CLINICAL APPLICATIONS

* Diabetes mellitus

* High blood glucose levels and/or high urine ketone levels

* Polyuria, polydipsia and/or polyphagia

 

WESTERN THERAPEUTIC ACTIONS

* Antihyperglycemic effect to lower plasma glucose levels by increasing the production and the release of insulin

* Antidiabetic function to alleviate insulin resistance

* Neuroprotective benefit to protect the nerves

* Nephroprotective activity to protect the kidneys

* Circulatory effect to improve blood circulation to peripheral parts of the body

* Treats the cause and the complications of diabetes mellitus, such as neurological, renal, and microvascular disorders

 

CHINESE THERAPEUTIC ACTIONS

* Nourishes Lung, Stomach, and Kidney yin

* Clears deficiency fire

* Dries damp

 

DOSAGE

Take 3 to 4 capsules three times daily on an empty stomach [one hour before or two hours after meals]. To effectively control blood glucose level, it is important to keep in mind that dosing must be adjusted to reflect the condition of the patient and the response to the treatment, as the severity of diabetes is different in every case.

 

INGREDIENTS

Bai Zhu (Rhizoma Atractylodis Macrocephalae)

Cang Zhu (Rhizoma Atractylodis)

Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae)

Hong Hua (Flos Carthami)

Huang Qi (Radix Astragali)

Lian Xu (Stamen Nelumbinis)

Lian Zi Xin (Plumula Nelumbinis)

Shan Yao (Rhizoma Dioscoreae)

Shi Gao (Gypsum Fibrosum)

Xi Yang Shen (Radix Panacis Quinquefolii)

Xuan Shen (Radix Scrophulariae)

Zhi Mu (Rhizoma Anemarrhenae)

 

BACKGROUND

Diabetes mellitus is defined as a rise in blood glucose levels due to impaired insulin secretion and peripheral insulin resistance. The clinical manifestation, however, is much more complicated than its definition. Patients with chronic diabetes mellitus are frequently plagued by various complications, such as visual disturbances, prolonged delay in healing of wounds, frequent recurrence of infections, and impotence. Treatment of diabetes mellitus, therefore, must focus on treating both the cause and the complications simultaneously.

 

FORMULA EXPLANATION

According to traditional Chinese medicine, diabetes mellitus is classified as upper, middle or lower xiao ke (wasting and thirsting) syndromes. Upper xiao ke (wasting and thirsting) syndrome is characterized by Lung heat drying up the moisture, leading to polydipsia; middle xiao ke (wasting and thirsting) syndrome is characterized by Stomach heat damaging fluid, leading to polyphagia; and lower xiao ke (wasting and thirsting) syndrome is characterized by Kidney deficiency, leading to polyuria. Furthermore, patients with high blood glucose commonly show signs of damp accumulation and Spleen deficiency. Overall, the clinical presentation of patients with diabetes can be summarized as yin deficiency with damp and heat.

        Xi Yang Shen (Radix Panacis Quinquefolii) greatly replenishes the vital essence of the body and promotes the secretion of body fluids to treat polydipsia. Shi Gao (Gypsum Fibrosum) and Zhi Mu (Rhizoma Anemarrhenae) are a pair commonly used to clear heat in the middle jiao. They sedate Stomach fire and suppress appetite to relieve polyphagia. Xuan Shen (Radix Scrophulariae) enters the Lung, the Stomach, and the Kidney to replenish the vital essence and clear heat simultaneously. Huang Qi (Radix Astragali) and Shan Yao (Rhizoma Dioscoreae) strengthen the Spleen and enhance its function of transportation and transformation. Bai Zhu (Rhizoma Atractylodis Macrocephalae) and Cang Zhu (Rhizoma Atractylodis) strengthen the Spleen and dry up dampness. Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) and Hong Hua (Flos Carthami) activate blood circulation and enhance the overall effectiveness of the herbs. Activation of blood circulation also reduces the risk of atherosclerosis by preventing buildup of cholesterol on the inner walls of blood vessels. Proper blood circulation also helps to prevent diabetic neuropathy. Lastly, Lian Zi Xin (Plumula Nelumbinis) and Lian Xu (Stamen Nelumbinis) tonify the Kidney and control frequent urination.

        Together, the herbs in Equilibrium effectively treat the cause and the complications of diabetes mellitus.

 

CAUTIONS & CONTRAINDICATIONS

* This formula is contraindicated during pregnancy and nursing.

* Patients should not stop using their drug treatment abruptly as there is a risk of hyperglycemia or diabetic ketoacidosis. Herbal and drug treatments should overlap for one to two weeks before patients begin tapering off their drug treatment, in order to ensure adequate control of blood glucose levels.

* Equilibrium may reduce the dosage and frequency of insulin injection needed; however, Equilibrium can never replace insulin, especially in type I diabetes mellitus patients. Patients with type I diabetes mellitus should always be treated with insulin, or the combination of insulin and herbs, and should continue to test their blood glucose regularly.

* This herbal formula contains herbs that invigorate blood circulation, such as Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.[1]

 

CLINICAL NOTES

* For patients with type II diabetes, Equilibrium in combination with diet and exercise provide excellent clinical results. Most patients will experience satisfactory clinical results within three to four weeks of herbal treatment. Clinical effects include a significant reduction in blood glucose levels and less fluctuations throughout the day.

* In Western medicine, diabetes is defined simply as an increase in blood glucose levels. Diagnosis, however, can be difficult because diabetes has many complications, including impairment of vision, impotence, chronic infections, neuropathy, poor healing of wounds, and risk of coma.

* In traditional Chinese medicine, diabetes is commonly referred as xiao ke (wasting and thirsting) syndrome. However, it is important to keep in mind that even though these two conditions share many similarities, they are not equivalent. Both diabetes and xiao ke (wasting and thirsting) syndrome are characterized by the presence of three P¡¦s: polyuria, polydipsia and polyphagia. Diabetes is defined as an increase in blood glucose level, with or without the presence of the three P¡¦s. In addition, diabetes may have many complications that are not present in xiao ke (wasting and thirsting) syndrome, such as visual disturbance, impotence, amenorrhea, and frequent or chronic infections. Conversely, xiao ke (wasting and thirsting) syndrome is diagnosed based on the presence of three P¡¦s. Polyuria, polydipsia and polyphagia may be caused by factors other than diabetes, such as fever, dehydration, or kidney diseases. Understanding the similarities and differences between the two is essential to achieving optimal treatment of the patient.

* Patients with diabetes mellitus can be treated with drugs, herbs, or both. However, if both drugs and herbs are used, it is important to monitor the patient's condition frequently to ensure proper control of the signs and symptoms. Over-dosage with drugs and/or herbs may cause "hypoglycemic" signs and symptoms, and under-dosage may contribute to "hyperglycemic" signs and symptoms.

* Equilibrium is an herbal formula developed by Professor Xiao-Ping Zhang of Anhui Hospital of Traditional Chinese Medicine. It is an empirical formula designed to treat patients with diabetes mellitus. It has been used for over 30 years in China and has helped several thousand patients with diabetes by lowering their blood glucose level and reducing the long-term risks and complications associated with diabetes.

 

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* Type II diabetes: wiry, forceful, and deep pulse on the right guan

 

SUPPLEMENTARY FORMULAS

* For high cholesterol and triglycerides, add Cholisma.

* For high cholesterol and triglycerides with fatty liver and obesity, add Cholisma (ES).

* For hypertension, add Gastrodia Complex.

* For chronic buildup of cholesterol leading to coronary artery disease, add Circulation.

* With thirst and dry mouth, add Nourish (Fluids).

* For blurred vision or visual impairment, combine with Lycium Support.

* For impotence due to impaired blood circulation, combine with Circulation (SJ).

* For neuropathy, add Flex (NP).

* For infection, add Herbal ABX.

* For recurrent yeast infections, add V-Support.

* For urinary tract infection, add Gentiana Complex.

* For infection of ear, nose and throat, add Herbal ENT.

* With compromised kidney functions, add Kidney DTX.

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Quchi (LI 11), Sanyinjiao (SP 6), Yanglingquan (GB 34)

* Shenshu (BL 23), Taixi (KI 3)

* Pishu (BL 20), Shenshu (BL 23), Qihai (CV 6), Sanyinjiao (SP 6), Yanglingquan (GB 34), Shenque (CV 8)

¡± For excessive thirst, add Feishu (BL 13), Yishe (BL 49), Chengjiang (CV 24).

¡± For hunger, add Weishu (BL 21), Fenglong (ST 40).

¡± For polyuria, add Guanyuan (CV 4), Fuliu (KI 7).

 

Classic Master Tung's Points:

* Diabetes (general): Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21), Tianhuang (T 88.13), Minghuang (T 88.12), Qihuang (T 88.14), Tongshen (T 88.09), Tongwei (T 88.10), Shuijin (T 1010.20), Shuitong (T 1010.19), Piyi (T 88.35)*, Pier (T 88.36)*, Pisan (T 88.37)*, Tianhuangfu [Shenguan] (T 77.18). Moxa Tianhuangfu [Shenguan] (T 77.18), Zhongwan (CV 12), Guanyuan (CV 4), Zusanli (ST 36)

* Diabetes (vision problem): Linggu (T 22.05), Dabai (T 22.04), Shuitong (T 1010.19), Shuijin (T 1010.20), Minghuang (T 88.12), Tianhuang (T 88.13), Qihuang (T 88.14), Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21)

* Diabetes insipidus: Simazhong (T 88.17), Simaxia (T 88.19), Tianhuangfu [Shenguan] (T 77.18), Renhuang (T 77.21), Zusanli (ST 36)

 

Master Tung¡¦s Points by Dr. Chuan-Min Wang:

* Diabetes: Tianhuangfu [shenguan] (T 77.18), Dihuang (T 77.19), Renhuang (T 77.21)

 

Balance Method by Dr. Richard Tan:

* Left side: Sanyinjiao (SP 6), Yinlingquan (SP 9) or ah shi points nearby, Fuliu (KI 7), Hegu (LI 4), Waiguan (TH 5)

* Right side: Zusanli (ST 36), Weizhong (BL 40), Zulinqi (GB 41)

* Left and right sides can be alternated from treatment to treatment.

 

Ear Acupuncture:

* Main points: Pancreas, Endocrine

* Adjunct points: Kidney, Sanjiao, Shenmen, Heart, Liver

* Select three to four points for three to seven days.

 

Auricular Medicine by Dr. Li-Chun Huang:

* Reducing blood sugar: Pancreas, Diabetes, Ear Center (Vagus), San Jiao, Pituitary, Endocrine, Thalamus

* Diabetes insipidus: Pituitary, Thalamus, Endocrine, Thirst, Mouth, Bladder, Urethra, San Jiao

* Diabetes mellitus: Diabetes, Pancreas, Ear Center, Pituitary, Thalamus, San Jiao, Endocrine

 

NUTRITION

* Avoid the consumption of simple sugars, which have an adverse effect on glucose tolerance.

* Eat a low-fat, high-fiber diet including plenty of raw fruits and vegetables.

* Avoid supplements containing the amino acid cysteine, which interferes with absorption of insulin by the cells.

* Avoid excessive amounts of vitamin B₁ (thiamine) and C, which may inactivate insulin.

* Avoid the consumption of alcohol and use of tobacco in any form as they increase nerve damage.

* Increase intake of nourishing, cooling foods/roots such as Mexican yam, yam, radishes, potatoes, carrots, melons, cucumbers, beets, turnips, malanga, celeriac, taro, and rutabaga.

* Avoid spicy/pungent/aromatic vegetables such as pepper, garlic, onions, basil, rosemary, cumin, funnel, anise, leeks, chives, scallions, thyme, saffron, wormwood, mustard, chili pepper, and wasabi.

 

The Tao of Nutrition by Dr. Maoshing Ni and Cathy McNease:

* Recommendations: pumpkin, wheat, mung beans, winter melon, celery, pears, spinach, yams, peas, sweet rice, soybeans, tofu, mulberries, squash, daikon radish, cabbage, peach, and organic pig or chicken pancreas.

* Eat a slice of pumpkin with each meal.

* Make pumpkin and yam pie with no sweeteners.

* Prepare soup with cabbage, yam, winter melon, and lentils.

* Drink daikon, celery, carrot, and spinach juice.

* Make soup from mung beans, peas, and barley.

* Drink chrysanthemum tea.

* Steam millet with yam and a few dates.

* Avoid sweets, sugar, honey, molasses, caffeine, and spicy foods.

 

LIFESTYLE INSTRUCTIONS

* Regular exercise, a sensible, healthy diet, and weight control are essential for long-term management of diabetes.

* Hot baths may be beneficial to regulate pancreatic functions.

* Avoid smoking and drinking.

 

CASE STUDIES

* R.C., a 55-year-old male, presented with high blood sugar. Objective findings included being overweight as well as pain in the right heel, which was the reason he couldn¡¦t work out. Pulse was soft and his tongue was red with a center crack. The practitioner diagnosed this condition as Spleen qi deficiency with damp accumulation; his Western diagnosis was pre-diabetes. Upon diagnosis the patient was given Equilibrium for treatment. With taking the herbs and receiving acupuncture for two weeks, the patient saw improvement overall, which lead to increase in energy and being able to run again. Two weeks after, the patient had received blood work confirming everything was normal and he didn¡¦t have to return until another year. The patient was very pleased. Submitted by T.W., Perrysburg, Ohio.

* L.M., a 72-year-old female, presented with high blood pressure, being stressed and overwhelmed. She had also mentioned having an intense sugar craving. The TCM diagnosis was Kidney yin deficiency with Liver yin deficiency. Gallbladder damp-heat and Liver yang rising was also present. Equilibrium was prescribed for treatment. In response to taking the herbs for two months, her cravings were controlled and her blood sugar level started to maintain from 250 to 140 mg/dL. Submitted by V.G., Virginia Beach, Virginia.

* A 45-year-old female with type I diabetes mellitus presented with night sweats and aching feet with a blood sugar level of 200 to 300 mg/dL. The practitioner diagnosed her condition as Kidney yin deficiency. Within one week of taking Equilibrium, the patient¡¦s blood sugar level dropped so drastically that she needed to ingest some sugar in order to elevate her blood sugar level. Her condition stabilized during the second week of treatment at which point her blood sugar level reading was around 160 mg/dL. Surprisingly, her night sweats also subsided. Submitted by S.T., Morgan Hill, California.

* J.K., a 45-year-old female, was 5' 3" and weighed 160 pounds. She had urinary tract infections once or twice each month within the last 12 months. Her other symptoms and signs included constant thirst, increased fluid intake, and increased frequency and volume of urination. She was diagnosed with diabetes mellitus after testing positive for high levels of blood glucose. She was prescribed Equilibrium, 4 capsules three times daily before meals. Two weeks after the initial treatment, she reported significant improvement of her signs and symptoms. Two months after the initial treatment, her blood glucose levels were within the ideal range. She did not have any urinary tract infections during these two months. She continues to take Equilibrium, 4 capsules three times daily before meals. Submitted by J.C., Diamond Bar, California.

* A 45-year-old female with type I diabetes mellitus presented with malaise, fatigue, night sweats, hot flashes and low back pain. Other signs and symptoms included abdominal bloating, red eyes, weak nails and a pale complexion. She was diagnosed with hepatitis C. The practitioner prescribed Liver DTX (3 capsules three times daily) and Equilibrium (3 capsules three times daily). The treatment regimen also integrated a pancreatic homeopathic prescription (10 drops six times a day) as well as another homeopathic prescription, Hepan Comp (1 drop three times daily). Two and a half months later, the patient was able to cease her insulin intake. Once her viral load reached a normal range, she discontinued taking all her prescribed pharmaceuticals. There was a total reversal of her clinical picture. Submitted by I.B., Miami, Florida.

* A 49-year-old male computer analyst presented with chronic skin lesions over his entire body. Visual inspection of his body exposed scars from past lesions as well as fresh, red, edematous sores especially on the lower extremities. The severity of his lesions appeared to fluctuate. He also complained of pain in both legs and right arm, which were all indicative of peripheral neuropathy. He was diagnosed with type I diabetes mellitus and had a history of kidney problems. The patient was also reported to be overweight. His tongue was dusky with purple veins on the underside. His tongue coating was scanty and his pulse was deep, weak, thready, and slippery. The practitioner diagnosed the patient¡¦s condition as Liver and Kidney yin deficiencies, qi deficiency, damp-heat in the skin, and qi and blood stagnation. Along with acupuncture, the patient started a combination of Equilibrium and Silerex at one-third the dose since he was on a large variety of other herbal treatments. After one week, no improvement of his lesions was noted and fluctuations of his blood sugar levels were minimal. After the second week, the herbal dose was increased to two-thirds the recommended dose. The patient¡¦s lesions slightly improved along with the blood sugar levels. The severity of the arm and leg pain also decreased. His pulse was also noticeably stronger. The practitioner concluded that some of the symptoms might have been due to other medications, which were taken concurrently by the patient. Nevertheless, the practitioner hypothesized that by clearing the skin condition, the patient would eventually decrease use of other skin medications. Submitted by N.M., Torrance, CA.

* A.G., a 60-year-old male, was 6' 1" and weighed 280 pounds. He was always hungry and ate two or three bowls of rice with every meal. He noticed that his cuts or scratches required a longer period of time to heal, sometimes up to one month. His diagnoses were diabetes mellitus and high cholesterol. He was given Equilibrium, 4 capsules three times daily for his diabetes; and Cholisma, 4 capsules three times daily for his cholesterol. After taking the herbs for three months, his blood glucose levels were within the ideal range and his cholesterol level dropped from 260 to 220 mg/dL. His weight also dropped from 280 to 255 pounds. He ate less and did not feel constantly hungry. He continues to take both Equilibrium and Cholisma. Submitted by J.C., Diamond Bar, California.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Equilibrium is formulated to treat diabetes mellitus by helping the body to regulate blood glucose levels and manage symptoms such as polyuria, polydipsia and polyphagia. It contains many herbs with marked effects to stimulate production and release of insulin, reduce blood glucose levels, and decrease insulin resistance. Furthermore, it also utilizes many herbs to treat common complications of diabetes mellitus, such as diabetic nephropathy, diabetic microalbuminuria, chronic glomerulonephritis, and neurotoxicity.

        Huang Qi (Radix Astragali) has multiple benefits to manage plasma glucose and diabetes mellitus. Use of Huang Qi (Radix Astragali) is associated with a marked effect to lower plasma glucose levels and alleviate insulin resistance. The antihyperglycemic action appears to be due to increased production and release of insulin.[2] Other benefits of Huang Qi (Radix Astragali) include antiobesity and hypolipidemia activities.[3] Zhi Mu (Rhizoma Anemarrhenae) also has a significant antidiabetic effect. Therapeutic benefits include increased insulin secretion,[4] decreased insulin resistance,[5] and prevention of pancreatic atrophy.[6]^,[7] Shan Yao (Rhizoma Dioscoreae) has an antidiabetic effect, and is effective in controlling the normally sharp increase of blood glucose following intraperitoneal injection of glucose.[8] Xi Yang Shen (Radix Panacis Quinquefolii) has exhibited significant hypoglycemic activity in normal and hyperglycemic subjects.[9] Finally, Bai Zhu (Rhizoma Atractylodis Macrocephalae) and Cang Zhu (Rhizoma Atractylodis) have antidiabetic effects and have been shown to decrease blood glucose levels.[10]^,[11]

        Clinically, these herbs have been used in many studies to treat diabetes mellitus. According to one study, one formula with Xi Yang Shen (Radix Panacis Quinquefolii) showed a 77% rate of effectiveness to lower plasma glucose levels in 105 patients. [12] According to another study, adult onset diabetes mellitus was treated with a 92% rate of effectiveness using an herbal formula that contained Cang Zhu (Rhizoma Atractylodis), Huang Qi (Radix Astragali), Shan Yao (Rhizoma Dioscoreae), Xuan Shen (Radix Scrophulariae) and others. Of 52 patients, 25 had complete recovery, 23 had improvement, and 4 had no effect.[13]

        Equilibrium uses many herbs to treat several common complications of diabetes mellitus, such as microvascular, neurological, and renal complications. Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) and Hong Hua (Flos Carthami) have powerful effects to promote blood circulation and inhibit the aggregation of platelets and formation of thrombi.[14] Together, they effectively manage microvascular complications of diabetes. Shan Yao (Rhizoma Dioscoreae) and Huang Qi (Radix Astragali) have neuroprotective and neurological effects. Administration of Shan Yao (Rhizoma Dioscoreae) shows significant protection against drug-induced neurotoxicity, according to in vivo and in vitro studies.[15] Use of Huang Qi (Radix Astragali) is associated with a marked enhancement of the growth of axons in the peripheral nerve, according to in vitro and in vivo studies in subjects with nerve defects.[16] Huang Qi (Radix Astragali) is one of the most effective nephroprotective herbs.[17] Huang Qi exerts its nephroprotective effect by reducing fasting blood glucose and albuminuria levels, reversing the glomerular hyperfiltration state, and ameliorating the pathological changes of early diabetic nephropathy.[18] Clinically, Huang Qi (Radix Astragali) has been shown in clinical studies to successfully treat diabetic nephropathy,[19] diabetic microalbuminuria,[20] chronic glomerulonephritis,[21] and drug-induced nephrotoxicity.[22]

        In summary, Equilibrium is an effective formula for treating diabetes mellitus and many of its complications.

 

COMPARATIVE ANALYSIS

Diabetes mellitus is one of the most common disorders in developed countries. The disease is well understood, and there are numerous treatment options. For type I diabetes (juvenile onset), insulin is the drug of choice. For type II (adult onset), drug treatment usually begins with oral medications, followed by insulin if necessary. Oral medications, such as Glucotrol (glipizide) and Diabeta (glyburide), are beneficial to control blood glucose levels, but may cause side effects such as seizures, loss of consciousness, skin rash, itching or redness, exaggerated sunburn, yellowing of the skin or eyes, light-colored stools, dark urine, unusual bleeding or bruising, fever, and sore throat. Furthermore, long-term use of these medications may lead to weight gain and insulin resistance, thereby decreasing overall effectiveness. Insulin is an effective and reliable drug to control blood glucose. However, once insulin injection therapy begins, endogenous production of insulin slowly decreases and the body becomes more and more dependent on exogenous sources. Eventually, the patient will become dependent on insulin for life. Lastly, there are many complications of diabetes mellitus. Some are well controlled by drugs, others are not.

        Many herbs effectively treat both diabetes and its complications. For diabetes, herbs have shown marked effects to stimulate the endocrine system, increase production of insulin from the pancreas, and control blood glucose. Furthermore, many herbs are effective to alleviate symptoms of diabetes, such as thirst, hunger, frequent urination, and other manifestations of xiao ke (wasting and thirsting) syndrome. Lastly, as described in this monograph, many other formulas may be used as adjuncts to successfully treat complications of diabetes. However, herbal therapy has its limitations. Because herbs work primarily by stimulating the pancreas to produce insulin, it is only effective for type II diabetes. Therefore, for type I diabetic patients, herbs should be used to manage complications, but herbs cannot cure diabetes itself.

        For type I diabetic patients, insulin must be used for diabetes, and both drugs and herbs may be used to treat complications. For type II diabetes patients, both drugs and herbs may be used to treat both the disease and complications. Optimal treatment requires integration of both medicines and selection of the most effective agents with the least number of side effects.