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Will Morris

 

Subject:

Re: Herbs for Lupus

Date:

Mon, 27 Dec 1999 15:50:01 -0800

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Systemic Lupus Erythematosus

Diagnosis and Treatment

© 1994 William Robert Morris O.M.D. L.Ac.

 

Western Diagnosis and Treatment

 

Diagnostic Features:

*Occurs Mainly in young women

*Rash over areas exposed to sunlight

*Joint Symptoms in 90% of patients

*Multiple system involvement

*Depression of hemoglobin white blood cells and platelets

*Antinuclear antibody with a high titer to native DNA

 

According to the American Rheumatism Association, a diagnosis of SLE can

 

be made with reasonable probability if 4 of the following 11 criteria

are present simultaneously or serially, during any interval of

observation: malar rash, discoid rash, photosensitivity, oral ulcers,

non-erosive arthritis, serositis, renal disorder, neurologic disorder,

hematologic abnormality (hemolytic anemia, leukopenia, lymphopenia, or

thrombocytopenia), immune dysfunction (positive LE preparation,

antinative DNA, false-positive syphilis serologic tests over 6 months),

and positive antinuclear antibody.

 

Demographics:

SLE appears most commonly in young women ages 13-45. More than 16,000

Americans develop Lupus each year with an estimated 500,000 currently

suffering. 90% of all cases reported are female. Lupus strikes 1 in 400

white woman and 1 in 250 black women, it is also common in China; all

races can be subject.

 

Prognosis:

The 10 year survival rate is exceeding 85% according to recent reports.

In most patients, the disease pursues a mild course with occasional

flaring of activity. The severity of the disease tends to diminish with

time. It is common to find normal lab levels after five years.

 

Standard Western Therapies:

Aspirin and other NSAIDs are used to treat the milder symptoms of

Lupus, such as joint pain, fever, etc.. The problem here is increased

permeability of the gastric mucosa. This increases the likelihood of

large size protein molecules crossing the gut-immune barrier. This

renders NSAIDs inefficient as a long term solution due to

antigen-antibody increased musculoskeletal inflammation. Antimalarial

drugs are being used to treat skin lesions, although side effects such

as visual disturbances and nausea can occur in the course of prolonged

treatment (possible use of Artemisia ching hao?). The standard drug

treatment for the more severe SLE is corticosteroid therapy, most

commonly prednisone. Side effects can include acne, sleep disturbances

with resulting fatigue and irritability, personality changes,

susceptibility to infections, weight gain, and symptoms similar to

Cushing's Disease (moon-like face, changes in posture, high blood

pressure, diabetes, absence of menstruation, purple skin markings,

etc.). Prolonged, intensive corticosteroid therapy can also cause

psychiatric disturbances known as " steroid psychosis. " This can mimic

psychosis due to Lupus' effects on the central nervous system and may be

 

difficult to distinguish from it. Other possible side effects of

long-term steroid use are osteoporosis or osteonecrosis.

 

Oriental Medicine: Diagnosis and Treatment of SLE

 

Professor Ding Jie Ming's Treatment of SLE

 

SLE was not described in classic literature other than as fragments of

internal or external syndromes. Professor Ding Jie Ming has treated over

 

500 SLE patients during the course of 5 years. According to Professor

Ming, etiological factors considered in the development of SLE include

wind, damp, and cold. The result of this is slow developing inflammation

 

of the joints. The pathogenesis then progresses into the tissues of

skin, nerves, and blood. Focus of the therapy is adjusted according to

the location of the internal SLE lesions.

 

The following are the treatment protocols given by Professor Ming in

lecture sponsored by the Research Institute of .

 

Base Formula:

Cinnomomi cassiae Ramulus (Gui Zhi)

Bupleurum chinense (Chai Hu)

Lycopodium clavatum (Shen Jin Cao)

Glycyrrhiza uralensis (Gan Cao)

 

For lesions in the brain and CNS, add Cicada periostricum (Chan Tui) and

 

Polygala tenuifoliae (Yuan Zhi) to the base formula.

 

Liver lesions:

For severe headache (wind) add Uncariae cum uncis (Gou Teng) and Peonia

alba (Bai Shao).

To tonify yin add Ecliptae prostatae (Han Lian Cao), Ligustri lucidii

(Nu Zhen Zi), Scrophularia ningpoensis (Xuan Shen), and Haliotidis

concha (Bao Yu).

For hypochondriac pain add Scutellaria baicalensis (Huang Qin), Moutan

radicis (Mu Dan Pi), Cyperi rotundis (Xiang Fu Zi).

 

Spleen lesions:

 

1.If the Spleen is enlarged add Coptis chinensis (Huang Lien),

Atractylodes macrocephala (Bai Zhu), and Hordeum vulgaris (Mai Ya).

 

2.For diarrhea or loose stool remove Scrophularia ningpoensis (Xuan

Shen). Add Dioscorea oppositae (Shan Yao), Massa fermentata (Shen Qu),

Saussurea lappa (Mu Xiang), Carbonized Zingiberis officinalis (Gan

Jiang), and Atractylodes macrocephala (Bai Zhi).

 

3.For severe dampness of the spleen, subtract Scrophularia ningpoensis

(Xuan Shen); add Coicis lachryma-jobi (Yi Yi Ren) and Atractylodes

macrocephala (Bai Zhi).

 

4.For thin muscles and fatigue add Astragalus membranaceus (Huang Qi),

Angelica sinensis (Dong Gui), Lycopi lucidus (Ze Lan), and Salvia

miltiorrhiza (Dan Shen).

 

Lung lesions:

 

Add Ephedra (Ma Huang), Peucedani praeruptorum (Qian Hu), Platycodon

grandiflorum (Jie Geng), and Polygala tenuifolia (Yuan Zhi) to open the

lungs, and dissolve phlegm.

 

When Lung is inflamed, add Cortex of Mori alba radicis (Sang Bai Pi).

 

Coughing blood add Ophiopogonis japonicus (Mai Men Dong), Nelumbinis

nucifera (Lotus Root or Ou Jie), Biota orientalis (Bai Zi Ren), Caucumen

 

biota (Ce Bai Ye).

 

Skin lesions:

Use Astragalus membranaceus (Huang Qi), Angelica sinensis (Dong Gui),

and Clematidis chinensis (Wei Ling Xian). The treatment strategy is to

nourish Qi and Blood, and disperse wind.

 

Ascites: Areca catechu Shell (Da Fu Pi) to relieve damp.

 

When the lesion is in the kidney, Warm the Yang, Expel Wind, and Benefit

 

the Kidney.

Xien Ling Pi is the base formula for this: Aconite carmichaeli (Zhi

Chuan Wu), Lycopodium clavatum (Shen Jin Cao), Scrophularia ningpoensis

(Xuan Shen), Glycyrrhiza uralensis (Gan Cao), Cinnamomi cassia Ramulus

(Gui Zhi), Atractylodes alba (Bai Zhu), Astragalus membranaceus (Huang

Qi), Coicis lachryma-jobi (Yi Yi Ren), Achyranthes bidentatae (Niu Xi),

Chaenomeles lagenaria (Mu Gua).

 

Modification for Yang Deficiency: subtract Scrophularia ningpoensis

(Xuan Shen). Add Achyranthes bidentatae (Niu Xi), Cistanches salsa (Rou

Cong Rong), Eucommia ulmoidis (Du Zhong), Aconite carmichaeli (Fu Zi).

Modification for Yin Deficiency: increase Scrophularia ningpoensis (Xuan

 

Shen) and add Rehmannia glutinosae Raw (Sheng Di Huang).

 

Proteinuria: add Astragalus membranaceus (Huang Qi), Atractylodes alba

(Bai Zhu), Zea mays (Yu Mi Shu), Coicis lachryma-jobi Radix (Yi Yi Ren

Gen), and Blackbeans.

 

Elevated BUN:

Add Achyranthes bidentatae (Niu Xi), Chaenomeles lagenariae (Mu Gua).

 

For Heart Lesions: make the following modifications to the above kidney

based formulas.

 

Heart Yin deficiency

add more Scrophularia ningpoensis (Xuan Shen); also add Ophiopogonis

japonicus (Mai Men Dong), Polygonum multiflori Caulis (Ye Jiao Teng),

Biota orientalis (Bo Zi Ren), and Schisandra chinensis (Wu Wei Zi).

 

Heart Yang deficiency

remove Scrophularia ningpoensis (Xuan Shen); add Aconite carmichaeli Cx

(Fu Zi), Salvia miltiorrhiza (Dan Shen), Catharsius malosis (Chiang Lian

 

Chung) , Acori graminei (Chang Pu), and Polygalae tenuifolia (Yuan Zhi).

 

Practical Surgery of gives three differentials for

Lupus they are:

 

1.Yang deficiency of Spleen and Kidney presenting with a cluster of the

following; mild erythema, bluish-brown subcutaneous purpura, chills,

cold extremities, mild fever, aching in the joints, low back pain,

sparse hair, irregular menses, fatigue, perspiration, weakness of the

arms and legs, edema, loss of appetite, muddy stools, scanty urine,

swollen tongue, weak pulse.

2.Yin Deficiency with Internal Heat has a cluster of the following;

constant low-grade fever, skin injuries, occasional erythema,

palpitations, insomnia, dry mouth, dry throat, vertigo, tinnitus, joint

aching, low back pain, night sweats, significant hair loss, irregular

menses, dry stool, yellow urine, a red tongue with a thin yellow coat,

and a thready rapid, tense pulse.

3.Excess Toxic Heat symptom clusters may be; fresh erythema, hemorrhagic

 

blisters, purpura under nails or on conjunctiva, high fever,

irritability, fainting, thirst, constipation, decreased urine, red

tongue with thin dry yellow coat, and a tense rapid pulse.

 

1.For Spleen-Kidney Yang Deficiency use Eucommia and Rehmannia Formula

(You Gui Wan) as general treatment. A specific formula used contains

Curculiginis orchioides (Xian Mao) 15g, Epimedium sagittatum (Yin Yang

Huo) 15g, Cuscuta chinensis (Tu Si Zi) 15g, Cynomorium coccineum (Suo

Yang) 9g, Atractylodes alba (Bai Zhu) 9g, Codonopsis pilosula (Dang

Shen) 9g, Smilax glabra (Tu Fu Ling) 30g, Glycerrhizae uralensis (Gan

Cao) 6g, Antelopis cornu (Ling Yang Jiao) 3g. Goat horn is a possible

replacement for antelope.

2.For yin deficient internal heat use Rehmannia glutinosae (Shou Di

Huang) 18g, Scrophularia ningpoensis (Xuan Shen) 12g, Ophiopogon

japonicus (Mai Men Dong) 12g, Peonia alba (Bai Shao) 9g, Testudinis

plastrum (Gui Ban) 18g, Lycium chinensis (Gou Qi Zi) 15g, Anemarrhena

asphodeloides (Zhi Mu) 9g, Phellodendron amurense (Huang Bai) 9g, Smilax

 

glabra (Tu Fu Ling) 30g, Rubus parvifolius (Ci Bo) 15g, Glycyrrhizae

uralensis (Gan Cao) 3g.

3.For Excess Toxic Heat use Rehmannia glutinosae Fresh (Sheng Di Huang)

 

30g, Peonia alba (Bai Shao) 12g, Moutan radicis (Mu Dan Pi) 9g, Gypsum

fibrosum (Shi Gao) 30g, Anemarrhena asphodeloides (Zhi Mu) 9g, Isatis

tinctoris (Ban Lan Gen) 9g, Lithospermum erythrorhizon (Zi Cao) 9g,

Glycerrhizae uralensis (Gan Cao) 3g.

 

For severe aching of the joints, add Polygoni cuspidatum (Hu Chang) 15g

and Clematis chinensis (Wei Ling Xian) 12g.

 

For purpura, add Ecliptae prostratae (Han Lian Cao) 15g.

 

As is true for most clinical situations, treat what you find. Patients

have had remarkable improvement using simple patent Yin Tonics when

appropriately indicated.

 

Classic Formulas Used in the Treatment of SLE

 

Clematis and Stephania Combination (Shu Jing Huo Xue Tang): Activates

Blood, Dispels Wind and Dampness. Use for pain in

muscles, nerves, joints (esp. below the waist) and purpura.

Angelica sinensis (Dang Gui) 2g

Peonia alba (Bai Shao Yao) 2.5g

Ligustici wallichi or Cnidium (Chuan Xiong) 2g

Rehmannia glutinosa (Shou Di Huang) 2g

Persica (Tao Ren) 2g

Poria cocos or Hoelin (Fu Ling) 2g

Atractylodes alba (Bai Zhu) 2g

Citri leiocarpae (Chen Pi) 1.5g

Notopterygii incisium (Qiang Huo) 1.5g

Angelica dahurica (Bai Zhi) 1g

Clematis chinensis (Wei Ling Xian) 1.5g

Stephania tetrandra (Fang Ji) 1.5g

Gentiana scabrae (Long Dan) 1.5g

Sileris or Ledebouriella (Fang Feng) 1.5g

Achyranthes bidentata (Niu Xi) 1.5g

Zingiberis recens (Sheng Jiang) 1.5g

Glycyrrhiza uralensis (Gan Cao) 1g

 

Stephania and Carthamus Combination (Shu Feng Huo Xue Tang): Activates

Blood, Dispels Dampness, Opens the Channels, Clears Heat and removes

Phlegm. Use for pain in the muscles, nerves, joints, purpura. There is

stabbing pain and the joints are red and swollen.

Clematis chinensis (Wei Ling Xian) 2.5g

Arisaema consanguineum (Tian Nan Xing) 2.5g

Atractylodes lancea (Cang Shu) 2.5g

Notopterygii incisium (Qiong Huo) 2.5g

Angelica sinensis (Dang Gui) 2.5g

Ligustici wallichi or Cnidium (Chuan Xiong) 2.5g

Stephania tetrandra (Fang Ji) 2.5g

Phellodendron amurense (Huang Bai) 2.5g

Carthamus tintoris (Hong Hua) 1g

Cinnamomi cassia (Gui Zhi) 2.5g

Zingiberis recens (Sheng Jiang) 1g

 

Bupleurum and Rehmannia Combination (Chai Hu Qing Gan Tang): Cool the

Blood, Dispel Wind Heat, Clean the Liver. Use for adenopathy, skin rash,

 

pleurisy; to improve physical condition. A classic abdominal

conformation for this formula is tight rectus abdominus muscles and

flaccid tissue below the naval.

Bupleurum falcatum (Chai Hu) 2g

Platycodon grandiflori (Jie Geng) 1.5g

Glycyrrhiza uralensis (Gan Cao) 1.5g

Mentha haplocalyx (Bo He) 1.5g

Arctium lappa (Niu Bang Zi) 1.5g

Forsythia suspense (Lian Qiao) 1.5g

Trichosanthes kirlowii Rt (Gua Lou Gen) 1.5g

Scutellaria baicalensis (Huang Qin) 1.5g

Coptidis chinense (Huang Lian) 1.5g

Phellodendron amurense (Huang Bo) 1.5g

Gardenia asphodeloides (Zhi Zi) 1.5g

Angelica sinensis (Dang Gui) 1.5g

Peonia alba (Bai Shao Yao) 1.5g

Rehmannia glutinosa raw (Sheng Di Huang) 1.5g

Ligustici wallichi or Cnidium (Chuan Xiong) 1.5g

 

Tang Kuei and Astragalus Combination (Dang Gui Bu Xue Tang): Blood

Deficiency with Qi Deficiency. There is a red face, irritability, thirst

 

with preference for warm beverages, hot sensation in the muscles, pale

tongue, fidgeting, the pulse is large and empty.

The red face is due to heat generating in the presence of blood

deficiency.

Astragalus membranaceus (Huang Qi) 30g

Angelica sinensis (Dang Gui) 6g

 

Jujube Combination (Shi Zao Tang): Dispel Water Stagnation. Used for

Uremia from SLE. This is a very strong, toxic formula due to the

Euphorbia content (Gan Sui & Da Ji). It should be used only for a strong

 

constitution, under control and if absolutely necessary. Begin

administering the formula in small amounts initially, then gradually

increase the dosage.

Euphorbia kansui (Gan Sui) 1g

Daphne genkwa (Yuan Hua) 1g

Euphorbia pikinensis (Da Ji) 1g

Zyziphi jujube (Da Zao) 4g

Minor Bupleurum Combination (Xiao Chai Hu Tang): Sooth the Liver,

Cleanse the Gallbladder, Tonify Spleen, Half Internal Half External

(Shao Yang) condition. Use for chest distension, pain below the ribs and

 

a tubercular constitution. Add Cinnamon and Hoelin Formula (Gui Zhi Fu

Ling Wan) with blood stagnation. Add Hoelin Five Combination (Wu Ling

San) with fluid stagnation and wind attack.

Xiao Chai Hu Tang

Bupleurum falcatum (Chai Hu) 7g

Scutellaria baicalensis (Huang Qin) 3g

Pinellia ternata (Ban Xia) 5g

Zingiberis recens (Sheng Jiang) 4g

Panax ginseng (Ren Shan) 3g

Zyziphi jujube (Da Zao) 3g

Glycyrrhiza uralensis (Gan Cao) 2g

 

Gui Zhi Fu Ling Wan

Cinnamomi cassia (Gui Zhi) 4g

Moutan radicis (Mu Dan Pi) 4g

Paonia alba (Shao Yao) 4g

Prunus persica (Tao Ren) 4g

Poria cocos or Hoelen (Fu Ling) 4g

 

Wu Ling San

Poria cocos (Fu Ling) 5g

Atractylodes alba (Bai Shu) 4g

Panax ginseng (Ren Shen) 3g

Citri leiocarpae (Chen Pi) 3g

Autantii immaturis (Zhi Shi) 1.5g

Zingiberis recens (Sheng Jiang) 3g

 

Bupleurum & Schizonepetae Combination (Shi Wei Bai Du San): Dispel Wind

and Detoxify. Bupleurum conformation (full, tender and tight below the

ribs) plus skin rash or boil.

Bupleurum falcatum (Chai Hu) 3g

Zingiberis recens (Sheng Jiang) 1g

Schizonepeta tenuifolia (Jing Jie) 1g

Siler or Ledebouriella (Fang Feng) 2g

Prunus serotina (Ouhi) 3g

Angelica duhuo (Du HUo) 2g

Poria cocos (Fu Ling) 2g

Platycodon grandiflori (Jie Geng) 3g

Glycyrrhiza uralensis (Gan Cao) 1g

Ligustici wallichi or Cnidium (Chuan Xiong) 3g

 

Research From China

 

Treatment principles being researched in China include: dispel noxious

heat from blood, replenish the vital essence, invigorate blood

circulation and resolve the stagnation. Salvia miltiorrhiza and Lonicera

 

japonica are two typical herbs used in these studies. There was an

effectiveness rate of 92% for 230 SLE patients treated with TCM and

corticosteroids, 85% for 76 patients treated with TCM alone, 79-89% for

rash, trichomadesis, oral or nasal pharynx ulcer patients. The ANA titer

 

was decreased markedly for 75% patients. TCM had no side effect and

could take in part the place of hormone in dosage and lessen its side

effect.

 

 

Sixty-two cases of systemic lupus erythematous (SLE) were treated with

Gentiana Combination. 5 tablets three times per day or 10 tablets twice

per day and prednisone 10-30 mg per day were reported. As controls, 19

cases of SLE were treated with prednisone alone at the same time. The

results showed complete remission in 86.46% (50/62) cases in the

observation group and 31.57% (6/19) cases in the control group. Eight

cases of SLE treated with Gentiana Combination alone also achieved

complete remission in 6 cases and improvement in 2. There was very

significant statistical difference between the two groups (P less than

0.001). The Gentiana Combination was more effective on the improvement

of nephropathy, arthralgia, erythema and restoration of ESR, LE cells

and CH50, C3 than prednisone alone. No apparent side effects of Gentiana

 

Combination were found in this observation.

 

Food Therapies

 

As SLE can be considered a rheumatic condition, the use of foods for

wind, cold, damp and heat are indicated.

 

For Cold type arthritis: garlic, green onions, pepper, black beans,

sesame seeds, chicken, lamb, mustard greens, ginger, spicy foods,

grapes, grape vine tea, parsnip. Avoid cold foods, raw foods and cold

weather.

 

For Wind type arthritis: scallions, grapes, grapevine tea, black beans,

most grains, green leafy vegetables. Avoid meats, shellfish, sugar,

alcohol, smoking and stimulants.

 

For Damp type arthritis: barley, mung beans, mustard greens, red beans,

millet, sweet rice wine with meals, cornsilk tea; diuretic foods and

herbs. Avoid cold foods, raw foods, and dairy products.

 

For Heat type arthritis: fresh fruits and vegetables, dandelion,

cabbage, mung beans, winter melon, and soybean sprouts. Avoid spicy

foods, alcohol, smoking, stress, green onions, and red meat.

 

General Dietary Recommendations:

 

1.Avoid food sensitivities: particularly chicken, seafood, and pickles.

Dairy, spinach, asparagus, rhubarb, vegetables from the nightshade

family: tomatoes, green peppers, potatoes, pimentos, and eggplant;

coffee, caffeine, sugar, refined foods, and fried foods.

 

2.Eat a low calorie, low fat diet. Mouse model studies clearly show

benefit from this diet, suggesting that the same would be true for

humans.

 

3.Limit beef and dairy, the same study as number two above, suggesting

benefits to humans in Lupus.

 

 

4.Consume ample sesame seeds, kale, artichokes, green beans, millet,

celery, barley, okra, almonds, collards, turnip greens, raw goat's milk,

 

goat whey and black mission figs, gelatin (make a gelatin mold with

cherry concentrate no sugar), burdock root, cherries, pineapple,

quince, watercress, blackberries, black currants, mustard greens, limes,

 

lettuce, olive oil.

 

5.Avoid alfalfa as it may aggravate Lupus, or possibly create a

Lupus-like syndrome. L-canavanine sulfate, a constituent of alfalfa was

incorporated into the diet and reactivated the syndrome.

 

Other considerations in the treatment of Lupus.

 

There are at least 37 published references for the use of Centella

asiatica (Gotu Kola or Zhi Xue Cao) in the treatment of Lupus. It

appears as though Centella's prime action is on the connective tissue.

 

The use of Omega 3 fish oils (EPA) also show to be promising in

rheumatic conditions and autoimmune problems. Interestingly, over the

counter snake oil remedies purchased in Chinatown have been shown to

contain 20% EPA. Apparently, the snake being cold blooded, produces

Omega-3 essential fatty acids as an adaptation response to cold

temperatures.

 

In my personal experience, all rheumatic conditions respond better when

combined with topical oleation therapy. Using a sesame oil as a base,

add a powder of the indicated formula and apply regularly.

 

Hydrochloric Acid deficiency can be a factor in the Lupus picture. Out

of 9 patients with Lupus erythematosus, none had normal HCL levels, 2

had no detectable HCL. Deficiency of HCL is best quantified with the

use of a Heidelberg Gastrometer (the swallowing of a capsule which

measures HCL). Jonathan Wright, M.D. offers a provocation determinant

for HCL: On three consecutive mornings, take one, two then three HCL

tablets on an empty stomach. If there are no adverse reactions then use

one or two tablets of HCL with each meal for a week. If there is some

improvement, you have a confirmative result. If there are GI distress

symptoms, discontinue the HCL, as there is ample. If there is too strong

 

a reaction, it can be neutralized with baking soda or milk. Remember not

 

to use HCL with Aspirin or other NSAIDs due to the possibility of

increasing the risk of ulcers.

 

Chemical sensitivities should also be ruled out as Lupus patients have

been shown to have higher than normal levels of sensitivity to foods and

 

other substances. 4 patients with SLE developed remissions when given an

 

elimination diet and nutritional supplementation. Another 70 patients

with Lupus and Lupus-like syndromes showed similar improvement.