INTERNET JOURNAL OF THE

INSTITUTE FOR TRADITIONAL MEDICINE

AND PREVENTIVE HEALTH CARE
TREATMENT OF DIABETES WITH
CHINESE HERBS AND ACUPUNCTURE
by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Web Posting Date: January 2003

Key medical terms: diabetes mellitus, NIDDM (type 2 diabetes, non-insulin dependent)
Key Chinese medical references: deficiency and impairment of qi, yin, and yang
Chinese herbs: alisma, anemarrhena, astragalus, atractylodes, dioscorea, ginseng, ho-shou-wu,
hoelen, lycium, platycodon, polygonatum, pueraria, rehmannia, salvia, scrophularia, trichosanthes
Chinese formulas: Baihu Jia Renshen Tang, Liuwei Dihuang Wan, Bawei Dihuang Wan,
Maimendong Yinzi, Fangfeng Tongsheng San, Yu Quan Wan, Xiao Ke Wan

SUMMARY: Diabetes is out of control in the U.S., with incidence rates as high as 15-20% in
some population groups (e.g., the elderly, blacks, Hispanics, and Native Americans), and with
substantial increases in all age and racial groups in the past few years. Chinese medicine, relying
mainly on herb formulas, but also on acupuncture, has been utilized extensively in East Asia to
reduce blood sugar in persons with diabetes, especially those with the most common type (noninsulin dependent diabetes mellitus, NIDDM). Based on extensive laboratory and clinical
evaluations, about 20 herbs have emerged as primary candidates for treatment. These herbs have
been utilized in a small number of traditional formulations for centuries, both for treating obvious
diabetes and for other disorders that produce similar symptoms. Acupuncturists have identified
about 20 points on the body that appear to be effective in lowering blood sugar; typically, a dozen
of these points are selected for treatment at one time. Although more clinical research needs to be
done to demonstrate the level of effectiveness of the herbs and acupuncture, these methods of
therapy are currently available in many locations in the Western cultures as a result of the
increasing acceptance of Chinese medicine during the past three decades. This article outlines the
history and development of Chinese approaches to diabetes and reveals the currently accepted
concepts. A second article will present treatment for secondary effects of diabetes, such as
impairment of circulation and resulting damage to the eyes, peripheral neuropathy, and increased
risk of heart attack.

TREATMENT OF DIABETES WITH

CHINESE HERBS AND ACUPUNCTURE

. Lowering Blood Sugar

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Diabetes is a major health problem worldwide, but particularly in America. It is estimated that about 2.1% of th
he disease is out of control in America. In the U.S., current estimates are that over 6% of the adult population has th
iabetes mellitus (late onset or non-insulin-dependent: NIDDM). Type 2 diabetes usually appears around the age of
een years in some cases of obesity. The incidence rate becomes quite high among elderly Americans (20% for thos
enetic or other predispositions including blacks (14%), hispanics (15%), and Native Americans (19%). Furthermor
rowing, apparently because of increased rates of obesity.

CDC data on prevalence of diabetes across the United States in 1994 (left) and in 2000 (right). The rise in diabetes
o states had less than 4% of the population with diabetes, and only 10 states had under 5%.

Despite the major medical advances in rapid and easy monitoring of blood sugar and treatment with drugs, diab
ugar regulation that can be attained by standard methods, particularly when patients are not fully compliant with al
dequate to avoid common secondary effects of diabetes, including cardiovascular diseases, degenerative eye condi
lceration, and kidney failure. Thus, investigating other avenues for aiding the treatment of diabetes and its seconda
ndertaking.

Although the incidence of diabetes is far lower in China than in the U.S., predictions are that China and the rest
he world's main site of diabetes cases (by the year 2025) due to the combined high population and change in lifesty
isease has been known since ancient times and it has been a subject of considerable laboratory and clinical researc
Chinese medicine will no doubt play an important role in the coming years in the population of East Asia. Chinese m
erbal prescriptions, acupuncture, and dietary recommendations. There is not a single established treatment for diab
aditional medical ideas about diabetes and the research that has been conducted to date to give guidance in using t
wo-part series focuses on treatments to lower blood sugar; part II focuses on treatment of secondary manifestations

Practitioners of Chinese medicine in the U.S. and other Western countries often have more time to spend consu
octors. This extra time gives an opportunity for exploring with the patient the key roles of exercise and dietary con
nd preventing its development with aging for those who do not currently have the disease. While acupuncture and
atients, it is clear from the evidence that exists that as much or more can be accomplished through changes in beha
eep current with information about dietary advice, as some concepts that were common just a few years ago have t
nd are replaced by new approaches backed by recent research.

BRIEF HISTORY OF CHINESE MEDICINE AND DIABETES

Chinese medicine owes its current stature to the long history of its practice, dating back more than 2,000 years in a
Chinese physicians appear to have had a reasonably good understanding of diabetes since ancient times. In one of th
heory, the Huangdi Neijing (1), compiled around 100 B.C., the condition known as xiaoke is mentioned. This is tr
xhaustion. The literal translation of the term is emaciation-thirst, referring to the disease manifestation when it has
weight despite eating normally, and thirst is persistent. According to this ancient text, the syndrome arises from con
ood. It is said that it typically occurs among wealthy people: "you ask them to refrain from a rich diet, advice whic
hat of non-insulin-dependent diabetes mellitus.

Two of the traditional herbal formulas most frequently used in modern China and Japan for the treatment of dia
(2), which is about miscellaneous diseases, written around 220 A.D. The text described symptoms character
hirst, frequent urination, and loss of body weight. One of the formulas is Rehmannia Eight Formula (Bawei Dihuan
riginally indicated for persons who showed weakness, fatigue, and copious urine excreted soon after drinking wate
iabetes as we know it today. The other formula is Ginseng and Gypsum Combination (Baihu Jia Renshen Tang); it
nd fatigue and is considered ideal for diabetes of recent onset.

In 752 A.D., the distinguished physician Wang Tao mentioned that diabetes was indicated by sweet urine and h
ancreas as a treatment, implying that the pancreas was the organ involved in the disease (3). Further, he suggested
e tested daily (by tasting for sweetness) to determine the progress of the disease and its treatment.

Liu Wansu (ca. 1120-1200 A.D.) propounded the theory that diseases are usually caused by heat in the body, wh
ad a cold nature (4). One of his published formulas for diabetes, Ophiopogon and Trichosanthes Combination (Ma
escribed as clearing heat and nourishing yin. It is comprised almost entirely of herbs that have been shown by mod
Another of his formulas, Siler and Platycodon Formula (Fangfeng Tongsheng San), is recommended by many Japan
ccompanying type 2 diabetic syndrome (5).

By the latter half of the 20th century, there were about 200 standard prescriptions recorded as suitable for treati
may be viewed as combinations that rely primarily on about two dozen anti-diabetic ingredients (see Table, page 4)
hese other herbs are understood to have complementary properties (assist the function of the main herbs) or are aim
f the disease. The main traditional prescriptions brought forward include Rehmannia Eight Formula and its simplif
Ginseng and Gypsum Combination, and Ophiopogon and Trichosanthes Combination.

A theory has arisen as to how diabetes progresses (7, 41). The disease begins with a deficiency of yin. This seem
atient, who often shows obese constitution and low metabolism, signs that would correspond to excess of yin and d
with early stage of diabetes actually have a hyperactive metabolism that does not provide useful energy. Hence, the
tilized; hunger persists, sugar pours out in the urine, thirst develops, and there may be easy sweating. This yin defi
athological and then parches the yin. The imbalance of yin and yang eventually degrades and inhibits the qi, so tha
oint, secondary effects, such as blood stasis and damp-heat, manifest, causing many serious symptoms (29). Witho
ang eventually becomes impaired, and the patient, now with advanced disease, has a combined deficiency of qi, yi

MODERN HISTORY OF EVALUATING HERBS AND FORMULAS

he research on diabetes treatment has been ongoing for several decades, yet remains in the developmental stages d

nitial laboratory animal studies of blood-sugar lowering effects of herbs were conducted in China, Korea, and Japa
everal commonly used herbs were shown to lower blood sugar, including yin nourishing rehmannia, scrophularia,
inseng, atractylodes, and polygonatum (haungjing, which also nourishes yin); and heat clearing herbs, such as phe
nd alisma. This hypoglycemic effect occurred when the herbs were used to treat blood sugar increases induced by
ormone.

Since the 1960s, a much invigorated program of diabetes research arose. New laboratory evaluations were mad
hemical alloxan selectively destroys the beta cells of the pancreas. Thus, mice, rabbits, or other laboratory animals
diabetic syndrome quite similar to that of a person who has insulin-dependent diabetes (type I, early onset). Dr. S.
Rehmannia Eight Formula reduced blood sugar in alloxan-treated rabbits in a 1960 journal report (6). Comparing th
nimals with those in alloxan-treated animals provides some indication of the mechanisms by which the herbs affec
nformation is obtained when using the same herbs to treat animals affected by epinephrine. Progress has been made
rst described in 1979-that gain weight unusually and begin developing a type 2 diabetes after about 10 weeks of gr
f the hypoglycemic role of ginseng and its active constituents in the traditional formula Ginseng and Gypsum Com

Perhaps the most extensive laboratory investigation of Chinese herbs for diabetes has been carried out by Huan
National Research Institute of Chinese Medicine in Taiwan (16). Dr. Huang tested a variety of herb extracts in both
n order to compare the impacts of the herbs with or without insulin involvement. To obtain more significant results
t different times after administration of herbs, in glucose tolerance tests, and with differing dosages of the herb ma

Herbs that showed significant hypoglycemic action in both alloxan-treated and untreated mice included some th
aditional formulas, such as red atractylodes (cangzhu), cyperus, and phaseolus (mung bean). Herbs that showed a
lloxan-treated mice but little effect in normal mice, however, matched the pattern of traditional herb therapy; they
stragalus, coix, moutan, lycium bark, lycium fruit, trichosanthes root, alisma, and asparagus root. Traditional herb
ypoglycemic activity by these tests included Rehmannia Six Formula (Liuwei Dihuang Tang), Rehmannia Eight F
Ginseng and Gypsum Combination (Baihu Jia Renshen Tang).

The dosages of herbs administered to the mice to obtain the significant hypoglycemic action ranged from 1.25
igh, and it is difficult to translate the effects seen in these diabetes models with these herb dosages to human requir
xpected to be at the high end of the range normally recommended for treatment of other diseases based on these fig

A summary of Chinese laboratory research on hypoglycemic agents, reported in the booksModern Study and
Pharmacology and Applications of Chinese Materia Medica (13) yielded the following listing of herbs. Onl
ere; there were also a small number of additional herbs that showed positive effect but are not included repeatedly
ublished clinical trials. Note that most of the materials are roots and rhizomes and many of the herbs contain sapon
Common Name
Pinyin Name

Anemarrhena

Botanical Name
Plant Part

Comments

Alisma plantago-aquatica

in Rehmannia Six and Rehman

triterpenes

Anemarrhena asphodeloides

in Ginseng and Gypsum Combi

Trichosanthes Combination; co

hypoglycemic action
Astragalus

Astragalus membranaceus

contains flavonoids and saponin

Atractylodes

Atractylodes macrocephala

contains essential oils; action o

Atractylodes, red
cangzhu

Atractylodes lancea

contains essential oils; gradual

treated rabbits

Dioscorea
shanyao

Dioscorea batatas

in Rehmannia Six and Rehman

Panax ginseng

in Ginseng and Gypsum Combi

Trichosanthes Combination; co

Polygonum multiflorum

treats peripheral neuropathy; co

Poria cocos
mushroom

in Rehmannia Six and Rehman

and Trichosanthes Combination

Lycium chinense

slow and lasting action in reduc

Lycium chinense

produces sustained decrease in

carbohydrates

Platycodon

Platycodon grandifolium

contains saponins; reduces bloo

treated animals

Polygonatum
huangjing

Polygonatum sibiricum

inhibits epinephrine-induced hy

Pueraria lobata

in Ophiopogon and Trichosanth

Rehmannia glutinosa

in Rehmannia Six and Rehman

Trichosanthes Combination

Salvia miltiorrhiza

shows prolonged hypoglycemic

Scrophularia
xuanshen

Scrophularia ningpoensis

action is weaker than rehmanni

Trichosanthes
tianhuafen

Trichosanthes kirilowii

in Ophiopogon and Trichosanth

Polygonatum officinale

contains glycosides; reduces blo

Ho-shou-wu
heshouwu

Lycium bark

Rehmannia

danshen

CLINICAL APPLICATIONS
Clinical trials of Chinese herbs for diabetes have been conducted with increasing frequency over the past thirty year

Medicine in 1975, Dr. Takahide Kuwaki reported on partial success in treating 15 diabetes patients with traditional
eated (duration of using herbs ranged from 2 to 36 months) showed notable improvements (6). In Beijing, a Diabe
Department of Traditional Chinese Medicine at the Capital Hospital; a summary of their recommendations has been
pportunity for Western practitioners to provide similar treatments to their patients (14). In Changchun, the Kuanch
stablished; in 1989 researchers there published results of a highly successful clinical trial of herbs used for treating
atients showed marked improvements after consuming a complex formula comprised almost entirely of herbs that
15). These Chinese clinics, and other facilities in China and Japan, have provided herbal treatments to thousands o
ave often been monitored and reported.

Examples of clinical recommendations and evaluative trials for the treatment of diabetes are presented in the bo
Traditional Chinese Medicine (17). The formulas that had been shown to have hypoglycemic effects in the animal
Ginseng and Gypsum Combination, were recommended to treat those who have normal insulin secretion but suffer
nsulin-independent diabetes). These formulas are for the common qi and yin deficiency syndrome found in early st
ariation of Rehmannia Six Formula was also suggested, made by adding anemarrhena and phellodendron (to form

Reducing Sugar Tablet A (Jiang Tang Jia Pian), comprised of astragalus, polygonatum, trichosanthes root, pseu
ecommended for those with low levels of insulin, but who are still capable of producing insulin. The herbs were ad
with 2.3 grams raw material per tablet, 6 tablets each time, three times daily, for a total dose of over 40 grams per d
ffects were said to be enhancing sugar tolerance and elevating the level of serum insulin. In the treatment of 405 ca
he Guanganmen Hospital, 76.5% of the patients had improved sugar tolerance. Among those patients who most clo
erbs-those with qi and yin deficiency-the effective rate was slightly higher, 81%.

Rehmannia Eight Formula was recommended for those patients who produced little or no insulin. This is for pa
epresenting a deficiency of yin and yang (the cinnamon bark and aconite added to Rehmannia Six Formula to prod
o restore yang). In laboratory animal studies, use of this formula resulted in reduction of water demand (thirst), blo

Jade Spring Pill (Yu Quan Wan), a patent formula from China, is recommended for diabetes treatment in the do
orm was large honey pills of about 6 grams each), for at least one month. In laboratory animal studies, this formula
ells. The Sichuan Province United Pharmaceutical Manufactory, developed a second generation of Jade Spring Pill
oot, rehmannia, licorice, schizandra, and other herbs not mentioned on the label. These pills are indicated in the pa
slets of Langerhans." The relatively small pills are packed into small bottles with a total of 6 grams each, and 20 bo
ccompanied by instructions to take one bottle each time, four times daily (the box is a five day supply at 24 grams/
s said on the package insert, the new product had been clinically proved to have an improved rate of cure and that t
ill is useful for the early stage of diabetes, when yin deficiency and dryness dominate. In a recent clinical evaluatio
iabetes, Jade Spring Pills, used for the control group, was reported to be effective in reducing blood sugar for 79%

Several clinical trials have been reported in Chinese medical journals with brief English summaries appearing i
Hong Kong publication produced from 1986-1996). A representative report is one that originally appeared in the Jo
Medical College in 1989 (18). Patients were treated with a decoction containing astragalus, codonopsis, rehmannia,
tractylodes, anemarrhena, and tang-kuei. This combination of qi and yin tonics plus blood vitalizing herbs is appro
tage disease showing some secondary symptoms. Modifications of the formula would also be made for the specific
ariety of secondary manifestations of the disease, including nephropathy, peripheral neuropathy, dermatological di

Among 19 non-insulin dependent cases treated, fasting blood glucose levels decreased from the pretreatment range
atient with insulin-dependent diabetes showed a decline in fasting blood sugar from 500 mg% before treatment to
eatment. Generally, it was found that blood glucose decreased after 1-2 weeks of treatment and became steady afte
hanges were followed by symptomatic improvements.

A new patent formulation developed by the Chengdu University of Traditional Chinese Medicine and Pharmac
Dihuang Wan (Rehmannia Six Formula with tang-kuei and red peony) with added morus leaf, litchi seed, and copti
emonstrated to be effective in lowering blood sugar (34, 35, 36).

DIFFERENTIAL THERAPY
Although certain herbs have been identified as having hypoglycemic activity, Chinese physicians prefer using them
ifferential diagnosis rather than relying solely on herbs proven effective in laboratory tests. As an example of how
ollowing is the strategy outlined by Lu Renhe in the treatment of 865 elderly patients with diabetes (41); the large n
ifferentiated diagnostic categories. He first divided the disease into five stages, representing a progression from sim
own of the body systems (note that "impairment" is more severe than deficiency, in that it involves active degradat

Yin deficiency; preclinical stage.

. Yin deficiency produces internal heat; early clinical manifestation
I. Impairment of both qi and yin; early stage of complications
V. Impairment of qi, yin, and yang; stage of intermediate complications
V. Failure of qi, yin, and yang; stage of advanced complications

The first four stages were subdivided into a total of 16 syndromes based on the organ systems affected and type
attern. Within each of these subcategories, the patients could further be grouped according to the severity of manif
hoice of herbs to use in treatment. For each pattern, a base formula of 8-12 herbs was presented (see Table below).
sted in this table, there is frequent reference to a few that are known as hypoglycemic agents. These are (number o
arentheses):

ueraria (12)
ehmannia (8)
ichosanthes (7)
crophularia (7)
alvia (7)
olygonatum (6)
o-shou-wu (6)
phiopogon (6)

Aside from these herbs, some herbs were used with less frequency, but commonly relied upon for certain syndr

optis to clear heat

chyranthes to vitalize blood
irculation
oelen to remove dampness
hubarb to purge the intestines

In the case of rhubarb-containing formulas, the rhubarb would be included only so long as constipation remains
emoved.

Differential Treatment of Diabetes by Stage and Syndrome

Principle of Treatment

Main Herbs

I. Yin deficiency causing hyperactive yang (9)

nourish yin, check exuberance of yang

rehmannia (raw), ho
trichosanthes, haliot

I. Deficiency of yin with exuberance of liver (11)

replenish liver yin

rehmannia (raw), sc
wu, pueraria, trichos

Syndrome (# of patients)

II. Retained heat in the stomach and intestines (70) dispel evil heat from the stomach and intestine, protect
gypsum,
qi andcalcite, chi
(raw), pueraria, trich

II. Stagnant qi of the liver transforming to heat (65) disperse stagnancy of qi of the liver and remove evilbupleurum,
heat
peony, r
pueraria, trichosanth

II. Deficiency of spleen with accumulation of dampness

invigorate
and the function of the spleen, resolve dampness,
red atractylodes, phe
heat (50)
assisted by removal of heat and diuresis
polyporus, hoelen, m
trichosanthes
II. Retained heat in the lung forming toxic heat (20) clear heat in the lung, remove toxin

adenophora, ophiop
forsythia, scrophula
chin-chiu

III. Unrelieved dryness and heat leading to impairment

reinforce
of qi the kidney, replenish qi, overcome dryness,polygonatum, rehma
and yin of the kidney (80)
invigorate blood circulation
pueraria, trichosanth

III. Impairment of qi and yin causing lack of nourishment

reinforce
to the kidney, replenish qi, invigorate blood polygonatum, rehma
the channels and conduits (90)
circulation, strengthen the pulse to restore flow of qipeony, salvia, dipsac

III. Impairment of qi and yin damaging the spleen and

reinforce
lung qi, invigorate the spleen, replenish the qi ofastragalus,
the
atractylo
ophiopogon, scroph
chih-shih

III. Impairment of qi and yin damaging the heart andreinforce

spleen the kidney and replenish qi of spleen and heart
polygonatum, pseud
rehmannia (raw), co

III. Impairment of qi and yin resulting from persistentregulate the center to resolve dampness, protecting the
platycodon,
qi and atractyl
dampness (60)
codonopsis, pueraria

III. Impairment of qi and yin causing stagnancy in thereplenish

liver qi, nourish yin, remove stagnancy of the liver,
pseudostellaria, poly
with blood stasis (65)
resolve blood stasis
bupleurum, peony, c
schizandra, crataegu

IV. Impairment of yin, yang, and qi leading to stagnation

regulate
of and replenish yin and yang and activate the polygonatum,
blood
tang-k
phlegm and qi (50)
rehmannia (raw), re

pueraria, trichosanth

IV. Impairment of yin, yang, and qi causing lack of reinforce the qi, replenish the kidney, invigorate the yang,
American ginseng, d
nourishment for the pectoral energy and sinews (30) strengthen the sinews
pipefish, seahorse, c

IV. Impairment of yin, yang, and qi causing lack of reinforce qi, invigorate the spleen, nourish the liver and
Astragalus, tang-kue
nourishment to the tendons and muscles (30)
polyporus, hoelen, s
ophiopogon, puerari
IV. Impairment of yin, yang, and qi causing lack of regulate and reinforce qi, move the bowels
nourishment to the stomach and intestines (40)

polygonatum, tang-k
licorice, chih-shih, s

V. Failure of yin, yang, and qi (85)

address specific man

attempt emergency treatment

DOSAGE AND FORM OF ADMINISTRATION

he dosage of herbs applied to treatment of diabetes is often quite high. As revealed by the experience with Reducin
formula that is considered highly effective must be taken in dosages of about 12-24 grams per day even when pres
made from about 40-80 grams of crude herbs) in convenient form. This apparent requirement is reflected in severa
ecoction form.

In the book Clinical Experiences (19), a number of different decoctions are suggested. The dosages of the form
rescription" containing three herbs (astragalus, rehmannia, and dioscorea, 30 grams each in decoction) at a total do
n each of three formulas for yin deficiency syndrome (each prescription contains rehmannia, ophiopogon, and scro
ne day. There is also presented in this book a modified Rehmannia Eight Formula for advanced cases showing yan
ay dosage. Added to Rehmannia Eight Formula are the anti-diabetes herbs trichosanthes root, pueraria, salvia, and
tated that the early-onset type of diabetes responds poorly, but the insulin-independent type with slow onset respon

In the book 100 Famous and Effective Prescriptions of Ancient and Modern Times (20), the Decoction for
ontains rehmannia, trichosanthes root, dioscorea, gypsum, ophiopogon, dendrobium, and seven other herbs. Taken
made with 226 grams of herbs for a daily dose. This formula is usually prescribed with additional herbs to address s
osage often reaches 250 grams. In a study with 215 diabetic patients, it was reported that 62 cases were relieved of
he urine; the fasting blood glucose declined to below 130 mg%. Additionally, 88 others had some degree of improv

In the book Integrating Chinese and Western Medicine (21), four herb formulas are described: each of the fo
made with over 250 grams of herb materials (thus, over 125 grams/day). All four formulas contain twelve to thirtee
ehmannia, and salvia. Nothing is said directly about the degree of effectiveness of the formulas, but the text ends w
lso very effective," citing Rehmannia Six Formula, Jade Spring Pills, and Diabetes Pills (Xiao Ke Wan).

A Clinical Guide to Chinese Herbs and Formulas (22), three formulas for diabetes are presented. The form
ypoglycemic herbs as mentioned above, and the dosage is usually 10-15 grams of each major ingredient, with 6-7
bout 100 grams per day. The formulas can be modified for specific symptoms, which might add about 10 to 30 gra

The large amount of raw materials apparently needed for treating diabetes may be a reflection of the need to co
mixed non-toxic active components (e.g., flavonoids, saponins, alkaloids, iridoids, anthraquinones) derived from he
mprovements within a typical treatment period of three months or less. It is expected that most of the anti-diabetic

f approximately 2% (or less) of the dried herb material. Decoctions that have 90-150 grams of materials (or more),
ypoglycemic constituents, perhaps an average of 250 mg of each chemical type.

Condensing the active components will yield dried materials that must be taken at a level that is often still rega
xample, dried decoctions (manufactured mainly in Taiwan and Japan) of mixed herbs typically yield a product that
rams of raw materials yields 100 grams of finished product). Such materials are available in the West and often pa
he equivalent of a dosage of 100 grams of crude herbs in decoction, one would consume about 20 grams of the drie
f herbs would be a 5 day supply. This is similar to the dosing for the second generation Jade Spring Pills described

Attempts have been made to isolate active constituents, as one way of making treatment more convenient, but o
dvantages of whole herbs and formulas. One item of current interest is the alkaloid berberine, which has many ther
yperglycemia. Rats treated with alloxan and with berberine were less likely to show blood glucose rise and patholo
ndependent diabetes patients treated with 300-500 mg of berberine daily for one to three months (along with dietar
lood sugar (23). Berberine is an active component of coptis and phellodendron, used in several diabetes prescriptio

A flavonoid-rich fraction isolated from guava leaves was extracted, made into tablets with 400 mg of the conce
osage of 6-12 tablets each time, three times daily (total daily dose is 7.2-14.4 grams), to produce hypoglycemic ac
omponents of many herbs, though not necessarily the key components of most anti-diabetes herbs.

Ginseng and its saponins have been studied in alloxan-treated, genetically diabetic, and normal mice (24), reve
aponins also stimulate the production of insulin. In elderly patients with hyperglycemia, the saponins reduced seru
ypically provided in tablets of 50 mg each, with a dose of 1-2 tablets each time, two to three times per day. Other s
he Indian herb gymnemma, have been shown to lower blood sugar, and the dosing appears to be in a range of abou

Still, an article in the Journal of Traditional Chinese Medicine (26) suggests that a condensed blend of herbs ca
rticle described treatment of 102 cases of non-insulin-dependent diabetes, using the Gan Lu Xiao Ke capsule, with
phiopogon, asparagus, scrophularia, cornus, tang-kuei, hoelen, alisma, and cuscuta. Patients were treated with the
verage blood glucose level fell from an initial value of 200 mg% to 154 mg%. The dosage of material in the capsu
However, the results were also modest (30% were markedly improved, 57% were improved, but the average blood
would receive additional herbs to treat specific symptoms: those herbs, adding to the total dosage, might also contri

Another example, was a report about treatment of persons with vascular complications of insulin-independent d
ascular disease of the lower extremities, stroke, retinopathy, etc.). They were treated with a sugar-reducing, pulse-i
ngredients were not specified other than astragalus and rehmannia; the formula is said to tonify qi, nourish blood, a
owdered and given in capsules, at a dosage of 2-3 grams each time, three times daily (29). The treatment time was
eemed effective, it would then be continued. Improvements in blood parameters were noted in 82% of the cases th
which the formula mainly addressed), but only about 63% for other cases (yin deficiency with fire, or yin and yang
asting blood sugar was maintained below 150 mg% for 77% of those treated.

Further investigation is necessary to determine the minimum formula size (number of ingredients) and the prop
he best form (powdered herbs, extracts, or a combination) to get the desired effects. The use of nutritional supplem
10) might add to the benefits of herbal medicine prescriptions, a factor that has not yet been the subject of study.

COMBINING DIABETES DRUGS WITH HERBS

here is no evidence that diabetes drugs and Chinese herb therapies are incompatible, but there is a concern that wh
may decline too far. If the herbs are added gradually over a few days with continued monitoring of blood sugar, this
uccessfully contribute to lowering blood sugar, drug dosage may be reduced under a physician's instructions.

While Chinese literature sometimes mentions, in passing, the use of Chinese herbs along with modern drugs, sp
re not commonly presented. A report on integrated Chinese and Western treatment of diabetes was published in 19
formula made with codonopsis, astragalus, atractylodes, rehmannia, ophiopogon, and lycium fruit was given (the
or those with non-insulin-dependent type, they were treated with the same mixture either alone or with tolbutamid
quid form, were given twice daily for three months. It was reported that the herbs exhibited a hypoglycemic effect
rugs. For the group of 53 patients treated, the average fasting blood glucose at the beginning was 177 and at the en
nother clinical trial (18), a group of 10 patients was identified who had responded poorly to Western drugs and also
hey were then given both the herbs and drugs concurrently. Significant improvements were observed in eight of th
eported to reduce the dosage of insulin needed by patients and to prolong the action of a dose of insulin (13).

ACUPUNCTURE FOR DIABETES

Acupuncture therapy is a common approach to treating diabetes in China. Many Americans assume that acupunctur
erhaps because the initial introduction of acupuncture was mainly for this application. Indeed, the general opinion
ught to be used mainly for treating chronic back pain. Therefore, relatively few people have turned to acupuncture
eople with pain and other health problems for which acupuncture is selected also have diabetes.

A report in the 1994 Journal of Traditional Chinese Medicine (37) serves as a model of Chinese research on acu
atients with diabetes and divided them randomly into two groups: the acupuncture group (38 patients) and the con
were found to be well matched for symptoms and laboratory results (blood and urine tests). Both groups followed a
roup received acupuncture. Electrical stimulation of the needles was used (this method replaces twirling the needle
timulus that can be continued for the entire treatment period). Acupuncture was administered once a day for 30 day
quchi (LI-11),sanyinjiao (SP-6), zusanli (ST-36), and yishu (special diabetes point located at 1.5 cun lateral to
f the 8th thoracic vertebra). Supplemental points include yuji(LU-10), guanyuan (CV-4), and baihui (GV-20).

For the control group, a well-known herbal pill, Xiaoke Wan or Diabetes Pill, was administered. This pill had b
evel of effectiveness was already established. The patients were not using diabetes drugs during the trial except for
njections.

To evaluate the effects of treatment, three levels of responses were defined. Patients who experienced markedly
heir initial symptoms essentially disappear by the end of the one month treatment and their fasting blood-sugar leve
ugar two hours after a meal would be below 150). Further, the 24-hour, urine-sugar content was reduced by 30% o
o beginning of treatment. These patients were not "cured" of diabetes but they showed very evident improvements.
not markedly effective), symptoms were improved but not gone, and fasting blood-sugar levels dropped to below 1
nd the 24-hour, urinary-sugar excretion declined by at least 10% from initial values (but not up to 30%). If these st
eatment was deemed ineffective. All but two of the patients showed declines in blood sugar and urinary sugar excr
More than one-third of the patients had marked improvement.

For the 38 participants in the acupuncture group, there were 25 cases rated markedly effective and 10 cases rate
eated showed marked improvement and only three patients failed to respond. Further, it was reported that the patie
tatistically significant decline in cholesterol, triglycerides, and beta-lipoproteins. The drop in triglycerides was mos
verage value of 151 at the start to 117 one month later (a decline of more than 20%). There were significant impro
which is a measurement of blood circulation through capillary beds (poor circulation through these beds is one reas
lceration), which has also been observed in other diabetes studies (11, 12). Among those who were using insulin, t
cupuncture declined in six of the eight individuals; in two of those cases, the insulin could be stopped altogether.

The objective of the study was to show the benefits of acupuncture, using a common patent pill for the control
ook the diabetes pill, there were 8 cases rated as markedly effective and 12 cases as effective (2 ineffective). In bot
most patients responded well. The authors of the study concluded: "the therapeutic effects of acupuncture on diabet
ills, however, acupuncture excels in the prevention of complications, especially cardiovascular diseases."

In another study, the acupoint sanyinjiao (SP-6) was used as the primary treatment, with adjunctive points acco
atients with diabetes (38). Among the common adjunct points were feishu (BL-13) plus sanjiaoshu (BL-22) for thi
zusanli (ST-36) for hunger; and taixi (KI-3) plus shenshu (BL-23) for polyuria. Treatment was administered
eatment, then a 2-3 day break before starting another course. Needle retention was for 30 minutes following gettin
he effectiveness of treatment (evaluated as reduction of blood sugar to normal or near normal) was better for young
hat it generally took 2-3 courses of treatment to get optimal results. He pointed out that diabetes may be due to a co
nd yin complexed with blood stasis: "Sanyinjiao is the crossing point of the liver channel, spleen channel, and kidn
upplementing qi, nourishing yin, and removing blood stasis. Acupuncture of sanyinjiao can therefore regulate the l

Differentiation of the disease manifestation with corresponding acupuncture for each syndrome was reported by
Nanjing College of Traditional Chinese Medicine (39). Their treatment patterns are summarized in the table below:
Syndrome
(Number of Patients)

Principle of Treatment

Main Points
(Body Points)

Dry heat in the lung and stomach (33)

clear away heat, moisten and promote production of body (BL-13), weis

Dry intestines and impairment of body fluids (13)

nourish yin, irrigate the intestines

Damp-heat of spleen and stomach (7)

clear away heat, resolve damp, activate the stomach,zhongwan (CV-12),

strengthen the spleen

Stagnation of liver qi (10)

relieve the depressed liver, regulate circulation of qi,taichong

promote (LV-3), qu
blood circulation, remove stasis

Deficiency of spleen qi and kidney qi (4)

invigorate the spleen and replenish qi

Deficiency of liver and kidney yin (6)

nourish liver and kidney

(LI-11), fenglo

(BL-20), weis

taichong (LV-3), tai

Deficiency of spleen yang (6)

warm and invigorate the spleen and kidney

Deficiency of lung qi and spleen qi (5)

warm the spleen and nourish the lung to replenish qi

mingmen (GV-4), gu
yinlingquan (SP

(BL-13), pish

The authors concluded that the best results were attained in younger patients and those with milder disease man
cupuncture treatment of diabetes (40), Hu Hui, of the Dongzhimen Hospital of the Beijing TCM University, observ
mong back shu points (e.g., the bladder meridian points), front mu points (e.g., the conception vessel points), and l
idney, and liver points). He listed the most commonly used points
feishu, pishu, shenshu, zusaanli, sanyinjiao, guanyuan, taixi,zhongwan, geshu, yishu, quchi, hegu, shenmen, diji
chengjiang.

APPLYING THE ACUPUNCTURE TECHNIQUES HERE

n the U.S., it is uncommon for people to receive acupuncture therapy every day, as is the method used in the clinica
medical journals. Instead, one may undertake a course of therapy with acupuncture once or twice per week. Needles
eatment is not as great as with daily acupuncture. However, through the combination of the less frequent acupunct
might reasonably expect to accomplish results comparable to those reported in China where the majority of patients
ormalization and relief of symptoms. Best results are expected for younger individuals and those who have had dia

Most acupuncturists in the U.S. have not been called upon to treat many patients with diabetes, mainly because
ot suitable for that disorder. Nonetheless, acupuncturists are in a position to provide expert treatment because the p
arious other combinations) for treating other disorders. For example, the acupuncture pointzusanli (called Stomach
he most commonly used points for chronic diseases and is used especially when the disease is obviously affected b
oints listed above have been used in the U.S. and other countries. The needling techniques reported for the diabete
s used world-wide, without requiring special additional training.

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December 2002

ACCESS: Seven Forests herb formulas are available only by prescription from a licensed health care professional. You can find
here
Further information links: CDC site for diabetes information and other helpful links:http://www.cdc.gov/diabetes/faqs.htm
For more information about Liuwei Dihuang Wan, see the article: Rehmannia Six Formula.
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