Author: Wei Zi-xiao

Diabetic peripheral neuropathy (DPN) is a  common  chronic complication in diabetic patients, closely correlated with the development of the disease and with poorly controlled glucose levels. The common clinical signs show paresthesia, mostly manifesting as multiple peripheral neuritis, such as having a chilly or causalgic feeling, anaesthesia, formication, and pain, etc. All the symptoms usually start from the four extremities. The abnormal sensations at the limbs manifest as hyperesthesia in the early stage; however, it will decrease or vanish in the later stages. Dyskinesia is not uncommon, seen as decreased tendon reflex or myoatrophy.

According to traditional Chinese medicine (TCM) theory, the above symptoms belong to the TCM category of blood impediment (Xue Bi), beriberi (Jiao Qi) and so on.

As early as in the Han Dynasty, the book, "The Golden Chamber (Jin Gui Yao Lue)," discussed this disease of blood impediment as "the body numbness as wind blockage should be treated with Huangqi Guizhi Wuwu Decoction, including Astragalus and Cinnamon". The pathogenesis is blood deficiency. So the ancient doctors believed numbness belonged to the category of the deficiency syndromes.

Beriberi was found firstly in the intelligentsia in the Eastern Jin Dynasty (A.D.317-420). It was given great attention to from the Southern Dynasty (A.D.420-589) the Tang Dynasty (A.D. 618-907). The book, "Prescriptions Worthy of a Thousand Gold for Emergencies. Beriberi Theory," fully summarized the treatments for beriberi before the Tang Dynasty. The book, "Prescriptions for Universal Relief," remarked that this disease was caused by Shen (kidney)deficiency. Beriberi
is classified as dry beriberi (no edema) and wet beriberi (with edema). Excessive water pathogens result in wet beriberi, and excessive wind pathogens result in dry beriberi. Along with progression of the disease, beriberi can influence the functions of Xin (heart) and Shen (kidney); and the phenomenon above is easily correlated with other chronic complications of diabetes.
In practice, the author treats patients with beriberi as having DPN for those without edema as blood impediment; and for those with edema as having wet beriberi.

Basing on the severity and the developing tendency of the disease, it is obvious that Huangqi Guizhi Wuwu Decoction is not efficient enough to relieve the blood impediment. No matter how complex the syndromes are in clinic, it is always based on the guide of Buyang Huanwu Decoction to invigorate qi and nourish blood, and to activate blood.

For mild cases, slightly modified Buyang Huanwu Decoction can be used as a basic formula, which includes raw milkvetch root 30 g, tangerine peel 9 g, suberect spatholobus stem 30 g, Chinese angelica root 12 g, Chuanxiong rhizome 12 g, red peony root 15 g, white peony root 15 g, peach seed 9 g, Safflower 9 g, earthworm 12 g, and Ground Beetle 9 g. The other modifications can be referred to as different syndromes of Bi (blocked), i.e. wind, cold, dampness and heat.

The following traditional Chinese drugs: epimedium herb 15 g, frenugreek 12 g, Chinese cinnamon twig 15 g, medicinal evodia fruit 9 g, and prepared common monkshood daughter root 12 g, can be added to the treatment for patients with intolerance of cold and cold extremities;

For those with severe pain, if they belong to the heat syndrome, red peon root and white peony root are replaced with white peony root 30 g,  and raw licorice root 9 g and paniculate swallowwort root 15 g are added; if they belong to the cold syndrome, Chinese cinnamon twig 15 g, common monkshood mother root 9 g, Kusnezoff monkshood root 9 g (the two traditional Chinese drugs must to be boiled for one hour in advance), and Manchurian wildginger herb 3 g are added.

For those with numbness and insensitivity, mulberry twig 15 g and common Flowering-quince fruit 9 g are added; and the key point is to increase the dosage of milkvetch root to 45 g.

For those with scorching pain accompanied by yin deficiency, Chinese angelica root is removed, and figwort root 15 g and tree peony bark 12 g added.

For severe cases, the prescription of Buyang Huanwu Decoction is still used, but more herbs are added to promote blood circulation, remove stasis, and relieve pain. The ingredients include raw milkvetch root 45 g, tangerine peel 9 g, suberect spatholobus stem 30 g, Chinese angelica root 12 g, Chuanxiong rhizome 12 g, red peony root 15 g, white peony root 15 g, peach seed  9 g, Safflower 9 g, leech 9 g, processing olibanum 9 g, and processing Myrrh 9 g.

If they have yellowish greasy skin, the patients should be treated by clearing heat, and dampness should be resolved first. Milkvetch root, tangerine peel, Chinese angelica root and white peony root should be removed from the above formula, and Chinese atractylodes rhizome 12 g, amur corktree bark 9 g, achyranthes root 12 g, common Flowering-quince fruit 9 g, raw coix seed 30 g should be added. Also, the combination of Simiao Powder,consisting of Chinese atractylodes rhizome, amur corktree bark, achyranthes root, common Flowering-quince fruit, and coix seed) and Simiao Yongan Decoction,composed of Honeysuckle flower, figwort root, Chinese angelica root, and licorice root) may be used as the basic prescription.

Patients with swollen extremities should be treated as having wet beriberi. Modified Jiming Powder is often applied as the basic recipe, which includes areca seed 12 g (it can be used at doses of 15 g or more if the patient's stool is sticky and sluggish), common Flowering-qince fruit 9 g, medicinal evodia fruit 3-6 g,fresh ginger 6-9 g, common perilla leaf 9 g, mulberry twig 15 g, raw coix seed 30g, incised notopterygium Rhizome and root 9-12 g, and pubescent angelica root 9-12 g.

The modifications are similar to treating dry beriberi. However, milkvetch root should not be indiscreetly used in wet beriberi due to its stagnant property. There were many prescriptions for treating beriberi in anc