Transcript What is an Autoimmune Disorder? cont.

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: [email protected]
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
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.
What is an Autoimmune Disorder? cont.

The disorders include:
 Lupus,
 Hashimoto’s
thyroiditis
 Myethenia Gravis
 Scleroderma
 Multiple Sclerosis
 Sjogren’s Syndrome
 Rheumatoid arthritis.
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.
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
Examples:
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.
1. Sunshine
2. Wind
Wind, dampness & heat
block channels
Cold damp Bi
Damp heat Bi
3. Cold
4. Heat
5. Dampness
6. Summer-heat
Weak constitution of body
Excessive or deficient
heat (in five Zang organs)
causes reckless movement
of blood
Yin deficiency of
Liver & Kidney
Erythematous rash
Interior-organs
Disorders
Exterior-6 Evils
Etiology and Pathology, Chart 1
Emotional disorders
Qi & Yang Deficiency
Edema
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).
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.

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
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

Shui niu jiao (Cornu Bubali) 15g

Sheng di huang (Uncooked radix rehnanniae) 15g
Xuan shen (Radix scrophulariae Ningpoensis) 10g
Sheng di huang (Uncooked Radix Rehmanniae) 12g
Jin yin hua (Honeysuckle flower) 9g
Lian qiao (Forsythia fruit)
6g
Huang 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)
UB 40 (Wei Zhong)
Du 10 (Ling Tai)
Modification:


LI 4 (He Gu)
PC 3 (Qu Ze)
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
 Irritability
 Insomnia
 Red eyes
 Red tongue with no coating
 Rapid thready pulse
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
Shu di huang (Prepared rehmannia) 9g
Mai men dong (Ophiopogon root) 6g
Niu xi (Cyathula root) 6g
Xuan shen (Radix Scrophulariae ningpoensis)
10g
Sheng 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 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
Pattern & 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) 20g
 Sheng di huang (Radix Rehmanniae Glutinosae) 30g
 Shao yao (Radix Paeoniae Lactiflorae) 9g
 Mu dan pi (Cortex Moutan Radixis) 6g
Pattern & Suggested Measures, cont.

Acupuncture Points:
Er Jian,
St 44 (Nei Ting)
Sp 10 (Xue Hai)
LI 11 (Qu Chi)
UB 40 (Wei Zhong)
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
Pattern & Suggested Measures, cont.
Treatment Measures: Tonify spleen and kidney,
promote urination
Formula: Ji Sheng Shen Qi Wan

Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae )10g

Gou Qi Zi (Fructus Lycii )10g

Fu Ling (Sclerotium Poriae Cocos )15g

Shan Zhu Yu (Fructus Corni Officinalis )10g

Fu Zi (Radix Lateralis Aconiti Carmichaeli Praeparata )10g

Ze Xie (Rhizoma Alismatis Orientalis )12g

Che Qian Zi (Semen Plantaginis )10g
Pattern & Suggested Measures, cont.

Acupuncture Points:
Du4 (Ming Men)
St 36 (Zhu San Li)
BU 23 (Shen Shu)
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:
6/29/2006
Case Study, cont.
6/1/2006
6/1/2006
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
Case Study, cont.
Western Diagnosis:
Raynaud’s disease
Vasculitis
Lupus
Sjogren’s disease
Fatty Liver
Ht blood deficiency
TCM Diagnosis:
Bi syndrome due to
wind and
dampness blocking
meridians
Rashes due to
blood deficiency
and stasis with
internal wind
Case Study, cont.
EX: Acupuncture points:
GB20, LI11, SJ5, Lu10, Ren12,
Sp10,LI4,St36,Sp6,Lu3
 Herbal formula: Dang Gui Shao 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

Case Study, cont.
Herbs:
 Shu Di 9g
 Dang Gui9g
 Bai Shao30g
 Bai Xian Pi 9g
 Fang Feng9g
 Di Gu Pi 9g
 Dan Shen 9g
 Zhi Gan Cao9g
 Ju Hua 9g
 Di Fu Zhi 9g
11/05/06
+Ba Xie
Si Wu Tang+Wu Pi Tang, Yi
Yi Ren, Fang Feng, Gui Zhi,
Yin Hua Teng
Case Study, cont.
05/25/06
TG166 (Normal <150)
HDL27 (Normal >39)
ANA 1:1280
10/12/2006
7/27/2006
10/12/2006
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.com
E-mail: [email protected]
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.
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.
Treatment of Western Medicine & Prognosis
Severe lupus is treated immediately with a
corticosteroid such as prednisone, Sometimes
an immunosuppressive drug such as
azathioprine, cyclophosphamide
is given to suppress the body's autoimmune
attack. Mycophenylate mofetil is another new
alternative immunosuppressive drug.
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).
Etiology and Pathology
Cause heat &
toxins in the body
Fever, anxiety,
constipation, sores, rash, bleeding, etal.
Dampness inside the body acne, fatigue, full
abdomen, turbid urine
Chemicals:
Sweet, warm, hot,
pungent and dry
Injure Yin (Lu, Ht, Liv, St, Ki),
deficiency of Zang fu organs
Injure Qi or Yang
Low grade fever, night sweats,
rash, hot sensation, etal.
Fatigue, obesity, edema,
poor appetite, loose stool, sweating
susceptive, irregular menstruation,
infertility
Injure blood
fatigue, palpitation, dizziness, pale
face & lips
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.

The Prevention of side-effects of Prednisone
Treatment: nourishing Yin & clear fire
Formula: Zuo Gui Wan (restore the Left Pill) (T178)
 Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae)
 Shan Yao (Radix Dioscoreae Oppositae)
 Gou Qi Zi (Fructus Lycii)
 Shan Zhu Yu (Fructus Corni Officinalis)
 Niu Xi (Radix Achyranthis Bidentatae)
 Tu Si Zi (Semen Cuscutae Chinensis)
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 reoccurrence
Manifestations: fatigue, spontaneous sweating, susceptive, poor
appetite, obesity, profuse urine, pale tongue with thick white
coating, deep slow pulse.
Treatment: tonifying spleen & kidney Yang
The Prevention of side-effects of Prednisone

Formula: Jin Kui Shen Qi Wan (Kidney Qi Pill from the
Golden Cabinet) (T07)
Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae)
 Shan Yao (Radix Dioscoreae Oppositae)
 Shan Zhu Yu (Fructus Corni Officinalis)
 Fu Ling (Sclerotium Poriae Cocos)
 Mu Dan Pi (Cortex Moutan Radixis)
 Ze Xie (Rhizoma Alismatis Orientalis)
 Fu Zi (Radix Lateralis Aconiti Carmichaeli Praeparata)
 Gui Zhi (Ramulus Cinnamomi Cassiae)

The Prevention of side-effects of Prednisone
Acupuncture Points:
Ming men (Du 4)
Zhu San Li (St 36)
Shen Shu (UB 23)
Qi Hai (Ren 6)
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)
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)
San Yin Jiao (Sp6)
Zhu San Li (St 36)
Zhong Wan (Ren 12)
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.
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 (Rhizoma Polygonati)
 Huang Qi (Radix Astragali Membranacei)
Acupuncture Points:
San Yin Jiao (Sp 6)
Zhao Hai (Ki6)
Jue Gu (GB 39
Xue Hai (Sp 10)
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

The Prevention of side-effects of ISD
on Gonads & Reproductive system
Formula: Wu Zi Yan Zong Wan
Er Zhi Wan
Fu Pen Zi (Fructus Rubi Chingii)
 Gou Qi Zi (Fructus Lycii)
 Tu Si Zi (Semen Cuscutae Chinensis)
 Wu Wei Zi (Fructus Schisandrae Chinensis)
 Che Qian Zi (Semen Plantaginis)
 Nu Zhen Zi (Fructus Ligustri Lucidi)
 Han Lian Cao (Herba Ecliptae Prostratae)

Acupuncture Points:
Ming Men (Du 4)
Shen Shui (UB 23)
Guan Yuan(Ren 3)
Tai Xi (Ki 3)
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, Bao Xiaohui, Zhuo zhiling, 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 wi thAcupoint Catgut
Embedding Therapy Combined with Chinese Drug.Tian YuanSheng; 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. Jia XiLian; Li PeiLin; Xiong XiangMing; Qu
ZhuQiu. 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.
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
Questions/Discussions