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The TCM management of Autoimmune Disorders – lupus (part i )

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.com E-mail: Bzhong@acaom.edu. Contents. TCM Treatment of Systemic Lupus Erythematosus (SLE)

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The TCM management of Autoimmune Disorders – lupus (part i )

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  1. 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.edu

  2. Contents • TCM 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

  3. What 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 own—for 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.

  4. What is an Autoimmune Disorder? cont. • The disorders include: • Lupus, • Hashimoto’s thyroiditis • Myethenia Gravis • Scleroderma • Multiple Sclerosis • Sjogren’s Syndrome • Rheumatoid arthritis.

  5. Introduction • Systemic 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.

  6. Manifestations & 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

  7. Examples:

  8. Etiology and Pathology Congenital deficiency, external contraction of the six environmental evils, unregulated emotions and unregulated eating habits and drinking alcohol, over-taxation are the causes of SLE.

  9. Etiology and Pathology, Chart 1 1. Sunshine 2. Wind 3. Cold 4. Heat 5. Dampness 6. Summer-heat Wind, dampness & heat Cold damp Bi block channels Damp heat Bi Exterior-6 Evils Excessive or deficient heat (in five Zangorgans) causes reckless movement of blood Erythematous rash Interior-organs Disorders Weak constitution of body Emotional disorders Yin deficiency of Liver & Kidney Qi & Yang Deficiency Edema

  10. Etiology 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).

  11. Principle of the Treatment • Purging the excess evils for excess pattern or an acute stage. • Tonifying the deficiency for deficient pattern or a chronic stage.

  12. Pattern & Suggested Measures 1. Excessive heat toxicity Symptoms/Signs: • High fever that is temporarily reduced after perspiration followed by immediate elevation of temperature • Red 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

  13. 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) 30g • Zhi mu (Anemarrhena rhizome) 9g • Shuiniujiao (CornuBubali) 15g • Shengdihuang (Uncooked radix rehnanniae) 15g • Xuanshen (Radix scrophulariaeNingpoensis) 10g • Shengdihuang (Uncooked Radix Rehmanniae) 12g • Jin yin hua (Honeysuckle flower) 9g • Lianqiao (Forsythia fruit) 6g • Huang lian (Coptis root) 9g • Huang qin (Scutellaria root) 6g • Huang bai (Phellodendron bark) 6g • Zhizi (Capejasmine fruit) 6g

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

  15. 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 • Irritability • Insomnia • Red eyes • Red tongue with no coating • Rapid thready pulse

  16. Pattern & 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 9g • Shudihuang (Prepared rehmannia) 9g • Mai men dong (Ophiopogon root) 6g • Niu xi (Cyathula root) 6g • Xuanshen (Radix Scrophulariaeningpoensis) 10g • Shengdihuang (Uncooked Radix Rehmanniae) 12g

  17. 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)

  18. Pattern & Suggested Measures, cont. 3. Blood stasis with heat • Symptoms/Signs: • Rash in dark red color • Petechiae spreading all over limbs • Epistaxis • Irritability • Insomnia • Dark scanty urination • Deep red tongue with petechiae • Thready, choppy pulse

  19. Pattern & Suggested Measures, cont. • Treatment Measures: Cool & invigorate blood, stop bleeding Formula: Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) • Shuiniujiao (CornuBubali) 20g • Shengdihuang (Radix RehmanniaeGlutinosae) 30g • Shaoyao (Radix PaeoniaeLactiflorae) 9g • Mu dan pi (Cortex MoutanRadixis) 6g

  20. Pattern & Suggested Measures, cont. • Acupuncture Points: ErJian, LI 11 (Qu Chi) St 44 (Nei Ting) UB 40 (Wei Zhong) Sp 10 (XueHai)

  21. Pattern & Suggested Measures, cont. 4. Spleen and Kidney Deficiency • Symptoms/Signs: • Malar flush • Splinter hemorrhage • Malaise • Severe pitting edema in lower limbs • Pale tongue with white coating • Deep thready pulse

  22. Pattern & Suggested Measures, cont. Treatment Measures: Tonify spleen and kidney, promote urination Formula: Ji ShengShen Qi Wan • Shu Di Huang (Radix RehmanniaeGlutinosaeConquitae )10g • Gou Qi Zi (FructusLycii )10g • Fu Ling (SclerotiumPoriaeCocos )15g • Shan Zhu Yu (FructusCorniOfficinalis )10g • Fu Zi (Radix LateralisAconitiCarmichaeliPraeparata )10g • ZeXie (RhizomaAlismatisOrientalis )12g • CheQianZi (Semen Plantaginis )10g

  23. Pattern & Suggested Measures, cont. • Acupuncture Points: Du4 (Ming Men) BU 23 (ShenShu) St 36 (Zhu San Li) Sp 6 (San Yin Jiao)

  24. 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: 6/29/2006

  25. Case Study, cont. 6/1/2006 6/1/2006

  26. Case Study, cont. Lab Exam: 11/15/05 • ANA 1:10000(Normal <1:100) • DNP(快速SLE因子) Positive • U1RNP Positive • RF 20.90(Normal <15) • ALP 26(Normal 42-141) • A/G 1.24(Normal1.5/2.5) • TG1.98(Normal 0.56-1.70) • HDL0.94(Normal 1.04-1.55) • Apo-A163.40(Normal 100-160) • ECG: deficient blood of Ht

  27. Case Study, cont. TCM Diagnosis: Bi syndrome due to wind and dampness blocking meridians Rashes due to blood deficiency and stasis with internal wind Western Diagnosis: • Raynaud’s disease • Vasculitis • Lupus • Sjogren’s disease • Fatty Liver • Ht blood deficiency

  28. Case Study, cont. • EX: Acupuncture points: GB20, LI11, SJ5, Lu10, Ren12, Sp10,LI4,St36,Sp6,Lu3 • Herbal formula: Dang GuiShao Yao Tang (T23) May 4th: Facial pain no change, Rash is less. Fingers cold, pale and purple and pain is gone. • Acupuncture points: Ren12,6, GB20,8, LI4, LI11, Liv3, Sp10, Sp6, St36

  29. Case Study, cont. Herbs: • Shu Di 9g • Dang Gui9g • Bai Shao30g • Bai Xian Pi 9g • Fang Feng9g • Di Gu Pi 9g • Dan Shen 9g • ZhiGan Cao9g • JuHua 9g • Di Fu Zhi 9g • 11/05/06 • +BaXie • Si Wu Tang+Wu Pi Tang, Yi YiRen, Fang Feng, GuiZhi, Yin HuaTeng

  30. Case Study, cont. 05/25/06 TG166 (Normal <150) HDL27 (Normal >39) ANA 1:1280 10/12/2006 7/27/2006 10/12/2006

  31. TCM Prevention & Treatment of the Chemotheraputic Side Effects during Autoimmune Disorders of Connective Tissue – Part 2 Baisong Zhong Ph.D, L.Ac, M.D (China) Associate Prof. of ACAOM Website: www.easternbalancetcm.comE-mail: Bzhong@acaom.edu

  32. Treatment of Western Medicine & Prognosis • Lupus tends to be chronic and relapsing, often with symptom-free periods that can last for years. Flare-ups occur less often after menopause. Because many people are being diagnosed earlier than in the past and because better treatment is available, the prognosis has improved markedly over the last two decades. However, because the course of lupus is unpredictable, the prognosis varies widely. Usually, if the initial inflammation is controlled, the long-term prognosis is good.

  33. Treatment of Western Medicine & Prognosis • Lupus tends to be chronic and relapsing, often with symptom-free periods that can last for years. Flare-ups occur less often after menopause. Because many people are being diagnosed earlier than in the past and because better treatment is available, the prognosis has improved markedly over the last two decades. However, because the course of lupus is unpredictable, the prognosis varies widely. Usually, if the initial inflammation is controlled, the long-term prognosis is good.

  34. Treatment of Western Medicine & Prognosis Severe lupus is treated immediately with a corticosteroid such as prednisone, Sometimes an immunosuppressive drug such as azathioprine, cyclophosphamideis given to suppress the body's autoimmune attack. Mycophenylatemofetil is another new alternative immunosuppressive drug.

  35. Treatment of Western Medicine & Prognosis Generally speaking, these are the side effects of Western Medicine for autoimmune diseases: • Side-effects on the endocrine system (sterol affects on ACTH) • Immuno–depression (sterol) • Adrenal cortix addiction (sterol) • Effects on hair, bone, digestive and reproductive system (azathioprine, cyclophosphamide).

  36. Etiology and Pathology Cause heat & Fever, anxiety, toxins in the body constipation, sores, rash, bleeding, etal. Dampness inside the body acne, fatigue, full abdomen, turbid urine Injure Yin (Lu, Ht, Liv, St, Ki), Low grade fever, night sweats, deficiency of Zang fu organs rash, hot sensation, etal. Chemicals: Sweet, warm, hot, Injure Qi or Yang Fatigue, obesity, edema, pungent and dry poor appetite, loose stool, sweating susceptive, irregular menstruation, infertility Injure blood fatigue, palpitation, dizziness, pale face & lips

  37. The Prevention of side-effects of Prednisone • Early stage: taking prednisone for the first 10 days around. Treatment: treating primary differentiation of syndrome. • Middle stage: after taking high dosage of prednisone for long period of time. The hyperactivity of Yang due to Yin deficiency becomes evident. Manifestations: red face, overeating, thirsty, red tongue with less coating, rapid pulse.

  38. The Prevention of side-effects of Prednisone Treatment: nourishing Yin & clear fire Formula: ZuoGui Wan (restore the Left Pill) (T178) • Shu Di Huang (Radix RehmanniaeGlutinosaeConquitae) • Shan Yao (Radix DioscoreaeOppositae) • Gou Qi Zi (FructusLycii) • Shan Zhu Yu (FructusCorniOfficinalis) • Niu Xi (Radix AchyranthisBidentatae) • Tu Si Zi (Semen CuscutaeChinensis)

  39. The Prevention of side-effects of Prednisone Acupuncture Points: Sp6 (San Yin Jiao) Liv 3 (Tai Cong) Ki3 (Tai Xi) Lu 5 (Chi Zhe) • Taper off Dosage Stage: patient’s symptoms are stable after taking the prednisone. The Yang deficiency becomes evident. Use TCM to reduce dependence on the prednisone and re-occurrence Manifestations: fatigue, spontaneous sweating, susceptive, poor appetite, obesity, profuse urine, pale tongue with thick white coating, deep slow pulse. Treatment: tonifying spleen & kidney Yang

  40. The Prevention of side-effects of Prednisone • Formula: Jin KuiShen Qi Wan (Kidney Qi Pill from the Golden Cabinet) (T07) • Shu Di Huang (Radix RehmanniaeGlutinosaeConquitae) • Shan Yao (Radix DioscoreaeOppositae) • Shan Zhu Yu (FructusCorniOfficinalis) • Fu Ling (SclerotiumPoriaeCocos) • Mu Dan Pi (Cortex MoutanRadixis) • ZeXie (RhizomaAlismatisOrientalis) • Fu Zi (Radix LateralisAconitiCarmichaeliPraeparata) • GuiZhi (RamulusCinnamomiCassiae)

  41. The Prevention of side-effects of Prednisone Acupuncture Points: Ming men (Du 4) ShenShu (UB 23) Zhu San Li (St 36) Qi Hai (Ren 6)

  42. The Prevention of side-effects of an Immunosuppressive Drug (ISD, such as azathioprine, cyclophosphamide) • The Prevention of side-effects of ISD on digestive system: taking ISD for the first 10 days around. Manifestations: nausea, vomiting, poor appetite, abdominal pain, diarrhea or constipation, fatigue, pale tongue with thin coating, weak pulse Treatment: tonifying spleen & stomach, regular Qi (Treating patients before the patients have been treated by chemotherapy for a week)

  43. The Prevention of side-effects of an Immunosuppressive Drug, cont. Formula: Xiang Sha Liu Jun Zi Tang (Six Gentaleman Decoction with Aucklandia and Amomun) (T169) Acupuncture Points: Nei Guan (PC6) Zhu San Li (St 36) San Yin Jiao (Sp6) Zhong Wan (Ren 12)

  44. The Prevention the side-effect of ISD on Hematopietic System • The Prevention the side-effect of ISD on hematopietic system: after being treated by ISD one month around. The liver & kidney essence deficiency becomes evident. Manifestations: lost hair, lower WBC, fatigue, pale face, insomnia, pale tongue, deep weak pulse Treatment: Tonifying kidney essence & bone marrow.

  45. The Prevention the side-effect of ISD on Hematopietic System Formula: Huang Jing Tang (Yellow golden Decoction) • Gou Qi Zi • Sang Shen (Frucuts Mori Albae) • Huang Jing (RhizomaPolygonati) • Huang Qi (Radix AstragaliMembranacei) Acupuncture Points: San Yin Jiao (Sp 6) JueGu (GB 39 Zhao Hai (Ki6) XueHai (Sp 10)

  46. The Prevention of side-effects of ISD on Gonads & Reproductive System • The Prevention of side-effects of ISD on gonads & reproductive system: after being treated by ISD six month around. The kidney Yang deficiency becomes evident. Manifestations: infertility, lower sex drive, irregular menstruation, fatigue, pale tongue, weak pulse Treatment: tonifying Kidney Yin and Yang

  47. The Prevention of side-effects of ISD on Gonads & Reproductive system Formula: Wu Zi Yan Zong Wan ErZhi Wan • Fu Pen Zi (FructusRubiChingii) • Gou Qi Zi (FructusLycii) • Tu Si Zi (Semen CuscutaeChinensis) • Wu Wei Zi (FructusSchisandraeChinensis) • CheQianZi (Semen Plantaginis) • Nu Zhen Zi (FructusLigustriLucidi) • Han Lian Cao (HerbaEcliptaeProstratae) Acupuncture Points: Ming Men (Du 4) Guan Yuan(Ren 3) ShenShui (UB 23) Tai Xi (Ki 3)

  48. Notes Notes: • No sunshine. • No spicy food. • No seafood / greasy food. References 1.Clinic Observation on Nephrotic Syndrome of Lupus Nephritis treated with Integrated TCM. Wu Qiao, Ye Regao, Wu Kaimu,et al. Chinese J. of TCM & Western Medicine. 1998;(12) 718 2. Clinic Observation on SLE with Removing Blood Stasis. Wu Jialin, BaoXiaohui, Zhuozhiling, et al. Chinese J. of TCM & Western Medicine. 2003;(11) 860. 3. On the Diagnosis and Treatment with TCM and Western Medicine. Chinese J. of TCM & Western Medicine. 2000;(12): 883. 4. Therapeutic Effects of 138 Cases of Hyperthyroidism Treated withAcupoint Catgut Embedding Therapy Combined with Chinese Drug.TianYuanSheng; Yang WeiQian*; Cao JinMei. Chinese Acupuncuture & Moxibustion 2002 , 22 ( 9 ): 585-586. 5. Effect of Xiaoying granule on heart rate,body temperature andserum T~3|,T~4| in experimental hyperthyroidism model of rats.JiaXiLian; Li PeiLin; XiongXiangMing; QuZhuQiu. Hebei Journal of Traditional Chinese Medicine 2002 , 24 ( 8 ): 632-635 6. Association of the differentiating Zheng of TCM with thyroid hormone receptor mRNA in patients with hyperthyroidism & hypothyroidism.Li XiaoMiao; Wang Li; Zhang NanYan; Li Yuan; Li DeQiang. Journal of The Fourth Military Medical University 2001 , 22 ( 16 ): 1512-1514.

  49. Thank You! Dr. Baisong Zhong’s final webinar: • Thursday, July 12, 2012: The Abdominal Nine Needles for Improving the Side Effects of HAART of HIV/AIDS

  50. Questions/Discussions

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