Where East Meets West - Traditional Chinese Medicine in Diabetes Treatment

| Sep 1, 1998

Darryl Rawlinson, a 47-year-old middle manager for a Silicon Valley semiconductor plant, was a little hesitant to have needles stuck in his body. Although Rawlinson had diabetes, the needles he was concerned about would not be delivering insulin but would help to stimulate his flow of qi (pronounced CHEE).

If you haven't heard of qi before, you probably have never been treated by a practitioner of traditional Chinese medicine (TCM). Qi is the body's life force according to TCM, and its practitioners use a combination of herbs and acupuncture therapy to ensure that a person's qi is free flowing and balanced.

Although he was skeptical, Rawlinson began treatments with Ira Golchehreh, L.Ac., O.M.D., a licensed acupuncturist and doctor of Oriental medicine from San Rafael, California. Rawlinson came to Dr. Golchehreh for relief from a host of distressing symptoms, including narcolepsy (uncontrollable daytime sleepiness), frequent night-time urination, mood swings and sore and swollen feet. He also had high blood pressure and elevated triglyceride levels and weighed 275 pounds (up from 225 pounds in 1989). His post-meal blood sugar level was 220 mg/dl.

For his diabetes, Rawlinson was taking Micronase (a sulfonylurea drug which stimulates the pancreas to produce insulin) and Glucophage (a drug that decreases the liver's glucose secretion). He was also taking Lopid to lower his triglycerides, and Delacor and Cozazar to lower his blood pressure. As to be expected, the medications caused a variety of side effects.

"Micronase made me hungry all the time. I was so hungry, I couldn't keep on any diet," he said. Rawlinson also felt continually sick to his stomach, no matter what doses he took of the various medications. And his left leg and foot swelled up to the point that he had trouble walking.

The Full Treatment

Dr. Golchehreh treated Rawlinson about once a week for three weeks. To begin, he placed slender needles into specific points on Rawlinson's hands, feet, and abdomen, along what are known in TCM, as the liver, spleen and kidney channels. In addition to the acupuncture, Dr. Golchehreh recommended a week-long cleansing diet of only fruits and vegetables and as much water as he could drink.

Rawlinson was also given a combination of three liquid herbal extracts to regulate his blood sugar (10 drops of each, three times daily). The herbs, rainforest vine (Gymnema sylvestre), goat's rue (Galega officinalis) and fenugreek (Trigonella foenum-graecum), are not traditional Chinese herbs, but Dr. Golchehreh has found the combination works well for diabetes patients.

Dr. Golchehreh also put Rawlinson on an herbal laxative and detoxification formula called Hepaclenz (two tablets, three times daily), which contains 10 cleansing and liver detoxifying herbs, including beet, milkthisltle, cascara sagrada, parsley, and dandelion.

After the cleansing diet, Rawlinson added lean protein and whole grains such as brown rice to his menus. After two weeks, Golchehreh also switched Rawlinson from the liquid herbal extracts to a Chinese herbal formula in powdered form called Rhemannia 6 (9 grams, three times daily) to strengthen his kidney function.

About six weeks later, Rawlinson lost 30 pounds, his blood pressure dropped from 179/111 to 150/83, his blood sugar stabilized at 147 mg/dl (post-meal), the swelling and tightness on his left leg and foot eased, and his mood improved. He also stopped taking Micronase. "I don't know what maintenance is going to look like," says Rawlinson, "but I do know taking the herbs does make you feel better, so I'll keep taking them. Why close your mind to something just because you don't understand it?"

While no one would recommend that you play Russian roulette with unconventional treatments, some health professionals are beginning to recognize that therapies such as those offered by TCM can help to improve type 1 and type 2 patients' quality of life.

Blessed by the Feds

With the news in November that the National Institutes of Health (NIH) had endorsed the use of acupuncture in the treatment of certain conditions-such as tennis elbow, nausea from chemotherapy and pregnancy, and carpal tunnel syndrome-the popularity of Chinese medicine in the United States continues to rise. According to the U.S. Food and Drug Administration, Americans are now receiving an estimated 9 to 12 million acupuncture treatments annually.

"The data in support of acupuncture are as strong as those for many accepted Western medical therapies," said the NIH in its report on acupuncture. Dr. David J. Ramsey of the University of Maryland, who chaired the NIH acupuncture panel, summed it up this way: "It's time to take it [acupuncture] seriously. There are a number of situations where it really does, in fact, work-the evidence is very clear-cut. It has few side effects and is less invasive than many other things we do."

Diabetes was not included in the list of conditions treatable by acupuncture in the NIH report. But the NIH did say that other complex conditions-for example, asthma and fibromyalgia-would probably benefit from a combined program of acupuncture and conventional Western medicine. It is possible that people with diabetes may benefit from a similar combination.

An Edge on Complications

"What acupuncture and herbs are able to do is to stabilize the disease," says Josh Piagentini, L.Ac., an acupuncturist and herbalist with the Health and Healing Clinic, one of a small but growing number of complementary medical clinics licensed under the auspices of a major conventional hospital. Piagentini's clinic is part of the California Pacific Medical Center, one of the largest medical facilities in San Francisco.

Piagentini, who has type 1 diabetes himself, believes that acupuncture and herbs help mitigate the complications that accompany diabetes. At age 43, he keeps his own diabetes in check by taking 40 units of regular and NPH insulin and tests his blood sugar three times a day. To that regimen, he adds careful diet management, including lots of cooked vegetables, little or no refined sugar, stress reduction measures (such as catnaps, when time permits) and regular consumption of Chinese herbal teas. His most recent HbA1c test was 5.7%.

When he was first diagnosed with diabetes in his late 30s, it took Piagentini several years of self-treatment with acupuncture and herbal teas-along with continued insulin injections, an improved diet and decreased stress-to stabilize his diabetes. Over the last few years, he has helped approximately 20 other individuals with type 1 diabetes do the same. "People see me long-term" says Piagentini. "Probably six months to a year is a good time period for people to start to shift (to more stability)."

His patients usually receive acupuncture treatments about once a month, which he says helps to strengthen the organs and open up the flow of energy. While acupuncture is important, he considers herbal therapy a must for diabetes treatment.

Piagentini's favorite herb for diabetes is ginseng, in particular red Chinese ginseng from the Jilen province of China (also called Jilen shen), because, he claims, it helps stabilize blood sugar and strengthens the energy of the digestive organs. This type of ginseng is not usually available at health food stores, but most herbalists can obtain it for their patients. Other Chinese herbs for diabetes recommended by Piagentini are in the "kidney tonic" category. These strengthen the root energy stores of the body and include Morinda, Cistanche and Ho Shou Wu.

Piagentini's patients brew the raw herbs in tea-sometimes as many as 15 to 17 herbs are in each formula-and drink two cups of the brew daily. Piagentini prefers that patients take their herbal treatment in tea form, because it is strongest and the formulas can be customized. However, if a patient absolutely refuses or is not able to take the time to brew the teas, Piagentini will give them capsules or powdered herbs.

The cost for Piangentini's treatment protocol is around $100 per month, including the herbs, the acupuncture treatment, and the herbal consultation.

An Integrated Approach

Gary Arsham, M.D., Ph.D., co-author of Diabetes: A Guide to Living Well (Chronimed Publishing, 1997) and former chairman of the Accreditation Commission for Acupuncture and Oriental Medicine, a national accrediting body, says more scientific research is needed to document the effects of Chinese medicine on diabetes. Until that research is available, he suggests that those who elect to try acupuncture or Chinese herbs should closely monitor their blood sugar levels even more frequently than normal and maintain their normal insulin doses.

"I see no harm in people themselves evaluating the effectiveness of acupuncture or herbal treatments for their diabetes," says Dr. Arsham, "as long as they don't stop doing whatever else they're doing to manage it. I don't want anybody to think that they can stop taking insulin." Dr. Arsham also notes that some herbal remedies may have some food value. People with diabetes need to be aware of this so they can monitor their blood sugars accordingly.

Dr. Arsham, who has type 1 diabetes, has received acupuncture treatments for musculoskeletal injuries, and says the sessions not only gave him relief from pain but were relaxing and pleasant. He has not tried acupuncture for diabetes control, noting the lack of clinical and research evidence, particularly for type 1 diabetes.

"I'm not aware of anyone who has had type 1 diabetes going off insulin," says Dr. Arsham. "But I've certainly heard anecdotes of type 2 people who have been able to either decrease their dose or get off their dose [using Chinese medicine]." But the anecdotes, he says, are not proof, and there may be other metabolic factors responsible for the improvement in type 2s. "In the case of Mr. Rawlinson," he adds, "a low-calorie, low-fat diet in itself could have accounted for the weight loss and the resulting improvement in his problems."

Nevertheless, for those wanting to give it a try, Dr. Arsham recommends finding an acupuncturist who is experienced in treating diabetes, and who is well-versed in Western medical diabetes management. Ideally, the individual should be someone who can work in tandem with a Western physician to provide the patient with the best of both types of medicine.

Will TCM become a "normal" part of Western medical practice? It depends on whom you ask. Dr. Arsham would prefer that integration continue. "I personally would like to see more complementary integrative activity between Eastern and Western medicine," he says.

Keri Brenner, L.Ac. is a licensed acupuncturist and freelance writer from Fairfax, California.

Diabetes Health cautions readers to use care when trying alternative or complimentary medicines, as these substances are not regulated by the U.S. Food and Drug Administration; to use these treatments only under the guidance of a physician; and never to substitute herbal or other therapies for insulin.

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Sep 1, 1998

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