Diabetes is an endocrine and metabolic disorder disease characterized by increase of plasma glucose level, and is called the three worldwide diseases together with cancers and cardiovascular diseases. According to the report of the International Diabetes Federation in 2017, there were about 451 million diabetes patients in the world, and the number is expected to skyrocket to 693 million in 2045. Diabetes is mainly divided into type 1 diabetes and type 2 diabetes: type 1 diabetes is an autoimmune disease that results from the destruction of pancreatic β cells, which 5%~10% diabetes patients have and is mainly treated depending on insulin, with the long-acting sustained-release preparations being the R&D focus of the pharmaceutical companies; 90% type 2 diabetes (T2DM) is a result of gene and environment, of which the main pathological mechanism is insulin resistance and the incidence has shown a rapid growing trend in recent years. In terms of T2DM treatment, the hypoglycemic effects of Western medicines are significant, however, long-term use will easily cause many adverse reactions such as ketoacidosis, obesity, hypoglycemia, and cardiovascular diseases.
TCM compound preparations lay emphasis on holistic treatment, have many active ingredients, and can intervene with the disease occurrence and development through additive effect for a single target, multi-target synergistic effect, and toxicity dispersion effect, to produce the therapeutic effect of toxicity reducing and efficacy enhancing; they are especially applicable to intervening with the occurrence and development of complex T2DM jointly affected by gene and environment factors. Seeking new diabetes drugs from TCM compound preparations has become a new direction in hypoglycemic drug R&D. Diabetes treatment with TCM compound preparations mainly includes classic compound preparations, modern compound preparations, and TCM and Western medicine compound preparations.
In TCM syndrome differentiation and treatment, many classic formulas are used to treat Xiaoke disease, of which the pathogenesis is overall root deficiency and branch excess, and clinical manifestation is mostly "polydipsia, polyphagia, polyuria, and emaciation", similar to modern diabetes. In the classic formulas, besides Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) and other liver and kidney nourishing compound preparations that have certain hypoglycemic effects in the long-term use, the TCM classic formulas much studied in recent years also include Huanglian Jiedu Decoction, Gegen Qinlian Decoction, and Buyang Huanwu Decoction, etc. The occurrence and development of diabetes involve a long-term process and experience the change from heat to deficiency: for example, Huanglian Jiedu Decoction and Gegen Qinlian Decoction clear stomach heat and benefit bowel moisture at the stage of heat, and Buyang Huanwu Decoction invigorates qi and promotes blood circulation at the stage of deficiency. Huanglian Jiedu Decoction stems from the Handbook of Prescriptions for Emergency; it is prepared from coptidis rhizoma, Radix Scutellariae, Cortex Phellodendri, and Fructus Gardeniae, has the efficacy of clearing away heat and toxic materials, and is indicated for Sanjiao Heat Toxin Syndrome; its main component is coptidis rhizome, and the main active ingredients for reducing blood glucose are alkaloids like berberine, jatrorrhizine, and coptisine, and flavonoids like baicalin, baicalein, and wogonoside. Gegen Qinlian Decoction stems from Zhang Zhongjing’s Treatise on Febrile and Miscellaneous Diseases: Differentiation of the Pulse, Symptom Complex, and Treatment of the Taiyang (Initial Yang) Syndromes, is prepared from kudzu root, Radix Scutellariae, coptidis rhizome, and radix glycyrrhizae, has the efficacy of relieving superficies and clearing interior, and is indicated for diarrhea due to interior cold and exterior heat; its main active ingredients for lowering blood glucose and lipid are flavonoids like puerarin and baicalin and alkaloids like berberine, coptisine, and jatrorrhizine. Buyang Huanwu Decoction is prepared from Astragali Radix, Angelicae Sinensis Radix, red peony root, earthworm (without e...
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