Urgent! ! ! How to treat connective tissue lupus erythematosus with thrombocytopenia?

/This is the website of Beijing Guotai Hospital, which specializes in the treatment of lupus erythematosus.

Thrombocytopenia is poor thrombosis and bleeding caused by decreased platelet count (thrombocytopenia) or decreased function (platelet insufficiency). The platelet count is lower than the normal range 140000 ~ 400000/μ L. Thrombocytopenia may be caused by insufficient platelet production, retention of platelets in the spleen, dilution of platelets due to increased destruction or utilization (Table 133-65438+) or scattered ecchymosis at the slightly injured site. Mucosal bleeding (nosebleed, gastrointestinal tract and urogenital tract and vaginal bleeding); And massive postoperative bleeding. Massive gastrointestinal bleeding and central nervous system bleeding can be life-threatening. However, thrombocytopenia does not manifest itself as internal bleeding secondary to coagulation diseases (such as deep visceral hematoma or hemophilia) (see section 13 1).

1. Drugs that cause low bone marrow regeneration or pancytopenia. Chemicals and drugs that can easily cause bone marrow dysfunction in a certain dose;

(1) 2 alkylating agents such as benzene and xylene: nitrogen mustard, cyclophosphamide, nitrogen mustard phenylpropionate, etc. ③ Antimetabolic drugs: such as cytarabine and mercaptopurine. ④ Anti-cancer antibiotics: such as Zhengding mycin and adriamycin. ⑤ Others: such as organic arsenic.

2. Drugs that can cause bone marrow regeneration disorder or hypofunction: such as chloramphenicol, sulfonamides, penicillin, streptomycin, neocyanine I, trimethyldione, phenytoin sodium, ethosuximide, antithyroid drugs (such as tabazole, propylthiouracil, hyperthyroidism) and diabetes drugs (such as metsulfuron, chlorsulfuron, chlorsulfuron, etc.). ), butazone and thiophanate.

3. Drugs that selectively inhibit the production of platelets by megakaryocytes: such as chlorothiazides, estrogens, ethanol, metsulfuron-methyl, listeriomycin, etc.

A thrombocytopenic diet

Dietary Therapy for Thrombocytopenia —— The Topic of Thrombocytopenia

Diet therapy for thrombocytopenia I:

Syndrome differentiation: spleen yin deficiency, blood dryness, internal heat due to yin deficiency, collateral bleeding due to heat injury.

Treatment methods include nourishing yin, strengthening spleen, moistening dryness, and clearing heat and removing spots.

Jiawei piyin decoction.

It is prepared from Radix Rehmanniae10g, Radix Paeoniae Alba 30g, Eclipta prostrata15g, Rhizoma Dioscoreae 20g, Lotus Seed15g, Fructus Forsythiae10g, Semen Phaseoli 30g, Rhizoma Coptidis 6g, Bamboo Leaves10g, and Fructus Schisandrae Chinensis/.

Usage: decoct with water, 1 dose, twice a day.

Dietary therapy for thrombocytopenia II:

Syndrome differentiation of blood heat and spleen deficiency.

Treatment of hemostasis and blood absorption.

Fangming Zhixue Decoction.

It consists of 20g of Radix Rehmanniae, 30g of Radix Astragali, 0g of lotus root node10g, Rhizoma Bletillae10g, 0g of hawthorn10g, 0g of madder10g, 0g of red dates10g and 6g of peanut skin.

Usage: decoct with water, 1 dose, twice a day.

Four dietary supplements for thrombocytopenic diseases

(1) red jujube mutton bone porridge

Formula: jujube 15, 500 grams of sheep bone and 200 grams of rice.

Preparation and administration method: wash sheep bones (preferably leg bones), knock them into two parts, add water and cook them with slow fire for 1 hour, fish up the bones, remove the bone marrow from the soup, add rice and red dates and cook them into porridge. Take it twice a day.

Indications: replenishing qi and blood, replenishing marrow and generating blood. It is helpful for thrombocytopenic purpura, allergic purpura and aplastic anemia.

(2) Fresh lotus root porridge

Formula: 30-50g japonica rice, 50g fresh lotus root and proper amount of sugar.

How to make and eat: First, cook the rice into porridge until it is half cooked, add the washed fresh lotus root slices, cook until the porridge is cooked, and add a little sugar for breakfast.

Indications: clearing away heat, cooling blood and promoting fluid production. It is helpful for the blood thermodynamic blood group of thrombocytopenic purpura and allergic purpura.

(3) Ejiao glutinous rice porridge

Formula: Ejiao 20-30g, glutinous rice 100g, brown sugar 15g.

How to make and eat: firstly, wash the glutinous rice, add water and boil it in a pot. After the porridge is cooked, add the mashed gelatin particles, stir well while cooking, and add brown sugar to serve, in moderation for each meal.

Indications: nourishing yin and tonifying deficiency, nourishing blood and stopping bleeding.

(4) Peanut and jujube soup

Formula: 200 grams of raw peanuts, 20 red dates and appropriate amount of rock sugar.

How to make and take: Wash raw peanuts and red dates, put them in a pot, add water until cooked, add crystal sugar and stir well, and chew red dates and peanuts with soup.

Indications: Warming the spleen and stomach, nourishing blood and benefiting qi, and playing an auxiliary role in various types of thrombocytopenia.

Dietary ankylosing thrombocytopenia

Dr. Shi, an expert in hematology at Beijing Huajun Chinese Medicine Hospital, China International Institute of Biomedical Engineering, makes all-day visits every Saturday.

According to the theory of auricular points, all tissues and organs of the human body have corresponding acupoint connections in the ear. Stimulating these acupoints can enhance and regulate the functions of various tissues and organs and improve the metabolic level of the human body.

I have a patient who often bleeds his gums while brushing his teeth. Later, he bit steamed bread and ate bananas, leaving blood on his food. After blood tests in the hospital, it was diagnosed as thrombocytopenia. I have eaten some preparations such as Agrimonia pilosa, blood coagulation syrup, vitamin C and so on. Because patients are afraid of taking various drugs since childhood, they often miss taking them, so the effect is not good.

Later, I asked them to choose 30 grams of peanuts, 20 grams of red dates, and 20 grams of lotus seeds with belt cores to be boiled in water and eaten as snacks twice a day.

Because it was quite popular at that time that "food supplement is not as good as exercise", so I really need to strengthen my physique and improve my hematopoietic function. According to the theory of auricular points in Chinese medicine, I designed a simple ear movement: hold the ear with the index finger and middle finger, rub it up and down for 2 minutes, and rub it red and hot, and feel the blood circulation on the ear accelerate. Twice a day.

According to the theory of auricular points, all tissues and organs of the human body have corresponding acupoint connections in the ear. Stimulating these acupoints can enhance and regulate the functions of various tissues and organs and improve the metabolic level of the human body. Taking ear exercises as "holographic" gymnastics for physical exercise saves time and effort.

Now the patient's thrombocytopenia has been completely cured and has not recurred so far.

Does thrombocytopenia necessarily lead to bleeding?

Thrombocytopenia does not necessarily lead to bleeding. This mainly depends on two aspects, one is the degree of thrombocytopenia; The second is individual differences. The number of platelets in normal people is (10 ~ 300) x10'/L. Generally speaking, mild thrombocytopenia ((8 ~ 100) x 109/L, that is, (80000 ~/kloc). Platelets decrease moderately (50 ~ 80)x 10 '/ liter, that is, close to 10000 ~ 80000)/ cubic millimeter), and there may be mild spontaneous bleeding, such as bleeding after skin and mucous membrane bleeding, and the menstrual flow of women increases. In severe thrombocytopenia (below 50 x 10'/L, that is, below 50,000), most of them will have obvious spontaneous bleeding, and the most common is purple pain on the skin. The more serious situation is thrombocytopenia (below 20 X 10'/'/L, that is, below 20,000), and even life-threatening symptoms such as intracranial hemorrhage and gastrointestinal hemorrhage may occur. Individual difference means that different people have different clinical manifestations of thrombocytopenia due to differences in body structure (such as vascular permeability) and bleeding tolerance. For example, in some patients, when the platelet drops to about 50x 10'/L, extensive subcutaneous congestion will occur, and in some patients, even if the platelet is only 20x 10'/L, there is no bleeding. Of course, even if there is no spontaneous bleeding in the latter case, there is still some danger, so we need to be vigilant and do a good job in preventive nursing of bleeding.

Prevention and treatment of thrombocytopenic purpura

Patients with thrombocytopenic purpura should prevent colds, closely observe the changes of density, color and size of purple spots, and pay attention to body temperature, consciousness and bleeding, which is helpful to understand the prognosis and outcome of the disease so as to deal with it in time. Avoid trauma, and those with massive bleeding must stay in bed. Chronic patients can exercise properly according to the actual situation, avoid internal injuries of seven emotions, keep a happy mood and have a light diet. If you have gastrointestinal bleeding, you should input semi-liquid or liquid, and avoid spicy and irritating things such as alcohol and tobacco. Those with itchy spots can be wiped with calamine lotion or Jiuhua powder lotion, and pay attention to skin hygiene to avoid scratching the skin arch and infection.

Diagnostic criteria of lupus erythematosus in China

1. Butterfly erythema or discoid erythema: flat or fixed erythema appears on the neck, which usually does not involve nasolabial groove and discoid erythema. The raised erythema is covered with horny scales and hair follicle damage, and skin atrophy may occur in the focus.

2. Photosensitive X 10'/L or hemolytic anemia: skin allergy caused by sunlight.

3. Oral mucosal ulcer: painless ulcer in oral cavity or nasopharynx.

4. Non-deformed arthritis or multi-joint pain: Non-erosive arthritis involving two or more peripheral joints, characterized by joint swelling, pain or exudation.

5. Pleurisy or pericarditis: chest pain, pleural friction or pleural effusion; Pericarditis, abnormal electrocardiogram, pericardial fricative sound or pericardial effusion

6. Epilepsy or mental symptoms: non-drug or metabolic disorder, such as uremia, ketoacidosis or electrolyte disorder; Psychosis: Non-drug or metabolic disorder, such as uremia, ketoacidosis or electrolyte disorder.

7. proteinuria, tubular urine or hematuria: proteinuria >; 0.5g/dl or 3+; Cell casts can be red blood cells, hemoglobin, granular casts or mixed casts.

8. White blood cells are less than 4x 10'/L or platelets are less than 100.

9. Fluorescent antinuclear antibody is positive.

10. Anti-double-stranded DNA antibody positive or lupus cell positive.

1 1. Anti-Sm antibody is positive.

12.o decrease

13. Skin lupus band test (non-lesion site) was positive or renal biopsy was positive.

Those who meet any four of the above 13 can be diagnosed as lupus erythematosus.

Pathological phenomenon

(1) fever

The immune function of lupus erythematosus is abnormal, and many substances can be produced in the body as heat sources to keep the body warm. About 80% patients may have fever, mostly high fever, and about 12% patients show low fever. The first symptom of some patients is fever of unknown origin. We should pay attention to a young woman who has long-term fever for unknown reasons, accompanied by joint pain and swelling, and a rash. It is highly doubtful whether she has the possibility of lupus erythematosus, so we should ask a specialist for further examination to see if there are any autoantibodies to make a definite diagnosis.

Fever often indicates that lupus erythematosus is in the active stage, and measures should be taken in time to avoid the development of the disease. Another feature of fever caused by lupus erythematosus is that the body temperature can quickly subside and return to normal after using glucocorticoid. If you stop using hormones, your body temperature will rise again. But patients with lupus erythematosus, especially after long-term use of hormones, will also have fever. At this time, we should be highly alert to the emergence of infection. Because after the hormone is used, it inhibits people's immunity and reduces the body's ability to resist diseases and bacterial infections. At this time, bacteria can take advantage of the opportunity to infect the body, the most common is lung infection. In particular, we should be careful about the infection of mycobacterium tuberculosis and use appropriate antibiotics in time to avoid the development of the disease and endanger our lives.

(2) Erythema rash

More than 80% patients have skin lesions, erythema and rash. Butterfly erythema on zygomatic face and edema erythema around nails and fingertips are the characteristic manifestations of SLE. Butterfly erythema does not exceed nasolabial groove, and irregular erythema can also be seen on the bridge of the nose, forehead and auricle. Erythema of different shapes can also appear on the back of elbow, palm, knuckle, knuckle back, palm, sole of foot and other parts of upper arm. The shapes are discoid erythema, annular erythema, edematous erythema and polymorphic erythema.

Discoid erythema is flaky, with clear boundary, slightly flat in the middle of the protuberance, with keratin debris stuck on it, which can not be wiped off. It is connected with the lower hair follicle and is a hair follicle corner plug, which can leave atrophic scars and slight depressions in the future.

Rash includes red papules and maculopapules, which are generally not itchy or slightly itchy, and can occur in all parts of the body, especially the face, neck and limbs. A few people have blisters and blood bubbles. After erythema and blisters subside, epidermal atrophy, pigmentation and keratinization may occur.

Light sensitivity, about 1/3 patients appear red all over the face as soon as they are exposed to the sun. Mainly sensitive to ultraviolet rays. In summer, under the shade of the house, the face will turn red because of radiation, and some patients will have sunshine allergic skin rash after sunbathing.

(III) Mucosal ulcer and alopecia

About15 patients have mucosal damage, involving lips, tongue, cheeks, nose, cavity and so on. , leading to painless mucosal ulcer. If there is a secondary infection, there may be pain.

Patients with lupus erythematosus are prone to hair loss. In addition to hair loss caused by inflammation in the rash, hair loss can also occur in other parts, not only hair, but also eyelashes. Eyebrows and body hair will also fall off.

There are two forms of hair loss: one is diffuse hair loss, the residual hair is sparse, dull or yellow, the hair is dry, sparse and easy to break, resulting in sparse or alopecia areata; Another kind of hair loss is concentrated on the forehead, which is what we usually call "flowing into the sea". Hair is sparse, yellow and easily broken, and the length of hair is uneven, forming "lupus hair".

The alopecia caused by lupus erythematosus is completely different from what we usually call seborrheic alopecia, and its pathological basis is also different. Lupus alopecia is mainly caused by vasculitis under the skin, which leads to the disorder of nutrient supply of hair follicles and affects the growth of hair. It exists as a clinical manifestation of lupus erythematosus, and the first symptom of some patients with lupus erythematosus is alopecia, so it should be noted that alopecia in lupus erythematosus is more common.

Generally, hair can be regenerated after the disease is controlled. It is particularly noteworthy that alopecia in patients with lupus erythematosus may be the first symptom of disease recurrence, which should attract the attention of doctors and patients.

(4) arthritis

More than 90% patients have joint pain, which may occur at all stages. Some joint pains have appeared several years before the onset, and some soft tissues around the joints are swollen, tender and edematous, showing acute arthritis. Proximal phalangeal joints, metacarpophalangeal joints, wrist, elbow, knee and toe joints, etc. Usually symmetrical. Some patients are stiff in the morning. Some patients have a long course of joint disease, while others have a short course of joint disease, and even have short-term joint pain.

Most X-rays can't show worrying bone changes and deformities. After taking glucocorticoid for more than 5 years, about 5% patients can have aseptic osteonecrosis.

(5) Hemacytopenia

Because of the existence of autoantibodies, red blood cells, white blood cells and platelets will destroy themselves and decrease.

Anemia is mostly positive cell anemia, anti-erythrocyte antibodies are mostly lgG type, and hemoglobin is also reduced. White blood cells are generally granulocytes or lymphopenia. Thrombocytopenia and short survival time. Platelets are self-destructive because they have lgG antiplatelet on their surface.

(vi) Cardiac injury

About14 patients have pericarditis, which is mild and asymptomatic, with only obvious precordial pain, chest tightness and temporary pericardial fricative sound, which may not be found in clinic. Echocardiography or B-ultrasound and X-ray chest film need routine examination, which can show pericardial effusion. 34. 15% SLE patients were found to have pericardial effusion.

(7) Lung injury

Many SLE patients have two punctate nodular shadows and cord-like or reticular shadows in the basal segment of the lung on X-ray chest films, which are interstitial changes and most of them are asymptomatic.

Pleurisy can be asymptomatic, only found in the following examinations, that is, B-ultrasound and X-ray chest films have a small to moderate pleural effusion, sometimes coexisting with pericardial effusion. LE cells can be seen in pleural effusion.

(8) Lupus nephritis

Clinically, about 75% of SLE patients have renal damage, and urine tests show protein, red blood cells and white blood cells, and a few patients have casts. Lupus nephritis occurs in the early stage. If the lesion persists for many years, it may have extensive damage and evolve into uremia due to renal insufficiency.

(9) Brain injury

There are many manifestations of nervous system damage in SLE. Psychopathy is manifested as schizophrenia, and various mental disorders such as irritability, insomnia, hallucinations, suspicion, delusion, obsessive-compulsive ideas, etc.

Brain injury is common in the terminal stage of chronic SLE or severe cases of acute SLE attack. A few cases of brain injury were born slowly, with mild illness, often accompanied by headache, dizziness and abnormal EEG changes. In rare cases, it is the first symptom of acute phase. Generally speaking, after timely treatment, brain injury is reversible, as are abnormal changes in EEG and brain CT scanning.

Severe intracranial hemorrhage and cerebral hernia can lead to death.

(10) lymphatic reticular system

About 50% SLE patients have local or systemic lymphadenopathy, especially in the neck, submandibular and axillary lymph nodes, which are soft and have different activities and generally have no tenderness.

Many patients have swollen tonsils and pain, which often leads to the onset of systemic lupus erythematosus. Antibacterial and anti-inflammatory effect is not good.

About13 patients have hepatomegaly, but SLE has no special liver lesions. A few patients can have a slight increase in GPT and GOT, which rarely causes jaundice and cirrhosis. About 20% patients have splenomegaly. Spleen enlargement is usually found in B-ultrasound. For example, it has been increased by 1- 1.5 times that can be felt under the ribs in physical examination. Very few patients have splenomegaly.

(1 1) Irregular menstruation

Menstrual disorders are common in early and active SLE patients. Menstruation is advanced, delayed, decreased or menstrual flow is obviously increased. If anticardiolipin antibody (anti-Acl) is positive, there may be stillbirth or abortion. B-ultrasound can occasionally find pelvic effusion, suggesting the existence of pelvic serositis.

(XII) Reynolds phenomenon

The phenomenon that both hands and feet turn white, cyanosis and flush symmetrically is called Reynolds phenomenon. This is caused by spasm of arterioles in limbs. About 15%-20% of SLE patients have Raynaud's syndrome on their hands and feet, which appears in all stages of SLE, and some of them existed before the onset of SLE. This phenomenon is caused by cold, which mostly occurs in winter, and the heavier phenomenon can occur below 20oC. Warm weather can relieve itself, and it will reappear in autumn and winter. Some patients have cold and tepid hands in summer.

(13) vasculitis

A large number of petechiae can appear on both hands and feet, which is caused by embolic vasculitis and peripheral necrotizing vasculitis caused by the accumulation of immune complex into macromolecules blocking tiny blood vessels, which can cause depression, ulcer and necrosis of fingertips and toes. Very few cases can cause arteritis obliterans of dorsum of foot, accompanied by severe pain.

Netted and flaky blue spots can appear on both legs. Cyanosis reticularis, like fishnet, is caused by spasm of central arteriole in subcutaneous tissue, and cyanosis caused by dendritic branches of capillaries is reticular around the middle ischemic pale area. It is most common in the inner thigh, and reticular green spots can also be seen in the inner leg, trunk, upper limbs and hand traction.

The flaky purple spots on the legs often coexist with reticular green spots, which are subcutaneous bleeding caused by necrotizing vasculitis of cutaneous arterioles or thrombocytopenia. Some have vascular embolism, which can palpate small nodules, and flaky purple spots are more common in calves, thighs and upper limbs. Embolic phlebitis can also be seen in clinic.

The nails have changed. Many patients have onychomycosis, which is related to fungal infection after taking corticosteroids for a long time. There is also peripheral vasculitis, which leads to the thinning, softening and atrophy of nails and looks like onychomycosis.

(14) digestive tract injury

The common symptom of digestive tract is loss of appetite, and many patients have constipation and abdominal distension. Some patients have symptoms such as nausea, abdominal pain around navel and frequent defecation. Ascites is related to lupus peritonitis and mesenteritis, and some are related to hypoproteinemia of lupus nephritis.

Pancreatitis caused by lupus is rare. This is related to pancreatic blood vessels.

(15) eye diseases

About 20%-25% patients have fundus changes, including fundus hemorrhage, papillae edema and oval white mixed substance in retinal exudate, which is the product of retinal nerve fiber swelling and deformation caused by small vessel embolism and can cause visual impairment. With the remission of the disease, these changes can disappear. Other vitreous hemorrhage and scleritis.

treat cordially

(1) Non-steroidal anti-inflammatory drugs: These drugs can inhibit the synthesis of prostaglandin and can be used for symptomatic treatment of fever, joint pain and myalgia. For example, indomethacin has a good effect on fever, pleural and pericardial lesions of SLE. Because these drugs affect renal blood flow, they should be used with caution when complicated with nephritis.

(2) antimalarial drugs: chloroquine is mainly concentrated in the skin after oral administration, which can inhibit the combination of DNA and anti-DNA antibodies and has certain curative effect on rash, photosensitivity and joint symptoms. Long-term administration of chloroquine phosphate 250-500mg/d may cause retinal degeneration due to its accumulation in the body. Early withdrawal of drugs can recur, and the fundus should be examined regularly.

(3) Glucocorticoid: it is the main drug for treating this disease at present, and it is suitable for acute or explosive cases, or when major organs such as heart, brain, lung, kidney and serosa are involved, autoimmune hemolysis or thrombocytopenia will make blood tend.

There are two kinds of usage, one is a small dose, such as 0.5mg/kg/d, or even taking half to relieve the disease. Second, the high dose should be maintained at 10- 15 mg/d at the initial stage. If the disease rebounds during the reduction period, the dose should be maintained with 5 mg before the reduction. High-dose methylprednisolone pulse therapy can be used for fulminant or intractable lupus nephritis and central nervous system diseases, 1000mg/d intravenous drip, halved after 3 days, and then maintained with prednisone. Some cases can achieve good curative effect, but we should pay attention to its side effects such as hypertension and easy infection.

(4) Immunosuppressant: it is mainly used for cases where the disease recurs after hormone reduction or the hormone is effective but excessive dosage causes serious side effects, as well as diseases such as lupus nephritis and lupus encephalopathy that are difficult to control by simple hormones. Such as cyclophosphamide. 15-2.5mg/kg/d, intravenously or orally, or 200mg every other day. The main side effects are bone marrow suppression, gonadal atrophy, teratogenesis, hemorrhagic cystitis and alopecia. It should be noted that cytotoxic drugs cannot replace hormones.

(5) Other drugs, such as levamisole, can enhance the immune response below normal, which may be helpful for SLE patients with infection. Usage: 50mg/d, three days in a row, rest 1 1 day. The side effects are loss of appetite and leukopenia.

Anti-lymphocyte globulin (ALG) or anti-thymocyte globulin (ATG) is a large number of immunosuppressants used to treat severe aplastic anemia in recent years, with high activity of T lymphocyte toxicity and inhibition of T lymphocyte immune response. Some hospitals used it to treat active SLE and achieved satisfactory results. The usage is 20-30mg/kg/d, diluted in 250-500 ml physiological saline, and slowly infused intravenously for 5-7 days. The side effects are rash, fever, general joint pain, transient thrombocytopenia and serum sickness. If hormones are supplemented at the same time, it can be alleviated.

(6) Plasma exchange therapy: by removing the patient's plasma, immune complexes and autoantibodies contained in the plasma are removed, and then normal plasma is input. The effect is remarkable, but it is difficult to last, and the price is expensive, which is suitable for acute and severe diseases.

Chinese medicine treatment:

There are many ways to treat lupus erythematosus in traditional Chinese medicine, including drug therapy and other therapies. Drug therapy is commonly used in traditional Chinese medicine, and other therapies include acupuncture, massage, local sealing and physical therapy. Most of these therapies are symptomatic treatment for a symptom of lupus erythematosus.

Lupus erythematosus can be treated with oral Chinese medicine, including TCM syndrome differentiation, one side for each disease, one side for each side, and Chinese patent medicine. Among them, the method of syndrome differentiation and treatment has the characteristics of wide coverage, great flexibility and treatment according to the situation, which is one of the treatment measures worth taking. However, due to the extensive damage and complex and changeable symptoms of systemic lupus erythematosus, every doctor has different understanding of the disease in clinic, so doctors have different opinions on syndrome differentiation and prescription selection. According to various types of clinical syndrome differentiation and treatment summarized by most doctors in China, their opinions and clinical experience are integrated. State administration of traditional chinese medicine, China, issued the standard of syndrome differentiation for red butterfly spots, which can be divided into six syndrome types: excessive heat toxin, internal heat due to yin deficiency, liver and kidney yin deficiency, liver injury due to pathogenic heat, spleen and kidney yin deficiency, and rheumatic arthralgia, generally including acute active stage, stable stage and organ injury of systemic lupus erythematosus. According to the clinical manifestations of each syndrome type, different treatment prescriptions are selected respectively. One side of a disease is to grasp the main pathogenesis of lupus erythematosus according to the changing law of the disease, and set up treatment prescriptions according to the pathogenesis, with one side as the treatment, some with nourishing yin and tonifying kidney, some with promoting blood circulation and removing blood stasis, some with detoxification and clearing heat, and some with expelling wind and removing arthralgia. The most commonly used traditional prescriptions for treating one disease are Qingre Dihuang Decoction, Liuwei Dihuang Decoction, Buzhong Yiqi Decoction, Jisheng Shenqi Pill, Shengmai Decoction, Guipi Decoction, Niuhuang Qingxin Pill, Siwu Decoction, Gui You Pill and Zuogui Pill. More widely used is the self-made prescription created by each doctor according to his own experience. Commonly used drugs in these prescriptions are Polygonum Multiflori Radix, Radix Rehmanniae, Radix Scrophulariae, Cornus officinalis, Fructus Lycii, Polygonatum sibiricum, Radix Ophiopogonis, Stemonae, Fructus Ligustri Lucidi, Eclipta prostrata, Radix Pseudostellariae, Ginseng, Radix Astragali, Poria, Rhizoma Dioscoreae, Atractylodis Macrocephalae, Radix Codonopsis, Rhizoma Coptidis, Scutellariae Radix, Flos Lonicerae, Fructus Forsythiae and Gypsum Fibrosum. Commonly used prescriptions are tripterygium wilfordii and its preparations. Among them, there are tripterygium wilfordii tablets, tripterygium wilfordii polyglycoside tablets, tripterygium wilfordii syrup, santengyin and so on. Begonia Kunming is used for systemic lupus erythematosus and discoid lupus erythematosus. In 1970s and 1980s, a pharmaceutical factory produced its tablets, each containing 50mg; Natural medicine. Artemisia annua and its preparation have certain curative effect on discoid lupus erythematosus. Among them, Artemisia annua pills and Artemisia annua extract tablets are both taken orally, while artemisinin is an injection, which has been reduced in the 1990s. In addition, some preparations are also used in clinic, such as compound Jinqiao tablet, three snake syrup, gallnut and amitabha powder, safflower preparation, salvia miltiorrhiza preparation, rhubarb preparation and so on.

In addition to oral Chinese medicine decoction and application of Chinese medicine, there are different treatment methods such as acupuncture, ear acupuncture, acupoint sealing, selective therapy, dietotherapy and physical therapy. These therapies can be used as adjuvant therapy for systemic lupus erythematosus.

To sum up, there are many methods of treating lupus erythematosus in traditional Chinese medicine. In clinical application, one or several treatment methods should be selected according to the different symptoms of patients.

I wish your old man a speedy recovery!