Part 5

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Professor Pei Zhengxue believes that systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple systems and organs, and its Western medical diagnosis is relatively clear. Summarizing the clinical characteristics of this disease, there are seven common symptoms based on their probability of occurrence: elevated erythrocyte sedimentation rate, fever, nephropathy, arthropathy, positive antinuclear antibody, increased globulin levels, and hepatomegaly. This disease corresponds to "butterfly rash," "visceral paralysis," and "facial wind" in traditional Chinese medicine. The causes of this disease can be divided into internal and external factors. Among the internal factors, the most important is insufficient congenital endowment, especially deficiency of kidney yin and yang and depletion of vital energy; or it may be due to emotional injury, emotional fluctuations, or excessive fatigue; or due to improper sexual conduct, leading to an imbalance of yin and yang, qi and blood. Qi stagnation and blood stasis, as well as blockage of the meridians, are also among the factors that exacerbate the condition. External factors include pathogenic heat, often triggered or rapidly worsened by prolonged exposure to sunlight (ultraviolet rays). Pathogenic heat enters from the exterior to the interior, scorching yin and blood, causing blood stasis and meridian blockage, damaging the viscera, and eroding the muscles and bones, thus leading to the onset of the disease. If the disease persists for a long time or if yang-tonifying medicines are used repeatedly, it can easily result in yin deficiency with yang excess, or both qi and yin deficiency, where yin damage extends to yang, leading to deficiency of both yin and yang, coupled with disharmony of qi and blood, stagnation of blood vessels, blockage of the meridians, and even separation of yin and yang, resulting in critical conditions. In summary, this disease involves complex interplay between yin and yang, with ever-changing symptoms, including patterns of genuine deficiency with real excess, mixed deficiency and excess, upper excess with lower deficiency, upper heat with lower cold, internal heat with external cold, water-fire disharmony, qi-blood disharmony, and yin-yang imbalance. From a symptomatic perspective, when heat damages the blood vessels, blood heat overflows and stagnates in the skin, resulting in cutaneous erythema; when pathogenic heat transforms into cold, cold congeals blood stasis, qi stagnates and blood stasis occurs, leading to cutaneous purpura, skin desquamation, and skin pain; when pathogenic heat stagnates and the meridians are blocked, joint swelling and pain appear; when pathogenic heat invades the viscera, all five zang organs and six fu organs can be affected; when pathogenic heat is rampant and spreads throughout the body, signs of liver and kidney yin deficiency, as well as qi and yin deficiency, can be observed. In short, this disease has both fundamental deficiency and superficial excess, with liver and kidney deficiency as the root cause and wind-damp-heat as the manifestation. During onset, deficiency and excess coexist, and cold and heat are mixed. Professor Pei Zhengxue's treatment principle for this disease is to tonify the root and consolidate the foundation, proposing "tonifying the liver and kidneys, nourishing yin and fluids" to strengthen the root, while dispelling wind, removing dampness, clearing heat and detoxifying, and activating blood circulation to treat the manifestation. The San Xu Zeng Ye Tang is used as the basic formula for treating this disease, with adjustments made according to specific syndrome differentiation. 4. TCM Syndrome Differentiation and Formulas 1. Exuberant Pathogenic Heat Syndrome Symptoms: High fever or intense fever, butterfly-shaped erythematous rash on the cheeks, cutaneous purpura, joint and muscle pain, irritability and thirst, preference for cold drinks, restlessness and insomnia, mental confusion. In severe cases, patients may experience delirium, speech disturbances, convulsions, and even hematemesis, hematochezia, and other bleeding symptoms, along with constipation, frequent and reddish urination, oral and lingual ulcers, red or dark purple tongue, yellow greasy or yellow-white greasy coating, or dry yellow coating with prickly appearance, and a rapid, forceful, or wiry pulse. Treatment Principle: Clear heat and detoxify, cool the blood and protect yin to resolve the rash. Formulas: Xijiao Dihuang Tang, Qingwen Baidu Yin, Huanglian Jiedu Tang, Wuwei Xiaodu Yin with modifications: Xijiao (water buffalo horn can be used instead, increasing the dosage accordingly, same below) (decocted first) 10g, Chishao 10g, Danpi 10g, Sheng Shan Zhi 10g, Sheng Di 10g, Sheng Shi Gao 10g, Zhimu 10g, Jin Yin Hua 10g, Lian Qiao 10g, Ban Lan Gen 10g, Huang Lian 10g, Zicao 10g, Bai Mao Gen 10g, Xuan Shen 10g. 2. Yin Deficiency with Internal Heat Syndrome Symptoms: Prolonged low-grade fever, or afternoon tidal fever, heat in the palms and soles, irritability and insomnia, dry mouth and throat, spontaneous sweating and night sweats, fatigue and reluctance to speak, soreness in the lower back and knees, joint pain, flushed complexion, dark red rashes, yellow coating on the tongue, or a mirror-like tongue, and a fine, soft, and rapid pulse. Treatment Principle: Nourish yin and clear heat, cool the blood and detoxify to resolve the rash. Formulas: Use Qinghao Bie Jia Tang, San Xu Zeng Ye Tang, Qing Ying Tang, etc., with modifications: Qinghao 10g, Yin Chai Hu 10g, Di Gu Pi 10g, Hu Huang Lian 3g, Sheng Di 12g, Xuan Shen 10g, Shi Hu 10g, Tian Dong 10g, Mai Dong 10g, Zhimu 10g, Yin Yang Huo 15g, Hu Zhang 10g, Si Zi 15g, Chuan Xu Duan 10g, Han Lian Cao 15g, Cao 10g, Dang Shen 10g, Huang Qi 20g, Dang Gui 10g, Bai Shao 15g, Tao Ren 10g, Hong Hua 6g, Jin Yin Hua 15g, Lian Qiao 15g, Bai Hua She She Cao 15g, Ban Zhi Lian 15g, Huang Bo 10g, Gou Qi Zi 10g, Nu Zhen Zi 10g. 3. Liver and Kidney Deficiency Syndrome Symptoms: Soreness in the lower back and knees, weakness in the limbs, hair loss, facial heat, five heart palpitations, oral and lingual ulcers, dry mouth and throat, menstrual irregularities or amenorrhea, accompanied by dizziness, tinnitus, bowel movement disorders, scanty and yellow urine, pale tongue with little fluid, thin yellow coating, and a fine or deep, weak pulse. Treatment Principle: Tonify the liver and kidneys, nourish the blood and clear heat.