🌿 Folk Prescriptions

Research on Lupus Erythematosus in Traditional Chinese Medicine II: The TCM pathogenesis of lupus erythematosus involves individuals with genetic predisposition to lupus who, under triggers such as infection, physical factors (e.g., ultraviolet light), or certain drugs, experience disruption of immune homeostasis, leading to massive production of autoantibodies. These antibodies directly or via immune complexes cause mucinous edema, fibrinoid degeneration, and necrotizing vasculitis in connective tissues, resulting in multi-organ and multi-system damage. TCM views the pathogenesis of this condition differently among practitioners. Based on summarizing various theories and my own clinical research over a decade, I believe although complex and variable, there are patterns: the pathogenesis can be summarized as "One Root, One Manifestation, Five Obstructions." "One Root" refers to constitutional deficiency and deficiency of the five zang organs; "One Manifestation" refers to metabolic products obstructing the triple burner; "Five Obstructions" refer to impaired circulation of qi and blood in meridians, affecting different systems and organs, forming "Lung Obstruction," "Heart Obstruction," "Spleen Obstruction," "Liver Obstruction," and "Kidney Obstruction."
1. Constitutional Deficiency and Deficiency of the Five Zang Organs
Lupus erythematosus prevalence varies across ethnic groups and has a genetic tendency. Those with such susceptibility are termed individuals with lupus genetic predisposition. TCM holds that these patients have constitutional deficiency and deficiency of the five zang organs. Constitution refers to inherent physical characteristics determining susceptibility to pathogens and tendencies toward certain pathologies. This constitutional factor is often inherited from parents—such as parental weakness, inadequate fetal vitality, poor prenatal nourishment, or birth trauma—leading to unhealthy organs, insufficient qi and blood, and weak vital energy, creating opportunity for this disease. Dietary indiscretion, irregular living habits, overwork, emotional injury, or childbirth-induced qi and blood damage can further harm the five zang organs. Dietary indiscretion includes binge eating, prolonged fasting, or picky eating, damaging the spleen and stomach, reducing their function, depriving the five zang organs of nutrients, leading to general deficiency. Emotional injury harms the five zang organs according to TCM: "anger injures the liver," "joy injures the heart," "worry injures the spleen," "grief injures the lungs," "fear injures the kidneys." Overwork damages the five zang organs, especially mental exertion: "using mental faculties excessively injures the heart," "planning deeply injures the liver," "excessive thinking injures the spleen," "worrying about events injures the lungs," "excessive sexual indulgence injures the kidneys." Initial damage may affect one organ, spreading through the five zang’s generating and controlling relationships, ultimately forming the constitutional predisposition to lupus. Under this constitutional vulnerability (equivalent to individuals with lupus susceptibility), exposure to external pathogens (especially viral infections) and internal emotional stress (social-psychological factors), drug toxins, or sunlight can trigger lupus.
2. Internal Accumulation of Phlegm and Blood Stasis, Obstruction of the Triple Burner
The triple burner differs from other organs—it is not a physical organ but a functional concept, dividing the body into upper, middle, and lower burners. Wang Haogu considered the area from head to heart as upper burner, from heart to navel as middle burner, and from navel to feet as lower burner. Zhang Jingyue defined the transverse septum and navel cross-section as boundaries: above the septum is upper burner, from septum to navel is middle burner, below the navel cross-section is lower burner. Upper burner houses heart and lungs, middle burner houses spleen and stomach, lower burner houses liver, kidneys, bladder, and intestines. Functionally, the triple burner governs primordial qi, regulates qi movement, and facilitates fluid metabolism, primarily involving qi and fluid dynamics. Pathological changes relate to qi movement and fluid metabolism. Due to constitutional deficiency and five zang deficiency, a susceptible individual develops metabolic byproducts (autoantibodies, immune complexes, etc.) upon triggering, equivalent to TCM concepts of blood stasis, phlegm, and dampness. The triple burner serves as the hub for overall qi movement and fluid regulation. When these tangible pathogens obstruct the triple burner, its qi movement and fluid regulation functions become impaired, causing diverse and complex symptoms. For instance, in lupus patients, triple burner obstruction leads to impaired qi movement, loss of defensive function of wei qi, hence frequent colds. Triple burner blockage causes accumulated fire, resulting in persistent high fever. Qi fails to move blood, blood fails to reach extremities, or extremity qi stagnation disrupts transformation, obstructing the flow of qi, blood, and body fluids, depriving the five zang organs of nourishment, further weakening them, causing recurrent illness. Impaired fluid regulation leads to fluid accumulation: pleural effusion in upper burner, ascites in middle burner, oliguria and lower limb edema in lower burner; widespread fluid overflow causes severe systemic edema.
3. Impaired Qi and Blood Circulation Leading to Five Obstructions
Systemic lupus erythematosus causes multi-system and multi-organ damage, with complex and varied symptoms depending on affected organs. This condition corresponds to TCM’s "Zhou Bi" category. "Zhou Bi" means obstruction throughout the body, as described in Ling Shu: "Zhou Bi occurs within the blood vessels, moving upward and downward with the meridians, unable to stay on either side." It manifests as cough, phlegm, shortness of breath, chest tightness—corresponding to lupus pneumonitis or lupus pleuritis; obstruction in heart meridians forms "Heart Bi," presenting palpitations, chest pain, chest tightness—corresponding to lupus myocarditis or lupus pericarditis; obstruction in spleen meridians forms "Spleen Bi," presenting poor appetite, vomiting, diarrhea, reduced blood cells, general fatigue—corresponding to lupus gastrointestinal or hematologic damage; obstruction in liver meridians forms "Liver Bi," presenting rib pain, jaundice, headache, dizziness, epilepsy, psychiatric symptoms—corresponding to lupus hepatitis or lupus CNS damage; obstruction in kidney meridians forms "Kidney Bi," presenting reduced urination, proteinuria, edema—corresponding to lupus nephritis.
In summary, the main pathogenesis of lupus erythematosus is constitutional deficiency and five zang deficiency (deficiency at root), internal generation of phlegm and blood stasis obstructing the triple burner (excess at manifestation), and impaired qi and blood circulation (five obstructions), leading to damage of various tissues and organs and complex, variable symptoms. The condition combines deficiency and excess. Throughout the disease process, due to varying degrees of zang-fu yin-yang deficiency, clinical presentations shift between excess dominance and deficiency dominance. Common syndromes include phlegm-blood obstruction with intense heat toxicity; liver-kidney yin deficiency with internal false heat; liver-kidney yang deficiency with qi-blood deficiency; five zang deficiency with lingering pathogens. Variations may present as five zang obstructions. Treatment should be tailored to the syndrome. During acute phases, prioritize eliminating pathogens and treating manifestations; during remission, focus on tonifying deficiency and treating root causes. Adjust treatment according to the characteristics of five zang obstructions for optimal outcomes.