Lupus Erythematosus
Lupus erythematosus (LE) is a common autoimmune disease that primarily affects women aged 15–40. It has diverse clinical manifestations, can affect organs throughout the body, and often follows a complex, prolonged, and relapsing course. LE encompasses a spectrum of conditions. At one end is discoid lupus erythematosus (DLE), in which lesions are mainly limited to the skin; at the other is systemic lupus erythematosus (SLE), which involves multiple internal organ systems and often causes skin lesions. Many subtypes lie between these ends, including disseminated discoid lupus erythematosus, lupus profundus, subacute cutaneous lupus erythematosus, and antinuclear antibody-positive systemic lupus erythematosus.
In TCM, lupus erythematosus is called “red butterfly sore” (hong hudie chuang). Historical TCM texts have used various names based on its different clinical manifestations and sites of onset. Some names refer to its presumed cause, such as “sun-induced sore” and “kidney wind-toxin”; others refer to its pathogenesis, such as “yin-yang toxin,” “warm-toxin macules,” “heat-toxin macules,” “blood-heat macules,” and “latent qi warm disease.” Names based on clinical symptoms include “red butterfly sore,” “red butterfly erysipelas,” “butterfly patches,” “red butterfly patches,” “ghost-face sore,” “malar ulcer,” and “malar abscess.” In addition, multiple joint pain is classified as “bi syndrome” or “zhou bi”; nephritis or impaired renal function as “edema”; liver damage as “jaundice” or “hypochondriac pain”; acute endocarditis or myocardial injury as “palpitations”; pleural effusion as “suspended fluid”; and altered mental status as “mania” or “epileptic disorders.” A review of historical TCM terminology shows that physicians placed particular emphasis on the skin manifestations of lupus erythematosus. Disease names such as “warm-toxin macules,” “red butterfly,” “crow sore,” and “red erysipelas” reflect, to some extent, characteristic features of the disease.
TCM Pattern Identification and Treatment Reference
|Common Symptoms
Clinical description:
Characteristic erythema on the face, backs of the hands, or other parts of the body; low-grade fever or no fever; sometimes a sensation of fullness or oppression in the chest, constrained and uncomfortable qi, frequent sighing, or abdominal distension, poor appetite, and nausea; irritability and a tendency to become angry; irregular menstruation or amenorrhea; a wiry-slippery or wiry-moderate pulse; and a mostly dark-red tongue, sometimes with stasis spots or patches and a white coating.
In plain language:
- Characteristic red patches may appear on the face, backs of the hands, or other parts of the body.
- You may have only a low-grade fever or no fever at all.
- Your chest may feel tight or full, and you may feel low or emotionally constrained, often sighing for relief.
- You may experience abdominal bloating, poor appetite, and nausea.
- You may become irritable or angry easily, with noticeable mood swings.
- Your periods may be irregular or may stop altogether.
- On palpation, the pulse may feel taut like a stretched string and may be slippery or somewhat moderate in pace.
- The tongue is often dark red or has stasis spots or patches, with a usually thin white coating.
|Treatment Approach
Clinical description:
Soothe the liver and regulate qi; invigorate blood and resolve stasis.
In plain language:
- Aims to soothe liver qi and regulate the flow of qi, helping ease chest and rib-side fullness, low mood, or difficulty belching.
- Aims to promote blood circulation and resolve stasis, helping ease stasis marks, pain, or irregular menstruation.
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|Common Symptoms
Clinical description:
Erosions of the lips and buccal mucosa, sores on the mouth and tongue, dry mouth, flushed cheeks, heat in the palms, soles, and chest or low-grade fever, bowel movements that are initially dry and then loose, a deep-thin or thin-rapid pulse, and a red tongue with little coating or a thin black coating.
In plain language:
- The lining of the lips and inside of the cheeks may become damaged and eroded, causing noticeable pain or discomfort when touched.
- Small ulcers or sores may appear in the mouth and on the tongue, causing stinging pain when eating or speaking.
- Your mouth may feel dry and make you want to drink, and your cheekbones may look flushed.
- Your palms, soles, and chest may feel hot, or you may have a low-grade fever.
- Stools may initially be hard and difficult to pass, then become loose and poorly formed.
- On palpation, the pulse may feel deep and thin, or very thin and somewhat rapid.
- The tongue may be red with little coating, or have a thin black coating.
|Treatment Approach
Clinical description:
Nourish yin and clear heat; invigorate blood and soften hardness.
In plain language:
- Aims to nourish yin and clear internal heat, helping ease restlessness, thirst, dry throat, insomnia, hot flashes, or night sweats.
- Aims to promote blood circulation and soften firm masses, helping address abdominal masses, nodules, or localized hard swelling.
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|Common Symptoms
Clinical description:
Sudden onset; persistent high fever; red patches on the cheeks or hands, with a bright-red color; aching pain in the muscles and joints of the limbs; in severe cases, delirium or impaired consciousness; dark-yellow urine; constipation; a red tongue with a yellow coating; and a surging, slippery-rapid, or wiry-rapid pulse. This pattern is most often seen during an acute active phase of SLE.
In plain language:
- Symptoms begin suddenly, with a high fever that persists and is difficult to bring down.
- Bright-red patches may appear on both cheeks or on the hands.
- The muscles and joints of the limbs may ache at the same time, with greater discomfort during movement.
- In severe cases, delirium or confusion may occur.
- Urine may appear dark yellow or reddish and concentrated.
- Stools may be hard and difficult to pass, with constipation.
- The tongue may be red with a prominent yellow coating.
- The pulse may feel forceful, slippery and rapid, or taut and rapid.
|Treatment Approach
Clinical description:
Cool the blood and resolve macules; clear heat and detoxify.
In plain language:
- Aims to cool the blood and address skin eruptions, such as pinpoint bleeding, red patches, or purplish spots.
- Aims to clear internal heat and counter toxins, helping ease fever, restlessness, sore throat, or red and swollen sores.
|Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.
|Common Symptoms
Clinical description:
Irregular fever or low-grade fever; bright-red skin eruptions; hair loss; dry mouth and sore throat; night sweats; heat in the palms, soles, and chest; poor sleep; dizziness and fatigue; joint pain; and heel pain. The tongue is red with little coating, and the pulse is thin and rapid. This pattern is most often seen during a period of relative clinical remission in SLE.
In plain language:
- Your temperature may rise and fall or remain mildly elevated.
- The rash may be bright red.
- You may experience noticeable hair loss.
- Your mouth may feel dry and your throat may hurt.
- You may sweat while asleep at night.
- Your palms, soles, and chest may feel hot.
- You may sleep poorly or wake easily.
- You may feel dizzy and tire easily.
- You may have joint pain.
- You may have heel pain.
- The tongue may be red with very little coating.
- The pulse may feel thin and somewhat rapid.
- This pattern is often seen during a period of relative clinical remission in systemic lupus erythematosus.
|Treatment Approach
Clinical description:
Tonify qi and nourish yin; invigorate blood and open the channels.
In plain language:
- Aims to replenish qi and nourish yin, helping ease fatigue, shortness of breath, dry mouth and throat, restlessness, or insomnia.
- Aims to promote blood circulation and unblock the channels, helping ease numbness in the limbs, aching joints, or difficulty moving.
|Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.
|Common Symptoms
Clinical description:
A sallow complexion; swelling of the eyelids and lower limbs; aversion to cold and cold extremities; fatigue and weakness; soreness and weakness of the lower back and knees; fullness in the chest and rib-side; abdominal distension and loose stools; poor appetite or dizziness; bodily fatigue and reluctance to speak; frequent urination at night or reduced urine output; a pale, swollen tongue with teeth marks, a white slippery coating, and a deep, thin, weak pulse. This pattern is most often seen during the progressive or later stages of SLE.
In plain language:
- Your complexion may look dull or sallow.
- Your eyelids and lower legs may become swollen.
- You may feel cold easily, with cold hands and feet.
- You may feel tired and weak.
- Your lower back and knees may feel sore and weak.
- You may feel fullness or discomfort in your chest and along both sides of your ribs.
- Your abdomen may feel bloated and your stools may be loose.
- You may have a poor appetite or feel dizzy.
- You may feel lethargic and have little desire to talk.
- You may urinate more often at night or, conversely, produce less urine.
- Your tongue may be pale and enlarged, with teeth marks along its edges.
- Your tongue coating may be white and slippery.
- Your pulse may feel deep, thin, and weak.
- This pattern is often seen during the progressive or later stages of systemic lupus erythematosus.
|Treatment Approach
Clinical description:
Warm and support kidney yang; strengthen the spleen and promote diuresis.
In plain language:
- Aims to warm and support kidney qi and strengthen yang, helping ease sensitivity to cold, cold limbs, soreness and weakness in the lower back and knees, or fatigue.
- Aims to strengthen spleen function and promote the elimination of retained fluid, helping address poor appetite, a heavy feeling in the body, difficulty urinating, or swelling.
|Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.
References
- Immunology Group, Chinese Society of Dermatology, Chinese Medical Association. Guidelines for the diagnosis and treatment of cutaneous lupus erythematosus[J]. Journal of Clinical Dermatology, 2012, 41(6): 390–392.
- Chinese Society of Rheumatology, Chinese Medical Association. Guidelines for the diagnosis and treatment of systemic lupus erythematosus[J]. Chinese Journal of Rheumatology, 2003, 7(8): 508–513.
- Zhao Bian. Chinese Clinical Dermatology[M]. Nanjing: Jiangsu Science and Technology Press, 2009: 789–806.
- Zhang Zhili. TCM pattern differentiation and classification of lupus erythematosus[J]. Shaanxi New Medicine, 1986, 15(6): 9–12.
- State Administration of Traditional Chinese Medicine. Standards for the Diagnosis and Therapeutic Effect of TCM Diseases and Patterns[S]. Nanjing: Nanjing University Press, 1994: 150–152.
- Chen Hongfeng. TCM External Medicine[M]. Shanghai: Shanghai Scientific and Technical Publishers, 2007: 236–240.
- Li Yueqing, He Qinghu. TCM External Medicine[M]. Beijing: China Press of Traditional Chinese Medicine, 2012: 205–209.
- Liu Ruiping, Zhu Ni, Li Da, et al. Relationship between TCM pattern differentiation in systemic lupus erythematosus and the autoantibody profile[J]. Guangdong Medical Journal, 2012, 33(2): 273–275.