Sjögren’s syndrome

CHAPTER 15 Sjögren’s syndrome



Contents


1. Western medical aetiology and pathology 249

2. Diagnosis by Western medicine 250

3. Chinese medical aetiology and pathology 251

4. General treatment principle 251

Differentiation and treatment 251
1. Deficiency of the Lung and Stomach Yin 251

2. Deficiency of Liver and Kidney Yin 252

3. Flaming up of Fire due to Yin deficiency 253

4. Blood stasis with Yin deficiency 253

5. Appendix 254

Case studies 254

6. Analysis of the cases 260

7. Lifestyle prescriptions and health issues 261

Sjögren’s syndrome is a chronic autoimmune disorder in which immune cells attack and destroy the glands that produce tears and saliva so they do not function correctly. The result is dryness of the mouth and eyes. The disease can affect other glands as well, such as in the stomach, pancreas and intestines, and can cause dryness in other places, such as the nose, throat, airways and skin. The condition is also known as keratoconjunctivitis sicca.



1 Western medical aetiology and pathology


Sjögren’s syndrome may be caused by a combination of genetic and environmental factors. Several different genes appear to be involved, but scientists are not certain exactly which ones are linked to the disease as different genes seem to play a role in different people. However, the possible trigger may be viral, such as Epstein–Barr virus, or bacterial infection. The trigger stimulates the immune system to act, but some gene alters the attack by drawing lymphocytes to target organs, such as the glands of the eyes and mouth. Once CD4+ T cells have infiltrated glands, they produce cytokines1 such as interleukin-2 (IL-2) and interferon-γ (IFN-γ) and drive the inflammatory response. These fighter cells die during the process, causing Sjögren’s syndrome and exacerbating the damage.


When the unknown infectious agent damages the salivary and lachrymal glands, it attracts lymphocytes into the glands, which release specific autoantibodies such as rheumatoid factor (RF) and antinuclear antibodies. These antibodies are directed against proteins termed Sjögren’s-associated antigens A and B (or SS-A and SS-B). They can enter the bloodstream and are measured in blood tests that can confirm a diagnosis of Sjögren’s syndrome. Additional T cells enter the gland and the damage is perpetuated. The continued destruction of the gland represents an abnormal balance of the excessive action of helper T cells, which stimulate B cells to create more and more antibodies, and the deficient action of suppressor T cells, which cannot suppress the production of B cells.


Sjögren’s syndrome, characterized clinically by xerostomia (dry mouth) and xerophthalmia (dry eyes), is associated with the destruction of glandular tissue and the resultant impaired secretory capacity, mainly of salivary and lacrimal glands.



2 Diagnosis by Western medicine


Once Sjögren’s syndrome is suspected, a physician will request a series of blood tests, including:


• Antinuclear antibody (ANA)

• Sjögren’s antibodies, called anti-SS-A (or SS-Ro) and anti-SS-B (or SS-La)

• RF (rheumatoid factor)

• Erythrocyte sedimentation rate (ESR)

• Immunoglobulins – IgA, IgM, IgG, IgE and IgD.

Ophthalmological tests include:


• Schirmer’s test – measures tear production (normally more than 6 mL in 6 min)

• Rose Bengal and Lissamine Green (staining with vital dyes) – dyes are used to observe abnormal cells on the surface of the eye

• Slit-lamp examination – indicates the volume of tears by magnifying the eye and viewing it in its resting state.

Dental tests include:


• Parotid gland flow – measures the amount of saliva produced over a certain period of time

• Salivary scintigraphy – measures salivary gland function

• Sialography – a radiograph of the salivary duct system

• Lip biopsy – used to confirm lymphocytic infiltration of the minor salivary glands.


3 Chinese medical aetiology and pathology


There is no name for Sjögren’s syndrome in Chinese medicine. However, according to its clinical symptoms, it can be characterized by Xiao Ke image, diabetes, Bi Zheng image, arthralgia syndrome, and Xu Lao image, consumptive disease. Sjögren’s syndrome can affect multiple organs and manifests as Yin deficiency, Yin deficiency with excess Yang, and Blood stasis in the channels, collaterals and organs.


Fluid is a Yin substance. The Fluid in eyes and joints is called Jin Ye. The dilute and easily flowing Fluid is called Jin; the thick and less easily flowing Fluid is called Ye. They are distributed to the surface and pores of the body, and function to moisten the skin, hair, muscles, mouth, mucus, eyes, nose, articular cavities and other areas. Jin Ye pours into the internal organs, marrow, spinal cord and brain, and has the function of nourishing them. The volume of Jin and Ye is a function of pre-heaven Jing. Thus, Jin and Ye sufficiency or deficiency depends on the parents’ genes.


The formed substance of organs, glands, blood, fluids, cells and visible material – all that can be seen by the eye or microscopy – belongs to Yin. The process of secreting saliva belongs to Qi or Yang. Yin and Yang should be in harmony in the body, including the Yin and Yang of every single organ, gland and cell, and their functions. There is no name for gland in Chinese medicine, but, depending on its function and location, it may belong to a specific organ’s Yin. For instance, the salivary glands located in the mouth belong to the Stomach. Their function is to moisten the mouth and aid in the swallowing of food. The Liver opens on the eyes, so dry eyes are a symptom of Liver Yin deficiency. The Kidney controls Yin in the entire body. When Yin deficiency has developed over a long period of time, Kidney Yin deficiency always occurs. Fire burns the inside due to Yin deficiency. Fire burning in the body thickens the Blood and causes Blood stasis.


Yin deficiency is generally a prolonged and chronic problem associated with any number of diseases. It is due to Fire flaring out of control and damaging Yin or due to other chronic problems that drain the Yin over time, causing a negative impact on different organs in the body.



4 General treatment principle


Nourish Yin, cool the Blood and remove Blood stasis.




Differentiation And Treatment



1 Deficiency Of The Lung And Stomach Yin



Clinical Manifestations


Cough without sputum, dry or sore throat, thirst, dry mouth, hoarseness, difficulty swallowing and eating, tidal fever and night sweats, fatigue, constipation and stomach reflux. The tongue is red with less coating. The pulse is thready and rapid.



Treatment Principle


Nourish Lung and Stomach Yin, and regulate Blood flow.



Herbal Treatment


YU NU JIAN variation


Jade Woman Decoction


Sheng Di Huang Rehmanniae Radix 12 g


Shu Di Huang Rehmanniae Radix preparata 12 g


Zhi Mu Gardeniae Fructus 10 g


Huai Niu Xi Achyranthis bidentatae Radix 10 g


Mai Men Dong Ophiopogonis Radix 10 g


Sha Shen Glehniae/Adenophorae Radix 12 g


Shi Hu Dendrobii Herba 12 g


The herbs above are decocted in water for oral administration.



Acupuncture


ST-6 Jiache, LU-7 Lieque, LI-11 Quchi, BL-13 Feishu, BL-21 Weishu, BL-18 Ganshu, SP-6 Sanyinjiao, KI-3 Taixi and LIV-2 Xingjian.



Supplementary Treatment


If the patient has thirst, a dry mouth, blurred vision and constant eye discomfort, add Gou Qi Zi Lycii Fructus and Mu Zei Cao Equiseti hiemalis Herba, and needle BL-1 Jingming and GB-37 Guanming; if there are recurrent mouth infections, swelling in the parotid glands, hoarseness, and difficulty swallowing and eating, add Huang Lian Coptidis Rhizoma and Niu Bang Zi Arctii Fructus, and needle ST-6 Jiache, LU-7 Lieque, Ren-23 Lianquan and LU-11 Shaoshang.



2 Deficiency Of Liver And Kidney Yin



Clinical Manifestations


Dry eyes, blurred vision, night blindness, dry mouth, insomnia, dizziness, tinnitus, night sweats, amnesia, and lassitude in the loins and knees. The tongue is red with less coating. The pulse is thready and rapid.



Treatment Principle


Nourish Liver and Kidney Yin, and regulate Blood flow.



Herbal Treatment


QI JU DI HUANG WAN variation


Lycium Fruit, Chrysanthemum and Rehmannia Pill


Gou Qi Zi Lycii Fructus 12 g


Ye Ju Hua Chrysanthemi indici Flos 12 g


Sheng Di Huang Rehmanniae Radix 12 g


Shan Zhu Yu Corni Fructus 10 g


Fu Ling Poria 10 g


Mu Dan Pi Moutan Cortex 10 g


Ze Xie Alismatis Rhizoma 10 g


The herbs above are decocted in water for oral administration.



Acupuncture


KI-3 Taixi, SP-6 Sanyinjiao, BL-23 Shenshu and BL-18 Ganshu.



Supplementary Treatment


If the patient has anxiety or emotional disorder, add Chai Hu Bupleuri Radix, Bai Shao Paeoniae Radix alba and Zhi Zi Gardeniae Fructus, and needle LIV-2 Xingjian, Du-20 Baihui and Yintang (extra).



3 Flaming up of fire due to yin deficiency



Clinical Manifestations


Dry mouth and eyes, dry skin, flushed face, insomnia, bitter taste in the mouth, dizziness, anxiety and constipation. The tongue is red with a yellow coating or less coating. The pulse is taut and rapid.



Treatment Principle


Clear Fire, nourish Yin and regulate Blood flow.



Herbal Treatment


LONG DAN XIE GAN TANG variation


Gentiana Longdancao Decoction to Drain the Liver


Long Dan Cao Gentianae Radix 6 g


Zhi Zi Gardeniae Fructus 12 g


Huang Qin Scutellariae Radix 12 g


Chai Hu Bupleuri Radix 6 g


Ze Xie Alismatis Rhizoma 10 g


Sheng Di Huang Rehmanniae Radix 12 g


Bai Shao Paeoniae Radix alba 12 g


Chi Shao Paeoniae Radix rubra 12 g


Gou Qi Zi Lycii Fructus 10 g


Nu Zhen Zi Ligustri lucidi Fructus 12 g


The herbs above are decocted in water for oral administration.



Acupuncture


LIV-2 Xingjian, SP-6 Sanyinjiao, SP-10 Xuehai and Ren-4 Guanyuan.



Supplementary Treatment


If the patient complains of palpitations and insomnia, add Huang Lian Coptidis Rhizoma to clear Heart Fire, and needle HE-7 Shenmen and LI-11 Quchi; if the patient complains of tinnitus, add Ju Hua Chrysanthemi Flos and Shan Zhu Yu Corni Fructus, and needle TB-6 Zhigou and SI-19 Tinggong.



4 Blood stasis with yin deficiency



Clinical Manifestations


Dry mouth and eyes, stabbing pain in the joints, and rough or squamous and dry skin. The tongue is red and purple with less coating. The pulse is thready and uneven.

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Jan 19, 2017 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Sjögren’s syndrome

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