Lupus

//Western Diagnosis//
Inflammatory connective tissue disorder

Etiology
- Unknown - 90% of cases in young women

Signs & Symptoms
1. Onset either abrupt with fever or insidious with recurring bouts of fever and malaise 2. Articular symptoms - 90% of cases -intermittent arthralgias -Acute polyarthritis -Contractures and 2 degree joint deformity without x-ray erosion - Jaccoud's arthritis - chronic 3. Cutaneous lesions -Malar butterfly rash -Discoid lesions: differentiate between DLE -erythematous firm maculopapular lesions: face, neck, chest, elbows -Generalized alopecia in acute -mottled erythema on sides of palms -Periungual (around the nailbeds) erythema and edema -Macular reddish-purple lesions on anterior fingers -Mucus membrane ulcerations 4. Photosensitivity - in ~40% of caes 5. Recurrent pleurisy 6. Pericarditis 7. Pulmonary hypertension 8. Generalized lymphadenopathy 9. Splenomegaly in ~10% of cases 10. CNS: headache, personality changes, epilepsy, psychoses 11. RENAL Involvement -can become evident at any time, even if other signs not present -benign, asymptomatic -progressive, fatal -proteinuria -focal glomerulitis -diffuse membranoproliferative glumerulonephritis

Lab Testing
1. ALA positive in ~98% of cases but not specific to lupus 2. anti-DNA antibodies if ANA positive: more specific for SLE 3. LE cell - not done as frequently 4. elevated sed rate 5. C-reactive protein not elevated 6. Leukopenia: lymphopenia in active disease 7. Urinalysis: may be negative even with active kidney disease -monitor every 4-6 months during remissions -RBC and granular cast in active disease

Differential Diagnosis
Easy if fever, rash, arthritis, renal. pleuric pain, leukopenia, anti-DNA 2. and be mistaken for other ct disorders early 3. DLE 4. classified as mild or severe

Prognosis
1. Variable depending on organs and inflammation 2. Chronic, relapsing with years of remission: totally unpredictable 3. long term prognosis good if initial acute phase controlled 4. rare after menopause 5. 10 year survival rate in over 95% in developed countries

Treatment
Mild or remittent may need no therapy 1. **NSAIDS for arthralgias** until inflammation controlled: then active exercise 2. **Anti-malarials for joiny & skin:** hydroxychloroquine, quinacrine 3. **Corticosteroid therapy** needed immediately if severe and life threatening -Prednisone -Immunosuppressive agents: azathrioprine, cyclophosphamine 4. After inflammation controlled, minimum doses given 4. Treat intercurrent infection vigorously

DHEA showed improvement in a study with large doses Omega fatty acids- trial symptoms improved in 50% Cod liver oil

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==================================================================  ** Systemic Lupus Erythematosus ** ** Diagnosis and Treatment ** ** William Robert Morris, O.M.D. L.Ac. **   **__ Western Diagnosis and Treatment __** ** Diagnostic Features: ** *Occurs Mainly in young women *Rash over areas exposed to sunlight *Joint Symptoms in 90% of patients *Multiple system involvement *Depression of hemoglobin white blood cells and platelets *Antinuclear antibody with a high titer to native DNA According to the American Rheumatism Association, a diagnosis of SLE can be made with reasonable probability if 4 of the following 11 criteria are present simultaneously or serially, during any interval of observation: malar rash, discoid rash, photosensitivity, oral ulcers, non-erosive arthritis, serositis, renal disorder, neurologic disorder, hematologic abnormality (hemolytic anemia, leukopenia, lymphopenia, or thrombocytopenia), immune dysfunction (positive LE preparation, antinative DNA, false-positive syphilis serologic tests over 6 months), and positive antinuclear antibody. ** Demographics: ** SLE appears most commonly in young women ages 13-45. More than 16,000 Americans develop Lupus each year with an estimated 500,000 currently suffering. 90% of all cases reported are female. Lupus strikes 1 in 400 white woman and 1 in 250 black women, it is also common in China; all races can be subject. ** Prognosis: ** The 10 year survival rate is exceeding 85% according to recent reports. In most patients, the disease pursues a mild course with occasional flaring of activity. The severity of the disease tends to diminish with time. It is common to find normal lab levels after five years. ** Standard Western Therapies: **

Aspirin and other NSAIDs are used to treat the milder symptoms of Lupus, such as joint pain, fever, etc.. The problem here is increased permeability of the gastric mucosa. This increases the likelihood of large size protein molecules crossing the gut-immune barrier. This renders NSAIDs inefficient as a long term solution due to antigen-antibody increased musculoskeletal inflammation. Antimalarial drugs are being used to treat skin lesions, although side effects such as visual disturbances and nausea can occur in the course of prolonged treatment (possible use of Artemisia ching hao?). The standard drug treatment for the more severe SLE is corticosteroid therapy, most commonly prednisone. Side effects can include acne, sleep disturbances with resulting fatigue and irritability, personality changes, susceptibility to infections, weight gain, and symptoms similar to Cushing's Disease (moon-like face, changes in posture, high blood pressure, diabetes, absence of menstruation, purple skin markings, etc.). Prolonged, intensive corticosteroid therapy can also cause psychiatric disturbances known as "steroid psychosis." This can mimic psychosis due to Lupus' effects on the central nervous system and may be difficult to distinguish from it. Other possible side effects of long-term steroid use are osteoporosis or osteonecrosis. **__ Oriental Medicine: Diagnosis and Treatment of SLE __** ** Professor Ding Jie Ming's Treatment of SLE ** SLE was not described in classic literature other than as fragments of internal or external syndromes. Professor Ding Jie Ming has treated over 500 SLE patients during the course of 5 years. According to Professor Ming, etiological factors considered in the development of SLE include wind, damp, and cold. The result of this is slow developing inflammation of the joints. The pathogenesis then progresses into the tissues of skin, nerves, and blood. Focus of the therapy is adjusted according to the location of the internal SLE lesions. The following are the treatment protocols given by Professor Ming in lecture sponsored by the Research Institute of Chinese Medicine. Base Formula: Cinnomomi cassiae Ramulus (Gui Zhi) Bupleurum chinense (Chai Hu) Lycopodium clavatum (Shen Jin Cao) Glycyrrhiza uralensis (Gan Cao) For lesions in the brain and CNS, add Cicada periostricum (Chan Tui) and Polygala tenuifoliae (Yuan Zhi) to the base formula. Liver lesions: For severe headache (wind) add Uncariae cum uncis (Gou Teng) and Peonia alba (Bai Shao). To tonify yin add Ecliptae prostatae (Han Lian Cao), Ligustri lucidii (Nu Zhen Zi), Scrophularia ningpoensis (Xuan Shen), and Haliotidis concha (Bao Yu). For hypochondriac pain add Scutellaria baicalensis (Huang Qin), Moutan radicis (Mu Dan Pi), Cyperi rotundis (Xiang Fu Zi). Spleen lesions: 1.If the Spleen is enlarged add Coptis chinensis (Huang Lien), Atractylodes macrocephala (Bai Zhu), and Hordeum vulgaris (Mai Ya). 2.For diarrhea or loose stool remove Scrophularia ningpoensis (Xuan Shen). Add Dioscorea oppositae (Shan Yao), Massa fermentata (Shen Qu), Saussurea lappa (Mu Xiang), Carbonized Zingiberis officinalis (Gan Jiang), and Atractylodes macrocephala (Bai Zhi). 3.For severe dampness of the spleen, subtract Scrophularia ningpoensis (Xuan Shen); add Coicis lachryma-jobi (Yi Yi Ren) and Atractylodes macrocephala (Bai Zhi). 4.For thin muscles and fatigue add Astragalus membranaceus (Huang Qi), Angelica sinensis (Dong Gui), Lycopi lucidus (Ze Lan), and Salvia miltiorrhiza (Dan Shen). Lung lesions: Add Ephedra (Ma Huang), Peucedani praeruptorum (Qian Hu), Platycodon grandiflorum (Jie Geng), and Polygala tenuifolia (Yuan Zhi) to open the lungs, and dissolve phlegm. When Lung is inflamed, add Cortex of Mori alba radicis (Sang Bai Pi). Coughing blood add Ophiopogonis japonicus (Mai Men Dong), Nelumbinis nucifera (Lotus Root or Ou Jie), Biota orientalis (Bai Zi Ren), Caucumen biota (Ce Bai Ye). Skin lesions: Use Astragalus membranaceus (Huang Qi), Angelica sinensis (Dong Gui), and Clematidis chinensis (Wei Ling Xian). The treatment strategy is to nourish Qi and Blood, and disperse wind. Ascites: Areca catechu Shell (Da Fu Pi) to relieve damp. When the lesion is in the kidney, Warm the Yang, Expel Wind, and Benefit the Kidney. Xien Ling Pi is the base formula for this: Aconite carmichaeli (Zhi Chuan Wu), Lycopodium clavatum (Shen Jin Cao), Scrophularia ningpoensis (Xuan Shen), Glycyrrhiza uralensis (Gan Cao), Cinnamomi cassia Ramulus (Gui Zhi), Atractylodes alba (Bai Zhu), Astragalus membranaceus (Huang Qi), Coicis lachryma-jobi (Yi Yi Ren), Achyranthes bidentatae (Niu Xi), Chaenomeles lagenaria (Mu Gua). Modification for Yang Deficiency: subtract Scrophularia ningpoensis (Xuan Shen). Add Achyranthes bidentatae (Niu Xi), Cistanches salsa (Rou Cong Rong), Eucommia ulmoidis (Du Zhong), Aconite carmichaeli (Fu Zi). Modification for Yin Deficiency: increase Scrophularia ningpoensis (Xuan Shen) and add Rehmannia glutinosae Raw (Sheng Di Huang). Proteinuria: add Astragalus membranaceus (Huang Qi), Atractylodes alba (Bai Zhu), Zea mays (Yu Mi Shu), Coicis lachryma-jobi Radix (Yi Yi Ren Gen), and Blackbeans. Elevated BUN: Add Achyranthes bidentatae (Niu Xi), Chaenomeles lagenariae (Mu Gua). For Heart Lesions: make the following modifications to the above kidney based formulas. Heart Yin deficiency add more Scrophularia ningpoensis (Xuan Shen); also add Ophiopogonis japonicus (Mai Men Dong), Polygonum multiflori Caulis (Ye Jiao Teng), Biota orientalis (Bo Zi Ren), and Schisandra chinensis (Wu Wei Zi). Heart Yang deficiency remove Scrophularia ningpoensis (Xuan Shen); add Aconite carmichaeli Cx (Fu Zi), Salvia miltiorrhiza (Dan Shen), Catharsius malosis (Chiang Lian Chung), Acori graminei (Chang Pu), and Polygalae tenuifolia (Yuan Zhi). ** Practical Surgery of Chinese Medicine gives three differentials for Lupus they are: ** 1.Yang deficiency of Spleen and Kidney presenting with a cluster of the following; mild erythema, bluish-brown subcutaneous purpura, chills, cold extremities, mild fever, aching in the joints, low back pain, sparse hair, irregular menses, fatigue, perspiration, weakness of the arms and legs, edema, loss of appetite, muddy stools, scanty urine, swollen tongue, weak pulse. 2.Yin Deficiency with Internal Heat has a cluster of the following; constant low-grade fever, skin injuries, occasional erythema, palpitations, insomnia, dry mouth, dry throat, vertigo, tinnitus, joint aching, low back pain, night sweats, significant hair loss, irregular menses, dry stool, yellow urine, a red tongue with a thin yellow coat, and a thready rapid, tense pulse. 3.Excess Toxic Heat symptom clusters may be; fresh erythema, hemorrhagic blisters, purpura under nails or on conjunctiva, high fever, irritability, fainting, thirst, constipation, decreased urine, red tongue with thin dry yellow coat, and a tense rapid pulse. 1.For Spleen-Kidney Yang Deficiency use Eucommia and Rehmannia Formula (You Gui Wan) as general treatment. A specific formula used contains Curculiginis orchioides (Xian Mao) 15g, Epimedium sagittatum (Yin Yang Huo) 15g, Cuscuta chinensis (Tu Si Zi) 15g, Cynomorium coccineum (Suo Yang) 9g, Atractylodes alba (Bai Zhu) 9g, Codonopsis pilosula (Dang Shen) 9g, Smilax glabra (Tu Fu Ling) 30g, Glycerrhizae uralensis (Gan Cao) 6g, Antelopis cornu (Ling Yang Jiao) 3g. Goat horn is a possible replacement for antelope. The pulse is lacking root in the right proximal position and the left middel position; or, it may be yielding, or soft in those positions. 2.For yin deficient internal heat use Rehmannia glutinosae (Shou Di Huang) 18g, Scrophularia ningpoensis (Xuan Shen) 12g, Ophiopogon japonicus (Mai Men Dong) 12g, Peonia alba (Bai Shao) 9g, Testudinis plastrum (Gui Ban) 18g, Lycium chinensis (Gou Qi Zi) 15g, Anemarrhena asphodeloides (Zhi Mu) 9g, Phellodendron amurense (Huang Bai) 9g, Smilax glabra (Tu Fu Ling) 30g, Rubus parvifolius (Ci Bo) 15g, Glycyrrhizae uralensis (Gan Cao) 3g. For yin depletion, the vessels usually get thinner and harder as the yin is depleted from the intima of the vessel wall.

3.For Excess Toxic Heat use Rehmannia glutinosae Fresh (Sheng Di Huang) 30g, Peonia alba (Bai Shao) 12g, Moutan radicis (Mu Dan Pi) 9g, Gypsum fibrosum (Shi Gao) 30g, Anemarrhena asphodeloides (Zhi Mu) 9g, Isatis tinctoris (Ban Lan Gen) 9g, Lithospermum erythrorhizon (Zi Cao) 9g, Glycerrhizae uralensis (Gan Cao) 3g. Here, the pulse gets urgent, and also gets wider when lifting from the organ to the qi depth. For severe aching of the joints, add Polygoni cuspidatum (Hu Chang) 15g and Clematis chinensis (Wei Ling Xian) 12g. For purpura, add Ecliptae prostratae (Han Lian Cao) 15g. As is true for most clinical situations, treat what you find. Patients have had remarkable improvement using simple patent Yin Tonics when appropriately indicated. ** Classic Formulas Used in the Treatment of SLE ** Clematis and Stephania Combination (Shu Jing Huo Xue Tang): Activates Blood, Dispels Wind and Dampness. Use for pain in   muscles, nerves, joints (esp. below the waist) and purpura. Angelica sinensis (Dang Gui) 2g Peonia alba (Bai Shao Yao) 2.5g Ligustici wallichi or Cnidium (Chuan Xiong) 2g Rehmannia glutinosa (Shou Di Huang) 2g Persica (Tao Ren) 2g Poria cocos or Hoelin (Fu Ling) 2g Atractylodes alba (Bai Zhu) 2g Citri leiocarpae (Chen Pi) 1.5g Notopterygii incisium (Qiang Huo) 1.5g Angelica dahurica (Bai Zhi) 1g Clematis chinensis (Wei Ling Xian) 1.5g Stephania tetrandra (Fang Ji) 1.5g Gentiana scabrae (Long Dan) 1.5g Sileris or Ledebouriella (Fang Feng) 1.5g Achyranthes bidentata (Niu Xi) 1.5g Zingiberis recens (Sheng Jiang) 1.5g Glycyrrhiza uralensis (Gan Cao) 1g Stephania and Carthamus Combination (Shu Feng Huo Xue Tang): Activates Blood, Dispels Dampness, Opens the Channels, Clears Heat and removes Phlegm. Use for pain in the muscles, nerves, joints, purpura. There is stabbing pain and the joints are red and swollen. Clematis chinensis (Wei Ling Xian) 2.5g Arisaema consanguineum (Tian Nan Xing) 2.5g Atractylodes lancea (Cang Shu) 2.5g Notopterygii incisium (Qiong Huo) 2.5g

Angelica sinensis (Dang Gui) 2.5g Ligustici wallichi or Cnidium (Chuan Xiong) 2.5g Stephania tetrandra (Fang Ji) 2.5g Phellodendron amurense (Huang Bai) 2.5g Carthamus tintoris (Hong Hua) 1g Cinnamomi cassia (Gui Zhi) 2.5g Zingiberis recens (Sheng Jiang) 1g Bupleurum and Rehmannia Combination (Chai Hu Qing Gan Tang): Cool the Blood, Dispel Wind Heat, Clean the Liver. Use for adenopathy, skin rash, pleurisy; to improve physical condition. A classic abdominal conformation for this formula is tight rectus abdominus muscles and flaccid tissue below the naval. Bupleurum falcatum (Chai Hu) 2g Platycodon grandiflori (Jie Geng) 1.5g Glycyrrhiza uralensis (Gan Cao) 1.5g Mentha haplocalyx (Bo He) 1.5g Arctium lappa (Niu Bang Zi) 1.5g Forsythia suspense (Lian Qiao) 1.5g Trichosanthes kirlowii Rt (Gua Lou Gen) 1.5g Scutellaria baicalensis (Huang Qin) 1.5g Coptidis chinense (Huang Lian) 1.5g Phellodendron amurense (Huang Bo) 1.5g Gardenia asphodeloides (Zhi Zi) 1.5g Angelica sinensis (Dang Gui) 1.5g Peonia alba (Bai Shao Yao) 1.5g Rehmannia glutinosa raw (Sheng Di Huang) 1.5g Ligustici wallichi or Cnidium (Chuan Xiong) 1.5g Tang Kuei and Astragalus Combination (Dang Gui Bu Xue Tang): Blood Deficiency with Qi Deficiency. There is a red face, irritability, thirst with preference for warm beverages, hot sensation in the muscles, pale tongue, fidgeting, the pulse is large and empty. The red face is due to heat generating in the presence of blood deficiency. Astragalus membranaceus (Huang Qi) 30g Angelica sinensis (Dang Gui) 6g Jujube Combination (Shi Zao Tang): Dispel Water Stagnation. Used for Uremia from SLE. This is a very strong, toxic formula due to the Euphorbia content (Gan Sui & Da Ji). It should be used only for a strong constitution, under control and if absolutely necessary. Begin administering the formula in small amounts initially, then gradually increase the dosage. Euphorbia kansui (Gan Sui) 1g Daphne genkwa (Yuan Hua) 1g Euphorbia pikinensis (Da Ji) 1g Zyziphi jujube (Da Zao) 4g

Minor Bupleurum Combination (Xiao Chai Hu Tang): Sooth the Liver, Cleanse the Gallbladder, Tonify Spleen, Half Internal Half External (Shao Yang) condition. Use for chest distension, pain below the ribs and a tubercular constitution. Add Cinnamon and Hoelin Formula (Gui Zhi Fu Ling Wan) with blood stagnation. Add Hoelin Five Combination (Wu Ling San) with fluid stagnation and wind attack. Xiao Chai Hu Tang Bupleurum falcatum (Chai Hu) 7g Scutellaria baicalensis (Huang Qin) 3g Pinellia ternata (Ban Xia) 5g Zingiberis recens (Sheng Jiang) 4g Panax ginseng (Ren Shan) 3g Zyziphi jujube (Da Zao) 3g Glycyrrhiza uralensis (Gan Cao) 2g Gui Zhi Fu Ling Wan Cinnamomi cassia (Gui Zhi) 4g Moutan radicis (Mu Dan Pi) 4g Paonia alba (Shao Yao) 4g Prunus persica (Tao Ren) 4g Poria cocos or Hoelen (Fu Ling) 4g Wu Ling San Poria cocos (Fu Ling) 5g Atractylodes alba (Bai Shu) 4g Panax ginseng (Ren Shen) 3g Citri leiocarpae (Chen Pi) 3g Autantii immaturis (Zhi Shi) 1.5g Zingiberis recens (Sheng Jiang) 3g Bupleurum & Schizonepetae Combination (Shi Wei Bai Du San): Dispel Wind and Detoxify. Bupleurum conformation (full, tender and tight below the ribs) plus skin rash or boil. Bupleurum falcatum (Chai Hu) 3g Zingiberis recens (Sheng Jiang) 1g Schizonepeta tenuifolia (Jing Jie) 1g Siler or Ledebouriella (Fang Feng) 2g Prunus serotina (Ouhi) 3g Angelica duhuo (Du HUo) 2g Poria cocos (Fu Ling) 2g Platycodon grandiflori (Jie Geng) 3g Glycyrrhiza uralensis (Gan Cao) 1g Ligustici wallichi or Cnidium (Chuan Xiong) 3g ** Research From China ** Treatment principles being researched in China include: dispel noxious heat from blood, replenish the vital essence, invigorate blood circulation and resolve the stagnation. Salvia miltiorrhiza and Lonicera japonica are two typical herbs used in these studies. There was an effectiveness rate of 92% for 230 SLE patients treated with TCM and corticosteroids, 85% for 76 patients treated with TCM alone, 79-89% for rash, trichomadesis, oral or nasal pharynx ulcer patients. The ANA titer was decreased markedly for 75% patients. TCM had no side effect and could take in part the place of hormone in dosage and lessen its side effect. Sixty-two cases of systemic lupus erythematous (SLE) were treated with Gentiana Combination. 5 tablets three times per day or 10 tablets twice per day and prednisone 10-30 mg per day were reported. As controls, 19 cases of SLE were treated with prednisone alone at the same time. The results showed complete remission in 86.46% (50/62) cases in the observation group and 31.57% (6/19) cases in the control group. Eight cases of SLE treated with Gentiana Combination alone also achieved complete remission in 6 cases and improvement in 2. There was very significant statistical difference between the two groups (P less than 0.001). The Gentiana Combination was more effective on the improvement of nephropathy, arthralgia, erythema and restoration of ESR, LE cells and CH50, C3 than prednisone alone. No apparent side effects of Gentiana Combination were found in this observation. ** Food Therapies ** As SLE can be considered a rheumatic condition, the use of foods for wind, cold, damp and heat are indicated. For Cold type arthritis: garlic, green onions, pepper, black beans, sesame seeds, chicken, lamb, mustard greens, ginger, spicy foods, grapes, grape vine tea, parsnip. Avoid cold foods, raw foods and cold weather. The pulse is tight - the crest of the wave oscilates radially - ulnarly. For Wind type arthritis: scallions, grapes, grapevine tea, black beans, most grains, green leafy vegetables. Avoid meats, shellfish, sugar, alcohol, smoking and stimulants. For Damp type arthritis: barley, mung beans, mustard greens, red beans, millet, sweet rice wine with meals, cornsilk tea; diuretic foods and herbs. Avoid cold foods, raw foods, and dairy products. For Heat type arthritis: fresh fruits and vegetables, dandelion, cabbage, mung beans, winter melon, and soybean sprouts. Avoid spicy foods, alcohol, smoking, stress, green onions, and red meat.

** General Dietary Recommendations: ** 1.Avoid food sensitivities: particularly chicken, seafood, and pickles. Dairy, spinach, asparagus, rhubarb, vegetables from the nightshade family: tomatoes, green peppers, potatoes, pimentos, and eggplant; coffee, caffeine, sugar, refined foods, and fried foods. 2.Eat a low calorie, low fat diet. Mouse model studies clearly show benefit from this diet, suggesting that the same would be true for humans. 3.Limit beef and dairy, the same study as number two above, suggesting benefits to humans in Lupus. 4.Consume ample sesame seeds, kale, artichokes, green beans, millet, celery, barley, okra, almonds, collards, turnip greens, raw goat's milk, goat whey and black mission figs, gelatin (make a gelatin mold with cherry concentrate no sugar), burdock root, cherries, pineapple, quince, watercress, blackberries, black currants, mustard greens, limes, lettuce, olive oil. 5.Avoid alfalfa as it may aggravate Lupus, or possibly create a Lupus-like syndrome. L-canavanine sulfate, a constituent of alfalfa was incorporated into the diet and reactivated the syndrome. ** Other considerations in the treatment of Lupus. **   There are at least 37 published references for the use of Centella asiatica (Gotu Kola or Zhi Xue Cao) in the treatment of Lupus. It appears as though Centella's prime action is on the connective tissue. Usually, the left proximal pulse position will be weak and thready. The use of Omega 3 fish oils (EPA) also show to be promising in rheumatic conditions and autoimmune problems. Interestingly, over the counter snake oil remedies purchased in Chinatown have been shown to contain 20% EPA. Apparently, the snake being cold blooded, produces Omega-3 essential fatty acids as an adaptation response to cold temperatures. When taking the pulse, the skin will feel dry if this agent is appropriate In my personal experience, all rheumatic conditions respond better when combined with topical oleation therapy. Using a sesame oil as a base, add a powder of the indicated formula and apply regularly.

Hydrochloric Acid deficiency can be a factor in the Lupus picture. Out of 9 patients with Lupus erythematosus, none had normal HCL levels, 2 had no detectable HCL. Deficiency of HCL is best quantified with the use of a Heidelberg Gastrometer (the swallowing of a capsule which measures HCL). Jonathan Wright, M.D. offers a provocation determinant for HCL: On three consecutive mornings, take one, two then three HCL tablets on an empty stomach. If there are no adverse reactions then use one or two tablets of HCL with each meal for a week. If there is some improvement, you have a confirmative result. If there are GI distress symptoms, discontinue the HCL, as there is ample. If there is too strong a reaction, it can be neutralized with baking soda or milk. Remember not to use HCL with Aspirin or other NSAIDs due to the possibility of increasing the risk of ulcers. Chemical sensitivities should also be ruled out as Lupus patients have been shown to have higher than normal levels of sensitivity to foods and other substances. 4 patients with SLE developed remissions when given an elimination diet and nutritional supplementation. Another 70 patients with Lupus and Lupus-like syndromes showed similar improvement.

Dietary Recommendations
Plenty of fruits and vegetables; no salt.