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Course:
Date:
Diabetes Seminar
Dr. Zheng Zeng
October 3, 2009
Introduction
This is the #3 killer in the US at this point.
Diabetes is a disease in which blood glucose levels are above normal. WE mostly see type 1 and 2
diabetes though there is a 3rd.
Type 1 – insulin resistant diabetes. Dependent upon insulin administration as they cannot make enough
or any. Herbs to lower blood sugar don’t work for these types. You can use herbs to mitigate
circumstances however.
Type II – make insulin, but don’t use it well. Insulin resistance is first. This is a condition in which
muscle, liver and fat cells don’t use it properly. At first the pancreas keeps up with demand by producing
more, but over time lose ability to secrete enough in rsvp to meals. Herbs work better if never had
insulin tx. Helps with complications of diabetes (diarrhea and incontinence for instance).
Gestational Diabetes – develop in late states of pregnancy. Generally around 28 weeks. Usually resolves
after delivery of child, but higher risk of diabetes in later life. Mostly don’t need herbs though many are
safe – more on that later. Change in diet/exercise will manage. Often due to Spleen Qi xu, unable to
convert food to glucose properly.
Diagnosis of Diabetes
FPG test (fasting plasma glucose) measures blood glucose after 8 hours w/o eating. In the diagram to the
right, the FPG numbers are indicated by the arrow on the left side. OGTT, the oral glucose tolerance
test, mostly used for preggers testing. Measures blood glucose
after 8 hours w/o eating then 2 hours after drinking glucose
containing beverage.
Steps to delay/prevent Type 2?
Change diet to lo fat, lo cal and lose a modest amount of
weight. Walking briskly for 30 minutes 5x per week will do
the trick actually.
The most important thing for diabetics is exercise, followed by
diet. And the thing about exercise is that Qigong and Yoga
don’t work. Gotta get physical.
Points to Remember
 Check the blood glucose levels.
This is key for diagnosis. You can’t tell by symptoms alone.
Symptoms of Diabetes
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Some patients don’t have the following symptoms since they appear after having diabetes a while. This
exacerbates the symptoms.
 Increased urination
 Increased thirst
 Increased hunger
 Unexplained weight loss
TCM Discussion
Etiology
Heat in the body can be the problem, but
mostly related to the diet. Greasy foods
(especially greasy foods) and lots of
sugars can create damp heat.
Emotionally it could be too much stress
or emotional stimulation/shock which
block the channel.
Overwork including
mentally/physically. This can generate
stress.
Inheritance
Differentiations
Etiological factors can lead to disorders of Zangfu – lung, kidneys for instance. Xiao Ke indicates
excessively thirsty/hungry but with weight loss (ke).
Some people divide diabetes into upper, middle and lower xiao. This is similar to upper/middle/lower
jiao problems.
 Upper jiao = lung or heart fire generating dryness which can increase thirst. Herbs will be more
nourish yin.
 Middle jiao/xiao = stomach fire (excess heat) or yin xu (deficient heat). This manifests as
excessive hunger (or possibly thirst). Unexplained weight loss and fatigue can be attributed to
Spleen and ST qi deficiencies. Even without other symptoms the fatigue is usually found. Spleen
isn’t digesting/converting properly, hence the high blood sugar levels. Spleen also ascends clear
essence/yang – with Sp qi xu can’t ascend, so essence isn’t ascending and blood sugar isn’t
working. This is why we use Huang Qi in many diabetic support formulas. This assists in
fatigue, regulates blood sugar. Huang Qi makes the blood sugar normal with both hypo and
hyperglycemia. Shan Yao is another good food/herb – 100 – 200 Shan yao per day. Many
practitioners will recommend the decoction because you don’t get the carbs (and the resultant
sugar conversion problems).
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Many herbs for tonifying Qi and yin.
 Lower jiao/xiao = Kidney and Liver yin xu, LV qi yu, and often/eventually KI yang xu.
Increased urination results.
Blood Stasis, Phlegm or Damp and Heat
These are always found in diabetes!
Blood Stasis.
This is the most important of the three. When heat consumes the body yin/fluids the blood gets
thicker – circulation problems. Blood sugar raise also = circulation problems. Vascular disease
such as retinopathy, macular degeneration/edema, TIA’s, peripheral neuropathy, tingling, erectile
dysfunction and more are common for this reason. Even if a patient doesn’t have stasis symptoms
you can add herbs for blood stasis. (Dan Shen for instance – gentle and no bruising/bleeding)
Early stages of neuropathy can be improved by blood sugar control. If the blood sugar levels are
high the responses are poorer.
Damp/Phlegm
High cholesterol – tends to follow damp retention/blood sugar problems. Incontinence not
uncommon for insulin dependent/Type 1 diabetes. Blisters on the feet also common. Patients can
have this even in the presence of yin xu. This is the only one that may not be present of this
triumvirate.
Heat
Skin infections that last for a long time. Toxic and damp heat. Excessive thirst and hunger are
also heat related.
Notice in the table above how large the Tonify Qi and Tonify Yin herbs are. Helps blood sugar
levels.
Single herbs to lower blood sugar levels
There are more than are listed here, but this is a good starter pack!
Clear Heat, Drain Fire
Shi gao for instance. This is a big time clear heat, but it was noticed in context of the formula Ren Shen
Bai Hu Tang. When Shi Gao was taken out of this formula using only ren shen and zhi mu the lower
blood sugar effect seemed not so good. Shi Gai and Zhi Mu paired help lower heat and blood sugar. Zhi
mu in tincture (true of other herbs too) works well. Shi gao, zhi mu and tian hua fen good effect for the
excessive thirst too. Bai Hu Tang formula has these.
Tian Hua Fen has a side effect to create a lot of saliva – that’s why it helps with thirst. If you don’t have
the dryness or thirst, that’s really annoying however! Like Huang Qi it will 2-way regulate blood sugar.
Tian Hua Fen tincture doesn’t lower blood sugar, but decoction does. ZZ: theoretically tincture not so
good for diabetes…just her opinion. Tian hua fen extract with abdominal injection can cause uterine
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contractions which terminates preggers…but there are some proteins in this herb that can cause allergic
reaction. Some reactions were quite severe.
Clear heat and cool blood category
Sheng di and xuan shen commonly used. On the handout, page 11, look at the bottom. Add Sheng di to
the middle line. These are paired herbs. In the case of the middle line, it’s a trinity.
Sheng di can stimulate the production of insulin and make the body more sensitive to insulin. Overdose
of sheng di can make the bowel movement loose. ZZ gives about 15g of sheng di. Can also cause gas
and bloating because it’s cloying, though Shu di is worse.
Xuan Shen can lower blood sugar, but when comparing singles, sheng di is stronger. Can also lower
high bp, which is handy since a lot of diabetics have high bp. Xuan Shen doesn’t increase/decrease
insulin receptor binding rate, however.
Clear heat and dry dampness
Huang qin and huang lian. Some research says huang bai also.
Huang qin lowers blood sugar after eating, so not just for empty stomach. Also prevents complications
of diabetes, esp cataracts, kidney problems.
Huang lian also lowers blood sugar for high blood sugar patients, but not if blood sugar is normal. Also
decreases cholesterol level…of course this is only in rats, so if you have a rodent with this problem, now
you know what to give them. Huang lian clears MJ and heart heat as well. For MJ problems, use small
Diabetes Seminar – Fall 2007
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doses and stomach muscles will become more active and digestion is better. The formula Jian Pi Wan
has a chief of bai zhu, but 6 grams of huang lian. Large doses (10g or higher) will reduce contractions in
the GI tract, which is how it is used for dysenteric diarrhea.
Huang qin/lian often used together for excess cases.
Clear heat and relieve toxicity
Ma chi xian (purslane or portulaca) doesn’t get a lot of press here. In china it’s both a veg and an herb.
Used to treat diarrhea in china. Has good result for eczema, esp fresh version.
From sacredlotus.com:



Relieves Fire Toxins and Cools the Blood
For dysentery from Damp-Heat or Fire Toxins, urinary tract infections with Blood, red and white
vaginal discharge, and post partum bleeding.
Reduces Sores from Damp-Heat
Can be used both topically or internally.
Used to reduce the swelling and pain from snake bite or wasp stings.
Clear deficiency heat
Di gu pi and gou ji zi come from the same plant. Di gu pi is the root bulb. Both lower blood sugar, bp
and cholesterol. In tincture or decoction form lowers bp. Di gu pi 50g per day cooked with 500mg of
water is used as a common tea in parts of China. Can help drop blood sugar to normal level.
Cool herbs that release exterior
Niu bang zi lowers bp and blood sugar levels. Actually helps keep it even. Not a lot of clinical reporting
about this though.
Ge gen lowers blood sugar and secondarily treats and prevents diabetes complications including
cataract, nerve, kidney etc. Also lowers bp and chol.
Sang ye (leaves), sang zhi (twigs – expel w/d and clr heat category), sang bai pi (root bark), and sang
shen zi (fruit), all mulberry tree components, lower blood sugar. Even the silk worms and silk worm
poop do this. Basically, eat the whole tree, bugs and all.
Stabilize and bind
Shan zhu yu lowers blood sugar and also increases insulin secretion. Helps body use blood sugar more
efficiently. Mostly for xu cases – yin xu for instance.
Transform phlegm cold
Jie geng is actually neutral despite the category. Has a lower blood sugar level in both decoction and
tincture form. Cholesterol level related to phlegm can also be treated with this herb.
Aromatic herbs that tx damp
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Cang zhu is fabulous. Won’t raise/lower if blood sugar normal, but if low will slightly raise – not so
strong. Diabetes can be related to spleen/stomach abnormality and failure to use blood sugar correctly.
This would be used for damp retention causing blood sugar problems.
Historically upper xiao was treated with he ye, middle with pei lan, and lower with bi xie. All of them
treat dampness/draining damp.
Drain damp
Fu ling is used as an insulin sensitizer, making the body more aware of it.
Yi yi ren helps lower blood sugar and can be used in the diet rather than in herbal decoction form. Both
drains damp and tonifies Spleen. Can induce ovulation. Don’t use for preggers due to possibility of
miscarriage.
This herb is used in PCOS patients…which is complex since many patients with PCOS are coming for
infertility! PCOS patients are often insulin resistance – often report excessive hair growth, acne, and
weight gain despite small food intake. PCOS patients often have a lot of damp retention.
Ze xie also lowers blood sugar levels.
Move blood
Most cases for diabetics reflect blood stasis. Not that many herbs listed here, but you can use the others.
Niu xi seems to target lower extremity circulatory problems. Legs are far away from the heart due to the
distant proximity to the heart. The first vascular complications typically show in the feet for this reason.
Xue jie heals wounds and prevents blood clots. Also lowers cholesterol. Not used much in the clinic.
Dan sen
Stop bleeding
San qi also promotes blood circulation. Stops bleeding through moving blood! Huh? Bleeding due to
clots for instance. This is not uncommon for abnormal gynecological bleeding – lots of blood with huge
clots. (Don’t use for small clots – this is a different situation.) Only use for a couple of days and will
usually do the trick. The heavy bleeding occurs because the clots break loose – usually comes along with
cramps. You can also use san qi for problems of the eyes due to diabetes. Dosages should be small.
Large doses will cause too much bleeding because the blood would be strongly encouraged to flow.
Choose the raw San Qi (which you can get in powder form/capsule form), not the steamed. (Steamed
nourishes, not stops.) Start at 1.5 grams, up to 2-3 times. Same for lowering blood sugar – go small, like
1-3g per days. San qi is effective for about 24 hours, then the blood sugar goes back up.
Taking san qi long term can reduce platelets. This is the chief herb in yunan biayao. Only use as needed.
Downward draining
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Da huang not often used in clinic. Poop-a-pa-looza. Can be used for insulin resistance. High insulin
blood level will breed high cholesterol/bp. Several formulas for high chol/bp have da huang in them.
Good herb for pts with history of intestinal infection.
We study da huang as a purgative, but it’s also cooling and moving. To mitigate the purgative, cook
longer and helps cool/move blood.
More excess cases tend to have insulin resistance. Use da huang in these cases.
Subdue LV yang
Mu li (sheng version). Supplies calcium, improves insulin saturation. Patients with heat and lots of
sweating – LV qi stagnation with heat – responds well to mu li. Also controls blood sugar. Diabetes
patients can take this long term….which is a good thing because diabetic patients take herbs long term
and take a lot of ‘em.
Tonify Qi
This is the big category. Commonly and often used.
Ren Shen
Xi yang shen and dang shen work too, but the research is about ren shen. Lowers blood sugars.
Xi yang shen is more often used in Texas. Ren shen has a 2 way regulation on blood sugar.
Hypoglycemics with light-headedness and such have qi and blood xu. Works for them too.
Strongly tonifies qi. Lowers sugar in the urine and in the blood – if used singly can mean that the
patient doesn’t have to take as much insulin.
Caution: Then again, if you take a bunch, can raise bp.
Bai Zhu
Regulates intestinal functions. Dries dampness so could cause constipation…then again, helps
with diarrhea!
Huang qi
Lowers blood sugar, but also for complications related to diabetes. Huang Qi Tang is a Sun Simiao formula, used for Xiao Ke: huang qi (chief), fu shen, gua lou, zhi gan cao, mai dong, sheng
di, all at 9 grams but for sheng di at 15 grams. All of these herbs lower blood sugar. Interesting
that gan cao, though sweet, lowers blood sugar.
Formula also raises blood sugar for hypoglycemic patients.
Huang qi is also very good to help protect the KI functions. Can lower the protein spillage to the
urine. Huang qi in larger doses (20-60g) helps reduce proteins in urine. Tonifies qi, promotes
urination/drain dampness to get out excessive water.
If someone already has this and gets to the dialysis stage, use da huang rather than huang qi.
Diabetics can have long term ulcers – if due to qi xu, use huang qi, dang gui, zao jiao ci.
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Shan Yao
Used as a food in China. Don’t use the chao form as it does not lower the blood sugar. Only the
raw works – steam cooked works ok. 150g/daily and blood sugar will drop within 10 days. Since
it is expensive here usually only dosed at 50g daily.
Bai Bian Dou
Tonifies spleen qi, is used as a food in China. Lowers blood sugar and cholesterol.
Tonify Blood
Bai Shao – Nourishes blood and treats Liver problems. Combine with da huang and sheng di. Both
decoction and tincture will work.
Nourish Yin
Mai dong
Sang shen zi
Gou qi zi
Nu zhen zi – nourishes yin and is less cloying than something like shu di huang. No gas/bloat side fx.
Also lowers cholesterol as well as the eye pressure (glaucoma).
Yu zhu nourishes yin especially for stomach problems, treating excessive stomach fire/hunger. Combine
with shu di.
Tonify Yang
Yin yang huo helps blood sugar levels and blood cholesterol levels. If patient has water retention,
combine with other herbs. Because it is warm, can help blood circulation in certain tissues/organs.
Yang xu can result in blood yu as can yin xu.
Sha yuan ji li
Diabetic complications, mostly urinary.
Warm interior herbs
Fu zi. Not used often and if so, in small doses. Helps body use glucose instead of raising insulin level.
Rou gui. Some studies are using rou gui/cinnamon to lower cholesterol and blood sugars—between 1
and 6 grams per day. Even 1 gram works. Beware of heat and/or yin xu with xu fire with use of this
herb, however.
Use these herbs – choose by differentiation.
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Pairing Herbs
Shi Jinmai promoted the concept of pairing herbs. He was famous for this from 50’s thru 70’s.
Spleen def can result in too much sugar in the blood, then in the urine. Fatigur, catch bugs easily, sugar
in urine. Change in diet is very helpful. To treat this Shi Jinmai used these pairs:
Huang qi + shan yao
Ton sp qi, lowers blood sugar levels. Yin component is shan yao while huang qi is more yang, thus the
pair is balanced.
Cang zhu + xuan shen +
Similar. Thi is more for spleen and kidney.
Ge gen and dan shen
This pair is actually from Shi Jinmai’s student and s about assisting the blood.
Dosages were traditionally large. Now they are less since our requirements are less. Also, they are gentle
and they are food.
 Huang qi = 30-50g + Shan yao = 30g
Spleen Qi xu
 Cang zhu = 15g + Xuan shen = 30 g
Yin xu, damp ret, stagnant heat, blood heat
 Ge gen = 15g + Dan shen = 30g
Blood stasis
Can use all pairs if they have all of the above. You can also use sheng di huang, cang zhu sheng.
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Formulas
Lung and heart symptoms.
Benefits liquids. Thirsty
symptoms mostly, caused by
lung heat/dry and heart heat.
Xiao ke fang/dan xi xin fa
Most important formula for
upper jiao xiao ke. Tian hua fen
has that drool side fx. Huang lian
is about fire/heat clearing. Sheng
di nourishes yin/cool blood. Ou
zhi isn’t often used – that’s the
lotus root juice. Cow milk was
rare in China long ago – now it’s
not so common since there are
lactose intolerance and allergies.
You could also add mai dong to
nourish the yin.
Excessive thirst and drinking will cause excessive urine since the water metabolism is so far off –
basically goes right through. You cd also add ge gen or lu gen or mai dong.
Bai hua jia ren shen tang used for diabetes with excessive thirst, hunger and constipation. You can
swap ren shen for xi yang shen and save some $.
Er dong tang also used for excessive thirst and dryness – mouth, nose, dry cough.
If you look at the top 3 formulas you see they help benefit the liquid, good for excessive thirst.
Sheng mai san often used for diabetics. Qi and yin xu in diabetics often seen as well. This is a
commonly used formula for this pattern with diabetes. You can add the three pairs of herbs above plus
this combination.
Jia jian yi yin jian also nourishes yin. Useful for when patients have “metal and water” or Lung/KI yin
xu diagnosis. Excessive thirst, weak lower back/knee, night sweating, hot flashes, dryness, thirst in
evening/afternoon, qi xu sx. Can add qi tonifying herbs – huang qi + shan yao. Again, tonify the Sp qi!
unless you see strong wiry/slippery pulses which are excess sx.
Huang qi tang here is different than found in the book mentioned earlier. This one is huang qi, ren shen,
mai dong, wu wei zi; add sang bai pi, gou qi zi and shu di.
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Mai dong yin zi shares 3 herbs (ren shen, mai dong, wu wei zi) with huang qi tang above. Lots of calm
shen herbs herein. Nourishes heart and lung yin . Traditionally used for overthinking + diabetes +
irritable and thin/rapid pulse.
Middle jiao symptoms include SP and ST problems such as ST fire, ST yin xu with xu fire, constipation,
excessive weight loss, strong/powerful/slippery/wiry pulse.
Bai hu tang
Add herbs inside such as ren shen or xi yang shen. “Except about that” add some clr heat herbs such as
huang lian, clr ht/drain fire such as tian hua fen or ge gen for excess types. For yin xu with xu heat you
add shu di and other things to tonify yin.
Da huang gan cao yin zi
Da huang is the chief. Also gan cao and hei dou (black beans). Helps reduce cholesterol level, but no
research says that it directly reduces blood sugar. Traditionally cooked 3-5 hours so black beans are all
mushy like kanji. Cooking da huang and gan cao together for a long time will reduce purgative functions
so is more clr ht/move blood.
Zhu ye shi gao tang
Used for ST yin xu. (Excess fire long term damages the yin.) Clear heat herbs and nourish yin herbs in
this formula. Ban xia is in this formula even though this wasn’t one of the single herbs discussed
previously. You’ll see this in the Lan Xiang Yin Zi formula below also. Some historic practitioners
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disagree with this thinking it was too dry. Cang zu and pei lan are more gentle to clear the damp than
ban xia.
Yu quan wan
There is a patent for this. Very good formula to nourish qi and yin. Not many side fx and can take long
term.
Formula may differ from what is listed above in the table.
Another formula you can use for MJ problems to benefit body liquid is Zeng Ye Tang.
Sidebar: how long does a patient need to take herbs? Years? Not always. Depends on length of
time patient has had diabetes, severity of situation, patient response. If patient is already on
drugs, probably more long term. If your patient takes herbs as well, encourage them to check
blood sugar levels 3 times daily.
Use the pairs for Sp Qi xu.
Exercise and diet change are more important than herbs!
Sheng di ba wu yin
ST heat w/excess hunger and Ki yin xu. Rarely used
Lan xiang yin zi
ST heat with damp rêt. Excessive hunger, appetite might not be excessive. Thirsty, low energy, constip,
sweating.
Bai zhu san
Sp qi xu, esp in early stage. Originally created for pediatric practitioner for children’s food stagnation.
Yu ye tang
More frequent use than previous 2. Strong Sp qi tonification for Sp qi xu type diabetes. Good formula.
Contains a couple of the pairs. Ji nei jin within this formula – this is the chicken gizzard from the food
stagnation category.
With neuropathy, move blood!! – for Mrs. Barnes.
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Mostly kidney problems, often excess urination – difficult and/or cold urine. Early stage diabetes is
often Sp qi xu, but when that lasts a long time without good blood sugar control patient “can long termly
has” Kidney yin xu. Later stages with poor blood sugar control KI yin xu will then transform to Ki yang
xu.
Zuo gui yin
Used for long term diabetes. You’ll see Ki yin xu.
Liu wei di huang wan
Ton Qi, enriches and nourishes KI yin and Lv yin.
Mai wei di huang wan
Ton Ki essence.
Yu nu jian
This is the formula used for ST heat and KI yin xu.
Da Bu yuan jian
Tonifies KI qi. Patients with long term diabetes or pt blood sugar uncontrolled long term  ki qi xu.
Will have ki xu sx or ki yang xu sx: weak lower back/knee. Also night urination, sexual problems like
impotence/premature ejaculation. Can treat those by tonifying ki yang, but not all pts have good results.
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Jin gui shen qi wan
Both this and the next are for ki yang xu.
Zhen wu tang
Yang xu with water retention. Reduces edema from this complication – swollen feet/lower legs plus
proteins spilling in the urine.
One other formula is Ji sheng shen qi wan, based on jin gui shen qi wan and adds promote urination,
move blood herbs – good for protein in the urine too. You can add huang qi to formulas to help with this
too.
NOTE: when a patient can’t get rid of toxins and need dialysis. In ancient times used da huang to clear it
out through the GI tract. We often don’t give these patients herbs now because of the toxin buildup.
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Commonly used modifications
Thirst. Wu mei might help
w/thirst due to the ubersour taste! In the MJ
formulas above, yu quan
wan (jade spring), can use
for excessive thirst.,
Hot flashes. Don’t have to
use these 2 herbs. Could
use yin nourishing herbs
and clear deficient
heat/clear heat/cool blood.
Could also use sheng di,
mu dan pi, di gu pi, zhi mu.
Differentiate between full
and deficient heat!
Excessive hunger. ST
excess heat = shi gao, zhi
mu.
Freq p.m. urination. Ask whether it is scanty or profuse. If scanty, dh in the lower jiao. Profuse is ki
xu. Sang piao xiao to stabilize the bladder will help too. Gou qi zi and xu duan will help lower blood
sugar.
Urine incontinence. Bai guo is astringent. Sang piao xioa too. Zhi ki helps make muscle stronger to
help control the bladder.
Constipation treatment depends on type/differentiation. Dang gui and bai shao nourish and moisten. He
shou wu and nu zhen zi also moisten. He shou wu however should not be used with liver problems like
elevated liver enzymes, other liver dysfunction, especially with long term liver dysfunction.
Itching skin. Bai ji li and di fu zi are listed, commonly used for lots of different skin itching, but there
are others. This is more to take internally to take with itching skin.
Edema on the lower extremities. There’s a difference between edema lower and edema upper/face.
Edema on the upper/face is due to lung. If on the lower body, use urination/drain damp herbs. If on the
upper, use expel wind and induce sweating herbs. Diabetic complications are mostly lower extremity
version. Bie xie separates and clears…and I didn’t catch the other. Whatever. Look it up. Zhen wu tang
can be used for lower body edema.
Lower back pain. Lots more than listed here. Xu duan and sang ji sheng are mentioned here and are
gentle. Use strengthen tendons/bones herbs.
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Weakness of knees. Often with lower back pain. Qian nian jian in strengthen tendons/bones mostly for
arthritis type cases with knee pain—overdose can = toxicity, so use less than 12 g. Gou ji, xu duan, du
zhong all tonify ki, str tendons/bones.
Numbness on extremities. Xi xian cao is expel wind/damp herb. Ji xue teng is a blood mover to help
extremity numbness. Gou teng too—note that both this and the previous are vines – the extremities of
the plants. Both treat numbness.
MOVE BLOOD!! For numbness/tingling. Acupuncture is the 1st choice and works better than the herbs.
The earlier the tx, the better. Several years…less response.
Try heat lamp, zheng gu shui when there is tingling. Encourage daily self-massage, heating pad.
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Complications of Diabetes and Treatment
Eyes, feet, cerebral/brain and kidneys are commonly affected as is nervous tissue. Many of these are
related to blood circulation problems. Many practitioners will add move blood herbs into a formula even
if there are no complications evident when the patient is treated. This has excellent effect to delay
complications. Can even lower necessary insulin doses.
Eyes
Fluctuating blood sugar causes the lenses of the eye to swell and shrink, resulting in fluctuating vision.
When sugars are high, damage is underway. Once damage begins, it’s hard to stop. Loss of vision in
diabetes is due largely to blood vessel damage. Blood vessels leak causing blood on the retina. Blood
vessels also become blocked and then new vessels are formed. Abnormal growths cn press on the retina,
even cause the retina detach. Abnormal pressure changes occur as well. There can be damage even
before the patient notices problems.
Retinopathy.
There are two kinds – nonproliferative and proliferative. Nonproliferative is common for Type 1
patients. In proliferative the blood vessels close off, there is vitreous hemorrhage, and retinal
detachment. Retinopathy is often treated through laser surgery or traditional surgery. Earlier diagnosis
yields better results. TCM treatment depends upon differentiation.
1. LV/KI yin xu.
Early stage is more likely to be yin xu.
Blurry vision, dry eyes/skin, weak lower back and knee, etc.
Qi du di huang wan, ming mu di huang wan (better taken long term), shi hu ye guang wan, and
bu zhong yi qi tang.
2. Qi/yin xu Early stage is more likely to be yin xu.
sheng mai san plus qi ju di huang wan. Both are good. Qi ju di huang wan also helps for dry
eyes.
3. Yin/Yang xu
Mostly later stages of diabetes with eye problems.
Jin gui shen qi wan + huang qi, dan shen, che qian zi, kun bu. Kun bu helps resolve nodules and
abnormal growths, used since long term retina problems include scarring.
Zhu jing wan is a classic formula for clearing the vision, eye problems with ki xu and water
retention: shu di, che qian zi, shan yao, shi chang pu. Also used directly after eye surgeries in
China. Short term formula – 1 to 4 weeks.
Modifications for these formulas
1. Bleeding in the vitreous hemorrhage. Bleeding in the bottom of eyes.
a. Huai hua -- stop bleeding, lower bp, helps upper part of the body, makes blood vessels
more flexible thus less bleeding
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b. sheng pu huang – non-dry fried is better to stop bleeding (dry fried moves blood stasis).
You could also use san qi in small doses to emphasize stoppage (1-2 g per day). Too
much will make bleeding worse. Don’t use raw, use powdered instead. If you are giving a
raw formula, include san qi powder separately and have patient mix it in to the cooked
decoction.
2. History of vitreous hemorrhage (bottom of eyes), blood stasis not absorbed
a. San qi
b. Dan shen – gentle, low dose (10-15g raw is enough).
c. Sheng pu huang
3. Macular edema
a. Che qian zi – excellent for herbs
b. Dan shen
4. Scar tissue growth
Herbs are about resolving phlegm nodules
a. Kun bu – kind of food in china. Prescribed as food. Eat 1ce to 2ce a day. Works for
enlarged tonsils and such too.
b. Hai zao - food
c. Sheng shan zha – also food
d. Bei mu
5. Constipation
Pushing required to get fecal matter out can cause pressure in the eye and cause bleeding in the
eye. Heart attack and stroke not that uncommon either.
a. Huo ma ren – moistens the intestines.
b. Da huang – purgative. Helps intestines move better.
c. Zhi shi – different opinions about this herb. Some practitioners won’t use it because
there’s a possibility of raising the blood pressure. Studies about injectable forms have
found this to be true.
d. Gua lou ren
6. Excessively thirsty
Discussed previously.
a. Tian hua fen
b. Shi hu
c. Ge gen
d. Shi gao
e. Zhi mu
Teas
In China the tea lasts longer when they drink it – put the herb in the water, drink. Refill with hot water
when the previous is almost gone – don’t drink it totally down though or it’s not as active on successive
refills.
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1. Ju hua, huai hua, green tea 3g each and drink daily. This benefits the eyes, lowers blood pressure.
2. Ju hua 3 – 6 g, jue ming zi 15g, and shan zha 15g.
Careful with jue ming zi – 5-6 g the first go round and increase slowly. Helps lower cholesterol.
3. Huai hua 3g, gou qi zi 10g, jasmine tea 3g.
Benefit eyes.
Acupuncture treatment
Puncture or massage the points around the eyes.
BL 1 and 2, Qiu huo are all inside the eye socket. Slight danger depending upon your technique
ST 3, BL 2, GB 1, SJ 23, tai yang – around the eye
BL 20, BL 17, ST 36 – general points around the body.
Flower bone one – 55.02
Bottom of foot directly opposite the LV channel on the dorsum. This is a 4 point unit that
isn’t in a straight line so much, but follows the bone anatomy of the foot. You have to
feel it with your fingers. Retain the needles for an hour. You can do one or both feet.
Easiest if the patient is lying face down.
First one is about ½ cun from the webbing between the 1st and 2nd toes. They’re all about
½ cun apart, with the most proximal one being at about the level of the knuckle of the big
toe.
This is indicated for eye problems, red eyes, night blindness, vision problems, glaucoma,
cataracts, macular degeneration, detached retina with severe floaters, lens implants and
herpes in the eye.
Cataracts
60% of diabetic patients get ‘em. This is a cloud
over the lens of the eye. Surgery is the common
treatment. The lens is removed and it is replaced
with plastic so it doesn’t cloud over again.
Glaucoma can occur afterwards. Retinopathy also
gets worse after the removal of the lens.
Herbal treatment is for LV/KI xu and is the same as
previously mentioned for retinopathy. Qi ju di
huang wan, ming mu di huang wan, shi hu ye guang
wan (which may no longer be available), and bu
zhong yi qi tang.
Think about lack of clear essence ascending to the head – that’s what bu zhong is about.
Glaucoma
Common condition for diabetics – 40% more so thn for non-diabetics. This is where the internal eye
pressure gets higher putting pressure on the retina and blood vessels carrying the blood to retina/optic
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nerve. Resulting reduced blood flow in these vessels decreases circulation in the retina and optic nerve,
damaging them in the long run.
TCM treatment is broken into 3 differentiations:
1. Liver and GB fire with internal wind
Ling jiao gou teng tang is the formula for this problem, especially glaucoma and headache/pain
around the eyes. Higher pressure can also cause nausea and vomiting. This formula quickly
descends the heat.
2. Yin xu with hyperactivity of LV yang
Zhi bai du huang wan
E jiao ji zi huang tang to expel any internal wind
3. LV Qi yu w/ stagnant heat
Jia wei xiao yao san + zuo jin wan
Ju hua, jue ming zi, and nu zhen zi. Small doses of chuang xiong with zhu hua and perhaps bai
zhi to guide herbs upward.
Gu jing cao and mi meng hua for retina problems or cataracts.
Don’t use a lot of astringent herbs to stop bleeding. San qi and pu huang are better to move/stop
bleeding.
Foot Complications
Most important thing is to move blood!
Skin changes
Skin becomes dry, peels, and cracks. Diabetic dermopathy, roundish slightly indented patches of
skin that are brown/purplish, and calluses which occur more quickly than normal are all common
skin changes around the feet. As a word of warning, don’t cut calluses or corns nor remove them
with chemical applications. This can result in ulcers and infections. Remember diabetic patients
have vascular degeneration and reduced blood flow. Use lotion immediately after using a pumice
stone to remove calluses.
Poor circulation, ulcers, and infections
Poor circulation causes blood vessels of the foot and leg to harden and narrow. The result can be
foot ulcers that won’t heal. Amputation may be necessary. For blood circulation, niu xi is the
common herb to use and add into formulas. You can also add jie xue teng, dan(g?) shen, tao ren,
hong hua.
Short term skin infections can be helped with wu wei xiao du yin (toxic heat) or xian fang huo
ming yin (phlegm damp resolution herbs – also toxic heat, drain out pus). Components of these
formulas can also be used for chronic infections which can be another complication of poor
circulation.
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One Chinese hospital study used insulin dissolved together with huang qi and used externally
resulted in quicker healing of these kind of infections. Another treatment is huang qi injection
which increases circulation and results in fewer amputations.
Diabetic neuropathy
Diabetic neuropathy is nerve damage in the feet. This causes lack of sensation which can lead to
unnoticed injuries. Can also manifest as changes in the shape of the feet and toes.
Moxa and body work on KI 1 can be beneficial. Increases circulation and blood flow. Check
diabetic’s toes and feet for damage. Be careful about body work and make sure your hands are
clean as the feet can crack when you do the body work. If there is any cracking or bleeding, refer
to an MD or minor emergency clinic for wound care.
Zheng gu shui is good to promote circulation. Unless there’s an open wound! Then do something
else. More on that later.
The Patho 1 class covered the difference between dry and wet gangrene (start at slide 61).
 Dry gangrene when due to deficiency:
Can be qi and yin xu
Shen ling bai zhu san + hau niu xi and ji xue teng
 Dry gangrene due to excess:
Like toxic and damp heat
Xue fu zhu yu tang + chuan shan jia and di bie chong.
 Wet gangrene with deficiency in body
Liu wei di huang want + dang gui, huai niu xi
 Wet gangrene with excess
si miao yong an tang
Skin complications
This also applies to the foot complicatons and fits together with it. Many of these can be avoided with
proper sugar control. Possibilities include
 diabetic dermopathy
 necrobiosis lipoidica diabeticorum
 Atherosclerosis
 Allergic reactions
 Diabetic blisters (bullosis diabeticorum)
 Digital sclerosis
 Disseminated granuloma annulare
 Acanthosis nigricans – darkened skin on the hand.
 Eruptive xanthomatosis
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Wu wei xiao du yin tackles infections as previously noted. For skin itching you can add bia ji li 10g, di
fu zi 15g, bian xian pi, tu fu long. For upper body, add chan tui and jiang chan. For lower add mu gua
and bai xian pi.
Vaginal itching responds to zhi mu 10g, huang bai 10g.
Externally you can use ku shen 30g, she chuang zi 15g, huang bai 15-20, bai xian pi 15, sheng di yu 15,
di fu zi15, mang xiao 15. Works for yeast and bacterial infections too. Make a decoction with small
amount of water, no soak necessary, cook for ½ hour. Wash the vaginal area with water, no soap. Then
apply the herbs externally. If there is itching inside, either get the applicator for Yin Care or soak a
tampon…use the kind with the plastic tubes!! Don’t use with swelling or burning.
Internally, for dry eczema, use wen qing yin or dang gui yin zi. You can also use xiao feng san. If there
is damp heat, use that external formula for vaginal itching above.
 Wei qing yin is for nourishing and clearing heat.
Contains dang gui, bai shao, shu di, chuan xiong (all 4 = skin problems due to damp and xu),
huang lian, huang qin, huang bai, and zhi zi (for damp heat). All herbs are at 4.5g. Water
decoction, 1 bag per day taken on an empty stomach. Originally to regulate menstruation with
cramps and damp heat.
 Dang gui yin zi is for blood xu causing dry skin. When they scratch gets bloody. No blisters, no
discharges. Can also be used for hives (look for pale tongue)
dang gui, bai shao, jing jie, he shoul wu, chuan xiong, gan cao, huang qi, sheng di fang feng, bai
ji li, and sheng jiang.
 Xiao feng san
The Yin Care formula, while a closely guarded secret, does contain jin yin hua and other clear toxic heat
herbs. Some people say it doesn’t help much, probably because concentration is not strong and because
it sits on the shelf for a while and suffers from factory-ness! The raw formula above is better.
Ku shen is a single herb that’s good to add for damp heat/skin problems.
Lu rong is a unique thing in this respect. Older patients with SP/KI yang xu, if internally taking
damp/toxic heat herbs might not have good result. Try lu rong for skin infections with this
differentiation at 1.5gBID.
Zheng gu shui with no open wounds. Soak feet in warm water first. Open wounds, use that external use
soak for vaginal itching. You’ve boiled the bejesus out of it so the bacteria should be dead.
Kidney Disease/Nephropathy
Kidney damage can occur without symptoms. By the time the patient has sx, the organ is majorly
damaged. If there are sx, they will likely be:
 Fluid buildup/edema – moxa at Ren 9 is excellent for this. So it ST 28, KI7, SJ 5
 Loss of sleep
 Poor appetite, upset stomach
 Weakness
 Difficulty concentrating
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High blood sugars make for vascular problems and nerve injury. Applies to the kidney organ also. If a
patient has high blood pressure the risk for kidney disease is higher. Patients should be checked
regularly for blood pressure, urine for protein, blood for waste products, and other organs for
complications.
Biomed Treatment for Ki disease:
 Control of blood glucose
 Control of blood pressure
Weight loss, lower salt intake, get regular exercise. Medicines may be necessary if all else fails.
 Low protein diet with macroalbuminuria – never do this without doctor’s supervision and advice.
 Dialysis when kidneys fail
TCM Treatment
 Qi/yin xu, LV/KI xu
o Shang mai san + liu wei di huang tang (modified). Add huang qi.
 SP/KI xu with blood stasis
o Si jun zi tang + liu wei di huang wan modified. Add gentle moving blood herbs – dan
shen for instance.
 Yang xu w/blood yu, water retention
We won’t see these KI complications – but we can help prevent them.
o Zhen wu tang + ling gui zhu gan tang
Fullness in the stomach, swollen/won’t descend
o Jin gui shen qi wan + fang ji fu ling tang
Fang ji 9g, huang qi 9g, gui zhi 9g, fu ling 18g, and gan cao 6g
o Yi mu cao and ze lan single herbs will move blood but will also treat edema
 Damp retention and disturbance of ST
o Da huang fu zi xi xin tang
Depression
Depression is common in diabetes, more so than in populations without it. Some phys causes of
depression are drugs/alcohol, thyroid problems and side fx from medications. Symptoms – look for 3 +










Loss of pleasure – loss of interest in things used to enjoy
Change in sleep patterns
Early rising, can’t get back to sleep
Change in appetite
Trouble concentrating – even watching TV or reading
Loss of energy – fatigue
Nervousness/anxiety
Guilt
Morning sadness – worse than other times of day
Suicidal thoughts
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Treatments
 LV qi yu – chai hu su gan san
 Ht/LU yin xu
Bi he di huang tang + gan mai da zao tang
Gan mai da zao tang can also used around menopause/pms – crying without reason. Don’t have
to take forever – take 2 months often and then reduce dosage
 Phlegm and Qi stagnation
Ban xia hou po tang (huang liang wen dan tang)
Mostly about plum pit qi. If no plum pit, but psycho-emo sx then take huang lian wen dan tang
or just wen dan tang.
 Qi/blood stagnation
Xue fu zhu yu tang (dan shen yin)
 HT yin xu
Tian wang bu xin dan
 Ht/SP xu – qi/blood xu
Gui pi tang
 LV/KI yin xu – often manifests with anxiety, sensitivity. Red tongue, less coating or tongue is
reddish, edge is peeled. Pulse is thin/wiry.
Yi guan jian
Neuropathy
Usually the earlier you start, the better result. Use acupuncture in addition to herbs. Acupuncture better
for nerve injury/damage.
Neuropathy is most often seen in diabetes. High blood pressure can also cause it as there is damage to
the blood vessels carrying oxygen and nutritents to the nerves. Autoimmune problems causing
inflammation in nerves are an other cause. If there is mechanical damage such as carpal tunnel, the
nerve can be damaged. Inherited traits and lifestyle factors (smoking/alcohol) can also cause it.
Neuropathy, again, is most often due to blood stasis.
1. Peripheral neuropathy
Affects the nerves in the toes, feet, legs, hands, arms. Sx include:
Tingling and numbness, insensitivity to pain/temperature; tingling, burning, prickling sensation;
sharp pain,cramps; extreme sensitivity to touch; loss of balance/coordination
Symptoms are worse at night…because this is blood stasis!
There are 5 differentiations. Note that all have blood stasis components. Qi and blood xu is best
response, followed by SP/KI yang xu and finally Yin xu.
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a. LV/KI yin xu with blood stasis
i. Hu qian wan + shao yao gan cao tang
b. Qi/blood xu with blood stasis
i. Huang qi gui zhi wu wu tang
See the handout, pg 46 for the formulary information.
c. SP/KI yang xu with blood stasis
d. Qi yu with blood stasis
e. Damp heat with blood stasis
Ginko products are also used
Si teng yi xian tang: ji xue teng 30, gou teng 15, luo shi teng 15, hai feng teng 16g, wei ling xian
15.
Foot soaks like hai tong pi tang are good treatments for diabetic neuropathy. Hai tong pi 6, tou
gu cao 6, ru xiang 6, mo yao 6, dang gui 4.5, hua jiao 9, chuan xiong 3, hong hua 3, wei ling
xiang 2.4, bai zhi 2.4, gan cao 2.4, fang fen 2.4 grams.
Another foot soak is da huang, hong hua, bai zhi, chuan xiong, zhi mo yao, huang lian all at 10g
each, di gu pi 15g, ge gen 30g.
You can also do points on the legs and use e-stim. Good for nerve recovery. If you don’t use
electricity, you then have to manually manipulate.
2. Autonomic neuropathy
This is more related to internal organ sx. Trt’d according to organ fx’d. Nerves fx’d include
ht/blood vessels, ST and intestines, urinary tract/bladder, sex organs, sweat glands, eyes.
This form of neuropathy can cause low blood sugar
3. Proximal neuropathy
4. Focal neuropathy
Idiopathic diarrhea
Often in type 1 diabetes. Common complication of diabetes mellitus. Mostly for acute stage, some tx for
chronic. See pg 50 of handout.
Ge gen huang qin huang liang tang is good for diarrhea, burning sensation. If they have watery diarrhea,
use huo xiang zheng qi san. You can also add the singles listed on pg 50. Huang lian su is used for
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diarrhea. Originally used for bacterial causes, but today seems to be more heat related. Pay attention on
this slide to the chronic versus the actue.
Gastroparesis and Diabetes – pg 52
After eating patient feels blocked - hard to descend the Qi. Delayed digestion.
Very important to control blood glucose level.
Pg 54 for treatment.
Coexisting excess and xu, cold and heat accumulation
Ban xia xie xin tang. Ban xia is the chief herb.
St yin xu
SP/ST qi xu – Qi wei bai zhu san: 1st 4 are from si jun zi tang.
Qi stagnation.
Si ni san
<<I’m trying hard to stay awake, but I seem to have tuned out for a bit here>>
Overactive bladder – pg 59
Control blood sugar, then not as thirsty, don’t have to pee as much. TCM treatments and acupuncture.
Baliao points in the lower back area. Lower ab point, like Ren 3 – be careful with full bladders. Very
superficial, transverse puncture downward.
Spleen qi xu – note ren shen is in both formulas, also chai hu and fu ling. If you modify, you don’t need
to double up on these herbs! use for frq urination, incontinence.
Ki yang xu
Formula promotes urination.
Damp heat in lower jiao.
Ba zheng san promotes urination. Dao chi san not as strong for this.
Add pelvic floor muscle rehabilitation. Can help with urinary incont, sexual function in both men and
women, pelvic prolapse in women. Consult website for how to:
http://www.seekwellness.com/incontinence/how_to_do_pelvic_muscle_exercise.htm
Sexual problems – pg 62
Mostly due to nerve damage. Can give tonify ki herbs, but probably not the best long term.
KI yang xu: jin gui shen qi wan has 3 drain herbs. You gui wan is more tonifying. Wu zi yan
zhong wan is for fertility problems, esp male with low motility/sperm count. Don’t have to use
wu zi yan zhong wan – more for tonifying kidney.
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Other warm yang herbs / fortify yang herbs can be used too such as xian mao, yin yang huo, etc.
to help sexual drive. The problem for diabetics isn’t usually drive, but ejaculation/erection and
dryness problems.
Ki yin xu – use move blood herbs. Zhi bai di huang wan (nourishes yin) or er zhi wan. Vaginal
dryness might be a sx here.
LV qi yu. Some pts have sexual problems due to liver qi rather than due to kidney.
Chai hu su gan san and add tu si zi, gou qi zi, zhi yan zhi, shi chuang pu
Damp heat in lower jiao
Long dan xie gan tang for impotence with thick yellow tongue coating. May also have pain in the
genitals. Si miao san is another.
Proximal Neuropathy – pg 65
Constant pain in side, hip area rather than on distal areas. Lumbosacral, femoral areas. Also diabetic
amyotrophy. Acupuncture is more important than herbs. Du huo ji sheng tang or sheng tong zhu yu tang
is commonly used herbal tx.
Focal Neuropathy – pg 66
Again, move blood! Some tonification. For all nerve damage, acu is better than herbs alone.
More complications follow…almost all of them are about blood stasis. Can be combined with other
diagnoses, but qi/yin xu and blood stasis ae the common ones.
Heart problems – p 69
1. Don’t have to choose both chest tightness formulas, choose one. Dan shen yin is more gentle. Adding
dan shen to either and they become similar.
2. Shortness of breath - sheng mai san more for qi/yin xu. Good for sob, fatigue, palpitation, irregular
pulse, even if it’s just anxiety. Zhi gan cao tang is used for all kinds of deficiency.
4. Gua lou xie bai ban xia tang more for phlegm retention type heart problems. Look for the greasy
coating on the tongue.
Hypertension – p70
Can progress to stroke. Can blood let on the ear to help lower in the short term. Post stroke (p 71) herbs
are classic – bu yang huan wu tang. Huang qi dose is high because supposition is that insufficient qi to
move blood. Now go with 20g and increase slowly.
Acupuncture is an important treatment post stroke. Use scalp points and others.
Periperal vascular disease – p 72 (last one!!!)
Blood vessel problems = (guess what…) blood stasis.
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Diet and Supplements – see supplemental handout
Jiao gu lan – Gynostemmae Herba
Low energy. Tastes like hell. Also called Panta Tea and sold as Jiao gu lan in pills.
Bitter Melon – Fructus Balsampear
Food to balance the sugars. Cool natured, so clears heat in summer. Also comes in a patent.
“Bitter Melon Sugar Balance Plus.”
Shan Yao – Rhizoma Doscoreae
Once 150g each day…but expensive now! Use pills/herbs.
Stima Maydis – corn silk
Reduces proteins in urine, helps KI fnx recov. NOT the corn though.
Buckwheat – Semen fagopyri cymosi
Lowers sugars. Eat bookwheat noodles
Semen Litchi – li zhi he
You use the seed, not the yummy fruit part. Dang! Very bitter tasting. Also works for hernia,
guides to Liver
Pericarpium Granati – shi liu pi
Peel only
Yi yi ren
Use as a food. Congee recipe from http://herbal.recipes.webs-sg.com. Lowers blood sugar levels.
Not specifically mentioned for diabetes…leave out the sugar in any recipe.
Garlic and onions
Lowers blood sugar. Theoretically if pt has yin xu could be too warm for these patients.
Cordyceps (dong chong xia cao)
Can cook with it…seems pretty freakin’ icky though…also it’s expensive. Lowers blood sugar
Ling zhi
See the aforementioned website. Cook with it and lower blood sugars. Not specifically
mentioned for diabetes…leave out the sugar in any recipe.
Bai mu er - Tremellae
Lowers blood sugars. Lots of water, add gou gi zi and cook overnight on low. Liquid will be
thick. Can add da zao and gou gi zi. Tastes too “weird” per ZZ’s daughter.
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Yam – ganoderma lucidum seu japonicum
In China made into a yam cake or yam noodles. Shirataki makes a yam noodle you can get in the
Asian markets. Helps with detoxifying the body. Don’t use if you have skin rashes. Lowers
blood sugar levels.
Pumpkin – asian kind though
This is a softer version, available in asian markets. Will also lower blood sugars. Sweet taste.
Can help with sweet cravings.
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