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Treatment of Diabetes Mellitus with Herbs

Diabetes, affecting up to one-third of the population of industrialized countries, is the most common endocrinologic disorder. Beyond the more immediately-perceptible metabolic dysfunction accompanying a typical hyperglycemia, long-term complications of diabetes mellitus involve disorders of the eyes, kidneys, nerves, and blood vessels. Due to the widespread prevalence of diabetes and the severity of its complications, extensive research and development efforts are underway to find more effective remedies to improve the quality of life of those affected by the disease. This article will focus on an integrative approach of the treatment of diabetes from the perspectives of both western and Oriental medicine.

DEFINITION

Diabetes mellitus is a chronic endocrinologic disorder characterized by high blood levels of glucose due to insufficient secretion of insulin by the pancreas or improper utilization of insulin by target cells.

WESTERN MEDICINE

Diabetes is classified into two categories: Type I Diabetes, or Insulin-dependent Diabetes Mellitus (IDDM); and Type II Diabetes, or Non-Insulin-Dependent Diabetes Mellitus (NIDDM).

Type I, IDDM, is also referred to as juvenile-onset diabetes, with onset in the early teen years in many patients. Affected individuals usually experience an abrupt onset of symptoms, including thirst, excessive urination, increased appetite, and paradoxic weight loss. Untreated, symptoms may progress to ketoacidosis and even coma. Patients secrete little or no insulin, and must rely on exogenous injections of insulin to control blood glucose levels. Type I, IDDM, does not respond to prescription drugs, such as sulfonylurea therapy.

Type II, NIDDM, is also referred to as adult-onset diabetes, with symptoms appearing around or after age 40, or into advanced ages, but occasionally affecting juveniles. Patients with NIDDM are usually obese, but may show few symptoms or no symptoms in the early stages. As the disease progresses, patients begin to notice increased thirst, increased consumption of water and food, excessive frequency and volume of urination, and other symptoms and signs related to complications. Patients with NIDDM have normal-to-elevated levels of insulin secretion, but blood glucose levels remain high due to insulin resistance. Type II, NIDDM, responds to both insulin and prescription drug treatments.

Long-term complications of Diabetes Mellitus affect various tissues and organs. Complications of damage to blood vessels include poor circulation, delayed wound healing, heart disease, impotence and gangrene; complications affecting the eyes include decreased vision and blindness; complications damaging the kidneys manifest in increased urinary volume and frequency, and kidney failure; complications in the nervous system include peripheral neuropathy, sudden or gradual weakness of a leg, chronic damage to nerves; and complications of the blood include increased susceptibility to infection, especially of the urinary tract or skin.

TRADITIONAL CHINESE MEDICINE

According to Traditional Chinese Medicine, diabetes mellitus is a disorder characterized by Yin deficiency with dryness, heat and dampness. Yin deficiency is the underlying cause of the disease; dryness and heat represent the symptoms and signs; and dampness is reflected in increased blood glucose. Diabetes mellitus is most closely related to Wasting (Xiao Ke) syndrome, which can be categorized into Upper, Middle and Lower Wasting (Xiao Ke) syndrome, with the organs affected including the Lungs, Stomach and Kidneys, respectively.

Upper Wasting (Xiao Ke) Syndrome is characterized by Lung heat drying up body fluids. Symptoms are fidgeting, polydipsia, dry red tongue (with or without cracks), with a thin, yellow coat, and a forceful, rapid pulse (especially at the cun position). Middle Wasting (Xiao Ke) Syndrome is characterized by Stomach fire damaging fluids, with such symptoms as polyphagia, constant hunger with good appetite, red tongue with a yellow coat, and a slippery, forceful, rapid pulse. Lower Wasting (Xiao Ke) Syndrome is sub-divided into Kidney Yin deficiency or Kidney Yin and Yang deficiencies. Kidney Yin deficiency is characterized by symptoms such as polyuria (especially at night), red tongue with little or no coat, and a deep, thready, rapid pulse; Kidney Yin and Yang deficiency is characterized by polyuria (especially at night), teethmarks on both sides of the tongue, pale red tongue with a white coat, and a deep, thready, weak pulse.

Despite the similarities between Diabetes and Wasting (Xiao Ke) Syndrome, it is important to keep in mind that they are not identical. Both Diabetes and Wasting (Xiao Ke) syndrome may be characterized by the presence of the three P's: polyuria, polydypsia and polyphagia. Diabetes, however, is defined as an increase in blood glucose levels, with or without the presence of the three P's. In addition, Diabetes may have many complications not present in Wasting (Xiao-Ke) syndrome, such as visual disturbances, impotence, amenorrhea, and frequent infections. Conversely, the presence of the three P's constitutes diagnosis of Wasting (Xiao-Ke) Syndrome. Polyuria, polydypsia and polyphagia may be caused by factors other than diabetes, such as fever, dehydration, or kidney disease. Understanding the similarities and differences between the two is essential for an accurate diagnosis and for optimal treatment of the patient.

LABORATORY VALUES

The ideal blood glucose level is 70-100 mg/dL fasting, 70-100 mg/dL preprandial, <160 mg/dL postprandial (1 hour), and >65 mg/dL at 3 A.M.

An acceptable blood glucose level is 60-130 mg/dL fasting, 60-130 mg/dL preprandial, <200 mg/dL postprandial (1 hour), and >65 mg/dL at 3 A.M.

Levels above the acceptable range are considered high, and require treatment.

WESTERN MEDICINE

I. Oral Antidiabetic Drugs

Oral antidiabetic drugs are commonly used to treat Type II, NIDDM, patients. There are three types of oral antidiabetic drugs: sulfonylureas, biguanides, and glucosidase inhibitors, each with its unique functions and side effects.

a. Sulfonylureas are the most common oral antidiabetic drugs. These drugs lower blood glucose levels by stimulating the pancreas to release insulin. Patients with Type I, IDDM, do not respond to sulfonylureas because their pancreas is not capable of producing insulin regardless of drug stimulation. Despite their effectiveness, sulfonylureas have unwanted side-effects and toxicity, including nausea, vomiting, hematological and dermatological reactions, obstructive jaundice, hyponatremia, and intolerance of alcohol. Examples of sulfonylureas include tolbutamide (Orinase), chlorpropamide (Diabinese), glyburide (Micronase) and glipizide (Glucotrol). b. Biguanides lower blood glucose levels by increasing the uptake and utilization of glucose by muscle cells. They also reduce glucose production by the liver. Biguanides are only effective in patients with Type II, NIDDM, because their ability to function requires the presence of insulin. Common side effects of biguanides include nausea, vomiting, epigastric distress and diarrhea. There are also risks of developing lactic acidosis and hepatic disease. Metformin (Glucophage) is the most common type of biguanide. c. Glucosidase inhibitors reduce the peak of blood glucose levels following a meal by delaying and inhibiting the absorption of carbohydrates. Glucosidase inhibitors work on both Type I, IDDM, and Type II, NIDDM, as the inhibitors' effectiveness is not dependent on the function of the pancreas. The major side effects are gastrointestinal, including nausea, vomiting, abdominal pain and cramps. Acarbose (Precose) is the most common glucosidase inhibitor.

II. Insulin

Patients with Type I, IDDM, secrete little or no insulin and are dependent on external sources of insulin to regulate their blood sugar. Insulin is injected from once to several times daily to control the fluctuation of blood glucose levels. Though effective, insulin injection has numerous side effects, including hypoglycemic reactions, local lipodystrophy, visual disturbance, edema, allergy, and insulin resistance.

Note: In recent years the use of Chinese herbs has become a more and more popular option. To facilitate the understanding between drugs and herbs, we have dedicated a whole section entitled the Drug-Herb Index in our Clinical Manual of Oriental Medicine: Lotus Collection. Our goal in creating this section is to point out the similarities between the drug and the herbal treatments, so that a practitioner may suggest herbal alternatives to their patients who are unable to tolerate drugs or the side effects of drugs. This handy reference includes a combination of more than 300 most commonly used brand names and generic drug names. Knowing herbal alternatives to drugs gives the practitioner another treatment option so they can decide with their patients on the best therapy possible.

HERBAL TREATMENTS

Chinese herbs are very effective in treating patients with Type II, NIDDM. When prescribed correctly, Chinese herbs lower blood glucose levels, manage common signs and symptoms, and treat the complications of diabetes mellitus. Patients generally respond to herbal treatment within three-to-four weeks, with significant reduction in blood glucose levels and little fluctuation throughout the day. However, some patients may require up to six-to-eight weeks. For patients with Type I, IDDM, Chinese herbs are used in conjunction with insulin to manage symptoms and complications. Chinese herbs can also reduce the frequency and dosage of insulin injections. However, it is important to keep in mind that herbs cannot replace insulin, and patients with IDDM will still require insulin injections.

I. Equilibrium

Equilibrium is the formula of choice for treating diabetes mellitus. From the perspective of Western medicine, Equilibrium contains herbs with excellent hypoglycemic effects, lowering blood glucose levels and reducing synthesis of fatty tissues. In addition, Equilibrium contains herbs that lower blood cholesterol levels and improve blood circulation to the coronary arteries and peripheral parts of the body--thus managing common complications of diabetes, such as hyperlipidemia, atherosclerosis, coronary artery disease, peripheral neuropathy, etc.

In terms of Chinese therapeutic actions, Equilibrium nourishes Lung, Stomach and Kidney Yin, clears heat, and dries dampness. It can be used for patients with Upper, Middle or Lower Wasting (Xiao Ke) syndromes. It effectively manages the three cardinal symptoms of Wasting (Xiao Ke) syndrome: polydipsia, polyphagia and polyuria.

Equilibrium treats both the cause and the complications of diabetes mellitus. American ginseng (xi yang shen) greatly replenishes the vital essence of the body and promotes the secretion of body fluids, to treat polydipsia. Gypsum (shi gao) and anemarrhena (zhi mu) are a pair commonly used to treat heat in the Middle Burner (Jiao). They sedate Stomach fire and suppress appetite to relieve polyphagia. Scrophularia (xuan shen) enters the Lungs, Stomach and Kidneys to simultaneously replenish vital essence and clear heat. According to Oriental Medicine, an elevated glucose level is equivalent to excess retention of dampness in the body. Therefore, astragalus (huang qi) and dioscorea (shan yao) are used to tonify Qi and strengthen the Spleen to enhance its functions to dispel dampness. With their aromatic properties, white atractylodes (bai zhu) and atractylodes (cang zhu) strengthen the Spleen and directly dry dampness. Salvia root (dan shen) and carthamus (hong hua) invigorate blood circulation and enhance the overall effectiveness of the herbs by improving micro-circulation. Activation of blood circulation also reduces the risk of atherosclerosis by preventing buildup of cholesterol on the inner walls of blood vessels. Lastly, lotus embryo (lian zi xin) and lotus stamen (lian xu) tonify the Kidney and control frequent urination.

II. Modification of Herbal Treatment Based on Wasting (Xiao-Ke) Syndrome

Equilibrium is the essential herbal formula used to lower blood glucose if the patient shows no other significant complications. If diabetic patients exhibit prominent signs and symptoms of Upper, Middle or Lower Wasting (Xiao Ke) syndromes, treatment must be modified by combining Equilibrium with the following formulas:

1. Upper Wasting (Xiao-Ke) Syndrome is characterized by Lung heat drying body fluids, resulting in symptoms such as fidgeting, polydipsia, a dry red tongue (with or without cracks) with a thin, yellow coat, and a forceful, rapid, pulse (especially at the cun position). Patients with Upper Wasting (Xiao-Ke) Syndrome should combine Equilibrium with Ginseng & Gypsum Combination (Bai Hu Jia Ren Shen Tang). 2. Middle Wasting (Xiao-Ke) Syndrome is characterized by Stomach fire damaging the fluids, leading to such symptoms as polyphagia, constant hunger with good appetite, a red tongue with a yellow coat, and a slippery, forceful, rapid pulse. Patients with Middle Wasting (Xiao-Ke) Syndrome should combine Equilibrium with Rehmannia & Gypsum Combination (Yu Nu Jian). 3. Lower Wasting (Xiao Ke) Syndrome with Kidney Yin deficiency is characterized by such symptoms as polyuria (especially at night), a red tongue with little or no coat, and a deep, thready, rapid pulse. Patients with Lower Wasting (Xiao Ke) syndrome with Kidney Yin deficiency should combine Equilibrium with Rehmannia Six Formula (Liu Wei Di Huang Wan). 4. Lower Wasting (Xiao Ke) Syndrome with Kidney Yin and Yang deficiencies is characterized by polyuria (especially at night), teethmarks on both sides of the tongue, a pale red tongue with a white coat, and a deep, thready, weak pulse. Patients with Lower Wasting (Xiao Ke) Syndrome with Kidney Yin and Yang deficiencies should combine Equilibrium with Rehmannia Eight Formula (Ba Wei Di Huang Wan).

III. Modification of Herbal Treatment Based on Complications

If diabetic patients exhibit prominent signs and symptoms of complications, treatment must be modified by combining Equilibrium with the following formulas:

1. For patients with high cholesterol, combine with Cholisma. 2. For patients with hypertension, combine with Gentiana Complex or Gastrodia Complex. 3. For patients with chronic buildup of cholesterol leading to coronary artery disease, combine with Circulation. 4. For patients with blurred vision or vision impairment, combine with Nourish. 5. For patients with impotence due to diabetic complications, combine with Vitality For Men. 6. For patients with recurrent urinary tract infections, combine with Gentiana Complex.

CAUTIONS

Patients should not stop using drug treatments abruptly as there is a risk of hyperglycemia or diabetic ketoacidosis. Herbal and drug treatments should overlap for 1 to 2 weeks before patients are to begin tapering off drug treatments to ensure adequate control of blood glucose levels.

Concurrent use of drugs and herbal treatment may have synergistic effects on lowering the blood glucose levels. During the transition period when the patients take both drugs and herbs, their blood glucose levels should be monitored at least twice daily to assess the effectiveness of the treatment and to avoid hypoglycemia. Dosage must be adjusted as needed to keep blood glucose within the normal range. Herbal treatment may reduce the dosage and frequency of insulin injections needed; however, it can never replace insulin, especially in insulin dependent diabetes mellitus (IDDM) patients. Patients with IDDM should always be treated with insulin, or a combination of insulin and herbs.

LIFESTYLE INSTRUCTIONS

Lifestyle adjustments are absolutely critical for short-term management and long-term recovery of diabetes. Patients should be encouraged to engage in regular daily exercise, sleep by 10 p.m. to enhance restoration of Yin elements in the body, and eliminate sugar, carbohydrates and caffeine from the diet. Additional dietary advice may be useful based on the primary organ systems affected.

CLINICAL NOTES

For patients with Type II, NIDDM, Equilibrium in combination with diet and exercise provides excellent clinical results. Most patients will get satisfactory clinical results within three-to-four weeks of beginning herbal treatment. Maximum effectiveness may require up to six-to-eight weeks of herbal treatment. Clinical effects include a significant reduction in blood glucose levels and less fluctuation throughout the day.

Diabetes mellitus is defined simply as a rise in blood glucose levels. The clinical manifestations of the disease, however, are much more complicated than its definition. Patients with chronic diabetes mellitus are frequently plagued by various complications, such as visual disturbances, prolonged healing of wounds, frequent recurrences of infections, impotence, etc., which must be addressed within the overall treatment strategy.

CONCLUSION

Diagnosis and treatment of the most common and complex endocrinologic disorder continues to pose a challenge for health care practitioners. Diabetes mellitus commonly may go undiagnosed as patients with early stages of Type II, NIDDM are often asymptomatic. Also, as patients with chronic Type II, NIDDM often have a wide variety of complications, diabetes mellitus is frequently overlooked or mis-diagnosed. Once the correct diagnosis is made, diabetes and its complications can be effectively managed by both western drugs and herbal remedies. In conclusion, herbal medicine offers a safe and effective alternative for patients with diabetes mellitus.

CASE STUDIES

1. J.K., a 45-year-old female, was 5'3" and weighed 160 pounds. She had urinary tract infections once or twice each month within the last 12 months. Her other symptoms and signs included constant thirst, increased fluid intake, increased frequency and volume of urination. She was diagnosed with diabetes mellitus after testing positive for high levels of blood glucose. She was prescribed Equilibrium, 4 capsules TID before meals. Two weeks after the initial treatment, she reported significant improvement of her signs and symptoms. Two months after the initial treatment, her blood glucose levels were within the ideal range. She did not have any urinary tract infections during these two months. She continues to take Equilibrium, 4 capsules TID before meals.

Clinical Note: Urinary tract infection is a common complication of chronic diabetes. The frequency of infections, polydipsia and polyuria, in combination with her age and body weight, indicated possible diabetes. Prior to treating the urinary tract infection, her blood glucose levels must first be tested to rule out diabetes. In this case, persistent high levels of blood glucose levels confirmed the diagnosis of diabetes mellitus. After treatment with Equilibrium for two months, both symptoms and complications of diabetes mellitus were under good control.

2. A.G., a 60-year-old male, was 6'1" and weighed 280 pounds. He was always hungry and ate two or three bowls of rice with every meal. He noticed that his cuts or scratches required a longer period of time to heal, sometimes up to one month. His diagnoses were diabetes mellitus and high cholesterol. He was given Equilibrium, 4 capsules TID for his diabetes, and Cholisma, 4 capsules TID for his cholesterol. After taking the herbs for three months, his blood glucose levels were within the ideal range and his cholesterol level dropped from 260 to 220. His weight also dropped from 280 to 255 pounds. He ate less and did not feel constantly hungry. He continues to take both Equilibrium and Cholisma.

Clinical Note: High cholesterol levels are a common complication of diabetes mellitus. If untreated, high cholesterol levels can lead to atherosclerosis, hypertension, coronary heart disease, angina, and myocardial infarction. Therefore, effective treatment must address both blood glucose levels and blood cholesterol levels. In combination with dietary changes, this patient showed excellent progress in reducing his blood glucose and cholesterol levels.

Copyright Copyright © 1998 by Lotus Herbs, Inc. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, except for brief review, without the prior written permission of Lotus Herbs, Inc. Lotus Herbs, the Lotus Herbs logo, the Lotus Collection, the Lotus Collection logo, the Clinical Article of Oriental Medicine, the Lotus Classics, the Lotus Classics logo, are trademarks of Lotus Herbs, Inc.

Professional Use Only: This article is intended as a reference for licensed health care practitioners, as professional training and expertise are essential to the safe and effective use of the herbs. Similarly, all herbal products are sold only to licensed health care practitioners. The advantages and disadvantages of each herbal formula are disclosed in full so both the doctors and the patients can make informed decisions.

Structure & Function Claims: The information is presented in this article in an accurate, truthful and non- misleading manner. Claims are supported by modern research and referenced accordingly through the entire Article. Nonetheless, the FDA requires the following statement: These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.

General Disclaimer: Great care has been taken to maintain the accuracy of the information contained in this article. The information as presented in this Article is for educational purposes only. We cannot anticipate all conditions under which this information and our products, or the products of other manufacturers in combination with our products, may be used. In view of ongoing research, changes in government regulation, and the constant flow of information relating to Chinese and western medicine, the reader is urged to check with other sources for all up-to-date information. We accept no responsibility for the results obtained by the application of the information within this Article or the safety and suitability of our products, either alone or in combination with our products or with the products of other manufacturers. Neither Lotus Herbs, Inc. nor the authors of this Article can be held responsible for errors or for any consequences arising from the use of the information herein.

John K. Chen, Ph.D., Pharm.D., OMD, L.Ac. is a recognized authority on western pharmacology and Chinese herbal medicine. He graduated from the University of Southern California (USC) School of Pharmacy and South Baylo University of Oriental Medicine. He also received extensive postgraduate training in China specializing in herbology and internal medicine.

Dr. Chen currently teaches herbal medicine at USC, Chinese herbology at South Baylo University, and western pharmacology at Yo San University and Emperor's College. He is the Chair of the Herbal Medicine Committee for the American Association of Oriental Medicine (AAOM) and an herbal consultant for the California Association of Acupuncture and Oriental Medicine (CAAOM).

Dr. John Chen is the president and founder of Lotus Herbs, and is available for medical consultations through the Lotus Herbal Consultation Line. Tel: (626) 916-1070; Fax: (626) 917-7763;

Lotus Herbs: 1124 North Hacienda Blvd. La Puente, CA 91744.

Copyright 1998 All rights reserved. Written by Dr. John K. Chen, Ph.D., Pharm.D., OMD, L.Ac.

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