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Analysis of Determining Treatment Based on Pattern Types of 201 Cases of Type 2 Diabetes

Abstracted & translated by Michael Johnston L.Ac.

The following is an abstract of an article published by Cha Jie titled “Analysis of Determining Treatment Based on Pattern Types of 201 Cases of Type 2 Diabetes.” It was published in issue #2, 2006 of the Shi Yong Zhong Yi Nei Ke Za Zhi (Journal of Practical Traditional Chinese Internal Medicine) on page 144. The original article was a report on a cohort study conducted in Shenyuan, Liaoning. Dr. Cha works at the Chinese Medical Research Institute in Shenyuan. According to Dr. Cha, diabetes can be divided into four basic patterns. These are the heat and dryness pattern, the damp heat pattern, the qi and blood vacuity pattern and the yin and yang vacuity pattern. In the following study, Dr. Cha determined treatment based on these four patterns with good clinical outcomes. I have chosen to translate and publish this article for two reasons. The first is because of the rapidly growing incidence of diabetes mellitus, and the second is because I find Dr. Cha’s protocol easy to implement clinically.

1 Cohort Description

The total number of individuals enrolled in this study consisted of 201 cases of Type 2 diabetes mellitus. Among these cases, 98 were male and 103 were female. Their ages ranged from 10-80 years old, and their disease duration ranged from 1-30 years. Every case enrolled in this study met the World Health Organization’s basic diagnostic criteria for Type 2 diabetes.

2 Analysis of the Pathomechanism

The shaoyin, i.e. the kidneys and heart, are the viscera of water and fire and the residence of yin and yang. Evils affecting the shaoyin mostly are due to the transformation of fire, which scorches yin and causes detriment to humors. Due to loss of regulation of the kidneys’ barring and opening, there is stirring and beating. The yangming or stomach is the mansion of dry earth and, therefore, easily transforms dryness. Thus, stomach fire blazes and becomes exuberant, leading to the swift dispersion of grains and a predilection to hunger. Heat burns lung yin, the lungs’ liquids cannot spread, and this results in thirst. In the initial stage of the disease, the “three polys” are marked. These are polydipsia, polyphagia, and polyuria. Therefore, the condition is called “wasting and thirsting.” Simultaneously, taiyin or spleen dampness may transform into damp heat lying deep internally. In that case, one may see pudendal itching and a dry mouth without a desire to drink. In order to treat the above, treatment should follow that which is given in the classics i.e. Nei Jing (Inner Classic). Based on the theories that repletion should be drained, heat should be cleared, vacuity should be supplemented, detriment should be boosted, and stasis should be dispelled, one should treat according to pattern identification.

3 Diagnosis based on overall analysis of patient’s condition

Hot and Dry Type Drain heat and enrich yin using Bai Hu Tang (White Tiger Decoction), and Da Bu Yin Wan (Big Replenish Yin Pill) as the basis, adding Tian Hua Fen (Radix Trichosanthis), Shan Yao (Radix Dioscoreae), Yu Zhu (Rhizoma Polygoni Odorati), Hei Yuan Can (Radix Scrophulariae).

Damp Heat Type Clear heat, dispel dampness and enrich yin using Gan Lu Yin (Sweet Dew Beverage) as the basis, adding Long Dan Cao (Radix Gentiana), Huang Bai (Cortex Phellodendri), and Pu Gong Ying (Herba Taraxaci).

Right Vacuity Type Supplement the qi, nourish yin and support the righteous using Sheng Mai Yin (Vessel Engendering Beverage), and Liu Wei Di Huang Wan (Six Ingredients Rehmannia Pill) as the basis, and adding Gou Qi Zi (Fructus Lycii) and uncooked Huang Qi (Radix Astragali).

Yin and Yang Vacuity Type Regulate and supplement yin and yang, warm and boost the qi and blood using Fu Fang Er Xian Tang (Compounded Two Immortals Decoction) as the basis, adding Xian Mao (Rhizoma Curculiginis), Xian Ling Pi (Herba Epimedii), Ba Ji Tian (Radix Morindae Officinalis), Dang Gui (Radix Angelicae Sinensis), Zhi Mu (Rhizoma Anemarrhena), Huang Bai (Cortex Phellodendri), Shu Di Huang (Cooked Radix Rehmanniae), Gou Qi Zi (Fructus Lycii), Shan Yao (Radix Dioscoreae), Tai Zi Shen (Radix Pseudostellariae), Hong Hua (Flos Carthami), Dan Shen (Radix Salvia Miltiorrhizae), Tu Si Zi (Semen Cuscutae).

Additions and subtractions: if there is extreme thirst, Ge Gen (Radix Peurariae) is added. If there is emaciation, Tu Si Zi (Semen Cuscutae) is added. For dry stools, Dang Gui (Radix Angelicae Sinensis) and He Shou Wu (Radix Polygani Multiflori) are added. For thin, sloppy stools, Shan Yao (Radix Dioscoreae) and Cang Zhu (Rhizoma Atractylodis) are added. For pudendal itching, Pu Gong Ying (Herba Taraxaci) is added. For nausea, Lu Gen (Rhizoma Pharagmitis Communis) and Ban Xia (Rhizoma Pinellia) are added. For numbness and pain in the limbs, Hong Hua (Flos Carthami) and Xi Xin (Herba Asari) are added. For blurred vision, Niu Xi (Radix Achyranthis Bidentatae) is added.

4 Outcomes

Out of the 201 cases enrolled in this study, the symptoms were basically controlled in 48 cases. A marked effect was achieved in 45 cases, and improvement was seen in 78 cases. No change occurred in 30 cases. Thus, there was a total effectiveness rate of 85.07%.

5 Discussion

According to Dr. Cha, the mechanism of wasting and thirsting begins with yin vacuity dryness and heat. Heavy or serious yin vacuity is located particularly in the kidneys. This is the root of this condition. Dryness and heat are the external manifestations, which are located in the lungs and stomach. These are the tips or branches of this condition. Yin vacuity results in fire effulgence, while fire effulgence leads to an increase in yin vacuity. In other words, extreme heat is due to yin vacuity, and yin vacuity is due to extreme heat. Both of these mutually interact as both cause and effect. Generally, the onset of this condition is due to repletion, which then develops into vacuity. It begins with yangming dryness, which changes to dryness and heat blazing internally. Similarly, the taiyin spleen may transform dampness, and damp heat brews internally. These are the repletion patterns. However, over a long time, the pattern changes into vacuity. This is because the righteous qi cannot overcome the evils. Finally, the patient’s condition turns into a serious pattern of yin and yang vacuity and debility. Thus Dr. Cha’s four patterns correspond to the different stages in the progression of this disease, and this helps me focus my diagnostic hypothesis more quickly when dealing with new patients. Those with recently diagnosed diseases and few externally observable symptoms most commonly present Dr. Cha’s repletion patterns, while those who have had a long-term confirmed diagnosis of diabetes most commonly present with the vacuity patterns complicated by blood stasis. Unfortunately, Dr. Cha does not expound on the presence of blood stasis as the most commonly seen complicating mechanism of this condition.

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June 2007
Volume 5, Number 6

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