Guest guest Posted October 21, 2007 Report Share Posted October 21, 2007 I'm wondering if anybody has some good ideas on how best to treat Type II diabetes due to damp-heat. Gotta patient who takes a couple of shots of insulin everyday. We'd like to see if we can lower his injection quantity. He's kind of an overweight, excess type guy. Good health, but for some high cholesterol for which he takes a statin drug. When his blood sugar gets out of hand, the symptoms include a feeling of heaviness and fogginess in the head, sweating, pressure in his temples, and general malaise. Complexion tends toward the red. Energetic gregarious guy, think John Belushi here. He can get impatient or frustrated easily if he's going to lose balance emotionally, though I've never seen him angry and most who know him see him as a somewhat even tempered guy. He is a very active person and enjoys off-road bicycling. Pulse is a little sunken, likely due in part to his excess weight (having to push harder to get through adipose tissue in wrist). Slippery, wiry pulse. Tongue has teethmarks, slightly purple, with a moist yellow coating, though it isn't really very turbid or thick. I've been working with what Sharon Weizenbaum describes as the " chalky " herbs lately for some of my phlegm-damp, yin deficient patients. (ge gen, shan yao, tian hua fen), But this one has the added issue of excessive heat as well. Any ideas? -- , DAOM Pain is inevitable, suffering is optional. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 21, 2007 Report Share Posted October 21, 2007 Al, have you thought about the rx yu ye tang? it might address a lot of what is going on with your patient: Shan Yao (radix Dioscoreae oppositae)Š30g Huang Qi (radix astragali membranacei)Š15g Zhi Mu (radix anemarrhenae asphodeloidis)Š18g Tian Hua Fen (radix trichosanthis kirilowii)Š9g Ji Nei Jin (endothelium cornei gigeriae galli)Š6g Ge Gen (radix puerariae)Š4.5g Wu Wei Zi (fructus schisandrae chinensis)Š9g Indications: used for wasting and thirsting disorders (Yin deficiency), excessive consistent thirst that is not quenched by drinking, frequent copious urination, fatigue, shortness of breath, P- thin rapid. The zhi mu would clear damp heat: it has huang qi to upbear the sp qi. Note that the high dose of shan yao is related to the sx of thirst. You could omit the wwz, unless the sweating is from qi def, in which case you might want it in. Cara O. Frank, R.OM, Dipl Ac & Ch.H. Six Fishes Healing Arts & President China Herb Company of the Chinese Herb Program Tai Sophia Institute of the Healing Arts 215-772-0770 Al Stone <al Sun, 21 Oct 2007 15:57:00 -0700 Chinese Herbal Medicine List Damp-heat Type II Diabetes I'm wondering if anybody has some good ideas on how best to treat Type II diabetes due to damp-heat. Gotta patient who takes a couple of shots of insulin everyday. We'd like to see if we can lower his injection quantity. He's kind of an overweight, excess type guy. Good health, but for some high cholesterol for which he takes a statin drug. When his blood sugar gets out of hand, the symptoms include a feeling of heaviness and fogginess in the head, sweating, pressure in his temples, and general malaise. Complexion tends toward the red. Energetic gregarious guy, think John Belushi here. He can get impatient or frustrated easily if he's going to lose balance emotionally, though I've never seen him angry and most who know him see him as a somewhat even tempered guy. He is a very active person and enjoys off-road bicycling. Pulse is a little sunken, likely due in part to his excess weight (having to push harder to get through adipose tissue in wrist). Slippery, wiry pulse. Tongue has teethmarks, slightly purple, with a moist yellow coating, though it isn't really very turbid or thick. I've been working with what Sharon Weizenbaum describes as the " chalky " herbs lately for some of my phlegm-damp, yin deficient patients. (ge gen, shan yao, tian hua fen), But this one has the added issue of excessive heat as well. Any ideas? -- , DAOM Pain is inevitable, suffering is optional. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2007 Report Share Posted October 22, 2007 Cara & Al, Could you explain a bit on how zhi mu will treat the damp-heat? I have never heard this. Overall I am unsure why one would need to force his condition into a pattern of yin xu merely for having a dx of diabetes. Maybe I missed some s/s. Otherwise I personally would treat the damp-heat pattern while making sure to include ze xie (lowers blood sugar) as well as something like fan shi liu ye (also very effective for lowering bld sugar levels.) Also consider shan zha. The below Rx seems like it would be contraindicated for damp-heat style Diabetes. Maybe I missing something, comments? Also I would rule out is enduring stagnation of phlegm-damp-heat-blood stasis etc. before using any tonifying approach. - > ---- > Cara Frank <herbbabe > Re: Damp-heat Type II Diabetes > 21 Oct '07 23:21 > > Al, > have you thought about the rx yu ye tang? it might address a lot of what > is > going on with your patient: > Shan Yao (radix Dioscoreae oppositae)„1¤7 30g > Huang Qi (radix astragali membranacei)„1¤7 15g > Zhi Mu (radix anemarrhenae asphodeloidis)„1¤7 18g > Tian Hua Fen (radix trichosanthis kirilowii)„1¤7 9g > Ji Nei Jin (endothelium cornei gigeriae galli)„1¤7 6g > Ge Gen (radix puerariae)„1¤7 4.5g > Wu Wei Zi (fructus schisandrae chinensis)„1¤7 9g > Indications: used for wasting and thirsting disorders (Yin deficiency), > excessive consistent thirst that is not quenched by drinking, frequent > copious urination, fatigue, shortness of breath, P- thin rapid. > > The zhi mu would clear damp heat: it has huang qi to upbear the sp qi. > Note > that the high dose of shan yao is related to the sx of thirst. You could > omit the wwz, unless the sweating is from qi def, in which case you might > want it in. > > Cara O. Frank, R.OM, Dipl Ac & Ch.H. > Six Fishes Healing Arts & > President China Herb Company > Director of the Chinese Herb Program > Tai Sophia Institute of the Healing Arts > 215-772-0770 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2007 Report Share Posted October 22, 2007 Jason, you’re completely right. I replied when I was very tired. Zhi mu clears deficiency heat, not damp heat ( I was thinking about huang bai). but: I was trying to honor Al’s choices, by offering a more well rounded formula. further: tian hua fen and zhi mu do both clear phlegm and heat ( although not damp heat) what is fan shi liu ye? also jiao gu lan lowers blood sugar and is very well researched. I’ll try to forward some links later if I have time today. Cara O. Frank, R.OM, Dipl Ac & Ch.H. Six Fishes Healing Arts & President China Herb Company of the Chinese Herb Program Tai Sophia Institute of the Healing Arts 215-772-0770 Mon, 22 Oct 2007 09:51:36 +0000 Re: Damp-heat Type II Diabetes Cara & Al, Could you explain a bit on how zhi mu will treat the damp-heat? I have never heard this. Overall I am unsure why one would need to force his condition into a pattern of yin xu merely for having a dx of diabetes. Maybe I missed some s/s. Otherwise I personally would treat the damp-heat pattern while making sure to include ze xie (lowers blood sugar) as well as something like fan shi liu ye (also very effective for lowering bld sugar levels.) Also consider shan zha. The below Rx seems like it would be contraindicated for damp-heat style Diabetes. Maybe I missing something, comments? Also I would rule out is enduring stagnation of phlegm-damp-heat-blood stasis etc. before using any tonifying approach. - > ---- > Cara Frank <herbbabe <herbbabe%40verizon.net> > > Re: Damp-heat Type II Diabetes > 21 Oct '07 23:21 > > Al, > have you thought about the rx yu ye tang? it might address a lot of what > is > going on with your patient: > Shan Yao (radix Dioscoreae oppositae)�1�7 30g > Huang Qi (radix astragali membranacei)�1�7 15g > Zhi Mu (radix anemarrhenae asphodeloidis)�1�7 18g > Tian Hua Fen (radix trichosanthis kirilowii)�1�7 9g > Ji Nei Jin (endothelium cornei gigeriae galli)�1�7 6g > Ge Gen (radix puerariae)�1�7 4.5g > Wu Wei Zi (fructus schisandrae chinensis)�1�7 9g > Indications: used for wasting and thirsting disorders (Yin deficiency), > excessive consistent thirst that is not quenched by drinking, frequent > copious urination, fatigue, shortness of breath, P- thin rapid. > > The zhi mu would clear damp heat: it has huang qi to upbear the sp qi. > Note > that the high dose of shan yao is related to the sx of thirst. You could > omit the wwz, unless the sweating is from qi def, in which case you might > want it in. > > Cara O. Frank, R.OM, Dipl Ac & Ch.H. > Six Fishes Healing Arts & > President China Herb Company > Director of the Chinese Herb Program > Tai Sophia Institute of the Healing Arts > 215-772-0770 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2007 Report Share Posted October 22, 2007 On 10/22/07, wrote: > > Overall I am unsure why one would need to force his condition into a > pattern of yin xu merely for having a dx of diabetes. Maybe I missed some > s/s. > Nope. No yin xu. While we tend to look for upper, middle, or lower jiao yin xu with diabetes, there are some other syndromes that can show up too, such as the earlier stage type 2 conditions of Stomach fire. I'm thinking that this damp-heat is also a sort of precursor than the more commonly found yin xu conditions. Otherwise I personally would treat the damp-heat pattern while making sure > to include ze xie (lowers blood sugar) as well as something like fan shi liu > ye (also very effective for lowering bld sugar levels.) Also consider shan > zha. > Thanks. I was thinking about ze xie too. I can't find any references for " fan shi liu ye " , though I see that e-fong manufactures it. Not sure if they have it available from their US distributor. Can you provide some properties and functions? Also I would rule out is enduring stagnation of phlegm-damp-heat-blood > stasis etc. before using any tonifying approach. > Yeah, I see little reason to tonify at this point, though lifting the pulse with some huang qi per Cara's suggestion might not be a bad idea. I remember ECTOM's classics-minded Tiande Yang once used huang qi, ze xie, and yu mi xu to " make it rain " which was his treatment principle for a patient with nephritis with a turbid, thick yellow tongue coating. This may apply here too, to expel some of his dampness and generally regulate the water passages. Looks like yu mi xu has been used for diabetes too. (chen & chen) But my issue with clearing damp-heat is that I'm unclear on exactly how to do this. If it were a yangming damp-heat, I could build a formula around huang lian. If it were a Liver organ damp-heat, I could build a formula around Long Dan Cao. It if were damp-heat in the skin, I'd start with Ku Shen. But this is more like a qi level issue. Maybe I should look to wen bing or san jiao differentiations here. I agree with moving the blood, though. Probably a little dan shen and chi shao, or perhaps mu dan pi and zhi zi which will address some damp-heat too, though I just don't think that the damp-heat problem is at the blood level. The Liver pulse isn't excessive or anything and I don't really see the anger that he described. He's a laid-back guy. -- , DAOM Pain is inevitable, suffering is optional. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2007 Report Share Posted October 22, 2007 Upper, middle, and lower wasting only describe advanced diabetes. Our patients typically are diagnosed 10 or more years before these patterns manifest. The Chinese medical literature is only now coming to grips with this. Bottom line, especially when it comes to diabetes, treat the presenting patterns regardless of what the textbooks say. Bob , " Al Stone " <al wrote: > > On 10/22/07, wrote: > > > > Overall I am unsure why one would need to force his condition into a > > pattern of yin xu merely for having a dx of diabetes. Maybe I missed some > > s/s. > > > > > > > Nope. No yin xu. > > While we tend to look for upper, middle, or lower jiao yin xu with diabetes, > there are some other syndromes that can show up too, such as the earlier > stage type 2 conditions of Stomach fire. I'm thinking that this damp-heat is > also a sort of precursor than the more commonly found yin xu conditions. > > Otherwise I personally would treat the damp-heat pattern while making sure > > to include ze xie (lowers blood sugar) as well as something like fan shi liu > > ye (also very effective for lowering bld sugar levels.) Also consider shan > > zha. > Thanks. I was thinking about ze xie too. I can't find any references for > " fan shi liu ye " , though I see that e-fong manufactures it. Not sure if they > have it available from their US distributor. Can you provide some properties > and functions? > > Also I would rule out is enduring stagnation of phlegm-damp-heat-blood > > stasis etc. before using any tonifying approach. > > > > > > > Yeah, I see little reason to tonify at this point, though lifting the pulse > with some huang qi per Cara's suggestion might not be a bad idea. I remember > ECTOM's classics-minded Tiande Yang once used huang qi, ze xie, and yu mi xu > to " make it rain " which was his treatment principle for a patient with > nephritis with a turbid, thick yellow tongue coating. This may apply here > too, to expel some of his dampness and generally regulate the water > passages. Looks like yu mi xu has been used for diabetes too. (chen & chen) > > But my issue with clearing damp-heat is that I'm unclear on exactly how to > do this. If it were a yangming damp-heat, I could build a formula around > huang lian. If it were a Liver organ damp-heat, I could build a formula > around Long Dan Cao. It if were damp-heat in the skin, I'd start with Ku > Shen. But this is more like a qi level issue. Maybe I should look to wen > bing or san jiao differentiations here. > > I agree with moving the blood, though. Probably a little dan shen and chi > shao, or perhaps mu dan pi and zhi zi which will address some damp-heat too, > though I just don't think that the damp-heat problem is at the blood level. > The Liver pulse isn't excessive or anything and I don't really see the anger > that he described. He's a laid-back guy. > > -- > , DAOM > Pain is inevitable, suffering is optional. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2007 Report Share Posted October 22, 2007 fan shi liu ye = guava leaf. One can make it into a tea and just drink it over the day... - > ---- > Cara Frank <herbbabe > Re: Damp-heat Type II Diabetes > 22 Oct '07 12:21 > > Jason, > you¡¯re completely right. I replied when I was very tired. Zhi mu > clears > deficiency heat, not damp heat ( I was thinking about huang bai). > but: I was trying to honor Al¡¯s choices, by offering a more well > rounded > formula. further: tian hua fen and zhi mu do both clear phlegm and heat ( > although not damp heat) > > what is fan shi liu ye? > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2007 Report Share Posted October 22, 2007 Al, Consider san ren tang modified. It is very mild and can be taken long-term Or check Xue Sheng-Bai's formulas - Famous wen-bing doctor (qing dai). He took San Ren tang and modified it for upper, middle, and lower jiaos + others. He has some interesting ideas. But there are many formulas that can be used in this situation. Finally if there are no other signs than a ¡°a little sunken¡± pulse (to indicate deficiency) I would consider removing stagnation. Many times such a pulse is merely due to obstruction (i.e. damp-phlegm-stasis etc), and will pop up once you remove this bloackage. Tonifying fluids MAY be incorrect if such accumulation is present, (i.e. ge gen, shan yao, & tian hua fen)¡ Just my 2 cents¡ - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2007 Report Share Posted October 22, 2007 I agree... I have seen many diabetes cases treated here in China that have not (even) one remotely tonic herb in the Rx... They treat what they see... I also find that " the literature " is always far behind clinic practice... - > ---- > Bob Flaws <pemachophel2001 > Re: Damp-heat Type II Diabetes > 22 Oct '07 17:32 > > Upper, middle, and lower wasting only describe advanced diabetes. Our > patients typically are diagnosed 10 or more years before these > patterns manifest. The Chinese medical literature is only now coming > to grips with this. Bottom line, especially when it comes to diabetes, > treat the presenting patterns regardless of what the textbooks say. > > Bob > Quote Link to comment Share on other sites More sharing options...
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