission, night perspiration, heat sensation in the palms and soles, toothache, dry mouth.
Applications: retarded growth of children, lumbago, optic neuritis, central retinitis, pulmonary tuberculosis, diabetes, hyperthyroidism, Addison’s disease, hypertension, neurasthenia, functional anovular uterine bleeding, chronic urinary tract infections, deafness.
For Diabetes add Trichosanthes kirilowii root (Tian hua fen)
For more severe yin deficiency add: Asparagus cochinchinensis (Tian men dong), Ophiopogon japonicus (Mai men dong), Scrophularia ningpoensis (Xuan shen)
For extreme thirst add: Gypsum fibrosum (Shi gao), Dendrobium nobile (Shi hu)
For visual problems generally (including glaucoma and cataracts) and especially associated with diabetes add Lycium chinensis berries 6-9g, Chrysanthemum morifolium flowers (Ju hua) 6-9g, Tribulus terrestris (Bai ji li) 6-9g, Haliotis diversicolor (Abalone shell) 20-30g THIS FORMULA IS CALLED MING MU DI HUANG AND IS SPECIFIC FOR VISUAL WEAKNESS.
For Yang Deficiency add Cinnamon cassia bark (Rou gui) 2-5 g, Prepared Aconitum
carmichaeli (Fu zi) 3-9g —- THIS FORMULA IS CALLED REHMANNIA EIGHT COMBINATION (BA WE DI HUANG) OR JIN KUI SHEN QI). It is indicated when there is a deficiency of both kidney yin and yang.
Some Specific Chinese Herbs that are Useful for diabetes
Dendrobium nobile (Shi Hu)
Orchidaceae
Stem is used
Energy and flavor: sweet, not flavor, slightly salty, slightly cold
Organ Meridians: lung, stomach and kidney
Actions: 1. replenishes vital essence of the lung and stomach, promotes the secretion of fluids, 2. Eliminates excessive heat
Indications: febrile diseases, dry mouth, vomiting, abdominal pain, dry cough and chronic tidal fever.
Contraindication for feverish diseases with no dryness or dehydratin.
Dose: 9-20g
Prepared Rehmannia glutinosa (Shu di huang)
Scrophulariaceae
Energy and flavor: sweet, slightly warm
Organ Meridians: Heart, Liver, Kidneys
Actions: 1. nourishes blood and regulates menses, 2. replenishes the vital Yin essence of the kidneys
Indications: 1. dizziness and palpittion caused by anemia, 2. Chronic tidal fever, night sweats, dry mouth, lumbago, nocturnal emission all caused by Yin Deficiency.
Contraindicated: for weak digestion or loose stools
Chemical composition: Rehmannin, Mannitol, sucrose, Amino acid, Vitamin A, Catalpol
Dose) 9-30 gm
Cornus officinalis (Shan zhu yu)
Cornaceae
Dogwood berry fruit
Energy and Flavor: sour and warm
Organ Meridians: kidney and liver
Action: 1. replenishes the liver and kidneys, 2. astringent or styptic.
Chemical constituents: iridoid glycoside, cornin, saponins, tannin, ursolic acid, tartaric acid, sugars, Vit. A
Properties: 1. Diuretic, 2. Anti-hypertensive, 3. anti-tumor, 4. increase white blood cells, 5. anti-bacterial, 6 anti-fungal
Dioscorea batata or D. opposite (Shan yao)
Dioscoreaceae
Energy and flavor: Sweet and neutral
Organ Meridians: Lung, spleen, kidneys
Actions: 1. tonifies spleen and stomach, 2. reinforces the lung and kidneys, 3. consolidates vital essence and sperm
Indications: lack of appetite, chronic diarrhea, leucorrhea, 2. dry cough, asthma, 4. nocturnal emission, enuresis, frequent urination, 5. Diabetes mellitus, 6. carbuncles boils and incipient abscesses (especially externally as a poultice)
Contraindicated for someone with true heat and dampness
Dose: 9-30g
Alisma plantago (Ze xie)
Alismataceae
Tuber
Energy and flavor: sweet and cold
Organ meridians: kidney and bladder
Action: 1. regulates water metabolism, resolves dampness, 2. Clears heat and dampness in the lower burner of the body
Indications: oliguria, edema, nephritis, acute diarrhea, 2. cholesterolemia, fatty liver
Contraindicated for a person with seminal emission caused by weak kidneys
Dose: 3-12 gms
Poria cocos (Fu ling)
Polyporaceae
Energy and flavor: sweet or no taste, neutral
Organ meridians: Lung, spleen, heart, bladder
Action: 1. regulates fluid metabolism, resolves dampness, 2. tonifies the spleen and stomach, 3. quiets the heart (sedative)
Contraindicated for a person with frequent urination, spermatorrhea or prolapse of uro-genital organs
Dose: 6-18g
Paeonia suffructicosa (Mu dan pi)
Tree peony root bark
Ranunculaceae
Energy and flavor: pungent, bitter, slightly cold
Organ meridians: Heart, liver, kidneys
Actions: clears heat caused by pyrogens in the blood, 2. blood stagnation
Indications: 1. High febrile disease with epitaxis and spitting of blood 2. Abdominal tumors, amenorrhea, dysmenorrhea, 3. appendicitis, boils, carbuncles
Contraindicated for a pregnant woman or person with loose stool
Dose 6-12 g
Lycium chinense (Gou qi zi)
Chinese wolfberry