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Systemic lupus erythematosus (SLE) is one of the most serious autoimmune diseases. Unlike other autoimmune conditions, SLE attacks a wide variety of tissues, and lupus-induced kidney damage can cause death. See Table 1 at the end of this article, for a list of the symptomatic manifestations of lupus, which may arise as the immune system attacks various tissues. Exacerbations and remissions of symptoms are typical. Conventional medicine lists lupus as a disease of unknown etiology, although a likely genetic component has been identified. If the disease were entirely due to genetics, however, we would expect to find equal rates among primitive people and those living in the developed countries. Incidence is much higher in the developed countries, and systemic lupus and other autoimmune diseases are rare in primitive societies following traditional lifestyle and dietary habits, although they begin to appear in those societies when Western diet and stresses are introduced (Trowell and Burkitt). Thus, natural therapies involving diet and lifestyle may be effective at modifying or removing the cause of SLE. Conventional treatment is symptomatic only, and in clinical practice drug side effects commonly complicate the symptom picture and make natural treatments more difficult. In emergency conditions or SLE complicated with myocarditis, ascites, uremia, or cerebral edema, conventional treatment should be initiated without delay. Natural treatment Natural and herbal treatment of SLE is controversial from a scientific point of view, usually based on empirical approaches, traditional Asian herbalism, or on emerging concepts of pathology which have not been definitively proven in the literature. TCM syndromes The underlying syndromes for systemic lupus in traditional Chinese medicine involve Deficiency patterns and Heat syndromes (especially Deficiency Heat or False Fire). The most important Chinese organ system for therapy is the Kidney, which in Western terms most closely fits the hypothalamic-pituitary-adrenal axis. The therapeutic challenge with herbal medicines (regardless of the medical paradigm) is how to tonify to increase strength in SLE patients without simultaneously increasing heat and inflammation. A window into the therapeutic balance necessary for treating lupus might be seen in the commercial formula Lithospermum 15, produced by the Institute for Traditional Medicine in Portland, OR. Table 1 shows the herbs in Lithospermum 15, and the rationale for their inclusion. Tonics in the formula are mild, and potentially overstimulating tonics such as deer antler or Asian ginseng (Panax ginseng) are avoided. About 20% of the volume of the formula is composed of cooling, heat-clearing herbs. Whatever paradigm of herbalism is used to treat SLE, the principle of using mild tonic herbs combined with cooling herbs is applicable. Heat-clearing herbs The application of traditional Asian terms such as "heating" and "cooling" to Western herbs is in its infancy, and thus classification may be imprecise or subject to debate. In general, bitter herbs are viewed as "cooling," and mild bitters may be useful in lupus. During remissions, gentle bitters such as dandelion (taraxacum off.), burdock (Arctium lappa), or agrimony (A. eupatoria, A. pilosa) might be included in formulas. During exacerbations, the stronger artemisia species might be used following the same "heat-clearing" strategy that conventional medicine applies with antimalarial drugs. Sweet Annie (Artemisia annua) is used in China as an antimalarial, and also used for exacerbations of SLE. A dose of 12-24 grams of the dry herb, decocted in a quart of water, and drunk in three doses throughout the day, may be appropriate. American ginseng (Panax quinquefolius) also has cooling properties, as do the leaves of Asian ginseng (Panax ginseng). Asian ginseng leaf costs only a few dollars a pound, whereas American ginseng root may cost several hundred dollars. Immunomodulating herbs Contemporary American herbalists classify a group of herbs, including reishi mushroom (Ganoderma lucidum), shiitake mushroom (Lentinus edodes), maitake mushrooms (xxx), and astragalus root (Astragalus membranaceus) as "immunomodulating." The term is common is the journal articles of Asian scientists researching traditional Asian herbs and medicinal mushrooms (Chang; He J et al; He Y et al, 1992; Wang and Lin; Yoshida et al.) These herbs have complex actions on the immune system when measured in in-vitro and in-vivo trials. Among herbalists the term is used to indicate herbs that have traditionally been used to restore balance to the immune system rather than to stimulate it. The herbs tend to have a neutral "temperature" or mild action in traditional usage, and are traditionally taken for long periods of time in food quantities, especially as soups or decoctions. The herbs might be administered in a "tonic soup" which the patient can prepare in large quantities every few days. An example might be reishi mushroom, shiitake mushroom, astragalus, and peony root (Paeonia lactiflora), decocted in a nourishing soup with vegetables, grains as tolerated, meat, or meat broth. Peony root is a cooling tonic which can offset the tendency of astragalus to aggravate inflammation. The use of echinacea in lupus is controversial, with differences of opinion among practicing herbalists around the world. One of the five patients in this study reported that taking echinacea would make her lupus symptoms worse. She had tried it several times with rechallenge before stopping its use. Gut-healing herbs The article on the "leaky gut" syndrome [see "Gastrointestinal: Leaky gut, molecular mimicry, microchimerism, and autoimmunity" in this volume] explains the possible connection between loss of efficiency of the gut barrier and autoimmune conditions. Restoration of the integrity of the barrier may be the most important herbal therapy for autoimmune diseases, to modify their course or severity. A gut-healing strategy might include demulcent, antiinflammatory, and carminative herbs. One possible basic formula might include equal parts of chamomile (Matricaria recutita, M. chamomila), peppermint (Mentha piperita), fennel (Foeniculum vulgare), and licorice (Glycyrrhiza glabra). The herbs may be given in decoction or powdered. If powdered, they should be given in warm water. Amounts might be modified and other herbs added to the formula, depending on the presenting picture. Demulcents might best be given separately in order to provide more of the herb than would be available in dose. Slippery elm powder (Ulmus fulva) can be given with applesauce or added to oatmeal. Marshmallow (Althea off), can be given as a simple. A possible complication of "leaky gut" is an overload of gut pathogens on the liver. Nutrients and herbs that support liver detoxification may be appropriate as addition either to a leaky gut formula or to tonic soups. The gentler cleansing herbs, such as dandelion, burdock, or agrimony might be preferred, along with the hepatoprotectant milk thistle seed (Silybum marianum). Nutrients such as magnesium and vitamin B6, essential to the process of liver detoxification, may be helpful, and may also reduce elevated estrogen levels which promote hyperactivity of the immune system. Diet/Supplements/Exercise Food allergies may be either a cause or a consequence of the leaky gut syndrome. The chief offenders appear to be dairy, wheat, and soy.[see "Gastrointestinal: Leaky gut, molecular mimicry, microchimerism, and autoimmunity" in this volume, for a full discussion of possible mechanisms]. All five SLE patients in this demonstrated severe allergies to dairy and/or wheat, confirmed by removal from the diet and rechallenge. Two of the patients could trigger full-blown lupus flareups with joint pain and/or kidney involvement by eating a single cookie made of wheat, with the outbreak following by 12-36 hours. Fasting and reintroduction of suspected foods may dramatically demonstrate to both practitioner and patient the importance of food allergies to the presenting symptom picture. Abandonment of the modern diet in favor of a whole foods diet is essential in the treatment of lupus. The foods most likely implicated in the Western diseases (see introduction) are sugar, refined flour, and refined oils, and margarine. Refined omega-six oils and margarine combined with a relative deficiency of omega-3 oils, such as appear in fish and wild game, can lead to prostaglandin imbalances that favor the inflammatory response. It is the author's experience that flax oil and other omega-3 oils from vegetable sources are usually ineffective in treating inflammatory conditions, despite their popularity among customers of health foods stores. Wild salmon (not farmed) and/or sardines added to the diet on a regular basis can produce dramatic clinical results with reduced inflammation. Nutrition supplements administered must be selected for easy assimilation, because impaired digestion or intestinal absorption may otherwise render supplementation useless. An easily assimilable form of magnesium is essential. An ionic liquid mineral supplement high in magnesium is available from Trace Minerals Research in Utah. The author has seen dramatic changes in energy-level and/or inflammation in each of the patients above given this supplement. Homeopathy, flower essences A history of suppression of symptoms with pharmaceutical drugs is the rule in lupus patients, even if they are currently refusing recommended steroids or chemotherapy agents. Underlying emotional complexes either predating the illness or in response to it are also common. These two conditions argue for the value of homeopathic remedies or flower essences, traditionally used to treat deep seated emotional conditions or the ill effects of suppression of symptoms with drugs. Stress management Each of the lupus patients in this review has suffered from mild to severe post-traumatic stress disorder, following major childhood traumas, sexual or physical abuse, or war, according to DSM IV criteria. Each also had unusual stress in their current situation, such as professional lives characterized by deadline pressures or pressure to overwork, abusive marital situations, or poverty. Chronic stress may lead to exhaustion of cortisol secretion by the adrenal glands (which might be measured by a simple salivary cortisol test). The loss of the antiinflammatory effects of the cortisol can exacerbate the autoimmunity. Dihydroepiandrosterone (DHEA) production by the adrenal glands may also be depleted, further contributing to immune imbalances and reduced tissue repair. TCM treatment of the Kidney organ system (see discussion above) is consistent with restoring proper adrenal function. Reducing stress is no simple matter clinically, and the full array of possibilities might be explored, including psychotherapy, group support, prayer, meditation, spa therapy, extended vacations, etc. DHEA supplementation may be helpful in severe cases of Systemic lupus erythematosus, especially with kidney involvement, or to break the cycle of stress and adrenal depletion. In the author's opinion, DHEA supplementation should be given only in conjunction with treatments that address the cause, and not relied on to "cure" the illness. Dosages of up to 100 mg of DHEA have been reported in the alternative treatment of lupus (Pizzorno), but therapeutic doses should normally be limited to 10-20 mg per day. DHEA does not address the cause of the disease, and will not heal the leaky gut or remove food allergens. Two-phase strategy A dual strategy, with separate treatments for outbreaks and remissions, may be useful. Fasting on water and lemon juice and resting during fever or severe inflammation can reduce the antigenic load on the gut and promote elimination of immune complexes. Mild heat-clearing herbs might also be appropriate, while all tonics should be discontinued during such a period. For milder outbreaks, a light diet or modified fast, especially from potentially allergenic foods, might be useful. Removal of medications The drugs commonly used to treat lupus, including NSAID and steroids, may themselves cause leaky gut syndrome. While they may have their place in treatment, healing is unlikely without their removal. Birth control pills may also induce leaky gut syndrome. - Case 1: Early Stage Lupus
- Patient: 25 y.o. female, 5'5" 120 lbs.
- Overall health self-assessment: 7 of 10
Chief complaint: Lupus-like autoimmune outbreaks. The patient was told she had "pre-lupus" by her physician. Raynauds phenomenon. Painful swelling of all the lymph glands in the body during attacks. Joint inflammation. Possible kidney pain. Low grade fever. About four outbreaks a year, spaced at regular three-month intervals. "Could set the calendar by them" Mild hair loss. Most recent outbreak three weeks prior. Daily meds: 1000 mg Vitamin C. Discontinued all conventional meds eight months prior.
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