Dihuang Yinzi for Diabetic Cerebral Lesions

Dihuang Yinzi (Rehmannie Decoction) originates from the Jiabao Fang; in the Shiyi Dexiao Fang it is also called Sheng Dihuang Yinzi. The formula consists of equal parts of Renshen (Ginseng Radix), Shengdihuang (Rehmanniae Radix recens), Tiandong (Asparagi Radix), Maidong (Ophiopogonis Radix), Zhiqiao (Aurantii Fructus), Shihu (Dendrobii Caulis), Pipaye (Eriobotryae Folium), Zexie (Alismatis Rhizoma), and Zhigancao (honey-fried Glycyrrhizae Radix). Grind the above herbs into coarse powder; each time take 3 qian (9g), decoct with 150ml water down to about 90ml, strain out the dregs, and take warm after meals and before bedtime.

Dihuang Yinzi nourishes yin and supplements blood, and boosts qi and generates fluids. The original formula was used to treat xiaoke (wasting-thirst, i.e., diabetes) caused by yin deficiency and blood vacuity with deficiency-heat in the stomach, presenting with dry mouth and throat, a flushed face, and irritability. Modern research has found that, used as a base formula with modifications, it is also very effective for treating cerebral vascular dementia, brain atrophy, and sequelae of stroke.

To treat cerebral vascular dementia, use Dihuang Yinzi as the base formula and add kidney-supplementing herbs, using the following: Shengdihuang (raw Rehmannia) 15g, Bajitian (Morindae Officinalis Radix) 10g, Shanzhuyu (Corni Fructus) 10g, Shihu (Dendrobium) 10g, Roucongrong (Cistanches Herba) 10g, Paofuzi (processed Aconiti Radix) 5g [decoct first], Rougui (Cinnamomi Cortex) 3g [add later], Baifuling (white Poria) 10g, Shichangpu (Acori Tatarinowii Rhizoma) 10g, Yuanzhi (Polygalae Radix) 10g. If the patient is obese with pronounced phlegm-dampness, add Cangzhu (Atractylodis Rhizoma) 10g, Fabanxia (processed Pinelliae Rhizoma) 10g, Tianma (Gastrodiae Rhizoma) 10g. If the tongue body is dark purple or the sublingual veins are prominent, add Chuanxiong (Chuanxiong Rhizoma) 20g, Danshen (Salviae Miltiorrhizae Radix) 10g, Chishao (Paeoniae Rubra Radix) 10g. One dose daily; one month = one course, take continuously for two courses. The total effective rate can reach 61.76%. (Journal of Nanjing University of Traditional Chinese Medicine, 1999, 15(3):146.)

To treat brain atrophy, the following base formula may be used: Shudihuang (processed Rehmannia) 15–30g, Roucongrong (Cistanche) 12g, Bajitian (Morinda), Shanzhuyu (Cornus), Shihu (Dendrobium), Maimendong (Ophiopogon), Fuling (Poria) each 9g, Paofuzi (processed Aconite), Rougui (Cinnamon), Wuweizi (Schisandra), Shichangpu (Acorus), Yuanzhi (Polygala) each 6g, Bohe (Menthae Herba) 3g, Shengjiang (fresh Ginger) 3 slices, Dazao (Jujube) 4 pieces. If phlegm-heat is present, appropriately reduce Cinnamon and Aconite and add Zhuru (Bamboo shavings), Qingbanxia (cleared Pinellia), Dannannan (Arisaema cum Bile). If kidney-yin deficiency predominates, selectively add Guiban (Testudinis Plastrum), Zhimu (Anemarrhenae Rhizoma), Nuzhenzi (Ligustri Lucidi Fructus). If liver-blood insufficiency is present, add Danggui (Angelica), Baishao (Paeonia Alba), Heshouwu (Fallopia Multiflora), Danshen (Salvia). If insomnia is severe, add Suanzaoren (Ziziphi Spinosae Semen), Yejiaoteng (Polygoni Multiflori Caulis), Shenglongchi (raw Draconis Dens). If headache is severe, add Tianma (Gastrodia), Juhua (Chrysanthemi Flos). If there is lower back pain and aching legs, add Duzhong (Eucommiae Cortex), Sangjisheng (Taxilli Herba), Qiannianjian (Homalomenae Rhizoma), Lujiaojiao (Cervi Cornus Colla). If aphasia or slurred speech is present, add Baijiangcan (Bombyx Batryticatus), Gan Dilong (dry Pheretima). Use continuously for 30 days as one course; stop the medicine for 3–5 days, then continue for another course. The total effective rate can reach 92%. (Practical Journal of Internal Traditional Chinese Medicine, 1999, 13(4):10.)

To treat stroke sequelae, the following base formula may be used: Shudihuang (processed Rehmannia) 20g, Shanzhuyu (Cornus) 20g, Shihu (Dendrobium), Maidong (Ophiopogon), Wuweizi (Schisandra), Shichangpu (Acorus), Yuanzhi (Polygala), Roucongrong (Cistanche), Bajitian (Morinda), Taoren (Persicae Semen), Honghua (Carthami Flos), Dilong (Pheretima) each 15g, Danshen (Salvia) 20g, Shuizhi (Hirudo) 10g. If dizzy, add Jueeming (Cassiae Semen) and Juhua (Chrysanthemum) each 20g, Zhenzhumu (Margaritifera Concha) 30g. If limbs are weak and limp, add Sheng Huangqi (raw Astragali Radix) 20g, Dangshen (Codonopsis Radix) 15g. One dose daily; 14 days = one course. The total effective rate can reach 96.2%. (Information on Traditional Chinese Medicine, 2004, 21(4).)

These clinical reports show that although Dihuang Yinzi was historically used mainly to treat xiaoke (diabetes), using it as a base formula with symptom-based modifications yields good efficacy in treating various cerebral lesions. This suggests the formula has a certain targeting effect on brain diseases.