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Systemic Lupus Erythematosus : Treatment
Western Medicine
Chinese Medicine
The management of SLE should be comprehensive and include drug and non-drug treatment. Therapy is individualized for each patient depending on the manifestations of disease and their severity.

Systemic corticosteroid therapy is the mainstay of treatment in SLE. However, not all patients require steroids, and steroids can do more harm than good. When needed, oral maintenance doses of prednisone or prednisolone are usually prescribed.

Severe symptoms affecting the whole body, such as sustained high fevers and severe blood disorders, often need to be treated with higher doses of corticosteroids. Involvement of organs such as the heart, lungs, and central nervous system also usually requires treatment with corticosteroids.

A topical steroid is usually prescribed for skin rashes.

Mild symptoms of arthritis and muscular pain are usually managed with non-steroidal anti-inflammatory drugs (NSAIDs), such as indomethacin, naproxen and ketoprofen. More severe symptoms may need an antimalarial agent and occasionally low doses of corticosteroids may be required.

The antimalarials chloroquine and hydroxychloroquine possess anti-inflammatory properties and have been found of benefit in treating inflammatory conditions which have an immunologic basis. They are usually used when other first-line therapies (such as NSAIDs) fail. They are prescribed for more severe skin and joint manifestations of SLE.

As long-term corticosteroid therapy, particularly at the higher doses, tends to cause side-effects, immunosuppressants such as azothiaprine, cyclophosphamide and methotrexate are sometimes added in an attempt to lower the dose of corticosteriod required. These drugs suppress the immune response. As immunosuppressants themselves pose a risk of long-term toxicity they need to used with care, but can be useful in the treatment of acute and severe organ involvement.

Psychiatric support
The threat of a chronic disease can be very stressful. Visiting a doctor frequently and having many laboratory tests with long waits for the results can be an emotional burden. Emotional support in the treatment of SLE is essential. It is also important that patients have extensive rest.

Preventive measures
All possible means to prevent provocation or exacerbation of SLE should be undertaken. (See Prevention section.)

As SLE is an episodic disease and is characterized by exacerbation and remission, it is extremely important to withdraw therapy slowly when an exacerbation has quieted down. This avoids unnecessary drug toxicity.

Patients with SLE need a to see their doctors at least once every three to six months, even if the disease is inactive. Patients with active disease must be assessed more frequently.


Treatment of SLE from a TCM perspective will depend on the symptoms of the individual patient. In addition to herbal decoctions used to alleviate disharmony pattern symptoms, treatment may include acupuncture for relieving pain and stiffness in the joints, and qi-gong to help focus the energy of the body in fighting the disease and strengthening the mind.

Examples of decoctions used for the different disharmony patterns

Excessive toxic heat accumulation

Therapeutic aim:
To clear away heat and toxins, cool down the blood, protect the yin, remove obstructions in the meridians and clear up rashes.

Qingying decoction
shi gao gypsum
shu di huang processed rehmannia root
mai dong dwarf lilyturf tuber
zhi mu common anemarrhena root
niu xi achyranthes root

For individuals with high fever, poor concentration and delirium, the dosages of heat-clearing drugs should be increased or the following added:
shang shi gao unprocessed gypsum
huang lian golden thread
da huang rhubarb

Some patent Chinese medicines like Purple Snowy Pill, Bezoar Bolus for Resurrection and Treasured Bolus can be taken at the same time.

Yin blood deficiency

Therapeutic aim:To replenish the yin, nourish and cool down the blood, and eliminate toxins.

Modified Zhibai Dihuang pill
zhi mu common anemarrhena root
huang bai amur cork-tree
shu di processed rhemannia root
shan yu rou Asiatic cornelian cherry fruit
shan yao common yam root
ze xie oriental water-plantain root
dan pi tree peony bark
fu ling Indian bread

For individuals with spleen deficiency add:
bai zhi large head atractylodes root
chen pi dried tangerine peel
fu ling Indian bread

In cases of very high fever add:
yin hua honeysuckle flower

For dizziness add:
ju hua chrysanthemum flower
chuan xiong Szechwan lovage root

Toxic factor attacking the heart

Therapeutic aim:To nourish the yin, replenish the qi, calm the mind, and clear away heat and toxins.

Modified Huanglian antidote decoction
huang lian golden thread
huang qin baical skullcap root
huang bai amur cork tree
zhi zi Cape jasmine fruit

For spleen deficiency add:
dang shen pilose asiabell root
bai zhi large head atractylodes root

For individuals with a feeling of chest fullness add:
hou po magnolia bark
su geng perilla stem

For yin deficiency add:
yu zhu fragrant Solomon's seal rhizome
huang jing agastache or Solomon's seed
dong chong xia cao Chinese caterpillar fungus

Kidney yin deficiency

Therapeutic aim:To nourish the yin, tonify the kidneys, activate the blood circulation and eliminate toxins.

Modified Siwu decoction
dang gui Chinese angelica
chuan xiong Szechwan lovage root
shu di processed rehmannia root
bai shao white peony root

For dampness-heat symptoms in the lower burner add:
che qian zi plantain seed
Bi xie long yam
qu mai Chinese pink herb

For individuals with backache add:
tu si zi dodder seed
chuan duan Himalayan teasel root

For joint pain add:
ji xue teng suberect spatholobus stem
shen jin cao common club-moss herb
liu ji nu diverse wormwood herb
xu chang qing paniculated swallow-wort root

Impairment of the liver due to heat

Therapeutic aim:To nourish the yin, cool down the blood, eliminate toxins, activate the blood circulation, clear away blood stasis and remove obstructions in the meridians.

Modified Xiefu Zhuyu decoction
tao ren peach seed
hong hua safflower flower
dang gui Chinese angelica
sheng di common yam root
chuan xiong Szechwan lovage root
chia hao red peony root
niu xi achyranthes root
jie geng platycodon root
chai hu Chinese tororwax root
zhi qiao orange fruit
gan cao liquorice root

For individuals with severe blood stasis add:
san leng bur-reed tuber
e zhu zedoary rhizome
yi mu cao motherwort herb
chuan xin lian andrographis herb
gui jian yu winged spindle tree

For severe abdominal distention and pain below the ribs add:
hou po magnolia bark
chen pi dried tangerine peel
xiang fu nut-grass

For qi deficiency and residual heat toxins add:
huang qi milk-vetch root
qin jiao large-leafed gentian
wu she black snake

For over heated blood and a well-defined rash add:
ji guan hua cockscomb
mei gui hua rose
ling xiao hua trumpet creeper flower