by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon
DOSAGE AND FORM OF ADMINISTRATION
The dosage of herbs applied to treatment of diabetes is often quite high. As revealed by the experience with Reducing Sugar Tablet A and Jade Spring Pills, a formula that is considered highly effective must be taken in dosages of about 12-24 grams per day even when presented as a highly condensed extract (made from about 40-80 grams of crude herbs) in convenient form. This apparent requirement is reflected in several books that recommend herbs in decoction form.
In the book Clinical Experiences (19), a number of different decoctions are suggested. The dosages of the formulas, range from that of an "experiential prescription" containing three herbs (astragalus, rehmannia, and dioscorea, 30 grams each in decoction) at a total dose of 90 grams per day, to a dozen herbs in each of three formulas for yin deficiency syndrome (each prescription contains rehmannia, ophiopogon, and scrophularia) according to the affected "burner," with about 120-150 grams for one day. There is also presented in this book a modified Rehmannia Eight Formula for advanced cases showing yang deficiency, with about 170 gram/day dosage. Regarding efficacy, it is stated that the early onset type of diabetes responds poorly, but the insulin-independent type with slow onset responds favorably.
In the book 100 Famous and Effective Prescriptions of Ancient and Modern Times (20), the Decoction for Diabetes (Yi Tang Tang) is mentioned. It contains rehmannia, trichosanthes root, dioscorea, gypsum, ophiopogon, dendrobium, and seven other herbs. Taken as a decoction, the standard formula is made with 226 grams of herbs for a daily dose. This formula is usually prescribed with additions to address specific symptoms, so that the total daily dosage often reaches 250 grams. In a study with 215 diabetic patients, it was reported that 62 cases were relieved of thirst, overeating, polyuria, and sugar in the urine; the fasting blood glucose declined to below 130 mg%. Additionally, 88 others had some degree of improvement (total effective rate: 70%).
In the book Integrating Chinese and Western Medicine (21), four herb formulas are described following a discussion of Western therapies: one each to treat the three burners and one to treat stagnation of blood. Each of the formulas, a two day supply of herbs, is made with over 250 grams of herb materials (thus, over 125 grams/day). All four formulas contain twelve to thirteen herbs, and they all include pueraria, rehmannia, and salvia. Nothing is said directly about the degree of effectiveness of the formulas, but the text ends with the comment that certain pills "are also very effective," citing Rehmannia Six Formula, Jade Spring Pills, and Diabetes Pills.
In A Clinical Guide to Chinese Herbs and Formulas (22), three formulas for diabetes are presented (according to the burner that is affected). The formulas are comprised of typical hypoglycemic herbs, and the dosage is usually 10-15 grams of each major ingredient, with 6-7 major ingredients, and a total dosage of about 100 grams per day. The formulas can be modified for specific symptoms, which might add about 10 to 30 grams of herbs additionally.
The large amount of raw materials apparently needed for treating diabetes may be a reflection of the need to consume several hundred milligrams of mixed non-toxic active components derived from herbs to attain substantial physiological improvements within a typical treatment period of three months or less. It is expected that most of the anti-diabetic active constituents are present at a level of approximately 2% (or less) of the dried herb material. Decoctions that have 90-150 grams of materials (or more), might yield only about 2 grams of hypoglycemic constituents.
Condensing the active components will yield dried materials that must be taken at a level that is often still regarded as inconvenient by many. For example, dried decoctions (manufactured mainly in Taiwan and Japan) of mixed herbs typically yield a product which is not more than about a 4.5-1.0 concentration factor (450 grams of raw materials yields 100 grams of finished product). Such materials are available in the West and often packaged in units of 100 grams. To obtain the equivalent of a minimal dosage of 90 grams of crude herbs in decoction, one would consume about 20 grams of the dried extracts (a one day dose), and a bottle of herbs would be a 5 day supply. This is similar to the situation with the second generation Jade Spring Pills described above.
Attempts have been made to isolate active constituents, as one way of making treatment more convenient, but one then loses several of the purported advantages of whole herbs and formulas. One item of current interest is the alkaloid berberine, which has many therapeutic uses, including treatment of hyperglycemia. Rats treated with alloxan and with berberine were less likely to show blood glucose rise and pathological change in the beta cells. Insulin-independent diabetes patients treated with 300-500 mg of berberine daily for one to three months (along with dietary control), showed definite reduction of blood sugar (23).
A flavonoid-rich fraction isolated from guava leaves was extracted, made into tablets with 400 mg of the concentrate in each, and administered at a dosage of 6-12 tablets each time, three times daily (total daily dose is 7.2-14.4 grams), to produce hypoglycemic action (17). The higher dose of 36 tablets per day is analogous to the use of Golden Book Tea Pills at 12 pills three times daily mentioned above.
Ginseng and its saponins have been studied in alloxan-treated, genetically diabetic, and normal mice (24), revealing a hypoglycemic effect; ginseng saponins also stimulate the production of insulin. In elderly patients with hyperglycemia, the saponins reduced serum glucose (25). Ginseng saponins are typically provided in tablets of 50 mg each, with a dose of 1-2 tablets each time, two to three times per day.
A preparation (method unknown) reported in an article in the Journal of Traditional Chinese Medicine (26) suggests that a condensed blend of herbs can be prescribed in moderate dosage. This article described treatment of 102 cases of non-insulin dependent diabetes, using the Gan Lu Xiao Ke capsule, with rehmannia, codonopsis, astragalus, ophiopogon, asparagus, scrophularia, cornus, tang-kuei, hoelen, alisma, and cuscuta. Patients were treated with the herbs for three months. The group average blood glucose level fell from an initial value of 200 mg% to 154 mg%. The dosage of material in the capsules was only 5.4 grams per day. However, the results were also modest (30% were markedly improved, 57% were improved, but the average blood sugar remained quite high), and patients would receive additional herbs to treat specific symptoms: those herbs, adding to the total dosage, might contribute to the hypoglycemic action.
Further investigation of the minimum formula size (number of ingredients and dosage of ingredients) to get the desired effects is necessary to assure a satisfactory level of compliance with minimal side-effects. When using isolated active components, one is often subject to adverse reactions, but, on the other hand, the complex formulas in high dosage can also cause problems aside from the unpleasant taste (and potential to cause nausea). For example, one difficulty with the high dosage decoctions is that they often contain a large amount of sugar which causes an increase in blood glucose during the hour after it is consumed (later, the herbs cause a gradual and sustained decrease). Rehmannia, codonopsis, and ophiopogon are examples of herbs with high sugar content. The other difficulty is that many patients resist regular consumption of very large dosages because of the inconvenience and high cost.
Using powdered crude herbs in place of decoctions or dried decoctions is often an option for treating functional disorders, but there is little relatively little precedent for this as applied to diabetes in Chinese medical practice, with the possible exception of the single herb ginseng and treatments for secondary effects of diabetes. This is likely because the amount of active ingredients that could be conveniently ingested in this form is not high enough.
There is a potentially promising example, however, from recent research which may suggest that powdered herbs in modest dosage can be used with some success. Persons with vascular complications of insulin independent diabetes (e.g., coronary heart disease, vascular disease of the lower extremities, stroke, retinopathy, etc.), were treated with a sugar-reducing pulse-invigorating formula (ingredients unspecified other than astragalus and rehmannia; the formula tonifies qi, nourishes blood, and vitalizes blood) in capsules of powdered herbs, at a dosage of 2-3 grams each time, three times daily (29). The treatment time was three months, and if the treatment was deemed effective, it would then be continued. Improvements in hemorrhology were noted in 82% of the cases marked by qi and yin deficiency (which the formula mainly addressed), but only about 63% for other cases (yin deficiency with fire, or yin and yang deficiency). Fasting blood sugar was maintained below 150 mg% for 77% of those treated.
While it is quite common in China to utilize very high doses of herbs in decoction, pill, or tablet form, in the West, this requirement usually causes poor compliance. Therefore, one would like to select the most effective herbs, prepare them in the most effective form, and provide them in the most convenient manner. According to the Chinese research, the minimal amount of dried extracts or powdered herbs to be consumed daily is in the range of 6-24 grams. Presumably, for a given formula within this range, the higher the dose, the more dramatic the hypoglycemic action.
http://www.itmonline.org/arts/diabherb.htm
http://www.depsyl.com/
http://back2basicnutrition.com/
http://bionutritionalresearch.olhblogspace.com/
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