Tilo Medical and Acupuncture

Diabetic Peripheral Neuropathy

abstracted & translated by

Bob Flaws, Lic. Ac., Dipl. Ac. & C.H., FNAAOM (USA), FRCHM (UK)

In issue #9, 2003 of the Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine) , Qian Qi published an article titled, "The Treatment of 42 Cases of Diabetic Peripheral Neuropathy with Zhi Gui Hua Yu Tang (Hirudo & Dang Gui Transform Stasis Decoction). This article appeared on page 382 of that journal. A summary of its clinically important parts is given below.

Keywords: Chinese medicine, Chinese herbal medicine, peripheral neuropathy, diabetes mellitus

Cohort description

All 42 patients included in this study met the WHO diagnostic criteria for both diabetes mellitus and peripheral neuropathy. Among them, there were 18 males and 24 females aged 32-82 years, with an average age of 59.1 years. The shortest course of disease was three months and the longest was 16 years, with three cases suffering for one year or less, 17 cases suffering for 1-3 years, and 22 cases suffering for more than three years. Fasting blood glucose was normal in nine cases and elevated in 33 cases. Two-hour postprandial blood glucose was elevated in all cases. All these patients experience bilateral lower limb numbness and tingling, while seven cases also had accompanying pain.

Treatment method

All 42 patients were administered Zhi Gui Hua Yu Tang which basically consisted of: Hirudo Seu Whitmania ( Shui Zhi ), Radix Ligustici Wallichii ( Chuan Xiong ), Radix Achyranthis Bidentatae ( Niu Xi ), and Rhizoma Curcumae Longae ( Jiang Huang ), 10g each, Radix Angelicae Sinensis ( Dang Gui ), 15g, and stir-fried Rhizoma Corydalis Yanhusuo ( Yan Hu Suo ), 20g. If there was lung-stomach exuberant heat, Gypsum Fibrosum ( Shi Gao ), Rhizoma Anemarrhenae Aspheloidis ( Zhi Mu ), Radix Trichosanthis Kirlowii ( Tian Hua Fen ), Rhizoma Coptidis Chinensis ( Huang Lian ), uncooked Radix Rehmanniae Glutinosae ( Sheng Di ), and Tuber Ophiopogonis Japonici ( Mai Men Dong ) were added. If there was kidney yin depletion and vacuity, Liu Wei Di Huang Wan (Six Flavors Rehmannia Pills) were added. If there was qi and yin dual vacuity, Radix Panacis Ginseng ( Ren Shen ), Radix Astragali Membranacei ( Huang Qi ), Tuber Ophiopogonis Japonici ( Mai Men Dong ), Tuber Asparagi Cochinensis ( Tian Men Dong ), Rhizoma Anemarrhenae Aspheloidis ( Zhi Mu ), and Sclerotium Poriae Cocos ( Fu Ling ) were added. And if there was a yin and yang true vacuity, Jin Gui Shen Qi Wan ( Golden Cabinet Kidney Qi Pills) were added. One packet of these medicinals was decocted in water twice to obtain 400ml of liquid and administered warm two times per day, morning and evening. Thirty days equaled one course of treatment and 1-2 courses were given before outcomes were analyzed. Patients continued on with their original Western hypoglycemic medications but were not allowed to either increase or decrease dosages.

Treatment outcomes

Seventeen (40.48%) out of 42 cases were judged to have gotten a marked effect. This meant that, after one course of treatment, their fasting blood glucose was equal to or less than 6.0mmol/L, two-hour postprandial blood glucose was equal to or less than 8.0mmol/L, and limb numbness and pain either had disappeared altogether or had basically disappeared. Twenty-three cases (54.76%) got some effect. This meant that, after 1-2 courses of treatment, their blood glucose was 8.0-10.0mmol/L and their limb numbness and pain were markedly decreased. Only two cases got no effect. Therefore, the total effectiveness rate was reported as 95.24%.

Discussion

According to Dr. Qian, more than 60% of all persons with diabetes mellitus suffer from peripheral neuropathy which may manifest even in the early stages of this disease. However, as the condition becomes longer in duration, the incidence of this complicating condition increases. In Chinese medicine, peripheral neuropathy is categorized as impediment condition and/or wilting condition. It is due to qi and blood dual depletion which results in vacuity leading to repletion. In other words, this qi and yin dual vacuity eventually causes stasis and obstruction in the vessels and network vessels. In the early stage of diabetes, yin vacuity, dryness, and heat scorch and damage fluids and blood. Hence the blood vessels become astringed and stagnant. It is also possible for damp heat evils to obstruct and stagnate. In either case, qi and blood movement and transportation is no longer freely and easily flowing. Instead the vessels and network vessels are static and obstructed. In the middle stage, consumption and damage to qi and yin causes an inability of the qi to push or propel the movement of the blood. In addition, yin vacuity, scanty blood, and fluid depletion also leads to the blood vessels becoming static and stagnant. And finally, in the later stages of this disease, yin detriment reaches yang. Yang becomes vacuous and loses its warming and shining. Hence cold congeals the blood vessels and the movement of the blood again becomes static and stagnant.

Based on the above descriptions of the disease mechanisms of peripheral neuropathy associated with diabetes mellitus, Dr. Qian believes that the main treatment principle for this condition is to quicken the blood and transform stasis. Within the above formula, Shui Zhi, Dang Gui , and Jiang Huang quicken the blood and transform stasis. Chuan Xiong is a qi within the blood medicinal which moves the qi to quicken the blood. When combined with Yan Hu Suo , it rectifies the qi and moves the qi, and, by promoting the movement of the qi, these two move the blood. Niu Xi guides the blood to move downward. When all these medicinals are used together, they have the ability to quicken the blood, transform stasis, and move the qi. When this formula is modified with appropriate additions and subtractions based on each individual patient's presentation, Dr. Qian believes it achieves relatively satisfactory results.