Acupuncture for Diabetes

Clinical and Experimental Studies in Treating Diabetes Mellitus by Acupuncture

 

Diabetes mellitus is a commonly seen endocrinal metabolic disease pertaining to the disease of consumptive thirst in traditional Chinese medicine. The prevalence of diabetes is as high as 4-5% abroad and 0.67% in China , third among disease affecting the health and life of mankind. Modern medicine has achieved much in the treatment of diabetes; however, the problems of side-effects and drug resistance leave much to be desired. The authors are attempting to search clinically and experimentally for effective means in acupuncture for the treatment of the disease.

 

Clinical Date

60 cases of diabetes mellitus were randomly divided into 2 groups: The acupuncture and the control groups. The acupuncture group consisted of 38 patients, 16 males and 22 females, aged 21 to 71 years, averaging 48.6 years; the duration of disease was from 1 month to 15 years, averaging 4.2 years. According to diagnosis by modern medicine, the disease was classified as of type I in 8 cases, and of type II in 30 cases. According to traditional Chinese medicine, the cases were divided into the type of deficiency of yin with excessive heat in 8 cases, the type of deficiency of both qi and yin in 21 cases, and the type of deficiency of both yin and yang in 9 cases. No case was complicated with diseases of the heart, brain or kidney, and other endocrinal disease were ruled out. The conditions of patients and laboratory findings in the control group were similar to those in the acupuncture group.

 

Method of Treatment

Both groups were subject to controlled carbohydrate intake.

• The Acupuncture Group:

The main acupoints selected were Quchi (LI11), Sanyinjiao (Sp6), Zusanli (St 36) and Yishu (located at cun lateral to the lower border of the spinous process of the 8 th throracic vertebra). The adjuvant points were Yuji (Lu 10) for the type of yin deficiency with excessive heat; Guanyuan (Ren 4) for the type of deficiency for both qi and yin, and Baihui (Du20) for the type of deficiency of both yin and yang.

 

Manipulations: For the first session of treatment only Yishu was selected bilaterally for needling. After occurrence of the needling sensation, the needles were connected to the electrical acupuncture set for 20 minutes. The microcirculation was tested before and after the needling. For subsequent session, Yishu was first needled and the needle withdrawn immediately after inducing needling sensation without retention; the other acupoints were then needled with 30 minutes of needle retention. For the types of deficiency of both qi and yin or deficiency of both yang and yin, 30 minutes of mild moxibustion by an ignited moxa roll was added. The treatment was administered once daily, 10 days constituting one course and 3 courses completing the treatment.

 

• The Control Group: For comparison, patients of this group were administered Pills of Consumptive Thirst,- pills daily, 30 days constituting one course of treatment.

 

Results of Treatment

Criteria for the Evaluation of Therapeutic Effect

The criteria for evaluation of therapeutic effect were in accordance with the stipulations by the Bureau of Drug Administration of the Ministry of Public Health in “Technical Guidelines for Clinical Studies of the Treatment of the Disease of Consumptive Thirst with Herbal Drugs, 1988.”

 

Markedly effective: Symptoms essentially vanished after treatment and fasting blood sugar concentration fell to < 130 mg / dl or < 150 mg / dl 2 hours after meals; total 24-hr urine sugar was < 10 g, or the blood sugar and total 24-hr urine sugar were reduced by 30% or more after treatment.

 

Effective: Symptoms definitely ameliorated and fasting blood sugar concentration reduced to < 150 mg/ dl or < 180 mg / dl 2 hours after meals; the total 24-hr urine sugar was 10-25 g, or the blood sugar and total 24-hr urine sugar were reduced by 10-28% after treatment, the blood sugar and total 24-hr urine sugar were not reduced to the stipulated standard.

 

Therapeutic Effects

Among the acupuncture group, 25 cases were markedly effective, 10 effective and 3 cases ineffective after treatment with acupuncture, for a total effective rate of 92.1%. Among the control group, 8 cases were markedly effective, 12 effective and 2 cases ineffective after treatment with herbal pills, the total effective rate being 90.9%. The therapeutic difference between the two groups was not statistically significant (P>0.05).

 

Effects on Blood Sugar and Blood Lipids (see Table 1)

Table 1 shows that blood sugar dropped significantly in both groups after treatment with insignificant differences between the two groups, and that blood lipids drop ped significantly in the acupuncture group but insignificantly in the control group.

 

Effects on Insulin and Trace Element Level (see Table 2).

 

Table 2 shows that the contents insulin and trace elements increase significantly after acupuncture treatment.

Group	Blood sugar  mmol/L	Total cholesterol mmol/L	Triglycerides mmol/L	ß-lipoprotein mmol/L
Acupuncture (38 cases)
Bef. tr.	12.48± 4.51	6.28± 1.41	1.51± 0.54	5.38± 1.33
After tr.	8.06± 2.98	5.01± 1.22?	1.17± 0.41??	4.24± 1.26
	P<0.001	P<0.01	P<0.01	P<0.01
Controls (22 cases)
Bef. tr.	11.83± 5.67	6.24± 1.89	1.60± 0.43	5.42± 1.41
Aft. tr.	7.87± 3.21	5.92± 1.93	1.57± 0.51	5.01± 1.37
	P<0.01	P>0.05	P>0.05	P>0.05

Note: Compared between groups: ?P<0.05 ??P<0.01

Table 2.

	Cases	Bef. Treatment	Aft. Treatment	t	P
Insulin ( )	24	6.854± 4.432	9.141± 6.341	2.583	<0.05
Zn (ppm)	24	0.794± 0.198	0.987± 0.213	2.136	<0.05
Cu (ppm)	24	0.792± 0.297	1.022± 0.304	2.243	<0.05

 

Effects on Nail-Fold Microcirculation

According to examinations of the nail-fold microcirculation in 28 cases of diabetes mellitus before and after acupuncture treatment, 26 cases were complicated with various degrees of microcirculatory disturbances. It was also found that acupuncture therapy ameliorated significantly vascular blurring, apical blood stasis, retarded and irregular blood flow and blood cell aggregation in the vascular loops, as well as the proportion of abnormal vascular loops. The scores were 4.2 ± 1.2 before the treatment and 2.1 ± 0.5 after the treatment, with t=2.102 and P<0.05, the differences being very significant.

 

Effects on the Requirement of Insulin Injections

Among the 38 diabetic patients in the acupuncture group, 8 were insulin-dependent. The administration of insulin was continued after admission too the ward, but gradually reduced when acupuncture began to show effect. After termination of acupuncture therapy, insulin was stopped in 2 cases, reduced to half dosage or less in 4 cases, and remained indispensable in the other 2 cases. Acupuncture was thus shown to replace insulin in some insulin-dependent diabetic patients.

 

Discussion

The evolution pattern of the symptoms and signs in diabetes mellitus:

Diabetes mellitus originates from deficiency of yin and is manifested externally as a syndrome of excessive heat. With progress of the disease, deficiency of yin produces dry-heat which in turn damages qi and yin, leading to deficiency of both yin and yang. According to observations on this series of 60 cases, the development state of the type of deficiency of yin with excessive heat (the initial stage) averaged 2.9 years, the development of the type of deficiency of both qi and yin (the intermediate stage) averaged 4.7 years, and the development of the type of deficiency of both yin and yang (the late state) averaged 8.2 years. During the developmental states, blood stasis also progressed in severity, as manifested in 26 of the 28 cases that underwent nail-fold microcirculation examination.

 

The guiding principle for selection of acupoints:

Based on the evolution pattern of symptoms and signs of diabetes, the main points are selected in accordance with the pathogenetic mechanism, while the adjuvant points are selected in accordance with symptom differentiation. The combination of Quchi (LI 11), Sanyinjiao (Sp 6) and Zusanli ( St. 36) results in clearing the heat from Stomach and Lung, and also replenishing the Kidney yin and yang. Yishu is a specific acupoint in the treatment of consumptive thirst disease, while it invigorates the blood circulation to reduce stasis and prevent complications.

 

The mechanism of acupuncture therapy:

While in other ways, the authors are interested in its effects of raising the insulin level by stimulating secretion of the pancreatic islets. On the other hand, the zinc increased prolongs the glucose suppressive action of insulin and also activates the transformation of proinsulin into insulin, which in turn regulates the content of zinc. This synergic action produces desirable therapeutic results.

 

To summarize, the therapeutic effects of acupuncture on diabetes are similar to those of Pills of Consumptive Thirst, however, acupuncture excels in the prevention of complications, especially cardiovascular disease. The authors also stress the combined use of acupuncture and moxibustion in the treatment of diabetes mellitus.

 

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