Autoimmune Disease Treatment with TCM: Lupus, COPD, SJOGREN SyndromeAdina Stanescu, R.TCMP December 1, 2009
Traditional Chinese Medicine (TCM) is fast becoming global medicine, spreading from its traditional home in Asia to all of Europe, Australia, North America and Africa. The professional online forum that I belong to has members in all of these regions, some of whom work in hospitals or alongside medical doctors.
In Japan, China and Taiwan, the public medicare system covers the cost of certain herbal formulas that have proven themselves highly effective for various tenacious, chronic diseases, and many hospitals are engaged in research to further solidify the evidence. While there are plenty of TCM practitioners in Canada, consumers and medical doctors are largely unaware that this medicine can make a great contribution to the treatment of autoimmune disease. This article, Part 1 of which was published in the November issue of Vitality, will continue the discussion of this treatment.
Systemic Lupus Erythematosus (SLE) is a fairly prevalent autoimmune disease. In the U.S., it affects 52 people per 100,000. The incidence is highest among women, particularly those of West African or Asian descent. Consequently, it is also quite prevalent in China, and TCM has worked alongside modern medicine to improve treatment and outcomes for those affected.
Lupus is a connective tissue disease that can affect almost every organ in the body, but particularly the joints, kidneys and blood vessels. For unknown reasons, the body launches antibodies against the nuclei of the cells of these tissues, and it is this attack of circulating antibodies that provokes the symptoms and subsequent damage. Symptoms vary widely according to the stage of the illness, whether it is in relapse or remission, and the organs affected. For this reason, TCM is an invaluable treatment, as the traditional diagnosis is always geared toward the specifics of each case.
Treating During Flares
One generalization that can be made when Lupus is active is that it is a “Heat” disease. Often, the first symptoms are fever, a butterfly-shaped red rash on the cheeks and bridge of the nose, and joint pain. As the condition progresses, kidney, pulmonary, digestive, cardiovascular and neurological / cognitive function may all become affected. For this reason, subduing the inflammation quickly is essential, and this is usually done in concert with Western treatment, which often involves corticosteroids as well as immune suppressive drugs. Both drug classes are quite depleting to normal immunity and organ function, and combining them with herbs to minimize the dosage needed goes a long way toward protecting the body from further damage.
Many Chinese herbs can treat the Heat / inflammation of Lupus to bring symptoms under control, no matter which organ system they are in. These herbs are immunomodulators, meaning they regulate the function and reactions of the immune system to a normal level. This is very important in any autoimmune disease, as we want to walk a fine line between the overactive immunity that causes the disease, and the underactive immunity that Western drugs often induce, predisposing the patient to new problems such as infections and cancer.
Effective herbs include Gentiana macrophyllae Qin Jiao, as well as the antimalarial Artemesia anomala Qing Hao. The use of antimalarials in Lupus is quite interesting. Like malaria, Lupus presents with fever and a relapsing and remitting nature, with flares of active disease followed by quiet periods of low to no symptoms. The herb Qing Hao is now the premier source of antimalarial drugs in the world, and it shows a similarly positive effect on Lupus. However, both Qing Hao and Qin Jiao are combined with many other herbs which address the constitution of the patient and his or her current symptoms. A study published in the Chinese Journal of Integrated Traditional and Western Medicine(1) used a formula that contained Qin Jiao along with several other Heat-clearing ingredients. One group of patients were treated only with herbs, a second group with herbs and prednisone (a steroid), and a third group with prednisone alone. After seven to nine months of treatment, while all groups improved more or less equally, the two groups that were given herbs had a higher proportion of patients in complete remission. This is highly suggestive of the possibility that herbal treatment addresses the cause, rather than suppressing symptoms.
In mild and early cases, or where the disease is confined to the skin, herbal medicines are often sufficient on their own.
Treating Between Flares
When the disease is quiet, we have a chance to really attack the root of the problem, without much attention paid to subduing symptoms. This is called “treating the root when the branch is quiet.” This usually entails some form of strengthening and tonifying treatment that boosts the kidneys and liver, and enriches the yin (water) aspect of the body. By doing this, the water / fire elements are brought back into balance and the subsequent flaring up of heat will be less and less. Herbs used for this purpose include Rhemannia glutinosa, Scrophularia ningpoensis and Moutan radicis.
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Chronic obstructive pulmonary disease (COPD) has only recently been found to have an autoimmune component, according to research published in the American Journal of Respiratory and Critical Care Medicine in 2008. According to Dr. Steven Duncan, author of the study and professor of medicine at the University of Pittsburgh School of Medicine, “this new work shows that in some patients with COPD, immune system antibodies attack the cells that line the airways and air sacs of the lungs called epithelial cells.” While COPD is overwhelmingly caused by smoking, it may be that cigarettes trigger an autoimmune reaction that continues to keep the disease active long after the patient has quit.
COPD is essentially characterized by severe, chronic bronchitis with profuse production of phlegm, repeated lung infections, breathing as if through a straw, and possibly emphysema. TCM has a great contribution to make to its treatment, based on its potent arsenal of respiratory herbs that can reduce inflammation, open the airways and greatly reduce phlegm production. While we cannot claim to cure this condition, long term herbal treatment can profoundly improve symptoms and quality of life for people with severe respiratory disease. I have consistently been amazed at the results obtained in my clinic in this regard, when patients report and can be observed climbing the stairs to my office at a normal pace, and no longer arriving gasping for breath. Another common outcome is a reduction in the number and severity of respiratory infections contracted through the winter.
A review published in the European Respiratory Journal (2), found that the Chinese herbs Panax ginseng and Salvia miltiorrhizae were “significantly superior to placebo in improving pulmonary functions.” However, it would be very simplistic and occasionally quite wrong to prescribe ginseng as a single herb for COPD. This very strengthening herb can improve lung and heart function, but should really be given in combination with herbs to address the phlegm. Always consult a qualified herbalist when seeking treatment for a serious condition such as this one.
Other Chinese herbs that might be used for this purpose include Fritillaria thunbergii, Pinellia ternata, Stemona root and Citrus seu ponciri. Another thing to remember is that the alkaloid ephedrine, one of the mainstays of Western medicine’s asthma treatment, comes from TCM’sEphedra sinica Ma Huang. Many of the world’s herbal traditions have powerful decongestant and antiasthmatic herbs that can make a great contribution to the treatment of COPD and other respiratory diseases.
This peculiar autoimmune disease, which affects about 1% of the population, is characterized by dryness of the tear ducts and salivary duct glands. The immune system attacks these glands and compromises their secretions, leading to painfully dry eyes and mouth, but it can also impair and “dry up” organ tissues of the kidneys, blood vessels, lung, gastrointestinal tract and liver. Many patients also suffer from joint pain and severe fatigue. It is as if their engine has no fuel to power itself.
This condition closely resembles the TCM diagnosis of Yin Deficiency. This is a deficiency of the water, blood and body fluid components of the body, and it produces exactly the dry symptoms of Sjogren disease. Another interesting parallel is that the onset of Sjogren is generally after 40 years of age, and especially around menopause. This is a time when, according to TCM theory, the Yin fluids of the body begin to decline naturally. This combines with a pre-existing constitutional fluid weakness to put the patient’s deep dehydration over the edge, and trigger this very uncomfortable condition.
When there are no fluids in the mouth, eating becomes extremely difficult, necessitating a swallow of water to make every bite go down. The protectant effect of saliva upon the teeth is gone, and severe cavities and ulcerations may develop in the mouth. The eyes may also suffer from painful ulcers.
Western medicine has no effective therapy for this disease, but TCM can employ a great many herbal formulas that enhance the production of body fluids. Sheng Mai San, which contains ginseng root, ophiopogonis root and schizandra berry is a famous formula which translates as “Generate the Pulse Powder.” It is called this because of its ability to engender fluids, thereby making the blood vessels and pulse “swell up” with them. Another formula with a specific effect on dryness of the mouth and eyes is Sha Shen Mai Dong Tang. Its herbs such as morus leaf and glehnia root moisten and calm inflammation of mucous membranes. Finally, herbal lozenges that enhance salivary secretions can be used throughout the day to lessen the discomfort while the internal herbal therapy is working to correct the root of the problem.
A study done in a Japanese hospital on the related TCM formula Mai Men Dong tang(3) concluded that the formula “was very useful in managing oral manifestations in patients with Sjogren Syndrome.” Patients treated with the herbal formula experienced an increase in measurable salivary secretions, which was “significantly more than the increase in control group.”
If you suffer from an autoimmune condition, TCM is well worth your while. It can often accomplish a surprising amount, either as supportive therapy that allows for a minimum dosing of the harsher Western medicines, or in many cases on its own, working to address the fundamental imbalances that allowed the autoimmunity to develop in the first place.
High dose, boiled herbal decoctions are usually needed to treat any severe symptoms, so insist on these rather than pills when seeking out a qualified practitioner. Strong symptoms must always be matched by strong medicines.
(1) Treatment of systemic lupus erythematosus with compound qinjiao tablet and minimum dose of prednisone, Chinese Journal of Integrated Traditional and Western Medicine, 1989; 9(3): 156-157.
(2) Eur Respir J 2006; 28:330-338
(3) Ohno S, Suzuki T, Dohi Y
Second Department of Internal Medicine, Saitama Medical School.
Ryumachi 1990 Feb;30(1):10-6