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

Diabetes is one of the major American health problems. About 2.2% of all Americans have the disease, 90% of them with the late onset, type 2 or "non-insulin-dependent," diabetes mellitus. Late onset diabetes usually appears around the age of 50 or later, therefore, the incidence rate is quite high among Americans of that age group. Furthermore, the rate at which Americans are affected by diabetes is growing. Despite the major medical advances in rapid and easy monitoring of blood sugar and treatment with drugs (mainly insulin and pancreatic stimulants), diabetes remains a serious problem. The blood sugar regulation that can be attained by standard methods is usually not adequate in avoiding common secondary effects of diabetes, including cardiovascular diseases, degenerative eye conditions, limb pain, ulceration, gangrene, and kidney failure. Thus, it is reasonable to examine other avenues for treating diabetes that may, together with the standard dietary and drug approaches, yield better results.

Chinese medicine is one such avenue. Although the incidence of diabetes is lower in China than in the U.S., the disease has been known since ancient times and it has been a subject of clinical research for the past forty years. Chinese medical treatment of diabetes includes acupuncture, herbal prescriptions, and dietary recommendations.

The long history of dealing with this disease in China without modern drug therapy indicates that great effort has gone into alleviating the various symptoms of diabetes by natural methods. In one of the oldest books about Chinese medical theory, the Huang Di Nei Jing (compiled around 100 B.C.), the condition known as xiao ke is mentioned, and this is translated today as diabetes or diabetic exhaustion (the literal translation is emaciation-thirst). According to this ancient text, the syndrome arises from consuming too much fatty, sweet, or rich foods. It is said that it typically occurs among wealthy people: "you ask them to refrain from a rich diet, which they may resist." The description fits that of non-insulin-dependent diabetes mellitus.

Two of the traditional herbal formulas most frequently used in modern China and Japan for the treatment of diabetes were described in the book Jin Gui Yao Lue (written around 200 A.D.). One is Rehmannia Eight Formula (Ba Wei Di Huang Tang), originally indicated for persons who showed weakness, fatigue, and copious urinary excretion soon after drinking water: in some cases, this may have been diabetes as we know it today. The other is Ginseng and Gypsum Combination (Bai Hu Jia Ren Shen Tang), used more frequently in modern Japan than China; it was indicated originally for severe thirst and fatigue and is considered ideal for diabetes of recent onset. Numerous laboratory and clinical studies have demonstrated that these herb formulas-and several of the individual herbs within the formulas-can significantly reduce blood-sugar levels.

In 752 A.D., the distinguished physician Wang Tao published the famous book Wai Tai Mi Yao, which was a comprehensive guide to medicine. In it, he mentioned that diabetes was indicated by sweet urine and he recommended the consumption of pork pancreas as a treatment, implying a conclusion that the pancreas was the organ involved in the disease (he also recommended animal liver for night blindness, sheep's thyroid and seaweed for goiter, and other remedies that seemed to anticipate the results of scientific studies that would be undertaken more than a thousand years later). Further, he suggested that the urine of diabetes patients should be tested daily to determine the progress of the disease and its treatment.

Acupuncture therapy has also been applied to diabetes, and virtually all other diseases, for the past 2,000 years in China. Many Americans assume that acupuncture is only suitable for treating pain, perhaps because the initial introduction of acupuncture to the U.S. in 1972 was with flashy stories about analgesia provided by acupuncture during surgery. Indeed, the general opinion here appears to be that acupuncture ought to be used mainly for treating chronic back pain. However, in China, the concept is entirely different.

As an example, in the 1994 Journal of Traditional Chinese Medicine (published in English in Beijing), there is a report about "Clinical and Experimental Studies in Treating Diabetes Mellitus by Acupuncture." It explains one of many such clinical trials that have been based on traditional methods of treatment that had been expounded in the past. The researchers recruited 60 patients with diabetes and divided them randomly into two groups: the acupuncture group (38 patients) and the control group (22 patients); the two groups were found to be well matched for symptoms and laboratory results (blood and urine tests). Both groups followed a regulated diet during the study, but one group received acupuncture at three points (on both sides of the body, thus six acupuncture needles): one of the forearm (inner elbow) and two on the lower leg with needles retained in place for approximately half an hour. One other point was treated on the back with only brief retention. Additionally, patients would receive acupuncture at one adjunct point (it could be on both sides), depending on the traditional Chinese diagnosis of the patient based on the ancient yin/yang concept. Electrical stimulation of the needles was used (this method replaces twirling the needle by hand). The treatment was administered once a day for 30 days. For the control group, a well-known herbal pill, Xiao Ke Wan or Diabetes Pill, was administered. This pill had been the subject of earlier study and the level of effectiveness was already established. The patients were not using diabetes drugs during the trial except for 8 patients who required insulin injections.

Among the 22 participants who took the diabetes pill, there were 12 cases rated as effectively treated and 8 cases as markedly effective. The definitions of these improvements are as follows: the patients who experienced markedly effective results had their initial symptoms essentially disappear by the end of the one month treatment and their fasting blood-sugar levels had dropped below 130 (or the blood sugar two hours after a meal would be below 150). Further, the 24-hour, urine-sugar content was reduced by 30% or more at the end of treatment compared to beginning of treatment. These patients were not "cured" of diabetes (if they had been, the fasting blood-sugar would usually be below 100), but they showed very evident improvements. For those deemed effectively treated (not markedly effective), symptoms were improved but not gone, and fasting blood-sugar levels dropped to below 150 (or two hours after meals below 180), and the 24-hour, urinary-sugar excretion declined by at least 10% from initial values (but not up to 30%). If these standards could not be met, then the treatment was deemed ineffective.

It can be seen that the diabetes pill was quite effective, which confirmed what had been established in earlier studies. All but two of the patients showed declines in blood sugar and urinary sugar excretion and improvements in symptoms. More than one-third of the patients had marked improvement.

For the 38 participants in the acupuncture group, there were 10 cases rated effective and 25 more cases rated markedly effective by the definitions used above. In other words, nearly 2/3 of the patients treated showed the marked improvement and only three patients failed to respond. The average duration of diabetic affliction among this group was 4.2 years (maximum 15 years). In general, better results are obtained with acupuncture and with herbal therapy when it is started earlier in the chronic disease process rather than later, when many complications may have developed. Thus, persons who have been diagnosed with diabetes for ten years or more may not experience such dramatic results as the group involved in this study.

These results seem impressive, and the research report provides additional background information that explains the outcome. It was shown that the patients receiving acupuncture experienced a small but statistically significant decline in cholesterol, triglycerides, and beta-lipoproteins. The drop in triglycerides was most substantial, with a decline from an average value of 151 at the start to 117 one month later (a decline of more than 20%). There were significant improvements in "nail-fold microcirculation," which is a measurement of blood circulation through capillary beds (poor circulation through these beds is one reason persons with diabetes suffer from skin ulceration). Both these results indicate improvement in the cardiovascular system. Further, among those who were using insulin, the amount needed after the 30 days of acupuncture declined in six of the eight individuals; in two of those cases, the insulin could be stopped altogether.

The authors of the study concluded: "the therapeutic effects of acupuncture on diabetes are similar to those of the diabetes pills, however, acupuncture excels in the prevention of complications, especially cardiovascular diseases." It should be noted, however, that in addition to diabetes pills there are special pills made for treating vascular complications of diabetes, and these may provide benefits similar to those obtained through acupuncture. In the 1994 Journal of Traditional Chinese Medicine, there is an article about "A clinical study on treatment of vascular complications of diabetes with the sugar-reducing and pulse-invigorating capsule." According to the authors, this herbal remedy, given to 625 diabetics, "helps in abating myocardial anoxia, improving left heart function, stimulating blood circulation to the brain, resisting coagulation and resolving thrombosis, also dilating the arteries of the legs."


In the U.S., it is uncommon for people to receive acupuncture therapy every day, as was done in the previously described study. Instead, one may undertake a course of therapy with acupuncture once or twice per week. Needless to say, the impact of the intermittent treatment is not as great as with daily acupuncture. However, through the combination of the less frequent acupuncture and the daily ingestion of herbs, one can expect to accomplish similar results to those reported above, at least for persons who have had diabetes for only a few years.

Most acupuncturists in the U.S. have not been called upon to treat many patients with diabetes, mainly because of the misconception that acupuncture is not suitable for that disorder. Nonetheless, acupuncturists are in a position to provide expert treatment because the points to be needled are also used (in various other combinations) for treating other disorders. For example, the acupuncture point zusanli (called Stomach 36; located on the lower leg) is one of the most commonly used points for chronic diseases and is used especially when the disease is obviously affected by dietary factors. Acupuncturists can also determine from their training and experience with treating other disorders whether or not it might be better to select alternative acupuncture points for a person's unique situation in place of the ones mentioned in the research paper.

The selection of herb materials for treatment of diabetes and its complications are described in great detail in publications of the Institute for Traditional Medicine (available to all acupuncturists), and several formulations are readily available as tablets, pills, or granules (the latter are dried herbal teas that are swallowed down with a glass of water). The Xiao Ke Wan and Sugar-Reducing Pulse-Invigorating Capsule used in the previously mentioned studies are not exported to the U.S., but comparable formulas are used here.

There are currently about 7,500 licensed or certified acupuncturists in the U.S. (with 30 states plus the District of Columbia providing licensing), and about 6,000 of them also prescribe Chinese herbs. The Institute for Traditional Medicine maintains a listing of several hundred practitioners who are experienced and have access to its resources of Chinese medical information. The typical course of acupuncture therapy for diabetes is a minimum of ten treatments (two treatments per week to start; but may be continued afterwards at the rate of one treatment per week, or as needed). As part of its ongoing research and charitable activities, ITM offers persons in the Portland area a low cost treatment program for diabetes.


April 1996