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H
erbal Medicine
 

Lupus
The Use of Herbs In The Treatment of Systemic Lupus Erythematosus

© David L. Hoffmann BSc (Hons), MNIMH

by Meryl Baskervill

Introduction:

The purpose of this limited study was to determine the benefits, if any, of using herbal preparations traditionally used for adrenal support and toning in the treatment of a steroid-dependent client diagnosed with Systemic Lupus Erythematosus. It was not my intent to replace or supplant standard allopathic treatment but rather to use herbs to support it. Using the frequency and severity of observed symptoms during the course of treatment I hoped to determine:
  • If herbal support could play a role in reducing dependence on cortico-steroids
  • If herbal support could adequately address the symptoms that frequently result in an increase of cortico-steroid dosage

Background:
Systemic Lupus Erythematosus (henceforth referred to as S.L.E.) is a multi-symptom, multi-organ connective tissue disease that primarily affects women of child-bearing age. SLE tends to run in families with l0% of sufferers reporting additional affected family members. It is l0 times more likely to afflict women than men and black women are at much greater risk than white women (l in 1000 for white women vs. 1 in 250 for black women). The reasons for this statistical difference are as enigmatic as the disease process itself. While no specific causative agent has been identified, the triggering of symptoms is thought to be multifactorial, with the following playing a part in the overall disease picture:
  • genetics
  • environmental factors
  • immunologic response patterns

It is a disease that frequently alludes early diagnosis, hiding behind multiple vague symptoms that are easily explained away by both patient and health practitioner alike. While its presence is generally heralded by an acute flare-up of non-deforming arthritis in one or more joints, it can strike any organ in a variety of complex and sometimes baffling symptomatology.

Diagnosis is made based upon observed symptoms and histological evidence of increased auto-immunological changes in the blood (i.e. increased FANA levels, increased T cell count, etc.). Prognosis for those afflicted with SLE varies greatly depending on the severity of the auto-immune response by the body and the organs afflicted, with most fatalities occurring as a result of acute kidney failure. It is a disease that can creep through the body for many years doing little more than disrupt normal activity or it can move with devastating speed, destroying vital organ tissues in the process.

The advent of modern corticosteroids (ie...prednisone, cortisone, et al...) has done much to improve and prolong the life of the average SLE sufferer. In the late l950's the expected life expectancy after diagnosis averaged 5 years, today's treatment regimens allow patients to survive in access of l0 years after diagnosis, with many achieving normal life spans. However, these potent pharmaceuticals are not without their drawbacks. Prolonged corticosteroid use, such as is employed in the treatment of advanced manifestations of SLE, frequently results in adrenal atrophy and immunological suppression of the body's defenses. Additionally, its long term usage frequently results in a variety of unpleasant side-effects including:

  • mood swings
  • depression
  • generalized edema of body and face
  • redistribution of body fat to the abdomen
  • weight gain
  • lethargy

Many of these symptoms can also be caused by the illness itself, which only adds to the health care professional's treatment dilemma.

Case Report

Presenting symptoms

Client is a 41 year old female diagnosed in February 1990 as having SLE. Diagnosis was based on standard medical tests and criteria by a clinical rheumatologist. Client first presented for treatment in May 1990. At that time, she was on a daily dosage of l5 mg of Prednisone (down from a high of 20mg). She exhibited extreme effort at the least exertion and was spacey and generally in a debilitated state, both physically and emotionally. She stated feelings of anger and resentment at being ill and generally felt out-of-touch with her body. I found her to be personable, witty and very intelligent with a tendency to underestimate her abilities for both self-expression and self-mastery over her current condition.

Client stated the following physical complaints, some of which she felt were from the Lupus and some from the allopathic steroid treatment:
  1. Sleep disturbances
  2. Sore throat
  3. Skin rash with intense itching
  4. Great fatigue, unrelieved by sleep
  5. Joint pain and stiffness
  6. Chest pain with difficulty breathing
  7. Puffy eyes
  8. Abdominal complaints of gas and bloating
  9. Headache
  10. Raynaud's syndrome

History
Client stated a history of standard childhood illnesses - nothing remarkable. Prior surgery for removal of benign ovarian cyst done in 1987, following years of female complaints including amenorrhea, dysmenorrhea and the like. Client states that the first Lupus-related symptom of itching occurred following this surgery and she feels strongly that this surgery triggered the onset of lupus symptoms.

Itching continued for three years without definite diagnosis as to cause. All standard reactions and causes ruled out. Last December, client developed puffy eyes, extreme fatigue and flu-like symptoms that did not go away. These were followed by the rapid development of chest and pleuritic pain and later by diverse joint and muscular involvement. Standard workup by a clinical rheumatologist showed decreased compliments, high ANA titers and other histological indications consistent with a diagnosis of Systemic Lupus. Because of the rapid involvement of multiple organs, client was placed on steroid therapy in the form of 20mg per day of Prednisone which she states helped alleviate some of the symptoms but caused side-effects. Steroids had been reduced to 15mg daily at the time of our first visit.

Physical Assessment/Initial Workup:
On physical workup and observation I noted the following:
  1. Joints appeared normal with no heat or swelling
  2. Some observable limitation of range of motion in hand, wrist and shoulder.
  3. Difficulty climbing the stairs
  4. Noticeable facial edema, especially around the right eye
  5. Cold hands and feet
  6. Noticeable abdominal distention
  7. Client appeared very fatigued, speaking and moving with effort
  8. Noticeable stiffness
  9. Cough, especially after exertion

Assessment of the body's energy field via Polarity and Reiki methods showed marked reduction in overall vitality with significant blockage in those areas normally associated with adrenal function and reproductive health.

Treatment Plan:
In looking over the totality of symptoms and general health needs of this client, I decided on the following course of action:
  1. Begin a course of herbal tonification to increase physical vitality and minimize steroid-induced atrophy of the adrenal glands. I decided to introduce the herbs slowly, so as not to excite the immune system or overburden the body.
  2. Rebalance and re-vitalize the body's energy via appropriate bodywork treatments on a weekly bases.
  3. Encourage the client to keep a journal of symptoms experienced so that we could look for patterns.
  4. Work with client to build better communication skills with her body through education, discussion and visualization during the energy/bodywork treatments.
  5. Empower the client to take charge of her illness via positive feedback, visualization and other methods of self-care, including the making of her own herbal tinctures.

Herbal Formulations & Selection Criteria
My selection process involved the determination of action needed to address the multiplicity of symptoms presented as well as a basic understanding of the processes involved with Lupus, having researched this following the initial visit. I determined that the following actions would be beneficial:

Anti-inflammatories: as Lupus is a disease process with marked inflammation of multiple systems, anti-inflammatories are essential
Anti-catarrhals: to help reduce the amount of excess mucus in the lungs
Demulcents: demulcent to help with the associated chest pain and cough, and to assist the expectorant action.
Expectorants: to help clear mucus and phlegm from the lungs
Pulmonaries: to tone and strengthen the lungs
Nervines: to help the body cope with the overall effects of such a stressful illness. Also to address the insomnia and itching on an as needed basis
Anti-rheumatics: to ease the joint pain and stiffness involved
Diuretics: as needed to help alleviate the edema associated with the use of steroid therapy
Adrenal Tonics: Essential for helping tone and protect the adrenal glands from the effects of long-term steroid usage

Because of the need to proceed slowly, not all of the above actions were addressed in initial formulations. I started with a minimum of herbs, combining actions where possible. Additional herbs were added to the formula as needed to address new symptoms and changing prednisone levels.

Original Formula: (weeks 1-10)
Verbascum thapsus l part
Glycyrrhiza glabra l/2 part
Dioscorea villosa 2 parts 5ml tincture, 3 times a day
Urtica dioica infusion, 2 cups per day

This formula provided the following actions:
Anti-inflammatory - Dioscorea villosa, Glycyrrhiza glabra
Anti-rheumatic - Dioscorea villosa
Pulmonary - Verbascum thapsus, Glycyrrhiza glabra
Adrenal tonic - Glycyrrhiza glabra
Expectorant - Glycyrrhiza glabra, Verbascum thapsus
Demulcent - Glycyrrhiza glabra, Verbascum thapsus
Diuretic - Urtica dioica

Formula #2
The basic formula outlined above was expanded on August 2, with the addition of a Chinese herb - Bupleurum falcatum (radix). This herb was added to increase the adrenal tonic actions of the formula. Promising new research out of China and Japan has shown Bupleurum's ability to protect the adrenal glands from steroid-induced atrophy. This herb was added in the form of a TCM decoction, taken in l/2 cup doses 2X daily. One part of tincture was also added to the formula. Additionally, as prednisone dosage was reduced below the 9 mg level, Borago officinalis was added into the formula to increase adrenal support. This was added to the tincture formula.
Verbascum thapsus l part
Glycyrrhiza glabra 1 part
Dioscorea villosa 2 parts
Borago officinalis l part
Bupleurum falcatum l part 5 ml tincture, 3 times daily
Urtica dioica infusion, 2 cups per day (optional)
Bupleurum falcatum decoction, l cup per day

This formula provides the following action:

Anti-inflammatory - Dioscorea villosa, Glycyrrhiza glabra
Anti-rheumatic - Dioscorea villosa, Bupleurum falcatum
Pulmonary - Verbascum thapsus, Glycyrrhiza glabra
Adrenal tonic - Glycyrrhiza glabra, Bupleurum falcatum, Borago officinalis
Expectorant - Glycyrrhiza glabra, Verbascum thapsus
Demulcent - Glycyrrhiza glabra, Verbascum thapsus
Diuretic - Urtica dioica

Course of Treatment:
I have seen this client on a weekly basis since May 1990. During that time, I have implemented the steps outlined in the treatment plan with good results. For purposes of this study, I will address only the herbal tonification portion of the treatment plan in detail.

During the first 2 months of treatment with the initial herbal formula, no negative reactions occurred, although there was little improvement in the overall condition of the client. After the introduction of the Bupleurum falcatum on August 2, 1990, an immediate sense of well-being was noted by the client with a subsequent reduction of overall symptomatology. The difference was quite remarkable and with the supervision of the attending physician, a systematic reduction of prednisone dosage was implemented at the rate of lmg every 3 weeks.

At the 9 mg level of steroids, and exacerbation of symptoms occurred, necessitating a return to the l5mg level. At this point, the Borago officinalis was removed from the formula, and herbs added to address the increased symptomatology (Scutellaria laterifolia for the itching and Ginkgo biloba for the Raynaud's syndrome).

Once symptoms had subsided, a systematic reduction of steroid dosage was again implemented by the attending physician. During a routine review of the treatment regimen in mid-September, it was discovered that a fundamental misunderstanding had occurred concerning the dosage of the tinctures. The client had been taking one dropperful of tincture, 3 times a day, thinking that to be equal to l teaspoon (5ml). After measuring out the number of dropperfuls needed to equal one tsp. , it was found that she had been taking only l/5 of the recommended dosage! I cannot help but wonder, what progress would have been made had the herbs been consumed at a more therapeutic dosage. I do think that perhaps the dramatic improvement noted with the introduction of the Bupleurum falcatum tea, was due in part to the fact that the herb was ingested in amounts sufficient to produce a therapeutic effect; whereas, other herbs in the tinctures had been ingested at sub-therapeutic levels. (Please see note at end of this section)

The reduction of steroid dosage continued and the reduction to a level below the critical threshold of 9mg was achieved with minimal exacerbation of symptoms. Increased symptomatology generally followed within 3 days of reduction and lasted for approximately one week. Additional herbs were added to address these symptoms on an as needed basis.

By far the most annoying symptom proved to be the intense itching and hive-like rash that accompanied each reduction below the 9 mg level. This itching was treated first by the prescription cream, Lidex (a steroidal compound) which had been prescribed by the physician. This cream was being overused by the client, with little results. I formulated a salve out of Plantain and Peppermint oil in a safflower oil and beeswax base which proved to be very successful in eliminating not only the rash but also the itch.

At the 8mg level, I suggested that slowing the reductions into l/2mg increments, with one week in between the reductions, might substantially reduce the flair of symptoms encountered; while still accomplishing the same overall reduction of lmg every three weeks. This was approved by the attending physician, and has allowed the drop to 6 l/2mg without the uncomfortable flair of symptoms that was occurring when drops were done in lmg increments.

Currently the client is doing well, without obvious symptoms of the disease process. She is currently at a prednisone dosage of 6 l/2mg, reducing l mg every three weeks and continues with the following herbal formulas:

Current Herbal Formulations
Tincture# l
Glycyrrhiza glabra l part
Dioscorea villosa 2 parts
Bupleurum falcatum l part 5ml tincture, 3 times day

Tincture# 2
Verbascum thapsus l part
Scutellaria laterifolia l part
Ginkgo biloba 2 part 2ml, 3-6 x day

Infusions, Decoction:
Urtica dioica infusion, 2 cups per day (optional)
Bupleurum falcatum decoction, l cup per day

Note: The tinctures were divided into two separate formulas at the request of the client, since she is now making her own tinctures at home and felt that it was easier to measure parts this way.

These formulas provide the following action:

Anti-inflammatory - Dioscorea villosa, Glycyrrhiza glabra
Anti-rheumatic - Dioscorea villosa, Bupleurum falcatum
Pulmonary - Verbascum thapsus, Glycyrrhiza glabra
Adrenal tonic - Glycyrrhiza glabra, Bupleurum falcatum, Borago officinalis
Expectorant - Glycyrrhiza glabra, Verbascum thapsus
Demulcent - Glycyrrhiza glabra, Verbascum thapsus
Diuretic - Urtica dioica
Circulatory stimulant - Ginkgo biloba
Nervine - Scutellaria laterifolia

Results and Observations:
Systemic Lupus Erythematosus is a complicated and difficult disease process to treat; whether treatment is allopathic or herbal. It is a disease marked by spontaneous remissions and exacerbations which makes evaluation of any treatment difficult. The standard treatment with steroids further complicates the role of the herbalist, as the steroids can interfere with absorption and may even negate the actions of certain herbs.

However, having said that, during the 6 months of treatment, this client has made remarkable improvement. She has gone from an extremely debilitated state to one of near-normal activity. Her steroid dosage has been reduced from l5mg to 6 l/2mg per day, a substantial reduction. She in involved in the growing of some of the herbs and makes her own tinctures and decoctions. She currently leads a full and active life and the disease of Lupus no longer controls her life. It is her observation and mine, that the herbs, especially the Bupleurum falcatum, have make a significant contribution to the improvement in her condition.

The most dramatic improvement occurred following the introduction of Bupleurum falcatum into the treatment regimen. While the research on this herb was most promising, neither the client nor I had expected such a dramatic improvement in such a short time. Bupleurum's reported ability to increase circulating ACTH within the bloodstream via action on the pituitary gland appears to have been instrumental in the successful reduction of steroids within the treatment plan. It would appear that it's inclusion within the formula not only protected the adrenal glands from atrophy, but also increased the ability of the adrenal glands to return to normal function once prednisone dosage was reduced below the 10mg level (the threshold at which the adrenal cortex starts to produce its own cortico-steroids). It is at this level that so many steroid-dependent patients get stuck, their adrenal glands unable to make the return to full functioning.

It should also be noted that the overall improvement in observed symptoms has been validated by histological findings:
  • increased complement levels
  • decrease in ANA titers
  • decrease SED rate, indicating a reduction in overall inflammation

Comments:
Based upon the improvement noted in this one person, I feel that the role of herbs in the treatment of steroid-dependent Lupus sufferers (and possibly non-steroid dependent sufferers as well) should be further investigated. Their use in the treatment plan appears to enhance the reduction of steroids and they seem capable of addressing the symptoms this multi-system disease causes, at least in this patient. While the purpose of the herbalist is not just to treat symptoms, but rather to bring the body into a state of wholeness that allows for healing, I do not feel that the role of herbs in alleviating the many symptoms of lupus should be discounted. These symptoms are usually treated by allopaths with strong, side-effect producing chemicals, and where herbs can take the place of these strong drugs, I feel that their use is justified, even if just for relieving symptoms.

Future treatment of this client will continue with the current formulas and hopeful elimination of all synthetic cortico-steroids. I also plan to introduce immune-modulating herbs into the formulation in hopes of effecting a change in the underlying auto-immune response. I an still researching current literature and research papers to find the best choice for this action. I know that it will need to be a non-stimulating adaptogenic herb, since the immune response is already overstimulated in SLE sufferers.

Bibliography:
The Merck Manual, l5th Edition, Merck & Co., Inc. l987 pgs l274-l277
Harrison's Principals of Internal Medicine, l0th Ed., McGraw-Hill. NY pgs 387-39l
Macbryde's Signs and Symptoms, 6th Ed., Robert Balcklow, JB Lippincott Co. Ny, pgs 522-549
Current Medical Diagnosis and Treatment l990 Appleton and Lange, San Mateo pgs 550-553
John Hopkins University, OT Week April 2l, l988 pg 6
Bay Area Lupus Foundation Newsletters, Winter l990, et al...

Meryl's description of patient/practitioner mis-communication is all too common. One similar experience of mine from Wales involved an woman in her late 60's complaining of aches and pains due to osteo-arthritis. English was not her first language, and my welsh is embarrassing! I prescribed enough internal medicine for 2 weeks and a bottle of liniment.

Two weeks later at her second visit there had been no change in her condition (as expected) but otherwise all was well. In passing she mentioned that the medicine had run very soon. Upon questioning this I found that she had drunk all of the internal medication on the first day, and all of liniment on the second! The liniment was a stimulating, rubifacient formulation in iso-propyl alcohol, strong enough for a horse. She was being very welsh with the idea that if a little does you good a lot will be better.........

It had no appreciable impact upon her stomach, probably because she was a hill farmer from the Cambrian Mountains, of ancient Celtic stock. I thought I had explained clearly enough and put appropriate details on the labels. Obviously I had not been clear enough!
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About The Author
Whilst working in conservation and lecturing in ecology and the eco-crisis for the University of Wales, David Hoffman became convinced that to heal the world, to embrace planetary wholeness and responsibility for it with hope, he as an individual had to be whole within himself....more
 
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