Lupus and MIscarriages

[Guest guest]

Hi all,

 

Got an interesting new member today. Her note to me was the following:

 

I'm really interested to learn more about TCM. I have lupus and have had

9 miscarriages. I am now using acupuncture but would like to learn more

about herbs.

 

Firstly, welcome aboard. Many people who to this list have a

specific issue that they hope to learn more about, but I don't always have

the time to really respond. However, lupus is something of an interest to me

and I'd like to discuss it just a bit, as well as the miscarriage issue.

 

My own herb mentor has something of a following on the East coast (of the

US) all arising from one patient with lupus. He flies from LA to Boston a

few times a year to see his patients there. The point is that his success

with lupus got me interested in how this issue is treated.

 

Later on, I was given the opportunity to edit the PMPH (People's Medical

Publishing House)

book<http://www.pmph.com/en/product_detail.aspx?articleId=3767 & columnId=10>on

how to treat lupus with integrated medicine.

 

I'll speak in simplistic terms for the benefit of the consumer level members

of this list. Practitioners should note that there are lots of shades of

gray between the black and white that I can talk about here...

 

Lupus is of course an auto-immune disease where the body's immune system

begins to think that the body is an invading pathogen and so it attacks

itself. That's the Western interpretation of course.

 

In Chinese medicine we don't really look at it that way. We generally see

symptoms of heat. Redness in the face, other inflammatory reactions, tend to

look hot. Chinese medicine (CM) as a rule does the opposite from what

appears. So, if there's too much heat, we add cold or remove heat.

 

But lupus is a chronic condition and so we have to factor in another

treatment variable. The idea of " excess and deficiency " refers to whether a

given problem is due to too much of something or not enough. As a

theoretical rule, long-term chronic issues are due to deficiency while

short-term acute problems are due to excess. Lupus however demonstrates both

of those ideas in that it is a long-term issue, but there are acute

flare-ups.

 

Most of the experienced zhong yi's (Chinese medicine doctors) who's

approaches were described in this lupus book agreed that it must be

addressed as both deficiency and excess. That requires a lot of skill when

prescribing herbs. You have to find the heat and clear it, while finding

what is deficient and supplementing it.

 

Heat in the body can present locallized to a small area, or it can present

(appear clinically) as existing systemically in the body. An example of

localized heat would be an ingrown and infected fingernail. An example of

systemic (everywhere in the body) heat would be a flu with a fever.

 

In Chinese medicine, we can similarly describe the location of heat as

localized to an acupuncture channel such as we might describe that ingrown

fingernail. Heat can appear in a particular organ too. Stomach fire (fire is

a more localized and intense version of " heat " ) can present with heartburn,

but because the organ is burning, you can easily see that heat from the

Stomach appearing anywhere along the trajectory of the Stomach channel,

specifically as it enters the jaw and mouth. Stomach fire can produce

bleeding gums, bad breath, and perhaps chanker sores as well.

 

So, heat can reside in a single organ but it can also show up on body-wide

levels or " fen " in Manderin. There is a theory that arose a few hundred

years ago, probably in reaction to some of the infectious pandemics such as

The Plague that were arising at the time. This school of thought is called

the Wen Bing school. Wen Bing means " warm disease " or diseases that produce

a fever. (I should add that Wen Bing theory is the darling of current

pandemic viral problems such as SARS.)

 

So, this wen bing school looks at heat as entering from the outside of the

body. It can reside superficially at first, and give rise to what we might

call the common cold with a sore throat. If it is not pushed out of the body

from the " wei (defensive) level " (remember, this is seen as some hot wind

that got into the body, the treatment principle at this point is to sweat it

out.) it can go deeper to the qi level where it looks like a flu with a high

fever. At this point, the goal is to get rid of the heat usually through

purgation (bowels). If this heat goes deeper, it can get into the ying level

which still has a high fever, but now it's producing some shen level

(cognitive) effects such as fever dreams or dementia. The fourth and deepest

level of systemic heat is called blood level heat. This heat causes the

blood to boil out of its container. Think hemorrhagic fever.

 

Now, this blood level heat doesn't always cause you to die of bleeding to

death, however we do see low-grade " blood level heat " issues arise on a

somewhat regular basis. Some women with excessive menstrual flow for

instance are treated for blood level heat and the quantity of menstrual flow

comes down to a manageable quantity.

 

Lupus can present as blood level heat. As I mentioned above, heat can also

reside in a given organ. Because the (Chinese concept of the) Liver stores

the blood, heat in the Liver and blood level heat can overlap quite a bit.

I've been seeing this one little girl since she was five years old. She was

something like 10 years old when diagnosed with lupus. Since then, I've seen

her as having Liver heat or heat in the blood. Sure enough, she developed

her menstrual period earlier than her peers, something like 10 years old.

She is of Hispanic heritage and peoples from tropical environments tend to

get their periods earlier than those farther from the equator, so it isn't

crazy early, but still early. She was also somewhat moody as is consistant

with " heat in the Liver " .

 

I didn't get the opportunity to treat her too seriously. Her complience with

the herbs is weak, but I do get to see her every few years.

 

The integrated approach to Lupus is to use steriods during intense

flare-ups, and to use the herbs to prevent the flare-ups from recurring. So,

during the phase betwen flare-ups, the treatment focuses on preventing the

lupus. Then there's the gray zone between these two points where both

steriods (at a smaller dosage) and herbs are used together.

 

During the flare-ups, herbal approaches seek to locate the heat, and remove

it. During the preventive phase the herbal approach is to supplement

whatever is deficient (qi-energy, blood, yin-fluids, or yang-warmth). So

that becomes something of a balancing act since tonic herbs for instance

tend to be warm, but if you're busy clearing heat too, you're going to undo

that if you're not careful.

 

That's the challenge of treating lupus, to clear heat while supplelmenting

deficiency as it often (according to the book) presents.

 

As for the miscarriages that our new member mentions, we often look to one

of the (Chinese concept of) Spleen's functions as " holding things up " . Now,

if these miscarriages are due to the immune system attacking the fetus, that

may be a little different, but if there was no lupus, it could be very

likely that your Spleen qi is deficient.

 

The way that we'd confirm this is by looking for other indications of Spleen

qi deficiency such as brusing easily, lack of appetitie, thin weak

musculature or weight gain with edema. If none of these other indications

are seen in the patient, we'd still want to locate the heat (probably in the

blood as it is related to many female reproductive functions) and clear it.

 

So, that's a little primer to lupus. Hope that it gives you some hope. I

realize I didn't reallly talk about clinical outcomes, but the idea is that

CM has a well-developed approach to this chronic condition.

 

Oh, I should note that Chinese herbs are not known to remove the problem

entirely. Our approach is to manage the disease, not cure it. However if we

can put ten years in between flare-ups versus one month without herbs,

that's a pretty good outcome.

 

-al.

 

--

, DAOM

Pain is inevitable, suffering is optional.