Research - Benefits of Jiang Tang Wan Herbal Formula for Diabetes with Exercise & Meta-analysis

Chinese Medicine which includes acupuncture and Chinese herbal medicine, among other techniques, has long been used alone and in conjunction with western medicines for the treatment of type II diabetes. A variety of Chinese Herbal formulas can be helpful with diabetes given the appropriate underlying diagnosis (see What Does Acupuncture Treat?, to better understand TCM diagnoses). One often used Chinese herbal formula is Jiang Tang Wan along with some popular modifications to the base formula.

Researchers from Anhui College of Traditional Chinese Medicine in Anhui Province China recently conducted an animal study exploring the biochemical mechanisms behind the positive affect of this herbal formula along with exercise. This study explored effects on the JNK signaling pathway in pancreatic tissues. The JNK pathways (there are multiples) are elevated during stress and inflammation and are important markers of disease. In diabetes, then, expression levels of JNK will be higher in pancreatic tissues and these levels will be lower in non-diabetic patients.

Within this study researchers injected 78 male rats with streptozotocin and fed them a high fat diet to establish diabetes. They were then divided into an exercise group, a herbal medicine treatment group and a group that combined both - with 12 rats left out as a control. Treatment was offered over a 8 month period.

After treatment researchers found that the exercise and herbal medicine treatment group had a sigificant decrease in the p-JNK protein (good) and an increase of PDX-1 and insulin protein (also good). They concluded that exercise and the herbal formula may be helpful due to decreasing the JNK signaling pathway.

There have been a host of studies on other Chinese herbal formulas on both human and animal subjects. A very comprehensive meta analysis of related studies is found in a 2009 study entitled "Chinese herbal medicines for people with impaired glucose tolerance or impaired fasting blood glucose" . As this is a very long article, a very important snippet is included below:

------ quoted from study linked to above -------

"Herbal medicine plus lifestyle modification versus placebo plus lifestyle modification

Two trials compared a Chinese herbal medicine with placebo with the co-intervention of lifestyle modification.

Danzhi jiangtang jiao capsules (Fang ZH 2007) combined with lifestyle modification were significantly better than a placebo and lifestyle modification in improving 2hr-oGTT blood glucose (MD -1.44 mmol/L; 95% CI -2.01 to -0.87). But there was no significant difference between the groups in reducing fasting blood glucose (MD -0.40 mmol/L; 95% CI -0.83 to -0.03). Trigylcerides and insulin levels also showed significant reductions .

Bofu-Tsusho-San (Hioki C 2004) significantly improved fasting blood glucose (MD -0.28 mmol/L; 95% CI -46 to -0.10) but not 2hr-oGTT blood glucose (MD -0.12 mmol/L; 95% CI -0.60 to 0.36). There was no significant difference in the HbA1c between those taking Bofu-Tsusho-San and the control group. There was no significant difference in cholesterol levels found in the trial of Bofu-Tsusho-San, and while Bofu-Tsusho-San did not show an improvement in total cholesterol outcomes it demonstrated a significant difference in increasing HDL-cholesterol (MD 0.25 mmol/L; 95% CI 0.12 to 0.38).

Herbal medicine plus lifestyle modification versus metformin plus lifestyle modification

There was no significant difference in the 2-hr glucose tolerance test levels between Tangping san plus lifestyle modification and metformin plus lifestyle modification at the end of the three months intervention. No other outcomes were reported for Tangping San (Qu LX 2002).

Herbal medicine versus placebo

Compared with placebo, those taking Qi wei tang ping capsules (Wang BQ 2008) showed significantly better results for fasting blood glucose and 2hr-oGTT blood glucose. There was a significant higher level of normalisation of fasting blood glucose compared to placebo (RR 2.94, 95% CI 1.47 to 5.87). There was no significant difference in BMI or waist-to-hip ratio in the herbal medicine group compared to those taking placebo.

Herbal medicine versus metformin

There was no significant difference between Fufang cangzhu decoction and metformin in reducing fasting blood glucose, cholesterol, triglycerides, insulin, weight, or waist-to-hip ratio (Shi J 2005). We were unable to ascertain if this comparison was constructed as a non-inferiority trial.

Herbal medicine plus lifestyle modification versus acarbose plus lifestyle modification

There was no significant difference between the Jian pi zhi shen huo xue (Tang QZ 2007) and acarbose in any of the outcome measures (FBG, 2hr-oGTT blood glucose, insulin, lipids or HbA1c). There was also no significant difference between Jian pi zhi shen huo xue and acarbose regarding the normalisation of fasting blood glucose (Tang QZ 2007).

Herbal medicine plus antihypertensive medication versus antihypertensive medication alone

The Chinese herbal medicine, Yi qi yang yin huo xue combined with antihypertensive medication was significantly better than the antihypertensive medication alone in reducing fasting blood glucose (one trial, MD -0.96 mmol/L, 95% CI -1.55 to -0.37). Yi qi yang yin huo xue was also significantly better than the control in reducing cholesterol, triglycerides and increasing HDL-cholesterol. There was no significant difference between Yi qi yang yin huo xue and the control in regard to systolic or diastolic blood pressure. This trial also evaluated quality of life using an instrument comprised of eight scales designed for hypertension based on a study of an American hypertensive population (Testa 1989) and validated for a Chinese population (Du 1994). The trial found that on the five of the eight scales: physical symptoms distress scale, sexual symptoms distress scale, sleep dysfunction scale, positive symptom scale and working performance, there was a significant difference in favour of the herbal medicine group (Lu X 2005). There was no significant difference in the measures of life satisfaction scale, social participation scale and general well-being adjustment scale. However, it was difficult to disentangle the effects of the various compound on quality of life. This study reported that there were no adverse renal or liver findings and in ECG tests.

Herbal medicine plus basic education versus basic education alone

In this comparison one study compared Jinqi jiangtang tablets with a control with a co-intervention of basic education about IGT (Wang YX 2005). This did not involve diet or exercise instruction. Normalisation of blood glucose was significant (RR 10.80; 95% CI 3.47 to 33.66) as was the incidence of diabetes (RR 0.44; 95% 0.22 to 0.87) and reduction of fasting blood glucose (MD -0.88; 95% CI -1.14 to -0.62) and 2-hr oGTT. There was a significant reduction in triglycerides but not total cholesterol in the intervention group compared to the control ."