TREATMENT OF SYSTEMIC LUPUS ERYTHEMATOSIS (SLE) WITH CHINESE HERBS

Lupus is an autoimmune disease involving antibodies that attack connective tissue. The disease is estimated to affect nearly 1 million Americans, primarily affecting women and arising mainly between the ages of 20-40. In China, lupus is even more prevalent than in the West, affecting about 5 million people. The principal disease form is a systemic one (systemic lupus erythematosis; SLE), which is the subject of this article, though a more circumscribed form, discoid lupus, sometimes occurs. The systemic disease includes production of antinuclear antibodies (ANA; mainly targeting the nucleic acid guanosine), generation of circulating immune complexes, and activation of the complement system. Most cases of lupus are mild; however, in some severe cases, untreated lupus can be fatal as it progresses from attack of skin and joints to internal organs, including lung, heart, and kidneys (with renal disease being the primary concern). Lupus mainly appears as a series of flare-ups, with intervening periods of little or no disease manifestation. Triggers for the flare-ups include emotional distress and ultraviolet light exposure; infections may also serve as triggers.

Modern medical treatment involves immunosuppressive strategies, mainly the use of corticosteroids such as prednisone, which are given during periods of flare-ups, but may also be given persistently for those who have experienced frequent flare-ups. Even with effective treatment, which reduces symptoms and prolongs life, the combination of drug side effects and continued low-level manifestation of the disease can cause serious impairment and premature death. New disease management strategies include cyclophosphamide, methotrexate, antimalarials, hormonal treatment (e.g., DHEA), and antihormonal therapy (e.g., the antiprolactin agent bromocriptine).

Antimalarial therapy has a long and successful track record in the management of patients with mild SLE, especially for patients who manifest cutaneous symptoms (it is usually effective for discoid lupus, which is characterized by cutaneous symptoms). Medium to long-term use of hydroxychloroquine, alone or in combination with mepacrine, ameliorates lupus and may reduce the relapse rate. The dose of corticosteroids given for lupus patients may be reduced when antimalarials are used, and the side effect profile of these antimalarials is quite limited (though overdosing can cause significant reactions). Antimalarials have certain beneficial effects on lipid and glucose metabolism as well as having weak anticoagulant activity. One of the main Chinese herb therapies for lupus is the antimalarial herb ching-hao (qinghao, Artemisia annua) and its active component arteannuan.

Traditional Chinese texts from the Qing Dynasty period indicate an awareness of the disease, suggesting that summer heat causes the red patches to appear because of an underlying heat toxin in the blood that is activated by the heat. In fact, it could be that the sunlight (a natural and strong ultraviolet source) is the primary trigger, rather than heat. Herbs that clear heat and toxin, nourish yin (to control heat), or reduce the impact of damp-heat (associated with late-summer weather conditions) were recommended. The herbs and formulas for lupus were based on the treatments for warm diseases. Such formulas had been popularized by Wu Youxing and others as a response to numerous serious epidemic diseases that occurred toward the end of the Ming Dynasty period. Lupus, which often presented with fever as well as reddened skin, was considered one of the warm diseases.

Chinese medical journals have relayed information about lupus treatment throughout the 20th Century and it remains a subject of intense interest. In most cases, lupus is treated in China with corticosteroids; in addition, herbal therapies are frequently employed as an adjunct to steroids. The modern Chinese literature focuses on two primary means of treating lupus with herbs: using antitoxin herbs (usually in conjunction with herbs that vitalize blood circulation) and using ching-hao or its active components.

Because the Chinese medical literature on lupus is so extensive, only sample information from recent clinical trials will be presented here to illustrate the practices that have evolved after several decades of experience. Because it is difficult to interpret clinical results with lupus treatments due to the high variability of the disease manifestation in each person over time, only the details of the treatment methods and some laboratory measurements will be relayed here. In all cases, the study authors determined that the patients who were treated with herbs plus prednisone responded better than those who were treated with prednisone alone (e.g., quicker response time, more complete resolution of symptoms, less prednisone required so fewer side effects). The basic treatment time in each case is 3 months, which would often be repeated for a total of six months treatment duration.