Main Points of Diagnosis

1.The onset of disease is slow, early symptoms include fatigue, anorexia, emaciation, arthralgia, low fever, skin rash, photosensitization, etc. The initial symptoms are usually atypical, and diagnosis is difficult.

2. Functional damages of multiple organs: As the disease progresses, there appear functional damages of the liver, kidney, cardiovascular, digestive and nervous systems. Cardiovascular and renal damages are predominant features and renal failure is the major cause of death.

3. Accessory examinations

(1) Blood picture shows anemia, decreased numbers of white blood cells and platelets. ESR may be increased.

(2) Serum albumin is reduced, with elevated globulin. IgG (Immune globulin G) is elevated markedly, elevation of ¦Á₂ globulin in patients with prominent renal lesions. Some of the patients are positive for rheumatoid factor (RF).

(3) Lupus cells are positive in 70-80 percent of the patients, ANA (antinuclear antibody) is positive, up to 95 percent; sensitivity to anti-DNA-antibody is high in some cases; serum total complements and C₃ can be used to determine whether SLE is complicated by lupus nephritis. Skin biopsy is specific for diagnosis.

Differentiation and Treatment of Common Syndromes     

1. Domination of Heat-toxin

Main Symptoms and Signs: Sudden onset, high fever, flushed face, fresh red-colored skin rash, purpura dotted over the skin, irritability, thirst, even coma and delirium in severe cases, arthralgia, constipation, scanty and dark urine, deep red tongue with yellow greasy fur, full and rapid or taut and rapid pulse.

Therapeutic Principle: Clearing away pathogenic heat and toxic materials, cooling blood and nourishing yin.

Recipe: Modified Antipyretic and Antitoxic Decoction.

buffalo horn powder (taken after being mixed with the finished decoction)

dried rehmannia root

red peony root

moutan bark

gypsum

anemarrhena rhizome

scrophularia root

honeysuckle flower

forsythia fruit

arnebia or lithosperm root

ophiopogon root

cogongrass rhizome

All the above herbs except buffalo horn powder are to be decocted in water for oral administration.

2. Internal Heat due to Yin-Deficiency

Main Symptoms and Signs: Low-graded fever or hectic fever in the afternoon, feverish sensation in the palms and soles. deep red-colored eruption, night sweat, fatigue, irritability, insomnia, aching pain of joints, soreness of waist, baldness, red tongue with thin yellowish fur or mirror-like tongue, thready and rapid pulse.

Therapeutic Principle: Nourishing yin and clearing away pathogenic heat, cooling blood and removing toxic material.

Recipe: Modified Sweet Wormwood and Turtle Shell Decoction in combination with Bolus for Replenishing Vital Essence.

sweet wormwood

stellaria root

wolfberry bark

picrorhiza rhizome

dried rehmannia root

scrophularia root

anemarrhena rhizome

phellodendron bark

arisaema tuber

ophiopogon root

fresh-water turtle shell

prepared licorice root

All the above herbs are to be decocted in water for oral administration.

In case of deficiency of the liver-yin and kidney-yin manifested as vertigo, blurred vision, tinnitus, dryness of mouth and throat, 12 grams of glossy privet fruit and 12 grams of eclipta should be included in the above prescription.

If the case is marked by jaundice, hypochondriac distension and pain, abdominal distension and anorexia, hematemesis, nosebleed and hepatosplenomegaly, belonging to impairment of the liver due to heat, treatment should be aimed at soothing the liver, regulating the circulation of qi and promoting blood circulation to remove stasis. The recipe preferred for it is modified decoction for Dissipating blood Stasis under the Diaphragm. The compositions are bupleurum root 10g, Chinese angelica 10g, red peony root 10g ,white peony root 10g, giant knot-weed rhizome 10g, Sichuan chinaberry 10g, corydalis tuber 10g, curcuma root 12g, globethistle 10g. All the above drugs are to be decocted in water for oral administration.

If the articular symptoms are dominant marked by migratory arthralgia, heat, pain and swelling in the affected region, difficulty in flexion and extension, etc. the suitable treatment should be aimed at clearing away heat, dispelling wind and removing dampness to dredge the channels and collaterals. The chosen recipe is modified White Tiger Decoction and Pubescent Angelica and Loranthus Decoction. The compositions are pubescent angelica root 10g, loranthus mulberry mistletoe 18g, large-leaf gentian root 15g, notopterygium root 10g, Ledebouriella 10g, spatholobus stem 30g, achyranthes root 10g, anemarrhena rhizome 10g, gypsum 30g, Chinese angelica 10g, hypoglauca yam 12g, giant knotweed rhizome 12g, honeysuckle stem 30g. All the herbs are to be decocted in water for oral administration.

3. Deficiency of the Spleen-Yang and Kidney-Yang

Main Symptoms and Signs: pale complexion, puffy face, edema of limbs, distension and fullness of abdomen, cold extremities, shortness of breath, disinclination to talk, disturbance of urination, loose stool, pale tongue with whitish moist fur, deep and thready or thready and weak pulse.

Therapeutic Principle: Warming and invigorating the spleen and kidney and activating yang to promote diuresis.

Recipe: Modified Decoction of Two Immortals Drugs combined with Powder of Five herbs with Poria.

curculigo rhizome

epimedium

astragalus root

dodder seed

codonopsis root

cinnamon twig

umbellate pore-fungus

poria

water-plantain tuber

white atractylodes rhizome

waxgourd peel

cogongrass rhizome

All the above herbs are to be decocted in water for oral administration.  

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