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0Experts' Experience
Prof. XIE Chun-guang's Experience in Treating Diabetes
YIN Li-ping DENG Xi-fang XPH^ & DU Rui-ling
Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
Professor XIE Chun-guang (), a doctorial student tutor of Chengdu TCM University, has accumulated rich experience in his long-term theoretic and clinical researches into diabetes. The authors are his students and try to present his academic thought in treating diabetes as follows.
Replenishing Yin and Clearing Away Heat According to the Pathogenesis
Diabetes, a commonly and frequently encountered disease, is mainly manifested by excessive dry heat at the early stage. Dry heat impairs yin and lingering illness depletes fluid to transform excess syndrome into deficiency syndrome. Yin deficiency can not produce qi to cause deficiency of both qi and yin. In the light of its pathogenesis, Prof. XIE treats diabetes by replenishing qi, nourishing yin, clearing away heat and promoting fluid production. He is good at using the modified Liuwei Dihuang Tang ( Six-ingredient Rehmannia Decoction) with good therapeutic effect. The basic recipe comprises Huang Qi (MK Radix Astragali), Ren Shen (A# Radix Ginseng), Sheng Di Huang ( ^ № M Radix Rehmanniae), Shan Zhu Yu (¿^^ Fructus Corni), Shan Yao (¿^ Rhizoma Dioscoreae), Fu Ling Poria), Ze Xie Rhizoma Alismatis), Mu Dan Pi
Cortex Moutan Radicis), Ge Gen Radix Puerariae), Huang Lian (M ^ Rhizoma Coptidis), Tian Hua Fen ( A ^ © Radix Trichosanthis), Cang Zhu ( ^ A Rhizoma Atractylodis) and Xuan Shen ( ^ # Radix Scrophulariae). Huang Qi can replenish qi and promote the production of body fluid. Ren Shen can strongly supplement primordial qi, promote the production of body fluid to quench thirst. Ge Gen can clear away heat, arrest vomiting, and promote the
production of body fluid to quench thirst. Huang Lian can clear away heat from the heart and stomach. Tian Hua Fen can clear away heat and promote the production of body fluid. Cang Zhu can expel dampness and strengthen the spleen. Xuan Shen can clear away heat and replenish yin. The paired drugs, Huang Qi with Shan Yao and Cang Zhu with Xuan Shen have a good hypoglycemic effect.
Typical case: On his first visit on March 20, 2005, a male patient, aged 52, complained of dry throat, thirst, increase in water intake, lassitude, thin body and 17.5 mmol/L of fasting blood sugar. Half a year before, he ate too much often with hungry sensation and daily water intake increased from 800 ml to about 4000 ml. A hospital diagnosed his illness as diabetes. In spite of orally taking hypoglycemic drugs for more than 2 months, his blood sugar level was still at 17.5 mmol/L before coming to the authors' hospital for TCM treatment. With his symptoms of dark complexion, dimly red tongue with less fur, varicose vein under the tongue, stringy, thready and rapid pulse, his syndrome belonging to yin deficiency, dry heat and blood stasis was treated by replenishing yin, clearing away heat, promoting blood circulation and removing blood stasis. The recipe was composed of Huang Qi (MK Radix Astragali) 30g, Ren Shen (A # Radix Ginseng) 30g, Sheng Di Huang Radix Rehmanniae) 15g, Shan Zhu Yu (¿^^ Fructus Corni) 15g, Shan Yao (¿^ Rhizoma Dioscoreae) 15g, Fu Ling Poria) 10g, Ze Xie Rhizoma Alismatis) 10g, Mu Dan Pi (ttftfc Cortex Moutan) 10g, Ge Gen Radix Puerariae) 20g, Huang Lian (M^ Rhizoma Coptidis) 12g, Tian Hua Fen (A^© Radix Trichosanthis) 12g, Cang Zhu (^A Rhizoma Atractylodis) 15g, Xuan Shen
Radix Scrophulariae) 15g, Dang Gui Radix Angelicae Sinensis) 12g, Chuan Xiong Rhizoma Chuanxiong) 12g, Chuan Niu Xi Radix Cyathulae) 12g, Chi Shao (^^ Radix Paeoniae Rubra) 12g and Gan Cao (^^ Radix Glycyrrhizae) 3g. Having taken 30 doses, he had his thirst and lassitude basically relieved and his blood sugar reduced to 12 mmol/L. After he had taken another 30 doses, all his symptoms were obviously alleviated and his blood sugar was reduced to about 8 mmol/L.
Nourish the Spleen and Kidney
The failure of the spleen to transport nutrients causes water retention to produce phlegm, which further impairs spleen yang to make deficient spleen qi unable to govern kidney-water, leading to deficiency of essence and qi. Because both essence and qi originate from the spleen and kidney, Prof. XIE often says that diabetes should be treated by replenishing qi to invigorate the spleen, and nourishing yin and tonifying the kidney. To treat both the spleen and kidney is better than to nourish the spleen or the kidney alone in the treatment of diabetes. The basic recipe consists of Huang Qi Radix Astragali), Shan Yao (¿^ Rhizoma Dioscoreae), Cang Zhu (^ ^ Rhizoma Atractylodis), Xuan Shen Radix
Scrophulariae), Sheng Di Huang (Radix Rehmanniae), Gou Qi Zi (ff^ET Fructus Lycii), Shan Zhu Yu (¿^^ Fructus Corni), Nu Zhen Zi (^ ^T Fructus Ligustri Lucidi), Bu Gu Zhi Fructus Psoraleae), Ge Gen Radix Puerariae), Dan Shen Radix Salviae Miltiorrhizae), Ji Nei Jing (X^ ^ ^ Endothelium Corneum Gigeriae Galli) and Gan Cao Radix Glycyrrhizae). Huang Qi, sweet in taste and slightly warm in nature, enters the spleen, replenishes qi and elevates the spleen yang. Shan Yao, sweet in taste and neutral in nature, replenishes qi, reinforces yin and nourishes the spleen, lung and kidney. Huang Qi combined with Shan Yao can replenish qi and yin of the spleen. Ge Gen can clear away heat, promote fluid production, assist the spleen to elevate lucid yang, transport fluid to the whole body and nourish the internal organs. Sheng Di
Huang, Shan Zhu Yu, Gou Qi Zi, Nu Zhen Zi and Bu Gu Zhi can enter the kidney to reinforce Fin-essence, protect the kidney-qi and harmonize yin and yang. Dan Shen can promote blood circulation and dredge the meridian. Ji Nei Jin can strengthen the spleen and stomach. Cang Zhu can strengthen the spleen, remove dampness and eliminate turbidity. Xuan Shen, sweet, bitter and salty in taste, cold in nature and moist in property, can not only replenish yin and remove heat from blood, but also clear away heat, eliminate vexation and quench thirst. When the two drugs are used together, the moisture of Xuan Shen can offset the dryness of Cang Zhu, and the warmness and dryness of Cang Zhu can offset the greasiness of Xuan Shen. Huang Qi for replenishing qi and elevating yang mainly reinforces spleen-yang and Shan Yao for nourishing the spleen and lung mainly replenishes spleen-yin. When the two drugs are used together, yin combines with yang to strengthen the spleen. The recipe for strengthening the spleen, nourishing the kidney, replenishing qi and reinforcing essence can strengthen internal organs and make qi and blood flow smoothly.
Typical case: A male patient, aged 65, paid his first visit on June 10, 2005. He had suffered from diabetes for 4 years with the symptoms of thirst, poor appetite, frequent urination, lassitude, cold body and limbs, loose stool, pale and enlarged tongue with tooth-prints, thready and slow pulse. His fasting blood sugar was 13.9 mmol/L and his blood sugar 2 hours after meal 17 mmol/L. His syndrome belonged to deficiency of both spleen and kidney and impairment of both qi and yin. The recipe consisted of Huang Qi Radix Astragali) 30g, Shan Yao (¿^ Rhizoma Dioscoreae) 20g, Cang Zhu ( ^ ^ Rhizoma Atractylodis) 20g, Xuan Shen ( ^ # Radix Scrophulariae) 20g, Sheng Di Huang (^i&M Radix Rehmanniae) 10g, Gou Qi Zi (ff^ET Fructus Lycii) 10g, Shan Zhu Yu (¿^ Fructus Corni) 10g, Nu Zhen Zi (^^T Fructus Ligustri Lucidi) 15g, Bu Gu Zhi (##$h Fructus Psoraleae) 15g, Ge Gen Radix Puerariae) 30g, Dan Shen Radix Salviae Miltiorrhizae) 15g, Ji Nei Jin Endothelium
Corneum Gigeriae Galli) 15g and Gan Cao Radix Glycyrrhizae) 10g. The decoction was orally taken one dose a day. Having taken 30 doses, thirst, lassitude, poor appetite and other symptoms were obviously improved and the fast blood sugar reduced to 8.5 mmol/L and blood sugar 2 hours after meal reduced to 12 mmol/L. After He had taken the decoction for another 2 months, his symptoms basically disappeared, the fasting blood sugar reduced to 5.6 mmol/L and blood sugar 2 hours after meal decreased to 7.6 mmol/L.
Remove Phlegm and Blood Stasis
Diabetes, caused by many factors and related to wind, rain, cold, heat, diet and emotion, has long illness course, complicated illness condition and varied syndromes. In its illness course, blood stasis is caused by yin deficiency and dry heat impairing blood, or by deficiency of qi and yin unable to promote blood circulation or by yang deficiency and cold accumulation. Phlegm and blood stasis are not only pathological products but also pathogenic factors. Both of them influence each other and interact to aggravate diabetes and eventually lead to various complications, thus making the illness condition complicated and diversified and the disease uncured. Therefore, appropriately using the method of resolving phlegm and removing blood stasis to treat diabetes is a key link to achieving good therapeutic effect. The basic recipe comprises Huang Qi (MK Radix Astragali), Ren Shen (A# Radix Ginseng), Dang Gui Radix Angelicae Sinensis), Chi Shao Radix Paeoniae Rubra), Chuan Xiong Rhizoma Chuanxiong), Dan Shen Radix Salviae Miltiorrhizae), Fu Ling Poria), Yi Yi
Ren Semen Coicis), Ban Xia (^H Rhizoma
Pinelliae), Chen Pi ( ^ ^ Pericarpium Citri Reticulatae), Sheng Di Huang (Radix Rehmanniae), Shan Zhu Yu (¿^^ Fructus Corni) and Gou Qi Zi (ff^ET Fructus Lycii). Huang Qi and Ren Shen can replenish qi and invigorate the spleen. Sheng Di Huang, Xuan Shen, Shan Zhu Yu and Gou Qi Zi can replenish yin, promote fluid production and reinforce qi. Chuan Xiong can promote circulation of
qi and blood. Dang Gui, Chi Shao and Dan Shen can promote blood circulation and remove blood stasis. Fu Ling and Yi Yi Ren can expel dampness and invigorate the spleen to eliminate phlegm. Ban Xia for dispelling dampness and removing phlegm and Chen Pi for invigorating spleen and regulating qi are used together to remove phlegm and promote qi circulation. Therefore, the recipe can resolve phlegm, remove blood stasis, replenish qi and nourish yin.
Modifications According to the Symptoms
Diabetes with many illness causes, complicated illness condition and varied syndromes can not be treated with a single drug, one recipe, or one therapy. The law used by Prof. XIE for governing modifications according to symptoms is as follows. Ge Gen and Tian Hua Fen are added for severe thirst. Ren Shen, Mai Dong Radix Ophiopogonis) and Wu Wei Zi (AiAT Fructus Schisandrae) are added for deficiency of qi and yin. Yi Zhi Ren (ffi^t Semen Alpiniae Oxyphyllae) and Sang Piao Xiao (# Ooetheca Mantidis) are added for frequent micturition. Quan Xie Scorpio), Jiang Can (M
S Bombyx Batryticatus), Di Long ( № % Pheretima), Dang Gui, Ji Xue Teng Caulis
Spatholobi) and Hai Feng Teng (Caulis Piperis Kadsurae) are added and large dosage of Huang Qi is used for peripheral neuritis, numbness and pain in the body and limbs. Jin Yin Hua Flos Lonicerae), Pu Gong Ying (^ ^ ^ Herba Taraxaci), Lian Qiao (^M Fructus Forsythiae) and Zi Hua Di Ding Herba Violae) are added
for skin infection. Fang Feng ( Hfr M Radix Saposhnikoviae), Chan Tui (№ № Periostracum Cicadae), Di Fu Zi (№№T Fructus Kochiae) and Chi Shao are added for skin pruritus. Jin Yin Hua, Xuan Shen, Dan Shen, Hong Teng (Caulis Sar-gentodoxae), Huang Qi and Tu Fu Ling (i^^ Rhizoma Smilacis Glabrae) are added for gangrene in lower limbs. Bai Bu Radix Stemonae), Bai He
(H^ Bulbus Lilii) and Chuan Bei Mu Bulbus Fritillariae Cirrhosae) are added for lung infection and cough. Tian Ma A 0 (Rhizoma Gastrodiae), Long Gu (%# Os Draconis), Mu Li (tt№ Concha Ostreae), Niu Xi (Radix
Achyranthis Bidentatae) and Gou Teng ( Ramulus Uncariae cum Uncis) are added for hypertension, headache and dizziness. Zhi Shi Fructus Aurantii Immaturus), Shi Chang Pu Rhizoma Acori Tatarinowii), Dan Shen, Dang Gui, Chuan Xiong, Sheng Pu Huang (^^^ Pollen Typhae) and Wu Ling Zhi ( i ^ M Faeces Trogopterorum) are added for coronary heart disease, oppressed feeling in the chest and cardialgia. Chong Wei Zi (^MT Fructus Leonuri), Gou Qi Zi, Qing Xiang Zi (WffT Semen Celosiae) and Ju Hua (Mtt Flos Chrysanthemi) are added for cataract and blurred vision. Huang Qi, Yi Mu Cao Herba
Leonuri) and Yu Mi Xu Stigma Maydis) are
added for nephrosis and proteinuria. Bai Mao Gen (S^tS Rhizoma Imperatae), Che Qian Cao ^ Herba Plantaginis), Zhu Ye (ft H Herba Lophatheri), Zhi Zi (MMT Fructus Gardeniae) and Hua Shi Talcum) are added for infection of
urinary system, frequent micturition, urodynia, urgent urination and chaude-pisse.
Typical case: A male patient, aged 60, paid his first visit in November 2004. Suffering from diabetes for 8 years, He had taken Diamicron and Metformin for a long time to control blood sugar at 8-11 mmol/L. The patient had numbness and sometimes burning and pricking pain below knee joints for 1 year and felt pain too severe during sleep at night for 2 weeks. His pain was slightly alleviated after he had taken analgesic. His illness was diagnosed as diabetic peripheral neuropathy. He complained of thirst, lassitude, numbness, pricking pain and burning heat in lower limbs. Examination showed dark red tongue with less fur and some petechia, thready and uneven pulse. His disease was treated by replenishing yin, clearing away heat, promoting blood circulation and
removing blood stasis. The recipe consisted of Huang Qi (M% Radix Astragali) 30g, Dang Shen Radix Codonopsis) 30g, Tai Zi Shen (AT# Radix Pseudostellariae) 15g, Shan Zhu Yu (¿^^ Fructus Corni) 15g, Fu Ling Poria) 10g, Ze Xie Rhizoma Alismatis) 10g, Ge Gen (tS Radix Puerariae) 20g, Cang Zhu (^^ Rhizoma Atra-ctylodis) 15g, Xuan Shen Radix Scrophulariae) 15g, Sheng Di Huang Radix Rehmanniae)
20g, Di Gu Pi Cortex Lycii Radicis) 15g,
Tian Hua Fen Radix Trichosanthis) 15g, Mai
Dong Radix Ophiopogonis) 15g, Dang Gui (^ 0 Radix Angelicae Sinensis) 15g, Yan Hu Suo (M^H ^ Rhizoma Corydalis) 15g, Tao Ren Semen
Persicae) 10g, Hong Hua (^X^ Flos Carthami) 10g, Shui Zhi (7K® Hirudo) 10g, Di Long ( Lumbricus) 10g, Ji Xue Teng (^ 0 Caulis Spatholobi) 15g and Gan Cao ( ^ ^ Radix Glycyrrhizae) 10g. After he had taken 30 doses, all his symptoms slightly relieved, his pain reduced, numbness in his lower limbs remained and fasting blood sugar decreased to 8 mmol/L. After he had taken another 30 doses, his blood sugar decreased to 6 mmol/L, all his symptoms were relieved and the pain was so obviously reduced that he could sleep at night. In order to avoid taking drugs for a long time to impair qi of the spleen and stomach, Prof. XIE added Chao Bai Zhu (^S^ stir-baked Rhizoma Atractylodis Macrocephalae) 15g, Shan Yao (¿^ Rhizoma Dioscoreae) 15g and Chen Pi (^ ^ Pericarpium Citri Reticulatae) 15g for the patient to take for more than 1 month to consolidate the therapeutic effect.
(Translated by DUAN Shu-min gWK) Received June 16, 2009
