Chinese Medicine Update: The Chinese Medical Treatment of Lupus

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Chinese Medicine Update: The Chinese Medical Treatment of Lupus

In Chinese medicine, the Western medical disease called lupus erythmatosus (SLE) is considered a type of bi zheng or impediment condition. Impediment conditions primarily refer to various types of rheumatic pain conditions. According to Chinese medical theory, the flow of qi, blood, and fluids in the channels and vessels of patients with impediment conditions is obstructed by some combination of wind, cold, dampness, or heat. In this case, wind means an unseen, often but not necessarily airborne pathogen invading the body from outside. The basic dictum regarding all pain in Chinese medicine is that, "If there is pain, there is no free flow; if there is free flow, there is no pain." Therefore, if wind, cold, dampness, and/or heat lodge and obstruct the free flow of the qi and blood, pain will arise at the sites of that obstruction. In the case of lupus, it is usually a combination of wind, dampness, and heat which are the obstructing evil or pathogenic qi.

However, lupus is more complicated than a simple impediment condition. First of all, if wind evils have invaded the body, the person's defensive qi must be insufficient, since it is the duty of the defensive qi to protect the body from such external invasion. The spleen is the root or source of this defensive qi. Therefore, most patients with lupus, and most if not all other allergies and autoimmune diseases, do have a spleen qi vacuity. According to Chinese medical theory, the spleen governs the movement and transformation of fluids in the body. If the spleen becomes weak, it may fail to perform its duty vis à vis fluids. These may then gather and accumulate, transforming into pathological dampness. This dampness may then flow outward to obstruct the channels and vessels. Because the qi is yang and, therefore, warm by nature, if dampness and wind evils obstruct the qi, the qi will back up and may transform into heat, thus giving rise to wind damp heat impediment.

If that were not complicated enough, there is more to this Chinese story. If the qi is impeded from flowing freely, this causes damage to the liver's coursing and discharging. This then leads to the development of liver depression qi stagnation. Since the qi moves the blood, if the qi bocomes stagnant, the blood, over time, may also become static. Hence the engenderment of blood stasis. Because the spleen is in charge of not only the creation of the qi but the production of blood, spleen vacuity may lead to blood vacuity. Because the engenderment of fresh or new blood is hindered by static blood, the presence of blood stasis makes blood vacuity all the more likely. In addition, because the liver controls the spleen, liver depression may aggravate spleen qi vacuity. Since the blood and essence share a common source, blood vacuity may lead to liver blood-kidney yin vacuity. On the other hand, since the spleen qi and kidney yang are mutually promoting, spleen qi vacuity may lead to kidney yang vacuity. Because lingering dampness may congeal into phlegm, especially when there is either concomitant cold or heat, damp impediment may become complicated by phlegm nodulation.

A couple of other "facts" in Chinese medicine to keep in mind, women, because of their monthly loss of blood through menstruation and also because of gestation and lactation, are more prone to spleen vacuity than men. Also, the spleen tends to become weak due to aging in even healthy women at around the age of 35. Other causes of spleen vacuity include overeating sugars and sweets, too much thinking, worry and anxiety, too little exercise, and too much taxation, meaning fatigue due to overwork. Liver depression is caused or aggravated by unfulfilled desires, and every chronically ill person certainly has a number of these. It may also be caused by overconsumption of sour-flavored foods and drinks. And damp heat may be caused or aggravated by over-eating oils and fats, fried and grilled foods, alcohol, and hot, spicy foods.

Below are précis of two articles on lupus published within recent years in China A) showing how lupus is treated in Chinese medicine, and B) confirming that Chinese medicine does offer hope as a viable treatment alternative. The first is from "A Clinical Audit of the Treatment of Systemic Lupus Erythematosus by the Methods of Drying Dampness & Dispelling Stasis" by Xi Jin-shan, He Nan Zhong Yi (Henan Chinese Medicine), #2, 1995, p. 88-91. This study discusses the treatment of 120 cases of SLE by the author between Jan. 1991-Jan. 1994 utilizing the methods of drying dampness and dispelling stasis in combination with treatment based on pattern discrimination. The criteria used to diagnose these patients with SLE were those developed by Chinese National Rheumatology Association in Beijing in 1982. The clinical manifestations included: 1) butterfly or disciform red macules; 2)joint inflammation and pain but without deformity; 3) hair loss; 4) Reynaud's phenomena and vasculitis; 5) ulceration of and sores on the oral mucosa; 6) oromeningitis, 7) photoallergy; and 8) neurological and psychological symptoms. Also taken into account were a number of serological and urological examinations, including positive lupus cells, albuminuria, and positive antinuclear antibodies (ANA).

Cohort description:

Of these 120 patients, 24 were men and 96 were women. Twenty-three cases were 8-20 years old, 46 cases were 21-30, 24 cases were 31-40, 23 cases were 41-50, and four cases were 50 years old or older. In terms of the course of disease, there were 61 cases with a one year course, 38 cases with a 2-3 year course, 12 cases with a 4-5 year course, seven cases with a 6-10 year course, and two cases whose course of disease was over 10 years. In fact, the shortest course of disease was two months and the longest was 14 years.

Treatment method:

Lang Chuang Kang Fu Tang (Lupus Health Returning Decoction) consisted of: Rhizoma Atractylodis (Cang Zhu), Cortex Radicis Dictamni Dasycarpi (Bai Xian Pi), carbonized Radix Et Rhizoma Rhei (Da Huang), Flos Resae Rugosae (Mei Gui Hua), Flos Campsis Grandifiorae (Ling Xiao Hua), Radix Salviae Miltiorrhizae (Dan Shen), Hirudo (Shui Zhi), Radix Astragali Membranacei (Huang Qi), Herba Artemisiae Apiaceae (Qing Hao)

Additions & subtractions based on pattern discrimination:

Toxic heat blazing & exuberance pattern: Strong fever, red butterfly macules on the face, soreness and pain of the joints, muscles, and flesh, purplish red skin, vexation and agitation, oral thirst, clouding of the spirit, confused speech, spasms and contractions of the hands and feet, constipation, short, reddish urination, a crimson red tongue with a slimy, yellow coating, and a surging, rapid pulse. To the base formula, powdered Cornu Antelopis Saiga-tatarici (Ling Yang Fen), Gypsum Fibrosum (Shi Gao), Flos Lonicerae Japonicae (Yin Hua), uncooked Radix Rehmanniae (Sheng Di), and Plastrum Testudinis (Dai Mao) were added.
Yin vacuity, internal heat pattern: Low-grade fever which does not recede, heat in the hands, feet, and heart, spontaneous perspiration, night sweats, heart vexation, no strength, disinclination to talk, joint pain, heel pain, low back pain, hair loss, a red tongue with a surface like a mirror, and a fine, rapid, soft pulse. To the base formula, uncooked Radix Rehmanniae (Sheng Di), Radix Scrophulariae Ningpoensis (Xuan Shen), Radix Panacis Quinqefoliae (Xi Yang Shen), Fructus Ligustri Lucidi (Nu Zhen Zi), and Rhizoma Anemarrhenae (Zhi Mu) were added. These two patterns (No. 1 & 2) correspond to the acute and subacute stages.
Liver-kidney yin vacuity or kidney yin deficiency detriment pattern: No fever or only a low-grade fever, dark brown macular rashes in the affected areas, low back soreness, lower limb pain, a mild degree of joint pain, hair loss, menstrual irregularity or blocked menstruation possibly accompanied by dizziness and vertigo, tinnitus, a parched mouth and dry throat, dry stools, yellow urination, a red tongue with scanty fluids and a thin, yellow coating, and a fine, rapid pulse. To the basic formula, Radix Glehniae Littoralis (Sha Shen), Radix Angelicae Sinensis (Dang Gui), Fructus Lycii Chinensis (Gou Qi Zi), and Fructus Meliae Toosendan (Chuan Lian Zi) were added.
Evil heat damaging the liver pattern: Jaundice, chest and lateral costal distention and pain, abdominal distention, torpid intake, dizziness, loss of sleep, menstrual irregularity, purplish macules on the skin, vomiting of blood, epistaxis, if severe, liver and spleen enlargement, a red tongue with a scanty coating and purplish dark static macules, and a fine, wiry pulse. To the basic formula, Radix Rubrus Paeoniae Lactifiorae (Chi Shao), Scolopendra Subspinipes (Wu Gong), unidentified (Tu Yuan), Herba Leonuri Heterophylli (Yi Mu Cao), and Agkistrodon Seu Bungarus (Bai Hua She) were added. This pattern is mostly seen in those with liver and spleen damage mixed with symptoms of stasis.
Spleen (qi)-kidney yang vacuity pattern: A lusterless facial complexion, superficial edema of the face, eyes, and four limbs, abdominal distention and fullness, low back and knee soreness and weakness, lack of strength, heel pain, chilled limbs, hot face, dry mouth, parched throat, scanty urination or blocked urination, possible suspended rheum, chest and lateral costal distention and fullness, rapid breathing, dyspnea and cough, phlegmy rales, essence spirit dejection, a pale tongue with scanty coating, a fat, tender tongue, and a deep, fine, weak pulse. To the basic formula, Radix Lateralis Praeparatus Aconiti Carmichaeli (Fu Zi), Ramulus Cinnamomi (Gui Zhi), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Sclerotium Poriae Cocos (Fu Ling), Herba Epimedii (Yin Yang Huo), Semen Cuscutae (Tu Si Zi), and Fructus Psoraleae Corylifoliae (Bu Gu Zhi) were added. This pattern is mostly seen in SLE patients with kidney, spleen, and lung damage.
Wind damp heat impediment pattern: Mainly joint and muscle and flesh symptoms, swelling, distention, soreness, and pain of the large and small joints, soreness, pain, and discomfort of the muscles and flesh, possible low-grade fever, a red tongue with a coarse, yellow coating, and a slippery, rapid or fine, rapid pulse. To the basic formula, Ramulus Mori Albi (Sang Zhi), Radix Gentianae Macrophyllae (Qin Jiao) , Gypsum Fibrosum (Shi Gao), Caulis Lonicerae Japonicae (Ren Dong Teng), and Radix Clematidis Chinensis (Wei Ling Xian) were added. This pattern is mostly seen in lupus patients with joint damage.
One packet of this formula with additions and subtractions based on pattern discrimination was administered each day with 30 days equaling one course of treatment. If there were no obvious improvements after 2-3 such courses, treatment was discontinued. The shortest duration of treatment in this group was one course and the longest was five courses. Sixteen patients received one course, 19 patients received two courses, 36 patients received three courses, 33 patients received four courses, and 16 patients received five courses. Each week of treatment the patients had their blood and urine examined and every two weeks had their liver function and sedimentation rates checked. Every month, they also received ultrasonography, electrocardiograph, and an immunology examination.

Definitions of treatment outcomes:

Cure meant that the clinical symptoms and various examinations all returned to normal and that there was no recurrence on follow-up after one year. Marked effect meant that the clinical symptoms and the various examinations all returned to normal. Some effect meant that the clinical symptoms obviously diminished but, although some of the examinations improved, they did not return to normal. No effect meant that there was no marked improvement in either the clinical symptoms or the various examinations.

Treatment outcomes:

Of this group of 120 patients, 37 cases or 30.83% were cured, 43 cases or 35.83% were markedly improved, 34 cases or 28.33% experienced some improvement, and 6 cases or 5% experienced no result. Thus the total effectiveness rate was 95%.

The highest rates of success were with the spleen-kidney yang vacuity and evil heat damaging the liver patterns, while treatment was least effective for those with the patterns of heat toxins blazing and exuberant and wind damp heat impediment. Heat toxins blazing and exuberant is associated with the acute phase of lupus, while wind damp heat impediment pattern is associated with damp retained in joints and lingering damp evils are difficult to treat.

Before treatment with the above Chinese medicinals, 82 cases took orally 10-30mg of cortisone. After treatment, all these patients were able to stop taking steroids. There were 26 other patients who were taking cortisone in excess of 30mg. After treatment, 16 of these were able to stop using steroids, while the other 10 patients used 10mg or less per day.

The second report comes from "Experiences Treating Acute Stage Skin Damage in Systemic Lupus Erythematosus by the Methods of Cooling the Blood, Resolving Toxins, Eliminating Dampness & Scattering Stasis" by Sun Feng-qin et al., Zhong Yi Za Zhi (Journal of Chinese Medicine), #8, 1995, p. 484-485. Beginning in 1993, the authors saw 10 patients with lupus as both in-patients and out-patients. They mainly had varying degrees of face and whole body edematous, fresh red macules, purple red macules, or subcutaneous nodulations accompanied by varying degrees of fever, joint pain, lymphadenopathy, reduced whole blood, increased blood sedimentation, and organic damage. The greater part of these patients had been administered steroids with no marked result. Because they did not want to take increased doses of steroids, they asked to be treated by Chinese medicinals.

Based on their signs and symptoms, all these patients were categorized as blood division heat toxins blazing and exuberant mixed with dampness and stasis. Therefore, they were treated mainly by cooling the blood and resolving toxins, eliminating dampness and scattering stasis. In most of these cases, within one week of treatment, their psyches improved and their temperature decreased. Within 1-2 weeks, their joint pain and lymph node enlargement had receded. And within 1-3 weeks, their skin damage had receded and various laboratory examinations had moved towards normal.

Representative case history:

The patient was a 26 year-old, female worker. She had had a skin rash on her upper arm and head for more than one year, while she'd had red macules on her face accompanied by burning joint pain for half a year. In the week before her initial examination, she had had a headache with nausea and vomiting which had gotten gradually worse, and this had brought her to the hospital. At the time she entered the hospital, she had a low-grade fever, lack of strength, migratory joint pain which was difficult to endure and which restricted her activity, severe headache, occasional nausea and vomiting, torpid intake, heart palpitations, profuse dreaming, easy fright, and a rash on the skin of her face which was itching and painful. Her temperature was 37.5øC. Her pulse was 100 beats per minute. Her blood pressure was 14/10Kpa. She was emotionally depressed, sometimes vexed and agitated, and had generalized lymphadenopathy. Her face, cheeks, and both ears had purplish red or dark red colored, edematous macules and there were 7-8 subcutaneous nodules 1cm x 2cm around her nose, lips, and philtrum. These were markedly painful to the touch. There were also 10 painful subcutaneous nodules on both upper arms which were 1cm x 3cm, as well as a number of nodules, mostly brown in color, on the front of the chest. Her tongue tip was red and there were static macules on the tongue with a slimy, yellow coating. Her pulse was fine and rapid. Serological examination showed that the hemoglobulin was 10%, RBCs were 3.6 x 10(12)/L, WBCs were 3.1 x 10(9)/L, and the sedimentation rate was 58mm/hour. Antinuclear antibodies (ANA) were 1:320. She was diagnosed as suffering from SLE and her pattern was categorized as blood heat toxin exuberance, dampness and stasis mutually binding.

Therefore, the treatment principles were to cool the blood and resolve toxins, quicken the blood and disinhibit dampness assisted by the simultaneous boosting of qi. The medicinals used were: Herba Oldenlandiae Diffusae (Bai Hua She She Cao), 30g, Fructus Forsythiae Suspensae (Lian Qiao), 15g, Radix Scutellariae Baicalensis (Huang Qin), 15g, Radix Salviae Miltiorrhizae (Dan Shen), 20g, Cortex Radicis Moutan (Dan Pi), 15g, Radix Rubrus Et Albus Paeoniae Lactilforae (Chi Bai Shao), 10g ea., Flos Rosae Rugosae (Mei Gui Hua), 10g, Semen Plantaginis (Che Qian Zi), 10g, wrapped, Sclerotium Poriae Cocos (Fu Ling), 20g, Radix Gentianae Macrophyllae (Qin Jiao), 15g, Caulis Milletiae Seu Spatholobi (Ji Xue Teng), 30g, uncooked Radix Astragali Membranacei (Huang Qi), 30g.

One packet was decocted in water and administered each day for a total of three packets. After three days, her fever receded, her headache and vomiting stopped, and all her symptoms decreased. Administration was continued for one week, after which time the joint pain had disappeared, her activity was back to normal, and her psyche had improved. The color of her red skin macules darkened and the nodular pain decreased. After she had resided in the hospital for one half month, her symptoms were much reduced. At this time, the nodulations on her chest and upper arms had gradually gotten smaller and no new ones appeared. Her lymph node enlargement disappeared. Her tongue was red with scanty fluids but its slimy coating had become thin. Thus boosting the qi and nourishing blood ingredients were added to the previous formula to support the righteous. After residing in the hospital for three weeks, the subcutaneous nodulations on her upper arms and front of her chest completely disappeared as did the one on her face. After one month, her skin damage was cured, her symptoms were gone, and laboratory examinations (including ANA) were all normal. After four months, there had not been any recurrence.

Conclusion:

In treating Westerners with lupus erythmatosus with Chinese medicine, most of my patients have had a combination of wind damp heat impediment with spleen qi and kidney yin vacuities universally complicated by liver depression qi stagnation and sometimes complicated by blood stasis and/or phlegm nodulation. When Chinese herbal medicine is correctly prescribed based on an individual pattern discrimination and combined with appropriate diet and lifestyle modifications, it can remit the signs and symptoms of this disease and help keep patients in remission for long periods of time. Again according to my own experience, when remittent patients become active again, it is typically due to some combination of faulty diet, stress, and over-taxation.

Townsend Letter for Doctors & Patients.

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By Bob Flaws

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