The TCM management of Autoimmune Disorders lupus (part i)Baisong Zhong Ph.D, L.Ac, M.D (China)Associate Prof. of ACAOM

Website: www.easternbalancetcm.comE-mail: Bzhong@acaom.edu1ContentsTCM Treatment of Systemic Lupus Erythematosus (SLE)The Introduction of the Etiology, Pathology Treatment of TCM on Autoimmune Diseases (i.e. Lupus)TCM Prevention & Treatment of the Chemo-therapeutic Side Effects during Autoimmune Disorders

Beginning course details and/or books/materials needed for a class/project.2What is an Autoimmune Disorder?An autoimmune disorder is a malfunction of the body's immune system, causing the body to attack its own tissues. Normally, the immune system can distinguish what is self from what is not self or foreign (see Biology of the Immune System: Introduction) and reacts against foreign substances called antigens. Antigens may be contained within or on bacteria, viruses, other microorganisms, or cancer cells. Antigens may exist on their ownfor example, as pollen or food molecules. Sometimes the immune system malfunctions, interpreting the body's own tissues as foreign and producing abnormal antibodies (called autoantibodies) or immune cells that target and attack particular cells or tissues of the body. This response is called an autoimmune reaction. It results in inflammation and tissue damage. Different cells or tissues are targeted in the various autoimmune disorders.

Objectives for instruction and expected results and/or skills developed from learning. 3What is an Autoimmune Disorder? cont.The disorders include: Lupus, Hashimotos thyroiditis Myethenia Gravis Scleroderma Multiple Sclerosis Sjogrens Syndrome Rheumatoid arthritis.

IntroductionSystemic lupus erythematosus (SLE,lupus) is a chronic inflammatory connective tissue disorder that can involve joints, kidneys, mucous membranes, and blood vessel walls. About 90% of people who have lupus are young women in their late teens to 30s, but children (mostly girls) and older men and women can also be affected. Lupus occurs in all parts of the world but may be more common in Blacks and Asians.

Introductory notes.5Manifestations & Signs:Symptoms vary greatly from person to person, but can include:Fever: high fever or episodes (called flare-ups) of fever Pain: headaches, arthralgias, chest pain Skin rashes: including a butterfly-like redness across the nose and cheeks (malar butterfly erythema)Other symptoms: cough, breathlessness and angina

Relative vocabulary list. 6Examples:

Etiology and PathologyCongenital deficiency, external contraction of the six environmental evils, unregulated emotions and unregulated eating habits and drinking alcohol, over-taxation are the causes of SLE. Etiology and Pathology, Chart 1Exterior-6 Evils

Interior-organs Disorders1. Sunshine2. Wind3. Cold4. Heat5. Dampness6. Summer-heatWind, dampness & heat Cold damp Bi block channels Damp heat BiExcessive or deficient heat (in five Zang organs)causes reckless movementof bloodErythematous rash

Yin deficiency of Liver & KidneyWeak constitution of body

Emotional disordersQi & Yang DeficiencyEdemaExample graph/chart.9Etiology and Pathology, Cont.Generally speaking, the primary pathology of SLE is Zong-organ deficiency, the secondary pathology of SLE is excess (heat, toxin, dampness, bloodstasis).Principle of the TreatmentPurging the excess evils for excess pattern or an acute stage.Tonifying the deficiency for deficient pattern or a chronic stage.

Pattern & Suggested Measures1. Excessive heat toxicitySymptoms/Signs: High fever that is temporarily reduced after perspiration followed by immediate elevation of temperatureRed face with erythematous rash Soreness and pain of the muscles and joints Irritability Thirst with desire for cold beverages Dark red tongue Rapid, slippery or rapid flooding pulse

Pattern & Suggested Measures, cont.Treatment Measures: clear heat & purge fire Formula: Modified Qing Wen Bai Du Yin(clear epidemics and overcome toxin decoction)Shi gao (Gypsum) 30gZhi mu (Anemarrhena rhizome) 9gShui niu jiao (Cornu Bubali) 15gSheng di huang (Uncooked radix rehnanniae) 15gXuan shen (Radix scrophulariae Ningpoensis) 10gSheng di huang (Uncooked Radix Rehmanniae) 12gJin yin hua (Honeysuckle flower) 9gLian qiao (Forsythia fruit) 6gHuang lian (Coptis root) 9g Huang qin (Scutellaria root) 6g Huang bai (Phellodendron bark) 6g Zhi zi (Capejasmine fruit) 6g

Pattern & Suggested Measures, cont.Acupuncture Points: Shi Xuan (M-UE1) LI 4 (He Gu) UB 40 (Wei Zhong) PC 3 (Qu Ze) Du 10 (Ling Tai)Modification:For dark, purple skin lesions: Sp10 (Xue Hai) LI 11 (Qu Chi)For spirit cloudy: Du 26 (Shui Gou)

Pattern & Suggested Measures, cont.2. Yin deficiency with empty heat Symptoms/Signs: Butterfly rash aggravated after exposure to sunlight, it is bright red Low-grade fever Dry mouth Epistaxis IrritabilityInsomniaRed eyesRed tongue with no coatingRapid thready pulsePattern & Suggested Measures, cont.Treatment Measures: Nourish Yin & clear heat Formula: Yu nu jian (Jade Woman decoction) & Zeng ye tang (Increase Fluid Decoction)Shi gao (Gypsum) 15g Zhi mu (Anemarrhena rhizome 9gShu di huang (Prepared rehmannia) 9g Mai men dong (Ophiopogon root) 6gNiu xi (Cyathula root) 6gXuan shen (Radix Scrophulariae ningpoensis) 10gSheng di huang (Uncooked Radix Rehmanniae) 12g

Pattern & Suggested Measures, cont.Acupuncture Points:Sp 6 (San Yin Jiao) LI 4 (He Gu)Liv 3 (Tai Chong) GB34 (Yang Ling Qiuan)Modification:For severe stomach heat: St 44 (Nei Ting) For Kidney deficiency: Ki 3 (Tai Xi), Ki 6 (Zhao Hai)Pattern & Suggested Measures, cont.3. Blood stasis with heatSymptoms/Signs: Rash in dark red colorPetechiae spreading all over limbs Epistaxis IrritabilityInsomniaDark scanty urination Deep red tongue with petechiaeThready, choppy pulsePattern & Suggested Measures, cont.Treatment Measures: Cool & invigorate blood, stop bleeding Formula: Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction)Shui niu jiao (Cornu Bubali) 20gSheng di huang (Radix Rehmanniae Glutinosae) 30gShao yao (Radix Paeoniae Lactiflorae) 9g Mu dan pi (Cortex Moutan Radixis) 6g

Pattern & Suggested Measures, cont.Acupuncture Points:Er Jian, LI 11 (Qu Chi) St 44 (Nei Ting) UB 40 (Wei Zhong) Sp 10 (Xue Hai)Pattern & Suggested Measures, cont.4. Spleen and Kidney DeficiencySymptoms/Signs: Malar flush Splinter hemorrhage MalaiseSevere pitting edema in lower limbsPale tongue with white coating Deep thready pulsePattern & Suggested Measures, cont.Treatment Measures: Tonify spleen and kidney, promote urinationFormula: Ji Sheng Shen Qi Wan Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae )10gGou Qi Zi (Fructus Lycii )10gFu Ling (Sclerotium Poriae Cocos )15gShan Zhu Yu (Fructus Corni Officinalis )10gFu Zi (Radix Lateralis Aconiti Carmichaeli Praeparata )10gZe Xie (Rhizoma Alismatis Orientalis )12gChe Qian Zi (Semen Plantaginis )10g

Pattern & Suggested Measures, cont.Acupuncture Points:Du4 (Ming Men) BU 23 (Shen Shu)St 36 (Zhu San Li) Sp 6 (San Yin Jiao) Case Study Ni Ya, Female, 37 April 20, 2006

Facial pain for 9 months. It started from temple and lower part of face spreading to all area around mouth. Now on both sides were 10/10 at beginning-could not chew and sleep. Right 3th,4th, and 5th fingers cold, pale, purple and pain. Rashes of all body, itching. Less period. Deep and week pulse. Tongue is the following:

6/29/2006A list of procedures and steps, or a lecture slide with media.24Case Study, cont.

6/1/20066/1/2006Case Study, cont.Lab Exam: 11/15/05ANA 1:10000(Normal