Photosensitive epilepsy

Keywords: Chinese medicine, Chinese herbal medicine, acupuncture, systemic lupus eruthmatosus, autoimmune disease, inflammation

Note: This article has been abstracted and condensed from Bob Flaws & Philippe Sionneau's The Treatment of Modern Western Medical Diseases with Chinese Medicine published by Blue Poppy Press.

Also known as disseminated lupus erythmatosus, this is yet another autoimmune disease causing inflammation of the connective tissue. According to Western medicine, its etiology is unknown. Ninety percent of SLE patients are female. It predominantly affects young women, but it may also occur in children. Lupus may begin abruptly with fever or may develop insidiously over months and years. Although symptoms may manifest in any organ system, 90% of patients complain of articular symptoms ranging from intermittent arthralgias to acute polyarthritis. A past history of "growing pains" during childhood is not uncommon.

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This condition is characterized by butterfly-shaped malar erythema. Other skin conditions may include discoid lesions and erythematous, firm, maculopapular lesions on the face, exposed areas of the neck, upper chest, and elbows. Oral ulcers are common, and generalized alopecia is frequent during active phases of this disease. Forty percent of lupus patients are also photosensitive. Generalized adenopathy is common, especially in children, young adults, and Afro-Americans, and splenomegaly occurs in 10% of patients. CNS involvement can cause headache, personality changes, epilepsy, psychoses, and organic brain syndrome. Lupus patients frequently experience spontaneous abortions (probably due to autoimmune ovaritis), and postpartum flares are common.

Disease categorization

In Chinese medicine, various of the main clinical manifestations of SLE have traditionally been categorized as diseases in their own right. The skin lesions of lupus are variously called hong mu die chuang, red butterfly lesions, zhu yu dan, Evodia redness, ri shai chuang, sunshine lesions, yin yang du, yin yang toxins, xue feng chuang, blood wind lesions, mian fa du, face emission toxins, etc. Other of the symptoms of lupus fall under the categories of shui zhong, water swelling (or edema), xu sun, vacuity detriment (fatigue), chuan xi, panting breath (dyspnea), xue zheng, bleeding conditions, guan ge, block and repulsion (inability to swallow), and bi zheng, impediment condition (joint pain).

Disease causes

Former heaven natural endowment insufficiency (i.e., genetics), external contraction of the six environmental excesses (infection), both unregulated emotions and unregulated eating and drinking, and over-taxation

Disease mechanisms

Any of the above causes can result in loss of regulation of yin and yang, qi and blood depletion and vacuity, lack of ease or smoothness in movement and transportation, qi stagnation and blood stasis, and channel and network vessel obstruction which may then give rise to the multiplicity of signs and symptoms associated with this disease. Because this disease mostly occurs or worsens after exposure to sunshine, it is believed to be mostly due to external contraction of heat toxins evils. These heat toxins enter the interior where they scorch and burn yin and blood, impede and obstruct the channels and vessels, damage the viscera and bowels, and corrode the sinews and bones and the skin. In addition, allergic reactions to foods and medicinals, addiction to thick-flavored foods, living in damp environments, and contraction of the six environmental evils may all give rise to internal engenderment of heat toxins. If the former heaven natural endowment is insufficient and original yin or original yang are depleted and vacuous, then this can give rise to all the various symptoms of SLE. Joint pain associated with SLE is mainly due to wind damp heat impediment.

Treatment Based on Pattern Discrimination

1. Heat evils blazing & exuberant pattern

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 lesion may be large or they may be blood blisters, generalized lack of strength, muscle and joint aching and pain, vexation and agitation, insomnia, emotional worry and anxiety, possible spirit clouding and delirious speech, spasms and contractures, dry, bound stools, short, reddish urination, oral thirst with a predilection for chilled drinks, red eyes, red lips, possible spitting blood, spontaneous ejection of blood (i.e., epistaxis), and/or hemafecia, possible sores inside the mouth, sore, swollen throat, a red, crimson, or purplish, dark tongue with yellow, slimy, yellow, dry, or yellow and white, slimy fur or a smooth bare tongue, and a bowstring, rapid pulse

Note: This pattern describes the signs and symptoms of the initial attack or a subsequent acute, active exacerbation of this disease. Such active episodes can be life-threatening and should be treated with a combination of modern Western and Chinese medicine.

Rx: Qing Wen Bai Du Yin Jia Jian (Clear the Scourge & Vanquish Toxins Drink with Additions & Subtractions).

Ingredients: Uncooked Gypsum Fibrosum (Shi Gao), 60g, Cornu Bubali (Shui Niu Jiao), 30g, Rhizoma Anemarrhenae Aspheloidis (Zhi Mu), Rhizoma Coptidis Chinensis (Huang Lian), Radix Scutellariae Baicalensis (Huang Qin), Fructus Gardeniae Jasminoidis (Zhi Zi), Fructus Forsythiae Suspensae (Lian Qiao), and Radix Scrophulariae Ningpoensis (Xuan Shen), 15g each, uncooked Radix Rehmanniae (Sheng Di), Cortex Radicis Moutan (Dan Pi), Radix Rubrus Paeoniae Lactiflorae (Chi Shao), and Radix Angelicae Sinensis (Dang Gui), 20g each, and Folium Bambusae (Zhu Ye), Radix Platycodi Grandiflori (Jie Geng), and Radix Glycyrrhizae (Gan Cao), 9g each.

Additions & subtractions: For dry, bound stools, add nine grams of Radix Et Rhizoma Rhei (Da Huang), decocted later. For high fever which will not recede or essence will symptoms, add 0.3-0.5 grams of Cornu Antelopis Saigatatarici (Ling Yang Jiao), swallowed down with the decoction. For low-grade fever which will not recede, add 15 grams each of Radix Stellariae Dichotomae (Yin Chai Hu) and Cortex Radicis Lycii Chinensis (Di Gu Pi). For bleeding, add 9-20 grams each of Nodus Rhizomatis Nelumbinis Nuciferae (Ou Jie), Rhizoma Imperatae Cylindricae (Bai Mao Gen), Herba Agrimoniae Pilosae (Xian He Cao), and/or Cacumen Biotae Orientalis (Ce Bai Ye) depending on the site and cause of the bleeding. If damp heat is marked with thick, slimy tongue fur, add nine grams each of Rhizoma Atractylodis (Cang Zhu) and Rhizoma Acori Graminei (Shi Chang Pu) and delete the Sheng Di, Xuan Shen, and Zhi Mu. For arthralgia, add nine grams each of Radix Et Rhizoma Notopterygii (Qiang Huo), Radix Gentianae Macrophyllae (Qin Jiao), and Radix Angelicae Pubescentis (Du Huo). For severe thirst, add 12 grams each of Tuber Ophiopogonis Japonici (Mai Men Dong), Herba Dendrobii (Shi Hu), and Rhizoma Polygonati Odorati (Yu Zhu). For profuse erythema, petechiae, or purpurae, add 12 grams each of Radix Lithospermi Seu Arnebiae (Zi Cao), Flos Immaturus Sophorae Japonicae (Huai Hua Mi), and Flos Campsitis (Ling Xiao Hua).

2. Wind damp heat impediment pattern

Main symptoms: Early stage disease with profuse, severe joint pain, especially in the fingers, toes, ankles, and wrists, migrating pain of several joints, fever, dry throat, oral thirst, sore, aching muscles, weakness of the limbs, possible joint swelling, a red tongue with yellow and/or slimy fur, and a bowstring, slipery pulse

Rx: Du Huo Ji Sheng Tang Jia Jian (Angelica Pubescens Decoction with Additions & Subtractions)

Ingredients: Uncooked Gypsum Fibrosum (Shi Gao), 30g, Ramulus Loranthi Seu Visci (Sang Ji Sheng), 15-30g, Cortex Erythinae (Hai Tong Pi), 15g, and Radix Et Rhizoma Notopterygii (Qiang Huo), Radix Gentianae Macrophyllae (Qin Jiao), Radix Clematidis Chinensis (Wei Ling Xian), Radix Ledebouriellae Divaricatae (Fang Feng), Radix Stephaniae Tetrandrae (Fang Ji), and Rhizoma Anemarrhenae Aspheloidis (Zhi Mu), 9g each.

Additions & subtractions: If fever abates and only joint pain remains, Shi Gao and Zhi Mu should be replaced by Cortex Phellodendri (Huang Bai) and Rhizoma Atractylodis (Cang Zhu) and nine grams each of Radix Angelicae Sinensis (Dang Gui) and Radix Albus Paeoniae Lactiflorae (Bai Shao) should be added. If there is then marked fatigue, add 15 grams of Radix Astragali Membranacei (Huang Qi) and nine grams of Radix Codonopsitis Pilosulae (Dang Shen).

3. Heat damaging qi & yin pattern

Main symptoms: Vexatious heat, spontaneous perspiration, heart palpitations, chest oppression, shortness of breath, cough, vacuity vexation insomnia. Vexation and agitation may be relatively severe and the lips may be greenish purple or the facial complexion may be somber white. There may also be counterflow chilling of the four extremities. The four extremities may lack strength and the essence spirit may be listless and fatigued. The pulse is fine and weak, bound, or regularly intermittent. The tongue is pale with thin, white fur. This pattern is mostly seen in those with accompanying cardiopulmonary damage or central nervous system damage.

Rx: Zhi Gan Cao Tang (Mix-fried Licorice Decoction) & Xie Xin Tang (Drain the Heart Decoction) with additions and subtractions.

Ingredients: Radix Panacis Ginseng (Ren Shen), 15g, Fructus Zizyphi Jujubae (Da Zao), 20 pieces, uncooked Radix Rehmanniae (Sheng Di), 50g, mix-fried Radix Glycyrrhizae (Gan Cao), 15g, Gelatinum Corii Asini (E Jiao), Tuber Ophiopogonis Japonici (Mai Dong), uncooked Rhizoma Zingiberis (Sheng Jiang), Ramulus Cinnamomi Cassiae (Gui Zhi), Semen Cannabis Sativae (Huo Ma Ren), Rhizoma Coptidis Chinensis (Huang Lian), Radix Scutellariae Baicalensis (Huang Qin), and Radix Et Rhizoma Rhei (Da Huang), 10g each.

Additions & subtractions: If qi vacuity is severe, add 30-100 grams of Radix Astragali Membranacei (Huang Qi), increasing the dosage gradually. If spleen vacuity is pronounced and resulting in loose stools and decreased eating, add nine grams each of Sclerotium Poriae Cocos (Fu Ling), Rhizoma Atractylodis Macrocephalae (Bai Zhu), and scorched Three Immortals (San Xian: Massa Medica Fermentata, Shen Qu, Fructus Crataegi, Shan Zha, and Fructus Germinatus Hordei Vulgaris, Mai Ya). If yin vacuity is marked with dry mouth, parched throat, and dry cough, add 20 grams of Radix Glehniae Littoralis (Sha Shen) and 12 grams each of Tuber Asparagi Cochinensis (Tian Dong) and Tuber Ophiopogonis Japonici (Mai Men Dong). If there is vacuity vexation with difficulty sleeping, add nine grams each of Cortex Albizziae Julibrissinis (He Huan Pi), Caulis Polygoni Multiflori (Ye Jiao Teng), and Semen Zizyphi Spinosae (Suan Zao Ren). If vexation and agitation are severe, add five grams of Folium Bambusae (Zhu Ye) and nine grams each of Fructus Forsythiae Suspensae (Lian Qiao) and Cortex Radicis Lycii Chinensis (Di Gu Pi). If there is hasty, rapid breathing, cough, and uneasy hacking out of phlegm, add nine grams each of Cortex Radicis Mori Albi (Sang Bai Pi), Herba Houttuyniae Cordatae Cum Radice (Yu Xing Cao), Radix Asteris Tatarici (Zi Wan), and Flos Tussilaginis Farfarae (Kuan Dong Hua) and 15 grams of Herba Oldenlandiae Diffusae (Bai Hua She She Cao). If the facial complexion is somber white and dread of cold and chilled extremities are pronounced, add nine grams each of Radix Lateralis Praeparatus Aconiti Carmichaeli (Fu Zi), Cortex Cinnamomi Cassiae (Rou Gui), and Herba Epimedii (Yin Yang Huo).

4. Liver channel depressive heat pattern

Main symptoms: Liver area aching and pain, possible chest, rib-side, venter, or abdominal glomus, fullness, distention, and/or pain, heart vexation, easy anger, emotional depression or dysphoria, red or purple, dark-colored skin lesions, dysmenorrhea or amenorrhea in females, and/or menstrual irregularity. It is not uncommon to also see (due to concomitant spleen vacuity) dread of cold but emission of heat, torpid intake, lack of strength, dizziness, and insomnia. The tongue is crimson and may have static macules and there is either thin, white or yellow, dry fur. The pulse is tight and fine or bowstring and rapid. This pattern is mostly seen in those who have used steroids for a prolonged period of time. Typically, the blood pressure is elevated and there is liver-spleen enlargement and functional impairment.

Note: The signs and symptoms given include some blood stasis symptoms even though the words "blood stasis" do not appear in the name of the pattern.

Rx: Yi Guan Jian (One Link Decoction) & Si Miao Yong An Tang (Four Wonders Resting Hero Decoction) with additions and subtractions.

Ingredients: Radix Angelicae Sinensis (Dang Gui) and uncooked Radix Rehmanniae (Sheng Di), 30g each, Radix Scrophulariae Ningpoensis (Xuan Shen) and Fructus Lycii Chinensis (Gou Qi Zi), 20g each, Flos Lonicerae Japonicae (Jin Yin Hua), 15g, Radix Glehniae Littoralis (Sha Shen), Tuber Ophiopogonis Japonici (Mai Dong), Fructus Meliae Toosendan (Chuan Lian Zi), and uncooked Radix Glycyrrhizae (Gan Cao), 9g each.

Additions & subtractions: For liver-spleen enlargement and liver area aching and pain, add 30 grams each of Plastrum Testudinis (Gui Ban) and Carapax Amydae Chinensis (Bie Jia) and 15 grams each of Rhizoma Cyperi Rotundi (Xiang Fu) and Tuber Curcumae (Yu Jin). If blood stasis is severe, add 15 grams each of Rhizoma Sparganii (Sang Leng) and Rhizoma Curcumae Zedoariae (E Zhu) and nine grams each of Radix Rubrus Paeoniae Lactiflorae (Chi Shao) and Cortex Radicis Moutan (Dan Pi). If spleen vacuity is pronounced, add 20 grams of Sclerotium Poriae Cocos (Fu Ling) and nine grams each of Radix Panacis Ginseng (Ren Shen) and Rhizoma Atractylodis Macrocephalae (Bai Zhu). If heat toxins tend to be exuberant, add nine grams each of Radix Et Rhizoma Rhei (Da Huang), Radix Gentianae Scabrae (Long Dan Cao), Radix Bupleuri (Chai Hu), and Fructus Gardeniae Jasminoidis (Zhi Zi).

5. Yin vacuity with fire effulgence pattern

Main symptoms: Long-term low-grade fever which gets worse with taxation and stirring, vexatious heat in the five hearts, tidal redness of the facial region, red cheeks, night sweats, spontaneous perspiration, lack of strength, red or pale red skin lesions which begin in small number and gradually get more or larger, especially after stirring or activity, more skin lesions on the face, joint aching and pain, dizziness and vertigo, tinnitus, dry, lusterless or falling hair, dry mouth, parched throat, red urine, dry stools, menstrual irregularity in females, a red tongue with scanty fur, and a bowstring, fine, rapid pulse. This pattern is mostly seen in those with acute or subacute disease occurrence.

Rx: Da Bu Yin Wan (Greatly Supplementing Yin Pills) & Si Wu Tang Jia Jian (Four Materials Decoction) with additions and subtractions.

Ingredients: Plastrum Testudinis (Gui Ban) and Carapax Amydae Chinensis (Bie Jia), 30g each, uncooked Radix Rehmanniae (Sheng Di), Cortex Phellodendri (Huang Bai), Rhizoma Anemarrhenae Aspheloidis (Zhi Mu), and Radix Angelicae Sinensis (Dang Gui), 20g each, Radix Albus Paeoniae Lactiflorae (Bai Shao) and Radix Ligustici Wallichii (Chuan Xiong), 9g each.

Additions & subtractions: If qi vacuity is severe, add 20 grams of Radix Astragali Membranacei (Huang Qi) and nine grams of Radix Panacis Quinquefolii (Xi Yang Shen). If nights sweats and/or spontaneous perspiration are pronounced, add nine grams each of Os Draconis (Long Gu) and Concha Ostreae (Mu Li). For spleen vacuity with scanty eating, add 20 grams each of Radix Dioscoreae Oppositae (Shan Yao) and Sclerotium Poriae Cocos (Fu Ling) and nine grams of Rhizoma Atractylodis Macrocephalae (Bai Zhu). For marked tidal heat and vexatious heat in the five hearts, add 20 grams each of Radix Dioscoreae Oppositae (Shan Yao) and Sclerotium Poriae Cocos (Fu Ling) and nine grams each of Cortex Radicis Moutan (Dan Pi), Fructus Corni Officinalis (Shan Zhu Yu), and Rhizoma Alismatis (Ze Xie). Or one can add 9-15 grams each of Cortex Radicis Lycii Chinensis (Di Gu Pi), Radix Scrophulariae Ningpoensis (Xuan Shen), Radix Trichosanthis Kirlowii (Tian Hua Fen), and Herba Artemensiae Apiaceae (Qing Hao). For static blood and marked skin lesions, add nine grams each of Semen Pruni Persicae (Tao Ren) and Flos Carthami Tinctorii (Hong Hua), 15 grams each of Radix Salviae Miltiorrhizae (Dan Shen) and Radix Rubrus Paeoniae Lactiflorae (Chi Shao), and 20 grams each of Rhizoma Imperatae Cylindricae (Bai Mao Gen) and Nodus Rhizomatis Nelumbinis Nuciferae (Ou Jie). If kidney depletion is marked with low back and knee soreness and weakness, dizziness, and tinnitus, add nine grams each of Fructus Lycii Chinensis (Gou Qi Zi), Semen Cuscutae Chinensis (Tu Si Zi), Fructus Rubi Chingii (Fu Pen Zi), Herba Cistanchis Deserticolae (Rou Cong Rong), Radix Achyranthis Bidentatae (Huai Niu Xi), and Radix Polygoni Multiflori (He Shou Wu).

6. Qi stagnation & blood stasis pattern

Main symptoms: Cyanosis of the tips of the extremities or a mixture of somber white and greenish purple, purple-colored skin macules or disciform, deep or abnormally colored skin lesions, scaley, cracked skin, joint and muscle aching and pain, emotional depression in females with menstrual irregularity, dysmenorrhea, or amenorrhea, a purple red tongue, and static, purple, engorged sublingual veins. This pattern is mostly seen in those with accompanying serious Raynaud's disease or pronounced vasculitis.

Note: This pattern typically does not present in its pure form like this. Rather, blood stasis commonly complicates most, if not all, patterns of chronic, enduring disease.

Rx: Xue Fu Zhu Yu Tang Jia Jian (Blood Mansion Dispel Stasis Decoction with Additions & Subtractions).

Ingredients: Uncooked Radix Rehmanniae (Sheng Di), Semen Pruni Persicae (Tao Ren), Flos Carthami Tinctorii (Hong Hua), Radix Rubrus Paeoniae Lactiflorae (Chi Shao), and Radix Achyranthis Bidentatae (Niu Xi), 20g each, Radix Bupleuri (Chai Hu) and Radix Ligustici Wallichii (Chuan Xiong), 15g each, and Fructus Immaturus Citri Aurantii (Zhi Shi), 9g.

Additions & subtractions: If there is emotional depression or dysphoria with chest and rib-side distention and pain, add nine grams each of Tuber Curcumae (Yu Jin), Rhizoma Cyperi Rotundi (Xiang Fu), Pericarpium Citri Reticulatae Viride (Qing Pi), and Fructus Citri Sacrodactylis (Fo Shou). For aching and pain of the tips of the extremities and/or joint aching and pain, add 9-15 grams each of Ramulus Mori Albi (Sang Zhi), Ramulus Cinnamomi Cassiae (Gui Zhi), Radix Gentianae Macrophyllae (Qin Jiao), Caulis Milletiae Seu Spatholobi (Ji Xue Teng), and Caulis Lonicerae Japonicae (Ren Dong Teng). If there is more blood stasis with cyanosis of the tips of the extremities and greenish purple of the skin with a relatively prolonged disease course, increase the Chuan Xiong up to 20 grams and add nine grams each of Rhizoma Sparganii (San Leng) and Rhizoma Curcumae Zedoariae (E Zhu), 15 grams each of Radix Pseudoginseng (San Qi) and Radix Angelicae Sinensis (Dang Gui), and six grams each of Resina Olibani (Ru Xiang) and Resina Myrrhae (Mo Yao). If there is more qi stagnation with inability of the yang qi to spread to the four limbs and therefore a somber white of the tips of the four extremities and the skin with counterflow chilling over a continuously long time, then add nine grams each of Cortex Cinnamomi Cassiae (Rou Gui) and Radix Lateralis Praeparatus Aconiti Carmichaeli (Fu Zi), Caulis Akebiae (Mu Tong), Radix Aconiti Kusnezoffi (Cao Wu), and Radix Aconiti Carmichaeli (Chuan Wu) and three grams of Herba Asari Cum Radice (Xi Xin). If joint and extremity aching and pain are pronounced, add nine grams each of Herba Oldenlandiae Diffusae Cum Radice (Bai Hua She She Cao), Buthus Martensis (Quan Xie), and Scolopendra Subspinipes (Wu Gong).

7. Spleen-kidney dual depletion pattern

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, if 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 purple and dark in color, a pale, fat tongue or dark and pale tongue with tooth-marks on its edges and thin, white fur, and a soggy, fine or deep, fine pulse. This pattern is mostly seen in those with concomitant kidney disease, Raynaud's disease, or those who have undergone prolonged hormone (i.e., steroid) therapy.

Rx: Shen Qi Wan (Kidney Qi Pills) & Si Jun Zi Tang (Four Gentlemen Decoction) with additions and subtractions.

Ingredients: Cortex Cinnamomi Cassiae (Rou Gui) and Radix Lateralis Praeparatus Aconiti Carmichaeli (Fu Zi), 15g each, Radix Dioscoreae Oppositae (Shan Yao), 20g, Sclerotium Poriae Cocos (Fu Ling), 30g, Rhizoma Atractylodis Macrocephalae (Bai Zhu), Rhizoma Alismatis (Ze Xie), Fructus Corni Officinalis (Shan Zhu Yu), and Cortex Radicis Moutan (Dan Pi), 12g each, and Radix Panacis Ginseng (Ren Shen) and mix-fried Radix Glycyrrhizae (Gan Cao), 6g each.

Additions & subtractions: For severe nausea and vomiting, add 20 grams of uncooked Rhizoma Zingberis (Sheng Jiang), and nine grams each of Pericarpium Citri Reticulatae (Chen Pi), Rhizoma Pinelliae Ternatae (Ban Xia), Cortex Magnoliae Offiicinalis (Hou Po), and Rhizoma Acori Graminaei (Shi Chang Pu). For more kidney vacuity, add 9-15 grams each of Semen Cuscutae Chinensis (Tu Si Zi), Rhizoma Curculiginis Orchioidis (Xian Mao), Herba Epimedii (Xian Ling Pi), Ramulus Loranthi Seu Visci (Sang Ji Sheng), Radix Dipsaci (Chuan Duan), Fructus Lycii Chinensis (Gou Qi Zi), Cortex Eucommiae Ulmoidis (Du Zhong), Radix Polygoni Multiflori (He Shou Wu), and Herba Cistanchis Deserticolae (Rou Cong Rong). If urination is inhibited and water swelling is severe, add 9-15 grams each of Sclerotium Polypori Umbellati (Zhu Ling), Pericarpium Arecae Catechu (Da Fu Pi), Rhizoma Imperatae Cylindricae (Bai Mao Gen), and Semen Phaseoli Calcarati (Chi Xiao Dou). If there is diarrhea, increase the amount of Shan Yao up to 30 grams and add 20 grams of stir-fried Rhizoma Atractylodis Macrocephalae (Bai Zhu) and nine grams each of Semen Myristicae Fragrantis (Rou Dou Kou) and Fructus Amomi (Sha Ren).

8. Heart-spleen dual vacuity pattern

Main symptoms: In the latter stages, if disease has damaged the heart, there may be heart palpitations, shortness of breath, chest oppression, profuse sweating, chilled limbs, insomnia, profuse dreams, low-grade fever, night sweats, fatigue, lack of strength, emaciation, disinclination to speak and/or weak voice, poor appetite, possible abdominal distention and loose stools, a pale white or sallow yellow facial complexion, a pale, enalrged tongue with white fur, and a fine, weak, possibly rapid, possibly bound or regularly intermittent pulse.

Rx: Gui Pi Tang (Restore the Spleen Decoction) & Tian Wang Bu Xin Dan (Heavenly Emperor Supplement the Heart Elixir) with additions and subtractions.

Ingredients: Sclerotium Pararadicis Poriae Cocos (Fu Shen), 12g, and Radix Codonopsitis Pilosulae (Dang Shen), Radix Astragali Membranacei (Huang Qi), Radix Angelicae Sinensis (Dang Gui), Radix Scrophulariae Ningpoensis (Xuan Shen), Radix Salviae Miltiorrhizae (Dan Shen), Tuber Ophiopogonis Japonici (Mai Men Dong), Fructus Schisandrae Chinensis (Wu Wei Zi), Semen Biotae Orientalis (Bai Zi Ren), Semen Zizyphi Spinosae (Suan Zao Ren), Radix Polygalae Tenuifoliae (Yuan Zhi), and Arillus Euphoriae Longanae (Long Yan Rou), 9g each.

Additions & subtractions: During remission periods, Gui Pi Wan (Restore the Spleen Pills) or Tian Wang Bu Xin Dan (Heavenly Emperor Supplement the Heart Elixir) may be administered in ready-made pills form to patients with mild heart vacuity symp-toms.

If heart qi vacuity is marked with spontaneous perspiration, replace Gui Pi Tang and Tian Wang Bu Xin Dan with Zhi Gan Cao Tang Jia Jian (Mix-fried Licorice Decoction with Additions & Subtractions): uncooked Radix Rehmanniae (Sheng Di), 15-20g, mix-fried Radix Glycyrrhizae (Gan Cao), 12g, Tuber Ophiopogonis Japonici (Mai Men Dong), and Gelatinum Corii Asini (E Jiao), 9g each, Radix Panacis Ginseng (Ren Shen), and Ramulus Cinnamomi Cassiae (Gui Zhi), 6g each, uncooked Rhizoma Zingiberis (Sheng Jiang), 2 slices, and Fructus Zizyphi Jujubae (Da Zao), 3-5 pieces. If there are heart palpitations or arrhythmia, add 12 grams of Semen Zizyphi Spinosae (Suan Zao Ren) and nine grams of Magnetitum (Ci Shi). If there is constipation with dry, bound stools, add 9-12 grams of Semen Cannabis Sativae (Huo Ma Ren). For concomitant blood stasis with chest pain, add nine grams each of Semen Pruni Persicae (Tao Ren) and Radix Salviae Miltiorrhizae (Dan Shen).

If there is heart yang vacuity with spontaneous perspiration and chilled limbs, replace Gui Pi Tang and Tian Wang Bu Xin Dan with Zhi Gan Cao Tang (Mix-fried Licorice Decoction) and Shen Fu Tang (Ginseng & Aconite Decoction) with additions and subtractions: uncooked Radix Rehmanniae (Sheng Di), 15-20g, mix-fried Radix Glycyrrhizae (Gan Cao), 12g, Tuber Ophiopogonis Japonici (Mai Men Dong), and Gelatinum Corii Asini (E Jiao), 9g each, Radix Panacis Ginseng (Ren Shen), Radix Lateralis Praeparatus Aconiti Carmichaeli (Fu Zi), and Ramulus Cinnamomi Cassiae (Gui Zhi), 6g each, uncooked Rhizoma Zingiberis (Sheng Jiang), 2 slices, and Fructus Zizyphi Jujubae (Da Zao), 3-5 pieces. If there are fright palpitations, add 12 grams each of Os Draconis (Long Gu) and Concha Ostreae (Mu Li). If there is concomitant blood stasis with chest pain, add nine grams each of Radix Salviae Miltiorrhizae (Dan Shen) and Radix Rubrus Paeoniae Lactiflorae (Chi Shao).

9. Liver-spleen disharmony pattern

Main symptoms: In the latter stages, if disease has damaged the liver and spleen, there may be chest and rib-side distention and pain, hypochondral accumulations (i.e., hepatosplnomegaly), reduced food intake, nausea and vomiting, abdominal pain and diarrhea, jaundice, dizziness, insomnia, menstrual irregularities or amenorrhea, a normal or darkish tongue with thin, slimy fur, and a bowstring, fine pulse.

Note: Although Chinese sources say that this pattern presents in the latter stages of this disease, it is our experience that most SLE sufferers present this pattern early on, even before an SLE diagnosis has been made, and often revert to this pattern during periods of remission. In that case, digestive symptoms may or may not be pronounced.

Rx: Xiao Yao San Jia Jian (Rambling Powder with Additions & Subtractions).

Ingredients: Rhizoma Atractylodis Macrocephalae (Bai Zhu) and Sclerotium Poriae Cocos (Fu Ling), 12g each, Radix Bupleuri (Chai Hu), Radix Angelicae Sinensis (Dang Gui), Radix Albus Paeoniae Lactiflorae (Bai Shao), Radix Codonopsitis Pilosulae (Dang Shen), and Cortex Magnoliae Officinalis (Hou Po), 9g each, and Pericarpium Citri Reticulatae (Chen Pi), 6g.

Additions & subtractions: If there is chest and rib-side distention and pain, add nine grams each of Radix Rubrus Paeoniae Lactiflorae (Chi Shao), Radix Salviae Miltiorrhizae (Dan Shen), and Lignum Dalbergiae Odoriferae (Jiang Xiang). For poor appetite, add nine grams each of scorched Fructus Germinatus Hordei Vulgaris (Mai Ya), Massa Medica Fermentata (Shen Qu), and Fructus Crataegi (Shan Zha). For nausea and vomiting, add nine grams each of Rhizoma Pinelliae Ternatae (Ban Xia) and Caulis Bambusae In Taeniis (Zhu Ru). For abdominal pain and diarrhea, add nine grams each of Radix Auklandiae Lappae (Mu Xiang), Radix Puerariae (Ge Gen), and Fructus Terminaliae Chebulae (He Zi). For jaundice, add nine grams each of Herba Artemisiae Capillaris (Yin Chen Hao) and Fructus Gardeniae Jasminoidis (Zhi Zi) and three grams of Radix Et Rhizoma Rhei (Da Huang).

If there is chest and rib-side distention and pain and marked hepatosplenomegaly, replace Xiao Yao San Jia Jian with Chai Hu Shu Gan San (Bupleurum Course the Liver Powder) and Ping Wei San (Level the Stomach Powder) with additions and subtractions: Radix Bupleuri (Chai Hu), 12g, Radix Albus Paeoniae Lactiflorae (Bai Shao), Radix Ligustici Wallichii (Chuan Xiong), Rhizoma Cyperi Rotundi (Xiang Fu), Cortex Magnoliae Officinalis (Hou Po), Fructus Citri Aurantii (Zhi Ke), and Pericarpium Citri Reticulatae (Chen Pi), 9g each, Radix Glycyrrhizae (Gan Cao), 3g. If there is severe abdominal pain, add 15 grams of Rhizoma Corydalis Yanhusuo (Yan Hu Suo) and 12 grams of Fructus Meliae Toosendan (Chuan Lian Zi). If depression has transformed heat with a bitter taste in the mouth, add nine grams of Radix Scutellariae Baicalensis (Huang Qin) and three grams of Rhizoma Coptidis Chinensis (Huang Lian).

10. Liver wind internally stirring pattern

Main symptoms: During critical stages of this disease, there may be persistent high fever, vexation, agitation, and restlessness, deranged speech, crying and laughing without constancy, possible convulsions or seizures, possible spirit clouding, hemi- or paraplegia, urinary incontinence or retention, a red or dark tongue with no or scorched yellow fur, and a bowstring, rapid or bowstring and fine pulse.

Note: This stage of this disease should be treated with a combination of Chinese and Western medicines.

Rx: Ling Yang Gou Teng Tang Jia Jian (Saiga Antelope & Uncaria Decoction with Additions & Subtractions).

Ingredients: Uncooked Radix Rehmanniae (Sheng Di) and uncooked Concha Haliotidis (Shi Jue Ming), 30g each, Bulbus Fritillariae Cirrhosae (Chuan Bei Mu), Caulis Bambusae In Taeniis (Zhu Ru), and Sclerotium Pararadicis Poriae Cocos (Fu Shen), 15g each, Flos Chrysanthemi Morifolii (Ju Hua), Radix Albus Paeoniae Lactiflorae (Bai Shao), and Ramulus Uncariae Cum Uncis (Gou Teng), 12g each, Folium Mori Albi (Sang Ye), 6g, and Cornu Caprae (Shan Yang Jiao), 3g.

Additions & subtractions: If there is persistent high fever with convulsions, add 15 grams each of uncooked Gypsum Fibrosum (Shi Gao) and Radix Scrophulariae Ningpoensis (Xuan Shen) and nine grams each of Rhizoma Anemarrhenae Aspheloidis (Zhi Mu) and Tuber Ophiopogonis Japonici (Mai Men Dong). For heat harassing the spirit with deranged speech, add nine grams each of Fructus Forsythiae Suspensae (Lian Qiao) and Radix Polygalae Tenuifoliae (Yuan Zhi) and six grams each of Plumula Nelumbinis Nuciferae (Lian Zi Xin) and Rhizoma Copitidis Chinensis (Huang Lian). For tremors and convulsions, add 12 grams each of Concha Margaritiferae (Zhen Zhu Mu), Haemititum (Dai Zhe Shi), Os Draconis (Long Gu), and/or Concha Ostreae (Mu Li).

Clinical tips

1. Most cases of lupus display the following combination of patterns: qi and yin vacuity; some sort of evil heat (whether toxic, depressive, damp, or vacuity); and liver depression qi stagnation. If the condition has endured, there is often blood stasis as well. If the patient is a female 45-55 years old, spleen qi vacuity may also have evolved into kidney yang vacuity. Unlike rheumatoid arthritis, there is no cold damp impediment pattern of lupus.

2. Additional medicinals for specific symptoms may be chosen depending on the presenting pattern:

A. For low back and knee soreness & weakness, dizziness, tinnitus & kidney vacuity, one can choose from: Fructus Lycii Chinensis (Gou Qi Zi), Cortex Eucommiae Ulmoidis (Du Zhong), Herba Cistanchis Deserticolae (Rou Cong Rong), Semen Cuscutae Chinensis (Tu Si Zi), Rhizoma Cibotii Barometsis (Gou Ji), Rhizoma Polygoni Cuspidati (Hu Zhang), Radix Dipsaci (Chuan Duan), Ramulus Loranthi Seu Visci (Sang Ji Sheng), Ramulus Cinnamomi Cassiae (Gui Zhi), Cortex Cinnamomi Cassiae (Rou Gui), Rhizoma Curculiginis Orchioidis (Xian Mao), Herba Epimedii (Xian Ling Pi), Herba Cynomorii Songarici (Suo Yang), and Fructus Alpiniae Oxyphyllae (Yi Zhi Ren).

B. For superficial edema, one can choose from: Semen Plantaginis (Che Qian Zi), Herba Plantaginis (Che Qian Cao), Rhizoma Alismatis (Ze Xie), Seme Phaseoli Calcarati (Chi Xiao Dou), Pericarpium Arecae Catechu (Da Fu Pi), Semen Coicis Lachryma-jobi (Yi Yi Ren), Sclerotium Poriae Cocos (Fu Ling), Sclerotium Polypori Umbellati (Zhu Ling), Rhizoma Imperatae Cylindricae (Bai Mao Gen), Stylus Zeae Maydis (Yu Mi Xu), and Folium Pyrrosiae (Shi Wei).

C. For joint aching and pain, one can choose from, Radix Gentianae Macrophyllae (Qin Jiao), Ramulus Cinnamomi Cassiae (Gui Zhi), Ramulus Mori Albi (Sang Zhi), Ramulus Loranthi Seu Visci (Sang Ji Sheng), Radix Clematidis Chinensis (Wei Ling Xian), Radix Stephaniae Tetrandrae (Fang Ji), Radix Ledebouriellae Divaricatae (Fang Feng), Rhizoma Polygoni Cuspidati (Hu Zhang), Caulis Milletiae Seu Spatholobi (Ji Xue Teng), Caulis Lonicerae Japonicae (Ren Dong Teng), Radix Dipsaci (Chuan Duan), Rhizoma Corydalis Yanhusuo (Xuan Hu), Rhizoma Sinomenii Acuti (Qing Feng Teng), and Herba Pycnostelmae (Xu Chang Jing).

D. For rib-side distention and pain and emotional depression, one can choose from: Tuber Curcumae (Yu Jin), Rhizoma Cyperi Rotundi (Xiang Fu), Pericarpium Citri Reticulatae Viride (Qing Pi), Rhizoma Corydalis Yanhusuo (Yan Hu Suo), Fructus Citri Aurantii (Zhi Ke), Fructus Citri Sacrodactylis (Fo Shou), and Radix Bupleuri (Chai Hu).

E. For heart palpitations, one can choose from: Fructus Schisandrae Chinensis (Wu Wei Zi), Rhizoma Acori Graminei (Shi Chang Pu), Radix Polygalae Tenuifoliae (Yuan Zhi), Sclerotium Poriae Cocos (Fu Ling), Sclerotium Pararadicis Poriae Cocos (Fu Shen), Cortex Eucommiae Ulmoidis (Du Zhong), Radix Scrophulariae Ningpoensis (Xuan Shen), and Semen Biotae Orientalis (Bai Zi Ren).

F. For insomnia, one can choose from: Caulis Polygoni Multiflori (Ye Jiao Teng), Flos Albizziae Julibrissinis (He Huan Hua), Fructus Alpiniae Oxyphyllae (Yi Zhi Ren), Rhizoma Sinomenii Acuti (Qing Feng Teng), Rhizoma Acori Graminei (Shi Chang Pu), and Semen Zizyphi Spinosae (Suan Zao Ren).

G. For dry cough or yin vacuity cough, one can choose from: Tuber Asparagi Cochinensis (Tian Dong), Tuber Ophiopogonis Japonici (Mai Dong), Bulbus Lilii (Bai He), Radix Glehniae Littoralis (Sha Shen), Radix Rubiae Cordifoliae (Qian Cao Gen), Radix Platycodi Grandiflori (Jie Geng), Bulbus Fritillariae Cirrhosae (Chuan Bei Mu), and Folium Eriobotryae Japonicae (Pi Pa Ye).

H. For precordial pain and coronary artery insufficiency with heart viscus impairment, one can choose from: Radix Pseudoginseng (San Qi), Radix Ligustici Wallichii (Chuan Xiong), Radix Angelicae Sinensis (Dang Gui), Fructus Crataegi (Shan Zha), Radix Ilicis Pubescentis (Mao Dong Qing), Rhizoma Corydalis Yanhusuo (Xuan Hu), Fructus Trichosanthis Kirlowii (Quan Gua Lou), Herba Leonuri Heterophylli (Yi Mu Cao), Radix Salviae Miltiorrhizae (Dan Shen), Ramulus Cinnamomi Cassiae (Gui Zhi), and Radix Albus Paeoniae Lactiflorae (Bai Shao).

I. For liver area pain, liver-spleen enlargement, or liver viscus impairment, one can choose from: Tuber Curcumae (Yu Jin), Radix Bupleuri (Chai Hu), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Herba Artemisiae Capillaris (Yin Chen Hao), Herba Taraxaci Mongolici Cum Radice (Pu Gong Ying), Plastrum Testudinis (Gui Ban), Carapax Amydae Chinensis (Bie Jia), Radix Salviae Miltiorrhizae (Dan Shen), Radix Ligustici Wallichii (Chuan Xiong), Radix Angelicae Sinensis (Dang Gui), Rhizoma Sparganii (San Leng), and Rhizoma Curcumae Zedoariae (E Zhu).

J. For kidney viscus impairment with albuminuria, one can choose from: Radix Codonopsitis Pilosulae (Dang Shen), Radix Astragali Membranacei (Huang Qi), Fructus Rosae Laevigatae (Jin Ying Zi), Fructus Schisandrae Chinensis (Wu Wei Zi), Fructus Crataegi (Shan Zha), Semen Euryalis Ferocis (Qian Shi), Fructus Germinatus Hordei Vulgaris (Mai Ya), Rhizoma Imperatae Cylindricae (Bai Mao Gen), Flos Lonicerae Japonicae (Jin Yin Hua), etc. For granular casts, choose from: Fructus Crataegi (Shan Zha), Radix Dioscoreae Oppositae (Huai Shan Yao), Herba Cynomorii Songarici (Suo Yang), and Radix Morindae Officinalis (Ba Ji Tian). For pus cells, choose from Semen Abutilonis Seu Malvae (Dong Kui Zi), Semen Plantaginis (Che Qian Zi), Flos Lonicerae Japonicae (Yin Hua), and Herba Houttuyniae Cordatae Cum Radice (Yu Xing Cao). For viral disease, choose from Shen Fu Tang (Ginseng & Aconite Decoction), Rhizoma Anemarrhenae Aspheloidis (Zhi Mu), Cortex Phellodendri (Huang Bai), Cortex Cinnamomi Cassiae (Rou Gui), and Radix Et Rhizoma Rhei (Da Huang).

K. For bleeding or abnormal blood coagulation, one can choose from: Cacumen Biotae Orientalis (Ce Bai Ye), Radix Rubiae Cordifoliae (Qian Cao Gen), Pollen Typhae (Pu Huang), Cornu Bubali (Shui Niu Jiao), Herba Agrimoniae Pilosae (Xian He Cao), Rhizoma Imperatae Cylindricae (Bai Mao Gen), Gelatinum Corii Asini (E Jiao), carbonized Radix Sanguisorbae (Di Yu), and Nodus Rhizomatis Nelumbinis Nuciferae (Ou Jie).

L. For decreased white blood cells, one can choose from: Fructus Ligustri Lucidi (Nu Zhen Zi), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Cortex Cinnamomi Cassiae (Rou Gui), Radix Sophorae Flavescentis (Ku Shen), and Herba Solani Nigri (Long Kui).

M. For decreased eating and drinking and torpid intake, one can choose from: Endothelium Corneum Gigeriae Galli (Ji Nei Jin), Radix Linderae Strychnifoliae (Wu Yao), uncooked Rhizoma Zingiberis (Sheng Jiang), Pericarpium Citri Reticulatae (Chen Pi), and Radix Gentianae Scabrae (Long Dan Cao).

N. For high blood pressure, one can choose from: Fructus Crataegi (Shan Zha), Fructus Schisandrae Chinensis (Wu Wei Zi), Radix Ilicis Pubescentis (Mao Dong Qing), Radix Salviae Miltiorrhizae (Dan Shen), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Radix Scrophulariae Ningpoensis (Xuan Shen), Cortex Radicis Lycii Chinensis (Di Gu Pi), Cortex Eucommiae Ulmoidis (Du Zhong), Cortex Radicis Moutan (Dan Pi), Radix Puerariae (Ge Gen), and Rhizoma Sinomenii Acuti (Qing Feng Teng).

O. For central nervous system impairment with emotional and nervous disorders, one can choose from, Rhizoma Gastrodiae Elatae (Tian Ma), Ramulus Uncariae Cum Uncis (Gou Teng), Radix Stephaniae Tetrandrae (Fang Ji), Rhizoma Arisaematis (Tian Nan Xing), Rhizoma Acori Graminei (Shi Chang Pu), Radix Polygalae Tenuifoliae (Yuan Zhi), Bombyx Batryticatus (Bai Jiang Can), Sclerotium Poriae Cocos (Fu Ling), Succinum (Hu Po), Margarita (Zhen Zhu), and Cornu Antelopis Saiga-tatarici (Ling Yang Jiao).

P. For qi vacuity emission of heat (i.e., fever), one can choose from: Radix Astragali Membranacei (Huang Qi), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Radix Codonopsitis Pilosulae (Dang Shen), Fructus Zizyphi Jujubae (Da Zao), and Arillus Euphoriae Longanae (Long Yan Rou).

Q. For blood vacuity fever, one can choose from: Radix Angelicae Sinensis (Dang Gui), cooked Radix Rehmanniae (Shu Di), Gelatinum Corii Asini (E Jiao), Rhizoma Polygonati (Huang Jing), and Rhizoma Polygoni Odorati (Yu Zhu).

R. For yin vacuity fever, one can choose from: Herba Artemisiae Apiaceae (Qing Hao), Cortex Radicis Lycii Chinensis (Di Gu Pi), Radix Stellariae Dichotomae (Yin Chai Hu), Rhizoma Picrorrhizae (Hu Huang Lian), Gelatinum Corii Asini (E Jiao), Caulis Milletiae Seu Spatholobi (Ji Xue Teng), and Radix Scrophulariae Ningpoensis (Xuan Shen).

S. For allergic fever, one can choose from: Radix Scutellariae Baicalensis (Huang Qin), Radix Stephaniae Tetrandrae (Fang Ji), Pericarpium Citri Reticulatae (Chen Pi), Herba Ephedrae (Ma Huang), and Radix Glycyrrhizae (Gan Cao).

T. For bacterial fever, one can choose from: Fructus Forsythiae Suspensae (Lian Qiao), Herba Houttuyniae Cordatae Cum Radice (Yu Xing Cao), Rhizoma Coptidis Chinensis (Huang Lian), Flos Chrysanthemi Morifolii (Ju Hua), Flos Lonicerae Japonicae (Jin Yin Hua), Herba Taraxaci Mongolici Cum Radice (Pu Gong Ying), Radix Bupleuri (Chai Hu), Folium Daqingye (Da Qing Ye), Radix Pulsatillae Chinensis (Bai Tou Weng), and Cortex Radicis Lycii Chinensis (Di Gu Pi).

U. For viral fever, one can choose from: Folium Daqingye (Da Qing Ye), Radix Isatidis Seu Baphicacanthi (Ban Lan Gen), Radix Pulsatillae Chinensis (Bai Tou Weng), Herba Oldenlandiae Diffusae (Bai Hua She She Cao), Herba Scutellariae Barbatae (Ban Zhi Lian), Herba Lobeliae Chinensis (Ban Bian Lian), Radix Dianthi (Qu Mai Gen), Flos Lonicerae Japonicae (Jin Yin Hua), Herba Taraxaci Mongolici Cum Radice (Pu Gong Ying), Herba Violae Yedoensitis Cum Radice (Zi Hua Di Ding), Radix Albus Paeoniae Lactiflorae (Bai Shao), Cortex Radicis Lycii Chinensis (Di Gu Pi), Radix Bupleuri (Chai Hu), Folium Eriobotryae Japonicae (Pi Pa Ye), Fructus Rosae Laevigatae (Jin Ying Zi), Herba Artemisiae Capillaris (Yin Chen Hao), and Herba Artemisiae Apiaceae (Qing Hao).

Copyright [c] Blue Poppy Press, 2004. All rights reserved.

by Bob Flaws, Dipl. Ac & CH, FNAAOM, FRCHM

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