Bu Yang Huan Wu Tang & Early Diabetic Nephropathy

abstracted & translated by
Bob Flaws

On pages 19-21 of issue 7, 2009 of Xin Zhong Yi (New Chinese Medicine), Ye Ren-qun, Lin Guo-bin, Xie Jia-jia et al. published an article titled, “The Effects of Bu Yang Huan Wu Tang on Angiopoietin-1 & Its Receptor Tie-2 in Patients with Early Stage Diabetic Nephropathy.” A summary of this article is presented below.

Cohort description:

Sixty cases of type 2 diabetes mellitus with early stage nephropathy were randomly divided into two groups of 30 cases each. All were seen at the endocrinology out-patient clinic at the hospital in Shenzhen where the authors work. In the treatment group, there were 15 males and 15 females aged 35-75 years, with a median age of 56.2 ± 12.53 years. Their course of disease had lasted for from six months to 21 years, with a median disease duration of 11.68 ± 12.37 years. Their mean body mass index (BMI) was 24.8 ± 4.1. In the comparison group, there were 16 males and 14 females aged 33-77 years, with a median age of 57.4 ± 13.2 years. These patients’s disease duration had lasted from four months to 20 years, with a mean duration of 11.09 ± 13.16 years. Their mean BMI was 24.3 ± 3.8. Therefore, in terms of sex, age, disease duration, and mean BMI, there were no marked statistical differences between these two groups (P ≥ 0.05). All patients in this study had stage III diabetic nephropathy according to Mogensen staging. Urine analysis on two separate times showed a protein discharge rate of 30-300 milligrams per 24 hours. Patients with essential hypertension, heart failure, urinary tract infections, acute nephritis, fever, or other potential causes of proteinuria were excluded from this study. In terms of Chinese medical pattern discrimination, all patients presented a pattern of qi vacuity with blood stasis. Symptoms included fatigue, lack of strength, shortness of breath, disinclination to speak (due to fatigue), chest pain, rib-side pain, low back pain, upper back pain, numbness and tingling of the extremities,  worse pain at night, a dark tongue with static macules, and a bowstring, deep, and/or choppy pulse.

Treatment method:

All members of the comparison group were counseled on proper dietary therapy. On top of this foundation, they were also prescribed insulin or various hypoglycemic agents. Patients with hypertension and/or high cholesterol were treated standardly.

All members of the treatment group were orally administered Bu Yang Huan Wu Tang (Supplement Yang & Restore Five [Tenths] Decoction) on top of the basic treatment described above. These Chinese medicinals consisted of:

Huang Qi (Radix Astragali), 60g
Chi Shao (Radix Rubra Paeoniae)
Dang Gui (Radix Angelicae Sinensis)
Di Long (Pheretima)
Tao Ren (Semen Persicae)
Hong Hua (Flos Carthami), 9g each
Chuan Xiong (Rhizoma Chuanxiong), 6g

One packet of these medicinals was decocted in water and administered per day TID.

For both groups, two months treatment equaled one course.

Study outcomes:

The above listed symptoms were rated according to a point system in terms of severity from 0-4, with zero meaning no presence of the symptom and 4 meaning severe presence of that symptom. In addition, fast blood glucose (FBG) was analyzed before and after treatment. The following table shows the differences from before to after treatment in these two parameters in both groups.

This table shows that the integrated Chinese-Western medical protocol was more effective in both reducing the mean symptom score and mean FBG compared to the Western medicine only protocol. The next table shows changes in the discharge of protein in the urine over a 24-hour period, blood urea nitrogen (BUN), and serum creatinine, all markers for nephropathy, before and after treatment.

This table shows that reduction in 24-hour proteinuria was considerably better in the treatment group than in the comparison group. The last table shows differences in mean serum angiopoietin-1 (Ang 1) and Tie 2 from before to after treatment in both groups.

This table shows that the integrated Chinese-Western medical protocol was also more effective in reducing mean Ang 1 and Tie 2 than the Western medical protocol alone.

Discussion:

The angiopoietins are protein growth factors that promote angiogenesis, the formation of blood vessels from pre-existing blood vessels. There are now four identified angiopoietins: Ang 1, Ang 2, Ang 3, and Ang 4. The tie receptors are tyrosine kinases, so named because they mediate cell signals by inducing the phosphorylation of key tyrosines, thus initiating the binding and activation of downstream, intracellular enzymes. This process is called cell signaling. It is somewhat controversial which of the Tie receptors mediate functional signals downstream of Ang stimulation, but it is clear that at least Tie 2 is capable of physiologic activation as a result of binding the angiopoietins. Diabetic nephropathy is characterized by expansion of extracellular matrix in the glomeruli which eventually leads to proteinuria and renal failure. This expansion of extracellular matrix may be due to over-stimulation of angiogenesis in the glomeruli by Ang 1 and Tie 2 with the formation of immature, leaky vessels, thus leading to proteinuria and nephropathy. In the above study, both the pure Western medical protocol and the integrated Chinese-Western medical protocol reduced mean levels of Ang 1 and Tie 2. This reduction in serum Ang 1 and Tie 2 was accompanied by reduction in symptomology and FBG as well as the 24-hour discharge of protein in the urine, BUN, and serum creatinine. 

According to the Chinese authors, Bu Yang Huan Wu Tang boosts the qi, quickens the blood, and frees the flow of the network vessels. Within it, Huang Qi greatly supplements the source qi. Once the qi becomes effulgent, the movement of blood can become normal. Chi Shao, Chuan Xiong, Dang Gui, Tao Ren, and Hong Hua quicken the blood and transform stasis. Di Long frees the flow of the network vessels and quickens the blood.

Copyright © Blue Poppy Press, 2009. All rights reserved.