There are many ways to treat lupus erythematosus in traditional Chinese medicine, including drug therapy and other therapies. Drug therapy is commonly used in traditional Chinese medicine, and other therapies include acupuncture, massage, local sealing and physical therapy. Most of these therapies are symptomatic treatment for a symptom of lupus erythematosus.
Oral administration of traditional Chinese medicine can be used to treat lupus erythematosus, including TCM syndrome differentiation treatment, medication for one disease, unilateral treatment and Chinese patent medicine treatment. Among them, debate therapy has the characteristics of wide coverage, great flexibility and treatment according to the circumstances, and it is one of the treatment measures worth taking. However, due to the extensive damage and complex and changeable symptoms of systemic lupus erythematosus, doctors have different opinions on syndrome differentiation and prescription selection. According to various types of clinical syndrome differentiation treatment summarized by most doctors in China, the opinions and clinical experience of various families are integrated. State administration of traditional chinese medicine, China, issued the syndrome differentiation standard of red butterfly spot, which can be divided into six syndrome types: excessive heat toxin, internal heat due to yin deficiency, liver and kidney yin deficiency, liver injury due to pathogenic heat, spleen and kidney yin deficiency and rheumatism, including acute active stage, stable stage and organ injury of systemic lupus erythematosus. According to the clinical manifestations of each syndrome type, different treatment prescriptions are selected respectively. One side of the disease is to grasp the main pathogenesis of lupus erythematosus according to the changing law of the disease, formulate the treatment prescription according to the pathogenesis, and treat it with one principle. Some use the method of nourishing yin and tonifying kidney, some use the method of promoting blood circulation and removing blood stasis, some use the method of detoxifying and clearing heat, and some use the method of expelling wind and removing arthralgia. The most commonly used traditional prescriptions for treating one disease are Qingre Dihuang Decoction, Liuwei Dihuang Decoction, Buzhong Yiqi Decoction, Jisheng Shenqi Pill, Shengmai Decoction, Guipi Decoction, Niuhuang Qingxin Pill, Siwu Decoction, Gui You Pill and Zuogui Pill. More applications are self-made prescriptions created by each doctor according to his own experience. Commonly used drugs in these prescriptions are Scrophularia, Cornus officinalis, Lycium barbarum, Polygonatum sibiricum, Ophiopogon japonicus, Stemona, Ligustrum lucidum, Hedyotis diffusa, Pseudostellaria heterophylla, Ginseng, Astragalus membranaceus, Poria, Yam, Atractylodes macrocephala, Codonopsis pilosula, Coptidis Rhizoma, Scutellariae Radix, Lonicera japonica Thunb, Forsythia suspensa, Gypsum Fibrosum, Anemarrhena asphodeloides, Antelope and so on. Among them, there are tripterygium wilfordii tablets, tripterygium wilfordii polyglycoside tablets, tripterygium wilfordii syrup, santengyin and so on. Begonia kunmingensis is used for systemic lupus erythematosus and discoid lupus erythematosus. In 1970s and 1980s, a contract factory produced its tablets, each containing 50 mg. Natural medicine. Artemisia annua and its preparation have certain curative effect on discoid lupus erythematosus. Among them, Artemisia annua pills and Artemisia annua extract tablets are both taken orally, while artemisinin is an injection, which has been reduced in the 1990s. In addition, some preparations are also used in clinic, such as compound Jinqiao tablet, three snake syrup, gallnut and amitabha powder, safflower preparation, salvia miltiorrhiza preparation, rhubarb preparation and so on.
In addition to oral Chinese medicine decoction and application of Chinese medicine, there are different treatment methods such as acupuncture, ear acupuncture, acupoint sealing, selective treatment, dietotherapy and physical therapy. These therapies can be used as adjuvant therapy for the treatment of systemic erythema wolf.
To sum up, there are many methods of treating lupus erythematosus in traditional Chinese medicine. In clinical application, one or several treatment methods should be selected according to the different symptoms of patients.
About the treatment of lupus erythematosus
Treatment is mainly to relieve symptoms and inhibit pathological process. Because individuals vary greatly, it should be different according to each patient's situation.
First of all, the general treatment for acute activities should be bed rest. Those with chronic stage or stable condition can take part in the work appropriately. Psychiatry and psychotherapy are very important. Patients should be followed up regularly to avoid inducing factors and irritation and direct exposure of skin to sunlight. Women of childbearing age should strictly use contraception.
Second, medication.
(1) Non-steroidal anti-inflammatory drugs can resist the synthesis of prostaglandin and can be used for symptomatic treatment of fever, joint pain and myalgia. For example, indomethacin has a good effect on fever, pleural and pericardial lesions of SLE. Because these drugs affect renal blood flow, they should be used with caution when complicated with nephritis.
Chloroquine, an antimalarial drug, is mainly concentrated in the skin after oral administration, which can inhibit the combination of DNA and anti-DNA antibodies and is sensitive to rash.
Symptoms have a certain curative effect. Chloroquine phosphate 250-500mg/d, long-term use can cause retinal degeneration due to accumulation in the body. Early withdrawal of drugs can recur, and the fundus should be examined regularly.
(3) Glucocorticoid is the main drug to treat this disease at present. It is suitable for acute or explosive cases, or when major organs such as heart, brain, lung, kidney and serosa are involved, autoimmune hemolysis or thrombocytopenia tends to hematopoiesis.
There are two ways to use it. One is a small dose, such as 0.5mg/kg/d, or even half of it can relieve the disease. The other is a large dose, which is maintained at 10- 15mg/d at the initial stage. If the disease rebounds during the reduction period, the dose should be maintained with 5mg before the reduction. High dose methylprednisolone pulse therapy can be used for fulminant or refractory lupus nephritis. Intravenous drip 1000mg/d, halved after 3 days, and then maintained with prednisone. Some cases can achieve good curative effect, and their side effects such as hypertension and easy infection should be paid attention to.
(4) Immunosuppressants are mainly used in cases of onset after hormone reduction or serious side effects caused by excessive dosage of hormone, as well as diseases that are difficult to control with hormone alone, such as lupus nephritis and lupus encephalopathy. Such as cyclophosphamide 15-2.5mg/kg/d, intravenous injection or oral administration, or 200mg every other day. The main side effects are bone marrow suppression, gonadal atrophy, teratogenesis, hemorrhagic cystitis and alopecia. It should be noted that cytotoxic drugs cannot replace hormones.
(5) Other drugs, such as levamisole, can enhance the immune response below normal, which may be helpful for SLE patients with infection. Usage: 50mg/d, three days in a row, rest 1 1 day. The side effects are loss of appetite and leukopenia.
Anti-lymphocyte globulin (ALG) or anti-thymocyte globulin (ATG) is a large number of immunosuppressants used to treat aplastic anemia in recent years. It has high activity of T lymphocyte toxicity and the function of inhibiting T lymphocyte immune response. Part of normal saline is slowly injected intravenously for 5-7 days, and the side effects are rash, fever, general joint pain, transient thrombocytopenia and serum sickness. If hormones are supplemented at the same time, it can be alleviated.
(6) Plasma exchange therapy removes the immune complex and autoantibodies contained in the patient's plasma, and then inputs normal plasma. The effect is remarkable, but it is difficult to last and expensive, and it is suitable for acute and severe diseases.
Integrated traditional Chinese and western medicine treatment
Systemic lupus nephritis (LN) is an inflammatory autoimmune disease involving multiple organs, including the kidney. The main clinical symptoms are fever, joint pain, rash and kidney damage. The incidence of systemic lupus erythematosus in China is about 70 cases /65438+ 10,000 people. There is no record of lupus nephritis in TCM literature. According to the main clinical features of LN, it can be divided into the following categories: fever, butterfly, sunburn, edema, fatigue, drinking, etc. Clinically, LN is complex and changeable, and the treatment is difficult. In recent years, we have summarized a set of methods for treating lupus nephritis by combining traditional Chinese and western medicine. The main contents are as follows.
1, recognizing that exercise is used repeatedly. Clear solution: exercise is acute active stage of lupus nephritis, and rest stage is static stage or subacute mild active stage of lupus nephritis. In the active stage of lupus nephritis, its clinical feature is that heat and toxin are flourishing. Heat toxin can penetrate deep from the muscle surface, starting from the Wei-fen, then entering the Qi-fen, then entering the camp and even entering the blood. It may also be caused by the poison of medicine and food from the inside. From the beginning, I saw the clinical manifestations of qi-excess heat or qi-excess double burning. Due to the fastest spread of heat toxin, the syndrome of qi-excess heat and qi-excess double burning are common in the course of disease, especially the syndrome of qi-excess double burning, but the syndrome of Wei deficiency is rare. At the beginning of most cases, the symptoms are full of qi and double fever, and even the critical syndrome of heat toxin entering blood points appears. In this regard, we emphasize the reuse of heat-clearing and detoxicating, and advocate that regardless of syndrome differentiation, we should use products that are thorough in heat and cool in camp, so as to eliminate qi and camp, so as to quickly cut off and reverse the disease. Clinically, we found that the pathogenesis of lupus nephritis is characterized by deficiency of essence and excess of essence. Although the active stage of lupus nephritis focuses on substantial evidence, the essence of yin deficiency has long been included. Its yin deficiency is dry, deficiency fire is blazing inside, and blood is bitter for a long time. When the heat of qi suddenly rises, it quickly becomes the trend of nourishing the second coke with qi and starting a prairie fire with heat and poison. Therefore, although the camp is not manifested, it should be placed in a place that is not affected by evil. In the choice of prescription, Qingwen Baidu decoction is the most suitable, which integrates the functions of Baihu decoction, Asarum Dihuang decoction and Huanglian Jiedu decoction in clearing qi, cooling camp and detoxifying, and is very consistent with our principle of treating active lupus nephritis. When the acute active period is controlled and enters the subacute mild active period or the rest period, the excessive heat toxicity gradually subsides, and the syndrome of insufficient essence is more prominent. The syndrome of yin deficiency is aggravated by yin deficiency and dryness-heat, and the toxic heat damages the body fluid, or the syndrome of deficiency of both qi and yin appears. The treatment should be mainly based on nourishing yin and promoting fluid production or benefiting qi and nourishing yin, but it is still necessary to clear away heat and detoxify, and there is fire in the ash, so it is appropriate to make up.
2, promoting blood circulation and removing blood stasis, throughout; Regardless of acute active stage, subacute active stage or static stage, blood stasis is always one of the important pathogenesis that runs through different stages of lupus nephritis. It can also be that heat toxin blocks blood vessels, burns the camp, makes the blood thick, and causes blood stasis due to poor operation. When the course of the disease enters subacute mild active stage or resting stage, heat toxin gradually dies, yin deficiency or deficiency of both qi and yin is the main pathogenesis, and meridian deficiency can also be caused by yin deficiency, lack of blood and unsmooth pulse; Or qi deficiency leads to blood deficiency and slow blood circulation, leading to blood stasis. A large number of clinical and experimental studies in modern medicine have proved that immune response is the key to lupus nephritis. Because the in situ immune complex or circulating immune complex is deposited in glomerulus, the complement system is activated, which leads to inflammation and coagulation in glomerulus, and leads to microthrombosis and fibrin deposition in glomerular capillaries. It can also cause the proliferation of glomerular intrinsic cells, the increase of matrix, the infiltration of neutrophils and monocytes in glomerulus, and the narrowing or even occlusion of capillary walls. Therefore, Professor Ye takes the method of promoting blood circulation and removing blood stasis as the treatment rule throughout the disease when treating lupus nephritis. And it is reflected in the syndrome differentiation and treatment of different syndromes in traditional Chinese medicine. We emphasize that no matter how to establish various treatment methods, we should use the method of promoting blood circulation and removing blood stasis. In addition to peach kernel, safflower, salvia miltiorrhiza, red peony root, motherwort and medicinal materials, we prefer to use insect drugs such as ground dragon and silkworm. Because of its merits, it can not only dredge the twelve meridians's injustice, but also dredge collaterals and blood stasis, which is very effective in improving glomerular capillary lesions.
4. Combine Chinese and Western cultures to learn from each other's strengths; Clinically, we are used to treating lupus nephritis with combination of traditional Chinese and western medicine. Lupus nephritis in acute active stage and subacute active stage is often treated with hormone standard course of treatment, and combined with traditional Chinese medicine according to different stages of hormone treatment, in order to strengthen the curative effect of hormone and reduce the toxic and side effects of hormone, so as to play the dual role of traditional Chinese medicine in enhancing efficiency and reducing toxicity. For lupus nephritis complicated with chronic nephritis or nephrotic syndrome, it is often combined with cyclophosphamide pulse therapy on the basis of hormone standard course of treatment; For patients with acute progressive nephritis with short-term renal function, methylprednisolone pulse therapy (see the chapter on acute progressive nephritis for the scheme) was first used, followed by hormone standard course plus cyclophosphamide pulse therapy. Combined with oral or intestinal perfusion of traditional Chinese medicine, such as Jiujun, mirabilite, etc., it can excrete poison through the intestine and improve the internal environment of the body. For patients whose condition is relieved and lupus is basically inactive after the above treatment, it is good for the future to use Chinese medicine to regulate the qi, blood, yin and yang of the body. For example, the heat toxicity of lupus stays for a long time, and toxic drugs such as hormones and cyclophosphamide hurt yin and consume gas, which often leads to deficiency of both qi and yin after illness. At the same time of hormone withdrawal, the patients were given Shenqi Dihuang decoction to replenish qi and nourish yin. For patients with leukopenia and decreased immune function in peripheral blood during cyclophosphamide pulse therapy, Ejiao, Colla cornus Cervi, Cordyceps sinensis and Yupingfeng are commonly used to warm kidney, replenish essence, replenish qi and consolidate exterior, so as to make qi abundant and vigorous, strengthen bone marrow, and be beneficial to the regeneration of leukocytes and the improvement of immune function. For patients with lupus nephritis complicated with other organ damage, in addition to routine western medicine treatment, combined with TCM syndrome differentiation treatment, for example, for patients with lupus myocarditis, Danshen Shengmai Yin (Danshen, Ginseng, Ophiopogon japonicus, Schisandra chinensis, etc. ) it is to replenish qi and nourish yin, promote blood circulation and pass the pulse; For patients with lupus liver injury, Zishui Qinggan Decoction (Liuwei Dihuang Pill with Angelica, Radix Paeoniae Alba, Semen Ziziphi Spinosae, Fructus Gardeniae, Bupleuri Radix, Herba Artemisiae Scopariae, Zhang Hu, etc. ) it is for nourishing yin and nourishing blood, clearing liver and relieving summer heat. Through the complementary advantages of traditional Chinese and western medicine, the clinical efficacy of lupus nephritis is greatly improved, and the toxic and side effects of the two drugs are reduced, which has strong clinical practical value.
What are the commonly used western medicine treatment methods for lupus erythematosus?
Lupus erythematosus is a very complicated disease. Doctors who specialize in this disease need to understand the patient's condition comprehensively and deeply, and then give individualized treatment according to the different changes of each patient. A unified treatment model does not always solve the problem. At the same time, patients and their families need to cooperate in many aspects, such as diet care, in order to achieve the best therapeutic effect, otherwise the curative effect and prognosis will be greatly reduced. Generally speaking, lupus erythematosus has the following treatment methods;
1, non-steroidal anti-inflammatory drugs: such as indomethacin, aspirin, naproxen, fenbid, etc. These drugs are mainly used for patients with fever, joint pain, myalgia, fatigue and other symptoms without obvious organ damage, but they are easy to cause liver and kidney damage. Patients with lupus nephritis should be especially careful when using them.
2. Anti-malarial drugs: Not all anti-malarial drugs can treat lupus erythematosus, here mainly refer to chloroquine and hydroxychloroquine. These drugs have anti-inflammatory and immunosuppressive effects, have photoprotective effects on human body, can alleviate skin damage of patients with lupus erythematosus, and have certain effects on controlling rash, relieving symptoms and photosensitivity. It is the main drug for the treatment of discoid lupus erythematosus.
3. Glucocorticoid (hereinafter referred to as hormone); Although long-term use of glucocorticoid has many side effects, it is still the most important treatment for most patients with lupus erythematosus, especially patients with acute or fulminant lupus or patients with kidney, heart, brain, lung and other major organ damage. The principle of medication is early, sufficient and continuous medication. The dosage is large in the early stage, and it should be gradually reduced with the improvement of the disease. The reduction rate depends on the recovery degree of the disease, and most patients can maintain the dose below 5- 15mg after one year.
4. Immunosuppressants: These drugs are often used in combination with glucocorticoids or alone. They are mainly suitable for patients with lupus nephritis, lupus lung and central nervous system involvement. It is also suitable for those who are prone to relapse after hormone withdrawal, but the hormone is effective but the dosage is too large and toxic. These drugs have great toxic and side effects, especially bone marrow suppression and liver and kidney function damage. Blood routine and liver and kidney function indexes should be checked regularly during medication. At present, cyclophosphamide (CTX) is commonly used in this kind of drugs, and its main side effects are bone marrow suppression, gonadal atrophy and teratogenesis. At present, other immunomodulators are used to treat lupus erythematosus, such as thymosin and transfer factor, and heparin is also used to treat lupus nephritis.
5. Other therapies: When the above methods are ineffective, patients with severe organ damage can adopt plasma exchange and organ transplantation, and patients with severe renal damage and renal failure can adopt dialysis therapy or kidney transplantation. In addition to the selective application of the above treatment methods, traditional Chinese medicine can also be used according to the different constitutions of patients. This can not only improve the curative effect, but also minimize the toxic and side effects of western medicine, especially after the acute phase, we should take Chinese medicine for a long time, strengthen our physique, adjust and gradually stabilize the immune system function, so as to consolidate the curative effect. During the treatment, patients should prevent colds, pay attention to rest, be emotionally stable, and avoid spicy, seafood and hot meat.
In addition, for lupus erythematosus, photosensitivity is a prominent clinical manifestation. Ultraviolet rays in the sun can make the body produce strong antigenicity substances, which can easily stimulate the body to produce systemic immune response. Therefore, patients with lupus erythematosus should pay attention to avoid sunlight. When going out in strong sunlight, they should wear sun hats or umbrellas and long-sleeved clothes.