Clinical experience of Fanrenzhong to treat diabetes insipidus
                                           Written by Zhenghangyu        Translated by Hu Xiaohua

Identification according to the etiology
Diabetes insipidus is a disease due to deficiency of antidiuretic hormone with the symptoms of polyuria, polydipsia, hyposmotic urine, etc. Professor Fan thinks that diabetes insipidus pertains to Xiaoke in TCM. Neijing recorded that pathogenesis of Xiaoke “Weak-body patient over-taken rich fat and sweetness or emotional stress which causes heat retention and body fluid deficiency.”The patients are forbidden to take fat rich food and heat-natured herbs in treatment. Zhangzhongjing, TCM saint, recorded that pathogenesis of Xiaoke was stomach-heat and kidney deficiency, so he created Baihu Renshen Tang and Shenqi Pill, etc.
Professor Fan concludes that diabetes insipidus is caused by syndrome of yin deficiency with yang hyperactivity, the patients feel dry mouth and lip, severe thirst with desire to cold water, dysphoria, insomnia, nightmare, dry skin, feverish feeling in palms and soles, dry stool, red and dry tongue with yellow fur, thin and fast pulse, frequency of micturition with large urine volume like water, diurnal urine volume reaching over 20000ml, dull complexion, languishing and emotional exhaustion, hypodynamia, aching and weakness of the loins and knees, etc. which shows asthenia and sthenia syndrome with heart-stomach heat, insufficient middle qi and kidney deficiency. Professor Fan thinks that this syndrome is due to Yin-insufficient constitution, over taken rich fat, pungent-heat food and excessive drinking, overwork or being worrying and anger long time, which can cause internal dryness-heat, severe heart- stomach heat to consume Yin, dysfunction of kidney. Yin deficiency involves qi deficiency, middle qi is consumed. Dysfunction of kidney is not capable of governing water, which can induce incontinence of urine. Deficiency of spleen and kidney can consume Yin and internal fire, which induces vicious circle. Professor Fan concludes that nourishing yin clearing heat, replenishing of the kidney and spleen to recover the circulation of body fluid. The prescription includes Radix Rehmanniae, Prepared Radix Rehmanniae, Chinese Yam, Cornus Officinalis, Tortoise Plastron, Common Anemarrhena, Coptis Chinensis, Lanceolata, Glycyrrhiza, Prepared Aconite, Mantis Egg-case, etc.
Professor Fan uses more Lanceolata, Glycyrrhiza, Chinese Yam, etc, from the angle of deficiency of spleen which can not masukiyo, or can’t transport and transform the fluid, so puts forward the idea of replenishing qi to rise fluid and quench thirst. It is similar to warm kidney to stream and raise fluid. So the treatment of diabetes insipidus should pay more attention to reinforc spleen and kidney. For the patient with severe frequency of micturition, add Schisandra Chinensis, Raspberry; for dyspepsia, add Dark Plum and Polygonatum; for constipation, add Rhubarb and Fructus Cannabis, Calcined Longgu, Calcined Oyster, Dendrobium, Pharagmitis Rhizoma, Buffalo Horn, Mulberry, etc. can be added according to the syndromes.
Case
Zhang, Male, 28-year old. Firstly visited on Mar. 20, 2005.
The patient had polydipsia and polyuria, drinking 8 to 10 bottles of water every day, 20-24 times of emiction per day, has been diagnosed of central diabetes insipidus, chinese and western drug therapy, no good effect, and then came to Professor Fan, the patient felt thirst with desire for cold drinks, frequency of micturition, both drinking amount and urine volume are about 10000ml. dry mouth and lip, being irritated, insomnia, feverish feeling in palms and soles，pale complexion, Hypodynamia, weak voice, adiaphoresis, weak loin and knees, red tongue with little fur, weak and thin pulse.
Prescription: Radix Rehmanniae 40g, Prepared Radix Rehmanniae40g, Tortoise Plastron 15g, Wolfberry fruit20g, Lanceolata 30g, Glycyrrhiza 30g, Chinese Yam 30g, Anemarrhena 20g, Coptis Chinensis 10g, Tuber of Dwarf Lilyturf 15g, Mantis Egg-case 15g, Cornus Officinalis 15g, Prepared Aconite 8g, Buffalo Horn 30g, Fructus Cannabis 15g, Mulberry 15g. The patient took 14 decoctions, urine volume decreased obviously. And then, added Calcined Longgu, Calcined Oyster, Red Ginseng, Dark Plum, Dendrobium, Pharagmitis Rhizoma, etc. After 4-month treatment, drinking amount and urine volume are under 3000 ml.
Comments
Diabetes insipidus is a difficult disease, western medicine treats it by hormone replacement therapy and antidiuretic, and the patients need lifelong taking medicine, water intoxication and hepatorenal damage often happen. Professor Fan concludes that the pathogenesis is heart-stomach heat to consume Yin, deficiency of spleen and kidney, so treatment focuses on clearing heat and nourishing Yin, reinforcing spleen and kidney together.