NOTES FROM OVERHEADS: Lupus
The Treatment of Lupus Can Be Divided Into Six Patterns:
1. Heat Evil Blazing:
Main symptoms: A high fever or a continuous fever which will not recede, the emission of red macules or edematous red macules on the skin of the facial region, if severe, these
lesions may be large or they may be blood blisters, muscle and joint aching and pain.
Treatment principles: Clear heat and resolve toxins, cool the Blood and nourish Yin, transform stasis and disperse macules.
RX: Qing Wen Bai Du Yin Jia Jian
Ingredients: Shi Gao (Gypsum) 60,
Shui Niu Jiao (Cornus Bubalus bubalis) 30;
Zhi Mu (Rz Anemarrhena asphodeloides),
Huang Lian (Rz Coptis),
Zhi Zi (Fr Gardenia jasminoides),
Lian Qiao (Calyx Forsythia suspensa),
Xuan Shen (Rx Scrophularia), 15 each;
Sheng Di Huang (Rz Rehmannia glutinosa),
Mu Dan Pi (Cx Paeonia suffruticosa radicis),
Chi Shao (Rx Paeonia veitchii/rubra),
Dang Gui (Rx Angelica sinensis),
Dan Zhu Ye (Folium Lophatherum),
Jie Geng (Rx Platycodon),
Gan Cao (Rx Glycyrrhiza), 9 each.
Analysis of formula: Shi Gao (Gypsum) and Zhi Mu (Rz Anemarrhena asphodeloides) clear heat from the Qi stage, Shui Niu Jiao (Cornus Bubalus bubalis), Xuan Shen (Rx
Scrophularia), Sheng Di Huang (Rz Rehmannia glutinosa), Mu Dan Pi (Cx Paeonia suffruticosa radicis) and Chi Shao (Rx Paeonia veitchii/rubra) clear Blood heat. Huang Lian (Rz Coptis), Huang Qin (Rx Scutellaria baicalensis), Zhi Zi (Fr Gardenia jasminoides) and Lian Qiao (Calyx Forsythia suspensa) clear heat and resolve toxins. Dan Zhu Ye (Folium Lophatherum) generates fluids; Mu Dan Pi (Cx Paeonia suffruticosa radicis), Chi Shao (Rx Paeonia veitchii/rubra) and Dang Gui (Rx Angelica sinensis)
activate Blood; Jie Geng (Rx Platycodon) guides herbs to the skin. Sheng Di Huang (Rz Rehmannia glutinosa) nourishes Yin; Gan Cao (Rx Glycyrrhiza) harmonizes. Modification: For dry stool, add Da Huang (Rx Rheum); for high fever that will not recede, add 0.3-0.5 g Ling Yang Jiao (Cornus Antelopis/Saiga); for low-grade fever, add
Yin Chai Hu (Rx Stellaria) and Di Gu Pi (Cx Lycium radicis) . For bleeding, add Ou Jie (Nodus Nelumbo rhizomatis), Bai Mao Gen (Rz Imperata), Xian He Cao (Hb Agrimonia) or Ce Bai Ye (Folium Biota/Platycladus) depending on the site and cause of the bleeding. For arthralgia, add Qin Jiao (Rx Gentiana macrophylla) and Du Huo (Rx Angelica pubescens f. biserrata). For severe thirst, add Mai Men Dong (Tb Ophiopogon), Shi Hu (Hb Dendrobium) and Yu Zhu (Rz Polygonatum odoratum). For erythema, add Zi Cao (Rx Lithospermum).
Acupuncture: Shi Xuan, LI 4, UB 40, PC 3, DU 10. DU 10 is an empirical treatment for skin disease due to heat. Modifications: If there is spirit clouding, add Du 26;
constipation, add SJ 6; high fever, LI 11, DU 14, SJ 5; dark purple skin lesions, SP 6, SP 10, LI 11. For muscle and joint aching and pain, GB 34, GB 39. For severe lack of
strength, use ST 36; for vexation or agitation, use PC 7.
2. Liver Wind Stirring:
Main symptoms: Persistent high fever, vexation, agitation, restlessness, deranged speech, crying and laughing, possible convulsions or seizures, possible spirit clouding, hemi- or paraplegia, urinary incontinence or retention, yellow coat, wiry, rapid or wiry fine pulse.
This stage should be treated with combination of TCM and western medicine.
Treatment principle: Clear Liver, extinguish wind, quiet the spirit.
RX: Ling Yang Gou Teng Tang Jia Jian
Ingredients:
Sheng Di Huang (Rz Rehmannia glutinosa) and Shi Jue
Ming (Concha Haliotis), 30 each; Chuan Bei Mu (Bb
Fritillaria cirrhosa), Zhu Ru (Caulis Phyllostachys) and Fu
Shen (Sclerotium Poria cocos pararadicis), 15 each; Ju Hua
(Fl Chrysanthemum morifolium), Bai Shao (Rx Paeonia
lactiflora/alba) and Gou Teng (Ramulus cum Uncis
Uncaria), 12 each; Sang Ye (Folium Morus)--6, Shan Yang
Jiao (Cornus Naemorhedis)--3.
Analysis of formula: Shan Yang Jiao (Cornus
Naemorhedis) and Gou Teng (Ramulus cum Uncis
Uncaria) settle the Liver and extinguish wind. Shi Jue Ming
(Concha Haliotis) heavily settles and subdues counterflow.
Sang Ye (Folium Morus), ju hea, Gou Teng (Ramulus cum
Uncis Uncaria) clear the Liver. Zhu Ru (Caulis
Phyllostachys) clears Liver, eliminates vexation. Fu Shen
(Sclerotium Poria cocos pararadicis) quiets the spirit.
Chuan Bei Mu (Bb Fritillaria cirrhosa) enriches Yin and
transforms phlegm.
Modifications: With high fever, add Shi Gao (Gypsum),
Xuan Shen (Rx Scrophularia), Zhi Mu (Rz Anemarrhena
asphodeloides), and Mai Men Dong (Tb Ophiopogon). For
heat disturbs spirit, add Lian Qiao (Calyx Forsythia
suspensa), yuan zhi, and lian zi xin.
Acupuncture: LIV 3, GB 20, GB 34, LI 11.
Analysis of points: LIV 3 and GB 34 clear and drain the
Liver heat. GB 20 extinguishes wind and opens the orifices.
LI 11 clears heat and abates fever.
Modifications: If there is dizziness, vertigo, agitation, and restlessness, add DU 20 and Yin Tang. For persistent high fever, bleed DU 14 and/or Shi Xuan. For concomitant
phlegm fire, add PC 8 and ST 40. For loss of consciousness, add DU 26.
3. Wind Damp Heat:
Main symptoms: Early stage disease with profuse, severe
joint pain, especially in the fingers, toes, ankles, wrist,
migrating pain of several joints, dry throat, thirst, muscle
aches.
Treatment principles: dispel wind and eliminate dampness,
clear heat and alleviate impediment.
RX: Du Huo Ji Sheng Tang Jia Jian
Ingredients: Shi Gao (Gypsum) 30,
Sang Ji Sheng (Cs Loranthus/Taxillus), 15-30,
Hai Tong Pi (Cx Erythrina) 15,
Qiang Huo (Rx Notopterygium),
Qin Jiao (Rx Gentiana macrophylla),
Wei Ling Xian (Rx Clematis chinensis),
Fang Feng (Rx Saposhnikovia),
Han Fang Ji (Rx Stephania),
Zhi Mu (Rz Anemarrhena asphodeloides), 9 each.
Analysis of Formula: Shi Gao (Gypsum) and Zhi Mu (Rz
Anemarrhena asphodeloides) drain fire and clear heat. Hai
Tong Pi (Cx Erythrina), Qiang Huo (Rx Notopterygium),
Qin Jiao (Rx Gentiana macrophylla), Wei Ling Xian (Rx
Clematis chinensis), Fang Feng (Rx Saposhnikovia) and
Han Fang Ji (Rx Stephania) all dispel wind and eliminate
dampness.
Modifications: If fever abates and only joint pain remains,
Shi Gao (Gypsum) and Zhi Mu (Rz Anemarrhena asphodeloides) should be replaced by Huang Bai (Cx Phellodendron) and Cang Zhu (Rx Atractylodes lancea), add Dang Gui (Rx Angelica sinensis) and Bai Shao (Rx Paeonia lactiflora/alba). For marked fatigue, add Huang Qi (Rx Astragalus) 15 and Dang Shen (Rx Codonopsis) 9.
Acupuncture: LI 11, DU 14, SP 9.
Bleed UB 40 and Shi Xuan to clear heat and abate fever, ifnecessary.
Modifications: For dark, purple skin lesions, add SP 6, SP
10. For agitation, add PC 7.
4. Yin Deficiency with Fire:
Main symptoms: Long-term low-grade fever, five center heat, tidal redness of the facial region, red cheeks, night sweats, spontaneous perspiration, lack of strength. After
stirring or activity more skin lesions on the face, joint aching and pain dizziness. Also tinnitis, falling hair, dry mouth, dry stools, menstrual irregularity in females, a red
tongue and scanty fur, a wiry and rapid pulse.
Treatment Principle: Enrich the Kidneys, nourish Yin,
clear heat.
RX: Da Bu Yin Wan and Si Wu Tang Jia Jian
Ingredients:
Gui Ban (Plastrum Testudinis/Chinemys) and
Bie Jia (Carapax Amyda) 30 each;
Sheng Di Huang (Rz Rehmannia),
Huang Bai (Cx Phellodendron),
Zhi Mu (Rz Anemarrhena) and
Dang Gui (Rx Angelica sinensis), 20 each;
Bai Shao (Rx Paeonia lactiflora/alba),
Chuan Xiong (Rx Ligusticum sinensis cv. Chuanxiong), 9 each.
Analysis of Formula: Gui Ban (Plastrum Testudinis/Chinemys), Bie Jia (Carapax Amyda), Sheng Di Huang (Rz Rehmannia) all supplement the Kidneys and
enrich Yin; Dang Gui (Rx Angelica sinensis) and Bai Shao (Rx Paeonia lactiflora/alba) supplement the Liver and nourish the blood; Gui Ban (Plastrum Testudinis/Chinemys), Bie Jia (Carapax Amyda), Zhi Mu (Rz Anemarrhena) and Huang Bai (Cx Phellodendron)
clear empty heat.
Modifications: If Qi deficiency is severe, add Huang Qi (Rx Astragalus) and Xi Yang Shen (Rx Panax quinquefolius). If night sweats and spontaneous sweating are pronounced, add 30 grams of Long Gu (Os Draconis) and Mu Li (Concha Ostrea). For Spleen vacuity with scanty eating, add 20 grams of Shan Yao (Rx Dioscorea
opposita) and Fu Ling (Sclerotium Poria cocos) and 9 grams of Bai Zhu (Rx Atractylodes macrocephala/alba). For marked tidal heat and vexation heat, add 20 grams of
Shan Yao (Rx Dioscorea opposita) and Fu Ling (Sclerotium Poria cocos) and 9 grams each of Mu Dan Pi (Cx Paeonia suffruticosa radicis), Shan Zhu Yu (Fr Cornus)
and Ze Xie (Rz Alisma), or use Di Gu Pi (Cx Lycium radicis), Tian Hua Fen (Rx Trichosanthes) and Qing Hao (Hb Artemisia annua). For static blood and marked skin
lesions, add Tao Ren (Semen Prunus persica), Hong Hua (Fl Carthamus), Dan Shen (Rx Salvia), Chi Shao (Rx Paeonia veitchii/rubra), Bai Mao Gen (Rz Imperata) and
Ou Jie (Nodus Nelumbo). If Kidney depletion is marked, add Gou Qi Zi (Fr Lycium), Tu Si Zi (Semen Cuscuta), Fu Pen Zi (Fr Rubus), Rou Cong Rong (Hb Cistanches, Huai
Niu Xi (Rx Achyranthes) and He Shou Wu (Rx Polygonum multiflorum).
Acupuncture: KI 7, HT 6, UB 23 and KI 2.
Analysis of points: KI 7 supplements the Kidneys, enriches the Yin and generates fluids. HT 6 nourishes Yin, quiets the spirit and stops sweating. UB 23 supplements the
Kidneys and enriches the Yin. KI 2 clears empty heat.
5. Qi Stagnation and Blood Stasis:
Main Symptoms: cyanosis of the tips of the extremities, purple macules or skin lesions that are disciform, deep or abnormally-colored; scaly, cracked skin, joint and muscle
aches and pains, emotional depression in females with menstrual irregularity, dysmenorrhea or amenorrhea, a purple-red tongue and static, purple, engorged sublingual
veins. This pattern can also be seen in those who have been diagnosed with severe Raynaud’s disease or pronounced vasculitis. Treatment Principle: Activate the blood and transform stasis, rectify the Qi and free the flow in the network vessels.
RX: Xue Fu Zhu Yu Tang Jia Jian
Ingredients:
Sheng Di Huang (Rz Rehmannia),
Tao Ren (Sm Prunus persica),
Hong Hua (Fl Carthamus),
Chi Shao (Rx Paeonia lactiflora/rubra),
Niu Xi (Rx ), 20 each;
Chai Hu (Rx Bupleurum) and
Chuan Xiong (Rz Ligusticum sinensis cv. Chuanxiong), 15 each;
Zhi Shi (Fr Immaturus Citrus aurantium), 9.
Analysis of Formula: Sheng Di Huang (Rz Rehmannia), Tao Ren (Sm Prunus persica), Hong Hua (Fl Carthamus), Chi Shao (Rx Paeonia lactiflora/rubra), Niu Xi (Rx )
and Chuan Xiong (Rz Ligusticum sinensis cv. Chuanxiong) activate the blood and transform stasis. Chai Hu (Rx Bupleurum) and Zhi Shi (Fr Immaturus Citrus aurantium)
move and rectify Qi. Sheng Di Huang (Rz Rehmannia) and Niu Xi (Rx ) nourish the blood.
Modifications: Add Yu Jin (Tuber Curcuma longa), Xiang Fu (Rz Cyperus), Qing Pi (Pericarpium Citrus reticulate viride and Fo Shou (Fr Citrus medica var. sarcodactylis) for emotional depression and sub-chondriac pain. Add Sang Zhi (Ramulus Morus), Gui Zhi (Ramulus Cinnamomum cassia), Qin Jiao (Rx Gentiana macrophylla), Ji Xue Teng
(Cs Spatholobus) and Ren Dong Teng (Ramus/Cs Lonicera) for aching and pain of the extremities and joints. If there is more blood stasis with cyanosis of the tips of the
extremities and greenish-purple skin during the course of a prolonged disease, increase the Chuan Xiong (Rz Ligusticum sinensis cv. Chuanxiong) up to 20 grams, and
add San Leng (Rz Sparganium), 9 g, E Zhu (Rz Curcuma zedoaria), San Qi (Rx Panax notoginseng), Dang Gui (Rx Angelica sinensis) and Mo Yao (Commiphora myrrha), 15
each. For coldness, add Rou Gui (Cx Cinnamomum cassia), Fu Zi (Rx Lateralis Aconitum carmichaelii preparata), Mu Tong (Cs Clematis) and Xi Xin (Hb cum
Radice Asarum). If joint and extremity aching and pain are pronounced, add Bai Hua She She Cao (Hb Hedyotis/Oldenlandia diffusa)
Acupuncture: SP 6, LI 4, UB 17, DU 10. For cyanosis or pain of the tips of the lower extremities, add Ba Feng. For cyanosis of the tips of the upper extremities, add Ba Xie. If there is marked Liver depression, add LIV 3, PC 6, DU 4, LI 11 and SP 9.
6. Spleen and Kidney Deficiency:
Main Symptoms: Cold body, chilled limbs, low-grade fever or tidal heat, lassitude of the spirit, lack of strength, scanty Qi, disinclination to speak, stirring leading to aggravation of these symptoms, torpid intake, abdominal distention, severe vomiting and diarrhea, a somber white or sallow yellow facial complexion, low back and knee soreness and weakness, joint swelling and pain, superficial edema, inhibited urination, skin lesions not marked or possibly purple or dark in color.
Treatment Principle: Supplement the Kidneys and fortify the Spleen, warm the Yang and disinhibit water.
RX: Shen Qi Wan, Si Jun Zi Tang
Ingredients: Rou Gui (Cx Cinnamomum cassia), Fu Zi (Rx
Lateralis Aconitum carmichaelii preparata), 15 g each;
Shan Yao (Rx Dioscorea opposita)—20 g, Fu Ling
(Sclerotium Poria)—30 g,
Bai Zhu (Rx Atractylodes macrocephala/alba),
Ze Xie (Rz Alisma),
Shan Zhu Yu (Fr Cornus),
Mu Dan Pi (Cx Paeonia suffruticosa radicis), 12 g
each; Ren Shen (Rx Panax ginseng),
Gan Cao (Rx Glycyrrhiza), 6 g each.
Analysis of Formula: Rou Gui (Cx Cinnamomum cassia), Fu Zi (Rx Lateralis Aconitum carmichaelii preparata) and Shan Zhu Yu (Fr Cornus), warm and supplement Kidney
Yang. Shan Yao (Rx Dioscorea opposita), Fu Ling (Sclerotium Poria), Bai Zhu (Rx Atractylodes macrocephala/alba), Ren Shen (Rx Panax ginseng) and Gan
Cao (Rx Glycyrrhiza) tonify the Spleen and the Qi. Mu Dan Pi (Cx Paeonia suffruticosa radicis) activates the Blood. Fu Ling (Sclerotium Poria), Bai Zhu (Rx Atractylodes macrocephala/alba) and Ze Xie (Rz Alisma) transform damp and disinhibit water.
Modifications:
For severe nausea and vomiting, add Sheng Jiang (Rz Zingiber officinalis recens)—20 g, Chen Pi (PC Citrus reticulata)—9 g, Ban Xia (Rz Pinellia)—9 g.
For Kidney vacuity, add Tu Si Zi (Sm Cuscuta), Xian Ling Pi/Yin Yang Huo (Hb Epimedium), Xian Mao (Rz Curculigo), Sang Ji Sheng (Cs Loranthus/Taxillus),
Chuan/Xu Duan (Rx Dipsacus), Gou Qi Zi (Fr Lycium), Du Zhong (Cx Eucommia), He Shou Wu (Rx Polygonum multiflorum) and Rou Cong Rong (Hb Cistanches), 15
grams each.
If urination is inhibited and water swelling is severe, add Zhu Ling (Sclerotium Polyporus umbellatum), Da Fu Pi (PC Areca), Bai Mao Gen (Rz Imperata), Chi Xiao Dou (Sm Phaseolus calcaratus), 9-15 grams each
If there is diarrhea, increase Shan Yao (Rx Dioscorea opposita) to 30 grams, add 20 grams of Chao Bai Zhu (Rx Atractylodes macrocephala/alba preparata) and 9 grams
each of: Rou Dou Kou (Sm Myristica) and Sha Ren (Fr Amomum villosum).
Acupuncture: KI 3, REN 4, ST 36 and SP 9 Analysis of points: KI 3 and REN 4 with moxibustion supplements the Kidney Qi and Yang and disinhibits water. ST 36 with moxibustion fortifies the Spleen, boosts Qi and downbears the turbid. Draining SP 9 disinhibits water and disperses swelling. Supplementing REN 3 with moxibustion warms the Kidney Yang.
Modifications: For nausea and vomiting, add REN 13 and PC 6. For more marked Kidney vacuity, add DU 4 and UB 23. If urination is inhibited and water swelling is severe, add REN 3 and SP 6. If there is diarrhea, add REN 8 (use moxibustion).
Prevention and Conclusion:
Avoid exposure to sunshine. Avoid catching colds, flus and other infections. Pregnancy and childbirth may aggravate symptoms. Avoid antibiotics such as penicillin and streptomycin and avoid sulfur drugs and birth control pills. Avoid spicy foods, greasy foods and alcohol. Eat more fresh vegetables and fruits. Avoid overstrain and
fatigue. The root of the disease is Kidney deficiency and Qi deficiency. Supplementing the Qi and nourishing the Yin are the principles of treatment and should be carried out
throughout the treatment. Fire toxin is one of the major inducers of the disease. So herbs that clear heat and relieve toxins can stabilize the disease process. Blood stasis is
another factor. Herbs that activate the Blood should be used to reduce the viscosity of the Blood. The differentiation patterns of Lupus can be divided into phases with specific treatments:
Early Stage:
Focus on clearing heat and toxins. Main symptoms: skin lesions, erythema, osteoarthritis.
Principles of treatment: clear heat and dry damp.
If high fever: HT 9, HT 6, SI 1, SI 6, LI 4, LI 11, LIV 3, DU 14, SJ 5, Ba Xie.
If cloudy spirit: DU 24, GB 13, HT 7, DU 11, UB 44, DU 26.
Middle Stage: Yin deficiency and a low grade fever are the main issues.
Principle of treatment: tonify Kidney and Liver Yin; expel and clear heat.
General points: LU 9, HT 7, ST 36, LI 10, REN 17, GB 39, KI 3, KI 6, KI 13, KI 16.
Late Stage:
Spleen and Kidney damage and both Yin and Yang deficiency are the main issues.
Principle of treatment: warm and tonify the Kidneys and Liver; regulate Yin and
Yang; expel the water and clear the Lungs.
The basic formulas are Zhen Wu Tang and Jin Gui Shen Qi Wan.
General points: REN 5, REN 9, REN 17, ST 28, LU 9, ST
36, LI 10, GB 39, KI 26, KI 27, UB 23, UB 43.
About the Authors: Dr. Tang Xin is the Vice-Chief Director of the External Diseases of TCM Department at the Tian Shan Hospital of Traditional Chinese Medicine in
Shanghai, China; Dr. Naiqiang Gu is the former Vice-Chairman of the TCM External Diseases Committee of the China Association of Traditional Chinese Medicine and is
currently an instructor and clinical supervisor at Emperor’s College of Traditional Oriental Medicine and Yo San University of Traditional Chinese Medicine. Please send
any correspondence to: Dr. Naiqiang Gu, 1807B Wilshire Blvd., Santa Monica, CA 90403