Liu Wei Di Huang Wan (Six-Ingredient pill with Rehmnnia) comes from the classic Craft of Medicinal Treatment for Childhood Disease Patterns (Xiao Er Yao Zheng Zhi Jue) << 小兒葯証直訣>> written by Qian Yi in Song dynasty. Composed of Shu Di(Radix Rehmanniae Glutinosae Conquitae), Shan Zhu Yu(Fructus Corni Officinalis), Shan Yao(Radix Dioscoreae Oppositae), Ze Xie(Rhizoma Alismatis Orientalis), Mu Dan Pi(Cortex Montan Radicis) andFu Ling(Sclerotium Poriae Cocos). It is a formula derived from Shen Qi Wan(Kidney Qi Pill) which subtracted Rou Gui(Cortex Cinnamomi Cassiae) and Fu Zi(Radix Lateralis Aconiti Carmichaeli Praeparata) in the classic Essentials From The Golden Cabinet(Jin GuiYao Lue)《金匮要略》. This article will discuss the clinical practice of Liu Wei Di Huang Wan (Six-Ingredient pill with Rehmnnia) in treating Diabetes Mellitus (DM) and itscomplications.
1. Diabetes Mellitus (DM)
Dr. Xi Yinping  used modified Liu Wei Di Huang Wan as an accessorial treatment for 48 type 2 diabetes patients as the treatment group. The control group consisted of 44 patients. Both groups were treated with metformin 1.5 g/d. For the treatment group, Liu Wei Di Huang Wan was added. The result came as follows: for the treatment group there were 32 patients cured (66.7%), 9 patients effective (18.8%), and 7 patients ineffective (14.6%); for the control group there were 10 patients cured (22.7%), 16 patients effective (36.4%), and 18 patients ineffective (40.9%). As the result indicates, Liu Wei Di Huang Wan can significantly improve the treatment effectiveness for type 2 diabetes.
Dr. Zhong Lei  used modified Liu Wei Di Huang Wan to treat 65 type 2 diabetes patients. After treatment, 30 patients showed no symptoms, body weight return to normal, fasting plasma glucose < 7.7 mmol/L, qualitative test of preprandial glucose in urine (-), 24h quantitative test for glucose in urine < 5g, and 28 patients were effective, with a total efficiency rate of 89.2%. Asymptomatic diabetic patients can also be treated with modified Liu Wei Di Huang Wan. Due to lacking of symptoms such as polydispia, polyuria and polyphagia, these diabetic patients were occasionally diagnosed during their regular physical examination. Dr. Hu Jianping  used Liu Wei Di Huang Wan to treat 21 asymptomatic diabetic patients, with 7 cured, 10 fundamentally cured, 3 effective and 1 ineffective. The total efficiency rate was 95%.
2. Diabetic Nephropathy (DN)
Based on pattern differentiation, Dr. Dai Shuangming  divided DN patients into 3 types: Liver and Kidney Yin deficieny, deficiency of both Yin and Yang , and edema due to Yang deficiency. In addiction to Liu Wei Di Huang Wan as the main therapy, he also used insulin or hypoglycemic medications to control blood glucose, plus furosemide in case of profuse edema, plus captopril and nifedipine in case of severe hypertension. Among 24 DM patients, 7 showed remarkable results, 13 were effective, and 4 were ineffective . Modern pharmacological research has identified kidney hypertrophy and high filtration as the first phathological changes for DM. Damage of lipid peroxidation caused by free radical contributes to this deterioration . In the early stage of DN, the content of lipid peroxide (LPO) in the kidney tissue of the diabetic mouse induced by streptozotocin (STZ ) was positively correlated to the degree of kidney hypertrophy and high filtration (P<0.05). Liu Wei Di Huang Wan not only can decrease the level of fasting glucose and the content of LPO in the kidney tissues, improving the activity of superoxide dismutase (SOD), but also alleviate kidney hypertrophy and high filtration. Dr. Xu Zhonghua  thinks that the pathogenesis of purpuric diabetic nephritis is Yin deficiency with Yang hyperactive, wind heat combat pattern, evil toxic stagnation transformed into heat, which disturb collaterals and result in reckless movement of blood. The etiology is deficiency of Liver and Kidney causing deficiency fire. 12 patients with this disease were treated using Liu Wei Di Huang Wan: 9 were cured, and 3 were effective.
3. Diabetic chronic liver disease
DM patients have to regularly monitor the liver function and the damages caused by chronic liver disease. Improper control of blood glucose can cause hepatomegaly and liver damage. It could lead to hepatocirrhosis after 4 to 5 years. Dr. Li Shuyuan  used Liu Wei Di Huang Wan and Yi Guan Jian combined with insulin, vitamin B and vitamin C etc. to treat 23 diabetic patients with chronic liver disease. 17 showed remarkable effect and 6 were effective, with a total efficiency of 90.55%. Dr. You Yuanyuan  used Liu Wei Di Huang Wan to treat 25 hepatic diabetes patients who presented thirst, polyuria, emaciation, fatigue, sore in the lower back and weakness in the legs, abdominal distention, insomnia and hepatalgia etc., with a alleviatory rate of 92%.
4. Diabetic ophthalmic disease
Dr. Zhou Changyan  observed the dynamic changes of the crystal and serum SOD activity and the content of LPO in the STZ induced mouse models of diabetic cataract. He found that the chinese herb compound formula based on Liu Wei Di Huang Wan (Tang) can reduce blood glucose, increasing the SOD activity, reducing the content of LPO and delaying the developing and progression of cataract in mouse. Some other researches  showed that some individual herbs and compound fomula such as modified Liu Wei Di Huang (Tang) have anti-oxidation effect and can clean free radicals. Dr. Meng Jufeng et all [10,11] treated 9 patients of type 2 diabetes who had vitreous hemorrhage and their across vision were almost blind. After using Liu Wei Di Huang Wan accompanied with troxerutin and adrenosem in the course of 3 months to 2 years, all the patients’ eyesight improved in various degrees. Some also reported using modified Liu Wei Di Huang (Tang) to treat 22 diabetic retinopathy patients (total of 42 affected eyes), the eyesight of 12 eyes was enhanced more than 3 lines, and the eyesight of 24 eyes was enhanced more than 1 line. The eyeground hemorrhage of 8 eyes was fully absorbed, and of 33 eyes the hemorrhagic exudation was reduced. In summary, Liu Wei Di Huang Wan (Tang) is very effective in treating DM and its complications, especially DM caused by Liver and Kidney Yin deficiency.
1. Xi Yinping, To Treat 48 Type 2 Diabetes Patients Using Added Liu Wei Di Huang Wan (Six-Ingredient pill with Rehmnnia) as An Accessorial Treatment, Clinical Journal of An Hui Traditional Chinese Medicine, 2002, 14, (11):5
2. Zhong Lei, Wu Zhongmei, Treating Non-insulin Dependent Diabetes With Added Liu Wei Di Huang Wan (Six-Ingredient pill with Rehmnnia), Hubei Journal of Traditional Chinese Medicine, 1999, (2): 20~21
3. Hu Jianping, Treating 21 Asymptomatic Diabetes Patients With Added Liu Wei Di Huang Wan (Six-Ingredient pill with Rehmnnia), Journal of Sichuan Traditional Chinese Medicine, 1999,17 (11): 35
4. Dai Shuangmin, Treating 24 DN Patients With Cooperation of TCM and WM, Shanxi Journal of Traditional Chinese Medicine, 1997,18 (12): 544
5. Xu Zhonghua, Treating Purpuric Nephritis With Liu Wei Di HuangTang (Six- Ingredient Decoction with Rehmnnia), Jiangxi Journal of Traditional Chinese Medicine, 2000, 39(16): 29
6. Li Shuyuan, Li Zhongyuan, Ma Yi, Treating 23 DM Patients Accompanied by Chronic Liver Diseases With Cooperation of TCM and WM, Shandong Journal of Traditional Chinese Medicine, 1997, 16 (5): 216
7. You Yuanyuan, Kang Shuhua, Treating 25 Liver Source DM Patients with Liu Wei Di Huang Wan (Six-Ingredient pill with Rehmnnia), Fujian Journal of Traditional Chinese Medicine, 1998, 29 (1): 46
8. Zhou Changyan, Treating Diabetic Cataract with Added Liu Wei Di Huang Tang (Six-Ingredient Decoction with Rehmnnia), Shandong Journal of Traditional Chinese Medicine, 1998, 17 (10): 454
9. Fang Chaohui, Researches on Shouxingbao Influencing Free Radical Metabolism of Aged Mouse, Tianjing Journal of Traditional Chinese Medicine, 1998, 15 (1): 37
10. Meng Jufeng, Ge Chengjun. Treating Diabetic Vitreous Hemorrhage With Cooperation of TCM and WM, Shanghai Journal of Traditional Chinese Medicine, 2000, 34 (7): 42
11. Meng Jufeng, Ge Chengjun, Treating Diabetic Retinopathy Using Liu Wei Di Huang Wan (Six-Ingredient pill with Rehmnnia) Accompanied with Troxerutin, Ophthalmology Journal of Integrated TCM and WM, 1997, 16(5): 216~217
This Article was published on the Academic Periodical of Changchun College of Traditional Chinese Medicine, Vol.19, 3, 2003 Feng Fei, Liu Tao (Nanjing University of TCM, Nanjing, Jiangsu 210029)
On June 26th, 2013